Fertility delayed

I went to the ob/gyn today for my annual checkup. Everything seems healthy and in place, and she seemed pretty nice. Her advice on how to proceed with trying to conceive was exactly what I had been planning on doing - try on my own for six months with charting and ovulation predictor kits, and then go in for help if it's not working.

I found out that I would be sent straight to a reproductive endocrinologist (RE), which I would prefer since even if we just use Clomid, I'd like to be monitored better this time. I didn't realize at the time last time that I really shouldn't have simply been given a prescription for fertility drugs and sent on my merry way, but in fact should have been monitored to make sure I was 1) ovulating, and 2) not overovulating and in danger of conceiving sextuplets. If nothing else, I'd like to spare myself the uncertainty of last time of not being sure if/when I was going to ovulate. Obviously I got it right, but it would be nicer to have an ultrasound tell me next time.

There's just one hitch: I asked to have my iud taken out and she said we needed to check and make sure my insurance will cover it. I'm a little confused - I want the iud out either way, so what exactly will happen differently if my insurance doesn't cover it, besides my having to pay for it? My inner Pollyanna hopes there's some sort of insurance billing voodoo they can perform to get it covered. My inner cynic thinks this is a great way to get a second office visit fee. Either way, I wasn't expecting to have to wait another two weeks and I'm feeling a little impatient. I don't really want to get pregnant this month since it's going to be insane enough with Christmas and moving, but there are other ways to ensure that doesn't happen.

Warming up

One thing I really enjoyed about my mother's visit this time is that K has started showing real affection for her. K was calling her "Gramma," giving her kisses and in one particularly sweet move, put some pillows on a chair in the dining room for her as she was slowly walking in. And I'm sure that was what K intended, because when I pulled out a different chair and told her that it was the chair Grammie was sitting in, she moved the pillows over. Sooo incredibly sweet.

I've always felt so badly for mother that she couldn't interact with K the way her other grandparents do, and have been wracking my brain for ways to help them bond when my mother can't do anything physical with her. The simple fact is that most of the bonding that goes on with a very young child is through either 1), physically caring for them, or 2), playing with them, which is usually also pretty physical. Mom can read her books and talk to her, but that's about it. She's given K some rides on her lap, but K never seems hugely comfortable with that (although she'd probably be more open to it now) and I'm not thrilled with how precarious it seems. The last time I was really comfortable with my mother holding K without someone else right there to catch her was when she was two weeks old and weighed 9 pounds. Ever since then, she's been too big and too wiggly for me to be really sanguine with her in my mother's uncertain grip.

An additional barrier is the wheelchair itself. It's electric and much higher off the ground than a manual wheelchair. It's part of why I worried when K is sitting on her lap - it's much farther to fall than normal, and there are various metal parts to hit on the way down. But it also prevents K from being able to go up and interact, because she's just too short.

I want K to have a close relationship with both of her grandmothers. And I know how hard it is for my mother not to be able to take care of her grandchild. In a couple years it will be easier, because once K is old enough to perform basic self-care and can be relied on to obey spoken orders, my mother will be able to babysit and take her out without us. But it's hard right now, to see the difference between how K greets B's parents and my mother. I don't begrudge her relationship with B's parents for a second; I just want it for my mother too.

So it was really nice this visit, seeing her warm up to my mother so visibly. I think it helped that we couldn't get the electric wheelchair into the house, so Mom had to walk up the steps (with heavy support) and sit on the couch. It made her a lot more accessible, and she could do things like participate in games of catch with the beachball by kicking it, or let K march the dinosaurs she gave her across her lapboard. Hopefully this trend will continue at Christmas.

Because I'm sure you're as enthralled with my child's bladder as I am

K has been flirting with the toilet for the past several weeks. She's never shown much interest with sitting on her potty, but I got one with a lift-out lid that could be used as a toilet seat insert while the base could be inverted to use as a stool, and she just loves sitting on the toilet. And I love the idea of not having to clean out a potty on a regular basis, so hey - kismet!

But with life's general chaos, we hadn't been pushing it much - we sit her on the toilet if she asked and occasionally asked her if she wanted to sit on it (usually no if it wasn't her idea). The other week, we woke up and heard her in the bathroom, and discovered that she had put the toilet seat on by herself, stripped naked and sat on the toilet all on her own. The only success we've had before today was when she was dancing around the bathroom naked and started to pee, and I quickly grabbed her and put her on the toilet to finish.

