blackmoondog

Friday I have to go in for a pelvic ultrasound to check for ovarian cysts. Since I've heard just how wonderful the experience is, I decided to do a little test run tonight to measure the capacity of my bladder. Here's how it went:

5:30 pm - First 8oz glass of water. No biggie. I haven't really had much to drink this afternoon anyway.

5:45pm - 16oz down so far. Still not feelin' anything. Tho I'm gonna make sure the cat doesn't crawl into my lap and dance on my bladder.

6:15pm - 24oz down. Half way there. Still feeling a little bloated from lunch. Stomach starting to feel a bit sloshy. About 15 minutes ago I realized that my "8oz every 15 minutes" schedule is gonna have me drink an extra 16oz. How the hell did I make it through 3 semesters of calculus???

6:30pm - First hour has elapsed. Not gonna make the same mistake as King Theoden of Rohan at Helm's Deep and wonder if it really is this easy. Time to complicate things by heading to the neighboring friends' house for dinner.

6:50pm - 32oz down the hatch. Still feeling no real discomfort. Keep wondering when I'm gonna start doing the peepee dance.

7:03pm - Crap! I have to drink another cup of water in the next 7 minutes.

7:30pm - At 40oz I kinda lost track of whether it had been 5 cups or 6. Eating a burrito may have not been helpful during this experiment. I start feeling some pressure and normally, I'd go to the bathroom around now. Instead, we start the clock to see how long I can hold it.

7:50pm - Since I lost count, I drank one more glass of water. Good thing too, that only got me to the required 48oz.

8:03pm - Why is time moving so damned slowly???

8:11pm - Come on. It has to be 8:30 by now. My goal was to make it an hour after the end of the 2 hour drinking period to give me time for the ride to the office, sitting in the waiting room, and going through the acutal process.

8:30pm - Finally! Looking back, it really wasn't that bad. Which makes me question whether or not I need to add more water. I've had a harder time when I forget to pee before leaving work and then go and run a bunch of errands. I should be able to handle this. But maybe I'll try this again tomorrow at work just to see.

I am never going to follow the lab's instructions for preparing for a pelvic ultrasound again. The practice runs did not prepare me for waiting in agony while a handful of other people got called back to do their diagnostic stuff.

I drank the requisite 48oz of water within the 2 hour period before my appointment. That was mistake #1. Mistake #2 was getting to the lab 30 minutes early. I spent most of this time out in front of the building pacing and trying to call on any zen-like powers I could possibly have stowed anywhere in my body or mind. When it was down to 5 minutes before my appointment time, I went back inside and did the pee pee dance in the corner, whimpering each time someone else was called back. For those taking notes, Mistake #3 is making a 1pm appointment. The techs come back from lunch at 1pm, which means that if they get delayed for any reason, you and your aching kidneys get to wait. And wait. This was probably the closest I'll ever get to living in dog time. Every second felt like *hours*. Finally, it was my turn! The tech lady was very nice. She asked if I was miserable. I'm not sure that was a strong enough term. I have had 4 crowns put on my teeth. This experience blew them all away. Anyway, the ultrasound itself was pretty easy and I peed for longer and with more force than ever in my life.

It turns out that I don't have any cysts and that I don't have blood chemistry that indicates PCOS (polycystic ovary syndrome), but I am in some pre-PCOS state. So basically, I get to eat like a diabetic to see if I can back myself out of the pre-PCOS. I'll also be taking progesterone to try to knock my body back to a "normal" cycle. We'll see how that goes. It means another ultrasound next month (thankfully, with very little water drinking -- she said that 16oz should be plenty) to see if any follicles are ready to burst. If so, then we measure my progesterone levels about a week later to see if the kickstart worked.

In other news, Mark doesn't have any indication of fertility problems. Instead of a little gold star, he gets to turn the hot tub back on. I'm simultaneously relieved and depressed about his test results. It'll be a hell of a lot easier to get things figured out but I also got smacked in the head with the feelings of my body being "broken". I'm kinda getting past that and just being thankful that this isn't more complicated and will likely be motivation do use exercise and nutrition to drop more of the extra weight I'm hauling around. This week has been a good start, with two guest visits to the gym (Thanks, Trisha!), 2 bike rides for the knuckleheads, and probably a lot less sugar than average (despite the proliferation of birthday cake).

