How to ship blood

In case this is helpful to anyone, here is my little tutorial on shipping blood.  It is really easy.  We've been doing it as long as I've been a patient at the PPVI Institute.  Different labs calibrate their machines differently, and that can mean the same blood sent to two different labs would give noticeably different results.  For this reason, PPVI doctors require a patient's blood to be shipped to the PPVI lab (National Hormone Laboratory) for analysis there.  This is especially important for progesterone levels as all of the standard curves for NaPro are based on the PPVI lab.

[Side note:  Some NaPro doctors have ordered a set of controls from the PPVI lab to be run at their local lab see how closely the local lab's results compare to PPVI.  This allows the NaPro doctor to create a calibration curve to convert the local lab results into the PPVI standard.  Then all the patients for that NaPro doctor don't have to ship blood to PPVI; they can just go to that particular local lab, and the results will be sent to the NaPro doctor like any normal blood draw.]

First you have to find a lab that is willing to let your blood sample to leave their lab and go to another lab for analysis.  Not all labs allow this.  I have had the most luck with hospital outpatient labs; I have mailed blood to PPVI from two different cities.  The independent (not connected to a hospital) labs have all turned me down when I called to inquire about this.  So call around to your hospital lab(s) and ask if they are willing to just draw your blood and centrifuge it and then mail it to another lab for analysis.  You can also ask if they would let you mail the blood yourself (after it has been centrifuged).

In the first city where I lived, the lab was reluctant accommodate my request, but one of the lab admins said she remembered they had done this for a patient who was part of a research study, so in the end they agreed.  After taking down the name of the person giving me permission over the phone, I went to have my blood drawn at that lab and had to re-explain everything to the person drawing my blood.  The phlebotomist was hesitating, but as soon as I said it was for a research study, she stopped questioning me immediately and became very understanding.   Technically the PPVI Institute does do research so it's not totally wrong to say my blood draw was for research.  (Sorry for encouraging little white lies...)  I don't know why "research" was more acceptable than "my doctor wants to use her lab because it's standardized."  PPVI has written instructions on the back of the requisition form (blood draw order form) on how the blood is to be centrifuged before it is mailed, so I reviewed that with the phlebotomist before I left.  I didn't leave until I was confident that my sample was not going to be analyzed in town at that lab.  They promised to mail my blood to PPVI.

In the second city where I live now, the lab admin I spoke to on the phone was much more willing to cooperate.  He even sent an e-mail to all his phlebotomists letting them know that I was coming and what I would be asking for.  When I arrived with my requisition form in hand that PPVI had mailed to me, the phlebotomist said, "Oh, you're the girl we got an e-mail about," and she pointed to a printed copy of the e-mail.  What great service.  :)  I was impressed.  They made copies of the requisition form (which is marked as a "standing order" since I need the same P+7 labs each month) and keep in them in a file with the other frequent customers.

Now every time I go, after the staff person retrieves a copy of my requisition form from the file cabinet, I remind him/her that I'm the special case where my blood will be mailed to a different lab.  I rarely get the same phlebotomist, so I point out the written directions and make sure they understand before my blood goes to the lab for centrifuging.  The lab ladies do know the drill by now, and they even remember my name.  (I met them last month when the phlebotomist wanted me to go back to the lab to make sure everything was going to be done correctly.)

When I first started using my current hospital lab for this, they would ship the blood to PPVI for me.  Because it was not a standard request, they didn't know how to bill me, so they didn't charge me at all.  Then the lab manager decided I should be charged (and I agreed), so they did figure out how to bill me a set fee.  After quite a while doing this (maybe a year?), the lab manager decided that the lab was no longer capable of mailing my blood to PPVI.  I have no idea what changed.  They gave me two options:  have the blood analyzed locally or mail the blood myself.  So now after my blood is drawn, I wait for the lab to centrifuge the blood and separate out the serum.  They hand the tube of serum to me, and I mail it at the post office.  I am very spoiled, but they do not charge me for the blood draw or for the centrifuging.

