Thursday, April 30, 2009

IVF #5 underway

Here we go again! I'm on day 3 of stims today and so far all is well.

Day 2 FSH = 7.0
E2 = 30
LH = 7.5
AFC = 4-6 on each side.

Numbers look great, same as always. But we aren't fooled this time. We're just hoping that somehow, some way, the result will be different than all of the other times. Of course you know how the saying goes about doing the same thing over and over again but expecting a different outcome? Hmmm...I think we might be slow learners. Or maybe, just maybe, the laparoscopic surgery for endo will make a difference?

As Will mentioned, we're both busy, but I'm insanely busy for the next 8 weeks or so with finishing my internship, defending my dissertation, and launching this grant project off of the ground (not sure if I mentioned this before, but I was awarded that grant I applied for a while back that will fund a two-year postdoctoral fellowship. I will be the principal investigator of a clinical research study implementing a novel treatment for trauma. The grant also includes a scholarship to get an M.S. from one of our local medical schools. The masters is a required part of the grant, or I would opt out. How many degrees do I need, after all?! It's getting embarrassing to even tell my family. They think I have an addiction to academics or something. Oh well. More on all this later.

For now, while Will is busy smelling the lilacs and remembering our baboon friends (ah, we're a complementary pair, aren't we?!), here is a short list of things I must do:

Must complete IVF cycle.
Must defend dissertation.
Must complete grant acceptance process for myself and team.
Must see patients.
Must bathe. At least occasionally.
Oh, and must not stress (snort!).


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Wednesday, April 29, 2009

Wednesdays with Will - Lilacs and Baboons

I have been thinking a lot about lilacs and baboons the past few days.

Mo and I have been busy - we are normally busy but this (especially for Mo) is on the verge of ridiculous. Anyway, I was walking through Central Park the other day, and the path I was on had a natural canopy of lilacs. You couldn't help but smile at the incredible smells. While the saying goes that you actually need to stop, sometimes it seems you don't have to. With all this craziness going on, we need to at least be open to the nice things all around us, it doesn't have to take work.

The baboons are another story. When Mo and I were on safari in Kenya about two years ago, we really wanted to see baboons. Each day, however, no baboons were to be found. But then we made a siting of one lone baboon in a tree. As our Range Rover drew closer, we found that they were actually about 15 in number. There were mommas and papas, uncles, aunts, and of course children. There was a lot of playing, arguing, cajoling, fighting, and moments of tenderness. But what really struck me was that there seemed to be no grudges. If you got dropped, you might scream and punch, but within a few minutes things were back as they were.

I think I have lilacs and baboons in my head because I am learning that today is the future I pondered years ago. That holding on to things and begruding the crappy things in my life have done little more than occupied my time. For sure I will still feel the anxiety and frustrations of work and IVF, but hopefully I can learn to dust off my fur and get back to the real work of now and enjoy some of the lilacs along the way.


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Monday, April 27, 2009

Is there something my RE isn't telling me?

The meds arrived at the end of last week for my upcoming cycle. And in amongst the syringes and alcohol swabs and the menopur, follistim, and ganrilex was the new sharps container to dispose of my syringes.

Now, having been through this a few times - er, cough, four times - before, I'm used to getting a sharps container that can be tucked away in the bathroom or kitchen and then easily transported to the clinic for disposal.

Well, when I opened the meds box this time, I was greeted by the following sharps container (shown here, next to my toaster, to give you a sense of scale):

It's GINORMOUS! I have no idea how we will truck this sucker in for disposal. And just how many cycles is my RE planning on me doing anyway?!


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Sunday, April 26, 2009

Sundays of grace #10

1. Walking in my neighborhood on a balmy spring evening. Everyone is out and in the warm air, everyone is just a bit more relaxed, dining at sidewalk cafes, strolling with their dogs, their spouses. Feeling like I can exhale and just be, not rushing for once to the next destination but just walking with my husband, Will.

2. Mmmm...a frosted black-and-white cookie from a local bakery. A last indulgence before stims start in the next few days. Seeing all the cupcakes and cookies lined up in their colored frosted assortments. Walking inside and being surprised by the crisp coolness, marvelling that it's warm enough that the air conditioner is on. What a difference a few weeks makes.

3. Gazing at all the apartments lining the avenue, their windows glowing yellow in the nighttime. Taking the time to notice the details of stained glass and carved wooden transoms. Appreciating all the lives, all the history, packed tightly into this one place.


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Friday, April 24, 2009

Visit with the oncologist

I had my yearly cancer check up yesterday. At this point, a decade after diagnosis, these visits feel mainly like social occasions, although I am being followed for late effects from the chemo, so there is a medical component. I've been seeing this doctor since I moved to NYC just after I went into remission, and I love him.

One of the reasons I'm so fond of him is that he always remembers the details about my life - even now that he only sees me once a year (back at the beginning, he used to see me every couple of months). He's very friendly, very bright. And he's one of those doctors who obviously loves people - he truly wants to know what you're up to, how you are, what you're thinking about, etc. All of which astound me, because I know he is insanely busy.

