First OB Appt

Today, I had my very first prenatal appointment with a wonderful OB named Dr. Yoder Katsuki. She was the OB my high risk GYN recommended. She went down my list of health conditions, and my medications and told me what to start taking and what to not stop taking. She than scheduled the dating ultrasound, and referred to MFM. She and MFM would co-manage me. We also got to see baby peanut today for the first time. I cried! Cannot wait for my dating ultrasound!

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A closer look at baby, at 6 weeks; This ultrasound photo was very emotional for me to take, because last year on 11/4/2015; we were told we were miscarrying our son, Avery Matthew, and there were no fetal poles, and the sac hadn't increased and there was no heartbeat. This ultrasound overjoyed me, but filled me with emotions, because not only was there a teeny tiny baby there, but you could see electrical activity, which would develop into a forming heartbeat in the coming weeks. It was re-assuring, that baby was here to stay. It was also discouraging slightly, because babies CRL measured 6 weeks and 1 day, when baby should have been 7 weeks and 4 days, but my OB told me that at this early, its hard to tell, and they would order another ultrasound for proper dating.

Lovonox Injections....


Today... I started my Lovonox Injections, of 40mg in the AM and 40mg in the PM; These prevent me from clotting early on, and keep the baby in utero, and prevent early losses. I also was started on Progesterone in Oil Injections again, which would do the job of the placenta until it could take over. Many woman with PCOS have low progesterone levels, and so when they become pregnant, their body cannot hold the baby and continue to have it develop, so they have early miscarriages; This is one of the pieces of what kept happening to me.

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We're Having A Baby!

I know... shocked? I know I was...

Most of you know, but for those who don't and may just be following this blog, it has been a rough journey and a rough road of infertility. 

In five years of wanting a second child, and having gone through a few relationships, one which ended after seeking a fertility specialist out to have children, I pretty much gave up.
In that five years; I've had: Multiple Recurrent Pregnancy Losses which include 7 first trimester losses, and 2 second trimester losses at 14 weeks which required D&Cs, and a stillborn at 20 weeks who had HLHS and was the result of a placental abruption and clots in the cord. I also had 1 chemical pregnancy. This pregnancy makes pregnancy 13.

I've gone through multiple ultrasounds, 2 Saline Infusion Sonograms, 2 Hysterosalpinograms to clear my tubes and check for uterine abnormalities, 2 Endometriosis Surgeries, 1 of which was out of state in Atlanta, GA by the worldwide renowned surgeon Dr. Sinervo (See previous blog posts from 2015)

I've gone through 3 cycles of Clomid and 3 cycles of Femara (which I never want to go through again; they made me into a crazy raving bitch and I didn't ovulate at all on them) 2 Cycles of Gonal-F (Injectibles of FSH; Basically, this is to help healthy ovaries develop (mature) and release an egg or
cause your ovaries to make multiple (more than 1) eggs) 

I've gone through Genetic Thrombophilia Testing and Genetic Karyotype Testing, I've gone through removal of pre-cancer cells and uterine fibroids, and gone through inducing my cycles every 90 days with Provera AND I've been told that I needed IVF and it would never happen naturally. 



The original plan was as follows: Become a patient of Dr. Bravermans in NYC (who is a worldwide renowned reproductive immunologist, there are only 3 in the US, one in California, one in Chicago, which is Dr. KK and then Braverman) 

So I would become a patient under his immune protocol. Pay 3,000 out of pocket for a full immune panel to be ran, of which insurance would give me back 1350, and that could go towards my treatments which would likely include Nupogen, IVIG or some other immune protocol that he places his patients on, with an understanding of their complex immune system and he would monitor and treat me with the help of my OBGYN/REI. 

I would go through immune treatment recommended by Braverman, complete the requirements for Bariatric Weight Loss Surgery, go through getting the Gastric Sleeve, get the Mirena IUD for 18mos, and than in 18mos, when Matt and I wanted to try for a child, we would go through IVF once my immune system is optimized through Bravermans Protocol for Immunity Related Issues...


