Got
a little nauseous today making out checks for the first of the medical
bills coming in from Dr. Kwak-Kim over $800 and lab-work is still coming
yet, another $250 to our RE to keep our embryo's in storage another
year. This all better come together this year cause we can not do this
again. Makes me so mad what we all have to pay just for a chance to be
parents. Not even a guarantee it will happen in the end only a small
sliver of hope while our pockets get emptied and you pray it's all going
to be worth it. :( I
never thought we'd be at it still after doing IVF I thought that be it.
I know this is our last year of ART treatments so it's got to work or I
have to learn to live childless. It's become very hard emotionally and
financially. I wish it didn't have to be so difficult for any of us.
Next week Friday is our follow up with Dr. Kwak-Kim at 1pm. Will be a long drive there again about 3hrs from WI to IL. We are thinking of trying to make the drive back again after the apt just to save on a hotel room but not sure if my husband can do all that driving. I am pretty useless in that area, I don't enjoy driving nor handle traffic well so it mostly falls to him to get us there and bake home. Please pray for us, safe travels and that she has some answers for us. In some ways I am looking forward to it and in other ways scared to hear what she thinks is wrong, what her plan of action is, and can we afford it all. I used to be excited about treatments but several mc kinda took a emotional toll on me and the thought of getting pregnant makes me happy and apprehensive. Sometimes I wish God didn't think I was strong enough to deal with infertility.
Heavenly father, I come to you as humbly as I know how, first thanking you for your many blessings. And asking you to bless us financially as we continue with treatments for the disease of infertility. Provide for the many medical bills and take away the stress of paying them. Continue to bless my husbands in his job, strengthen him and give him favor in the workplace. Also bless the works of my hands as I make items of hope for others and allow my hobby to continue to bring in the income for gas and expenses for the trips to the RI and RE. Lord I am broken and need healing emotionally from the many ups and downs of infertility. Heal my many hurts and clothe me with your armor to get up and continue to fight. I lift up all my fellow ttc sisters and pray you look down upon us all and bless us this year with a miracle. Guide my dr.'s and give them the wisdom on my case so that everything will come together for us this year. Protect me from any more mc and grant us the joy and privilege of becoming parents. I ask this all in your son's name. Amen
- And my God will supply every need of yours according to his riches in glory in Christ Jesus.Philippians 4:19
- Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What
shall we drink?’ or ‘What shall we wear?’ For the Gentiles seek after
all these things, and your heavenly Father knows that you need them all.Matthew 6:31-32
- Take my yoke upon you, and learn from me, for I am gentle and lowly in
heart, and you will find rest for your souls. For my yoke is easy, and
my burden is light.”Matthew 11:29-30
Heavenly
father, I come to you as humbly as I know how, first thanking you for
your many blessings. And asking you for a Financial Blessing for myself
and my family. - See more at:
http://www.prayers-for-special-help.com/i-pray-for-a-financial-blessing.html#axzz2MFpsqgW0
Heavenly
father, I come to you as humbly as I know how, first thanking you for
your many blessings. And asking you for a Financial Blessing for myself
and my family. - See more at:
http://www.prayers-for-special-help.com/i-pray-for-a-financial-blessing.html#axzz2MFpsqgW0
Wanted to share this important information about PCOS and how it can not only cause infertility issues but lifelong health problems.
PCOS: How Does PCOS Affect Women?
In the first entry, we discussed its definition and symptoms, and why PCOS is somewhat controversial in fat-acceptance circles.
In this post, we're going to describe how PCOS affects women, how if
often develops and presents, and how it can affect women down the line
as they age.
In later posts, we will discuss testing and diagnostic issues, its
effects on fertility, pregnancy and breastfeeding, and give more
details on how it affects menopause and aging.
Readers should know that we'll be doing this mostly from a size-acceptance point of view, rather than the usual "you have to diet" point of view present in most PCOS websites. Weight loss will be discussed as only one possible treatment ─ with an honest look at the potential benefits and drawbacks of weight loss as treatment ─ but other alternatives will be emphasized.
