Infertility 101

So you’ve been diagnosed with infertility?

First of all I want to say that I’m sorry you are finding yourself here. It’s not easy. But know you’re not alone.

I know when we first figured out we were going to have to walk this journey I was completely clueless as to what that meant emotionally, financially, factually. After 3.5 years of appointments, treatments, googling, and reading forums I kind of sort of have a grasp on it. At least enough to share in hopes to help you understand, whether because you have started this journey yourself, know someone, or are simply curious.

First off there’s a lot of jargon and abbreviations to be familiar with:

RE= Reproductive Endocrinologist
ttc=Trying to conceive. (We’ve been ttc for 2 years)
dpo=Days post ovulation (I’m 9dpo and have noticed…)
cd#= Cycle day (I’m cd3 and my progesterone…)
hpt= Home pregnancy test
pos= Pee on stick
bfp= big fast positive! (pregnancy test)
bfn= big fast negative (what we all hate)
dh= dear husband (dd is dear daughter, ds is dear son)
af= Aunt flow (period)
cm= Cervical mucus (important for cycle tracking)–with this comes the desired “ewm” or egg white mucus. Yup. It gets gross.
bmt= Basal metabolic temperature (important for cycle tracking)
bd= Baby dance (sex)
2ww= Two week wait (the time between ovulation and your period)

These are procedure specific and I’ll go in detail later:
IUI= Intrauterine insemination
IVF= Invitro fertilization
fet= Frozen embryo transfer
trigger= HCG shot

So you might see something like this:
My dh and I have been ttc for 3 years. We’ve done 2 rounds of iui and 3 rounds of ivf with no success. This is our 4th IVF with our fet done on cd12 by our RE. I did an hpt with a bfn 7dpo. I pos every day and I’m currently 2 days before af is due and I got a BFP!!!

It’s almost it’s own language.

What causes infertility?
LOTS of things. Some things are easily fixed via a supplement or diet change. Some things require procedures some are not fixable. Infertility might be that you can get pregnant but can’t maintain pregnancy, or you can’t get the embryo to implant, or perhaps you’re not ovulating at all. Or it’s a male factor cause–infertile sperm. I’ll cover the most common reasons starting with the men.

You’ll learn quickly that there’s actually a lot to know about sperm and all the numbers have to be in the normal range for viable odds of getting pregnant.

Sperm count–how many
Morphology–shape of the sperm
Motility–movement of the sperm

If any of those are low then your chances are also low. There are other factors to consider as well…thickness of semen, how long the sperm live, how fast they swim, etc. If men have low testosterone they will also have low sperm count. Testosterone replacement therapy actually makes the man infertile…so they will raise testosterone using female reproductive medications like HCG (pregnancy hormone) or clomid.

Common causes of female infertility:

Endometriosis:
Generally speaking the treatment for this is oral contraceptives as they help regulate hormones and make the symptoms better. Symptoms of endo are wacky cycles, abnormally heavy or light cycles, long cycle length, horrible cramps. Endometriosis itself is the growth of the cells lining your uterus outside of the uterus. We don’t know why this causes infertility, we just know that it does.

Since birth control is the opposite of what we want the next step is laproscopic exploration and/or removal. Unfortunately THE ONLY definitive way to diagnose endo is to look at it. You CANNOT diagnose this via an ultrasound or palpation. I’ve had general practitioners tell me they couldn’t feel anything so I didn’t have it. Well. I did. Stage 2 with lots of adhesions and I had it removed. I’ve also heard of women being told they didn’t have it because nothing showed on an ultrasound. Any respectable OB/GYN or RE knows that you cannot diagnose this without laparoscopic exploration. This is where they poke 3 holes in your abdomen and take a camera inside to look around. If anything is found they laser it off.

Polycystic Ovarian Syndrome (PCOS):

PCOS is a nasty disorder to have as it not only affects fertility but it messes with a lot of hormones. Women with PCOS tend to struggle with their weight and have a higher rate of diabetes. There are a lot of other crappy side effects and PCOS is worth an entire post in of itself. Treatment for this is symptomatic–treat symptoms and diet change. Getting pregnant with a PCOS diagnoses is a tough journey and I’m fortunate to not have PCOS though I do have polycystic ovaries.

What’s Normal?

A woman’s normal cycle lasts around 28 days on average. You ovulate around cycle day 12-16–the best time to bd. Next is the dreaded two week wait. If you’re trying to get pregnant you will probably be googling pregnancy symptoms constantly and wondering if there is any possible way to get a positive test so early after ovulation. You’ll be reading about implantation symptoms (which occur around 7-12 dpo). Some women get implantation bleeding which happens shortly before your period so it’s often confused as an early period. Your period marks cycle day 1 by the way. You generally won’t get your BFP until 9-16dpo depending on how much hcg your body is producing. Your HCG doubles every day or two so it’s easy to want to take a pregnancy test a million times.

