Wednesday, January 26, 2011

the RD experience

first, a note
i'd like to share most of the details from this appointment, because i know that personally i've always been curious what an RD visit entails, and i know that if it were on someone else's blog, i'd want to read about it. furthermore, i've received several emails from other women also experiencing technical difficulties TTC, and i think that for some, hearing about my experiences thus far could be helpful.

that said, i just wanted to note that in the next section, i'm going to delve into some of the details, which includes some discussion of things like kcalories and BMI. and i know that there are some people out there who really try to avoid reading about those types of things. as charlotte pointed out just this morning (i LOVE this woman's insights, btw), a fixation on numbers can lead to comparisons and obsession, and therefore it makes sense for some to try to stay away. so please: if that is the case for you, just skip this post! you can always email me if you have questions.

the visit
on a very trustworthy recommendation, i went to profile associates in chapel hill. i could tell almost immediately that the RD i saw was very experienced and knowledgable, and i also found her very nice and easy to talk to.

to begin with, i laid out my whole story: lowest adult BMI (19); highest ever BMI (just under 21 -- in med school before i really started running any real mileage); exercise history (years of marathon training, now tapered off to a much-reduced workout plan); periods (nonexistent post-pill for more than a year and a half before starting fertility meds).

interestingly, in telling her my tale, i had a bit of a lightbulb moment that REALLY, this was all likely to be related. while some of you may say "duh" and others may disagree, i think i was in denial about the issue for quite some time. it is not normal or healthy to have amenorrhea. my arguments (to myself) were always:
a) "but i am NOT underweight." and i have never been.

b) "other people who are clearly smaller than i am seem to be getting pregnant left and right, so how can this be my problem?" sigh. well, no one ever said life was fair. time to get over it.

c) "seriously: i eat A LOT." it's true: i tend to snack more than i see others snacking, and if you put me in the right restaurant situation i can do some serious damage. however, if i really think about it, i do usually lean towards healthier options and have not always been consistent in matching my intake with my activity -- perhaps a more important issue than i realized back in those marathon training days.

d) even my reproductive endocrinologist initially put me in a 'lean PCOS' category, and she did not mention gaining weight or cutting back on running until i asked about it specifically after 3 failed cycles.

so this in itself was perhaps the most valuable part of this visit for me. especially since the RD (who has a lot of experience working with infertility patients) agreed flat-out that this was most likely the cause of my ovarian issues.

her explanation was that everyone has a threshold need for estrogen to induce regular ovulatory cycles, and some of that is contributed by adipocytes (ie: FAT). with all of my activity -- especially the longer runs, which rely on fat stores for fuel -- it is likely that i was not holding my stores high enough/consistently enough, and therefore --> amenorrhea.

as an endocrinology fellow, i'm inclined to believe that it is more complex than that, but it does make solid evolutionary sense. furthermore, the proof is in my follicles, which (at least based on the last cycle) seem to respond better to medications now than they did when i was running more with lower BMI (and therefore less fat --> less estrogen on board).

so now what?
while i think (or at least hope) i'm where i need to be weight/activity-wise right now, the RD stressed the importance of making sure that i stay there. while i'd love to say, "well, no problem!", i admit that i still have irrational moments when i just wish i could fit back into my (skinnier) jeans.

therefore, i really appreciated having her examine my eating habits and provide concrete guidelines on what i should be getting in each day. following a plan (y'all know i like plans!) makes me reassured that i am doing what i need to do for the right reasons, and that is a good thing.

in order to see what i was currently doing, i recorded 3 days-worth of diet history for her to go over.

of course i put a stray cute notebook to good use!

i was surprised to see how INCONSISTENT i was, even over this 3-day period! one day my intake was super-low (1200 kcals) and the next much higher (2200).

she felt i would benefit from really trying to even things out so that estrogen levels stay constant. and again, i can imagine the evoluationary reasoning behind this, in that the best time to procreate would be a time when food stores were abundant enough to eat well every day, not just feast a few times a week.

visual aids

she then taught me about exchanges (they do not teach this in med school!) and laid out an example plan, designed to provide about 2000 kcals daily. she also skewed the plan a bit towards protein and fat for fertility reasons.

finally, she asked me to to track the exchanges for 2 weeks and then to come in for a follow-up. the only part i have trepidation about is having to think about it all so much -- i don't want to spend lots of time measuring, or take the joy out of food! however, as a temporary exercise, i think it could be valuable and that it certainly couldn't hurt.

so far, so good

so that about sums it up! i hope some of you got something out of reading this, and that i didn't come off as overly crazy or obsessive (umm . . . or at least not in a bad way).

and on a completely unrelated note
if you have ever worked in a lab, you NEED to watch this:




workout: 60 minute yoga download. some of you have asked which flows i like, and i definitely can recommend this one:

it has some challenging moments (and i did work up a bit of a sweat) but is not super-hard, nor is it confusing.

another wonderful edible mosaic recipe
i cannot say enough wonderful things about faith's blog, an edible mosaic. her photography is amazing, the recipes are fantastic, and she tends to gravitate towards the most interesting dishes.

her cauliflower aloo gobi was no exception. i loved the mild cauliflower flavor melded in with the great spice mix! i'm already excited about eating leftovers for lunch today.

served with tandoor chef nan (baked from frozen) + homemade [improv] raita