Tuesday, March 27, 2012

Why Dealing with Secondary Infertility and Being a Senior Citizen are Similar

I had a to laugh at myself this morning when I thought of this post idea. And the more I thought about it, I realized, the two groups of people share more in common than one might realize.

  1. We talk about our doctors, our tests, our blood work and our PROCEDURES.
  2. We bemoan the cost of prescriptions and many of us participate in pharmacy rebate programs.
  3. Early Bird Special. We all go out to dinner at 5:30. (The T Family went out to dinner on Sunday night at 5:30 sharp and it was us and the Canasta/Shuffle Board set.)
  4. We know better than to cancel a doctor's appointment and make all plans around those sacred times.
  5. We see multiple treatment providers and specialists.
  6. We use pill boxes. 
  7. We are unsatisfied with our health care coverage and the role it plays in determining our treatment and where we can go.
So there I was, brushing my teeth and I remembered I had to start my Estrace today. I reached up and grabbed my Day-of-the-week Pill Box. And sure enough, in the Tu box there was a new, little, blue pill.  I bought the pill boxes last weekend. It's hard to keep up with 7 different pills taken at 2 different times in the day!  Mr. T thinks it humorous that I had to buy a pill box. But the reality is, some mornings I second guess whether or not I put deodorant on, let alone remember if I took the CORRECT FOUR pills.  

Wednesday, March 21, 2012

IVF Orientation, Take 2

This morning was our IVF orientation and injectibles class. I'm going to summarize my two experiences with this class at both clinics.

Dr. M's office:
Nurses had a "We are doing you a favor in teaching you how to shoot yourself up."
We learned about the IVF cycle in an empty procedure room with Mr. T sitting in a blood draw chair.
We then moved into another ultrasound room to learn about our injections and dosing. The syringes and supplies were laid out on the exam table.
The nurse carefully instructed us on how to use the medication that comes in PEN form.
This was only a problem, because that was not the medication I was using.
I was handed a list of medications and told to pick a pharmacy to fill them at.
I was so unsure of what I actually needed and when, I burst into tears when I finally made it to the specialty pharmacy. 
As we wrapped up, the nurse advised us to look on youtube for videos if we needed additional assistance.

Dr. Neutral's office
The nurses walked through every.single.step of what was going to happen. Even though I'd been through this twice before, it was so nice to hear it again.
We sat in a conference room and all of the samples were in front of us. 
The nurse explained that she'd call in 10 days worth of my medications at a time. 
She then agreed to call in only 5 days worth as I'm a little gun shy of ordering the whole kit and kaboodle at once.
She explained what each medication was for, when I'd take it and at what dose. (Estrace, Ganrielex, Ovidel, Bravelle, Menopur, Medrol and doxycyline)
We were then told that we would get a reminder call the day before I'm supposed to start the Estrace.
I learned that I'm going to save some money by skipping the injectible Progesterone-in-oil and can use the gel!!! (Since we are out of pocket for all injectibles, I'm excited to save a little money)

And then......

The Calendar.  The Calendar.

You know the one that lays everything out. What day to start stims. When a tentative Egg Retrieval is. When the tentative Embryo Transfer might be. And the funniest thing happened. I started to have a Pavlovian Response to the conversation. Instead of being excited about dates, I started feeling my hands shake and my heart beat a little faster. I was feeling panicked about the thought of not making it to Egg Retrieval. I tried my best to get it under control and I'm not really sure it was obvious to anyone else. But it was there. And I am just hoping against all odds that I can prove DREAD and FEAR wrong.  

I'm ready to share too many dates yet, but it would be fair to say that by the first week in May, I will know whether this worked or not. 

So, game on. IVF attempt 3 will formally begin next week with the start of Estrace. In the meantime, Acupuncture tomorrow. Spinning class on Friday and Lunch bunch with Toddler T and pals tomorrow.

Monday, March 19, 2012

Mock Embryo Transfer and Diggin' at the Job Site

A crazy pairing of words. But such is the day of an individual dealing with secondary infertility.  I was lucky enough to have my mom come and stay with Toddler T while I left to have blood work, a hysteroscopy and the mock embryo transfer. 

