Not much, what's new with you?

I cannot figure out how to write this.

I guess I will just do it chronologically.

There was Christina, standing in my living room, looking a little worried and telling me she had news. So I uncharitably guessed that an unmarried friend of ours was pregnant, and she said, No, I am. Which was a major things-you've-given-up-hoping-for-coming-true moment. And, oh, she'd been a little worried about how I would take it, but I was elated. Floated around for about a week with a smile on my face, my faith in the universe restored.

Until I remembered it wasn't over. I still had to somehow make the same happen for myself. Do what I'd been trying to do for years. Number one goal, unmet. Worse, really -- met, and snatched away, twice.

So I saw a new doctor, who scheduled a test, and almost all these tests involve me on my back, legs spread, and a couple strangers poking around in my lady bits. No exception here, where iodine was injected into my womb. The test said: normal.

I saw my cardiologist, who didn't have anything new to say other than to continue to be an annoying prick who I need to fire.

I started sleeping better after my husband, who should be sainted, resolved a snoring issue. Sleep is the great equalizer, no matter what anyone says.

I tried the Paleo diet and juiced vegetables and quit caffeine and started a baby aspirin regimen. I walked a lot. I half-heartedly attended cardio-kickboxing classes. I lost almost 20 pounds. 

I went to a dentist, which I'd been putting off for years. Two cavities, but other than that, nobody said The disease in your mouth has been affecting your fertility. Which I'd kind of hoped for, just so I'd have an answer.

I asked for progesterone. Doctors nowadays often won't say I think you should take this. They say We can try this if you want. So basically your health is in your hands, and this is the biggest lesson of the last three years. I asked for it and started taking it.

I started acupuncture and herbs, which I didn't know if I believed in. The effect I know it did most certainly have was to make me feel relaxed and positive -- I felt like I was doing something good for myself every week, working toward a goal. And as crazy as it sounds, there was the vision I had on my third visit in which I was standing in the sand, holding a male baby.

And what I didn't know at the time was that I was pregnant.

I always test too soon. I tested on Day 20, and nothing showed up in the first few minutes, so I threw it out. I tested on Day 21 and forgot about it for an hour or two, left it on the bathroom counter. I came back to find a faint, faint positive line. Burst into tears, started shaking. Dug through the trash for the Day 20 test. Even fainter positive line. Googled "false positive pregnancy tests" and "evap lines" with inconclusive results. For those wondering, I don't believe in false positives or evap lines. I've been testing for years, and the only positives I've ever gotten, no matter how long the stick sits there, have actually been positive.

 Days 20-26

And by the way, sorry for the fertility lingo if you're reading this and wondering about Day 20 and evap lines and all that. This has been my world for a while.

That was in March. Today is July 1 and I am 19 weeks pregnant with a boy and this whole thing feels very unreal, like I'm watching it happen to someone else. I mean, yes, that's me in the maternity pants, buying all the peanut butter chocolate ice cream while the clerk eyes my belly with an "is it burritos or a baby" expression, but I scarcely believe it.

It's thrilling and frightening and yes, I'm going to be someone's mother, and no, nobody made me prove I could do it first. It's terrifying but such a relief at the same time.

I'm posting this on both my personal blog and the Tired & Stuck blog, but I plan to update with baby-related stuff only on my personal blog. For those ladies out there who've followed along and been through similar struggles, thank you so much for every kind word. I wish the same miracle on you. 

French Wine & Sacred Icons

About a year ago, I was emotionally preparing myself for a childless Mother's Day.

I woke up that Sunday morning and the first thing that happened is I started my period. I wasn't surprised, but the timing stung. It felt like a slap from the Mother of Mother's Day.

John and I went to Mass with my parents. I sat by my mom and thought about how grateful I was to have her as a mother. Of the four of us (my mom, dad, John and me), I was the only one who still had a mom to celebrate Mother's Day with. What a gift and one not to be taken for granted.

The day improved substantially from then on. When they honored all the mothers at Mass, they included "godmothers" for the first time. (When it comes to godchildren, I'm blessed with 5.) Even my dad was excited about this and said, "Christina, that's you!" I stood up with all the other moms as the priest gave us a blessing.

