mfm consult

This morning, I had a consult with the Maternal Fetal Medicine doctor at VCU.  This was one of the constraints that Dr. Nair set forth for us due to my history and obesity.  No big deal - I was followed by one during my two pregnancies and it really just means more ultrasounds and extra monitoring, but nothing bad.  I had tried to schedule in December to get the last of my 2019 benefits, but was unable to do so.  I had also made appointments with both the old MD that saw me at Virginia Women's Center and the one at VCU.  I finally made the decision to go ahead and go to the one at VCU because she would be the one following me for this pregnancy.  Boy am I glad I did. 

First impression is everything.  Dr. Lanni came into the room with a huge smile, a firm handshake and was absolutely lovely.  She was okay right away with having Bethany on the phone to listen and join in the conversation as she needed to.  I liked her style.  Pretty red dress, knee high boots, great jewelry, tattoos over a lot of her body.  Most importantly, I appreciated her candor and ability to be direct.  Even though this arrangement is altruistic, there are risks as there are with ANY pregnancy.  Maybe being obese here is one positive simply because I will have the extra monitoring and extra support should it be needed?  People at healthy weights should probably be offered the same if it allowed them to feel more comfortably with their pregnancy.

We talked about a lot of things. 

• My only noted deficiency on my bloodwork at SGF was Vitamin D.  Dr. Lanni suggested that the maintenance dose of 2000 units/day is not good enough.  Instead, she prescribed 50000 units/week for 8 weeks and then going back to the maintenance dose.  No problem here!  I have already started it!
• Nutrition will be key.  I need to add about 300 calories to my diet and focus on protein throughout the pregnancy.  Approximately 1.1 grams of protein per kilogram of body weight.  This is a lofty goal, but if we could get to 70-80 grams a day, everything will be fine.  I have a list of new things to try, such as egg white protein powder and Rx bars.  Works for me - done!
• Risk come with every pregnancy.  Although there are heightened risks with overweight people, frankly, people at any weight could experience any of these.  Regardless, we needed to go over them:
• Miscarriage – due to weight and age
• Birth defects – take a prenatal to increase folic acid to help
• Pre-eclampsia - high blood pressure during pregnancy (frankly, mine has run low during the my biological pregnancies)
• Fetal loss at the end – ultrasounds will be done each week after 34/36 weeks to ensure baby is growing and looks okay.
• Placenta accreta/previa – risk due to prior c-sections

• Delivery will likely be a planned cesarean at 39 weeks, which is good for me.  I had Gregory 5 days early and Meade 10 days early.  That is right in the middle and perfect.

Ultimately, Dr. Lanni said there are three things I can control throughout the pregnancy and that is it.  All risks/issues can be found in anyone at any time for a host of known reasons.  We just have to do our best to control the things we can:

1. Going to the doctor.
2. Taking medicines as directed.
3. Being mindful of dietary consumption and nutrition.

I am on board with all of this.  I trust and believe that we will be fine, but know if we face more obstacles, we will do our best to mitigate those risks before they become issues.

One more thing that has resonated with me often since meeting with Dr. Lanni is her approach to obesity.  She made it very clear up front that obesity is a diagnosis and should not be an adjective that describes someone.  Instead of saying "she is obese" society should really focus on the fact that "she has a diagnosis of obesity."  We all know society will never change.  I mean, how many people with diabetes do you know that say "I have a diagnosis of diabetes" verses saying "I'm diabetic?"  A little food for thought.  I like it though, obesity should not define me.  

If you think about it, I will have the diagnosis of obesity until I drop below 165 pounds, according to the CDC.  I'm short, which doesn't help, but that means I need to lose 35ish more pounds to be considered "just" overweight.  It is what it is.  I am healthier than I have EVER been and I am thankful to be in this position and on this journey.  After today, I am so happy I met with Dr. Lanni and she will be with us each step of the way!