IVF – Here we go!

Maybe this isn’t true for everyone, but for me, going into IVF felt like walking into a dark room with absolutely no information. This remained true even on my first day getting baseline values. So, in effort to give others some clarity, and to share my feelings throughout the process, I’m going to provide a timeline of our journey.

Day 0 (03/2021) – On day 2 of the last cycle before you are to start your IVF cycle, you start taking birth control. You take this daily until you’re told to stop which will correlate with the next steps.
There’s not a whole lot to say here. It seems slightly odd to be on birth control when that’s the exact opposite of what you want, but when you consider that you’re trying to chemically control and dictate what your body does…it makes sense. I was more responsible about taking it at this time than I was when I was younger. Granted, when I was younger, I wasn’t using it to prevent birth, I was using it for horrendous cramping. This time around, I didn’t know how important being exact was, so I set an alarm to take it at the same time everyday. No real changes here.

Day 1 (4/20/2021) – this is your baseline day. On your baseline day you go in for two things, a vaginal ultrasound and blood work.
During the ultrasound (which at this point, if you’re going through IVF, you’ve had many for the same reasons) they are assessing the lining of your uterus, the size of your ovaries, and counting your follicles.
I don’t remember all of my measurements but I know I had 14 follicles on one side and 17 on the other, providing me with 31 follicles. This is a high number, or so I’m told. There are pros and cons to this. The pro being, more follicles, more chances. The cons? I’m a higher risk for a couple of issues. Ovarian hyper-stimulation syndrome (OHSS) which can also lead to ovarian torsion. OHSS is a possibility with any woman, but usually those undergoing fertility treatment. To reduce the risk of this, I’m on activity restrictions – basically I can’t do anything. I’m being dramatic, but I’m not supposed to run, bike, swim, do things that will engage my core (which is basically everything).
The lab work is simple (unless you read my blog about IVF and the government effect). They take 1 vial of blood and send you on your way. Easy.

Day 2 (4/23/2021) – this occurred for me 3 days after baseline. This is when I started taking stimulation drugs. In the EVENING (I set an alarm for 2000), I am to be injected with Gonal-f (a follicle stimulating hormone) and Menopur (gonadotropins).
I could inject these myself but to keep Mike in the loop, he does it for me! This is our nightly routine until we are told to stop, so I’ll let you know what day that is.
The first night, Mike stabbed me 3 times. I flinched a little during the second injection and so he took the needle out and stabbed me again. The second night, he only stabbed me twice, but this time there was some blood and it hurt a little.

About the drugs – The Gonal-f is fool proof. It comes in a pen that you have to dial to your prescribed dose and then inject it subcutaneously. The Menopur on the other hand feels a little like a chemistry class. You get a vial with sodium chloride, one with the Menopur, a Q-cap blister a syringe, and a needle. Mike and I choose to set everything out at the start and then start prepping. You have to take the plastic caps off of the two vials, unseal the Q-cap, then without touching the top of the vial or the Q-cap (sterility after alcohol wiping), you flip the Q-cap over onto the vial with the sodium chloride and puncture the top. Then you prep the syringe by pulling it back to the desired dosage (1mL) and twist it onto the Q-cap. Flip everything upside down (making the vial the top), push the air out of the syringe and then draw up the sodium chloride to the prescribed amount. Now, pull of the syringe and Q-cap and put it on the vial with the Menopur (pushing down to puncture the top). Push the fluid out of the syringe into the Menopur and make sure the solution dissolves. Then draw the solution back up into the syringe, untwist the syringe from the vial and Q-cap. Now you’re ready to attach the needle to the syringe and prep your injection site. That’s it.
No really, it sounds like a lot and the first time it is a lot, but by the second night Mike and I had a really good rhythm and it all took no time at all.

Day 4 (4/26/2021) – was a lab day. I went in for that one vial of blood work. Still a crazy wait time but not much I can do about that.

Day 6 (4/28/2021) – Mike and I have continued to shoot me up with drugs every night. Today we had an ultrasound appointment and lab work (FYI, I pulled my ticket for lab work before Mike pulled his but he got called back already. The perks of being the active duty service member I guess)

The ultrasound went well. It looks like have 23 follicles maturing (slightly down from the baseline of 31, but still really good). I actually have to start another medication today – antagon. It’s to prevent ovulation. My body is one confused chem lab right now. While I start the antagon I will be increasing the menopur from 1 vial to 2 tonight.