After talking about it with a few friends, I had basically agreed that after severe pain during each cycle, likely caused from Adenomyosis and Possible Regrowth of Endometriosis (though the first is more likely than the latter) that I would go through the process to get approved for a Mirena IUD to allow my system to cool down for a few years until I was in a stable relationship and ready to actively try. 

I also agreed that the IUD was the best option for me, because I was also a patient with Cleveland Clinic's bariatric weight loss program, and the requirement post surgery is that you do not get pregnant for 18 months post-op.

I know... I know... me and birth control don't get along... but this was something well thought out... I promise... 


So... I went to my hematology consult, and they approved the Mirena IUD; I went to my consult with OBGYN to talk about birth control/IUD and they approved me as a candidate for the Mirena IUD (it was the Mirena or Skyla, but Mirena shows more potential in Endo/Adeno cases) and I had that Mirena IUD insertion scheduled to be inserted;

Fortunately/Unfortunately, that did not happen, and God had other plans in mind for us, and intended on providing me with a miracle child, I just didn't know it yet.
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I had sex on my birthday on 9/26/2016 with Matt; I was day 65 into my provera cycle and knew that it was highly unlikely to ovulate that far into a cycle, so I had unprotected sex. Even though OB has my last period date of 9/8 this is not accurate; I was spotting on 9/8, and never had a full bleed; I constantly spot in between cycles for no known reason.

On 9/28/2016, because I was still having bleeding and spotting all month long, in between cycles, they decided they wanted to do a routine ultrasound on me. The technician wrote in her notes "one dominant follicle from right ovary" which meant that I likely ovulated that month, though they were not 100% sure and couldn't confirm this. She also noted in her notes on the ultrasound that I had a "hyperechoic nodule" and a "dermoid cyst" that remained unchanged from previous imaging. 
I didn't think anything of it at this point, and my OBGYN, Dr. Raymond continued to push me to consider hormonal treatment of some kind, preferably the Mirena IUD to manage my symptoms for a bit. I told her I would have to think about this.

About two to three weeks later, my period was late (again) and I was having severe heartburn and nausea which I had seen the doctor on October 4th for, and she told me that it was simply my GERD acting up and to get plywood and elevate my head while I sleep, but this heartburn and nausea was not going away; 

Because my cycle was late and I was right at the 90 day mark, I knew this meant I needed to go get a test and take it and because I was having severe nausea and heartburn already, I decided I'd better be safe than sorry and before I take provera to induce a cycle, test. 

The reason behind this is because if you take provera when you are pregnant, it will induce a bleed, and essentially, you'll have a very early miscarriage, so they ALWAYS tell you to use best judgement and test before picking up the medication
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To my surprise, I tested Positive on 10/26/2016 with a blue dye test. At first I thought, OMG, this cannot be positive; Perhaps its an evap line, or a faulty test, because I had read previously that blue dye tests were inaccurate, and often yielded false positives. 


I texted Matt, and was like "um...." and he knew what I was going to say but was at dinner with his father at that moment in time for his upcoming birthday, and he was as shocked as I was. I wanted to be 100% sure that I was not seeing things. I couldn't believe it, and didn't want to believe it. So right away, I messaged a few friends I could trust.

Jennifer Harmon and Nicole Fazio were the two I messaged, freaking out, asking if the test was positive and sending different angles. I was freaking out, because I was on medications that could, at the time seriously affect outcome of pregnancy; 

So right away, I stopped ALL my medications. Some of these included Methotrexate and Depakote, which treated my migraines and my lupus. (Never ever do this; not advisable. I got very sick, very fast, and the withdrawals were the worse) 

They both confirmed that it was indeed positive, from all angles; I than told Jessica Fuller next; and finally after some time, told Maryjo Hays, Tina (from cheer-leading) and my photographer friend, Bobbi Frohman.

So right away, I contacted my OB who scheduled the Mirena to be put in, and asked her to please put an order in for a Beta HCG. I was seeing a woman named Danielle Whein who took over for my OBGYN, Dr Raymond, because Dr. Raymond moved to Twinsburg office.