Going through this process would simply not happen without the support of our families. I am at the doctor's office at least 1 time a week most times twice a week and have been for the past 6 months. This is stressful and challenging and to walk out my door and know that Toddler T is having a blast puts my mind at ease and keeps my mom-guilt at bay.

Now on to the appointment. Let me again say, I love this new group. I haven't jumped on board with doctor worship, but I truly appreciate a professional and caring environment. But, truth be told. I have one complaint. I am beginning to look like a junkie. The nurses cannot seem to draw my blood in one attempt. I am officially a two stick girl. The second stick usually involves some fishing around with the needle in my arm. I have begun to make a joke about it with each appointment and hope my veins will get a break soon.

I was surprised that the mock embryo transfer was so official. I was sent over to the surgical side of the office and was handed a gown, hat and booties. I walked back to the procedure room and could not have been any happier that both the hysteroscopy and mock embryo transfer took no more than 10 minutes. Without divulging too much information, they are both mildly uncomfortable when you have just consumed 40+ ounces of water.

The good news, yes GOOD NEWS.  Is that both went well. No issues. No concern that the actual transfer might be problematic. Now, let's just get there this time!

I'm back to the office on Wednesday with Mr. T to sit through our injection class as well as IVF orientation (I think we will be at the top of the class as this isn't our first time to the dance.)

I drove home, windows down, non-kiddo music blasting and got to spend some quality time with my mom while Toddler T napped. Precisely two hours after he went to bed, his little eyes popped open and it was ON.  "I want to go outside and dig. Ride my bike. Look for the birds. Play, Mommy. Is it time to wake up now?" 

So, that is what we did. All of it. Toddler T can have a max 2 minute attention span when playing inside. But, put him outside with a shovel and his diggers and a pile of dirt. He doesn't move. He has created his own jobsite in our backyard.  He loves it. I love it.  He amazed me while he was riding his bike. I had no idea he could go that fast AND steer. He is truly, all boy and I am thrilled that he can run off some of that boy-energy outside in the fresh air.

Sunday, March 18, 2012

Hope, My Frenemy

There has been a thread here between my a lot of my posts. I seem to vacillate between clinging to and walking away from hope. Today would be a day where I'm inviting Hope back to the party.

Last Wednesday was my follow up consult with Dr. Neutral to discuss our next steps. If you couldn't tell, I was feeling completely defeated following the discovery that my lone tube was 100% blocked. I just had this sick mantra going through my head.. Blocked Tube. High FSH. No Options. Blocked Tube. High FSH. No Options. I prepared for the consult. I read everything I could about High FSH and IVF protocols. I had my list of questions. I was ready.

Walking into Dr. Neutral's office puts me at ease. He stands up. Shakes my hand and Mr. T's hand and talks with us. He asks how we are holding up, laughs when I make my slightly inappropriate jokes and welcomes my questions. This is such a difference from Dr. M. as, I have this feeling that I am a part of the equation with an opinion that matters. We also got 45 minutes of his time compared to a 5 minute call from Dr. M.

This is when I sent Hope an evite to this next IVF cycle.  We have a plan and it looks completely different from the last two IVF attempts.  I'm going to start supplements (DHEA, melatonin and an antioxidant blend) and Metformin (believed to help improve egg quality). He seemed pleased with my weight loss (Ten pounds, thank.you.very.much) and was so supportive of continuing with acupuncture. He's also comfortable with me adding wheat grass to bring down my FSH.

(Hope, are you coming back? I'm sorry I was angry with you last week. Please come back. Doesn't this sound different than anything else we heard?)

After all this discussion of complimentary therapy I was very anxious to get down to how this IVF cycle would be different from the previous two. What I'll be doing is avoiding anything that could suppress my fragile reproductive system. No birth control to start with. NO Lupron. NONE. This was music to my ears, because I hold Lupron responsible for the debacle that became my failed cycles. I actually suggested this to Dr. M and he just responded. "No." I then asked Dr. Neutral about using an estrogen priming therapy leading up to my cycle as it seems that I prematurely ovulated with the most recent failed attempt. Using an estrogen therapy has been shown to stop premature ovulation and we both agreed it was worth a shot. This approach is referred to as an Estrogen Priming Protocol and targeted for poor responders. 

