Is This a Test?

So I have a theory. And it only has a sample size of 6, so I would love for you to weigh in. I looked over my HCGs from the past. Normally I look at percent growth and try to make heads or tails. But today I noticed something different. See, I always knew that there was some things the doc say to make you feel better about a crappy HCG. It goes like this. First you are told it should double every 48. Then you are told it actually can take72hrs. Then you are told it's okay, as long as it doesn't go down. Then you are told some excuse for it going down. Exception-lab variability is very real. Do not change labs unless you have to and never compare one lab with anthers. Note, this is all based on my six experiences and nothing more. But I have found that my babies just do more than double initially in just 48hrs if all is well. You see below, M is my only case that did awesome at first and then did poorly. That is because he was my first infection baby and that is how infection works. The next baby was much sicker. What I am rambling about is revolutionary to me-every baby that didn't make it didn't double by 24dpo. It can be really close (Anthony), but if it doesn't by far, it never worked out. Why does this matter? Before, it was always the heartbeat that meant relief. Correction-an on time heartbeat. This is why dates matter. Dates are off all the time. But if you 100% know your dates from charting, then no one can say come back in a weak it's probably off, and keep you in limbo. You know this isn't good. Knowing sooner is better, in my opinion. So heart beat is early notice (6.5 weeks, same as 28dpo), but 22 and 24 dpo is even sooner. I will come back to this point.

	12dpo	14dpo	15dpo	16dpo	17dpo	18dpo	19dpo	20dpo	21dpo	22dpo	23dpo	24dpo	25dpo	26dpo	27dpo
M				514		1544		3438				5271		5184
G				279		321		353		444
C			546		1201		1838*		3365					12708
A				207			500		1634		3219			5247
G								899		1300s		2209 (sat)
N				47		100		215				625
K?	29	114	n/a	X	n/a	X	n/a		X

AJ has the flu. Type A. He maybe was a little warm yesterday. He was clearing his throat a lot, some junk was bothering him. He woke at 1:30am saying his eyes hurt and he was thirsty. He had a fever of 103. I wasn't too concerned. I stripped him down to summer pi's (because I knew he was burying in covers), gave him Gatorade and a popsicle, along with some advil and sent him back to bed. He woke at 6:30am (too early for more Advil) with a fever of 104.5. I wasn't messing around. I was out of Tylenol. I didn't want it to get any higher. Off to Children's Mercy ER we went. He was a brave one! The strep test wasn't able to be done in one swab and he willingly opened for her to get another. He got a chest x ray and a nose swab. They wouldn't have swabbed him, but because I am pregnant, it would make a difference in his care (Tamiflu). He didn't like the swab. But as soon as Advil kicked in, he perked right up. Sweet boy, you know he asked me today to pray a rosary with him? First time ever! God, of course, and also the fact we went yesterday and said one at adoration. My doc is worried about me getting flu, so it's Tamiflu for me too. And despite this, God has it. He has us, me and this baby, wrapped in His loving arms. (will add pics if I can get them to download!)

Dr. Hilger's nurse Stephanie called back today. I really love her. She said Dr. Hilgers has been spending a lot of time with my chart. I am sure-quite interesting reading. :) I am the four who had Dr. Toth's full treatment that I know of. Pretty sure he is following me closely, as he continues to learn daily. Dr. Hilgers wants me on HCG. I have heard of women on this to increase progesterone. It started after my last loss, I believe. Dh is going to give them to me, thankfully because I can't go there again. Not even for a baby because it has nothing to do with desire. It's about debilitating anxiety. But dh will give them and it will be fine. I realized something on the call though; once I take that first shot (obviously sooner is better), its no more HCG quants for me from the lab. I will get Sat and Monday, but then I will get the meds in the mail, and it will skew the result. So there goes that theory and the idea of earlier knowledge.

But you know what, I am okay. I feel like God is saying, are you really at peace? Is your faith in me? Or are you still trying to control? You said the baby is mine. Is that really true? So I am giving it to Him. Every bit of control over this baby. I don't want it. You are the one I want in control. You know best. Take my HCG quants, take my early sono, whatever you want to take it is yours. I will do all the shots, or none of the shots.  Your will be done.

