A Trial Run

Last night, we received a reminder that we are not in control.  Around 6:30 p.m., my stomach started feeling really hard and uncomfortable.  I wasn't really sure if it was contractions because it was just an uncomfortable tightness that slowly came and went; I couldn't really count or time what was going on.  Per the instructions from my doctor's office's website, I drank water and laid down on my left side to see if the feeling would go away.  It didn't.  After about an hour, we made plans to drop off Lil' Bit with her godmother and headed out to the hospital to get me checked out.  The sensations became more distinct to the point where I was able to identify two separate "contractions" in the 20 minute drive to the hospital.

When we got there, all the triage rooms were full, so they put me in a labor and delivery room.  This turned out to be a real perk because those rooms are way more comfortable than triage--more private, too!  They put me on the monitors and checked me for dilation.  I was roughly 1-2 cm dilated, which surprised me, but is apparently totally normal at this point for a second child.  Jellybean looked great on the monitor, an ultrasound determined he had plenty of fluid, and they didn't find any evidence of an infection or dehydration that might be causing the contractions.  However, the monitor made clear that I was having contractions, and the longer we were there, the more regular they became.  They didn't hurt, although they were uncomfortable, and they never got above 40.  By the time they discharged me, they were very regular, coming three minutes apart and roughly all the same strength.  I didn't know you could have regular contractions only three minutes apart and not be in labor.  Turns out you can.  They aren't considered Braxton Hicks because they were too regular and don't go away with rest, but because they didn't seem to be causing labor to progress, they were deemed "preterm contractions." 

We were at the hospital until about 11:30 or so.  They checked my dilation again before discharging me to see if the contractions had caused any further dilation in the 2-3 hours I had been there.  Because I wasn't any further dilated, they were sending me home.  I was surprised that they weren't going to do anything to stop the contractions, but given Jellybean's gestational age (34 1/2 weeks) and the fact that any meds they gave me to stop the contractions could cause issues for him, they explained that their preference was not to stop any contractions.  Generally, when the body goes into labor at this point, babies generally do just fine and most don't need ventilators or any special care and there's usually a reason for the labor, so they prefer to trust the body that it's time.

It was certainly odd to be discharged while still contracting.  My orders were to come back if they got worse and they gave me a method to attempt to gauge that.  At the same time, they didn't want me to wait too long if I thought they were getting worse because they hoped to be able to transfer me to Detroit if I was, in fact, progressing, but they couldn't do it if I was in labor.  So, we were left with this grey, fuzzy area to decide when and if we thought we needed to come back.  Fun!  On the plus side, I was already scheduled to see my doctor today, so the on-call doctor from last night left word to have them check my cervix again today and make there hasn't been any further dilation.

We picked up Lil' Bit and got her home, but getting her back to bed was extremely difficult--particularly given that it was 12:30 a.m. at that point and all three of us were very tired from being up way past bedtime.  By this morning, the contractions seemed to have stopped--yay!  Outside of two doctor visits (and writing this post), my goals for the day are sleeping and drinking water.  Ah, what a glamorous life!

What surprised me most about this whole incident was how calm I was.  On the way to the hospital and as they were hooking me up, I was more worried that they were going to put me on the monitor and tell me I was crazy because nothing was going on than I was that it would turn out I was actually in labor.  Once it was clear I was contracting, I was so relieved I'm not sure I ever processed what it would mean if I was really in labor.  Fortunately, I didn't need to.  And, we got the opportunity to test out our contingency plan for Lil' Bit and local delivery in the event we don't make it to the induction, which makes me feel a little calmer about that, too.

Still, it was a very real reminder that Jellybean is going to come when he wants, and all I can do is try to be prepared for whenever that is.  Even so, I spend a few minutes every hour or two singing the "Just Keep Swimming" tune from Finding Nemo to Jellybean, except the words I use are "Just keep cooking."

T-minus 4 and 1/2 weeks and counting...

We're In For a Long and Wild Ride or, What I Know So Far

We've pretty well established at this point that I like to research and plan.  These are the things that calm me when I'm freaked out.  Plus, I'd rather learn this stuff while I have the time and energy to process it, rather than when I am recovering physically and emotionally from birth, let alone the wringer of open-heart surgery on my child.  So, it should come as no surprise that I've spent a lot of time this last week researching Jellybean's condition.  Obviously, any of the information I've found is subject to change based on Jellybean's specific situation, official diagnosis, and the protocols of CHM, but it's helpful to have some sense of the breadth of the challenge we're facing.  That said, here's what I've found so far.

The CDC reports that, each year, only 960 babies in the US are born with hypoplastic left heart syndrome (HLHS), or 1 in 4,344.  According to Boston Children's Hospital, HLHS "is one of the most challenging congenital heart defects to care for."  Everything I have found certainly supports this statement.

The first surgery--the one done at 7-10 days of life--lasts approximately 6 hours.  After it's completed, they wait several days before closing the chest to prevent the compression of the heart by the rib cage until the heart has had a chance to adjust to the new circulation.  After surgery, kids remain in the hospital about a month.  The good news is that the success rate of this surgery is high, with 90% or more of the kids making it home.  However, of those that make it home, another 10-15% are lost before the second surgery.

The care at home between the two surgeries looks pretty intense.  In addition to the weekly check-ups with the cardiologist, and likely lots of meds, Jellybean will probably be on oxygen and an apnea monitor.  Weight must be checked daily to make sure he's eating enough, and a pulse-ox monitor has to be used twice a day to check his oxygen saturation.  He may be on a feeding tube, depending on whether he's strong enough to feed himself; the low oxygenination caused by the mixed blood flowing through the body can make children suffering from HLHS too tired to feed well, so they often need supplements to make sure they get more calories per swallow.  Sometimes, because they had an intubation tube in so early, they associate having something in their mouth with that sensation, resulting in difficulty taking a bottle or breastfeeding.

Although I've found descriptions of the second and third surgeries, I haven't found much on recovery or mortality stats or care afterwards.  But, quite honestly, that's about a year away, and based on what I've already learned, I will have so much on my plate between now and then, I'm not sure I need to know more just yet.  The goal, for now, is to be ready, rested, and as prepared as possible for whenever Jellybean arrives, because once that happens, the roller coaster is gonna take a sudden, turn down a high, steep curve that will take my breath away, and I don't want to fall out.

Just Another Manic Monday

So what do we do?
Nothing. Strangely enough, it all turns out well.
How?
I don't know. It's a mystery.
-Shakespeare In Love

Today was our third fetal echocardiogram and, although we still don't have a firm diagnosis, in terms of what needs to happen, the official diagnosis doesn't much matter at this point.  What we know:  Jellybean's left ventricle is still significantly smaller than the right.  In fact, it is no longer growing like they had hoped, as it no longer reaches the apex.  In addition, the mitral valve which serves the left ventricle is also small.  This means that Jellybean has hypoplastic left heart syndrome.  In addition, he only has one great artery.  There should be 2--the aorta and the pulmonary artery.  He appears to have an aorta, given its shape, but it looks like it's attached to the right ventricle, which is where a pulmonary artery would be.  Thus, they aren't quite certain which one he has.  It could also still be truncus arteriosus, but that diagnosis requires certain features they aren't certain he has.

