Category Archives: Medical issues

Learning to raise the white flag

Thank you to everyone who has commented on my last couple of posts. The support of this community means the world to me.

One of the comments exhorted me not to give up.

But that’s exactly what this is about.

I believe there could be a different outcome if we just kept trying and trying and trying and trying. Eventually, at some point, there would be another good embryo and a cycle that worked.

If we had unlimited financial resources and bottomless emotional reserves and endless time and an unceasing willingness to put our lives on hold, we could probably get there.

But we don’t.

One of the most insidious things about infertility treatments is there is nothing to tell you to stop.

If you succeed in building the family you want, whether that’s one child, or two, or more, then it’s easy. You write thank you letters to your doctor and the rest of staff at the clinic and skip away into the sunset.

But when you don’t end up where you wanted to be, the finishing line is much murkier.

I have a follow up appointment booked with my doctor for early December. I would love for him to tell me that we are making the right decision. I would love for him to look at my history and agree with me that thirteen embryos transferred resulting in one live birth and one miscarriage and a 70% attrition rate for the embryos during IVF cycles and a total failure to get pregnant during FETs suggests that maybe there is something else going on that we don’t know about and can’t (yet) test for. I would love for him to acknowledge that we got lucky, really really lucky, with the cycle that produced E., but that maybe he was a fluke and we should count our blessings and walk away.

I don’t think he’s going to do that. I think he’s going to tell me it’s all been a run of bad luck. I think he will be highly optimistic (because this man is ALWAYS highly optimistic) about our chances of success if we try again.

He’s not going to help us to walk away.

The onus is on us.

And here is the problem.

This is the first time in my life where working really really hard and doing everything right has not led to success.

I have not learned how to fail.

I have not learned how to give up.

I have not learned how to accept defeat.

Right now all I want to do is figure out a way to rationalize trying again.  And I can’t yet tell whether this is an indication of just how deep-rooted my desire for a second child is, or if it is a defense mechanism (because as long as I am planning another cycle that means I don’t have to actually deal with the grief), or if it is my stubborn perfectionist nature refusing point blank to accept that something I’ve done in my life might not turn out well.

I’m sure at some point in my life I would have had to learn this lesson.

I just wish it hadn’t been this.

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Filed under Cycle Madness, Grief, Lonely Onlies?, Loss, Medical issues, Money Matters, Second Thoughts

6w3d- Ultrasound

Ok. Here’s the deal.

The technician saw two gestational sacs.

In one there was a baby, measuring 6w2d, with a strong heartbeat of 127 bpm.

The other was smaller and empty.

The u/s tech tried (I think) to let us down gently.

“The doctor will explain it all to you,” she told us. “Sometimes they still develop. Sometimes they are just slow.”

Then she asked if we wanted a picture.

“I give you one of the good baby,” she said. “That baby looks perfect.”

While waiting for the doctor, I read my chart. I showed it to Q.

“That second sac is completely empty,” I told him. “It’s not going anywhere.”

Q. thought for a minute. “Maybe we should have told her that her telling us that second sac wasn’t going to keep developing would have been really good news,” he said at last.

He was right. As much as I have tried to get my head around the possibility of twins over these last couple of weeks, there’s no denying that when it was clear from the u/s tech’s measurements that the second sac was empty, I mostly felt relief. A twinge of sadness for the baby that tried to be, but mostly it was relief.

The ultrasound tech was really cheerful (she’s not usually- I’ve had many an ultrasound with her before). She printed us a picture. She said congratulations a whole bunch of times. It must be one of the only nice parts of their job.

Then we met with my doctor.

“That second sac isn’t going anywhere, right?” I asked.

He shook his head. He had been talking in terms of a “brother or sister for E.” I don’t think he would have mentioned it at all if I hadn’t asked him about it.

“There’s a very very small clot located right next to the gestational sac with the baby in it,” he said. “You’d have to really be looking for it to find it.” (I have no idea how they can find ANYTHING. I could see the two sacs- they were black blobs- but how she managed to see and measure the baby and identify the yolk sac and the heart is beyond me.)

“That, plus the empty sac raises your chances of miscarriage. I’d like you to aim for a very restful week. Do you need a note for work?”

