(No Longer New) Midlife Mommy

Still In Limbo

Well, at the risk of making my entries all about me and my health, all the time, we still don't know where we are.  I am still on a pill month, still supposed to start Lupron on 11/10, and I am no closer to any answers than I was before.

I mentioned that I went to the well-respected university hospital internist, and he said that they just don't remove asymptomatic gallbladders, even if there is a planned pregnancy.  And, while I might be having a gallbladder problem, it really sounded like something else.  He guessed that it could be a possible hiatal hernia and asked that I have an upper G.I.  He also recommended that I talk with a general surgeon from the university.  The person that he recommended didn't have an opening until December(!), so we took another surgeon at the same center who had a more reasonable schedule, Dr. B.

I had the upper G.I. last Wednesday, and it really wasn't so bad.  I hated swallowing the Alka Seltzer type thing that they made me drink to put some air in my stomach more than I disliked the barium.  It wasn't a treat, but it wasn't bad.  The technician was really nice, as was the radiologist.  Really, really nice.

Yet, might I say how much I am beginning to hate all medical facilities and most of their personnel?  I had the upper G.I. at a (large) local, non-university hospital, and the check-in person didn't even bother to ask if I wanted the results to go to anyone else.  I wanted them to go to the prescribing physician, Dr. B, and to me.  My state has a law that requires that health care providers give you a copy of your medical record on written request.  Your state probably does too (and HIPAA also gives you that right).  Now, "give" is a bad word; they can charge for the record, and I do take exception to the charges, but at least it's a recognition that it's your f*cking record.

So, after the check-in person stood up to herd me back to the testing area (I wasn't even aware that she was finished with her intake), I told her that I needed the results to go elsewhere.  She didn't seem very cheerful about that, because that required that she get back into the computer and actually enter the information.  I gave her Dr. B's name and address, and I told her that I would like a copy sent to me as well under the blah blah blah Act.  Well, they just didn't do that.  If I wanted a copy, I could wait until the results were in (whenever that was) and make a special trip back to the hospital to get it from the medical records department.  What an ass she was. 

I complained to the receptionist in radiology, and I told her that I thought it was an odd way to respond to a request under the state law.  She said that customarily, patients do come back to get their records, but if I really wanted a copy, they could send one to me if I signed their form and let them copy my driver's license.  No charge.  Easy peasy.  Except that in the end, they didn't bother to send the record.  And, the reason that I asked for it is that my doctor won't call unless there's a problem, and if there isn't a problem, he will send you a copy of the report -- in two weeks.  Not acceptable.  After I called to complain that they'd ignored my request made under the blah blah blah Act, I was told that they would immediately send the results to me.  And they did.  And it was negative.

And that was the most positive experience that I've had so far.  Because Dr. B?  Well, she is a beyotch.  My husband doesn't think so, so perhaps I'm overreacting.  On the positive side, at least she will answer questions.  On the negative side, she is an authoritative, directive jackass.  How do you think a patient who believes that her body belongs to her, that nothing will happen without her wholehearted consent, and that every decision along the way will be explained to her reacts to such a person?  Not well, let me tell you.

We drove a long way to see her.  And I didn't even see her for the first hour, because I had to meet with her physician's assistant.  She was very thorough gathering background information and doing an exam.  Except I had to repeat a lot of the same information to the surgeon, who also did her own exam.  I'm sure my bill will be reflective of all of this double effort.  (I am really blessed to have health insurance.)

The bottom line?  She doesn't have a clue either.  But, like the other three doctors, none of whom could find any gallbladder symptoms, I think she thought it was an easy out to say that it was a possibility that the problems were caused by my gallbladder.  (Honestly, it seems like there is a whole lot of lazy thinking going on.)  But, if it's not my gallbladder, then she also wouldn't take it out, even knowing that I plan a pregnancy.

She did have some other thoughts.  She thought it could be a diaphragmatic or paraesophageal henia.  When I later used the words "hiatal hernia," she quickly, and I think snottily, corrected me and said that she had never said that.  I admitted that she hadn't; the internist had used that term.  (Except when I went home and did some research, I learned that there are two types of hiatal hernias -- diaphragmatic and paraesophageal.  So, even though I was inadvertently correct, apparently, she thought I would be impressed with big words.  Distancing -- keeping herself on a pedestal while trying to minimize me -- that was all that was about.)  And, of course, she would recommend surgery for that (surprise!) before getting pregnant.  Having researched this, I learned that if it is a paraesophageal hernia (and only 1% of the hiatal hernias are this type), then surgery is the recommended approach, even if the person is asymptomatic.  The risk is that the stomach might twist and require emergency surgery.  The mortality risk is 1% for surgery in the normal course; it is 15% if done on an emergency basis.  Diaphragmatic hernias (99% of the hiatal hernias) are usually just managed for symptoms unless the patient gets really uncomfortable.

She wanted a CT scan in addition to the upper G.I. I already had.  Here's the "best" part -- if it is a hiatal hernia, the tests might not show it -- and they would have to do exploratory surgery to figure it out.  She asked some questions that I couldn't answer, such as was there undigested food more than three hours after eating when I made myself sick to get rid of the stomach pain.  I just couldn't remember.  She said that she would like to be sure before she proceeded to take out my gallbladder, because she would feel so silly taking out an asymptomatic gallbladder.  I told her that she might feel "silly," but I would be pissed.

Or, she thought it could be a diaphragmatic tear.  She asked if I'd ever been in an auto accident before the symptoms started, and I had.  She asked what I was treated for, if anything, and I told her that I just had some back problems that resolved within a few months with some physical therapy.  (I researched this as well when I got home -- diaphragmatic tears occur 4-7% of the time in an auto accident, but it requires abdominal trauma.  I didn't have that -- but she didn't ask.  Nor did she ask me how long it was before the symptoms started.  In fact, it was four years.  Most of what I read suggested that the symptoms started at least within a year or so.)  And, of course, I should just go ahead and get this fixed too (surprise!).

I reminded her that the only reason that I was there was because we were trying to get pregnant, and I didn't want to have a medical condition that would be problematic.  As for the stomach problem, I'd lived with it for 20 years, and frankly, I was not interested in unnecessary surgery, thankyouverymuch.  And now, we get to the best part.  Read the following and imagine a loud, authoritative, somewhat sarcastic voice:

Well, if it's OK with YOU to risk developing problems with your gallbladder in the first trimester and subject your unborn child to the risks that could occur from anesthesia, then go ahead.

