Meeting with the Hematologist

I went up to University Hospital today to meet with Dr. Anti-Coagulation, upon Dr. T's insistence. It was a pretty useless and uninformative consultation, and Dr. AC was sort of weird. He was weird in that way that my husband seems to love; in fact, he reminded me a lot of my PCP, Dr. A, who is also weird in a way that doesn't necessarily work for me, but that my husband loves. But at least he was not like OMG no way you can have this surgery! In fact, he seemed to think it was pretty stupid I was there, and that Dr. T was stupid for wanting me to be there. Overall, he was extremely snarky about pretty much everything and everyone, and seemed anxious to get home. That was actually good, because my appointment was at 4:00 and we had dinner reservations at 6:00, so it wouldn't have worked if he had been running late and had not been clearly anxious to get home. Traffic was really bad on the way up to UH, and it took us about an hour and 45 minutes to get there. We arrived around 3:55 and were called back so promptly I didn't have time to finish out the health questionnaire they gave me. I was trying to finish it during the pauses when Dr. AC was going through my records until he barked, 'Don't worry about that. I'm not going to read it!' LOL. There you go.

He did take a very thorough history, up to a point, and we talked about everything from my childhood nosebleeds to my tonsillectomy to my post-pregnancy bleeding to my recent DVT. We really didn't talk about cancer, though. I'm not sure if he was actually aware I have cancer. Seriously. Somehow we didn't really get that far, and I'm not sure how well he really read my history. I mentioned my two lumpectomies, but I'm not sure if he was listening. It is hard to describe his very quirky personality, but this illustrates it pretty well: In going through my history, he asked if I had ever had any bleeding problems during or after surgery or childbirth. I said no, though I did bleed a lot after my daughter was born, but that was because part of the placenta was stuck inside me. He replied, 'For real, or did someone just make that up?' I said no, for real. He said, 'Real as in you actually went into the operating room and had the placenta taken out?' I said yes, I definitely had surgery. Then he said, 'Okay, because you know, sometimes medical people just make things up.' HA! Then we got to the part about my hemoglobin E, and apparently somewhere along the line it got recorded as hemoglobin E/beta thalassemia. As he read it aloud, he looked at me, and I said, 'I do have hemoglobin E, but some medical person just made the beta thalassemia part up.' He thought that was hilarious. I told him it was so long ago that I was told I have hemoglobin E that I was starting to wonder if I had made it up, except I was pretty sure it was real because my son has it, too. That much I remember. In the end, he said having thalassemia wouldn't be out of the question, as it's a very common mutation, and, 'Since you're here, we'll run a test for you to be sure it's made up.'

He said he would run a number of tests on me, but they likely wouldn't be very helpful. He said that approximately 1 in 20 people have some sort of factor that makes them 'more likely' to develop blood clots, but that 1 in 20 people don't, in fact, develop blood clots. So whatever. Then he added, 'And besides, I don't know if you've seen these e-mails between me and your surgeon, but I asked her [sic] what she would do if you did have an elevated chance of a blood clot.' Which is exactly what I've been trying to get at! I mean, that's the important part, right? So I asked what Dr. T had said, and he read the response to me verbatim, 'I just want to be sure she doesn't develop another blood clot during surgery.' Then he rolled his eyes and made a comment about how this was such a typical wishy-washy doctor response. So he had replied to the e-mail, 'Yes, but what are you going to do?' And Dr. T had replied that he would do a 'less invasive' surgery. Which is exactly what I've been worried about! And exactly what he will not admit to me! Which is exactly what has been keeping me up all night, tossing and turning and wondering if I'm being wined and dined and if, after all of this, I will wake up with an implant on August 26th! ARGH! So I guess Dr. AC is at least sort of advocating for me, even if in a really bizarre and roundabout way. Like... what exactly does Dr. T want to hear? And what will he do if he doesn't hear what he wants to hear?

Eventually Dr. AC said he didn't see a reason to think I had a substantial risk above the usual risk, and hopefully all the blood tests would come back normal, in which case he would be fine recommending a low dose of prophylactic anticoagulant post-surgery. I asked him what his recommendation would be if the results weren't normal, and he shrugged and said he didn't really know. He said I could possibly do the surgery and be on a high dose of anticoagulant post-surgery, but that plastic surgeons were always worried about hemorrhaging 'messing up their work.' I said I didn't think I was as worried about thrombosis as Dr. T. I mentioned that he had read some obscure study about how people with hemoglobin E who had had their spleens removed were at higher risk for blood clots, which is why he was so worried. I said I had looked up the study, and the reason the people had their spleens removed was because they had hemoglobin E plus another mutation. Dr. AC snarkily congratulated Dr. T for reading journal articles - impressive for a plastic surgeon. LOL. He said spleens were, in fact, very important as far as blood clot formation goes, but my spleen was intact, so it wasn't really an issue. Which is exactly what I think!

