Tag: endometriosis

Hi Thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from?

Julia: I’m Julia Motyka. I’m from Western New York. I’m from Binghamton. I’ve lived in New York City for quite a long time. So

P:  that’s nice. Let’s talk about family. Do you have siblings?

J: I do. I do. I have a younger brother who is about four and a half years younger  than I am. And then I have what I like to call my adult onset family. My mom remarried when I was in my 20s Until I wound up with four additional step siblings. But we have a unique relationship because we didn’t grow up together. We kind of pal around at the holidays and have this kind of regard for one another as kind of slowly chosen family. But but my my deepest sibling relationship is with my my biological brothers

P: and coming from that setting. Did you think oh, I’m definitely gonna have a family.

J: Gosh, you know, I mean, it was a complicated journey for me. My family history was sort of thorny as a child because my my parents are wonderful and complicated. And I’m a product of an early divorce couple. It was a very acrimonious divorce. And both of my parents went through sort of long road towards becoming who they are now, in some ways, much changed from when I was a kid. And so when I was in my teens and early 20s, I wasn’t sure that actually having a child in any way particularly a biological child was going to be right for me. I also have an illustrious history of mental illness in my family on both sides, and have been a primary caretaker to my father, who was sick in my late teens for a while. So there was a period of time for me where I looked around and I said, you know, maybe this genetic line doesn’t need to continue. Maybe we’re okay. It’s okay to just finish it here. And I wasn’t sure that I needed to do any more caretaking to be honest. But there was a moment or a series of moments, I suppose in my early 30s I was partnered with my current husband. And he really deeply wanted children. And I felt wasn’t a sense of negativity around it, but I felt profound ambivalence. And I started to really consider why that was the case and unpack my own family history and sort of intergenerational legacies of mental health challenges and I started to have these dreams of a little girl. Big, big dark blue eyes and like a mop of curly dark hair, and the dreams were very strong. She was always about 18 months or so. And I would always wake up and feel like the imprint of a body on my body. 

P: Wow. 

J: And if they came every it was like it was over the course of over a year I would have some sort of instrument. And then one night I had one of those dreams and I woke up in the morning and she’s with me all day. Like my little silent passenger. She’s my constant companion. And I from time to time would work as an audiobook narrator so I was recording a book a day, and I was in the studio. And I was about halfway through my session and she vanished. The film doesn’t disappeared. Whoever she was, she was gone. And for the first time, I felt this enormous space of regret open up inside my body, and I thought oh, I don’t attempt to become a mother somehow I will regret this. I will regret it. In a way that I hadn’t experienced before. And I wasn’t sure yet at that time, how motherhood would come and how we would proceed but I knew it was something that I wanted to watch for and so we did. And so that’s already

P:  that’s amazing to have a feeling of pre regret.

J:Yeah, it was really it was like it was like advanced regret. Congratulation. It’s like, you know, I’m that deeply Jewish. Regret in advance.

P:  I see you I see you and I’m applauding. That’s well done.

J: Very good. Thank you. It’s like it’s a show it’s a special show.

P: So when you guys decided to get pregnant, what are you imagining pregnancy will

be like, 

J: you know, to be honest. I always assume, hahaha. That it would be like falling off a log. I was like, you know, I’m healthy. I’m like, I’ve been practicing yoga. I’ve got I’m really aware of my pelvis. I’ve got a Kundalini I know what it was like and like, it’s like I’m I’m available to myself. And I like to think of myself as being very physically aware. And so I was like, it’s gonna be great. And if it didn’t, wasn’t great, it wasn’t easy. And it started to take us quite some time. And initially, sort of like, wow, that’s just the right baby’s gonna come. I got very woowoo about the whole thing. That all came from a dream so why not? 

And then it was almost two years after we decided to start trying to have a baby, that we ultimately decided to see a fertility specialist. Now again, you know, Pride goes and all of that. So I and my husband both assumed that it would be an issue of his because he’s a lifelong type one diabetic. And so we were like, well, you know, with many type one diabetic men sperm count can be an issue there. There are all kinds of complications that come with that particular chronic illness. And so we both thought, probably that may be the case.

P: so, Real quick here. type one diabetes is an autoimmune condition that affects someone’s ability to produce insulin and you’ll want insulin to help move sugar from your blood into your cells. Without it you leave too much. sugar in the blood and not with the cells which is required for energy. Having this condition can affect the process of sperm development in men and sperm require a lot of energyto  be good swimmers, and this insulin issue affects their ability to do that.

J: And lo and behold, we both got checked out so I’ll go to I’ll get checked out to why not. And they did a vaginal ultrasound that was wonderful. In New York City that we went to, and within about 45 seconds, finishing the obstetrician went, Oh, well, there’s your problem. I have Excuse me. We have a you have a huge endometrioma eclipse in your left ovary and I and I had never heard that term before. What what is that? What do you mean to describe an endometrium? It’s technically but it’s really just a sort of a stack of layered endometrial tissue of uterine tissue that has grown outside of the uterus. And he said, well, that we’re gonna have to remove that. And he said, Do you have endometriosis? And I said, Not to my knowledge. And he said, Well, you intend to have extreme pain with your period. I burst into tears. 

