Hysteroscopy II

Last night before going to bed I reread the post about my first hysteroscopy and it made me feel better to remember that it's not a big deal procedure with minimal recovery. 

Our new clinic is very different than the old one as we discovered with my husband's surgery. Since the new clinic is part of a hospital, all OR procedures happen there. When I went in this morning, I was scheduled between a bone operation and a kidney surgery. 

Things were very different than the first procedure. It was very busy in pre-op. They took my vitals at least six times. They separated us until my IV was in. We waited for nearly two hours before being walked back. I saw at least 9 nurses throughout the day saying they're the ones going to take care of me. Contrary to old clinic where they have a cubby for your stuff and you go back to the same room after surgery, in the new clinic each part was a different location. I was told I should give anything valuable to my husband for safekeeping. This included my glasses. I was VERY uncomfortable giving up my glasses before needed since I cannot see without them, but I couldn't risk them getting damaged or lost for that very reason. 

Forty five min after my scheduled time, I gave up my glasses, said goodbye to my husband and walked semi-blindly with the nurse to the OR. They got me set up, hooked up a bunch of things, and started medication. As we waited for the doctor to come the nurses complimented my eyebrows and we had a whole conversation about the benefits of threading. The doctor came and everyone was ready to start but we had to wait for the anesthesiologist to come before the nurse could administer the dose that would put me to sleep. At that point my doctor complimented my eyelashes and everyone chuckled since she clearly missed the threading conversation. I joked with them to keep the compliments coming; the oxygen mask covering my face made talking difficult and my eyelids were getting heavy. 

The anesthesiology doc finally showed up and the nurse gave me the heads up that they're about to start. I felt a cold sensation in my IV arm and I was out. The next thing I knew they were trying to roll me onto a gurney but my body was totally dead weight. I fell asleep again and woke up in recovery sobbing, hearing someone telling me to take deep breaths. I don't even know why I was crying - relief? Pain? Drugs? Who knows. I feel like this is a common theme with me waking up from surgery. 

The doctor was telling me something ".... and we'll go over your results." By the time I opened my eyes again I wasn't sure how much time had passed but my doctor was gone. They told me they need a few more blood pressure readings before I can go to the next stage of recovery where my husband will get called. They gave me water and ginger ale and crackers and said I have to be able to go to the bathroom before they can take me to the next stage.  I sipped my water down and asked for another. I took a few swigs of the ginger ale. The crackers were ignored. 

At one point I was still disoriented and the nurse pulled the curtains back and said something like "....I'm just going to check..." - lifted my robe and peeked into my mesh undies. First of all, when did I acquire said mesh undies. And second, I know that while I was out they could do literally anything, but dude I'm awake and I'm right here!!!  I was still out of it enough not to make a stink about it but still. They likely do this every day; they're just doing their job; but a little courtesy and warning goes a long way. 

About 50 min after arriving at post op they asked if I was ready for the bathroom. We walked over and I did my business and as a reward I was allowed to level up to the next stage. They called my husband over. The nurse was about to give me something for the nausea but I declined -- I'd rather a day of nausea than a week of constipation, tyvm. Also, thanks for asking and giving me a choice rather than just shoving it in my IV. I already liked her better. I was about to get dressed when I asked if I was going to see my doctor. Apparently I had asked for her twice already and she was being paged. She called the nurses station and I walked over to talk on the phone. She said we'll talk at the post-op, remember? I said I had no memory of this but thanked her and hung up. Clearly I was not lucid when that conversation took place. 

They took out my IV, I got dressed, and they wheeled me out. I asked if I could walk and they said it's policy. Being in the chair made me so nauseous and I really preferred to walk, but I also knew that if I argued it would delay going home and that was my ultimate goal. 

I got home starving. It was nearly 3 pm and all I'd had was water and a little ginger ale since 6 pm last night. I had my prepared healthy lunch of roasted sweet potatoes, hard boiled eggs, and whipped cottage. I was no longer hungry but I was very dissatisfied. I had an intense need for cake. I. NEED. CAKE. I took to the freezer and found some ice cream. I also found some cheese curls hidden in one of the drawers. I had both and was still not happy. 

