Friday, February 03, 2012

The Halfway Switch

WARNING:  long post ahead!

I'm officially at 20 weeks--halfway there!!  To celebrate, I'll be switching OBs.

When I first got the positive pregnancy test, I didn't have an OB in Lafayette yet.  So I made an appointment with the only doctors whose names I had heard.  I ended up not liking them at all.... which is highly unusual, because I see a LOT of doctors (family practioner, fertility specialist, dentist, endocrinologist, neurologist...) and have not previously had any problems finding ones that I like.  But let me explain to you the ridiculousness of this particular OB's office:

Appointment 1: 8 Weeks
At my first appointment, I spent almost a full hour talking with the nurse, going over my medical history in detail.  I explained that I had seen a fertility specialist two weeks before and that I was kind of paranoid because I had miscarried 3 times in the past.  I also explained my (long and complicated) history of thyroid problems and migraines.  I assume that all of this made it into my chart, as the nurse took notes the entire time.
When the doctor finally came in, he had me hit the medical history highlights again.  Then I told him that I had been having "frequent" migraines, and he prescribed Fiorecet, which I had not used before.  I then asked him what the office's policity on inductions was, since all 3 of my kids have had to be induced.  He replied, "We don't even discuss that until 41 weeks."  Um, okay.  I'm not looking to schedule right now, but I'd kind of like to know what your policy is before I get to that point, just so I'm prepared.

Before I could ask any more questions, I looked at his watch and said, "Sorry, I've got to go."  And then he left.  And that was the end of the appointment.

I was left feeling very unsettled.  I had never had a doctor just walk out on me, like "sorry, that's all the time I've got for taking care of you today."  Especially at my first appointment, it did not give me a good feeling about the practice.  But there were still two other doctors in the practice, so I figured they might be better....

Appointment 2: 12 Weeks
At my second appointment, I met the other male doctor in the practice.  He glanced prefunctorily at my chart and asked why I hadn't had an exam during my first appointment.  He said that all new patients receive exams, so why hadn't I?  Well, I said, I don't really know, but that doctor left my appointment in a hurry, so I guess he ran out of time?  This new OB seemed to think that was perfectly acceptable.

I told him that I was having daily migraines.  He kind of blew off my concerns and said, "Oh, don't worry, those always go away in the second trimester, and you're almost there."  I figured that since he had my medical records, he should have already known about my history with migraines, but I explained it to him anyway.... that I had suffered from migraines with all three of my older kids and that the migraines had NOT gone away in the second trimester in any of those pregnancies.  Furthermore, I explained, I have chronic migraines even when I'm not pregnant.  When not pregnant, I have to take Topomax as a preventative and still get at least 1-2 headaches a week, even with that.  So while it wasn't shocking to me that I was getting migraines daily during pregnancy, I also wanted to know what could be done about it.

"Oh," he said, "Just keep taking the Fiorecet."  But, I explained, I had to take 2-3 Fiorecet every single day to get rid of the migraines.  I said that I wasn't comfortable taking that much medication for the next 28 weeks.  "Okay," he said, "Can you get comfortable taking that much for just one more week?"  Um, okay, but what magic occurs then?  He reiterated his argument that he was sure that my migraines would magically disappear when the calendar flipped another week, but on the off chance that they didn't, he said to call the office and he would phone in a preventative for me.  He said the preventative wasn't safe until the second trimester, but once I crossed that line, he'd call it in.  The "not safe until the second trimester" thing didn't exactly inspire me with a lot of confidence, but it was clear that was the best he was going to do.

I then asked again for more information about the possibility of induction, and again, I was told that "we don't discuss that until at least 41 weeks."

"Anything else?" he asked, in a voice that indicated that I had already asked enough questions.  But, sorry, I had other questions.  I explained that I was having a severely upset stomach, resulting in horrible diarrhea a minimum of 4 times a day.  "Do you have any idea what might be causing that?" the doctor asked.  Um, yeah, I'm pregnant.  I suspect they're related.

I explained that since I was taking prometrium, and diarrhea is a common side effect, I thought that might be the cause.  "Wait, why are you taking prometrium?" he asked, confused.  I explained that I had seen a fertility specialist when I had discovered that I was pregnant, and that doctor but me on prometrium to help me sustain the pregnancy, since I had a history of miscarriages.  The OB's unfamiliarity with this entire story demonstrated to me that he had NO IDEA what was in my medical records (in spite of the fact that he had them in his hand).

"Oh, well, just stop taking it," he recommended.  Um, excuse me?  STOP TAKING the medicine that helps me prevent miscarriage?  Why on earth would I want to do that?