Or, if it's OK with YOU to develop problems with your gallbladder in the second trimester and expose yourself to the risk of preterm labor, then go ahead (but she added that the second trimester is the absolute safest time to have the surgery, they have good results, and preterm labor is a general risk for anyone).

Or, if it's OK with YOU to develop problems with your gallbladder in the third trimester and risk of injuring the child when we have to do the surgery, then go ahead.

I was really pissed.  And my feelings were hurt.  Here I was, going through all of this for the sole reason that I was worried about a pregnancy, and I get a snarky lecture suggesting that it might possibly be OK with me to deliberately risk hurting my unborn child.  Never mind that I walked through the gates of infertility hell almost ten years ago and I now fully appreciate the gift of life in a way that, quite frankly, I never did before.

I wanted to tell her to go straight to hell.  What I told her instead was I was confused.  How could she say, on the one hand, that if there were no symptoms, these potential problems were non-issues, yet on the other hand, suggest that I was taking a large risk when she wasn't sure that I even had a gallbladder problem?  She said that she thought it was a gallbladder problem, but while they were in there removing it (with the many attendant risks in doing that, which she explained), they could "take a look" and see if I have other problems with my stomach.  (Cha-ching!  Two potential surgeries.)  I asked her what she would do if she were me, and she said she would have the CT scan and then have her gallbladder removed (apparently it doesn't matter what the results are?).

So, I'm scheduled for a CT scan on Sunday (she insisted that I have it at the university hospital, for no better reason than it was more convenient for her -- I kid you not).  Another "no eating" test, but it's not that onerous.  I do hope that if I have a hiatal hernia (and I'm inclined to think I do), that it shows up.  I had another "incident" with my stomach last week, and I noticed that there was undigested food nine hours after my last meal (sorry if that's TMI).  My husband, who is usually pretty conservative and who has had the opportunity to sit and listen to me answer all of these questions and do his own research also doesn't think it's my gallbladder.  Obviously, neither one of us is a doctor.  But when you don't have even one typical symptom of an active gallbladder problem, it really does seem like a convenient excuse.  I would prefer to keep my gallbladder if I could, because some of the potential side effects from the surgery are not good.  Not to mention that one of the side effects is DEATH, and I have a little girl to think about.  Most importantly, I strongly suspect that having it removed would not resolve the stomach problem.  And, even if I decide on a surgery, unless I see an attitude change, Dr. B will not be laying a f*cking glove on me (and I will be sharing my delightful experience when I get the survey that they always send).

So, there we are.  I am supposed to see Dr. B(eyotch) again next Thursday, 11/6.  That gives me four days to think about what I want to do before I am supposed to start Lupron. 

Hope springs eternal about this cycle, I guess.  If I say that I'm depressed about all this, that would be an understatement.

I Just Couldn't Resist

Ever have one of those days?

PSA - Just Passing Along What I've Learned So Far

(This post has nothing to do with kids or infertility.  It's just a discussion of my latest obsession -- coupon clipping and grocery shopping.  It kind of feels like fiddling while Rome burns, but at least it makes me feel productive while my 401K slowly dissolves.)

A long time ago, I lived next door to someone named J.  We became friends, and she is now my daughter's godmother.  J didn't make much money at the time (even less than me, and I wasn't doing that well either -- neither of us had a degree or much of a job at the time).  But J could save money.  Once, I saw her buy $100 worth of groceries for $25 by using coupons.  And, she is the type of person who can walk into a store just as they are selling the floor model of some crazy expensive item, and she can pick it up for a price that is so low you wouldn't believe it (how about a $9 designer dress?  or a large screen TV for $250?).  Now, being in the right place at the right time is just luck.  But learning how to save money at the grocery store?  Even I can do that.

I have been on a mission to reduce our expenses at the store.  One of the ways I have been trying to do this is by following the local circulars to find out where the sales are and, of course, clipping coupons from the Sunday paper.  We go to a restaurant that provides free newspapers to the patrons on Sundays (how great is that?), so I don't even have to buy a paper.  (Of course, we could save some money by not going to breakfast, but eh.  It's a habit.)

For the longest time, I never used coupons at all.  Or, all I would ever do is look for coupons for things that I use and that would be that.  I had no particular organization.  I just tried to use them by their expiration date and thought that was all anyone can do.  But, I've learned that if you keep your coupons with you when you go to the grocery store (in an organizer of your choosing), all you have to do is wait for a sale.  And, most coupon items go on sale within 30 days after the coupon is in the circular.  I just go to my regular grocery store and look for the items that I would normally buy.  If they're on sale, I use the coupons.  My grocery store doesn't fuss if I buy several of the same thing using duplicate coupons.  Since I'm skimming the circulars anyway, I just pay attention to what is on sale at other places and use a coupon there.  (I make a list during the week of where I want to go and what I want to buy.)  There are some surprising deals at the pharmacy/store.  And Aldi's (though you should really visit their website to learn about how they work before you go the first time), even though it's basically a no-brand store that doesn't take coupons.

There are free coupons on line.  I go to couponmom.com.  The link that I have is the least annoying site for coupons, but there are lots of links to browse while you're there.  Some sites make you jump through a million hoops, they want to collect all kinds of information about you, and you have to click through advertisements.  There are other free coupon sites that are easy to use, but I couldn't ever get their coupon printers to work with IE7 or the latest version of FireFox.  Fortunately, they all seem to have similar coupons, so I don't think it matters where you end up.

For awhile, I was buying 100 or 200 coupons at a time from e-Bay for a dollar or two (just type in "coupons" and see the million or so that come up).  It was OK, but you really don't know what you're going to get.  I would always pass these on to someone else after I'd gone through them.  It didn't seem like such a great deal after awhile.

Then I discovered the couponclippers.  It is a coupon clipping service, and they do charge a small amount for their coupons, and most times, you have to buy a minimum number of each coupon.  But the charge is small, and you are only getting the coupons that you want.  This site has a minimum order of $3.00, and there is a small handling charge, but this is great if you find a coupon in the Sunday paper that you would love to have a lot of.  Or, if there is something that you really want, and you don't find enough coupons to get you to the $3.00 minimum order, you can always go back to e-Bay and type in the item name and the word "coupon."  If there is a coupon available, I guarantee that someone will be selling 15 or 20 of them at a time for a dollar or two.

