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Monday, September 26, 2011

Et tu Prometrium?

It has been a grueling three weeks since my last update. There was the lovely trip to Leavenworth and my neice's birthday dinner, but most every other moment has been very unpleasant. I was almost getting used to the nausea. Getting a handle on it anyway. I finished up the last of my IVF follow-up hormones on the 18th, had my last fertility clinic visit the next day for a blood test, then to the pharmacy for some Colace that afternoon. Despite why I was there, I enjoyed the little trip, because it was my first time driving in about 2 weeks, and the nausea from earlier that day had abated. Everything went downhill very quickly from there.

I had no idea constipation and bloating could be so painful and soul-crushing. Days of being so full that I spent most of my time wondering if I was going to burst or vomit first. Every 2-3 hours, I would get ravenously hungry, eat a small bit of food, endure painful digestion with burning and stomach cramps, have less than an hour's reprieve, and then start the process over. Bed time was the worst because I take all my medications 30-45 minutes before bed with a full glass of milk or juice.  My doctor suggested the Colace that I had already started, and also Metamucil. This didn't seem to do a whole lot of good. By Friday the 23rd, the bloating was abating despite continued constipation, and a new symptom arrived: spotting and uterine cramping. Over the weekend, the spotting got worse and so did the cramping, which actually had the effect of "moving along" the constipation. My bowels were getting better, my stomach wasn't hurting when introduced to food, but that afternoon I became seriously worried about the intensity of the cramps and brightness of what was no longer really spotting, but not quite a flow either.

And then I picked up my phone and got a voice mail that, despite constantly checking for on Monday and Tuesday, my provider decided to hide from me until I gave up looking when I was so sick. The blood test showed my progesterone levels weren't where they should be, and I should continue taking Prometrium (200mg) 3x a day for the next two weeks. There was much freaking out after that. The after-hours nurse at my fertility clinic consulted with a doctor, and in the end it was decided that there wasn't anything they would do differently despite the spotting/cramping, they just wanted me to start up the hormones again immediately. Which I had already done much earlier, since it took them 4 hours to get back to me. Sundays!

I woke up this morning clear-minded and energetic, and with my first real appetite in over a week. I have not had eggs for over a month now, and this morning I just had to have one after Eric made eggs for himself. This afternoon, 24 hours after starting back on the Prometrium, the spotting is almost gone, the cramping is on the way out and manageable without pain reliever, there's been almost no nausea, and NO naps!

Prometrium, you are my new best friend! I take back everything bad I ever said about you in the past! Bring on the swollen breasts and nausea - baby and I will deal with that just fine from now on!

I went online to see if anyone else had had anything similar happen to them - could the week of constipation and stomach cramps and bloating to explosion levels have been caused by going cold turkey? I didn't see any evidence of that, but I'm pretty sure it was responsible for the spotting/cramping. It's an odd drug to research - you can't just go online, read the first hit about side effects and be done with it. Because the first thing you'll see is that you're not supposed to take it while pregnant. Way to scare the pregnant lady by slapping that sticker on the bottle guys! I didn't find cases online like mine, but plenty of women freaked out from that warning!

But Prometrium is one of those drugs that has multiple uses - menopause hormone therapy, cycle regulation, forcing a period, balancing out women with making too much estrogen, as well as keeping baby safe after IVF implantation. I am in that last class, because for some reason an IVF pregnancy does not trigger the necessary amount of progesterone to be manufactured naturally. A companion to the estrogen injections (that I do not have to restart!) that helped build up my uterine lining as baby first developed, progesterone was telling my body not to shed that lining. By the 2nd trimester, the baby will be making enough progesterone that I can stop again. Unfortunately, there isn't an exact date for that to happen, so we're going another full 2 weeks.

It's just kind of scary that there are a group of women out there that are afraid to take their doctor's prescribed Prometrium, and another group afraid to discontinue it when it's time. It seems the information sharing out there isn't that great for Prometrium. Between what doctors say/don't say and what patients hear/don't hear/forget, there is a lot of drama!

Thursday, September 1, 2011

Congratulations, you're having a blob!

We had a follow-up ultrasound today, and what a difference 7 days makes! The keiki is at 150 BPM and "looks perfect". The yolk sac looks good and the developing placenta is visible (trusting My Doctor's eyesight on that one). We definitely saw the heart beating today. Other than that, it's just a lumpy blob.

In the last frame that she froze to print a picture for us, keiki looked a bit like a a running figure. Kind of like the Kozmo mascot, sans disembodied head. Once it was printed however, the much smaller image just looked like a lumpy "^". After a few minutes, the blob transformed into a waving ghost with the body of a genie, then a smiley-faced stubby dolphin, then the head of a seahorse.

I would post a picture, but my new scanner scares me.

My Doctor says we should be in the clear. *grin*

August 25, Part 2: 131.5 B.P.M.

Thursday, August 25, 2011: one of the most emotional days of my life.

I had allowed myself to be distracted from my dread for the first time in 2 days. After much hemming and hawing, I had decided we should go ahead with our camping trip - we had stuffed the car to the gills the night before. I read an exciting, but long, chapter in my book.  I was still fuzzy from sleep. All the fuzzy vanished when I saw the blood clot.

