Ma Vie en Amphibole

Sleep Training

2011-02-24T08:40:00.000-08:00

A 3.5 hour stretch of sleep last night, and I am a new person.

We approached sleeping with no preconceived notions, not rejecting anything along the spectrum of Dr. Sears (co-sleep) to Dr. Ferber (cry it out) outright. During our four days in the hospital after Luca was born, he slept with either Ben or me, because the plastic bassinet on wheels seemed so antiseptic and far from our beds.

At home we already had an Arm's Reach co-sleeper attached like a sidecar to our bed (thanks, ladies from my shower!). The first night, Luca spent about 5 minutes in the co-sleeper - too far away for us to hear him breathing so both of us were craning our heads over to the co-sleeper. So into bed Luca came.

It felt so nice - this sweet baby breathing and moving right next to me. Fearful of crushing Luca in our sleep (really my sleep, since I was still on vidocin due to my c-section), we got an in-bed co-sleeper: The First Years Close & Secure Sleeper. This is really a glorified little box, with 4-inch high plastic sides so you can't roll over on the baby. The sleeper took up a third of our queen bed - Ben complained that his elbow wasn't in the bed - but it was so nice for both of us to be right next to Luca at night.

And, thanks to the advice of our doula, we got separate non-down blankets to minimize risk of suffocating baby.

All great. Sleep started out promising with two hour stretches, and sometimes a 2.5 or 3 hour span in a night. But then Luca started waking up more often, and often wanting to eat more. And he did not want to stay in his glorified box. So I started comfort nursing, and/or one of us would sleep with him on our chest or in our arm. I think the comfort nursing encouraged him to wake up even more often for a snack. The last couple weeks he's had several hour stints of waking up every 30-60 minutes to eat. And, at some point we jettisoned the in-bed co-sleeper, though in its defense I think it was because we thought we would somehow get Luca into the Arm's Reach sidecar co-sleeper.

Even though I used to survive quite well on 4 hours of sleep, honed on startup hours and mid-week bar outings, I am sadly out of practice now. A few times I lost it and wimpered to Ben in exasperation to take crying Luca away upstairs.

So last night, we decided to start sleep training last night. I found this posting on preventing sleep problems from a Dr. David Olson to be very helpful:
http://en.allexperts.com/q/Pediatrics-1429/6-week-old-sleep.htm, and just found a similar but more general description here: http://www.babycenter.com/404_how-do-i-teach-my-baby-to-soothe-himself-to-sleep_1272921.bc

The big ah ha was putting Luca down when he was drowsy but awake versus asleep and then hoping he would not wake up. The other thing was a nighttime routine. My friend, Monica, had told me she implemented this for her daughter who is 6 weeks older than Luca. Ben and I are not routine people, so we were a bit loath to do it at this young age, but I was so sleep deprived desperate yesterday that we decided on a routine over dinner.

Plan hatched, we started at 9:30 pm: bath and "story" with Mrs. Mustard's faces book - thank you, Bart - so appropriate because Luca was crying/pouting. Then breastfeeding, swaddling, and in the sidecar at 10:15 pm. Luca cried a little, and I picked him up and comforted him and put him back into the sidecar. He was asleep in 10 minutes! I could not believe it.

Luca slept until 1:45 am - 3.5 hours! Then he woke up hungry, so another breastfeeding session then back into the sidecar at 2:30 am. This was the hard part, and I appreciate that Ben told me at dinner this sleep training plan would fail at first and we'd have to persevere. Luca kept waking up and crying every 5-20 minutes. I would either pick him up, rub his tummy or jiggle him and talk to him. And the giraffe noise machine was on full throttle - thanks, Naureen. Finally, he went into a deep sleep at 4 am. Frankly, I was able to keep calmly soothing him for an hour and a half because I had gotten 3.5 hours sleep earlier in the night!

Luca woke up again at 6:30 am, we had another feeding, and now he is still sleeping soundly in his sidecar as I sit in bed writing this post.

Hope this works again - maybe even better? - tonight...

Now I'm not sure what to do for naps during the day. We had been using a sling (New Native Carrier) which I love because it's easy to get on quickly, and he's with me all the time. Dr. Sears is a big advocate of slings. But it seems like the womb-like sling isn't preparing Luca for the sidecar at night. I tried priming him with a carseat nap yesterday afternoon, which he initially didn't like but fell asleep after a couple strolls around the house with carseat on the Snap N Go.

Anyone have any advice for daytime naps?

Luca's Birth Story

2011-01-22T12:02:00.000-08:00

Our sweet Luca was born on 12 January via c-section. Here is the birth story...

In late December, I began weekly ultrasounds and fetal monitoring, standard practice for "geriatric" - over 40 - moms. Go geriatric moms! And, they found I had low amniotic fluid and the baby had turned breech. So I began every-few-day visits for fluid check-ins - and tried about 47 baby turning techniques, including moxybustion and hanging from an inversion table.

The baby didn't turn (had he run out of room in his short mom's tummy?!), but my fluid remained low yet stable, so we made it to week 39 for a planed c-section.

After I was able let go of my desire to have a natural, unmedicated, woo woo hypnobirth birth, the project manager in me was rather happy to have a specific date and time for the delivery, and that the delivery would be over in less than an hour. It was fun to pick out the baby's birthdate - 1/12/11. I love palindromes. And, I learned that "2" is my husband's favorite number.

Of course, the baby had his own plan, as usual.... at 4 am on the 12th, my bag of waters released, and I started having surges (contractions in hypnobirth speak). I was in disbelief, since it seemed too coincidental, and thought maybe I just kept peeing on myself (!), but the contractions were very strong and regular. So off we went to St. Luke's and when I was checked, my midwife could feel the baby's bony butt. They arrested my labor with a drug called Terbutaline, so we could go forward with a scheduled instead of emergency c-section.

So, the 12th was truly meant to be the baby's birthday! Dr. Norrell at St. Luke's was amazing throughout the process and with my surgery. She even cut so she would avoid my tattoo.

In the end, Luca came out, bloody and beautiful. I still can't believe he's here!