What I have just admitted to you is the extent of my obsession at this point.  I know that there are people who are into this much more than I am, but honestly, they probably have more time than I do.  Frankly, it is a bit time consuming, but so far, it's worth it.  You do have to be willing to build a little stockpile of things, but if you're doing it correctly, you're not spending too much on it.  For example, if you can buy toothpaste for $1 a tube, rather than $3, and it doesn't expire for two years, and you will use what you buy within that time, I don't see anything wrong with keeping a few tubes of toothpaste in your closet.

DH, on the other hand, is more of a buy it when you need it kind of guy.  He'd rather keep his dollar in his wallet now and spend it in the future only when necessary.  We definitely don't see eye to eye on this.  He thinks I'm buying more than we need, and that's true to a point.  But, again, if it isn't going to spoil, and it's something that we will use, and I can buy it for a fraction of the cost, then I think it's worth it.  And, the other thing that's good about this is if, for example, you have enough soup in your pantry already, and there is an awesome deal with coupons, you can go ahead and buy anyway and donate the soup to a local food pantry.  And everyone wins.

I'm curious -- do you use coupons?  Has it worked for you?  Any ideas that I haven't mentioned?

Updated to add:  One thing I forgot to mention.  Don't lose your common sense in search of a deal.  I shop at Sam's Club, and honestly, they do better than the coupons sometimes.  For example, my grocery store is selling chicken noodle soup for $1.00 a can, which is a good price for the store.  I have a coupon that will bring it down to $.80 a can for tomato or chicken noodle soup (if I buy four cans and count the fact that my grocery store doubles coupons $.50 and under).  But, I also know that Sam's will sell 12 cans of chicken noodle soup for just over $7.50.  So, yeah, wonderful couponing, but I would still spending more than I need to if I buy from the grocery store. We do eat the soup though (or donate it), so it's not a waste to buy 12 cans at a time from Sam's.  But, since I know that they will be at Sam's whenever I want them, I don't have to stockpile.  (OTOH, most of the other brands of Campbell's soup are also priced at $1.00 right now, and Sam's doesn't carry them, so it is a good deal to buy them from the grocery store.)  So, for items that we buy a lot of, I've kept a list of the per unit price so that I will have a comparison point, and the list is tucked inside of my coupon holder.  (Yes, it is an obsession.)

Goodness, Going Green Can Cost A Lot of Green!

I've mentioned before that I try very hard to involve DD in decisions, to become aware of the world around her, to understand the blessings that she has (and the corresponding obligation to help others who don't have as much), and hopefully, to respect the planet, at least through recycling.  But, honestly, I haven't done so well explaining how to be more earth friendly.  I have to work on that. I am trying though.  We had a little discussion over breakfast about solar and wind power, and why it's better than oil and coal. 

DD does know about gasoline prices.  And she has heard me complain a lot about them, though I am delighted that we are all getting a break at the pump.  I've always tried to buy cars that got reasonably good gas mileage, even before it was fashionable to do so.  My diesel VW Beetle got an awesome 42 MPG.  And, my Honda Civic gets 32 MPG on average, though I have gotten as high as 38 MPG driving an unimpeded 75 miles per hour for a long distance.

If I were in the market for a new car, I would love to buy a hybrid, once I have a full understanding of the economics of it, i.e., do the batteries last a long time, and if they don't, can they be replaced in a reasonably affordable manner?  I'm really excited about the Volt, though I have no idea what it will cost.  Even though I drive 80 miles round trip to work, it would still help if 40 of those miles were on a battery.  Though there are usually pollution offsets in generating electricity, it still reduces our reliance on foreign oil.  H*ll, if I could convert my car to run on natural gas (and could afford it), and find a station that sells the stuff, I would do it.  It would be nice to move away from oil until we can find a better solution.

I think that I've mentioned that when we bought our house, it came with an in-ground pool.  It was a huge expense at first.  The home inspector didn't "do" pools, but we thought, what the heck could go wrong?  We stupidly did not buy the rider on our home insurance policy that would have covered the pool.  I'm not going to say which of us thought it was a waste of money.  (Hint:  it wasn't me.)

OK, where were we?  Ah, yes.  Things that can go wrong with a pool.  Well, let's see.  When we tried to turn it on the first summer, we realized that the pump didn't work and needed to be replaced.  Cha-ching.  And then we discovered that the liner was leaking (that was the second year).  Cha-ching.  And, of course, the gas heater didn't work either.  After two summers of not wanting to go into the pool because it was always freezing, we replaced the heater as well.  Cha-ching.  And you have to fix these things.  The alternative is to have a slimy water hole in your yard filled with frogs and mosquitoes that no one can use (and that your neighbors call the city about).  DH and I did talk about filling it in with dirt to avoid the repair expense, which would have been a whole lot cheaper.  He was more in favor of that than I was, because I thought that as we had children, they would really love it.  And, I was right (though now I live in fear of DD drowning in the pool, but that is a whole other story).

But, at least we did something smart.  The cost of a gas heater was around $1,500.  And, we were told by they guy who opened the pool that the cost to heat it during the summer season could run over $150 a month (can you believe it?).  We'd heard about solar heaters, and when we (well, actually when DH) looked into it, we learned that for $3,000, we could have a heater that would work really well with no added expense.  And, even though it cost twice as much, all we really needed to do was run it for two summers and we saved ourselves the difference.  A couple more summers, and it's paid for itself.  The solar heater rocks, and when we keep it covered when we're not using it, the pool stays really warm (seriously -- it can get over 90 toasty, wonderful degrees).  And there is no effect on the environment.  Everyone wins, except when it's cloudy outside.

So, I was feeling pretty good about this solar thing.  And, the economic recovery plan included some credits for energy efficiency among all the pork (along with the wooden arrows and everything else).  I wanted to price out what it would cost to generate part of our electricity from solar power.  Not that we have any money to do this; it was more just curiosity than anything else.  Since the credits are so small, I thought the price would be small as well.

I went to findsolar.com to get an idea of what this system would cost.  I thought that it would be another pool heater type of experience.  But, holy sh*t Batman, it wasn't anywhere close. 

Our average electric bill is $121 per month.  The estimate was for a system that would provide only HALF of our electricity usage. Want to wager a guess at how much this system would cost?  Go on.  I'll wait.
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$53,100.  To save around $60 bucks per month.  That's right -- OVER FIFTY THOUSAND DOLLARS.  WTF?  Who could ever possibly afford to do this?

