I am new here, and need advice please!

[amandaihde]

Hi, my name is Mandi, and this is my second pregnancy. I also had HG with my first. I am 19 weeks, and am due in November. My problem is that I have been seeing my midwife throughout this pregnancy, but once I crossed that magic 20 lb loss mark, she had to refer me to a perinatologist. Thankfully I still have my normal appointments with my midwife, but I now also see a high risk doc for my hg. Anyways, I am really frustrated, because I feel like this new doctor doesn't care about me like my midwife did. He has written me a bunch of prescriptions, I am on Zofran 8 mg. q3, Kytril 1 mg q2, and Protonix once a day. I also test my ketone level twice a day. He said that he wants me to call him if my ketones are small or above, and then I can go into the hospital and be rehydrated. Well, the first time I called him, they were small, and so he said wait til tomorrow and see what they are then. Well, by then they were so large that I go 5 pokes just to try and start an IV. So, now I don't call until they are moderate, but the same thing keeps happening. He says to try and drink something and give him a call after 4-5 hours of trying to keep down liquids. Does he think I am not trying my hardest or what? So, anyways, after he will finally admit me with very large ketones, to the point that I am too weak to even walk, he orders 2 liters of IV fluids over 2 hours, and then he sends me home, no matter if my ketones are down or not, which he wouldn't know anyways because he only tests them when I am admitted. For instance, yesterday I called him about 2 pm with moderate ketones. He said to take another Kytril and wait an hour before trying any fluids. Then give myself at least 5-6 hours of trying to keep down fluids before I call him back. So, about 9 pm, I called him back with very large ketones. He called me in to L&D, and they put in an IV. By the time the IV got started, it was 11 pm, so I tried my best to sleep for the 2 hours of IV fluids. The nurse woke me up about 1:30, and said that I could go home as soon as she got my discharge papers done, because my doctor didn't want me to stay. He didn't even recheck my ketone levels, and I hadn't peed at all. The worst thing is that this was not the first time that my doctor had me discharged in the middle of the night. I am so frustrated, because it is very obvious that the perinatologist doesn't care about me or my health at all. Has this ever happened to anyone else? I am so angry at him for his I don't give a crap attitude, that I told my husband the next time my ketones go so high I am half tempted to stay at home and die, and then maybe he will realize that this is serious. No, I would never do that, but that is how upset this is making me. Do any of you other women have any advice on how to handle this? Any and all input would be appreciated. Thanks.

[bratty477]

I would change doctors and/or just go to the emergency room for rehydration rather than waiting on his lazy hind to tell you to wait 'til you get worse.

Many of us end up staying in the hospital for a few days at a time when it gets that bad so it's puzzling as to why he would discharge you so quickly. In my first pregnancy, when I went in to be admitted, I was in there for at least 4 days AFTER they've made sure that I had somewhat stopped vomiting for a period of time and they were able to get plenty of fluid into my system.

[samib]

I'm sorry, I suffered for 13 weeks before I could get into see a doctor. And then another 5 before I finally asked for Zofran......but in retrospect I wish I had demanded more. So that's what I think you need to do. It sounds as if you are are undertreated......DEMAND a new doctor...I've never heard of someone being discharged in the middle of the night! That's so unfair.

Best of luck!

Sami

[mammaclare]

Yep. Fire that doctor. Ask your m/w, since you trust her it sounds, for another referral to a different OB (doesn't have to be a peri, many of us get great or better care from a plain old OB although I would feel better with a peri if I had to do TPN or something)...or simply ask her if she would be willing to manage your care herself and with your input.

Then, regardless what happens, if you are headed downhill and get a run-around when you call in, take yourself to the ER and get the "cocktails" you need. ER docs can be as bad or worse (often the latter) than your OB but at least I don't think they'd let you go home still spilling ketones...liability issues and all.

When you get fluids does the peri order D5LR (5% glucose in lactated ringers which has electrolytes)? If you are only getting normal saline (NS) then it may be contributing to your not being able to stay hydrated as your body needs both fluid and glucose to clear ketones. The same may be happening at home...you call the peri, he says to drink and if you are drinking only water and not eating anything it will NOT clear the ketones which will keep rising. Ugh. I haven't even been to medical school and some days I think any one of us could manage an HG pregnancy better than some of the docs out there.

Also, I haven't known anyone who took Zofran and Kytril--not saying it is bad, just that I haven't heard of them used that way as they are in the same class of drugs. Hopefully someone here will have some more information on that. I'd also think that if you are needing rehydration that often you either need a change in meds (e.g.--adding another antiemetic in a different class like phenergan, or vistaril, or reglan) AND/OR consider a more regular hydration schedule...either going in every couple days, or having home health a couple days a week or perhaps the best would be to get a PICC line and be able to run a couple bags every day and more on the really bad days...that would eliminate all the calls and too-short hospital stays.

But again, first on the list is to fire the doctor and talk with your m/w about another referral or sticking just with her.

Welcome here...so sorry you are a part of the club but you found a great place for information and support...and while the circumstances under which we all know each other stink, the women here are some of the most wonderful I've ever met.

[peanut]

Being a nurse I know a few tricks to try to force the doctor's had to admit you. When they bring you the discharge papers state firmly that you do not feel that going home would be a "safe discharge". Then tell them why - for instance if you are very sick and need help and nobody can help you at home 24/7. Be creative with the reasons - the more the better. If they still insist on sending you home (it would be them risking a lawsuit as the law requires that you be discharge to a "safe environment") when you sign the discharge papers write on the paper that you feel that it is an unsafe discharge. Make sure you press really hard as you write so that it goes through all the copies. Then keep your copy - the hospital will keep theirs. If something happens, then you can (a) sue them (b) report the doctor and nurse who discharged you to the licensing board. Good luck hopefully when you play hardball with the doctor he will get the mesage that you are not fooling around.


Lora

[rjdecker]

I think these ladies already said it all. I am concerned that you keep spiraling down and down, and not really have enough time to get on top of the dehydration, which can be serious. I agree that you might need a change in meds. I never responded to zofran, it was like giving me nothing, but vistaril really helped a lot. It seems to me like like doc is out to prove something. sounds like he thinks he knows what he is doing, but for heaven's sake! I would get anohter doc. Has he tried anything different than what he is doing?

Keep us posted on how you are doing.

Jenny

[pamedic]

Wow, you doc is a real jerk. I can't imagine feeling like this and having such horrible treatment. I would defientely talk to your midwife about your concerns and get a referal to a new doc. THere is no reason why they give you 2 hours of fluids and send you home. I've been hospitalized twice and each time they kept me for 3 days and gave me 9-10 Liters of fluid and in the end put in a PICC line so I can have constant IV hydration. It sounds like you would probably be better off with a PICC too. Just becuase you can't drink doesn't mean you don't need fluids and for your doc to tell you to just try to drink more s nuts. Sorry you are suffering.