It's an "on" month for IUI! I had a lot of pointed pain on my left side the first couple days of my period; I thought it might be a cyst again. Before I started depo provera in my early thirties, I had to go to the emergency room a couple times for cysts, so I think I am prone to them.
Had my ultrasound on day 3 - Friday - with Jenna. No cyst, but there was a little fluid behind my uterus, so it's possible it ruptured, if there was a cyst at all. 8 follicles on the left ovary, 3-4 on the right. Back on lupron now.
I've been trying to take things at a different pace this time. The first two times I did IUI, I didn't slow down my schedule or take extra time. This time, I am going to take most of the day off for my procedure and the next day, too.
I've also been doing acupuncture and taking herbs again. I had originally started this last November, and believe that this is one of the main reasons I got pregnant the first time. I've been seeing Anna for six weeks, and am feeling more balanced. She said yesterday that I am still very tired, and she worked to bring up my qi.
I have been feeling that I have too many "projects" right now - we are still finishing our house remodel, I am working on an acquisition at work, and my mother was diagnosed with multiple myeloma in July. We have been on the verge of finishing our house remodel for what seems like months! Each week there is some new problem - a leak in the roof, needing waterproofing in the basement, the bay bridge closing, dimmers not working with our LED lights. We are in the last couple weeks at this point, so lots of final finish decisions, but we're almost done. As for work, it will be as all consuming as I allow it. Then, there's mom. I know I can't do much to directly impact her health, since I'm not a doctor and she lives in Houston. But I've been so worried, and surprised that I never realized that my parents are mortal. I was able to visit my mom right before Halloween, and it really calmed me. She had been receiving platelet transfusions on a weekly basis, but she looks to be responding to her new chemotherapy, and has not had to have a platelet transfusion in the last couple weeks. And, she looks healthy. Some discomfort in her knee from the steroid she receives with her chemo, but she looks good.
So, I'm hoping that the next couple weeks can be relatively calm - including moving if that's possible - so the third time will be the charm.
Sunday, November 8, 2009
Monday, October 12, 2009
La Deuxième Fois
I got the news on my birthday - October 5 - not pregnant. My husband took me to dinner at Millennium - yum! I decided to walk from our house, a brisk 45 minute walk. I felt really good. Then I started spotting during our first course. The saving grace was I was able to order a glass of wine in time for our main.
Back to Kaiser last Wednesday to see if I could start another round. Four large cysts this time, so I have to wait a month. I did not feel them this time. My body is sometimes such a mystery.
I had been hopeful this time because I had tolerated the fertility medication a lot better - no night sweats, and am used to the slight burn of the injected meds. I started with 4 follicles on the left ovary, 1 on the right. And, I had 4 mature follicles when I got my HCG trigger shot - one at 21, and 3 at 18. But it's all about probabilities, I guess. Ivan said that the chance of getting pregnant with IUI is 10-15%, lower stats than I had seen on the internet. He suggested we do one more round of IUI, equivalent of a year's worth of mature follicles, then think about IVF.
Back to Kaiser last Wednesday to see if I could start another round. Four large cysts this time, so I have to wait a month. I did not feel them this time. My body is sometimes such a mystery.
I had been hopeful this time because I had tolerated the fertility medication a lot better - no night sweats, and am used to the slight burn of the injected meds. I started with 4 follicles on the left ovary, 1 on the right. And, I had 4 mature follicles when I got my HCG trigger shot - one at 21, and 3 at 18. But it's all about probabilities, I guess. Ivan said that the chance of getting pregnant with IUI is 10-15%, lower stats than I had seen on the internet. He suggested we do one more round of IUI, equivalent of a year's worth of mature follicles, then think about IVF.
Sunday, August 30, 2009
Catching Up
A month off the blog, so I'm catching up! IUI did not result in pregnancy, though I experienced cramps, different from what I usually have each month, but reminiscent of the cramps I had in February when I was pregnant. At that time, the nurse said this sometimes happens when the body is ready to have a period and the egg is implanting - a kind of tug-of-war.
I was taking progesterone and estradiol this time, so I wonder if my body was ready to have a period, and these hormones were creating the tug-of-war.
Kaiser wanted me to go onto the flare protocol for my next cycle, since I didn't respond very strongly to the down protocol. The flare initiates fertility drugs immediately, instead of starting with a cycle of birth control pills. The bcp quiets the reproductive system, and the follicles mature more evenly with the down protocol. But the flare is faster...
Alas, I couldn't go on the flare this cycle. I went in for my first ultrasound on the second day of my period, and had a 2.5 cm cyst - corpus luteum cyst - on my left ovary. Likely a vestige of my largest follicle from the IUI cycle. Cysts react to the fertility drugs, and can grow larger. So, I have to forego this month.
In some ways I'm relieved. The fertility drugs are not easy. I'm not a strict schedule person, and having to be home at 10 pm each night ready for a shot has been an adjustment. The night sweats, headaches, and fatigue are not inconsequential. And, there are exercise limitations. Up-and-down bouncing movement and quick physical inversions are not allowed because the ovaries are enlarged and could twist, resulting in ovary death. I don't love running, and haven't trained for a race in a long while, so this isn't a huge issue. What I do love is dancing, and it's meant that I can't dance the way I'm used to. And yoga. They say you can do yoga, just not certain poses. Since I'm not totally clear what these are, I thought it best to just not do it.
The cyst continued to cause discomfort for about 10 days after Jenna identified it on the ultrasound, but now I'm fine.
Back to the fertility monitor for this month [Thanks to my friend, Jane, for passing it along to me after she got pregnant!] And, back to dancing. It's been fabulous.
I was taking progesterone and estradiol this time, so I wonder if my body was ready to have a period, and these hormones were creating the tug-of-war.
Kaiser wanted me to go onto the flare protocol for my next cycle, since I didn't respond very strongly to the down protocol. The flare initiates fertility drugs immediately, instead of starting with a cycle of birth control pills. The bcp quiets the reproductive system, and the follicles mature more evenly with the down protocol. But the flare is faster...
Alas, I couldn't go on the flare this cycle. I went in for my first ultrasound on the second day of my period, and had a 2.5 cm cyst - corpus luteum cyst - on my left ovary. Likely a vestige of my largest follicle from the IUI cycle. Cysts react to the fertility drugs, and can grow larger. So, I have to forego this month.
In some ways I'm relieved. The fertility drugs are not easy. I'm not a strict schedule person, and having to be home at 10 pm each night ready for a shot has been an adjustment. The night sweats, headaches, and fatigue are not inconsequential. And, there are exercise limitations. Up-and-down bouncing movement and quick physical inversions are not allowed because the ovaries are enlarged and could twist, resulting in ovary death. I don't love running, and haven't trained for a race in a long while, so this isn't a huge issue. What I do love is dancing, and it's meant that I can't dance the way I'm used to. And yoga. They say you can do yoga, just not certain poses. Since I'm not totally clear what these are, I thought it best to just not do it.
The cyst continued to cause discomfort for about 10 days after Jenna identified it on the ultrasound, but now I'm fine.
Back to the fertility monitor for this month [Thanks to my friend, Jane, for passing it along to me after she got pregnant!] And, back to dancing. It's been fabulous.
