Seeing an MFM on Thursday!

[MomTimesThree]

I think those are great questions. And I am hopeful that having a specific plan written out will allow you to feel comfortable moving forward. We were terrified when it came to TTC #2 and those first few weeks pregnant until we had a solid plan in place... it made all the difference, and having a team you trust.

Only other question I can think is asking her what else she thinks you should know that perhaps you didn't think to ask.

I hope it goes well!

[flori]

I'm back!

I really liked this doctor, she was very thorough and patient. She answered all of my questions (some before I even asked them) and didn't make me feel like I was being a pest by asking so many things and quoting things I'd read online. Here's a recap:

She said she would never say no to trying again, but did say it had its risks
Changed my bp meds to pregnancy safe stuff (eliminating an ACE inhibitor)
My liver, kidney, and thyroid function is all normal
Wants me to get a flu shot
Quoted me a 30% chance of developing preeclampsia again, 5% chance as severe/early and 5% chance of HELLP
--- said it will likely come later (yay)
LDA @ conception, but said starting prior wouldn't hurt
No lovenox (unless I test positive for lupus or APS ((kind of fussy OB didn't order that lab already)))
Clomid okay
Working okay
Exercise during pregnancy ok
Early bedrest probably won't help and would actually end up being more harm than good
Ultrasounds monthly unless growth issues suspected/found
Agreed to co-manage pregnancy with OB, but okay being the primary doc
Repeat C at 36-37 weeks (not a fan of VBACC, but would agree if I was insistent)
Will be the delivering OB if delivery is scheduled
Didn't think more weight loss would change my odds, but definitely recommended it for general pregnancy health
Doesn't believe in extra supplements (no vit A/C/D)
Wants me to stay on omega-3s and prenatals
If HELLP shows up, immediate delivery

Husband asked about the two year window I'd told him about and she said she believed more in giving my body 18 months from the Gracie's birth to conception of Rainbow. I googled it and only found that info on the March of Dimes sites. Anyone have any extra insight on this?

I am so glad I finally took this step. We won't be trying until June/July-ish but it feels good to know what I can do and what will happen. I left feeling so excited and hopeful for the future. ALTHOUGH, I am kind of nervous about her "NO LOVENOX" approach. I can't remember if there have been any posters who've been on it but not had a clotting disorder. Angie maybe?

I know Jean carried her rainbow on only LDA, but can anyone remember if there was anyone else? (Yes, I know Lovenox is not the answer, but it would help me to see that it CAN be okay without it.)

[flori]

Forgot to add- we went to Costco afterwards and I bought their generic LDA, which said it was comparable to Bayer. Is there another brand I should look into instead? I forgot to ask doc.

Also, my OB wanted me to stay away from fish oil but to keep taking omega-3s. I bought a super fancy one from Target and saw just recently that the main ingredient is fish oil (d'oh!). Can someone recommend anything? I'm kind of ignorant about these things, but is the DHA/EPA stuff they sell packaged with prenatals okay? I always thought that it was for pregnancy only. Is fish oil okay until conception? OB worried about mercury levels and what not.

Thanks again for everything, lovelies. I appreciate it all.

[lisa112]

I am so happy for you that your appointment went so well!! Sounds like the doctor you found was very encouraging and hopeful. From what I've read on the forums it looks like not many doctors prescribe lovenox unless there is an underlying reason for it, but I'm sure someone with more experience can answer that better than I it just seems to be what I've been seeing. I'm crossing my fingers for the same type of news. Just wondering, was this the first MFM you saw? I have two appointments set up with different doctors in two weeks and finding it a little nerveracking and overwhelming on picking doctors to meet with, but I think it's just an overall anxiety about everything.

[sam10]

I am glad your appointment went well. My doctor told me also no lovenox for me, since I don't have a clotting disorder. He said there is not enough evidence to show that it helps. He also reminded me that lovenox is a potent drug and hast its own risks and should not be used by default. So, I decided not to sweat it and trust my doctor on that one and how much nicer not to have to inject every day

[LalaPants]

I'm so glad your appointment went well and that you liked this doctor!

