Oh Well

I'm not going to be able to get blood work part 1/attempt 2 done before I leave for vacation. These are the tests that I can't do in network. 

These tests are:

NKA, RIP, TH1/TH2 Cytokine, Fox P3, T-Cell Subset, KIR Receptors, CBC with differential, and LAD. 

It's overwhelming how over my head all of immunology stuff is. I try to understand things to the best of my ability, but immunology is crazy complicated. I have an extreme respect for anyone who understands any of it. 

I had made an appointment this morning for tomorrow but then found out that Repro.source doesn't process blood on Saturday. I tried to get in today to do it but my clinic closes early and I called too late. 

Oh well, it will hopefully only put us back a week. It makes it pretty clear I won't be on only one pack on birth control pills before starting stims again. Hopefully it will only mean an extra week or so. 

I spoke with the financial coordinator at Dr. Braver.man's office today and she was super helpful. We talked about what the price included and how we will move forward with things. I'm looking forward to getting all of the results and trying to understand it all. 

But even more I'm looking forward to 9 days of vacation. Look out lobster and crab, here I come!

Denied

I had submitted a pre-authorization form to my insurance company last week to see if I could get the out of network blood work covered. It was a pain to do and required a lot of calling around since the insurance company wanted all of my previous medical records.

Well, I heard from them yesterday that they denied it. The reason was because it was for IVF. The thing that pisses me off about that is that it isn't for IVF. Yeah, that's my plan, but I'm not doing this testing in order to do an IVF cycle. Recurrent pregnancy loss testing and IVF aren't mutually exclusive.

Oh well, it's just money, right? That's what's we're trying to tell ourselves.

So I have to get that blood work done again and soon since we are leaving for vacation on Friday. We are spending a little over a week in Maine and I am super excited . It's going to be so nice to have a break from work and to be able to spend time together.

The plan is to not think or worry about any of this infertility crap while we are away. I'm feeling a little stressed now because we don't exactly have a plan. Well, I guess the plan is to get the blood work results and then figure out what to do from there. Worrying about it isn't going to change anything.

I have two more weeks in this pack of birth control pills so I'm hoping it will all come together in the next few weeks.

Work

Work has been particularly emotionally draining lately. There are a few issues that are getting to me.

1. The child I see who is in foster care. I was seeing him when he was home and didn't see any huge issues. I am a mandated reporter so have to report things if I see them. He was removed from the house because his parents refused medical treatment for him when they took him to the hospital with a high fever. Since then I have been seeing him once a week at the county office building during his supervised visitation with his parents. The other visit is done at the foster family's house. The biological parents are good about knowing I don't want to get involved and that I am there for the child. Well, the bio mom just had another baby. She had no idea that they were considering taking the baby. They baby was born on Thursday and never went home with mom. Instead, on Monday the judge ruled that the baby would go to the foster family. I can't help but feel horrible for this mother. She had no idea her infant was going to be taken from her and I can't help but wonder what it will do to her relationship with her child. She is not able to bond with her infant son. I can't even imagine! Needless to say it is emotionally draining to be involved in this and to feel for both sides. 

2. A family I am really close with today told me and the other providers that the husband wants to leave. Their son was diagnosed with autism a few months ago and I saw there marriage crumbling. I remember learning that the divorce rate is close to 80% for parents of children with autism. This is very new but I know it's going to get ugly. Apparently the dad has been keeping a secret bank account from his wife. They have two children under 3. 

3. I'm working with a child who is almost 14 for the summer. Generally I work with children under 5 so this is a new challenge for me. He is very involved and has a nurse there whenever I see him. Today the mom was out of town and I spent a lot of time talking with the nurse. I asked her if she had any children and she told me she was never able. We then got talking and I learned that she had 4 ectopic pregnancies. I guess she was just about to do IVF with her husband and he backed out at the last minute. They later  ended up divorced so it seemed like she was correct in saying that everything happens for a reason. I told her somewhat about we have been going through and it was really great to connect with her. Its amazing how when you open up you find so many others with a similar story. 

23 tubes

Today I was successful with blood draw #1. The phlebotomist was able to get all 23 tubes from my right arm. It took a while but she had me fully reclined in the recliner type chair so I didn't feel too lightheaded or anything. My arm is super sore but I'm hoping it feels better tomorrow.

The bad news is that the lab doesn't do 3 of the tests that were ordered. I'm trying to see whether I can get those tests added to the Repro.source order and then send it again to my  insurnace comapny to get pre-authorized.

The insurance company received the pre-authorization form but are requesting my medical records. I was successful in talking to someone at my first clinic and they said they would send the info over ASAP. I was unsuccessful with my current clinic because they are only open a half day on Thursday. Hopefully tomorrow will be successful with them.

I can't believe how complicated it is just to get blood work done. Hopefully this will be behind me by the end if next week as we are leaving for a week in Maine next Friday. It would be nice to not think about it while on vacation.

I'm trying to convince myself that even if we don't find out anything ground breaking with this blood work at least we are ruling it out as a possibility. I often suggest children with speech delays get their hearing tested even if just to rule it out as a factor.

What a Headache!

