Thursday, August 31, 2006

A new, positive outlook for the future... FINALLY!

I finally have a new, positive outlook for what is to come for TTC...finally, finally.

On first impressions alone, the MFM clinic had their act together - we were amazed from the second we stepped into the clinic. All we had to do was hand over our paperwork I completed ahead of time, they copied my insurance card and drivers license, and we paid my $10 co-pay. Plus, they validated our parking ticket, so we didn't have to pay for parking - spiffy! Less than ten minutes later, Dr. W actually came out to get us, personally, and led us to his office (which his walls were PLASTERED with diplomas and certifications...very reassuring we are in the best of hands). What a breath of fresh air that was!

...I must say up front that I am going to have some FUN with Dr. D next time I see him! Dr. W explained to us that he sees Dr. D at least 2-3 times a week, between weekly staff conferences at the obstetrics department in the hospital and consults while women are laboring/delivering - so, he assured us, he and "Tommy" (yes.... TOMMY!) will be in touch often about what is going on in our case, well beyond the formal "consult report" he will send over to Dr. D this week. What a nice reassurance that was... And, I am going to have a ball calling Dr. D "Tommy" next time I'm meeting with him. Heehee!

Now, onto the nitty gritty of the appointment...

After explaining the usual "stuff"of the consults they run through - how at least 70% of women will go on to have normal PG's after habitual m/c's, how nothing can really be done in the 1st trimester if a woman is going to m/c, how the "school of thought" is split on certain protocols of treatment (like progesterone, baby aspirin, etc.), yada, yada, yada - we went over family history. He said Dr. D did not send him everything from the recurrent loss panel he would have liked to see (i.e., the chromosome panels on both Hubby and I) - he wants to see it because of a case of CP and a case of Down's Syndrome on Hubby's side of the family. But, that is okay for now since Dr. D did not flag anything. He will request it from Dr. D after the appointment, just to verify Hubby's chromosomes are okay (Hubby is jealous that, technically, he can call me a "mutant" and can't - what a weirdo I married!).

He reviewed the genetic testing results from the d&e in 11/05 and the d&c in 3/06. Obviously, a gender could not be determined in the 11/05 d&e because there was really no baby to test. I knew that. But, he said that in the genetic testing from the 3/06 d&c, it showed a "normal female." I knew that too. He said that, honestly, there is really no way to tell the gender of that baby - at the stage of PG I was at the time of the d&c, there is a good likelihood that part of what was included in the genetic testing was specimens from me from the procedure, resulting in the "female" result. I knew that too - I have read up A LOT on how many errors in gender can be made on genetic testing from a d&c. But, in my heart, I know my last angel was a girl - and, he was kind enough to respect that.

He then asked the question "Why were we here?"

I explained that after Dr. D found the homozygous MTHFR mutation and elevated homocysteine levels, he urged us to come over for the consult before we considered getting PG again. Dr. W then said that he was glad it was Dr. D who suggested the consult, not us pushing for it and forcing the issue. The reason for his thoughts on that are, even though he knows we are scared and nervous about TTC again (as are many couples who have dealt with recurrent losses), our heads and hearts are in the right place to try again. He said when women/couples force their docs for the consult, especially after only one to two losses, emotionally they are not ready for this - and, in the end, they may not even have a problem that needs to be addressed. Not that being proactive is bad, in his estimation... He said that, even though we (really I) have had a hard time dealing with the losses, we (really I) are thinking logically and pushing to address the long-term issues of my healthy first - and THAT will make his role in this more successful. It is very nice to know he would like to see the long-term issues addressed first - can't have a healthy PG withouth a healthy mommy, right?

Then, we got into the specifics of why we were there...

Dr. W said, first and foremost, we HAVE to get the homocysteine levels way down. He said that, well beyond PG losses, the levels are not good for my overall, long term health (specically cardiac) and they have to be brought down now. So, he wrote a script out for Folgard to start immediately - then, since we are not looking to start TTC again until Janaury, he will retest the levels in early November. Of course, one of the other docs involved (either Dr. D or Dr. McC) can test it earlier if they want - just make sure a report is sent over to him to keep him updated. Once I DO get PG, then I will be seen very often in the 1st trimester for u/s's and check-ups at the clinic, in addition to Dr. D, since the 1st trimester is the most important for the condition. So, we should have many u/s pics to share, when the time comes. :)

