Monday, June 22, 2009

Busy weekend - now 5dp5dt

I had a crazy busy weekend at work. Was on call both nights, and basically up all night on Sat dealing with various things and then a nasty stabbing. The OR was crazy - starting a central line (huge IV in the neck) while the surgeon was opening the chest to see if the heart was still beating or had been stabbed (couldn't feel pulses on the patient), later putting in an arterial line in the femoral artery (for direct blood pressure monitoring) in while they were operating in the abdomen, trying frantically to stop the bleeding. It was probably the most insane OR I've ever seen. Blood everywhere - I swear we must have used up most of the blood bank trying to save this patient.
Apparently labour and delivery was calling my staff in a snit because they'd been waiting for an epidural for a long time. Well, that patient had been on oxytocin being induced for who knows how long. They could have asked me to do the epidural earlier that evening (never count on a quiet Sat night in a trauma hospital, especially after 1-2am when the bars are emptying out and the stabbings/shootings start), and should have been grateful I got the epidural in the woman having her second baby as quick as I did, and that I stuck around for the couple minutes after the trauma page came through to prime the epidural pump and program the loading dose, or she would have been out of luck too. Or they could have called my staff to do the other epidural when I ran off, saying that I was going to a major trauma in ER. Considering we needed at least 4 people at the anesthesia side of things (my staff and me getting the lines in, managing the blood pressure with meds, directing the use of the blood products), and a couple focusing only on checking and giving the blood products, there was no one to spare to go do the epidural. Dying patient in the OR vs patient in labour - it's not exactly a fair contest.
I spent the entire time I was home the next day sleeping, and then had to go back in for more on Sunday night. I had a fair bit of time in bed, but had trouble sleeping, and every time I was just about there, my beeper would go off. Hate that! But it was my last night on call as a resident ever, so wahoo! Only 3 more days, and I'm officially done.
Not much news on the IVF front. I feel absolutely no different than I did before. Thought there might have been some extremely faint cramping on 3dp5dt. But then it was gone again. No bloating, no abdo pain, no nothing right now, really. Boobs might be getting slightly more tender today, but I wonder if that might be from the falling progesterone? I'd much rather have it be from being pregnant!
I was bad on Sunday morning (4dp5dt), and dropped my blood off for a progesterone check at the hospital (still had reqs from my old RE). It came back at 55.5, E2 was 2300 or so. (Canadian units). I have no idea what it peaked at, but I usually peak at around 7dpo, and it's usually plummeting around 9-10dpo from the peak. I stopped by the clinic on the way home this AM, but no one would approve me for an early progesterone check. I really need to be reassured that my levels are good enough for a happy endometrium and to sustain any pregnancy that I might be lucky enough to get out of it. If it's not great, I'd rather go up on the progesterone suppositories, or change to IM, or start the HCG support a day or two early. They told me to email the nurse, and when I got up from my sleep (after 4pm, when the clinic was closed), she'd sent an email asking if I'd rather come in tomorrow for the check. I guess I'll just show up and tell them she said I could come in - I have the email to prove it now.
I wish I just knew that this would work out, and then I could relax a little more. I think I'm too scared of a BFN to pee on any sticks, and had had too much to drink before coming home this morning to have concentrated urine for an early 5dp5dt test. We'll see how my willpower holds out. After the HCG booster, they'll be false positive anyhow.
It's all a test of my patience.
I've been lurking on some cycle buddy threads, and am kind of scared on behalf of some of the people. I thought Dr H was premature triggering when he did (E2 was 8500), but we still got 14 good eggs, with 13 fertilized and 6 blasts at the end. Results I'm happy with. One girl has 10+ on each side from 17-20mm, with an E2 that went from 23000 to 32000 after a day of coasting. And her RE recommended she trigger, with "informed consent" about the risk of OHSS. Supposedly she triggered at 19000 last cycle without getting OHSS. Is it just me, or is this RE totally insane? They shouldn't have waited 2-3 days after her E2 got to over 8000 to do more bloodwork and scan again. They wanted more follicles to get into the right range, so they waited another day after she hit 23000. I hope she doesn't end up in the ICU with severe ascites and pleural effusions from bad OHSS, or liver or kidney failure or a pulmonary embolus from the hemoconcentration. She thinks that she just won't feel so good for a week or so, and then it'll all get better. (Don't forget these are Canadian E2 values, so 32000 is about 8700 in US units. Risk of OHSS supposedly starts to go up after about 3000 US units).

5 comments:

one-hit_wonder said...

Yes, too many IVF'ers think that OHSS just means that they'll be bloated for a few days or weeks. They don't know how serious it can be. I know I'm very lucky that mine went away so fast.

Glad that you have so many distractions at work (even though it has to be at other people's expense!).

Re: the no symptoms. Well, I'm the poster child for how no/few symptoms can still lead to something good. I hope the same for you, of course!

Anonymous said...

Wow, that's a crazy weekend!! It gives me a little peek of what it's like to be a doctor.

By the way, when I was in 2ww, I had every pregnancy symptom, including darkening of areolas. It turned out to be a BFN. I just want to wish you lots of patience and strength! It's so hard to wait for beta.

Kristy said...

Your will power to avoid POAS is inspiring! How much longer until they do their beta?

Clare said...

Wow I cant imagine how you keep it together in such stressful situations like you had this weekend. Crazy. And what a world we live in where you can just predict the stabbings and the fights! Makes for very interesting reading though! Admire your willpower no poas! But I guess you have access to other tests in your job. Wishing you the best news!

IF Optimist, then... said...

Wow. What an interesting post. As I was reading, I was thinking...This is better than watching ER on TV!

Best wishes for good news in the next few days. I'm rooting for you.