The specific tests you are having done determine whether you can ship the blood at room temperature or whether it needs to be shipped while frozen.

Here are the different colored tubes the phlebotomist
could use. Make sure red is used. (source)

NOTE:  For the routine P+7 progesterone and estradiol, the phlebotomist only needs to fill one red top tube with your blood, not two.







How to ship blood at room temperature

For these tests:  progesterone, estradiol, prolactin, FSH, LH, HCG, and DHEA

As long as the blood will reach PPVI within 5 days, it is okay to send it without anything to keep it cold.

1.  Pick up your blood sample from the lab.  It takes a half hour or so for my blood to be centrifuged by the lab after it is drawn, so I usually just wait in the waiting area.  When you receive your blood, make sure the tube contains a yellow liquid, not red.  (One time my lab gave me a tube of red blood.  I handed it back to them and said it's supposed to be yellow (the serum).  They apologized for forgetting to separate out the serum and took it back to correct it.)

2.  Put the tube of yellow serum in a ziploc bag.  My lab gives it to me in a ziploc bag with a biohazard symbol on it. 

3.  Put that ziploc bag in a second ziploc bag.  I use a sandwich bag.  Also fold up a paper towel (or some other absorbent material like cotton balls) and put that in the bag as well.  The idea is that the paper towel should be large enough to absorb all the serum if it were to leak out.  The post office requires that the tube of serum be in two "containers" in addition to the mailing envelope, hence the two ziploc bags.

Sometimes my lab used to give me my serum in two
ziploc bags.  I didn't put the paper towel in the bag yet.

4.  Put the bundled up serum in a padded mailing envelope.  Also include the blood draw order form.  Seal the envelope well.  I always use extra packaging tape.

5.  Mail the envelope.  I use the post office for mailing and have it sent as a regular first class parcel, which is the cheapest.  Sometimes the post office clerk asks if the package is liquid, perishable, hazardous, etc., and when you're mailing blood, the answer is yes.  Sometimes they ask further questions to make sure the blood is packaged securely.  I just tell them it is in two separate containers (in addition to the plastic tube holding the blood and in addition to the envelope).


How to ship blood frozen

For these tests:  thyroid, testosterone, and androstenedione

I have only done this twice, and somehow it managed to work out for me.  This is what I did:

1.  Pick up your blood sample from the lab.  It takes a half hour or so for my blood to be centrifuged by the lab after it is drawn, so I usually just wait in the waiting area.  When you receive your blood, make sure the tube contains a yellow liquid, not red.

2.  Put the tube of yellow serum in a ziploc bag.  Put the bag in your freezer for several hours.  (I left it there overnight one time.)  I did this to maximize the chance that the blood would still be cold when it arrived.

3.  Right before you're going to mail the blood, take the bag with serum out of the freezer.  Put it in a second ziploc bag (size of a sandwich bag) along with a folded piece of paper towel or enough cotton balls to absorb all the serum if it leaked.

4.  Put the filled ziploc bag in a large (gallon-sized) ziploc bag.  Also put two ice packs in the large bag.  Seal the bag.

I used two of these ice packs.  The label says it's a "long lasting ice pack."
  The business card next to it is to show scale.

5.  Put the large bag containing the blood and ice packs in a small box.  The box I used was smaller than the size of a shoe box.  Put the blood draw order form in a separate ziploc bag (so it is protected from getting wet) and add that to the box.  Seal the box well with packaging tape.

6.  Mail the box using overnight shipping.  Use UPS or FedEx or some other company.  Don't use the post office because it might not be delivered the next day as requested.

