"The Druggist"

My follow up appointment with the hematologist was today to go over the results of the thrombophelia panel of tests they ran at my consult. The good news is that the tests reveal that I have Factor V Leiden (DUH) and really nothing else of any significance. I do have a MTHFR mutation but not the version of it that causes miscarriages in pregnant woman, so that's good news.

The results of my timed blood draw last week were not good. My level was .88 and I need to be over 1.0. 

The doctor explained to me that it's not possible to know right off the bat how much more Lovenox I need to get me to that level, so it's going to be trail and error. I can either be bumped up to 165mg or 180mg. He opted to bump me up to 180mg.

Here's where it gets awesome! Not. 

I was already on the max dose of pre-filled syringes of Lovenox. Doctor explained that the manufacturer of Lovenox doesn't make pre-filled syringes of a higher dosage than 150 mg (thanks a lot assholes) and that I would need to mix my own syringes.He wrote me a script for needles and syringes.

He said that I have to be careful what pharmacy I take my script to because "the druggist" may unknowingly sell me syringes where the needles aren't removable. What the hell is a druggist? I know this doctor is old, but seriously... they are called P-H-A-R-M-A-S-I-S-T-S now.

Although he's still using the term druggist he's a lovely man who clearly knows his shit. I know he's a good doctor because I overheard him on the phone advocating for another patient. He was questioning the other doctor about if he was absolutely sure that their patient didn't have malignant lesions in her lungs, because one of her tests that he was copied on the results for was suspicious and he just wanted to be absolutely positive she was in the clear. Thankfully, it sounded like she was legitimately in the clear.

When I dropped the script off, the "druggist" was questioning the doctors order. According to her, it does carry risk of infection due to the fact we're fucking around with transferring meds into all these extra syringes and needles. She made the helpful suggestion of switching the order to a 30 day supply of 80mg and 100mg pre-filled syringes which does save me about $15 but then I'd have to stab myself TWICE every morning. No fuckin' thanks lady. Easy to suggest when it's not your stomach taking a beating at 7am. I'm sure she was looking out for my well being so I don't get an infection but I buy clearance meat (close to expiration date) every week at the grocery store and drink my milk a couple days past the expiration date, so I think I'll be okay.

The druggist sent me on my way and said she'd call the doctor to clarify. When I came back an hour later, she went over the instructions with me and said "the doctor insisted that you mix your own syringes" and you could tell it pained her to say that. I had to get a tutorial in the pharmacy on how to load all these bigger syringes and again there came that pesky math and my pits started sweating.

I left there with a giant sized plastic grocery bag packed to the gills full of meds, needles and syringes. I feel like such a dilapidated old woman with my grocery bag of shots that it's not even funny.

To keep things fun around here instead of dessert after dinner, we had a syringe filling party. Since I take my shot at 7am seven days a week I wanted to practice tonight so I don't fuck it up tomorrow when I'm waking up in a groggy haze. There is math involved in this process so it causes me some anxiety and I'd like to practice with a clear head.

Here's what my kitchen table looked like:

Wanna come over for some dessert? ;-)

Stab on Sister!

So this morning was day 4 of Lovenox shots and day 3 of administering them myself- eek. Never thought I'd have to balls to stab myself every morning @ 7am. The injection site burns for about an hour afterwards, I don't know if that's because it's generic and the formula is a little bit different than the brand name. Nothing ya can't get over.

Yesterday morning when I got up to use the bathroom and take my shot, I heard the LMFAO song, "Shots" again, except my H was playing it on his phone so I could hear it through the bathroom door. It was a pretty funny moment.

I need to call the Hematologists office because I have some questions about the course of treatment, like what day do I have to go for the timed blood draw. A lot of information was thrown at me on Friday and now that I've had time for stuff to sink in, I've got questions.

I will also be calling the RE's office to let them know how the Hematology appointment went. I'm going to tell the nurse that I'm confused about what I should do. I know she can't make the decision for me, but I'm hoping she might have some words of encouragement. Apparently I'm being the need patient, lol.

If I follow the "natural cycle on Lovenox" plan that the Hematologist has just suggested I'll be waiting a full month longer than we had planned to start IVF. We had a plan in place and now with the new information, aren't sure what the hell to do. I've already been waiting 4 years (in October) part of me says "that's long enough". The other part says "What's one more month, if this Lovenox actually works"...

"If you want to make God laugh, tell him your plans.”- Woody Allen

Shots. Shots. Shots. Shots-shots-shots. Everybodyyy!

This morning I gave myself  my first Lovenox shot in the gut. I got up at 7am (on a Saturday morning) and went to the kitchen where I had left my shots. Ripped open the package and got down to biz-nass. I'm a big kid now! I had places to go and had to get my morning going.

I was picking up my lil sister to take her down to the Farmers Market so I could help her buy enough Roma tomatoes to feed all of Italy and the Jersey Shore House. She's going to can them. Have fun with all that sista-sis!!

The Farmers Market,- where walking around with a baguette and colorful floral bouquet is a status symbol. Like we are all walking around on the set of a Jennifer Aniston romantic comedy. We didn't get those things but I did see a couple of crunchy granola chicks with uni brows and hairier legs than my husband. Why do they insist on looking like a dude in a sundress. So gross! But it takes all kinds to make the world go round...

