My appointment with Dr. S. started well enough.  Traffic into downtown Baltimore was brutal, but I gave myself plenty of time.  The drive from my office (just on the edge of the city) to the hospital where Dr. S. maintains an office is well, interesting.  It takes me through some of Baltimore’s toughest neighborhoods, which can be a little intimidating. 

Baltimore is a rough city.  Riddled with drugs, crime, corruption, and poverty, the inner city has become something of a battle ground.  Rarely does a day pass when there hasn’t been a murder, nevermind the two or three that seem to be the “norm.”  And it’s getting worse.

As I drove through the streets of Baltimore, at 1pm, I was struck by the number of people just . . . hanging out.  These people were not at work in the middle of the day; they were just sitting on their stoops shooting the breeze.  Doesn’t anyone work?  Seriously, there were hundreds of people just hanging around.  I saw at least two drug deals go down (where are the cops?!?)  Anyway, I am digressing a bit from my original purpose for this post (must focus my short attention span better). 

So, after the enlightening drive in, I arrived 20 minutes early for my appointment.  The first thing that I noticed was the very busy waiting room.  Normally, when I go to Dr. S.’s office, it’s pretty empty.  Yesterday, there were at least six people waiting.  I signed in, paid my co-pay, and took a seat. 

A few minutes later, the medical assistant person (one I’d never seen before) called my name (actually, she called Ms. Burnadette – why is it so difficult to pronounce a name that is so freaking easy?). 

She weighed me (SCARY!!!), took my BP (slightly elevated, but not surprising given the aforementioned drive in), pulse (also slightly elevated), and BG (120 mg/dl).  Then, and this is why I’m still reeling, she began to enter my info into the computer.  At one point, she was clearly frustrated. 

She said, “This is so messed up.  It has two different diagnoses for you.  One is Type 1, and the other is Type 1 Adult Onset.” 

Hoping to help her out, I told her that I am a Type 1 who was diagnosed in my twenties.  She then asked if I take “pills” for my diabetes.  I told her that no, as a Type 1, I need insulin to control my blood sugar. 

She said (and this is where I nearly lost it), “I don’t even know the difference between Type 1 and Type 2!”

WHAT?!? She works in an endocrinologist’s office and she doesn’t know the basics of diabetes!

I calmly attempted to explain the difference, but once she heard “beta cells in the pancreas,” her eyes glazed over and she stopped listening (must find less technical ways of describing diabetes).  I gave up and returned to the waiting area. 

Here’s something I really like about Dr. S.: *he* comes to the waiting room and escorts patients to his office.  Most doctors have their office set up so that you (the patient) are escorted to an exam room by a medical assistant.  Then, you sit in that room until the doctor comes in.  Dr. S. does the talky part of the appointment first, then the exam after that.  It’s really nice.

Here’s the other thing I really like about him: he actually apologizes to patients when he keeps them waiting.  My appointment was at 2:00, but I didn’t see him until 2:40.  Most doctors would just act as though their time is far more valuable than yours. Dr. S. doesn’t do that, and I respect him more for it.

He escorted me back to his office, and we talked about what’s been going on.  Telling him about Lisa was especially hard, but I managed to do it without sobbing, so score one for me!  We also talked about the failed IUIs and other infertility stuff. 

Then, I started babbling about my weight and how unhappy I am.  I told him about my new low-carb resolve (today is day three and I haven’t cheated once!) and asked for his thoughts on Metformin.  His answer surprised me.  He didn’t feel that the potential benefits (Met is weight neutral, meaning that it doesn’t cause weight gain OR weight loss) were worth the potential risks.  When I said that I needed something to help get a handle on my weight, he said that because I’m TTC, I have very limited options.  His exact words were:  “yeah, it sucks.”

I can go back on Symlin during the times when there’s no chance of pregnancy: like now, thank you ovarian cysts, or the time from when I get my period until IUI day.  But it’s not really worth it if I can’t ever adjust to the drug long enough to avoid the horrible nausea.  Besides, I’m not eating enough carbs to take Symlin.

When I left his office, we had made no changes to my treatment plan.  I felt somewhat defeated, but I recognize that there is no magic pill for weight loss.  I’ve got to stick to my new way of eating and get some exercise.  It can work; I just have to stay focused.

So, that’s the (not-so) skinny on my appointment with Dr. S.  I see him again in three months (I can’t believe November is three months away!), and I’m hopeful that I’ll have lost a decent amount of weight by then. 