I paged my world and asked them to bring cake. One person brought babka; another brought an apple crumble. While it was greatly appreciated that people answered the call, they didn't bring the right cake. The babka was store bought and gross; and I don't like baked fruit. I couldn't direct them because I didn't even know what I wanted. I couldn't tell them they brought bad cake because even in my insanity I still felt protective of their feelings. My mom offered to make sponge cake. I declined, not wanting her to bother. I decided I need chocolate chip cookies and made a batch. They were heaven. I planned on eating the entire batch but I was satisfied and full after two cookies. They really hit the spot. 

At this point it's been over five hours since I woke up from the procedure. Cramping has subsided significantly. There's more bleeding than last time but I don't know what that means, if anything. Hopefully it will go away in time for mikva. Sex is allowed as soon as bleeding stops but that's not my concern right now. Even though cramping has gotten better and I'm not in physical pain, I'm really tired and feeling light headed. They did general anesthesia, not the twilight stuff I'm used to. I'm also really annoyed. Really, really annoyed. I don't know why, but I'm just mad at the world. I've limited visitors because I can't be trusted not to snap at someone or say something I might regret. My filter went for a hike and I don't know if it's coming back today. 

Shabbat food was already made last night so we're prepared; all I need to do is light. Going to shower, light, eat, and sleep for 15 hours. Shabbat shalom. Love and peace to all. 

Food

I'm down six lbs from my heaviest April weight. That's still 3 more than my pre-transfer weight in February. When I reach 10 lbs down I'm thinking of maybe buying a new purse - I have my eye on a MK knock-off. After that my new goal will be the next 10 lbs.

We've been eating better lately than we have in a while. Home cooked healthy meals every day. It's been a lifesaver to plan the week in advance, including breakfast, lunch, and dinners. It takes the edge off thinking and if the groceries are already in the house it makes it that much easier. Since they're all fresh ingredients I have to make sure to use them up quickly before they go bad.

When I don't eat sugar my appetite is very steady and I don't have those insatiable munchies. I miss cereal but I'm never hungry. So much so that sometimes I'll feel fine enough to delay eating to the point of feeling light headed. Then I remember that I can't do that and go eat my prepared snack. Still learning. Also still waiting for the RD to call me. I followed up today.

My research online told me that oatmeal, cinnamon, and apple cider vinegar are good for lowering sugar. I still don't know what lowers insulin but apparently a low sugar diet is a good start. So now I'm eating oatmeal with cinnamon for some breakfasts. I'm still figuring out how to use acv.

I found someone selling dehydrated fruit and vegetables and in a moment of weakness I placed an order for $30 worth of snacks. There's no added sugar, salt, or preservatives, plus the produce is all organic so I figured it's a good snack to include. I'm excited for the zucchini chips.

Making the wait count

Things have fully transitioned to summer mode around here and the change has been nice. Things are slower at work, the weather is finally hot, and it seems like we're on our way to getting our summer projects started.

I'm still learning about insulin. I don't understand how my fasting and 2hr glucose are both well under the limits but my fasting/2hr insulin is high. I think I broke Google trying to come up with an answer because it doesn't seem to know. Beside that there are conflicting opinions about what to eat. Some say to strictly limit all forms of sugar while other opinions say that fruits are fine. Cutting out fruit entirely would be really hard for me so I'm not doing that yet. I have a call in to the Registered Dietician and in the meantime I'm working on cutting out white flour and refined sugar. I think that if I try to change too much too quickly then it will backfire so I'm focusing on small steps to help the changes stick.

This week's changes are to include at least 30 min of activity most days. That's up from 0-2 per week ever since the March loss. I'm also back to counting calories and, while not cutting it out entirely, limiting white flour and sugar. I found some recipes from an Instagram blogger that I'm excited to try. One is a lemon-garlic chicken and the other is a zoodles salad recipe. Very diet friendly and they both sound delicious.

