Saturday, September 26, 2009

mad, mad, mad world

My DH comes home today - in just a couple of hours, actually. I'm going to try to get my shockingly lazy behind to the grocery store between now and then. I've concluded that some significant part of my strange behavior in his absence has been prompted by loneliness. Not that I never see anybody (actually I've seen lots of people, everyone has been very good about keeping me company), so not alone-ness - just loneliness. I wonder whether I am also lonely when he is here, but I don't notice it because there's someone around me all the time? I think this is probably true.

At any rate, I have way over-invested myself emotionally in the success of several TV romances. That between Michael and Fiona on Burn Notice, of course (love that show); I don't think she's the ideal match for him, she seems to privilege being manipulative over having a secure relationship, but she's had a rough life. However, since he obviously loves her devotedly and has no illusions about who she is, how can I not be supportive? (You would think I knew these people.) And then there's House and Cuddy - well, I don't know that I so much need to see that relationship go anywhere, as him dig himself out of the latest mess. That's a rational audience response, right? And finally, of course, there's Booth and Bones. Mostly because Booth's obvious unspoken care for her is so heartbreakingly poignant! Forget the whole education bit - I am a sucker. Maybe it's easier to be invested in these things (honestly, I could fix all of each pair's problems with a short conversation - in witness whereof, my apparently doomed relationship turned into a beautiful marriage. More hard work, less angst. Plus grace. Works every time).

One thing for which I think I deserve favorable credit is dancing around by myself in my living room to high-energy music videos on youtube - for this purpose I specially recommend Hanson's Mm-Bop and Beyonce's Single Ladies. It's good for the metabolism, and I dance so shockingly badly that I pretty much never do in public. (On that score, it has been nice to be home alone, because I can't see doing this with my husband here. And he gets home earlier than I do. An hour in the evenings to start dinner and act like a loony before he arrived would be really nice.) On the subject of metabolism, I have been going to the gym for three or four weeks and trying to moderate what I eat, a little. A starvation diet seemed too drastic. I wanted to lose ten to twelve pounds in the six weeks before my surgery. I have two weeks left. I have gained a pound. Even if I can go back to work the week after, my belly will still be swollen. What will I wear? This is very frustrating.

I also tracked down some other pop tunes I've heard on the radio - a few each from Avril Lavigne and Pink. I knew Pink was a little hardcore (I remember listening with enthusiasm to "Don't Let Me Get Me" in college. I was definitely my own worst enemy, but I never dated a teacher and my parents didn't hate me until I considered becoming a nun. Sigh). But although her videos are really unnecessarily graphic (and can she wear some clothes? For someone whose persona is so strongly committed to the difficult project of making herself appear unattractive, she's always showing a lot of skin), I found nothing so disturbing as Avril Lavigne's.

By all objective information she was raised by a happy, normal family. Of course, she appeared on the pop scene FAR too young, but the violence toward other (very young) women in pretty much ALL of her videos is shocking. Pink ignores some gals, allies herself with a few, and attacks others - but clearly because she feels persecuted. Ms. Lavigne savagely attacks the innocent and defenseless, apparently because she wants to see them suffer. She also advertises herself (in at least one song) SPECIFICALLY as easy, with no other merits. There are easy gals out there, but I think they all think (they might be right) that being easy is a footnote to being attractive, or fun-loving, or warm-hearted, or lonely, or unable to trust men, or something else that really defines them. Who makes herself the heroine in a story in which she's breaking up a relationship by advertising sex, period? It's disturbing.

So, anyway, I have been living in the internet. The internet is entertaining, but it does not have a healthy bedtime and it is not very warm and cuddly. I am looking forward to having my husband back.

Also, on the when it rains, it pours front, I am now on my SIXTH STRAIGHT DAY of fertile CM. Monday was very slight, so I figured that would be a lead-up day and then there would be maybe three days, culminating in a discernible peak. That's how it used to be. However, I haven't seen any clear increase (i.e., toward peak), and also, it's not in the same, er, quantity as once upon a time (though certainly more than in the months I'm going to refer to as my Dry Spell. Har, har). But SIX DAYS? What is this?

You know, I just thought you'd all like to know.

Tuesday, September 22, 2009

it's baaaaaack!

You know how when you finally stop looking for something is when it sneaks right up on you? I was thinking the other day that it was too bad my DH was going to come back after my fertile phase was over (not that it matters, of course - I'm not NFPing pre-surgery because I am capable of learning from experience over here). It didn't occur to me to wonder how exactly I could tell it was my fertile phase - I've been mystified for several cycles (only the temperatures indicate, after the fact).

Well, you can guess how. I didn't visit the bathroom early and often today to make a voyage of CM discovery, as I have been wont to do these past few months, when it was nowhere to be found. I don't think I went until after lunch, when I'd been at work for hours. And I was completely taken aback by what, in happier days, I used to see every month. I never would have imagined that something so essentially gross would be cause for celebration - having a messed-up body changes you. So the fertile CM is back. Slight yesterday, quite definite today. We'll see about tomorrow (I may not be all the way back to a normal-length fertile phase yet?)

When I interviewed for my job (I promise this connects), they asked me where I saw myself in ten years. It should be an easy question for someone with a career (ha!) to answer, but I can't answer that question at all (people at work still ask me now and I do no better. Fortunately my interviewers decided to overlook my complete inability to come up with an intelligent response). What I thought when they asked the question in the interview was, immediately, I want a family and I don't care if I never work again. You can see how having that at the forefront of your mind would make it difficult to come up with a reasonably accurate but more palatable answer to keep the conversation going.

So one of my big problems dealing with infertility is that, absent children, I have no idea what I want. I just keep running my mind into a brick wall in my attempts to picture my future. Subtract babies. Think forward. Put imagination in gear. Oh, no, wall - CRASH! Repeat.