Wednesday, July 29, 2009
Ultrasound after Ultrasound
Ultrasound #2 took place on Thursday, instead of Friday. Not very promising. I had one primary follicle at 14 mm, all others were small. All of the side effects and none of the benefits of the fertility drugs. They had wanted me to have ~4 follicles.
Ultrasound #3 on Sunday. Better. One primary follicle still, at 17 mm, but several more catching up. I was surprised that there were more than the original nine from my first ultrasound.
Ultrasound #4 on Tuesday. Primary follicle at 22, and two follicles at 15, and several more. Jenna thought waiting one more day would be favorable because follicles can get fertilized at 16.
Ultrasound #5 today. Primary follicle at 27, and two follicles at 17, and one at 16. Yeah! I get the HCG trigger shot tonight, and IUI Friday morning.
Last night, my friend Sinead gave me a dab of holy water from her grandmother. Hopefully it helps bring the outcome I'm looking for. More on Friday.
Ultrasound #3 on Sunday. Better. One primary follicle still, at 17 mm, but several more catching up. I was surprised that there were more than the original nine from my first ultrasound.
Ultrasound #4 on Tuesday. Primary follicle at 22, and two follicles at 15, and several more. Jenna thought waiting one more day would be favorable because follicles can get fertilized at 16.
Ultrasound #5 today. Primary follicle at 27, and two follicles at 17, and one at 16. Yeah! I get the HCG trigger shot tonight, and IUI Friday morning.
Last night, my friend Sinead gave me a dab of holy water from her grandmother. Hopefully it helps bring the outcome I'm looking for. More on Friday.
Sunday, July 19, 2009
First Steps
A lot of waiting, then suddenly a lot of activity this last week. Dr. Huang put me on a long-down protocol for IUI. The start was to get back on the pill for a cycle. The doctor also wanted me to go on the pill for my tubal recanalization, to ensure I was not having my period at the time of the procedure. Taking the pill added a couple weeks to the beginning of my timeline, and Kaiser's limited availability of appointments in radiology for my tubal recanalization stretched things out two more days.
I had my tubal recanalization last Tuesday. This was a follow up procedure to my HSG in January, where it looked like one of my tubes may have been blocked. In the tubal recanalization a soft wire is used to unblock the tube after dye has been injected into the uterus. I like to think of it as a pipe cleaner. With the tubal recanalization, I was sedated. So, I was saved the sharp yet short pain I had during the HSG due to the injected dye pushing on the uterine muscle. During the procedure, the blockage was reconfirmed, and they were able to open my tube. Just a little nausea from the sedation. Step 1: all good.
Tuesday night, I started the hormone injections for the long down protocol. This site has some background on the down protocol for IVF, which is very similar: http://www.advancedfertility.com/ivfstim.htm. I started with 10 units of lupron each night. My husband has been injecting me. At first, I wanted to do the injections, but now I am happy for him to take the responsibility so he has a role. I get the side effects, after all! Lupron is mainly used as an anti-cancer drug. For IUI / IVF, it is used to suppress LH surge and therefore ovulation. Side effects can mimic menopause. The first two nights I had crazy night sweats, but these have completely subsided, and now I only experience bouts of nausea. Step 2: ok.
Daily injections are interesting to manage; I am glad I am not a diabetic. The injection needs to be given at the same time every night. We went out on Saturday night, so I brought a loaded syringe, and injected myself in the car between two events. At first this seemed a bit illicit, but alas these are prescription drugs being used as per the instructions.
Today, I went for my first ultrasound. 6 follicles on 1 side, 3 on the other. I was a little surprised, since I've had 14 consistently in previous check-ins. Hopefully this will be enough. The doctor said we could proceed to the Menopur. Step 3: ok.
Menopur is FSH. It will stimulate the follicles to develop. Three vials of Menopur + 10 units of Lupron a night. This requires much more sophisticated mixing and syringe technique. We start by injecting 100 cc's of lupron + saline into the first vial of Menopur, then transfer this to the second, then to the third. The doctor said to target at least 90 cc's of liquid at the end. 85 on the first night. Room for improvement! And, this one stung when it went in, but not too bad. Step 4: ok.
Next ultrasound is Friday. More soon.
I had my tubal recanalization last Tuesday. This was a follow up procedure to my HSG in January, where it looked like one of my tubes may have been blocked. In the tubal recanalization a soft wire is used to unblock the tube after dye has been injected into the uterus. I like to think of it as a pipe cleaner. With the tubal recanalization, I was sedated. So, I was saved the sharp yet short pain I had during the HSG due to the injected dye pushing on the uterine muscle. During the procedure, the blockage was reconfirmed, and they were able to open my tube. Just a little nausea from the sedation. Step 1: all good.
Tuesday night, I started the hormone injections for the long down protocol. This site has some background on the down protocol for IVF, which is very similar: http://www.advancedfertility.com/ivfstim.htm. I started with 10 units of lupron each night. My husband has been injecting me. At first, I wanted to do the injections, but now I am happy for him to take the responsibility so he has a role. I get the side effects, after all! Lupron is mainly used as an anti-cancer drug. For IUI / IVF, it is used to suppress LH surge and therefore ovulation. Side effects can mimic menopause. The first two nights I had crazy night sweats, but these have completely subsided, and now I only experience bouts of nausea. Step 2: ok.
Daily injections are interesting to manage; I am glad I am not a diabetic. The injection needs to be given at the same time every night. We went out on Saturday night, so I brought a loaded syringe, and injected myself in the car between two events. At first this seemed a bit illicit, but alas these are prescription drugs being used as per the instructions.
Today, I went for my first ultrasound. 6 follicles on 1 side, 3 on the other. I was a little surprised, since I've had 14 consistently in previous check-ins. Hopefully this will be enough. The doctor said we could proceed to the Menopur. Step 3: ok.
Menopur is FSH. It will stimulate the follicles to develop. Three vials of Menopur + 10 units of Lupron a night. This requires much more sophisticated mixing and syringe technique. We start by injecting 100 cc's of lupron + saline into the first vial of Menopur, then transfer this to the second, then to the third. The doctor said to target at least 90 cc's of liquid at the end. 85 on the first night. Room for improvement! And, this one stung when it went in, but not too bad. Step 4: ok.
Next ultrasound is Friday. More soon.
Sunday, June 7, 2009
Starting Where We Left Off
On Friday, I had my first appointment with the reproductive endocrinologist, Ivan, after my miscarriage. He asked whether I had been trying to get pregnant yet. Hm. I had been told to wait six weeks or one or two cycles - depending on which medical practitioner I asked. This appointment was exactly 6 weeks after my D&C. Though truth be told, we have not been using protection for the last couple weeks. I wasn't ignoring medical advice, but just thought that the likelihood would be so low - since it took me several months to get pregnant the first time. In the end, Ivan told me that the "right" amount of time to wait is really not known, and he knows people who have gotten pregnant right after a miscarriage, but the standard guidance is 1-2 cycles.
So now we start again in earnest. Ivan asked my husband and I if we wanted to start where we left off. Before I got pregnant in January....
Last October, I met a woman at a baby shower who had received a donor embryo. She and her husband had been trying for a while. She was older. She went through fertility testing and found she had a very high FSH. Basically, she was going through menopause. No more eggs. But today, four years later, she was a happy mother via a donated embryo.
