On Wednesday, December 30, per my monitoring appointment the previous day, I reduced my Lupron injections to 5 units each morning instead of 20 units. I also began taking Estrace (which is a tiny blue pill to be taken orally), once per morning with my prenatal vitamins. Everything was going along swimmingly until I started thinking to myself, based on what I remembered from my FET three years ago, "Hmm...I wonder when I'm supposed to increase my Estrace dose to two pills a day (one in the morning and one in the evening)?" The nurse didn't mention anything about it in my monitoring appointment on the 29th so I thought maybe I wasn't supposed to increase my dose until my next monitoring appointment on Tuesday, January 12. As busy as I was with getting our house ready to put on the market, making decisions for our new house that is being built, trying to keep up with my 2 1/2 year old twins, and fighting colds, I didn't check my FET booklet for a few days. The thought about the pills continued to nag me but not as much as the other chaos happening in my household.
But it finally nagged me enough the morning of Friday, January 5. I checked my medication and monitoring schedule in my FET booklet just before leaving for work. To my alarm, not only was I supposed to start taking my Estrace twice per day starting YESTERDAY (Thursday, January 4), I was also supposed to start taking 81 mg of baby aspirin once per day with my prenatal vitamin, morning Estrace dose, and morning Lupron shot way back on Wednesday, December 30! My nurse NEVER mentioned baby aspirin in my monitoring appointment on the 29th - only the Lupron reduction and Estrace once per day. If she had mentioned it, I definitely would have started taking it when I was supposed to! Although, to her credit, she did tell me to follow along in my FET booklet... She just didn't specifically mention the baby aspirin. ARGH!
So I took my morning dose of baby aspirin and another in the evening before I went to bed to "catch up" on at least one missed dose, which made it as though I had only missed five baby aspirins instead of six. Yikes. SIX.
And then I allowed myself to freak out: Panic. Anger. Thoughts of "I've totally ruined this cycle already!" And every other emotion in the spectrum. Except I didn't cry. I had too much anxiety for that.
I called my RE's office at 8:01 am (on January 5) - as soon as they opened. Naturally, I had to leave a voice mail, which, as usual, was very detailed. And, as usual, I specifically said it was ok to leave a voice message on my cell phone if I was unable to answer when they called. To recap, I basically told them I forgot to take my evening dose of Estrace the night before, which would have been my first day of taking it twice per day. I then asked if I should take an extra dose today (so three pills today) or just continue with my prescribed two pills today. I didn't mention anything about the baby aspirin because I figured it was less important and I had plenty of days yet before my actual transfer to get it built up in my system. (And I was embarrassed to admit I messed up two meds and didn't want them to think I was a complete idiot.)
So I waited.
And waited.
And waited some more.
NO ONE called me back before the office closed at 4:00 pm! I was beyond livid! I called them again at 4:22 pm and requested to speak with the on-call physician. I told the medical messenger person what happened, I heard her typing notes, she said she paged the doctor, and she told me if no one called me within 20 minutes to call back again. And what do you know...the on-call physician called me back within five - yes FIVE - minutes. Apparently, I should page the on-call physician more often instead of bothering with the unreliable nurse line.
But the doc obviously didn't read the notes from the medical messenger because I had to explain the whole situation all over again...with my toddlers shouting and pushing and screaming in the background. Fun times. I'm not even certain it was a doc who called me back...I think it may have been a nurse?? Anyway, she said it was too late to take the missed dose now (duh lady, even I knew that) and to just continue with my normal two doses as if I hadn't missed anything last night. She said it was early enough in my cycle that it wouldn't matter. I also expressed my anger regarding the message I left at 8:01 in the morning that was NEVER returned. She said she could say something to the nurses in the morning, to which I said, in a tone that indicated I was not to be messed with, "Yes, please do."
Then I thought to myself, "If this one missed dose doesn't matter, why prescribe so many Estrace pills?? I mean, those suckers are like five bucks (or more) each!" I was kicking myself for not asking that question when I was on the phone with the on-call doc.
The doc must have actually said something to the nurses the next day (January 6) because I received a call from my usual nurse (Theresa) at 11:49 am. I wasn't able to answer but she did leave a long rambling voice message and an attempt at an apology, along with instructions to not take the missed Estrace dose at this point. Seriously? Seriously. I don't know why I'm having so many issues with the staff this time around. Maybe because I'm not naively unaware of the process?? Maybe I'm less tolerant of "how it all works" with the whole nurse line messaging?? Maybe I'm more tired and stressed out with having twin toddlers this round?? I can't quite put my finger on it...
