31 Weeks and the HMO



Happy 31 weeks (3 days ago)
I made the poster this week, and it has a punctuation theme: the background has commas, which represent the paused waiting we’re engaged in, and the foreground has a 31 constructed of exclamation points to represent our excitement and celebration at each successive week’s passing.

Elizabeth is looking quite large at this point, and Little Cap’s kicks have changed in quality. Recently they became harder, and even more recently we have felt him simply pushing against her tummy for several seconds at a time. She has fun trying to guess whether its a foot or hand and seeing how he reacts when she pushes back.

Today I had the day off to make a doctor’s visit. Our general practitioner, Dr. Grant, sent me to a pulmonary specialist, Dr. Margolis. He listened to me breath and asked if I snore… he specializes in sleep disorders. For some reason, this fellow also supposedly knows about lupus anticoagulant, for which I tested positive in my last blood test. Despite what I have read on the internet and what Dr. Grant initially said, Dr. Margolis insists that the coumadin I’ve been taking does not interfere with the lupus results.

After telling me that it is rare for him to see this independent of some other disorder, such as lupus, he decided the best therapy would be to remain on coumadin (warfarin) indefinitely. I asked if repeated tests might be done to confirm my diagnosis. He replied that it might be worthwhile getting tested again after a few years – not what I had in mind at all.

While on coumadin one is supposed to be monitoring vitamin K intake because that changes the clotting level of the blood. This is hard to do because vitamin K is in a lot, such as spinach, mayonnaise, broccoli, eggs; it seems doctors recommend eating a steady diet, though recommendations have been contradictory between doctors. The other annoyance is that it isn’t supposed to be mixed with alcohol, though this specialist said one glass of wine wouldn’t hurt.

I now know that one huge downside of having and HMO is that there is no such thing as a patient pursued “second opinion.” If I want to ask another doctor to check me out properly for lupus anticoagulant, I need to either select another primary care doctor or pay out of pocket. Fortunately, we fully intend to switch primary care doctors as soon as the baby is born, and then I will request the new (old) doctor to reevaluate my condition. We really like Dr. Bowers in Hinsdale, and she makes the HMO life seem quite good.

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Even Denzel would approve!

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