Then last week I had a blessing. A friend invited me to a Catholic lawyers' and professionals' organization event. It was put on very nicely and all sorts of good things. Then they introduced the speaker. She was supposed to talk about how to live your faith in the DC working world. Great. She didn't, by the way; she talked about the different activities her organization puts on, but that wasn't the problem. Oh, I should note that this woman is very impressive and accomplished - not that I really care. The man who introduced her made me so angry I almost walked out. I have what probably amounts to a fairly unique view of the role of women, the world, and their faith. (I am persuaded that I am right, so I don't care whether everyone else thinks I'm crazy.) And I've had to confront this issue early and often - I went to a competitive undergrad, then law school, and now I'm an attorney. Everyone has always had notions for me - how high-powered my career should be, that sort of thing. So the role of women is something I think about a lot, or, perhaps, try not to think about.

Anyway, the introduction. I think the very first thing he said was that she was the first woman and the first layman to hold a particular ecclesiastical office in the diocese. She is not 90 and she is not a Supreme Court justice, so the "first woman" crap - gag me now. I'll tolerate sixty seconds of it about Sandra Day O'Connor (don't like her opinions, but I get how her life was unusual), but not for a woman who has lived this woman's life. She should be able to shine on her own merits - or not at all. The other problem, of course, would be that if no layman had ever held the office before, there probably was a good reason only ordained ministers of the Church held it until the last ten years - and they should have kept it that way.

Anyway, the introduction went on, and on, and on. I heard more about her being the first woman at things (truly, nothing that would make anybody stand and take note - jobs and career moves you've never heard of. Oh, including being the first woman president of their organization. If anything, that reflects poorly on the organization - not well on her). And the gushing - it was terrible. He threw in a point about how she had been so trailblazing because she had found a way to "serve God and the Church as a woman." Poor Ss. Therese of Lisieux, and Catherine of Siena, and Joan of Arc - and Mary, the Mother of God. If only they had had this woman to show them how to serve the Church as a woman, imagine what they might have been able to accomplish!

The stupid introducing man finished by thanking her personally, on the basis that he has a ten-year-old daughter - and the girl is lucky that women like this exist, to show her how she can live a worthwhile life too. Too bad the fellow doesn't think his own wife is example enough for the girl. And, seriously - if the speaker and the ten-year-old were both working on being, I don't know, blind stock-car racers, then fine, you need a trailblazer there. But a Catholic woman with a job? Seriously?

So anyway, neither during the introduction nor during her rather pointless address was it ever mentioned whether she had children. Or what her husband's name was. Or what her experience of marriage was like. Those are her vocation. Her job is - a job. Maybe it's a great job, but that's the best of a bad lot. Your real life, and your real faith, is the people you love, not what you earn your paycheck doing. Her talk made it clear that she doesn't know that (or chose not to express it to us? Sort of missed the title of her own remarks), and neither do the people who know her.

So after I was done being alternately patronized and bored, I went home and was struck rather forcefully by a realization. If I really, really wanted it, I could have her stellar career. I don't want it. I want to have time to be at home, see my friends, call my sister, learn new dessert recipes; more than I want to have a cool CV. In fact - I don't want to have a cool CV at all. I'd like to have jobs that demand something of me, are a little fun, intriguing. If other people think they're cool, bonus. But just to have a title? To have a lot of authority? Be the "first" at things? Assume positions because they're prestigious? No. Maybe if I could get a job that would catapult me into position to teach law - OK, then, because then I could have a fun job and also have summers off and be home in time to make dinner. Score.

Anyway, I realized that although my future seems like a blank to me, there's actually a lot that I do know - starting with never wanting this woman's life. My faith may be suffering - and though I didn't see it, hers may be very deep - but I never want someone to introduce me as a Catholic - and talk about my jobs. Even if I never have kids, I want my marriage to be so important that nobody who knows me could miss it. And though I have only an itty sliver of a view of what I want my future to look like, there is something there. In my mind, I see myself with a house full of at least a few people, pulling something or other out of the oven. No babies running around. I don't know what I do the rest of my day, but I know I want a home, into which to welcome people; I want people around to love (and to feed); and I want time enough to be invested more heavily in my home than I am now, and less in work (not that I have to work excessively hard as it is).

So I do have a future. I don't have to have kids. I don't know what else I'll do. It sounds silly to me to be really invested in making your home a home when you don't have kids, but I think that's what would make me happy. So until I receive further direction, that's what I'll do. I don't know the rest of the story, but if I can devote a reasonable proportion of my life to making pie, I don't think anything else could be so bad.

In the meantime, I want to get myself on a schedule where I have more life and less work (which means I need to get to bed at a decent hour and get up earlier). I want to get into a churchgoing arrangement where I belong - I'm going to need to find a daily Mass in English to make that work. I don't need to fill myself to the brim with fertility medication and I don't care whether my estradiol and progesterone are in a 1:10 ratio ever again, but I want my old familiar (apparently completely healthy) CM back, I want my digestion to work well again, I want my accustomed energy back, and, once I can drag myself off the couch without the Jaws of Life, I want to get my 22-year-old figure back, and wear cute pants again (!), and skip off to work in my adorable Elie Tahari tweed suit that I loved so much and only fit for about six months. I don't need miraculous abilities (you know, like childbearing) that I never had. I will contentedly settle for the restoration of the unremarkable health that I once took for granted.

**************************************

On an unrelated note (I was going to make these messages of equal length, but I can't seem to get control of this brevity thing), I would ask your prayers for my husband's uncle. He is eighty and has terminal cancer - he just learned today. He has less than a year to live. He's actually a religious priest, and probably less afraid to die than anyone I know (other than the other monks in the order - they're all very matter-of-fact about death. They care for their own brothers when they're dying, so they see death as part of their ordinary lives). I know his siblings will really miss him, to say nothing of his numerous nephews and nieces. And I will surely miss him too. He said our wedding Mass. He's a wonderful man.

Monday, September 21, 2009

one step forward

I wonder whether I am even more lethargic and ill-disciplined because my DH is gone? Possibly I refuse to go to sleep until 3AM...on a work night...because he is not here? I mean, it's a fact that I do that whenever he's not around, but I wonder whether I do it because he's gone or I just don't do it when he's around because he'd tell me to go to bed.

