Saturday, May 19, 2018

Developing Thirst

Inspired by Thirst Aid Kit --  for your thirsting needs -- and a conversation with one of the nurses while I was on night shift.

thirst (Google definition)
TH…ôrst/
noun 1a feeling of needing or wanting to drink something.

  1. "they quenched their thirst with spring water"

thirsty (Urban Dictionary definition )
when you are horny for some ass
         "I always get thirsty looking at your fine ass"

I remember the exact moment I realized it was okay to find White Men attractive.  It was Sophomore year and I was in my High School Latin room after school. --  I spent a surprising amount of time after school in my Latin classroom, and that probably says something about me. -- I was one of the last people in the classroom after either a Certamen practice (Latin Quiz Team, don't judge me) or club meeting.  I had recently seen "A River Runs Through It," and I was trying to describe Brad Pitt.  Obviously he was a wonderful actor, but there was something else.  I remember as I was leaving the classroom and thought "Oh my God, Brad Pitt is Hot."  Immediately followed by "Am I allowed to think this?"



As a Black Girl growing up I understood from TV, movies and family who was attractive.  I was lucky to grow up in the 90's when there was a bevy of attractive men of color in the media.  Everyone could agree that Denzel Washington was attractive. Wesley Snipes was also shown to be particularly desirable.  Though honestly I probably got most of my thirst pallet from sitcoms, especially "A Different World" and "Living Single."





The witty banter between Max and Kyle, along with his stunning afrocentric fashion sense, made him clearly attractive.  The "Dufus turned cool" manner of Dwayne Wayne along with his devotion to his love interests taught me that brains and passion could be found in a single person.  (For more check out this compilation). Ron Johnson was always smooth and cute.  Shazza was just unreasonably large and attractive; although his personality sometimes left much to be desired.  Showing that just because they look good, doesn't mean they are good.  I was pretty clear on all kinds of brown being reasonable thirst objects.  My first really memorable crush (outside of elementary school) was on an Indian kid in my Latin Class.  It was a long lasting crush even when he switched schools.  This may be because I was also often the only Black American in my classes and there were not a ton of guys of color in my classes either.  Though my mother insisted that many of my guy friends (I had way more guy friends in high school than girl friends) had crushes on me, they were all White and therefore off limits. . . Right? 


 



Maybe it was the fact that Brad Pitt's character in "A River Runs Through It" has a love interest who is a woman of color.  Maybe it was the fact that this is the beginning of peak Brad Pitt acting and attractiveness.  But something at that point clicked and I realized that White Guys could be hot too.  Later watching movies like "Corrina, Corrina," I had an example of a White (ish - for a long time I thought Ray Liotta was some kind of brown) man who could find a Black Woman attractive as well.

-- Can a take a moment to note that we don't get another major movie example of this until "Something New" 12 years later.   Something New came out the same year as "Broke Back Mountain."  But the plot with a White Man and a Black Woman is called "Something New."  But I digress --

Possibly much to my guy friends' dismay I didn't find any of them particularly hot.  --Really what high school student is?-- However, I was able to start looking at all people through new eyes.  I started to think it was possible that some of my guy friends could theoretically be attracted to me. Also that it would not be the end of the world if I ended up with someone who was not Brown.  I was still shocked when riding home from church one day my father went into a lecture about "If you decide to marry a white man" completely unprompted by any of my actions.   The realization that I was "allowed" to fancy who ever I found attractive, also helped when I realized, a short time later, that I found some women attractive.



We are enculturated to believe certain things are expected of us romantically.  Through many conversations I realized not everyone has examined the origin of their thirst or questioned it.  Junior year of college I went on "Alternative Spring Break" building trail in the cumberland gap.  One night we had an in depth conversation and one of the White Guys on the trip was horrified to realize that the could not find Black Women attractive.  He was distressed to find out he was that programed. One colleague in medical school was attracted to Black Women, but married an Asian Woman instead because that is what his family expected.   I recently had a conversation with a Black woman who stated she could not find white men attractive nor even light brown men of any race.  When we pressed her on how she could find her nephew cute (who was light brown) but not other men she avoided the question. 

My general "type" is nerds/geeks of all races and genders.  I'm more of a 2-3 on a Kinsey scale and lean a little more toward masculine than feminine.  I'm excited that we are moving to a time when media is more than a parade of similar looking White Men and people of all colors and cultures are starting to be portrayed as attractive.  Every person deserves to feel people like them are attractive and have the option to find people who don't look like them attractive as well.

Thursday, May 10, 2018

Don't Wish Me Happy Mother's Day.

