Tuesday, June 30, 2009

diagnosis, prescriptions, and sex?

I had my post-round-one-of-tamoxifen consultation appointment yesterday. I learned a lot of interesting things. First of all, long before I started the tamoxifen, I got a p+7 blood draw the results for which took literally three months for the blood lab to return (no explanation given). The results were:

progesterone: 14
estradiol: 84

Dr. L said that the progesterone was in the normal range (over 12), though she would prefer to see over 15 - but the real problem was its relationship to the estradiol, which is supposed to be 1:10. (It's 1:6.) The estradiol was just way too low - she said it should be over 150. (I asked her whether this was a sign of, say, premenopause, and she said it was just a luteal phase defect. Hmm.)

Then last cycle I had a p+7 draw (admittedly I had to guess when p+7 was) and the results were:

progesterone: 19.8
estradiol: 197.8.

That's almost exactly ten times, and both numbers are good. Dr. L was beaming. Rarely do doctors get excited about one's health (I think they're sort of bored of it), and nobody ever says nice things about mine (even when my blood pressure this time was 96/60, the nurse was totally unimpressed. DUDE, THAT'S REALLY GOOD. Actually, she told me not to WORRY because it wasn't "TOO low"!!!), though I can certainly see why not, given what they have to work with.

Anyway, I brought up the CM problems and my extreme dissatisfaction with them. I asked three different ways whether the HSG and SHG, or the colpo, could have caused the problems, and she was adamant that this was impossible. It sounded totally possible to me, but OK. She also said that since my estrogen was clearly higher, I should have had more CM, not less. Nevertheless, she obligingly wrote out instructions for me to take Mucinex (apparently I need to take TWO of my crazy extra-strength pills that I bought), and amoxicillin (apparently I need three a day to do the job). I'm to start taking both on CD11, or four days before I expect peak day (I appear to have ovulated on CD14 last cycle, so maybe I'll start on CD10?). I figured I'd fill the prescription on Friday, which will be CD8.

Her nurse had told me via phone that she does not treat thyroid problems, so I already got a referral for an endocrinologist from a friend and made an appointment for September 3rd - the first slot available. I planned to ask Dr. L whether that was too far off; I'm certainly hoping to have it moved up, since as I understand it ttc is pointless until I get on thyroid replacement, and also I plan to start my diet (that no-artificial-carb diet) and exercise kick as soon as I get the pills. To my surprise, instead of starting with a disclaimer that she doesn't treat thyroid issues, she said I should at least be on some replacement for now, and wrote me a prescription for (I think) thyroxin or whatever it's called. She also wrote a requisition for a full blood lab for thyroid testing, and told me to fill the prescription and start taking the meds when they call me with the test results (unless they advise otherwise). I was going to get the blood drawn tomorrow morning, but as it turns out, she circled "thyroid panel" on the requisition, and my lab has stated that they do not do "panels" and the doctor has to circle the individual tests. So I left a message at the clinic, and hopefully I can sort this out and I can go on Thursday. About a week for the results to come back means I'll be lucky to start on the meds before ovulation, but maybe they'll help anyway. I'm just delighted that she did this already. I did ask whether she could determine a dosage before further testing (my TSH level was 7.04, BTW, and I believe normal is under 2.5), but she said she was starting me on a really low dose. I was startled when she said it was 50mcg. One of my aunts is only on 10 - my mother takes 50! But, I'm not a doctor, and I'm so happy I'm getting something to treat this now, instead of in September after I've wasted months on tamoxifen that won't work and been tired and depressed for longer.

I had one other question about the thyroid blood draw, and maybe y'all can help me with this: does it matter what cycle day I do it on? I know my first one was on p+7, but maybe that's just because I was having progesterone and estradiol done that day already? I'd really like to do the draw as soon as possible.

So that's the story from the doctor's office, but I'm not done. This is the Cervical Mucus Sequel and it makes the first chapter of the mystery sound bland and really unmysterious. So anyway, I'm clearly having an improved cycle (thank you, tamoxifen) - other than the several extra days of cramps I can't medicate away, of course. I had NO tail-end spotting - NONE. And on CD3, when I fully expected the spotting to start, it was practically heavy (normal flow). Unusual for me! Anyway, today is CD5. I started the tamoxifen on CD3 as I was supposed to (though I took it in the late afternoon on CD3 and CD4, and in the morning today). I still have faint spotting today, but I also noticed this morning...slippery. I did the stretchy thing and there was no stretching at all, so I decided that didn't count (since I had a similarly weird interlude last cycle). Then in the middle of the day (this is gross, sorry), I noticed that I had a clear spot on my pad, which stretched almost an inch. Wasn't sure what to make of that, but I wasn't sure that on a pad counted. I got home from work and though I've still got spotting color, this time there's a little bit more slippery (not the drowning-in-CM I'm accustomed to for 2-3 days of my fertile phase EXCEPT RECENTLY, but clearly some), and it stretched almost two inches. There's no ignoring that one.