What Does PCOS Look Like?
As one article puts it, "Polycystic ovarian syndrome is a
clinically, histologically, and biochemically heterogeneous
condition." Translation: PCOS presents in each woman a little bit differently. The Classic Presentation
The classic case is a woman who:
is quite heavy
has very irregular or totally absent periods
has facial hair growth on her upper lip and/or chin (and often elsewhere)
has dark patches of skin in various places on her body
has skin issues, with cystic acne well into adulthood
struggles with infertility issues
has trouble getting or staying pregnant
probably gained a lot of unexplained weight at some point
has struggled with her weight ever since, often yo-yoing up and down chronically
has slightly enlarged ovaries with many cysts on them
has health issues such as glucose intolerance/diabetes, high cholesterol, and blood pressure concerns
Women like these are fairly easy to diagnose with PCOS because
their symptoms are so clear. The main markers looked for in PCOS
(irregular periods, physical signs of too many androgens, and cystic
ovaries) are obviously present.
Sadly, however, even women with obvious cases of PCOS often go
undiagnosed. It's very common for these women to see many doctors for
their symptoms before someone realizes what is going on. Too often, her
weight is blamed as the source of her symptoms and all other
possibilities are ignored.
Sometimes, the woman figures out her PCOS status on her own from
the internet or a friend, and only then can she get the testing she
needs.
Although Stein and Leventhal first "discovered" this condition in
1935, it has taken a long time for doctors to really take it
seriously. It is only in the last 10-20 years or so that awareness of
it has really taken off. Even so, many providers still just want to
blame the woman for being fat and not look deeper for other possible
mechanisms. They view fatness as the cause, and refuse to believe
fatness could merely be a symptom of a deeper problem instead.
Variations in Presentation
Of course, not every case of PCOS follows this classic profile. If
it's hard for women with very obvious symptoms of PCOS to get
diagnosed, imagine how hard it is for someone whose case is more
subtle!
For example, not all women with PCOS are fat. Some women with
PCOS are average-sized ─ but still have very strong issues with insulin
resistance and fertility (like actress Emma Thompson). It is unknown
why some women with PCOS have weight issues and others do not. It's
probably not due to differences in eating patterns but rather
to some unknown metabolic difference. Whatever the reason, it can be
hard for the skinny woman with PCOS to get diagnosed.
But generally speaking, a lot of women with PCOS have very
significant weight issues. The usual statistic quoted is that 50-60%
of women with PCOS are "obese" ─ but because many doctors
underdiagnose the condition in fat women, it's possible the percentage
may actually be higher.
Hirsutism is extremely common in women with PCOS (some sites
estimate it is present in 70-80%), but not every woman experiences it.
Some have only a little body hair and no facial hair, yet because
doctors really look for facial hair as a sign of androgen excess, women
without this classic sign are sometimes told they don't have PCOS,
despite other pertinent symptoms.
Thinning scalp hair is much less common than hirsutism as a
symptom, but is often overlooked as a potential sign of androgen
excess. And because many women find ways to cover this up or are too
embarrassed to mention it to their doctors, it is underused as a
symptom for diagnosis.
Fertility is another symptom that can vary. Many women with PCOS
have significant fertility issues, yet not all do. For some, it's
closely tied to co-morbidities like hypothyroidism; if they treat that,
fertility is less of an issue.
Sometimes, fertility for PCOS women is okay in younger years but
declines over time, so some only develop infertility later on as the
condition progresses.
Although some doctors consider fertility issues central to the diagnosis of
PCOS, some women show clear skin and metabolic symptoms of PCOS yet
never have problems conceiving or maintaining a pregnancy. Still, they
may benefit greatly from treatment of the metabolic issues of PCOS, so
many providers have begun to expand their definition of PCOS beyond
its past focus on infertility.
Clearly, the heterogeneous nature of PCOS means that there are many gray areas in diagnosis.