Or that I’m pregnant – that would rock, too.

Tomorrow, I see Dr. S.  Yep, it’s time for a visit to the principal’s office.

I have mixed feelings about this.  I am looking forward to and dreading this appointment at the same time.   There will be no lab results; no A1c.  As always, I’ll be weighed (dreaded moment #1), BP checked (this shouldn’t be bad, but who knows?), and BG tested on their dinosaur meter, whose results are ALWAYS vastly different from mine.

We’re going to review my Dexcom reports (dreaded moment #2) and see what, if any, chances need to be made.

We will be making changes.  I have to make some changes.

I know he’s going to ask me about my weight gain (dreaded moment #3).  I have some good reasons for this: my sister’s death, fertility drugs, blah, blah, blah.  They’re all just bullshit excuses.  I’ve gained weight because I’ve been eating like crap and not exercising.  PERIOD.  

But, I feel so deep in this hole that I have no idea how to get out.  I was doing so well on Symlin, but it’s not safe during pregnancy, so I had to stop.  And it pisses me off because so many of the things I’m doing (or not doing) because they’re unsafe for pregnancy are probably for nothing. 

I have a point; I promise.

Starting today and for the foreseeable future, I’m going to be eating only low-carb foods.  No more pasta; no more fries.  I will not eat any of that stuff because it is my own personal kryptonite.  I’m going to stick to protein, fat, and veggies (of the uncooked variety – I loathe cooked vegetables)

I’m also going to ask Dr. S. about Metformin.  This is a big fear because Met is one of the meds I was given during my misdiagnosis fiasco. It did nothing for me except make me sick.  But, I’ve read that the XR version is much easier to tolerate, and at this point, I’m willing to try.  It’s also a pregnancy category B drug, which means that it’s probably safe (nothing is category A).

One of my biggest problems right now is my insulin intake.  I’ve definitely got some resistance happening, and it’s leading to much higher doses of insulin to cover basal and bolus needs, which is leading to more fat storage, which is leading to greater insulin needs, etc. It’s an endless cycle.

There’s got to be an easier way!

I have made no secret of my struggle with diabulimia. And there is this big voice in my head that’s telling me to just stop taking so much insulin.  Just take a small shot here and there to avoid DKA.  My weight would drop so quickly, and I’d feel great.  That’s the thing that makes it so appealing.  When I was restricting insulin, I felt fantastic.  Most of the time, I had no idea how high I really was, but it didn’t matter – I had tons of energy.  Now, I struggle just to get out of bed in the morning.

But, I won’t do it.  I’ve spent the past three years trying to maintain a decent A1c so that I can have a baby.  I’m not going to throw that all away now for a quick fix to my weight issues.  I want to.  But I won’t.

I have a plan, and I’m going to do my best to stick with it:

1. Eat low-carb
2. Take Metformin
3. Exercise

If anyone has any suggestions or words of wisdom, please, please share!

Part of the reason I’ve been able to get through it all has been because I haven’t had to worry about work.  My boss, who has always been kind and supportive, allowed me to take the time for doctor’s appointments and to grieve for Lisa.  She was always someone who I felt like I could talk to.

Don’t get me wrong, I’m not all take, take, take.  I have worked very hard to earn (I think) her trust and the freedom she gives me.  And she knows that I will do whatever it takes to get the job done. 

So, when I brought a continuing issue to her this morning, I expected her understanding.  I expected her empathy.  I expected her to hear me out.

What I got was a response that upset me a great deal.  Instead of understanding and empathy, I got condescension.  Instead of hearing me out, I was told, “I don’t see what the drama is?”  (There is something about using the word “drama” that drives me crazy – it implies diva-like behavior). 

I remained calm and tried to explain the situation better.  She continued to imply that I was being low and petty for even bringing it up.  To me, this problem is something that directly affects my job.  It is a big frustration, and one that could be easily fixed.

As soon as I got back to my desk, the tears began.  Am I crying because I’m angry?  Is it because I’m upset?  Is it because the smallest things seem to make me cry lately?  Probably all of the above. 

I know that my boss is going through a lot herself.  Maybe I caught her at a bad time.  I don’t know why she reacted this way, but for whatever reason, her reaction managed to shatter the composure I’ve worked so hard to maintain. 