C-Section Tomorrow

2011-01-11T22:38:00.000-08:00

Less than 12 hours before boogie makes his first solo appearance. I'm excited and scared and excited. I made it to 39 weeks, with my low amniotic fluid checked every couple days. And since boogie is still breech, I have a planned c-section tomorrow. It's strange knowing - actually picking - the baby's birth date. A strange output of calendar availability for us and our preferred ob-gyn (Norrell at St. Luke's); and lucky numbers (apparently my husband's favorite number is 2). Boogie is fortunate to get a numeric palindrome - 1/12/11. However, he misses binary - 1/10/11 or 1/11/11 - though I frankly couldn't figure out what either of these meant, if anything.

I have to confess that I'm scared of the c-section surgery. I know that 27% of births in the US are via c-section, so it's a routine procedure, but I am not looking forward to the longer recovery, not being able to go up and down stairs, etc. Moreover, I'm not good at asking for help - learning to ask will be my biggest challenge.

Back to excitement. So excited to meet baby. So excited to know whether he has hair. And what he looks like. And, and, and...

Boogie Baby Prepares to Make His Appearance His Way

2011-01-01T17:37:00.000-08:00

This is definitely my husband's child. After several weeks of checkups with a heads down baby, Boogie turned breech at week 36! My husband was breech - he tells me it is a sign of royalty. The only reference I have found is to Kaiser Wilhelm II, who didn't fare too well during his breech birth. So, readers, would love any pointers to information to substantiate or refute my husband's claims to royalty.

To turn the baby, I've been trying everything. Overachieving as usual. Acupuncture (moxybustion), chiropractor (Webster technique), hypnosis, inversion table, shoulder stands. My favorite so far has been lying upside down on an ironing board (head lower than feet) with an iPod and a light at the bottom of my uterus and an ice bag at the top. The theory is the baby will move its head away from the ice and want to go toward the music and light. But he hasn't budged.

I also had an external cephalic version at the doctor on Thursday, which was uncomfortable but not painful. The doctor said his butt is wedged in my pelvis; he's probably there to stay!

So I'll probably deliver via c-section. And early likely. I've been at the doctor every couple days over the last week. My amniotic fluid is on the low side; if it gets too low the baby will be delivered.

The project manager in me has not dealt with this well. Earlier in my pregnancy I had expected to deliver very early, since I was born six weeks early. At some point, I abandoned this expectation and decided I would be a week late, since the majority of first time mothers are a week late. It was decided.

So on Thursday when I was told that if my amniotic fluid was too low on Friday morning, I would have a c-section that day, I was devastated. Three weeks early. The house wasn't ready, we didn't know how the car seat worked, I didn't have any diapers, and I hadn't finished my work transition.

But as I sat on the couch Friday morning before we left for the hospital, I realized I wasn't emotionally ready. It's been such a special time, being joined with this growing being. And I wasn't - I'm still not - ready for us to graduate on to being two separate people. Then I realized I'm going to be unbearable if I'm this sappy at every single life transition this kid has. So tears dried, we went to the hospital, and... my amniotic fluid had held steady. I had drank 2 cups of water each hour from 6 pm to midnight the night before... Baby gets to stay inside me for a little while longer.

We go back Sunday morning for my next check. More water guzzling tonight!

Do Not Weep

2010-12-12T22:11:00.001-08:00

Thank you, Cynthia, for sharing this poem with me, especially since I continue to want to feel my Mom around me. Thank you.

Do Not Weep
-Mary Elizabeth Frye

Do not stand at my grave and weep;
I am not there, I do not sleep.

I am a thousand winds that blow.
I am the diamond glints on snow.
I am the sunlight on ripened grain.
I am the gentle autumn rain.

When you awaken in the morning's hush
I am the swift uplifting rush
Of quiet birds in circled flight.
I am the soft stars that shine at night.

Do not stand at my grave and cry;
I am not there, I did not die.

Family Tree

2010-12-07T17:31:00.000-08:00

My friend, E.K, wrote this poem in memory of my Mom. E.K. first met my Mom when we were in high school in Houston. Thank you so much, E.K.

Family Tree
In Memory of Adelina, 1938 - 2010
by E.K. Keith

Our family tree
branches and roots

We are the branches
mother
daughter
son
father
brother
sister

What if a mother
crosses an ocean
and her daughter and son
don't share their mother's
mother tongue?
Who are we not?

A bigger family
with wider branches
and deeper roots

We have our time
Branches turn to roots
gone from view, underground.
Remembering is our responsibility
Remember who roots us
to the history of the world

Our family tree
branches and roots
and the forest is the human family

Timing is everything

2010-12-07T17:13:00.000-08:00

I have accepted my Mom's death, but I'm still working through the "why now?" timing. I want to feel my Mom around me. It's interesting feeling this way, and not being religious. I see how believing in Heaven and that one's loved one is there looking down, can be very soothing.

My Mom was at peace with the timing of her death. Earlier this year, she told my husband and me that if it was her time, she was ready to go. She felt she had lived a full life. Her big concern had been to see my brother and me grow to adulthood, and since I'm 40, that happened a long time ago.

But I wasn't ready to let her go. I remember during the two weeks at the hospital never thinking she would not pull through. Until the day before she died. Her leukemia doctor told us she wouldn't make it because she was experiencing multi-organ failure, and the drugs she was receiving were not helping her because her kidneys could not process them or get rid of the IV fluids. I could see this physically, but I couldn't accept it. I kept insisting it wasn't her time yet, but actually I was the one who was not ready for her to go.

My Mom and I didn't always see eye to eye. Still so many things about her inspire me: her grace, her optimism. Her love of travel and of people. We had grown closer recently, partly because I had started to do more traditional family things - getting married, starting to have children. Grandchildren were so special to my Mom. She loved the time she spent with my nephews, especially the young three year old. And two more were on the way.

Timing was everything. I blithely counted on her being with us for Thanksgiving and Christmas, but it was not to be. I am trying to take comfort in the cycle of life - my Mom made sure she knew that my brother's son was born healthy, and that I was far enough along in my eighth month before she passed on.

It's so hard to believe I won't see her again. Especially because we don't live in the same city. So she might just call me one Sunday. And if not, how she will live on: in me, in my baby on the way?