Insiders tip: Amazon has super cheap pregnancy tests in bulk. They are just as accurate though more annoying. You have to dip them instead of pee on them. When you’re ttc hpts get very expensive because you’re probably going to get obsessive about pos. And ladies, I’ll tell you no matter how many times you go back and check that test won’t magically turn positive.

BEWARE of the pregnancy tests. People will tell you how impossible it is to get a false positive, but you’ll quickly learn within the infertility community how inaccurate that is. Blue dye tests are notorious for having this problem so save yourself heartache and stick with pink dye or digital.

Cycle Tracking

Tracking your cycle is important so you know when that sweet spot of fertility is. There’s a few things you can do.

Ovulation Predictor Kit (OPK):
These are kits you can by over the counter, or again in bulk online. The first few months you use them it’s wise to start cycle day 1 (when your period starts) until your next period. It works just like a pregnancy test where there are two lines, one dark control line and then a test line. The strips measure an “LH surge”. This is when your body produces the lutenzing hormone at it’s peak and ovulation should follow within the next 24hrs. This will show on the strips when both lines are equal in color or the test line can even be darker than the control line.

Basal Metabolic Temperature (bmt):
Lots of women use the bmt to track their ovulation and it seems to be the best indicator of ovulation. Again, it may take a few months to get a good picture of your cycle. There are many apps you can download that you can use to track your bmt and they can predict when you’ll ovulate the next month. With the bmt you’ll see a dip in temperature before ovulation and the a spike in temperature when you ovulate and will stay higher until your period where it should dip again. If it stays high that’s a good sign you may have conceived. The difficulty tracking bmt is that you have to measure it immediately and at the same time every day. As soon as you get and and move it throws off the temperature. The temperature change also isn’t huge it’s just a fluctuation from 0.5-1 degrees.

Cervical Mucus (CM):
Eww. Yes. Eww. However, it’s a great indicator of fertility. Your cervix produces different types of mucus depending where you are in your cycle. The best cervical mucus is called egg-white cervical mucus (ewcm) due to it’s uncanny appearance to egg whites. Your cm can be anywhere from sticky, to lotiony, watery, or dry. The best environment for sperm is indeed the thinner more slippery types of textures. Sticky and dry are the worst environment. You can check your cm in the shower by doing exactly what you think. Close to ovulation you’ll see a change towards ewcm and closer to your period it gets more sticky. Google images will help clear it up for you if you’re not sure.

All of these things combine will help you hone in on the most fertile days you have. However, even with the most perfect timing you only have at most a 30% chance of conceiving. Right? Totally stupid.

Infertility Treatment

Everyone has heard of IVF. We’ll get there, but there are a few more less invasive steps you can take first.

Fertility tracking is the first thing you can try, by using the stuff mentioned above. The next best thing would be medication.

Find a reproductive endocrinologist. They will run a bunch of tests to make sure your hormones are appropriate, that your ovaries are healthy, and uterus has no blockages or growths that would interfere with pregnancy.

Low progesterone is probably one of the largest hormonal issues. Replacing progesterone is simple–a pill or suppository. Low progesterone can cause a short lutenizing phase of the menstrual cycle–short second half between ovulation and menstruation. Extending that phase gives your embryo a chance to implant.

There are also medications that cause “hyper ovulation”. Letrozole (Femera) or clomid. You’ll have an ultrasound (vaginal) to watch where you are in your cycle and then you’ll take one of those meds for five days. This will stimulate ovulation increasing your chances at ovulating. Clomid is older and has a greater chance at multiples, but it also has a lot more side effects. Letrozole has comparable outcomes, but it a more gentle medication with less of a chance of multiples. I’ve done letrozole twice, but would like to try clomid next time. They will also do what’s called a “trigger shot” where you’ll take a dose of HCG to increase your success of conception.

Intrauterine Insemination (IUI):
With an IUI you’ll go through the medication regimen as above, but when the time comes to have intercourse you’ll actually do it artificially. They will collect a specimen from your partner and then insert it directly into your uterus to give those swimmers a better chance at survival, thus increasing chances of conception. It is said that with 3 cycles your chances can be as high as 80%. That being said, there are many women who have done several IUIs without success.

In Vitro Insemination (IVF):
IVF is much more invasive and costly rounding out to approximately $26,000. There are companies out there that will help finance costs which is helpful. With IVF your ovulation will be over stimulated and then the eggs will be collected. A sample from your partner will also be collected and at this point they can be combined and let things happen on their own or you can do ICSI where they literally inject the sperm into the egg. The embryos are allowed to grow to a certain point and then re-implanted. You can choose to implant 1-3 embryos, though most will strongly advise against more than 2 as each of those embryos have a chance at splitting into twins. Embryos that are left over are then frozen for another round or you can donate them.

Embryo Adoption:
Embryos frozen from IVF rounds can be adopted out to parents who are having difficulty conceiving. You can adopt embryos and they are implanted just like with IVF. You carry them and birth them just like your own babies. Personally, I love this.

