Go Big, or Go Home

You guys, I'm so tired! Not like regular Monday morning tired, although that's usually pretty bad (have I mentioned I'm a fan of the four day work week?). No this is an exceptional level of tiredness. In the last ten days I've: had surgery, gone to work for three days, had my post-op, traveled to Augusta, gone to three separate graduation shindigs, cleaned the grodiest rental ever, celebrated Mother's Day, packed up all some of our stuff, and moved, not to mention the regular stuff like church and small group. But today, we're going to focus in on that teeny little part smack dab in the middle of all of that: my post-op appointment.

I had my post-op Thursday morning last week before going down to Augusta for Sam's graduation (more on that later). Now, a little background to set the scene: Dr. Slayden and I had discussed some next steps during my appointment in April. We discussed skipping straight ahead to IVF, which we can't do because we don't have the funds. We also discussed, a multitude of other less expensive options with various chances of success. My doctor is super nice and understanding about the financial issue, so if it's on the back burner, he figures we might as well try to be successful in the mean time without spending too much money. His scenario with the greatest chances of success (other than IVF) was the surgery (Laparoscopy + Hysteroscopy + D&C) + Pregnitude + Metformin/Glucophage + Femara + IUI... he briefly mentioned the IUI. We spent much more time talking about the other options. Sam and I are really over IUI's. We've done three. They didn't work. It has seemed to us that it would be the definition of insanity to keep throwing $1,500+ a pop at something that doesn't work, when we could save twelve of those and pay for IVF.

So with that said, I spent a small amount of time before the surgery deciding how we would proceed. If we found endometriosis, our odds would increase; therefore, it might make sense to try an IUI (and all the other stuff). If no endo then we would do nothing. The only thing I was really prepared to invest in after learning that there was zero endometriosis inside of me was Femara. I've had good, safe results of Femara. I ovulate regularly, with good healthy follicles, nice, lush linings, and no cysts. However, my nurse said that they wouldn't prescribe Femara without a full cycle of monitoring. So I even thought about calling my OB/GYN to get a script. But Femara was my only plan upon entering the post-op appointment.

And then my doctor entered. Have you ever met someone who just sweeps you away with their enthusiasm? That's my doctor. I sometimes wonder if he tells EVERYONE that they can set something up, but that he's confident they'll cancel before the appointment because they're pregnant. But seriously, he was just SO EXCITED; I couldn't help but get caught up in his enthusiasm... a little. He took several photographs during the surgery, and you guys, you'd have thought it was Christmas! He was so excited about how beautiful everything looked, how gorgeous my fallopian tubes are, that he got to see a spleen, etc. I'm not a biology/anatomy kind of girl, so I just saw grossness, but I tried to humor him.  But once we got past that part, he jumped straight into scheduling my next appointment to get the IUI cycle started.... what? wait a second... why are we doing an IUI? I've done three of those. But he wasn't having any of that. He was full of phrases like "hit it hard" and "go big or go home".

By the end of it all, I guess he had convinced me. Either that or I just didn't have the heart to squash his excitement. So... I guess that means we are doing another IUI. You can't be as surprised as I am. But apparently between the D&C and the thorough flushing my tubes received my chances are practically 100% increased a little. "So what's the game plan?" you may be wondering. It's kind of shocking. If I don't start a new cycle on my own between now and Memorial Day, I'm going in for a baseline scan. Dr. Slayden swears that I don't actually have to start a new cycle... my hormone levels and follicles just need to be in the baseline range. From there, we're doing Femara for five days from CD3-7 and then, wait for it, on CD8 we're doing some form of an FSH injection at 75 units. Yes, I almost died when he said this. No, I'm not sure this is a good idea. Yes, I'm scared to death of 4+ follicles. Yes, my husband will kill me if I get pregnant with triplets. No, I don't want to be the next John & Kate + 8. And no, I don't want me cycle to be cancelled. But with all of that said, I don't really want to do another Femara cycle (at least one that costs a zillion dollars) and only end up with one follicle. I want the follicle stimulation of Clomid 50mg and and the lining support and ovulation timing of Femara at 7.5mg. Dr. Slayden feels like this is as close as I'm going to get.

