Monday, May 21, 2007

Why, G-d?

I must announce at this time the birth--and death--of our beautiful daughter at 18 1/2 weeks gestation. I am heartbroken.

There is so much to say but the words won't come. I am exhausted and sore and empty. There is little in the way of Jewish ritual to deal with this.

I miss her. I miss feeling her kick inside me. I miss dreaming and thinking about welcoming her into our family. I miss the security of knowing we would at last have our long-prayed-for third child. I am sad I will never get to know her, never learn her hopes and dreams, never watch her find her own way, never hold her little hand in mine, never kiss her sweet face.

We do not know yet what happened, other than that when I went into the doctor's because I had the stomach flu, they could not find a heartbeat. Three ultrasounds and two hours later it was confirmed. There was no heartbeat. She had died, as much as a week or two earlier.

Labor was induced the next day and I labored for 9 1/2 hours and with one push she was out. We held her tiny body and marveled at how developed she was. Her hands were the size of my little finger's nail. Her knuckles and fingernails were exquisite. She had long slender fingers.

We will have a short private funeral/burial tomorrow. I don't want to say goodbye. I want to still be pregnant.

It is not fair. This pregnancy helped me out of my depression last winter. It was a promise of hope, that life goes on, that it's worth going on. And now? Now it's taken away. It feels like a cruel joke. I worry that this will send me right back into depression.

My meds have been adjusted to deal with this and whatever postpartum depression might follow. My care team is in place. We know we will try again.

But this doesn't change the fact that my baby is dead. And I am heartbroken.

Sunday, May 13, 2007

I don't even know where to start (good post)

I would never in a million years have guessed what has happened over the past two months.

Yes, I am still pregnant, baruch Hashem! Four and a half months and counting. Baby seems to be doing well and I should start feeling movements any time now. I have developed gestational diabetes for the third time in as many pregnancies, and while I have to inject insulin twice a day so far, and test my blood sugar four times a day, I'm doing okay with that. I don't enjoy the needle pricks, but I do like knowing that I'm taking care of myself and my baby by doing so.

That isn't the zinger though. The event that blew my mind is this:

Apparently, I am not bipolar and have been living with the wrong diagnosis for 13 years.

Here is the background. Remember when I was really depressed in January? I was referred to a psychiatrist and a psychiatric physician's assistant back then, but didn't get an appointment until April. I guess a lot of people need psychiatric help. I had an in-depth intake and several long appointments. They reviewed my psychiatric history over the past 17 years and had one question: how did I get the bipolar diagnosis?

I remember that part well. It was 1994. I was hospitalized for the second time in six months and my doctors convinced me to begin medication. To determine what meds I should be on, I had to answer a ton of questions about my moods.

Did my depression last for more than two weeks? Yes.
Did it interfere with my ability to live life? Yes.
Did I ever feel like I had a lot of energy? Yes.
What did I do with that energy? Clean, organize, shop.
Did I find it hard to sleep when I had this extra energy? Yes.
Did this extra energy alternate with the depression? Sort of. I never had the extra energy during my deepest depressions.
And so on.

There was no question about episodic depression, and one doctor suspected bipolar. So I was put on an anti-psychotic, a mood stabilizer. I was told that if this stabilized my moods, I was bipolar. If I didn't react to it, then I wasn't.

It stabilized my moods. Sort of. I wasn't sad but I wasn't happy either. I was just mildly depressed all the time. I lived life like a zombie. I did this for two years and finally couldn't stand feeling like I was just taking up space. I weaned off the meds and found that exercise, avoiding sugar, and a strong spiritual/religious life kept me pretty grounded most of the time. My depressive episodes slowed to two bad times per year--October and January--and two more mild episodes in April and July. My psychiatrist at the time told me to keep doing what I was doing, and eventually ended treatment.

Fast forward to April 2007. I was asked more detailed questions about these energy surges.

Did I ever feel invincible? No.
Did I ever take risks that put me or others in harm's way? No.
Was this excess energy goal-directed or generalized to everything? It was always goal-directed. That's why I couldn't sleep. I was so excited about my grand plans for whatever I was about to do (as in finding that perfect clock radio), that I couldn't wait until morning.

Then they asked other things:

Do I ever feel anxious in social situations? Yes. Always.
Do I ever worry about something that may or may not happen in the future? Constantly.
Do I ever have physical symptoms from my worrying? Yes--lack of sleep, headaches, stomachaches, sore muscles.
What do I do when I feel anxious? Clean, organize, shop.


There is nothing here, the psychiatrist said while patting my very fat psychiatric file, to indicate mania. Episodic depression, yes. Anxiety, yes. And a high likelihood of Seasonal Affective Disorder. Even indications of Obsessive Compulsive Disorder--a type of anxiety disorder. But not mania. Every episode I had where I had to clean my kitchen until it sparkled, or shop for the perfect clock radio, or reorganize all the bookshelves? Anxiety attacks.

After a month of appointments, they are about to toss the bipolar diagnosis. My new diagnosis is Major Depression, General Anxiety Disorder with Obsessive Compulsive Features, and Seasonal Affective Disorder. And the reason for the recurring depressive episodes--roughly every three months? Most likely a hormonal imbalance.

As it turns out, the Prozac I'm on is what they'd first recommend for the depression and anxiety. And I don't have to worry about triggering a manic episode. Come September, we will develop a plan for when the baby is born, since I have a documented track record for severe postpartum depression. After that, probably after the baby weans, we'll look at other options, and both have said that I will be a full participant in deciding which option to try in what order. But medication may be some combination of an antidepressant and hormones.

This has completely changed my identity. Here I have worried, sometimes excessively, about triggering a manic episode, and the worry itself is part of what's wrong.

And yet it's a relief. It feels more right than the "atypical bipolar II" ever felt. I don't have to explain how my manic episodes aren't like everyone else's manic episodes. Now when I get the urge to clean (and it's not just prior to Pesach), I ask myself if I'm anxious about anything. So far, I always am. I try to deal with what I'm anxious about instead and that helps a lot.

The best part is, I feel like I can finally get the help I need for what's really going on with me, and that, I believe, will better my life not only for me but also my entire family.