Mourning our losses

My husband’s grandfather passed away last week (thus the blog silence). We’re doing a lot of mourning this autumn — my grandmother just passed away in September.

My husband’s grandpa was a wonderful, dear man — lively, smart, adventurous and loving. We really miss him. He had suffered with Parkinson’s disease for the past several years, and his health was in decline. I suppose we should have expected that he would die soon, but we were really hopeful he would get better. We had tickets to go visit him (in California) in December. We are sad we will not get to see him again, this side of heaven.

I happened to be reading a book this fall that has turned out to be very helpful in all this sadness: Henri Nouwen’s “With Burning Hearts: A Meditation on the Eucharistic Life.”  It is a delightful little book (very short, with lovely artwork). I highly recommend it.  It’s not specifically about death and mourning at all, and there are probably many other books (perhaps some by Nouwen, even) that deal with that topic better and more directly. But I’ve found it this book to be beautiful and quite helpful.

In the book, Nouwen writes about mourning our losses and giving them over to Jesus. That topic touched home with regards to infertility, of course, and with the loss of these two wonderful grandparents. Much of the book is a meditation on the gospel story of the risen Jesus and the disciples on the Road to Emmaus (where they don’t recognize him until he breaks bread with them — Luke 24: 13-35). I keep returning to one particular passage again and again … the “stranger” here is Jesus talking to the disciples:

“The stranger didn’t say that there was no reason for sadness, but that their sadness was part of a larger sadness in which joy was hidden. The stranger didn’t say that the death they were mourning wasn’t real, but that it was a death that inaugurated even more life — real life. The stranger didn’t say that they hadn’t lost a friend who had given them new courage and new hope, but that this loss would create the way to a relationship far beyond any friendship they had ever experienced. Never did the stranger deny what they told him. To the contrary, he affirmed it as part of a much larger event in which they were allowed to play a unique role.”

My sadness over these deaths is real. But I know it is part of a larger sadness in which joy is hidden. It is a loss to us, and we will continue to weep. But we also know these deaths inaugurated even more life, real life, for our departed grandparents. For that we rejoice — thank you, Jesus.

Quandries

Firstly, thank you to everyone who weighed in on my previous prometrium question. Several of you said your doctors prescribe it starting at P+3. That was good news, since I picked mine up on P+3 and thus had to start it then. But it was bad news because whyohwhy did my doctor prescribe it for P+1, when everyone else does it P+3? Pray tell, how would I even do that … since you can’t really confirm P+1 until you’ve progressed to at least P+2 or P+3…?

Oh, sigh. SIGH.

This is not the first time my doctor — whom I can’t help but *love*, even with all this craziness — has been less-than-clear about when I should take medication. During the estrogen debacle of last summer, he wrote one thing on the prescription and then the nurses told me another thing on the phone. We switched around the timing of that several times, until it totally freaked out my body to the point that my poor ovaries went on strike and refused to ovulate. They showed him! Those ovaries.

He also told me two weeks ago that he wanted to consult with another doctor in the practice about what I should be doing and call me back. I expected a call last week. I held out and left a message on Monday. Still no word. I’d also like an order for bloodwork, please!

Sigh. SIGH.

And yet, I have an even more vexing conundrum. My ovaries hurt. Why would that be happening?

Perhaps it is not my ovaries exactly. But something hurts — it’s in that general region, on both sides, low in my abdomen right at the sitting angle. It’s a very dull pain, kind of like the pain I felt at ovulation the first time I took clomid. Maybe lighter. An annoying but not at all crippling pain. It’s been going on pretty much nonstop since last night. This is at P+3 and P+4. What could it be? I can’t imagine it is anything good. (I am fairly certain I was right about ovulating several days ago — I had a positive OPK and my temps went up. also, no fertile CM anymore.)

In happier and completely unrelated news, I received a cat Santa hat in the mail today, which — if we can get our cat to actually tolerate it for 5 seconds — will make for a truly hilarious Christmas card photo.

And I had one other small success: I finally found a gift for my husband for our upcoming third anniversary.  My husband reads my blog (hi darling!), so I will not say what the gift is. But I am glad I found one. We do the traditional gifts, and this year is leather. That sounded easy enough until we tried finding things to get eachother (shoes are too hard to get without the person trying them on, a leather recliner is too big an investment without collaborating on it, etc.). So, it feels like a success.

Also, I hope all your Virginia people are voting today! Living in DC, I have nothing to vote for. But the VA Gov race is very interesting.

