Archive for November 25th, 2008

PICT0196-1 So we've all heard the debates about nature vs. nurture and we all have our own opinions about them.  Some people believe that everything is totally ingrained and nothing we do on the nurturing side can change nature's ingrained tendencies.  Some people believe that nothing is written in stone and nurturing is absolutely 100% responsible for the way people turn out in life.  Clearly, most of the time, the truth lies somewhere in the middle.  But I am learning that there are definitely some things that are honestly just programmed into our code from the very beginning. 

Take my Abby, for example.  She's my little music snob.  She hasn't had time to have had this ingrained through the nurturing process.  But she comes by it honestly.  I was  a flutist for 15 years and also played oboe for 8 years.  I majored in music in college until I had an injury in my junior year that kept me from finishing my last several performance credits for the degree (I do have a minor in music, but fat lot of good that does me).  I studied under some of the best musicians in the world and had some fantastic opportunities to tour with orchestras in the US and Europe.  I always expected music to be an integral part of my life and I'm shocked to discover that it's not nearly as much in the forefront of my daily life as I expected it to be. 

Back to Abby – that was all just background.

A couple weeks ago, as the babies were finishing up dinner, I put on Tchaikovsky's Fourth Symphony.  If you know Tchaikovsky at all, you know that he wrote a lot of ballet, and much of what he wrote that ISN'T ballet still lends itself to ballet.  Now, I am clearly no ballerina.  But my kids were in their high chairs looking amused, and Tchaikovsky was floating out of the CD player and there was this big, wide open space in the living room/dining room, so I started pirouetting around and doing really bad arabesques.  Sam and Ellie clapped and smiled, but Abby – oh Abby was cracking up.   I mean, seriously, she was totally CRACKING UP.  She could not stop giggling and laughing and reaching out toward me.  She was completely, totally CRACKING UP.  It's so funny, because she's normally so serious, so watching her crack up was so amusing to me.

I didn't think much of it, because I figured that she was just laughing at her crazy mama making a fool out of herself in the living room, right?    The next day, the babies were playing with toys on the living room floor, and I put the same CD back in and Abby immediately smiled and looked up at me.  I started pirouetting around again, and she started CRACKING UP!  The fun didn't last long, though, because I was getting ready to change their diapers and put them down for a nap.  Seth wandered upstairs and noticed the music on and said, "Oh no!  Did I miss pirouettes AGAIN?"  No way am I ever going to let anyone else ever see me doing pirouettes, not even my husband.  He'd probably fall over laughing.  So I scooped Abby up into my arms and started spinning around with her with the music still on.  Once again, she started cracking up, laughing hysterically.  When I stopped spinning she looked around at the world like it was a new and fascinating place. 

Still, I didn't think much of it, because what kid WOULDN'T love to be scooped up into mommy's arms and spun around for some fun?

Later in the week, my mom was over and I wanted to show her how Abby cracks up when you spin her around, so I scooped her up and spun her around.  She smiled.  And she let out one tiny chuckle.  But no cracking up.  I was completely perplexed.  I tried again.  Still, nothing.  Just a smile.  No cracking up.  How could this be?  How could my daughter be sitting there in my arms purposely making a liar out of me?

And then I realized how quiet it was in the house.  Could that be the problem?  Could my daughter be so discerning that she wanted the music on?  Nah.  Couldn't be.   But, just in case, I turned Tchaikovsky back on, and sure enough, Abby grinned immediately, and as soon as I started spinning her around, she CRACKED UP.

Interestingly, Abby does not respond nearly so strongly to Mozart, Brahms, Moussorgsky, Beethoven, Bach, Prokofiev or Rachmaninoff.  But Ellie totally digs Rachmaninoff – more than anything else.  Isn't it neat that they both have a favorite?  Ellie gets up and dances for Rachmaninoff.  Sam dances for all of it.  He's just a dancing fool.

I love it.

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First, see my previous post for the latest on my girly parts.

Second, here’s the latest on the insurance situation:

I am definitely switching to the insurance at Big Large Corporation (BLC). It is unquestionably better coverage. If I exhaust my coverage under BLC, I can go back to my husband’s insurance and then exhaust his coverage. Sneaky, eh?

Unfortunately, the insurance with BLC, which uses Well Known Insurance Company (WKIC), does not include Dr. McB as a preferred provider. In order to continue seeing him, I would have to see him as an out-of-network provider, which would completely defeat the purpose of having kick-ass benefits under BLC/WKIC. This is, of course, not an all together bad thing, what with the 30-40 mile drive (depending on whether you’re driving from my house or my office), but you know? I had really begun to like Dr. McB. And we had a plan. And a timeline. And we were moving forward. And it was all good. Except the geography. But everything else was pretty good. Okay, so his SART Stats weren’t great, but SART Stats, to be honest, aren’t everything. Even SART says flat out that the stats can be deceiving because some clinics have a habit of purposely weeding out patients that will pose a greater challenge, and some clinics specifically see those patients that are more of a challenge, so their stats may be lower. So you see? It’s all a little deceiving.