Warning: This talks about loss and infinity wars.

Mother's Day after a miscarriage is hard.  There are plenty of other websites and blogs about this.  Every person who has experienced a miscarriage feels it differently.  Some would actually like the acknowledgement of the loss in some way.  According to an informal pool on one of the TCC apps I put up when I realized Mother's Day was coming, about 57% of people who have had a miscarriage are dreading mothers day.  Only 8% are looking forward to it and the rest are just trying to ignore it.  The thing about miscarriage, just like any loss, there is no straight line through grief.  I have often wished that the stages of grief were linear and simple to go through


The reality is that it is not linear but convoluted going back and forth with being okay one minute the next wanting to cry when you se a mom with a baby in target.   It's like ripples on a pond. There is still water between the swells. Some you can prepare for like a co-worker's baby shower.  Others you can not like "Infinity War."


  SPOILER ALERT -- 
MCU - AVENGERS, INFINITY WAR 
-- SPOILER ALERT 


Tony Stark at the end of "Infinity War" has the same feelings as a woman who has gone through a miscarriage.  He realizes he would like a kid at the beginning at the movie; all of a sudden he realizes he is now responsible for this new young being.  Just as he is getting used to his role, the child literally turns to dust in his arms.  He is left empty wondering what he could have done to change that fate.  That is exactly what a miscarriage feels like.  Watching that scene was strangely cathartic.

SPOILERS OVER


Every person who has had a miscarriage experiences this differently but for me please don't wish me "Happy Mothers Day."    For me it will just bring up my loss and cause more ripples and possibly tears. Here are things I will accept -

  • Extra Random Hugs
  • Good Wishes via text, phone, Facebook, Twitter, or Marco Polo
  • Fertility Gifts - One of my colleagues made me a bracelet,  and it was an amazingly touching gift. 
  • Random gifts that make you think of me (if you already have them and just haven't sent them, or were thinking of sending me something anyway)


This is just for me and maybe 57% of people who have experienced a miscarriage.  There are some who like to hear they are a mother.  If you know someone else who had a miscarriage just ask.  "What can I do to make this Sunday better for you."

Tuesday, April 03, 2018

GAD-ing

My instinct is to make a joke about how this will not be about Gilderoy Lockheart's best-seller Gadding with Ghouls, but I realize not everyone would get this obscure harry potter reference so. . .

The DSM-5 defines Generalized Anxiety Disorder as :

  1. Excessive worry about a variety of events for at least 6 months
  2. Worry that difficult to control
  3. The worry is associated with at least three of these symptoms: restlessness, easy fatigue, difficultly concentrating, irritability, muscle tension, or sleep disturbance.  (only one symptom needed for kids)
  4. The anxiety causes significant distres or impairment in functioning socially or with work
  5. You can not attribute the worry to the effects to a medical condition (like hyperthyroid) or drugs (Cocaine)
I've had GAD since I was about 5 or 6 yrs old.  I remember staying in the bath tub until the water was cold and I was shivering because I was afraid that ALF - yes that ALF - was going to eat me.  I loved muppets but for some reason Alf always wanting to eat the cat made me worried that he would one day turn his taste to children.  My older siblings would chase me around the house saying "Pac-Man" making alligator type arms to demonstrate how large Pac-man would be if he was out of the screen, and how he would probably eat me if he could.  




Between the ages of 7-9, I started realizing how scary the world was.  I realized that at anytime I could die.  I had a lot of deaths in my early life; so I thought about it quite a bit.  I would worry every day my father drove me to school that we would get into an accident and die. I worried when I was carrying scissors from room to another that I would trip and they would go into my eye and I would die.  I worried that The sharp edge of the TV tray that was often up in the family room would be sharp enough that I could fall and it would impale me.  I worried walking home from school to my grandmother's house that I could be hit by a car or abducted.  Those were the big fears.  There were always the smaller fears of failing a test, disappointing my parents or family, or generally not doing something correctly.  

Some of this can be explained by being born into my  amazing family. Three generations of Graduate school graduates (on both sides) and over a dozen Doctors (MD &PHD) is a lot to live up to.  The fact that my elementary school was in inner city Cincinnati in Walnut Hills, which used to be an upperclass black neighborhood and in the 80's had seen better days, could account for some of my neighborhood fears.  Even a  8-year-old knows car accidents are common.   However all of these factors don't explain why these thoughts kept me up at night and a fairly stressed child.  It also lead to a slight break down in 7th grade.  

