February 2008 - Posts
I kind of had the type of day on Monday. Last week following my appointment with my primary OB practice, I realized there were a few things I needed to talk with one of their receptionist about.
The first one being that my bi-weekly appointments with their practice were currently scheduled a day apart from my appointments with the high risk group. Seemed a bit like overkill one week, and draught the next, so I moved my appointments with my primary practice one week later so I'll only be seen once a week - every odd week by my primary practice, and every even week by the high risk group.
The second was to inquire whether or not the group ever received the ultrasound report from my high risk group. It seems that when I met with my primary practice, they hadn't received the latest ultrasound report from the week before (I had my ultrasound on the 13th, and my primary appointment on the 18th). The doctor I saw on the 18th had asked me to follow up with the high risk group to ensure that they had sent it over. I had called the high risk practice prior to calling the primary practice and they assured me that it was sent over on the day of my appointment (rule in their office), and that they always send it to the main office in Hartford. In explaining to the woman on the phone from my primary practice what had occurred and inquiring whether or not they did receive the report, she replied that it was, "right there in my file," and she didn't understand how the doctor could have missed it. Okay, cross that one off the list.
Finally, I had asked to have the last two ultrasound reports (including the first trimester screening results) as well as the doctor's notes from my appointment on the 18th forwarded to my rheumatologist as I would be seeing her for a check-up on the 25th. I was kindly told I needed to sign a release, and after agreeing, she said she'd stick it in the mail. This way I'd get it on Wednesday and be able to fax it back so that they had plenty of time to forward the reports. I hadn't requested they fax the release to me as our fax line is the same as the phone line and it's a bit of a hassle for me to keep running up and down the basement stairs (where our fax is) each time the phone rings to switch it over to the fax. Stupid me.
Fast forward. Monday morning I realized that I had never received the release, so (call twice, forward once) I called the primary practice back and explained that I hadn't received my release and I needed the files sent prior to my 1:45pm appointment that day. The woman I spoke with this time was a bit shocked that I had never received the release, and of course, I asked her to stick another one in the fax - I was willing to deal with the inconvenience.
It came through, I filled out the form in detail even providing the dates of the ultrasounds and appointments. Within minutes of sending it back the woman I originally spoke with called to say that they could send the doctor's notes from the 18th, but that they never received copies of the ultrasounds - either one. Strange as the first ultrasound was tied to my first trimester screening and I had gone over those results with a doctor from my primary practice at a previous appointment. Additionally baffling as last week the office had both ultrasound reports. I explained this to the woman on the phone, and her reply was that she, "saw nothing." I further explained that all reports are sent to the Hartford office - would there be any reason someone else would have this information...the answer, no.
Arg. I asked her to call the high risk group and get what she needed, and she said it would probably be faster for me to call (arg, arg) and they could just fax it to both places at the same time...ensuring that my rheumatologist had the information for my appointment that afternoon.
Gotta love the laugh I got from the kind woman (who I talked with last week about the "missing ultrasound") when I explained that it was now missing again. Her response was that they have this experience on a fairly regular basis with that group. Something I'll definitely raise with the next doctor I see in a week and a half. She did fax both doctors both ultrasound reports, and by the time I was at my rheumatology appointment, the physician had all the information she needed. Only took several calls, and a lot of proactivity on my part. What kind of gets me is that I was basically chewed out by the practice that's "misplacing" my reports for not having had my rheumatologist forward my diagnosis report...but now it's completely fine for them to not follow through on my requests.
Good news is that the appointment with the rheumatologist went very smoothly, no noticeable changes in my status (other than the weight gain from the pregnancy). I did talk with her a bit about the dry skin, and have to be more diligent about dishpan hands and applying cream every time I wash my hands...which these days is like once or twice an hour between diapers and my own bathroom trips. As I had blood drawn right before my appointment (as a follow-up to my first trimester screening), my rheumatologist wrote me a slip to combine with my next pregnancy-related blood draw...so I won't have to feel like a pin cushion. Her words, not mine. Thought that was nice. Regarding my dosage for Plaquenil, I'm going to keep taking 200mg every other day until the pregnancy fatigue dies down, then I can go up to 200mg a day. I'll be back to see her in another 2 months. Hopefully my RA will remain minimal and by then the dry skin will have improved. Not sure I can expect any improvements from my OB practice.