When Enough is Enough and The Peace That Surpasses All Understanding

I appreciate the responses to my last post. TEBB is never fun. But...I'm okay. It was a clear sign. I don't like ambiguity. I know my hormones are great. I know the TEBB is the result of infection. I know our Chlamyd.ia infection is resistant to everything we've thrown it's way.

I know we could still try. We have only tried 2 cycles since our late Aug treatment. Sept was 30 days of  antibiotics. I believe we tried in October, in November I missed my fertile signs so we didn't try. In December we tried one time after seeing what I thought was TEBB and then were on Cipro the rest of the cycle. In January we tried for the second cycle. It's already February, and here I am in the fertile phase again.

Given our history, there is a decent chance that we would get pregnant this cycle trying. But, also given our history, there is a decent chance we will miscarry. Do I know the exact percent? Of course not. But I feel like we passed the tipping point in my mind. Like 55% miscarriage, 45% fine. Is there still a chance things would be fine. Of course. But I am not good with chances like 55/45. I am just not.

Is it for the right reasons or the wrong reasons? I have asked myself this. I have prayed about it. And you know what I have? Peace. I have had peace about quitting since June. We did full treatment in NY, but I didn't have too. I didn't feel desperation. I felt like I was open to it, and my dh lead us and I was happy to follow. I had realistic expectations after talking to some amazing gals that did the Hilgers/Toth route before me. I knew it wasn't necessarily our ace in the hole. No guarantees. We don't regret going. Honestly. We don't feel like we were owed something because we went.

Some thoughts in my head have been 'Is continuing to try better or worse for my marriage?' Dh and I can only be together during fertile times. We were recommended that by Dr. Toth and we did it, not because we wanted to but because it is what was healthiest for our future child. It is not good to have relations that only exist at fertile times for the purpose of procreation. It is not good to not connect in that important way at other times of the month. My dh and I have been hit some huge blows in our family and personally. My dh is struggling with shoulder pain and needs surgery; is in a job with a verbally abusive unappreciative boss he can't stand-for the last 8 years. My sister lost her husband, got caught doing meth, lost her kids. We discerned custody of the kids. These are big things. Are hearts have been heavy. We are not great experts of supporting each other and showing love when we can't be together. Yes, we need to learn to do this better, and I am reading Simcha's book on NFP (so good!) but we are real people with sin and avoiding all this time is hard. We have avoiding all 6 pregnancies including two full term. I think we've had a life time of avoiding in our 7 years of marriage. Seven years of marriage, six pregnancies. All consuming.

And when I wait those twelve weeks to see if a pregnancy will last? Time stops. It just stops. It moves so slow everyday. I live and die by blood draws. I am so emotionally drained I eat chocolate and watch tv and that's my life. I can't hardly function. That's not healthy. And really, with infection, it can cause pre-term labor and all sorts of complications at any point if not managed. So the risk never really goes away.

I also ask myself 'is it more selfish to try or to not try?' Babies in heaven is not a bad thing, necessarily. I mean, it is the goal. But if we believe a person is a person no matter how small then the pain, oh the pain of this mother's heart at parting earlier than expected. Are we not trying to avoid the pain of another loss? No. It isn't nearly that simple.

I was not a good mom to my kids during my losses. I was consumed by the pain. My last pregnancy, Nicholas, was conceived on Christmas. I bled for five long weeks. I passed his body and held it in my hands. I am still having a hard time with not giving him a proper burial. We were so taken off guard. We lost him on Valentine's Day. It is all very fresh still. I saw his fingers, you guys. His fingers!

My life is not calm. My nuclear family is always in turmoil. My dad and mom are no longer in good health due to a life of stress. My stress is not the focus of the family. It is a drop in the bucket. My stress and losses are one more thing for my mom to feel guilty about not being there for me.

My life revolves around insurance, appointments, and lots of lots of blood draws. The medicines add up in cost, and the cost of it all is beyond financial. I am tired.

I am happy for my little sister's pregnancy. She is 12 weeks-praise God! Genuine happiness. I am not sure if that would continue if I was pregnant myself, dying through the first trimester day by day. Or God forbid experiencing a loss.

