Homily insights and hope

A couple lines from recent homilies have given me a lot to think about, so I thought I'd share them here.

1.  Thanksgiving Day:  "If you're constantly thinking about what you don't have, you'll end up in misery."

The priest spoke about gratitude and focusing on the blessings you have in your life before he said this line I quoted.  When I first heard it, I was tempted to think it doesn't apply to me.  After all, it's natural and good to desire children, so when you're infertile, it makes sense that you would be thinking a lot about what you don't have (i.e. a child)...especially with the constant focus on diagnosis, treatment, timing of the cycle, etc.  Oh, how quickly I forget that this can be an all-consuming endeavor...which can lead to misery.  So the priest was right, and infertility is a prime example of his point.  I don't want to be miserable, but it's so hard not to think about my infertility when everywhere I look is another easily-achieved pregnancy or another baby.  As attractive as avoidance seems some days, I don't think it would be so practical to only associate with non-married people or those beyond their child-bearing years...as much as I want to right now.  Perhaps some convent or monastery would let us move in there?  ;)  Obviously I have to learn how to cope somehow without being completely consumed by the thought that we don't have children...  If only I could limit my infertility thoughts to x minutes per day.  Once I reach x minutes, then I wouldn't be allowed to think about it any more that day.  HA.  Imagine that.  What probably needs to change is how I think about infertility, which leads me to the next quote...

2.  First Sunday of Advent: "Advent is a season of hope.  How are you growing in the virtue of hope?"

Hearing that was a wake up call.  Or more a like a kick in the pants to get moving.  I had realized a while ago I was really struggling (failing) to have hope, but I haven't done anything about it.  Specifically I mean hope related to infertility.  It feels so vulnerable to put my desire for children before God and ask, "Please, God?"  On my braver days, thoughts may cross my mind like, "I know God will give us children one day," accompanied by an optimistic type of confidence.  But the reality is that He may say no...and that thought tends to stifle any optimism I had.  The thought of a future without children is not something I like contemplating.  I admit I don't dwell on it deeply—just enough to say to God, "Fine!  That's how you want my life (with this pain of infertility)?"  :<  [that's supposed to be an angry pout, complete with arms crossed]  I swear sometimes I have the spiritual maturity of a three year old.  hahaha ;)  When I think about it more, it leads to despair, the opposite of hope, and a constant fixation on the fact that I'm not getting what I think will make me happy.  Me. Me. Me.  This sounds like a recipe for misery (see quote #1).

So how do you cultivate hope, especially in the present circumstance of infertility?  (If anyone has ideas, please share them.)  My first thought is to try to focus less on the end result (baby vs. no baby) and more on what God is asking of me right now with this cross.  That's definitely easier said than done.  Have I mentioned that it doesn't take much to turn me into a crying mess this days?  I realize I have redefined hope to mean the end of my infertility.  How narrow is that??  But I suppose it's not surprising.  It's so easy to become self-absorbed with the situation in front of me which allows me to ignore the bigger picture.  Jesus didn't come into the world so I could be cured of my infertility...He came so we could spend forever with Him.  Okay, so I need to broaden my definition of hope.  That would be a good start.  Here are some excerpts from the Catechism:

"Hope is the theological virtue by which we desire the kingdom of heaven and eternal life as our happiness, placing our trust in Christ's promises and relying not on our own strength, but on the help of the grace of the Holy Spirit." (1817)

"The virtue of hope responds to the aspiration to happiness which God has placed in the heart of every man; it takes up the hopes that inspire men's activities and purifies them so as to order them to the Kingdom of heaven; it keeps man from discouragement; it sustains him during times of abandonment; it opens up his heart in expectation of eternal beatitude. Buoyed up by hope, he is preserved from selfishness and led to the happiness that flows from charity." (1818)

Don't you just love the Catechism?  :)

In a little prayer book I have, I found an examination of conscience on hope, which I think was exactly what I needed.  Right before the list of questions, it says, "...in God's providence, He allows us to fail in those areas in which He especially wants us to grow in virtue."  Okay, so it's really time to do something about this.  And what better time to work on hope than Advent.  Here is the examination:

• Do I immediately say a short prayer when I find myself getting discouraged?
• Do I daily say a short act of hope?
• Do I dwell on my worries instead of dismissing them from my mind?
• Do I fail in the virtue of hope by my attachment to the things of this world?
• Do I try to see God's providence in everything that "happens" in my life?
• Do I try to see everything from the viewpoint of eternity?
• Am I confident that, with God's grace, I will be saved?
• Do I allow myself to worry about my past life, and thus weaken my hope in God's mercy?
• Do I try to combine every fully deliberate action with at least a momentary prayer for divine help?
• How often today have I complained, even internally?

