Homebuying Update: The Inspection

Just catching up? We went house-hunting, and made an offer on a house. This post will cover the experience of the home inspection.

We did not know what the home inspection process would be like. It lasted about 3 hours in total. The good news? No major surprises! Our home was built in the late 1980s, so we were hoping for no major structural or other issues that would have possibly led us to walk away from the deal. We do highly recommend getting the home inspection, even if your lender does not require it. Our inspector showed us everything and generated a long (25+ page) report detailing all of the structural aspects of our future home. It is also helpful to consider things that are not major enough to ask the home owner to repair before closing, so you have an idea of some of the repairs that may need to happen in the next few years (e.g., the roof may not need immediate replacing, but it could be showing signs of deterioration which could increase the potential for leaks). 

What to anticipate for the inspection:

1. Plan at least 1 1/2 - 3 hours for the full home inspection. In our case, we had two inspections occurring simultaneously -- the regular home inspection and the termite inspection. It is a good idea to allot plenty of time as you do not want the inspector to feel rushed. Ours lasted 3 hours.

2. Cost. We paid $375 for the home inspector and another $85 for the termite inspection. Budget for this before you make your offer on your home. It is much better to spend a few hundred dollars before closing than end up with a home needing an immediate costly repair after you move in. Even if the seller offers a home warranty, it is best to opt for the inspection.

3. Logistics. The inspectors will be taking several notes and many pictures. Our inspector got up on the roof to look at the cap on the chimney, the condition of the roof, and the seal around the skylight. He went down into the crawlspace to evaluate the foundation, the wood, and look for any signs of structural damage. The inspector will also turn on all of the faucets, check for leaking pipes, test all electrical appliances, and even tests the smoke detectors. Every outlet and every ceiling fan will also be tested to ensure everything is in working condition. Our inspector was also kind enough to show us how to take care of some of the general annual maintenance tasks (e.g., how to change the filters in the furnace). 

Typical things found in a home inspection:

1. Electrical: All outlets located in bathrooms, kitchens, and other rooms with water should have GFCI (ground-fault circuit interrupter) outlets installed (see photo below). These are essential around water, as they reduce the risk of shock by cutting off the electricity if it senses a disruption in the current. Newly constructed homes likely have these already installed, but older homes may not. Our house had a few of these, but not in all of the locations where they were required. We asked for this in our request to the home owners. Other electrical things that will be checked include the circuit breakers, outlets (to ensure they have electricity), lights, and ceiling fans.

2. Water and Plumbing: By turning on all of the faucets, running an empty load on "hot" in the washer, and testing the shower faucets, the inspector can evaluate if the hot water tank is functioning properly. Dripping faucets or leaky pipes under the sinks will also be evaluated. The inspector also carefully looks for water damage or evidence of mold. In our case, the vapor barrier had deteriorated in the crawl space and there was some minimal signs of moisture on the beams. Luckily, the sellers agreed to replace the vapor barrier and have the beams thoroughly cleaned. The new vapor barrier should help prevent moisture from affecting the beams. This is a huge issue to make sure is taken care of -- moisture in the crawl space over time not only can weaken the wood, but also can attract pets (e.g., mice and termites). Mold is also a serious issue. We have friends who walked away from a home they loved after their inspector found the attic was filled with mold and the sellers were unwilling to cover the cost of mold removal. 

3. Major appliances and systems in the home: The furnace, AC, and hot water heater will all be inspected. There are several minor things (like an "earthquake strap" around the hot water tank to stabilize it) that we had no idea were even requirements, as we do not live in an area prone to earthquakes! The inspector will also turn on the oven, make sure the refrigerator is chilling, and run the washer and dryer. The repairs required in this area in our inspection were minimal. The main one was asking for the flexible aluminum dryer vent hose to be replaced by a semi-rigid hose (as the flexible hose is prone to collapse and could cause a fire). 

4. Windows & Doors: Inspecting the jams, panes of glass, and the general condition of the frames. Lucky for us, nearly all of the windows of the home (except 2) were replaced in the last 5 years. One of the two windows that was still original to the house had some wood rot at the bottom of the window. The sellers agreed to fix this, and rather than repair the section with wood rot they just replaced the whole window! 

5. Pests: Termites can obviously cause significant harm to the wood frame and structure of a home. The termite inspector looked in the crawl space, as well as examining all exterior and interior walls. Our new home is termite-free. We plan to look into having another inspection in one year to make sure there are no issues. 

---

Are you in the process of buying a home? Did you opt for an inspection? Tell us in the comments what the inspection process was like and if there were any issues found. Happy Homebuying!

Making an Offer on a House

If you missed the first part of this story, click here to read it.

After touring the four properties with our agent, we had a decision to make. I was a hard sell -- mainly because I really had not anticipated falling in love with a house on the first day of touring properties and it was just overwhelming to think about making an offer without even having a chance to sleep on the decision.

