Public Health Announcement

Tuesday, November 24, 2015

Well folks, it's the middle of November... somehow. I'm not sure how that happened, but here we are. November means lots of things. Cooler temperatures (at least in the northeast), boots get pulled out of the closet, pumpkin spice lattes abound (or in my case, caramel apple spices!), and Thanksgiving is right around the corner. However, a dangerous and much scarier event is also lurking right around the corner. In fact, it might already be here.

(Insert ominous music here!)

Imagine there is a disease that you can contract from someone sneezing at another end of the subway car that you're on. Imagine that this disease can occur throughout the year, throughout the world, and that the attack rate (or the biostatistical measurement of how fast a disease can spread in a population), is 10-15% for adults and 20-30% for kids. Imagine that this disease was expected to result in 3-5 million cases of severe illness (that can land even healthy people in the hospital, but is especially bad for the very young and very old), and that it will cause between 250,000 and 500,000 deaths. Imagine that this disease shows up, every year, without fail. Then imagine that there is a vaccine. Would you get it?

I would hope so.

Surprising probably no one, I'm talking about influenza. Influenza (or the "flu") has its peak incidence between December and February, but can occur as early as October and as late as May. It can also randomly pop up not during the "flu season," because influenza is a virus and it does not give a crap about your seasons. As a future physician, current public health degree-holder and enthusiast, and person generally in favor of people not being deathly ill, here are a few helpful tips, some busted myths, and some interesting facts about the flu.

No, You Can't Get the Flu from the Shot

You would think that by now, this myth would have died. You would be wrong. Last December, an article was published about a 2012 online survey in which 1,000 people were surveyed about their concern about the flu shot. Nearly 40 percent of the people surveyed believed that you could get the flu from the flu shot. Even when half of the group was given information from the CDC about the safety and efficacy about the flu vaccine, a bunch of people (statistical term, obviously) still were concerned, and a third of those surveyed said they wouldn't be getting the flu vaccine. 

WHAT? I would think information is power! Make better, more informed choices! Turns out that the more information you give people about vaccines and their safety, the less likely they are to get the vaccine. Figure that one out. As you probably know, trying to change someone's mind is intensely difficult, and the best tool we have, information, doesn't seem to work. 

The truth is, it is biologically impossible to get the flu from the shot, as what is in the vaccine is dead virus particles. Yes, you might feel crappy and your arm might hurt, but that's because even with dead virus pieces, we're activating your immune system, and we also just stuck a needle in your arm, so that might be sore. The good news is that you won't actually get the flu, and now that you got the vaccine, you're far less likely to contract the flu. All good things. (And I promise, your arm will stop hurting soon. Try some ice.)

If you opt for the nasal vaccine, FluMist, you will be receiving live-attenuated virus (which means we took some live flu virus and beat it up a bit, to make it less virulent), but you still can't get the flu from that. You might get stuffy, or even a bit of a cold, but you won't get the flu. I know that giving people this information is unlikely to change anyone's mind, but here it is. 

There is No Such Thing as the "Stomach Flu"

Lots of people will say that they have the stomach flu. They are lying, although probably unintentionally. I don't know how the phrase "stomach flu" got started, but the flu is a respiratory virus. Yes, some strains (H1N1, for example) can cause nausea and vomiting. Also, kids are usually more likely to experience nausea and vomiting with the flu. Symptoms of the flu include fever/feeling feverish/chills, cough, sore throat, muscle and body aches, runny or stuffy nose, headaches, and fatigue. Not everyone who contracts the flu will get a fever, however.

So, if you're puking up your guts, chances are, you don't have the flu. You probably have gastritis, and it's probably viral.

Semi-related: You probably don't have food poisoning. At least, probably not from food you JUST ate. Depending on the bug, it can take anywhere from an hour (if you've picked up Staphylococcus aureus, yes, the same organism responsible for MRSA) to 28 days (if you have Hepatitis A). So, wash your hands, make sure you cook meat until the internal temperature is high enough, and don't contaminate your work surfaces with raw meats. Oh, and while I was working on my MPH, our epidemiology professor told us one very important thing: don't eat the potato salad. It's always the potato salad.

Every Year is Different

Mazel tov, you have beaten the odds and have yet to get the flu. However, just because you haven't gotten the flu doesn't mean you won't ever get the flu. And yes, you do have to get the flu shot every year. Viruses, despite not being technically alive, are pretty smart, and they mutate. This is why sometimes, the flu shot "doesn't work". Scientists start building next year's vaccine a year ahead of time, because it takes that long to develop the vaccine. A network of labs all over the world analyze data and patterns, do a lot of math, cross their fingers, and hope that what gets spit out on the other end will be a vaccine for the major strains of the flu circulating in the coming year.

But like I said, viruses are smart, and sometimes, they outsmart us. Last year, lots of people were up in arms because "the flu shot didn't work". It did, just... not as well as we thought it would or would have liked it to work. That being said, just because a virus mutates doesn't mean that it completely changes its identity. Parts of the virus stay the same, and so the vaccine can confer some immunity, because our immune system is really good at picking up patterns. Even if you got the flu last year, chances are, if you were immunized, your illness was less severe and you weren't sick as long as you would have been without the vaccine. If you want to try and create a vaccine, check out this website. It's pretty fun, and it shows you just how complicated vaccine design can be!

