Tuesday, December 31, 2013

I don't got this

I totally dropped off the face of the Bloggy Planet, and I'm sorry.  I've been pretty good about reading, but a terrible commenter and I obviously haven't been writing on here.  Please know that I'm keeping up with all of you and I'm thinking of you, even if I'm not writing out those thoughts.  All will be explained.  It's been shitty.

A week ago Monday, I woke up very early to catch the bus out to my dad's.  He had a chemo appointment, and I was just going to stay out there till Thursday anyway since it was Christmas and there was a lot to do.  I was not looking forward to the week.  As I've been mentioned at length in other posts, Dad has been down, he hasn't been eating well, and his health has been pretty poor.  We talked a few days before his appointment and decided that a) it was time for him to get a CAT scan to see if these meds were even working; and b) that he needed at least a week off from his chemo to try to recoup his energy and appetite.  

I was dreading the appointment because I was worried that we would get push back from his nurse on taking off the week from chemo, and I was generally dreading the week because I had so much to do (Christmas shopping, cooking, present wrapping, dealing with my sis) and I worried that it would be a week of trying to buck up my dad which was increasingly feeling like an impossible job.  I sat on the bus, waiting to leave Port Authority and I gave myself the Megs patented pep talk that I give myself before all things I am dreading/scared of.  "You've got this.  You have got this.  You are Megan and there's just no way you can't handle this because you can handle anything."  You get the picture.  It's stupid, but it helps.

A LOT happened that day so I am going to give the shorter version otherwise this post will wind up being so, so long and probably boring for most people.  Dad picked me up from the bus stop and we headed to chemo.  He was really quiet in the car and when he did speak, I could barely hear him so I had to keep telling him to speak up.  Please note that no one in my family is soft-spoken, we come from a long line of excellent voice projectors so this is unusual.  I got pissier and pissier because I thought he was "just" depressed and I was starting to feel sorry for myself and how I have somehow become the goddamn adult in this family even though I'm the youngest and why isn't anyone helping me, and why is everything so damn difficult and blah blah blah.

When we got to the doctor's office and started walking in, it became clear to me that I was an asshole and my dad was very ill.  He was walking so slowly and struggling to breathe.  

"When did this shortness of breath start?" I asked.
"Um... just now?" Dad offered.

The nurse couldn't even get any blood out of my dad - that's how low his blood pressure was.  I immediately told Mary, our nurse practitioner, about the shortness of breath, she took Dad's pulse (120!!!) and listened to his lungs.  She shared her concern - that Dad might have a pulmonary embollism (blood clot in his lungs) and the best thing to do would be for me to take him straight to the ER at our hospital because they could give him the necessary tests immediately.  Dad was NOT happy, but that's tough shit.  They got a wheelchair, wheeled him down to the car and off we went to the hospital.

"Wow, you'll do anything to get out of going to Sissy's for Christmas dinner," I cracked.  Dad laughed.

The ER sucks, people.  I hate it there.  The last time I took Dad, when he had his bowel obstruction, we weren't stuck down there for too long before Dad was admitted.  It became clear pretty quickly that a) Dad would wind up getting admitted, at the very least for observation; and b) the ER was super busy.  We were stuck there for over 6 hours before we finally got admitted to the oncology ward, which I realize isn't that long, but it felt interminable.  Dad has an iodine allergy (which he developed from repeated exposure to the CAT scan contrast dye), so in order to get a CAT scan with contrast, he has to take pre-meds.  That takes too long, so they had to give him a nuclear scan (super old school, but it works fine, it just takes a long time) to check for the pulmonary embollism (PE).  So we wound up separated for nearly 3 hours, I got kicked out of our curtain area, they stuck me in a horrible, cold, smelly consult room which had an alarm that kept beeping and I couldn't get it to turn off.  And then the nurses abandoned me, were short and rude to me, and never bothered to tell me when Dad was returned to the ER.  I hate them all.  And I should say that I love nurses - but this small handful of ER nurses on this one day?  They sucked.  Even once Dad got cleared of a PE and the doctor had said he wouldn't have to have any surgery, they still refused to give him any water or hook him up to an IV of fluids, until I started getting a little sharp (politely sharp, but sharp nonetheless) and convinced them to go talk to the doctor.  

In the middle of this shit show, I called Sissy to tell her what was going on, and she was her usually stressball self.  Not helpful.

Once we were up on the ward, all was much better.  The nurses on the oncology ward are wonderful and kind and competent and I was so, so happy to be there after the nightmare in the ER.  Dr. T's partner was on-call that day and she explained to us why she wanted Dad admitted and then the cardiologist came by and explained in excellent detail the various things that could be wrong and what had been ruled out.  In the end, he felt fairly confident that the main cause of Dad's shortness of breath was his recent extreme weight loss and fatigue, which can cause muscle deterioration and can just make it that much harder for your body to do anything.  But he wanted Dad to have more tests to thoroughly rule out any heart problems.  And Dad would also finally have his CAT scan with contrast to check on the cancer.

I left Dad in the hospital that evening.  When I got to his house.... well, I don't want to say I found it in shambles.  For a lot of people, this would look normal, but my Dad keeps a tidy house and he never leaves dirty dishes.  There were two dirty pans from Friday when I had made Dad french toast and bacon.... it was now Monday.  That means that from Friday till Monday Dad did not wash two dirty pans.  That is so, so unlike him.  There was also a rotted banana that he had not bothered to throw away.  I had talked to him on both Saturday and Sunday and he had done a good job of making me think he was feeling okay.  Clearly he was not.  And from what I could tell, he hadn't been eating anything other than Ensure.  My first thought was "Hmmm, I decidely do not got this."  And then I thought "I'm going to have to move home and take care of him, I can't leave him alone anymore."  Jeeves pointed out that we could hire someone to come in and look after him and that calmed me down a little.  

So, that's how my Dad wound up in the hospital until Christmas day when they finally let me spring him.  Jeeves came out to NJ on Christmas Eve and helped me wrap the presents for Dad and my nephews.  I spent a lot of time at the hospital.  Dad got better while he was there, and ate more food than I've seen him eat in weeks.  In the end, his heart and lungs look just fine.  His CAT scan shows that his liver metastasis are stable, but the pelvic mass and the lymph nodes have continued to grow, so he's off the chemo for the time being.  We'll see Dr. T after the New Year and he'll come up with something new.  In the meantime, Dad and I talked about the things we need to do to make his life better/easier.  We'll see.