My family went to brunch at our favorite fancy restaurant tucked away in a rural part of Almaden. The cell reception at La Foret is spotty at best. When we returned to civilization, I realized I had missed phone calls and text messages from many of my friends. They wanted to tell me I was a mom, a godmother, a spiritual mother, the kind of mom all women can be to our friends and family.

At the very end of the day, my dear friend Liz showed up at my doorstep with a present wrapped in lavender tissue paper. I knew what it was as soon as she put it in my hand ~ a small white statue of Mary that Liz's mother had given her. Most statues show Our Lady holding Baby Jesus. This one shows her pregnant. Liz and her husband, Dan, had been married 14 years before being blessed with their daughter Eden, who is now 2. If anyone knew Mother's Day stings the hearts of infertiles, it's Liz. Along with the gift, she wrote me a beautiful letter reminding me that while we don't understand it, God does have a plan.

In some weird, hard-to-explain way, I felt I had celebrated my very first Mother's Day that day. My heart was so full. I felt honored and grateful that my brand of motherhood (while not to children, but maybe in the way I love my friends) was valuable and meaningful.

This year was different. I celebrated Mother's Day 24 weeks pregnant.  

Me & John, Mother's Day 2013

(If this news hurts your heart and you want to stop reading, I completely understand.)

We found out we were pregnant on December 18th, one week before Christmas. I still feel like I'm living an alternate version of reality. Not that I mind. I love this new world John and I have found ourselves in. If fertility is your struggle, I wish I could draw you a road map to get you to the place where I am now.

The truth is, I had been doing less than usual in my attempts to conceive. I hadn't been taking my metformin for about six months. I had stopped taking all my supplements and prenatals. I had actually gained 10 pounds.

But toward the end of 2012, it felt like something was about to happen, I just wasn't sure what.

On the first Friday in November, John and I had two priests over for dinner. At the end of our evening, they blessed our home and prayed over us. They knew we were struggling with infertility, and they asked God to fill our lives with life. They did not ask God to give us a baby, and I felt a peace knowing our lives had been filled with life, especially through the joy of spending time with our friends' children and my sister's kids.  

In a chance meeting, two days later, my friend Alison introduced me to a woman named Carol after Mass. Carol and her family were new to the parish. During the course of friendly small talk, Carol asked me if we had any children. I replied, "No, but not by choice."

Carol immediately explained that while on her honeymoon and visiting the St. Francis of Assisi Basilica in Italy, she had touched an icon of the Madonna and Child and had a vision of herself holding her son. This happened in the gift shop, where the wood carving was for sale, so she bought it. And now she wanted me and John to borrow it, bring it into our home and pray with it.

I don't know about you, but when a stranger offers to lend me a priceless, irreplaceable holy object, my answer is immediately, "No, thank you." In case of damage, breakage, or general wear and tear, I have a policy not to borrow anything I can't replace for 150 bucks. So I politely declined.

Three days later, Carol called. She had the icon in her car and she was bringing it to church for me to pick up. Carol had wrapped the wood carving in baby blanket materials. She said to me, "I'm just going to step out and claim your baby from God for you." Then she said, "When you have your baby, I'm going to make you a blanket out of this material."

The icon was beautiful. But I didn't see a vision or even get chills when I touched it, and I really wasn't sure what to make of her bold prayers on my behalf.

I struggled to make sense of what Carol and her icon were supposed to mean to me. I settled on, if nothing else, that I thought meeting her was a reminder from God that He knew the desires of my heart. He had not forgotten about me, and I quietly told Him I wouldn't be mad if the icon didn't miraculously bring a baby into our lives.

The following Sunday, there was the anointing of the sick at Mass. It's a great tradition, and perfect for cute old ladies with their walkers, but I look relatively young and healthy and didn't want to draw attention to my malfunctioning uterus. However, it had been only 10 days since the priests prayed over us and a week since I met Carol. I kind of felt a spiritual push to get over myself. So I went up to the altar, and I was glad I did.

Exactly a week later, I started my period. But the next month, I didn't.

I thought for sure I was going to. I had abdominal cramps for more than a week, which I blamed on the Jillian Michaels-impersonating instructor at the kickboxing class Erin and I were attending somewhat regularly. 

And I would be remiss if I didn't say I was experimenting with eating gluten-free, plus John and I had challenged ourselves to juice once a day in the month of December. (That went out the window once nausea set in.)

But in terms of dietary changes, the most important was obviously switching from California to French wine for the month of December.