The reason why I didn't have a chance to think through the decision longer was because the houses in our price range are moving FAST. We knew this was not just our agent pretending the market was better than it was -- most of the homes we had toured through open houses had offers pending within a matter of days.

This process very much felt like taking the leap and learning to fly on the way down. Thankfully, we have a seasoned agent who could help us manage everything.

I was a nervous wreck before we made the offer. Walking in, I cried (for about 30 seconds) from the overwhelming decision. Mostly it was excitement, coupled with the realization that we were making potentially the biggest financial decision of our lives in the span of about 60 minutes.

We drafted the offer, which was just a smidge below asking price and we also asked the seller to cover closing costs. We finished signing everything with our agent around 6:00PM. The seller had until 10PM to respond.

We waited for what felt like an eternity. I paced around our apartment. C ordered a pizza, but my stomach was doing somersaults and I couldn't eat.

As the clock ticked closer to 10, we grew more convinced they were rejecting it.

Finally, at 10:03 our agent called to tell us "Congratulations! They accepted the offer without countering!"

We were utterly shocked and also very excited. My stomach remained in knots for the rest of the night and I had trouble sleeping.

Two days later, I still can't believe that happened! We are now waiting to get the home inspection and appraisal scheduled.

To be continued...

The Homebuying Process

Sorry for the lack of posts lately. I promise I haven't forgotten about the blog!

We are currently in the process of buying our very first HOME! We just started working with a Realtor last week, but have been spending several of our Sunday afternoons visiting dozens of open houses and getting familiar with several different neighborhoods in our area.

On Thursday, we sat down with our buyer's agent for the first time and discussed what we were looking for in a home. He pulled up all of the newer listings and we decided on five homes to walk through on Friday. Our timeline had been to put in an offer on a home sometime in early June.

On Friday, we went to look at the homes on the list after work. Our list narrowed to 4 (house #5 had an offer pending between Thursday night and Friday morning!). Here is an overview of each house:

House #1: An older ranch-style home in a more rural setting. We arrived prior to our agent, so we just stood awkwardly in the front yard waiting. Eventually, a neighbor walked over to say hello and tell us about the house. We walked around the perimeter and found that while this house was the closest to work, it was a bit too rural for our liking.

Pros: 6 minute (!) commute to work and friendly neighbors.

Cons: Unpaved driveway, too rural (there were random cornstalks growing directly next to the front door), tiny kitchen, very old furnace, and the floor and door jams seems to point to a possible issue with the foundation. The house was also located on a very busy road that cars flew down.

House #2: A cute 1950s-era home with a full basement and very large backyard. The seller had put in new hardwood floors in the main living area, which we really liked. The full basement was unfinished, but relatively clean (given the age of the home). The kitchen was old (avocado green stovetop) and had very outdated cabinets. The bathrooms were also covered in white and gold-flecked tile. The highlight of this house was our agent happening to find a BAT in the hood of the stove. Luckily this discovery occurred with a flashlight and NOT his hand. Gave all three of us an uneasy feeling!

Pros: Nice front porch, large backyard, big basement, formal dining room (the only house we saw with this), most square footage. Loved the new hardwood. 

Cons: Similar to house #1, it was situated on a busy street with noise. Shared an unpaved driveway with the house next door. Kitchen would have needed a complete remodel -- including all appliances. Master bathroom was teeny tiny and only had a standing shower. THE BAT. 

House #3: Prior to looking at the properties, this was our favorite from the pictures. It was also the newest home of the four (built in 1993). It was featured in a neighborhood we really liked and on a quiet street. All brick, with a sun room and nice above-ground pool. Unfortunately, this was a home that photographed much better than it actually appeared in real life. The kitchen cabinets were in very poor shape -- missing handles on about half of them and one cabinet was missing a door entirely. Popcorn ceilings in every room of the home, and there was damage to the ceiling in three or four rooms. Overall, this house had potential but it was clear the current owners had not done much to care for the general maintenance and upkeep.

Pros: Beautiful exterior. Nice sun room and pool, awesome for entertaining! Great neighborhood. Vaulted ceiling and fireplace in the living room.

Cons: Not well maintained. The popcorn ceilings would've needed to be removed from multiple rooms due to damage. The kitchen was perhaps the greatest disappointment of this house. It was also extremely cluttered -- I know you have to live in the home while it is on the market, but it is hard to see beyond the mess to envision the potential of the home.

House #4: This house was located just a few blocks from #3, so it was in the same area (just a different subdivison). This was the most recent one to hit the market, having been listed just 48 hours prior to our visit. Located on a quiet street. Well-maintained and the yard was beautifully landscaped. Vaulted ceiling and fireplace in the living room. Largest kitchen of all of the houses we viewed. Beautiful, well-insulated sun room. Master bath featured dual sinks and a skylight. Laundry room located off of the kitchen, which was the furthest location from the bedrooms -- ideal if we have a sleeping baby in a nursery and I wanted to do laundry!

