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What to do when docs disagree???

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What to do when docs disagree???

Postby jjbeck » Wed Nov 12, 2003 04:28 pm

I feel very fortunate to have great docs. My OB recently switched me over to my peri for full care because of problems with severe hyperemesis ( which is now under control) and high bp. SHe also asked me to follow up with my cardiologist as the last pg I dev some heart problems.
I really like my new peri and feel he is very competant and knows what he is doing.
I have known my cardiologist for a few years and know she is very competent as well.
I had an appt on Mon and the cardio strongly felt my rise in bp was pg related, as she knows I run a low bp or 100/60 pre pg. Now it is ave a high of 150/111 ( still not too bad...but as you can see, high for me). I also get out of breath very easy and have a very rapid pulse, up to 120 at rest. SHe is doing and echo to rule out pg induced cardiomyopathy.
SHe went on to say, she sees many preg woman and knows that some woman just get PIH earlier than others. Makes sense to me...especially where my heart reacted so early the last time with arrythmias.
She also said she did not want to treat the hypertension just yet, as she feels where I have a normal low bp, meds can cause it to drop too low which is not good for the baby.

Well, today I went to my peri and he says, " I know that your cardiologist said you have PIH, but there is no way you do...it does not occur until after 24 weeks".
He does feel that the "CHRONIC" hypertension should probably be treated....we will see next week.

This is all so confusing. My last pg, I was having bps as low as 75/45.
I worry meds will cause this to happen. I worry about making the right desisions.
I have heard three different things from three different docs...
OB says dont treat bp until it reaches 200/115
peris says 150/110
cardio says not until 160 to 180/105.

I just dont know. They all have there own opinions. I trust all of them.
I just dont know what to do.
I have read taking meds early can mask pre e . Is this true?

How important is it to KNOW what type of hypertension I truely have? How do I find out?
Pre pg and upto 7 weeks, my bp was fine. It started creeping up at 8 weeks.

UGH! ANy advise?




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Re : What to do when docs disagree???

Postby sweetiesuzy » Wed Nov 12, 2003 04:34 pm

I don't have all the answers. I'm sure you will get help from many women here. I can tell you that from my personal experience my OB didn't want my blood pressure to go too low because my blood pressure runs high anyways. The baby was "used" to my bps being at a certain place. This was my baseline. My bp was somewhat controlled with meds after 31 weeks when I was getting really high readings. I have been diagnosed with chronic hypertension. I suffer from it now - while not pregnant. I did not have problems till my third trimester so I can't help you with the issues you are having so early. It sounds like you have some underlying issues with your cardiac system. Maybe that is the culprit?! I am sure you will get the care you need. You are VERY proactive about your care!
Continue to keep us posted.
Suzanna

"Go confidently in the direction of your dreams. Live the life you've imagined." - Thoreau

DS 3/25/95
DD Stillbirth 10/26/01
DS 12/30/02



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Re : What to do when docs disagree???

Postby ileana » Wed Nov 12, 2003 04:48 pm

Have them in a conference call? [:D]

Honestly, I think the lowest numbers that you mentioned 150/105 are high enough to be dangerous and anyone would treat you at those numbers.

The ob's number seem outrageously high, but the other 2 specialists have almost the same numbers, I'm sure they'll come to an agreement.

Good luck and keep those BPs down!

Ileana 33
Angel stillborn 24w p-e 2/17/03
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Re : What to do when docs disagree???

Postby jjbeck » Wed Nov 12, 2003 05:24 pm

Is it important to find out weather or not the hypertention is chronc or pg related? Or doesnt it matter?
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Re : What to do when docs disagree???

Postby ileana » Wed Nov 12, 2003 05:44 pm

I think it doesn't matter. You will know whether it's PIH if it goes away within 6 weeks postpartum.

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Re : What to do when docs disagree???

Postby laura » Wed Nov 12, 2003 06:50 pm

Here's my thoughts, for what it's worth. I'd go with the OB on this one. The existing litertature on the subject, (and our own experts here) concur that hypertension before 20 weeks is and should be considered chronic hypertension. I have essential hypertension that complicates my pregnancies, but for me, the hypertension doesn't necessarily 42 days after my kids are born.

