herveryown

Another Spin-Off

A few of my co-workers were unable or unwilling to comply with my request for relative privacy about the pregnancy, so now all of my co-workers know about it.  This means that every day, I am subjected to numerous sappy "How aaaaaare you, Akeeyu?"s.  When I pretend oblivion and offer a generic "Fine, thank you," they move in closer and say "But how aaaaaaare you?", inevitably meaning how is the pregnancy.  The women, especially, seem to want something, seem to expect me to start exuding some form of giggling camaraderie or kinship that we never had before and certainly don't have now.

What I don't say in response is "It's none of your fucking business, and when I want to discuss my uterus with you, I'll come find you," or the more succinct "How the fuck should I know?", but I want to, every single time.  Right now, we don't know a damned thing, and we won't until the end of the week.

In lieu of any sort of news, let me offer y'all my suggestion for Dick Wolf's next drama:

Law & Order: IVF
In the criminal justice system, the people are represented by two separate, yet equally important groups: the detectives hopped up on Progesterone in Oil injections, and the district attorneys they haven't (yet) bludgeoned with stale breadsticks in fits of hormonal rage.  These are their stories.

Beat Cop: "Thank you for coming, detectives.
IVF Detective One: "Oh, we were in the neighborhood anyway.  That new deli just opened up down the street, and their pickles are fucking fabulous."
IVF Detective Two: "Yeah, we would have been here sooner, but we had to take a three block detour around the construction site on the corner.  Man, those portapotties reek, to say nothing of the guy working the jack hammer.  Anyway, let's get down to business.  Is that B negative I smell?"
IVF Detective One, rolling eyes: "That's AB negative, obviously."
IVF Detective Two: "Well, one thing's for certain: The killer definitely needed a shower.  Fucking A."
IVF Detective One: "At least he brushed his teeth recently."
IVF Detective Two: "Ah, yes, Colgate."
IVF Detective One: "Tartar Control."
IVF Detective Two: "Yes, very nice."
IVF Detective One: "Now, the killer's last meal was obviously one of those nasty ass sandwiches from Lunchables R Us.  You know, the kind with those chicken strips that smell like laundry detergent?"
IVF Detective Two, sniffing intently: "And he cracked his molar on a sesame--" (sniff sniff) "--no, make that a poppy seed.  Must have been quite painful; I can smell his tears over here.  Quick, to the phone!  Now, I can smell his grody fingerprints (and my God, you do not want to know where those fingers have been) on the five, seven, three and eight buttons..."
IVF Detective One: "Hang on, I'll just Google for local emergency dentists with those digits in their phone numbers...a-ha!  Three blocks west of here.  Let's go."
IVF Detective Two: "Ooh, west?  Is it anywhere near that ice cream parlor you were talking about earlier?"
IVF Detective One: "Kitty corner."
IVF Detective Two: "We are so stopping there on the way."
IVF Detective One: "Clearly.  Now, let's call for backup."
IVF Detective Two: "Okay, but make sure they've all applied deodorant and haven't been anywhere near the ocean this week.  I swear I smelled whale pee on that last guy."

Sniff

Last week several of my symptoms completely disappeared for a couple of days, throwing me into a spiral of "Oh crap, I bet they're dead."  Lucky for me, the morning sickness and hypersnifferism returned with a vengeance a couple of days ago, throwing me into a reverse triple salchow spiral of "Oh crap, this is just like it was with GE, I bet they're dead."

I just can't win over here.

I can, however, smell.  Everything.

In the past three days, I have smelled:

• chemicals in tap water
• B.O. on a ten year old from a distance of two yards
• B.O. on everybody, dear God, people, haven't you ever heard of Dial?
• everybody's perfume
• ...and aftershave
• ...and fabric softener
• in one memorable case, somebody's earwax
• mildew
• cat farts
• clouds
• fear
• every cigarette smoked within a three block radius
• the inside of a PortaPotty that came very close to doubling as a Vomitorium
• your breakfast
• ...from yesterday
• the fish you ate two hours ago
• the fish you had just a bite of last week
• your mouthwash--it's nice
• your deodorant, which is also lovely
• trees
• the ocean
• whale pee
• each individual ingredient in my face soap
• book binding glue
• every alcoholic beverage sipped anywhere near me, most of which smelled delicious
• individual molecules of food that are five minutes past their expiration date
• That Smell, as in "What in the fuck is That Smell?"