It's clear she gets what the toilet is for. She'll sit on the toilet and sing about pee*, and when B had discovered her on the toilet, she said "Poop!" There wasn't any mind you, but she knew where it went. She always wants her own toilet paper when I'm using the toilet and either wipes herself (outside her clothes), or tries to help me wipe myself (I typically decline her kind offer). Then she throws it in the toilet and waves bye-bye to the pee as it gets flushed.

Today, however, she had her first success. I suppose with the amount of toilet sitting she's been doing, it was mathematically likely that she was going to pee while sitting on it at some point. Everyone was very proud of her anyway, and she had the bonus of a grandmother here to admire her great accomplishments the way only a grandmother can.

I'm still not going to push much though. We're moving in the next month and taking a plane ride at Christmas, and all of that is going to be easier if we don't have to worry about getting a small child to the toilet on time. Also, the new house will have a toilet on each floor which will be much easier than our current house where I would have to hustle her upstairs every time she needed the toilet.

But still, our first potty success! Another milestone for the baby book.

*The lyrics usually go "Pee, pee, pee, pee, pee..." Stephen Sondheim she's not.

So. I work Friday through Sunday, usually alternating between one day and two days per weekend. But which days within the weekend I work hasn't been the same yet. Meanwhile, B works Saturdays, but not every Saturday. He also works Sunday afternoons periodically, since he either gets overtime or comp time for them. Essentially, chances are good that any given day of the week, one of us is working. But not the same days every week. Our household schedule is different every single week.

It's official: I no longer have any idea what day of the week it is. There is not a single bit of regularity in my weekly schedule to let me know what day it is. I can't even count on church since I can't go to church the Sundays I work. I've been sitting here most of the evening, convinced that it's Sunday. Or possibly Thursday, or a week from next Tuesday. It's all a blur at this point.

Meanwhile, I've been working for a month but haven't gotten paid yet. I can't get paid because my child abuse clearance hasn't come through yet. And why hasn't it come yet? Because they sent it back to me today (after over two weeks) claiming I didn't include information that I had written on an additional page, THE WAY THEY TOLD ME TO. Why tell people to write down information that doens't fit on the form on an additional page if you're not going to look at it? Grrr. For all that I complain about how little I'm getting paid, I really need that pittance. And now I'm likely going to have to wait another two weeks before I can even go in to get my employment forms taken care of.

I'm still really enjoying work though. Not quite enough to do it as a volunteer, but it's fun. Weeding an ancient collection is bound to throw up some real gems. For instance, today I found myself inexplicably transfixed by Trudy Wells R.N., Pediatric Nurse. Can Nurse Wells convince the childless millionaires to adopt an older child instead of buying a baby on the black market? Sadly, I'll have to wait until next week to find out.

I also recently found a guide to disco dancing. And believe it or not, I decided to keep it. It had a pretty comprehensive instruction section on ballroom dance, so it was worth keeping, despite the fact that it also had instructions for twelve different version of the Hustle and scary scary pictures of a man wearing the finest seventies polyester and sporting a moustache that needs to be covered up in public in case it frightens small children and horses.

My mother and brother are arriving tomorrow. Yay!

Regular-size me

I'm feeling a conflict of diet theories these days.

A lot of what I've been thinking about diet lately was crystallized by a blog post I read recently, which talks about the moral value society attaches to foods and how this screws us up:

Teppy wrote a great post yesterday about “demand feeding,” which is a really terrible name for “eating what you want when you’re hungry and stopping when you’re full.”

That’s something I recommend frequently, as it’s a key component of the Health at Every Size strategy. The problem with it, as Teppy points out, is a whole lot of people don’t know when they’re hungry, what they feel like eating, or when they’re full. Ex-dieters, especially, are so used to categorizing foods as “good” and “bad,” and having specific foods and portions dictated to us, the thought of really eating whatever we want — as opposed to the diet version of “eating whatever you want,” which means allowing yourself one bite of ice cream SO YOU DON’T FEEL DEPRIVED (oy) — can be overwhelming and frankly frightening.

[...]

But regardless, “We will give you permission — in some limited way — to eat ‘bad’ foods!” is a tremendously effective marketing strategy.

And that’s because so many of us really believe somebody needs to give us permission; simply choosing to eat fatty, sugary food because you feel like it is absolutely not an option. And then somebody also needs to put a limit on that permission, so we won’t go and devour the world. In this culture, most of us never learn to trust our bodies when it comes to eating, and we certainly never learn to trust our desires. Choosing what to eat is a daily battle between good and evil.

