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Wednesday, June 30, 2010

World Champion Snowballer

(written this past Monday)

My heart is in my throat today. I’ve got that double-time tightening in my chest that leaves me super-sensitive to the everyday annoyances that a well-functioning adult should be able to shake-off with a gentle but stern reminder that no babies died . .. oh, wait . . .

As my husband expressed to my therapist – who nodded in agreement - in our first counseling session, I am a control freak. It was entirely appropriate to bring up this trait in a clinical psychology context since it is definitely a trait that tends more towards the pathological than the organizational. When my mood is off-kilter then the world is off- kilter as well, and I feel likely to roll right off the razor edge of order into the abyss of accident, loss, grief, disorder, isolation and imperfection unless I whip everything into ship shape. And as soon as I start rolling … well you know… I just keep rolling and rolling, gathering up all my fears and gripes with the Universe into an ever-growing ball of misery. I am a professional Snowballer. And don’t try to console me with stories of your own epic snowball sessions; ‘cause I’m the World Champion Snowballer and I train almost everyday, all day.

Joking aside, the heart-in-the-throat feeling can be summed up with one word – anxiety. Straight up fear. My whole nervous system hums with adrenaline and I am ready for a fight, poised to strike as soon as I’m struck. In this super-sensitive state of mind, I react very aggressively to the smallest imperfections. Today, for instance, I could barely tolerate my husband’s badly-cooked chicken and an unvacuumned carpet. In fact, I really didn’t tolerate it at all, but complained instead that the chicken he cooked was dry, the avocados he chose at the grocery were hard, and had his moratorium on washing utensils now expanded to blenders as well? It was the kind of seemingly innocuous negativity and judging that poisons a relationship – slowly and surreptitiously. I am afraid that my anxiety and depression (and now I need to add envy after reading a couple of y'all's posts on the subject) in general, and infertility in particular, could poison my relationship and my life irrevocably.

Who knows why the anxiety is up today? Could be that it’s Monday. Maybe I drank too much this weekend. Both are likely reasons. But I also think it has something to do with the fact that I got my period today which means that I am supposed to call my RE and make an appointment to do an xray of my uterus. And that makes me scared. Not scared that they’ll find something wrong – that might be a relief. Just scared. Scared to move forward, scared of the impending decisions, scared of success, scared of failure, scared of life. Scared. And unfortunately, I have yet to discover a decompression strategy that doesn’t involve adult beverages or prescription medication.

On days like today (and there are more of them than not), when my inadequate coping mechanisms are so starkly revealed, I wonder if I could really handle the messy, unpredictable, uncontrollable world of children. Maybe I’m better off limiting the victims of my anxiety-driven rampages to my long suffering husband. Really, truly - maybe I should just let this go . . . except that that thought causes equal amounts of anxiety.

Let me ask you all, how do you cope with the fear and anxiety?

And where’s my mojito? Seriously, where did I put it?

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P.S. Thanks everyone for your comments. I don't have internet at my home in BFE, and I work in the same 10 ft by 10 ft office as my boss. So getting time to read and respond to blogs and comments isn't easy for me. But I'm reading all of them and soaking it all up.

Tuesday, June 29, 2010

Nice to Meet You: Epilogue

It has been an absolute trial, this third one, for so many reasons. In the first place, we heard a heartbeat – three times. We had pictures of a little white glob. We even saw his facial features (it was a boy). We told people; making happy plans about grandma visiting from Georgia. And we got married, planting a tree on our 5-acre property to signify the growth of our relationship and the growth of our family. There had been a lot of hope and love surrounding this last pregnancy and within the space of a few hours, it was snuffed out completely.

We were able to find resolution to the cause of the third miscarriage after a farcical series of missteps. As it turns out, my 13-week-old boy fetus was not sitting close to my cervix and removed by the emergency room doctor, but had most likely fallen into the toilet in that moment when I felt a larger mass of something come sliding out.

Fortunately, I am on the pro-choice side of the spectrum when it comes to conceptualizing human life. This was a fetus still - not a baby boy (though I seem to waver back and forth between calling all three of my "stars in the sky" "baby" and "fetus"). The fetus was a precursor of sorts - not yet mine, still belonging to the forces of biology and natural selection. Even still, the thought that the fetus (whose arms I saw moving and facial features I glimpsed briefly on the ultrasound) was flushed down the toilet like a dead fish is absolutely horrifying. I don't know how we didn't see it in the toilet when we looked; mercifully we didn't/unfortunately we didn't.

