Migraine update: Neurologists are Amazing

I saw a new neurologist this morning, just two days after getting a referral. I was so impressed with the way she made time to answer my 800000000 questions, even looking up whatever she didn’t know off the top of her head. She also took my desire to get pregnant next year seriously! She told me that while I should avoid triptans (the class of meds that includes Imitrex and is usually used to treat the headache once it has started) I can use them for now; she’s even letting me try a new one, since Imitrex almost never works anymore. She also heard my request for a preventative medication that either won’t be a nightmare to get off or that I can safely take while pregnant. I have a new beta blocker, a drug that blocks adrenaline receptors, lowering blood pressure and therefore the pressure in my scalp if my blood vessels constrict during a headache. I was taking one, but it wasn’t helping. And as I said, this new one might be ok during pregnancy. We’ll talk about tfat when the time comes. I’m just glad she didn’t try to convince me to add medications–she simply believed me when I said “these don’t help” and replaced those. I even get to come back in a month or earlier (a really short period of time for a neurologist) and check in. Also, just on case you were concerned, I did pass the physical neurological exam. Which means I can stand still with eyes closed without falling over, among other things. Hope! Thank goodness for good doctors.

Later the same day…

I picked up my prescriptions, and found out the “yikes” way that Flova, my new triptan, is not available in a generic yet. So that’s expensive. But this new beta blocker is really cheap, so if it works, it’ll all balance out. Anyway, what I really wanted to mention was that the neurologist recommended some really affordable supplements to add to my ever-growing list of daily pills. So if you have migraines, you might want to ask your doctor about these two: Riboflavin (vitamin B2) and CoQ-10 (Coenzyme Q-10). Both work to prevent migraines from happening in the first place by improving “energy metabolism. Read about one riboflavin study here and a CoQ-10 study here.

In looking for research about these supplements, I also found a fantastic blog called The Migraine Chronicles that I highly recommend.

Reader Profile: Jenna’s Wait

I wrote on Sunday about my gratitude toward the readers who have responded with stories of their own. I did so in part because I had just heard from a childhood friend, Jenna, about her own frustrations surrounding preconception care. It turns out that Jenna has her own blog, and she’s been writing about the grief she has experienced and the faith that has gotten her through about six years of “infertility.” I use the quotes because, like many couples, Jenna and her husband Jason don’t have the money or insurance to cover every single test to find out why they haven’t been able to conceive. They don’t know if one or both of them is actually “infertile” or what, exactly, to do about it. They do know what it’s like to wait for a desperately-wanted baby. Jenna and I are the same age, by the way, and I have to say that I am so impressed with how she and Jason dealt with so much so young. I’m sure you’ll agree that they have made some incredibly wise choices. This post is much longer than anything I usually put up, but Jenna has written her story so beautifully that I just can’t find anything to cut.

Background: Jenna and I were close friends as children. We used to ride our bikes around Grand Rapids, Minnesota, have sleepovers, go to the playground. Neither of us actually remembers how old we were when we met or started spending time together, but we think it was fourth grade. We parted ways at some point, but we can’t remember much about that, either. We are both glad that we have reconnected. I had no idea that she’d be such a good writer, by the way, so reading her answers to my questions was pretty exciting!

Two things: she explains “charting” really well, but I’ll do a post later about what I think about this, and the Fertility Awareness Method or Natural Family Planning (not the “rhythm method”). I also asked Jenna both questions I have for her and questions I suspected other people would ask her and/or her husband. For example, while I was curious if Jenna and Jason had considered adoption, I didn’t need to know, personally; I wanted to know how she responds to this question, though, because I figured it had come up a lot. And for the record, I offered anonymity, and this couple basically said no need, bring it on.

Jenna and Jason

 

Why [did you start trying to conceive] so early? Can you tell us a bit about your background?

I’m from a small town and went to college in a small town. At our college it is normal to get married after your sophomore year and even your freshman year. I met my husband on the first day of my sophomore year and we were married at the end of that school year. We were dating for 7 weeks when we were engaged! With young marriages in a small Christian community also comes lots of babies early on. After about six months of marriage we decided we wanted to begin trying and see what happened. I had always wanted to be a young mom, not a teen mom but early 20s because I wanted to be fun and run around with the kids for as long as I could. I imagined raising my babies with other young moms at college and having this great community experience.

 

What did you do before you first started trying to get pregnant?

Honestly, I just threw out the pills. I was working under the assumption that babies come naturally for everyone. Some of the things that I did incorporate into my lifestyle in the beginning were taking prenatal vitamins and reading about pregnancy — not infertility. I have always stayed away from alcohol, smoking, and prescription pain meds.

Your husband?

My husband didn’t really change anything when we started trying. He was also taken aback that babies weren’t going to come easy for us.

 

How did that change when you realized it wasn’t going to be easy to conceive?

As the wait grew longer I began to make small changes in preparation for conception. I wanted to believe that the wait would end next month, in a few months, by next year…and six years later I’m still in the preconception stage. It’s more like a way of life now. I slowly integrated more lifestyle changes: fish oil, more regular exercise, eating less processed food, consuming less dairy, charting, taking alcohol-free Rubitussin around my most fertile times for its ingredient Guaifenesin which is an expectorant and is used to loosen and thin mucus (it works for all mucus areas), magnesium, acai, ovulation predictor kits, sperm-safe personal lubricant (TMI ?), reading even more. I still stay away from smoking and drinking all the time. I made a commitment to my children that they would not have fetal alcohol syndrome, or even fetal alcohol exposure. When a new diagnosis was thrown around I would read up on it as best I could and change my diet again. It took me a year and a half to type “infertility” into my search engine. It took me 2 years to say it out loud. I wanted to pretend that I was somehow still going to be normal. This was a difficult and slow process for me to realize that “normal” does not exist.