You're Not Getting the Flu Shot for You

It's pretty great that you can get a vaccine and protect yourself from the flu, but it's even MORE awesome that you can protect lots of other people by getting yourself vaccinated. If you are over the age of 6 months, you should get a flu vaccine. (Also, to the 6 month old babies reading this blog, I commend your advanced skills, but you should probably work on like, rolling over or something. There's plenty of time for public health later.)

Here are the people who shouldn't get a flu shot:

- Kids younger than 6 months of age
- People who are allergic to the vaccine (this means eggs, gelatin, or any other vaccine ingredient)
... and that's about it. Here are the people who should REALLY get a flu shot:

- Kids between the ages of 6 months through 4 years

- People over the age of 50

- People with chronic illnesses like asthma, cardiovascular disease (except if you have high blood pressure), kidney disease, liver disease, neurologic conditions, blood disorders, and metabolic disorders (including diabetes!)

- Immunosuppressed people (like people who have had organ transplants, who have autoimmune disease, and those who have HIV or AIDS)
- Women who are pregnant, or who will be pregnant during the flu season

- People between the ages of 6 months and 18 years who are on long-term aspirin therapy (This is because being on aspirin and getting the flu can give you this other condition called Reye syndrome. No bueno.)

- People who live in nursing homes or other assisted living and chronic-care facilities

- American Indians and Alaskan Natives
- People who are morbidly obese (this means that your BMI > 40)

- People who work in health care

- People who live with or take care of or hang out with kids younger than 5 or people over than 50

- People who live with or take care of or hang out with people who have chronic medical conditions (like those listed above) who are more likely to have chronic complications from getting the flu

That list is a lot longer. And even if you don't think you fit into any of those categories, just think about all of the people with whom you come into contact every day. On the bus, in the grocery store, getting your coffee at Starbucks, touching doorknobs and keyboards and faucet handles all day... and there's no way to know if a little kid or an immunocompromised person or an elderly person (or really, anyone who is around any of those people) is also touching those things or sitting next to you on the bus or is behind you in line at the grocery store. 

By getting vaccinated, you're helping yourself, but you're also helping all of those people who need to be more protected. The reason vaccines work is due to herd immunity. This means that by getting vaccinated, you're helping ensure that people who can't get vaccinated, or who are at a higher risk of contracting an illness even if they are vaccinated, don't get sick. So get vaccinated, and you could save a life!

Here are a few more fast facts about influenza for you. You know, to share at cocktail parties and such. Trust me, you'll be super popular.

- You can't get the flu from going outside in the cold without a coat.
- The flu is not "just a really bad cold".
- You can still transmit the flu if you feel okay.
- For the love of God, don't take antibiotics if you have the flu. The flu is a virus.**
- Only certain people should get the FluMist nasal vaccine.
- Just washing your hands a lot is not enough to prevent the flu. (But still, wash your hands.)
- If you got the vaccine and still got the flu, it doesn't mean the vaccine didn't work.
- There is no link between the flu shot and Bell's Palsy.
- There is no link between the flu shot and Alzheimer's disease.
- There are egg-free, preservative-free, low-dose, and high-dose vaccine options.
- People die from influenza EVERY year.
- Getting the vaccine at ANY point during flu season helps reduce your risk. But earlier is better!

And if you want even MORE information, check out NPR's list of concerns and flu facts

I hope this post helped you learn about the flu, and I really hope that if you haven't gotten vaccinated yet, that you will at least think about it. If you don't have a primary care physician, the clinics at CVS and Walgreen's have the flu shot, and you can stop in on the way to work, on your lunch break, or when you're out running errands without making an appointment. (Note: I do not work for CVS or Walgreens, I just want people to not get the flu.)

tl;dr - The flu sucks. There is lots of misinformation out there. Read the CDC's website. Get vaccinated.

With much love,

Your friendly, neighborhood, public health advocate (and future physician)

Life Lately: November

Friday, November 20, 2015

Hi. It's been a minute. I have a bunch of posts brewing, and I promise, they're coming soon. I decided I should at least update what's been going on here before I start talking about why you should get the flu shot, how not to refinish a dresser, how I study in medical school, and lives I may have lived if I was a completely different person. Also, probably a lot of things about cats.


THINKING about how I just need to get through this week and Monday's exams so I can relax for 6 days straight. Also thinking about how cool psychiatry is, and how I might actually like it as a career. To be continued.

FEELING sleepy. Ever since DST, I've been practically falling asleep at 5 pm. I maintain that people were meant to hibernate between November and March.

READING books for school. First Aid for the Psychiatry Shelf and Psychiatry Case Studies are super thrilling, let me tell you. I'm supposed to be starting The Secret History for a book club, but I keep forgetting to pick it up at the library. Also still reading a ton of blogs and journal articles.