So apparently somebody decided I should start my buildup to peak (or otherwise have a bizarre day?!) on CYCLE DAY 5. I now have no idea when to take the Mucinex and amoxicillin or even when to fill the prescriptions - or whether I need them at all! And another question that requires your collective wisdom to help me answer (keeping in mind that I'm STILL bloated and crampy): do I have sex with my husband tonight???

I swear all this stuff is designed to confuse me.


  1. Wow, what an intense appointment! That is great that your last p+7 draw came out so perfectly! So you (your doctor?) think that the thyroid issue is the bigger issue than the progesterone and/or estradiol issue (or any conception issue, really)? That was really proactive for your doctor to write the thyroid prescription and order some related bloodwork- I hope you/she can figure out the right meds soon!

  2. Okay, I am on amoxicilian 250 mg 4x a day. I was instructed to take the amoxicilian right after my period. I think CD 11 is a little late. Just my VERY HUMBLE OPINION. If you want to take it earlier, I really suggest it. :) I am not going against what your doctor said though. :) I don't think it would hurt but again, just my opinion.

    My estrogen was low like yours as well, I was considering if I was even female it was so low. When my estrogen was at 672 my MUCUS SUCKED! The only thing that helped it were antibiotics. Just don't forget to take them. Take them religiously! The moment I forgot to take mine my mucus changed from silky to thick. Just a little FYI!

    You progesterone and estrogen look great on tamoxifen! Go BI!!!!

    I used to have the strechy mucus at the end of my cycle as well and never counted it to mean anything. :)

    So excited for you!

  3. Just a bit about my experience with Synthroid or the generic or whatever: It can take a while to find the right dose, and getting there can be a frustrating process. As in it took months for me to see some real improvement in my test numbers, and then I went hyperthyroid, then way hypo again. After that blip, and despite all sorts of insane reproductive stuff going on, things have evened out. I wanted to tell you this, because we seem to share some aspects of our temperament: the desire for things to WORK and get going, dammit!

    And just because it's fun to compare notes, I'm currently on 125 mcg! A really T4 junkie...

    I'm always for having sex when in doubt. Uhem.

  4. Nice stretch. My doctor recommended that I start Mucinex on CD8 and continue it through P+1. That could be because I can peak early (CD11 - 13 usually). I don't mind since it means I won't miss my peak time by starting it too late. I can't give you any opinions on when to take the rest since I don't have experience with them. I'd also BD now. You obviously have fertile mucus. Might as well take advantage of it.

  5. Those are some great-looking levels! Gotta love it when something comes back not just normal, but great. Doesn't happen often with us IF'ers, so we treasure it all the more!

    That's great that she is happy to treat the thyroid - so many doctors don't realize how much the thyroid affects our hormone levels. With the thyroid under control, you may not even need the Tamoxifen in the future. Wonder why you had such a drastic change in CM before even starting the mucinex and amox? I know most of us don't have two cycles that look alike, and I don't really know what tamoxifen does in the body I guess. Even after all this time, I', starting to realize how little I know...

  6. I can help with the thyroid info... Thyroxine or Synthroid take at least 4 weeks to make any difference in your TSH levels... If your RE is prescribing for you, make sure they are running another tsh and t4 test in 4 weeks, that way if they need to adjust the dose they can do so. They always want you to be signed of by an Endo though.

    It doesn't matter what cycle day you have your thryoid panel on, it doesn't fluctuate like all the other hormones in our body. You should still be okay to try it's when your tsh is slow it causes problems with implantation. When it's too high is when ovulation problems usually occur, but you seem to be okay... Check out thyroid.about.com.. all the best!

  7. First, don't worry about the stretchy cm on CD 5... it's highly unlikely that it is your peak build-up, since Tamoxifen is an estrogen inhibitor. All of the ovulation inducers work by suppressing the estrogen ON the days that you take it... which in turn tricks to FSH into working harder, so that the estrogen follows suit. But this process takes several days.

    My opinion is that the stretchy cm was endometrial fluid, which some women will normally see either right before their period, or right at the end of it during the VL days.

    On the antibiotic front, I would say start by CD 10, since you had a Peak at CD 14 last cycle. It won't necessarily boost your chances to start any earlier than that, though, because the sperm can only live 3-5 days. And you don't want to be taking antibiotics indefinately. (This coming from the Antibiotic Queen. But s'all good, 'cuz I have the clap. But you don't, so don't OD on the antis.)

  8. hey misfit, I'd love tips on your endrocinologist and to talk to you about your treatment and mine ... we both have low estrogen but seem to be getting really different advice from the same practice...? sigh.

    I should also do a post about the variety of mucus enhancers Dr. B recommended for me -- I do the antibioitic, mucinex, robitussin and vitamin B... but all of them just once a day. I think I should perhaps increase. I've found mucinex to work MUCH better than the cheaper no-name brand I bought. Of course. Everything has to be a little bit pricier.

    Anywhim, would love to email about the estrogen/endocrinologist questions, or we could even get together here in DC! If interested, could you please email me at inallthingsgood@gmail.com?