Pregnancy with a toddler in the summer

… Kind of sucks. Growing a human is beautiful and I can’t wait to meet this little boy, but oh my goodness this is so much harder than the first time. 

I’m 34 weeks pregnant and we’ve been going through a heat wave here in NYC, with lots of hot, humid days with a heat index above 105° F. I’ve never been a summer person, preferring cool weather or even a rainy or snowy day to the clear skies with the burning sun. 

So this summer, with the heat wave, the third trimester, and the challenges of parenting a toddler… I’ve felt a bit like I’m melting to pieces. Many times it’s all I can do to get through the hour or the day. Tears seem to fall more easily. I go to sleep when my daughter does most nights, spending 10 hours in bed, and often still want a nap. 

I’m getting better at managing, though. I’ve been frank with my husband about the support I need, lowered my expectations of myself, set an earlier start to my leave (less than 3 weeks to go!), built more rest and refreshment time into my days, and also spoke with my doctors and increased my anti-depressants. All of this is helping, and I’m feeling more stable and ready and in control. We’ve made it to mid-August and there’s just a little summer left. 

One day soon, I will walk outside into a cool fall breeze, holding my new baby and watching my toddler and husband play, and it will be beautiful. 

My experiences so far with pregnancy and mood

As a dysthymic person with a history of almost yearly dips into depression, and as a planner, I took many steps before getting pregnant to prepare myself. I read articles and spoke to numerous psychiatrists in my search for one who I felt knew as much as there was to know about managing mental health and pregnancy and birth.

I know the statistics. As one who has had so many incidences of depression, it is very likely I will have more. My brain is used to this pattern, and it takes careful care to keep it from slipping back into that state where bed seems like the only place to be and life looks like a long gray stretch of things one has to do, or is supposed to do, just so that one can keep living to do more of those things one has to do. So, as such, I am at increased risk for postpartum depression.

As one doctor told me, at this point it’s more a question of when I will have another depression and for how long it will happen than a question of if. The best thing I can do for myself is to stay in regular care, take care of myself and watch my moods, and get help at the first sign of any symptoms. Knowing myself, I know the best way to do that is to have a doctor I feel comfortable talking to.

So I am glad to say I now have a good doctor that I am very comfortable with. She’s a reproductive psychiatrist and a mom of young children, and I feel I really couldn’t have better care at this point.

She and my OB told me that there was really no way to know how my brain would react to pregnancy. Some women’s moods get better, some stay the same, and some get worse.

Well, at about 3 months pregnant, I’m thrilled to say that so far, I’ve been feeling better. I can hardly remember a time when I felt so calm, confident, and at peace. I am filled with anticipation and excitement for the future in a way I haven’t felt since we got married (almost 7 years ago!). I feel the best way to describe it is that I feel overwhelmingly content.

The low-grade, nagging worry that I felt for years as I wondered if and when we would finally have the children I’d been wanting desperately since my baby fever days (see posts in 2006 and 2007!) is gone. I worried we’d never have the stability or health we were waiting, I worried we’d have trouble and I’d worry it was because we waited too long; I worried I we would be one of the 10-15% of couples who would have fertility troubles.

The sane side of my brain knew that I was and am lucky, being in a committed and strong relationship, with two capable individuals on solid career tracks, who earnestly look forward to having children together. Still, while I might bury it at times, it was hard to completely rid myself of those worries.

Until now. At nearly the end of my first trimester, with Husband recently starting a new, salaried job with great pay, and with me a year into a job that is my favorite yet and where I’ve earned recognition for my excellent work, all of those concerns are gone.

The anxiety that I wrote about in the trying to conceive and early pregnancy days has faded. Women in my forum groups write about their worries and nervousness, about their screenings and the baby’s health, and I don’t feel it. I know the odds and am confident that we are making a healthy baby. Our healthy baby.

I feel happy, healthy, confident, and excited. I know I am extremely lucky, and I am thankful.

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Can I keep my sanity during the two week wait? Episode 1

In my last post I talked about my first cycle charting my fertility signs. At the end I felt more confident in my fertility than I ever have, knowing that I was lucky to ovulate and have a normal length cycle in my first cycle after birth control pills.

