November 30, 2008

Warning: A Movie to Avoid if You're Feeling Fragile

R and I decided to have some fun this afternoon (and procrastinate on work) by going to see a movie. We figured that in keeping with the spirit of holiday cheer, we would go see "Four Christmases."

I'm a fan of Reese Witherspoon, and it was a cute movie, but a word to the wise: If you are feeling fragile about infertility and the holidays make it even worse, this is NOT the movie for you.

There was NOTHING in the movie previews that hinted at the subplot of this movie, and none of the reviews I found online mentioned it at all, either. I won't spoil it for those of you who are in a happy place and are planning to see the movie, but suffice to say this movie did not end up at all where we expected it to.

Fortunately I was in an okay place, so it didn't leave me in tears, but R has been struggling a bit lately, and he was pretty bummed by the end of the movie.

On a different note, I had an appointment with the regular endocrinologist on Tuesday. It did not go well. He basically told me that my TSH levels are abnormal but not abnormal enough to cause symptoms. (Never mind the rapid heartbeat, high blood pressure, tremors and dry eyes at the time of the hyperthyroid results, or the fact that I can't seem to stay awake for more than 8 hours at a stretch now that I am on the hypo side of things.)

The only thing he is willing to do at this point is have me keep coming in every month to get blood drawn. (Which, of course, he requires be done through his private lab, rather than any of the labs my insurance is contracted with.) So basically, I'm paying big bucks every month to pad his bank account while he sits there and tells me that nothing is really that wrong with me.

I pointed out that doing nothing about this isn't really an option, since we have 10 embryos on ice right now. His response was that even if he does something to address the TSH, that's a moot point because I have anti-thyroid antibodies since my issue is being caused by autoimmune thyroid disease. So he said that, combined with my history of miscarriages, means that in his opinion there is no way I will ever carry a successful pregnancy. Nice timing, now that we've already created the embryos.

November 28, 2008

My Non-IF Hobby

When I'm not poking myself with needles, obsessively researching treatment options or tending to my day job (whish provides the funds for the needle poking and treatment options), my other hobby is baking.

When I have a chance to bake, which isn't often, I tend to go, um, how shall I say this? A wee bit overboard.

Take yesterday, for example. I was in charge of the Thanksgiving pies. I baked four - for eight people.

Yes, I know, one would have sufficed. But FIL loves pecan pie (lower right - it's not burned, though it looks like it in the photo), so I always make one for him. And BIL's favorite is cherry; this year I decided to fancy it up a bit and make a lattice top crust.

I've never made an apple pie, and this year I was determined to do it. I use store-bought crusts, because I'm not that into making dough, but I made the filling from scratch, with three different kinds of apples. (I read a tip in a magazine that using a variety of apples gives it more flavor.) I tried to press a design into the top crust, and that didn't turn out so well. Next year, I want to copy a pie crust I saw in a magazine that used cookie cutters to cut apples and leaves from dough and then added those to the top crust; first, I have to find apple and leaf cookie cutters.

And then of course it wouldn't be Thanksgiving without a pumpkin pie (in this case with a pecan strudel on top), so that made a total of four.

But the good thing is, we left about 90 percent of them over at my in-laws, so the pies will stick to their waistlines more than ours!

November 24, 2008

Day 6 Was Less Exciting

The lab was hoping 7 to 9 more would make it, but we wound up with 4, so we have a total of 10.

That's a good number, I know, but ultimately it doesn't mean anything until we get the CGH results back and find out if we have any normal ones to transfer.

And speaking of transfer, I got a phone call from RE's nurse today. In an e-mail I had sent her last week, I mentioned being afraid to transfer them back to me and that we might at some point decide to go the gestational surrogate route instead. So she called to let me know that there are additional FDA rules requiring more bloodwork for R and me for GS, and she didn't know if we would be able to meet those rules at this late date.

It turns out we are, but only because R left work unexpectedly for an heroic and frantic sprint to two different labs so that his blood could be drawn before they closed this afternoon. All of that panic was because it turns out the male partner has to be tested for communicable diseases within 7 days of egg retrieval, and today was the 7th day. (Two labs were because the blood could only be drawn here, then has to be shipped to the clinic for testing, and the first lab he went to - the one closest to his office - does not do blood draws if they are not also going to be running the test.)

