A Surprising Doctor Visit - it actually went well

I had an appointment with my primary care physician today....well a PCP in the practice, not mine because she is 'on a leave of absence' or as I predicted no longer works there. It is for the best really since I never really liked her.

Anyway, my stand-in PCP was nice. I went into the appointment very well prepared with my research. Prepared to fight. Prepared to have to point to the highlighted portions of my research.  Surprise, surprise no fighting required.  I was honestly stunned by this.

They, the PCP and student doctor, seemed to be very receptive to my research about my TSH level and sustaining a pregnancy. I even expect her to actually read the studies and journal articles I passed along.

Long story short my TSH level in December 2007 was 1.78 as compared to the December 2011 level of 4.34.  I'm not sure how to interpret the change in values but it seems like a big change to me.  They did NOT comment about the rise in level but DID order bloodwork which was the main goal of my visit.

I was told that if my levels weren't 'normal' they would call me for a follow up appointment. I am ok with that. It gives the Dr. time to read my research and get a handle on her interpretation and next steps.

I am so happy. Happy that I didn't have to argue as expected.  Happy that my bloodwork is complete.  Happy that I am moving in the right direction.  I will be calling the office on Thursday or Friday to get the lab results. We will see where that brings us.

Rainbow:      It was such a welcome relief to have a doctors appointment go well for a change.  It was so unexpected that I even teared up and thanked them for actually listening to me.  It has been so long since anyone has actually listened to me.  It felt wonderful.

Rainshower:  Not a cloud in sight today.  I hope this weather pattern continues:)

I'm obsessing today

Obsessing about hypothyroidism, it's effects on a fetus, it's long term effects on me.

I'm obsessing about getting the appropriate testing through my primary care doctor. I'm obsessing about what to do with those results.

I'm obsessing about finding a new PCP, OBGYN & RE. I want to wipe the board clean with all of them and get a fresh start with all new people. People that I grow to trust. People who will listen to me. I just need to FIND those people...a daunting process that is difficult.

I fear than my appointment, at which I will be requesting bloodwork, will not go well. I fear he will just send me off with a referral slip to see an endocrinologist. There is nothing wrong with that other than the appt will have been just ANOTHER waste of time, like my last RE appt.

Getting into a thyroid doctor will certainly require a waiting period. Then there is the waiting on medication to go into effect.

This waiting SUCKS. I just want to be pregnant:( I would welcome the obsession/anxiety that pregnancy brings over the obsession over the unknown that I am currently enduring.

Geesh, the feelings I have waiting for this next appointment are on par to the feelings I have during 'the two week wait'

Rainbow: I'm heading in the right direction. I just need patience.

Rainshower: Patience is easier said than done.

Next Steps

After a difficult follow up appointment with my Reproductive Endocrinologist I’ve had a couple of days to think about moving forward.  My husband and I have a talked over a plan based on the appointment and considering the possibility that I have a mild case of hypothyroidism.  Here it is.

1.     Thyroid testing –

I have an appointment with my primary care physician on August 28.  At that appointment I will pour it on thick to get the testing I want.  I want a FULL workup of my thyroid – TSH, T3, T4, Thyroid Antibodies.  I will let the doctor know how much I’ve been through in the last year and how much I have been let down by both my OBGYN and RE and hope for his sympathy.  If that doesn’t work I will be laying on the tears.  That should do it.   After all, I DO have hypothyroid symptoms.  With the results I will:

·      Compare my TSH test from a couple years ago to the December 2011 test and the new test to see if it has risen.

·      IF my T3, T4 or antibodies are abnormal, or my TSH has risen, I will be looking for a referral to a Endocrinologist to consider treatment.

·      IF my TSH levels haven’t risen and T3, T4 and antibodies test normal I will consider it a non-issue (for now at least).

2.     Clomid -

After the thyroid testing and when we try again I will be taking Clomid to help speed up the process and hopefully get a fully developed egg.  (My RE suggested this so that it doesn’t take another 6 cycles to conceive next time)

·      My husband really wants to give this a try.   He thinks that if I drop two eggs and both are fertilized we have a better shot at seeing one of them to term.

3.     Prometrium –

I will also be taking Prometrium after ovulation in case I have a luteal phase defect and to help make my uterus extra inviting.

Rainbow:        If feel better knowing that we have a plan now.