That’s A Lot

Yes, there’s a lot of information. A lot to think about and a lot of money. Insurances don’t generally cover fertility treatments or medications which has made this road a bit slower than desired for my husband and I. So far we’ve spent over $10K on trying. It hits your pocket, but it hits your heart harder. Beginning this journey is an emotional roller-coaster and I STRONGLY recommend therapy. People will give you well intended advice and know it comes from a place of love though it is often ill-informed. The advice I hear the most is to stop thinking/worrying about it, because that’s when it will happen.

It’s easy to say this when you haven’t been on this road for years. It’s easy to say if you’ve never experienced it. It’s easy to say when you’re not taking hormone supplements that constantly remind you of why you are taking that pill. We had male factor infertility which required injections…not so easy to just forget that. But if we just “stopped thinking about it”, stopped the injections, then there would have been a 0% chance of pregnancy. It’s not that easy. There are days/months that I can give it up to fate/God. I know that things will happen when they happen how they happen and it will all be ok. I can be at peace with everything. But then I can also find myself in a lot of pain with my heart aching to be able to share Christmas with my child. Being sad that we are dealing with this does not mean we are not hopeful. It does not mean we are not joyful or grateful…believe it or not you can be both. I can mourn another month gone by without conceiving and still be thankful for my husband and my life. I can sob because I’m brokenhearted from feeling the emptiness that should be a child, and I can also find joy in others. Don’t let anyone tell you, you should feel how you’re feeling. Don’t let anyone tell you that it’s not ok to grieve this journey. It is what it is. And you’re not alone.

 

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Hope Rises

Right now in my life and journey to healing, I’m doing very very well. I’ve gotten to a place where symptoms are manageable and I can see and look forward to the future. I’m figuring out what it means to love myself and who I am. Getting to this place was far from easy. It took a lot of patience, a lot of work, and a lot of therapy. But I’m here and I’m still moving forward.

Today’s blog is about hope. It’s about how you can find it even when it seems impossible. It’s about who/what you can turn to. It’s about being realistic. There is no “cure” for mental illness. There is no “getting over it” or “conquering/overcoming”. There is living with it. There is learning how to manage symptoms, how to accept who you are with the illness as a part of you–not defining you, not an enemy. It’s about learning resilience.

There’s hope for you.

I’m not just throwing that out there to make myself feel better by offering some platitude. I am the person who was convinced there was nothing beyond the darkness. I was the person convinced hope was a load of crap. That there was no way out of the pit I kept falling deeply into. That same person who didn’t believe the proverbial light at the end of the tunnel existed is telling you it does. As long as you don’t understand that the light isn’t a goal, or a final destination. I once explained to my therapist that I felt like I could see the finish line, but I just couldn’t get there. She responded to me that the finish line will just keep moving, I’ll never “get there”. She was very right. There is no “there”. There is only here. Hope in the future is allowing yourself to accept where you are right now, warts and all. It’s realizing that your emotions do not define you. It’s learning how to cope with the emptiness and keep moving. It’s about consciously working toward rewiring your brain.

Changing the way you think requires flipping around a lifetime of neuronal pathways. This takes a lot of time and a lot of work. Which leads me to resources that you can…and should…turn to.

The Dreaded Therapy

Therapy took me years to finally convince myself to do. It took both my physician and husband to tell me that it was more than necessary or I was going to keep stumbling back into that pit. I knew it was true, but the idea sickened me. The thought of opening up all of those old wounds with a stranger was terrifying.
“What could they possibly teach me that I don’t already know?”
Everything.
I was very fortunate that the first therapist I found was my therapist “soulmate”. This is not always the case. I tell people that it’s an awful lot like dating. Sometimes you have to date a few people before you find “the one”. But once you do, it’s completely worth it. Each therapist has a different style and you’ll respond best to certain personalities and therapy modalities. Keep trying. You’ll find the person who will be able to guide you into healing. I’ve been seeing mine for 3 years and she’s helped me completely change my life.

Types of Therapy

CBT
Cognitive Behavioral Therapy or CBT is very commonly used and works well short term. It helps identify unhealthy thought processes and the behaviors they lead to and teaches you how to manage and intercept those thoughts. However, this doesn’t work to find the cause of the thoughts/behaviors in the first place so it’s very easy to fall back into old habits.

Psychoanalysis
Psychoanalysis gets a bad rap. Think Freud. Analysis focuses on consciousness and unconsciousness. Finding the root of the wounds and reworking those moments to find healing within them. This can be difficult to do as it requires remembering painful moments, but the work is worth it. It can bring about healing in places you never thought possible.

DBT
Dialectical Behavioral Therapy is fairly new, but is quickly becoming the mainline treatment for many disorders, specifically Borderline Personality Disorder. DBT combines components of CBT with the idea of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT is most often done in groups, but can be used in individual therapy.

Most likely your therapist prefers a certain modality, but will often use a personal approach that best fits your relationship. Personally, I believe that the best approach is combining components of all of them. I have a special place in my heart for DBT because I know first hand how effective it is.

