Dr. Ahmad – First Visit

Well, today was my 29-week check up. Officially, today, I am 29 weeks, 1 day. And when I tried to say I was counting as 30 weeks, Dr. Ahmad was not thinking I was funny. And so, let’s delve into that.

The practice that I go to has Drs Perry, Neubeck and Ahmad and Nurse Practitioner Sue. I began with Neubeck and saw him through the first 25 weeks. Last appointment, I saw Sue, the nurse practicitioner and was thoroughly impressed and content after my visit with her. So, week 29 I get Dr. Ahmad. Andrea had told me that he was extremely smart, was to the point (which Neubeck is not, but that’s one of my favorite things about him) and had an accent that could be hard to understand.

Well, I definitely got the to-the-point part.

He got in my stuff about why I wasn’t taking my thyroid medication. A look back at my thyroid travels and this is the summary: my doctor in Naperville was overly cautious on the thyroid thing, prescribed the pills and upped my dosage…though my numbers continued to read on the high side of normal. Because of this, I stopped taking the pills (a daily regimen) on my own, because I didn’t want to take a pill while pregnant, really, if I didn’t have to, and if my TSH levels were fine, then why was I messing with my body? So, I chose to stop taking the pills. Haven’t taken then since probably before the baby was born in any meaningful, daily way. I started forgetting, then realized that the pills were making no difference in my way of life or living and felt BETTER. So, in charge of my own body, I made a decision.

And today, Dr. Ahmad slipped in this lovely little comment (to the effect of): “Well, it’s really important that your thyroid hormone is regulated because it can cause abnormal brain development in the baby in the first trimester.”

Really?

That’s what you just said to me? So now, in addition to all my other fears that stand between me and delivering a healthy baby girl (i.e., will the cord be wrapped around her neck? what if she is born with some sort of physical impediment? what if she’s albino? blind?). So, thanks, doctor, you’ve now added ‘dumb’ to the list of things to fear.

I should have called him out. I should have said something. I DID say something when, as he was sort of trying to be done with me I said “I have a list of questions” and pulled out my blackberry and the MemoPad.

Question #1: I have severe tailbone pain. Is that normal? Is there anything to do to relieve it?

Ahmad: It’s normal. Your center of gravity shifts when you’re pregnant so you don’t tip over forward. It will get worse.

(INTERNAL DIALOGUE: Awesome. Great delivery on that one, doc.)

Question #2: I have a discharge that I have some questions about. It sort of has an odd odor to it.

Ahmad: We will take some cultures. [Insert here the part where the nurse comes in so the exam can be done and Ahmad says, “If I see anything abnormal, I will tell you right away. Otherwise, the culture work won’t be back until Monday or Tuesday and then I’ll call you with the results.]

Ahmad: How long have you been with your partner?

Me: Three years.

(INTERNAL DIALOGUE: Ok, so now you’re insinuating that Jon – JON? – could be a culprit in my late-pregnancy-onset discharge issue I’ve just asked you about? Could Jon be the culprit? Stop it, Lindsay. That’s stupid. Why the hell would the doctor ask me that and leave it hanging out there??)

Question #3: I have a history with hemrhoids – the inside kind. Could the tailbone pain be hemrhoids or is that separate or what?

Ahmad: The hemrhoids will get worse. We don’t do anything about them – but keep an eye on them and if they turn black and blue, then we’ll drain them. Hemrhoids are actually inflamed blood vessels (or something medical like that – my words, not his).

(INTERNAL DIALOGUE: This guy is a piece of…)

Me: You know, you’re really a breath of fresh air this morning, I just have to tell you.

Ahmad: laughs.

Question #4: Talk to me about breastfeeding. I’m a fact-based, research-driven person and people SAY breastfeeding is best, but I’d really like to see the research. I’ve done my own scholarly searches and can’t find much except for this one study that was ordered by the NIH and while it did list some benefits, I just am not sure…

Ahmad: It is better, from what I have seen over the years. I understand what you mean and I will try my best to have some research – at least one good article for you – at your next visit.

