Your Briefs or Mine?

I've been writing a &%$#$ closing brief for the better part of two weeks now. It's due Thursday. Wish me luck! Your water quality and aesthetic enjoyment of our natural world may depend upon it.

I meet with the RE in January. The husband is anxious to get on with that--but I'm kind of glad that I changed that appointment (Dec 20) as I will likely still be hung up revising this disgusting brief.

The endometrial biopsy was a piece of cake. Seriously. No pain. This of course worries me to death. Why wasn't it painful? What's wrong with me?

Argh.

The M'er F'er Gene Mutation

I didn’t hate the physical. In fact I beamed with pride when the doctor exclaimed with surprise and glee, “Wow! Great reflexes” after he pounded lightly on my right knee. No sooner had I imagined a glorious future that included trapeze swinging, sparkly costume wearing and a multitude of squirming children under one arm, did I fail to barely register the second knee tapping. I sighed. I am like that. If some wondrously unexpected thing happens (yes, at this point, with my body failing, this constitutes, “wondrous”) I know not where or when or how it came to be and then . . . nothing. I am totally, and absolutely, inconsistent. I am, the One Hit Wonder. The doctor quickly moved on to the squishing of the breasts and the pressing of the stomach. The doctor was somewhat dismayed at the many layers of hospital gown I had wrapped myself in, “You’re really kind of tied up in there, aren’t you?” I prefer a little mystery doctor, don’t you? Then he asked me to slide my feet into the stirrups and when the lights were dimmed, the disco ball spinning and the sonogram machine buzzing, I noticed that there was a somewhat strange formation, elliptical and light colored on the back of my uterus. He looked at it from several different angles, took pictures of it, highlighted it, measured it. But back in his office, he didn’t mention this strange little formation but instead discussed my somewhat enlarged left ovary that looked ready to release an egg ANY MINUTE, which he indicated was a bit strange, considering where I was in my cycle, but not altogether unheard of. I got the impression that I was supposed to be overjoyed by the knowledge that this particular ovary, the left one, was about to release an egg. As this egg is going nowhere, I don’t know how I could be anything but, well, neutral. He asked if I had the blood work done and I said that in fact I had and so that was that.

The next day was the dreaded sono-hysterogram, which had me popping ibuprofen left and right in preparation for the lovely cramping. All in all it wasn’t awful, but it wasn’t altogether pleasant either. It was the insertion of the catheter that had me trying to levitate off of the table. It was a pain that I can only describe as a long drawn out note on a high octave, which I later related to nerve pain, although I understand that there are no nerves in the cervix. This little bit of information is from my sister, however, who is able to slide children out of her own uterus with barely a cough and a sneeze, so take it as you will. For those few moments that I was not grimacing, I caught a glance at the sonogram screen with its tiny droplets of colors dancing about, moving here and there in conjunction with the wand and it really was, for a moment, if not exactly pretty, interesting. Strange, cavernous, swooshing sounds kept emanating from the machine. When I asked the sonogram tech what exactly those sounds were, she squealed with delight, telling me that the sound was coming from my ovaries and that it meant they were ALIVE. As she continued to move the wand and take pictures, she told the doctor about her great fascination with reproductive medicine and her astonishment at some of the procedures being undertaken in order for people to have children. The doctor mentioned the recent approval of womb transplants. She laughed, nudged me conspiratorially and said, “Can you believe what a hot commodity a uterus is? Aren’t you glad you have one? I mean, I’ll tell you why people do this stuff, desperation. They are desperate! Isn’t that crazy?” She looks at me. The doctor shifts uncomfortably. I realize that she likely knows nothing about me. That she was just scheduled to go in, move the wand around, tell the doctor to push in more saline, and take a few pictures of my uterus, the endometrial lining and my ovaries. I realize that she doesn’t really know that I could very well be on my way to being one of those crazy desperates. But then she spots the strange formation on the back wall, and they discuss what it could possibly be. It could be a fibroid. Then again, she says, it could be left over from the . . . and she trails off. The embryo. It could be from the embryo. Afterwards, after I had had a chance to throw my clothes back on in the dark of the room, my doctor came back in and told me a little bit about the spot on my uterus, what it could be, what they will do about it, etc. He was far more interested, however, in telling me about the results of my blood work. I am positive for MTHFR. He mentioned that I have a fairly rare type, a duplicate of the duplicate or some such incomprehensible thing and that, although I deviate slightly from patients with the MTHFR gene mutation that he sees, he will treat me the same. I will have to take a folic acid (and Vitamin B-12) supplement. I have since read countless studies and reports of a connection between the MTHFR gene mutation and miscarriage. It seems incredible that something so simple like adding a supplement could change my pregnancy outcomes for the better but apparently, it just might be true. When he told me how my particular gene mutation is more rare and more strange, I said, “Well, I always wanted to be special!” Which sounded funny internally, but really, sounded kind of pathetic once it was uttered. At any rate, Monday I will have the endometrial biopsy. Then, I hope, we will sit down and discuss all the results and my options.