I love you, and I miss you, Mom.

November 24

2010-11-26T15:05:00.000-08:00

My Mom died the night before Thanksgiving. She was supposed to help me raise this baby. She was so excited about him. She was in the room for our embryo transfer. Now she won't be here for the birth. It's strange, I feel her around me, but I can't talk to her. Or rather, I can't hear what she is saying back to me.

I want to keep her alive, and can't think of a better way than sharing her obituary, so here it is:

Remembering Del

Del passed peacefully late on the eve of Thanksgiving after a difficult battle with the flu. She valiantly fought myelofibrosis for seven years, and multiple myeloma cancer for the last two; these diseases had taken a toll on her immune system.

Del was passionate about her community, and was recently honored for more than a quarter-century of service at St. Cyril’s of Alexandria. She was an active member of the church choir, building on her love of classical music and opera, and her work as a solo vocalist and pianist. Del was also a Eucharistic minister and regular volunteer at Tremont senior retirement community. She had deep affiliation with her Filipino roots, and was a long-time member of the Tagalog Association of Texas, supporting their educational scholarship fund.

Del earned her PhD in Chemistry at University of Illinois, Urbana-Champaign in 1969, and enjoyed a long career in the oil industry. She was most recently Section Manager at Champion Technologies, and continued to consult with the company after she retired. She took pride in mentoring younger colleagues, and was holder of seven patents.

Del loved her friends and extended family deeply, and she was anchored by her immense optimism and faith. She had a wonderful smile that would light up a room. She is survived by her husband of 41 years, her two children and their families.

Third Trimester

2010-10-30T17:48:00.000-07:00

29 weeks tomorrow - in my third trimester! I've been feeling good, and trying to make good on my commitment to maximize social time before the baby comes. Not doing as good on the leisure time since we've returned from Italy, even though people keep telling me to get sleep now, before the baby comes.

Baby coming is starting to feel imminent. Childbirth class is in November. Baby shower in early December (thanks lovely friends and family). And, I'm looking fabulously huge, just in time for Halloween.

I still haven't decided on a costume for tonight. I want to celebrate the belly. I have been thinking of being a basketball player - paint my belly like a basketball and wear a basketball jersey - but I may end up with something more free-form and simple since I'll be painting in a mirror and using theatre makeup which gets on everything.

Still having some pregnancy-related ups and downs - but minor now. My numbers were slightly elevated (141) for the 1 hour glucose test, a screen for gestational diabetes. Diabetes runs in my mother's family, so I knew this might be an issue. I am generally careful of sweets, but ice cream really soothed my stomach in the first trimester, and I've continued to allow myself a little bit more than usual last few months. So I had to take the 3 hour glucose test, which entails a 12 hour fast, fasting blood draw, then drinking 100 g of glucose. Then a blood draw every hour for three hours to see how quickly my body metabolizes the sugar. My number was again slightly elevated after the first hour, but went to normal in for the last two blood draws. This was very good, as it means I don't have to monitor my blood sugar daily, but I am now watching my carbs and sugar. Tough for this Asian girl to cut down on rice.

Today was a very good day, as I got the call from my brother that Co had their third child - Dillon. He was two days shy of his due date - Halloween - healthy and apparently with a full head of hair! Can't wait to meet him over Thanksgiving.

Baby Moon

2010-10-03T20:16:00.001-07:00

We just spent 9 days in northern Italy - Lake Como and Venice - on our baby moon. So glad we went. We haven't been off on more than a long weekend since our honeymoon in December 2008. Thanks to all who encouraged us to (1) go on a baby moon, and (2) go during the 2nd trimester.

Our planes, trains and automobiles 24 hour adventure getting to Bellagio was long but manageable in my current state. 3 plane rides from SFO to Philadelphia to Frankfurt to Milan. Then train from Milan to Lake Como. Then bus to Bellagio! Would have been able to cut out one of the flight legs if we hadn't bought our tickets at the last minute, as usual. But we made it, and Lake Como was beautiful and romantic.

We did find that no one knew what a baby moon is. Another fanciful west coast concept...

I loved rediscovering leisure with Ben, short-lived as our holiday was. With that, I am realizing that we will lose any concept of leisure in a few months. I've finally come to the realization that a real live baby is coming in January! At times I have felt just a bit regretful that we've taken this path, revisiting the discussions Ben and I had about life changes, before we decided to have a child. But I am happy about this growing life within me, and looking forward to meeting him soon.

So now we go into appreciation time in earnest. 3.5 months of as much leisure and social time as we can? Oy ok.

Disappearing Navel

2010-09-18T10:05:00.001-07:00

My navel is disappearing. Hello more belly, good-bye belly button.

The Curly Hair Gene?

2010-09-07T22:31:00.000-07:00

Relief. It turns out that Ben also has the same satellite of DNA on chromosome 22. So, boogie baby is alright. Or at least he's got whatever dad's got - curly hair, propensity for puns, skinny legs? Interestingly, Ben's aunt may have the same satellite. She had amniocentesis with both of her children, and she and the kids all had a "chip" on one of their chromosomes - it's 20 years ago, so we don't know which chromosome, but I expect it's the same. Funny, the cousins don't spout off puns, but they do have curly (wavy) hair...

So, now we get to focus on being pregnant! I'm in my 21st week, already half way. I can feel boogie baby tap-tap-tapping, dance-dance-dancing every so often. So fun yet very weird to have an alien in my belly.

Not Quite Free and Clear

2010-08-26T13:04:00.000-07:00

Our amnio results are here. We are relieved, mostly. No Down's, Trisomy 18, Trisomy 13, or other "big" chromosomal abnormalities. And, it's still a boy! But there is a satellite on chromosome 22 - extra DNA at one end. Extra DNA is normal, but this satellite is unusually long. Our genetics counselor said she has never seen this type of result in a cytogenetic test during the four years she has been working at UCSF. The easy and hopeful explanation is that either Ben or I have the same satellite in our DNA, and we have passed on this inconsequential extra DNA. If that's not the case, then our counselor said they would do "more review of the literature". Beyond that, there doesn't seem to be anything that can be done, except possibly more ultrasounds. So we're not quite free and clear.

