My first peri appt was a little strange...

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My first peri appt was a little strange...

Postby tahoe4 » Mon Nov 24, 2003 11:45 am

I'm 11 weeks now with my second pregnancy. I had eclampsia with my first and delivered this past December at 34 weeks. With this pregnancy I'll be seeing my OB as my primary and a peri as a secondary. They're supposed to be working together.

So I went to see my OB for my first visit last Wednesday. I had my list of questions ready along with all of my blood pressures documented for her to see. That visit went very well.

I saw my peri for the first time on Friday. I've only seen a peri one time as a pre-pregnancy consult. This peri was in the same practice, but she's leaving the practice now. So the peri I saw on Friday is from the same practice, but the first time I saw her. The visit was very strange. She never took a urine sample or my blood pressure. The only thing she talked about was Lovenox injections that my hematologist recommended starting in the second trimester (due to Factor V Leiden). She said that while she doesn't disagree with the injections, she thinks it's a bit overkill. She thinks baby aspirin should be enough. I did have blood clots in my placenta last pregnancy. I told her about this thinking that maybe she was unaware, but that seemed to have no relevance on her opinion. So she basically left it up to me. That is the only thing she talked about. Nothing about how the next visits would go, how often I'd see her, what tests will be done, very little discussion about my last pregnancy experience and nothing about BP.

I still don't know what the point was of going to see her. She did absolutely nothing for me. She is the head of the MFM department at the hospital so I thought she'd really know what she's doing. Maybe my expectations were too high?? Not sure if this was normal for a peri visit or not. She isn't my primary care, so maybe that's why she did very little for me. When she left the room my husband and I were just staring at each other in disbelief. The least she could have done was take my BP? Does this whole experience sound strange or am I expecting too much from my secondary care?
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Re : My first peri appt was a little strange...

Postby catherine » Mon Nov 24, 2003 12:22 am

It is disappointing but I don't know that it is that unusual. If your BP is behaving then there probably isn't that much to talk about. When I was at the same point in my last pregnancy I had pretty much the same experience except that my MFM specialist was also my OB!!! (The NP did BP and urine). He suggested the baby asprin, offered the option of Lovenox, also left it up to me to decide. They had already done a bunch of blood tests for baseline values but that was it. His attitude seemed to be that he wasn't going to treat a problem that didn't exist. He took things one step at a time. So long as I was looking fine no need to chat about what might not happen. I don't know whether that is the most comforting approach to encounter, I rationalized it as... all day he deals with dire emergencies, he knows one when he sees it, he knows what he's doing, if I'm fine, then.... All the way through to my last visit! I did get the "phone or come in if there is even a hint of a problem" and on the rare occasion that I did call, I always got a very rapid response and always from people who were familar with my previous OB history.

It sounds like you have a good OB and that the role of the perinatologist is a consultant. So far, and long may it stay that way, she probably doesn't have much to consult about.

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Re : My first peri appt was a little strange...

Postby annegarrett » Mon Nov 24, 2003 03:05 pm

It is true--most perinatologists feel there is nothing to be done but "wait and see" and so they do "expectant management". There is lots of good advice on taking care of yourself with diet and supplements on the Ask the Experienced section--not that we "endorse" any one thing but as long as the advice seems sound to you and your doctor--it is not going to hurt to be extra healthy in your eating. (Alyssa has some good posts on that topic).

This may sound odd--but the questions that you list...did you ask those? I would always write a list and just go down it at the office. A lot of doctors don't have much time and they don't want to burden you with "too much information" so you have to be proactive and ask.

This is particularly the case with preeclampsia where the doctors tend to lean towards "let's not stress her out unnecessarily" (like with you--seemingly doing well.

I should also mention that ALL women who develop preeclampsia etc...will have blood clots in their placenta. That is what sets the disease in motion. It would be perfectly appropriate to ask WHEN they will be doing an ultrasound of the placenta--not if. Just the fact you have a peri is a good start--but don't be afraid to push for better care.

