Enjoying the holidays!

Hope you are too!

Holidays on the East Coast

We’re in DC right now and we’ll be headed to Virginia in a few days… enjoying holidays with the family.  This year we’re with my side of the family and next year (and last) with the hubby’s.  It’s nice and chilly here in DC, and we’re touring all the touristy stuff (today was the Natural History museum of the Smithsonian… awesome!)  We’re staying in the home of a friend I’ve never actually met in person… he’s a jiu jitsu guy, salsa guy and fellow blogger.  He’s out of town for his own holidays and graciously allowed us to crash his pad. 

By the way I have some Gonal F for sale… 900 iu pen exp 1/13 and 900 iu pen exp 9/13.  Each for $300 plus $7 shipping.  Let me know if you’re interested!

Hope you’re well and enjoying the holidays!

Your Fetus Is an Alien

So why doesn’t a pregnant woman’s body attack it?

By Randi Hutter Epstein Posted here on Jezebel Thursday, July 26, 2012.

“Of all the miracles of life, here’s by far the most miraculous of all: Women’s bodies, for the most part, do not attack and destroy the fetus growing inside them.

From an immunologic point of view, the fetus is an alien. Like a germ. Or an organ transplant. And your body is programmed to mount an assault on foreigners. But my fetus is half me, you say. And so, you may suspect—as others have before you—that the “half-me” part signals the body to avoid all-out warfare. This makes emotional sense! But the success of surrogate moms and donor eggs—with women gestating babies produced by the eggs of other women, their bodies accepting the presence of a fetus that is not “half-them”—proves that idea wrong.

So that leads us to the big question: Why does pregnancy even work?

Pregnancy, as Yale School of Medicine’s Harvey Kliman sees it, is a metaphor for marriage. The placenta is controlled by the father’s genes, the embryo by the mother’s. Each side has its own agenda. Yet, the key to a successful union—whether it be mother and fetus, or husband and wife—is compromise. The details of this compromise have always been a mystery, but in the past few years, scientists seem to be edging closer to understanding the specific negotiations that occur deep within the cells of the women’s body that allow the fetus to escape destruction.

For years, doctors have been eyeing T cells, the immune cells that attack and destroy invaders (which should include the fetus). A few years ago, a team of researchers at NYU School of Medicine, lead by Adrian Erlebacher in the department of pathology, discovered something that had never been seen before: In pregnant mice, even when the T cells were experimentally nudged into attack mode, they did not bite.

These early studies prompted the NYU team to dig deeper, trying to figure out the chain of events that would stop the T-cell attack. They eyed a certain family of genes that, when working properly, recruit and send T cells marching toward invaders. But in the pregnant mouse, the genes were silenced in the decidua—the tissue surrounding the fetus and the placenta—by a chemical that attached to the genes’ proteins, altering the way the genes look and therefore how they act. With this physical change, the genes can no longer communicate “attack!” to the T cells.

The upshot: In a pregnant mouse, at least, the genes can’t do their job, which means that the cascade of events that would lead to an immune assault on the fetus never happens.

Erlebacher says that he and his team found “a fundamentally new way to think about the maternal-fetal interface,” and they recently published their findings in the June 8 issue of Science. Next the NYU team plans to prove that what they discovered in mice holds up in humans as well.

“This is a very exciting finding for us because it gives a satisfying explanation for why the fetus isn’t rejected during pregnancy,” Erlebacher notes, “which is a fundamental question for the medical community with clear implications for human pregnancy.”

And not just for pregnancy: These recent discoveries may not only reveal mysteries of pregnancy and offer novel ways to prevent miscarriages and preeclampsia, but they also might lead to clues to treat cancer and autoimmune illnesses. (Tumors grow, in part, by avoiding immune assault. And contrarily, autoimmune illnesses are caused by an über-revved up immune system.)

