Tuesday, February 22, 2011

The good, the bad and the ugly (with an update and a request)

Prior to November 2009, I think I had seen a doctor maybe 4 times in my life. Most little infections and all things medical were managed by my mom, and she was my mom, even when she had her doctor's hat on.

Then, I started the TTC process. So began a year of a ridiculous number of blood tests and visits to a variety of doctors. I've encountered disinterest, callousness and  sheer laziness: doctors who could not be bothered to look at anything other than the most basic things and got annoyed if you asked them to do even a little bit more.  But I've also encountered the opposite. Some of my doctors have been genuinely kind, caring and empathetic. Others have been sharp as whips, keep up with the literature and most importantly, are interested in the little details which sometimes can be the most important ones. Some of them  (all of the smart ones actually) managed to combine the two (kindness and competence) and these are the best!

I've written up bad reviews  for the worst offender and good reviews for the nice one. But still, websites like Yelp can hide your reviews if they are too positive or negative. So this post, where I name my doctors, their practice and  review my experience with them, has been a long time coming. My blog is also google-search able so anybody trying to decide whether to go with these doctors will also have more information to help make that choice.

The Good

My RE in San Diego, Dr. Gabriel Garzo at Reproductive Partners Medical Group.
I love this practice, overall. The doctors actually do the inseminations themselves!  Their bottom line is just how much they can help their patients and they are genuinely kind on so many different levels. Dr. Garzo listened to my history carefully and ordered that really important test for anti-thyroid antibodies, we would have never caught that problem without that.  I've sent him many papers and he actually takes the effort to read them. The nurse coordinator there who dealt with me (Lindsay Ray) was just wonderful. Lets face it, I'm not the easiest patient to have. Medical practices are not used to having a patient who knows so much and hence demands that they go in so many different directions to investigate all possibilities. She dealt with all my requests for tests, my going off on multiple tangents with amazing patience. She always came through, always tried her best to followup on test results even if it meant staying late. I was very impressed by her professionalism.  Kudos, all the way around.

Dr. Robert Lind, an Endocrinologist with New York University.
While most doctors today do pretty much the same things and follow, more or less, similar treatment philosophies, what sets the really good ones apart from the run-of-the-mill ones is an ability to listen to the patient, care for the patient and see them as more than a face in a parade walking in through the door. Another important quality is the keeping up with latest scientific literature, and to be able to judge to objectively. This doctor had the best reviews from the endocrinologists my insurance let me go to, and he more than lived up to them. I went to because I wanted somebody to manage my thyroid during pregnancy. He took an extremely detailed review on my history, covered every single avenue when it came to testing,  and showed that he was extremely well versed with the latest studies and judged them sensibly, and more than anything, was willing to carve up time from his day, to follow up, to listen to me, to accommodate me as a patient. He responds to my emails. This is a very small thing, but its important. Another doctor, an RE, also at NYU, on my emailing him with a question, wrote back, just to tell me to call his office with the very same question, and not email him on the subject(!!!). Doctors and their egos. Dr. Lind is different, he is the best kind of doctor. I recommend him wholeheartedly.    

 The Bad 

Dr. William Hummel at San Diego Fertility Center
This was, sadly, the first practice I went to. Lets get the minor offences out of the way first- you never see the doctor after the initial consult, and all interactions are through nurse practitioners. The doctors love to delegate everything to somebody else- ultrasounds, IUIs everything short of an egg retrieval is done by nurse practioners. 
The more major offences:
Laziness: They do not re-wash thier IUI-ready sperm. Most clinics actually do this, and there is a reason for this, that there could still be prostaglandin contaminants which will make you cramp horribly after an IUI.  After my first IUI, done with this clinic, I was curled up in bed wishing I had a hot water bottle, the pain was fairly bad. My second IUI, done by Dr. Garzo- I was fine all day after.
Utter lack of interest and sheer callousness: 2 weeks after my first miscarriage, I had a query about cycle parameters (estrogen, length of luteal phase etc and corresponding egg quality). It was not a question the nurse could answer, and I asked her to forward to Dr. Hummel. One week later, I get a reply by mail saying basically this." I am a very busy man and do not have have time for such questions. Luckily for you, there are lots of other REs in San Diego, go to one of them." I've saved the letter because I could not believe my eyes, it was incredible. BUT--that was the biggest favor he could have done, I then ended up with Dr. Garzo.
Utter lack of attention to details and incompetence:  In the initial workup  this clinic had asked for had included a TSH test. That value had come back at 2.74. Now, any RE or OB-GYN worth his salt will know this- a TSH of over 2.5 is not good for pregnancy.  This is a paper that 3 different doctors I've seen have mentioned to me, it is a hall mark study. This practice was either unaware of this paper or ignored my test result - if they had followed up and tested me for anti-thyroid antibodies at that point, who knows, I might have been sitting with a 1 month old baby right now and not writing this sad entry. Ironically, this doctor has written a book on miscarriage and successful pregnancy- guess what features prominently in pregnancy loss list of usual suspects??? Anti-thyroid antibodies.  This guy is the main reason I'm writing this post. Accountability is much called for here.