So that was last month. This month, after finishing my plan to transition to just one, more baby-friendly antidepressant (Zoloft), and after saying goodbye to the last symptoms from my most recent depression (which occurred fall/winter 2012), we decided we were ready to actually try to conceive, or TTC as it’s called by many.

After last cycle’s experience, I’d gained a better sense of how to classify my cervical fluid, so the waiting to ovulate part of the cycle wasn’t too stressful. If you’ve never done this, just imagine rubbing mucus from your hoo-ha between your fingers and trying to stretch it, and then asking yourself, is this more like lotion, raw egg whites, or overcooked rice? Or, when it doesn’t clearly fit any, searching the Internet for more examples, descriptions, or pictures. Oh, the things we do when we want a baby!

So I was excited this cycle to see my first days of fertile cervical fluid. My temps are still fluctuating so without that and an ovulation predictor test, it would have been harder to say which day I ovulated, but I was able to determine it was likely day 18 (with a chance of day 20).

After a number of raised temps confirmed ovulation, I found myself in my first two week wait (2WW) – the time between ovulation and either a positive pregnancy test or your period. We had very well timed intercourse and I had some fertile cervical fluid, so the possibility of conception was very excitingly real.

While some pregnancy symptoms can show up before a test would turn positive, they are mostly caused by progesterone, the same hormone that causes many PMS symptoms. It’s almost impossible to tell in any given cycle if what you are feeling is because you have a tiny little blastocyst in you or because you are about to menstruate in full force. And there-in lies the rub.

Basically, the two week wait is like PMS in a pressure cooker!

I have felt daily cramps and lower backaches all week, and I haven’t had a lower backache from PMS since I was a teenager. I’ve had headaches and some nausea and some serious irritability. Add to this the fact that I’ve wanted a baby for years and am ecstatic to finally try, and you get an over-sensitive woman who is somewhat in pain yet hoping that every little twinge is a sign of possible pregnancy rather than the return of unregulated menstruation.

I found myself looking at my chart multiple times a day, going back to note whenever I felt a new symptom, and talking with others online in the same situation.

These days, many tests turn positive before you would miss a period, so based on the advice in some books I read and having experienced these symptoms more strongly than I have in years, I tried to take a test on Saturday. That was ten days past ovulation (10 DPO) and 3 days after a temperature dip which if I was pregnant would be called an implantation dip. I say tried to test because I basically failed at peeing on a stick properly. I got no control line, because I had soaked it. Who knew it was so easy for one’s first TTC pregnancy test to end comically?!?!

I talked to husband about the situation in general – how crappy I was feeling and how while he’s trying to think of it in terms of months and cycles, I am feeling these things in my body every day. He suggested we take a more chill approach and assume always that I am not pregnant, until one day my period doesn’t come and we realize that I am. I am thinking that approach may be less of a roller coaster, so I want to aim for that, but I live in my body with my mind and I’m not sure how well I will achieve that state of mind.

So after Saturday’s invalid test, I tried again Sunday morning (11 DPO). It was negative. 11 DPO is during the time in a cycle when a positive always means a positive (though could become a very early miscarriage) and a negative sometimes means negative and sometimes means you tested too early. Still, I managed to change my thought patterns from “I hope I am” to “I’m probably not, but some day I will be” and that made it easier. But I held out hope for this cycle, because my temps were still rising and last cycle at this time they were falling already.

This morning, my temperature dropped .5 degrees, which usually signals menstruation is on its way. At this point I’m looking forward to the end of this cycle, this two week wait, and ready to try again next time, which is probably about 3 weeks away. Oh, and I’m shamelessly popping pills for the PMS. If I can’t escape it, I’m at least going to dull it!

Preconception Charting

As I mentioned in my last post, after a long period of titrating down my medications and some visits with my new doctor, who is a specialist in reproductive psychiatry, we are officially trying to conceive (TTC).

One of the concerns that my doctor expressed is that just the process of trying to conceive itself can be very stressful. I can already see why, but then I’d say for us the process of getting ready to try was also very stressful, so this is just a different phase of the experience of planning to and trying to expand our family.

As I was trying to find out about the risks of antidepressants and depression on pregnancy, I read some books on pre-conception health. My favorite was The Impatient Woman’s Guide to Getting Pregnant, because it felt more like advice from a girlfriend than clinical lessons from a doctor.