Erlebacher’s not the only one studying this stuff. Kliman, the Yale researcher, also investigated human placentas, and his findings suggest an entirely different mechanism in play. Kliman suspects that a specific protein in pregnant women, called PP13, acts as a decoy of sorts to trick the mom’s immune system to stay away from the baby. His findings were published in the October issue of the Journal of Reproductive Sciences.  Kliman spotted a cluster of PP13 flooding dead tissue in the placenta of women who had just had abortions. (Kliman studied the placenta within moments of the abortion so he believes that what he saw is what happens during an ongoing pregnancy.)  Kliman’s theory is that the PP13 drive immune cells to this area of the placenta, away from the growing fetus, allowing the fetus to escape attack.

Another theory comes from Koji Yoshinaga, the program director of the reproductive sciences branch of the National Institute of Child Health and Human Development. Yoshinaga has been studying, among other things, BIEFs, or blastocyst implantation essential factors—the factors that impact the interaction between embryo and uterus. He believesthat these factors signal to the mother that her body must provide nutrients without attacking. As he sees it, pregnancy is a huge balancing act between the mother’s body revving up certain systems to nourish the baby and stanching other systems that could hurt the baby. It’s a complex dance between hormones and the immune system. For instance, Yoshinaga says that prolactin—the hormone that stimulates milk production—also revs up T-cell production. But progesterone, another key pregnancy hormone, triggers something called PIFB, pregnancy-induced binding factor, which seems to protect the embryo from those revved up cells. Still, we really don’t know precisely how progesterone does the trick.

So how do all of the various findings coalesce into one big picture? No one knows yet. The ultimate answers, Yoshinaga says, will come when scientists who are experts in the immune system work closely with scientists who know hormones to develop one unified way of thinking about pregnancy and fetal survival.

(One thing scientists do know is that the old wives’ tale, about pregnancy compromising a woman’s entire immune system, is fiction. You may not fight off the fetus, but you can fight off a cold. The reason pregnant women often feel like their bug lasts forever is probably because pregnant women are hyperattuned to their bodies, obsessing on symptoms more so than when not pregnant.)

Researchers seem to be on the right path when it comes to figuring out the complicated compromises between mother and fetus. How those compromises play out after birth—you may have heard of a complex interface called the “mother-daughter relationship”?—remains a deep, dark secret, however, one that may confound science for all time.”

Humira starts tomorrow…

I’m doing fine… I must have misunderstood Dr. B but I will not be on neupogen after all.  He said he doesn’t know why I couldn’t be on it with the IVIg/Humira, but he doesn’t want to play polypharmacy with me.  (I am still a big believer in throwing everything at the problem from the get-go, but I accept his choice… for now!)  So I start Humira on Friday– one shot, wait two weeks, another shot, wait three weeks, get my $450 Reprosource bloodwork done again and see if it worked.  If it didn’t, then another series of two shots/five weeks.  If it did, then IVIg by IV infusion, 14 days before transfer. 

As for side effects, the website says: Common side effects of HUMIRA include injection site reactions (redness, rash, swelling, itching, or bruising), upper respiratory infections (sinus infections), headaches, rash, and nausea.  Also,

• Serious infections have happened in people taking HUMIRA. These serious infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some people have died from these infections. Your doctor should test you for TB before starting HUMIRA, and check you closely for signs and symptoms of TB during treatment with HUMIRA. If your doctor feels you are at risk, you may be treated with medicine for TB.
• Cancer. For children and adults taking TNF blockers, including HUMIRA, the chance of getting lymphoma or other cancers may increase. There have been cases of unusual cancers in children, teenagers, and young adults using TNF blockers. Some people have developed a rare type of cancer called hepatosplenic T-cell lymphoma. This type of cancer often results in death. If using TNF blockers including HUMIRA, your chance of getting two types of skin cancer (basal cell and squamous cell) may increase. These types are generally not life-threatening if treated; tell your doctor if you have a bump or open sore that doesn’t heal.

 

Sounds like fun, right?  Ahh, the things we’ll do to have children!

 

IVIg is supposed to make you feel like you have the flu while you get the infusion, and maybe for a day or two afterwards, but if you’re well hydrated you can avoid that to some extent.