The biggest challenges are going to be planning ahead and avoiding cereal. Planning ahead is crucial to having healthy food already in the house so that we don't resort to take-out which has been a major go-to in the past few months. Cereal is my food drug of choice in all forms and flavors. I can easily inhale two bowls for a snack, or instead of any meal of the day. It's not only a lot of processed sugar but there's also barely any nutritional value and it's a waste of calories. I'm not going to attempt to go cold turkey but it will have to be eaten sporadically and within small controlled portions.

In treatment news I'm getting ready for the hysteroscopy scheduled for the end of the month. I'm still on bcp so I can schedule my period around when it needs to be. The tricky part is with regard to mikvah since the procedure needs to be on a certain day of the cycle and will likely cause spotting. Hopefully the procedure will go smoothly with limited recovery which won't delay anything. After that I get a two week break while they get the results over to the RPL specialist and we all wait for the start of my next cycle.

If all looks good, we'll start an unmedicated ERA in that cycle. I've done two already but they were both with the medicated FET protocol. Per the medicated ERA results I need an extra day of progesterone for my lining to be receptive. The RPL specialist wants to see if I still need that extra day if I'm not on any meds. Obviously we don't want to miss the window if I do an unmedicated FET with an actual embryo, so we can't use data from a medicated ERA. I understand the reasoning, I just hate the idea of another uncomfortable biopsy.

I'm trying not to "bird view" the summer because thinking of all the things ahead makes me anxious, but it's helpful to think that if all goes well with the hysteroscopy and ERA then the next step is a retrieval. That finally feels like progress. It's also the biggest hurdle before a transfer, since we have nothing to transfer now. So while things are slowly moving forward, there are still a lot of steps to happen between now and a potential pregnancy.

In the meantime we're working on taking one day at a time. We also added a new project: enjoy the wait. The time will pass regardless of whether we're anxious or not, so we may as well do things that make us happy in the meantime. There's a time to be sad and anxious and worried, but it's not all the time. It's a gift to wake up every day and our time shouldn't be wasted harping on things we can't control. We'll work toward what we want and we'll put in everything we can in to it. But at some point it becomes up to Him and our job is to just wait. So why not enjoy the wait. It's easier some days than others but it's a mitzvah to be happy and it's worth the effort to prevent becoming depressed and bitter. We don't have money or PTO to do lavish trips around the globe but we can do outings and things on a smaller scale. Yesterday we went to see The Incredibles 2 (3D) and it was fun. Highly recommend.

Insulin

I got a call from the nurse at the RPL specialist's office to go over the results from the bloodwork I took last week.  They tested for a bunch of stuff (9 vials of blood) and almost everything came back fine, including glucose, except insulin. She went over the numbers - they like seeing the 2 hr insulin under 40 and mine was just under 60.  In my mind that's not atrocious but I really don't know anything about it. Apparently high insulin levels are toxic to a developing fetus. She offered two solutions: lifestyle change or medication.

Lifestyle change:

• Low-carb, low-sugar, high vegetable diet. Lean meats. Whole grains. Limited fruit. 
• Exercise at least 30 min a day (if not there yet, work on getting there)
• Lose weight

I think if I do the first two, weight loss is inevitable. 

Medication: 

• Metformin

Now I understand message boards full of ladies talking about PCOS and pre-diabetes taking metformin and suddenly having successful pregnancies. It's not only to control sugar but it also takes care of insulin as a happy side effect without anyone actually realizing. Another simple blood test they can take at the beginning of fertility treatment to get information before waiting for a loss to occur. 

I asked the nurse if I was pre-diabetic and the answer wasn't clear. I understood her answer to say that I'm pre-pre-diabetic. In other words, if left untreated and things continue to deteriorate then I may become pre-diabetic and then eventually develop diabetes. 