Frankly, putting on a happy face every day is exhausting.  Trying to act like everything is fine is really taking its toll.  I spend so much energy just getting through the day that when someone I’ve come to trust and respect hurts me, I have no defenses left.

The day after my sister died, I got my period.  With that, all of my dreams of having conceived a child on her birthday were shattered.  It was more pain on top of some of the greatest pain I’ve ever felt.

Nevertheless, just two days later, Brian and I drove home to Maryland so that I could continue with the fertility plan – it’s what Lisa wanted; she wanted to be an aunt almost as much as I want to be a mommy.  I went to the appointment at 7am the day after we arrived home (after driving for 15ish hours).  I moved forward with the cycle, did the awful drugs, had the icky condom cam more than once, and went through two more IUI procedures.

For reasons I’m not going to get into, I didn’t think it worked this month.  But, even when your head knows something, sometimes your heart is still holding out hope.

This morning at 7am, I had the blood draw that would definitively tell me if I’m pregnant.  I got to work and attempted to catch up on some blog reading, but I was super busy.  I did stumble across Elizabeth’s post, which, as you can tell from my comment, invoked certain emotions in me.

Then, just after lunch, I got an email from a coworker announcing that his wife is pregnant with their 2nd child.

Then, not even five minutes later, I got the call that my pregnancy test was negative. Again.

And now, I can’t stop crying.  Seriously, I’ve been crying for over an hour, and it just won’t stop.  I actually had to leave work because I couldn’t hold it in. I don’t begrudge anyone the right to have a child; I really don’t. I just wish that it didn’t have to be happening all around me. ALL. THE. TIME.

More than anything, I want to talk to my sister (and please don’t tell me that I can talk to her anytime – I want to HEAR her voice).  I want to tell my best friend how much it hurts, and I want her to tell me that it’s ok to feel robbed.  That my pain doesn’t diminish anyone else’s happiness.  But, I have no sister; my best friend is gone.

They say God never gives us more than we can handle.  Well, I don’t know who “they” are, but they’re full of shit.  Because I can’t handle all of this.  I need a break.  A break from diabetes, from infertility, from everything.

I ordered this pendant to hold a small amount of her ashes. It is even more beautiful in person, and I'm wearing it today. I hope it gives me strength!

How is it possible that it’s only been three weeks since she left? Three weeks since she took her last breath.  Three weeks since I watched the funeral home person load her into a hearse.

It feels like three years.  Except, by the time three years go by, I hope to feel a little less empty and a little more like me.

But, it’s only been three weeks.  I’ve picked up the phone to call her a few hundred times, and after every good, bad, annoying, sad, and stupid experience I have, I think “I can’t wait to hear what Lisa thinks about this!” 

I feel like a huge part of me is missing, and while I try to go through the motions – even putting on a happy face – it’s hollow.  I just don’t know how to exist in this world without my sister. 

I need some good news, and I need it NOW.

Lisa was my only sister – my only sibling.  She was “that person” for me.  The one person I could call with any issue; the one who called me.  She was more than my sister; she was my best friend.  I will miss her every day.

You guys know all about our struggle with infertility.  Since that first appointment at the fertility practice (I can’t believe that was only three months ago!), I’ve had blood tests and ultrasounds (condom cam!) and surgery and awful procedures (HSG, anyone?).  I’ve taken drugs (Clomid, Follistim, and tonight, Ovidrel) that have made me hot and cold at the same time.  I’ve worked my ass off to get my A1c down to an acceptable pre-pregnancy number. 

Now, all of the hard work and anticipation is over.  Now, it’s up to my body and some (hopefully) strong swimmers.  Because tomorrow and Friday, I get inseminated.  Yeah, you know how sexy that sounds, right?  But, the fact is that with our fertility issues, an Intra Uterine Insemination (IUI) is really our only option.  We could continue to try “the old fashioned way” for years, but it wouldn’t work.

This morning, I had my blood drawn and an ultrasound to check the status of my superovulation (basically, forcing my body to mature and release more than one egg).  I don’t have the bloodwork results yet, but the ultrasound showed what appeared to be four mature follicles.  This is exactly the sort of result we were hoping for.

So, tomorrow morning at 9:30ish, I will have my first of two IUIs.  I have no idea what to expect (do I get a martini before and a cigarette after?), but I’m very excited.  Brian and I will make the drive from our home to Rockville (where the BIG fertility office is). 