Yes, this was good news. There was no guarantees given and we even talked about the next steps should this cycle not work. With that said, I truly believe I am about to give this cycle everything I've got.  Dr. Neutral and I are coming at this from every way possible. Mind, Body and Spirit.  And it feels different. I feel a sense of control and I feel well cared for.

So, Hope... sometimes I think you let me down and I've been tempted to never allow you back into my life. But let's give this one more shot, OK?

Tuesday, March 13, 2012

70 Degrees and Sunny

Today we spent two hours at the park. The sun was shining down on Toddler T and I. We dug holes in the sandbox and built castles. He swung on the swings and surprised me at how strong he's gotten since the summer. Toddler T needed the fresh air and I needed to feel the sunshine on my face. I know it benefited us tremendously even if in completely different ways. 

My son is good for my soul. He talks from the minute his little eyes open in the morning and I'm pretty sure I ask 8,700 different "Why" questions before lunch. Lately he has been having flail on the floor meltdowns over the wrong straw, shirt, snack or any other difference of opinion. We also put the breaks on potty training. It was becoming a power struggle. So, I handed him a diaper and told him to tell me when he wanted to try sitting on the toilet again. There are days when I am counting down the minutes until he takes a nap and I've often told Mr. T that I lose the ability to speak coherent sentences by 5pm.  But in the midst of him trying to figure out his independence, he will remind me that he is still my sweet baby.

Today we were leaving the park. I was buckling Toddler T into his car seat and I was about to shut the door. And I heard this little, tiny voice. "Mama, I need to give you a hug and a kiss, too."  It should be known that I have been Mom or Mommy for almost 2 years. In the past week, my little/big boy has started to go back to Mama. I've never corrected him and probably never will. 

Nothing went away, nothing magically changed. But today was 70 degrees and sunny and I had the best and most wonderfully ordinary day.

Monday, March 12, 2012

Working through the hurt...

Today, I needed the stars to align. Today, I prayed with every ounce of my soul for one small piece of good news. I pleaded. I promised to be a better person, a better mother a better everything. I begged for something positive to help me maintain my strength to go forward. 

I had my early morning appointment for blood work and an ultrasound. The ultrasound showed one follicle that was of decent size. Dr. Neutral even mentioned the possibility of an IUI on Thursday. I started crying and said "IF. IF my HSG is clear and IF the stars and the moon align. and IF I'm lucky."  I was so struck by the fact that he stopped and talked about what a difficult journey we'd been on and how there are a lot of IF's and how normal it is for me to be overwhelmed (read: crazy).  For a few minutes, I felt peace. I left and was looking forward to my HSG.

The test was done with another doctor from the practice. I laid in my gown on a CT scan table and stared at the ceiling. I realized then that I had forgotten to take my advil before the test. I hoped it would be quick. I've heard they are. I started to feel pressure. A Lot. I asked if it was normal and before I could hear the answer, the pressure was full blown pain. It felt exactly like the pressure you would imagine in trying to unclog a pipe when the sludge just wont move. Why did it feel that way?  Because that's exactly what was happening. My tube had completely scarred over from the previous ectopic removal. Did you know that 80% of woman who have surgery to remove an ectopic pregnancy go on to heal with minimal scarring? Once again, I'm in the minority. 

Again, I started crying. Because it was validation of the fears I've been having all along. One more piece of evidence to show me that my body has failed me. And I cried, unashamed, on that CT scan table. Tears fell down my face as I numbly walked through the halls of a hospital I had never been to in an attempt try and find my way out. I sent 3 word text messages to Mr. T and my mom. TUBE IS BLOCKED. I got in my car and drove home. I cried for the two ectopic pregnancies and all the time this treatment has taken away from my family. I cried for the fear that I will not go on to have more children. I cried for myself, because now this feels too much. And then I said, out loud, "Why did You do this to me?" I wanted to take it back as soon as it came out. Then I realized that I felt better. 

