Update again

Dr. SF did call me back yesterday--I was out all afternoon and evening and so couldn't update. Then this morning Blogger wouldn't let me post--grr.

As I predicted, he wants to go to a straight Follistim cycle. Since I'm continuing to get only one follicle on Clomid, even on a higher dose, and there's a good chance that on another Clomid cycle, I'll get the follicle on the wrong side again, he feels it's best to stimulate both ovaries more in the hopes of getting one good follicle on the right side. I'm totally on board with that, but I did tell him that my concern with injectibles is the risk of multiples (remember, even twins are a bad idea with my unicornuate uterus), and I made it clear that reduction is not an option for us. He said that the dose of Follistim he'd start me on (100 IU) is very low, so the likelihood of overstimming is also low. He also said that two follicles does not necessarily equal twins--in fact, "With two follicles you're still more likely not to get pregnant at all than you are to have twins." But he said it was totally up to me if I wanted to try another Clomid cycle. I said I was willing to try the Follistim and see what happens, and he said we can of course always cancel if there are too many follicles for my comfort level.

(Re: the low dose, thinking of Robbie's 37.5 IU of Gonal-F and Ornery starting on 75 IU Follistim (though eventually going up to 125), I wonder is that still not low enough? Anyone have thoughts?)

There is still a tiny chance that the egg from my left side could cross over and get picked up by the right tube. "Try to have intercourse this weekend," Dr. SF urged. Um, thanks. Will get right on that.

Dr. SF said my nurse would call me to schedule me for an injection class--she called, I kid you not, about 60 seconds after I got off the phone with Dr. SF. (Love my new clinic!) Class May 11--of course, it's from 10-11:30 am, a hideously inconvenient time given that I, you know, have a job, but whatever, I'll have to make it work.

Thalia asked if continuing with IUI is really the right thing to do, rather than just going straight to IVF to circumvent the whole tube issue. I keep wondering that myself, especially because with single-embryo transfer, we could bring the chance of multiples down to almost zero. But every doctor I've spoken to feels that we really haven't given sperm and egg a decent chance to get together on their own--remember, I still have not had one completed IUI cycle--and that given my age and that the real problem is still my irregular cycles, it's worth it to give IUI a chance. I do think about this a lot--all the doctors say that unicornuate uterus isn't what's keeping me from getting pregnant, but come on, if I keep on ovulating on the side where there's no tube, of course it has something to do with it.

But here's the other issue: I have basically unlimited insurance coverage for IUI and related costs--all I pay is a $20 copay for office visits, and a small copay for meds. I only have $10,000 in coverage for IVF--that barely covers one cycle, and since I'd definitely do single-embryo transfer, it's likely I'd have to do more than one cycle, or at least an FET or two--and meds for IVF are not covered. So as long as there's a chance that IUI could work, from a financial perspective it makes sense to keep going with it as long as possible.

I'm willing to trust my doctor and give it a go for a couple more cycles. It helps that my husband is pretty relaxed and optimistic about everything--when this cycle got canceled, his take was to focus on the good news that I did produce one perfect-looking follicle. He said it shows we're on the right path, and something will work eventually. I'm not sure I believe it myself, but I'll go with it for now.

Repeat performance

At this morning's wanding, we saw one beautiful, fat, perfect, 18 mm follicle...on the left side. Where I have no tube or uterine horn. Again. The largest follicle on the right side was only 10 mm.

Obviously there is no point in continuing with this cycle. The doctor (not mine, though I loved this guy--short and jolly, like a little fat elf in scrubs) said I should probably ovulate on my own within the next 48 hours. I'm to call Dr. SF early next week to discuss next steps. I suspect he will want to do a Follistim-only cycle to jack up both ovaries enough to hopefully get one follicle on the right. Fine by me as long as we take the necessary precautions against multiples.

I feel strangely neutral about this, my fourth cancellation in a row. Actually, to be honest, there's a tiny tinge of relief in there. My husband is going out of town on Sunday for about a week, so there was potential there for some complications re: timing of the IUI. He could have made a quick trip home for a day to provide a sample, but it would have been a major pain in the ass.

I did have a nice flaky chocolate croissant and a big latte to soothe myself afterward. I would have had a big drink except, well, first of all, 8:30 a.m.; also the damn metformin has really messed with my alcohol-consuming prowess. Anything more than a single glass of wine and I feel sick to my stomach. I may just have to push it tonight, though. I think I deserve a cocktail.