Now, the backstory of that is that I had gone to multiple doctors for decades, with unexplained extreme pain during menstruation. I had sciatic pain I developed nerve pain in my back, I would have to sit down in the aisle of the drug store in the middle of a cramp. In order to not lose control of my legs. Sometimes I had a really severe pain, but it had been dismissed and dismissed and dismissed to the point that I just stopped mentioned. And kind of forgotten about it completely. Just kind of was living with this debilitating pain every month. And so when asked about, Oh, I’m so aware of my body and yet decided to numb myself to this incredibly important piece of physical information that I received month after month, because everyone outside my body had told me it was nothing.

P: we are lucky to have the founder and CEO of integrative Women’s Health Institute on our show, Dr. Drummond, thanks so much for coming on. So why don’t you tell us about your training and your institute?

Dr. Drummond: Sure. So I started my career a little over 20 years ago, my initial training is as a physical therapist, and I practiced you know, pretty direct hospital and clinic physical therapy for many years more recently got a doctorate in Clinical Nutrition, and also became a board certified health coach and about, like 12 years ago, started the integrative Women’s Health Institute as a training school for my colleagues to learn about functional nutrition in women’s health and we also have a flagship Women’s Health Coach certification, which is the only health coaching certification that has that third party Board approval in the world that focuses on women’s health. And so I’ve been doing that for quite some time now and I also maintain health coaching and clinical nutrition practice around pelvic pain and endometriosis.

P: So let’s start with some basic stuff. Can you define for everyone what endometriosis is?

Dr. Drummond: Yes, endometriosis is a disease process where you’ll have these lesions that are made of tissue that is very similar to although not exactly the same as the tissue that lives the inside of the uterus, and that’s called clinical terms, the endometrium, which is where it got the name used to be thought that these lesions were a consequence. of what’s known as retrograde menstruation, meaning that the menstruation was are going into the body instead of out of the body, and that the endometrial tissue was growing and kind of forced growing outside of the uterus. But that theory has been pretty strongly disproven in the last decade or so. And it’s not fully known sort of where these lesions come from, if you will, but there is a genetic component to about 10% of people with uteruses around the world have endometriosis. And about 9% of fetuses, female fetuses or fetuses with uteruses have endometriosis at birth. So these lesions exists in about that 10% of the female population throughout life so there’s absolutely a genetic component, but there’s also an inflammatory and very likely autoimmune component. So it’s a multifactorial disease in terms of how it’s expressed. And it’s tricky because there’s staging of this disease in terms of extensiveness throughout the body and severity of the lesions, but that doesn’t very well correlate with symptoms. So people can have a lot of endometriosis everywhere and have very little symptoms. They may not even know they have it unless they’re struggling with infertility or they just simply may never know they have it. And others cannot, you know, maybe when the surgeon goes in to remove the lesions, doesn’t see a lot of lesions, but a person can still have real severe symptoms.

P: had they done a vaginal ultrasound before the last

J: time I had gone to the to the OBGYN specifically for pain. They did do a vaginal ultrasound there were no endometrial like at that time. So I don’t necessarily fault the doctors that didn’t know what to look for or how to look. But I do have a large finger wag for the the kind of culture of women medicine that has spent so much time pretending it doesn’t exist. Just that

P: Well The dismissal is so frustrating.

J: Yeah, it was it was just it. I mean, I was told repeatedly, right? Well, you probably just have a low pain threshold. Some women just have more painful periods. And I’ve been moving because I’m slight build. I’m tall and I sort of i It’s not that I present the trail. I’m quite strong, but I presented really, I suppose. And so people would look at me here about my painting. Now this is probably just a look, she probably the truth was I was in horrible, horrible, horrible pain. And I will say that on a pain scale, right? This is the reason we have a subjective pain scale because it shouldn’t matter if my seven on the pay scale is your tooth. I’m still at a seven. And it’s not for anyone else to judge what that seven does or doesn’t mean about my strength. It means nothing. You know, so the basis for their statements I take issue with

P: I brought this issue of dismissing pain to Dr. Drummond: maybe we could talk about why it’s so hard to diagnose exactly or why women’s pain is being dismissed and whether that’s like a larger cultural thing or something specific to endometriosis.

Dr. Drummond: Yeah, so that’s absolutely a larger cultural thing that women’s pain is just generally dismissed. In fact, the word hysteria essentially comes from someone you know you’re crazy if you have a uterus, right? That’s Mr. His means uterus and Latin. And it sort of points to how women are perceived in general when it comes to pain. This is significantly worse in women of color which is problematic the patient you’re talking about right now is her experience around it’s normal to have painful periods you’re fine you’re probably this sensitive to pain we don’t see anything is extremely common as an initial response and fact even now, so I’ve been doing this for just over 20 years, and it used to be 15 years diagnosis when I first started, and now it’s still pretty bad. It’s 12 years to diagnosis.

