Posting up a storm

Since I'm doing the research and it's on my mind, I though I'd post a very interesting article on the so-called Wil.son's Syndr.ome.  http://www.quackwatch.com/04ConsumerEducation/News/wilson.html

To be fair, the literature that Dr. Sti.gen sent over, written by PPVI did say that this condition was not accepted by the American medical community and the American Thyro.id Association has denounced this claimed affliction.

Oh, forgot to mention

Dr. Stig.en said she does not suspect PCOS without laparoscopy confirming it.  She asked me if I had coarse black hair growing anywhere....  Thankfully, no.  I told her I didn't suspect PCOS either.  I have no symptoms.

This may be just a knee-jerk reaction but I'm (temporarily) seriously considering quitting Creighton.  I totally applaud and feel great that a number of the infertile Catholic ladies chart for two to three months and they've got their diagnosis.  I've been diligently charting for two and a half years and all the predictions about my hormone levels taken from the charts were not confirmed with hard evidence, i.e. blood tests.

Being undiagnosed sucks.        

That can't be good

What I expected to happen, didn't happen.  Here's the straightforward hormone profile results analysis performed by Dr. St.igen:

1. My peak estradiol value is "a little on the high side."  If it were low, she'd prescribe Clomid or Femara but it's not low, so she's not prescribing it.
2. My post-peak estradiol is "a little high."  She'd like me to experiment with a high soluble fiber diet which she's had some success with other patients in bringing those levels down.
3. Post-peak progesterone is normal.
4. Androgens are normal.
5. Prolactin is normal.
6. The FSH:LH ratio of peak +7 is 1.6.  She said it should be around 1.1.
7. The thyroid panel was normal with the exception of the T3:Reverse T3 ratio at 4.1.  She said that's high. So, I "probably have Wil.son's Syndrome" or something to that effect.

When she looked at my charts last week, she had predicted low estrogen and low progesterone.  Looks like those predictions didn't pan out.  I'm upset that I'm going back to doing nothing for several more months.  I could schedule the surgery for September but I don't want to make that decision today since I'm clearly upset by the news I was given this morning.

In terms of the thyroid issue, I'm tending to not believe this condition exists.  I didn't ask her how this condition ties to infertility but she didn't offer up anything like that.  She didn't say, "Well, if you do this treatment, you'll get pregnant."  I know there's more testing to be done, but some tie-in to what I'm seeing her for might have been nice.

In terms of the high post-peak estrogen, I have been very diligent about a high soluble and insoluble fiber diet for the last five years.  Not eating enough grains, fruits, and vegetables makes me feel ill and gross.  In our house, 95% of our meals are made with whole foods, fresh and varied produce and plenty of berries and seasonal fruit.  My theory on doctors believing that the majority of their patients are ill-nourished is that they globalize that belief on all their patients; inner city patients, indigents, upper-middle class women who went to college.  The NaPro doctor I saw back in March or so wanted to test me for essential vitamin levels.  I told him my internist does this every couple of years and it's always been fine.  I knew why I was vitamin D deficient because I cover up head to toe in the sun.  I'm never exposed to the sun.  So, it didn't take an MD to figure out what that was all about.

Do I sound angry, defensive???  I'm going to take some time to simmer down and reassess my options.  This infertility thing is really starting to aggravate me.

Physicians & Infertility

I think Dr. D's office dropped me.  I did a lot of dating in my twenties and I know that if you haven't heard from somebody in a week, it means they've dropped you.  I didn't think about my blood test results while I was getting the blood draws (it was hard enough to navigate the hospital staff through the process) until one of the staff told me last Tuesday that the results should be getting to the doctor "about now."

After the draws were complete last Thursday, I confirmed with the hospital that they had the right fax number and they were in fact, faxing the results to the ordering physician.  The hospital told me they faxed the results three times to the doctor.  So, on Thursday I called Dr. D's office and tried to speak to Eva, the one who told me how to get the tests done and gave me the standing order.  Eva didn't call me back on Thursday, so I tried on Friday and was told she was busy and hadn't been able to go through the stacks of faxes but she will get back to me.

Eva also asked, "How are you charting with?  Have you met with Karen?  Because Karen graphs the results for you and gives it to the doctor."  I said, "I'm not charting with anyone.  I do it myself.  I've been charting for 2 and a half years.  I learned it from my parish during my marriage prep.  But, I guess the question here is, do you have the results?"  "No, not yet."