I looked at Q. He sighed.

“I’ll teach your class tomorrow,” he said (one of the perks of a husband who works in the exact same field you do).

I’m not on bedrest (and I don’t know how I’d manage that if that had been the request given the toddler in our life). But I’ll try to keep my feet up as much as possible, and I’ll get someone to cover my duty day at E’s nursery school on Monday. The good news is he told me to start doing the Fragmin every other day. My stomach bruises are getting really ugly, so that suits me just fine.

I’m back in to the clinic tomorrow for another intralipid infusion, and then another ultrasound next Thursday. Hopefully that one will show the empty sac has been reabsorbed and the baby is growing well. If I’m really lucky the clot could be gone too, but I had one with E. (I think it was bigger but not as close to his sac) that stuck around for the whole first trimester and never caused a problem.

So. Good news for this stage in the game, but I feel very much still in limbo. It still seems tenuous, uncertain.

It’s going to be a long week.

 

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Filed under 2.0 Pregnancy, A matter of faith, Anxiety Overload, Medical issues, Ultrasounds

5w1d- Waiting for Beta

With E’s pregnancy I had four betas drawn- the first three were every 48 hours and then the final one was four days after the third. The clinic must be feeling good about this pregnancy as they only made me do two betas before moving me to the final one, which will be tomorrow morning.

I’ve had three days now without any documentable proof that the pregnancy is progressing without any problems. That’s proved to be more than enough time to completely freak out on any number of occasions. The worst by far was on Sunday when we woke up to discover that our basement had flooded thanks to the cold snap- a pipe had frozen and then broken when the weather warmed up. I spent about forty minutes helping Q. ferry things up from the basement before I realized I had started cramping. That earned me an automatic trip to the couch for the rest of the day, with orders from Q. to concern myself with nothing more pressing than keeping E. entertained. But when the cramping didn’t subside quickly and in fact only increased in strength the longer I sat there, my mood degenerated.

Logically, as I said to my saint of a sister who dropped everything to come over and help Q. carry all the things that were too heavy for me to lift, a pregnancy that could be uprooted by something as simple as carrying a few things up and down stairs was one that wasn’t going to make it. If it hadn’t been that, it would have been something else.

Logical, yes, but it didn’t make me feel any better.

By evening things had settled down a bit, and I remembered that I freaked out about cramping with E.’s pregnancy too (and probably right around the same point).

I’ve been a bit more on an even keel ever since.

It’s been stressful, however, to have to ‘out’ myself as pregnant. Not to friends or family- we’re not telling anyone who didn’t already know that we were in the middle of the IVF cycle until we hit twelve weeks (with the exception of our parents- we told them last time at the eight week mark and we might do the same this time if all goes well). No, it’s the medical practitioners.

First I had to email my GP’s office to request that they fax a referral letter to my endocrinologist. He requires a referral letter to be sent annually and he won’t let you make a new appointment unless this happens. I should have done this back in early December after I last saw him, but I dropped that ball during the IVF. In the email I had to say that it was a relatively urgent matter because I’d just learned I was pregnant and he would need to see me.

Then I had to call my endocrinologist’s office to see if my GP’s office had sent the referral (luckily they had). The receptionist started to book me for May, so I had to interrupt and say I’d just learned I was pregnant. Instead of May I now have an appointment tomorrow morning.

And finally my midwives called back to offer me care, and assigned as my primary midwife the woman who was my backup last time and who ended up delivering E. This made me so happy, but it meant another phone call, another appointment to schedule (this one is on the 15th, a week Wednesday).

Every time I got a little bit more nervous.

I didn’t have a lot of choice in the matter. If you want a midwife in my city, you have to call the second you find out you’re pregnant. And it makes sense to see my endocrinologist as soon as possible so he can raise the dose of my synthroid to make sure everything will be kept under control in the early weeks of the pregnancy.

These are good, sensible things to be doing. They are signs of a responsible pregnant person.

It still makes me feel like I’m waving a giant red flag at the bull of the universe, essentially shouting out, “Hey! Look! There’s an infertile who’s barely into her pregnancy and she’s making APPOINTMENTS like it’s just going to go along normally!”