Prometrium question

I picked up my prometrium this morning. I had put off getting it because of insurance and funding issues, but I realized after picking it up that I should have gotten it last week.

I am supposed to take it P+1 through P+13.

Today is P+3. Oops.

(Dr. B went back and forth on the phone about when I should start it, and I did not remember it was supposed to be P+1. Apparently, it was.)

I took one this morning at 10ish am. It says on the patient instructions  that if you are taking it at night and miss a dose you can take one the next morning, then take another that night. Do you think I should double up today?

Anyone have any experience with prometrium?

Thanks!

A fluid situation

So, yesterday and the day before I had beautiful, abundant cervical fluid – clear, stretchy, fertile stuff. And it was with only vitamin B to assist, since I am running low on my other various mucus enhancers. It was so exciting! My body appeared to be doing what it was supposed to do! This morning I had a positive ovulation predictor test. On day 14! How quaint!

But wait … My cervical fluid? Nothing. Nearly nonexistant.

Seriously?!!

Sometimes I just want to fire my reproductive system for poor performance.

Prometrium

So, last Friday I was sitting in my desk, about to leave for a little midday run (my special treat to myself on Fridays), and I heard a buzz. My phone! It was a mysterious 703 number. I thought, “that looks like my doctor’s office.” I was surprised to pick it up and hear Dr. B’s voice! Praise be!So glad I did not go on that run earlier, as I had planned.

I had bloodwork done the week prior, but Dr. B was out of the office. In his absence, I cajoled the nurses to give me the low-down on my numbers. I had made an appointment with another doctor in his practice for later this week, and I was not expecting to hear from Dr. B.

All to say, I was pleasantly surprised to get the call. Dr. B always says “thanks for picking up the phone.” And I’m like “ARE YOU KIDDING ME? Thanks for calling me!” He asked if I was busy, and I replied, “I am never too busy to talk to you.” He thought I was being funny. I was serious.

In seriousness, I usually am busy when he calls, so I always end up sprinting out of my cubicle into a less dense part of my office. He inevitably asks something about the calendar or my pharmacy’s phone number, and I have to sprint back to my computer once or twice during the conversation. It is a bit comical.

But that is not what you are interested in. What about the bloodwork?

Dr. B said the first numbers look good, but my levels were a little low on the latter two days. He asked a lot of questions, including “what kind of symptoms do you have?” I replied, “symptoms of what?” He didn’t want to lead my answer, so I just told him the first thing I thought of, which is that I cry all the time. Like, once or twice a day. I cry when I read a touching story in the newspaper, or when I hear something sad on the radio, or when I think about my grandmother or my non-children or most anything. I cried once because my cat is A CAT. I felt bad for him.

I cry a lot.

I used to cry like this one week out of every four — just before my period. These days, it is all the time. Dr. B said it is because my hormones are all whacked out on clomid. Also, am I depressed?

He asked if I had ever taken anti-depressants. I have not. He said there have been some compelling reports about prozac and infertility. Some people have had success concieving while taking very low doses of prozac (the lowest available). Dr. B said he was skeptical about it, but then saw that regime work for 5 of his patients. It seems that when prozac boosts the serotonin, it might also give a helpful boost to other hormones.

I have always been hesitant to take depression or anxiety meds. I know they are lifesavers for many people, and I am grateful for that. But I also know they can have a lot of side-effects, and I figured as long as I can function under my current brain-hormone-situation,  I should stick with it.

So, my first thought on the phone was “no thanks.”

But then the more I thought about it, the better it sounded. I do sort-of have low-grade depression these days (crying, not wanting to get out bed, not wanting to be around humans sometimes … um, yeah, when I put it that way, sounds an awful lot like depression). It seems to be worse with clomid.  I am interested to ask him about it again.

For the time being, Dr. B said he wants me to try prometrium during my luteal phase, to help boost my progesterone numbers. He sent a prescription to my pharmacy ($67 — why can’t everything be as cheap as clomid?).

He also said he wants to talk to Dr. C about it and get her opinion on what I should do. He said he would call me back this week (supposedly by Thursday).

I am happy to try something new. But as I have said in the past, I feel like they are just kind of improvising with me. This whole conversation — “what are you taking again? want to try prometrium? I’ll talk to the other doctor …” — added to that feeling. Sometimes it frustrates me; but oftentimes I feel like this is just How Things Are. When it comes to hormones, I think all doctors end up improvising. For my friends who have suffered with mental illness, I know it has sometimes taken years and years to get the prescriptions right. I saw another friend Sunday who has a thyroid disorder (she found out about it from other signs, not infertility … not sure if she has tried to get pregnant yet) and she said it can often take a while to get thyroid meds right.