Ultimately, the result is the same for either diagnosis.  He needs a series of three surgeries, the first of which occurs at 7 to 10 days.  The second surgery generally occurs at 6-9 months, although it can be done as early as 3 months if necessary, or as late as 12 months if everything is going well.  The third surgery is done anywhere from 18 months to 3 years depending on how the child is doing.

Mortality is highest between the first and second surgery.  75 percent of children who get through all three surgeries survive.  15 percent of those who survive go on to have serious complications.  They have only been doing this for roughly 30 years, so they have no idea about long-term survival.  They can say that they have lots of patients in their 30s, which is good news.  The cardiologist indicated that she has some patients who have had these procedures done who are competing in college-level athletics, so there can be some degree of normalcy.  There's no way to say up front which category Jellybean will fall into.  We'll just have to wait and see.

So, what does all of this mean for us?  Well, Jellybean will need to have an ultrasound and be placed on prostaglandins and an IV shortly after birth, so they want me to deliver in Detroit.  We are in the process of scheduling an appointment with an OB recommended by the cardiologist.  However, the more problematic issue is that they want me to have a spontaneous, vaginal delivery as close to 40 weeks as possible.  Because the surgery will require him to be on by-pass, they need his lungs in the best condition they can be, which means letting him cook as long as possible.  In addition, because vaginal delivery helps squeeze fluid from the lungs better, they don't want a c-section.  At the same time, they don't want him in there too long, so induction may be necessary if we go too far past 40 weeks.  Ideally, I would be somewhere closer than 2 hours away from Detroit when I went into labor.  As of yet, we haven't quite figured out how to make this happen.

Assuming delivery goes as needed, he will be in the NICU at the women's hospital for roughly 4 days before being transferred to the NICU at the children's hospital where they will then ultimately do surgery #1.  We don't yet know how long to expect him to be in the hospital post-surgery, but upon discharge, we can expect to go to the doctor weekly until surgery #2.  We are hoping we will be able to see the local cardiologist for these visits and not have weekly trips to Detroit, but we don't yet know about this.  We also don't know if/when Jellybean is allowed to go to daycare, which makes my ability to return to work a huge issue.

We are continuing down what appears to be an extremely long and stressful road, with no real end in sight.  We certainly have our work cut out for us figuring out the logistics of how to make all of this work in the best way possible.  Sadly, this diagnosis means we will not be going anywhere for Thanksgiving, Christmas, or New Year's and it means we can't have the celebration come to us because too many visitors would place Jellybean at increased risk of infection.  Given the likely timing of the second surgery, we also likely won't be able to attend family reunions and our favorite gaming convention next summer.

When we moved forward with having a second child, it never occurred to me that he might require more medical care than Lil' Bit.  But, it is what it is.  All we can do now is research, plan, and prepare as best we are able and know that things will work out, even if it seems like a huge mystery at this point.

A Not Entirely Unexpected Complication

Today we went in for a fetal echocardiogram to check out Jellybean's heart.  Turns out it was a good thing we did.  Looks like he (it's a boy!) has some issues, including a VSD.  What the doc saw could be any number of things, so we don't have an official diagnosis.  Instead, I have to go to Detroit for more tests sometime in the next few weeks.  They will get more and better pictures (not sure how), and come up with an official diagnosis.  The doc today did say that she thinks Jellybean will need surgery shortly after birth--not with hours, but within the first week.  Because of that, she thought it might be better for me to birth at the Detroit hospital.  Obviously, we have lots more testing and follow-up before we reach this point, but this adds way more degrees of difficulty to the delivery.  On the plus side, she didn't think it was anything that would require early delivery or a C-section.  That is, she thinks Jellybean can tolerate labor and delivery.  So, that's good news.

The doc today is contacting Lil' Bit's pediatric cardiologist, in part because that's who Jellybean will see after birth, but also because Dr. S is affiliated with Detroit.  The doc today is affiliated with UofM, but we are more comfortable dealing with Detroit since we already know the folks there.  Dr. S is going to work on the fetal referral process to get me on the schedule for the additional testing.  As we go along, I will likely have OB visits with my regular OB, my high-risk OB, and a new OB in Detroit so I will be familiar with them before delivery.

All of this news is frightening, frustrating, and overwhelming.  However, I have some small semblance of calm in that I know how some of this works because of Lil Bit's surgery.  This time, we know the surgeons, we know the hospital, we know the area, etc.  We also have the benefit of knowing early, rather than finding out 6 months in, so we can prepare (Read--plan!!!  Always look on the brightside, right?)  Still, I had been hoping and praying the Jellybean would be "normal."  Instead, it looks like he is already trying to outdo his sister.  This sibling rivalry thing sure starts early!

So, to sum up:  We know there's something wrong, but we're not sure what.  We should find out soon, but we don't know when.  There will be lots of planning required, but nothing I can do yet.  And I'm not supposed to stress.  Yeah.  Good luck with that.

The Unplanned Plan

I began my shots for this latest FET attempt on January 18.  I wasn't sure what to expect since I have had varied responses to the Lupron.  Fortunately, this time around, Mutant M returned.  Outside of the fact that I still suck at giving myself shots, even after all of this practice, I have had no reactions or responses to the meds.  Yay!

I have been doing my best not to plan and let things fall as they will this time around.  Today, I had my blood drawn for my estrogen levels to make sure my system is adequately suppressed.  The magic number was below 50, and I was at 30.  The nurse noted that last time I was at 29, and commented that I appear to have a pretty consistent response to the medication.  Anyway, because the blood work was good, we set about scheduling the FET.  Dear readers, I wasn't sure whether to laugh or cry.  My FET is scheduled for Valentine's Day.  The day after Ash Wednesday, when Phil's (other) busy season officially begins.  The day one year ago when we were excited because our first beta had come back positive.  I rather expect that, even without being hopped up on hormones, I would have been pretty emotional that day.  Now, it's pretty much guaranteed.  And, with the whole Lenten element this time, there will be plenty of stress to try and avoid.  Still, I can feel the excitement growing; the hope building.  Third time's the charm, right?!  I have been trying to keep my feelings in check, knowing that there are no guarantees.  It doesn't matter.  I am who I am, and I am a person who hopes and dreams big, even if it means my feelings get horribly dashed when things go wrong.

We do have one last, rather important, decision to make, though.  Two or three.  The doctor has recommended we transfer three embryos given my history and age, and I have researched the recommended protocols and confirmed that three is perfectly appropriate under these circumstances.  And, since it increases the odds of success, it increases the odds that I don't ever have to do this again.  So, for many reasons, three is the way to go.  But, it takes us back to the big question--could we handle multiples if they all stuck around?  The answer is, technically, yes.  We have the ability and capacity to do it.  Nevertheless, it would be extremely challenging.  Certainly, I am less afraid that I would actually end up with triplets now that I have had a completely failed cycle and knowing that, each time we go back, the embryos we are using are considered of lower grade than the ones previously.  Still the idea of triplets scares me.  Enough to stick with two?  I'm not sure yet, but we have to decide soon; probably within the next 12 days so that the center knows how many to thaw.

Even so, the news is good and exciting.  I start taking the hormones tonight.  We are underway.  The 18-day countdown has begun!  And so, I leave you with my hope, my wish, and my sense of humor.  Because, you see, I have figured out what I am giving up for Lent this year.  I am giving up not being pregnant.

