The PLAN

Sidenote: I had to call Dr. G&D's office today about obtaining my records, and (of course) it took a few calls just to execute a simple task. I asked them to send all of my charts to Dr. T's office, so he'll always have them and I can always access them. I honestly don't understand why patients can't get ALL of their chart. It IS my uterus. I should be able to have every single sheet of paper and film in that file. Makes me wonder what's really going on in that file if I can't have it ALL. Anyway . . .

I made it back home today, and I'm so glad. It's nice to be in a doctor's office where people are polite, caring, friendly, and doing their jobs as expected. Of course my blood pressure was high, but we aren't talking about that right now, are we? I'll try to make this brief, as it seems all of my recent posts have been close to the length of War & Peace.

Dr. Terrific and I sat down for my consult. Taking out my notes (dialogue) from the last discussion I had (and will ever have) with Dr. G&D, awesome Dr. T knew I was ready to get down & dirty. Dr. T first mentioned he heard that Dr. G&D has little sense of a personality. I told Dr. T he was wrong - that Dr. G&D has NO personality. He chuckled and said he was just being nice. :) He asked me to catch him up, and boy did I!

A brief analysis of points made by the FORMER RE, and Dr. T's responses. (not quoted, but very very close to his exact words)

Dr G&D, Point 1: No bicornuate uterus
Dr. T: told me he already knew that as he & I discussed last month. He just didn't see it during my lap surgery, which is when it would have been completely evident.

Dr G&D, Point 2: "MTHFR . . . is not associated with an increased in m/c."
Dr. T: Bullshit. We both know that isn't true. Especially for those who have the homozygous mutation. You will be taking Lovenox for your next pregnancy.

Dr G&D, Point 3: (speaking of Lovenox) I don't need to be on Lovenox for future pregnancies.
Dr. T: see response to point 2 (now Dr. T is getting agitated)

Dr G&D, Point 4: I can get pg, and if I make it past 8-10 weeks I might be okay.
Dr. T: I guess that's the fourth thing I completely disagree with now. WTH? (his words) A majority of fibroids cause problems in the middle of the 2nd Tri. Your losses have all been early, thus pointing to something else. I think it's a biochemical issue, which is why we need to do Lovenox.

Dr G&D, Point 5: Injectibles (Follistim) should be used to get pg quickly.
Dr. T: "And that's number 5."

Dr. T has been doing this for 23 years and has delivered over 8000 babies. Yet another reason why I value his opinion and trust him. (I have no proof of that with Dr. G&D.) I asked Dr. Terrific what he recommended. He told me that he couldn't make a choice for me, but he would give me the possibilities.

Possibility 1: Get pregnant (we know I can get pg) and start Lovenox the day I get a bfp. Continue with folic acid and baby aspirin. Close monitoring (including a perinatologist).

Possibility 2: Have a myomectomy which would include an abdominal incision, 1-2 days in the hospital, recovery time, possibility of breaking through the uterus, 5% need for blood transfusion in the OR for blood loss, scar tissue & making the uterine lining worse than it was. Then get pg, start Lovenox, continue folic acid and baby aspirin, close monitoring, etc.

Well, gosh. What do you think, my wonderful readers??? Well, I'm thinking Possibility 1 in case you're wondering. Dr. Terrific thought that would be a good idea, yet he also encouraged me to discuss it with DH. He then "scribed" (uh, scribbled!) our "PLAN" options.

PLAN A: SEX. Foltex. Lovenox.

PLAN B: Myomectomy. SEX. Foltex. Lovenox.

We're going with Plan A. In fact, we set PLAN A into action tonight. :) I'm pretty sure I've already Od according to my temps, but the PLAN is moving forward. It's so nice to have a PLAN. Please pray that this PLAN works to bring us not only a pregnancy, but a healthy pregnancy that ends with me delivering a healthy baby. That is all we want.

Lesson learned - ALWAYS TRUST YOUR GUT. A woman's instinct is one of the strongest natural forces out there. If something doesn't look right, feel right, or sound right, validate your feelings and go with it.

Thank you, Dr. Terrific. I'll be calling about checking my cervix in the garage very, very soon. :)

I need a secretary to take dictation.

