Thursday, November 28, 2013

18 Months!

*This post was originally written for HelloBee and includes ALL updates from 16-18 months. I just didn't have the energy to write up another one.**


Weight & Length:
At his 18 month appointment, the buddy weighed 19 lbs & 13.5oz and was 31 in. tall. Our little guy is rockin' out the 4th percentile in weight and 10th percentile in length.

Clothing: I feel like this is all across the board. There are still a handful of items that he can fit into that's 9-month size! Granted, it's just a few things and the pants are too short on him, but they technically fit. Mostly he wears size 12-18 months. But, interestingly enough the only footie pajamas that fit him are size 18 months! So, he fits into quite a span of clothes. :) He now has a size 5 shoe and I think he will be moving up to 6 before we know it.

I would say that the time between 15 and 18 months has been the most stressful sleep-wise, as we've been attempting to transition from 2 naps to 1. We were forced to start the transition because he started coming with me to Mother's Day Out (although in my case it's "Mother's day at work") when he was 15 months old. He started taking just one nap at Mother's Day Out two days a week, but still took 2 naps on the days we were home. And since then it has been a struggle to figure out how to transition a child that is just not ready for one nap. This has involved a lot of middle of the night wakings, which is just exhausting and frustrating for everyone. He's been on just one nap for over a week now, but even now we're having some night wakings and I'm very ready get past this phase. Whew!

Eating: The buddy has recently become the picky toddler we were dreading. He still eats a wide range of foods, but one day he will eat half an avocado for dinner and later in the week he will refuse them. He still loves all kinds of meat, sweet potato and cheese, and has recently become a big fan of kale (cooked in coconut oil) and whole milk yogurt. But, who knows? Maybe tomorrow he will turn them both down.

Personality: He also has such an amazing personality. We feel so blessed to be his parents! He loves to make us laugh and has started throwing his head back and giggling, which is so cute! He has his moments of whining and being cranky, but for the most part he is spunky and silly. He loves dancing and singing and pretending.

Milestones & Firsts:
-When asked who Jesus loves, he says, "me, me, me"
-Can successfully feed himself cottage cheese, yogurt, applesauce and oatmeal from a spoon
-Got ALL his teeth except for his 2-year molars
-Can point to his eyes, ears, mouth, head, hair, toes, feet, hands, fingers and belly when we say the words
-When we start counting "one," he responds with "two"
-Really started talking up a storm and uses polite words like please and thank you when he asks for something -He started scribbling with a pencil or crayons.
-We took him trick-or-treating for the first time.
-He picks out and asks for his favorite books. Currently his favorite is, "The Pop-Up Mice of Mr. Brice." He asks for "mice" each night at bedtime.

New words: teetee=tickle, go, na-na=banana, baby, yuck, beep beep, meez=please (more,please), apoo=apple, bubbo=bubble, tay too= thank you, book, da dahn=all done, go, a-side=outside, milk, nak=snack, cahker=cracker, dis=this, wook=look, no tay-too=no thank you, rock, bowl, poo=spoon, buc=cup, hoc=hot, hac=hat, bus, truck, shup=chop, home, mice, nice, mo-meel=oatmeal, two, soup, wach=watch, wuvey=lovey

Monday, November 25, 2013

Understanding a Semen Analysis

In the infertility world, it seems that there is less attention paid to male infertility than female issues. Because our diagnosis was male infertility, we have seen this first-hand. It doesn't help that there are A LOT of differing opinions everywhere you go!

We have seen two different Reproductive Endocrinologists (REs), three different acupuncturists (two specializing in fertility issues) and three different urologists. Ugh! Not ONE of them has given us the same answer or treatment protocol for Mr. Piñata's issues. That's a whole lot of information and it can be very confusing to sort through. One urologist said we would need IVF with ICSI and another said that Mr. P's semen analyses looked like that of a "healthy, fertile male" to him (which we know is not true). That is on the opposite ends of the spectrum!

 All that to say, we've done a lot of research on our own. It turns out part of the issue is that there are different guidelines for "normal" sperm parameters. Add to that the fact that the term "normal" isn't very clear either makes it all very confusing to figure out on your own, or even with the help of a doctor. We thought "normal" parameters might mean "average," or at the very least that getting pregnant would be easy. But, as it turns out, neither of those things are true. I have looked up numbers and guidelines on all kinds of fertility clinic websites, blogs and even talked to one of the leading urologists in male infertility. What finally made all the numbers make sense was reading an article from the Oxford Journals. There was a lot of jargon and statistics that made it difficult to read easily, but after reading this article and the charts within it, I think I finally have a clearer picture of what a "normal" semen analysis means and what it should look like.

