Just a quick update for you on my third and final Beta HCG test today: 4479 and rising "very nicely" according to the nurse who phoned the result through to me.
It was a bit hilarious at the medlab this morning. They know me by name now, and I know most of the phlebotomist's faces or names. So I was a bit surprised when a teenage-looking boy (let's say 19 - 21) in a lab coat called my name.
A senior technician was there too and she explained that the trainee technician was going to do everything "except the needle" and I was fine with that. The poor dude was so nervous, I think they chose me to be the first real live patient! He did most of the prep fine, but didn't get the tourniquet quite tight enough. He was shaking really badly!! The senior took over and did the blood draw which took a bit of digging. She only got a tiny amount of blood and had to check with another technician if it was enough for the test. It didn't hurt at all which is lucky.
Feeling very hungry most of today - I actually drove to the supermarket at lunchtime from work and got cans of salmon, a bad of nuts/cranberries, croissants, tomatoes and kiwi fruit for lunch (well, it will become several lunches!)
This evening I was still quite ravenous, but immediately after dinner I got so very sleepy. I did a bit of work after dinner but then actually fell asleep in the lounge chair lol. Of to naps for me!
Showing posts with label fertility clinic. Show all posts
Showing posts with label fertility clinic. Show all posts
Tuesday, November 12, 2013
Tuesday, November 5, 2013
15dp3dt Second Beta (aka 4 weeks 5 days)
Second beta test today came back at 453! Woohoo!
This gives us a doubling time of roughly 42hrs, which is right smack bang in the middle of average.
Got a different nurse on the phone this time, but she sounded very positive and said "it's a good number". The relief I felt when I finally got the call was amazing. As you can tell from my previous post, I was getting a wee bit stressy about it. I was just so unbelievably happy that it came back positive that it was like walking on a cloud for about half an hour. After which time the adrenaline rush wore off and the fatigue set in.
They tested my progesterone too and it is 338 so the nurse said I should start weaning myself off the dreaded progresterone pessaries by dropping the dosage from 2 x 3 times daily, down to 1 x 3 times daily until they run out, or roughly 4 more days. Apparently I am making plenty of my own.
I need to go back in a week (next Tuesday) for another HCG test. The only way I found this out was by refusing to let the nurse hang up on me a la "just one more question!" haha I was determined to get the info out of her! Actually, I think the nurses' office must have been fairly busy, as I could hear other nurses talking to patients on their phones in the background.
I enquired about when is appropriate to enlist an ob/gyn and midwife. Nurse said that the fertility clinic has care of us until the 8 week mark which will be 29th November for me. At that time I should travel back up to Hamilton for my first ultrasound scan. Now, don't get me wrong, I cannot wait for this ultrasound. At about weeks today, I'm about halfway there. These milestones are incredibly important and hold great significance to me and my husband, and all those supporting us. But do I really want to travel over mountains for 3 hrs, have an over night stay, pay for a night in a motel, and book a day off work for two people?? Um, no. I asked the nurse if there was anything special about the ultrasound scan, and she thought about it for a moment, they said "well, there is a radiology place that you could ring and enquire if they would do it, but you would have to pay privately for it, just call and see if you can get an appointment for around the 29th Nov and then let us know so we can send a referral note through to you. They will then need to fax the results back to us." If it's less that the cost of all that travel and missed work, then we'll do it.
I keep thinking it would be great for the fertility clinic to provide a flowchart of procedures and appointments, just a general "what could happen" document. Rather than having to wrangle the info out whenever they choose to phone.
Once I got home Hubby suggested we book an appointment to see our GP this week to get his advice, as we may be able to get the scan for free??? I don't really care too much about paying for it, I just want to know that I won't have to travel. We have an appointment with the GP this Friday so I'm hoping I will learn heaps there!
Some more good news: I got my HbA1c result back. 16 Oct = 45 or 6.3% A slight rise, but this was taken after the transition to the pump (still learning) and before the application of copious amounts of crazy IVF hormones.
Went to the two elder step-kids senior high school prize-giving ceremony tonight and they both received awards! Very proud. It was cool with Hubby and I, their Mum and her parents, youngest step-son, and MIL. Some big cheers!
The school hall was packed for the ceremony and it got very hot. I was fanning myself with the paper programme, and started to get some really bad cramps, especially on the right side again but moving all over the place. I felt a bit faint, and figured I just needed to cool down and have some water. Which worked very well.
Thank you everyone for your lovely comments and support. It's wonderful to know you are all out there cheering us on! :D
This gives us a doubling time of roughly 42hrs, which is right smack bang in the middle of average.
Got a different nurse on the phone this time, but she sounded very positive and said "it's a good number". The relief I felt when I finally got the call was amazing. As you can tell from my previous post, I was getting a wee bit stressy about it. I was just so unbelievably happy that it came back positive that it was like walking on a cloud for about half an hour. After which time the adrenaline rush wore off and the fatigue set in.
They tested my progesterone too and it is 338 so the nurse said I should start weaning myself off the dreaded progresterone pessaries by dropping the dosage from 2 x 3 times daily, down to 1 x 3 times daily until they run out, or roughly 4 more days. Apparently I am making plenty of my own.
I need to go back in a week (next Tuesday) for another HCG test. The only way I found this out was by refusing to let the nurse hang up on me a la "just one more question!" haha I was determined to get the info out of her! Actually, I think the nurses' office must have been fairly busy, as I could hear other nurses talking to patients on their phones in the background.
I enquired about when is appropriate to enlist an ob/gyn and midwife. Nurse said that the fertility clinic has care of us until the 8 week mark which will be 29th November for me. At that time I should travel back up to Hamilton for my first ultrasound scan. Now, don't get me wrong, I cannot wait for this ultrasound. At about weeks today, I'm about halfway there. These milestones are incredibly important and hold great significance to me and my husband, and all those supporting us. But do I really want to travel over mountains for 3 hrs, have an over night stay, pay for a night in a motel, and book a day off work for two people?? Um, no. I asked the nurse if there was anything special about the ultrasound scan, and she thought about it for a moment, they said "well, there is a radiology place that you could ring and enquire if they would do it, but you would have to pay privately for it, just call and see if you can get an appointment for around the 29th Nov and then let us know so we can send a referral note through to you. They will then need to fax the results back to us." If it's less that the cost of all that travel and missed work, then we'll do it.
I keep thinking it would be great for the fertility clinic to provide a flowchart of procedures and appointments, just a general "what could happen" document. Rather than having to wrangle the info out whenever they choose to phone.
Once I got home Hubby suggested we book an appointment to see our GP this week to get his advice, as we may be able to get the scan for free??? I don't really care too much about paying for it, I just want to know that I won't have to travel. We have an appointment with the GP this Friday so I'm hoping I will learn heaps there!
Some more good news: I got my HbA1c result back. 16 Oct = 45 or 6.3% A slight rise, but this was taken after the transition to the pump (still learning) and before the application of copious amounts of crazy IVF hormones.
 |
| Not too shabby. |
The school hall was packed for the ceremony and it got very hot. I was fanning myself with the paper programme, and started to get some really bad cramps, especially on the right side again but moving all over the place. I felt a bit faint, and figured I just needed to cool down and have some water. Which worked very well.
Thank you everyone for your lovely comments and support. It's wonderful to know you are all out there cheering us on! :D
Thursday, October 24, 2013
3dp3dt A call from the lab
And.... the second-best embryo made it to morula then blastocyst stage but was too poorly to freeze.
I saw a missed blocked call on my phone and assumed it was the lab, so I called the embryologist M back. Instead I spoke to C who said that unfortunately our last embryo didn't make it to freeze. She was very kind and compassionate about it, and answered my questions. I called from my desk at work (open plan) as I thought, well it's no good waiting until I'm home as the lab will be shut. Plus I was already pretty certain it wouldn't make it, although there was always an outside chance we would get one to freeze, and that was my goal, I knew in my heart when the lab said back on Saturday that the second-best one was slow that it would be a long shot. Oh well.
The embryologist on the phone mentioned happily that the 3 day embryo we did transfer was of a good grade, so I asked her about their grading system. She said day 3 embryos are given a number grade of 1 to 5, with 5 being the best. The one we transferred was a 5! How awesome is that?! She then went on to say how once they reach blastocyst stage, there is a different grading system of a number plus two letters. Anything 3 or below has such a low chance of turning into a healthy pregnancy that they are not generally frozen. She didn't offer a grade for our blast, and I didn't ask since she had already explained some of the biological issues it had. Sounds like it was a bit of a mess by the day 6 report! Poor little embryo.
My good friend and colleague was well within earshot and she knows what we're doing do I told her, and she said "well it doesn't matter cos you already have the best one!" and then "you know, I've started knitting already!" way to jinx things lol.
But actually it does make a big difference. I hope with all my heart that this first IVF cycle works. But the lack of any frosties means that there will never be the potential for a full-sibling. If this cycle works then we will not be eligible for another funded cycle. If this cycle fails we are not guaranteed another funded cycle, but it's likely that we would get one after about a 6 month wait.
Ah, the dreaded 2WW. Where suddenly every little feeling has the greatest significance to it. My symptoms are as follows: sore breasts and very tender nips, a hardening/ tenderness/swelling in left breast, occasionally mild cramping and feelings of pressure low down in abdomen, plus this evening I got two very distinct sharper cramps on the right side. My outlook is very positive, I'm very smoochy lolz, and overall I feel pretty calm about all this.
Diabetes has been ok, nothing dramatic although any stress I can see my bloodsugar shooting up. I have taken to bolusing for stress! And work is not even that stressful. I worked a full day today and again freelanced until 9.30pm.
We got some healthy burgers this evening, as they have little pottles of the best dark choc ice cream! Oh so delicious! I managed to carb count very well and actually started dropping rapidly with the hour of eating.
Hubby is being very supportive and kind to me like always :D he said this evening how great it would be for us to have a child together. Yes, it would indeed be great. Scary, worrying, hopeful, exciting a whole big mixture.
I saw a missed blocked call on my phone and assumed it was the lab, so I called the embryologist M back. Instead I spoke to C who said that unfortunately our last embryo didn't make it to freeze. She was very kind and compassionate about it, and answered my questions. I called from my desk at work (open plan) as I thought, well it's no good waiting until I'm home as the lab will be shut. Plus I was already pretty certain it wouldn't make it, although there was always an outside chance we would get one to freeze, and that was my goal, I knew in my heart when the lab said back on Saturday that the second-best one was slow that it would be a long shot. Oh well.
The embryologist on the phone mentioned happily that the 3 day embryo we did transfer was of a good grade, so I asked her about their grading system. She said day 3 embryos are given a number grade of 1 to 5, with 5 being the best. The one we transferred was a 5! How awesome is that?! She then went on to say how once they reach blastocyst stage, there is a different grading system of a number plus two letters. Anything 3 or below has such a low chance of turning into a healthy pregnancy that they are not generally frozen. She didn't offer a grade for our blast, and I didn't ask since she had already explained some of the biological issues it had. Sounds like it was a bit of a mess by the day 6 report! Poor little embryo.
My good friend and colleague was well within earshot and she knows what we're doing do I told her, and she said "well it doesn't matter cos you already have the best one!" and then "you know, I've started knitting already!" way to jinx things lol.
But actually it does make a big difference. I hope with all my heart that this first IVF cycle works. But the lack of any frosties means that there will never be the potential for a full-sibling. If this cycle works then we will not be eligible for another funded cycle. If this cycle fails we are not guaranteed another funded cycle, but it's likely that we would get one after about a 6 month wait.
Ah, the dreaded 2WW. Where suddenly every little feeling has the greatest significance to it. My symptoms are as follows: sore breasts and very tender nips, a hardening/ tenderness/swelling in left breast, occasionally mild cramping and feelings of pressure low down in abdomen, plus this evening I got two very distinct sharper cramps on the right side. My outlook is very positive, I'm very smoochy lolz, and overall I feel pretty calm about all this.
Diabetes has been ok, nothing dramatic although any stress I can see my bloodsugar shooting up. I have taken to bolusing for stress! And work is not even that stressful. I worked a full day today and again freelanced until 9.30pm.
We got some healthy burgers this evening, as they have little pottles of the best dark choc ice cream! Oh so delicious! I managed to carb count very well and actually started dropping rapidly with the hour of eating.
Hubby is being very supportive and kind to me like always :D he said this evening how great it would be for us to have a child together. Yes, it would indeed be great. Scary, worrying, hopeful, exciting a whole big mixture.
Monday, October 21, 2013
CD 15: Embryo Transfer day! 0dp3dt
Our Day 3 embryo transfer went perfectly. I am now - dare I even type it? - PUPO!
Since our appointment was at 11.10am, we didn't rush getting up. I woke at about 7.30am and made us both tea and toast (I am on caffeine free tea, but not being terribly strict about it).
We packed up the motel room and drove down to the lake for a walk. Since it's spring here in NZ, there are just loads of cute baby animals all around. Awww! I saw 3 baby pukekoes and a bunch of ducklings. In case you have never heard of a pukeko, here is a pic:
And that is not counting all the baby lambs and calves, and kid-goats and piglets I saw out the window on the car on the drive up!
Focus. Ok, so it went really well. When we got to the clinic I was busting, since they needed me to drink lots of water for the external ultrasound. We were shown to a room where I could get changed into the beautiful hospital gown moo-moo. Once again I clipped my insulin pump to the neckline, and we then found I'd cleverly left the Dexcom receiver down in the car! Poor Hubby had to race back down to get it. The embryologist and Dr G both came to see us, and nurse M gave us a gently-toned lecture about keeping my core body temperature after the procedure, and using the progesterone pessaries until told to stop.
We were led through to the OR with the spaceship door, and I had to walk right around the bed and climb on. The lovely nurse D was helping setup the bed with stirrups and towels and stuff, and Hubby took a seat to the left of my head. The ultrasound screen was, as before, to the right of my legs and then - I looked more to the right, past the hatch to the lab - I saw our one little embryo on screen!!!! The photo had been take yesterday when it was just a 6-cell, although the embryologist, M, had said it was now a great looking 8-cell. We only get to transfer 1 embryo since this is a publicly funded cycle, and even then I don't think anyone would be in a hurry to risk multiples in a Type 1 Diabetic woman.
Hubby and I were both shocked at this tiny little thing. Granted, it was magnified to be about 10cm wide on screen (only 125 microns in real life, we later learned) but it was amazing. I am hoping to receive a copy of the pic soon, will share when I get it!
Nurse D squeezed gel on my tummy and used the ultrasound thing to show us my (full) badder and uterus-squashed-flattish-under-said-bladder. She showed us where to look. Then Dr G came in and both of them laughed about how no one had told the lab that we were in here, and how there was some mild role-reversal going on with doc making the call to the lab and nurse working the ultrasound!
The doctor inserted the speculum and did something else, advising me I would feel some "mild tugging" on my cervix. Now, how am I supposed to know what that should feel like, eh? Anyway, to me it felt like a catheter being inserted - I could feel it go the length of the, um, journey into my cervix and there was some mild stingy/cold (very mild), mainly tickley sensations. Not unpleasant at all. Just weird as it was novel. This was not the real deal yet, so I'm now entirely sure what Dr G was doing, a test run maybe?
Next thing they were checking my name and date of birth again, Dr G checked the name matched the petri dish on the shelf at the lab-hatch. The lab tech then loaded up the catheter from the petri dish. I could see her peering under the microscope and taking her time/having a devil of a job scooping up the embryo into the catheter. She passed it carefully through the hatch to the doctor, I made sure to watch the screen and take a deep breath.
Of course, I was looking in the wrong place. I caught the "bright spot" out the corner of my eye right in the centre of the screen, but Hubby saw it no worries. It stayed bright for the time the ultrasound was trained on it, and Dr G told us that it was the bubble of liquid around the embryo that we could see.
And then it was over. I wasn't asked to lie down for an hour. I could get up right away and make my way back to the first room. Cue a stream of nurses all telling me to avoid raising my core body temperature, again. Nurse H, Nurse D, and Dr G all wished us best of luck and that they hoped it would work for us.
So that is that. We drove home this afternoon. I had a horrendous high blood sugar caused by a not so brilliant lunch choice, and that damn progesterone. Seriously, that stuff is an absolute nightmare for a diabetic, let alone one who is now supposed to be watching her blood sugars like a hawk! I am having to set a 20% basal increase for 2hrs every time I have the progesterone, although unlike an injection I never know when it's going to "kick in"! Arrgh!
Apart from that it's all good. Surreal, but good. I don't feel any different and it will be nice just to be calm for a while with no trips back to Hamilton planned for the near future.
p.s. So, you are wondering about the other embryos eh? Well, yesterday the second-best one was a 5-cell and had grown to a 6-cell today. They will culture it on and if it gets to blastocyst stage, then it will go into the freezer. The other one stopped growing at 3-cells. I kinda wished we had at least one more to freeze, knowing that we have had a pretty consistent 40% attrition rate all along this journey. Maybe my stim meds were not strong enough? Oh well. For now, I will wait and see what happens at the end of the 2ww.
p.p.s. Dr G said I have a small polyp on my cervix. Looks benign, but that sux.