Rainshower:   It stinks to have to look for a rainbow after a terrible rainshower (my Reproductive Endocrinologist appointment).  This process is exhausting.

My Reproductive Endocrinologist drives me nuts

So my Reproductive Endocrinologist (RE) drives me nuts.  She has this ‘face’ she makes when she feels bad for you and she does it CONSTANTLY while talking to you.  Some people may see this as a positive but I’m a straightforward type of gal that just wants to get to the point and keep my emotions out of it. She is not my counselor she is my doctor.

I guess what bothers me about the face she makes isn’t so much the look she is giving me but rather the lack of bedside manner, as my husband puts it.  -As if by delivering rude, thoughtless and inconsiderate comments with a sad face will make it all ok. 

For example, she started off the appointment by reiterating that my “very early biochemical miscarriages" are nothing to be concerned about because they happened so soon. That most women wouldn’t even had known they were even pregnant.  AND that this last pregnancy wasn’t even ‘a pregnancy’ – that she didn’t to count it as a loss. (BAM! That was when it felt like all the air had been sucked out of the room)

I must have had a ‘look’ on my face after she said that because she quickly backtracked and said that ‘yes they were all pregnancies’ but just biochemical pregnancies.  Gee thanks.  That clears that up, right?

It’s kind of hard to recover from that, especially when it happens at the very beginning of the appointment.  I treated it as the writing on the wall.  Right then and there I knew EXACTLY how the remainder of the appointment would go and I was right.

She reviewed everything she had already reviewed at a previous appointment (bloodwork) and reiterated that everything came back normal.  At that point my husband interrupted her to inquire about my thyroid because he knew that by then I was in ‘shut down mode’ – I wasn’t making eye contact with her and not even acknowledging what she was saying.  (My husband knows me quite well to recognize my 'shut down' cues even when they are not directed at him).  She said it was of no concern and said something about a study not providing conclusive evidence blah-blah-blah.  Really? Just because it hasn’t been proven be a problem doesn’t mean that it will hurt to look into it more.  I’m glad my husband was there to witness all of this. I told him previously that “she railroads you” and doesn’t let you ever talk or ask questions.  She treats it as her opportunity to have a monologue.  It is so frustrating.  Especially when I heard the same monologue last time. Thankfully my husband agreed with me about her ‘railroading’ you.  At least I know now that I am not over analyzing that.

At the end of her thyroid piece she did say ‘you are welcome to look into it more with your primary care doctor if you want.’ Having said this on the heels of 'disproving' the recommendation of Endocrinologist Societies to lower the range of normal TSH levels to 0.3 - 3.0 it just felt condescending.

She even shot me down on my inquiry about MTHFR gene mutation testing saying that since they tested my homocysteine levels that it was unnecessary.  Is that true?  Because my homocysteine level is within normal limits does that really mean it is of no concern?

So to sum things up – she said that there is nothing wrong with me after saying that my last miscarriage doesn’t count.  No additional tests.  No advice on anything to try to sustain a pregnancy moving forward.  Only fertility options, which she quickly pointed out do not reduce the risk of miscarriage, that only help get us pregnant (which we don’t have a problem with).  It feels as though she has washed her hands of me.  I feel so warm and fuzzy right now, how about you?

Rainshower:               This is exactly why I was anxious about this appointment.  Deep down I knew that I was going to walk out of there disappointed, heartbroken and depressed.

Rainbow:                    Rainshowers and more rainshowers today.  At least I know that I wasn’t being too harsh on her last time because my husband was not impressed with her bedside manner (even though he did find her helpful in other ways).

Reproductive Endocrinologist appointment tomorrow

I'm getting anxious about my appointment tomorrow. It is for my follow up appointment after my third miscarriage.

On one hand I'm looking forward to it on the other I'm dreading it.

I'm hopeful that the RE will have some additional testing in mind prior to my inquiry BUT I'm preparing myself for another 'canned' response that does not soothe my soul.

At least now, after a third loss, she cannot tell me that there is not something going on.... The odds of having three recurrent miscarriages being 'just really bad luck' have to be minuscule.

I'm also hopeful that she will give me the appropriate time to ask questions and that she will not shut me down when I broach the subject of my thyroid level.