 Here are few take-aways from the article for me.

1. First of all, in 2009 the WHO (World Health Organization) did a clinical study that changed the sperm parameters to a new "normal." So, when you just google what sperm parameters should be, you can get all kinds of different answers from all different people from all different years. It makes the most sense to stick to what WHO considers the normal reference values from 2009 and not the older guidelines, or what you find on a Wikipedia article.

2. When they establish "normal" this does NOT mean average!

For me, this was the most important piece of information to understand. For the first year or so of our fertility journey, I thought that if Mr. Piñata's semen analysis could get to the normal range that this would mean it would be pretty easy to get pregnant, right? WRONG!

Actually, when they defined normal they took the semen analysis from 4,500 men from over 14 countries. The analysis numbers from those who were able to get their partners pregnant in one year or less were the ones that were used for the basis of "normal." So, not just men that got their wives pregnant within the first few months were included, but also those for whom it took a whole year! This was good information for me to learn.

Not only that, but they put these numbers into percentiles (just like those standardized tests we had to take growing up). When they gathered all the information on the sperm numbers, they consider everything normal that is above the 5th percentile. That's right! The 5th percentile (where you wouldn't want to be on a standardized test either)!

Let's say we're talking about total sperm count. It's in the "normal" range if a man has at least 39 total million sperm. However, 95% of fertile men have MORE sperm than that because that's the number from the 5th percentile! If you want to know what the average sperm count would be, you would want to look at the 50th percentile and see that  the average number of sperm in a sample is actually closer to 255 million! (255 million is actually the median number, which means that half of men have sperm counts higher than 255 million and half have sperm counts lower than 255 million.) Which is quite a lot more than the minimum required to be considered normal.

The same is true across the board for all parameters including motility, morphology, total volume, etc. This was both encouraging and discouraging at the same time. It was a reminder that just because someone has a "normal" semen analysis doesn't meant it will necessarily be easy to get pregnant. There may be nothing wrong in the sense that all the numbers are in the normal range, but it can also take longer than you'd like getting pregnant. So, if a couple is having a difficult time conceiving and all the sperm parameters are considered normal, but on the lower end, it definitely makes sense that it might take a littler longer. And maybe the not-too invasive procedure of IUI would be a good option for helping it happen quicker by bypassing the uterus. It was also encouraging for me  because the chart even shows the numbers in the 2.5th percentile as well. Those numbers may be even lower than normal, but those men did achieve pregnancy with their partners, so getting pregnant with a not-so-ideal semen analysis is definitely possible, just not easy.

3. There are two different measures of morphology. When they look at how sperm are shaped and if they're shaped correctly for good implantation into an egg, it's called morphology. But, there are two different scales for looking at it and it's good to know which method your laboratory uses. Most fertility clinics use the Kruger method, while there are some places that use the WHO method. The WHO method is a lot more general and it's more common to find "normal" numbers in the 30% range. However, using the Kruger method, they are much stricter on what qualifies as a "normally formed" sperm. The charts below in #4 are using the Kruger method even though these numbers come from WHO. You can tell that it's a lot stricter because it's considered normal if just 4% of the sperm are shaped correctly!

4. The actual numbers

Here is a chart taken from the article that shows the percentiles of each semen analysis parameter. This chart was SO helpful for me in understanding what normal vs. average actually looks like in numbers.

But, here is my simplified version for you if you're interested. It shows the difference between normal (5th percentile) and median (50th percentile).

 Whew! I know that's a lot of information. Thankfully, most of the population doesn't need these details and is able to achieve a pregnancy without ever needing to get a semen analysis done. However, there are those of us that have had far too many tests, lab work, ultrasounds, etc. and can get overwhelmed by the jargon that the doctors and nurses use, and just want to understand what is normal and where they fall in comparison to that.

