after my third miscarriage dr h did a basic blood panel and discovered that i have an elevated titer of anticardiolipin antibodies. he put me on baby aspirin for my next pregnancy.

but i pprom-d with earl and lost her, so dr h sent me to a rhematologist (dr r) to see if he’d missed something. dr r did a workup and said no. this was both relieving and baffling. clearly there is something wrong with some part of my system, and someone, dammitalltohell, should be able to find it.

later, after i pprom-d with ruby, dr l thought i should consult with a perinatologist who suggested a) we should get me checked out for ehlers-danlos and/or marfan syndrome(s) and b) we should get the dr r’s report to see what tests he did to see whether we need to look harder and further.

three weeks, four phone calls and two faxes later the dr r’s report (back from 2005) is finally in my hands. and everything is negative. the report even includes the comment that i have no apparent connective tissue diseases, which i am assuming is shorthand for eds and marfan’s.

so that’s good, right? right?

except that i don’t know whether dr r looked for “everything” — what the hell is “everything” anyway? — so maybe it’s neither good nor right. and it’s all getting a little scary, since, oh, the zero trimester could be ending any day now.

today was my much-anticipated visit with dr. s, the man with the power to tell me (or not) that it is ok (or not) to toss out the dreaded rubber sheaths and start seriously thinking about v.4.0

but not before taking my full history (how i love recounting all seven pregnancies) and asking me all kinds of questions that i have always been just as happy not to know about my family’s medical history, and then starting with the ugly stats: given my age alone, things look bleak for a future baby’s chromosomes. as he rattled off percentages (1 in 25-30 chance of conceiving a baby with down’s, for example, and a 1 in 70 chance of delivering a baby with down’s — “because of attrition, you understand”) i kept reminding myself that these stats are no worse than those we learned in 2005 and that all three children i’ve delivered have been chromosomally normal and that it doesn’t make me crazy, not totally anyway, to want another child anyway and in that way i was able to calm myself down and not run screaming from the room. because really, who in their right mind would consider conceiving when your go-to doc is giving such scary news?

yeah, me, that’s who.

soon the scary morphed into the weird. “at this point” says dr s “we’re out hunting for zebras.” maybe, he conjectured, i should be examined for ehlers-danlos syndrome (eds) and marfan syndrome, both syndromes of weakened connective tissues that can affect the cervix (and i suppose, given collagen blah blah blah, can probably also affect the amniotic sac). but the little bit of reading i’ve done suggests to me that i probably do not have even mild variants of either syndrome. yep, i’m tall but not unusually so, and not unusually so within my family. i’m thin, but not extremely. i bruise easily, but then i also walk into doors on a regular basis. my limbs are not long relative to the rest of me. i don’t easily sprain or dislocate my body parts. i am pretty flexible, but not freakishly so. (no future in the cirque du soleil for me.) but since women with the classical type of eds are more prone to premature rupture of the membranes, we will be looking into this. by “we” i mean, of course, the army of doctors i feel i’m about to get real up close and personal with.

as for mthfr. well. for starters he reminds me that it is most closely associated with cardiovascular disease in adults. but then he tells me it’s a non-entity, because it seems that recently it has been de-linked from c-v disease in adults. and if i am homozygous for mthfr then i’ll just take lots of folic acid, and if i’m a decently-fed woman in the united states i’m probably getting enough anyway. (sound familiar? i swear these guys must talk to each other.) but you can bet your booty (pirate or high-and-deep) that i’ll be taking as much folic acid as anybody allows.

and then we got to metalloproteinase-8. ahh, the dreaded enzyme discussion. you know, i felt like there was something here. after all, i read — i read, dammit — that in women with prom the measurements of the stuff were higher than in women without. (remember this, from that medical report that nobody could read…?)

Spontaneous rupture of membranes in preterm gestation but not in term gestation was associated with elevated amniotic fluid concentrations of MMP-8.

so i’m telling dr s about this study and the first thing he does is tell me it doesn’t sound like a clean study (ooh! a dirty study!) and i spend a millisecond wondering why the word “clean” is preferable to the phrase “badly-designed” but he’s moving to talk about the fact that sure, we can test my amniotic fluid for mmp-8 but even if we find it we can’t do anything about it. and then i’ve had an amnio, which brings with it (he did not need to remind me) the 1/4% chance of pregnancy loss.

while in salt lake i’d had to stop at a drugstore for baby tylenol and an ear-thermometer for my getting-sicker-by-the-minute toddler and i saw — da da da dah! — collagen supplements. who knew? and turns out they include vitamin c, which jives with some of the other reading i’ve been doing. so i asked dr s about taking collagen supplements and, good researcher that he is, he told me he can’t give me an opinion because he doesn’t know anything about their efficacy. he did suggest (strongly) that if i’m going to take them i bring the bottle to him or dr l so they can determine whether the pills include anything that will do additional harm. as i was listening to him tell me this i just kept thinking “i bet he says a version of that to all his patients who want to use homeopathic remedies” and found myself wondering if he’d think those patients are weird (i always assume they will but am looking forward to being proved wrong).

and then a new piece of news: part of ruby’s placenta’s pathology describes our placenta as having “perivillous fibrin deposition” which means, he said, that for my next pregnancy i would be on baby aspirin and heparin. this surprised me. he told me that most people assume heparin is the important treatment, but studies suggest that the two are most successful together. baby aspirin with earl. heparin with mairin. heparin with ruby. heparin and baby aspirin with v.4.0 it is. (for some good scary reading, google perivillous fibrin deposition and maternal floor infarction. and stay away from the pictures.)

but the best news of all: there is no need (save “old wives’ tales” — or, as dr s corrected himself, “old obs’ tales”) to wait for three periods. the purpose of waiting is to give the uterus a chance to clean itself out — to build and shed and build and shed the endometrium so that that yummy-sticky-jam-sandwich of a lining is all fresh. but he said two periods would be as good as three. and period #2 is due in about 6 days. (how do i know? poor s is already running for cover when i walk in the door, that’s how.)

so the upshot: we do a little more medical workup but nothing that needs to happen pre-conception. and, oooh, it will be nice to remember how fun unencumbered sex can be.

as for the zebras: dr s may be hunting for them, but as s says it doesn’t matter whether we find one. it only matters that we shoot the lion before he kills it.