Once we got Dad home from the hospital, he opened his presents and stayed home to rest.  Jeeves and I went to Sissy's and had a really nice time with her and my nephews, who loved their gifts.  We stayed at Dad's till Friday to make sure he was well and truly on the mend.  He's been eating well and getting stronger.

The week was long, and exhausting, and stressful.  But it was filled with really good things too, like the love and support of my husband, time with my nephews, Kate and her family who fed me and supported me, some new cookbooks, kind nurses, and deep, albeit short, sleep.  We came back to the city on Friday and fortunately/unfortunately had no down time because my college friend Meg came to visit for three days and we went to my college roommate's wedding. 

Tomorrow is New Year's Eve, and I hope the new year brings all of us many wonderful things and that we can say adios and good riddance to crummy 2013.

Thursday, December 19, 2013


The bitching and moaning will be epic, but not pregnancy-related, so this post is safe.  It might get bilious.  I want to start this by saying that I logically know that all parties involved care about my dad and are trying to be helpful.   

Remember how I said last post that there's been some stuff going on with my dad and it has been stressful?  Well, just to fill in the blanks I will explain that for the last 3 or so months, Dad is on a new chemo protocol that combines pills and a biweekly infusion.  About midway through, he had started to have bad side effects - loss of appetite and fatigue.  Dad's appetite is not exactly voracious even under normal circumstances and he lost a bunch of weight (and he's already thin).  So, Dr. T lowered his dosage and that seemed to do the trick.  But a couple of weeks ago, he went back to not really eating and he just seemed.... down.  In a funk.  We had a long talk about it and that led to a long talk with his nurse practitioner, and long story short (too late), she prescribed a low dose of an anti-depressant.  It hasn't even been a full week that he's been on it and so we don't expect to see much in the way or results for a bit.  His appetite is still not great.  And then this week he got a stomach bug.  Wheeee!  Isn't this fun?  His weight is low and I am concerned. 

In the midst of all this, my sister started texting me (we primarily communicate via text, which is actually a good thing, as she's not a good listener and sometime says really ridiculous things, and texting allows me to respond in a positive, supportive way instead of yelling. "What did you just say???") about how worried she was about Dad because of his appetite loss.  I should explain that my sister is not involved in my dad's medical treatment (other than what we tell her) and it's been like that from day one.  There are many reasons for this, but they're not very important.  I asked Dad what, if anything, he had told her about his appetite loss, anti-depressants, etc.  He said he had not told her about the anti-depressants because he didn't want it winding up on Facebook (my sister is a notorious Facebook oversharer, but the "good" news is she only overshares about her own life and the life of her children).  I explained this to Dad and suggested we should tell her about the anti-depressants, so he agreed.

So, I explained what was going on, and my sister pointed out that Dad gets lonely and spends too much time alone.  I said yes, and that it was important for us to both spend as much time with him as we could.  She said one of her patently ridiculous things, and I'm just going to skip to the chase which is that the conversation quickly devolved into my sister wanting to move my dad into a senior living community down the street from her (something he would never agree to) and acting like Dad is our aunt who has dementia.  I convinced her to chill.  She chilled.  This is one of my pet peeves, not just with my sister, but with a lot of people when it comes to an elderly relative.  I think it is inappropriate to discuss plans of "what to do" about an elderly relative without that relative present when said relative is of sound mind.  To me, it infantalizes the elderly relative.  My dad is of sound mind, and other than the fact that he has cancer, he is quite able-bodied, and I will not participate in a conversation where we're talking about packing up and moving Dad unless Dad has expressed that he wants that.

So yeah, this week Dad had a stomach bug, and on Wednesday when the husband and wife who clean his house came by, Dad was in bed and explained to the husband that he was "having a bad day with his cancer" or something to that effect, which was (Dad admits) not a good way to put it.  More on that in a minute.

Fast forward to today, I came out to visit Dad.  He's still a bit under the weather, slept a lot today, and mentioned that my sister had stopped by and she had commented that he didn't look well.  At dinner, we had a long and kind of depressing conversation about the stress we both feel over his condition and what our next steps should be/what we want to talk about with his nurse next week.  I should note that this type of stress and these types of conversations are a totally normal part of the process with cancer treatment.  I have felt this way numerous times over the last 5 years, it just happens more frequently now.  And while the conversation is a downer because we are implicitly admitting that we know that Dad won't live forever, it is also a good and important conversation to have.

On the drive back to Dad's from dinner, my sister starts calling me.  Turns out the wife who cleans Dad's house had called my sister because she was so concerned with how Dad looked [Dad found this amusing, as she didn't actually see him, only her husband saw him], and noted that there was no food in the fridge.  I checked the fridge - Dad threw out a lot of old/bad stuff last week.  Is there a lot in there?  No.  Does this look like my dad's fridge has looked for the last 3 years?  Yes.  Then my sister said, "Well, did he tell you I came to visit and he was sleeping and he forgot I was coming and he looked terrible?"  I said, "Yes, yes, dear sister, I know.  He told me.  He has a stomach bug.  You know this.  He is on chemotherapy.  You know this."  Except I said it nicer.  Eventually I calmed her down, explained our plans for the appointment next week.  But man, I have to say.  I was pissed.  I realize that the cleaning lady cares about Dad and was trying to be helpful.  But it was not helpful.  I am here EVER FUCKING WEEK.  I talk to my dad EVERY FUCKING DAY.  I am my father's legal healthcare proxy.  I am fully fucking aware of every goddamn thing that happens to my father and I don't need the cleaning lady calling me up to discuss my dad's health and give me advice on what I should do.  My sister gets wound up and then she wants to wind me up, because that relaxes her.  And yes, it irks me that people call her at all.  They assume because she is the oldest that she is responsible for Dad, when nothing could be farther from the truth.

