Saturday, July 6, 2013

What's next?

Not really sure at this point...we will have to wait and see what Wed's levels are at....
I did however correspond with my Local RE about all of this...Here is our messages from the portal. I am too tired to paraphrase....So this is the Jist of us hashing out what to do next...

ME:
so I talked to Greta (my nurse) about the HCG levels today. they did go up some.....I know they should drop on the 7th day past metho...I know my baseline is under one normally, as I have had several HCG draws showing my level normally is less than one, for a baseline... so I am not sure what good doing a qualitative urine test is going to do, since they have a threshold of 25( they wanted me to do a urine and blood test on wed)..Thats pretty much a waste of money for me to get charge 150 bucks for a urine test at the lab...
Also, seeing how I had such adverse reactions from the last methotrexate shot, I would prefer NOT to do that again, even if it does continue to rise...so what are the other options? I am still experiencing some nasty pain on the right, and cramping constantly in the pelvic area....I am concerned about infection inside considering the pain and cramping.


RE:
I agree, I'm not wild about another methotrexate shot either. I know the urine pregnancy tests aren't very responsive under 25, but it's strange to see your levels drop so nicely, then hit a floor at a frustrating 10.then rise again... The real motivation behind the simultaneous urine/serum test is to go fishing for "phantom hCG syndrome." With that, your body is reacting to the reagents in the test kit to cause the persistent low positive reaction, rather than the test detecting the hormone it's looking for. That situation is rather rare, but if anyone is going to have a bizarre plot twist, it's probably going to be you. (No offense is meant, just Murphy's Law at work.)

How about this: let's check only bloodwork next time. If the levels go down, we're good. If the levels go up, then maybe it's worth a home urine pregnancy test. If the levels are the same, check again in a week. If the levels go up, check a urine test and keep watching, waiting for surgical intervention.

I can't plot out how this is going to go, but I agree--I don't think we'll use methotrexate again for this pregnancy, and I'm not wild about using it for future losses. But that's another story for another time.


MY reply:
Ok that sounds reasonable. I did a home pregnancy test today (first response brand) and I am still testing positive, so I don't think it is the other issue. here is hoping things are going down on wed

RE:
Your urine home pregnancy test is positive? Good, I can stop pondering phantom hCG syndrome. At this point, removing methotrexate from the arsenal, leaves waiting or surgery. (And I'd pick waiting over surgery.) Surgery could be a D+C at its simplest, hoping to knock out some last vestige of cells, or a laparoscopy, hoping to find and remove placental tissue outside your uterus. 

Let's wait for now, and keep checking hCG. If it climbs up impressively again, we may need surgery.

Dr. Grossman

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