In the past 72 hours, I've smelled so many things that other people are completely oblivious to that I'm starting to wonder if my nose is hallucinating.

By the way, this is for that guy on the 405 this morning: I didn't zip around you and cut you off like an asshole because I'm an asshole, I did it because your catalytic converter has failed and your car smells really bad.  So there.

Rational Fears

I only got angry once during my first prenatal exam.

The midwife was going over the warning signs of miscarriage and telling me which number I should call if I start experiencing pelvic pain or any of the other symptoms on the list.  I calmly told her that I was already experiencing generous amounts of pelvic pain due to the OHSS, the endometriosis and the round ligament pain, and probably wouldn't really notice anything new.  Furthermore, GE's demise had been entirely symptomless. 

"Well, if you did have any symptoms," the midwife went on, following her script, "you'd want to call this number."  I took a deep breath and pasted on a bland smile that didn't reach my eyes and nodded.  I was fighting the urge to say "And what in the fuck would happen if I called that number?  Would it be like the last time, when Nurse WellMeaning said 'You might be having a miscarriage.  There's nothing anybody can do,' in the same disinterested tone that most people use when saying 'It's probably going to rain on Thursday'?"

Here's a clue, free of charge, for Nurse WellMeaning and Evil Insurance Company, Inc.: The reason you can't do anything about miscarriage is because you don't fucking know anything, and the reason you don't know anything is that you don't care enough to investigate.  Pregnancy?  You don't run a followup beta.  Sometimes you don't even run an initial beta.  Bleeding?  You're not going to do an ultrasound to see if it's a subchorionic hemorrhage.  Spotting?  You're not going to check progesterone levels to see if supplementation is needed.  One sided pain?  Yeah, in the instance of one sided pain, you don't bother to check for the presence of an ectopic.  Dead embryo?  You don't perform karyotyping to see if the embryo was abnormal.  Miscarriage?  You don't do followup ultrasounds to verify that the miscarriage was complete and the uterus is healthy.

What you DO is shrug and sigh and say "We don't know what causes miscarriage," as if you're not nurses and midwives and doctors and pathologists, people whose fucking jobs it is to investigate, diagnose and treat medical problems.  You say it as if miscarriage is always unexplainable, unknowable, mysterious, almost magical.

Do I sound angry?  I am.

I hadn't realized how angry I was until they handed me another one of those useless prenatal information packets and suddenly it came rushing back, whitehot.  I'm surprised my hand didn't scorch the glossy pictures on the outside of the folder.  

It doesn't offend me when Dr. BrightEyes tells me they don't know the cause for my miscarriages, because he ran tests, ruling out a lot of causes for repeated loss in my case.  I know that my uterus is the correct shape and relatively unscarred.  I know I don't have any common clotting disorders or genetic peculiarities.  I know that my husband and I are capable of generating healthy embryos.  When Dr. BrightEyes says "We don't know why you miscarry," at least I know that he knows a great big list of reasons why it isn't.  I know these things, but Evil Insurance Company, Inc. does not, because they don't test for them.

No, they prefer to fall back on "We don't know what causes miscarriage," dumping the ball squarely back into the female court (or uterus, as the case may be).  Doctors said the same thing to Julie, who has a clotting disorder, to Soper and Grrl, who have uterine abnormalities, and to Julia, whose husband has a balanced translocation.  "We don't know," they said, right up until they bothered to look, at which point they said "Well, there's your problem, right there."  Maybe if I had been born twenty years later there would be an explanation for my unexplained losses, a test, a treatment, at least a goddamned entry in Wikipedia to detail the exact way in which I am fucked.

