Wow, Thanks For All The Woo!

I appreciate everyone's positive comments and karma from my last post. All the woo seems to be woo-rking. (Sorry, couldn't resist).

I went on Clomid, which thankfully had none of the side effects you read about (crankiness, grumpiness, headaches, ovary aches). Before the pills, I took another day three blood test, which this month showed my estradiol was actually lower than previous months (which is good. The grandma ovaries apparently wax and wane with the aging, and a lower number means it's more of a Botox month: things look good when the estradiol is low.) My FSH numbers always seem to be in good shape, too.

After swallowing Clomid for five days, I had another round of blood tests this morning to see if the Clomid actually worked. On day ten of the cycle, this bloodwork measures the estradiol levels again, as well as the FSH levels. My FSH levels stayed the same, which means they aren't working overtime to produce an egg (this is a good thing, as FSH overtime means your body is working too hard and you may be closer to menopause.) But the best news is that my estradiol level soared. This means that the Clomid worked, and that my ovaries (woo! woo!) are actually gearing up the egg production.

Now I start peeing on sticks once a day to see when I ovulate, then rush to the doctor's office the next day for some mechanical mating, the IUI procedure.

And to bring this on topic to diabetes, I noticed this week that I was craving bad food. One day, I bought two Hershey bars and a bag of M&Ms from the office vending machine, and I haven't done that in years. Another day I ate a white-flour wrap for lunch and was high all afternoon. Typically I eat pretty healthily, high fiber and veggies and all, but damn, this week it was like, bring on the crap. Not sure what that's all about, and I've seen a few blood sugars these week that look like bad SAT scores, but I expect that's over with if the IUI happens in the next week or so.

Less Talk, More Action

With all the sex I had last month, you'd think I'd surely be knocked up by now.

Nope.

It was late, that wily period, making me think that maybe, just maybe, this was the month. The month where I didn't have to buy a new box of Tampax. The month where instead, Mr. Lyrehca bought me a pregnancy test and I peed on yet another stick and saw something good.

(Odd that ovulation prediction kits and at home pregnancy tests both involve holding a plastic stick under you while you relieve yourself.)

But nope.

He did buy the test, a day or two after I knew the period was supoosed to be here. But the damn thing was negative--just as I was *so* sure I was starting to notice weird smells.

"Honey, do you smell that? It smells like something's on fire."

"No, I don't smell anything."

(Me, excited.) "Maybe I'm pregnant if I smell things no one else does!"

Three days later, I bought a new box of tampons.

Annoyed, we called our infertility doc to get the next open appointment, and I went in like gangbusters.

"Look, it's been more than six months," I said. "I just turned 36. We're impatient. We don't want to keep going without help. Should we just look into adoption?"

(Mr. Lyrehca tells me I need to think more positively. For the last few weeks, he'd look at me, and tell me to follow his lead: Pump your arm into the air, and say, "Woo, woo... go ovaries!" After I was sure I'd already ovulated, the phrase changed to "Woo, woo... go feetie," which is short for fetus, of course. No, I am not making this up. Instead, I'm thinking positively and actually did these chants. Kind of like acupuncture: I don't know exactly why or even if it works, but it doesn't hurt to try.)

The infertility doc listened to me rant, listened to the Mister ask calmer questions, and suggested we move on to Clomid and IUI before we consider adoption. The Clomid starts tomorrow, and I was pleased to notice that my out of pocket costs for this round are reasonable. Like, I could stay in for dinner one night and recoup the cost of this month's Clomid.

Clomid is supposed to crank up my grandma ovaries so that I should produce some solid eggs. Apparently, I'm producing an egg somewhere, but it seems to have missed the message about connecting with its soul mate, the Mister's sperm. Like two ships in the night, they're just passing each other for points unknown.

Later this month, we move on to IUI, the romantic turkey baster method of conception to try to ensure a more lasting soul connection within. Apparently, our genetic material needs some help getting together.

Think of the marketing possibilities for this. IUI: the mechanical dating service. Sort of like Match.com for internal plumbing.

After this week's doc's appointment, I immediately signed up for a secondary insurance plan that somewhat covers all this infertility schtick, since my regular insurance chooses not to.

Monthly, this extra insurance will cost about the same as a very fancy pair of shoes. Like, Sex and the City shoes. Altogether, these shoes will ultimately cover a portion of what could amount to a year of college tuition if we have to move forward with IVF cycles.

(And that's a private university, not the in-house state school tuition.)

But first thing's first. I'm being positive.

"Woo, woo... go ovaries!"

But Enough About Me: Stop S. 1955

Others have written about S. 1955 far more eloquently than I can:

Nicole. Kassie. Shannon.

Please don't wait. Take action now.

Book, 'Betes, Baby?

The book project has been steaming ahead this week, and I thank the women who have emailed me their stories and experiences.

Weirdly, it's been tough to find actual numbers of how many type 1 diabetics out there are pregnant each year. Every diabetes association I've contacted--and you know the ones--has responded that they don't keep these kinds of statistics on hand.

Well, why not?

I've been able to find some statistics through medical studies, and I've been in touch with researchers to see how the numbers in 2006 add up.

In other news, my period's due any day now, and while I hope this is the month it doesn't arrive, I feel pretty much the same as I always do. If you start feeling the sore boobs or the nausea, how soon does it usually show up?

Saw my endo last week, and had the usual battery of blood work done. My thyroid levels are actually a tad low now (last month they were too high, so I went on more medication for it), but my cholesterol and A1c levels are pretty awesome.

I went off Lipitor last year in order to start ttc, and thankfully, my cholesterol didn't soar. Instead, because I'm eating pretty healthily in order to keep my blood sugars on a short leash (and have laid off the French fries at dinner), I was psyched to hear my cholesterol is 149.

And because of my boring eating patterns (oatmeal for b'fast, grilled chicken sandwich for lunch, reasonable stuff for dinner), by A1c has responded well this year. I've been under 6 for months, and the latest A1c was 5.6, which was a repeat from my last test. I don't even get that excited any more. The numbers are great, but they've been great for awhile.

So to sum up, book project: chugging along. Diabetes stuff: textbook. Pregnancy schtick: still a waiting game.

Want To Be Interviewed?

I have been very focused this week on pulling together the book proposal for the T1 pregnancy book and I need your help.

For the proposal and a sample chapter, I'd like to interview a few women about their concerns and experiences when deciding to get pregnant, or while trying to conceive.

Should the book become reality, I'd like to be able to use each woman's real name, and her honest experiences as a way to shape the rest of the book.

Interested? Type 1 and know something about getting or being pregnant? Email me at Lyrehca AT gmail DOT com and I'll either call or email you for an interview.

A Mid-March Update

As I've mentioned, I started this blog to try to get some momentum and feedback on chronicling a type 1 diabetic pregnancy.

While things are still on the starting block with that (I'm in the midst of the two-week-wait 'til the period's either late or Very Much There), I got an encouraging email from a potential party interested in a potential book about diabetes and pregnancy.

I'm cautiously optimistic, but need to spend the rest of the month polishing and perfecting a book proposal, so my nose will be right up against that grindstone.

More details down the road.

And yep, as blogged about elsewhere, I did indeed attend the first Boston D-blogging get-together. It was great to share insight and stories, and in short, I look forward to the next one.

Extra! Extra! Read All About It!

I'm super excited that Jenni from
Chronic Babe has featured me and my site in her Lady Bloggers column.

Jenni does a terrific job writing upbeat, snappy columns and comments on news about all kinds of chronic illness, and I'm thrilled to be a part of it.

What is Normal?

Sometimes I never really think much about what I'm doing, because I figure it's normal for me. But I forget that my normal is different from a lot of other people's normal.

In the past two days, three different people at work have asked if I had a nifty beeper as they saw me bolusing. And three times, I've explained, "no, I'm diabetic, and this is my insulin pump."

These three people (the top boss at work, my immediate boss, and an acquaintance) all seemed to think the pump was cool. "Do you write down all the math for when you're figuring out what to eat?" the big boss asked. "Nah, I do it all in my head," I said.

Another coworker, who has heard me explain the details of diabetes, said once that it was hard to fathom how someone she worked with, who is dealing with the same work issues as she is, is also dealing with a whole other set of concerns all the time.

"Diabetes is like the full-time job that never goes away," I said. "Weekends, 24-7. It's always there."

But while diabetes may be the job, I am clearly the boss. The key, I've found, is to streamline as much about the condition as I can, particularly in trying to maintain very tight control while trying to get pregnant. This is why I eat pretty healthily, and try to sneak exercise into my day when I can (I take a lot of stairs), and why I carry my meter with me always and test often.

(Heck, it's 9am on Saturday and I've already tested three times today and bolused twice. The blood sugars have been all in range so far. And I haven't even eaten breakfast yet.)

But not everything runs so smoothly all the time. Earlier this week, while talking to my therapist, I mentioned that when I get to the gym, I like to do 60 minutes of cardio, but that I've had to stop mid-workout because my blood sugar was--look at that!--37.

She seemed impressed that I could maintain an hour on the elliptical trainer, and of course was concerned about the low (She's diabetic herself). Sure, sure, I was low, and great, I'm glad 60 minutes impresses someone. I'm usually more annoyed that I have to stop the workout and eat some Lifesavers (that day, it was the Butter Rum flavor, which I despise, but it was the only pack I had brought to the gym with me). I'm also annoyed that I don't have the time to do the 60-minute elliptical drill every day. These extra 25 pounds would be history if I could.