That being said, even the raw data for my old clinic is better – over 10% of their transfers are elective single embryo transfers, which is well above the national average of 3%, and well above the Hatchery’s 0%. And the number of cycles initiated is vastly bigger – nearly 1200 compared to 36 in my age group. Bigger isn’t necessarily better, but it does make their data easier to interpret since their sample size is bigger. There is defintely something to be said for the smaller clinic and the single doctor who isn’t going to forget me. But I never felt like my doctors didn’t know who I was at the big clinic, either. I never felt like a patient number at the old clinic (though I still know my patient number by heart).

Anyway, it’s the right decision to make – to go back to the old clinic. Geographically, financially, and probably in terms of success rates. But it sucks because I had a plan, and now the plan has changed and because I really did like Dr. McB as it turned out, and I think he would have done good things for us. I hate that money stands in the way of the things we want in life. Or in this case, money and geography.

So the plan:

1. Get HSG done – either clinic could use the same HSG results anyway – CHECK
2. Schedule a pre-pregnancy consult with perinatologist – CHECK (Dec. 15th)
3. Schedule consult with Dr. Amazing at old clinic – CHECK (Jan 5th)
4. Go on BCPs when next period starts – I’m still going to do this in anticipation that Dr. Amazing will be on board with my plan to go forward with IVF and that way I won’t be delayed in waiting to start a cycle – I’ll already be on BCPs. Sneaky, right?

And now we wait.

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The Plot Thickens

So I had my HSG today. Truthfully, an HSG wasn’t strictly necessary, since we knew we were going to do IVF no matter what the HSG indicated, so I could have just done a sonohystogram, since all Dr. McB really needed to see was the uterine cavity, but he left it up to me to decide what I wanted to do. Me being me, I’d prefer to know what the status of all the girly parts is whenever possible, even though my last HSG was totally clear back in 2005 and there’s no reason to think anything has changed. But really, my last HSG didn’t cause me any true discomfort, except when threading the catheter through my cervix and that was short lived, and I’m not really all that concerned about the invasiveness of the procedure. Truly, you don’t get much more invasive than a high-order-multiple pregnancy and subsequent c-section, to be honest. Frankly, my comfort level for one procedure is not my main concern here – getting the baby on the other side of all of this is my main concern. So bring it on, doc.

Which brings us to this morning. I hauled my tushy all the way up to The Hatchery, 33 miles away, arrived 30 minutes early (whoops), and waited. And waited. Okay, I didn’t wait that long – they were running about 10 or 15 minutes behind, so it wasn’t so bad, but considering how early I was and the fact that I’d failed to bring any books with me and the Radiology Center at the University doesn’t have any decent magazines… it sure did feel like forever.

Doing the HSG at The Hatchery is different than at my old clinic (I’ll have to think of a new pseudonym for the old clinic…). The Hatchery uses the University hospital services for everything they do – so the HSG is done downstairs at the radiology center, retrievals and transfers are done in the main hospital (I think in a regular OR, but I could be wrong about that). The old clinic was a self-contained unit – everything they did was in their own suite, their own labs, their own surgical center, their own facilities, period. So I was taken to a changing area where I changed into a gown, but then from there I had to walk down a hall to a room where they took a flat, pelvic xray, and then down the hall to another room where they did the actual HSG. Both times I walked through the hall, there were several gentlemen sitting in chairs waiting in the hall. Not really who I want to be walking past as I’m walking in a gown with nothing covering up my nether-regions ifyaknowwhatImean… (I mean, I know the GOWN covered up my nether-regions, but I still felt a might bit TOO exposed for comfort’s sake.

The equipment that this radiology center used for the HSG was different than my old clinic, also. Rather than being on a bed with stirrups, I was on a flat x-ray table, and rather than having this adjustable floaty thing above me that was attached to a computer screen showing my uterus in real time and all that like last time, there was a more normal x-ray machine (just smaller) that slid out over me when the time came (still attached to a computer thingy with live shots, but they took several still shots rather than having the computer capture the pictures). It seemed… less modern, but it did get the job done, so I don’t know if it was less modern, or just different. I am certainly no doctor, and I will say that my husband works at this hospital and is the pharmacy manager for technology and they are anything but archaic in the pharmacy department, so I can’t imagine that this was archaic – it was just different.

Dr. McB came in and was really very pleasant. Honestly, I really feel badly for calling him brusque after our first meeting – in retrospect, while his manner was quite matter-of-fact, he was probably at least partly responding to my manner, which was pretty much, “I know why I’m here, I don’t need you to hold my hand through this, let’s get on with the show.” It’s just that any consult with an RE is a bit… I dunno… demeaning in a way. It feels like it strips away a bit more of my femininity each time I walk into an RE’s office and I get a bit more defensive each time, I think, even though I don’t mean to, and I know it’s not their fault I’m there.