Luckily the doctor did retrieve other products of conception and despite placing these POC's in a preserving formalin solution which can render the tissue useless for any chromosomal tests, a karyotype was able to be performed and the diagnosis of triploidy was established.*

If you don't feel like clicking over to read about triploidy, here's my summation:

  • the fetus has a full set of extra chromosomes so that instead of 46 chromosomes, it has 69
  • triploidy is inconsistent with life
  • triploidy is a random genetic mishap that is NOT a factor of age (unlike Downs and other trisomies). 19-year-olds can get it as often as 39 -year-olds
  • there is no greater-than-average statistical likelihood that this will happen a second time
  • triploidy is typically an error in cell division of the egg, not the sperm

We were very lucky to have gotten this last piece of the puzzle. Knowing the cause certainly puts your mind at ease (not because I thought it was my fault; I actually don’t suffer that kind of guilt). This baby was going to die eventually - and definitely better that it occurred sooner than later. And it's an important diagnosis in terms of identifying potential areas of concern vs. things we can rule out.

With this diagnosis, I was able to tackle the intimidating field of advisable tests, doctors' opinions and the overall issue of whether to TTC again with more clarity and confidence. Below this post, I will provide a dry accounting of the tests I've taken and the results so far. With that, I will have revealed my back story to you all, and from here on out, you move forward with me in real-time as my husband and I try to decide what the hell to do next.

Remember when, after my first miscarriage, I basically double-dog-dared the Universe by claiming that the maximum number of losses I would tolerate would be three? Well, I think I also believed that, after a third miscarriage (impossible), I would bow out of the fight gracefully and reasonably.

I know, I know. Silly girl.

I just keep falling in hope . . . again and again and again … and again.

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* So everyone out there reading, if you find yourself in this unexpected position, be very, very clear with whoever is rummaging around in your uterus that you want to know what exactly they took out and what exactly you'd like done with those tissues - because they sure don't ask.


TESTS
anticardiolipin = normal range of 9.4
Factor V Leiden = negative
Prothrombin Mut = negative
Proteins C and S = normal
Lupus Ant = negative
Karyotype on me = normal
Hysterosalpingogram= normal
No tests on husband. We conceive every time we try.

Saturday, June 26, 2010

Nice to Meet You: Part 3

During my first miscarriage, I distinctly remember sitting on the toilet while waiting for the beginning of the end and having this thought: “I can do this three times.” It is eerie at this juncture that I chose that number; why three? I guess if I get to four, it won’t be such a significant number; but right now, right here - I can’t believe I jinxed myself like that.

I guess three is a number that demonstrates your willingness to soldier on multiple times, though not quite so many times that you get a reputation for masochism. Plus it seems to be a magical terminal number in so many clich├ęs - three strikes you’re out , three’s a crowd, third time’s the charm. But honestly, who the hell really knew on that toilet that day what I could or couldn’t handle. One thing you learn fast in the infertility business is you never know what you are going to do or how you’re going to feel until you do.

Of course, back then at 34, healthy and capable, three times was inconceivable. I was just hustling the universe, upping the ante, laying down a bold and definitive bet, and daring the Universe to take me on. But that Dirty Old Universe, it called my bluff. I could no more foresee the pain I was in for than I could . . . well . . . hold on to a pregnancy.

With my eye still on the prize and holding on to the dogma of statistical probabilities, I barely registered my second miscarriage. I didn’t tell my parents until after the D&C, told my sister a week later during the Christmas holidays, and didn’t tell my brother at all. There were no dramatic visits to the mental ward and no late night sobbing into the phone. I wanted it out so I could move on. Sure, I was sad and disappointed but this was all an unfortunate streak of bad luck and the next time was going to be fine. Because I was just not one of those 3-miscarriages-in-a-row type of people. That's not how I roll.

