Thursday 22 August 2013

Compassion and Courage

As I get ready to return to my teaching job, and all its myriad rewards and challenges, the very last thing that I want to think about is "school shooters." Words cannot describe the horror that strikes my very being at the thought of a murderer in a school, taking lives and shattering precious trust and safety. I never ever want to meet such a person. I don't want anyone, loved one or acquaintance or stranger, anywhere in the universe, to ever meet such a person. I don't want anyone to be such a person. I want to build a world where nobody would ever consider walking into a school with a shotgun.  Even though we practice lockdown drills yearly, even though I've watched policemen at my school doing a drill (complete with "victims") where they take down a gunman, I shudder to even picture an actual gunman at my school, or any school. I'm pretty sure that if I ever experienced such an event, supposing I survived it, it would be the end of me as a teacher.

But when a Facebook friend brought this story to my attention, I just had to share it.

Meet Antoinette Tuff, the woman who prevented a mass school shooting yesterday.
(The video interview is well worth watching and listening to.)

Another article that shares some quotes in print from Antoinette

What blows my mind is that Antoinette Tuff showed such compassion and empathy and love to the gunman. To someone whom she knew could kill her and/or all number of other people any second. It would have been so much easier, so natural, to react with panic or anger. But the qualities that Ms. Tuff showed instead gave her a power that no gun, body armour or security system could give her.

If I have children I want them to live in a world where there are never any school shootings. I want that fear to never even enter their heads. Hell, I want that for all children, whether or not they are mine.

Sadly that isn't the world we live in. So second best, I would like my children to know that there are people like Antoinette in the world, and to know that it is truly a better place because of people like her. I would like them to try to find in themselves the courage and compassion that she shows, although I still hope they will never need to use it in the kind of situation she experienced.  I would say that I want them to know that Antoinette is a true hero, but she says herself that she is not: "I give it all to God." And that doesn't surprise me, and I respect that.

Antoinette says in her interview that she is going back to work tomorrow. People, there is hope for the world.

Monday 12 August 2013

Happy Pincussion

The latest in fertility news (dum, dum, dum.....) This time, an update from the Traditional Chinese Medicine (TCM)  side.

I saw Dr. Q for a Cycle Day 2 appointment. It wasn't planned that way, but AF decided to show up after 19 days this cycle.  I wasn't exactly surprised that I had a short cycle although I was hoping my suspicions were wrong.  After my first appointment with Dr. Q, Day 10, I used my fertility monitor and it gave me a very high number, which implied that I had already ovulated, or more likely attempted to ovulate, probably around Day 7 (the Ovacue and how it works).

Anyway, AF had rather convenient timing since we were able to plan for the rest of the cycle at this appointment. I had a treatment today, and have 3 more scheduled for this cycle: Day 6, Day 9, and Day 11.  I am getting quite used to being full of needles  and am able to relax, although I still have a fear that she will leave one in my hair. I have to shake my head out thoroughly after every appointment.

Mr. Turtle hoped to talk to Dr. Q this appointment, but she was busy and he had to run to another appointment, so she just missed him.

Obviously 19 days is far too short a cycle. On the other hand, this period arrived with practically no pain or cramps at all, and there are fewer clots, which Dr. Q considers a good thing. It is a good thing even if all it means is I am less miserable! Big clots are usually accompanied by nasty cramps and discomfort.  The colour also turned bright red faster. Other apparently good news is that I have been less cold lately.

Dr. Q said to eat an egg daily (already doing that, cause I like eggs) and to eat chicken soup a couple times a week. It is supposed to be especially good during a period.

I mentioned Dr. Cotter's stance on herbal remedies to Dr. Q. Dr. Q's response was that nothing should be taken during an IVF cycle, but since I am nowhere near having an IVF cycle scheduled, they would not do any harm. Plus all these remedies have been used for 100s of years, etc. I was curious what she would give me so I didn't object. Here's what she gave me: (cost: $22.00)

This one is 8 pills/ 2X a day for days 1-5. Interesting name, "999". 9 is my lucky number.

Lots of interesting ingredients, including, erm, poo.

Next is Day 5-14, 1 bag 2X a day.

No poo, but 2 kinds of branches.  Well, I can't remember the last time I found a medication funny, so this should be good  for stress, anyway.

I should add that since every patient is unique  in TCM, just because Dr. Q gave me this stuff doesn't mean that every other infertile would be given it.

It so happens that my MIL, also a TCM practitioner, is visiting so I ran the herbs by her and asked if there was anything I should be concerned about. She said no, they were typical herbs to reinforce basic health.  So I thought it wouldn't hurt to take them for a cycle when I'm highly unlikely to be pregnant anyway and see if there is any effect on my menstrual cycle.  

