Friday, January 17, 2014

Going to get help. "I think I might have postpartum depression."

In a previous post, I wrote about the night Philip asked me, "Honey, do you think you might have postpartum depression?"

I'd like to pick up with the day I went to get help.  

I pulled up to Sancta Familia's parking lot for my appointment.  Sancta Familia is a Catholic Medical Apostolate dedicated to treating its patients as unique children of God from the moment of conception to natural death.  As I wrote in my previous post, I chose to make my appointment with Sancta Familia because I knew that one of their nurse practitioners was trained in the Creighton Model (this meant that she would be very familiar with the hormonal irregularities that can occur during the postpartum phase).  To learn more about Sancta Familia, please check out their website.        

When I walked in the door, I knew I had chosen the right medical practice.  A lobby separated two rooms.  To my right was the medical practice.  To my left was a chapel.  After completing some paperwork, the sweet receptionist invited me to wait in the waiting room or the adjoining chapel.  I opted for some quiet prayer time.

I knelt for a long time, praying for God to help me calm my nerves.  I was anxious about the appointment, and I still wasn't sure what my diagnosis or treatment options would be.  I prayed that the Holy Spirit would give me the words to be humble and honest about what had been my everyday reality.  I prayed that He would open my ears to hear the medical advice I sought.  I prayed that I would be brave enough to do whatever it took to get better.  

After awhile, I sat back to take in the chapel.  Isn't it beautiful?  It was pretty amazing waiting for my appointment with God in the tabernacle.  I loved having the images of the Holy Family to look at.  When I looked at Mary, I asked her to intercede for me as a wife and mother.  I asked her to help me follow her example in perfect obedience and trust.  When I looked at Joseph holding the Christ Child, I pictured Philip at home, holding our babies.  I prayed that Joseph would continue to watch over our family.  In fact, I think this was the moment I decided he would make a great patron saint for our family in 2014.  Joseph stayed by Mary's side even though he got more than he "signed up for."  I prayed that Philip would find comfort and peace in Joseph's example--that sometimes marriage gives us more than we sign up for, but God will reward us for our obedience and faithfulness.  I knew that my depression had been difficult for Philip, and I prayed for God to bless him for his devotion to our family.  

When I sat back, I noticed this card on the seat next to me.  It's a "Prayer to Jesus Christ, the Divine Physician."  I read and re-read the prayer until the receptionist tapped me on the shoulder to let me know that it was time for my appointment.  

 Deep breath...

After getting my height, weight, and vitals checked by a nurse, I waited for a few minutes in one of the exam rooms.  The Divine Physician hung on the crucifix on the wall above the exam table.  Yup, this was definitely the right place.

Moments later, my nurse practitioner, Teresa, walked in.  She asked why I came in, and I said, "Well, my husband and I think I might have postpartum depression, but I'm not sure.  I thought you could tell me what you think and we could go from there."

Just like that night on the couch with Philip, Teresa went through a list of symptoms of PPD, asking me to say whether I had them with a "no" or "yes."  I said "yes" to almost every single one.  

From there, Teresa let me know that she has been treating women with PPD for 14 years across the country.  Through her training and time in practice, Teresa is very familiar with the way a woman's hormones fluctuate before, during, and after her childbearing years.  Teresa explained that a woman's progesterone levels plummet from the moment she delivers the placenta.  Until a woman's cycle returns, women with PPD experience fewer symptoms when given progesterone therapy.  (The Pope Paul VI website explains the use of progesterone therapy to treat postpartum depression here.)  Progesterone therapy works very quickly (unlike antidepressants, which may take weeks to take effect), is relatively inexpensive, and works with a woman's naturally occurring hormones.  When a woman's cycle returns and her progesterone levels come back to normal, she should experience fewer PPD symptoms and should wean from the progesterone.

Teresa prescribed a course of 5 progesterone shots every other day, and she gave me the first shot at my visit.  I asked her how quickly I should expect a difference, and she said, "Within hours."  She said, "My favorite part of treating women with postpartum depression is calling them the next day and asking, 'How are you feeling?' because they almost always say, 'Great!'"  

Teresa reassured me that the depression wasn't just something in my head.  I left knowing that PPD is a treatable medical condition and that I would not feel bad forever.  I left my appointment at noon, and I felt like myself again by 3 p.m.  I had more energy, I wasn't anxious, I didn't have angry outbursts.  I felt ready to tackle the rest of the day.  

Philip and I were thrilled, and Philip called my prescription in to the pharmacy.  Fortunately, being married to a doctor meant that he could give me the shots from home instead of going in to the clinic every other day.  Unfortunately, the pharmacy filling my prescription couldn't get the progesterone oil in for four days.  This meant that I felt great for a few days, but I started to have a reoccurrence of the symptoms.  

