Talking to the Big Guns

Last week I went to the Maternal Fetal Medicine specialist office and I met DrGav.  He seems like a very intelligent and thoughtful man.  My ObDoc loves him, says he’s a sweetheart.  I started off the appointment by answering a ton of personal and family medical history questions with the MFM nurse who stayed during our appointment the whole time.  MrBeep was with me, sitting opposite in a chair, his serious face set and ready.

DrGav arrived and looked over my medical and family history.  We discussed my heterozygous MTHFR issue with the added knowledge about my brother’s thrombosis a couple months ago.  He said that he was glad to know my homocystine level was normal, that was a very good thing.  He was also glad ObDoc kicked the folic acid dosage up and that I was taking a baby aspirin per ObDoc’s instructions.  He said that he didn’t want to put me on any heparin for now because he thinks the baby aspirin and folgard will do fine.  He does want me to take 2 baby aspirin per day instead of 1 because I am carrying twins.  So one in the morning and one in the evening.  Taking two baby aspirin is means the kiddos will get a daily dose of aspirin. They’re so small.  This makes MrBeep nervous which therefore makes me nervous, but we will go with his expert advice.  He said that in order to monitor the babies, we’ll get an ultrasound at 16 weeks and then compare it to future ones to make sure their growth seems on track.  If it is not, then we will assume the MTHFR is causing placental problems and I will go on heparin or lovenox.

They took more blood to check my thyroid.  The results showed all is fine and normal.  DrGav did notice that I had a slightly elevated pulse.  He seems convinced that I will get high blood pressure during this pregnancy because my mom had high blood pressure before her kidneys finally gave out.  I don’t know.  I guess it may be likely.  I have, on his recommendation, bought a home blood pressure monitor (so we can see if it is slowly elevating over time) and I am also cutting out excess sodium.  The blood pressure pre-judgment frustrates me because I have always had normal or low pressure. My mom had it from the time she was in her early twenties, she smoked a pack a day, etc.  I know it can still happen but c’mon.  Honestly it is really hard to take someone’s advice you have just barely met, but I have done my research on this practice and the specialists and they are top notch.  I must admit I agree with him it is important to monitor and try to prevent a serious condition before it happens.  A proactive approach is wise. 

I talked to my mom and my brother and jokingly whined at them that their health problems are causing me grief from my doctors and would they please take better care of themselves.  They promised to do their best.  I see my ObDoc on Wednesday afternoon for a routine check-up.  It’s been three weeks since I heard the little monster’s heartbeats.  Every time I get close to a doctor’s visit I get extra nervous.  Anyone else crazy like that?

It’s interesting how many nice comments say things akin to “Wow. 15 weeks sure did fly by.”  I want your time machine folks because my weeks seem like they are really dragging.  I alternate between nervous terror and excitement.  A small part of me wants to go to sleep and wake up 15 weeks from now, but most wants to savor every minute.  I lay awake in the quiet of the night and try to feel them move.  Sometimes I think I can sense a fluttering and other times I’d swear it’s just my pulse.  C’mon my monsters, Mommy is looking forward to Squirmfest 2010.

I am NOT a Drama Queen

Well, I am officially off of bed rest for now and I’ve made it to 13 weeks and that is another reason to say “so far, so good.”  Thank you all for your well wishes.  I have had no other spotting or bleeding since the first incident and am taking it very easy from now on.  I went to my ObDoc for a routine appointment on Thursday.  I was weighed (hard to accept that gaining a pound in a couple of week is a “good thing”), we got culture samples and my ObDoc checked my uterus. We were able to hear two separate heartbeats at 149 and 155 bpm on the doppler gizmo so that gave me a little bit of breathing room.

Before I get to the next part of my tale, I just wanted to state this for the record.

I am NOT a drama queen.

I hate drama, I don’t want drama.  Keeping drama to the movies I watch is the only place I want that shit in my life.  I don’t thrive on it.  I am not an attention hog.  I want to be normal and boring and typical when it comes to this stuff.  I’m not a person who goes out of their way to create tension or strife.  Hell, I’m even a happy drunk…BTW…“I love you man.”  I like zany, I like snarky, I like laughing ‘til my face hurts.  I like good food and drink, fun conversation and a night of playing board games. 

Imagine my face then when three days ago my ObDoc’s office calls and lets me know that after my big bleed episode of the prior week (I had 12 vials of blood taken for various tests) it seems that I was tested and have come back positive for a blood clotting disorder, specifically for compound heterozygous MTHFR. 

MoTHerFuckeR.