I'm reminded of something I learned years ago, with a different therapist (God, I sound like a mess, don't I? But I think all this therapy has given me a lot of insight and self-acceptance): The definition of what one can handle changes all the time, and with insight, a person can learn to live with a lot of things that she might have originally thought impossible.

That concept gets me through a lot in life.

Even the nasty taste of Butter Rum Lifesavers while treating a 37.

A New Cycle Is Upon Us

Lots of family stuff this weekend took me out of town and away from the blog. My nephew turned one recently, and there was a family birthday party for him in Manhattan last Sunday.

I must say, being back in the big city for the weekend made me appreciate what I have at home. However, I always love walking the streets of New York, always love getting half-price theater tickets, and always love the city's energy.

Heck, my blood sugars alone were terrific from walking on Saturday, and I didn't wake up feeling achy the next day as I do when I haven't gotten to the gym enough.

But it was quite chilly there and driving out of the city back to New Jersey, where my brother and sister-in-law live, reminded me that I don't miss driving in NYC. And I don't miss how the money ebbs and flows. While the Mister and I had fun, I also went through more money than I typically do in a week at home.

I definitely don't miss that.

On the health front, I went for my second acupuncture appointment tonight and it was more of the same: 10-12 needle pricks, literally painless, and then a half-hour of lying in the dark, listening to calm music.

While horizontal, I thought about all the babies and young children I've known recently: my one-year-old nephew, my nearly-two-year-old nephew, the twins my boss just had last week, and my many friends who have kids of their own. I figured if I could think about fertility, perhaps my body's meridians would pick up the baby vibe and get me on that road for myself (and the Mister, of course).

After my first acupuncture session last week, I got my period the next day, which wasn't unusual. On the third day of my cycle, I got more blood tests to figure out if my TSH, FSH, and estradiol numbers were in sync. (Last month, the TSH and estradiol were too high, and we didn't TTC because of fears of conception horrors with too-high TSH levels).

On the drive to the tri-state area, my nurse called me with the results: the FSH was good, and the TSH was actually a smidge too low. The estradiol was lower than it had been the month before, but still not in the my-eggs-are-so-fertile-I-could-be-in-high-school range.

However, the Mister and I got the go-ahead this month to try to conceive. In an effort to ensure we're not missing anything, we figure we'll have sex-a-go-go for the next three weeks straight. Believe me, I'm exhausted just thinking about it, but as they say, it's for a good cause.

(And yes, we've heard you're supposed to fuck every other day for the week around ovulation when you're trying for a baby. For the past six months, we've been there, done that, and gotten bupkes. This month, we're taking a new approach.)

Between that, the acupuncture, the assorted blood tests, the recent check of the tubes, and the talk therapy, if I'm not pregnant in another month or so, it'll be time to start Clomid and then IUI.

And I actually received a shocking envelope in the mail today: the bill from my first visit to the infertility clinic. Inexplicably, it was for a tiny amount of money and weirdly, my insurance company has actually picked up a good chunk of the bill. I don't want to jinx anything because I clearly have paperwork that states my insurance company doesn't cover infertility, but perhaps they mean they don't cover specific treatments like Clomid and IVF. But for blood tests and the $350-a-pop reproductive endo, by gosh, the insurance company covered a large portion of the total bill.

Who knew?

The Work-Life Balance: I Take A Stand

I decided not to interview for the job.

I must say, after thinking all weekend about whether to go to NY to even interview, much less consider how I'd manage working in one city while having a husband and a house in another, I'm relieved I made the decision.

As one friend told me, "you have more priorities than magazines now."

So thanks for your insight, everyone, and yes, at one time I would have agreed that I should at least go and interview, just to see what happens and to be able to say, "oh yeah, I've talked to people there."

But these days, I've got other things on my mind than being able to say "I'm an editor at (really well known) magazine."

The quest to be a parent continues on.

I started acupuncture last night.

Has anyone tried this for infertility reasons? I'd called my local chapter of RESOLVE and asked for acupuncturists in my town who specialize in treating women who want to get pregnant.

I found a practice and an acupuncturist who has been business longer than I have been alive. When I went last night (and I appreciate that they're conveniently open late, so I can get there after my long commute home and not feel rushed), they pointed out all the baby photos on the wall.

I'd already questioned the doc over the phone before I made the appointment.

Success with infertiles? Yes, they submit studies to academic journals about how acupuncture gets things moving and gets women pregnant.

Covered by insurance? Nah, but the sessions are reasonably priced.

Will the treatment make anything else about me feel better? It could, perhaps, help my blood sugars out and maybe make me feel a general sense of well-being, but getting pregnant is the goal.

Am I typical patient? Actually, no. They tend to see women in their early 40s who are already undergoing IVF and want to make the process work. I told the doc that I wanted to avoid getting to that point, and hopefully I could get pregnant on my own.

As a diabetic, I had no concern of the pain of needles, although one or two of them did hurt either when going in or when I flexed a muscle while they were in me.

To begin, the doc took my pulse and looked at my tongue, and said that despite my checkered medical history, I was in pretty good shape. Based on the pulse and tongue check, the doc decided where to place the needles and how many I'd need.

Basically, I lay down on an examining table, fully clothed, and relaxed as the doc poked about 12 thin needles (total) into my forehead, wrists, belly, and ankles. Then I closed my eyes and listened to Asian-y calming music for 30 minutes, in the dark, and thought about how I didn't need to understand WHY the needles would work, just to have faith that they should.

Afterwards, the doc told me that the chi (energy force) in my spleen and liver was off, and that twice-weekly acupuncture sessions were what he'd recommend.

Today, I had perhaps a half-hour of menstrual cramps, took an Advil, and rejoiced when my period arrived this evening. I'm calling my reproductive endo tomorrow to schedule a new round of day three blood tests on Friday (to see if my estradiol and thyroid levels are perhaps in better shape they were a month ago), and we'll see if the sex for babyhood can start up again this month.

Stay tuned.

Timing

So much of life is about the right timing.

I had a reasonably good week. The Mister and I had a phone conference with the reproductive endo, who said it was OK for us to continue trying to conceive on our own for a month or two before starting to take Clomid.

My CT scans showed I haven't had any recurrences of my weird abdominal tumor, and that my insides are in good shape.

I'm starting to meet with an acupuncturist next week who sees a lot of infertility patients. I figure if something can help me along, why not try it and see what happens?

I started talking again to a therapist who I've seen previously, through phone sessions. This is a woman who used to run group support sessions for diabetics and I was a part of this group for a few years before I left New York. I always loved the idea of therapy--you're paying someone to listen to you talk about yourself for an hour so you can figure out how to deal with your issues. I brought her up to date on where my health is at and where the diabetes is at, and how I finally seem to be ready to have a baby and my body doesn't seem to be cooperating.

And yet....

A week ago I saw a posting for a job I was totally qualified for, at a company where I've always dreamed of working. Like, for years. I've wanted to work for this place and specifically, one of their well-known publications.

Problem is, the company is back in NY, and I'm pretty firmly planted in Mass. along with the husband and the house and the family roots.

When I applied, I'd just come off a horrifying week of long hours and bad management at my current job, and I was feeling pretty cranky about it. So I sent off my resume and a quick cover note.

Wouldn't you know, several days later, I got a call from the human resources department asking about an interview.

But because I knew I couldn't just hop around the country for a new job, I played hardball and said I needed to know the salary range for the job before I considered traveling out of state for the interview. The assistant asked me three times what my salary was, what I would be willing to relocate for, and what my preferred salary range would be, and three times I told her that my current salary was irrelevant, that I didn't want to lowball myself by naming a figure, and that someone in the company knew what the budget for the job was, and that I wanted to know it before I scheduled an interview.

A few friends I told about this were proud of me. But I just figured it's easy to be firm when I know the situation is a long shot.

Sure enough, the senior human resources person called me late on Friday, several days after that first call, after I'd already thought my ballsiness may have cost me the interview. And sure enough, the salary is terrific. Much more than what I make now. At a company a lot more prestigious than where I work now.

But the timing is off. If I were single and still living in New York, I wouldn't think twice about going and giving a kick-ass interview. But now I'm married. Several years older. Living out of state with the husband and the house and the roots. And how can we actively try to have a baby when I'd be in another state, working at my dream company?

I told the HR woman I needed to think about it, after she assured me this is a full time job that could not be done through telecommuting.

The Mister and I have talked, and he's opposed to moving, opposed to uprooting, and while he doesn't want me to feel he's holding me back, he wonders why I should interview for the job at all. I'm thinking I could go and perhaps wow them so much in the interview that they'd be willing to consider my working in the office part of the time and at home the other part.

But then how would we have time to try to have a kid in the next year? And frankly, would it make sense to postpone the kid thing if I'm already close to 36 and already talking to an infertility doc?

I've always been focused on my career, always loved working, and always valued making money. But my body is at a stage where I feel I can't be cavalier about waiting to have a kid, and that if I put it off, I might not be able to have my own. And while I can consider adoption in the abstract, it's not something I want to feel is my only option.

So do I go on the interview and see what happens, or just forget about it?

