#MicroblogMondays: The Sands of Time

Not sure what #MicroblogMondays is?Read the inaugural post which explains the idea and how you can participate too.

It's amazing how time dribbles away in little things.  I think I have a long gap in my day, and I plan things I'm going to get done in that gap, and then it's gone and I've done very little on my list.  Some of that is Facebook+gaming+ADHD.  Some of it is things taking longer than I think they will.  Some of it is needing at least some mental break.  Some of it is getting new referrals to call, which is a very good thing but still takes time I haven't planned for.  It seems to hit every time, though.  I need to work on that...when I get a chance.

A Thin Line Between Depression and Anxiety

I've always been anxious, but for most of my life I didn't know it.  I used to always think that feeling in the pit of my stomach was guilt.  Guilt for everything I had messed up.  Guilt for everything I had left undone.  Guilt for everything I had done that I shouldn't have.  Guilt for everything I hadn't done quickly enough or perfectly enough.  Guilt, guilt, guilt, always guilt.  It wasn't until a few years after becoming a mental health therapist that it finally hit me upside the head one day...BOOM!  That's not guilt!  That's ANXIETY!!

Oh.

You'd think that knowing that and being a therapist, I'd know what to do about it, what techniques to use to help myself relax.  But I can't.  Because along comes the depression to tell me I don't deserve to relax, right along the anxiety telling me I can't afford to relax.

I have ADHD, so I always have something, somewhere that I'm screwing up or haven't done or haven't done well enough.  Usually lots of somethings.  And that's even with constantly worrying and trying to focus on everything I have to do in a vain effort to keep up with things.

So when someone (most often my husband) tells me to relax and calm down, it feels like doing so would be the equivalent of fiddling while Rome burns.  Because I already screw everything up as it is, so how much more would I screw up and drop the ball on if I did give in and relax???

I can't afford to relax.  I can't afford to go to bed when I'm merely tired and not collapsed.  I can't afford the time, because every time I relax, there's yet another thing that I fail at.

I'm trying to give myself permission to relax.  Right now, I've got a glass of wine (brought by my husband) and Cake Wars on (put on by my husband) while I blog.  But I'm also feeling guilty for taking the time to blog when there's other things I didn't get done today.  Even though I didn't get them done because I was doing other things that badly needed doing.

I'm trying.

Decisions, Decisions

I got a call from my nurse earlier today, and the cycle is officially dead before it began.  Again.  After having said that the pre-implantation genetic diagnosis (PGD) probe needed to be done before I started shots, my doctor switched up on me (again) and said that he won't let me start pills until it's done.  This is at least the second time he's switched things up on me, after originally saying that he would prefer a day 5 biopsy instead of a day 3 one and then changing "would prefer" to "will only do."

My nurse is also pissed at this point.  She's pissed at the gene lab for putting her in the middle and telling her to call me and tell me they needed parent samples rather than calling me themselves.  She's also pissed at the gene lab only saying at first that they wanted samples from my parents and then later saying they actually wanted samples from both sets of parents.  She's also pissed that I did what I was supposed to and that other people not doing their jobs is what is preventing me from cycling.  So at least I'm not the only one that's pissed.  She and I were kinda yelling to (and specifically not *at*) each other on the phone today since we were both upset.

So where does that leave me now?  Well, for one thing, swinging back and forth between numbness, tears, and anger.  Especially with getting the final word from my nurse, it's a good thing I had called in sick today (I'm basically ok, but running a bit of a temp and just feeling crappy), because I would have had a hell of a time holding it together for clients. 

It also leaves me with a major decision to make, about whether to cycle in one month or three, and I'm interested in opinions.  DH told me it was my decision and that he was ok either way.  Two months just isn't an option because of an event at the end of June that DH and I are running. 

If we cycle in one month, we have to have the probe done (which takes 3 weeks after they receive the samples from all 4 parents) by April 21.  Overnight FedExing of the sample kits each way, but I'm not going to have the last address until tomorrow at best.  I'm scared of the probe not being done in time and having to go through this emotionally again.  Cycling in one month would also mean missing something at the end of May that is fulfilling to me.  I've been told my friends will make it be ok if I choose to miss it, but it's something I get a lot out of and a chance to see friends I rarely see.  Cycling in one month would also make it possible to get a second cycle in before my plan year ends on 9/30 (DH's plan year is 1/1 to 12/31).  I have an out-of-pocket max of $3000 and an employer-paid deductible of $1500.  This year, we put the other $1500 on DH's flex spending account both so that we didn't have to pay taxes on it and so we had it all at once instead of having to save it up.  For a cycle after 9/30, we would need to either pay the $1500 between deductible and out-of-pocket max by gathering it together between 9/30 and the end of the year or by waiting for that next cycle until January 2013 so that we could have a new year's flex spending account.