**UPDATE**
I totally heart Dr. SF. He called me at 11 am to discuss this morning's scan. Of course, I was on the other line and missed his call, and when I called back he was with a patient, and I'm still waiting for him to call me back again...but just the fact that he called, and so quickly, puts him head and shoulders above any doctor I've ever dealt with. Will update again as soon as I talk to him.

Ripping off the bandaid

In the spirit of desensitization therapy, today I went to lunch with my newly-pregnant coworker and then after work went to a movie with R., my newly-pregnant friend. And I survived! Not only that, but I feel much better. Thanks for all the kind words. Am feeling very proud of myself for bucking up and not letting the bitterness swallow me up.

Sunday was my last day of Clomid, which may or may not have something to do with the lightening of my mood today. Friday morning (CD12) I go in for the first wanding of this cycle, where the decision will be made whether or not to begin Follistim. Fingers crossed that there is something to see.

Another one down

This is not my week. A coworker of mine (not the fertile one, another one) just announced she's pregnant. Due in November. Naturally, she said "And we only tried once!" For those keeping score at home, that's 2 pregnancy announcements in 5 days, bringing to a grand total of 23 (yes, twenty-three) the number of friends, relatives, and coworkers of mine that have conceived and/or given birth since last August. Let's go for an even 25 by this August, shall we?

Which begs the question, why does this still upset me so much? You think I'd be used to it by now. But I still had to stiff-upper-lip it through the congratulatory conversation, and as soon as she left I shut my office door and welled up. I'm able to be unreservedly happy for fellow IFers, but let someone else announce they're pregnant and I'm a basket case.

I'm in a foul mood. I'm feeling very pessimistic about this cycle. And I'm having what I assume are side effects from the Clomid--acne, mood swings, and other hormonal delights. I'm signing off now before I become even more of a bummer.

Vignettes

1. Yesterday, I got an unexpected call from my clinic. It seems that when Dr. SF did my Pap smear he also did a culture for ureaplasma. The ureaplasma test came back positive. I'd never heard of this before--my old clinic certainly never tested me for it--but apparently an overgrowth of ureaplasma bacteria in the vagina is associated with early miscarriages. The nurse said it's fairly common for people to have it, and that newer research is starting to cast doubt on the miscarriage theory, but my clinic likes to be very conservative about these things and so they test for and treat it, just in case. I have to take antibiotics for five days, as does my husband--apparently, while it's not an STD, the bacteria can be passed back and forth between partners. Appetizing, no? Anyone else heard of this?

I just have to say that I have never been more grateful to have a private office, with a door that shuts. My assistant really doesn't need to hear about my vaginal bacteria.

2. Wednesday night I had dinner out with a bunch of girlfriends. One of my best friends, F., just attained one of the best benchmarks of success in her field (sorry to be so cryptic but what she does is related to what I do and I'm working hard at being anonymous here, what with the vaginal bacteria talk and all) and we and a bunch of her other friends (who I'm also less-close friends with) went out to celebrate. One of these other friends, R., announced that she's ten and a half weeks pregnant.

I was shocked by how much it hurt. When she said, "I'm pregnant!" it was like a full body blow. I really struggled to smile and say nice things. I thought I was moving past resenting every pregnant person around me--then again, I also thought everyone I knew who could get pregnant already had, and so I'd be safe for a while. I guess I forgot about R.

Out of all these women, only F. knows about our infertility struggles. But it was F. (a mom herself) who really got the pregnancy talk rolling, offering to lend her maternity clothes, discussing how soon one really began to "show" and when she started needing maternity wear, etc. The pregnancy talk went on so long I actually had to excuse myself and go to the bathroom, where I shocked myself again by bursting into tears. What is wrong with me?

(I didn't want to say anything to F., because it was "her night" and I don't want people to feel like they have to constantly tiptoe around me. But it still hurt.)

3. Thursday morning, when I got to work, Fetus Guy was camped out in front of my office building. Fetus Guy is a man who on most days can be seen stationed in front of various office buildings along the block, saying nothing but wearing a sandwich board with a giant picture of a fetus on it and the words CHOOSE LIFE. My building is in his regular rotation, though I hadn't seen him in a while. I think security can't do anything about him as long as he stays on the public sidewalk and doesn't harass anybody. Of course he has the right to express his beliefs in whatever form he chooses, but it's rather gruesome to be confronted with a three-foot-high fetus before you've had your morning coffee, you know?