Dr. Q's next advice was about trying to reduce stress and anxiety. She said that wanting or insisting on control is a major source of stress.  I didn't think I was projecting my control freak personality from the treatment bed, but I guess.....Or maybe Dr. Q has a more than a passing familiarity with fertility patients and their demons and figured she might as well mention it. She recommended meditation and prayer as a way of letting go. Organized religion is not a part of my life and it is extremely unlikely it ever will be (that's a whole other story).  I can't say I understand much about prayer or meditation either.  But I do have activities I do to relax and/or redirect my thoughts, which I feel are as effective or more so for the kind of person I am.

Still, I think I grasp the gist of what she was saying, which was to enter into a state of mind where I can be calm and accepting of what is going on with my fertility. I am not going to get pregnant at a certain time because I want to be. I am not guaranteed to get pregnant because I take something or do something or "fix" my problem in some way. I think I've actually gone some way toward accepting that already because nobody knows any way to fix my problem anyway. The best way forward from here that I can see is to do a series of things to try to improve my reproductive health, coupled with the best that modern science can  come up with.  I am not stressing about why we are not conceiving a baby because, well, it has been explained  to me in detail why we cannot do that. I do get a little sad or grumpy sometimes, though. Some days I'm more patient and accepting than other days. But that is why we work on things.

The only thing about stress and TCM treatment that seems a little incongruous for me is that in order for this to effective I have to monitor a lot of things. Cervical mucus, period flow and colour, when I go pee, etc. etc. I am OK with that, but monitoring is one thing that tends to increase my stress. My stress level usually goes down when I ignore what my body is doing as much as possible, but then I don't have anything useful to tell to doctors. So it will be an interesting challenge to be detail-oriented without obsessing over how things might be going "wrong."

Anyway, I'm pretty optimistic about lowering stress, but the fact remains that my stress is lower with a plan, even if the plan might change. And on that topic, no word yet from The Fertility Clinic on the Fragile X test. I left a probably pointless and annoying message asking if they were still going to call me back when they have the result. Because I felt like it.  They were nice enough to phone back on Tuesday and let me know that they still do not have the results but they should have them soon. I also had a message on my phone of someone singing in an operatic voice about pirates. That is not related but it is just absurd enough to share.

Thursday 8 August 2013

Charting a Course

Today we had our 3rd meeting with Dr. Cotter at The Fertility Clinic. I think it went well.  Slowly the pieces seem to be coming together, at least in the version of the puzzle that exists in this moment in time.

We received most of the latest test results for me.
Thyroid: Normal. They detected some antibodies which mean that at some point I had a mild case of thyroiditis, but nothing looks amiss now.
Genetic tests: I am not a mosaic.  Hurrah. Didn't even know what that was until today.
We are still waiting to hear if I am a Fragile  X carrier. This is the piece of the puzzle that we need to have before setting a direction.

Prior to the meeting, Mr. Turtle and I went over the information we have so far and mapped out a plan, and wrote down questions.  Since meetings at The Fertility Clinic take weeks to schedule, and go by so quickly, I wanted to make sure that we had a  clear sense of what we wanted to communicate and what we wanted to learn. Even more importantly, as a couple we need to be working together and understand what we are getting into. This was something I committed to when we got the first diagnosis, and luckily Mr. Turtle believes in communication  and cooperation, too. One of the first blogs I ever read was CGD's Adventures in Infertility Land.  Sadly, in addition to their unsuccessful quest to have a baby, CGD and her husband also ended up divorced. Although CGD's blog is no longer available, she did share her experience on Episode 18 of Bitter Infertiles, and I think everyone who is pursuing fertility treatments should listen to it. In fact, if you haven't, go ahead and do so right now.

We also both read Chapter 3, "Planning Your Itinerary" in  Melissa Ford's book Navigating the Land of IF (another resource I highly recommend). In the chapter Mel (She of the Stirrup Queens) goes over eight factors influencing decisions about infertility:

  • Cost
  • Certainty of reaching parenthood
  • Sureness of leaving infertility
  • Possibility of a genetic link
  • Possibility of a biological link
  • Amount of control over prenatal health
  • Average speed of resolving infertility
  • importance of maternal age
Mel suggests each partner independently rank these factors and then compare notes. That is what we did. We had the same top two:
  • Certainty of reaching parenthood
  • Amount of control over prenatal health
We were slightly different for number 3; Mr. Turtle put down Possibility of a Genetic Link, and I put down Importance of  Maternal Age. But when you think about it those show similar priorities because if I am to  be genetically related, my age does matter because of the POF.