My experience with FedEx
The second time I mailed frozen blood I went to a FedEx store at 5:00 pm.  I had my blood in a small box, but I didn't seal the box in case they preferred that I use a standard FedEx box.  I brought packaging tape and scissors along in case they said I could use my own box.  The store manager said they were not allowed to ship hazardous/infectious things or even sell me the postage/mailing label for my box.  (Technically, blood isn't considered infectious—unless you do have an infection, which I don't—but the fact that it was blood made the manager nervous.)  He said I was free to use the FedEx drop box outside.  He did give me a large clear plastic-like FedEx bag ("clinical pak"), so I taped up my box, put it into the bag, and sealed it.  I filled out a mailing label complete with credit card number and stuck it to the outside of the bag. They would bill me when they picked it up.  I chose next day delivery by late afternoon.  I put it in the drop box.  According to online tracking, the package arrived at PPVI before noon the next day, several hours ahead of schedule.

My experience with the post office
I sent DH to the post office to mail the box with my frozen blood.  It was first thing in the morning on a Tuesday.  It also happened to be the day of a predicted snowstorm, but the post office clerk still said the box would arrive in Omaha the following afternoon.  The receipt even said "guaranteed delivery" the next day.  We had a tracking number.  On Thursday morning, my box was sitting in a warehouse less than an hour from where we live.  It didn't leave my state until Thursday night.  I was upset.  I figured my blood would have been thawed by then and therefore useless.  Friday morning I called the PPVI lab to let them know the situation and asked that they not even do the thyroid tests.  I said I'd send them a new sample later.  Surprisingly the lab tech said my blood had just arrived and it was still cold, so she said they could still do the tests.  I later read online that others complained that the post office's "overnight shipping" was actually 2 or 3 days, so I learned it wasn't just the snow to blame.

If I had to mail blood frozen again, especially if it was summer, I'd prefer to use dry ice.  The lovely Wheelbarrow Rider is more of an expert on shipping with dry ice, and she said you can check the phonebook to try to find a local place to buy some.

A little medical mistake

On the plus side, the medicine I'm taking to reduce my prolactin level (bromocriptine) is working.  Let's focus on the positives here.  :)

My prolactin level rechecked last week was 1 ng/ml.  That's pretty low.  Maybe a tad too low... (goal is under 10; I started at 60)

The endocrinologist mailed me a letter with the result.  She said I should reduce my dose from taking the medicine twice a day to once a day.  I passed the information along to Dr. K.  Apparently there was a bit of a miscommunication when the medication was called into my pharmacy.  This reduced dose is actually what my starting dose was supposed to be.  Ooops.  Dr. K thought the mistake happened because the order was given verbally to the pharmacy instead of in writing.  Also the pharmacist maybe thought there was a mistake with Dr. K's order because it meant I had to cut each pill in half since it doesn't come in smaller doses (which is exactly what she intended).

So I started at double the typical initial dose...  That might explain the crazy side effects I had on the first day or so and the ongoing random bouts of dizziness.  (I almost fainted at Mass last week for the second time.)  I'm glad nothing worse happened.  I hope with this lower dose the dizziness goes away.

The prolactin medicine and/or whatever caused my TEBB to disappear (this is the second cycle without TEBB in a row!) is having a great effect on my hormones.  My P+7 values have been in the normal range for a long time, thanks to low-dose Clomid and post-peak HCG.  However, my P+7 results from last cycle—the first cycle on bromocriptine and no TEBB—set a new personal record.  They pretty much blew all previous months out of the water.

	Last cycle	Goal	My typical value	My previous high
Estradiol	53	>12	30	40
Progesterone	73	>13	20	58

So no TEBB = very happy hormones. If this keeps up, I wonder if Dr. K will have me stop the Clomid?  Now if only this would lead to a pregnancy...  :)

Doctor visit

I had my appointment with an endocrinologist yesterday.  My goal was to find out what the significance is of having a diffusely enlarged pituitary.  Nothing else.  I don't want more cooks in this (IF) kitchen than necessary.  The appointment went okay...apart from the ten minutes or so when I was led to believe I had a brain tumor.  But I did learn what I wanted to know so I'm satisfied.