Since our appointment was at 11.10am, we didn't rush getting up. I woke at about 7.30am and made us both tea and toast (I am on caffeine free tea, but not being terribly strict about it).
We packed up the motel room and drove down to the lake for a walk. Since it's spring here in NZ, there are just loads of cute baby animals all around. Awww! I saw 3 baby pukekoes and a bunch of ducklings. In case you have never heard of a pukeko, here is a pic:
 |
| Source. These rather prehistoric looking creatures have enormous feet and live in fields and wetlands. |
Focus. Ok, so it went really well. When we got to the clinic I was busting, since they needed me to drink lots of water for the external ultrasound. We were shown to a room where I could get changed into the beautiful hospital gown moo-moo. Once again I clipped my insulin pump to the neckline, and we then found I'd cleverly left the Dexcom receiver down in the car! Poor Hubby had to race back down to get it. The embryologist and Dr G both came to see us, and nurse M gave us a gently-toned lecture about keeping my core body temperature after the procedure, and using the progesterone pessaries until told to stop.
We were led through to the OR with the spaceship door, and I had to walk right around the bed and climb on. The lovely nurse D was helping setup the bed with stirrups and towels and stuff, and Hubby took a seat to the left of my head. The ultrasound screen was, as before, to the right of my legs and then - I looked more to the right, past the hatch to the lab - I saw our one little embryo on screen!!!! The photo had been take yesterday when it was just a 6-cell, although the embryologist, M, had said it was now a great looking 8-cell. We only get to transfer 1 embryo since this is a publicly funded cycle, and even then I don't think anyone would be in a hurry to risk multiples in a Type 1 Diabetic woman.
Hubby and I were both shocked at this tiny little thing. Granted, it was magnified to be about 10cm wide on screen (only 125 microns in real life, we later learned) but it was amazing. I am hoping to receive a copy of the pic soon, will share when I get it!
Nurse D squeezed gel on my tummy and used the ultrasound thing to show us my (full) badder and uterus-squashed-flattish-under-said-bladder. She showed us where to look. Then Dr G came in and both of them laughed about how no one had told the lab that we were in here, and how there was some mild role-reversal going on with doc making the call to the lab and nurse working the ultrasound!
The doctor inserted the speculum and did something else, advising me I would feel some "mild tugging" on my cervix. Now, how am I supposed to know what that should feel like, eh? Anyway, to me it felt like a catheter being inserted - I could feel it go the length of the, um, journey into my cervix and there was some mild stingy/cold (very mild), mainly tickley sensations. Not unpleasant at all. Just weird as it was novel. This was not the real deal yet, so I'm now entirely sure what Dr G was doing, a test run maybe?
Next thing they were checking my name and date of birth again, Dr G checked the name matched the petri dish on the shelf at the lab-hatch. The lab tech then loaded up the catheter from the petri dish. I could see her peering under the microscope and taking her time/having a devil of a job scooping up the embryo into the catheter. She passed it carefully through the hatch to the doctor, I made sure to watch the screen and take a deep breath.
Of course, I was looking in the wrong place. I caught the "bright spot" out the corner of my eye right in the centre of the screen, but Hubby saw it no worries. It stayed bright for the time the ultrasound was trained on it, and Dr G told us that it was the bubble of liquid around the embryo that we could see.
And then it was over. I wasn't asked to lie down for an hour. I could get up right away and make my way back to the first room. Cue a stream of nurses all telling me to avoid raising my core body temperature, again. Nurse H, Nurse D, and Dr G all wished us best of luck and that they hoped it would work for us.
So that is that. We drove home this afternoon. I had a horrendous high blood sugar caused by a not so brilliant lunch choice, and that damn progesterone. Seriously, that stuff is an absolute nightmare for a diabetic, let alone one who is now supposed to be watching her blood sugars like a hawk! I am having to set a 20% basal increase for 2hrs every time I have the progesterone, although unlike an injection I never know when it's going to "kick in"! Arrgh!
Apart from that it's all good. Surreal, but good. I don't feel any different and it will be nice just to be calm for a while with no trips back to Hamilton planned for the near future.
p.s. So, you are wondering about the other embryos eh? Well, yesterday the second-best one was a 5-cell and had grown to a 6-cell today. They will culture it on and if it gets to blastocyst stage, then it will go into the freezer. The other one stopped growing at 3-cells. I kinda wished we had at least one more to freeze, knowing that we have had a pretty consistent 40% attrition rate all along this journey. Maybe my stim meds were not strong enough? Oh well. For now, I will wait and see what happens at the end of the 2ww.
p.p.s. Dr G said I have a small polyp on my cervix. Looks benign, but that sux.
Sunday, October 20, 2013
CD 14: How many embryos made it?
And are we going to be doing a day 3 or day 5 embryo transfer?
Today was the first day I lost my shi*t in this whole thing. I had been getting dreams last night about the embryo transfer and so when I woke up it was the first thing on my mind. I woke at 7.30am, and then had to wait until "lunchtime" for the embryologist to call us with the news of how many embryos had made it overnight.
I didn't realise how attached I would get to them. Those three little potential-people.
MIL was preparing for her first open home so we went around there to help her prepare a bit, and we were just walking in from the garden when I heard a phone ring. I nearly jumped out of my skin and literally yelled at Hubby "PHONE!!!!" He looked at me like I had lost my mind - which I had - and politely told me it was my phone.
I answered, but in my nervousness I couldn't remember how to put it on speakerphone so we were head to hear trying to listen-in. T the embryologist was lovely, and said that of the 3, one of them didn't look so good today. But of the other 2, on looked great and the other was ok. She said "well since we already have our shining star, we will do a day 3 transfer, I have an appointment for you at 11.20am tomorrow morning."
I asked about whether it would be possible to get a photo of the embryos and she said yes she would note that down for us but we would also need to tell the embryologist on tomorrow as it will be her day off. Then I wanted to know if the clinic provided valium or anything for the ET, and she said no. I explained that I had read some things suggesting it would be good to relax the muscles, and she said "stop reading!! I have seen hundreds of ETs over 7 years and there has never been a problem like that" I felt very reassured. We thanked her once again for explaining things so well the other day, and then hung up. We were off to Hamilton again!
Every now and then the enormity of what we are doing just hits me. It is so amazing and scary and exciting. There is such hope. We have been through so many obstacles and although I am trying to think of this as "a chance at a chance" it is becoming more difficult not to get attached to those little embryos. I must try and think of this just as another medical procedure. Stay calm, as going nuts doesn't help and it just puts additional pressure on Hubby.
So we are now up in Hamilton. We have been out for a big meal and I have been writing lesson plans to send to the relief teacher who is looking after my class tomorrow.
Wish us luck. This is a surreal time.
p.s. my sister just clicked that she might become an aunt tomorrow! How cute :)
Today was the first day I lost my shi*t in this whole thing. I had been getting dreams last night about the embryo transfer and so when I woke up it was the first thing on my mind. I woke at 7.30am, and then had to wait until "lunchtime" for the embryologist to call us with the news of how many embryos had made it overnight.
I didn't realise how attached I would get to them. Those three little potential-people.
MIL was preparing for her first open home so we went around there to help her prepare a bit, and we were just walking in from the garden when I heard a phone ring. I nearly jumped out of my skin and literally yelled at Hubby "PHONE!!!!" He looked at me like I had lost my mind - which I had - and politely told me it was my phone.
I answered, but in my nervousness I couldn't remember how to put it on speakerphone so we were head to hear trying to listen-in. T the embryologist was lovely, and said that of the 3, one of them didn't look so good today. But of the other 2, on looked great and the other was ok. She said "well since we already have our shining star, we will do a day 3 transfer, I have an appointment for you at 11.20am tomorrow morning."
I asked about whether it would be possible to get a photo of the embryos and she said yes she would note that down for us but we would also need to tell the embryologist on tomorrow as it will be her day off. Then I wanted to know if the clinic provided valium or anything for the ET, and she said no. I explained that I had read some things suggesting it would be good to relax the muscles, and she said "stop reading!! I have seen hundreds of ETs over 7 years and there has never been a problem like that" I felt very reassured. We thanked her once again for explaining things so well the other day, and then hung up. We were off to Hamilton again!
Every now and then the enormity of what we are doing just hits me. It is so amazing and scary and exciting. There is such hope. We have been through so many obstacles and although I am trying to think of this as "a chance at a chance" it is becoming more difficult not to get attached to those little embryos. I must try and think of this just as another medical procedure. Stay calm, as going nuts doesn't help and it just puts additional pressure on Hubby.
So we are now up in Hamilton. We have been out for a big meal and I have been writing lesson plans to send to the relief teacher who is looking after my class tomorrow.
Wish us luck. This is a surreal time.
p.s. my sister just clicked that she might become an aunt tomorrow! How cute :)
Saturday, October 19, 2013
CD 13: Fertilization report
Happy news! We have 3 good looking fertilized eggs!
Last night I went to visit my parents and got home a bit too late at 10.30pm. Hubby was already asleep! I slept well but was woken rudely by the Dexcom yelling at me that I was low. The first two times the alarm went off, I didn't look at it, rather I dreamed I looked at it and in my dream it said I was high lol. Getting up, doing a test, handling the pump and wobbling about getting juice was not fun, I had pretty much list my balance from a combination of tiredness, hypo, and effects of the sedation and codeine wearing off.
Woke this morning with a really sore throat. I later looked at my throat in the mirror and there are little nodules over my throat :( boo. By tummy felt a lot better and I was comfortable stretching out today. Still had some mild cramping this morning which has since eased, but mainly it feels like I have done a million low-ab crunches.
I took the first of my progesterone pessaries (yuk) called utrogestan, this morning. Little buggers are hard to get into "location"! I feel like I am filling up with little white marbles lol. So far my blood sugars have been going low, which may be a combination of previous hormones wearing off, and tiredness. Not sure if the lows are directly attributable to the progesterone yet, as I normally got higher in that part of my cycle.
Had a shower and by the time I came out into the lounge, Hubby was sitting on the couch with the number for the lab all dialled up and ready to call. We left the embryologist a message and asked her to call back to Hubby's cellphone. With that, we could leave the house knowing we would get the info.
I really wanted a walk, but I knew I wasn't up to that yet. I had read that gentle walking is good to help stimulate blood flow to the endometrium lining so that's another good reason to get up and about.
We had to get a warrant of fitness check for our car and it turned out that we needed a new tyre. At the tyre shop they were able to do it right away so we went for a gentle stroll into town and back for 20 mins. I have never wanted to sit down so badly! But it was excellent to get a walk to loosen up all my muscles.
We took the car back to the testing station and while standing in the carpark, in the glorious spring sunshine waiting for the re-check, we got the call from the embryologist, T.
I suddenly got a rush of worry and trepidation and nerves. Her first words gave no indication of what sort of news she was about to deliver. I was simultaneously deciding that it was bad news and that I wasn't sure what my reaction would be in the carpark, and I was making deals with myself about how many embryos would be "good" or "ok". I was silently hoping for 3.
When she said "it's good news" I just about sank with relief. T went on to explain how out of the 5 eggs, 3 has fertilized normally and looked great, one more had fertilized abnormally and failed to eject one of the DNA halves it needed to, and the fifth failed to fertilize at all. 3!!! Thats a 60% fertilization rate. Yay!!!! It's so amazing to think that we have just created 3 potential people!
The embryologist will phone us again tomorrow about lunch time to tell us how the three of the have grown/not-grown overnight. She will also be able to advise us whether we will need a day 3 or day 5 transfer. Today is day 1. If we need to do a day 3 transfer then we will be back on the road again tomorrow after lunch.
T had previously explained how there are pros and cons with transfers on both days 3 and 5. If there are only a few embryos then a day 3 ET is more likely, however if there are more then they might choose a 5 day ET to grow some on to blastocyst stage. Of course, it might mean that none grow-on, but as she pointed out that would just save us from a 2ww to find out the same result. However she also pointed out that some people believe a day 3 ET is better to grow the embryo in the natural surroundings, so to speak. I am not fussed. I kind of expect a day 3 ET simply because we only have 3 embryos (as of today) but I'm not fussed either way.
My boss and friend at work both know what's going on and they support me, so I will be able to take sick leave for either time. Actually, there's not really an option is there? I mean it's not like you can move this sort of appointment lol!
Symptoms today: I'm generally feeling much better. My brain has mostly returned. The nips have been incredibly tender and almost clenched? Well, painful anyway. They did start to relax a bit today. I had some minor bleeding from the egg retrieval yesterday which is petering out today. All in all I'm feeling... well. :D
I went very high after a lunch with MIL (damned pizza and cake :( boo) and actually slept for a couple of hours. Hubby cooked another lovely dinner of gurnard fish, roast potatoes and a salad with almond and Parmesan on top.
And now we are watching an old James Bond movie :)
Last night I went to visit my parents and got home a bit too late at 10.30pm. Hubby was already asleep! I slept well but was woken rudely by the Dexcom yelling at me that I was low. The first two times the alarm went off, I didn't look at it, rather I dreamed I looked at it and in my dream it said I was high lol. Getting up, doing a test, handling the pump and wobbling about getting juice was not fun, I had pretty much list my balance from a combination of tiredness, hypo, and effects of the sedation and codeine wearing off.
Woke this morning with a really sore throat. I later looked at my throat in the mirror and there are little nodules over my throat :( boo. By tummy felt a lot better and I was comfortable stretching out today. Still had some mild cramping this morning which has since eased, but mainly it feels like I have done a million low-ab crunches.
I took the first of my progesterone pessaries (yuk) called utrogestan, this morning. Little buggers are hard to get into "location"! I feel like I am filling up with little white marbles lol. So far my blood sugars have been going low, which may be a combination of previous hormones wearing off, and tiredness. Not sure if the lows are directly attributable to the progesterone yet, as I normally got higher in that part of my cycle.
Had a shower and by the time I came out into the lounge, Hubby was sitting on the couch with the number for the lab all dialled up and ready to call. We left the embryologist a message and asked her to call back to Hubby's cellphone. With that, we could leave the house knowing we would get the info.
I really wanted a walk, but I knew I wasn't up to that yet. I had read that gentle walking is good to help stimulate blood flow to the endometrium lining so that's another good reason to get up and about.
We had to get a warrant of fitness check for our car and it turned out that we needed a new tyre. At the tyre shop they were able to do it right away so we went for a gentle stroll into town and back for 20 mins. I have never wanted to sit down so badly! But it was excellent to get a walk to loosen up all my muscles.
We took the car back to the testing station and while standing in the carpark, in the glorious spring sunshine waiting for the re-check, we got the call from the embryologist, T.
I suddenly got a rush of worry and trepidation and nerves. Her first words gave no indication of what sort of news she was about to deliver. I was simultaneously deciding that it was bad news and that I wasn't sure what my reaction would be in the carpark, and I was making deals with myself about how many embryos would be "good" or "ok". I was silently hoping for 3.
When she said "it's good news" I just about sank with relief. T went on to explain how out of the 5 eggs, 3 has fertilized normally and looked great, one more had fertilized abnormally and failed to eject one of the DNA halves it needed to, and the fifth failed to fertilize at all. 3!!! Thats a 60% fertilization rate. Yay!!!! It's so amazing to think that we have just created 3 potential people!
The embryologist will phone us again tomorrow about lunch time to tell us how the three of the have grown/not-grown overnight. She will also be able to advise us whether we will need a day 3 or day 5 transfer. Today is day 1. If we need to do a day 3 transfer then we will be back on the road again tomorrow after lunch.
T had previously explained how there are pros and cons with transfers on both days 3 and 5. If there are only a few embryos then a day 3 ET is more likely, however if there are more then they might choose a 5 day ET to grow some on to blastocyst stage. Of course, it might mean that none grow-on, but as she pointed out that would just save us from a 2ww to find out the same result. However she also pointed out that some people believe a day 3 ET is better to grow the embryo in the natural surroundings, so to speak. I am not fussed. I kind of expect a day 3 ET simply because we only have 3 embryos (as of today) but I'm not fussed either way.
My boss and friend at work both know what's going on and they support me, so I will be able to take sick leave for either time. Actually, there's not really an option is there? I mean it's not like you can move this sort of appointment lol!
Symptoms today: I'm generally feeling much better. My brain has mostly returned. The nips have been incredibly tender and almost clenched? Well, painful anyway. They did start to relax a bit today. I had some minor bleeding from the egg retrieval yesterday which is petering out today. All in all I'm feeling... well. :D
I went very high after a lunch with MIL (damned pizza and cake :( boo) and actually slept for a couple of hours. Hubby cooked another lovely dinner of gurnard fish, roast potatoes and a salad with almond and Parmesan on top.
