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I need your input and advice (RE: my Dr's appt) * X-posted in DDC *


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  #1  
May 11th, 2010, 04:20 PM
krystal g's Avatar Happy to be a SAHM!
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I could really use some advice/input from you ladies. Just tell me what you would do if you were in my situation. (sorry this is so longÖIíve warned you )

OK Ė some background. Iím a military spouse and I have no real choice on who I see/where I go for my healthcare. Pregnant women have 2 choices: Family Practice or OB/GYN Clinic. I have always been assigned to Family Practice so that is where I am currently being seen by a Family Practice Dr Ė Dr. Webb. As it turns out, I absolutely love my doc. LOVE LOVE LOVE!!!! He was there with me in the ER for my first m/c and d&c, he knows my history, he knows who I am, he takes time with me (I donít think Iíve ever had a visit less than 30 minutes), heís super personable, I am 100% confident in his skills, he will (barring any unforeseen events) be in the delivery room, and I have never been this comfortable with a Dr. before in my life.

I was diagnosed with Gestational Diabetes last week and was referred to the OB Clinic per Family Practice policies. Since they consider anyone with GD high risk, I needed to be evaluated by an actual OB. The game plan (per Dr. Webb) was to have one visit to OB, let them evaluate me, then to come back to him and they can ďco-manageĒ my case if that is what I choose. He also said that as long as everything is manageable and not severely high-risk, there should be no issue in him continuing with my care. My orders were to monitor my blood sugar twice a day and start watching my diet and go from there.

I had my appt. with the OB today. She looked at my numbers for the last week and she decided that my fasting/before breakfast numbers were too high (they ranged from 71 to mostly in the 90s and the highest being 104). The diabetes nurse (in the OB office) told me last week that my range should be <95 but <110 was acceptable, so I think Iím not doing too badly. Well, the OB said I should be <90. OK, Iím not going to argue with her, sheís the specialist, thatís fine. She decides that I need to be put on Glyburide at bedtime to control my morning levelÖ.and weíll wait and see about the rest of the levels Ėso far they have been fine. Plus she tells me I need to check my blood 4 times a day. Again, thatís fine, I will absolutely do what needs to be done to control this. But, I went from failing my 3 hour GTT by only 4 points to being put on meds and accuchecks 4 times a day! Itís just a bit of a shocker.

The OB then tells me that I will be transferring to their office. They have 3 OBs & 3 midwives (although high risk do not see the midwives). I will see whoever is there and basically whoever is available when I go into labor. So I tell her about my discussion with Dr. Webb, staying with him, etc., and she said thatís fine (as long as heís comfortable with it) and they can co-manage, but I will still need to see the OBs every other visit and at probably starting at 32 weeks go in for NSTs twice a week and still fax them my accucheck readings weekly, blah, blah, blah.

I go back to Dr. Webb on the 25th and will discuss everything with him. It may be a moot point since he may not want to continue to see me since Iím on meds and such, but I now have to decide where I want to be seen. The thought of changing Drís over halfway through really upsets me. I cried in the car on the way home. But my practical side (and I am a very practical person) tells me to just stick with OB because it will be less of a headache than trying to coordinate with two doctors and Iím being a baby about this. It seems like even if they co-manage and Dr. Webb remains my primary physician, OB wants a lot out of me.

I went from Dr. Webb telling me not to stress, telling me that I should be able to manage such a borderline case with diet alone, to take it seriously but not let it take over (heís a D.O. and a pretty holistic approach to medicine guy)Ö.to today with a new Dr. putting me on meds and going over worse case scenarios and c-section discussions. Iím all for information and education and I like to be practical and realistic about things, but holy crap lady, just calm down!!! Itís not like my fasting level was 200 or something!

So I guess my question is whether itís worth it to fight for my Family Practice Dr. or just go with the flow and go to the OB Clinic. Is it going to matter to me when Iím in labor who my Dr. is? I think I will be comforted by Dr. Webb being there vs. just whoever is on callÖbut does it really matter? Is it going to be worth the frustration dealing with two separate offices? Am I just being an over-emotional pregnant crazy who wants to get her way and doesnít want to deal with change? Would you all just bite the bullet and make the change and suck it up?
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  #2  
May 11th, 2010, 07:26 PM
alethia's Avatar Platinum Supermommy
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id fight for my doc. i had gd with ds and was on meds,,,,my ob was able to manage it
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  #3  
May 11th, 2010, 08:07 PM
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I think it's important that you're comfortable with your Dr.