I tried to be patient so I waited until Tuesday of this week to call and see if they received the fax.  Again, I was told, "no."  So, I went to the hospital myself and got the records likety split.  No problems.  I scanned them and emailed them to the NaPro surgeon I saw last week.  Her staff has been super responsive and I just learned I have a phone consult scheduled tomorrow morning.  Talk about efficient.

I was telling my husband Tuesday at lunch how frustrating Dr. D's staff is so he suggested I talk to Dr. D myself.  Great idea.

Dr. D is very good about calling back the same day, bless his heart.  He called back within 1 1/2 hours.  I recounted my experiences with Eva and how I didn't understand why I had to make another appointment with Karen to chart since I already chart and have my charts and gave him my charts last month.  He wasn't cooperating with me.  Dr. D told me, "How do you know how to chart?  Are you using the Creighton Model?  How do you know what the peak day is?"

Now, I was confused by the last question at first.  Does he want the definition of "peak day?"  Cause I can rattle that off, no problemo.  But, then I quickly became insulted, thinking, "Don't you remember me?  I gave you all my charts.  We talked at length about my charts.  Am I a retard?  Do I know what the peak day is?"

Dr. D went on saying, "Without the graph, those test results mean nothing to me.  And I suspect it will mean nothing to the NaPro surgeon as well without the graph."  I was very surprised by that statement.  I mean, I know he's not an endocrinologist but the lab gives you a range and even I noticed that going from 329 of estrogen to 39 in two days, pre-peak doesn't look so good.  But I do understand given that I've done plenty of business plans that yes, graphs sure tell a good story.

Instead of saying all those things, I acquiesced and said, "Maybe I should talk with Karen?  Can she call me?"  "Yes, I'll see her this afternoon and give her your number."  "Great. Thanks."

That was Tuesday.  Today is Thursday.  I haven't received a call from Karen.

So, I moved on.  I went ahead and graphed those stinkin' numbers, myself.  And you know how I did it????  With Excel.  It was fairly easy but the double y-axes did throw me for a loop temporarily until I googled it.  So, I emailed the graph to the NaPro surgeon and they acknowledged receipt within two hours.  Hello, Eva?

Terry, the NaPro surgeon's office manager never asked me who I charted with.  She never said that the doctor couldn't talk to me without an approved graph.  I'm thinking the call tomorrow will go smoothly and I should probably pray about that along with prayers for my super prayer buddy.  Hang in there!

Tomorrow is also the day for the pelvic u/s.  Busy infertility day.

UPDATE: I decided to reschedule the ultrasound until next week.  I want to talk to Dr. St.igen first.  And I did hear from Eva!  Saints be praised!  She said the hospital STILL had not faxed the test results and I should call and "yell at them."  Direct quote.  "Actually, I have the results and I can email them to you."  And so I did along with my own chart that I created.  Eva said I'm a high priority to her.  I told her I appreciate that because I'm a high priority to me. :)

Hormone Profile Results

When I started reading Catholic-Women-Infertile blogs, um, about five months ago, I was bored senseless by hormone level reporting.  I didn't understand what the numbers meant, and it seemed so laborious to get a blood draw so often, I swore to myself I'd never be that woman.  And I was sensitive to calling myself infertile after five months of trying without success in a group of people who have tried on average for three years without success.

So, I saw the light and taken the time to understand the numbers and now that the test results are back (I retrieved them myself from the lab because Dr. D's staff was not making it a priority to obtain them), I'm thinking that my estradiol levels mid-cycle are the problem (baring any physical obstructions/problems.)  My highest estradiol at CD 13 was 329 pg/mL.  CD 15 estradiol dropped dramatically to 39 pg/mL.  All the pretty graphs on the PPVI website, random websites, and my college physiology book all have a peak estrogen level then a gradual down slope, not a dead drop.  I'll spare you the details but all the progesterone and sundry hormones (LH, FSH, T3, etc.) were normal.

I'm voraciously reading the physiology textbook to get to the deeper meaning of a drop in estrogen but I haven't found a plausible theory quite yet.  I suspect estrogen doesn't hang around my system long enough to produce enough CM.  And perhaps my estrogen levels aren't around long enough to produce LH.  Sometimes, my ovulation predictor kits have all come out negative for LH so there's a clue.  But this hasn't happened all the time.