A Message From Elmo

As Phil and I sat with our grief and sadness and worked through our decision not to try again, we realized that we had been somewhat naive to think that we could make the decision ahead of time.  There is simply no way to make a decision of this magnitude beforehand.  In thinking about it, I realized that I had made at least two errors in my calculation.

1) In the back of my mind, I was certain it was going to work, so making the "we get what we get and we don't pitch a fit" agreement was easy because I assumed I would get what I wanted;

2) To the extent that I knew that it might not work, making the decision ahead of time was going to keep me from feeling grief (Ha!).  I wouldn't have to sift through the grief to figure out where I was--I had already done it ahead of time.

We talked back and forth and finally reached a point where we were both in agreement that we were willing to reconsider our decision.  We might still stick with it, but we could change our minds.  In this vein, we went to doctor's appointments with both the fertility doctor and my obgyn to get all of the facts on moving forward and stopping.  Then, we sat down to digest the information.  This was exceedingly hard for me.  At one point, I realized I didn't really care which decision we made, we just needed to make one so I could move forward.  Of course, this is a bad way to make a decision, but I am someone who loves certainty and planning and making a decision was the only way to get that--or at least the illusion of that.  See, our decision comes down to "no" and "maybe."  There is no "yes" option.  I hate that, but my hate doesn't change the fact that those are my only options.  I came to the conclusion that I wasn't ready to give up.  Yes, I hate the roller coaster.  Yes, I hate the uncertainty.  But, I truly believe I am meant to have another child and the only way to achieve that is to try again.

As I was coming to terms with whether I was willing to change my mind, Phil and I became aware of some hints we were receiving.  They weren't necessarily the universe telling us what to do, but the fact that they made us wonder meant that we had more thinking to do.  The two biggest of these gentle nudges came in the form of a television show and some laundry.

The evening after we met with the fertility doctor to talk about what another round would entail versus what was necessary to donate the remaining embryos, we were watching Elmo with Lil' Bit.  Sesame Street has started a new line of Elmo shows called "Elmo the Musical."  This particular episode--a new one--was called Circus the Musical.  In it, Elmo is "a monster with a dream."  He keeps trying to find a way to join the circus, but is thwarted by his inability to fill in for any of the missing acts.  He ends up having a discussion with a chicken, who tell him he needs to do what she does, "Just keep cluckin'."  Essentially, try and try until you achieve your dream.  Phil looks over at me and says, "Did Elmo just tell us to try again?!"  We laughed it off, but it did make both of us think.

Then, today, Oliver's original due date, we were scheduled to meet with my obgyn.  Phil picked me up and, on the way to her office, he told me a story.  He had recently gotten in the habit of washing his clothes and leaving various pins attached to this shirts.  One particular pin was a comma--a symbol in the United Church of Christ of the quote by Gracie Allen which it has adopted as it's own motto: Never place a period where God has placed a comma.  Phil began to wonder if, by stopping, we were placing a period where God had placed a comma.  I made a really bad joke about us placing a period after God had placed a "period," but it made us think more about it.

After the doctor visit, we went out to lunch to process.  We both reached the same place, but we kept tiptoeing around it in case the other one wasn't there.  We didn't want to impinge on the decision-making process of the other.  Ultimately, we both agreed that we felt led to try again.  We made no decisions about what would happen after another attempt.  Those decisions would have to wait until then.  We could only decide what we were going to do right now, and we both felt that we needed to try.

Now, you can probabaly guess that, once we had made a decision, I was ready to charge down the path.  But, I didn't.  I am reining myself in on the planning.  Why?  Because I ignored this nagging feeling I had last time that the timing was off.  I had planned it and this was perfect timing, my gut be damned.  So, this time, I want to go with the flow.  I want us to take our time and figure out how we'll finance another round.  I want us to wait and call when we're ready and see when the next available cycle is.  Now, once I have a month, I will calculate everything within an inch of its life as I always do.  But, until that point, I want to allow for more flexibility in recognition of the fact that God's time isn't necessarily my time.

So, to sum up this really long post in a few sentences--we're trying again, but we don't know when.  We are extremely grateful for all the love, support, and prayers we have received since all this began and hope you'll be so kind as to share it with us again as we make our way back to the amusement park for another ride on the roller coaster.

Marching Orders

[This post is going to look very similar to the one from January, because the protocol is identical.  We're mostly just changing the dates around.  Still, a plan is a plan.  So, here it is.]

This morning I had my blood drawn to check my estrodiol (estrogen) levels.  It needed to be under 50 and mine was 29.  Yay!  You might notice a discrepancy between the necessary levels for this test, and the one I talked about in January.  The difference is that the test can be run on cycle day (CD) 1, 2 or 3.  This time, I had the blood drawn on CD 1, whereas last time it was on CD 2.  The levels should necessarily be lower on CD 2, than CD 1.  Hence, the difference in the level I needed.

I contacted the fertility center and left the pertinent information in a message.  The coordinator called me back and we began calculating when my procedure would be.  We then counted back 18 days from that date to determine when I start my additional meds.  Why do it this way?  Because they only do FETs on Tuesday through Friday (because they have to thaw the embryos and give them time to grow and don't want people to have to come in on the weekend to do it).  So, they don't want people to begin taking meds on a day when their procedure would fall on a Monday or a weekend.  Go figure.  Anyway, we determined that the earliest I could start the meds was tomorrow, but then day 18 would fall on a Monday (the 17th), which is a no go.  The 18th was out because Phil had something on his calendar.  I didn't want Friday the 21st, because I need two days of bedrest (transfer day and the next day), which meant I needed two weekdays so  that Lil' Bit would be in daycare.  That left the 19th and 20th--exactly what I predicted back in June.  Am I good or what?  As I noted in that June post, this transfer date makes for a June baby--roughly June 13th, give or take how they calculate the age of the embryo and everything.

But, what this means for me more immediately is that I have only 18 shots left!  Woo Hoo!  *happy dance*  For those looking for technical details, the protocol is as follows:

• I cut my Lupron dose in half beginning tonight.
• On 9/3, I begin taking estrogen, with the dose increasing on days 6 and 10.
• On day 11 (9/13), I will have an ultrasound to make sure everything is developing appropriately for the transfer.
• Assuming everything is on track, I continue the Lupron and estrogen for 4 more days (including 9/13).
• On day 15 (9/17), I stop the Lupron, reduce the estrogen, and start progesterone.
• On day 16, I start taking antibiotics and steroids in addition to everything else.
• Day 18 = Transfer Day! Followed by the dreaded two-week wait (TWW).

The excitement is building.  We are only 3 weeks away from transfer!  Can you feel that?  It's the roller coaster slowing down as we near the top of the first hill.  Fellow travelers, get ready to raise your hands up over your head, scream as loud as you can, and enjoy the ride.

Lessons from GenCon

We recently returned from a week-long visit to Indianapolis, where we saw family and attended GenCon. We had previously attended before Lil' Bit, but didn't make 2010 or 2011, so it was wonderful to finally make it back and visit with people we hadn't seen in a few years.  And, so, having completed another excursion away from home, it's time for another edition of lessons from....

1)  Attending conventions requires lots more pre-planning with a toddler.  For one, we had to make sure we didn't schedule events at the same time so that the other parent was available to watch Lil' Bit.  We also had to stay at a hotel for the first time (we used to stay with family about 30 mins away), because of Lil' Bit's medication and nap needs.  It worked out fabulously and we will definitely do it that way again in the future.