I also have to do the tests, but for some reason the FDA grants the female partner 30 days instead of just 7.

Maybe I'm just in a mood to be extremely irritated by every little thing, but it really ticks me off that no one at the clinic mentioned it to us before now. It would have been so much simpler to have the blood drawn while we were there the day of my retrieval. I'm particularly nervous about it having to be shipped, because I had to do that for the one-day workup, and the lab that drew it (the same one R wound up at today) stuck it in the back of a freezer, where it sat for a week while they insisted that they had mailed it and that the receiving lab had lost it. That little escapade took four hours of my life over the course of three days before I could finally get someone to locate it in their freezer and actually put it in the mail to be shipped.

So I'm not looking forward to having to keep track of shipping again, particularly because if they lose these vials, it's not just a matter of re-drawing it; it would mean we couldn't use the embryos from this cycle for GS at all.

And it's so totally ridiculous that we have to go through all this hoopla in the first place. If we had never done IVF before and had never had any miscarriages, I could see why no one at the clinic would bring up additional testing for the possibility of GS.

But the two VERY. FIRST. THINGS. out of REs mouth during our initial phone consult this spring were 1) donor egg and 2) gestational surrogate. So it's not like the subject hadn't come up. And with 6 miscarriages, it's something they could have at least said "ya might want to consider this, just to cover all your bases."

I know that ultimately, we cycled where we did for the lab. Although honestly, we had 10 blasts that were frozen during our first IVF too, so right now to me everything feels exactly the same, and I don't know that we're getting a whole bunch of benefit from the revered lab.

Next up: Six to eight weeks of waiting for the CGH results, and tackling the thyroid issue, beginning with another appointment with Regular Endo tomorrow.

November 22, 2008

The Day 5 Report That Almost Wasn't

I swear I'm not usually a **tch, but my guess is the staff at the clinic probably stands in a back room somewhere and draws straws to find out which of them is going to be the unlucky one who has to deal with me.

I started getting nervous late this morning when I didn't get the call with our Day 5 report, because we got our Day 1 and Day 3 reports before 10 a.m. Then 11:30 a.m. turned into 1 p.m., which turned into 2 p.m., and finally at about 3:45 p.m. I couldn't stand it anymore, so I called the on-call nurse to find out what was going on with our embryos and whether they had forgotten about them or dropped the whole lot of them on the lab floor or something.

You'd think they would understand that a patient wants their Day 5 report on, well, Day 5. But she informed me all the embryologists had gone home for the day, and if I wanted my Day 5 report, I would have to call back on the morning of Day 6.

Seriously, when has that kind of a response ever gone over well with a still-hormonally-ramped-up infertility patient?

So I threw a hissy fit and informed her that that was a totally unacceptable answer and that someone needed to either a) call me from home with my report or b) get back in their car, drive back to the clinic, look the da** report up on the computer and give me a call.

About 20 minutes later, I finally had numbers: they biopsied and vitrified 6 of the 18 today. That sounded like a woefully low number to me, but the embryologist said a rate of 30% or higher on Day 5 is great. She said they're still growing the other 12, and it looks like 7 to 9 of those might be able to be biopsied tomorrow. She promised me someone would call me tomorrow without me having to make another ticked off/hysterical plea.

I asked how many she thought might wind up being normal, but she said there's just no way to tell, and pointed out that if they could determine which ones were good based on the way they look, there wouldn't be a need for chromosomal testing to begin with. Fair point, but ya can't blame a girl for tryin'.

I also asked about R's sperm. He had 65 million per ml on the day of retrieval. Way to go, R! Numbers like that are still so amazing to us, given that at the beginning of this process nearly 6 years ago, he had 5 to 10 (not million, just 5 to 10) normal in each sample. I think that numer alone made his day.

Tomorrow, I will try to sit and wait for the call patiently. We're going to a Christmas concert matinee with R's family, so I won't be able to post until late again tomorrow.

November 20, 2008

Day 3 Report From Home Sweet Home

We finally made it back. On the one hand, I was thrilled to see our furbabies, and it's very nice to sleep in our own bed.

On the other hand, it's still 80-friggin'-something hot here! Next week is Thanksgiving, for Pete's sake. I shouldn't be having to turn on the ceiling fan in the bathroom while I'm getting ready in the morning, nor should I be sweating (even with the A/C on) while I'm driving in to work.

