Wednesday, November 15, 2006

Updates, Updates and Updates...and crappy workload!

I am FINALLY getting back to post an update after the "wedding of the century" (which, by the way, went very well.... Will post pics of Chris in his monkey suit very soon (he looked very smashing!).

I am just "down" at the moment because this is the first time I have had the chance to either post here or on my BG's in more than 2 weeks! Work has been kicking my ass like crazy - everything is a priority, everything needed to be done yesterday...and some of it is because others involved in the projects NOT at Rutgers have dragged their feet on their jobs, which turn it into a rush for me. It is very aggrivating - not to mention, I feel like I am dropping the ball on my end and things are falling through the cracks, which is not how I like to work. The stress is the highest it has been in a long time here, and it's not going to get any easier until well into the new year - just in time for me to get back into TTC. Something has to give here...just not sure what. So, I hope that, now that the wedding is over, maybe I can at least post on the weekends...

For now, on to the updates I can get to today...

In my "Update to "...Lets keep the good news a'rollin' in!"" post from 9/27, I went over where I stood with my current bloodwork... Here is how all of that stands now with the bloodwork I had done on 10/27 (Dr. D was holding the bloodwork results "hostage" until we met for our TTC consult on Monday night...more on that and the appointment with the other upper-GI doc after the results of all of the bloodletting):

For the MTHFR issues (which is the BIGGIE with TTC again and the #1 factor in my miscarriages thus far):

Homocysteine levels:


  • from May: 10.8
  • from August: 15.3
  • from October 27: 3.9
  • average range limits: 3.3-10.4 (although the limits on the 10/27 bloodwork says limits are 5.0-12.0, and I am below that!).
WhooHoooo! This is the BEST news I could have received on Monday! That means that the Folgard I have been taking since August 30th has really been working and, although according to one range I am low, it puts me in a great position to TTC again without complications!

For Thyroid issues:

TSH:


  • from July 15: 2.555
  • from August 15: 1.964
  • from September 22: 2.012
  • from October 27: 2.204
  • Average range limits: 0.350-5.500

T3:


  • from July 15: Not run
  • from August 15: 26
  • from September 22: 24
  • from October 27: 33
  • Average range limits: 24-39

T4:


  • from July 15: 12.1
  • from August 15: 13.6
  • from September 22: 7.2
  • from October 27: 7.1
  • Average range limits: 4.5-12.0

Free T4:


  • from July 15: not run
  • from August 15: 3.5
  • from September 22: 1.07
  • from October 27: 2.3
  • Average range limits: 1.2-4.9
As far as the thyroid stuff is concerned, I am still well within average limits despite the elevated anti-thyroid antibodies (which was not tested this time around), but I am still above the 2.0 TSH mark that Dr. S (the endocrinologist) wants it to be before Janaury. I have yet to speak to her about the results (I am going to call her today to confirm she received the results of the bloodwork) - but, I am sure that after it is re-tested at the end of this month, it still won't be below 2.0 and I will probably have to start taking meds for that. That is the crappy news, but not necessarily terrible because Dr. D still feels she is "nickle and diming" the number - although he will still defer to her on how she wants to handle it.

CD 3 Hormone check:

FSH:

from October 27: 4.7
Average range limits (in follicular phase): 2.5-10.2

LH:

from October 27: 10.1
Average range limits (in follicular phase): 1.9-12.5

So, as always, I am well within average ranges - despite the irregular cycles. Gotta love it!

Now, onto the nitty-gritty of the doctors' visits from Monday:

I met with Dr. Stef on 11/13 around 3 pm. I had seen him before I got PG with Chris because I was crampy all of the time and Dr. D wanted me to see him to rule out intestinal issues - of course, I had the lovely scope done then (with anesthesia, of course!) and found I had a few Diverticuliti (not a big deal right now and quite common, unless it develops into Diverticulitis later on - which means scoping every 5 years - yuck!) and IBS. I explained what has been going on since April/May/June with the stomach pressure and nausea/vomiting episodes and how Dr. R did nothing about it (and how Dr. McC had to step in and put me on Librax to ease it off). He said what I have is called Gastritis/Gastro-Dyspepsia. He is pulling me off Librax and putting me back on Ativan/Lorazepam....again. If you recall from the spring, Lorazepam is what was suspected in triggering the GERD issues - so, I am not quite thrilled about trying it again for that reason, not to mention it is ALSO a Category C-D drug for pregnancy: Known fetal risks.

Although I am rather hesitant to take it again, the one thing he did that Dr. R didn't do was schedule a real follow-up on December 4th to see if the Lorazepam is working. If it is, but is causing GERD again, he will add in Aciphex again to stop that until the Gastritis ceases. He assured me we have plenty of time before January to get this really corrected so we can get back to TTC. It was a good appointment...now, I just have to make the switch of meds, which I will do over the weekend since Lorazepam used to knock me out cold!

Hubby and I met later in the evening (around 7 pm) with Dr. D for the TTC consult, which went extremely well!

He is thrilled to see the homocysteine levels way down - and, told me that there is a new prenatal vitamin coming out that is made specifically for issues like mine, which he will switch me to once my current prescription runs out. So, I should only need one pill instead of two.

We discussed the baby aspirin/blood thinners idea and he said for now, not to take them. He may add in baby aspirin once I am PG because he has read all of the new studies too and it might be a good benefit for me after I am PG. But, taking into consideration my current stomach issues, he thinks taking it would be more detrimental to implantation than beneficial for the MTHFR issues. My homocystein, which is the real culprite for me since I am not testing positive for any other clotting disorders, is his main concern and it is down so well, he doesn't feel I need anything more right now. So, I stopped taking it as of Tuesday.

