Disappointed with medicine

So yesterday morning Mr. Rhody and I went to see a maternal-fetal health specialist at our local hospital. Maternal-fetal health specialists are also known as perinatologists or genetic counselors, but, honestly, I don't think this guy had that much specialized training. If he did, he certainly wasn't using it.

After waiting a bit in the jam-packed waiting room, we were led into a small office. We introduced ourselves. I told the doctor that both Mr. Rhody and I were biochemistry majors and that we had a strong background in genetics. He countered by telling us he had hated biochemistry, because of having to learn all of the pathways. Umm, ok. I nodded and smiled politely, but I was thinking, "But isn't that what you do now?!"

Anyway, he walked us through all of the tests, even though I told him I had looked them all up already. He didn't listen when I asked him if my homocysteine levels appeared low only because I'd been taking extra folic acid for months. He said that wouldn't make a difference. Um, but that's how the pathway works. Oh, right, he hated learning those pathways.

He said the prothrombin mutation that I have is no big deal. He acted like he wasn't even convinced that it had caused my miscarriages. He told me I should take baby aspirin and that would fix it. "What about Lovenox?" I countered. This is when I kicked myself for leaving the article at home which showed a side-by-side comparison between aspirin and Lovenox for my exact mutation; the article shows both increased fetal success rates as well as high birth weighs for patients on Lovenox. The doctor said the risk of heparin, even a low molecular weight heparin like Lovenox was too high, pointing mainly to the risks of osteoporosis.

The doctor then started into a whole spiel about his oath to "Do no harm." I countered, politely but strongly, "What about the risks of another D&C? Every time I have the procedure comes with increased risk." He stated firmly that he thought the aspirin would lead me to have a healthy pregnancy.

The doctor then looked at me critically and turned to Mr. Rhody and said, "She doesn't look very convinced." Mr. Rhody, standing up for me, told him, "She doesn't get convinced easily," to which the doctor replied, "Oh, now you're in trouble!" speaking to Mr. Rhody. It was supposed to be a joke, but I found it offensive. My husband knows me. He knows I don't back down, and I like to think he appreciates that.

One last-ditch effort, I tried to invoke the article that I'd left at home. Telling the doctor about this article, he replied, "Well you can find anything on the internet." As if it was wrong for a patient to be searching the internet, advocating for her own health! Not even that, but I wasn't blindly searching Yahoo! Answers to find someone to agree with me; I was searching the medical literature! Quietly, I offered, well I can send the article if you're interested. "I'm sure I can find it myself," he snapped back.

I felt like I'd been scolded like a puppy who'd soiled the carpet. I asked the few other questions I had--what this mutation would mean in a childbirth and non-pregnant sense (nothing, of course, was his opinion)--and then slunk out of the room, feeling the need to apologize for challenging him on the way out.

This was about 24 hours ago. Since then, I've run through a range of emotions: angry, scared, disappointed. I didn't say anything to Mr. Rhody about it at first, instead I had gone straight to work. Mr. Rhody is the type who doesn't like to question authority, and I wanted to get my thoughts together before he and I talked. While at work, Mr. Rhody emailed me, "I just read the article. I think we should go with the Lovenox."

So here we are, still researching, reading. I'm going to try to get in to see my regular OB next week. Mr. Rhody's father (also an OB) spoke with a perinatologist at a conference who told him in no uncertain terms that if it were his child, he'd go with the Lovenox. It's scary. I'm usually a person who eschews drugs of any sort, but I can tell you, I am way more scared of ending up in that OR again.