On Friday, we’ll repeat the process.  I LOVE that they do two IUIs instead of the usual one.  It’s a pain in the ass to drive all the way to Rockville two days in a row, but I’ll do it without complaint.

What makes this timing even more special is the fact that Friday is my sister’s birthday.  NOTHING would make me happier than to conceive her niece or nephew on her birthday.  When I spoke with her this morning, although “high” on morphine, she was very excited and hopeful. 

Wish me luck, guys.  The odds aren’t great (roughly 20% conceive on the first try), but I’m optimistic.  I really feel like it’s our turn.

A few years later, when my parents divorced, we both experienced the trauma in different ways.  There is not a single human being, other than her, who knows what it was like. 

When she became a teenager, she wanted nothing to do with a little sister.  Still, I idolized her.  I dressed like her, which drove her crazy.  I tried to style my hair like hers, too.  But my thick, wavy mass would never do what her straight (or even permed) hair did. 

As we got older, she became more extroverted; I became an introvert.  We began to have less and less in common.  I was the “smart one” to her “pretty one.”  I was overweight; she was thin.  I hated her almost as much as I loved her.

As we grew into adults, our differences became more pronounced.  She was always content to skate by, while I was an overachiever who never wanted to struggle.  We made different lives for ourselves.  I moved far away.  But, somehow, the distance made our relationship grow.

Well into our thirties, we learned how special our sister relationship is.  She still drives me crazy sometimes; she’s one of the most stubborn people on earth.  But, after all these years, I still idolize her.  I still see her as larger-than-life. 

And last Monday, after my mother had gone to sleep, I snuggled into her bed, and we talked nonsense for hours.  I will treasure it always.

I’m feeling so many mixed emotions these days that I hardly know which way is up. 

My sister.  How do you accept that your sister is dying?  How do you reconcile hurt feelings and anger when the knowledge that her time is so limited is always weighing on your mind.  Am I allowed to be hurt when she hurts me?  Or do I have to just forget about it?  Am I allowed to feel taken for granted?  Or do I just accept the knowledge that I will never be as important to her as she is to me?  I don’t know the protocol and it’s killing me.

Babies.  When you’re trying to conceive, babies are everywhere.  They are in every conversation, every commercial.  They are discussed at meetings and social events.  You just have to grin and bear it.  Even when people complain about their lack of sleep/time/social life, you just have to shut up and nod accordingly.  Nevermind that you’d give your right arm to experience that lack of sleep/time/social life.  Nevermind the energy/time/money you’ve expended just to have a chance at a baby. 

Diabetes.  I hate you. 

This is, without a doubt, the hardest time of my life.  With the exception of Brian, I feel very alone.  I’m scared, angry, hurt, and sad.  The cracks in my shell are starting to show.

I guess I had a blog post in me after all.

I’ve written about my sister before, and she’s a common commenter on my posts.  Her latest scans and bloodwork did not yield good news.  Her cancer is growing.  FAST.  I’m angry and scared about what this means, and I fear that I’m going to have to step out of my denial bubble soon.  I like my denial bubble – it’s safe there.  I’m traveling to Florida to see her in a month or so, and I’m hopeful that her new treatment won’t leave her feeling sick, weak, or anything else bad.  I know she doesn’t want that.

You all know what’s going on with the fertility stuff.  I got more blood test results today, which indicate that I need more blood tests.  WTF?  My arms are already bruised from the last two blood draws on Tuesday.  Now, I have to go for more (they’re going to have to take a gallon or so for all of these tests!).  I HATE having my blood drawn – mostly because I have to deal with morons. 

The big D is a big B lately.  Almost every day, I’m going low right after I eat lunch, which causes me to treat and then skyrocket a few hours later (damned Symlin).  Today, I’m not eating until I bottom out.  I know that Apidra is a fast insulin, but I seem to have a much longer response time in the morning.  Not to mention my I:C ratio and basals in the morning are so much higher than the rest of the day.  I need an advanced math degree just to figure all of this nonsense out.  I really need a diabetes vacation.

So, that’s why I’ve been scarce lately.  My subconscious is desperately working on sorting all of this out, hence some very weird dreams lately, which have left me completely exhausted when I wake up.

On a happier note, I believe that by now, little BSparl has made her way into the world.  I want to offer Kerri and Chris my most heartfelt congratulations.  I’m very happy for you all.