Wednesday, April 18, 2007

Peeing On A Stick: A Play, Sort Of!

Act One


Scene 1:
Outside the Infertility Specialist's Office. Three days before I leave for the BlogHer Business conference.

Newbie Nurse: Please step on the scale.

Me: [sigh]

Newbie Nurse says the number aloud and writes it down. I try not to grimmace.

Newbie Nurse: I need to take your blood pressure.

We go through the process. I worry that my blood pressure will be high because sometimes it seems to spike up, and I was in pre-conference craziness. And also I'm getting tested to find out if I'm fertile, which isn't exactly a stress-free process.

She takes the band off me and starts scrutinizing the numbers on the high-tech screen. She writes stuff down. Then, with my numbers flashing for any passers-by to see, some other nurse passes by.

Newbie Nurse to Other Nurse while pointing at the machine: Hey -- um, this is her pulse and this is her blood pressure, right?

Me: !

Other Nurse, not stopping: Yeah.

Newbie Nurse, still to Other Nurse: Aren't these numbers kind of high?

Me: !!!

Other Nurse kind of nods, kind of shrugs dismissively as she continues walking down the hall with some other patient. I am kind or horrified but do not say anything.

Newbie Nurse: Just go straight down here and into the Consulting Room. Dr. F will be with you in a minute.

I go down the hallway to the Consulting Room and open the door, only to find a couple already in there, seated and looking at pamphlets. We all apologize and I run back out of the room to try and find Newbie Nurse, but she is nowhere to be seen. I don't know what to do, so I just stand there. Eventually, Some Other Nurse comes by.

Me: Um, I was told to go in there to wait for Dr. F, but there's a couple in there.

Some Other Nurse: There is? Who told-- Please just wait in the hallway a moment.

A few minutes later an entirely different nurse goes to the Consulting Room and escorts the couple out, and tells me I can go in. I am not feeling as positive as I had been.



Scene 2: In the Consulting Room With Dr. F, The Infertility Specialist

Dr. F: So, tell me a little bit about why you're here.

Me, with a lot more stammering than this: My sister has a baby. At about a year-and-a-half, he was diagnosed with Fragile-X. I made an appointment with the Geneticist, KB -- the one who I believe you spoke with, who recommended you? Anyway, I got myself tested, and I am a carrier. And I know that one of the risks of being a carrier is premature ovarian failure. And um, I'm worried about that.

Dr. F: Yes, KB said that she had some concerns about that, too.

Me: Right. So I guess I'm here because I want to know if I am fertile now. And how to monitor it going forward. And um, what the procedure will be when I do want to have a baby.

And I guess I said some magic words, because all of a sudden he was off to the races! A diagram came out and he was drawing all over it and telling me all about the procedures one takes if one seems to be infertile. It was a spiel he'd given probably hundreds, maybe even thousands of times. I could tell when he was on auto-pilot. He'd been an infertility specialist for something like 25 years. But I had to interrupt him.

Me: But, um, I don't think that I am infertile. I mean, I don't know, but I am having normal cycles. And...well, I had trouble ovulating before, years ago when I was married. But I got some bloodwork done at the beginning of my cycle last week -- do you have those results?

Dr. F: Yes. Here --

And then there were more drawings and all sorts of numbers, that boiled down to: my hormone levels are all pretty normal.

Me: And I am supposed to go back in another couple weeks and get tested for something else?

Dr. F: Yes. They will test your progesterone level. You will want that to be at 8 or above. 8 or above and you're probably okay.

But he seemed skeptical and went back to explaining what to do if I wasn't okay. If I wasn't ovulating.

Dr. F: Polycystic Ovarian Syndrome...

Me: ???

Dr. F: ...is fairly common and reversible. It's good that you have regular cycles. Generally the symptoms of PCOS include irregular cycles [and then he rubbed his chin to remind me where my breakouts were] and some acne.

Again, I tried not to grimmace.

Dr. F: For now -- and I know how this will sound, but -- the best thing you can do is lose weight...

By the end of my visit, I'd gotten the information I needed, but felt utterly defeated.

