Tuesday, August 25, 2009


I am thoroughly overwhelmed. Beware that this post contains ~way~ too much detail and is not for the faint of heart.

Where to start? With Elric's appointment two weeks ago, or the drug he had to get from a special fertility pharmacy? With our health insurance changing last week and all the hassle that caused? Or with my follow-up appointment with my GYN, possibly the most overwhelming appointment I've ever had. Ladies and gentlemen, we have a winner!

So this morning was my follow-up with the GYN, Dr R. At the last appointment, Elric and I were tasked with having appointments or follow-ups with a couple other doctors (the urologist for him and the endocrinologist for me), and with using an ovulation test kit each month. Our plan was for Elric to attend today's follow-up with me, but at the last minute he needed to work, so I went ahead on my own.

I was able to report to Dr R that Elric and I both had our other appointments. I've already written here about my appointment with the endocrinologist and going on the thyroid medication. At Elric's follow-up with the urologist, the doctor felt that his slightly lower sperm count was cause for concern, prescribing Clomid for Elric to take every other day. We have been using the ovulation test kit for the past two cycles, and I showed the Dr. R the spreadsheet I created to track the test results, my cycle, and the dates we have sex. (Elric jokes that I have a spreadsheet for everything, and yes, it's very true.)

Dr R said that my ovulation cycle looked good, and she was pleased to hear about the medication Elric and I are now taking. Since I've only been on he thyroid hormone for a month, an Elric started the Clomid less than two weeks ago, Dr R felt that we had two options.

We could leave things the way they are for a couple cycles, giving the measures we've already taken a chance to work, and have a follow-up in a few months to look at out next step. Or, we could go ahead and take the next step now. Given that the magic age of 35 is fast approaching (the age at which pregnancies are deemed "higher risk"), I opted to move forward with our next options now, instead of waiting another few months first.

The next step is to put me on Clomid and, as Dr R put it, if we're going to put me on Clomid, we might as well put me on progesterone also. Dr R said that the science doesn't back up the use of progesterone here, but that they have seen positive results with it.

I'll save you the detailed explanation about how the body normally produces progesterone when an egg is fertilized, but that the body doesn't always recognize the fertilized egg and that taking the progesterone medication can fool the body into giving the egg longer to implant.

I asked Dr R about side effects, and drug interactions with the Levothyroxine. No drug interactions, although I can't take the Clomid at the same time of day as the thyroid hormone. Side effects: Twins. That's a big one. 5-7% increased chance of having twins. I didn't ask about the percentage of having triplets. We're not discussing the likelihood of twins today. That's not a topic I can handle right now, so I'll think about it tomorrow. (Name that movie.) Other side effects: ovarian cysts, nausea, mood swings (fun!) and some other things that seem uncomfortable, but that Dr R said would only last the few days that I am taking the Clomid each month. The Clomid may also extend my cycle, so I may ovulate a little later than usual, and then get my period a little later.

Doesn't that seem rather straight forward? Take these two medications (in addition to the one you're already on), give it a few months and see what happens. Sure, until you see what the schedule is for taking these things.

And let's remember that until last month, I never took medications regularly. I've been remarkably healthy, without ever even a serious injury before fracturing my shoulder in February. The adjustment already to taking a pill every day has been a big one, especially knowing that I'll eventually need a replacement dose of the thyroid hormone, which means that in all likelihood, I'll now be taking a pill every day for the rest of my life. This is a whole new world for me. My default position has always been to avoid medications that I don't absolutely need, so other than the occasional antibiotic, I've never taken regular medications. even when I was on birth control, I took Depo-Provera, a shot that I got every three months. It was just a semi-regular doctor's appointment, not a pill to deal with every day.

Did I mention that I can't swallow pills? I've tried, and tried, and tried. Please don't give me your fool-proof tips in how to swallow a pill. I've tried it. It doesn't work for me. I get that this is an entirely psychological issue, but it's not one that will be resolved right now. My solution, when needed, has always been to crush the pill and mix it in applesauce or pudding. This past month, I've been having a few scoops of applesauce every morning with my thyroid pill.

So below is the schedule I'm supposed to keep track of. This probably seems very simplistic for anyone who has gone further down the path of fertility treatments, but this is all quite overwhelming to me.

Day 1: first day of my period.

Day 5-9: Take Clomid for 5 days. But don't take it at the same time of day as the Levothyroxine, so make it the thyroid hormone in the morning and the Clomid at night, along with my now-usual applesauce with each crushed pill.

Days 10-12: Wait. (This is the easy part.)

Day 13: Start using the ovulation test kit. Start having sex every other day. But wait, it's not that easy. Don't get up in the morning and pee before I'm really awake and start my routine. I have to make sure I've got my little cup ready to pee in, and the little strips all ready to dip in the cup. But the little strips don't like humidity, so don't store them in the bathroom, and remember to grab them before you head in. And the sex? Scheduling sex is always fun and romantic, right? Don't get me started about "keeping it interesting." Yeah, we get it. We know the tricks. And we're still tired of appointment sex.

Days 13 until ...: Keep testing every day and having sex every other day until the ovulation test kit comes back positive. The day the test is positive, I'm to start taking the progesterone, and we should have sex that day, as well as the next day.