Unfortunately for us, Dave falls below even the 2.5th percentile in the morphology department, so that's our constant fertility struggle. The good news is that even if your numbers fall outside normal, by seeing a Reproductive Endocrinologist there are procedures that can be done (like IUI and IVF) and even drugs and supplements that can help with sperm quality. We have yet to achieve a pregnancy, but also haven't gone too far down the fertility treatment route either. Finances play a big role in our hesitation to move forward with the likely needed IVF. Hopefully one day I will be able to get pregnant, but even if I don't, I hope all the research I have done can help someone else struggling with male fertility issues.

My biggest advice is to not delay seeing a specialist if you suspect you or your partner may have a problem. Knowledge is power and you and your doctor won't know which treatment route to take if you don't get tested and begin the process. Lots of luck to all of you on the roller coaster of infertility!

*The information on this site is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment, and is for education purposes only.  Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition.

Saturday, November 23, 2013

Faith & Fertility

**So sorry for the weird repetitions in the first version of this post. I don't know how that happened!*

This post has been brewing in my head for awhile now. In the past few months I've been wrestling with my faith and what that means for our fertility. I'm kind of a "black and white" thinker and have a hard time letting in the "gray." I want to be able to have an answer for everything and, well, infertility kind of prevents that.

I've been struggling with a few trains of thought/faith. I've wondered if I should believe that we WILL conceive and that it's just up to God when the timing is. I've wondered if it's my lack of faith that has kept us from conceiving. I have also wondered if it's "my fault" that I haven't been able to get pregnant because if I had just trusted God more it would have happened.

Slowly but surely God has spoken to me that none of that is true.

Whew! What a relief!

In the midst of wondering if my faltering faith was our true "problem" God spoke to me at our church's All Saint's Evensong Service (planned by my wonderfully talented husband!). The Gospel reading was from John 11, the story of Lazarus's rising from the dead. But, what struck me was the very beginning of the passage. When Jesus was told that his friend Lazarus was sick he responded by saying, "“This sickness will not end in death. No, it is for God’s glory so that God’s Son may be glorified through it." -John 11:4

First of all, Jesus knows that Lazarus will die. Even though he says that "this sickness will not end in death." Of course Jesus also knows that HE will raise Lazarus from the dead and that THAT is the true ending of the story. What a miracle!

But really, the part that stuck out to me in the midst of me crying out to God for an answer and wondering WHY we are going through infertility was "it is for God's glory so that God's Son may be glorified through it." There's my answer. God has allowed us to go through infertility and the suffering along with it so that Christ may be glorified. And you know what? THAT is the best reason.

However, that doesn't mean that I know exactly HOW God will be glorified through our infertility. So, I'm praying every day that God will reveal that to me and that He will show me how I (and we) can best glorify Him through this circumstance. Could it be that He will be most glorified through a miraculous conception? Maybe. Could it be that He will be most glorified through another miraculous adoption story? Maybe. Could it be that He will be most glorified if, despite a very discouraging diagnosis and journey, we continue to praise God for his goodness and faithfulness to us, trusting that He alone will be our ultimate source of contentment and joy? Yes, definitely!

So, that's where I sit right now. Asking God for me to glorify Him through my attitude and focus on Him. Do I falter? Yes. Do I still have questions? Yes. Can our infertility journey still be confusing and frustrating? YES! But, I know that God has brought us through this in order for us to glorify Him and so I must trust each day that He will do what brings HIM the most glory, NOT what makes us most happy. The truth is that if we're trusting that God will do something for us and waiting for that thing (which for us would be another child) then we're missing the point. The point of prayer is not just for God to give us what we want. The point is for us to be closer to Him.

Over 2 years ago I did a great Bible Study by Beth Moore called, "Believing God." It was about trusting and believing God to do great things and it was a great study! But, now 2 years later I have been thinking about one of her key points throughout the study. She would say that if we ask for something from God in faith He WILL give it to us, unless he has something better planned. I've been pondering and praying about this thought too.

But, here's the thing. Our sanctification and a closer walk with God is ALWAYS BETTER than whatever we can ask for! Even if that "thing" we're asking for is something so good and even blessed like having children! Even having, loving and raising children is not as good as the process of becoming more holy and content in just Christ. That's hard for me to say, because it may mean the loss of dreams for us. 

