Thow to handle medical doctor who doesn't think ID twins need to be seen more than 1X a month in 2nd

So, based on my research here and elsewhere, my understanding is for ID twins 2nd twins should be seen at the very least every other week starting at 16 weeks, and every week in the Third Trimester? (Mayo Clinic, March of Dimes...) please correct me if I'm wrong?

My OB told me my care will be seeing her 1X a month until 24 weeks, then every other week at 24 weeks, which she says "is a lot more than single pregnancies" Granted, I have been worried the whole time, but my worry over frequency of care is NOT an overreaction, I've seen some stories of ladies who have had serious TTTS develop even at every other week visits!

I have Kaiser, and she is the best Doctor I ever have had there. really, it's a cr** shoot, and I'm likely to get much worse.
What member services does if you are not getting care you need is to tell you to choose another doctor, and we DON'T have the time to F*** around with that, it can take weeks or a month to get in with someone else. Plus, she is the most responsive of any OB I've ever had at Kaiser (if there is an emergency will try to fit in the next 2 days).

How did those of you who ran across something similar handle this? I am *NOT* OK with this. Do you have any suggestions? Any resources that I can maybe go to for additional outside care/scans?

Literally, I'm at my wits end. I have no idea how to get the care I need for my bbs, other than pretending to have an emergency every week so the ER will do a scan! Which really isn't an option, the last thing I need is a reputation as a hypochondriac/boy who cried wolf... I need them to take me seriously if something DOES go wrong...


Help? SUggestions? I would be very grateful for any input, but especially anyone who has experienced Kaiser,, and even more so in the greater SF Bay Area in California (I'm in the east bay)

Thanks guys!

 

I personally would make an appointment with a Perinatalogist and see him every 3-4 weeks in addition to your ob, and alternate the visits, you are seeing someone every two weeks, and the peri is not going to screw around. Im not pg with twins this pregnancy but lost my twins because the ob was "too busy" to give me the proper care I needed. My insurance considers them a specialist, I paid the first $50 c0pay and havent paid anything for my last two appts.

Good luck

 

Oh how I remember the Kaiser problems! My dd was born at K-Redwood City and my son at K-San Fran... I also used to live right down the street from K-Hayward..
I called the Patient Advocate when they wouldn't refer my son to an ENT. After throwing a complete fit they relented and gave us the referral (it was internal I wasn't trying to find someone outside the Kaiser system...) My son ended up with tubes/tonisils/adnoid surgery within 2 weeks of seeing the ENT.. Good luck!

 

I would contact Mary at the TTTS Foundation (google it) - have her give you the info, and possibly get in touch with Dr. delia or Dr. Quintero who can talk to your dr and make recommendations. If you want to be monitored for TTTS, make it happen. You are the best advocate for your babies. Mary and the folks at the TTTS Foundation will help you figure out how.

Jenny

 

QUOTE(momoftheforest @ May 8 2008, 03:04 PM) [snapback]763160[/snapback]
I personally would make an appointment with a Perinatalogist and see him every 3-4 weeks in addition to your ob, and alternate the visits, you are seeing someone every two weeks, and the peri is not going to screw around. Im not pg with twins this pregnancy but lost my twins because the ob was "too busy" to give me the proper care I needed. My insurance considers them a specialist, I paid the first $50 c0pay and havent paid anything for my last two appts.

Good luck



Thanks... that would work, except I have to be referred by my OB to see a Perinatologist! Ugh! I hate Kaiser

 

QUOTE(nana2C&C @ May 8 2008, 03:11 PM) [snapback]763173[/snapback]
Oh how I remember the Kaiser problems! My dd was born at K-Redwood City and my son at K-San Fran... I also used to live right down the street from K-Hayward..
I called the Patient Advocate when they wouldn't refer my son to an ENT. After throwing a complete fit they relented and gave us the referral (it was internal I wasn't trying to find someone outside the Kaiser system...) My son ended up with tubes/tonisils/adnoid surgery within 2 weeks of seeing the ENT.. Good luck!



Cool, Patient Advocate, you say? Are they different than member services?

Thanks, I appreciate it.

