Forgot the link:

http://kateharding.net/2007/07/12/fat-hatred-kills-part-one/

Patients, drs, fat, and PE

This is a must read. I got the link from Fat Doctor's blog.

I have always seen military drs all my life, till my dh got out of the military about 7 years ago. They all insinuated weight was why I had this issue or that. Some insinuated weight caused me to have PE and partial hellp syndrome. Some insinuated that I didn't eat right and that caused it too. My first civilian pcp I fired. I fired her for several reasons. She told me to never get pregnant. She told me that my weight caused me to have pe and hellp and a premature baby. It took me about 4 years to fire her (and I will never put up with that again!!!!). I havn't looked back on it. Drs are there to help, not humiliate.

When I had S. at my first visit I was told that I needed to do the diabetic 2000 calorie diet because I was overweight. I was at 267lbs! Unfortunately, God had other plans with me which included having severe hypermesis. I literally lived on vanilla milkshakes, mac & cheese, icecream because I could not keep anything down. It was so bad the same midwife that prescribed the 2000 calorie diet ended up writing the justification for me to get approved for 40 Zofran a month and this was in addition to B6 and unisom every single day. Karma huh. My insurance at the time approved 10 zofran and this was for chemo patients! But I had lost over 20lbs in 2 months. She got the 40 zofran appoved. But then I was in the second trimester and the swelling started. I ended up regaining the 20lbs plus 8 for a total pregnancy gain. The day after delivery I weighed LESS than when I had become pregnant. The weight melted off. I lost 68lbs after delivery in less than 2 months. AMAZING. It also prompted a slew of slow down on the weight loss comments from my ob and pcp.

My current pcp is overweight. She will counsel you on diet but she doesn't ride you. My ob was great. When I finally started gaining weight (due to swelling) he said nice weight gain (in a good way, too bad it was swelling). After I had S, I asked if my weight caused this. If I lost just a x amount of weight would it prevent pe/pih/hellp? Both emphatically said no. My weight had absolutely nothing to do with me getting the above. No losing weight would not prevent it as that was just how my body reacted to pregnancy. Even with all of that weight lost, I still have to take a bp med each day.

But it is amazing how with just a few words, someone's life can be changed forever. You see I used to believe in that crap, that I did it to me. But not anymore. More educated I suppose. I am sure that there are some in my dh's and my family that think my weight or how I ate caused me to be sick. But it doesn't. They know better to state that. Pe patients already take enough blame. They don't need their weight on top of that. Besides, plenty of skinny pe patients get it too. It has no rhyme or reason in which victim it chooses.

So docs, think about what you say to a patient before you speak. You may have a woman that was listed in the above link. If she had had kind and compassionate drs, maybe she would have lived.

What ifs, girlies, fish, and pregnancy.

Oh my both my girlies are growing. Dh is out of town right now. He was due to be out till 8/16. However, he may come early. YEAH. I have been using the time for me time, enjoying my girlies and household projects. About those projects, I redid the playroom. I have hated the colors in that room since we moved here. But it was always a backseat to everything. So I painted it. Then I promptly dumped a half gallon of white paint on my nice burgundy carpet!!!!! It also splashed onto the tv and the nightstand that holds the tv. I wasn't so concerned with the nightstand. We bought it as an odd and ends about 12 years ago for about $70. It was in the PLAY room. But my carpet. I immediately tried to clean it up, but that made it worse. So I got my steam cleaner and it got it all up. OMG.



Took the girlies to go look at fish. We want a couple for a small tank. But I have "easy" requirements. I don't want anything that is too hard to take care of, that I can't kill and to have two in the tank. One for each girlie. Petsmart was very disappointing. Very little selection and no knowledge. Uh dude like maybe this one. Um no thanks. So then today we went to the other pet store. FOUR enormous rooms of fish. Rows upon rows of fish tanks. The girls were in awe. We are going back to pick up some fish next week. The sales guy helped us get chemicals to get our tank ready. He said wait a week and then come back. We are getting a beta fish and two algae fish. He promised they won't get eaten. WHOO HOO. The girls are so excited. Take that pet smart.