On 10/27/2016, A Thursday, I went in and had my Beta HCG Drawn. On the morning of 10/28/2016, It was confirmed. I was definitely pregnant, and was approx. 6 weeks along. I was still very early, but she scheduled an ultrasound anyway, to confirm that there was a sac and a baby developing there.
Definitely Pregnant!


So next, we have the viability ultrasound. I'll update from there!

Hiatus...

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The image says it all.
After everything that has happened with losing Avery and my relationship, I need time to regroup my thoughts and focus on myself, my relationship, my health, and my daughter and getting healthy. So, for now, I'm taking a blogger Hiatus, but I'll be back... sometime... just don't know when.

Avery Matthew....

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To Our Surprise, I ended up falling pregnant. 
We didn't expect it to happen that quickly after my surgery for Endometriosis...
We weren't even really trying...

We found out about you on 10/19/2015.
You were a big surprise to us. But we were happy.
We lost you at 7 weeks on 11/5/2015.

There was no heartbeat. No fetal poles. There was nothing.
Bleeding was the reason I went into the OB.
We didn't expect that news from Dr. Kalan.

On 11/8/2015, the hardest part (which is always the hardest part of losing the baby in my opinion) happened. I passed the sac. It was a bubble like feeling, and probably the weirdest sensation. I was just happy I didn't need a D&C. 

It was that day, we decided to name you Avery Matthew. We felt that you were a boy.
It was probably one of the hardest things we've gone through as a young couple.
We felt alone, isolated, depressed.
But you WERE and ARE loved and missed.

So ... I wrote this poem in your honor...

Dedicated To My Son...
Avery Matthew Blau...

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So quickly you came into our lives,
So quickly torn away. 
Never got the chance to meet you,
There's so much I want to say.
Where there once was joy and happiness,
Is now sadness, guilt, and pain.
All these thoughts running through my head,
It's enough to drive me insane.
Though you lived only seven short weeks,
You were loved so very much. 
I wish that I could hold you,
I long to feel your touch.
On that night of November 5th
My world was ripped from under my feet.
I pray that in another life,
We get the chance to meet.
We love you so very much son.
Rest Easy...


(Some of you have asked how Matt is handling things; To be honest, I don't really know, because it is his first child... he seems to isolate himself, be alone and depressed, so I'm not too sure what will happen. Time will tell...)

I Owe My Life to a Doctor....

I owe my life to a doctor, an amazing doctor, and I wanted to share a bit of that journey with you.

A little bit under a month ago on August 9th, I left my last day of work with several feelings. The next day, which would be August 10th, my boyfriend and I started our trip on the long journey from Cleveland, OH to Atlanta, GA via Greyhound. That day, I left for one of the most nerve-wracking endeavors in my life. In fact, if you ask my boyfriend, he will tell you that during the morning of the 10th, I broke down, with anxiety, and had a full-on panic attack because I was so nervous. With the Lord in my heart, and in my mind, guiding me, after much prayer, my journey to become officially endometriosis free had began.

I was blessed to have been able to travel to Atlanta, GA to meet with one of the best of the best, a worldwide renowned excision surgeon by the name of Kenny Sinervo. The hope, that he would give me my life back.

To give you a bit of history: In October 2014, I underwent a laparoscopy to remove, or excise my endometriosis. Unfortunately, the surgeon who performed that surgery was not a skilled excision surgeon, and missed a large amount of endometriosis, and also misdiagnosed my staging.

Many woman with Endometriosis have to live with their pain lifelong, or they suffer. Many woman undergo surgery after surgery with surgeons who are not excision specialists. Many people asked me why Atlanta, and the reason? This doctor could fix me, or that was the hope...

And so our trip began. The day of the 11th was filled with meeting with Dr S. and his wonderful staff at the CEC, and of course, having an ultrasound done, and a pelvic exam done which showed I had moderate to severe pelvic floor dysfunction(which I will be doing PT for as soon as I am cleared by my PCP) lab work done, and the whole routine stuff like meeting with anesthesia, and registering at the hospital for my stay.

That night, I had to have my bowel prep, and let me tell you, I will never drink Gatorade again. Yuck! My poor boyfriend had to force me to drink the Miralax stuff. Before long, I was feeling the results. It seemed like between nerves, and the bowel prep, I was not getting much comfortable sleep that night.