For each class, in 7th grade, I would change my attitude and personality to be what I thought the other students and teacher expected of me.  The only ones which were similar were Latin and English.  All of the changing and trying to live up to expectations took its toll.  Around the end of first quarter I had a breakdown while working with my best friend Anjali on a Latin project in the library after school one day.  I don't remember what quite set it off; it may have been a minor argument.  I do remember putting a book on the shelf, saying good bye, walking down a hall, riding the bus home, and being in my basement.  I have no memory of anything in-between, but I have a clear feeling of being outside of my body.  That disassociation was way more scary than disappointing some teachers or classmates.  After a few hours of crying in my basement and another month of school I was finally myself for all classes. 

My coping mechanism, that I figured out around age 10, was to figure out what the worse case scenario  for each situation and prepare myself for it.  As long as I was prepared for the worse then I could deal with everything else.  What if I'm a disappointment and dishonor my family?  Just work harder and do something original (like going to peace corps) so they have to keep you.  What if I don't pass my medical boards?  Study harder, take some time off and do them again in 3 months.  Make sure I have money saved or work arrangements so I can support myself.  But this drives me to study harder now.  What if I get pregnant but there is a chromosomal anomaly like Trisomy 21, 18, or 13 where my child could not have a complete life?  We get genetic testing at 10 weeks so if I have to terminate it will be early and do all of the other things I can possibly do to have a healthy pregnancy.  This has led me to saying things to my husband such as "So if you are going to leave me, please do it now so I can recover enough for: medical boards, residency interviews, Medicine Senior rotation, etc."

The other part of my early coping mechanism was likelihood.  I could be impaled by the corner of the TV tray, but how likely is it?     My computer could explode sending shards of glass into my heart and causing me to bleed out right now.  However, it is not likely.  I could be sued tomorrow for a mistake I made medically as a first year resident, causing me to never be able to practice medicine again and the government take all of my belongings because I owe over 300,000$ for my education, and have to live on the streets.  But it is not likely. . . I hope.   As a scientist this plays well into my desire for data and evidence.   Having the numbers helps put my fears in their places. 

Not all anxiety is bad.  Because I grew up when HIV was being discovered I was extremely careful about washing my hands, checking for rogue syringes everywhere (including under movie theater seats),  and delayed intercourse until well into my 20's.  My highly educated family instilled a drive to uphold the name.  I traveled the world, have multiple graduate degrees and even an extra fellowship on top of my residency.  I had the wonderful honor of being hooded by my big sister the  orthopedic surgeon at my medical school graduation.  The continued desire for data and to do the right thing keeps my medicine evidence based and documenting as much as I can for my patients.  Even though there are multiple times I wish I could be lazier. 


The down side are things out of my control or that I can't prepare for.  Hospital credentialing and trying to find someone to notarize one of the forms literally left me shaking in my front room and crying at an insurance office.  My schedule changing frequently - which it did in residency and now in an area of physician shortage - causes insomnia, tension to migraine headaches, and trying not to fall apart in the hospitalist dictation room.  Oh and panic attacks are a major down side.  Panic attacks are full on activation of your sympathetic nervous system i. e. the "Fight, Flight or Freeze" system.   When I found out that I did worse on my MCAT than I did on my first practice test, I ran to the highest stair well, took about 30 minutes to stop hyperventilating  (okay it was probably more like 10 minutes but it felt like 30), and called my best friend 14 times zones away at 3am.  Panic attacks literally make you feel like you are going to explode and implode at the same time.  I'm fortunate that for my last one I could walk myself through the sympathetic nervous system and talk myself out of it.  Panic attacks are terrible.  

Over the years I have picked up more coping strategies: yoga, deep breathing, exercise, and open honest communication.   I had counseling in public health school, medical school and residency which was extremely helpful each time.  My counselor in residency convinced me to actually try medication; Celexa was amazing.  Just 10mg helped make everything a little bit easier.  As soon as the whole TTC adventure is completed - either with a small person or an IUD and a dog - I am planning on restarting Celexa.

The thing about GAD is that so many people have it, but like all mental health problems it is stigmatized.  Society doesn't look favorably on people who are "nervous," need counselors, or have had breakdowns.  Anxious kids are often either seen as "sensitive" if they cause an outburst or ignored if they are not causing problems.  GAD is a chronic disease.  I know it's not going away.  GAD has been with me my entire life and will be there until the end.

Thankfully my laptop did not explode while making this blog . . . yet. 

Monday, March 12, 2018

Miscarriage Lessons

WARNING-  This one is way longer than I expected it to be.


