tag:blogger.com,1999:blog-1406547525301395071.post6834417345519715527..comments2023-09-19T04:20:38.429-07:00Comments on Status Iatrogenicus: Medical Decision Making as a "Patient": Pregnancy Leads to A Trip Down The Rabbit Hole - A Personal StoryScott K. Aberegg, M.D., M.P.H.http://www.blogger.com/profile/17564774546019869201noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-1406547525301395071.post-58039912585926947792016-09-13T11:54:47.971-07:002016-09-13T11:54:47.971-07:00The main point is how educated is your provider wh...The main point is how educated is your provider which is sad that many patients will never know because they are not as invested in their care (or their wifes care) as are you... as a physician, I know that NIPT is not recommended by ACOG in a low risk patient (ie 28 year old like your wife) due to exactly your point. It is recommended for high risk woman (ie >35 yo, prior child with T21/18/13). many believe the "less specialist" someone is, the less tests they order which is not the case, many specialists, (ie cardiologists and mfm/genetic counselors) would not have made the recommendations of your CNM due to knowledge of other areas. just an observation. Every provider has their strengths, I just think we often do a poor job presenting them to our patients and also our inability to educate patients of our ignorance. Your CNM will likely do great for birthing process but the prenatal nuances are not her strength. Its great that you are there to help your wife, hope all goes well with the pregnancy. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-84336534819198985412016-09-07T11:45:31.238-07:002016-09-07T11:45:31.238-07:00The synthroid was declined and the repeat TSH was ...The synthroid was declined and the repeat TSH was normal. Now consider the counterfactual possibilities: synthroid was given and TSH was normal - the desirable result would be attributed to the synthroid; synthroid was given and it threw the feedback loops out of whack - then we'd be running around stressing about it and adjusting doses and chasing our tails.Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-39107133928379188102016-08-28T17:14:04.006-07:002016-08-28T17:14:04.006-07:00Much of our population at large is vitamin D defic...Much of our population at large is vitamin D deficient. Some say that the majority is insufficient. Pregnant women are more likely to be low on D than the general run, but it's more important for her to be at least sufficient than for the general run. And, afterwards, mother's milk is notoriously low in D. D for two.<br />Have you tested for that? It might be more important than the tests that have been done. More important, that is, for your wife than for her midwife. <br />What does Bayes say?Anonymoushttps://www.blogger.com/profile/14779148922194647476noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-90588934912740857782016-08-14T16:27:26.580-07:002016-08-14T16:27:26.580-07:00As a physician, a long-time reader of your blog, a...As a physician, a long-time reader of your blog, and a husband with a pregnant wife, I can say I totally relate. My wife has also been to the cardiologist! It would be funny if it weren't so frustrating and occasionally consequential.Joshnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-15504581003768247982016-08-12T08:59:29.570-07:002016-08-12T08:59:29.570-07:00Since she is 28, her risk is on the order of 1/120...Since she is 28, her risk is on the order of 1/1200, let's round up to 1/1000. We can use my lovely Bayes Theorem calculator on the sidebar of the blog and put in .001 for the prior and I'll go out on a limb and put .999 (or 99.9%) for sensitivity and specificity, along with 1000 for the population size.<br /><br />Doing this, we see that the 1/1000 chance is reduced to .000001 with a negative test (the high NPV you referred to), and a positive test makes it 50/50. We also can add up positive tests (2) and negative tests (998) to see what is the probability we will be faced with either of those results. There is a .998% chance we will be delivered a negative result, which is almost the same as the .999% chance that we will have a child without DS WITHOUT TESTING!<br /><br />The issue is what you would do with the unlikely positive test. I guess amnio or CVS as you mentioned and all that.<br /><br />Consider this - we're both motorcycle riders. So our risk preferences probably don't comport with the average doctor's and nurse's risk preferences.<br /><br />I also estimate that in a few years if we're still having kids, we may revisit these numbers, especially in light of any new data or technology.<br /><br />Thanks for your comment! <br /><br />SKAScott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-69064665879982997382016-08-11T20:32:37.953-07:002016-08-11T20:32:37.953-07:00FWIW, the "average" risk of T21 increase...FWIW, the "average" risk of T21 increases after age 35, and I don't know how old your wife is, but it does occur in younger people. NIPT is lauded for its very high NPV, and I had a positive NIPT at age 33, confirmed by CVS. I knew I would terminate (perhaps different from your scenario), since I am in the medical field and the cardiac abnormalities detected on the subsequent u/s would not have justified carrying to term with all the surgeries that would have been needed--if survived to term at all. I suppose you're not getting the triple tests either? Because, c'mon compared with cfDNA..a composite number of "biomarkers"?? I also contemplated not getting the NIPT for all the reasons you mentioned, statistical probability and "low risk", but in reality am SO happy I did. I got it for all my subsequent pregnancies (well, was considered at risk at that point), but it was very reassuring and the reduced anxiety in subsequent pregancies was very worth it. Anonymousnoreply@blogger.com