Diabetes & Pregnancy: The 4th Trimester

NOTE:
This post is a continuation of a series about managing my diabetes while trying to get pregnant and being pregnant. For more, you can check out these previous posts:

Diabetes Type 1.5/LADA
Diabetes & Miscarriage
Diabetes & Pregnancy: The 1st Trimester
Diabetes & Pregnancy: The 2nd Trimester
Diabetes & Pregnancy: The 3rd Trimester
Diabetes & Pregnancy: Childbirth

As always, these posts are not meant to be taken as medical advice, and merely discuss my personal experience with my specific diabetes. Everybody's experiences are different, and I am only speaking about mine.

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My last post about my diabetes talked only a little about how my blood sugars and insulin needs changed after giving birth on New Year's day, January 1st, 2020. The focus of that post was more about managing my diabetes during labor and delivery, with just a few passing comments about changes that happened in those first few days after, while I was still in the hospital. This post will pick up where that one left off, continuing through the first three months postpartum - a time period some refer to as the "4th trimester," when a person's body readjusts to a state of no longer being pregnant.

Before becoming pregnant, I had only been on Levemir (basal insulin); I had no prescription for Novolog (mealtime insulin) until I first saw MFM at 8 weeks gestation. (MFM = maternal fetal medicine, the doctors and nurses who helped me manage my diabetes while pregnant.) My pre-pregnancy Levemir doses were 5 u. in the morning and 7 u. at night, for a total of 12 u. Over the course of 9 months of pregnancy, my total Levemir increased to 16 u., though we shifted when the bulk of it was taken, to 10 u. in the morning and 6 u. at night. I also started taking insulin with meals; by the end of my pregnancy, I was taking 12 u. Novolog with breakfast, 5 u. with lunch, and 6 u. with dinner. This increase in insulin requirements happens because the placenta causes insulin resistance - meaning that my body needs more insulin to process the same amount of blood sugar. (Though to be fair, I also wasn't eating the same amount of carbs during pregnancy as I had been before... Once I had access to mealtime insulin, I didn't need to be on a lower-carb diet anymore - and was actually told NOT to be, since growing a baby requires quite a bit of energy from carbohydrates. So I also was giving my body more blood sugar to process, as well.)

It was expected that after giving birth, my insulin needs would go back down to approximately what they'd been before getting pregnant. But I wanted to continue taking mealtime insulin after giving birth so I had a bit more flexibility with the amount of carbs I was "permitted" to eat - especially since I was planning on breastfeeding for the first several months of my baby's life, and would need similar dietary needs for breastfeeding as I had while pregnant. And that meant I couldn't just revert back to exactly what I had been taking pre-pregnancy, when I was taking enough basal insulin to cover post-meal glucose spikes as well. Still, those pre-pregnancy doses gave us a baseline to start at, with the expectation that it might take a bit of time to figure out exactly what insulin doses I should be taking for my basal insulin and at meals.

Taking all that into consideration, MFM recommended that I try 4 u. Levemir in the morning and 8 u. Levemir at night, for a total of 12 u. of basal insulin (same as I'd been taking pre-pregnancy). They also suggested that I try NOT taking any mealtime insulin at first, doing only 1-2 u. corrective doses if my blood sugar was high two hours after eating, until I better understood how much insulin it might be prudent to take with each meal. I wasn't super into that idea (it seemed like the first step toward ending up back where I was pre-pregnancy - only taking basal insulin and not having access to mealtime insulin), but they were the recommendations I brought with me to the hospital nonetheless, and what I planned to implement in the first few days after delivery.

That plan lasted one meal.

Other than a 2 am snack a few hours after giving birth, my first real meal postpartum was breakfast on January 2nd. Following MFM's plan, I took 4 u. Levemir and no fast-acting mealtime insulin. Three hours later, my blood sugar was at 197, and I took a corrective dose of 1 u. - which did the trick and brought me back down to normal ranges. Still, I was over that nonsense. Managing my diabetes at the hospital required jumping through a ridiculous series of hoops multiple times a day: reminding the nursing staff when to check my blood sugar (per their own protocols - I had my own ways of checking my blood sugar on my own any time I wanted), asking the nursing staff for access to insulin, having a doctor sign off on the dose, and waiting for the insulin to be brought into the room - all while my hospital cafeteria food grew cold as I waited. Taking a "wait and see" approach with every meal just meant even more of a hassle - a hassle I didn't need on top of everything else. We were dealing with my baby daughter's low blood sugar, treating her with glucose gel and formula, and trying to establish breastfeeding; I didn't want to be subjected to extra blood sugar checks in the middle of all that, making decisions to correct highs after the fact. It seemed easier to just take preemptive insulin and avoid the highs in the first place.

Of course, I was also still very much in the mindset of keeping a very tight control over my blood sugars - a mindset that it was hard to get out of. For the past year and a half, I'd tried to keep my blood sugars below 120 at all times - during my first pregnancy (which lasted 8 weeks and ended in miscarriage), during my second pregnancy (which was full-term), and during the months in between, when I started using my CGM and we were trying to get pregnant again. When you start thinking of anything above 120 as bad, 197 seems downright criminal. (Compare that to the typical recommendation for (non-pregnant) diabetics: keeping blood sugars below 180. If that's the goal, 197 doesn't seem nearly as off-target.)

There was also this: I expected to experience lows postpartum. I'd read that some diabetics struggle with low blood sugars when breastfeeding, and so had taken precautions to strategically leave snacks around my house in the places I planned to do a lot of nursing, just in case that became an issue for me. I also brought a lot of snacks with me to the hospital, for this same reason. So I felt more prepared (both mentally and literally) to deal with the possibility of lows than highs.

All of this meant I started requesting 1-2 u. of mealtime insulin with breakfast, lunch, and dinner (depending on what my blood sugars were before eating, and what exactly I was planning to eat). I suspected this might require a change to my basal insulin, since now my total insulin levels were likely higher than they needed to be - but I figured it'd be easier to take too much insulin and then treat with more snacks if I needed to, than to not be taking enough insulin, and need to add more - especially since I often had to wait at least a half hour (and sometimes as much as an hour or more) between my request for insulin and when the hospital staff would bring it to me.

Still, even with that extra mealtime insulin I started taking, I didn't experience a postpartum low until 6 am on January 4th. I was getting so little sleep (up all hours of the night trying to breastfeed or pump, and visiting my baby girl, who had been taken to the NICU for a couple days to monitor her nasal congestion, breathing, and jaundice levels) that I was often hungry and ate frequent snacks - my body's way of compensating for lack of sleep, I guess. I decided to run an experiment; the night of January 3rd-4th, I didn't eat any snacks after 10 pm. Finally, I saw the low blood sugar I was expecting. When the nurses came to check my fasting blood sugar, I was at 61; my CGM said 62. During my pregnancy, I only very rarely felt hypoglycemia symptoms; for my first postpartum low I again didn't feel any symptoms. The nurses brought me graham crackers, and I ate those before breakfast.

I was discharged later that day, even though my baby was still in the NICU. We were allowed to board in another hospital room closer to the NICU for a couple days. My insulin pens were returned to me, and I was once again able to manage my own diabetes, but we were still on the hospital premises until our baby was also discharged on January 6th. I knew from the "experiment" I'd done that I had to eat a snack at least once overnight - one of the times I was up anyway, nursing or pumping - or risk going too low. Alternatively, now that I had access to my own insulin again, I also had the option of adjusting my insulin however I saw fit, without having to run it by the hospital staff. I could choose to not take insulin with a snack or meal, and then more easily correct it after the fact, if I saw myself going too high. Or I could decrease my basal insulin, to compensate for the fact that I was taking more mealtime insulin than MFM had originally suggested.

At first, I continued to follow the insulin plan I had been doing (4 u. Levemir in the morning, 8 u. Levemir at night, and 2 u. Novolog with breakfast, lunch, and dinner), making sure to eat snacks in between meals when needed, and at least once overnight. I made it through the night of January 4th-5th this way with no problems. But the next night, my CGM urgent low alert went off before I ate my middle-of-the-night snack, and I found myself needing juice and a snack during one of the few chunks of time I'd been able to set aside for sleeping. A few hours later, when I woke up to eat breakfast, I was back down to 74 again - not low, but getting close.

I was beginning to understand that I was trying to keep unnecessarily tight control over my blood sugars. I didn't need to subject myself to occasional hypoglycemia in an attempt to keep my highs from getting too high; I wasn't pregnant anymore, and didn't need to stay below 120. Now, it was more important for me to avoid lows, rather than to avoid highs - especially if my body was still unaware of my hypoglycemia, showing no symptoms. What might happen if I was unknowingly low while holding and carrying around my newborn? I had to ease up on my blood sugar control to take better care of myself - so I could also take better care of her.

My daughter was discharged later that day, and we finally got to take her home. At home, I ran an even greater risk of hypoglycemia for two reasons: 1) I had access to a wider variety of food, including options with fewer carbs, meaning I ate fewer total carbs throughout the day than I had at the hospital, and 2) now that she was no longer in the NICU, she was under my and my husband's care 24/7, without help from the NICU nurses. It was harder to find time to eat several snacks throughout the day just to keep my blood sugars up, when I was responsible for every feed (no more supplementing with formula!). That night, my blood sugar was at 77 at 10 pm. I decided it was time to start decreasing my insulin; I took 6 u. Levemir instead of 8.