And now we are watching an old James Bond movie :)
CD 12: Egg retrieval procedure
Please forgive me if this post makes less sense than usual, or rambles, as I am still awash with codeine!
Good news! We got 5 excellent looking eggs! I'm really happy with this and the embryologist said they all look the have good membranes.
By now, we may have a 7-hour-old! How crazy is that?
Started off this morning very early with a light breakfast at 5.40am (4hrs prior to OPU) and then napped until 7am. I got up, had a shower, got dressed and we packed up the car and drove over to the fertility clinic at 9am.
As normal we checked in and were given little slips of paper to take across to the other side of the building. Mine said OPU 9.40am (oocyte pick-up) and Hubby's said sperm sample! I told the receptionist that wouldn't be necessary or possible since Hubby had to have TESA sperm retrieval, but on closer inspection the form said "from andrology" so it must just have been a "defrost this please" note lol.
We were in the waiting room long enough for me to look through a couple pages of the morning paper, and then our old nurse came out to take us through to the Pre-op/post-op room with the armchair.
We got talking about diabetes and she told us how she has struggled with T2 and so has her family. It was nice to share with her, and Hubby showed her the Dexcom while I went to the bathroom.
Then started an onslaught of nurses, doctors, embryologists all checking my name and date of birth. I had yet more forms to fill out, and they must have told me all about everything at least thrice.
I was very impressed with the embryologist, T, who told us how she feels a great responsibility to take get time to search for the best quality sperm from a sample, since she is choosing the DNA of our potential future children. We asked her when exactly would the ICSI fertilization take place, and she said she would start the process at 2pm, carefully washing the eggs, then putting then in an acid solution to remove the outer membrane. She would then take her time looking for good quality sperm to fertilize all the eggs with. She reckoned that 2.30pm should be about fertilization time! :D
---- I had a break from writing, got a bit tired! ----
Anyway, after the doctor tried to come in several times only to find the nurse and I were busy chatting (she took my blood pressure too - slightly raised for me), she was finally able to put in the cannula for the IV. I only told her afterwards what a drama it was last time!
It made a lot of difference having a plan to manage diabetes, and having the medical folks take it seriously. I made sure that I remained calm (and I truly never got stressed even when I got locked OUT of the OR! Lol) as it can affect my blood sugars and make them drop rapidly.
Getting the cannula in meant that I could have IV dextrose should I need it, and having the early breakfast ensured I had a "buffer" in the tank. But the Dexcom was the absolute winner on the day. Hubby could hold on to the receiver and manage it, we even practiced with him testing my blood sugar via fingerprick test the night before. We made sure to tell all nurses and the doctor that the alarms might go off and not to panic. We were able to discuss with Dr G how she would give small boluses of 20% dextrose should I go hypo.
I was now in my stylish white hospital-moo-moo gown and I clipped the insulin pump to the neckline. I was told to go to the bathroom one last time, and then it was show time!
When I came out of the bathroom the pre-op room was empty, but I could hear Hubby's voice behind the big wooden spaceship theatre door. They were saying "push the green button!" and once I figured out they were talking to me, I let myself into the OR!
Setup similarly to when Hubby had his sperm retrieval, the bed was on the left and I had to walk around him at the head of the bed, around the ultra-sound machine at the foot, past the hatch to the embryo-makin' lab, and climb on from the other side.
The stirrups were padded, but they still freaked me out a bit. I knew that there would be lots of scary equipment in there so I guess I was prepared for it. I hopped up (carefully this time!) and the two nurses, H and P, kept wanting me to shuffle down the bed. I got my calves in the stirrups and they laid a large white towel across me and asked me to shuffle the bottom of my gown/moo-moo up.
--- got tired again and had some dinner! ---
While one nurse attached a blood pressure cuff to my right arm, and a blood-oxygen monitor to my left index finger (which kept slipping, causing me to adjust it, causing the nurse to scold me for moving my IV arm hehe!), the other nurse was placing black drapes over my legs to keep them warm. They unhooked the "bum" of the bed and suddenly the towel didn't feel like enough coverage lol!
The doctor appeared at the foot of the bed and asked me my weight, she then used this to calculate the dosage of midazolam and fentanyl. The nurse gave me these (and some augmentin antibiotic since I'm T1) and warned I would start to feel loopy. I got a rush of cold choking feeling all up around my neck and got a bit worried, but everyone quickly reassured me that would just be because the medication was cold.
Hubby was right by my side and kept his hand on my right shoulder. :D
The drugs took effect very quickly and I got loopy really fast! I was intent on watching the ultrasound screen - I really wanted to see my eggs! - but it was all mostly hazy. I don't remember seeing the hatch or hearing the embryologist to my right at all, although she was well within earshot.
I felt the ultrasound probe and then the doctor told me to take a deep breath and she went in for the right ovary. There was pain which made me wince, but it was over relatively fast. Two eggs retrieved on the right. I knew I'd seen 3 there the other day so my brain was still working, sort of. I was awake enough to make jokes and be surprised at how awake I was. The sedation was pretty light, but I was really loopy.
Another breath, now the left side. This one was a lot more painful, and it got worse in the seconds following the needle going in, a kind of wrenching movement. I described the nature of the pain later to Hubby as being similar to when you get an intra-muscular injection in your arm, well think of a wider needle, and then imagine you get a really bad cramp in the muscle the moment of the injection. Yes it hurt, but it was very short lived feeling and I got instant relief once the needle was out. I later learned we got 3 on the left side.
It was over! We had eggs! I was really happy to be through it, and to know that it was a calm, happy, exciting experience. Yes there was some pain but it wasn't too bad and it felt like it was only a total of 30 seconds.
It seemed like after all the activity, there was a lull for a minute. The doctor and nurses seemed to vanish out of the room (probably just out of my line of sight) and I recall a kiss with my Hubby and him telling me he loved me and how brave I was. It was pure relief.
Nurse H took my blood pressure one last time and then re-installed the end of the bed and helped me take my legs out of the stirrups. I was unhooked from all the monitors and the nurse put a pad in my knickers and then got me to slide into them while half sitting up.
Then came the slow ascent to sitting up, swinging my legs down to the left. They made me wait until I was steady enough to stand and then Nurse H helped me up and held me steady from behind by each upper arm as she walked me back to the pre-op/post-op room. I sat in the big armchair and she wrapped me up in one of those flannel blanket sheet things. Nurse P brought in a tray of tea, coffee for Hubby, and plain biscuits. The embryologist popped in to say there were a total of 5 high quality eggs retrieved. Dr G came in on a couple of occasions to check on me. Two nurses and the doc all explained on separate occasions how to use the progesterone suppositories which I have take for 5 days at least! Eew!
Oh, the embryologist wrote her direct dial number down as I have to call her at 10am tomorrow (Sat) morning to learn how many have fertilized.
She will also call us on Sunday to advise whether a day 3 or day 5 embryo transfer will be best. Looks like we will be back in Hamilton on Monday or Wednesday!
We waited about an hour then I was awake enough to leave and we went to get lunch at our favorite kitchen. I picked up the prescription for codeine and then we set off home. I took another 2 codeine tablets after the one at the clinic, but the ride home was fairly loopy and dozy, although we were both pretty happy about how well things went.
After the clinic meds and the initial Codeine wore off I got some sharp stabby cramps so took another tab. I have had mild to moderate cramps for the rest of the day, although not too bad. I can walk carefully but no long distances - by which I mean walking from the house to the car is plenty!
It was great to get home and see the pets. My friends and family were all texting me supportive texts, and after a yummy dinner cooked by Hubby, he dropped me around to my parents and my Mum cut my hair for me! Win!
Please cross your fingers, wish me luck, say a little something, or think a happy thought for good news from the embryologist tomorrow! Thank you! :D
Good news! We got 5 excellent looking eggs! I'm really happy with this and the embryologist said they all look the have good membranes.
By now, we may have a 7-hour-old! How crazy is that?
Started off this morning very early with a light breakfast at 5.40am (4hrs prior to OPU) and then napped until 7am. I got up, had a shower, got dressed and we packed up the car and drove over to the fertility clinic at 9am.
As normal we checked in and were given little slips of paper to take across to the other side of the building. Mine said OPU 9.40am (oocyte pick-up) and Hubby's said sperm sample! I told the receptionist that wouldn't be necessary or possible since Hubby had to have TESA sperm retrieval, but on closer inspection the form said "from andrology" so it must just have been a "defrost this please" note lol.
We were in the waiting room long enough for me to look through a couple pages of the morning paper, and then our old nurse came out to take us through to the Pre-op/post-op room with the armchair.
We got talking about diabetes and she told us how she has struggled with T2 and so has her family. It was nice to share with her, and Hubby showed her the Dexcom while I went to the bathroom.
Then started an onslaught of nurses, doctors, embryologists all checking my name and date of birth. I had yet more forms to fill out, and they must have told me all about everything at least thrice.
I was very impressed with the embryologist, T, who told us how she feels a great responsibility to take get time to search for the best quality sperm from a sample, since she is choosing the DNA of our potential future children. We asked her when exactly would the ICSI fertilization take place, and she said she would start the process at 2pm, carefully washing the eggs, then putting then in an acid solution to remove the outer membrane. She would then take her time looking for good quality sperm to fertilize all the eggs with. She reckoned that 2.30pm should be about fertilization time! :D
---- I had a break from writing, got a bit tired! ----
Anyway, after the doctor tried to come in several times only to find the nurse and I were busy chatting (she took my blood pressure too - slightly raised for me), she was finally able to put in the cannula for the IV. I only told her afterwards what a drama it was last time!
It made a lot of difference having a plan to manage diabetes, and having the medical folks take it seriously. I made sure that I remained calm (and I truly never got stressed even when I got locked OUT of the OR! Lol) as it can affect my blood sugars and make them drop rapidly.
Getting the cannula in meant that I could have IV dextrose should I need it, and having the early breakfast ensured I had a "buffer" in the tank. But the Dexcom was the absolute winner on the day. Hubby could hold on to the receiver and manage it, we even practiced with him testing my blood sugar via fingerprick test the night before. We made sure to tell all nurses and the doctor that the alarms might go off and not to panic. We were able to discuss with Dr G how she would give small boluses of 20% dextrose should I go hypo.
I was now in my stylish white hospital-moo-moo gown and I clipped the insulin pump to the neckline. I was told to go to the bathroom one last time, and then it was show time!
When I came out of the bathroom the pre-op room was empty, but I could hear Hubby's voice behind the big wooden spaceship theatre door. They were saying "push the green button!" and once I figured out they were talking to me, I let myself into the OR!
Setup similarly to when Hubby had his sperm retrieval, the bed was on the left and I had to walk around him at the head of the bed, around the ultra-sound machine at the foot, past the hatch to the embryo-makin' lab, and climb on from the other side.
The stirrups were padded, but they still freaked me out a bit. I knew that there would be lots of scary equipment in there so I guess I was prepared for it. I hopped up (carefully this time!) and the two nurses, H and P, kept wanting me to shuffle down the bed. I got my calves in the stirrups and they laid a large white towel across me and asked me to shuffle the bottom of my gown/moo-moo up.
--- got tired again and had some dinner! ---
While one nurse attached a blood pressure cuff to my right arm, and a blood-oxygen monitor to my left index finger (which kept slipping, causing me to adjust it, causing the nurse to scold me for moving my IV arm hehe!), the other nurse was placing black drapes over my legs to keep them warm. They unhooked the "bum" of the bed and suddenly the towel didn't feel like enough coverage lol!
The doctor appeared at the foot of the bed and asked me my weight, she then used this to calculate the dosage of midazolam and fentanyl. The nurse gave me these (and some augmentin antibiotic since I'm T1) and warned I would start to feel loopy. I got a rush of cold choking feeling all up around my neck and got a bit worried, but everyone quickly reassured me that would just be because the medication was cold.
Hubby was right by my side and kept his hand on my right shoulder. :D
The drugs took effect very quickly and I got loopy really fast! I was intent on watching the ultrasound screen - I really wanted to see my eggs! - but it was all mostly hazy. I don't remember seeing the hatch or hearing the embryologist to my right at all, although she was well within earshot.
I felt the ultrasound probe and then the doctor told me to take a deep breath and she went in for the right ovary. There was pain which made me wince, but it was over relatively fast. Two eggs retrieved on the right. I knew I'd seen 3 there the other day so my brain was still working, sort of. I was awake enough to make jokes and be surprised at how awake I was. The sedation was pretty light, but I was really loopy.
Another breath, now the left side. This one was a lot more painful, and it got worse in the seconds following the needle going in, a kind of wrenching movement. I described the nature of the pain later to Hubby as being similar to when you get an intra-muscular injection in your arm, well think of a wider needle, and then imagine you get a really bad cramp in the muscle the moment of the injection. Yes it hurt, but it was very short lived feeling and I got instant relief once the needle was out. I later learned we got 3 on the left side.
It was over! We had eggs! I was really happy to be through it, and to know that it was a calm, happy, exciting experience. Yes there was some pain but it wasn't too bad and it felt like it was only a total of 30 seconds.
It seemed like after all the activity, there was a lull for a minute. The doctor and nurses seemed to vanish out of the room (probably just out of my line of sight) and I recall a kiss with my Hubby and him telling me he loved me and how brave I was. It was pure relief.
Nurse H took my blood pressure one last time and then re-installed the end of the bed and helped me take my legs out of the stirrups. I was unhooked from all the monitors and the nurse put a pad in my knickers and then got me to slide into them while half sitting up.
Then came the slow ascent to sitting up, swinging my legs down to the left. They made me wait until I was steady enough to stand and then Nurse H helped me up and held me steady from behind by each upper arm as she walked me back to the pre-op/post-op room. I sat in the big armchair and she wrapped me up in one of those flannel blanket sheet things. Nurse P brought in a tray of tea, coffee for Hubby, and plain biscuits. The embryologist popped in to say there were a total of 5 high quality eggs retrieved. Dr G came in on a couple of occasions to check on me. Two nurses and the doc all explained on separate occasions how to use the progesterone suppositories which I have take for 5 days at least! Eew!
Oh, the embryologist wrote her direct dial number down as I have to call her at 10am tomorrow (Sat) morning to learn how many have fertilized.
She will also call us on Sunday to advise whether a day 3 or day 5 embryo transfer will be best. Looks like we will be back in Hamilton on Monday or Wednesday!
We waited about an hour then I was awake enough to leave and we went to get lunch at our favorite kitchen. I picked up the prescription for codeine and then we set off home. I took another 2 codeine tablets after the one at the clinic, but the ride home was fairly loopy and dozy, although we were both pretty happy about how well things went.
After the clinic meds and the initial Codeine wore off I got some sharp stabby cramps so took another tab. I have had mild to moderate cramps for the rest of the day, although not too bad. I can walk carefully but no long distances - by which I mean walking from the house to the car is plenty!
It was great to get home and see the pets. My friends and family were all texting me supportive texts, and after a yummy dinner cooked by Hubby, he dropped me around to my parents and my Mum cut my hair for me! Win!
Please cross your fingers, wish me luck, say a little something, or think a happy thought for good news from the embryologist tomorrow! Thank you! :D
Wednesday, October 16, 2013
CD 10: Blood test and trigger shot
I was full of beans for most of today even after the huge road trip (9.5hrs) yesterday, trying to get home from the clinic through a storm, floods, slips, bridges out, trees fallen over!
The fertility clinic had called yesterday and advised that I would need a blood test this morning (progesterone and something else...?) so I was up early, had my last Orgalutran injection, then it was off to the med lab to visit the vampires. I passed over my "regular fertility patient" card for the first time, and decided to get an HbA1c while I was there. The technician was really great and told me an awesome story about the last time she got stuck on the road after a crash involving, of all things, a molasses truck. Good times.
Work was alright and I taught my class fine. In the after-lunch session the nurse called to advise me of the exact time for the trigger shot (Ovidrel): 9.40pm tonight. Since the egg collection will be precisely 36hrs after trigger, that means our appointment will be 9.40am on Friday morning (CD 12).
Mid-afternoon I felt absolutely exhausted. Yesterday is really catching up with me! I went around to have a chat with my Mum, and the Dr G (who did the scan yesterday) called twice to give me advice about the egg retrieval procedure. I can't eat for 4, preferably 6 hrs before the procedure, and can't drink for 2hrs prior. If I go low I can manage things with small amounts of clear apple juice, but the doc would really prefer if I woke up early and ate a small breakfast (this would be at 5.40am). At one point she wanted me to disconnect the insulin pump altogether as she thought that would prevent hypos, but I quickly informed her that it delivers my basal and I can't take it off. She was cool with it once I explained the difference between basal and bolus doses, but man, I really hate when other medical professionals (especially well meaning ones I have only just met) make sweeping proclamations about Type 1 Diabetes management! She wanted to know what model of pump I had, cos, she said, if I had one of the newer ones with the cgm capability that would be better. Why yes, yes I do have one of those, and Animas Vibe with Dexcom CGM and it is fantastic. I should have done it ages ago. But hey.