So everything looks to be on track, maybe a little ahead of schedule, we will know more when we repeat this process on Friday. I may have the joys of getting my first COVID test on Friday as well. Despite not being exposed, presenting with no symptoms and being fully vaccinated it’s still required to have a negative COVID test before undergoing anesthesia. Safety first. Logic never.

Day 8 (4/30/2021) – At this point I’ve had another ultrasound and more bloodwork. They never talk about the labs – no news is good news I suppose. I have used the patient portal and looked at the lab results and couldn’t tell you anything from that.
At the ultrasound today, the doctor counted 18 “large” follicles (size 9-17 mm ea) plus a bunch of other little guys. Still not sure if we will trigger Sunday for Tuesday or Monday for Wednesday. I get to go back for more labs and another ultrasound on Sunday.
I got the privilege of taking my first (hopefully only) COVID test today. It really wasn’t that bad. It was the up your nose one. I’ve had to go through letting someone put a nasopharyngeal airway in before, so that was worse. Really, if you focus on breathing it’s fine. I just think it’s dumb that I have to have a negative COVID test when I’ve never had, never had symptoms, and am fully vaccinated. By the way, the results are in….I do NOT have COVID.

Some mild frustrations:
1. Reporting on Sunday for another appointment. I have battle assembly this weekend, so now, last minute, I get to work out arriving late on Sunday.
2. The last minute aspect of the retrieval day is interfering with my work and therefore negatively affecting my coworkers and patients. As of today, I will have to report for another appointment on Monday. My schedule was already full for Monday, so I had to ask coworkers to cover my patients, call my patients and reschedule, etc. I’m fine taking the inconvenience for myself, I hate that it affects others.

Day 10 (5/2/2021) – I went for another ultrasound and lab work. It’s go time. This time I counted them counting 19 good sized follicles…it’ll be interesting to see what they come up with on TUESDAY!! So everything looks good and ready so I’ll trigger tonight.

They had to wait for the lab work to come back before they decided a couple of things and then called and told me what to do. First, they had to see what my hormone levels were to ensure I wasn’t at even higher risk for OHSS. If I was I would have had to use a different trigger other than the HCG. I forget what’s called, but I didn’t have to take it. Second, they had to compare my results with all the other people going through this and put us in a list of priority per our results. That would determine what time I would take my HCG.

I guess I got a little lucky, my HCG trigger was at 2330. I guess it can be anywhere from 2130 to in the early morning hours. So Mike and I set an alarm for 2315, mixed the vial of saline and HCG and Mike stabbed me in the butt. It was an intramuscular injection this time.

Day 11 (5/3/2021) – More lab work. It’s was a little faster but still a 35 minute wait.

Tomorrow I go in for the retrieval. I don’t really know what all this entails. I do know that it requires anesthesia. And I should wear loose fitting, comfortable clothes. So, more on this process later!!

Day 12 (5/4/2021) – May the fourth be with you! I laid my eggs today!! they were able to get 16, we will hear tomorrow how many are viable to move forward after insemination!

We had to arrive at 0700 but I didn’t go back to the OR until 1030. When we got there, we were greeted by some AWESOME nurses. I wasn’t anxious or uneasy, but if I had been, these nurses would have squashed that! We did the standard vitals stuff and got an IV started and just waited.

The nurse prepped us for the visits from a lot of other medical people and gave us a heads up on what they would be telling us. I thought this was super awesome because it gave me time to think and figure out if I understood or had any questions. Then we were visited by the nurse anesthetist, the sperm doc, and the OR doc.

Mike left to do his thing but was back before I went anywhere.

The OR. I was transported about 50 feet in the hospital bed but when we got to the OR I had to get up and walk in and to the “nest” (table/bed for the procedure). The nest has a hole in it where they want your butt to hang off. The nurse (a different one from earlier), put compression sleeves on my legs and lifted them into some pretty intense stirrups. Hips and knees bent to 90 degrees and the abducted a good amount. These stirrups support your whole lower leg (calf/shin region) and they strap them in. Shortly after that I was out.

Per the clock, about a half hour later I was done and back in the first room. I had some mild discomfort, I wouldn’t have called it pain yet. It got a little worse with time but nothing more than a 1-2/10. The nurse took my vitals and gave me grape juice and graham crackers (I hadn’t eaten or drank since dinner the night before). Just had to wait for our number of eggs and then I was required to urinate before we could leave.

