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01/10/2006
Medical moment
On the advice of my OB/GYN after I failed my more-than-a-year-postpartum glucose tolerance test, I recently visited my primary care doctor for the first time in five years. Three things of note happened at this appointment:
- She glanced at my glucose numbers and barked, "That's not high. Why are you here?"
- When I told her I'd recently lost weight, she asked whether I intended to lose more. I told her I'd like to drop ten more pounds. "And you think you can do that?" she asked, sounding more skeptical than I strictly cared for. "Sure," I answered heartily. "I've lost twenty pounds already. Why not?" She parried with a question: "When was the last time you were at that weight?" During my twenties, I told her. "That was fifteen years ago," she told me sternly, glancing at my birthdate, and changed the subject.
- As we discussed Factor V Leiden, I told her my OB/GYN had directed me to stop taking the pill. "What are you doing for birth control now?" she asked. "Nothing," I told her. She looked incredulous, then said slowly, as if I were a very small, very slow child, "You know you could get pregnant."
I attended a long-awaited consultation with a hematologist about Factor V Leiden. Here is what I learned:
- On average, the risk of developing a blood clot (or a DVT, deep-vein thrombosis) before age 40 is about 1 in 10,000. Because I'm heterozygous for Factor V Leiden, my current risk is somewhere between 4 and 8 in 10,000.
- If I use oral contraceptives, my risk is 35 times higher.
- If I use drugs that stimulate estrogen production, such as in controlled ovarian hyperstimulation, my risk is 100 times higher.
- If I get pregnant, my risk is 7 times higher.
- These risks are based on my status as having Factor V Leiden alone, without taking into account my family history of DVTs.
- These risks are automatically compounded by increasing age.
While lying on my chaise longue languidly eating bonbons and dangling a marabou-trimmed mule from one impeccably pedicured toe, I noticed that the most recent CDC stats are out. These numbers are for 2003, when I did three cycles at my local clinic, so I was eager to see how everyone else I saw dejectedly slumped in the waiting room did that year.
According to the clinic's reporting, which I have no reason to doubt, 52 fresh non-donor cycles were started for women in my age group. How many of those cycles ended with live births? 48%.
To contextualize that number, I'll point out that for the same year in the same age bracket, Cornell, widely regarded as one of the country's best clinics, came in with a 46.5% live birth rate. The nationwide live birth rate is a dismal 37%.
In summary, that year my local clinic kicked embryonic ass. But I know personally and intimately of three cycles that did not result in live births. So let's crunch the numbers. Say I'd gotten and stayed pregnant on my first cycle:
If, out of 50 cycles (52 actual - 2 of mine that failed), there had been 26 live births (25 actual + 1 of mine that hypothetically might have occurred), my local clinic's live birth rate for 2003 would have been 52%.
Say I'd gotten and stayed pregnant on my second cycle: the live birth rate would have been almost 51%.
Say I'd gotten and stayed pregnant on my third. 50%.
Or, heck, say I hadn't cycled at all. 49 cycles, 26 births. 51%.
So...hmm, carry the three, divide by pi...yes. By doing three unsuccessful cycles, I personally was responsible for knocking three whole percentage points off my local clinic's live birth rate.
Jesus, no wonder they suggested I consider donor eggs.
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Your primary care physician sounds like a real harridan. I'm always amazed at how much you KNOW about all of this stuff. Since we are fairly new to infertility, I feel like the amount information swirling around me is hard to conceptualize. I guess I'll get there eventually.
Congratulations on the 20 pounds!
Damn doctors think they know EVERYTHING! This is why I watch that "Mystery Diagnosis" show on Discovery Health. Doctors think that they are so smart without looking at your history - "Congratulations on your 20 lb weight loss! I guess it isn't that big a deal that your not using birth control since it takes invasive medical procedures to get you pregnant" might have been a better response if she had, you know, LOOKED at ANYTHING in your chart.
Ahh, well. At least one of the two doctors isn't concerned about your glucose levels.
And people wonder why I don't have a PCP...
I'd say it is time for you to find a new PCP so you can bring him/her up to date on all of your medical history in one fell swoop...
I once had a family doctor tell me I had shingles on my torso without actually touching me or lifting my shirt. Then sent me home.
I did not have shingles, thank Heavens, but even being a ridiculously bad doctor, he still got my $80.
I'd find a new doctor if I were you. AND you can drop those last 10 pounds. Good for you on the 20!
You're just a troublemaker all-around, aren't you?
;-)
Congrats on the 20 lbs.