Paracetemol (acetiminophen) is contra-indicated with the Dexcom, and the nurse yesterday had asked me to take 3 x panadol tabs before the procedure. Dr G confirmed that I could just skip that altogether as it would be far better to have Hubby able to monitor my blood sugars, and they could manage my pain with fentanyl and codeine... good stuff. Codeine normally doesn't cut pain for me, it only makes me loopy. And I have had fentanyl before with no pain so I figure I should be fine. I confirmed that they will have a dextrose drip handy should I go low during the egg collection, and to get the cannula line in as soon as possible. That's all I really wanted them to do. I did not want suggestions on the pump or anything, I can do that thanks, been doing diabetes management for 25 years, and now Hubby and I have the Dexcom it's taken it, in his words "from a dark art to a manageable science." Indeed.
Oh, and I also had to do an infusion site change, and a dexcom site change! I was working my way through those site changes methodically while Hubby cooked dinner, and it took me over half an hour. By the end of it I thought I was going to slide off my chair with tiredness, but a tasty dinner of fish cakes, bacon, eggs on toast worked well to perk me up.
I took a shower after dinner, and didn't hear any of the reminder alarms going off telling me to take the Ovidrel. Whoops! step out of the shower and the insulin pumps says 9.39pm OMG rush out dripping and rip the Ovidrel out of the fridge. I quickly prepped my skin with an alcohol wipe and stabbed it in no probs. But man, I could have thrown the whole schedule out of whack!
No drugs or anything tomorrow. We have been madly checking the road closure websites, and it looks like we should be able to take our preferred route up tomorrow afternoon. Although Hubby has also been checking the airlines to make sure we can take a flight should it all go pear shaped! I figure we are setting off the afternoon prior to our appointment for a 3 hr journey, that should give us enough time to drive even the longest way should we need it. But I have to teach one more class tomorrow before we leave. Thankfully I will only miss one class this week (I don't teach Friday's on this semester) and then maybe another couple of days next week if we get to embryo transfer. Fingers crossed. I believe I am calm now, but I suspect I might get more tense and nervous once the transfer takes place cos then it's just up to me.
The fertility clinic had called yesterday and advised that I would need a blood test this morning (progesterone and something else...?) so I was up early, had my last Orgalutran injection, then it was off to the med lab to visit the vampires. I passed over my "regular fertility patient" card for the first time, and decided to get an HbA1c while I was there. The technician was really great and told me an awesome story about the last time she got stuck on the road after a crash involving, of all things, a molasses truck. Good times.
Work was alright and I taught my class fine. In the after-lunch session the nurse called to advise me of the exact time for the trigger shot (Ovidrel): 9.40pm tonight. Since the egg collection will be precisely 36hrs after trigger, that means our appointment will be 9.40am on Friday morning (CD 12).
Mid-afternoon I felt absolutely exhausted. Yesterday is really catching up with me! I went around to have a chat with my Mum, and the Dr G (who did the scan yesterday) called twice to give me advice about the egg retrieval procedure. I can't eat for 4, preferably 6 hrs before the procedure, and can't drink for 2hrs prior. If I go low I can manage things with small amounts of clear apple juice, but the doc would really prefer if I woke up early and ate a small breakfast (this would be at 5.40am). At one point she wanted me to disconnect the insulin pump altogether as she thought that would prevent hypos, but I quickly informed her that it delivers my basal and I can't take it off. She was cool with it once I explained the difference between basal and bolus doses, but man, I really hate when other medical professionals (especially well meaning ones I have only just met) make sweeping proclamations about Type 1 Diabetes management! She wanted to know what model of pump I had, cos, she said, if I had one of the newer ones with the cgm capability that would be better. Why yes, yes I do have one of those, and Animas Vibe with Dexcom CGM and it is fantastic. I should have done it ages ago. But hey.
Paracetemol (acetiminophen) is contra-indicated with the Dexcom, and the nurse yesterday had asked me to take 3 x panadol tabs before the procedure. Dr G confirmed that I could just skip that altogether as it would be far better to have Hubby able to monitor my blood sugars, and they could manage my pain with fentanyl and codeine... good stuff. Codeine normally doesn't cut pain for me, it only makes me loopy. And I have had fentanyl before with no pain so I figure I should be fine. I confirmed that they will have a dextrose drip handy should I go low during the egg collection, and to get the cannula line in as soon as possible. That's all I really wanted them to do. I did not want suggestions on the pump or anything, I can do that thanks, been doing diabetes management for 25 years, and now Hubby and I have the Dexcom it's taken it, in his words "from a dark art to a manageable science." Indeed.
Oh, and I also had to do an infusion site change, and a dexcom site change! I was working my way through those site changes methodically while Hubby cooked dinner, and it took me over half an hour. By the end of it I thought I was going to slide off my chair with tiredness, but a tasty dinner of fish cakes, bacon, eggs on toast worked well to perk me up.
I took a shower after dinner, and didn't hear any of the reminder alarms going off telling me to take the Ovidrel. Whoops! step out of the shower and the insulin pumps says 9.39pm OMG rush out dripping and rip the Ovidrel out of the fridge. I quickly prepped my skin with an alcohol wipe and stabbed it in no probs. But man, I could have thrown the whole schedule out of whack!
No drugs or anything tomorrow. We have been madly checking the road closure websites, and it looks like we should be able to take our preferred route up tomorrow afternoon. Although Hubby has also been checking the airlines to make sure we can take a flight should it all go pear shaped! I figure we are setting off the afternoon prior to our appointment for a 3 hr journey, that should give us enough time to drive even the longest way should we need it. But I have to teach one more class tomorrow before we leave. Thankfully I will only miss one class this week (I don't teach Friday's on this semester) and then maybe another couple of days next week if we get to embryo transfer. Fingers crossed. I believe I am calm now, but I suspect I might get more tense and nervous once the transfer takes place cos then it's just up to me.
Tuesday, October 15, 2013
CD 8 + 9: A Scan and a Mega Road Trip
Wow. What a way to spend a Tuesday. We have just returned from the clinic where we did the first ultrasound scan to check this IVF cycle is on track.
Results: Yes, all good.
Lining = 7.9 mm
Left side: 12, 16, 14, and 13 mm follicles
Right side: 16, 16, and 14 mm follicles
Total of 7, although the nurse said at this stage only 6 of them will probably be useful.
The scan itself was the only part of the day that went well.
We started off getting up nice and early, and realising we had forgotten to pack any breakfast and wouldn't have time to get to our favourite cafe. I was due to have a FSH and Oestradiol blood test early enough to get the results in to the clinic. Got over to the path lab at 8.05am and I walked in while Hubby waited in the car. The waiting room was about a third full, and I started the-first-of-the-things-to-go-wrong! It took over 35 mins for the technician to call my name, which was plenty of time for Hubby to get worried and come looking for me.
We hurried out of there, and had 20 mins so we skipped around the corner to a cafe and got a quick bite of quiche lorraine and a cuppa tea.
In the clinic doors and up to the reception. The clinic is arranged with two wings, I like to call them the "office" and "doctor" wings. I was expecting us to be led through to the office wing to have the scan, like last time, but instead we were given a slip of paper and told to go across to the doctor wing. The doctor wing has no reception, and you have to just wait, in limbo, in the waiting room for the locked doctor-doors to open. Sometimes someone in the office will take pity and come and check on you, but most of the time we get left there for ages staring at the horrid crart (craft-art).
The nurse associated with our old Dr R came out to see us, and informed us that we were terribly early. To which I said, no, you are 6 mins late! She then pointed to the slip of paper and it did indeed say 10.22am. We had been told 9.10am!!! "Oh! But so-and-so called you yesterday and left a message!" I said no, I got no messages and no phone calls. I have asked them who-knows how many times to EMAIL ME. How hard is that? This nurse gets super-defensive very quickly, and sure enough she was intimating that I didn't know how to work my phone, or Hubby his phone, or either of us our home phone!! Grrr. Long story short we had another hours wait, so we took off and drove to a mall. I was wanting a bit of walk and it was raining, so a mall seemed like a semi-tolerable option. Of course, as soon as we got there it was time to turn around and come back. Red lights all the way back to the clinic.
When we strode into the doctor side for the second time, there were two other couples (?) in the waiting room. One of them had a toddler (! Why would you do this??? To the other patients? I mean really? You brought your CHILD to a fertility clinic. Words fail me.) and when a passing nurse asked who we were and what time our appointment was for, I said "9.10" this patient-with-toddler snidely commented "9.10!!" because we were now a tad late. Grr. Anyway we were hurried through the locked doors and I was asked to go for a wee then join Hubby and the doc in the scan room.
A new nurse, a new doc. Just whoever was on-call. I don't know their names. "Just take your bottom-things off" I nearly cracked up. Damn, should not have worn skin-tight skinny jeans! Doh! I was just hopping up on the exam table when the doc whipped back the curtain and at the very same moment my knee went through a hole in the table! Turns out it is a fancy pants table/bed and most people do not get on it knee first. lol.
Ice broken.
The scan went well, no pain at all. See the good scan results above. 7 follies. Definitely no over stimulation. Whew.
Pants on, go next door to get more drugs and talk to the nurse.
Turns out the egg retrieval will be this Friday (3 days away CD 12). I have one more stim injection of Puregon which I have given myself tonight (Tues CD 9). Tomorrow morning (Weds CD 10) I have the last Orgalutran injection, and in the afternoon the clinic will call to tell me what time to give the trigger Ovidrel injection. It has to be given exactly 36hrs prior to the egg collection procedure.
We asked what that procedure would be like, and the nurse said it was done under sedation (hyponovel and fentanyl) and should take about 10 - 15 mins in theatre. I asked to have a dextrose IV ready, and Hubby asked to have the IV cannula inserted as early as possible because we have learnt from prior surgery that a diabetic hypo + collapsed veins = no fun. The nurse agreed that this was all a good idea, and then said "so are you what, type 1 diabetic?" This was after telling her directly that I was type 1 diabetic, and showing her my dexcom and insulin pump prior to the scan to check it wouldn't interfere with the ultrasound. So she finally understood (at one point she thought it was Hubby who was the diabetic one! Read the medical notes PLEASE) and went to check with another doc if the egg retrieval procedure could be scheduled as late as possible so that I could still eat breakfast on Friday morning. This was after telling her not to worry, and that I would prefer the first appointment actually, and that I could miss a meal now that I am on the pump. People hear what they want to hear, not what you tell them sometimes.
She gave us these drugs:
Puregon (Tuesday night, 150 units) (for the record, I had an unexpected low blood sugar 30 mins after injection. Don't know if it's related or not.)
Orgalutran (for tomorrow morning, this one is to prevent premature ovulation)
Ovidrel (this one is the trigger injection and is to be given 36 hrs before egg collection)
It was a bit hilarious being taught how to use the puregon pen, considering I had been doing multiple daily injections for diabetes since I was 5. Still good to watch and just make sure there was nothing new to see.
We got out of there are started the drive home knowing that a major storm had just thrashed the north island and the road south was currently closed.
The trip should consist of 3 hrs in the car going across one mountain.
It ended up taking us 9.5 hrs, and we went to 3 cities, tried to get over 1 mountain, went around 2 other mountains, across a gazillion rivers, through a million puddles, past a trillion slips and goats, and got turned back back sorry-for-themselves looking road workers in orange jackets telling us "the bridge has been washed away" "there is severe flooding" "you will have to go back" "the road is closed".
We were trying to go from a northern region to the south-western region. We ended up having to go south-east, then more south, then more east, then very south, to come right around and enter the western region from the south instead of the north! It was the longest road trip of my life and it is the only occasion that I have physically been unable to get to my homeland. At one point, I considered how it would have been easier to fly to Australia and back in, rather than drive!
But we are finally home. Everything went wrong except for the scan!
Oh, and I have to go in for a blood test tomorrow morning, do an infusion site change, and teach a class. Oh and re-book the motel for Friday. I need a nap.
p.s. If you're wondering what happened to CD 8: I went to work and taught class in the morning, then we drove up to Hamilton and checked into the motel. I had my Orgalutran injection in the morning and did a +20% temp basal increase for 4 hours which worked great guns.
Results: Yes, all good.
Lining = 7.9 mm
Left side: 12, 16, 14, and 13 mm follicles
Right side: 16, 16, and 14 mm follicles
Total of 7, although the nurse said at this stage only 6 of them will probably be useful.
 |
| My scribbly notes from the meeting post-scan with the nurse. |
We started off getting up nice and early, and realising we had forgotten to pack any breakfast and wouldn't have time to get to our favourite cafe. I was due to have a FSH and Oestradiol blood test early enough to get the results in to the clinic. Got over to the path lab at 8.05am and I walked in while Hubby waited in the car. The waiting room was about a third full, and I started the-first-of-the-things-to-go-wrong! It took over 35 mins for the technician to call my name, which was plenty of time for Hubby to get worried and come looking for me.
We hurried out of there, and had 20 mins so we skipped around the corner to a cafe and got a quick bite of quiche lorraine and a cuppa tea.
In the clinic doors and up to the reception. The clinic is arranged with two wings, I like to call them the "office" and "doctor" wings. I was expecting us to be led through to the office wing to have the scan, like last time, but instead we were given a slip of paper and told to go across to the doctor wing. The doctor wing has no reception, and you have to just wait, in limbo, in the waiting room for the locked doctor-doors to open. Sometimes someone in the office will take pity and come and check on you, but most of the time we get left there for ages staring at the horrid crart (craft-art).
The nurse associated with our old Dr R came out to see us, and informed us that we were terribly early. To which I said, no, you are 6 mins late! She then pointed to the slip of paper and it did indeed say 10.22am. We had been told 9.10am!!! "Oh! But so-and-so called you yesterday and left a message!" I said no, I got no messages and no phone calls. I have asked them who-knows how many times to EMAIL ME. How hard is that? This nurse gets super-defensive very quickly, and sure enough she was intimating that I didn't know how to work my phone, or Hubby his phone, or either of us our home phone!! Grrr. Long story short we had another hours wait, so we took off and drove to a mall. I was wanting a bit of walk and it was raining, so a mall seemed like a semi-tolerable option. Of course, as soon as we got there it was time to turn around and come back. Red lights all the way back to the clinic.
When we strode into the doctor side for the second time, there were two other couples (?) in the waiting room. One of them had a toddler (! Why would you do this??? To the other patients? I mean really? You brought your CHILD to a fertility clinic. Words fail me.) and when a passing nurse asked who we were and what time our appointment was for, I said "9.10" this patient-with-toddler snidely commented "9.10!!" because we were now a tad late. Grr. Anyway we were hurried through the locked doors and I was asked to go for a wee then join Hubby and the doc in the scan room.
A new nurse, a new doc. Just whoever was on-call. I don't know their names. "Just take your bottom-things off" I nearly cracked up. Damn, should not have worn skin-tight skinny jeans! Doh! I was just hopping up on the exam table when the doc whipped back the curtain and at the very same moment my knee went through a hole in the table! Turns out it is a fancy pants table/bed and most people do not get on it knee first. lol.
Ice broken.
The scan went well, no pain at all. See the good scan results above. 7 follies. Definitely no over stimulation. Whew.
Pants on, go next door to get more drugs and talk to the nurse.
Turns out the egg retrieval will be this Friday (3 days away CD 12). I have one more stim injection of Puregon which I have given myself tonight (Tues CD 9). Tomorrow morning (Weds CD 10) I have the last Orgalutran injection, and in the afternoon the clinic will call to tell me what time to give the trigger Ovidrel injection. It has to be given exactly 36hrs prior to the egg collection procedure.
We asked what that procedure would be like, and the nurse said it was done under sedation (hyponovel and fentanyl) and should take about 10 - 15 mins in theatre. I asked to have a dextrose IV ready, and Hubby asked to have the IV cannula inserted as early as possible because we have learnt from prior surgery that a diabetic hypo + collapsed veins = no fun. The nurse agreed that this was all a good idea, and then said "so are you what, type 1 diabetic?" This was after telling her directly that I was type 1 diabetic, and showing her my dexcom and insulin pump prior to the scan to check it wouldn't interfere with the ultrasound. So she finally understood (at one point she thought it was Hubby who was the diabetic one! Read the medical notes PLEASE) and went to check with another doc if the egg retrieval procedure could be scheduled as late as possible so that I could still eat breakfast on Friday morning. This was after telling her not to worry, and that I would prefer the first appointment actually, and that I could miss a meal now that I am on the pump. People hear what they want to hear, not what you tell them sometimes.
She gave us these drugs:
 |
| Puregon Pen and needles. |
 |
| My dosage for tonight is 150 more units of stimulation using the drug Puregon this time. |
Puregon (Tuesday night, 150 units) (for the record, I had an unexpected low blood sugar 30 mins after injection. Don't know if it's related or not.)