Mom and Pop both gave blood today for a chromosomal analysis to compare to boogie baby. We get the results back in a week. The anxiety from this roller coaster is really wearing on me. There hasn't been enough time for me to just enjoy being pregnant. I keep feeling like I have to hedge my bets - don't get too excited, be prepared. It's even made me hesitate buying maternity clothes.

Another week of waiting...

Just a little prick

2010-08-14T11:34:00.000-07:00

With all of the worry and deliberation about the amnio, I had nearly forgotten that we would find out boogie baby's gender at the second level ultrasound. It's a boy! That will be grandson #4 for my parents, and grandson #1 for my DH's parents.

The doctor and the ultrasound technician both said he is very photogenic on the ultrasound. Taking after Ben, I'm sure. Always ready for pictures! He's already 6-8 inches long. His face looks like Darth Vader (a future actor), 5 fingers on each hand (down from 7 but I'm sure he'll still be able to spin plates), and his heart beats happily. Ultrasounds are cool.

In the end, Ben and I decided to do the amnio. Even if the level 2 ultrasound did not show any soft markers, we needed to have certainty, and I didn't want to be wondering for the rest of my pregnancy. Dr. Schaffer a perinatologist at UCSF, performed our amnio. He and Ben bonded over Philly, and Brenda, our ultrasound technician, regaled us with stories of Eastern Airlines. They were great, and helped me to relax.

The procedure was somewhat painful but very short (5 minutes). A long needle is inserted into the abdomen, guided by the ultrasound, then amniotic fluid is collected. Boogie is a fiesty one. He was grabbing for the straw that was being used to collect the amniotic fluid. The doctor said that this was fine, since the needle had been removed at that point (it's like an IV). Very cute. He's probably been bored in there...

So now I'm resting at home. Doctor said I can return to normal activity within 24 hours, as long as there is no bleeding or amniotic fluid leakage. So far so good. And, I had a half a glass of wine last night to relax. A fertility doctor I had talked to earlier in the week recommended it so the uterine muscle would relax after my procedure. I've become a cheap date! I almost couldn't finish it, I was really tipsy.

So now, we wait until Tuesday for the amnio results...

1/73

2010-08-10T22:31:00.000-07:00

I had a blood draw for the second trimester genetic screen on 3 August, and basically forgot about it. The nurse/midwife said it would take two weeks to get the results, and that the state would only call early if the results were "interesting" (=bad). I was focused on my close friends' wedding in Yosemite over the weekend, my friends whom I would marry. Monday afternoon, I was still basking in the glow of the wedding and catching up on work, when I saw the number for St. Luke's flash on my phone. Mary, one of the midwives from St. Luke's. I couldn't think of why she would be calling - my centering pregnancy class didn't start until 20 August.

I had screened positive for Down's. 1/73. I could feel the tears coming, and I tried to think of the questions I should be asking. I wasn't prepared. I had assumed my 1:220 probability for Down's from my first trimester screen would improve. Mary told me they would coordinate with UCSF to move my Level 2 ultrasound forward, include genetic counseling, and an amnio if we elect to do it.

I didn't understand - my AFP was 0.82, HSG 1.54, and estradiol 0.66. Each of these individually are in the normal range. Mary told me that further interpretation was something that a genetic counselor would need help me with.

So I'm crushed, and - again alternating between - wondering why we waited to have kids, thinking it's all going to be ok, and wondering what to do about the amnio or level 2. I laid out the odds for miscarriage from the amnio in my 14 July post. 1:340. I'm also seeing 1:500 and even lower in some studies on the internet, but the references are poor. I can't determine what amnio stats to believe. And, the level 2 ultrasound provides some "soft" markers, but still half of the Down's cases do not show evidence on an ultrasound.

So now our appointment at USCF prenatal diagnostics is moved to Friday afternoon. It seems like forever from now, but on the other hand I feel there's so much I need to research and think through.

No Hiding It Now

2010-08-04T21:04:00.000-07:00

Sixteen weeks and I have somehow managed to gain 12 pounds, or is it 14? My acupuncturist suggested I gain five pounds when I was trying to get pregnant, and I was only too happy to oblige, and of course support our local Precita Park market through my ice cream purchases. Favorite flavor still Ben & Jerry's Half Baked Frozen Yogurt.

Dr. Rubashkin says I should target gaining 1/3 of my total gain in the first 1/2 of my pregnancy. Yes, more math. So if I gain the high end of the recommended range, 35 pounds, I should gain 17 pounds total by week 20. Gotta put the brakes on the sweets though I just discovered a yummy pistachio gelato by Ciao Bella!

The happy part of gaining weight is that I'm pretty much past the "has she just gained weight?" phase. But now I'm starting to navigate the uncharted territory of maternity clothes. I ventured into Pea in the Pod for the first time last week, and all the pants have these crazy stretchy waist bands on them. I hovered close to the entrance for the first few minutes, trying to determine whether I should run out screaming, but a happy sales person descended on me, and started creating a room for me, so I was pulled in. I ended up buying a pair of jeans with the stretchy "patent-pending belly band", which I've already returned. Luckily Anna lent me a few pairs of more acceptable (to me) "starter" maternity pants which will hopefully keep me clothed for the next couple months.

And, I told my boss today. He was in town for a meeting. He simultaneously asked me how much time I was taking off, and whether I was going to become a full time mom, then gushed about how much he loved raising his three girls - except the "argumentative phase". Very sweet. By the way, my answers were "three months", and "no"....

More Math

2010-07-14T21:29:00.000-07:00

I will be 40 when Boogie is born, so we need to do genetic testing. We decided on the quad screen and nuchal translucency instead of going directly to an amniocentesis, because of the chance of miscarriage. The quad screen is a blood test, and nuchal translucency a special ultrasound. In an amniocentesis, a needle is inserted into the placenta to get some of the amniotic fluid surrounding the fetus. There is a 1:340 chance of miscarriage if the amnio is performed at UCSF (the nationwide probability is 1:200, so all of us older mothers in the Bay Area are lucky). The difference is what the amnio is certain because you get cells from the baby, while the quad screen only gives you probabilities.

