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Archive for December, 2009

The Saga Continues

I saw my perinatology practice last week.  Dr. P. had left for the day, so I saw Dr. M.  I like her, but sometimes she’s a bit wishy washy.  I told her about the difficulty I’ve been having with finding an obstetrician willing to take me on – and mentioned that several doctors have told me that my best bet is to simply see the perinatology group directly.  She didn’t really acknowledge that last part, and just gave me some more names of doctors to try.   (Meanwhile, I dropped my records off last Tuesday to a practice to review before deciding whether to take me on as a patient… it took them a week, but this Tuesday they called to confirm that they were declining to accept me as a patient)  I can call doctors until I’m blue in the face, but it’s clearly not getting me anywhere.  Sigh.

The rest of the appointment with her was good.  She prescribed IV Steroids to see if that helped the nausea.  It did, a little (though not a lot, but I’ll take it!), until I started trying to taper the steroid.  Sigh.  The baby looks great and is growing exactly on schedule.  And Dr. M. also called the home health company to order that the dressing on my PICC line be changed stat – the tegaderm needed to come off, because my skin was so raw and painful and ick, that it posed too great a risk for infection.  Plus, hello?  It HURT!

The home health company couldn’t come out that night  to change it, plus we were expecting a big snow storm that night/the next day (we got 20 inches!).  Also the home health co. didn’t like the idea of just wrapping the PICC line in gauze – but there weren’t a lot of options because tegaderm clearly does not agree with my skin at this point.  I ended up having to go to the emergency room to have the dressing changed.  By Monday, when my nurse came to change the dressing again, the difference was astounding – it no longer hurt, the skin was healing, it was perfect.  But… the home health care company was still not going for it.  Their protocol is that if there’s gauze on the site, the dressing has to be changed every 48 hours (though my primary nurse admitted that no one has shown her this policy written anywhere – it seems to be a rumour floating around).  So they sent a new dressing out to me to try that.  And?  It’s just a different kind of tegaderm.  I’m already hurting and itching, and it was just put on yesterday.

I do have some possibly-good news, though.  Since I can’t seem to find a doctor who delivers at the hospital five minutes from my house (where I delivered my triplets), I called the birth advisor at another hospital that isn’t quite convenient, but it’s not so bad as long as we don’t have three babies in the NICU this time around.  She got me an appointment with one of the other practices that several friends had suggested.  They had previously expressed that they wouldn’t see me, but I was talking to a receptionist and the birth advisor was speaking with a clinician.  So I have that appointment on Tuesday – I don’t know if they’ll take me on directly, but at least he’s willing to talk to me directly instead of just reviewing my records.

If that fails, I’m seeing Dr. P. on Wednesday – and I’ll talk with him directly.  If he won’t take me on as a direct patient, I’ll head down to the big OB/GYN practice at a nearby University hospital – they are excellent and will take me as their practice is made up of both regular OBs and MFMs – but I was trying to avoid that.  It would mean going into the city for every appointment and delivering at a not-so-local hospital.  Having a hospital 5 minutes from home makes me really begrudge the 30 minutes (without traffic) that it would take to get downtown.  I work just four blocks from the physician’s office building, but I’ve been working a lot from home, and I only expect that to increase, so it won’t be convenient forever.

Hopefully, I won’t have to go that route.

It would be lovely to have a doctor at some point, wouldn’t it?

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Proof

Just so you don’t think I’ve been making this whole pregnancy thing up, I’m including proof of my status in this post.  Personally, I think I just look fatter, but my husband assures me that I look pregnant.   I guess we can compromise and say I’m a bit of both.  😉

I was quite surprised at how quickly I popped out this time around.  I think I’ve got a more prominent pregnant belly than I did at this point with the triplets.  Go figure.  I will say this, though – shopping for maternity clothes is *much* more fun this time around.  My pre-pregnancy weight with the triplets was about 70 pounds higher than my current weight, and I’m down 4 dress sizes (literally), so the variety of comfortable, (somewhat) flattering clothes is exponentially better than the last time.   I loathe spending money on clothes that you’ll only wear for a few months, but I’ve found some good sales (plus sized maternity clothing seems to never go on sale, so I had no such luck with the triplets).  Old Navy had maternity tees for $1.50 each!!!

My little monster is definitely still hanging out  – s/he is kicking a lot, but there’s no real pattern to it yet.  Still, its reassuring… especially considering how dreadful I feel, and the fact that I still don’t have an OB.  I’m seeing the perinatologist on Friday, though, so hopefully I’ll get some more answers then.

Okay – too tired to post more, but I don’t have anything interesting to say anyway.