A sweet story. But it started nagging me. She looked to be 4-5 years older than I, so she was trying to conceive at my current age. In late November, I decided to go in for fertility testing. Usually, infertility is defined as not conceiving after a year. But, at my "geriatric" age of 38, Kaiser allowed me to proceed with the tests immediately. One of the tests, for FSH, has to be completed on day 3 of the cycle. I got the results in mid-December. FSH of 13. "Slightly elevated for my age" was the diagnosis. I researched madly on the internet. FSH below 10 is considered normal. FSH can go into the 30's- 40's, and indicates menopause. So it was only slight, but considered perimenopausal (http://www.advancedfertility.com/day3fsh.htm). A girlfriend told me that in Sweden, 13 is still considered normal. How she knew, I don't know, but I liked this diagnosis better.
Kaiser wanted me to see the reproductive endocrinologist immediately. First appointment with Ivan. An ultrasound showed that I had a healthy number - a normal number - of antral follicles - a total of 14 in my ovaries (http://www.advancedfertility.com/antralfollicles.htm). This was at odds with the FSH test results, but he still recommended fertility treatment, given my age.
We discussed three options: Clomid, IUI and IVF. I was not considered a candidate for Clomid, the least invasive option, due to my FSH level. FSH is the hormone that tells the follicle, the egg, to develop. An elevated FSH basically means that the body is having to yell to get the follicles to develop. Clomid basically mimics FSH, so more yelling would likely not increase my chance of getting pregnant.
IVF I was familiar with: hyperstimulation with hormones to produce a large number of eggs. The eggs are harvested, then fertilized in vitro - in a lab - then one or more are returned to the uterus.
IUI is in between. Hyperstimulation, but much less than IVF. The eggs are not harvested; artificial insemination is used. IUI was also very inexpensive under my health insurance.
OK, we would go with IUI.
First, I had to take an HSG, to ensure there was no blockage of my fallopian tubes. A dye is injected into the uterus and its flow through the fallopian tubes is observed on an x-ray (http://www.webmd.com/infertility-and-reproduction/guide/hysterosalpingogram-21590). A quick procedure, but the 5 minutes were much more painful than I expected, as the dye pushes on the inside of the uterine muscle.
The dye flowed very vigorously on one side, not on the other. They repeated it, because it was not clear whether the dye was just flowing slowly on the second side. Inconclusive on the second side still. Ivan wanted me to undergo tubal recanalization to ensure the other side was open, before the IUI.
OK. More steps. Right before my HSG, a girlfriend had told me that her sister had gotten pregnant right after her HSG. I didn't put any hope in that story. But then in early February, one week before my tubal recanalization was scheduled, I had a positive pregnancy test! So, maybe there is something to clearing out those dusty tubes.
Back to the present. Starting where we left off. I want to go forward with the IUI now, since I may be entering my fertility twilight years (hopefully not twilight zone). Ivan wants me to complete the tubal recanalization first. So, this will be at the end of June, then IUI in early July. Actually, not too bad of a schedule for my impatient self.
Unless I'm pregnant again before! Wouldn't that be nice.
So now we start again in earnest. Ivan asked my husband and I if we wanted to start where we left off. Before I got pregnant in January....
Last October, I met a woman at a baby shower who had received a donor embryo. She and her husband had been trying for a while. She was older. She went through fertility testing and found she had a very high FSH. Basically, she was going through menopause. No more eggs. But today, four years later, she was a happy mother via a donated embryo.
A sweet story. But it started nagging me. She looked to be 4-5 years older than I, so she was trying to conceive at my current age. In late November, I decided to go in for fertility testing. Usually, infertility is defined as not conceiving after a year. But, at my "geriatric" age of 38, Kaiser allowed me to proceed with the tests immediately. One of the tests, for FSH, has to be completed on day 3 of the cycle. I got the results in mid-December. FSH of 13. "Slightly elevated for my age" was the diagnosis. I researched madly on the internet. FSH below 10 is considered normal. FSH can go into the 30's- 40's, and indicates menopause. So it was only slight, but considered perimenopausal (http://www.advancedfertility.com/day3fsh.htm). A girlfriend told me that in Sweden, 13 is still considered normal. How she knew, I don't know, but I liked this diagnosis better.
Kaiser wanted me to see the reproductive endocrinologist immediately. First appointment with Ivan. An ultrasound showed that I had a healthy number - a normal number - of antral follicles - a total of 14 in my ovaries (http://www.advancedfertility.com/antralfollicles.htm). This was at odds with the FSH test results, but he still recommended fertility treatment, given my age.
We discussed three options: Clomid, IUI and IVF. I was not considered a candidate for Clomid, the least invasive option, due to my FSH level. FSH is the hormone that tells the follicle, the egg, to develop. An elevated FSH basically means that the body is having to yell to get the follicles to develop. Clomid basically mimics FSH, so more yelling would likely not increase my chance of getting pregnant.
IVF I was familiar with: hyperstimulation with hormones to produce a large number of eggs. The eggs are harvested, then fertilized in vitro - in a lab - then one or more are returned to the uterus.
IUI is in between. Hyperstimulation, but much less than IVF. The eggs are not harvested; artificial insemination is used. IUI was also very inexpensive under my health insurance.
OK, we would go with IUI.
First, I had to take an HSG, to ensure there was no blockage of my fallopian tubes. A dye is injected into the uterus and its flow through the fallopian tubes is observed on an x-ray (http://www.webmd.com/infertility-and-reproduction/guide/hysterosalpingogram-21590). A quick procedure, but the 5 minutes were much more painful than I expected, as the dye pushes on the inside of the uterine muscle.
The dye flowed very vigorously on one side, not on the other. They repeated it, because it was not clear whether the dye was just flowing slowly on the second side. Inconclusive on the second side still. Ivan wanted me to undergo tubal recanalization to ensure the other side was open, before the IUI.
OK. More steps. Right before my HSG, a girlfriend had told me that her sister had gotten pregnant right after her HSG. I didn't put any hope in that story. But then in early February, one week before my tubal recanalization was scheduled, I had a positive pregnancy test! So, maybe there is something to clearing out those dusty tubes.
Back to the present. Starting where we left off. I want to go forward with the IUI now, since I may be entering my fertility twilight years (hopefully not twilight zone). Ivan wants me to complete the tubal recanalization first. So, this will be at the end of June, then IUI in early July. Actually, not too bad of a schedule for my impatient self.
Unless I'm pregnant again before! Wouldn't that be nice.
Sunday, May 24, 2009
Travail
Right before I found out I miscarried, two people reached out to me about potential new jobs. A new job? I love my team, and I have a great boss. I came to my current company through an acquisition three years ago. Over these three years, I have been given tremendous growth opportunities that I would not have had in another environment. The first two years I felt like I was drinking from a fire hose, making it up as we went along, my learning curve as steep as I wanted it to be. It was fun. The last year has been more incremental, even though I have taken on and enjoyed new challenges like managing a development team.
So it seemed like a good time to get pregnant. With my job being in more of a steady state, I could take some time off. My previous pregnancy had turned out to be well timed - I would have given birth at the end of November, right before the holidays. So, my maternity leave would have been easy to manage with work.