I mean, think about it for two seconds. People are selling plans that allow you to “eat what you want,” to the tune of billions. That’s lunacy. Because I love you, I shall offer you the Kate Harding Lifetime Diet Plan — which permits you to eat whatever you want — absolutely free! It goes like this:

DAY 1:

Eat whatever you want. It’s your body. You’re allowed.

DAY 2 THROUGH DEATH:

Repeat Day 1.

The problem with the Kate Harding Lifetime Diet Plan is exactly what Teppy talks about — figuring out what you’re hungry for and how hungry you are after a lifetime of being told you are always too hungry for the wrong foods. I still struggle with staying on my own plan, for exactly the reasons Teppy and her commenters describe. I have a major fear of deprivation when it comes to food, plus a whole lot of baggage about “good” and “bad” foods, so trying to listen to my body instead of the voices in my head involves a lot of conscious effort — which is exactly what you’re trying to drop by, you know, listening to your body.

I highly recommend the rest of the post. Reading it made a frightening amount of sense to me, especially after I thought about it for a while. It's the way K eats, after all. I control her menu, of course, but within the foods I offer her, she chooses what she wants and how much she eats. And as far as I can tell, she only eats when she's hungry and stops when she's full. Even if it's treat like cake - I've seen her leave half a piece on the plate because she's not hungry any more. And her body seems to tell her what she needs to eat. I don't really worry about her getting enough nutrients any more because I've noticed that over the course of the day she eats a pretty balanced diet. She may eat a lunch of only turkey and cheese, but she ate mostly cheerios for breakfast and grapes at both meals, so it balances out. *

Demand feeding also jibes well with research that shows that deprivation leads to gorging - in a study where children were offered sweets, children who were on very restrictive diets gorged themselves on the sweets, whereas the children who were allowed to eat sweets ate moderate amounts and then stopped.

The more I thought about it, the more I realized that this is pretty much how I've been eating for the past couple years as well. I've made stabs at following diets and "eating better," but mostly I've just eaten what I felt like and stopped when I was full. And you know what? My weight is stable and while it might be a little higher than I would like, it's healthy. My cholesterol and blood pressure are fine. So it seems like the only thing I need to change is give up the guilt, the persistent voice in the back of my head that I should be consuming nothing but spinach salad and sparkling water.

But then there's the other side of the coin, the gigantic But.

I think demand feeding is a great idea. For people with normal metabolism who don't have health conditions that are affected by what they eat. Because the simple fact is that some people absolutely cannot eat whatever they want. People with high blood pressure can't have salt, people with food allergies can't eat the things they're allergic to and diabetics really shouldn't eat foods that cause their blood sugar to swing wildly.

And people with PCOS have a condition that is caused by insulin resistance, and therefore do much better on a diet low in carbs.

So you see the dilemma? I'm all hep to the idea of the Bobby McFerrin-zen approach to eating where restriction is the worst thing you can do to yourself. And I'm seriously considering going on a low carb diet.

The problem is that PCOS is directly affected by how much I weigh and what I eat. It started to get worse after college, when I started eating a mostly vegetarian diet and therefore eating a lot less protein. I started gaining weight, which made PCOS worse. And then I got mono, which stuck around for over a year, and all of that lying around on the couch made me gain more weight and get worse. At that point, the PCOS was making me feel so awful that I couldn't exercise or be active, so it continued on a spiral that just kept feeding itself until I managed to artificially convince my body it had a normal metabolism with metformin. I got back down to a healthy weight and things seemed fine.

But it clearly wasn't enough because I wasn't ovulating. Thus my dilemma: I weigh about what I did before I got pregnant. Low-carb diets are a proven way for women with PCOS to lose weight and improve their fertility. So if I'm serious about trying to conceive, should I go low-carb?

Before anyone starts yelling about how unhealthy low-carb diets are, I will say that any low-carb diet I follow won't be rib-eye steaks with a pork-rind chaser. It will be lean meats and lots of vegetables. Basically, I would replace the starches in my diet with vegetables that have less effect on the blood sugar and give up sugar entirely to start. Then I would get to slowly add carbohydrates back in until I'm on a diet of lean proteins, vegetables, fruits and complex carbohydrates. The way my diet would like in the end is meals that look more or less normal, but with smaller portions of carbohydrates, with Barilla high protein pasta or shirataki noodles instead of regular pasta, beans or pearled barley instead of rice, and no potatoes. Or sugar. Or white bread. And that's where the thought of this makes me groan, because I _like_ potatoes and sugar and white bread (not necessarily together). And the path I would have to take to get to that point would be long and hellish.

