Friday, January 16, 2015

The Differential Diagnosis Always Includes Pregnancy

Here's another one from my past...I'm pretty far past this point but it is interesting to see how my feelings have evolved over time. I thought I would share for those of you who have also felt puzzled by this awkward question.

* * *

I can't REALLY blame you for asking, we look like we'd be great parents, right?

Have I posted about this already? I honestly can't remember, but it keeps coming up, especially in light of my recent bout of illness.

Can people please stop asking if I am pregnant? 

I think I got asked 20 different times the past week, and each time the answer was no. 

I don't think I will ever be at risk of being on one of those Lifetime Original Series type shows, I Didn't Know I Was Pregnant. I pay pretty close attention to my body. I understand that some of the symptoms of early pregnancy are fatigue, nausea, vomiting. But I also understand that those are some of the symptoms of residency, influenza, food poisoning, and cancer. Just because I am hungry or sick or tired or cranky doesn't mean that I am pregnant. And I don't like thinking I am not allowed to feel much of anything without falling under suspicion.

People are probably just trying to helpfully remind me of this option. "Have your realized that maybe pregnancy could be in the differential for how you are feeling?" (For those of you not in the medical field, a "differential," or "differential diagnosis" is a list that includes the top most likely medical problems that are associated with the present signs and symptoms.)

Or maybe they hope to be one of the first to make the baby diagnosis? "Yes, I knew it!" 

Or maybe they are just being hopeful as they must clearly recognize what amazingly beautiful offspring I will have considering my good looking husband. "I hope you are because I can't wait to see your babies!"

Whatever the reason, it makes me feel a little embarassed. Or annoyed. (No, I don't think I'm pregnant unless pregnancy includes fevers, chills, sore throat, and diarrhea, as well.) And it makes me unsure what to say because it almost inevitably is followed by, 

"Are you sure?"

Which really baffles me. I'm not sure what I am supposed to say here. A simple, "No, I'm not pregnant," doesn't seem to be enough.

Should I say, "Actually, it has been xyz since my last cycle, which would suggest that no, I am not?" Or would more information on my private life with my husband be helpful? Can I bring up my calendar app on my phone or should I take a pregnancy test? 

Can any woman truly know with certainty at any moment that she is 100% sure she isn't carrying a bun in the oven (with a few exceptions)? This is why they do pregnancy tests on all women ages 11-50ish before surgery at our hospital. (And even then, pregnancy tests have to be correctly timed.)

Actually, I am glad I wrote this post because I now know exactly what to say,

"Are YOU? You know many women don't have any symptoms of early pregnancy."

And now we are back to the Lifetime network. (You Didn't Know You Were Pregnant)

When I am pregnant, I anticipate I will be asking myself those same questions without prompting from you. And when the time is right, I would appreciate if you would let me inform you in the way and time that I prefer. Until then, I hope to not have to share my fertility status with any acquaintance I meet who happens to notice I may not be feeing or looking so well. 

And finally, despite how awesome you think it would be for me to have a baby right now, I'm the one that has to make it work. 

Thursday, January 15, 2015

Embryo Harvest -- The Ultimate Stay-cation

With the first phase of my board exam behind me just a few wee hours, I am ready for some blogging.

I thought I would start at the beginning of my IVF treatment. Some of these posts were written months ago, some are still unwritten, and others will be a little of both.

I wanted to delay my postings, partially for emotional reasons, partially for privacy, and partially for logistical reasons, like deciding when to tell work. Telling your boss you are hoping to have a baby can be awkward and a little scary.

* * *

Getting ready for some belly shots
After completing my residency at the end of June, I had a choice:

Vacation or IVF.

I had spent 5 years in residency. I felt I deserved a much needed break traveling somewhere lovely and tropical as a reward for my hard work before beginning my life of work at my new job a few weeks later. 

Or I could spend my two weeks off at home nursing my ovaries.

After much deliberation, I felt that as much as I hated the idea, ovary time it was.

I knew it would be the easiest and most stress free way to undergo the treatment which had the possibility of making me uncomfortable and would keep me at the beck-and-call of my doctors for almost daily ultrasounds, blood tests, and appointments.