John and I love California wine and rarely drink anything else (not that we drink wine all day, but you know what I mean.) The characters on a show we like drink French wine, so when the BevMo coupon arrived in the mail, I thought it would be fun to see if Bordeaux and Burgundies were worth all the fuss. 

Maybe the soil is more fertile in France. I really don't know. As one of our friends pointed out, "the French are very romantic." They are the only people I know, other than the Eskimos, who have a kiss named after them.

Ultrasound at 19 weeks

Anyway, here we are. Twenty-five weeks pregnant with a baby girl expected to arrive sometime late August or early September. I stare at my swollen belly in joyful disbelief, and every night, I pray for those whose hearts ache for a child. Infertility will always be a mystery to me, and so far, I feel the same way about motherhood.

the two faces of crinone

I realized last week (shortly after I ranted about how I had no way of knowing whether I'd ovulated due to the lack of temperature spike) that my temps were at least showing a rise in progesterone, however meager. So I started the crinone gel.

And hooo boy. That stuff isn't messing around.

First side effect I noticed: nausea. Then headaches, cramping, and major fatigue. Then, on my second full day of it, HOLY RAGE MONSTERS.

There's a bit of moodiness involved with the taking of this particular hormone, apparently. I will cry at anything. Anything. It's annoying. It can sneak up all surprise-like, which is extra annoying. It's frustrating because I know how I feel about things, and I don't feel like crying, but my body reacts involuntarily with grief, and then I'm in a puddle on the floor.

Yeah.

Anyway, the moodiness popped up after my last acupuncture appointment, which went well this time. I was so deliciously warm.

And.

Brace yourself for hippie madness.

I did not voluntarily imagine this, but it came into my mind like a vision. It is what it is. Hallucinations of a progesterone-addled mind, perhaps.

I saw a version of myself, nude, standing in the sand with a white-hot sun beating down on me. Icky creatures were crawling around my feet but I felt some sort of calm immunity from them. My hair was wild like it gets when you swim in the ocean and then dries all Medusa-like. I was holding an infant. A boy.

It just is what it is. I take it how I want to, which is as a transmission of hope.

Then I felt a surge of a need for action. A number of issues in my life rose to mind. I sensed I was stagnating on several fronts and needed to begin working much harder to move forward. K says my yang is stuck, and maybe it's stuck in more ways than one. In any case, I was inspired.

K said my pulse was stronger, which is a good sign. She advised me to continue to avoiding carbs, which I mostly failed at over the weekend but have revitalized my efforts this week. And she advised staying hydrated due to certain intestinal side effects of the progesterone.

I'm officially out of "gather vitality" herbs and still taking "jade moon phase 4," or worcestershire sauce as I like to call it.

And, in very good news, my temperatures look much better than they have in several cycles. They are actually above the cover line in the second half of my cycle. This is likely due to the crinone gel, which is why I'm happy to continue taking it, crazy-making though it is.

the perils of temping

Funny story.

My temperatures were looking really stupid. Here's my chart so far this cycle.

I mean, seriously. 97.7 five days in a row? A bit suspicious, even if I was temping at different times (which I was). But then the numbers started going up a bit so I was like, OK, I guess my thermometer's not broken. But then I realized, Hey. It's Day 18 and according to my chart, I haven't ovulated, even though my most fertile days were Day 15 and 16, according to my opk machine. And I'd been waiting to ovulate so I could take the crinone gel.

(Not to mention that I'd been waiting to ovulate so I could put my stud horse out to pasture, if you know what I'm saying. My poor husband is exhausted.)

So I ordered a new thermometer, got it yesterday, tested it against the old one, and my temperature on the new one was a full .6 degrees higher. Which in the world of basal body temperature charting is the difference between ovulating and not ovulating. It's huge. So obviously there is something amiss with the old thermometer.

Lesson learned: Change the batteries in the thermometer every month.

The problem now is I have no idea if/when I ovulated, and I'm uncertain about whether I should just start using the crinone gel. If I haven't ovulated yet, excess progesterone can block the release of the egg. My number this morning was less than helpful: 97.7. Some past charts show delayed ovulation on Day 20, so perhaps I'll wait to see what tomorrow's number is and then start using the gel.