2)  It's hard to allow your toddler moments of independence when you are surrounded by roughly 41,000 other people.  Lil' Bit often wanted to run free or help push the stroller, rather than ride in it.  When it seemed less busy, I was more than happy to let her.  I would try and steer her, the stroller, or both, away from people, and we did manage to not hit anyone.  But, there were times when she wanted down and it just wasn't safe.  Yes, it made her mad, and I apologize to those who had to listen to my toddler throw a screaming fit because I wouldn't let her run around, but I'd rather piss people off with her screaming than lose her in a sea of thousands of strangers.

3)  No more late evenings.  Holy cow!  We only stayed out late one night, and it was the night before we left, and even that was rough.  That 4:45 wake-up for meds comes no matter what.

4)  If your toddler has to get sick, the morning you are trying to pack and leave is both the most and least convenient time.  Since you are trying to pack and get out of the room without incurring an addition charge, having to stop and snuggle your barfing child and change her clothes four times, etc. isn't the most stress-free environment.  Plus, you wonder if she's going to barf on the trip home.  However, you don't care if she barfs all over the sheets because it is not your bed, you don't have to clean it up, and you aren't even coming back that night.  So, grab every clean towel you need.  No worries.

5)  Don't overschedule yourself.  I had given myself two short periods throughout the con to go through the dealer's hall and look for crap, I mean stuff, to buy.  However, when Lil' Bit started to have a meltdown from being tired and around lots of people and noise, the only solution was to take her back to the room and *poof* there went my time to poke around.  So, next time, I will make sure to schedule myself more free time to do that without Lil' Bit.

6)  Lil' Bit is still the best thing ever.  I have to say, there is simply nothing like the feeling of coming out of a seminar or game, looking over to see your spouse and child playing together waiting for you, and then, witnessing the moment when your child looks up and sees you and grins bigger than her face, and starts running toward you.  Honestly, it never gets old and it makes up for the crabbiest tantrum.  In our house, we call it a "heal your heart" moment.

7)  Family naps are amazing.  Every morning we got up at the crack of dawn (read 4:00 a.m. or so) to do meds and played with Lil' Bit until 6:00 a.m., when we would head down to the restaurant for our free buffet breakfast.  We'd end up back at the room shortly before 7:00 a.m. and usually, by 7:15 a.m. doodlebug was ready for, or already taking, a nap.  Holding her in my lap, rocking her to sleep, placing her in the middle of the bed, and each of us taking a snooze on either side of her was not only refreshing for the sleep, but the whole rocking, snuggling, napping thing was another "heal the heart" moment.

8)  Lil' Bit isn't little.  And I don't mean just your normal, she's not my baby anymore.  No.  I mean, when people hear how old she is, they are impressed by her size.  For example, there I was, standing in line with Phil and Lil' Bit, waiting to get Wil Wheaton's autograph and trying not make a complete and utter fool of myself.  Our turn arrives.  We walk up and begin to make small talk.  "How old is she?" he asks.  "21 months," I reply.  "Wow!  She's the HUGEST toddler I have ever seen!" he replies as his eyes bug out of his head.  Yes, Wil Wheaton thinks my toddler is gargantuan.  I thought it was totally hilarious and, in all fairness, at 35 inches she is in the 90th percentile for height.  Still, I can't help but wonder what he would have thought if we had explained she was that big *and* had a heart condition and open-heart surgery.  How much bigger might she have become?

9)  Lil' Bit loves her clothes.  I bought her a GenCon shirt, although it's more like a dress since they didn't have anything smaller than a 4/5.  But, when she saw me put on my shirt, she began throwing a fit because she thought I was wearing hers.  I had to take hers out and put it on her for her to understand there was more than one.  She did it again when Phil wore his.  I think she wore the shirt 3 days in a row before we were able to get it off of her.

All in all, GenCon was amazing.  Although it was my most tiring one, it was also my favorite since I started attending.  I can't wait to take Lil' Bit back next year.

Already?!

As you know, we decided to do one last round of IVF in September.  As it's still June (although just barely), September seems so very far away.  Summer just started; September means school.  That's forever away.  Now, I would be lying to say I haven't been thinking about our last time--it consumes much of my free thought--whenever I actually have some, and I keep getting frustrated that I have to wait so long.  But, this week brought me back to the now.  Because, you see, I had forgotten something.  Something that is both exciting and terrifying.  In the world of IVF, it's already time to start gearing up!  Ack!  I'm not ready!

I spoke to one of the IVF coordinators this week about getting the meds ordered and they will be sending me my folder and consent forms within the next week or so.  We're doing the long protocol again, so in roughly one month, at the end of July, we start the process.  Granted, the first 21 days are more waiting, but we have to actively and accurately count those 21 days.  On day 21 (roughly August 18), the shots start again.  Holy cow!  I am less than 2 months away from starting shots!  And I haven't even thought about what to put in my feel better bucket this time!  Breathe.  *gasp*  Breathe.  *gasp*  BREATHE! *pant pant* Okay.  I'm okay.

Ten to fourteen days later (last time it was 12), we start the additional meds and begin what they call "procedure month," i.e. the 18-day countdown to transfer.  Since they only do transfers Tuesday through Friday, we'll make sure that day 18 falls on one of those days before we start.  That means we're looking at a transfer maybe September 14, but more likely September 19, 20, or 21.  All of which means a June baby. June.  It's June now!  If we're successful, in less than a year I will have another child!

All of this is so crazy to contemplate.  I am so excited (you can tell by the fact that I got to plan out all those numbers up there)!  I'm also terrified.  Although I am still absolutely certain that this will be our last round, it's bittersweet.  It means we've reached the end of our journey in creating our family.  All of the time, energy, and resources we have been utilizing to make decisions and plans and take care of all the medical stuff necessary to make it happen will be over.  No more shots.  No more calendars.  No more agonizing decisions.  I can have my surgery and we can work on settling in as a family of whatever size--3, 4, 5(?!).  And whether that event occurs October with an unsuccessful try, sometime thereafter with a pregnancy loss, or next June with another baby, it's going to happen within the next year.  It means change.  It means loss.  It means growth.  It means time is moving on.

I know everyone always said that time moves so much faster as you get older and even more so once you have kids.  I am discovering how true that really is.   So, as I kick myself into overdrive, trying to lose that last bit of weight, planning things for my feel better bucket, and getting myself physically and mentally prepared, I want to also take a few extra minutes each day with Lil' Bit and enjoy her just as she is.  Be amazed at who she is becoming.  Because whether she's an only child or a big sister, change is coming, and it will be here soon.  In fact, it's almost already here.

Frustrated Expectations and Tough Choices

So today we took Lil' Bit to the cardiologist for another echocardiogram.  Although her pressures were slightly elevated from earlier, it was generally the same--in December Dr. S got 42 and Dr. R got 48 and today Dr. S got 49.  Still better than the 60s she was at, but 20 is normal.  So, what does that mean?  I asked what purpose the meds served if the pressures weren't going down.  The answer was that they may be what's keeping her pressures at the level they are currently at.  So, instead of her having a heart cath this November and getting weaned off her meds, she's going to get a full-sedation echo this December and a heart cath next November when she's three.  That means we have to keep medicating her 6 times a day for at least the next 18 months.