Jason was at first a little reluctant to change his lifestyle. When we were still assuming marriage automatically lead to a baby carriage it was the unspoken rule that everything before labor and delivery was all about me. I think most couples operate under that same rule. I kept talking about everything that I was learning. After a while he was more and more interested and eager to make changes. He also took fish oil, a multivitamin, CO-Q 10, ate more colorful food like tomatoes and fruit, ate less processed food and exercised.  We also started having sex in the recommended baby-making positions and in the morning. After waiting for so many years it’s hard not to wonder if any of these methods, techniques and tricks really work. But I think my research is pretty solid and I know others have gotten pregnant because of these small changes.

 

Can you explain what “charting” is, for the uninitiated? Just the basics, please.

“Charting” is a method of keeping track of fertility health. Each month there are several indicators of the most fertile days in a woman’s cycle. Once these indicators are known and followed or “charted” a woman can follow her fertility and know fertile days, non-fertile days and if there might be any problems during cycles such as anovulation (when an egg is not released so ovulation does not occur). It is quite fascinating and amazing how our bodies are made. Usually basal body temperature (waking temperature), cervical mucus consistency and cervix opening are charted. When all three are charted consistently and properly a woman can have a pretty good picture of which days during a cycle she is most fertile. You should also keep track of days of intercourse, period start and stop, health issues such as antibiotics taken or migraines. These are all important pieces of information to have when using this method of birth control or pregnancy achievement.  When put together in a pre-designed fertility chart, you can have a pretty clear picture of your fertility or fertility problems. Charting can be used when one is preparing or trying to get pregnant, trying not to get pregnant, or just wants to keep track of fertility health. A really great resource, probably the best out there, is Taking Charge of Your Fertility. She is amazing. There is so much information and sample charts are included in the back. These charts can also be downloaded online but make sure you know the proper way to check temp and cervix or all the effort of charting might be misinterpreted.

 

Can you describe your experience with charting?

Haha, well it wasn’t until the second year of trying that I started charting. I was so young and people around me just didn’t talk about fertility or charting. I wish I had known about it earlier. I charted consistently for about two years. There were months that I was certain I would be pregnant — everything in the chart was perfect. Other months I threw my charts against the wall out of sheer frustration. After two years of anal-retentive, OCD chart keeping my husband and I threw it out the window for the most part. I still keep track of some things mentally. I write the dates of my cycles in my planner. I know when my cervical mucus is “stretchy.”I did it for so long that I pretty much keep track in my head but the constant writing and charting and measuring…it was too much added stress for the overly stressful infertility crisis we were enduring. My husband and I reached a critical meltdown point. Our sex life was over-scheduled and mechanical. Instead of looking to each other for passionate signals, we looked at the calendar. It was just too exhausting and all-consuming for me. It got to the point where I was feeling guilty if I missed something — forgot to take my temp, didn’t write something down. I would constantly wonder Was this the month and I messed it up? What if this was the only month?? I also found myself living for the future. My future happiness was somehow dependent upon this little, floppy piece of paper. I wanted to live for today and enjoy what was around me. I saw myself headed for a downward spiral and I pulled out. Now, for my sanity and health, I am more laid back. We have time, though sometimes it seems like time is running out. And I never know what God has in mind.

Charting was very helpful in increasing my understanding of myself and my fertility. It was also helpful in discovering possible fertility issues such as my low body temp, ovarian cysts and a miscarriage. I can’t imagine myself continuing that for another two years without success and completely exhausted. Other’s experience might be dramatically different. This is just me and I don’t want to discourage anyone from using this valuable technique. It has helped countless women achieve pregnancy and avoid pregnancy. With that in mind, we are responsible for our overall health. Just because I am not charting does not mean I am eating crap and living in total disregard for my well-being. I do believe God is in control but I also have freewill to make my own choices, and I want them to be good choices.

 

Can you explain how your lack of access to comprehensive health care coverage has influenced your decision making? What would you like to do that you cannot afford without insurance?

Because of a few opportunities to see a doctor I have found out I have ovarian cysts, bicornuate uterus — which is very minimal — and there is suspicion about endometriosis. What a cocktail! So I have some idea of what is going on, but I would really like to know more. Our decision making and options have been very limited to say the least. It is extremely frustrating most days. Other days I am thankful. If we did have great health insurance I might have jumped at fertility treatments out of desperation and anguish rather than rationality and confidence in the best choice for us. Having limited options has allowed me the time to process through my grief, grow in my self-awareness, and know where I stand and how far I would go to get a baby. I know where my moral line is and where I am willing to be flexible. I know a couple who immediately went through one round of IVF (invitro fertilization) and later wished that they had taken more time to consider their options. I wanted a baby so bad I would have done most anything. Because our options are so limited I have been taking advantage of all the natural and herbal “remedies” and treatments I can.

Now, I am glad I couldn’t do anything because it allowed me to have time and space to work through this process and learn from this journey. It is still a daily frustration — wondering if our six years of waiting might have been avoided with one simple test. But again, I know there is a purpose in this and I know that it is all in God’s timing. When I think about it I realize that had I not gone through the past six years, I would not have the strength and voice I have about fertility issues nor would I be writing to you now. If the growth and knowledge I have gained in my six years of waiting will help another woman in her struggle, who’s to say that wasn’t God’s plan all along?

I would definitely like to have the basic tests done for both me and my husband. I would be overjoyed and so grateful. Though I do not necessarily agree with all the aspects of the IVF procedure, I have less reservations about “adopting” donated fertilized embryos. This is something I have been thinking about but would still like more information about if I were given the opportunity to go ahead with it.

 

What tools do you and your husband have to help you deal with the emotional fallout of this?

Each other. We’ve pretty much been making our way through this process clinging to each other for dear life. No one around us was talking about infertility so we had to talk to each other and figure it out together. In northern Minnesota there aren’t many support groups for infertility. There was time when we easily could have gone either way. We made a decision together that no matter what we were in it together for the long haul. We started talking more, supporting and encouraging each other, taking every opportunity to laugh together and made ourselves available to cry together.