I have been having problems with the girls fighting lately. S. tries to beat her sister up by hitting, biting, or sitting on her head. K. tries to be a mom to S. who doesn't want anyone telling her what to do. Today S. wanted something. K. tried to take it away. S. started hitting her. I immediately scopped up S and put her in timeout. She was in shock. They don't do timeout in daycare and I think that is a load of crap. I finally after a few minutes went to timeout to talk with her. I told her she was being very naughty for hitting her sister. She immediately put both hands on her face, gave me the pouty face that looked like she was going to cry. It broke my heart. I told her to give her sister a hug and say she was sorry and she did. But she looked like she was going to cry the whole time. Gosh I still want to cry. K never did this stuff. Course she never had another sibling till she was 6.



Ahhhh I see pregnant women EVERYWHERE. From the day that I had S. I have wanted to get pregnant again. Not even just want to, but desparately want to get pregnant. I have thought about it alot why. We never thought we could afford more than 2 and well our job circumstances changed drastically in the last 2 years. We can afford another one. That's another thing, the other day, my ob made a comment that rubbed me wrong. I asked for an out of network referral for a specialist for pelvic pain and endo. He said well how are you going to pay for that, cash??? Ummm maybe I caught him on a bad day. He is not usually like that and is very concerned about not using up too much of patient's resources (thoughtful on rxs that are 10 days and will write for 30, bedrest - can you afford to take off). So I guess it threw me offguard. I mean I make very good money and so does dh. We make more than twice what the average household income is here. We both drive newer SUVs (ok, I didn't pay nearly what they are usually advertised for, I got a good deal on both and less than what a car would have cost). We live on a nice street, but not the ritzy part of town. We don't live in the slums either. Definitely middle class. We have been planning on moving, but don't want to move while I am pregnant. So it was either this summer (which nothing was on the market that we liked) or after baby, which is in about 2 years. Not a big deal. Anyway, I said to him, ummm no. That is why I am asking for an out of network referral. That way I would pay IN network costs. Unless you know of a specialist elsewhere that is in my network. Ummm no you are right, there is no other specialist. I'll write the referral. Better, I'll have my billing person do it. Insurance said to check and if not done by middle of August call his office back. But he did say that he would work with this new specialist to take care of me. :)

Dh and I were talking today on the phone. He is actually looking forward to a new pregnancy and baby. I felt so robbed. With K, it ended up that everything ended like that. We are terminating your pregnancy. But at least I had good days. With S. I was miserable every single day with heartburn, bp issues, vomiting, nausea, exhaustion. Not one good day. Even still, I was very upset when she came out. No time to see K. No time to prepare. Out she had to come. Maybe I am hoping for better this time. Maybe I won't be robbed. Dh told work last week that he will be unable to come out next summer to do training for them. Apparently he has been doing an excellent job. They asked him to come out again. But he turned them flat down and said that that he was expanding in a family way next year. GOOD FOR HIM. I never knew that babies could be healthy and happy as K was very ill for a long time. S was healthy and happy. No problems. But I am very excited to try. I would try now, but I don't want a spring baby. I want a summer baby. I want to spend the summer off again. It was fabulous with S. But I am planning for a baby at 35-36 weeks cause look at my track record. Sometimes I get so jealous of those women that are running around at 9 months pregnant cause that was something I never could do.

Sometimes the what ifs come in. What if I die. What if the baby dies. What if I get really sick. What if I have a baby that is permanently damaged from it. What if. Well with that I think, my chances of pe are 25%, hellp is 5%, 100% bedrest (I did it before and I can do it again), 100% bp issues (did it before I can do it again), and early delivery. But I am my best advocate. I know when things are not right. I will be vigilant in checking them. My drs will be too.

