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Monday, July 28, 2014

wow I forgot how much coordinating out-of-state treatment sucks

So we had some drama with coordinating my care over the weekend. For whatever reason, my blood test results didn't get to CCRM. I did my usual dance--got blood drawn. Called CCRM around 4 CST to find out if they received the results. A nurse returned my call around 5:15 stating that they did not. I called the hospital that drew my blood and asked them to re-fax the results. They said they would. I called CCRM back around 6 CST to find out if they had received the results. CCRM is closed at that time so I got the answering service. I asked the service to contact a nurse (because they are still at CCRM at that time--they just don't answer the phone anymore) to find out if they had received my results. The service said the nurses make those calls until 7:30 PM CST so I should wait and if the nurse didn't call back by 7:30 call the answering service back and they would get me a nurse. I asked whether a nurse would still be at CCRM to see if my results had arrived after 7:30 PM and the service said yes.

So, as you can imagine, they didn't call by 7:30. So I called the service. And, as I suspected, there are no nurses at CCRM after 7:30. So they paged the on call nurse who was at home and had no access to the fax machine to find out if my results had come through. She refused to call the lab to get the results (and the lab won't give me the results over the phone. They'll give them to a nurse over the phone but not me. I have to go there in person and sign a release. I've never tried impersonating a nurse to see if I can them over the phone that way because I hate lying. But it seems to me that's the loophole). The on-call nurse also seemed pissed that I was calling because they don't consider pregnancy med results "urgent" and they don't make changes to preg meds over the weekend.

You know, I consider changing my hormone levels while pregnant urgent. In fact, I'm pretty sure that's why my nurse ordered the blood test Fri instead of waiting for Monday's standing order. Because they made a change on Thurs and wanted to make sure all was OK.

The on-call nurse said "if the results are OK you'll stay on PIO every other day so just do that over the weekend". I asked "what if the results aren't OK? Wouldn't it be great if we could make a medically informed decision by getting my test results rather than guessing". She then advised me to call CCRM back first thing in the AM and find out what my results were. She's just making shit up.

So I did. But first I drove to the hospital to get my freakin' test results just in case CCRM still hadn't gotten the fax. When I called the after hours line on Sat, they were annoyed that I called on the weekend for my preg hormone results. But it turns out that the results were not "OK". My p4 was 13 and they want it over 15. So the Sat nurse advised me to go back on PIO every day until I could talk to my nurse on Monday.

Got my blood drawn again for my Monday standing order.

My nurse called me back Monday at 5 PM CST to let me know she got the results from Fri and today. She wanted to know what my meds were now. She seemed surprised that I was still on PIO every day. Goddammit. I could've been doing it every other day instead of every day?! But rather than put me on every other day, she opted to have me decrease my e2 and stay on PIO every day until Wed. Skip Wed shot then go in Thurs for blood draw to see levels.

She suggested I decrease my patches from 2 every other day to 1. I asked why are we decreasing patches instead of estradiol given that my e2 isn't really decreasing with decreasing patches so maybe we'd get more bang from decreasing estradiol. We did that order during DD's pregnancy. She said she usually weans off patches first because patients tend to complain about skin irritation with the patches and they are more expensive. But I'm lucky-my insurance covers my patches. So we're decreasing the e2. Only 1 pill per day starting tomorrow. So I'm nixing the morning one so I don't have to lay down for 1/2 hour each morning. Fingers crossed this decreases my e2 as I suspect it's contributing to my nausea and weight gain.

One thing I will not miss is coordinating care out of state. Esp since the CCRM IVF nurse line almost always goes straight to voicemail. Then they call back. And often I'm in a meeting or in the bathroom or something and miss the call. So then I have to call back and leave another message etc. I mean seriously?  A lot of us have jobs. Which is part of why we struggle with IF, right, because we delayed pregnancy?! So for them to expect us to be available whenever they call us back but don't pay us the same curtsey. I won't miss it one bit.

Friday, July 25, 2014

Weaning, weaning, weaning

Based on the results of Monday's blood test (e2=1609, p4=26.06), I get to continue to wean off my meds! Starting Tues I got to wear 2 patches every other day. And last night (Thurs) was my first night with no PIO shot!!! It was glorious!

The weird thing is that I've been super nauseous this week, starting Tuesday. I don't know if I coincidentally caught a stomach bug or whether the change in meds (e2 especially given I didn't start weaning p4 until yesterday) is making me nauseous. Either way, I'm staying home from work today--I'm too nauseous to get through a day of meetings. I tried weaning sea-bands yesterday and a mom at DD's daycare spotted them and knew it meant I'm preggers. She's a sweetheart so I don't mind her knowing but it made me realize that I can't wear my sea-bands this time around in case people figure it out. And we're not ready to go public yet. Not until we get to the 2nd trimester. Too much has gone wrong this year for us to be that confident yet.

I have a blood test today to find out how my body's responding to the weaning. Fingers crossed I get to continue to wean off the freakin' PIO.

Saturday, July 19, 2014

8.5 weeks and all is good (and I get to wean off meds!)

Got to see Obi yesterday. And hear the heartbeat! All is going well! Growth is good--measuring in at 8w2d. Heart rate was 180, which is good for this age (heart rate peaks at this age).
Here's a pic of my beautiful baby:

In other cool news - I can feel the baby moving! I know it's super early and at first I thought I was misinterpreting other physical sensations as Obi dancing. But it's happened several times over the past few days and it's such a distinct feeling - I can feel Obi boogieing! It's amazing!