The doctor spent the first part of the appointment explaining my "macroadenoma."  My heart sank.  (that word means large tumor)  I was sitting there thinking, "I guess I do have a brain tumor."  She said it was just starting to impinge on the optic nerves.  She asked me multiple times if I had any vision loss or problems.  She talked about getting another MRI in six months to see if it decreased in size.  At some point I interrupted her and asked, "So I do have a tumor?"  "Yes, you do, and macro means it's larger than 1 cm."  Then she stopped and pulled up my MRI report.

"My mistake.  No, you don't have a tumor.  Your pituitary is just enlarged.  You won't need another MRI." 

That's a relief (to find out for the second time).  I wish she would have read the report a little more closely.  It's really not fun to be told you have a tumor when you thought you didn't.

She said the enlarged pituitary could very well be a normal variant.  Normal!!  I was not expecting to hear that.  Her only guess as to why my pituitary was enlarged was the HCG I've been taking post-peak for four years.  She said it's common in pregnancy for the pituitary to become enlarged due to the presence of HCG.

She did want to do some labs to see how else the pituitary is functioning, but she said she can't check the hormones I'm being treated for because it won't tell her anything.  The (anterior) pituitary makes six hormones, and I'm on medicine that affects five of them.  (Example:  The pituitary makes TSH, which tells the thyroid to make thyroid hormones.  If you take thyroid hormones as a medicine, the pituitary goes to sleep because TSH isn't needed.)  The only one of the six she could test is growth hormone, so she's doing that.  She's rechecking my prolactin since I've been on the medicine just over a month; she said it didn't matter that I wasn't fasting.  I asked her to recheck my vitamin D, since it was low last fall.  There's something else too but I don't remember what...I do remember the four tubes of blood they took from me.  I'm glad it wasn't more.  :)

She said she would refrain from commenting on my thyroid labs from February if that's what I preferred.  Yes, that's what I preferred.  :)  She did let me know what she thought of them in a back-handed way.

As I expected, she was very skeptical of NaPro, both the long-distance concept and the actual treatment approach.  She asked me why I was originally put on T3 ("because it's standard everywhere to only use Synthroid/levothyroxine") so I explained it was due to low temps, symptoms, and a low T3 to reverse T3 ratio.  (reverse T3 is inactive)  "That's not mainstream medicine," she says.

Clearly.   You can say that again.  (She did say it again later.)  :P

If I didn't roll my eyes, I definitely wanted to multiple times...she wasn't just asking out of curiosity; she bordered on condescending...  The thing that usually stopped her accusatory tone was when I said, "NaPro has some great pregnancy success rates.  They've found    (insert NaPro medicine here)     worked for their patients."  I said that when she asked why I was working with a doc in another state, how I picked PPVI in the first place, and why reverse T3 ratios are used to plan treatment.  She did ask if there were papers published so she could read to learn more.  I told her they (Dr. H) tried, but no one wanted to hear about that.  (Dr. H got sick of journals rejecting his research paper submissions for that reason so he stopped submitting.)  She nodded in understanding.  I mentioned if she really wanted to, she could buy the 1000+ page NaPro textbook.  As soon as I said that, she scribbled something in her notes, but didn't say anything.  I have no idea if she would actually consider purchasing the textbook.  I would be shocked if she did.  I'm supposed to go back in three months for another appointment, so maybe I'll find out then.

