Letters to my doctor

So, here is the full version of the letters I sent to my previous doctor. I am still so happy that I was finally heard. It feels unprecedented, which is actually kind of sad.

First, my original e-mail-

Dear Dr. -- and other doctors of --:

I expressed concern at my follicle scan this morning regarding the volume of Novarel which is given as a single intramuscular injection. Ten milliliters seemed like an unusually high and unnecessary volume to give IM. When I expressed my concerns, I was told that this medication is given as two, 5 cc injections. I continued to state that this seemed unnecessary, and was told that if I don’t like the dosage, I should take it up with the drug company.

I wanted to inform you that I have in fact contacted the drug company and was told that it is not necessary to give this medication in a 10 cc volume. As they show in the instructional video on their website, it can be reconstituted in as little as 1 cc. (http://www.ferringfertility.com/medications/trainingguide.asp)

Attached is a letter from a nurse at Ferring Pharmaceuticals explaining this as well.
Please, do not continue to give this medication to patients in 10 cc. It causes unnecessary harm.
I will also fax a copy of this letter to your office.


Thank you,
Lisa

E-mail from Ferring:

Thank you for contacting Ferring Pharmaceuticals Clinical Hotline in regards to Novarel. Please see the following in regards to guidelines for the reconstitution of Novarel.

It is recommended that the amount of diluent used to reconstitute NOVAREL is selected on the basis of the dose to be injected.

--For ovulation induction requiring doses of 5000 IU to 10,000 IU, the volumes of diluent usually used for reconstitution are a 1 to 2 mL
--For cryptorchidism or hypogonadotropic hypogonadism requiring doses of 500 IU to 1000 IU, the volumes of diluent usually used for reconstitution are 10 to 20 mL

Thank you

Amy

Then, my final e-mail to the owner of the practice-

Dear Dr. --,
I wanted to tell you that I received your voicemail last night and to let you know how much your call meant to me. As I am sure you know, women going through infertility experience a roller coaster of emotions, but the one feeling that takes hold and will not let go through the entire processes is helplessness.
Feeling like my voice was heard, even if I had to fight harder than I should have, meant more to me than you will ever know. I wish you and the other doctors luck in your practice; however I feel that it is best that I move on to a specialist for my infertility treatments.
I hope you understand.

And last, the reply from the doctor which I just received:

Thank you for your kind reply. One of our beliefs in the physicians need to keep listening and learn from whatever valid source they encounter. Thank you again for being that source. We wish you well with your efforts. You will obviously be a great Mom.

I am now ready to let this go...after I do my happy dance a couple more times.

Real vindication came today...

I got a phone call from the owner of the ob/gyn clinic today. Apparently he received my e-mail regarding the Novarel and he wanted to let me know that they stand corrected regarding the administration. I can't even begin to describe how amazing it felt to get this phone call. It is posted below for your listening pleasure. I cut out the first few seconds of the call to protect the name of the doctor and the practice. By making this phone call, he has helped me to let go of some of my anger. All the same, I will only return to that practice once more. To pick up my medical records.

A poem

Here's a poem that I found (I'm not really creative enough to write one of my own)
For those dealing with IF, it will surely hit home. For those who know someone who is dealing with IF, please take a moment to read it, the questions and statements made are so common and none of them are helpful. Don't say them...

Useful Advice
You're 37? Don't you think that maybe
It's time you settled down and had a baby?
No wine? Does this mean happy news? I knew it!
Hey, are you sure you two know how to do it?
All Dennis has to do is look at me--
Some things just aren't meant to be.
It's sad, but try to see this as God's will.
I've heard that sometimes when you take the Pill--
A friend of mine got pregnant when she stopped
Working so hard. Why don't you two adopt?
You'll have one of your own then, like my niece.
At work I heard about this herb from Greece--
My sister swears by dong quai. Want to try it?
Forget the high-tech stuff. Just change your diet.
It's true! Too much caffeine can make you sterile.
Yoga is good for that. My cousin Carol--
They have these ceremonies in Peru--
You mind my asking, is it him or you?
Have you tried acupuncture? Meditation?
It's in your head. Relax! Take a vacation
And have some fun. You think too much. Stop trying.
Did I say something wrong? Why are you crying?

