Wednesday, November 3, 2010

Mo and embryo take their 1st international trip

Tomorrow morning, I will leave on a flight for an international conference I am presenting at over the weekend. The whole trip has felt very surreal and up in the air to me, because part of me has been waiting for Something Bad to Happen. This conference is a big one in my clinical and research area and two of my colleagues will be attending - not to mention many collaborators and colleagues from other institutions. It's been strange to have my co-workers all hyped about the conference and me to be secretly thinking "sure, if I go," or "great, if I'm not miscarrying or getting a D&C instead of giving a symposium presentation," etc. I haven't said anything to anyone because of course no one knows I'm pregnant. But in my mind it has felt far from sure that I would be attending (a bit awkward since I'm an invited speaker). I was so uncertain about things that I didn't even buy my plane ticket until this past weekend. (All this uncertainty is very costly in so many ways, I tell you!)

But here we are, less than 24 hours from my scheduled departure, and I am going! Still pregnant! Still giving my (completely unprepared-yikes!) talk on Saturday (hmmm...that better change and soon).

I am a fearful public speaker, even though it is a not insignificant part of my job as a researcher/clinician in an academic medical center. Don't like it. Kind of accept that I may never like it. So it will be very helpful that I won't be standing up there alone, that this little embryo will be giving the presentation with me. I defended my dissertation during pregnancy #5 and it was pretty awesome to know that I had a very small person on my side (and inside of me) while doing that. I'm hoping this time it will be just as comforting to know that there is a little tiny one in there with me as I'm going about my days out of the country and giving my talk.

There are two issues that I'd love to get your thoughts on:
  • One of my colleagues - who is a friend but also a superior - has already expressed her excitement about getting to drink together at the conference. Of course, I won't be drinking. Wondering how to handle this without having a neon flashing sign that says "I AM PREGNANT!!" She knows we have been through multiple losses, have been trying IVF, etc. So I'm pretty certain she will surmise the situation, but because I am in the middle of negotiating a promotion, I don't want to acknowledge that I am pregnant. Since we're friends, I also don't want to outright lie. Any thoughts? Also, how do I handle it if she asks me directly if I am pregnant?
  • It also just occurred to me that I'm now on daily PIO shots. Which is the one shot I don't give myself. The lovenox will be fine, but the PIO has me a bit unnerved. Come hell or high water, I will be giving myself this injection every night while I am away. But any advice on ways to make it easier? Because of all my med allergies (sesame, peanut, olive oil injections were all a no-go), I'm taking progesterone in ethyl oleate, which is thinner than some of the other oil concoctions, so that will help I think. I'm also going to have Will draw two bull's eyes on my rear tonight so I don't end up injecting in the back of my knee or something by accident. But would love any thoughts you self-PIO folks have.
I'm hoping the trip will be a good distraction from all of this pregnancy panic going on over here. Because you know that ultrasound yesterday? That made me feel reassured until, oh, just about 4pm yesterday, at which point I returned to my fearful baseline. I think fear of presentation will compete nicely with fear of pregnancy doom, which is a good thing. And by the time I get back, the presentation will have been given (phew!) and I will be only a few days away from having another ultrasound (gulp), that will hopeful reveal a heart beat (double gulp).


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  1. my go to 'excuse' for not drinking is 'i'm taking so many allergy meds right now any drinking at all just isn't a good idea'

    signed -
    a lurker who is still holding good thoughts for you all

  2. The targets are a good idea for the PIO. I used to walk in around my house after the shot to work it in the muscle and ignore any residual pain. Good luck with everything!

  3. Question 1 - I think if she asks, you have to fess up. She already knows too much about your history to bluff, I think. I might couch it by saying it is early, and you aren't ready to talk much about it yet, let alone tell people. But she will notice, most likely ask, and hopefully understand your need to keep this under wraps for now.