I Weep For My Brother

Every day on my insanely long commute, as I wind through street after street, admiring the brownstones as they go by, I encounter a strange little milieu of red spray painted words of various lucidity on wood boards presumably found on the grounds nearby. It is not far from the Crack is Wack mural by Keith Haring and if you weren’t looking, you’d probably miss it. Oftentimes he, because I most definitely presume that it is a he, includes a stuffed animal on a chair or a potted plant. I can never quite make out the point of the scene as the phrasing, the setting, the various items that he includes, do not form a cohesive whole. Recently, however, he spray painted, "I weep for my brother" on an old board, propped it up on a chair, and set it next to a car door which he had painted with dripping red paint. The paint ran down the windows and onto the side of the door. Although I cannot be certain, I believe it is a memorial to Sean Bell, the man who was recently gunned down by police on his wedding day. He was 23. He was the father of two children. In 1999, police killed an unarmed West African, Amadou Diallo. He was shot 19 times. The officers were acquitted of all criminal charges. In 2003, Ousmane Zongo, also West African, was shot four times during a raid in the warehouse where he repaired African art. He was shot twice in the back. The officer claimed that he had a gun, which he in fact did not. In this case, the officers claim that there was a fourth armed man amongst the wedding party. No witness has come forward. I cannot say for certain what happened. It is hard to not believe, however, that fifty shots at three unarmed men is excessive. And so, I weep, I too weep for my brother.

The Good Doctor is In

I wouldn’t say, exactly, that I am optimistic. I would say that I may be slightly edging towards excited for this evening’s physical extravaganza at the RE’s (this is likely because it’s for a physical (take that Jude Law! I don’t need you!) and not for anything that involves any real pain—that takes place tomorrow). I believe in this doctor. I am thrilled that the clinic actually has a program specifically for recurrent pregnancy loss (most do not) and that the good doctor seems thoughtful and thorough. This is the beginning of maybe, just maybe, getting somewhere.

I did find myself, however, for a moment, missing my OB/GYN as I was scheduling the sono-hysterogram yesterday (They are going to do what? Where? FOR AN HOUR? I’m sorry, did you say “cramping”?) as I am used to him and his gruff, humorless ways and his protruding belly and the fact that his wife seems to be giving birth every other day. I really did, though, miss him. Although he’s literally never asked me anything about myself (I suppose there may be no perfect time to ask someone where they went to undergrad (Arizona) or where they grew up (difficult to say, West Coast?) or their favorite color (green) or favorite artist (Sally Mann? Frida Kahlo? Picasso?) when you are staring at the fuzzy image of an embryo without a heartbeat) there is comfort in the familiar. And although he’s made me angry before when I was convinced that I was losing babies because of familial periodontal disease (not likely) or because of an as of yet diagnosed bleeding disorder I was convinced that I had (again, probably not) he’s always called to follow up and listened and been there. And when he’s told me something that I absolutely did not believe (a D & C is less painful than miscarrying naturally, for example), he’s been right. So, here’s to you, Dr. OB/GYN, may your thousands of children be healthy and happy and may we meet again under more auspicious circumstances.

More Poking and Prodding or a Little Glitter?

I have a physical exam scheduled with my RE for the same day as a movie premiere I was invited to where one Jude Law and one Kate Winslet will also be in attendance. Not that I have a clue as to what to wear (really, what does one slightly nerdy eco attorney/freelance photographer wear to these things?)— but I’d really like to cancel that physical (I have to have an HSG done this week, anyway) and move it to later on in December (even though that will likely mean I will YET AGAIN have to take time off of work for it—something I have been trying to avoid because I am still fairly new at this job (started in June) and subsequent to that start date I had a chemical pregnancy and then a miscarriage which meant many trips to the doctor and/or the hospital). Thoughts?

