Nervous Nellie

I’ve had anxiety most (if not all) of my life. Some of my earliest memories are anxiety-laden:

  • sitting in my father’s car while he was outside talking to my uncle, feeling worried about being alone in the car
  • in elementary school, feeling worried about a state project due in May…during the month of December
  • the night before I turned 10, feeling intense worry that I would never be 9 years old again

I could go on and on.

There were times in my life when my worry worsened. A few weeks to months each year during my childhood when I would be exponentially worried – we began to call these episodes “La Etapa” (a stage of my life). I remember the worry intensifying in high school. I moved to a new school district during my freshman year and I would feel intense dread in the morning when people loitered by their lockers since I didn’t (really) know anyone. I remember hiding in the bathroom during this time, as this was preferable to socializing. I experienced intense anxiety during freshman year of college- fear of meeting new people/would I fit in/etc. I drank too much and gained a ton of weight which only made things worse. My anxiety worsened in medical school, especially on rotations where I had less control over my schedule/time. One way of dealing with my anxiety was through food restriction and overexercising – I could have control over one area of my life, even when everything else was in disarray. I started dieting in high school, so that need has been there for a long time.

I did speak to a few people during these years. In college, someone tipped off a counselor that I may have an eating disorder, and so I started seeing her. She would weigh me facing backyards so that I couldn’t see how much I weighed. I lost more weight when I stopped weighing myself because I was afraid of gaining weight, so clearly the anxiety was still there. I then met with a psychiatrist in medical school, during my surgical rotation, because I was incredibly moody and would break down over the smallest things. I remember running to the first appointment so that I wouldn’t miss my workout that day. He started me on Celexa. I took this for a few weeks, maybe 1-3 months max? My husband (boyfriend at the time) thought it helped, but I wasn’t so sure and stopped shortly after starting. The third time I reached out to get help was when I was struggling with infertility due to hypothalamic amenorrhea. I met with a therapist a few times near my residency program, pretty much crying the entire time through those sessions. That also did not last long.

Why did I “quit” so many times? Probably because I have pretty high-functioning anxiety. It never stopped me from accomplishing my goals or having (mostly) healthy relationships. It’s an ever present background hum, but in many ways it has driven me to succeed. I excelled in school, attended an Ivy League college, graduated medical school and matched into a competitive residency. In other words, even though I personally suffered, my goals did not. I was still able to interact normally with others, connect with/take great care of my patients, and perform daily activities with little interference. However, I have recently started wondering whether things could actually be better. For years, I thought being thin had led me to succeed. Part of the fear of gaining weight was that I would lose everything I had worked for. This was obviously a lie I had been telling myself and the world did not end when I gained weight. And so I started thinking: what if life could actually be better with my anxiety under better control? What would it be like to live in the moment, to not have the ever present buzz of worry, to not feel imminent doom over every little thing?

The other tipping point was this: my 4 year old has started to show signs of anxiety and it is heart-breaking. Yes, it could be hereditary. My whole family deals with anxiety, so maybe it would have been passed on anyway. But I also wonder whether an anxious milieu of the womb or anxious parenting (my husband, too, would factor in here; although normally a very calm person, he is quite an anxious parent) had any effect. I feel intense guilt over this. Although I can’t change anything I’ve done, at the very least I can do my very best to control my anxiety as my kids begin to grow and understand more.

Finally, I think it will be good for my marriage. My husband and I love each other dearly, but our differing personalities (mine characterized by anxiety) have definitely led to some repetitive arguments.

And so I scheduled an appointment with a psychiatrist specializing in women’s health, particularly around birth and motherhood. I met with her last week and she agreed I had generalized anxiety disorder and recommended three pillars of treatment:

  1. Medication
  2. Psychotherapy
  3. Self care

She said we could do any combination, so I am started with medication and trying to incorporate self care into my life. I opted for medication because, if I am truly honest with myself, I am dog-tired. I’m tired of always worrying about everything, of making to-do list after to-do list, of constantly playing out scenarios in my head. It is absolutely exhausting. And I want to get better as fast as possible. My father, a psychiatrist, always said that medication could be incredibly helpful to patients, to normalize their brain chemistry while they utilized psychotherapy to change their thought patterns. I picked up Zoloft right after the appointment and felt a huge sense of relief as I swallowed it. Obviously all of my feelings were still there, but I was relieved to finally be doing something about it.

