Posts Tagged ‘OBGYN’

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Lovenox *gulp*

August 28, 2009

After my first loss I asked my doctor to run any tests she had to find out why. She was kind of enough to oblige though I’ve heard some docs won’t run these until three or more. While waiting for these results I got pregnant again. She called me 5 weeks into my pregnancy and asked me to take a baby aspirin because I tested positive for lupus anticoagulent and referred me to a maternal fetal specialist to discuss lovenox. He ordered a series of 15 tests on me.  In the meantime I lost that pregnancy. A few days after the loss I learned my lupus anticoagulent was now negative though there were other numbers that were borderline high. She said next time I got pregnant to get lovenox immediately upon a positive test. True to her word as soon as I called in she wrote me a prescription for lovenox.

I waited to fill my appointment until the next day because I had an appointment with a hematologist. He said he didn’t think lovenox was medically necessary for me and that I should wait two weeks for him to run some more tests on me. I asked him why did I test positive for lupus first go around, and then negative the next go around. He said sometimes lupus anticoagulent follows one pregnancy but not another. I asked him if now I was safe in this pregnancy, he said I can’t be certain. So while he said I didn’t need to take lovenox he did say that if my OB  felt I should, I can go ahead and take it. I began leaning towards taking it since the thought of this lupus thing coming and going like an apparition trying to steal my pregnancies freaked me out. But I still hesitated. Dr. F said not necessary and he’s an expert on all things blood. Jack thought I should wait out the two weeks.

After fretting for sometime someone advised me the obvious: ask you OBGYN. The hematolist may be a blood doc but he works with cancer, this is a recurrent pregnancy loss issue, you should trust the people who work with the preggo people. So I e-mailed my OB-GYN last night and she said she wanted me on it on the advice of the maternal fetal specialist.

I’m freaking out now. I am hoping by listing my fears they’ll seem less scary:

1) Lovenox costs $1,000/month. My insurance covered it this go aroud but I’m switching insurance in October because my job ends. What if the new insurance gives me problems?
2) I got a positive pregnancy test TUESDAY at 13dpo. Now its FRIDAY 16dpo. I didn’t start too late did I? I’m so upset that I waited. I should’ve gone with my instinct and just started stabbing myself with the needles as soon as they were ordered. The hematologist just confused me. UGH. It’s always better safe than sorry.

Nope, still scared. Please don’t let it be too late. Please don’t let it be too late.

Anyone have any advice on how to take Lovenox?

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Planning

August 26, 2009

Thank you for your well wishes on my previous post. I’d be lost without you.  My coping mechanisms surprise me. I expected to panic. I feel a bit pensive but very calm. I hope this feeling remains.

I see the hematologist tomorrow to talk about Lovenox. My OBGYN already called in the ‘script. I’m scared of side effects but we’ll see what the hematologist says. Jack thinks I should get my HCG and progesterone drawn to determine the viability of this pregnancy. A part of me considers this, but a larger part shakes its head no. Waiting for those results, the lack of sleep, staring at the phone, anxious shallow breathing- it was brutal.  I don’t want to go through it again. True the results could comfort me but I dread that wait. I don’t know if I can do that wait. The OBGYN’s office asked to schedule a confirmation visit. I stalled. Confirmation visit: pee on a stick, get brochures on pregnancy, have a pelvic exam where you’re told its too soon to see a heartbeat on the u/s so come back in two weeks. No thanks. I’m already getting the meds. I’m considering scheduling a visit in three weeks when we’d find a heart beat. My goal is to stay as peaceful as possible. Any tips on how you find peace much appreciated.

I e-mailed the RE to cancel next week’s appointment. My two word response: ok. canceled. I felt taken aback. No good luck? No, that’s good news? They deal with IF day in day out so I thought they’d give a friendlier response. I never felt more like a canceled business transaction before.

The evening is drawing to a close and I glance at my pregnancy test. I’m struck by the first thought that comes to mind as I look at the two bars. Will this time be it? Have I paid enough? Am I absolved? I’m surprised by these thoughts, but this year has felt like a sort of purgatory where I sit and wonder what I did. I hope the lovenox works. I hope an earlier egg is a fresher egg. I hope. I hope. I hope. I hope my penance is complete.

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Slapped

August 18, 2009

Sara and I have been best friend since 8th grade. Though we went to different colleges, and now live in different cities, we remained close talking on the phone every week and visiting at least twice a year.  I don’t have many close friends and I cherished her presence in my life.