I've sent the results off to the NaPro surgeon and trying to schedule a phone consult to get her thoughts.  Is an HCG trigger in my future?

Nine

Starting my period on my birthday was one heck of a gift.  My husband said he was sorry this keeps happening (which is very sweet of him to say.)  He also made me feel better by lowering my expectations, explaining that I shouldn't expect to get pregnant until we know what the "problem" is.

Appt with NaPro surgeon: RECAP

Yesterday was my last blood draw!  Yippee!  And the hubby and I went to see the sout.hern Cali.for.nia version of Dr. Hil.g.ers.

Background:  This appointment was a referral from the delightful Dr. D.  The plan was to do the full hormone panel (done), a pelvic ultrasound, hysterosonogram, selective HSG, laparoscopy, and follicular ultrasound series.  He also told me to take 500mg of Vitamin D every day (doing), and Mucinex (did for one cycle but it thinned the mucus out so much I did not want to keep taking it).

The appointment yesterday was just a consult to talk about the surgical options laid before me and to confirm what the surgeon thought about my charts and other medical records.

The Game:  I had all my records including the charts already copied and paper clipped.  The nurse asked some cursory questions like how long are your cycles, average days of blood, how many times have you been pregnant?  I could have just said "zero" but I was sensitive to this question so I inflated the answer, "I've never gotten pregnant, ever."  In response to the cycle questions, I handed her my cycle analysis which you can see on the blog.  I posted it a few days ago.  The the nurse took all my records and said the doctor would review them right now.

By the time the doctor did come in, she'd already looked at the charts and figured out in her mind what the possible issues were.  She spent a good 45 minutes talking with us in the examination room but it would have been more appropriate in an office.

From looking at the charts, she said I had diminished mucus and my cycles were irregular (in the last two years, I've had a 23 day cycle and several cycles later, a 33 day cycle), and I had a problem with tail end brown bleeding.  She then laid out a surgical plan: hysteroscopy, endometrial cultures with a biopsy, selective HSG, and a laparoscopy.  This would all be done at once under general anesthesia.

What I Discussed with the Doctor:  At first, I was really into the idea of exploratory surgery.  However, after reading this post and the comments it generated on Blondie's site, I was not supportive of the endometrial culture idea.  I haven't seen anything that would indicate this condition would cause infertility.  And I'm still not convinced the TEBB is that big of a deal.  And I told the doctor as such.  She said she'd be willing to tailor the surgery to what I wanted to do.  That made me feel better.

For the diminished mucus cycles, she suggested I start taking FertileCM.  And I should give the Mucinex one more try.

On the topic of my "irregular" cycles, she said that I will likely show low estrogen and low progesterone.  I'm very eager to see the results of the now complete blood tests.  While the NaPro booklet talks a lot about variable luteal phases being a problem, it doesn't say much about possible indications of the variability of entire cycles.  But, I'm emotional enough to think maybe my hormones are out of whack.  So, Dr. D and the surgeon will look at that and if I need progesterone supplements, she'll prescribe it.

I asked about the redundancy of doing a hysterosonogram and then a hysteroscopy.  She said it doesn't make sense to do the sonogram so I'm just going ahead with the pelvic ultrasound.

I did tell her that I have no physical symptoms of endometriosis, no pelvic pain anytime, anywhere.  Nor have I ever had irregular bleeding suggesting to me no fibroids.  These conditions don't run in my family.  Also, I've had regular S.T..D testing for fifteen years (I was obsessed) and I've never tested positive for anything (with the sad exception of H..P...V) so that ruled out any pelvic scarring for me.

The surgeon said she's booked out for surgery until September which seemed fine to me.  Then my husband piped up and said, "I think we should wait until we get the blood results back before we schedule surgery."  I kind of protested but then we all decided hubby and I should talk it over and call the office back when I wanted to schedule the surgery.  And then we went on our merry way.

Post-Game Analysis:  I'm very excited to get the blood results back because I'm tending to believe hormones are my issue.  I don't want to commit myself to an expensive procedure right now (in the next six months) that might be completely unnecessary.  And I want to do the ultrasound series before invasive surgery is done.