I understand that if she is not helpful I should be finding a new RE. While this would be a good idea regardless of the outcome tomorrow I hesitate.

I hesitate only because this whole process is unpleasant. I don't want to have to rehash my history and dwell in the negative at a new doctors office. I don't want to waste time waiting to get in to see a new doctor either.

I'd rather waste time waiting to see an endocrinologist right away, not after a NEW RE refers me.

I suppose I will push to have my current RE refer me to an endocrinologist and then search for a new RE to continue working with.

I guess that's my plan if tomorrow doesn't go well.

I hope I'm pleasantly surprised tomorrow though.

Rainbow: I feel like I'm finally heading in the right direction

Rain shower: It's unfortunate that the right direction I'm heading in had to be after 14 months and three lost pregnancies.

The Dreaded Doctors Office

On the heels of my third miscarriage I have been making regular visits to the doctors office for blood tests to monitor my HCG levels until they return to zero.   

I see a specialist for my recurrent pregnancy loss ‘issues’.  A Reproductive Endocrinologist.  An RE.  The worst part about an office visit is the waiting room.  Although their waiting room isn’t as miserable as the waiting room at the OB office, it isn’t a happy place to find yourself either.  At least there aren’t babies galore and pregnant bellies everywhere I look.  Nothing is worse than sitting in a waiting room packed full of happy, optimistic soon-to-be parents when you are in the midst of a miscarriage.  It is a slap in the face, a ‘see what you can’t have’ kind of proof.  It is heartbreaking.  It makes the whole experience that much harder on me.

The specialists’ waiting room has a completely different feeling to me.  It is a depressing place.  I think, “It is so unfair that I have to be here”.  There is a sadness that comes over me when I am there.  It’s an admission of a problem.   There is no escaping that feeling when you are there.  No distractions to keep your mind off of your struggle.

I feel like there is a mutual, unspoken conversation that patients have with one another as they settle in.  We say to one another:

“It sucks that we have to be here”

“I hope it works out for you”

“I really hope that things work out for you SOON”

“I hope you at least have good news today”

“Good luck”

“I’m sorry”

At the same time I’m silently sympathizing with my new pal I find myself wondering about her story, circumstances, and challenges.  I size her up against myself. 

• She’s older - IVF?
• She’s younger - miscarriages, like me?
• She looks nervous – is she doing an IUI, IVF, testing?
• She looks nervous - maybe she is in a treatment cycle?
• She looks sad – how many treatment cycles has she been through
• She’s slightly smiling - maybe she got lucky and is looking forward to getting out of this dreadful place but respects my heartache by containing her happiness?  (I need to remember this when I get good news)

I long for the day that the RE sends me off to my OB with a growing belly, strong heartbeat and optimism.  That will be the day that the waiting room will no longer feel like a torture chamber.  It is then that I will sit in the OB waiting room, a cautiously expecting soon-to-be parent, scanning the waiting room for that sad-faced, flat-bellied woman that reminds me of myself and feel true heartache for her.

Rainbow:              I am consoled by the women that I have a mutual, unspoken conversation with in the waiting room

Rainshower:       It is unfair that a room full of chairs, magazines and diplomas has produced such a profound feeling of dread in me.

Poised for a baby boom (according to CNN money)

Gee, thanks CNNMoney for this headlining article. Now I can't even get the news without being reminded that I'm not pregnant. Way to rub it in.

It's bad enough there are pregnant people everywhere I turn and celebrity gossip columns obsessed with 'bump watch' these days. Even my Barista is pregnant for goodness sake.

Now I hear we are poised for a 'baby boom' because of pent up demand following this dreadful recession. Great. More pregnant people to encounter. Wonderful.

Ugh. And I thought my week was going ok.

Rainshower             Reminders are everywhere, even in the places you go to distract yourself from your problems

Rainbow                  Hopeful I'll be part of this baby boom they are forecasting. It would be nice to be associated with a positive statistic for a change.

Seeking Control

Some weekends my time is consumed by all things baby/miscarriage.  I login to my websites, read forum posts and research the many things that ‘could’ be wrong with me, etc.  Then other weekends I don’t really give it much thought, which are the best kind of weekends.

I was able to get a few things done around the house this past weekend.  I find that when I am able to fill my time with these types of things, things I enjoy doing, my workweek begins much better.