So a few weeks before finishing residency I started the hormones. This was really great for our end of year banquet. Yes this means I cried.
Proof I was pretty hormonal
Before you get started they send you a medication calendar. This is because things get very overwhelming and confusing without it. You pick up your first of many bags at the pharmacy and have your first little heart attack when you get your pharmacy bill. Thank you insurance! You never quite get used to the receipts but it is more like chest pain than an actual heart attack with time.

Your medication timeline.
Just gets more tricky with time as you add more and more drugs into the mix!
Sadly this was a smaller receipt than many others!
The first bag of many bags-- feels like grocery shopping at the pharmacy
The first pharmacy shopping list. Overwhelming?
I give injections to patients all day every day, but I am a bit of a needle-phobe myself (with a history of fainting). So I was quite nervous to begin. Abe was on-call working nights when I had to start my injections so my friend Dr. B. was nice enough to assist me with my shots most days when he wasn't available. 

Friends don't let friends administer their own shots.
At least not at first!
During normal ovulation, usually only one follicle (containing the egg) grows. During IVF, the Docs are in control and they stimulate as many of your follicles to grow as possible. If you are like me (Polycystic Ovarian Syndrome), then you may grow A LOT of follicles. The clinic monitors this with ultrasounds every few days to check on the progress of the growing follicles.

Drugs Drugs Drugs
The follicles have to be over 1 cm in size before they can be collected. Once they reach adequate size, you are ready for the harvest. I was really hoping for a harvest on my birthday at the end of June so I would have plenty of time to have my transfer before starting work on the 7th. Unfortunately, mine were a bit behind schedule and this pushed my harvest and the subsequent transfer back to the 7th (A big day -- our anniversary, my first day at my first real job, and now our transfer). Bad timing and another issue for later.

By my last ultrasound I had almost 40 enlarged follicles about the size of those jumbo grapes you see at the grocery store. So, by my birthday I was feeling pretty uncomfortable and bloated, walking around with two huge bunches of grapes in my abdomen. Luckily I wasn't out and about too much or people would have wondered why I was walking like a 9 month pregnant lady.

Come early July, my follicles were finally ready for harvest. Abe met me after rounds for the procedure, performed under sedation. The doctors use a needle to collect as many follicles as they can from the swollen ovaries. Some people complain of pain after the procedure but I luckily didn't experience any immediate discomfort.

Ready to go!
After a short recovery time, you are allowed to go home and rest. You aren't supposed to do any vigorous physical activity, and need to monitor fluid intake and urine output, and watch for any symptoms of hyperstimulation (an uncommon but serious complication from all of the hormones).

Feeling groggy afterward.
 It was weird to be the patient this time instead of the one doing the sedation for someone else
I felt pretty good right after getting home, but by the end of the evening I felt very uncomfortable, super bloated, and I had gained 7 pounds in one afternoon. I felt nauseated and Abraham said I looked like I was already pregnant. After a few days of taking it easy I started to feel back to normal.

A few days later we got our report from the reproductive endocrinologist. I was very lucky as I had a great response!
They collected
33 follicles...
27 went on to fertilize...
25 fertilized normally ...
6 survived to day 5 growth (in a petri dish, not a test tube!)...
leaving us with 6 blastocysts (embryos) ready for transfer.


Wednesday, January 7, 2015

Bored, Bored, Boards

Some of the books I've been using to study feel off the top of this big stack. 

I started studying for the first phase of my board exam (for Oral Maxillofacial Board Certification) this fall. It feels like that's all I've been doing (even if this post will demonstrate that isn't quite true). I have been wanting to blog for weeks but have felt guilty taking the time rather than studying (silly?). Today it is my day off, the high temperature is -8, and I think I need a bit of me time to blog before hitting the books again. I'm getting pretty burnt-out, with only about a week to go before the massive brain dump of the 7 hour test is upon me!

Life has been crazy since my last post. From mid-October until mid-December Abe was away on a rotation in Mason City, IA, a small town almost 3 hours away from home. He only had a few weekends off when he was able to come home. So, most weekends I would make the 4-5 hour drive from Burlington after work to meet him for the weekend. Not very fun after 10 hours of driving during my commute each week.