I like the surgeon, don't get my wrong and I think she spent lots of time listening to my concerns and working it out.  However, since she is the So..Cal version of Dr. H, she presented the procedures as, "this is what we do at NaPro."  And not, what is the most likely cause of your infertility, if I'm infertile at all?  I'm cognizant to the fact that I'm more educated on my condition that the majority of the population.  This issue is very important to me and I'm going to find out all I can.  Doctors might not be prepared for that.  I want to do what's smart, cost-effective, and is going to help keep/boost my serenity.  Lord knows that's what I need the most.          

Interested in making your husband happy?

Last year, I printed a series of very simple salad recipes from the NY Times.  I never made one but this summer, I recalled it and spent ten minutes racking my brain before figuring it out I could just print it again.  Here it is for you: http://www.nytimes.com/2009/07/22/dining/22mlist.html

101 Simple Salads for Summer!  I got the print out Friday and by Sunday night I'd made five of the salads on the list.  There's some truly incredible pairings and combinations; tomato and strawberries, add some basil and a touch of olive oil.  Husband couldn't believe I was branching out with my cooking and he was happy.  I guarantee these salads will make your hubby happy, too.  If you try any, drop me a comment!  I'd love to hear what you think.

Because I couldn't figure out a way to format a table in blo.gspot, I just grabbed the image from my excel spreadsheet.  Am I not awesome? ;)  My luteal phases have only been four days apart from cycle to cycle, once.  Other than that, I'm coasting along at 0, 1, 2, and 3.  Cool.  The light blue highlighting are the months we used white and green baby days.  I love how my body says, "What did you do?  I don't care.  You'll get your period on schedule."

I've read that some ladies quit charting after a certain period of time of infertility.  I've thought about doing that, too.  And it makes a lot of sense.  Why figure out the days of fertility if you're infertile?  I'm seeing my third NaPro physician this week and I'll have her look at the charts.  I had to point out to the first two, my so-called limited mucus cycles.  They thought the chart looked pretty darn normal.  Am I obsessed?  Yes!  I can't quit charting.  The method is seared into my brain.  I can't ever go back to crumpled paper and dab.

My mother of all people suggested I start charting my temperature.  Seems like a lot of trouble to me and why did I learn Creighton for gosh's sakes?  I'm reluctantly considering septo-thermal for the next cycle.  Or maybe try number 9 is the lucky one.  My prayer buddy wasn't asked to pray for pregnancy but she might have thrown that in?!? :)

Blood draw recap

I only have three blood draws left although the one on Sunday tests the mother load including luteinizing hormone.  Pre-peak tested only estradiol with the exception of Day 5 which was only FSH.  And now, post peak it's testing estradiol and progesterone.  Not that I question the wisdom of PPVI but why test LH after ovulation?  Given the spike right before ovulation, what does getting LH levels on one day post peak going to actually tell me?  If anybody had the full hormone series, can you shed some light on this for me?  Pretty please!

The registration and blood draw ladies both asked me this morning if I'm getting tired of being poked with needles.  I told them that was the easy part.  It's the registration that sucks the life out of me.  What a waste of my time.  My husband again suggested I bypass registration.  He's never come with me so what does he care?  I look at it as being almost finished and I can get through three more.  I just won't do this ever again.  One shot at this, only.

I've got an appointment with the "local" NaPro surgeon next Thursday.  It's just a consult before we talk about scheduling the selective HSG and laparoscopy.  

Feels just like it should

No, that's not me.  [But, doesn't she look good on my background?!?] Just a chick on the int.er.net.  I promised my husband that I'd try to grow my hair long, this time.  I typically chicken out because I get bored, frustrated and get a fresh chop.  I've been doing that for the last sixteen years.  I always have a new color; natural, blonde, red, brown, nearly purple one time.  And a new cut; pixie, layered bob, shoulder length bob, chin length bob.

I got a freshen-up trim last week.  My stylist did the flat iron on my hair, it was so shiny, so swingy.  I loved it.  I told her that I would just scrunch and blow dry without a brush because I couldn't master the flat iron.  She said it was so easy and I said, "try it with one hand."  But, I went home and tried the flat iron the next day and voila!  I did it.  And my hair was shiny and swingy.  Well, I've flat ironed it the last five days and now I'm bored and I've lost about fifteen to twenty minutes in the morning making me wake up earlier which makes my cranky and nasty to my husband.  And he's nasty back.  So, my hair is flat and cute but my life's just nasty.  I should just go back to natural and enough sleep.