It took lots of redirecting to get the information I needed from the doctor, which was tiring in and of itself. (Like, we did eventually get to discussing what to do when I DO want to conceive, and how to test for Fragile-X early on, but that was not his area of expertise. I know this because at one point in the session, he got up and went to the computer to look up whether you could test for Fragile-X in vitro. And you can. And you know how he found that out? By looking it up on GOOGLE.)

My problem was that I went into the session thinking that I was basically healthy. Yes, I am overweight and yes, I am a carrier of some crazy genetic thing, but I thought I was otherwise fine. I thought I was just gathering information so I could know how to best plan for the future.

Instead, I left wondering if maybe I have some other kind of Syndrome, and how I'd even know. And realizing weight loss is no longer a cosmetic thing. And feeling horrible and dumpy and acne-laden and high-blood-pressured and gross.


Act Two

Scene 1: At Home, Trying to Get My End-of-Cycle Test Results

Answer Nurse: How may I help you?

Me, after asking about my ear being clogged and maybe mentioning the hydrogen peroxide and ear cigarettes thing: I, um, also had some bloodwork done related to fertility. I am wondering if those results are in? I haven't heard anything.

Answer Nurse: Oh, let me look...is...was that for the prednisone?

Progesterone.

Me: Yes.

Answer Nurse: Well, I don't know anything about that. I can't tell you what it means, but it says 4.6.

Me: Oh, okay. I will follow up with my doctor.

Answer Nurse: I will pass it on to his office, too. Someone from there should call you soon.

And I got off the phone and looked at the diagram with all my doctor's scribbles and saw what I already knew. That 4.6 is not 8 or above.

I wanted to cry, but not before getting a second opinion. I figured if the ditzy answer nurse thought it was prednisone, maybe she'd read everything wrong.

So I called back.

Second Answer Nurse: Oh, I can't give you that information. I am not qualified to interpret the results.

Me: But you can't just tell me what the results are?

Second Answer Nurse: No, we aren't allowed to do that. Because I could tell you, and the first question you'll ask is, "What does that mean," and I can't give you a good answer. Someone from that doctor's office will give you a call about it.

Sigh.

A couple days later, I had to go in to see a different nurse for my sinus/ear/congestion issue. She was wonderful. She also used a larger arm band for the blood pressure reading, and discovered my pressure is pretty normal.

On a whim, I decided to ask her about my test results, in case she knew anything. She showed them to me. She also didn't know how to interpret the number, but I saw on the screen: "Progesterone" and "4.6."


Scene 2: At Home, On The Phone With Yvette, Dr. F's Nurse a few days later

Yvette: So we got your results back.

I know.

Me: Uh huh?

Yvette: And your progesterone level was at 4.6, which means you did not ovulate.

There it was.

Me: Okay. So what are my steps now? How do I monitor this?

Yvette: Given that you aren't actively trying to get pregnant, I would just recommend that you start on a weight loss program. We offer a whole bunch of classes, and I will mail you some of that information.

Me: Is there anything else I can do?

Yvette: You can use an at-home ovulation predictor kit, that's about it.


It took me until then to cry.

It's not the end of the world. It can be reversed. I can lose weight. I have time, I think. I hope. I'm only 31. A lot can happen in a couple of years, and who knows. Who knows?

I'm not sorry I know this. I'm glad I found out. I just wish...


I had to go to Walgreens to pick up my steroid-enriched nasal spray (woohoo!) and while I was there, I decided to buy an ovulation predictor kit. Maybe I'm just a glutton for punishment, but I prefer to think of myself as an eternal optimist.

Besides, it wasn't that expensive, and who DOESN'T love peeing on a stick every morning, huh? Awesome!


Scenes 3, 4, 5 and 6: My Bathroom, Around 8 a.m. on Thursday, Friday, Monday, and Yesterday

I pee in a cup. I pop open the tube full of predictor sticks. I place the predictor stick in the cup for 5 seconds. Then I lay it flat. I see the Control line form in full, rich darkness. I see the Test line form, faint. I clean everything up, grouse, and go about my day.


Scene 7: My Bathroom, This Morning
Pee Stick!

So what am I supposed to do with this, then? Because that test line right there? That is definitely darker than the control line.

I guess...um...

Maybe I ovulate every other month?