I've had it.

Go the bathroom (or insert a catheter), get some popcorn (or a couple of meals), pour a cold drink (or ten), & let's see if I can get this down. I don't even know how to type all this crap out now. I need to get it out so I don't go completely insane and to help me remember when I do go nuts. Plus, I need the reminder in case I ever consider talking Dr. G&D ever, ever, ever again. Before I forget - I called the RE to whom I had been referred by friends and the first available appointment is at the end of February (aka as another cycle gone).

After the first call from Dr. G&D's office, my cell phone rings again. Two more times. While my class is taking a test! (Thank goodness for the vibrate ringer.) Dr. G&D wanted to at least do a phone consult with me. They asked if he could call me at 3:45. Sure. WTH.

So, the office calls AGAIN --- remember, they are efficient --- and when I call back, Dr. G&D is there to talk with me. I think he had enough sense to know that I am pissed at him and he is not my friend anymore. (I've been on the playground with the kids too much lately.) I was VERY short in my responses and my monotone voice showed my curtness, not courtesy.

Bottom line: I do not have a bicornuate uterus. I repeat, I do not have a bicornuate uterus. I do not have a septate uterus. I repeat, I do not have a septate uterus. WTF????? I'll be using a lot of quotation marks from here as I quote exactly what I wrote down while talking to Dr. G&D.

The HSG report showed "bicornuate uterus suspected." The MRI results "were not consistent with a bicornuate uterus or a septate uterus." He said on more than one occasion that my "uterine cavity is not normal." In looking at the HSG and MRI, Dr. G&D said that it appears there is a :uterine fibroid in the fundus (top) of the uterus." Another fibroid? And why is that damn thing STILL THERE? Didn't I just have surgery just 60 days ago to get all that crap out of my bum ute? I digress . . .

Dr. G&D also says that this is probably the only reason I'm having difficulty; that basically nothing else points to my losses. (I think he's more concerned than I am about WHY I've lost three babies. I've had to write off getting those answers to prevent me being taken away by the nice men with a three-armed white jacket.) I digress again . . . I responded, "Well, that and the MTHFR." He then states that "MTHFR by itself is not associated with an increase in miscarriage." Oh really, Sherlock? That's not what the research I've read offers. Through my research and talking with other women who have the MTHFR mutation, I beg to differ. Actually, I won't beg. I know that can't be true. There's just no effing way.

Then comes the suggestion that "we need to address the fibroid." As in send it a postcard? As in I need to send invitations to everyone for another hooha party? Dr. G&D vacillates between the facts that (1) I'm running out of time, (2) the fibroid needs to be "addressed", and (3) I need to get pregnant. I try multiple times to figure out what exactly he's talking about, and I begin to wonder if he even knows. (Funny that I would question that - AGAIN.) When I asked him what options he means, he says that it needs to be "addressed either abdominally or hysteroscopically." I think he's talking surgery. Again. The fourth in less than two years. Me = not happy. Still.

He continued to vacillate more than a cheap, old, metal fan with rust on it at your Meemaw's 100 year old house. He said that I could get pg, and if I "made it past 8 to 10 weeks" then things would probably be okay. How reassuring! I always spot in the sixth week of pregnancy (6w3d to be specific) and have miscarriages in the eighth week, so gosh, let's try the pg crapshoot again. I finally tell him that "I am getting mixed messages here. Are you saying that I need to get pg or have surgery?" I need one or the other. He finally says it - "Surgery."

Then I'm getting even more angry. I told him (while choking back tears because I cry when I don't scream) that "I wish I would've known this before the end of last year. I spent close to 1/10 of my annual salary last year, and this is STILL NOT FIXED." His heartfelt response? "I'm sorry." Asshole. That's just not enough. I then told him I needed to speak with my husband and ended the phone conversation.

Crying, I leave everything behind at school (and you have no idea HOW BEHIND I am right now) & trying not to completely lose my shit. For the bajillionth time in the past 22ish months, I have my personal cryfest in the car. I curse at people, I cry, and then the phone rings. It's DH. He knows I'm upset, so I tell him I talked to Dr. G&D and I'm not happy. We can talk when I get home.