Our faith. Infertility has shaken the very foundation of our faith. How could a God who is love allow us to go through such pain and sorrow? Together we have seen the amazing blessings that have come out of this process in spite of the sorrow. Our relationship is stronger than I could have ever imagined. We’ve made some great friends. And here I am, writing on this blog and speaking out more and more about infertility issues. Even though life seems unfair and has crappy moments or years, we know that God has a purpose in everything.

 

If you could go back six years and give yourself some advice, what would you say?

“God is good and just, even when life is unfair. Yes, this is happening. Yes, it will hurt a lot. You will survive. Keep talking and writing.”

 

Name one thing you found more helpful throughout your process. Is it a book? A relationship? Keeping a journal? Medical professional? Anything. 

All of the above. I have made some AMAZING friends throughout this process that I probably would not have connect with had I not been dealing with infertility. I am forever grateful for these women who get me through the worst moments. I Will Carry You by Angie Smith was the most powerful read for this crisis. But the most helpful thing, BY FAR, has been journaling. I have always been writing and journaling. I stopped in high school. But when I hit a wall in coping with infertility I bought a journal, started writing and never stopped.

Two snippets of advice I would give about getting through or coping with this process are 1.) Don’t try to fit with other people’s ideas of coping strategies. Find what helps you cope; what gets you through the day. I’m talking the simple things. A cup of tea, your favorite socks, a good book, a sad movie…It’s the little things that make the biggest difference. 2.) KNOW YOURSELF and be confident in this knowledge. Know your body. Don’t assume that because doctors have the fancy degrees that they know more about you than you know about you. You will meet great doctors and frustrating doctors. Know your concerns and voice them even if you have to change doctors or clinics.

 

What’s the most obnoxious, invasive question anyone has ever asked you about conception, fertility etc? 

Haha! I love this. . I do have two questions that stick out:

“Are you sure you are doing it right?” — my mom, and I’m afraid she was dead serious.

“What kind of underwear does Jason wear?” — a girl that at one point had her eye on my husband before we were married.

What advice do you have about keeping a relationship strong even while trying to get pregnant? 

Just keep talking. There will be moments when one of you is carrying more of the stress of infertility or preconception than the other. Then, unexpectedly the weight shifts. Pay attention to this and keep talking. Talk about what you each need to cope through the bad days and what you would like to do on the good days — and take advantage of those good days when they do come! Pay attention to each other’s stress and grief levels in order to keep encouraging and supporting each other. If you like to plan and enjoy knowing what to expect, this will be an especially difficult time as it is all about changing expectations and plans. Be spontaneous together to make the most of this crazy time. If you have been in the preconception stage for more than six months or have lost a child take time to plan a get-away. It can be cheap. It can be short. Just get away. Take a break. Actually leave your home – not to visit family or friends. Get out of your environment. Talk about what you are going through or make it a point NOT to talk about it. Just get away and have some fun together without the constant reminders of baby-making.

Why put yourselves though this for so many years? How you considered just putting it on hold until you have insurance? What about adoption? Becoming foster parents? What is or is not appealing about “other options?” 

Awesome question. I’m glad you asked.  I must explain that I have very conservative views in regard to pregnancy and conception. You could call me pro-life if you want. I just value life — old, new; healthy, sick. I didn’t really know where I stood for a while but through this journey of infertility I have gained a value and respect for life that I did not have before. I have thought about going back on the pill to save myself from the disappointment/hope rollercoaster each month but I just can’t do it. I don’t want to miss an opportunity but I also wouldn’t want to lose a pregnancy. Part of the pill’s job is to hinder fertilized eggs from implanting. This is the “back up plan” in case the original plan (to stop ovulation and fertilization) fails. I don’t want to be trying and waiting for a baby and all the while possible babies are being expelled from my uterus. So we might not be trying as intensely as we once were, but we are still trying. We are definitely not not trying.

I also know that I could easily quit school, get a good job, get insurance and pursue more intense fertility treatments but I am certain that I need to finish this out. Every day I make the choice to continue on this path of schooling and set aside, for the time being, insurance and medical care. There are so many fertility facilities here but I am not about to spend thousands of dollars I don’t have to get a baby then have no money to care for this baby. I just can’t justify that.

I have a brother who is adopted so adoption has always been on my heart. My frustration with questions of adoption to “infertiles” is the assumption that is being made. For some reason people tend to assume that the go-to solution for infertility is adoption. Not true. People also assume that those who struggle with infertility should be ready and willing to make the decision to adopt. Again, not true. Adoption and infertility are related but their relationship should not be exclusive. When I am asked if I have considered adoption I respond Have you? Just because someone is free from the stress of infertility doesn’t mean that person is excused from exploring the possibility of adoption themselves. Adoption is not for everyone, but it is also not an option limited to those who are dealing with infertility.

I would JUMP on the chance to adopt. Before we started grad school my husband and I were looking into foster-to-adopt programs in our area. We do dream of one day being a forever home for some great kids who have never had a home to call their own. I would also absolutely LOVE to be a forever home for kids with developmental disabilities who are rarely adopted out of the foster care system. These kids need a stable, safe, caring home too! These adoption programs are relatively inexpensive as the state is looking for immediate placement for these children. Yes, they will not be newborns. Yes, they might have many issues to work through but how great would it be to love a child who had not known what love was?  It makes me think of a quote from Martian Child, “I can understand not wanting to bring a child into this world, but what’s wrong with loving one that’s already here?” If I am going to desire so strongly to have children and I value children, I can’t help but live my message and be willing to love every child – and I do.

But for right now, while we are still finishing our master’s programs, we are patiently and eagerly awaiting the day we can bring a child into our home — biological or adopted. But no matter what adoption will be a part of our story. Foster care and working with children with developmental disabilities are two of my greatest passions. I apologize if this was a long answer to your question :)

Advice from Jason to other husbands:

Get involved in her experience. It’s going to seem foreign and uncomfortable at first, but she needs you. Be willing to try new things. They might seem silly but just agreeing to try shows her you are in it together. Every month of a negative pregnancy test is really hard and can feel like rejection. Make a point to spend time with her after this. So much of this process is focused on the woman so you have to be your own advocate. Speak up about what concerns you and keep talking with her. No matter what do not let this struggle determine who you are as a man, a husband, a father.