So get excited! Come along for the ride... it's sure to be crazy. And I'm sure to be pregnant by the end of it (or so my doctor says).

Reflections

Now that I'm out of the haze of anesthesia, I'm able to more clearly analyze my feelings. The laparoscopy revealed zero endometriosis. Does that ever happen?!?! I feel like every infertile leaves the surgery with a diagnosis of at least stage I. I really thought it was going to be stage I or stage II. My doctor wasn't so sure, but based on my history of painful periods, the regular presence of large clots, my mid-cycle cramps, and my higher than normal CA-125 levels, he felt like it was worth a shot.

Endometriosis is no joke. I certainly don't want to have to repeat a laparoscopy every six months or year. I never want to go on birth control ever again (unless of course for IVF). I don't want to worry about endometrial tissue damaging my ovaries or causing my tubes to adhere to my abdominal walls. Endometriomas sound terrible and terrifying… no thank you. I totally get that endo is not a fun diagnosis. 90% of the world assumes endometriosis is "killer cramps"… I don't envy the girls who have to explain that it's so much more. So why was I/am I upset with my "all clear" post surgery?

Everyone was asking and wondering what I was hoping for in terms of the surgery. I hadn't spent too much time thinking about it beforehand. Honestly, I was so scared, I just wanted to wake up and to have all of my essential reproductive organs still intact. But as I said before, upon hearing that there was no endo, I began to cry. I was admittedly kind of surprised by my reaction, and I'm sure a lot of it was due to the anesthesia. But I also think that on some level, I was disappointed. I wanted there to be a reason, a partial explanation, a diagnosis that I can explain to people. I wanted to leave the surgery with an increased chance of pregnancy. I want there to be something there that we can treat.

Instead, I'm left with knowledge. I don't take that for granted. I now know that despite my symptoms, despite my elevated levels, I do not have endometriosis. There has not been anything within my uterus obstructing implantation. My tubes are open and capable of transporting the eggs effectively. These are all good things to know. I'm super thankful that I can mark those things off the list. Any pain that I've experienced from the surgery I consider well worth the knowledge we've gained.

However, with this knowledge, with these answers, comes more questions. And several of these questions are hard. For example: Is my body killing off healthy embryos? Are Sam's sperm and my eggs incompatible? Are there genetic or chromosomal reasons why we can't conceive? You get the picture… the questions I'm left with are game changers. Endometriosis is terrible. But in the big scheme of things, it was an option that I could wrap my hear around. I knew what the treatment options would be and I knew that our chances of conceiving a child (even if via IVF) would still be high after treatment. Now that I've marked it off my list of "why's", I'm forced to look at two years of actively trying and only one recorded pregnancy which quickly failed, and well, I'm forced to confront the possibility that things may be a lot worse than I thought.

But that's as far down that rabbit hole as I'm willing to go at this point. This coming week has a lot of really good awesome things worth celebrating, (like Sam's graduation) so I'm not letting myself spiral into despair yet. I've got to schedule my post-op tomorrow… there's plenty of time to wonder and worry after I talk to my doctor. Until then.

I'm a Survivor

I'm assigning absolutely zero credit to myself in this, but I survived the laparoscopy. I know you were all equally worried, so I wanted to make sure to ease your fears.

The day was crazy long, and comparatively to others, I think it was short, so props to people who have to do that over and over again. Of which I will not be one. But we'll get back to that later.

You may remember that I ended up having my pre-op a few hours before surgery due to a miscommunication about my last appointment. I'm so thankful I did. I would have been seriously irked if I'd taken off work for that nonsense. Basically, they couldn't find me in the schedule, couldn't find my paperwork, couldn't organize their crap! So that was a great way to start the morning and an awesome vote of confidence for how the day would go.