I got off the phone and said to Dad, "You need to give your cleaning lady my cell phone so she stops calling Sis when she gets worried about you."  Dad agreed.  I explained to Dad my discomfort with people calling up and my sister wanting to have long discussions about "what to do" about Dad's appetite.  It feels gossipy and infantilizing.  If the cleaning lady is concerned about Dad, she should ask Dad, "Are you okay?  I'm worried about you."  Or, here's a thought - bring him some fucking food so that I'm not the one who has to spend all damn day worrying about what he'll eat and what I can tempt him with from the bakery.  Such phone calls to my sister also feel suggestive - like she's suggesting we don't know what's going on with Dad and she somehow does, or like she's suggesting we're not doing a good enough job of taking care of him.  I know.  I KNOW.  I am being 100% unfair to this poor woman who probably thought she was doing a good deed.  I know that part of this is projection - that I feel like I am not doing a good enough job unless I either move back home or get Dad to move in with me.

I took some deep breaths after this and climbed into Dad's car so I could run to Kohls to do some Christmas shopping.  As I'm sitting in the car, checking my phone, my dad's neighbor, Mr. N, comes over to me.  Remember how I said Dad slipped on the ice on Sunday and fell?  Yeah, Mr. N was snow blowing Dad's driveway for him (which he always does, because he is so, so kind) and witnessed said fall.  "Is your dad okay?"  Mr. N asked me, concern etching his face.  Oh man, guys.  Now I'm crying.  It's not my job to make everyone feel better about Dad.  It's supposed to be everyone else's job to make ME feel better about Dad.  But that's not how it is for a primary caretaker.  "He's okay," I assured Mr. N.  I explained about the change in chemo, and how Dad is tired and has a loss of appetite, but we're working with his doctor to get it fixed.  Mr. N wanted to know if I knew Dad had fallen.  I explained that he had told me, and that Dad drives me crazy by going outside in the snow.  Mr. N said he knows, he's always telling Dad to stay inside, but he doesn't listen (sounds about right).  He asked if there was anything he could do, and I said, "You already do by plowing out his driveway in the snow.  We're so grateful."  He said it was the least he could do.  

But it was just the last straw for me today.  I'm done with this day.  This days sucks, and I want a new day.

I guess my parting words are advice.  If you know someone who is very ill, the nicest thing you can do is not call up their primary caretaker and tell them how shitty they look or how you're worried about them.  The nicest thing you can do is offer to bring some food.  Or just bring the food, don't even offer.  Or you can shovel their steps in the snow, or you can bring them a good book, or just visit and keep them company.

Sunday, December 15, 2013

Silver Linings

silver lining: noun.  something good that can be found in a bad situation: a consoling or hopeful prospect.
- Merriam-Webster Dictionary

I'm not going to talk about my pregnancy, no cute ultrasound pics, no bitching about symptoms.  So consider this post "safe" although it might be a little bit of a downer?  Maybe?  Maybe not.  I have a hard time maintaining downer status.

I'm in a mood today.  I'm stressed over my dad.  As most of you know, he's 78 years old, has stage IV colon cancer (metastasis to his liver, lungs, lymph nodes, soft tissue in the pelvis), and lives alone.  Unlike most people with stage IV colon cancer, he's been at this point for nearly 5 years.  He responded incredibly well to chemo.  Most of his tumors are drastically smaller than they were when he was diagnosed (the pesky pelvic mass being the one exception, but at least it's not on a vital organ).  Anyway.  This whole year has been pretty stressful where my dad is concerned because he's had to change chemo protocols twice and the side effects have been worse than with the protocol he was on for 2+ years.  He's lost weight.  And he's seemed depressed.  Luckily it's being dealt with, and that's really the topic of another post.  But it snowed out here yesterday, and of course, of course my dad managed to slip and fall on the ice.  He's fine.  But he's a fucking ice magnet and I feel like he does it just to freak me out.  It seriously happens every time it snows.  So, I am feeling stressed and anxious and grumpy.

I have a very close friend, Liana.  We lived together in an apartment for three years in our early 20s when I was in law school and she was working full-time as a perinatal nurse.  We were next door neighbors our freshman year at college.  I've known her for 17 years.  A year after we met and became fast friends, she was diagnosed with multiple sclerosis.  We didn't know it at the time, but the type of MS she has is particularly aggressive and not particularly responsive to all the cool drugs they have now.  About three years ago, she had to make the transition into a wheelchair.  And about two years ago, she had to stop working as a nurse (her true passion in life) and she transitioned to permanent disability.  You will just have to take my word for it that the Liana I met in in 1996 was vibrant and talkative and funny and outgoing.  The life of the party.  She is still talkative and funny.  But MS has changed her in many, many ways.  She has had so much bad luck, more than anyone I know. 

This year, she finally got a lucky break - she was accepted to live in wheelchair accessible affordable housing that was built by United Way.  She loved it, and it was so great to see her blossom there.  Then in July, when trying to transition from her armchair to her wheelchair, she fell and "shattered" (the word of the surgeon) her tibia.  She has been in rehab facilities since then.  For a long time, she was working on losing weight and building up arm strength so that she could learn to properly transition from a stationary location to her chair.  Her primary goal was getting back to her beautiful apartment.  But then Medicaid bureaucracy wound up dumping her in a nursing home in November with no more rehab.  She's been losing the arm strength she worked to build.  Her family is working so hard to get her transferred to the proper facility, but you can imagine what it's like trying to make an impact with Medicaid while simultaneously not pissing anyone off in a way that could cause blowback for Liana's treatment.

Sometimes Liana likes to tell me things, really dark things, that she feels she can't tell other people because they freak out.  What she needs is to have someone hear her, validate her, and that in turn unburdens her and dissipates the dark feelings.  She e-mailed me this week with a blog post she had thought about posting, but thought better of because she knew it would upset people.  One of the things that really struck me about her would-be post was she talked about how she's always tries to find the silver lining in her bad life events, and that she hoped years from now she would look back on this incredibly dark time in her life and see that it had gotten her some place better, but that right now that just seemed so unlikely.

I wrote to her that I think that many of us are always looking and hoping for a silver lining.  But that sometimes terrible, shitty things happen to people, and maybe there is no silver lining.  Still, I hoped like hell there would be one for her at the end of this crap mountain that she's proverbially climbing.

