Thursday was my Dr. appointment. Clay and I arrived around 1245pm or so. The nurse checking us in said the doctor may be a few minutes late since he was out "visiting his babies." I thought that was nice. We made our first of many $40 co-pays and took a seat in the waiting room. I quickly grabbed a copy of Conceive magazine. I had read a bit from them when we were in Champaign for Clay's semen analysis and enjoyed it. I settled into a few of the articles and before I knew it, about 20 minutes had passed. I considered stealing the magazine so I could read the rest of the articles. (Skipping ahead, it did end up in my purse so I did accidentally bring it home. I may be posting about some of the articles in the future.) About that time I saw a man walk through in scrubs and a coat and go into the back. Something about him I didn't like. I was hoping he wasn't my doctor. Just then, we got called back and I was sure he was going to be the guy. The nurse took our picture for the file and then left. We waited in that room for a few minutes and then the doctor walked in. It wasn't that other guy. Instead it was this guy....
Dr. John Jarrett (I wonder if I can call him JJ? Maybe not yet...and I'm not sure what to think of the semi-glamour shot.) He shook our hands and sat down. He began to look at the papers in front of him and ask us a few question. My memory is increasing fading with regards to the order of questions and the details. I think we will be investing in a tape recorder to take with us. He asked if we wanted a baby and a few other random questions then got started. Looking down at my information for a moment, then up at me. Then he said, "Jesus." He apologized for saying it and rephrased it with a "girl, you have some hormones, don't you?" Why yes, I do. He then proceeded to explain. In a normal woman the Follicle Stimulating hormone (FSH) and the Lutenizing hormone (LH) are much different than mine. He explained that even in a "typical" woman with PCOS they look for the LH level to be 2x that of the FSH levels. My FSH level when tested last July was 7.7miU/mL, so you would expect the LH to be approximately 14 or 15. Brace yourselves, my tested LH level was 41.9miU/ML. Yep, that's right, almost 4 times greater. It's actually the level close to that of a menopausal woman (maybe that's why I'm usually always really hot.) And my testosterone is also SUPER high. He then said I was quite the overachiever. Why Yes, yes I am. Just not in a good way I guess. So then he asked, "What is the least you have weighed since age 18?" Interesting question. I explained my current weight was generally my "normal" weight. I've been 150-155 since high school pretty much except for my beer weight in college and my recent push towards 170 last year. "Currently I'm at 157 and have lost 10 lbs since Dec" I explained. "My lowest weight was 147 around the summer/fall of 2007." He nodded.
"Are you good at sports?" He continued. "No." I replied given I really am not good at any sports. "Well you should be," he laughed.
The questions continued and I'm fuzzy about the order. I should have written this blog immediately on Thursday but it was much more exciting to call a few friends and share it with them. We continued on and I know we talked about my Metformin and when I started it, which kind I take, etc. I read directly off of my timeline. I don't know whether this happened then or later but he made a comment about my detailed behavior and how we would get along perfectly. It would make his job easier. Well, glad I could help and put my anal need to document to use. Later I would also just hand over a copy of said timeline and a copy of my basal body temp charts for him to keep because of course I have my own copies saved on the laptop. Although now I worry about the timeline since it had the acupuncture information on it but oh well.
Now because the details are getting fuzzy, the following happened but may have occurred in a completely different order. We discussed Clay's semen analysis. He asked it as a question like "You had a semen analysis and everything was normal?" Clay and I said yes but then hesitated and asked about it more. He spouted off the numbers.....284 million with 8% normal and good motility..."That's normal in my book." Clay and I had been a bit concerned because the numbers didn't match the normal "reference range" from the sheet. But, he has been in this business for a long time so it was nice to hear him say that it was "normal."
At one point we talked about my cycles and the fact that I had just started another cycle all by myself on Tuesday that week after Christmas's cycle. He looked at the calendar briefly to which I said "48 days" He smiled. I asked if he wanted me to double check and he said "NO, I'm sure you are correct." (I double checked anyway and I was right." We mentioned the past cycles of Provera and moved one.
He then asked if I had ever had an ultrasound. I hadn't. "Hmm he said.... I'm only approved to do a consult....(he paused).... well, what they don't know won't hurt them.. let's go." He then got up and said we were going to do an ultrasound. I was in shock. This is already more than I was expecting and he was trying to help me immediately even if he didn't have the insurance company's approval. As we walked through the nurse's station he announced "We are NOT going to do an ultrasound. We don't have approval for that so we would NEVER do that. We are just going on a tour... Here is the restroom." I was almost laughing so I played along and said, "Oh how nice."
We got into the ultrasound room and I was handed a sheet. I was given brief directions to wrap the sheet from the waist down and empty my bladder. I sat in the bathroom assuming it was going to be a jelly on the belly kind of ultrasound so I left on the underwear and the tampon, but when I exited the bathroom to take my seat I noticed (from the tool the dr was holding) that I was in for something else. I quickly joked that there was a "roadblock" I needed to remove and entered the bathroom again. Now ready to go I took my place on the table with the stirrups. (Gotta love those stirrups) And off we went.....
"This is your uterus..." This was pretty neat even though it just looked like a black cavity. "Do you have any pain during intercourse?" he asked. "NO not typically, why?" "Well, you have a tilted uterus." OH! I thought. Great! Add that to the list of things working AGAINST ME...hormone imbalance, tilted uterus, I'm doing great. Then he prodded to the right. "This is your right ovary." This is what I saw...