Yeah, the cramps are back. Supposedly from all that my doctors have said, this is fairly normal...unless it feels like labor cramps. For someone who never got to experience labor or labor cramps, that's a tough one to figure out. I know about the back pain, the "tightness" over my abdomen, etc., so I'm just thinking this is normal cramping. Whatever that means.
I joined some friends for dinner on Monday night at a Japanese place (and no I didn't have sashimi!) just about 10 minutes from home. As always, we spent the first hour or so just talking before we even placed our dinner order. Nice to just sit and have a civilized conversation with another adult without wiping faces, fixing food, or picking up food off the floor.
I made it through our meal, but all of a sudden started to sweat and have some cramping. I thought it would pass, but it just became more persistent. I excused myself from dinner, left my portion of the bill, and headed home (I was happy to hear that my friends did stay and talk for a while longer). I was drenched by the time I got home, and after visiting the bathroom, headed to the couch in my comfy pjs to lay down. The cramps continued all night long, but they were high up under my chest, not down where the baby is. I woke the next morning not crampy, but sore (like I had done about 8,000 sit ups). Maybe stuff is moving around in there. However, by the afternoon, the cramps were back with a vengeance...as they were after my nap yesterday afternoon. Maybe it's an end of the day thing.
I've been drinking quite a bit, but I'm also fighting yet another cold. I've been congested the past few days, and my son has been a little runny and coughing. Think we're clearing through the worst of it, but last night nearly took everything out of me. My son (who I think is working on his 2 year molars) fought us to go to sleep last night. Instead of the typical 8:15-8:30 bedtime, he probably didn't fall asleep until well after 9, only to be up crying around 10:30. When I went up to comfort him, I realized it might be the teething as his hands were jammed into his mouth and the drool was very evident, so we brought him downstairs to calm him down for a few minutes and get some Motrin in his system. I was ready for bed by that time, so at 11pm we all headed upstairs and tried to tuck the little guy into his crib. No luck. He joined us in bed for about 30 minutes until he had calmed down and seemed sleepy. My husband moved him into his crib, where he immediately began to cry, then scream, then wail. Spent the next few hours shuttling back and forth between my bed and rocking/singing/calming my son to sleep in his room. Each time I'd lay him back in his crib nearly asleep, he'd wake and start the screaming process all over. He finally cried himself to sleep just before 2 and then coughed for the next 20 minutes. I was shocked when he was up before 7 this morning...so here's to hoping for an early and long nap this afternoon! Functioning on under 5 hours isn't something I'm up for just yet.
I'm officially 16 weeks today, and as of my ultrasound last week, the baby has now "caught up" to the measurement. Earlier on, the baby's development was about 4-5 days behind (not surprising as I ovulated late), but as of last Wednesday, I was measuring 15w1d and I should have been 15w1d. Yeah.
I had another appointment (quick in and out) yesterday with my primary practice. Everything sounded great, and the doctor (this time I saw the OB that delivered my son...and predicted he was BIG) mentioned that feeling some "pulling" when I sneeze or cough or laugh is totally normal. Good to know, as several times in the past few weeks I've laughed and had to hold my stomach because it felt like it was pulling. From what the doctor explained, it's because that area has already been stretched out so it will feel like I've got some tightness from time to time.
I was thinking the other day about something the ultrasound technician said during my appointment this past Wednesday. It's been bugging me, but at the time, I just tried to laugh it off. While the doctor was measuring the baby's heart beat, the technician was looking on. The doctor asked me what symptoms I've been experiencing, and I replied that it was just the dryness and fatigue right now - dry eyes, mouth, skin, etc. The technician's reply was something to the effect of, "maybe I have it too as I'm dry with this weather."
First of all, I can kind of understand people trying to sympathize and relate to being dry. It's natural, and yes, at this time of year most of us have dry skin and need a humidifier. However, are these people also so dry that when they inhale their tongue sticks to the roof of their mouth because there's no saliva? Do they wake in the middle of the night because their mouth is so dry that their tongue has split down the middle? How about having eyes so dry that it feels like sandpaper every time you blink?