Anxiety, Panic & Depression

I’ve talked about my “mood disorders” and my “diagnoses” and my “anxiety,” but I don’t think I’ve really explained what life is like, day-to-day. So here’s how it works:

I feel anxious every day, to some degree. I almost never panic. What’s the difference? Anxiety happens around something real, like a job interview. Everyone feels anxious about a job interview, right? That’s normal. I feel anxious about the job interview and then anxious about whether or not I am qualified and then about whether or not I should have written a different cover letter and then about whether or not I will ever find any job and then about the money I spent on the cup of coffee in my hand, which I clearly shouldn’t have spent because I’m about to be jobless forever and poor. Not so normal. It’s a lot better than it used to be; it used to spiral from anxiety about a job to panic that I was a fraud and totally incompetent and didn’t deserve a job, all in about five minutes. As you might imagine, I’ve cancelled a number of job interviews in my life. I cancelled because I had worked myself into an anxiety attack. During an attack, I’ll cry hysterically and start to hyperventilate, often sitting on the floor clutching my hair. It’s painful. I usually have to sleep afterwards.

A panic attack is different in one essential quality: there is no discernible reason for me to sit on the floor in the bathroom, crying. Sure, the example above is a completely disproportionate reaction to the job interview. But it’s an extreme version of the emotion that everyone feels before a job interview. In college, I once came home from a perfectly fun night out, went into the bathroom to wash my face, took one look in the mirror and burst into tears. It took me over an hour to calm down. I still have no idea what triggered that panic attack. The kinds of thoughts that race through my mind during a panic attack have a general theme of self-hatred, but I don’t need a reason. The bathroom sink, the front door, the coffee machine. These have all driven me to tears. I haven’t had a panic attack since I started taking Klonopin. You might understand if I’m nervous about going off the drug. The panic attack can’t get going, you see, if the physical symptoms don’t start it. A good cry doesn’t turn into panic if the medication keeps my brain from sending crazy electrical signals that say “you can’t breath!” or make me dizzy.

I do not experience depression unless I stop dealing with the anxiety, start feeling panic, go deep into denial and, essentially, start giving up. Depression happened because I tried to pretend that the anxiety wasn’t there. I was pretending because I thought that it wasn’t normal, it would go away, I could just work harder and make it stop. The diagnosis is Major Depressive Disorder, however, because depression is the place I go when I am extremely discouraged. I stop getting out of bed. I cry a lot. I don’t eat much. It follows me because I know I will go back there if I allow anxiety to take over my life again. That’s not the reaction that most people have, so it’s a disorder.

“Mood disorder” is the umbrella term for each of these more specific disorder for an obvious reason: my mood stops matching the situation and becomes very dark. Psychosis is not a mood disorder; during a psychotic state, people see, hear, believe, know, things that aren’t real. It’s not about the mood so much as the thoughts. Anxiety, panic and depression are all about the mood you’re in when something happens. They’re sneaky because they live inside my reactions to my life. A perfectly normal reaction can turn into an anxiety attack, especially when I’m vulnerable. When I’m sick, have had a series of migraines, have not been to therapy in awhile, then it’s harder to say “no” to the thought “you are not good enough.” The thought spins around, in it’s various, highly detailed permutations, until it has spun my mood out of control. It takes an awful lot of work to turn that mood around.

It looks so hard when I write it all out. It is difficult, I suppose. But my alternatives are worse. And I just got used to doing that work, once I learned how. I’m still learning. I know that the analogy I’m about to share is a little bit silly, but my therapist in college came up with it and it just describes what I’m learning to do so well. She said that it’s like I have been walking through the woods, and suddenly here’s this path. It’s not going anywhere. There’s no destination. But since I’m walking through these woods anyway, it’s really a lot easier to walk on the path. I lose it sometimes and end up fighting my way through stray branches, roots, rocks and dense trees. But I find it and get back on. And keep walking.

Psychotherapy: How Does That Make You Feel?

I want to start this week with a post or two about therapy. There is still a stigma attached to mental illness, and therapy is still widely misunderstood. I also want to write about therapy this week because I have no therapy this week. The wonderful, talented, empathetic and possibly even psychic “L” is on vacation. I am constantly thinking of things to tell her and then remembering that she won’t be back for another two weeks.

A note before I begin: Psychiatrists, psychologists, social workers and people with various other degrees can all practice therapy. Only a psychiatrist should be prescribing any drug or making any recommendations to you about medication. I see a psychiatrist in Manhattan, the incomparable Dr. C, and a therapist with a degree in social work here in New Haven (L). I see Dr. C about four times a year to talk about changes that need to be made, if any, to my medications, and to check in. I’ve been seeing him since 2006. I’ve been seeing L for about eight months. Because I see her twice a week, it’s important that her office is close to home.

Types of Therapy:

The Mayo Clinic website lists thirteen types of therapy. I won’t go through all of them, just a few.