Unfortunately, yesterday my oncologist's elephantine memory resulted in a painful and awkward exchange.

He came bursting into the exam room (did I mention he's pretty enthusiastic too?), exclaiming, "How's the baby?"

I felt like I'd been punched.

I had been pregnant the last time I saw him, and of course, he remembered. Eyes downcast, lump in throat, I said, "There's no baby."

"But you were pretty pregnant the last time I saw you! Weren't you? What happened?" (Ok, so his memory isn't perfect. I wasn't that pregnant.)

Through tears, I explained that I lost that baby (m/c #2) and the baby after that (m/c #3). And that since then, despite multiple IVFs, I haven't gotten pregnant again.

He asked what the doctors are thinking, and I told him what we've heard. And he shared that he is aware that there is a higher risk for spontaneous abortion (i.e., miscarriage) in women treated with ABVD, my chemo regimen. I hadn't known that. But I'm living it.

We went on to have a fine visit, where he was his usual excellent clinical self. But it was a rocky beginning.

I would have said that I'm "over" the miscarriages, but all it took was a simple question to knock the wind out of me and leave me in tears.

I wonder, will it always be like that?


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Wednesday, April 22, 2009

Wednesdays with Will - Dilemma

Work has been busy (which I am grateful for), so I spent my day off doing errands and going to appointments. One of my appointments today was with my therapist. It's a long story about how and why I see her, but I can tell you it has been positively life-changing.

I always look forward to our meetings. Today was no different. But near the mid-point of our session she dropped a bomb: "I'm pregnant."

Ugh. She did tell me in a very professional way, so no qualms there. We talked a bit about how I felt (shocked, speechless) and discussed what that means about our relationship. I'm not sure, honestly. I am feeling a bunch of different emotions that are all over the map.

I sort of feel that I am losing the only other person aside from Mo who knows me intimately. I never thought I was that attached to her. Heck, if you had told me a few years ago I would be in therapy, I would have called you crazy.

My therapist and I will continue to discuss the complexities of our changing relationship and I will somehow decide what is best for me. After all, this is one of the few things in life that is all about me.

I am curious as to your thoughts/reactions. How would you feel in my situation? Do you think you could/would keep seeing your therapist?


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Sunday, April 19, 2009

Ten years since diagnosis - a cancer story

A little break from my radio silence to mark an important milestone. Today is ten years to the day since I was diagnosed with Hodgkin’s Lymphoma. In this blog, I’ve referred to having had cancer many times, but I’ve never told “the cancer story.” So today seemed a good day to write it – one in which I am celebrating that this illness is a thing in the long-distant past.

The short version of the story is that I was diagnosed with a very treatable cancer. I received standard chemotherapy for my disease. I have not had any problems (minus a few scares) since. Unless you count the infertility. Which no one can link back directly to the chemotherapy but everyone agrees was bad, seemingly very bad, for my ovaries.

The slightly longer version of the story is that I was diagnosed with Hodgkin’s lymphoma at age 27. I had gone in to see my internist for something else, something relatively minor. But while I was there, I asked her to look at a swollen lymph node on my neck, a lymph node that had been there for at least three months. I was embarrassed to show her. I figured I was being one of those “worried well” types. She looked at it and felt it and excused herself. She came back into the room with another doctor whose lab coat said his name and then “Oncology.” I immediately disliked him. They said the lymph node needed to come out ASAP. They also said I needed a chest X-ray. Stat.

Once they started asking questions, it became clear that a number of other symptoms that I’d thought were unrelated and minorly annoying were in fact symptoms of cancer. I’d lost approximately 10 lbs. in the past few months (I thought this was great). I was tired and had stopped exercising (I thought I was lazy). I had terrible itching of my lower extremities (I thought that I needed to switch laundry detergents and was being “sensitive”). I had low-grade fevers (I didn’t think much about this at all).

This appointment happened late on a Friday afternoon, and by Monday afternoon, it had been confirmed (via excisional biopsy) that I had Hodgkin’s lymphoma in my neck and also had a 5 cm mass in the space between my lungs, in my mediastinum. Over the next several, excruciating days I learned that the cancer had not spread below my diaphragm (which was good) and was not in my bone marrow (which was very, very good, although painful to tap into my hip bones to find out).

After getting a second opinion (yes, even a decade ago I was a fan of the second opinion) and weighing different treatment options, I opted for ABVD (a combo of four drugs: adriamycin, bleomycin, vinblastine, and dacarbazine) mainly because it would mean that I might be able to dodge radiation treatment. From the research I had done, chest radiation in under 30s women is best avoided because of increase in breast cancer risk (also not so good for your heart and lung function). My doctor agreed to do the ABVD and take a wait-and-see approach on the radiation. Giving it only if necessary. Fortunately, it didn’t turn out to be needed.

So I underwent six months of ABVD treatments. One treatment every other week. And according to my medical records I sailed through unscathed. Most of the notes say “Tolerating treatment well.” And now that it’s almost 10 years out, I’ll agree. At the time, I found the vomiting, hair loss, fatigue, and nausea very difficult. But it got me my life back.