 

QUOTE(ferfischer @ May 8 2008, 03:19 PM) [snapback]763190[/snapback]
I would contact Mary at the TTTS Foundation (google it) - have her give you the info, and possibly get in touch with Dr. delia or Dr. Quintero who can talk to your dr and make recommendations. If you want to be monitored for TTTS, make it happen. You are the best advocate for your babies. Mary and the folks at the TTTS Foundation will help you figure out how.

Jenny



Thank you! I actually tried calling them and emailing them, but never got a response, and their mailbox was full. I found an email address for Dr. De Lea, though... do you think it would be OK to try to email him directly? I will try again, thank you!

 

QUOTE(desolation_anonymous @ May 8 2008, 03:43 PM) [snapback]763236[/snapback]
Cool, Patient Advocate, you say? Are they different than member services?

Thanks, I appreciate it.


I would call Member Services and ask to speak to a Patient Advocate/Patient Liaison.

 

Here is the info/numbers for Mary at the foundation:

800-815-9211 or [email protected]

hopefully you can get through to her -- she has many resources that can help.

 

with mine my dr started seeing me every other week starting at the 20 week mark. I'm seeing a peri every 4 weeks.

can she explain to you her reasoning... the best thing you can do is go in prepared.. with the information that you found online and see if you can influence her, otherwise i'd make a call to kaiser, because of the way kaiser is set up they have alot of policies that can make things difficult. At least that was my experience when i had kaiser. As well as get in to see a peri, to up those appts.

 

I was also going to mention contacting Mary with the TTTS Foundation. . . a compassionate advocate for sure. If you can't get in touch with her via phone, try e-mail and giver a week. I contacted her via e-mail to get the TTTS book when we received our diagnosis. We were quite touched when she personally called me back. Please be patient with her, and I know she will advocate in some way for your babies' care.

My docs wouldn't do another u/s (after the initial at 9 weeks) until 19 weeks. We were fortunate our TTTS did not demand attention sooner. . . The OBs really need to be educated on TTTS.

 

I just went through this with my doctor. I am 15 weeks pregnant. I don't have Kaiser, but I was also not comfortable with the level of monitoring I was getting for my modi twins. My doctor, and the entire practice, said that for any twins (fraternal or ID) they do ultrasounds every 4-6 weeks and they would not refer me to a peri since there already was an MFM in the practice. I explained very calmly that I had been doing a lot of research, had contacted Mary at the TTTS Foundation, and that I would feel much more comfortable if starting at 16 weeks I could have u/s every 2 weeks. My doctor made a face and said that "not a lot can happen in two weeks to warrant that frequency of ultrasounds". There were many minor things along the way that made me a little unsure of this practice to care for my twin pregnancy. But when the doctor made that comment, I knew at that instant I will NOT go back to that practice. I just don't feel comfortable. You don't want to go through your whole pregnancy doubting your OB. I called on Monday and found a new practice who has more experience with twins.

I feel for you having issues with your insurance company though. If I were you, I would try any of all of the following:
Contact Mary at TTTS to speak to your doctor or recommend other doctors in your area.
Ask your OB for a referral to peri. Try to explain why it would make you feel more comfortable to have an extra set of eyes watching out for you.
Contact a patient advocate at Kaiser and explain your situation. See what other doctors are available within Kaiser, and call them to see if they have experience with twins. (It is a pain doing this, I know, but just keep telling yourself you are doing it for your babies).

I know this is all overwhelming as I just went through it. Feel free to send me a message if you need anything else. Good luck!

 

I too was going to suggest talking to Mary or Dr. DeLia. Thankfully I had wonderful doctor's peri's etc. who made sure I was coming more than enough but it was offered that either Mary or Dr. Delia would speak as advocates to get the suggested care if ever needed. They both go above and beyond any kind of help you could ever imagine. Good luck.