Anyway, on Friday, January 8, I increased my Estrace dose, per my FET booklet, to 3 mg (three pills) per day...one dose in the morning, one at noon, and one in the evening. By this time, I was also still taking one baby aspirin per day, one prenatal vitamin per day, and one 5U dose of Lupron per day.
And I continued taking my meds as noted in my FET booklet - or so I thought - until my second monitoring appointment on Tuesday, January 12 at 8:15 am. This next part is where my memory is a little foggy: I can't remember if I checked my booklet the morning of the 12th and discovered my next medication slip-up or if the nurse talked to me in my appointment about my med schedule and that was how it was discovered. Either way...I took my morning 5 units of Lupron FOUR days too long! I should have taken my last dose the morning of January 8. I mean, who does that?!?!
Me. That's who. %*&#@!
At least I had good results from my transvaginal u/s at my appointment on the 12th: my ovaries were quiet and my uterine lining was super thick at a 10B. I asked my nurse what they look for in a lining, and while she didn't give a specific answer, she did say my lining for my last successful FET was at a 9 so I was looking really good this round. (I should ask for copies of my records just to have all that info from last time that I neglected to document. But I'm afraid they will charge me for it...)
Then the nurse said to start my progesterone in oil (PIO) shots on Thursday, January 14 (1 mL once per evening in my rear end...with a 1 1/2 inch intramuscular needle), Doxycycline (an antibiotic) on Saturday, January 16 (one 100 mg oral pill twice per day - once in the morning and once in the evening), and that she would let my doc (Dr. C.) know what happened with my Lupron. She said someone would call me if there was any change to my med schedule or transfer date, and indicated my doc may push my transfer date out a few days (which was tentatively set for Tuesday, January 19). It was a bit of a relief to hear these options because I was afraid my cycle was going to be canceled altogether and get re-dated for March. Then I told her the problems I'd been having with the nurse line so she said someone would call me either way, which was a big relief.
I made a stern mental note to myself to not screw up the PIO shots or the Doxycycline.
At 1:49 pm on January 12, I received the call. And the news was better than I expected: continue my meds as outlined in my FET booklet except increase my Estrace dose to 4 mg (four pills) per day instead of 3 mg (three pills). I was to skip my noon dose and take two pills in the morning and two pills in the evening. Aside from the added cost of extra pills, that sounded like a better plan anyway...it's so hard for me to take the noon dose at the same time every day because I don't eat lunch at the same time every day. And it's usually a late lunch...like 1:00 or 1:30 or sometimes even 2:00. Pretty much whenever I feel hungry.
And there were no changes to my FET date...it was still a go for Tuesday, January 19! It did seem a bit odd, though, that they didn't want me to come back again for any more blood work before my FET just to make sure my E2 levels were on track after my Lupron screw-up. But I guess they know what they're doing! I can't imagine I'm the only one who has ever messed up their meds...
***
Edited to add: I forgot to note that I did have my blood drawn at my second monitoring appointment on January 12. Nothing out of the ordinary there...I had the same paperwork to give to the receptionist as with my first monitoring appointment. And the receptionist then handed it off to the same technician to do my blood draw. Queue painful stab, etc, etc. When I received the call from my nurse later in the afternoon instructing me to up my Estrace dose, she didn't mention any specifics about my blood work and E2 levels and I didn't ask. I figured it didn't matter anyway since I messed up my meds so much the past few days.
Thursday, February 4, 2016
FET #1 cycle updates: meds and monitoring appt #1
After completing my 23 BCPs in the month of December, CD 1 started just three days later on Saturday, December 26. And per my FET instruction booklet, I started giving myself 20 units of Lupron (actually, Leuprolide, which is the generic version) on Sunday, December 20 once per day for 10 days between the hours of 6:00 am and 9:00 am using small insulin syringes. I chose 7:15 am as a good time for the shots because I didn't want to get up at 6:00 am on the weekends if I didn't have to (re: if my daughter actually let me sleep in). Plus, during the week, we usually leave for daycare drop-off around 7:30 am so if I did anything later than that, I'd likely have to give myself my shots at work. No. Thank. You.