WATCHING a lot of things on Hulu/the internet. So far in the rotation we have SVU, Criminal Minds, American Horror Story: Hotel, and Quantico. Ken and I also watch Last Week Tonight and The Daily Show, and I'm planning on catching up on Blindspot, and maybe starting Chicago Med. We'll see. Over the weekend, I saw The Martian, which was excellent. Highly recommend.

DRINKING so much mint tea. My favorite is Jade Citrus Mint from Teavana right now. I've also been trying to drink a lot more water. Success has been... less than optimal.

LOVING that Sarah, Josh, and Patrick are here this weekend! I met Sarah our freshman year of college when we lived in the same dorm, and we've been pretty inseparable since then. They live in Lexington, KY where she is a resident physician, so we don't get to see each other very often. I am so happy she's visiting; she is seriously part of my heart.

LISTENING to podcasts, of course. I started listening to Radiolab, and now I can't stop. Thankfully, there are about 937,000 episodes, so I don't think I'll run out any time soon. I also downloaded the first season of Invisibilia, which is great. There are only 6 episodes, but they're supposed to be doing a second season.

PLANNING for next week/weekend. After Monday, I am off for 6 glorious days. On Thanksgiving, Ken and I are driving to New York to see his best friend Pete and have dinner with Pete's family. Then on Saturday, we are cooking "Thanksgiving" for what turned into 9, possibly 10 people! I've never had dinner for that many people in this house, other than ordering pizza for game nights, so this should be interesting. My mom will be around to help with the turkey and stuffing, but it's all happening at our place. It should be fun!

WEARING scarves, so many scarves! Victoria just gave me a blanket scarf, and I have yet to really master wearing it without looking like I fell into a pile of fabric. Also, if I could just wear pajama pants for the rest of my life, that'd be great.

WONDERING what I'm going to get people for the holidays. I love giving presents, but I'm not very good at it sometimes.

WISHING that I could nap way more frequently and that I had time to really finish decorating our house. Winter break will hopefully be a time for that!

And how about you? What are you up to lately?


Tuesday, October 13, 2015

I've been working on a few posts. There's one about flu shots and why you should get them. There's one about World Arthritis Day, which was yesterday, so I guess better late than never. There's one about how I study in medical school. This is not any of those posts.

This is a post that was inspired by talking to one of my best friends, V. The context is unimportant, because the message is really what matters.

Part of depression and anxiety, a big part, at least for me, is the near-constant self-doubt. At times, it can be crippling. Despite having a list of pretty decent accomplishments, ranging from graduate degrees, to successful jobs, to personal accomplishments like marrying a fantastic man and having an amazing group of friends, there are times (a lot of times) that I feel like a big failure. Like someone who is just playing pretend at being a grown-up. Like someone who somehow doesn't deserve whatever good has come my way. Like someone who, at her core, is not "a good person," whatever that means.

Another part of it is the exhaustion of feelings. I tell people all the time that they have to "feel their feelings," and that having feelings, no matter what they are, is totally okay. (Of course, I'm not as gracious to myself.) I joke a lot about having a lot of feelings, a la "Mean Girls," but it is seriously true. I have a lot of feelings. What's worse is that I have feelings about my feelings. That is the exhausting part. But, as Kelly Williams brown aptly puts in her book, "You don't have to have feelings about your feelings." My therapist also tells me this. I tell other people this. And yet, here I am, having feelings about my feelings on a regular basis.

We've all done it at least once.

"I know it's stupid, but I feel nervous when I fly on airplanes."

"I shouldn't feel jealous of that girl from high school who got married before I did, but I do."

"I'm so mad that I am so upset by the fact that my boyfriend broke up with me. He was a total jerk!"

And on and on. But it's okay. You can be afraid to fly on airplanes, you can be jealous and not be a bad person, you can be sad about something, even if in the end, it might be better for you.

The time I sabotage myself the most, oddly enough, is when I feel good, though. You would think that someone who suffers and struggles through feeling functional, let alone feeling good, would welcome "good" with open arms. That positivity would feel amazing, not terrifying. Maybe for some people, that's how it works, but not for me. The minute I start to feel good about something, whether it's an upcoming exam, or a job prospect, or life in general, there's a tiny voice in the back of my head that says, "You can't feel good. The outcome could be terrible, and then you'll have felt good about something that turned out to be BAD. And then what would you do?"

Spoiler alert: This usually ends with me in what I refer to as "the doom spiral," the ending of which is always that Ken will leave me, and all my friends will leave me, and my family will abandon me, and I will live alone, in a box, in a van, under a bridge, down by a river, and there I will die, childless, and alone, and I will be eaten by wolves. Basically, a bad time.

Second spoiler alert: It doesn't MATTER if it turns out terribly. How I feel right now has literally NO BEARING on the outcome of whatever I'm feeling good about. It only affects how I feel right now, and if I feel good, then I need to just let myself feel good. I don't need to feel anxious about feeling good, I don't need to feel sad or stupid or angry or anything else about feeling good. I can just feel good, and that's fine.