From Father Hardon's Catholic Prayer Book by Fr. John A. Hardon, S.J.>

shift my perspective, but I think it's going to take a lot of tiny, tiny steps.  When the waves of grief hit, they hit hard, and it's so difficult to look past the pain.  But I'm going to try.  :)  I have a feeling I will be referring back to this list of questions often...

Heme appointment #1

So I had my hematology appointment.  First I saw the fellow who took my history and went through my labs with me.  Elevated Factor VIII can be caused by any number of things including stress, infection, etc. so he said that number doesn't tell us anything specific.  The rest of my labs all support the idea that I clot really well—more quickly than normal.  (Extra vWF = clot faster = shorter PTT)  He didn't say what the implications of that are.  Somewhere in the discussion he did casually mention it's possible to acquire "vW disease" but usually it's genetic—it sounded like he was thinking out loud.  He was not saying that is my diagnosis...but I wonder if that's the most likely explanation?  (I don't have a diagnosis yet.)

Then the attending Dr. D came and asked me some more questions.  I swear I was asked by each of them at least twice if anyone in my family had clotting issues.  My answer was no all four times.  ;)  I really wanted to say yes just to satisfy them... hahaha  Dr. D wanted to know if I was sick on the day my blood was drawn for the labs.  I hadn't been sick, but I did mention my uterine strep infection that was found the same day.  I assumed he already knew that—it was listed in the medical record right next to my clotting lab results plus I had already told the fellow about it.  Dr. D asked if I had been treated for it.  I said no.  Apparently that was the WRONG answer.  He went from pleasant to super annoyed in no time and demanded to know why it hadn't been treated.  I wanted to hide under my chair...  I didn't have a good answer...I hadn't asked either of my NaPro docs for an antibiotic yet...they were both really concerned about the clotting labs so I assumed they wanted that part taken care of first.  And if Dr. C (ob/gyn who knew about the infection) thought it was that urgent, he would have given me a prescription right away, right?

So what I gathered from this reaction is that Dr. D might have wanted to repeat some of the labs at this visit but now could not because the strep would skew the results...and perhaps my previous labs were also skewed and therefore not usable?  Dr. D said I am to call him when my "doctor is sure the strep infection is gone" so they can redo the labs and then I'll have another appointment with him.  (Now I really hope that my TEBB disappears with the next antibiotic so I'll have a little "proof" the infection is gone...)  Another trip to see Dr. D isn't so bad...even if it is a long drive.  I asked if I could have the labs done at the hospital closer to home...not an option—they have to be done at his hospital's lab.  Sigh.  I asked if I could have them done the same day as my next appointment with him to make one less trip...no, obviously.  (silly me for asking)  Sigh.  So that means two more trips.  Ugh.  I just want this clotting issue diagnosed and treated sometime soon, and I think it would take longer if I started over with a different hematologist. I'll stick it out with Dr. D at least until the next round of labs.  Hopefully he'll be in a better mood the next time I see him.

Oh, they did say one thing sort of definitive.  This yet-to-be-named clotting issue isn't preventing us from conceiving, in their opinion.  That's good to know.  I didn't get a chance to ask if there is an increased risk of miscarriage with it (should we ever conceive), but I will next time.

Medical update

My appointment with the hematologist is this week.  I was definitely more anxious about it back when the appointment was made two months ago.  Maybe having to wait this long has been a good thing in disguise.  Now I just feel resigned to whatever I find out from the doctor.  Whatever it is, I hope it's fixable.  :)

In other news, I don't think I mentioned the results of my endometrial biopsy.  The pathology report never showed up in my online record (not sure why) but no one ever called me about it so I assume it was normal.  However, the culture showed Group B strep.  That might explain why I still have tail-end brown bleeding (TEBB)...the antibiotic I took (before the biospy) does not cover GBS.  I haven't had any mid-cycle spotting since finishing that antibiotic, so maybe it did some good?  I am excited that we know what bacteria we're facing.  There's less guessing with the next antibiotic choice.  :)  I hear these low grade uterine infections can be tough to eliminate, so I don't know how long it will take, but I'm ready to kiss this TEBB goodbye.  My chart will look so pretty without the TEBB...one more step toward a normal-looking cycle.  :)

In the elevator

One day at work I met a very sweet, elderly woman.  She needed help finding her way out of the building, so I accompanied her.  We chatted along the way.  She was telling me about her family and mentioned the number of children she had.  I don't remember if it was 8 or 11, but it was some lovely large number like that.  :)  I commented that it would be nice to have a big family.  Her eyes caught mine, and she asked how many children I have.  Rather cheerfully I responded, "None yet."  I said nothing else about it, and the conversation continued in another direction.