Dr. B ordered an insane amount of blood work. I have been working hard at getting it completed and as much paid for by insurance as possible. The entire order was sent to an out of network lab (Repro.source) originally. Since some of the testing can be done in network I was able to get two different scripts for the testing. 

All of the following tests will be performed at an in-network lab:

 protein C, Protein S, lupus anticoagulants, antithrombin, Factor X, Factor IX, Factor VII, complete thyroid panel, prolactin, Homocysteine, prothrombin gene analysis, beta 2 glycoprotein, MTHFR, Cardiolipin, Vitamin D, platelet antibodies, DNA double stranded anitbodies, ACE insertion/deletion, Annexin 5, Prothrombin gene (factor II), C3, C4. 

Then there is a script for a karyotype for both me and my husband. 

In addition, there is DNA testing for both of us. These tests include: HLA A, B, C Class I DNA TYP-antibodies and then HLA DR, DQ Class II DNA- antibodies. I'm not sure exactly what all of those abbreviations are for, but I know it has to do with DNA. Aren't I a genius?

For this blood work I had better success today with Quest Diagnostics. I had been try Labcorps but decided they sucked and I should go elsewhere. Today at Quest they seeemd initially overwhelmed and annoyed but then told me that I can return tomorrow afternoon and get all of the tests performed. I'm sure it's going to be a lot of blood, but I will be so happy to have it done and behind me. 

There are a few tests that cannot be performed in network and I therefore have to use a specific company (Repro.source). They sent me two boxes by FedEx and instructed me to take these to my clinic and have them draw the blood and then they would send it. 

Etsy shop lilflower

I brought the boxes with me to my baseline appointment yesterday. When I pulled them out the nurse got a bit upset and wanted to call in the NP to see what to do. I heard them talking about it in the hallway and then the nurse and NP came back. 

The NP came in and was a bit rude about it all. She asked me who ordered these tests and why I was doing them. When I mentioned Dr. Br.averman she appeared even more upset. Things didn't improve much from there. I felt like I was being lectured. She told me that he thinks outside the box and that he does some different things, but that I have to be careful because he will take a lot of my money. She asked if he would be managing my cycle and I said he would. She asked if he would be doing the retrieval and I said he wouldn't. She then said she will need to have written orders from him during my cycle and that her past experiences with him did not include any formal instructions. This is the only way it will be possible. 

She then left the room and the nurse came back in to draw my blood. Once again she seemed annoyed but got it done. The NP popped her head back in the room and seemed to have calmed down a bit but was obviously not happy about the situation. She wrote me a prescription for birth control pills and then said she was going to need the plan to know what to do next. At one point while I was getting my blood drawn I heard Dr. K in the hallway talking to her but I wasn't sure what about. It's pretty rare to hear his voice down in that part of the hallway.

The worst part of this whole thing is that I learned the extra blood work through Repro.source could be covered by my insurance with pre-authorization. I hadn't gotten it prior to getting my blood work done the other day so I had to cancel that set of tests in order to wait for the pre authorization from my insurance company. Then I get to do it all over again. Yay!!

For the past two days I have been upset about it all. I'm frustrated that my clinic appears so upset about an outside opinion. I tried to get their opinion about what I could do differently and I feel like they told me to keep doing the same thing. I can't expect any different results if I keep doing the same thing. I need to make changes and know that I am trying my best and maximizing each cycle to increase success rates. It's almost like the goal of getting me pregnant was forgotten at my clinic and everything was taken personally. I'm not trying to offend them but I don't feel like I am getting what I want from them. I'm willing to pay extra money to feel like we are making positive changes.

A big issue is that I'm too sensitive. I internalize others people's feelings and let it bother me way more than it should. 

One of my friends previously told me she didn't like this NP. She said she didn't feel like the NP includes the patient in discussing the plan or making decisions. I like her because she tends to be more aggressive than the other nurses. I guess I found out that she doesn't like to be told what to do. She really took it personally that I was seeking outside input.

Obviously an option is to not use Dr. B for this cycle and if it doesn't work this time to go to him. That would still involve using my local clinic for monitoring. W and I talked and we still want to move forward with using Dr. B. It is more expensive, but this whole process is so expensive so does it matter that much if it helps? At this point it just feels like a drop in the bucket.

So the questions I could use some input on are: Do I continue with the same NP and hope she turns around on her opinion/attitude?  There are plenty of other nurses at the office but none that know me as well as she does. I think it would be awkward if I suddenly stopped requesting her and then saw her in the office.

Do I send my RE and email telling him the plan for using Dr. B? I was planning to let Dr. B deal with that but from the interaction with the NP I'm wondering how good he is about being in contact with the nurses and doctors. At my clinic it really feel like I only see my RE for retrieval and transfer. There isn't much discussion with him throughout the cycle and I feel like the NP is the one making the decisions.

I also don't know how to put the negativity behind me and move forward. Like I said before I'm really sensitive about other people's reactions to things. I care too much and then worry about it a lot. I just want to move forward and reduce stress as much as possible leading up to this next IVF cycle.

29

On Friday August 3rd I celebrated my 29th birthday. That's right, the last year in my twenties. I know, boo hoo, right? 