    Question 2 - I was a PIO self-injector. I found it to be much less painful/easier than when DH tried to do it - granted, he's not an MD like Will. My tips are to stand with your full weight on the other leg, so the muscle can relax on the injection side. When in doubt, veer towards the outer and upper hip area as much as possible. Take your time injecting (although with the less viscous medium it might be easier to do), and rub the area afterwards with your fingers to help the stuff distribute. Use the mirror to see what you are doing. But mostly, trust yourself that you can do it, and it will be easier than you think! I found it hurt a lot less - although I think that was mostly the power of being in control on my side.

    You'll do fine! And break a leg (figuratively!) at your talk!

  4. Mo, I don't have any advice (other than the bull's eye) but had NO trouble giving myself PIO. I'm right handed, and it was much easier on the right than the left (but I wrangled that too). I think mostly it's a matter of twisting around your spine as much as you can so you can SEE. enjoy the trip!

  5. I always would tell well-intentioned friends that we were "mid-cycle" and that alcohol doesn't mix well with the meds...worked like a charm!

    Good luck doing the PIOs...I haven't had to do them myself, but I'm sure you'll be fine!

    And congrats with your preso!!

  6. First off - Yay!

    Secondly, can you use the old "I'm on medication that doesn't mix well" line?

    Thirdly - giving myself a PIO always freaked me the hell out & was never that big a deal. Definitely mark out bulls eyes. Unless you're way more limber than I am, it's tough to visualize exactly where you're stabbing in a mirror or just twisted. I did it all three ways - standing on the opposite leg, sitting on the opposite hip, and lying down on the opposite side. Do it fast, just like a belly-needle, and it really doesn't hurt, it's just scary looking at the big needle.

    Hope the presentation goes well but also that it keeps distracting you! Call when you get back?

  7. Not sure about what you should do if asked directly. But if not asked the "P" question, yeah, you're not drinking due to meds interactions. And you truthfully are on meds.

    As for the PIO shots. You. Can. Do. It. I generally did them sitting on my bed. Easy enough to twist around to my dominant hand side, for the other side, I used a folding hand mirror propped on the bed next to me. Also, doing them myself, I never drew back. Too hard to do that with all the twisting, but the only time I had a bleeder was when a friend helped me with it in a restaurant restroom. Whatever. The PIO got in and I wiped the blood splatter off the floor. (Is it any wonder I still have the sharps container with my PIO needles in the back of my linen closet? My badge of courage.)

    Oh, and when I did them in a hotel room (right after transfer), I used the little coffee maker in the room to make hot water to put on a washcloth for a hot compress for afterwards.

    Hope you and little flicker have a good time.

  8. Congratulations on your talk - you are going to do a fantastic job, you and Baby.

    I love that you have the floating baby on the sidebar LOL

  9. In regards to drinking. When you sit down to order you can ask her what she is having and say that sounds good. Unfortunately I can have any right now because
    a) where I am in my cycle
    b) meds I'm on
    c) watching yor weight (not sure if that would work at all) You could say you would rather eat your calories

    If it works out differently you could always say, before you ask, I'm not drinking because of x. I would have an issue of stating that I'm not pregnant. Superstitious I guess.

  10. For the colleague, I'd say one of two things: (a) I am meds right now that restricts alcohol consumption or (b) I am in the waiting stage. You see... (b) is not an outright lie. You ARE in the waiting stage for your first tri to finish but she can interpret it any way she wants! :)

    As far as the PIO, I did all my PIO shots. Here is how I did it:
    1) Ice the injection site -- this will pretty much numb the area so you wont feel any pain when the needle goes in
    2) Warm the syringe by holding it in the palm of your hands -- this might not be a problem for you since your PIO might be thinner to begin with.
    3) Stand with your weight on the other leg so as to relax the muscles on the injection site
    4) Wipe with alcohol pad followed with a cotton ball to wipe off the alcohol -- waiting for the alcohol to dry will reduce the numbness in the area
    5) Inject syringe slowly into the numbed area and push the plunger slowly too -- this is against the convention that the nurses taught aka to jab the syringe -- but for the love of God, I couldn't jab myself. If you can jab, then by all means go ahead. I also never pulled back to check for blood and I have never had any problems with my 9+wks of daily PIO during my last pregnancy
    6) Massage the area really well afterwards and walk it off. Heat sometimes helps dissolve the PIO faster. But since you are PG, be careful not to overheat.