This was the right choice - my blood sugars stayed pretty steady within a good range of 70-140 over the next couple of days. I hadn't had another overnight low. Still, when I called MFM to discuss the change I'd made to my nighttime insulin, they recommended that I decrease it even further, going down to 4 u. Levemir at night. They also suggested I cut my lunchtime dose to 1 u. instead of 2 u. (Though, I admit - going through the whole process of using an insulin pen needle to take only 1 u. seems a bit silly to me... I usually choose to either not take any insulin, or to take 2 u., depending on what my blood sugar is before eating and what I plan to eat.) 

A few weeks later, I switched my care back to my regular endocrinologist, and he agreed with my decision to continue taking those doses (or near those doses, per my discretion) - so that's precisely what I've been doing since January 8th:

- 4 u. Levemir in the morning

- 2 u. Novolog with breakfast

- 0-2 u. Novolog with lunch

- 2 u. Novolog with dinner

- 4 u. Levemir at bedtime

This seems to be a good amount of insulin for me. There are times when I see slightly higher numbers than I grew used to seeing over the last 1.5 years - but those "highs" aren't too high, just higher than what I was aiming for when I was pregnant. There are also times when I have occasional low blood sugars. But both scenarios seem less frequent than I was experiencing when pregnant - my blood sugar in general stays steadier, with fewer peaks or valleys. Everything acts a little more predictably, and easier to control.

In fact, everything has gotten so much "easier" that I've stopped counting calories and carbs of the things I eat. I still try to eyeball portion sizes and guess how many carbs I'm eating, but I don't add everything together when I make a recipe. Maybe I've just gotten better at guessing what 40-50 g. carbs looks like, after meticulously counting everything for several months; or maybe it really is that my blood sugars are steadier even if my estimate is "off" and I'm closer to 30 or 60 g. It probably also helps that I continue to use my CGM (continuous glucose monitor) - I can see at a glance what my blood sugar is doing and if it's trending up or down, which in turn influences what I decide to eat for a given meal or snack.

When I started making this change, I thought I'd only do it for a couple months. Recording every gram of carbohydrates I ate was just too much to keep track of on top of recording nursing sessions and diaper changes. (The first I'm still keeping track of, so I know how often (and how long) my baby eats; the second we kept track of for only the first 3 weeks or so, to make sure she was having enough wet/dirty diapers). But as time went on, and my blood sugars still stayed within a good range, I decided to continue being "more lax" about what I was eating. 

Constantly counting carbs can start to feel like an eating disorder after awhile - even if it's done for a healthy reason, like knowing how much insulin to take. I find that it can really start to negatively impact how I feel about certain foods, leading to me thinking of foods as "good" or "bad" - and myself as "good" or "bad" depending on what I choose to eat. I want to model for my daughter how to have a healthy relationship with my body and food. I don't want her growing up thinking that some foods are "bad", nor do I want her seeing me obsessing over numbers and constantly adding up nutrition facts in my head to determine whether or not I can allow myself to eat something in that moment. I don't want to pass on disordered eating to her.

If/when I am pregnant again in the future, I will probably have to revert back to my hyper-vigilance, making note of everything I eat. Not only is it important to have tight blood sugar control during pregnancy - it's also a lot harder. Part of that is because the targets are stricter - but it's also just hard to keep up with the changes a pregnant person's body is going through. Eating 30 g. of carbs vs. 60 g. of carbs makes a much bigger difference, and everything seems to follow a much less predictable pattern, which makes simply "eyeballing" foods a lot more difficult. 

In fact, I may even have to revert back to recording what I'm eating once I stop breastfeeding, and my body once again readjusts to a new normal. My endocrinologist told me that I will likely continue to need only about 12-14 total units of insulin a day as long as I'm exclusively breastfeeding. Not only does nursing burn calories - it also creates another avenue for excess glucose to exit my body, in addition to the traditional avenue of urine. (For those who don"t know, the full scientific name diabetes mellitus actually comes from the Greek words for "sweet urine".) Of course, I don't want to give my baby excess glucose through my breastmilk - but the fact remains, in those rare times when my blood sugars are a little too high, I probably do... to the benefit of my own blood sugar, at the expense of hers. (Thankfully, my baby's pancreas is better equipped to handle that excess.) Once we start introducing solid foods in a few months and she starts breastfeeding less and less frequently, my insulin needs are likely to increase a little again. But for now, I seem to be doing okay without recording everything I eat, and I intend to continue doing it this way until my blood sugars show that that approach is no longer working. I'm hoping that, moving forward, keeping such careful track of my carbs will be a the exception rather than the rule - something I only do temporarily, when pregnant or going through a similar hormonal shift (e.g. menopause), or when I'm making a lifestyle change (e.g. weaning off breastfeeding, or if I suddenly decided to start training for a marathon or something - HA!).

Another thing I've had to readjust since giving birth is how I wear my CGM sensor. During pregnancy, I had so many problems with my CGM giving me false low alerts, or going entirely offline and being unable to register my blood sugar, that I started wearing it on the back of my upper arms instead of on my abdomen. (My growing baby bump made it hard to have enough available belly fat for the CGM, which is inserted into subcutaneous fat tissue.) For the first few weeks after giving birth, I continued to wear it on my arm - until my arm started giving me the same sorts of problems. My postpartum body now had plenty of belly fat to work with - and my arms did not, as my baby continued to grow and I spent much of my days carrying her and holding her. So I switched back to putting my CGM sensor on my abdomen instead.

There is one final aspect I want to talk about - the guilt and worry that comes with being a diabetic mother. Every time my baby has a health problem, I wonder if my diabetes caused it. When my baby had some trouble with nasal congestion and breathing in those first few days after birth, was it because of all the IV fluids I was given during induction - something that wouldn't have had to happen if I hadn't been diabetic? When she had jaundice - both in those initial days and over the course of the next several weeks, in what was ultimately determined to be "breast milk" jaundice - was it because I, a diabetic, was breastfeeding her? When her blood work came back indicating high liver enzymes for several weeks in a row, even after her jaundice had finally disappeared, was it because nine months in a diabetic womb, or months of being breastfed by a diabetic, or just an unfortunate combination of my "autoimmune disorder" genes, had somehow damaged her liver or some other liver-adjacent organ (such as the insulin-producing pancreas)? 

We all have predispositions we might pass along to our children, and things that we've experienced that we want to see our children spared from - but from my perspective, being diabetic seems to amplify those worries. I'm not just worried about passing along some bad genes or less desirable habits - I also worry what the physical environment I'm exposing my daughter to. Hopefully as she gets older - once she has spent more time outside my body than inside of it, and as I wean her off my breastmilk someday - her body will feel less connected to my own, and those worries, at least, will start to fade. Then my diabetes and the choices I make for how best to manage it will only affect my body, my health - and not also hers.

Diabetes & Pregnancy: The 2nd Trimester

For my account of managing my diabetes during my first trimester (0-13 weeks of pregnancy), visit this blog post.

*Disclaimer: These posts are not meant to give medical advice. I'm not a doctor. I'm merely recounting my personal experience managing Type 1/LADA during my pregnancy - and everyone's diabetes and everyone's pregnancy is different.

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I started out the 2nd trimester (14-28 weeks pregnant) with an incredible A1C of 5.1% - likely due, at least in part, to how many low blood sugars I was having at the end of my 1st trimester. Around 14-15 weeks pregnant, I was taking 18 total units of insulin a day: 6 u. of Levemir (my basal insulin) in the morning + 4 u. at bedtime, and 2 u. mealtime insulin with breakfast, 3 u. with lunch, and 3 u. with dinner. This was probably too much, and the beginning of my 2nd trimester still saw several instances hypoglycemia. Even with blood sugars lower than 55, I rarely felt symptoms. If I felt anything, it was only being a bit warm, or feeling irritation at how difficult it was for me to poke a straw into a juice box. Thankfully, my CGM (continuous glucose monitor) continued to be pretty accurate, now that I was wearing it on my arm rather than on my abdomen, and I could (usually) count on it to alert me when I was going low.

Also thankfully, most of my low sugars were now happening during the day instead of overnight. I didn't mind these as much - they were typically 2-4 hours after eating a meal or snack, and about when I would/should be eating another meal or snack anyway. I was also more likely to notice falling blood sugar before it got low enough to trigger the urgent low alert on my CGM, since I was awake and looked at my CGM often. If I saw I was at 72 and still trending downward, I could just adjust when I planned to eat next, or how many carbs I planned to eat, to avoid having to treat with candy or juice.

Still, just because daytime hypoglycemia is easier to deal with doesn't mean it wasn't a nuisance at times - like around 16 weeks, when I saw blood sugars below 65 six times, sometimes more than once in a single day. At 16w3d, I had blood sugar that stayed stubbornly in the 50s-60s for nearly three hours, despite eating candy, yogurt, pasta, and more candy. And the next day, my CGM urgent low alert went off another three times: once overnight (at 4:30 am), once three hours after breakfast (at 10:30 am), and once 1.5 hours after dinner (at 7:30 pm). These were not particularly unbalanced meals either, that might have caused a post-meal sugar crash. I tried not only to eat the recommended 50-60 g. of carbs with every meal, but also to balance those with protein, fiber, and fats.

Like I had done before in the 1st trimester, I started decreasing my mealtime insulin doses without express permission from my doctors, making small adjustments as I needed to in order to get through the day. If I was already below 70 before eating a meal, for example, I might take only 2 u. of insulin with my meal instead of 3 u. But even those adjustments weren't always enough, and MFM (maternal fetal medicine, the doctors and nurses who were helping me manage my blood sugar while pregnant) suggested I decrease my morning Levemir by one unit. A week later (at 17 weeks), they extended that suggestion to my nighttime Levemir as well. For the next several weeks, I took 5 u. in the morning and 3 u. at night. Even with those changes, I still had to occasionally take only 2 u. with lunch or dinner; on such days, my total insulin was therefore down to only 15 u.