But a new job. Hm. Could I do it? My husband encouraged me. He and I have had a shared attitude about work: prioritizing our career, and always pushing to learn more, do more. To him, staying in a job that was only "incremental" would not be fulfilling. I would have agreed a couple years ago, but now I was torn. I was concerned that while pregnant I wouldn't be able to perform in a new job to my expectation level, and then only for six months before I went on maternity leave. Not a great way to start, from my perspective. Also, I was still learning in my current role, and a couple of large initiatives were going to kick off over the summer.
In the end, my miscarriage decided for me. I didn't want to make a radical change for now.
But how will I feel in the future? What if I don't get pregnant again or soon: when do I make the decision to turn my focus from pregnancy back to finding that heady level of learning and excitement in my career?
It's a strange thing, not being in control, feeling like I don't have all the facts to make an informed decision. I don't even know why I miscarried. Most first trimester miscarriages are due to genetic issues, but there could be other issues including fibroids, collagen vascular disease (lupus), hormonal problems, and diabetes (http://www.medicinenet.com/miscarriage/page5.htm). During my D&C, they found a fibroid that they said was too small to impact a pregnancy, but who knows?
What I do know is that I will have to turn my focus away from pregnancy, and back to driving my career. For now, I'll give myself six months, and schedule a check-in for December.
So it seemed like a good time to get pregnant. With my job being in more of a steady state, I could take some time off. My previous pregnancy had turned out to be well timed - I would have given birth at the end of November, right before the holidays. So, my maternity leave would have been easy to manage with work.
But a new job. Hm. Could I do it? My husband encouraged me. He and I have had a shared attitude about work: prioritizing our career, and always pushing to learn more, do more. To him, staying in a job that was only "incremental" would not be fulfilling. I would have agreed a couple years ago, but now I was torn. I was concerned that while pregnant I wouldn't be able to perform in a new job to my expectation level, and then only for six months before I went on maternity leave. Not a great way to start, from my perspective. Also, I was still learning in my current role, and a couple of large initiatives were going to kick off over the summer.
In the end, my miscarriage decided for me. I didn't want to make a radical change for now.
But how will I feel in the future? What if I don't get pregnant again or soon: when do I make the decision to turn my focus from pregnancy back to finding that heady level of learning and excitement in my career?
It's a strange thing, not being in control, feeling like I don't have all the facts to make an informed decision. I don't even know why I miscarried. Most first trimester miscarriages are due to genetic issues, but there could be other issues including fibroids, collagen vascular disease (lupus), hormonal problems, and diabetes (http://www.medicinenet.com/miscarriage/page5.htm). During my D&C, they found a fibroid that they said was too small to impact a pregnancy, but who knows?
What I do know is that I will have to turn my focus away from pregnancy, and back to driving my career. For now, I'll give myself six months, and schedule a check-in for December.
Wednesday, May 20, 2009
Patience
I have often said that patience is a virtue for others. Apparently, I've been missing some learning opportunities. Why patience is a virtue from WikiAnswers:
I love fast. I like the feeling of being somewhat overwhelmed, learning a lot on the fly, making quick decisions, doing minimal postmortems. I was like this as a child, and six startup years cemented it. Fast makes me happy and light.
Trying to get pregnant has been the antithesis of fast. It has required patience and much planning. We spend so many years trying to not get pregnant. In fact, our physical life cycle is not longer aligned with our societal life cycle. Teenagers can get pregnant so easily and don't want to. 30- and 40-somethings ready to have children have a hard, sometimes very hard, time.
Who knew that it's really only 1 or 2 days that you can get pregnant in a month? Yes, there are the stories of people who conceived a week after having sex, but those definitely seem to be the outliers at my age. And, who knew that modest business travel would get in the way of getting pregnant? There were three months last year where Ben had to go to conferences, and we missed my peak time each month. Those were the only times he had to travel those months. I'm not lucky, but what are the odds?
Starting to try a second time feels even slower. Right now, I'm just waiting, not even out of the gate. Waiting until my uterus has recovered. Being a type A, I can't help but compare where I am now to where I would have been. T-1 or 2 months before trying again, versus 4 months along. I'm competing with myself (or my alternate reality self?). Lovely.
Clearly I need to work on my attitude... Patience, please. I'll have a double. Straight up with a twist of optimism.
Patience is a virtue because it makes us better people. The definition of the word is to tolerate delay. This implies self control and forebearance as opposed to wanting what we want when we want it.
I love fast. I like the feeling of being somewhat overwhelmed, learning a lot on the fly, making quick decisions, doing minimal postmortems. I was like this as a child, and six startup years cemented it. Fast makes me happy and light.
Trying to get pregnant has been the antithesis of fast. It has required patience and much planning. We spend so many years trying to not get pregnant. In fact, our physical life cycle is not longer aligned with our societal life cycle. Teenagers can get pregnant so easily and don't want to. 30- and 40-somethings ready to have children have a hard, sometimes very hard, time.
Who knew that it's really only 1 or 2 days that you can get pregnant in a month? Yes, there are the stories of people who conceived a week after having sex, but those definitely seem to be the outliers at my age. And, who knew that modest business travel would get in the way of getting pregnant? There were three months last year where Ben had to go to conferences, and we missed my peak time each month. Those were the only times he had to travel those months. I'm not lucky, but what are the odds?
Starting to try a second time feels even slower. Right now, I'm just waiting, not even out of the gate. Waiting until my uterus has recovered. Being a type A, I can't help but compare where I am now to where I would have been. T-1 or 2 months before trying again, versus 4 months along. I'm competing with myself (or my alternate reality self?). Lovely.
Clearly I need to work on my attitude... Patience, please. I'll have a double. Straight up with a twist of optimism.
Sunday, May 10, 2009
Water babies
Going public with my miscarriage has been a surprisingly supportive and cathartic process. My husband and I decided to send the miscarriage news via email because we didn't want to end up in an awkward social situation should someone asked us how the pregnancy was going.
This "who do you tell" decision felt very similar to the decision I made about who to share my fertility issues with. Initially, I didn't want to tell anyone. I felt ashamed, and frustrated that I could not be successful at this in the same way that I was in my career, interests, etc. Then, I told a couple friends who asked me how "it" was going. The support and information they gave me was tremendous. I learned about acupuncture, heard stories about IVF, and I found out who among my friends I could talk to who had had similar experiences. Prior to that, I only knew two of my friends had had fertility treatment. This was only a fraction.
I ended up getting pregnant at the end of January right before starting fertility treatment. I didn't believe it so I ended up taking eight pregnancy tests. I'll save that story for another blog posting. Suffice to say that the sense of normalcy and shared experience helped me last fall and winter.
With my miscarriage, statistics give some comfort - 20% or greater chance of miscarriage in the first trimester, usually due to genetic issues. But, the stories are what have made me feel normal. I have been surprised at the number of my friends who responded to my email to say they had had a miscarriage, sometimes multiple. And they have beautiful children now.