Been Tagged Again

Four jobs I've had:

--ghostwriter for an advice column on a website for teen girls. (Loved this job.)
--police reporter for a suburban newspaper. (Fires and car crashes, yes. Murders and tangled love triangles gone awry, not so much.)
--fact checker for Cosmopolitan magazine. (I've talked to J.Lo's hairdresser and renowned sex therapists all in the same day.)
--research editor for a magazine (no more details; I'm not ready to out myself just yet.)

Three movies I've loved:

--Heathers
--Exotica
--The Truman Show

Four books I love:

--anything by Jennifer Weiner, but Good In Bed and Little Earthquakes in particular
--Invisible Man, by Ralph Ellison
--The Outsiders, by SE Hinton
--The Outside World, by Tova Mirvis

(Weird theme going on there. It's a coincidence, I swear. I know I fit in somewhere...)

Some places I've lived:

--New York (the Big Apple and beyond)
--Massachusetts (the Hub and the 'burbs)

Some places I've visited:

--Hawaii (Oahu, Maui, Kauai)
--London
--Shorter, Alabama (really, it's essentially a truck stop and a Motel 6 off the highway. But cool name, huh?)
--Mexican Hat, Utah (another blink-and-you'll-miss-it place with a nifty name. But why didn't they call it Sombrero?)

TV I like:

--What Not To Wear
--Grey's Anatomy
--Six Feet Under
--Sex and the City

Four cuisines I love (why limit it to just four foods?)

--Vietnamese
--Cambodian
--Sushi
--Really salty Jewish deli with half sour pickles.

Four sites I check out daily

--My own blog (yeah, I admit it.)
--Mediabistro
--The Diabetes OC
--Springmail and Gmail

Who's up next? Go 'head, Art-Sweet!

Beyond Jelly Sandwiches

I used to eat out all the time.

When I was in my 20s, and living alone, and meeting friends for dinner frequently, I ate a lot of sushi. And Thai. And Vietnamese. I also went through a phase where I'd eat a lot of Fruity Booty before going to bed. God, that stuff was good.

I always tried to count carbs and take the right amount of insulin. Far too often, though, my blood sugar would shoot up in the middle of the night. And far too often, even while on the pump, I'd have to bolus at 2 am and lie in bed awake until my sugar went down and I could fall back to sleep.

One weekend, though, when I didn't have any plans and didn't want to order take out, again, from the few local restaurants in my neighborhood, I checked out the fridge situation:

Bread, miraculously unmoldly.
Grape jelly, artifically sweetened.
Not much else.

I ended up eating jelly sandwiches for dinner and realized something had to change.

Cooking Light became my savior.

I'd heard about the magazine through some diabetic friends, who had raved about the recipes. I bought a copy and became a convert. And a cook.

I explored my local supermarket far more frequently. I learned about spices, about herbs, and about foods that weren't ready-made. (I'd rarely bought raw chicken breasts before Cooking Light. Or fresh basil.)

Now the magazine comes straight to my door every month, and usually it makes my mouth water. Vietnamese clam chowder with cilantro and lemongrass--fantastic. Pork with capers and wine sauce--super delicious. A cranberry cheesecake that was labor-intensive but didn't make my blood sugar skyrocket--a treasure.

The key thing, I've learned from cooking over the past few years, is that these recipes have detailed, specific nutritional information about carbs and fiber and fats. With those, I know exactly what I'm eating and precisely how much to bolus. This is because I follow recipes to the letter. Need an eighth of a teaspoon of something? A few shakes won't do--I measure it out. My two sets of measuring cups and two sets of measuring spoons all get used when I cook.

While I still enjoy Cooking Light, and will be receiving it in the mail for the next two years, I recently went to the library to check out other cooking magazines.

The ones with the most scrumptious photos, and the most unbelievable-looking foods, are the ones without the nutritional information included.

Gourmet, Food & Wine and Bon Appetit all look delicious, if not complicated, but without the carb and fat counts, I don't think it's worth the effort. I wonder if they don't include nutritional information because it would be obvious just how high-fat and high-carb these meals would be.

And if I want delicious food that I doesn't include the nutritional information for, I can always go out to eat. (Something I still do quite frequently).

But the magazines Eating Well, Everyday Food, and to a smaller extent, Cook's Illustrated, intrigued me because they either had the nutritional information included, or had a delicious asparagus recipe (from Cook's Illustrated) that I knew wouldn't send my sugars sky-high.

And while the library had some sort of "Diabetic Recipes" magazine on the shelves, the photos didn't make anything look all that appetizing, and the articles about "eating well when you're diabetic" were pretty elementary. So I skipped that one altogether.

With the carb, fiber and fat counts available for any recipe, a food becomes diabetic-friendly no matter what magazine it comes from.

The Diabetes Personality

I know I'm Type A.

I know I sweat the small stuff.

And I know I'm detail-oriented.

Was I like this before I had diabetes, or did the D make me this way?

My A1cs are good, and I'm on top of what I eat and when I see the docs. As I've said before, besides the diabetes and the cancer scare and everything else, I'm really healthy.

I think this is due to the diabetes personality. I'm convinced that the disease requires you to become a great juggler. Of time, of medications, of paraphernalia like meters and insulins and pump supplies and test strips. Of paperwork and insurance claims and doctors visits. The more you can juggle all the details, the more likely your blood sugars are likely to be within range.

And since I've gone on the pump, and gotten really serious about being diabetic, my sugars have been the best they've been in years. (Of course, the difference between when I was diagnosed, in 1977, and when I went on the pump, in 2000, is immense.) I've also thought more about this disease more in the past, say, ten years than I ever did as a child. I think that's due to the diabetes personality solidifying as I realized I needed to take more responsibility for my health and take it more seriously than I ever really did as a child or young adult.

Do YOU think there's a diabetes personality? Or even more specifically, a type-1 D personality?

Testing, Testing: The HSG

I have some good news and bad news about my hysterosalpingogram (HSG) test.

The good: my fallopian tubes and what they could see of my uterus look clear and unblocked.

The bad: it hurt like a motherfucker to find this out.

If you are scheduled to have an HSG and are reading this, know that it was the speculum used, and not the test itself, that caused me so much pain.

My HSG was yesterday, rescheduled from Monday when the radiologist told me I had too much dye from an earlier CT scan still in my body. Once again, I downed 800 mg of Advil an hour before the test, left the office to get to the hospital in time, and signed in at the front desk. The receptionist nodded at me.

"You were here the other day?" he asked.

"Yep, they had to reschedule the test."

He gave me two johnnies to change into, but when I got into the changing room, I realized he'd given me one gown and one pair of pants. Considering that this test has you lying in stirrups like a typical gyno exam, I knew the pants would only get in the way. But these hospital johnnies require an advanced degree to figure out how to wear one without having it fall open in the front, or have your ass hanging out if you're wearing it backwards. Typically, they give you two to wear: one forwards and one backwards, and it's like wearing a loose nightgown: shapeless but comfy.

With only one johnnie, I tied some oddly-placed ties as best I could, then held my winter coat in front of me to try to avoid inadvertently flashing anyone in the waiting area.

A nurse I'll call Seattle came to get me and brought me to the same testing room I'd been in two days before. We went over an explanation of the test, what brought me here, and a few other details. I pointed out that I'd been here two days before, that I had an insulin pump that I needed to clip out of the way, and asked if I could take more Advil.

"800 milligrams should be plenty," she said. "Some people don't experience any discomfort during the procedure, but others do."

(I am no medical professional, but this is my recollection of the test. For legal and any other purposes, my description only constitutes my experience and shouldn't be considered a doc's opinion or advice).

During the test, the patient lies on her back with her legs up not in stirrups, but in braces that hold your legs up, but let you bend at the knee so your feet hang down. A speculum is inserted so the doctor can see a clear path to the cervix. Once sighted, a small tube is inserted through the cervix and a small balloon is inflated, opening the area up. The doctor then injects a small amount of dye through the cervix to see if there are any obstructions in the fallopian tubes or at the first part of the uterus. They say the patient may experience cramping during the test or afterwards, and that infection or bleeding is a side effect. I signed a consent form for this procedure.

Besides nurse Seattle, I had a woman I'll call Barbados sitting in on my procedure. It was her first day training to be a medical assistant. I also had Dr. Radiology Fellow, a small woman with a cold-fish handshake, and Dr. Radiology Resident, a guy with glasses. Fellow and Resident were the same from Monday's aborted procedure.

"You're back again? I thought it was too late in your cycle," said Resident.

"My IVF doctor said day 11 of my cycle was fine," I replied.

Resident again had the same limp handshake. And again, she did an initial X-ray to see if there was still dye in my body. There was. It looked the same as the x-ray from two days prior. In fact, said Resident, it looked more concentrated than Monday's test because I had had a lot more water in my body that day.

Not again.

The radiologists consulted with the Attending, more senior radiologist outside of the test room, and decided to call Dr. IVF himself to ask whether it was worth it to continue the test, considering it was day 11 of the cycle, this was my second attempt, and I was lying there on the table ready to go.

During that time, I chatted with Seattle and Barbados.

Finally, Fellow and Resident came in and said Dr. IVF gave the go-ahead for the test, saying to just forge on and hopefully, the dye wouldn't get in the way.

Seattle positioned me on the table, and Fellow instructed me to keep my pelvis down, my legs opened wider, and my knees down while she inserted a speculum. Gyno tests have never been comfortable for me, so I clutched Seattle's hand with the first attempt and said, "Just talk to me about anything so I can take my mind off of this. Anything."