    I am sure you will be fine. Also, since you are on a thinner PIO, see if you can ask for a higher gauge needle like a 23G or a 25G instead of the 22G. It can help too.

    All the best with everything during your trip. Safe travels.

  11. Congrats on making it to the "I'm really going to go to the conference" stage!

    I'd complain about dehydration from the flight -- not wanting to be jetlagged or some such blather -- usually works for me on short trips.

    On the PIO, I found that lying on the opposite side and using a warm compress before and after was the best thing. But you will be fine with the bullseye. Also, don't forget a letter from the MD about flying with syringes, esp overseas. I never got stopped, but it's good to have.

  12. I dont have any advice on how much to tell the friend. You could simply say that some of the meds your taking wont go well with alchohol. That's not totally lying! ;)

  13. You could always tell your friend that you shouldn't really drink because of some of the treatments you are on... technically true. She'll figure it out but if you are evasive and change the subject she'll know you don't want to talk about it.

    As for the projesterone shots, I got to be an expert on doing them myself because my husband freaks over the sight of even a drop of blood. I also had some problems with the shots. Here's what I came up with that worked pretty well for me:

    1) those bulls-eyes will be really important, so definitely have them drawn on your butt. Be sure though not to inject too low in the safe area. I did this and got a huge amount of pain in my hip joint that made walking horrible. High is better.

    2) take a heating pad. Heat the area for about 10 minutes before the injection (and warm up the injection in your bra or something) and then heat again for about 20 minutes or so after.

    3) I gave them to myself standing up, leaning against the counter so that I could take the weight off of the injection leg. This was easier for me to get the positioning right.

    4) After injecting I would vigorously massage the area for as long as my weakling hand could muster. And then go to the heating pad.

    It did hurt and I had constant butt pain but was TOTALLY worth every injection. So not a big deal in the whole scheme of things, and since you are a doctor it should be even easier!

    Have a wonderful trip and super good luck with your talk!!!

  14. Yup - I agree with the others - just say that you're on various meds to help with the whole conception thing and you've been advised not to drink on top of them. Not an outright lie but vague enough. I actually stopped drinking for while because I was trying to conceive - well, you'll try anything won't you - and it meant that folk got used to me not drinking without it meaning anything. A colleague who had a reputation for enjoying her booze was rumbled immediately on a night out because she wasn't drinking - she'd only just found out that week that she was pregnant. She went bright red and denied it when asked, and we all knew! Good luck with the talk.

  15. Just wanted to stop by and wish you safe travels and good luck with your presentation. Funny, we have the opposite phobias, you and I, as I love public speaking but wouldn't board a plane to do it.

    Use any of the aforementioned suggestions if she asks you for drinks but don't feel pressured into telling her anything. You already know you can't un-tell and I doubt she would be so uncouth as to press you simply because you didn't order a drink. However, you could always order a wine spritzer and nurse it.

    Good luck with the PIO.

    And, at the end of the day, remember to exhale and do NOT put so much pressure on yourself.

  16. GREAT youtube on do-it-yourself PIO:

    and heartbeat? double gulp double gulp double gulp double gulp....

    You'll do GREAT Mo, have a good trip, a happy presentation, and a safe journey home to happy news.


  17. I agree with the commenters who have said to be vague about why you're not drinking. If she knows your history, some comment about 'trying again' will probably be all she needs, and I would hope she'd be too tactful to press further unless you were volunteering.

