riehlism

[cmccaffrey]

I know you and I have spoken about your MFM before, but I was wondering what sorts of information he gave you at your preconception consultation? He has had to reschedule me twice (once before we had arrived at the office and another time after we had already been waiting for 3 hours to see him) because he is so busy, which I completely understand because I am not pregnant so it's not an emergency. Anyways, my husband is wondering if this doctor is even worth all the trouble because of all the waiting and rescheduling. For me, I am willing to deal with it to see if he has something more proactive planned for future pregnancies than my other MFM, but if his plan is not so different, then I wonder if it is such a good idea to see a doctor that is SOOOO overbooked with patients. I am having a hard time explaining to my husband that this guy is literally THE BEST. I mean... I have shown my husband several articles written about this MFM and he is still wondering how the doctor has not come up with a better system to manage all of the patients. I don't know... I still plan on meeting with him, but I just wanted to read your point of view.

[riehlism]

I saw him for pre-conceptual counseling maybe 2 months postpartum. He ran requested bloodwork for a thombophilia panel, reviewed my history (which was brief since I had nothing remarkable in my history), and answered any questions I had. I asked how soon I could get pregnant. He said 8 months due to the classical c-section. I asked about a plan for once I do get pregnant and he said baby aspirin, lovenox (if needed only, but likely not), maybe even prednisone. But he pretty much said baby aspirin is definite and to start immediately, but that changes in the plan would be made if needed (growth restrictions, etc).

Just remember, I have chosen to stay with my OB and just have trimester check-ups with this MFM. So if you're comfortable with the MFM you have, I'm sure he/she can do a good job as well. He probably kept canceling because of his active patients. You may be right with that one. I honestly think he made time for me in for a pre-conceptual because of who my OB is.

In terms of a pre-conceptual consult, he gave me the information I needed at the time. I am going to see him this Wednesday. If there is anything else interesting I'll update on this post. I am going to guess your MFM appt didn't go differently from mine. However, his reputation from basically...everywhere is pretty amazing. It's very hard to turn down an opportunity to see someone like that. I'll let you know what all the cool kids are talking about.

[cmccaffrey]

I am waiting to meet with this doctor again.... This time my husband couldn't make the appointment. It feels so weird meeting with someone over something that has not happened yet, especially when everyone in the waiting room is literally about to pop. Hopefully I will get to meet with him tonight and he won't have to reschedule. I'll let you know what happens at the appointment.

[riehlism]

So I saw him last night. Actually...I saw his this morning! Dr. ** is pretty crazy working the hours he works. But moving on.

So my appt was at 7:30pm. I got there and the front office said he is running 4 hours behind. I later found out it took him 3 hours to get to the Northridge office (405 issues). He has patients at Northridge, Santa Monica, and the big hospital in Westwood. I live close to the clinic so she said I could go home, call at 9:30 to see how the time is running. I call at 9:30pm and she says to come around 10:30pm where I can start drinking my fluid to fill my bladder for the U/S.

I get there at 10:30pm and there are 2 ladies ahead of me. I finally got in around 11:45pm. While waiting all I could think was: this is ridiculous. I can't keep going through this.

So I go in, and we meet him in the exam room. He had a cell phone, 2 pagers, and a fanny pack. He's a very busy man. I think he's a night owl because he had so much more personality than he did at the preconceptual counseling. He looked at the baby and then we went to the office to have a discussion. He spent quite a bit of time talking to me about HELLP, gave me a recurrence rate of 20%, and medication options.

At the pre-conceptual counseling appt he ordered a bunch of tests. He said there is a specific way of treating each underlying disorder. This is the first time I heard this. On the boards it's baby aspirin and lovenox. But he says if so and so test is positive, then you have to use x steroid. While baby aspirin and lovenox is common, it is because the outcomes of the test call for that. There are a lot of underlying things that may need to be treated differently from the standard aspirin/lovenox.

For me, he recommended that I stay on aspirin, add more folic acid, and...Lovenox

He also said he would like to monitor me closely because this can require dosage changes throughout the pregnancy. I will still be seeing my OB, who will deliver me. But I will see my OB once a month and Dr. ** more often to monitor.