It got me thinking about how I'm always doing that - looking for the silver lining in the bad things that happen to me.  My mom died in 2006.  And even though I'd give anything to have her back, I know that the reason Dad and I are so close now is because her death meant that we talked to each other more directly.  I think her death also forced me to be a better, more attentive daughter.  And when I think of my dad's cancer, well, I don't think Mom would have handled it well emotionally, and so I'm frequently thankful that she's not around to deal with it.  And what about the year Dad was diagnosed with cancer, 2009?  Terrible year.  Just terrible.  But Dad's cancer made us closer, it strengthened my relationship with Jeeves, and it made me a better advocate for my own healthcare, which was pretty important when it came to my infertility treatment.

Then I wondered what I would think about 2013 when I look back at it down the road.  It was a pretty shitty year.  We started treatment, I had a chemical pregnancy, then Dad had a bad scan and he had to switch protocols.  I had a failed IUI, then got pregnant, then had a miscarriage.  Then Dad had another bad scan and he had to switch protocols again.  My sister's mental illness flared up, my cat got sick and died.  But yeah, IUI #4 worked, and that was the first really lucky break we got this year.  Will I see a silver lining when I look back on all of this?  Or will I just remember that I got pregnant (doubtful that will be all I think of when I look back on this year)?

I know a lot of (most of?) the people in the IF community have had a terrible year.  And not just because of infertility, though that obviously makes it all worse.  Maybe shitty things just happen and when we look back, we won't see any silver lining from it.  Then today one of the women in my Facebook group was kind of freaking out because she is worried she might have pre-eclampsia.  Another woman in the group told us the story about the stillbirth of her first child 18 years ago, caused by placental abruption which was in turn caused by undiagnosed pre-eclampsia (it's a really scary and upsetting story that I will spare you).  After the stillbirth (and I might add, she nearly died in the process), she decided to put starting a family on hold and made the decision to go to medical school and become a doctor.  We all thanked her for sharing her story.  Here is what she said: "My experience has made me a better doctor than I could've been without it.  It's easy to look at the numbers and say 'your chance is 1 in a million,' but what if you are that 1 just like I was? So the good I was able to take from that horrible experience is my diligence to all my patients.  So my baby's death was not in total vain.... the only reason I share is so everyone whose path crosses mine will have a fighting chance to avoid negligence like this.  If I put it in your heads to speak up to your healthcare providers when you might not have before, then I'm happy."  I think it goes without saying that this lady is pretty tough, has been through stillbirth and infertility and miscarriage, and I admire her grit a lot.

Maybe there's not a silver lining for everything.  Or maybe finding the silver lining is a choice we make.  If it is a choice, I'm going to try really hard to look for it in the shitty things that have happened to me this year, and that will inevitably happen down the road.

As an end note, I'm trying to get a care package together for Liana - I would usually pack it full of her favorite candy and junk food, but I know she has worked hard to lose weight and I want to encourage her.  Can any of you recommend non-perishable healthy snacks?  I was thinking little bags of nuts.  Anything else that would be fun for a gloomy nursing home room?  Coloring books.  Definitely Care Bears coloring books (take my word for it, she'll like it).

Friday, December 13, 2013

Food issues and why I haven't turned into a pork pie. Yet.

This is a post about one of my major pregnancy symptoms.  If you're having a tough time right now, please go take care of yourself.  Next week I'm going to be blogging about the Sunshine and Lovely Blog Awards that I got nominated for, and also my favorite books of the year - no pregnancy talk allowed.  So please go drink some wine or take a bubble bath and take care of yourself, and enjoy this picture of spaghetti carbonara that I ate my first night in Rome back in 2012.  It was delicious.  All the pasta in Italy is delicious.  It's the law.

I think I've made it pretty clear from this blog that I love food, I love to eat, and I love cooking.  I have been lucky in this pregnancy that I am not/was not plagued with terrible morning sickness.  I experienced some nausea on four or five occasions.  But I did/do have plenty of digestive and/or food related symptoms.  From around week 6 or 7 on, I would feel really bloated and full after I ate a small amount of food.  My morning Greek yogurt would leave me feeling stuffed and kind of gross.  I also started having a healthy dose of acid reflux.  And stuff I usually really love (all Mexican food, ice cream, certain cheeses) suddenly sounded disgusting.

I am not heavy, and I was definitely one of those annoying people who, as a teenager and even in college, could eat whatever I wanted and still stay thin.  Try not to hate me too much - it didn't last forever, and I was really flat-chested back then.  Like most women, in my twenties, my metabolism slowed down and I suddenly couldn't eat whatever I wanted and forego all exercise and still stay skinny.  So I had to start exercising (blerg) and I had to stop eating cheese all the time.  And the older I got, the more pronounced it got.  It got especially bad when I moved in with Jeeves and we got married.  Plates of pasta like the one above probably did not help.  My point is this - my BMI is still in the normal range, but I can't eat whatever I want and stay that way.  We eat very healthfully most nights of the week.  I eat the same boring, healthy lunch and breakfast every day.  And I have some healthy snacks around the house, like fruit and nuts and popcorn that I pop in a paper bag (so good with a little chili powder on top).  I don't keep soda or Doritos in the house.  Sometimes we will splurge and get some brie cheese (my kryptonite), or I'll make ice cream, but we try to ration that shit.

When I did IUI, I lost a little weight - just a couple of pounds.  I attribute this to not drinking any wine (which I love so much).  And then I got pregnant and I thought about my sister and I got a little worried.  When my sister got pregnant with my oldest nephew, she was a regular gym-goer who swam almost every day and lived on veggie stir frys.  She was very fit.  Then she got pregnant, went totally hog wild with ice cream and other sweets, and she gained 50 lbs.  50 lbs!  On my 5'3" sister!  My nephew wound up being 10 lbs (he came out looking like a 2 month old) and my sister had to have a C-section because my nephew was so giant and would not drop down.  So I wanted to be careful about how much weight I gained.  For someone in normal BMI range, the expected weight gain in pregnancy is 25-35 lbs.