I won’t lie; I’m quite frustrated with my husband right now.  He is dragging his heels on a pretty big project at our house.  He is in charge of Step 1, Demolition, so we can hire a contractor to do the job (because I’m fed up with waiting for him to get around to the rest of it).  He has avoided this project since January.  I have done 75% of it myself so far.  I’m just asking for help with the last 25%.  Apparently this is too much to ask.

Why is the demolition  a big deal?  -I feel like the only place I have control is at home. 

The things I can’t control:

• my job
• my body
• my ability to carry a baby to term

Home is the only place I have control.  Home is my safe place, the place that makes me happy, gives me hope.  I can control its appearance and I thoroughly enjoy altering it to make it our own, especially because I am a creative type. 

So, get with the program, husband.  Please help me be distracted from the many things out of my control.  Help me feel progress at home because I’m not moving ahead anywhere else in my life. 

Rainbow:              When a baby eventually arrives my house will be in perfect shape.  You know, just in time to be destroyed by a toddler.

Rainshower:       I need help with household projects and I don’t have any help.

I'm in a Catch 22

Bare with me here:  I want a new job – I have tried for years to do just that with no luck.  I also want to get pregnant and quit my job.  I don’t want to get a new job, get pregnant right away, and then quit the new job so it might be best to stay at my current job.  But my current job sucks – there is no satisfaction in my role, no room for advancement and no recognition of my effort; it causes situational depression.  Then there is this whole uncertainty of WHEN and IF I’ll have a healthy pregnancy, which brings me back to the beginning of this paragraph.

My husband wants me to just quit, no new job, no backup plan and no income because he knows that it is adding to my misery.  It’s a scary thought but one I’m beginning to more and more wish was possible.  At the same time I am a very rational person and know this isn’t an option yet (financially). 

I’m a planner.  I have a Master Plan.  Keep working, get out of debt, save money by working through a pregnancy (or most of it at least), build up a savings to supplement the loss of my income after a baby comes and cross my fingers that husbands’ growing career will make up the difference by the time the savings run out.  Sounds great on paper, doesn’t it?  So quitting now doesn’t sit well with me because it interferes with the master plan even if it might be good for me right now.

The planner in me thinks it sounds like my Master Plan is a perfect plan.  Then reality sets in.  There are always unexpected expenses.  Being on a tight budget long term is quite difficult especially for Mr. Big Spender.  Then throw in all of this recurrent pregnancy loss grief, uncertainty and anger and all of a sudden this plan of mine is just ridiculous.  I’m planning for a future that is more uncertain than certain.  Another Catch 22, I guess.

Rainbow          It could be worse.  I’m thankful I have a supportive husband that understands I am really struggling right now.  I’m thankful that he has suggested I quit.  I really shows me how supportive he is.

Rainshower    I just feel trapped in every way (at my job and in this parenthood journey).  It would be nice to have an end in sight, a reason for the losses. 

Sadness has set in

I'm sad.

I didn't feel this upset when I found out I was pregnant and miscarrying.  I guess it has taken me awhile for it all to set in, especially considering I didn't even know I was pregnant this time.  

The uncertainty of everything adds to my sadness.  I'm uncertain that my thyroid is the problem.  I'm uncertain how long it will take to diagnose it, if it is in fact the problem.  I'm uncertain how long it will take to correct my levels so we can TTC again.  What is even more uncertain is the thought of my thyroid NOT being the problem.  Then what?

Recurrent miscarriages alter your thought process.  I really want to find something wrong with me.  Strange, right?  At least there would be a reason for all of this.  At least then I would feel more confident moving forward again for the forth time.

Yesterday I received a "tool" in the mail that I ordered last week.  It helps you to quickly determine your due date based on ovulation.  When we were TTCing I would always look up my potential due date online for each cycle. It is a fun way for me to pass the time and dream about during the two week wait.  Well, the wheel arrived yesterday.  It wasn't nearly as fun to play with as when we were TTCing.  

It was quite depressing really.  In fact, at one point I told my husband that it was 'the wheel of death'.  See where I was going with that one?  Not good.


Obviously I wasn't seeing anything in a positive light yesterday.


Rainbow:        Acceptance is a necessary step in the healing process
Rainshower:   Sadness and uncertainty are probably here to stay for awhile.  At least until after my follow up appointment in a couple of weeks.