Overall impression:
I was unhappy with the wait. Then I saw him and I understood. Once you finally get to him, no one else is more important than you at that moment. He doesn't run off to see another patient. He doesn't shoo you away (even when it's 12:30am the next day). He provides thorough answers, and gives you plenty of opportunity to ask questions. If he has to spend an hour with you, he will. Are his waits a pain in the butt? Oh yeah. Is the inconvenience worth it? It was for me.

This appointment was different from my preconceptual appt. You can easily be dissuaded by the generality he gives you at the preconceptual counseling. But that is because there really isn't anything to talk about until you're actually pregnant. It would just be a conversation of what-ifs. And a man like that wants objective facts to make suggestions.

It was different, but I was happy...minus the Loevenox.

[sam10]

That sounds like crazy office hours, but if it is worth it...May I ask why he recommended Lovenox for you. If I remember correctly you have MThFR? Do you have any other underlying disorders?

[riehlism]

MTHFR is nothing. A third of the population have it, so it's not really a factor. I started to get BP problems at 22 weeks, so he was more concerned with how early and how severe it got with me.

[sam10]

Interesting.....if I understand correctly his reason was the early onset and severity of PE in your case? I am just curious to understand your doctor's reasoning.
I asked my MFM when I was "briefly" pregnant in Feb/March of this year (before my MC) if I need Lovenox and he said no. Not enough research and it is a drug that should not be prescribed lightly. He thinks for me it benefits don't outweigh the risks, (no clotting disorders, "only" homocygote MTHFR, but with normal homocysteine levels). But I had early onset of severe PE. No other risk factors.

[cmccaffrey]

okay... so annoyed because I keep posting and then keep accidentally deleting my post!
here goes again!

The preconception consultation did no go much differently than my other MFM consultation in that he pretty much had the same game plan except for a few details. He said that he would be fine with us ttc any time now, as long as I am paying attention and get started on lovenox(30/40) and LDA upon a positive pregnancy test and viability scan. He also wants manage me exclusively and see me every week, not every other week like the first MFM suggested. I asked him why he didn't want me to see OB in addition and he said that because I had a DVT and preeclampsia starting at 26 weeks he wants to keep an extra close eye on me and feels that last time there were too many people managing my healthcare and someone missed something along the way and thats why I got sick. I gave him copies of all of my previous medical history, including my blood panel from the hematologist. He decided right on the spot that he wanted all new labs because he was not sure whether or not he trusted the labs that were previously ran.

My husband was not very pleased, however. He felt like it was ridiculous that I waited for 2.5 hours, had 1 hour consultation and then had to wait another half hour for blood work. I got there around 8 and didn't leave until midnight, but I feel like this doctor is very dedicated. I appreciated the fact that he took the time to see me AND he wanted to run his own blood tests, not just take another doctors tests and assume they were done correctly. I guess my husband's main concern is that this doctor is spread too thin and may not be able to work me into his already busy schedule and that I will just spend tons of time waiting around and possibly under the care of a less knowledgeable doctor in an emergency situation. I understand his point of view, but I want the best doctor I can have in this situation... I know this doctor is AMAZING, but I am still wavering as to whether or not he is the best for me.

Either way, I will wait on the test results... maybe he will catch something that the hematologist was unable to see.

[riehlism]

It's a tough decision. I can understand your husband's concerns about the inconvenience factor. But this man is thorough. Very thorough. But he makes a strong case for you that seeing too many providers might have been a contributing factor to missing possible warning signs. Well, I'm seeing him. And I'm glad I am. Was your husband just upset about the time? What did he think about the consultation itself? The consultation always takes longer. His staff told me after the consultation it gets better.

[cmccaffrey]

My husband seemed indifferent to the consultation, he said he didn't feel much difference between this doctor and the other we met with in terms of knowledge. I think I will just wait and see what his test results are and then make a more informed decision. I was really impressed with the fact that this doctor wanted his own set of test results and didn't just take the easy way out and use my hematologists tests. That really stood out to me... I think its important for a specialist to gather information just in case someone missed something. Plus, he wants to see me fairly often, which makes me think that I should be getting that kind of attention regardless now. If a doctor who only takes high risk patients wants me in his office weekly, then I must need extra attention. I will just have to make my husband see that.