If we cycle in three months, I don't have to miss my May event (although I would miss it next year if the cycle worked, but then I'd miss it less because I'd have a baby), and I don't have to be scared of the probe not being completed in time.  I would start shots while DH is at or just coming back from a curling trip (yes, in the summer), but I would be about at or already at the beach with my family, and several of my cousins are/were nurses (one's a doctor, but I dunno if he'll be there).  *Insert Smithers-like tapping of fingertips together*  I would have to wait longer to cycle, though, and I don't think there would be any way to get another cycle in before my insurance plan year ends.  So IVF #2 would entail either waiting until January or coming up with $1500.  Which I know isn't an astronomical about, but still.

I don't need to make a decision right away, but I do need to make it soonish since I need to buy plane tickets if I'm going to the thing in May.  I'm working on getting the sample kits out to the parents right away either way, to leave myself that flexibility, although if it takes long to get those back, that'll make the decision for me.  It feels like the two main things driving me right now are fear of the probe not being done in time for waiting just one month and not wanting to miss the May event.  What do y'all think?

Orange Crushed

Wow, I feel like a fucking idiot.  I didn't give the RE's office my new insurance card ahead of time, so I got into the finance office all excited about starting a cycle on about January 1 with almost perfect timing (if nothing was screwy with the genetic testing people) and found out that insurance companies take 4-6 weeks to approve IVF.

I think it was 20-30 minutes before I stopped crying.  Mostly.

DH was really supportive, telling me I haven't ruined everything and that I didn't know, it's not like I did it on purpose.  I feel so stupid, though.  I should have known.  I should have given them the new card when my insurance changed.  Or gone over there with a copy of the new card when I made the appointment (even though that was still less than 6 weeks from when we wanted to start a cycle, I think it was more than 4).

I called in crazy to work, at least for the morning.  I'm already 3 hours ahead on the pay period anyway, the two clients I had for the morning are ones I can easily reschedule, and I'm just not in a state at the moment to be emotionally present for clients.  I know I will be ok, but I'm not ok right now.  I told my boss I'll decide about the afternoon once I see to what extent a couple hours of kitty therapy (and a nap) help.

Pitfalls and Tripwires

That title was a chapter title in one of the Wheel of Time books I've been listening to lately, and it seemed to fit, since everything we encounter seems to push back our dream of a family farther and farther. 

My insurance is changing again.  I'm going from no coinsurance to 50% coinsurance.  That's only up to an out of pocket max of $1500, but there's no way we can pay $1500 for close to another year (at which point the insurance will probably change again).  So the box of medications gets to sit there in the dining room, as lonely and forlorn as I feel.  I don't even know if we'll be able to use it when we can get money together, or if I have to try IUI first.  After all, my RE was surprised that it wasn't a requirement on my last insurance.  I just sent an email to our representative at the new insurance to ask her.

Ended up losing my cool and crying like an idiot in front of our HR person, our financial manager (who almost everyone is intimidated by), the insurance rep and the insurance broker yesterday.  I still don't get how it's impossible for them to get shit together to give us longer than a 4-day open enrollment period.  Every company I've worked at before has given a month, and every company DH has worked for has given either 2 weeks or a month.  I was at least able to find out that if I go with our insurance, I can cancel that through 10/31 if it turns out that the insurance is better at DH's new job.  We have friends that work there, but it's hard to get what we need in terms of answers about coverage at this point because there's 4 different plans DH can choose from, and our friends don't know details about all 4.  Still, being able to make that change helps avoid the short open enrollment period screwing us over like it did last year.  It makes me so mad to think about the fact that we could have had a couple of cycles under our belt, maybe even one that worked, if the open enrollment period last year had been even 2 weeks, long enough for me to get answers from them about what was covered! 

Since I've been having such a hard time with all this lately, I'm going up to 150 on the Zoloft, at least for a little while.  Still need to talk to the nurse at work about the real safety of Zoloft, with those commercials making DH twitchy.

Still haven't heard back from the genetic testing people on whether DH is currently covered for the test.  If I hadn't been a stupid SMA carrier, we could have actually had this cycle before the insurance changed!  September 8 was the one-year anniversary of this blog and was also supposed to be the day I would start my shots.  Instead I felt like crap and went home early and took Tylenol and lay down.

Slamming on the Brakes

From cruising down the highway feeling the wind of my passing to...SCREECHHH!!! 

I got a call this morning from the doctor.  Not the nurse. The doctor.  My genetic testing had come back.  I figured I wouldn't be a carrier for any genetic diseases since there was no family history and I wasn't a part of any at-risk group.  So much for that.  Apparently I'm part of the 1 in 50 that is a carrier for spinal muscular atrophy.  So now we have to get DH tested before we can proceed with IVF. 

