Thursday, February 2, 2012

Mocking Me

Got home from my day at work, and was slurping golden borscht made by Mr. A, when he asked me whether I could feel the injections. Well. Maybe there are a few signs.

If you knew Mr. A, you would know that from asking "how does it feel" to talking about math is a very short distance. In fact, as far as he is concerned, everything is a short distance to math.

I messed up my last equation. And now I am in the vice grips of WORRY.

Let's revisit the equation, but this time with increased accuracy, thanks to Mr. A who knows me well enough now to always check my math.

The dele.strogen has 20mg/ml. The dose is 0.2ml per injection, or every 3 days (and not 20ml per injections - man, that would require an IV, almost). 

2mgs estra.ce t.i.d., PO + 2mgs est.race, PV + oes.clim patch 5mg every three days < 20cc of Dele.strogen IM, every three days.

The reduced equation would be:

6mgs PO + 2mgs PV + 5mgs every 3 days < 4mgs every 3 days

To reduce it to daily dosage would be:

9.67mgs < 1.33mgs

Wait.

that equation doesn't work.

I envisage one of two things going on:

Hypothesis 1
There is one heck of a difference between injectable estrogen (estradiol valerate), and estrogen in pill form (estradiol-17B) plus estradiol transdermal.

Hypothesis 2
the doctor omitted to read my file, which clearly pointed to the massive quantities of estrogen needed to produce a somewhat acceptable lining in this particular patient.  

As far as hypothesis number 1 goes, well it's entirely possible that estrogen that has to be handled by your liver and estrogen that has to come through the pores of your skin and that of the wall of your vagina can be much less efficient than estrogen that comes directly through the muscle, and into the bloodstream. So, hypothesis number 1 is viable, even though I still have some doubts.

Hypothesis number 2 makes me nervous. Hence the vice grips of WORRY. What if this mock cycle is completely awash because the estrogen is entirely insufficient. And we have to do a second mock. And a third mock. (notice the catastrophizing going on here, ladies). Clearly, I will be made a mockery.

If any of you have any insight, please share. I am clearly lost here. I am making puns for goodness sake.

11 comments:

  1. I believe your hypothesis 1 is correct. I have taken HRT both orally and transdermal/patch and I know the oral is a much higher seeming dose because of the liver effect. It would definitely make sense that directly into the bloodstream would not need to be as high of a dose. I hope this mock isn't a wash for you and that the injectables prove to do the trick and best outcome.

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  2. I am no help. I admit it. I will pour you a cup of tea and listen for as long as you worry. My chair is comfy, so take the time you need. Gah. Sorry that this throwing you for acloop.

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  3. I am also no help due to the fact that I am a mathematical idiot. However, as regards your hypotheses above #1 rings true to me. Truly. Given the absorption rate of pretty much any medication, an injection will always be the more effective delivery. My guess is that anything given through the skin would have to be many many times that dose to have the same effect.

    Sorry to hear of this worry. Let this be IT on the mocking front.

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  4. I'm super confused. The only thing I understood was that the injectable dose of estrogen prescribed is 4 mg (not 1.33 mg) administered in a dose of 0.2 ml once every 3 days.

    I'm unclear as to what this (2mgs estra.ce t.i.d., PO + 2mgs est.race, PV + oes.clim patch 5mg every three days) means. I'm assuming they are all forms of estrogen and you have a total of 9 mg administered in various forms, in a period of 3 days.

    Trying to calculate which form will deliver a greater amount of estrogen into your system (an injected dose of 4 mg vs the alternative of 9 mg) is impossible to determine- too many variables IMO.

    What is what your doctor is prescribing?

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  5. I love math. And I love that you're mathing this out. I unlove that it's making you worry. And I love you. Not helpful on the whole in any way, but I do have a grey kitty nestled between my calves (legs, not little cows) (although that would be pretty cute) who doesn't seem concerned about any of it. And he's pretty smart about this--and most--things. Hopehopehoping that these medical people (and cats) know what they're doing. That would be refreshing. And no mocking my Gussie. xoxo

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  6. You are getting a lot of estrogen I think it's totally reasonable to call the doctor or their nurse and reviewing the meds. That part of their job.

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  7. Hi,
    First, let me start by saying that I'm making a reel effort this morning to write in english so every one can understand my answer (not that I think that I'm that interesting, but more out of respect for your readers) - even if my brain thinks that english is comparable to chinese these days. This could probably be explained by the fact that it's friday (thank g*d) and also because of all the estrogen I'm actually taking. So please be indulgent with me, all my mistakes and weird phrasing...
    As a nurse, I can tell you that hypothesis 1 is absolutly right. The injection route is more effective than the oral or transdermic route. I have another example for you: when I had my first IVF, I had to take progesteron via injection (i/m). When it's was time for my 2nd IVF, my clinic changed there protocole and I had to take progesteron p/v. I don't remerber the exact numbers, but the dose p/v was about ten times higher then the dose i/m. So, to my humble opinion, it's quite normal that the dose you're actually taking in injection is quite lower that the dose you used to take po, pv and transdermic.
    But like others said, a call to your doctor could be a good idea if you're really worried.
    Bon courage pour la suite! Féelie.

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  8. I hope you've called for reassurance by now! Don't forget that you're totally entitled to have questions and concerns. After all, you have to shell out maaaaaad cash for this, rather than them doing it as a generous service!

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  9. My, my. I vote for a call to the DR. and put some trust in hypothesis 1. Besides it being endorsed by nurse Sans sigogne, from my (and now my friend's) unfortunate battle with estrogen and other hormones, HOW you take the dose can make a huge difference in how much circulates in your blood stream. Patches never worked for me, I ended up taking 4 est.rgen pills in the am and another 4 in the PM to get the required #s. My friend, however, didn't respond well enough to 4 pills in the am/pm. She ended up take one (OF THE SAME PILLS) PV. Yes, up there. And the pill was blue. And she said that she had a very "colorful" experience. The one oral pill taken PV more than quadrupled her circulating estrogen levels compared to orally taking 4pills in the am and pm. Route makes a difference. I'm sending peaceful thoughts your way!

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  10. I think how you take the dose makes a difference too..I can't come up with any examples but I'm hoping by now you've made the Dr's answer this one for you and put your mind at ease.

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  11. Complete math idiot here so I cant shed any extreme light on anything. But there are some very wise commenters before me that have made me feel less stressed on you behalf, so I hope they've had the same effect on you.
    I hope you get formal reassurance from your clinic (call them, please!) soon. And let me just say, I'm tentatively excited and hopeful for you as you head towards your cycle. Wanting this so bad for you.

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