W woke me up in the morning by wishing me a happy birthday. After work he stopped and bought me beautiful flowers and picked up a few yummy items per my request. We had reservations at a fancy Italian restaurant for an amazing dinner. W wined and dined me and we left full and satisfied.

We stopped on the way home and rented a scary movie. We spent the rest of the night snuggled up on the couch together. 

Saturday we went over to my in-law's lake house since it was unbeliveably hot. We swam out to the sailboat that is on a mooring and connected our floats to the boat. I relaxed and cooled down while W practiced his olympic dives off the boat. 

At the lake we hung out a bunch with our nephew, read a few books of his and some of mine, went for a sail, and then headed to my parent's house for dinner. 

My step-dad is still in bed from his hip replacement surgery and my brother was passed out from a slumber party the night before. My in-laws come for dinner as well as one of my mom's friends. Dinner was delicious and my mom got my favorite ice cream cake for me. She bought me candles made out of chocolate. I made a different wish than usual so I'm hoping it will come true : ) When I pulled the candles out of the fridge to take home the numbers had switched around and said 92 instead. Hopefully I will celebrate that birthday some day, just not any time soon. 

W split an iPad with me for my birthday and I am loving it! It's taking some getting used to typing on but the image/resolution is amazing. The screen is so crisp and big compared to my iphone. 

I met a blogger friend last week for fondue. She brought her adorable little girl which made things a bit crazier, but also lots of fun. She goes to the same clinic as me and it was nice to share stories and get to know each other better. It was a bit strange to have someone know so much about me. I haven't invited anyone IRL to read my blog so I tend to be more open. I'm hoping we hang out again and that she invites me to swim in her pool soon (hint, hint Amanda!!) Just kidding... sort of. 

We have tickets to go see Mumford and Sons tomorrow and I am super excited. I also have my baseline appointment and W is going to join me since we both need to get some blood work done. I'm still working on the other blood draw but Labcorps seems to hire a bunch of rude idiots. Wish me luck on that one. 

I'm so grateful for the support and shout out for meds from other bloggers. I'm still on the hunt for more Cetrotide, but hopefully I will figure it out. I have quite a while before I need it. I'm so grateful to have so many extraordinary people in my life. 

Consult

Tuesday, July 31st was our long awaited appointment with Dr. Br.averman. We live in Upstate NY and planned to make the drive down for the appointment. I scheduled it a few months ago and then the weekend prior I got an email confirmation about it. I thought I had scheduled the appointment for the NYC office, but the email said it would be on Long Island. No biggie, it was actually good for us because it meant we wouldn't have to navigate around the city and leave our car at some bus or train station as was our plan.

The appointment was at 5:45 so we left really early in order to have some time on the beach. We spent about 3 hours on Jo.nes Beach and had a great time. It was totally surreal to be sitting on the beach on a Tuesday of a work week. It's a really beautiful beach and it wasn't busy at all. 

We left the beach with lots of time to get to our appointment in case there was traffic. We arrived at the office at about 5:30 and walked in.

All of the lights were shut off. I called the number and it rang and rang. Finally we saw a receptionist in the office despite it definitely being closed. W and I knocked on the door repeatedly and she came over.

I showed her the email and she told me that Dr. Br.averman was in the NYC office on that day. She suggested she call over and see if we could still make it on time to see him since he was running a bit behind.

It took her a while but she finally came back and said she didn't think he would be there by the time we got there. She gave me his cell phone number and we said we were going to try to make it since we had come so far to see him.

So, at 6:00 we were heading from Long Island into NYC with crazy traffic. We never intended to drive into Manhattan so we were both a little overwhelmed. On the way, Dr. B called me himself and told me he would wait for me so not to kill ourselves trying to get there.

We got into midtown Manhattan with the use the map on my phone and W dropped me on some random corner in order to go find parking. I power walked a few blocks and made it to the second floor. I poked my head in a random office and they said his office was down the hall. I went down the hall and wandered around some random office that has no signs of being open.

At that point I pulled out his cell phone number and called him. Somewhat annoyed he asked me how I got that address since it was an old one. I told him it was on my iphone and I just followed what it said. At that point it was about 7:10 and he said he would wait for me but probably not be able to stay for long. He said, "It's not your day, is it?"

I called W frantically and he was just about to pay $25 for parking. Luckily it was just in time and he was able to pull out of the garage and head towards where I was. He picked me up and we headed to the correct address.

He once again dropped me at the corner and I hustled a few blocks to the office. Finally, around 7:30 I arrived in the right place.

Not Surprised

Today was my beta. I tested yesterday and it was negative so I wasn't surprised when I received the call. 

When I went in this morning I didn't share my negativity. The receptionist was so positive and wished me good luck. I smiled back. Then the nurse commented on my D.O.B and the fact that my birthday is tomorrow. She said that a positive would be such a great birthday present. I just agreed. 

When she called later she sounded so disappointed. I could tell by the tone when she said hello that she was dreading the call. I think she sounded more upset than me. 

I'm fine with the results. Sure a positive would have been amazing, but I'm not going to feel too bad about things. My birthday is tomorrow so I'm going to put it behind me and focus on the now.