Anyway, despite the fact that my house has remained in museum-quality preservation since my guests left after 3AM Friday (that wasn't a work night, just for the record), and I may want to get rid of the empty beer bottles and pieces of pretzel some time before the husband returns, I was good and made even MORE phone calls this lunchtime than I had assigned myself. I called my pharmacy about endocrinologists (still need an abbreviation here) who prescribe something other than synthroid, and they plain refused to help. "We don't know that information, there are too many prescriptions."

This is where big business is the opposite of efficient, and you need small-town. (It's nice to have tasty and affordable Ethiopian and Thai food within a three-minute drive, but I miss my small town so.) So I called a local pharmacy, and (after I was on hold ten minutes), the woman told me Armour was no longer available, listed all the formulations that are now being used instead, named three doctors and one practice that prescribe these, and gave me the phone number (apparently off the top of her head). Note to self: change prescriptions from Giant to Preston's CARE Pharmacy.

The practice was the Kaplan Clinic, so I decided to be good and add a call to my roster: find out whether they have openings and whether they take my insurance. Maybe even make an appointment! Imagine my bewilderment when I was told they do not take any insurance and bill on a fee-for-service basis. I was proud of having enough presence of mind to follow up with, "Do you have a schedule of fees?" No. They charge by the hour. That doesn't leave me with any easy basis of comparison. Apparently the initial visit is $325 with most of the docs there and $525 with Mr. Senior Doctor.

I think this is probably more than reasonable, compared to what I would pay without insurance anywhere else. But I already have the insurance...paying by the hour would be an additional expense. I'm sure I could afford it, but it does seem sort of wasteful. And I don't want to call the very nice pharmacy back and ask for even more names. Maybe tomorrow at lunch I will call every endocrinologist listed on the Blue Cross website and see what they prescribe. That's what I was hoping to avoid. Ah, well.

My other planned phone call was to Fr. Paul to see whether he can recommend me a spiritual director (I was good and called him last week, but he was out of the office till today. I did leave a message). Turns out the whole office was empty when I called today, so I will be patient and wait for his return call. He's far too disciplined to fail to return a phone call, especially, I would think, to someone looking for spiritual guidance.

Score: misfit: 3; creeping laziness: 0. Results: misfit still spiritually and physically unhealthy. Maybe tomorrow will be a better day.

Saturday, September 19, 2009

so much for that

Got a call back from my endocrinologist's colleague (also an endocrinologist - my Dr. is on vacation) yesterday. I had left a message for her to inquire into a different thyroid medication, more complete than Synthroid. So I told her I'd been doing a little reading and it sounded like some natural supplements were more thorough - maybe Armour? She said that she never recommended Armour "to any patient" because, since it's made from animals' glands, the dosage can't be calibrated at all and you have no idea how much you're getting. Like many things I've heard from doctors, this sounds extremely persuasive ten seconds after you hear it and after ten minutes you realize that it is certainly complete and total BS.

Superficially, if you just grind up the gland, yeah, you could be getting anything. But this assumes that I am slaughtering the unsuspecting creature on my back patio and cooking up the meds on the stove. In reality, of course, if anybody is ever prescribed this medicine, and they don't have to be hospitalized as a result, the prescribing doctor knows how to dose it. In an entire month on Synthroid, I take one and a half MILLIGRAMS of the actual ingredient. You couldn't dose this stuff randomly - you'd kill somebody.

Moreover, I'm pretty sure thyroid hormones are not the only ones for which supplements are derived from animals. (Insulin? I'm right about this, aren't I? Also, progesterone?) And since I took all of five semesters of chemistry and didn't even go to medical school, here's what I would do if I wanted an exact dosage. Take the part of the organ that has the chemicals you want and physically remove any accessible matter that is extraneous. Clean the remainder carefully. If non-essential components can be removed chemically without damaging the hormones you want (or if the hormones you want can be extracted chemicaly - chelation? Carbon fixation?), do so. Once you've gotten it down as pure as you can without damaging it, pulverize it into minute particles and dissolve it in solution. Homogenize it so it's evenly distributed in solution. Take a small sample and test the concentration of the active ingredient(s). Divide the quantity you need to give the patient by the concentration of your representative sample and you get the volume of the solution that you need. Take that volume, dehydrate the solution, and prepare the dehydrated remains in capsule form. If I can figure this out, something tells me the pharmaceutical industry can.

This woman is full of $hit.

She told me (of course) that my tests showed my thyroid function was perfect. I pointed out I had tested for low thyroid function, and had symptoms thereof; I now test for normal thyroid function, but have the same symptoms. I asked her whether a normal TSH range conclusively demonstrates that my symptoms could not be caused by thyroid problems of any kind. She said that nothing could ever be said with absolute certainty. (Yes, I took math and science in college too. What about that part of the sentence after the "but," where you say it's your professional opinion that this is ruled out as the cause? Oh, not going to go there, are we? Fine. I don't care about your health any more than you care about mine. That achieves some sort of balance, right?)

She then pointed out that thyroid symptoms are very non-specific (yes, I know. But doesn't the fact that, absent medication, I am clinically hypothyroid narrow it down a bit for you?), and said that I should see my general doctor to look into other causes. Here's the part where a medical degree might come in handy. I know depression could cause some of my symptoms (though I don't believe it could cause exhaustion while exercising. The difference isn't emotional, it's physical). But I don't think I'm that depressed. Other than depression and hypothyroidism, my layman's knowledge would suggest that only another hormone imbalance could cause these symptoms. Am I missing something here? And if I'm not, well, this woman is an endocrinologist. My "regular doctor" (if I had one) would not be. So...who should I be calling to look into the problem?

I also asked whether I should have my cortisol levels tested. She told me flatly that adrenal fatigue is "not a medical diagnosis." That's genius, lady. Once upon a time, the only medical diagnoses were impurities of the humors and the need for bleeding. I bet not too long ago hypothyroidism was considered laziness, and "not a medical diagnosis." See how greater knowledge causes the profession to stop patronizing its patients - or, rather, switch to patronizing its patients on a different subject? You can call it a diagnosis or a fruit cocktail, but if testing demonstrates that someone's blood hormone levels are out of the normal range, then treatment would seem indicated.