One of my college girlfriends told me about water babies, unborn or not fully formed humans. In Japan, there are temples devoted to Mizuko kuyo, rituals for water babies. Zen master and teacher Robert Aitken writes, "[The water baby is] given a posthumous Buddhist name, and thus identified as an individual, however incomplete, to whom we can say farewell. With this ceremony, the woman is in touch with life and death as they pass through her existence, and she finds that such basic changes are relative waves on the great ocean of true nature which is not born and does not pass away."
We already had an in utero name for our bump. Ben named it Tex. Good-bye, Tex. I imagine Tex is surfing.
This "who do you tell" decision felt very similar to the decision I made about who to share my fertility issues with. Initially, I didn't want to tell anyone. I felt ashamed, and frustrated that I could not be successful at this in the same way that I was in my career, interests, etc. Then, I told a couple friends who asked me how "it" was going. The support and information they gave me was tremendous. I learned about acupuncture, heard stories about IVF, and I found out who among my friends I could talk to who had had similar experiences. Prior to that, I only knew two of my friends had had fertility treatment. This was only a fraction.
I ended up getting pregnant at the end of January right before starting fertility treatment. I didn't believe it so I ended up taking eight pregnancy tests. I'll save that story for another blog posting. Suffice to say that the sense of normalcy and shared experience helped me last fall and winter.
With my miscarriage, statistics give some comfort - 20% or greater chance of miscarriage in the first trimester, usually due to genetic issues. But, the stories are what have made me feel normal. I have been surprised at the number of my friends who responded to my email to say they had had a miscarriage, sometimes multiple. And they have beautiful children now.
One of my college girlfriends told me about water babies, unborn or not fully formed humans. In Japan, there are temples devoted to Mizuko kuyo, rituals for water babies. Zen master and teacher Robert Aitken writes, "[The water baby is] given a posthumous Buddhist name, and thus identified as an individual, however incomplete, to whom we can say farewell. With this ceremony, the woman is in touch with life and death as they pass through her existence, and she finds that such basic changes are relative waves on the great ocean of true nature which is not born and does not pass away."
We already had an in utero name for our bump. Ben named it Tex. Good-bye, Tex. I imagine Tex is surfing.
Saturday, May 2, 2009
Anemia and the Vegetarian
The doctors told me that although it would take me a month-and-a-half to rebuild my blood stores, I could resume my normal activities a few days after my surgery. It's been a week, and I'm exhausted! I was lucky to avoid a blood transfusion, but I had not fully appreciated how I would feel from the anemia caused by my blood loss.
I have had anemia often in my life. My parents say I was a precocious child. I could recite the alphabet when I was two years old. My physical talents were limited, however. So, I was excited when I became the tallest girl in my fifth grade class. This and needing to wear a training bra turned out to be indicators of early menarche at 10 years old. I was so young that my mom had not yet told me about the birds & the bees, much less a girl's "time of the month". I thought I was bleeding to death out of my bottom. My mom gave me a crash course on napkins and tampons.
From that time, I fought with anemia for many years. I had to be hospitalized when I was in 7th grade for passing out during a math test. I had had a period that ran for six weeks, and was very anemic. I got to stay at the Texas Children's Hospital for a week, and was very happy that I had my own TV to watch Dallas on, and that I could get popsicles from the nurse's station each day.
After that incident, I was put on the pill to regulate my cycle, but I still had migraines and fatigue each month due to the iron deficiency anemia associated with menstruation [1]. In my late-20's I discovered depo-provera, which was fabulous because I did not menstruate. Gone were the migraines that typically left me with no option but to turn off all light and sleep for several hours in the late afternoon. This was really life-changing for me. Being suddenly down for the count had been tough to manage with my start-up jobs, and my post-college social life.
Over the past 10 years, I have slid into vegetarianism. I have insisted that I will never become a strict vegetarian because of bacon (bless you, bacon, for your magical impact on hangovers). But, the reality is that I haven't had bacon in a couple years (unfortunately, no correlation with hangover frequency). Why vegetarianism? I love tofu (try it soft, raw with just a bit of ginger and soy sauce). I have lived with several vegetarians over the years, including my husband. So, cooking vegetarian food is natural for me. The health impact of eating meat versus vegetables has also swayed me. Finally, as I have learned about the significant environmental impacts of eating meat versus vegetables, it has become more firm as a way of life. It is how I am choosing to reduce my impact on the earth [2,3]. And, yes, I've become one of those somewhat opinionated but hopefully quiet about it West coast slow/local food folks. Quick plug for our organic produce box: Terra Firma Farms: www.terrafirmafarms.com.
How does this relate to anemia? I need to eat iron-rich foods, and meat contains more iron than vegetables. Happily, one of my surgeons at Kaiser is a vegetarian, and did not think I needed to eat meat to re-build my red blood cells and iron. She told me focus on eating iron-rich vegetables, and take the iron she prescribed. I have been taking 325 mg tablets of ferrous gluconate three times a day. Over the past week I have eaten broccoli, spinach, beans, and tofu. Vegetables have been steamed to retain their iron content, in our cast iron skillet to add iron. Vitamin C helps absorption so I have been drinking orange juice with the iron and vegetables. Each day I would get a headache starting at about noon, and continuing until I gave up and took a long nap in the early evening.
Getting enough iron from vegetables is not issue for healthy females. Healthy females 19-50 years old typically need 18 mg of iron a day. A 1/2 cup of tofu contains approximately 6.7 mg of iron, a cup of lentils 6.6, and a cup of spinach 6.4 [4,5].
That said, iron is more plentiful and more readily available in meat versus vegetables. Cooked beef contains approximately two times the amount of iron as tofu [5]. Generally, the redder the meat the more iron. So beef, more than chicken, etc. Interestingly, beef has 25% more iron than lamb [6]. The heme form of iron in meat makes it more readily available for absorption into the body. Also, meat preparation makes a big difference - shorter cooking keeps the iron in heme form [7].
So two nights ago, I decided to eat beef for one week, lunch and dinner. I have had tenderloin, beef burritos, and beef tacos the past couple days. I'm cooking a hamburger for lunch today - local, grass-fed organic beef, of course. I'm contemplating Blue Plate's meatloaf, though I guess that doesn't rate well on the cooking time scale... Looking forward to warding off those headaches.
References
I have had anemia often in my life. My parents say I was a precocious child. I could recite the alphabet when I was two years old. My physical talents were limited, however. So, I was excited when I became the tallest girl in my fifth grade class. This and needing to wear a training bra turned out to be indicators of early menarche at 10 years old. I was so young that my mom had not yet told me about the birds & the bees, much less a girl's "time of the month". I thought I was bleeding to death out of my bottom. My mom gave me a crash course on napkins and tampons.
From that time, I fought with anemia for many years. I had to be hospitalized when I was in 7th grade for passing out during a math test. I had had a period that ran for six weeks, and was very anemic. I got to stay at the Texas Children's Hospital for a week, and was very happy that I had my own TV to watch Dallas on, and that I could get popsicles from the nurse's station each day.
After that incident, I was put on the pill to regulate my cycle, but I still had migraines and fatigue each month due to the iron deficiency anemia associated with menstruation [1]. In my late-20's I discovered depo-provera, which was fabulous because I did not menstruate. Gone were the migraines that typically left me with no option but to turn off all light and sleep for several hours in the late afternoon. This was really life-changing for me. Being suddenly down for the count had been tough to manage with my start-up jobs, and my post-college social life.