They claimed that we would have a federal tax credit of $15,930, for an estimated net cost of $37,170.  Hmmm.  Not sure where that number comes from, and it would still mean that anyone who wanted to put in this system would still need to come up with the $53,100 up front.  They claim that the value of my house would go up over $12,000.  Don't think so.  Not in this market.  The value of my house has gone down, just like everyone else's.  But, they added all of this together and came up with 178% return on investment considering the solar system alone, and 270% if the system and the property appreciation are taken into consideration.  Sounds like funny math.

They also estimated a 25 year utility savings of $26,520.  So, avoiding the funny math and just looking at how long it would take to get $53,100 in savings, apparently, it won't really pay for itself until after I'm dead. I complained about this to one of our friends this evening, and he mentioned that he REMOVED one of these systems when he bought his house.  I guess the previous owners put in a solar system in the late 70's-early 80's for around $30,000.  They had two, 200-gallon hot water heaters, and the water never got warmer than lukewarm.  Seriously!  He said that he took out the miles and miles of copper from the panels and sold it for scrap.  I wouldn't have done that -- I probably would have taken out one of the hot water tanks and hoped that it would heat the other.  After all, it's no additional expense.  But, to each his own.

This whole exercise was really disappointing.  I do worry about the world that we are going to leave to my daughter and all the other precious little ones.  No one seems to know when we are going to run out of fossil fuels, but the fact is, we will.  And the supply issues are just going to get worse.

They say if you build a better mouse trap, the world will beat a path to your door.  I just wish that there were some affordable renewable energy alternatives for the little folks. 

Just In Case You're Keeping Score At Home

Internist #1:  I have no idea why you have very infrequent stomach pain.  Let's do an ultrasound.  (Ultrasound completed.)  Handwritten note, read by a clerk, instructing me to see a surgeon for gallstones.  The note is subsequently mailed.  No further discussions with internist.  WTF?

Surgeon #1:  Hmmm.  (After quizzing me about 16 possible symptoms, none of which I have).  I'm sure it must be your gallbladder.  And, I have an answer for everything.  You need surgery!  Side effects?  Bah, no side effects.  And do stay away from the Internet.  It will just confuse you.  I take out seven of these a week -- or more!  It's no big deal.  Why, just recently, I removed a gallbladder from a 17 year old, and she didn't even have gallstones!  I thought that I might have been a little hasty there.  But, her mom later told me that she feels better now.  So, I must have been right.  I'm always right.  Now, when do you want to do your surgery?

OB/GYN (now retired from OB, but who delivered DD, over the phone):  When you're pregnant, the bile becomes viscous.  It causes stones to develop.  GET IT OUT!!!  If you were my wife, that's what I would tell you.  GET IT OUT!!!  Even if you're not having symptoms.  You don't want to take a chance that you will get pregnant and have a problem.  (I love him with all my heart, but this is not exactly what I wanted to hear.)

Internist #2:  Gee.  Your (one) symptom doesn't sound like a gallbladder problem.  And, we don't usually go around removing gallbladders that aren't causing any trouble, especially since many, many people are walking around with this problem and don't even know it.  I think the chances would be small that you would have a problem if you were to get pregnant, but that is not my area of expertise.  Have you talked with your RE?  (No, he's an a$$hole, and it would not be beyond him to insist that I have surgery if I wanted to continue treating with him, because he's an ultraconservative jerk.  But I did talk with my old OB.  He said GET IT OUT!!!)  Well, you should meet with a surgeon.  (We did.)  Well, he sounds like an interesting guy.  Was he wearing an expensive Italian suit as well?  Perhaps a more conservative surgeon might be a bit better.  And, since I don't think that your stomach problem has anything to do with your gallbladder, why don't we get an upper GI?  (As opposed to an endoscopy.  F*ck.)

Interview with Surgeon #2 next week.  Location:  East outer Mongolia.  And in the meantime, I have to figure out where to get an upper GI locally (to avoid a 100 mile round trip to the university hospital).  BTW, this is the test that I never, ever wanted to have done.  Even during the few times a  year that this problem actually bothers me, I would just tell myself that making myself throw up is far better than having to swallow chalk.  I don't know why this test just freaks me the heck out, but it does.  Damn, damn, damn.

In the meantime, I asked my RE if I could take an extra month of pills, because I am having a stressful period at the moment (um, that is not a lie).  He agreed.  So, the Lupron that I was supposed to start on Monday will now be delayed until 11/10.  It would be nice if I could trust him more, but after that p*ssing contest we got into over breast feeding and having a medicated cycle, I'm just not going there with him again.

I think, in the end, I might just have to flip a coin.  After I swallow some chalk.

The More Things Change

the more they say the same.

I love The Daily Show and The Colbert Report.  I think they do a fair job of skewering both sides of the political coin without being offensive to either side.  DH and I tape both shows and watch them the next day, during the one hour of television time that we get alone after DD has gone to bed and before we also succumb to exhaustion.

Last week, Jon Stewart had Sarah Vowell on his show.  She is on the staff of "This American Life," heard on NPR.  I love, love, love that show.  But, it's been a long time since I've had a chance to listen.  If DD is in the car, and the radio is on, she whines until she wears me down, asking for some of her own music.  So, it's easier to keep the radio off to keep the subject from coming up.  Once I take her home for her nap, I've already missed the program.  Or at least I think I have.  Like I said, it's been a long time since I've had a chance to listen, and for all I know, they've changed the Saturday lineup.

Anyway.  Sarah said that she'd rediscovered Roosevelt's Fireside Chats.  And she found an odd comfort in listening to them.  I had some extra time at lunch today, and I found the transcripts of the thirty chats.  Here is one from March 12, 1933 on the banking crisis.  The rest are here.  I read a couple, and I hope that I find the time to read rest.

I hope and pray that economic times that bad will never happen again.  But if you get a chance to look, I think that you will find the description of the events sounds oddly familiar.

Teaching Everything

One of the "duh" parenting moments for me was when I realized that, at least in the beginning, you have to teach children everything!  Like, how to get off the couch.  Because if you don't, then they think they can fly, try to fly, and then they will bonk their head on the coffee table when they abruptly land, resulting in screaming (oh, the screaming), and then the cat will attack your leg because he thinks that you've deliberately hurt your child (oh, the snarling), and then you're running around the room trying to figure out if your child is permanently damaged all the while you are trying to kick the cat off your leg.  I'm just saying that might happen.

