Is the TDAP Vaccine safe?

PC Diary @ 28W 1D

Is the TDAP Vaccine safe?  This is a question I asked myself AFTER I had the vaccine when it was offered to me at my 28 week appointment. How unlike me to not look into it before hand!!!?!

I was given a bundle of information at my first OB appointment – it all went into a folder and I occasionally check through it to see what is coming up next in my pregnancy.  It is pretty handy!  But for some reason I didn’t bother reading the info about the TDAP Vaccine.  Why?  Well I thought, I’ve had it before so – blah. whatever.

What is the TDAP vaccine? It’s a combination vaccine to protect against Tetanus, Diptheria and Whooping cough (Pertussis).  Well that is where I made my first mistake.  In 2007 I had a Tetanus, Diptheria and POLIO vaccine. Not Pertussis.  Silly Ps.  Anyway that is irrelevant because that needs a booster every ten years or so if you are travelling to some countries, so it was about due.  But actually here the issue is the Pertussis part – whooping cough.  This is the part that pediatricians are most worried about.  Babies can’t get vaccinated and start building protection against whooping cough until they are two months old. So to reduce this gap the mummy gets the vaccine during the third trimester of her pregnancy as there is some evidence that immunity may be passed on to baby.  They also ask for dads, grandparents, caretakers etc visiting the baby in the early 2 months to also have the TDAP vaccine – to create a safety bubble around the baby.  It all makes sense.

So when I was offered the vaccine I said – sure, yes! And signed my life away to receive it.  I also said yes to getting the flu vaccine too.  I have never had a flu vaccine before but thought as I am responsible for the baby I’m carrying I should probably get that too.  So I had one injection in each arm.  They were painless.  In fact, anything compared to Progesterone in oil injections seems easy!  The nurse asked which arm I would like my TDAP in because it can get a bit sore.  So I asked for that one in my left arm.

Several hours later my arm started to ache as the nurse warned me.  The arm with my flu shot also was sore a little bit, so sleeping was proving problematic.  I like sleeping on my side so I struggled to get comfortable and had the worst night’s sleep EVER.  Half way through the night I woke up in extreme pain, I was crying.  My left arm had gone practically numb and the rest of my body ached like I had run a marathon.  The next time I woke up (an hour later or so) the whole of my left side of my body was numb and tingly.  What the ??!!  I was exhausted and couldn’t face going into work.  I was achey and shivery.  I took a warm Epsom salt bath and a couple of paracetamol (acetaminophen) -the first time this pregnancy I have needed any drugs!  The internet suggested Ibuprofen, but we know that is not recommended so I stuck with the paracetamol.  After the bath I fell asleep for an hour and woke up feeling much much better.  the drugs, sleep and heat must have worked!  So I decided to take myself off to work because I had a lot to do and didn’t want to fall behind.  Honestly, it wasn’t a great day at work, I would have done better working from home, but Chris was already working from home so that wouldn’t have worked out.

I came home from work feeling like crap.  I wondered if this was normal.  So I decided to read the info about the TDAP vaccine.  Oh yeh – this can happen to 1 in 10 people who take it. WHAAAT?!  So I then looked into it more online to see how people were fighting these side effects.  Then I discovered the articles about TDAP in pregnant women.  Seriously, googling this stuff had me FREAKED out.  I came across websites dedicated to the dangers of TDAP in pregnant women.  That the CDC was citing one trial on 48 women in 2013.  Even I know that is statistically a pile of CRAP especially as this is about the effects on the unborn baby, not the woman.  The recommendation for women to have this vaccine in their third trimester has only been around since 2012.

Headlines like: “TDAP vaccine pushed on pregnant women despite fetal risks” and “Is your unborn baby part of a vaccine experiment?” are some of the first to come up on google results.

So I started to freak out at my lack of due diligence.  I had no clue when taking the vaccine how long it had been recommended for or what the evidence was.  I asked Chris – did I just do something naively? Was this something new?  Was I part of an experiment?

