PIFT is the new PIA February 11, 2008

Get it? That’s pain in the fallopian tubes.

Yeah, I didn’t think it was that funny either.

It wasn’t nearly as bad as I thought it was going to be, but I thought it was going to be really, really bad. I took Zofran a couple of times, I took a bunch of naps, and I had cramps mild enough to be tamed by Tylenol, but I moaned about anyway.

The worst is that I was, and still am, dizzy, as I have been since I got pregnant, and it’s the misery of being dizzy that is making me think seriously about just how quickly I want to try again. I am sure that by May I will be ready, but I’m looking forward to enjoying a couple of clear-headed months in between. (Not that I’m assuming I’ll get pregnant again on the first month, of course.)

First things first, though: Blood test tomorrow morning and again on Friday. It is my understanding that the beta could be up tomorrow, but should be down by Friday and if not, we get to rinse and repeat. Woohoo.

Meanwhile, file this under you can’t make this shit up: In the high winds yesterday, an entire tree fell on Tata’s and her boyfriend’s cars. Yes, plural for both of their cars, which were parked next to each other. I feel terribly for her, and it wasn’t great for us, either,  since it wasn’t like either of us could miss another day of work. Grandma filled in today while she got everything worked out with insurance including, thank god, a rental car.

Useful information February 8, 2008

If you should find yourself in need of a shot of methotrexate, you should know that when Dr. Google describes it as intramuscular, he means in your ass. So don’t go in thinking that it’s going to be in your arm or anything delicate like that.

Also, it most likely means two shots in your ass.

Also, if your practitioner tells you to bend over so she can deliver said shots in the ass, you should not pull your pants down. She means the very top of your ass, in an area you may never have thought of as even part of your ass, and if she turns around to find you have your pants around your knees you will feel like… an ass.

I hate the word ass.

If you are not too traumatized by the idea of having a pregnancy that could have killed you (not that mine got anywhere near that far) and you can live with a 10-20% chance of recurrence and would like to try again, you must wait, not for the return of one real period, as after a “normal” miscarriage, but through an ovulatory cycle and a second period, because apparently methotrexate fucks up the next egg in line.

Finally, if you are looking for something to give your blog stats a spike, there’s nothing better than a good pregnancy drama. And it really does help when times are bad to know that the innernets care. Thanks again for being here.

Edited to add: It is a good idea to demand that your doctor give you a “just-in-case” prescription of Zofran before you leave. And if you don’t have a 24 hour pharmacy near you, it’s a good idea to fill it before closing time, just in case. I will not puke. I will not puke. I will not puke. Oh, lordy.

No news is… no news February 7, 2008

(After a 90 minute wait at Grand Central Station in Dr. Nice’s waiting room, exam room, and ultrasound room) he and the ultrasound tech couldn’t see a damn thing. Which is exactly why I am glad I self-prescribed yesterday’s beta, because we needed another point of data.

Dr. Nice’s hypothesis: Since my uterus lining is very thin, but my numbers are still going up, he thinks that it’s an ectopic, and the bleeding last week was my uterus sloughing off its lining, but not the embryo. I think that sounds logical.

My options were:
1. Do the methotrexate today
2. Do more bloodwork tomorrow morning, and if it’s still going up, do the meth tomorrow
3. Wait and see and monitor (basically hope this will resolve on its own)

We are going with the in-between option 2, which just feels like a stay of execution to me because I will fall out of my chair if I get a lower beta tomorrow. After this, they follow up with blood work on days 4 (Tuesday) and 7 (Friday). If the beta goes down, I can expect to finally miscarry in a couple of weeks. If it goes up, I will shoot myself.

.
What I need from you guys now is this: Accounts of experience with the meth that do not include the words “I thought I was going to die,” “I’ve never felt so horrible in all my life,” or similar. Truly, if you don’t have anything reassuring to say, don’t say anything at all. Dr. Nice claims those adverse reactions are very rare, and as much as I love and trust him, and even though it’s his birthday, I don’t believe him.

Revise your answers, if necessary February 6, 2008

The third beta came in at 694 today. Still growing, dammit, with no miracle bursts.

I spoke with Dr. Nice, who reassured me that even if it is ectopic, ectopics tend not to burst till HCG levels hit 4,000 or so. Not that it’s impossible for them to burst at lower levels, just not usual. He’s going to take a look on the high-end ultrasound machine, and he did say he’d prescribe the dreaded methotrexate if he sees a sign of anything outside the uterus. At this stage, it would be way too small for surgery. He wouldn’t be able to find it. He didn’t mention what he would do if he sees nothing at all or something of inappropriate size in the uterus

I asked what would happen if I have the methotrexate shot and there is a problem over the weekend, and he told me that the doctor on call (him on Sunday, head of the practice on Saturday) would meet me at the hospital, not leave me in the hands of the notoriously bad local ER.

I would put money on him not seeing anything with such a low beta. As much as I fear the methotrexate, I may ask for it even if he sees nothing or something in the uterus. There is no chance that this can turn into a baby with any chance of making it, and I can’t see any point in letting it drag on and grow bigger and more difficult to remove when it eventually dies/stops growing. Add to that the fact that I am wildly dizzy– too dizzy to drive– and I’m just ready for this to be over.

Thanks for being here with me.  I wish I’d had your support the first time around.

Homework assignment February 5, 2008

This one is for those of you with degrees from Google U., Message Board U., Blog U., personal experience, or actual medical degrees in miscarriage.