  • Pyschoanalysis is the opposite of what I do. I am absolutely interested in doing it someday, though, after talking with people who are trained in it. It is easily the most misunderstood type of therapy out there. Yes, it’s what Freud pioneered. Yes, you often lay on a couch. Yes, you often avoid looking at your analyst. Yes, you often go up to five times a week. But today’s psychoanalysts are not judgmental like Freud (anyone read Dora?) and the couch thing is optional. Rather than define it (the Mayo Clinic does that quite well), I’ll tell you why I want to do this someday: I tend to try and come across as perfect, even to a therapist, and not being able to see her reaction seems like a pretty good way to circumvent that impulse. I once asked my therapist in Queens why she wasn’t happy for me when I improved at something (I don’t remember what it was anymore), and she said that she had been trying to keep her face neutral. Why? I was taking her smile as approval from her. She didn’t want me to need her approval. Smart lady. I sure was interpreting a smile as approval and the absence of a smile, or a neutral expression, as disapproval. You can get to those thoughts and feelings that your conscious mind doesn’t really want to think about a little easier when you’re not trying to gauge your therapist’s reaction like that. It can also feel disorienting, I’m told. I haven’t done analysis yet for that reason; the last thing someone with tons of anxiety needs is to feel disconnected and disoriented even in therapy! One day, I’ll be even better at dealing with my anxiety, and that will be the day
  • Interpersonal therapy is what I have chosen. My visits with L feel like visits; we have an ongoing conversation. We focus on my relationships with other people–anyone counts–in order to help me feel less anxious, more connected, communicate better. She’ll ask me to expand on something or to describe my feelings about something. An interaction I with M, my therapist in Queens, is a perfect example of why interpersonal therapy works so well for me: “Anne-Marie, you are interpreting my facial expression as disapproval. I was trying to be neutral. Does that happen often?” “Why, yes, actually, now that I think about it, I’m constantly looking for approval from my boss, my husband, my mom, my sister, in just the same way. And now that I think about it some more, it feels kind of gross for everyone.” What I really like about interpersonal therapy is that the relationship is very close. We’re not friends, and it’s a one-way thing. But the best therapists are even good at talking about their own feelings about your relationship (how can you see someone twice a week and not have a relationship?) in an effort to help the patient understand the other relationships in her life. Note: the concept of transference is a Freud thing, but one that I believe in quite strong. I don’t agree with him in that he tended to think that it was all a kind of romantic love, e.g., Dora thinks she’s in love with me because she can’t work out her true sexual feelings for the other guy or her father. It gets creepy. What is true is that because I never find anything substantial out about who my therapists are outside our sessions, I tend to subconsciously compare the relationship to other close relationships in my life. Claire (long ago and far away) reminded me of my sister. Kate (college days) reminded me of my sister. M reminded me of my sister. L, who is a bit older than any of the past female therapists, reminds me of a really important mentor in college, Nancy Klein Piore. During our first office hours session to talk about my writing, Nancy looked me straight in the eyes and said “Anne-Marie, you are insecure.” I cried. She gave me oreos. I will love her forever. I can totally see L doing the same thing. She would probably say “Do you think you’re insecure?”
Note: the constant questions, coming from a good therapist, are supposed to be real questions. They often know the answer in advance, but if you come out with a totally unexpected answer, they embrace that. We’ve had some huge breakthroughs in undoing harmful patterns when I’ve said “No, it’s not like that, it’s like THIS! I never thought of it that way!” It can be pretty exciting to undo a years-old habit that way. Of course, you can’t just say “NO. I DON’T FEEL THAT WAY!” Because come on, these people deal with denial and lying for a living. You’ve got to have an alternate explanation, and if I personally get angry or defensive, it’s less convincing, even to me.
  • Cognitive Behavioral Therapy or CBT has been an important component of my life in therapy. But because my anxiety is an ongoing thing and my mood disorders are not related to a specific event, like a death, I wouldn’t benefit from straight-up CBT. But say there’s something specific that really bugs you, like being too confrontational and too defensive in your relationships. CBT takes your current unhealthy behaviors (yelling at your spouse), examines them briefly, and then works hard to find alternate behaviors that you can put in to practice. This actually changes the way you think. You get less angry. I’ve used CBT techniques when things like overwhelming anxiety about leaving my house crop up. Example: I HATED walking to the subway. I bought audio books, put them on my iPod and put my iPod on about 15 minutes before leaving the house, while I was getting ready. This habit replaced the habit of procrastinating getting ready to go, with much healthier results. It worked because it distracted me from the anxiety–I get caught up in books really easily. There’s a reason I spent so many years studying literature. If you feel anxiety about something specific, but don’t have generalized anxiety like me, you might find that a set number of sessions with a CBT-trained therapist enormously helpful.
That’s my take on therapy. I hope it helps debunk some myths. Please, ask questions. It’s hard to be objective about something I’m so close to! And, for the record, I cannot wait for Linda to come back. I LOVE that safe space. I’m tempted to ask for keys to her office so I can just hang out there when she’s on vacation. (Joke. That would not be legal.) But seriously, bring on the questions! I love talking about therapy, because it saved my life. Meds only do so much. It’s therapy that actually creates lasting change. And everyone who knows anything agrees that the combination of the two is usually best. Thank you to all the therapists I’ve ever known. I’ve been lucky to encounter some brilliant minds.
A final note: this post is dedicated to someone who is starting therapy relatively late in life. You are brave. You are one of my heroes. I love you. You inspire me daily.

See how it looks like their friends? They're just talking? That's what therapy can look like.

Dear readers,

Thank you for sharing your stories with me. Old friends and new have written to me to say “me too! I get it!” about something you have read here. What I wanted when I started this thing was to start conversations just like these. I talk about the anxiety, the meds, the intense desire to be pregnant, the migraines, the therapy and whatever else is hard to say because I know that when we just say them out loud, our fears become easier to face. You inspire me. Thank you. Keep talking!

Love always and yours truly,
Anne-Marie

Warm fuzzies from Lewis the Dog, who loves you no matter what.

