A Little Bittersweet

Today was my last day of work in this job that some days I loathed but mostly was compelled to give my all. Any yet it is bittersweet. This end. It's hard to let go sometimes of something you have thrown your life into especially if it might still stand on fledgling legs. Monday morning I will likely wake in the wee hours of the morning my mind rushing through the tasks of the day until I remind myself these tasks are no longer mine. I will try to quiet my mind but it will be no use and so I will wake and for the first time in forever have a proper Monday morning breakfast sans Starbucks. Maybe in addition I will even have time to workout. Shower. Apply makeup and style my hair. Fancy that. Oft times before it was either eat breakfast or groom for work. And I can probably count on one hand the number of times I worked out before racing out the door for work.

It's too early to reflect on my successes and accomplishments. I am still in the phase of thinking what have I left undone, what could I have done more, or better. Of all my ever regrets I regret the moments I did not correct gossip or stop chatter that was intended to raise doubts of another's worth or capabilities. I aim to be less of a listening ear and agreeable sort whom others feel they can vent to and stand for changing the tides. 

There were lots of satisfying moments. But for now I am glad this chapter is done. 

I will miss this. That I know. It's a little bittersweet. Letting go. Moving on. 

February Reads: 500 pages

Coulda, Woulda, Shoulda is the title of my 500 page read by Tara Lee Reed. It is a grown up adventure novel about a young woman, Elle Masters navigating the dating world.  It is an easy read that is fun that you would enjoy on the beach or on a plane. I was great at first dates in my twenties not so great at second or third dates. Or if I made it to regular dating I wasn't quite sure how to transition to being boyfriend/girlfriend or if we were. It was fun and at times uncomfortable reliving those memories. I was famous for picking the same type and then wondering why it did not work out. Until my friends reminded me that what I thought was my type was not working. My first long term relationship that was an actual relationship was with L. And he's a great catch! I love him. 

Most of the other relationships I had I wondered many of the things Elle wonders in this book. To give him your number, turn to section 87. To take his number, turn to section 3. To leave a message after the beep, turn to section 38. To hang up and try again, turn to section 21. To let it go, turn to section 73. To tell him what you think, turn to section 47. Clearly each of these choices you go into thinking are valid options. What should I do? Sometimes you revert to the silly rules of dating and other times you throw caution to the wind or try to guess where it might lead or what he is thinking. And then sometimes what you thought was a solid choice is not the best choice. 

It was a little unnerving reading from a second person voice. Generally most novels are written in first person or third person. This level of interaction influenced many of the choices I made. But then after my scenario would end I had to go back and pick the second option or other back options just to see what woulda or coulda happened. 

I finally figured out midway through that the aim might be to get married. It's a tricky route to get there. However reading the scenario choices you start to feel for Elle, or you, and sometimes this Nick character is a real jerk in some scenarios. So by the end sometimes after you had read the worst case scenarios where he is not a gentleman you wonder in the other best case scenarios if really this is what Elle wants. So to get married (don't worry I won't give it away) I came across a scenario on the opposite page to my scenario END and decided to follow it back. Hey! We've all done it with adventure novels. It kinda kills it then however and you end up reading the scenarios out of order multiple thumbs in multiple pages considering where each choice might lead you and wonder if there is a second outcome that also leads to a proposal. There is. Yay! 

Eventually I read it somewhat linear if I came to a page where I had not encountered that choice I followed it until I reached a page where I knew where I was. And so I read all 510 pages. Likely if I was not on a quest to finish a book with 500 pages I would have given up much earlier because it seemed a little ridiculous after awhile.

There are a few good dating rules. Some are subjective. It is not an advice book. A good dating rule to pick up from this book is to not abandon your girlfriends in favor of a date. The only time this advice doesn't stick is when you are asking him to hang out with your girlfriends for the first time and one of the girls asks you to make a choice essentially picking sides between the girls and his point of view. Advice don't hang him out to dry in an already uncomfortable situation. You can apologize to friends after but also call them on their behavior. Also good advice after you get serious stay busy. Have a life. 

I liked the format a lot and thought this would be a fun way to write a book. On the authors blog you can find a post where she writes about a new novel under way but also considered if she were to make a sequel to this novel with Elle having a second option. What if one of those choices led to something else or someone else. I like the picture she has of post it notes tracking the sequence of options. It gives a look into how complex it would be. 

I think it is fascinating that this author decided to publish this novel independently. Kuddos! That would not be an easy choice. I also love that she is Canadian! Even though the book is set in San Francisco there are a few references to Canada. I hope a future novel by Tara Reed is entirely set in Canada.