Support Groups
There are likely many support groups near you that you can connect with as most therapy clinics provide some sort of support groups. NAMI (National Alliance of Mental Illness) also provides support groups such as Peer to Peer or Family to Family which allow you to connect to others facing mental health issues or other family members supporting someone with a mental health diagnoses. Support groups can be a great way to identify and connect with people who have experienced similar life events and responses as you have. You fell much less alone.

211 Helpline (South Dakota based)
The Helpline offers online and over the phone support 24/7. Just dial 211. What they offer:

  • Volunteer Services
  • Child Care Resources
  • Suicide and Crisis Support
  • Military and Family Support

Which leads me to Volunteering. Often volunteering for organizations like NAMI, support groups, or local crisis lines can be very healing. Helping others can allow you to reach places where you can help yourself.

Finally, your loved ones. This is probably the most difficult than reaching out any other place. People often tell you they are here for you, but it’s difficult to navigate if they really are and if you’re in a place to reach out. People often don’t know what to say/may say the wrong things, but most people are well intended and come from a place of love. If you can find at least two people you trust and know you can reach out to, please talk to them and let them know you may need to lean on them. I know it’s easy to feel like your bothering them or a burden, but remember how you would respond if the tables were turned. You know you would be there in a second if one of them turned to you for support. It is no different on the other side. I have found a couple friends I know I can talk to when I’m in a crisis or very low point. They love me and understand me through those moments. They don’t have expectations of me. They’re just there. They meet me where I am.

If you’re wanting to be one of those people for someone else, please remember this. You can’t fix it. You cannot change how the person is feeling no matter what you say or do. You cannot take the pain away and you won’t make them suddenly have a different perspective. It’s best to not give advice, they don’t need it. Don’t have expectations of them or try to take away their pain. Just love them. Just be there. I know it can be uncomfortable to sit with those difficult emotions, but being there for someone is not about your comfort. You may not understand where they are coming from, you may have no place of reference, but how they are feeling doesn’t require your understanding. Your ability to understand or relate has no impact on the validity of their feelings. Again, it’s not about you. Just meet them where they are. Just hold them in that place. Just love them. That’s all the need. That’s all we need.

There is hope. I promise. You can get through this, you are worth it. You are beautiful and there is nothing wrong with you. We are all the same kind of different. We all experience life uniquely. We all have different perspectives. Keep pushing. Hope does rise.

Substance Abuse and Addiction: It Could be You

Substance abuse is an ugly secret that no one likes to talk about. But it’s very real and it’s also extremely full of shame. When mentioning substance abuse most people think of illegal drugs, but the reality is the majority of substances abused are prescriptions.

Image result for substance abuse statistics in the united states

Substance Abuse and Addiction

Addiction is very complicated and multi-factorial. And, yes, it is a disorder. It is as much of a disorder as any other mental health condition or physiological condition. Substance use changes the brain–it effects the reward center of the brain and with time it becomes a need. Factors that contribute to risk of addiction includes genetics, type of substance, length/frequency of use, coping skills, etc.

Addiction can happen simply from pain medication use after a serious injury or surgery. There is a difficult balance between pain control and dependence and unfortunately addiction seems unavoidable. If a person is experiencing severe pain and requires an opiate to control it, if used long enough, it will create an addiction. This leads us down the rabbit hole of opiate abuse.

I’m sure you’ve heard the term “drug seeker”. I hate it. Working in healthcare I hear it all too often and it’s generally a label slapped inappropriately to someone with legitimate pain. Remember, you’re not the one in pain. There is absolutely no way for you to know if it’s “legitimate” or not. If pain medications end up being prescribed to someone who already has a genetic and/or social predisposition to addiction we find ourselves in a conundrum. Some doctors will give in and allow the person to maintain their dependence, some try to cut them off cold turkey. My stance on this is: even if the person is using their medication inappropriately we cannot suddenly end it. Addiction is evil and controls the wants/needs of your brain creating a horrible physical reaction to going cold turkey–aka withdrawal. Not only does addiction occur physically, but often psychologically as well. Substances can become a crutch for the person and are used as a a way to cope. Pulling that completely away leaves the person without proper coping skills, no support, and dealing with withdrawal symptoms. They need support. They need us to recognize their agony (emotionally and physically) they need us to help them understand their addiction. They need us to help them through weaning off the medication and provide resources for them.

Any of you can become addicted. You may just not have found yourself in that situation. And of course not everyone who abuses substances will become addicted. Have you ever gotten drunk? That’s substance abuse. Do you smoke? Addiction. Caffeine? Yup. It doesn’t matter the substance, it affects our brain the same. The same reward centers are used and the same responses occur. Cravings, dependence, withdrawal. It’s all there, but alcohol, nicotine, and caffeine are more socially acceptable. The difference between that and heroine, is the drug is a lot more deleterious and side effects are deadly. Not to mention legality. So how could someone get addicted to drugs? Ask yourself when you’re sipping that latte. You haven’t found yourself in the same position as the person who became addicted.