Maybe the test results were wrong?

Maybe my pee stick is lying?

Or maybe I should be done, now, with testing and worrying and trying to control things that aren't even happening right now. Maybe I back away, and work on getting healthy, and feeling good, and enjoying my time and life and right-now-ness.

Maybe I take this as a good, hopeful sign, and leave it at that.

Yeah?


21 comments:

  1. I am sorry you are going through this. Knowledge is power though and I can empathize somewhat. We recently went thru genetic testing for a heart disease that increases the risk of sudden cardiac death. We found out last year that a family member had the gene (he almost died, found out more about heart problems than we could ever want) and we all got tested. My kid has it. I am devestated. Based on the medical materials and research and his results, it's very serious. He is devestated because he can't do anything physical or he might die. I don't know what it's like to walk around knowing if you run or jump too hard your heart will stop and you'll die. He's scared.

    My primary solace is that at least we know. My primary frustration is that in order to get the best medical care for my kid, I have to work really hard at staying one step ahead, trying to figure out what questions to ask, etc etc etc.

    Sorry... way to much information. Basically, Genetic stuff sucks. But knowing and taking steps to improve one's quality of life in hopes that one's quality of life will not diminish (or end suddenly) helps one get up each morning with hope. Let go of what you can't control, take care of what you can and understand that obssessing will make any condition worse.

    At least in our house that's how we're trying to deal with it. I'll let you know if it works.

    ReplyDelete
  2. My best friend has PCOS and low progesterone levels. When she was ready to conceive, she saw a reproductive endocrinologist, who put her on Clomid and Glucophage. She conceived in her first cycle on those two medications. Her progesterone levels were still low, so her doctor gave her supplements. She now has a healthy three-month-old.

    Fertility issues suck. And it sucks that weight is often a part of it. I am currently on Weight Watchers, losing weight, mostly because I do want to conceive, and I am not sure that I am at a healthy place for that now. I do not know that I have fertility issues, but so many people do, and they are awful. Just know that modern medicine is amazing and a lot can be done.

    Thinking about you...

    ReplyDelete
  3. I love that you took a picture of your peed-on stick and posted it on the internet.

    Sending hugs, love, prayers, and strength your way.

    ReplyDelete
  4. I am so sorry you're going through all this. I can't imagine what a trial it all is. Can I tell you thought that you need a new doctor? One who gets it, gets you, and has a staff with half a brain? Something this sensitive shouldn't be managed by a bunch of dingbats which is what it sounds like you're dealing with. Hang in there...

    ReplyDelete
  5. Wait now...you are not anywhere close to being ready to get pregnant. Do you even really want children? Why are you putting yourself through all this now???

    ReplyDelete
  6. K - you know that medicine is not even close to being an exact science. Hormone levels fluctuate wildly and vary day to day.

    Ovaries don't always just automatically spit an egg out every month like clockwork. Sometimes they take a month off. You could also have one ovary that's lazy and only coughs up an omelette every couple of cycles.

    All of which seems a moot point if you're not even trying to get pregnant.

    Know that if you find yourself in the position of wanting a child, there are a myriad of ways you can have one. Traditionally, in-vitro, foster program, adoption...

    My mom always said the sure fire way to get pregnant was to either spend everything in your savings account or lose your job.

    Apparently it works like a charm.

    ReplyDelete
  7. Hi Kristi,

    I've been reading your blog for about 6 months now and have loved it. So, even though I don't know you I kind of feel like I do! I have PCOS, and was just diagnosed in the last 3 months. I've spent entirely too much time researching the subject so...this is all by way of saying, if you want some information or to talk to someone that is experiencing it please feel free to e-mail me. Chances are it's not an issue for you, but sometimes it's good to hear about symptoms so you can say "oh good, I don't have any of those things". Like a previous poster, I know several people who have become pregnant despite the PCOS.
    Best of luck working through all of it, I'll be sending good thoughts your way.
    Rebecca

    ReplyDelete
  8. doh! That should have read,
    "Dear Kristy"
    Sorry!