Seriously though.  How to eat.  How to sleep (through the night).  How to latch.  How to go up and down the stairs (that flying thing again).  How to talk.  How to use the potty.  How to dress.  How to write.  How to draw in between the lines.  How to cross the street.  Now, granted, the older the child gets, the more she will learn on her own, and the more that she will learn from others as her social circle widens.  But still.  There are lots and lots of things that you must teach, and they get much more complicated as the child gets older.  It's not all bad, and I'm not complaining.  And I do look back wistfully on those days of total dependence when DD had no choice but to snuggle for as long as I wanted (insert maniacal laugh here).  Sigh.  I miss those infant days, because it seems like as soon as DD started to crawl, she was crawling away from me, starting her long journey to become her own person.

The list of things to teach goes on and on, and I worry that I've missed telling her something that she will need to know that might help her when she's in trouble someday.  Or that I've not communicated well enough regarding the things that I've already tried to teach her.  For example, a few weeks ago, when we were talking about how to get out of a fire, DD said "stay low and go."  We saw someone doing this on a dry run on Sesame Street when a little girl was walking us through her family's fire drills.  My husband had the good sense to ask, "DD, what exactly does that mean?  Where would you go?"  DD said, "daddy, you just stay low and go."  "Yes, DD, but go where?  Where would you go?"  She had no clue.  So, that prompted a further discussion.  (This is one of the reasons why I'm so glad that we had a chance to go through that fire enactment last week, because it allowed her to put what she'd learned to the test.)

One of the things that I have always worried about is "stranger danger."  I don't want to deny DD her childhood, and I don't want her to be afraid of everything, but I do want to give her the tools that she needs to stay safe.  I remember talking about this with my mom, and worrying out loud how I could protect DD.  Her simple answer was "you can't."  She remembered some program on television where they'd gathered a group of parents who thought that they'd prepared their children not to go with strangers, yet, during the test, all but one of the kids went with the stranger.  And, my mom admitted that her mother told her about not going with strangers, yet one day, she went over to the car of someone that she didn't know because he offered her candy.  She said that the man grabbed her wrist, and fortunately, her mother came out onto the porch at that moment and started yelling for her.  The man got scared and drove away.  I'm certain that if my grandmother hadn't come out at that moment, I wouldn't be here today.  And, I remember being a kid on vacation and letting some strange man put sunscreen on for me.  I was older, maybe 10 or 11, and I'd wandered away from our group (maybe to go to the bathroom?).  He didn't do anything untoward, and I probably needed the sunscreen, but still -- I let a strange man put his hands on my body -- and I knew better too.  My mother was very freaked out when I told her about it a few minutes later.  And I'm not even going to tell you how when I was 15(!), my honorary cousin and I took off with two men when we were supposed to be at a carnival attached to our campground (they were old enough to know better, since they were at least in their 20's).  Fortunately, nothing at all untoward happened.  But it could have.  How effing stupid we were.

I think I may have heard about The Safe Side in an advertisement a few years ago.  You may recognize the people who are responsible for the DVD.  John Walsh, who lost his beloved son Adam after he was kidnapped from a mall at only six years of age and who has devoted the remainder of his life to ridding the earth of scumbags and making the world safer for our kids, and Julie Aigner-Clark of the Baby Einstein fame (and who among you hasn't worshiped at the altar of Julie Clark at some time or another?  I just wish that her DVDs were longer).

It sounded good, and I ordered a copy.  I let DD watch it when she was two, but she was a little young at that point to understand.  But, I took some of the principles and started drilling them into DD's head.  For example, there are only a handful of people who can pick her up from school, and she isn't allowed to go with anyone else.  Or, that she should run away when approached by someone that she doesn't know, whether they offer candy or puppies or anything else (we would practice hypotheticals over and over and over).  And, if someone tries to take her somewhere, she should scream "you're not my mom," or "you're not my dad."  If you're lost?  Find a woman with children.  I drilled and drilled, and hopefully, I gave her some tools.

But now, she's old enough to really "get" what they are talking about on the DVD.  It really brings things down to a kid's level.  It's funny.  And realistic -- it demonstrates that even a kid who knows karate can't overpower an adult (don't they all think they are invincible?).  And, even when it gets a little scary (during the enactments when someone tries to take or touch a child), it's empowering at the same time -- because it tells the child what she can do to get away.  It also classifies adults into three categories -- Safe Side Adults, Kinda Knows, and Don't Knows.  Safe Side Adults are always safe (they recommend having three; my daughter has a few more).  The other two categories are self-explanatory.  I love it when DD will, out of the blue, start reciting some of the principles.  "Mommy, Mrs. A is a Kinda Know.  So I couldn't go anywhere with her unless you say it's OK."  "Mommy, all those people in the parking lot are Don't Knows.  So, I won't talk with them unless you are with me.  And I won't take anything from them either.  And I will never, ever go anywhere with them."

Now, will this work if (Lord forbid) she needs this information someday?  I pray it will.  And, even though neither Julie Clark nor John Walsh have a clue that I'm plugging their product, I do it wholeheartedly.  I might just buy a copy for DD's kindergarten class, if they think it's OK to show.  I will definitely buy a copy for her grade school.

I just pray that my daughter is smarter than I was.  Or at least as lucky.

 

My Little Monster

You know, DD is usually a sweet, polite child.  She is very stubborn, and we often have clashes of will at home.  But, every single teacher that DD has had has told us that she's one of their favorites.  She generally follows the rules (but has trouble sharing at times), she plays well with others (though she is a bit bossy), she can play alone, she's (usually) polite, and she's a great helper.  It is often a marked contrast between the child we know and the child they know, because she can be a little bit difficult at home sometimes.  The teachers are quite surprised to see DD cross over into the home persona before we leave school on occasion, for example, when I tell her we need to stop somewhere that she just doesn't want to go, thankyouverymuch.