I'm theoretically coming to the end of my 3rd cycle taking progesterone supplements. I'll start the pills again on Thursday. The first two "cycles" were completely anovulatory. I didn't bother to get the ultrasound because I never got any indication whatsoever that ovulation was imminent.

This "cycle" has been very odd. For the first 10 or so days, my basal temps were disturbingly low (96.2F-97.2F). Then there were 4 days of normal-ish temps (97.4F-97.6F). For the past 2 days, I've woken up with hot flashes and my temp has been 97.9F. I've had some ferning show up on the spit-o-meter (OvuScope just doesn't have the same ring to it ;) but it hasn't been consistent *at all*. I ended up not getting the ultrasound again because I would have probably needed to do it either while we were out of town, or on a weekend when the lab was closed. Oh well. Maybe next time.

I think I'm gonna schedule an appointment with the OB/GYN soonish since I haven't actually followed up with her since my nurse practioner left the practice. I'm gonna hold off making an appointment with the endocrinologist about my thyroid until my temps stop being so wacky.

If my boobs start hurting, I'm gonna get suspicious (tho I'll likely think that it is psychosomatic). We've done just about all the random crap people tell you to do when you're not getting pregnant. We've gone on vacation. Stopped Trying (tm). Just spent $$$ for me to join the gym. Not that any of that was intended to increase fertility, well, except joining the gym since any weight I can get rid of would likely help.

I've been trying to eat more fruits and veggies and less flour/sugar. When we're in town, I go to a 90 minute yoga class on Saturdays. Today I worked in the garden for 2 hours, prepping a place to plant my tomatoes. Tomorrow I'm gonna go to the gym to peek in on a couple of classes and probably use the treadmill (I wonder if I can knit and not kill myself on it...) My dog would love me more if I started taking her out for walks in the morning again. Hopefully this stuff will help counteract the wonky hormones and steer them back to their normal balance. Alas, only time will tell.

For those reading via LJ, you can get the backstory on this here:
http://www.blackmoondog.com/archives/hysteria/000007.html

and here:
http://www.blackmoondog.com/archives/hysteria/000009.html

Since I'm lazy and decided to just not try to move my old posts to LJ.

OK, fine, not really clones, per se...

After taking progesterone near the end of my last three cycles, something seems to be happening. Last cycle we weren't actually gonna be around to schedule an ultrasound to check for follicle development (and the prior 2 psuedocycles didn't really give me a reason to think that I'd need to.) Things look to be "normal" so far so I made an appointment to do the ultrasound on Monday (cycle day 16).

If there are follicles that look ready to pop or if it appears one already has, I go to the lab a week later and have blood drawn to check my progesterone level. If no follicles are preparing, we go back to the doctor and see what paths are available. I'm hoping to avoid Clomid if at all possible. The emotional side effects can be horrid and I'm really not interested in quintuplets. Maybe we can look into finding someone with a really mellow baby, and cloning it! :)

Thankfully, this time the ultrasound is primarily gonna be the wand so I don't have to drink 10 gallons of water ahead of time and make my kidneys threaten to leave me in a bathtub full of ice and take off to Tahiti.

When we last left our heroine, she was getting ready to have a second ultrasound. That was in May.

I've been meaning to write about the current lack of events in the conception department for a while now but just couldn't quite pull my thoughts together. The ultrasound in May looked promising but then my body delivered a 62 day cycle. Progesterone did nothing but short circuit my cycles. No one I've seen seems to be able to agree on whether or not I actually have PCOS. My NP left the practice suddenly, making me glad that I'd actually had my last annual with the female OB in the office. She has picked up where things left off.

At the end of May, my OB started me on Metformin. Metformin is a diabetes drug that is used off-label in PCOS-like patients to break the insulin resistance that is often preventing ovulation. Metformin has some fun side effects like nausea, diarrhea, and vomiting (until your body gets used to it). Technically, I've been really lucky. I've only had the first of those three. But, damn, do I *hate* nausea. The insert that came with my pills also mentioned appetite suppression. I did not expect that to mean "total obliteration of any semblance of normal hunger signals". I had some pretty ugly hypoglycemic episodes when I first got up to the theraputic dose (1500mg). It freaked me out enough that I called the doctor and dropped it back to 1000mg for almost a month. I'm finally back up to the full dose and making sure that I eat regularly whether I feel hungry or not.

