In Which Gwinne's Sordid Medical History Is Sorted Out

Well, the trip to the hematologist was interesting, if not entirely enlightening.  Once again, I found myself miles away, in a teeny-tiny town, for medical care (the upside of which is I think LG and I need to take an afternoon and drive there for an ice cream and a walk or something).  The doctor came in with my big stack of records from 2003 and said, well, I hope you can help me make sense of this.  I think she eventually located my original APA lab results.  But, idiot that I am, I hadn't thought to have Dr. Gorgeous send all the repeat RPL workup from 2009.  So once she's able to review those records, she'll decide what I need to be (re)tested for.

I have to say I'm glad I went.  Although the result might be that I'm pulled off Lovenox as I do not technically meet the criteria for APA Syndrome (I haven't had 3+ consecutive losses, nor as far as I know, low platelet count), I'm also confident that she will be testing me for basically every inherited and autoimmune marker for thrombophilia before doing so.  One thing I learned, though, is that if Dr. Gorgeous tested my homocysteine level (which she should have done when she tested me for MTHFR), it would be invalid because I supplement with folic acid and b12, which artificially lowers homocysteine levels; it needs to be a fasting level, and even a prenatal will throw it off.  So the longterm plan for me is that once I'm done with all matters reproductive (breastfeeding, say), she'll pull me off all supplements for 6 months and then get baseline levels of both homocysteine and b12.  She also asked WHY I have a vitamin b12 deficiency, which is usually only found in older people or vegans (hell if I know, but my sister actually takes IV b12); she was less concerned when I told her it had come up appropriately on supplements but suggested that's something worth investigating later on.

In a nutshell, she was smart as shit.  She said she doubts she'll take me off Lovenox as I took heparin already for an entire pregnancy, I've had a complicated history, and even this pregnancy started off rocky.  She said the 3+ loss rule was made up by a bunch of men, and she understood why women would do anything to prevent even a second pregnancy loss.  But she also cautioned me that there's no long term studies about Lovenox use; the concern really wasn't about Peanut but what it might do to me.  (Regular heparin use, for instance, has been linked to bone loss, and I took that for about 12 months in 2003-2004, when long term treatment is only considered  one month).  If I do continue anticoagulation therapy and get switched over to regular heparin at 36 weeks, she said my platelet count would need to be checked weekly, which is something my OB didn't do when I was pregnant with LG; I think maybe it was tested once the whole time.

At this point, I think I'll be okay if she pulls me off Lovenox, as long as my OB is monitoring me as closely as she is.  I've never really been worried about me having a stroke, but I've been petrified of IUGR and fetal death.  I should have asked if my mother's pregnancy history--low birth weight and premature babies [I was a 33-weeker, at 3.5 lbs]--might also be relevant here.  Anyway...I guess I look forward to a mega-blood draw sometime soon, and a repeat visit in early September to come up with a plan.