In DD's new room in pre-K (the class before Kindergarten), the teacher has a color change system.  It's simple.  She has four paper plates that she's hung on the wall -- from the top down, the colors are green, yellow, blue, and red.  Every child has a clip-on clothes pin labeled with a number, and only the child, the teacher, and mom and dad know the number.  If there's a color change, the child must walk over to the wall and move their clip down to the next level (I call it the "walk of shame").  Redemption is available, because they can move back up if they start making good choices.  If a child reaches red, then they are sent to the front office (kind of like detention), and mommy and daddy get a phone call at work.  I'm not certain what happens next, and I hope that I don't ever find out.

When the system began, DD emphatically told me that she would never ever get a color change.  And she did very well for awhile.  Her first color change (to yellow) was part of a group color change.  Some evil force took over the children one afternoon, and they trashed the room and ignored the teacher's instructions to clean up.  So everyone had to line up and move their clip to yellow.  They all redeemed themselves by the end of the day, but the teacher forgot to let them move their clips back.  DD cried and cried about her color change that evening, because she no longer had a perfect record (even though she admitted she deserved the color change).  It gave us an opportunity to talk about mistakes, and while you can't go back and change anything that is in the past, you can move forward and try to do better.  So, instead of telling herself that she will never ever have a color change, she could move forward by saying that she will never ever have a color change -- again.  She seemed happy with that, because it gave her a sense of control.

But this week?  Holy h*ll, Batman.  Even though DD ended up back on green by the end of the day on Tuesday, she went all the way down to blue.  The daily report said that she was asked ten times to stop hitting.  That really annoyed me.  Hitting is not acceptable.  We don't hit her; she is not allowed to hit anyone else.  But, when I asked her about what happened, she either:  a) ignored me; b) kicked at the car seat; or c) told me she didn't remember.  Now, I knew that latter claim was quite the crock, and she admitted the next day that she just didn't want to tell me what had happened.  She lost five privileges in short order, after I counted her out each time she gave one of those responses.  That evening, she preferred to sit in a chair with no activity for a half an hour(!) rather than tell me what happened.  Even after I told her that we could bake cookies if she would spill the beans.  I told her that whatever it was, we were going to find out from her teachers.

We were unable to connect with either of her teachers the next day.  But the following day, DH learned from Miss T that DD had gotten into an altercation with H.  Both girls do have a bossy streak.  Apparently, DD started choking her!  H wasn't hurt, but I have no idea where that came from.  DD told Miss T that she was angry at H.  Now I know why DD didn't tell me.  And later in the morning, J was riding a toy that DD wanted, and she pushed him over.  And then kicked him!

I am absolutely appalled by this.  I have never seen this behavior, and we just don't allow hitting or kicking or anything of the sort.  DD knows that if she even throws something, she will lose it for the day.

But then, I talked with Miss B (the other teacher) at the end of the day.  She kind of chuckled about the choking incident, and she said it wasn't as bad as it sounded.  I asked what wasn't so bad about my daughter's hands around someone's neck?  And, Miss B said that she thought the kicking incident was an accident.  But, she admitted that pushing the child off the toy was not.  I asked if this kind of thing was unusual, and she said that she's seen all kinds of behavior from four year olds, and she added that this really was unusual coming from DD.

So, by this point, DD had already lost a boat load of privileges that were spread out over two days, and sat in "detention" for half an hour because she wouldn't talk to me about what had happened.  This was now the third day after the incident, and even though I was angry that she'd done these things and then lied to me about not remembering them (because when we discussed it with her, she certainly did remember), I wasn't sure what to do.  DH said to let it go.  So we did.  However, we did tell her that if we hear of more bad things at school, then she wouldn't be allowed to go on the field trip that is planned for next week.  And, if she continued to get color changes at school, then she would lose privileges at home.

But yikes.  I would have never believed that DD, of all kids, would do something like this. 

I Must Be Too Picky

Honestly, there are so few doctors who impress me.  And the ones that impress me often don't connect with me.  Except for my OB/GYN (now, only a GYN, sad to say).  I would walk through fire for him.  He rocks.  And so does his staff.  I can ask questions of him.  He is not offended.  And I have never, ever not done what he wanted me to do.  Not ever.  Because once he explains why he thinks it's the best course of action, I have always agreed.  Unfortunately, I think he is in the minority.  I also love, love, love my daughter's pediatrician.  She's cut from the same cloth as my GYN.  Totally awesome.

I would love to tell you about my sonohystogram, except I haven't had it yet. Even though Nurse J and I agreed that I would come in on 10/7 at 9:15 a.m., that wasn't when she booked my appointment!  And, of course, she didn't bother to tell me.  If I said I was p*ssed, that would be an understatement.  She told me that I could schedule on any Tuesday or Friday, but apparently, this Tuesday, my doctor was giving a lecture.  So, she just wrote it in for tomorrow and apparently assumed I would find out through osmosis or something.  And I got to waste my gas and time to be there on Tuesday!  Lucky me.  They never cease to amaze me.  Really.

I was not impressed with the internist who referred me to the surgeon to discuss the gallbladder problem, though his education, training, and hospital affiliation are impressive.  It would have been nice if he'd talked with me about what was wrong and answered any questions that I might have.  Instead, I found out what his recommendations were when someone from the office read them to me over the phone (after I called to find out the results).  I received a copy of the instructions and the ultrasound results by mail.  By implication, then, I guess his belief is that the only treatment for this is surgery.  Since he knew I was looking for a new internist, he knew what type of person I was looking for, and he said he would love to be my doctor, this wasn't such a great ending to the interview.

So, today my husband and I met with the surgeon.  If I tell you it was worse than I expected, that would be an understatement.  First, his assistant came in to take a history.  When I mentioned that the ultrasound was done for my stomach problem, and that the problem had been going on very sporadically for over twenty years, she gave me an odd look.  Though it was not as odd as when I told her that I was still briefly nursing my daughter twice a day.  And that she'd just turned four (well, she asked).  Now, I realize that this is out of the norm, but really, it is not weird for us.  We keep it private, and I expect that it will stop soon.  But whatever.  The only concern this should be for a doctor is to provide an awareness of the types of medications that should be prescribed and to know that we can abstain if necessary until a drug gets out of my system.  After looking at me as though I'd just grown an extra eye, she looked over at my husband, as though he might not be aware of this strange thing that I was doing.  And yes, my dear, my husband knows and doesn't take issue with this.  FWIW, we received an identical performance from the doctor shortly thereafter.  Except he had the charity to add that it is still good for my daughter.