This is all easier said than done, of course. Anxiety isn't something I can fold up and put away on a shelf because I want to. But for me, it helps to remind myself that if the thing I'm feeling good about goes well, then I got to feel good, and then I will feel even better! And if the thing I'm feeling good about goes badly, then having felt good about it doesn't make the bad outcome worse, and if I had forced myself to feel negatively about the whole thing, it wouldn't make the bad outcome LESS terrible. The two events have nothing to do with one another. How I feel right now has no effect on the outcome of this thing. So if I feel good, I'm going to feel good.

Or at least I'm going to try.

Here's to feeling our feelings, and letting ourselves feel good without repercussion from our inner anxiety and depression voices.

What do you think? Do you have feelings about your feelings? What do you do to make it easier for yourself to feel whatever you're feeling? Are you sick of hearing the word "feeling" at this point?

Life Lately: October

Tuesday, October 6, 2015

Oh, hey there. I guess I should blow the dust off of this blog and get back to writing, huh? The last two weeks have been nuts, with exams and being sick and general life stuff, so I figured before I get back to the real writing, I'd quickly update everyone with a little look at what life has been like around here.

THINKING about how much cardiology I have to cram into my brain between now and next Friday. We basically have an exam every two or three weeks, which is way nicer than when I was at Nova and it was every Monday, but it's still a lot. Also, I still am really bad at reading EKG's. 

 like I'm on an emotional roller coaster. Some days, I feel okay, and then there are days where I can't get out of bed and nothing feels like it's worth it. And then there are some days that I feel great. Feelings are hard.

READING All the Light We Cannot See, which I am loving. I only get through a few pages every couple of days, but it's lovely. I'm also reading a ton of blogs. And journal articles. #nerdstatus

WATCHING all the fall TV! Granted, I'm watching it via Hulu and other streaming services since we dumped cable last year, but still. This year's line-up includes The Blacklist, Law and Order: SVU, Criminal Minds, Scandal, How to Get Away with Murder, and Blindspot. I also want to start Quantico before I get too far behind, and of course I'll be "checking in" to American Horror Story: Hotel when it starts TOMORROW. If you want a great review of fall TV, check out Becca's post about it!

EATING more healthfully... or at least making a valiant attempt. Since last January, I've put on about 20 pounds, which is not great, especially because it makes my PCOS symptoms worse, which makes me gain more weight, vicious cycle, etc etc. Of course, I've been craving carbs and sweets like crazy, which is not helpful. Carrots and celery are just not the same as Reese's peanut butter cups, yanno?

LOVING the weather, now that the weekend is over and Hurricane Joaquin has passed. It's been so nice now that the temperatures have dropped below sweltering, and I am so glad that we were finally able to turn off our air conditioning. Fall is my favorite season, and I'm hoping it hangs around a bit before we go straight into the winter temps.

ENJOYING the second year of medical school, even though it makes me want to cry or yell or quit life to go herd goats in Greece at least once a week. The material is so much more relevant to actual doctoring, and despite the fact that there's so much material it is absurd, I can appreciate why they want us to know this stuff. I am sure I will regret saying this at least 28 times before the end of the year, though, so please don't say "I told ya' so," when that happens.

HOPING that the blood work I had drawn yesterday for the reproductive immunologist comes back soon, and that it's good news. More on that to come.

LISTENING to podcasts! My favorites right now are Undisclosed and Freakonomics. Undisclosed is a podcast about the Serial podcast, and it makes me so thankful that I am not a lawyer. The Freakonomics podcast is done by Stephen Dubner, one of the authors of the books of the same name, and it makes me wish I had studied more economics (or... you know, any economics). Other podcasts on my "to-listen" list include Mystery Show and RadioLab. Do you have any favorites that I should be downloading?

PLANNING a trip to DC next weekend, a trip to Atlanta in November for a conference, a trip to FL to see my dad in January, and possibly a trip to the midwest again for spring break to see some of my favorites. We'll see how many of these actually happen, but it's nice to dream...

LOOKING FORWARD TO our wedding-photographer-turned-friend's twins' first birthday party! The girls were born on Halloween and they are ADORABLE, and their party is a costume party! I've never been so excited to go to a child's birthday party. Now, to figure out our costumes!

What are all of you up to lately? 

How To Make a Baby

Monday, September 21, 2015

Don't worry, this isn't "the talk" you got when you were a kid, although this information is just as important.

As my friend and fellow blogger, Becca, said recently, "Getting pregnant is supposed to be easy." Spoiler alert: It isn't always that easy.

When I was a kid and a teenager, it seemed like all we heard about was how we had to make sure not to get pregnant, as if sperm and eggs were just flying all over the place, willy-nilly, creating life. There were more than a couple of times in my adult life where I had a low fear in my belly; "Could I be pregnant?" (Forget for a moment that I was religiously on the pill and hadn't missed a period. I didn't say the fear was logical.) But the general idea was that if you weren't EXTREMELY CAREFUL ALL THE TIME, you would get pregnant.

Would Coach Carr lie to you? (I mean, the man couldn't spell chlamydia so... maybe.)
It turns out that each month, a woman only has about a 15-25% chance of conceiving, and that is if you time it perfectly, you or your partner have no health problems, you're not over 30, if the planets are aligned, and if it happens to be a Tuesday. (Okay, those last two probably aren't true, but I'm beginning to think they might be.)