The difficulty is that it's extremely hard to do anything when your child needs meds at 5, 6, 10, 2, 5 and 6, and it's extremely hard to find babysitters who you trust to medicate your child properly and timely.  It makes scheduling trips and just figuring out how to get in nap time and meal times really difficult.  Although we still plan to make our scheduled trips this year, it's going to take a lot more planning.

Don't get me wrong.  The fact that her pressures haven't increased is great news, and I'm lucky that there are meds that keep her healthy.  I just had thought the light at the end of the tunnel was this November and now it's been pushed out a year, with no guarantee that that's the end either.

And so, as I drove home today from the doctor's office, I asked myself several questions to which there are no easy answers.  We had attempted to schedule my pregnancy with Oliver so that I would be due after everything was done with Lil' Bit.  Now that the end won't come until almost 2014--if at all--are we willing to try having another child in the midst of all this craziness?  Can I take the risk of having another child knowing that, at least currently, I lack the capacity to cope if the next one also has medical issues?  How long do I have the patience and ability to wait while we try and figure out the answer to these questions?  The longer we wait, the older I get; the more we pay for embryo storage fees; the longer we make our child-raising years; and the longer we delay my hysterectomy.

I know that I don't have to (and shouldn't) make any decisions today.  But if I had to, I would say that I've hit my squeal point.  I think Lil' Bit will have to be enough.  I just don't have it in me right now to cope with pregnancy and Lil' Bit's meds and the lack of a guarantee on the health of any subsequent baby.  And that makes me even more sad.  Because I feel like I've lost everything all over again.  I am overwhelmed.  I am tired.  I feel like a complete failure.  I feel like I just can't catch a break and the world is dumping on me and I don't know why.  It sucks.  And all I can do, is just keep going.  Because really, at some point, I have to reach a tomorrow that is better.  I just hope it's sooner rather than later.

Lightning Does Strike Twice

It's official--we're pregnant again!  Both betas are back and the news is all good.  Today was rough, though.  I had my blood test at 7:00 a.m.  Monday's results had come to me at 9:00 a.m., so I expected something similar today.  No dice.  I still had no call by 12:30 p.m.  I had just about decided I would call them around 2:00 p.m. when Phil called me to tell me there was a message on the phone at home to call them (they had never called me at that number before).  Well, they are closed from 12 to 1 for lunch, but I called and left a message anyway and said to call my cell.  Sometime around 1:15, I guess, I got the call.

Monday's beta was 68, so the magic number we *thought* we were looking for today was 136.  We got 119.  My initial thought was to totally freak out, but before I did, I managed to notice that the lady at the other end was still talking in a happy voice.  So, I managed to push down most of my fear and listen.  Apparently, they look for the number to "roughly" double, because the doubling time is 48 to 72 hours.  Because the beta tests were only 48 hours apart, 80% of the way to doubling is well within that range.  Yay!  I double-checked with the nurse that it didn't need to be higher and she assured me the numbers were fine.  However, she offered to order another test in two days if we wanted, but I told her I was willing to take her word for it.  [She has no idea how big a step that is for me!]  I texted Phil right away so he could put the news out, and I posted a picture of Lil' Bit in her new "I'm the big sister" shirt.  [We actually let her wear it to daycare today we were feeling so good about the news from Monday.]

The plan from here (because you must know by now that there will be a plan and I will share it) is that we have our ultrasound scheduled for March 1--which will be just over 6 weeks pregnant if I calculated correctly--at which point they can tell us if we're having twins.  My guess is no, particularly in light of my numbers, but you never know.  So, any betting folks out there?  Boy?  Girl?  Both?  A pair and a spare?  Before you ask, I have no preferences boy or girl, but my guess is that it's a boy.  I would prefer just one, but I will take what I get and be thrilled to bits.  For now, I'm just basking in the glow and totally amazed that we managed to have successful IVF cycles on the first try both times.  I am dumbfounded, but also truly blessed and grateful.

We Have a Plan

And there was much rejoicing (at least, by the piece of me that needs/yearns/longs to plan)!

I had my blood drawn this morning.  They were checking my estradiol (estrogen) level.  It needed to be under 25 and, as an overachiever, mine was 12.  I dutifully called the fertility center and left a message with the coordinator with all of the pertinent information.  She called me back and said I could start my additional meds today!  This is good news because it means:

• we're underway.  Always exciting!  
• I am, with minimal give or take, 17 days away from transfer day!  OMG!  That is freakishly soon!
• FEWER SHOTS!  Again, with minimal give or take, I now have only 14 shots left.  Can I get a "Woo Hoo"?!  That is like passing "Go" and collecting $200.  

Okay, now for the plus or minus caveats.  I am scheduled for an ultrasound on the 26th, at which point they will determine whether my lining is sufficient.  If not, they could push things out a little further, which would involve additional shots.  However, according to the doctor, it is unusual for things not to be spot on.  So, although there's a chance for a few additional shots and some pushback in the schedule, we're looking at a February 2 procedure.  As the person always thinking ahead, my first thought (and I'm sure your's too) was:  "What would this mean in terms of due date?"  I frantically scoured Google for the answer because, well, it's me.  It's what I do.  This really should shock none of you by now.  Anyway, the answer is, roughly October 22.  I say "roughly" not just because due dates are always estimates, but because I don't know exactly how the due date is calculated for an FET and the on-line FET calculators ask whether it's a 3-day or 5-day FET.  I *think* it will be considered a 3-day, but I don't know and, honestly, it isn't going to make that big a difference.  *Gasp*  Did I just say that?  Yes, I did.  Who am I?!  Well, likely, I'm still me because the truth of the matter is, they will tell me my "official" due date when the time comes, so this rough guesstimate is fine for now.

Finally, for those interested in the technical details:

• Today I started taking estradiol pills and tonight I will cut my Lupron (the shot) dosage in half.  
• The Lupron will stay the same, but the estradiol will increase on days 6 and 10.  
• On day 11, I have an ultrasound (the 26th for those paying attention from earlier).  
• If everything is fine, I continue the estradiol and Lupron 4 more days  (including the 26th, so through the 29th).
• On the 30th (day 15) drop Lupron altogether (NO MORE SHOTS), cut back on estradiol, and begin progesterone supplements.
• Day 18 (Feb 2)--Transfer day!

Now comes the hard part.  Now that we have a plan in place, I have to acknowledge I'm not in control!!  Gah!  Memo to me--plan does not equal control.  *Sigh*  At least I can maintain a semblance of control by making sure all my meds are timely.  Right?  Who's with me?  *crickets*  Fine.  But hey, we're on our way.  And not even my lack of control and burst that bubble today!  Woo Hoo!  

The Spanish Inquisition

[The following is a post that was started while in the hospital with Lil' Bit back in November.]

During my youth, I was quite enamored with Monty Python.  One of their signature bits is "The Spanish Inquisition," the tagline of which is, "Nobody expects the Spanish Inquisition."  I have always thought of it as a funny way to remember that although you can anticipate the unexpected, you are never really prepared for it.  And so it was, in the midst of all of the craziness going on in the hospital as we awaited our escape--I mean discharge--I received the opportunity to re-learn that, no matter how hard you try, you simply cannot plan for everything.

When we got ready to go to the hospital for Lil' Bit's surgery, I knew I would forget things.  I did my best to think of everything I could:  toys that were easy to clean for when she tossed them on the floor; multiple toys so we could introduce a new one each day to postpone boredom; blankets from home to comfort her; clothes for her return home; her favorite puffs, both for eating and distraction purposes.  And, all told, I did a great job--particularly considering that the stay doubled its original expected length and almost tripled.