Are they going to redo the glucose tolerance test? What if you get better results? Will they be able to transfer you back?
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  #4  
May 11th, 2010, 08:14 PM
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I'd fight for the doctor that i like because I think it's important to love your doctor...i mean I'd feel better with the one I am comfortable with and that spend enough time with me during each visit.
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  #5  
May 11th, 2010, 10:54 PM
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STAY with your doctor you love!!! Trust yourself and your instinct momma!!! You aren't being a baby! You like him - he's a good doc - you trust him - trust yourself!!!!
I think you are much less likely to end up with all the scary problems if you are working with someone who isn't expecting them. (your watching closely for them - but not assuming - KWIM?)
Anyway - big big big
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  #6  
May 12th, 2010, 06:06 AM
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I think it will be a pain to have both doctors BUT that being said I think I would stay with the doctor you love. There is a lot you can put up with to see a doctor you are comfortable with and feel safe with. I have had moments of thinking I needed to switch doctors after 5-6 hour waits for my appointments but then as soon as I see the doctor I remember why I put up with it. I think when you go back to Dr.Webb you will be reminded of why you wanted to co-manage in the first place and (provided he will still do it) you will be more willing to do the things both doctors want to ensure you are still seeing Dr. Webb.
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  #7  
May 12th, 2010, 06:20 AM
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We're military too and I think it's rare to find that Dr. you love. I would stick with him. Also, as he is a DO, I would have a really frank discussion about your GD. I'll bet he has some different opinions about it. There's some strong evidence available out there that shows that these "ranges of normal" that we put on lab tests work for that middle 50th percentile person at best. Many tests have must wider "ranges of normal" than what I printed on a given sheet about the test.

This is your body and your health. I'm kinda non-interventionist type of person unless necessary. If it were me, I would ask for a couple things. I would definitely ask for another week and then for the test to be redone. Try one more time with dietary changes and see if it works. And, I would ask to be co-managed by both Doctors. I bet your original Dr. might even be flattered that you appreciate his care so much that you want to continue with him. Just because you have GD doesn't mean you can't have a normal pregnancy and delivery. Don't let all this business with the GD make you feel that you are "broken" or "sick"....cause you're not...you are healthy and strong and this GD is just a pregnancy quirk (I'm NOT saying you are going to ignore it but it doesn't have to define your pregnancy and care if that makes sense.)

Good luck and keep us posted!
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  #8  
May 12th, 2010, 07:53 AM
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Umm, I think they are over-reacting to your bgl. Mine are higher than yours, and I see a Perinatologist full time as my OB, and he's thrilled that I'm keeping my levels so close to normal with just diet. My fasting levels are never below 100, but never above 115, and he's thrilled with that. You are right, if the numbers were above 150 regularly then the glyubride may have been called for. But according to my Maternal-Fetal Specialist (mind u, he's the best in my city, see's the highest risk patients for most of the state) it is not neccessary. On the other hand, every doctor has differing opinions on some things it seems, but... that's just my two cents. So don't get too worked up and upset, while GD is a pain it sounds like you're in my boat and it's really not too awful. I did the 4x a day too, but he was so please with me because my numbers were always below 150, that now I only have to do it 2x a day. I mean, he sees people who's numbers are 200-300+, so I'm a relative breeze for him. I'd suggest you work really hard at the low glycemic diet, and keep your numbers low, prove to them you can, and then ask for a re-evaluation.

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  #9  
May 12th, 2010, 08:26 AM
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I think you should stick with the doc you are comfortable with already. It is already a stressful time. Having someone you trust with you along the way, and in the delivery room, will go a long way towards allaying your fears.

Good luck with your decision!
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  #10  
May 12th, 2010, 08:35 AM
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Stick with who you feel comfortable delivering your child. If that means to fight for your Primary doctor, then do it. Talk to him.
The doctor's office where my OB is, had many different doctor's and I was told from the beginning that whoever is on call will deliver by baby, it could of been a doctor that had no idea who I was, I have never seen. I was not a fan of that. I had a c-section (not by choice), and the doctor that I saw was the one that did it.
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  #11  
May 12th, 2010, 09:56 AM
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Quote:
Originally Posted by Herpersmama View Post
Umm, I think they are over-reacting to your bgl.
BIG OL'

I can't believe they put you on meds just b/c your fasting numbers were a little high!!!

I have had GD twice now and both times I had issues with my fasting numbers..they were 120's-140's. My OB just told me to cut out my after dinner snack and see if that helped. It did help some but not enough so my OB cut my carbs for dinner from 45g to 30g. That did the trick!!! No meds for GD for either pregnancy. And both kiddo's were born perfectly healthy!

I would seriously discuss this with your family doctor and see what he says! And I would 100% stick with for family doc as long as baby is doing well and you are doing well.