But after some more searching, I discovered that a lot of these stories are old and pre-date some much bigger studies that have been done over the past two years and recently published in 2015 and 2016.  You have to look hard to find these, I guess because of google’s algorithms with popularity the hype stories and anti-vaccine pages come up first.  Which is disappointing.  Here are two recent studies that show that the vaccine is safe, with much more confidence than the CDC had in 2013.

Pertussis vaccination in pregnancy is safe, study finds and Infant outcomes after exposure to TDAP vaccine in pregnancy: an observational study.

Admittedly, scientists do say if the baby is exposed to whooping cough early on, there is a good chance the baby will still get whooping cough, but evidence indicates that if mummy had her vaccine in the third trimester the symptoms will be less severe or life threatening.  So something to be aware of.

I only discovered all of this because I had a side effect to the vaccination, otherwise I wouldn’t have questioned it or thought otherwise!  I’m pro-vaccinations.  The only vaccination I ever turned down was anthrax, just before I deployed to Iraq.  Why?  Because even the Army nurse said I wouldn’t bother if I were you.  Chris and I both want our children to be vaccinated as our pediatrician recommends, but perhaps I will be a bit smarter about reading up on what is actually being given to my baby – just so I can have an informed debate on the whole vaccination thing with people who don’t vaccinate their kids.

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Effects of flying and jet lag on fertility pt 2.

In my previous post I described some research that indicates fertility may be effected by the disruption to the body clock as a result of travelling across time zones (or any other job that requires shift work).  There is one hormone that may be taken as a supplement to help overcome and regulate the problems our bodies face as we fly in to different time zones – melatonin.

Melatonin is not new to me.  Some of my US colleagues have told me about the use of Melatonin to help them overcome their jet lag quickly when they are in Europe.

Last year I landed in Germany with a terrible headache that had lasted more than two days, pain killers just didn’t touch it, and I couldn’t sleep – which was probably perpetuating my headache.  So my US colleague suggested I took some melatonin to help me sleep and kick start my body into a natural rhythm.  He warned me that melatonin can have side effects, such as vivid dreams.  I already dream a lot normally, and I had problems in Afghanistan with Anti-Malerial drugs causing vivid dreams and hallucinations; so I was very cautious of taking melatonin.  But I was willing to give it a try as by my third night in Germany I was consistently unable to fall asleep until about 5AM, then working all day with this awful headache.  So I took two of the little melatonin pills, and they helped me to fall asleep before midnight.  Bliss.  I did have some vivid dreams, actually they were more like nightmares, but at least I got some shut eye!  My headache didn’t disappear though, so I decided not to take any more melatonin. I was more afraid of my dreams than my headache.

I didn’t know much about melatonin at that time; I didn’t really look into it.  But since suffering from infertility I have been educated more into melatonin and its purpose.  I came across it in the book “It starts with the Egg” by Rebecca Fett, but I didn’t pay it much attention.

So what is melatonin?  It is a hormone that helps regulate many other hormones in the body and helps to maintain our body clocks (or circadian rhythms).  During light hours of the day, our natural melatonin production drops and when it is dark, the body produces more melatonin.  If we are not exposed to enough light during the day or too bright artificial light in the evening this can disrupt the body’s natural melatonin cycle.

What does melatonin have to do with fertility?  Melatonin is produced by the pineal gland in the brain, but it is also produced by the follicles within an ovary, the mass of cells that surround the follicles, and in the immature follicle itself.  It is here where melatonin acts as an antioxidant which supports cellular health and protection of the immature egg from oxidative stress, especially at the time of ovulation.  Melatonin has beneficial effects not just on eggs but also on embryos.  Mouse embryos grown in a lab with melatonin showed an increased rate of forming bastocyst-stage embryos [1].  As a result of this success, clinical trials were undertaken.   A study of 115 women showed that melatonin may increase egg quality by reducing the level of one oxidising agent called 8-0HdG in the ovum, which is a natural product of DNA oxidation [2].  Women who were given melatonin had a fertilisation rate much higher than their previous cycle and nearly 20% of the melatonin treated women became pregnant.  Whereas only 10% of the non-melatonin group became pregnant.