Then we stepped into the elevator.  No one else was around.  As soon as the doors began to close, she asked, "Can I pray for you?"  Surprised at the question, I replied, "Um, yes. Thank you," assuming she meant she would keep me in her prayers in the future after we parted ways.  I guess that's what a typical Catholic would assume, right?  After all, I hadn't given her any specific intention to pray for.

Well, she grabbed the back of my hand and held it as she placed it on my stomach.  Then she bowed her head and began to pray out loud—still with her hand on my hand on my stomach.  Good thing her eyes were closed so she didn't see my puzzled expression.

A light bulb turns on in my head:  Oh!!  She meant to say, "Can I pray OVER you?" I get it!  I've had people, Catholic and Protestant, pray over me before, but usually it's a little more clear that that is what I am agreeing to and usually there is a specific intention...but, no matter.  Prayer is prayer, and I'm grateful for any kind, even if it startles me a bit.   :)

I was still very confused why our hands were on my stomach.  Holding hands, I can understand.  But the belly of a perfect stranger?

I wish I would have written down her exact words.  It was a short prayer because it was a short elevator ride.  She started out by praising and thanking God.  (I was thinking, "This lady is so sweet...")  She continued, and the only part I distinctly remember her saying was, "Lord, please open her womb."

The entire prayer was for me to become pregnant.  Wow.

How did she know?  I did not tell her we were TTC.  I did not say we had TTC for a year or so without success.  The simple response of "none yet" was something I have said throughout our marriage to anyone who asked if I had children—whether we were TTC or trying to avoid pregnancy.  And I know I was cheerful and smiley when I said it...if I had said it in a more depressed tone, I could see how one might guess we were having difficulty TTC.  Yet, somehow she knew.

Amazingly I managed to maintain my composure and not cry.  If I had been post-peak, there would have been tears.  It was so moving.  I was still in a small state of shock when she was finished, so I simply thanked her, and we chatted about something else while we left the elevator.  After a short walk she recognized the way to the exit, so she turned to leave, but not before giving me a big hug.

That little encounter made my day.  Actually it made my week.  I hadn't prayed for any consolation, but God decided to send me one anyway.  He takes care of us infertiles.  :)

The phone call

Earlier this year I received a phone call.  It was from DH, who was out of town attending a family reunion.  (I couldn't go because of work.)  We chatted briefly about the relatives he saw, and then his voice became very serious.

DH: Um, are you sitting down?  I need to tell you something.

I immediately thought the worst—like someone died or his mom's cancer returned.  I actually did sit down.

DH: You are going to be an aunt.

I was confused at first—none of our siblings are married.

Me: What do you mean?
DH: My older brother is having a baby.  Well, his girlfriend is.
Me:  Oh. Wow.

[Silence]  I sat there in complete shock with my mouth literally hanging open.

Me: I didn't know he was dating anyone.
DH:  I didn't either.  He met her a few months ago, I think.  They haven't been together very long.
Me:  Are they going to have the baby?
DH:  Oh, yes.  For sure.
Me:  Are they going to keep the baby?  Are they thinking about adoption at all?

I was thinking, "Oooh, we could adopt their baby!  Wait...what a weird situation that would be—raising your brother's biological child.  And we haven't even discerned adoption yet.  Okay, scratch that thought."

DH:  They will keep it.  You know how much my brother wants kids.
Me:  Are they taking about marriage at all?
DH:  Actually, yes, but there isn't a date.  They had to tell some of her relatives that they were engaged to keep peace in the family.  In the meantime, she's going to move into his house.

At some point during the conversation I started to cry.  I had a million thoughts racing in my head.  Why do they get to have a baby?  Why can't we?  It's not fair.  They knew each other for a few months at most before they got pregnant.  And now we're infertile, and they're having a baby.  We're supposed to be having the first grandchild, not them.  (It's scary how much I sound like the older brother in the prodigal son parable...being infertile brings out some pretty ugly thoughts.)