Until we get that blessed diagnostic machine that we can hook ourselves up to like a car an an auto shop, I think it is just going to be like this.

So, for the time being, I am facing at least one month on prometrium. Anyone else want to share your experiences? I am a little nervous about how it might affect me — my luteal phase is currently the hardest part of my cycle (I feel like I am in some hormone-induced fog. it is not charming).

Thank you!

And it seems to be impossible for me to write a short post. I apologize.

Tail-end brown bleeding?

File this one under: bodily fluids.

I am here to ask a little about our friend — or shall I say, our enemy — tail-end brown bleeding. I know it exists. And I know it’s generally considered Not A Good Thing. But I don’t know exactly what it is or what it indicates.

Oh ye women wiser than me, help me.

What exactly is tail-end brown bleeding? And what does it mean?

Here’s my situation. I have noticed that I have brown spotting at the end of my period. Is this tail-end brown bleeding? I don’t know. I also know that menstrual blood that starts out looking red can look more brown when it has been, err, sitting around or exposed to oxygen for a while. So I don’t know if the brown spotting I am seeing is just my residual period stuff or the dreaded TEBB. Are there any distinguishing characteristics?

And of what is tail-end-brown-bleeding a symptom? I read endometriosis somewhere on the internet. I have a vague memory of my “Taking Charge” book saying it has something to do with a luteal phase defect — I think she may have said that anything past 2 days post-menstrual brown bleeding indicates a bad luteal phases in the previous cycle. My brown spotting is just for one or two days.

I have not yet had a laproscopy or anything to look for endometriosis, but I may have the endo surgery in the not-too-distant future. My doctor wanted to try other things first, since he said I did not have any of the obvious signs of endo (besides infertility, of course).

Avoidance

At work.  I was just in the hallway and saw coworker-who-recently-had-a-baby and coworker-who-is-very-pregnant walking together down the hall. These two don’t work together directly. I know what they have in common (pregnancy, babies) and what they talk about.

I didn’t feel like hearing it.

So I smiled and waved, then hopped in the elevator. And, umm, I didn’t hold the elevator door. (But I don’t *know* that they wanted to take the elevator anyway. They may have been, say, walking to the bathroom. Or just taking a stroll through the hallway. And there are plenty of elevators in our office anyway. Right? Right? )

It is part of a trend of avoidance. Coworker-who-recently-had-a-baby used to sit in the cube next to me. It was tough, because she announced her pregnancy just as I was realizing I was dealing with infertility.  The whole office moved cubes, and she no longer sits near me. I don’t chat with her very much anymore.  I think she might wonder why I do not ask her more about her baby — I am, after all, the girl who used to love to share pictures of her baby nephew. Now I am the person who puts her headphones on if baby chatter starts.

I am kind of baby-ed out with friends. I’d rather avoid it at work.

The pregnant coworker had a surprise shower two days ago. I did not go and did not contribute. (Though to be honest, many of my coworkers also did not. Pregnant woman works on a different floor in a different department, so we don’t really know her anyway.)

I feel a little guilty about all of this, though. It’s a thin line between my own self-preservation and rudeness. Not sure if I am balancing on it properly…

Bloodwork numbers and reference ranges

I called and got the rest of my bloodwork numbers from my doctor’s office today, after some cajoling.

I am now on CD 29. No big temperature drop yet, but I expect my period to start Any Day Now.

I am including my numbers below. I’d be grateful for any of your thoughts on what I should ask the doctors to try next. The nurse told me that my first numbers were good but the others were “low.”  (…although they still appear to be in the “normal” range… but the “normal” range is awfully large)

By way of background: This is my second clomid cycle. Without any medication, I ovulated but had wonky progesterone-estrogen levels in my luteal phase. The progesterone was too high, particularly in relationship to the estradiol. The first attempt to fix that was by applying an estradiol ointment — aka “the lady cream” — to “balance it out.” It did not balance it out. Estrogen took over and my cycles were all messed up and annovulatory. Fantabulous.

The new regime is clomid, which I like more than I thought I would (shorter cycles, obvious ovulation, no terrible side effects and it’s cheap!). I also apply 1/2 of an estradiol 1 mg packet each day from when I start the clomid until ovulation. (Dr. B said that part was kind-of optional.)

