Make It Stop

Consuming.

That's the word that keeps coming to mind in the past couple of days.  The pain consumes me, eats me up.  Not much is left behind.

Last Wednesday was the best day, pain-wise, that I've had in months.  I went to PT that day and she did "skin rolling," which she said might leave me sore.  I've been in agony since Friday.  I'm not sure if it was the PT or some other thing that did me in.  It's followed the same general 24-hour cycle it's done in the past—mornings are tolerable and afternoons I contemplate going to the ER.  It's reduced me to a monosyllabic, glazed-over zombie the past few days.  Worse than usual.

Sometimes it feels like a horrible stomachache and I try to pacify it with food.  It's become a rather bad habit, feeding an ache that doesn't really need food.  I don't know what it needs.

Right now it feels like my entire pelvis is burning, pain level about an 8.  If I zone out and kinda become one with the pain, I can feel it take over my entire abdomen, burning a line through my core, out my arms, and leaving my head foggy and achy.  My legs have been spared for now.

I'm forcing myself to blog because I need to get out some of my angst.  The thought of composing an email to a friend or talking to a family member is overwhelming...no ability to concentrate on conversation or care about anyone else's problems.

It feels very indulgent, this hyperfocusing on myself.  I know that might sound ridiculous, yeah, I can't control much about the pain.  But when it goes on for 6 solid months, it feels horribly egocentric and my world feels very small. 

I want to make a quick list of things I want to do when I get better, things I'm afraid I won't appreciate or take the opportunity to do once I'm able.  I want to hold myself accountable.  Here goes:  I want to run again.  I want to go to a yoga class.  I want to have my little nieces and nephews over for a slumber party.  I want to walk around the neighborhood.  I want the pharmacist's cashiers to forget my name (ok, not a goal but a wish nonetheless).

I'm doing everything right.  I'm doing my what my PT says, taking soothing baths, meditating, doing diaphragmatic breathing.  It is still hard to keep the panic at bay, and I don't see how anyone could stay calm through this.  It just creeps in, little voices telling me it might not get better, maybe this is the new normal.  Maybe I will always be too sick to raise a child.

I haven't responded to comments from my last post—sorry.  My infertility therapist is actually required by her workplace to have a certain percentage of her patients be IF patients.  I don't feel betrayed or anything; she doesn't really have a choice.  I'm fine with it mostly, just a little sad.

I'm taking the amitriptyline at night.  The nurse recommended experimenting with taking it at dinnertime to see if that helped with drowsiness the next day, and it hasn't.  I think I'm officially done with this med.  I don't think it's helping and the sleepiness is horrible.  I doubt multiple cups of coffee a day is helping the pain.

When I take a pain medication, I get some relief for about an hour.  Tonight I took it around dinnertime and actually talked to my husband.  He's been getting a lot of "don't talk to me but find something for us to eat" the past few days.

I'm scared.  When I feel the pain in new places, when the pain in my core seems to reach up through my chest and into my jaw and teeth, it's hard not to worry. 

Somnolence, A Break-up, and Books

Y'all, I'm sleepy.

Side note:  I consciously made myself write "y'all" instead of "you guys" or some other y'all alternative.  My non-Southern college friends cultivated the "y'all" out of me (I'm Southern) but I'm trying to get it back.  I just like the way it sounds.

Back to being sleepy.  The amitriptyline (trycyclic antidepressant) is kicking my butt.  I am SO, so drowsy all the time, but not actually tired.  I don't yawn and can't fall asleep before my normal bedtime.  But when my alarm goes off in the morning, the struggle to stay alert begins.  And it is a fight. 

I'm trying to get in touch with my doctor to see if there's a different med I can try.  I don't know if the amitriptyline is even helping, so maybe he'll just wean me off of it.

*****
My therapist is dumping me.  She tried to soften the blow by saying we'd slowly see each other less over time, that she wasn't making a clean break.  And all the usual "it's not you, it's me" stuff.  Since she specializes in patients seeking infertility treatment, I'm no longer in her wheelhouse.  I think she's required to primarily see infertility patients.  It makes me a little sadder than I expected.  She's really helped me through all of this.

However, my psychiatrist will not be dumping me.  She specializes in pregnancy and women who are nursing, but she has room in her practice for a two-time pregnancy FAIL survivor.  I've been seeing her for medication management, and maybe I'll transition to seeing her for talk therapy, too.

*****
In the past year, I've read several books that are memoirs of infertiles or novels with strong infertility/loss/adoption currents throughout, and some stand out as my favorites.  I'm not too coherent now and am never literary enough to write a proper review, so I'll just list 'em.