I learned that Seattle came from Seattle, now lived in my hometown, and had looked at 12 apartments in one day before settling into the one she lives in today. Her husband is a social worker that works in a drug rehab facility. We talked about the recent brouhaha over James Frey's A Million Little Pieces book and how Oprah had blasted him. (As an aside, I find that entire situation fascinating; I just read the book for the first time in December, and as a journalist, accuracy and fact checking are paramount to my career.)

Talking to Seattle and later, Barbados, helped me deal with the uncomfortable procedure, but Fellow kept muttering to my spread legs that she couldn't get the speculum in the right place to get a clear view of my cervix. "Please keep your pelvis down." "Please open your legs wider." Over and over again.

The speculum just hurt too much at times, and I asked if Barbados could stand at the foot of the table and hold my leg open wider, but Fellow said no. Finally, FINALLY, Fellow got the tubing inside me and started to inflate the balloon. This part I did not feel at all and there was a screen right near my head that showed what my insides looked like with the tubing and balloon within. It looked like a mass of gray and white to me, and not something I could identify clearly, but the radiologists knew what they were looking for.

But then Fellow said there was a problem.

"The balloon isn't inflating fully. We're going to have to do this again."

Can you believe it? I still can't. 

The second time I clutched Barbados' hand and asked why she would choose this kind of job as a second career. (It pays better than her administrative job at a nearby hospital.) Barbados came to the U.S. in the 1970s and has a 17-year-old son who's a basketball star. He doesn't have a girlfriend yet. I was just starting to ask Barbados about whether she was seeing anyone (she's separated from her son's father), when Fellow really started causing pain downstairs with her damned speculum. Like FUCK. For the first time, I addressed the male Resident, who wandered into my field of vision.

"Dude, why would you possibly want to learn these kinds of procedures as a guy," I spat through gritted teeth and anguish. He calmly replied that this was just one radiology procedure he was part of, and that there are all kinds of tests besides this one.

I moaned some more. YOUCH! I am hating speculums and the limp-handshaking Fellow right now. Where's her limp touch now?

Seattle told me to breathe in and out and try to relax, but it wasn't working. I was now crying and asked if we could just try this again next month. A new woman rushed into the room.

"Who are you?" I cried.

I don't remember her name, but she repeated that I really needed to try to relax, and that Fellow couldn't get a clear view. "Could you give me some kind of drug to relax?" I asked. The new woman, who turned out to be the Attending, or most senior radiologist, said there was nothing she could give me to relax the vaginal area. "What about a Xanax," I begged. "Will that calm me down?"

The new woman said no, she couldn't prescribe anything for me. But then she told the Fellow to try a smaller, more narrow speculum. "This one doesn't always allow us to get in to see the entire area," she told me, "but we'll try it."

Apparently the narrow speculum worked fine, though, because Attending got it inside, then threaded the tube and a new balloon into me without a problem.

"Your tubes and uterus look fine," the blessed Attending said. "There's nothing there."

Halle-fucking-lujah.

I was so relieved that I didn't think to ask if they could see everything with the smaller speculum. I didn't think to ask if the dye in my body obstructed any view. And it was only later, walking out of the hospital, feeling physically fine, that I wondered if perhaps the attending was just telling me everything she could see looked fine, just because my case had been difficult.

At that point, and today, half a day later, I don't care.

I called Mr. Lyrehca and told him the test fucking hurt, but that my tubes were clear. And to celebrate, I had a prosciutto-and-mozzerella grilled sandwich for a late lunch and later, for dinner, four slices of a pepperoni-and-sausage pizza. I haven't eaten that kind of pizza in years. My blood sugars were super low at bedtime, but super high when I woke up 12 hours after the pizza, but I still don't care.

At that point, I was more concerned about comfort than blood sugar control. I know I can live with a day of wacky blood sugars after that ordeal, but damn, if that's any indication of what it's like to give birth vaginally, just give me the epidural right now.

The RANT: Pre-HSG

(Begin RANT)

Once again, I'm reminded by how much of an advocate for my own health I need to be.

You'd think I'd be used to this, being diabetic all these years, and knowing how to handle the condition.

And a few years back, when I was dealing with a potential cancer diagnosis, it was the same thing: tell EVERY doctor I was seeing EVERY different health issue I had (the 'betes, the thyroid, the eyes, the whatever-the-heck-it-is tumor thing growing in my stomach).

I can add potential fertility issues to the list.

Yesterday I had scheduled several tests at my hospital to help me figure out why I haven't been getting pregnant. Several docs said "you should schedule some follow-up CT scans to make sure your abdominal tumor hasn't returned, 1.5 years after it was removed." I'd been scheduling these CT scans every few months immediately after the removal, but had tapered them off last fall as the mister and I started trying to conceive. Once you're pregnant, you have to avoid all CT scans so you don't irradiate the kid growing within.

Fine with me.

But since I'm not getting pregnant, the docs figured now would be a good window for a tumor check. SO I go yesterday for the CT scans, which entail waking up super early so I can have the first appointment of the day, drinking two jugs of this nasty milkshake-like concoction that coats your insides so the docs can better read the CT scan, lying flat while they shoot the CT scan rays at you, and give you an IV of a dye so they can also see what's happening inside more clearly.

Because I don't like to spend my days out of work, hanging out at the hospital, I thought it would be a good idea to also schedule the HSG test on the same day. This is the test the IVF doc ordered to see if there's a blockage in my fallopian tubes. So I scheduled THAT test at the same hospital on the same day, just six hours later.

As I was having the IV put in for the abdominal CT scans in the morning, I asked the nurse about my afternoon test. She said that the dye from the CT scans might still be in my body that afternoon, and it might hinder the HSG tests, making it hard to see if there's a blockage in the tubes.

Great.

Why didn't anyone point this out to me when I was making my appointments? Why didn't anyone at the infertilty doc's office notice this when I said I planned to make both appointments on the same day so as to save time?

Since I'd already drank the milkshake goop, and the hospital didn't do the fallopian test in the mornings, just afternoons, there was no way to get the gyno test done first. And to top it off, I pointed out that since my insurance wasn't covering anything infertility-related, I did NOT want to waste my time and money having an HSG test that would turn out to be a bust because the tubes couldn't be seen.

The CT scan tests moved along and while I'm not expecting to hear that my insides have grown any new tumors, I've got to call the docs associated with those body parts (my cancer surgeon and another doc) to find out what those results are. Hopefully, everything looks fine inside, but if my tumor has returned or some other questionable nodules inside look odd, this whole pregnancy thing is off anyway. However, my ab tumor (again, a full story is better told another day, or perhaps on another blog), was some oddball growth that had apparently been inside me for years and didn't appear to be badly malignant, so I chalked it up to just another freaky health problem I've had. Because of its location and frankly, weirdness, I went to a major cancer center to have it removed, but since then, except for the periodical CT scans, I don't worry about it all that much. The diabetes and now the infertility issues far more affect my day-to-day experience.

I went to work after the CT scans and drank 1.5 liters of water in a few hours. It's a lot of liquid, and between that and the crappy milkshake, I didn't think to eat all day. My blood sugars were weird: woke up at 110, was 138 two hours later and corrected to 100, was 184 when I got to work (stress-related, I'm sure), corrected again to 100, but was 243 when I tested before leaving work around 6pm. Again, I hadn't eaten all day, but was annoyed and on the phone with docs all afternoon, so there you go, folks: stress affects blood sugar levels.

At 1:30, I downed 800 milligrams of Advil, as directed, for the pending (potentially painful) vaginal test. At 2:30, I was back at the hospital for the HSG. At 2:40, the radiologists told me they would do a quick abdominal scan to see if the dye from this morning's procedure was out of my system. Remember, I'd drank a ton of water and made several bathroom visits to flush this stuff out, as I was directed to do. For the record, I'd also asked the infertility doc more than once before the test if it was OK to do this test on the same day and was told, more than once, that it'd be fine.

But no.

The radiologists showed me there was still dye in my system, and that it would affect their readings of the HSG test. I pointed out that my IVF doc said it wouldn't be a problem, and they pointed out that since they were the ones reading the scans, their opinion counted more. No test.

Adding to this is that I was told this test could be done on days 7-10 of your menstrual cycle, and this was day 9 for me. I rescheduled the test for today, day 10, but was told I might still have the dye inside me.

I then went to the hospital lobby and sat down in a private area on the floor and called several people on the cell.

One was Mr. Lyrehca, to tell him the test had been a bust.

Two was the IVF center, to ask "What the fuck?" The doc's assistant, who has only known me a week but is probably already sick my calls, listened to me bitch about the scheduling. I told her that I'd only been going there a week, but frankly, I already felt like things weren't working smoothly and I didn't want to fuck around if I'm trying to have a child and I'm not told beforehand the issues around scheduling tests and whatnot. I feel like now I have to always ask WHEN a specific test should be scheduled, both WITHIN my cycle (This appears to be a key thing. I would have scheduled the HSG test on day 7, last Friday, if I'd known I could) and IN TANDEM with my other health concerns (the diabetes, the tumor, the thyroid, ad nauseum).

She got the doc on the phone for me, and he did say he didn't realize that there would be a problem with scheduling both tests on the same day. I felt a bit better about that--at least someone was taking the fall for my runaround.

