Saturday, July 25, 2015

A smoking gun?

Hypothyroidism, it seems is a source of a bit of controversy, and no one seems to agree what levels are "normal" for TSH. When I had my thyroid testing done it was said it was normal. So, you know, I thought it was normal. Who knew "normal" is such a highly debated idea. From the research I've gathered, it seems like normal depends on your situation.
A TSH level above 10 is pretty widely accepted as abnormal.  Like, your general family doctor would be all "whoa" and treat you.
A TSH level between .4 and 5.0 is most optimal.
A TSH level between 5 and 10 is elevated, but not necessarily going to be treated by a doctor. An endocrinologist, however, would notice.
But, if you are trying to conceive or sustain a pregnancy, more than 3 is going to elevate your risk of miscarriage. 


Mine was 5.7. 


This New York Times article on it says it best:
"My good friend Marty Surks is not impressed and doesn't think you should treat patients with a T.S.H. between 5 and 10, but there's mounting evidence that over 2.5 is abnormal," said Dr. Wartofsky, an endocrinologist and professor at Georgetown School of Medicine.


The more I dig into this, the more shocked I am. A study by the National Academy of Clinical Biochemisty said that 95% of Americans have a thyroid TSH level less than 2.5.
So statistical normal is less than 2.5? And pregnancy women should be less than 3? And most normal levels are less than 5? AND NO ONE THOUGHT MINE WAS HIGH.
I am a bit angry about it


This, plus untreated APS. Ugh. 

I have lost 5 babies. 

I am on HRT now. Hormone Replacement Therapy. The cocktail I'm taking is making me a bit crazy. Crazy and angry isn't a good combination. 






Thursday, July 23, 2015

All or nothing.

It's thundering, and the skies have finally opened up. We're getting a good, strong, soaking rain, a restful and refreshing summer storm. The garden needs it. Mak and I have just got back from the pool. She's in dry clothes and napping and the house is quiet. I sit here, listening to the rain, thinking...

I have written three blogs over the last few days trying to put into words all that has been rattling in my brain. Here's another shot.

On Tuesday, Jake and I went back to REACH in Charlotte. This was the referral from my OBGYN following miscarriage number 5 back in March, the surprise one. My OB practice - as in all the doctors there - are stumped. After five, they have shook their heads in despair.
Dr. Miller, without any further ideas, said to go back to REACH. She mentioned surrogacy and said she simply didn't know. We had visited REACH back in 2012 when we thought are primary struggle was infertility after Clomid didn't work. I was told I had low progesterone and mild PCOS, was given injectables (OI) that ultimately didn't work. This back when the first miscarriage was just a "fluke"or so we all thought.

This visit was to see what hasn't been done, if anything, and what her advice was speaking from the knowledge of a RE. In other words, have we tried everything that's possible to prevent a pregnancy loss? There is some quote about doing the same things again and again and expecting a different result being crazy. Why should we keep putting ourselves through it if we know it will end? Anyways, based on this consultation we would decide to keep trying or prevent any more pregnancies surgically. Either tubal ligation or vasectomy. And the "no more" answer would be okay. We've really found a lot of peace with that possibility. If no biological children are in our future and God wants to close that door, well, we are along for the ride. Our happiness, our love, our success, and our marriage is NOT defined by, dictated by, or dependent upon biological children, or any children, for that matter. And we are both so done with miscarriages. More on that.

Dr. Teaff gave us a lot of office time walking through my history. To summarize the visit, she felt that we had not yet exhausted all efforts. In fact, she explained that there have been a lot of things untreated in most of my pregnancies, with number four (the one we thought stuck) being the one we came closest to the best plan of treatment. So let's explain my issues. I have a lot of things working in tandem:

1. I do have PCOS. Polycystic ovary syndrome means I have small cysts on my ovaries. I actually saw them in the ultrasound. It is responsible for my hormonal imbalances. I have low progesterone. This needs to be treated with not only progesterone support (we've done that) but with metformin and Ovasitol.
2. I am anovulatory as a result - this means my hormones don't always have enough oomph to make me ovulate, at least on each cycle. Clearly it does happen on its own occasionally,  as 4 of my pregnancies have been natural. So this means I need Letrazole and probably Ovidrel injections to make me ovulate when we want me to.
3. I have the symptoms of APS. Notice I didn't say diagnosis. To get a diagnosis you have to test positive on two separate times for antiphospholipid antibodies - ‘lupus anticoagulant’ and ‘anticardiolipin’ antibodies. The two positives must be 6-12 weeks apart. I haven't had the positive tests on the right times, but I have had positives. To treat this, you take low-dose aspirin and either heparin/warfarin or lovenox injections. Basically, it is an autoimmune disorder that causes small blood clotting. I have not been able to get a doctor to prescribe this! She said at this point it was wise to treat it as something is clearly at play, even if we don't have all the signs. It may be too late if we wait for a legit diagnosis.  I nearly cried when she said I needed to be on lovenox, because it's something I have advocated for since forever ago!
4. Since APS is autoimmune, I will take a steroid, prednisone. This will also help if I have uterine NK cells (natural killer). There may be more immune suppressors, like intravenous immunoglobulin (IVIG) infusions.
5. I definitely will continue the extra folic acid for my MTHFR mutation. This causes me not to absorb folate from food, meaning I need big doses.
6. Lastly, she called Wednesday and said I have to adjust my thyroid. While it is still in the normal range, it's less than ideal for conception. My TSH was 5.7, but she wants it optimal. So I am taking synthroid.
And then, of course there's bloodwork. Some of mine needed a little upgrading. So the vampires attacked and I got my life drained out of me. Some additional tests. Most are repeats, but two new ones are for killer cells and for AMH (anti-mullerian hormone).

In a nutshell, she thinks we haven't been treating all of these components as strongly as we need to, and all at the same time. I was kind of blown away. Furthermore, and this was a biggie... she doesn't think we can do all this our own and suggested and IUI or Artificial Insemination. Timed, planned, monitored. I just can't get pregnant on my own and then try to play catch up. In order for the medication and treatment plans to be the very best possible, we have to step-by-step monitor it. Like weekly or more often. So even though it's not necessarily infertility as in "I can't get pregnant" - it's that if I am going to sustain it- I need to be hand-held the entire way from conception forward.

The genetic testing we had done on pregnancy #4 was normal, we already knew... but she gave us new details. It was a boy. A BOY. I knew it. I have a son. A SON! :) The cool thing is that because of him, the genetic screening was more conclusive of no genetic abnormalities. It would have been more a guessing game if it had been a girl, as the "products of conception" can easily be confused with the mother's genetic material. But with it being a boy, it was no question it was the baby. And he was healthy. It was so, so hard, yet strangely comforting to hear this.

I am currently on day 8 of this cycle, taking all my meds, and doing a "dry" run that won't include the IUI and injections until the thyroid gets down. I go back in a week for a check up with the ultrasound and in a month to check the thyroid.

Insurance will cover three cycles of IUI. Three and then it's over.
And we're okay with that.
I don't know if we could handle more even if we could afford more.

I am nervous. I am scared. I am excited. For the first time in a very long time, I am hopeful.
I am really, really scared that I am too hopeful.  Yesterday, I caught myself daydreaming. I haven't done that in so long. I actually let myself imagine a nursery, a shower, a belly... it was so emotionally overwhelming. I couldn't believe my own thoughts. I had to admonish myself fast.

One of odd results of multiple miscarriages is how quickly an easy you let down your guard on your personal life. It's so funny how my menstrual cycle has become a topic of conversation. My reproductive system woes have become anyone's business. I could seriously care less which doctor or ob-gyn examines me. I have weekly dates with that transvaginal ultrasound wand. Ha! Whatever. Like, I have no shame anymore. Miscarriages can rob you of that. It's not even my personality to be that way. I have some friends who still only see female doctors, and I know women who only let that one particular one do their "exams." I might have been that way too.  I have one dear friend who basically needs a valium for a pap. Haha, I can't imagine anymore. Examining my uterus is as nonchalant to me as taking my temperature or checking my pulse. I was just sharing this with my husband yesterday. It becomes an "it is what it is" thing. I can't let it be an issue, especially now as we embark on this journey. People ask what's wrong, what we're going through, where we are - and I am so grateful that there are people who care to ask - and how do you begin to explain this tangled web of medication, procedures, and such without delving into it? It's just another way these miscarriages have changed me, shaped me, scarred me.

