Not Eventful First OB Appt, Lab, Injections

I survived the "new OB" appt. I survived a new nurse that doesn't know me. I survived the how many live births and how many pregnancies question. I survived (and even smiled) being handed the bag (full of hospital registration info and samples), even though it stays untouched and out of site.

I did see the doctor, but didn't get scanned. His scans are less accurate for early, and the ultrasound tech wasn't in that day. We made an appt for Monday (5w5d) for my first and for the following Tues (6w6d) to look for a heartbeat.

I got my first progesterone draw, and it went great. The lab I always used no longer mails to PPVI, so I wasn't sure what to do. PPVI actually mentioned to me who they receive blood from in the area, which was very helpful. The lab told me they do it all the time, and seemed competent. I guess the test will be if it gets there! I am curious to see if there was healing in that area.

HCG shots are going well. Dh is giving them in my thigh without too much trouble. HCG insurance is another story. Kubats got a request for precert so I paid out of pocket this month ($250-by far the cheapest!). Then I called my insurance. Usually if you go to their mail order pharmacy, they have the ability to access your medical benefits (not just pharmacy). Often medical will cover injectible specialty meds when pharmacy denies them. I found out after lots of calls that medical actually denied it as well. The pharmacy they wanted me to go to for coverage (if there had been any), was Freedom Fertility Pharmacy. So then it gets confusing stating it isn't for fertility, I don't have any fertility benefits, etc. Can you believe their cost is over $900 for a month? Yikes! So the plan now is to request Dr. Hilger's office to submit a letter of medical necessity. They told me they were willing to do anything as they see me being on this long term. I did, however, see something online about HCG during pregnancy being harmful, so while I trust Dr. H, I did ask them in an email to help me understand the risk.

That is it for now. The boys are doing a decent job distracting me, and I suppose it's time to get the Christmas tree down. :) Illness kept us from doing anything after Christmas officially ended. And I have a few fun things planned to look forward to. Dh and I are going on a movie date tonight (american sniper) and I have been arranging a few girl's nights. If you don't mind, I would appreciate continued prayers as this is the period (20-24 dpo) that levels really dropped and signified an issue for us. If you want, you can join me in my novena to St. Gerard. And please include some friends in your prayers. One woman just had her fourth baby, a boy after three girls. However, her husband has colon cancer and a big surgery coming up. Another friend is still mourning the loss of her baby at 37 weeks. I have several friends discerning or at some point in the adoption journey, and you may have heard of this blogger, http://luckyassunshine.blogspot.com/, who experienced a terrible late loss just recently.

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.

Insurance is Maddening plus Hormone Forecast

Just a quick update on what is going on in my world:

Within the family, my oldest sister is still following through with her decision to disown me. Easter was alright with her gone. I realize that following God's will, of course, never meant everyone would like you for doing it. I still feel I did the right thing, and that writing that letter was prompted by the Holy Spirit. Confirmation is the continued bubble of peace :)

My little sister is now 24 weeks pregnant with a little boy. He is doing well. She was worried she never felt him move, but sono shows the placenta is in the way. She had a scare on Easter re losing her mucus plug, but her cervix is tight so it should regenerate. They are keeping a close eye on her.

In other drama, as you recall, I was told by our insurance company that our claim was denied due to inconsistent codes.  The location codes of doctor office mixed with home health were especially confusing, and detrimental as home health triggered a pre cert. Of course, that triggered hope they could be redone correctly. I spent a lot of time on the phone today about this. It started with finding out that wasn't at all the reason and that they are awaiting medical records. I clarified Toth had sent them all, and they mistakingly requested them from Hilgers for the HCG request and combined them with the Toth appeal. She said no, they want everything from Hilgers now because Toth's office was flagged as infertility (due to a google search by a nurse-really?!). Okay...we can fight this. First of all, Hilgers records sure don't state IF. Secondly, Toth is a pathologist and I saw him for infection. Third, I don't have the history of X amt of cycles of unsuccessful trying. We knew about various dx and were able to have meds on board from day one so thankfully we were proactive and never got there. Additionally, Hilgers office told us BC/BS was sued and it was now policy that repeat miscarriage is NOT infertility by their definition. So...bring it. Additionally, I called Jessica from Toth's office and she was under the impression the codes were changed based on their conversation. Which wasn't the case, unfortunately, so she is correcting that paperwork so it never gets down to this. I am doing this for me, and for all woman who go down this path. I really hope this reimbursement will come through. Jessica is already excited for all the extra knowledge she gained in the coding process that she can pass along.

