Lunchtime quicky

Today at lunch, I did the deed. Of course for me the deed consists of a speculum, a syringe with some sperm being put through my cervix into my uterus and then laying there for 20 minutes - just like straight sex, right?

Afterwards, I went back to work. This just doesn't seem right. No egg count, no fertilization report and no bed rest. Not to mention that I only did 1 shot per day. This entire cycle I have felt like I am forgetting something. When we did IVF, between R and I we were injecting 4-5 different drugs per day. There was discomfort, there was pain, there was bloating so severe that R looked 4 months pregnant - for the love of god, there was something tangible. But with this cycle there was nothing. I mean there was some cramping during the stimming phase but I haven't felt a thing since I triggered Monday night. It also just seems too simple. What -- you squirt some sperm in me and I'm supposed to get pregnant?!?!? I know that most people get pregnant this way. Hell... I even got pregnant this way. But once you venture into IVF-land, it's hard to go back. I miss knowing that embryos are being put into my uterus and not just that we're hoping that the sperm and eggs will mix together.

My paranoia continued through my afternoon at work. Being a physician, I have the knowledge and access to equipment that allows me to take my paranoia to a whole new level. (I can't believe I'm really about to admit this even with this being an semi-anonymous blog. There are only 2 people that I know in real life that read this even though they're not "supposed to" - *wink* hi K&H). So this afternoon, I kept feeling all drippy. And of course my paranoia took over. I know that the sperm can't drip out because it's put through into my uterus, but in my mind, it was possible. (OK - this is the embarrassing part). So I went into the bathroom and took a swab of my girly parts, put it on a slide and looked at it under the microscope. No swimmers - dead or alive!!! Just normal stuff, but no swimmers. I feel much better now about my girl parts and keeping the swimmers where they should be - way inside. Now the wait...

We had a Sunday morning session with the wand. Today I had 2 follicles on each side that will definitely be players, an additional 2 follies that might be players and then a few more smaller ones that probably won't make it in time to participate this round. With my ultrasound 2 days ago, I had about 10 follies that were about the same size. Where did they go? I know that sounds crazy to want more than the 4-6 that I have for an IUI cycle. I guess I'm used to IVF and to seeing more.

I'm currently alternating between thinking I'm nuts for inseminating with so many (although now that it's 4-6 - I'm not so nuts) and thinking that it won't work. We have soooooo much hope for this cycle. I wish R would get her period soon so that I could worry about her cycle and not obsess about mine. I like us both trying - damn it, one of us has to get pregnant (and stay pregnant).

I will be triggering tomorrow night and having my IUI on Wednesday. Now I'm all worried that I will ovulate prematurely. Damn, I miss lupron and cetrotide from our IVF cycles that helped give me some assurance that premature ovulation wouldn't happen. IUI cycles just seem so primitive - LOL (I remember when we thought injectable cycles were stressful, now they are simple). I just want it to work.

Lunch hour wanding

I ran out during my lunch hour today for a follie check. The clueless receptionist was on today at the RE clinic. She's the one who once pointed out that it was her son's due date and then seemed clueless when I said that it once was my due date as well. R stopped me from going into detail about my miscarriage. Anyway, today she loudly says "wow, I haven't seen you for a while" (meaning like 2 months). Then she says, "now you're not here for a prenatal u/s, right?". Yes dumb fuck, I am not here for a prenatal u/s.

So onto the good news. My little ovaries are waking up nicely this time around. I was afraid the lupron from the last IVF could have put them into a semi-permanent slumber but the little girls are making me proud. I have a nice crop of developing follicles. The RE is very pleased. We have agreed to push the envelope some with this cycle. We have had the selective reduction talk and I have agreed to it if it comes to that. However we know that my uterus eats up embryos like tic-tacs and it would be highly unlikely for a uterus full of embies to stick around. I'm willing to take my chances. We have spent so much time worrying about multiples and we still don't have a single child.

I will go back on Sunday for the next follie check. He's predicting that the IUI will be on Wednesday! I'll keep you all posted.

And now presenting for the first time in 2007...

After 49 long days - AF finally dragged her sorry ass to my house. It's her first visit of 2007 and I couldn't be more excited! I had taken Jennifer's advice and tried the "old fashion" remedy to get her to show up. The night before, while not having a frisky bone in my body or thought in my head, I knew I had a job to do. I did what I had to do - I'm guessing it was much like baby making sex for straight couples. You do what you have to do, not because you particularly want to at that moment but rather because you have to. There's a purpose for it.