I am a little (perhaps more than a little) frustrated because my numbers are “low”, yet no doctors are available to give me any advice over the phone on what I should try for this next cycle, and I can’t get an appointment until Oct. 30th.  Although come to think of it, that might be right around the time of my next ovulation, so perhaps there is still hope.

(An aside: I know October 30th is not that far away. Patience, patience. But I feel like I’ve been spinning my wheels with these people for the past year, and I am a little anxious to get things moving.)

Anyway, here are my results…

P+6 or 7ish: estradiol 126 pg/mL
progesterone 18.78 ng/mL

I  went out of town for four days, so I have a data gap.  Now I really wish I had that info.

P+10ish: estradiol 94
progesterone 9.64

P+11ish: estradiol 86
progesterone 8.2

And now for something *truly spectacular*.  Because my Very Friendly inner-city lab actually gave me a print-out with some of my results, I have the reference ranges for what are considered “normal” levels of estrogen and progesterone. This is the kind of stuff I poke around for on the internet all day. Here you go!

Reference range for estradiol
Female:
Follicular Phase: 11-212 pg/mL
Mid-cycle: 18-480 pg/mL
Luteal phase: Less than or equal to 247 pg/mL
Post-menopausal: Less than or equal to 27 pg/mL

Male: 13-54 pg/mL

Progesterone reference values

Non-pregnant female:
Follicular phase: <1/4 ng/mL
Luteal Phase: 3.3-26.0 ng/mL
Mid-luteal phase: 4.4-28.0 ng/mL
Post menopausal: <0.7 ng/mL
Oral contraceptives: 0.1-0.3 ng/mL

Pregnant female:
First trimester 11-45 ng/mL
Second trimester 26-89 ng/mL
Third timester 46-423 ng/mL

Adventures in bloodwork

I apologize for my blogsilence since my last blood test results a month ago. Words left me for a while after my grandmother died. I may write more about that later.

For now, I am back for another very special edition of ADVENTURES IN BLOODWORK.

When we last left our heroine, she had just learned of her hormone levels on a clomid cycle. Lovely though they were, they did not lead to a pregnancy. So she was back at it again this month — this time for P7, P9 and P11 estradiol and progesterone. A simple enough task … and yet will it be? Nothing is truly simple on the infertility rollercoaster. Stay tuned for a very long post …

***

Last Friday was P7-ish. Perhaps P6 — I am not exactly sure.  But I wanted to get my bloodwork, because I was going to be out town that weekend to visit my granddad in South Carolina. My plan was to ride my bike from work to one of the labs downtown during the day. Simple, yes? No. Work got in the way, as it is wont to do, and I  was too busy to leave my desk before 4, when all the labs downtown closed.

So, I send a desperate email to my husband, who discovers a new lab that stays open until 6. Problem solved! Kind of. Now I just have to get there.

It is a new lab on U Street — an area famous for jazz, late-night chili and vibrant night life. Not so famous for its medical labs. At least not yet! Due to another work-related delay, I had to get a cab there. So, I open my wallet and hope for the best.
The best does not come.

Several blocks from my office I realized my insurance card was still sitting on my desk, where I had taken it out so I could call and ask about getting bloodwork from SC (verdict: forget it, too complicated). So the cab driver turns around, I run back to my office, get insurance card, get back in the cab, get stuck in traffic and watch the clock tick down to 6 pm.

I start to wonder if God really wants me to get this bloodwork.

But then, glory be, traffic clears. The cab arrives at U Street. It’s 5:57 pm. There is a glimmer of hope! Me and my suitcase (for weekend trip, not for bloodwork) run down the block. No lab. I run the other direction. Still can’t find it. Frantically call husband. The address is wrong. Frantically call lab. I look up and see a banner across the street advertising the lab. LO AND BEHOLD!

The previous labs I have utilized were either in big office buildings or in a hospital. This one is not. This is your inner-city lab. It is in a row house in a part of the city known as “Little Ethiopia.” It is between restaurants and shops, across the street from a large gay sports bar. There were guys out front selling hacked copies of movies from China.

I live in the District in part because I love an urban adventure, so frankly, this was right up my alley. But I was just a little bit nervous about ringing a dirty doorbell for a place that would eventually be sticking me with a needle. I go for it anyway, and am rewarded by meeting the extremely friendly man (African immigrant, I think) who runs the place,  He stayed open even though it was time for him to close. He’s already one up on LabCorp.

The lab is on one floor of a rowhouse, and it feels kind of like walking into some sort of little government agency in a small town. There is a desk, a computer, a printer.  I sit next to the desk, help them enter my information in the computer and watch as he reads the requirements for estradiol and progesterone tests. I notice that most of the paraphenalia in the office has to do with urine drug tests. It appears that is their specialty — I assume that many of their neighboring restaurants send people over.

