Sunday, March 31, 2013

Easter

  Happy Easter everyone!!  Today I will be spending the day with my favorite little "chicks" at work.  I know you must be thinking that it must suck to be here on a holiday.  Honestly, this one I don't mind.  It's nice to see the families so excited.  Granted it makes me sad when there are families that don't visit.  It also gives me a reason to avoid questions at family parties.  Now, don't get me wrong, I LOVE my family (both by blood and by marriage).  There are just some days I don't want to deal with the questions.  I also don't want to publicly deal with the fact that this is yet again another holiday where we don't have a child.  No little easter dress and bonnet or suit shopping.  No easter egg hunt in our back yard.  No treat basket.  I know that's not what the holidays are about, but it just makes me sad.  So I guess being at work and spending the time with other people's babies and being a part of their celebration is the next best thing. 
    Honestly, to some families here, we are an extension of their family.  We become adopted "Aunties," and rejoice in the accomplishments of their kids, no matter how small they seem.  On days I am fully of self pity, its a reminder that it can always be worse and to remember to look for the little things to be happy about.  Maybe next year will be different.  I am optimistic that this spring brings forth rebirth and new life.  And if that's not a baby, then maybe finding my life again.  Infertility is so consuming sometimes that when I step back and look at myself, some days, I don't even recognize me anymore.  I am not the same person I was 2.5 years ago.  Some days, Im not so sure that's a good thing, but I know for sure I am a stronger person because of it.  Again, looking for the little things. 

I hope everyone that celebrates enjoys their holiday and hug your families tight.  BTW, still no results from the labwork. 

Friday, March 29, 2013

Holy Lab List Batman!

So Dr. KK has a patient portal.  And being the type A nurse that I am, I'm exploring in it.  There's a spot for completed orders basically listing everything we did weds.  Including the list of what labwork they drew.  Get ready for this.....

Testosterone, Free And Total
Vitamin D,25-Hydroxy
Cbc (Includes Diff/Plt) With Tech Review
Comp. Metabolic Panel (12
Protein C And Protein S, Activity
Antibody Screen, Rbc
Antiphospholipid Ab Panel
Pai-1 Activity
Dehydroepiandrosterone Sulfate (Dhea Sulfate), Serum
Insulin, Free
Homocysteine, Cardiovascular
Aptt
Anti Dna Screen
Th1/Th2 Cytokine Ratio
Natural Killer (Nk) Full Panel
Tsh & T3 Free & T4 Free
Factor XIII, Qual.
Dehydroepiandrosterone (Dhea), Unconjugated, Serum
Ana Ifa W/Refl To Titer/Pattern
Fibrinogen
Thyroid Peroxidase And Thyroglobulin Ab
Plasminogen Activator Inhibitor 1 4g/5g
Immunoglobulin Iga, Igg & Igm, Quantitative
Human Platelet Antigen 1 Genotype
Hiv-1 Ab Screen
Hiv 2 Antibodies, Eia

Thats a lot of testing....I can't wait till the results are in!

Wednesday, March 27, 2013

Reproductive Immu...what?