Pros: Beautifully maintained. Big kitchen with stainless steel appliances. Great neighborhood. Good backyard for entertaining. Lots of windows for natural light.

Cons: No dishwasher in the kitchen. Some of the sinks in the bathrooms were dated colors. Top of our price range.


After viewing all four homes, we decided to make an offer on...

Home #4!!

It really was far and away the best house out of the four we toured, as well as nearly all of the dozens of homes we had walked through for open houses previously.

I'll make a second post about making an offer!

A Post for the Not-Yet-Mothers on Mothers' Day

Spent my morning today sipping a tall flat white at Starbucks, smiling at all of the cute photos people in my newsfeed on Facebook were sharing of themselves with their mothers. Photos of new mothers with freshly-born babies swaddled tight in their arms, mothers holding the hands of little ones first learning to walk, and mothers standing next to their adult children as they graduated from college or stood on the altar to exchange vows with their new spouse.

These pictures symbolize the journey of motherhood. A journey that now begins with two pink lines approximately 2 weeks after conception (or even sooner, detected by beta hCG levels for couples who are undergoing blood tests coinciding with fertility treatments). This is actually a modern marvel in terms of learning about pregnancy -- mothers used to have to wait much longer to find out if they were expecting.

The very first urine-based pregnancy test was first documented as early as 1350 BCE! "A woman who might be pregnant could urinate on wheat and barley seeds over the course of several days: “If the barley grows, it means a male child. If the wheat grows, it means a female child. If both do not grow, she will not bear at all.” Testing of this theory in 1963 found that 70 percent of the time, the urine of pregnant women did promote growth, while the urine of non-pregnant women and men did not." So, women who suspected pregnancy in those days had to wait for those seeds to grow.

It was not until the 1930s (when many of our grandparents were children themselves) that hormones were first identified as possible markers of pregnancy. And it would be several more decades before at-home pregnancy tests would be available in 1977 -- known as E.P.T. (early pregnancy test). It has only been a little over 30 years that mothers could first confirm pregnancy in the privacy of their own bathrooms.

I love thinking about this history and advancement in pregnancy testing when I am in my own TWW. Thinking about how different this process looked for my own mother and grandmothers. We can celebrate a positive test now many weeks earlier than they could. We also have significant advancements in infertility care that allows women who previously would have had no medical options in achieving pregnancy to try several different routes. We can also now have a simple blood test to look at all of our hormone levels to easily identify if something is outside of the normal range.

While all of this is fun to think about in our own journeys to achieve pregnancy, it does not take away the heartache when we stare anxiously at the test after 5 minutes and see one solitary, lonely line. A reminder that this month is not the month. That nausea we thought we detected three mornings ago was likely due to bad Mexican food consumed the night before, not the pregnancy we had hoped it was hinting toward. The tiredness we experienced over the last week was actually, as we feared, due to work stress and not due to an embryo taking up residence.

This disappointment is hard to endure month after month, looking with great hope down at that test. The hope vanishes after squinting hard at the test and determining that line we hoped and prayed hard would appear is simply not there. That barren space where it should be reminds us with sadness that the space where we hoped to learn a baby was growing is also barren, too.

I've shared all of this history to show that we have had generations of women who relied on any number of either old wives' tales, blood tests in doctor's offices or "fundal height" checks to anxiously see if they were expecting. Infertility used to be more silent and less talked about. I wonder what these women endured, as they anxiously waited many months or years to achieve a pregnancy and had very little in terms of medical procedures to try to assist in their journey.

Sending my love out into the universe today for all of you "not-yet-mothers." I know the pain of seeing that barren space where you hoped to see a second line. I know the feeling of the hot tears of disappointment that well up in your eyes as you think "well, another month of trying ahead." Know there have been generations of women before you who had these same reactions.

Halfway through the 6-month race...

The word "Infertility."

Typically for a woman under 35, you have to have 12 months of trying unsuccessfully to conceive before you're officially classified as experiencing "infertility."

Given our unique situation of me being diagnosed with hyperprolactinemia, secondary to a microprolactinoma, before confirmation of infertility it was suggested by the reproductive endocrinologist to use the more stringent criteria typically reserved for women 35 and older. Instead of a 12-month mark, we're using a 6-month mark. 180 days, instead of 360.

I have officially been on the cabergoline for 2 months. It does appear to have shortened my cycles a bit. For the entire year of 2015, my average cycle length was 55 days. So far for 2016, my average cycle length is 38 days. Technically, cycles over 45 days are "abnormal," so the cabergoline shortened my cycles from "abnormal" to "normal."

Hoping for some more progress before June. If we have not conceived successfully in 3 more cycles, we officially move into the territory of infertility classification. At that point, it is likely that the reproductive endocrinologist will suggest more aggressive treatment and testing is warranted.

