Intro - Worried

YackoWackoDot

Hi. I don't even know where to start....

I'm 37. I have 2 boys ages 10 & 7. This is my 3rd pregnancy, I'm 8 weeks 3 days. 

I was preeclapmtic with both my boys-I was induced with both at 38 weeks. I have PCOS. 

I had high bloop pressure for a couple of months (that I know of) before getting pregnant (surprise!) But I was trying to get it down naturally and had finally decided I needed to find a doc and get on meds when I ended up pregnant. So, decided to just go to midwife instead. 

At my initial visit my BP was 186/106. I was put on 500mg methyldopa every morning. At 2nd appt (just 5 days later BP was down to 14?/8? midwife seemed okay with the progress. 

They of course took a ton of blood and did a 24 hour urine.

My liver function test came back weird so they drew more blood. Then last week they called and said they were sending me to a nephrologist (kidney doc) because my liver enzymes were elevated. She mentioned protein in my urine, but seemed the focus of the phone call and greatest area of concern was the elevated liver enzymes. Thought it was weird, asked the lady on the phone from the midwife office "Isn't a nephrologist a kidney doctor?" She said "Yeah, but they do liver too." I though, okay, whatever...

So last week (Friday) I went to the nephrologist, and they are asking questions all about my urine and kidney function and family history and don't seem at all concerned with the liver. I asked the PA about the liver enzymes and she was like "We do kidneys, not livers" So doc orders more blood work, ups my meds to twice a day because my BP was 138/86 and wants to see me back in two weeks. 

Of course I leave that office on a Friday afternoon so I can't speak to my midwife office until tomorrow or Tuesday (As I have to take my mom to preop tomorrow so not sure there will be time to call the midwife or not.)

My liver enzymes are supposed to be in like the 30's and 40's but are 55 ans 60...so not badly elevated but I'm still concerned because it seemed to concern the midwife office yet they sent me to a kidney doctor about my liver?

I can't use the OB I used with my last 2 pregnancies because the hospital in my town no longer has L&D. I also have 2 insurances so if I switch docs they have to take both (and my choices are very limited-I'm already driving 30+ minutes to my midwife & hospital now) I'm not sure how feasible switching to a new doctor is, but I'm already considering it... 

Any advice or encouragement? 

Oceanbreezy1

No experience or suggestions but I'm sending hugs and prayers!

mandyreads

If you are not comfortable with your midwife I would switch. I had to due to a horrid phone call with a hotline nurse when I was spotting. I was not about to use a hospital if that was the type of people they employed. Now I am being sent to a HR dr at said hospital. But I am sucking up and being a big girl bc they are supposed to have the best HR drs in the state.
As for the other issues...I wish I could be of some help.

YackoWackoDot

I'm honestly not sure switching is an option. I'm going to be looking into it if they don't make me feel confident when call about the liver enzyme/nephrologist issue. But with 2 insurance and small town, I'm not sure it's even possible.

I will also be seeing a perinatologist in a separate practice, as well. So here's hoping he's a great doc!

DixieNormous330

and see a gastroenterologist with a sub specialty in hepatology to discuss the liver issue.

YackoWackoDot

I was able to call the office today. Seems Thursday we had a miscommunication. Apparently they were much more concerned with the protein in the urine than the elevated liver enzymes. Thursday's call caught me so off guard that I didn't even think to ask how elevated my protein level in my urine was. They actually called and woke me up, plus I simply didn't expect a call like that at all. Plus I think the woman calling expected that someone else had already called me and discussed lab results, and she was intending to simply call me and inform me of the Dr appointment with the nephrologist that the midwife office made for me. 

So, today I talked with a nurse who pulled my chart and looked at everything as we talked. My protein was 409 so,yeah, nephrologist. My liver enzymes are barely elevated but seeing as how I had untreated high blood pressure for a few months before I got pregnant, not unexpected. 

The nurse offered to send my chart back through to the doctor for review again, to ease my mind, even though there are no new tests or results since the doctor lasted reviewed it (and wanted me refereed to a nephrologist) 

  

KnitPixy

Glad the miscommunication got worked. out.  I've had a few instances like that over the years (totally different issues but same communication problems) and man can it be stressful, I can only imagine having to deal with that while pregnant! 

FX that the nephrologist gets you some answers and everything works out well.

YackoWackoDot

Grrrrrrr! 

Nurse called back today and they do want to send me to a GI!!!!!! Really?!?!?!?

My next appointment is the 29th, so which ever midwife I see I think I'm going to have a talk with her and tell her I think they need new communication protocols in their office. I fear it's a too many cooks situation as it's a rather large practice. 

I looked into switching doctors again today and I really don't think there are any other options (I normally love living way out in the boonies, but it does have its drawbacks) There might be one other option but it would mean switching hospitals which I'm not opposed to but don't look forward to either. Depending on how the next appointment goes and how well I like the preinatologist will be the deciding factor in switching or not. 

sagegoodenough

Are they still wanting to watch the liver only your enzymes were slightly elevated?

Mine ended up at 3300 with my oldest. You could feel my liver pushing out from under my ribs and after an emergency c section at 32 weeks, I was transferred to a different hospital and prepped for a transplant (didn't end up needing one but they wanted to be ready). It hit me out of nowhere and was completely unexpected although I felt something was off from the beginning, but being 16 and pregnant no one thought I knew what I was talking about.

I'm glad they're monitoring you closely although I suggest getting at least a second opinion and then making the decision to stay with your mw or switch

YackoWackoDot

They want the GI doc to check me out because of the elevated liver enzymes. I don't know if it's just a cover their butt thing or if they are really concerned. When the midwife looked over my labs with me int eh room, she mentioned the elevated liver enzymes, said they were only slightly elevated and didn't seem concerned at all really. She moved on to the A1C number...

I'm thinking as much as I would love to use a midwife that I might be better off to switch to an OB being so high risk...

KnitPixy

Why are they doing an A1C?  Do you have pre-exisiting diabetes?  If you don''t it won't help diagnose GD because it's a three month average of your blood sugars... most of the time GD doesn't develop until later in pregnancy so it wouldn't really impact your A1C until really close to your due date. 

I am getting the feeling that this practice likes to do catch all tests to cover their butts

YackoWackoDot

A1C was done during initial visit. I am high risk for GD and actually took my GD test early with both previous pregnancies. 

I agree it sounds like they test everything to cover butts, but I haven't used them before so I dont' know if this is their normal or if it's because I'm high risk... either way, I'm glad as I just found out today I might have lupus (from the nephrologist they sent me to for having lots of protein in my urine)

KnitPixy

Okay if you have a high risk for GD I can see why they would want to do an A1C to make sure that you didn't actuall have type 2.  It also gives a good baseline measure if they are doing more screening for diabetes later on.  Still seems a bit of overkill to me... mind you not a doctor and definately don't know your medical history... and if they are concerned about lupus well it is probably a good thing they have lots of tests going on.

((hugs)) and hopefully everything goes well for you from here out!