Then I realized:  their having a baby has nothing to do with my inability to have one.  This jealousy has no purpose except to make me bitter and anxious inside.  Fertility doesn't depend on whether you're married either...crazy thought.  No one can "earn" a baby...God doesn't work like that.  We should be thanking God they are letting this baby live.  And we should praise them for making the choice to let this baby live..that cannot have been an easy decision.

I've had a while to ponder this.  When I think about it now, it still hurts a little but I think it's mostly because it shines a spotlight on our infertility—reminding me that we can't have a baby so easily (or at all, at the moment), which makes me sad.  I'm trying to see the upside of the situation.  Here's what I came up with:

1.  They live far away, and we rarely see them (less than once a year), so I won't have to face them often.
2.  This might satisfy my mother-in-law's desire for grandchildren for a while, so hopefully she will stop asking DH when we're going to have kids.  DH told her there are some medical "issues" but hasn't been more specific.  You would think that would be enough for someone to back off the subject, right?  (especially given the fact that two of DH's married cousins—on my MIL's side—are infertile, so this is not new in their family...)  We shall see.
3.  I now have an excuse to peruse the baby aisles at stores.  I will still secretly wish it were for our own child, but this will do for now.  (Eh, who I am kidding?  I never needed an "excuse" to browse the baby aisles before.)  ;)
4.  I also have an excuse for a sewing project.  Or an inspiration for one.  More to come when it's finished.

The verdict on HCG

I found out the results of my lab tests from last cycle.  Dr. A wanted to see how my hormones were responding to the HCG injections, so he ordered some post-peak labs on three different days.  I was optimistic that the HCG was helping even before having the labs done.  Since starting HCG, my post-peak phase is about three days longer than before (not that it needed to be longer), my mood-related PMS symptoms are gone (oh, how DH loves that), and my post-peak mucus has nearly disappeared.  DH likes all this evidence that his injection-giving technique has been working; the HCG is getting where it needs to go—very reassuring for him.  Anyway, the labs say my progesterone is much improved since HCG, and estrogen looks good, too.  It's nice to have one problem solved!

Speaking of injections, DH is such a trooper in giving them to me.  I remember telling him after the first few failed TTC cycles, "You know the first treatment I'm going to get is HCG.  You know who gives the HCG injections, right?  The husband.  You know I wouldn't be able to do it."  His eyes got very wide, he shook his head, and he said he would never give me any injection.  Over time he softened a bit so by the time Dr. A actually ordered HCG, DH was willing to administer them.  (thank goodness!)  He was so nervous for the first one, bless his heart.  He had been trained by a nurse, we had general step-by-step written instructions from the clinic, and we had a random website I had discovered that went into great detail for each step.  (DH declined watching the how-to video on YouTu.be that I found...I think that would have made him more nervous.)  I had been told (and read) that the injection shouldn't really be painful at all—just a quick stick.  I suppose that is true if the injection giver is experienced, but for a newbie like DH, perhaps not.  There was some definite offering up of some burning pain that first cycle...  ;)  I swear one time DH rested the needle on my skin and slowly pushed it downward.  I don't recommend that technique.  DH did get the hang of the dart-like motion eventually, and the rest have been pretty much pain-free.  If at some point we get pregnant, I will likely need progesterone injections, which make the HCG ones look like a walk in the park.  For now, I am very thankful for HCG.  :)

The fertile world around me

Lately I have been reminded how fertile my friends are.  A couple weeks ago I received a birth announcement and a pregnancy announcement on the same day.  Two other friends are further along in their pregnancies.  There were two more births this week.  I am assuming there will be another pregnancy announcement shortly since I know a couple who has been TTC for a little while now.

I try to share in their joy.  I really do.  I love that God is blessing so many of my friends with such a beautiful gift.  I express my congratulations in the most heartfelt way I can muster.  Some days I impress myself.  For some reason it is easier for me to be happy and sincere on the phone than by e-mail...perhaps it's because I let myself cry while writing e-mails because no one sees or hears the tears.

After one of the recent births I was looking at the baby pictures posted online, and I just started to sob.  DH simply held me.  He understood and didn't have to say a word.  It felt just like the scene from Ju.lie and Jul.ia.  I was so happy for my friends but at the same time I hurt so much.  I wondered if they knew, if truly knew the magnitude of the blessing they had been given.  Somehow the blessing seems infinitely greater when you're looking at it from across the chasm of infertility.

What's my diagnosis?

Want to pretend you're a hematologist for a day?  Want to show off your Dr. Google skills? 

