The Things We Do

I sit here tired...no, not tired. Tired doesn't even begin to describe it. Exhausted. Bone-tired exhausted. I sleep every night. Sort of. I can get to sleep - a little quicker with a modest snifter of cognac, but I can't stay asleep. I wake up. Not just a slightly dreamy roll-over, full-on awake. Not just once, but three, four, five, six, sometimes even ten times a night. Every 45-60 minutes, I'm wide awake. I have to pee, my butt muscles are screaming at me to change positions, my shoulder is crying from the pressure of sleeping on it when it's still not healed. 

This morning we went to the reproductive endocrinologist again for another endometrial biopsy. This is the fourth? fifth? Honestly at this point I've lost count. I had one after the first failure, then I had several more trying to confirm that we'd gotten rid of a chronic inflammatory condition discovered after the first one, and then looking at whether the new drug protocol was working right in several trial cycles.

We did another two-embryo frozen embryo transfer IVF in early December and got the negative test on the 12th. We thought we'd cleared all the issues that we'd had going on during the fresh round and the cycles leading up to this.

The only thing I didn't know about the time, was that the doc wasn't entirely happy with what they saw on the last endometrial biopsy. Progesterone that occurs naturally or in our case, added through drugs, has several effects on the endometrial lining that make it an attractive place for an embryo to embed and begin growing. Apparently mine didn't look as happy and inviting as it should have last time - though all other signs were good, so he chose to proceed with the transfer.

I trust my doctor, so I don't know that I'd have made a different decision than that if I'd known, and honestly it's pointless to debate the idea.

We have one frozen embryo left. One last chance to get this done - or we're out. I don't have another $28-$30,000 to do another donor round short of winning the lottery, we've tapped all the resources we have access to at this point.

So this time around, we have to get things as perfect as we possibly can. So I've spent a full cycle on all the drugs, plus added Crinone - progesterone suppository gel, so nearly double the progesterone most IVF patients get during a cycle. Usually it's just intramuscular shots of progesterone oil, which is just a joy ride in and of itself. 1.5 inch 22 gauge needles in alternating butt cheeks at 4 or 5 in the morning, depending on when the Man has to be at work each day. I'm bruised and feel like I've been beaten repeatedly with a 2x4 across the ass every day.

I'm already on double the amount of trans-dermal estrogen with the patches (I wear two rather than one) - and instead of twice daily oral estradiol, I take it vaginally to help with absorption because apparently with my rearranged gut I wasn't getting enough of it through my digestive tract. Where a normal estrogen blood level for a pre-menopausal woman is 20-375, my levels have been running at 1400-2100 depending on how far we are into the cycle. The blood progesterone level isn't so much in question now although it's likely to be huge, but we're looking at the evidence in the lining from the biopsy today.

The sleep issues are, at least in good part, attributed to those massive hormone doses, and unfortunately sleeping pills are not an option during all of this. I spent quite a bit of time after the Nightmare sleeping with the assistance of Ambien, and dear God do I miss it. I'd trade 9 hours of my alleged sleep for 5 uninterrupted hours of Ambien-fueled sleep any day. 

So today I took another 3 inch needle internally for the local anesthetic before the biopsy - I'm thankful I don't have to see this part of it - knowing how long the ass needles are is bad enough. If the anesthetic really is reducing the pain, I'm not sure I'd want to know how much it really hurts, because honestly even with it, it hurts like a motherfucker. Hurt like a motherfucker squared is not really something I care to do.

So we wait now for the pathologist to take a look. The senior pathologist - since he and the doc reviewed my sample together last time. Doc is anticipating this will come in by Wednesday. Thankfully, I've been relieved of having to do the IM shots for the next few days, and I can give up the vaginal estradiol as well until the results come on. Should the sample be sufficient, we'll stop all the other drugs, let me have a period, and start it all up all over again. If the results are as desired, we'll do about 2 weeks on the two estrogens, another round of ultrasounds and blood work to check things out, and then both forms of progesterone again leading up to the final transfer.  If the results aren't as desired, he'll have to figure out another way to improve the progesterone action - which will mean another full test cycle.