Sara is an OBGYN resident. In January 2008 when we began TTC I told her my fears of PCOS. She brushed the idea away and told me to wait a year. She was my best friend and an OB-GYN so I said okay. A few months later I told her I planned to switch doctors because progesterone induced cycles seemed pointless if I had a deeper issue. I didn’t think the doctor knew what she was doing. I wrote about it here but to sum it up Sara got pissed and told me that there’s nothing I can do about what’s happening. I should stick with the doctor and maybe in a year seek diagnosis and if I can’t have kids so be it, its just not in our control what happens to us. I was thrown off by this conversation. In 17 years she’d never snapped at me like this. I told myself she had my best interest at heart and agreed with her. Luckily some IF bloggers e-mailed me vehemently disagreeing with my friend and urging me to switch doctors and try getting diagnosed. Thanks to these bloggers I met different doctors until I found one I trusted and was diagnosed with PCOS.

I felt confused by Sara. I had textbook PCOS and she’s an OBGYN. After the diagnosis I told her I had PCOS. Her response was oh, followed by silence. Then she said she had to go. Okay, fine. She’s my friend, not my doctor, but I felt hurt by her response. No words of sympathy, just awkward silence. I told myself I shouldn’t hold this against her but I found it harder to call her or return her messages.  Four months went by. In the meantime I got pregnant and had my first miscarriage. The day of my miscarriage she had left a message saying it’d been a while. I thought of her and how close we’d been. I called her back. She said she was sorry to hear and I knew she genuinely felt bad for me even though she didn’t know what to say. We changed topics to other things such as what she planned to specialize in once her residency ended and that’s when it happened:

Sara: Sometimes I consider going into RE. Its good hours and lots of money.
Kate: You should definitely do it!
Sara: But then I don’t know because I don’t believe in it. I can’t practice RE in good conscience.
Kate: Why not?
Sara: Because if you can’t have a kid you shouldn’t and I’m sick of people trying to fight nature, living unhealthy lifestyles, and then coming to me to try and get pregnant.

I felt for a few moments like I could not breathe.You have to understand Sara. She has a gentle lilt in her voice and wears pink skirts and has a hello kitty phone. Never could I imagine these words coming from her mouth. She made this comment so nonchalantly I just sat there like an idiot unable to formulate a sentence.

That was in May. She’s called a few times since then and left messages but I have not returned her calls. I know she’s upset that I’m bad at keeping in touch. She has no clue how her words affected me. Jack asked me the other day You and Sara were so close you haven’t called her in the longest. I told him what happened but he said Sara is a good person and I shouldn’t end things with her. Maybe in this one area she sucks as a friend but that doesn’t negate her as a whole being. He said she’s all alone in Chicago and maybe she’s frustrated and took it out on you. Besides she doesn’t understand because she doesn’t have IF issues that she knows of yet.

But if my friend gets hit by a truck I’m not going to say people should be careful where they walk because I don’t know what it feels like to be hit by a truck. I don’t know what to do.Thanks to her I wasted a lot of time TTC in vain but I could get over that since she isn’t my doctor so I can’t blame her for giving me bad advice. But her last comment, I don’t know how to get past that. I really don’t want to let a 17 year old friendship go down the tubes but I don’t even know how to confront her and frankly, I don’t want to confront her. She called and left a message today, annoyed that I hadn’t called her in months. I know the right thing to do is tell her how I feel but I’m under enough pressure as it is with everything that’s happening, the thought of that ugly confrontation wipes me out before I begin.  I wish I knew what to do.

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Co-existing with infertility

August 16, 2009

Sitting in the doctor’s office after my last miscarriage, Jack on one side of me, the doctor on the other, I felt as if I was part of an intervention. Don’t be so hard on yourself, Jack said shaking his head and patting my hand. Dr. D nodded, In your life when you put your mind to something you’ve accomplished it, but in this matter there’s a lot that’s out of our control. She’s right. Since I was a child, the lessons imparted to me by my parents, teachers, society, was If you work hard enough you can achieve your dreams. And this was true, until now.

In the realm of infertility and pregnancy loss, I can take my Metformin to keep my insulin in check. I can pop the baby aspirin to thin my blood so it won’t strangle a future fetus. I can take the prenatals and make sure I’m eating a balanced baby friendly diet. I can try Clomid. IUI. IVF. I can jump on to lovenox after a positive pregnancy test. I can work as hard as I can and while I should keep my feet moving I have no control over whether any of this will work. This is hard to accept. Perhaps this is why I start sign hunting by checking my boobs, debating the degree of nausea and exhaustion during each two week wait. But sign hunting won’t give me the end result, its just a maddening way to waste two weeks (and in my case often longer) of your life.