I have a long history of processing things in life by figuring out what lessons come from painful experiences.  Fell in love with a high school friend who is dating someone else; what lesson can I learn from this?  Took 26 credit hours and when making a study schedule couldn't schedule sleep until Thursday; what lesson can I learn from this?  The friends with benefits situation suddenly and dramatically fall through; what lesson can I learn from this?  Find out there is "Not a place for you," at your place of work which is actively trying to hire people; what lesson can I learn from this?

So as I'm going through this new journey of miscarriage I'm looking for the lessons.  Here are some that I've found, but I'm sure there will be more.

This is a different kind of grief. - I've had a lot of loss in my life.  I lost Papa Shegog, my paternal grandfather, when I was 4.  I lost Grandma Shegog when I was 6.  I remember being sent out to the car to get something and screaming at the sky when my grandmother died.  Since then I've lost family friends, Uncles, Aunts, Cousins, and most recently powerful my Aunt Rose and my Father.  I've grieved a lot, and been trained to help people through it.  I know that this is a process.  There is no drug that can make it go faster and no short cut around it.  One has to just go through grief.  It never really goes away. 

But this grief is different in many ways.  It is physical in a way that no other grief is.  There are so many hormonal changes that my body is going through in addition to the literal loss through bleeding and passing tissue.  The physical pain in someways mirrors the emotional pain.  I literally lost something that was apart of me. 

The grief of miscarriage is also different in the fact that it is lost potential.  In other losses I have been able to celebrate the lives that my friends and family lived. Take solace in the lessons my loved ones have taught me.  This loss is the loss of what could have been.  It is also feels like the loss of time, money, effort and energy put into getting to that point (see TTC ).  There is literally nothing good that I can see in this loss other than that I found out at 9 weeks and not later.

Because I didn't find out until after the pregnancy was over I still can't quite process the fact that this was a loss of twins.  But it does make the loss literally and emotionally greater.



Grief or Depression or Anxiety is not a fun new game.  -- Since I already have anxiety and history of depression, when I let myself think about my emotions, there is a constant wondering which element is contributing most to how I feel right now.  I've always treated my anxiety by figuring out the worse possible situation and trying to prepare myself for it.  My depression I've treated with counseling and medication.  Grief has always amplified these, but, as I mentioned in the beginning, this is a different kind of grief.  There is some time in each day that I try to figure out if I'm back into a major depressive episode or just grieving.  This does not help my baseline anxiety, but it does make me feel like I have a little control.


You can never hear "It's not your fault" too much.  - As far as I have read about other's experiences formally in blogs and informally in online support groups, all people who are pregnant wonder if there is something we did to cause it.  I was working a hospital shift when it happened, was it because I was working too hard?  I had caffeine two days this week, was it that?  I started spotting after orgasm once, did that cause it?  Am I just too darn old? 

For the first two weeks one of my fellow family medicine docs, who had a similar experience, texted me "It's not your fault," about every other day.  Every time she text it I needed to hear it.  It is easy for me to fall into feeling like I need to punish myself; the constant reminders that it is not my fault help.


There are triggers everywhere.  -  I was looking forward to going the farmers market.  We haven't gotten a chance to go since we moved here.  It was almost 3 weeks since I found out and two weeks since my last cytotec.  I've been seeing patients; therefore, I can go out in a social situation.  What I was not prepared for was all the people walking around with their babies: in arms, in strollers, in carriers.  Each one dripping a little bit of salt water into my wound. You never realize how many pregnant people there are in the world until you are suddenly and unexpectedly not.  You can be watching your previous favorite TV show then, BAM, one of the main characters is pregnant, delivering and making your wound bleed a little brighter.

It's pretty easy to start to feel resentful of anyone who has not gone through this.  Even more frustrating are those mothers who are "accidentally pregnant," on their 4-6+ child, or on any kind of substance from tobacco to meth and heroin.  I want to yell at them - DO YOU KNOW HOW HARD I WORKED FOR THIS TO HAVE IT END LIKE THIS?!?! 

I really want anyone lucky enough to have their G's (pregnancies) and P's (live deliveries) match to know how lucky they are.   I pretty much only want to surround myself with other people who have experienced a pregnancy loss,  because they are the only ones that get it.  It's an exclusive club that no one wants to be in.  Annoyingly this is not completely possible.


Bleeding like grief can pop up at the most random of moments.  - I chose to use Cytotec/Misoprostol, a medication to help cause uterine contractions and opening of the cervix,  instead of an procedure to help complete my miscarriage.  There was cramping and bleeding for about 8 days and then just spotting for 2 weeks.  Then out of the blue more cramping, bleeding and clots again pretty heavily for about 45 minutes.  I was worried until my husband, after lots of searching,  found that this can be common.