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Building a Yurt

I admit that I’m not sure HOW to build a yurt – though wikipedia did provide excellent step-by-step photographs on how to build a yurt.  I’m clearly going to have to brush up on the technique, though, because right now I think I might have to take my friend’s advice to deliver this baby in the wilderness in a yurt.  I’m definitely keeping it as a back up plan.

So the OB I met with on Monday talked with the perinatologist, reviewed his notes from our meeting, and reviewed my records…  and he definitely won’t take me on at this point in the pregnancy.  My perinatologist had recommended another practice as well – I called them today and had to leave a message with their OB coordinator because the practice has a policy that women coming into the practice past 16 weeks must have their records reviewed prior to them deciding whether to take that patient on.  I’m guessing… that’ll be a strikeout also.

I’ve left a message for the perinatologist’s nurse to find out whether they will take me on directly or if they have other recommendations.  Right now I’m just frustrated, and a little scared, about what to do next.  I have another doctor to call  – but she’s at a hospital that is just… really hard to get to from here.  It’s not far, it’s just not easy to get to.  I wish I knew what to do.  I’m really a very nice person and a good patient.  I just …  I feel awful and I’d like to know where I’m supposed to go on the bad days.

Meanwhile – I’ve still got the excellent back up plan.  I just have to build that yurt.

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Unpopular

Okay, so it’s not like I was *ever* one of the cool kids.  I got left behind when people were picking teams for kickball most of the time.  My red-headed nemesis in 6th grade used to pull on my pigtails to harass me on the playground.  (Joke’s on him – we ended up dating half a dozen years later).  But popular or not, no one likes to be openly rejected.  When someone you thought was a friend stops speaking to you with no explanation in high school, it’s easily attributable to the whims of teenagerhood.  But as an adult – well, no one likes to be disliked.

So I’ll admit it, my feelings are still a little hurt by having been fired by my OB last month.  Sure, I’m worried about what to do about my care.  Sure, I’d like to move on.  But let’s face it:  mostly?  My ego is bruised.  My feelings are hurt.  I feel rejected, and I *hate* that.  No one wants to be broken up with – it’s much better to be the breaker upper than the break-ee.

But, since I am currently OB-less, because the cool kids kicked me out of their practice, I need to suck up the hurt feelings and move on, which is precisely what I’ve been trying to do.  Oh, never mind that my former OB has failed to send me my medical records yet.  It’s not like I requested them two weeks ago or anything.  Oh, wait, yes I did.  See?  Another fine reason for me not to be there anymore.  Their loss, not mine, right?  RIGHT?

So I had a consult appointment with a new OB today.  Everybody loves him.  Four separate women referred me to him, independent of one another, and the perinatologist had him on the top of his list for people for me to talk to.  I couldn’t have asked for better recommendations – everyone has high praise for him, and I was particularly pleased with the fact that he is  a sole practitioner, so I wouldn’t have to worry about getting lost in the shuffle at a big practice.

I didn’t have my medical records with me to provide him, because my former OB’s office still has not sent the records to me, so I gave him a quick sketch of my medical history and brought him up to date on what’s been going on with my current pregnancy.  He asked a lot of questions, clearly didn’t love the answers, and I don’t think he cracked a smile once – well, he smiled when he introduced himself to me, but nothing after that.

And, essentially, he’s not sure he can take me on as a patient.  “It’s a lot to take on, especially this far into your pregnancy.”  He thinks I should be on TPN, but won’t order it himself, because he hasn’t done so since he was a resident – instead he’d want me to get in with a GI doctor pronto to get them to order it and manage it from there.  That would mean juggling three doctors: the OB, my perinatologist, and a GI doctor.  (Nevermind my primary care pracitioner, and my neurologist).  He’s not opposed to a VBAC, but definitely didn’t sound thrilled about it – he said he would insist on an epidural at 4-5 centimeters, and I’d have to be in active labor (no induction) or 2-3 cm dilated by 40 weeks (I would love to GET to 40 weeks!  Right now I’m just trying to get to next week!).  He can (and does) handle a hyperemesis patient.  He can (and does) handle a patient at high risk for PTL.  He can (and does) manage a patient with underlying medical issues.  Etc.  But with me – it’s rolling all of that into one patient, and that… well, that’s a lot to take on.