Cut to today. It's been a month and a half since my third miscarriage at thirteen weeks. It was a surreal experience played out in an emergency room on May 7, 2010:

My lower back had been aching all afternoon at work - nothing unusual; but late in the evening, the sensation became stronger and sharper. I kept thinking maybe it was gas, but after an hour of constant intervals of pain, I finally decided to call my doctor to reassure myself that this was all OK and would pass. The nurse on-call advised that I visit the emergency room.

By the time we got to the hospital (a thirty-minute drive), were processed by check-in, and left in a room to wait, I had been having ferocious contractions for about 2 hours (though I didn’t know they were contractions at the time – rather, I hoped they were not contractions. Denial and hope are powerful blinders.) When the ultrasound tech finally arrived, waiting patiently for me to settle myself into the stirrups, the pain was so intense that I couldn’t lie down but only stand doubled over my stomach.

Suddenly I felt my water break, and I ran to the toilet. Fluid streamed out while the ultrasound tech stood in front of me, trying to be helpful and asking me if I wanted her to hold my hand. I wasn’t sure what I was supposed to be doing: it seemed like a grave enough situation to warrant spotlights and needles and machines and doctors with masks on - not me on the john with a stranger holding my hand in a quiet, white-tiled hospital bathroom. Jason was in the other room, trying to stay out of the way.

My solution to such a surreal landscape was to give her a blow by blow of my bodily functions while we waited for the inevitable. “That’s not pee, ” I whispered. “OK – that’s pee.” Then I felt something larger come sliding out. “Oh my God.”

I sat there for a few seconds, terrified to look in the toilet and see a dead baby. I told her I didn’t want to look and she came around back of me to see what she could see. There was nothing to see. In fact, when I did peek, the toilet bowl was still clear. There was just a little string of mucusy blood. Sigh of relief – no dead babies yet.

Now, keep in mind that I can recount the events so lucidly because I have had time to think about what was happening at each stage of the miscarriage. But at the time, I didn’t know for sure if those were contractions or if that was my water breaking. I have only surmised it after the fact. At the time, it was one horrifying event after another, a movie playing out on my body, in my life, while I watched and waited, wracked with enough pain that all I wanted was an ending.

The pain did go away, very suddenly and completely, after my water broke. Finally, the tech could get on with her job, clicking around my uterus, assessing the landscape, I assumed, examining the fetus, solving the mystery. It must have taken five minutes and all-the-while I felt fluid leaking from me. I assumed it was more amniotic fluid - the clear stuff - but it was actually blood. A lot of it. The blood was what I was waiting for. When the blood came, I knew it was over.

I asked her if the baby was dead – it was kind of rhetorical, but I needed someone to TELL me with finality that this was the case. No one had yet to say the words ‘dead’ or ‘miscarriage’ – there was only implication and innuendo. And I think my frankness did her in.

That sweet tech, Gina - who had spent the most time with me in that awful green room, held my hand while I passed pregnancy fluids, looked for my fetus in my uterus - started crying, apologizing for her emotions and explaining that she couldn’t see the baby in the uterus. She supposed it was close to the cervix, undetectable by the wand. I loved her for her tears; she cried before I did.

The next few moments/minutes/hours are a blur. I know the doctors came in and removed what was left inside of me. They shot me full of Ativan and I remember Jason telling them that he wanted to make sure I would be able to sleep that night. I staggered out of the stirrups into the bathroom to put on the biggest sanitary pad I’d ever laid eyes on, and then they wheeled me out to the car. I don’t remember getting into bed; but I slept just like they promised I would.

Checking-Out

On re-reading my accounting of the journey so far, I wonder why anyone would particularly care about my gruesome little corner of IF land? I've begun to follow many blogs out there, and am increasingly realizing that my experience is pretty universal among IFers. All the new thoughts that fly up in my head, all the epiphanies and new life-lessons are very very typical.

And I don't know about everyone else, but I tend to begin to glaze over after reading tragic story after tragic story. Like the oil spill response - everyday is a new cluster fuck and I no longer register the day-to-day since nothing is working anyway. The oil just keeps gushing and gushing and spreading and spreading as our delusional species scrambles around trying to manhandle millions of gallons of oil run-amuck, revealing the pathetic limits of our influence.