Orgalutran (for tomorrow morning, this one is to prevent premature ovulation)
Ovidrel (this one is the trigger injection and is to be given 36 hrs before egg collection)
It was a bit hilarious being taught how to use the puregon pen, considering I had been doing multiple daily injections for diabetes since I was 5. Still good to watch and just make sure there was nothing new to see.
We got out of there are started the drive home knowing that a major storm had just thrashed the north island and the road south was currently closed.
The trip should consist of 3 hrs in the car going across one mountain.
It ended up taking us 9.5 hrs, and we went to 3 cities, tried to get over 1 mountain, went around 2 other mountains, across a gazillion rivers, through a million puddles, past a trillion slips and goats, and got turned back back sorry-for-themselves looking road workers in orange jackets telling us "the bridge has been washed away" "there is severe flooding" "you will have to go back" "the road is closed".
We were trying to go from a northern region to the south-western region. We ended up having to go south-east, then more south, then more east, then very south, to come right around and enter the western region from the south instead of the north! It was the longest road trip of my life and it is the only occasion that I have physically been unable to get to my homeland. At one point, I considered how it would have been easier to fly to Australia and back in, rather than drive!
But we are finally home. Everything went wrong except for the scan!
Oh, and I have to go in for a blood test tomorrow morning, do an infusion site change, and teach a class. Oh and re-book the motel for Friday. I need a nap.
p.s. If you're wondering what happened to CD 8: I went to work and taught class in the morning, then we drove up to Hamilton and checked into the motel. I had my Orgalutran injection in the morning and did a +20% temp basal increase for 4 hours which worked great guns.
Tuesday, October 8, 2013
CD 2 The Money Shot
Today I gave myself the Elonva injection; the one that will stimulate my ovaries to grow lots of follicles all at once.
After doing an infusion site change this morning, the Elonva injection seemed like nothing at all. The only bit I was worried about was the fancy schmancy spring-loaded syringe: inject, push plunger down, then once you release the plunger it springs back up inside the casing! And if you don't get the plunger all the way down then that's it! No second chances with this puppy!
You'll be relieved to know that it all went well, just as the instructions planned. The injection didn't hurt, but once I got near the end the sheer volume of liquid going in started to sting a bit. It didn't swell or go red or anything.
About half an hour later I was at work, and my blood sugar just tanked. I couldn't get off the floor and powered through my stash of emergency juice and mentos. This could have been the Elonva kicking in perhaps as it was accompanied by some weird cramps, or it could have been the arithromycin antibiotics that both Hubby and I took.
No real side effects for the rest of the day really. I have been peeing like a racehorse (unfortunately that's one of my low symptoms!) and have had very mild cramping and a really fuzzy brain. Not really able to concentrate on much!
There is nothing for me to do on this protocol except take my Pre-natal vitamins until CD 6 when I start the Orgalutran injections.
I've booked the motel as we are scheduled for a blood draw and scan in CD 9.
I let the nurse know via email about how I'm now hooked up to an insulin pump and dexcom, and her and the RE both seem to think it shouldn't interfere with the IVF treatment.
I am calm and relaxed about this. Every other medical thing I've done to my body has been a bit if an experiment, and so is this. There is no guarantee it will work perfectly, but it's also not a pass/fail situation; there are lots of other ways this could play out.
Could be that we get pregnant first go. Or I might get OHSS and have the cycle called off. The number of eggs I can muster up could be twenty or it could be zero. Things might fertilize or not. There might be some to freeze or not. Etc etc forever and ever. So many possibilities, which means do many chances for things to go in a ok-fine-good-great-wonderful direction.
Yep so that's where we're at today. More when something interesting happens or when I get some crazy hormone symptoms!
After doing an infusion site change this morning, the Elonva injection seemed like nothing at all. The only bit I was worried about was the fancy schmancy spring-loaded syringe: inject, push plunger down, then once you release the plunger it springs back up inside the casing! And if you don't get the plunger all the way down then that's it! No second chances with this puppy!
You'll be relieved to know that it all went well, just as the instructions planned. The injection didn't hurt, but once I got near the end the sheer volume of liquid going in started to sting a bit. It didn't swell or go red or anything.
About half an hour later I was at work, and my blood sugar just tanked. I couldn't get off the floor and powered through my stash of emergency juice and mentos. This could have been the Elonva kicking in perhaps as it was accompanied by some weird cramps, or it could have been the arithromycin antibiotics that both Hubby and I took.
No real side effects for the rest of the day really. I have been peeing like a racehorse (unfortunately that's one of my low symptoms!) and have had very mild cramping and a really fuzzy brain. Not really able to concentrate on much!
There is nothing for me to do on this protocol except take my Pre-natal vitamins until CD 6 when I start the Orgalutran injections.
I've booked the motel as we are scheduled for a blood draw and scan in CD 9.
I let the nurse know via email about how I'm now hooked up to an insulin pump and dexcom, and her and the RE both seem to think it shouldn't interfere with the IVF treatment.
I am calm and relaxed about this. Every other medical thing I've done to my body has been a bit if an experiment, and so is this. There is no guarantee it will work perfectly, but it's also not a pass/fail situation; there are lots of other ways this could play out.
Could be that we get pregnant first go. Or I might get OHSS and have the cycle called off. The number of eggs I can muster up could be twenty or it could be zero. Things might fertilize or not. There might be some to freeze or not. Etc etc forever and ever. So many possibilities, which means do many chances for things to go in a ok-fine-good-great-wonderful direction.
Yep so that's where we're at today. More when something interesting happens or when I get some crazy hormone symptoms!
Monday, October 7, 2013
The night before the first IVF injection
Those drugs in the fridge are looming in my mind. Not because of the needles or anything like that, but rather because I am about to step (leap?) into the unknown.
I have no idea if IVF will work for us. We have been given very good chances by our reproductive endo, but still. He also gave us a whole long list of scenarios that could also happen. And I appreciate knowing that things are a bit up in the air at this point.
When I woke up this morning, it was before the alarm had gone off and even before the cat had time to jump on the bed andpolitely request demand and stomp all over us with wet feet for his breakfast. That familiar cramp. I decided that it was only, maybe, October the 4th??? at best so it must just be lack of a kiwifruit the day before. Oh, I was wrong. This WAS CD1!!! Wow. Never thought I would be telling the interwebs that news, especially not with so many exclamation points lol.
I dug out the phone number for the nurse and called and left her a message. Then I wondered a bazillion things, then ate breakfast.
At work, I kept jumping for the phone. It was my first day back after a short mid-semester break and the change in routine, plus first period with the insulin pump to deal with, plus waiting for the nurse to phone me back with dates and instructions just clouded my brain up real good.
Take some neurofen. Go for a walk with my friend and get doughnuts and hot chocolates. Damn, even the glorious bolus calculator can't figure this one out. Sigh.
She rang and was really personable and happy. Like she remembered who I was and actually cared. I got instructions and dates for what meds to take when, up until day 9 which is when I will need to go in for a scan and bloodwork. Once I got off the phone, I texted Hubby then got online and booked our motel of choice in Hamilton. We are 3hrs away so I will miss a day and a half of work, and since the appointment is early in the morning we will just go up the night before to make it less stressful.
I forgot to tell the nurse I am now on an insulin pump. Thinking about emailing her that info shortly.
My whole focus, my whole energy right now, is on remembering to take the Elonva injection tomorrow. Calmly, and without fuss. I have been harpooning myself every 3 days or so now with insulin pump site changes and dexcom changes, so another needle is not the problem. It's the unknown. I get one shot at this, and if I screw it up with this injection I can't grab another from the local pharmacy or anything.
Oh, speaking of said local pharmacy: I did NOT know that the antibiotics Hubby and I both have to take as part of the IVF stint are not funded. At all. Even worse, because they are prescribed by a specialist, it's a higher prescription charge. Still less than $40 for 4 tablets, but I thought this was publicly funded? I didn't quibble, just paid and decided to be calm.
Other news:
I have no idea if IVF will work for us. We have been given very good chances by our reproductive endo, but still. He also gave us a whole long list of scenarios that could also happen. And I appreciate knowing that things are a bit up in the air at this point.
When I woke up this morning, it was before the alarm had gone off and even before the cat had time to jump on the bed and
I dug out the phone number for the nurse and called and left her a message. Then I wondered a bazillion things, then ate breakfast.
At work, I kept jumping for the phone. It was my first day back after a short mid-semester break and the change in routine, plus first period with the insulin pump to deal with, plus waiting for the nurse to phone me back with dates and instructions just clouded my brain up real good.
Take some neurofen. Go for a walk with my friend and get doughnuts and hot chocolates. Damn, even the glorious bolus calculator can't figure this one out. Sigh.
She rang and was really personable and happy. Like she remembered who I was and actually cared. I got instructions and dates for what meds to take when, up until day 9 which is when I will need to go in for a scan and bloodwork. Once I got off the phone, I texted Hubby then got online and booked our motel of choice in Hamilton. We are 3hrs away so I will miss a day and a half of work, and since the appointment is early in the morning we will just go up the night before to make it less stressful.
I forgot to tell the nurse I am now on an insulin pump. Thinking about emailing her that info shortly.
My whole focus, my whole energy right now, is on remembering to take the Elonva injection tomorrow. Calmly, and without fuss. I have been harpooning myself every 3 days or so now with insulin pump site changes and dexcom changes, so another needle is not the problem. It's the unknown. I get one shot at this, and if I screw it up with this injection I can't grab another from the local pharmacy or anything.
Oh, speaking of said local pharmacy: I did NOT know that the antibiotics Hubby and I both have to take as part of the IVF stint are not funded. At all. Even worse, because they are prescribed by a specialist, it's a higher prescription charge. Still less than $40 for 4 tablets, but I thought this was publicly funded? I didn't quibble, just paid and decided to be calm.
Other news:
- Hubby has a perfect heart. No really, I know this as a medical fact. Last monday, he dropped the kids off back to their Mum's and then promptly took himself in the the emergency department as he thought he was having a heart attack with chest pain radiating down the left arm with tingles in his hand. He called me at work and we then spent 7hrs in A&E, 3 EKGs, 2 lots of blood work, and a heart attack was ruled out. Stress, they said, but could be angina. So last Thursday he got to do a EKG stress test on a treadmill. They were supposed to get him to exercise to only 80% of the target rate, but pushed him to 110% because they couldn't find anything wrong. Stress, they said. So I have been trying to help Hubby calm down and relax some. He is working the equivalent of 2 x full time jobs, both very stressful. The freelance project with be over soon, and the more "normal" job is offering more security and hours so there is light at the end of the tunnel.
- Last week we averaged a 1hr bike ride per day. Even in the midst of chest-pain-o-rama!
- Holidays are good and I had just remembered how to have them when it turned into time to go back to work. Bah.
- One of our four chickens is sick. She has a sore infected foot and I took her to the vet today. Poor chookie is also now on antibiotics. Enough for a great dane dog, according to the packet!
- Of course, the day I need to be in Hamilton is also the second day of term! I have already provided my payroll lady with a letter from the clinic so I can take IVF days off as sick days which is very good.
- The cat thinks he wants to go to the vet also. He has been catching (big, ginormous) rats and eating just their tails. They, in response, have been scratching him on the eyeballs. Requiring expensive and painful vet treatment and nasty sticky eye ointments which make him think that I never loved him. Poor kitty! I am hoping it's just a sympathy squint cos he saw the cat box I used to transport the chicken in.
- I have a new hobby. I like to burn things. Don't be calling the authorities on me! I am talking about lampworking and making glass beads. Highly addictive and meditative. And beautiful.
Right. Off to take my pre-natal vitamins and watch a video about how to give an Elonva injection. Wish us luck!
And so, we start.
Monday, 7th October and it's CD1.
It's 8.30am and I'm going to have some breakfast and call the nurse.
The big money shot (Elonva) will be tomorrow I imagine.
A bigger update for you when I get home from work tonight.
Wish us luck! We are finally starting treatment after years and years and years of waiting!!!
It's 8.30am and I'm going to have some breakfast and call the nurse.
The big money shot (Elonva) will be tomorrow I imagine.
A bigger update for you when I get home from work tonight.
Wish us luck! We are finally starting treatment after years and years and years of waiting!!!
Saturday, September 7, 2013
Our Pre-IVF Appointment
Yesterday we had our pre-IVF appointment in Hamilton. It went very well and Hubby and I are both much more relaxed about the process. :)
We travelled up (3hrs) on Thursday, had an interesting meal at a restaurant named after a lizard, and stayed in a nearly-brand new motel which was superb. Our appointment was for 11.40am on Friday 6th September so after a breakfast at a kitchen over in East-Hamilton, we had some time to kill.
A walk around the lake sounded like a fine idea, but the wind got up and then it got nasty-bitter, so much so that my ears were aching bad :( So we experimented with the navigation app on Hubby's new phone and drove to the botanic gardens which wasn't so windy-pants.
The appointment itself was very good. We learnt a lot and left feeling like the process is truly underway now.
In the waiting room, our old doctor walked in and although she smiled and said hi, she couldn't really look Hubby in the eye. Awkward! :/ For a moment there I thought there had been some mistake and we would still have to see her.
But our new doc, the head of the clinic Dr S came out and greeted us shortly afterwards. He was very friendly and seemed genuinely happy to meet with us. First up, he mentioned how he was familiar with our file and he confirmed that we had now transferred to his care. The relief I felt at hearing this was quite surprisingly strong and I immediately felt confident about our treatment - for I think the first time ever.
Dr S explained that we would be good candidates for a newer IVF regimen. As he put it, at least there was some silver-lining to having to wait so long! So we will be using a drug called Elonva which is a one-shot injection that replaces 7 daily FSH injections. Personally, I don't mind having to do injections (hey, I do about 8 a day already!) but I like the other benefit of Elonva: the action profile seems to make sense to me. He explained how it has been created by taking the FSH molecule, which has a half life of about a day, and combining it with a segment of the hCG molecule which imparts it's 7 day half. He said the results are equivalent or better to what they are seeing as with patients using the traditional daily injections. Oh yeah, and no down-regulation will be necessary with this protocol which means no menopause which is the most terrific news you can give to a woman, let alone a T1D woman! Yay! :D
We discussed my AMH test (which was 9.35 about a year ago) and Dr S advised that I should do another one that day since it would be funded as part of the cycle. We talked about how it is kind of useful to have such long term (3 years worth) data on my FSH (latest: 5.5), oestradiol and AMH levels.
Since we have good quality sperm frozen already, it all came down to what my body is doing. I must say I was immediately nervous when Dr S said he wanted to re-check the AMH since it was just at the cusp of the "green" level last time, but he didn't expect it to have altered too much, and he explained how it is variable. He wouldn't be worried unless it was 3 or below, and treatment wouldn't change unless it was below 5 or above 20.
We talked about my diabetes and how that is controlled, and this time it it felt like I was really being listened to when I spoke about my diabetes treatment. Because it DOES matter. I told him how I will be going on a pump on September 18th (in fact, my prescription was written last week and I should pick it up from the pharmacy this coming week! Exciting!), and Hubby talked about how I need any IV lines placed as early as possible to avoid my veins collapsing with a hypo in pre-op.
I had prepared a short list of questions with Hubby the night before, and they had pretty much all been answered before I even got to ask them :) The only thing he raised that I wasn't expecting was that both of us would need to do a short course of antibiotics, and that because of my diabetes I would need some antibiotics prior to egg retrieval / transfer (I can't remember which oops).
One thing that we spent a lot of time on was getting an idea of possible scenarios and outcomes. Although we have been given a 40 - 50% chance of IVF working, there are many ways this could play out:
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We travelled up (3hrs) on Thursday, had an interesting meal at a restaurant named after a lizard, and stayed in a nearly-brand new motel which was superb. Our appointment was for 11.40am on Friday 6th September so after a breakfast at a kitchen over in East-Hamilton, we had some time to kill.
A walk around the lake sounded like a fine idea, but the wind got up and then it got nasty-bitter, so much so that my ears were aching bad :( So we experimented with the navigation app on Hubby's new phone and drove to the botanic gardens which wasn't so windy-pants.
The appointment itself was very good. We learnt a lot and left feeling like the process is truly underway now.
In the waiting room, our old doctor walked in and although she smiled and said hi, she couldn't really look Hubby in the eye. Awkward! :/ For a moment there I thought there had been some mistake and we would still have to see her.
But our new doc, the head of the clinic Dr S came out and greeted us shortly afterwards. He was very friendly and seemed genuinely happy to meet with us. First up, he mentioned how he was familiar with our file and he confirmed that we had now transferred to his care. The relief I felt at hearing this was quite surprisingly strong and I immediately felt confident about our treatment - for I think the first time ever.