 -- Why isn't miscarriage more studied?  This data was surprisingly really hard to find. There are some, but they often stop after 2 weeks. (example 1 and 2)   This may be another example of women being ignored in health care research.  But, I digress. --

Because of the physicality and pretty much ignoring how I actually felt all week.  It brought all the feelings from the background to directly in front of my face.


Ignoring your feelings can help temporarily but only temporarily. -- See above lessons.


What not to say when people have a miscarriage. -- Here is a list of things that have been said to me that are not useful

  • "Everything happens for a reason" -  Technically yes,  it was probably a genetic abnormality.   But this is not helpful in anyway.
  • "I know what you are going through, I had a abortion/spotting in my successful pregnancy/lost a family member/pet." - Unless you have had a miscarriage of a wanted pregnancy,  You Don't.
  • "At least you know you can get pregnant." - Again, Technically true.  But that excitement sailed around week 6.  Two-thirds toward the end of first trimester it's just painful: so close to the end of the first trimester when miscarriage is less likely, almost done with the fatigue and nausea, and the point when I already had to start buying new clothing to accommodate my physical changes (34 G Bras are impossible to find). 
  • "I'm sorry for your loss." - This might be specific to me, because I have gone thorough so much loss,  but I hate this phrase.  I'd rather people say "I'm so sorry,"  rather than qualify it.  It seems more empty and trite.  For me it is similar to when people say "I'm sorry if you were offended," instead of "Sorry for offending you."  
There are some more things not to say in this article.  

Here are some useful things people have said to me. 
  • "It's not your fault."
  • "I can't imagine what you are going through."
  • "I also had a loss, here's what happened to me..."
  • "Sending Hugs/Love/Warm Fuzzies."
  • "Can I give you a hug?"
  • "I'm here for you for whatever you need."
The best thing was how many people opened up about their own experience.  We don't talk about pregnancy loss enough, but finding a community of my friends and family who understand is a refuge. 



Music still helps.  -- I often have a soundtrack of my life and what things are happening right now.  Music has always helped me express emotions that are hard for me.  When I realized I was in love with one of my friends in college, and my roommate was gone for the night, I would put on a playlist and cry under my blankets.  This strategy can still be very cathartic.  Here's my current play list

I'm In a Sexy French Depression - Crazy Ex Girlfriend Cast (I still have a bit of sense of humor,  plus the end french monologue is pretty spot on)
Tears of a Clown - Smokey Robinson  (this is work mostly)

It's constantly updating so I'm sure there will be more.   --- Yes I know in theory I could do this with some Spotify type thing, but that takes way more effort than I'm willing to put into it right now. --  Watching movies and shows about people with a loss is also helpful.  I've watched "Frida," and may watch "Pan's Labyrinth" next. 


Trust your body, or try to.   -- With PCOS (PolyCystic Ovarian Syndrome) I often feel like my body has betrayed me or that it just doesn't work.  Although my body doesn't work like normal.  It makes extra ovarian cysts for no reason.  It is resistant to insulin and doesn't process sugar making it unreasonably hard to lose and maintain weight.  It doesn't ovulate monthly without a lot of effort and medications on my part.  In the early part of my pregnancy I was surprised to that my body was acting like normal: nausea, some breast tenderness, increased urination, and fatigue.   There was so much fatigue I wasn't able to exercise as I usually did.  With the miscarriage I feel like this is one more example of my body betraying me.  However, with the cytotec it did what it was supposed to do.  My beta HCG levels are dropping appropriately, and my basal temperature is back to normal.  Working out again feels wonderful. 

 If I get lucky enough to be pregnant again I will try to be a little active in spite of the fatigue. 


If you are able to be pregnant again, this miscarriage will color that pregnancy.  -- Even with this loss we are still TTC (at least for the next 11 months or so). So the first cycle after a miscarriage tends to be more fertile.  I was reading up on how miscarriage can affect your next pregnancy.  But so many of the things I was already doing because I know everything that can go wrong.  I was already checking for spotting obsessively, anxious about all the visits, and not super excited for a positive pregnancy test.  All of this knowledge did not make the loss hurt less.  I'm not sure if I'm going to want to get an ultrasound earlier or later than 6 weeks.  I'm not sure if I want to just wait until 12 weeks before having my first prenatal appointment or want to be seen super early.  I had already kept my pregnancy a secret with a select few;  maybe I really won't tell anyone else until third trimester or tell everyone at 20 weeks.  I'm not sure what changes this will have if I get pregnant again, but I know it will change my next pregnancy as it has changed my life. 