Tell the rain not to drop

I had an impromptu pap smear today.  Who can say that?  Background:  When I saw Dr. D, I gave him copies of all my recent gyne records so everything since October 2009 when I received the (then) devastating news of pre-cancerous cervical cells.  That sucked.  I keep meaning to write about that day.

So, Dr. D. said I should get another colposcopy in August with my local, secular (very secular) gynecologist which was the next date for a pap smear.  I wasn't so jazzed about that idea.  Not that my previous colposcopy was painful or anything, it just seemed like a lot of trouble.  So, I was in with the secular guy who I'm about to quit for his brash, insensitive, non-listening, anti-Catholic behavior for some solid cell mass under the skin, down there.  He said, "Don't do anything.  It's not cancerous."  "I never thought it was cancerous, just annoying."  I tend to argue with this doctor.  I asked him what he thought about another colposcopy?  "What, not necessary, when are you due for your next pap?"  "I don't know, August??"  "Let's do it now!"  "Now?!?!"  "Sure, scoot on down."

He said he scraped a little harder this time.  I'm getting to be such an old hat at this stuff it doesn't faze me one bit.

In other related news, my P+3 blood draw was today.  I'm sick of blood draws; not the actual drawing of blood but the having to register every time I go into the hospital.  I've met some very sweet, sympathetic phlebotomist ladies who treat me so kindly and are happy to see me so often.  I have a problem with the WWA (Women with Attitudes) who insist on making copies of my insurance cards over and over again and can't see to find the screen on their system which explains I have a standing order; expect me a lot!  Blood draws are over next Thursday.  I'm afraid it's going to be normal.    

Stress

When confronted with certain life events, I try to imagine something that most people probably don't.  I think about what me 20,000 years ago would have done.  My mother is an armchair archeologist and I read National Geographic a lot over the years, so this is probably why I go to this place.  I'm not trying or haven't even tried dating Adam and Eve time so give me a pass on this one.  I don't know when Creationists say the Earth was created or when modern homo sapiens came around so I'm just trying to get into a ballpark range here.

Imaging me 20,000 years ago is very helpful in the following areas; eating (food), exercise, and stress.  This idea helps me realize that how my body and mind respond or process information is the same now as it would be for me thousands of years ago.  We've not evolved that much.  And in this case, I use my idea to address the theory that stress is a possible cause of infertility.  My theory is that a certain percentage of any given human clan or population center has always been infertile for physical or physiological reasons.  Their lines died out. 

The rest of the human clans did reproduce successfully and if you're reading this, congratulations, their success is your existence.  And early humans (20,000 years ago) and really, up until and during the industrial revolution and in most places on earth currently, women were/are really stressed.  And a large percentage of the population still got pregnant.  So stress like war, famine, or at least severe political and social instability.  Take the top five countries in total fertility rate: Niger, Uganda, Mali, Somalia, Burundi.  The total fertility rate is a figure for the average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given fertility rate at each age.  The United States and other relatively prosperous nations are at 124 and below on the world's list.  I'd say women in Niger, Uganda, Mali, Somalia, and Burundi are probably stressed to levels Western women couldn't imagine and they're getting pregnant, many, many times over.  


Now I can buy the fact that "nervous" women have a harder time getting pregnant.  And my only evidence there is that I'm a nervous person and I'm not getting pregnant which is getting pretty comical.  I mean, if I knew that I never had to use birth control, I would have saved myself quite a bit of worry in the past.  So, that's my only correlating fact for that theory.    

So, when I get the odd, random advice to go get a manicure or a massage to "take it easy" and "relax" so I can get pregnant, I reply that as long as I live in modern America, I'm about as relaxed as I'll ever be.

Manners?

Two things annoyed me today about not being pregnant.  This news, which really has zero bearing on my life and I shouldn't even be commenting on it but, seriously, what the hey???  Yes, she's a little younger than me but what the heck is wrong with me that I can't get pregnant?  Despite doctor appointments and diagnostic tests scheduled up the yin yang, I'm terribly impatient.  Prayer buddy, I need you!  This makes me pray extra hard for my prayer buddy.  Hang in there.