During the four weeks from 17-20 weeks pregnant, I had blood sugars under 65 twelve times, for an average of three times a week. However, around 19.5 weeks, something else started to happen - even though I was still having occasional daytime lows, I was also having some daytime highs as well. I saw numbers in the 140s-150s more regularly after breakfast, and occasional blood sugars in the 140s or even as high as 180 after dinner. For a non-pregnant diabetic, those numbers would still be considered pretty good, but pregnancy blood sugar targets are <120 two hours after eating, so at the end of 20 weeks, MFM recommended I increase my breakfast insulin to 3 u. This helped, and between 21 and 22 weeks, I had fewer instances of higher glucose - but even more instances of low blood sugar. During those 2 weeks, there were 8 days when my blood sugar dipped below 65.

20 weeks marks the halfway point of a full-term pregnancy, and about when most pregnant people have their "anatomy scan" to make sure all the organs look normal and the baby is growing appropriately. Because of my diabetes, I was also given a fetal echocardiogram - a more detailed look at the baby's heart, to make sure it was pumping and working as intended, and that all chambers and major vessels were accounted for. My anatomy scan and fetal echo were at 21w2d, so that my husband could also be there.

A sonogram from my anatomy scan on September 3, 2019, when I was 21w2d pregnant.

Everything looked great - it was all good news! But that didn't stop me from starting to worry about what my baby's birth weight might be. One of the most well-known risks of a diabetic pregnancy is the risk of a "big baby," and even though I was trying my best to keep my blood sugar levels on target, there were certainly times (an hour here or there, while I waited for an insulin dose to catch up) when my baby was floating in an amniotic sac with high blood sugar. I would sometimes watch my CGM rise near or above 200 after eating - and even though by two hours after eating the number would be back on target (<120), and MFM only cared about that "two hours after" number, I still worried what that half-hour of high blood sugar might've done, before my mealtime insulin kicked in.

I actually had 3 ultrasounds during my 2nd trimester, and the first was at 16w2d, which showed my baby in the 64th percentile for size/weight. I also saw MFM at 17w4d, and my OB at 20w2d, for general check-ins without ultrasounds. They measured my fundal height for the first time at that 20-week appointment. This is a measurement of how high the top of the uterus is, which apparently correlates in cm to how many weeks along one's pregnancy is. I measured 23 cm - a little larger than expected for 20 weeks. Then at my anatomy scan ultrasound at 21w2d, my baby was measuring in the 85th percentile.

I was also starting to gain weight myself, at a rate of about one pound a week. Even though this is the recommended rate for the 2nd and 3rd trimesters, I worried that it was too much, and I would soon outpace this recommendation. I was averaging 2300-2400 calories a day - which was more than I wanted to eat, but when I was trying to make sure I was eating enough carbs and trying to avoid low blood sugars by balancing those carbs with proteins and fats, that amount of calories felt rather inevitable. (Weeks when I had several days of hypoglycemia saw that average raise even higher, to about 2600 calories/day, as I treated my low blood sugars with candy and snacks.)

My doctors, however, were miraculously not worried - not about my weight gain, and not about my baby's size (at least - not yet). They told me babies grow at different rates and it was still too early to tell if it would be a big baby at birth. I was surprised; I'd heard so many stories about doctors' concerns about the size of babies born to diabetics that I was sure that the "85th percentile" news would prompt lectures about dietary changes or insulin adjustments. Instead, they told me I was doing a good job with my blood sugars and that (barring any other complications), there would likely be no need to induce me before 39 weeks after all. (Originally, they'd told me most diabetics need to be induced between 37-38 weeks). They congratulated me on my blood sugar logs and gave me high-fives.

Then, at 23 weeks, the insulin resistance I'd been warned about finally started to hit. That week, I had zero instances of hypoglycemia under 65. It was the first time that I'd had an entire week without low blood sugar in 14 weeks - since my first appointment with MFM at 8.5 weeks pregnant, when I'd started taking mealtime insulin. More than that, I also saw several higher numbers after eating again: 130s after breakfast, 130s (and even a 161) after lunch, 130s-150s after dinner. Most were only slightly higher (and the 161 was because I'd forgotten to take my insulin at lunch that day), but then at the end of 23 weeks I finally saw a post-meal reading that truly gutted me: 208 two hours after dinner. Before when I'd seen a number that high, it had corrected itself before the two hour mark. Or it was high only on my CGM, and a check with my meter reassured me that my CGM was inaccurate and I wasn't actually that high after all. But this time, it was my meter that showed me at 208 - my CGM was inaccurate in the opposite direction, and thought I was only at 174.

Logically, I knew that one night with blood sugar above 200 wasn't going to hurt. It's not about perfection 100% of the time; it's the pattern of your readings and how often the baby (and your own body) is subject to high blood sugars that truly affects health complications. Still, seeing that number dashed my hopes that maybe having LADA instead of a "true" Type 1 meant I wouldn't see much insulin resistance after all. LADA probably delayed the insulin resistance a bit (the book Pregnancy with Type 1 Diabetes by Ginger Vieira warned that insulin resistance might begin around 16 weeks, which I'd passed 7 weeks earlier) - but in the end, diabetes is still diabetes, and even if my pancreas isn't as malfunctioning as others', it's still not functioning as it should be. It's easy for me to forget that sometimes.

In the last 5 weeks of my 2nd trimester, MFM increased my morning Levemir from 5 u. to 6 u. to 8 u., and my bedtime Levemir from 3 u. to 4 u. to 6 u. (and then, when 6 u. proved a bit too high, back down to 5 u.). My mealtime doses were also tweaked - my breakfast Novolog went from 3 u. to 4 u. to 5 u., lunch went from 3 u. down to 2 u., and dinner went from 3 u. to 4 u. With small adjustments being made nearly every week (or even multiple times a week), it started getting very difficult to keep track of what I was supposed to be taking when.

To put another way, I was taking a total of 17 u. of insulin each day at the start of 23 weeks, and a total of 25 u. of insulin by the end of 27 weeks. This was increased gradually at first - I was steady at 19 u. for two and a half weeks, for instance - but then at 26 weeks, MFM started adding more insulin in greater jumps. I had a week with fasting blood sugars consistently between 90-110 (when they're supposed to be under 90), and after that MFM just started piling on the changes (or so it felt to me).

In the past, they usually adjusted me by 1 unit at a time, and then waited a week or so to see if that would be enough - but on October 8 they had me increase my morning Levemir from 6 u. to 8 u., and on October 10, only two days later, they also asked me to increase my bedtime Levemir from 4 u. to 6 u. It solved my high fasting blood sugars (at 27 weeks I was back down to between 70-82 every day), but it also, unsurprisingly, caused a resurgence of hypoglycemia issues. I had 5 days of low blood sugar in the last two weeks of my 2nd trimester, and on the very last day, my CGM urgent low alert went off overnight (twice!) for the first time in 8 weeks. I had to treat hypoglycemia at 1 am - and again at 5 am - and then for the rest of the morning, I continued to struggle getting my blood sugars to stay up. At 7:30 am, before breakfast, I was at 61; by 10:30 am I was back down to 72 and having to eat a snack; and less than two hours later, I was at 62, requiring me to eat an early lunch. After that day, I convinced MFM to back down a little, scaling my bedtime Levemir back to 5 u.

On the plus side, I was able to eat fewer calories most days (those hypoglycemic days notwithstanding), now that I had more insulin resistance. For a few weeks, I was gloriously not worried about low blood sugars at all. My daily calories averaged between 2100-2200 from 23-27 weeks - which was not only more in line with how hungry I was/how much I actually wanted to eat, but also slowed down my weight gain a bit (and which I hoped might also help prevent my bigger-than-average baby from getting any bigger). Still, by the end of the 2nd trimester, I'd already gained 23 lbs. compared to my pre-pregnancy weight - and I had the entire 3rd trimester still to go.

At 24w2d I had another check-in with my OB. This time, my fundal height measured 24 cm - right on track to where I "should" be for how far along I was. For a few days, I worried less... But then at my third 2nd trimester ultrasound at 25w1d, my baby's estimated size/weight came back as being in the 92nd percentile, and all my anxieties and guilt about having a "big baby" resurfaced.

To be clear, I'm not trying to fat shame here. I have nothing against "big babies" in general. I wasn't even that concerned about the idea of having to deliver a larger-than-average baby, which is probably what most pregnant people are worried about when their baby is measuring large. It was just that I was worried I was responsible for making my baby bigger than they otherwise would be, due to the unavoidable fact of my diabetes. If I hadn't been diabetic, I wouldn't have thought much of it - I would've chalked up my baby's size to genetics or something, and looked forward to seeing all those cute rolls on my baby's arms and legs. But because of my diabetes, I was filled with mommy guilt that my baby's size was my fault. I worried I was giving my baby a difficult start to life, and a childhood potentially riddled with health problems, all because of the glucose they'd been exposed to in utero.

That same day I had my A1C tested for the first time since the end of the 1st trimester. Given how big my baby was measuring, how much weight it felt like I'd gained, and my recent insulin resistance, I thought it might be higher than my previous 5.1% result - but hopefully not too much higher. (After all, I was trying so hard to control everything and keep my blood sugars as low as was safely possible for me to do!)... So imagine my surprise when the result came back as 4.8%! All those hypoglycemic episodes had outweighed the few 200+ blood sugars I'd had after all, and my average blood sugars remained solidly in the standard non-diabetic range of 4.0-5.6%. It confused me, frankly. With an A1C like that, what more could I do than what I was already doing? And how could my baby's size be because of my diabetes? Maybe I wasn't at fault after all!