We then talked about the results of my day 3 bloodwork. He confirmed that yes, because my thyroid levels were inexplicably out of wack, we should not try to conceive this month until my adjusted synthroid dose kicks in... right around the time of my next cycle. My estradiol levels are more of a concern. They fluctuate month-to-month, but mine are higher than they should be, which means I'm in perimenopause at 35. This is the time before your body goes into menopause, and there's no way to know how long it'll last. So while THAT didn't thrill me, the doc said it was the most common reason he sees infertility patients, and that getting pregnant would be more difficult. When I asked about having a second child, he said that too would be more difficult, but that he's had patients get pregnant when they had higher estradiol and worse FSH levels than me.

He said he'd be fine with me having this HSG test on day 11 of my cycle, and that the dye would surely be out of my system by then, and the test would still be effective. OK. News to me, since I'd been told by the radiologist that it was days 7-10 when the test could happen, but whatever. I'm scheduled for another HSG test for Wednesday.

I asked him if the husband and I should start looking into adoption agencies, and he said since he'd just met me, he would have to get to know me a bit better and know what the mister's and my goals were in this process. I thought that was a good point.

After finishing with him, I called the clinic back and asked to speak to the financial person in the office. Apparently, they have a person who wades through insurance issues to find out exactly how one can pay for all this. The person I'd spoken to a week ago was only a part-timer, while I wanted to speak to the head person.

Based on Kassie's advice on yesterday's post, I emailed my insurance rep from work and asked specifically about getting anything infertility covered, since I live in a state that mandates it (although my insurance is based in another state). The rep wrote back and said that anything diagnostic, tests and the like, could be covered, but that the actual infertility treatment was not. This is actually different than what my insurance paperwork says, so I emailed her back a few times just to make sure, and then talked to the head financial person at the clinic and pointed out what I'd been told. The head person said having this in email was great, and that I should forward this information to her so that when my bills are submitted to my insurance, they will code whatever they can as diagnostic and we'll see how that plays out.

She also told me about some finance plan for infertility treatments, and when I asked if I could pay for the infertility bills monthly, after the fact, she told me that all infertility treatments need to be paid in full, in advance. Great. It's not like the Mister and I *wanted* to deplete our savings for this.

She then asked me if I did consulting work, which I do. She told me I could qualify for a secondary insurance plan for my freelance work that would cover infertility treatments on the plan. In essence, I would pay the monthly rates and a certain deductible, and even though it's still thousands out of pocket, as the finance woman told me, "it's a drop in the bucket compared to paying for even one IVF cycle out of pocket." And that's just counting one IVF cycle. Suppose I need three or four? Now the thousands are in the double digits without this secondary insurance.

I feel like this secondary insurance plan might be the answer for me and called the broker to have information sent to me.

I then called the hubby and told him, briefly, about my day, then went back to work for a few hours and barely did any work, instead emailing the details of both my failed HSG test and all the conversations I'd had with the doc and the financial woman.

On my drive home, I thought about how this will all play out.

And when I got home, the hubby was supportive, but told me that he thinks I'm getting overly agitated about things that just happen because that's life. He also said that I think too far ahead of the game, and that we don't need to sign up with adoption agencies now if we haven't even tried any kind of assisted reproductive technology yet. He also said he does a lot of things for our house that don't always go the way he wants them to, and he's waited in line for stamps only to be told the post office is sold out of 2 cent stamps, and he doesn't get as pissed as I do about it. I pointed out that we're talking about our potential family here, and my health, and our children, and I think those are more important than trying to buy some stamps.

I *know* he's not trying to be thick-headed, but I just don't think he knows how to respond when I get wild-eyed and loud about yet another health issue or problem or setback. For the most part, he's generally a great guy, so rather than scream and yell at him about how his answers to my health problems make him sound like a Neanderthal, I calmly listened when he suggested I go (back) into therapy as we sort through this next health chapter, and calmly, I agreed that might be a good idea. At least a shrink would let me talk all about myself and not come back with some dumb anecdote about stamps, for fuck's sakes.

"Go rant on your blog," he also said.

And here it is, people. Thanks for sticking with me if you've actually read this all the way through.

(/RANT complete.)

The Blood Tests

The day after the doc's appointment, I called to schedule the HSG test (it's happening tomorrow) and some unrelated CT scans to ensure a tumor I had removed two years ago hasn't returned.

I also got the results of the day 3 of the cycle bloodwork. Apparently, my FSH levels are fine, but my estradiol had risen from 72 in November to 91 this month. The doc likes to see the numbers below 70. My TSH, for which I've been on Synthroid for more than a decade, was 7.5, up way too much since November, when it was 3.4.

I'm not sure why the TSH and estradiol went so high, so quickly, and I emailed my endo immediately to alter my Synthroid dose. It takes a month to affect the TSH level, though, and while reading a Marie Claire magazine this weekend, I read that babies concieved when a woman's TSH level is off "suffer all sorts of problems." I'm not sure what to do about lowering the estradiol, and the nurse was like "You can talk about that with the doctor when you return in four weeks."

Well, I wasn't planning to wait four weeks to have a lot more sex with the husband on days 9-16 of the cycle, but maybe it'll just be wasted effort if my estradiol and TSH levels aren't in the right place. I figure I'll call the doc's office yet again tomorrow, in between CT scans and HSG tests, to figure out if the sex should be protected this month, just in case.

I've read about the HSG and talked to a friend who has had one. Apparently, you raise your legs up while you're on your back and get an injection of a dye into your cervix and are then x-rayed so that the path of the dye can be tracked. While I'm hoping my tubes are clear and everything looks fine, I'm frankly so used to hearing bad news about my health that I wouldn't be surprised if there's some problem. And since I was told me to take a lot of Advil an hour before the procedure (600-800 mg), I wasn't surprised when my friend told me today that the test hurts. Pain doesn't really scare me any more, but I am glad the test is a short one. I'm hoping I can go back to work that afternoon.

And to top this all off, neither my insurance nor the hubby's covers anything infertility-related, even though we live in a state that mandates infertilty coverage. (Our insurances aren't based in our home state, and we can't change insurance until a year from now). So I've thought about maybe doing all the big-gun infertility stuff like IUI and IVF in a year, when it'll be more likely to be covered under another plan (although I'll be 36 by then), or else just push forward, keep picking up freelance assignments (I do a lot of work outside my day job, mostly for the extra income), and just pay as we go and hope we don't have to spend thousands of dollars out of pocket. An IVF cycle costs $7,500 (that's one try, one month), while an IUI cycle is something under a thousand, for one month. The doc's visit was $350, the blood tests were $375, and tomorrow's HCG test is another $350.

I don't know how people without insurance, or frankly, without savings, have children this way.

But I don't feel sad or upset or anything just yet. I feel like the mister and I are just going through the system, trying to figure out where the problem lies, so we can figure out how to treat it and move on. It's too early to know what'll happen and what the outcome can be.

I did mention to Mr. L. that maybe we should look into adoption agencies now, since I read that the wait to adopt a baby who would look like us can take several years. He told me it was too early to do that and to just see how this week goes.

That sounds reasonable. I can wait a week.

The Clinic Within: Part Two

The doctor was an older man, someone I typically would have avoided, as I prefer female doctors. This guy, however, is widely regarded in his field and the clinic is considered the best place to go for infertility.

He introduced himeself to us, then went over our medical records a second time, covering some of the details that the resident had. He pointed out that I appeared to be ovulating (I'd brought in two months of basal temp charts), and that I was relatively young (35). Again, we covered the basics of my history: type 1 diabetes, abdominal tumor a few years back, some retinopathy, etc., etc. He recommended I get day 3 bloodwork to see how my ovaries were doing. I'd already had this done on my own, back in November, but he wanted to repeat things to see where they stood. The November results were OK, although my estradiol (which tells you if your body is working too hard to produce an egg) was slightly high. My FSH (follical stimulating hormone) and TSH (thyroid levels) were fine.

We also talked about Mr. Lyrehca's health, his high blood pressure and the drug he takes for it (it can affect the sperm in some minute way), and talked about scheduling a sperm analysis.

The doc also recommended I get a HSG (hysterosalpingography) test, which is an x-ray of your fallopian tubes and uterus while they're injected with dye to see if there's any obstructions or abnomalities within. I'd been wondering if I could get a test like that, so while it doesn't sound pleasant (it's on for this Monday afternoon), I'd like to know what's up downstairs and if there's a blockage, it would explain the months of fooling around without a fertile result.

The doc did a vaginal, breast and thyroid exam, and said everything seemed normal.

Back in his office, he said, depending on whether my FSH/TSH/estradiol levels were OK the second time and if the HSG test was normal, he wouldn't be concerend if we wanted to keep on trying to conceive naturally for a few more months, then consider taking Clomid for up to three tries, and then IUI and then IVF. Of course, without the results of any updated test, this was all just speculation.

We left the office nearly two hours later. Mr. L. had to run back to work for a meeting, and I went to have blood drawn for the day 3 test (conveniently, the period timed itself so that my day 3 was the actual day of the appointment. Here's just one rare example of my body doing something I'd like it to be doing.)

Call tomorrow for the results of the bloodwork, they told me.

A day later, I did just that.

The Clinic Within

So yesterday Mr. Lyrehca and I went to see an infertility specialist, or more specifically, a reproductive endocrinologist.