I would have probably chucked the pills a while ago if I hadn't seen some promising results. I've dropped about 8lbs since I started the Metformin in May (without much in the way of exercise -- nausea just isn't much of a motivator to get me to the gym) and just finished off a 35 day cycle. And now that I know that nausea is my new and unimproved hunger signal, I make sure to eat if I start to feel uneasy in the tummy and that will head it off. I see my OB again in a couple weeks. Not sure what we're gonna talk about then other than how things are going with the Metformin.

Being around babies recently has definitely got me jonesin' for my own little bundle of poop. It has erased any lingering question of whether or not I really want to be a mom. I most definitely do -- I can feel it in my bones. Even after hearing Trishimi's wail over the phone when she was in the midst of labor! I'm still torn over when to call it quits and adopt. Definitely not yet. I think my personal comfort zone for trying to conceive goes up to age 35 (I've got just under another 4.5 years before that comes into play). It also doesn't include any invasive medical procedures. If the current track doesn't do the job, I'm heading for a local MD who is also trained in acupuncture and traditional Chinese medicine. She's been recommended to me by a couple people independently.

While I have good days and bad days dealing with being less than fertile, I think one of the things that keeps me going is my ability to live vicariously through others. Like spending time with Trishimi and Jayden. The lovely (though infrequent) visits with my nephews. The monthly newsletter written by the infamous Dooce to her beautiful little Leta. There are too many things to list... Some times they leave a melancholy aftertaste but most days they keep me going with the hope that one day we'll finally make it to the ranks of the sleepless & breastfeeding.

I had a followup visit with my obgyn today. Short version: Stay the course.

We went over my basal body temp charts and the results of the HSG. She's very encouraged by the charts, which indicate that I am having normal, ovulatory cycles and the HSG came back totally clear. We agree that my infertility is pretty much due to endocrine dysfunction and is a waiting game while the metformin works to undo the hormonal wonkiness of the past 5-10 years. In any case, I am going to make an appointment with an endocrinologist since infertility is annoying symptom of other conditions (hypothyroid, quasi-PCOS, diabetic family history) that fall squarely in an endocrinologist's jurisdiction.

After the $1400+ bill for the HSG, my fervor for having bloodwork fizzled. She did give me a slip for thyroid and cholesterol and asked if there was anything else I would like to have checked. I declined, though it would have been nice to check testosterone and maybe glucose/insulin (but since they would likely be under an "infertility" diagnosis, I was concerned the whole claim would be denied by the insurance).

I have another followup scheduled with the obgyn in May and she mentioned that at that point we may want to start considering intra-uterine insemination (IUI). Not so sure I really want to shell out hundreds of dollars for something with a 6% to 26% success rate. She also said that because I appear to be ovulating, she doesn't consider me a good candidate for Clomid. That was pretty good news since I really didn't want to take it in the first place.

I think I'm finally getting to the point where I just don't care anymore. At least on the day-to-day basis. That actually makes it easier to some extent. I am starting to go about my business and stop thinking about whether I shouldn't do something in case I get pregnant this cycle. If it happens, it happens. If it doesn't, well, that sucks but ultimately life goes on. Of course, now that I'm in this cycle's luteal phase, my attitude is gonna change every half an hour. :)

I give*. Throw in the towel. At least for a while.

I've been waiting to feel a bit less hormonally deranged before sitting down to write this post. I dunno if I waited long enough or not.

In June it will have been two years since we started trying to conceive. By this time in 2004, we'd already quit actively trying to prevent conception.

It was one thing when every cycle ended with nothing. That was frustrating. Little did I know it would be taken to an entirely new level the past 2-3 cycles as I've had mild pregnancy symptoms and rising basal temperatures that crap out about 4 days before my period starts. I can't do this anymore. Not without a rest from the heartbreak.

So, I'm gonna keep training for the Bay To Breakers. Donate blood. Maybe get a tattoo. Get the tetanus shot for which I'm now overdue. Ask my boss for the raise that is *way* overdue. Hell, maybe even change jobs. Plant my garden. Try to plan a trip to Seattle. Avoid baby related stuff as much as I can and try to heal for a bit. Then we'll re-evaluate the situation.