My beautiful girl

Where does the time go. K was a flower girl in sil's wedding two weeks ago. OMG, I remember this tiny tiny baby in a little incubator after she was born. The incubator was by my bed for a bit. I could only reach in with two gloved hands to touch her. Even through the throes of mag, I tried to calm her crying by rubbing her back. Look at her now. She is beautiful! She read a reading from the Velveteen rabbit in front of over a 100 people in the church. She did it with such grace, poise, and elegance. She has matured so much. Many people have come up to me and said wait till she is in high school. She is going to be class president. Miss Cheerleader. All American girl. The little 2-3 year old who would not participate in circle time at daycare, look at her now. I wish I had gotten a tape of it, but I was too busy wrestling S. As far as S. , she was fired from being a flower girl because she was being a 2 year old. :(

I just can't believe she is over 8 years old. We have been talking in front of her about trying for another baby. She is like mom can I watch the birth. Mom can I go to all of your appts? She'll be 9 in March. I think I would like her there for the birth. Of course someone would need to be there with her. I think my sil would volunteer. But yes, she is so grown up now. I can't get over it. She is growing up into everything I dreamed she would be. Love ya so much K.

Post Op Appt Update

My ob is giving me the out of network referral for Dr. H. I asked him if he knew about him. He said yes, he has referred several patients with endometriosis to him. HELLO WHAT ABOUT ME???? I said well he is out of network and I need an out of network referral. He said well how are you going to pay for it, cash? I said umm no, that is why I am asking for an out of network referral. He said ok and gave me a rx for an out of network referral. I said what do I do with this???? He looked at me confused (he must have delivered too many babies this week!). I said I think YOU have to coordinate it with the insurance company. Then he kicked into gear and said he would coordinate it with his billing person. She does all his disability paperwork, billing, and stuff. I thought I hope the billing person knows how to do this. I said I would go in network but I scrubbed the entire area and there is no one else but regular obgyns. I told him that he had talked about a general surgeon but I didn’t want a general surgeon cause they like to CUT you. He laughed and agreed. He said that there is no one else. That this is where I needed to go and he would work it out with the billing person. I asked him how would I know if it had gone through, he said that I could call and ask the billing person or the insurance company would send him a letter and carbon copy me on it. He did take down when the appt was and time and said he would work it.

The lower incision looks great. The belly button incision is looking a tiny bit infected. I have been using peroxide and Neosporin religiously. I told him it was still open a bit. Each day it closes a little bit. He said yeah it is still open a bit. Stop using full strength peroxide because it is damaging the tissue. He said that stuff is really strong and to cut it in half with tap water to clean it. He said keep using Neosporin. He said if it gets any worse he wanted me to call and let him look at it again. What would he do for it, put me on an antibiotic?? That would suck.

He asked me about bleeding. I said it was light and spotting after surgery. Stopped on Sunday night, Monday morning after surgery (a week) and then started back up in force on Tuesday morning. He said oh the surgery (anesthesia) threw your cycles off. You are having your period (which made me turn even redder. I hate turning into a tomato!) I figured as much with the excruciating pain it was. I had pain even with Lortab and motrin but at least it was bearable this time with the Lortab.

As far as meds when I ttc. No to motrin, I have to switch to Tylenol (will that even work???), start baby aspirin after I see him for a positive pregnancy test to prevent pe, and yes Gluconsamine and chondroitin are ok to take.

He went ahead and wrote orders for a 24hr urine and Preeclampsia labs as a baseline. I told him I had clotting bloodwork done in January and he said he had a copy of that (they copy all the drs here on that stuff. He said HIPPA makes it hard to get labwork from the hospital, so they list the obgyn and PCP as primaries on all hospital paperwork). The only thing that was high was protein S but my pcp said it was up because I had just had surgery. Oh and he told I would get a container for a 24 hr urine. I said btdt. I have done many 24 hr urine tests.
A 24 urine test is the only way to know reliably how much protein your body is dumping. Less than 300mg/dl is normal. Anything over 300mg/dl when pregnant is preeclampsia. When I had my oldest, I was dumping 5000mg. My kidneys were not working.