Melatonin also helps to control body temperature, the timing and release of female reproductive hormones and possibly egg quality.

Finally, melatonin is known to act as an antioxidant during early pregnancy.  In addition, melatonin in the mother’s blood passes through the placenta to aid the creation of the fetal suprachiasmatic nucleus (SCN) where the central circadian regulatory system is located.

Melatonin levels decline with age, and as a result the ovaries lose their natural protector against oxidative stress; hence could be an additional contributor to age-related infertility.

If you are going to consider taking melatonin as a supplement when trying to conceive you need to be careful and should ask your doctor, because the melatonin supplement may disrupt the natural hormone balance and interfere with ovulation.  If you are going through a controlled hormone cycle with IVF this is less of a concern.  In addition, melatonin can cause side effects, such as daytime droziness, dizziness, and irritability and may worsen depression.  Melatonin can also interact with other drugs, so this is why it is important to check with your doctor before taking it.

If you are going to take melatonin as a supplement whilst travelling it is also important to know what time to take it.  You should take the supplement after dark the day you travel and after dark for a few days after arriving at your destination.  In addition, taking melatonin in the evening a few days before you fly if flying eastward.  Again, there is caution to be made here because the long term effects of taking the supplement are unknown.  Therefore this is not overly helpful for airline attendants or shift workers, and only for those who travel infrequently.

For me, personally, I am undecided as to whether or not I will take melatonin as a supplement for either my next IVF cycle or when I am on my next international trip.  But I will certainly be asking my doctor next time we speak.

Have you taken melatonin as a supplement? What are your experiences with it?

flying

[1] The effect of melatonin on in vitro fertilization and embryo development in mice.  Available here: http://hera.ugr.es/doi/15015646.pdf

[2].  The role of melatonin as an antioxidant in the follicle.  Available here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296634/

6 weeks post methotrexate treatment

It’s been 6 weeks since I was treated with methotrexate to terminate my ‘ectopic’ pregnancy.  The first few weeks involved dealing with miscarriage bleeding and pain.  Pains that made me worry about ending up with a burst fallopian tube.  Pains that I had never experienced before.  Then there was the emotional pain that accompanied it;  sadness and grief over the failure of what could have been.  Finally, at what would have been my 13th week of pregnancy my hCG levels are below 5 and I am officially out of any danger.

Progression of my hCG levels over time

Progression of my hCG levels over time

But although I am grateful I have had zero complications (i.e. no tube ruptures or not needing a D&C) it hasn’t been the easiest of rides.

4 weeks ago I fell ill with what seemed to be the usual cold/cough that one catches in September time.    Methotrexate can lower the number of white blood cells, which increases the chance of getting an infection and being able to fight it off effectively.  I haven’t been able to shake off this cough completely and it got worse over the last four days of my work travels to Germany.  I think my cough has gotten worse because my stress levels increased due to the nervousness of the upcoming conference, and my poor sleep due to flying/time zone changes.  Basically, I haven’t been good to my body.  I had to avoid my multi-vitamins until my hCG levels were below 5 because the Folic acid in them can interfere with the effectiveness of methotrexate.  So I have been dosing up on Vit C, but I have been missing out on all the other immune boosting vitamins and minerals.

The morning of the beginning of the conference and the day I was presenting was when I felt my worst.  I had to run out of the conference during the key note speech because I was about to puke up my guts from all the coughing.  I wasn’t sure I was going to be able to close the day with my presentation….which I was already stressing about because it was in front of my about 100 of my peers and various other important people I need to make an impression with. Fortunately, I managed to survive  and my presentation went down well – I had lots of excellent feedback.  But the stress of it all was just making my cough worse.