Happy Family Day & Valentines Recap

Oh, the lonely moors, the breezy moors,
        And the stormy hills so free;
    Oh, the wild, wild moors; the wild, wild moors,
        The sweet wild moors for me.
       --  Edwin Waugh

                                                                         

I've had a great five day long weekend. Here is a recap of the weekend happenings.

I was able to tack on a day in lieu off on Friday to my doctors appointment on Thursday.

Thursday I met with my doctor who reviewed my past cycle. I really should have wrote more questions down however the doctor is confident that we will get pregnant as my eggs are great quality and I responded well to the medication in the past cycle. I am set to have a frozen egg cycle in my next cycle. She is only willing yet to put in one egg and then said if this does not work we will put in two eggs next time. But then she qualified that and said lets not think about next time. Let's think positive.

As for why it did not work? That was a little vague. She showed me the various eggs on various days and said that likely this one just did not make it by showing me the rate at which some drop off and did not make it on various days.  L said BS as he said we put in a 4AA egg when I told him this on Friday- he would have agreed with this if perhaps it had not been one of the better eggs. I thought it was possible but I also think I have implantation issues. She agreed that Metformin would be an excellent choice for me and prescribed me 1500 mg a day. I am to work my way up to having 500 mg 3x a day. So far I am at 1000 mg and occasionally I feel right awful. Like last night. I have heard if you have a meal with too much sugar or fat that you will feel that way.  I had made a roast in the slow-cooker that we turned into beef dip with gluten free bread, grilled asparagus and a cabbage salad and water to drink. I thought that was fairly healthy but apparently my stomach disagreed and I felt quite nauseous.

I met up with my brother K and his wife A after for dinner. I enjoy spending time with them. They are so much fun. We went shopping in the evening. MEXX is going out of business and so we had fun with the huge discounts they were offering. I bought a suit coat for work that was originally $170 for $35. K was in the market for new suits for work. He is turning into one classy dresser.

Friday I had coffee with A at Starbucks. A had the day off work also as one of her flex days. I am really enjoying getting to know her more. Then I was off to IKEA. I spent way too long trying to find the wire baskets I was looking for and then inserts that would fit to organize my art supplies. I am trying to organize my things before we move so that I do not have just random boxes with items dumped in. In organizing I am also able to get rid of some things that we have never used. My pile for good will continues to grow. Finally I was back on the road home. L would be home after working in SK for the past week. We had leftover borscht for dinner and watched an episode of Doctor Who.

Saturday was Valentines. We had some errands to run on Saturday including new safety glasses for L for work and checking on his parents place while they are away and watering their plants. For Valentines we had some fun things planned. We had made reservations at Twist Wine & Tapas Bistro. We had the tapas deep fried manchego cheese as our appetizer. Mmm delicious! L remarked who knew that deep fried cheese could taste so good. For our entree we had the Valentines special of steak and prawns. It did not have as much flavor as the tapas and so we decided next time we return we will just have tapas. Oh and wine! We had a lovely bottle of Casa de Campo Malbec from Argentina.  I highly recommend! For dessert I had the apple crumble and L had the Turtles Sundae. After dinner we had tickets to go see Boeing Boeing by MHMT. Excellent acting by this volunteer cast in this swinging sixties comedy of a successful architect who juggles the hearts of three airline hostesses.

Sunday we slept in. As in really slept in. We woke up at 10:45 AM. The day was almost over. L made his famous bacon and I made hashbrowns and eggs for breakfast. Then we started prep for our roast which meant a last minute run to the grocery store to pick up oninons and consomme. Sunday afternoon we went on a hike along the trails of the South Saskatchewan River. I love going for hikes with L. Here are a few photos from our adventures. We finished off the evening with not just one but two episodes of the Doctor. 

Which brings us to today, Monday, Family Day. L got out his tools and finished a project on my list in the morning. And now I am writing this post while L shoots some aliens on the x-box before lunch. After lunch he is off to SK to start work for another week. 

Its hard to imagine going back to work tomorrow. I have officially 11 days left of work. This week coming up and next I have scheduled interviews for summer staff. Then I have to attend the Teachers Convention and promote the upcoming theater performance for schools, our new Archives program and the sponsored school trips to the First World War exhibit. I need to ensure I complete my invoicing for January and February school visits and the Outreach Artist program. I need to meet with the Cultural Director and finish the Education Business plan for the next three years. Ridiculous but anyways. Saturday somehow I allowed myself to be talked into doing a presentation of vision boards with youth at the YMCA. I am not looking forward to that. Later this week I am helping to set up for Pecha Kucha. I think that should be a fabulous night even if I will be tired the next day. We have a great line up of presenters planned. Next week I have to lead a number of school and public programs, complete the plan for the next Education Coordinator to take over and have a number of meetings. Thursday next week is a going away coffee for me. I think there will be carrot cake. And then Saturday I have to help with a family workshop and presentation by the artist. It will be a busy 11 days. I am not really excited about working two Saturdays in a row but c'est la vie! 