Though I'd known about this appointment for three months, and although I left my office in plenty of time, public transit made me perhaps five minutes late to the doc's office. Mr. Lyrehca called me as soon as my cell phone and I emerged from the underground train.

"It's 10:28 and I'm sitting here in the doctor's office," he said. "Where are you?"

"I'm five minutes away," I panted. "I'll be right there."

(I get more consistent exercise running to and from trains than anything else these days.)

Sweating and huffing, I bolted off the train and into the bowels of a medical building I've been to several times before.

(Weirdly, it's the same pace where I've visited two different gynecologists over the years, as well as a cosmetic skincare clinic. I went there once to have a high-end facial before I got married, and I've been there for my annual vaginal checkups and Pap smears. Now I'm seeing someone there to figure out if I can have a child. I haven't thought about this 'til now, but this building represents some major turning points in my life as a chick: being sexually active, getting married, and trying to have a kid. As far as I know, there's no funeral home inside, but maybe I'll be going back there once I start having hot flashes and complaining about the "change.")

The receptionist asks me for MY health insurance and MY name, even though the hubby is over there in the corner, waiting in the waiting room, and since we have separate insurance (it's cheaper for now, but this year is going to alter that thinking. We'll get to that in a moment.) I sit down and point out to the Mister that I have no intention of having my insurance cover any semen analysis, should we get to that point.

And then we wait and wait. Fifteen minutes later, as I'm getting up to ask the receptionist how much longer it'll be, a too-happy nurse chirps into the waiting room and yells out my first name and last initial. Again, I wonder why I am the patient, since right now, we're not sure where the problem lies, with the Mister or with me.

My weight is noted and my blood pressure is checked (I've given up on Weight Watchers. I can only deal with one major life issue at a time, and losing a few pounds is no longer my top concern). Both are reasonable enough. The Mister and I meet with a resident to go over some of our details, and I hand her a stack of papers explaining my health issues, along with forms the clinic has asked us to fill out about our health histories.

For the record, diabetes is not my only concern, although it covers a lot of ground: retinopathy, thyroid issues, kidney stuff. I take a lot of drugs and see a lot of docs to keep myself looking and feeling fine, but on paper, I'm a challenge.

(And in a story better told another day, I've also had major abdominal surgery to remove an avocado-sized oddball tumor that was actually deemed not-super-malignant-but-not-entirely-benign-either. Suffice it to say that I'm familiar with not one but two major health conditions. As I've said to many doctors, besides the diabetes and cancer stuff, I'm the healthiest person out there.)

The Mister talks about a few of his health issues, and we talk about our timing and our sex lives and how I have two months of waking basal temps all charted out. The resident wonders if our timing is off; i.e., we're not having enough sex at the right times of the month.

(Remember back in school where they told you that having sex without birth control would--dum, dum, DUM!--get you pregnant? This is no longer the case. Research now shows that the women most likely to get pregnant are those who fuck just before ovulation, usually mid-cycle. I wonder what they tell the horny teenagers back in health class? Then again, AIDS is far more prevalent today than it was back when I was in high school, when it was still considered a gay man's disease. But I digress...)

I am sure our sex schedules are well-timed, but the resident thinks otherwise. She points out that I appear to have regular cycles and I seem to be ovulating on time. Bloodwork I had done two months ago indicates my eggs are still in production. The Mister and I talk briefly when she leaves the room and I tell him we need to start having sex every day, no matter how tired we are.

Could it be just a matter of having more sex and I'd be pregnant?

And then the resident comes back to get us.

"The doctor will see you now," she says. "His office is at the other end of the hall."

And down that hall we go.

End Month Five. Start Month Six

Well, my period has arrived. 

Mr. Lyrehca was sad and quiet when I told him, but I feel glad that the infertility doc appointment is in two days. At least there's something new to move on to, rather than another month of wait and see.

And now I don't have to feel guilty about the high sugars I've had. Or the bites of salami and brie I've had this month.

Something's Around the Corner

This upcoming week should bring something new.

My period is due on Wednesday, and considering my track record these past few months, I'm thinking I'm not pregnant and my period will show up right on time.

I don't feel any different--no nausea, no sickness, no boob pain or anything. I just feel as I always do. Plus, I haven't been eating as great as I have been trying to eat over the past five months, and my sugars haven't looked good at all. If nothing else, getting my period this week would mean a fetus wasn't subjected to blood sugars flirting with the 200 and occaisionally higher range these past few weeks.

And on Tuesday, I have an appointment with an infertility clinic that I had to make three months ago, when I'd only been trying to have a kid for a few months. So now that January's here, it's been close to six, and that officially lets me talk to an infertility person to try to figure out what's going on.

Unlike some things I've read, I'm not upset about going to a fertility clinic, and I don't feel like I'm being punished because I'm 35 and some people likely think that I've waited to long to try to have a child. I just want to get this show on the road already, and if something's blocked or clogged or not a strong swimmer or whatever, I just want to narrow it down.

Then I can decide what to do next: take some Clomid? See an acupuncturist? Have laprascopic surgery? Get semen analyzed? Consider IUI and IVF? Look into adoption?

I'll keep you posted.

Insulin: Anytime, Anywhere

I just finished up a week of crazy work deadlines, long hours, and literally taking the midnight train home a few nights. The nuttiness will end this Monday, but right now, I feel like I've just emerged from a dark, narrow tunnel.

I thought about potential blog posts a few times this week when I had to refill my pump at work, or take a quick injection because my pump reserves were low and my sugars were high.

I also reflected on the comment about how someone's doctor said diabetes only takes 10 minutes a day.

Is it diabetes-thinking that makes me eat the same lunch nearly every day, so that I don't have to think more about how my blood sugars will react to an unfamiliar food? Case in point: Thursday night's dinner, consumed at my desk. A coworker went out to a local sandwich shop I've never eaten at, and swayed by the menu, I got a grilled panini sandwich with chicken, pesto, peppers and cheese.

This is actually similar to the grilled chicken and cheese combo I usually eat for lunch from another establishment. But the differences were these:

Lunch sandwich: multi-grain bread, topped with measured portions that are documented on the company's website so I can easily know the carb and fat content of the meal, extra veggies on the sandwich.

Dinner sandwich: white bread, bigger slices, dripping with cheese and pesto and a few roasted peppers. Frankly, delicious.

So I did the best I could with estimating a carb count for the supper, but sure enough, an hour afterwards, I was 290.

Oy.

I took about 5 more units to bring me down, tested an hour later, and the sugar hadn't budged. Cursing the high fat, I took another 4 units. An hour later (and yes, still at work), I was 150.

When I finally got home that night, the blood sugar was fine.

But that correcting and working through the high (my office being freakishly warm this week didn't help, either), took up more mental space than I would have liked. And while I have a desk job that consists of a lot of reading and Internet research and some writing, it's not like I had to stop working for a long time to test and correct and calculate.

But it's still time spent on something other than work, or writing, or things I'm more interested in.

I've also filled my pump while sitting in my cubicle. I work in an open office, and everyone's got a cubicle, but no one is staring directly at me when I'm sitting in mine. But this week I've also filled up the pump in the ladies' room, which in my office is fairly dreary. I usually have to put my bottle of insulin on the floor when I'm not using it, in fear of it falling and dropping if I tried to balance it on the toilet paper roll affixed to the wall. (There's no flat rectangular toilet paper holder surrounding the actual roll as I've seen in other places; those holders are a handy little shelf which can balance my works as I fill up the pump.)

But my favorite story of insulin-ing in public happened before I went on the pump. When I lived in New York, I had a long subway ride into Manhattan to get to work. I often would buy my breakfast of a roll or yogurt and newspaper from a local bodega on my way to the train, and then breakfast on the elevated outdoor platform waiting for the 1 train.

Dining al fresco, if you will.

But one day, the train arrived before I could take my insulin from a deserted corner of the train platform. I was starving, so I definitely wouldn't wait til I got into work, 45 minutes later, so I made a quick decision.

I was on shots way back then, lived out at the end of my subway line. The train was often near-empty when I boarded, and I liked to sit at a certain end of the train so I could minimize how many people would sit near me.

One day, I filled my syringe, looked around the train car quickly, and then jabbed it into my upper arm as discreetly as I could. I thought I was home-free to start eating my yogurt, but instead, a woman sitting several seats to my left (I'd injected into my right arm near the right corner of the train car, away from the public's eye), spoke up.

"Jesus loves you," she intoned.

My first thought was actually, "I'm sure he doesn't. I'm Jewish."

I wondered if she thought I was shooting an illicit substance (in which case, I'd likely shoot into my vein than my arm fat, but whatever.) I also have a big mouth, so I could have told her I was diabetic.

But instead, I remained silent and ignored her, which is likely the best way to deal with a stranger talking to you on the New York subway. I've often thought about that incident and wonder if she thought Jesus would still love me even if I hadn't injected my insulin while riding the number 1 train.

Time Management

Ever feel like there's never enough time to get everything done in a day you want to get done? This week has been one of those.

And yet, even when I want to focus on more exciting things like interesting freelance projects or reading certain books or doing certain things like organizing my house (I'm a huge fan of decluttering) or even writing a new blog entry, there's always something else more pressing happening, like work deadlines or diabetes details.

Diabetes takes up a lot of time. Testing ten times a day. Adjusting the insulin. Figuring out the carb counts. Scheduling and going on doctor's visits. Managing high or low blood sugars. Changing out the pump and infusion set. And this is pre-pregnancy.