Frankly, I appreciated his candor.  A lot of doctors would have said, “no problem!” instead of really thinking about the impact of taking on a patient like me.  He seemed to think I’d probably just be better off seeing only the perinatologist (I’m all for it), but he said he’d talk to Dr. P. tonight or tomorrow and he’d call me to let me know how he thinks I should proceed.  Honestly, it was both overwhelming and a bit of a relief to have a doctor look at it all down on paper and admit that it’s just a lot, and an extremely complex pregnancy.  My old OB made me feel like I was hysterical over nothing (I was never hysterical, for what it’s worth).  They made it out to be a pregnancy that was no higher risk than any other, and that I was making a bigger deal than I needed to.  At least SOMEONE is taking me seriously.

Meanwhile, I’m still OB-less.

Honestly, I’m beginning to get a little worried.  How long can I go without a primary OB to turn to?  How long can I hold off on making other decisions about my care (e.g. should I do progesterone shots to mitigate some of the risk of preterm labor?) before it’s too late?  I’m too high risk for a midwife, I can’t possibly have a home birth (not safe for me – though I totally dig the idea, and absolutely understand why other women do it).  I clearly need solid prenatal care.

I just wish I understood exactly what led to my old OB firing me, so that I could at least not do it again.  The OB I saw today has worked a lot with my old OB’s practice and he said he has NEVER heard of them sending a letter terminating care without a detailed explanation and a signature from one of the doctors taking credit/blame for the decision.  My letter was unsigned (just listed the names of the members in the practice) and did not provide sufficient explanation for the termination.  Just “we feel that you need to find a provider with whom you can have a more communicative relationship.”  So I’m left with… a whole lot of nothing.

I see the perinatologist again on the 18th.  I plan to suck it up and ask him to please just take me directly.  I don’t know how much longer I can handle uncertainty like this.

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Still OB-less

I’ll write more later, but the long and the short of it is that I’m still, for the moment, OB-less.  Saw the shiny new OB today and he doesn’t know if he’s comfortable taking me on as a patient because of the complexity of care that I require.

Sigh.

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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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That Magic Number

Mostly, I don’t question what’s going on with my pregnancy – I don’t sit waiting for the next appointment with a doppler or ultrasound machine to find out if I’m still pregnant. I don’t need independent confirmation right now because I’m fairly certain that I wouldn’t still be throwing up in the event of a sudden fetal demise. So, mostly, I just don’t question my status as a pregnant woman. But you can’t totally take the infertile out of a veteran like me, so I admit that I am sometimes skeptical of the long term prospects of remaining in this state.

I don’t have any good reason for questioning it, but it seems to take a certain amount of hubris to assume that there will definitely be a baby at the end of all this sickness. I would have thought that getting into the 2nd trimester would have left me feeling better about the future. I’m well past the point of my miscarriage three years ago. I’m well into the 2nd trimester. And yet? Occasionally, something reminds me that it’s an awfully big assumption to make that all will be well. In some ways, I’m grateful for the constant, if miserable, reminders that I’m very definitely pregnant right now.

So what number will I have to hit to believe this is all going to be okay? I don’t know. I think I was about 31 weeks before I believed that with the triplets. But those are triplets. It was natural to worry.

For some reason, I can’t get out of my head that a pregnancy loss before 20 weeks is a "miscarriage" and after 20 weeks is a "stillbirth". For some unknown reason, I rarely consider the possibility of stillbirth, despite the fact that I know several women who have had stillbirths. For some unknown reason, it’s the risk of "miscarriage" specifically that crops up in the recesses of my mind occasionally.

I think there’s a societal feeling, at least around here, that miscarriages happen. That a baby lost through miscarriage never really had a chance in the first place, so that life is, somehow, less relevant. The trauma and tragedy isn’t as concrete as a stillbirth. A stillbirth is a real BABY that died in people’s minds, but a miscarriage was the loss of something… less. I know that we in the infertile blogosphere understand that this isn’t true, but in the general society? I think that the dividing line remains, at least in the collective subconscience. For whatever reason, I’m not worried that I’ll have a stillbirth – I don’t think of it as a real possibility. But there’s also something about knowing that NO ONE would deny me my right and need to grieve that loss, whereas an earlier loss… well, you’re just expected to get right over that.

I know I’m talking in circles, mostly because I’m trying to get these thoughts out of my head and onto the virtual "paper" in front of me.

However screwed up my "logic" (or lack thereof) is, I feel like when I hit 20 weeks, I’ll just… feel more secure. But, for the most part, like I said, it’s not that I sit around thinking about the fragility of this pregnancy. For the most part, I assume I’ll have a family of 7 (!!) next year. I’d just like that little voice that occasionally pops up and says, "you know it’s not too late to have a miscarriage!" to go away.

This episode of self-pity and self-indulgence is brought to you by the letters H and G and the number 5.

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