I never make eye contact with him, but this morning he held out some of his literature to me. I shot him a smolderingly hostile look, like, I used to volunteer AT PLANNED PARENTHOOD, do not even TRY that shit with me, motherfucker.

That was it. I walked past Fetus Guy, went into my building, rode the elevator up and went to work. But the encounter really stuck with me. I kept thinking about it, especially in the context of having just burst into tears the night before over another woman's pregnancy, devastated that once again someone else had what I can't seem to reach. I debated whether or not to post about it, but then tonight, reading about the horrible runaround Julia has experienced, in the midst of her family's pain, I got angry, and I just, well, I guess I feel the need to say something.

I know that some wonder how infertile women can still be pro-choice. I can only say, how can I not be? Am I not choosing, with every fiber of my being, to pursue parenthood no matter what the cost? Can I deny others the right to choose the opposite?

And I ask, how can anyone who knows about the unspeakable grief that women like Julia (the other one) and Cecily and so many others have experienced--how can anyone who has read their stories wish for laws that would have made their decisions even more painful, that would have placed more obstacles in the way of their finding their way through the darkness?

This is what I believe. I'll fight for the rights of women in situations like Julia's and Julia's and Cecily's...and for the scared thirteen-year-old I saw shaking and puking in the recovery room after her abortion...and for my dear friend who, junior year, got sloppy about condom use with her long-time boyfriend and faced the consequences. To me, they all deserve to have a choice--a real choice, not one so fettered with criteria to meet and hoops to jump through and people to prove oneself to that the choice is meaningless. All of them.

I realize many people who read this blog may disagree with me. You can focus on the vaginal bacteria part of this post instead, if you prefer.

I'll try not to hold it against them

At my new clinic, when you're having blood drawn, they give you a little stuffed monkey to squeeze. I was slightly horrified by the cutesiness of it all, but slightly more horrified that as the needle slid home, I was smushing the monkey's little face in my clenched fist. Poor monkey.

CD3 bloodwork all OK. We are cleared for takeoff.

I'm such a dork

Reading my April horoscope on Astrology Zone just now (beginning of the month was crazy and I'm just now getting around to it), I came across the following:

"If you are attached and hope to conceive or adopt a baby, try at the most fertile new moon of the year for you, the one we have been talking about above, April 27, and the weeks that follow."

April 27 will be CD11. How dorky am I that, on reading that, I got a little tingle of hope?

(Side note: How exactly does one "try" to adopt? Props to Susan Miller for trying to be inclusive there, but surely there was a better way to word that sentence.)

The lowdown

A little more about my consult with Clinic C: I should tell you that I was already pretty much resolved that I would go with Clinic C unless the doctor turned out to be a raging asshole (and I'd been assured by the acquaintance who referred me to Clinic C, as well as the folks on IVF C0nnections, where I did my due diligence, that he was not). I liked Dr. She, but Clinic B's statistics are just not in the same league as Clinic C's (or, frankly, as Dr. S.'s).*

I'd been told the place was a well-oiled machine, and we definitely got that feeling the minute we walked in. Everything was very efficient, but my husband and I agreed later that we felt very at home and comfortable there. I was even joking around with the receptionist. We did have to wait about 25 minutes to see the doctor, but I've been so downtrodden by Dr. S. that anything less than an hour seems like heaven to me.

We met the doctor and went over my records. (Let's call him Dr. Silver Fox, since he is silver-haired, mustachioed, and sleek.) I went over the details of my three canceled cycles, and Dr. Silver Fox said, "So basically, you haven't really done anything yet." I blinked, then had to agree. Yet again, that depressing thought--seven months of treatment with nothing to show for it.

He wasn't that surprised that I didn't have a very good response to Clomid--"It's just not that good a drug," he said. The lining-thinning side effect that Clomid can sometimes have is a particular concern in my case, he said, because "with unicornuate uterus, you want a really nice thick lining." So initially, he said that while we could do more cycles on Clomid if we really wanted, he'd recommend going to injectibles, which he feels work much better. (Since the main issue so far seems to be getting me to ovulate, and my husband's sperm analysis looks good, he didn't think we needed to go to IVF yet--same analysis as Dr. She.)