Let's Read Non-Fiction: "Unexpected" Infertility, Miscarriage and IVF Failure Explained

When a thing was new people said it was not true. Later, when the truth became obvious, people said it was not important. When its importance could not be denied, people said it was not new. William James, 19th century philosopher

Is Your Body Baby Friendly? I just finished this medical text by Dr. Alan E. Beers. This was going to be my January Read of 500 pages but I inadvertently thought it had 500 pages when I picked it out only to find one third of the text were notes or references to medical journals and studies. So I skipped ahead and this has become my April non-fiction selection in February. Also I wanted to read this text of immune tests and treatments prior to my appointment with Dr. Foong later this week where she will explain what may have gone wrong and hopefully what we can do next time to improve.

I was surprised after our textbook quality embryos, hope from doctors for a successful cycle and gleeful nurses to have a failed IVF cycle. Likely these tests or treatments recommended by Dr. Beers will not be available at the Regional Fertility Program in Calgary.  Immunological testing has not yet been entirely accepted by the medical IVF community. There have not been enough blind studies completed with placebo subjects despite the success rates of 85% Dr. Beers has achieved with his patients who come to him after several failed IVF or miscarriages.

"There is an anecdote about an engineer who visited a factory to view a marvellous new machine churning out widgets.  He turned to his host and said, " I see it works in practice, but does it work in theory?""

We fixed the lack of ovulation with IVF now to fix the implantation issue and/or ability to maintain a pregnancy. This may not be easy.

I wonder if I have one or more of the categorical immune issues identified by Dr. Alan E. Beers.

There are five categories.

• Category 1: Tissue Type Compatibility
• Category 2: Blood Clotting Defects
• Category 3: Immunity to Pregnancy
• Category 4: Antibodies to Sperm
• Category 5 A: Natural Killer Cells
• Category 5 B: Antibodies to Hormones and Neurotransmitters

I wonder if I have category 2 as my father also has blood clotting issues and several members of my father's family take blood thinning medications. I also have a clotty cycle. I was prescribed baby aspirin in my past cycle and I think that may have helped along with acupuncture. It is likely I also have category 5 issues as Polycystic Ovarian Syndrome is discussed within this section. It has been confirmed by several doctors that I have PCOS and I have also seen it on the ultrasound monitor. 

"Women with polycystic ovarian disease and ovarian cysts have a higher incidence of autoimmunity of the type that leads to insulin resistance (high fasting free insulin levels), autoimmune thyroditis and recurrent pregnancy losses.

Elevated levels of insulin lead to poor endometrial development , which can prevent the embryo from implanting. Other fertility problems can manifest themselves as failure to ovulate, irregular periods and poor egg/embryo quality. 

Furthermore, an excess of insulin can interfere with normal blood clotting balance, leading to restricted uterine blood flow. It also reduces glycodelin output. Glycodelin (also known as placental protein 14" or PP14) is an immunosuppressive protein found in the uterine lining with inhibits NK and T cell activity. Therefore, low levels of this key protein can increase the chance of miscarriage. For women with untreated PCOS, these category 2 immune problems combine with those of Category 5, can increase the risk of miscarriage between 30% and 50% during the first trimester. "

We were told we had good endometrial lining likely due to the doctors being able to control my hormone levels of estrogen, progesterone and testosterone. During the 2 week wait I was not monitored but I was taking progesterone supplements orally. So I am curious to learn what Dr. Foong suggests may have gone wrong.

I think I will also ask to go back on Metformin. I am not looking forward to the side effects again but think it is probably best to try to get my PCOS under control even if I never am able to carry a baby to term to mitigate against stroke, heart attack, diabetes, and weight gain.

"The most effective treatment for PCOS is metformin hydrochloride, the same drug that is used to treat type 2 diabetes. Metformin increases the body's sensitivity to insulin and allows it to be used more efficiently. It also reduces the amount of glucose produced by the liver, and the amount of glucose absorbed by food from the stomach. By controlling levels of insulin, metformin helps to elevate levels of glycodelin, which regulates the NK cells, thereby lessening the risk of immune mediated infertility and miscarriage. Metformin can even correct blood clotting problems to a degree."

