I am not an ignorant, uninformed fool after nearly two years on this journey, so
Why do you talk to me like one?
Following is an email exchange between my IUI nurse and I today.
(The ellipses are from sections I cut out of the emails for privacy reasons.)
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Good morning!
… I was wondering two things.
(1) Should I get a P4 test at 7dpo? My temps are not nearly as high as usual on my BBT chart, which kind of concerns me. Just wondering if it was only a weak O. Would the prometrium I’m on affect that result anyway though?
(2) For the beta test… do you send me orders for that or do I just call the clinic and ask for that blood to be drawn?
Thanks!
Josey
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Their response…
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Josey,
[Clinic] docs do not think BBT is a reliable way of determining ovulation and even if it usually works for you, taking a trigger shot is different than natural ovulation so it is reasonable to expect that your “chart” would be different.
I know the concept of a “weak ovulation” is all-over the IVF chat blogs and support websites but as with BBT is not a theory our doctors support.
No, you do not need a Progesterone level done yet. We will check it with your pregnancy test if the test is positive… I will send orders to you.
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First off, why is “chart” in parenthesis? FINE if you don’t use it as part of your protocol, but as a leading IF clinic, I would hope you at least were familiar with BBT and knew it wasn’t just some old wives tale! Why are you being so condescending?! UGH.
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[Nurse] –
To clarify, if you refer to my chart you will see that I did not end up taking a trigger shot, which is the reason I was slightly concerned about making sure I actually ovulated. My body seems to mess things up all over the place when it comes to reproduction and I have definitely lost some faith in it throughout this journey.
Whether [the clinic] supports BBT or not, there is science behind it, and my temps have reliably told me if/when I ovulated and how long/short my LP was for the past 2 years (and my BBT charts were the reason I knew to get help in the first place!), so it is definitely something that I look at – hence the reason I mentioned it.
Josey
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I tried to come across in a pleasant manner, but I was pissed!
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Josey,
I am sorry, I forgot that you surged on your own. Your LH was at 40.6 the day before the IUI, which is a very good number so I don’t think you need to worry about whether you ovulated. It is true that BBT works for a lot of patients but there are so many individual factors and variations in patients that it is not a good “clinical” tool and it definitely does not work for everyone. It is very possible that the “stim” drugs could have affected the way your chart looks. If you are not pregnant this month, we could do an ultrasound on the day of IUI next month – this would tell you for sure if you have ovulated or are close to it.
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Okay, so her final response was definitely better than the first, though it still kind of rubbed me the wrong way (though maybe more from residual annoyance after the first response than anything else?). Was that so hard to respond to me like I’m an intelligent human being who just had a couple of questions about a process (medicated IUIs) that is VERY NEW to me?
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Your response was perfect. She was clearly talking down to you. I think about 90% of their job is to make us feel a part of the process and to make us feel that we have at least some control over our bodies. She was doing neither in her e-mail. Give em' hell!
Good grief… what a jerk. I'm glad the second response was more understanding. There are two nurses (thankfully only two) at my clinic that are not the most helpful when I ask questions. Thankfully, I have Cathy as a nurse most of the time, and she is a.maz.ing.
My thoughts…First, the fact that you have a direct point of contact by email to your clinic is SUPER crazy! I didn't even have a direct line, let alone an email address to a nurse! That's so wild!Second, if your clinic is huge like mine was, they probably see lots of people that have been trying for a number of years or months without luck. Her first response probably wasn't meant to rub you the wrong way, but with everyone that comes through, she probably has to have a bit of tone with her emails so people aren't asking her non-sense questions all day. (I'm not saying you were saying anything wild, I'm just saying that some get one answer and then they think their clear for 100 more, you know?)Also, you have to remember that if your clinic is anything like mine. You're talking to the nurse. While she's reading your chart, she's not you and she's not your dr. I had to remind my nurses of things all the time and while it was a pain in the butt (because it's their job) I think you have every right to ask and ask away! Don't stand back and let your cycles pass you by. Stay on top of it and bust their chops when they don't tell you something that you need to know! Seriously.Good luck!