I'm gonna keep taking the metformin and continue charting my temps (since I'm already in the habit and it is handy to know in advance when Aunt Flo may be dropping by) but that's it. Nothing else.

And now, I'm going to bed since I already know that cursed Daylight Savings Time is gonna kick my ass in the morning.

(*- This really means "we" give. Mark is getting pretty worn down by the whole thing too, and was relieved to hear I was thinking about taking a break from trying to conceive. I don't often enough acknowledge how hard this is on him and just how much his support means to me.)

Despite our decision to take a break from trying to conceive, I decided to call the doctor recommended by a couple of people (one of whom was treated by said doctor for infertility). I expected to have to wait to see her so I called last week to make an appointment. The receptionist said she was taking new patients but only for infertility. Pretty handy. Then she said they could see me Monday or Tuesday. A little faster than I'd expected, but I figured I might as well see her sooner rather than later.

I was under the impression that she was an M.D. who also was licensed for Traditional Chinese Medicine. It turns out that she is actually an M.D. in *China* and a licensed acupuncturist here. A little different than what I expected but not really a showstopper for me.

When I arrived at her office, I was given a form to fill out and they copied my insurance card (pretty standard fare). I met the doc, and we moved into a room where she asked me a bunch of questions about my medical history, how I felt my energy level and digestion were doing, info about my cycles (I brought all my temperature charts along), and asked if I had a lot of tension. After that she looked at my tongue (which she said looked pretty good) and took my pulse on both wrists.

Because I'm right near ovulation, she wanted to go ahead and do acupuncture today and also suggested I start taking baby aspirin to help speed up circulation, as she'd determined that I had some stagnation in my system (Traditional Chinese Medicine is all about keeping a balanced energy flow) but that it was mild. Also, I'm supposed to start taking some smelly herbs (they're supposed to arrive by mail in the next few days, also she didn't call them smelly but the lady that runs the front desk did. :)

This was my first experience with acupuncture and it went pretty well considering I'm not so fond of needles (or at least the kind used to take fluids *from* me, acupuncture needles are teeny in comparison). I laid down on the table and she put the needles in my lower legs, ankles, scalp, and a couple about 3 inches below my belly button. One of the belly button needles was attached to a machine that appeared to emit an electric pulse. She asked if I felt it and said it would help me to relax. It was definitely an odd sensation. She turned on some music and then left the room for 20-30 minutes. When she returned, she removed the needles, asked if I had any questions, and we were finished for today.

After leaving the office, I did notice that my neck and shoulders did seem to be less tense. I stopped by Costco for a bottle of baby aspirin. And the kicker? My insurance will cover up to 12 visits per year once my deductible is met.

I composed this timeline after getting the first positive test but before the second (which you saw in the picture).

The OB office I went to recently went through a split so now instead of having 3 OBs and 3 midwives in the practice, there are 2 OBs practicing separately and one OB backing the 3 midwives. My original OB is working on her own now so while my first prenatal appointment was with the nurse practitioner, it was made clear that I would have to decide who I wanted to go with for the second visit and beyond.

I initially chose that particular practice because I had been looking into birth options in the area that didn't make me a slave to some doctor's routine medical procedures. This particular group of midwives had been highly recommended by a co-worker of Mark's, as they were then expecting their *7th* baby and they used various local midwives for all of their births, IIRC. Because of the strong recommendation from them and the statement by our doula that they're very good (a good sign since she keeps tabs on the local birthing scene) and my apprehension about having an OB who doesn't have any backup, I decided to follow the practice with the midwives + 1 OB (which still only has one actual doctor but he's not the one and only person in the practice that can attend the birth).

In any case, my second prenatal visit was July 10th with one of the midwives. We heard the heartbeat which triggered the going public with the pregnancy news and I got the results from the bazillion tests run the month before at my first visit. Everything looked good until I asked for my thyroid (TSH) number. 3.71. Taken over a month before. While technically still in the "normal" range for this particular lab, it was too close to hypothyroid for my liking. Because of my background with thyroid problems and PCOS, the midwife suggested I see an endocrinologist (something I'd been meaning to do for *months* anyway) and went right then to call the *only* one in SLO county (who she saw for thyroid problems as well).