Dr. Toth and Dr. Hilger's did not tell us not to try. They did say they have nothing more to offer me at this point. They did say they would throw a ridiculous amount of antibiotics at me after conception. You know what I think? I think that after the fact isn't nearly as good as prior in fixing a problem such as infection. Dr. Toth was never going to give us a post conception IV again. Nope. We think I am immune to that. I already became immune to Biaxin for sure. So it was going to be Zithromax alone and hope it works. Lots and lots of Zithromax. Around 1000 mg (the max). Until I can't take it anymore either. And we don't even know if that will work? Not to mention where will that leave me in the future when I get something like, God forbid, the MRSA my dad has? Is there such thing as being resistant to difluca.n? I don't want to find out. I take it monthly now and so does dh. My stomach is strong as can be against these antibiotics, it's amazing. But the yeast...Did I mention HCG shots? If I got pregnant, not only would I continue the four progesterone shots in my hips (2 shots, 2 cc each, twice a week for the entire pregnancy), but Dr. Hilgers wants me to give myself HCG shots in my stomach throughout the pregnancy as well. Just in case. Due to so many losses. I don't mind needles, but that is so much. I remember Dr. Hilgers trying to comfort me when we had our phone consult. He told me women with eight losses had gone on to conceive. Let's just say I didn't feel better. That is fine for them, they have that right. But I didn't plan on letting it get to that point!

So what's changed? This was always the plan since Aug, no IV after conception. And HCG shots. My sister didn't just get pregnant. My life didn't just now get crazy. My husband and my marriage didn't just now get stressed. I could go on and on. Except one thing. One thing changed that changes everything. The TEBB is back. And that's enough. The scales have tipped in favor of miscarriage, and that isn't a risk I am willing to take. It doesn't feel like a decision made out of fear. To try feels like a decision made out of desperation for us. To throw everything and the kitchen sink at it, Andrea's words-God love her, is possible. But not desirable. I just don't feel I need to know I did everything. Even though we basically did. You know what I feel? Peace. And a bit of freedom and excitement about what might be in store for us. And that, my friends, only comes from God. Because that sure as hell isn't me talking! :)









have made it no secret on my blog that I feel at peace. I am grateful

WIDE OPEN!

So, I left off where Meriam told me to come on down to Omaha for prep. I really appreciated the anonymous blogger who assured me it likely wasn't for nothing. And it wasn't. The irony is that my period start Wed at 10:30pm. I don't know about y'all, but I almost always start first thing in the morning. But by starting when I did, surgery actually became CD3. How about that?! Not bad for scheduling a month out and all the stress, etc when the goal was 4-8. Not bad at all. God has a funny sense of humor :)

Omaha was good. We stayed at Hawthorne Suites about 2 min from ppvi. It was only $64 for a king suite and it included a kitchen and hot breakfast. It was a great recommendation off the discussion board. It was great to do my preop at Creighton with Nina. Nina. Who last year recognized me from six years prior. She is kind of amazing. It was good to see a familiar face. Then was the ultrasound with Rachel. She was pretty new last year when I went. Then I got to do my favorite part, say a big thank you to every nurse I see. Teresa is pregnant with child number 8! And Stefani is just as young and adorable as she sounds on the phone. Meeting Dr. Hilger's son Steve went well. And we were all set for the next day. We found a great little cafe and cupcake place not far aways, Jones Cupcakes. Yum!

We were at the hospital bright and early at 5:45am. I did get a little teary after the nurse put the IV in, thinking this is likely my last surgery and hopeful for the outcome. The last thing I remember is a nurse asking me if I wanted a rosary and slipping it into my hands, telling me it was blessed by the pope! I love Dr. H!

I woke up and things were mostly good. A surgery is never easy, but they handle my nausea with anesthesia well and know better than to even suggest a narcotic. I had less shoulder pain with the gas, though there was definitely some. They seemed a little short staffed and let me sleep until 3pm, which seems unheard of. I am used to getting kicked out when I can barely stand. I thought I could go home late that same day, but I didn't really factor in that a late check out isn't really at all that late so we extended another day and went home Saturday. I almost didn't have a choice, there was some rodeo in town, but someone expected cancelled.

