Re: OB Dilemma & Blood Pressure Probs

[Guest guest]

Hi ,

Thanks for sharing your pregnancy experiences with me. It makes me feel

better to know my doubts about the OB weren't unfounded and that blood

pressure fluctuations aren't so uncommon. My blood pressure has never been

high, even at my most hyper. That it dipped so low while I was experiencing

lots of other hypo symptoms further supports my suspicion that my thyroid

levels have dipped too low. One other thing that bothered me about this OB

was that she dismissed my concerns that I was experiencing hypo symptoms as

normal pregnancy stuff when I knew otherwise. I only had one 'Meet and

Greet' appointment with this doc, so I don't feel bad about dumping her. She

also was a bit defensive when I asked her about the possibility of the baby

having to be transferred to a hospital with more intensive care capabilities.

I just didn't get a good vibe from her.

I know it seems incredibly early in the pregnancy to be worried about where

to give birth, but the doctors are tied to individual hospitals. So, when I

choose a doctor, I'm also choosing to deliver at the hospital at which they

work. It's a difficult choice for me to make so early in the pregnancy for

exactly the reasons you mentioned. I've narrowed it down to two hospitals,

each with their own advantages:

Evergreen, from all accounts, including Pam B's, a wonderful hospital that

has been named one of the top ten places to have a baby. It's a level 3

facility and if the baby were to need intensive care, I'd be able to stay in

the same private room with him rather than having him go to a nursery. The

problem is I don't know what it means to be a level 3 facility. I don't

understand under which circumstances the baby would have to be transferred to

a hospital with more intensive care capabilities and if those are

circumstances that I, as a Graves patient, should even worry about or if the

potential complications from Graves are " mild " enough to be sufficiently

cared for in a level 3 hospital.

Swedish Hospital is my other choice. It is also a great hospital, and has

the capabilities to handle whatever complications that arise, including

newborn surgery, if needed. Unlike Evergreen, however, if something were to

happen which required intensive care, the baby would have to go to a special

care nursery rather than stay in the room with me. It is further away from

my home than is Evergreen, but I doubt I'll be fortunate enough to have such

an easy labor that whatever difference in travel time matters much, eh?

Also, I've found a doctor at Swedish that I really like, but Pam B recently

sent me the name of a good doc at Evergreen to try as well.

Such tough decisions! It would be so much easier if I could just pick a

doctor I like and decide where to give birth when I have more info about how

risky the delivery will actually be.

Thanks again for your advice,

Tori

In a message dated 12/14/2002 3:24:02 PM Pacific Standard Time,

petri017@... writes:

> Tori,

>

> I do disagree with your ob, although this isn't reason to dump her, but to

> talk to her again and reconfirm her feelings.

>

> From what Elaine has reported, what I've read, and what my ob-gyn AND endo

> (who is on Shomon's top doc list and who is Almost God say is that

> sometimes becoming a bit hyper during pregnancy is NOT an issue. Indeed,

> thyroid levels that dip a LITTLE in either direction and then are caught

> and regulated will not harm your baby.

>

> But my endo has had me running a little high rather than low and the

> pregnancy is going better for it. Part of this picture is very very

> individual -- because of high blood pressure concerns, U's doc would

> prefer to err on the side of hypo. For me, I'm one of those unusual people

> who get high blood pressure while hypo, which is all the more reason to

> keep my thyroid levels in the higher half of normal.

>

> One difference I have found during this pregnancy (with thyroid disease)

> adn the ohters (without, although who knows for sure) is that my blood

> pressure throughout boht other pregnancies was the SAME was it was when I

> wans't pregnant, which is about 100/60 to 90/60. This pregnancy, my blood

> pressure has stayed at about 120/60. Nobody but me thinks this is

> interesting since that's a normal reading - but I find it odd that ever

> since I've had Graves then Hashi's, my blood pressure has never returned to

> its normally very low state but been a bit higher.

>

> Anyway, I'd do some reading and investigate this a little further. Also,

> how much hypo is a little hypo for her? Remember, she may mean it doesn't

> matter if you slip out of that normal range much (e.g., a hair above 5 or

> with a TSH of 4.9) yet there are now recommendations that the normal range

> be changed to TOP off at 2.5!!! So if her rule of thumb is that your'e

> okay if you're all the way at a tsh of 5, yet the rules are changing, and

> she's unaware . . . well, I'd be concerned about that.