Dr S explained that we would be good candidates for a newer IVF regimen. As he put it, at least there was some silver-lining to having to wait so long! So we will be using a drug called Elonva which is a one-shot injection that replaces 7 daily FSH injections. Personally, I don't mind having to do injections (hey, I do about 8 a day already!) but I like the other benefit of Elonva: the action profile seems to make sense to me. He explained how it has been created by taking the FSH molecule, which has a half life of about a day, and combining it with a segment of the hCG molecule which imparts it's 7 day half. He said the results are equivalent or better to what they are seeing as with patients using the traditional daily injections. Oh yeah, and no down-regulation will be necessary with this protocol which means no menopause which is the most terrific news you can give to a woman, let alone a T1D woman! Yay! :D
We discussed my AMH test (which was 9.35 about a year ago) and Dr S advised that I should do another one that day since it would be funded as part of the cycle. We talked about how it is kind of useful to have such long term (3 years worth) data on my FSH (latest: 5.5), oestradiol and AMH levels.
Since we have good quality sperm frozen already, it all came down to what my body is doing. I must say I was immediately nervous when Dr S said he wanted to re-check the AMH since it was just at the cusp of the "green" level last time, but he didn't expect it to have altered too much, and he explained how it is variable. He wouldn't be worried unless it was 3 or below, and treatment wouldn't change unless it was below 5 or above 20.
We talked about my diabetes and how that is controlled, and this time it it felt like I was really being listened to when I spoke about my diabetes treatment. Because it DOES matter. I told him how I will be going on a pump on September 18th (in fact, my prescription was written last week and I should pick it up from the pharmacy this coming week! Exciting!), and Hubby talked about how I need any IV lines placed as early as possible to avoid my veins collapsing with a hypo in pre-op.
I had prepared a short list of questions with Hubby the night before, and they had pretty much all been answered before I even got to ask them :) The only thing he raised that I wasn't expecting was that both of us would need to do a short course of antibiotics, and that because of my diabetes I would need some antibiotics prior to egg retrieval / transfer (I can't remember which oops).
One thing that we spent a lot of time on was getting an idea of possible scenarios and outcomes. Although we have been given a 40 - 50% chance of IVF working, there are many ways this could play out:
- IVF stimulation works perfectly first time (best guess for drugs, dosages, and timing)
- Could result in a positive pregnancy test, which could result in a baby... or not.
- I could get OHSS (Ovarian Hyper Stimulation Syndrome) which would probably mean the cancellation of the cycle while I recover.
- Dr S expects us to retrieve about 10 eggs, although this is of course just a guess. Out of that he estimates we may get 1 - 3 usable blastocysts, so maybe one or two to freeze. But maybe none. I really hope we get some to freeze!
- If I make it through the stims alright, but get OHSS which makes embryo transfer not a good plan, then we could do a "freeze all" cycle, which apparently has very good outcomes and Dr S said that there is some research to suggest that all IVD cycles should be freeze all so that the woman can rest and recover her body for best possible chances.
- So depending on what the embryologist thinks, we may end up transferring day 3 or day 5. Only day 5 embryos are frozen, and of course there is the chance that they may all need to be frozen if I am in no fit state for a transfer.
- If this first transfer is unsuccessful, then we can continue and do FETs with the remaining frosties. These are all considered part of our first cycle. If none of these work, then we can apply for a second funded cycle, but there would be a waiting time of between 6 and 12 months for this. Any pregnancy from the first cycle negates the second funded round of treatment. I am not sure if by "pregnancy" they mean "live birth" or just a positive pregnancy test??? Will have to find out, not that it will change much...
We discussed the fact that I would need a high-risk obstetrician, and although I knew this, I asked if we should secure one now or wait until I'm actually pregnant? His opinion was that we didn't need any more pre-conception counselling (although he offered us IVF counselling - which would have been useful, like, 3 years ago maybe!!) and he recommended one out of the two high-risk OBs in our home town. Now I need to find out a) how expensive they are to attend privately, and b) since I am diabetic I will be needed one anyway, so could I choose which one? I wonder...
Dr S wanted to do an internal ultrasound to check my follicles (antral follicle count), so we got to meet our new nurse and even before I'd seen her, I was behind a curtain stripping of my pants lol. I was pleased with myself for wearing cute socks and entirely by accident! We got on well immediately and it was all so much easier and relaxed than with the previous doc and her nurse. So, anyway. No pants, ultrasound, Hubby, nurse and doc in the room with me. Should have been unnerving but I always find any chance to look at my insides just fascinating. I was asking lots of questions and the doc explained it very well, showing that my uterus is looking good with lining and no polyps (which I had been worried about), and then looking at the right ovary which proved hard to find as normal, then the left. All up I had 11 follicles with one showing the corpus luteum - a burst follicle indicating I had probably ovulated the day before on the 5th Sept. Interesting, as this means I will finally be able to work out precisely how long my lutenising phase is. :P
Although I was worried about what the AMH re-test might show (we won't get the answers for another two weeks) Dr S said that the antral follicle count number usually is very closely related to the AMH number, and he expected my AMH re-test to come in anywhere between 8 - 11. So, good, predictable news. In fact, the whole appointment was just all about good news!
After the scan, we went through to the nurse's office to discuss our plan and have our drug training, which although was not scheduled for the day, they decided would be fine to do so we wouldn't have to make another trip up just to be taught how to do a handful of injections. I mean, really. I have done tens of thousands of injections. I am NOT freaked out by needles, only by the actual drugs themselves. Who knows what holy-hell they are going to play on my diabetes?
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She gave us our plan, and discussed how it would all occur. We got our drugs in a little green cooler bag, just about the right size for a six-pack, along with a sharps container and enough alcohol wipes to do 36 injections - just a bit overkill. I only have 1 Elonva injection to stimulate egg growth, then about 5 Orgalutran injections to prevent premature ovulation, and other meds will be added later as they work out how my cycle is progressing. The FSH may need to be topped up, and of course there will be a trigger shot at some stage.
I got three scripts for antibiotics, plus blood-draw forms and a serial blood draw card to make things easier but it turns out that I won't have to do any in hometown, and it looks like there will be approx 3 more trips up to Hamilton (1 for scan and blood draw, 1 for egg retrieval, 1 for transfer) I think. Just as well we've found a really good motel. It will be hard getting time off work, because Hubby is just starting in his new position and I have a rigid weekly schedule, but I have given my employer over 1 years heads-up so there can't be any complaints there, I will just have to do a lot of prep work so my job can be covered appropriately.
Oh yeah, and did I mention that I am turning bionic on September the 18th? More to come on that adventure... :)
Monday, August 12, 2013
Animas rep visit - insulin pump
A couple of bits of news:
So, the exciting news first: I got to hold my first insulin pump today. Sounds silly I know, but I have seen so many pictures and heard so many people talking about them online that to actually get to hold and play with one was a big thing for me. It made it more real.
The rep was really helpful and met with my and Hubby just over lunchtime. She asked me how much I knew about basal and bolus insulin, just to get to know the level of my knowledge. Then, in the hospital cafeteria (I know! I would have preferred somewhere a little more private too!) she opened her kit of demo pumps and showed me how they work.
Since I am VERY interested in getting the CGM (continuous glucose monitor) too, I asked to see those as well. The Dexcom system looks great and I am very keen to try it out. In fact, I was offered a one-month trial to see if I like it. Just have to buy a box of four sensors ($125 p/sensor) and they lend me the transmitter and receiver. I want to do this and see if I like the Dexcom receiver enough to buy the standalone unit too.
The Animas Vibe insulin pump itself looks like a good option with many features that I like. It's waterproof, has small dosing increments, and a high-contrast colour screen. The screen is clear but it's not always immediately intuitive so I think that would just take some practice to get used to. The Vibe pump acts as the receiver to the Dexcom system, although it has slightly older algorithms compared to the Dexcom receiver.
Unfortunately, nothing about the Dexcom is funded, although the Animas rep suggested that "they" (govt, I presume) are looking at funding them in the future for a select group. When I asked if that select group was likely to be people already using the Dexcom CGM, she replied yes. So that is something positive to look forward to. The receiver and transmitter each cost just shy of NZ $1000 each, plus the monthly running cost for full time wear of about $500. Whew. Not cheap, but don't have to wear it all the time. At one sensor lasting 7 days, that's $17.90 per day. Ridiculously expensive, anyway you look at it. But I figure I want to have access to this level of sophisticated technology to better my health in the lead up to IVF.
My Diabetes Nurse Educator (DNE) stopped by and said she wants me to meet with the Medtronic rep also, which I think is a good idea before committing to something so major. I think that is next Monday???
I asked my DNE how long it would take before a prescription could be written for my pump, and even though I have an appointment to see my Endo towards the end of this month she said I shouldn't have to wait that long since I already have approval for funding. She is just interested to get a couple of people into pump training (2 x half days) at the same time for efficiency's sake. Fair enough. But so much waiting. I wanted to sign up for a dexcom trial right away! lol.
The IVF stuff. Right so we got a letter saying we have a Pre-IVF appointment and we needed to confirm said appointment. It didn't really say anything about what would be covered or even who it was with. So I rang them up and said, can I change it from a Wednesday to a Friday? Yes. What is it about and can we do it via Skype? No, there may be a ultrasound scan involved, and you will be doing the plan for IVF. Can we switch doctors? Umm, can I call you back?
We wanted to switch from Dr R (who has been nothing but bad news, I'm sure she's a nice person but treatment-wise, not my favourite person. I just don't have faith in her) to Dr S (who performed the successful sperm retrieval without Hubby feeling any dramatic emergency-room level pain!!!). The receptionist wanted to know why. I just said that we had had several poor experiences with Dr R, and a very good experience with Dr S. She said that Dr S was on leave at the time we needed out appointment, and the next one for him was about a whole month later.
She called back again, after working her magic where she had managed to scored us a Friday appointment with Dr S the week we needed it! Wahoo! I was just so happy!
So gotta go and have the spiel again from anther doctor, and I hope this transition will be permanent. Dr S gives us both a feeling of confidence and control that we weren't getting from Dr R.
Good things happening :)
- met with the rep from Animas today and looked at the Animas Vibe insulin pump and the Dexcom CGM system.
- an update on where we're at with the IVF: hooray! We have been able to switch to another doctor!
So, the exciting news first: I got to hold my first insulin pump today. Sounds silly I know, but I have seen so many pictures and heard so many people talking about them online that to actually get to hold and play with one was a big thing for me. It made it more real.
The rep was really helpful and met with my and Hubby just over lunchtime. She asked me how much I knew about basal and bolus insulin, just to get to know the level of my knowledge. Then, in the hospital cafeteria (I know! I would have preferred somewhere a little more private too!) she opened her kit of demo pumps and showed me how they work.
Since I am VERY interested in getting the CGM (continuous glucose monitor) too, I asked to see those as well. The Dexcom system looks great and I am very keen to try it out. In fact, I was offered a one-month trial to see if I like it. Just have to buy a box of four sensors ($125 p/sensor) and they lend me the transmitter and receiver. I want to do this and see if I like the Dexcom receiver enough to buy the standalone unit too.
The Animas Vibe insulin pump itself looks like a good option with many features that I like. It's waterproof, has small dosing increments, and a high-contrast colour screen. The screen is clear but it's not always immediately intuitive so I think that would just take some practice to get used to. The Vibe pump acts as the receiver to the Dexcom system, although it has slightly older algorithms compared to the Dexcom receiver.
Unfortunately, nothing about the Dexcom is funded, although the Animas rep suggested that "they" (govt, I presume) are looking at funding them in the future for a select group. When I asked if that select group was likely to be people already using the Dexcom CGM, she replied yes. So that is something positive to look forward to. The receiver and transmitter each cost just shy of NZ $1000 each, plus the monthly running cost for full time wear of about $500. Whew. Not cheap, but don't have to wear it all the time. At one sensor lasting 7 days, that's $17.90 per day. Ridiculously expensive, anyway you look at it. But I figure I want to have access to this level of sophisticated technology to better my health in the lead up to IVF.
My Diabetes Nurse Educator (DNE) stopped by and said she wants me to meet with the Medtronic rep also, which I think is a good idea before committing to something so major. I think that is next Monday???
I asked my DNE how long it would take before a prescription could be written for my pump, and even though I have an appointment to see my Endo towards the end of this month she said I shouldn't have to wait that long since I already have approval for funding. She is just interested to get a couple of people into pump training (2 x half days) at the same time for efficiency's sake. Fair enough. But so much waiting. I wanted to sign up for a dexcom trial right away! lol.
The IVF stuff. Right so we got a letter saying we have a Pre-IVF appointment and we needed to confirm said appointment. It didn't really say anything about what would be covered or even who it was with. So I rang them up and said, can I change it from a Wednesday to a Friday? Yes. What is it about and can we do it via Skype? No, there may be a ultrasound scan involved, and you will be doing the plan for IVF. Can we switch doctors? Umm, can I call you back?
We wanted to switch from Dr R (who has been nothing but bad news, I'm sure she's a nice person but treatment-wise, not my favourite person. I just don't have faith in her) to Dr S (who performed the successful sperm retrieval without Hubby feeling any dramatic emergency-room level pain!!!). The receptionist wanted to know why. I just said that we had had several poor experiences with Dr R, and a very good experience with Dr S. She said that Dr S was on leave at the time we needed out appointment, and the next one for him was about a whole month later.
She called back again, after working her magic where she had managed to scored us a Friday appointment with Dr S the week we needed it! Wahoo! I was just so happy!
So gotta go and have the spiel again from anther doctor, and I hope this transition will be permanent. Dr S gives us both a feeling of confidence and control that we weren't getting from Dr R.
Good things happening :)
Friday, April 26, 2013
Why I'm so happy to have mens underwear in my handbag
Today we have had our first successful experience with fertility treatments: the second surgical sperm retrieval procedure was a success!!! :) Hooray!
It was such a dramatically different experience from last time; just about everything was different and the positive outcome feels like the icing on the cake.
How it went:
We drove up to Hamilton (3.5hrs) yesterday afternoon and checked into our motel. Went and got some dinner, bought some books, and then watched some crappy movies on telly back at the motel.
Since we had got some Valium for Hubby, he took that and was snoring pretty soon. I had a lot of trouble getting to sleep, and would wake up heaps during the night. Woke up feeling like I'd been jogging all night, whilst eating soap (you know that taste? Yeah, that's sleepless night mouth taste for me!)
I was afraid that Hubby might not get up to the alarm in the morning with the extra medicine, so I set me alarm for 6.45 and since I was already awake, I got the first shower! Ha!
Watched breakfast news on telly, I ate some toast and Hubby made baleful-eyes at me since he was nil-by-mouth until after the procedure.
We packed up the room and loaded the car. I signed out of the motel and we headed over to the clinic.
This time when we arrived the clinic was alive with people (last time we got there before the staff!) and we signed in and went to the waiting room. Very quickly we were called back through to the yellow pre-op room with the lounge chair in it. We met the nurse who would be looking after us, Nurse H.
Then began the parade of introductions. First off Nurse H wanted the pre-op health questionnaire completed (last time we had all this done perfectly before we got there, this time? Meh! If they want it they will ask!). Then she did Hubby's blood pressure (188/something) so definitely high.
The embryologist, T, came and introduced herself and started explaining how she would be behind the little pop-hole in the room with the micro-scope. We told her we knew that and this was our second time... she hadn't read our chart! Not promising...
Next came the person who made the whole event possible: the anaesthetist, K. She was super cute and amazing, and instantly put both of us at ease. She had a great sense of humour (talked about propofol being "the Michael Jackson drug") and a relaxed attitude - and hey, you want the one with the drugs to be cruisy, right? :) Once Hubby relaxed I did too, and after she left we even laughed a bit!
Hubby had to change into the glamorous hospital moomoo:
The nurse came back and put a tray full of stuff to put the IV line in on the table, and went out again.
Then the RE arrived. Now, up until this point, we didn't actually know who would be performing this operation. We knew with about 90% certainty that it wouldn't be our original RE, Dr R, since when Hubby took the call for the appointment booking, the nurse had told him that Dr R wouldn't be doing it. So we thought, well then, it must be someone who won't make such a hash of it, surely!
And we were right. We got Dr S, the senior doctor at the Hamildog clinic! He was confident and his manner and calmness relaxed us greatly. Instead of going straight to TESE (biopsy, more invasive, incision, stitches etc), he said he would try both PESA (small needle aspiration from the epididymis) and TESA (large needle aspiration directly from the teste) first. He reasoned that since Hubby would be sedated, there would be no problem moving from one technique to another until we got some sperm, and this way he may even be able to get a sample without doing the biosy altogether.
The anaesthesiologist came back and said that she wouldn't insert the IV line until Hubby had walked into the OR and gotten on the table, in case he fainted. I asked if I could come too, and did Hubby want me to? Yes? Ok. So through we all went.
It felt a bit surreal, here were were again, people in the same places as last time. Except this time we had K the anaesthetist sitting on Hubby's left, and different people in the role of Doctor, nurse, and embryologist. Others in the room were: Hubby, myself, and other nurse (same as last time for surgery assistance).
K got the IV line in very quickly, and Dr S prepped "the area" with drapes and sterile swab. Hubby and I joked about no matter how much they warm that liquid up, you can never get used to that feeling!