I believe in religion and prayer. I believe in living a decent life and probably should go to church more. But, 12 months later, my faith is being challenged. I am struggling to remain optimistic and to believe that the T family can beat the odds. That with a climbing FSH level and 2 cancelled IVF cycles in my chart, I will once again be blessed with a baby.  

In two days we will meet again with Dr. Neutral. If I had to guess, I'd say we have the following options. Possible surgery to correct the damaged tube. Proceed to IVF with a different protocol. Proceed to IVF with egg donation. Contact an adoption agency.  I am drawing up a list of questions and have called my acupuncturist to help me with an herbal plan to reduce my FSH. I am spent. I am sad. But in my heart, I know I'm not done.

Sunday, March 11, 2012

Clomid Challenge Test and Resolving to find support

The word challenge sounds fun and rewarding. Here are two examples:

I Challenge you to a race.

That was a challenging workout, but I feel so much better now that its over.

Now apply the word challenge to having a baby, not so fun (but hopefully rewarding!!)

I picked up my prescription for Clomid last week to start the Clomid Challenge Test.  It sort of feels like a step backward, but remember, we are starting at the beginning with this doctor. The goal would be to see if my body produces more follicles while taking Clomid thus making an IUI a reasonable next step. Now, while the Clomid is running through my endocrine system and wrecking havoc on my emotions, I will prepare for phase two of the monitoring.

Tomorrow I'm scheduled for an HSG test. The purpose of this test is to run dye through my remaining tube to see if its clear and free of scar tissue. It its free and clear AND my body actually responds to the Clomid then maybe just maybe an IUI.

I'm getting the feeling that the stars will all need to align for this to go through.

Now, back to Clomid. It certainly is challenging. The doctor warned me of mood changes.  A better description may have been to not panic if I feel like I'm going to jump out of my own skin at any given moment.  I think these two little pill have done more emotional damage than the lupron, bravelle and menoupur combined. I have had no patience for the last 48 hours. None.  

I realized that trying to set up an iPhone with a mac when I'm a PC girl at heart was a big mistake. Yes, syncing my calendars this morning caused me some tears.  But once again, Mr. T to the rescue. He took Toddler  T outside all morning. They played soccer, explored the shed and had a picnic lunch in the backyard. I sorted laundry because it felt good to be successful at something. Why is Mr. T even better still? Because I went to the grocery and to a Resolve meeting and he fixed my phone and my computer while I was gone.  Why? Because that's what he does. 

Now, for my meeting.  I'm trying to branch out and find support. Friends and family are amazing and helpful in every way imaginable. But, talking with someone who knows what you mean when you talking about side effects, emotions, fears, treatments because she is doing or has done the same thing, has an important place in the infertility puzzle. So, I was excited to go and maybe talk with some girls who could help me with my first Clomid experience. But sadly, not the case. There was only one other person at the meeting and our issues were totally different.  She apologized and said that most of the time there is about 5 people there all dealing with primary fertility. This makes me nervous but perhaps I'll learn some tricks for dealing with medications and procedures. I'll try again next month and will remain optimistic for increasing my support.

The only thing I do now is wait for my 7:15 appointment tomorrow morning. Blood work and an ultrasound to track the progress with the addition of Clomid. It should be pretty straight forward except I have this AWFUL IN MY STOMACH feeling that I already failed the Clomid Challenge Test by starting  on the wrong day. I'm not sure where the breakdown occurred, BUT I thought I heard the nurse tell me to start the medication last Wednesday. So that's what it did. A day later I actually looked at my pill bottle and read that it should be taken cycle days 5-9.  Great, I started it on cycle day 4.  So, I am feeling like this is going to be a bust before it starts.

Is this the Clomid talking? Or am I really becoming unhinged? 

Saturday, March 10, 2012

Training Day

Does anyone remember that movie? The one with Denzel Washington and Ethan Hawke. 

Right, that movie was great.