How Does PCOS Develop?
PCOS tends to run in families, and can come from either side of the
family (mother or father). If lots of women in your family struggle
with their weight, have irregular periods, diabetes, hypertension, and
other common consequences of PCOS, the chances that you might have PCOS
are higher. Or if the males in your family have lots of premature
balding and metabolic syndrome, this may also indicate a familial
predisposition towards PCOS. However, it takes a combination of
genetic and environmental factors for PCOS to manifest itself, so not
every family member is always affected. Family history is a clue, not
an automatic indication.
Often PCOS first presents a few years after periods begin (although
some with very severe cases may show symptoms like acanthosis
nigricans and significant fatness even well before puberty).
Typically, menstruation begins normally, but within a few years,
periods begin to skip here and there. Eventually, menstrual issues
worsen; some develop long cycles (more than 35 days), some develop
erratic cycles, some skip whole sets of periods, while the most severe
cases stop cycling completely.
At some point most women with PCOS develop secondary skin-related
symptoms like hirsutism, thinning hair, or significant acne (especially
boil-like sebaceous cysts under the skin). These can be quite
distressing socially, so this is often when these women begin to seek
medical answers, often without success.
It's not unusual for many woman with PCOS to experience a
significant, unexplainable weight gain ─ with no change in habits ─ in
her late teens or twenties (and sometimes later too); this is often
despite similar caloric intakes as women without PCOS. As one website notes:
Approximately 60% of women with PCOS have weight management issues
which can lead to obesity with only normal caloric intake. Energy in
the form of glucose (food) is stored right away as fat, instead of
being made available for other functions within the body. This can
lead to chronic fatigue and undernourishment, despite the fact that
there is adequate food intake and even an appearance of
overnourishment. Those with the most severe cases of PCOS may become
supersized because of a vicious cycle of insulin resistance and yo-yo
dieting. High levels of insulin in the blood lead to weight gain, so
women diet to lose weight, only to regain to an even higher weight as
the body's metabolism reasserts itself. Concurrent hypothyroidism can
greatly exacerbate this gain. Some women develop eating disorders
(compulsive overeating or binge eating disorder) as a result of years
of dieting, and many experience very strong carb cravings due to
hyperinsulinemia. Thus it can be difficult to untie the influence of
insulin issues, yo-yo dieting, eating issues, and disease
co-morbidities on weight, but there is often a synergistic effect of
all of them together.
In some women, PCOS symptoms accelerate and worsen with time.
Those with the most severe cases usually have great difficulty
conceiving, often develop diabetes and/or high blood pressure in their
twenties or thirties, struggle with sleep apnea and other
complications, and become "super obese" at some point from a
combination of factors. Co-morbidities like sleep apnea are common,
and as a result, many get so desperate they resort to bariatric surgery
to try and mitigate their symptoms, regain some mobility, or have a
chance at pregnancy.
In other women, the symptoms stay relatively mild throughout their
life or progress much more slowly. Often, normal blood sugar and blood
pressure are maintained for years, and the only signs of metabolic
derangement are subtle differences in labs; a tendency towards weight
gain, reactive hypoglycemia and/or gestational diabetes; and skin
symptoms (like sebaceous cysts, acne, or thinning hair). However, the
symptoms often worsen significantly around or just after menopause, and
many are diagnosed with issues like hypertension or diabetes at this
time.
A lot depends on the woman's pancreatic beta-cell function. If the
pancreas is capable of producing enough insulin to compensate for the
insulin resistance in the body, blood sugar remains in the normal
range. In those whose beta cell function is compromised, the body is not
able to produce enough insulin to overcome the insulin resistance and
diabetes develops early.
Some women think that as long as their blood sugar and blood
pressure is fine and they don't want children, PCOS is not a big
worry. However, just because blood sugar is normal doesn't mean the
body is okay; it still has to deal with the side effects of too much
insulin and too many androgens in the body. And over the years, this
can take a toll, even on those with milder cases.