I am holding off on psychotherapy for now because of the time commitment, but I am trying to do some self care. My family is in town this weekend so it’s a wonderful opportunity. I am taking the time to write this, and I also scheduled a couples massage for this evening. In the past week I’ve made time for mom/baby yoga and a stroller workout class.

And so I am trying and hoping for the very best outcome here.

Charley horses and baby kicks

A few days ago I woke up with a terrible muscle cramp in my right leg. It woke me up from my sleep, which was aggravating because I really love my sleep. But it was also incredibly painful! I had completely forgotten about Charley horses during pregnancy, but yes, it is a thing that happens.

(Speaking of things that happen: here’s another one no one told me about. After my second delivery, I experienced terrible uterine contractions – almost as bad as pregnancy – whenever my newborn nursed. This is apparently a thing. When you nurse, oxytocin is released, leading to uterine contractions. Because the uterus has less muscle tone after your first delivery, this contraction is often quite mild – it definitely was for me. However, with each subsequent pregnancy, they become more intense (as uterine muscle tone increases). I was literally doubling over in pain after my second was born, so I am NOT excited to experience this again!)

I have also started to feel this baby kick. At first (around week 17) it felt like very light flutters. It still feels light, but I am certain now that it’s the baby. This makes everything feel more real. We bought baby’s first outfit yesterday. I can’t go too crazy (I already have 2 kids’ worth of boy clothes) but I definitely wanted him to have a new hospital outfit.

I also have his anatomy scan this week. I am always so worried about this test, but trying to stay calm before the ultrasound.

 

What I Ate Wednesday

When I had an eating disorder, I would relieve the anxiety of said eating disorder by writing down all of the things I had eaten that day, or was going to eat that day. I would be in lecture – college, medical school, residency – and start scribbling on the side of my notes: banana 100 calories, cereal 120 calories, soymilk 80 calories…and on and on and on. I would write different permutations depending on what I thought I would eat that day. I had most foods memorized by caloric content and was pretty proud of that fact.

I would also read a lot of blogs by people who had “recovered” from disordered eating or who were advocates of “healthy eating”. These blogs would undoubtedly have a What I Ate Wednesday (or WIAW) feature. These bloggers would write things like “spoonful of dark chocolate chips” or “tablespoon of cashew butter” to show how indulgent they were in their eating. All of it was insane.

I also remember thinking: “After I have kids, I’ll still eat healthy and work out. I won’t let myself go!” Well, that was also an insane thought, because I can barely manage to pack a lunch these days, much less make sure that it’s nutritionally sound.

And so I thought it would be interesting to write down what I really ate today, this Wednesday, mostly as a parody but also so that if anyone with disordered eating or hypothalamic amenorrhea were to read this, they would hopefully realize that most people don’t measure out what they eat, and that’s actually normal.

Breakfast: I have no idea. I know, this is a terrible way to start WIAW. But the main point here is: when you don’t obsess about eating all day, it actually takes quite a bit of effort to think about what you ate. I know I drank coffee w/ soymilk (Yes, coffee is not great during pregnancy, but I just now in the second trimester starting craving it again and only have 6-8 oz on the days that I do drink it). Oh wait, now I remember: a scone from Trader Joe’s – not sure what type.

Lunch: PB&J sandwich, Strawberry Fage yogurt

Mid-afternoon snack: biscotti, hot chocolate, apple

Dinner: tortilla chips, TJ’s meatless patties x 2, baked oven fries, bites of the veggie burgers I made for my kids. Most of this was eaten standing up.

Dessert: chocolate chip cookie, vanilla ice cream

The best part about having recovered from disordered eating is that I can write everything down and feel nothing – no joy if I ate “well”, disappointment if I ate “badly”. That list is just facts. I don’t feel good or bad about it, and that’s an incredibly liberating feeling. Honestly, there was a time in my life when I thought that I would never feel that sense of freedom around eating. I feel so fortunate to have overcome it and hope that anyone struggling with disordered eating will soon overcome it as well.