I had another ultrasound at the very beginning of my 3rd trimester (28w1d), which showed my baby now in the 96th percentile.

A 3D sonogram of my baby's face, from my ultrasound at 28w1d pregnant - the very beginning of my 3rd trimester.

My doctors seemed divided in opinion. On the one hand, they still congratulated me on my (mostly) excellent blood sugars (though they also seemed a bit more keen to point out the couple of times I'd gone high); on the other hand, they were non-committal about if my diabetes was influencing the size of my baby. One told me, "Whether it's because of your diabetes or not, making changes to your insulin probably won't make it better at this point. You're just going to have a big baby."

They also started talking about the possibility of an induction earlier than 39 weeks again, and how I wouldn't be able to manage my own diabetes during labor and delivery - I would have to be on an insulin drip so the doctors could control my blood sugars themselves. When I started to question whether I would really need to cede all control over my insulin to doctors who didn't even know me or my diabetes, I was told that if I wasn't on an insulin drip it would make the doctors "irritated" and "uncomfortable." As if my priority when I'm in the middle of childbirth should be being a model patient and doing whatever they tell me, instead of advocating for what I want and need based on what I know of my body and my diabetes. Uh, NO. I don't think so. If that's the person they're expecting me to be, they're about five years too late.

In fact, here's how much I'm NOT that person anymore: about halfway through my 2nd trimester, I decided to hire a doula - a childbirth coach/companion. I worried that doctors and nurses would see the word "diabetes" on my chart, make assumptions about my risk factors, and then make decision about how my labor and delivery would go based on those assumptions, without consulting me first. There were a lot of things I was concerned about - whether or not I'd be induced or require a c-section, whether I'd be allowed to move around or if I'd be connected to too many wires and machines (IVs, fetal monitors, etc.) to leave a hospital bed, and how much I would be allowed to manage my diabetes while in the hospital. I worried that if I was given insulin through an IV, I'd be given way more than I needed, and/or that if hospital staff were in charge of treating any hypoglycemia episodes that may occur, they would over-treat me and make my blood sugar skyrocket (like they did after my D&C last year, when the post-op nurse saw that my blood sugar was slightly below 70 and gave me a huge cup of apple juice to drink, which resulted in me having to deal with 300+ blood sugars for the rest of the day after I was discharged).

I knew I would feel more comfortable with someone in the room (besides my husband) who will help me advocate for myself, ask the questions I want to ask, make sure doctors explain their recommendations to me and keep lines of communication open, remind me what my options are, and emotionally support me through the whole process - whether I end up having a relatively normal labor and delivery, an emergency c-section, or somewhere in between. Based on several articles and books I read, it seemed like a doula was exactly what I wanted - and now that I'm already getting pushback from doctors when I bring up my preferences for and concerns about labor and delivery, I'm so happy that I made this decision to have a doula on my team.

In the end, I realize I probably won't have much of a choice on the insulin IV during labor and delivery - but if I agree to it, it won't be because it's what will make the doctors comfortable; it'll be because it's what makes me comfortable. My priorities are figuring out what's best for myself and for my baby - not what's best for my doctors. For them this is their day to day job; for me, it's an experience of a lifetime, one of the most important days of my life, which I'll remember forever. And when I look back on this experience, I want to remember feeling empowered - not coerced into medical procedures or protocols I wasn't comfortable with and didn't need to do.

There's one last thing I want to talk about regarding my diabetes during this trimester - and that's to talk about the effort it takes to manage a chronic illness. I did already explain this in my last post about diabetes, but I don't complain often (except in blog posts I create specifically to complain, like this one), so please bear with me if I repeat myself a bit. :)

Near the beginning of my 2nd trimester, I switched from using Fiasp brand mealtime insulin (the last of the free sample pens my endocrinologist gave me before I was pregnant) to Novolog (the brand my insurance covered with my new mealtime insulin prescription, which now cost me $40/month). I also got a prescription for meter test strips for the first time; before I was pregnant I was not going through my insurance for test strips at all, and was simply buying them on Amazon. Without a prescription, I was using the Contour Next glucose meter, and paying $34 for 100 strips. With a prescription, I switched to True Metrix (the brand covered by my insurance), and ended up paying only about $4 for 150 strips.

Obviously I was glad to save some money (especially now that I was paying for mealtime insulin)... but those savings didn't come without a price. Getting my test strips through the hospital has proven to be a much greater hassle than just placing an Amazon order. First, I had to pick them up in person because my signature wasn't yet in the system for them to auto-bill my insurance. I was assured it would be smoother in the future, and that next month I could just call, ask for a reorder, and they'd be shipped directly to my house. But by the next month the hospital's medical supply distribution center had changed hands (and names), requiring all prescriptions to be resubmitted. This resulted in three back-and-forth phone calls before I was able to relay this message to my doctor's office and get this problem solved, and then another few days before the request went through, by which time I was down to my last couple of test strips. (Good thing I have a CGM as a backup way of checking my blood sugars!)

And the third month I went to reorder supplies? I had to go through the whole process of resubmitting my prescription again, because somehow they had "no record" of my prescription ever being resubmitted the previous month - or the package of test strips they'd sent me. Then, when that third month's supply finally arrived, it was the completely wrong thing. Instead of getting True Metrix test strips, I was sent AccuCheck lancets (which aren't even lancets I can use, because they require an AccuCheck brand lancing device which I don't have). I had to call them back (again) and ask them to send the test strips I needed.

Refilling my insulin is also often a chore, this time requiring arguments with my insurance. For much of the 2nd trimester I was not taking enough Novolog every day to finish an entire insulin pen before it expired (which, due to the nature of insulin, is 4 weeks after the pen is removed from the refrigerator and used for the first time). This meant that my insurance wouldn't let me refill my prescription when I needed to, since according to them I "hadn't used up" my last refill yet. I had to argue that it didn't matter how much of the pen I used - if I was following the instructions from the medicine's manufacturer, I would need a new pen every 4 weeks regardless. (And I had to make this same argument every 4 weeks, because the solution was always just a one-time override, and not changing whatever needed to be changed so that it wouldn't happen again.)

During my 2nd trimester, I really started to notice how much time and energy I was putting into managing my diabetes every day - and how much harder it was to keep track of everything for so long. I spend a lot of time:

1. Keeping track of what my blood sugar is doing (both on my CGM and verifying the CGM's accuracy with at least a few follow-up finger sticks a day)
2. Being constantly vigilant about when I need to eat next and what I should eat next - which also entails deciding whether or not I need to pack a snack and/or insulin pen(s) in my bag every time I leave the house; planning meals and buying groceries up to a week in advance; calculating the calories, carbs, and fiber of every ingredient in every dish I prepare; looking up those same nutrition facts online for any restaurant I'm planning to go to, so I can decide ahead of time what to order; and making a note of those three stats for every bite I put into my mouth
3. Reorganizing all those pen-and-paper notes I keep into an online spreadsheet so that the info is easier to assess and find patterns, downloading CGM data to my computer from my receiver unit, and printing out all my charts and graphs to take to every doctor's appointment
4. Remembering what my current dose of insulin is and making sure I take the right amount from the right pen, for 5 different injections taken at 4 different times every day (and properly disposing of my medical sharps, taking them to an appropriate recycling facility when the containers get full)
5. Dealing with hypoglycemia alerts, sometimes multiple times a day and/or in the middle of the night, having to figure out each time if it's a false alert or real, and (if real) making sure I treat the low blood sugar as required, even if I don't want to - including trying to prick my finger and line up a drop of blood onto a small test strip in a dark bedroom in the middle of the night, or eating a snack when I'm not hungry, and
6. Reordering test strips and lancets from the aforementioned dysfunctional hospital medical supply center, refilling prescriptions for insulin pen needles and two different types of insulin at Walgreen's, and reordering CGM sensors, transmitters, and overlay patches from another medical supply company, or from Dexcom directly, as needed.

All of that management requires a lot of physical space (our kitchen table is covered in my diabetes notes, paperwork, and prescriptions) and mental space - and sometimes it takes a toll on me emotionally. When I make a mistake (and with that many things to constantly keep track of, mistakes are inevitable), I feel guilty. By 23 weeks (before my craziest insulin adjustments even started), I was already seeing proof that managing every aspect of my diabetes was taking its toll on me. Things that should've been easy to remember started falling through the cracks.

As mentioned briefly above, I forgot to take a lunchtime insulin dose at 23 weeks pregnant, resulting in a post-meal blood sugar of 160 (which I actually thought was pretty good, considering I'd taken 3 less units of mealtime insulin than I should have). Then, a few days later, I finished a box of insulin needles and went to grab a new box off my shelf - only to find that there wasn't one. I'd been so sure I had another box in reserve that I hadn't bothered to check once I noticed the box I was using was getting low - but somehow 40 days had passed since I'd last filled my needle prescription and I'd gone through all 200 needles. This discovery resulted in a frantic phone call to Walgreen's, checking ALL the Walgreen's in the area, and ultimately having to get a different brand of needles than usual (a brand I disliked, because I found that I was more likely to bleed and bruise when using them), which I picked up just minutes before the pharmacy closed (because of course this happened on a Sunday when the pharmacy closed early). I was very lucky that I ended up not having to miss a single insulin dose due to my error; if I'd had to wait until Monday morning to pick up the prescription, I would've missed at least 4 doses, for a total of 16 units of insulin. I had no idea how badly that might have messed up my blood sugars, and was glad I didn't have to find out.