Continuing on my quest, I call Dr. Terrific's office & leave a message with "Nurse Excellent" (Dr. T's wonderful, excellent, empathetic nurse) that I need to speak with Dr. T. She calls me back within twenty minutes and is not happy to hear what Dr. G&D said. When I mentioned surgery, Nurse E said, "Why don't you let Dr. T do it if it has to be done?" I hadn't thought of that. I told Nurse E that I will be contacting Dr. G&D's office on Monday to get all of my files together. "I want all reports, charts, films, and (party) pics. It's my uterus, and it will become a part of my uterine briefcase now." She wholeheartedly agreed. I'm going to become Rain Man after all by keeping my "red, severe injury book".

So . . . the next part of this screwed up story is a consult with Dr. T on Wednesday. If he can get me through this, get us pregnant, keep us pregnant, deliver us a precious little baby, and up my Prozac dosage in the meantime, then we might have a plan. He's my main man anyway.

Aannnnddd - SCENE.

What is MTHFR?

I've seen many posts on the online forums which I visit and have received questions from many others about the MTHFR genetic mutation. This is my perspective.

Disclaimer: PLEASE consult your own medical professional and do not consider my thoughts and opinions in your own treatment. Everything included herein is not based on information from a medical professional. (I am an elementary school teacher!!) Everything written here is based upon MY personal experience and research. I cannot/will not be held liable for erroneous information or for those seeking answers or treatment.

MTHFR - methylenetetrahydrofolate reductase - is a gene that we ALL have. So if someone says "I have MTHFR," of course they do! However, some of us unfortunately have mutations of the MTHFR gene which can cause miscarriage and Recurrent Pregnancy Loss. The MTHFR mutation causes the body the inability to absorb folic acid (vitamin B9) and may also cause clotting issues, both of which are vital for a successful pregnancy. It is possible to carry a successful pregnancy with the MTHFR mutation, but the risks are higher for cystic fibrosis and other neural tube defects due issues with folic acid deficiencies.

Testing of the MTHFR gene is simple. One of the standard tests in the RPL panel includes testing of the MTHFR gene. This blood work can be drawn to test for many disorders which might explain RPL in some women. Many insurance companies do not cover costs of the RPL panel until three (3) or more miscarriages have been diagnosed. Check with your insurance company or "work" with your doctor for coding should you require/need/want RPL testing prior to three (3) miscarriages.

Very little information is available on the MTHFR mutation because it was discovered just a handful of years ago. There is some information available on the internet, but much of it is in medical journals which can be difficult to decipher and comprehend. The resource I have found to be the easiest to understand in my research is here.

There are homozygous and heterozygous mutations of the gene, and each can create different issues depending on the type of mutation one carries. RPL results will show the exact mutation(s) although treatments are often the same.

* Typical protocol for treatment includes an increase in folic acid (appx. 4mg daily) , a daily dose of 81mg aspirin (the same dosage of baby aspirin), and the possibility of blood-thinning injections during pregnancy. Some doctors increase the intake of vitamins B6 and B12. Of course, all women trying to conceive should take prenatal vitamins - either prescription or over the counter. An OB/gyn should have patients do a fasting blood draw to test your homocysteine levels. If they are elevated, he/she will most likely prescribe Lovenox or Heparin shots upon a positive pregnancy test.

My diagnosis & treatment: After two early m/cs (both at 8.5w), my amazing OB/gyn felt it would be smart for me have the RPL panel run. He coded my paperwork so that my insurance would cover the testing without question. I was found to have a homozygous MTHFR mutation of the C677t, which means that I have two copies of that gene. My Rx includes 4mg Foltex each day, plus my PNV (which also contains f/a), and an 81mg aspirin each day. When tested, my homocysteine levels were not elevated, but my ob/gyn wants me to have Lovenox injections with my next bfp because (1) I've requested it because I feel in my gut that it will help, and (2) he's proactive and willing to "pull out all the stops" for me to have a successful pg. He's an awesome doc.

Hope that helps to answer some questions and provide information that might help you or someone else.