I recognize that many people try to understand what someone's going through by putting themselves in the same situation. However, in thinking about the technician's response (and the glare the doctor gave her) I would like to think that those in the medical profession would be more professional about these types of things. Ha ha. But come one, don't trivialize what someone's going through. I'm fortunate enough that my symptoms are relatively minor (I'm not in organ failure, I don't have cancer, I'm not blind). However, imagine someone who did have more severe symptoms or was more worried about their condition receiving the same response. Almost like the one I got from the GYN I first saw who basically accused me of self diagnosing Sjogren's because she didn't have the medical diagnosis on paper - a slap in the face.
I'm fortunate that all of my friends and family have been sensitive (if not humorous) about my situation. My sister says that everyone has something they have to deal with - so this is my something. She's also the one who asked me to cut the onions this summer as with fewer tears, I'm less likely to cry when cutting an onion (don't worry, my eyes still sting, they just don't water nearly as much as a normal person). Funny. Everyone needs a little humor...and a little supportive understanding (not belittling).
At 15w1d we had our fourth ultrasound - second one with the high risk practice. The whole appointment took nearly an hour, as the first half we met with the ultrasound technician who took several pictures of the little one with its hands up by its face, sucking its thumb, and laying nearly completely stretched out in my womb. Our son was always curled up in the fetal position upside down when we had his ultrasounds. This child is very active and stretched out...however, my husband reminded me that this is much earlier than we had our other ultrasounds so perhaps there's more room right now to move around.
Everything looked great from a developmental standpoint, and although the measurements of the body still indicate I'm about 5 days behind gestationally, the measurements of the head indicate that everything is on track (supposedly the head is a more accurate predictor of gestational age). It's amazing that the baby can be so small, but they can get pictures of the body that are so clear like the hands and fingers, the legs, and brain.
We did try for a second time to determine gender, and although she took some time to make the determination, she indicated that it could go either way. At this point things are still developing and there could be some swelling that makes it more difficult to tell for sure. I have another ultrasound in 3 weeks, so we'll have to wait and see if the third time really is a charm.
After meeting with the ultrasound technician, she went to call in the doctor so she could monitor the heart (which is why we were really there - to start the heart monitoring). The technician came back in and said that we'd need to switch rooms, as the other room had the machine that they needed. Nothing like getting that ultrasound goop on you twice...and having to clean it off twice! The heart monitoring was amazing. The doctor found the beating heart (can you believe they can see things like that at this point - the baby's just a few inches long!), and then used the computer to put a bracket around the beating heart. This enable the computer to calculate the heart beat interval, which I'm guessing is some type of measurement (not an actual beat per minute). The doctor said anything above 140 was a good measurement, so seeing the two measurements at 153 and 159 we were pretty happy.
Since things looked so good thus far, the doctor said I didn't need another appointment for 3 weeks (which is great because there's a $30 copay for each visit as they are a specialist!), so at that appointment they'll measure the heart beat interval again, as well as take a few more pictures of the baby's development...and hopefully gender!
I broke down and called my rheumatologist this afternoon and left a message inquiring whether Plaquenil could be making me more tired than I was before taking it. Seems counterintuitive, but anything's possible, right?
I did look around online for other people having this seemingly silly side effect, and found people on both sides of the coin. We all know how reliable the Internet is, so I called my doctor. She returned the call and confirmed that it was highly unlikely, but anything is possible. Until I see her next week, I'm to drop the 400mg/day to 200mg/every other day. Oh well, so much for starting that yesterday. No need to take the meds tonight though.
She's thinking that in a week if I'm not so tired we can figure out whether the fatigue is somehow med related or if it's just the pregnancy. Nice how it's tough to tease apart the culprit. I'm thinking it's just the pregnancy, but I hit a wall in terms of being tired at nearly the same time I started the medication. Strange coincidence.
A few people have asked me if I've noticed a difference after being on 200mg/day of Plaquenil after 2 weeks. Well, if feeling MORE tired is a difference, yeah.
Not sure if it's at all possible for fatigue to be a side effect of the medication, as it was my understanding that it's supposed to help improve my fatigue. I could just be lucky enough that the fatigue during the second trimester just happened to coincide with me starting the medication.