What I forgot, however, is that she's a baby.  I was busy planning for everything related to surgery and recovery and everything that was different about this event.  What I forgot was the normal stuff.  And so it was, after several days of lots of fussiness, spitting up lots of mucus, and numerous other problems we hadn't expected, that we discovered that Lil' Bit was teething.  That's right teething.  Right in the middle of trying to figure out all this other crap, she went ahead and did what kids normally do around this time and began to sprout more teeth.  Did I think to bring any teethers?  Any orajel?  Heck no.  Teething was nowhere on my radar.  Teething, it turns out, is the Spanish Inquisition.  Who knew?

Once More Into the Breach

When we last left our intrepid parents, they were traveling home from family visits with a tired, precocious 13-month-old, trying to recover from a rather eventful trip while discerning whether they were crazy enough to have additional children....

Before we get back to that part of the story, I have to confess that I there is a rather large piece of the equation regarding our decision to have additional children that I haven't shared, but is a driving force behind my feelings of urgency.  That is, once we're done having children, I'm having a hysterectomy.  My body and I have never really gotten along in this regard.  Whether it was ruptured ovarian cysts, extremely severe Mittelschmerz, endometriosis, or excessively long and heavy periods, I have always felt at war with myself.  My cycles started when I was 9 and I was on birth control by age 16 to regulate my body and stop the cysts.  However, you (generally) can't be on birth control and have kids.  So, those years we were trying to have kids, without success, were particularly difficult for me because I was experiencing horrible physical pain in addition to the crushing sensation of failure each month.

Once we got pregnant with Lil' Bit, I had a reprieve that lasted almost 6 months postpartum, but it all came back with a vengeance.  There had been a chance that my system would regulate itself and some of the issues would be gone.  Sadly, it was not to be and each month I wait for the pain to begin all over again.  Every month that we postponed having another child was another month of agony for me.  I wasn't ready to say "no," however, because I knew that once we made that decision, it would foreclose the possibility for good.  And so I struggled.  I wanted to make sure we made the best decision we could for our family, but I desperately wanted to stop the pain which meant either having kids now, or foreclosing the possibility for good.

So, with that additional background, we find ourselves again in the middle of yet another discussion regarding additional children.  Only, it went nothing like I expected.  Today was our "drop dead" date for a February procedure because I would have to start shots tomorrow.  With that in mind, as we were driving home on Monday, I asked Phil whether he would prefer if we just skipped February.  In my mind, I was offering him more time to consider our options, the same way I had when I asked if he wanted to postpone the cycle from a January procedure.  So, imagine my surprise when the first words out of his mouth were, "I think I'm okay with February."  After I recovered from the mental whiplash I suffered upon processing his answer, I said something to the effect of, "Me, too."  Although I certainly had not been expecting that answer, I knew it was what I wanted, so I was going to take him at his word and get the ball rolling.

Still, I wondered how had we gotten here?  Only days before, we had both been leaning heavily toward not.  I can't speak for Phil, but I know what changed for me.  Mainly, I discovered that some part of my brain had been miscalculating the equation.  In the midst of all the frustrating and stressful parts of parenting, some piece of me got the idea that the difference between 2 kids and 1 was the same as between 1 and 0.  It isn't.  Once you have the first, stress and frustration are a given.  Not having a second child was not going to make my life stress-free.  Lil' Bit would still get on my nerves and warm my heart and do all of the things she does now, regardless of whether we had additional children.  Once my mind finally accepted that life was going to be stressful no matter which way we went, I was freed up to say "yes."

I also realized that one of the reasons I would like another child is the chance to pay better attention.  When Lil' Bit came along, we had no idea what we were doing as parents.  Everything was new and I was exhausted and overwhelmed.  Now, I fully expect that there will be periods where I am exhausted and overwhelmed if there are additional children in our future.  But, I get the chance to pay attention; to watch the baby grow and learn.  To love the newborn when all it is is a lump that needs so much love and attention.  I have spoken to or read accounts from many families where parents take great joy in the third or fourth child because they know it will be their last and so they savor every moment.  I want to do that.  I want to savor the moments because, chances are, this will be it.  And, I want to watch both Lil' Bit and the possible future children grow into fully-functioning adults.  I want to see who they become and watch how that happens.  I want to see how they are different and how they are the same.  I want to see them interact as siblings.  I can honestly say that I want to have additional children for those children.

In addition, I realized that the 1-year follow-up visits for Lil' Bit aren't set in stone.  Medicine is flexible.  If and when we get pregnant and have a due date, we can alert the doctors and make sure the visits occur either prior to my due date, or get any number of friends to help us out if we have a newborn or two to deal with.  Either way, we can manage it.  I have every faith in my ability to schedule and plan that we can make it work.

Suddenly, *poof*, like magic, all of the problems didn't seem like problems anymore.  And the decision felt right.  Unlike the overwhelming sensation of drowning I had when we were looking at a January procedure, I have mostly a sense of calm about a February procedure.  (I say mostly because I must admit to being slightly anxious about starting shots again tomorrow).

So, there you have it.  The long of it (because there really is no short here), is that we have decided to go ahead with a frozen cycle--starting tomorrow!--resulting in an early February procedure and the potential for an Oct/Nov baby.  Let's see what happens, shall we?

Assumptions

I have started several posts about our time at the hospital for Lil' Bit's surgery, and may or may not get around to finishing and posting them.  For now, we'll talk about today.  Today was to be our triumphant return.  Discharge day.  And it was.  Sort of.  We are all home and, although totally exhausted, we are doing fairly well.  But I relearned a few lessons today. 

First, I relearned not to make assumptions.  This lesson came upon the discovery that I had, in fact, made a giant assumption.  I did not realize I had, but I did.  I had assumed that surgery would "fix" my child.  Sure, it would be difficult and emotionally taxing and recovery would be hard.  But, in the end, surgery would either fix my child, or it wouldn't.  I never considered what would be involved during the waiting to find out period.  You know, the period where you get to bring them home, but you still have to give them meds.  That's right meds.  It never occurred to me that when I brought my child home she would be on medication, let alone three different meds multiple times per day.  Oh, and did I mention that they all tend to make her vomit?  We have learned a few tricks and most of the time they work.  But today we had 5 administrations for 3 doses, and lots of "clean up on isle mommy."  I hate holding my screaming child and trying to get her to take medication I know she needs.  I really hate having to do it 6 times per day.  I'm freaked out that I will have to start doing it 8 times a day once the third med finally arrives.  Yeah.  About that third med.  It's one of those black box medicines that I will need gloves to handle because I've signed up for another round of IVF and we will have to use separate syringes and pill crushers for.  *sigh*

As I sat on the floor, trying to be calm (but probably failing miserably) during the last medicine administration, I got angry and couldn't quite figure out why.  Until, thud, it finally hit me that I had made this giant assumption that once we brought her home, even if she wasn't fixed, we would be done for now.  I don't know why I never considered ongoing treatment such as meds, I just didn't.  And, quite honestly, I'm just thrilled that she didn't have to come home with an NG tube (and even more thrilled that I didn't have to be trained how to put one in and take one out)! 