Nothing bad has happened yet.

But it is so very hard not to assume that something will.

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Filed under 2.0 Pregnancy, Anxiety Overload, Medical issues, Medications, Midwives, Symptoms, Thyroid

In which I suddenly come to understand exactly why these PIO shots are so much of a PITA

Those of you who were reading during my pregnancy with E. will remember that I had to switch from the PIO shots to the progesterone pills/suppositories combo after I developed a severe allergic reaction (read: full body hives) at the six week mark.

When we resumed PIO shots with the FET this past September, I reminded my f/s of my reaction and he immediately told me I could only use the castor oil vials.

I grumbled and grimaced and gritted my teeth all through the PIO shots for that FET, and the PIO shots for the next one. But, no matter what Q. did, they almost always HURT. And sometimes they hurt a lot.

Then we started stimming for the IVF, and both Q. and I were taken aback by how easy the stim injections were. The needle didn’t hurt as much! Q. didn’t have to practically force the medication into my body!

The first night we started the PIO shots again after the retrieval I pulled out a needle and got it all set up. Q. jabbed me, struggled for a while, and then said he had to pull it out and try again. “I just can’t get it to go in,” he told me. He pulled it out, we changed needles and then he tried again. It took a practically superhuman effort to force the oil in.

“It’s always hard to do that,” he said. “But this is much harder than last time.”

I dug out my instructions. We were using a 25 G needle, the pink and orange one, just like the instructions said.

Then I remembered that my other packages of needles (we had a LOT of needles kicking around the house by this stage) were clearly labelled, “Castor Oil Needles”.

So I went and got them and discovered that we’re supposed to be using 22 G needles with the castor oil. I got mixed up this time because we had the other type in the house from stimming.

The other day curiosity got the better of me and I got out my camera. We used the 25 G needles for stimming and for all the PIO shots we did in 2009/2010. We’ve been using the 22 G needles for all the PIO shots with our 2.0 TTC efforts.

This is the 18 G needle I use to draw out the oil:

IMG_3498

And this is the 22 G needle we’ve been using these past few months:

IMG_3499

And this is the 25 G needle I would still be using if I hadn’t developed that allergic reaction.

IMG_3500

And, just to drive the point home, here’s the 25 G (top) and 22 G (bottom) side by side.

IMG_3501

No wonder it hurts so much this time around! That’s a huge difference!

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Filed under 2.0 Pregnancy, Medical issues, Medications

2dp5dt- it wasn’t a fluke

I was on my birth club yesterday, trying to explain why I was so twitchy about the clinic not calling. I explained my 77% attrition rate between day 3 and blast last time around, and how it should have been around 50-60%.

“I’m sure last time was just a fluke,” one of them said.

It wasn’t.

The clinic called this morning at 10 when we were in the car, off to visit friends.

I knew it wasn’t great news from the moment she started with, “Well, you had ten eggs that fertilized.” I already knew this. Then she told me that we decided to go to blast (yes, I knew that too), and that we transferred two on Friday (yep, I was there) and that we didn’t freeze anything on Friday (yep) and that we pushed four embryos to day six (uh-huh- this is not news).

Then there was a pause.

“One embryo was frozen,” she told me.

“Ok.” I said. “Thank you for the report.”

I hung up. I relayed the news to Q.

We were both quiet for a little while.

“One is better than none,” I said at last, trying to put a brave face on it.

It is. It certainly is. One is better than none. One more chance is better than the road ending right here with this cycle.

But it’s not what I was hoping for.

And it means that despite the better technology and the embryoscope, we still had a 70% attrition rate with our embryos.

There probably is something wrong with my eggs.

“Maybe we should have only transferred one,” I said to Q.

“But the fresh cycles get better results. And that was what worked for us.”

We’re holding on to that now. Nothing has worked for us- absolutely nothing- except a fresh cycle where we transferred two early stage blastocysts.

That’s exactly what we did on Friday.

It’s our best shot.

And if it fails, we’ll have six months or so to start to get our heads around the idea of E. as an only child, and then we’ll have one more chance to change that future.

But I’m not going to lie- it’s looking a whole hell of a lot closer than it did a few weeks ago.