I've decided that I will leave a voicemail for my endocrinologist, tell her what her colleague said, explain that I don't think that my health is being regarded as a priority or my symptoms being taken seriously and I have never been a hypochondriac (not in real life) and feel that if I pay for medical care I should be supported in my attempt to live a healthy life, and that if she shares her colleague's perspective, would she please let me know so I can look for a different practice. I will also be canceling my appointment with the colleague (on October 2, to check my blood levels before my 10/12 surgery) - what conceivable use would that be? Verifying my TSH levels is making her happy, but it's not doing me any good. It's not my goal to make her happy for no collateral benefit to my health.

I will also be calling Tepeyac to see whether Dr. L (or anybody else there) can recommend an endocrinologist who is not a pain in the @$$. Even better would be a suggestion from my internet friends in the trenches, who have had to live with the consequences of lazy medical care. (Hey...I seem to have the same approach to running that Dr. Go the non-Armour prescriber has to treating patients. Coincidence...?) Any ideas, folks? In view of the fact that I live in a really big city, I'd rather not drive more than 25 miles, on the theory that any product or service I want can be had here for ready money, provided only I know where to look.

Wednesday, September 16, 2009

I'm not fat, I'm infertile

Though it took a few days to really sink in, I was inspired by Sarah @ callmemama and her comment to pester my endocrinologist to consider putting me on a different thyroid medication. So the idea is, levothyroxine (right now I'm on the brand name version, Synthroid) replaces the missing T4 in your body if you're hypothyroid. It does not replace T3 (it assumes that the T4 will convert itself to T3 at a sufficient rate). They have been super-good about calling me back and right now I owe them another phone call to see whether I'm going to be able to persuade the doctor to change my regimen. Unfortunately, my next appointment is October 2; surgery is October 12, so that wouldn't give a new medicine much time to kick in (thyroid takes a while) before I'll be feeling weak and sickly, thyrid problems or no thyroid problems.

I was momentarily stymied when I dug up my (pre-synthroid) T3 level, which is 2.7 pg/mL. According to this site, a normal level is 1.4-4.2. While that range sounds rather wide, I am smack in the middle of it. As far as I know (corrections, anyone?), T3 and T4 are basically the thyroid hormones, so if I'm on replacement for one and the other is not low, then I probably can't benefit more from different medication. But I'm still going to pursue it just in case (not my usual attitude toward treatment), and here's why.

Per Sarah's suggestion, I visited stopthethyroidmadness.com to see what information they had around. (It's awesome that this woman put this site together, by the way. It's SO hard to get THOROUGH, non-anecdotal medical information for the layman, and if any IFer doesn't know you have to be your advocate by now, well, you will.) The site includes a list of symptoms. Now, and I know this is sort of a paradox, but one of the things I'm paranoid about is being a hypochondriac. In the daydream version of my life, everything that happens to me is dramatic - from adventures to illnesses. But while I entertain amusing notions of having really exotic (or severe) ailments, I have never, shall we say, acted on these notions. When I call the doctor to say that I have a cyst and I need it checked out, it's because I actually rationally believe it to be so. I feel confident in saying this because every time I have said there was something wrong with me, there was and it was pretty much exactly what I said. So I'm actually a rational person and not a hypochondriac. But I have to say that. I'm a little insecure about it, I guess.

Anyway, I read other lists of symptoms (nothing this comprehensive) before I was even diagnosed as hypothyroid, and I noticed that I never had the objective ones. Brittle hair, losing my hair, uncharacteristically dry skin - nope. I have increasingly bad skin (which I've NEVER had - I thought it would get BETTER off the tamoxifen??), don't know whether that's a symptom or not. But I do have all the symptoms of hypothyroidism that I could be imagining in my mind. I'm tired, mildly depressed all the time, my mind wanders, I have no energy for anything. When I first read those lists, I thought, "I'm unhappy that I'm infertile, and I'm out of shape and lazy. That's not a disease." I figured if the synthroid made me an Olympic athlete, it would indicate that I wasn't lazy or out of shape. That didn't happen. I concluded it was me.

But there were a few striking things on the STTM list. One leapt off the page and slapped me in the face: "Chronic Low Grade Depression." THAT'S WHAT I HAVE! It's not when I'm PMSing. It's not SERIOUS depression, where I have thoughts about death and can't deal with people (been there, done that. Got through it without medical intervention - I was under a crushing amount of stress, and I got out from under it). This is specially important to me because I understand what SERIOUS depression is, and I do not want to be referred to a shrink or given psychiatric medication (which I would not take) when I know that's really not what I need. I do need to keep sorting out my IF issues (I feel like I'm sort of moving forward on that, slowly. Also, Fr. Paul called me back, I need to call again, and with any luck I can find a spiritual director and that will help me sort out some of my directionless-life issues).

When I'm socially backed into a corner (at least once a week), I go out, and once out, I interact and have a good time. If I don't get my arm twisted, though, I want to be on the couch - ALL THE TIME. I go to work and I get my assignments done (well, according to my boss), but I feel like it's sort of by accident. I have to trick myself into doing the exciting ones first, eat a piece of candy at regular intervals and take frequent walks to the bathroom or get water so I don't fall asleep, do things in discreet pieces because the idea of taking on a whole project at once is too intimidating. I'm competent to do the work in theory, but I think in practice I do it in spite of myself. I see people, but I have to FORCE myself to read my email and listen to my voicemails. I never want to answer the phone, but sometimes I do anyway. I avoid signing onto skype because I don't have the energy to talk to my husband. I give myself lectures so I'll actually communicate with people. I do not sit down and write emails to people I've fallen out of touch with - no matter how much free time I have. Washing the dishes is an ordeal (and I don't mind washing dishes). My job exhausts me (it shouldn't), but if I didn't have it, I might be able to work it so I never had to leave the house. Do you have any idea how good that sounds? The other weekend I had to bribe myself with $20 of shopping permission at a thrift store and even that barely made me want to get in the car. The thrift store is one mile away...and I love thrift stores.