I'm going to drop some science on you. (Yup, I did it again.)

In women of reproductive age who have no health issues that would interfere with her hormones etc, a woman will have a bunch of follicles mature and a single egg will ovulate each month. This maturation process begins on the first day of the menstrual period, during which the non-pregnant uterus sheds its old lining in preparation for a new cycle. After mensturation ceases, estrogen levels begin to rise, which makes the lining of the uterus grow and become thicker.

Meanwhile, the body is also producing FSH (Follicle Stimulating Hormone) which stimulates the ovaries (where the eggs live in their follicles) to produce a mature egg. There are many follicles in each ovary, and they each contain an immature egg. They all develop at different times, and typically, only one will be mature and ovulate each cycle. Eventually, the rising estrogen triggers a spike in another hormone called Luteinizing Hormone (LH). This "LH surge" is what causes the dominate follicle to rupture, allowing the mature egg to head towards the uterus via the uterine tube (AKA: The Fallopian tube. Because remember, everything in anatomy has at least two names.) This is ovulation, and it typically happens between Cycle Days 12 and 16 (CD 1 = First day of the menstrual period). After ovulation occurs, the follicle begins to produce yet another hormone: Progesterone. This hormone is what supports a pregnancy (it's right there in the name!) and once a fertilized egg implants and begins to grow, the placenta will take over in the progesterone department. Until then, it's up to the follicle.

So, the ovum floats down the tube to the uterus, and hopefully along the way, a friendly sperm will meet it and fertilize it. This usually happens in the tube itself, which is why the number one location for ectopic pregnancies (pregnancies outside the uterus... no bueno) to occur is in the fallopian tube. The egg will live for about 24 hours once it has left the ovary, whereas the sperm can live in the female reproductive tract for 3-5 days. The fertilized egg will head towards the uterus, which has a nice, cushy  lining in which the zygote (fertilized egg) will implant, grow, and make a baby. Once the fertilized egg implants (usually about a week after ovulation), the body produces another hormone: hCG, or Human Chorionic Gonadatropin. This is only made during pregnancy, and is the hormone that is detected by tests. If the egg remains unfertilized, progesterone levels fall, the body realizes that hey, we don't need this stuff in the uterus this month, and menstruation begins again.

The miracle of life. Or whatever.

Clearly, there's a lot going on there, and since the egg only lives for 24 hours after ovulation, there are really only a few days during each month when conception can occur (the few days prior to and including the day of ovulation). It's a miracle that anyone gets pregnant at all! And yet, people do. Every day. But not everyone.

Infertility: Not Just a Lady Problem

Infertility is defined as the inability to conceive after one year of having unprotected sex, or 6 months of unprotected sex if you have a health issue or are a woman over 35. Infertility can occur for many reasons, at each of the steps involved in making a baby. It can happen to men and women; a recent study showed that among infertile couples seeking reproductive assistance, 18% of men were diagnosed with a fertility issue. If you'd like to read about the multiple infertility issues that can occur, check out the CDC's Infertility FAQ (where a lot of this info is coming from).

For me, the issues are multifold. I was diagnosed with endometriosis in 2005, PCOS in 2011, and an autoimmune disease in 2013. This means that my uterine lining grows where it shouldn't (outside the uterus), which can cause blockages and scarring, that my hormones are imbalanced and therefore I might not ovulate or have good-quality eggs, and that my body attacks itself, causing all sorts of inflammation and other uncool things. Basically, none of that is good for pregnancy.

My Intro to Fertility Treatments

I've talked about how losing two babies in a row was heartbreaking. What I haven't talked about is how after my first miscarriage, people kept saying, "At least you know you can get pregnant!" and after I got over wanting to set them on fire, there was a small part of me that was amazed and hopeful. My body had finally done something that it was supposed to do. I was (foolishly) convinced that since we had been so fortunate to get pregnant after 4 months of trying without intervention, that we would have similar luck when trying again. There were even a couple of people who said that they had always heard that after a miscarriage, women are more fertile than other times. (This, by the way, is a total lie.) When I didn't get pregnant right away, I was devastated. Every month, it was the same thing.

Focus. Anxiety. Hope. More anxiety. Devastation when each month, a big, fat, negative pregnancy test appeared.

I knew that if I called my reproductive endocrinologist and said that we wanted to try some low-tech interventions, I wouldn't have to fight for it. For some reason though, I just... didn't want to. I tried to talk through it in therapy. Before I had ever gotten pregnant, I was 100% gung-ho for heading towards fertility treatments, including IVF if we had to and our insurance covered it. I had never expected to get pregnant, miscarry, and then not be able to get pregnant again. My body did it by itself once, why couldn't it do it again?