Migraine Update

I thought that this list might be helpful. These are the things I now know cause migraines, after keeping a headache diary for the past couple of months:

  • Hunger. If I don’t eat, I get a headache. I have to stop what I’m doing and eat, no matter how busy things get.
  • Caffeine. One, maybe two cups of coffee a day, only in the morning or very early afternoon, and I’m fine. If I use it as a cure, it triggers a “rebound” headache.
  • Sugar. Sodas, in particular. If I have something like this on an empty stomach, it’s a pretty good bet. Usually only in combination with another factor.
  • Disrupted sleep pattern. It could be a too-long nap in the middle of the day (woohoo for under-employment) or staying up too late. Sleeping too much or too little. Regular sleep is the best medicine for my headaches since pain killers.
  • Hormone shifts. Artificial hormones, as my other migraine post explains in detail, like the ones in The Pill. Natural estrogen spikes will do it, too, but less aggressively.
That’s my list. I’m slowly bringing back the foods that supposedly trigger migraines, because in my experience, they really don’t. They do for some, but not for me. It seems so simple, doesn’t it? Unfortunately, I’m the kind of person who will fail to realize she hasn’t eaten until it’s been 12 hours. I’m working on it, but I tend to put whatever I’m doing for someone else ahead of what I need. And that’s a bad lesson to learn–taking care of myself is not less important or self-centered. But it can often seem that way. (I know, I know, just wait until I’m a mom–gotta work on this now!)
All-time best description of migraine symptoms, in French:

"J'ai envie de vomir" = "I want to vomit"

Found here.

Science is Awesome! Brain Research & Neuroplasticity

I’ve been a little hard on doctors lately, so I wanted to do a post about some doctor stories that have me bouncing-in-my-chair excited.

I just started reading a book called “The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science” by Norman Doidge. I’ll do a full post/review of this book when I’m finished reading it, but I just have to tell you what I’ve learned so far! (Rolfer Brooke recommended it to me, so I got it for the kindle immediately.)

There’s a concept called “neuroplasticity,” named for “neuron” (receptor cells, receivers of signals of all kinds) and “plastic” as in malleable, changing, flexible. The basic idea is this: if something is damaged in the brain or in a body part that is essential for communicating with the brain–e.g. damaged retina = loss of sight–then you can use various exercises and tools to teach the brain a new path to the same result. It finds away around that damaged part. The damage is still there. You don’t fix it, you find a new path. And for those of us who have felt un-fixable, this is some pretty great news!

The first doctor/researcher Doidge features can help the brain of a person who has been blind from birth create actual visual images. They use a camera strapped to a pair of glasses and an electrode strip on the tongue. Camera tells electrodes to fire, tongue tingled (like “champagne bubble fizz”), brain gets signals from tongue and creates a visual image. It works. For real. He got the idea of using the skin to send “visual” signals to the brain when he realized that a blind person using a cane turns the vibrations in the hand into a map of the room in the brain. How cool is that?! As a certain seven-year old likes to say, that is double-scoop awesome.

Why am I so excited? Well, for a long time, there was an attitude about disorders like my anxiety and depression that sort of went like this: “Your genes caused your brain to deal badly with serotonin and other chemicals. Sorry, but that’s how it’s going to be forever. We do have these pills you can take, though.” Now, my amazing therapist “L” is talking to me about how new research is showing that therapy and meds in combination can RETRAIN my brain to stop re-uptaking too much serotonin and let more of the stuff hang out, helping my moods. The neurons also find new pathways g (She may have used different language.) By practicing mindfulness and other anxiety-reducing “cognitive-behavioral” tools, I can train my brain to actually be less anxious. The neurons themselves seem to be learning.

Cognitive-behavioral therapy, or “CBT,” is not technically the kind of therapy I use (interpersonal therapy has been my method of choice). But many of the strategies and tools we’ve developed for me overlap into the CBT area of therapy, which is all about using outward behavior to produce new and different cognitive (in the mind) results.

Who feels hopeful about a medication-free life?! Or at least a medication-free couple of years while I pop out some kids? I do! I do!

Here’s the catch: I have to want it, badly. I have to do things that feel exhausting, terrifying, embarrassing, uncomfortable. I have to take the meds, for now. I have to pay for twice weekly therapy and quarterly, crazy-expensive, far away (NYC) psychiatric appointments. Because, as I may have mentioned, no one can put a price on Dr. C’s support as I try to get off my meds. A psychiatrist whose goal is to get me to the point where I don’t need the meds and therefore all but stop seeing/having to pay him? Yes. I found one.

I have to work with a whole support network, a team, which means I have no shyness left. I can write this stuff for the Internet at large because I talk about it with near strangers so often. But oh, dear readers, I am actually molding and changing my brain. Genetic lemons? Hand me a juicer. I’ll make lemonade until my arms fall off.

Bring. It. On.

Migraine

Other titles I considered for this post include:

Honey, Hand Me an Icepick

Why I Love Opiates

or

“It Will Prepare You For Childbirth”

Here’s what seems most bizarre during a migraine attack: no one can see that anything’s wrong. People actually smile at me, as though my eyeball were not about to pop out and liquid brain were not about to slide down my face. People try to talk to me in voices that sound huge and impossibly loud. I have to explain the situation to them even though the effort it takes to talk and open my eyes is exhausting. And when it’s finally dark and quiet, the phone always rings. The whole thing starts to feel like a mean joke.

My first migraine headache hit me at age 20, during the summer after my sophomore year at Barnard. I had a headache on the subway coming back to my dorm after my internship and thought it was the heat, so I took a nap when I got to my room. I woke up to the worst pain I had ever experienced. I thought I was dying. I thought that my brain was slowly pushing its way out of my right eye socket. I wanted to dig out that eye with my fingernails just to speed up the process.

It sounded lame even to me when I explained to the head of composition in the English department that headaches–not projectile vomit or high fevers or anything measurable– had prompted me to cancel, sometimes twice a month, the classes I was teaching. But I really was working and studying through so much of the pain.