I tell myself that it's my lack of exercise, but until a few months ago, I was honest-to-goodness running three times a week. I had been doing so for months, and I felt tired and lethargic every time. I've never felt that way. When I got the hypothyroidism diagnosis, I actually stopped running (or, didn't resume - I'd stopped already), and figured I'd start again after I got on the meds and had my energy back. It's not back. I've started going to the gym recently but I still feel like I'm dragging deadweight around. Most of you haven't met me, so I'll specify: I hit a new lifetime-high weight (this has been happening every couple of months lately), but that's only 140 lbs. and I'm 5'7". I hate the way my clothes fit and want to be in good shape again (the hips are public enemy number 1. I'm a size 4 on the top and nearly a 10 on the bottom and I will not stand for this), but I know I'm not fat. If I were fat, some fatigue with exercise would make sense. There is no reason I should be this tired. (I also have fairly low blood pressure, 106/64, so my cardiovascular endurance should be good.) And feel vaguely but not completely like crap all the time.

This long, long diatribe (BTW, yes, it's late, but I took something like a five hour nap that I just woke up from, so I am actually catching up on sleep - back to bed shortly) is all leading up to one thing, and that's this: THIS IS NOT IN MY HEAD. It could be in my head. Or it could be a product of the fact that I'm a complete raving basket case over infertility and it's expressing itself here, there, and everywhere. But that's not true (for one thing, my anger about IF is hardly repressed at this stage - sorry, bloggers who are subjected to my ranting). This is physiological. I'm not crazy and I'm not imagining this and I'm not lazy and I'm not a misanthrope and I'm not feeling sorry for myself! I could have said those words before but it's only just now that I've sort of had an epiphany and mean them.

Do you know how impossible it is to believe that the failure to join every activity, lose ten pounds like falling off a log, volunteer for every organization that will take you, and bleach every square inch of your house every night before bedtime, is not a personal moral failing? How can I even explain this adequately? I didn't think these things were grave so I didn't let myself freak out about them, but it makes more difference than I can say to think that of all the things wrong with me that I allowed to happen through this infertility journey and need to fix, the list is important but short. I'm not doing everything wrong because I'm a pathetic waste of space and a useless human being. I need to make some changes that have nothing to do with free T3, but I'm not an overweight sluggish fifty-something with a bad attitude and untreated depression (though that's exactly what I feel like). Do you know what this means - I might never have children, but I could be young.

I'm going to have surgery and stop being in pain and carrying around this insanely bloated and distended abdomen (it looks ridiculous and feels terrible). I'm going to get somebody to give me the right thyroid medication and put on sneakers and walk out the door and feel the joy of running into the wind lifting me up; I want to cry because I can barely remember what that feels like. I'm probably not going to take any more fertility meds (anyone interested in a five-day set of tamoxifen, BTW?). I don't want to feel like crap any more, for any reason. I'm going to stop having to walk around with my skirts so snug I look like a woman of easy virtue (I can't afford to replace all my suits, and even as I buy new ones I outgrow them), and I'll get to wear the clothes I think look nice on other people - right now, I stare at girls with the figure I used to have - and I'll take up the hobbies and projects I would be interested in if I could be interested in anything, and I'll move my work schedule to early hours and actually get up in the morning, and maybe even go to Mass in English before work! I can't tell you how I miss daily Mass in a language that I speak. I'm going to do something insane, walk in uncharted IF territory. I'm going to live my life. Because there's nothing wrong with me. And the defective reproductive system can go to Hell.

Monday, September 14, 2009

the Lord God made them all (but I don't know what He was thinking)

Two Thursdays ago (that's September 3rd, for those scoring at home - and honestly, is there a better place to be scoring?), when I had my visit with the endocrinologist (among the things of which endometriosis has robbed me is a convenient abbreviation for this woman's job title), I realized I was in the same hospital where I get my blood drawn, and I should drag my leaden carcass and my latest bloodwork requisition down to the lab and git 'er done. Which I did.

Last week it occurred to me that it had been a little while and I might want to call in today to check up on those. I was going to today, but I just didn't (see leaden carcass, above). But at 6pm - she called me! I feel like a high school girl. I got a phone call!! Speaking of which, I was one of the girls who got asked on exactly zero dates in high school, which, in retrospect, was a blessing. But have you ever thought about whether you'd have had normal fertility - no endo, no POF, blah, blah, blah - if you'd just gotten knocked up at sixteen?

Anyway, here's what she said. Second testing also says I have no thyroid antibodies - so no Hashimoto's. Good, but if I didn't inherit it, why am I hypothyroid? Could poor exercise and depression actually *cause* this?

Also, when I was planning to call her, I was going to ask whether she could move my TSH target range to 1-2, rather than under 3 (in response to everyone's wonderful advice). But apparently no need - she says my level is 1.4! (Or was that 1.48?) Previously it was over 7.

So that's good news. Well, largely. It does mean that hypothyroidism was not the cause of my IF, since I had been on that dose for two months when my blood was drawn. And today is CD2. (On the other hand, with my insides being a veritable multimedia collage of damage and disease, and virtually every hormone level abnormal, who really believed that a little synthroid was all I needed?)

The other thing is that I was hoping my TSH was still very high and I needed to double my dosage of synthroid. I still feel exhausted all the time (I know the not sleeping is part of that), and slow and heavy, with no endurance at all. I've been going to the gym at work to do biking and stairs (I *will* conquer the hips), which should build muscle mass. If it's made a difference so far, I haven't noticed. I can do maybe five minutes before I'm exhausted. Is it possible that all the cysts and adhesions and gas and abdominal pain are taking so much out of me that I always feel weak and sleepy? I feel so old. I'm not ready to be old yet.

In far less ambivalent news, a week or two ago I noticed a bug on the kitchen counter (and squashed it). I didn't recognize it, but there are lots of bugs in VA I've never seen before (and I don't like any of them). I figured I'd find out what it was eventually. I've squashed about one a day since then, and one, maybe two, has gotten away.