Anyway, I continued with the 20 units of Lupron and managed to give myself the shots every day between 7:00 am and 7:15 am. Per my nurse consult back on Monday, December 14, it was ok to administer the shots within one hour of my preferred time...so I was safe with the 15 minute interval. With my first shot, it was almost like visiting an old friend. The familiarity of it all came rushing back. Along with the sting of the injection. Like a rookie doing it for the first time, I forgot to release my fingers from the pinch on my stomach before taking the needle out so the medication didn't drip out of my body when I removed the syringe. By the next morning, though, I had much improved my technique.
Everything was going well until my first monitoring appointment - the day 10 Lupron and estradiol check, and ultrasound. My appointment was Tuesday, December 29 at 7:45 am, and I forgot to take my Lupron shot beforehand at the normal time. Ugh. Usually when I forget something in my morning routine, it's because there has been a change to the routine - like today when I had an appointment at my RE's office instead of just heading straight to work. I contemplated turning around and driving back home as soon as I realized I forgot my shot but I knew if I did, I was going to be seriously late for my appointment. So I continued on the road, freaking out, and praying everything was going to be ok.
And it was! I told my nurse what happened and she said as long as I could still take my shot this morning within a reasonable time (i.e. within the 6 - 9 am preferred time period), I would be ok. Even if it was slightly out of the normal time frame, one time wasn't going to hurt anything. So we proceeded with my appointment and I received good results. My u/s showed quiet ovaries and a thickening uterine lining (measuring at 4A). Then the nurse said to drop my Lupron to 5 units the next morning, start taking my Estrace pills once per day, continue following along in my FET booklet, and schedule my day 14 u/s and estradiol check on my way out. She also handed me my paperwork to take to the front desk for my blood draw.
When I had no more questions, the nurse left so I could get cleaned up and dressed. Then I checked in at the front desk again, scheduled my day 14 checkup (Tuesday, January 12 at 8:15 am, which was the earliest available), and handed them my paperwork. The paperwork provided my patient information (name, DOB, etc) and indicated what blood test I needed (estradiol, or E2). They then handed off my paperwork to the blood draw technician (very technical term), and I was shocked and upset to see it was the very same tech I dealt with back in 2012. I had hoped enough time had passed that she was able to draw blood for another clinic or hospital. {sigh...} So I mentally prepared for the worst and hoped for the best (maybe she had improved her technique over the past three years??). And the worst happened...the same familiar stab in my arm. I even looked at the bend in my arm the next day where the needle was inserted and noticed a line on my skin leading up to the puncture, like a scratch mark. So yeah, I wasn't imagining it. She scratched me with the needle before it actually went in my arm. But at least I didn't bleed all over this time.
Then I headed home again to take my shot, which I managed to do by about 9:30 am...not too bad! It just made me super late for work, which no one even noticed. Whew!
The nurse who was in the room with me for my u/s said if all was normal with my blood work, I would not receive a followup call. I anxiously waited all day but everything must have been good because no one called me. Another successful milestone checked off on this new journey. :)
***
Side note #1: As I waited to be called back for my blood draw, I let the receptionist know I had another question for my nurse that I forgot to ask during my appointment. She checked my nurse's availability and let her know I was in the waiting room and to come see me when she was done with her next appointment. A few minutes later, my nurse called my name and I asked my question right there in the waiting room. If my question had been more personal, I would have requested a private room or something but all I wanted to do was confirm I was supposed to be taking prenatal vitamins. I said I assumed I was supposed to but no one said anything about it at my nurse consult on December 14. And she confirmed yes, I was indeed supposed to be taking them. Everything with IVF is so specific, I didn't want to take something, even prenatal vitamins, that wasn't recommended yet so I thought it was better to check.
***
Side note #2: Per our financial consultation also on December 14, we were to pay our FET fees today (December 29) since we didn't send a check in the mail before my first monitoring appointment. No one at the receptionist desk asked for payment when I checked in today, and I didn't remind them, so I made it through without having to fork over $4,335. That is until they called me at 2:04 in the afternoon and asked for it. Humpf. At least the lady was nice that I talked to; she blamed the staff rather than me for the oversight. She said I could send a check in the mail or pay over the phone with a credit card. Credit card?! This was new information! I gave her my card number so I could rack up a few thousand reward points. I pay my card off every month anyway so the reward points are like a sweet bonus for all my typical (and atypical) spending. I'd just end up reimbursing myself with my HSA (Health Savings Account) anyway.