In deference to my bruised ass, he did offer me a rest cycle, but there is something to be said for back to back medicated cycles that can encourage my body to get with the program and make a nice comfy nest for embryos. So despite the bruising and pain, I chose to have him go forward with whatever will become of the next cycle - another test or the real transfer.

I question my sanity in continuing this regularly - but I'd never stop questioning whether we could have success if we didn't see it all the way to the end.

I know success will ultimately lead to far more sleeplessness - pregnancy impacts it, having a newborn of course does, I just - I don't know. It's hard to consider it "worth it" right now - instead it's a barely tolerable side effect.

The things we do...

What's For Dinner? Beef, Vegetable, and Barley Soup

It was really cold this week, at least for North Carolina, and my urge for soup was really strong. It's difficult at times to get a sufficient amount of protein into a meal if soup is the main course, and this recipe is no different. You have a few options - adjust your eating throughout the day so that this meal can handle having only about half the normal amount of protein in a meal, or add extra meat to the soup. If you do that, remember the nutritional information will change in all respects, not just in the protein count.

Don't skip the fresh herbs, it really makes the flavor.

This recipe makes a ton of soup when you're eating it in just 1 cup servings, but it freezes well. I use 2-cup storage bowls and pop them in the freezer, that way I'll either have a meal for both of us, or two lunch servings for myself. 

Beef, Vegetable, and Barley Soup
 

• 1 small turnip, peeled and diced (about 1 cup)
• 1 medium onion, diced (about 1.5 to 2 cups)
• 4 or 5 medium carrots, peeled and diced (2 cups)
• 2 stalks celery - outermost fibers peeled off, then diced (1 cup)
• 2-3 small red potatoes, diced (1 to 1.5 cups)
• 1 cup petite peas, frozen
• 3 tbsp butter
• 1 cup pearled barley
• 12 cups low sodium beef broth
• 4 cups low sodium vegetable broth (or homemade)
• 12 oz beef tenderloin cut into small cubes
• 1.5 tbsp minced fresh thyme
• 1.5 tbsp minced fresh oregano
• kosher salt
• pepper

Melt butter in large pot. Add all vegetables, along with a healthy teaspoon of kosher salt and a few twists of freshly cracked black pepper. Saute for about 10-15 minutes until they soften and onions begin to turn translucent. Add broth, bring to a boil. Reduce to a firm simmer and cook for 20 minutes. Add barley, and herbs, stirring well. Cook for 30-35 minutes until barley is softened. It will absorb quite a bit of liquid, so what may have looked like a very brothy soup will be thicker at this point. Add  the beef, simmer another 10 minutes for beef to cook through.

Nutritional information: Makes approximately 12 1-cup servings. 204 calories, 6.2g fat, 25.8g carbohydrates, 5.5g dietary fiber, 5.5g sugars, 12.6g protein

 

What's For Dinner? Simple Chicken Posole

Cool weather is finally starting to arrive here in North Carolina, and one of the challenges in bariatric eating is to find warm, hearty dishes that won't be too heavy on our limited stomachs, but also meets our nutritional needs.

Posole is a traditional Mexican stew, typically made with pork, but sometimes with other meats. I had chicken left over from roasting a whole bird a few days ago, so I chose that as my meat. An added bonus to using cooked meat is bypassing the braising step all together. It does, however, move this even further away from authentic posole, but the spirit of the dish remains I think.

I'll note that I am not super heat-tolerant in spices. My choice in the measurements for cumin and chile pepper may be too mild for your taste. Give the flavors a few moments to blend, then taste and add more to your desired level of spicy. 

Do be sure to drain the hominy, the liquid is quite salty.

Serve with a variety of toppings - radishes, shredded lettuce, a bit of cheese, and avocado are favorites. Add a few broken up tortilla chips of you choose to eat those. This is often served with warm flour or corn tortillas - avoid those if you aren't eating bread or don't want the extra calories. 

