New and Very Worried

[jeffcanfield]

I called my wife's OB and asked for a referral. Unfortuantly the OB was away. I told the nurse in very firm terms that I needed my wife to be referred to a doctor who had been recommended by some of the members of this board. (Thanks for the head up)

My wife should be receiving a refferal from her OB tommorrow. Thank you again to everyone on the board.

[fiona]

Jeff, good to hear from you. How is your wife feeling today? Do you know how her BP is running? Any headaches, facial swelling, URQ pain or general malaise?

I'm very concerned that she may not be seen for a while. Please go into L&D (not the ER) should you be in the least worried.

[jeffcanfield]

Jennifer (my wife) is now on a blood pressure medicine. It is called methyldopa. I am not sure how long she needs to be on it before any effect takes place. Her blood pressure yesterday was 170/90. She is still having headaches, and a little dizziness.

I don't really know what I am supposed to be doing for her. I am staying home from work and making her stay in bed. I am doing my best to eliminate sodium from her diet and of course caffine. By the way this is all on my own. Her doctor gave her no instructions as to bed rest, etc. In fact, I have yet to hear from her OB.

Thank you all for your concern and help.

[jeffcanfield]

Jennifer (my wife) is now on a blood pressure medicine. It is called methyldopa. I am not sure how long she needs to be on it before any effect takes place. Her blood pressure yesterday was 170/90. She is still having headaches, and a little dizziness.

I don't really know what I am supposed to be doing for her. I am staying home from work and making her stay in bed. I am doing my best to eliminate sodium from her diet and of course caffine. By the way this is all on my own. Her doctor gave her no instructions as to bed rest, etc. In fact, I have yet to hear from her OB.

Thank you all for your concern and help.

[dynamicdoula]

I don't think sodium *elimination* is wise, but definitely making sure that you're not overloading (which is hard in our typical western diet). I know some other women here will weigh in with more info but here are my thoughts on sodium/pre-e (not based in anything but conjecture).

I think that in the Western diet we typically eat EXTREMELY sodium rich foods- fast food, packaged foods, sodas, many people salt their already salty foods... it's an overload to the extreme. If your diet consists mainly of home-cooked foods, fresh fruits and vegetables, little/no boxed/canned foods and you aren't salting to high heaven, you are probably okay. We NEED sodium in our bodies, so eliminating it might only exacerbate a problem rather than solve it. We just don't need the hundred million pounds of it we eat in a single meal. There has to be balance, you have to give your body what it requires to function.

Spend some time reading the boards and ask lots of questions! Get a blood pressure cuff and monitor at home. You can download my [url="http://www.dynamicdoula.com/BP.xls"]chart[/url] (my data is in there but just remove it and put in your own) to keep track over time, and then take that to your doctor when you see him/her. Also, start thinking about finding a doc who is more aggressive about looking after your wife. Pre-e is not something you want to 'wait and see how things go', it's something that you want to be on top of the whole time. One of the hardest things I have found there is to do is to simply trust your instincts, and call/go in if you feel something is wrong. Support your wife by encouraging her to trust her gut; if she thinks something doesn't feel right, back her up and take her in. It sometimes is just a 'feeling' you get. The hope is that it turns out to be nothing at all and you go home with reassurance. :)

I'll see if my husband would be willing to pop in here and offer you some of his own perspective; this is our 3rd pregnancy with hypertension/pre-eclampsia and the first time we've actually had some decent management. He has his own worries for sure, he was terrified I would die last time but things are going much smoother this time around. It might be helpful to have another guy's perspective?

Keep talking and asking questions, the women here are amazingly knowledgeable (moreso than many docs, in my experience) and will offer as much support as you can handle receiving. :)

Blessings,

[fiona]

Jeff,

that BP is very high on meds. I was on methyldopa in my first two pregnancies and I would have expected you to see a significant change by now - what is her non pregnancy BP?

In my non-medical opinion, your wife should be having a full blood work up and an u/s asap. If the referral is taking time, I would strongly urge a trip to L&D and paging the peri/MFM on call. I was hospitalized with a dx of pe at the same point in my first pregnancy. It really isn't a time to wait and see.

FWIW, eliminating sodium from a pregnant woman's diet is not advised - and unless she usually has a strong sensitivity to salt is unlikely to be affecting her BP right now.

All you can really do for her is get her the medical attention she needs: there is no magic pill for pe - she needs careful monitoring by someone who's experienced in early onset pe.

I hope she gets to see someone today.

[kara]

I'm echoing Fiona here. Speaking from experience only here, your wife needs to be seen in hospital, in the labor & delivery department (not the ER). When you arrive tell them you want her to be seen by the Perinatologist or MFM on duty...and don't leave until that happens. If you are unhappy with your OB, and think she may thwart your hospital efforts, you can simply say that you don't think her current doctor is providing adequate care, and you prefer she not be involved with the hospital visit...at least until after your wife has been thoroughly evaluated by the peri/MFM. As Fionas says, she should be having a full blood work up, and an ultrasound, as soon as possible....like right now. Please get her to the car and get her into the hospital. Those blood pressures alone, not to mention while on medication, are high enough to be considered Severe Preeclamptic. She is at risk for stroke and seizure unless they can get those pressures under control. Again I speak only from experience, but I would also strongly urge you to get her to the hospital.

[dynamicdoula]

The only problem I can see is that most L&D won't even talk to a woman before 20 weeks. You might have to put your foot down and be heavy handed about it, or if they do limit you to the E.R. make them page a peri to work with you there, instead. I agree - take her to the hospital.

[caryn]

Jeff, while all of those are proven strategies for lowering chronic hypertension, they're not thought to help much at all with pregnancy hypertension. The problem isn't really driven by diet/exercise/stress -- it's an immune system conflict between mom's body and the foreign placenta.

Think of the placenta as a half-foreign transplanted organ, and preeclampsia as the response when the mother's body starts to reject the transplant. Just as willpower and sodium restriction won't keep her body from rejecting a foreign kidney, they won't have much to do with PE either -- and so she needs to have her meds adjusted to try to lower her pressures more, and to do that they need to do an ultrasound to check blood flow to the baby, since they don't want to lower the pressure to the point where the placenta isn't properly perfused with blood.

I want to agree that she should be seen sooner rather than later, at L&D. Severe preeclampsia this early often has *bad* outcomes, and the sooner she's seen, the better the odds are.

[frasiah]

Jeff,
How is your wife doing today? Have you been able to see the MFS for more testing?