The meeting with the doctor went rather well. I was really glad that my husband was with me to hear the doctor's answers. I think it helped him to understand my concerns better. But I was not completely satisfied with my doctor's answers.
When the nurse called us back, she just led us into the doctor's office. The doctor made a comment and laughed about my impressive list of questions:
- How did the immunology tests get overlooked?
- What is the level of Lupus Anticoagulants detected in all immunology testing?
- What is your opinion of Lupus Anticoagulants and its effects on pregnancy?
- If there is concern for the effects of LA on pregnancy, what is the treatment you prescribed of LA?
- What study data can you provide me to help me understand your opinion of LA and treatment?
- What are the risk factors when the treatment of Heparin and Baby Aspirin are used?
- How long would I take Heparin and Baby Aspirin if prescribed for treatment?
- How frequently will you be monitoring LA?
- What is the level of Progesterone detected October 4, 2001 and October 8, 2001?
- Was my Progesterone level tested at any time during any of my past pregnancies? What were the levels?
- How long do you recommend I take the Progesterone supplements?
- What were the side effects you see in women on Progesterone?
- Is there a decrease in nausea when Progesterone suppositories are used?
- Are there any interactions with Progesterone and Heparin?
- How frequently will you be monitoring my Progesterone levels?
- At what stage in pregnancy will the cerclage be placed? And what type of stitch will be used (McDonald or Shirodkar)?
- Do you have any recommendations on activity level before and after the cerclage?
- How frequently will you be monitoring my cervix with vaginal ultrasound?
- At what stage in pregnancy will the cerclage be removed?
- What are some complications associated with the cerclage?
- What are the effects of Heparin use and do they cause complications with the cerclage?
- Are there any other risk factors that we should be concerned with testing for?
- How often can I expect to meet with you to ask questions, receive exams or collect blood and tissue samples?
- How do you handle a patient who is extremely nervous, who questions all areas of care, and who has certain expectations of care and treatment?
- Do you have a perinatologist you recommend in case serious complications arise and can you recommend a consultation visit with a specialist that can work with you during my care?
- Can I get copies of all my records regarding my OB/GYN care?
- What do you recommend I do if I ever feel uneasy about this pregnancy or I suspect something is going wrong?
While I didn't feel that all questions were properly addressed, I do feel that his suggested treatment was satisfactory. He wants me to continue the progesterone supplements until week 10 (but I am going to pick another day to argue with him about taking them until week 12).
I start the heparin shots and I continue to take baby aspirin daily. He also wanted me to take a 500mg calcium supplement to offset the risks for osteoporosis that prolonged use of heparin brings. And if everything goes well, we can plan for the cerclage around week 12.
I could feel the stress finally start to melt away. Since my progesterone levels went up to 15 from 7, he suggested I get started on the heparin today. That was a huge relief in itself. He mentioned he wanted me to take .5 cc twice-daily subcutaneously during the first trimester. During the second trimester the dosage would be increased to .75 cc twice daily and during the third trimester the dosage is increased again to 1.0 cc twice daily.
Since it was lunchtime, and the triage nurse wasn't available for another 30 minutes, my husband and I went to get us some lunch really quick. We chatted about what the doctor discussed and he was happy that I started to feel less anxious.
When we returned, I started to feel a bit anxious. I had talked myself into the fact that I would have to give myself shots but now the moment was upon us and I was scared. Thank goodness it wasn't as bad as my imagination started making it out to be. When the triage nurse came, she informed us that I would do some practice shots with her.
She stuck me once to show me how to draw the solution (saline for practicing) from the vial, clear out the air bubbles, and inject the syringe. Then it was my turn! Since I had some experience with giving my old cat shots for his diabetes, I did rather well. Of course sticking yourself is a bit harder because you have to find a spot that doesn't hurt so much, but after the nurse showed me 4 zones around my belly that work well, I found a spot that didn't hurt too much and gave myself my first shot. She had me practice one more time and then I was set.
That afternoon, after my husband went off to work, I went in search of filling my prescription. I had no idea that most pharmacies do not stock heparin. I tried my local grocery store and they said they would have to order it in because they only had the single dose vials, which would be a big waste. I went to Walgreen's where they told me to check with the hospital pharmacy because they didn't stock it either. Fortunately, there is a small, local hospital in town (I live 30 minutes away from the big one my OB/GYN is set up in) and I found that they stock the heparin regularly. Since my insurance doesn't cover syringes, the hospital pharmacy gave me a special deal of 60 syringes for $10. The heparin was only $10 with my insurance co-pay and I got quite a few vials. I could only imagine what I would have to pay if I didn't fill at a compassionate pharmacy!
Once I picked up my meds, I went home right away to give myself my first REAL shot. Practicing with the saline was nice and not painful, but it didn't prepare me with how bad the shot burned when I had the real heparin. Now I understand why you get bruises from these shots. I guess this means I officially join the ranks for the Bruised Belly Brigade!
I go see the doctor in one week for my first ultrasound. I am nervous but I am going to try to keep busy until then so I don't stress myself out too much.