So...I haven't been charting. But since I am not on HCG, technically a miracle conception could lead to a miscarriage without post peak support. So for now, I am semi charting and we are avoiding when I have really obvious signs. I need to get back on HCG for many reasons, but...there are barriers. Barrier one is it is flgged for infertility and they aren't covering the $100 a month. Barrier two: my skin is THICK! You really need to go at it with major force. Problem is I have no depth perception and I am afraid to stab myself hard in the wrong spot. Done it. Bad bad bad memories. My dh has never done the stomach ones. I am thinking I should maybe try my thigh, but there is no fat there and it seems painful. How is that not in the muscle? It's a sub cutaneous shot.  So I am struggling mentally with making myself continue this med indefinitely. But I know it is selfish. Plus, I was psycho over Easter and pretty sure it was hormone related. I just felt so angry about everything. I don't remember being like that before. It prompted dh to ask this morning for a hormone forecast, lol. He wanted to know if the forecast was "get the hell out of the house." Yes, I did laugh!

So that's it for now. Dh seems not ready to talk adoption (his work sucks, he is overwhelmed by house projects, the $15k from NY is still fresh in his head, and more) so I just info gather and try to be patient. It may not happen at all, and I am really okay with that even though I do badly want it. Not sure if that makes sense? I am sure $15k back from insurance wouldn't hurt toward that cause.

I hope everyone had a wonderful Resurrection Sunday and are enjoying the Easter season. He is Risen!

First shot sub-q, cycle update, and "sicker than a dog"

Where does the phrase "sicker than a dog" come from anyway?  Oh, well.  Here it is entirely appropriate.  I don't think I have ever been this sick in my life and the timing sucks.  But, in all fairness, there is never a good time to be sick (and always a worse time to be sick-like when you are pregnant and can't take crap and have to make awful decisions like "is this illness hurting the baby or would my taking the meds hurt the baby?  which is worse?")  I digress...I have a virus that turned into a secondary infection.  I am: coughing (though occasional, always disgusting junk that is hard to move, tastes horrid, and makes my throat feel like fire, and my chest seize up), more physically exhausted then I have ever been (heart pounding, tired going up stairs, etc), with fever/aches/chills/headache to top it all off.  I pray it doesn't move into my sinuses.

It is bad timing primarily because my husband is working crazy hours and can't help much with me or the baby, my mom is taking care of my sister's 3 kids while she is out of town so she can't help, and I am fearful that my hubby will get this because I know he won't be able to stop working.  I dread when I feel better and have to go back to the piles of laundry, dishes, school, and work that have been piling up.  Not to mention the disinfecting that will need to occur.  Additionally I worry about my son getting it, of course; he already has a junky cough and a few sneezes but seems otherwise unaffected.  My husband is helping the most he can, letting me be upstairs in our room while he is with our son, taking care of the meals he is home for (i.e. takeout), last night he did the bed/bath routine (bathing is exhausting on a good day!) and today he took my son with him to church while I slept.  Being sick sucks!  Oh yes, it also bad timing due to the meds.  I will explain later.

Anyway, on to the "good" stuff!  I love love love being back on the meds for the most part because things are predictable and the signs are clear.  Of course, I am completely tied to the clock, and the number of meds is insane, but I am hoping and praying it is temporary (we are only trying 3 cycles before we know this regime won't work and will look for additional problems, etc).

Reminder: this cycle is the first one medicated since I got my period back and the 3rd one I have had since nursing.  We are NOT trying this cycle, just getting on the meds and then doing a peak plus 7 draw and then we will know based on the cycle review and levels if they are good enough to support a pregnancy.  Then, and only then, would we be given the green light (I am hoping for it to be around Valentine's Day-totally possible and dh proposed the Sat before, but would be ecstatic for any BFP as anyone who knows me knows). 