    Also, if you're negotiating a promotion, she might well prefer not to know if you're pregnant so that it doesn't become a factor in the decision (i.e. if they turn you down for other reasons, there can be no question of them being influenced by the pregnancy).

  18. Enjoy your trip and I hope your presentation goes well:).

    I always self-injected PIO's by lying on my left side (I am right-handed). For me that was easier than doing it standing up. Targets are a great idea. You'll be fine:)

  19. Same thing happened to me.. I was at a conference with colleagues and everyone drank except me b/c I'm TTC so I just told them that I'm on a cleansing diet-- so only water tonight. They were impressed and left me alone.

  20. I've used the "It's too soon to say, so no drinking for me" line before. It's a little dissembling, but not much. Or maybe you want to just tell her and enlist her in helping you avoid having to face that question with other people. It could be nice to have someone help run interference.

    Good luck with the presentation, good luck with the shots, and I can't wait to hear more good news about your little firefly.

  21. A) I thought you knew...I haven't been drinking while doing IVF.
    B) That would be lovely!

    The shorter, less lengthy answer, the better.

  22. Re: the drinking, you could do what I did when I was in a similar situation -- I ordered a light beer and just took a few sips. Even back then, I knew that there was NO WAY that was going to affect the outcome of the pregnancy, and it becomes less obvious that your not drinking.
    Re: giving yourself the PIO shots. I had to do that as well a few times. It sucks, but your overwhelming desire to have the pregnancy turn out ok will mask most of the discomfort.

  23. I'm with blaming "medications" and/or jet lag, or nursing a glass of wine or a beer. I've got a family member who doesn't drink at all and European extended family who can't understand/accept that and insist on pouring a glass of wine. It ends up in houseplants. And I like the "hopeful" or "waiting" idea, suggested above if (heaven forbid) she asks about pregnancy (yikes!).

    I did PIO myself and found it easiest (uh-oh, oversharing alert) to, um, sit on the toilet (why is that, I wonder? nice stable seat, I guess) and just reach around to the other side. Honestly the biggest problem was cramps in my arm as I tried to stretch around, but otherwise it really wasn't bad.

    Hope you have a lovely trip and a productive conference!

  24. Congrats on the beautiful embryo! To not lie you certainly could simply take a sip or two of some low alcohol beverage and if asked why you aren't drinking much say "I don't feel perfectly well." Or "I don't want the repercussions" (with a smile.) Or don't drink and say either of the above. If asked directly you can say, "Oh I don't want to talk about pregnancy or anything else too serious right now. (inflect as you like: flippant, serious, whatever.) But I would love to talk about you, did you have fun today?" No lying necessary, but remember the TRUTH is this is YOUR BUSINESS and you have the right to keep it that way so if you do end up lying a little, really that is fine. Good luck. - S

  25. Knock 'em dead in the presentation. You little assistant will be whispering sweet nothings in his/her uterine palace.

    Hmm to the drinking thing. I had one last wk with work folks too. I caught the server and asked her to help me out - soda and lime in a short glass. Dunno with 2 of you though how to hide it in the bill.

    Can you say you have a urinary tract infection? Ew but at least she wont ask you to share a bottle of red wine.

    No ideas on PIO. Relaxing the muscle is key if you can manage it.

    Have a great trip. Get some international coins for the little one's collection.

  26. You might say I am low carbing. But then you have to actually look like you are low carbing. In the first 10 days they do not like you to drink any alcohol. You are supposed to drink 10 glasses of water which is super good for pregnancy and lots of high quality protein. And greens.
    You could break this news early in the trip. mention it on the plane as you guzzle water.
    Pack your own airplane food. Read a copy of living low carb on the plane. stick a copy of Atkins in the front pocket of your bag.

  27. Hmm, I'm not sure if I'd tell her but I'm sure you'll know what to do if the time comes. Your gut instinct will lead you on that one.