3 more months...

Recent Reads -- March

A selection of blog posts and articles we thought were worth reading.

• A Few Minor Changes from Little House. Big Heart. A young couple with an adorable house (hence the blog title) left their tiny house in the USA to live in a 15th-century, 900 sq. foot apartment with their young daughter. What an experience! I love reading about families transitioning to try new things. Although A's job as a psychologist will likely keep us bound to the U.S. at least until retirement, it is fun to think about what it would be like to uproot and move abroad for a few years!
• Left Behind from In Due Time. A woman struggling with infertility shares openly the vulnerable emotions associated with feeling "left behind" when it feels as though everyone you know is achieving pregnancy without any difficulty. Although we are still early in our journey to try to conceive, I can relate to the feeling as we've already been married 6 1/2 years and the "when are you going to start trying?" questions feel nearly constant. Very frustrating when you are actively trying and just have not conceived!
• I Have Never Felt So Vulnerable from Inside Martyn's Thoughts. Martyn is a stay at home, single dad of two young boys. He also has muscular dystrophy, which made a family trip to a museum in London particularly difficult. Due to a strike, taxi service was unavailable and he had to navigate safely transporting a 4 and 6 year old from the train station to the museum by himself, knowing that mobility issues would make this particular task more difficult without the help of another adult in case he fell or otherwise needed assistance. Parenthood in and of itself seems to require more vulnerability than most new parents realize their signing up for. You have to plan for seemingly endless possibilities, wondering how much you can realistically handle while still prioritizing the needs of a child. Although this dad's physical mobility limitations make that more pronounced in this story, it helps you realize just how much parents have to think about to ensure basic safety needs of their kids!
• The Day I Stopped Saying 'Hurry Up' by Rachel Macy Stafford on CreativeChild.com. This is an excellent post about how much we miss by constantly forcing ourselves to be in a rush. One of us (A) is working on living more mindfully -- savoring the moment, rather than a.) rushing through it or b.) missing it by being absorbed by the screen of an iPhone. This is something we both would like to actively work on. What a gift it is to your child when you are able to slow down and see the world through their eyes! 
• Shut 'Er Down by Zac, a financially-minded dad of twins on AsDadSeesIt.com. I enjoy Zac's posts because he offers a different perspective than most mommy and daddy bloggers. From calculating costs of baby essentials, to the family's decision to hire an Au Pair (it was cheaper and more convenient than traditional daycare), I like reading his posts. This one is a great overview of his wife's experience in breastfeeding twins -- which included the need to purchase two additional freezers to store it all! She even pumped on the way to and from work in the car. That is true dedication to keeping up supply for a set of twins for 13 months. 

What have others been reading lately? If you are a blogger, please leave me a link in the comments! You never know, one of your posts could end up in a future "Recent Reads" post!

Expanding the blog to Twitter!

Just a quick post to say we are now on Twitter!

Want to follow us? The username is @PrepTheBun

We've also added a widget in the column to the right which provides live updates.

Thanks!

How We Became Obsessed With the DC Eagle Cam

All images in this post are copyright 2016 American Eagle Foundation

Two days ago, we saw an NPR post about a live Eagle cam focused on a nest with two eggs close to hatching. Since then, watching the cams has turned into a slight obsession. 

Step 1: Get to know the proud parents 

If you're going to admire their hard work, it is important to get to know the parents of this operation. Given that they're nesting at the U.S. National Arboretum in Washington D.C., the eagle pair have been named "Mr. President" and "The First Lady." According to the American Eagle Foundation, this same pair successfully reared another eaglet last year.

Mr. President and The First Lady, anxiously watching the first eaglet emerging from its egg.

Step 2: Obsess over every aspect of the egg

We quickly learned what hard work it is to hatch! The first eaglet emerged more than 24 hours after this first "pip" appeared on the shell. As time went on and the parents shifted the eggs around, we anxiously watched to see if any progress was being made. The parents seemed equally obsessed, getting up periodically to stare at that egg. Being born is hard work! The "pip" on the second egg has not appeared yet; the eggs were laid four days apart (February 10th and 14th), so we suspect to start seeing a pip on the second egg in a few days.

First pip sighting!

Step 3: Eagle Cheerleading

Any progress observed in the nest is cause for enthusiastic celebration. Eagle Cheerleading includes messaging everyone you know and getting them on board with watching the cam so that you have multiple people to discuss every aspect of progress and eagle life. Slowly, the cheerleading process morphs into you becoming a novice eagle expert. Every message begins with "Check the cam." or "CAM A, TURN ON CAM A NOW!"

One of our many text messages conversations devoted to Mr. President and The First Lady's brood. 

Step 4: HATCHING IS IMMINENT -- RED ALERT!