Did I mention that the progesterone is a vaginal suppository? I'm to put it in at night. So, here's an every-other-nightly routine: Get home between 8:30 and 10pm, maybe Elric's home, maybe not. One of us figures out dinner, so we eat around 9:30 or 10:30. If I don't try to get any work done from home, and we actually crawl in to bed together, we better have enough energy for sex. At that hour, who has extra energy to make it interesting or romantic? We're lucky we can stay awake long enough. But then, instead of cuddling up and falling asleep in a post-coital coma, now I've got to get up and put in a suppository before going to sleep. Then Elric's alarm will go off at 4am. I get to sleep longer than that, but I better be awake enough when I get up to remember to have the test kit ready before I hit the bathroom. But the progesterone and the sex only overlap for two days, thank goodness. We don't have to keep having sex beyond the day after the positive ovulation test, unless we want to, Dr R says. Want to? At this point, I just want to get a full night's sleep! Frankly, for a woman with a pretty high libido, I wouldn't mind being done with sex for awhile.

So then I keep taking the progesterone every night until I get my period, roughly two weeks. (Hang on. Will the suppository leak? Do I have to wear panties to bed for two weeks? I've never used a suppository before. Apparently it all gets absorbed, so there's nothing to remove in the morning. But could it leak? I have no idea, and just thought of this now, so I didn't ask Dr R.)

Then I get my period, realize I'm not pregnant, and debate slitting my wrists. (Not really. I'm not actually suicidal. You don't need to schedule an intervention. I'm already seeing a therapist and I'm not a danger to myself. But some days it does seem like it would be easier.)

Dr R mentioned that the drugs could extend my cycle, so it might take a little longer to get my period than normal. If I my period is a week late, I'm to take a pregnancy test. If the test comes up negative and I still don't get my period, then I have to call the doctor, as something could be wrong.

We're going to try all this for three months and se what happens. Of course, we hope it doesn't take three months for us to get pregnant. If we don't succeed, we see Dr R again the Friday before Thanksgiving to follow-up again.

This encyclopedia I've written so far gets me to about 10am today.

Did I mention that Elric had to get his medication at a specialty pharmacy? CVS said the insurance wouldn't let them fill it, and sent us to a fertility pharmacy. Dr R said if CVS couldn't do Elric's medication, they wouldn't be able to do these either, so she'd send the info to the fertility pharmacy.

And did I mention that our health insurance just changed? And that I went through six layers of Dante's Inferno trying to get the information I needed to refill my thyroid hormone last week? I never did get all the info I needed, and ended up paying for that script out of pocket. We've been on the new insurance almost two weeks, and we still don't have our insurance cards. The insurance agent is a complete waste of air and I'm not going to talk about him right now, because I don't want my blood to boil.

I called the pharmacy to see what info they would need to fill the prescription, dreading having to call Kevin, the worse-than-useless insurance agent. (Keep it up Kevin, and I'll publish your last name and phone number here.) Although the pharmacy did need more information than I had, I was luckily able to get the info I needed from Nicole, the lovely office lady at Elric's company. (Thank you, Nicole!) So the prescription has been ordered and Elric will pick it up Thursday night.

I made all the prescription-filling phone calls on my way to work after my appointment. Work was actually pretty good today, and the one person who drives me right up the wall was (oddly) very well-behaved. One of my sweetheart co-workers even brought me a coffee frappe (my favorite comfort food) to improve my day. I spent the morning trying not to cry for sheer overwhelmation. (Yes, that's a new word. Deal with it.) I needed some serious horse time today, and only lost it a couple of times when I was alone with a pony who I could hug and tell my troubles to. Once I started teaching (and once I had my frappe), the work day improved.

I didn't leave work until past 8 tonight. My new schedule will have me there until 7:45, but I got chatty with my last client and her mom. Then I started driving home.

Of course, I haven't mentioned the car problems we've had for the last two weeks. The mechanic said the alternator was just fine, nothing wrong with it. Lots wrong with other things, major safety things, so we dropped about $560 on the car about a week ago. Had the same problem Saturday night and the car wouldn't start to take me home. Elric bought a new battery ($65) on Sunday and put it in.

Tonight, the car didn't make it home. I called Elric, he came out with the jumper cables to rescue me, and it wasn't enough. The car couldn't get enough juice to start. AAA towed it for us, but it'll be parked at my folk's place until at least this weekend. Not sure how I'm getting to work tomorrow, or Thursday. Friday is payday, then we get to decide: pay rent or fix the car? Without the car I can't get to work, but the rent's already partly late. Apparently, the problem IS the alternator.

I planned to tell Elric all about the fun doctor's appointment over a cup of tea in our living room tonight. Instead, we had the conversation on the side of the road, leaning against an inoperable vehicle.

But wait ... my overwhelming day isn't over yet! While I'm on the side of the road, on the phone with AAA, a cop pulls up. Earlier this year we had a little issue renewing our registration because of overdue excise taxes. I was driving on an expired registration for awhile, and racked up three tickets for it. We paid the excise taxes, renewed the registration, and I thought I paid all three tickets. It turns out I only paid two of the tickets. So the ticket that I forgot to pay? Yeah, it caused the RMV to suspend my license, which the cop was happy enough to point out to me. Since I don't have a car to drive for the next few days, this is rather academic, but let's add paying the ticket, the late fine, and the license reinstatement fee to the pile of things I can't afford right now. If I don't have my license, I can't drive to work. If I don't fix the car, I can't drive to work. If I don't go to work, I can't pay the rent. So let's use the rent money to fix the car and reinstate my license. But that still screws my landlords, who are very nice, and very, very sympathetic people. No good way out of this one.

After getting the car delivered to my parent's place, we finally got home at 11:00. Elric turned the oven on and finished cooking the dinner he had started before I called. And today is over. And I have stayed up way too late writing this, knowing that if I wait to finish it tomorrow, it'll never get written.

In closing, here's the refrain that got stuck in my head while we followed the tow truck:

"They're coming to take me away, ha-ha, he-he, ho-ho, to the funny farm, where life is beautiful all the time and I'll be happy to see those nice young men in their clean white coats. They're coming to take me away! Ha-Ha!"