Update and Tips for Anyone Doing Blood Draws to send to PPVI

I am pretty much 100% now, and Charlie seems to be better but definitely NOT 100%-he isn't eating or sleeping great and it is hard to tell what is the cause.  I normally feel so confident about him, but there is so much going on at the same time-I know his throat is sore, the junk is running down his throat and he is swallowing it which could make his belly sore.  He is congested, etc, and he is also teething.  I am not sure which is blame, but he is eating less and less variety; thank goodness for signing or I would NOT have known he was hungry in the middle of the night-thank goodness he told me!  Hoping he will feel better soon.

I have been wanting to write a post about my experiences with lab draws.  As we ttc #2, and there is more and more new territory (new things Hilgers does/tests for, new ways to give my hcg, blood draws with a 15 month old on my lap! etc), I have to remind myself there are plenty of things that have become old hat.  I am hoping the things I am familiar with can help others.  So here is a post about getting your blood draw to mail to Dr. Hilgers. I hope what I have learned can benefit those new to the process, and maybe even make it more efficient for those who have been doing it awhile.

There tends to be a few reasons why you would have your blood draw to mail to the Nation.al Hormon.e Laboratory at Pop.e Paul the VI Insti.tute: a hormone series, a peak plus 7 draw, a pregnancy test, or progesterone draws during pregnancy.  I have done all of these, except the series, at least 3 times.

First of all, you can always get your requisitions from PPVI ahead of time.  That is nice so you don't have to wait after you think you already might be pregnant.  Secondly, always make a copy of your requisition to keep at home.  I actually scan all of mine (front and back-back is important for the lab), so I can print them out as needed.  Anyone need a requisition?  lol 

As far as where to do the draw, I have found the best place to be the local hospital.  The reason is that Qu.est, LabCo.rp, La.bOn.e , etc have all turned me down.   They don't like to draw a sample and then not get to run it themselves.  Plus, most hospitals have longer hours and you don't need an appointment.  We live in a large metropolitian area, so our hospital labs are open 24/7.  That is the most convenient since you are working around your cycle and you may want to do a pregnancy test on a Sunday, etc and not wait another day.  Some hospitals do have problems with giving you the blood to take with you.  To avoid problems, I always call ahead of time and speak to the manager at a new hospital (I have done this at at least 10 hospitals due to traveling, etc)  In many cases, their fears are eased if you explain the situation and tell them you will bring the packaging in with you to show them how you will be shipping it.  This has happened to me several times.  Unfortunately, locally I am now down to only 1 hospital option in our area from 3 because 2 stopped letting blood go home with you because a new "risk management" policy...

If you are doing monthly peak plus 7 draws, Dr. Hilgers' staff must write "series" are "repeat draw monthly" on the requisition. Then when you register (required in every hospital I've been in), you can simply register as a series and not have to register again each time you come in for a draw.  Now, if you change hospitals or go somewhere else for travel, of course you have to register again.  It depends on the hospital how long registering is good for-some places it only has to be renewed every year.  Anything that saves time, right?!

When you are done registering and go to the lab, I have learned that if possible get to know the staff and even come around the same time to get the same people.  There is definitely a learning curve when it comes to this.  It is not at all what they are used to and these people are not phlebotomist because it is their life's passion.  It is a job, it pays the bills (and not well, mind you).  I highly suggest you become very familiar with the requisition.  When you check in, explain to the secretary that they will be drawing it, not running it.  But that they do need to let it clot and spin it (this is true for all but some of the hormone series).  Tell them you need to take a filled out requisition with you, but that you will be back monthly (if that is the case), so please make several copies.  Often they will show you where they are filed so you can show the person when you come next time, if it is a different person.  I always bring a copy just in case they can't find it too.

When the person goes to draw you up, remind him/her that it is 1 red top tube (for peak plus 7, pregnancy test, or progesterone levels; for a series it depends).  Sometimes they want to draw 2 (one for progesterone and one for estrogen-but there is only a very little serum required so many tests can be run off one tube).  Sometimes they want to draw a lilac tube because they see that is part of the specimen key at the bottom.  Grr.  Just one red top tube please.  And I ALWAYS have to remind them to fill out the line on the requisition.  Before the phlebotomist leaves, I remind him/her they aren't running it, just letting it clot, spinning it, and pouring it off.  I show them the back of the requisition.  I have the items circled that apply.  When I leave, I tell the secretary: I will be back in one hour because it needs to clot for 30 min and spun for 15.  I also show them on the back where it says "room temp is fine if it will get there in 5 days."  I tell them it will, so please please please do not put it in the refrigerator, even if I don't come back until tomorrow for some reason.

Even with all of that, I sometimes come back to find that they hand me blood.  They should be giving you clearish serum.  That is what they pour off after spinning.  Ideally they give it to you in a clear plastic transport vial with a biohazard bag.  The bag has a pocket for the requisition, filled out, to accompany the product.  In the beginning I used to pay to overnight the serum.  I also used to use dry ice.  Over time I have found that is not at all necessary.  Most people live where it will get to Omaha in the 5 days.  Overnighting it is a huge unnecessary charge.  In KS, I simply buy padded envelopes (very small) and put plastic bag with tube and req in.  If you are doing this monthly, I highly recommend you buy a ton of the same kind of envelopes.  That way, you only have to weigh it once at the post office.  I have a PDA and I put in the "notes" section of the Outlook contact for Dr. Hilgers the amount of stamps (in my case only 3) and dollar amount.  This way, I can just remind myself and it should still work even if the price of stamps goes up.  Especially with a 15 month old, I spend as little time in the post office line as possible!  You can usually weigh in the lobby, but for $40 I have invested in my own scale (10# or under) that I purchased from the post office.  You can buy postage online and print it off too.

I know this all probably sounds like a pain.  It really isn't that bad; I definitely find it worth it.  I do as much "preventative" as possible and I have never had to repeat a draw (they have taken too much blood and they have had to respin it...)  I know it sounds like I must be a complete pain to these people, but I never talk degrading to them and they seem to find it helpful to navigate the unfamiliar.  They often come to me for questions, or bring the person running it out to talk to me.  I must say, after all this bloodwork (series and the peak plus 7 draws) it was pure joy to get to go in with the peak plus 16 pregnancy test requisition.  I have had many lovely lab ladies celebrate with me, feeling they knew me after all our time together! :)  See here for our story about our first positive pregnancy test and how the lab lady screamed (in the back) when she read the results (we could hear her from the lobby) she was so happy for us!  And see here for how the one who ran the test for Charlie had no idea she was delivering the news to me that I was pregnant, lol!

I hope this is helpful to anyone who is new at this (and maybe even if it isn't?). If you have anything I mentioned that is not correct in your state, or doesn't apply to your situation, I would be happy to hear that feedback.  I would also be happy to know of any other tricks or tips you have developed over the years, if you too are "old hat" at this process.  I plan on doing a post soon about IVs (hopefully none of you have to experience these to have a healthy pregnancy, but just in case!)  Please share this post with anyone you know that might be helped by it.