We got our number – 16- pretty quick, but I wasn’t going to the bathroom. 2 liters of IV fluid and 16 ounces of grape juice wasn’t enough to make me have to go….but I started getting nauseous. After about 45 minutes of nausea and a dose medicine to reduce the nausea, I vomited. Then I was better. I still didn’t HAVE to go to the bathroom, but I was able to make myself go. Now I could get dressed and head home!

I vomited again in the car – they had given us a bag for that just in case. We got home, and I slept for 3 hours or so.

My list of meds and routine has changed now. I have an antibiotic that I take tonight and then twice a day for the next 2 days. I have oxy for pain relief – taken as needed.
The important stuff though, I have progresterone suppositories that I have to take 3 times a day every 8 hours starting tomorrow until someone says stop. I also have estrace, it’s a pill I start tomorrow as well. 1 tomorrow, 2 the next day, and 3 the subsequent days, until told to stop.

That’s probably all the update until, I think, Sunday, when we transfer.

Well guys, it’s Tuesday. I left you hanging on Sunday. I’m going to be honest, it wasn’t the day we had hoped for, so it was full of raw, confused emotion. The day after the retrieval, they called at let us know that of the 16 harvested eggs, 14 were mature. Good news. Then they said that only 8 fertilized. Ok news. Sunday, only 2 fertilized, and 1 was questionable. That hit hard. We had approached this day so optimistically and hopeful that we’d get to transfer a really strong blastocyst and then freeze 3-5 more. Now, we were left with a good blastocyst and a questionable one.

Yes, we were/are grateful for the 1 we had. Yes, we are blessed. Yes, we are hopeful this one takes and turns into a pregnancy. But, so much can be unpacked from the information of only 2 out of 8 surviving. And yet, we still don’t know what or why we can’t do this on our own.

Also, now that we’ve made it this far, and have this much information (that still amounts to no information), why am I the one that has to carry the diagnosis of unexplained infertility? We know nothing, but in that, we don’t know that this issue lies within me.

Fast forward to today, Tuesday, May 11, 2021. I received a phone call stating that our questionable embryo was good enough to be frozen. I don’t know the grade yet, also can’t tell you what that would me right now either, but maybe later. In the next few days, I may receive a phone call with the grade. Don’t really know what that means.

The next steps. On Tuesday, May 18, 2021 I have to go to Walter Reed and get blood draw for a pregnancy test. I’ll leave and sometime later that day, I’ll get a phone call letting me know if it was positive or negative. The catch here, even if it’s positive, we still won’t be sure. I’ll have to go back to the lab two days later and do the blood work again.

Continuing to be honest with you, because these are my feelings, and you may relate, you may not, but if you’re reading this, I think you’re trying to understand your own struggle, so it may be helpful to know, you aren’t alone in feeling alone and worried.

I hope Tuesday is positive. I hope Thursday is positive. But I’m still scared. Last time, it was natural and unassisted, but it didn’t work. Maybe I’ll feel safe after the first trimester, that’s what I’m telling myself anyway. But it may not feel safe to be happy until there’s a baby here. I don’t really know.

IVF and the government effect

As I am writing this I am sitting in the laboratory waiting area at Walter Reed waiting to get my first blood draw of the whole process. But, I’m going to take you back a bit to a different starting point, I wouldn’t call it “the” starting point because I’m not really sure when that was or how to define it.

This first part is going to highlight some of my frustrations that aren’t necessarily related to infertility but more so to government and the idea of “universal healthcare”.

After I experience my miscarriage I was told my only “real” option of “success” would be to do IUI. (Maybe I’ll tell you more about that process in a different post, but suffice it to say, it’s an invasive and very transaction experience). I was informed that I’d have the opportunity to undergo IUI six times before we would have to consider other routes. Unfortunately, we never had success with IUI.

After about four cycles the pandemic hit. Infertility wasn’t considered essential so I wasn’t allowed to conduct rounds five and six for another two months. Maybe two months doesn’t sound like much to you, but when you’ve been trying to conceive for four years, two months is long and unfair. There’s a long and drawn out process to all of this so every delay always has a trickle down effect. This particular delay meant that our decision time on participating in IVF was delayed by two months as well, hoping it wouldn’t come to that point.