(INTERNAL DIALOGUE: Wow, a doctor who is going to provide me research at my next visit, like he’s planning that far in advance?)

Ahmad: This is my pager. Someone is in labor, so I need to answer this.

Me: Ok, you do that.

I walked to the front to schedule my next visit and the women who run the office and I had a good laugh about how Dr. Ahmad had really made my morning. At least I laughed…I don’t know if it was a good one or not.

In the meantime, I was also concurrently having my glucose tolerance test (GTT) done across the hall in the lab. I arrived at 8:40 to have my blood drawn while fasting. My doctor appointment was at 9 a.m. So, I had the blood drawn and then drank the 75 gram sugar solution thing. GROSS. Choked it down is a better description. The cross-eyed phlebotomist who is normally cranky but seemed pleasant enough this day was doing the draws. Ok, fine. Good. She tells me to have my next draw done at 9:40 a.m. Ok, can do.

After my 20 minutes in the Ahmad show, I was back to the lab. So, at this point it’s like 9:20. Literally. So the cross-eyed phlebotomist says ‘oh, we have some pre-employment screenings coming in and I don’t want to have to draw you while they’re here, so I’ll draw you now.” I say “I thought I had to wait an hour from the first draw?”. She says “I have 10 minutes to play with on the draw, so I can do it now, we were at about 8:30 when I drew the first labs.” Ok, that’s a lie lady. I was still in my car, on the phone fighting with AT&T about our UVerse service until 8:35 and my car clock is three minutes fast and I had to get the paper work from the doctor’s office. But whatever, get me out of here quicker. Let’s do this.

So, I sit in the lab with my iPad and am feeling icky because of the sugar water solution thing and not eating. And you can’t drink more than a few sips of water. All awful. So, at around 9:45 the pre-employment screenings come in (good we hurried to get me out of the way…I was the ONLY person there for blood at this point of the day). There are five women who are getting pre-screened for different jobs working in various labs. Cool, something to distract me.

It’s now 10:25. I say to the other phlembotomist that I need to have my final draw done. I mean, the woman said she had 10 minutes either way and that my first draw was at 8:30. Right? This all transpired. I was NOT imagining it. The cross-eyed one comes around the corner – while still managing the other pre-employment screenings – and says “NO. You have to wait until 20 til.” The other person and I look at each other innocently. I respond, “You drew at 20 after the last time, so it’s been an hour and then it’s been an hour and 55 minutes since you said the first draw was done and I thought you said there was a 10 minute window” This is the response that comes from ol’ cross-eyed: “Miss, I KNOW how to do my JOB.”

OOOOOOkkkkkk. This is the woman I remember dealing with at other labs. Right. Ok.

So, I’m now in the room waiting to have my blood drawn and I’ll be DAMNED if I’m going to go sit down, I’m ready to get this going. I’ve got like 3 minutes now until she can draw. Oh no, she tells the other one to tell me to get out of the blood drawing room. SERIOUSLY lady?

I walk out and look at her (or try to — can’t really tell where to look) and say “You are a REAL charmer, I have to tell you.”

So, I sit back down and watch this woman carry cups of urine of the last six ladies back and forth into and out of the blood draw room, hoping to God that she’ll remember to change her gloves before she draws my blood.

Finally, she says to no one in particular, “You can come back now”.

I sit there and do my normal routine when getting blood drawn. I ignore her and close my eyes. She says if it hurts tonight, to put a warm compress on the spot where she is applying pressure. Ok. Fine. Just let me the HELL out of here, lady. I’m over you.

“Thank you” I tell her.

Because that’s just the kind of sweet bitch that I am.

Anyway — today’s experience is now committed to the annals of history. Not that anyone should care, but it has been therapeutic to get this all out of my head as I’ve been pissed about it all day. And feeling icky after that sugar water. And worrying about my ‘dumb’ baby. Great day at the doctor’s office.