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Filed under 2.0 IVF, A matter of faith, Anxiety Overload, Medical issues, PCOS, Second Thoughts

2.0 IVF- Retrieval Recap

I figured I should post a recap of my retrieval experience, partly in case anyone stumbles across the blog looking for that sort of information, but mostly as a record for myself.

On Sunday we weren’t asked to be at the clinic until 11 a.m., but Q. and I went down there quite early so we could stop at a grocery store (as E. had eaten the last of his Che.erios and the WORLD.WOULD.STOP. if there were none for breakfast on Monday) and so we could pop into a store near the clinic so I could do the penultimate look for a particular Bruder dump truck and excavator combination. I have been looking for this for months now. I did find it once before in another branch of the same store (when I had E. in tow), but someone had stolen the excavator.

Anyway, given this store is a block away from the clinic, I’ve been going in every time I’ve had to do cycle monitoring to look. They’ve had Bruder logging trucks, and cement mixers, and cranes, and, on Friday, even a fire truck and a tow truck carrying a jeep, but not this set. E. already has the Bruder garbage truck. He loves it. He’s played with it every day for months now.

The thing with the Bruder trucks is their size. I don’t want more than two in our house. So even though I knew E. would like the crane, or the fire truck, or the tow truck, I kept refusing to buy them. I was holding out hope that this branch would come through.

Sunday I dragged Q. inside. “We just need ten minutes to see if we can find the truck for E.,” I told him.

I scanned all the shelves. I’ve learned that stock turns over incredibly quickly in this store (largely because they sell things far more cheaply than anyone else). I pulled out boxes to look behind them. Logging truck. Crane. Fire truck. Cement mixer. Tow truck with jeep. Garbage truck. Giant excavator.

“They have a lot of them,” commented Q., looking a bit overwhelmed.

I sighed. “There’s one more spot to check,” I told him. I circled back to where, on Friday, I’d found two enormous flatbed trucks with backhoes. They would have been perfect except they were SO big I really didn’t want to bring them into the house. Plus they were a lot more expensive.

The two flatbed trucks were still there. But so was one more box- a box with a dump truck and a mini excavator priced at the (ridiculously inexpensive) sum of $35.

I may have cheered.

I didn’t even hesitate for a second. I grabbed it, showed it to Q., and said, “E. is going to lose his mind on Christmas morning.”

That was pretty much the highlight of my day.

After that we wandered over to the clinic, where all the nurses in the IVF suite commented on our giant truck. Q. went off to do his thing, one of the nurses came in to take my blood pressure and get my IV hooked up (she wasn’t at all pleased at what the IV for the intralipid infusion had done to my right arm), and then we just chilled out for an hour or so.

I think it was around 12:30/12:45 when my f/s turned up (the retrieval was scheduled for noon but he is always, always late), and they called my name first. I went to the ‘loo (massively awkward with an IV attached) and then we headed into the OR. The nurse walked me through what would happen, and then she started up the drugs. I remember that my legs suddenly got really heavy and that I was feeling a bit dizzy. Then my f/s came in, started getting ready, realized I was still feeling more than he would like, and ordered more drugs.

That’s the last thing I remember until I was back in my cubicle. Q. says I actually fell asleep during the retrieval, which is a new one for me, and not really something they wanted to have happen, so he and the nurses kept having to remind me to “take deep breaths, Turia!”. Q. was sent off to buy the Dostinex to guard against OHSS. Apparently I had a lengthy conversation with one of the head nurses about taking this pre-emptive measure. I don’t remember this at all.

We stayed in the cubicle until 2:30 or so, when the nurse came to take out the IV, and I told Q. I felt well enough to go home. We went downstairs and hailed a cab. Arriving home we learned that E. had refused to take a nap, but he seemed to be in good spirits and had absolutely loved spending the day with his Auntie C. He’d made a snow globe, and a bunch of vehicles out of bits and pieces from the recycling, and had read stories, and had a blast. Q. snuck the giant truck upstairs, and I crawled onto the couch and stayed there for the rest of the afternoon/evening.