Once you commit to IVF, you don’t get to start the next day, you have to wait until the next cycle begins. Point of contention number 2. Mike and I came to the decision to pursue IVF in the late summer/early fall of 2020. We couldn’t start the process until late January/early February 2021.

Now, the journey you’re about to embark upon isn’t at the forefront of your mind the whole time, but it is constantly lingering. Will it work? What’s the process like? Is it going to effect my emotions? Will I handle it well? I can’t work out while we do it, what will my stress reliever be? Moments of optimism seep into your mind, maybe we won’t need it, maybe we’ll conceive on our own! Continuing the rollercoaster of false hope and shattered dreams monthly, while you wait for an outsider to determine when you get your chance to have a baby.

Never mind all the people around you, starting to try, conceiving, and giving birth all the while you have nothing. Add in the stupidity and insensitivity of others telling you “just stop trying and it’ll happen”, “you have to relax, you’re too wound up, that’s why you can’t have a baby”, “maybe if you’d eat meat you’d be able to conceive”, “you know I don’t agree with you reducing your exercise, you should be working out as much as you want”, and my favorite, “you know I’d be a surrogate for you”. Eff you. All of you. There are so many more comments I’ve heard and endured. It’s amazing how insensitive and narrow minded people are. To answer some of your comments, we didn’t focus on it for the first year and a half, we simply had unprotected sex and rolled with it. Relax?! I don’t feel stressed, yes I’m upset but I’m pretty chill, and you’ve got me wound up because you didn’t even ask or you’re ignoring the fact that I have a process within my own body that wasn’t functioning correctly to conceive. Consider that. Maybe if ate meat?! I probably get more protein, more complete protein that most of the meat eaters around me. Don’t worry about working out? Well when your body stops performing a process because your body fat percentage is below 14% and your body wants to focus on keeping you running, come talk to me. You’ll be my surrogate? Specifically to this person, you can’t even be my friend, why on God’s green earth would I want you to be my surrogate?! But also, how about you ask me what I’ve been through, what the next steps are, how I’m dealing with all of this?!

Anywho, I digress. So we were starting IVF in January/February 2021. But then. I received a phone call letting me know that the sprinkler had gone off in the OR and so they have to delay my start date while they check the equipment. “Keep taking the birth control you’ve been on for the last month and we will get back to you on your new start date.”

A week later, they won’t be able to start my IVF cycle. Not sure when, hopefully in April. The water damage ruined the room and they had to do construction work in it. I lost a month of trying naturally because I was on birth control like I was told, and now I was on nothing because I was no longer preparing for anything. How is this acceptable? Well, it’s socialized medicine, it’s the universal healthcare everyone wants. Don’t get me wrong, I’m usually grateful for the medical interventions that I have accessible to me through our military insurance, but this isn’t ok. Did I mention that through this process I asked to see a counselor three times and to this day I haven’t had any success? I asked my medical team 3 times, I called the number provided several times and no one got back to me. Also, not ok. Thankfully I have an awesome husband, a supportive family, and a few trustworthy friends. But I still struggle. I don’t want to lay this all on them and I don’t. I keep a lot of it in and just deal. But there are days and weeks when it’s really, really hard.

So, after 2 years of trying on our own, a year of trying with medication, conceiving and miscarrying, 6 IUIs over the course of a year, and a series of delays sprinkled throughout, a bunch of blood work, even more vaginal ultrasounds to amount to over 4 years of trying, I’ve now been sitting in the socialized medicine laboratory for 1 hour and 9 minutes to get my blood drawn to start IVF. They took 1 vial of blood, that takes less than 30 seconds.

To close, I want to say that I am SO EXTREMELY grateful for the healthcare I have. The cost of healthcare to our family is so cheap financially, the cost of IVF is pennies compared to what it would be in the private sector, I’m super blessed and I don’t discount that. My point here is twofold. This last year hasn’t just been about a virus. It’s been about how fearmongerers have controlled our lives leading to delays in life progression, increased depression, abuse – physical/substance/emotional/you name it. We’ve lost control, we need to take it back. Secondly, I want everyone to have medical care, but I think you’re crazy if you think universal healthcare or socialized medicine is the answer. Consider that only 1% of our population serves in the military, so it’s reasonable to suggest that my medical establishment serves 1% of the local population (ignore the fact that I can count 5 other military medical treatment facilities within the same radius). It took them 1 hour and 9 minutes to spend 30 seconds with me to take my blood. How long will it take if 100% of our population is pulling on the same resource?