Dr. Aniruddha Malpani, an RE at the Malpani Fertiliy Clinic in Mumbai, India
Although I ended up having a baby ( a result of an IVF cycle where I designed my own protocol from start to finish), every time I trusted this doctor and went with his flow, I paid very badly for it.  My first IVF where I trusted him to design the protocol ended very badly with a horrible response, and going through a surrogacy managed by him was one of the most tension-fraught experiences of my life, and my daughter was born with a respiratory infection that resulted in a 4-day NICU stay and one week of IV antibiotics. His behavior was also far from professional and was frankly jaw-dropping: he refused my requests to transfer my embryos and sperm to another clinic, and instead demanded that I pay him storage fees for continued storage, or he would destroy them (No, I am not making this up). Four embryos and two of my vials of donor sperm have now been destroyed.
I have written about my experiences in detail here, and offer alternatives fertility treatments in Mumbai.


The Ugly

Dr. Andrew Hull at Repromed Department of UCSD.
This was the perinatologist who saw me during my second pregnancy. I was actually first struck by both his and his colleague (Dr. Maryam Tarsa's) brusqueness and shortness, but that is ok.  It would be icing on the cake if you were kind and interested in me as a patient but that is not really a requirement.

Why he is on this list is because of what happened after we found out my baby's heart had just stopped. After the initial shock (during which utterly no kindness or empathy was shown, its like, whoops looks like your baby no longer has a heartbeat) I was just standing there saying F___ no, this cannot be happening again. At this point he stops me and says, " Please do not swear in my presence". To this, I replied something to the tune of, my baby just died, what do you mean I cannot swear right now? The words 'I don't care' were left unsaid, but he just repeated- "please don't swear again'. Don't know what to say about this guy, you can only shake your head. I was going to let it go, but I think this story deserves to be out there.

27 comments:

  1. Good for you putting this out there Jay. I cannot believe the first guy wrote you that letter, wow. If that happened here they would be censured by the medical board (provided someone complained of course, however infertile women don't do a lot of complaining...). Andrew Hull clearly needs to get a new job as he is clearly in the wrong one.

    As for me, yes, definitely IVF starting May. I get back from Australia 1st May and then it will just be dependent on CD1 timing and whether or not my friend wants to do a long or short cycle...I am eager to get started and wish I didn't have to go to Oz!

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  2. I think it's great that you wrote this post! You balanced it with the good (which is appreciated)... your bad and ugly experiences are completely unacceptable. I can't believe these idiots are still allowed to practice medicine! Hope you've found (or are working on finding) a good doctor in NYC!

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  3. Posts like this are much needed! I picked our clinic b/c of a girl who carefully documented every step of her journey at CCRM. Thanks for putting this out there!

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  4. What a good idea for a post.

    I'm so sorry to hear you suffered miscarriages.

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  5. wow. i can't believe the "ugly" RE. i would have wanted to smack him if he said that to me. ugh. thanks for the reviews. i think that's a great thing to share your experiences.

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  6. Wow, the "ugl" made me my jaw drop. I think it's great you are sharing info

    Also, wanted to let you know, I changed my blog's address:
    http://alittleblogaboutthebiginfertility.blogspot.com/

    Jess

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  7. It's so good you put this out there...your blog is so full of important & useful info regarding TTC.

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  8. ThebabychaseprojectFebruary 22, 2011 at 5:54 AM

    I can't believe the BAD doctor sent you that nasty email. I hope you have found a RE in NY that you like. In my next life, I think I want to be a RE..

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  9. Well, Dr. Hull, I hope you google yourself one day and read this: Fuck you.

    And yay for another post from Jay finally :)

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  10. Wow! I don't know how you didn't smack ugly doc upside the head after that. I would surely have been very, very tempted.

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  11. I really like how you reviewed these docs, especially since you give a little about yourself, and mentioned that you know you must be "difficult" to treat because you know so much. If I were to read these reviews while looking for an RE, I'd completely believe you, because you're so rational and straightforward about your review, and not overly dramatic like a lot of the bad reviews out there can be.

    And seriously? You got lectured on swearing after finding out you'd had another m/c? You've got to be kidding me. I guess he would have lectured me, too, after my m/c, because my response was identical to yours. What an ass.