All the books I read said to expect weight gain in the 2-3 lb range for first trimester, but that some women would not gain at all due to morning sickness.  I used to always think it would be soooo easy for me to gain weight when I got pregnant and that I would actually have to be careful not to over-indulge.  My friends, that has not been a problem.  I am 13w3d pregnant and I have not gained a pound.  And that's starting to worry me.  The good news is that I think I am turning a corner.  Unfortunately, it's not a very pleasant corner.  Now I am at the point where if I do not eat every 3 hours or so, I start to feel ill.  You know that pleasant little feeling you get when you start to feel hungry and you daydream about what you want to eat?  Yeah, I haven't felt that way since before I was pregnant.  Basically what happens is I eat and then I feel quite full.  For awhile.  Then, quite suddenly, I am starving and feel like I must eat something immediately or I might get sick.  It's been lovely.  But it does mean that I'm eating more, and I have noted that a lot of my food aversions are starting to go away.

Have you ever seen the movie Fargo?  There's a scene where Frances McDormand's character, who is pregnant bends over and says "Think I'm gonna barf."  Then she stands up and says, "It passed.  Now I'm hungry again."  That about sums it up.

As I said to Jeeves this evening, these are not bad problems to have.  I don't mean to complain - I would tolerate a lot worse for this babe.  But it does feel weird to have such mixed feelings about food right now - to be both grossed out and constantly hungry, and to feel irritated at how freakin' often I have to eat now, since a few months ago, eating was probably my favorite thing to do.

Oh, and of course now, what's the one thing I really, really want to eat?  An Italian sub.  Which I'm not supposed to have unless I microwave the meat until it's steaming (gross).

On the bright side, I get to eat ranch dressing on my salad and not feel bad about it.

Wednesday, December 11, 2013

Reflections on a sad day

I'm sad today.  Everything is fine in Megs Land, but things are not fine in IF Bloggy Land.  My friend Adi (I used to call her Anne, but her name is actually Adi) from the Second Bedroom, who just got her very first positive pregnancy test the day before Thanksgiving, went in for her 6 week ultrasound today and got bad news.  Not only did she get bad news, but it was given to her tactlessly and callously by a jerk doctor (not her regular doctor).  I am a firm believer that ultrasounds before 7 weeks are generally bullshit and are designed to upset us.  So a small part of me still holds out hope that something miraculous will happen for her.  I think I've mentioned before that I am in a private Facebook group for other pregnant infertiles, and three of the women in that group had terrible scans at 6 weeks (empty sacs) that turned into fetal poles with normal heartbeats at 7 weeks.  So look, it can happen.  But I realize that those women are the exception, not the rule.  And indeed, if you looked back at my miscarriage last June, my story certainly wouldn't fill anyone with hope.

Adi's situation has me reflecting back on my own miscarriage.  I told her earlier today that while it was too early to make such a decision, if the time came and she wanted to know about my experience with a D&C, I would tell her about it.  As I thought about it, I figured maybe it would be best to just write it out here.  Maybe it will be useful to someone else down the road.  Adi, you're not alone, even though I know right now is probably the loneliest you've felt in a long time, if not ever.  This story won't be gory, but there will be some mention of bodily fluids, so if that grosses you out, feel free to skip this post - I'm hoping to write about happier things later this week.

Quick recap of my miscarriage.  I got pregnant with IUI #3 and had normal betas for the first 3, but the fourth beta rose much more slowly and my RE's office freaked out, worrying that it might be ectopic, so they made me come in for an early scan.  At 5w5d, I had one gestational sac, measuring behind.  At 6w5d, I had a gestational sac measuring on time, with a yolk sac.  At 7w3d, I finally had a fetal pole, but it was measuring 6 weeks (over a week behind) and there was no cardiac activity.  My RE diagnosed a missed miscarriage, but asked me to go for high resolution scan as a second opinion.  At 7w4d, my RE's diagnosis was confirmed.

My RE called me as soon as she got the confirmation to discuss next steps.  I could (1) wait for a natural miscarriage - this could take up to 4 weeks; (2) take medication to induce the miscarriage; or (3) have a D&C.  We discussed the pros and cons, but because I am me, I had already done a lot of research.  I knew I wasn't interested in waiting up to 4 weeks for a natural - I was terrified of being in the middle of a work meeting, or out to dinner with friends and suddenly being incapacitated by cramps and bleeding.  I was concerned about taking the medication because I had read a study that indicated that up to 30% of the women who take the meds wind up having to have a D&C anyway.  I had also read some anecdotal stuff that made me worry about the amount of pain I could expect from the meds.  My fear with the D&C was the risk of scarring.  I talked it over with the RE and she confirmed there is a small risk of scarring with a D&C.  Ultimately, I decided I wanted to do the D&C - my RE could test the products of conception (POC) and tell us what had happened (some REs will test the POC for you if you collect it at home with a natural miscarriage or from taking the meds - my RE doesn't do that), I would be in control of something, and the physical pain would hopefully be less.

At 7w6d, I went in to my RE's office for my D&C in the morning.  It was mid-June, but it was cold and rainy, which seemed about right given my mood.  Of course Jeeves came with me.  I checked in and was called back right away.  I had gotten a little snotty with the desk clerk who told me that I would have to provide a urine sample - turned out he was wrong.  I was pissed about it because they don't want you to drink or eat anything after midnight and I had already peed that morning.

I got into my little gown, booties, and put my shower cap on, and then sat in a chair, waiting to be brought back.  Dr. R, one of my REs, was there, greeted me and asked me some questions.  Then I met the anesthesiologist, who was so very nice.  "I see you brought your veins!" he said, gesturing to my hand.  We talked about my previous experience with general anesthesia (from wisdom teeth extraction), and then I had to sit and wait a few minutes.  As I was sitting, they wheeled the last patient out.  She had clearly just had a D&C.  I say "clearly" because she was crying and wailing to the nurse "It's just so sad!  So sad!"  She was also in a lot of pain!  The anesthesiologist had to give her a shot of something special, and she would periodically moan, back behind her curtained area.  That seriously freaked me out.  "Everyone on the internet said that a D&C wasn't that painful!" I internally spazzed.

They brought me back to the operating room, and the table was quite comfy.  The very first thing Dr. R did was check one last time on ultrasound to make sure nothing had changed.  I had read some stories on the internet about women who got to this point and there was miraculously a heartbeat when the doc did the last ultrasound check.  That didn't happen for me.  Nothing had changed at all.  It was sad, but it reinforced for me that I was doing the right thing.