   Today was my consultation with Dr. Kwak-Kim.  She is a reproductive immunologist.  Her patients include women with unexplained infertility, multiple failed IVFs, and recurrent pregnancy loss (although that's not her complete list).  When I found her, I was searching for any answer I could find as to why we still aren't pregnant.  Seeing that there are about 6 RIs in the country, 2 of which being in Chicago, I felt that it was a sign I should at least see if there was anything else we are missing.  I was reluctant to keep the appointment once we found the polyp and my labwork was all coming back normal.  The office assured me that there could possibly still be other things wrong and I should still keep it.
  Luckily, I live about an hour south of the office.  I have read stories of couples who fly across the country to see her.  I was instructed not to eat anything after 10pm, then an hour before my appt to drink 32 oz. of water.  The also said it was okay to take my meds, so I took them with my first 8 oz of water and hopped in my trusty Jeep for my little road trip.  I opted to go alone, so that Jeremy wouldn't have to take another day off work.  I know some of the area because my inlaws live nearby, so I wasn't too worried about where I was going.
  When I finally got there, I checked in, filled out their standard forms and waited.  I was the first appt and the only one there.  I was called back for my ultrasound a few minutes later.  We did an external ultrasound first just to check structure and such(hence the 32oz of water).  Yes I still have a uterus and ovaries, phew!  Next came the transvaginal.  Oh Joy.  Let me tell you.  The ultrasound alone was worth the drive!  I forgot to mention that while they have the ultrasound machine next to me, they also have an additional monitor posted near the ceiling  directly in my line of vision so that I could watch the ultrasound too!  So cool!!!
  We looked at structure more, she took some measurements, and did a dopplar study to look at blood flow.  Remember a few months ago when I questioned the RE if maybe I was PCOS?  Well low and behold on the ultrasound today I had multiple cysts on both ovaries.  As soon as she looked at them, I knew.  I'll get more into that in a minute though.  She also looked at my bloodflow to both my ovaries and uterus.  That showed some decreased flow as well, more so the left ovary and uterus, which could explain why my right ovary responds better.  We also scanned my thyroid then, since thyroid issues can also be seen in PCOS.  A radiologist will read the images, which should take about 2 weeks.
  Next up was the blood draw.  They put me in a recliner lab chair and started pulling tubes.  22 vials.  Yes you read that right, 22!!  The nurse asked which vein would be best, so I pointed her toward my RE nurse's favorite.  Amazingly enough, she got them all on one stick!  I was beyond impressed.  I was then moved to a room to meet with the nurse practitioner who did a physical and interview.
  Finally I was moved to the conference room to meet Dr. Kwak-Kim.  She was absolutely wonderful!!  She has battled infertility herself, so I felt comfortable talking with her.  I also cried about 4 times in the appt.  whoops.  Damn you IF!  She explained that typically she sees IVF failure for 4 reasons.  Genetic, endocrine, immunologic and hematologic.  As far as genetic, she said there is a 15% chance the failure was due to genetics, meaning there's an 85% chance it wasn't.  That made me feel better.  It sounds like she is looking more towards immune and hematological due to my family history and what she saw from the ultrasound.  Endocrine is another factor she's considering because of the newly developed polycystic changes we are seeing in my ovaries.
   Our game plan will depend on how my labwork comes back.  We have a follow up appt on 4/19 to talk about them and make our plan.  Her recommendations until then were to try to lose more weight, reduce my BMI (which will all help especially if I'm PCOS, as well as stress reduction).  She also recommended that we not cycle in May.  Her reasoning is that with my lower AMH level, I'm working against time.  If I cycle without fixing problems, I run the risk of overstressing my ovaries.  Doing so could cause premature ovarian failure.  We don't want that, especially if I am not considering donor eggs at this point.
   I talked to Jeremy when he got home from work and agreed that this is a doable option.  We want to give this the best chances we can.  She had also said that chance of success from IVF starts to plateau after 3 cycles.  I don't want to waste my best cycles.  So it looks like I have a phone call to make tomorrow to reschedule my cycle for June.  I also need to talk to my boss to work on time off again.  I wish these things would happen before I make my work schedule.
   After the appointment, I stopped at a pretty huge mall on the way home.  They have a LUSH store there.  I may or may not have spent an hour or so in the store indulging in some retail therapy.  It's better than crying in the car, right?
        

Saturday, March 23, 2013

"Excuse me Maam, can I help you find something?" "yes, how about my dignity"

This week has been a challenge.  I had been procrastinating buying a birthday gift for DH's best friend's baby who is turning 1 in a few days.  Her party is today, about 2 hours away.  I finally caved & went shopping Wednesday.  I boldly decided to go to BuyBuyBaby, because I could get what I wanted plus be able to use a coupon.  I'll tell ya, as soon as I stepped foot in the store, I knew I made a mistake.  It was like an instant panic attack.  I'm pretty sure they pump Dreft though the air ducts.  I grabbed a cart for stability, and tried to find my coveted Little People Zoo.  It didn't take long to find it, but I also wanted to get an outfit or something to go with it. 