Anyway, yes, I did decide to start using crinone gel after I visited K the acupuncturist last week. She was as kind as ever, but I'm afraid she had zero insight after I showed her my charts and labs. I shouldn't have set my expectations so high -- I mean, at this point I already know what's going on. Or at least, I think I do; my wonky thermometer may have been leading me astray.

Another lesson -- last week's session was much less relaxing because my hands were freezing. Why didn't I just tell her my hands were freezing? I'm dumb. I will tell her next time.

She prescribed another herbal concoction. This one is in liquid form. You mix it with water and it is nasty. It's possible it's not herbs at all, and just worcestershire sauce. Ick. I'm still taking "gather vitality" as well -- 3 pills, 3 times a day.

On my way out I asked K basically if she thought she could fix me. And she said the same thing she told me the first time; we'll nourish the egg and my hormones will respond properly to that strong egg. I officially no longer believe this, but that's ok because I still think herbs and acupuncture are potentially beneficial. She advised me to go ahead and use the crinone gel, so I figured I should.

Meanwhile I'm on Week 3 of Paleo. It's significantly easier than it was mid-week in Week 2, when I was depressed and had begun thinking there is no way this diet is sustainable and I'm going to have to give it up and eat bread again and I'll be fat forever, etc. I was having the worst cravings. This week I feel much better (although the idea of pizza ... is a little heartbreaking). That said, the weight loss has slowed WAY down. I'm sure if I was sticking to it really well, literally eating only meat and vegetables, I'd still see a big difference. But I can't do a no-fruit diet. It's just unreasonable at this point.

What's baffling to me is that I really have cut out all grains and dairy and legumes and this weight loss-stall is still happening. Pretty interesting. I guess I need to really watch my fruit and up the exercise.

tcm

I don't know why it took me this long to try acupuncture. I mean, I've been studying Making Babies as though it were a holy screed for the last two and a half years, and the book clearly says acupuncture and Chinese herbs would be beneficial for me.

Timeliness is not my strong suit, I guess.

Anyway, I decided on Friday to just go ahead and do it. I called the office to make an appointment and they were like: Would you like to come in today? And I was like: Sure.

So I went in and met my acupuncturist, K. She asked a lot of questions about my medical history. She is officially the first person I've sought fertility help from who's asked me how I have dealt with my miscarriages emotionally. Just her caring enough to ask made me a little teary. She confirmed that Paleo is the best diet I can be on right now in order to minimize insulin surges.

I asked for her thoughts on the crinone gel I'd recently been prescribed and she said it can certainly help, but that her take on my condition is that my eggs need to be nourished and built up so they'll be strong. When I produce a strong egg, my body will react in accordance with the proper hormones. I'm not totally sure I agree, but I do agree that I'd like strong, nourished eggs.

For the treatment portion of my visit, she felt my pulse, palpated my stomach, and felt my cold hands and feet, at which point she declared that my yang is stuck. Although she pronounced it "yong." My qi is deficient and needs to get ... efficient. This information totally jibes with what Making Babies has told me.

She popped some needles in my forehead, lower abdomen, legs, and feet. Then she did this moxibustion thing I'd never heard of, where they heat some kind of dried Chinese plant and touch it to the needles. I think the theory is that it stimulates circulation. She placed a heat lamp over my belly and a heating pad at my feet. I was instructed to let my heart grow with unconditional love and send that love down my right arm, into my hand (which was resting on my lower stomach), and into my ovaries. I began to picture my ovaries as purple mirror balls. It was involuntary, what can I say.

I was left to relax for ... I don't know. Half an hour? I laid there and listened to the hippie music and got nice and deliciously toasty, and once I got bored of sending love to my glittering ovaries, I let my mind wander wherever it wanted to. I didn't fall asleep -- I'm simply not that chill of a person. Perhaps on a future visit I'll be able to relax that deeply.

When the session was over, K asked if I'm familiar with basal body temperature charting. Um. YES. She wants to see my charts. She is the first person I've sought fertility help from who's expressed the slightest interest in my charts. My personal belief on this subject is that most doctors have no clue what the temperatures mean.

K also wants to see my most recent blood work, so I got that for her as well. She prescribed some herbs and gave me a moxibustion stick to light and hold over my stomach. I told her I will try anything. Why not?

When I got home, there was an email waiting for me with my treatment plan inside. I'm to go for weekly sessions for one full cycle, and then reevaluate. She also strongly suggested I buy a certain book ... you guessed it! Making Babies! I believe I've stumbled upon the holy grail of acupuncture practices.