When I finally got my second shot, I felt the same relief within hours.  The progesterone comes in sesame oil, and it's very thick, so the needle that dispenses it is pretty big.  It needs to be injected in my rear end for the best results.  It definitely doesn't tickle, but it's worth the discomfort for the results.  

After that second shot at home, I continued to feel better, but I noticed that my symptoms would start returning by the time I was due for another shot.  When I reported this to Teresa, she suggested supplementing the shots with oral micronized progesterone.  This way, I would receive a slow, steady dose of the hormone in addition to the shots.  Teresa suggested taking 1 progesterone pill a day and bumping it up to 2 if I still felt the symptoms.  

I took 1 progesterone pill daily on top of the every-other-day shots.  I had more good days than bad, but  I still had bad days with angry outbursts, anxiety, exhaustion, etc., so I decided to start taking 2 progesterone pills daily.  Since I started taking 2 progesterone pills daily on top of the every-other-day shots, I feel like I have a handle on things.  

Unfortunately, breastfeeding was becoming one of my contributing stressors to the PPD.  After a lot of prayer and anguish, I decided to start weaning Harry at nearly five months.  Harry was used to taking bottles of breast milk, and he didn't even seem to notice the difference between breast milk and formula.  The morning after he had his first bottle of formula, my cycle returned!  Cycling again means that my body is amping up to start producing healthy levels of progesterone on its own, and I need to start weaning myself off of the progesterone shots and pills.  I am scared.  I finally feel like I'm in a good place after battling PPD for a few months, and I'm nervous about what will happen when I start to go off of the progesterone.  I am supposed to immediately discontinue the shots, continue on the pills for another week, and see what happens from there.  I agree with the logic behind this decision, and I know it's the right thing to do, but I don't want to experience a relapse.  I know I am in good hands, though.  I know that the worst that can happen is a brief relapse, and I can resume my progesterone therapy.  

In the meantime, I am going to schedule an appointment with a Catholic therapist, and Philip is going to come with me.  We have some stressful times ahead with listing the house and moving.  I want to make sure that I am equipped to emotionally handle these stressors when they arise.  I've always struggled with managing my anger.  I want to make sure that I am modeling appropriate emotional control around the kids, and I want to have that control for myself.  It feels awful when you're losing it--yelling, clapping your hands, clenching your jaw.  I don't want my children to learn those behaviors from me, and I don't want to continue doing them.  I want them to know that it's okay to feel however they feel, that it's good to talk about whatever they are feeling, and that there are good and bad ways to handle our feelings.  In a lot of ways, I am grateful that God allowed me to suffer during this time so that I would pursue therapy--not only for my sake, but for the good of our whole family.  I know my treatment from PPD will be much more successful with therapy in conjunction with my medication.

So, that's where we are now.  I am waiting and praying that the PPD symptoms won't return as I wean off of the progesterone.  I pray that therapy will be healing and helpful.  

My amazing nurse practitioner, Teresa, agreed to do a Q&A interview about postpartum depression to publish on the blog.  I will be sending her my questions soon, and I look forward to sharing her responses with you.  I think it will be a great opportunity for women to learn more about progesterone therapy for PPD.  I hope you'll stop by to learn from her years of experience.  

A dear friend said something that only a dear friend could.  After I gave her an update on how things were going with my PPD, she suggested that maybe God was allowing it so that I could share my story with others.  Maybe she's right.  After I shared my story about miscarrying Therese, I received so many messages from women that experienced something similar.  Since sharing my story about my experience with PPD, several women have reached out to share their stories with me.  Miscarriage and postpartum depression have been two of my biggest crosses so far, but I am ultimately grateful for them because they have been sources of great healing.  

It makes me think about that scene in Genesis when Joseph forgives his brothers for intending great evil against him.  He says, "you meant evil against me; but God meant it for good" (Genesis 50: 20).  No matter what happens to us in this life, God can use it for good.  So, whether or not I have a reoccurrence of my PPD symptoms, it is unlikely that this will be the last cross God asks me to carry.  The good news is I don't have to carry it alone.  Even if He gives me more than I can handle, He will give me rest, and He will use it for good.    

"Come to me, all who labor and are heavy laden, and I will give you rest.  Take my yoke upon you, and learn from me; for I am gentle and lowly in heart, and you will find rest in your souls.  For my yoke is easy, and my burden is light."  (Matthew 11:28-30)

Thank you for your continued prayers and support! 

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