I am so sorry you are frustrated, Josy! Like you said, her second response was better, but definitely does not make up for the first. I do not have the email option with my clinic, but we do have access to talking to a nurse when needed. So far, I have been satisfied when asking questions or discussing issues with them. I know clinics are very different and have their own approach, but you are definitely not off base with your questions. I am actually shocked that you did not receive this info before/after the IUI. I hope you receive the answers you need in the future…Including a positive HPT 🙂
Oops…I meant Josey, not Josy…Sorry about that!
So sorry! I hate when the doctors or nurses are patronizing. I can say, though, that I have encountered the same thing – I used charting and OPKs reliably to detect ovulation and got to know my body quite well while we were TTC without medical assistance. Even during medicated, fully monitored IUI cycles, I still got lots of useful info from charting and OPKs (most often that I had started surging on my own before trigger was scheduled or that AF was about to come). However, the nurses never wanted to hear any of it, even when it would affect the timing of my IUI. Anyhow, just wanted to let you know that unfortunately what you are experiencing seems pretty typical (though really sucky nonetheless).
Honestly, I would pitch whatever fit necessary to get your 7dpo progesterone. (Even more critical if you are not on progesterone supplements now…) My clinic told me a zillion times that my progesterone would be fine on follistim, and it WASN'T. I guess there are conflicting opinions on whether progesterone support in the luteal phase is going to make any difference, but I would totally want my levels checked anyway, after what happened to me in December 2009 (if you want to go back and read my posts).
I hate when people treat you like you are a moron. I am glad that you wrote her back and told her whats up!
Yeah – we nurses get sooo used to talking to an uneducated/uninformed populations, we forget we don't have to "dumb it down" for everyone! :-/ I am a pretty big advocate for dpo7 profesterone checks, an infertile AND as a nurse. If the clinic won't order one, your PCP or local gyn might. Also, you can always act all "psycho patient" and just bug the fool out of them… the clinic will order the level just so they don't have to deal with you anymore.:) Good luck!
Yeah I agree that would piss me off too. My fingers are crossed for you sweetness! Just a few more days until you know for sure.
It is a little surprising that they would dismiss your charts just like that – I think you responded well though. I think I missed something; why didn't you take the trigger shot? You o'd on your own? How are you feeling?
I'm annoyed by her first response but agree that the second one is much more personal and sensitive and HELPFUL.FYI, at my first RE clinic, they didn't do 7DPO P4 testing and they didn't do Betas unless you got a positive HPT. So annoying. At my second RE clinic, they did 7DPO testing and a Beta, no matter what. (Btw, I never surged on my own like you did in this cycle, in fact my LH was only present in trace amounts throughout IF treatments….I think we all could've used the P4 info.) Personally, I prefer getting the extra info (it suits my Type A personality!!), but my pt is that it's not totally weird for a clinic to NOT order those blood draws. I've got everything crossed for you!!!!!!! xoxo
As I found out from my last post, more often than not IFers don't BBT chart. Therefore, the nurse is probably not used to dealing with someone who does. I assume a woman who has yet another tool to use to identify changes in her own body should have that much more say in her own treatment, but obviously this nurse may simply not care. At least you have a direct line of contact though. I say bug the heck out of her until she caves and gives you what you want.
Woohoo for surging on your own!
Dear mean nurse,Get off you high RE horse.Thanks so friggin much,SarahIm sorry you had to deal with that! She was definitely talking down to you. You did great with your response though! Ugh. This reminds me of a jerk nurse I had awhile back. I had an emotional breakdown in the exam room, complete with tears. She just looked at me funny and said "Why are you crying?" But in a mean and snotty way! She is still my least fav there 🙂
I didn't like all her quotes. Very condescending. You should have written back:Thank you for all your "expert" advice.
