Tales of a new doctor

I am officially a patient of Dr. K at the PPVI Institute. Yay! Since I was a patient there a few years ago, the process to become an active patient again was straightforward: fill out a few forms and have copies of my medical records sent to them. I would say it was a “quick” process except that the medical records department at the hospital where I had my laparoscopy took their sweet time in sending my records to Dr. K. Apparently they have up to a month to complete the record request, and they barely made that deadline. ;) (For new patients, there’s an extra step in the process: you have to wait for one of the PPVI physicians to review your case and make an initial written recommendation, which is mailed to you.)

Dr. K’s first two recommendations were to have an ultrasound series and endometrial cultures done. The cultures I had done a year ago were not thorough enough. Dr. K wanted to test for six different types of organisms which might be taking up residence in my uterus: aerobes, anaerobes, mycoplasma, ureaplasma, Chlamydia, and fungus. The cultures could be done locally, but the ultrasounds would have to be done by a NaPro-trained ultrasound tech. Knowing that a trip to Omaha probably isn’t feasible for me in the near future, I asked if I could have them done locally as well (assuming there was a 99% chance they would say no). They said no. I had heard of cases where a non-NaPro ultrasound tech is given written directions on how to do the NaPro ultrasound, so that’s why I inquired. Obviously that is far from ideal, but I figured it would be better than no ultrasound at all.

DH and I have been discussing it, and he is really supportive of getting the ultrasounds series done. If he had said it’s too much hassle to make the trip, I would have gone along with that and not pushed the idea. It makes you feel really good when your husband is on board. :) DH is trying to plan how he could take a week off, which is even more encouraging because normally it’s hard for him to even take one day off, let alone a week. Dr. K said if it’s at all possible, DH should come along so we can TTC the cycle of the ultrasounds. The bigger issue now is that I don’t have enough vacation days to use; I used them up during the trip to visit DH’s family. So I’d either need special permission to work from the hotel, which is not out of the question—except I’d rather not have to fill my boss in on the details of my IF and the reason for this trip—or we’ll have to wait until January at the earliest. We may have to wait until January anyway since I estimate that my ultrasound week would fall during both Thanksgiving and Christmas. I honestly wouldn’t mind doing the series over Thanksgiving, but I don’t know that the clinic would be open or that the ultrasound tech would be too excited about the idea. ;)

To have the endometrial cultures done, I made an appointment with an ob/gyn in town whom I had never met. I needed a new ob/gyn anyway for pap smears (and maybe, hopefully, God-willing someday for the ob aspect). Armed with a prescription script from Dr. K listing the required tests, I was mentally resigned to face any reaction on the spectrum from indifference to hostility. You just never know how a mainstream doctor is going to react to NaPro.

Before the doctor even came into the exam room, I could hear the conversation just outside the door between the nurse and doctor. Walls and doors don't block any sound in this office apparently. The doctor wanted the nurse to call PPVI to ask how the sample was to be collected. She was transferred a few times before she actually got a PPVI doctor on the phone. I breathed a sigh of relief. Who knows where the doctor might be—with a patient, in the middle of surgery, on vacation—especially on a Friday afternoon...

In the meantime the doctor came in to meet me and take my history. He wanted to know what kind of tests had been done for our IF and why these cultures were being requested. I described the hormone profile, surgery, and why it was suspected that I had an endometrial infection. No doctor can argue that periods lasting up to 13 days including a week of brown bleeding are normal. At least I had that evidence going for me! Most mainstream doctors would not suspect infection as a cause of brown bleeding, however.

He asked if we'd done ovulation stimulation or ovulation predictor kits to see if I'm ovulating or IVF. I said no to all of the above. I mentioned that I was charting to know the time of fertility and that the next thing PPVI wants to investigate is whether I'm ovulating...by doing ultrasounds. He looked like he was about ready to roll his eyes. He said that what I've had done so far is not usually how most doctors handle IF pts. Really? I had no idea! ;) I wonder if he thought I'd been shortchanged out of the usual IF offerings: Clomid, ovulation kits, and then IVF?