ETA: I did talk to Dr. D about my stomach issues and the meds I am on for that, since I had just seen Dr. Stef earlier in the day. Although lorazepam is a Category C-D drug for PG, he said it is not the worst of meds to be on getting PG. If the lorazepam works to help my stomach and I am still taking it when I get PG, I will need to come off it - and, if my stomach starts raging again, he will work with Dr. Stef to see what med would be safe to take when I am PG. So, that helps my reservations a bit about the lorazepam...for now. He does, however, want to make sure my stomach is better BEFORE starting TTC - if it is not, he wants to hold off until it is. Otherwise, how can I eat well, right?

He is going to check into the BC/BS High-Risk OB Managed Care program for me - if he can enroll me now so every doc is on the same page, he will. If enrollment has to wait until I am finally PG, he will make sure that happens right away. This is most important because Dr. McC's office staff are not the most compitent folks you could ever run across and he too has had problems getting messages to the doctors. So, he wants to make sure fluid communication is happening for me too.

We went over our TTC limits and, although he glad to see we have discussed this, he doesn't feel we will have to get to that point. He told me about one of his patients who had 9 miscarriages in between child #1 and #2 and he said that, statistically, she would eventually have a healthy pregnancy. But, he said that it got to the point where at each 8-week u/s, he had to tell her the baby was no longer living and she would go home to miscarry. He could never find out what the issue was - and she did eventually have child #2. But, he said that after a while, he couldn't understand how many more times she was going to put herself through it and was going to suggest that she stop TTC, at least for a while anyway. He is glad that for us, he will never have to force us to stop - we are looking at this in the right frame of mind and with the best of intentions for the perfect little guy we do have with it. It was very refreshing for him to hear that.

Last, but not least, we discussed the dreaded "protocol" for January...

He is giving us more say in how the cycle protocols, which is wonderful because we do have limits in place on how far we are willing to go. He gave us two options: Either try Clomid again for up to 4 cycles (number of cycles is up to us) and then move on to injectibles, or go straight to injectibles.

The drawbacks to going straight to injectibles are 1) he would chose to refer us out to the St. Barnabas IF clinic so I could be monitored more closely and in conjunction with the MFM clinic; 2) the chances of hyperstimulation are greater: If I did hyperstim, then that may mean a forced TTC break again, which we want to avoid; and 3) I would be responsible for injecting myself with the stims and the trigger (which, really, is no big deal in my world...but then again, I am responsible for doing it at the right time every day).

The drawbacks to trying Clomid again are that 1) we don't know what kind of reaction I will have to it - will it be like the previous cycles or better like when I conceived Chris? and 2) I will have to do OPKs in addition to his u/s monitoring - and I wanted to minimize the amount of "charting" I had to do on my own.

But, what I have in my HUGE favor right now is that I have lost 30-35 pounds since we first started TTC in 7/05 - which can make a big difference in how Clomid works. I weigh less than I did when I got PG with Chris on 50 mg Clomid - and he will be starting me off on 100 mg from the start this time around, if that is what we chose to do.

So, we decided to give Clomid one more chance - 2-3 cycles at most, starting at 100 mg and if that 1st cycle doesn't work, then moving on to the next 1-2 cycles on 150 mg. If that doesn't work, then we will move on to injectibles and do the referral to the clinic. All I have to do now is get a period in late December/early January and then we will be off and running....

...Of course, I highly doubt I will get a period on my own, so I am betting on needing Provera. But, sneaky me....HeeeHeee....didn't mention I still have the 9 Provera pills left that I didn't use because I got my period on my own this cycle after taking the first pill. So, if I don't have a period by Christmas day, my gift to me this year will be taking those 9 Provera pills and bringing on my own period - I just have to call and ask for the Clomid script before Christmas. just in case it starts early (Dr. D's office closed between Christmas and New Year's). HeeeHee!

So, the first step to all of this now is making sure my stomach rebounds and calms down... Keep your fingers crossed because we have 45 days until 2007 - and I would love to see a healthy BFP for my birthday on January 23rd!

2 comments:

Dianne said...

Hey tina! Glad to see you have an update on your blog now, i was waiting to hear about all your apts! I was confused about one of your tests that the doc didnt like the result because it looked to me that all were within the ranges you gave. Everything really looks like it is ready to go!! Hoepfully the lorazepam wont affect you too much, i do know how it makes you sleepy- it did for me and joe too. hopefully no more stomach issues, they can stink! great deal with the clomid cycles and everything with upping the dosage and all that... sounds like everything is pretty much ready to go! only 45 days til january- doesnt seem too too long! and a month or 2 after that I will be TTC :) i hope to get af on my own soon but it took 6 months with conner so who knows how long it will take, a couple weeks and i can get my provera. ad again congrats on losing the 30-35lbs, that is SO awesome!!!!!!! I hope work gets a little easier- OR your dh gets a great job so you can go part time!
talk to you soon
:) Dianne

Jessica said...

Phew- That's a whole lotta update! I sure hope the Clomid does the trick. As a clomid chick myself, 100mg and 150mg isn't so bad. I'm on 200 now. You sound like you are all set with everything in the right place (levels and weight etc). I will be praying for ya.

In the meantime lets hope things get easier with the job, I miss you!