The next morning I was slightly disappointed when I woke up without AF in sight. I showered and got ready for work. I decided to try another trick - I put on white undies. That seemed to do the trick! About 15 minutes later, I saw light pink!!! By mid-morning, AF had arrived. I quickly called and e-mailed my RE. I was determined not to let the holiday weekend start without some vaginal wanding action. I spent my lunch hour having my first dildo cam experience of 2007! Everything looked great. Since I had just started bleeding about 2 hours before, my lining was still nice and thick. The RE predicted hemorrhaging all weekend long which is fine by me. I had at least 5 antral follies on one side and 7 on the other! I start injectables today!

It's been almost exactly a year since I last tried with my own eggs. An injectable cycle will seem like cake after our last 2 IVFs. I'm sad that I wasn't able to carry R's baby. I think that would have been so cool - the only real way to have a child that was both of ours in the eyes of the law (genetically hers but I birthed it - even a backwards ass judge in Florida couldn't argue with that one). Perhaps if we end up with frozen embryos later on, I can try again. For now, I can't take the chance that my uterus will continue to gobble up her embryos.

My RE also had some news for me. First I learned that I am truly a girl - 46xx. My chromosomes are normal! I then got the results of the lasts of the tests that we were waiting on. Turns out my Plasminogen Activator Inhibitor-1 Antigen (PAI-1 antigen) level was elevated. Basically it's a clotting problem that can lead to miscarriages. I've never had a problem with blood clots but I have had the miscarriage part. So this time around after insemination, my doctor is going to put me on heparin shots. I'm all for anything that will help prevent another dead baby.

The other thing that happened at the RE's office was R doing the unthinkable. While waiting to be called back, I noticed a basket of valentine's day candy on the counter. I walked over to it and grabbed a snack size bag of M&M minis. From across the room, R asks what kind of candy I got. When I replied M&Ms, she walks over to me and grabs them out of my hand, saying "NOOOOOO Chocolate". Mind you there is a lady also in the waiting room who is probably about 100 lbs over weight and who is chomping on a big bag of peanut M&Ms who then glares at R. R insists that it's for that baby. "Chocolate has caffeine, so no chocolate this cycle" she tells me. WTF, we have never discussed this new crazy strict ass rule. For the love of god, I'm on cycle day 1 and about to get wanded and she pries chocolate out of my hand?!?! Needless to say, I wasn't very happy. Especially since I don't drink soda or coffee or really consume anything with caffeine in it even when not trying to conceive. So what the fuck is a snack size bag of M&M minis going to do? And this is all coming from the girl who special orders her diet cream soda from the grocery store. I can't wait to go all caffeine nazi on her when starts her period. (Of course she had to run home and blog about it on her blog so that she didn't seem like the bad guy, while I went back to work and couldn't blog until today).

Send a search party

Last night I had a dream that someone was missing. I don't remember the missing person having a name but I'm pretty sure it was Aunt Flo. There was a big search and rescue operation underway and I was head of the command center. I don't remember how we found her but we finally did. I then e-mailed the nurse at my RE clinic and remember getting a reply that said. "We are all very excited. The entire office erupted in cheers when we heard the good news".

But really, I'm not obsessing about things. I'm calm and not worried at all about my lack of bleeding for the past 48 days. I hope you can sense my sarcasm here. I am analyzing every symptom like I was in my 2ww, not to mention studying the toilet paper like I was actually pregnant (although here I want to see pink or better yet bright red). I've been having some cramping for the past 2 days - surely that's a sign that it's coming. I've been off the provera for 5 days now.

Last night I cried while watching American Idol. It was the show in which Paula, Randy and Simon meet with each contestant individually to tell them if they made it to the part of the show where America gets to vote on them. The contestants were super nervous. Every time the judges told one of them that they made it - I cried. Yup, that's right, I cried for all 12 girls and 12 guys that made it through. I didn't really cry for the ones that didn't make it. But surely all this crying must also be a sign.

So where the hell is she? I just know that she'll show up Friday after my clinic closes and I'll have a hell of time getting a hold of them on the weekend and then Monday is a holiday. I only want to see one specific RE who said that he wanted to be more aggressive with me this time around. I think it's an ego thing and he's miffed that he hasn't gotten me pregnant thing. I say bring on the ego and let's get me pregnant. Now if only my fucking period would show up - I hate this waiting.