Author of infertility poetry Catherine

Vindication

As a follow up to my earlier post:
I decided to contact the drug manufacturer and ask about the proper resuspension of Novarel. The nurse was appalled that the doctor would give a 10 mL injection (or even 2, 5 mL) injections. She told me that the drug could be reconstituted in 1-2 mL and given that way. She also sent me an e-mail which conveyed this information to pass on to my (former) OB/GYN.

I sent a letter to the OB and all of the doctors in the practice with this information and then made an appointment to see an RE. I am happy to report that I will be seeing this new doctor on Thursday. I have hope again, I feel powerful again and when struggling with infertility, these feelings are like gold. :)

Feeling Defeated

So, yesterday was Mother's day and I tried to sulk, but Tim wouldn't let me. We spent most of the day running errands which was a good distraction.

Today, I went in for a follicle scan to see if I am ready to trigger and do the IUI. The trigger, Novarel, is an HCG injection that has to be given IM. I had to pick up the medication yesterday at the pharmacy and bring it with me today in case they wanted to give it. When I got the Rx, I looked at the instructions and it said "inject 10 milliliters (mL) intramuscularly for 1 day". I freaked. No one gives that much volume as an IM injection. It's f-ing crazy. So I went online and tried to look up how people give the medication and I went on the bump and asked the ladies how they have gotten it. It turns out that generally, the medication is reconstituted in a smaller volume if it is all being given at once IM so I felt better. Until my appointment.

The follicle scan showed only one follicle with any potential, but it is still too small to trigger so I have to go back in a couple of days to see what happens. While I was there, I told the doctor that the instructions on the Novarel freaked me out, I couldn't believe that they would give an injection of 10 cc IM. He laughed and said "yup, but we actually give it as 2 shots" I just about broke down right there. He told me that if I didn't like it I should "take it up with the company".

I just want to cry right now. I feel so defeated and so unheard. I don't understand why my body won't just do what comes natural to the vast majority of women. Sometimes I just want to give up.

Infertility Creeps In

Last week, my best friend's father was tragically killed. He was here one day and gone the next. It has been such a hard time for her and her family and I wanted to be there to help her through it.
Tim and I drove up to see her for the wake and funeral this week. My heart goes out to her. I know what it's like to lose a parent and I know that there isn't anything I can say to make it better. I actually didn't say much. I tried to distract her and ask about other things, but I knew better than to tell her that it's going to be alright or that it will get better in time, because those sentiments didn't help me when I was grieving.
As I sat with her, I listened to the things that people said to her and her mom in an attempt to comfort them and one thing was said over an over again--"he will live on in his children and grandchildren". The statement is true and I do think that it offers comfort to the family, but for me, sitting there, it made me want to cry.
I know that the past few days weren't about me or my own struggles and I would never expect anyone to edit their comments to someone just because I am sitting there, but it was still like a knife twisting in my heart.
What if we never get to have that? What if we are a genetic dead-end? What if something happens to Tim or me? What will people say when they realize that they can't use those comforting words? Who will keep Tim occupied or help him with arrangements when I'm gone? How would he cope? How would I cope?
It is amazing to me that even in this time when there is already so much grief, infertility can creep in and somehow make it that much worse.

Moving Forward

Well, I have an appointment with my doctor tomorrow to discuss our options. I am expecting that we will do u/s monitoring, HCG trigger and hopefully IUI. To be honest, since I am not working with an RE (reproductive endocrinologist), I may not be able to get IUI, this month. If that's the case, I will ask my doc to refer me to an RE as soon as possible. I don't want to keep wasting cycles without doing everything possible.