I told him I had counted out my loestrin and that I didn’t have enough to get to November 1st and that I needed one more. He gave me a sample of it. So now I have enough. No turning back on that seeing he didn’t write a rx.

I asked him about the prometrium. Did I need to stop it when I stopped the loestrin. He said yes. He said that it’s not that my body is low in it, it’s that I needed an extra kick to stop breakthrough bleeding. He said that my body should make enough prometrium for pregnancy.

I told him Dr. L would be switching me to Aldomet in September. He said good and he remembered discussing that.

So keep your fingers crossed that he can get the referral through (I lost a little faith with how he was a little off kilter above). I also contacted my pcp’s office and said he was giving it to me and working with me on it. But I worried he wouldn’t get it through. They said if he can’t we will.

Oh and he said it was ok to still try in Nov even though I am seeing this specialist in Oct. He said there wasn’t anything wrong with that at all. I said well at least I would have the consultation done. He agreed. I told him that I didn’t think that there was anything more that he could and he agreed and said I needed to see this dr. He said that he would coordinate care, send post op reports and records to him. I will have the pelvic pain and endo stuff dealt with by the specialist and (OBGYN) would handle everything else. He is ok with that. He said my insurance company wouldn’t pay for like regular annual exams and stuff with the specialist. So I feel a bit better. I just hope that my insurance gives me the out of network authorization and then the referral. Please let these people in his office NOT be idiots. The billing clerk and I had a run in a couple of years ago. So I have to be nice to her to have her help me. She does very well with flattery….

I also called and checked with my insurance company and the rep said it most likely will be approved. They may need to get more info but they would work with my obgyn on that. They said my primary can help with that too. My copay would be $15 for the visit, $15 for outpatient surgery, nothing for inpatient.

Oh and I made my lovely annual exam for 2/15/08. Hope to skip that and be pregnant. If I got pregnant in November, I would have to get it earlier. UGGGGGH. I detest them. Maybe he’ll let me skip if I am pregnant. I doubt it. I had to have one at nine weeks with S. They wait till you are 9-12 weeks preggo for an internal/annual exam.

So please pray that everything falls into place. Pray that I get pregnant in November. Pray that there will a magical solution in October for this pelvic pain. Pray for as little pain as possible. Pray that I make it full term. Pray for a healthy baby. I would like a boy to be different, but at this point, all I care is having a healthy baby. That is how I know that I REALLY want another.

I got in with the specialist!!!!!!!

Ok, so I sent off my little questionaire for the special pelvic pain and endometriosis doc. I called today to find out I was accepted as a patient. My appt is scheduled for 10/5 at 2pm. The earliest appt was 9/28, but last is the last day of the fiscal year. No can do. Darn. I have to bring post op reports and what records I have with me. I guess I need to sign a form at my obgyn's office to send my records. K had to go to Dr. L yesterday because she had a wicked spider bite. It literally ended up being about 5 inches by 7 inches big. Enormous. Dr. L put her on prednisone and a special steroid cream. It has cleared it up quite a bit. She had an allergic reaction to the bite and that was why it was so bad.