Under ordinary circumstances, this would take 3-4 weeks: time to order the test, get the kit sent to us, mail back a sample, and about 2 weeks for processing.  However, we aren't sure if DH's insurance covers it.  Which is better than being sure it doesn't...we have a chance because the test isn't necessarily for infertility.  If it's not covered, we'll wait a little longer to see if DH's new insurance covers it.  Yes, new insurance.  He starts a new job on 9/26.  For those that know us in person, you'll have to ask him about it.

I asked one of the nurses whether I should continue taking my Pills until we are able to start the cycle or if I should stop them instead.  She told me that I could do either one and that some people prefer to get off of them as soon as they can because of side effects.  Um, no, I'll keep taking them, thanks.  The worst part of TTC (until it reached the point of IF) was not having the Pill helping to keep me out of pain.  Besides, the nurse mentioned that if I kept on them, we could start the cycle whenever we had the test results since we wouldn't have to wait for me to take the Pills for 2-3 weeks.  Because of that, I don't have to start the cycle at any specific time of the month, which makes it easier to control (in a broad sense) when all the appointments end up falling. 

From what I've been told, it's not that big a deal even if DH shows up as a carrier for the same thing as me.  We would need to use PGD to make sure that no embryos with the wrong genes are transferred.  I shouldn't have any problem having enough embryos to still transfer, given the number of antral follicles I had.

At this point, the main thing I feel is stunned and jarred, as if I really had slammed on the breaks when driving on the highway.  I had a few tears come to my eyes as it hit me that we had to put this off, but I haven't broken down crying or anything.  I don't know if, as it sets in, I'll be sad or angry or what.  What does bother me is that putting off the cycle decreases the chance (already small) of DH's dad getting to meet a grandchild.  He's got a year at most left unless a miracle happens, and a year is with chemo that would be utter hell to go through.

As we were watching hurricane coverage tonight, DH noticed again an ambulance-chasing commercial for people who had given birth to babies with defects after taking antidepressants during pregnancy.  One of the antidepressants mentioned was Zoloft, which I've been told by multiple people (including my psychiatrist) is safe to take during pregnancy.  DH raised the question of whether taking medications at all during pregnancy is a good idea.  Like I told him, it's a very small percentage of people that have problems, but then again, it's a very small percentage of people who are carriers for SMA, too, which makes me less confident about trusting to chance even when the odds are that stacked.  If I was to do it without meds, I could.  I made it through worse than those hormones without meds.  The biggest issue would be DH's reaction to me, though.  He already worries enough about what pregnancy hormones would do to my depression, since a bipolar friend had to be off work for about 9 months after giving birth to get her meds straightened out.  I told him I'd ask one of the prescribers at work what she thought, and we would make a decision over time based on that.  I'm fine with the idea of being off meds...my original plan was to try to do it med-free.  I only went on the Zoloft when I felt myself dipping into an episode after losing a friend to cancer.  So, we'll see.

I've realized something recently about the relationship between the image I have of myself and the images others have of me.

I've always had a fairly fragile self-image.  People who know me at all well can tell you that I'm quick to see myself as not worth much and not really good at much of anything.  I tend to emphasize the things that others are better than me at, downplay the importance of the things that I am good at, and not believe that I deserve any recognition that I get.  With words of affirmation being one of my primary Love Languages, words about me doing things well can lift me up, but only temporarily.  Words about me being bad at things or not having qualities that I should have will rip me to pieces in a heartbeat.

One area where this has been shown clearly is in how I see my reactions to the infertility issue.  I had muddled my way through for several months doing the best I could but not really focusing on whether the job I was doing was good or bad.  Then, I got hit with the feedback that I was handling things badly and that I needed to shape up.  I got into therapy, increased my meds, and started this blog.  I could see an improvement in myself, especially given how what I was feeling got worse, but I continued to receive feedback about how awful I was at handling things, culminating with the comments that led to me not writing for several weeks in January and considering killing the blog.

In March, I was shocked when our couples therapist told me that I actually was handling things surprisingly well.  DH also was able to understand that, whether he could get what I was feeling or not, what I was feeling was normal.  With their support, I started to build the beginnings of a more positive set of beliefs about myself and about how I am handling an extremely difficult set of circumstances.

I learned just how fragile these positive thoughts and beliefs were, however, a week and a half ago when a person whose opinion I greatly respect told me that being honest about how I feel is not ok and that the progress that made still leaves me so far below what is acceptable that it is worthless.  I was also told that I am in the process of driving away my friends because they have to come up with a plan for how to tell me their good news in such a way that I don't make a public scene.

DH and I were talking about this in relation to the Johari Window. (For those who are not familiar: http://en.wikipedia.org/wiki/Johari_window)  As we were talking, I realized that I felt like I was being told the Facade and Blind Spot areas were mutually exclusive in this case.  The Facade section held the idea that I am handling things about as well as could be expected.  The Blind Spot section held the idea that I'm so bad at handling things that I'm not worth being around.  Those can't both be true.  My natural inclinations, as described above, combined with the fact that I respect this person's opinion and this person told me a lot of people share the Blind Spot view but don't want to tell me.  This led to me thinking that the Blind Spot opinion must be right and that I need to find a way to completely change my brain and personality if I want to keep my friends.