The anesthesiologist put the IV line into the back of my hand.  That was seriously the most physically painful part of the entire process.  Truth.  As he did that, we talked about my job, the mayor of New York, Germany (where he was from), and the environment.  He was really good at distracting me, and I'm still thankful for that.  At one point he asked me if I had any children, or if this would have been my first.  I explained that it would have been my first.  He asked if we would try again. I said yes.  He said, "Good.  Don't give up.  It's so worth it in the end."  I appreciated his kindness.

Dr. R and the nurse came back in, and after they confirmed for the gajillionth time that I wanted the POC genetically tested, the anesthesiologist put something in my IV line and I remember thinking, "Hmmm, those lights look funny."  

What felt like a few minutes later (but was in fact, closer to 30 minutes later), I woke up to the nurse and the anesthesiologist wheeling me down the hall, repeating my name.  "It went really well," they reassured me.  

I had cramps.  They felt like moderate menstrual cramps.  The nurse asked me what my pain was on a scale of 1 to 10, I called it a 5.  She gave me some Tylenol, and that did the trick.  She had to help me get them in my mouth though, because wow - hand/eye coordination was not working.  I then sat in my recovery chair, munching on graham crackers, and drinking juice.  After about 30 minutes (but it felt more like 5 - the anesthesia really plays tricks on your internal clock), I was ready to get up and get dressed.  I was given a thorough discharge sheet (I would have to come back in one week for an HCG test, and every week after that till it dropped to zero) that explained what I should expect, and what would be considered abnormal.  It also admonished no sex, no swimming, no tampons till my HCG was negative.  I think some REs only make you wait 2 weeks.

I trudged out to the waiting room and Jeeves and I left and caught a cab home.  I was really tired.  I got into my jammies, got into bed, cuddled with my kitty cat, and promptly fell asleep.  I had very mild cramps off and on that day, and I took some ibuprofen for them.  I ate a little soup.  By evening, my appetite was normal.  I went to bed really early.

I was sad, but not nearly as sad as I had felt during the two weeks of ultrasound hell.  I was glad that it was done.

The next day, I felt fine.  I went for a walk and had a little cramping, but it was mild.  I went out to dinner with friends.  By Saturday I felt completely fine, physically, and Jeeves and I made sure to do fun things over the weekend.

I had a tiny bit of spotting for a day or two.  Then nothing.  About 5 days later, I started bleeding clots.  This happens to some women, whereas other women will have nothing.  It was upsetting, but there were no cramps with it (cramps and heavy bleeding can indicate that tissue was left behind).  I called my doctor, but she reassured me it was normal.  The clots stopped.  My HCG levels dropped.  Four weeks after the D&C, my HCG had finally dropped to negative, and a few days after that, I had a period.

The toughest part emotionally is that after a D&C (and this is true for natural or drug-induced miscarriage as well), your HCG plummets pretty quickly.  This sends your body into "hormone withdrawal" which in my case caused my clotty bleeding, but also caused me to get quite weepy over things that would not normally make me weepy.  It was even the subject of one of my first IF posts.  

This is just one woman's experience.  I know plenty of people who waited for a natural miscarriage and were happy they did, and I know plenty of people who had a drug-induced miscarriage and were happy they did.  There's no right or wrong answer here - just a shitty situation where we get to make a choice about how we want to handle it.  

In the end, I'm standing on the other side of this at 13w1d pregnant with a son.  I know it doesn't feel like it now, and it probably won't for quite awhile, but I really do believe that good things are ahead. For all of us.

Monday, December 09, 2013

Son or daughter

I think I've mentioned on more than one occasion that I have three nephews from my sister and two nephews from Jeeves' brother.  I love them all very much.  But my very first nephew, Connor, is my mini-me, and I know I shouldn't play favorites, but he's kind of my favorite.  He was my first nephew, I was at the hospital when he was born, and from the time he was a newborn until he was about 8, we saw each other all the time because I lived nearby.  Now he is 11.  He is a sweet boy and he's turned into a little nerd.  His idol is Stephen Hawking, and he made me a Power Point presentation of what he wanted for Christmas, complete with suggestions for who should buy him what.  He loves outer space and physics, and he loves telling me about Dr. Who.  Unlike his auntie, he is popular in school, and even got elected Student Council treasurer.  He is my pride and joy, and it's been like that since he was born. 

My other nephews are wonderful too and I have a good relationship with all of them.  Despite the fact that I am so used to boys, before we started dealing with infertility I always wanted a daughter.  I had a bunch of girls' names I liked, and there were so many boys in our family, I thought a girl would wind up being a pretty big deal.  I knew my dad really wanted a granddaughter (he never shuts up about how he prefers girls, and how happy he is that he had daughters).  So did my mother-in-law, and I knew my sister wanted a niece.

Then we started struggling to get pregnant, started IUI, and I thought, "I really don't care, boy or girl, I just want us to be parents."  And that was compounded by the miscarriage.  

But this time, as we made it through different milestones, I think I started to hope again, not just for a healthy child, but maybe a little for a girl.  It wasn't a strong tug, but it was there.  Jeeves and I used to joke that we would each be okay with having just one child - but that was only true for me if our first child was a girl, and it was only true for Jeeves if our first child was a boy.  But as we were plugging away towards finding out the gender, I think Jeeves started to hope for a girl a little bit too - the first girl in our families!  How exciting would that be?!? And when we talked about names, we only talked about girls' names.  Let's face it - there are a lot of good girls' names out there.

So, last Monday Dr. R called me at work to tell me that our MaternitT21 results were back and the baby looked healthy.  Yay!  That was the most important news.

Dr. R: Do you plan to find out the gender?
Me: Yes!
Dr. R: Okay, do you want to know now?
Me: Yes! Tell me!
Dr. R: It's a boy!
Me: A boy!