My nanny is drinking pregnancy tea

This hurts my heart because she’s preparing for her second round of IVF and I feel like a terrible person for having two children already and now being pregnant with a third (and I haven’t told her about this yet, although I’m pretty sure she’s figured it out). It hurts my heart because I remember those days very vividly – wondering why everyone seemed to get pregnant so easily and why it was taking me forever. What was wrong with me? Would I ever be a mother? I wore fertility bracelets, temped, took supplements, checked CM, joined a yoga for fertility group, set up a meditation corner in my bedroom to relieve stress, started acupuncture, and on and on and on. And I think: how much harder would it have been if my job was to take care of small children? And how conflicting it must be when that job is paying for your opportunity to have your own child.

In addition to my nanny, I haven’t told a lot of people I’m pregnant yet, but there are two people in particular who I should have told but I have not. They are very dear friends to me. One recently miscarried in her first trimester after deciding to have a second child, and the second is undergoing her second round of IVF, having failed a first in an attempt to have a second chid. I should have told them, but didn’t know how to break the news directly after they announced what they had been through. And, to be honest, distance and our busy lives make it easy to evade. But I am 15 weeks tomorrow, so it’s time. And eventually I’ll need to tell my nanny, who likely already knows. I only hope that in a few weeks to months she shares the news that she’s expecting as well.

No longer a salad person

Tonight, we had dinner at a local pub. We sat tables across from my son’s classmate (their family is not very friendly, so this seating was unfortunate). The mom, who is quite slim, ordered a salad and picked at it. For a second, I looked down at my forkfuls of mac n’ cheese (swiped from my kids), veggie burger (I have been vegetarian for 2 decades), and french fries, and felt a bit ashamed. But then I remembered the days of being a salad person, and was overwhelmed with happiness that I am no longer a salad person.

Disclaimer: people who eat salads are good people. And salads are good for you. My concern is with being the type of person who would only order “salad, no bread, and dressing on the side, please” and then lose her shit if the dressing was accidentally mixed into the salad or someone dared throw a bread crumb in there. Or someone who spent 2 hours on the elliptical in college because she had “eaten too much” the day before and then headed to the cafeteria mid-day to eat her one meal of the day – salad.

In college, there was a painfully thin blonde freshman with wavy hair and glasses. All she ate was salad. We (including everyone with an eating disorder who didn’t actually think they had an eating disorder) called her Salad Girl. She would buy two trays full of just greens with nothing on them. Then she would work out next to me on the elliptical for 2 hours. There was a 30 minute limit for the elliptical (a popular machine if you have an eating disorder because you can “work out” while still exerting minimal effort since you’re always running on empty) so we would all sign up with different names. This was in the pre-everything-online days so we had to sign in by hand or call the night before. So if you were signing up twice you had to call twice and make sure you waited a while (sometimes hours) so the front desk wouldn’t catch on. But of course other people would see you on the elliptical for that long and realize you were not both Bridget and Amy.

I am so happy to no longer be a salad girl. Sometimes, I think the pendulum swung the other way – my diet is not the best at the moment. But I try to have a few healthy things sprinkled here and there, and mostly I do my best. And I count my blessings that I am no longer counting every calorie, obsessing over every bite, and mapping out the details of every workout – that shit was exhausting.

If you are struggling with food restriction, I don’t have any great advice for you, but I do want you to feel hopeful that your life will not always be this way. I never imagined I could live the way I do now – but here I am! One day the switch just flipped. The main reason I had an eating disorder was because I thought I needed it to succeed. I thought being thin was the ticket to career advancement, finding a man, getting married, having a family, and owning a white picket fence. I held on to that fantasy for dear life. And then when I was told I had to gain weight if I wanted to get pregnant, I panicked. But what about the rest of my life!? The amazing thing was this: when I gained weight, my life did change – it improved. My career went on, I stayed married, I had children, I bought that white picket fence, and, most importantly, I freed myself from the intense anxiety of choosing french fries over salad.

For the record, I now choose french fries 95% of the time, and despite owning an elliptical, I rarely use it.

 

Trying to conceive

My two attempts at becoming pregnant went something like this:

Pregnancy #1: Got married, starting trying to conceive (TTC), started to think that I most likely had hypothalamic amenorrhea (HA), was diagnosed with HA, underwent fertility treatment and became pregnant almost 21 months after we started trying. Those are the facts. The reality is that it was an emotional rollercoaster – hope, anxiety, disappointment, anger, sadness. And most of all, terrible fear that I would never be able to have a child.

Pregnancy #2: Oldest was 11 months, period came back naturally (hurrah), and the next month it didn’t come. I naturally thought my HA had returned (especially because I had a negative pregnancy test at 35 days), but I was actually pregnant. Second hurrah! I literally had to do nothing and I pretty much worried 0% about getting pregnant that time around.