I also have read portions of Before Your Pregnancy, which is practically a textbook, and Get Ready to Get Pregnant, written by a male ob-gyn. While both are filled with great information, they are also filled with do’s and don’ts that can make a woman worry that she is never going to live up to the health standards they recommend. The suggestion is that you practice these healthy behaviors for at least 3 months before TTC and then throughout the process of TTC and pregnancy. If you’re lucky that adds up to a little over a year but it wouldn’t be unusual to be 2 or more years.

One of the things I read about is charting, the practice of observing your body’s fertility signs daily so that you can tell if and when you ovulate and when to expect your period. Usually this involves taking your basal body temperature (BBT) each morning upon waking and checking the consistency of your cervical fluid. It may also include taking ovulation predictor kit tests (OPK) and checking your cervix position. Using these techniques you can usually pinpoint your ovulation day, and then you can assess whether you had an optimal intercourse pattern and a healthy luteal phase (time between ovulation and period) length.

It’s not too useful to track this while you are on hormonal contraception, such as the birth control pill (BCP), because that regulates things for you. Additionally, I learned that it’s not uncommon to have irregular cycles or to not ovulate for a few months after BCP.

So even though we weren’t yet TTC, in January I stopped BCP and began charting. I didn’t really know what to expect and braced myself for the possibility that I wouldn’t ovulate for a while. While I had no real reason to believe that I didn’t have a healthy reproductive system, in the past I had experienced some very painful cysts and had vaginal ultrasounds done (not fun!), so I was looking forward to more information about my cycles and hopefully evidence that everything really was fine.

The charting was complicated a bit because a dr I saw at the time put me on levothyroxine as an addition to my antidepressants; I am often so low on energy and she has found success with that as treatment before. It’s a thyroid medication, and might affect basal body temperature. So it may have affected my chart; I think it raised my BBT a few tenths of a degree. I stopped taking it at the end of that cycle. I had a high amount of temperature fluctuations and no fertile cervical fluid (also something that takes a little while to return to normal after BCPs).

During the cycle, as I tried to track my waking temp and check and classify my cervical fluid, I experienced anxiety and confusion. At first the software I used (FertilityFriend.com) thought that I ovulated on the 8th day, which meant that some of the unprotected sex we had thinking I wasn’t fertile yet was actually during my fertile period. As I watched my temp after that, it later went up again and the software suggested it might be triphasic, which while not a guarantee of pregnancy, does occur more often with pregnancy than without. So for a couple of days I thought we may have already gotten pregnant, and somewhat anxiously told my husband of my concerns. The next day I tested negative and the tool moved my ovulation from day 8 to day 21, the point that it had originally thought was a triphasic shift. So there ended that.

Fluctuating temperatures and scant cervical fluid aside, I was able to pinpoint ovulation on the 21st day of my cycle and calculate a 12 day luteal phase. I was excited and happy to see that even after about 11 years of hormonal contraception usage, I was one of the lucky ones with ovulation and a pretty normal cycle. By the end I felt better, having charted and learned about my body, than I had before the cycle began.

But how would this experience change once we were actually trying to conceive? I’m just now finding out.

We’re finally ready to start a new journey

It’s been a while since I’ve posted here, but I’ve been feeling the need to write again lately, and today feels like a great day to start.

So much is different from the last time I wrote. About a year ago I got my energy up and my resume together and started applying to jobs. I got a good amount of interest and interviews and ended up with opportunities at several places, most of which were great and 2 of which seemed like dream jobs. After consideration I picked one, putting the opportunity to work on a team of people who I could learn from above my initial interest in the industry, and also keeping in mind how well the role and culture would likely work with our plans to start a family.

Almost a year ago now I started there, and I couldn’t be more happy about it. I’ve grown tremendously, get to do important work for the company, and really enjoy the company of my coworkers, who are smart, hard working, and fun. On top of that my income has nearly doubled! (I’m still amazed to be able to say that!)

It’s the best job I’ve ever had, and I feel so lucky.