Joan Didion describes this early stage of chronic migraine perfectly– “… I had no brain tumor, no eyestrain, no high blood pressure, nothing wrong with me at all: I simply had migraine headaches, and migraine headaches were, as everyone who did not have them knew, imaginary. I fought migraine then, ignored the warnings it sent, went to school and later to work in spite of it, sat through lectures in Middle English and presentations to advertisers with involuntary tears running down the right side of my face, threw up in washrooms, stumbled home by instinct, emptied ice trays onto my bed and tried to freeze the pain in my right temple, wished, only for a neurosurgeon who would do a lobotomy on house call, and cursed my imagination.” (“In Bed,” The White Album, 1979)

Of course, I didn’t go see a doctor, either. I just stumbled to 24 hour drugstores for Excedrin and Starbucks Double Shot iced liquid sugar/caffeine and then stumbled home, filled my pillow case with ice packs and fantasized about a massive hypodermic needle. I wanted to use this needle to go in through my temple and extract the unbearable pressure behind my eye. Excedrin rarely helped after awile. When I was in Europe or Australia, I could get an over-the-counter drug, essentially Tylenol 3 (acetaminophin and codeine), that worked every time. So I asked vacationing friends to buy the biggest boxes available and bring them back for me across the oceans. Not European chocolate or Australian wine. No, I wanted pain killers.

Once I finally had health insurance and the courage to see a neurologist, I got prescription medications, including a daily preventative called TopaMax. (By the way, you know things are bad when you are disappointed that your MRI has come back clean, your blood pressure is fine, your neurological exam goes well and your test for epilepsy has ended without inducing a seizure.) I think that because migraines are so elusive and invisible, it’s tempting to put all of one’s faith in the first person who promises help. So, I took TopaMax eagerly, despite the fact that relatively common side effects include “loss of some neurological function” and “memory loss.” It’s also a good thing I read the fine print, too, because I managed to catch this uncommon side effect: my birth control was maybe going to be less effective. So I threw it out. No way was I taking that risk. And Praise The Lord, the drugs worked! Or so I thought.

This June, our new doctor in New Haven suggested that I try a few things to get rid of even those twice monthly headaches I was still experiencing. By regulating my hormones, he suggested, we might relieve them altogether. Why not go back on birth control? I wasn’t taking the TopaMax anymore. Also, I should cut out wine, chocolate, cheese and nuts. Oh, and I should take a drug called a Beta Blocker as a preventative; it would “open up” the blood vessels in my brain.

Soon, I was in bed again two or three times a week. I had a migraine in July that lasted for over three days. The only thing that helped during that attack was a combination of acetaminophen and oxycodone. And it only helped for six hours. In desperation, I went online, clutching an ice pack to my right eye and cursing the light from the laptop screen. I went looking for something, anything that I hadn’t already heard of that could be causing this pain. I was incensed when I found this: “Certain medications can aggravate migraines, especially oral contraceptives” (mayoclinic.com). I threw out the birth control (again) and seethed with anger.

The TopaMax hadn’t taken care of the headaches. Going off the artificial hormones in my birth control had done that. Here I was, back on the same birth control and getting headaches with the same frequency. And not a single medical professional had ever even mentioned the possibility that they were connected–not my gyn, not my primary care physician, not even my neurologist. Doctors make mistakes. Fine. But I am talking about a common side effect of one of the most common prescription drugs! And I found out about it on the internet.

That was six weeks ago. Each week since then, migraines have become less frequent. Last week, I had one, and a relatively low dose of Imitrex killed it. No narcotics necessary. This week, so far, nothing. (Knock on wood.)

I still want to live headache-free. But this time, I asking for help in a new place. Today, I had my first appointment with Brooke, at New Haven Rolfing. She’s working with the connective tissues in my body to help loosen the muscles in my upper back, strengthen those in my lower back and retrain my nervous system. (It feels like a massage but with the precision of acupuncture.) My shoulders and neck always tense up and hurt like hell before, during and after a migraine, so I’m going to start with that and see if the connection goes both ways. Lose the muscle pain, lose the head pain? I think it’s worth a try. Because I want fewer prescriptions, not more. I want a solution I can use while pregnant or breast feeding.

My neck and shoulders feel like someone hit them with a baseball bat, but Brooke warned me that I might feel bruised after our session. (Rolfing does not actually give anyone bruises, by the way.) And anyway, pain like this is easy. I know where it came from and that it’s going away.

I don’t know if this is true, but someone once suggested a silver lining to all this: migraine attacks may prepare me for childbirth. It makes a certain kind of sense; at least contractions end and after the pain, you get a prize. So far, all I know is that I should take care of this body in every way I can. The price for ignoring its signals is way too high. I have never particularly felt at ease in this body; now, I think I may just grow to love it.

I Am Not My Uterus, II; or, Make Up Your Own Mind Because The Liberal Approach Is Also Bonkers

First, a small clarification: I am using the terms “conservative” and “liberal” in the quantitative sense; i.e. a conservative or liberal amount of something. My last post was about a “do as little as possible” approach to preconception health, while this one is about the “try to do everything” approach.

So, what are we supposed to do? Cut out everything that is not healthy, including everything from processed foods to artificial hormones (The Pill, forever) and, not least, we should eliminate all unnecessary electronic devices from our homes for fear of “electrosmog” (electromagnetic pollution). I’m getting this from the folks at Foresight, a British organization devoted to preconception health. Much of the information on the sight is actually pretty great. My nutritionist recommended that I check it out, and I have found much of it very helpful. Besides its unfortunate name, which I still think rightly belongs to some group protesting circumcision, what I find most objectionable about this group is, again, all in the language. Why, I keep asking myself, does it seem necessary to couch some good advice (fear of electricity notwithstanding) in all of this fear?

Foresight defines their approach to preconception care as a comprehensive plan aimed at “improving natural health in both parents [in order to] enhance fertility and successful pregnancy.” So far, pretty good. We’ve got both parents involved, here. And since my husband’s gender actually produces sperm daily, while my eggs were made in utero, I think we ought to be concerned about the male side of this conception process. I take issue with what comes next.