So, this is what we put together. 

Plan A
Fresh IVF cycle, our own gametes. (Assuming I do not carry Fragile X.)
We  would like to try to have a genetically related biological child.  We realize that due to the DOR/POF particularly, the odds are slanted against us. I am not going to produce  a lot of eggs and there is a chance I won't produce any. IVF is a game of diminishing returns in the best of cases, and we are not the best of cases. (If there even is such a thing as "the best case" when talking about infertiles.) However, that doesn't mean I won't produce eggs and we won't get an embryo and hopefully a pregnancy and baby. Neither of us is happy to walk away without at least trying. Fresh IVF is a gamble, and we will be sad if it doesn't work, but we can't draw a line under this option without at least giving it a try.

I will go on DHEA and Co-Enzyme Q10 for 3 months before starting the cycle. It will be Flare Protocol.  SO LONG FAREWELL to my un-medicated existence untouched by doctors with prescription pads. It was nice while it lasted. One thing's for sure, there's no cosmic reward for living your life "naturally." (What, me bitter? OK, maybe just a little.)

Reassess Plan A either: A) after one unsuccessful cycle  or B) after diagnosis of Fragile X

Plan B
IVF cycle with donor eggs
Should my own gametes be formally declared a hopeless case, then we will look at donor eggs. In Canada it is illegal to buy or sell gametes, so no paying an egg donor for her services. Doctors are also not allowed to treat anyone who is not Canadian, so no bringing a donor from another country. That means we can either A) find our own volunteer Canadian donor ("Sister, can you spare some eggs?") or B) use a donor in the USA or vitrified oocyctes from an American egg bank  ("you can buy and sell anything in the States," sez Dr. Cotter). Not sure which route we would end up taking here, but I would think the USA donor/egg bank is more likely. Plan B needs more research and is still a bit surreal, admittedly.

Because I was curious about it, I asked about how an IUI cycle with donor sperm would compare to a donor egg IVF cycle. Dr. Cotter clearly recommended donor egg IVF over IUI with donor sperm, which  she gave no more than a 5-10% chance of success, due to my dodgy ovulation. "You're at the end of your reproductive life, so it's hard to tell what your ovaries are going to do." Not one to mince words, eh.

We also asked about embryo adoption, and Dr. Cotter said, yes, there is a  list. You need to have done one cycle of IVF before being eligible for the waitlist.

Reassess Plan B when: Not sure; we'd make that decision when we get to Plan B.

Plan C
We didn't discuss this yet, but Plan C comes into place whenever we are done with unsuccessful fertility treatments, which for me, would be in 2, max 3 years. I could change my mind, of course, but I'm pretty sure I don't have it in me to do treatment after treatment, year after year. One way or another, infertility will be resolved.

We also asked Dr. Cotter for her views on naturopathy. I have started acupuncture treatments, as I previously described, and Mr. Turtle has  been seeing a lymphatic drainage specialist.  It is taking a lot of trial and error for him to find a way of reducing the edema of the scrotum, but he is optimistic about the most recent technique. Of course, we don't know if reducing the swelling will improve sperm quality, but it seems like a logical assumption and worth pursuing.  And if it only helps Mr. Turtle be more comfortable and less self-conscious, it will have been worth it.  Mr. Turtle also plans to talk to Dr. Q to see if she can suggest anything else for him.

Dr. Cotter said there is no evidence of acupuncture making any difference in achieving pregnancy, though there is some ongoing research into that. She did say that it helps fertility patients "live through what we do to them." So, acupuncture is OK.  Lifestyle or dietary modifications are also OK, "as long as it is not excessive." I asked her about herbal remedies in general (nothing specific has been proposed to me) and she was adamantly against the whole idea. She said that there is more money spent on natural remedies in the USA than on prescription drugs, and that there is no regulation or accountability in the industry. So basically, when you take a supplement, you have no idea what you are taking or what effect it will  have on you or on a fetus. She said (with some heat) that that is a completely unfair thing to do to a baby ("the effect on you will be short lived, but the child will live with it for 80 years.")

Final thoughts?
I actually left this meeting feeling fairly confident and calm. Mr. Turtle also thought it went well. The tone was overall more optimistic than the last meeting. We felt less like deer in the headlights.  Mr. Turtle observed that Dr. Cotter was using language like "when we get you pregnant" as opposed to before when she was being extremely cautious. I was very focused on  getting my questions answered and I felt that I did.