I don't want anyone to think for a second that I didn't feel happiness at what she told me - I did.  I called up Jeeves at work, told him the good news that the baby was healthy and then asked him to guess gender - he guessed boy.  That night we discussed it, and admitted that maybe a little tiny part of us had hoped for a girl, but that a boy was great and we are super used to boys.  "Maybe this just means that we should have a second kid down the road!" I said.  "Let's see how we handle one first," Jeeves retorted.  He is, of course, right.  Even though I always thought I would have two kids, I am no spring chicken in the childbearing department, and as our attempts to have children took longer and longer, I realized that we might wind up only having one.  

We also started talking about boys' names.  There are a lot less that we like/agree on than in girls' names, but we've come up with three so far, which isn't bad.

As for our families, they have responded in different ways.  My dad admitted that he had hoped I would have a girl.  Whatever, he'll deal.  My sister, whom I tend to assume will always say the wrong thing (she says the wrong thing A LOT), surpassed my expectations (as she has the entire infertility journey, by generally never saying anything stupid or insensitive) by telling me that she was "thrilled" I was having a boy, and reminding me she is the expert on boys and is always there to help.  And my MIL said "Another one for team blue!"  I said, "Yes, I think that's all this family can make."  She laughed.  Jeeves and I hope that our baby will be loved by our families because he's ours.

That night, I thought, "I'm going to have a son.  This is my son making my belly stick out." It made it more real.  On Thursday at the scan, when I looked at the picture I could see his little toes.  "Those are my son's toes," I thought.  Love love love.

Thursday, December 05, 2013

On the cusp

Warning - pregnancy talk and scan pictures ahoy!  If you are in a bad place, skip this post, have a nice glass of wine, put your feet up, and check back for the next post where I will surely be talking about Kettle Chips Zesty Ranch flavor, which, ahem, yes, I ate the bag by myself.  To serve as a buffer, please enjoy this picture of "War Fries"or patat oorlog as the Dutch call them.  That's peanut satay sauce, mayonnaise, and onions on fries.  They are amazing.  I don't know why this isn't a thing here.

Okay.  So big things happened this week!  First and foremost, I hit 12 weeks.  According to everything I have read, 1st trimester doesn't end till 13 weeks, but still.  12 weeks!  That also means my nuchal translucency scan was this week.  Today in fact!  But I'm getting ahead of myself.

You may recall that I mentioned having the MaterniT21 screening test done at my last OB appointment.  I was told results would be back in two weeks, which would mean this Friday.  But on Monday, late afternoon, I was sitting at my desk and my OB called.  Results were back already!  The great news - everything came back normal.  MaterniT21 is a cell-free DNA test, and it's one of the few perks of being made to feel like you are 123 years old - it's only "approved" for women who will be at least 35 when their baby is born.  You can still get it if you're younger, but your insurance probably won't pay for it, or so I've been told.  Anyway, cell-free DNA testing has a higher predictive rate for trisomies 13, 18 and 21 (aka Down Syndrome) than the first trimester screening (which is a blood test for HCG and PAPP-A plus the nuchal translucency scan (NT)) while also having a lower false positive rate.  So the fact that everything came back normal is really promising.  But I still had to go for the NT scan because as great as MaterniT21 is, it can't tell you anything about anatomical defects, like a heart defect.

At first I felt great about these results and thought the NT scan would be a breeze.  But one of the expectant moms in my Facebook group also got good results from her M21 test, but then got a bad NT scan that indicates potential for a heart defect.  She won't know for sure until she has a fetal echocardiogram, which isn't for another 3 months.  There's always something to worry about.

I had to go into the NT scan with a full bladder, and holy moly, it took a lot of concentration to not piss myself when the tech started pressing down on my abdomen.  The bun was chillin', and at first I couldn't see its heart beating, and I thought the tech had turned on the sound, but we didn't hear anything.  I thought the baby had died.  Jeeves thought the same thing.  But two seconds later, she really turned the sound on and we could hear the heartbeat and as she moved the wand, we could see it beating too.  Sweet relief.  Still, because I am neurotic and crazy, I did worry that the bun didn't seem to be moving much.  More on that later.  She took all the measurements and immediately said, "there's the nasal bone!  Very good!"  The nasal bone is one of the main things they look for in the NT scan.  She measured the bun, showed us its legs, and one arm.  She didn't show us the other arm (Jeeves worries now that it only has one arm, to which I said, "Well, then we'll love our one-armed baby."  And we will.).  She measured the nuchal translucency and it was 1.1mm.  The doctor told me afterwards that that is about as small as you can be and still be measurable (small is good - it indicates lower risk of trisomy 21 and heart defect).  It really looks like a baby, you guys!  It is also measuring 57.3mm from crown to rump, which is 2.25 inches.  Crazy.

After the scan was done, we met with the doctor.  He walked us through our results and explained that with the combined blood and NT scan, my risks for the trisomies went from 1 in 235 (for Down Syndrome) and 1 in 416 for trisomies 13 and 18 to 1 in 4,681 for DS and 1 in 8,301 for 13 and 18.  In other words, I went from the risk of a 36 year old to the risk of someone in her early 20s.  Woohoo!  BUT, with my MaterniT21 results, our risk for DS is now down to 1 in 346,394.  Now, the thing is, these are screening tests, NOT diagnostic tests.  Only a diagnostic test like CVS and amnio can really tell you what's what in your uterus.  But with screening results like this, I feel no need to do the diagnostic tests and run the risk of miscarriage.  We'll still have an anatomy scan at 18-20 weeks to make sure everything is okay, and we'll do the quad screen to check for neural tube defects.  But I'm feeling pretty good about all this for now.

A couple of pictures of the wee one.

This one right above is kinda cool cause you can see the legs and little toes.

Oh, yeah, and I spazzed a little about how the baby wasn't moving much.  The doctor showed me the pictures sped up and it was moving, shifting a bit.  But not waving little arms or legs the way I expected.  The doc said it's normal - that they go through phases of activity and sleep and just sitting there.  So no worries.  Hopefully it will be moving around more at the anatomy scan.

You might recall that I mentioned a couple of weeks ago that MaterniT21 can tell us the gender.  Well, we found out the gender of the bun on Monday when my OB called.  Now that we're so far, and we've gotten such good news, it's time for us to tell our friends.  Some of them are like family to us, and I feel bad spilling my guts all these months to the blog and keeping such big news from them, even though I had my reasons, and I know you guys get that.  Plus, Phil and Anh (real life friends) read the blog, and I don't want them to learn the gender from this post.  So once I've sent out that e-mail to them, I will write a separate post about the gender of our kid, and our reaction to it.  