And then my husband tells me this morning that he ran into the mother of an ex-girlfriend and she asked about "when a baby was going to be on the way?"  Talk about supremely tacky.  I should mention that the split with this ex was not amicable and after all sorts of drama, my husband does not talk to her anymore.  My husband, to his great credit told me he said, "we're thinking about getting started on that.  I'm still taking time to get used to being married."  I should be thankful that next to no one, not even my mother.-in-law asks about the delay in getting pregnant, bless her heart.  


I did tell my mom in law last week what kinds of tests I'm going through and told her we're having some trouble with TTC.  I felt really good about letting her know.  If I was in her position, I'd want to know, too.  So, we're square.  


Today was blood draw #4.  There's a new registration person every time and this one told me to wear a hospital bracelet.  I balked but then relented.  Luckily, she made it so loose that I slipped it off once I got past the interior doors.  Not so luckily, I dropped my blackberry on the hard floor while slipping it off.  She's OK, I can still get my email. :)

We've got nothing but time

I got my first blood draw for the full menstrual cycle hormone profile. Despite my nervousness about the hospital staff not understanding the standing order, they appeared to grasp the concept of what they are doing. So, it worked out. I'm "back to happy" and looking forward to scheduling the remaining tests, hysterosonogram, pelvic ultrasound, selective HSG, laparoscopy, and follicular ultrasound series. The hysterosonogram and pelvic u/s are ordered for a radiology center across the street from Dr. D's office however that's too far for me for relatively routine tests. I'll only trust the HSG and lap to the NaPro surgeon, however. So, I'm looking for a good, local radiology practice.

I was telling MLM that I'm working to do all the tests relatively concurrently, get any appropriate treatment, then get back to the bedroom (or living room ;) and then pray for the best. I've always been impatient and have struggled to reject proverbs that extol the absolute virtues of patience. Not that I reject the biblical teachings of the importance of patience in matters of the heart and soul. But when it comes to a lot of things in life, faster is better!

Nothing in my life could come early enough. I took calculus my junior year of high school (not at all common in CA.) Most people waited until college. This actually turned out to be a bad decision to rush it since I forgot what I'd learned and had to retake pre-calculus my first year of college. I rejected Washington D.C. after six months of living there and got out after eleven months. I'd switched careers by 27. My husband preferred to date longer before getting married but I was eager to get married and start a family ASAP.

So, now when I was told I should TTC for a year before seeking medical attention, I rejected that completely. I started talking to my doctor about infertility after three months. Now I feel justified after eight months with nothing to show for it. Even Dr. D (and many friends) said, after finding out my age, "You are very young so there's lots of time." I replied, "I want more than one child." The thought bubble said, "Young?!?! I need to get on this stuff STAT! It's already taken too long."

I feel terrible for some women when I hear their stories about trying to conceive for literally years before seeking help. I think it's a crisis of public health information and medical research in America that women are not told about the dynamics of the reproductive system and getting pregnant is not like falling off a chair. 10% of the population is not small and ART centers take wild advantage of couples telling them IVF and/or IUI are their only chances for becoming parents. ART is not just morally wrong is economically evil. Thank the Lord for giving us the Roman Catholic Church and the holy people that are working to make ART unnecessary.

Hormone Profile to Begin

Today is CD 4, so I start the blood draws for a full hormone profile, tomorrow on CD 5. I've decided to go with the local lab and not ship to PPVI. With my work schedule, although somewhat flexible given the freedom I have, I can't really figure out how it would work drawing blood, going back to pick up the serum, going back home to store, then going back to work. The local lab opens at 6am on weekdays so at least I can get it out of the way before work starts.

Last week, I did some checking on what my insurance would cover. I knew that my Ant..hem B.lue Cr.os.s did not cover infertility. Dr. D's staff told me it was my responsibility to find out if the hormone testing was covered. After I got off that call, I hesitated for a couple minutes thinking, "I don't want to call the insurance co!" I did make the call and gingerly danced around the tests Dr. D prescribed. The woman said, "Oh, you're doing a hormone profile. Let's see what's covered because infertility can be really tricky here." Oh, great.

Ins. Girl - "Ovarian dysfunction. Yes, that's covered. What are you trying to have a baby?"

Me - "No."

Ins. Girl - "Oh, are you just not feeling well?" [Tone was not caring but more snooping]

Me - "I feel fine."

Turns out that my favorite hospital is renegotiating their contract with my insurance so their lab might not be covered post today (July 1.) Got to check that. Actually, I should do that now.