After working out the kinks, I sat in the waiting room to fill out paperwork and sign all of my rights away. I was called back very quickly by a blood drawer person. She said "Amanda." Well that's me, so I went. And my morning spiraled from there. Apparently, there were two Amanda's on the schedule that morning (I know, shocker), and as she didn't use a last name, we had no idea that I'd just volunteered myself for blood work and an ultrasound to check GESTATION!!!!

I have absolutely zero idea if they ever sorted out the vials of blood correctly. She never had me verify anything on the vial, so I was still clueless. After my blood work she sent me to waiting room two. You have to keep in mind that this is not my doctor's doctor office, it's the main clinic, and basically feels like a zoo. I had no idea I wasn't waiting on an open bathroom. But no, I was waiting on an open ultrasound room to measure my baby. Awkward! I started to feel a little confused when all the ladies around me were discussing pregnancy symptoms and all the women coming out of the rooms were holding ultrasounds photos. They don't give you photos of your follicle, so I knew something was up. But I continued to patiently wait.

Finally, the blood draw lady (sorry to all of them for the super professional title, I'm too lazy to google right now) saw me still sitting there, asked for my last name and what I was having done. Lights went on in her head. "Ohhh, honey. You just sit right back down, I'll find out where you need to go." I should have explained that I knew where I needed to go. I needed to pee, because I hadn't all morning. Alas, she led me to another waiting room and told me someone would be right with me. So I waited there for another ten minutes. Finally, I stood up, explained who I was and what I was having done that day, and asked if I was in the right location. I'm still not sure if I actually was in the right waiting room, but she assured me everything was fine before scampering off to find my pre-op person.

Pre-op was all of five minutes. Blood pressure, a little chest listen. They took my word for it as to my weight and height. Then she left to do my urinalysis, which as I had still not supplied, I assumed she meant getting it ready. 30 minutes later she came in to ask where I left my sample. Ughhhh... In my bladder. Sam had finally found me by this point and explained that there are two Amanda's in the office... A second one was called just after me. Light bulb! I bet she's pregnant. Haha! I wonder what her morning looked like: "ma'm we just need to get a urine sample before we take you back to the surgery center." Commence freak out. The pre-op lady was like, "Oh that explains it. There's a cup back there that says Amanda but its under a different doctor's name". Awesome. Her blood work is going to scare the crap out of her when she hears hCG level of ZERO. Bless her heart.

Anyway, I finally peed. Waited some more, my doctor came to visit me and to "scout out the terrain" (i.e. look at my belly button) which he declared was teeny-weeny and that nothing fun would be discovered in that. Bummer. Some people lose some really odd stuff in their belly buttons, or so I'm told. Other people get belly button rings the night before surgery. Oh well, mine passed inspection; he just said he'd have to downsize the scope.

And with that my pre-op was complete. I turned in all of my paperwork and went back to the main waiting room. Despite the pre-op only really lasting about ten minutes, we'd managed to spend two hours accomplishing all of that. You can imagine how frazzled my nerves were at the thought of any of these people having anything to do with my surgery. I just sat there chanting "I trust doctor Slayden" over and over. And then they called my name again to go back to the surgery center.

I was lead to my eightieth fourth waiting room of the day. But very quickly they took me back to "get me started". Ummm, no I'm good. We can wait. Thank the Lord, from that moment on everything was handled with exceptional amounts of grace, kindness, and professionalism.

The room was freezing... Like free-zing and they still wanted me naked. Ughhh. My get-up was quite humorous. I had a blue hair net, a ginormous hospital gown, some ugly, itchy red bootie-sock things, and then these nude tube things. I had to ask what those were for. Supposedly they are compression socks. Ohh, I know all about compression socks, DVT runs in my family. These were compression socks for Sam sized calves, I could barely keep them on when I stood. Comical to say the least.