My cycle day 3 bloodwork and ultrasound were not.

I met a new doctor (the new group rotates each patient through their 4 doctors). He was super nice and introduced me to the other nurse and the Resident. Resident would be conducting my ultrasound. Resident was very, very nervous.  Resident had trouble finding my right ovary much less getting an accurate count of my antral follicules. 

Six months ago, I would have welcomed a resident to practice her skills on me. I believe in education and I spent 2 years as an intern in the mental health field. How else can a doctor perfect their skills without having someone to perfect them on?  (Just want to make it clear that I am not anti-teaching/residents)

The problem is, my appointments are borderline grim. There is not a lot of smiling and there is never any mention of me actually getting pregnant. We just focus on whatever the task is at hand on that particular day. The task last week, was to locate any antral follicles in an effort to speculate what my follicle production might be for this month. I was nervous. A five minute ultrasound took about ten and it was not comfortable. I was also losing patience rapidly and just stared off into space counting down until it was over.

I was most appreciative when Resident stepped aside and let the doctor finish up.

My appointment was over, I was to start the clomid challenge test and schedule and HSG.

Busy week ahead.

Friday, March 9, 2012

"At least you are staying positive"

As many of you know, I have not have very many positive experiences during my doctors' appointments this year. I actually mentally prepare myself to feel emotionally pummeled with every OB/GYN and RE appointment I have been to and will go to. I had a 6 month dental appointment yesterday. I was slightly anxious. Last March, I was 7 weeks pregnant when I went. I thought it might be time for x-rays, so I asked Dental Hygienist if I needed them and subsequently told her I was expecting. My Dentist's office is unique in that the ENTIRE T family goes there and have been for 30+ years. So, I had to remind her that our news wasn't public and I was only sharing with her out of medical concern.  I also knew that my father in law had an appointment there the next week.  I didn't really think he should learn of his second grandchild's arrival in between spitting out Scope in the little sink and have a crow-bar like device shoved between his teeth (I hate the dentist, if you can't tell).  I also knew that based on HIPPA laws, my secret should be safe. 

Well fast forward to September, 6 months later. I go for my next check up. I am not pregnant nor am I showing off pictures of my premature but healthy baby.  I saw the quizzical look from Dental Hygienist and said, I am not pregnant, I had a miscarriage. I thought I could leave it at that. Then she asked if I had had any surgeries recently and well, she had me. "Yes.", I said. "One D&C two weeks ago, followed by laparoscopic surgery the following day to remove an ectopic pregnancy." She patted my arm and said good things were to come.

Here we are. It's March. I value dental health, so back I went. 

Yesterday started off great. I've been following a strict diet to cut out caffeine, white flour and sugar in an effort to both lose weight and rid my body of toxins.  I'm really at a point where I'll try anything to get pregnant. BUT- it has been working. I lost 7 pounds. SEVEN!!!! Yesterday morning, I asked Mr. T if I looked like I lost weight. He agreed and I finished getting ready with an extra dose of self esteem.

I checked in for my appointment and Dental Hygienist came around the corner. She looked directly at my stomach and exclaimed for the entire office to hear "CONGRATULATIONS!!!!!!!!!!!!" 

Yes, please re-read that again and let it sink in.

I looked at her with 97 different emotions running through my blood and my soul. And said, "Me. oh no. Furthest thing from it." I couldn't believe I was able to keep walking. I was pretty sure my fragile emotional being had just been fired upon by a firing squad. But I did, and the initial shock of her ignorance gave way to fiery anger.  

Let's review why this is wretched on two levels. 

  1. I thought I looked slim and not like someone who is pregnant. So, thanks for calling me chudgy (chubby and pudgy)
  2. I am having a really, really hard time getting pregnant and my medical chart just keep getting more grim (more on that in another post). So, thanks for reminding me that I'm not pregnant.
I was there and needed my teeth cleaned so back I went into the chair, laid back put the paper towel on a chain thing around my neck and let this Peach of a Dental Assistant work in my mouth. I tried to lay back and think of anything positive and it struck me that once again I was blindsided. I'm ready for bad news at the RE. Nurse call backs are really never positive. But the DENTIST. I really thought I was in safe territory. 