Clearly the desert has not received the memo re November = autumn temperatures. I tend to hold pretty conservative views, but if you don't believe in the greenhouse effect, come spend Thanksgiving week in a place where the temperatures make a tank top feel like overdressing and the pumpkins wilt, and then decide for yourself.

Ok, on to more fun stuff. Today's Day 3 report: 15 of the 18 are the "ideal" 6-10 cells, 1 is 5 cells but may still catch up, 1 is 11 cells and 1 is 13 cells. In terms of fragmentation (ideal is 20% or less), 2 are at 20%, 2 or 3 have no fragmentation at all, and the rest are at 10% or less.

The embryologist was quite happy. Possibly almost happy enough for both of us. Which is good, because this report has elicited a rather unexpected response from me.

We signed up for the cycle aware of RE's prediction that we would only have 0-2 normal embryos. Not a happy thought, but if that turns out to be the case, at least it would give us an answer. And, I wouldn't necessarily be able to blame myself, because maybe it could be me, but maybe it's R (given his sperm issues, that's not out of the realm of possibility), or maybe it's just our genetic material combined that doesn't work. We would have no way of knowing, and I think I could be okay with accepting that. (Not to say we wouldn't necessarily try and try again, but just that we would have some answer.)

And, it could still turn out that we have 0-2 normal when the CGH is said and done. (I didn't ask the embryologist today what she thought the chance of that was. Maybe I'll ask during the blast report on Saturday.)

But now this report, and the embryologist's enthusiasm, has kind of raised my hopes that maybe we'll have more than 0-2 normal. And while that would be great for obvious reasons, the main reaction I'm having is fear.

If we have several normal ones, I may be too afraid to put them back in me. Because then, if they go back in me and it still doesn't work, it will be my fault. Or, at least, my body's fault. But since I'm in my body, ultimately it will be my fault.

Even if my thyroid issues get resolved, I don't know if I can do this. (Apparently I've begun using the term "if" with all medical issues, infertility or not.)

I'm not quite sure where that would leave us. I don't know my sisters, so I couldn't ask them to be a gestational surrogate for us. We're closer to R's sister, but she's not necessarily in a situation to do that, either. One of my best friends would have been totally willing, but she had a uterine cauterization procedure done a few years ago, so that's not an option. (She's so sweet - she said if she had known then that I might need her uterus, she wouldn't have done that procedure.) I don't know that I want to find an unknown surrogate, because to me that feels like it has too much potential to go the route of all of our adoption situations and fall apart.

But I also just don't know if I can attempt another pregnancy. I suppose this is something I should have thought of before we created all these embryos. I didn't expect to feel this way.

November 19, 2008

Fertilization Report

We got the call from the embryologist this morning. Of the 30 eggs retrieved, 24 were mature, and 18 fertilized normally. So far, it sounds almost identical to our first cycle. I'm curious to see if all 18 make it to day 3, like all 17 did last time.

Surprisingly, I'm not in nearly as much post-retrieval pain this time around. I spent yesterday liberally popping Extra Strength Tylenol, and it hurt quite a bit when R made me laugh last night, but I stopped the Tylenol after this morning because it seemed like overkill.

Last time, the day after retrieval I could barely get in and out of the car because it hurt so much to bend down or bend over just a little bit. (I had a small car at the time, and it was pretty low to the ground.) So I'm thankful that isn't the case this time, because I was a little nervous about whether I'd be in pain sitting on a plane for a couple of hours, but I think I'll be fine.

Which brings me to my next bit of happy news: We get to go HOME!! We're flying out tomorrow night. I was actually tempted to try to leave tonight, but I didn't come up with that bright idea until about 7 p.m., which gave us exactly 2 hours and 40 minutes to pack up (we hadn't even started packing), notify the hotel and car rental company that we were leaving a day early, drop the car off at the airport, catch the shuttle to the main terminal, get through security (with two laptops and R being hand-searched), get to our gate and get our butts in the seats before they closed the door behind us. Not to mention, call my in-laws sometime during all of that and convince them to pick us up at the airport at 11:30 p.m.

Needless to say, R nixed that crazy scheme pretty quickly. Oh, well, it's been 15 days, so at this point what's one more day, right? I will be so glad to see our furbabies though!