This leads me to my second assumption.  I assumed that I was prepared to have her home.  I expected the return home to be a great relief.  Instead, I felt the same panic as last year when I brought home a newborn and wondered what the heck I was supposed to do with her.  The panic is the same, but the specifics are different:  What happens if she still won't drink whole milk or Pediasure?  (This issue is the subject of a post in progress about poor planning on my part).  What happens when she vomits up the meds at home?  How do we get her to take them when all the tricks we learned failed?  How long after taking the meds does vomiting count as not having gotten the dose?  (Apparently, the answer to this for our purposes is 20 minutes).

All of these are difficult things to handle by themselves.  Doing them on little sleep, after a long day of travel, with nerves and emotions still raw from 2 1/2 weeks of adrenaline and anxiety, is damn near impossible.  And yet, we managed to get her meds in her, give her a bath, and get her to bed.  We have overnight meds we have to set an alarm for and lots of other challenges ahead of us.  We're creating a chart so we can track and make sure we have given her all her meds-- a necessity, since we're lucky to remember our own names these days. 

But we're home.  And she's doing amazing.  And we're taking things one day at a time.  Which is, in fact, the only way anything can be done.  We live life, whatever challenges, joys, successes, and sorrows come our way, the only way we can.  One day at a time.  One minute at a time.  One moment at a time.  Sometimes, though, it takes a giant 2x4 upside the head to remember that lesson.  And man, do I have quite a headache.

Doing the Job

Last week, Lil' Bit got sick.  We took her to the doctor who said she had (yet another) ear infection.  He put her on antibiotics and we raced against the clock to get her better because if she's sick within 2 weeks of her surgery, they could move or cancel it.  We took her back in to her doctor today, and he gave us the all clear.  Phew!  I breathed a sigh of relief that we didn't have to rearrange all the plans we had made, but put in a call to the surgeon to let him know what was going on.  I spoke with one of the nurses and she assured me everything was fine and they would just make sure to give her a good once-over when she came in for the pre-op testing.  All was copacetic.  Sure, Phil and I got put on antibiotics (because we got whatever Lil' Bit had), but otherwise, everything was fine.  Or so I thought.

Part way through my day of napping and recovery, I discovered that I was super hungry and my stomach was upset.  I found this odd, particularly since it was last week that I was on the steroids that generally cause increased appetite.  But no.  The hunger came today. Not helpful.  Why?  Because I started Weight Watchers about 2 1/2 weeks ago.  It's been going very well; I've already released 10 pounds.  (In my family, we try not to say that we "lost" them, because generally you try and find things you have lost).  Anyway, I was surprised to discover that I had nom, nom, nommed my way through my points for the day by 2:30!  What the heck was going on?! And what about dinner?!

It took me a while to realize that the hunger and the upset stomach were my body's way of telling me my stress level is out of control.  I didn't think I was stressed.  After all, I spent the day recuperating and being told all my plans were still in good order.  It wasn't until dinner that I finally figured it out.  I was washing dishes while Phil fed Lil' Bit her dinner.  She was doing really well, but had some fussy moments.  And in those fussy moments, I knew I was "done."  "Done" is a magic word in our house.  It means that it is time for the other parent to come to the rescue because whoever is "done" has run out of energy/patience reserves.  The thing was, I wasn't the parent on duty.  Phil was taking care of Lil' Bit.  Why was her fussiness driving me crazy to the point I was "done"?  It hit me.  I was done because I had run out of minutiae to worry about and plan.  There's nothing left to do but wait.  In calling the surgeon's office, I had to acknowledge that Lil' Bit's surgery is less than 2 weeks away.  The hunger (my long-term coping mechanism of eating when stressed), the stomach ache (putting all my stress in my stomach), and being done; they were all signs that I'm finally having to accept that Lil' Bit's surgery is going to happen, and soon.

I can cry.  I can scream.  I can shout n't fair!  None of it will change the fact that I have to take my daughter to the hospital and let them cut her open and operate on her heart if I want her to be healthy.  I feel like Dr. Seuss's Grinch--it doesn't matter how much I hate it or try to avoid it, I can't stop this surgery thing from coming.  And it doesn't matter that it's the right thing to do.  And it doesn't matter that she'll be okay.  There is nothing reasonable or rational about how I feel.  I am a mother.  It is my job to protect my daughter, but I can't.  I can't protect her from this.  I can't keep it from happening.  I can't control it.  I can't fix it.  I want to rage at the world.  I want to rage at God.  I want to hold my daughter tight and never let go.  I want this not to be happening.

But it is happening.  And my world is out of control.  So, I want comfort.  I want to eat a pint of pumpkin cheesecake ice cream.  I want an entire bag of barbecue potato chips.  I want a dozen Tim Horton's doughnuts.  These are the patterns that have always brought me comfort (hence, the need for Weight Watchers).  But I won't.  And do you want to know the crazy reason why?  Because I can control that.  I can control what I eat.  I can control not letting my weight loss goals get sabotaged by old patterns.  I can control me.  And I'll do it.  Not just for me, but for Lil' Bit.  Because she needs me to be strong enough to get through this, so I can help her get through this.  She needs me to "be the mommy."  And I remember that I signed up for this job.  I fought for this job.  I paid good money for this job!  So, it's time to pull up my big girl pants and do this job.

Please Sir, I Want Some More

Yes.  I have just likened having another child with the quest for more gruel in Oliver Twist.  Still, it seems fitting.  After all, I am still finding it hard to believe, given how vocal and certain I was at the time of Lil' Bit's delivery that we were only having one, that I now find myself having passed the "serious consideration" stage and am actively contemplating another child.  Still, that's where we are.  So, I thought you might like some insight into how we reached our decision.

Last week, we went back to the fertility center and met with the doctor to discuss what doing another IVF cycle would entail.  (By the way, did we ever mention that the doc looks like Stephen Colbert?  We just kept waiting for him to hold out his hand and say, "Nation..."!  But I digress.)  Part of the need for discussion was based on the fact that this cycle would be frozen instead of fresh, so there is an entirely different protocol.

On the IVF side of things, we learned several important things.
1)  Frozen cycles are only about half the cost of fresh--maybe even less depending the meds my insurance will cover.
2)  There are waaaaaaaay fewer injections.  In fact, it appears as though there's only one med done by injection and everything else is pill or suppository.  It just keeps getting better.
3)  My success rates have not gone down even though I aged.  Because we froze my eggs before I was 35, my success rates are calculated from the <35 category, meaning we're still above 50%.  Also, we have an increased chance at success because we had a successful pregnancy from the same batch of embryos.
4)  Although my doctor would like me to lose 10-15 pounds to increase my chance of success, I actually already weigh 8 pounds less than I did before the last procedure!

All of this was good news, which is to say, it all helped pile us more firmly into the "yes, let's have another" column.  In addition, I got word last week that I got a promotion at work that not only came with a pay raise, but would be a career position that would not require my boss getting re-elected.  Permanency and pay raise also significantly favor the "yes" column.

