Sunday, August 07, 2005

About my doctors and timely action...

(Julie, I started to answer your question in the comments and it's longer than a comment would be, so I thought I'd do a post. It's relevant to what I write, anyway. Bear with me, as it's pretty long.)

So how am I getting action from my doctors in a timely manner? Well, let's see. Perhaps I'm really not. After my first loss, I went to the follow-up appointment alone, and took copies of my charts with me since I wanted Dr. K (who has been my gynecologist for the past seven years) to give me a progesterone test.

Ok. I need to back up a bit. Let's go back to 2004; it was time for my annual exam (June-ish?), G and I had a big trip planned in October (to Nantucket, it was lovely) and we were not going to start TTC until after we returned. So I mentioned to Dr. K that we were going to start trying in October, and that I was charting. She said "ok, but when October comes, I want you to put away the thermometer." I also said that I noticed that my LP was on the shorter side of normal (at the time, between 10-12 days) and I was concerned about a possible luteal phase defect. She said "don't worry about that now; just have sex a lot and if that doesn't work, we'll talk."

So, my second cycle started mid-November, and we got pregnant. At 7w4d I had started spotting, they brought me in the next day for an ultrasound, and we had no embryo. Could have been a blighted ovum, or could have reabsorbed, since I didn't have an earlier u/s I'll never know for sure.

Back to the follow-up. Dr. K took a look at my charts and said "well, you're ovulating, so I don't see a problem." I said something about my LP. She said "well normally we like to see them 14 days, but you're close." When I inquired about progesterone testing, she said that "there was no normal level" and she wouldn't do the test. She also said again that I should stop charting, and just have sex on days 10, 12 and 14. When I inquired about the fact that I was almost 35, she said "we don't really worry anymore until someone is 38." I started crying in the exam room.

About four months later I turned 35 and got my period the same week. (Not a "happy birthday", exactly.) But the cycle after my birthday, we got pregnant again; found out Memorial Day weekend. (By the next national holiday I had miscarried again.)

We had spotting this time, too. It was late afternoon on the Friday of the long weekend, Dr. K was on call that day, and had me rush into the sonography department before they closed. We went into the same room where we'd learned about the last loss, which I somehow knew was a bad omen. And as the tech was struggling to find anything, and then saw a smaller-than-it-should-have-been embryo, she asked me "have you ever been told you had a septate uterus?" I told her no, and that I didn't really know what that meant. She didn't explain.

The perinatologist who came in to confirm her measurements also mentioned a septum, but only to the tech. He said little to me until it was time to tell me that I was measuring three weeks behind the 9 weeks I should have been.

I had my follow-up hcg levels after the miscarriage. When someone other than Dr. K called to tell me the results, he was professional in a strangely chipper kind of way. And I was feeling so fragile, talking to this man I'd never met, that I kind of broke down and though I was choking back tears, asked about testing to find out why I was losing my babies. He started talking vague statistics: "most losses" and "very few causes" blah blah blah. I snapped. I said that I still wanted to be tested, whether through their office, a referral to a specialist, or I would find another doctor.

After that, his tone changed; I got an appointment for the following week.

I had G with me this time, and I was prepared to be defiant. Dr. K seemed kind of defensive at times (when she talked about there being no way to fix an elevated FSH level, for instance) but I insisted. The only thing I lost on was the progesterone draw. I think the only reason I'm getting the HSG so quickly is that there may actually be a problem there.

So that's the long story. I still may end up firing Dr. K, depending what she does after we get some of the bloodwork back, but I thought I'd give her one more chance to make me feel she's on my side. I'm sorry that all women going through this (or even worse, later term losses) have to go through agony to get seen, get tested, get results from people they're PAYING to treat them. It's a shame.


Blogger Julie said...

You know, you need to email me. We have some commonalities.
Thanks for the explanation. With the recent closing of one of our major Women's Centers, my options are dwindling, not that I really *want* another doctor, but I'm getting perturbed. What is with the hesitancy to checking progesterone anyway?? And, for the record, mine has forbade me from BBT charting, "it only serves to make you upset" - so of course I do it anyway.

8/07/2005 8:35 AM  
Blogger Lorem ipsum said...

Hey, congrats on getting your period. Even our bodies have ways of marking the time (usually).

My tale... My doctor (who is consistently voted best in the city) didn't even want to look at my charts. Period. She said temping was 'unscientific' and (like Julie's doctor) only stressed people out. Then I had a luteal progesterone level of 11.5 and she said it was perfectly fine, but other people on FF have been told that it should be at least 20. (To her credit, though, she recommended I see an RE after two losses, not three. My age, you know.)

A few days ago I was on the phone with one of her (compassionate) medical assistants telling about how unimportant I feel, that the only time I see Dr. B is when I'm pregnant or having a D&C. Then the D&C is done and I'm relegated to seeing one of the nurse practitioners. The MA told me that Dr. B is such a popular doctor she's booked for regular GYN appointments till next February. Seems she doesn't have a regular GYN practice; she spends much of her time consulting with pregnant women and delivering babies. That said, I will be seeing the RE within two weeks of having made the appointment with him. I hope that won't be the only time (if you know what I mean).

I'm hoping the progesterone all it is and that your RE is more thorough and timely. Make an appointment this week; it may take several weeks to get in and you can always cancel it.

8/07/2005 10:51 AM  
Blogger Catherine said...

Run, don't walk, to another doctor. Why are you giving this doctor "chances?" Good grief...if you had a serious illness would you just hang around if you felt your illness wasn't being aggressively treated?

8/07/2005 10:56 AM  
Blogger Lisa P. said...

Cath, I don't know. My gut tells me to run, but my legs don't move. I worry (needlessly, I'm sure) that if I go to an RE now, before finding out what's wrong, that insurance won't pay for it. (I never said I was logical.)

8/07/2005 11:13 AM  
Blogger Lisa P. said...

Or I'm just being an idiot and making excuses. I don't know.

I'm tempted to see what the bloodwork says before doing anything else, though, at this point. That way at least I'd be armed. I am probably crazy of course, but it's the only thing that's making sense right now.

8/07/2005 11:26 AM  
Blogger Lorem ipsum said...

Guess what? An RE can run the same tests your OB can. Probably without as much argument, too.

8/07/2005 2:57 PM  
Blogger Jill said...

Lisa, get out of there. My OB runs whatever test I want as long as there is at least some small piece of logic behind my request. That logic has been as dodgy as 'I need to do it for my mental well-being even though I know intellectually it is unneccessary. Please can we and then I will not ask again?? Pahleaeeeeeese??'

Your doctor seems to be locked in a power struggle with you, intent on showing you who has the power in the relationship. This needs to be a partnership - after all, she's the third party in your BABY MAKING - intimate possie, no?

I am really pissed at her attitude if you can't tell!! It'll be good to get those test results back anyway and then you can go to the RE next.

8/07/2005 5:37 PM  

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