[url]Spectrum Essentials[/url] makes a non-fish oil DHA supplement (it's actually produced by algae; my husband did some of his PhD research with the company that makes it and has friends who work there). When I was taking it (stopped because my lupus doc says that it can be bad for people with lupus), this is the brand I took.

I was reading something on lovenox the other day (I have lupus with APS so definite clotting disorder) and being on it can be really bad for your bones, like early onset osteoporosis bad, so it makes sense that your doctor doesn't want you on it without a clear reason to use it.

[kerisue]

So glad you found someone who will listen to you and doesn't mind a ton of questions! Her recommendations sound similar to my docs recommendations. Don't be too worried about the "no lovenox" thing. It does seem like a lot of folks around here take it during subsequent pregnancies, but I've seen two MFMs and both, independently of the other, have said no to that too- just not enough research supporting its benefit over its risk I guess. Like yours, my docs also suggested 12-18 mos. before trying to conceive. one of them told me why he thought so- physical healing from the classical c-sec, reduction in inflammation from the preeclampsia, and emotional healing from the trauma and loss.

[angieb]

Yes, I was on lovenox with no clotting disorder, as have been handfuls of other posters (especially those who have delivered in the 20-26 wk timeframe with IUGR.) ( riehlism....something like that, sorry if I messed up her screenname) , Ashley (nolansmom maybe? She hasn't been on here in forever), several others. But it does vary widely by MFM and don't be afraid to get another opinion from another mfm. I met with 2. One said yes, absolutely lovenox.The other said absolutely not. (A friend of mine who had severe pre-e 2x and delivery before 30 wks, recently met with a popular mfm in our area that I have not met with. He planned to put her on lovenox regardless of her clotting tests but told her he'd feel more confident it would help if she had a clotting disorder. She did have mthfr which a lot of mfm's don't treat with lovenox anymore.)I didn't want to later regret not doing it,I have enough regrets from my 1st preg, so I went with the lovenox plan, it worked out for us. I'm on it again for our 3rd preg.Whether it made a difference or not is unknown, certainly we have had plenty of members not on it who have healthy pregnancies, my MFM is of the opinion that there are more clotting issues/disorders than they have tests for and just because they didn't find it with the tests doesn't mean there isn't one.

(Osteoporosis is a risk, they have me increase calcium by 1000 mg when I am on lovenox, and this time she expects me to be off it by 20 or 24 wks, once the placenta is totally established and everything looking good, I will stop. I stopped last time about 28 wks, we were more paranoid and I had blood flow notching.)

Personally, I'd probably try to talk to another mfm if I were you. The 18 month thing seems pretty excessive.

[angieb]

Jules (jules2) is another one who had early onset and was only on LDA and had a great 2nd preg.

But conversely, here's a slightly encouraging study on the flip side:
http://www.preeclampsia.org/forum/viewtopic.php?f=28&t=41553

Low molecular weight heparin versus no treatment in women with previous severe pregnancy complications and placental findings without thrombophilia.Low molecular weight heparin (LMWH) treatment has been recommended for pregnant women with previous adverse pregnancy and who were diagnosed as having a thrombophilia. We now examined the effect of LMWH on pregnant women without thrombophilias who had severe pregnancy complications and placental vasculopathy in an earlier pregnancy......[skip to the conclusion]:Treatment with LMWH may reduce the rate of the recurrence of severe pregnancy complications and significant placental vasculopathy in women without thrombophilias.

[flori]

Thanks for the replies, everyone!

I didn't really think about seeing another MFM. I thought about it before this appointment, but maybe I was so happy with our meeting that I let it slip my mind. I think I will get a second opinion, just in case. I'm pretty sure she knew about the IUGR I had with Gracie, though I didn't think to ask if she thought Lovenox would help. A bunch of the other MFMs available are in her "group" (not sure if that's the right word). Do you guys think that they will all have the same approach as her or should I try to see someone that is not affiliated with their practice?

Angie, I'm not too hung up on the 18 month thing. This month will make 18 months since I conceived Gracie. At this point I'm more interested in getting pregnant again before next March (the sooner the better, obviously).

Lala, thanks for the omega-3 supplement info.