Well, tonight I'm supposed to up my dose to 400mg/day. We'll see if that makes any further difference. I did call my health insurance company to discuss whether an eye exam every 6 months would be covered. I explained what was going on - that a potential side effect of this medication is blindness (irreversible, so doesn't that sound like something to be monitored closely??). They indicated that if my eye doctor marked that it was medically necessary vs. routine it would be fully covered. Here's to hoping that 1) there is no change in my vision and 2) that it really is covered. Going to have that exam in early July.
I did got and have my teeth cleaned this afternoon. Knowing that dental hygiene is very important for those with Sjogren's due to the dry mouth issues (causing more cavities), I want to make sure I'm not only brushing and flossing at home, but getting in for regular visits with the dentist. The hygienist commented during my visit that my mouth was very dry...and bleeding. She said that the excess bleeding could be due to the pregnancy hormones, the Sjogren's, or the fact that I'm a mouth breather (guess it changes the texture and sensitivity of the skin on your upper palate). Great. Nothing like having good teeth with few problems, but wind up with bleeding gums throughout your cleaning. At least there were no cavities.
Time to probably start looking into more of the medication side effects so they are top of mind, not to mention read more about other symptoms of Sjogren's to monitor whether I'm progressing or not. My next visit with the rheumatologist is on the 25th, so we'll be able to chat about things at that point as well. Want to be armed with any questions ahead of time though. Be prepared. Is that the motto of Motherhood? I know it's the boy scout motto.
Although I'm not there gestationally, this is where I am from a LMP standpoint.
Had another visit with my primary practice this morning, after waiting about 30 minutes for the doctor, the visit was all of 2 minutes. The baby's heartbeat is right around 160 bpm, so continuing to be a good sign there won't be issues of CHB...just 12 more weeks, so I'm about half way there. I also only racked on a pound in 2 weeks, so my weight gain is a bit better than it was with my son.
The doctor went through the results of my first trimester screening, and I have about a 1 in 8,800 chance of having a baby with Downs Syndrome, and a 1 in 10,000 chance of having a baby with trisomy 3. The doctor basically said that's like a 0 in a 100 chance. Good.
I need to have more blood work taken between the 15th and the end of the month, and another appointment with this practice in 2 more weeks. Next week's appointment with the high risk practice will hopefully reveal the baby's gender as I'll have another ultrasound. We can hope, as I'm holding off...as best as possible...from buying any clothing or room decor. The pink outfits are SO cute though!
I totally forgot to whine about how tired I've been. Can someone explain why I'm now able to fall asleep at the drop of a hat, that I can easily get in 2+ hours nap time with my son in the afternoon and then fall asleep around 10...and don't want to get up at 8am? Oh yeah, I'm pregnant. Oh, and the Sjogren's doesn't help. It's been a week on the meds, but I have yet to notice a difference. If asked, I'd almost have to say the fatigue has gotten worse. Might not be the meds, just that I'm into the second trimester.
That's the word from my primary OB about my first trimester screening. Not that I thought it was going to go the other way, but it's still nice to have those reassuring words.
I'm still battling whatever this illness is, sore throat comes and goes as does the hoarseness. My treat today was not only a nice 2+ hour nap (in my comfortable bed vs. the couch) while my son slept, and then I convinced my husband to stop and pick up some good Italian food, a coffee milk shake and a movie for tonight. Although I'm sick, this is a great way to spend my birthday.
I also received a call from the nurse at BCBS checking up on me. She inquired about my laryngitis, asked how I was feeling otherwise, how my diet and weight have been, and what the results of the first trimester screening showed. Completely painless. She also asked me if I knew what the signs/symptoms of high blood pressure are...considering this is a precursor to preeclampsia. I had not idea. Headache that can't be kicked by Tylenol, feeling ill, blurry vision, etc. Signs that I should call my doctor, especially if I start to notice swelling in the face and hands or a rapid increase in weight (like a few pounds in a day or so). Good to know.
Time to sit down for a little dinner and then some family time this evening. Second pregnancy, and second time I've been expecting on my birthday. Nice to share that with baby as well.
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