Who cares what else is happening when it appears the eaglet will be emerging from the shell. As this process goes on, it will stall and all facets of fear and doubt will cycle through your head. Progress slows and you worry. Has something happened to the eaglet? Is it just tired? Taking a break? Why does it seem like there is no progress on the egg since The First Lady last shifted and the egg was visible? Has something happened to the eaglet? DO NOT DIE ON ME EAGLET! Oh, whew. It's moving again. Definitely alive.

The business of being hatched is hard work.

Step 5: Begin personifying/over-identifying with the eagles

After staring at every movement of these eagles for a time, you begin wondering about their emotional experience throughout all of this. When they get up to re-adjust and take a moment to glimpse at their eggs, you begin seeing human-like emotions: stress, concern, wonder, curiosity. Who knows if that is what the eagles are actually experiencing -- you just start to believe they actually are feeling what you would feel if you were an eagle who spent the last month on a nest.

Wet feathers, a sign that these parents tolerate harsh elements to protect their tiny eaglets. 

Step 6: Realize this process involves a lot of fish

Apparently, fish are the primary dietary staple of nesting eagles. Who knew? Whoever is "off-duty" will occasionally stop by to deliver a fresh catch. At times, there are just 2-3 bloody, half-eaten fish hanging out on the edges of the nest. C likes to make jokes about their Omega 3 intake being stellar. 

Delivery! 

Step 7: Have actual arguments about things occurring in the nest that others do not believe

Two days ago, Mr. President arrived back to the nest with a twig that had several flower buds on it. He appeared to "present" the twig to The First Lady. One of us observed this, but was not fast enough with the "Print Screen" button to capture it; naturally, the non-observer questions the validity of this statement (Note: It definitely happened!!). Proceed to have a 15-minute text conversation about how plausible this possibility would be. Eventually, agree to disagree.

Are you watching the DC Eagle Cams? Have you seen anything noteworthy? Let us know in the comments! We now have several friends and family members watching and we would love to know if you are, too! Click here to watch live.

U.S. National Arboretum © 2016 American Eagle Foundation, EAGLES.ORG © 2016 American Eag

Considering Caffeine Intake TTC

Our typical Saturday morning involves waking up at about 7, then heading to the local Starbucks around 9 to enjoy some coffee and either catch up on work or a good book. This originally became our weekend routine when I was working on finishing my dissertation last Spring (thankfully, that beast is no longer part of our Saturday routine -- that was stressful to finish!). 

A few friends have mentioned in the past that they don't know how we wake up so early on our day off. Although we do "sleep in" a bit in comparison to our typical weekday, rising at 7 rather than 5:45, we end up getting out of bed significantly earlier than we used to before we had a routine. This took a little time to adjust. But now we prefer this routine -- it mimics the suggestion that it is easier to get out of bed on weekdays when you keep your sleep schedule roughly the same on the weekends. After making this our routine for several months (and I was no longer burning the midnight oil to finish my dissertation) we found it was so much easier to wake up on weekdays. Although we love our sleep, it is much better to get up earlier and enjoy a few more hours of daylight on the weekends. 

It is such a nice thing to look forward to now on our weekends. We plan out what we would like to do --  I recently joined a womens book club, so this is an excellent opportunity to get caught up on the next book I need to read. My husband enjoys catching up on his newest comic book or a podcast. 

One thing I realized was the suggestion to cut down (or completely cut out) caffeine while trying to conceive -- does that mean I have to now opt for herbal tea on our Saturday mornings? Many of the other adjustments, like cutting out alcohol (I don't drink at all, so that was no problem!) or lunch meat (I consume very little lunch meat typically) was easy. Not wanting to completely cut out my morning cup of coffee until we have officially confirmed pregnancy, I explored what this meant for my morning caffeine intake.

How much caffeine while TTC?

Several different sources [The Bump] [American Pregnancy] suggested 200 milligrams of caffeine intake to be a safe upper limit of caffeine intake. Others [Livestrong.com] just have very vague "be as conservative as possible" intake guidelines. Previous research suggests any daily intake above 200 milligrams significantly increases the risk of miscarriage.

Comparing Options at Popular Coffee Chains

We created the following charts for both coffee and non-coffee options at popular coffee chains to provide a guide of the safest and riskiest options at each chain. You will notice across all of the chains, even small sizes of regular brewed coffee are over the 200mg limit (with the exception of Tim Hortons). It is also important to remember that darker/robust roasts tend to have slightly lower caffeine content than lighter/blonde roasts.

Have you cut down your caffeine intake while trying to conceive? Are you surprised to see caffeine levels in similar drinks differ significantly between these chains?

Note: These are recommended levels based on previous research on caffeine level use in women trying to conceive. If you have struggled with miscarriage or pregnancy complications in the past, consult with your physician to determine what caffeine level (if any) is safe during the process of trying to conceive. 

Recent Reads

A selection of blog posts I read over the last week.