During this year, we continued working on lowering my antidepressants, because we wanted me to try going off them before getting pregnant. At the time I was on a significant dose of both Wellbutrin and Prozac. All told I think I’ve been working on reducing that for over 2 years! As I got to a minimal dose of both and then just one, I realized I was struggling again. But when I saw my doctor in the fall in that state of mind, I didn’t have the strength to tell him no when he, not bothering to ask how I was feeling, suggested we take the final step and drop it altogether.

As the fall continued I slipped further, having a harder time talking to my husband about what was on my mind, worrying more and more, ruminating often. Life was stressful as we filed to sue his former client and my former employer for nonpayment of a considerable sum, and as he worked less while dealing with the case money was getting tight again, but I didn’t share my fears of being broke again. Instead, I stayed in my head, worried and sad.

As fall turned to winter I stopped getting up to go to the rink. Still loving work, I managed to keep it from affecting my job performance more than a little, but it definitely affected my relationship and my marriage.

One day it came to a head, and I realized I could and should do something about it. So I went back to the doc and told him this wasn’t working, and I wanted some meds again. He gave me meds but sighed and acted like he didnt want to, and he didn’t consider that we should try the safest one because I might need to stay on it. He just said, “This is going to delay you further. You will need time to get this out of your system again before you start.”

I started crying, quietly, and he either didn’t notice or didn’t care, because he said nothing. So I left with my prescription and a plan to find a new doctor, crying on the train and in the park before collecting myself to go back to the office.

That’s when I found a reproductive psychiatrist – someone who specializes in mental health and medication during events like pregnancy and breast feeding. She has deep knowledge in the area and gave me lots of information about all of the studies on both SSRI’s and Wellbutrin during pregnancy. I am so glad to have her to work with me, and with her guidance we’ve switched me to Zoloft, as it has less accumulation in the baby’s system than Prozac and is better for breast feeding than Wellbutrin.

If you check my archives you’ll see that I had baby fever over 6 years ago, and I’m elated that everything is in place now. I have no depression symptoms, am happy with my job, we moved to a nicer, more baby-friendly apartment and neighborhood, and husband is ready and excited too.

So, I’m super excited to say that as of tomorrow, I will have completed my medication transition plan, and we are ready to try to conceive!

Lost some momentum

After my last significant update from October, I lost some momentum. There are a lot of reasons why, but suffice it to say I went through the holiday season in a state of grasping for things to make me feel good.

Do you know that feeling where you start eating cookies and you can’t stop until they are gone, because with each one you think “I’ll stop after this one” and then “but it tastes so good” and “just one more” and before you know it you’ve had a thousands calories and untold grams of fat, and all just for 10 minutes of enjoying the deliciousness? And you feel as though you can’t stop yourself, that it’s a compulsion really, but there is some quiet voice in the back of your head saying “well you could fight it” and the rest of the voices just sort of tilt their heads to listen to that one and then just shrug and say “too tired to fight it…”

I felt that way all too much in the last few months. And I don’t really feel the energy and strength to pull out of it now. But I’m trying – at least. I’m trying to break the changes I’d like to see in myself into very small steps. I know with each small step I can feel a little more proud, a little stronger, and a little more in control. Whether it’s 5 minutes of meditating or getting up within the first two snoozes, I think the little changes are the first steps. Now, to take those steps…

Making changes

I’m writing now from a workout bike … i’ve been thinking a lot lately about my lifestyle now, how it has evolved since taking this job in January, and what I want it to look like. I’m thinking about health, both physical and mental (which has a physical basis of course), and how I can be more healthy.

You see, I fell into another clinical depression this summer, known as a double depression for a dysthymic, and after feeling it’s pull for sometime, I began looking around for new information, for new approaches that might allow me to at least avoid falling into depression annually.

I felt myself falling into negative thought patterns that I had not experienced since my bulimic days more than 7 years ago – getting trapped inside my head and doubting that even those closest to me, such as Husband, wanted to listen to my worries or help me find ways out of them. I felt so unsure of myself it became difficult to ask for help for basic things. I slept more and more, by the end often more than half of the day on the weekends. I let the mail, dishes, bills, clothes, and clutter pile up. And I struggled to get out of bed on weekdays and get to work on time. I would always stay late and work on weekends to make up for missed time, but my bosses started showing displeasure at my late arrivals.