Nine weeks is a long time to be separated and I am so glad he is home now! But, his absence did mean I was able to get a lot more studying done.

Visiting the crash site of Buddy Holly while in Mason City

Christmas parade and fireworks in Clear Lake, IA close to Mason City

Part of my board preparation included a trip to Denver in November for a preparation course. The course was quite intensive, the weather unseasonably cold, and the trip definitely business (sometimes classes would last from 8 am -8:30 pm). The best part was seeing old friends from college, the Marsh family and having an alumni BYU Women in Dentistry Club 2005 meeting by going to lunch with Tara Bruggeman and Laura Milroy, the only two women in the club with me at that time. It was so cool to meet up with them and see how far we have all come and to share our common experiences as LDS women dentists. If you live in the Denver area look them up because they are amazing and committed dentists.

We have continued to have some disappointments in the fertility department. During this time we completed two more embryo transfers. This includes daily painful shots in the hips and multiple medications by mouth. Abe was gone for part of this time which made the shots difficult. Luckily I know some helpful nurses. After three rounds of failure, the doctors seem puzzled by our lack of success. Each disappointment has been harder to swallow than the past. I am trying to stay positive and hope we will have success on further attempts, even though even the doctors agree it should have worked by now. It is hard to not ask "How many times do I have to do this, only to find out it wont work?" But I do feel lucky in many ways (we still have embryos left!) and as time goes by I find more and more positivity to go forward.

Medications and supplies from my last round

We were both able to take a few days off around Christmas and the New Year this year. What a blessing after years of holidays stuck working in the hospital. We joined Abe's family in Chicago right before Christmas with his family and spent the New Year celebrating on our own with a staycation in downton Iowa City.

Beignets at Grand Luxe Cafe Chicago-- I was feeling a bit like the Grinch on my shirt after nasty Chicago traffic

In a lot of ways, it has been a difficult past few months. This is ironically supported by the fact that as I was planning this post I found out my grandmother passed away yesterday after a long battle with Alzheimers. 

To be honest, it feels a bit like the bad/sad news keeps coming lately. I also recognize many blessings in my life despite or maybe in relation to the challenges. 

I am looking forward to the New Year with some (tempered) optimism.  I'm hoping for some better news including a passing board score, a successful pregnancy, and some continued improvements in my other goals this year. 

Friday, October 24, 2014

Rainy Days and Mondays

This morning I woke up early after a restful but somewhat fragmented sleep. I got a few things ready around the house and then headed in to the hospital in the dark, misty fog, parking in the old familiar staff parking lot (but feeling a bit like an imposter) and heading up to the Women's Clinic. I obtained my lab requisition and headed over for a blood draw.

I waited outside the door, until the lights turned on signalling the presence of a lab tech and the door finally unlocked. It was probably 7:01. I was anxious to be on my way to work and every minute counts, but mostly, I was anxious for the results.

I sighed and was relieved it only took one poke to get the required blood. I rushed back out the door, foregoing my jacket after a burst of hot flashes -- I think excitement, nervousness, or wasit merely hot in there or I was overdressed in boots and a scarf? Maybe it was just the hormones I've been pumping into my system multiple times per day for the past months.

On the road, I tried not to think about it as I maneuvered through the fog. I pulled in behind a semi truck going an appropriate speed and let him lead the way as I wondered what the result would be and when I would hear. 

I had been expecting the worse--preparing myself for the worse for the past 10 days. I wondered if this was the right way to go or if I should have had hope by default.

I wondered if I would have to wait until 10:30 again to hear the results. I was relieved when Abe called me about 8:15, when I was about 15 minutes from work.

"Unfortunately, it didn't work again."

"Ok, I expected that," I said.

"I feel disappointed again."

"Yeah, I know. I don't feel anything yet."

I was grateful to hear before arriving to work, having to wait for hours, wondering and feeling distracted while trying to take care of patients. Wondering if I would have an unprofessional emotional response. But I made my way in, slightly late from the appointment but maybe more so because of the thick fog I had driven through, physically and emotionally. Changed into scrubs, I headed to work and back to what seems to be becoming more and more my normal life.