1. Life from Scratch by Melissa Ford.  Ok, this is not a book about infertility, but Melissa Ford is the web hostess of the largest network of infertiles around:  Stirrup Queens.  Her novel is excellent and many passages are simply beautiful, ones I would have highlighted if I'd known how to on my Kindle.
2. The Memory Keeper's Daughter by Kim Edwards.  I strongly recommend this to women feeling like no one can relate to their loss.  Edwards explores loss so thoughtfully and she really, truly gets it.
3. State of Wonder by Ann Patchett.  Patchett is one of my faves.  She wrote Bel Canto, and while I couldn't decide what I thought about that one, her others have knocked my socks off.  Like Bel Canto, State of Wonder has slowly building suspense.  The settings are so vivid that I felt them, saw them, and smelled them.  The infertility theme in this is subtle at first, but keep reading and you won't regret it.
4. Run by Ann Patchett.  Two brothers in this novel are adopted, which is an important aspect of the book.  I love Ann Patchett for passages like this:  The ache in his ankle was like an angry conversation coming from another room, something persistent, irritated, abstracted, something you should get up and take care of but for whatever reason you don't.  I connected strongly with that.
5. The Patron Saint of Liars by Ann Patchett.  I'm on an Ann Patchett kick, can you tell?  This novel is about a woman who goes to a home for unwed mothers in the 1960's.
6. Good Eggs:  A Memoir by Phoebe Potts.  I picked this up for a couple of bucks at Border's when they were going out of business (sad).   When I got home with it and opened it for the first time, I realized it wasn't a book in the conventional sense.  Instead of text, Potts uses cartoons to tell her infertility story.  She drew me in right away and her personality, wit, and ability to convey emotions.  Loved it.
7. Waiting for Daisy by Peggy Orenstein.  Another infertility memoir and her story is beautifully told.  Loved it, too.

*****
It turns out that you need to be awake to do almost anything.  Work, drive, blog.  I'm up to three or four cups of coffee a day and it barely touches my sleepiness.  Ugh.  I am reading your blogs and would comment if I could formulate thoughts.  I promise to be a better bloggie friend.

Have a nice weekend!

Hey...I've Been Here Before

At my infertility support group last year, the therapist had us write down some of our negative thoughts (eg, "Everyone around me is pregnant") and use cognitive restructuring on them (eg, not everyone around you is pregnant—your 60-year-old coworker isn't pregnant).  I'm realizing that I'm in exactly the same place I was a year ago, except instead of infertility dominating my thoughts, it's pain.   Both have a lot of unknowns, an almost complete lack of control, and a loss of faith in your body.   And lots of negative thoughts.

Overgeneralization
Then (whilst TTC): "Everyone around me is pregnant."
Now (with pain): "Everyone around me can work out."

Wishful thinking (I think I made this one up)
Then:  "If I try doing a handstand afterward I'll get pregnant!"
Now:  "If I lie perfectly still for a week the pain will go away!"

Personalization
Then:  "I didn't get pregnant last month because I ate a conventionally grown strawberry/struck the wrong yoga pose/drank a sip of coffee." 
Now:  "I screwed up my recovery by getting the mail/walking the dog/pulling a weed."

Fortune telling:
Then:  "This cycle will be a bust because I only have one follicle."
Now:  "The new physical therapist won't tell me anything new or helpful."

Catastrophizing
Then: "This will never end."
Now: "This will never end."

So, in terms of personal growth, at least I realize I'm having the exact same kinds of thoughts?  Heh.

*****
One of the downsides of not being TTC is not knowing with laserlike precision when my period will come.  I mean, I know on my Outlook calendar where I marked CD1 for my last period, but I don't know when I ovulated.  I do know I'm well into PMS territory.  I think my pain is picking up in preparation for Aunt Flo, making me even grumpier than usual.

I'm trying a monophasic Pill after this period arrives.  When I took a triphasic one a few months ago, I got really weepy with all the pain, so I'm not too hopeful that this hormonal experiment will work. 

The super fun experiment with my moods will most likely occur when I'm at the beach next week with my family.  Lucky them! 

*****
I wrote the above post last week—I'm at the beach now, which explains why I haven't been blogging and commenting.  I'm also trying to get ready for a trip for work the day after I get back. 

I won't start the Pill until we're back from the beach so my family is being spared the mood swings.  Or at least they are being spared the Pill-related mood swings...they're all my own right now.  And Pain's.  Everyone is at the beach this morning except me.  I'm hanging out at the beach house on CD2, with AF cramps added to my regularly-scheduled abdominal pain.  Good times.  Being here in pain beats being at work in pain, at least.

When I get back and work slows down a bit, I'll tell you about the adoption information session we attended.  And about my great new physical therapist. 

I just realized that my post title also reflects how yet again, my period has come in all its painful glory while I'm on vacation.  Thanks for screwing up another vacation, period! 

Just Relaxing the Pain Away

Hey there!  I have been drowning in work lately and am missing my blog friends.  I very much appreciate some of you giving me blog awards, even though I'm not great at passing them along.  Thank you!!  Bloggers are really some of the nicest people out there.