J: Ultimately, right upon receiving the diagnosis, good undergo a surgery and then for hours, it’s usually about a 30 to 45 minutes surgery, and mine took four hours. It turned out that I had five endometrium between five and seven centimeters in size. And they eclipsed one of my ovaries one was attached to my bowel one was attached to the outside of the uterus and they were everywhere for my pelvis. I also had two small fibroids and I had scar tissue that was so profound that it was completely burying and occluding one of my fallopian tubes.

P: It’s great that there are things you can do to put endometriosis at bay like surgery, I brought this question about efficacy to Dr. Drummond. So Julia had surgery to remove her endometriosis, and I’m wondering wonted like the tissue lining of the uterus grow back.

Dr. Drummond: Maybe it depends on a couple of factors. So when I first started doing this, the kind of surgery that was done was called unit was called ablation surgery where they would like burn off the lesions.

Fortunately, while this is still done, but it shouldn’t be if your surgeon says they’re going to do ablation, and out of that office, so what you want is excision surgery where they actually cut out the lesions in the same way that cancer sort of cut out and the better of it is cut out the roots. Now there are times there’s a kind of endometriosis called Deep infiltrating endometriosis that again, cutting it out is key, but sometimes that’s not fully possible, sometimes even with great excision surgery. Just like with great cancer surgery, it grows back sometimes sometimes the surgeon just missed an area where maybe they didn’t see it. It was too small and it grew in another place. And sometimes they just didn’t see it yet and it grows in another place. So but what I would say is that in the first half of my career, I commonly saw people who had 15 endometriosis surgeries like just a surgery every year and they just kept going and burning it off trying again, you know, now I work primarily, you know, my clients and patients primarily see excision surgeons I even either see them after before and after, ideally, if they have surgery, which isn’t always appropriate varies, but a lot of the time it is and that you know, I might see someone with a maximum of maybe three surgeries in the lifetime, but it’s much much more common to see just one surgery. 

J: So I finished the surgery, and I was told that even with the surgery, our odds of becoming pregnant naturally were relatively. I was 35 at the time and I remember kind of lying my bed in the in the week after the surgery, sort of it you know that semi lucid but I was sort of taking my my pain medication and sleeping a lot and I was thinking a lot about the women in my family who I referenced before who had struggled mightily with mental illness and and I had this sort of strange experience where I felt like they had kind of like I had cleared a pathway. And it was as though one of the kind of historic pain of the women in my family has kind of been excised along with these sort of lumps of tissue. And so I wonder what would what would happen and at the same time, we went to an adoption fair and we started foster care paperwork and I said, Listen, however your child, you are welcome. And we decided to do four rounds of aid and insemination, four rounds of IUI

P: let me say one thing here about the doctors predictions? Who would prefer a world in which the doctor said well, we have our averages. On average, women are 35 and have endometriosis and the husband has diabetes on average. It is harder for those couples. We do not have a crystal ball and we cannot predict what will happen in your case. So we can give you the average and then you can make your own conclusion but to say you will have a hard time frustrating right because those all words have effect right? So 

J: yeah, yeah. Well and it creates a situation in which you feel like you’re kind of living out a preordained path, right like, oh, we will have a hard time we this will not work or and I wonder for how many couples or how many, how many people seeking to become parents. That’s the end of the story. Because they take that word, and go okay, well, I guess we tried that of canoeing on their own path in your own way. So for us, I didn’t feel ready to completely let go of the idea of biological motherhood, but I also felt that was important to kind of look at it as I’m a firm believer that there are many, many, many ways of becoming a parent in this life. And you get absolutely the right child, no matter whose body they have originally come out of. So we went to the adoption fair and started I went to the first foster meeting and started reading all the paperwork. Meanwhile, we did our second IUI attempt. And about five days after that attempts, I kind of had this feeling of like, I wonder feels a little I just feel a little something. And I thought you know, don’t delay. 

But lo and behold, about a week after we started our foster care paperwork, I turned up pregnant. And after all the difficulties in becoming pregnant and in finding our way toward pregnancy my pregnancy with my first child was really just juicy. It was a good a really peaceful time in my life that I had profound nausea. I was not it was not so fun at different moments, but it was an uncomplicated pregnancy. We decided not to from the sex of the child, but we didn’t know who we were going to get through this common. We have picked out a name for her for the baby and for on and on and on. Everybody thought it was a boy, the girl who improved and then the day before her due date. I went into labor and I went into back labor and had really like a 36 hour saga of of childbirth 

P: before you get to the birthing. Let’s talk for a second about what you thought it would be.

J: Oh, yeah. No, I pregnancy I actually thought that my pregnancy would feel weird to me if that makes sense. Because it’s such a strange thing that happens in the body. But what I ultimately wound up feeling was was it felt very, very natural to me to be pregnant with my first child. The second child has a different story. So that was intense. But the first child I was like this was I was I was designed. I felt really easy in my body. I’m the kind of person who I always have 12 different things happening. I do a lot of different things in my life. And I like it that way because my mind tends to function best when I have a lot of different things spinning in the air around me during the pregnancy. It was one of the first times in my adult life where there was nowhere else I wanted to be. There was nothing else I wanted to do. I was content to just be in that moment growing that baby. It was a profoundly peaceful time. 