Tell your PCP that you were thinking of getting pregnant, having a 10lb baby, and then voila.
I bet she'll give you a coloring page at you next visit.
You have got to be the funniest person on the planet. My husband thinks I am insane cause I stare at the screen then burst out laughing and lunge for the mouse to click Charlie/cat pics.(PS What a cutie!!! And the cats not bad either.)
Your doc's a tool. I know you didn't need me to tell you that. Where do you come up with these people? Random selection from my health plan list only results in about 60% toolhood for my, but you're pushing somewhere in the neighborhood of 90%, I think.
As for your local clinic, you should share your calculations with them. Maybe they'll pay *you* to take your custom elsewhere should you decide on a next time, thereby sparing Charlie's pedialyte fund AND their numbers.
One infertile apple spoils the barrel.
Your doc has the same bedside manner as the first OB/GYN I saw after getting married and relocating to a new city. The first time I saw him was about a month after my wedding, when I was still at my wedding weight - you know - after not eating during my entire engagement. So the next time I saw him was a year after that and well, let's just say I was no longer at that weight. He started asking me if I had had an accident where I couldn't exercise, had I been on medication that might make me gain weight and I said nope, he had just seen me the first time at an unusally low weight and now I was back to my normal weight. He looked me (through my legs that were up in the stirrups) and said "So it's just a fork problem then." I nearly put a foot through his face at that moment. And I never went back. I mean, he was right - it was a fork problem, but let's be a little softer about it, shall we?
Congrats on your 20 pounds - that is great!! And you'll make the last 10 and cuss that doctor every calorie of the way.
Doesn't it make you wish that the doctors we've finally "trained" to deal with us as acutal humans were qualified to treat us with respect to ALL things medical - not just girlie-part-related?
Your pcp is about as helpful as my GI dr.
Congrats on the weight loss
Forget about the 20 lbs -- congrats on being a f@*#ing brilliant writer. Who else in the world can make their glucose tolerance news great reading?
So, how *did* you loose 20 lbs? Did you just do something sensible like eat better and move more? Cos I'm looking for something remarkable because I clearly can't eat better and move more.
I mean, come *on*.
Congrats on the weight loss. Maybe you need to find a new doctor, though.
Now why didn't I think of that?
OMG - as we do the new job/new health insurance shuffle, this is exactly (ok, only sort of) the situation I point to when telling hubs that we WILL be getting the PPO even if it costs more.
I have enough OB/GYN problems as it is and last year my GYN wanted me to see an endocrinologist for a myriad of things. But our POS said i needed a referal from my PCP...so off to random PCP I had never met, told her exactly what was going on and said she had to sign the form because the appointment was the next week, and that was that. So retarded that the PCP got my money for doing nothing. Makes you feel like channeling your inner high school punk and just forging signatures on some badly photocopied form referral that you pilched from the secretaries desk while someone else pulled the fire alarm.
Ugh. I've always had great experiences with my GYNs, but absolutely no relationship or goodness ever came out of a PCP. At least not since I was little and loved my pediatritian :)
Funny, I've had amazing PCPs but have never met a GYN that respected me and females in general..
I just saw you were nominated for a BOB Award (http://www.thebestofblogs.com/) YAY YOU!
And congratulations on the weigh loss thing too. You rock!
I love you.
Someone's doctor obviously rides the stupid train to work. Way to be positive for the patients, champ.
Hey, Julie... how stupid will you feel when you can't shed that last stubborn ten pounds, and the you find yourself knocked up?
Oh... wait....
Never mind...
~C~
P.S. I think you should have brought the maribou-trimmed mule with you to the appointment and beat the doctor with it. Just a suggestion... you know.... for next time....
We have so much in common. Whoa
Surprisingly mellow comments so far (beatings with mules excepted). Doesn't sound like your doctor was representin' very well.
A big if? Hmmm....
My RE thanked me for NOT messing up their numbers -- but in a joking way -- I think ...
Thank you. I don't even know how I stumbled upon your site, but it was exactly what I needed tonight. So much of it was like reading about my own experiences w/miscarriage, ectopic, etc, only this time I could laugh. And w/the worst period of my life, despite the best efforts of myself and DH and our RE, I needed the laughs tonight.
As usual, you SLAY me. Carry on.
I've been reading your blog for some time now, and I've found it very helpful to me as I struggled to have my sweet baby. But I think I want to propose a topic for debate.
Are you nuts?
After all you went through to get Charlie, with all the risks you face to try again, why do that to yourself again when it could end in heartache not only for you, but for Charlie as well?