Things such as sign hunting and the devastation that follows when you see blood made me think of stepping out of the baby making game for a while until I had my head in the right place emotionally. I told my therapist this thinking he’d agree because if anyone knows how much of a wreck IF has made me, it should be him. I was surprised when he disagreed. You’re in the game and I think you should keep moving, you need to learn to handle the challenges better but I don’t think you will take a time out. I think its an intellectual exercise to debate whether you should or not, you’re too deep in to step back. I think he’s right. I could never stop. The challenge for me is not taking some time off, but learning how to co-exist with my infertility. To walk side by side with this challenge and not let it wear me and turn me into a one dimensional person.

In an effort to co-exist with my IF I decided to focus on things in my control, so I can keep on moving on in this journey but not be paralyzed emotionally while I do so.

No more Sign Hunting. What do I get out of checking my boobs and gauging my levels of exhaustion? If I’m pregnant I am and I’ll find out soon enough. Some people say its good to have your hopes up and be positive. Maybe this works for some, but for me getting my hopes up means they are crushed in a bloody heap at the end of the cycle. Most people get that a miscarriage is sad, but most non-IFers don’t get that the end of a cycle that did not work is heartwrenching too. It is also a loss. I’m not sure how I’m going to succeed here but I’m not googling for signs and symptoms anymore and the goal is to firmly tell myself not to read into things when the urge strikes. If that means chanting a mantra you’re not pregnant, stop it! or Google is not a fortune teller. So be it.

Focus on the things I have control over like . . .

My fitness and nutrition. Exercising burns adrenaline and calms me but when I’m stressed or depressed the last thing I want to do is go for a run. My neighborhood is full of rolling hills and my plan is to stick on the iPod and power walk. I’m also considering yoga. With PCOS losing weight is challenging but its possible. Its time I took greater control.

My hobbies. I love to read. Scrapbook. Try new recipes. Write poetry (of questionable merit).  Instead of imploring Dr. Google to predict my future status of motherhood I will do things I enjoy.

My writing. Though my writing is technically a hobby at the moment since I’m not paid to do it, I have a finished manuscript that I’m revising one last time before submitting to agents. Since the miscarriage issues I’ve neglected it entirely. I need to update my query letters, and pursue this dream.

Reflecting. A dear friend reminded me how important it is  to take advantage of silence and down time to contemplate and reflect. When she first suggested this I wondered what I needed to reflect on or contemplate, but after a few days of plugging out for a few hours from TV, music, cell phone and internet and just taking a walk, or making dinner in silence I saw what she meant. The world comes into sharper focus. I realized its hard to really think clearly when you’re always plugged in. This act of taking time out for silence each day is helping me in ways I could never have anticipated from the simplest areas of appreciating things I never thought to appreciate such as the brilliant orange of a carrot I’m cutting for dinner, the sound of its crispness as I slice through it, the sweet flavor of homegrown tomatoes. Being plugged in, you can end up just doing things by rote and not realizing.  It’s not always easy to co-exist with silence because sometimes thoughts that are unpleasant that I’ve tried running from also make themselves known, but now at least I can begin tackling these thoughts instead of pushing them away, because the truth is, even if we don’t think about things and reflect, they are still there, poking us under the surface, stealing our peace of mind.

My Marriage. Its easy to take Jack for granted. He’s my best friend and he’s always there for me. While I’ve gotten better about dumping all my IF issues on him, I still can’t forget when he said he wanted his wife back. I hope as I try to flesh out the other parts of me that go beyond my desire for motherhood, Jack will see his wife returning. I cannot control all aspects of my marriage but I can control my end of things.

I hope by focusing on the areas of my life I have some measure of control over, I can take away the tunnel vision on IF that has taken over my life. I accept that no matter how much control I take over my life, IF sucks and failed cycles will always hurt, I just hope that I will bounce back faster and not allow IF to take over all of my life. The best I am praying for is it to co-exist with my infertility and not let it wear me as it has for two years.

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Officially Unpregnant

August 13, 2009

My HCG results were so low they’re negative! exclaimed the nurse. When I get sick I bounce back very fast. The doctor used to say your body reacts fast to pathogens, it won’t tolerate any intruders. I process this information, and marvel at how good my body is at this thing, like a bouncer at an elite club dealing with an undesirable mess, quickly ridding itself of all evidence of the dirty deed. Next time around I’ll have to put my little bean on the “all access VIP list” and hope my body parts the velvet rope.