At least I get to stop the shots for a few short weeks. Just as I was getting good at them, too!

* * *

We have been doing IVF since the end of June. This was our second embryo transfer and our second negative result. It is hard to know how I feel after the negative results again. For some reason I felt I had to just quickly pound this out, while I wait for my last few patients of the day. I guess I just feel like I could use some support as I try to sort through this all and no reason to keep it a secret anymore.

Friday, October 10, 2014

The Reality Of The Test Tube Baby

Trying to look nerdy and "science-y" in my fake glasses
When I was a little girl, I remember one cozy night sitting in bed. After my mother finished telling me a story about a mom and her baby, I told her,

"When I grow up, I want to have a test tube baby!"

Alright, obviously that never happened!

I don't think anyone thinks that in vitro fertilization will be in their future. Even after having trouble,  because my twin sister got pregnant on clomid I assumed I would, too. A few months of some pills and BAM! -- my baby would be on the way.

When the doctors told me that I would most likely need IVF to become pregnant, I was very upset. Up to that point I hadn't had the chance to mourn my infertility. I had been heavy in the trenches of residency and a baby would have just complicated matters. Every month I wasn't pregnant was a disappointment but also maybe a sigh of relief. One more month of not having to "make it work" during long hours of call, late nights, coordinating day care and call schedules and managing pregnancy symptoms in the OR, etc.

After months of oral medications (clomid and letrazole) we were told to have a predictable chance, IVF would be the way to go. Despite feeling nervous and a little dread, I was relieved to be moving forward, to have a plan. And I figured that although I knew it was "hard" that it would work.

Abe can look "science-y" too, but he has a PhD so it should be easy for him!

I definitely had to take some time to mourn my infertility after having the reality of it slap me in the face (or more like stab me in the belly with a medical-grade needle)! Suddenly this was all very real, not just an inkling I had always had. I hadn't had the years of heartbreak to realize something really was wrong and to prepare myself emotionally to jump right in.  Yes, I had experienced months of disappointment but it felt sudden to begin expensive and intensive treatment when I hadn't ached for that little baby yet. And I wasn't ready to give up my romantic ideas regarding a natural pregnancy, (things like the surprise of a positive home pregnancy test) for the sterile cold world of a procedure based conception.

My disappointment turned to dread after my consultation with the doctor which gave me a new understanding of what the treatment actually meant.

Did you know:
That IVF means you will administer shots daily for weeks? I'm talking sometimes 4-5 times per day, in varied places (belly, thigh, hip, butt) and at varying times of day.
That the hormones can make you feel pregnant before or even if you are not? Yay for mourning sickness, bloating, weight gain, etc when you aren't even pregnant.
That you can have serious complications from the treatment--complications that could be life threatening? It's called Ovarian Hyperstimulation Syndrome.
That your baby has a higher chance for birth defects?
That you have a higher chance for multiples even if you just implant one embryo?
That it may not work the first time--or ever? There is about a 50-60% chance of success each round.
That it costs thousands of dollars just for a single trip to the pharmacy, not to mention appointments and procedures?
That you may have doctors appointments, blood draws, ultrasounds every day during treatment?
That you have to sign consent forms regarding what to do with your embryos if your spouse dies or you die or you both die? Or that you have to figure out what to do with the "extras" when you are done?

I didn't. So I'm not surprised people started congratulating me and acting as if I was already pregnant when I told them I had to do this treatment to be successful. Still, this made me very upset.

I felt like, "Really! Really? Is it congratulations that I have to go through all of this to maybe not have a baby anyway? Is it congratulations when people are accidentally getting pregnant or aborting babies and I have to stab myself every night with painful shots that make me wacky (when I am needle phobic)? Or to have complications and end up disabled or dead?" (Dramatic, I know, but sometimes feelings aren't always rational or boringly sensible.)