I am so so so glad Auntie C. is staying with us for this week, as it was a life saver to have her able to entertain E. That meant Q. could keep an eye on me, and make dinner, without E. getting riotous or stroppy. At one point Q. and Auntie C. forcibly bundled E. (who was protesting mightily) into his snow gear so he could go play in the 20-odd centimetres of snow that had fallen over the last day. Once he was outside, as predicted, they all had a marvellous time.

Once I got onto the couch, I felt well enough to eat, so I ate some white bread, and then a whole wheat roll. Then, when I still felt ok, I ate some pretzels and some rice crackers. When they seemed to settle well enough (I was still completely starving by this point, having eaten nothing since 9 p.m. the night before), I ate some of my sister’s granola. I think that was the straw that broke the camel’s back, as shortly thereafter I realized I had better go hang out in the ‘loo for a while, and sure enough I puked my guts out.

For supper I drank around a third of a mug of miso soup and then ate some french fries. That stayed down, and by the late evening I was feeling much much better, although I was still very sore and uncomfortable. I went to bed early, around 9 p.m. Poor Q. had to come up to give me the first PIO injection and he had a terrible time with it. I realized this morning that we were using a 25 gauge needle, which is what they tell you to use on the instructions, but if you’re using castor oil, which is even thicker, you have to use a 22 gauge needle. No wonder he was struggling so much to get it in!

Monday I felt much more human. Still sore and still massively bloated, but no longer nauseous. I felt well enough to go do my duty day at E’s nursery school, and then went and got (another) poutine for lunch. It is perhaps the one good thing from this whole mess- being under doctor’s orders to eat terribly.

Now it’s a waiting game. I don’t know what their cut off for blastocysts is.

I hope we make it.

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Filed under 2.0 IVF, Anxiety Overload, Cycle Madness, E.- the third year, Medical issues, Medications, PCOS, Second Thoughts

2.0 IVF Day Twelve- Fertilization Report

I’m not going to lie. I’m disappointed.

Yesterday they retrieved 25 eggs.

Of those 25, 12 were mature enough to be ICSI’ed.

Of those 12, 10 fertilized.

Obviously it is a great ratio of mature eggs to fertilized ones, but I am gutted that so many of my eggs were immature. I’ve felt all the way through this cycle that I was stimming too quickly- so much more quickly than the cycle that produced E. Now I wonder if I was right.

I don’t know if we’re going to be able to go to blastocyst with ten embryos. They’re going to call me tomorrow to tell me whether or not I should be on standby, but the final decision won’t be made by my f/s until Wednesday morning, so I could literally have only a couple of hours notice.

I want to go to blastocyst because that’s what worked with E., but at the same time, I am so worried that if we do go to blast, I’ll have the same terrible attrition rate that we did in 2010. If 17 embryos produced only 4 blasts, what if 10 only produce two? What if we have nothing to freeze and this becomes an ‘all or nothing’ transfer?

I’m not ready to have my hopes of making E. a big brother extinguished. I was counting on having something to freeze so we could revisit the whole issue next summer/fall if we had to.

I am holding on to my doctor’s assurances that they have massively improved their technology with regards to embryos and embryo survival between days three and five.

I am holding on to the hope that maybe the embryoscope will help support a couple more who might have struggled in the regular incubator, that our decision to use it might make a difference.

I know, I KNOW that it only takes one.

I just wish we were starting with a better hand.

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Filed under 2.0 IVF, Anxiety Overload, Medical issues, Medications, PCOS, Second Thoughts

2.0 IVF Day Eleven- Retrieval

25 eggs.

Still feeling not at all well, and am struggling to keep food down. I don’t remember anything from the retrieval after my f/s arrived, did a few preliminary things that made me jump, and then demanded the nurse give me more drugs. Q. says my f/s commented during the retrieval that it had taken a surprising amount of drugs to get me to the right point, which probably explains my total lack of memory and my current state.

Will post more tomorrow after we get the fertilization report.

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2.0 IVF Day 6

The advantage to having a projectile vomiting toddler?

It takes your mind off of your ovaries.

Yep, it’s hard to stay focused on the fact that your entire mid-section feels miserable when you’re scrubbing puke out of the carpet (and the couch, and the table, etc. etc.).

