Tuesday, June 22, 2010

whiskey tango foxtrot?

I was able to get to the bottom of this bloodwork issue today, thanks to the original doctor's incompetence (or should I say, "complete lack of common sense"?).

My psychiatrist faxed the bloodwork results to my midwives. I'm still not sure why, except that since she kept saying "I want you to have a copy to show your midwife" I assumed it was something relevant to my prenatal care, and therefore told her to fax it to them when she suggested I drive downtown, pay for parking, and pick up the stupid thing myself.

So... the "deficiencies"? My vitamin B12 is at a level that the lab guidelines classify as "possibly indicating deficiency", and my TSH (thyroid stimulating hormone) is 3.25, right in the middle of the lab's "normal" range of 0.5-5.0. The doctor's note on the front, addressed to my midwives, states that "patient should be started immediately on intramuscular B12 injections, and should be referred to Dr. Y___ for endocrinology follow-up."

Now, before any of you Google MDs start typing out your responses, let me say that I understand that both the B12 guidelines and the TSH range have been recently (or not-so-recently) criticized as being outdated and inaccurate, and doctors are advocating revamping and tightening the guidelines. The current guidelines, it seems, originally included a number of people who had what were called "subclinical" cases of deficiency or whatever.

HOWEVER... neither of these bloodwork results is alarming enough to warrant calling a patient and insisting that she needs to come in the next day to discuss, all said in a panicky tone of voice. And to my mind, neither of these things needs to be addressed right this second, when I'm 39 weeks pregnant and I'm likely to be facing wildly fluctuating hormone levels in the next little while. And finally, neither of these things is something that my midwives can or should really address. They can't make the direct referral to edocrinology, and they don't have the expertise in thyroid stuff to know whether they should. IM B12 injections are also not within their scope of practice, I think. So why on earth did my psychiatrist a) freak me out with her whole "I need to see you tomorrow" drama, and b) suggest/insist on involving my midwives?

I feel like the answer is to accept that my psychiatrist is generally high-strung and anxious, and either ask my family doc for a new psychiatric referral or brace myself for more lapses in common sense.

What would you do? And would you bitch out the psychiatrist, if you were me?

17 comments:

Amanda said...

uhhhh....i think what your psych did to you is B.S. I mean really??? It doesnt make a whole lot of sense.

Munchkin said...

I love how you're now analyzing your shrink. Awesome!

Heather said...

I would definitely ask why she felt it was important for the midwife and what her concern is/was? When she doesn't have a good answer THEN bitch her out. I'm kidding but I would ask why.

I have no idea what B12 is for so I would assume anything out of range would be good info just for the midwife's information - but then again, I'm not a professional who was paid to analyze the information.

WindDrop said...

I'll start off by saying that if you were earlier in your pregnancy it might make sense, but considering you are at the end I wouldn't worry.

I know TSH while TTC should be between 2-2.5. Having hypothyroidism, I plan to keep my levels no higher than 2.5 during my pregnancy. New standard levels should be anything over 3 is considered hypothyroidism.

B12 deficiency can be problematic for long periods of time. You can start taking 1000mcg pill rather than getting the IM injection. It can lead to nerve damange IF it is bad enough and had been low for a while.

After the baby is born you should have the number retested for both. Not that big of a deal and really couldn't change anything now.
FYI, I know Metformin can lead to B12 deficiency.

ms. c said...

Oy.
I have no idea how either of these "maybe" deficiencies should be treated, but I am appauled how you were treated! Just... wow.
I would speak to your psychiatrist about her behaviour, and I would also ask for a referral to a new one, just in case.
I'm sorry that you had to go through this.
One thing that you did mention, and I would wholey agree with is that you are 39 weeks pregnant and your hormones are whacky, and will likely be whacky for a few month yet. So hormore therapy is not something that I would justp into right this moment. You have bigger fish to fry!!

Aurelia said...

I think your psychiatrist is being completely reasonable and yes, you should see an endocrinologist or at minimum a GP about the TSH and the B12 right away.

For example, the wonky thyroid, is going to interfere with breastmilk production, and if you can't breastfeed, you'll be pissed, I know. If the midwife or a doctor or a lactation consultant is aware of it, then they can make sure your milk comes in and give you medication to increase production immediately. There are also issues with bleeding after birth and other problems, and a simple shot of B12 is nothing compared to that.

If your GP can't help, or your midwife, why not call Dr.Eyebrows? Bet he could help, asap.

And no, I would not get mad at the psychiatrist at all. If left untreated, you will get even more hypothyroid after birth and may even get more depressed, PPD, or have a major fibro problem. And this is so so easy to fix.

Call me if you want to chat. K?

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