• Organizing Our Home Office from Young House Love. I've followed Young House Love for some time now and I love how they blend great style with functionality. I am currently considering how to make my desk space more functional -- would love for it to be this gorgeous!
• Co-Sleeping, You Are Not the One from The Random Adventures of Geek Dad. This is a newer parenting blog I recently discovered. Co-sleeping is definitely a hot parenting topic right now and something we haven't made a decision on, yet. Blogger Alex shows how they modified their bedroom setup to accommodate a crib next to the bed.
• Love is a verb. from Coffee + Crumbs. Ashlee, a mom of two, talks about how the addition of a second baby really made co-parenting with her partner more difficult. We have started discussing how the addition of a third member of our family will be different, but know we will have no appreciation of how much that will change our relationship and marriage after a baby (+sleep deprivation, stress). 

A Helpful Form to Prepare For Preconception Genetic Testing

Genetic testing prior to conception can easily identify known genetic risks prior to conception. This is important because many of the inherited diseases which can be fatal in childhood can now be easily avoided, if you know your risks and the options for conception without passing along fatal genes.

Some of these diseases include:

Cystic Fibrosis

Cystic fibrosis is a life-threatening, genetic disease that causes persistent lung infections and progressively limits the ability to breathe. In people with CF, a defective gene causes a thick, buildup of mucus in the lungs, pancreas and other organs. In the lungs, the mucus clogs the airways and traps bacteria leading to infections, extensive lung damage and eventually, respiratory failure. In the pancreas, the mucus prevents the release of digestive enzymes that allow the body to break down food and absorb vital nutrients.

Info from the Cystic Fibrosis Foundation

Tay-Sachs

A baby with Tay-Sachs disease appears healthy at birth, and seems to be developing normally for a few months. Symptoms generally appear by six months of age. While symptoms vary from one child to the next, there is always a slowing down of development. Gradually, Tay-Sachs children lose motor skills and mental functions. Over time, the child becomes blind, deaf, mentally retarded, paralyzed and non responsive to the environment. Tay-Sachs children usually die by age five.

Children with Tay-Sachs disease lack a vital enzyme, hexosaminidase A (Hex-A). Hex-A is needed for the body to break down a fatty waste substance found in brain cells. Without Hex-A, this substance accumulates abnormally and causes progressive damage until the nervous system can no longer sustain life.

Info from National Tay-Sachs & Allied Diseases

Sickle Cell Disease

Sickle cell disease is an inherited blood disorder that affects red blood cells. People with sickle cell disease have red blood cells that contain mostly hemoglobin* S, an abnormal type of hemoglobin. Sometimes these red blood cells become sickle-shaped (crescent shaped) and have difficulty passing through small blood vessels.

When sickle-shaped cells block small blood vessels, less blood can each that part of the body. Tissue that does not receive a normal blood flow eventually becomes damaged. This is what causes the complications of sickle cell disease. There is currently no universal cure for sickle cell disease.

Info from Sickle Cell Disease Association of America

These diseases are inherited if both parents carry the recessive gene associated with that specific disease. As a review from freshman year biology class, here is a refresher on Punnett Squares:

If both parents are carriers, they will show no symptoms of the disease. Each time they naturally conceive a child that baby will have the following risks:

• 25% chance of being "RR," meaning they inherited both dominant copies of the gene from their parents. They will have 0% chance of passing along that trait to their future offspring. 
• 50% chance of being "Rr," meaning they inherited one copy of the recessive trait. While these children will not develop the disease, they will have a 50% chance of passing this trait along to their offspring. 
• 25% chance of being "rr," meaning they inherited the disease. What this means is different for each illness. Some illnesses (e.g., Tay-Sachs, Canavan Disease) are almost always fatal in infancy/toddlerhood. Others (e.g., Cystic Fibrosis) may lead to an overall shortened lifespan, but with proper treatment and management the individual often survives to early adulthood. 

The most important step you can take prior to conception is knowing your risks and possibly requesting testing prior to conception. 

Here is a form I created to help you determine which disease(s) you may be at risk for -- this form should not take the place of medical advice, but should be used as a beginning step in discussing your risk factors with your gynecologist prior to trying to conceive.

Click here to access the form

Best of luck on your journey to conceiving a healthy baby!

Feeling Surreal

A quick update on my health and progress, since I realized I had not updated since our meeting with the reproductive endocrinologist over a month ago. We actually received the bill for that visit today and figured that was the best reminder to update the blog!

