I got a call from my doctor's nurse today. She said the result of my homocysteine test was back and that my level was low. Apparently the normal range starts at 5 and I had a 4.18. I have no idea what that means. Obviously it's good that it's not high (above 10) because that means it would cause an increased clotting risk in addition to my FVL. She didn't seem concerned that it was low, so I'm guessing it's not bad. I've been trying to find ranges for homocysteine levels and the significance of low levels online but I can't find anything but the risks of elevated homocysteine. She said given my history they want me on 4mg of folic acid and 500mcg of vitamin B12, which makes sense because of the whole MTHFR causing neural tube defects thing.
My OB consulted with the Peri and they decided that I will be put on 40mg of Lovenox daily once fetal heart tones are found. I will also do the nuchal translucency u/s at 13-14 weeks. They have discussed putting me on baby aspirin (BA) for life but I am not encouraged to use it while trying to conceive. The Peri also wasn't concerned with my positive ANA just yet so they will recheck in 6 months to see where my levels are at and go from there.
I'm a little upset. Based on the conversation with my OB, it sounded like I was going to start Lovenox as soon as I got pregnant. She also told me that I could go ahead and start taking BA while TTC, or even take a full strength aspirin for now if I wanted. Now, after talking with the Peri, that has changed? When we saw the Peri before any of the clotting disorders were known, she mentioned that she would put me on BA only after fetal heart tones were detected. She didn't want me to be on it in case I miscarried. I feel like that is transitioning into her view of when to start the Lovenox and now that I can't be on BA. To me, if they think that these disorders are serious enough for me to take a BA every day for the rest of my life, then why would I not even be on BA when TTC? Pregnancy is a hypercoagulable state and I'm already in a hypercoagulable state when I'm not pregnant!
I've had bleeding as early as 6 weeks in both of my pregnancies and they found the SCH at my 8+ week u/s during my last one. I'm not going to start off the next pregnancy the same exact way as my last 2 and wait until 8 weeks to change anything (other than the vitamins, of course). The damage could already be done and that could be too late. What if something is happening at implantation? Maybe my losses were only due to genetic problems because of MTHFR and the increased folic acid and B12 will fix everything. But what if FVL played a part too? I don't want to treat one before I ever get pregnant and not even prepare for the other. I've decided that I'm going to stay on BA until I start Lovenox. Based on my research, the benefits of being on it early outweigh the risks. I feel like a BA is not enough to cause significant problems if I do miscarry early during pregnancy and if I don't, then the benefit of thinned blood will already be there.
I love my OB and really like the Peri when we met her, but I'm having such a hard time trusting doctors. Not just my doctors, but any doctors. All of them have differing viewpoints and different ways of treating patients. It's hard to accept the plan they are creating for me when I see other women like me have a different plan of action. I don't know if I can ever truly trust the decisions they make until I bring home a healthy baby. I hate not having trust in the medical community at large but I feel like they have failed me in some ways. I also recently watched Michael Moore's "Sicko" (behind the times, I know) which has me really disappointed in the American health care system right now. I should just move to Canada where prescription medication is inexpensive (hello cheap lovenox!) and there is no $3000 fee to take home your baby. They let you have them for free! I think I'd very much like a free baby. :)
ok so my new OB is basically on the same page but does NOT use Baby aspirin at the same time as lovenox...so maybe your peri is right. I am also seeing a hematologist that specializes in pregnancy and I would suggest you see one too. my appt for her is aug 2 and then aug 9 for my MFM/OB (same new guy if you read the blog) he says he will have me seeing a peri once the placenta has formed to follow the blood flow etc...more closely...I think he mentioned that he did NOT want me on BA until after the pregnancy was over (if i have one) because of the risks of the two together...seek knowledge from a hematologist, this is a blood thing and who better than a blood dr to let you know...maybe THEN you can put all 3 opinions together and decide...xoxo
ReplyDeleteUghhh, I know how frustrating it is when you have different doctors telling you different things. It sure makes trusting a doctor hard.
ReplyDeleteI just had a weird experience at my new OB/GYN, and it sure makes me more anxious than I already was.
I'm hoping you can get this all straightened out - maybe tell each doctor what the other one said?
My OB and Peri are co-managing me and this is what my OB told me to do after talking to the Peri. I may seek out a hematologist once I get pregnant. Antoinette, I'll have to read how your appointment goes and decide if it's worth it.
ReplyDeleteI won't be taking the BA and Lovenox together but originally it sounded like my OB was ok with me taking it UNTIL the Lovenox. It's so hard to know what to do when every doctor has a different opinion.