Chinatown and Freaky Sunday

Blood work today. Yes, on a Sunday. At the only place in all of New York City and Long Island, apparently, that is open on a Sunday. Anyway, it was off to Chinatown yet again (I was there in early January - in order to detect the rapidly falling level of human chorionic gonadotropin (hCG) hormone in my system and its equally low achieving buddy, progesterone). In case you were wondering, and I know you were, I had the following tests administered (most of the info about the tests is from my old friend Dr. Google (disclaimer: I am absolutely not a doctor, nor a medical professional, haven't a clue, really, about any of it). I do have to say, though, that my doc (the good doctor!) did explain most of this to me at the time he wrote the prescription:

Antithrombin III activity: used to detect a problem with blood clotting and to help diagnose an antithrombin deficiency.

Blood type/Rh/antibody screen: I am Rh negative - if you really must know. Apparently I have some antibodies in my blood that they want to check out. I have had to get the lovely RhoGam shot every time I've miscarried (that would be three, three shots).

MTHFR: "5,10-methylenetetrahydrofolate reductase,": the MTHFR gene is responsible for absorbing folate. There are two different theories about the MTHFR gene and miscarriage: one theory claims that MTHFR increases the risk of blood clots, which could block nutrients from reaching the placenta. The other theory is that MTHFR causes lower folate and B-vitamin levels, which increase the risk of miscarriages. It's still pretty controversial I think. There haven't been extensive tests (i.e., medical trials) about this. My doc did say, however, that many of his "habitual aborters" have done well by increasing folate, but as he said, that's merely a "testimonial" - not really very scientific--but he believes in it.

Factor VIII: this is Von Willebrand factor--an essential blood clotting factor. It's possible that I actually clot more slowly than normal--which would be the opposite, essentially, to thrombophilia, as that is what one test showed back in August. My doc is testing this at my insistence--there isn't really a known connection to Von Willebrand's and miscarriage--but it is a hemophilia type bleeding disorder and hemophiliacs DO have problems with miscarriage. The problem with Von Willebrand's is that it is very difficult to diagnose--the Von Willebrand factor can increase because you are anxious, which generally speaking, people are when they are having blood draws. In addition, the Von Willebrand factor generally increases while pregnant which would decrease the chance, obviously, of it creating problems.

Estradiol: The estradiol test is used to help evaluate ovarian reserve. In combination with the Day 3 FSH test, the estradiol test can help to determine the quantity and quality of the eggs. By the way, my 41 year old sister offered her eggs to me. Sweet, really. But does the woman realize that she's SEVEN years OLDER than I am? I know, I know, she's so fertile she just LOOKS at her husband and well, you've heard this before from your sister, friend, mother, etc.

FSH (follicle stimulating hormone): again, this is used to detect ovarian reserve.

Homycysteine: I believe that this goes along with the MTHFR test. Anyway, this test is used to determine if a patient has a B12 or folate deficiency. The homocysteine concentration may be elevated in patients before B12 and folate tests are abnormal.

LH (Luteinizing hormone): used to test menstrual irregularities and to aid in the diagnosis of pituitary disorders or diseases involving the ovaries.

Prolactin: this tests pituitary function, low levels of pituitary function result in lowered levels of thyroid or adrenal hormones. Probably used to test for polycystic ovary syndrome (PCOS).

Testosterone: I believe they are looking at polycystic ovary syndrome with this test as well. Aack. Testosterone? Aaack. I don't really have any of the classic symptoms (except for weight gain) for PCOS. But really, weight gain? Having a miscarriage or two or three and then reaching for another cookie does not a disease make. I will be surprised if I am diagnosed with PCOS. But, one never knows.

TSH: (thyroid stimulating hormone): used to determine whether the thyroid gland is functioning properly. By the way, an underactive thyroid gland (hypothyroidism) can cause symptoms such as weight gain, tiredness, dry skin, constipation, a feeling of being too cold, or frequent menstrual periods. Hmmmm. That is interesting.

Wow, there really isn't much more exciting than going on and on about blood work is there? Can you imagine what I'll be like when I'm 90?

Also, as we were on the platform waiting for the train (that would be the L) we saw Jody Foster walking by, fast. She was wearing (because I KNOW you want to know) all black and a rather jaunty pair of green plastic glasses. Her hair was quite blonde and tousled. Very hip was she. And in a SERIOUS hurry. I mean, that woman walks fast. She looked kind of worried. Or annoyed. Perhaps it was because we were staring at her.

After the big soiree at the lab, we walked on over to an incredible baby store. Because, you know, I enjoy self-torture. Such a beautiful store. Bu and the Duck. They have the most amazing dresses and little hats. And handmade toys. Sigh.

More info . . .

