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Archive for December 3rd, 2009

Perinatology Update

So I saw the perinatologist yesterday.  I had a 3:30 appointment and I was done with the growth ultrasound by a little after 4pm.  Baby is growing perfectly – has a brain, legs, feet, hands, arms, spine, etc.  The sonographer couldn’t quite visualize the four chambers of the heart, but she said it’s a little early for that anyway.   Heartbeat was a respectable 158bpm, I think.    I didn’t get any printed pictures, but to be honest, the baby was never in a great position for a good picture anyway.  I mean, lots of good pictures of ulnas and femurs and fingers and such, but not so many that really resembled a baby and not Skelator.  I’m pretty sure I saw the “money shot” a few times, but fortunately, I’m good enough at ignoring such things that I still have no idea whether this is a boy or a girl.  I don’t want to know before delivery day.  Anyway, the important thing was that the baby is growing and so far seems to have all the anatomy in place that s/he should have at this point.  I’m pretty sure the baby was sleeping through the whole U/S – not much activity, even when the sonographer was poking my belly to try to get a reaction.

Once the U/S was done, I let the sonographer know I’d like to make sure to speak with the doctor (at the perinatologists’ office, patients don’t typically meet with the perinatologist at U/S appointments unless there’s a problem or the patient needs to ask the doctor any questions).   Dr. P. had stepped out to do an emergency cerclage removal – so I was given the option of waiting or talking to Dr. G. over the phone (he was at the other office).  I like and respect both doctors a lot, but I really wanted to see Dr. P. in person if possible, so I waited.  He got back to the office just before 5pm and then spent a solid hour talking with him (this is part of why I love him).

I told him that my other OB “fired” me and he laughed and said, “How the hell do you get *fired* by your physician??!!?”  So I explained what happened and he was pretty flabergasted.  The practice that fired me is a very well respected practice, Dr. P. works really well with them, and until recently, I loved them too.  Everybody loves them – I only know one person other than me that had any issues with that office – and that was a clashing of philosophies/personalities, not a concern about quality of medical care (this other person is… how shall I put this?  Kind of a witch).

He talked about possibly coming to a decision point about just moving me over to TPN.  I told him we’d sort of been dancing around the issue up until now and that I really just don’t know where the tipping point is – at what point do we decide enough is enough and just move to parenteral nutrition?  He said, “Unless you’re feeling better and think this is going to be gone in another couple of weeks, I think we’re there now.”  He wasn’t pushing to make the change immediately, but to definitely have it in mind as I’m trying to find a new OB (more on that later), and if I wanted to move to TPN before I get settled with a new OB, he’ll be happy to handle putting in the orders for it with the home health company.

He volunteered that he’s happy to cover me while I’m trying to get settled with a new OB.  And he gave me some recommendations for doctors to talk to.  The first one he mentioned was the doctor that I’d already set up a tentative appointment with for next Monday.  He said he’s a really good guy, excellent doctor, has the advantage (and disadvantage) of being a sole practitioner, and can afford to have some flexibility in terms of my care and management of my pregnancy.  He said that they work very well together, so it would be a good fit if I feel comfortable with him.  If that doesn’t seem like the right match, he gave me a couple other names to consider, and will cover me for however long it takes to find a new OB I’m comfortable with – even indefinitely.  But I think I’ll probably have a good fit with the doctor on Monday.  I just have some things I want to clarify with him, and ensure that he can work with my home health company and what his practices re: high risk pregnancies are.  Dr. P. thinks it will be a good fit, but didn’t push it.

I asked about the rash that I seem to get from the Phenergan.  He said he doesn’t find it entirely shocking, though agreed that it’s odd that it is limited to my left arm when the Phenergan’s going into a central line.  He agreed with my assertion that despite the negative side effects, I’m still better off with the Phenergan than without.  I asked if he’d ever used a steroid protocol for hyperemesis and he said he hasn’t, but he’s seen it used with some success.  He’s had the most success with a low-dose thorazine drip, as odd as that sounds.  He was certainly willing to discuss options and keep an open mind.  I told him I don’t want to make any drastic changes to my protocol before Monday when I see Dr. F., and he said that was fine, and that either I or Dr. F. could feel free to call him anytime to discuss changing the protocol if necessary.  Mostly, he’d just like to see me getting some actual nutrition at some point, though admitted that the *most* important thing is the fluid, which I’m getting already.

I noted that I’m starting to have contractions already and he said that so far, my cervix still looks good (it did at this point in the triplet pregnancy also), but reminded me that sometimes there can be a drastic change without a lot of warning.  The hope, of course, is that my issues with the last pregnancy were largely related to the triplet factor, but it’s clear that I probably just am going to have issues with contractions even in the singleton pregnancy, so they’ll monitor my cervix very closely and make sure that they’re careful about any shift.  Yes, tocolytics are likely in my future, but probably not necessary yet.

He’ll see me back in two weeks and two weeks after that.  If I need to see him in the interim, that’s fine.  Also, he’s the doctor on call this weekend, so if I need anything over the weekend, he’ll already know what’s going on and is happy to handle it for me.  I mentioned that my old OB practice probably *has* to deal with me right now if something happens and he agreed but said that unless it’s a clear emergency (like sudden, heavy bleeding), they could be difficult about it so absent a clear emergency, he recommends I just call him directly.

So all in all?  It was a good appointment.  I got most of my immediate concerns addressed, and I have a reasonable plan for the future.  Now if only I didn’t feel so cruddy – but that’s neither here nor there.

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