I really didn’t expect that it would feel that way to me. So when it came time to have the baby to birth then I went into it actually thinking it would feel easy. If no birthing I had like I had been like sitting on my birthing ball and bouncing and moving my pelvis and I’ve gone to prenatal yoga and I was like I was really I was ready. I pelvis is ripe, it’s blossoming flowers. Great. And then the labor actually began really awful. Because we were we were set up spine to spine. And it was very tough. There was a there was a lot of vomiting. There was a lot of labor began really fast. Slow back down. I had a really supportive birth team. My husband was deeply supportive. I had a doula who I treasure who really had that was a seasoned person in the birth world and was able to kind of help continue to shepherd me through the challenging moments and my obstetrician was also remarkable was was deeply patient and present with me and ultimately manually dilated my cervix a few times and in the sort of the continued hope of avoiding a cesarean which we ultimately did a voice which had been my hope so it had I had planned for an unmedicated birth at a birthing center and we wound up at about our 32 transferring to labor and delivery so that I could receive an epidural. 

Ultimately, interestingly enough, the epidural was what allowed my body to relax enough to let the baby down. So the baby was was born vaginally after 30 Almost exactly 36 hours like 36 hours and 10 minutes. And she as she was coming out of my body, the doctor said and I because I had the epidural I’m very present for this time. She said wow, that’s a lot of hair that the baby has and I kind of laughed and sometimes I wonder who she is who they are. We didn’t know the shoe yet. As the baby was being born, my doctor said hey, we get your baby and helped me kind of move the child onto my chest. And there was this big mark of black hair. Turned curly almost immediately. And these huge dark blue eyes looking up at me

P: goosebumps! Goosebumps! Wow oh my god,

J: and so the baby and my dreams had always been named as me and of course no that is a child thing. And she always had to be she waited for him, which I’ve always been really grateful for because it says special gift for me to get to be her mom. And then we thought that was it. We thought we toyed with the idea of a second child. You know, I had been told once I started menstruating again, it was sort of the definitive pronouncements as the medical industry here. I had been told by several doctors that that the year after I started menstruating again, was the most fertile window in which I could become pregnant and after that year, it would probably become difficult or you know, if not fully improbable. So about 14 months after I had Esme I started menstruating we were like okay, let’s do this. Let’s make this happen. And nevermind that I didn’t feel ready. Nevermind, nevermind that my child didn’t feel it. None of us were ready to do it. But we decided to go ahead and try and very quickly. It turned out that my left fallopian tube had occluded again, that it was no lot that nothing could pass to one side. You know, I was 3738 something like that. I don’t remember anymore now, but I was getting older.

P: it’s occluded…It’s because of endometriosis. Is that what’s going on? Okay.

J: Yeah, I mean it had been buried in scar tissue and even though they again there was no scar tissue evidence if the tube is so small I mean if you consider consider like Angel Hair Pasta right I mean, teeny tiny. And so it doesn’t take a lot of pressure to clamp it down. 

P: This is starting to sound like a design for all of us. 

J: Really, I mean, you would think given how long the the human race has managed to survive that those tubes would be a little more resilient and maybe they are I guess maybe if you consider the other things they undergo. But a scar tissue is not an easy thing.

P: I interviewed a reproductive endocrinologist and she said something like fallopian tubes if you look at them the wrong way. Just they collapse. So I feel like you’re our assessment here. is validated by someone who has seen them.

J: Yeah, that’s really thank you. That’s useful to know. 

You know, we talked about it and at the time, my husband was really in favor of pursuing IVF which we were told had, we had about a 20% shot at a baby with IVF and I sat with that idea for a while and I have friends for whom IVF have been extraordinary, who have beautiful families I have absolutely I champion it. I think if it’s the right choice for you. It is a fabulous choice. It was not the right choice for me. I had a lot of anxiety. I’ve had some hormonal imbalances in the past, and I just didn’t feel I didn’t feel good about making that choice for my for my own health. And I already had one child that I needed to be present for. And so I decided not to do that. And it was an extremely challenging time in my marriage. I think my partner my husband felt at the time that I was kind of that it was it was sort of my way or the highway in a certain sense and and it was being my body it was and that was very hard for him to feel he had no agency and also hard for me to feel that my body was somehow secondary or not. Well, my feelings around my body were not valid because they they negated something for him. It felt like and until we let it go. He traveled a lot. I worked a lot I spent time with our daughter. We kind of found our way back to each other. 