With my first trimester blood test, I screened negative for Down's and for Trisomy 18. Trisomy 18 is a different chromosomal disorder, where there are three copies of chromosome 18. Probability for Trisomy 18 was 1:11,000. So great. Probability for Down's was 1:220, somewhat better than the probability based on my age alone - 1:80.

We got lots of pictures of Boogie at the nuchal translucency ultrasound. And, the back of his neck measured 2.2 - 2.3 mm, which was in the desired range of 1-3 mm.

I have to wait until my second trimester blood test for an updated probability for Down's. Then we can make a final decision on the amnio. I do like certainty, so the amnio remains very appealing to me.

Boogie Baby Rocks On

2010-07-04T08:38:00.000-07:00

We had our first regular OB/GYN appointment on Friday, Dr. Nick Rubashkin at St. Luke's. 11 weeks, 5 days. "Dr. Nick" was recommended by several folks on the Bernal Parents yahoo group (thank you), and immediately demonstrated the great bedside manner he had been recommended for. It seems they usually start the first OB/GYN appointment with a sit down discussion on care options, etc. I steered the conversation to my fears of missed miscarriage, given my experience last year. He proposed we change the appointment order to have the ultrasound first. Wonderful.

Ultrasound on the belly this time. And, there was boogie baby! Bouncing about and doing back stretches. Ben said he saw seven fingers moving around on one hand - evolutionary advantage for our little pianist or plate spinner?! I'm so relieved and happy.

Boogie measured somewhere around 12 weeks, very close to my pregnancy based on IVF date. My due date is mid-January.

After the ultrasound, we got back to care options. Dr. Rubashkin discussed the centering pregnancy program at St. Luke's. This is a program run by mid-wives where monthly check-ups are with a group of women due in the same month as I am. It incorporates additional prenatal training. I assume it's a way to keep costs down, and provide broader care, both of which I'm all for.

I'm conflicted about this. I always imagined I would be an earth mama, but having gone through a very medical/interventional process to get pregnant, I'm not comfortable moving away from the intervention. In fact, I had originally planned to go to Laurie Green at Pacific Women's partially because I had assumed that I would have a difficult pregnancy and likely requiring a C-section. I feel I have some variant of Münchausen syndrome, where it's not because of desire for attention but because I want someone checking every minute for a baby heartbeat.

My mother-in-law feels it's important I get happy and positive about my pregnancy instead of being anxious. And, she's right. I think my fear is coming from the fact that I told myself so many times during my last pregnancy that my family doesn't miscarry (not sure why I started framing my outcome based on what happened with my and Ben's moms). By the time that I got to my 13th week appointment, miscarrying was not a possibility I was considering. So I'm fearful of being surprised again, if I start wholeheartedly believing all will be well.

So the next few weeks will be interesting. My next appointment is five weeks away, after my genetic tests are completed (we'll do the integrated screen including NT ultrasound then decide on amniocentesis). Hopefully I can wrestle my anxiety to the ground and just enjoy boogie baby and my growing belly. And yes, the belly is growing...

My DH

2010-06-24T21:21:00.000-07:00

DH is the name that women use for their "dear husband" on pregnancy sites. My DH thought it was important that we have the "pregnancy experience" to get ready to have a baby. He said this once when we discussed adoption as an option. He preferred we go through the physical pregnancy experience, and indeed if we could not conceive, he was more open to adopting an embryo than adopting a baby.

So here we are having the pregnancy experience. There are definitely emotional, psychological and social aspects. But much of the experience so far seems to be physical. So that would be Me. The newest fun thing was last night when I took off my bra and discovered I now have sticky boobs, for lack of a better term. This is a little early, and may be due to the switch of my progesterone from shots to vaginal suppositories. Yes, I have had daily intramuscular shots of progesterone in my tush since April... and now I get to move to lovely vaginal suppositories. (This is standard with IVF, and supposed to help keep me from miscarrying).

DH has claimed several times to have Couvades of some sort or another, especially craving ice cream, but I doubt that he'll claim to have sticky boobs at any point in the near future.

Apart from the sticky boobs, some of my pregnancy symptoms have stopped, including the little nausea I had. So naturally I'm freaking out a bit, even though nausea often abates in the tenth week because the placenta starts producing estrogen and progesterone itself. I rented a fetal doppler monitor, which arrived yesterday. It's often difficult to detect the heart beat in the first trimester, but try I did (so did DH). The placenta blood flow sounded like a whirlwind, but no fast beating baby heart.

I woke up this morning hoping little boogie baby is still tucked away somewhere in my tummy. I had my hand on my abdomen. Then I felt a tiny, fast push. It's impossible that I'm feeling boogie baby kicking because baby is the size of a kumquat. Logically it's gas or another one of my biological processes gone awry, but it's nice to believe that boogie baby is dancing away the early morning hours.

Boogie Baby

2010-06-15T17:42:00.000-07:00

We graduated from UCSF! Pea baby is looking a lot larger than a couple weeks ago, and was dancing. Really. Kind of boogying between its top-half/bottom-half. Looked like pea baby had some good rhythm, but I couldn't tell whether it was grooving off its 176 bpm heartbeat or some other tune.

Nine weeks. The doctor said that my chances of miscarrying now are less than 5%, probably 2-3% given my age. I am 39 - thanks to those of you who pinged me when I erroneously thought I had already turned 40 in my last post. Fixed that.

I did miscarry at nine weeks with my last pregnancy. The doctor said they usually like to see patients a week after the point of a previous miscarriage, so it's good I have an OB/GYN appointment next week.

Until then, lots of music for boogie baby.

One

2010-06-02T19:10:00.000-07:00

Finally, the day of the anxiously awaited first ultrasound.

There was a little blob on the monitor. And it's heart was beating! It blinked on the ultrasound. Almost indiscernibly, because the embryo is so small. So much uterus and so little baby. 9.1 mm, less than half an inch. Oh it's really a pea.