• 1 cup diced or shredded roast chicken - skin removed
• 1 15-oz can white or golden hominy, drained (found near the corn in the canned vegetable aisle)
• 2 cups chicken stock
• 1/2 medium onion, diced
• 1 heaping tablespoon tomato paste
• 1/4 tsp ground cumin
• 1/2 tsp ground California chile pepper (or other mild chili powder)
• 1/2 tsp butter

Melt butter in medium sized sauce pan, add onions. Saute until they begin to turn translucent. Add chicken stock and tomato paste, whisk to combine. Add cumin and chile pepper, with salt and pepper to taste. Bring to a boil, reduce heat and stir frequently for 2-3 minutes to allow flavors to combine. Add hominy and chicken. Simmer for five minutes or until all ingredients are up to heat.

Makes 3 servings. 

Nutritional information (soup only, exclusive of toppings): 189 calories, 3g fat, 22g carbohydrates, 18g protein, 2g sugars.

What's for Dinner? Cheesey Corn Chowder

I've been really quiet on the blog over the summer - a couple reasons for that. Still working on the baby making thing - had to deal with a few surprises in uterine health that I'm not going to get in to tonight. But then mostly? Summer eating for us is about steaks and corn on the cob on the grill. We'd eat that 3 or 4 nights a week and be really happy with it, so it's not very blog-worthy!

But, the weather has started to cool down, it's by no means "fall" yet here in the North Carolina, but we can start thinking about soup and not have it need to be chilled! I was watching the Food Network this morning and caught an episode oft he Pioneer Woman making a cheese and corn chowder. YUM! I started with her recipe as a jumping point, and shaped it to my tastes and needs.

The key to a good soup that has only a few ingredients is to use the best quality ingredients that you can. Each component really has to hold up. To that end, I used some late season fresh corn, home made chicken and vegetable stock, and good quality cheese. If corn is out of season, frozen would be preferable to canned, and commercial stock or broth will work as well. As for cheese, grate it yourself off a block. Most packaged shredded cheese offerings have corn starch or another added ingredient to prevent clumping in the bag, and that can create a grainy texture in a chowder. Take the extra minute or two to do it yourself.

Pre-op, I'd have made this with half and half and full fat cheese. I can tell the difference, but the differences are modest enough that it doesn't impact the dish for me.

That said - here's the recipe!

• 2 tbsp butter
• 3 strips cooked bacon with rendered fat reserved
• 1 large sweet onion, chopped fine
• 5 ears corn, kernels removed (about 2 cups)
• 1 small red bell pepper - seeded, chopped fine
• 2 cups home made chicken stock
• 1 cup home made vegetable stock
• 2 cups whole milk
• 8 oz Monterey Jack cheese - shredded
• 8 oz 2% sharp cheddar cheese - shredded
• 1 bunch green onions, white and green part  - chopped
• salt and fresh cracked black pepper

Melt butter in a large pot - preferably an enabled cast iron pot. Add reserved bacon fat. Saute onion until it begins to turn translucent.

Add bacon, then add bell pepper - cook for a minute or two until it begins to soften. Add corn, stir to coat with butter and fat.

Add flour, mixing until the fat is absorbed. Cook stirring frequently for 3 to 4 minutes letting flour and fat turn into a light roux bound to the vegetables.

Add chicken and vegetable stock - bring just to a boil. Mixture should begin to thicken.

Add milk, salt and pepper to taste (I use about 1 tsp kosher salt and a good dozen cranks of freshly cracked black pepper). Reduce heat and cover, simmering for 15 minutes.

Add both cheeses, stirring until melted into the chowder. Ladle into bowls, top with green onions.

Recipe makes about 9 1-cup servings.

Bariatric eaters: up the protein by adding diced roast chicken at the end - 1 oz chicken adds 7g protein, 35 calories, and 1g fat. 

WLS Post-Op Rating: 9+ months (fat content and corn). 

Nutritional information (1 cup serving): 263 calories, 15g fat, 24g carbohydrates, 13g protein, 9g sugars.

Recipe: Any Day Chicken with Lemon Scented Carrots and Snap Peas

There's some days where you just don't feel like cooking, are uninspired, tired, or otherwise just not excited about being in the kitchen. Today was one of those days for me. But, we still have to eat and as a post-op, still need to have a reasonably healthy meal.