Until they pinpoint the problem, though, the medical profession will continue to insist that miscarriages are mysterious and random and the fears of Habitual Aborters are silly and irrational.  We just need to think! positive!

The biggest problem I'm having right now is that my current fears are not irrational.  If this were the first time I was pregnant, if I had no history or risk factors for miscarriage (or, what the fuck, at least fewer risk factors), if we had an explanation for the previous losses and a plan to improve the current situation, if any or all of these things were true and I was as frightened as I am right now, I would know that I was being silly.  I would wave my hand and admit that I worry too much.

What do you do, however, when you're not worried too much?  Given my history, I would argue that I am probably worried to an entirely reasonable degree.  I'm not fretting over some unlikely or obscure disaster, but rather my own medical history.

This is my fourth pregnancy to date, bringing the score to gravida four, para zero.

Not only did we see the heartbeat previously, we saw the heartbeat of an embryo that later proved to be (genetically) perfectly normal and whose demise had (and still has) no clear explanation and no symptoms whatsoever.  There wasn't even a reduction in the normal pregnancy symptoms, my body merely went chugging along, cheerfully pretending GE was alive until the day after the D&C.

This sucks.

This means that when things are going well, my first thought is "Oh crap, I bet they're dead."  Everything that feels normal and textbook also feels just like GE's brief gestation which...well, we all know how well that went.

I've entered the week in which my most successful pregnancy to date spontaneously ended. 

To say that I'm feeling a little fucking brittle would be a gross understatement.

I Can Always Count On My Body To Let Me Down

In the past year and change, I haven't had a single CBC come back even one tick above the barest minimum that Evil Insurance Company, Inc. considers to be marginally acceptable.  Truth be told, I am usually slightly below their anemia cutoff, despite being on prenatal vitamins for the past three years, frequently flirting with iron supplementation, rarely getting periods, eating a varied diet and having a rather unnatural fondness for liver.

Two weeks ago, Nurse Sweetie called me and said "You're anemic.  You need to take an iron supplement."  Upon purchasing the supplement that she recommended, I noticed that she had suggested one of the higher potency varieties, but didn't think much of it.

Today my prenatal pre-screening bloodwork came back from Evil Insurance Company, Inc. and arrived in the form of an email from one of the midwives.  It had a markedly urgent and alarmist tone, which didn't initially bother me.  These are the same people who panic over soft cheese and hot dogs, after all.  How seriously was I supposed to take them?

I emailed them back, politely reminding them that I'd been anemic for years and wondering if they honestly believed further iron supplementation would drastically improve the situation, or if there was something else going on?  Also, exactly how anemic was I, anyway?

The midwives responded with disturbing promptness, and the answer turned out to be very.  My blood is currently only 30% er, actual blood, when the numbers should be running between 36 and 46% according to Evil Insurance Company Inc. (or between 37 and 48% according to the entire rest of the Internet).

I believe the technical term for this is "Well, crap." 

I'm completely mystified.  After comparing the numbers from GE's pre-natal prescreening to this round, I think we can rule out the idea that this is a normal early pregnancy thing. I know that sufficient iron is entering my body and that blood isn't leaving, which leaves what, Vampires?  Would I even be able to differentiate a Vampire from a  typical pasty-ass Seattleite, anyway? 

I'm also completely pissed off at my body.  Way to go, Asshole Body.  I waste perfectly wholesome food on you, even buy you organic, and this is how you repay me?  By crapping out when I really need you to perform within normal human parameters?  You're supposed to be blood-having-for-three, here, and instead you pull this shit?  Do I look like I need something else to worry about?  Hmm?

Jerk.

Nausea, Heartburn, Insomnia

Is it morning sickness, or just the result of Googling twin statistics late at night?

If you guessed 'both', you win a cookie.

Bonus, The Freakening

Thalia said:

Fab news Akeeyu, but I remember sam was VERY not keen on twins, and you weren't mad keen either. Is it the general uncertainty that's making this ok for now or are you in shock?