Desperation. A person who abuses substances is trying to escape, whether it be physical pain, emotional pain, anxiety, suicidality, fatigue…what is missing is healthy coping skills. The ability to manage the pain outside of substances. People who find themselves addicted to meth most likely haven’t developed appropriate coping mechanisms and most likely do not have support to help them through those difficult…devastating…moments. Imagine yourself feeling like your burning from the inside. Severe emotional pain and trauma. Vivid flashbacks of a rape, you keep reliving the moment over and over and over. You want out. You find something that can dull the memories, the pain. There is no one you can turn to, no one knows or would understand. Those you have reached out to tell you to get over it, it was 2 years ago. They tell you that everyone has experiences like that, it’s no big deal. The idea of opening up to a stranger, a therapist, is terrifying. Also expensive. Someone offers you a medication (legal or illegal it doesn’t matter). At this point you’ll do anything to rid of the internal torment. You find this medication dulls your memories, dulls the pain. Makes it more tolerable to be alive. Would you not want that?

Or maybe you had invasive surgery and find yourself in a lot of pain. You’ve been given pain killers, they work. They make it so you can halfway function, so you’re not writhing. Time goes on and you begin to heal, but every time you try to wean yourself of the pain meds the pain returns worse than ever. And because of tolerance you find yourself needing more to make it so you can work, you’ve used up your disability.

It’s easy. Given the right situation, anyone can become addicted.

If you find yourself or someone you love facing substance abuse and addiction, please seek help. You are worth it.

This is an amazing video. A neuroscientist explains addiction in a TED talk:

Anxiety: More than Nerves

Image result for anxiety

Everyone feels anxious sometimes. It’s completely normal and healthy to feel anxious before/during/after a life event. What’s not normal is when this feeling persists and begins to overtake your thoughts. Anxiety is more than someone overreacting, and generally the person experiencing it knows they are catastrophising, they just can’t control it. Sometimes feelings of panic come, seemingly, out of nowhere for reasons a person is not aware of.

I’m sure everyone has heard of “triggers”–especially due to the popular use of the term in the social justice warrior crowd. A trigger is something–anything–that brings back a memory or feeling of a traumatic event. This can be smell, touch, taste, words, sight…really anything. Often times the person is unaware that the trigger happened or what caused it. Sometimes there’s no trigger at all, stress in general can bring about the chaos of anxiety.

If anxiety is severe enough and unresolved it can result in a panic attack or anxiety attack. We’ve had numerous people come into the ER with symptoms of a panic attack thinking they are dying. Because it absolutely feels like it. A panic attack is a physical response to substantial anxiety that causes a person’s heart rate to increase, hyperventilate, lose concentration, disassociate, chest pain, dizziness, numbness…as a nurse I can tell you that a lot of those symptoms are secondary to the increase in heart rate and breathing. You can actually put yourself into what’s called “respiratory alkalosis” meaning the carbon dioxide ratio in your blood is skewed. This can result in serious physiological effects…and definitely makes a person feel like they are dying.

Please remember:
If you can’t relate to a person’s emotions or experience, this doesn’t make it any less valid. Your understanding of their experience is irrelevant to how they are feeling.

So what do you do?

-If you see someone looking panicked, catch their attention. While experiencing a panic attack the person feels completely out of control and letting someone know they are not alone can help ground them and bring them back to feeling safe.
-Get them to a quiet area. During a panic attack you feel completely overwhelmed and your environment can absolutely make this worse.
-Get them to breath. Slowing down breaths can get their attention on something other than their thoughts and physical feelings as well as keep them from hyperventilating.

Tips to preventing a panic attack or stopping it:

Believe me, I’m very well aware of the horrible sensation a panic attack creates. The feelings of being completely out of control and in immediate danger…yet not knowing why this is happening. However if you pay attention to your body you can start to recognize when an attack is brewing. You’ll notice feeling irritable, chest tightness, trouble concentrating, increased heart rate. Here’s what to do:

-Take time out. Find a quiet place where you can be alone.
-Breath. Take slow deep breaths. It helps to close your eyes and concentrate only on your breathing. I like to use the 5,6,7 rule. 5 seconds to inhale, hold for 6 seconds, 7 seconds to exhale. I cannot accentuate the importance of breathing enough! This is imperative to preventing and stopping a panic attack.
-It’s OK to cry. It’s OK to hurt. It’s OK to need to take care of yourself. You can’t pour from an empty cup. Let it out, gather yourself, and get back to what you were doing.
-If you can distract yourself by doing something you enjoy–a walk, music, scents…anything that’s calming to you.

Anxiety is a horrible feeling and coupled with depression, this makes for an ugly two-headed monster. Often both conditions cause a person to exhaust their ability to cope and self-medicating through alcohol and drug abuse can add a third demon to the already debilitating conditions. Depression, anxiety, and addiction are difficult to talk about separately because of the marriage between the three. To be continued.

Don’t be afraid to seek out help. There’s nothing wrong with medication–sometimes it’s the leg up you need to gain control over your mind.

You got this.

 

If you are feeling like self-harming or suicidal please call 911 or head to your nearest Emergency Room.

