Saturday, July 9, 2011

High Risk Evaluations

I had my consultation with the high risk doctors this week. Let me spoil the ending by shouting loudly from the rooftops:

"They didn't want me! I'm not high risk!"

With that out of my system, I do have some comments on the appointments themselves. (Of course I do. You know me well enough by now, right?)

Appt #1
Provider #1 reads through my sugar level notebook and downloads my glucose meter's chip to verify that the blood sugar numbers I've recorded are accurate (i.e., I haven't "adjusted" any numbers in my favor).

She seems concerned that I won't be able to manage my blood glucose via diet without nutritional counseling. Except that I have been managing. Which is perhaps why she doesn't provide any nutritional counseling during the appointment. (?)

Appt #2
Provider #2 dismisses the blood sugar numbers printed out by Provider #1 because it's in a graph form and his brain doesn't like looking at graphs. He prefers to read summary reports. Since my file doesn't have one we will skip discussion of my blood sugar numbers and he will defer to Provider #1's assessment that my numbers are fine.

He waxes eloquent about what Type 2 Diabetes is and what Gestational Diabetes is (mainly, he explains, for the benefit of the medical student sitting in on our meeting). The lecture begins with the question "You know that your body is made up of small pieces called cells, right?" and ends with a detailed description of the liver and pancreas and what he believes are ideal postprandial numbers.

Once he hears my first baby was born via c-section because of breech presentation he completely drops all concern over my VBAC attempt. Absolutely fine with him. Go for it.

He recommends additional thyroid testing due to concern over my Grave's Disease and how it may affect the baby's thyroid. He says that if the baby's thyroid is having issues they can treat the baby in the womb. I ask for details. He says he will not discuss the treatment until after the testing. I surmise it must be rather intense/worrisome treatment. He will not confirm nor deny and tells me not to concern myself about it--just leave it to the doctors. [I have since talked about this with my family practitioner and have received confirmation that the testing I plan to have for my baby after the birth includes thyroid testing. No need to do any special tests during pregnancy.]

He suggests getting the ultrasounds previously recommended by my family doc to help estimate the baby's size. He says that the ultrasounds are especially helpful to doctors when women fake their good blood glucose numbers--the ultrasounds can help "catch" those mothers in their lies. How flattering. I voice my concerns about the inaccuracy of sonograms and sizing and my worry about being induced for "big baby" when in reality the baby may not be too big at all. He assures me that never ever should any woman ever be induced for suspected big baby based on an ultrasound. He says that sort of thing puts the academic OBs into fits of despair. But he does understand that this sort of thing unfortunately happens in clinical practices, so he will put into my file a note that I am not to be induced due to suspected big baby. I am pleasantly surprised. "No, no, don't worry worry," he assures me. "If we suspect a big baby based on the ultrasound, you will not be induced. We will just automatically [c-]section you. Never an induction and trial of labor." Well, consider me relieved! :p

Both providers were very pleasant, certainly very smart, and neither had anything helpful to say at all, other than I'm not high risk. Best estimate is that I'll be charged a total of at least $600 for the two visits. I used nearly a full day of ETO time and lost 6 hours during which I could have been earning wages. Overall, a totally awesome way to spend a day. I absolutely recommend that every healthy pregnant woman check out their local high risk perinatology clinic, just for kicks and giggles.


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