Tuesday, August 30, 2011

Do we listen to the experts?

About Irene, I think a facebook friend said it best- her status update was' Irene, you bore me'. Thank god for boredom. I was in the mandatory evacuation zone, I packed up, stayed with a friend, had a tranquil weekend and came home to a perfectly untouched apartment. I did get to talk to many branches of my far flung family who called up panic stricken, because of CNN,  who were making it sound like the apocalypse was coming.  The majority of the reporters, were of course in Manhattan, trying to make as big a deal as they could of 1 foot of water. It would have been funny if it had not been annoying. From what I could see, Irene did very little to Manhattan, but did stir up trouble (though hardly as much as had been anticipated) to places like Long Island. Hope everybody is ok.

Even though many of the precautions seemed over the top in retrospect, I'm glad everybody played it safe.  But that is my nature. I got to witness an interesting example of the choice between playing it safe versus the alternative this weekend.  A friend cooked dinner, and one of the things she made was fish. Since I never eat fish without first finding out what kind it is, I asked, and was told, swordfish.  I definitely would not eat that. The reason I declined was because swordfish (along with shark) is one the the fish varieties that is very high in methyl mercury. My friend had no idea about that fact, and was completely taken aback that I would not even have a tiny bite of the fish.  She was like, well, what harm can eating it once do? The answer is, probably not that much, if you are not pregnant. Mercury is deadly during a pregnancy- tiny quantities can disrupt neuronal migration and hence can cause major defects in brain development. There is that ill-understood, poorly defined possible link between mercury and autism. The deal is, once you take mercury into your body, it is very hard to expel completely.  A good portion will go sit in your cells, in some corner of your body. If that cell is every broken down and recycled during pregnancy (low probability), mercury can renter your blood stream, and travel past the placenta, where it can wreck havoc.  So there is no way I will ever eat shark or swordfish or even tuna (certain varieties are kind of high) not until I close the door on having any children in the future.  I explained all of this to my friend, who ate all the swordfish anyway, and will probably continue to do so.  She served it to everybody else there- all women. One of them asked why I was not eating fish and I told them what I had told my friend. All the  women there were of child bearing age, 4 of us were single (it IS new york) and one woman was married, and I think, from her alarmed reaction, plans to TTC soon. Nonetheless, after initially bypassing the fish, she went and ate a few slices.  Honestly, the odds of any harm coming of eating it, this once, is pretty low. But because of my training and my knowledge and my own personal history of pregnancy loss, I could not help but be alarmist. Everybody ate the fish, and I'm glad, for my friends sake, that they did.  But it struck me, that, despite knowing how bad it is (the FDA counsels against any woman of childbearing age consuming any seafood species high in mercury, and I told them this), everybody went ahead with it anyway.  Maybe they will not repeat the process, now that they know, but who can say? Overall, the thing I was surprised by that none of them knew about the dangers of mercury and certain seafoods. Making a choice is fine- its your body, your life but I just want people to be educated before making that choice.

In other news- I got browbeaten by my doctor into agreeing to get the HSG done. I've protested to him time and time again, that an HSG is not supposed to be the best test to reveal scarring in the tubes/uterus. His rejoinder each time has been, the people who are doing it have not been using the test correctly, they do not know how to read it, an HSG, in the right hands, done by me, will tell us what we need to know.  What can I say? He IS the RE, I hope he knows what he is talking about. So, while I'm with him, the HSG is what I will have. 

Monday, August 15, 2011


Big chunks of the east coast seem to be cold and gray and rainy, and in a way, it echoes my mood. Nature can be an evil, capricious bitch sometimes, I think there are no words to express the rage and helplessness we feel when babies are targeted by that capriciousness- Shannon's news has left us all reeling. But still, there is definitely room for optimism, and while the coming period might be a harrowing one, there is a high likelihood that things will end WELL. I'm praying.

I want to apologize to whoever shared reviews of their doctors with me- I've procrastinated putting it up for so long it has been inexcusable. Still, better late than never, its up now, in its own page, with plenty of room for more if others wish to contribute.

Friday, August 5, 2011

The Glucose Tolerence Test...

They ordered the 2 hour GTT for me, instead of the 3 hour.  One part of me was fairly unhappy about this because I wanted more data points and the other part was resoundingly relieved that I'd have to just give blood twice, instead of being jabbed 3 times. After the first blood draw, I realized I had never confirmed that they were going to also check for insulin, I just assumed this would be so. Nope. They just had been ordered to do the bare needful, just glucose. And they collected blood in the wrong kind of tube, so they could not even add it on. This is when I wanted to just SCREAM.  The people ordering the tests knew I was worried about insulin resistance, but no, they did not bother adding insulin to the panel. ARGH!!!!

First, before moving on to the results- When I got the glucose drink, instead of being disgusted and sickened by it like most normal people, I tolerated it just fine, because its about a slight shade sweeter than my morning cup of coffee. That was when I realized I about give my body about half (in terms of volume) a GTT every bloody day! Scary stuff.

Anyway- I passed. With flying colors. My fasting glucose was 80, and the 2 hour was  lower, at 78. These are very good numbers, my body apparently is a champ at putting away sugars.

Should I take metformin? The majority of doctors would say no. Not with such clearcut evidence that I do not have any issues metabolizing glucose.. I'm stumped, I don't know what to do.

I had a quick phone conversation with Dr. L, where he said he does not want me on metformin. He also said he does not believe anti-thyroid antibodies are linked to miscarriage, and does not beleive in treating for them. I'm glad I get to call the shots there, thats all I can say.  I then asked him, if nothing is wrong with me, if I have a fantastically good ovarian reserve, make lots of estrogen and progesterone, and PCOS does not appear to be having a negative effect on my fertility, why did I lose 2 babies?? No answers were forthcoming, obviously. I should not blame him for that, this is a situation where nobody has answers, but his confident waving away of thyroid autoantibodies irked me a bit- atleast show some degree of uncerainity, because these is evidence both pro and con for that one.  

Sometimes this certain aspects of this debate on infertility and pregnancy loss seems like an atheist, an agnostic and a believer sitting there arguing about god. Nobody has any concrete answers, but everybody sure as hell has opinions. My Indian RE would want me on metformin. About 4 other doctors have said no. I'm conflicted. 

In the meantime- I have to call and order an HSG, to make sure my 2 D&Cs left no scarring in the uterus and fallopian tubes- last thing I need, is an ectopic. This is probably the one thing I can get an answer for, though I'm dreading the test. If anybody has an HSG done, or has heard an opinion about the usefulness of this test to evaluate scarring and is inclined to share, please do so!