Then he asked me, 'Since you've obviously read up on this and thought about it a lot, what worries you more? Hemorrhaging or thrombosis?' LOL. I said neither sounded great to me. I said I wasn't super worried about thrombosis because everyone seemed confident that my DVT was a result of my hip surgery and not a clotting disorder. He interrupted me to ask who 'everyone' was. Oncologists, I said. 'Oncologists?' he scoffed. 'What do they know?'

Did I mention that he IS an oncologist? I mean, it seems that almost all medical oncologists are board certified in oncology and hematology, but most are oncologists above all, and only hematologists insofar as it allows them to treat leukemia patients. Dr. AC is obviously a hematologist first, oncologist second, but it was still one of those comments that leaves you scratching your head. I said I didn't want to have to choose between hemorrhaging and thrombosis, and started to say, 'Isn't that why you make $400/hour?' but then changed my mind and said, 'Isn't that why I'm paying you? So you will tell me your opinion?' He laughed and said, 'Don't you know? The modern medical model is not that we tell people what to do; we collaborate with patients and give them information.' I don't like that model, I said. I'm tired of making decisions. I am old school.

So he said the potential clot formation would worry him more than the hemorrhage. 'I mean, you're not going to bleed out.' Then he said, 'What's the worst thing that could happen? You might have to have a mastectomy.' Huh? Newsflash - that's already happening. IS IT ME, OR IS EVERYONE AROUND ME CRAZY?! Finally I said I was fine taking an anticoagulant after the surgery, especially if that would make Dr. T feel better. Then my husband interjected, 'Yeah, I don't want his hands shaking when he's trying to reattach all those blood vessels.' LOL.

In the end, Dr. AC said, 'Now that I've been completely unhelpful, is there anything else you want to ask me?' So my husband jokingly said, 'Yeah, what's the traffic going to be like on the way home?' Then we made small talk for a few minutes. Earlier he had asked me about my job - noting that I taught at ABC College, and asking me what I taught. So then he asked me where I went to college and grad school. I said I went to college on the east coast and grad school on the west coast. I usually don't bother with the specific names of the schools because most people here haven't heard of them. But then he asked me, 'Do the schools have names?' HA! So I told him, and it was obvious he was familiar with them because he replied, 'So which one did you like better? Do you like cold weather with an air of elitist or warm and laid back?' I told him I was a definitely a cold and elitist person, much more than warm and laid back. He thought that was funny. Then my husband declared he was a proud graduate of a warm and laid back school, and somehow we started to talk about swimming and diving, and he and my husband started gossiping about some former executive director of USA Swimming.

I can't figure out if I loved the guy or if I think he is absolutely crazy cakes. Maybe a little of both. Either way, it doesn't matter, because I won't be seeing him again, I hope. So whatever. He definitely seemed willing to try to help me make the surgery a go, so that helps put my mind at ease. Like, he's definitely not in cahoots with Dr. T or anything. Overall, he seemed very reasonable, even if a little nuts.

The whole appointment took about 45 minutes. Afterward, he walked us to the blood draw lab and I sat there until 5:00 waiting to have blood taken. The phlebotomist was having a hard time getting blood from the woman ahead of me, and by the time she got to me, the cleaning lady was in the lab. Fortunately, I have good veins and the draw was fast. I probably should have said that I had already had some blood drawn by my PCP, only I wasn't sure exactly what tests either doctor had ordered, and I wanted to make sure that EVERYTHING that needs to get done by August 26th gets done, and figured duplications are better than leaving something out. Hopefully my insurance will pay for duplicate tests.

When we left, the clinic was shut down and everyone was gone. See? I was right. They were anxious to get us in and out. We left shortly after 5:00 and went and had a really nice but really insanely expensive dinner. (Thank you to my mom, who volunteered that we should have a nice dinner on our way home. Go mom!) When we got home, it was around 8:30, and we could hear my mom with the kids upstairs. We decided it would be easier if we just let her finish putting them to bed, so I came into the office to check my e-mail. Apparently the lab is open later than 5:00 because I had two test results back already! And the results make me very hopeful. The first result was just a standard CBC (complete blood count), but the second was a test for antithrombin III activity. Since antithrombin III inhibits coagulation, I should be worried about having a deficiency. Only I don't. Apparently the normal range is 72.0 - 125.0 U/dL and I was 91.0 U/dL, which I feel is safely smack dab in the middle of normal. Go me.

And so I continue to pray that this can happen and happen well.