In the face of the same-old same-old - oiled birds, brown ocean, empty sacs, blood and toilets - I have to mentally check-out. There's definitely a certain self-preservation mechanism at play here, but there's also the element of habituation. I get used to the macabre stories and they begin to lose their impact. I also realize I'm not anything special, I have no great new words of wisdom to offer the blogosphere, it's the same view over here in my chair in front of my iMac as it is for you wherever you are.

It all seems pretty fruitless, but you can't stop trying, can you? Whether it's oil spills or biology, we keep trying to assert control over forces bigger than us. Sometimes we win and sometimes we lose; but in the end, success is not a reflection of our power, just a reflection of our perseverance.

Thursday, June 24, 2010

Nice to Meet You: Part 2

After the mental ward debacle, I had, under the advice of my psychiatrist, switched from a midwife to an OBGYN. I wasn’t going granola this time; no warm fuzzy midwifes coaching me through one of the most natural and magical experiences of a lifetime. No “managing” my depression using the sheer willpower of a determined and loving mother. I wanted beeping machines, lube, metal instruments, tests, and full-fledged M.D.’s. And I definitely wanted my Zol.oft. When Jason and I were ready to try again 9 months later, I got off the Kolon.opin and started taking the lowest effective dose of Zo.loft. All I could do was just hope that me and any future children of mine wouldn’t be part of a study 30 years down the road reminiscent of the DES Daughters.*

In September 2009, Jason proposed to me in Barcelona with a perfect ring in a perfect restaurant by the sea. He gave me a wonderful story to tell my kids and grand kids unlike my first husband whose proposal went something like, "do you still want to get married?" Jason and I tried to conceive for the second time in Barcelona. It didn’t take; I blame excessive chocolate intake and a lack of A/C. This marked the only time in which we failed to conceive while trying – good sign as They say – “At least you can GET pregnant.”

We did conceive the next month back at home. Like my first pregnancy I had a disturbing lack of symptoms, though this time even my breasts weren’t tender. Having learned that in my body, a lack of symptoms equals no fetus, I was fully prepared to hear bad news on our first visit to the new doctor and even stopped the nurse mid-spiel to say that we probably didn’t need to go into all of the details since I was pretty sure I wasn’t pregnant anymore.

Well didn’t I feel like a silly doomsday drama-queen when the nurse came back with a positive on the urine test. My HCG’s were also rising appropriately. All seemed well at this early stage which was around 6 weeks. They told me to visit them again in two weeks for the transvaginal ultrasound. “Great,” I thought, “more waiting.”

Waiting is excrutiating. Waiting drains my energy and places me in limbo – and not the fun Caribbean dance kind of limbo. Purgatory more like. Those waits, whether they are 2 days long or 2 weeks long, are endless and deadening; they harden me into a brittle piece of glass, and the competing forces of hope, fear, doubt, resignation, and biting anger threaten to break you into a million shards of sharp loss before knowing if there actually is a loss. It is the waiting that leaves me breathless with panic - like a child walking alone through the forest, imagining monsters in the trees. I fear the waiting more than the actual loss.

The seven-week ultrasound revealed another empty sac. A D&C followed.

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* Zoloft is the recommended antidepressant for pregnant women since it has been on the market for the longest amount of time and, thus, offers us the longest view of the effects of this drug on children who have been exposed in utero or through breast feeding. The recommendation is based on the fact that no significant damage seems to have resulted in exposed children over the past 20 years or so. Comforting stuff, huh?

Wednesday, June 23, 2010

Nice to meet you: Part 1

My name is Melanie. That is a pseudonym, since my wish to speak frankly might have very embarrassing outcomes if I reveal my identity. But I am no one in particular. I could be you. I am every woman coping with infertility . . . so no need for formal introductions.

My official diagnosis - the one that the insurance company looks for before forking over payment for tests and doctors visits related to infertility - is "recurrent miscarrier" or "habitual aborter."

Nice.

I'll trade you that label - I'll take bad tipper, bitchy neighbor, pretentious snob . . . All of those have been true at one time or another. But they are all easily shouldered unlike this recurrent miscarrier title. That prize comes with equal parts shame, fear, anger and anguish rolled up in an inadequate, broken body.

My first miscarriage occurred in the Fall of 2008 with my now husband who was then my boyfriend, Jason. Being a veteran of one failed marriage, the marriage-go-round was not a ride I wanted to get on again anytime soon; but I was ready to have a baby with this man. I know it doesn’t make sense, but it doesn’t have to make sense. Life doesn’t make sense.

