Part II: Answers

>> Friday, August 12, 2011

Medicine defined is The science of diagnosing, treating, or preventing disease and other damage to the body or mind.

I love medicine. Before, during, and hopefully after our current life situation, I have loved medicine. I love the uncertainty. The problem solving part where you try and figure it out. I love when I have the knowledge to hear signs and symptoms and then know the diagnosis because it fits so perfectly. I love knowing what treatment works best depending on the situation and then applying that knowledge to the way I counsel people.  I love that medicine gives us answers that we need in order to process our feelings and emotions. I love that medicine can give us expectations for the progression of an illness, so that even when we are flying blindly we can at least cling to the statistics and facts. I also love that even when the odds are against us, there is always hope in medicine because it is not exact, those statistics have outliers, and medicine is always evolving.

"Medicine can only cure curable disease, and then not always" Chinese Proverb

Facts to take home from our appointment...

1. The new MD was incredible. He answered all questions, performed all tests that I think the first urologist was missing, and did it all with intelligence, confidence, and compassion. 

2. Hormone concerns from previous lab work seem like a fluke to him and are not an issue to treat. Nor is the varicocele which he could not feel with his "sensitive fingers" and therefore it is not the problem and not worth the surgery. 

3. All ducts and passageways are clear and free flowing. No scar tissue, no swelling, no obstructions, no concerns (I admit that this surprised me to hear, this is what I was betting on). 

#4 is the biggie...the answer I feel like we waited 3 years to hear...

4. Kevan has a calcification in his prostate. Most likely cause was an infection that produced no signs or symptoms. Calcium is a waste product of infection and since the prostate is a giant sponge, the calcium could not be dispelled through the body and therefore hardened at the infection site. The calcification which measures 6x3mm is putting pressure on the seminal vesicle. This pressure is not yet closing off the vesicle entirely, but if more calcification were to occur (ie. another infection) then it might. The pressure on the vesicle effects the volume of semen and the motility of the sperm.

For the visual learners...Imagine all your little swimmers have to pass thru a tunnel, however your tunnel is jagged with sharp edges that bump and injure the swimmers on their way out. It is only expected that after that journey they would have trouble swimming and therefore would be unable to be successful in the remainder of their venture.

The calcification is deep in the prostate, in a difficult to reach location. A TURP procedure (transurethral resection of the prostate) would be difficult due to location and etiology. Since the mass is a calcification, not a tumor or a cyst, it does not have defined edges and would be difficult to cut out.  The MD has done this procedure before and in our case, he thinks the risks might out weigh the benefits. He also is not sure that removing the mass would improve the vesicle and therefore lead to better swimmers.

Deep breath, long pause....He thinks that IVF with ICIS would be our best bet for biological children and he is doubtful that we will ever conceive without these steps.

5. There is nothing we did to cause this problem, nothing we could have done to prevent it, and (my personal favorite) nothing that could have been done differently to correct the calcification had we come to him 3 years ago.

6. There are also no medical indications, concerns, or risks that arise based on having this calcification. The only issue it should ever cause is our continued infertility.

If those aren't answers then I don't know what is...



Part I: Feeling the Wait

I have attempted to write this blog for weeks...two weeks to be exact since our 3 hour drive to find a new urologist. It's been hard to put the appointment into words...i am also struggling with how I want to remember the day. I know that may sound silly but I have fluctuated between wanting to record every feeling to sticking simply to the facts. Not sure why the blog-o-sphere has suddenly become the place where I think I am storing my memories of infertility but it feels permanent when I post here. Like someday when I do have a baby this will be my only reference point for how terrible things were because all that pain will fade away when I no longer define myself by infertility. I know that is a stretch but I like to imagine that it will be that easy. Hell, something should be that easy right?

So, Friday the 29th we packed up the car with the dog and cooler to head for a great weekend at my family's lake house on Norris. No work, just a weekend in the sun, on a boat, with a beer...well, right after we stop in Knoxville for that pesky appointment.

The drive was uneventful and I must say that having the dog always keeps the mood feeling lighter. So, we get to Knoxville, drive straight to my aunts house, drop the dog, and leave for UT Medical Center. At this point, we are arriving an hour early (really 1.5 hours early because the MD said to come 30 minutes early anyway). So we sit in the parking garage and start to panic for a little bit. We offer vague reassurances back and forth and then decide to talk it over one more time. I am a big advocate of talking about anything. So, Kev practiced his monologue-synopsis of our timeline and how we got here while I interjected the facts we just couldn't leave out. Then we reviewed the question list and I asked for the fiftieth time if there wasn't something we should add.  Finally, we decided to abandon the parking garage and wait in the office, just for a change in scenery.

Before leaving the car, we held hands and prayed. We prayed that the doctor would provide us with answers that we had been seeking and that God would provide us with peace - no matter what those answers were. Honestly, I had been praying this for weeks. Just prayers for answers and prayers for peace. I know selfishly I wanted to stipulate that God provide easy answers but I all I could muster the courage to ask for were some kind of answers and peace.

After pacing the hallway and returning a few phone calls we entered the waiting room. Kevan filled out a few papers and we sat. I then suggested we play scrabble on our phones since Dr. Phil and old issues of crappy magazines were the only other options. Scrabble was the best distraction I could have imagined. No time for anxiety, no time to fret...instead just refocusing energy of beating each other in calming game.

They finally called Kevan's name and led us down a narrow hallway to a big conference room. There was a large wooden table surrounded with leather chairs on casters. The walls were lined with bookshelves which housed Glenn's guide to Urologic Surgery, pamphlets galore for cialis, vesicare, detrol, and viagra, and last but not least several plastic models of the male urinary/reproductive tract. Our favorite replica was demonstrating how a penis pump implant could work for you!

Our new waiting room felt full of opportunities and I immediately felt comforted that we were going to have a place to sit and talk. I already felt like this time they were going to listen and I was prepared to voice my concerns. I opened my binder in front of me and re-read my question list. Then I re-read the lab work we were providing and tried to control my mind as we waited...



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A glimpse into my journey to grow my faith and my family. Each day I am trying to trust in God's plan for my life, while I struggle with my own desires for my career, my marriage, and my hope for a family.

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