As for the thyroid issues - he said that, until we know for sure if I really DO have a thyroid issue, he can't say for sure how things will go. Yes, my levels are elevated, but not HIGH - which means, either I am starting to go hyperthyroid or this could actually be a fluke and my thyroid could be normal (especially with no family history of the condition). So, he wants to see the results of the thyroid scan and uptake tests done on 9/13 and we will go from there. If I do have a hyperthyroid, I have four months to get it under control (which is plenty of time) - and, in his estimation, because it is not running rampant and it was caught early, I should just need oral meds to get it under control. For clinic purposes, if I am hyperthyroid, I would be seeing them often throughout the entire PG, checking for normal growth in the baby and thyroid levels. He said, yes it is a complication - but a managable complication as long as I am being seen regularly by them, my Dr. D and an endocrinologist (which I have to schedule today, just in case I need it).

He also said that he needs to request from Dr. D the thrombophila and autoimmune panels run in the recurrent loss panel from May - even though Dr. D said to me the results were normal, he wants to see them anyway to verify the results (not that he doesn't trust Dr. D's judgement - he assured me that Dr. D ran one of the most thorough recurrent loss panels a doc could run). If he sees anything that is on the high-end of "normal," he will consider also adding in the baby aspirin and/or heparin injections into the cocktail with Folgard.

Now...on to the part that pissed me off with Dr. R (the upper GI doc) and why I will NEVER, EVER see him again on purpose...

Not only did he not give the elevated thyroid levels urgency to me...
Not only did he not address the pressure in my stomach which was causing me to not be able to eat and feel sick to my stomach after what I did eat (chalking it up to good 'ol IBS)...

...He totally MISrepresented the CT scan results on the fibroids! I have worried for a month now that this was going to be an issue...and, depending on where they were located, I might have to have surgery to remove them. Turns out the report said I have one fibroid at the top of my uterus on the outside - which is the SAME ONE I KNEW I HAD FOR AT LEAST THREE FREAKIN YEARS!! So, I have worried for a month over nothing. I am pissed.

Dr. W said that, knowing this is the same fibroid I knew I had all along and that it caused no complications with PG and labor/delivery with Chris, that it should not cause any problems now. So, that takes fibroids out of the mix of complications to worry about. Yeah!

My goals for this week now stand at:

  1. Scheduling a much-overdue annual exam with Dr. D
  2. Scheduling an infertility consult appointment with Dr. D to see how he is planning to get me knocked up next time around
  3. Scheduling the endocrinologist appointment (just in case I need it)
  4. Calling Dr. P (my counselor) to update him on things, at his request, before my 9/11 appointment
  5. Finish up and pawn off my projects at work in prep for vacation - YEAH!
  6. and PACK!

Overall, I have nothing but hope for TTC again...finally. I still have the hurdle of the thyroid scan, but cannot worry about that now until the test is done.

So, for now, I am going to concentrate of LIVING again....and enjoy my vacation, and my time with Chris and my family. I am going to keep walking and feeling physically better. I am going to thank God for what I have in my life and take what is to come with some grace and resolve. I am going to live my life again. And, it is such a good feeling.

I do ask everyone to say a special prayer for my friend S... She had her FET done yesterday, and the procedure went very well (better than any of the previous transfers she has had done - BIG day for good news all around, huh?). She has gone way to long with infertility and it is her time to be called Mommy. Please pray that she gets that BFP she and her DH have been waiting for... They deserve this and it is their turn to get off the rollercoaster of IF.

I also ask everyone to say a special prayer for my sister's manager at work... He died suddenly between Tuesday night and Wednesday morning and wasn't found until his wife came home from an out-of-state business trip yesterday morning. They are suspecting a massive stroke and no one was there to get him to the hospital. May he find some peace....and everyone he worked with find a way to remember him as the nice guy he was.


Jessica said...

I am so glad you had such a great and informative appt and that you feel more positive having these answers. Yes I have said many prayers for S and am hoping that i can congratulate her in 2 weeks!
So sorry to hear about your sister's manager. How sad. :(

:hugs: to you!

mossyclog said...

Tina I am so glad you had such a wonderful and positive visit with the new doctor!! YEAH!!

I hope you have a wonderful vacation!!!!!!!!

ilyse said...

I am so glad to hear that everything went so well and you"sounding" so good!!!