Plus, the process of sanctification is not easy and involves suffering. Just Sunday my convictions were confirmed by our pastor who taught from Luke 21. The visual he gave was so powerful as he reminded us that Jesus encourages us to "lean into the suffering" and not avoid it because "b
y your endurance you will gain your souls." (Luke 21:19) Oye. Sanctification is no easy business and always comes when you just would rather life go as you planned. But oh,"tis so sweet to trust in Jesus."

"Yes, ’tis sweet to trust in Jesus,
Just from sin and self to cease;
Just from Jesus simply taking
Life and rest, and joy and peace."

Thursday, November 14, 2013

Why Do We Continue On?

**I'll start this post out by saying that I'm really not "down in the dumps" about our fertility. It's a discouraging process, but mostly (I think) because we're trying to get to the root of what's going on with Dave's health. If our family is only built through adoption there will be the loss of biological children that we will face, but we will be truly blessed. Honestly, if the buddy ends up being our only child we are truly blessed. But, we're on this journey and don't feel the peace to leave just yet, so below is what all is going on in my head and heart. (And I have a post brewing in my mind about our faith and how that currently ties together with our journey, but it's just not written yet).**

It's easy to get discouraged when you're dealing with infertility. For us it's frustrating that despite our visits to so many different practitioners and specialists who all seem to think they have an answer and solution, the problem never seems to be fixed. :/ We're kind of health-nuts around here who believe that how you eat and take care of your body directly affect your health. So, we often hear the message that if we were doing the "right things" and eating the "right things" that we would be healthy. And I would include reproductive health in that. Yet, it just hasn't worked out for us that way.

The further confusing part is this, "Why is it that we strive to be so healthy yet can't conceive while others that are not healthy at all conceive easily or even on accident?" Sigh. I feel like if we had an answer to WHY Dave's morphology is so bad it might be easier to at least understand, even if we had a hard time accepting it. As in, they could link it to a childhood illness, or if I was missing fallopian tubes due to an accident earlier in life. But, despite all the "issues" that various practitioners have found there has yet to be a solution that worked. I feel like when I try to do online research (I know, I know) that all I find are stories of people that transformed their health, started eating better, practiced a healthier lifestyle, or went to acupuncture for a few months and bam! they got pregnant. It's hard to read those stories and not think, "why didn't that happen to us?"

The truth is that we may just need to accept that life doesn't always make sense and we're not as in control of our lives as we like to think. I once visited a natural practitioner that told me that we are 100% in control of our health. But, I beg to differ. So far Dave and I have seen 3 acupuncturists (2 specializing in fertility), 2 different naturopath/nutritionists, 2 different REs and done some significant detoxification (yes, we have both done colonics). We even did a heavy detoxifying diet 2 years ago where we lost weight but didn't get pregnant. And I don't even want to get into the supplements we took! If it has ever been known to help with sperm quality, Dave took it! I mean, we probably spent over $1,000 on supplements alone.

You probably read that and think "they should probably read the writing on the wall and either move on to IVF or adopt again and just let go of biological children." And I wish we could do that. I wish we felt like that was the direction to move in. I WANT to move on. I don't want to keep trying this, that, or the other thing. But, for some reason I press on. Is it foolish? Maybe. Is it expensive? Yes. There's something about HOW CLOSE Dave's semen analysis came to normal back in August that keeps us from moving on. All along the way EVERY person we have seen has indicated that we have a good chance of pregnancy (especially if we do IVF while I'm still young), so it's hard to let go when there's a chance we could eventually get pregnant. A good chance? I guess not. But, there's a chance. None of our parts are missing and tests from 2 years ago indicate that I have good eggs left (although I'm terrified that this may not be the case for long). 

So, I feel like this post is horribly similar to my last post, but I guess it goes into WHY we continue even though we haven't conceived yet or gotten wonderful news on improvement. We don't feel like we will continue forever until I get pregnant, but it doesn't feel yet like it's time to stop trying. We definitely want to adopt again so I wonder when the time will come to renew our home study? OR when it's time to try IVF or just give up trying for biological children for good? But, we just don't feel at peace with any of those choices right now. So for now we continue on. With many blessings and contentment with where we are at the present moment, but a desire to continue on our journey of adding to our family and an openness to where God leads. It would be nice if this process were a whole lot easier, but also "easy" doesn't mean "better" so we continue to pray for God's best for us as trying as it can be.