Because I had such a positive experience, I'm seriously considering not taking the crinone gel when I ovulate this cycle. Is that insane? I just kind of want to see how my body responds to acupuncture first ... maybe give it a couple cycles. We'll see how I feel after the next session on Friday.

To top it all off, I got a card in the mail today from K, just welcoming me to the practice and wishing me a happy weekend. Which is way more than I can say for the multitude of doctors I've seen and paid wayyyy more money to. Now, if it works? I'll be completely sold.

a new drug

So I asked my doctor for progesterone and ... she prescribed it! Wonders will never cease when it comes to Dr. C. Why in the world I couldn't get a fertility specialist to test me for progesterone, I will never understand. Oh wait, I do: it's all about the money.

I'll be taking crinone gel. Please tell me you've heard wonderful things about this stuff and any tips/tricks you know when it comes to using it.

Meanwhile the battle of the bulge continues and I've embarked on the Paleo Diet. I know -- so obnoxious. It's one of the most restrictive diets I've been on, since it doesn't allow most dairy, legumes, or any grains. But after a lot of reading, I believe there is actually a significant amount of scientific evidence that backs up this way of eating.

And, there's also a butt-ton of evidence that the American government can't be trusted when it comes to what we should eat. Their food recommendations are always going to be tainted by the whispers of food lobbyists, who need us to keep eating corn syrup and getting cancer so they can make a lot of money.

Aside from all that, I'm just trying to relax. As the infertiles are constantly commanded to do. I should probably stop reading blogs, in that case. Today I read a blog written by an apparently fertile woman who was telling the quaint and adorable story of how she found out she was pregnant. This happens frequently. I read a blogger when she's single. Then I read about her wedding plans. And then I know it's coming ... she gets pregnant. Life keeps chugging along for some and stalls for others.

And then I read another blog by an infertile who finally had a kid after three IVFs, and her message of the day was basically: Don't sit on your hands. Make this happen for yourself. It's not how you imagined it was going to be, but you're going to have to accept that and start getting pushy with your doctors if you want this to happen.

It really rang true with me, since I do feel like I've sat on my hands quite a bit, waiting for a miracle. Thankfully, I started facing reality after the last miscarriage. Hence the battery of tests, and now the progesterone. I really only plan to give progesterone one or two cycles before I move on to something with a little more oomph. Time only moves forward and it's time to un-stall this process.

some thoughts about the luteal phase

... or as it is known by those in the know: The Two Week Wait.

- Is it just me, or are you always starving during the 2WW, too? I find dieting so much easier during the first two weeks of my cycles. But as soon as I ovulate, it's like I need all the food, NOW.

- my temperatures are still really low, with no thermal shift. This would seem to indicate my body is not responding to the increase in progesterone. As I mentioned a couple weeks ago, my progesterone numbers are considered normal. Perhaps on the low end of normal, but normal enough to indicate I am ovulating. Should I just ask for progesterone?

- I asked Dr. Google how I could naturally bump up my BBT numbers, thereby hopefully increasing progesterone, and wow. Talk about mixed messages. Never trust Dr. Google.

- For example, there's one dude who says you should eat more sugar, and eat lots of whole foods, to the point that you are overeating, and you shouldn't exercise. I'm like: Hey. I am a living example of why that particular "method" doesn't work. Also, it's a little scary when people who aren't doctors dispense medical advice on the internet.

- The rest of the internet thinks I have a thyroid problem. Multiple tests have shown that, clinically, I do not.

- Plenty of internet geniuses think I should cut out gluten. I don't even know, you guys.

- Making Babies is not helping me the way I want to be helped right now. It alludes to a possible luteal phase defect. And the book and my doctor seem to disagree about what adequate levels of progesterone are ... I'm leaning toward simply asking for the progesterone supplement once this cycle is over.

- Mostly I just want to stop thinking about this forever.

Ow, and ick

Well, good news. My uterus is normal. No polyps or fibroids or whatever. My right ovary has a promising looking follicular cyst that should pop out a nice little egg later this cycle, so I need you to send your most fertile vibes to my vagina, please. Thanks!