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  12. New to reading your blog and coming from only great doctors who have done their best to be sensitive to my losses, I am appalled that people could have treated you so unkindly.
    To Mr. Ugly - I hope you eventually get to tell him to F*&% off :)

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  13. Dr. Garzo and his staff are indeed awesome. Thanks to them, I have a 2 year old (IVF baby) but unfortunately the two IVF cycles I did with them in 2010 ended in (1) miscarriage at 14 weeks, and (2) BFN. The only complaint I had about them, actually, is that they *didn't* put me on levothyroxine when I had a baseline TSH of 4.7, and frankly I think that may have contributed to the loss at 14 weeks (chromosomally normal, everything looked perfect through 12 weeks, no explanation for why suddenly the heartbeat stopped). After that loss we did RPL testing and they finally flagged the high (but technically barely within the normal reference range) as something we might want to address. Since then they've wanted my TSH <3, but when it got up to the 2.8 range during my last IVF cycle they said that didn't bother them at all as long as it was <3.

    I have heard very mixed reviews about SDFC. Unfortunately, due to a change in insurance in 2011, I am now going to do an IVF cycle with them because it's covered completely with them and not with RPMG. I am very disappointed, but figured I would go through a cycle there (Dr. K) and see how it goes. If I have a really bad experience, I'll go right back to Dr. Garzo and pay out of pocket for the high level of care I believe they provide. Now if only I could get my nurse at RPMG to be more responsive...I think they are growing so quickly that they could use a few more staff to help. But I love them.

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  14. No freaking way! The 'good' and the 'bad' sound like stereotypically good and bad doctors in the traditional sense. As for Dr. Andrew Hull, he just blew my socks off. I am SO sorry you had to put up with that at your most vulnerable.

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  15. Good for you, Jay! Good for you to have the courage to put this out there for others. Hopefully, you'll save someone from making the same mistake. It will be very interesting to see if the actual doctors find and comment on this.

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  16. I'm so glad you posted this. AND NAMED NAMES! I always google the hell out of any new dr I see. When I get a few minutes I'll put up a post with a link to here. I think this is very important stuff. Maybe I'll put together my own "good, bad, ugly" collection and email it to you. Like the clinic that refused to treat me because I'm single. Or the RE who copped an attitude when I reminded him I needed a pap test. Or the awesome, like my Canadian RE who who emailed back and forth with me on a Sunday night about what we could do to make my 2nd FET successful.

    Oh, and Dr. Hull, if you're reading ... FUCK YOU, you insensitive ass!

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  17. Good for you for being so honest! I love it that you published those names.

    Are there other places you can post this? I posted a review of my RE on Park Slope Parents, a listserve for parents in one popular neighborhood in Brooklyn.

    If you haven't found a RE in NYC yet, I totally ADORED my RE. Dr. Bradley Trivax at Reproductive Specialists of New York. The first stop in Brooklyn for many, many subway lines. And opens 30 minutes earlier than Columbia.

    Not only could I ask him questions... he gave me his personal email address and would usually respond to my emails within the hour. And he saw me every visit apart from those that were ONLY bloodwork.

    You deserve someone that makes you feel secure. You are paying big bucks (or your insurance company is) for these services -- being well educated about the services you receive does not make you "difficult" -- it makes you SMART!

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  18. I don't know if you are looking for doctors across the nation, but I'll add in my two cents. Dr. Nezaam Zamah, at REI Care (http://reicare.com/) in Lee's Summit, MO would be on the BAD section. I was referred to him after my second miscarriage, and D&C. My OB had a HSG done, and it showed a tube was closed, so I went to Dr. Zamah to do my hystoscope, tubal lavage, and 'endo cleanup'. After I recovered, we did our first cycle with him, on Femera. By this time, we had moved about 3 hours away, and I drove up every other day for an ultrasound to see if I had any folical growth. After FIVE trips, he said the cycle was a bust, we'll try again next time. Because I moved, my health insurance (who pays mileage for dr.'s visits over 60 miles), required me to use a local doctor for three months before I could request to go back to Dr. Zamah. BEST THING EVER. Now for the GOOD (or GREAT even). Dr. Christopher Stine at The Women's Clinic in Springfield, MO (http://www.womansclinic.net/). He looked at my diagnosis, sorta laughed, and asked me if I trusted him. He changed my complete outlook on PCOS, and of the 5 cycles we did with him over seven months, we got pregnant 4 times. During my treatment, he did extensive 'specialized testing', and found some underlying issues, which were the cause of our miscarriages. He and his staff had such compassion as we struggled with the decision to continue or stop treatment. I respect that he took every concern of mine seriously. I would get a comment on my blog (about some rare condition), and he always responded "Ok, lets check that out". Every time it came back negative, but the fact that he was willing to do the testing to ease my mind. I was diagnosed with the MTHFR gene mutation, and he asked me how 'in depth' I wanted to treat it. I guess there is an acceptable range of treatment from just extra folic acid and baby aspirin, to daily injections of a blood thinner. My husband and I decided to do the most extreme, as long as there wasn't any lasting effects/damage, and Dr. Stine completely supported that. I have had several friends go there as well, and they have glowing reviews of him too! So though, a year later, we still don't have a baby, it was not for lack of trying or knowledge on his part. I know I've said it, but his compassion is amazing, he completely understood that after 6 losses total, we just couldn't do it anymore emotionally. On our last visit, he told us to "go adopt our baby, love on them for a year, and then come back". And we will.