I helped put on the blood pressure cuff on his right arm, and the surgery assistance nurse worked to get all the proper needles ready for the PESA, TESA, TESE procedures. Nurse H coordinated with the embryologist through the pop hatch to get dishes (petri dishes!) ready for the samples.
K started the sedation and Hubby's eyelids started to flutter. He was trying very hard to tell me something about getting the camera, I think, to take a photo of the procedure. But he was out like a light and snoring gently in no time. I rubbed his shoulder and told him I loved him as he went to sleep, then warned the doctors that they were about to be treated to some snoring! They assured me they were used to it.
First try was the PESA, with the smallest needle into the left side. This produced a small drop of fluid and T the embryologist found I non-motile sperm in it. Dr S proclaimed that this meant there were in the right spot, but would have to look further with TESA as the epididymis would probably not provide very much.
Next up was TESA, with the wider-gauge needle into the left teste. Very soon (and without half as much effort as last time! No squeezing, no worried looks! So little blood!) Dr S had the first piece of tissue. I could see if from where I was sitting as it was transferred into the petri dish. Nurse H passed it through the hatch, and T found 3 sperm in it, although she must have later complained that the tubules (where the developing sperm live) were very thin, since Dr S told her that there were more samples coming.
Dr S went in with the TESA needle again and got some more tissue. When the needle came out it obviously had a sample on the end of it, and when they flushed air through the line, another sample came out! That's right! Another 2! He said that this amount of tissue was equivalent to what we could expect from an open biopsy anyway, and since there had been a total of 4 sperm found already he was happy to leave things at that. Hubby would not need the biopsy! I had to ask and check again!
Twice Hubby began to rouse but K just gave him some more sedative each time. The first time he tried to lift his head up a little bit and the second time was when is right arm fell off the side of the bed (!) - yes I know. The same bed, much, much too small for an adult man! Aside: last time the RE partially blamed the difficulty of the procedure on Hubby being overweight. Well, firstly, way to lay the guilt on Dr R! Good God woman, don't you have any compassion? And secondly, Hubby has worked really hard and has lost 10kgs in 3 months. So there!
The snoring. Well, yes, there was some snoring happening, and at one point I recognised the breath-motions that indicate sleep apnea to me. Normally I would roll him over or give him an elbow in the ribs to get him to take a proper breath. But of course, I couldn't really wiggle him during surgery! So I just asked them all if his breathing was ok, and Dr S assured by that his blood-oxygen was great, and K said that the "abdominal breathing" looked strange but that is was just deep sleeping breathing. I wasn't sure, mainly because he had an oxygen mask on his face and whereas before it had been fogging up with each exhale, now there was no fog at all. K lifted his chin with her finger and his airway opened and his took a great noisy snore, with fog, much to my relief. I must admit I didn't believe them when they said his breathing was fine, but it was resolved quickly and they listened to me and checked his vital signs so it was all good. I just know his snores so much better! lol!
To recap so far: 1 sperm non-motile found during PESA, 3 sperm found during TESA 1, 2 more samples received but not counted yet from TESA 2.
Once Dr S indicated that the procedure was over, things went very quickly. I was stunned (hard to explain the feeling. It wasn't relief, it wasn't happy, it was still so surreal that it was over and some had been found, but mixed with a very strong concern about how Hubby would feel upon recovery.
What I didn't expect was for him to come around quite so quickly. He started to wake, and I made sure to tell him that is was over, that he was very brave, and that is was a success. He asked "It's over already?" "Yes," I said. "Haha!" he laughed, which caused everyone in the OR to smile. He made other noises about not remembering anything once K put the IV line in, but he was very focused when Dr S leaned in and told him that the procedure was a success and we had found sperm. Hubby was still lying down, but moved to shake his hand and say thank you. Goodness, so polite and collected and still pretty much out of it! :)
Nurse H encouraged Hubby to sit up carefully and swing his legs over the bed. I pointed out the hatch to the lab, where we could see the embryologist working over several pinkly-tinted tiny petri dishes with her microscope. He commented that his "boys" were all in there now, and that they better do well. Nurse H, K, and the other nurse all made noise about them being both boys and girls, since he gets to decide! Cute! It was a very friendly and happy atmosphere. Nurse H got him standing up carefully, and then we all walked the short passage back to the pre-op / recovery room.
Hubby must have asked me how it went upwards of 7 times, and I remembered that one of the effects of the sedation was that he would have some confusion and loss of memory for a while. I joked with him that it was like talking to a goldfish. He told me it was great to get good news over and over because each time was genuinely the first time he'd heard it!
At various times an ice-pack, tea, and biscuits arrived. Hubby was instructed to get into his tight "supportive" underwear soon, and put the ice-pack on the op-site. Of course, he was grinning and forgetting and I was kissing and hugging him too much and it was hard to get him to actually put pants on. That is where the title of this post comes in. He'd brought the wrong undies, so I dashed down to the car and grabbed the tighties plus the tramadol = first lot of undies in the handbag! He got changed, drank tea, we took photos (sorry, not going to post those here, they're just for us), and I told The Story Of How The Sperm Were Found several more times.
Nurse H came back and took a blood pressure reading, removed the cannula, and read out the post-op instructions. All in all the procedure itself took about 15 - 20mins, and we were able to walk out and go find a cafe to fill up a ravenous Husband at about 10am.
He has minimal bruising, a small amount of swelling, and with tramadol, neurofen and panadol has been pain-free the rest of the day.
UPDATE: the embryologist called at 3.30pm and told Hubby that they managed to get 10 straws frozen! One was thawed and it looked amazing, apparently "couldn't be better"! She said it was enough for 5 x cycles! Wow! We did a verse of this song to celebrate:
So, it has been a very good day!
It was such a dramatically different experience from last time; just about everything was different and the positive outcome feels like the icing on the cake.
How it went:
We drove up to Hamilton (3.5hrs) yesterday afternoon and checked into our motel. Went and got some dinner, bought some books, and then watched some crappy movies on telly back at the motel.
Since we had got some Valium for Hubby, he took that and was snoring pretty soon. I had a lot of trouble getting to sleep, and would wake up heaps during the night. Woke up feeling like I'd been jogging all night, whilst eating soap (you know that taste? Yeah, that's sleepless night mouth taste for me!)
I was afraid that Hubby might not get up to the alarm in the morning with the extra medicine, so I set me alarm for 6.45 and since I was already awake, I got the first shower! Ha!
Watched breakfast news on telly, I ate some toast and Hubby made baleful-eyes at me since he was nil-by-mouth until after the procedure.
We packed up the room and loaded the car. I signed out of the motel and we headed over to the clinic.
This time when we arrived the clinic was alive with people (last time we got there before the staff!) and we signed in and went to the waiting room. Very quickly we were called back through to the yellow pre-op room with the lounge chair in it. We met the nurse who would be looking after us, Nurse H.
Then began the parade of introductions. First off Nurse H wanted the pre-op health questionnaire completed (last time we had all this done perfectly before we got there, this time? Meh! If they want it they will ask!). Then she did Hubby's blood pressure (188/something) so definitely high.
The embryologist, T, came and introduced herself and started explaining how she would be behind the little pop-hole in the room with the micro-scope. We told her we knew that and this was our second time... she hadn't read our chart! Not promising...
Next came the person who made the whole event possible: the anaesthetist, K. She was super cute and amazing, and instantly put both of us at ease. She had a great sense of humour (talked about propofol being "the Michael Jackson drug") and a relaxed attitude - and hey, you want the one with the drugs to be cruisy, right? :) Once Hubby relaxed I did too, and after she left we even laughed a bit!
Hubby had to change into the glamorous hospital moomoo:
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| Fortunately, Hubby's gown wasn't open at the back! Image from: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDJ1L1McEz83m-HvhjyrtQ9VtROnwZ7VKSmQLWGCvUCE61EDSVZW95m8iDf2M2YNADIXMRXImutO1Tz2Lk-GvxZKmhkxphoiIilm4ZK0QR_cTkdIpAq8w3OFV_Spo4YQXfT_wm-DIMNE-J/s1600/HospitalGown.jpg |
Then the RE arrived. Now, up until this point, we didn't actually know who would be performing this operation. We knew with about 90% certainty that it wouldn't be our original RE, Dr R, since when Hubby took the call for the appointment booking, the nurse had told him that Dr R wouldn't be doing it. So we thought, well then, it must be someone who won't make such a hash of it, surely!
And we were right. We got Dr S, the senior doctor at the Hamildog clinic! He was confident and his manner and calmness relaxed us greatly. Instead of going straight to TESE (biopsy, more invasive, incision, stitches etc), he said he would try both PESA (small needle aspiration from the epididymis) and TESA (large needle aspiration directly from the teste) first. He reasoned that since Hubby would be sedated, there would be no problem moving from one technique to another until we got some sperm, and this way he may even be able to get a sample without doing the biosy altogether.
The anaesthesiologist came back and said that she wouldn't insert the IV line until Hubby had walked into the OR and gotten on the table, in case he fainted. I asked if I could come too, and did Hubby want me to? Yes? Ok. So through we all went.
It felt a bit surreal, here were were again, people in the same places as last time. Except this time we had K the anaesthetist sitting on Hubby's left, and different people in the role of Doctor, nurse, and embryologist. Others in the room were: Hubby, myself, and other nurse (same as last time for surgery assistance).
K got the IV line in very quickly, and Dr S prepped "the area" with drapes and sterile swab. Hubby and I joked about no matter how much they warm that liquid up, you can never get used to that feeling!
I helped put on the blood pressure cuff on his right arm, and the surgery assistance nurse worked to get all the proper needles ready for the PESA, TESA, TESE procedures. Nurse H coordinated with the embryologist through the pop hatch to get dishes (petri dishes!) ready for the samples.
K started the sedation and Hubby's eyelids started to flutter. He was trying very hard to tell me something about getting the camera, I think, to take a photo of the procedure. But he was out like a light and snoring gently in no time. I rubbed his shoulder and told him I loved him as he went to sleep, then warned the doctors that they were about to be treated to some snoring! They assured me they were used to it.
First try was the PESA, with the smallest needle into the left side. This produced a small drop of fluid and T the embryologist found I non-motile sperm in it. Dr S proclaimed that this meant there were in the right spot, but would have to look further with TESA as the epididymis would probably not provide very much.
Next up was TESA, with the wider-gauge needle into the left teste. Very soon (and without half as much effort as last time! No squeezing, no worried looks! So little blood!) Dr S had the first piece of tissue. I could see if from where I was sitting as it was transferred into the petri dish. Nurse H passed it through the hatch, and T found 3 sperm in it, although she must have later complained that the tubules (where the developing sperm live) were very thin, since Dr S told her that there were more samples coming.
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| A butterfly needle and syringe, used for TESA. Image from: http://www.ferretlove.co.uk/sub-q5-.jpg |
Twice Hubby began to rouse but K just gave him some more sedative each time. The first time he tried to lift his head up a little bit and the second time was when is right arm fell off the side of the bed (!) - yes I know. The same bed, much, much too small for an adult man! Aside: last time the RE partially blamed the difficulty of the procedure on Hubby being overweight. Well, firstly, way to lay the guilt on Dr R! Good God woman, don't you have any compassion? And secondly, Hubby has worked really hard and has lost 10kgs in 3 months. So there!
The snoring. Well, yes, there was some snoring happening, and at one point I recognised the breath-motions that indicate sleep apnea to me. Normally I would roll him over or give him an elbow in the ribs to get him to take a proper breath. But of course, I couldn't really wiggle him during surgery! So I just asked them all if his breathing was ok, and Dr S assured by that his blood-oxygen was great, and K said that the "abdominal breathing" looked strange but that is was just deep sleeping breathing. I wasn't sure, mainly because he had an oxygen mask on his face and whereas before it had been fogging up with each exhale, now there was no fog at all. K lifted his chin with her finger and his airway opened and his took a great noisy snore, with fog, much to my relief. I must admit I didn't believe them when they said his breathing was fine, but it was resolved quickly and they listened to me and checked his vital signs so it was all good. I just know his snores so much better! lol!
To recap so far: 1 sperm non-motile found during PESA, 3 sperm found during TESA 1, 2 more samples received but not counted yet from TESA 2.
Once Dr S indicated that the procedure was over, things went very quickly. I was stunned (hard to explain the feeling. It wasn't relief, it wasn't happy, it was still so surreal that it was over and some had been found, but mixed with a very strong concern about how Hubby would feel upon recovery.
What I didn't expect was for him to come around quite so quickly. He started to wake, and I made sure to tell him that is was over, that he was very brave, and that is was a success. He asked "It's over already?" "Yes," I said. "Haha!" he laughed, which caused everyone in the OR to smile. He made other noises about not remembering anything once K put the IV line in, but he was very focused when Dr S leaned in and told him that the procedure was a success and we had found sperm. Hubby was still lying down, but moved to shake his hand and say thank you. Goodness, so polite and collected and still pretty much out of it! :)
Nurse H encouraged Hubby to sit up carefully and swing his legs over the bed. I pointed out the hatch to the lab, where we could see the embryologist working over several pinkly-tinted tiny petri dishes with her microscope. He commented that his "boys" were all in there now, and that they better do well. Nurse H, K, and the other nurse all made noise about them being both boys and girls, since he gets to decide! Cute! It was a very friendly and happy atmosphere. Nurse H got him standing up carefully, and then we all walked the short passage back to the pre-op / recovery room.
Hubby must have asked me how it went upwards of 7 times, and I remembered that one of the effects of the sedation was that he would have some confusion and loss of memory for a while. I joked with him that it was like talking to a goldfish. He told me it was great to get good news over and over because each time was genuinely the first time he'd heard it!
At various times an ice-pack, tea, and biscuits arrived. Hubby was instructed to get into his tight "supportive" underwear soon, and put the ice-pack on the op-site. Of course, he was grinning and forgetting and I was kissing and hugging him too much and it was hard to get him to actually put pants on. That is where the title of this post comes in. He'd brought the wrong undies, so I dashed down to the car and grabbed the tighties plus the tramadol = first lot of undies in the handbag! He got changed, drank tea, we took photos (sorry, not going to post those here, they're just for us), and I told The Story Of How The Sperm Were Found several more times.
Nurse H came back and took a blood pressure reading, removed the cannula, and read out the post-op instructions. All in all the procedure itself took about 15 - 20mins, and we were able to walk out and go find a cafe to fill up a ravenous Husband at about 10am.
He has minimal bruising, a small amount of swelling, and with tramadol, neurofen and panadol has been pain-free the rest of the day.
UPDATE: the embryologist called at 3.30pm and told Hubby that they managed to get 10 straws frozen! One was thawed and it looked amazing, apparently "couldn't be better"! She said it was enough for 5 x cycles! Wow! We did a verse of this song to celebrate:
So, it has been a very good day!
Monday, April 22, 2013
Preparation for second surgical sperm retrieval
Since the first surgical sperm retrieval procedure (TESA/PESA) failed to produce any sperm, we have been rebooked for another one.
This time, instead of just a needle, it will be a testicular biopsy. A 3cm incision. Last time the needle biopsy wasn't supposed to be super painful, and it was. I can only imagine what this one will be like, but my money would be on "worse". I sincerely hope to be proved wrong: for this procedure to go smoothly and be much, much less painful for dear hubby. Please please please.
There is not a great deal of information about surgical sperm retrieval online, and without trawling numerous forums there is little detail about preparing for the experience either. So I have decided to write down here what we are doing to prepare for this next procedure... which is in 4 days time!
How to prepare for a surgical sperm retrieval procedure (from the woman's perspective):
First, I recommend asking your doctor as many questions as you need. I have a habit of emailing abig huge list of questions to our RE and getting some shitty, unsatisfying responses back. Sometimes it is better to talk to the nurse. Or phone the clinic to get a human to talk to. For this our second SSR procedure, we were basically told everything about it directly after hubby was recovering from the first one. That is no time to discuss future procedures. In fact the RE was even talking about it DURING the first procedure. We have not had any follow up appointments, and I had to badger them a lot for this second appointment. They are really slack in their communication. So don't you put up with it like we have. I only stopped with the avalanche of questions (which, as they were basically going unanswered, was making me frustrated) because hubby suggested that we just chill a bit, let them do their thing and get the next appointment sorted. Points for looking towards the future!
Second, do your research. There are videos of the procedures on YouTube if you're not too squeamish. Familiarise yourself with the various types of procedure, as then you can ask intelligent questions and understand the doctor-lingo so much easier.
Third, don't trust your doctors completely. I don't. I always rely on my instincts and the level of care I prefer for my family and myself is not always the same as what the RE's office is offering. To them this is their work. It is everyday, routine and possibly even slightly boring to them. To you, it is a major event and it can be traumatic. To give you an example: after the last procedure we had to wait around for a while before they would release us, but hubby was still quite stunned from the op. A simple thing like a blanket in the car to wrap him up and keep him warm afterwards would have been intelligent. And it's things like that which you can do, but your doctors can't. So prepare for having a husband who is in a bit of shock and pain, and think about what you can do to make his life easier.