On the evening before my flight back to the US I took some nytol/night nurse at 8pm and was immediately fast asleep.  I woke up at 1005 AM and realised I had slept through my alarm.  I was supposed to already be at the airport by now, my flight was leaving at 1215 PM!  I had been in a deep sleep for 14 hours! Aghhhh!!!! Panic!!!! It is not like me to sleep for long, I am not the kind of person who likes to lie in.  So there I was hacking my guts up and had a temperature running.  But I needed to get home!  So I threw everything into my suitcase – higgledy piggledy- checked out of the hotel and ran to the train station.  1 hr after waking up and freaking out I was standing at the airport check-in desk with 10 minutes to close!  I made it, but I was lucky to catch the train that I did, 3 minutes later I would still be in Germany right now!

I felt awful for the poor German teenage girl sat next to me on the flight (it was a completely full flight) because I was coughing every other minute the entire way.  Cough medicine, flu medicine, cough sweets, water – everything I tried, just could not stop me.  I felt like I had done 1000 sit ups!  My abdomen was aching and my throat shredded.

So here I am, finally tucked up in bed, at home, with magazines (thank you Chris :-)) and hot tea, relaxing.  I may be my worst enemy when it comes to being ill, but I will say that I totally blame the methotrexate.  My white blood cell count was already below the normal level before I took the shot – so I can imagine it was severely lowered afterwards.  I could have wrapped myself up in a cotton wool ball – but I would have been bored as hell and probably missed out on our epic holiday.  So, yes, I kind of did this to myself…but today I am FINALLY chilling out.

(Who wants to bet I have caught something else from the last few days to add on top of my cough?)

I am excited about next week though because the only meeting I have in my diary is our doctors follow up appointment.  Being out of office for three weeks does have its advantages!  Fingers crossed I wake up tomorrow feeling better and I can start everything -work, life, infertility – all afresh 🙂

Methotrexate Side Effects

I am just over 72hrs past my first methotrexate injection.  I have definitely noticed the side effects, but so far they have not been as bad as I thought.

Over the first 24hrs I felt nauseous and had a very dry mouth despite drinking lots – apparently this is very normal.  My bleeding also stopped – not what I was expecting.  Since those first 24 hrs, the nausea has continued 😦  I have spotted on and off (no more need for a pad, just a thin panty liner).  I have been super tired, but have been sleeping deeply – a silver lining I guess.  Last night I had weird pin-point pupils, Chris noticed them and so I looked in the mirror and absolutely freaked out.  With a quick google, it looks like it could be the painkillers that did that, so I am not keen on taking those anymore!  Pain has been bearable with pain killers – acetaminophen extra strong (NSAIDs like Ibuprofren are not good with the methotrexate), but the pain has been different to when I first started miscarrying where it felt like the worst period cramps, the pain I am experiencing now is short sharp bursts around my ovaries, but not constant.  Each time I get a short sharp burst of pain I hold my breathe (not literally) as I hope there is nothing crazy going on down there with a burst tube.

Apparently with methotrexate, the deed starts to kick in after 72 hrs, so I am hoping that tomorrow morning my hCG levels have begun to drop.

Emotionally, I have only broken down in tears three times – an average of once per day I believe is not bad going.  The things that upset the most is thinking about how for particular very short moments I actually believed this was a viable pregnancy and talked about the ‘may be’ and ‘what ifs’.  It makes me sick to my stomach just thinking like that.  Having said all that, I don’t think those thoughts are going to go away anytime soon.  So we have been focusing on our road trip out West, it helps a lot to re-focus the mind.  I think I am ready to go back to work tomorrow – I hope so, I’ve got a meeting in Stockholm to prepare for!  (that is if my doctor lets me fly :-s )

PS.  I have got to the point that I am not sure what category to post this under – ectopic pregnancy, suspected ectopic pregnancy, miscarriage, part of IVF vol I???? I just hate not knowing if this was actually ectopic or not, they had no visible proof of where the pregnancy was and it frustrates the hell out of me – I think I will put it under feelings for now and figure it out later.  I wonder what the doctors call this?

I said NO…am I crazy?