And then fast forwarding to the spring of 2020 where we all we all know what happens in the spring of 2020.  And my little family of three left the city as we were privileged to be able to do and then time in a country house for about seven months. And a couple of months into that time. My daughter started talking about wanting to have a baby I very famously she and I had a conversation. She was just about to turn four and she said I want a baby baby sister. So you never know but she said how could we get one and I said well, you know some people have a baby. Daddy has to give put something inside of the mommy. I sort of got like a about it. I tried to be clear without being too detailed because you She wouldn’t have been interested anyway, was a pause. And she looked at me and said, So you and daddy would have to do something together. Give me something and I Yes. I said, I didn’t don’t see that happening. Well, you never know. There are other ways you know, maybe some people adopt a baby and then for days after we talked about adoption, she wandered around the house like slapping her hands together and rubbing them together going. Now we’ve just got to find that baby. We’ve got to find that baby. How are we going to do it? We’re really be looking around. 

And so my husband and I, in some ways, because she was so deeply he started talking about adopting a child in the midst of that time. I mean, I haven’t really told this story line up this way before. It’s a bit of a saga I’m discovering. In the midst of that time, I discovered that I have one of the linchpins of disorders, which basically means that I have several cancers that I am genetically predisposed to. I have a genetic anomaly. My mother has it. My brother does not and I do as well as my mom. And it comes with up to 48% chance of uterine cancer and a 30 some odd chance of colon cancer. There’s some gnarly ones in there. The uterine cancer issue was particularly concerning to me because my endometriosis, right? Uterine cancer is actually cancer of the uterine tissue is cancer of endometrial tissue. And so given that mine grows all over my body felt like a problem. 

P: yeah, that feels threatening

J: yes, it feels threatening…So I received the diagnosis. Not really threatening, it felt like why why roll the dice in that way. And when when there’s a part of my body that I can potentially just remove and remove therefore remove the threat or largest so I started to plan for a hysterectomy. And I currently you know, I was at this time I was 14 was the summer before I was turning 41. And my menstrual cycle was only 22 days long. And my one fallopian tube was occluded. I was starting to have more severe pain again with each cycle. And I thought we know the baby maybe better to let this go now let them be all girl off into the sunset or a little party or something. So I was in the midst of making that plan and starting to identify you know, with COVID When were they going to do start elective surgeries what who did I want to do this and talking to my OBGYN who I like, like and trust and in the midst of that I missed my period and I thought that’s weird because I my periods come close together but they don’t I don’t. Initially I had done a lot of head standing in my yoga practice and I also an intermittent yoga teacher. So I’ve been teaching inversion practice that week. And it’s like well, sometimes when I’m upside down a lot, you can alter my menstrual cycle a little it must just be head standing in my trades doesn’t come like four days that I just never missed. I never miss it. It’s never it’s never been a skipped. I’ve never I’ve never been willing to skip through periods. And so four days and I thought gosh, stress, hard years pandemic you know, maybe it’s perimenopause, maybe I’m just going into menopause early. 

And then two nights later, I woke up at three in the morning. I thought God I want a bowl of cereal. And I and I went I lay in bed. I thought to myself Is it possible that I could be pregnant? I did the math and listen, I don’t know about your house. That’s the pandemic was not a sexy time. Not was not like, wasn’t like let’s get it odd. No, there was really like one opportunity that month and it happens to fall. Technically after I should have ovulated even on my shortened cycle. But I did the math and I guess conceivable it’s possible, but come on. It’s so unlikely and so I didn’t even tell I didn’t tell my husband I was like I can’t open up this can of worms again. I can’t I can’t pain that we went I can’t do it. We won’t survive it. And there’s nowhere for us to go. We can’t like…we’re trapped in this house  together. And so, made up a story about needing plastic bins. Like I need to buy bins, I need to go buy bins and he said, you know, middle of a pandemic Can’t you just order those on Amazon and I was like no, no I need to see them. I need to go to I need to go to Staples. See the bins. I got in our little car and I drove to Staples and I bought some beer and I didn’t see and then I pocketed a home pregnancy and I purchased that she didn’t steal it but I took home a home and just to be clear, 

I got home and I woke up at like 5am for a bowl of cereal and to pee and lo and behold it showed up positive and I looked at it and I thought well you know it’s going to be a chemical pregnancy it’s going to be ectopic there’s there’s just no way but I did at that time share with my husband  I said you know I woke them up. I poked him he sleeps with if we put earplugs and earplugs and a face mask. He sleeps like he’s at a spa. And so I let you jab him hard to get them to wake up. So I’m shaking him and he pulls the mask off and takes the thing out of his ears. And he looks at me like what your problem was that I have to tell you something. And he looked at me like what could you possibly have to say a 515 in the morning? And I said I’m pregnant. And he just started laughing hysterically. And then he looked at me and he said shut up and we started and we just sat there staring at each other for a few minutes. And then we decided we would tell no one because it was probably not viable. drove into New York City and had had kind of done all of our resident testing and quarantining on a way to see our our respective parents so that our daughter could see her grandparents for the first time in a while. And I was dropped off at my doctor’s office secretly, so that I could be checked. And lo and behold, I my OB even said, she says, you know, the odds of this being viable are very low. And if it was like, I know, she said, we’re talking needle in a haystack. And I said, I know that no one’s getting your hopes. And she’s

 P: Let me ask you a question, been so confusing you know, you have all these issues that should stymie your ability to get pregnant. All those things. This little guy, this little zygote has made it past all those barriers. So why do we think the pregnancy won’t last? 