So, my pain is....getting better!  FINALLY.  There have been huge improvements recently.  The pain doc increased my gabapentin dose and it's really helping.  Also, I went to my first physical therapy appointment last week and it was amazing.  The physical therapist spent a lot of time looking for the cause of my pain, be it a vertebral misalignment, pelvic floor muscle issue, etc.  She didn't quite find it, but gave me stretches and exercises for some problem areas.  I've been doing the PT religiously and it seems to be making a big difference.  Yesss!  I'm figuring out that taking a walk seems to trigger the pain but doing chores doesn't. Grrr. 

To add another doctor's appointment to the mix, since 14 appointments in 2 months may not be enough copays and missed work to satisfy me, I saw a psychologist last week to see if I'd be a good candidate for biofeedback.  The jury's still out on whether I would be or not—the psychologist is going to talk to my regular fertility therapist and come up with a plan.  The biofeedback psychologists were sure they could help me in some ways, though, even if it wasn't through biofeedback. 

And then they pissed me off.  They said my anxiety was contributing to the pain and we needed to get it under control.  I guess that's one of the general ideas behind biofeedback, so I shouldn't have been surprised to hear it.

Yes, I have a history of anxiety.  When I'm not taking SSRIs, I have panic attacks, some obsessive-compulsive tendencies, and a generally anxious mindset 24/7.  But I'm taking an SSRI now and am feeling pretty good emotionally, even with all of this pain crap.  I have moments when I'm depressed or anxious (and that's when I tend to blog, so you guys are seeing a lot of those moments), but am mostly ok.

So I'm confused.  I'm supposed to Just Relax?  Even if I'm already fairly relaxed?  It makes me think of the crazy time when I really thought Just Relaxing would get me pregnant.  I worked to achieve a Buddhist monk-like state of calmness for a long time after my first miscarriage.  For months and months, I did fertility yoga videos several times a week.  I meditated daily, practiced mindfulness all the freakin' time, and avoided potentially stressful situations.  And I didn't get pregnant until I gave up on relaxing and took letrozole.

That awful period of Just Relaxing has so many bad associations for me; I can't bear to do the fertility yoga or fertility meditations anymore.  They bring up way too many memories of crushed hope, failed cycle after failed cycle.  It turns out my body needed so much more to get and stay pregnant.

So I guess I get defensive when someone implies that I need to Just Relax, this time to help the pain.  I don't doubt there's ample clinical evidence of anxiety contributing to how you experience pain.  Totally makes sense.  I just don't think I'm very anxious right now.  So there.  /end rant

So, my next step on the road to a healthy pregnancy is a 3D sonogram, also known as a saline infusion sonogram.  I'm scheduled for one on Monday and am freaking out on many counts.  (Of course, these are healthy, normal freak-outs as opposed to pain-inducing anxiety attacks. :))  1)  What if this triggers another pain flare?  I have a call into my RE to discuss the wisdom of having the procedure this cycle as opposed to waiting one more cycle.  2)  What if there's something wrong?  I am pretty sure I will lose it if we see more scar tissue, septum issues, or polyps.

In addition to the 3D sono stress, I have a big work deadline on Tuesday.  If for some reason I'm in a ton of pain after the procedure, I could have major issues hitting my deadline.  Gonna work my butt off until the 3D sono to try to get ahead.

In infertility sadness-related news, why can't I anticipate which events/places will make my heart feel like it's breaking?  Went to my niece's and nephew's piano recital last weekend while I was PMSing, and seeing all the cute kids and parents made me want to weep.  I desperately want to attend all of my niece's and nephew's recitals or big games, but need to steel myself for them.  I'll be going to two dance recitals in June. 

For a moment at the piano recital, though, I wanted to protect myself from ever having to see that many kids and parents again in one place.  Avoidance can be fun!  I considered skipping my family beach trip this summer to avoid the hordes of children.  Last summer during the trip, I was pregnant.  This summer, in all likelihood, I'll start crying at the kid-filled outlet mall.  Good times.

Alright, back to work I go!

Closer to Fine: My Life on Prozac

I'm the first to admit that I'm not a happy-go-lucky kind of person.  Never have been, never will be.  I have a tendency toward melancholy and worry that probably starting showing in infancy.  What was diagnosed as colic or reflux was probably just my inner grump beginning to show. 

I took Prozac and similar medications, other selective serotonin reuptake inhibitors (SSRIs), all through my 20's.  My dose was probably too low to be optimal in retrospect but I managed ok.  Whenever I'd try to taper off, sadness would return and I'd go right back on the pills.  Before we started trying to get pregnant, though, I was determined to taper off for good.  I didn't want to expose my baby to meds and that was that.

