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.