my unwanted guest

I woke up three days ago with the most awful, stabbing pain in my upper right arm - lil' miss shoulder pain had arrived for another visit. She literally took my breath away. The back of my arm down to my elbow was numb.

I will never forget the first time she inflicted me with her presence - it was about 8:00 am, the morning of September 11, 2001. Shortly before I turned on my television and found the world changing before my eyes, she stabbed into me and twisted herself into my fibres. Since then, she comes to visit every few years, bringing days of relentless pain.

Despite setting her up on dates with Tylenol and Advil, shoulder pain is playing hard to get. She laughs at the humble analgesic's efforts to sooth and comfort her. She is a real bitch - an unwanted guest.

I want to show her the door, but she seems to have unpacked her bags and plans to stay a while.

trying again?

Three years and a half years have passed since the miscarriage. Over that time we have dealt with my post-miscarriage depression, my post-Mirena depression, and a lengthy 'mystery' illness that still remains elusive, although somewhat improved.

All of this time, we have been waiting for my health to get better so that we could try one more time for a baby. Last year I was advised to wait until I had been emotionally stable for at least a year. Well, I'm almost officially into my late thirties and there really is no more time to wait. If we are going to do it, it will have to be now. Going off antidepressants again? NOT an option.

A part of me is terrified. Our chances of conceiving are lower now, our risks are higher, the possibility of another miscarriage hangs over us, only outweighed by the idea of another post-partum depression. It's scary as hell.

There are so many reasons for us not to go forward. But somehow logic isn't winning this debate. It is fight between my head and the biological pull of motherhood.

I'm ready to try again.

Are we crazy?

mistaking a miscarriage for a drug seeker?

Three years ago I miscarried at 12 wks - an awful event that I documented in this blog post, in which I explored the psychological turmoil that surrounded my pregnancy loss. What I didn't write about at that time was the physical experience of the miscarriage. It was long and painful.

Yesterday, a post at one of my favourite medblogs "ER Stories", (where 'ERP' writes about life in the emergency room from a physician's perspective) touched me. The post lamented that medical staff discussed withholding pain medication from a known drug-seeker...who was dying of cancer. After yesterday's tone of compassion, I was disappointed to read today's post about drug seekers and how doctors are keeping score. I appreciate that ER physicians must make difficult calls for each patient, but the 'keeping score' attitude results in a culture of suspicion that undermines patient care.

Case in point: my miscarriage. After waiting nearly a week for the pregnancy to abort (they advised against a D&C), I was a physical and emotional wreck. The miscarriage lasted three days - over the May long-weekend. The only option for pain relief was the emergency room.

In the ER, I waited hours to be seen so that I could ask for pain relief and to find out how much blood loss was to be expected. The doctor who saw me asked me if I had tried Advil. Seriously? Who in their right mind would wait hours at night in a busy ER next to angry drunken people and police if they weren't in a LOT of pain and had tried everything else? He went on to ask me if I wanted to be examined. I don't know, you're the flippin' emergency room doctor. I've never miscarried before. You tell me - Is this normal?

The doctor treated me with a skepticism I would hope would have been reserved for repeat customers with a history of drug abuse. It was humiliating and made an awful experience even worse. Did he doubt I was really having a miscarriage? I would happily give consent for an internal exam to clear up any concerns about 'faking it'. Perhaps he thought that I was exaggerating the pain? Perhaps; even I was surprised at how painful it was - it was nothing like any period pain I had ever experienced. It was clear that he certainly didn't care.

Did he feel like he had scored after he failed to treat my pain?

Doctor 1 - Patient 0

Mirena IUD & Depression - Follow Up

Last year I posted about my unfortunate experience with the Mirena IUD triggering depression. I recently looked at the traffic report for this site and realized that 90% of people who visit my blog get here by searching for "Mirena +IUD +Depression".

I still don't think there is enough information in the public domain about the risks of Mirena re-triggering depression in women with a history of depression.

Of course, if you want more information about a medication, you can always look it up on the internet, right? Not so fast... if you live in Canada, the Canadian Mirena website takes you to a secure location where you need to register along with the DIN (Drug Information Number) of the product "you have been prescribed".

That means that unless you have been prescribed the Mirena IUD and have the package sitting in your hand, you cannot log on to the Mirena Canadian website. How's that for transparency?

If you are fortunate enough to be able to download the product monograph you will find the following:

Patients with a history of emotional disturbances, especially the depressive type, may be more prone to have a recurrence of depression while using MIRENA. In cases of a serious recurrence, consideration should be given to removing MIRENA, since the depression may be drug-related. (Mirena Product Monograph, p.9)

It is interesting to note that the Mirena US site makes absolutely no mention of depression whatsoever. The US site also does not list depression as a contraindication, or as important medical history to tell your doctor about. On the other hand, the Mirena UK site lists depression as the third bullet point under "most common reactions".

So, if you are concerned that your depression might be a result of your Mirena IUD - you are not alone!

Tell me your story - please talk about your experience with Mirena and depression in comments section below.

school is in session

The weather seemed to change overnight. Fall is in the air and it's time to get back to school. This term I am supposed to complete my comprehensive exams - eek!

I think I'm ready, but there is a little part of me that would like to do more coursework...mostly just to buy more time. The good news is that my research is on track and for the first time in forever, I am actually feeling well. [smiley]

diagnosing behind my back

You may recall a few months ago I saw an Internist who discussed the possibility of a diagnosis of fibromyalgia with me...I was not impressed.

I just asked for a copy of her report to my family physician and was shocked to find the following statement "I have diagnosed this patient with fibromyalgia". WTF??

When we discussed fibromyalgia during my appointment, she seemed to agree with me that it did not apply to me (fatigue being my dominant complaint) and even wondered aloud about whether or not fibromyalgia even exists as a clinical entity. She never once touched me during the appointment. In answer to my questions about the validity of 'trigger points', I was told me that "too much knowledge" can be a dangerous thing.

Why did she not tell me her diagnosis in person?

It feels disrespectful to have a diagnosis on my medical file that does not in any way reflect what was said during my appointment. It feels disrespectful to be given a diagnosis that the doctor herself doubts even exists!

But most of all, I am angry that she chose to write this in her report; avoiding saying this conclusion directly to me, face to face.

low ferritin?

My ferritin is low.

It used to be a measly "8", now it's in the low 20s. Despite numerous investigations, no one is quite sure why my ferritin isn't rising since I have been supplementing for over two years now.

One of my physicians assures me that low ferritin does not cause fatigue if other blood tests do not indicate anemia.

My research has found conflicting information. But the fact is, I am crazy fatigued most days...and I have low ferritin.

Any ideas on how to raise it? Would dessicated liver tablets help?

BTW, my folate and B12 are all well within range.