"That medicine doesn't really do anything," the OB said.  "It's completely a placebo effect."

I was utterly shocked.  I again explained that the medication had been prescribed to me by a FERTILITY SPECIALIST, who surely knows what he is doing.  "Sometimes older doctors think it helps," said the OB dismissively, "But they're wrong."

Well, I'm glad that you're smarter than ever other doctor.  But, I explained, of my past 6 pregnancies, I had used prometrium for 3 of them, and those children (hopefully including this one) were born safely.  The other 3, the ones I didn't have prometrium for, miscarried.  So even if you don't believe other doctors, I'd say that my own body has been a pretty good field test. 

Nope, the OB said.  Completely in my head.  Just stop taking the prometrium.  It wasn't doing anything anyway.

I was SO MAD.  Not only did this doctor have no idea what my medical history included, but he was dismissing other doctors' work out of hand without being familiar with that history.  Moreover, he was completely disregarding what I was telling him.  Folks, these are not signs of a good doctor.

I left the office angry, thinking that I would give them one more chance.  I had yet to see the third doctor in the practice, who happened to be both the only woman and the one who had actually been recommended to me.  So I decided to give it one more chance, then if I liked her, declare her as my primary and hopefully never see either of the other two again.

In Between: 13-14 Weeks
As I had predicted, my migraines did not magically go away when I entered the second trimester.  I gave it a couple of weeks, then called the office and asked to talk to the OB's nurse to get my preventative presciption, as the OB had instructed.  When I talked to her, though, she had no idea what I was talking about.  "I'll have to ask the doctor about that," she said.  "Let me call you back."  Clearly, he had not written a thing about it in my chart.

When she called back that afternoon, she asked how many days in the past week I'd had migraines.  "Six," I said, since I had been blessed by one rare headache-free day in the past week.  "Oh, sorry," she said, "The doctor said to only give you a prescription if you were having them every day."

What?!  He promised me a prescription at my appointment, yet wrote nothing about it in my chart?  He didn't think that SIX MIGRAINES in a single WEEK were enough to warrant treatment?  Particularly when they were actually EVERY DAY, but I'd for once managed to have a "good" week?  What was I supposed to do then?  "He says to just keep taking the Fiorecet," his nurse reported.  Yeah, thanks, because that's clearly done so much good so far....

Appointment 3: 16 Weeks
At this appointment, I met the third and final doctor in the practice, who happened to also be the only woman and the one who had initially been recommended to me.  So I had high hopes for the practice to be redeemed.  Sadly, I was disappointed... again.

I started out with my now-standard questioning about the particulars of induction.  And I received the now-standard response of "we don't discuss that until 41 weeks."  This time, though, I argued.  I explained that since I had never had so much as a single contraction on my own in any of my three previous births, the odds were good that I'd eventually be facing an induction, and I was not comfortable continuing with a practice that wouldn't even discuss the possibility with me.

She looked surprised but explained that she and the other doctors in the practice like to avoid inductions if at all possible, thus the policy of not even discussing them with the patient until 41 weeks.  Well, I said, I would love to have one kid without induction, since it's definitely no picnic... but considering that I'd had 4th degree lacerations getting out the kids I've had so far, it probably wasn't in my best interest to wait until they got 42- or 43-weeks huge.  "Hmm," she said, like she didn't believe me.

Next I again raised my concerns about my migraines.  I was STILL taking 2-3 Fiorecet EVERY SINGLE DAY.  I explained that I was VERY uncomfortable taking that much medication.  "Oh, it's fine," she said, "Fiorect is a very safe medication."  Really?  Even in those quantities?  Even if I had to take it for another 24 weeks?  Not a problem, she said. 

I argued.  I again explained that I suffer from chronic migraines and have to take Topomax even when I'm not pregnant, and told her that her counterpart had promised me a preventative and then not delivered.  Finally, she conceded and wrote me a prescription.... for Procardia.  Which is a drug to prevent pre-term labor.  Really, in a woman who has never gone into labor on her own?  Helpful.  But she told me that it's used in much larger doses to prevent pre-term labor, and for me it would just help to open up my veins to let the blood flow better.  Ok, I figured, it's worth a shot.

Even though I was not feeling overly impressed with this doctor at that point, I asked about declaring a primary within the practice.  Oh, no, she told me, we don't do that.  You'll see all three doctors throughout your pregnancy.  That was the point when I decided that I was going to find a new OB, which made the events of the rest of the appointment somewhat laughable to me.