And on a silly note, I will say that after 3 years we have officially arrived at the point that "intimacy" leading to a baby seems like something out of a science fiction movie. And absolutely CRAZY that that's how most of the world builds their family! Hilarious! (And yes, I do realize that's how most of my readers have had children, but still, it's seems impossible and crazy that that's how it happens. About as crazy to me as unicorns and leprechauns.)

Tuesday, November 12, 2013

And we continue on...

So, just in case you were wondering how our visit with our RE went....

He wanted to have Dave try another drug to lower his prolactin as that hormone was high in addition to the DHEA (what the low-dose steroid was supposed to be working on).

We also got his blood taken again. And actually, his hormones are doing WAY better! All in the normal range! This is good, but also kind of bad I suppose. It's good that his hormones are more normal, but not so good that this didn't cause his sperm analysis to improve. :/ Our hope here is that maybe with more time they sperm quality would improve?

Also, this made us think that with numbers in the normal range that we wouldn't have to worry about Dave taking this new drug, but the RE wants to get the prolactin number even LOWER hopefully pushing that testosterone number even HIGHER. Aargh. So, Dave is on a new drug and it's horrible. He has to take it with a meal, so he takes it with dinner since it makes him dizzy, woozy, drowsy and even kind of stuffed up until about 9am the next day. Blech. So, he's been going to bed pretty early which is a bummer since we don't have much time to hang out.

Dave will stay on this drug for 3 more weeks, then in 5 weeks will get his blood hormone levels tested again and we'll see where they are. But, again, then it would take 3 more months for sperm quality to improve. I know in the scheme of life 4 more months isn't that long, BUT we're not really hopefully that his numbers will get better. We've tried so many things in the past 2.5 years to improve his fertility and nothing so far has worked. :/ We have definitely not given up hope, but we're not counting on improvement either.

Honestly, I think this drug is moving us in the wrong direction, but Dave wants to try it so he can know he's tried it all and not look back with any regrets. I would like him to try visiting a local chiropractor who also does applied kinesiology with supplements. Just so say we've crossed everything off the list. I think the biggest thing that bothers me about the particular RE we're seeing (and really most of them I'm sure) is that when we asked if maybe Dave could have a nutrient missing from his diet and if that could cause the issue he said definitely not. But, we really believe that the food and nutrients we put in our bodies play a very key role in our hormones, health, energy level, etc. So, we know we're not really on the same page as this doctor if he discounts that entire sphere of health. :/

So, onward we continue. We are praying about if/when we should renew our home study to adopt again, but also if we should pursue more intense fertility treatments (such as IVF) since my eggs are only getting older. :/ If money weren't an object we may pursue both at the same time! But, money is definitely an issue and so is our health insurance situation, so we're not stepping forward in either of these areas yet. We'll be praying for guidance as we begin to need to make decisions. 

Wednesday, November 6, 2013

17 Months

Ok, so this post is pretty much a month late. Aargh! The good news is that I was very excited that I got the picture taken on the exact right day! Yay! And then proceeded to not have time to write this post until tonight. It's been an exhausting month. 

Weight & Length: No idea on this one. We'll just have to wait and see where he is at his 18 month appointment. He's definitely getting taller, but I'm not so sure about the heavier. He runs off all the calories He eats!
Visiting a local farm/pumpkin patch!

He was a pretty good sleeper in the last month. Although with starting the "Mother's Day Out" program he has had almost a constant runny nose or cough, so there were some rough nights where he had a hard time breathing. :( But, I would say mostly slept through the night and half of his days he had one nap and half of his days he had two. 

Ha! I don't know what he's so suspicious of here. :)

 The past month he started verbalizing what he wanted and didn't want to eat. This is overall good I'd say, but frustrating when he would say "no." He tried crackers for the first time and became obsessed! He also started loving avocados which he didn't always like. The big accomplishment is being able to eat thicker food with a spoon! There also is no more nighttime bottle or milk. 

Clothing: Clothing sizes are so different across brands. He wears some size 9 month things (like a handful), but only fits in 18-month onesies. He's mostly in 12 month sizes.