I was initially perscribed Metformin when the doctor suspected I might have PCOS when my pap tests came back with abnormal cells in 2010.  Instead at the time we were focused on determining if I had cervical cancer and so I did not think at the time, once the tests finally came back normal from the cancer board after several painful laporoscopy and biopsies, to ask to continue metformin for infertility. And as such we had given up after my first miscarriage on even conceiving and were focused on adoption.

I did not know much about metformin or PCOS then and I think was initially in denial that I even had PCOS and did not even want to take metformin because somehow in my head I equated that with diabetes. I thought I could manage my weight and insulin levels with diet and exercise. Obviously I am not doing the greatest with that as I am not as diligent as I once was with monitoring my insulin levels. In my twenties I was aware I had some issues with insulin as I used to have a strict diet of 21 grams of protein, 7-9 of fat, 28 grams of carbohydrates for every meal along with two snack of 3 fat, 7 protein and 9 carbohydrates daily. Then it was to lose weight and was the only method I found successful to lose weight. When I was successful in organising my food intake I was at my lowest adult weight of 122 lbs.  Impossible to maintain on an ongoing basis if you have family or friends or stress.

But perhaps with a return to metformin, a change in my lifestyle and a renewed focus I can lose some weight. I am currently at my heaviest at 170 lbs. I have been here several times before and this is generally my ceiling before I kick it into high gear and revisit exercising and cutting out sugar in earnest. I have to wise up to the fact that PCOS is not only causing me infertility it could in fact shorten my life. It is a full time job really managing one's insulin levels.

And so my challenge is this. Hopefully metformin, cutting out sugar, exercising, taking baby aspirin daily along with a multivitamin with folic acid, reducing stress, losing weight, getting daily vitamin D and cutting my favourite vice- coffee will improve my chances for a successful IVF cycle. If not then there is always the Alan E. Beers Center in California. The Centre for Reproductive Immunology and Genetics.

I checked out the website where the laboratory testing is done.

Testing is done if there is:

(a) two miscarriages or two IVF failures after age 35 or three miscarriages or IVF failure before age 35,
(b) poor egg production from a stimulated cycle (less than 6 eggs),
(c) blighted eggs,
(d) idiopathic (unknown cause) infertility,
(e) previous immune problems (ANA positive, rheumatoid arthritis, and/or lupus),
(f) previous pregnancies that have shown retarded fetal growth, and
(g) one living child and repeat miscarriages while attempting to have a second child.



Half of the battle will be finding a doctor in Canada who will agree to be a collaborating doctor and support the protocols recommended. I learned on the Reproductive Immunology Support group that possibly there is a doctor at the Victoria clinic and also in Ontario or there is also a clinic in Las Vegas that takes Canadian patients. The testing is $1200. The treatment costs identified depend on the testing results. Some could be expensive as they may be required several times during the course of a pregnancy.

I am hopeful for a successful FET cycle but I am also reserved.

Here's to hope. Again.

I hate losing the innocent joy that comes with infertility. The innocent joy when we first thought we would like to think about having children and were just having fun trying, then our first chlomid cycle which ended in miscarriage which led to several other chlomid cyles without positive pregnancy tests. Then when we first fell on adoption and thought this would be the answer to our infertility and thought we would have a healthy baby within two years. Then finally our first IVF cycles. Holding that picture with the perfect blastocyst I felt so much joy.

Here's to joy. Again.

I wish the universe recognized our efforts.  My friend S shared with me this past fall when I was picking up medication to begin my IVF cycle that she and her husband were excited to try to have a baby. Then after my unsuccessful IVF cycle we met again for lunch and she shared with me that they had a miscarriage. Just this past week L and I went over to play some games and were enveloped in their joy that they were pregnant and due in August on their first try after their miscarriage. I was surprised and happy for them but that evening tears slipped from my eyes and I wondered when me? will it ever be me? how is this fair? where is there justice God? are you not compassionate? merciful? how long have I prayed for this? can you not fix me?

The purpose of science is to change belief. If you believe that infertility, IVF Failure, recurrent miscarriages, prematurity, and low birth weight are 'God's will' which is not testable scientifically, you will never try to find effective treatment."  Sir Peter Medawar (Nobel laureate)

Here's to joy. Here's to hope. Here's to science. Again.

Help us God.

In other adoption news all is not a loss for our imminent move to SK. While we may have to lose our Taiwan adoption I have found a a sliver of hope with an agency in BC that works with SK to arrange adoptions from the USA. One of the USA adoption agencies they work with I think would be a great fit for us. So where to begin with all of that again.... the whole process is very daunting.

Daunting though this is; it will not stop me. Someday I will have a baby either by infertility treatment or adoption.