Background facts facts:
Dec. 22: LMP
Jan. 7: LH surge (Day 16- normal for me)
Jan. 8-9: Ovulation (dates for this exercise will assume Jan. 9, to be conservative)
Jan. 20: Positive HPT (11 dpo)
Jan. 28-Feb 1: Moderate bleeding (19-23dpo)
Jan. 29: Ultrasound shows nothing except “maybe some thickening of the lining”
Jan. 29: Beta- 282 at 20dpo (Reference: Median- 837; Range- 29-10,000)
Feb. 2: Beta- 464 at 24dpo (Reference: Median- 3,328; Range- 144-28,000)
Jan-29-Feb 2: “doubling” time: 113 hours (Reference: Median- 39.58; Range- 12.46-311.62)
Since Feb 2: No bleeding, no cramping, some dizziness (normal pregnancy symptom for me)

Your assignment
Part 1: Present a hypothesis as to what’s going on here. Ectopic? Blighted ovum? Doomed embryo located in uterus? Other? Please show your work/explain rationale behind your hypothesis. Please pay extra attention to the fact that there was blood and now there’s not, but the HCG is still going up, if way too slowly.

Part 2: What should I be aware of going into Thursday afternoon’s ultrasound? I figure three things can happen. 1) He can see an ectopic; 2) He can’t see anything and “presumes” ectopic; or 3) He can see something in my uterus. Am I leaving out any other possibilities? What questions should I ask based on any of the above scenarios? What should I know about treatment options? (Wait for it to resolve on its own, D&C, methotrexate, anything else?)

I’m most scared of the uncertainty around option 2. I’m also terrified of being prescribed methotrexate since I’ve read the horror stories of people lying on the bathroom floor cramping, bleeding, and vomiting. I especially hate this idea since my doctor doesn’t work on Fridays and, while I can reach a colleague on Friday, I think I’d be stuck with the local emergency room (notoriously terrible) if there is a problem over the weekend.

Responses are due no later than Thursday, 3:00 p.m. EST. Partial answers permitted. Thank you for participating.

Updated to add: Thanks for all the responses so far. Keep ‘em coming! Also, to clarify: I *know* there’s nothing viable going on in there, so no need to hope for good news in the form of a quadrupling beta and a heartbeat or anything. I realize that even if I see those things, I am almost definitely just dragging out an inevitable miscarriage of a chromosomally abnormal fetbryo, like Kathy McC’s comment. Good news this week is a declining beta and, failing that, something definitively located in the uterus.

And now for something bad February 4, 2008

Tuesday’s beta, at approx 21 DPO: 282
Saturday’s:464

So it’s growing, but not appropriately, which means that not only am I not going to get a baby out of this, but the situation is not going to resolve itself with a minimum of fuss, as originally hoped, which bites.

Ultrasound on Thursday afternoon.

Something good February 3, 2008

I’ve been exhausted all week, actually, getting into bed sometimes even before Gatito and sleeping 10-12 hours. I don’t know whether it’s ongoing jetlag or the miscarriage, light depression I haven’t been willing to admit to myself, or the combination of all those things gave me an excuse to act on my natural laziness. I was feeling low yesterday, and just for some time by myself, I jumped into the shower around 5:30. After I got out (and engaged in my stick peeing shenanigans), I was just putting on my pajamas when the doorbell rang. It was Tata, here to babysit, and I had half an hour to get ready!

After hearing the bad news earlier in the week, A had planned a secret date night, making reservations at a hot new restaurant and arranging for Tata to babysit. Never in my life has A ever done something so thoughtful and sweet. It was particularly surprising since I know he’d had mixed feelings (okay, that is putting it mildly– he was freaking out) about the pregnancy in the first place. I don’t think he was personally bothered by the loss, which is what makes it even more amazing that he was sensitive to how I was feeling. It was such a simple thing, but I can’t tell you how much it lifted my spirits.

Admit one February 2, 2008

I’m totally crazy: I’m not completely convinced I had a miscarriage. I haven’t been thinking this all week– just for the past few hours. The bleeding slowed to spotting and stopped today. Don’t get me wrong– it was a lot of blood for a pregnant person, but somewhat less than a normal period overall and not as much as I would have expected for a miscarriage. And it is conceivable (no pun intended) not to see a sac on a five week ultrasound, according to Dr. Google, especially on the low tech, mobile machine my doctor was using.

This evening in the shower, I became aware that my breasts were fuller. I came up with the logic that since I had never seen a convincingly dark line on my HPTs in the first place, if I’d really just miscarried, an HPT should be negative, or at least extremely faint or, you know, fainter than what I’d seen last week or, failing that, at least not darker.

I know. You’ve all warned me about the limitations of these tests. I already admitted I am insane. But I had one test left, just taunting me in the medicine cabinet. I had just peed right before my shower and only managed to squeeze out, seriously, two drops. I thought I’d wasted the test. But then, even before the control line showed, a bright test line appeared.

I actually had the second of my betas this morning. It wasn’t ordered STAT and I don’t know what happens at the labs on the weekends, so I don’t know whether results will be in Monday or Tuesday, but at least by Tuesday I figure I will have some quantitative proof that I belong in the fucking loony bin, and I will move on. I just need to figure out exactly how to frame my question to the OB nurse so that she doesn’t realize the crazy miscarriage girl thinks she might still be pregnant.

Don’t say that! February 1, 2008

It has come to my attention that a significant portion of what comes out of Gatito’s mouth lately, generally accompanies by an enormous, irritated sigh, is:

“It’s so annoying!”
“It’s impossible!”
“You’re kidding me!”
“Sucks!”
“Don’t say that!”

For generally happy people with pretty awesome lives, a certain red-headed mimic is making me see that we sure do complain a lot. I’d like to blame it on the nanny, but she doesn’t even speak English with him. Damn.