With all the questioning she did of my NaPro treatment, I'm a bit disappointed that she didn't ask about naltrexone.  (It's the ONLY one she didn't ask about.)  Knowing that they expect me to say I'm on it to treat an alcohol or drug addiction, I like seeing people's faces when I say it's a miracle drug for PMS.  :)

Debriefing

1.  Did you all survive Mother's Day okay?  I didn't e-mail our pastor ahead of time asking for sensitivity to IF with an alternative blessing that would include IF and miscarriage or an intercession mentioning IF like others were doing at their parishes.  I thought I'd take my chances going to Mass on Saturday hoping that it would be less mother-focused.  We have new priests since last Mother's Day, so I had no precedent to go by.  (The previous priests kept the Mother's Day references to a minimum and did not do a blessing of mothers.)  My plan backfired.  The priest, who was ordained last year and probably has a lot of new-priest zeal, did his best to infuse Mother's Day into every part of the Mass possible.  By communion time, I hadn't shed a tear or even had the urge to cry, so I thought I was doing pretty well.  When I returned to the pew and heard the line in the song ("when we have run with patience the race") that usually makes me cry because it reminds me how long IF has been and how long it might be yet, I lost it and started sobbing—the kind where your whole body shakes and people might be able to hear you.  I tried to stop, but there was nothing to do except try to think of people to pray for and let the tears come until my tear ducts were empty.  (I swear I have gallon-sized tear ducts.)  By the time everyone sat down, I had calmed down, and the tears were down to a slow trickle.  I noticed the wood of the pew in front of me was quite wet...  The priest then asked mothers to stand for a blessing, and under my breath I said, "Please, no..." and the tears picked up again.  I think he was trying to include more people because he said all "past mothers, current mothers, and future mothers" should stand.  I don't know if by "future mother" he meant those who are pregnant?  I'd like to hope I'm a non-pregnant "future mother" but I didn't stand.  His blessing wasn't really a blessing, but three different prayer intentions—for those whose mothers have died, for mothers who have lost a child, and for mothers of living children—so there was really no need for the standing.  I'm glad he acknowledged two groups who would find Mother's Day to be a sad day, but I'm not surprised there was no mention of those who long to be (physical) mothers.  I would guess that to a non-IFer, loss of a dream isn't on the same radar screen as loss of a real person.

Despite a not-so-great start to Mother's Day a day earlier, I spent a quiet day at home on Sunday with DH and tried my best to forget what day it was.

2.  Two very sweet friends sent me messages saying they were praying for me on Mother's Day.  Both were told prior to marriage that they would likely never hold a biological child in their arms, so they knew the pain of IF.  One recently gave birth and the other is pregnant and due in a few months despite doctors' predictions, so the fact that they still thought of me and other childless wives on Mother's Day was a nice consolation.  A couple of my mom friends posted an article on FB about remembering IFers and single women on Mother's Day, so the day wasn't all bad.  ;)

3.  I haven't cried that hard (see #1) in a long time.  AF is here, and there have been no tears.  Last cycle I think there weren't tears until CD4, and that was only because of some trigger like a cascade of pregnancy and birth announcements in rapid succession.  (Why do they come in groups??)  I actually think it has been months since I've cried on CD1, which is not at all how I used to handle CD1.  Either I'm all scarred inside and attempting to numb the pain or I'm learning to accept not being pregnant.  I suppose it could be partially a third option as well—I've given up thinking we'll get pregnant; if I don't get my hopes up during the 2ww, then there's less disappointment when AF shows up because I just know she's coming.  And I don't do it on purpose in an attempt to make CD1 easier; I truly don't have (much) hope about pregnancy anymore.  If God wants to surprise me, that would be fabulous, but at the moment He'd have to do it without any optimism on my part.  (totally within His purview, of course)  ;)

4.  It looks like, from my non-expert eye anyway, that we might have had an effective cycle (where everything is treated/fixed) last cycle.  I'm not excited about one incidence of spotting that happened around ovulation time because, in the past, I've only had that in cycles were I also had endo.  All mid-cycle spotting disappeared immediately after both of my surgeries.  Coincidence?  I hope so.  My periods aren't painful so that is encouraging.  But I am getting a little nervous because it was at this time point after my first surgery (about 15 months) that my periods became painful again.  It's been 15 months since my second surgery.  I really, really don't want a third one.  Right now probably the only thing that would convince me to have a third surgery is unbearable pain; fixing our IF doesn't seem like it would be enough of a reason anymore.  I am hoping and praying something we've done after the second surgery (diet or medicine) is going to help keep the endo away for longer, or dare I say it, permanently...