One wrinkle is that I've tried low-carb in the past and I think the longest I've made it is two weeks. I have reflux and my stomach doesn't like it when I remove those nice spongy carbohydrates that soak up stomach acid. But I've done a lot more research into alternative foods and recipes, so I think I may be able to deal with that better this time.

So I suppose the essential question is that if the potential improvement for my fertility is worth the deprivation, given that deprivation isn't a very good thing. I guess the thing to do is see what happens when/if my cycle comes back. I don't think it's a good idea to try and give up carbs right before the Thanksgiving-Christmas sugar-fest eating season, so I wouldn't try to start until January. At that point, I may have more of a clue if it wll be necessary.



*Note: I can be zen about how K eats because she eats a decent amount of food and will eat a wide variety, including vegetables. She's also a healthy weight. I understand completely how parents of very picky eaters and children who are very low in the percentile charts get neurotic about their childrens' diets - I was there myself for K's first 18 months.

Fertility and the future

Two weeks ago, I turned 33. It didn't get a lot of fanfare; I was insanely busy with work and none of the friends we've celebrated with in the past were remotely close enough to come for a party. So I had a quiet day with K and B, got a few books and some nice cards. Nothing exceptional. Except that for the first time, I've started to hear the ticking of the biological clock.

I hadn't worried about it the first time. I was 28 when we started trying and had more than enough to worry about with PCOS. The thing about being infertile is that you're much more concerned about dealing with the reasons for that than worrying about age-related fertility issues, particularly if you're on the near side of 30. But now it's occurred to me that I'm only two years away from the point when they start recommending the thorough prenatal screenings and considering me elderly. And that chances are that as time goes by, I'm unlikely to get _more_ fertile, so if trying for another baby is going to take as much time and assistance as last time, I should get cracking.

Fortunately, I'm finally feeling like I'm ready to consider trying. I hadn't planned on thinking about it until this summer anyway because I would like at least three years between children. And after unemployment, a major move, adjusting to a higher cost of living and dealing with the death of a parent, it just wasn't practical to start trying until now.

However, I'm painfully aware that being mentally ready for another baby doesn't remotely equal actually getting one any time soon.

For those who weren't reading last time around, my reproductive history in brief: I have Polycystic Ovary Syndrome. The brief version of this is that due to a missing enzyme, I don't respond to insulin as well as I should. This results in my pancreas pumping out higher levels of insulin to compensate, which in turn results in weight gain, blood sugar issues and massive hormone problems (and in my case, debilitating fatigue, to the point that I was disabled). The hormone problems are what causes the infertility, but the best way to address this is to get to the root of the problem, the insulin resistance. So I've been on a diabetes medication for the past five years which increases my insulin sensitivity and it works pretty well - I'm able to maintain a stable healthy weight, my symptoms are pretty much in check and when I went off the pill, I had regular periods. But it wasn't quite enough, because I apparently wasn't ovulating very often. So after over a year of trying, I took clomid and got lucky the first time out.

So you can see how contemplating a second baby isn't as easy as just going off birth control for me. It doesn't help that I have absolutely no idea what my current fertility status is. My current birth control is a Mirena iud, which has the salubrious effect of eliminating periods, so I havne't had a period since January of 2006. In the past, I've said I prefer birth control methods where I still get my period because it's a useful indicator of how I'm doing health-wise, but honestly, I've been enjoying the honeymoon from the monthly bloodletting. I haven't been having any other PCOS symptoms to speak of, so I decided to have a nice vacation in the land of Not Worrying. But now I have to start worrying and while I didn't miss my period, I kind of wish I had some way of knowing what my hormones are going to do.

The current plan is that I have a doctor's appointment in two weeks for my annual lady parts inspection and I'll ask the doctor to take my iud out and wait for my period to come back. If it doesn't come back or six months goes by without anything happening, I'll get more proactive and go back to the doctor. I may throw in asking the doctor if we can start testing to see if I'm ovulating as soon as my period comes back. But I'm not waiting a year again since I don't have as much time to wait.

