Doctor Visits, Specialist Visits, and Lab Tests Oh My!

Both my husband and I have been exhausted. Our cat, as usual, sleeps all the time. We have the feeling that maybe our hive is suffering from colony collapse. But let's hope it's nothing that serious. We're probably just overwhelmed with this whole IVF process, all the appointments, the uncertainty of our situation and future, and sacked out from work.

The lead up to any pregnancy often includes visits to the doctor and lab tests. People might check if they are healthy and in good condition to get pregnant or ask what vitamins they might need to take to ensure a healthy pregnancy and baby, for instance folic acid. When you have particular medical conditions though, the number of appointments is multiplied with visits to specialists on top of your GP. And lots and lots of lab tests.

Last week I went to the lab to get blood work done again, this time for the endocrinologist regarding my thyroid.

Yesterday, I visited my endocrinologist to review my thyroid levels, since mine are still in flux and thyroid levels are vitally important in pregnancy. Sub optimal thyroid levels can lead to:
1. Inability to conceive or lower chances of conceiving;
2. Higher risk of miscarriage in first trimester; and
3. Lower IQ in the baby (still in normal range, but at the lower end).
My endocrinologist reviewed the numbers from my blood tests, along with weighing me, and asking the same series of questions that he always asks. He concluded that my thyroid levels are currently perfect for pregnancy. I will do another set of blood tests for him and see him again in 3 months. If I get pregnant I will need to phone his office immediately and get an appointment right away (they make room even if there is no room because thyroid levels and pregnancy are so critical). Thereafter, I would see him every 4 to 6 weeks (usually every 4 weeks, unless the thyroid levels look really, really good).

In the same office, a while later, I saw my GP to ask for a new referral to a perinatal psychiatrist since my own psychiatrist refuses to treat me while I undergo IVF due to concerns with regard to what the prescribed hormones will do to my mental state and stability. But of course nothing comes easy, so my psychiatrist, through his assistant, refused to refer me and said that my GP would have to. That makes sense! The assistant said if I had trouble getting a referral from my GP to call back and she'd see what she could do about getting my psychiatrist to give me a referral. So reassuring. . .

My endocrinologist weighed in about this method of obtaining a referral to a specialist when I was visiting him earlier that day and said that that's often how things are done in our medical system where the GP is considered the hub, but he agreed that our system is really inefficient.

My GP was happy to give me a referral and prepared it while I was in the office. He also gave me a refill on my psychotropic medication to last me until I might see the new psychiatrist. The referral was sent out immediately. I received a call from his assistant later that day, saying that the psychiatrist's office has a three month wait.

I was in no man's land without a psychiatrist. Obviously, this is not a reassuring place to be while undergoing hormone therapy to try to become pregnant (my psychiatrist had warned me that the hormones could destabilize me). While I was feeling fine, I worried that if I started to feel unwell in the future, I would have no one to treat me and might end up in the hospital. Clearly, this should be avoided.

I called the perinatal psychiatrist's office this morning and talked to her assistant. I explained that I had seen this psychiatrist before and that my current psychiatrist won't treat me since I'm now on hormones for IVF. The assistant told me that that I needed a new referral (as she did when I talked to her last week). I told her that I had received one yesterday from my GP. She found it and asked why my psychiatrist hadn't referred me (especially since he was the one who wanted her to see me). She was perplexed as to why he had refused. I, of course, had no answer.

She reviewed the psychiatrist's calendar, as well as the other psychiatrist who also works in that office (it's in the Victoria General Hospital) and said that the earliest appointment available was July 26th (two months away). I asked what would happen if I became pregnant before then, because normally blood tests have to be done to check that the levels of the psychotropic medications are therapeutic (so the mother doesn't destabilize) and certainly not at a toxic level that would harm the mother or baby. She said she supposed I'd just have to be treated by my original psychiatrist. I again explained he was refusing to treat me. Silence. She clearly understood the ridiculous and unfortunate situation I was in but was perplexed about how to help me. I would have been too. She said I should call the office of the perinatal psychiatrist if I was pregnant and she would get the psychiatrist to give advice to my current psychiatrist, or my GP if the psychiatrist refuses to treat me even with this advice, on how to treat me while pregnant, until I can get in to see the perinatal psychiatrist. She also put me on the cancellation list in the hopes of getting me into the office sooner.

All in all, this has been an extremely frustrating experience. I can't imagine what would happen to someone who was less proactive and less able to be their own advocate. Our medical system certainly leaves something to be desired.

Doctor's office bathrooms always have awesome lighting!

Look at that fluorescent glow.

The waiting room in this doctor's office has a mix of florescent and natural light. 

The light in the exam room . . .