My sister-in-law was told that she has an increased chance of Downs because of her age, not that her child does in fact have Downs or even that they think that there is a strong likelihood of Downs. No tests have been done. It does make me wonder, however, if this, this possibility of Downs, is swaying her thinking more towards the idea of not keeping this pregnancy. I wonder too, if she is getting pressure from all of us, from her brother and myself and her parents - because WE all want this baby, and maybe she thinks that she should do it for us, even though she doesn't really want to go through with this herself. This is an incredibly personal decision and her own. And I must step back and let her do what she wants, give her what she needs and not be so selfish. To me, this baby represented something good from a year of pain, the pain of miscarriages and the very real possibility that I won’t be able to carry a baby to term. For my husband, I wonder if this baby represented a life with more direction for a sister that he worries about, a shove towards getting her life straightened out. And for their parents, I suspect, that this baby was perhaps their one chance at becoming grandparents. This is too large a burden for a child. A fetus, a baby, a child who is just over three months in utero. These thoughts are selfish, and naive, but real.

Awful News

My sister-in-law's baby may have Downs. This is very sad news.

As Fate Would Have It

The appointment went well with the RE. In a nutshell, I have to have a lot of tests. Fun, fun tests of the snagging bits of your endometrium kind and blood, much, much blood. But oh! I am used to the blood. How I used to be afraid of needles! And now, I proudly thrust force my forearm to be punctured by the nurses or the phlebotomists or the nurses and the phlebotomists. And did I tell you how they love using that one new nurse? Or that new phlebotomist? You know, the one who was just practicing on an orange? Well, they do. And oh, did I mention my tiny, tiny, pesky veins that they can never find? Oh, but what fun! What joy! And, oh, the bruising! But really, what's a little vampire action if we come away with a little one? Not much. Not much at all.

As fate would have it, not only is each and everyone of my friends pregnant (or just given birth) and all of my husband's myriad of cousins pregnant, but my husband's sister, my THIRTY-EIGHT YEAR OLD sister-in-law is pregnant. You know, the one who wasn't trying. The one who didn't necessarily want to have kids. Yep. That's the one. Part of me is really happy. It's exciting! How exciting! A new little being! My husband (and I) will have a new niece or nephew! And we will spoil her. And love her. And we will have her come out to our pad in New York. And we'll take her to Europe (hey, it's my fantasy). And we'll help with her college expenses (Columbia) and her pre-med studies (how exactly we're helping her with that isn't important!) and her trips to Africa with Doctors without Borders! Hey, I'm exhausted already. Part of me, however, is also mad. And jealous. And sad. That about sums it up.

The Latest . . .

1. I forgot that I needed to vote today no less than fifteen times on my way home. I did, however, vote . . . eventually. And the lady sitting at the table twittered away about my last name (which is unusual and shared by a very famous singer) for a good five minutes before I was able to shut myself into the little booth and stick it to the GOP.
2. I think I may have unwittingly gone on a date over the weekend. A guy that I was working with (shooting the marathon) asked me out for a drink afterwards - the thing is, I'm so old and married that it didn't occur to me that he may actually be INTERESTED in me until half way through the night. Then I made a quick getaway. I have to admit though, that I am flattered, if not somewhat clueless. But hey, I've still got it! Actually, he was probably just bored.
3. My husband got a haircut this weekend. He's looking a tad Emo Phillips. This will have to be remedied, and right quick.
4. Speaking of my husband, he went to a bar with a friend on Friday. The (female) bartender bought him quite a few drinks. What can I say? We're a dashing couple wanted by ones of people.
5. I saw an acupuncturist yesterday. Even though I was told that they take my insurance, they don't really, shall I say, TAKE my insurance, in that they don't actually BILL my insurance. Instead, oh crafty ones, they give the poor slobs with my insurance a discounted rate. I did it anyway (I was there, I was curious, the drive was long and annoying). She prescribed weekly visits (of course!) until my cycle is more regular. Um, no. However, it was quite relaxing and painless, even for a wimp like me (OK, when the needle went in on the top of my foot, it was slightly uncomfortable, which, by the way, she forgot to remove, which left me stammering, "Um, did you forget one?", knowing full well that she had in fact forgotten it and with an irrational fear that years from now I am going to find a tiny acupuncture needle embedded somewhere odd).
6. I have an appointment with a new RE (I saw one RE but only for one visit and then got pregnant again and all looked well and so no tests were done, but well, it didn't end well) on Thursday. I'm excited about it.
7. I want to tell you how much I am enjoying Lisa Williams: Life Among the Dead, but it's too embarrassing to admit, so I will tell you that if you haven't seen HEROES, it's a must. Well written, beautifully shot, great actors, interesting story.
8. I must get back into running.