My IVF nurse was the best support from the RE's office through the whole process. The receptionists are a whole different story, but I wasn't e-mailing them. Anyways, this kind of response would have stressed me out and who needs that on this journey? Nurses have a tough job of making each person feel like they are priority at that moment, but the best ones do it all the time!
boo I just wrote a long comment and blogger ate it.LOL at AP's comment! Love it!!I was going to agree with A and Amy about getting a 7dpo p4… but then I was thinking, you have progesterone, you could just take it, then you don't have to worry about what the level is?I think I'd give the nurse the benefit of the doubt on her first email – it does sound a bit snippy, but I'm willing to bet she wrote it without too much thought and was just toeing the party line (what she said is quite standard coming from an RE's office – they do not believe in BBT, and have lots of faith in their medicines – never mind that the package insert from Ovidrel says that it induces ovulation in 90% of cases)I 100% believe you O'ed, though, based on your LH surge. I do think you should probably take the progesterone given that your natural LPs and progesterone levels have been suspect – if they won't test it, I think you should take it to be on the safe side. xox
Hey Josey…I must admit I dont know a lot about your corner of infertility treatment but I do know that your nurse should have been more on the ball and given you more credit. I asked my nurse how many patients she has at any given time… 70!! Not to make excuses for them. It was good you reminded her that there is a peson with a history and brains behind that " chart".
It seems like many medical people often take a similar tone in emails. I've emailed my various doctors many times through the years, and even the nicest ones often respond very briefly and unsatisfactorily (and sometimes condescendingly). I'm actually impressed with at least the length of the nurse's response! I guess maybe it's hard as a medical person not to judge your patients and their level of medical knowledge too quickly–or to want to put them in their place if they question something.I do think you shouldn't worry about a weak ovulation, though I worried about that many times after reading the Chinese medicine perspective on charts. But she's right that the meds are probably throwing things off from your norm.
Hey Josey, just read your comment on my blog. Yes, I would still get your level checked, even on supplements. I know from experience, it will save you lots of second guessing in the long wrong – "was my level not high enough, what if I had it checked, and we could have bumped up my dose." I am all about eliminating as much stress from the situation as possible. There is NO reason for any or your docs NOT to order this simple test – it financially benefits them!:)
Seriously, why is chart in quotes? Whether they trust BBTs or not, it's still a chart. ridiculous!Try not to take her emails or attitude personally at all – I'm sure it has more to do with a million other women who have asked and she's just tired of answering. You know your body and how it reacts and you're paying for their expertise – you deserve a bit of respect (you treated her w respect!) and an answer. Glad the second email was better.
I looked at your chart and noticed that your temps seem less erratic this luteal phase compared to others. That could be a good thing?"chart" Yes, the gesture of putting that into quotes implies a tone of talking down to. It also offends me. I do think the second response was much better, she clearly thought about and re-worded how she was speaking to you. Sorry for the frustration. It can be difficult to put all of our trust in doctors and nurses when so much is invested in each cycle!
oops! I did not mean to comment as art 395!
Wench. Clearly someone at the point of IUI has experienced some heart break, loss, and frustration. Being supportive and empathetic should be a given. Very rude. BTW – I may have name dropped during a feature on my blog. 🙂 I thought I'd drop by and let you know. TGIF!http://himplusme.blogspot.com/2011/04/featuring-me.html
Ahhhhh I had dealt with a similar issue with my IVF nurse — and luckily I think she got the boot — and I got a new nurse. And I have been to an OB/GYN office where 1/2 the docs 'believe' in BBTing and 1/2 docs say it's crap. Well the first time I BBT'd I got pregnant based on charting. After that my charting was all over the place hence the determination that I wasn't ovulating. Thank you – free diagnosis. Yet it still took the docs almost a year to officially diagnose it. Ugh that would make me pissy too… Blog: http://www.becauseofmatch.com
Hey Josey,Sorry I've been MIA and didn't respond to this right away. I'm sorry you had to deal with insensitive side of medicine. I remember in one of my last conversations with Dr.B I apologized for asking so many questions and told him I didn't mean to imply anything negative about him or the clinic. He paused and said to the effect of "It is true, sometimes we get burned out on having to defend ourselves to patients who think that by googeling a little bit they know more than a staff of people who have gotten specialized education" All that to say, that while it is frustrating to deal with people who think they are demi gods just because they have a medical education, I also have been on the side as a vet tech trying to explain to an owner why vaccines need to be boostered at a particular time etc. Sometimes you want some recognition that you just MAY know what you're talking about. Please don't think I'm saying you shouldn't feel upset, but just trying to balance it with another point of view.
FYI: your two week wait is KILLING me!:) Sending lots of prayers your way these days:)