I stayed off of SSRIs for two full years while we struggled to get pregnant and suffered our first miscarriage (or, more accurately, suffered a miscarriage early in the process and then had trouble getting pregnant afterward).  The months after my first miscarriage were bleak.  Much to my surprise, I could function at work, showing up on time and even producing, while I was severely depressed.  All of my relationships suffered along with me, including my marriage.  Instead of having a partner, my husband had a shell of a person sitting next to him at dinner every night.   My misery and isolation were overwhelming.

The depression let up a little after several months but still lurked.  It came out in full force when I'd walk past pregnant women and racks of onesies at Target.  I thought that because I was functional—I could work and socialize and even fix my hair most days—I was having a normal response to infertility and loss.

Depression wasn't my only ghost.  I frequently had panic attacks but didn't know what they were.  Wouldn't any baby-crazed woman burst into tears when she realized hot baths were going to annihilate her husband's sperm?  Although I didn't recognize the panic attacks, I knew I felt hyped up and generally miserable all the time. 

I became a self-help junkie.  Listening to guided meditations calmed me down a little, so I meditated two or three times a day.  I practiced yoga and journaled.  I went to individual and group therapy.  I spent time with friends.  It all helped...a little.  I still felt oppressed by sadness and worry.

My husband and I started discussing my going back on medication.   He admitted he wasn't entirely sure I was depressed enough to take a medication, whatever "enough" means.   I wasn't entirely sure, either.  I wasn't down all the time.  I was able to enjoy things sometimes and smile and laugh.   But I felt like something had to change.  The happiness I fought to feel and project wasn't fooling anyone.  I felt like I was constantly fighting depression not to pull me under.  Acting normal, you know, like not bursting into tears when a pregnant woman walked by, was so hard.  I was so tired of the act.

Before I went on meds again, we agonized about the safety of taking SSRIs for a gestating or nursing baby.   After a long Q&A session with a pregnancy-specialized psychiatrist, we decided to go for it. 

The timing was perfect.  I started taking Prozac again last spring and had miscarriage #2 in the fall.  Grieving that loss was a completely different experience from the first one.  My heart still broke into a million pieces, but the backdrop of anxiety and depression was gone.  It's been four months since the miscarriage and I can honestly say I feel ok.   Not on top of the world, "I'm gonna have a baby in 8 months!," but pretty good.   No more 3 a.m. panic attacks.   No crying at the drop of a hat.   In other words, very, very different from how I felt after my last miscarriage.

The difference can't all be attributed to Prozac.  I've changed and adapted over time, too, thanks to tons of therapy and support from friends.  I think Prozac is making a significant contribution, though.

In an ideal world, we wouldn't take any medications at all, especially when we're pregnant.  However, living med-free isn't for me, at least for the time being and probably for the rest of my life.  Off meds, I constantly struggle to stay afloat.  On them, I can begin to believe that someday, this will all work out, and the present isn't such a horrible place, either.

Zero Sum Game

I'm pretty sure my therapist lied to me.

She has many good qualities.  She's a lovely, highly intelligent person who feels more like a good friend, albeit one with an intimate knowledge of infertility psychology, than a therapist.  Once a year, she leads a series of group sessions based on Alice Domar's research.  I attended the series last spring and continued receiving individual therapy from her after it ended.  I cannot begin to describe the many ways she's helped me.

However, despite her extensive scholarship and experience, I can't help but question some of her nuggets of infertility wisdom.  The one that's bugging me lately is about how other women's fertility does not affect mine.  Having babies, she says, is not a zero sum game in which I have to remain childless in order for some other woman to have her baby or babies.  My scientific training tells me she's correct, but there are times I question it.  Like when I found out last week that my husband's brother's wife is pregnant with baby #5. 

This will be their fifth baby in 6 years.  Their children are wonderful and of course I'm happy for them.  Heck, if they keep having them at this rate, maybe they'll even loan us a kid or two.  However, it also makes me sad about my lack of babies, and it's not the first time a pregnancy of hers has done that.  The announcement of pregnancy #3 provoked a weekend-long crying jag that was my husband's first glimpse of how baby crazed I was.  We weren't even trying at the time but I was—surprise, honey!—quite ready to start.  (For the record, I only cried for one night this time!  Progress.)

My husband's brother isn't the only genetic relation of ours to be amazingly fruitful.  My sister is so fertile I thought surely by virtue of sharing half of her genes, I'd be at least half as fertile.  Are our siblings using up our family's fertility allotment?  Outside our family, am I the token infertile friend who has to fulfill some pre-ordained percentage of infertiles in my sphere?  My rational mind accepts that my fertility (or lack thereof) is independent of others', but there's still a little niggling place in the back of my brain that doesn't accept it. 

p.s.  Thank you so much for your Liebster blog nominations.  I am putting together a post about it.  Family obligations over Thanksgiving kept me out of blogging for a while.