The 211 Helpline is available for crisis support. They are open 24/7 and are judgement free.

I love you. Please reach out if you need help. Hope does exist.

Depression: More than Sadness

I came across the idea of the “Black Dog” to personify depression years ago. I loved the illustration as I feel it captured well how depression feels in a way others may somewhat understand. You can watch the video here:

Depression is much more than feeling sad. People will often say they feel depressed or have felt depressed over a situational sadness. Everyone feels sad. Everyone has experienced grief. Not everyone knows the dark pit of depression.

Depression Statistics Inforgraph

Depression is a dark hole that a person falls into and seems to never be able to crawl out of. Depression is an all consuming fire burning the person alive. Depression is a large wave drowning you as you fight for your life. Depression is NOT a choice. One cannot simply “snap out of it”. “Just think about all the good thing you have”. “How can you be depressed, your life is so good”. “You’d feel better if you strengthened your relationship with God”. “You’re letting the devil control your life”. “You just need to ______”. Words I’ve heard over and over, and words that are so very far from helpful.

Depression is beyond situations…granted situations can make depression feel worse and situation grief or sadness can evolve into depression, but often it persists despite what is going on in a person’s life. Research into the cause of depression has shown it is a very complicated disease created from genetic dispositions and the way a persons brain is wired. I could go on and on about the neuroscience behind depression, but rather I’ll provide a link if you’re interested:

http://www.health.harvard.edu/mind-and-mood/what-causes-depression

Depression is defined in the DSM-V (psychology diagnostic manual):

Depressed mood or irritable– A person must feel depressed the majority of the time and can be subjective (reported by person) or objective (observed by another).

In my life I become very tearful and feel very empty. This is a consuming feeling and persists for days, to weeks, to months…to years.

Decreased interest or pleasure– A substantial loss of interest in what a person used to like to do.

One of my warning signs for heading into a depressive episode is that I start to lose interest in doing thing I normally love. I quit reading, I quit working out, I quit cooking, I start to just stay inside, I limit social contact, even my job seems difficult to enjoy.

Significant Weight/Appetite Change- Generally a change of 5% of body weight in 3-4 weeks.

For many eating is a coping mechanism. For me, I quit eating. I completely lose interest in food and things I normally love to eat taste bland and unappealing. In nursing school I lost 30lbs in three months because I couldn’t eat. I try to force myself when this happens, but with food not tasting well it’s hard to do.

Change in Sleep- Insomnia or hypersomnia. Can’t sleep or sleep way too much.

Mine shows up as insomnia. I cannot fall asleep and once I do I wake up constantly. However I’m always exhausted. Others sleep too much and struggle to stay awake.

Change in Activity- Psychomotor agitation or retardation. Think fidgeting too much or unable to move.

My depressive episodes are definitely mixed with anxiety so I will experience both. At times I cannot sit still. Other times I cannot move or move very slowly. I’ll walk slower and respond slower…sometimes it takes all day to take a shower.

Fatigue or loss of energy- I feel this ties in with the previous one. However the loss of energy is more than feeling “blah” or a normal “tired”.

At it’s worst I have to remind myself to breath. The loss of energy is so severe that breathing seems “too much”. Moving seems impossible…I’ll sit or lay in one position for hours…the entire time trying to convince myself to move. It’s as if your body is made of lead.

Guilt/Worthlessness- Excessive or inappropriate feelings of guilt and worthlessness.

Note: “Inappropriate”. Meaning irrational. Meaning the thought process and perception of the person is affected and you cannot reason a depressed person out of depression. Instead they often find themselves feeling very guilty for feeling the way they are. I will feel like I’m letting everyone down around me…I will feel useless, worthless. A burden.

Concentration- Indecisiveness, diminished ability to think.

Talking is difficult for me, I’ll struggle with expressive aphasia. Meaning I can’t get words out and I can’t get them out in the right order at times. When severe I can barely drive…I’ve almost wrecked my car many times because of this. It’s worse than driving drunk…you just cannot think right.

Suicidality- Thoughts of death or suicide. Has a plan.

If you’ve been following me at all it’s no secret this has been something I’ve definitely struggled with. And suicide deserves a post to itself. It’s a very complicated topic. For now I’ll explain that in these pits of darkness death seems to be the only way out. It’s not necessarily that the person wants to die, but rather escape.

To be diagnosed with Major Depressive Disorder one must possess 5 of the 9 symptoms listed above nearly every day for more than 2 weeks. The symptoms need to interfere with daily living-jobs, social life, relationships, etc.

Depression is often a co-morbid diagnoses most often with anxiety and addiction. Both of which I will touch on later.

Treatment for depression involves psychotropic medications such as SSRIs (Zoloft, Prozac, Celexa, Lexapro, etc) and therapy. I often tell people treatment is much like dating–you have to go through a lot of bad apples before finding “the one”. Not every medication is for everyone and neither are therapists.