It's hard to know how to feel about being infertile sometimes. I didn't have nearly as hard a time getting pregnant as many do; once we sought treatment, it only took one dose of Clomid. Comparing that to stories of ivf and miscarriages, we got off pretty easily. But that doesn't mean it was easy, or that it won't be harder next time. I also get to worry about the fact that PCOS raises your miscarriage risk by quite a lot. One weird thing is that many women don't find out they have PCOS until they try to get pregnant and can't. It's only then that they go on metformin, and since it doesn't usually work immediately, they still need a lot more intervention. But I was diagnosed with PCOS because it was making me so very ill that I couldn't possibly ignore the symptoms. And if I had been trying to get pregnant then, I would have had an absolutely miserable time of it. But instead, I was on metformin for three years, got back down to a healthy weight and mostly straightened my hormones out before trying. It's a weird position to be in: infertility made me absolutely horrendously miserable for several years. I just wasn't trying to conceive during most of them.

In any case, there's no point in obsessing about any of this until I get my iud removed. Not that I'll let that stop me from running a constant low-grade worry.

Grey

I got a call from a friend tonight asking how I'm doing, and I think the best answer is that life is just rather grey right now. I'm going about my life with a decent amount of success, but everything is muted like there's something sitting on me, oppressing my reactions.

It surprised me a little, when I was home. At the funeral, we spent our time talking about my father before he got sick and I mostly spent my time thinking about how much I missed that man. But I discovered when I was home this last trip that I just plain missed my father, even the way he was after he got sick. As hard as it was to watch him decline, we were lucky in that until the very end he was pretty pleasant to have around. He was very sweet and gentle, and able to give and receive affection. He loved to sit and have me talk to him even after he couldn't speak well and he got huge enjoyment out of watching K play. I miss that man too and the house felt very empty without him.

I think grief is a lot like a cloudy day. Sometimes it rains on you and makes it hard to go about your daily business. Sometimes it hits you with a gale-force hurricane and stops you cold. But even when you're functioning fine, it's always there, hanging over everything you do and hard to ignore.

Grey

I got a call from a friend tonight asking how I'm doing, and I think the best answer is that life is just rather grey right now. I'm going about my life with a decent amount of success, but everything is muted like there's something sitting on me, oppressing my reactions.

It surprised me a little, when I was home. At the funeral, we spent our time talking about my father before he got sick and I mostly spent my time thinking about how much I missed that man. But I discovered when I was home this last trip that I just plain missed my father, even the way he was after he got sick. As hard as it was to watch him decline, we were lucky in that until the very end he was pretty pleasant to have around. He was very sweet and gentle, and able to give and receive affection. He loved to sit and have me talk to him even after he couldn't speak well and he got huge enjoyment out of watching K play. I miss that man too and the house felt very empty without him.

I think grief is a lot like a cloudy day. Sometimes it rains on you and makes it hard to go about your daily business. Sometimes it hits you with a gale-force hurricane and stops you cold. But even when you're functioning fine, it's always there, hanging over everything you do and hard to ignore.

2000 words

New pictures up here.



And a new movie. K started dancing a lot more recently and I finally got it on film. Sadly, it's really dark due to the bad lighting in our living room, but you can still tell what's going on:

Moments of unbearable cuteness

K is trying to learn how to jump. She crouches down, then raises her arms and leaps upwards, saying "Jump!" Only her feet never leave the ground. But she keeps trying. The other day at the playground, she saw some girls playing jumprope and nearly died of the excitement of trying to jump along while she watched them.

We were having dinner with a friend last week, eating outside on the sidewalk at a restaurant. K started climbing up on a step and then jumping off in triumph. "Jump! Jump! Jump!"

I think I'll be disappointed when she can actually get off the ground.

****

Every night, we read K three or four books before bed, depending on how long she can manage to lengthen the bedtime process. Lately, when we put her in her crib, she has been demanding a book go in with her. Since it hasn't prevented her from falling asleep yet and the alternatives is a full-bore toddler tantrum, we give it to her. Satisfied, she lies back, gathers her baby doll in the crook of her arm, and proceeds to read the book to her baby.

****

Tonight, K insisted that I lie down on the couch, insistently pushing me back and then patting the end of the couch where I was supposed to put my feet up. Once I was settled, she put a blanket over me, tucked a pacifier at my side in case I should want it, and then proceeded to apply a screwdriver to my hip to give my joints a tuneup. Every time I lifted my head, she would sternly push it back down, ordering "Head down!"

I know toddler behavior involves a lot of modelling of what they see. But for the life of me, I can't think of when we modelled the behavior of putting her to bed and then poking her repeatedly with a screwdriver.