We then headed for an exam room--my husband was reluctant to come along, but Dr. Silver Fox strongly encouraged it. They have a 3-D ultrasound machine there, and Dr. SF wanted to check out my uterus for himself. (He also threw in a Pap smear and cultures while he was down there.) It was weird but cool seeing my uterus--it really does look like a long tube, or a banana. Also, based on the appearance of my left ovary, I had definitely ovulated (about one week prior, by my reckoning), making it infinitesimally possible that I could be pregnant.

After looking at everything, we went back to Dr. SF's office and talked some more. He suggested doing a Clomid-Follistim combination. In this hybrid cycle, you start with Clomid (days 3-8, like usual), then add low-dose Follistim. As he explained it, this allows us to have the best of both worlds--a low number of follicles, like Clomid (highly desirable for me, since high-order multiples in particular are a very bad idea with my uterus), but with the extra stim factor of Follistim. And the Follistim also counteracts the lining-thinning effects of Clomid. Basically, Clomid does the work of selecting the follicles, and Follistim juices them up.

I always like a creative approach, so I was sold. (I think my poor husband was still traumatized by the dildocam--he wasn't saying much at this point.) We decided that, provided I'm not pregnant already (ha!), I'll go in for day 3 bloods, then start 150 mg of Clomid (days 3-8). We can start the Follistim anywhere from day 9 to day 12, so I'll go in for a wanding on day 12, and if not much is happening, I'll start 75iu Follistim daily, with monitoring every other day.

I left feeling pretty good about the doctor and the offices. And I talked to the insurance coordinator on the phone the next day and she was soooo nice--very key, because insurance discussions frequently reduce me to tears and mean billing/insurance people do not help. My husband also said that this was his favorite place so far: "It just felt more accommodating."

The one thing that bugged me a bit was that, when we were talking about risk of multiples, selective reduction, etc., I said, "We really don't want to have to do selective reduction," and Dr. SF sort of rushed over it, saying, "Oh, sure, no one wants to do selective reduction." I brought it up later (12:30 am) to my husband, who pointed out, reasonably, "Well, you didn't explain why we don't want to do selective reduction." I was worried that it meant Dr. SF wasn't really listening to me. But I've decided to go with the flow for now. My husband and I both liked him otherwise, and really liked the clinic, and I like that I felt like Dr. SF thought about what would really be the right protocol for me given all the different factors. At the end of the day, if I see three fat follicles on my right ovary on that ultrasound screen, I have the power to say, "No, I don't want to go ahead this cycle." And I will keep emphasizing this to Dr. SF and whichever other of his colleagues I see at my monitoring sessions.

I did ask about single embryo transfer, and he said that it drops the success rate to "only" 40 percent, versus 60 percent at their clinic with two embryos transferred.** I'll take that.

So now, we wait. I should get my period no later than Wednesday, based on OPK and temps. And then we're off.


*Even though I knew it was likely I wouldn't be doing IVF just yet, of course I combed the latest (2003) CDC statistics to compare. Of the three clinics I was comparing (including my first clinic, Heinous Clinic of Evil), Clinic C had by far the highest success rates in my age group, with the most singleton pregnancies and lowest average number of embryos transferred (important for me, since I will likely do single-embryo transfer to avoid taxing my freaky uterus with multiples). Their FET rates are also the best (again, important because even if I get more than one embryo out of IVF, I will only transfer one and keep the rest on ice).

**I double checked: In 2003, 63.6 percent of all transfers for under-35s at Clinic C resulted in take-home babies, with an average of 2.3 embryos transferred. That's even better than the super duper famous Clinic Amazing, also here in Big City (yes, you've definitely heard of it).

Quickly

Will post at length about this later (probably the weekend), but quick update: Clinic C consult went well. We are 99% sure we're going with them. We'll be trying an exciting Clomid plus Follistim combination for our next cycle. And my husband got to see my ovaries on US for the first time. Quote of the day: "Wait, he put that thing inside you?"

Livid

We had an appointment for a follow-up consultation with Dr. S. today. (To Clomid or not to Clomid, ditto injectibles, etc.) When I made the appointment, I spent a lot of time debating with the receptionist as to when would be the time of day least likely to involve a long wait. (I have had to wait as long as TWO HOURS--for a regularly scheduled appointment, not the morning monitoring free-for-all.) We settled on noon.