Figuring out that we were both leaning fairly heavily toward "yes," the next question was when to do the procedure.  After all, since we get to plan this thing, we might as well make it as convenient for ourselves as possible.  Now, my "charge ahead first, ask questions later" personality said to go for it as soon as we could.  After all, there's nothing more frustrating to me than having made a decision, but not being able to move forward or do anything toward that decision.  Still, as we started talking about what certain procedure months would mean in terms of where vacations would fall, how much leave I would have saved up, when the baby would be due, when it would no longer be feasible to travel, and other similar considerations, we realized that waiting was better.  The further we pushed it out, the more leave I would have.  Plus, we would be able to visit family for holidays and go on a trip next summer that we've had to skip the last two years.  Waiting would also give me a chance to lose a little weight and develop some healthy eating habits.  My goal is to stick closely to a modified diabetic diet in an effort to prevent getting gestational diabetes again.  That way, even if I do get it, it won't require me to make too many changes in my diet at that point.

Still, I didn't want to push it too far out.  I really want my kids to have unique, separate birthdays.  Therefore, February was the furthest out I was willing to put the procedure given that Lil' Bit was an early March procedure.  Although, February would be a late October baby and that was really longer than I wanted to wait to move forward and the kids would have birthdays closer together than I wanted, I couldn't fight the seductive list of things we would be able to do if we waited.

Ultimately, the tipping point came when I realized that we were going back to the cardiologist in October to discuss our long term care plan for Lil' Bit with her VSD and missing pulmonary artery.  By waiting until after that visit, we should have a much better sense of the type of care Lil' Bit will need in the future.  That way, if it seems like she will need to have lots of surgeries, it may be worth it to save our leave time and money to properly care for her.  Also, I want to make sure any subsequent children will receive adequate time and attention from us, rather than always coming second because of the time and energy it takes to care for Lil' Bit.  My guess, given that she's asymptomatic at this point, is that she won't need much specialized care--just a lot of monitoring.  Still, since we have the ability to schedule when and if we have another child, it makes sense to wait so we can factor this information in.

Oh, and as for multiples and possible failure, we have decided to have roughly the same attitude we did with our first IVF.  We'll get what we're supposed to have.  If it's none, it's none.  If it's one, it's one.  And, God help us, if it's two, it's two.

So, there you have it.  Barring any bad news this October about Lil' Bit's healthcare, the plan is to reserve a spot for a February procedure, making for an October 2012 baby (or babies!).  More gruel(ing labor) anyone?

Choices

Growing up, my family did not call the food in the refrigerator "leftovers."  Instead, we were having "choices" for dinner.  You could choose to have anything that was available.  It was a small, but useful mindtrick.  It left us in control of what we were having for dinner.  You got to choose.  Now generally, I am a fan of choices.  They are empowering.  But there are times when it's difficult to make a choice because there are positives and negatives to either choice.  And that, dear readers, is where I currently find myself.

Phil and I have begun discussions about whether to have another child.  We have managed to do a good job laying out the pros and cons and letting each other know where we are on any given day.  Even so, we waffle back and forth.  I am having a particularly difficult time reconciling my emotional desire for another child with the rationalizations of whether I have the time/money/energy to raise another one (or two!).  Times like these I wish we had the ability to "accidentally" get pregnant.  It would make the decision much easier.  It allows for that, "We'll try, and if it's meant to be, it'll happen" type of reasoning.  Instead, we must look at financial balance sheets, consider whether and how to schedule procedures while taking care of Lil' Bit, and, ultimately, own that we are making a conscious, active decision one way or the other.  Whatever the results, we chose them.

Yesterday, as I spent a few more hours wrestling with where I am, I realized that I was trying to figure out which decision would leave me without grief and that there was no such option.  If I choose not to have another child, I have to grieve that loss.  If I choose to have another child, I have to grieve the loss of the time/energy/money/freedom that I might otherwise have had.  Then, there's the potential grief of deciding to have another child and the procedure not being successful.  The simple fact is, no matter what decision I make, there will come a time in my future where I will wish I had made the other choice.  There are times I would rather not have to choose, but, in the words of Rush, "If you choose not to decide, you still have made a choice."  Electing not to choose is the same as choosing not to have another child.  So, not choosing really isn't a separate option.

Ultimately, neither decision will leave me totally fulfilled and neither decision will leave me without regret.  Turns out that this was a rather freeing realization, because now I can remove grief and regret from the equation--it exists on both sides.  This has not stopped the waffling, however.  And I can tell I'm waffling because I have reverted back to my general position--when in doubt, seek out information.  So, I have appointments with the fertility doctors and my obgyn; I have Googled and otherwise scoured the internet for tips and things to consider; and I have asked friends for advice.  I am, however, about to reach the end of my information gathering and will have to make a choice.

In case you're wondering, at the moment, I'm leaning toward having another child--provided the doctors assure me it's a good idea.  But, we'll have to wait and see what tomorrow brings.

Being Human

I am a creature of habit.  I love routine.  I can eat the same foods every day for weeks on end without getting tired of them.  I have no doubt that one of the comforts of a schedule is my ability to feel in control.  So, it comes as no surprise that, as Lil' Bit gets older and begins to establish something of a routine, I began to feel more comfortable as a mom.  Phil and I have also done fairly well at making sure we each get some time to ourselves for relaxation or catching up on sleep.

However, I have discovered one giant snag in all of our well-laid plans.  Phil's job.  See, back when it was just the two of us, although it was inconvenient for him to be called away for church stuff or a fire page, it was no big deal.  I had things I go do, people I could visit, naps I could take, etc.  It may have crimped our plans on an occasion, or four, but I knew what I was getting into when I married him (with the exception of the fire chaplaincy thing), so I managed to take it all in stride.  Now that Lil' Bit is here, I find myself reacting much worse.  See, today was supposed to be my day to sleep in.  Phil has a busy weekend full of church things, but we had carved out a few hours for me to get some stuff done.  All that ended with the 3:00 a.m. phone call.  Phil was needed.  Did I understand?  Yes.  Not just because it is Phil's job, but because our parishioners are more than that, they are our friends, and I want to be able to help when my friends hurt.  I love that Phil has the ability to be with people and comfort them.  It is a gift, and one that is worth sharing.

I am, nevertheless, human.  I'm going to let you in on a secret.  Neither pastors, nor their spouses, are anything close to perfect.  They have the same problems and feelings you do.  Thus, I get angry and resent that my alone time is gone.  I am frustrated that I now have to figure out how to juggle our morning routine by myself.  I recognize that this is not the first or last time that this will happen, and it's not as though it's some giant surprise.  Phil's job has always been this way.  It's just that I find myself wishing, on occasion, that my husband worked a job with "regular" hours.  One that didn't involve late meetings multiple days of the week, or being on-call, or always working on weekends, thereby preventing quick weekend getaways.  There are many, many days when I feel like a single parent.  Coming home after a day at work, picking up Lil' Bit, feeding her, trying to cram down food for myself at the same time, giving her a bath, a little playtime, and getting her to bed, all (hopefully) in time to pump and head to bed myself.  It is in these glimpses of single-parenthood that I am grateful that I have a spouse who can and does help me.  I just find myself wishing he could help me more.  But, things are what they are.  We get by.  We make do.  We adapt.  And through it all, I learn that I am a stronger, more capable person that I previously thought.  And the truth is, on many other occasions, I wouldn't change Phil's job for anything.  I love the community and the support it provides.  It is a blessing in so many ways.

But I am human.  And no matter how rational I can be about all of this, I will, in all likelihood, still get angry or feel resentful at times.  The trick, I think, is to own it for what it is-grief over my lack of control-honor it, and get on with living life the way it actually is.  After all, I expect Lil' Bit to roll with the curves I toss into her schedule.  Why should I be unwilling to do the same?