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.

To have and to hold

I love weddings. It is so magical to watch people embark on their “happily ever after”. When I was single, weddings gave me hope that I would find the love of my life. When I was newly married, weddings were a joyous occasion with the knowledge that these newlyweds were as happy as we were. Now, more than half a decade into our marriage and brimming with children, weddings are a reminder of those exciting honeymoon days of a marriage. I love my husband dearly but I have to confess that marriage is very different with children than without children.

As a newlywed, my husband could do no wrong. His quirks were endearing, and I’m sure he felt the same way about mine. Now, after a full day of chasing after my toddlers and feeding/changing/rocking my baby, one of my husband’s quirks can quickly send me over the edge. After a full day with all three boys, my cup is empty, and I often feel like I have nothing to give to my husband. He too seems to need some time to unwind after the kids fall asleep. Don’t get me wrong – we love each other more than we did as newlyweds, but we have found that we need to be more intentional about conveying that love. We also need to take a step back to truly see and acknowledge one another. Most parents find that they have less time for self care once they have children and the same is true of spouse care!

When we argue, one of us may break the ice by bringing up two of the tricks we learned at our Catholic Engaged Encounter weekend, prior to our wedding. Both have always made us laugh. The first is to hold hands while arguing. If you try this, you’ll quickly learn that it is impossible to truly be angry at someone if you are holding their hands. The second is to consider whether your words are “life-giving”. If they are not, consider how they sound to the person hearing them.

We haven’t mastered the art of making time for each other since this last child was born (9 weeks ago). This is partly due to the fact that we live far away from family, but mostly due to the fact that we are exhausted. For now, we are focusing on not being short with one another, spending time together after the kids go to bed, finding joy in the mayhem, and allowing the other parent to rest when one of us feels more energized. This is about as “life-giving” as we can manage to be at the moment.

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?

Split second

This morning, we had a birthday party at a local playground. The kids were all 2-3 years old. I watched as other parents sat back and observed their kids playing while I chased after mine and made sure he didn’t hurt himself on the large play structure. “Why am I such a helicopter parent?” I wondered. It’s true – my husband and I tend to be very anxious, paranoid, and overprotective when it comes to our kids. As a disclaimer, I don’t think that there is a “right” or “wrong” parenting style. I would actually prefer to be more laid-back and relaxed about parenting, but it may be impossible for me.

In any case, at one point I thought to myself: “I think I can relax. I’m the only parent hovering over my child here. Let me take a step back and chat with some folks.” So I stepped a foot away from my son as he was climbing up a play ladder. One second later, he had tumbled to the ground 6 feet beneath him and had landed straight on his bottom. Shit.

I tried hard not to panic. He was crying and I scooped him and took him to a quiet area to evaluate him. “Can you feel my hands on your legs?” I asked. My heart was beating fast, imaging the worst-case scenario. “Yes,” he responded. Thank goodness. “Can you stand up and walk?”. He could. Phew. I watched him walk and wince in pain, touching his back. He was being a lot more cautious and didn’t want to play as much. I touched his spine, low back, tailbone, buttocks. “Does this hurt?” No, he said. But at first, it seemed like everything did hurt. He would start an activity and then reached down to touch his back. He was momentarily distracted by cupcakes, but then didn’t feel like playing anymore. “I’m tired, I don’t feel well…I want to go home.” Fuck.

I called our pediatrician’s advice line and it was recommended that I take him to Urgent Care. We stopped by our house first and I iced his back a bit. At that point, it seemed like he was climbing and running with less pain, so I second-guessed my logic for a minute. Still, there was no way I could live with myself if something was really wrong and I ignored it. So I took him in. At the urgent care, they have a playground in the waiting area. He climbed up the rope ladder, went down the slide, played on the seesaw. These people are going to think I’m crazy, I thought.

They didn’t say it, but the less than five minute evaluation spoke volumes. They palpated the affected areas – no pain. They asked him to walk – no pain. They asked him to run – fast, no pain. They lifted his legs up and down – no pain. “X-rays of the spine emit a lot of radiation,” the doctor said, “so I wouldn’t recommend it.” That’s all I needed to hear – we were out of there in no time.