But of course we still don't have the piece about the Fragile X. I expected to  have all the info today but I guess the labs are not especially speedy and it just doesn't all come together perfectly. I would really like to commit to a plan, whatever it is. Because of the DOR/POF, I'm being told to waste no time, but on the other hand it always feels like we're waiting for something, and we can't just make a decision about what we are going to actually do.  I don't mind a few months of hormone supplements, acupuncture, and pondering the meaning of  life as long as I know we are heading somewhere.

It's funny how our goals have adjusted as a  result of IF. When we first started TTC, the goal was simple: A baby!  Achievable within about a year, with luck.

Then we learned about the MFI,  and the goal was: Do an IVF/ICSI cycle. Hopefully get pregnant, but no promises, eh.

Then we learned about the DOR/POF, and the goal is, make enough eggs! Maybe. But no promises.

Notice how "baby" seems to be getting farther and farther away. In fact I think I don't even connect this whole process to a baby a lot of the time.  I can just conceive of getting pregnant.  But baby seems to exist now in some alternate universe that's made of very different matter than what I trip over every day.

But at least, we can almost see a path forward. Ask and learn and decide and one step ahead of the other. Don't get too attached to one course though, you don't know when the wind will change or if the kraken  will eat your boat. But still. Maybe a path.

Wednesday 7 August 2013

On the way, a rainbow

As we were driving home on the Trans Canada on Monday, we were gifted with the unusual sight of a rainbow spanning the mountains:

I wanted to share this bit of unexpected beauty. A couple more views:

Shortly after noticing the rainbow, we noticed the large queue of vehicles parked on the side of the highway, as people stopped to take pictures. Usually when you see cars parked by the side of this fast-moving highway, you look for a  bear on the side of the  road. In this case however, the rainbow was the object of attraction. We joined the crowd, got the photos, and then managed continue on our way without causing any accidents, as I hope all the other sky-watchers also did. (But I could see the headline in my mind already: "Multi-car pile-up on the Trans Canada attributed to Rainbow!")

Of course the rainbow has a lot of cultural meanings, most of which have something to do with bridging heaven and earth, or gods communicating with humans. (Iris, from Greek mythology, is my personal favourite.)  I considered calling this post something heavily suggestive like "After the Storm" (there was a wicked storm prior to the rainbow's appearance) but then I realized that I have no desire to throw up rainbow-y platitudes.

But I feel very happy to have seen the rainbow. It is an unexpectedly sublime surprise, experienced while driving home on a busy highway at around 6pm. Even though the drive through Banff National Park and Bow Valley Provincial Park is stunningly beautiful on any occasion, let's face it: when you are driving on a highway at dinner time on the last day of a holiday weekend, heading home, the highway is a means to an end. You keep your foot on the gas pedal, focus on the traffic, feel tired or even grouchy, and don't usually make that much of the experience. Then suddenly there is a rainbow.  Suddenly random commuters shared the experience of observing something utterly perfect. We didn't just pass through; we held a moment in time.

I loved every second of it.

Friday 2 August 2013

First acupuncture appointment

I have about a dozen things I need to do before leaving town with Mr. Turtle this evening to drive to my parents' cabin. We can't leave any earlier than 5pm, and we need to drive at least 5 hours. And I will be driving a lot since Mr. Turtle has to work today and I don't. But then I open up the blog, and time seems to slow right down and I get this powerful urge to read and write blogs, so I will.  I don't think it's a bad thing.

I went for my first appointment with Dr. Q yesterday. (I can't think of a clever nickname for her at the moment.)  Dr.Q has a degree from China in Western Medicine and Traditional Chinese Medicine.  Her website says she is  "specialized in treating conditions related to women’s health, fertility, pain syndromes, digestive disorders and mental health."  Sounds like a good choice, yes? Dr. Q was  recommended to me by a colleague. My colleague has fibromyalgia and uses massage, and occasionally acupuncture, as part of her health management.