How Does PCOS Affect Long-Term Health?
As women with PCOS age, the metabolic consequences of years of hyperinsulinemia and excess androgens begin to accrue.
Although you might expect that PCOS symptoms would disappear after
the ovaries shut down at menopause, many find that some symptoms
actually worsen after menopause instead.
Hirsutism on the face may get even worse, and the hair may thin
even more than before. Acne doesn't go away, and problems like sleep
apnea may worsen.
Chronic overproduction of insulin also tends to lead to
hypertension over time, and it exhausts the pancreas. Therefore even
those who had relatively good pancreatic beta cell function and normal
blood sugar and blood pressure for years tend to develop diabetes and
hypertension as they age.
This means that PCOS has life-long health implications. The
tendency towards blood sugar, insulin resistance, blood pressure issues
and perhaps an increased rate of clotting means that vascular disease
often develops. Many women with PCOS develop heart disease, and may
also have a tendency towards stroke.
High levels of androgens may also be connected to the development
of non-alcoholic fatty liver disease (NAFLD). One study found more
than three times the risk for NAFLD in women with PCOS, even after
controlling for BMI and other factors. Higher androgen levels are
thought to be the culprit but this still remains speculative.
Cancer is another potential risk. If the woman does not cycle
regularly, the uterine lining can build up and endometrial hyperplasia
(overgrowth) can develop. Unchecked, this can lead to a higher chance
of endometrial cancer. PCOS is clearly associated with a higher risk for endometrial cancer.
Is PCOS connected to the development of other cancers? Some research
ties PCOS to a higher rate of ovarian cancer, but research on this is
contradictory and unclear. In addition, insulin resistance and
hyperinsulinemia may be tied to a stronger risk for colo-rectal
cancer. Many researchers speculate that the relatively high rate of
unopposed estrogen in PCOS may increase the risk for postmenopausal
breast cancer too, although nothing has really been proven at this
point.
The connection between PCOS and these different cancers is still
being untangled and answers are far from definitive, but clearly there
is an increased risk for endometrial cancer at the very least.
Psychological Effects of PCOS
Psychologically, PCOS is a brutal condition.
In its most severe form, a woman is stripped of nearly everything
that society sees as womanly, a "theft of womanhood," as some sources
call it. She probably is very fat, balding, has a mustache or other
facial hair, has acne and body tags, doesn't cycle regularly, and has
difficulty having children. She is seen as sexually
unattractive, epitomizes the image of the "ugly" woman in our society,
and is the object of many jokes and much derision in the media. Is it
any wonder some women find this condition incredibly demoralizing?
Addng into this is the lack of understanding around PCOS as a
condition. Even when you have an official diagnosis, some friends and
family consider it a dubious finding. In their view, you're just
looking for an excuse for being fat, crying about how your "bad
metabolism" causes your obesity, instead of taking responsibility for
your supposedly poor eating. They roll their eyes or accuse you of
closet binge-eating instead.
Doctors often don't believe you if you tell them you eat normally
either, thinking you must be in denial about your eating, or that you
are too uneducated about "proper" nutrition to really understand how to
eat healthy. Furthermore, the shopping cart and food intake of a
woman with PCOS are under continuous scrutiny and criticism, adding
constant stress to daily life. The "obese" woman with PCOS always
feels on the defensive about her food or exercise habits.
This disbelief about their experiences and the burden of constant
surveillance often takes a considerable toll on PCOS women's
self-esteem. And for those who truly do struggle with eating disorders after years of dieting, the shame around dealing with that on top of PCOS can be overwhelming.
Some resources list depression and/or anxiety as one of the
possible side-effects of PCOS. It's not clear whether the tendency
towards this has a physiological basis, is merely a by-product of
mistreatment by society, or is a combination of both. Since many women
with PCOS tend to have borderline hypothyroidism (and depression can
be a symptom of hypothyroidism), there may be a good argument for a
physiological basis. On the other hand, the harassment that women with
PCOS receive in society could cause anyone to feel anxious or
depressed. Or there may be a synergistic effect between the two.