 

Nurse Practitioner: The Appointment

Ok, quick recap.

Today I had an appointment with the nurse practitioner at the office of Drs. Neubeck, Ahmad and Perry. Her name is Sue Molton (I think). Anyway, that’s probably the BEST appointment I’ve had at this particular office so far.

I have loved Dr. Neubeck and his definitively laid-back approach, but Sue was laid back but seemed to really want to talk baby — where sometimes Neubeck is more about tales/examples. I like both approaches equally and both have put me at ease.

I’ve had questions on my list to ask and have kept forgetting, so I made a list in my blackberry and remembered to ask them this time. My question list:

– How can I take a childbirth class that’s not at Hurley (McLaren offers the only one-day option I’ve found) and yet still get the tour of the facility?

– Is there any recommended locations to take a childbirth class that is one day?

– When should I plan on being my last travel day?

– Talk to me about cord blood banking: racket or investment?

 

But, there were other things before we got to my questions, namely my own shock and concern when I got on the scale. I was up 1.6 pounds from four weeks ago. That’s it. 1.6 pounds. Seems like I’ve gained more than that, but…the scale does not lie. I got back on just to make sure. Sue asked if I was taking pre-natal vitamins (resounding ‘NO’). Asked if I was getting my servings of calcium (my response: I drink the milk with my cereal in the morning, on morning’s when I eat cereal), if I was getting protein servings 2-3 per day (my response: yes). She asked if I found it difficult to eat healthy while traveling — I told her that it’s actually easier on the road to eat well than it is at home (sure sign I’ve been traveling too long/too much). She said I’m not getting enough calcium and protein, so I am to take three Tums per day. I ask ‘should I get the kind with calcium?’ and she says ‘Tums IS calcium’. I said oh, so it’s just a marketing ploy they’ve come up with to sell the kind with ‘extra’ calcium…good to know.

So, my concern at that point was what my lack of calcium and protein (or adequate amounts, at least) means to the baby. Sue said that up to now, it hasn’t been a huge deal as most of the energy that the baby gets from me goes toward organ development, but in these last 12 weeks or so, it will really go to bone development and that now is the critical juncture. She also said that if I don’t get enough calcium for her, that she’ll just take from me so she gets enough and then I won’t have enough. So, good, nothing too bad that I’ve managed to do to her in my yet-to-be-a-parent-to-a-living, breathing child role.

Sue also told me that I’m A+ (duh, obviously, but that also happens to be my blood type 😉

She asked if I’ve been taking the Levoxyl for my thyroid (NO). So, in three weeks they will run blood work on my TSH and T4 levels as well as I will then do the glucose tolerance test. At that point I will be 30 weeks and I will be visiting Dr. Ahmad for the first time.

The glucose tolerance test, Sue informed me, is to check for gestational diabetes in me, the mom. If a woman has gestational diabetes, then she is more likely to develop diabetes within 10 years, so you then need to have your blood sugar levels checked once each year to be cautious. Good to know. She also said that large babies can be a result of gestational diabetes as well as they now know that when the umbilical cord is cut, that babies who are used to an elevated blood sugar level in their mom can ‘crash’ (sort of) so they just like to know those things. Very informative, thanks Sue!

My friend, Molly, had to have her glucose tolerance done and they just do the one-hour version but Andrea, who goes to the same doctor as I do, said she had to have a two-hour version done. So, I asked Sue why it was now a two-hour thing instead of the one-hour version. She explained that for 30 years (as long as she’s been a nurse) that they had always done the one hour test, but that the guidelines changed about a year ago and that their office is progressive, so they’ve been doing the two-hour version for a year or so. Also good to know. I asked if they had seen a change in the results now that they are doing the test differently. She said that in fact, they are seeing elevations in blood sugar where they would not have caught them before, so it’s good to know.

