Not In Love but… Willing to Put One Foot in Front of the Other

We had our first telephone consult with the infamous Dr. Braverman today.  And it went… okay.

We waited 40 minutes past our appointment time.  And despite being told that I had to complete his 14-page questionnaire, he had neither received it (I was told it went directly to him for privacy reasons) nor read it. If I had not known this doctor practiced in NY, I would have been annoyed by this point.  Instead, the LP and I just exchanged eye rolls at opportune moments during the teleconference and at one point I wrote down “NYer” on my notepad and the LP nodded and rolled his eyes.

At the end of the call he had promised to transfer us to someone who would confirm that the person who collects the blood samples for the immunological testing is in his lab next week Thursday for our appointment.  Instead, he hung up hastily after saying he needed to take another call.  Oops.  No big deal, I called back and confirmed (for a second time) that all was in place.  I’ve read many complaints about the staff at this clinic but so far apart from a long wait to have my initial calls returned, the staff I’ve dealt with have been very helpful and mostly attentive.

The jury is still out on Dr. Braverman, but I went into this knowing I do not need to like this man, I just need to see if I can trust him.  Unlike many of the wonderful women I have encountered online who are [now pregnant  or with living children despite immune issues and RPL histories not unlike my own] patients or former patients of Dr. B, I cannot say I am in love.  At least not yet.  I am skeptical that I ever will be.  I think the cynicism that came from having defended doctors when they got into legal troubles and from being onto our third reproductive specialist, 100% out-of-pocket, in 18 months might make me a “tough customer” as the kids on Arthur would say (I never watched that show before I had the MT, who has it downloaded on an iPad… yes, I let my toddler watch tv shows on an iPad. Sue me.).

Enough mockery and negativity.  On to what was said.

First, Dr. B. thinks I have “an implantation problem” (not because he read the 14 pages of history that it took me two and a half hours to complete, but because I can now, in my vast experience yapping with specialists, narrow the essential evidence down to a very short synopsis and some key facts). Okay, I mean it this time, enough negativity about him being completely unprepared to talk with us today.

Second, Dr. B does not think much of the high IgE levels other than to say I may have hyper-IgE syndrome which involves an excessive histamine release, which can lead to implantation problems.  He agreed when I said it’s hard to know whether there is a causal connection or a correlation.  He said that women need some histamine to permit implantation but too much can be a problem.  Unfortunately, there is no way to test for histamine (???).  He also said we can use stronger drugs than steroids (???). He kind of meandered after this and mentioned two types of immune issues, being TH2 or antibody-based and TH1 or cellular-based, and suggested that hyper-IgE would suggest the former.

Third, he affirmed my decision not to do any more embryo transfers until we have a diagnosis. In his view without a diagnosis you’re basically guessing and cannot make a meaningful prognosis or effective plan (my words, not his).

I’m not sure that is true for anyone who does not have some kind of immune issue happening.  I don’t even know if my issues are immunological or just look that way, by which I mean I’m not sure which is the chicken and which is the egg or if they are apples and oranges and just seem to both look like pears at the moment.  I’m not sure I’m convinced that all of the immunological testing he will have us do is of real value.  But I am doing it.  One foot in front of the other.  There is something to be learned here and learning is what Azulito has sent me forth to do.  So do it I shall.

Fourth, the plan is to do all of the testing he prescribes, plan a protocol, do my next FET at his clinic and hope for  a positive outcome.  If that happens the next plan is either for me to find an ObGyn in my city who will work with me to have monitoring and/or prescribing done (that, I can safely say, is not going to be easy and may prove impossible) or for me to return to New York at 6 weeks and 10 weeks so he can do my monitoring and prescribe me meds accordingly (New York state law requires patients be physically present for Dr. B. to write them scripts).

So much for my retirement plan.  Oh yeah, what retirement plan?

Finally, I asked about what blood tests I might ask my doctor to do here.  He suggested fasting glucose, fasting insulin and hemoglobin C.  In addition to that my TCM/Acupuncturist suggested I ask my doctor to test my liver enzyme levels (ALT and CRP) and Parasite testing.  As an aside, she also suggested I consider stopping the Singulair.  I did.  No more dizziness – yay!  It wasn’t doing anything as far as I could tell anyway and never did last time I was prescribed it, either.

All in all, I do not care if the LP and I are not enamoured with Dr. Braverman as many other patients are.  And I am sure he would  not give it a nanosecond’s thought (nor should he).  If he can help us get and stay pregnant, I will pledge allegiance.  And say only nice things.  I promise.

Okay, I may still make the odd crack about him being very much a New Yorker.  Who can resist? (I apologize to all of you New Yorkers, some of whom I am deeply fond.  I say all of this affectionately, as does the LP.  You can poke fun at me in return.  Go on, ask me to say “about” and then snicker at how you think it sounds as though I am talking about a small sea vessel.)