This cycle looked good on paper.  I had 6 days of bleeding with no brown blood.  I had a little peak type on CD10 and CD13, but I knew not to be "faked out" because I took clomid 4,5,6 so I was figuring CD 15 peak type and that is when the real run actually began (of course we had to avoid those days anyway, just in case, poor dh, seriously).  Unmedicated I would have maybe had 1 day of peak type and it would have been 1".  But not on these meds, baby!  Six, yes six, day of peaktype that ended with 5" (sorry TMI) that I didn't think possible until I did the meds last time.  It was a pity not to take advantage!  lol

Peak day was CD 20.  Here is where the little problem came in.  I filled the amox and started it on CD10.  I was told to take it when I saw peak type and continue through peak day (weird, you don't know peak day until the day after...).  So that is what I did, but recall there was 2 false alarms so I actually had to fill the script twice and take it 10 1/2 days total-oops, I missed a dose somewhere in there.  Technically I should have filled it a 3rd time!  Additionally I am on clarythramyacin (biaxin) (and dh) on CD1-10.  But we didn't get told this (like the clomid) until my cycle review.  By time I got the call back with order, due to the holiday, it was CD 4.  So I was told to take it CD 4-14.  So lots of antibiotics.  (and probiotics) And yet, I got sick.  With a virus.  But they called me in a z pac.k.  I wasn't going to take it.  I got sick Thursday morning, Jan. 14th, my peak day, but by Saturday I was dying.  I called the doctor and they said it had become infection (a secondary one had developed) based on my symptoms and to take the meds.  Which are similar to Biaxin.  Gosh, I really hope we don't get resistant to this stuff.  Typically I don't worry about that since it is here to be used when we need it and it is important to take the right amount so it actually works and not dilute it or why bother...anyway, we only take it a few cycles and then have a break for one reason or another.   But this time I am little worried.  Such large amounts!

Sorry for the long post.  Just one more thing-I gave my first peak plus 3 hcg injection sub cutaneously today and it was so not a big deal.  Really!  I took a minute to get over the body's natural desire to not want to harm itself!  But I just did it in the stomach where I definitely had some extra, and no problem!  It is so much better than that progesterone in oil during pregnancy where you give anywhere from 2-4 cc's since my place doesn't compound it strong enough...and you give that veeeerrrryyyy slowly.

Seriously? Seriously?!

I called today to make sure that Cigna TelDr.ug had received the script. They had, but said it would be awhile.  Since I am showing peak type today, I don't necessarily have "awhile" so they were kind enough to put it on priority so it would go out today.  Then I get a call back, usually it is to set up delivery.  But this was to say that, fyi this isn't covered under your insurance.  I told them it was covered under medical if the dx isn't infertility and it is not.  It has to do with my cycle and hormones I am low on, PMS, etc.  She said the dx they were given was infertility.  That is absolutely BS b/c Dr. Hilgers never uses that term b/c he is smart enough to know that IF is a result (or symptom of the problem is maybe better way to describe), and not the cause.  He calls everything what it is. So I just left a message for the insurance nurse again, who is fabulous.  I am grateful for her to argue this on my behalf.  Grrr.

How Much is My Time Worth?