J: Well, we didn’t know yet that he had, because there are two ways in which the pregnancy could have shown a positive and been non viable, right. Initially, the pregnancy could have been a topic it could have been outside of the uterus, which given the state of my fallopian tube was was not unlikely necessarily, and it could have been chemical which given my age was also a possibility. So until we did the ultrasound to check and see that there was actually somebody cooking in there. There were still there were still a couple of variables that left it uncertain.

P: so I didn’t know what the chemical pregnancy wasn’t having a look at. According to the Cleveland Clinic. It’s basically a pregnancy that ends before five weeks, and embryo forms and might even embed in the uterine lining, sending out speaking of HCG, the hormone that indicates a pregnancy is present HomeKit but for whatever reason, the embryo stops growing and ends in a miscarriage. It’s referred to as chemical because the HCG was the only sign of its existence. It’s too early to see it on an ultrasound. You will be more likely to run into one of these types of pregnancies if you’re doing IVF because we’re being monitored so closely. 

P: I wonder if your cereal test is also a factor here. Would a chemical pregnancy make you have

a craving?

J:  I don’t know. I don’t know. You know, that’s an interesting, that’s an interesting question. And to be honest, in those early days of the pregnancy, I was so convinced that it was on that it was not going to be viable. That I didn’t. I didn’t question I didn’t look to the positive because I was so I think afraid of having my heart broken. So I didn’t I just didn’t even entertain it. I was like, There’s no way. This is unlikely. What whatever. And I was I was wrong. Right? So we did the vaginal ultrasound and it showed a very healthy, early embryo sort of little little back of baby and a little sack of placenta embedded very helpfully in the uterine wall. And my OBGYN looked at me and she smiles and she said, she said if you’ve been back in two weeks, and we’ll check the heartbeat, she said this looks really good so far. Is that includes your heartbeat in two weeks. Chances are April, we’ll have a baby. 

P: Wow, 

J: baby is someone who really wanted to be here. And I said yes. So two weeks later we checked there was in fact a heartbeat. And off I went into the pregnancy now to ask her about the first pregnancy. I will say that the second pregnancy my expectation had been that it would be very similar. I’m going to feel peaceful, I’m going to feel grounded and good. My body is going to feel good. I felt like like shit on a stick. I felt really bad. For the whole pregnancy. I felt miserable. I felt conflicted and I felt anxious and I felt tired. And I had kind of gotten into a space where I was peaceful as the mother of one child and who am I to look like a miracle look at a miracle in the eye and that really messed up my life here baby. But he that I felt what i felt like i The time had passed and I had moved on and I was doing all of these other things. I didn’t want to go back into the sort of deep absorption of a new baby and I really cherished and still cherish the deep relationship my daughter and I have and I don’t know that I want a triad here. I really like that we are a dyad  that’s important and something right about it. And then I had a series of pregnancy complications I had unexplained bleeding at around 11 weeks turns out to be something called a sub chorionic hematoma, which is basically just a pocket of blood inside the uterus that lends itself out. And if it is often not threatening to the baby, it doesn’t always resolve but it required almost six weeks of bed rest and having listened to another of your podcasts, I know that bedrest can go on for a whole lot longer. But I shudder to think about to be honest, but it just kind of everything added to the feeling of unease and anxiety that I had. 

When we did an ultrasound in the midst of all of the bleeding the baby was was doing actual little backflips. And so he was fine. He was imperturbable good to be unflappable, it’ll be a really it’s a swimming around. What’s this other liquid who cares? So, six weeks on bed rest, under a pelvic rest. I could do like movements that really was meant to stay chill. And then it resolved and I did ultimately have a home birth with the second baby. 

We talked a lot because of COVID. Initially we talked about what the different issues were in a hospital. Birth setting. And so my OBGYN who had delivered my first she was actually she no longer delivered babies. But she said, you know, listen, if you were a person who chose to have a home birth, I might be willing to make a special guest appearance. 

P: Wow. 

J: And come on over. So, so we found a midwife that I that we really responded to that also knew my doctor, we worked with the doula that the three of them all knew each other. And so when the day came, it was sort of like the inverse of the first pregnancy and birth. The pregnancy with my first was so easy, and the birth was such a challenge. And with the second baby’s birth, the pregnancy was so challenging and so filled with anxiety and doubt, and fear and concern and confusion, the sort of reinvention of myself as mother of two as opposed to Mother of One which doesn’t feel like a profound change. On paper, but it’s in my body it felt in women that felt like I was being asked to dimensionalize in a new way that I didn’t even know existed. And I didn’t feel I had the capacity. I just didn’t know how to do it, but the book itself beautiful. Birth, I went into labor has like five in the morning. It was slow and gentle. Gentle enough that  three hours later, I walked my daughter to school, and we would stop every eight or nine minutes and I have a contraction, and then we keep going and she knew that my mom was coming if my mom picked her up at school with baby day. And so we said okay, I gave her a big hug the goodbye is that I don’t know if a baby date yet. But if a baby get up mom would call my mom. You’ll see Mark at the underscore. That is me. And apparently when my mother arrived just in time to pick her up at school. My mom arrived when she got there and Esme was about 30 feet away, coming out the front door of the school and saw my mother and shouted at the top of her lungs, “it’s baby day!!!!”