>

> As for the birth center, I have to agree that more may be better than less

> in your case. Do you have to decide right away? You have thirty weeks

> left Wihtin the next few weeks, perhaps you can tell if thigngs appear

> to be running very very smoothy adn you're willing to take your chances

> with the birth center because all looks normal. But if you're struggling

> to balance your thyroid and feeling uncertain and things don't seem stable

> or EASY, you may want to stay with a larger hospital. I guess that's what

> I did: when I got pg at 39 post-Graves, with my thyroid intact and the

> theoretical potential for becoming hyper again, I went ahead and let my

> otherwise mellow ob label me 'high risk' and slot me for all kinds of bells

> and whistles should I need them. By week 20, I was clearly out of the

> woods and things were going so well I wasn't a 'risk' any longer. By week

> 30 when the receptionist told me to start coming in every two weeks, the

> ob-gyn said, oh let's keep going once a month till the last month. Things

> are going that well.

>

> But I was prepared for more and I think you should be too -- you can always

> downgrade later if you don't make a permanent decision on where to give

> birth right now?

>

> Keep us posted! The first trimester can be a very queasy experience and

> it sounds like you're in the thick of it. Dry popcorn and acupuncture

> wrist bands helped me with all three pgs.

>

> Best -

>

>

>

[Guest guest]

Hi ,

Thanks for sharing your pregnancy experiences with me. It makes me feel

better to know my doubts about the OB weren't unfounded and that blood

pressure fluctuations aren't so uncommon. My blood pressure has never been

high, even at my most hyper. That it dipped so low while I was experiencing

lots of other hypo symptoms further supports my suspicion that my thyroid

levels have dipped too low. One other thing that bothered me about this OB

was that she dismissed my concerns that I was experiencing hypo symptoms as

normal pregnancy stuff when I knew otherwise. I only had one 'Meet and

Greet' appointment with this doc, so I don't feel bad about dumping her. She

also was a bit defensive when I asked her about the possibility of the baby

having to be transferred to a hospital with more intensive care capabilities.

I just didn't get a good vibe from her.

I know it seems incredibly early in the pregnancy to be worried about where

to give birth, but the doctors are tied to individual hospitals. So, when I

choose a doctor, I'm also choosing to deliver at the hospital at which they

work. It's a difficult choice for me to make so early in the pregnancy for

exactly the reasons you mentioned. I've narrowed it down to two hospitals,

each with their own advantages:

Evergreen, from all accounts, including Pam B's, a wonderful hospital that

has been named one of the top ten places to have a baby. It's a level 3

facility and if the baby were to need intensive care, I'd be able to stay in

the same private room with him rather than having him go to a nursery. The

problem is I don't know what it means to be a level 3 facility. I don't

understand under which circumstances the baby would have to be transferred to

a hospital with more intensive care capabilities and if those are

circumstances that I, as a Graves patient, should even worry about or if the

potential complications from Graves are " mild " enough to be sufficiently

cared for in a level 3 hospital.

Swedish Hospital is my other choice. It is also a great hospital, and has

the capabilities to handle whatever complications that arise, including

newborn surgery, if needed. Unlike Evergreen, however, if something were to

happen which required intensive care, the baby would have to go to a special

care nursery rather than stay in the room with me. It is further away from

my home than is Evergreen, but I doubt I'll be fortunate enough to have such

an easy labor that whatever difference in travel time matters much, eh?

Also, I've found a doctor at Swedish that I really like, but Pam B recently

sent me the name of a good doc at Evergreen to try as well.

Such tough decisions! It would be so much easier if I could just pick a

doctor I like and decide where to give birth when I have more info about how

risky the delivery will actually be.

Thanks again for your advice,

Tori

In a message dated 12/14/2002 3:24:02 PM Pacific Standard Time,

petri017@... writes:

> Tori,

>

> I do disagree with your ob, although this isn't reason to dump her, but to

> talk to her again and reconfirm her feelings.

>

> From what Elaine has reported, what I've read, and what my ob-gyn AND endo

> (who is on Shomon's top doc list and who is Almost God say is that

> sometimes becoming a bit hyper during pregnancy is NOT an issue. Indeed,

> thyroid levels that dip a LITTLE in either direction and then are caught

> and regulated will not harm your baby.