A couple of days ago, a friend sent me a Facebook message telling me about her pregnancy news before she posted it on her news feed.  One of the things she said really touched me and made me feel better about who and how I am.  She said that she appreciated the genuineness and honesty of this blog.  That statement helped me to start picking up a couple more pieces of my self-image and to put back together a little of what had been smashed apart.

Just to make myself clear, I'm NOT writing this as a veiled request for people to stroke my ego or tell me that I'm handling things wonderfully or tell me that I shouldn't change a thing.  I know that I am the only person responsible for my self-esteem.  I'm just sharing where I'm at and one of the things that I am working on.

At couples therapy tonight, the therapist said that she was surprised at how well I'm handling the infertility and the uncertainty about whether we'll ever be trying again.  That made me feel a LOT better, given how many times I've been told in the past year that I suck at handling it and/or that I really ought to be able to handle things better if I actually want to be a mother.

Operation Feel Nothing continues.  I can do this.

When I was at therapy on Monday, I had a thought about the whole ideal of relaxing and not stressing.  After all, people say all the time that it doesn't help me to be stressed, and I know that.  However (analogy time again, boys and girls), telling an infertile that it would help them to relax is like telling a person that has been shipwrecked and floating without a life jacket for a day or two to tread water and breathe.  Yes, it will help, but the longer the person is out there, the harder that is to keep doing.

So, the Zoloft seems to be keeping the tears from being at the surface 90% of the time.  I feel numb in general a lot of the time, which I especially noticed when something unrelated happened that I should have been upset about and I wasn't.  That tells me that this dose would ordinarily be too much and that when this nightmare is over one way or another, I should go back to a lower dose.  This is what is letting me function at this point, though, so I'm going to keep it here as long as I need that level of numbing.

While the Zoloft numbs the emotions, it doesn't do anything for/about the negative thoughts.  The thoughts that every month is going to be this horrible, the thoughts that we can't afford to see a fertility clinic, the thoughts that we can't afford to adopt either, the thoughts that only rich people can create a family if it's not handed to them on a silver platter, the firm expectation and belief that I/we will continue to fail each month.  Hopefully the therapy will help with this part.

On a semi-related note, I came up with an analogy tonight to describe what my life is like and somewhat how that relates to my faith.  To set the scene, a couple weeks ago my mom had sent me the Footprints in the Sand poem over email.  I've always loved that one, but right now I feel like I'm not being helped or carried and I told her that.  She replied that God still is carrying me.  My thought in response was that if He is carrying me, it feels like He's letting parts of me drag along the sand to the point where I'm getting road rash.

So tonight I was thinking while I drove to drill.  A lot of stuff has been going on in the last week or two, some related to the infertility and some not, or not directly.  I realized that I feel like grain that God is grinding between the millstones of circumstance.  There may be something good that comes out of it, like flour, but in the process, I am being utterly mutilated and destroyed.

Previous circumstances have been like threshing the grain, knocking me out of my comfort zone and into where I can be used, but they only knocked me around, they didn't destroy me.  No matter how bad it got, I still knew that I could do it, that I could make it through and accomplish what I wanted to and needed to if I only kept fighting.  This is different.  Every time I think I might be able to get my head above water long enough to catch a breath, another wave of shit comes in and tries to drown me.  I try to cling to the few things in my life that are going well, but they're increasingly overwhelmed by everything else.

Gee, can you tell I like analogies?

In my continuing quest to survive, I took a couple steps tonight to try to care for my mental health.  I went to the psychiatrist to get my Zoloft raised, and I had an intake with a faith-based counselor.  Most of the intake was, of course, giving her background about what's been going on.  We did talk some about coping strategies that I've already tried and about my difficulty with taking care of myself instead of others.

Part of my difficulty with this stems from how much need there is in the world.  Yes, that's the social worker in me coming out, and yes, I know that I can't help everyone in the world.  But I do believe that I should make up for the fact that I can't help everyone in the world by helping everyone I can.  After all, imagine if everyone did that!

Part of the difficulty also comes from the fact that I often enjoy doing things for others, whether it's because the activity is something I enjoy doing or because the people involved are people I enjoy spending time with.  It seems like recreation to me to be doing things for others, at least some of the time.  However, I'm ending up in a situation where I'm doing so many things for others that there's at least one activity that I want to make time for, but I've been having trouble carving the time out.

I don't really know where this post is going, aside from to say that I'm trying to find ways to take care of myself.  I'm having to be creative, though, because most of the traditional coping skills aren't doing jack.