Take care of yourself and let us know if you have any more questions-lots of good advice here.

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Re : My first peri appt was a little strange...

Postby lisac » Mon Nov 24, 2003 03:42 pm

Hi there,
I was also told to take blood thinner (heparin) next pg. For me there is only a very very low positive cardiolipin, which is known to cause clotting. Even though they aren't sure that this is what caused the PE, two perinatologists concur that the risk with heparin is so low that it's worth taking from day one of pregnancy.

So here's a case of only a possibility of having clotting issues and being told that heparin is a safe bet. You know that you have a clotting disorder, so it seems that your case would be even stronger. I'm certainly not a doctor, but you may want to take the blood thinner option seriously and explore it further.
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Re : My first peri appt was a little strange...

Postby taras mom » Tue Nov 25, 2003 03:33 am

It sounds as if your OB is being very thorough, and the peri probably does see herself as just a backup for now, as the others have suggested. It's early, so as long as you're doing well she probably sees no need to get actively involved. The best thing you can do is make sure she has the most current data from your OB before your peri appointments. With the healthcare bureaucracy the way it is, you can't assume records are being transferred promptly; I was still juggling paperwork 8 months after Tara was born.

Since she's leaving the Lovenox decision up to you, maybe you should get more information from your hematologist. Finding out why he or she recommends this particular drug might help you make the decision.

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Re : My first peri appt was a little strange...

Postby tahoe4 » Tue Nov 25, 2003 07:32 am

I'm definitely going to take the Lovenox. I just thought it was odd that my hematologist wrote a letter to all of my docs explaining the need for it and that my peri agreed that it was the right decision. Then when I go and talk to her she acts like it's overkill.

I was ready to ask her all kinds of questions, but my appt ended very abruptly. After we discussed the Lovenox she said OK I'll be back in just a minute and she left the room. After my DH and I waited for about 10 minutes I went out into the hall and asked all the nurses if the doc was coming back. They said she just went in with another patient so she must be finished with me. So I didn't really get to ask her anything else. I did ask all of my questions to my OB though, so I'm comfortable enough with that. I guess I know now not to expect too much from my peri.
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Re : My first peri appt was a little strange...

Postby akemt » Tue Nov 25, 2003 10:29 am

What a bummer that it was such a disappointment. I'm glad that you've made up your mind and that you are happy with your OB!

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Re : My first peri appt was a little strange...

Postby jenny » Thu Jan 08, 2004 03:47 pm

I saw Anne mention women with pre -e. having blood clots in the placentas.....at about 13 weeks I had a subchorionic hemmorhage(blood clot) that was of a good size and later resolved completely I was told. But I was wondering if there has been any link made to these types of clots under or near the placenta early on with pre-e. later?
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Re : My first peri appt was a little strange...

Postby lisac » Thu Jan 08, 2004 04:02 pm

Hi Jenny,
That's a really interesting question. I had an ultrasound at 8 wks just to check things out because I didn't feel pregnant at all. It turns out that there was a hemmorhage on the u/s; my doctor was unphased--said it was either a vanishing twin or a hemmorhage Supposedly this is common.
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Re : My first peri appt was a little strange...

Postby maxs mom » Thu Jan 08, 2004 09:32 pm

My only advice would be, consider getting a different Peri. From the beginning we had slight problems with my OB/Gyn when I was pregnant. These problems never went away (constant tardiness, brief answers, long waiting, etc) The longer I stayed with her, the more miserable I was. When your Peri walks out and leaves you in a room, that's a little weird!

Now, I have noticed most Peri's work best in emergency situations. I see the Medical Director at my Peri group, and he is brief and to the point. I live with it because I know he is good and I can be just as fast and efficient as he is (e.g. have all of my questions ready to go, etc) But I could see his approach not working for everyone, so there are other options. You may want to explore this. Your current OB may know the personalities in the group and may be able to refer you to one that you are more comfortable with.

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