When it’s time for the blood test, I  head to the corner, where there is a chair with an armrest . The Very Nice Man is giving me a pep talk and asking me to pump my arms like I am lifting weights.It’s a little different than my experiences at LabCorp.  He chants: “OK. We’re going to do this! It’s going to be easy!” Pretty soon I figure out the pep talk is really for him.

It is possible I am the first person ever to get a blood test there.

Very Nice Lab Man gets ready, inserts a needle. “I got you!” It hurts. There is no blood coming out. I have done this enough times that I know it’s not right. I tell him it’s not working. I point to the other tiny holes in my arms, marked by so many previous blood tests. He sticks a new needle in one of those. This time it works. Thank you, Jesus.

After a bit more help with paperwork, I dash out of the office onto the metro and am off to the airport.

Four days later, my arm still hurts from the incorrect stab. But a glutton for punishment, I return for my next vial of blood, because I just love the friendly, quirky local business. He does a better job with my next two blood draws.

Today was the last blood test (P+11 or 12) and Very Nice Lab Man greeted me with a “Hey! I just called your doctor’s office! I got your results!” (Again, this would not happen at LabCorp.) He prints out a copy of the results for me, tells me they look good.

One glance and I can see they don’t look good, at least not to me. First progesterone is 18.78. Second one is 9.64. I am not pregnant. I manage to hold it together in the office, but as soon as I leave, I burst into tears on the sidewalk. I’m a big weeper, to be honest, but this crying episode is the real deal: scrunched up face, waterworks, crying noises.

I pull myself together — kind of — and start to run to work. Two people (also African immigrants?) stop on the street and ask me if I am OK. I am touched by their kindness. This is in DC, where you can be lying on the sidewalk with a severed limb and people will just cruise right by, eyes glued to their blackberries. But these two kind souls stop for me. I tell them I am fine. They clearly do not believe me. They do not move. I say, “No really, I’m OK. I’m fine. I’m fine.”

I’m fine. I am used to being Not Pregnant, after all. Right? I gave up on monthly mourning a long time ago.

But I’m not fine. I am crying. I am bursting into tears at work — which is generally not a cool thing to do in my office. I had been so hopeful this cycle. I had a new treatment, and everything seemed to come into place. I even imagined all sorts of (phantom) pregnancy symptoms the past few weeks … so now in addition to being infertile, I am also crazy. I guess I have “hysterical pregnancy” like the  wife on Glee.

I was so hopeful. I guess I didn’t realize just how hopeful until today.

P+7 blood results

So the real news in my life is that my grandmother  passed away last night. I am glad she has been liberated from her increasingly frail and confused body, and I am sure she is dancing a jig up in heaven with Jesus right now (she loved to talk about dancing a jig). But this was very sudden and unexpected — she had been pretty healthy for a woman in her 80s, and I had just been in the midst of planning a trip to see her later this year. She died at home in SC last night.

I was not ready to say goodbye to her yet and am really sad. Actually, even sadder than I would have guessed I would be: I couldn’t sleep last night and have been crying all day. I also feel very far away from my family, who are all scattered along the eastern coastline, and that is hard.

This has been a really hard year.

I don’t have the energy to say much else about it right now, but will write more in the future.

However, it takes much less emotional effort to write about blood test results, so I will do that quickly. Even if it feels a little ridiculous to do so…

I was able to get the P+7 blood draw from a hospital on Saturday — thanks to you clever people who suggested it!  I have an appointment next week, so I wasn’t planning to even bother checking on it until then. But my doctor’s office called me today UNSOLICITED and left the ACTUAL NUMBERS in a message on my voicemail this afternoon. This is unprecedented.

The nurse said that Dr. B said the results were “excellent” — I’ve heard from some of you that their enthusiastic adjectives are meaningless, so I thought I would see what you think.

Estradiol 227

Progesterone 20.3

What are P+7 levels supposed to be? Without any medication, I had skyrocketing progesterone and very low estrogen. With estrogen supplementation, it was even worse: slightly higher estrogen but absolutely no progesterone. So I will say that these results look much better than what I had experienced! But I don’t know what the ideal is … I’m just wondering for the purposes of my appointment next week if I should be pleased with how clomid produced these levels or ask to try something else.

Umm, also — would progesterone be higher on P+7 if I were pregnant? I just want to manage my expectations.