Monday, February 26, 2018

Nonviable Early Twin Pregnancy

Warning: This may get a little rage-filled and preachy

I was five days in to my miscarriage and going to an OB/Gyn for a completely different problem.  We had actually scheduled a pretty simple office procedure about 6 weeks previously.  I was starting to feel like I was healing a little bit.  I could put words to emotions and even mention to the nurse, that my urine pregnancy test would probably be positive because I was in the middle of a miscarriage, without signing or tearing up too much.

-- So while I love OB/Gyns for procedures and high risk pregnancies, for my prenatal care I stuck (and hopefully will get to stick) with my Family Docs and Midwives. --

I knew that he probably knew about the miscarriage since he is apart of the same hospital system as the ER.  But I was hoping to get at least one of my gyn problems taken care of.  I was also hoping to get a copy of my ultrasound read from the ER.   When I was led to a normal exam room and not the procedure room I suspected something was amiss.   Even more curious was the fact that there were no instruments for any procedure prepared in the room.

"Twins, huh?"  The OB/Gyn greets me.  Confused I say " No, Nothing."   We have some mundane conversation about delaying the procedure until we have a repeat ultrasound proving that the Cytotec worked. 

--Cytotec/Misoprostol is a common medication given for incomplete miscarriage, or in medical terms incomplete & missed abortions.  I was given a prescription for 400mg BID x 3 days.  Which is not the dose recommended by anyone as far as I could tell.  I checked ACOG (American College of Obstetricians and Gynecologist) and gave myself the correct 800mg with 1-2 repeats three hours later, which has a 66-99% chance of working --

He checks my uterus, orders the ultrasound and leaves.  My husband and I disappointedly walk out and I ask for a copy of my ultrasound read, for which I have to sign a release of information (ROI).  It is not until I read the ultrasound impression that I find out that I was pregnant with and miscarrying twins.

HOW DID NONE OF THE 4 DOCTORS I INTERACTED WITH NOT TELL ME I WAS MISCARRYING TWINS!

I talked to 2 ER docs. An OB came down in the ER to talk to me, and I stayed in the ER until the radiologist read the images.  My first US showed only a "Single viable intrauterine pregnancy corresponding to 6 weeks and 1 days." I did not mention having a twin pregnancy, which is generally a pretty key piece of information.  None of them felt it was appropriate to tell me what was happening with my body?! 

Devil's Advocate says: "Would it have made a difference given the fact that there were no fetal heart beats?" "They were probably busy and thought someone else told you.  You know how things go at shift change."  " They probably didn't want to make a bad situation worse."

However the primary care doc in me -- the one who has to give bad news on a daily basis, the one who has to translate the actions of other physicians so that patients understand the treatment they received, the one who believes that I am not just a physician but a doctor, which means to teach -- cuts them no slack. 

Why do people feel they can make decisions about other people's body and the information they should know?   This reminds me of all the injustices and decisions the government is trying to make about women's & fems' bodies (here is summary from BOOM Lawyered).  Is it because I'm Black?  We know that Black Women have worse perinatal health outcomes.   If I had not wanted to see my ultrasound read I would not have known that I had twins, which may have ramifications if I do get pregnant again. (And I had to sign an ROI for my own records?!?) This is the treatment I received when they knew I am a doctor; it was incomplete, with incorrect dosing, and extra hoops to jump.  What would have happened if I wasn't one?

There is now an inquiry in the hospital ED and radiology, and my prenatal folks are checking in with their ultrasound tech since they were missed first time.  I need to tell the OB/Gyn that "Twins" is not an appropriate greeting to someone in the middle of a miscarriage.  That is another reason I will not be seeing him if I am fortunate enough to conceive again. 

I would have rather every single one asked me if I knew I was carrying twins, than be set back to the beginning of my grieving process.  I was without words or expression, trying to figure out what went wrong and what I could have done differently.  Again. 





Tuesday, February 20, 2018

9 weeks and 2 days

I'm still processing so this may not be pretty.  Trigger warnings this talks about loss and body issues.

I've been exhausted for weeks.  I had a weekend hospital shift (which are notoriously hard). I was coming down the the virus that everyone else in the household had.  Everyone knew these facts.  What everyone did not know was that I was about 9 weeks pregnant.

