Re: Lupus and pregnancy
From: Charlie Chambers (ricechaz@earthlink.net)
Sat Jun 24 18:11:04 2006
Sherri
I could not agree more that we are all in it for the right reasons. I
think you made your point quite eloquently. However, I don't see SLE
patients as low risk. Plus, we're talking an incredibly small number
of patients which leaves a large number of truly low risk patients to
provide care. I can't imagine a situation where a doctor in any area
would turn down referral of an OB with lupus. Unless you have some
credible evidence of homeopathics, herbs and diets affecting SLE
(there isn't any), I do believe that treating these patients with
such is a disservice. However, I can see that your motivations are
honorable, and appreciate you sharing your opinion in such a
professional manner that many M.D.'s cannot do.
We'll just have to agree to disagree. But I do agree that we are all
in it to have safe outcomes.
On Jun 24, 2006, at 2:57 PM, Sherri Holley wrote:
> I understand your points, and I share your concerns. I take this
> very serious like many other conditions that arise in preg that
> need to be much more vigulant (sp) about.
> Every client of mine has to read a 10 page complication/emergency
> packet that I developed, and I talk in everyone depth about how at
> any time during their preg/ birth that I will transfer care/ or
> transport to hosp anything that out of my scope. I do not lead
> anyone on.
> The women who have higher risks like Lupus, come to me because
> they want a chance of being normal, of trying alternatives to see
> if they can do something different, but if they get worse or are
> bad to begin with know that I will transfer their care in a heart
> beat.
> I transfer care to the Dr's in town often for things that are not
> for me to do.
> With many of these women who are different, they are required to
> see me wkly or every 2wks throughout their preg to keep closer tabs
> on them and monitor baby. I do order all the apropriate (sp)
> testing, If things are changing to the worse they will be
> transfered- I get them the appointments and often go with them to
> their new MD appointment to make sure they follow through.
>
> I run a very large birth center with many women who are quite
> poor, or quite rich. Where I live their are only 5-6 Obs, and 1
> Family practice MD doing births. They are up to their eyeballs in
> clients and have to turn down many clients. If a client does not
> have medicaid or insurance (that pays) the Docs won't see them. Our
> hosp has sent women who can't pay,away in labor. Some of these
> ladies have to travel 50 to 350 miles away to give birth. So
> sometimes if I have a woman with higher risks
> that cannot get into the Doctors, eithr I have to arrange for
> another town hosp to take them, or I if they are only moderate risk
> I will deliver them.
> I have great success with strict diets, some safe herbs or
> homeopathics, most of my clients are very good about doing what is
> recommened by me to keep themselves in a healthy condition to stay
> as my clients.
>
> I try to not take unnecessary risks. But my training has taught me
> to be prepared always, because you never know what will fall in
> your lap !
> I have delivered over 1,500 babies in my career, and I have all
> sorts of situations that I have had to deal with like most of you
> have. Never lost mom or baby. But I know it may happen.
> I have to say I have been on this list for over 9 yrs, commenting
> occasionally. I love to see you and others ask each other for advise.
> I have gotten to know many of the personalities. I know Midwives and
> Drs. don't always agree, or think each other 's point of view are
> quite strange. Like mixing polar bears and moose- they don't ofter
> agree.
> But I hope all of us can agree that we are all in it to have safe
> outcomes.
>
> Sherri Holley LM, CPM
>> ----- Original Message -----
> From: Charlie Chambers
> To: Multiple recipients of list OB-GYN-L
> Sent: Saturday, June 24, 2006 10:41 AM
> Subject: Re: Lupus and pregnancy
>
> I believe it to be imprudent for a pregnant patient with lupus to
> cared for without a physician involved in care. Sure, a number of
> Lupus patients can get through a pregnancy without any
> complications. But, a patient with Lupus can go from stable to
> critically ill over a very short interval of time. Someone else
> wiser than me on this list made the analogy before that just
> because you can get across the street blindfolded without getting
> hit, doesn't make it prudent to continue to do so. Why take an
> unnecessary risk?
>
> On Jun 23, 2006, at 9:32 PM, Sherri Holley wrote:
>
>> I am a LM w/ 27 yrs in practice (formerly of Alaska)
>> I have had Lupus since 15 yr old-now 50yrs. I had 2 pregnancies/
>> births.
>> 1st preg- totally normal except severe hyperemisis & I went very
>> overdates- Had a home birth.
>> 2nd child born 12 yrs later- had preterm complications, bed rest
>> for 5 1/2 months. Went to Swedish Hsp, in Seattle several times I
>> was also in much pain in bones and muscles. Was put on Terb. for
>> Preterm then Penobarbital (to control the tachy in me) Was also
>> treated by an ND. I had him at home on his due date. Baby fine, I
>> went into a huge flair @ 6 wks postpartum however. The 27 yr old
>> son (1st) has Lupus w/ severe Bipolar. 16yr old (2nd) has Bipolar
>> with some slight immune problems.
>> I due take non severe lupus in preg clients and have found that
>> many of the natural remedies support these women, dier is
>> extremely important and in some cases add baby aspirin. I do
>> monitor them toxemia, preterm and kidney problems. I do do more
>> prenatals on them, to keep closer tabs on them with emphisis (sp)
>> on keeping them feeling non high risk.
>> I have had very good success one the more than 25 cases. ( always
>> explain in depth the risk and chance of hospitalization) I think I
>> have good outcomes also be case I know personally what its like.
>>> ----- Original Message -----
>> From: Elrod, Darryl G Maj 48 MDOS/SGOBO
>> To: Multiple recipients of list OB-GYN-L
>> Sent: Wednesday, June 21, 2006 2:21 AM
>> Subject: Lupus and pregnancy
>>
>> I am seeing a 26 yo G2P1 with a known diagnosis of SLE. She
>> recently had some bloodwork done that showed a positive lupus
>> anticoagulant. She had previously been negative for LAC. She now
>> is pregnant at about 5 weeks.
>>
>> She has no prior poor obstetrical outcomes, no prior history of
>> DVT nor family history of DVT.
>>
>> Would you
>>
>> a) do nothing and observe
>>
>> b) start baby aspirin
>>
>> c) start baby aspirin and heparin
>>
>> Thanks,
>>
>> Glen
>>
>> //SIGNED//
>>
>> D. Glen Elrod, Maj., USAF, MC
>>
>> Obstetrician/Gynecologist
>>
>> Chief of Obstetrics
>>
>> 48 MDOS/SGOBO
>>
>> RAF Lakenheath, England
>>
>> Telephone DSN: 314-226-8130
>>
>> Comm: +44 (0) 1638 52 8130
>>
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>
> **********************************************************************
> ******
> Charlie Chambers
> Hood River, OR
> cchamber@alumni.rice.edu
>
> "Almost anything you do will seem insignificant but it is very
> important
> that you do it....You must be the change you wish to see in the world"
> -- Mahatma Ghandi.
> **********************************************************************
> *********
>
>
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*
Charlie Chambers
--
Hood River, OR
cchamber@alumni.rice.edu
"No matter where you go...
there you are."
Dr. Buckaroo Banzai
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