    ReplyDelete
  9. anon 1:58 - Thank you for sharing. I can't imagine what it's like walking around with that knowledge...or, I guess, what it would be like not having it and finding out in the worst way. And yeah, let me know how it works out. (sigh)

    m.thom - it is AMAZING to me how many people do not conceive easily. (and p.s. WHERE WAS ALL THIS INFO WHEN I WAS IN HIGH SCHOOL, THANK YOU VERY MUCH). maybe we should start a little group...

    courtney - YAY! Me too! Thanks, Al Gore!

    mom101 - thanks for chiming in. i know you've had your own bouts with pregnancy scares (of a different ilk, but still). the geneticist i saw was awesome, but the rest of the experience was just frustrating. thanks for your empathy. and use of the term "dingbats."

    kirin - well, the thing is that i DO want kids, even if not RIGHT NOW TODAY. and because of the whole Fragile-X thing, it turns out that I may stop being able to conceive altogether at a v. young age (before 40). so i wanted to get tested to find out where i am on that spectrum -- if at least i seem to be in working order right now, or if it's going to be an uphill battle the whole way. based on these not-great but not-completely-horrible results, i think there's not much more i can do until i AM ready. but the bottom line is that i don't think i have until forever to get pregnant, and that waiting until i'm 35 or so just isn't a good idea.

    and i'm glad i know that at age 31 instead of age 36...

    jester - i just love you so much. well, and your mom in this case. not that i'm planning to lose my job, but i'll definitely keep it in mind if i get desperate. :)

    rebecca - thank you also for sharing. it's crazy. i'd like to hear about your progress, and anything you learn as you go along. write me or post here -- i'll be paying attention.

    ReplyDelete
  10. Kristy-

    I'm sorry that you have to deal with less than competent medical "professionals". (And I use the term loosely!) I know that it can be maddening.

    If it is any conselation, my SIL has PCOS and has two beautiful boys. The first one was a suprise. The second one took 5 years to materialize.

    Finally, I totally understand why you need to know now. After spending so much effort trying NOT to get pregnant for, oh lets say the last 15 years or so, I have recently discovered that I really don't need to try so hard anymore. And yes, knowing that 32 would have been a better time to try than 36, would have been helpful.

    -ko

    ReplyDelete
  11. Oy. It does seem like you might want to give yourself a break and take this as a good sign (because honestly, the Word of The Doctor isn't exactly all that confidence-inspiring in this case, is it?) and revisit the whole thing when you have to.

    I would probably be incapable of doing that. Doesn't stop me from trying to encourage you to, though!

    ReplyDelete
  12. sending lots of prayers and fertile well wishes your way. i've been told a great way to get pregnant is to stop trying and both get hammered. usually the stress levels are down, great monkky sex occurs and blammo, preggers. since you haven't even started trying yet my advice means nothing so i'll keep praying for you.

    (ain't it great that your blog can lead to people around the world praying for you? i'm no bible beater, but i just find that so amazing.)

    all the best to you.

    ReplyDelete
  13. Kristy, I think it's great that you are taking strides now to find out what you're in for. I think that the OPK is a good sign that things are at least in some sort of working order and when the time comes you can delve a little deeper.

    After 13 months of "not actively preventing" I am finally 12 weeks pregnant. I wasn't ovulating regularly either.

    So there is hope for you and what is possibly one ovary that just likes to drink wine and be lazy. :) Try not to stress yourself too much now and you can always chart yourself with the OPKs. In the mean time, take care of yourself and you'll at least feel a little better when the time comes.

    ReplyDelete
  14. First off a 4.6 doesn't really tell you anything unless you KNOW what day in your cycle you ovulate. The medical community ASSUMES day 14 for everyone but this is not correct. I URGE you to look into a book called Taking Charge of Your Fertility by Toni Weschler. There is an amazing wealth of knowledge (and power) in that book. It tells you how to track your fertile days of your cycle and how to KNOW if you ovulated and exactly WHAT day you ovulated. This can be incredibly useful when having hormone test done since most test are suppose to be drawn X number of days after ovulation.
    I use the method in that book as birth control (it's called Fertility Awareness Method). I am able to pinpoint my fertile or possibly fertile days and avoid sex during that time (or use condoms). I've been doing it for over a year.