The doctors confirmed there wasn't a second embryo or sac lurking in my uterus or fallopian tubes. Just one. I was mostly relieved, as I was having difficulty imagining carrying two. My thoughts drifted from comical images of being as wide as I am tall (as I'm not that tall), to babies spending months in NICU because they were born too early. But, I have to admit that twins had some appeal, as I would be done. I don't know if I'll have enough runway for a second child. If all goes well with this pregnancy, I'll be 40 when my first baby is born.

Well, I'm not going to worry about what happens after this pregnancy yet... There's a little being in me, and its heart is beating. That's really amazing.

My next appointment is 15 June, when I will be at nine weeks. Dr. Rosen says there is a big drop-off in miscarriage risk at nine weeks, so the next appointment is a milestone. Right now, I have an 85% chance it will be ok. If all looks good on 15 June, I "graduate" from the IVF program and am mainstreamed with a regular OB/GYN.

After all of the injections and special procedures with IVF, I'll be glad to be mainstreamed, though this pregnancy thing seems to be no walk in the park. Yesterday, I started experiencing sour stomach. Not morning sickness, but a sour feeling in my stomach and mouth. This is also in the not sexy category.

I always walk by A Pea in the Pod on my way to my acupuncturist, and fancy myself a sexy pregnant lady, just like Heidi Klum. The breathlessness, bloating and now sour stomach are really interfering with my projected self-image...

Not The Sexy Kind of Breathless

2010-05-27T20:05:00.000-07:00

Waiting with baited breath for my ultrasound on 1 June. I hope this pregnancy is sticking. I am certainly sampling the full gamut of pregnancy symptoms. First it was nausea and dizziness. So I bought sea bands. As soon as I purchased them, the nausea stopped. Then it was unending fatigue and thirst. Now I'm bloated, and still thirsty. I'm a little whale, but at least I can stay awake through dinner now. What else - I'm big on top and sore - I finally really require a bra! This is the one good symptom. Oh, and I'm breathless. Not sexy breathless. This is the needing more air as I shift my weight on the couch; I actually needed to stop while walking uphill and panting on Wednesday.

Having symptoms is comforting, but the coming and going is disconcerting. If I don't feel tired one afternoon, I'm sure I've miscarried. I keep recalling my missed miscarriage last year, that I didn't know I had miscarried for three weeks. I know I need to distract myself, and think positively.

Luckily, my friend's bachelorette is this weekend - good friends and something wonderful to celebrate will be a perfect distraction. I do need something sparkly for Saturday night, and sadly can't fit into any of my usual costumes. I wonder where I can find sparkly petite baleine outfits...

Perfect

2010-05-17T18:35:00.000-07:00

The nurse called with today's lab results. "Perfect." I was shaking. I think I still am. My HCG beta is 3400. For 85% of pregnancies, in early pregnancy, the HCG level doubles every 48-72 hours. Mine had not quite doubled last Tues to Thurs, which is why I had to take another blood test today.

This time my number went from 534 to 3400 over two 48-hour periods. Very good. As the nurse said, "Perfect."

I hope the rollercoaster ride is over, and this isn't just one of the long straight parts before a loop-the-loop. I just looked up the definition of neurotic: a person prone to excessive anxiety and emotional upset. Spot on. I need to become the antithesis of neurotic. synonym.com lists "rational" as the antonym. Too bad. That sounds boring.

My Own Private Rollercoaster

2010-05-14T19:36:00.001-07:00

Welcome to my little neurotic rollercoaster.

Pregnancy blood test scheduled was for 11 May - the end of the 2WW (see my last post). Ben wanted to go away the weekend before - our second anniversary! We decided to go someplace close to make it easy. We packed Elf in the car and went down the coast to Half Moon Bay. Just what I needed for the last few days of the 2WW.

Friday night I noticed I was spotting, really lightly. Right before we left our house, I had slipped and sat down kind of hard on the floor. A little kid move. I thought this might have been the cause, and/or my progesterone shots. Saturday we went on a relaxing walk on the beach. In town, we bought some metal goat sculptures to add to our urban farm (2nd anniversary - tin!) Still very light spotting.

Sunday morning cramping, spotting turned dark and more flow. I had the physical feeling my period was starting. Everything was moving down. I was sure it was coming. I blamed myself. I shouldn't have... fallen on the floor, gone on such a long walk, etc. I spent an hour in bed desperately searching the web on my iPhone for spotting, cramping, IVF, 2WW, looking for some certainty or hope. But, the forums can only tell you other people's stories. They can't tell you what is happening to you, for certain.

So we drove back to San Francisco in the rain. As soon as we got home, I did what I promised myself I wouldn't do. I took a home pregnancy test. Positive?! It came out positive. My surmise was that I had been pregnant and I was miscarrying. So I spent the rest of the day on the couch crying and hoping the cramping and spotting would stop.

Weirdly, it did. Monday, no spotting or cramping. No cramping at all. I had run out of pregnancy tests, and frankly didn't have the courage to test again since I was scared I had miscarried, so no pregnancy test on Monday.

Tuesday, I had to go to Sacramento for a two-day offsite. I would stop at UCSF lab on the way for my pregnancy blood test. I had bought another set of home pregnancy tests, and couldn't resist taking one before heading out. Positive? Weird. Ben didn't seem surprised. His smiled and said, "The test on Sunday was positive." OK, maybe this worked.

Tuesday afternoon, I got my results from UCSF. My beta HCG was 303! The nurse said normal range for 14 days post-transfer is above 100, and less than 1000. Smiling Tuesday evening. Read something on a forum about higher HCG possibly meaning twins. Getting ahead of myself and starting to count months til my delivery.

Thursday, I had a second blood test. My beta HCG was 534. The nurse was not completely happy with the number, as it was supposed to double. She said I might have had 2 embryos implant, and 1 was miscarrying. Or that I possibly had an ectopic pregnancy. She said we should be cautious. She didn't want me to be surprised at my first ultrasound. I am to take another blood test on Monday. I had just been getting used to my little fantasy of having a baby in February.

Now waiting for Monday. Monday, Monday.

The Gambler

2010-05-09T12:04:00.000-07:00

I was keeping it together pretty well until the last few days of the 2ww. For the uninitiated, that's the two week wait between ovulation/transfer and pregnancy test. For my IUI's I don't remember getting really stressed during the 2ww, just being disappointed when the dreaded period arrived. Initially this time, work was a wonderful distraction. By day 9, however, the realization that this was truly the last option before adoption, and the fear of having to start all over again with a big box o' drugs, began to eat at me.