Starting the Cabergoline

I have finally started the cabergoline, the medication to lower my serum prolactin level which should in turn shorten my cycles and ensure I am consistently ovulating each cycle. The prescription was a little delayed because the interpreted results of my MRI were not forwarded to the reproductive endocrinologist prior to the appointment. The MRI office had provided me with a DVD of my scans, but without the interpretation attached he could not give me a definitive diagnosis. We received confirmation of the microprolactinoma a few days later, then it took another few days for my doctor's office to get the prescription forwarded to the pharmacy. I went to Target that night to pick up the prescription, but the pharmacist informed me that they do not regularly stock cabergoline and it would have to be specially ordered in. Also, I only needed 4 pills (I take 1/2 pill each dose, with 2 doses/week) for a month's prescription. The bottles come with a minimum of 8 pills, so I had to purchase a 2-month supply. This was a little disappointing just because it means I will always have to purchase a 2-month supply when requesting a refill, unless my dose increases. Currently, I am taking 0.25mg every Monday and Thursday. Any guess how much this cost me? Luckily, I found a coupon through the website GoodRx.com, but even with that coupon I ended up paying over $100 for the two-month supply. For 8 pills! I strongly recommend using that website to search for coupons and compare prices. The website informed me that the cost varied widely by pharmacy, and that the same dose would have cost $367 (!!!!) at Walgreens without the coupon. The good news is that I have not had any negative side effects from the cabergoline.

Feeling Surreal -- Sharing the TTC Journey

Recently, two close friends asked us about when we thought we would try to conceive. Since we have been married 6 1/2 years now, the question comes up fairly regularly. Although we are not sharing information with most people, we decided to disclose the TTC status to two close friends. They both have children and will be an excellent resource for telling before we reveal a pregnancy to the world. I was actually shocked to see how excited they were to find out that we were trying to conceive. It felt exciting and also somewhat relieving to share that we are officially "Trying." We have only had two cycles so far (technically, we're now on cycle 3), but it still feels nice to have support.

The one thing that may be challenging is those two couples had a relatively easy time conceiving. Hopefully, that will also be the case for us now that I have started the cabergoline! But there is still definitely the possibility of having other underlying issues causing infertility. I have been reading two TTC blogs of two women we coincidentally went to high school with and I can't help but feel frustrated, angry, and sad for them each time they share about another failed cycle. One of them is currently prepping for IVF. I had no appreciation of the time, expense, and the toll of the drugs necessary for IVF actually are until I started reading about infertility issues. If we ever needed to go that route, it would take us awhile to save the $10,000-$15,000 necessary for just one cycle! Sending positive vibes that the upcoming IVF cycle will be successful for that couple.

Also, I'm listening to Pandora and the song "Dream" came on. Fits this post well!

I was a little girl alone in my little world who dreamed of a little home for me.

I played pretend between the trees, and fed my house guests bark and leaves, and laughed in my pretty bed of green.

I had a dream

I could fly from the highest swing.

I had a dream.

Long walks in the dark through woods grown behind the park, 

I asked God who I'm supposed to be.

The stars smiled down on me, God answered in silent reverie.
I said a prayer and fell asleep.

Lemon Buckwheat-Vegetable Soup -- Great TTC Recipe!

This installment of the Simple Saturday Project is actually a recipe. I know what you're thinking -- buckwheat?! Before you totally rule this one out, read below the recipe to see why buckwheat is an excellent TTC food for both women and men.

Ingredients:

Olive oil

1 carrot, diced1 celery stalk, diced1 small onion, diced
1/2 teaspoon sea salt6 cups chicken (or vegetable) broth1 small yellow summer squash, diced1/4 cup buckwheat, rinsed and drained2 wide strips of lemon rind (removed with a vegetable peeler)
1/2 lemonFreshly ground black pepper
Optional: Grated parmesan cheese

1. In a large stockpot, heat olive oil over medium heat. Add carrot, celery, onion and salt, cook for 5 minutes.
2. Stir in the broth, yellow squash, barley, and lemon rind strips. Carefully squeeze the 1/2 lemon into the pot, while being careful to keep the seeds from falling in. Bring to a boil. Simmer, uncovered, until the vegetables and barley are tender (about 20 minutes). Discard the lemon rind and season with salt and pepper to taste. Top with parmesan cheese once served into individual bowls, if desired.
3. Enjoy! We both gave this recipe a big thumbs up.

Why Buckwheat?

Packed with B vitamins, it is an ideal food to support fertility and energy levels. It is a good source of thiamin, riboflavin, and folate. It also helps to naturally lower blood sugar. Due to all the amino acids it has, it helps with blood flow and can assist with implantation. It is not only good for TTC, but also a great option for the first few weeks of pregnancy when you should be boosting folate intake to support that growing spinal cord and brain. Since it is also an energy-booster, it is also great to combat that early pregnancy fatigue. 

Diagnosis & The Endocrinologist

On Wednesday, we met with the reproductive endocrinologist for the first time. Our local clinic is one of the Boston IVF clinics (Here's a link to all of their clinic locations across the U.S.). My gynecologist actually dealt with infertility herself and referred me to the same endocrinologist she personally worked with. We are not actually classified as dealing with "infertility," as that requires six months of trying without conceiving to be diagnosed. This actually works to our advantage in this instance for billing purposes, as insurance will cover treatment for hyperprolactinemia but not infertility. I knew this, which is why I wanted a diagnosis and treatment before those magic 6 months passed. 