And so, as nervous as we were, we went to the hospital, checked in, and by my side he stayed the entire time. I had previously heard wonderful things about Dr S. I had read and had been told that he would hold your hand until you go to sleep, and that he would pray with you. And he did both! It definitely relaxed me! There are not many doctors who do that, and he did! It felt comforting to know that God was with me during my surgery.

90 minutes seemed like forever to my poor boyfriend, who was waiting updates via pager. While they were in there, they removed my appendix, which was twisted, and inflamed, and all around bad. They got rid of my endometriosis (which was Stage 2) and they took great care of me.

Unfortunately, during the surgery, they confirmed that I have adenomyosis. Adenomyosis, is a condition that is a painful condition of the uterus, which the only cure for is a hysterectomy. So in 1-2 years, I will have a hysterectomy. But he also saved my life. While he was in there, he removed my bad appendix, which was all twisted, and just all around bad looking, and he performed a PSN, or presacral neurectomy, which I believe is the largest benefit, to pain management to pelvic pain sufferers for medical conditions, because thats it. I am PAIN FREE! (with the exception of hormonal migraines, and occasional back pain) but my quality of life has improved significantly~!

I don't really remember too much of the first and second day of the hospital, other than the fact that I was on IV Fluids, given injections of torodol, had to blow into this Pulmonary thingy, and was on a Dilaudid PCA Pump. I think I slept most of it off, but by the end of my second day in the hospital, as hard as it was, I was up, walking laps around the hospital, which was nice.

We were blessed to have spent days 3-6 in Atlanta with someone who is my second mother. I love that woman dearly, and she cares for me, my boyfriend and six year old dearly. It was a blessing to spend time with her, and enjoy her company. It really helped cheer me up.

Post-Op, I was given Perocet. I had a rough battle with it at first, but then realized, I am not really in a lot of pain, and by 11 days post-op, I did not need it at all.

14 days post-op, I followed up with my OB/GYN as directed and she, while an amazing doctor, is not really educated in Endometriosis. She had said some concerning things to me, like that all that was done was a "deep cleaning out" and that the Endo would grow back. Concerned, naturally, I ended up e-mailing my doctor and surgeon and asking him if I would end up having to re-go through surgery and discussing my concerns with him.

Most normal doctors would not write back. Most normal doctors are too "busy" to care about their patients after they are out of their care. Most normal doctors dismiss their patients concern. Not this one. He responded, with a long e-mail addressing my concerns and re-assuring me. I just wanted to take a moment and give a huge shout out to Dr. Sinervo, in Atlanta, GA because not only did he reach out to me, addressing all my concerns, via e-mail, but he re-assured me, and he cared. He took the time to care about me, and not a lot of doctors do this.





Dr S gave me my life back. Since 11 Days Post Op, I have not touched a pain pill. I used to pop pain meds like they were candy. Torodol. Topamax. Percocet. Valium. Dilaudid. Tylenol. Aspirin. Aleive/Naproxen/Naprosyn, Butalbital, Oxycodone, Neurotin, Vicoden, Celebrex, Demerol, LorTab, Fentanyl, Morphine, Keterolac, Advil, and unfortunately, so much more. These are just the small amounts of pain meds, both over the counter, prescribed and narcotics that were used in the past two years of dealing with my Endometriosis flare ups. I haven't touched them. Not one, in nearly one month. I've been pain free, with the exception of a hormonal migraine, which I get each month during my cycles, which is easily resolved with Fioricet, and Flexeril, I've been pain free. PAIN FREE. and I owe it all to the Center for Endometriosis Care, and Dr. S. and his wonderful staff. He gave me my life back!

If you are an Endometriosis Sufferer, please consider a FREE consult with the Center for Endometriosis Care in Atlanta, GA where they will review your records and go over your options with you! Dr. Sinervo gave me my life back. The life that I lived chronic pain with, and popped pills. I thought that was going to be the rest of my life, but Dr. S gave my life back to me, and I promise you, the CEC can help you too!

Insurance... Insurance... Insurance...