Playing at the train table at the library

 As he gets more words and can communicate more he's getting more and more of a fun personality! He had a ROUGH few weeks at MDO, which was so hard for us. But, he finally started getting comfortable again and his teacher tells us he has such a sweet and fun personality there. Whew! This also makes behavior more interesting as he tells us more of what he does and doesn't want to do. I'm glad for the communication and him being able to assert himself. But, there's definitely a small part of me that wants him to be super compliant just to make life easier on me (how selfish!). :-)

Milestones & Firsts:
This was at the farm. He LOVED this!
-When asked who Jesus loves he says, "me, me, me"
-Really uses "no" when he doesn't want something (especially food!)
-Can successfully feed himself cottage cheese, applesauce and oatmeal from a spoon
-Got ALL his teeth except for his 2-year molars
-Understand when we ask him to sit down and obeys! (most of the time)
-Did his first finger painting
-Can point to his eyes, ears, mouth, head, hair, toes and belly when we say the words
-When we go to the park and I say, "1, 2, 3 GO!" he lets go and goes down the slide

New words: 
mo pease = More, please
apoo = apple
bubbo = bubble
tay-too= thank you
da dahn= all done
melk= milk
nak= snack (a fruit or fruit/veggie pouch)
cahker= cracker
dis = this (or more like, I WANT THAT!)
wook = look
no tay-too= no thank you

Sunday, November 3, 2013

ALDI & The Whole30

Do you have an ALDI in your area? We do, but I haven't shopped there much over the years because it's in a pretty inconvenient location to where we live. And in the past their produce was really awful. However, as we've tried to cut costs since I work part-time I've re-discovered it and LOVE it! There is a lot of processed food there that I wouldn't want to buy for our family, but there is some GREAT stuff there too! The produce has also really improved. They don't really have organic, so I try to stay away from the dirty dozen as much as possible. (Although I didn't know celery and summer squash were on the list and I went for strawberries when I shouldn't have. Sigh. Those will have to come from Trader Joe's next time.)

Anyway, Dave and I are attempting the "Whole30" program this month. It's a diet of sorts that you do for 30 days to clean out your system and focus on real food! It's a great idea, but definitely stricter than what we've done in the past since you don't have ANY grains or legumes! It's been kind of a "cold start" since we didn't really have a "let's decide whether or not we want to do this and when" conversation. I just started off this past week deciding to cut out gluten and sugar, but by Wednesday decided we needed to do this entire food change and so I guess it officially starts today? Or tomorrow? I've been eating this way for a few days, but Dave is having a hard time cutting out cereal/oatmeal for breakfast.

Well, all that to say, our focus is really on healthy meats, good fats and veggies. We've having fruit too, but it shouldn't be the focus. So, of course I needed to load up on produce and nuts and headed to ALDI. I was SHOCKED at some of the good finds I got! :-)

So, here is my loot. Anyone want to guess how much all this cost us? First of all I suppose I should share what all we got.

3 lbs of wild caught salmon
1 lb of flounder
3 lbs of chicken breast (not pastured, so not the best I know)
8 rolls of toilet paper
2 lbs of cashews
2 lbs of mixed nuts
8 oz of almonds
1 lb of whole carrots
bag of baby carrots
bunch of bananas
2 heads of broccoli
3 yellow summer squash
1 jar of spaghetti sauce (ingredients aren't bad!)
4 bags of frozen veggies
2 acorn squash
Italian Seasoning
8oz jar of wild mustard (also great ingredients!)
1 box of raisins
1 bag of dried apricots
2 lb bag of pears
2 lbs of vine tomatoes
3 kiwi
2 lbs of asparagus
4 avocados
2 mangoes
1 pomegranate

Any guesses? Ok. The total was $103!! That's It!! And that's after our crazy 9.5% sales tax! The best finds for me was the 1lb bags of wild caught salmon for just $5 and the big jars of nuts for $11. Those were definitely the most expensive, but WAY cheaper than we would have found elsewhere.

Dave says it's lame that I took this picture and am sharing this, but it's very exciting to me. :-) Of course we'll still need to pick up things elsewhere, like organic greens, milk, (for the buddy), etc. but this is a great start for us. I should also add that we bought 1/2 a cow with my parents at the end of the summer, so we aren't buying ground beef right now and just take it out of the deep freezer where the breastmilk used to be. :) We really want to get good quality bacon and other breakfast meats, but want to be sure we find a kind without added nitrites/nitrates. It's hard to find without paying a lot. I'll be on the lookout when we go to Trader Joe's for our other stuff. :) I still have to get Nathaniel's lunchmeat, almond butter and cheese there. Thank goodness we can have that almond butter! :-)