Somehow a miracle occurred and the endocrinologist (who normally has a 3-4 month wait) saw me *after hours*, a week and a half later (July 19th). This is probably due to the fact that I was pregnant, headed back toward hypothyroid, had a family history of type 2 diabetes, and a very high risk for gestational diabetes (because of the insulin resistance component of PCOS). I left her office with 140 100mcg doses of my thyroid meds (up from the 75mcg I was taking), a standing order for a monthly thyroid check, a glucose monitor, a bunch of test strips, and a grocery bag full of lancets (the poky bits). I'm supposed to test my blood sugar first thing in the morning and then 2hrs after breakfast, lunch, & dinner so we can get a baseline of where things are now and get an early warning should they start heading toward gestational diabetes land. The nurse also explained why babies of GD mothers get so big. My insulin doesn't cross the placenta but the extra glucose that I can't process does so the baby has access to more fuel and grows faster (bigger) than normal.

The testing is kinda annoying but hurts less than I expected. I was dreading it feeling like the finger prick you get at the blood bank when they check to see if you have enough iron. Thankfully, it is much less painful than that. I'm finally getting the hang of getting it right the first time. Thus far, my readings have all been pretty good except for today at lunch.

It appears that I have eaten my last Pop Tart ever. About half an hour after lunch, I wanted something else to eat and decided to go for the last of the smores Pop Tarts that I bought in a moment of weakness a couple of months ago. I toasted them up, grabbed a glass of milk, and basked in their smore-y goodness. And then, my blood sugar revolted. My stomach felt like total crap (still does 3hrs later) and I could not stay awake. I ended up going to bed until the alarm went off for my post lunch glucose test. It was 132. The highest I'd gotten before that for a 2hrs-post-meal test was 106. Well-managed blood sugar is supposed to stay under 120. If the indigestion wasn't already enough on its own, the idea that I could be fueling the growth of a King Kong-like fetus banging on the walls of its tiny uterine prison is strong enough image to keep Pop Tarts out of my life, at least for the next 6 months if not for good.

For the most part, this is what I sent out to the family by email after my prenatal appointment yesterday. I wanted to archive it here as well.

Yesterday I had my 2nd midwife visit (the initial appointment was with a nurse practitioner). It was pretty uneventful though it is reassuring to hear the heartbeat each month. I'm currently at 17 weeks, 5 days and our due date is January 10, 2007.

Since my last prenatal visit, I have seen an endocrinologist who increased the dose of my thyroid medication. This has made a huge difference in my energy level. I was getting to the point where I could barely get out of bed even after a full night's sleep. She also had me start checking my blood sugar levels 4 times daily since I have a pretty high risk of gestational diabetes. So far my blood sugar looks good and the monitoring helps me see the effects of various foods. Hopefully that awareness will help me keep from getting GD.

I'm definitely starting to show now and most of my non-stretchy pants are unwearable. Thankfully, I have a lot of stretchy pants that should hold me over until I get to the point where I can start wearing some of the maternity pants that Kathy (sister-in-law) gave me. I haven't yet felt any movement (that I could recognize as such) but it is still a little early. From the sounds on the doppler that the midwife uses to hear the hearbeat, the little monkey is moving around quite a bit. Next Wednesday we have an ultrasound appointment. If the gender is readily apparent, we'll have the doctor tell otherwise we'll let it be a surprise.

The back bedroom's transformation is nearly complete! Mark installed the ceiling fan we picked up for the room, the walls are now a pale lavender and the bamboo flooring has been installed. We had a neighbor who does flooring come over to finish up the tricky bits and do the baseboards but Mark and our friend Nick did almost all of the work. All that is left now is to put another coat of paint on the baseboards and on the trim around the door, put the door back on its hinges, and start putting the furniture back in the room. The handy part about taking everything out is that we're only putting back the things that we want to keep in there. We'll be filling it up with baby stuff soon enough.

Here is a picture that totally doesn't do the room justice as the paint is a very subtle shade and the photo was taken before the baseboards were installed:

And this came in the mail today:

Why, yes, that is in fact a tie dye nursing bra.