November 17, 2008

Retrieval is Done

I'm back at the hotel and resting. So far, there's minimal pain, but that's probably just because the anesthesia and pain meds haven't fully worn off yet. I'll be popping Extra Strength Tylenol like crazy for the next few days, I'm sure.

RE retrieved 30 eggs. I know, that sounds like a great number, particularly if you struggled to get even just 4 or 5. But keep in mind that last time we did this, we got 32 eggs, 20 were mature, 17 fertilized, 16 of the 17 had 8-10 cells on day 3 (the 17th had 7 cells), all had fantabulous GES scores, 2 were transferred at day 3, 10 of the remaining 15 made it to blast, 8 of those 10 survived thawing and were transferred during three FETs, and out of all of that we wound up with two pregnancies, 3 miscarried babies and 0 live kiddos.

One of my best IRL friends, on the other hand, cycled a few months before I did IVF #1, with the same RE that I did that cycle with. (Different clinic than current clinic, but still a top-notch clinic.) She wound up with 3 embryos, none looked fantastic, none to freeze, and she has an almost-2-year-old to show for it. She went back to said RE and cycled again two months ago, 4 embryos, only 1 looked decent, two were only 4 cells on day 3, they stuck all four back, and she's 10 weeks pg.

So, to me, 30 eggs means nothing. Except for the fact that I will probably be in a lot of pain for the next few days.

We'll get the fert report tomorrow, the day 3 report on Thursday, and the blast report(s) on Saturday/Sunday. The CGH report won't come until early January. If that shows a bunch of normal embryos, then maybe, just maybe, I'll be a tiny little bit excited and think that perhaps we really can chalk some of the past losses up to my thyroid issues.

Oh, and lest you read my previous post and think "What the heck is she talking about with regard to the title and description going next to the photo??" - I gave up and took the photo off the title bar and stuck it in the About Me bar. Not ideal, but better than what it looked like before.

A New Look...Sort Of

As you can tell, I decided to update my blog. After four years, it was way overdue.

However, as you can see in the title line, Blogger does not seem to be entirely cooperative. I'd like the title of the blog to go on one line to the right of the photo, and the description to go under the title. After I gave up on it, R spent 2 hours working in the html trying to get it to work, and he didn't have any luck either.

If any of you knows how I can get that to happen, by all means, please share.

November 15, 2008


Thank God. I've never been so happy to do an IM injection in my life.

I mostly coasted yesterday, with 37.5 units of Menopur in the morning and 37.5 units of Follistim in the evening, because my estrogen level shot up quickly. It was only 1,100 on Wednesday, but on Thursday it doubled to 2,200, and by yesterday it reached 3,700.

The coasting seemed to help, because it was back down to 2,700 today. Retrieval will be Monday morning. We're going to stick around for at least two days after retrieval, because the clinic wants me nearby to monitor for OHSS.

On a much more fun note, I slept in until 11:15 today. Well, technically, I dragged myself out of bed at 6:45 to be at the clinic by 7:15, but as soon as I was done there, I came back to the hotel room and went straight back to bed. It's been a long time since I've slept that long!

Once I finally got up for good, we went to Vail. We've never been there, so it was fun to see. It was absolutely beautiful! We walked around Vail Village, which features a very picturesque creek running through it. (Being from the Southwest desert, we're easily excited by any scenery that includes water, or trees for that matter. And trees ever-so-lightly dusted with real snow - it's almost beyond imagination! :-) )

On top of all the gorgeous scenery, we also got our pooch fix. We're missing our furbabies; we've never been away from them for this long. In Vail Village, there was a couple walking around with a pair of Bernese Mountain Dogs, and another person also had a BMD.

I love big dogs, and I've wanted a BMD for a while now. The gentleman who was part of the couple with the BMDs told us that they rescued theirs from a breeder. They said some of the top breeders destroy BMD puppies that aren't show quality, because they don't want them to wind up in the gene pool for future breeding if they aren't top quality. He said some of those breeders will let you rescue a puppy for a fraction of what their show pups cost, as long as you sign a contract agreeing not to breed the pup.

I was horrified. I worked for a while at our local animal shelter, and our entire zoo is comprised of rescues. Two of them are purebred Australian Cattle Dogs, and I belong to a couple of e-mail lists for that breed and another. Most of the breeders on those lists have the motto "if you don't rescue, don't breed." I've never heard of breeders destroying puppies that aren't show quality.

