Comments on Your Comments!
Wednesday, June 20, 2007
Kenneth F. Trofatter, Jr., MD, PhD
Yesterday, I received a very nice comment from JRae who had read my series on “Recurrent Early Pregnancy Loss.” She said, “Thank you so very much for taking the time to put this series of blogs together. I especially appreciate that even after concluding the series you are still responding to those leaving questions on the posts…. I think many…would benefit from your blog as I have (if they haven't already found you!). Thanks again. –Jrae.” Her commment reminded me that for awhile now I have wanted to pass along some comments regarding comments to my readers.
In my very first post, almost a year ago, I said “…my goals for this site are fairly straightforward. I would like to provide you with accurate information related to normal and complicated pregnancies. As I tell all my patients, NO question is insignificant, although you may be surprised that the answer is often much more complicated than the question itself. Where the facts are known, and well-established, mainstream information will be provided. When the issues are more controversial, or do not have widely agreed upon answers, I will make an honest attempt to provide unbiased information, presenting the various opinions on “both sides of the fence,” reserving the right in the end to tell you where I stand on the issue and why. I look forward to beginning a dialog with you on this blog. And, above all I would like us to have some fun as we exchange experiences and communications over time.”
Unfortunately, this site is not set up in a way that we can easily have a running dialog with readers. Quite frankly, since I have a ‘day (and frequently, night) job’, that would be difficult anyway since I write these posts in my free time. I have tried to respond to as many comments and questions as possible, but since my ‘comments’ only appear in the comments section of the blog in which the original comment was made, I never know if the original ‘commenters’ ever find their way back there to read my responses. It is also a shame that many of my responses would probably make, or provide the basis, for a ‘blog’ in and of themselves and I am sure there are many other readers that might benefit from the questions who never have the opportunity to see my answers.
Anyway, I would like to continue to respond to your questions, but have several comments of my own! First, I have found that many of your questions are already answered in the posts or in the comments of other readers, so please check out the original post and related ones as well. If you do need clarification or have a question about a post, or about your own situation, please provide me with thorough and accurate information and as specific a question as possible. Remember, I can only work with what you give me and have no delusions of grandeur with regard to being able to read minds or between the lines!
When I do respond, please be aware of the limitations of my answers. I can provide some thoughts, some information, some clarification of something you do not understand, some questions you might ask your providers, and maybe even a correct solution (given enough information) to your particular problem, but I cannot possibly understand your entire situation and I certainly CANNOT replace your own doctors in providing all the answers for your care. As wonderful as the internet is, it does not take the place of the face-to-face and hands-on attention of a physician who knows you well. So, don’t be afraid to ask them your questions, the same ones you are asking me! If they tell you something and you do not understand, then ask them to explain it a way that you do. Don’t ever leave your doctor’s office with big questions lingering in your heads, unless of course your doctor tells you up front that “I don’t know myself at this time.”
Anyway, thanks to all of you for reading and for the feedback and questions you have raised in response to the posts. I hope you have gotten as much out of this blog as I have!
3 Comments:
At Thu Jun 21, 11:18:00 AM 2007,
Leigh said…
Thank you for another great post Dr. Trofatter. I've learned so much from reading your blog.
At Wed Jul 11, 05:15:00 PM 2007,
PE Mommy said…
Thank you so much for posting your series of hypertension in pregnancy. My first daughter my bp went up at 24 weeks. But it was slow progressing. At 27 weeks, I lost sight in my left eye for an hour. Freaked me out. Still my ob did nothing. No tests, no change in bp med. No extra surveillence. At 33 weeks, I was starting to feel like I had the flu. I went to acute care and was told I had indigestion. At 35 weeks 5 days I was admitted. I was delivered 3 days later by emergency induction. They could not do a csection because they were afraid I would hemmorage or seize. The tests that finally were run in the hospital revealed LDH as 695, alkaline phosphate as 400+, uric acid 18.8, all of the tests came back bad except platelets. Those were 208k, but had dropped from 300k. So who knows. My protein was over 5000mg. My bp was 160/120. I stayed on mag for three days and had a healthy baby girl.
I was so scared to even think about trying again till 5 years later. My husband said now or never. I didn't even have an obgyn because my care had been so awful with my first. I had not seen an obgyn since the birth of my daughter. This time my bp went up early. By 17 weeks I was on Aldomet. My bp kept going up. I started to get swelling, headaches, URQ pain. At 26 weeks I went to part time work. At 30 weeks, I went to bedrest (had been on modified bedrest - work home bed). At 32 weeks I went on very strict bedrest. I had protein off an on the dipstick from neg to 2+. I was tested regularly. Monitored carefully. Saw my obgyn every two weeks till 26 weeks and then every week till I had another emergency induction again at 35 weeks 5 days (surprise magic number). When I delivered I was on 2000mg Aldomet, 60 mg procardia, and very strict bedrest. My bp was running 160-175/120-130 when I delivered. I also saw a peri for evals starting at 26 weeks. At delivery my ob stopped all bp meds to see if chronic or pih. My bp did not go up and went down. I still have high bp now 2 years later so final diagnosis is chronic htn with superimposed severe pih.
I want a third child and will be trying in few months. I have read every journal article written, all the new research, taken CMEs on it (yes I am a nerd). I have made contigency plans. I have planned to be out on bedrest by 26 weeks and delivery by 36 weeks because my obgyn and peri have told me 100% bp problems, 100% bedrest by 26 weeks, and count on delivering between 35-36 weeks. Course if it works out that everything is ok, then take that as gravy. But I want to be prepared in my case.
In case you are curious, my girls placentas were not the pitiful ones. They had enormous placentas. My severe pe/partial hellp baby was like 550 grams. My severe pih baby was 792 grams! I seem to be one of those with high flow bp versus high resistance.
I help run a site for PE survivors and I am going to post a link for your site.
At Fri Jul 13, 07:25:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Dear PE Mommy: Thanks again for sharing your personal experiences. There are many readers who will appreciate what you have been through and find comfort in knowing they are not alone! Best regards, Dr. T
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