Today, I realized I'd also noticed a gradual change in their appearance. The first one was gray (and vaguely resembled a pill bug). The one I killed this morning was slightly larger, and shiny and brown-black. I walked to the bus stop with a heavy heart, mystery solved. Hideous internet pictures confirmed my suspicions. Tonight I am buying every version of roach poison I can find. I caught it early. I hope. But I am distraught. I know they're very hard to get rid of (thank God we have a house, and no super-close neighbors).

I feel this is a grave judgment on me as a person. Sure, I have a few dirty dishes in the sink, but I've never had a spotless kitchen, and I've never had roaches before! What kind of person brings roaches into a roach-free home? I hope I can make inroads into the population before my husband gets home. That will make me feel a little better.

Saturday, September 12, 2009

house sadness

So I shared the pictures of the last house we went to visit (a few weeks ago). The one crammed with furniture and weird stuff, that had built-ins and kitchen cabinets added by a crazy DIYer in the sixties. You know.

Anyway, I didn't update on the ensuing events, I don't think. I got home, still seething from the jerky realtor telling me all my questions weren't important (apparently I don't need to know what type of wiring the house has, whether there's a false ceiling in the kitchen, or whether cracks in the plaster are indicative of structural damage - or, I can make an offer on the house and wait to find out all of those things until I get an inspection. 'Cause those things wouldn't affect my offer). So I decided to email him and ask them all again. This time, after each question, I added a whole paragraph explaining that I had understood his answer, but that the information I wanted was important ANYWAY and would he please ask the homeowner.

I should note that I started this out with the point that the homeowner knew a lot (and that I found it heartbreaking that they gave all those French doors away!); and I said repeatedly that I can't seriously consider this house with so little information. At whom were these lines directed? Mr. Realtor, of course. I cleverly predicted he would decide I was a headache and send them to his wife, the main realtor, who loves old houses and would probably give me better answers (maybe even appreciate that I was right to want to know).

I didn't predict what the wife did with the questions: email them verbatim to the homeowner. In the world of Murphy's Law of Emails, I admit this was obvious. But given my assumptions that she would actually read the questions (I still think she probably did), and the apparent fact that she would like to sell the house - in a slumped market - I figured she'd pull out some diplomacy and finesse the questions so as to make nice with her client (the seller). FTR, every other realtor of whom I've asked questions has done this - and those questions weren't phrased to refute an irritating sales pitch.

When I got the email from her saying she had forwarded everything to the seller (whose mother, the house's occupant of more than 30 years, has just died, BTW), I didn't even need to reread my questions to know how much they would offend him. So I was unsurprised when I didn't hear from her for a week or so. I sent another question (about the gallon jug in the bathroom) to see if I could goad her to respond. I got a quick response to that one - apparently all the plumbing works fine, the jug is there to catch the water before the shower heats up, because the homeowner's a conservationist. (I'm cool with that.)

Finally the other day I called Ms. Realtor and asked her about the original questions. She said she had already sent the answers (I can't tell whether this is true), and sent me another copy. The seller was obviously offended, but he did answer the questions, and the answers were reasonably reassuring about the solidity of the house.

Now I have a dilemma (that I knew was coming). If I were offering full asking price for this house, say, the seller would obviously take my money. He's not stupid. But I'm not going to do that, because I don't believe it's worth its asking price, in view of the repairs needed. (FTR, if all it needed was fresh paint in all the rooms and no repairs or major renovations, I might offer 5% less than they're asking. As it is, I think I'd have to offer 15% less - or more.) The caution with lowballing is always "insulting the seller" with your offer. If they're really ticked off, they won't counter your offer, and you basically have to walk away. Stupid sellers (in this market) are the only ones likely to ignore a remotely reasonable offer. But what about a seller who has already directly interacted with me personally - and is already offended? I would guess this guy would assume almost anything I offered was insulting because it came from me.

So I wrote him an email, which is probably crossing a line. I apologized for him getting my questions and explained that they were a response to things the realtor had said, that the realtor had explained his goal was to sell the town not the house, that based on my experience growing up it was super-important to me to get all available information on the house before making a decision, that I liked the house, that my statements were meant to convince the realtor that I really wanted the information and maybe I went overboard. (I didn't, but I read and re-read every line of the email under the assumption that he would immediately forward it to the realtors, and I made as sure as I could that I wasn't insulting the realtor, even fairly.)

It has been several days and he hasn't written back. I figured that he would see that if he wanted me to consider the house and was willing to ignore my email in favor of making a deal even with me, he'd immediately write back, "No hard feelings" (even if he thinks I'm a jerk) and put business first. I think my psychology there is pretty sound, so his silence tells me he's not willing to deal with me except (maybe) under duress. That's not going to work with this house.

So even if inspections showed it was a good prospect and we could make the numbers work, we're not going to buy this house. I'm not even going to consider making an offer. I said in my last email to Ms. Realtor that I was sorry that the seller had received my questions verbatim, he appeared to be offended, and I would be offended too (I wanted to see what she would say). She immediately responded that she didn't think he was offended (translation: she didn't do anything wrong). If you're going to be good at sales, I feel like you need at least some skill in reading people. And maybe to get the parties to get along so you make a sale every now and again - or, you know, not.

I know it's my fault for giving them an opportunity to screw this up. I know I should do business with the assumption that everyone around me is incompetent all the time (and speak to them as though they were all brilliant). I really know that I need to rein in my temper, and if my goal with my first email had been more persuasion and less making a point, then I might not be in this position. On the other hand, this is the realtor whom I called four times and emailed three times over a ten-day period before she ever responded, just to see the house in the first place. And I just cannot get my head around why a realtor would poison the well between a seller and a buyer - unless she has someone else in mind to buy the property, but I've looked, and it's still on the market. Taking both my DH's and my preferences into account, this house was the favorite. I've thought a lot about it and I would be willing to buy it.

Too bad.

Monday, September 7, 2009

guess what I have


So I don't really do blog giveaways or anything, but I was picking up my new thyroid prescription at the pharmacy the other day and what should I see but a $2 off coupon for mucinex! I should probably have taken the whole stack, but I grabbed one. The stuff does me no good, so I figured I would give it away.