I was also wondering if I was ready to be a mom, if I wanted a baby enough to go through all of this, if I wanted a baby "as much as a car" when comparing the financial aspects of it. And of course I did, but I was nervous to make that commitment, especially since I hadn't had the years of struggle and heartbreak I felt were almost a requirement or a right of passage to get to this decision.

And I was scared.

Then I talked to Channa.

Thank goodness I found someone who was able to tell me about her experience down to the very minute details. A friendly face and kind word made all of the difference, to just know someone I knew had gone through it and I could trust her advice and information on what to expect, even if it sounded scary or horrible! I felt like if she could do it, maybe I could, too. (Even though it seemed questionable!) And I finally found someone who understood! Who knew the fears and the anxiety and the nervousness both serious (what if it doesn't work, how will I feel?) and simple (how bad are the shots?).

After having some time to face the loss and sadness of my infertility, I still occasionally feel some of these negative feelings. But I also feel grateful. Grateful that now I at least have a fighting chance. That I have proved to myself that I can do hard things. That I can relate more to not only the infertility issues of others but also other battles of mourning and loss. That miracles are real, even if God uses science to make them happen.

We are praying for our own one day.

Monday, October 6, 2014

Still Working Hard

Coming back from Hawaii was hard. The weather was just beginning to turn (I am so dreading winter this year!) and I was having a hard time with some personal issues I am sorting through. I remember saying to a patient at work, "Sometimes you just need a vacation from your vacation."

And then I realized -- you get a vacation from your vacation! Less than a week after arriving home we were on a plane again to Orlando for an Otolaryngology conference. I have to admit this is really good for making my online persona look good!

I had high hopes for the trip. Using my extra time for getting in shape, studying for boards by the pool, maybe even some shopping or solo theme park expeditions while Abe was in his meetings.

Unfortunately, I was coming down with something on our way and I ended up in bed most of the time. (I could edit this part out to make my life look that much better, right?)

Abe's program has a lot of nice people who are pretty friendly and wanted to be social between meetings so we spent a lot of time with them which was fun.

Of course, you have to eat, even when sick so I braved it out for some Ethiopian food (which was amazing by the way).

Can you tell I'm sick? 
One of the attendings took us out to the Universal City Walk.

He treated us to a night of karaoke and pizza. We had a lot of fun singing with the live back-up dancers and singers. 

Abe's co-resident "Tiger" was a huge hit with the audience (middle back row, black hair and glasses), people chanting his name throughout the night and wanting to meet him. After taking pictures with the back up dancers, he had people asking for photos for their Facebook pages. Who knew we had such a hidden talent among us?

Abe and I had some mixed feelings about going to the parks the next day. I still wasn't feeling great and he was in the conference until the early afternoon. We decided to embrace our carefree and fun side and go for it! Upon arriving, we had a hard time deciding if we should go to Universal Studios or Islands of Adventure. Universal Studios has a new Harry Potter exhibit but we liked the roller coasters at Islands of Adventure last time we were there. We decided to go for the Islands of Adventure. 

This was perhaps the wrong choice. After going on a single roller coaster we both weren't feeling so hot. We stopped in a restaurant for some butter beer (Abe's main goal for going to the park) and got stuck there during a torrential downpour. After waiting about an hour, it slowed down enough for us to make it back towards the front of the park, only to get stuck again in the Jurassic Park exhibit for another downpour, before deciding to leave. It let up as we walked towards the entrance but very few rides were open due to the wet tracks and threat of lightening. We decided the only thing to do was to get a second butter beer (of course!) and head out. When we finally left I think we were relieved to be out of the rain. We still had fun, but I think Universal Studios would have had more inside to do and we would have at least seen the new Harry Potter attraction. And maybe I wouldn't have got so sick on the rides. 

Waiting inside with some liquid company.

Despite how it looks in the pictures, at least it was warm despite the rain!

Happy with his frozen butter beer. 
We bought tickets for the next day for Mickey's Not-So-Scary Halloween Party at Magic Kingdom for us and some friends.  We learned from our previous day's experience and bought ponchos before heading out for Disney World. By the time we pulled into the parking lot, it was pouring! We waited in the car hoping it would subside before donning our yellow courage and heading in. Good thing, too, because it rained for about 4 hours!