“The preconceptual approach of Foresight can help with overcoming some of the issues in connection with conception, pregnancy & birth:

  • Infertility
  • Low Sperm Count
  • Secondary Infertility
  • Miscarriage
  • Birth Defects
  • Low Birth Weight
  • Premature Birth
  • Post Partum Depression
  • Breast Feeding”
Why should I have to worry about all these things immediately? I can’t help but feel that their message is that if I don’t follow their program, then I haven’t done enough to prevent the grave misfortunes on that list.
And then there’s this lovely sidebar: “Vaccines – The Truth! Vital information regarding the adverse effects of vaccinations” which is not separated by more than a small space from the statement “Treating Autism: Because Autism Is Treatable.” I’m all about knowing what’s in a vaccine and the potential risks behind a vaccine, so I do like that “Vaccines – The Truth!” is actually a list of research about vaccines and links to that research. (Although some of it could be more accurately characterized as “research.”) But no causal relationship has been established between vaccines (MMR specifically). Not receiving vaccines is dangerous. In fact, it’s a lot more dangerous than the small risk associated with vaccines. And kids are now getting the measles again. I’d also like to remind everyone that the man who first “studied” the “link” has now admitted to fraud.

What’s my point? Why am I listening to anyone discussing preconception care if they’re all nutcases? Because they’re not all nutcases. What I’m trying to do here is find someplace in between these two infuriating points of view.

I’ve got to take what I want from both sides. I want vaccines for my kids, because I don’t want them to get the measles. I’m trying to cut out processed foods, because the additives scare me and real food tastes better. I always have eaten whole grains (thanks, Mom and Dad!). I don’t take The Pill anymore because it gives me migraines. I avoid plastics I’m not sure about because I’ve read the science, and it’s good science–bisphenol A causes serious damage. I am keeping my electronic appliances because, well, they’re useful, and I don’t believe in electrosmog. When it came time to buy new mascara, I bought some that looks great and is made without parabens and other scary chemicals. I clean my bathtub with baking soda and vinegar because it looks whiter and scrubs easier and doesn’t burn my lungs. It really is not about fear. I refuse to add fear to my life. It’s about doing what feels good and healthy for my family.

Maybe I will have trouble conceiving and we will get our hair tested for heavy metals, throw out the XBox and wear those pollution masks to filter out most of the air and any passing cigarette smoke we might encounter. I’m not counting on it. The women on both sides of my family have a serious history of fertility. Mom has seven brothers and seven sisters, for crying out loud, with no sets of twins thrown in there. That’s fifteen babies. Yeah. Take a minute for the courageous lade who was my Grandma Celia.

But a lot of things can and do go wrong in pregnancy, and we don’t always know why. We do know that I have a history of anxiety and depression. So I want to do what I can to decrease the odds that something will go wrong, especially psychologically, when we finally decide to try for a baby. It’s also about increasing the odds that things will go as smoothly as possible, in body and in mind, in a way that actually enhances our daily lives. Who doesn’t love the smell of bread baking? I have the luxury of time to bake bread from whole grain flour that is actually soft and yummy. Who doesn’t want a happy digestive system? My husband’s acid reflux has improved so much since we started paying close attention to what we eat. Anyone who has ever had a migraine will understand why it was easy to throw out my birth control (and switching methods! Sorry for TMI but I don’t advocate just throwing caution to the wind!) We’re taking our friends’ advice and ignoring people or instructions that seem crazy. Apparently, this is only the beginning of all that. Bring it on. There’s plenty of common sense in our house. Oh, and thanks for being my rock when I do completely lose it, Nathan. It’s a very good thing that you don’t mind having good sense for the both of us sometimes. I love you.

I Am Not My Uterus; or, Why I Dislike the Conservative Approach To Preconception Care

I think it’s time for a post that better defines “Preconception Health” as I see it, and not just because I was recently asked why I was anticipating fertility issues. Let’s start with the bare minimum–obviously, that’s the government and the first hit on google when I type in “preconception health.” Here’s what womenshealth.gov has to say:

“Preconception health is a woman’s health before she becomes pregnant. It means knowing how health conditions and risk factors could affect a woman or her unborn baby if she becomes pregnant.  … some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems, such as diabetes, also can affect pregnancy. Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned.”

Stop. Right. There. I need to rant, briefly: people, women included, need to be healthier–regardless of whether or not we plan on reproducing! I HATE being talked to or treated as someone who needs to think about her reproductive system as more important than anything else. This statement makes “every woman’s health” an afterthought, a thought after we have all given appropriate thought to the women who will be reproducing. Are you kidding me? I should be thinking about my health in case I get pregnant accidentally? We’re in the middle of an obesity epidemic, and that’s just for starters! Take care of yourselves, ladies, to prevent obesity, heart disease, diabetes, breast cancer, osteoporosis, even depression, for heaven’s sake! We are not incubators, and I resent even the slightest intimation that woman = uterus. We can continue, now. I have taken a deep breath and counted to ten.

“Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. … about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.”

Rant time, again. I can tell by the language they use here that they’re trying to reach as many women as possible and avoid sounding too preachy. I respect that. I don’t respect the manipulative use of “baby” when we are clearly talking about a “fetus.” This is an obvious attempt to push the emotional buttons necessary to get a busy or reluctant woman into her doctor’s office. I understand that. I don’t forgive it. I’m not even talking about the abortion debate rhetoric–a fetus is dramatically different from a baby, and I want to reclaim this language from politics. I recently read a great book about how gestation influences the rest of life. I came away from Origins, by Annie Murphy Paul, thinking WOW are we missing a lot by just looking at a fetus as just a future baby! There is so much more to this! But for the purposes of the webpage I’m talking about, I suppose that would be too wordy. But I think women deserve a straight up, educational, clear and concise wakeup call, rather than gooey talk about “your baby.” To me, the message is clear: too many women are not taking good care of themselves in general. If we focused on empowering women to take charge of their own health and health care, unplanned pregnancy would be a much less frightening prospect. Not to mention the fact that it would happen less often as women became more invested in and educated about their own bodies.

Now let me share the hilariously bad photograph that accompanies the preconception health page of womenshealth.gov. Because it’s just so… well… “.gov”… Can you count the ethnicities? Notice how the doctor is the only person who is clearly 100% caucasian? Love it.

The title for this photo is "man-woman-doctor," by the way. Glad she has her male protectors. *Rolls eyes*