Anyway, I have decided that anyone who wants it may comment with their idea of what they want to do if they DON'T have kids (maybe this is unfair to those who are certain they will?). No limits - if you want to be a professional boxer or the queen of England, have at it. I promise to choose on an entirely arbitrary and capricious basis, to be determined based on my mood at the time. Contest closes at midnight Eastern time on Friday.

Happy mucus, everyone! I mean Labor Day. Happy Labor Day.

Saturday, September 5, 2009

Julia

I haven't watched the movie (I may yet). But it has gotten me thinking nevertheless. And then I was goaded to actually write it out when I read this statistic appended to Pamela Tsigidnos's article:
One in six of all couples seek medical help because of childlessness, and one in twenty will never have a child despite all that medicine can offer.

Though my arithmetic abilities have shamefully atrophied since high schoool, I eventually did get most of the math straight on infertility. Before I was married (after my first endo surgery), my OB/GYN told me that 50% of couples conceive in six months of trying; 85% within one year. Add the facts that a formal diagnosis of IF means one year of trying with no pregnancy and that one in six couples (~15%) is infertile, and you have all the pieces of the equation.

It not infrequently occurs to me that my beloved ladies in the IF gang who have been hanging out on this particular street corner for, let's say, three years or more, are not just the hard cases to treat. They are also the cohort from which will be drawn those who will never have children of their own. I don't mean that to sound horrible and I know that it would be factually inaccurate to say that after three years of trying there's no hope. People conceive later than that all the time. But, of course, IFers who conceive before three years necessarily will (or, do) have their own children, so we can count them out; and, those who've been trying 1-2 years strike me as an uncertain group from which to draw the lifers, if you will. In the first year of treatment, you're still deciding whether you like your RE, getting blood drawn, doing ultrasounds, putting in your time on clomid, peeing on sticks, scrutinizing your charts, and getting good at denial. The real intractable cases set in later, right? Does this make sense to anybody?

OK, even if it doesn't. One in twenty is a huge number. Enormous. It means that almost one in three infertile couples will not cross over. (I figured it was one in a hundred and I'd still be in that category. At one in three, it seems like a foregone conclusion.) It's a current number, too, which means it reflects treatment by IVF and IUI, which (despite some numbers apparently floating around in Catholic circles) appear to be more effective, or, in fairness, at least more quickly, at treating really entrenched infertiles.

One in three, if you think about it, is double the percentage of infertiles in the general population. And you know and I know that IF only seems to be invisible. It's not discuss-able in polite society, really; but an infertile girl walking around can spot other infertiles pretty reliably, and even someone who never thinks about IF but is perceptive can usually pick out one or two IF couples among his acquaintance (provided he knows a significant number of couples of childbearing age). We know it's out there. But how about this. We know lots more infertiles than most people do. How many couples can you name who have exhausted their treatment options and will be childless for life (or will adopt any children they will ever have)? I would guess not very many. Practically none.

Which is one of the reasons I was so immensely struck by Pamela's blog. She is charting territory where by all appearances no one has traveled before. Except it seems as though lots of people have. What do you do to conceal permanent childlessness so that nobody notices it (i.e., even I can't name any IRL examples I know personally)? Get divorced? Become a CEO? Take up skydiving? Become sexually libertine? Pitch yourself off a building? Rely on people's natural denial to edit around it in their minds so they don't notice?

Which brings me, by degrees, to Julia. I understand from reading others' impressions that she took up cooking because she found herself traveling with her husband, her time unoccupied, and unable to have children. If I'm Julia Child, and I look back on my life, and I realize that I was able to excel stupendously at something about which I was passionate, and share my passion with others - indeed, to bring to so much of the world something it would have lacked without me - I may still be sad for my childless arms, but I know I had other work to do. I know I lived a full life, the life I was supposed to lead.

Given my particularly grim response to not getting what I want (how many fights my first year of marriage could be chalked up to this problem?), I have developed a certain knack for having low expectations. It requires constant work, because my inclination, in my secret heart of hearts, is to expect the moon, which, thus far, has not been forthcoming. A sweet, innocent Catholic girl might look at her life and think that her future really might contain such a thing - incredible success, maybe even fame, an opportunity to live a dream. I can say from personal experience that such a sweet, innocent girl would be irrecognizable after four years of constant disappointment in her hopes for a particularly humble dream: to have a few babies to care for in the anonymity of her home and family. So we can throw that line of thinking right out. I, at any rate, am not expecting to have a major television show. (That sort of thing is not even really a temptation for me. Many other materialistic things are, naturally.)

But here's the thing. I want what Julia had - I want a life whose stamp is such that I could reflect on it and see clearly what I was meant for, why I was here - that I was mistaken about the kids because there was something much bigger and better that I couldn't see. (God's grace is supposed to work like that, as I understand - what He wants for you is better than whatever you could want for yourself.) I can't well imagine any such possibilities, however. I have all the degrees I want and no interest in pursuing another line of work. As long as we live in this area and the economy's in the toilet, I can't afford to practice real do-gooder law, plus I seem to be decent at what I'm doing. Real exceptionalism in practicing law takes a handful of forms, none of which is compatible with being at home except to sleep, and sometimes not then; so that's not an option I'd be willing to pursue. I could volunteer, but I don't think charitable activities should be the meaningful butter on a life of pointless bread, if you will. I'm already married and that isn't supplying me with sufficient meaning to be content. Which means that either whatever is planned for me instead of having children is going to be totally out of left field, and not something toward which I'm currently traveling (and shouldn't I be headed there by now?), or there's nothing planned at all and life has no meaning.

(I note that this isn't actually a response to AYWH's post, I'd been thinking about this already; but hers definitely deserves a mention. I reject her conclusion not because I believe it's technically wrong but because I absolutely refuse to deal with the possibility. Infertility, for me, has been a lot of "I guess so" when a good person would say yes and I'd like to say no, and then inability to follow through with actually living a "yes" well. This is my first HELL NO. Of course, I know what "no" means. No means that's what you'll get, and you'll learn to deal with it. Moral of the story: it can always be worse.)