The on-call doctor called me first thing this morning and apologised she had not called yesterday with my results (she did have them yesterday after all and gave no reason).  She said my beta hCG levels have risen again and she wanted me to come in today to take the methotrexate shot.  I asked her if she had spoken to my doctor (- no she hadn’t) because my doctor had said she would keep monitoring me up to 7 weeks for a visible confirmation of ectopic before administering the methotrexate.  7 weeks was her cut off point.  The on-call doctor said it was ultimately my decision, but it would be against their recommendation not to take the methotrexate today.  She also checked with the other senior doctor who was there with her, and he said it was OK for me to wait – despite it being against their recommendation.  I said OK and asked when can I come in for another ultrasound, she said it was up to me.  My doctor isn’t back in the office until after the holiday weekend, Tuesday.  This is when my doctor said her cut off point was.  So I told the on-call doctor that I will wait for my doctor to come back.  I also asked what was my actual hCG level because she hadn’t told me up to then – it was 1300 (up from 1066 48 hours ago).  That was a lot less than I expected.  I have a feeling it’s tailing off.  Here is my chart:

Normal hCG levels compared to my hCG levels

Normal hCG levels compared to my hCG levels (Note this is on a Log scale)

The on-call doctor told me to call her anytime I wanted to change my mind, and please look out for any pain.  After I got off the phone, I panicked.  Chris was still asleep in bed at the time of the phone call so I woke him and basically cried at him.  He says he supports my decision, but wants me to take the methotrexate.  Ultimately I feel like crap right now.  I have had SO MANY unknowns from encounters with doctors and I am sick and tired of it:

  • When I was 18 I went to ER because I had a random massive vaginal bleed.  They couldn’t tell me why.
  • When I was 19 I spent a year in and out of doctors trying to diagnose my abdominal pains.  I was eventually diagnosed with Irritable Bowel Syndrome (IBS), but there is no test to confirm this, it was their last thing in the box (I know I do have IBS, but really we don’t know why – and no one really knows what causes IBS).  I could have endometriosis too, but IBS explains the pains too.  They couldn’t tell me why.
  • When I was 20 I ended up in an ambulance being taken to ER because I passed out from abdominal pains.  I freaked out a lot of people.  They suspected that it was IBS related after eating 3 days of ration pack food in the field whilst on Army Exercise.  But really – they couldn’t tell me why.
  • We can’t have a baby without medical intervention.  We have unexplained infertility.  They can’t tell me why.
  • I’m pregnant, but they can’t see anything on the ultrasound at 6W4D and hCG level of 1300.  THEY CAN’T TELL ME WHY.

What is wrong with my body?  It’s like I have a black box body of unknown-ness.  Am I actually an alien??!

Honestly, I think I might be going crazy for not taking the methotrexate, but there is something that just doesn’t feel quite right about it.  Why don’t I want to take this drug? Because I’m very afraid of the side effects and being put through this unnecessarily if the abnormal pregnancy is in fact just growing slowly in my uterus and not one of my tubes.  Methotrexate can really mess with your gut, and my gut really is bad enough as it is.  I am not even bothered by the fact that we have to wait 3 months before trying again – I will WELCOME this after everything we have experienced the last 2 weeks.  Chris thinks I should take the shot so we can end this right now, mostly for the psychological pain, plus of course he is worried I will end up in hospital. Aghhh.  This truly sucks.

So Letrozzzzzzzzzzzzzzzzzole sleepy…

Wow, these drugs make me sleepy!  Letrozole (AKA Femara) comes with a warning on the bottle ‘Do not drive or operate machinery until you know how these drugs affect you’. Well I never saw that on the bottle first time around!

Pharmacy Fun Time
Yesterday, I got my ‘refill’ of 10 tablets of Letrozole (2.5mg) from my local pharmacy just in the nick of time.  I am supposed to take x2 Letrozole tablets for five days, starting from CD3.  Yesterday was CD3, so I when I received an email from my local pharmacy saying I could pick them after 5pm I was relieved.  However, there was a note in the email saying that I would have to pay full price because it was so close from ordering to pick up, the insurance had not been calculated yet.  That would be $103 full price v $0.26 copay due.  Fortunately, when I got to the pharmacy, the insurance had done its thing and I only owed $0.30.  An increase from last cycle of $0.04 – weird  (My progesterone has gone up by $2.00 as well – has there been a nationwide increase in drug prices? Do drugs fluctuate like oil prices??)