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  19. Over from LFCA...

    I can add a BAD listing if you're doing national ones:

    http://www.infertilityivfhouston.com/
    Houston, Texas
    Dr. Sonja Kristiansen

    I saw her for 2 medicated IUIs. Both failed. I'm not upset about that, but I am upset at the lack of communication and the fact that both of them should have been stopped BEFORE reaching the IUI part since neither had a snowball's chance of suceeding. I saw her only for the initial consult and then for the actual IUI procedure (which was all of 5 minutes each time), otherwise I was stuck with a PREGNANT nurse. How is that for senstivity?
    First IUI, my lining was so poor there was no way that the IUI would have worked, but I was never given the numbers until after the fact. Each time I asked the nurse, I was told it was "fine" and I only found out that I had practically nothing there after repeated attempts to get the actual numbers. Second IUI, I had to demand extra estrogen to try to increase my lining - they were going to continue the exact same protocol despite the fact that I had poor lining, low response and developed cysts that benched me for 3 cycles. They left us sitting around for HOURS without telling us that we could have gone to lunch while waiting on the sperm wash, and then when I was asking the nurse about the post wash numbers, she told me to ask the doc, who breezed in said, "just a minute" and got the cath set up and pushed the plunger before telling me the numbers were at 1 mill... and I was soooo mad that she didn't give me the option of at least canceling the IUI itself but I guess she wanted her money more than she cared about a procedure actually working.

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  20. Good AND bad:

    Colorado: Dr. Schoolcraft from CCRM

    He did a full workup. He listened to us. However, after deciding that as an under 35 unexplained I would have to go through 3 IUI before 3 medicated IUI then on to IVF, (we stopped after 2 IUI) I only saw and spoke to nurses for each procedure. Others might have had a different experience but I felt like since I was "only" doing IUI he wouldn't give me a time of day to even show up for the procedure.

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  21. Hi Everyone,

    I want to let you know about my website http://BabyProFinder.com, it is a new, national directory of "Baby" Professionals, a term we use to collectively describe fertility, pregnancy, and infant care professionals. Our parent profiles are free and we do give you the option of rating professionals you have had experience with and giving them a 0-5 star rating. We launched in October, so there are professionals that are not yet listed in the directory but you can always email me their names and I will add them so that you can review them.

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  22. I'm pretty much floored. First, that Hummel did not pay attention to your TSH. That's basic, for goodness sakes (and a shocking oversight). Second, and perhaps more so, at Hull's utter lack of compassion. We are not at our best in those moments. And we certainly do not deserve lessons on cursing. Incredible. I'm glad you wrote that letter.

    Glad you found Garzo and Malpani (I think I've read posts by the latter and they've always struck me as very sensible).

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  23. Thanks for taking the time to share this, I feel strongly about it and love reading more on this topic. If possible, as you gain knowledge, would you mind updating your blog with more information? It is extremely helpful for me.

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  24. Did you use Malpani or know anyone that does? I can not find a lot of independent information on them. The website looked like it wasn't overjoyed with surrogacy, but would consider it.

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  25. I've just had a consultation with Dr. Malpani. My sense is that that they run a cutting edge IVF lab and Dr. Malpani is sensible and pragmatic. But yes, he is not a fan of surrogacy. I suggested it and he shot down the idea saying that, by all  indications, there is nothing wrong with my uterus. I agreed with that, so I let it go, but there are times when surrogacy IS called for.

    I'd write to him, tell him how you feel about surrogacy and go from there- he seems to be pretty good at responding to patient queries.

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  26. Thank you so much Jay!

    That's the impression I got from his website. Surrogacy is my only option as my uterine lining/wall is too damaged from a surgery many years ago. 

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  27. Dr.  Hummel is horrible and I am so glad I did not end up at their practice.  He advised me to use donor eggs due to my poor egg quality (it wasn't poor based on subsequent consults) in an insensitive manner.  I also went to RPMG and had Dr. Garzo and Dr. Agarwal and have nothing but great things to say about their follow up and professionalism.  I fell pregnant on the first try!!

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