Friday, October 15, 2010

meds and pregnancy

The whole medication and pregnancy thing is a little but weighing on me.  Taking them can increase the risk of miscarriage, and quite possibly some of the most disturbing birth defects EVER: an imperforate anus? internal organs on the outside of the abdomen? Absence of a brain? Gahhh!
And yet, NOT being on medications has risks too: low birth weight, lower APGAR, lower IQ, and increased risk of miscarriage and stillbirth.  Blech.
Doctors suggest that you should stop taking them "unless you absolutely need them".  That may be the single most useless piece of advice I have ever heard from doctors.  As if there is a whole population that only use anti-depressants socially. Okay, I know there actually are college students and the like who use Aderrall and Wellbutrin, but it seems unlikely these people are looking for pregnancy advice, and an underground ring of housewives getting their highs from recreational Zoloft use somehow doesn't really ring true for me.
I am MISERABLE when I am not on medication, as are the people in my immediate area.  Additionally, I just don't think that counseling is a good substitute for me.  I know that some people need a little montoring, some behavioral guidance, and they are good to go, but I am sure that my depression is 100% biological.  I feel like treating my depression with counseling would be like trying to teach me to be a little taller.  I am just not ure talk is going to cut it.
But then again, it may be worth trying.  This miscarriage was horrible, and if it could lower my risk of suffering through another, maybe I could try it for the first nine weeks.

Friday, October 8, 2010

We can neither confirm nor deny our ability to give a straight answer.

I am fairly certain that the entire medical industry in America is hell bent on providing the American public with absolutely no answers what-so-ever.  For years I have had abnormal Pap smears.  After each scary result wherein they suggest I may have cancer, but can't be sure, "it's probably nothing to worry about", they tell me to definitely come back in six months so they can run more tests and tell me how abnormal I am.  Awesome.
Then, I bleed upon conceiving.
"That sounds serious.  We should definitely see what happens in a month."
I bleed more, and my HcG levels are dropping.
"This is a very bad sign.  Come back in six weeks and we will definitely tell you that we are very concerned."
Finally, Tuesday I go in, and everyone is very grim faced and sympathetic.  "Yes, we are concerned.  Come back next week for another test.  We will have more platitudes we can give you as we stall for answers."
I can't take it, my voice trembling, I finally get the balls to ask, "Is this typical period for a miscarriage?"
"Well, you know, we need to watch it closely and work with what we have..."
"Yes, but generally, how long does a miscarriage take?"
"Everyone is different.  If this continues for awhile we will investigate."
"How long would you say?"
"Well, we don't want to intervene unnecessarily..."
"But what if I am still bleeding after the next several tests?""I think it is important to let nature take its course."
For a moment I briefly consider lunging over the desk and throttling the lovely spiritely woman who is clearly determined to make me cry.  I decide to try one more time before settling on manslaughter.
"Do you think I will still be bleeding in a year?"
Her expression demonstrates she thinks I am being ridiculously over-dramatic.  Finally, a straight answer!
'So sixths months or less?"
She purses her lips and looks insulted, "I would certainly step in before sixth months."
I honestly feel a wave of relief.  I go for broke: "Two months?  Do you think it will be longer than two months?"
"Listen," her tone no longer compassionate or sympathetic.  She leans forward and looks me into the eye.  I feel as though she is being honest for the first time, "If after our test next time I don't see necessary progress, we will do an ultra sound and probably consider a D&C.  If your levels do fall, but you are still bleeding by the end of the month, we will need to intervene.
I would thank her, but the sense of relief has made me choke up; I can only nod.

Saturday, October 2, 2010

Progesterone and You

      So as I mentioned in my last post, I have low progesterone: kind of, I guess.  I mean, I took this hormone test one time and my doctor said I did have low progesterone, as well as whacked cortisol, testosterone, capital letters, and vampirism.  Okay, she didn't literally say the vampirism thing but I assume that's what she meant as her voice started to trail as she various other hormonal inadequacies.
     It was alright though, it was not as though I was surprised, my depression is supposedly a hormone disorder after all, and now I had this chart conveniently detailing explanations for just about everything that ever went wrong with me.  Weird periods?  Low progesterone.  Hard time sleeping?  Out-of-sync cortisol.  Pimples?  Warts?  Often feeling cold?  Sugar craving?  Hormones were the explanation for everything!  Hooray!  I was saved!  All I would have to do is take a pill and everything would be fixed, right?  Yeah, maybe not so much.
     First of all, I had to drive like an hour and a half to this tiny maybe  not so legit pharmacy that was the only one in the area that would give me the special blend of stuff I needed.  That was a little sketch.  Then the fact that it came in a brown prescription bottled wherein the only thing written the label  was "hormones" gave me pause.  Finally, after taking the pills for a week and raging into two unreal screaming fits, I decided maybe this is not quite the right cocktail for me.
"Oh did I not mention that super natural bitch fests are a side-effect of the medication?" my doctor sweetly intoned.
So clearly "better" has several levels of meaning.
The real problem with the low progesterone is the problems it causes for pregnancy.  Low progesterone is the leading cause of miscarriage, can be treated with clomid, but that of course has side effects in and of itself.  While I was having my hormones checked to verify my miscarriage, I registered a 3 on my progesterone level.  Pregnant women will need at least a 9 to sustain a pregnancy.  Studies have shown that women with depression are more likely to miscarry than other mom's.  Fortunately, low progesterone is pretty easy to treat, and while the treatment can reduce the easiness of getting pregnant, it is definitely worth a try.