(Though, can we take a moment to please note the ridiculousness of the situation? I HAD medication on hand, just not the conduit to get the medication into my body. I think when you pick up your month's supply of insulin they should include the needles with it, instead of requiring two different prescriptions. Or, you know - maybe not require a prescription for those tiny insulin pen needles in the first place, but just have them available over the counter, on the shelf next to the test strips and lancets... But I digress.)

That was just one small mistake (and one I could easily blame on "pregnancy brain"), but it could've had serious consequences. I had another such mistake after my insulin doses started frequently changing after 23 weeks - I was looking at my evening Levemir dose (6 u.) instead of my morning Novolog dose (5 u.) in my notes and ended up giving myself 6 u. of Novolog instead of only 5 u. Again, in the scheme of things, this wasn't a disaster - but only by sheer luck. I happened, completely by chance, to almost do the right thing, and the difference of 1 unit didn't affect my blood sugars much. But what if I'd grabbed the wrong pen too, and given myself 6 u. of Levemir instead of 5 u. of Novolog? I would've had significantly more basal insulin in my body than I needed, and would've fought dangerously low blood sugars all day long, likely requiring a trip to the hospital to bring them back up.

I know that these sorts of mistakes are inevitable. I try my best to be diligent, but it's just impossible to be completely aware of everything I'm doing all the time. Still, when they happen, it's hard not to blame myself and feel guilty. Even when I don't make a mistake at all, but simply follow the plan my doctors and I have developed, things still happen - things that I want to believe I have control over, but which I probably (for whatever reason) just don't. Despite trying to eat right and get my insulin doses right, that first 200+ blood sugar two hours after eating wasn't the only one I had this trimester (there were two others, too). And despite my 4.8% A1C, my baby is measuring in the 96th percentile. Whether I have an explanation for something ("I forgot to take an insulin dose, and that's why this blood sugar is higher than I'd like") or not, I worry about it. I worry that my diabetes is hurting my baby.

According to everything I've read, the last trimester (particularly at 7 and 8 months of pregnancy) is the hardest for managing diabetes, because that's when insulin resistance is at its peak (thanks, placenta!). It may get a bit easier during the last few weeks, with insulin needs plateauing or even decreasing a bit as my body prepares for labor. And then, after labor and delivery of the placenta, my insulin requirements will likely go right back down to pre-pregnancy levels. Unfortunately, I don't know what those "pre-pregnancy levels" might be for me, since before my pregnancy I was 1) not taking any mealtime insulin, and 2) eating a low-carb diet to address that fact. I don't particularly want to go back to that (especially since I plan to breastfeed, and will likely need to maintain a fairly similar diet to what I've been eating while pregnant in order to successfully do so), but that means I don't know what my non-pregnancy insulin requirements will be, given that I've never regularly taken mealtime insulin when not pregnant. Maybe we'll start with the lowest doses I took during this pregnancy, and adjust from there?

I plan to write two future blog posts on these topics - one about managing my diabetes during the 3rd trimester and during labor, and another about managing my diabetes postpartum - but these likely won't get posted for quite some time. When my 3rd trimester is done, I'll have a few other things on my mind (a baby, for instance, and transitioning to motherhood!), but I'm hoping to have that 3rd trimester post available by March 2020, whether my little one arrives in January 2020 as my estimated due date would suggest, or in late December 2019, as my MFM doctors are likely to push for.

For When Times Are Tough

I've talked in previous posts (Missed Miscarriage, Yellow Nursery Stripes, April 19, From August to August) about the healing process I went through after my miscarriage - facing the grief and finding the strength to try it all again in pursuit of my dreams.

One thing I did was spend a lot of time finding and compiling facts and quotations I found personally helpful. I started with encouraging statistics and uplifting sentiments that were miscarriage-specific, but as I felt emotionally stronger, my document quickly evolved into one filled with more generic advice - something I thought I might be able to refer to again, for any number of losses (deaths, relationships, career choices, self-doubt, etc.), whenever the inevitable next one happened in my life.

Finding these quotations and organizing them into a love letter of sorts/a how-to guide for myself was very therapeutic for me (and admittedly a very "Ravenclaw" thing to do, so I realize it's not everyone's cup of tea...) It was also likely the process of creating the list, more than the actual content, which helped me most, since it necessitated spending time self-reflecting and prioritizing my mental health. I don't know if I actually will refer to this list again in the future; I might compile an entirely new list instead.

Still, I thought I would share some of the quotations I found (and the structure I organized them into), in case this might help anyone else, too. When I find it hard to accept my own thoughts or truly believe my own words, reading the words that others have written can be wonderfully affirming and invaluable.

An abridged version of the document I created is below. (And yes, the full document I wrote - and am still adding to, whenever I find more quotes that speak to me - really is even longer than this!) :)

***

You're allowed to feel the way you feel. You are allowed to grieve for things you've lost. First, you need to give yourself that time.

Then, when the grief is no longer all-consuming, read this letter to remind yourself that you are also allowed to romanticize, reframe, and transform your pain. You do not have to keep living in it.

Some of these sentiments contradict each others; still others are at least occasionally untrue. They may be things you want to believe, but have trouble actually believing. On days when you are determined to get in the way of your own happiness, that may seem like enough reason to reject them. But remember: something does not have to be an absolute truth to be beneficial.

"You're going to live your life based on delusions (and you are, because we all do)... Why not at least select a delusion that is helpful?" (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)

Think of this not as a list of truths, but as a list of useful delusions. And if that is not enough - if at any time your grief returns or you don't have it in you to forge continuously ahead - you are allowed to take a step back and grieve all over again. Grief is not linear. The words below will not always give you comfort. But in those moments when you're healed enough to hear them, they are here for you.

"The time to repair the roof is when the sun is shining." (John F. Kennedy)

This letter is your roof, and you have prepared it so it will be there for you when next it rains. Use it. May these words inspire you, and may its compilation remind you of your foresight and strength. You have outlived grief in the past, and you will outlive it again.

*

Dear Andrea,

Times are tough right now - so tough that you may want nothing more than to deny it or move quickly past it. But first you need to make sure you've allowed yourself to truly feel your grief. Name it. Analyze it. Confront it. Write about it.

• "Numbing the pain for awhile will make it worse when you finally feel it." (J.K. Rowling - Harry Potter and the Goblet of Fire)
• "Of all the things in the world, suffering is the most real. You can never ignore it or doubt it." (Yuval Noah Harari - 21 Lessons for the 21st Century)
• "Research has found that the act of not discussing a traumatic event or confiding it to another person can be more damaging than the actual event... Writing about traumatic experience can produce measurable changes in physical and mental health." (Brene Brown - Daring Greatly)
• "To survive something we first need to know what it is we're surviving." (Miriam Toews - All My Puny Sorrows)

To be human is to grieve, and for better or worse, you are a part of the web of humanity.

• "Every human requires food and water to survive and every human has a heart that bleeds, loves, and grieves." (Suzy Kassem - Rise Up and Salute the Sun)
• "Life isn't pretty / We all get a little wrecked sometimes." (The Veronicas - On Your Side)
• "You are allowed to feel messed up and inside out. It doesn't mean you're defective - it just means you're human." (David Mitchell - Cloud Atlas)
• "Life is a series of losses... We're all terminal." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)
• "There's always gonna be another mountain / I'm always gonna wanna make it move / Always gonna be an uphill battle / Sometimes I'm gonna have to lose" (Miley Cyrus - The Climb)
• "It if don't hurt now, just wait, just wait awhile / Ain't in fun / Living in the real world" (Paramore - Ain't It Fun)

Life is, at times, inexplicably and inescapably awful. The bad and good in life are permanently tied up in each other. Uncleavable.

• "I've made some friends, and I've lost some too." (Andrew McMahon - Cecilia and the Satellites)
• "You know time will give and time will take." (Phillip Phillips - Raging Fire)
• "I can't reconcile the way that the world is jolted by events that are wonderful and terrible, the gorgeous and the tragic. Except that I am beginning to believe that these opportunities do not cancel each other out. Life is so beautiful. Life is so hard." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)

You did nothing to deserve this pain. You did nothing wrong. In fact - you're doing everything right. You're hurt right now because in trying to experience all the good that life has to offer, you also stumbled upon the bad. You lost because you were brave enough to try to win.

• "Now we're falling through the ice / We made our bed and rolled the dice / Well every gamble has a price." (Banners - Empires on Fire)
• "Everybody tries to put some love on the line / And everybody feels a broken heart sometimes." (Teddy Geiger - These Walls)
• "The sorrow we feel when we lose a loved one is the price we pay to have had them in our lives." (Rob Liano)
• "What are you passionate enough about that you can endure the most disagreeable aspects of it?" (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)

When you love someone or something, you make yourself vulnerable to loss.

• "The course of true love never did run smooth." (William Shakespeare - A Midsummer Night's Dream)
• "Love is uncertain. It is incredibly risky. And loving someone leaves us emotionally exposed." (Brene Brown - Daring Greatly)
• "Where there is desire, there is gonna be a flame / Where there is a flame, someone's bound to get burned." (Pink - Try)
• "I find it bittersweet / 'Cause you gave me something to lose / If you love someone and you're not afraid to lose 'em / You'll probably never love someone like I do." (Lukas Graham - Love Someone)
• "He who loves 50 people has 50 woes; he who loves no one has no woes." (Buddha)
• "Here's the truth: Who is spared love is spared grief." (David Mitchell - Bone Clocks)

But that is no reason not to love, or live.