I opted to try the lifestyle change first. I'd much rather eat healthier and exercise (something I should be doing anyway) rather than take more medication that comes with its own slew of side effects. I also want to address the issue instead of putting a bandaid on it. I always knew I could do better with diet and exercise but it's disturbing to hear that a blood test confirmed I'm failing at taking care of myself. Maybe it's not what the results say but that's what it feels like. 

Google isn't helping at all. Results all link insulin issues with high glucose and pcos but I don't have either issue. For the record, I also never drink anything nearly remotely similar to the vile drink they gave me so how accurate is that test anyway. I eat plenty of crap and I know that's a defensive excuse, but it still feels counterproductive. They should have me bring a regular breakfast that I'd normally eat.

I may contact a nutritionist for some clarification. I'm not planning to "cheat" but I want to understand what happens when I'm not on top of my food 100% of the time. Such as, if I go on an appropriate diet and then go out for a celebration dinner - will that kill a developing fetus? If I eat well, exercise, and possibly lose weight but my insulin levels still test high would that mean I still have to continue that diet AND go on metformin? 

The nurse said they generally don't retest but I requested having another test in a few months, before we do a transfer. Just so that we know. I think it's important to have all the information before risking an embryo. 

So... more things to make this summer interesting. Egg white omelettes, here I come. 

Appreciation and Connection

There are parts of human nature that are similar across all people regardless of color, race, culture, background, or socioeconomic status. I say this authoritatively as an expert in nothing based only on my own experiences. As social beings, people need to feel heard, recognized, and appreciated. Some need more than others, and some deserve more than others.

This came up recently during a work event. My team was tagged on fb and we received accolades for a job well done on a recent event. I didn't expect the recognition and certainly didn't feel like I deserved it for doing my job, but it was nice to be recognized. A coworker from another department who assisted with this project felt resentful and hurt that she received no public recognition. As part of her job, she probably spent about 30% of her time on this project compared to 100% of the time my team spent on it. My initial reaction was to be irked this person complained about not being thanked but I tried keeping an open mind and putting myself in that situation to see how I would feel if I was left out and felt unappreciated.

I think it's important to show appreciation and I also believe that kindness goes a long way. The world is a better place when things aren't tit-for-tat, where kindness flows freely and expectations aren't self-centered. In her mind she was owed just as much acknowledgment as we were and those needs weren't met. It may or may not be a distorted view or reality but it was her truth and her feelings were hurt.

In a world where people like Kate Spade and Anthony Bourdain are suffering silently to the point that their families are shocked and confused at their sudden passing, there needs to be more kindness and less judgement. More reaching out to people, more listening, more taking out time to connect with people, more compassion. More asking people "How are you?" and being genuinely interested in the answer instead of using that phrase as a passive greeting.

When people stop caring so much about themselves and start caring about others then everyone wins. I'll try to remember that next time instead of being annoyed at someone's need for recognition.

One at a time

Patience isn't one of my strong suits. I work hard to suppress this personality trait in my every day life: when talking to people and they have boring stories I'm not interested in hearing; when dealing with slow clients on the phone; when coworkers come for a chat I'm not in the mood for; when people have solvable problems they're whining about; the list goes on. There are times my impatience wins but for the most part I'm able to function in society like a regularly patient person.

It's been difficult to keep my frustration at bay with how long everything takes in fertility treatment. I was frustrated when we needed to see the urology specialist who scheduled us for May but ended up having a cancellation in March. I was further frustrated when we discovered we'd need to do surgery which would delay any IVFs for three months, and then even more frustrated when the first available opening was at the end of May even though we were seen in March. I almost lost my marbles when I found out we'd have to  wait to see the RPL specialist in October but then it worked out that we were able to go sooner and got an appointment in May. That was nearly a miracle. And now I'm realizing how stressful May ended up being.