Abe's co-residents Marisa, Kristy, and Danielle getting ready!

The Halloween party was a really good option for us. The park closed at seven for its normal day-time guests but opened for the Halloween party from 7pm-12am. Since everyone was in conferences until about 2:30, it would have been a short and expensive day at Magic Kingdom. But luckily the party tickets were cheaper than regular admission, we were able to enter the park at 4 pm, and the party didn't end until midnight. I did not expect to stay until closing, but it turned out that I was sad when it was time to finally leave at midnight.

Thank goodness for ponchos!
Danielle had never been to Disney, despite growing up in Tampa, so it was fun to show her what she missed her whole childhood. I think once it stopped raining she was impressed.

We found some escape from the elements in Its a Small World
The biggest advantage to the night was minimal to no lines on the rides! After walking straight on to Splash Mountain, we sat in our ponchos getting completely drenched as the ride slowly maneuvered its way in a heavy downpour. After each getting a huge puddle in our laps and not even noticing the splash at the end of the ride, I think we had about had it with the rain so found some shelter and ate some dinner. Thankfully as we emerged from dinner, the rain had stopped, just in time for the parade, which was surprisingly good.

They had an amazing light show ON the castle (the coolest part of the night) and then some really impressive fireworks. 

We drove cars (not nearly as exciting as I remember -- I guess that makes sense as an adult who drives a real car).

And of course spun around in teacups (while Prince Charming looked on in admiration).

And rode flying elephants.

We even rode through a jewel mine.

And danced with monsters. 

One of the interesting parts of the night is that they have different characters than you would normally get to meet -- the villains -- out and about and taking pictures. We didn't take the time to wait in any of these lines but we tried to steal a picture with Mike from Monsters, Inc. 

He was too busy dancing to pose so we had to be quick!

Many of the park visitors were in costume as well as the workers. And they had trick-or-treating, giving away huge handfuls of candy.

It was probably some of the most fun I've had at a theme park. I wouldn't miss it if you have the chance to visit in September or October. Even in the rain!

And now we are home and back to work, as busy as ever. It was nice to have a few breaks at a much needed time.

Sunday, October 5, 2014

Hard at Work

At first I thought Hawaii would be the perfect location for a conference. I was so excited we finally had an excuse to go back.

Unfortunately, I found that instead of wanting to be at the conference, I wanted to BE IN HAWAII. Regardless, I think I found a good balance between enjoying the conference and making sure I spent plenty of time with my honey BEING in Hawaii.

We loved our hotel, the Modern Honolulu. The location was an easy walk to the beach, the decor was clean and modern (surprise), and we loved their pool.  

The nice anniversary gift didn't hurt, either!

We didn't do anything fancy since the conference sucked up a lot of time. We enjoyed relaxing at the beach and the pool and walking around the strip.

I think we ate Japanese food almost every meal! I was looking forward to Ramen for months since we got back from Japan. Unfortunately, wasn't quite the same.

One of my favorites from Japan, Okonomyaki!

Curry House...interestingly, WAY more food than you get at the same place in Japan.
And Dole Whips!

Proof I was at the conference (in case anyone from work is reading this--ha ha!). 

This is me registering for the conference after some exercise on our way. Promise I have a little more class than exercise clothes at a professional conference!

We met up with some friends for ice cream. Unfortunately, it isn't as easy to meet up with friends when they live in Hawaii -- I guess we will just have to go back. Wouldn't want to lose those ties!

One of the coolest parts of my trip was re(meeting) my cousin Shannon after 20+ years. It was strange to see this little girl who was probably four when I last saw her as a masters student. Fun to catch up and notice family similarities. Do you think we look alike? I think we have the same legs (if I worked out more).

And finally shave ice. Took me until the last day of the trip to finally get some. We tried this store at the recommendation of a friend and we were not disappointed!

And then made it up to the North Shore for some more at Matsumoto, our traditional favorite.

We enjoyed some more beach time on the North Shore  (especially when we came upon some nudists with some shady behavior)...

...before sadly making our way back to our friends' for a quick shower and a goodbye before our red-eye home.