Prior to our appointment, we had a long list of information to complete online. Known family history of genetic abnormalities, infertility, multiple miscarriages, etc., as well as a laundry list of possible health conditions for both of us. The very good news is that we have no other known health conditions. We've both had blood work in the last three months and received a clean bill of health. Thyroids functioning normally (very good news on both fronts for conceiving) and no signs of chronic health conditions.

Confirmation of Prolactinoma

As my gynecologist had initially suspected, I have a microprolactinoma. Also called a pituitary adenoma, this is a small, benign tumor (mine is 5mm, anything 10mm or below is considered "micro") on the pituitary gland that secretes excess prolactin. The great news is that it is not a macroadenoma, which may have required surgery. I found the above image in a Google search to show how close the pituitary glad is located to the optic chiasm. In the case of a macroadenoma, it can press on the optic chiasm and cause visual disturbances. We are very happy this is not the case! 

We are not sure how long I have had a prolactinoma, as my cycles have always been irregular whenever I was not taking birth control. I may have been born with it, or may have had it since I first started menstruating as a young teenager. 

While this benign tumor is not likely to cause major health issues, the excess prolactin will negatively impact my ability to ovulate every month. Although this does not mean every cycle is anovulatory (a cycle in which the ovaries fail to release an egg), there is a good likelihood that I'm at least not ovulating some of the time. Without treating the prolactinoma, my cycles would remain irregular and it would likely take an extended period of time to successfully conceive. 

Treatment Planning

In treating a prolactinoma, there are two medication options to shrink the tumor and limit its release of excess prolactin. The older medicine is bromocriptine (Parlodel) and would be taken daily. Bromocriptine has a high incidence of adverse side effects (78% of patients) in the variety of nausea, headaches, dizziness and vomiting. Additionally, the research suggests it is at least somewhat less effective than a newer drug available.

The other option, cabergoline (Dostinex), is better tolerated than bromocriptine (68% of women reported adverse effects) and the pill only needs to be taken twice weekly (Source). Collaboratively, we agreed that cabergoline was the drug of choice. The only downside is that cabergoline is more expensive. Although the cost per pill is significantly higher, the overall monthly cost is hardly noticeable -- $20 more per month for cabergoline. I'm willing to pay that difference to have a more effective and better-tolerated medication!

Here's a comparison of how each of these medications treats the excess level of prolactin:

(Source)

A quick glance at this chart shows cabergoline would be expected to quickly drop my serum prolactin level within 4 weeks. Once my prolactin level dropped below 20, we would anticipate it would also be much more likely that I would ovulate every month. 

I will begin my treatment with cabergoline next week and will plan to chronicle my progress here. I will also have a follow-up MRI in 6 months to determine if the cabergoline successfully shrunk the prolactinoma. I really like the endocrinologist we were referred to, and will create a separate post of what else the endocrinologist recommended outside of treating my prolactinoma. 

The MRI Scan Experience

*Not my brain -- borrowed from www.mstrust.org.uk

Yesterday, I had my MRI scan to rule out a pituitary adenoma. I had never experienced an MRI scan before so this was a brand new experience. I thought I would make a post to document what the experience was like. 

When I made the appointment, the MRI office mailed me a packet of paperwork to complete. Due to the strong magnetic field used to create the images, I had to verify that I had no wire implants, mesh, or other metal pieces that would potentially dislodge or otherwise be affected by the strong magnetic field. I do have a metal wire bonded to my bottom teeth (permanent retainer from when I had braces) but called in advance to make sure the bonded wire would not present a problem. I was also instructed to not wear any clothing with metal zippers, buckles or fibers. I opted for a dress (no zipper).

Once I arrived, the tech informed me the scan would be performed both with and without contrast. My doctor who ordered the test told me it was just without contrast so this was a bit of a surprise. I was then situated on the MRI table. My head was placed in a sort of metal bowl. A cage was then placed over my head to immobilize my head for the scan. Two pads were added to either side of my face to hold my head in the same position throughout the scan. While I couldn't move my head, the cage had large holes so I could still see.

The scan took about 90 minutes in total. The first 60 minutes were without contrast. The MRI machine is very loud with buzzing, clanging and chirping sounds and the tech forgot to turn on the music in the room for the first 30 minutes. Without the music, time seemed to drag by while I focused on trying not to move. Then the nurse came in to insert an IV with the contrast solution. After the contrast, I had a bit of vertigo -- try lying completely still while feeling dizzy! Luckily the dizziness subsided fairly quickly.

I was provided with a CD copy of my images to take to the reproductive endocrinologist. I'll update in a few days after my doctor's appointment to share what we learned from the MRI.