I am in somewhat of the same boat - I don't think it is wise for me to have another baby, not after what I went through for the first. I think that you can go take all kinds of chances when trying for your first baby. Go ahead and risk it all, your finances and even your life.
But now that there is a baby here, don't we owe it to our babies to the best care of ourselves as possible? physically and financially?
I just want to hear the arguements for and against....
E
I'm still burning with the question: why didn't they test you for the clotting disorder?
The Factor V Leiden information page that you linked to says, "A simple blood test, available since 1993, can test for Factor V Leiden."
It's been available since 1993. You had multiple miscarriages more than ten years after that. Why didn't they test you? Is it just not routinely done? Even if the blood test isn't routine, your problems weren't routine. I would have thought that they'd dig harder in your case.
Your PCP is a bee-och.
Congrats on the 20 - I've lost weight too, maybe 15 or so, just chasing after my youngins, ages 2 1/2 and 15 mos. I think I eat less also - I'm somewhat following the Kelly Ripa diet, which is to eat what falls off the high chair or table, ha ha. A few slices of banana here, a couple of Cherrios there, and voila! It's lunch!
I am there with you on the Factor V Leiden. I had a vanishing twin, 31 week stillbirth, m/c, severe pre-eclampsia, complete placental abruption and IUGR and they never tested me. Finally my pcp decided to test me because of strange bumps on my legs. Guess what positive. They still don't know what the bumps are but at least I now know what causes all the problems when I am pg.
An old PCP of mine misdiagnosed pneumonia. "Oh, it's just a virus. Get lots of rest, drink lots of fluids, and it'll go away." Two days later, I spiked a fever of 104, had a few hallucinations and took myself to the emergency room where a very kindly, small African doctor told me immediately that I had pneumonia. And once I told him what his colleague had said, he gave me my drugs for free.
My dad's a doctor, my sister's a doctor and my mom- poor diabetic, high cholesterol and seizure disordered patient that she is- has about 20 doctors. And what I've learned from all this is:
(1) they think they're smarter than you are b/c they are medical doctors
(2) they are *experimenting* on you. Sure, they are experimenting with a certain level of education and results behind them, but really, they're playing with an expensive chemistry set: your body
You shoulda smacked her in the head and gone about your business. Congrats on the 20lbs, etc.
Oy, nothing like pressure. Are you getting any closer to making a decision? No pressure to tell us what that decision is yet, though. Just wondering how things are going with your process.
btw - I just tried to contribute to Boulder & got an error saying that they're experiencing temporary difficulties.
Julie,
I have decided to take a moment out of my busy day of egg hatchery and prepare a short list of dangerous hobbies you should no longer engage in, now that you have a child:
Further Reproduction
Fencing (saber only)
Eating rare meat
Skydiving
Running with the bulls
Getting into and/or out of the bathtub
Cutting off anyone sporting a California license plate on the freeway
Bear baiting
Heavy lifting
Any form of childrearing
I mean, kids are just portable vectors of disease, and you could totally catch something icky while holding one and then be unable to parent your child effectively and stuff, and I think you owe it to Charlie to be at your personal best.
Discuss.
The reason I love you is as follows: you called it (accurately) a "chaise longue", rather than the now commonly seen "chaise lounge."
i'm de-lurking to say, you are an amazing writer!
thanks for sharing your journey.
will tell you my story at a later date.
I had errors a few days ago trying to buy a chance for Boulder. At that point it was at 59% tickets sold.
Yer a funny woman Julie. I'm so glad you were nominated for a BOB. I read a lot of blogs, less so now that I'm back in law school, but on my year at home with my baby I've read a lot of blogs, and it's strange how the infertility blogs seem invisible to the rest of the parent blogging world. You are definately one of the best bloggers out there, period. Why haven't you been in Glamour Magazine lately? Are you taking your Selma Hyak vitamins regularly?
I just wanted to say that I had a DVT at 25, using no birth control, while I was pretty slim (~120lbs at 5'6") and not any sort of hardcore athlete.
So, sometimes the statistics are crap. Don't fear what you can't change. If you are ready to try again, then do what it takes to have a second child.
As to the 'experimenting' comment, try having a (or several) Dr say to you (on more than one occasion) "I've never seen anyone with that before"
Fun, Fun
May the Schwartz be with you, no matter what you decide.
Congrats on the weight loss. That's hard work and it's just about the best thing that someone who might be predisposed towards diabetes can do for herself, I think.
(Surely I am allowed to say that and have it taken without offense--I had gestational diabetes and am still regularly checking my blood sugar.)