Let's play* "diagnose polkadot's clotting problem."  I've already tried to do it, and I've come up with a range of possibilities from benign to scary, so I doubt you'll find something worse than I did.

Here's the data you have to work with:

INR - normal
CBC - normal
PT - normal
PTT - very slightly short
Factor VIII - elevated
vWF antigen - elevated
vWF activity - elevated
platelet function (two different assays) - both short closure times

What diagnosis explains these lab results?  Anyone brave enough to try besides TCIE?  ;)

*Sadly I have no fun prizes like holey soap if anyone comes up with the same answer as my hematologist.  I will just be super impressed at your googling skills...and I have high standards when it comes to that.

Doctor #2

In an interesting turn of events, I recently had a consult with Dr. C, who is trained in surgical NaPro.  (random opening in his schedule...fortunately he's within driving distance)  After going over my history and test results, he gave me the plan:  laparoscopy, hysteroscopy, endometrial biopsy, and HSG (to flush out the fallopian tubes) all in one day.  I will be blissfully unconscious the whole time.  (That is really best for all those involved.)  He said he will be prepared to deal with whatever he finds—if there is a polyp, it will removed; if there is endometriosis, it will be lasered out.  He was rather cheerful and almost enthusiastic about it—kind of like a coach motivating his team with the game plan.

Just when I thought it was time to go, he decided he should do a pelvic exam.  I was so close to getting away without it.  As he was leaving the room so I could change into the gown, he asked very nonchalantly if he could do the endometrial biopsy today. 

What I was thinking: "How on earth are you going to get that sample?  That requires going through the cervix...  Can't you do it during the surgery while I'm unconscious?  You're going to be in there anyway.  That was the plan you mentioned five minutes ago."

What I said: "Okay."

Apparently I am easy to convince.  I had no idea what I had just agreed to.  He returned with a nurse and a large tray full of metal objects.  I am glad I didn't know ahead of time what was going to happen.  (I googled it when I got home, and the description sounded worse than what it was.)  It was uncomfortable, and there were lots of cramps.  He needed two samples, so he had to do it twice.  Fun.  Ah, the things we go through to figure out why we can't get pregnant...

Afterward he was silent for a minute and looked like he was pondering something.  Then he asked if I bruise easily (yes) and if my gums bleed easily (sometimes, yes).  Great, now I have a clotting problem.  Why has no one asked me about this before, I wonder?  (especially that dental hygienist who turned white as a ghost at how much my gums bled during a cleaning a year ago...poor girl was traumatized)  Dr. C decided to order a clotting panel and said if the biopsy and labs are normal, then we'll schedule the surgery.  It must have been quite the panel he ordered since it required eight tubes of blood.  He said if the results are abnormal, he will call me.  Otherwise, he won't.  No news is good news, got it.

Less than 24 hours later he called.  The biopsy results weren't back yet, but the labs were.  I do indeed have a clotting problem, one that is out of his area of expertise, so I am meeting with hematologist in a couple months (that was the earliest available).  I wrote down which of the assays were abnormal and consulted Dr. Google.  Not a good idea.  Based on what I found, I came up with a couple possible diagnoses.  Also not a good idea.  (I am not a doctor...what do I know?)  I hope I am wrong, and it's just due to stress, which is actually on the list of possibilities.  Now I have to wait for the appointment with the hematologist for the real diagnosis.

I sent the lab results to Dr. A hoping he would have some insight.  He could not comment specifically on my labs, but it was reassuring to hear him say that many infertile women have clotting abnormalities which are usually treatable, and they go on to have normal pregnancies.  I really could have used that reassurance yesterday when I was convinced I have a horrible disease and will never have children—biological or adopted.  DH likes to call me his drama queen from time to time...  :)

So now we are taking a break from TTC until meeting with the hematologist.  As much as I want to find and fix the cause of our infertility ASAP, I am looking forward to this break.  Infertility is going to teach me patience whether I like it or not.

P+17? Nope, CD1

The third cycle with HCG was a bust.  I did set a new personal record for post-peak phase length:  16.54 days.  Technically I could have gone to the lab to have my HCG level checked (pregnancy test) that morning before AF started, but Dr. A thought peak+17 might be a bit too early to test--HCG from the injection might still be hanging around.  Making it past lunchtime on peak+17 without AF starting was pretty exciting, though.

This cycle we're adding an antibiotic to see if it will eliminate some of the extra bleeding. Can I just say I would be ecstatic if I had fewer days of bleeding?  Obviously, if it helped me get pregnant, that would be great, but less bleeding would definitely be a welcome step.