My mom is so cute, she knew that my follow up with Dr. H wasn't until Oct. 10 and that I needed all the info before then if we were to try same cycle as Dr. Toth wanted. She totally recorded verbatim what Dr. Hilgers said. He agreed we could try this cycle and confirmed my tubes were OPEN! He didn't have to do a thing. Great news, of course!

He reviewed my meds when he got back to the office, and advised me for this cycle. He wants me off the turmeric, fyi, and he did say I needed to do the dreaded inflammation diet. Everything inside the uterus where I had the washes looked great. Unfortunately everything outside the uterus was very inflamed.

Today is Sunday, I am off the pain meds and doing more around the house. I get tired easily, but that is okay. I definitely feel I can go back to work tomorrow. I am not 100% today, but good enough. The not lifting for two weeks is definitely going to be the challenge. Thank you all for your prayers! ***Update-while the gas in my shoulders isn't as much of an issue as it was before, it seems to come when I am sitting or laying down making rest quite difficult at night or during the day. This seems more drug out then I remember and adds to an overall crummy feeling. Pain meds don't help for this, I think the only thing that really helps is being up and around. Also, the anesthesiologist took a little knick out of the roof of my mouth, so eating is painful unless its soft foods. I might work a half day today (Monday) from home. Feeling pretty puny.

IV Day 10 and Beyond, HSG questions, and news re Dr. Hilgers -updated

I don't think I mentioned this Monday, but I definitely did start my period yesterday, so actually Monday was probably CD1. Also Monday, I had called and left a message first thing with Dr. Hilgers office. I wanted them to hear from me exactly what we had done in NY, as well as the next steps layed out for us. Also, it occurred to me that though Dr Toth had said an HSG could be done anywhere in 30 days, I realized Dr. Hilgers may think differently. First of all, I know Dr Hilgers gets more info from his selective HSG. Secondly, I know Dr. Hilgers unblocked my tubes during the procedure where he was checking the tubes. I didn't want to turn this into two procedures when it only needed to be one. Third, I didn't know if I needed antibiotics on board just for checking. Finally, I wanted to talk to Dr. Hilgers about the need for me to do a cycle review this cycle and have all my meds back on board starting next cycle in case my tubes were unblocked.

On Tuesday morning, I took both my husband's and my IV out yesterday without incident. I just removed all the bandages, covered the spot with an alcohol pad and gauze and pulled out the tiny spaghetti string. It was maybe 10 inches or so. it didn't hurt, and it didn't really bleed at all. I packed up the pumps in bubble wrap and sent it insured to Dr. Toth's office right away. Yesterday was antibiotic free after that. My stomach is not hurting, I continue to have looser stools, but they haven't gotten worse at all.