A really shitty day

This has nothing to do with trying to conceive - because well, I'm still in a holding pattern. No period yet. This is about my really crappy day. My morning was crazy busy but not terribly unusual for a morning in the middle of winter. My afternoon was actually looking like it was going to be a little better. That's until my 1:45 appointment.

Without getting into too much detail, it was a young infant in whom I strongly suspected sexual and physical abuse based on my exam findings. I was so sickened that I wanted to cry and throw up right there in the room. The parents had no explanation for the findings. I called in one of my colleagues to take a look and he agreed that abuse was the likely explanation (actually it was pretty much the only explanation). I told the parents that I had to call a specialist because I was concerned about their child. Instead I called child protective services (CPS) and law enforcement. I kept stalling - telling the parents that I was still waiting to hear from the specialist.

I felt horrible for lying but I didn't want them to take the baby and run. They had no idea what was coming. CPS and the local sheriff showed up. They each spoke to the parents alone. The parents stuck to their story that the child woke up this way (impossible - trust me). After being in my exam room for over 3 hours, they were told that the baby would not be going home with them. She would be taken into protective custody. The mother cried - a similar cry to the wail of mother whose child you've just pronounced dead (that's the worst sound in the world).

I could not look these parents in the eye. Part of me is furious and sickened. How could they have done this. But another part of me wants to believe that this is something too horrible to do to an infant - there must be some other explanation (a rare 1 in 100 million bleeding disorder??? - don't worry, we'll test for that). I avoided the parents as they left. I did not know what to do or say. I actually avoided them after I walked back into the room with the "specialists" otherwise known as CPS and a cop.

This isn't the first time that I've seem something this horrible. In fact, I've seem much worse. However all of that was during residency. I did my residency in a major teaching hospital. It was also the county hospital (in a large city). Any child in the entire county (and also in several of the surrounding rural counties) who was removed from the home for suspicion of abuse was seen there. We also had a child abuse center that did forensic exams (took pictures of the bruises and injuries). As a resident, we all rotated through there and saw unspeakable horrors. I also took care of multiple "shaken babies" and other victims of abuse in the Pediatric ICU - some of whom died, others who probably should have. However, with all of these kids, they were already in custody of the authorities. I may have written reports confirming the abuse and recommending that they not be returned to their families but this is the first time that I have had a child removed from their home.

I know it was the right thing to do. I had no choice given the injuries noted. So why do I feel like an ass. Why do I care that right now the parents think I'm the scum of the earth for taking away their child. They brought her to me to help. They brought her to me because of vaginal bruising. I helped the baby but I did not help the parents. I hope they see it that way.

This day has truly sucked. Of course I then ran behind all afternoon. I had pissed off patients give me attitude. The patient who was right after the baby was really pissed. They had to wait an hour. My nurse informed them that I was running behind and would be with them shortly. Due to confidentiality laws, I could not say anything more detailed. I hope that they would have understood had I said, well the patient before you who was booked for a 10 minute appointment was sexually and physically abused. It took me more than 10 minutes to call CPS and law enforcement and file the reports. I think your 17 year old son's sore throat can wait a few minutes. Instead I just said I'm sorry for running late and they remained pissy, so pissy that they left without being seen just 2 minutes before I was finally able to see them.

I then had to work our evening urgent care. They day never seems to end. I came home to an empty house because R has a late class tonight. I came on to the computer to blog and noticed that an auction that R was bidding for on e-bay was 6 minutes from closing. I tried to win it and lost with 8 seconds to go - shit, fuck... can nothing go right for me. Today sucks... and still no period.

Now just waiting - for real this time

I'm once again back to waiting for my period to show up. No, not like I was 2 weeks ago, when I was merely hopeful that my body would do what it's supposed to do. I just finished my 10 days worth of progesterone, so now a period should really come. It can take anywhere from 2-14 days but I'm guessing it'll be in the 3-5 day range. My last pill was Saturday afternoon.

I know that I'll be starting soon because this morning, while watching the today show, I cried. They had a story about some guy who was sky diving and both his parachutes failed. He had a camera strapped to his helmet, so on the way down (just before hitting the ground) he said "oh *bleep* I'm going to die, bye" and you see him wave his hand good-bye in front of the camera. I knew that the guy lived since he was sitting on the today show couch waiting to be interviewed, yet this was enough to bring me to tears - a good sign indeed.