• "Vulnerability is the core, the heart, the center of meaningful human experiences... To foreclose on our emotional life out of a fear that the costs will be too high is to walk away from the very thing that gives purpose and meaning to living... Living without connections - without knowing love and belonging - is not victory." (Brene Brown - Daring Greatly)
• "When we were children, we used to think that when we were grown up we would no longer be vulnerable. But to grow up is to accept vulnerability. To be alive is to be vulnerable." (Madeleine L'Engle)
• "Love doesn't discriminate / Between the sinners and the saints / It takes and it takes and it takes / And we keep loving anyway... Death doesn't discriminate / Between the sinners and the saints / It takes and it takes and it takes / And we keep living anyway" (Hamilton Soundtrack -Wait for It)
• "Hope that you fall in love / And it hurts so bad / The only way you can know / You gave it all you had." (One Republic - I Lived)
• "If this love is pain, well darling, let's hurt tonight." (One Republic - Let's Hurt Tonight)

If we try to avoid the bad, we will fail to experience any of the good. There is nothing to do but lean in and embrace it all.

• "The world is an ugly place. We must live in it." (Madeline Miller - Circe)
• "If you hide under the covers / You might never see the light of day" (Mary Poppins Returns - Trip a Little Light Fantastic)
• "Numbing vulnerability doesn't just deaden the pain of our difficult experiences; numbing vulnerability also dulls our experiences of love, joy, belonging, creativity, and empathy. We can't selectively numb emotion. Numb the dark and you numb the light." (Brene Brown - Daring Greatly)
• "Action may not always bring happiness, but there is no happiness without action." (Benjamin Disraeli)
• "You are here to risk your heart. You are here to be swallowed up. And when it happens that you are broken, or betrayed, or left, or hurt, or death brushes near, let yourself sit by an apple tree and listen to the apples falling all around you in heaps, wasting their sweetness. Tell yourself you tasted as many as you could." (Louise Erdrich - The Painted Drum)

Practice fearlessness - even when you're afraid.

• "Even when I'm scared I have to try to fly / Sometimes I fall / But I've seen it done before / I gotta step outside these walls" (Teddy Geiger - These Walls)
• "If the highest aim of a captain were to preserve his ship, he would keep it in port forever." (Thomas Aquinas)
• "You have plenty of courage. All you need is confidence in yourself. There is no living thing that is not afraid when it faces danger. The true courage is in facing danger when you are afraid." (L. Frank Baum - The Wonderful Wizard of Oz)
• "I wanted you to see what real courage is. It's when you're licked before you begin, but you begin anyway and see it through no matter what." (Harper Lee - To Kill a Mockingbird)
• "Living a life that is driven more strongly by curiosity than by fear... You have to be willing to take risks if you want to live a creative existence." (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)
• "May your choices reflect your hopes, not your fears." (Nelson Mandela)

We can't choose what happens to us when we try. But we can choose to try anyway. And the act of making that choice both forges and proves our inner strength.

• "There are only two mistakes one can make: not going all the way, and not starting." (Buddha)
• "I am not what has happened to me. I am what I choose to become." (Carl Jung)
• "Vulnerability is not weakness, and the uncertainty, risk, and emotional exposure we face every day are not optional. Our only choice is a question of engagement. Our willingness to own and engage with our vulnerability determines the depth of our courage and the clarity of our purpose." (Brene Brown - Daring Greatly)
• "It was the difference between being dragged into the area to face a battle to the death and walking into the arena with your head held high. Some people, perhaps, would say that there was little to choose between the two ways, but... there was all the difference in the world." (J.K. Rowling - Harry Potter and the Half-Blood Prince)
• "The credit belongs to the man who is actually in the arena... who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly." (Theodore Roosevelt)

Picking yourself up and trying again is a choice you may have to make over and over again. But you can, and you will.

• "Just because it burns doesn't mean you're gonna die / You gotta get up and try, try, try" (Pink - Try)
• "Being defeated is often a temporary condition. Giving up is what makes it permanent." (Marilyn vos Savant)
• "You may have to fight a battle more than once to win it." (Margaret Thatcher)
• "This is how things go. You fix them, and they go awry, and then you fix them again." (Madeline Miller - Circe)
• "It was important to fight, and fight again, and keep fighting, for only then could evil be kept at bay, though never quite eradicated." (J.K. Rowling - Harry Potter and the Half-Blood Prince)
• "Our greatest glory is not in never failing, but in rising every time we fall." (Confucius)
• "I'll rise up / High like the waves / I'll rise up / In spite of the ache / I'll rise up / And I'll do it a thousand times again." (Andra Day - Rise Up)

You will glean wisdom from this pain. It will grow you and deepen you.

• "Experience is the only thing that brings knowledge and the longer you are on earth the more experiences you are sure to get." (L. Frank Baum - The Wonderful Wizard of Oz)
• "Biology gives you a brain. Life turns it into a mind." (Jeffrey Eugenides - Middlesex)
• "It matters not what someone is born, but what they grow to be." (J.K. Rowling - Harry Potter and the Goblet of Fire)
• "People who only have good experiences aren't very interesting. They may be content, and happy after a fashion, but they aren't very deep." (Peter Cameron - Someday This Pain Will Be Useful to You)
• "The goal is not getting comfortable, but normalizing discomfort. We need to cultivate the courage to be uncomfortable and to teach people around us how to accept discomfort as a part of growth." (Brene Brown - Daring Greatly)
• "Don't give in / Don't you dare quit so easy / There is a lot we can learn from this loss" (Snow Patrol - Don't Give In)
• "It's times like these you learn to live again / It's times like these you give and give again / It's times like these / Time and time again" (Foo Fighters - Times Like These)

Suffering brings enlightenment and empathy.

• "The wound is the place where the Light enters you." (Rumi)
• "I had to go through hell to prove I'm not insane / Had to meet the devil just to know his name." (Ella Henderson - Ghost)
• "Vulnerability is the birthplace of love, belonging, joy, courage, and creativity. It is the source of hope, empathy, accountability, and authenticity. If we want greater clarity of our purpose or deeper or more meaningful spiritual lives, vulnerability is the path. (Brene Brown - Daring Greatly)
• "There is no shame in what you are feeling. On the contrary, the fact that you can feel pain like this is your greatest strength." (J.K. Rowling - Harry Potter and the Order of the Phoenix)
• "My own suffering began to feel like it had revealed to me the suffering of others, a world of those who, like me, are stumbling in the debris of dreams they thought they were entitled to and plans they didn't realize they had made." (Kate Bowler - Everything Happens For a Reason: And Other Lies I've Loved)
• "The pain sculpts us into someone who understands more deeply, hurts more often, appreciates more quickly, cries more easily, hopes more desperately, and loves more openly." (Unknown)
• "In order to act morally...you need to develop a deep appreciation of suffering... And if you want to know the truth of the universe, about the meaning of life, and about your own identity, the best place to start is by observing suffering and exploring what it is." (Yuval Noah Harari - 21 Lessons for the 21st Century)
• "Compassion is not a relationship between the healer and the wounded. It's a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others." (Pema Chodron)

You are a block of marble, and pain is the chisel gradually shaping you into the masterpiece that you are. It's good that difficult times are inevitable - because they are also useful.

• "Under this pressure, under this weight / We are diamonds taking shape" (Coldplay - Adventure of a Lifetime)
• "Grief does not change you. It reveals you." (John Green - The Fault in Our Stars)
• "Even if I could [erase your scars], I wouldn't. Scars can come in handy. I have one myself above my left knee that is a perfect map of the London Underground." (J.K. Rowling - Harry Potter and the Sorcerer's Stone)
• "The scars themselves I offered to wipe away. He shook his head. 'How would I know myself?' They suited him. Whoever saw him must salute and say: There is a man who has seen the world. There is a captain with stories to tell." (Madeline Miller - Circe)
• "I am brave, I am bruised / I am who I'm meant to be / This is me." (Keala Settle, The Greatest Showman Soundtrack - This is Me)

Life is built from pain; so use your pain to build the life you desire. Treat this experience as nourishment for your soul and the spark that can light your creative projects.

• "The winter's cold / But the snow still lightly settles on the trees / And a mess is still a moment I can seize" (Gabe Dixon Band - All Will Be Well)
• "You're going to go through tough times - that's life. But I say, 'Nothing happens to you, it happens for you.' See the positive in negative events." (Joel Osteen)
• "I cannot bear this world a moment longer... Then child, make another." (Madeline Miller - Circe)
• "The opposite of war isn't peace... It's creation!" (Rent Soundtrack - La Vie Boheme)
• "Grief needs an outlet. Creativity offers one." (Hope Edelman)
• "Artists crave experiences because that's how they make art." (Whitney Scharer - The Age of Light)
• "Pick up a pen, start writing / I wanna talk about what I have learned / The hard-won wisdom I have earned." (Hamilton Soundtrack - One Last Time)

There is a time in every compelling narrative when things get difficult. Without conflict to overcome, there is no story. It is not easy - but it is worth it.

• "There was only one way to the other side, and that was through the pain." (Vanessa Diffenbaugh - The Language of Flowers)
• "The harder the struggle, the more glorious the triumph." (Unknown)
• "Such narrative arcs make good movies but shitty existences." (David Mitchell - Bone Clocks)
• "I guess the bad can get better / Gotta be wrong before it's right / But still the growing pains, growing pains are keeping me up at night" (Alessia Cara - Growing Pains)
• "You have set yourselves a difficult task, but you will succeed if you persevere; and you will find a joy in overcoming obstacles. Remember, no effort that we make to attain something beautiful is ever lost." (Helen Keller)

Challenging times are opportunities to remind yourself what you're made of, and chances to grow further evidence of your tenacity and success.