13 thoughts on “Not In Love but… Willing to Put One Foot in Front of the Other

  1. Thanks for sharing the synopsis of your consult. I love the approach you are taking and for whatever its worth, I think its awesome that you are able to see this as a necessary step, regardless of your emotional connection with the Dr. One step at a time and one day at a time.
    Keep us posted on how the actual in-person appointment goes. I am so hopeful that you are taking comfort in knowing that you are trying to get to the bottom of this, even if the doctor is not the ideal personality. 🙂

    • Thank you. To be fair, his personality seems genuine, it’s maybe just not ideal for me but frankly he could be Mother Teresa and I would likely be distant and aloof given what has happened recently. Our eye rolling was because he’s distracted, busy and has a weird sense of humour perhaps. He’s a perfect fit for lots of other women, so I would take my impression with a grain of salt, in fairness. About the humour – he made a joke I omitted on the synopsis because it threw me for a loop. It was about wait times. He said he’s aware they’re very long in Canada and that he heard of a woman who wanted to terminate her pregnancy and the first available appointment was in 9 months. I was talking about my 10-week miscarriage and how they didn’t send my tissue for testing despite saying they would (or the lab never tested it, it’s vanished into thin air). Neither of us laughed and he had to say “that was a joke”. I felt scolded and a little stupid. Can you say awkward? Ha ha!

  2. I really appreciate the one step at a time approach even when you are thousands of steps in. Hoping your time with Dr. NYer will lead to some solid insights and new data. Pledge away but PLEASE do not promise to only say nice things!!!!! You’ll need all of your whit, humor and honesty with this. Upside here is time in NYC – retirement is overrated anyway!!!

    • Thank you – it’s so great to hear from you!! I actually have a lot of confidence in Dr. NYer’s approach even if I’m not 100% certain of the science behind it (in short: his crap seems to work a lot of the time so either he’s got some serious voodoo magic or he’s building a science that in years to come others will acknowledge and adopt as legitimate… or something in between) despite my protests about what the LP described as his “flippant” demeanor on today’s call. But I need to be going in eyes open and heart shut here. The time for me blindly believing what these experts say has come and gone with my health crappier and my womb empty. It’s mercenary time!

      And you’re right, what would I do in retirement anyway? I’m sure I’d be over-committed to all kinds of unpaid work or I’d go bonkers.

  3. I’m so happy this doc wants to complete more testing before moving forward with another transfer. The more information you have the better, and test results are obviously information. I look forward to hearing the outcome of your tests and next cycle.

    • Thank you, Stef. I agree, more information when things are not working is important. It’s hard to have faith in the suggestion to just keep bashing one’s head against a wall without it.

  4. Nothing irks me more than when Doctor’s seem “too busy” for you. I hope you can find someone locally. Have you considered asking Dr. H at my clinic? At least to prescribe?

    • I have considered this and actually started an email to you about it but then I changed my mind. Doctors don’t like to Rx if you are not their patient (my plan was to have Dr. H do all my monitoring before the FET and then after). But if I’m going to travel there, I may as well travel to NY because, as you know, the flights within a country in which you only have two choices of airline cost about the same as flights to NY if you book in advance. And because I don’t want to transfer my embies across the border, I’ve heard a horror story about that and I just dont’ need any more horror stories. As for prescribing, I’m going to call my ObGyn today and see if they’ll get me in sometime before January 2015. No, I’m not joking about that wait time. If it’s only 3 trips to NY, I can live with that. I’ll be broke and I might complain and no one is getting anything for Christmas, but I will live. Heck, if I can make it to 10 weeks and beyond, I won’t even care how far in debt I am by that point.

      My first RE seemed too busy for me about 89% of the time after our initial consult way back when, too. I think it’s an industry problem. And in some ways I’m glad because he’s helping me practice my devotion to my intuition and avoid getting sucked in by the snake oil routine. 😉

    • Update: I’ve changed my mind thanks to finding out that the costs of initial testing through Reprosource (the lab Braverman uses) could exceed $5,000. I’ve sent a note to ask for a consult with Dr. H and I’m going to ask my GP for a referral to him when I see her Tuesday. I’m still worried about embies crossing the border but I’d like to hear what Dr. H has to say about our situation, regardless of whether we go ahead next week in flying to NY (which will depend on how much the testing is going to cost – waiting on return calls about that). I hate this journey and it’s hard right now not to hate my body for being so messed up and mysterious. 😦

      Thanks for your support.

      • Hope you get everything figured in a timely matter. I know how frustrating limbo land can be. I know it will all work out and you will go and see who you are meant to though. Looking forward to hearing more!

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