I’m drinking three 12 oz. glasses of Gatorade a day. I went with the fruit punch flavour this cycle (in 2010 it was the lemon-lime). Thus far I’m underwhelmed. And I’m eating pretzels (lots of pretzels) every day as they had the highest percentage of salt of the snack foods I looked at. I should eat prepackaged processed meals (or fast food) too, but I can’t bring myself to stoop that low. I’m also back on the All Bran, but I don’t think my digestive system is the problem at this stage.

I keep telling my co-dependent cat that she can’t sit on my lap anymore if I’ve got the laptop out. She is not pleased.

On the bright side: signs that you’re really learning something in this parenting gig: You don’t start the second load of vomit-encrusted laundry because you suspect if you just wait a bit longer there will be more.

Sigh. Sometimes I really hate being right.

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Filed under 2.0 IVF, E.- the third year, Food, Medical issues, Medications, Second Thoughts, The Sick, ttc

2.0 IVF Day 4: Ah yes, the IVF grind

Today is officially Day 4 of my IVF cycle, since my clinic restarts the clock on the day you start stims. I had to go back into the clinic this morning to see how things were progressing.

Far out. I forgot what happens on the weekend at that place and just how LONG it takes to get through cycle monitoring. I was in there for three hours and twenty-five minutes, and got home just in time to watch E. finish lunch, get down from his chair, and promptly vomit the contents of his lunch all over the carpet, just like he’d done at breakfast. Poor Q. didn’t have the greatest of mornings. E. was sick on Friday morning as well, but seemed to be fine yesterday, so we thought he’d be ok to go to nursery school tomorrow. Clearly not. He’s napping now and hopefully will be able to keep something down this afternoon, poor little thing.

The weirdest thing at the clinic this morning was the woman strolling around the waiting room, hooked up to an IV that obviously had an intralipids bag strapped to it, telling people, “I’ve got no idea what this is. Maybe Lupron?”, at which point the other woman would look very obviously confused since she was probably also on Lupron and knew that it was a medication that was kept in the fridge that you injected yourself with every morning and that was most certainly NOT a medication that required an IV stand. I just shook my head. I can’t imagine being that ignorant of what was going on. Maybe that’s what works for her, maybe she just really trusts her doctors, but I just wouldn’t be able to cede control to that extent. Especially not at my clinic where I’ve caught them making mistakes because they’re so busy. I feel so strongly that I have to be my own advocate.

My f/s was happy with how things are going. I’ve got 11 or 12 follicles on each ovary, all measuring somewhere between 9 and 4. This is definitely a better response rate than how I started out in August 2010, when on Day 7, they were measuring between 10 and 6. He kept the dose exactly the same (225 iu Gonal-F, 75 iu Repronex) and told me to come back in on Wednesday.

My TSH was too high (at 2.97) when they checked it last week, so he raised my dose (and I’m continuing to self-medicate by adding an extra 1/2 pill every second day). He said today it was too early to check it. As long as it’s down around 1 by the time of the transfer, I’ll be happy. I know he feels 2.5 is ok, but that’s too high according to my endocrinologist, and while the man has the bedside manner of a sea slug, he does know his stuff.

A few minutes ago I had a call from the clinic- Dr L. wants to move my intralipid infusion from the 16th to the 11th. This definitely means I’m responding faster than he was expecting. Looks like I won’t have any problems with the transfer spilling over too close to Christmas, but we might end up hitting beta day while we’re still out of town. We’ll sort that out with my f/s once we know for sure what is happening.

In that same post from that IVF cycle in August 2010, I wrote:

This morning I realized I was feeling just a touch out of sorts. A bit bloated, a bit tight through the middle, some heaviness in my abdomen. And I figured that maybe my digestion was getting out of balance, and I should start paying more attention to how much fibre I’m eating.

Bingo. I’m right there again. It’s as if I can feel my ovaries growing those eggs since the nurse gave me today’s dose. I was so much more uncomfortable on the way home than I was going in to the clinic.

So we’re definitely in business. Time to go buy some Gatorade.

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Filed under 2.0 IVF, E.- the third year, Medical issues, Medications, Second Thoughts, Symptoms, The Sick, Thyroid