5.  So now we're on to (hopefully) effective cycle #2.  I am very curious to see if the TEBB stays away again this cycle.  That would be a record for me—two cycles in a row!

6.  I have an appointment with an endocrinologist next week to find out the significance of my diffusely enlarged pituitary.  I hope it doesn't require a pint of my blood to figure out what other havoc my pituitary may be causing besides the elevated prolactin.  :P

IF t-shirts that talk for you

I made some more IF t-shirts for when you want to get your point across without saying a word.  Here are the previous years: 2011, 2012, 2013.  Enjoy!  ♥

And one for a husband to wear.

Need a little homemade pampering?

Yes, you do.  Especially tomorrow when, if you're like me, you wouldn't mind crawling under a rock somewhere and hiding until Monday.

Here are some recipes you could use to turn your home into a mini spa.  Most of the ingredients are really common, and you might already have them at home.  I made all of these recipes and put them in mason jars as a Christmas present for a relative who requested spa items.  They were a huge hit (and not just with the recipient) in case you need gift ideas for the ladies in your life.  I didn't get a chance to try any of the finished products, so I might be making them again for me very soon.  :)  (mason jars not required!)

All of the recipes below involve ingredients that are not in danger of spoiling.  When I was searching for recipes to make, I had to exclude all recipes that included fresh ingredients (meant to be used immediately) or those that required refrigeration because I made everything a few days ahead of time.  If you plan to use an item right away, you wouldn't be limited by those factors.  There are tons more recipes available online, so if there's a certain item you're looking for (face scrub, foot scrub, etc.) or a certain ingredient you want to use (strawberry, etc.), search for it by name.

Tea foot soak  source
1 cup baking soda
1/2 cup salt
4 Tbsp of loose tea* (or the contents of 4 tea bags)

Whisk ingredients in a bowl.  Store in an airtight container.

To use:  Add 2 Tbsp of mixture to a basin of warm water and soak feet in it.

*The original recipe called for peppermint tea.  I used autumn tea because it smelled the nicest of the teas we had in the pantry.


Scented foot scrub  source
3 Tbsp baking soda
1 Tbsp body wash
1 Tbsp water

Mix ingredients in a bowl.

To use:  After soaking feet, gently rub the mixture over your feet.  Rinse well.


Face exfoliator  source
3 Tbsp extra virgin olive oil
2 Tbsp honey
1/2 cup sugar  (I used brown sugar)

Use this 1 to 3 times a week depending on how sensitive your skin is.  It removes dead skin and rehydrates the skin.


Citrus salt body scrub  source
1/2 cup sea salt
1/2 cup sweet almond oil  (I used olive oil)**
1/2 tsp lemon zest  (I used zest from 2 lemons)
1/2 tsp orange zest  (I used zest from 2 oranges)

**In my opinion, this was too much oil.  Add it slowly as you mix it in.  I'd probably use 1/4 cup or less.  I also used about double the amount of zest that the recipe called for because I wanted a stronger citrus scent.  You could use even more zest.

Mix all ingredients in a bowl.  (make sure the bowl is dry so no water touches the mixture)   Store mixture in an airtight container.  Makes about 2 servings.

To use:  Just before showering, swirl ingredients together with your fingertips to mix. Clean body completely and just before exiting shower, apply this mixture to skin in a firm circular scrubbing motion with hands or a soft washcloth. Rinse off the mixture and pat body dry with a clean towel.  It is an exfoliant and full-body moisturizer for use in the shower.


Lemon facial mask  source
olive oil
lemon juice

Note:  I used a ratio of 3 parts lemon juice to 1 part olive oil, so 1 Tbsp lemon juice to 1 tsp olive oil. (3 tsp in a Tbsp)

Mix ingredients in a small bowl.

