/ The RE's Muse: All hail the mighty donut

The RE's Muse

After 4 years of infertility, 2 surgeries, 1 miscarriage, and 19 months of high risk pregnancies, hubby and I now have two little women in our lives--one a toddler, the other not far behind. Buckle your seatbelts, it's gonna be a wild ride.

Wednesday, October 13, 2004

All hail the mighty donut

Hopped up on 1100 mg of naproxen sodium, I drove 60 miles to Dr. Rub's main office this morning for my 7:30 saline infusion sonogram (SIS). Mind you, this is not my normal office. I go to a small satellite location by me. I came bearing two dozen fresh donuts for the good folks in the office (it's a large practice). They were very appreciative I tell you...plus, I think it's harder for them to forget you if you stand out from the crowd somehow. For me, this means bringing treats. Ah, who the hell am I kidding? I just want them to like me....

So, the SIS was completely painless--and I don't think it had anything to do with the naproxen, really. The SIS at my practice does not involve the dreaded balloon catheter which, Dr. Rub pointed out, typically causes the cervix to dilate immediately--hence the extreme discomfort for many patients having it done with that 'old school' catheter. That must be precisely why my previous one with Atlanta's Dr. Insulin (who turns out to be a good friend of Dr. Rub's) was excruciating.

Speaking of Dr. Rub's good friends, I'd like to see our REs in action in their 'real' life interactions with each other. Like at national conferences and stuff. After a day of sitting in sessions or presenting, do they hit the bars, go out carousing, try to pick up, get drunk, talk shit about the ones who aren't there? I mean, they all seem to know one another and the gossip about who's doing what where. Today Dr. Rub told me that my previous RE in Birmingham was now head of that program and the former head (who he said could be "difficult to work with") had left to open his own private practice. He then went on to tell me that the practice he refers people to in Birmingham was this other one run by Drs. X and Y. Turns out he did his residency with Dr. X, blah blah blah. Very small world those REs live in it seems. I wonder if they're all up in each other's business 'cause it sure sounded like they are based on today's conversation with Dr. Rub. Kind of cute to see him all in his element, talking smack (but good smack, not catty smack).

Oh, yeah, right, the SIS.... Dr. Rub went very slowly and gently so I think that helped too--he periodically asked how I was doing, if I was uncomfortable, etc. Hell, even the dildocam wasn't bad; all in all, a pretty good start to the day, all things considered. Once all was said and done, he went over the images with me.

Basically, everything looks great, no polyps/fibroids/cysts...nada. Instead, I have what Dr. Rub called a "gorgeous" uterus with a nice thick lining (today is, after all, CD13). And—whaddya know--I have a big ripe follie on my R ovary, 23 x 20, just waiting to pop any day now. If your scorecard is current, you know that I'm not doing stims/IUI this cycle. In fact, I am doing nothing this cycle except taking the glucophage--but, says Dr. Rub, "It's doing what it's supposed to," i.e., helping me ovulate on my own. So he suggested I go home and 'practice' this month. I told him I'd go home tonight and have a party (Deespeak for get my freak on) to which he countered, "I don't know about a party but just have sex with your husband." Ahchachacha--he must have been paying me back for my retort to his "I can do you with your husband in the room" comment ("well, okay, if that's what you're in to") at my last visit.

But here is the kicker: today Dr. Rub told me he's pretty sure I have adult-onset congenital adrenal hyperplasia (CAH). This is why my androgen levels are so high and why I take 2.5 mg of prednisone every night--and why, he tells me, I'll have to take it for the rest of my life. Of all the obscure things to have, leave it to me to get a doozy. Since my 17 hydroxyprogesterone tests are normal, my version of CAH involves a deficiency that only 5% of cases exhibit (11-hydroxylase as opposed to the very common 21-hydroxylase version). Yep, seems I'm a real freak. In case you're wondering exactly what CAH is, here is what I've learned from Dr. Google:

This condition is caused by an inherited defect in one of the enzymes in the adrenal glands. The adrenal glands manufacture the hormone cortisol and aldosterone from cholesterol. The process of making cortisol or aldosterone from cholesterol requires five steps each controlled by at least one activating protein (an enzyme). CAH is caused by a fault in one of these enzymes which literally runs slow. The effect is that the patient may not make enough cortisol or aldosterone or both. The low levels of cortisol reaching the brain makes the main hormone controlling gland (the pituitary) release a signal, called ACTH, to the adrenal glands to speed up the manufacturing of cortisol by switching on all the enzymes along the five steps of production. However, the CAH patient has one faulty enzyme so a backlog of partly processed hormone builds up. The adrenal gland then has to channel away this build up or the adrenal would silt up. The adrenal has one other route - which it opens up -allowing the partly processed hormones to be manufactured into male hormone called androgen. This androgen builds up in the blood and causes many problems especially in females. These are:

Extra hairs over the face, neck, breasts and body, especially up the front of the abdomen. (no--thank you sweet jesus--but you should see my penis!)
The voice may become deeper (nope)
Greasy skin and hair, acne (check)
Period may never develop, be very irregular or stop (nope--regular as they come for some odd reason)
Infertility (check)

Lucky me, huh?

For the record, I don't really have a penis--swear. It's just a joke hubby and I have. Because of my elevated androgen level, he claims he married a dude. Nice...I know.

Oh--and the donuts were such a hit, the cashier said she wasn't going to charge me for my co-pay. Either that or she liked me. Must be the donuts...you can ply just about anyone with food. Remind me to up the ante to bagels if we need to move on to IVF with this practice--there's no telling what that could do for us.


At 1:28 PM, Anonymous Anonymous said...

Your doctor sounds nice and that's great news about your lining and your follicle.

Interesting about the adrenal issue. I'm pretty sure I have adrenal exhaustion and there's no real cure for this, other than the acupuncture that I'm doing. Good that at least you know what it is.


At 7:02 PM, Blogger Stacy said...

I am so glad it went painlessly well. I was thinking about you all day. Was it painless because you took 1100 mg on Naproxen (and percocet, just kidding) or because of the good catheter? Regardless, YEAH! WOOHOO!

So in regard to the androgen thing can they do anything to get ya preggers? Any next steps?

Again, so glad it was painless.



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