This is one of my go-to dinners when I need something quick but don't want to go through a lot of fuss. All of the ingredients are regularly in my pantry. The only plan-ahead would be defrosting the chicken if I don't have any fresh in the refrigerator (tip: freeze breasts individually in Food-Saver bags - perfect portions for a post-op plus 1 or 2 others).  The process of flattening the chicken breaks up some of the muscle fibers which makes for a more tender piece of meat, something that can make chicken easier to handle for many post-ops.

• 1 lb boneless skinless chicken breast
• 1/4 cup all-purpose flour
• 1/2 cup dried bread crumbs - plain or Italian seasoned
• 3 tbsp extra virgin olive oil - divided
• 1/2 cup milk
• juice and zest of 1 lemon
• 6 medium carrots
• 1 cup sugar snap peas, trimmed
• 1/3 cup water

 Prepare chicken breast by pounding it out to 1/2 inch thickness. There's a couple ways to approach this. Place chicken between 2 pieces of wax or parchment paper. If you have a meat mallet with flat side (vs. the nubby side), put some muscle behind it and pound the meat with a slightly outward motion. The idea is to spread out the breast while making it thinner (rather than just smashing it down).  If you don't own a meat mallet, a heavy bottomed pan can also get the job done - I've been known to use my cast iron skillet - that will flatten it instantly!  Cut flattened breast into serving sized pieces - my very large one pound breast was cut into 5 pieces, roughly 3 oz each.

Heat 1 tbsp olive oil in large skillet over medium heat. Peel carrots, then slice thinly on a diagonal - about 1/8 inch thick. Trim ends and any strings from sugar snap peas. Saute carrots for 2 minutes, then add peas, saute for another 2 minutes. Add zest from the lemon, then it's juice along with 1/3 cup water. Cover and simmer over medium low heat while preparing the chicken.

Heat 2 tbsp olive oil in large skillet over medium high heat. Pan is ready when oil begins to shimmer.

 Pour milk into a shallow dish or plate. Using paper plates for easy clean-up, put flour and bread crumbs on their own plates. Working one piece at a time, dip chicken in milk then press into flour on both sides. Shake off any excess. Dip again in milk, then press into bread crumbs on both sides, again shaking off any excess. Sprinkle with salt and pepper as you place them in the pan. Saute until cooked through, about 4 minutes per side.

Nutritional information: Chicken: 3 to 4 oz serving - 197 calories, 6g fat, 10g carbohydrates, 28g protein. 

Nutritional information: vegetables - 1/4 recipe - 92 calories, 4g fat,  13g carbohydrates, 6g sugars, 2g protein

Recipe: Roasted Beet & Barley Salad

One of my favorite things is beets. I grew up eating canned pickled beets - an odd thing for a kid to really like, particularly when my mother served them hot as a side dish, where the juice would run and color all the other food on the plate. But then I ate them frequently in salads, and continued to love them as an adult.

Then I discovered roasted beets. So different! A mild sweetness, they do take on flavors that surround them. They still of course are that bright purple color, and they will color any other ingredient in the dish.

This is not my recipe - it was developed by Anna Thomas for this month's Eating Well magazine.

The only ingredient I didn't have on hand was fresh basil - my plant didn't survive our recent major thunderstorm. I actually think this would be even better with some argula mixed in - giving a bit more green color, plus the crunch of peppery leaf.

The magazine gives 6 servings for the recipe - 8 would be more in line with post-op serving sizes. 

• 1 1/4 lbs small beets
• 3/4 cup pearled barley
• 1 1/4 tsp salt
• 1/4 cup cider vinegar
• 2 tbsp extra virgin olive oil
• 1.5 tbsp whole grain mustard
• 1 tbsp honey or agave nectar
• 1 cup thinly sliced celery
• 1 cup thinly sliced radishes
• 1/4 cup thinly sliced scallions
• 1/4 cup thinly sliced basil
• 1/2 cup walnuts or pecans

Preheat oven to 400F. Scrub beats under running water. Wrap tightly in foil and roast in oven for 1 to 1.5 hours until beets are tender when pierced with a fork. When they are cool enough to handle, slip skins off with your fingers or a paring knife (this will color your fingers if you don't wear gloves). Chop beets into a small dice.