I also explained to her my dilemma over the due date. Again, Dr. Neubeck insisted upon October 27, I insisted upon October 18 and the ultrasound reveals October 14. I explained that my fear would be that if the due date remained October 27 and she was not coming, that I would have to go past that due date and THEN be induced so I’d be into November before I would even be induced. I explained that based on my LMP (that’s code for last menstrual period) and other things I know to be true, that there’s no way my due date would be later than October 20. I also told her that the ultrasounds have both revealed October 14 and 13, respectively and that that seemed okay by me. I also told her that I am pretty sure that the first ultrasound at the eight week appointment was measured wrong. She explained all the reasons that they like to go with the initial due date based on the ultrasound. She then measured me and I measure at 27 1/2 weeks, which, based on the ultrasounds, is exactly where I SHOULD be. I said I just didn’t want to end up going, technically, three and a half weeks past the October 14 due date, which is what would happen if the October 27 due date was kept. So…she talked it through and changed the due date to October 20! Woo hoo! I knew I could do it! You can’t argue the facts, I’m afraid.

On the cord blood banking, she indicated that maybe the privatized is a bit of a racket and that she would only encourage people to go that route if they had known genetic diseases that they themselves carried. I explained to her the occurrence of multiple myeloma on both sides of my family and she said that I should look into the donation of the cord blood into the national program, which by donating to you are then eligible to have ‘access’ to (or something like that, I need to do more research) and that the costs on that are miniscule compared with the cord blood banking that’s privatized. Which is what I thought, but I’m glad to have a professionals opinion.

We talked about birth control methods for after the baby is born (NuvaRing, thank you very much) after breastfeeding is done.

She asked what my plans were for breastfeeding and I told her that I thought I’d maybe give it a try but I wasn’t committed to doing it. I also told her i planned to do both…which she sort of discouraged for the first six weeks. I don’t know. I feel intimidated by the thought of breastfeeding, pumping, being the sole provider of nourishment to the baby girl. A bit overwhelming. We’ll see.

On the travel – she said that they don’t like their pregnant moms-to-be to be more than two hours from Flint beyond 32 weeks. Well, that really cramps my style. That would mean no travel beyond August 25. Don’t  know how realistic that is, but don’t know that I want to be caught going into labor four or five hours from home, which is what Chicago and Indianapolis would be.

On the childbirth classes, she said that just take the one day class wherever I can find it, which for first time births, they recommend not coming to the hospital until contractions are five minutes a part or if your water breaks. She said that I’d be uncomfortable/in pain at 10 minutes a part, so that the breathing techniques would help up to that point.

She asked what my thought was on epidural – I said “YES”. She said good, that she encourages first time mom’s to use the epidural. I asked about what Jay had said about how her epidural with Stella just took the edge off and with Amelia it totally numbed her and she didn’t like it at all. Sue said that that just depends person to person and how you react to it, and that there wasn’t a way to control that. She said that she would encourage to use it, and not just to take the edge off. I love Sue.

So, total weight gain for the pregnancy: 9.6 pounds, total gained in four weeks: 1.6 pounds (I think).

Oh, I also asked Sue about how thebump.com prompted me with the six-page birth plan you can fill out and I asked her if that was something good to have filled out in advance and have with me in a file or something to just hand over. She said that all their doctors will always make decisions in my best interest, and if I am not gung ho on any one particular thing, to just let them guide the process. My response: I am not a professional, so I’m glad there will be professionals in charge and I will just let them prompt me for what they’d like to know/do/try. She said to just go with the flow and trust the process, essentially.

I also told her that I’d recruited my Aunt Jenny as an advocate/to be there for Jon and asked if that’d be okay. She said, of course.

I love Sue.

Anyhow – that’s a very long version of the visit, but I was very annoyed heading into this appointment that I had to meet with the nurse but it was by far the best visit I’ve had to date (I should have known). For anyone out there who may be preparing to go through this journey called pregnancy, hopefully this sheds a little light into how to ask questions/how appointments might go and what to expect.

Oh, on a side note:

Minnie’s heart rate: 144 bpm
My blood pressure: 102/52 (that’s awesome!)

More soon,
L