• "When we meet real tragedy in life, we can react in two ways - either by losing hope and falling into self-destructive habits, or by using the challenge to find our inner strength." (Dalai Lama)
• "Grief and resilience live together." (Michelle Obama - Becoming)
• "What does not destroy me makes me stronger." (Friedrich Nietzsche)
• "Do not confuse my bad days as a sign of weakness. Those are the days I am actually fighting my hardest." (Unknown)
• "Experience gives us the advantage of knowing that we can survive the exposure and uncertainty, and that it's worth the risk." (Brene Brown - Daring Greatly)
• "You can take everything I have / You can take everything I am / Like I'm made of glass, like I'm made of paper / Go on and try to tear me down / I will keep rising from the ground / Like a skyscraper" (Demi Lovato - Skyscraper)

In the future, you will cherish the memories of this experience, and draw on them for comfort and strength.

• "Give it all or give it up / I won't settle for enough / It's the highs and it's the lows we remember" (Ocean Park Standoff - Good News)
• "There will be a sea of tears / But sooner or later the sea will dry up / And you'll learn to embrace the wet sand revealed." (Sanhita Baruah)
• "One day in retrospect, the years of struggle will strike you as the most beautiful." (Sigmund Freud)
• "Someday you're gonna look back on this moment of your life as such a sweet time of grieving. You'll see that you were in mourning and your heart was broken, but your life was changing." (Elizabeth Gilbert)

Your narrative is your own narrative, and it will follow its own timeline.

• "There is purpose in your season of waiting." (Megan Smalley)
• "Time is a force and we must allow it to do its work, must respect its power." (Miriam Toews - All My Puny Sorrows)
• "Anxiety happens when you think you have to figure out everything all at once. Breathe. You're strong. You got this. Take it day by day." (Karen Salmansohn)
• "If we walk far enough, we shall sometime come to someplace." (L. Frank Baum - The Wonderful Wizard of Oz)
• "Don't rush through the experiences and circumstances that have the most capacity to transform you." (Rob Bell)

Don't worry about what future bad things might happen.

• "Contemplating the task ahead would not make it easier." (J.K. Rowling - Harry Potter and the Deathly Hallows)
• "I don't think being frightened will help." (Madeline Miller - Circe)
• "Worry does not take away tomorrow's troubles. It takes away today's peace." (Randy Armstrong)
• "No good sittin' worryin' about it. What's comin' will come, an' we'll meet it when it does." (J.K. Rowling - Harry Potter and the Goblet of Fire)

Don't wallow in what would've-could've-should've been, either.

• "Nostalgia is a dangerous form of comparison." (Brene Brown - Daring Greatly)
• "You're holding on to what you never had" (Hailee Steinfeld - Let Go)
• "Don't fall in love with the way things were / It'll fuck up your mind" (Snow Patrol - Don't Give In)
• "Leave the past behind you. If you don't leave it there, it clutters everything up and you just keep tripping over it." (Laini Taylor - Muse of Nightmares)
• "May your past be the sound / Of your feet upon the ground / And carry on" (Fun. - Carry On)

Focus instead on the vast potential of your present and future - the things that are still changeable, the successes and joys you've yet to see. Allow yourself to be happy and optimistic. Allow yourself to hope and dream and want things.

• "Yesterday is not ours to recover, but tomorrow is ours to win or lose." (Lyndon B. Johnson)
• "It is as wrong to deny the possible as it is to deny the problem." (Dr. Dennis Saleebey)
• "We must have the stubbornness to accept our gladness in the ruthless furnace of this world." (Jack Gilbert)
• "You'll never find a rainbow if you're looking down." (Charlie Chaplin)
• "We are all in the gutter, but some of us are looking at the stars." (Oscar Wilde)
• "Happiness can be found, even in the darkest of times, if one only remembers to turn on the light." (J.K. Rowling - Harry Potter and the Prisoner of Azkaban)
• "The world unwraps itself to you, again and again as soon as you are ready to see it anew." (Gregory Maguire - Wicked)

Allow yourself to try again - to throw yourself back into the fray, to make new plans and follow through on them.

• "It does not do to dwell on dreams and forget to live." (J.K. Rowling - Harry Potter and the Sorcerer's Stone)
• "Life won't just happen to you. You have to happen to it." (Laini Taylor - Strange the Dreamer)
• "Hope is a combination of setting goals, having the tenacity and perseverance to pursue them, and believing in our own abilities." (Brene Brown - Daring Greatly)
• "Wishes don't just come true. They're only the target you paint around what you want. You still have to hit the bull's-eye yourself." (Laini Taylor - Muse of Nightmares)

Life doles out enough grief without you willfully adding more as a form of self-punishment. You don't have to wallow in it and invite it to prolong its stay in your heart.

• "I keep dragging around what's bringing me down / If I just let go, I'd be set free" (Linkin Park/Kiiara - Heavy)
• "All the broken hearts in the world still beat / Let's not make it harder than it has to be" (Ingrid Michaelson - Girls Chase Boys)
• "All my life had been murk and depths, but I was not a part of that dark water. I was a creature within it." (Madeline Miller - Circe)
• "I'd been stoking the most negative parts of myself, caught up in the notion that everything was unfair and then assiduously, like a Harvard-trained lawyer, collecting evidence to feed that hypothesis. I now tried out a new hypothesis: It was possible that I was more in charge of my happiness than I was allowing myself to be." (Michelle Obama - Becoming)
• "Our creativity grows like sidewalk weeds out of the cracks between our pathologies - not from the pathologies themselves... I refuse to seek out suffering in the name of artistic authenticity." (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)

Don't let hopelessness catch you in its spiral, telling you that where you are now is where you will remain forever. This is a self-fulling prophecy, a trap - and to believe such absolutes is a form of arrogance. You do not know what is to come.

• "Please keep in mind that whatever you're going through, this challenging time in your life is merely IN your life. It is not your whole life. So be sure to keep this slice of life in perspective and don't let it overwhelm you. Remember: nothing is everything. The part is not greater than the whole." (Karen Salmansohn)
• "Tone down the prophecies of doom and switch from panic mode to bewilderment. Panic is a form of hubris. It comes from the smug feeling that one knows exactly where the world is heading: down. Bewilderment is more humble and therefore more clear-sighted... Try telling yourself, 'Truth is, I just don't understand what's going on.'" (Yuval Noah Harari - 21 Lessons for the 21st Century)
• "Doubt kills more dreams than failure ever will." (Suzy Kassem)
• "Just because something isn't happening for you right now doesn't mean that it will never happen." (Unknown)
• "In this sad world of ours sorrow comes to all and it often comes with bitter agony. You may believe that you will never feel better. But this is not true. You are sure to be happy again." (Abraham Lincoln)

It is often easier to fall for that trap of depression than it is to remain hopeful - but just because something is easy does not mean it is the best course.

• "There will be a time when we must choose between what is easy and what is right." (J.K. Rowling - Harry Potter and the Goblet of Fire)
• "He had been broken and reassembled as a shell, only then to do the bravest thing of all: He had kept on living, though there are easier paths to take." (Laini Taylor - Strange the Dreamer)
• "Dying is easy - living is harder" (Hamilton Soundtrack - Right Hand Man)
• "We must try not to sink beneath our anguish, but battle on." (J.K. Rowling - Harry Potter and the Half-Blood Prince)
• "Don't squander joy. We can't prepare for tragedy and loss. When we turn every opportunity to feel joy into a test drive for despair, we actually diminish our resilience. Every time we allow ourselves to lean into joy and give in to those moments, we build resilience and we cultivate hope." (Brene Brown - Daring Greatly)
• "Healing takes courage, and we all have courage, even if we have to dig a little to find it." (Tori Amos)

Faith is fuel, keeping you moving through long stretches of desert. Belief in the future, in a light you cannot see, is not foolishness, but bravery.

• "You don't have to see the whole staircase. Just take the first step." (Martin Luther King, Jr.)
• "You need a leap of faith to leave your old life behind. True metamorphosis doesn't come with flowcharts." (David Mitchell - Bone Clocks)
• "That's what faith is, isn't it? Following the music when we don't hear it." (Francisco X. Stork - Marcelo in the Real World)

Believe in yourself. Forgive yourself. Be kind to yourself.

• "Never apologize, never explain it away, never be ashamed of it. You did your best with what you knew, and you worked with what you had, in the time that you were given." (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)
• "Cultivate the courage to be imperfect and self-compassionate. Perfectionism is not the path that leads us to our gifts and to our sense of purpose; it is a hazardous detour... Our worthiness, that core belief that we are enough, comes only when we own our stories (even the messy ones)." (Brene Brown - Daring Greatly)
• "Even when it's not pretty or perfect. Even when it's more real than you want it to be. Your story is what you have, what you will always have. It is something to own." (Michelle Obama - Becoming)
• "We have to be willing to give ourselves a break and appreciate the beauty of our cracks and imperfections. To be kinder and gentler with ourselves and each other. To talk to ourselves the same way we'd talk to someone we care about." (Brene Brown - Daring Greatly)
• "You, yourself, as much as anybody in the entire universe, deserve your love and affection." (Buddha)

There are things that are going to be outside your control. Understanding that is not an admission of failure, but an important step toward acceptance.