It doesn't end there. The RPL specialist wants me to repeat the hysteroscopy because the images sent from old clinic didn't have what he's looking for. I'm not thrilled about another surgery. I'm really unhappy about it, actually. But beside the fact that it needs to get scheduled around a period, they also need to do some work to figure out what the stain test is because it's not standard protocol. So I was able to schedule it only based on next month's estimated period, not this month. This pushes back everything else.

In addition to all the waiting, the RPL specialist recommended repeated the ERA, this time unmedicated. I'm really not thrilled about another unpleasant biopsy, especially since I already did this twice at $800 a pop out of pocket. Unmedicated means no FET drugs or birth control. He wants us to go straight from that to a retrieval cycle. The reasoning behind that is to take advantage of the cycle of not suppressing the ovaries with bc pills and possibly needing less medication to stimulate. From there he wants to go straight into an unmedicated FET in the third month. All this needs to be timed so that the retrieval month falls out after the necessary recovery period of the varicocele repair.

Looking at it all at once is very overwhelming. I'm seeing a very frustrating summer ahead and I get annoyed and upset and frustrated at everything that needs to happen, at just the right time, for us to even start thinking about a possible retrieval or transfer. All things considered, we're know we're so lucky we were able to get in to see the RPL specialist sooner rather than later for obvious reasons. But this is rough. It's really rough to just wait. It's really tough to see my friends starting to think about bar and bat mitzvah celebrations for their preteens. We're not even any closer to having an infant.

In the grand scheme of things it's only a few weeks. I know that logically and most of the time I'm ok with it. I've been able to shove down most of my frustration and impatience under the guise of "doing something" with these appointments. But every so often something pops up and I get reminded of how frustrating it all is. I'm upset today because the hysteroscopy was scheduled for end of June instead of next week. But the reality is that a few weeks don't make that big of a difference. I'm thinking of it compounding and if everything takes "just a few weeks" then it builds up to months and months of waiting.

I know I can't think like that. I just won't survive. My blood would boil in anger at the injustice and then they'll delay things even more to treat my sky rocketing blood pressure caused by all the impatience and frustration.

My husband made me feel better by saying we should just take it one day at a time. I can't think of a better way to tackle this. We really have no other choice. Every other year the summer seems to fly by. So maybe if I focus on one day at a time it won't seem so long. While I can't help but be impatient, I can try to incorporate fun summer aspects sprinkled throughout to help it go by faster.

When thinking about the difficult aspects of infertility, there are a lot. The first ones that come to mind are the devastating negative betas, or the traumatizing miscarriages, or the emotional roller coasters during stim days and embryo development. I'd rank these waiting days among the top five as well. Waiting for each procedure, each test, each surgery, each appointment one at a time with weeks in between trying not to scream in frustration while attempting to go about your daily life as though this is normal is pretty mind boggling.

So I had a cry. I got some hugs from people I love. I got in a good laugh and made some food for Shabbat. And now we just wait #oneatatime.

Latest happenings

It's been busy at work and I haven't had much time to think or process. Now that things are slowing down for the season, I wanted to update on what's been happening.

On Sunday I took advantage of my lab being open and knocked out the glucose/insulin test that the specialist recommended. It's a smallish lab -- only about 20 seats in the waiting room -- and they're only open until 11 am, so knowing I had at least a 2 hr wait, I had to make sure to be there early. I thought it would be a slow day, but the place was hopping the entire time I was there. I signed in and it took almost 30 min before they got me checked in and did the first blood draw. Then I had the gross drink and waited an hour for the second blood draw. At the two hour mark they took final blood. While I was waiting I was totally a backseat driver in the waiting room: telling people where to check in, showing them where they are in the queue on the screen, getting someone who had stepped out for a cig that it was their turn. At one point I overheard a clueless guy tell the receptionist that his doctor at [old clinic] didn't give him a lap slip so I helpfully suggested emailing his nurse. I was helpful all over the place. I hope results come back soon and that they're all normal. In the meantime have a beautiful purple-yellow bruise to remember my time there.

After bloodwork I went to get my nails done - it's been a while and I had a work event the next day. I went with a pale pink on my hands (business) and smokey red on toes (party).