I wonder if I'll ever have any time to myself ever again once I'm pregnant and have a child to take care of. This is one of the reasons I've never felt the urge to have a child earlier than now--I was always more interested in doing my own thing than sacrificing my time for my child. And yet, I know that once a person becomes a parent, in my opinion, that person really has to sacrifice a lot of their own priorities and interests for the sake of raising the child with love and affection and good parenting skills.

I've never heard of anyone saying they really regretting having children once the children were born, but that having your own children is worth the hassle and expense and aggravation and details. I don't quite understand this yet, but I figure I will when I actually have a child or children of my own. I used to feel the same way about being married: how did you know that person was the right one for you, and how did it feel to give up the independence (that I, for one, loved) as a single person. For the most part, after being married for about a year now to a man I dated for a few years, I can say that while I see the benefits of being single and married, being married to Mr. Lyrehca makes sense and works for me. I hope I have the same revelation about being a parent as well someday.

I just hope I'll still have time to freelance and work and write and read as a parent. And oh yeah, maintain good diabetes control.

The decluttering may have to wait, though.

Tagged!

I've been tagged by Kassie over at Noncompliant (such a terrific title for a D-Blog, by the way.) Since I'm new to this whole blogging scene, as you may be too, I understand that people within the diabetes blogging community randomly tag one another to spout out five random facts.

On that note, here's my five, plus one.

1. I am a magazine whore. I read because my life depends on it. My favorite thing about where I live is the proximity to my local library. Free books and periodicals...mmmm. Sweeter than candy.

2. I'm in the middle of writing a novel with a diabetic protagonist. Sort of a diabetichick lit. Bridget Jones with a pump. You'd buy this if you saw it on Amazon or at your local bookstore, wouldn't you? Would you buy a ticket to see it adapted to film?

3. I love to eat. Cambodian, Vietnamese, Thai, Greek, deli. Pickles. Peanut butter. Cheese. Cucumbers. Fish sauce. Noodles. Mussels and frites (well done). Ginger. Garlic. Dark chocolate. So much to eat. So little time.

4. I'd work out at the gym every day if I won the lottery and didn't have to instead schlep to my office regularly. While you wouldn't guess it from looking at me, I love Spinning, pushing weights around (though what's the link between retinopathy and weight training? Anyone?), biking, walking, and the elliptical trainer.

5. I'm a New Englander by birth and now by marriage, but I lived in New York while going to grad school and then for another seven years and I loved it. Walking the streets of Manhattan was great for keeping blood sugars under control. There's always something happening and you never know what you might find when you stroll down an avenue or turn a corner. The place is expensive and everything about living there is a hassle, but the energy and possiblity of the place thrilled me.

6. (By popular demand) Mr. Lyrehca just yelled from the other room that he's handy and want me to shout it from the desktop. The man knows his way around a toolbox and our house (and I) thank him for it.

Hmmmm.... I'm not sure who to tag next, since I haven't been reading everyone's blogs all that long. Anyone want to volunteer?

Natural, Schmatural

At a New Year's party last night, I talked with a woman who is pregnant with her second child, due sometime in the spring, and is one of those people who is hiring a midwife. She proudly didn't use any drugs the first time around, and actually said she didn't want more ultrasounds than necessary (she had five the first time) because, as her husband said, "they raise the temperature of the womb."

I pointed out that a high risk pregnancy gets a lot of ultrasounds, and the woman was quick to note that yes, a high risk pregnancy justifies the extra numbers of ultrasounds. What I didn't say was that, as a T1, I always thought that having all the extra tests and ultrasounds with a diabetic pregnancy was a good thing. Sure, there's more likelihood of having something go wrong, but at least the doctors are keeping a close eye on you along the way. And if you're doing all you can to maintain those freakishly normal blood sugars, as many D pregnant women have said they have been able to do, your chances of having a healthy kid are the same as a non-diabetic woman. So all that extra monitoring sounds reassuring to me.

Frankly, I've never heard of the theory that "extra ultrasounds" equal "heating the womb" and the subsequent conclusion of "overheating your fetus." I'll have to run this by a doc on my next visit, but the whole idea made me realize, again, how diabetes has colored my opinions about medical care.

As I've stated before, I've been T1 for 28 years, since age 7. To me, diabetes was always a condition that responded well to medical intervention. Without insulin and blood tests and (showing my old school roots here) urine tests, I'd have been dead years ago, and if I'd only had insulin and no blood or urine tests for 28 years, I'd likely have more horrendous complications today (if I were even still alive) than the relatively well-managed (and in my opinion, minor) complications I do have today.

Unlike many of my non-D peers, I don't fear going to the doctor and I certainly don't avoid it because "I feel fine so nothing's wrong." To me, going to the endo, or to the eye doc, or even the dentist (where unbelievably, my dentist gushes over how perfect my teeth are. My gums and plaque; well, they're another story. But at least my teeth haven't been affected by diabetes!), is another way to closely monitor the sweetness within. Are the A1c and fructosamine tests within range? Are my eye vessels staying out of the retinopathy designation? Is my cholesterol still in check? The kidneys still filtering the way they should?

When the answers are yes, or close to yes, I'm relieved. When there's something amiss, the doc visits are frequent enough that something can be attended to quickly, before a lot of damage or problems have set in.

So when I hear about women like this one last night who was proud of not using drugs while giving birth, or who wants to avoid extra ultrasounds, or about another D-blogger who thinks birth is overmedicalized, I don't get it. To be fair, the other D-blogger is a recently diagnosed T1, so I'm thinking she and I have different histories and experiences with medicine and doctors. But to me, the extra monitoring makes sense. It is expensive and results in a blizzard of insurance paperwork, I'll admit, but I'm fortunate to have the financial means, the intellect and patience to pay for, understand, and wade through the process to get the care (and coverage) I know is beneficial and gives me peace of mind.

And as one last note--the pregnant woman's two-year-old, strictly breast-feed, natural-birthed son was playing last night with my nearly-two-year-old nephew, who was fed with formula and delivered by c-section. Maybe it was the excitement of being up late on New Year's Eve, or maybe it's different parenting styles or just innate personalities. But I couldn't help but notice that the earth son was more of a wuss than my nephew, didn't have as big a vocabulary, and didn't fight for himself when when my younger nephew wouldn't share his toys, even though the earth son was a head taller than my nephew.

"At day care, bigger kids pick on our son to get toys from him," earth son's father said. I'm no parent (yet), and I'm all in favor of raising sensitive boys into terrific men who aren't jerks, but I certainly want my kid to be able to stand up for himself and be confident about it. If an epidural or anesthetized c-section is somehow part of that process, I'm not going to avoid it. After all, who undergoes any other kind of surgery without anesthesia or painkillers?

Bring on the drugs. And fast.

Another Month Gone

Got my period yesterday.

It's been four months of TTC, or trying to conceive, as they say, and Mr. Lyrehca and I are impatient.

Back in August, after eight months of fine-tuning the blood sugars, after an unrelated health issue on Mr. Lyrehca's part, after somehow feeling more OK about the whole baby thing than ever, I stopped taking the Pill.

My blood sugars were actually looking good, even to me. My always-low A1Cs crept even lower. The secret to having managable blood sugars, I figured, was eating pretty much the same thing every day.

Breakfast, it's oatmeal, Splenda-sweetened peanut butter, another packet of Splenda, and some raspberries or blueberries mushed together with a side of skim milk. It's a glorious deconstructed peanut butter and jelly sandwich that reacts appropriately to a bolus and doesn't (usually) send me soaring high an hour after I've eaten (as those white simple carbs do). I will eat this meal for the rest of my life.

Lunch, I'm keeping the local French sandwich shop across the street from my office in business. Since January 2005, I have eaten a turkey or chicken sandwich with herb mayo, Swiss, cucumbers and onions on whole grain bread. People at work can't believe I eat the same lunch every day, but as I tell them, it's easier for me to do the same bolus every day and forget about it. My sugars, again, react appropriately. (The office doesn't know I'm TTC, but they know about the diabetes. They'll learn about the reason behind my daily same-sandwich-schtick in due time).

Dinner's the wild card, because really, a girl's gotta have her fun sometime. And since I go out and socialize over dinner more often than I do over lunch or breakfast, dinner's when I carb count and bolus and generally eat whatever I want to eat.

That means my overnight blood sugars are generally whatever they want to be.

I am awake nearly every night in the wee hours, testing to see if I'm actually within range (which always shocks but pleases me) or woefully high (hello, bolus button!) or low (hello, LifeSavers!)

So, back to the TTC. (Interesting, all the acronyms and fake names for this activity. We're having sex without birth control so we can have a kid, People. Is that so hard to type? But on bulletin boards about pregnancy and elsewhere, TTC is the common term. Besides the more-sanitized TTC, I've seen the appalling BD, for doing the "Baby Dance." or BM, for "Baby Making." Doing the baby dance? Oy. We're trying to fuck over here--move the top hats and tutus to another bed.)

OK, off the soapbox.

August, went off the Pill, was told to have protected sex for a month to get said Pill out of the system, and September, we're going at it.

Early October, the period arrives (and its name is NOT "Aunt Flo," another cringe-worthy pseudonym). I call my high risk doc and endo and ask if we're doing something wrong.

"Get an ovulation prediction kit," I'm told.