I think insurance companies are put here to drive us all mad.  Seriously!  With their double speak and other confusing language it is no wonder that we all spend hours and days of our precious time WASTED!  Today I had to ask myself, how much is my time worth? I spent a good 2 hrs on the phone just today with the insurance company and mail order pharmacy (which, I realize, is really nothing as these things CAN go) and much more when you consider how long I have dealt with this particular issue.
I mentioned before that I was told hcg wasn't covered 2 year ago or so.  Somehow I got the impression it was just b/c of IF, can't recall why, and so a letter was sent by Dr. Hilgers that it wasn't IF.  I was told, it wasn't about it being IF, it just wasn't covered.  Thankfully I had some leftover from when it was covered so I used that.
Then when I called again, last week or so, they said it wasn't covered under pharmacy, but maybe medical if it wasn't for fertility.  I said it was not for fertility and so she said my doctor would have to fill out medical necessity paperwork and it would probably be covered.  That would have been helpful a year ago. I guess what the women should have told me back then was that the letter merely was processed by pharmacy and should have been processed by medical.
So today I call to check on it since Dr. Hilger's office had sent in the paperwork and I need to take it in about a week.  The first person I talked to said, yes it was approved and she sent me to Tel Dr.ug (their mail order pharmacy) because to get it anywhere else would be costly.  Here is why.  Now that it is covered under medical, Target etc are only contracted through Ci.gna pharmacy, not medical, so they would be considered out of network.  It is hard to find a medical provider that will give this kind of medication as if they were a pharmacy.  She suggested another option may be something like Apr.ia.  (I asked for this 2nd option because sometimes Tel Dr.ug is not the cheapest option).  Then they connect me with Tel Dr.ug who proceeds to tell me this medication is not covered-under pharmacy or medical.  This time, armed with the right information, I tell them it has been proven medically necessary and is covered by medical since it is not related to fertility.  Okay, she says, since it isn't fertility it can be covered.  (Man they train them well to be so anti IF!)  What if I didn't know and just said okay?!  Like I basically did last time!!!!  I ask how much it will be next.  Full price for this Novarel (hcg) is $102.38 per vial without insurance.  Of course, she had to transfer me back to Cig.na Medical to determine the coverage.  I want to know because now I have been informed that Fertility Friend is $59.  And I also learned that Kubats, who compounds it themselves, (mail order that Dr. Hilgers uses in Omaha) is $51!  So I wanted to make sure it wasn't higher than that with insurance.  At first I am told it is covered 90% and subject to my copay.  But then I push more-why then was my progesterone (similar situation) while I was pregnant covered 100% with no copay or deductible?  He puts me on hold again and low and behold-it will be covered 100%  Yippee!
Today I asked the question, how much is my time worth?  And now I know, it is worth free hcg while ttc.  That's actually pretty good for once!
I hope this post will help you know the right questions to ask to get something covered that perhaps wouldn't have been covered had you not had the exact same words. Ridiculous!  Please share this post with everyone you know on hcg!
P.S.This was the simplified version-there was even more confusion and transfers and I had to talk to Dr. Hilgers office twice (not their fault) and I am waiting for a 3rd call back.

Call back from Hilgers and not too late for one last thought on waiting...

We all can relate to Sew right now.  We are doers, and we are at our best when we can make use of that skill!  Today I got a call back from Dr. Hilger's staff.  He said that I should still get on the meds this cycle, and that we are still on the same plan (avoid and medicate this cycle, blood draw peak plus 7).  If the next draw comes back with good levels that can support a pregnancy, green light to ttc.  If not, then whenever it does-could be next month or could be several.  I was a little surprised, overall, having prepared myself to not even start meds this cycle.  It's amazing what happens when you give something over.
Here is what I am on-everything I was on before, really.
T3, prenatal, B6 (already taking).  Add baby aspirin daily, biaxin CD1-10 (dh and me), clomid (25mg) CD 3,4,5 (today is CD 4 so they said I could do 4,5,6 just this cycle); amox CD 11-15, mucinex cd15-Peak +2, and hcg post peak 3,5,7, and 9.  Plus probiotics.

There were a few surprises. 1) I expected biaxin 21 days before cyclical.  I didn't ask why not, not worried about it and trusting. 2) The nurse was surprised about the days I had amox and mucinex.  These were the days from last time, but she said the reasoning behind it didn't jive.  Basically you do amox 4 days before peak through peak and mucinex 4 days before peak through peak plus 2.  So she gave me the liberty to play with it while I was learning my cycles.  Interesting since the way it is listed above is what I did before.  And finally surprise 3) she (Tanya-I love love love her btw!) asked me how I did my hcg and I said intramuscular (butt) and she said, do you want to do it sub cu (tummy) and I was a bit taken aback-what, something has changed?! lol-I am used to everything being old hat and familiar, I guess.  Decisions!  On one hand, I have given shots to others (prog).  And dh hates to give the shots, and he is coming up on his crazy busiest work month where he works 80 hrs.  And it has been awhile since he's done a shot (well over a year) so nervousness will def be at an all time high for him.  But...dh he does it out of love and it has been a huge bonding experience for us.  I have a little nervousness, but I think needles and blood draws are neat (strange, I know) and like to watch procedures (dh can't even watch silly ER shows that aren't real without having twitches and ticks!)  I asked her if I could think about it, but it made a difference in the dosing, so I agreed to tummy shots, sad to give up the dh routine but thinking dh would be grateful for the gift.  (actually he seemed a little bummed on the phone-we are wierd creatures; I think he liked it as a way for him to be involved).