I also had my follow up appointment with my endocrinologist. My TSH has finally reached normal levels: 1.24. Hooray!  That means I don't have to keep coming back every 4-6 weeks to check levels. Now we're at 6 months checkups. She got the latest about what's happening fertility-wise and told me to keep her posted if my RE takes any labs that include thyroid, and when the next transfer is in case I get pregnant and the meds need to be adjusted as well.

I sent over the images from my hysteroscopy to the specialist and he said he couldn't see what he needed and recommended a repeat. So I need to schedule that for sometime in the next few days.

A few weeks ago I noticed a new trick my body likes to do which is make my heart race. At one point it scared me so much I went to urgent care and they got an EKG. My heart was beating at 100 bpm and my blood pressure was elevated but other than that they couldn't see anything wrong. EKG came back normal. Physical came back normal. I wasn't out of breath and didn't have pain anywhere. It was the Friday before a 3 day yom tov and right before my husband's surgery so they diagnosed it as anxiety. Maybe it was. It hasn't gotten as bad since but I have noticed the racing every so often, weirdly when I'm at rest. It never lasts more than a min or two and then I forget about it. I take my pulse often now to see where it's at, which is usually somewhere in the 70s. Every so often I'll feel it go back hovering around the 90s when I'm at rest. At urgent care they said as long as it doesn't go above 100 or 110 then it's not a big deal, especially since they couldn't find anything wrong. I mentioned it to the endocrinologist who said that it's not a side effect of the thyroid meds or any of the meds I'm taking. But she did say to look out for shortness of breath combined with leg pain, which is a sign of the bc pills causing clots, and (rarely) causing clots in the lungs which makes getting oxygen to the heart an issue. She did say that if it persists or episodes get longer that I should go back to the cardiologist. Maybe I'll do that anyway. I don't want to keep being the kid who calls wolf but I'd rather look dumb than have an issue, especially with a potential pregnancy on the line.

My husband sent me a picture of a bug he found in the kitchen and I panicked and called the exterminator for a full workup against roaches, mice, and all pests.  I googled roaches and the internet said if there's one there's likely hundreds more. Ewww. The guy took a look at the bug and said it was a beetle, not a roach. He searched the house and found not much more than a few spiders in the basement and couple of ants outside.

The weather has been unseasonably frustrating with lots of fog, rain, and humidity. There are mild patches of sun when we remember that oh yeah it's summer. At some point our roof started leaking. We called the roofer and got an estimate for a repair ($800) or replacement ($8000). So far we're putting out bowls when it rains and hoping that before we need to make a decision it will either repair itself or get so bad that insurance needs to get involved.

Another summer project I want to take care of, other than ttc, is decluttering. Every year I say I want to go minimal and I think this year I want to make it real. There are drawers of stuff that we don't need; closets of stuff we're storing and never look at; a storage area full of things we never touch. Why should they collect dust, and apparently spiders, when someone else can make use of it? If we don't use it on a regular basis, or at all, it needs to go. If I only manage to make a small dent in what needs to be gotten rid of, it's still a win. The ultimate goal is to feel like if we were to move tomorrow, I'd have nothing that I need to throw out. I'm still unsure what to do about thinks I know I'll never use again but am unsure about giving away, like my wedding dress. I guess I can start with the non-sentimental stuff and work from there.

Summer is upon us and I want to take advantage of the longer daylight hours. I want to get into a routine that includes better workout schedule and better food planning. I know it's just a matter of starting and I'm mentally motivated but need to get my butt in gear. My husband is on board to join in so that can be a big help if we do it together. Let's start with 10 lbs. I decided I'd get myself a present at the end of the summer if I'm successful. Maybe a bosch mixer or a new hairstyle.

Our 11 year anniversary is coming up. My husband's birthday is also coming up. This past week we sponsored kiddush in memory of our grandmothers, who happened to have the same birthday and died within a year of each other.

Happy summer :)