I think we'll consider a BMD at some point, as long as we can find one via rescue. But right now probably isn't the best time for that; as much as it pains me to think of any of our babies passing away, right now our furbrood is big enough, so we don't need to be adding to it.

November 13, 2008

My Brain on Drugs

During my blood draw today, the phlebotomist told me a story of how a patient completely forgot to come in for a blood draw one day in the middle of her cycle. The patient was three hours away, in the mountains, when she realized and called in a panic.

The phlebotomist said she could understand how a patient might forget something like that at the beginning of a cycle, but she didn't know how it could happen in the middle of a cycle, when you have to go in every day.

I have the answer for her: that's what happens to your brain when you're on all these drugs.

Immediately after that conversation with the phlebotomist, I left the draw room, went up to the receptionist and inquired about getting claim forms to submit for insurance purposes. Then I walked out the front door.

And about 9 hours later, while sitting at dinner in a restaurant and mentally running through tomorrow's schedule in my head, I let out a lound gasp that made R jump. Because I realized that I had forgotten to make an appointment for tomorrow's ultrasound and blood draw. Immediately after hearing a story about someone else who forgot to show up for an appointment.

I blame it on the drugs. At least the phlebotomist will get a laugh out of it the next time I see her. (Assuming, of course, that unlike the appointment, I can actually remember to tell her about this.)

So I guess I'm going to have to call first thing tomorrow morning and find out when they can fit me in. I don't think they're going to let me skip a day, because my estrogen doubled in the course of 24 hours, from 1,100 yesterday to 2,200 today. So at least for the next 24 hours, I am on almost zero stims - they've eliminated tonight's Follistim dose (150 units) and cut tomorrow's Menopur dose from 75 to 37.5 units.

To try to prevent OHSS, they've also told me to eat lots of salty foods to try to keep fluids in my veins rather than filling all the empty follicles I'll have after retrieval. The only thing is, high levels of salt cause hypertension. And my thyroid issues are already causing hypertension, so I'm on beta blockers to keep my heart rate and blood pressure down. So eating lots of salt probably isn't the best idea for me at the moment. Let's hope it doesn't cause my pressure to spike and wind up getting me canceled on retrieval day, because they said my pressure has to be normal for them to do the anesthesia.

The nurse is also now saying that my retrieval will probably be Sunday or Monday. It was originally supposed to be yesterday, but every day I go in, it gets moved one day further out, even though my eggs do seem to be growing. (At least, they look a heck of a lot bigger on the screen now than they did a few days ago. And I've done upwards of 50 ultrasounds, so I've gotten pretty good at reading them.)

I sent my mother (who lives with us) an e-mail tonight that said, "You might as well start packing up the house and plan to move up here, because I don't think we're ever going to get to go home..." I didn't think I'd get to see MamaSoon when she arrives for her cycle at Thanksgiving, but at this rate, I just may!

November 12, 2008

Did I Jinx Myself?

I may have spoken too soon.

My right side didn't seem to really grow today when compared with yesterday. My left side grew a little bit, but it looks like retrieval will be pushed out at least one more day to this weekend, rather than the end of this week.

Oddly enough, despite my follicles rather anemic growth, my dosage isn't being increased. I think they're still hoping that the slow growth will ultimately mean a few follicles will not continue to grow, and I'll get down closer to 20 follicles. But considering I've got 15 on one side and 15-20 on the other, I'm not necessarily optimistic about that.

I've been working remotely for 6 work days now. My boss is beginning to wonder if I'm ever going to come back. Thank God he's been very understanding and supportive, particularly given that I've been with the company for less than 8 months.

November 10, 2008

Finally, My Follicles Have Kicked Into Gear

This morning was the second day in a row that my follicles showed good growth - yea!

The down side is that it looks like there are 20-25 that may be growing. I know, I know, for most IVFers, that sounds like a great problem to have. And if only quantity equalled quality, I'd be thrilled. But during IVF #1, we got 32 eggs and still have no baby to show for it. So I'd much rather have a lower number of eggs and actually wind up with a kiddo out of this.

RE was hoping to keep it down to 20 eggs retrieved. We'll see if a few of them stop growing during the next couple of days, but my guess is we'll wind up closer to 30 than 20 in the end.