But it wasn't doing it again. I didn't know if I was ovulating. My ovulation tests were negative, and I had no idea if I was just missing the LH surge that the test detects, or if my body wasn't doing it. I had no idea what my hormones were doing. With a history of PCOS, not ovulating and having hormonal imbalances is always a possibility, and endometriosis and autoimmune disease definitely weren't going to help the situation. And yet I resisted moving on to even low-tech interventions like oral medications to induce ovulation. It just felt like "giving up," and I wasn't ready to admit that yet again, my body had seemingly failed to do the most basic thing its programmed to do. After lots of crying and frustration, talking to Ken, and running through all of these thoughts in my brain, we decided to try IUI, or intrauterine insemination, and we did our first cycle in July.

How to Make a Baby: IUI

More science time! In case you don't know, an IUI is when the semen/sperm is taken out of the male partner (or donor), processed and spun down in a centrifuge to concentrate it, and then injected into the uterus of the female partner (or surrogate) via a tiny catheter inserted through the cervix (the part of the uterus that connects to the vagina).

When you sign up to go down the path of an IUI, you don't just randomly show up on any old day to get it done. If I hadn't been obsessed with my calendar before this, being on fertility treatments would have made me obsessive. There are very specific times during which blood needs to be drawn, the uterus and ovaries need to be imaged via ultrasound, and drugs need to administered. Usually, there's baseline blood work to check hormone levels and an ultrasound to count developing follicles on Cycle Day (CD) 2, 3, or 4. If that's normal, ovulation induction medications (like Clomid or Femara) are given on CD4-8. Then on CD12, another ultrasound is done to take a look at the follicles, and if one is the right size (18-20 mm is the sweet spot), then later that night at a particular time, an injectable medication called a "trigger shot" is self-administered to force the follicle to mature and the egg to ovulate. 36-38 hours after that, it's back to the office for, ahem, sample collection, and then two hours later, during which the sample is processed cleaned up, and concentrated, it's go time. 

The actual process for the woman is a bit like a slightly longer pelvic exam, and for me, it has never been painful. Some women report cramping when the catheter is inserted, and if they have to clamp the cervix, that is definitely not a great feeling, but they never have clamped mine to stabilize it (at least not for this procedure, thank you God and all that is holy, because that single-tooth tenaculum is AWFUL. By the by, that link is totally safe for work, it's just a picture of the instrument. No body parts.) After the insemination, the doctors ask you to lay on the table and wait for about 15 minutes. If you're like me and like statistics and numbers, in 2009, the British Medical Journal published the results of a randomized controlled trial comparing women who had remained lying flat for 15 minutes post-IUI to women who were allowed to get up immediately following the procedure. In the group randomized to 15 minutes of rest, pregnancy rate was 27%, whereas the pregnancy rate in the control group was 18%, which was found to be statistically significant. If all of that made zero sense to you, that's okay. I have a plan to do a basic stats primer for people who want to be able to read journal articles and at least kind of know what is going on. (I know, it sounds super exciting.)

Patience is a Virtue... Just Not One of Mine

And then we wait. For two weeks. This isn't any different than a non-medicated, non-IUI cycle, as there is always the dreaded "two week wait" (TWW) between when you might have conceived and when you will find out. It's essentially the longest two weeks of my life. Every. Damn. Month. The only added "bonus" to an IUI medicated cycle with a trigger shot is that you definitely cannot trust an early test if you test before you've missed your period. This is because the injection that is used to trigger ovulation is hCG, which is the very same hormone that is detected by pregnancy tests. And I think the only thing worse than a negative pregnancy test is a false positive that turns into a negative. Really, testing early is generally not suggested for a variety of reasons, not least of which is preserving your sanity because if you get a faintly positive test and then your period shows up, it's just not a good time. (That being said, I am the worst at not testing a day or so early. But that's what cheap pregnancy tests are for, right?)

You might think that after over a  year of actively trying to get pregnant, I'd be better at going with the flow or chilling out. You would be very wrong. I will say that I am beyond grateful that NJ is one of the 16 states with mandated infertility coverage in its insurance policies. Otherwise, the option to do IUI's would be completely off the table, and we couldn't even think about IVF if we have to go that route. The fact that infertility treatments and assisted reproductive treatments are not covered by most insurance is another post entirely for another day, but it makes me really upset to think about, so I'm not going to go there now.

(deep breath)
Okay, I've calmed myself.

I hesitated writing about this because it is really personal, and it might make some people uncomfortable, but those people don't have to read my blog, and it's all medical information anyway. Plus, I talked about what I wanted to do with this blog, and educating people about science and medicine is part of that. One of the things that I've heard when I've talked about this in real life is that so many people have no idea what fertility treatments entail, and even fewer understand the basic biology that occurs in almost all women of reproductive age. By sharing my story, hopefully people will learn some useful info, and more importantly, other couples out there going through something similar might feel less alone. 

So that's what I've been up to. I am currently in the middle of our third cycle, and we thought we'd be doing IUI #3 this past weekend, but biology had other ideas, and so the meds and ultrasounds continue. If you have any questions about any of this stuff, please don't hesitate to ask them! If I don't know the answer, I will find the answer for you, or at least point you in the right direction. 

Thanks for reading, and for being on this wild trip with me.