Then she tried to find the baby's heartbeat and utterly failed.  And she FREAKED OUT.  I gave more details about this in an earlier post, but the shortened version is this:  She flipped out that she couldn't find the heartbeat.  I explained that since I have a retroverted uterus, doctors are often unable to find the heartbeat, and that this had happened frequently with my 3 older kids, and that this was not a cause for concern.  She continued to freak out, and I thought about how this was definitely NOT the kind of person I wanted in charge during my delivery.

In the end, she rushed me across the hall for an ultrasound, where the tech (who is the bright spot in this entire practice) revealed that 1) the baby's heartbeat is good, strong, and totally fine and 2) the baby is a boy.  Yay on both counts!!

But then I returned to "consult" with the OB, and she sat me down and gave me a lengthy talking-to about how she had looked at my chart, and she thought I was taking too many medications.  She advised that I stop taking some of my regulars.  Aghast, I explained to her that these medications had been prescribed by my endocrinologist and were basically all that kept my body functioning, and that I have blood tests every 4 weeks to make sure I'm on the right dosage.  Still, she said, couldn't I just stop during pregnancy?  Um, no.  My body doesn't make energy on its own.  I'd like to be able to grow this baby, thanks.  I then reiterated my concerns about the Fiorecet and the Procardia that she had just prescribed, and she blew me off.  "Oh, those are fine," she said, "I just don't like that you're taking so many other things."  Oh, right, so the medication YOU prescribe is fine, but not the stuff from other doctors?  Hellooo, double-standard!

In Between: 19 Weeks
Basically, I continued taking hearty doses of Fiorecet daily.  The Procardia did absolutely nothing to prevent headaches.  Finally, I gave up and made an appointment with my neurologist in Indianapolis.  You can read all the gory details here, but the basic summary is that
1) Procardia does nothing as a preventative--stop taking it immediately.
2) Fiorecet should never be used in patients with chronic migraines--stop taking it immediately.
3) Fiorecet is known for causing rebound headaches when taken in large doses.  Since I have a history of rebound headaches, I should never have been put on this drug.  In fact, I'm probably not actually experiencing daily migraines right now, but rather some migraines and some rebound headaches.
4) My OBs are clearly all idiots for recommending this course of action, especially given my medical history and all of the concerns that I expressed.

Appointment 4: 20 Weeks
I headed into this appointment knowing that it would be my last one at this practice.  I've already lined up a new OB, but since I was due for my 20-week ultrasound, the new practice told me to go ahead and do that with the old docs, so that it wouldn't have to be the very first time I saw the new ones.

The ultrasound was great.  Again, I love the tech.  She's the bright spot in that whole terrible place.  The baby is healthy, strong, and has all his parts.

And then I went in for my appointment with the doctor... which happened to be the second one I'd seen, who had not given me a preventative and had told me that prometrium did nothing.  This appointment was relatively painless, since I didn't ask any questions and just tried to get out of there as fast as possible, since by that point, I didn't trust a word he said.  He did ask how the migraines were going, and I reported that I had seen my neurologist, who had told me to discontinue both medications prescribed by the OBs.  I then reiterated what the neurologist had told me about Fiorecet (how it should never be used with chronic migraine sufferers, and how it causes nasty rebound headaches), and the OB was like, "Well, that's true.  Those are down sides."  Um, you KNEW about these things and didn't feel the need to warn me?  Particularly since you know, theoretically from my medical history (which I'm pretty sure he's never looked at) and also from me telling you repeatedly, that I am both a chronic migraine sufferer and prone to rebound headaches?  In other words, I am the exact portion of the population that should not be exposed to this medicine.  And I told you repeatedly that I wasn't comfortable taking so much, and you explicitly told me to keep doing it and that it wouldn't hurt me?  You, doctor, are incompetent.  As are your two cohorts.  Which is why I will not be returning to this practice.  Ever.

So that's the end of my (very long) story of the Most Terrible OBs Ever.  Looking forward to starting at a new practice next week and hopefully getting decent care for the second half of this pregnancy!


Katie DeKoster said...

Holy freaking cow. I maybe would post this somewhere on the internet as a review of that practice. Their behavior was shameful. SO happy that you are going to a new doctor!!!!

Jill said...

Hope the next group is a better fit for you! There are def a wide range of docs out there ...

Chris, Britta, Grace, Gianna, Toby, Josh, and Sam said...

Amy - You rock! You know you're body and you know what's right and wrong to point, which is of course why we see doctors...cause we didn't go to school to learn what they're supposed to know. (Supposed to being the operative phrase!!)

Just keep doing what you're doing, except taking all those drugs that you're not actually supposed to :) Stand up for're the best advocate you have for yourself at this point.

My pregnancy stories from this last pregnancy don't quite compare to yours, but I respect the OB switch!!