So today was my follow up appointment with the doctor (Dr. B) to check in about how the anti-depressant is working and talk further about our plans to try to conceive in the future and what testing we would do, since she would have had time to review the hospital reports.
I went in, and again, I was running late. I was doing great until I ended up in a turn only lane by accident and I wasted 10 minutes trying to backtrack on one-way streets through construction. So frustrating, and then to top it off, there was no parking easily available and I was feeling flustered again when I got there.
Fortunately, she was running a bit behind, so it ended up not being a big deal.
When I finally got back to an exam room (I left my book in the car, but figured since I was late, it wasn't necessary. I was wrong.), I talked with a new PA and really enjoyed her. We talked about how the Prestiq is helping and what it had done and how I was processing stuff, about exercise and weight (because wtf? I weighed 10 pounds more on their scale than I did on my scale Monday morning. Granted the clothes/shoes easily added two pounds, because I have in fact weighed myself in those clothes and out of them and yeah, two pounds, and I know it's not uncommon for me to put on 5-6 pounds right before my period starts, but dude.) and then she took my blood pressure. I was feeling very relaxed, but it came back really, really high - 145(ish)over 96. Yikes!
Then I sat and read a poster for NuvaRing seven times and Dr. B came in. I still like her. We talked some about the depression and she is really pleased with the Prestiq and how I was describing my reactions to it and how things have been going. We talked about the blood pressure, which she wasn't happy with (rightfully!) and she's recommending a new internist.
Then we moved on to testing. She originally said that we would not pursue the huge panel of bloodwork, because there were no links between my pregnancy losses that were apparent. After reading over the hospital reports, she has changed her mind. She said the clotting I described and the clot on the placenta make her want to rule out a clotting disorder and there is no reason not to test for it now, since that is usually very treatable, rather than risk another pregnancy by waiting with no good reason. In addition to a multitude of tests to check for possible clotting disorders, she's ordering a karyotyping to check my chromosome locations (my coworker joked that I really might be a freak of nature, lol), and is asking for cholesterol and thyroid tests and also the glucose tolerance test to check for diabetes. Just to identify any possible problems. All together, it's 14 different tests/panels that will have blood drawn for. My poor, poor, poor arms. While they have a lab on location, they gave me the slip so that I can schedule it at a location nearer to me and miss less time from work and not have to drive far after fasting in preparation for the tests.
Those things are all good, but the thing I am most pleased about is that she is willing to schedule the sonohysterogram for this cycle or the next; initially she had said in the New Year. But she is pleased with how I've responded to the anti-depressants and that my cycle has returned to normal, so she said that if the equipment is not booked (there is only one u/s machine in the office that she can do the shg with), then we can do it immediately. I am crossing my fingers that that is the case and we don't have to wait until December.
Speaking of my cycle - I've been a little anxious, but it was textbook for me. Ovulated right on time, normally, with normal cervical fluid (or, actually, less fertile fluid than in times past, which is actually a good thing, as it could be indicative of my hormones being better regulated), and a perfectly normal luteal phase. Twelve days, just like normal. 100% normal. I have never been so happy to get my period ever - I laughed when I told Jason it was a Happy Period!
Back to the tests - if there is scar tissue or some other obstruction, then I'll have to have surgery. If there is a clotting disorder, then it depends on the apparent severity - she said most likely, I'll be doing a treatment of baby aspirin, but if it's more severe, then Lovenex injections. Apart from that, we discussed my care management during pregnancy. We'd already discussed that I would be immediately sent for a beta series and set up for an early u/s, but I asked today what comes next. Immediately, she responded, "An ultrasound roughly every two weeks to monitor development, the placenta and the cervix. We're going to be keeping a very close eye on you." Which is, in fact, what I wanted to hear, and is a relief.
Even more so when she said she would like me to off anti-depressants for the entirety of the first trimester. Prestiq is not recommended in pregnancy, but can be taken in the first and second trimesters. Dr. B prefers to prescribe Zoloft to pregnant and nursing mothers, which is approved for pregnancy, but says the best course is always to be taking nothing. I agree, but also don't know if I can do it; my anxiety with Gabriel was so high and that isn't going to get better now. But the close monitoring is a relief and should ease that somewhat. And I'll be going to see the new therapist regularly throughout that time, so the hope is it will be enough.
Additionally (finally?), I will see a MFM (maternal/fetal medicine specialist - or - high risk doc) at least once during the next pregnancy, and more if there are complications. Dr. B said the bottom line is that even before we know the outcome of the tests, I am high risk because of my history. Period. She will co-manage my care with the MFM. We just have to see who takes my insurance and what hoops will have to be jumped through.
Basically, I am hearing all the right things and I am very happy with the plans for moving forward. I feel confident I will be well taken care of. I hope that means better things, but I also know that it is unlikely that if I had been seeing Dr. B before that things would be different. It is possible, but it is also possible that all the care in the world won't prevent another loss, another tragedy. That's the biggest lesson in all of this - it is all so completely out of my control.
But I am feeling good. Dr. B said that we will take care of whatever pops up from these tests and then we are free to try to conceive whenever we feel ready. So I'd say that we are feeling pretty good right now, even with my happy period.