 

I don’t know how long it will take to get me ready for a FET, I know there’s estrogen and other hormones I’ll be taking, and my linings weren’t the best the last two cycles (only like 7.3mm on trigger day, should be over 9) but Dr Braverman has a plan to improve the lining when we get there, so I’ll just flow with the go.  I have SUCH high TNF and IFN numbers (cytokines that indicate inflammation– stands for tumor necrosis factor-alpha and interferon-gamma) that I will not be surprised it takes more than one series of Humira.  In fact the last time we talked about it the doctor asked me if I would be willing to have a surrogate carry the baby!  (Uh, without any sisters, and without $60k to pay a surro, the answer was “no.”)  So I think he sees me as an uphill battle, too.

 

We go to Dallas this weekend, because my crown fell out while I was eating lunch on Tuesday and my brother in law is a dentist.  I had a local guy temporarily cement it back in place, but we’ll get a new one made (there was a small leak on one side, and though there’s no decay now, that’s not a good situation.)  My husband was going on a hunting trip with his college roommate this weekend, but DH is NOT a hunter, and wasn’t enthused about it especially with the warm weather we’ve been having.  Plus it’s a two-person deer blind, and his roomie is bringing his sons too… so sounded like my dental emergency was a blessing in disguise for DH.

 

Then the next weekend is our Christmas party/open house at our house… eggnog! champagne punch! lots of cookies I can’t eat!  And shortly thereafter we head for Virginia.  For the holidays, my husband and I alternate years with his family and mine.  This year, we’re going to Virginia to be with my side of the relations– we’ll spend 3 days in Washington DC for our own mini vacation, touring the museums especially the Smithsonian and staying in a friend’s condo while they’re away with their girlfriend… then 4 days with aunt/uncle/cousins in Norfolk, including Christmas dinner, then 4 days on the Eastern Shore of Virginia with people who are like second parents to me (they babysat me when I was in preschool with their sons, who are like brothers to me),  We’ll get back in Austin for New Year’s. 

 

How about you? 

Mmmm… shepherd’s pie is comfort food for the gluten-free…

This is not a traditional shepherd’s pie, as I make it with ground beef instead of lamb… but I think it’s awesome… it’s a great way to use leftover mashed potatoes or it takes hardly any time at all to make some specifically for this dish.  If you use lefties, you will probably want to add more milk to make them more creamy than thick.

Makes a 9×13 baking dish-full.

• 2-3 lbs ground beef, no more than 10% fat is best
• small bag of frozen peas (you could add chopped carrots, mushrooms or corn as well)
• 1 small can (I think 6 oz) tomato paste
• olive oil, 1-2 Tbsp.
• 1 yellow onion, chopped
• 3-5 cloves (up to you) garlic, pressed
• sweet (not hot) paprika, salt, pepper, oregano to taste
• 3-4 lbs russet potatoes, peeled and coarsely chopped
• 4-8 Tbsp. butter for mashed potatoes, to taste
• 1-2 cups milk for mashed potatoes, to taste

Preheat oven to 350 degrees. In big pot, cover your chopped potatoes with 1″ water and add a little salt.  Bring to a boil over high heat then lower the heat so you don’t boil over.  Cook potatoes until tender and fork pierces without any resistance.  Drain all the water out and leave potatoes in hot pot, no lid, on hot (turned off) burner.  You want them as dry as possible. Water causes the starch molecules to swell, break down, and gelatinize (get pasty).

In large frying pan, saute onions in olive oil over med-high heat until transparent.  Add ground beef and break up, stirring occasionally until evenly browned.  If you’re watching your calories, you can drain the fat at this point, but you will lose some flavor.  Add garlic, oregano, and paprika… I think I usually add about 2-3 tsp of paprika and the same of oregano.  Stir in tomato paste and reduce heat to medium, stirring regularly to blend well.

Meanwhile add butter to your potatoes and mash.  (Don’t add milk before or with the butter; you need the fat molecules to coat the starch molecules first before the cold liquid.)  After they’re fully mashed up, start adding milk until they get to the creaminess you prefer.  Adjust seasoning with salt and pepper.