 

Bills, Bills, Bills... Right?
What would one expect after having three major procedures performed during surgery.


I just want to take the time to say how very blessed I am for my work insurance, but holy jesus, is medical care over priced in America!

I am so grateful that I have such spectacular coverage through United Health Care and that they are covering the majority of my health care costs, otherwise I would be BROKE and IN DEBT for the majority of my life!


Before I give the breakdown of what my total surgery costs were, and who covered what I just want to make it known what my coverage is:

I pay $70.00 a month for United Health Care for their Choice Plus, Apple Plus Health Plan.
I also pay $106.70 a month through Medicare/Tricare which is my monthly premium, and that covers me for Medicare A, B and D. 
 UHC is my primary. Medicare/Tricare is my secondary.
The way that it works is they bill UHC through my work first, and then whatever is not covered they bill Medicare/Tricare.

Through Medicare/Tricare because I live in the state of Ohio, Anyone who is eligible for disability due to health issues, or prior service military or qualified through the US Government as a Disabled Veteran automatically gets Medicaid as well. 

In the state of Ohio, they combine Medicare/Tricare and Medicaid into one plan. That means if you are eligible for any Medicaid Plans at all, and you have any Medicare plan, whether just Medicare or you are apart of your disability, or like me, Medicare/Tricare, than effective February 2015, you were automatically enrolled in MyCare Ohio, who manages both your plans.

So essentially, I have three coverages. But realistically, for billing, only have two.
I have UHC, and then I have MyCare Ohio. MyCare Ohio manages my disability Medicaid and my Medicare/Tricare coverage.


Next Step... Claims...

So basically, one would wonder what surgery costs me through my really good coverage through UHC and Medicare through Northside Hospital and Dr Sinervo at the Center for Endometriosis Care.

I'll give a breakdown:

Northside Hospital:



Here, you see that my deductible for IN NETWORK is $300.00 and my OUT OF NETWORK is $600.00 of which I have $300.00 remaining to pay. You also see that my OUT OF POCKET MAXIMUM is $4,000.00. What does all this mean?

Well, if you go through an IN NETWORK provider, before they cover you 100% for care, you have to meet a $300.00 deductible, and then they cover you 100%. the same goes for OUT OF NETWORK except it is $600.00

The $4,000 out of pocket maximum also means that the most I would pay out of pocket is $4,000 for medical expenses. As you can see, I've already paid $540.00 this year. Typically this accounts for prescription RX, copays, and deductibles as well as medical bills.

Northside Hospital is IN NETWORK. 

When Northside Hospital billed, they billed $33,488.50 which broke down to the following:


And So I login to MyUHC Portal to see what all was covered:


My UHC Insurance covered ALL but $300.00 towards my two day hospital stay.

I would typically owe $500.00 which would include a $200.00 inpatient admission charge, but it appears that MyCare Ohio, which is my Medicare/Tricare coverage covered the $200.00 inpatient admission charge, leaving me my $300.00 deductible to pay. Not bad at all. I'd much rather pay $300.00 over $33,488.50 any day.

Center for Endometriosis Care / Dr Sinervo

As previously stated, the CEC is OUT OF NETWORK
So how exactly does this work?

Well, today, I spoke to Dr Sinervo's biller.
She said as follows:
The max that they bill for insurance is $16,700. That is the total cost of my surgery. 
She explained that my maximum that I could possibly owe is $10,000, and that they would write off the $6,700.00 and that my insurance will cover 70% of the $10,000. 
So I could only possibly owe them $3,000 from insurance to the CEC.

Thats not accounting for the $700.00 credit I will have, so technically, I will only owe them 2300.00.

Realization:
That seriously is not bad at all, considering the total cost, in network and out of network for my surgery was $16,700 + $33,488.50 totaling $50,188.50  of which I only get stuck paying $2300.00 for since I've already paid $1000.00 to the CEC, which includes a $600.00 deductible ($300 of which I am left to pay, so I have a $300 credit, plus the remaining $400.00)

REAL REALIZATION
The Cost of Healthcare is INSANELY EXPENSIVE in the US! 

So thats pretty much it.