Okay, time to stuff my face.  

Monday, December 02, 2013

Courage for the Present

"Don't be scared, Shroom said.  Because you're going to be scared.  So when you start to get scared, don't be scared.  Billy has thought about this a lot, not just the Zen teaser of it but what exactly does it mean to be scared out of your mind.  Shroom, again: Fear is the mother of all emotion.  Before love, hate, spite, grief, rage, and all the rest, there was fear, and fear gave birth to them all, and as every combat soldier knows there are as many incarnations and species of fear as the Eskimo language has words for snow."

I was going to write a cutesy little post today recapping my Thanksgiving weekend and my feelings about what I cooked, and how I miss my mom.  But I got another idea based on some things that have happened in the last few days.

In the last few days, there has been some really awesome news in IF Bloggy Land.  Anne at The Second Bedroom got a positive pregnancy test (that's what we call a "BFP" in the IF world, to my non-infertile readers) the day before Thanksgiving.  Anne was probably the first person in this community to read and support me in my journey, and she is kind and good and will make a wonderful mother.  And then a few days ago, Stupid Stork, whose blog posts pretty much kept me going during the darker days after my miscarriage, who considers Frida Kahlo to be the patron saint of infertiles just like I do, and who is pretty much the reason I started blogging about this stuff, got her BFP.  Her infertility journey has been crazy and scary, and seeing her get a BFP made me so, so happy.   I mentioned all this news to Jeeves at different points in the last few days and he said, "Everyone's getting pregnant!  They're dropping like flies!"

But, no.  No no no.  Because Marcy just got another negative, and Kasey's last cycle didn't work and she's starting IVF soon.  And there are so many others who are still at it.  And I know they are happy for the pregnancies they see in the IF community, but sad for themselves.

Over the weekend I got to visit with Kate (whom you may recall is my BFF and she is about 6 months pregnant and I am throwing her baby shower in January) and her family in Jersey.  Kate's little sis has struggled with infertility for over 3 years now.  Her second IUI worked, and everything was looking good, but she miscarried because the embryo implanted too close to a uterine septum (which had been mostly removed, but a small percentage was left behind).  Suffice it to say, she and her husband were devastated.  She got pregnant again through IUI, at the same time I did back in May, but a couple of weeks after my miscarriage, she miscarried too, this time with chromosomal issues.  She has been my cycle buddy for most of this year and we would text to cheer each other on, and we supported each other when we found out the surprising news that Kate was expecting.  I haven't told her I'm pregnant yet.  I kept waiting for the right time, and then I decided to just wait until I was a little farther along, but here I am, almost 12 weeks, and I still haven't told her.

While visiting Kate's family (which included her sister, her parents, and grandparents), the conversation turned towards Kate's pregnancy and her very difficult first trimester.  There was a lot of pregnancy and baby talk for a good chunk of the evening.  It didn't bother me, because even though no one at that table knew I was pregnant (except for Kate and Jeeves, of course), I am, and being pregnant does help make certain conversations that are torture when you're not pregnant suddenly palatable.  Still, I squirmed thinking of Kate's sister and how this must sound to her, especially when she had to get up and go take her Gonal-F shot.  At one point I looked over at her and she didn't roll her eyes, but she had a look on her face like, "Ugh, fertiles."  And I smiled and nodded, because I know.  I know.

When we said good-bye, I hugged her and wished her luck on this cycle, and she asked me how things were going for me and I said, "Good, I'll tell you about it later."  I may be alone in this, but I'm a firm believer that the best way to tell an infertile you are pregnant is not face to face.  It is via e-mail or phone call or text message.  Give me a goddamn chance to cry for myself, and then I will be happy for you.  

Then I got home from this weekend and I logged into Feedly because I have been waiting with baited breath to see what happened in the lab with Smile's eggs.  It wasn't all bad news - they got 4 to fertilize, but 4 out of 20 certainly confirms her fears about her egg quality.  And I know she's scared that these 4 little badasses won't be good enough.  And then I noticed that another blogger who comments a lot on Smile's posts had also had her retrieval on the same day, but when I clicked through to read how her fertilization report went, I was sad to see it was a disaster, and she and her husband have decided that they are done with treatments.  

We, as a community, get good news and that fills a lot of us with hope and keeps us going.  But there's always bad news in there too, and it's hard for me to not think of the women who are struggling, even as I see friends getting positives.  

In Billy Lynn's Long Halftime Walk, which I quoted above (and one of my favorite books I read this year - it's so, so good, you guys), our hero, Billy, who is home for a short leave from the Iraq War, is musing over things his Sergeant, who was just killed in action, used to say to him.  A lot of the book deals with the notion of fear.  I realize that it may be an inartful comparison - I certainly don't mean to equate war to infertility, but I do think that a lot of the fear that Fountain talks about is the fear of things beyond our control.  Fear about things beyond our control is pretty much where the Infertile lives all the time.  I used to repeat that line "Don't be scared.  You're going to be scared, so when you start, don't be scared," whenever I would allow my mind to wander to what would happen if x, y, or z treatment did not work for us.  It became like a mantra.  It didn't make me less scared, but somehow recognizing the fear helped me put it aside and not live in it.

I don't have any great epiphanies to share.  But I'm just writing this so that the women who are getting their BFPs know that I am so happy for them, I hope the rest of this journey is smooth and easy and drama-free, and I do believe they give a lot of women hope.  But I'm also writing this so that the women who have gotten bad news, or who are in the middle of a scary cycle, or who don't know what the future holds know that I'm thinking of them, wishing them courage and hope.

Jeeves and I set up our Christmas tree this evening, and we had a Christmas music-only station on.  I heard a quote that I liked because it made me think of all of you.  "What is Christmas?  It is tenderness for the past, courage for the present, hope for the future.  It is a fervent wish that every cup may overflow with blessings rich and eternal, and that every path may lead to peace."  To those of you in IF Bloggy Land, I am wishing you much courage for the present, and hope for the future.