Medical Confusion

First I want to state for the record that I apologize to my bloggy friends – I am WAY behind on reading blogs! I’ve been working so hard lately, as there are so many projects that need to get done before I go on maternity leave, that I haven’t had any time at work to blog. And let’s face it, work is my primary place for blogging… Usually when I go home, the last thing I want to do is get on the computer. But I promise to get better and get caught up!

I have had a whirlwind of doctor appointments over the last two days: my regular weekly OB appointment, my asthma doctor to update my scripts so I could have fresh meds for labor, and a pediatrician. My OB appointment was fine, except there was a bit of a scare – the nurse took my blood pressure and it was 148/102, which is very high for me, at the beginning of my appointment. Then I did the NST for about 30 minutes, and the doc came in. He took my BP again, using what I call the fat person cuff, and it was 122/82, which is more typical for me. So I worried a bunch while getting my NST for nothing… The nurse had told me that there wasn’t protein in my urine, but still! Pretty concerning to have high BP and just sit there and think about it for 30 minutes! At my asthma appointment today (which went fine), my BP was 120/78. So I think it was a fluke and a result of using a too-small cuff, like my doc said.

The doctor visit that threw me for a loop is the pediatrician. I went to a doc that was recommended by some ladies at work, and I expected to like her, and I did. But it was very interesting, and is causing me to do a lot of googling, so I figured I’d come to the best source – my infertile sisters!

As a brief medical history, I’ve been treated or at least consulted with 3 docs: Dr. Sher in Vegas, Local RE, and OB. Local RE ran a bunch of tests at my request after my miscarriage last summer, and I was diagnosed with compound heterozygous MTHFR – two mutations. He recommended taking Folgard 2.2 twice per day, and low-dose aspirin. My understanding is that these are meds for the rest of my life, now that we know I have the MTHFR mutation. Then I had a consult and testing with Dr. Sher, when he diagnosed me with elevated NK cells, and recommended intralipids for that, and in addition to the Folgard for MTHFR, recommended Lovenox during pregnancy and for 6 weeks after birth. I ended up going with Local RE for IVF and a subsequent FET, which resulted in a baby in my belly, but only because Local RE agreed to follow Sher’s intralipid and Lovenox protocols. But even though Sher didn’t think aspirin was necessary, Local RE recommended it, and so therefore I’ve been taking Folgard, low-dose aspirin and Lovenox, every day, throughout my pregnancy.

Meanwhile, after getting pregnant, I went to see my OB, who is fine with me taking baby aspirin and Lovenox, and is now the prescribing doc for Lovenox. He is not a fan of switching people to heparin prior to birth, and instead prefers to induce labor prior to me going into labor on my own, so we can control the timing of labor with the shots of Lovenox. So I will get an ultrasound next week at 36 weeks (can you believe it?!?!?!) and based on that, we’ll schedule an induction somewhere around 38 weeks (so excited – she’s almost here!!!). Nobody has really mentioned what will happen after birth, except I always knew that Sher’s protocol said Lovenox until 6 weeks post-birth.

So I go see the pediatrician yesterday for a “new mom” visit, and I don’t really know what I’m doing. Sure I’ve downloaded some questions to ask from the internet, but really I just want to see if I think I’ll get along with her, and like her style. She asks me at the beginning if there have been any complications with my pregnancy, and I give her the brief run-down: “No not really after getting pregnant. Trouble conceiving, miscarriages, IVF. Diagnosed with clotting disorder so taking Lovenox, so OB wants to induce around 38 weeks so he can control the timing.” Ped doc said that sounds like a good plan, and moves on. At some point, I ask her about her feelings of breastmilk vs. formula feeding.

Now as a side note, I feel very prepared to breastfeed, or at least as prepared as I can. I’ve read a couple books, including Jack Newman’s book, The Ultimate Breastfeeding Book of Answers, which I highly recommend. I’ve done a bunch of research online. I even dragged the hubs to a breastfeeding class. Bought a pump, nipple cream, breast pads and bras. In short, I really want to breastfeed, and I will do anything to make that possible.

I’ve read in the books about how to tell if a doctor/hospital is breastfeeding-friendly. And this new pediatrician, or at least her nurse, broke the number one rule. As soon as I checked in and was brought back to an office, the nurse happily exclaimed that she had all kinds of new mom gifts for me! Lots and lots of formula samples… But giving the office and the doc the benefit of the doubt, maybe they just want to get rid of the stuff that I’m sure the formula companies give them…

Anyway, I asked the ped doc about breastmilk vs. formula feeding, and she said that breast is best. She firmly believes in breastfeeding. But she’s supportive of situations that require formula. “Like for you, if you need to take Lovenox after birth.” I’m sorry, what? She said that Lovenox is a bad drug to take if you’re breastfeeding, so if I’m taking that, I’ll need to feed my baby formula. I responded that I read that Lovenox has a high molecular weight, and will therefore not pass into breast milk. So she got out her meds for breastfeeding book, and we went to Enoxaparin (generic name for Lovenox) and like she said, it’s listed as a Level 3 drug. Level 1 – great. Level 2 – just fine. Level 3 – no studies have been done to prove anything either way. Level 4 & 5 – bad. (At least that’s how I interpret the levels – some of you science types could refute me…) And she explained, which I wasn’t really aware of, although it makes sense, that the levels for breastfeeding are different than the classifications for pregnancy. I knew Lovenox was Class B for pregnancy, so I figured it would be fine for breastfeeding. But she said it was Level 3 – no studies have been done, so she doesn’t like me taking it and breastfeeding. Yes, the book mentioned the high molecular weight and that it’s unlikely that it could pass through to breast milk, but she wasn’t buying it – it was a Level 3, and that’s it. But it’s a judgment call and it’s up to me. Also, aspirin is classified as Level 3, and it has been linked to Reyes syndrome, but not in low doses. So that is up to me as well!

I’ve read a bunch of stuff online, and most things that I read say that both Lovenox and low-dose aspirin are just fine, but it is concerning to have a pediatrician disagree with you… I consulted Jack Newman’s book, and he mentioned low molecular weight heparins (like Lovenox, but not specifically addressing Lovenox) and that it has too high of a weight to get into breast milk. He doesn’t address aspirin at all.

Yes, I’ll talk to my OB about it, but I doubt he’ll have any kind of opinion as he’s just following the recommendations of other docs. Part of me just wants to stop both Lovenox and aspirin when I give birth. Yes, I know there’s a risk of me developing clots, but I’ve never had any kind of issues in my life until trying to get pregnant. I would have never even known about this if I hadn’t miscarried! And using Lovenox and baby aspirin is somewhat controversial for compound heterozygous MTHFR folks, so maybe I don’t even need it… I hate that once again, there is no clear-cut answer when it comes to infertility and the things we do to combat it.

All I know is I want to breastfeed my little Alex, and just be a normal mom. Is that too much to ask???