So, I spent an inordinate amount of time trying to calculate the probability that I would end up with 1 implanted embryo. At my age and at UCSF, the probability of any transferred embryo implanting is 22%. 3 were implanted. I taught stats in college as part of a population biology class, and sadly don't remember anything useful. So, I had to resort to the source of knowledge and truth, the internets. At first, it seemed simple. If each embryo is an "independent event", then don't you just add the probabilities? 22% + 22% + 22% = 66% probability that I would get 1 implanted embryo. Well, no, because if you have 3 coin flips, and are looking for 1 heads: 50% + 50% + 50% = 150%. You can't have 150% probability. I found this formula, which looked fabulously simple:
P(A or B) = P(A) + P(B) - P(A and B) - in words, the probability of A or B happening is the probability of A happening, plus probability of B happening, minus the probability of A and B happening. Until I realized I needed to know the probability of A and B happening. This apparently requires logarithms and other things that are truly beyond my ken.

So I had to resort to gambling. Having spent a few long nights at the craps table in Vegas, I felt quite comfortable with this fine and practical application of probability. This gambling table was perfect. Check out section 2, The Fundamental Table of Gambling (FTG). I was somewhere close to, probably over, 60% probability of 1 embryo implanting.

Great! But then I remembered that I'm only 1 person, and probabilities apply to populations. Boo.

Finally Recovered from The Valium

2010-04-30T18:26:00.000-07:00

I only expected the valium to take the edge off. Wednesday, the day of my transfer, I was prescribed 10 mg valium to prepare for the transfer. They want the uterus to be relaxed.

I had a qi gong session with Chris Fernie right before my procedure, so I was already feeling relaxed. He worked a lot on moving my lymphatic system and channeling my binqi out. It was so cold, but that's for another post. I guess I was so relaxed from the qi gong session, I didn't realize the valium had hit me until I was wandering around the tiny hospital bathroom like a goldfish.

Once we were in the transfer room, Dr. Huddleston gave us the fertilization report. I think it was:

#1: grade 2, 10 cells
#2: grade 3, 8 cells
#3: grade 2, 6 cells
#4: grade 3, 6 cells
#5: grade 2 (?), 4 cells

Grade goes from 1-5 scale, with 1 being the best. 2 is most common at 60% of embryos.

The first three were selected for transfer. Here are the three in this picture! The last two could not be frozen because of the quality. They think #5 didn't make it, since the embryo should have greater than 4 cells by day 3.

The experience was so clinical. One person confirmed my name on the syringe. After Dr. Huddleston shot the embryos in, they rechecked the syringe under a microscope to make sure that all of them transferred. Then we were up, out of there and back home. No waiting for 20 minutes with a pillow under me, as I had to do with the IUI.

Having finally convinced my mom that I didn't have to take bed rest, sleeping ended up being all I could do. There is a lot of debate on bed rest after transfer. UCSF and other sources say that bed rest is not required, and in fact there are a number of studies showing that bed rest does not improve implantation. My mom's stance had been "why take a chance?", but she's a scientist so she had to accept the study results. In the end, I frankly wasn't in much of a state to do anything else but sleep. I vaguely remember Anna coming over to needle me (thank you!) and leave me with OK! magazine and a couple DVDs.

And then it was Thursday...

5 for 5

2010-04-26T21:30:00.000-07:00

Unbelievable! Five eggs retrieved, and all five fertilized. Now my transfer is Wednesday, pushed back a day so the embryos can grow a little more and the best ones can be picked. Trying to remain cautiously optimistic.

Ready

2010-04-23T10:25:00.000-07:00

Thursday ultrasound. More survival-of-the-fittest nature channel on in the waiting room. Follicles at 18, 16, 14, 14 and 12 mm. and two 6 mm + a 7 mm. Estradiol 1191. I was surprised that Dr. Huddleston said she likely wanted to trigger me on Thursday. Wednesday she had said my protocol - E2 antagonist - called for two follicles 17 mm or larger. But, I think she was concerned that my leading follicle would get too large. In the end, she and Dr. Rosen decided to have me go one more day.

Friday. Successfully avoided the TV this morning. Follicles at 19, 18, 17, 16, 14, two 9 mm + three 7 mm. Estradiol 1627. Trigger will be tonight! Retrieval on Sunday. Wow.

Ultrasound #3

2010-04-21T19:44:00.000-07:00

Third ultrasound today. I still have five follicles growing together in a cluster. One is moving out in the lead, but just slightly. Now they are: 16, 14, 13, 13 and 12 mm. Two trailers at ~6 mm. Estradiol 821. Dr. Huddleston says my retrieval will be Sat/Sun/Mon. Is this good? I'm just glad my cycle hasn't been canceled yet. I spent some time last night reading other people's blogs, learning about cycle cancellations. Got me very anxious this morning while I was waiting for my appointment. The big-screen TV playing the survival-of-the-fittest nature show didn't help. Alligator pulling buffalo back into river, buffalo going under. Hmm.

N = 5

2010-04-19T18:47:00.000-07:00

Second ultrasound today. Day 6 of meds. Estradiol 489. Started Ganirelix.

I have five follicles all around the same size - 10, 11, 11, 12, and 13 mm. And, one trailer at 6 mm. The doctor seemed happy, and said I'm early in the process. Hopefully there are enough follicles. Ideally, I would have 8-15 good size ones - 18-22 mm - when I am ready for retrieval, but I'm a non-responder so I'm expecting fewer. Also, not all follicles result in an egg, and not all eggs fertilize... So I really can't count my chickens before they hatch.

Next ultrasound Wednesday...

4.7

2010-04-15T22:49:00.000-07:00

I have been seeing Anna again for acupuncture and herbs, this time for six months. In February, I had my day 2 FSH taken; UCSF needed new blood work before I could start IVF. My FSH was 4.7! 4.7. The number that started all of my worries was 13, in December 2008. 13 is "slightly elevated for my age" - I think my nurse used the word "slightly" to soothe me. 4.7, on the other hand, is downright sprightly. I know FSH bounces around cycle to cycle, and generally the highest value correlates with an individual's ability to get pregnant. But, I'm focusing on the 4.7. And I do think it's due to Anna's work.