On one level, I wouldn't say that it matters what the origin is of the hypertension, but there are preconceived ideas about what those things mean to the people who will treat you. One doc will say it's just chronic hypertension, and not worry about your pressures, another will say it's chronic htn, we'll watch closely. One doc will say 'PIH", no danger in that, others will say "PIH" lets see her twice a week before it turns into preeclampsia.

YOUR job is to make sure that regardless of what label they throw at you, that they take it seriously, ykwim? The boundaries do sort of blur- regardless, you're going to want them to ACT in the same way- frequent monitoring, frequent level II Ultrasounds, frequent visits.

Just for fancy situations like this, I bought Chesley's Hypertensive Disorders in Pregnancy- the pregnancy hypertension 'Bible'. You can mention to your cardio that Chesley's (which he or she should know or own) says on page 546 in the second edition, that hypertension before 20 weeks is considered chronic hypertension, and ask why your situation is different than that. (after they rule out cardiomyopathy, which is a whole different kettle of fish)

My other thought is that yes, medicines can make your pressure go too low, by reducing placental perfusion and causing growth restriction. That's not good. But they can watch for that through ultrasounds checking your baby's growth and adjust your dose accordingly.

I'm absolutely not a doctor- I just had a second pregnancy strikingly like yours- hyperemesis, pulse so fast that I couldn't walk by 26 weeks, hypertension, the whole works. A lot of it was cleared up with meds.

Whew! Was that a mouthful, or what? Take care, and let us know what happens!


Laura-28
DH Jack-30
Allie 5-13-98 (35 weeks-pre-e)
Baby Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/
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Re : What to do when docs disagree???

Postby akemt » Wed Nov 12, 2003 08:20 pm

JJ,

Laura always gives good advice, btw [;)] She is one of the resident hypertension specialists in training! j/k [:D]

And I agree with Ileana about the BP #s...My OB, in consult with peri's, would have delivered my baby if the majority of my bp's were in the 150/100+ range. He might have been a little over-cautious, but I had no doubts about my care when I was with him. He sent me in to L&D for observation every time my bp hit a new "bench mark" that we had set after it got in the 140/90's. Definately make some decisions about your care, discuss your personal "bench marks" and I don't know what else to say but GOOD LUCK!

Catherine (22)
DH Britton (27)
Emma Margaret (03/02/03) 37 weeks from PIH & oligo
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Re : What to do when docs disagree???

Postby jjbeck » Thu Nov 13, 2003 07:17 am

Thanks for the good advise. I will keep an eye things.
I know ultimatly we are responsible for ourselves.
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Re : What to do when docs disagree???

Postby annegarrett » Thu Nov 13, 2003 11:13 am

Also not a doctor but I would definitely DEFINITELY get on antihypertensives. They can be adjusted if for some reason your BP goes too low (cut in half, in quarters, in grains) but you can die if it goes too high. It is already way too high, in my (not a doctor) opinion.

I don't care what they call it--they should treat it.

Anne Garrett
Executive Director
Preeclampsia Foundation
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Re : What to do when docs disagree???

Postby sherry fisher » Thu Nov 13, 2003 11:28 am

I have to agree with Anne...Not coming from a Dr. here but my OB put me on meds at 10 weeks with a BP of 143/95. A high BP can cause damage to a placent early on as well as later in a pregnancy! (if I am correct there..help me out ladies!) Your BP's now are dangerous for you and your baby!! PERIOD! There is some dose that can bring your BP down, while not too far. That may be something that has to be worked with and figured out, but in the long run, again, safer for you and the baby!

**Not a Doctors opinion here!! lol

GOOD LUCK! We are still working on getting my meds at the right level. And just getting the right meds. Period! Its tough! I think you and I are about the same in gestation?!?! Keep us informed on what happens.


Sherry Fisher (28)
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#1) Alex 1/1/94-PE
#2) Abbie 12/17/97-PIH
#3 Will 08/03/02-PP PE
#4) EDD: 4/27/04
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