One quick gripe about work before I start my day - this one happens several times per day. It's minor - nothing like the crazy lady wanting to steal shit - but it's still kind of annoying. When taking the history on any sick patient, I usually ask if the child has had any fevers. Often times the parent will reach over and touch their child's forehead and give me an answer based on that. Hello - my nurse just took your kid's temperature - I didn't mean right this second. It usually goes something like this:

Me: So just to review, Kaitlyn has had 5 days of cough, runny nose, throwing up and some diarrhea. Has she had a fever?
Mom: Kaitlyn, come here (feels Kaitlyn's forehead) well she feels hot now
Me: my nurse just took her temperature - it's a normal 98.8, has she had fevers at home?
Mom: well she's hot now.
Me: yes, she may feel a little warm but her temperature is actually normal. Has she had any fevers at home?
Mom: No, this is the hottest she's been.

A speculum in the ear

My most demanding patient would have to be my wife. Last night she mentioned to me that her ear had been hurting her and she wanted me to take a look. I had to charge my otoscope so I could look in her ear. Of course we forgot about it until we were in bed. Once I was all warm and cozy, that's when she insisted that I look in her ear. Being the good wife that I am, I dragged my ass out of bed to gather my tools. Before I could even look in her ear, she starts her whining - "don't put it in too far", "it's going to hurt", "no don't do it". She made me get out of bed, I was now determined to look in her ear. Of course her ear ended up being totally normal but she freaked out when I put the otoscope in her ear and started giggling like a 5 year old (in her defense the only ear speculum that I had at home was a small one and thus I did put in quite far) and also when I insufflated (shooting a little puff of air into her ear canal to check for the normal movement of the ear drum). She was also majorly amused by the fact that those little things that go on the end of the otoscope to look into one's ears are called speculums. Apparently she thought that was a word reserved for the device used to look in one's vagina. See even you are are not actively cycling, you still have speculums stuck in you.

In continuing this week's theme of bitching about patients, I had this mom several weeks ago who was very upset because my rooms were not stocked to her likings. I must have been running a few minutes behind because when I walked in, she told me "Dr. F, I have one complaint. In the old days you would take your kid to the doctor and if you had a cut on your hand you would take a few band-aids while you waited and some packets of vaseline for the diaper bag or anything else that you needed. But your rooms have nothing useful and it's very upsetting. I have gone through all of your drawers and I couldn't find so much as a diaper or band-aid". I honestly thought this mom was joking - are you fucking for real? (And there were diapers in there, she just didn't look carefully enough) To make matters worse, she was really upset and kind of yelling at me for this. I tried to calmly explain that in the interest of keeping insurance premiums down and to provide good health care my rooms are stocked with the items that I need to practice medicine and not necessarily the items that she currently needs to stock up on. I seriously wanted to point her down the street to the nearest walgreens. I did ask her if she had a cut and told her that I could go get her a band-aid but she said no, she just wanted some band-aids for her purse. OMG- are you fucking for real lady? I just can't imagine her nerve. Am I way out of line here? Do you all expect this kind of shit when you go to the doctors office?

Not much is going on on the TTC front. I'm currently on CD 37 and on my 5th day of the progesterone. I'm supposed to take 10 days of the progesterone and then wait for my period 3-14 days later. R is also just waiting for her period. She's 2 1/2 weeks post her D&C. She had a beta done on Friday which came back at 44. We also received the chromosomal analysis on the tissue that they got from the D&C. It was chromosomally normal and it was a girl. Now there is the chance that some of R's cells contaminated the sample and that the chromosomally normal girl is actually R. I guess we'll never really know for sure and I guess I'm ok with that.

Since there is nothing going on with our reproductive parts to report, I thought I'd take this time to bitch about work for a while. It's not so much work that I want to bitch about but rather some of the clueless parents of my patients. In an effort to not write a small novel today, I'll share with you one thing that drives me crazy each day this week. Here's one that occurs on a regular basis.

Cell phones - For the love of god, put down your cell phone and don't answer it while we're talking or during the 5 minutes in which I'm examining your child (and don't forget to put your phone on silent mode. I just love it when the "conscientious" parents who don't want to be rude and answer the phone decided to ignore their phone and just let it ring - all 5 choruses of "I'm bringing sexy back" while the 5 year old sings along. It's even better when it's a rap song and the 5 year old is singing "bend over and show me what I'm working with"). I also love it when parents are on the phone and when I go to ask them "so what brings you in today" they say "hold on the doctor is trying to talk to me". Then with the phone still pressed against their ear, they answer my questions and then when I put my stethoscope in my ears to start examining their child they go back to their phone conversation. I can barely hear their child's heart and lungs over their phone conversation - "Did you know that Tina broke up with Josh - lub-dub, lub-dub (heart sounds) - yeah, he was cheatin on her - deep breath in and out". Afterwards, I again have to "interrupt" their phone conversation to tell them about their child's pneumonia which they promptly share with the person on the other end of the phone. It usually goes something like this:

Mom: (talking away on the phone)
Me: excuse me
Mom: hold on the doctor is trying to talk to me again
Me: well after examining little Sally, it sounds like she has a pneumonia
Mom (to the person on the phone): OMG, Sally has a pneumonia
Pause while the person on the phone reacts to the news
Mom: how did she get it? Was it because her dad let her go outside without a coat on?
Me: no, it most likely started with the cold that she had last week and has now organized into a pneumonia in her lung. Going outside without a coat on did not cause this.
Mom (to the person on the phone): My baby is sick
Mom (to me): can you write me a note so that she doesn't have to go to her dad's this weekend because I know she got the pneumonia from him.
Me: no I can not write you a note for that. Sally will need to be on antibiotics for the next 10 days which does mean that you'll have to take the antibiotics to her dad's house so that he can continue to give them to her.
Mom: Well I know that he won't give them to her, (then to the person on the phone) - do you think her dad will give them to her?
Another pause
Mom (to me): yeah, she doesn't think so either, can you write me a note saying that she has to stay with me this weekend because she needs medicine?
(I then glance at my schedule on the computer (we have computers in all the rooms and it's all on electronic medical record, I realize that I'm now running 20 minutes behind b/c this conversation is taking longer than expected)
Me: I have electronically sent her prescription to the pharmacy. Here's a letter that states that she needs to be on the antibiotics and what signs and symptoms to bring her back for. If her dad states that he can't give the antibiotics (twice per day) then she should stay with you.
Mom: (to the person on the phone) Let me call you right back
Me (in my head): fucking finally!
Mom: here, can you talk to her dad and tell him all of this? She hands me the phone.
Me: well it's all in the letter that I just gave you, I think that should do the trick.
Luckily his voice mail answers
Me (seeing my chance to be done): I think that about does it, have a good day, I hope Sally gets better. If you have any concerns don't hesitate to call or make another appointment (in my head - please don't)
By the time I am opening the door to see the next patient in the next room, she's back on the phone.

And yes, we do have multiple signs that ask parents to please turn their cell phones off while in the exam rooms.

Thank you for the requests for bridal gown pics. Out of respect for my marriage, I'll be keeping those private. I can tell you that we had a great time! My wife used to occasionally wear skirts and dresses but since gaining weight during the past 2 1/2 years of trying to conceive, she's given up on some of her more girly outfits. So putting her in a pink satin dress was a bit like my wife in drag (the dress for the wedding will be purple or victorian lilac to be more specific but the dress in R's size was pink). It was hilarious. I'm not sure the chick at the bridal store knew what to do with us.

The best part was that I tried on wedding dresses. My sister in law is the one getting married but she lives in the middle of no where. It's a 7 hour drive over several snowy mountain passes to get to the nearest bridal store. So she sent me an e-mail with the dresses that she likes for us to look at (you know check out the fabric and stuff). I decided to take it a step further and try on the dresses, take pictures and send them to K. I felt like a princess, it was so much fun. They don't just let you try on the dresses, so I had to register and a "bridal attendant" had to help me put each gown on. It was the most fun I'd had on a day off in a while (considering the last days I've taken off from work were either for best rest after IVF or for taking care of R after the D&C).

In other news, I'm on cycle day 33 and still nothing. I continue to feel myself up regularly and still no sore boobs or any other signs that my period may be coming soon. I called my RE to see how long he wanted to wait. The nurse e-mailed me, said that she just needed to ask me if there was "any way that I could be pregnant" before they could prescribe anything for me to help me get my period. She was very apologetic for having to ask me so I can't really get too pissy about it. Of course I didn't see her e-mail until after I finished seeing my own patients so by the time I got back to her with my definite NO answer, it was after 5:30 and she was gone. Luckily tonight I found a prescription of provera from last year that I never took because I got my period before I needed it (the provera). So I started taking it. My plan is to take it for 5 days and then hopefully I'll get my period a few days after that and can finally start the next cycle. I'm ready to start. I'm ready to be pregnant - for real this time. I want to feel pops in my belly and wonder if that's my baby's first kick much like some of the blogs that I read. I want it to be me (or R) - damn it, I just want it to be us for once.