We get the kit, which consists of seven sticks I'm supposed to pee on after a certain number of days after the last period. I pee. I see lines telling me I'm about to ovulate. We have our sex.

And again, the period arrives.

I call the high risk ob again and tell her we're still impatient. And since we're 35, we don't want to sit around, literally pissing the time away if there's a problem.

I'm given the phone number of a local infertility clinic and call in November. They don't have an opening until January, which I take. I figure if there's still no positive pregnancy result in the new year, it'll be closer to the "six months of unprotected sex and no pregnancy" definition of infertility, anyway.

In November, I do two things. I call the infertility clinic and tell them I want blood work for an ovarian reserve test, which are blood tests done on the third day of your period to determine if you're even producing enough eggs or not. (Being a researcher is handy; my super diabetes endo didn't know what I was talking about when I called her about this, but thankfully the infertility folks did.) Although my appointment's not for two months, I figure, if I can get the test done and figure out the results, I'll know we're not wasting time these two months if there's no egg to fertilize. I get the blood work done at my primary care doc's office, and get the results faxed to the infertility clinic and myself. And while the infertility clinic won't discuss the results with me til my Jan. appointment (and why would they? They haven't even met me yet, the nutty impatient research-happy diabetic who just wants to get the show on the road already), I can analyze the results myself through the wonder of Google. As far as I can tell, I've still got eggs aplenty. So cross premature menopause off the list.

I also start charting my waking temperatures and oy! observing my cervical mucus. According to a very-often-quoted book out there in pregnancy- and conception-land, taking your temperature first thing in the morning and checking out consistency of your vaginal goop will tell you when you're ovulating so you can figure out when to best fuck for fertility.

There's a nifty online package of this charting thing where you can enter your temps and goop reports online, and the program will pinpoint when you're ovulating (as long as there's no underlying medical problem). So in December, I take my temperature. I check out the mucus downstairs. I keep online records. I tell Mr. Lyrehca when it's time for sex. My computer chart looks great.

And then yesterday the period arrived.

I know next month might work for us and then I can cancel the expensive and not-covered-by-insurance infertility appoinment. I know in two weeks I could conceive and that this stuff just takes time for some people. I also wonder if there's something clogged in my uterus or tubes that's preventing things from connecting and moving along, or if Mr. Lyrehca's swimmers aren't swimming, in which case, bring on the infertility experts.

But right now, all we can do is wait.

And as you can guess if you're still reading along, patience ain't one of my virtues.

It Started Nearly A Year Ago

I married Mr. Lyrehca just over a year ago and we figured that since we were both approaching 35, we should think seriously about the baby thing. He, frankly, was more into it than I was, but intellectually I knew my eggs were getting older and heck, the diabetes wouldn't make things easy.

So we met with a high risk doc who works in tandem with my excellent endocrinologist. The endo focuses on pregnant diabetics, so I figured I was in good hands.

I've heard about those diabetichicks who are like, "I know my sugars weren't where they were supposed to be, but it just happened and now I'm pregnant," or those who aren't aware that super-tight blood sugar control is the best for a growing fetus. Or women who say, "I had a baby years as a T1 mom ago before we knew about such tight A1cs and the baby was born healthy."

I'm not one of those.

Instead, I'm a researcher who finds out the tiniest detail about something before it actually happens. I'd had a fairly hard-core endo when I lived in a different state back in my single days, and she too focused on pregnant type one patients. Her thought was that the A1c should be 6 or below before trying to conceive.

For those non-Ds following along, an A1c of 4-6 is a healthy non-diabetic range. It's generally considered that an A1c below 7 is a good place for a diabetic to consider trying to conceive, or TTC. My current endo says the 7 cutoff is what she recommends.

A year or so ago, my A1cs were actually around 6.3 or so, which may sound great, but for some odd reason, my A1cs have always been in that range, EVEN WHEN MY DAILY METER READINGS (WITH TEN OR SO TESTS A DAY) had much higher averages. So I never really thought my control was as good as my docs thought it was.

The recommended blood sugars for someone trying to get or remain pregnant go like this:

Pre-meals, 70-90
One hour post meal, 140
Two hours post meal, 120

Since I've had readings bounce from 40-400 in a day (thankfully, not that often), and I was seeing averages on the meter from 160 to 180, the idea of remaining around 100 all the time seemed impossible to me.

When Mr. Lyrehca and I first heard about this, I actually teared up and got, as we say, "klempy," which my husband, being more gooey about the baby idea than I was, thought I was crying tears of joy and getting verklempt.

But really, I was freaked out.

I mean, it's one thing for me to have a 200 and feel crappy. I've been doing this schtick for a long time and I know that I'm not going to die tomorrow if my blood sugar is 200 all day, particularly if I'm bolusing what I can to get myself back to normal. Besides, in the most frank possible way, I'm only hurting myself.

But having a baby depending on me for everything, growing inside me, and basically choking in a sugar brine because I can't get my blood to go down, makes me feel horrific and terrified that the kid is doomed from the start.

When I pointed this out to both my doctor and my husband, they had some calming words.

My endo said, and I think about this daily, that it's the average blood sugars that are most beneficial to a growing fetus, and that one high blood sugar once in awhile isn't going to harm the fetus in the way I think it will. It's the average A1C that's important.

She also, at my urging, also does fructosamine tests now, which measure your average blood sugar over the past two to three weeks, rather than the past two to three months an A1C tests. And while she saw how my fructosamines were more in line with my meter readings than my A1Cs were, she also pointed out that my averages, overall, weren't as high as I thought they were.

It's been said before, and I agree, that being a T1 is a never-ending battle for compliance. Sure, my A1C may be under 7, but there's the non-diabetic range that's lower. I may have a week of terrific blood sugar numbers, but that doesn't mean I'll have them next week, or even the next day. It's an ongoing struggle for control, and even when my A1Cs drop in the non-diabetic range, I'm still having a ton of lows and the occaisonal high.

My husband says he'll help me however he can when it comes to keeping certain foods or Diet Coke out of the house so it'll be easier for me to eat right and keep my sugars tight. He says he'll do whatever he can.

But as terrific as he is, and as great as my endo is, and as healthy as all those kids of diabetic moms have turned out to be, and as supportive as all you fellow D people are out there, I'm still doing this on my own. Still doing it all to try to have a healthy baby grow inside me and be born the healthiest that kid can be.

And that still scares the (*)*%^& out of me.

Another Day Educating the World

I just got in from my weekly Weight Watchers meeting. You may ask why I am doing WW when I am one, a diabetic, and therefore already counting carbs and two, trying to get pregnant.

While I'm not pregnant right this minute that I know of, I'm definitely overweight. And while I know how to count carbs and balance insulin ratios, I also know how to eat. And while my sugars and A1cs are great, so too is my ass.

I figure I'll try to lose whatever weight I can before I get pregnant and if the at-home test happens to turn positive before all the excess poundage is gone, so be it.

I've been going for a few weeks now, and like the weekly leader enough to stick around for the motivational meetings. Today she read some sort of holiday fable based on the movie "It's A Wonderful Life." I'm not big into Christmas schtick, but the story is about the guy who wonders what life would be like if he'd never been born. In her story, the character wondered what life would be like if she'd never joined Weight Watchers.

(Bear with me; the go-girl diabetes moment is coming up.)

So the leader says how the character realizes she's twenty pounds overweight, and how that puts her at risk for heart problems and DIABETES. Immediately, I'm thinking, "Where's the Type 2 qualifier in that statement?"

I waited til she was done with her story, and people around the room talked about the challenges of eating during the holidays, and all that. Then I spoke up and pointed out that "Being overweight has nothing to do with being a Type 1 diabetic, and while Type 2 diabetes is far more common, you should really make the distinction between T1 and T2."

The leader thanked me and said she hadn't known that about diabetes and other people around the room said the same thing.

Just one small step in the road to public awareness.

Back to quietly counting carbs and points now.

The Backstory

I've been a T1 diabetic nearly my whole life--28 years out of 35. I'm down with the diabetic scene. Been on a pump for five years, been shooting insulin for two decades before. I prick my fingers every day, many times. I count carbs. I exercise. I know how to do it.

Except I'm trying to have a kid and it's pretty unfamiliar terrain.

I'm amazed by how many diabetic blogs are out there and figure today's my day to join the crowd. I haven't seen anyone else write about being a type 1 diabetic pregnant woman on a daily blog. (If you're out there, let me know!) I've been reading a few diabetic pregnancy newsgroups for awhile now, and they're great. But everyone's in a different stage of being pregnant, and since I'm not even there yet, it's hard to know what will help me when I'm farther down that road.

I also have a terrific posse of T1 diabetic pals. They're all savvy chicks like me, longtime T1s. Between three of them, they have four kids. So I've talked their ears off. Heard them tell me it's possible to have a healthy child even with longterm diabetes. Heard them say it's possible to keep the A1Cs well within healthy ranges. Heard them say they can eat well and maintain the blood sugars and keep the kid healthy inside. I hope I can do it, too.

I've never been one of those "I've been dreaming of being a mom all my life/I can't wait to experience birth/I want a natural experience" people. To be honest, having a kid really scares me. I know how much can go wrong. But at the same time, I think if I chose not to ever try to have children, I'd feel I missed out on something huge. So it's time. For me, it's a question of where I am in life, how old I am, and finally finding the right partner to do it all with.

So here I go. It's going to be a long, wild, and crazy ride.