When Dental Hygienist was able to speak again, she again said, that "Good things would come my way." I muttered, "Yes, one day we will have more children. That's the plan at least." She had no idea how fake my answer felt. That even saying those words made me feel like a fraud. So, it was laughable when she responded. "At least you are staying positive."

If you only knew Dental Hygienist. If you only knew.

And just as a Public Service Announcement:

NEVER EVER say congratulations to a woman of or around childbearing age unless you were there to cut the umbilical cord or instructing her to pant like a dog

Trampolines and Toddlers

I must admit the next few posts are going to be out of order. The T household is currently a work in progress as Mr. Earl (our super nice, always takes time to indulge Toddler T's request, reliable painter) is currently scraping down walls and repainting.

Tangible needs folks. Tangible needs. Can't have a baby. Can't fix that. Have cracked, chipping paint. Can fix that. New paint = happier Mrs. T.  Tangible results.

As a result, we have been living like gypsies with nap times at Nannie's and sleepover parties at Mana's and I have not had much time to update.

So, back to trampolines and toddlers.

Last Friday, Nannie (Mr. T's mom) and I took Toddler T and I to a swing set store that offers a free play in the morning. Kids get to play, mom's get to oooh and ahhh over swing sets, mom's probably convince dad's that the swing sets are necessary because


Swing sets get sold and kids get to run around like maniacs. Everyone wins.

Except Toddler T.

I could see him eyeing up the trampolines. I brought him over and had the thought that having 2 kids of different ages, with different parent's may not be the best in terms of a trampoline experience. It seems as though the management felt the same as the asked for 1 child to bounce at a time, per the signs on EVERY trampoline. So, I said, "Toddler T, we have to wait our turn. One at a time. We'll come back." This was acceptable and off we went to the swing sets with forts to have a pretend spaghetti dinner.

 A little while later, I noticed one of the swing sets was vacant. I offered Toddler T a turn and he was PUMPED. Off came the shoes, in through the net and he was thrilled. I took a little while for him to get his trampoline groove, but when he did... it was pretty funny to watch.

And then Older Boy showed up. Older Boy was not with a parent (right next to him) and looked no older than 5. Older Boy climbed aboard, brought a basketball and started jumping and shooting hoops. I found myself with a clear mom-dilemma. Be THAT mom (the crazy one) and explain to this little boy that it was one at a time and we'd be done in a jiffy. Or I could just keep an eye on them and hope for the best. And then Older Boy jumped while Toddler T was coming down and as he crashed down I saw his neck whip back and forth. And then I heard THE cry. Not the whine, it was my turn or the fake cry because I want that Lightening McQueen band aid. But THE cry. The MOMMY, I'M NOT KIDDING THIS HURT SO MUCH I'M SCARED CRY.

I worked my way through the safety net and retrieved a hysterical Toddler T. While climbing off the ladder trying to assess him, I noticed Older Boy's Mom. She casually sauntered over and looked at her son, Toddler T then me and looked away.

Now, let me make something super-clear. Kids get hurt. I'm aware of that. Scrapped knees and bruises are a part of growing up. Toddler T has been bitten in daycare and has shoved kids out of his way when he wanted to play on his workbench ALONE. My point is, he's been on both sides of the coin. BUT, when he hits or shoves or just acts like an entitled little monster and I want to cringe and hide. I'M the one that's supposed to keep it together figure out what happened, have him apologize and move on.

So, it's not that he got hurt it's that I was surprised that Older Boy's Mom didn't even through out "Is he OK?" No need for an apology, just a simple question.

In the end, we ended up with a quick trip to the pediatrician's office as it seemed as though he didn't want to put any weight on his left leg. I shared my dilemma with the pediatrician about not wanting to be THAT mom and having a small child run and tell his mom that a strange lady yelled at him.  Even Dr. C had been there too. No one wants to be the pain in the ass mom.  For the record, Toddler T is fine. I'm still not sure how comfortable I'd be with being THAT mom.