Now that I've reached 8.5 weeks, I can start to wean off my meds. I get to start with going from 4 Vivelle patches every other day to 3 patches every other day. Sadly I don't get to decrease the PIO yet. CCRM likes p4 between 20-30 at this point and mine's 27. If it goes over 30 by Monday's b/w, I'll get to start weaning off it too. In the meantime, daily shots in the ass.

But I spoke to a different nurse on Friday and she said I can swim! Yay! So I'll start adding that in so I can start getting more exercise. I've already gained 5 pounds since I've been pregnant - I'm sure due to increased food cravings and lack of exercise.

So everything's going well!



Monday, July 14, 2014

PIO

One aspect of this that has been a pain in my ass (literally) is the progesterone in oil shots. I get one every night. In the tuckus. It's an intramuscular shot (as opposed to subcutaneous shots--in the belly--I've gotten for more of my IF treatment). Thus, the needle is freakin' huge because it has to make it into the muscle. Here's a side-by-side comparison of the size of the PIO needle vs the lupron needle (this is DH's hand holding the needles):



We can alternate sides of my ass to give the shot but it has to go in a pretty specific spot. Thus, the needle goes pretty much in the same spot every other day. My injection sites are totally bruised. They sometimes hurt like crazy. Sometimes it burns going in, sometimes it burns going out. Sometimes it hurts because of the bruising. Sometimes it hurts because DH (who gives them to me) gets the wrong spot. One time, he injected me too high up and I had a knot of what I think was the PIO being absorbed more slowly than it was supposed to. And that hurt. It makes it harder to sleep because it sometimes hurts to sleep on the side where the shot/bruising is. At first I was glad for the PIO rather than the pills because it's once a day. Done and done. But after weeks of PIO shots, I'm over it.

I got b/w results today. The nurse told me that if all looks good on this week's u/s, we can start weaning off the meds. I'll be most excited for this because it means Obi's doing well. I'll be second most excited for this because it'll mean no more freakin' PIO shots.

Here are today's b/w results:
e2=1,398
p4=27.49

Monday, July 7, 2014

Bloodwork still lookin' good, although more preg symptoms cropping up

Today's b/w results are all good:
e2=1,579
p4=28

I'm getting more and more tired these days. Probably not much different from when I was preg with DD. The difference is it's much harder to just relax with a toddler. I'm fortunate in that my job allows for me to work in the mornings (when I'm most alert), then around 1, I stop working and relax, watching TV for a couple of hours. I usually take a 1/2 hour-to-hour long nap in the afternoons. DH brings DD home around 5 and I get to spend time with her until her bedtime at 8. I love spending time with her, but it's getting harder and harder to do so because my body just wants to laze around on the couch and watch TV. When I push myself to play, I get nauseous and light headed. I try to not just watch TV all evening (we usually have a strict 1/2 hour of TV per day with DD--right before bedtime), but sometimes these days we watch a little more because "mommy's not feeling well". During DD's pregnancy, I think I spent most evenings vegging out in front of the TV.

We haven't told DD about Obi yet. We want to wait until at least the 2nd trimester just in case. So for now, DD knows that I can't pick her up or go swimming and that I get tired and don't feel well because I'm on medication. I'm looking forward to the 2nd trimester when I will (hopefully) have more energy.

Heartbeat!

On Thursday, we got to see Obi's heart beating!!! It was amazing. The rate was 111 (anything over 100 is considered good). Obi measured in at 6 weeks 1 day (within 1 week of where my preg is -- with is ~ 6.5 weeks -- is good). It makes sense to me that Obi would measure a bit under 6.5 given it looks like s/he was a late implanter.



I will continue to get weekly b/w to monitor meds. Meds stay the same. Lifestyle restrictions the same (no exercise other than walking, no baths/swimming) except we can have sex now. Next ultrasound will be ~ 7/17 (8.5 weeks).

Tuesday, July 1, 2014

Reactions to pregnancy

So I have a wicked rash all over my body. At first I thought it was heat rash (I read this can happen durign pregnancy as body temp rises due to p4 and increased blood) but it's spreading not getting better. So I went to the dermatologist yesterday and nope, not heat rash. Not yeast or fungal infection. The derm thinks it's probably a reaction to being pregnant! Some people's skin breaks out in response to preg hormones and some reactions are more common in 2+ pregnancies.

The derm prescribed me a topical steroid cream to help with the itching. Unfortunately, she prescribed me a medication that CCRM advises against because it's a category C medication (no research showing it's safe in preg humans). So I'm still super itchy with no way to manage it :( CCRM and my derm both said I could take Benadryl (a class B medication), but I don't feel comfortable taking any OTC meds this early in my pregnancy. Going to pick up some calamine lotion today to see if that helps. I'm also going to switch my soap to something very mild and see if that helps too (I've read that some women become sensitive to their soaps,lotions, etc when preg and my soap is the only thing that I put in all the areas I have a rash). FX I find a solution! I gotta say I'm disappointed that my derm didn't.

But I also remind myself that I'm having this problem because I'm PREGNANT! So if this is another price I have to pay, so be it.

Speaking of which--here are the results from this week's b/w:
HCG=8,710 (they don't monitor it anymore but I threw this test in because I wanted the reassurance the level was still rising)
E2=1,943
P4=31.16

Nurse says these all look good. I still have moments in which I can't believe it's actually working. After the two failed transfers and the rocky start to this one with the low initial beta. But it's looking good so far!

U/s Thursday morning to (hopefully) see the heartbeat. FX!