Some sweet lady came in to cover me with a warm blanket (bless her) and start my IV. This was honestly one of the worst parts of the whole thing. I'm scared of needles, but as I've mentioned before, two years of needle pricks is the cure to what ails me. I was only a 5-6 on the panic scale. She chose my left hand and went to work. She wasn't very pleased with any veins even after all the cord tying and stress ball squeezing. She proceeded to rub it and thump it and tie more cords. She finally decided it was good enough and actually got the needle in very quickly. I was SO proud. I didn't scream, cry, or pass out. She started the IV drip and approximately 30 seconds later my vein collapsed! Owwww! It was apparently not salvageable so she unhooked it all and pulled the needle out. I'll admit a tear escaped. She moved on to my right hand but quickly declared that hand to be worse. I'd already had a blood draw in my left arm, she moved in on the right. We had to go through the whole process again. My hand still hurts today: collapsed veins are no fun, I guess.

The anesthesiologist came back and he was so sweet. He listened to my heart, asked for my blood pressure, and asked about my experience with anesthesia before, which is pretty slim. I'm all, "I had my wisdom teeth out, does that count?" He asked if I preferred tropical vacations for my dreams. I informed him that I just wanted to wake up. He smiled, told me he'd take good care of me, and not to worry, and left. Haha, right. I started to feel pretty weepy at that point. I was alone, my hand hurt, my arm couldn't bend, I was freezing, and the man responsible for keeping me alive was talking about the beach. They brought Sam in and I had about .2 seconds to decide if I was going to lose it and cry hysterically or whether I was going to man up. Sam's not big on tears, nor theatrics, nor whiners, so I went with the latter. I dried my tears and blew my nose and held his hand.

All hooked up, waiting to go back,
and explaining my sad little hand to Sam

My doctor came back to see me briefly to make sure I didn't have any last questions. At this point, my brain wasn't even working, so no, just don't let me die and don't cut out my ovaries, were the only things I could think of. He left to get scrubbed up and before I knew it they were ready to take me back. I'm actually really thankful that Sam's not an emotional guy, because I would have lost it if he said more than I love you. A quick kiss and he was on his way out. They walked me back to the scariest room I've ever been in.

The anesthesiologist was there along with a zillion other nurses (what are they all doing during the surgery?), but I was pretty happy to see lots of people. I figure surgery on me should be an "all hands on deck" kind of ordeal. I failed to climb on the table in a normal way and therefore almost fell off, which I'm guessing was their cue to knock me out fast. They all started moving at warp speed: fixing my blanket, putting my legs in these squeezy machines, putting on a blood pressure cuff… the next thing I knew the anesthesiologist asked how I was feeling. I squeaked out "fine" and he said, "well, I just gave you a margarita with salt, so I hope you like beach vacations…" And that's the last thing I remember.

I woke up to a different nurse lady who had the terrible task of dealing with me post surgery. I didn't wake up slowly, as if a fog was lifting, I woke up from a dead (literally) sleep as if a gun shot went off by my ear. She scared the hell out of me. We spent the next several minutes half hour trying to understand each other. I don't think I was explaining myself very well, I'd ask for Sam, and she'd say I can't have water yet. It was frustrating. I felt like I couldn't breath and was a little nauseous until she took the oxygen mask off. Dr. Slayden came to check on me and tell me that I had no endometriosis. I did have two small polyps, which he removed, and a small fibroid, which he left. I was way too out of it to ask why, or how, or anything.

The blood pressure cuff was set to beep and start automatically every five minutes or so. The nurse told me this several times, but my brain didn't seem to be able to grasp this… every time it went off I freaked out. Sam came back eventually and interpreted for me. I was finally aloud to sit up and I started feeling a lot better. I was pretty funny I guess because Sam kept laughing at me… but I guess it wasn't too bad because he never broke out the video camera! I suddenly remembered that I'd seen Dr. Slayden, so I told Sam the news (he already knew). I guess I was hoping for endo, somewhere deep inside, because I started crying when I told him. But then the blood pressure cuff started up again and I lost that train of thought entirely. I started to get kind of panicky about being attached to so many things… IV, blood pressure cuff, pulse oximeter… the nurse finally started detaching me.