And now, here I am. 16 months post-partum (!) and I had expected to be pregnant by now. Although I initially thought my second should have a few more months of being the baby than my first did, I really did want them fairly close together. But now, if we do get pregnant, my last two would be >2 years apart. This bothers me.

It probably bothers me because I am a Type A person and want everything my way. But it also bothers me because I am afraid that maybe it will not be easy for me to become pregnant again. I’m conflicted on this point. First, I feel somewhat selfish for wanting a third child. Is this normal? I have two perfectly healthy children! Our lives are FULL. It’s not like we have oodles of time to fit a third child into the mix. I think about people who are going through infertility struggles for the first time, and I feel terrible for having this blessing and wanting more. How greedy of me! Second, it’s giving me more time to think about logistics, and I don’t want to be dissuaded from our decision to have a third. Financially, emotionally, etc., does it make sense to have a third child?

What it boils down to is this: if we can’t become pregnant naturally (and if we are not able to, I am not sure that I know the reason because I am nowhere in HA land and cycling naturally), would we go down the infertility work-up/treatment road? I don’t know the answer to that.

But this third attempt is bringing up a lot of emotions from my first attempt, and the synopsis of my month is as follows:

Week 1: period is here, wah(!), lots of negative emotions closely followed by attempts at positive thinking and planning for the upcoming cycle (fertility window is X and baby would be born on Y)

Week 2: TTC

Week 3: More TTC, then the 2 week wait begins. This week feels like the calm before the storm – anything is possible but nothing can be done to change what’s coming down the pipeline.

Week 4: Time to type every symptom into Google to see whether it could herald a pregnancy (AND I’m a doctor AND I’m been pregnant twice!). Is nasal congestion a sign of pregnancy? How about back pain? Cramping? Bloating? What about spotting for 5 days…oh wait, that’s just my period.

And the cycle starts again. What else can I say except that it sucks. I think about myself ~5 years ago, feeling so dejected and low. I remember sitting on my “meditation” mat where I was supposed to relax with incense and practice Yoga for Fertility, except I was sobbing. It was a hard, hard time. This time, it is not as hard because the stakes are lower and part of me does feel crazy for wanting to add a third to the chaos of my life. I also do feel incredibly fortunate to be cycling naturally (without birth control) for the first time since high school!

But I am still sitting here wondering whether the new acne I’ve noticed and the low-grade back pain I’m experiencing could have anything to do with pregnancy…and what will I do next week if it is instead a sign of my period?

The two week wait

For people who are trying to become pregnant, the two week wait is the worst of times. Here’s how it works: there are generally 2 weeks between ovulation and the time when you may be able to find out that you are pregnant. This translates into roughly 14 days that you can obsess about being pregnant/not being pregnant and swing from disappointment to elation to hope to relief.  The pendulum can swing either way and you have no control over it and you can’t force time to pass any more quickly than it is already moving.

With my first, for whom we underwent fertility treatment, I experienced a great number of disappointing two week waits. I am not a patient person, and I spent hours Google-ing any and all symptoms to see whether they could “correlate” with pregnancy. Slight abdominal twinge? Metallic taste in mouth? More sleepy than usual? Hair slightly curlier? Seriously – there was no such thing as low-hanging fruit. I can’t even tell you how much money I spent on ovulation strips and pregnancy tests! Sometime in March of 2014, a week and change after I ovulated, I experienced terrible cramps and was certain that I was out for that cycle (my fifth of oral ovulation induction). Then, a few days later – a positive urine home pregnancy test! Finally! It was the best of times.

With my second, I wasn’t sure when I ovulated (not a medicated cycle), so I took a slew of pregnancy tests around the 28-30 day mark until I was sure that I was not pregnant. However, because I was still late, I took another test a week later and, lo and behold, it was positive.

I am ruminating on this because we’d like to have a third. The situation is different now: with my first, I didn’t know if we would ever be able to have a child, so each two week wait was a truly emotional rollercoaster (would I ever be a mother? what was wrong with me?). With my second, it was more of a surprise (although not unintended). There was less stress and more joy. Now, I am torn between wanting to BE pregnant/closing this chapter of my life, and sticking with the familiar – two kids under three, a known chaos.