To use:  Apply the mixture to your face with a cotton ball.


Mocha body scrub  source

1 cup sugar  (I used brown sugar)  
1 Tbsp ground coffee
1 Tbsp cocoa powder
1 tsp cinnamon
generous pinch of nutmeg       
generous pinch of ginger       
1/4 to 1/2 cup almond oil  (I used olive oil)

Whisk together the sugar, coffee, cocoa, cinnamon, nutmeg, and ginger in a bowl.  Whisk in 1/4 cup oil until it is completely combined with the sugar mixture. Stir in the remaining oil by the tablespoonful until desired consistency is achieved.  Store mixture in an airtight container with a wide mouth.

To use: Apply to clean, wet skin in a circular motion. Rinse well and pat skin dry.

Caution:  Those with sensitive skin should consider doing a patch test before using.


Green tea body scrub  source

1 cup of brewed green tea, lukewarm***
2 cups sugar  (I used brown sugar)
3 Tbsp fresh, grated ginger

***this was way too much tea; spoon it in slowly until the mixture is a good, thick consistency; I scaled down the entire recipe and only made a third of a batch.

Mix ingredients in a bowl.

To use:  Step into the shower and rinse body so skin is wet.  Starting at your neck, work the scrub into skin by massaging in a circular motion. Once your body is completely exfoliated, rinse in warm water.  Apply moisturizer to cleansed, scrubbed skin.

~*~

I hope you get to enjoy some of these recipes.  Maybe light some candles, turn off the lights, poor a glass of your favorite beverage, and play some relaxing music.  :)

I am headed to Mass soon and I will be praying especially for all of you who find tomorrow to be one of the most difficult days of the year.

Stay tuned here tomorrow for my annual attempt at getting you to smile a little on an otherwise tough day.  :)

Lemons or something

A very curious thing happened this cycle.

I had no TEBB. (brown bleeding at the end of the period)

None.

This has only happened twice before:  1) the cycle after I finished the IV antibiotics two years ago and 2) the cycle after finishing the ampicillin last August. We've been continuing the antibiotics each cycle from CD1-CD10 in the hopes of keeping it away, but the TEBB reappeared and has been increasing little by little.

In August there was jumping up and down and dancing in the living room and a strong desire to scream out loud out of excitement. (I may have limited it to a small squeal.) :) This time, I'm mostly just scratching my head trying to figure out what made the TEBB go away and staring at my chart in disbelief. Don't get me wrong—I'm very happy to have a pretty red period. (Yes, I just used the word "pretty" to describe AF. After years of brown, which is truly ugly and gross, it seems fitting to me.)

The only things different this cycle were:
1) bromocriptine (to reduce prolactin) - started six days before AF arrived
2) turmeric - started day 6 of this current cycle
2) daily mug of lemon water

I tried to ask Dr. Google if bromocriptine could have an anti-inflammatory effect but didn't get very far, except for one seemingly unrelated article.  I suppose there could be a different mechanism at work, but I can't speculate what it could be. I think starting turmeric on day 6 is a little too late to explain the disappearance of the TEBB.  So that leads me to believe it's most likely the lemon water? It really seems too good to be true that such an easy "treatment" could be responsible...

In the past I had read about foods that were anti-inflammatory and knew lemons were on the list. Someone posted an article on FB about the benefits of drinking lemon water daily, so I decided, "Why not try it?" I figured it couldn't hurt. The directions said to put a thick slice of lemon in a cup of hot water, let it steep for a while, and then drink it. I was a little skeptical about the lack of sweetener in the water, but decided to trust the article. When DH made his daily cup of tea, he boiled some extra water for me for my "lemon tea" as I called it. (It actually sort of does remind me of lemon tea.) I was pleasantly surprised that the lemon water doesn't taste too bad, considering that lemons are so sour.