We got pregnant immediately and I remember feeling so happy and proud that we nailed it on the first try. I was always an A student - why should pregnancy be any different? A +, Melanie! I didn’t have many pregnancy symptoms either, just a little bit of breast tenderness. I was so smug with success.

Then an early 6-week vaginal ultrasound revealed an empty gestational sac. I never knew such a thing was even possible. A "blighted ovum;" that was my first inadequately-explained, infertility-related diagnosis that I would have to research.

The doctor explained that maybe my timing had been off and I was actually not as far along as I thought, suggesting that I come back in a week for another ultrasound. I went home holding on to the hope that I had counted wrong or misremembered. I’ve left many a doctor’s office since then with vague palliatives echoing in my head that “everything looked great” and “just keep doing what you’re doing.” But I knew full well what my window of fertility had been and that they should have been able to see a 6-week-old embryo. The next day my breast tenderness abated and for the next week I played the waiting game, sure about my own accounting of days, but hoping against all hope for a medical miracle. Strange things happen in the body, after all.

This marks the first time I fell in hope. One week later, the blighted ovum was confirmed and I was sent home with an oral and vaginal pill to induce the miscarriage.

The fallout from this miscarriage was pretty catastrophic. I ended up in St. Agnes right after Christmas - an inpatient unit of the hospital serving mentally ill individuals who need a little "time out." My time out was three days long, ending on my 35th birthday. Yay life.

Many factors landed me there. The unsuccessful end of the pregnancy obviously, compounded by the fact that I was still in the midst of healing from my divorce and completely unsure of my ability to make decisions regarding my romantic life. I was also forced to grapple with my fourth major bought of impotency with respect to my "life plan." The most damaging factor of all, however, was that I tried to muscle my way through pregnancy, miscarriage and the weeks afterward WITHOUT my antidepressants.

I have been on antidepressants since I was 19 years old. It is amazing to reflect that I have taken SSRI's my entire adult life, but I count myself unbelievably lucky to be born in a day and age when SSRI's are available and effective for me. I have checked in with my brain a few times since I was 19, trying to determine if a now mentally stable and properly-therapized brain could successfully take up where the medication leaves off.

Nope.

Even after exercising all my willpower and analytical skills, writing countless heart wrenching journal entries and spending thousands of dollars in therapy - my brain's natural normal is "clinically depressed" (another happy label), and just like with my miscarriages, there seems to be no rhyme or reason why I pulled that short straw since my childhood and family life was stable and loving and I have 2 siblings who have never (that I know of) taken an antidepressant in their lives.

I have happily taken first Zo.loft and then Pa.xil to curb my depression for 17 years. But before getting pregnant, I decided that I wanted to attempt pregnancy without my medication. It had been a long time since I had tested the sans-meds waters, and it seemed like the responsible thing to do considering the dearth of information on the effects of SSRI's on babies. It was rough going, and mostly hard to differentiate among the various stressors. Were my moods due to the discomfort of withdrawal symptoms, pregnancy hormones, or the brand new "oh-my-god-we're-having-a-baby!" panic? I muscled through the meltdowns.

But the shit really hit the fan when, after the miscarriage, I decided to remain off the medication - already planning my second pregnancy, which I still intended to attempt without antidepressants; I didn’t want to suffer the withdrawal symptoms all over again.

That was the beginning of a downward spiral that left me one morning - for the first time in my life despite some serious bouts of depression in my past - unable to get up and go to work, too paralyzed with fear, anxiety and hopelessness to face another day of my life. That afternoon, I was bunking with drug addicts, schizophrenics, and otherwise brain-damaged people (counting myself among them), calmed by a haze of Klon.opin and Ati.van. I celebrated the arrival of 2009 in that facility with my fellow loony tunes, glad I didn't have to be out in the world celebrating. I completed a 5000-piece puzzle instead.

After my release, I got back on my meds, got a psychiatrist, and added a new medication – Klon.opin - to my daily routine. You cannot take Klonopin while pregnant. I had to step way back from my plan, spending nearly a year picking up the pieces very slowly, very carefully and very very gently.