I was able to get dressed and Dr. Slayden came to see me one last time. And with that, I was discharged to go home. They wheeled me out in a wheelchair. I guess a lot of people put up a fuss about this because my nurse patiently explained that it's protocol and I had to do it. No arguments from me, I couldn't imagine walking. We loaded up in the car and set out for home.

Recovery has been surprisingly easy thus far. I have a feeling that this is in huge part to the fact that almost nothing was removed. I think the pain most experience must be directly related to how much endometriosis they find, so I was pretty lucky. My incisions are sore and I ended up with sutures because the glue stuff didn't work. I'm sore, but not too bad. I'm already down to Aleve only, so comparatively to people like Erika and Jessica, I got off really easy. I could certainly take the Percocet, and probably feel a lot better, put narcotics scare me. I don't want to get hooked and I don't want to feel nauseated, so for the time being, Aleve is doing the trick.

If you're still reading this, kudos. I just needed to get it all out before the details start to fade in a haze of drugs. And thank you everyone for the outpouring of love, kind words, and prayers. I was truly touched by all of you! I'll be back at a later date to discuss what this means and my thoughts on being endo free, but for now, I'm going to sleep... again.

Laparoscopy: Impending Doom

Scared out of my mind. That's basically the only way to describe my feelings going into my laparoscopy tomorrow. I know, I'm pathetic. A HUGE percentage of ladies struggling with infertility go through this; I'm not unique. At one point or another, even if there's no "evidence" of endometriosis, unexplained's get hustled to go under the knife. I'm volunteering myself. No one is forcing me, heck, no one is really even encouraging me.

So remind me again why I'm doing this. No, I know why I'm doing this. I'm doing it because I need to know. Everything about us is "unknown" or "unexplained" or "in the gray zone". After this surgery, we will know, once and for all, if endometriosis is playing any part in our inability to conceive. I feel like its pretty much the ONLY thing that I can know for sure. So I've just got to know. I can't march down the IVF road in good consciousness without knowing that A- we did everything we could to avoid it, and B- we're doing everything we can to make it successful.

I feel like the lap is necessary in order to check both those little boxes because A- pregnancy rates increase after a laparoscopy + hysteroscopy + D&C (even if no endo is found) and B- if anything might possibly impede implantation, it will be gone. So I've got to do it. Even if they find nothing... Even if I don't get pregnant right after... I've got to do it for my peace of mind.

But you know the saying "curiosity killed the cat"... Well, I'm being real honest here, I'd prefer not to die tomorrow just because "I need to know". Supposedly only like four people out of every one million who go under anesthesia die (yes, I googled it). I'd really like not to be one of those four. I'd also like to not be one of those poor souls who WAKES UP during the surgery, but can't move to alert the physicians. I'm pretty sure I'd die from fear and panic in that situation anyway.

I'm fully aware that I'm being a tad over dramatic here... Well, what's new? I apparently told my mom I was almost eaten by an alligator at preschool one day. She assumes I saw a lizard. Tons of people my age have surgery. They have an ACL repaired, or an appendix removed, or heck, maybe breast implants. Lots of people have surgery. This shouldn't be that big of a deal. But I'm scared senseless.

On a slightly more positive note, if tomorrow is to be my last day, at least I got to meet Erika! Erika and I have been blog friends for way too long to have not met, but we made it official today with lunch in Downtown Athens! As she has been through the same procedure with the same surgeon, we chatted about all that I have to look forward to (assuming I wake up).

So say some prayers that I survive, that I don't wake up too soon, that I leave with the same organs that I started the day with, and that we get some answers!