Hey, I had the opposite problem - great PCP, horrid GYN. I went to numerous GYN's who insisted I had a bladder infection and tried to ply me with antibiotics when, in actuality, I had endometriosis. Which is what my PCP insisted I had. He ordered me NOT to take the antibiotics, searched high and low for a GYN for me and finally found one who not only agreed I had endo, but decided to do surgery and apparently, was "amazed" by what he found.
Is it any wonder I kept my PCP even after I moved over 2 hours' away? Doctors can SO suck.
Way to go on the weight loss. I'm sure you'll kick off those last 10 pounds *and* not get pregnant without birth control.
I will never cease to be amazed by the number of doctors who should never be allowed to come in contact with real live patients.
Yesterday I went to my general practitioner for a referral to hospital for birth of my baby (yay!) as my reproductive endochrinologist can only give referrals for 3 months (not long enough). I used to see this dr for chronic fatigue syndrome when in my teens, but I hadn't seen him more than a couple of times in the last 5 years. During the appointment, he insisted I had a host of extra medical conditions, rather than accept that he had merged my file with someone else's.
I opened my referral afterwards to find "there is also a long history of chronic tiredness and I believe she is at risk of developing post natal depression: Sean-Paul (partner) also has a long history of chronic relapsing depression and again I think we need to watch these people very carefully when the baby comes, and after".
Why didn't he just write "FUTURE BABY MURDERER" in capitals?
If we can make it through ectopic pregnency and IVF and still come out stronger than before, that condescending freaking bozo can keep his smug and incorrect opinions to himself.
Sounds like fun! Happy De-lurking Week! xoxo
Doctors definitely think they are smarter than you are. I get so insulted when they try to "talk down to our level", or what they think we can understand. I'm sorry, I know many doctors, and the only reason they are there is because they are the Type A, anal, control-freaks that were desperate to get the attention that doctors get.
Maybe some patients see their doctors as all-knowing. I don't get it.
And Akeeyu, you slay me :-)
Hey Julie
Long time lurker, but had to delurk about the Factor V Leiden thing (& associated thrombophilia). Moi aussi (unfortunately) - fortunately my lovely drs (I;m in the UK) discovered it in a battery of recurrent m/c testing (only 3 miscarriages) & I now have my adorable son. I have lots of info if it helps (which I am sure you can google for anyway) but injected low molecular weight heparin & took daily low dose aspirin throughout my pregnancy & 6 weeks post-partum & had a healthy & gorgeous (now nearly 2 year old) boy. I am now on the same regime for #2 (significantly shorter ttc time thanks to sussing out PCOS, endo & thrombophilia first time round & knowing what you face is half the battle isn't it?) and so far so good (please let that not be tempting fate at 20 weeks pg). Anyway, this was not meant to be about me, I just kind of felt a side-glance of affinity with your situation. Yes there is high risk attached to a FVL pregnancy (ok lower for us heterozygotes than the poor homozygotes), but with treatment that is reduced, and the complications and risks (m/c, intra-uterine growth restriction, pre-eclampsia etc) are worth it all for a beautiful child or children. If you want any info. let me know - happy to oblige. Good luck by the way & 20 pounds is brilliant! Oh & serious apologies for the over-use of brackets, too many "asides" for my own good.
Hi guys. A good man would prefer to be defeated than to defeat injustice by evil means.
I am from Paraguay and also am speaking English, give true I wrote the following sentence: "Pharmaceutical major ranbaxy laboratories today said it has settled all."
Thanks for the help :D, Walter.
I'm not sure why, but something tells me I wouldn't like my doctor as much if he talked to me like that. He's always been more of the fatherly, how-are-you-doing-today-Miss-Lainey-and-my-haven't-you-grown type, welcoming me with a warm handshake and settling the both of us down to figure out what's wrong with me (as that's generally the only time I see him). I'm lucky - I don't have to dig around for facts or for proper, personal treatment. It's all just there for me, and (thanks to my mother) has been since I was born.
Also: the pics in the last post of Charlie and your cat are adorable!
I'm not sure why, but something tells me I wouldn't like my doctor as much if he talked to me like that. He's always been more of the fatherly, how-are-you-doing-today-Miss-Lainey-and-my-haven't-you-grown type, welcoming me with a warm handshake and settling the both of us down to figure out what's wrong with me (as that's generally the only time I see him). I'm lucky - I don't have to dig around for facts or for proper, personal treatment. It's all just there for me, and (thanks to my mother) has been since I was born.
Also: the pics in the last post of Charlie and your cat are adorable!