So I cast about, wondering if there was some way to stop this cycle. I finally got sick of it enough that I found some energy within to try to make a change. I downloaded some books on modern approaches to depression and dysthymia, and I started to think that maybe if I learned more I could construct my lifestyle in such a way as to ward off full-blown depression.

Just beginning to believe this made a difference. I knew that one of the strongest things I could do was to exercise regularly, but trying to start a new exercise routine was intimidating. So I started with Kinect (Your Shape, Adventures, Sports, etc) and just did 15 minutes at home on Saturdays. Even that left me sore for a few days, but I kept it up and felt myself getting stronger.

This slow change has been enough to help me see the light at the end of the tunnel. I am gaining momentum – reading about yoga, meditation, and mindfulness-based stress reduction. And Husband is on board now too. So, where will this lead? I look forward to finding out.

Goodbye, summer!

What a summer it’s been. Every year I brace myself as June comes along and announces that hot, sticky weather won’t be far behind. For me, with it comes extra transit delays due to track work and more time waiting in stifling subway stations. I also inevitably find myself jealously listening to other people’s vacation plans and stories, and wondering when we’ll get our finances and lifestyle in place enough to take trips ourselves. And to make it worse, I miss the convenience of having multiple outdoor rinks around the city where I can fit skating in at least weekly. I struggle to exercise as much, and start feeling sluggish. So I tend to think of a summer as a long hot slog through three months and I just bear it enough to get through.

This year, I remember thinking that maybe it won’t be so bad, that I need to try to enjoy it.

But, unfortunately that would not be so for me. This summer, my Husband and I:

Returned home from a pleasant walk on a Saturday afternoon to find our apartment had been burgled and 3 laptops, 2 of them work computers, had been stolen

Commenced an apartment search planning to finally move from our starter apartment that we’ve been in for 6 years, only to determine that we could not yet afford to move somewhere better

Worked overtime every week, feeling stressed and overwhelmed that we could not get things done in the timeframes asked of us

Learned of a family member’s struggle with cocaine use

Supported our family as they faced another eviction proceeding, which ended in us coming to the rescue with 1-2k that we’d been planning to use to book an anniversary trip, our first non-family-visit vacation since our honeymoon 5 years ago

Fought a tiresome battle with our CEO to get Husband’s freelancer paycheck in time to help our family close that eviction case

Fought another tiresome battle to get a review that was promised to me for 3 months after job start, and has still not been completed as we reach month 9

Experienced 2 painful cyst ruptures despite being on birth control which is usually prescribed to prevent cysts from forming, and

Had one breakdown that ended in doubling my dose of Prozac after months of carefully reducing it as part of a plan to try to reduce my meds before trying for baby. Now I’ll wait 3 more months and then try to reduce the Wellbutrin instead.

Now, there have been some good things happening – we are on track to finish paying down 2-4 of the debts we’ve been carrying for years, we’ve both gained tremendous experience in our jobs, and Husband is successfully charging over 20% more for his freelance work than he did just last year. Once he actually gets paid for that work, I’m sure that will feel good.

I turned 28 last weekend, and I’ve been thinking a lot. We need a change. I need a change. I feel as though inertia and lethargy have settled in, and I can barely stand it anymore. I want to start fresh, to move somewhere new, decorate our living space as the adults that we are instead of the college kid that I was when we moved here, start taking vacations, saving a nest egg, exercising and eating healthier, planning for a family, and enjoying life more. I’m trying to muster what energy I have to make that happen.

Perhaps this Fall we will get ourselves solidly on that path. I sure hope so.

Overcoming the Inertia of Depression

It was another hard week, one that brought a second set of impending eviction hearings against my extended family, news of a family member’s coke addiction, my second painful ruptured cyst in as many months, and an unexpected motherboard failure of my husband’s trusted computer, which he depends on for his freelance web development work. By week’s end I felt so gloomy it was hard to imagine a positive future, and I was caught in my head with worries of infertility, homeless relatives, and a continued struggle to meet basic needs like rent.

But these problems were not only mine but my husband’s too, and he was struggling more than I with fear and distress for his family. I knew that he needed me and even though he was there for me, I didn’t want to be another source of worry and energy drain for him. I resolved to do all that I could to get stronger.

On Friday, I went to the kindle store and searched for self-help books on dysthymia, depression, and addiction. I found some that seemed to be approaches I am comfortable with and downloaded samples to my phone. And I began reading.

