Friday, March 16, 2012

Testing Me

I knew eventually something like this would happen, but I never expected it to happen so soon. Yesterday afternoon around four, when I was working about 3 hours away from my home (out in the middle of nowhere), my phone rang with a familiar number. I quickly realized that it was my MFM office calling me. My first initial instinct told me that maybe they needed to change my appointment that is coming up on Thursday. When I picked up, it was the Nurse Practitioner from the office. She told me that my case was reviewed earlier that day my all of the MFMs as they do weekly reviews on most of their cases. She said that they spent a lot of time reviewing mine and they had come to some conclusions. The first thing that was decided was that they agreed with my decision and will let me keep working unless I experience 1). vaginal bleeding, 2). cramping, or 3). a shortening cervix. I was absolutely delighted to hear this as I just couldn't fathom why I would need to go out of work now, especially considering everything went so well with the Immunologist on Friday. I was very happy to hear this. The next thing she told me completely turned my world upside down. She said that two of the MFMs were in disagreement about the 17-P shots and wanted me to stop them. She said that since I have not had a 2nd trimester loss, that they felt that they were not indicated. One of the those that weren't in agreement with me being on them was the Chief of Maternal Fetal Medicine who was actually the first one (5 weeks ago) that briefly mentioned the use of progesterone after finding out that a cerclage was not possible. Their rationale for stopping it was that 17-P has only been shown effective IF you have had a 2nd trimester loss. I have so many problems with that statement it isn't even funny. Being as theory driven as I am, I had clearly done my research before starting this medication and was actually impressed with the literature that is out there supporting of 17-P in my case. I immediately told the NP that I did not agree with their decision in any way, shape, or form, and that I had no intention in stopping it unless they could show me, based on research, that it would be of no benefit or that it would potentially cause harm to my baby. She told me that wasn't the case so I told her that I wasn't stopping it without talking to them first. I asked her to have the MFM call me that originally told me that it was a good idea to do the P-17. I completely respect this MFM so I figured that she would be the voice of reason. I called the NP back later this afternoon as I had yet to hear from the MFM. She said that she probably would want to talk to me in person next week but was agreeing with the other two MFMs now. I personally think that since she is rather new to the practice, that she doesn't want to have a phone conversation with me and then go against what they say.

I have decided to write them a letter and I have already printed out almost a dozen journal articles that support the use of 17-P in my case. Here are the things that I am pointing out to them in my letter:
  1. my cervix has been surgically shortened by the CKC (this was actually discovered by the chief MFM)
  2. I cannot have a transvaginal cerclage because there is no cervix in my vagina
  3. women with shortened cervices have an increased risk of preterm birth
  4. 17-P shots have been demonstrated to be effective in prolonging pregnancy in a randomized trial of women with shortened cervices
  5.  there is no hazard to the 17-P shots whatsoever 
I have already made my mind up that I am not stopping them unless they could give me good evidence as to why I should. I am fearful about the outcome of this discussion, but to my benefit I already have the medication and I administer it myself, so they technically cannot stop me from taking it. Just to be sure that I was doing the right thing, I emailed the Chairman for the Department of Obstetrics and Gynecology at the Univeristy of Chicago as he is one of the leading researchers in the country regarding incompetent cervices and surgically altered cervices. I have talked to him in the past regarding so research that he did so I decided to use this contact one additonal time. He is completely perplexed by their decision and even said that he hopes that the one MFM that originally started the 17-P has enough independence from the chief that she would see the need to continue them and is not just agreeing with them because she has to. Seriously, why can't things ever go smoothly?!?!


  1. i don't know much about p17, but geesh, if it does not harm, what's the problem? i'm glad you have enough to make a decision independently no matter what they decide. and i'm very glad youre going to advocate for yourself.