It only took a second to make the connection: doctor questioned viability, I had been waiting for the signs of a miscarriage, here was a flashing neon sign. I started to cry, and that same horrific mourning came over me from last time. I apologized to the keiki, and began to sob. Eric woke up soon after that, tried for a moment to rationalize another reason, and then he just hugged me and we cried together in the bathroom. It was just before 8 a.m.

I spent 5 minutes researching miscarriages on the internet. What are you supposed to do when it's so early in your pregnancy that a miscarriage doesn't include the loss of full cups of blood? I spent another 5 minutes waiting for the clinic to open. When I finally reached them, somewhere in my mind I was impressed that there was only the smallest quiver in my voice when I said "I think I'm having a miscarriage and I don't know what to do." It only took a minute for them to slide me into the schedule to see My Doctor at 9:45 a.m.

I suggested we unpack the car. Eric just steered me back to bed, where he held me as I cried, where I apologized for killing a second baby, where he rocked me as he repeated over and over "No, you didn't."

The nail in the coffin was an even bigger clot that I found when using the bathroom just before we left. For the first time ever, I wasn't worried that a doctor was going to see my unwashed vagina. I wasn't worried about much other than surviving the drive to the clinic and the agony of the waiting room.

My Doctor looked sad, the nurse stood quietly in the corner. I told her about the clots, and that I had started cramping a few minutes after I had made the appointment. She was quiet and thoughtful, started to say something, then said we should look to see "what's still in there."

For once the monitor was turned towards me right at the beginning of the ultrasound, so I saw the sac still in place as soon as everyone else did. There was some zooming in, she used a cursor to point at a little blob and told me "there's the heart". The heart... flickered? Was that a trick of light by the ultrasound? She quietly took some measurements, and I watched as some numbers and letters popped up on the screen: 131.5 bpm

"The baby's heartbeat looks good," she said. Soon followed by announcing that the baby wasn't really that much smaller than it was supposed to be. The baby, with a heartbeat. The baby with a heartbeat safely in my uterus. The baby with a heartbeat safely in my uterus and alive.

She zoomed back in for us to see the heart again, and I saw that same little... hint at motion. She ended the ultrasound, and then the 4 of us all looked at each other in awe. We all believed it. We just couldn't wrap our heads around the fact that 5 minutes earlier we were all preparing to deal with a miscarriage.

Just to be sure, we cleared the camping trip with My Doctor, went home to grab some clothes and run some errands, and then we were off for the coast. Giddy. I think the best description of our emotions that morning were giddy.

It was hours later, as we laughed at Google Maps directions on how to enter the park (our little blue triangle drove straight through the invisible-in-real-life Visitor's Center), just what had happened that day. It was one of those experiences - good coming from bad, but on a monumental scale.

The pregnancy hadn't been real to me until I thought it had ended. The moment I saw that first blood clot, I believed the baby was real - and I had just lost it. The moment I saw that first flicker of quasi-motion from the heart, I believed the baby was alive. The machine's ability to calculate heart rate, followed by a second view of motion, and I believed my baby was alive and healthy. This terrifying morning had been the catalyst to make me believe in my pregnancy and acknowledge my keiki. If that morning hadn't happened... I don't want to think about that.

August 24, Part 1: I'm Mad

I've been waiting to post this until after the follow up. That came a little sooner than expected! And with very surprising results - see Part 2 for the happy ending.


- - - 

I am so angry. Yesterday, I was sad and scared. But as we left the clinic, anger washed over me and displaced everything else. I attempted to console Eric when we got home, and then I went out on errands before I exploded like the sun gone supernova. Normally, I use blogging as a way to self-examine my emotions. I am constantly trying to prove that my emotions are either valid or nonsense. There's an interesting topic for further discussion. But today? Fuck all that.

What set all of this off? The words "I can't say if it's viable or not." Yesterday was the first ultrasound, and although they found the sac, they could not see inside on maximum magnification. The sac was smaller than it was supposed to be, and all the way at the back of my uterus, which made the ultrasound not so effective. I listened calmly, I asked questions, I got dressed. I burst into tears, I mourned, I worried. I made the follow up appointment for next week that would tell us the answer for sure because of the rate of growth that happens in that single week. But the longer I was at the clinic, the angrier I got. We left just in time to keep me from starting to mutter under my breath in front of the other couples in the waiting room.

The state of my embryo is not their fault, and they assured me that it was not mine. So why am I so angry? Because once again, the clinic treated me like a number. Until now, I've been too afraid to say anything publicly. But today? Fuck that.

Yesterday's ultrasound was performed by the fifth clinic doctor I have had during this cycle alone. I didn't recognize his name or his face. He didn't understand entirely what I was trying to communicate before we began about my cramping - he thought I was afraid of the procedure causing pain. He was not wrong, but I was actually trying to convey that I was very anxious that the ramped up cramping that morning was so different from previous that it meant something was wrong. Instead of addressing that, his face cleared into a patient smile when he thought he realized the cause of my anxiety. He told me to lie back and not to worry, he would be gentle.