My husband and I had made a clear decision to tell as few as possible in the first trimester.  I took Reproductive Epidemiology in public health school.  I knew that about 1/3rd of all pregnancies end in miscarriage especially in the first trimester.  Also I just didn't want the questions and the looks.  I honestly intended on not telling anyone I was pregnant until they asked and then make them feel guilty for calling me fat.

I expected things to go terribly as my baseline anxiety kicked in.  I literally know everything that can go wrong.  However after a "normal 6 week US" and 8 week first prenatal.  I was cautiously getting comfortable with just making it through the first trimester.  Which is what people kept telling me that was all I had to do. 

Easier said than done with the bone deep fatigue, growing out of all reasonable bra sizes (34 G+ are hard to find), and my baseline duties as a new doc in a resource poor area.  I felt terrible canceling morning or evening clinics when I just could not do another thing other than fall into my bed.  I also have PCOS (Polycystic Ovarian Syndrome) and Insulin Resistance which makes eating more more than 1200-1700 calories against what I've practiced for the last decade.

But as the weeks racked up I was cautiously hopeful that I could make it one more month. 

So I did the right thing.  I called in back up for my hospital shift, which was amazing. I saw patients. I admitted patients.   I did a little clean up work from the previous hospitalist.  I got home about at about 12:30 intending on sleeping for 7-8 hrs before doing it all again.   Then right before I went to bed I went to the bathroom for the last time and saw bright red blood.

This led me to handing over my shift to my amazing medical director (one of 2 people at work who knew).  And heading to the ER at 1am. 8 hours some blood tests and the most uncomfortable ultrasound I've ever had later the verdict was in.  Where there were heart tones before, there were none now.  I got my meds for a missed/incomplete abortion (medical language for miscarriage) went home.  On the way I texted the 6 people who knew who responded with great outpourings of love and care.

It is impossible not to think about the what ifs and possible signs, even though I know the most likely cause is chromosomal abnormality.  At my dating ultrasound I was dating 4 days early was that a sign?  I had a terrible allergic reaction to the sheets at the ultrasound place was that a sign, or a cause?  I knew I was working too hard was that a cause? At my first prenatal 5 days ago she said my uterus was enlarged, should I have pressed to make sure she thought it was 9 week size?   What earlier sign could there have been to tell me that things were not going well?  What could I have done to change this situation?

It's strange to hope for cramping and bleeding just so this part completes itself.   It's strange to still have symptoms of first trimester even though I know I'm not now.  This directly plays in to my appreciation/distaste for my body (love/hate is not quite accurate).  Of course my body which can't process sugar,  lose weight, and makes unnecessary cysts would fail in these ways:  both in staying pregnant and not allowing it to end when it should. 

I'm hoping the meds did their job and this doesn't linger on.  In someways the physical pain is appropriate to the emotional pain.

I find it hard to give myself permission to feel during this.  As a doctor I'm so used to putting everyone's needs before my own, and yet I'm finding it very hard to care about (or even check) my inbox.  While I know that's probably appropriate, I still feel guilty.  I'm also not dealing well with the other pregnant people around me.  Yep,  I'm I little bitter and jealous at this time.

Part of me wants to hurry up and get this over with so I can move on to the next month. In theory my chances are higher the cycle after a miscarriage, but as I said previously my eggs are old.  So should I just go to reproductive endocrine? I only have about 1 year left of my trying (see TTC), so time is running out.

So why write about this?  I was talking to one of the 6 people, another family medicine doc, who knew who noted that people don't talk about this much even though we know from medicine it is so common.  Why don't we talk about it?  Because it's one of the sad realities of life, maybe.  Is because it feels like failing and people don't like to talk about their failures?  Is it because though I've lost so many people in my life (my Father and Aunt Rose most recently) the loss of potential relationship is harder? I don't know.  But I am writing to process, tell my story, and maybe help someone else feel not so alone.

There are no words for the difficulty of this experience.

Sunday, November 26, 2017

TTC

Spring of 2014 I was finishing my intern year of Family Medicine residency.  I would be turning 34 in July, and I was FREAKING OUT.    You see I had gained enough medical knowledge to understand all the things that could go wrong in pregnancy and delivery.  I also knew because of my PCOS I had lower fertility than others my age; also I was 1 year away from the dreaded AMA.

-AMA stands for advanced maternal age.  The term for when you will deliver over 35.  Of course with the update of the diagnostic codes it has been changed from the sad but acceptable "Advance Maternal Age" to "Geriatric Gravida"  which is infinitely worse-



Thankfully I had a visit from a friend who just had her first child who helped put my anxiety to a little bit of rest.  "If you guys have kids you will be great parents and it will be wonderful.  If you don't have kids you will continue to be great people and it will be wonderful."  So I allayed my fears for a few more years and made a plan.   The main way I deal with my anxiety is by making plans.