Even more so, what if this doesn't work, can I sustain more loss? The doctor said to me - "I don't see how you haven't thrown yourself off a bridge"... I said "uh yeah, don't I know it..." or something like that because she spoke so scary-close to the truth. I have fought depression for about three years. And sometimes, I have had dark, dark, dark days. The sight of a pregnant person would reduce me to nausea and tears. Sometimes it still does. Okay, it almost always still does.... And the idea of this not working and not getting pregnant at all doesn't scare me (or even the idea of never conceiving and carrying and totally calling it quits) nearly as bad as the idea of it working then failing yet again. To hear a heartbeat and then silence? To lie on another operating table, waiting on them to take another dead child away... again? That, to me, is where my most trepidation can be found. Those kind of what ifs. I would rather walk away now knowing I will never give birth than to face it again. But, at the same time, I can't walk away without knowing we tried everything we could.

I am a whirlwind of feelings, and managing the many bottles of medications and appointments (plus grad school and the impending back to school season) are giving me a place to focus my thoughts rather on the what ifs in this new journey.

Pray for us on this new path. I have no idea what awaits.

Wednesday, July 15, 2015

Mexico 2015.

Mexico as a family of three was amazing.

UH-may-ZING.

Makinzy's first plane ride was a little turbulent, and using in-flight wifi, I was ferociously pecking away on my computer working on a grad school paper as we bounced through the air. Makinzy has mixed emotions about flying - the view and the excitement was a plus, but the nausea and the nerves... not so much! Haha. I always love flying, I just less-love the sicky feeling I sometimes get! She handled the airport like a champ, though. Our mock security checks and TSA drills at home had her going through it like she was a pro traveler. :)

We had a few hiccups on the way to our resort. We didn't buy transportation! We totally thought it was included in the package we bought. With a little Spanglish and some help from the travel agency, we forked over 200 bucks and got a private shuttle to our resort, round trip. It was a hefty unexpected cost, but totally a good price as it was round-trip, private (meaning no stops at five hundred other hotels or cramped seating) and the distance to our hotel was roughly an hour.

After we arrived, we checked out the resort. We had booked "Barcelo Maya Beach & Caribe" without knowing what we had actually done was book 1 hotel (Maya Beach) at a resort that boasts four, well, five, hotels within it. No wonder we didn't know which one to tell the driver to take us to!

As you can see from the map, Maya Beach is on the end. To the left, you can go to all the other hotels and use their amenities, with the exception of the Maya Palace Deluxe (purple), which is separated and isn't included. We stayed in the furthest blue section to the left, so we were right near the buffet, the lobby, the teatro, etc. Beach & Caribe backed up to each other and shared the theater, and a pretty splash area. The pools are sprawling, so you just had to walk towards the sea and, bam, there's a pool. Similarly, Tropical and Colonial shared a theater and the buffet/lobbies were close. The big yellow sections are those. In between the four main hotels, right between Caribe and Colonial was the Maya Mall, a large, open air mall with a bowling alley and arcade, a sports bar, a bunch of shops and stores, a few restaurants, and more. Also, there was a putt-putt course and the Plaza Mexicana, another open air mall that features local artisans selling their wares. Also in this middle section is a water park (the largest of several), the wave maker called Flowrider, the spas, and the Dolphinarius pools where you can swim with the dolphins. So much to explore.

When we arrived, we were famished. I wanted to ditch our stuff and find food. Unfortunately, our room wasn't going to be ready until 3. But really, it wasn't an issue at all. They took care of our stuff and sent us on our way to the buffet where I had a steak and a margarita ready for me. Happy girl, I was. By the time we did a little exploring, during which Makinzy walked around with her mouth drooped open in awe and excitement, the room was ready, and we hit the pools. There are so many pools. The areas near the swim up bars seemed more for the young folks (I am freaking 27 and here I am talking about those young folks like I am an old geezer and they're a bunch of drunk whippersnappers I'm tsk-tsk-tsking... haha...) so we found the next one with the water playground to be the right spot for families. We did some beach time too. 