I'm having a very frantic week at work, and a very frantic day--not so frantic that I can't take 5 minutes to blog, of course, but there are lots of things happening for which I need to be here, physically at my desk to sign off on things etc., and I couldn't afford to be gone for two hours. So when 12:30, then 12:45 rolled around and we were still waiting, I was worried. I said to the receptionist, "Can you tell me how much longer it's going to be? I'm having a really busy day and I need to get back to the office." She said she'd check.

12:55. My husband said, "This is bullshit." We stood up, and I made eye contact with the receptionist. She said, "Oh, it's going to be another half an hour." I told her we were leaving and that I'd call to reschedule. We stalked out.

I am furious. And the worst part is, I'm not even surprised. I don't think I have EVER waited less than an hour for an appointment there, and usually it's closer to two. If the constant delays are because he's taking so much time with each patient, then they should schedule his appointments accordingly. But frankly, taken together with the debacle of last Thanksgiving, the chronic lateness, to me, is just indicative of the disregard my doctor has for patients as human beings with feelings and jobs and lives.

I've been unhappy at this clinic for so long, but this is the last straw. I am never going back there. (And I am putting it in writing, here, so if I get wishy-washy in a week or two you guys can kick my ass and remind me how much I hate him.)

But I'd better like Clinic C (consult on Monday), because it's looking more and more like that's where I'll end up.

Poke this

I've been thinking of trying acupuncture in conjunction with the treatment I'm already doing. We have a couple of friends who are studying acupuncture (literally; they are a couple and they are both studying it), and they have been raving about the acupuncturist they see. My husband is strongly in favor of my trying it--in fact, his vote for our next treatment step is to continue Clomid for a couple more rounds but add acupuncture. I'm pretty open-minded about complementary medicine, and I figured it couldn't hurt to at least look into it.

This weekend, I finally got the name of our friends' "amazing" acupuncturist, and checked out her website, all aglow with the happy anticipation of taking! positive! steps! on behalf of my fertility. Although this practictioner doesn't specialize in fertility, she does have a section of her website on infertility/pregnancy. It doesn't really talk about specific acupuncture techniques, but it does talk about other things you should and shouldn't do while pregnant or trying to get pregnant. And this is where my optimism turned into irritation. Here's her list of things that are "absolute contraindications during pregnancy, or if having difficulty getting pregnant":

• Ice in drinks
• Cold foods including salads
• Raw foods including salads
• Studying too much
• Overwork
• Over thinking
• Going to bed late at night
• Spices, especially chillies
• Garlic
• Onion
• News or stressful movies

Besides "studying too much," "ice in drinks," and maybe salads (not a fan of salad), this list pretty much describes my whole life. Not to knock Chinese medicine, but I really don't see how I could possibly eliminate garlic, onion, spices, and cold or raw foods from my diet. What's left? Plain rice? Bland porridge?

Also, don't the non-food parts of the list sound suspiciously like "Just relax"? She also adds that "Ideally the first and last trimester should be spent away from work." Oookaaay. I'm only the primary breadwinner in my household, but I'm sure I can just take off the whole first and last trimester and go on maternity leave. My boss would totally understand.

Should I try to look past this and give her a shot? Keep in mind that I don't have insurance coverage for complementary medicine, and she charges $100/pop. Should I look for someone else? I know Wessel really likes her OMD. Maybe I just need to find someone else. This woman also told my friend that if she undergoes acupuncture treatment, it "doesn't matter" how old she is when she tries to get pregnant. Doesn't that seem like overselling to you? I know acupuncture can help a whole lot (again, see Wessel's example), but isn't it a little snake-oil-ish to tell someone that it makes no difference at all if she's 32 or 42?

Miscellaneous

We had our consultation with an RE at Clinic B on Thursday. I'm still processing, and will post at greater length when I've had my Clinic C consultation and my followup with Dr. S--I need some comparisons to put it all into perspective. But to summarize: I liked her (yes, her!) well enough--she was very businesslike but friendly, and I found her pretty easy to talk to. The clinic seemed reasonably well run--we got there at 2:15 for a 2:30 appointment (they asked us to come early to fill out paperwork) and were seen at 2:40. Nurses seemed nice, and took a lot of time explaining to me what we'd need to do should we decide to cycle there. One stress--the clinic is located in an office building right across the street from mine, the same building as the radiology lab where I had my HSG and MRI. I happen to know a lot of people who work in that building (people in my industry). Every time I've gone in there, I've been worried I'd run into someone I know in the lobby. Worse yet, I discovered that the elevator opens directly into the waiting room of the clinic, where you can see the words "women's reproductive care" very large on the opposite wall. Can you imagine riding the elevator with a work acquaintance and stepping out into that? Not sure I could take doing that 2-3 times a week.