As I made my way around the store, it seemed like there was a sales person every 20 feet asking if I needed help.  No.  I know my way around the store.  All I wanted to do was disappear, get my items and get the hell out, so please stop asking if I need help.  The one thing I want is the one thing I can't buy at BuyBuyBaby.  I ended up finding the cutest little outfit and made the fastest beeline for the register.  The cashier rang me up and tells me the toy needs batteries.  No, I don't need your baby batteries.  If her parents want it to make noise, they can put their own batteries in.  I grabbed my gift receipt, a gift box and practically sprinted to the car.  All that to save 14 dollars. 

I'm just praying no one asks me when we're gonna have kids.  Or maybe I should just pray for wine. Lots of Wine.

Sunday, March 17, 2013

Worn out

This is my weekend to work.  Typically I don't mind working every other weekend too much.  It just seems that lately, I have a lot less tolerance.  I am tired of having to put on the brave face whenever I get caught off guard by another pregnancy announcement from people that have tried for a month.  I am tired of saying "no, not yet" through gritted teeth when patient's families ask me if I have kids.  I am tired of listening to people bitch about how sick they are, or say that they really didnt need to try to get pregnant.  And so help me God, if one more person tells me to relax, I will rip their eyes out of their sockets. 

I know there's a saying that you were given this life because you were strong enough to live it.  Well, I'm tired of having to be so freakin strong ALL THE TIME!  Yet at the same time, I can't allow myself to crumble and fall apart for fear that I won't be able to pull myself back together.

 I just keep reminding myself how much more I will appreciate my child for everything I have had to go through to get it.  The thought of my child lying on my chest as I rock them to sleep is what gets me through the bad days.  Until then, I can always dream. 

Friday, March 8, 2013

Post Op Follow Up

  I had my follow up with the RE today from my surgery Monday.  The appt went well.  He even gave me a copy of my photos!  He told me he got the polyp and that when he was looking around, noted that there was an area that was unusually thicker than the rest, which could have been the beginning of another polyp so he took care of that too.  Pathology also came back on the tissue he sent.  It was completely benign!  No cancer for this girl!  What a relief!  I know the risk of cancer was very low, but I was still worried about it.  He warned me my AF may be different this month, both in timing and the actual bleeding.  I reminded him I am still on the BCPs, so we were able to talk about when I can cycle again.
   Since the RE requires some time off after surgery to heal, we looked at the May week.  He played with some dates as far as BCPs & all that, and it looks like I am good to go for IVF#3 in May!  He modified my calender and I was able to set up my appts already for monitoring.  It feels so good to have a plan!  The schedule looks like this:
BCPs: 2/20-3/16 then restart BCPs 3/25-4/16 (he didn't want to leave me on bcps consecutively)
Lupron 20 units/daily starting 4/14, start baby aspirin
4/26-Baseline labs & u/s, start Prednisolone 10 mg daily
4/27-Start stims and decrease lupron to 10 units/daily.  Menopur 225IU in the mornings, Follistim 150IU in the evening.
4/29 start Doxycycline (ugh)   
5/1, 5/3, 5/4, 5/6 Monitoring  5/5 stop baby aspirin until after ER
Hopefully ER date should be about 5/8.  Once I'm retrieved, I'll increase the prednisolone to 3X a day for a week, then start to wean off( 1Xdaily for 14 days, then 1 pill every other day X5 days)

We are going to continue using the Crinone, starting the day after the ER, but the RE is also adding PIO (progesterone in oil) IM shots every other day.  I've never really had an issue with progesterone before, but we want to throw the kitchen sink into this cycle.  I'll continue that through the Beta, and if it's positive, until we have an U/S at approx 6 weeks.  I'm nervous about them, since they go in my backside and I really can't do them myself.  I'll have my nurse show DH, but I'm hoping I can find enough of my nurse friends to help me so he doesn't have to do too many. 