4x4x48

What is the “4x4x48”?
– It’s a challenge that you can complete at any time throughout the year BUT….. David Goggins schedules a world wide even in early March. It’s a 4 mile run every 4 hours for 48 hours. So, you run 48 miles in 48 hours. While it’s advertised as a run, rest assured, you can do ANYTHING every 4 hours. The idea is to push your self to do something difficult, and live to the other side and see that it wasn’t impossible.

I did it this year (2021).
– My husband did it last year and I just couldn’t live with myself knowing he did something I know I could do too. So, we did it together this year.
– I did not train. Not even a little bit. I couldn’t have told you the last run I did before embarking on this great adventure. Not a good idea. The physical therapist me was very disappointed. But that’s ok. I still listened to my body and made adjustments.
– I ran the first 3 legs. I walked the rest. During the second leg I had some sharp knee pain that did not go away. Even with rest, it hurt, especially with impact. I tried to see if it would warm up on the third leg, but to no avail. I walked the rest which meant, I slept less. Honestly, the lack of sleep was always going to be the harder part anyway.
– I also had drill during this. I was on virtual conferences throughout all the waking hours of this event. Kind of a blessing when it came to having to walk. I didn’t feel as bad about the walking. It also meant no day time naps.

Lessons learned.
– Don’t be dumb. Train. Even if you don’t think you need to, do it. It’s not just about “needing” the training time. It’s also about enjoying yourself. It’s a thousand times more fun when you enjoy yourself doing something hard. Training makes it possible.
– Sometimes doing the same route is good. Normally I like to through some diversity in my running routes just to see new things. Overall, I think with regular running days, that’s still what I like to do. When participating in the actual event though? It’s nice to repeat the same route. You get an idea of where you are in relation to start and finish. You can make judgements on how you’re doing/feeling/moving/etc. as you progress each leg. I run with something tracking me all the time, but I don’t particularly like looking at it all the time, so it’s nice when I can see a light post and think “oh, I’m a mile away”, or get to a hill and think, “this felt a lot harder last time”. Whatever. It’s nice.
– I like doing hard things. I thrive when I have a goal or challenge set in front of me. I’m not alway thriving in the specific goal or challenge I facing (case in point, this 4x4x48), but I do emotionally. I’m recharged and ready to conquer the world. I’m more focused on the daily tasks, I’m ready to implement changes, I’m hungry for more life.

So what? Who cares?
– Really, no one cares. Just me. Maybe Mike. Likely the cats. But that’s it. But the so what, is do hard things. Show yourself you can. Solve problems. Don’t sit back and accept mediocracy. We are in a world today that is looking for anything about you that says you’re a victim. You don’t have to be. Bad things legitimately happen, and I’m sorry for anyone that has been on the receiving end, but YOU choose YOUR story. Don’t let someone else put the cage of victimhood around you. Break free. Make a change. Overcome hard things.
– Also, I’m planning another hard thing. Not sure what it is, but I’ll keep you posted. If you have ideas, leave them in the comments.

Level Up with the Push Up

Let’s just start by saying, I HATE push ups. Yes, they’re good for arm strength; yes, they’re good for core strength; yes, they’re good for training your respiratory system; and yes, they’re apparently good for assessing your risk of a cardiovascular disease/incident. I still hate doing them.

While this article isn’t perfect, and likely doesn’t adequately assess the full spectrum of people – whether it’s age, race, culture, socio-economic status, physical activity, or gender (it specifically states the results are based active adult men), etc – and they fully admit the short coming of diversity it’s still an interesting place to start.

What is cardiovascular disease (CVD)? Well, firstly it’s the leading cause of death, IN THE WORLD. It’s better viewed as a categorical term, there are many “sub” diseases that fall under the umbrella of CVD. The short of it is, it’s a dysfunction somewhere affecting the way that your heart (cardio-) and blood vessels (-vascular) function. The following list of possible diseases is not all inclusive, but hits some of the more common and well known: heart attack, stroke, heart failure, arrhythmia, and valve problems.

What causes it? Everything and nothing. Honestly, you could be unlucky and have bad genetics. But you could be making some poor life decisions and doing it to yourself. Things like smoking, obesity, poor diet, lack of physical activity, and stress can contribute to the onset of CVD.