>

> But my endo has had me running a little high rather than low and the

> pregnancy is going better for it. Part of this picture is very very

> individual -- because of high blood pressure concerns, U's doc would

> prefer to err on the side of hypo. For me, I'm one of those unusual people

> who get high blood pressure while hypo, which is all the more reason to

> keep my thyroid levels in the higher half of normal.

>

> One difference I have found during this pregnancy (with thyroid disease)

> adn the ohters (without, although who knows for sure) is that my blood

> pressure throughout boht other pregnancies was the SAME was it was when I

> wans't pregnant, which is about 100/60 to 90/60. This pregnancy, my blood

> pressure has stayed at about 120/60. Nobody but me thinks this is

> interesting since that's a normal reading - but I find it odd that ever

> since I've had Graves then Hashi's, my blood pressure has never returned to

> its normally very low state but been a bit higher.

>

> Anyway, I'd do some reading and investigate this a little further. Also,

> how much hypo is a little hypo for her? Remember, she may mean it doesn't

> matter if you slip out of that normal range much (e.g., a hair above 5 or

> with a TSH of 4.9) yet there are now recommendations that the normal range

> be changed to TOP off at 2.5!!! So if her rule of thumb is that your'e

> okay if you're all the way at a tsh of 5, yet the rules are changing, and

> she's unaware . . . well, I'd be concerned about that.

>

> As for the birth center, I have to agree that more may be better than less

> in your case. Do you have to decide right away? You have thirty weeks

> left Wihtin the next few weeks, perhaps you can tell if thigngs appear

> to be running very very smoothy adn you're willing to take your chances

> with the birth center because all looks normal. But if you're struggling

> to balance your thyroid and feeling uncertain and things don't seem stable

> or EASY, you may want to stay with a larger hospital. I guess that's what

> I did: when I got pg at 39 post-Graves, with my thyroid intact and the

> theoretical potential for becoming hyper again, I went ahead and let my

> otherwise mellow ob label me 'high risk' and slot me for all kinds of bells

> and whistles should I need them. By week 20, I was clearly out of the

> woods and things were going so well I wasn't a 'risk' any longer. By week

> 30 when the receptionist told me to start coming in every two weeks, the

> ob-gyn said, oh let's keep going once a month till the last month. Things

> are going that well.

>

> But I was prepared for more and I think you should be too -- you can always

> downgrade later if you don't make a permanent decision on where to give

> birth right now?

>

> Keep us posted! The first trimester can be a very queasy experience and

> it sounds like you're in the thick of it. Dry popcorn and acupuncture

> wrist bands helped me with all three pgs.

>

> Best -

>

>

>

[Guest guest]

grooooooowwwlll

my sons had every single one of those reported side effects.. ook for

my sanity im going to decide that aussie drs didnt know this 9-7 yrs

ago.. or id have to choke someone..

sigh.. just makes me more sure they dont know half what they make out

they do..

can i ask if the beta blockers actually work to lowering thyroid

function? like can they make you hypo? given that i was 20 weeks in

hospital on soy products and in a low iodine area and on these beta

blockers.. and my son has craniostenosis.. a symptom of being low,

from what ive read..makes me wonder..

thanks so much for the info.. Grace

> Hi Grace,

> The Physician's Desk Reference or PDR states " that there are no

adequate and

> well-controlled studies in pregnant women. Latetalol HCL should be

used

> during pregnancy only if the potential benefit justifies the

potential risk

> to the fetus. "

> Most toxicological studies using beta blockers have been done on

propranolol,

> and the studies I've done were all done using propranolol. The PDR

for

> propranolol states " that there are no well-controlled studies in

pregnant

> women. Intrauterine growth retardation has been reported in

neonates whose

> mothers received propranolol during pregnancy. Neonates whose

mothers are

> receiving propranolol at parturition have exhibited bradycardia,

hypoglycemia

> and respiratory depression. Adequate facitlities for monitoring

these infants

> at birth should be available. "

>

> There is more information in Goodman & Gilman's Physiological Basis

of

> Therapeutics, but I've loaned my copy out. Many public libraries

carry this

> book as well as the PDR in their reference sections. Take care,

Elaine

>

>

>