Wow.  I really have a plan!  I'm really starting to think these socks are lucky!! 

Thursday, March 7, 2013

Mobile blogging and funky moods

I figured out there's a blogger app.  You can expect to see more posts from me in the future.

Im in a bad funk i cant shake.  Im feeling isolated and lonely.  Even from DH.  Maybe im just getting cabin fever.  

Tuesday, March 5, 2013

Delayed reaction

Apparently all my bragging about the lack of pain has caught up with me.  Im now having lots of bad cramping.  Just when i thought i was lucky.....

I survived!

Fear not, I survived the surgery!  I've just been taking it easy this past day.  Overall it seemed very straightforward.  I have minimal pain, which is very surprising.

We arrived at the sugicenter at 10:45 as instructed with my first morning urine in a cup in a paper bag.  I affectionately called it my pee bag.  Why did I need to bring a pee bag?  Oh because they needed to make sure I wasn't pregnant.  HA!  After filling out the forms, they called me back at about 11.  I was taken to preop when I changed into a gown and their slipper socks.  Even though I answered their pre registration, the nurse still had a million questions for me.  She took my vitals, and as I suspected, my blood pressure was very high.  What can I say, I was NERVOUS!

Once the Q&A were over, I got to meet my anesthesiologist.  She was super nice and friendly.  She had reviewed my questionaire and told me that my sleep apnea score was kinda high.  Jeremy says I snore sometimes, but I always atribute it to being very tired from work.  She said I might want to have an evaluation.  I'll keep it in mind, but I'm not running out to book another specialist appt. 

Next came my favorite part.  The IV.  My nurse (Marlene) started looking and I warned her my hands were icy cold due to my nervousness, so I might need a warm blanket to help her.  She agreed.  I know where my veins are, so I knew she was having a hard time finding one she liked.  Instead of sticking, she let he anestheologist (Dr. Kahn) try instead.  I appreciate that she did that.  It takes a lot to put pride aside as a nurse & admit when you need that kind of help.  Dr Kahn found one she liked in my right hand, and I asked her not to tell me when she was going to do it.  She was fabulous.  It hurt, but she talked to me the whole time to try to keep me breathing & next thing I knew, she was done.  Marlene started my IV fluids and I got to wait for Dr. Levrant.  I did have a moment that I panicked a bit because there was a huge air bubble in my tubing that was migrating toward my vein.  I called for Marlene & apologized for being a spazz.  She took care of it, no complaints. 

I could hear them calling Dr. Levrant's office on the phone, asking if hed be on time.  I had to laugh because that man is not very punctual.  The office swore he'd be on time, but as soon as I had confirmation they were talking about my Dr, I said I wouldn't be surprised if he was late.  They finally let Jeremy come back & sit with me.  I promptly showed off my newest outfit.  Next thing I knew, running in comes Dr. Levrant.  I laughed when he came in.  I told him to slow down, and he insisted he'd be ready in a couple minutes.  My OR nurse came to offer to take me to the bathroom.  I took her up on it, since I really didn't want to be catheterized. 

Next thing I knew it was time to go into the OR.  I kissed Jeremy goodbye and in we went.  The room was bright and freezing.  Once I got on the table, they gave me warm blankets.  Dr. Kahn came in & said lets get your comfy.  She gave me something to relax me, then put some oxygen on my face.  Next thing I knew, I was waking up & it was over.  I was moved to the Recovery room.  I graded my pain at a 5 on a scale of 1-10.  The nurse quickly got something for that.  Once I was more awake, they sat me up and took off the nasal cannula.  I had no nausea, so Dr. Kahn must have taken good care of me. 