How do you know you have it? Typically, you undergo some type of testing that is ordered due to a symptom or complaint you have relating to your health. You may have to do a blood test, stress test, x-ray, EKG, etc. It depends on how you’re presenting and what your medical history is.
I’m going to make a shameless plug here to urge you to get your yearly physical. Some of these issues can show up before they’re a big problem and you can do something about it. But if your doctor doesn’t know you, you don’t know you, and your doctor doesn’t know your health, then no one can know you’re at risk! We live in a world today where doctors have weekend hours, telehealth is more readily available (and covered by a lot of insurances), you don’t have to lose a day’s work to see your doctor, and a yearly physical will likely save you from more lost time later.
For any physiotherapists out there reading this, take your patient’s vitals! A good blood pressure reading takes 2 minutes, and you’re seeing your patient the most, you’re going to notice a change! You can send them to their primary care physician and make positive, early changes. If you’re a patient in physical therapy – ask your PT to check your vitals!

Back to the article- some of this can be detected with testing physical fitness and/or cardiorespiratory fitness. This is where the push ups come in. While it’s not a perfect test or correlation and WON’T guarantee you a healthy heart, it will likely assist in prevention and detection of an issue. The article shows an inverse relationship between the number of push ups performed and the risk of CVD events over a 10 year period. Basically, the more push ups a person could do, the less likely they would incur a CVD.

Other things to consider: People who can do a lot of push ups likely lead healthier lifestyles and participate in more physical activity. The age group, while ages ranged from 21 to 66, the average age was 39.6, so we don’t know how reliable this data is with aging. Genetics, they’re always a factor.

What I like about push ups: They don’t require any equipment. You can do them anywhere, anytime. No excuses. They work a good chunk of the whole body.

So, in summary, do push ups, there’s really no downside. Except that I hate doing them.

Here’s the link to the article, incase you want more information or you want to look at all the statistics.

Florida February 2021

Around February 13th we try to go on a trip somewhere. Not just because we like to travel, but it is Ace’s birthday! Last year we hit the slopes in Utah thanks to a generous friend, this year I came up with the plan. I went with the sunshine state, I wanted to be warm and possibly enjoy an area with a few less COVID rules (I am fully vaccinated for those wondering).

Plan: Go to Florida Thursday afternoon, come home Sunday afternoon
1. Fly into Orlando
2. Rent a Jeep Wrangler
3. Take the top off the Wrangler
4. Cruise around, get a sunburn on my bald head
5. Watch the sunrise on the beach
6. Run on the beach
7. Find something cool to do for the other day.

Winners and Losers: Some things went awesome, some things were a bust. Spoiler alert, more winners than losers.
Winners:
1. Avis car rental killed it! We landed and there was a HUGE line at the counter (I had a flash back from the two hours it took in Denver). But we went straight to the lot and our Jeep Wrangler was fueled, keys in it, and my name on the board to just drive off! BEST rental car experience I’ve had yet.
2. Discovery Cove was awesome. For a few bucks (they have a great military discount) we swam all day with exotic fish including sting rays. We even did the dolphin experience where I say the dolphin tried to pull me under, but it might have been a slippery spot and the included premium drink package that caused the problem.
3. American Airlines Admirals club was a nice refuge in the Orlando airport (MCO). Lots of room to enjoy a snack with your mask off (while keeping your distance of course).

Losers:
1. “The Club” at MCO was a bust. I don’t know if it was the COVID rules limiting the food selection and amenities but we couldn’t get relaxed and enjoy ourselves.
2. The Sheraton charged us $10 to self park in the lot in Orlando. Not cool in my opinion when you charge for parking when there is lots of land. The Four Points on Cocoa Beach had free parking when there is no room! Additionally, the front desk did not mention the charge…
3. I’m stretching looking for things here, but the flight to Orlando took an hour longer than the flight home. We were on an aircraft with two seats on each side the way there and three seats on each side on the way home. The bigger plane cut an hour off the flight and made a much smoother ride.

Looking at my list we hit all the items. We had a great time in Florida and staying in Cocoa Beach. The weather participated most of the time and we only got caught in the rain once. I think we will be back.

Don’t settle on a job.

So I’ve had the opportunity to mentor a few students since becoming a physical therapist and there are plenty of things to teach them, to help them fine tune, to grow their independence, etc. Honestly, I’ve had really intelligent students that will be great as physical therapists, the part I’m more concerned about is their work ethic, common sense, life skills, etc. I’m not going to go into all of it right now, more so because recently I had a student ask me what they should look for in a job and what they should ask in an interview, so I’ll focus on that. My list isn’t perfect but it’s a place to start.