An interesting tid bit about the Lovenox, if I didn't have insurance, the meds would've cost $3,066. Um- what? 'scuse me!! I'm on the generic, my co-pay was $10 and with my employee discount at the pharmacy, the total came to $8. Thank you, Jesus. I'm so grateful to have a good job with great insurance. Sure they might not cover anything more than 50% of fertility meds and nothing for IVF, but that's more than a lot of folks get. So I'm just happy to have help from my insurance.

What The Hell Just Happened?

I went for my consult with the Hematologist this morning as recommend by my RE. This was part of my "homework" from the IVF Orientation appointment. As he was wrapping up with us and handing us off to the RN, he said "Hey who's going to be handling the Lovenox issue" and I said "well no one is handling it right now, would that be an OB/GYN"? He suggested I go see the hematology specialist.

I was the youngest patient by far in a very crowded waiting room. The doctor old. I was joking to my H that "this guy is so old he invented hematology." He was very rushed. The office is also an oncology hematology practice so there were a couple of cancer patients waiting for blood work and chemo treatments and then the rest were geriatrics talking about their cardiologists and previous strokes. There were signs all over the place that nicely asked everyone to be patient. Due the nature of oncology hematology, emergencies arise and basically if you were having an emergency or crisis you'd want your doctor right away. Fair enough.

Everyone in the waiting room was very friendly and I quickly figured out that they all see each other frequently for appointments and weekly "timed blood draws".

When I met with the doctor he had a 2nd year resident with him. I cannot escape students anywhere! This doctor is a renowned clotting disorders specialist and I guess he travels around the country speaking on clotting disorders. Kind of cool to have access to him in my "own backyard". We reviewed my history- that I've never had a confirmed pregnancy, that I've known about my Factor V Leiden for 8 years and take my baby aspirin daily. He asked a little bit about any other clotting disorder testing that I've had and I couldnt' recall anything else.

Doctor got quiet and was alternating between blinking a lot and staring at me. I could see the wheels in his mind were turning but he wasn't really saying much. If I hadn't been so versed in doctors appointments and advocating for myself by asking TONS of questions, that appointment wouldn't have gone very well. The doctor does all his talking in his mind until I started asking questions!

Basically what he's suspecting, because he's seen it in similar types of patients like me, that I might have other disorders that won't allow me to get pregnant. He says "What would you think if I told you that you might have a shot at conceiving a baby naturally by taking Lovenox daily?" I said "Then I would take Lovenox (duh)!". He gets up and leaves the room leaving me with the socially awkward Resident.

He comes back w/ a syringe of Lovenox and tells me to come over to him. He says "you're going to take this Lovenox right now and then we're going to do a full panel of blood work." He tells me to pull up my shirt a bit to expose my scar bellied gut. Hope you boys liked the view!!!

He cleaned the area, told me to "pinch an inch" (in my mind I was all "I got more than an inch, dude)". He pushed the needle into the belly and then made me inject the meds. I'm such a puss that I went so slow and he was basically like "just push it all in already". It didn't hurt until after it was over, just a little sting- a little stronger than an IUI drug to the thigh.

Doctor ordered the entire thrombophelia panel plus some additional tests!

When the M.A. started pulling the vacuum tube vials, she was grabbing a lot of vials. I thought maybe she was gathering up tubes for everyone in the blood draw area. Ummm, not so much. She pulled 22 vials and lined them up in the rack. They were all for me (cue the sweaty palms). I took a picture because it's unreal the amount they needed. I was bleeding for 5 minutes straight as she filled all those tubes. I felt light headed and tired when I finally got out of the chair to book my follow up appointment.

 

Then it was down the hall to the blood draw area. It just so happened the draw blood in the chemo area. I had to sit in one of those comfy chairs where folks settle in for chemo. I got a little panicky and then teary eyed as I reflected on how fortunate I am and was 4 years ago when I had ovarian cancer. It was caught early and I didn't need chemo or radiation. It took 20 minutes for the M.A. to come draw my blood because they were so busy and a lot of the staff had the day off.


He put me on daily injections of Lovenox starting immediately. They have to be administered at the same time every day. I go back on September 7th for the results from the 22 vials of blood. I will need to have one of those timed blood draws weekly until the doctor feels my dose is regulated.

My arm hurts now and I've got quite the bruise from giving so much blood and from ripping off the tape. I also had a nice 20 minutes of hives after taking of the tape- but that went away. I guess I'm just too delicate.

So because this doctor isn't a fertility specialist, I'm taking his "you might have a shot at conceiving naturally" theory with a heaping spoon of salt-not just a grain of salt. His advice today was to "keep injecting myself with Lovenox and grab a bottle of wine and have a hot date with my husband".

This is extremely confusing and disorienting because I've already got my plan of IVF in October and the fertility drugs need to be ordered in early September (and paid for at the time of shipment) so to hear that we might not have to do that is leaving H and uncertain especially because of the cost and all the mental preparations we've already done.

We will see what happens next. Wish me luck tomorrow morning stabbing myself in the stomach.