Either way, there is no doubt that it is very difficult to be a
woman with PCOS in our society. Yet the situation is not without hope.
Many women with PCOS are able to develop a sense of peace with their
body, an inner strength to help overcome the biases superimposed by
society. Women with PCOS can be strong and assertive and body-positive; it isn't easy with negative messages all around, but it is possible..
Conclusions
Clearly, PCOS is a difficult condition that deserves to be taken more seriously.
Knowledge about PCOS is evolving, but not all care providers are
familiar with this condition. Some don't believe it really exists, some
believe it's far more about being fat than about metabolic
abnormalities, some apply too-stringent diagnostic criteria, while
others diagnose it without ruling out other possibilities
first. Therefore it can be very difficult to get an accurate diagnosis.
Unfortunately, there's no one "official" test you can take that
will tell you that you do or don't have PCOS. Often diagnosis is less
than clear-cut because of co-morbidities and the variability of
symptoms.
So even if you've been told that you don't have PCOS, you
might simply be at a less severe level on the PCOS spectrum ─ not
severe enough for diagnosis, but not clearly "noPCOS: How Doermal"
either. Or you might have a phenotype that your doctor did not
recognize. Or you might have something that looks like PCOS but is
actually caused by another condition. Or you might not have PCOS at
all.
Sometimes the answers are elusive and what you are told will vary
from provider to provider. This is why it's important to keep asking
questions, keep searching for a really good provider, always get copies
of your labs and tests, and keep a file of them over the years. It's
not uncommon for it to take multiple visits for this
condition to get recognized, for testing to be done (or interpreted)
incorrectly, or for an optimal treatment plan to be developed.
Persistence and good record-keeping is very important.
***In the past, some doctors viewed PCOS as a concern only if
you wanted to get pregnant, but research indicates it has significant
life-long health implications, including higher rates of diabetes,
hypertension, heart disease, and some types of cancer later in life.
Because of its implications for long-term health, PCOS
deserves to be taken seriously, regardless of the patient's age or
whether or not they want children. It needs to be seen as a life-long condition, not just a concern tied to pregnancy.
Scott and I left WI on Thursday the 7th driving into the snow storm the closer we got to IL, thankfully we made it there ok and found the hotel, got checked in and relaxed. 7:30am Friday morning came quickly, found the clinic and got checked in. I was glad I had asked what they would be doing before the apt. or I may of been lost what was going on.
First up with the external u/s that I drank water for to have a full bladder, after that I got to empty my bladder and undress for the vaginal u/s. That one was interesting as I got to see on the screen her measure the blood flow in different parts of the uterus, she examined the ovaries and found tiny cysts on them consistent with PCOS except I never had polycystic ovaries that my RE ever told me about. Was in u/s for about a hour then they transferred me to blood. Thankfully she got a vein on the first try, emptying me of 20 vials of blood. Felt a little dizzy afterwards so they took my bp and it was high 150/100. Next was a short physical exam and some other questions on health history with the nurse practitioner. Finally at the end I got to meet Dr.Kwak-Kim and talk with her. She ordered a Thyroid ultrasound at the end as she wants to make sure nothing is going on with it.
Relieved the first apt is over, the hardest part was the LONG drive there and back. We return on March 8th to go over all the test results and she will give me some recommendations. In the meantime I need to consult with my family dr. or a cardiologist to make sure the bp is under control better and continue on my weight loss journey, sticking to a insulin resistance diet.
Thank you everyone for the prayers!
First Apt. Agenda Friday, February 8, 2013
New Ultrasound 7:30 am
New Patient Blood Work 8:45 am GYN Exam 9:15 am - with M. Sullivan, NP
New Patient Repro 9:45 am - with J. Kwak-kim, MD at Vernon Hills Reproductive Medicine