I got off the call and immediately the adrenaline began pumping!  I am a doer, I thrive on this stuff, even the little stuff, especially after all the waiting (I am proud to say I was the first to get the local IV from the Dr. Toth group, though it was my mom who was the catalyst-I like a challenge!).  The task this time was to figure out the hcg dilemna.  I had 10 boxes (required to order that way) from my insurance before dh and I got married (fabulous state  employee blue cross/blue shield).  It was pretty cheap-about $320 for it all.  I used it to conceive all 3 babies and had 1 box left. (Of course, that box is expired-had I known you ladies it would have been shipped out to one of you!).  I realized as I got closer to running out (fall of 2007) that I should check with dh's (my current) insurance.  No go.  They said it wasn't related to fertility, just wasn't covered.  Can't fight that.  I didn't end up needing it, thankfully.  But now I do.  So today I called Tar.get to get the price of it not covered-$124 but you must order 10 boxes.  But a "substitutable" product is $120 (Novarel-anyone try it?) but you can order one month at a time.  Next I called Cigna tel drug to see what the cost, covered or not, through their tel-drug mail order program and to check about coverage again.  First pharmacy dept, then specialty (for injectables)-they said no go.  Then they suggested it may be covered under medical.  (of course I happily continued to get transfered, happy just to be doing something toward my goal!) Medical said no way for fertility, but if it is another reason then I can have the doc's office go through a process to get it covered.  Interesting  how you get different answers when you keep asking the same question!  Gotta love insurance companies.  So, lovely Merilyn from Dr. Hilger's (we meet again! same issue...) is going to start the process.

Of course, I need to take my own advice.  I did all this (and will go to Target to get the meds) today while I was supposed to be working on my dissertation  (paid for childcare and all!).  I need to start seeing that dang thing like the hcg and as a challenge, something to get me toward my goal as well, the goal of being done and having more time with my child/ren. That is something I can get passionate about.  I will pray for this and try hard to work on it, and I need prayers from you ladies to as I am sure the distractions/task (and more fun stuff, in my mind) will increase...Isn't it funny how you can miss all those appts and calls? :)  I think in a bad way, some of us, probably myself included feed off the drama.  What would we do if we didn't have IF? 

Okay, sorry for long post, but this is good stuff-Last night, I saw the newspaper for our diocese from last week.  Our archbishop wrote a great article on prayful waiting.  I didn't realize Immacule.ee Ilibagiza had a 2nd book where she wrote about waiting and trusting in God, but the description in the article makes it sound like a must read for all IFers (her first book, Left to Tell, is amazing; the second book is called Led by Faith: Rising from the Ashes of the Rwandan Genocide). The end of the article reads: "During the Advent season, the church invites us to cultivate a spirtuality of prayerful waiting.  In a sense, we are currently spending an indefinite amount of time on earth waiting to gain admittance to heaven.  How we spend this time of waiting is extremely important because it will determine our eternal destiny.  Immaculee's method of waiting is worthing of  imitation.  During this remaining week of Advent, spend some time recalling God's many blessings, thanking him for each by name.  Pray for those byname you have hurt by your sings and ask God to bless them.  Finally, and most importantly, ask the Lord to free your heart from the imprisonment of anger by granting you the grace to forgoive those who have hurt you.  Ask God to bless them by name."  Since waiting isn't limited to Advent, I thought I would pass on this great advice.