 

All I can go on is my experience. First of all you definitely need to be comfortable with your level of care. I didn't find out I was having twins until 13 weeks (I volunteered for u/s techs to practice, otherwise I wouldn't have found out until 19 weeks), I didn't find out they were ID until 16 weeks. At that point I was seeing my ob once a month and my peri once a month. My ob did all of my care, blood pressure, urine screenings, blood work listened to heartbeats ect... My peri gave me an u/s once a month and measured babies sizes, fluid levels, heart rates, cord blood flow and organs. After 24 weeks I was seeing my ob every two weeks and my peri every 2-3 weeks depending on scheduling. Once I hit 34 weeks I was seeing my ob every week, peri every two weeks and having NST's once a week. I delivered them at 37 weeks with no complications. If I EVER felt something was wrong my ob got me in immediately and would send me to the hospital if I was having too many contractions. I think you definitely need to be seing a peri to be measuring cord blood flow and fluid levels. The minute my ob found out it was twins, id or not I was scheduled for a level 2 u/s. Is there a peri near you that you can make an appt with?

What is her reasoning behind not referring you to a peri, she is an OB, NOT the same thing as a peri? They have totally different areas of expertise. I am not sure how Kaiser works and it sounds like a lot of the other ladies have a better feel for that so I'm sorry I can't be of more help.

 

QUOTE(ferfischer @ May 8 2008, 04:12 PM) [snapback]763270[/snapback]
Here is the info/numbers for Mary at the foundation:

800-815-9211 or [email protected]

hopefully you can get through to her -- she has many resources that can help.



Thank you so much!

QUOTE(jillangel @ May 8 2008, 07:45 PM) [snapback]763567[/snapback]
I too was going to suggest talking to Mary or Dr. DeLia. Thankfully I had wonderful doctor's peri's etc. who made sure I was coming more than enough but it was offered that either Mary or Dr. Delia would speak as advocates to get the suggested care if ever needed. They both go above and beyond any kind of help you could ever imagine. Good luck.



Thank you so much! I really appreciate it.

QUOTE(Emily@Home @ May 8 2008, 06:27 PM) [snapback]763452[/snapback]
I was also going to mention contacting Mary with the TTTS Foundation. . . a compassionate advocate for sure. If you can't get in touch with her via phone, try e-mail and giver a week. I contacted her via e-mail to get the TTTS book when we received our diagnosis. We were quite touched when she personally called me back. Please be patient with her, and I know she will advocate in some way for your babies' care.

My docs wouldn't do another u/s (after the initial at 9 weeks) until 19 weeks. We were fortunate our TTTS did not demand attention sooner. . . The OBs really need to be educated on TTTS.



I agree, and thank hyou so much!

 

You should be seeing a peri, no doubt about it. The others gave you some good advice on who to call, I'd insist on being referred to a peri.

I saw a peri only, but I did not require a referral. And mine are not even identical.

 

Thats weird.. because i got great treatment at kaiser. When i started going(to kaiser)... i was 20 weeks and i saw my OB every other week. Then everyweek at 26 weeks and U/S every month and fluid checks at every appointment. I would raise h*ll and see what they do..

 

QUOTE(AshleyLD @ May 9 2008, 07:45 PM) [snapback]765214[/snapback]
Thats weird.. because i got great treatment at kaiser. When i started going(to kaiser)... i was 20 weeks and i saw my OB every other week. Then everyweek at 26 weeks and U/S every month and fluid checks at every appointment. I would raise h*ll and see what they do..



Cool.... do you mind me asking what Kaiser you went to? When was it? perhaps the name of the OB you saw so I could *try* to switch as a last resort? (wink)


That is SO not what my Dr. is recommending, this is what she said

"I know you are worried about complications, but they just don't show up that early. The May 22nd ultrasound will show us that the babies look good, and I will see you in mid June. That is fine. There is nothing to do now except to let them grow and thrive. The problems with twin to twin transfusion will not come until later.

After 24 weeks I will see you every two weeks for a visit until you deliver. This is much more often than when you are pregnant with one baby. This is to check the water and check the cervix for signs of Twin Twin transfusion and preterm labor. You will also have an ultrasound of the babies every 4-5 weeks. We can schedule that in Oakland."


I will raise ****... am going to try the nice way, first. She really is very nice and the best Kaiser OB I've ever had... (sigh)

 

Absolutely advocate for your babies! I'm not familiar with TTTS other than what I've learned here on TS but my understanding is that it can start early (like 14 or 15 weeks) and sometimes progress very quickly so what your doc said makes no sense to me. Keep pushing for good care and you'll get it.