Well this isn't technically my ovary but it is similar. "I assume the black spots are bad, right?" I asked. "Well, in a typical PCOS woman we look for a minimum of 11 antral follicles" he said. "Oh, well I think I can count 11." "Honey, hate to tell you this but you could probably count 111." Of course I could. "Still the overachiever I guess." Oh and in case you are confused an antral follicle is also a cyst. It was an egg that started developing but was unable to reach full maturity for ovulation so it "dies" and forms a cyst on the ovary. FUN, right?We continued and he prodded to the left for the left ovary. "Well this one isn't as bad." Okay then, maybe one positive.
We went back to the room and took another seat. As our discussion continued I did mention that my periods are usually really lite. On Provera they are very light and the two I have had on my own recently were heavier than the past but still light. "Well you do have a rather thin lining from the ultrasound. "What does that mean?" I asked. He replied, "Well we will cross that bridge later." I have jokingly equated this to "Taking care of the eggs first and then later we can work on the basket." So, another thing on the something to overcome column. It worries me since women with PCOS are more likely to miscarry (I would think from the hormone levels and weak uterine lining.) This scares me to death. Should I feel the joy of being pregnant FINALLY only to feel the PAIN of losing the child? I am not sure I would be able to emotional deal with that. It is a constant struggle to face the infertility so I will move forward and push the dread back.
Moving on.... I think I asked what was next. Where would we start? Was there anything to do today? Again, we were stopped briefly since I was only approved for a consult. However, he said he would love to try medicine for the hormones that I would take on day 3-day 7 of my cycle. "Well, I'm on day 3 right now." I wanted to do something..."Can we get approval today." Eventually it was determined we probably couldn't get health alliance to move that fast but would we be willing to do it "out of pocket." I knew we would. He said it would be about $120. No biggie, I can handle that. SO we talked about a drug called Letrozole (Femara). He explained the drug is only "technically" FDA approved for the treatment of breast cancer, but it has been very popular for fertility. Alright, worth a try. Dr. Jarrett is on it I will tell you. He is so very sincere. He tried to get Clay and I a voucher for the drug so we wouldn't have to do it out of pocket, but the copy wouldn't work so we moved forward with the plan to do it out of pocket... more on that in a bit.
We also talked about options or the "game plan." He said he was still working on it in his head. He said he didn't want to tell me it was going to be impossible but he said I would definitely be a challenge and there may be a lot of work ahead to get everything working in our favor. Another play on the title. Not only is this post really really long but I think our journey ahead too will be long. So buckle up!
He did add that there would be much at the beginning that we would skip. He specifically said "I don't want to waste your time and I don't want to waste your money." I was happy to hear that we are going to hit the ground running and be aggressive from day 1. Of the options ahead, we discussed two possible surgeries as well. I do not remember both of them (hence the need for the tape player for sure.) One of them is in the booklet of information he gave us at the beginning of the appointment. It is a booklet of a very detailed power point presentation regarding PCOS and fertility options. The surgery I remember we marked in the book is an Ovarian Diathermy. Here they cauterize the inner part of the ovaries responsible for testosterone production without damaging the eggs/follicles from the surface of the ovary. He mentioned that in most this is low on the list but for me it may be higher on the options and of greater importance or priority. What did I ask about this... "Well do I get to watch?" I don't as I would be under but he did say he records it and I can take a copy home to watch so I guess that will be okay too. I don't remember the other surgery but he mentioned trying them both at the same time so I would only be under once. Deal!
I asked about next steps for release to his "care and custody" but he said that was up to his nurse and she would get right on it. We did talk a bit more and eventually I brought up the basal body temps again and let him know I had my charts.
I gave him a copy of those. As I was explaining that the first chart from Nov 2nd to Dec 24th was very erratic but the second one....he said, "Well this is great. You ovulated last month. This is promising. I feel more optimistic and positive now. You ovulated. I want to see your next chart. I want you to fax it to me. I want to see it." Alrighty then.... good stuff. I will continue to take my temps every single morning at 6 am.
As we wrapped up, Dr. Jarrett left and the nurse came back in. We discussed calling in the prescription, and what was expected. Taking the medicine days 3-7, ultrasound on day 12, and if all looks good planned and scheduled intercourse on days 12,14,16,18. What if I don't ovulate by day 18 since my last cycle was 48 days and I didn't ovulate until day 33. Do we continue the every other day schedule? Other questions raced through. We got our ultrasound scheduled for Saturday Feb 21st at 730am in Champaign and our next appointment with the dr on Tuesday March 24th. Now it's just one day at a time and baby steps forward.
Continuing on the story about the medicines, some one of a higher power was on our side. We took it down to the pharmacy and said we understood it wouldn't be covered and we wanted to pay out of pocket. They said it was going to be closer to $200, but we wanted to proceed. Then she said maybe she could get a one time no prior approval price... then she wanted a copy of our insurance card...and then... "How does $20 sound?" Perfect! Dr. Jarrett is in network and somehow my file indicated "consult and prescriptions." We left with my $20 meds and a smile from a great and PROMISING appointment with dr. that I think will be wonderful!!!
My spirits were and still are up about this. I can tell he and his nurses generally care. Our goals are the same. I like the way he put it on the cover of his booklet and all over his website, he's in this for "Building families." Just what we want. Time to build this Brockman family ;o) One day of hope at a time....
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