Bring large saucepan of water to boil with 3/4 tsp salt. Add barley, reduce to a minimal simmer and cook uncovered 45 minutes. Drain well, spread onto a baking sheet to cool.

Heat dry skillet over medium heat on stove. Add chopped nuts - toast stirring frequently until fragrant. Remove from heat to cool.

Whisk vinegar, oil, mustard, honey, fresh cracked black pepper to taste and remaining 1/2 tsp salt in a large bowl. Add beets, celery, radishes and scallions, toss to coat. Let sit for about 15 minutes, then add barley.

 Just before serving, stir in basil and nuts.

Nutritional information (based on 8 servings): 181 calories, 24g carbohydrates, 7g sugars, 9g fat, 4g protein

Faith, Denial, Hope or Despair

Otherwise known as someone has to be on the wrong end of a "great chance".

We got the call Friday afternoon. My quantitative HCG test was negative. More accurately, the value was less than 1, but effectively that's negative.I go in Wednesday for a consult on whether anything else needs to be done before we move on to round 2 with the frozen back-up team.

I spent the last week searching for some sort of sign - I should have felt differently, I should have "known". Any time you get a bunch of women together on the internet talking about pregnancy or trying to conceive, there's always the contests - who knew the exact moment that implantation occurred - no hints from a little bit of spotting, oh no, that's too obvious - but they felt it. Suddenly their life took on an beatific glow, and before they could take the time to drive down to the 24-hour pharmacy there was enough HCG flowing through their system that a single drop of urine would produce an unquestionable double line on the test.

You know what? They're full of shit. Sure, some women, even some women I know, experience some early symptoms, but not everyone does. Others do only through the rosy-pink glasses of confirmation bias. Others, though I find it nearly equally as incredulous, never know they're pregnant until they're about to deliver. Everyone's experience is different.

I know, though, that for at least a day or two, I had two viable embryos inside me.

I suspect the one on the left was our little over-achiever - the one that made 9 cells by day 3. I don't know why neither of them "stuck" - and I don't think that anyone will ever be able to tell us why. There were some things that the doctor may want to investigate in some manner, that's what the consult on Wednesday is about.

My husband held me while I cried - and then told me that there was no need for despair, because the back-up team in the deep freeze would do fine and in another month-ish I'd be pregnant. He had faith.

I had hope, and what it got me was another kick in the gut. Faith only seems to delay the inevitable disappointment. I suppose that firmly believing something will be true will make you happy while you wait, it could forestall any angst in the mean time, but is that really better?

Anxiety isn't fun. Though the Man does sometimes tease me about not being happy unless I have something to worry about, I don't really believe that's true. I need to guard my heart. We made the decision to move forward with this, knowing that the 80-90% chances we were quoted were good. But I also know there's no guarantee that we'd be one of those 8 or 9 out of 10 - that we could just as easily be part of the 2 - or even the single 1.

I need to know, that even if we're not successful with the reserve team that everything will be OK. Right now, I'm having a hard time imagining the finality of "no more chances". Well, I can certainly imagine that outcome, but I can't imagine what I'll actually do with myself.

For over 7 years now, we've been trying in one way or another. The interventions we had shortly after we got together, the time it took for us to decide that we'd become foster parents, the training, the waiting. The wonderful time we did have in that experience, and the stark disappointments of the reality of the whole process. The nightmare, the fallout. Hearing that my WLS may improve fertility, realizing that in terms of motherhood I'm fucking old.

I don't know what to do with myself. Almost everything has been cleared out of the bedroom the girls used to share. The only remnants are the shelves he put up, the chest of drawers in the closet, and the framed pictures of J up on one of the shelves. I had to put down the pictures of T, but I've been able to enjoy the pictures of J for what they are. But today I'm tempted to put them away, or close the door again. The black hole that hides behind two sheets of wood and a couple of hinges. It was closed for the better part of a year. We've been waiting to replace the guest bed until after we knew we'd need a new crib or not.

Part of me wants to be able to have hope, to have faith that the universe isn't so cruel as to say no to us again. I'll admit that a larger part of me right now says that to believe so is only to be in denial.

Maybe that room should be closed - otherwise it's where hope will go to die.