My big concern was treatment recommendations. I believe my question to her was something along the lines of, given that I only have one tube and that we want to avoid multiples at all costs, are we kidding ourselves if we continue trying IUI? Should we just go straight to IVF? But she said no, she'd actually recommend I try a few more cycles of Clomid IUIs. I haven't had any Clomid side effects, and despite the fact that this cycle produced a follicle on the wrong side, she said because I am still young (32), and because my lack of regular cycles is what's really at the root of my infertility, it's worth it to keep trying. She'd keep me on the metformin--even though it hasn't had any noticeable effect, I'm tolerating it pretty well now (after a gruesome first month or two, the last few months on it have been a piece of cake, relatively speaking), and there's very little downside to staying on it, and big potential upside (lower risk of first trimester miscarriage, better embryo quality if I go to IVF). After Clomid, she said that she'd recommend low-dose injectibles--so Dr. S. isn't crazy after all, I guess. "Low and slow," she said--while most women on gonadotropins do 9-10 days of stims, she says she'd put me on a very low dose (say, 75 iu of Gonal-F to start with) for a couple of weeks and monitor very carefully.

Basically, her philosophy is that if there is no urgent reason to go to IVF (age, no tubes at all, etc.), "if you can possibly get pregnant without it," as she put it, it's good to exhaust all other options first. She kept reiterating that I'm young, my FSH level indicates my egg quality is probably fine, and although the risks of IVF are small, they are real, so why not give the less aggressive options a shot? Again, I'm not really sure how I feel about that. On one level, it's reassuring to hear that I have plenty of time, biologically speaking. But I've already been trying for two years, I'm frustrated, I just want to kick things into gear already.

Will post more thoughts about this after the 10th, when I have my Clinic C consultation.

Thursday night I had dinner with a very good friend of mine who I hadn't talked to in several months--since before the whole Thanksgiving debacle. She is a DES daughter and has had associated health issues, and though she's not actively TTC herself, we've talked a lot about infertility and she's the one person I know in real life who understands what I'm going through. It was sooo good to see her. We had brightly colored cocktails and too much food and talked and talked and talked. I started laughing when she said, "And can I just say that EVERYONE I KNOW IS PREGNANT?!?"

What else...oh yes: The RE at Clinic B (let's call hr Dr. She, in honor of the singularity of her gender in a world of asshole male REs), after hearing that I had a 15 mm follicle on Monday, asked if I was using OPKs. I said no, we'd decided to scrap the cycle--I'd just been charting BBT so I'd have an idea when to expect my period. Dr. She said, "Well, it's a very slim chance, but it is theoretically possible. Everything is kind of crowded together in there, and your right tube could pick up the egg. It couldn't hurt to try." So I have been watering OPK sticks and checking CM for the past couple of days. I'd thought I'd missed it yesterday, when my BBT went up a little, but lo and behold, this morning my BBT went down again and the OPK showed a strong positive. I dutifully seduced my husband, much to his surprise and delight--I didn't tell him about the OPK, so he probably just thinks I was overcome with lust, a rare occurence these days.

I don't want to get my hopes up--the chances are so, so, so slim--but it's really hard.


**ETA: One thing that really bothered me about Dr. She: When she looked over my bloodwork from 1993 (the results that got me diagnosed with CAH), she said, "Well, looking at your 17-OHP levels, you weren't in range for CAH. I wouldn't have diagnosed you with it." She showed the results to another doctor there, who concurred. But here's the thing: That lab expressed results in ng/ml, so my number was 190. However, the scale more commonly used today is ng/dl, which translates to 19,000. Now, 190 ng/dl would be a normal number. 190 ng/ml, however, is way, way out of normal range. Every doctor whom I have ever shown this bloodwork to has figured that out right away, including Dr. S. Heck, I was able to figure that out in about one minute, and I have no medical training beyond a few college chemistry courses and a degree in Googleology. So what does it say about Dr. She (and her colleague, who is supposed to be one of the top REs in the city) that neither of them noticed that? And what does it say about me that I didn't point it out to her?