Over the past 10 years, I have slid into vegetarianism. I have insisted that I will never become a strict vegetarian because of bacon (bless you, bacon, for your magical impact on hangovers). But, the reality is that I haven't had bacon in a couple years (unfortunately, no correlation with hangover frequency). Why vegetarianism? I love tofu (try it soft, raw with just a bit of ginger and soy sauce). I have lived with several vegetarians over the years, including my husband. So, cooking vegetarian food is natural for me. The health impact of eating meat versus vegetables has also swayed me. Finally, as I have learned about the significant environmental impacts of eating meat versus vegetables, it has become more firm as a way of life. It is how I am choosing to reduce my impact on the earth [2,3]. And, yes, I've become one of those somewhat opinionated but hopefully quiet about it West coast slow/local food folks. Quick plug for our organic produce box: Terra Firma Farms: www.terrafirmafarms.com.
How does this relate to anemia? I need to eat iron-rich foods, and meat contains more iron than vegetables. Happily, one of my surgeons at Kaiser is a vegetarian, and did not think I needed to eat meat to re-build my red blood cells and iron. She told me focus on eating iron-rich vegetables, and take the iron she prescribed. I have been taking 325 mg tablets of ferrous gluconate three times a day. Over the past week I have eaten broccoli, spinach, beans, and tofu. Vegetables have been steamed to retain their iron content, in our cast iron skillet to add iron. Vitamin C helps absorption so I have been drinking orange juice with the iron and vegetables. Each day I would get a headache starting at about noon, and continuing until I gave up and took a long nap in the early evening.
Getting enough iron from vegetables is not issue for healthy females. Healthy females 19-50 years old typically need 18 mg of iron a day. A 1/2 cup of tofu contains approximately 6.7 mg of iron, a cup of lentils 6.6, and a cup of spinach 6.4 [4,5].
That said, iron is more plentiful and more readily available in meat versus vegetables. Cooked beef contains approximately two times the amount of iron as tofu [5]. Generally, the redder the meat the more iron. So beef, more than chicken, etc. Interestingly, beef has 25% more iron than lamb [6]. The heme form of iron in meat makes it more readily available for absorption into the body. Also, meat preparation makes a big difference - shorter cooking keeps the iron in heme form [7].
So two nights ago, I decided to eat beef for one week, lunch and dinner. I have had tenderloin, beef burritos, and beef tacos the past couple days. I'm cooking a hamburger for lunch today - local, grass-fed organic beef, of course. I'm contemplating Blue Plate's meatloaf, though I guess that doesn't rate well on the cooking time scale... Looking forward to warding off those headaches.
References
- Anemia: http://www.webmd.com/a-to-z-guides/understanding-anemia-basics
- Environmental impact of meat versus vegetable consumption: http://en.wikipedia.org/wiki/Environmental_effects_of_meat_production
- Quantification of the environmental impact of different dietary protein choices: http://www.ajcn.org/cgi/content/full/78/3/664S
- Kaiser Vegetarian Meal Planning booklet
- USDA National Nutrient Database for Standard Reference at http://www.nal.usda.gov/fnic/foodcomp/search/
- New Facts about Iron in Meat: http://www.nutraingredients.com/Research/New-facts-about-iron-in-meat
- Heme, Ferritin and Vegetable Iron Absorption in Humans from Meals Denatured of Heme Iron during the Cooking of Beef: http://jn.nutrition.org/cgi/reprint/116/9/1720.pdf
Monday, April 27, 2009
Que est-ce que c'est Amphibole?
My husband says that my blog is too serious, so I'll try to lighten things up for this post. I won't guarantee you will laugh, however....
You may be wondering what Amphibole is.
Amphibole is a mineral of metamorphic (or igneous) origin. I like the concept of external forces shaping us, but that we retain our core character through those experiences.
A related word is amphibology, a logical fallacy, or an ambiguous grammatical construction. Life is seemingly logical but often not...
Here is an example of an amphibology from Groucho Marx:
And a literary example from statemaster.com: From Edward II, an Elizabethan play written by Christopher Marlowe:
Sources: http://www.statemaster.com/encyclopedia/Amphibology and Wikipedia
You may be wondering what Amphibole is.
Amphibole is a mineral of metamorphic (or igneous) origin. I like the concept of external forces shaping us, but that we retain our core character through those experiences.
A related word is amphibology, a logical fallacy, or an ambiguous grammatical construction. Life is seemingly logical but often not...
Here is an example of an amphibology from Groucho Marx:
“ I once shot an elephant in my pajamas. How he got in my pajamas I'll never know. ”And a couple of cute and short ones:
- from Animal Crackers
Eat our curry, you won't get better!
No food is better than our food!
And a literary example from statemaster.com: From Edward II, an Elizabethan play written by Christopher Marlowe:
- Edwardum occidere nolite timere bonum est.
Depending on how the reader punctuates this line, this can be interpreted as Edward's death sentence, or as an order to preserve Edward's life
- Fear not to kill the king, 'tis good he die... kill not the king, 'tis good to fear the worst. (5.4.8-11)
Sources: http://www.statemaster.com/encyclopedia/Amphibology and Wikipedia
Saturday, April 25, 2009
Lucky
I am optimistic, but not usually lucky. Luck struck twice this week.
Jessica's friend was able to get me onto the surgery schedule as an add-on. This meant that my procedure would be done at the end of the day. I was told to arrive at the hospital at 1 pm, and that my procedure would likely be at 6 pm, but could be as early as 3 pm. I was issued a cute operating gown with flaps to pump in hot air. It provided much better coverage than the typical hospital gowns that never manage to cover your bum. A nurse came to give me an IV. I told her that I have really small veins, but she did tried to insert an IV in the top of my hand anyway. We ended up with an IV in my forearm, and yet another needle in my other arm for a blood draw. I had not eaten since 6 am, since doctors do not want you to not eat for 8 hours before receiving general anesthesia. I was smarting from the needle pokes, and getting increasingly hungry. I was starting to feel sorry I had not kept the morning procedure in Richmond, where I would not have had to have an IV.
Finally a little after 6 pm, my turn came, and they wheeled me into PACU, which turned out to be the real pre-op/post-op room. I heard moaning and heated voices from the other beds. I forced myself to keep reading the Economist. The Economist as my happy place. Oh dear.
Jessica's friend came by to reassure me a couple times before my procedure. Then I met my surgical team. All women! A nice girl power moment as I was wheeled in to the operating room.
I didn't remember anything more until I woke up again in PACU. The haze wore off after an hour or so, thought I don't clearly remember whether the surgeon or my husband told me that I had lost a lot of blood during the procedure. They estimated a liter. I might need a blood transfusion. I would need to stay overnight at the hospital.
The hematocrit level is the percentage of red blood cells in your blood. WHO provides guidelines for normal levels for women at 36%, pregnant women is 33% (see http://www.anemia.org/patients/faq/). One of the surgeons said I started the procedure at 33% and halfway through I was at 27%. They would take another blood test overnight, and if my hematocrit was below 20, I would need a transfusion.