The procedure -- the sonohysterogram -- was ok. Mine was performed by a doctor who, if I had to guess, is about 150 years old. Imagine all the vaginas that dude has seen in his lifetime. Anyway, he shoves in the speculum and realizes my cervix is too high (I'm really beginning to wonder if my high cervix/tilted uterus is what's really behind my fertility issues, although I don't suppose that would explain the miscarriages). So his little helper nurse runs off to find a longer one. Oh, joy.

The longer one works fine. I feel some discomfort akin to menstrual cramps, in addition to the mental discomfort of two people staring at my vagina under fluorescent lights. He swabs my cervix with iodine, puts a catheter through it, and then helper nurse pumps saline solution into my uterus while he does a vaginal ultrasound. If there is any sort of prize for most use of the word vagina in a blog post, this one might win it.

So yeah. Kind of a relief, but still kind of a mystery. I'm gonna give this cycle a shot before I run off for karyotype (chromosome) testing and subject my husband to another sperm analysis. I'm just wondering if all this infertility crap is my dumb, shitty luck. It just would not surprise me.

Meanwhile I'm continuing to have my heart checked out and went this morning for my holter monitor, which is strangely more painful than an old man digging around in my vagina. That's because for the monitor they've got to scratch the points of contact on your chest and other areas on the torso. It really burns for like half an hour. After that it's just annoying because you feel like a robot. Going to the bathroom is especially fun.

My echocardiogram is Saturday, and that's just an ultrasound of the heart. I fully expect these results to come back "normal," as in normal for me, slightly abnormal for others. I just want the doctor to say I should be fine to carry a pregnancy, which I expect he will. Not that I really care what he says; I'm still trying regardless, at least for the moment.

de blood

Well, it's been a couple weeks and a few doctor's visits, so here's my update:

Nothing.

My blood was tested for everything under the sun, and they came back with everything looking perfectly normal. Even progesterone (although on the low end of normal). While being good news, I was extremely disappointed. I wanted her to say, Oh! Your progesterone sucks. Here's a pill! All better now.

No such luck.

Next moves are:

- karyotype testing. This tells you if your chromosomes are jacked.
- another semen analysis.
- sonohysterogram. They inject saline into your lady parts and do an ultrasound. Sounds joyous.

Meanwhile I'm simultaneously having my heart re-checked and will also be having to wear a holter monitor for 24 hours (if you've never done this it is one of the most annoying things on the planet) and undergo an echocardiogram (an ultrasound of the heart) to establish that my heart is healthy enough for me to get pregnant in the first place. It is. We're just double checking.

If all that other shit comes back normal, and I have a sneaking feeling that it will ... the next move is probably something like Clomid and/or IUI. Ah, and I really need to try acupuncture. Been meaning to but just haven't gotten around to it yet.

I'm reaaallly hoping I can make something happen before that, but we'll see. I'm still taking my new "job" of losing weight seriously and have embarked on another juice cleanse -- I got pregnant shortly after I did this the first time. I do think weight loss will be the key for me, so I'm really not messing around right now. It's not easy, never has been and never will be. But it's so important, I can't ignore it anymore.

new job

I've given myself a new full-time job.

All I have to do all day, every day, is work toward losing weight. If nothing else happens, whatever. I just need this weight gone.

It's easy enough to "forget" or simply push aside all of the evidence out there that points toward weight being a major impediment to not only getting pregnant, but maintaining pregnancy, and producing a healthy child. I've been re-reading Origins in an effort to psyche myself up for pregnancy since I'm hell bent on making it happen ASAP. Early on in the book, what do you think the author mentions?

Weight. Specifically that kids born to pregnant women with weight issues have a higher incidence of birth defects, and then to add insult to injury, they also often inherit their moms' weight problems. In a study of women who had one kid, then weight loss surgery, then another kid, the second kid was shown not to have inherited their mothers' weight issues. Insane stuff.

I've read it so many times and listened to a heartfelt 20-minute lecture from a fertility specialist about it. And as a result, I've lost 15 pounds. But I need to do that, oh, at least a couple more times.

It's amazing that even with such a massive motivation, I haven't been able to shed all the weight yet. I'm not punishing myself for it, but simply marveling at it. Losing weight is extremely difficult. Everything in my body wants to stay at the weight it is now. Working against that and various other roadblocks (holidays, family meals, eating out with friends, PMS, cravings) is a full-time job that requires vigilance.