Thursday, February 21, 2013

Appointment Update and General Blah-ness

Today I had another appointment with my doctor, Dr. B. Coming into this appointment, I was determined to talk to him about starting me on Clomid since I was 100% sure that I wasn't ovulating on my own. However, the appointment didn't go as planned.

My date with the dildo wand showed that I still had numerous cysts on my ovaries, the largest being on my left at 1.3 x .9 x .8 cm. The ultrasound tech asked what Dr. B was doing to help control my PCOS and I told her that I had been on Metformin since September. She responded by saying that PCOS is a pain to control and that hopefully the cysts would decrease soon.

After a sit in the waiting room, I got called back to talk to Dr. B. He walked in with a smile on his face and congratulated me for losing an additional 12 pounds since my last appointment on September 27, making my total weight loss almost 25 pounds. I agreed that the weight loss was good, but I wasn't sure if I was loosing it in the best way possible. Since my last Metformin dosage increase, I've been so nauseous that I'm only eating once a day, just enough to keep me going. I've talked about my nausea numerous times, so I won't go into too many details here, but I feel like it's gotten worse over time. Dr. B agreed that nausea is a side effect of the Metformin but its something that I just have to deal with. He sympathizes with me and was nice enough to give me a prescription for Zofran, (but I seem to have gotten the generic pills, Ondansetron,) which I can take every 8 hours as needed to try and combat the nausea.

We then talked about my levels. In September, my cholesterol levels were elevated, but I was hopeful that they were elevated from Thanksgiving which was a few days before. Unfortunately my bad cholesterol levels were still elevated and my good cholesterol levels were lower than they needed to be. Dr. B said that exercise would help fix those levels as well as continuing on my "diabetic" diet. I again stated that I'm barely eating enough to get me through the day so I didn't think that adding exercise would be the best plan, but he pushed me to agree to do at least 10 minutes a day.

Dr. B also increased my Metformin dosage from 1500 mg/day to 2000 mg/day because my numbers still aren't what they need to be. He said that they'd like to see 4.5 (I'm not sure what is being measured here or what unit is used,) and I'm at 4.1. These numbers are better than they've ever been, but still not what they need to be. To try and help counteract the nausea, Dr. B wants me to take one 1000 mg pill in the morning and another 1000 mg pill at night.

Next, he asked if I had been keeping track of my ovulation by using OPKs. I agreed that I had and pulled out my book of OPKs (I tape them in a book so that I can see how the line has (hopefully) darkened throughout the month.)

Exhibit A: OPK book with OPKs from Cycle 1 off of birth control

Exhibit B: OPKs from this cycle, Cycle 2. Look at CD 14, does it look like a positive to you? 

He looked at my OPK from cycle day 14 from last cycle as well as my CD 14 OPK from this cycle (pictured above) and declared that I ovulated. I stared at him in shock because as far as I could tell, I didn't. I told him I was surprised because I thought that I hadn't. He asked if I was still temping and I agreed that I was. Thankfully I had the forethought to print out my charts for him this morning, so I was able to show him my last cycle and the first 15 days of this cycle. Again, he thought that I ovulated and that my chart supports that. He says that on my last cycle, I ovulated on cycle day 15 which is proven by the elevation in temperatures the next two days.

Exhibit C: Last cycle (Cycle 1) with a supposed ovulation on CD 15. 

I dunno, I just don't buy it. If I did ovulate, why isn't FertilityFriend giving me cross hairs? I know that FF is just a program and not everyone will fall into the parameters of the program, but I just don't agree.

Anyways, Dr. B wants to wait a full three cycles of us trying "naturally" before talking about adding Clomid or another medical aid. I told him that I know that generally doctors don't like to have a woman on Clomid for more than 6 cycles in a row, so I asked what we would do if we got to that point. Dr. B said that doctors won't do more than 6 cycles of Clomid once they get a patient up to a dosage that seems to be working, which means that I could be on Clomid for more than 6 cycles as we find a dosage that works for me. He said that if we get to that point, we'd start looking into seeing if there are other factors that are stopping me from getting pregnant. We'd do things like a semen analysis on Keegan, a more invasive ultrasound to check my tubes and uterus (I'm assuming he was talking about one with saline or dye,) and perhaps a laproscopy. 

Dr. B did say that he felt I was getting too ahead of myself by talking about these things. I told him that I'm a planner and I just wanted to know that I could possibly be in for if we don't get pregnant naturally. He reminded me that 80% of couples get pregnant within a year, but I think he was quoting a statistic of "normal," "healthy" couples, ones without PCOS. He reminded me that by controlling my levels, we have a better chance of getting pregnant than we ever had before. 

After the our talk about my levels and Clomid, I had a few more questions, one of them being if I would continue on Metformin if I get pregnant. He said that there isn't medical "proof" about Metformin either way, but he would suggest that I'm not on it during pregnancy. He said that I would have to get checked for gestational diabetes early in my pregnancy and that I may have to go on insulin to control my levels. If I didn't feel comfortable being on insulin, we would talk about continuing on Metformin during pregnancy. 

This post is getting ridiculously long, but I want to quickly talk about how I feel about the appointment. Honestly, after the appointment, I felt (and still feel) really defeated. I just feel like I'm not doing enough to help my body and that Dr. B was almost looking down on me for trying to figure out our next steps without having completed this phase. I was also really upset that my levels aren't where they need to be after almost 6 months of trying to figure them out. I'm sick and tired of feeling nauseous all the time and not having an appetite for any kind of food. I know that I'm messing with my hormones and my body in general by being on the Metformin which is the cause of the nausea, but I feel like only eating once a day is bad for my health, no matter how you put it. Dr. B brushed off my extreme nausea by saying that it's just my body's way of dealing with not craving carbs and blamed my low appetite on my body getting used to eating smaller portion sizes. 

Throughout the entire appointment, I had tears in my eyes. I'm really bad at speaking up for myself with doctors because I feel like they went to school for years to learn this stuff; who am I to try and counter what they say with something I read on the internet? I really wish that Keegan was able to go with me because he is so much better at advocating for things like this. I was really hoping to prove to Dr. B that I'm not ovulating and that my body just feels off in general, but things just didn't go that way. I don't think that Dr. B is doing this to be mean, or to torture me in some way, I think that he just wants to make sure we give my body time to adjust to things and see if we can achieve pregnancy "naturally." 

So, that's it for now. I got back in 7 weeks to talk about our next steps if I'm not pregnant. I hope that I'm able to handle the increased dosage of Metformin gracefully and increase my eating, as well as my exercise.

If anyone has any opinions about if I did ovulate either last cycle or this cycle, let me know. I'm thinking of maybe getting the Clear Blue ovulation kit that flat out tells you if you're ovulating or not so that I can take out the guess work of trying to read a couple of pink lines.

1 comment:

  1. I almost immediately had to be placed on 1500 twice daily. I feel ya.