To the right of our resort, literally the next resort over, is the Bel-Air resort, which used to be Xpu-Ha Palace, where we took our honeymoon. We were so surprised to see the beach area between the two resorts was no more - just rocky areas, and though the water was shallow enough to walk there, it changed a lot. I vowed to go check it out.

So here's the summary of our adventures:
Monday: 7-ll/Starbuck stop, Check-in, chill out, pool time, exploring, checking out the theater shows and crashing!



Tuesday: Beach time and lagoon diving near Xpu-ha (being brave adventurers), water park #1 where I skinned my back going down the slide and the lifeguard reminds me I'm an adult, visiting the dolphins, and more beach time! This was probably my favorite day because of all the wonder on Mak's face. She had never seen water so beautiful, so deep and clear, and we dove in like nomad explorers, like pirates washed up in some uninhabited lagoon!



Wednesday: We spent the morning on the beach, swimming in the crystal clear Caribbean, and playing in the pools. That afternoon, we headed over to the dolphins were Mak swam, danced, and kissed them! Later that night, we went to dinner in one of the restaurants, La Fuente, a Spanish-themed (as in Spain) restaurant, and the theater show and danced to a real Mariachi band!
Thursday: We used our coupons (certain travel companies include these %off of the resort extras) and went to the biggest water park, and spent most of the day there, where we all three went down the slides. Mak even tried out the Flowrider thing where she got to buggieboard on the waves.  We hit the beach a little. We had family portraits made that evening, and then went to dinner. We changed into comfy clothes and went to the nightly show! 


Friday: Probably one of the most memorable days, definitely my second fav. We got up early for a tour- a trip snorkeling with sea turtles at Akumal Beach! This was the exact same spot where Jake swam into the water with our camera on our honeymoon. I mean. the. same. place.  We saw two adult sea turtles, two babies, and two manta rays. They were SO COOL. We ate a snack they provided and loaded back up, only to find out there was more to the trip - a cenote visit! We drove 15 minutes in the cramped van  down the bumpest road (but the people were all uber-nice, especially a couple from London... Mak nearly LOST it when she asked about my middle school kids "aren't they a bit naughty?") and we went to Cenote Carocol near the Ecopark Labnaha, which is not open anymore, but used more as a nature preserve now. We went into the jungle, explored caves, and then came to the underground cenote where we snorkeled in an underground cave in wetsuits. It was unbelievable. I didn't take my camera underground, so here's some examples of what the place looked like. We ended the day with pool naps, putt-putt, and Coke Light and cheese sticks, then dinner and a show!


Saturday: Our excursion included transportation to a few stores and Playa Del Carmen, we went Saturday morning. We first were taken to a jewelry, leather, and tapestry shop, then to a tequila and coffee store where Mak and I held a monkey named Tim, I kid you not. We also saw coffee roasted and bought some Chiapas beans! Then, they took us to Playa. We got to visit Starbucks, shop 5th Ave., Mak got her hair braided, visited the beach and watched ferries to Cozumel and Isla Mujeres, and got gelato. We also got some Sol (well, dad and I did, teehee) and saw a wedding parade. We almost missed the van back. The driver was rocking out to some old school American pop and hiphop (think old Lady Gaga and Eminem), to which Mak and I did the macarena. I mean, como se dice I know you have no idea but this song isn't appropriate for kids? So we made the best of it. When we made it back, we got lunch and hit the beach. I drooled on myself during my beach nap. We dressed for dinner, got our pictures back, and hit the hay early.
Sunday: We got up WAYY early, told the beach goodbye, and met our transportation. We got to the airport and made a quick Starbucks stop. Mak didn't feel great, but I think it was a combo of airplane nerves, sadness, and up so early! She was better by the time we got on the plane. Our flight was much less turbulent, but our flight attendants were technology nazis so we couldn't get online or such for most of the flight. We landed in Charlotte, and were picked up by Jake's parents.

I really want to go back.

Like, can I be deported? 

I got to check Facebook on the Wifi ever-so-often, and my feed was full of rainbow and rebel flag controversy, political spats, whining, and bleh. I thought, you know, here the only flag people worry about is whether or not the dive flag is up! I know Mexico ain't perfect (that whole corrupt government and drug cartel business is a downer), but dang. I don't see why illegal immigration isn't all the Americans sneaking over the border. I wouldn't have said that five years ago. I try to be proud to be an American, but I find it is increasingly hard to do so. 