Yes.
Yes.
Yes.
Yes.

Issue One: It's true, Sam has never been enthusiastic about the idea of a multiple pregnancy.  He looks at it as a greater risk to me, which it is, and this worries him. 

A few weeks ago, Julie wrote a post about decision making and persuasion, and I left this comment:

I must admit that I usually have an easier time making these decisions than Sam. In my case, the absolute worst possible scenario is: I die. In Sam's case, the absolute worst possible scenario is: I die. This is clearly worse for him. Death is a finite experience, whereas being a surviving spouse is an Energizer Bunny version of Hell.

As the primary owner of the only uterus in the relationship, there are plenty of risks that I am willing to take, so the choices are easier for me. For Sam, it's different. It's harder. He also ultimately has much less control over the situation, since little to none of it is happening inside (or even remotely near) his body. Furthermore, he has a front row seat to any and all suffering and gets the added bonus of Having To Be The Strong One.

Poor bastard.

After watching my parents experience my father's death, I believe that it is more painful to survive the death of a loved one than to be the one doing the dying, so I respect that in some situations, it is harder to be Sam than it is to be me.  It's easier to suffer than to witness the suffering of someone dear to you.

This, of course, leads directly to my reservations about multiple gestation.  Issue Two: The risk that keeps me up at night isn't mine.  No matter how you slice it, mortality rates for twins and high order multiples are statistically quite a bit higher than single pregnancies.  While I am comfortable with taking all kinds of dumbass risks with my own health and life (off the top of my head, 'cycling more than once given my risk for developing OHSS' comes to mind), I am very uncomfortable assigning those risks to a third party or parties.

Because Sam and I discuss the risks and our feelings about them (ad nauseam), we have been accused of being negative about twins.  Look, I'm not going to lie to you.  It drives me crazy when I see women and couples online trying to 'maximize their chances of having twins or triplets'.  I once saw a poster on IVFC trying to figure out the best way to (deliberately) get their gestational surrogate pregnant with triplets, and my fucking head almost exploded.  I firmly believe that the goal of REs and people trying to conceive (through traditional means or ART) should be to attain the healthiest possible pregnancy/gestation/baby, and statistically speaking, singletons give the best odds for this outcome.

Does this mean that I think all twins are sickly or that you're an asshole if you have/had twins or high order multiples?  No, of course not.  It's a known risk of ART, and sometimes things just happen.  Believe me, I understand that.  My irritation is reserved for intent, not outcome, so if you went into a stimmed IUI with a specific goal of conceiving quintuplets "because HOMs are, like, sooo cute!" (without a whit of concern for the reality of the situation), then okay, fine, I think you're kind of a dick, but everyone else, I'm really not trying to get on your case or be all judgy.  You and your families have my respect for the way you have dealt with the unique challenges of life, and I wish you all the best.

Issue Three: There is a metric assload of denial/uncertainty in the water supply at the Buttmansion abode.  For those not familiar with the metric system, that would be a lot.  This is my fourth pregnancy with nothing to show for it.  I've been pregnant enough times that this whole early stage feels disturbingly familiar, but as it's never led to anything in the past, I have a hard time believing that it ever does, or at least for me.  Around these parts, 'being pregnant' does not equal 'having a baby'.  For me, seeing two gestational sacs on a five week ultrasound is supercool, but it does not automatically mean two babies in the end (or even one), so it's hard to get all that that wound up about the realities of a multiple gestation right at the moment.

Right now, none of this feels real.

I'm kind of reserving any potential freaking out and/or excitement for my eight week ultrasound, and possibly much later.  No, that wasn't a typo.  Yes, I just said "eight week ultrasound".  No, the clinic isn't the one responsible for scheduling my first ultrasound that far out.  I am.  When I called to schedule what was supposed to be my seven week ultrasound, I discovered three things: One, that Dr. BrightEyes was really busy that week.  Two, that I'd rather chow down on one of the dubious delicacies from the Steve, Don't Eat It! menu than allow someone other than Dr. BrightEyes to perform such an emotionally perilous exam.  Three, I'm in no damn hurry.