Full disclosure: Some of the links in this post are affiliate links for which I will receive a very tiny amount of money if you click on them!

The Joy that Was and the Joy that Wasn't

Tuesday, September 8, 2015

Wednesday, August 26th, was quite a day.

It was the original due date for the baby we lost in January.

It also was the day that I found out that I was pregnant again.

Talk about a lot of feelings, right?

Obviously, Ken and I were over the moon excited about the fact that yes, we were going to have a baby! We decided not to tell a lot of people because it was so early, but we did tell some close friends. I called my doctor and they told me to come in for labs on Thursday. My first HCG level (HCG = the hormones that indicates pregnancy) came back at 126. The number itself kind of means nothing, other than yes, I was definitely pregnant. What matters is that in early pregnancy, the HCG should double every 48 hours or so. I had my labs redrawn on Monday, 96 hours later, which meant that my HCG should have been roughly 500.

It was 277.

I had been waiting all day for the phone call that would tell me that our baby was growing, growing, growing! I felt good. I was feeling the early signs of pregnancy; I was exhausted, my boobs hurt, I wanted to eat the couch, that kind of thing. I was surprisingly not anxious, given what happened the last time I was pregnant. In fact, I was really proud of myself for not being a neurotic disaster about all of the untoward things that could possibly occur during a pregnancy. The fact that my HCG would not double did not even cross my mind. This baby would be fine. Statistically, there was a very low chance that I'd have a second miscarriage. And come on, the universe owed me this after the shitshow of last winter, right?

When I heard the news from my nurse coordinator, who by the way, I am convinced is an angel on earth, it felt like a punch to the gut. This baby was not okay. Or, we didn't think it was okay. There was no way of knowing until the next HCG level was drawn, but my nurse was honest and told me that it wasn't looking good. My numbers had not even increased 50% every day, let alone doubled every 48 hours. I would just have to wait and see. I got this information shortly after leaving the house to go out for the evening, so I didn't turn around to go tell Ken. Instead, I sobbed for 20 minutes and then drove to Philly. Given the situation, I ended up having a really good time that evening, but once I got home, my exterior shell crumbled when I told Ken what was happening and I spent the rest of the evening in bed.

So, against my better judgment, I took to the internet to do some research. Surprisingly, the internet had a lot of good, happy, stories about women whose HCG was wonky who then went on to have totally healthy, normal, babies. Also, I learned that HCG doubles every 48-72 hours in only 85% of pregnancies. I did and redid the math. If I had doubled every 72 hours instead of 48, my 277 would be okay! And 277 was well within a normal range for a very early pregnancy, even if it hadn't doubled. And it had gone up, so that had to be reassuring. By Wednesday, I had convinced myself that yeah, this baby was totally fine. I'd be due in early May, right after the school year ended for me. I wouldn't have to be pregnant all summer. It would be great.

I had my blood drawn on Wednesday morning and then proceeded to menacingly stare at my phone, willing it to ring for the rest of the day. I knew that my nurse wouldn't call until after 3, but by 3:00, I felt like I was going to throw up, pass out, or pee. I did none of the above, and my phone finally rang in the middle of a lecture about infectious diseases and antibiotics that I wasn't really paying attention to anyway. I went into the hallway.

"Alison, I'm so sorry. Your HCG dropped to 134."

I crumpled into a chair in the hallway and tried to remember to breathe. I felt like my body went numb, or that I wasn't a part of it anymore. The nurse said a lot of very kind things and I just kept saying, "Okay," because even though it wasn't okay at all, it was all I could think to say. She told me that I had to come back on Friday. I hung up the phone, walked back into lecture, quietly packed up my things, and left. Then I got to my car and burst into tears.

I just couldn't believe that this was happening again, and I couldn't believe the insane pace at which it was happening. And I also couldn't believe that after the initial grief and shock, I felt... fine? Not fine. Calm. Semi-numb. Sad, but functional. Well, semi-functional. I spent the entire day in bed on Thursday. After my lab draw on Friday, I came back home and went back to bed for hours. My life plan at that point was hour-to-hour, and was generally take a Klonopin, fall asleep, wake up a few hours later, take another Klonopin, repeat. I also kind of forgot to eat unless Ken put food in front of me. So yeah, semi-functional.

My only hope and wish at this point was that my HCG would continue to drop precipitously, so that my not-very-long-national-nightmare would end quickly and that I could get on with my life. I knew that I could not handle another protracted miscarriage in which I had to have two D&C's, separated by a dose of misoprostol. See also: The longest few months of my life, during which I may as well have been in some kind of fugue state because I don't really remember anything between January and April. When the call came on Friday that my HCG was down to 39. I had instructions to come in this Friday if my period hadn't returned. Fortunately, I won't have to do that, as it seems that my reproductive system has decided to at least cooperate a tiny bit this time.

Like I said, the 26th was a big day. The week that followed was a whirlwind, a roller coaster, a crazy experience that ran the gamut from the ridiculous to the sublime. I'm sad, I'm frustrated, I'm scared. I'm in disbelief, but not denial. I'm concerned. My biggest fear is that I will continue to get pregnant, only to lose our baby, over and over again. My fear is that no one will figure out what is wrong, or even worse, that there's nothing specifically wrong or fixable. It's just shitty lucky.