If you haven’t had luck with therapy I’d encourage you to try again. Being able to connect with the person is very important and often therapy is unsuccessful because the relationship between the therapist and patient doesn’t mesh well. Therapy can help identify precipitating factors that cause depressive symptoms and help you rework the mis-wiring of your brain. It’s not a short term process nor a quick fix. Medications aren’t either. They can help, but do not cure. Ultimately you learn to live with your symptoms, learn to lessen them, and cope with them.

Anxiety and Substance Abuse/Addiction are next. Then we’ll finish of Mental Health Awareness Month with the difficult subject of Suicide and an overall discussion of coping skills, therapies, and resources.

If you are feeling suicidal please call 911, go to the ER, or go to your nearest behavioral health facility for an assessment. Your life is worth it. I promise.

Helpline 211 is also available 24/7 to chat or talk on the phone, they are here to help.

The Paradox of My Heart

I wrote this as a way to explain how I feel when I am wanting to no longer exist and the paradox I fall into.

I stand on the edge of a cliff. The wind caressing my face as the sun wraps it’s warm rays around me. My eyes scan the beauty of the valley below, the horizon extending beyond infinity. This is God. I close my eyes and breathe deeply as tears roll down my face. I’m standing in the very core of Love but the urge to jump is nagging at my heart. My tears moisten my dry lips and I can taste the salt. I let a sob escape as I spread my arms as if I was hugging the very air keeping me alive. I collapse to my knees, crumbling into myself. The rocks dig into my skin the pain offering some sort of relief as it reminds me I am, indeed alive. I roll onto my back staring at the crisp blue sky above me, the sun continuing to hold me and forcing my eyes closed as the light overwhelms my sight. Again, this is God. I take another deep breath consciously trying to slow my heart down. I’ve done this before. Over and over and over. I feel so lost, yet so loved. My heart aches and feels as if it will explode with love, yet sits deeply within despair. God is here, but He is also on the other side. If there is an “other side”. Does it matter? An ache radiates from my chest to my finger tips as if the poison of death is pulsating through my veins. I grab at the pain in my chest digging my fingernails into my skin until it bleeds. Maybe I can claw the pain out. I open my eyes again to be met with the sun trying to outshine my suffering. My crying has stopped now as I sit up. My mind wanders into limbo, my senses disappear as I force numbness into my heart. I look forward, but I don’t see. I just am. Time trickles but I don’t notice as I’ve detached from this world, I’m somewhere else now. A dragonfly lands in front of my gaze and I am quickly snapped back into this world. Love wells up inside and bursts forcing out more tears. The dragonfly. Always has been God’s kiss to me, a reminder that this world exists. That I exist on purpose. I spin around and stand up again scanning the scenery I’m blessed to be in the presence of. Again my heart aches, but differently this time. It aches with a sweet sadness. A sadness filled with warmth and I drop my head as I succumb to my existence. I look over my shoulder as I head back home knowing we will meet again. We will always meet again.

2016

I found myself cursing this past year as one full of declines and lack of progress in my life. I haven’t been reading, I quit working out, I quit eating well (as I’m chewing on a handful of my 6lb bag of Gummie Bears), I haven’t been painting as much as I’d like, I haven’t been meditating/doing yoga…on top of a handful of some other crappy things. But then I was halted by a voice that told me I was being unrealistic. It pointed out the accomplishments my family and myself have made.

In my first year of being a nurse:
I got my “I See You” poem published in Scrubs Magazine
I got employee of the month
I joined the research council
I became a formal preceptor
I joined the NEXUS committee-championing better patient outcomes based on “teach back” education.
I earned my Progressive Critical Care Nurse certification
I got “Star of the Week” for Advancement on our unit

We remodeled our house
Nate got a new career
I spoke at NAMI’s Dancing With the Sioux Falls Stars
I’ve become open, which has made me a lot happier
My Faith has grown tremendously

Ok. Maybe I am doing better than I tend to give myself credit for. But those accomplishments aren’t even comparable to the insights I’ve gained. If 2016 had a theme it would definitely be Family. I’ve started to rekindle lost relationships, I’ve refused to give up on those that I love. I refused to give up on myself. Our family went through some large storms this year and it has changed us all for the better.

As I was sitting at the Christmas Eve service with my husband’s family I got lost in the music and my mind replayed a lot of memories. Memories that reminded me how beautiful my family and loved ones are. How our time on this Earth is short and holding on to transgressions is not worth losing a person.

This year I decided I am going to love whoever I want to love. I’m going quit dancing around taboo subjects that I am experiencing…because lots of you experience them too and I want you to know you’re NOT alone! I remember when I realized I wasn’t alone…where had these people been!?

Be the change you want to see in the world
-Ghandi

I am no longer going to wait for “someone” to do “something”…I’m going to be that someone. If I don’t, who will? I’m tired of sitting back and wishing things were different. I’m open. I’m involved. I’ve got nothing to lose except complacency.