I know that's wrong.  I know that as an infertile, I am supposed to crave ultrasounds more than the accidental stars of Cops crave smack, but somehow I don't, or at least not right at the moment.  I'm feeling a little wand shy right now.  The issue I can't get around is that I had a perfectly normal six week ultrasound with Good Embryo.  Longtime readers may recall that everything looked perfect and we even saw the heartbeat, and yet GE died a week later.  GE died at seven weeks, making a six or seven week ultrasound seem entirely meaningless to me.  At this early stage, there's not a goddamned thing anybody can do for Fitz-Hume and Millbarge no matter what they see on an ultrasound, so I'd rather just wait.

If we see two heartbeats on the eight week ultrasound, Sam and I will both be overjoyed.  We both already love Fitz-Hume and Millbarge very very much (which I fully admit is a reckless and stupid sort of emotion to have this early, given our reproductive history).  We will also be scared shitless. 

If we see one heartbeat on the eight week ultrasound, we will undoubtedly grieve, but we will still be happy and grateful for what remains.  We will also still be scared shitless.  I went to my prenatal pre-screening at Evil Insurance Company, Inc. on Friday and discovered, much to my surprise, that they placed me squarely into the High Risk Pregnancy category without even taking into account the possibility of a multiple gestation.  Between the repeated pregnancy loss, endometriosis, PCOS, history of infertility (I was a little surprised to see them classify this as a risk factor) and hypothyroid, apparently my uterus is not considered to be this year's hot vacation spot.

Issue Four: Still in shock?  Fuck, yes.

Bonus

Today's followup slap and tickle with My Favorite Wandmonkey showed that while the pockets of fluid behind my ovaries are still present (and stable), the one up by my ribs has disappeared.  It's just as well.  I never liked that one, anyway.

My ovaries have each gone down slightly, as has my waist measurement and my overall discomfort level.  Everything still hurts, but not quite as much, which translates to "Hey, this isn't half bad" in the Buttmansion house.

By the way, did you know that it's possible to see nothing at four weeks, six days, and yet see something at five weeks, one day?  I'm not saying you can see heartbeats or fetal poles or freckles or anything cool, but it is possible to see a gestational sac.

After fishing around in my ovaries, My Favorite Wandmonkey turned her magic gaze uterus-ward and said "Ooooh, look!  A sac!  A tiny little sac!"

I squeezed Sam's hand.  My Favorite Wandmonkey poked around a little bit more, measuring dimensions and pointing out the sac's voluptuous roundness while we stared and squeezed.  "So, um, just the one, right?" I asked, initially unsure if I was more relieved or disappointed by this idea, then deciding I was both at once.

"Yup.  Just the one, although it's really too early to rule out...hmm.  Well, this might just be...  There appears to be another one over here.  Yes, this looks like two."

Dr. BrightEyes concurred.

So, acknowledging that 5w1d is just terribly early and lots of shit could still happen (as some of us know entirely too well) and clearly no chickens or embryos should be counted before their time, your mileage may vary, not all applicants will qualify for preferred rates, bla bla bla, I would just like to say holy crap.

For the time being, there are two in there.

July Is Busting Out All Over

O Gatorade, how I hate thee.  Let me count the ways.

1. If I am going to be consuming large quantities of empty calories, I'd prefer they be buttered and/or chocolate covered.
2. Gatorade doesn't pair well with any food.
3. Orange-juice-after-toothpaste tastes like sweet ambrosia as compared to Gatorade-after-toothpaste.  If you are unfortunate enough to grab a swig of Gatorate after brushing your teeth, it might be advisable to rinse your mouth out with ass, since the flavor would be considerably less offensive.
4. The 'flavor' of Gatorade that I find most tolerable (rather optimistically called 'Lemon-Lime') is the same color both before and after use.  Every time I pour myself a cup of the stuff, I don't know if I should drink it or dip a pregnancy test in it.