I realized I didn't want a transfusion. I had agreed to one before the procedure. It seemed so unlikely that I would need it, and natural to accept it to save my life. But, now that I had made it through the procedure, I didn't want it unless the situation was really, really dire. I recalled the risks the doctor had reviewed before my procedure: less than 1:2 million risk of Hep C, less than 1:2 million risk of HIV, 1:200K of Hep B (actual infection rates for for Hep C and HIV are 1:2.6 million: http://www.merck.com/mmpe/sec11/ch146/ch146e.html). There are other potential complications, including various types of rejection or reaction to the transfused blood.
To stop the bleeding, during the procedure a balloon with 30 cc of water had been put in my uterus. The balloon pushed on the blood vessels in the uterus to stop the bleeding. My geeky side was very happy with this tidy little solution.
The next morning, my blood test was back. 27. I had not lost as much blood during the surgery as originally thought, possibly closer to a half-liter. No transfusion. Slowly, the water was taken out of the balloon. 15 cc, then 2 hours waiting, the other 15 cc, and another 2 hours waiting. Then the balloon was pulled out. It turned out that it is actually a catheter for incontinence. Hmm, I liked the dual purpose but it didn't seem as cool any more.
Finally, I was released from the hospital at 1 pm, 24 hours after being admitted. I had been lucky ending up at the hospital for my procedure. If I had gone to a clinic, especially outside of Kaiser, would they have been able to deal with my bleeding complications?
When it rains, it pours. Or at least sprinkles: Lucky incident #2. I logged into facebook and found I had won a Hitachi mini hard drive with an Infectious skin (friend Tim Robert's company - infectious.com). I never win anything, so winning something I don't need is still exciting!
Jessica's friend was able to get me onto the surgery schedule as an add-on. This meant that my procedure would be done at the end of the day. I was told to arrive at the hospital at 1 pm, and that my procedure would likely be at 6 pm, but could be as early as 3 pm. I was issued a cute operating gown with flaps to pump in hot air. It provided much better coverage than the typical hospital gowns that never manage to cover your bum. A nurse came to give me an IV. I told her that I have really small veins, but she did tried to insert an IV in the top of my hand anyway. We ended up with an IV in my forearm, and yet another needle in my other arm for a blood draw. I had not eaten since 6 am, since doctors do not want you to not eat for 8 hours before receiving general anesthesia. I was smarting from the needle pokes, and getting increasingly hungry. I was starting to feel sorry I had not kept the morning procedure in Richmond, where I would not have had to have an IV.
Finally a little after 6 pm, my turn came, and they wheeled me into PACU, which turned out to be the real pre-op/post-op room. I heard moaning and heated voices from the other beds. I forced myself to keep reading the Economist. The Economist as my happy place. Oh dear.
Jessica's friend came by to reassure me a couple times before my procedure. Then I met my surgical team. All women! A nice girl power moment as I was wheeled in to the operating room.
I didn't remember anything more until I woke up again in PACU. The haze wore off after an hour or so, thought I don't clearly remember whether the surgeon or my husband told me that I had lost a lot of blood during the procedure. They estimated a liter. I might need a blood transfusion. I would need to stay overnight at the hospital.
The hematocrit level is the percentage of red blood cells in your blood. WHO provides guidelines for normal levels for women at 36%, pregnant women is 33% (see http://www.anemia.org/patients/faq/). One of the surgeons said I started the procedure at 33% and halfway through I was at 27%. They would take another blood test overnight, and if my hematocrit was below 20, I would need a transfusion.
I realized I didn't want a transfusion. I had agreed to one before the procedure. It seemed so unlikely that I would need it, and natural to accept it to save my life. But, now that I had made it through the procedure, I didn't want it unless the situation was really, really dire. I recalled the risks the doctor had reviewed before my procedure: less than 1:2 million risk of Hep C, less than 1:2 million risk of HIV, 1:200K of Hep B (actual infection rates for for Hep C and HIV are 1:2.6 million: http://www.merck.com/mmpe/sec11/ch146/ch146e.html). There are other potential complications, including various types of rejection or reaction to the transfused blood.
To stop the bleeding, during the procedure a balloon with 30 cc of water had been put in my uterus. The balloon pushed on the blood vessels in the uterus to stop the bleeding. My geeky side was very happy with this tidy little solution.
The next morning, my blood test was back. 27. I had not lost as much blood during the surgery as originally thought, possibly closer to a half-liter. No transfusion. Slowly, the water was taken out of the balloon. 15 cc, then 2 hours waiting, the other 15 cc, and another 2 hours waiting. Then the balloon was pulled out. It turned out that it is actually a catheter for incontinence. Hmm, I liked the dual purpose but it didn't seem as cool any more.
Finally, I was released from the hospital at 1 pm, 24 hours after being admitted. I had been lucky ending up at the hospital for my procedure. If I had gone to a clinic, especially outside of Kaiser, would they have been able to deal with my bleeding complications?
When it rains, it pours. Or at least sprinkles: Lucky incident #2. I logged into facebook and found I had won a Hitachi mini hard drive with an Infectious skin (friend Tim Robert's company - infectious.com). I never win anything, so winning something I don't need is still exciting!
Thursday, April 23, 2009
Trials and Tribulations of HMO's II
My sister-in-law called last night. Jessica had a friend in ob/gyn at Kaiser. Maybe this person could help. In 30 minutes I was on the procedure list for the next day in SF. I was reluctant to give up my appointment in Richmond because it had taken so much to secure it. Irrationally, I was scared that the SF appointment was not "real". After many confirming questions about the procedure, timing, etc., I took the SF appointment. I felt more comfortable in a familiar place.
This last turn of events makes me feel very lucky. In the end, I got the outcome I wanted. But, it took hours of trying and a personal connection to make it happen.
From a physical safety standpoint, I don't understand why my nurse practitioner or any of the other nurses I spoke to on the phone didn't make this option available to me. Space could be made if needed. I don't know if it comes down to systems issues, cost or desired spare utilization in case of emergencies. It really makes me question the HMO concept. Clearly quality of care needs to be balanced with cost/efficiency, but balanced not compromised. And, is this a design issue - where whoever designed this system has a different perspective on "balance" from me, or is it poor systems/IT/process design that is impacting their ability to deliver the quality of care expected. I don't know where to take this yet, but I have a friend who is a consultant at Kaiser, engaged in process re-engineering. Will start with scheduling dinner with him...
This last turn of events makes me feel very lucky. In the end, I got the outcome I wanted. But, it took hours of trying and a personal connection to make it happen.
From a physical safety standpoint, I don't understand why my nurse practitioner or any of the other nurses I spoke to on the phone didn't make this option available to me. Space could be made if needed. I don't know if it comes down to systems issues, cost or desired spare utilization in case of emergencies. It really makes me question the HMO concept. Clearly quality of care needs to be balanced with cost/efficiency, but balanced not compromised. And, is this a design issue - where whoever designed this system has a different perspective on "balance" from me, or is it poor systems/IT/process design that is impacting their ability to deliver the quality of care expected. I don't know where to take this yet, but I have a friend who is a consultant at Kaiser, engaged in process re-engineering. Will start with scheduling dinner with him...