My gut is telling me that there is something we can do. Something to be discovered. Clearly, I can get pregnant, and I am so grateful for that fact. The trouble seems to come after that part, and the medical community at large knows far less as to why that happens than it does about getting people pregnant in the first place. I know that my history of PCOS, endometriosis, and autoimmune/inflammatory arthritis certainly aren't helping things, but since we know so little about all three of those things affect pregnancy, aside from the fact that all three increase your risk of miscarriage, making the leap to some kind of cause is difficult, if not impossible. Because I'm me, I went into triage mode and made an appointment with a reproductive immunologist in north Jersey for the beginning of October. Maybe, just maybe, he'll have some ideas. (At the very least, he's a DO, so I know he'll be awesome.)

It is incredibly exhausting to carry so many diametrically opposed emotions. I was so sad at the thought of my original due date coming and going and not having a baby to show for it. I was overjoyed when I found out that I was pregnant again. I was devastated when I learned that once again, I wouldn't be bringing this particular baby home. And now I'm relieved that I don't need extensive medical interventions to let this extremely unfortunate event pass. The joy and sorrow, intertwined, reminded me of this poem by Khalil Gibran called Joy and Sorrow, one of my favorite poets, authors, and thinkers. My favorite line is this:

The deeper that sorrow carves into your being, the more joy you can contain.

That is keeping me afloat. At the end of this, I will be overfull with joy.

Revamp, Rethink, Re-evaluate

Wednesday, September 2, 2015

Last week, I had the opportunity to meet up with some of the awesome women of PHLBloggers to talk about social media and blogging. My friend Chrystina started the group last year, and she's done a great job setting up really cool programming for us! Of course, thanks to med school, I have been to approximately 2 of the events, but I knew that I wanted to go to this one, and I am so glad that I was able to actually make it.

Besides talking about the various types of social media and how we can maximize its use for blogging, the session gave me time to think about my blog and what I want for this space. I have a lot of questions that only I can answer, really.

What is my niche?

Ah yes, the elusive "niche" question. When I started blogging (waaaaay back in the day on OpenDiary... I just dated myself there), my online journal was just that: a journal. It was pretty much exactly like my paper journal, but online. It wasn't very interesting to anyone who didn't know me, and I didn't really have anything earth-shattering to say. I moved to LiveJournal in college and there was more of the same. When I started blogging her, I had just gotten married and was working, and for the most part, wrote about life, the universe, and everything. As I started reading more blogs, I felt a distinct lack of direction for my own. In fact, I hestitated to even call myself a blogger, because I couldn't define my blog. It definitely wasn't fashion, food, or business related. I didn't have a product, or a brand new idea, or a super cool job. I wrote about marriage and mental health, my cats and some traveling we did. It was totally random. Chrystina said that maybe it was a lifestyle blog, so I went with that. Yeah, a lifestyle blog. Whatever that means.

I decided that I wanted to get serious (or at least more serious) with blogging when I hired Jenn to redesign my blog, and it was really the first time I invested real money into this space. I love the redesign and it made me feel so much more "legit" as a blogger. Since then, I've kind of tried to trim my content, but I still wasn't sure what I wanted to write about. I decided that I needed to consider two things: What do I know, and what are my passions?

What do I know? What are my passions? Where do they intersect?

I know a little about a lot of things, and a lot about a couple of things, some of which aren't very interesting or blog-worthy. I was able to group the good ones into a few categories:

Medical school/grad school
Communicating well
Cats (okay, maybe this one doesn't count)

Then I went to my passions and included some goals in there as well:

Helping people
Talking and writing about and destigmatizing mental illness
Writing/talking/communicating in general
Educating people
Making people laugh
Cats (okay, maybe this one also doesn't count)

Fortunately, some of these things overlap! Which left me with:

Depression/anxiety/destigmatizing mental illness
Communicating/educating people about the above topics
Cats (or... not)

Based on these results, I need to write a blog that focuses on medical science and mental health, with a primary focus on communicating to large groups of people and hopefully educating them. Also, I'd love to be able to make you laugh if I can.

So now what?

Excellent question. What do I want to do with this space? What is my pie in the sky goal? Well, I'll tell you. I mean, it is Wednesday, which used to mean confessions.

My big goal?

I want to write a book. A book about depression, anxiety, and mental health in general, focusing on the medical school and physician populations. I want to drag this subject out into the light, in a real and meaningful way.

I used to think that this was a stupid idea, because who the hell cares what I have to say? I guess that could still be true, but mental health is so personal that I feel like if my story can help even one other person, I want to tell it.

So there it is. I'm going to reshape my blog in order to get my brain into a setting where I can write this book. I don't know when I'm going to write the book. I don't know how one goes about writing a book. But the idea is out there in the universe now. There you go.

I guess a good place to start would be to post on some kind of regular schedule. I'll... get right on that.

What do you think of the new blog idea? The book idea? And has anyone out there ever changed their blog name successfully? Let me know!