My family is open. We decided we are going to actually involve each other in each other’s lives. I’m not going to hear from my brother and sister-in-law on holidays. I’m not going to pretend everything is ok when it’s not. If I have words of encouragement, I’m going to say them. If there’s something lurking in my mind negatively about someone, I’m going to address it. And so far all this has done has made us much closer. Do you know what it means to someone when you tell them the truth of why you’re scared of losing them, or why you’re hurt? When you remove that obstacle? It tells them you love them enough to be vulnerable with them.

There’s a lot in this world that’s scary and horrible-like what’s happening in Aleppo. But aside from casting a vote every four years, there’s not a lot I can do as one person. As one person I can’t change much at all…but I can start, or continue, the ripple that might. And my something as simple as just loving those around me. I can love my patients, their families, my family, my friends, the stranger in Target. I can choose to assume the best instead of the worst when someone cuts me off in traffic. And my energy might just impact someone in just the right way…my words someday may change someone’s life. There are plenty of people who have spoken a single sentence to me that I’ve hung on to for many many years. I’m sure you do to, and I’m sure most of those people probably have no idea. We’re “those people” too.

So that’s what I do. I know I can affect myself and those around me, and I choose to try to do so by simply loving them.

If your only goal is to love, there is no such thing as failure.
-Richard Rohr

Bring on 2017. We’ve got this.

We Already Love You

 

Waiting for baby Weber. Infertility offers a lot f questions, a lot of unknowns, a lot of waiting. We took a few months off working with our Reproductive Endocrinologists (RE) and casually tried ourselves.

We did have one very hopeful moment. Nate’s grandpa passed away…and I was a week late starting my period. It was our anniversary when we buried his grandpa. We talked about how beautiful it’d be if I was indeed pregnant…circle of life. I was experiencing some odd symptoms…it looked so promising. But the moment we opened our mouths, the moment the wish was vocalized through our lips…it was over. We held each other and cried. Cried at the loss of grandpa, cried at the loss of our dream, cried at the loss of hope. We didn’t celebrate our anniversary…and it will always go down in my memory as such a sweetly sad day.

We didn’t put a lot of effort into the next couple of months. Then we got our semen analysis back…it was pretty normal! Our morphology is still a 1% lower than ideal, but it was at least in the “normal” range now! …but I most likely have endometriosis. Another wrench. No way to officially diagnose it without surgery so we are just going to keep moving forward.

20161118_074649

07:30AM ultrasound on my day off in a blizzard. 

Our next step is timed intercourse with meds. Nate is currently, and has been, taking HCG to stimulate spermatogenesis. It’s worked wonders along with changing his eating and exercise habits. I’m on Femera, or letrozole. Letrozole causes hyper ovulation…the goal being that I have 2-3 eggs released rather than just 1.

Once a day for five days. Five days of crazy town. You get to start these beauties on the third day of your period…I’m already moody…then these guys amplify it. My poor husband.

Infertility certainly removes any shame regarding the nether regions. Before starting letrozole you get to have an ultrasound…let me remind you this is day 3 of your period. Um gross. I get a follow up a week from starting the meds to make sure they worked. Then we have to have sex on a schedule–so incredibly romantic. I work Thanksgiving and that’s when I have to do my follow up ultrasound…unfortunately our bodies don’t work with our schedule. I’m going to have to use my 30 minute break, at work, nude waist down with some cold jelly jabbing around to find those little eggs. I wonder if they’ll let me eat a granola bar or something during😉

And my poor husband has to come back from his family’s so we can time “it” just right. We’ll do this for two more months and then it’s back to the drawing board.

But while all of this creates a monstrous roller coaster of hope and broken dreams, I know it will all be worth it. And I hope someday my little one knows how much we wanted them and how much we loved them even before they were conceived. Somewhere out there is a little soul meant to become a part of ours…even if they are already born somewhere else…

We will wait for you, my love. Mommy and Daddy already love you more than you’ll ever know.

Descent into Madness

With every passing hour as the sun comes closer to the earth

I am reminded of my imminent descent into madness

I try to distract myself with pretty little things

With knick-knacks…

I fill my time with those I enjoy all the while hearing the

“tap tap tap” of the finger reminding me the clock is ticking

I smile, I laugh, pretending the panic rising within doesn’t exist.

Just maybe this time I can will it away, maybe this time I can run

But, you see, you cannot run from your own mind

So as the leaves begin to turn, the night seeps into the daytime

So do does my mind decay into a writhing pain

Emotion swallows my reality; I’m shrouded in the darkness


I fade.

WHO AM I!?

Come Dance with Grief

Come Dance with Grief

As Grief’s glances stole my eyes from across the room

I knew his heart and who he was, or rather he knew me

I know we’ve danced a thousand times but I cannot quite recall

Because every time you dance with Grief it’s never what it seems

He reaches his hand to summon mine, his fingers long and tired

Yet despite the wear within his palms his grasp gently inspired

I tried to arouse the memories ago our dances from miles away

But I stumbled to remember Grief never dances the same

I’ve danced with Grief a thousand times, his movement oh so familiar

But memory is useless here as he will always be a stranger

Grief whispers love into my ear, “Dear, come dance with me”

I remember to forget and surrender to his lead