    Secondly, the ovulation tests look for a hormone called Luteinizing Hormone (LH). Your body produces LH PRIOR to ovulation, it's the trigger for Ovualtion. So don't chalk up your cycle as anovulatory yet.
    I ovulate late in my cycle. Day 16-18. Then I have about a 11-12 day Luteal Phase (which is just a fancy term for the time period after ovulating but before your period hits). So I know that should I ever need hormonal testing I know NOT to go before day 16.

    All this I learned from the aforementioned book and charting my cycles. It's amazing. And yes, PCOS sufferers and women with irregular cycles can also chart their cycles. I belong to a FAM support board and we have 2 or 3 PCOS sufferers.

    ReplyDelete
  15. It's just ridiculous that every single issue you can go in for, they focus so much on you losing weight. My mom went in once to an ER to get her broken foot looked at, and the doctor said, by the way, you need to lose weight.

    Sorry you have to be dealing with this stuff so young, but I think working on being healthy and feeling good and enjoying your life is a really good thing to focus on.

    ReplyDelete
  16. I think you are totally right to be taking care of this now while you still have time to fix anything that may go wrong.

    After spending my early 20's trying NOT to get pregnant and then spending my early 30's trying to find out why I couldn't get pregnant and then wind up with a diagnosis of breast cancer at the ripe old age of 33...I wish I would have started the fertility thing much earlier.

    I wish you all the best.

    ReplyDelete
  17. "Newbie Nurse: Please step on the scale.

    Me: [sigh]

    Newbie Nurse says the number aloud and writes it down. I try not to grimmace."

    I went to the doctor yesterday for my annual exam. After my usual half-joking with the nurse ("are you sure you have to weigh me? haha"), I got on the scale, and told her not to tell me what it said. (I just didn't have the strength for it yesterday.)

    So she figured my weight, and then told me anyway. And then I winced and felt like crap about myself for the rest of the day. And she didn't even take off a pound or 2 for my VERY HEAVY shoes and clothes. Damn.

    At any rate, best of luck, I think things will work out for you.

    ReplyDelete
  18. You do not have to step on the scale at the check-up. It is not a requirement. You simply say you are working on this with another Dr and you chose to pass right now, but thank you. (You may discuss the weight with the doctor, if (s)he is your regular internist or ob-gyn ... otherwise, your weight is your business - certainly not newbie nurses or old ones if you don't want it to be... Hi Kristy! :)

    ReplyDelete
  19. I have been reading you for a couple of years (ever since the picture of you in the sundress…LOVED IT). I was finally prompted to comment since I just had a baby who had some genetic quirkiness that I didn't know about before she was born (she has coloboma and a heart defect that was just repaired). Please feel free to take or leave what I am about to share...but I wanted to at least put it out there.
    I am significantly overweight (I like to call it chunky but funky) and it had no impact at all on my ability to conceive. Before we started trying to have a baby, I was *freaking out* about all the hoopla about being at a healthy weight before trying to conceive and my first month off the pill...BAM! Pregnant. I just wanted to put it out there since it sometimes seems like the healthcare industry tries to blame every thing on weight. The important bit is to be healthy regardless of the numbers on the scale.

    ReplyDelete
  20. For fluffycat, regarding why K's doctor was not coming out of left field in addressing her weight:

    When it comes to PCOS, weight really can be a factor. Being overweight, and specifically, carrying the excess weight around the midsection (being apple-shaped rather than pear-shaped) is associated with PCOS.

    I believe that people can be "overweight" and still completely healthy. (And, conversely, one can be an ideal weight and completely unhealthy -- I approach that category.)

    Still, there are some cases where excess weight really is a factor. (Another example, people who are overweight and apple-shaped have a higher risk of heart disease.)

    ReplyDelete
  21. Two cents from a stranger...

    Hi K, I read your blog regularly, usually lurking around in anonymous-ville... giggling because you write exactly in the same manner in which I think.

    Anyways, I thought I'd take a sec to offer this up to you. I was diagnosed with PCOS last year at the age of 27, so I know what you're going through. I learned alot at this website:
    www.soulcysters.com. The message board is a great place to ask questions and learn more.

    Hope that helps! :)

    ReplyDelete