Anyway, I don't think the doctor was in the room for 45 seconds before he was suggesting surgery.  This was before the exam or before any in-depth discussion.  He really based his conclusion on the two sentence ultrasound report that said that I have a moderate number of gallstones.  I was disappointed, but I guess I wasn't surprised.  He really did seem to be pushing it, even handing me a "what you need to know about your impending gallbladder surgery" handout, and I told him that I would appreciate it if we could discuss some questions that I had before he wanted to subject me to a surgery that would give me a 20-40% chance of lifetime digestive problems.  He told me that was absolutely not true!  Why, it hardly ever happens (that is simply not true; it is regularly listed as a potential side effect to the surgery).  Of course, there were no other options.  Not even the medication that I'd found described on the NIH website that can dissolve certain types of gallstones over a period of time.  And, I really should stay away from the Internet.  It will only confuse me.  (Hear that pat pat pat on my head?) 

This is so not the way to deal with me.  Truly.  I do have a healthy respect for the knowledge that a doctor has, but please, please don't be condescending.  It's offensive.  A large part of the work that I do involves research, and I'm really good at it, mmmmkay?  Do tell me where I'm off base.  Do tell me that there's something I'm missing, because I didn't go to medical school, and I don't have your experience.  But, I'm one of those annoying patients who wants to be participative when it comes to decisions about my body, and my treatment.  Frankly, if I were a doctor, I would like me as a patient.  Because, don't you think that once you have someone buying into all the decisions along the way, with full knowledge of the pros and cons, that they are less likely to blame you if something goes wrong?   

So, he believed that my stomach problem was related to the gallstones.  Except I didn't have any of the other plethora of symptoms that he was asking about.  And, he really pushed on my gallbladder during my exam.  It didn't hurt.  He said that he thought it was a bit enlarged.  There was a measurement on the ultrasound report, but it didn't mean anything to me.  Maybe it is.

So, I asked him, if I've really have had gallstones for the last twenty years, and it has only been mildly annoying, why should I have surgery at this point in time?  (I really did try not to sound argumentative, but I was taken aback by the immediate surgical recommendation without knowing anything about me.)  He said that there could be some complications, such as pancreatitis (I read on the nasty Internet that could happen about 10% of the time).  And, one of the stones could also block the common bile duct, and that could cause some problems as well (I'd read about that too).  But, really, if I didn't want the surgery, that was fine with him.  I told him that I was just trying to decide if this was something that I wanted to do, considering that we are trying to have a child.  And, since I was undergoing infertility treatment, which involved taking estrogen, would that make whatever problem that I had worse?  He didn't know.  He did say that he sees a lot of women who are pregnant, and depending on where the top of the uterus is, they can do the surgery during the pregnancy.  (Now, that would be scary.)  He is scheduling surgeries at one hospital for the first week of November, and at another for the second week of November.  He thought that I could get pregnant immediately after, but he wasn't sure.  OK, I'll forgive him on that one; that would be out of his area of expertise.

Basically, he does at least seven of these surgeries a week at two hospitals.  He visits the office that I went to on Thursdays.  I don't know where else he has office hours where he meets with his referrals (he also has a regular office).  But, he appears to be someone who just takes out gallbladders for a living.  Now, I don't quarrel with that.  I expect that he's quite good with all that practice.  But, unfortunately, he only has one answer to everything.

You know, one of the things that I learned from the NIH website is that watchful waiting is a legitimate alternative to surgery, "because no therapy may ever be required.  For patients with silent or minimally symptomatic stones, the rate of development of moderate-to-severe symptoms or gallstone complications is estimated to be between 2% and 6% per year, leading to a cumulative rate of 7%-27% in 5 years."  Honestly, wouldn't I qualify as someone who is minimally symptomatic?

So, I guess I am going to continue this cycle.  But I will also call the internist at the university hospital who told me that he didn't need to see me again until I turned 50 or had an issue.  We don't click personally, but I think that he will probably give me better advice.  Even if it's the same advice, at least he doesn't have a vested interest in my decision.

If It Weren't For Bad, Sucky Luck

I guess I would have no luck at all.

OK.  We've had three cycles with our new donor; one fresh, two frozen.  I wanted to do another cycle right away.  I only have two cycles left at the most from this donor (two straws of embryos). 

I did talk to my clinic, Nurse J in particular, when I came in to sign the forms again.  I was really kind of ticked off at them because of their response to my request to use embryo glue (it's supposed to help with embryo implantation).  Now, mind you, all my questions are filtered through nurses, usually Nurse J.  I asked about embryo glue, and I received a call back telling me that it isn't being marketed yet.  I told her that was absolutely incorrect, and I faxed her copies of a number of pages from the company's website, complete with ordering information.  She called me back and said my doctor was not interested in using it, because it is not in wide use and he didn't think that it was efficacious.  I was p*ssed, because I thought that the response was dismissive, and the initial research that I'd done seemed to indicate that it was at least worth trying.  When I came in for my cycle day three blood work and ultrasound, the nurse talked to me again.  She said that they'd looked into it further, because they didn't want to be dismissive (surprise!), but they still didn't want to use it.  Not only didn't it appear to be very effective, but it also appeared to increase the possibility of ectopic pregnancies.  OK, fair enough.

But, I wasn't finished.  I told the nurse that honestly, even though my doctor was a pioneer in IVF, he appears to be sitting on his laurels now.  She said that he is the most conservative doctor in the practice, but he wasn't that far behind.  She said that as a small clinic, they are not involved in a lot of clinical trials, but they do follow the research trends.  If it seems like it will help a patient, balancing out the physical, and frankly financial, burdens, they will try it.  But, they don't try everything just because it is new. 

I asked about immune issues, since several people had suggested that might be a problem.  She said that they were certainly aware of the work in that area, and they'd even sent a few patients to the primary clinic where the research was being done (out of state).  Their experience was that it was an expensive proposition, and they'd seen no increased results.  So, they don't do it anymore.  OK, again fair enough.