To help with that I have made a list of items we are packing for Friday:
Fourth, if you're not sure about anything, call for help. Have those numbers handy! Go back to your RE's office. Here in NZ they can prescribe other things too... we had left hubby's blood pressure meds at home, so the nurse was able to call our GP and get a one tab prescription organised and signed off by the RE. Yes it was a hassle, but at least hubby was cared for properly.
In what might turn out to be good news, our RE (you remember, the one who couldn't manage to find any spermies) is not going to be doing this op. To give you an idea of the level of communication we've had from this clinic, we do not actually know who will be performing the op, but my gut tells my it's simply got to be better than our current RE. Maybe she got spooked after I asked her to send all our case notes to our GP? hehe
So wish us luck and keep everything crossed that they find what they're looking for on Friday.
Now, some diabetes stuff. Pharmac in their wiseness decided to reduce the number of different blood sugar meters available in NZ down to just 3. That's right folks, you can only choose from 3 different meters, but if you consider that they are all made by the same company, and two of them take exactly the same test strip, then it just looks even grimmer.
I was not happy to change meters. My meter is fine, and it would cost me money and time to change. I think it sucks massively that the NZ government is failing to really listen to what Type 1 Diabetics need. Don't treat T1Ds like Type 2s!!!
Anyway, Pharmac let everyone know that you had a set number of months to change over. Fine. I still had a bit if time. Last month I went to get my repeat of old test strips and the pharmacist says, sorry, no, can't give them to you. Even though you have already paid for 3 repeats and only been dispensed 1 repeat. Even though you are a T1D and need this stuff to live. Even though you have a valid prescription. Even though the changeover hasn't happened yet. You will need to get a new meter. Pronto.
Gah! Turned out that the pharmacy had been running it's stocks low to the point of running out early and couldn't even order any more test strips in for me. They just weren't available anymore.
I wish I wish I wish that healthcare professionals would recognise what a living hell this can plunge a T1D into. The stress and panic. Plus I very easily slip into panic mode and I get really mad that there was nothing I could do to prevent this from happening. It is the only time when I resent diabetes - and event then I don't really resent diabetes as it's a part of me and without it I wouldn't be the same. But I seriously resent other faceless organisations and people getting in my business about my diabetes. You don't know what it's like. One flick of the beuracratic wrist on a keyboard and my life is all unsettled for more than a month. I mean, it's not like some other medicines where if you don't have it for a day or two you'll be fine. This is the sort of thing where if you don't have it, it's a complete f*cking disaster.
So instead of working at my job, I spent the afternoon driving between doctors office to get prescriptions, a new meter (piece of crap that I don't trust, it's not accurate enough!), back to the pharmacy. And to make it even worse, the nurse at the docs office screwed up the script and gave me less than a third of what I need. She didn't even read my prescription history, just wrote me a "Type 2" script. She caused me to waste money on an incorrect script (I didn't spot it, the pharmacist who knows me did thankfully). Then because meds are dispensed in thirds (repeats) I had to go back each week for three weeks to get... another 2 measly boxes of strips. Sigh.
Today I went to the docs to get a new script written. I checked it while standing at the counter, and it was wrong again. Still not enough strips listed. "This now says ten times a day - but I test 14 - 16 times a day. Can I get more?" I ask. Nurse responds: "No. You'll see I wrote ten a day, but they will only ever give you 2 boxes at a time." "Really??" Her: "Yup."
Well, I thought that can't make sense. If the script says I need 10 a day (it's wrong, but it's more right than it was at 4 a day) then why does mitte: 2 packs override it? How the hell is the doc supposed to set dosage of anything? I asked my pharmacist whose a good guy to help me out. He called the nurse and turns out she was working under the assumption that there was a limit of 2 packs per repeat for diabetics. There's not. Insulin dependent diabetics in NZ get access to as many strips as they need according to the pharmac website (one small blessing). So he got the script changed and faxed over, and gave me a bunch more strips.
(Note: I hadn't run out of strips completely. No, you can tell that I am not like that. I have a certain "level" of supplies I like to keep at home. So I normally have close to 10 boxes in my cupboard. That should keep me going for several weeks. And when this changeover happened I very quickly ran my stash of strips down. I only have 3 boxes left now. And this means I am cutting things close, considering it is HARD to get a reasonable amount of strips out of my nurse at the GPs. I will keep working on her. In the meantime I am trying to build up a decent stash of new strips before making the actual switch to my new meter.)
I know it's ridiculous to complain about strips when so many people around the world can't get what they need due to insurance restrictions etc, but here there are no restrictions. And that's my point. It was just sheer incompetence that was the problem, mixed with a lack of trust on the nurse's part. And she's the one whose been to all these extra diabetes training workshops.... doesn't know jack about T1D that's for sure. This meter changeover has cost me upwards of 16 boxes of strips that I will never see since the scripts for old strips can't be filled, and the first new script has been superceded. Gah, what a waste.
Solution: if T1Ds are allowed to have as many test strips as they want (and lets face it, you can't really "overdose" on them, it's a medical consumable tool, not medicine per se) why not put your money where your mouth is, eh Pharmac? Why not let any T1D just rock up to their pharmacy and say, "I test 16 times a day" and have the pharmacist calculate the number of boxes to dispense, then give it all at once. None of this splitting it up into thirds shit. I know you do that because a lot of patients never collect their repeats so it saves wastage. But, hey, diabetes is not really like that. This stuff is going to be used. So why do I need a prescription each and every time? Why not just get one prescription to kick things off, then let the pharmacist and diabetic work it out between themselves... that would be, oh, wait! Convenient to the patient! Nooooo we can't have that now. Better make it so complex and time consuming that it will drive folks mad with rage.
In other news, the cat went to the vet today. He's done something random to his eye, such as running into a rosebush or similar. Has small white spots on his eye just exactly like small puncture wounds The vets words were "thanks for coming in with something interesting to show me!" lol poor kitty. He will be fine, I must go put ointment in his eye now...
In other other news, we got 3 new chicks in spring and now that it's autumn, one of them is the most glorious and beautiful rooster... sigh. At least I have two places lined up to take him should the neighbours start complaining. I think he's lovely. Illegal, but lovely.
That is all. I'm sure you'll hear more from me at the end of this week. Wish us luck!
This time, instead of just a needle, it will be a testicular biopsy. A 3cm incision. Last time the needle biopsy wasn't supposed to be super painful, and it was. I can only imagine what this one will be like, but my money would be on "worse". I sincerely hope to be proved wrong: for this procedure to go smoothly and be much, much less painful for dear hubby. Please please please.
There is not a great deal of information about surgical sperm retrieval online, and without trawling numerous forums there is little detail about preparing for the experience either. So I have decided to write down here what we are doing to prepare for this next procedure... which is in 4 days time!
How to prepare for a surgical sperm retrieval procedure (from the woman's perspective):
First, I recommend asking your doctor as many questions as you need. I have a habit of emailing a
Second, do your research. There are videos of the procedures on YouTube if you're not too squeamish. Familiarise yourself with the various types of procedure, as then you can ask intelligent questions and understand the doctor-lingo so much easier.
Third, don't trust your doctors completely. I don't. I always rely on my instincts and the level of care I prefer for my family and myself is not always the same as what the RE's office is offering. To them this is their work. It is everyday, routine and possibly even slightly boring to them. To you, it is a major event and it can be traumatic. To give you an example: after the last procedure we had to wait around for a while before they would release us, but hubby was still quite stunned from the op. A simple thing like a blanket in the car to wrap him up and keep him warm afterwards would have been intelligent. And it's things like that which you can do, but your doctors can't. So prepare for having a husband who is in a bit of shock and pain, and think about what you can do to make his life easier.
To help with that I have made a list of items we are packing for Friday:
- Ice packs (these should be small enough to go inside the undies, near the op site)
- Non-fluffy gauze pads
- Tight "supportive" undies
- Tramadol (painkiller - no driving for hubby on this one!)
- Panadol (3 x before the op, plus maybe some afterwards too)
- Neurofen (as a backup only or instead of the Tramadol)
- Blanket / duvet (for in the car to make hubby comfy)
- Pillows
- Other meds (it's so easy to forget, and such a hassle when you have to get access to meds outside of your home town)
- Valium (we would like to have 1 tab available for hubby before the op, to calm nerves, but won't necessarily be using it)
- Bottled water (hubby won't have been allowed to eat or drink for 6hr before the op, and water is all he wanted directly after the last procedure.)
- Snacks (choc bars, biscuits, etc)
- Towels (no specific reason, but they can be handy. Think propping up knees or feet to help get into a more comfortable position in the car on the drive home.)
- First aid kit (since we have a 3.5hr drive home after the procedure, I want antiseptic liquid and bandages available if things go bad on the way home. Hope like all hell I don't have to use any of it though.)
- Purchase extra data plan for the phone (so we can access email, web, maps, on the go. This makes me feel quite a lot more "able" when having to navigate a strange city on my own. And I will be pretty much on my own afterwards since the pain meds make hubby loo-oo-oopy!)
- Printed maps (mark the following places: motel - we go up the night before the procedure, fertility clinic, a park or lake where you can park up to rest or eat lunch or just think and regroup, a cafe (for before the op), a restaurant (for dinner the night prior), a good bakery or place to buy lunch (for after procedure when hubby will be in no fit state to eat in a cafe amongst the general public), a service station, a supermarket, a pharmacy, plus any other sites that you may need to access in a hurry. I am not the best navigator on my own, so having the backup of pre-planned and mapped destinations will make me a much calmer driver)
- RE appointment letter (because I always like to have a physical record of my appointment in my hand. You would be surprised how easy it is to forget exactly what time you are supposed to be at your procedure! Have the letter to hand lets you check and get it right.)
- Entertainment (there will be waiting. Like, fertility clinics seem to specialise in making you wait. Plus as well as things to do in the waiting room itself, you want something to keep your brain from going crazy when you're stuck in the motel room, or waiting for hubby to reappear from the operating room. A book, a magazine, or if you're like me, you are totally addicted to solitaire on your iPhone...)
- Clothes and toiletries as per normal for a night away.
- Phone charger
- Money / credit card for unexpected purchases while on the road. One time we had to buy ear plugs because the car windscreen came partially unstuck and made this horrendous trumpeting/howling noise. It was safe and we got it checked by a mechanic as soon as it occurred but that sort of purchase is strange and unexpected and you need a couple of dollars handy for the unexpected.
* Note about valium, tramadol etc... Hubby is going along to see the GP tomorrow to discuss which of his current meds are ok with the anaesthesia he will be having, and to ask for prescriptions for pain relief and calm-down stuff. Much better to have it before the op and not need it, than to be prancing around a strange out of town pharmacy with a man-in-pain in tow.
Fourth, if you're not sure about anything, call for help. Have those numbers handy! Go back to your RE's office. Here in NZ they can prescribe other things too... we had left hubby's blood pressure meds at home, so the nurse was able to call our GP and get a one tab prescription organised and signed off by the RE. Yes it was a hassle, but at least hubby was cared for properly.
In what might turn out to be good news, our RE (you remember, the one who couldn't manage to find any spermies) is not going to be doing this op. To give you an idea of the level of communication we've had from this clinic, we do not actually know who will be performing the op, but my gut tells my it's simply got to be better than our current RE. Maybe she got spooked after I asked her to send all our case notes to our GP? hehe
So wish us luck and keep everything crossed that they find what they're looking for on Friday.
Now, some diabetes stuff. Pharmac in their wiseness decided to reduce the number of different blood sugar meters available in NZ down to just 3. That's right folks, you can only choose from 3 different meters, but if you consider that they are all made by the same company, and two of them take exactly the same test strip, then it just looks even grimmer.
I was not happy to change meters. My meter is fine, and it would cost me money and time to change. I think it sucks massively that the NZ government is failing to really listen to what Type 1 Diabetics need. Don't treat T1Ds like Type 2s!!!
Anyway, Pharmac let everyone know that you had a set number of months to change over. Fine. I still had a bit if time. Last month I went to get my repeat of old test strips and the pharmacist says, sorry, no, can't give them to you. Even though you have already paid for 3 repeats and only been dispensed 1 repeat. Even though you are a T1D and need this stuff to live. Even though you have a valid prescription. Even though the changeover hasn't happened yet. You will need to get a new meter. Pronto.
Gah! Turned out that the pharmacy had been running it's stocks low to the point of running out early and couldn't even order any more test strips in for me. They just weren't available anymore.
I wish I wish I wish that healthcare professionals would recognise what a living hell this can plunge a T1D into. The stress and panic. Plus I very easily slip into panic mode and I get really mad that there was nothing I could do to prevent this from happening. It is the only time when I resent diabetes - and event then I don't really resent diabetes as it's a part of me and without it I wouldn't be the same. But I seriously resent other faceless organisations and people getting in my business about my diabetes. You don't know what it's like. One flick of the beuracratic wrist on a keyboard and my life is all unsettled for more than a month. I mean, it's not like some other medicines where if you don't have it for a day or two you'll be fine. This is the sort of thing where if you don't have it, it's a complete f*cking disaster.
So instead of working at my job, I spent the afternoon driving between doctors office to get prescriptions, a new meter (piece of crap that I don't trust, it's not accurate enough!), back to the pharmacy. And to make it even worse, the nurse at the docs office screwed up the script and gave me less than a third of what I need. She didn't even read my prescription history, just wrote me a "Type 2" script. She caused me to waste money on an incorrect script (I didn't spot it, the pharmacist who knows me did thankfully). Then because meds are dispensed in thirds (repeats) I had to go back each week for three weeks to get... another 2 measly boxes of strips. Sigh.
Today I went to the docs to get a new script written. I checked it while standing at the counter, and it was wrong again. Still not enough strips listed. "This now says ten times a day - but I test 14 - 16 times a day. Can I get more?" I ask. Nurse responds: "No. You'll see I wrote ten a day, but they will only ever give you 2 boxes at a time." "Really??" Her: "Yup."
Well, I thought that can't make sense. If the script says I need 10 a day (it's wrong, but it's more right than it was at 4 a day) then why does mitte: 2 packs override it? How the hell is the doc supposed to set dosage of anything? I asked my pharmacist whose a good guy to help me out. He called the nurse and turns out she was working under the assumption that there was a limit of 2 packs per repeat for diabetics. There's not. Insulin dependent diabetics in NZ get access to as many strips as they need according to the pharmac website (one small blessing). So he got the script changed and faxed over, and gave me a bunch more strips.
(Note: I hadn't run out of strips completely. No, you can tell that I am not like that. I have a certain "level" of supplies I like to keep at home. So I normally have close to 10 boxes in my cupboard. That should keep me going for several weeks. And when this changeover happened I very quickly ran my stash of strips down. I only have 3 boxes left now. And this means I am cutting things close, considering it is HARD to get a reasonable amount of strips out of my nurse at the GPs. I will keep working on her. In the meantime I am trying to build up a decent stash of new strips before making the actual switch to my new meter.)
I know it's ridiculous to complain about strips when so many people around the world can't get what they need due to insurance restrictions etc, but here there are no restrictions. And that's my point. It was just sheer incompetence that was the problem, mixed with a lack of trust on the nurse's part. And she's the one whose been to all these extra diabetes training workshops.... doesn't know jack about T1D that's for sure. This meter changeover has cost me upwards of 16 boxes of strips that I will never see since the scripts for old strips can't be filled, and the first new script has been superceded. Gah, what a waste.
Solution: if T1Ds are allowed to have as many test strips as they want (and lets face it, you can't really "overdose" on them, it's a medical consumable tool, not medicine per se) why not put your money where your mouth is, eh Pharmac? Why not let any T1D just rock up to their pharmacy and say, "I test 16 times a day" and have the pharmacist calculate the number of boxes to dispense, then give it all at once. None of this splitting it up into thirds shit. I know you do that because a lot of patients never collect their repeats so it saves wastage. But, hey, diabetes is not really like that. This stuff is going to be used. So why do I need a prescription each and every time? Why not just get one prescription to kick things off, then let the pharmacist and diabetic work it out between themselves... that would be, oh, wait! Convenient to the patient! Nooooo we can't have that now. Better make it so complex and time consuming that it will drive folks mad with rage.
In other news, the cat went to the vet today. He's done something random to his eye, such as running into a rosebush or similar. Has small white spots on his eye just exactly like small puncture wounds The vets words were "thanks for coming in with something interesting to show me!" lol poor kitty. He will be fine, I must go put ointment in his eye now...
In other other news, we got 3 new chicks in spring and now that it's autumn, one of them is the most glorious and beautiful rooster... sigh. At least I have two places lined up to take him should the neighbours start complaining. I think he's lovely. Illegal, but lovely.
That is all. I'm sure you'll hear more from me at the end of this week. Wish us luck!
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