Heme appointment #1

So I had my hematology appointment.  First I saw the fellow who took my history and went through my labs with me.  Elevated Factor VIII can be caused by any number of things including stress, infection, etc. so he said that number doesn't tell us anything specific.  The rest of my labs all support the idea that I clot really well—more quickly than normal.  (Extra vWF = clot faster = shorter PTT)  He didn't say what the implications of that are.  Somewhere in the discussion he did casually mention it's possible to acquire "vW disease" but usually it's genetic—it sounded like he was thinking out loud.  He was not saying that is my diagnosis...but I wonder if that's the most likely explanation?  (I don't have a diagnosis yet.)

Then the attending Dr. D came and asked me some more questions.  I swear I was asked by each of them at least twice if anyone in my family had clotting issues.  My answer was no all four times.  ;)  I really wanted to say yes just to satisfy them... hahaha  Dr. D wanted to know if I was sick on the day my blood was drawn for the labs.  I hadn't been sick, but I did mention my uterine strep infection that was found the same day.  I assumed he already knew that—it was listed in the medical record right next to my clotting lab results plus I had already told the fellow about it.  Dr. D asked if I had been treated for it.  I said no.  Apparently that was the WRONG answer.  He went from pleasant to super annoyed in no time and demanded to know why it hadn't been treated.  I wanted to hide under my chair...  I didn't have a good answer...I hadn't asked either of my NaPro docs for an antibiotic yet...they were both really concerned about the clotting labs so I assumed they wanted that part taken care of first.  And if Dr. C (ob/gyn who knew about the infection) thought it was that urgent, he would have given me a prescription right away, right?

So what I gathered from this reaction is that Dr. D might have wanted to repeat some of the labs at this visit but now could not because the strep would skew the results...and perhaps my previous labs were also skewed and therefore not usable?  Dr. D said I am to call him when my "doctor is sure the strep infection is gone" so they can redo the labs and then I'll have another appointment with him.  (Now I really hope that my TEBB disappears with the next antibiotic so I'll have a little "proof" the infection is gone...)  Another trip to see Dr. D isn't so bad...even if it is a long drive.  I asked if I could have the labs done at the hospital closer to home...not an option—they have to be done at his hospital's lab.  Sigh.  I asked if I could have them done the same day as my next appointment with him to make one less trip...no, obviously.  (silly me for asking)  Sigh.  So that means two more trips.  Ugh.  I just want this clotting issue diagnosed and treated sometime soon, and I think it would take longer if I started over with a different hematologist. I'll stick it out with Dr. D at least until the next round of labs.  Hopefully he'll be in a better mood the next time I see him.

Oh, they did say one thing sort of definitive.  This yet-to-be-named clotting issue isn't preventing us from conceiving, in their opinion.  That's good to know.  I didn't get a chance to ask if there is an increased risk of miscarriage with it (should we ever conceive), but I will next time.

What's my diagnosis?

Want to pretend you're a hematologist for a day?  Want to show off your Dr. Google skills? 

Let's play* "diagnose polkadot's clotting problem."  I've already tried to do it, and I've come up with a range of possibilities from benign to scary, so I doubt you'll find something worse than I did.

Here's the data you have to work with:

INR - normal
CBC - normal
PT - normal
PTT - very slightly short
Factor VIII - elevated
vWF antigen - elevated
vWF activity - elevated
platelet function (two different assays) - both short closure times

What diagnosis explains these lab results?  Anyone brave enough to try besides TCIE?  ;)

*Sadly I have no fun prizes like holey soap if anyone comes up with the same answer as my hematologist.  I will just be super impressed at your googling skills...and I have high standards when it comes to that.

Doctor #2

In an interesting turn of events, I recently had a consult with Dr. C, who is trained in surgical NaPro.  (random opening in his schedule...fortunately he's within driving distance)  After going over my history and test results, he gave me the plan:  laparoscopy, hysteroscopy, endometrial biopsy, and HSG (to flush out the fallopian tubes) all in one day.  I will be blissfully unconscious the whole time.  (That is really best for all those involved.)  He said he will be prepared to deal with whatever he finds—if there is a polyp, it will removed; if there is endometriosis, it will be lasered out.  He was rather cheerful and almost enthusiastic about it—kind of like a coach motivating his team with the game plan.

Just when I thought it was time to go, he decided he should do a pelvic exam.  I was so close to getting away without it.  As he was leaving the room so I could change into the gown, he asked very nonchalantly if he could do the endometrial biopsy today. 

What I was thinking: "How on earth are you going to get that sample?  That requires going through the cervix...  Can't you do it during the surgery while I'm unconscious?  You're going to be in there anyway.  That was the plan you mentioned five minutes ago."

What I said: "Okay."

Apparently I am easy to convince.  I had no idea what I had just agreed to.  He returned with a nurse and a large tray full of metal objects.  I am glad I didn't know ahead of time what was going to happen.  (I googled it when I got home, and the description sounded worse than what it was.)  It was uncomfortable, and there were lots of cramps.  He needed two samples, so he had to do it twice.  Fun.  Ah, the things we go through to figure out why we can't get pregnant...

Afterward he was silent for a minute and looked like he was pondering something.  Then he asked if I bruise easily (yes) and if my gums bleed easily (sometimes, yes).  Great, now I have a clotting problem.  Why has no one asked me about this before, I wonder?  (especially that dental hygienist who turned white as a ghost at how much my gums bled during a cleaning a year ago...poor girl was traumatized)  Dr. C decided to order a clotting panel and said if the biopsy and labs are normal, then we'll schedule the surgery.  It must have been quite the panel he ordered since it required eight tubes of blood.  He said if the results are abnormal, he will call me.  Otherwise, he won't.  No news is good news, got it.

Less than 24 hours later he called.  The biopsy results weren't back yet, but the labs were.  I do indeed have a clotting problem, one that is out of his area of expertise, so I am meeting with hematologist in a couple months (that was the earliest available).  I wrote down which of the assays were abnormal and consulted Dr. Google.  Not a good idea.  Based on what I found, I came up with a couple possible diagnoses.  Also not a good idea.  (I am not a doctor...what do I know?)  I hope I am wrong, and it's just due to stress, which is actually on the list of possibilities.  Now I have to wait for the appointment with the hematologist for the real diagnosis.

I sent the lab results to Dr. A hoping he would have some insight.  He could not comment specifically on my labs, but it was reassuring to hear him say that many infertile women have clotting abnormalities which are usually treatable, and they go on to have normal pregnancies.  I really could have used that reassurance yesterday when I was convinced I have a horrible disease and will never have children—biological or adopted.  DH likes to call me his drama queen from time to time...  :)

So now we are taking a break from TTC until meeting with the hematologist.  As much as I want to find and fix the cause of our infertility ASAP, I am looking forward to this break.  Infertility is going to teach me patience whether I like it or not.