I chatted with my post op nurse and it turns out she just went through IVF, but has to do a FET due to OHSS.  Its so funny the places you meet fellow infertiles.  She moved me to "phase 2" recovery which was a smaller room with a recliner in it.  She helped me get in the chair, then offered me snacks and a drink.  I'm telling you that was the best cheese its & cranberry juice ever.  Jeremy was allowed to come back then.  We went over after care instructions, then I had to try to pee (it was Dr. Levrant's rule for sending me home).  It was successful, so the nurse took out my IV and let me get dressed.  I was given prescriptions for pain meds and something for nausea in case I needed it.  Jeremy went to get the car and I was allowed to go home.  It was right before 3.

According to Jeremy, Dr. Levrant showed him photos of what he did and that it was a polyp.  The polyp is on it's way to pathology.  He also mentioned something about other "abnormalities" and that he went in for some additional scraping, but considering this info came from Jeremy, I'll take it with a grain of salt.  Im supposed to stay on the BCPs and see the RE either at the end of the week or beginning of next week.

Since then, I've just been taking it easy.  I've only needed a couple doses of the pain meds, and honestly, it feels somewhat like AF cramping at the worst.  I'm glad this is all behind me.  I heard back from the RI's office after sending them my additional testing.  They would still like to see me, as there are other things that could still be at play.  Looks like I'll keep the appt afterall.  May is looking like a good month!

Sunday, March 3, 2013

Irrational fears

   Well folks, I am less than 24 hours away from surgery.  Yes I know they are not cutting my skin, but I'll be in a surgical center, under general anesthesia (meaning IV drugs and being intubated) so in my book, that's surgery.  Plus they are still cutting something out of me.  Nerves are starting to set in.  I was thankful this was my weekend to work.  I likened it to being like when I took my nursing boards right before my weekend to work so that it would keep my mind busy while I waited for what I couldn't speed up.  However, working hasnt gotten my mind off things, especially when I was cancelled from my first 8 hours today. 

   I was lucky enough to be assigned to a good set of patients in the same room as one of my friends.  I needed a day like that after they past couple weeks I've had at work.  I really haven't said anything to anyone at work about tomorrow, besides my friend I was with yesterday, my supervisor yesterday (only because I was asking for thursday & friday off), and my unit manager.  As my day progressed, I kept thinking more & more about monday.  It isn't even the huge stuff-will the polyp be cancer etc.  It's all little stuff.  I suppose I'll blame the nurse in me for a lack of control and the fact that the last time I had surgery, save for the egg retrievals and having my wisdom teeth removed, was when I was 15. 

   I've started to develop a list of irrational fears.  I think it's kinda funny, but perhaps that's the fear talking.  I'd like to share that list.
1.  I'm afraid that they'll knock my teeth out & I'll choke/swallow them while they are intubating me. 
2.  I'm afraid that I'll get the paralytic medicine and not the sedation (basically being awake but unable to move & tell them)
3.  I'm afraid I'll need a foley and that they'll put it in/take it out while Im awake.
4.  inability to get the IV on the first attempt.  I can't eat or drink after midnight, dont have to be there till 10:45 & wont be in the OR until noon.  There's a high likelyhood that I'll be dehydrated by then thus making an IV difficult.
5.  Im afraid of extreme pain.  There's just something about uterine pain that is like nothing I've ever felt before-this coming from the girl that has broken her leg 2 times and had 5 surgeries on it.
6.  Let's be honest.  I worry that this polyp could be something bad.  I know the RE said there's a less than 1% chance of that, but cmon.  I broke the same leg, same bone on two seperate occasions.  stranger things have happened.
7.  I worry it'll be worse than he thinks when he gets in there and that he might need to done something more extensive than we planned.
8.  I worry that maybe he wont let me cycle in May.
9.  Air embolism in my IV.  We can blame my friend Lisa for that one.  I wonder if they would mind if I bring them a tubing filter from work.
10. I worry that even after we do this, I still won't get pregnant.

There.  I think that's everything.  Now that they're out there for all to see, maybe I can move past these fears and work on staying focused and positive for tomorrow.

I've decided to send the newest labs to the RI's office and let them know of the new developments.  Maybe they'll tell me not to come.  I really don't know if I should go or not.

I wonder which lucky socks I should wear tomorrow.