Friday, September 4, 2009

in which the misfit actually ATTENDS a scheduled doctor's app

First of all, I have to note that Dr. L (whom I sometimes refer to as Dr. C, which seems to me to make more sense if the other fellow is Dr. B, but moving on) is an absolute angel. I think the nurses at Tepeyac are going to have my number BLOCKED on their caller ID at some point, because I call a LOT and I am pretty much always a pain in the @$$. Speaking of which, that's something I probably need to work on.

Anyway, I begged for her to call me (but added that she couldn't call me Thursday because I couldn't answer the phone, given work stuff. I don't want to be so demanding - no, really. I know I'm pretty demanding in general - but I just knew she would call and I would see the number, sitting in training unable to leave, and I would have a Rage Episode. I have had several of these with regard to missed calls from Tepeyac, because if you call them back THAT SECOND they DO NOT ANSWER and I have used up my LIFETME ALLOTMENT OF PATIENCE on FOUR YEARS OF INFERTILITY and I just can't deal with it. I feel like maybe they have a referral relationship with some local shrinks and they're trying to drum up business, because I am seriously in danger of busting a vein). She very, very generously called Friday, and allayed my fears that, despite my many clarifications, Tepeyac is secretly planning to schedule me ONLY for a laparoscopy and telling me when I wake up that they're scheduling the laparotomy for a month from then, so that I can quit my job to make time for surgery and have the joy of being unemployed AND childless. (I note that I recognize the value of voluntary unemployment. As long as I have this much law school debt, however, I will be employed until or unless I have children.) Anyway, she was super-sweet and explained that they will, indeed, do the laparotomy at the same time, which is all I wanted. Now I'm happy, and it was so nice of her to confirm this with me. I get that the nurses can do it, but they kept giving me contradictory information, and I thought my head might explode.

So anyway, the appointment I actually attended was yesterday, with an endocrinologist (NOT an RE) at VHC. They take all my blood, and I like them, so I went there. I was initially VERY apprehensive when the doc walked in and she looked about my age or possibly younger, but then I did the math and realized that she just looks young - she's somewhere close to ten years older than I am. Also, she obviously totally knew her way around a thyroid, so I felt much better. She explained that their goal as a practice is to get women who are trying to get pregnant to under 3 for a TSH level (I know I've heard lower from other people - how low??) and suggested some things. For the benefit of others, the details: there's synthroid (scientific name levothyroxin), and then four generics of it on the market. Though the dosage is technically the same for each (50mcg, for me), each has a slightly different formulation, and if you change types, it can affect the amount your body is absorbing. But you can't request a particular one of the generics - the pharmacist uses whatever he has on hand, which could change from refill to refill. If you use the synthroid, though, it will always be the same. So I'll switch to that. Then, she said, if you're trying to get pregnant, they see you at six weeks, then five-ish, then four-ish, to make sure that your dose is exactly right, and your levels are exactly consistent. After they've achieved that, you come in every couple of months "until" you call them and say you're pregnant - then they see you within the week, and every two weeks thereafter, to get you to the right pregnancy dosage (apparently the pregnant body needs more thyroid). I didn't tell her that the word she wants is "unless," because she seemed so sweet and positive. I don't want to burst your bubble, lady. Sure, everyone can get pregnant if they just seek treatment responsibly! And there are rainbows and unicorns greeting patients in your scary parking garage. Whatev.

Anyway, I decided I like her (after another rage episode walking around the parking lot for 25 minutes trying to find her office after they changed locations FOUR DAYS before my appointment and never told me, but I am not going into that now), and I am happy that her attitude is all close monitoring and precision. Let's have something in this whole defective mess that can be measured exactly and corrected with scientific precision. Awesome. Also, I still feel lethargic a lot, so I wonder whether my current dose is too low. The other possibility is that it has nothing to do with hypothyroidism and I am just depressed, but I don't wat to see a therapist right now (I can't understand why I would be depressed. Infertility, yes, but why now? Especially when I feel like I'm addressing it better than at least I usually do), though I've been meaning to email Fr. Paul to recommend a spiritual director for a month or so. And I definitely am not adding psychiatric medication to the delightful cocktail of treatment I'm currently enjoying.

So this post was supposed to be lighthearted and informative because I was all proud of showing up to my appointment and maybe making a sliver more progress. But I sound kind of pissy, huh? Like I said, I need to work on that.

Tuesday, September 1, 2009

excitement

My phone tag with Tepeyac is at an end (for now): I have surgery scheduled for October 12 at the entirely reasonable hour of 7:30 in the morning. I guess doctors are different from lawyers, because I get UP for work at that time. My pre-op will be October 6. I have butterflies in my stomach - I feel like I just bought a ticket for the prom. Am I crazy? (Don't answer that.)

I should note that unlike AYWH, I don't have anxiety issues with surgery - I can honestly say I don't have anxiety issues at all. (Just a temper. That's so much more attractive, right?) I'm stoked that this got scheduled so fast (less than six weeks after the day I called, on the date I picked, when my husband is expected to be in the country).

I will admit to being anxious (not in the anxiety disorder sense) about one thing. The nurse told me I couldn't eat or drink for 8 hours before surgery, but nothing about the prep that AYWH did. I only have enough sick leave to do this about once in 18 months or so. I think I'm going to write Dr. L a nice letter and explain (as politely as I can - people seem to take my precision as hostility, but I HAVE to be precise!) that I have some criteria.

(1) If you're going to do exploratory surgery, fine, but you're going to do the WHOLE procedure as soon as you finish.
(2) If it requires an incision, it gets done that day. That means the polyp, the cysts, and the incisions ALL go, or no surgery.
(3) It ALL has to go. If all the adhesions can't be removed, I will reschedule for when the technology is available. I'm ambivalent about more treatments after the surgery. I'm committed to spending my thirties pain-free, surgery-free, and with normal digestion, and THAT is what has convinced me to go forward with surgery.