One of the first things I had said to him was that the approach my (NaPro) doctors were using was not mainstream. at. all. It might have made a tad more sense why we were taking this “unusual” route if I had explained that IVF and any other ART are not options for us morally and that we’d like to actually fix what’s wrong with my body, but there wasn't an opportunity to interject that information. You can only cover so much at the first appointment.

He also said that this unconventional approach was expensive.

Yes, but since when is IVF cheap? And it’s this “unconventional approach” that is responsible for finding and fixing the first two of my IF-related problems—endometriosis and a luteal phase defect—neither of which mainstream medicine would have found nor fixed. Why is it so hard for mainstream doctors to understand this? It’s frustrating...

He stopped short of saying NaPro is "silly" or "a waste of money" but I don't think those thoughts were far from his mind.

He left the room when the nurse had a PPVI doctor on the phone. Again I could hear every word he said loud and clear. I heard him express his skepticism about everything that had been done to me so far. I'm sure the PPVI staff gets this all the time.

He returned to my exam room with good news, bad news, and interesting news. The good news was they would be able to do the cultures. The bad news was that they were going to do an endometrial biopsy, and it was going to hurt. I know what you're thinking. Noooo! Not a biopsy! Those are horrible! I would agree. Last year’s biopsy was no fun. But I pretty much expected that was going to be the case, so I consented.

And the interesting news? He knew the PPVI doctor with whom he had just spoken. In other words, he was personally acquainted with her, and she had explained NaPro to him in the past multiple times. Talk about a small world! Perhaps it was Providence? :) That connection I think may be a substantial reason why he turned out to be so cooperative.

The doctor left to get the necessary supplies. The two nurses in the hall were having a tough time figuring out what kind of swabs were needed for the six different cultures that Dr. K wanted. I heard them make a couple phone calls—presumably to their lab. I heard them pull out the instruction manual for the swabs they had on hand. I heard them say they don't have the all the right ones. I heard them on the phone again. This went on for a while. Meanwhile I decided to make myself comfortable and lie back on the exam table.

The doctor returned briefly to say they were working on it and promised they wouldn't close up the office for the weekend with me covered with a sheet on the exam table. I was glad he was so good-natured about the whole thing.

Finally he returned, ready to go. He said PPVI had called back and changed their instructions: no biopsy needed. Just use the swabs. That meant no scary metal objects through my cervix, just a long q-tip-like stick. Yay! They had to take 3 or 4 samples but it did not hurt at all. I'd almost say a pap smear is worse. I highly recommend this method over the biopsy. Afterward the doctor gave me the (half-joking) disclaimer that it wasn't his fault if it turns out PPVI really needed a biopsy and I end up having to come back. He was just following orders. ;)

Now as much as this doctor was clearly skeptical of the NaPro approach, he was and is remarkably cooperative. He said he will do whatever PPVI asks, as if he's the local arm of their clinic. Wow! I was stunned. I was definitely not expecting that. His only request was that PPVI send him a summary of their approach to treating me so he understands the bigger picture. Seems reasonable to me. Hopefully PPVI already has such a document. He also wants all PPVI orders faxed to his office to ensure legitimacy and so he can follow along what is being done. Not a problem, I assume. I bet this will be a bit eye-opening for him. But to be honest I'm not sure how many more orders for tests and things there will be, other than the monthly Peak+7 blood draws. Since I just go to the hospital lab for that, it doesn't really involve him, unless for some reason the lab stopped accepting the paper order that I bring along and needed an order from a local doctor. I guess I'll just have PPVI fax him orders when they need him to do something—pelvic exam, other test, etc.

They said the fungal culture could take up to three weeks because it grows slowly. Nothing with IF is ever quick, is it? ;)