Allons-y

2010-04-14T22:24:00.000-07:00

We start. I had my first ultrasound today. Six follicles on the left, four on the right! No cysts. Very good. Dr. Lamb was surprised because Dr. Rosen had only seen four total in previous ultrasounds. I hope I'm on the right protocol. I'm on an E2 agonist protocol, which is for non-responders. I assume because I didn't get pregnant via IUI.

My protocol started with 2 mg estradiol daily, a week after ovulation. So, similar to my IUI flare protocol, no down regulation. I had to use ovulation strips to determine my ovulation day. Audra, my nurse, did not want me to use the fertility monitor, just the "cheap strips". So, I ended up using two different kinds and testing twice a day just to be sure I didn't miss it - since I had never used strips before. I liked the ones that come in a little tube, like a pool test kit. They were also super cheap.

First day of my next cycle, I stopped the estradiol. Baseline ultrasound day 2, today. First shot tonight. I take 2 vials Menopur and 4 vials (300 IU) Gonal-f. Six vials: a lot of mixing and transferring. But the shot didn't sting. Two good things today.

I'm optimistic now, but not excited about the timing. Next week is my 10 year reunion for business school. My transfer may happen over the weekend, so I would end up missing a lot of the festivities. But, timing is never good. At least we are finally almost done with our house remodel. Wasn't I saying that in November?

Big Box O' Drugs

2010-04-07T21:06:00.000-07:00

I wasn't prepared for the size of the box. I reviewed the long prescription list with the pharmacist, but didn't expect a 2' x 8" x 8" box. And, when it arrived, I didn't think it would be full. I have Gonal-f, Ganirelix, progesterone, HCG, estradiol, and lots and lots of needles. Lots of needles. And no bubble wrap. The only good thing in the box is the valium for my transfer; it has the added benefit of not being administered by a needle. I had Menopur left from my IUI regimens, so at least I didn't have to order that.

The needles. The needle gauge is inversely proportional to the actual needle size, so large gauge = small needle and vice versa. The mixing needles are 18-1/2 gauge and gargantuan. We will still use the tiny 27-1/2 insulin needle for most of my shots, which is comforting. I'm used to this now. The needle that terrifies me is the 22-1/2 gauge that will be used for progesterone. UCSF's protocol calls for intramuscular progesterone in oil. The needle must be wide so the oil can pass. We don't use the progesterone until right before or after my retrieval, but at that point I get a daily shot until my pregnancy test. If it's positive, I take a daily shot for NINE more weeks. Lovely. I just hope my husband or I don't need to travel during this time. I don't know if I can inject my back hip with the monster-needle.

New Year, New Approach

2010-04-04T20:17:00.000-07:00

I can't believe it's already April. The new year's not so new any more. And, I'm finally ready for my next fertility treatment adventure. Four IUI rounds with decent - even good - follicle counts, but no pregnancy. So, on to IVF. My company's Kaiser plan didn't cover IVF. We're lucky that the UHC PPO covers 70% of up to $18K. We changed insurance from Kaiser to United Healthcare PPO in January. I didn't want to leave Kaiser, and I still haven't learned to navigate the how's of finding a primary care physician, etc. But, I did manage to get a mammogram, which wasn't as bad as some of my girlfriends' stories, despite my minimal endowment.

Following the rules to get PPO coverage for IVF meant waiting until we were officially covered in the new year, calling UHC's family planning referral center to get assigned a case nurse, playing phone tag with a nurse who always left me a message at 4:29 pm saying she finished work at 4:30, finally securing approval from the nurse for IVF at an approved center, then making our first appointment at UCSF. We had our first appointment at the end of January.

Ivan, my doctor at Kaiser, recommended a few folks he has worked with at UCSF, but I chose first available because I'm i-m-p-a-t-i-e-n-t. So we got Dr. Rosen. He is a researcher, which I like. And he's a bit geeky, which I also like. He always has a student/resident working with him, which I really like.

Dr. Rosen posits that I did not get pregnant with IUI because I have a blockage in my tubes, possibly due to my miscarriage last year, and/or my appendix removal. He says that the procedure I had last year to open a blocked tube, a tubal recanalization, does not always open the tube. So, he thinks I may have better success with IVF. He gave me 20% probability of getting pregnant, and said I might have to go through several rounds of IVF.

20%. Ivan said 10-15% for IUI. The IVF odds don't seem a whole lot better. But, maybe it's a blocked tube so the mechanics of IVF will make a difference...

Third Time's the Charm?

2009-11-08T08:11:00.000-08:00

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.

La Deuxième Fois

2009-10-12T20:55:00.000-07:00

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.

Catching Up

2009-08-30T09:25:00.000-07:00

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.

Ultrasound after Ultrasound

2009-07-29T18:09:00.000-07:00

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.

First Steps

2009-07-19T23:08:00.000-07:00

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.

Starting Where We Left Off

2009-06-07T09:33:00.000-07:00

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.

Travail

2009-05-24T09:34:00.000-07:00

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.

Patience

2009-05-20T23:32:00.000-07:00

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:

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.

Water babies

2009-05-10T09:27:00.000-07:00

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.

Anemia and the Vegetarian

2009-05-02T08:15:00.000-07:00

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

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

Que est-ce que c'est Amphibole?

2009-04-27T22:54:00.000-07:00

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:

“ I once shot an elephant in my pajamas. How he got in my pajamas I'll never know. ”
- from Animal Crackers

And a couple of cute and short ones:

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

Lucky

2009-04-25T11:43:00.001-07:00

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!

Trials and Tribulations of HMO's II

2009-04-23T06:49:00.000-07:00

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...

The Trials and Tribulations of HMOs

2009-04-23T06:00:00.000-07:00

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.

My Options

2009-04-22T17:13:00.000-07:00

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.

Pregnant in my head

2009-04-21T23:25:00.000-07:00

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.