I figured I'd give myself 18 months to see if I could conceive (by which ~91% couples do).  So in typical fashion I started to research.  I started Pintrest boards, a Amazon wish list for possible registry, and started following some blogs.  I had already been following my cycle since I had an IUD and I added a few more apps specifically for tracking.  There was a whole set back with the Nov 2016 election.  (see Nov 9 2016 330 am)  After that experience I realized that though attempting to have a kid may be a fundamentally bad idea (given the fact that the world is pretty actively terrible), If we the US was not in nuclear holocaust by July 2017 would try anyway.




Armed with 2 new apps I entered a new world of acronyms and short hand.  If you are not apart of this world I will give you a taste because they are truly non-intuitive:

  • AF - though I initially thought this was the more common "As F**k" it actually means "Aunt Flo" or period.   
  • BD - Baby Dance.  Why people can't just say sex, intercourse, nookie, or any other euphemism I don't know. 
  • Baby Dust - Not to be confused with BD-  It is wishing someone good luck, though I sometimes think of it as fairy dust and is therefore wishing more GLBTQ children into the world for fun. 
  • DPO & CD - Days post ovulation and Cycle day.  These actually make sense and are useful
  • DH - Dear Husband - I first came across this one in wedding groups.  Still don't like it. 
  • TTC - Trying to Conceive.  Which is what most people are trying to do on these groups anyway and I'm not sure why this is an acronym.  There should be one for the folks who are not trying.
  • BFN/P - Big Fat Negative or Positive in reference to pregnancy tests.  Why they have to be "big and fat'  I am unsure. 
  • TWW -  Two week wait.  Also known as the truest purgatory known on earth.  It's the two weeks after ovulation and before your period.  It is HELL.
  • EWCM - Egg White Cervical Mucous.  Yep it's what it sounds like.  
So now I'm apart of this very strange community of people actively trying to get pregnant and generally complaining about it/confused/wondering if they can check a pregnancy test 2 days after ovulation, "I mean I know it's really early, but. . . "  

I started out doing more stealth doctoring.  "You know the best medications for PCOS is Metformin low carb diet and exercise."  "There is no evidence to having your legs elevated after sex to insure conception." "No a BFN two days after ovulation does not mean that you have not conceived this month."

I've found that there are 3 large categories in these groups.  1) TWW screams from purgatory:  to check or not to check, how sucky this, I just checked but I can check again.  2) What to try next: better supplements,  fertility meds experiences,  should I go to the doctor?  (I generally answer yes) 3) Hoping: baby dusting, wishing they could by baby clothes, hoping this is the month.   

Then I realized this is a group of strangers who don't know I'm a doctor and I can ask stupid questions that I also already know the answers to.  I also realized that though there is a group of people going through the same thing, TTC is a very isolating experience.  Though my partner is amazing and there is a group (though sometimes questionable) of people going through the same thing, at the end of the day it's still what's going on with my body.   While I can track my basal temperature, check my cervical mucous, take my meds, try to exercise and fit in nookie with my new grown up doctor job which inconveniently schedules events every fertile weekend so far, it still feels wildly out of my control.  I'm still AMA, PCOS, in a high stress job, and my body doesn't seem to like to cooperate. 

It's a month to month rollercoaster over 4 weeks ultimately waiting to find out if I am infertile enough to get help or will it magically happen.  Using my planning skills I have kept myself on track with adding something every 2 months or so.  First adding cheap ovulation tests, then the expensive ovulation tests. 

(Can we take a minute to talk about how unreasonably expensive conception items are.  American consumerism truly makes all large events in life more expensive than needed:  Weddings, TTC, actually having a baby.  I mean really. It should not be 45 dollars for 1-2 months of ovulation tests and 39$ for one month of a supplement that actually has medical evidence.)  



But I digress

After 4 months I added Pregnitude which actually has evidence of supporting ovulation for people with PCOS. Then after 6 months I officially get to go get the whole fertility work up as appropriate for people over 35 TTC.   I am hoping that with the work up that more things keep getting added, because I need a plan, and my plan runs out in January. 

I realize I'm only 5ish months into this journey and I'm already over it.  I would like to know if my body will cooperate or not.  I also feel comfortable with my limits.  I'm not doing IVF or any truly invasive procedures.  If I'm in that 9% then I shouldn't be having kids I can just get an IUD and a dog.