Here is an awesome blog I found that has a good tutorial.  Here is a good page on Thombophilias from the March of Dimes website.  The ObDoc’s office immediately put me on a prescription for FOLGARD taken twice daily.  Each pill is a mega-dose of folic acid 2.2mg, B-6 25mg, and B-12 1mg.  I have also been put on low-dose aspirin.  Hopefully these things will help.  If you have a MTHFR mutation your body does not absorb folate properly and you are also at greater risk for blood clots affecting you and baby.  MTHFR mutation complications and risks (some mutations are more serious than others) published in scientific papers in peer reviewed journals have been linked to multiple miscarriages (including early 1st, late 1st and 2nd term loss), implantation problems, congenital heart defects, preeclampsia, and clots that affect baby’s placenta, causing growth problems and pre-natal death. 

Great.  Think at 41 you make it to 13 weeks with kiddos looking fine you can perhaps maybe breathe just a little bit easier.  F-You IF Optimist, what do you think?

<Sigh>

I am NOT a drama queen.

Here is what I am.  I AM a bit ticked off that no one found this out earlier so I could have taken better precautions, I mean I was tested for just about everything under the sun between my RE and my myomectomy ObDoc.  I AM grateful for my current ObDoc, a fine and intelligent lady.  I AM happy that even though I have this, it isn’t the most dangerous form of the mutation and can be managed by doctors.  I AM concerned because I have read of ladies losing their babies in the late part of their pregnancies because of clots in the placenta or umbilical cord.  I AM relieved to know that most of those who had tragic losses were untreated for their MTHFR and once they were aware, properly monitored and treated, went on to have healthy babies.  I AM worried because remember me having to take off to Florida to take care of my brother?  That was because of deep vein thrombosis (a blood clot in the leg) leading to a pulmonary embolism.  I AM glad that although my brother had this serious condition, he was a two-pack a day smoker while I have never smoked (he has since quit smoking).  I AM glad that although they found the MTHFR mutation, currently my homocystine levels were normal.  I AM extremely happy that I have made it this far in the pregnancy.  I AM also very glad that the NT scan looked good, so I hope I am doing OK for folate absorption. 

As I said earlier, I found out about MTHFR on Tuesday so both MrBeep and I were spending a lot of time on Dr. Google, NIH and PubMed to find out more, make sure we understand the dangers, etc.  I didn’t want to post until I had a much clearer understanding of my current situation.  I did come up with a list of questions for my ObDoc.  I now have a little red moleskin notebook that I will take notes and write questions so I don’t forget for my doctor’s appointments.  After our routine exam was completed, here were the questions I asked her:

Q:  My brother was just hospitalized for 6 days due to a deep vein thrombosis and subsequent pulmonary embolism. He is 1.5 years older than I am.  He is also 80 lbs overweight and a 2 pack a day smoker.  While my homocystine levels tested normal, does this put me at greater risk? 

A:  (At this information her face dropped a little and her tone became more serious) I want you to call the MFM specialist, get an appointment and let him know this.  I think we are good with the extra Folgard and the baby aspirin, but he may want to put you on lovenox.

Q:  I am curious to know what prompted to you test me for MTHFR?  Was it the big bleeding episode?

A:  Actually, it was because of your chemical pregnancy back in June.  We also tested you for other common clotting disorders including Factor V, Protein C, Protein S, Lupus, etc.  You tested negative for all other clotting factors which is a very good thing.

Q:  Do you think that my big bleeding episode last week was caused by the Total Previa or the MTHFR issue?

A:  Previa.  MTHFR doesn’t normally cause that type of bleeding, even with the clots you had.  Also it is a common thing with a total previa, even in early pregnancy.

Q:  My homocystine levels were normal.  How often will this be tested to make sure there is no increase?  Also, I was not fasting when the blood was taken, are you concerned about this?

A:  We’ve found that these levels rarely change this far into pregnancy.  I’m not concerned about the fasting, studies show no difference.

Q:  I have been reading about people with this condition getting Lovenox.  When is this prescribed versus just extra Folgard and baby aspirin.

A:  Typically it is prescribed if you have had several losses, have had  known clot or thrombosis yourself, or if you have more than one clotting disorder. 

So, my friends.  That was my week.  I have a call into the Maternal-Fetal medical specialists who will consider whether or not I should also receive injections of Lovenox in addition to my current vitamins.  While I don’t like having additional factors to worry about, I am actually really glad we caught this early.  I am very very happy that I found a good team of doctors who are proactive and on the ball.  I get to decorate the house for Christmas tonight with MrBeep, my MIL and FIL.  My ObDoc (I promise to write more about her later) has been able to put me at ease with her great personality, superb knowledge and professionalism.  She did say this to me, “well won’t it be great to have these two kiddos out for Christmas next year?”  I was so happy at that thought I could cry.  I just said, “I hope so.  That would be really wonderful.”