Topics of discussion with a prospective employer:

  • Compensation. We aren’t all worried about money. Figure out your priority and find an employer that is willing to meet you halfway. Maybe you are ok with a smaller salary if you have more time off? Maybe you want more flexibility to manage your own schedule? I don’t know, but figure it out and talk about it. What is the spread on base salary versus bonusing? Some companies will offer you a lower salary because they have high compensation for bonus, but then as you get raises your bonus value goes down and at the end of the day, you’re making the same money after 5 years of experience as you were as a new grad. Make sure you understand their compensation plan.
    • For me: I like to be in control of my time. I didn’t get into physical therapy to get rich. I did it because I care about people. So I’m going to be there for my patients. But I want to be able to live my life too, and for me that means travel, which requires more time off.
  • Productivity. How do they calculate productivity? If a patient cancels, is it your fault? Are they focused on number of patients seen? Number of new evaluations? Are they focused on number of units billed? Type of units billed? What’s the expectation here? How important is the number of visits each week? And how does that compare with the mandatory work hours.
    • For me: Again, I will see as many people as I can, as long as I can give them good care. I don’t feel I should be “punished” for a patient cancelling. They have lives and things come up. We also need to provide more grace to patients having to cancel because they may have a sick child or parent, they may have other issues, and to “punish” (cancellation fees, kicked off the schedule, etc.) them on top of it all? How does that help? 
  • Schedule. You’ve made it far enough to have obtained a doctorate. I’d like to think that didn’t happen on accident (but you’d be surprised), and that you know how to manage your own schedule. Obviously, your employer wants at least 40 hours from you, how much freedom do you want in scheduling those hours? Your schedule should be regular for predictability and patient needs, but life happens, are you allowed to make adjustments? 
    • This will have another blog of its own at some point. For me: I’m smart I understand that my employer wants me to work 40 hours a week AND see at least 55 patients a week. Got it. Now, if I have something come up (not something superficial, last minute like wanting to go boating with my friends that day), can I move my hours around to keep the 40 hours and still see 55 patients? Or are you just going to make me use PTO?
  • Documentation. Do they provide time for documentation as part of your normal 40 hours? Most don’t. How quickly do you HAVE to have the documentation done? You shouldn’t wait until the last minute because there’s no way you’ll remember everything you did and thought, but if you have some blank space in your work day, why not do it then rather than give up your time?
    • For me: Like I said, most employers don’t give you documentation time. I haven’t had a big issue with that. I can get most notes done during the visit or at lunch. The most I am left with at the end of the day is 3 or 4 notes, at about 5 minutes each, I’m done in 20 minutes. The important part here is, can you do them from home? Yes, you still have to adhere to HIPPA, but that’s possible from your couch. I would rather go home at 7pm, get my dinner and do my notes than sit at the clinic for another 20-30 minutes and get home and start dinner that much later.
  • Education. Do they offer courses themselves? Do they have reimbursement opportunities? What do they have in place for possible specialties?
    • For me: I want the freedom to choose my own continuing education, so I prefer a lump sum available to me. 
  • Bonuses. This is a nicety. Depending on the area they may offer a little incentive to attract new therapists. Even if it’s not advertised, don’t be afraid to ask. Some really push this for new-grads to help with those student loans.
    • For me: Why not get the sign on bonus? I didn’t have any student loans, which made it even sweeter. I just got to pocket the money. If you’re leaving another job and they want their money back for some continuing education, you can usually get a sign on bonus from your new employer to cover those fees.
  • Growth. What does the employee structure look like? Is there potential for growth? Do they try to higher within the company? Do you want to be a clinic director at some point? Adjunct professor? What is the relationship between the company/clinic and the neighborhood/city?
    • For me: I like developing people and leading people. I love being a clinician, but I get to help more people if I can teach more people how to help people. That’s a confusing sentence, but I trust you get it.

Every setting is different and has different demands. I wouldn’t say any setting is harder or easier but they are more suited for different people. Use this list to find a setting and employer that allows you to flourish and avoid burn out. You went to school for 7 years, do you really want to quit after 3?

Hope this helps, let me know if you have any other questions or want me to elaborate!