As an aside, here's a little snapshot into how I typically manage my health care. Back in November, I developed a chronic pain in my right shoulder and arm. I had had a stiff neck for some weeks, which was probably related, but I chose to view it as inconsequential and assumed it would go away. ("Wow-I-slept-with-my-head-the-wrong-way-again??") Then one day in class, I leaned casually over a student's desk, and ow ow ow - my back was suddenly throbbing with pain. I straightened up, made a face and complained a bit. But assumed it would go away. Well, it didn't. Sometimes it would get better, but overall it got worse. The pain would vary in location: sometimes in the middle of my back, or in my shoulder, or in my right arm or wrist. Any sort of movement (or lack of movement) could bring incapacitating pain, but fine motor movement was especially  bad. I had to give up using the mouse with my right hand and I haven't since. (I am a  lefty so it was not a difficult switch).  Anyway, this went on for about 4 months. I did finally go to a walk in clinic, and saw my doctor as well. Solutions included everything from a  prescription for physiotherapy that I didn't use, exercises to relax the muscles (which seemed to help eventually), an ergonomic assessment at work (which helped a lot), a prescription for an anti-anxiety drug (WTF?). And my colleague gave me Dr. Q's contact info. I thanked her and resolved to check out Dr. Q's website in January. By the time I actually phoned, it was July. Right.

I'm not proactive about seeking health care. Maybe I just don't like doctors that much. I don't enter into trusting relationships easily.

My experience with Dr. Q did get me thinking a little bit about how the appointment with her was quite different from my other limited experiences with  health care  professionals. Before the appointment I filled out a detailed questionnaire which we went through point by point. We must have talked for half an hour. Dr. Q asked many additional  questions and scribbled notes on the form as we went. She noticed my picked-off cuticles and told me if I didn't stop doing that, my nails would thicken. (Thanks, I'll make another attempt to kick the habit.) She took my pulse (no comment.) Looked at my tongue and told me (accurately) about my poo. Mainly we focused on fertility, though I had not mentioned it specifically before making the appointment.

The conclusions:

  • My cycles are too short (yup)
  • I am likely not ovulating in some cycles even though I am getting a period (I am inclined to agree)
  • When I do ovulate, I am probably not producing a quality egg because it is happening too early (makes sense)
  • My period flow is light and therefore my uterine lining is probably too thin (ultrasound showed it was OK, but who knows)
  • One ovary may be working fine, the other may not be (interestingly, ultrasound showed follicles (4) on only one ovary)
  • Many women with wonky ovaries have acne issues (Testify!)
  • My Kidneys and Spleen are weak (note that the terms for body parts mean something different in TCM than they do in Western medicine)
  • In conclusion,  I definitely have some problems. Although they do not seem to be very very bad.
Dr. Q said she would work with me to lengthen my cycles  to 27-28 days, and thicken the uterine lining. It is important to see her on certain days of the cycle. Since I didn't time this appointment with my cycle (wasn't possible) she seemed a bit concerned about being able to work successfully with this cycle. Me too but I appreciate that she was really thinking about it and seemed to care.  We then did a treatment. I had a forest of needles in me: head, face, belly (lots!) legs and feet and hands. It was very relaxing although I was hoping she had counted them all so she didn't forget any in there, especially the ones in my hair. Dr. Q  warned me I would feel tired afterwards and boy did I ever. I felt like the Earth's gravity must have substantially increased during my appointment.

I have another appointment for CD 15 and we'll see where it goes. She will also discuss some herbs with me at that time. Should be good timing because we go back to The Fertility Clinic next Thursday to go over the latest test results and discuss (I hope) a direction.

What do I think? I felt like the assessment was a lot more thorough than what I'm used to getting from Western doctors. I started with a new doctor about this time last summer (Dr. Gnomish, who is also Mr. Turtle's doctor). On our first appointment, Dr. Gnomish asked if I had any health conditions, was on any prescription drugs, or if I smoked. The answer being no to all of the above, we were pretty much done. Dr. Gnomish was impressed. "Most people have a string of health conditions and a list of prescriptions as long as my arm." A few weeks later I came in for a physical. Did all the usual stuff, was assured none of my moles looked cancerous, and was sent on my way. Now I'm not saying Dr. Gnomish did anything wrong.  But my experience with him, and doctors in general is this: If I am not sick and I don't need drugs, well, they have no further business with me.  I always seem to be in and out the door in record time.

Again, I'm not trying to blame anybody, but it does seem to me that this attitude is not conducive to understanding fertility. In hindsight, although we've only been TTC for two years, I've always known in the back of my mind that there might be something "off." The acne. The irregular cycles. The fact that I had regular spells of unexplained nausea as a teenager, which I suspect were related to hormones. (It is not so severe anymore, but I still get mild nausea one or two times in second half of my cycle.)  But the symptoms never made me sick, in the incapacitating sense.

So I suppose the main difference I felt in Dr. Q's office was that she was willing to take time with me, to listen and ask questions, to question my assumptions, and to make time for treatment, rather than sending me out the door with a prescription and the unspoken conclusion that seriously, I am a pretty boring patient.

How all of this will fit together with The Fertility Clinic I am not sure yet, but I'm glad I'm giving it a try.