    Good luck with your talks! I'm sure you'll do fine. Just remember to breathe. My trick: Keep a glass of water (or coffee) in front of you so you can pause for a drink when you need to collect your thoughts or pause before answering a question.

    PIO? I usually ask the nurse to draw a bullseye on my hip, but of course I forgot to do that today (I am triggering tonight). I stand up in front of a mirror, weight on opposite foot, let leg hang loosely...hold skin taut with free hand, needle straight/level, in slowly, you can let go at this point as the needle is deep (it won't go anywhere). Readjust your grip and aspirate to look for blood. If blood, remove, change needle, try again in other hip.

    If none, push in slowly, withdraw, immediately place gauze or alcohol pad on area and press for a bit. That's it! You'll do fine. The first one is always the most scary! :) I've never used ice. Heat afterward feels a bit good though.

    Bon voyage!

  28. How to avoid drinking with the colleague - since she knows you've been trying IVF, can you tell her you're on medications for your next upcoming procedure, and you can't drink while you're on the medication because alcohol interacts with it? You don't have to tell her that your "next upcoming procedure" is an ob ultrasound...

    The PIO injections - I have a little rectangular flip mirror (something like 3 inches by 5 inches) that stands on its own when I open it. If you have something like that, bring it. Depending on how your bathroom and/or hotel room is laid out, you may be able to prop it up in front of you so that it reflects a mirror behind you, so that you don't have to be a contortionist to see the circles on your backside.

    Also, I'm not sure what gauge needle you usually use for PIO, but I've used 25 and 27 gauge needles for PIO without a problem. It might take a little longer to inject, but it's a heck of a lot less intimidating than using the bigger 22 gauge.

    And, bring a couple of small ziplock bags if you use ice. Even if you don't normally ice first, having them will give you the option in case you decide you want it.

    I hope those help. Have a safe trip, and good luck on your presentation!

  29. Has nobody suggested the invaluable EMLA cream? Nickle size dollop 30-60 mins prior, covered with occlusive dressing and it doesn't matter WHERE you hit!!! J/k.

    I always did my PIO in the morning so that I could walk off the butt knots ... better than sleeping on them!

    Break a leg!

  30. I go up to get the drinks myself, and get myself a soda with a slice of lime. Most people assume it's alcoholic without asking.

    Feel free to lie if she asks you straight out. She's the one who being rude.

    Maybe some YouTube videos of self-injections might help with the PIO?

    Congrats on being an invited speaker :) You obviously know your stuff.

  31. I agree with Dandle Dreams about ordering the drinks yourself and getting sparkling water with lime, or alternatively ordering a light beer or glass of wine and nursing it. According to the docs I've talked to, one drink once a day isn't a big deal. I'm sure that you'll handle it with grace, however it comes out.

    Good luck with PIO you've gotten a lot of good suggestions on here, so I won't regurgitate them.

    Break a leg on your presentation and remember that you know more about the topic than almost anyone in the room; that's why *you're* the invited speaker!


  32. If you really don't want to tell her, you can always say you have a UTI and order some cranberry juice. I did that once and it worked like a charm.

  33. I always say that the meds I'm on combined with alcohol isn't a pretty picture. Seems to work...and when it doesn't, I order a daquiri (sp?) and immediately "go to the bathroom"...when I'm really hunting down the waiter to ask to make it a virgin.

    I've only done 3 or 4 self PIOs. I have to look in the mirror and can only do them on my right side because I'm right handed. Once you get over the mental part...the rest is easy.

    Hope your presentation goes well this weekend. Try to enjoy where you are going!!

  34. I recommend 10 minutes of icing before, heat after (a small drugstore hot/cold gel-pak submerged in hot water from the coffeemaker for a couple of minutes works great), and 28g needles.

    I wish I had thought to be comforted by the embryo inside me when I gave a conference talk five weeks after transfer once. Have a great talk and conference!


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