I've had to stop working again because that whole 'standing upright' thing turned out to be way too much.  I tried taking it easy at work.  I tried resting more frequently.  I tried reducing my hours.  I just couldn't do it anymore.

I kept trying to convince myself that was just being a big whiner who should be at work, and then I'd get up to pee and end up panting and exhausted for ten minutes afterwards.  It wasn't working out so well.

Nurse Sweetie had me come in for a quick check this morning.  "With as much pain as you're in, we'd expect to find more free fluid," they said.  Interestingly, this time they found not only small pockets of fluid behind each ovary, but another one setting up housekeeping up around my rib cage.  That's new.

When I asked why I felt so much worse now than I did the last time I had OHSS, given that my ovaries and the fluid pockets were much larger back then, Dr. Pinto said "Well, we're not seeing that much free fluid right now, but I think it will probably get worse.  If you accumulate more fluid, we may have to drain it or admit you to the hospital."  She said this in the same caring, concerned tone that the morning weatherman uses to relay the weekly forecast.  Then she told me to go home, take narcotic painkillers, and not return to work until released by them.

Released, as if I am in captivity.

Nurse Sweetie was somewhat more encouraging.  "It'll probably get worse until six weeks, but then it should start to taper off.  Hey, nobody ever said being pregnant was easy," she said.  "True," I agreed, "But I'm only five weeks pregnant.  I kind of expected the hard part to start a little bit later than this."

Huge on the Internet

Sam, having completely taken leave of his senses, rolled over in bed last night, surveyed my OHSS-tastic abdomen with awe and said "Wow, honey, you're huge."

Yes, thank you, honey.  Very helpful.

Doesn't Everybody's Bedrest Include Pirates?

During my first round of OHSS, I didn't leave the house much.  I was on bedrest, after all.  Clearly, 'Bedrest' involves being in an actual bed and watching way too many Lifetime movies and eating way too many Rice Krispie Treats* and being bored half to death for days (if not weeks) on end and getting a wretched case of cabin fever and feeling sorry for yourself and going on frequent and copious crying jags, right?

Well, maybe not.

This time I decided to fuck all that noise and get out of the house.  It turns out that 'Bedrest' can also include laying on a blanket in a park and watching the dogs go by for a couple of hours.  It can includes playing cards and swearing a lot.  It can even include going to see the Seafair Pirates land at Alki, as long as you assert your right to crash on a blanket under a tree and allow others to fetch you food as if you were the goddamned Queen of Sheba accepting tribute from the masses.

It's not a bad gig.

I highly recommend it, although if you can manage to avoid the part where you have OHSS, that's probably a good idea.  I'm still pretty poofy and uncomfortable, and the longer I'm on my feet in any given day, the bigger I get** and the more round ligament pain I have.  From what I understand, round ligament pain typically starts in the second trimester of pregnancy, meaning my Vicuna has once again moved on to Advanced Forms of Fucking With Me.  I suspect that the early round ligament pain is being caused by the fact that the last time anyone checked, I had endometrial implants on my uterosacral ligaments which, long story short, ow, and further more, fucking A.

I don't really mind, though.

After I explained the OHSS and related discomfort to a co-worker, he looked horrified and stammered "Well, I hope you get better soon."  "I don't," I said cheerfully. "It's being pregnant that's making me so sick, so I kind of hope I stay sick for a while."  "Oh." He thought about this.  "In that case, I hope you don't get better soon, then."

That's about the size of it.

*Of course I am kidding.  There is no such thing as too many Rice Krispie Treats.
**But I'm not kidding about this part.  If I'm on my feet for any significant amount of time, my waist measurement will pop up by an inch by the end of the day and I'll have trouble sleeping.  When I take it easy, the inch comes off and I sleep somewhat easier.  Better living through slacking: Just one of the benefits of OHSS.