Rahhhhh - Dodgeball is a great place to let off some steam

Rahhhhh – Dodgeball is a great place to let off some steam

What time of day do you take your Letrozole?
I have decided to take the Letrozole in the early evening because last time when I took them in the morning, the drugs were affecting me on my drive home from work, dangerously so.  They do make me extra sleepy – I guess from using all that energy up to grow those extra follicles.  Let’s see how this works out.  Last night I slept pretty well for the first time in a while, maybe it was the drugs or maybe its about time I had a good nights sleep after two weeks on the progesterone.

Dodge, Duck, Dip, Dive and Dodge
Right – off to dodge some balls at our social club and let of some steam!! More on dodgeball next week when I will be facing the dilemma of whether to play in the play offs or sit on the side lines…. :-S

Half way through the two week wait and feeling low…

So this is it…the half way point in the 2 week wait (AKA the 2WW).  I am feeling a little low.  It is probably as a result of a mix of things – first of all, being stuck inside all weekend behind a computer, second of all, I am impatient being in the middle of the 2WW, thirdly I am fed up with the progesterone suppositories leaking everywhere.  Is there a chance that my feelings are related to hormones and medications?  Maybe, I can’t tell.

diesel worried

Diesel don’t look so worried, it’s gonna be OK

My lowness hasn’t been helped that I had two course projects due this evening.  Both were programming assignments….the first project I developed a web app that uses the CDC’s most recent data on Assisted Reproductive Technologies (Here is some info on it).  I was unable to fully deploy the app online before the deadline. It worked perfectly yesterday on my computer and all day today I have bee trying to figure out why it won’t go live. Sooooooo frustrating.  Hopefully my graders will see my code and be generous.

My second project was a little dull, statistics and investigating relationships in cars between Miles Per Gallon and transmission types (amongst other things).  I completed my report, but in the last hour before the deadline I could not get it to convert to a pdf file.  Such a simple task.  I am gutted.  I will have to re-take this module as it counts for 60% of the grade.

I will admit that I have screamed and cried at my computer several times this weekend.  I am not very good at not being in control of it!

Our cats, Sushi and Diesel, have been overly affectionate the last couple of days.  I am sure they can sense when we are down or ill.

Next week is a new week, no more snow, warmer temperatures, back to some gentle exercise, and the end of the week we are having friends over to watch rugby, eat some bad foods, and play some board games.  Something to look forward to.  With all that fun it will then be time to take the test. Which incidentally, will be the same day as our 3 year wedding anniversary – it would be a good present to ourselves if we got the big fat positive.  Monday Monday!!!

These guys help when I feel low

Sushi and Diesel being cute together, can’t help but me smile

go home cat, you're drunk
go home cat, you’re drunk – Classic Diesel

Wonky Boobs – a side effect?

If I could post a picture of my wonky boob I would, but I don’t think the internet needs anymore pictures of wonky boobs, I’m guessing it’s a pretty saturated market out there.

Yesterday I woke up and looked in the mirror to discover my right boob had grown overnight, it also felt overly soft compared to normal.  Chris thought I was exaggerating.  So I didn’t think much else of it.  But this morning it was still like that, so rather than poo pooing my crazy claim, Chris examined it a bit closer.  Upon closer inspection, he concurred that my right boob had indeed grown in size, whilst also laughing in amazement when he came to this conclusion.  Luckily I shared his humour on this one.  I am guessing this is a side effect of the Letrozole (well I can’t think of any other explanation for it!).  I am due to ovulate from the right side, so is it coincidence that it was my right boob that grew?

Will my boob return to normal size and match the other one??? I hope so!  Or perhaps next cycle the other one will catch up – may be I won’t need a boob job after all!  (Just kidding, I don’t really want a boob job, and never have, luckily I like my boobs as they are).dani