I had been drinking the lemon water daily for 3-4 weeks before AF arrived this cycle. I didn't write down the exact date I started it, probably because I didn't think it would have this dramatic of an effect.

If anyone has a better idea of why my TEBB disappeared this cycle, feel free to enlighten me. I'm not holding tightly to the lemon water theory. ;) (I spared you from the pun. You're welcome.)

So the TEBB is gone and I had been on the bromocriptine for three weeks prior to ovulation time this cycle...do you know what that means?  If there isn't another issue (still low vitamin D?) or five that remain undiscovered, we might be able to count this as our first "effective" cycle*. After nearly five years of TTC, the concept of me having an effective cycle is completely foreign. The 2WW is going to get rough, especially if I get to the afternoon on P+16 like last cycle. (Thank you, bromocriptine, for lengthening my post-peak phase to the point where the mind games begin.) This cycle I won't be able to tell myself that there is no chance of pregnancy like last cycle (because prolactin was super high), so there is a possibility I could go crazy. ;)  But it's been a very long time since I've had any optimism about our chances of conceiving, and that feeling seems really hard to shake.  I probably should be a bit more excited than I am.


And the scoop on the bromocriptine...

Bromocriptine has definitely required time to get used to it. I knew beforehand that it has a reputation for its side effects; sometimes the side effects are bad enough to make patients switch to another medication that is easier to tolerate. (That other medicine isn't quite as "safe" to take if you're pregnant or TTC, hence starting with the safer but harsher med first. It's quite possible the nicer medicine is also safe, but a bit less is known about its effects on pregnancy.) The list of side effects on the information sheet from the pharmacy was super long...seemingly longer than most other meds I've been on. I just hoped I would be spared from nausea and vomiting. (I'll deal with them if a baby ever took up residence, but not before then.)

I took the first pill with a little fear—the first time I've been afraid to take a new medication. The side effects came rather quickly and wiped me out. I counted six different side effects on that first day, a couple of which were on the "uncommon side effects" part of the list. Lucky me. One of them was full body weakness; I could barely walk (only tiny, slow steps) and I couldn't even lift a half gallon of milk. It felt like I had the flu plus a sinus infection with some nausea on the side. Lovely, right? Thankfully I felt better the second day and the nausea was gone. On the third day I felt totally normal. I thought, "That was it? I can handle this medication!"

On the fourth day, I came *this close* to fainting during Sunday Mass. Yep, dizziness is on the list of side effects. It was warm in church and I was wearing a cardigan, but it wasn't that warm, DH claims. (In my teenage years, I fainted now and again during Mass if it was too warm, so I know the experience.) After nearly blacking out during the prayers of the faithful, I spent a while sitting with my head between my knees (still in our pew), taking slow, deep breaths in an attempt to keep oxygen flowing to my brain and trying to will myself to remain conscious. I recovered by the sign of peace, and the older woman behind me gave me a big smile of relief as I shook her hand. I swear the look in her eyes said, "Oooh, I bet this girl is pregnant." Do you know the look? (One of my Creighton clients nearly fainted once during Mass, and that's what the old ladies told her after Mass—that she must be pregnant. I knew for a fact that she was not.)

The following Sunday I made sure to wear short sleeves. I did start to feel a little dizzy again but no where near blacking out this time. Since then, I sometimes get dizzy if I stand too quickly. Thankfully, other than that, I have no remaining side effects.

Now that I know my body recognizes the bromocriptine, I hope it will be able to do its job and lower my prolactin. I think I'll find out my new prolactin level in a couple weeks.


*An effective cycle is one that looks normal (and presumes or knows ovulation occurred), has a good mucus cycle, has normal P+7 estrogen and progesterone levels, and has all known medical issues addressed (including appropriate management of stress).  There also should be more than one act of intercourse during the fertile time.  NaPro usually recommends TTC for 12-18 effective cycles.