I found that just having the books added to my sense of control. I am doing something. I am educating myself further about the current guidelines for what works and what doesn’t. And I will use this information to craft a lifestyle that keeps my dysthymia in check.

As I read through the introductory chapters, I found it comforting to be reminded that my lack of activity and energy is not because I am a failure, a slob, or a lazy bum. Rather, I had fallen into a vicious cycle that affects many. I am not alone in this, and there are ways to manage it.

One thing I read in many places is the beneficial effect of regular exercise on both neurochemistry and hormone levels. I’d not been exercising (beyond walks) since the end of the skating season, and I felt like a failure as I continued to neglect exercise. But reading these books motivated me to try and to start simple. So on Saturday after our walk I fired up the Kinect and played Kinect Adventures until my body was tired.

That little act was very powerful in it’s effect on me. I felt more in control because I’d successfully gotten myself to exercise, my body felt better because the muscles were active, and my brain felt better because the exercise released dopamine.

Half a year into the new job

And I can’t believe that much time has passed. I love the job and am still so grateful for the opportunity. I actually enjoy going to work most days and I am really excelling. The company is having a strong year and I believe I’ve been a big part of that. The environment is so much better for me – I feel accepted and comfortable and valued.

I’d even thought about ending this blog. After all, it was originally an exploration of school and depression, research and science, and life in academia as a woman scientist. I’m no longer in school, academia, research, or considered a woman scientist professionally.

But, that doesn’t mean the themes of my life aren’t similar. I still struggle with dysthymia, and I’m still in a male-dominated industry. I’m still a young woman figuring out herself and her future. And I still enjoy the outlet of blogging and the companionship of other bloggers (although I’ve mostly been a lurker lately).

So, I’m still here. And I still have things to talk about.

I’ve wanted to start a family for many years now. The time is nearly right, and I’m glad I’ve waited through our struggles with money and career. A few months ago, we started decreasing my antidepressants. Following my friend’s suicide last fall I had spiraled out of control, and it took many months to feel better again. During that time we changed my medication, such that I was on both Wellbutrin and Prozac. It helped me feel alert enough to go to work mostly on time and feel aware in the mornings. It felt like the cloud lifted and my head was clearer.

Then I started the new job in January, and I felt energized and motivated. Also, my students did well and finished the skating season fabulously, earning an invitation to skate at the end of year gala with Olympians, where I shook Evan Lysacek’s hand and watched him give a $100,000 donation to my organization.

So earlier this year I began talking to my doctor about planning for a baby, and we started tapering off my meds. We started with Prozac because Wellbutrin had been the more recent addition and had helped a lot. We dropped the Prozac from 40 mg to 30, then to 20, and things seemed ok. So we dropped it to 10, and then planned to start reducing the Wellbutrin.

But somewhere around then things degraded. The increased stress and long hours of the new job had started taking their toll on me. I began crying too often and worrying and sleeping too much. The doctor said we had probably dropped it too fast, and we upped it half a pill, to 15. That was about a month ago.

Work continued to be stressful even as I enjoyed it and felt proud of it. Night and weekend work that had seemed like a temporary measure dragged on. I got a summer intern which relieved some of the pressure, but the work kept increasing and that wasn’t enough. We won more and more work from new clients, and the projects I led went extremely well, but I was getting worn-down.

The last few weeks I noticed increasing negative and repetitive thought patterns, and I found myself crying alone quite a few times. Finally, on Thursday about a week ago, I got so upset during the work day that I dashed to the bathroom so no one would see as the tears started. I finally had broken down, and I called my husband and told him how much I’d been struggling.

It was disheartening to reach that point, but it forced me to see that I must change something now to prevent a full relapse of depression. I saw my dr that eve and told him how I’d been feeling, and he said I sounded depressed and increased the Prozac back to 30. I talked to my boss and told him that I could not keep working nights and weekends, that there had to be an end in sight for that. Then I worked from home the next day and rested over the weekend. The next week, I forced myself to take full lunch breaks and go home at a decent time. And I took all my meds.

It’s been about 9 days and I’m starting to feel better. I want to keep writing, and focusing on my health and sanity. Maybe I’ll even stop lurking and let some of you know that I’ve been reading.