Playing this exchange over and over in my head, I told myself that if my actual doctor had bothered to show up, she would have understood me. And then I remembered the last appointment I had with her, and how whatever concern I had at the time puzzled her when I first tried to explain it. I am so good at puzzling doctors, I'm beginning to think I may be speaking some alien language. But this post isn't about me. Not today. I beat myself up 24/7 in my own mind. I am my harshest critic, aware of all my flaws, constantly walking through life embarrassed at everything I do wrong or how badly I react to situations. But today? Fuck all that.

I think it's time to start at the beginning.

Looking for a fertility specialist, I had a referral sheet from my gynecologist, which had the names of a half dozen doctors at two clinics. I made the first appointment with the only female doctor on the list. At the first appointment, I was so at ease, I soon after cancelled the back up appointment at the other clinic. Dumb. Very, very dumb.

In April 2010 I was told that I was basically infertile, had a freak out, and then with Eric decided our next step would be to try IVF with donor eggs - her eggs, his swimmers, my body as incubator. The process of just prepping for all of this took forever. Tests and paperwork and searching for a donor. Then more tests and more paperwork and contracts and money. Lots and lots of money. And with that final check received, things changed at the clinic for me.

I believe it started with my nurse emailing me the wrong information on the medication calendar. The issue was quickly fixed, but then there were the unreturned emails. I thought I had just gotten a bad nurse, so I didn't say anything. There was the time that we went in for an ultrasound and my doctor was inexplicably absent - a doctor I'd never met before, a male doctor, performed the examination. Then there was the phone call to schedule the actual implantation procedure - my doctor would not be performing it because she had the day off. I finally said something, explaining that I had chosen the clinic almost solely on the fact that I needed a female doctor. The scheduler was very sympathetic, but of course couldn't do anything about the situation. The procedure had to happen on a specific date, so moving it wasn't an option. She assured me this is the way a multi-doctor clinic worked.

On the day of the procedure, I was comforted that my doctor would at least be the one I had met recently. The female nurse was unfamiliar, but her presence was comforting. The lab tech who just walked in through the back door (the door that my vagina, on full display, was directly pointed at) to introduce himself was male. The two men performed the procedure while the female nurse looked on.

Ten days later I was admonished for having taken a home pregnancy test. Hadn't my doctor told me not to? (No.) Didn't I know they weren't reliable? (Not according to the pages of fine print I read that came with each of the 3 tests I took that gave me negative results.) It was all up to my lab tech to explain this to me and console me. No doctor. Not even a nurse. And of course, the anticipated phone call later that day confirming what I already knew - I wasn't pregnant.

Flash forward a few months, and I finally get to see "my" doctor again. I saw her once or twice after that. Then it was back to doctor #2 (still male!) and the surprise of doctor #3 (also male). I believe it was doctor #3 that I had to question about my calendar - it stopped on the day of the procedure, didn't tell me what drugs to take that day, or what the weeks after that would be like. I think my nurse got scolded, because she called soon after we got home to explain the post-implantation schedule and then emailed it to me. Yes, this was a different nurse then the one from my last cycle. But did I mention she made the exact same mistake about the same medication as in the previous cycle? At least she caught the mistake herself before I could ask her about it. 

Then it was time for the procedure which would not be performed at my clinic at all, because they no longer did them there. And no, I wouldn't be seeing "my" doctor once again - each day there was a selected "procedure doctor". At least this 4th doctor was female, right? The day went great. The 10 day wait went great. The phone call with the good news went great, as did the mini-break trip to the ocean we were on in case the news was bad (we could be alone) or good (we could celebrate intimately). The past few weeks have been... weird. Not only have I had a hard time believing this was real, but the physical side effects have been incessant.

And then yesterday, the day we were supposed to finally see "my" doctor again, as well as our first view of the little keiki. Instead, I got doctor #5, no explanation of "my" doctor's absence, and no vision of the keiki. Just those terrifying eight words. Afterwards, Doc #5 said next week's ultrasound should be performed by "my" doctor because she knew my case better. (Was the correct response there "duh" or "not really"?)

I was filled with a familiar sense of deja vu when the check-out clerk got a frustrated look on her face. "My" doctor would not be available until Thursday. Two extra days of not knowing and waiting in terror and sorrow. She had Monday off, with Tuesday and Wednesday fully booked. With no other choice, we scheduled for Thursday, but she promised to talk to "my" doctor about fitting me in sooner - after she got back from vacation in 2 days.

To be fair, "my" doctor read her email on her day off and gave the green light for a Tuesday appointment, about which I was called within minutes of getting home. It's just a bit too little and a bit too late though.

I contemplated going to another clinic for the 2nd attempt, and now that I'm faced with a strong possibility of a need for a 3rd attempt, I'm considering it again. But oh yah, the same problem still exists. The other clinic I was referred to, the one I cancelled my preliminary appointment with so long ago, is the only fertility clinic in the area as respected as my original clinic. And they bought my clinic in January. Doctor #4 and #5 were unfamiliar because they are doctors from this other clinic.

My only other option has become moot.

This is the part where I should remember to be reasonable. After all, none of these annoyances have been grievous errors. Right? Fuck that.

I'm mad.