While we were at it, she was really surprised to hear my lap was normal. I am pretty disappointed that Dr. E didn't find anything. Everything was normal. It still doesn't answer what is going on. I told her that Dr. E wants to send me to a general surgeon. But I feel that I don't need a general surgeon. Besides general surgeons like to cut! She agreed that I didn't need a general surgeon. I told her about this specialist I found. She had never heard of him before. She wondered if Dr. E had heard of him too. She said that if Dr. E would not give me the out of network referral she would. I knew that she would, but I was surprised that I did not have to ask for it. She just came right out and said, he won't give it to you, let me know and I can help you out with that. She said she had several patients in my position with excruciating pelvic pain and awful periods. She said that she would like to know my experience with him because if I like him (she knows I am a nerd, yes, I check my drs out through a state website and I ask around), she wants to have a doc to refer patients to. This new dr is in a referral based practice for abdominal and pelvic pain. I am going to keep all my other stuff with Dr. E and then Dr. H can handle the pelvic pain issues. I really hope he can help. As I told Dr. L, I like what he has to say in my paperwork. He is the dr of last resort for many patients. He says if you hang with him, he'll hang with you. He realizes you have answered a zillion questions, had a zillion tests, and had surgery. But he has a process that he does to start from the beginning and works through everything. AND he DOES NOT immediately jump to surgery. My appt is Oct 5th. Wish me luck.

In the meantime, life goes on. We are still going to be on track ttc in November come hell or high water. I absolutely do not want to be over 35 when the next baby is born. I want them three years apart. Then we are done. I always wanted 4, but I am lucky dh has agreed to a third. No way would he agree to a 4th. I have too many problems in pregnancy to do that. I pray that it will be a quick conception, healthy pregnancy, and easy delivery and post partum with a healthy baby. I 'm not sure how it will work with Dr. H, but if I still have pain in pregnancy then he and Dr. E can work together. It is not guaranteed to work the first try. It could take months.

I know I need to see this doc. Today was a miserable day. I woke up bleeding (think the surgery threw off by bcp and I think I got a period today). Uggh, before I even got out of bed I was popping Motrin. When I got to work I had to take Lortab to function. I have taken it every 4-6 hours since. I don't know how will ever get through going off continuous bcp ttc. It will be torture. But maybe Dr. H can help with that. I had to go to work today because I am working on a very important project.

So please please pray that my insurance company grants the out of network referral. I know Dr. L will work as hard as she can to get it for me if Dr. E refuses. But he is a very reasonable guy. If he was willing to refer me to a general surgeon, if I bring in my paperwork, maybe he'll be willing to refer me to this new doc. Well if he doesn't, I have taken care of that for him.

So today I was doing a little planning.....

I decided I was not going to let a little endo, adhesions, pelvic pain get in my way. While I am waiting to see the new endo/pelvic pain doc, I have decided to keep on with my plans ttc. Being up on the fourth floor last week and seeing the new babies. Well that made me definitely decide for November to ttc. So I did a little planning today. I am the one that makes the bread in our family. Dh helps but I make almost twice what he does. So I figured out if I got pregnant on the first try, where would 26 weeks be. Where would 35 weeks be. Then I used a leave predictor sheet. I figured out with out any work at home (work at home extends it out further!), and using my leave and disability. I would have enough leave to be out from May 24th, 2008 through the end of October. Course that means no vacations from now till next summer. But hey 6 months off is good too! I figured I can make my peri appts in the afternoon when I get off work since dh and I no longer commute. Before with S., I had to schedule mid day. Ugggh. Now, I can schedule after 2pm. My obgyn's office is open till 4pm. So I can schedule between 3-345 with him. When I go in for postop next week, I hope to go ahead and schedule my annual exam. If I get pregnant when I want to, I will be at the gestation they like to do exams on 9-12 weeks. They don't like before 9 weeks because of risk of miscarriage. So keep your fingers crossed. I am getting really excited about it now. I hope the pain/endo goes in remission with pregnancy, if not, then just one more thing to deal with. I'm not waiting for that to get fixed. Otherwise I could be in menopause. Oh and when I go for my post op appt, I am peppering my ob with some ttc questions. Need to know about progesterone, folic acid (folgard), baby aspirin, bp meds.

Anyway, when looking at my leave. I figured the worst case of when I would be off work with room for negotiations either way. I am eligible to work from home if needed. Anything that I get above that (later off of work bedrest or GASP a normal pregnancy, that's gravy baby).

Dang do I got babyitis bad. Too bad my dh is leaving for a month. I would be very tempted to try RIGHT NOW.