Stimming for this long (9 days so far, with probably at least 3 more to go) is a new experience for me. Not that I have a lot of experience to draw on, since we've only done one other IVF prior to this. But that time, I only stimmed for 9 days total. What I gather from the nurses is that it's common for PCOS patients to stim much longer here, and in a way I'm glad about that - it gives me a little bit of hope that maybe the outcome will be better this time.

The only things I'm not liking about the long stim are all the needles and ultrasounds involved. The ultrasounds usually don't bother me at all, but I was wincing a lot today - those parts of me don't see action on a daily basis, well, ever! :-) So I'm starting to get sore.

And the needles - ugh. I didn't have a lot of good veins for blood draws to begin with when we started this process 6 years ago. Now, between the scar tissue that has formed over some of the veins and others that have just plain worn out, phlebotomists have even fewer options. After drawing me today, the phlebotomist gave me a baby heel warmer and told me to activate it as soon as I'm done with tomorrow's ultrasound and stick it on whatever spot I want her to try for. (The heat brings the veins closer to the surface of the skin.)

I also don't remember my last clinic having me on Lupron this long. I think they had me stop the Lupron soon after I started the shots, although I could be wrong about that. Between that, the Follistim, the Menopur and the Lovenox, I'm doing four injections a day. I have a big stomach, so lots of surface area to work with, and I'm still running out of room! (This is the only, and I do mean only time I have ever looked at my stomach and been even just a teeny (very, very teeny), tiny, little bit glad that it's not totally flat, because if it was, I don't know where I'd stick all these needles!) If someone who didn't know me saw my stomach, they'd think I'm a drug addict for all the track marks I have. :-)

November 09, 2008

My Eggs Are Growing...Slooowly

We managed to get ourselves (and the meds) packed, on the plane and to the clinic relatively unscathed.

Thanks to the advice some of you gave in the comments, we used a regular lunchbag with some cold packs to take the meds with us. I put R in charge of that, which worked out in the end, although I did have a few moments of panic about three hours before we left when I asked him if the cold packs were in the fridge and he said, "Um, I think we have some, somewhere in the garage - I haven't gone to dig them out yet..." Nothing like leaving that to the last minute. I have no idea what he would have done if he hadn't been able to find them.

We were quite the sight going through security at the airport. The terminal we were in has four different security checkpoints. We opted for a lesser used one, even though it meant we had to walk farther, because there was absolutely no line whatsoever.

In addition to the lunchbox with the meds and a plastic grocery bag with all the needles and syringes, we had two laptops and a portable printer, and R has to be hand-searched now because of his defibrillator. I think at one point there were four TSA staffers working to get us and all of our stuff through security. They were very kind about it, even packing one of the laptops and the printer back into a bag for me while I tried to gather the rest of our stuff and R was still getting patted down.

We've been at the clinic for 5 days now, and there's not much to report on yet. I've decided that this part of the process is the medical equivalent of watching paint dry.

I had 45 antral follicles (gotta love those PCOS ovaries!), so the challenge is to get less than half of them to grow. RE started me on a very low dose of stims (75 units twice a day), and has only upped it by 75 more per day so far.

Today was the first day the follicles looked like they've really started to respond, so retrieval probably won't be for 4 or 5 more days.

In other news, I finally got a call from the regular endocrinologist's nurse on Thursday. (I was supposed to get my results from them on 10/30.) It turns out that the bloodwork they ordered on 10/28 showed my TSH level to be high rather than low, like it was a month ago. So the endo thinks I have thyroiditis, which means eventually my thyroid will burn out and I will become hypothyroid.

"Eventually" being the key word. I asked the nurse what the next step is, and she said, "Oh, we just have to wait for your thyroid to stop swinging wildly from one extreme to the other and settle down. Then we'll take it from there."

I said, "Do you have any idea when that might be? Because apparently it's been swinging for about 7 years now, and I don't have another 7 years to wait for it to make up its mind..."

I swear, the thyroid thing explains so much of my life for the past several years. Like, for instance, why when I work really hard on dieting and exercising, even though R and I eat the same things but I eat less of it, and I exercise and he doesn't, weight falls off of him without any effort (except for eating the healthier stuff we cook), and at the same time I gain weight!

My next appointment with the endo is two days before Thanksgiving, so hopefully we'll finalize a plan at that point. (And believe me, waiting for my thyroid to make up its mind on its own is not going to be part of the plan.)