Wow. Tangent, much?

Anyway, Dr. McB came in and gave me my consent form and ran down the list of risks that there are associated with an HSG, but I’ve been there, done that. Kudos to him for explaining them very clearly and explaining exactly what they do to mitigate those risks. Needless to say, I wasn’t worried before, I am not worried now. We joked around for a bit as everyone was getting ready and then it was time for me to assume the position, which isn’t as easy as it sounds on a totally flat table, but whatever. I told him that this was certainly MY idea of a good time on a Tuesday morning, and he said it’s certainly a typical Tuesday morning for him. It’s only my second HSG, but I sure hope it’s not just his second… he assured me that although I was only his second of the day, I was not his second HSG ever.

Now, next bit of kudos to Dr. McB – he did a really good job of always letting me know what he was about to do next, which I really appreciate in a doctor. Not all doctors think to do that, but it’s a nicety that really helps patients feel like they matter. So if any doctors ever read this blog – by golly, take that as a lesson to you! He told me he was about to insert the speculum and I said, “You do what you need to do, doc!” But holy smokes, that hurt. And it didn’t stop hurting until the end of the procedure when he pulled it out. Could it have been pushing against my cervix or something? Whatever it was, it hurt! “Now I’m going to wash your cervix with betadine,” he said. “Okay, hold it right there, doc. Now I think you’re getting just a little too up close and personal, don’t you think?” Hang on there, kiddo, it’s about to get a lot more personal than this! Then he told me he was going to give me something to numb the cervix. Hey, I don’t remember my old clinic doing that – apparently he’s just nicer than them. “You won’t even notice this…” YEOWCH! Big huge, horrible, ouchy pinching! “really? The last woman didn’t even notice me doing that!” Clearly, I’m just a sensitive soul.

He let his resident inflate the balloon, which she seemed to have a little bit of difficulty with, but I have no problem with that – you have to learn somehow, right? And he was in total control of the situation the whole time, which was abundantly clear, so I wasn’t in the least bit concerned. There was some discussion about catheter sizes. Apparently my cervix wasn’t as cooperative as one would l ike. Tell me about it. I felt exactly the same way when it shortened from 4cm to 1cm overnight while I was pregnant. Uncooperative, indeed! Mind you, all the while I’m still in some pretty fine pain from the damn speculum. Dr. McB asked a couple times “How you doing up there?” “Just as great as could be, doc!” “Well, I just like to keep the lines of communication open down here!” And good for him. How dare I judge him at our last appointment? No really, how dare I?

And then came the dye. At my last HSG, the worst of it was getting the catheter through my cervix. After that, it was smooth sailing and I never noticed the rest of the procedure. So I figured that the rest of this procedure would be a piece of cake. Not so.

Holy Crap! They actually had to remind me to breathe, because I really couldn’t move a muscle it hurt so much. I wanted to squirm but knew I shouldn’t and I wanted to writhe, but knew I couldn’t. They started taking pictures and I said yeowch a few times (as calmly as I could) and Dr. McB said, “Well there’s an obstruction there on the left side.” Huh wha? Excuse me? That’s a new development. And so not okay. Well, said Dr. McB, it doesn’t really matter since we’re doing IVF anyway. But that certainly doesn’t mean I wanted there to be something else wrong with me just for the
heck of it, now does it? He kept taking pictures and asked if I could roll a bit over on to my left side and I swear I was in so much pain that I couldn’t remember which side was my left side, but I did figure it out in time. Yep, definitely obstructed.

WTF, people?

I mean, seriously! I’m supposed to be doing this IVF thing because IUI works too well – not because I actually need IVF! Okay, that’s a little harsh, since I almost moved on to IVF twice the last time around, so clearly I did have indications for IVF regardless. But it does change my perspective a little bit. Somehow, I feel just a little bit more “legitimately infertile.” This is ridiculous, of course, because the 5 years of infertility, the $20K, the 5 cycles of clomid, the 6 IUI with Follistim cycles, the miscarriage, the hundreds of injections I gave myself – those all should have been clues that … hello? I’m infertile. (And don’t anyone go pointing out that I have a gaggle of kids so I must not be infertile – infertility and barrenness are not the same things – I am SO tired of people saying, “You’re not infertile, look at all those kids!”)

So it turns out that I need this IVF thing after all. Not just to avoid another set of multiples, but because without it, I’d only have a chance at getting pregnant whenever there was a dominant follicle on my right ovary. What a pain in the tushy.

Meanwhile, the plot thickens on the insurance front also, so more on that later – this post is long enough in and of itself.

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