I am still worried, of course. I think: what if he fractured his tailbone and the pain is worse when he wakes up from his nap? What if he ends up having a slipped disc/nerve injury/becomes paralyzed? I can’t help myself. Being in medicine, I see worst-case scenarios all of the time. People who didn’t have cancer until they did, were pain-free until they developed debilitating pain, lived normal lives until being diagnosed with a life-threatening condition. So any time anything happens to my kids, I shift into worst-case scenario mode. It’s a terrible way to live.

In sum: I think that helicopter parenting is in my future for a good while longer.

On Children, by Khalil Gibran

I think about this often. My life at the moment revolves around my kids – a 9 month old and a 2.5 year old. When I am at home, I do not have a minute to myself. The days fly by in a blur of mealtimes, nap times, and activities to entertain the kids. The hours pass while we watch the kids play in their playroom, stroll outside with one baby in the carrier and one on his Strider bike, wash dishes, do laundry, clean pump parts, cook – the list goes on. These are lovely moments – reading books on the window seat, playing peek-a-boo, and even answering the same question over and over again. I have already seen how these little people are born with their own desires, disdains, and personalities. I know that it is only a matter of time before they fly away from me. They will make their own friends, create their own worlds, and go on to have busy, busy lives. It is the nature of things and I am trying to prepare for it. For now, I am soaking up these precious days – trying to be as present as possible despite so often being exhausted. And in the back of my mind trying to remind myself that these children are not my own.

Your children are not your children.
They are the sons and daughters of Life’s longing for itself.
They come through you but not from you,
And though they are with you yet they belong not to you.

You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams.
You may strive to be like them,
but seek not to make them like you.
For life goes not backward nor tarries with yesterday.

You are the bows from which your children
as living arrows are sent forth.
The archer sees the mark upon the path of the infinite,
and He bends you with His might
that His arrows may go swift and far.
Let your bending in the archer’s hand be for gladness;
For even as He loves the arrow that flies,
so He loves also the bow that is stable.

So sleepy

I always stay up past my bedtime. I’m on vacation at the moment, waking up ~2 times per night because our baby isn’t quite used to this travel sleep set-up, but I can’t seem to get myself to bed at night. I should be falling asleep as soon as the kiddos go down, but I stay up because I can. I stay up for this quiet time when no one needs anything. I stay up because I can think without interruption. I stay up because I can waste time or be productive without counting down the minutes until nap time is over or independent play has grown stale.

I love this quiet time. I love my family, and I cherish the moments with them so very much, but I also like this feeling of quiet solitude. I could have it in the morning if I somehow managed to drag myself out of bed before the first baby stirred, but this is impossible at the moment. And so I hold onto these quiet evenings. I wait until everyone goes to sleep and then I sift through my to-do list, I plow through notes and patient messages, I fill in my calendar, I online shop, I wander aimlessly from website to website, I contemplate (and sometimes even write) a blog post. And then I finally feel ready to sleep – having savored a small bit of ‘me’ time, if only for a short while, if only at the very tail of the evening.

Sleeping again (maybe)

My youngest turns 7 months in a week. This is truly unbelievable and I can’t believe how quickly the past few month have flown by! One of the perks of him turning 7 months is that he is now sleeping through the night – hurrah! This is happening because we’ve worked on it (by letting him cry and self-settle, more on that in a later post), but also because he’s getting older and doesn’t need to eat every 2 hours. Admittedly, he was eating every 2 hours approximately 2 weeks ago, at a time when he most certainly did not NEED to eat every 2 hours, but these little babies sure can be manipulative!

In any case, I am again amazed by how sleeping through the night gives you a whole new perspective on life. Granted, it has only been two nights, and I’m an old hand now – I know that regressions are around the corner – but WOW does it feel good to sleep without waking up every 2-3 hours! I can actually think more clearly, and act more quickly, and I have a much better temperament. Also – the possibilities seem endless! Now that I’m sleeping through the night, perhaps I will actually wake up early to go to the bi-weekly exercise class I signed up for in January. Or maybe I will blog more. Who knows? Again – endless possibilities.