Anyways, without getting too far off track there, it is safe to say it was a wonderful trip, and I wish it lasted longer. Way longer. 

Mexico will forever hold a piece of my heart. We made some WONDERFUL family memories, and the laughs and wonder coming from Makinzy made it so much more perfect.

Friday, July 03, 2015

Summertime 2015, part 1.

Holy smokes, summertime.

STOP SPEEDING BY.

I can't believe we're already to July. After the 4th, it's a slippery slope right back to school. And y'all, as much as love-love-love my kids and my job, I stinkin' love me some summertime.
So when I saw this floating on Facebook, I laughed so hard. I mean I legit love summer, and couldn't help but relate.



Anyways. So far, here's a recap of our adventures. School ended June 11th for teachers, so our first weekend was spend celebrating our anniversary and for me, finishing up my first summer grad school class (ugh), then the very next week we got the chance to chaperone our church's youth group's trip to St. Simon's Island, GA. We did this back the summer before Mak came, and it was such a relaxing and fun trip. The kids get a real chance to just hang out with you, get to know you, and it's at a Methodist-run facility, so it's so low-key and easy. The beautiful sunsets, wide open beaches, Spanish-moss covered trees by the river make a real picturesque place to have some devotional time with God, so this is a trip that benefits me spiritually too. Mak got to hang out with Nana, and she's got children's church camp coming up herself in August!

The very next week, we jumped right into VBS. Our church did Lifeway's Journey Off the Map theme, and I taught 5th grade (rising 6th) like I do each year. Jake assisted, like usual. I had a first-time decision in my class, and it never fails to give me chills (and another healthy dose of humility) to get to lead an eager young person through the sinner's prayer for the first time. Praying together under a tree in the grass, I got to help a young man ask Jesus in his heart, and that made the decoration and set up, the lesson planning, and the early mornings so, so, so worth every bit of it. It's also a great way to get to know many of my future students.  I really love getting to see my students through church where they can get to know me in a Christian context and as a friend, cheerleader, and mentor.

This week has been much more unstructured for our family. My second grad school class has started, but with nothing big on the calendar, we took the opportunity to sleep in and get lost in books. I have read through about 5 murder mysteries on my iPad this week alone. So between reading for school and reading for pleasure, we've spent a lot of time in books! My poor FitBit numbers are abysmal, but hey, it's like the only week we get to do this. We also took some time to get some things for our upcoming trip to Mexico - Mak wanted a Spanish-English phrasebook/dictionary (and she's spent a healthy amount of time laying in between us in bed or across her trampoline studying it!). She's so excited. I can't tell you how proud I am of how much she's growing and maturing. She still has some residual issues we still are working on, but honestly, she's becoming such a good kid. I love her personality and sense of humor. Teary mom moment.

Probably the biggest developments this summer so far are these two things - first, Jake has a job in administration. He has accepted a position and we couldn't be more excited. We prayed God would place him somewhere good for the students and school, good for our district, good for his career, and good for our family, and God delivered all around. So blessed. :) Secondly, not exciting though - my mom has had a diagnosis of skin cancer. While it is the less scary kind (basal cell carcinoma as opposed to melanoma), I can't help but tremble at the C-word. I feel peace, though, and I know God has her in His hands through that journey. She will have surgery later this summer.

So there you have it. Our summer, so far.

I don't have to get into the other going-ons of the summer - my Facebook newsfeed is covered in gay pride flags, confederate flags, and shark attack reports. I have tried to keep my political ideals to myself (I have always said I think politics should be discussed over coffee, not the Internet), but I will say this much: God's love is so much bigger than all of this. We get caught up in the pettiest stuff. The law of the land has no effect on God's law. Divorce is legal (and thriving even in the church) and I believe it is as much at odds with God's definition of marriage as gay marriage is. The confederate flag is just one of many riffs creating racial tension, and it's going to take more than its removal from the state house to fix the hate in the hearts of so many on both sides of issue. Frankly, I am not really concerned with what flag you fly (or don't fly), I am more eager to ask you if you know my Jesus. I find this fourth of July I will spend more time praying for America than I have before.

Happy 4th, y'all.