It remains uncertain if the chemotherapy impacted my fertility. All of the doctors I’ve consulted say that out of the options I had available, ABVD was the least toxic to the reproductive system (MOPP for instance, another regimen, would almost certainly have rendered me sterile). There is little research on subfertility, which is technically the category I fall into (I’m not in menopause/premature ovarian failure and I’ve been pregnant a few times now, but with abnormal embryos).

Despite the lack of research evidence, all of my doctors agree that the medications were not good for my reproductive health. I lost my period for over a year during and after treatment, which they say indicates that my ovaries were damaged (although able to recover). I just have to hope that there are a few good eggs in there somewhere.

At this point, the Hodgkin’s is a long-ago experience. One that has shaped me definitely, and influenced my career path, and that helps me understand patients who are grappling with a number of difficult medical realities. I really wouldn’t change having gone through it. Except for the fertility part.

I try to remember to not be greedy. I have my life, which I would not have without the treatment. And having gone through cancer has given me several gifts, including an incredible appreciation for my health and my strength, which is something I might not have learned for a long time.

But still. These days, four IVFs later, it's hard not to wonder what if. If I hadn't had cancer would I be a mother by now? And since I have had cancer, will I ever be? But I try not to linger there, instead trying to stay grateful for a decade of life now, since my diagnosis.

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Saturday, April 18, 2009

Radio silence

Not much to say so have been hunkered down, quiet. Hopefully it's a sign of healing, rather than moping.

I survived the past weekend's baptism and my friends were very sensitive, which was much appreciated. Nothing about my situation mentioned, which was just fine. At one point, my friend R. quietly turned to me and said that she knew there were many reasons why I might not have wanted to/been able to come, including the recent surgery, my dissertation deadlines, as well as my own struggles to conceive. She told me how much she appreciated my presence and how she knew it was probably not easy to be there. Then she said it would have been ok if I'd had to say I couldn't come. That she would have understood. I thanked her and assured her I wanted to be there and then we let the subject pass. It was lovely that she acknowledged it. And I was thrilled she didn't dwell on it.

I held her daughter throughout the weekend, feeding her, burping her, soothing her. And sometimes I'd look in her eyes and she, all 2 1/2 months of her, would stare back, and I'd wonder: Could I love you? If R. gave you to me at the end of this weekend, could I love you like you were my own? Maybe. And if I could, then, could I love an adopted child? Maybe. Not sure. But maybe.

Since I've gotten back, I've been immersed in trying to get this dissertation moving. Between that and the fact that I'm not sure what to say about infertility these days, you may not hear so much from me in the next little while. But I'm here. Results section of my dissertation is due on Monday. I have another co-culture biopsy on Tuesday. Discussion section (not yet started) is due on Friday.

I am quiet but I'm here. Hope to surface again soon, on a number of levels.


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Wednesday, April 15, 2009

Wednesdays with Will - Spring is here!

For some reason Easter felt different this year. It has been kind of nice that both Easter and Passover have overlapped because it seems that like me, alot of my friends and colleagues are celebrating the beginning of Spring. Whether you are celebrating coming out of the desert or the resurrection, and whether or not you subscribe to either faith to the letter of the law, it is the perfect time to reassess where you are.

Crap, it has been a hell of a year here in our tiny abode, not to mention the U.S. But there are a lot of things to be grateful for and a lot of things I am excited to brush off and start working on anew. New Year's marks the day to start a new year. The Spring seems like the time to start getting outside and start living.

On Sunday I went to see my nephew playing Little League - the ballfield in Riverside Park overlooks the Hudson and there is this neat portion of an elevated highway that was never finished. I love to stare at it and try to figure out how things would be different if they had finished it. It's a strange reminder that it's important to just start something; the destination is not the end all.
Have a great week and enjoy the beginning of the Spring.


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Friday, April 10, 2009

Just quiet

Still here, just feeling on the quiet side, processing all that has occurred in the past month or so (fourth failed cycle, major surgery, the latest consult) and trying to feel my way forward emotionally toward how to face the uncertain future.

I'm starting to feel better from the lap - still a bit fatigued, but the discomfort seems to have subsided.

Tomorrow I catch a couple of planes to go to the baptism of my friend R's baby. I will be her godmother. Will is not able to come, so I will go on my own. I'm looking forward to meeting the baby in person finally and to celebrating with my friend and her family. At the same time, I know the trip will be depleting and bittersweet. It will be hard to hold R's daughter and know that I may never have this experience for myself.

I am so happy for my friend and at the same time sad for us that we are not moving forward on our own journey and may not make it out the other side with a happy ending, despite all of our efforts and wishes to do so. And although I'm trying not to, it's also easy to lapse into the place of "It's not fair." R. is 44 and conceived her daughter after a single IVF. I am thrilled for her but can't believe that she could have the outcome she's had, while we are having the experience we are. Of course I know life isn't fair (got that pretty thoroughly when I was diagnosed with cancer at age 27, and then again when I lived but watched others die of my same illness). And I know that I'm just torturing myself comparing our two situations, so I try to avoid doing this...down this road peril lies.

Any advice on how to cope with the emotional complexities of the weekend?


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