• "Control is a drug, and we are all hooked, whether or not we truly believe that we can master the future with our words and attitudes. The entire motivational-speaking industry rests on the assumption that you can have what you want, you can be what you want... [and that] there is a hidden logic to this seeming chaos... [But] nothing human or divine will map out this life, this life that has been more painful than I could have imagined. More beautiful than I could have imagined." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)
• "Someday it might make sense to you - why you needed to go through this botched-up mess in order to land in a better place. Or maybe it will never make sense. So be it. Move on anyway." (Elizabeth Gilbert - Big Magic: Creative Living Beyond Fear)
• "'It is not fair' and 'It cannot be' are two different things." (Madeline Miller - Circe)
• "Fairness is one of the most compelling claims of the American Dream, a vision of success propelled by hard work, determination, and maybe the occasional pair of bootstraps... In a world of fair, nothing clung to can ever slip away... Give up that little piece of the American Dream that says 'You are limitless'. Everything is not possible." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)

But just because some things are uncontrollable does not mean everything is. Control what you can. Even when you are swimming in uncertainty, there is always something you can do. You can try to enjoy today.

• "We are never so wise as when we live in this moment." (Paul Kalanithi - When Breath Becomes Air)
• "Do not save this for tomorrow / Embrace the past and you can live for now / This is the new year / A new beginning" (A Great Big World - This is the New Year)
• "There's only now / There's only here/ Give in to love / Or live in fear / No other path / No other way / No day but today" (Rent Soundtrack - Another Day)

Be grateful for where you are right now. If your lungs are still breathing, your heart still beating, you have at least two things to marvel at.

• "A rainy day is better than no day." (Rachel Simon - The Story of Beautiful Girl)
• "Even if I'm dying, until I actually die, I am still living." (Paul Kalanithi - When Breath Becomes Air)
• "Live unburdened. Live free. Live without forevers that don't always come... The water is rising and levees may break and it will sweep us all away. But until then, I am here." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)
• "Look around, look around at how lucky we are to be alive right now / Look at where you are / Look at where you started / The fact that you're alive is a miracle / Just stay alive, that would be enough" (Hamilton Soundtrack - That Would Be Enough)
• "Aging is a fucking privilege." (Kate Bowler - Everything Happens for a Reason: And Other Lies I've Loved)
• "It doesn't mean that it does not hurt. It doesn't mean that we are not frightened. Only that: we are here. This is what it means to swim in the tide, to walk the earth and feel it touch your feet. This is what it means to be alive." (Madeline Miller - Circe)

Remember: if the bad and good are permanently tied up in each other, that means good times are also inevitable. Good times are coming. You will get through this. This too shall pass.

• "If life didn't change, it wouldn't be life, it'd be a photograph." (David Mitchell - Bone Clocks)
• "Even the darkest night will end and the sun will rise." (Victor Hugo)
• "It's been a long cold lonely winter / It feels like years since it's been here... Here comes the sun / Here comes the sun, and I say / It's alright" (The Beatles - Here Comes the Sun)
• "All will be well / You can ask me how but only time will tell" (Gabe Dixon Band - All Will Be Well)
• "This feeling will pass. This workload will pass. These people will pass. This moment will pass. This fatigue will pass." (Lin-Manuel Miranda - Gmorning Gnight)
• "It's funny how some distance makes everything seem small / And the fears that once controlled me can't get to me at all" (Frozen Soundtrack - Let it Go)
• "Pain will come with time, but time will heal the pain." (Anthony Liccione)

Letting go of the comfort of grieving can be difficult. But you are capable of accomplishing this final hurdle in moving on. Just because something is gone does not mean it will be forgotten.

• "I wanna let go but there's comfort in the panic" (Linkin Park/Kiiara - Heavy)
• "The brain is built to forget things as we continue to live; memories are meant to fade and disintegrate and sharp edges become blunt; the pain of letting go of grief is just as painful or even more painful than the grief itself. It means goodbye." (Miriam Toews - All My Puny Sorrows)
• "This is what I know about loss: It doesn't get better. You just get (somewhat) used to it." (Jennifer Niven - Holding Up the Universe)
• "You think the dead we loved ever truly leave us? You think that we don't recall them more clearly in times of great trouble?" (J.K. Rowling - Harry Potter and the Prisoner of Azkaban)
• "Nothing's really left or loss without a trace / Nothing's gone forever - only out of place... Maybe all you're missing lives inside of you" (Mary Poppins Returns - Where Lost Things Go)

I love you and I believe in you.

Love, Andrea

Turning 30

30 is a big one - simply because our society likes base ten and thinks of any age or anniversary ending in zero as "a big one," and not actually because anything TRULY changes. Still, I'm not above such sentimentality, so I've taken turning 30 as an excuse to reflect back on my 20s and make plans for my next decade.

Turns out when you look at an entire decade, it's easy to feel accomplished. You can do a LOT in ten years! My 20s were no exception; they were certainly my most accomplished decade yet, if not likely my most accomplished decade I'll ever have (depending on how you define such things). I experienced many milestones that are universally considered significant in my 20s - as many do - but I also had some great experiences that were meaningful on a more personal level, too. 

My 20s included*:

*a non-exhaustive list

SCHOOL & PROFESSIONAL ADVENTURES

• Finishing my thesis and earning the thesis award
• Graduating with highest honors from EMU and earning a double-concentration BFA in Graphic Design and Watercolor, with a minor in Art History
• Working at EMU Campus Life
• Working at Charming Charlie
• Working as a substitute teacher
• Working as a graphic designer at Temple Israel
• Working as a freelance custom invitation designer for several weddings and bar/bat mitzvahs
• Being flown to Denver to be interviewed for L'Art Erotique, a Quebec art TV show
• Selling my artwork on Etsy and at Paint Creek Center for the Arts
• Creating artwork commissions for family, friends, and strangers
• Showing work at EMU art galleries, the Detroit Scarab Club, the Canton Village Theater, the Carr Center, and the Grosse Pointe War Memorial

TRAVEL ADVENTURES

• Going on a Mediterranean cruise with my soon-to-be-husband's family
• Honeymooning on the Greek islands of Santorini and Mykonos
• Taking a road trip out west with friends
• Nearly annual trips to Virginia Beach
• Visiting Universal Resort's Harry Potter World in Florida
• Spending eight days visiting museums and seeing plays in New York City

PERSONAL ADVENTURES

• Getting engaged
• Planning a wedding and getting married
• Buying a house and moving to Rochester Hills
• Completing lots of home improvement projects, including new bathrooms, patio, roof, siding, insulation, and windows
• Adopting a puppy
• Prioritizing self-care and self-esteem building
• Being diagnosed with diabetes and starting insulin
• Getting a tattoo
• Getting pregnant

Of course, there were some not-so-great experiences with the great ones. Some of the items on the list above were challenging times (or led to challenging times) - but I wanted to include those moments as well, because they have helped shape me into the 30-year-old I am. Of course I wish I was never diagnosed with diabetes, or that my first pregnancy hadn't ended in miscarriage - but I can't change those things; I can only change how I feel about them. As for things I DID have some control over, even at the time - things like jobs I worked or decisions I made or paths I pursued: I don't tend to feel regret about my past; I don't tend to think of anything as a "mistake." Instead I romanticize challenges as Things I've Survived, focusing on what I gained or learned from them. If I had my 20s to do over again, I'd probably do it all over again in a very similar, if not identical, way. Sure, there are some things I wish I'd figured out earlier - like how to prioritize and take care of myself more - but I'm getting there. It's all part of my journey, which, being MY journey, I get to do at my own pace.

I started trying to make a list of things I'd like to accomplish in my 30s, but it's hard to think that far into the future. There are some obvious choices for things to put on the list - things I want immediately or soon, and hope to accomplish in the next few years. But then what goals should I make for the REST of my 30s, after I complete those? It's hard to imagine what my goals will be for the years I'm 37, 38, 39... 

But here are my immediate goals and priorities, the things I'm already working towards, thinking about, planning, setting the stage for, etc.:

• Having artwork shown in more galleries/exhibitions
• Getting a novel published
• Getting pregnant again; having children
• Doing "short vacations" around North America (e.g. returning to Stratford, Ontario for more theater experiences; finally seeing the Tulip Festival in Holland, Michigan; taking long weekend trips to interesting cities around the U.S. I haven't been to yet)
• Doing more home improvements (e.g. adding built-ins to the living room and/or dining room; renovating the kitchen)

I'm sure I will add so much more to the list as my 30s wear on and I come up with more ideas, more things to pursue.

A lot of people fear turning 30 (or 40, or 50, or 60, or whatever they've decided is their arbitrary designation of Real Adulthood or Old Age), but I'm not one of those people. I'm not immune to the existential anxieties that come from starting a new decade; I just try to find other things to focus on instead. I find things to look forward to, things to dream about, goals to write down. And I also like to send presents into the future to myself - things that can help me get through potentially challenging times. When I was 23, I wrote myself a letter to open on my 30th birthday. I wrote another such letter when I was 26. I sealed these letters in envelopes and put them in my desk drawer; I see them every time I open that drawer to grab a stamp or address label. By now, I've totally forgotten what I wrote, and I'm really excited to read them all again. I am so anxious to see what stupid and wise things I wrote to myself, what questions I wanted to know, and what I was hoping to accomplish by 30 or feel at 30. It will be like rediscovering a lost corner of my mind, it will deepen and bolster my sense of self, and it will contribute to the narrative of my life I am continually writing and rewriting. As a result of those time-traveling letters, then, my primary emotion associated with turning 30 is not anxiety about growing older, but excited anticipation.

So naturally I'm doing it for when I turn 40 as well. Just today I wrote a letter and sealed it in an envelope: "Do not open until your 40th birthday - December 20, 2028!"