Yesterday I also talked to Dr. Hilger's nurse, Teresa, and I am glad I did. First of all, she was very interested to hear about NY, as well as Dr. Toth's retirement plans. She had already received a copy of the D&C and HSG results. She listened to everything I said. If I understand right, she did think Dr. Hilgers would like to do an selective HSG, but potentially during a lap to get a better look. I don't know how I feel about that for a few reasons, mostly because I don't know if the risks outweigh the benefits. Once the procedure becomes surgery, I have great fear about spreading any potential remaining infection. Also, who knows when I can get in as we all know his surgery schedule is crazy and timing with this is key. And it just makes the logistics more difficult. I could be wrong, but I thought I could drive to Omaha, have the HSG and drive home. If it turns out I am under anesthesia, I might have to coordinate to bring my mom or someone else with. Just more hassle. If its worth it, fine. But the idea that we might undo $15k worth of treatment with something that may not be necessary...well I think I just stopped breathing for a second there. This is sort of our one chance at this full treatment per dh, you know? Teresa was going to check the surgery schedule and then talk to Dr. Hilgers either by writing it up and getting a written response or at their weekly meeting on Monday. She asked me which I preferred and we both just agreed that this is time sensitive. Obviously, I am going to wait and see what Dr. Hilgers recommends, but I do think he is new to this controlling infection during surgery. It seems there is a good chance it is inflammation and they will open without us even checking. I mean, Dr. Hilgers was able to open them last time with a wire during the selective HSG. That would indicate it probably wasn't scar tissue last time. If its the same, they may open on their own. We could potentially try without even checking them. However, there is risk in that. We are as clean as we will be. We are abstaining. Once we start ttc, we will start sharing any bugs we have that may have been left in either of us. We don't want to "waste" ttc and potentially spreading infection for three months with blocked tubes. So that makes me think we should check them as Dr. Toth suggested. He said anyone could do the procedure and I don't think he was worried about infection spreading for the typical checking of tubes. However, I could be wrong. I don't know much about the procedure and I thought a former patient said the Dr. Toth should be the one to unblock tubes because he can minimize infection. However, Dr. Toth told me he doesn't unblock tubes anymore. I don't know. So then, the question is do i have a local person do an HSG, Dr. Hilgers do an HSG or Dr. Hilgers do a lap HSG? Again, I am open to hearing people's thoughts because I don't know enough about the differences. It seems maybe if  Dr. Hilgers does the lap HSG, then he can unblock with a wire whereas he can't unblock them if he is just testing them? However, if you can only unblock the tubes that are closed due to inflammation, that seems to me they will already be opened if that is the case so that isn't a big threat? If they are really blocked due to scar tissue, could that be done during the same lap? I assume not, but I don't really know. If they are blocked and Dr. Hilgers finds out through HSG that doesn't include a lap, will he have teh full info he needs to determine if it is a minor versus major repair. If it's minor surgery repair, obviously I will be facing the surgery decision regardless if we avoided the HSG lap. So lots of unknowns about the procedure and risk. I will wait for Dr. Hilgers input, but in the meantime I would like to hear from those of you with experience.

Teresa also had some helpful recommendations for immune support.

• D3 (start at 4000 iu a day for a month and then go to 2000ius)

• The dose of Tumeric is 1000mg twice a day-turmeric is a powerful anti inflammatory-Dr. HIlgers later took me off this saying there is preliminary evidence of birth defects and he didn't want to chance it. 

• a 12 strain probiotic -The probiotic is called thera biotic complete from a company called Prothera inc. You need a doctor's code to order it. 

• a concentrated antioxidant drink you take 1 fl oz daily, contains acai, blueberry mango seed...I need to refer back to my notes but you can buy it at whole foods or through other places. I found this on amazon and it looks the exact same. Note, price is for 3 bottles, each with 32 servings.

http://www.amazon.com/SUPERFRUIT-ELIXIR-Concentrated-Liquid-Antioxidant/dp/B0097XGLE0/ref=sr_1_1?s=hpc&ie=UTF8&qid=1377710480&sr=1-1&keywords=concentrated+antioxidant+drink

This morning we started the oral antibiotics. We are on once a day 300 mg and 500 mg Zithromax. The is the one that can tint your sweat, tears, urine etc red so that would be crazy. It also might upset your stomach, but is best taken on an empty stomach. I took it at 7, felt nauseated around 8:45am despite breakfast by then, and then felt better around 10:30am. That makes me think it was the medicine, but we'll see. Charlie said he feels sick to his stomach after breakfast, so it could be a bug or a something we both ate.

The news I wanted to share about Dr. Hilgers that I am excited about is that both his son and daughter are ob/gyns and doing a fellowship with him. How cool is that?! I wish Dr. Toth would work more toward training others, but I am so grateful to Dr. Hilgers commitment to continue his life's work!

All Lab Results Are Not Alike

I have removed my recent post due to its "inflammatory" nature (not your comments, basically my title which was not correct in hindsight).  That wasn't my intent and I assure you, I am working on it.  I seem to be having a lot of "foot in mouth moments."  Sigh.  I hope you all know that I really do mean well.

However, the information I gained from it was very useful and new to me, so I am including it here.  In the words of the lovely Mrs. Blondies, "Dr. Hilgers uses a different scale (ng/dL) than what you often see in other labs (pg/mL) so the number from Dr. Hilgers are going to look like 1/10 of the numbers of what other labs will say. So estrogen that is 259 pg/mL from another lab is actually 25.9 ng/dL on the scale used by Dr. Hilgers.  The progesterone scales seems to be the same across labs (ng/mL)"

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.