Taste your beef mixture and add salt and pepper as needed.  I usually add about a teaspoon or two of salt, depending on how much beef and what brand of tomato paste I used (some are salty already.)  Put your frozen peas in a bowl in the microwave and defrost them, then use a slotted spoon to get them out of the extra water and stir into the beef.  Pour the beef/pea mixture into the 9×13 baking dish, then pile the mashed potatoes on top in heaping giant spoonfuls, smoothing it out to seal all the way to the edges of the dish. I find it makes a nicer presentation to have little “crests” or “peaks” of potato sticking up instead of being perfectly smoothed out, because you’ll broil it at the end and get them nice and brown.

Usually with my oven, I cook this for 40-45 min– if your dish is glass, you’ll see the beef mixture bubbling away under the mashpots– and then I put it under a hot broiler for about 10 minutes to make the top crispy and golden brown.

Especially if you put additional veggies in, this is a relatively healthy one-pot meal which really smells good while cooking and warms the tum.

If like me you only put peas in, here’s a recipe to go with it:

Sauteed Zucchini with Onions– serves 3-4

Halve and chop into 1/2″ slices 3 or 4 zucchini squash.  Cut 1/2 of a yellow onion into thin wedges.  Saute the onion in 1-2 Tbsp olive oil over med-high heat, stirring occasionally, until brown on the edges and pretty soft.  Sprinkle in some salt and pepper.  Add your zucchini and continue to saute until zucchini is getting softer and golden brown.  Sprinkle a little more salt if you think it needs it, then add a good splash all the way around the pan of white balsamic vinegar (at least a good couple tablespoons, maybe up to 1/4 cup or so.)  Keep stirring while the vinegar turns into a glaze, about 2-4 minutes, and remove from heat.  Optionally you can serve with goat cheese or parmesan sprinkled on top.

Here you can see our dinner on Monday night– the shepherd’s pie didn’t broil as long as I might have because we were hungry 🙂

Hope you enjoy!

 

 

One blast added, for a total of four…

I was kind of disappointed, in a sneaky fearful way (fearing that I would karma myself into never having children for being so greedy!)  But with six eggs and the doctor telling me four were doing well… and then down to two… on day five he froze a grade B blast and said there was still a grade A morula which he hoped would be a blast the next day.  But, it arrested, so we now have four blasts on ice– one grade A and three grade Bs. 

What next?  Humira should be delivered Friday and I hope to have instructions from Dr B. by then… that, plus IVIg, plus neupogen, for the next couple months or so?? and hope it works to make my uterus a happy place for a FET in the spring.

Since I am now done with the egg retrieval thing (and I have meds leftover, if anyone needs Gonal F, Ovidrel, Lupron, just email me, I’m not looking to profit!) I am back in the gym big time.  Every morning, 45 min of cardio– stationary cycle, rowing machine, treadmill.  Anything I can do while reading a book!  (Just finished Escape by Carolyn Jessop, about her life in and departure from the FLDS lifestyle in Utah/Arizona.  Anyway…)

I’m also doing a lunchtime class which is like crossfit, lots of pliometrics and interval training.  I came back from NY weighing 154 and I am already down to about 149.5.  I just need to be strict about what I eat– I’m already back on the gluten-free train– and I’ve been bringing veggies and salad with sugar free dressing to work for lunch.  Last night I made a spinach salad, the world’s best shepherd’s pie, recipe courtesy of my awesome cousin Kathy in Long Island… and sauteed zucchini with onions and a splash of white balsamic vinegar.  Yum!

About to leave New York…

Headed home today… and as of last night, we had two grade A morulas expected to be blasts, and the other four were lagging behind a bit, but Dr Braverman said he’d wait and see.  Whatever makes it to blast today will be biopsied and then frozen… and we’ll get CGH testing done.

I wonder when Dr Braverman will get me started on humira, ivig, and neupogen…