I asked about the tests that my doctor had suggested just before our donor cycle -- he'd wanted to do a sounding and a sonohystogram.  I told her that at the time, I'd been concerned about infection, because he wanted to do the sonohystogram so close to the donor cycle.  But, since we wanted to start a new cycle, I wasn't as concerned.  However, I did want to know why he wanted to do it, since I don't have fibroids and have always had normal GYN exams.  She said that there are other things that they look for, including something that causes fluid buildup in the fallopian tubes that can be toxic to an embryo (I can't remember exactly what the term is).  OK, makes sense, so I scheduled it for tomorrow.  Then she said that he could do the sounding at the same time (a sounding is a dry run for the embryo transfer, where they insert a catheter to see which angle is necessary to get through the cervix).  Except -- this doctor has done a bunch of transfers with me!  She said that after pregnancy, sometimes, the angle changes (I had a C-section, so I'm not sure that's the case for me, but I didn't think about that until after I left the office).  And, he's done five transfers since my pregnancy.  But, whatever.  It takes a second. 

I started my birth control pills, and I think we start Lupron on the 13th.  But here's the s*cky part.  I've had some minor health issues that I kept putting off talking to someone about.  Very, very slight swelling in my ankles at the end of the day.  My joints have started "clicking" sometimes.  I had a mole that I wanted checked out.  And, I've had a stomach problem for at least 20 years -- bad pain in the center of my stomach that goes away if I make myself throw up (sorry if that's TMI).  I just kept thinking that I really need to talk with someone before I get pregnant (wishful thinking!), because if there are any serious issues, they should be taken care of ahead of time.  Being a responsible adult and all.  And these little problems seemed to be adding up.

So, the first two things.  No big deal.  The mole?  Big deal.  It didn't fail the mole test (ABCD -- not Asymmetric, it had clear Borders, the Color was uniform, and it had a small Diameter [smaller than a pencil eraser]).  Except it was a dark, dark brown.  Kind of like looking into a cup of weak black coffee.  You know that it's brown, but it is really dark, almost black.  Apparently, that is the classic type of mole that becomes a melanoma.  Would I mind if he took it off that day?  Holy h*ll, not at all.  How about now?  Is now good?  That wasn't such a big deal, but it is taking forever to heal.  But one less thing to worry about.

As for the stomach thing, the doctor was stumped.  He thought that it was probably just muscle spasms.  But he wanted to do a CBC and an ultrasound, just in case.  I have to be honest with you -- the technician spent a LOT of time taking measurements on my liver last Wednesday.  A lot of time.  And, since my mom died of non-alcoholic cirrhosis, that kind of FREAKED ME THE F*CK OUT.  And, of course, when I joked with the technician about whether or not she found something (I know, they don't usually say, but sometimes they do), I received a deadpan response that a radiologist would read it that day or the next, and my doctor would have the results by Friday afternoon.  So, of course I thought I was doomed.

I obsessively Googled abdominal ultrasounds, trying to figure out what kinds of problems they could find, and what would be a "normal" amount of liver measurements to take.  Well, I did find one textbook that would have given me the answer regarding the number of measurements, but I would have had to buy it, and I wanted a more immediate answer than that.  And then I started looking at pictures of ultrasounds.  Ultrasounds of people with problems.  And, of course, I had no idea what I was looking at, but I assumed that given the number of measurements, and the deadpan face of the technician, that of course, IT MUST BE A TUMOR!  A rational response?  Eh.  Probably not.  And, of course, I was seeing 11's everywhere.  And, as I've admitted before, whenever that happens, it always seems to coincide with really bad news.

I finally screwed up the courage to call the clinic last Friday late in the day.  And, if you want test results, you need to leave a message.  And they will get back to you.  Maybe in 24 hours.  Maybe in 48 hours.  So, I left a message.

Now, you should know that the doctor said that if there were problems, he would call me.  And I convinced myself that if it were really, really serious, the facility where I had the ultrasound done would actually call the doctor.  And, no calls.  No news.  Good news, right?

Not.  No tumor (thank you Lord).  But -- I have effing gallstones.  Gallstones!  With no symptoms that match any other human!  (Though does happen that there are no symptoms.)  My first thought was that this was a geriatric disease.  Heh.  Not so much.  It occurs three times more often in women, usually between the ages of 20 and 60.  It often occurs after a pregnancy or in conjunction with HRT (hormone replacement therapy) because . . . the amount of estrogen in your body increases when these things happen (gee, what have I been taking a whole helluva lot of over the last forever years?).  And, being even moderately overweight doesn't help (I suppose 20 pounds too much falls within that definition).  And the gold treatment standard is to take the damned gallbladder out.  Which scares the cr*p out of me.  90% of the time, they can do it laproscopically (the remaining 10% of the time requires a major abdominal cut).  And 60-95% of the time, there are no after effects.  Except someone that I know has the after effect (which means that she can't eat fatty food without having to immediately use the facilities), and she told me today what a horrible time she had after the surgery (just what I needed to hear!).  There is a medication that can be prescribed for the "problem," but it is a Category C (so probably not a good idea during pregnancy), and it is not a good idea for breast feeding, because it binds to fat soluble vitamins.  Lovely.  Just lovely.

So, I fell like I'm totally scr*wed.  The responsible thing to do is to talk with the surgeon that the doctor recommended.  I've never heard of him, and I can't pronounce his name (nor could the nurse who scheduled the appointment, and she sees him regularly).  If I can't understand him, I will find someone else.  Biased?  Yes.  But only against people whose English I can't understand (and I'm pretty good at listening); I really don't care about heritage.  I guess that I figure that if I can't understand him/her, then he/she can't understand me, and that is not the basis for a good relationship.  Because I'm all about the talking (and talking and talking and talking, even though I know surgeons are not really into all of that).  He is based out of a hospital I've never been to; that makes me uncomfortable.  But the alternative is to go to my regular doctor (who pooh poohed me for coming in for an annual exam several years in a row, because statistically speaking, I didn't need to do that until I was 50(!), since I was getting regular GYN exams).  So yeah, he is not my favorite person either, and I can understand him perfectly.  He is part of a university hospital system, and they do good work, but it would probably take forever to schedule the surgery, and for crying out loud, I only did this because I wanted to have a healthy pregnancy and a healthy baby and holy sh*t why is this happening to me?

So yeah.  I'm a little freaked out right now.  But I'm not going to tell my RE tomorrow.  The last thing I need is for him to demand that I have the surgery when there's a remote possibility that the surgeon may think otherwise on Thursday.  But why am I even thinking that there's a possibility of a good result on Thursday?  Not with my luck.  And seriously.  A surgeon?  Who cuts for a living?  What do YOU think he will say?  Yeah, I think so too.  And then I will have to come clean with my RE.  And who knows what he will say.  And that makes me want to cry.

Damnit.