It was for sure a done deal now. We were all paid and ready to go! :)
Anyway, I continued with the 20 units of Lupron and managed to give myself the shots every day between 7:00 am and 7:15 am. Per my nurse consult back on Monday, December 14, it was ok to administer the shots within one hour of my preferred time...so I was safe with the 15 minute interval. With my first shot, it was almost like visiting an old friend. The familiarity of it all came rushing back. Along with the sting of the injection. Like a rookie doing it for the first time, I forgot to release my fingers from the pinch on my stomach before taking the needle out so the medication didn't drip out of my body when I removed the syringe. By the next morning, though, I had much improved my technique.
Everything was going well until my first monitoring appointment - the day 10 Lupron and estradiol check, and ultrasound. My appointment was Tuesday, December 29 at 7:45 am, and I forgot to take my Lupron shot beforehand at the normal time. Ugh. Usually when I forget something in my morning routine, it's because there has been a change to the routine - like today when I had an appointment at my RE's office instead of just heading straight to work. I contemplated turning around and driving back home as soon as I realized I forgot my shot but I knew if I did, I was going to be seriously late for my appointment. So I continued on the road, freaking out, and praying everything was going to be ok.
And it was! I told my nurse what happened and she said as long as I could still take my shot this morning within a reasonable time (i.e. within the 6 - 9 am preferred time period), I would be ok. Even if it was slightly out of the normal time frame, one time wasn't going to hurt anything. So we proceeded with my appointment and I received good results. My u/s showed quiet ovaries and a thickening uterine lining (measuring at 4A). Then the nurse said to drop my Lupron to 5 units the next morning, start taking my Estrace pills once per day, continue following along in my FET booklet, and schedule my day 14 u/s and estradiol check on my way out. She also handed me my paperwork to take to the front desk for my blood draw.
When I had no more questions, the nurse left so I could get cleaned up and dressed. Then I checked in at the front desk again, scheduled my day 14 checkup (Tuesday, January 12 at 8:15 am, which was the earliest available), and handed them my paperwork. The paperwork provided my patient information (name, DOB, etc) and indicated what blood test I needed (estradiol, or E2). They then handed off my paperwork to the blood draw technician (very technical term), and I was shocked and upset to see it was the very same tech I dealt with back in 2012. I had hoped enough time had passed that she was able to draw blood for another clinic or hospital. {sigh...} So I mentally prepared for the worst and hoped for the best (maybe she had improved her technique over the past three years??). And the worst happened...the same familiar stab in my arm. I even looked at the bend in my arm the next day where the needle was inserted and noticed a line on my skin leading up to the puncture, like a scratch mark. So yeah, I wasn't imagining it. She scratched me with the needle before it actually went in my arm. But at least I didn't bleed all over this time.
Then I headed home again to take my shot, which I managed to do by about 9:30 am...not too bad! It just made me super late for work, which no one even noticed. Whew!
The nurse who was in the room with me for my u/s said if all was normal with my blood work, I would not receive a followup call. I anxiously waited all day but everything must have been good because no one called me. Another successful milestone checked off on this new journey. :)
***
Side note #1: As I waited to be called back for my blood draw, I let the receptionist know I had another question for my nurse that I forgot to ask during my appointment. She checked my nurse's availability and let her know I was in the waiting room and to come see me when she was done with her next appointment. A few minutes later, my nurse called my name and I asked my question right there in the waiting room. If my question had been more personal, I would have requested a private room or something but all I wanted to do was confirm I was supposed to be taking prenatal vitamins. I said I assumed I was supposed to but no one said anything about it at my nurse consult on December 14. And she confirmed yes, I was indeed supposed to be taking them. Everything with IVF is so specific, I didn't want to take something, even prenatal vitamins, that wasn't recommended yet so I thought it was better to check.
***
Side note #2: Per our financial consultation also on December 14, we were to pay our FET fees today (December 29) since we didn't send a check in the mail before my first monitoring appointment. No one at the receptionist desk asked for payment when I checked in today, and I didn't remind them, so I made it through without having to fork over $4,335. That is until they called me at 2:04 in the afternoon and asked for it. Humpf. At least the lady was nice that I talked to; she blamed the staff rather than me for the oversight. She said I could send a check in the mail or pay over the phone with a credit card. Credit card?! This was new information! I gave her my card number so I could rack up a few thousand reward points. I pay my card off every month anyway so the reward points are like a sweet bonus for all my typical (and atypical) spending. I'd just end up reimbursing myself with my HSA (Health Savings Account) anyway.
It was for sure a done deal now. We were all paid and ready to go! :)
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