P: that’s appropriate

J: but it was just it was a truly gentle labor. So I labored on my own. My husband was there and then he was setting up the birthing pool and kind of doing all of the doing all of the things that that I was ultimately so grateful that he did he was making sure that everything was set up for safe and we had just moved putting up curtains so I didn’t have to give birth to all of Manhattan Avenue. getting everything ready. Sort of like the neighbors. I really didn’t know we were going to be your neighbors. Welcome. But I kept having this experience where I would feel the baby drop off. And I would be like, Oh, this is when I threw up last time. This is when my body didn’t know what to do last time. But this baby was positioned differently. I was older. I had done it before. And this time I knew how to let go into the birth process and kind of lean toward it as opposed to pushing against it. So we I think it was about 15 hours of labor start to finish and two hours of really active into transition and then 15 minutes of pushing and he came out in the water, happy and peaceful and ready to go. And yeah, it was it was a remarkable visit. And there was this moment where my doula and my doctor and my midwife were all there and you were to the midwife had two assistants. I’m surrounded by five women. And there was a chorus around me, they all you know, this, the contraction would come and I would just hear the word breathe. And they were all like echoing like a little chorus around me to breathing. Breathe a baby down. Breathe the baby down. And you know, my husband had his hands on my back and it just it felt this sort of was almost like a meditation of strong sensation moving the baby out of my body and the second child born or you know, until he became really determined otherwise until he lets me know something else. Okay, and my daughter is dark she isn’t she has my eye color there now dark green and she has like thick curly hair. And it’s like intense. And my other child has strawberry blonde hair and crystal blue eyes and greets the world of like, hey, like happy to be here. Thanks for inviting me to the party.

P: Everyone wants a surfer…good work

J: work. Listen, it’s great. I’m thrilled. He’s gonna He’s gonna get with a smile but she gets a sledgehammer you know, life’s good for him. He arrived and and has been a little light beam that has been to be one in April this year. So I am now that he is almost one I’ve been told in terms of my other conditions, you know, basically that I can nurse him for as long as I wish to and will wait until I get a little closer to natural menopause and then likely I will go ahead and have a hysterectomy in order to curb the likelihood of uterine cancer emerging on the later side. And in the meantime, of having biannual pelvic ultrasound and an annual colonoscopy which is a real delight and you know, taking care to check in as much as I can with my body and do everything I can to keep it healthy. 

P: That’s amazing. I don’t know whether to say you should run out and buy a lottery ticket or if your son is the lottery ticket. Someone’s going on some kind of magic though and how does Esme like her brother

J: You know, I asked her the other night we went up for our first mommy daughter dinner. In the beginning of the pandemic. We went to a restaurant and she and I were sitting there by ourselves together. used to do all the time and we never do now and we’re sitting there and she’s eating spaghetti and meatballs. And I looked at her leaning cause of me. How is it having a brother? What do you think about that? What is it like for you to be an older sibling with the cause, very thoughtful for a moment and I was like oh, here it comes. She’s gonna send me some tomatoes. Oh like him. I was like Okay she does she likes him. He likes us. World the earth and for her for him. And I think she really excited by the prospect of having a sort of a comrade in our compatriots.

P: that’s an amazing story to have all this success despite the predictions that you were given at the onset.

J: Yeah, I mean, I think it’s that my story is a real testament to not letting the barbarians get you down right like don’t if you have a sense that that you their journey is not over or not what what you’re being told that it must be listened to that thing, right? It’s that that no path is preordained, despite what the medical field might like to say largely right because they don’t want to get it wrong. And it’s easier to say no than to say yes

P: Yeah managing expectations is a big game. So we talked in the beginning before we started taping about your writing about this. Do you want to talk a little bit about that? 

J: Sure. I mean, I you know, it’s very much a work in progress right now. The pieces that I’ve published have largely actually been sort of tangentially related to my parenthood. I write a lot right now about a whole different stories in my life. I know I mentioned at the beginning that caretaker for my father and so I’ve written a lot about the transformation in that relationship. My dad has had HIV and AIDS for a very, very long time, and I was his primary caretaker. In the 1980s for quite a while, and he’s very, very sick. So I’ve written a lot about my parenthood, as reflected through the lens of having gone on that journey with him. And then I’m just starting to come back to some work about my own journey toward parenthood. And fertility and what it was to decide to become a mother with the legacy of mental illness that that exists in my family and also the physical challenges that presented themselves along the way. Those are works in progress and forthcoming.

P: Well, you can give me links to your website and I’ll put it in the show so people can find your writing.

J: Yeah, we love that.

P: Thanks so much for coming on the show.

J: Such a pleasure. I’m so happy to have this conversation.