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Clomid. Progesterone. Bloodwork. Oh My!

August 5, 2009

My doctor called today with the results of the panel of tests my maternal fetal specialist ordered to investigate my lupus anticoagulant disorder. The results were funky. The lupus anticoagulant test came back normal which confused my doctor and me. Her theory is that either I’m borderline and the test got me on a good day, or the aspirin is helping fix that issue. Four tests came back bad and I wish I knew the names but they were so convoluted I got confused, however those four clotting disorders that were present increase the risk of miscarriage. My next step is to see a hematologist and go over the results with them and see if they recommend anything above and beyond lovenox or heparin and if this will affect me beyond just getting and staying pregnant. She can’t refer me to a hematologist since I’m no longer pregnant so now I get to go through some insurance fun to figure out my recommendation. Fun times!

As much as I know I should avoid Dr. Google, he’s just always there for me. I’ve been doing some research on the link between PCOS and low progesterone and the results seem to be mixed. Some say that PCOS causes low progesterone which can cause miscarriages. Some say this theory is rubbish. My progesterone levels at 5 weeks pregnant were 9.5 which my doctor said was low. However, the question is: Did the low progesterone cause the miscarriage, or was the pregnancy doomed hence the progesterone low? The reason I’m researching is because I’m considering taking Clomid next cycle. Until now I’ve gotten pregnant twice on Metformin alone but my ovulations happened on crazy cycle days like CD29 and CD40. To be effective progesterone supplements must be taken immediately upon ovulation. Clomid would help us predict ovulation and thus when to take progesterone supplements. So my goal with Clomid is to be able to time my progesterone supplements.

In my OB’s opinion she didn’t think progesterone supplements did anything but it never hurts to take them so she fully supports a Clomid/progesterone cycle if it will ease my worries. She encouraged me to talk to the RE in September to get a more informed opinion.

I’m already taking more pills than an 84 year old grandmother so the thought of adding more pills if I don’t have to is causing me confusion. There are side effects to clomid I’ve read such as decreased EWCM and occasional implantation issues, so if I dont have to take it then I don’t want to [though my ovulation is so unpredictable there is a huge thought of comfort that with Clomid at least I’d most likely ovulate]. I’m just so confused about whether or not progesterone does in fact save pregnancies, or if my issue is just the clotting issue which lovenox could resolve.

Have you used Clomid? Or had low progesterone but successful pregnancies via Lovenox? Any thoughts or advice on any of this that you might have would be much appreciated.

**And by the way- My boobs are aching. I feel ready to sleep at 9pm and have to drag myself out at 8am. I have waves of nausea! Is this normal post-miscarriage? I thought all this stuff should be going away, not to mention I didn’t have them when I was actually pregnant!

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My doctor and the plan

July 30, 2009

I’m still recovering from having passed out as I did. I’ve passed out before but never like this. Jack acts like he’s seen a ghost. I’m worried about some chest pains I’m having, I wish I knew when its serious enough to seek immediate help. I have a mild heart condition (Mild mitrovalve prolapse and Type I AV Nodal Block) so I’ll certainly call my cardiologist tomorrow, I just hope its nerves getting to me and nothing more.

I went to see my OB-GYN today, and we talked about coming up with a plan. I told her that next go around I want progesterone as soon as I ovulate but I never know when I ovulate. She read my mind and offered the following two plans:

a) TTC naturally again and as soon as I get pregnant start lovenox and progesterone.

b) When I’m ready, as soon as I get my period I will go in for her to check my ovaries, and then start me on estrogen meds,  and then Clomid and then progesterone. This will ensure that I will have the progesterone from the get go and will be able to get a positive pregnancy test in a reasonable TWW so I can start the lovenox ASAP.

We’re still waiting for a more complex battery of tests that should come back in a week or two which may mean I will need more meds or more evaluation. Right now I’m leaning towards plan B. Jack wants to start TTC in October. I kind of want to start in September, but maybe two months off is not a bad idea. We still plan to see the RE in September and see what he has to offer.

I am feeling very hopeful. A feeling that’s coming of its own accord without my prodding and reasoning my way into it. I grieve the loss of my miscarriages and the babies for whom I held such dreams and hopes. I will always miss them. Still, I am grateful to know why it possibly happened. Next time we will have more knowledge and perhaps this knowledge will result in a baby I can hold in my arms and cherish. Perhaps. It is this word within which all hope and prayers hinge on.