The Trials and Tribulations of HMOs
I am a Kaiser baby. I was born at the Oakland Kaiser. When we were still in the days of paper file, folks were always surprised at how low my medical ID number was, and yet how thin my file was (we moved to Houston shortly after I was born, and I only returned to Kaiser after college). From a business perspective, I liked the efficiency of Kaiser. I knew that sometimes it was harder or took longer to get something done, but I believe that Kaiser is doing a lot of things right. I also know that regardless of the health system you are in, you have to be your own advocate.
The first appointment for surgery that Kaiser San Francisco could give me was April 30 – nine days longer than I wanted to wait. I needed to move forward not only because of my physical concerns – the potential for septic shock – but also for my mental well being.
I asked Jenna at Kaiser, my ob/gyn care provider, if I could go to another Kaiser. This was Jenna who had been so wonderful on Monday. When she measured the fetus size and detected no heartbeat she effectively switched from happy and upbeat to facts, soothing, and outlining my options – all while we were suddenly in the middle of a power outage. My favorite thing she said that day was "This sucks."
Jenna's response to my request to go to another Kaiser was essentially that they had started my care at San Francisco, and should complete my care there. I asked the same question to the nurse who was to help me prepare for the April 30 appointment. She found a referral for me to Choice, an abortion clinic in San Francisco, that was covered by Kaiser insurance. She also told me that if I wanted to be seen at another Kaiser, I would need to reach out to those facilities myself. Great.
I called my friend at Planned Parenthood. Her feedback on Choice was: variable. Some of the providers are good and experienced, others not as much. Great.
I called the Kaiser hotline, and spoke with an advice nurse. I asked her to reach out to other ob/gyn facilities in the area – Daly City, Oakland, Walnut Creek, Richmond, San Mateo. The responses dribbled in over a day as the local offices called me back. Daly City and Walnut Creek could not take me any earlier. San Mateo did not do the procedure. I never heard from Oakland. Great.
I cancelled my appointment at Choice, and made an appointment at Planned Parenthood. Just to give myself options. I know the organization well, and trust its care. Even though it would not be covered by insurance, in this case time was more important than money.
Then Richmond Kaiser called. They would take me this week. They could take me this week! Weirdly, 30 minutes later I got a call back from San Francisco reconfirming that their facility could not take me any earlier than April 30, and they had no knowledge of my Richmond appointment.
Hours of time. And, I'm lucky that my husband helped me with the calls and research. I still want to be a believer in HMOs. All the people I spoke with were very nice and helpful and really understood why the situation was causing me emotional stress. But, they didn't have the ability to help me with my problem. I had to continue to be my tireless advocate. And this was just for one appointment, one procedure.
Strangely and perhaps serendipitously, I'm feeling victorious, not sad right now. The miscarriage feels miles away.
The first appointment for surgery that Kaiser San Francisco could give me was April 30 – nine days longer than I wanted to wait. I needed to move forward not only because of my physical concerns – the potential for septic shock – but also for my mental well being.
I asked Jenna at Kaiser, my ob/gyn care provider, if I could go to another Kaiser. This was Jenna who had been so wonderful on Monday. When she measured the fetus size and detected no heartbeat she effectively switched from happy and upbeat to facts, soothing, and outlining my options – all while we were suddenly in the middle of a power outage. My favorite thing she said that day was "This sucks."
Jenna's response to my request to go to another Kaiser was essentially that they had started my care at San Francisco, and should complete my care there. I asked the same question to the nurse who was to help me prepare for the April 30 appointment. She found a referral for me to Choice, an abortion clinic in San Francisco, that was covered by Kaiser insurance. She also told me that if I wanted to be seen at another Kaiser, I would need to reach out to those facilities myself. Great.
I called my friend at Planned Parenthood. Her feedback on Choice was: variable. Some of the providers are good and experienced, others not as much. Great.
I called the Kaiser hotline, and spoke with an advice nurse. I asked her to reach out to other ob/gyn facilities in the area – Daly City, Oakland, Walnut Creek, Richmond, San Mateo. The responses dribbled in over a day as the local offices called me back. Daly City and Walnut Creek could not take me any earlier. San Mateo did not do the procedure. I never heard from Oakland. Great.
I cancelled my appointment at Choice, and made an appointment at Planned Parenthood. Just to give myself options. I know the organization well, and trust its care. Even though it would not be covered by insurance, in this case time was more important than money.
Then Richmond Kaiser called. They would take me this week. They could take me this week! Weirdly, 30 minutes later I got a call back from San Francisco reconfirming that their facility could not take me any earlier than April 30, and they had no knowledge of my Richmond appointment.
Hours of time. And, I'm lucky that my husband helped me with the calls and research. I still want to be a believer in HMOs. All the people I spoke with were very nice and helpful and really understood why the situation was causing me emotional stress. But, they didn't have the ability to help me with my problem. I had to continue to be my tireless advocate. And this was just for one appointment, one procedure.
Strangely and perhaps serendipitously, I'm feeling victorious, not sad right now. The miscarriage feels miles away.
Wednesday, April 22, 2009
My Options
There are two options for terminating pregnancy – or in my case making the miscarriage happen: medical management or surgical management. There is a third option, expectant management - essentially waiting - but given that nothing has happened three weeks after fetus death, I've already exhausted that option. I liked the idea of medical management because it seemed natural and more personal. I would take mifepristone (RU486) to block progesterone in my body, and then misoprotol to induce the uterus to contract. Medical management is 90% effective up to 8 weeks, but it drops to 60-70% at nine weeks. And, there is higher risk of hemorrage. Surgery is a faster/cleaner option, but there is some risk of injury which can result in heavy bleeding or infection, and the cervical injury could impact future fertility.
I love data. Data makes me comfortable and happy. Finding data quantifying these risks has proven to be difficult. Especially since most of the available information is slanted toward abortions versus miscarriages.
In the end, I decided on surgery without the comfort of data. My Chinese Medicine doctor and a friend at Planned Parenthood were both concerned about how far along my pregnancy had been, and the fact that I might have a lot of necrotic tissue which would best be removed quickly to prevent infection.
Decision done. Next: my battle with Kaiser.
Tuesday, April 21, 2009
Pregnant in my head
Yesterday morning, I was a mom-to-be. This was the thirteenth week of my pregnancy. I was so excited to be at the end of the first trimester, getting ready to openly announce our coming baby, excited about the prospect of maternity clothes. I thought the only gate was our genetic screen, scheduled for this Thursday.
I didn't think anything significant of my monthly check-in which took place yesterday afternoon. At the end of my appointment, I was pleasantly surprised that I would get to hear the heartbeat during this visit. I had only heard it once at 7 weeks. My nurse practitioner could only detect moving liquid with her portable monitor, so she rolled in an ultrasound machine. Jenna started an ultrasound on my stomach, finding only a 9 week old fetus and no heartbeat. Then we lost the power in the building. It would not come back until evening. I was sent home with the knowledge that I didn't have a baby any more. I wasn't a mom-to-be anymore.
I am having a "missed miscarriage". Still feeling pregnant – breast tenderness, what I thought was round ligament pain. No bleeding or spotting. Jenna said that my body is still producing pregnancy hormones. Maybe my spirit wanted this so badly that it just kept pushing my body forward in pregnancy mode in spite of the death of the fetus. My breasts are still tingling. It's hard for me to get my head around the reality when I don't "feel" it's true.
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