P: To get to Julia for sharing her story of overcoming the process of becoming someone’s parent requires so much flexibility, the ability to withstand physical challenges, and willingness to manage uncertainty. It’s a miracle any of us are here. As mentioned previously, you can check out the extended show notes at war stories from the room.com and there you’ll find links to all the things we talked about, including Julia’s writing, and ways to take a look at Dr. drumlins Integrative Health Practice. Thank you for listening. If you like this episode, feel totally free to share it with friends to Like and Subscribe. 

Thanks also Dr. Drummond. She and I have a longer conversation about endometriosis than is shared in the body of this episode. One thing I asked her is how people could potentially get a diagnosis more quickly, and I’m including her answer as a coder to this episode. So just after the music ends, you can hear her answer. Keep listening. We’ll be back soon. With another inspiring story 

P: is there any advice you can give to women to help them get a diagnosis faster? Is there anything they can do to present more clearly to whoever they bring the issue to?

Dr. Drummond: Yeah, that’s a great question. I think it goes a little bit back to when you were talking about in this case, the woman had a vaginal ultrasound, and in endometrial the moon was found. Here’s the tricky part about that. That if someone is if there is evidence of endometriosis on imaging, someone actually can see it that shows that that’s a diagnosis. of endometriosis. The problem is, is that not seeing it on imaging does not rule it out. The only way to truly make a diagnosis of endometriosis is by a skilled laparoscopic surgery which I highly recommend being done by a person who specializes in endometriosis or pelvic pain or at least minimally minimally invasive gynecologic surgeries. So not your kind of OB GYN who is, you know, three endo surgeries a month or a year. But someone who does this this is their whole job because it’s as complex, as good cancer surgery.

So you want someone who really knows what they’re looking for because sometimes these lesions can be missed, especially if they’re not in the most common places. So back to your question about how to kind of drive this diagnosis forward. So just because something is not seen on imaging or there are no abnormal biomarkers, blood markers, things like that. Doesn’t mean a person doesn’t have endometriosis. So if you still have symptoms, keep pushing the issue. A few things that might be valuable to test in the bloodwork would be just chronic inflammation markers, things like CRP but also ca 125. The markers of increased risk of ovarian cancer can be valuable. But really, it’s more of a symptomatic diagnosis. So if your story is something like huh the women in my family all kind of said things like Welcome to womanhood. You have your period this get used to it, it’s gonna be bad, you know, that’s a red flag and the history of infertility especially because generations before didn’t really talk about it. In this comfortable away, you know, that’s a red flag. Any any other woman, you know, cousin and sister, mother, grandmother, whoever had surgery for endometriosis or had early hysterectomy. That’s a red flag. The challenges is that I’ve seen two things in sort of a family history story. One is that person you know, the family just didn’t talk about it much there. There’s you know, there was a lot there’s a lot of shame around any kind of problem with menstrual health. So it was either not talked about or it was normalized that everyone in his family has bad periods. Or I see kind of from the more the sort of less conservative, will you say like pressive crunchier natural medicine. It you might hear stories like oh, you know, this pain is part of the like, process of your body expelling the toxins or something like that. Also, not accurate but a different take on it. So that kind of family history is a big red flag almost all of my patients, there’s something the family history, they just maybe didn’t know about it and then the second thing is that really intense periods that disrupted middle school, high school trying to, you know, play during the softball championships and just white knuckling the whole thing being in the nurse’s office throwing up passing out one of the doctors who is a brilliant endo surgeon up in Massachusetts he has the because it kind of like the signal that someone probably has I know if you ever found yourself sitting on a bathroom floor in a school with like your chin on the toilet just trying to like, cool down. That’s a big red flag.

P: Yeah, Julia Julia mentioned that she during her periods, she just collapsed like the CVS because she you know, walking further

Dr. Drummond: pain down the leg. Yeah, a big one. Because of the nerves involved, but also that vasovagal response that kind of autonomic nervous system sweating, passing out needing to kind of lay down in the girls bathroom, putting your head on a cold, toilet or anything else. Those are all big red flags. And to me, there’s no reason that should happen. So a few other things that can lead to that degree of discomfort or variances for example, which can be seen on ultrasound. So if if that’s not the issue, or if someone is treating that well with nutrition and supplementation, and they’re still, you know, their hormone tests look normal and all of that. That’s where I’m really looking for that index of suspicion and the final thing that tends to overlap is digestive issues. So I certainly wouldn’t skate back, skate past that. So I think the faster we can educate these, you know, middle school health teachers, middle school nurses, that’s where we’re going to make inroads because that’s where it first presents. And most of my patients get really good. You know, like this patient you’re talking about at tolerating pain and powering through it. And they just stopped bringing it up after a while. And that’s the problem. So by the time they’re old enough to like, see, you know, let’s say they actually are seeing a gynecologist who even knows to look for this, which more and more of them do but you know, you might be 22 years old. You’ve had it since you were 1112. You just forget about you don’t bring it up anymore, because, you know, it’s been dismissed. So many times.

P: Yeah, you’ve been told us nothing. So it’s hard to think to bring it up. Yeah. Okay, that’s helpful.