(((HUGS))) Hang in there!
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  #12  
May 12th, 2010, 10:33 AM
krystal g's Avatar Happy to be a SAHM!
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Quote:
Originally Posted by ~*Kixs*~ View Post
I have had GD twice now and both times I had issues with my fasting numbers..they were 120's-140's. My OB just told me to cut out my after dinner snack and see if that helped. It did help some but not enough so my OB cut my carbs for dinner from 45g to 30g. That did the trick!!! No meds for GD for either pregnancy. And both kiddo's were born perfectly healthy!

(((HUGS))) Hang in there!
See, this is how mine is. The nights I've skipped the snack before bed and went light on my carbs at dinner, my fasting levels were like 71 to low 90s. The nights I did have a snack, the numbers were upper 90s to 104. I told this to the OB and she said that I absolutely MUST eat a snack before bed...it just doesn't make sense.

However, this morning my fasting was 113 which is higher than it's ever been and I didn't particularly eat a ton of carbs last night and my snack before bed was spoonful of crunchy peanut butter. Sigh...

If I do need meds, that's fine. I'm not necessarily opposed to it. I guess it was just frustrating that I was slammed with all of this...I guess I really just expected her to say "lets watch your diet and see how that goes for a while".
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  #13  
May 12th, 2010, 10:36 AM
Pitridge's Avatar Platinum Supermommy
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Can you go back to your OB and talk to her, tell her that you would like to control your diet first and if that doesn't work to give the meds to you.
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  #14  
May 12th, 2010, 11:53 AM
~*Kixs*~'s Avatar Platinum Supermommy
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I agree...if you can diet control you GD than you should. Pumping your body full of meds that you don't really need is not the way to go.

Did you go see the dietitian? I think you mentioned you did. What is your carb intake for each meal?

My was breakfast -15 /AM snack - 15 /lunch -45 PM /snack - 15 /dinner - 30. But this was very modified due to my high bgl's.

Are you keeping a food diary? This helps a lot!!!

And sometime WHEN you eat certian food can make a difference in your bgl's too. My OB told me to eat fruits as part of my AM snack or with lunch but to avoid them in the morning and at night b/c of the way the sugar in the fruit metabolizes it can effect your next reading.

And what are you drinking??? Fruit Juice? That is a no-no and counts towards your carb intake. Crystal Light, Water & Tea are good choices. Remember even milk has carbs in it and you have to account for those too. Carbs are sneaky!

If you MUST have a snack before bed try something that is all protien like a string cheese, beef jerky, veggies and dip.

Really talk to your doctor about this and see if maybe he can change the OB's mind about the meds and see if diet changes can help.

Good luck!
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  #15  
May 12th, 2010, 12:46 PM
krystal g's Avatar Happy to be a SAHM!
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Quote:
Originally Posted by ~*Kixs*~ View Post
I agree...if you can diet control you GD than you should. Pumping your body full of meds that you don't really need is not the way to go.

Did you go see the dietitian? I think you mentioned you did. What is your carb intake for each meal?

My was breakfast -15 /AM snack - 15 /lunch -45 PM /snack - 15 /dinner - 30. But this was very modified due to my high bgl's.

Are you keeping a food diary? This helps a lot!!!

And sometime WHEN you eat certian food can make a difference in your bgl's too. My OB told me to eat fruits as part of my AM snack or with lunch but to avoid them in the morning and at night b/c of the way the sugar in the fruit metabolizes it can effect your next reading.

And what are you drinking??? Fruit Juice? That is a no-no and counts towards your carb intake. Crystal Light, Water & Tea are good choices. Remember even milk has carbs in it and you have to account for those too. Carbs are sneaky!

If you MUST have a snack before bed try something that is all protien like a string cheese, beef jerky, veggies and dip.

Really talk to your doctor about this and see if maybe he can change the OB's mind about the meds and see if diet changes can help.

Good luck!
I haven't seen the dietician yet...still playing phone tag for an appointment (although I saw her a few months ago because I'm overweight).

My carbs so far are like 15-20 for breakfast, 15-20 for snacks, 30-60 for lunch & dinner. I've stopped drinking fruit juice which sucks because OJ is my latest craving. I've been eating a lot of string cheese and cruncy peanut butter for snacks, along with apple slices or whole grain crackers. But it's usually just protein and maybe a tiny amount of carbs at night.

I will probably still have to modify my diet. My post meal sugars have been great, it's just the fasting.
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  #16  
May 12th, 2010, 01:47 PM
~*Kixs*~'s Avatar Platinum Supermommy
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Hopefully the dietician will help you get your numbers under control. Fasting was always an issue for me too.

If you are craving OJ...Crystal Light makes an OJ flavor and they have something called Sunrise something another that is YUMMY!!! It is OJ, Banana, and Strawberry. It is not the same as the real stuff but it is good.

One more thought...how late do you eat dinner and your PM snack? You should NOT have anything to eat two hours before bed. Maybe that would help your fasting number.
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