Pre-TTC Appointment Checklist

[LadyNymeria]

Feb 18, 2015 11:35:43 GMT -5 Sparkly said:

Feb 18, 2015 11:19:59 GMT -5 LadyNymeria said:

I was also curious, so I went on the Rainbow Light website. Their Women's Multi has the same amount of Folic Acid as their Prenatal, but the standard Multi has more of things like Vitamins A and K (among others). I believe Calcium was the same (already closed the browser windows), but Iron on the Prenatal was higher. 

Not sure I've ever seen Rainbow Light's standard Multi in stores before.

I'll just add the reason for less of certain vits (eg A and K) in a PNV is you do want to avoid excess quantities of the fat-soluble vitamins when pregnant - but you're also not really that likely to OD on them - you really would have to consume a lot. Almost ALL women from puberty through post-menopause do not get enough calcium, and should never consider the amount in a multi or PNV enough unless you are absolutely sure you're covering it with your diet. Most people aren't.

I'm already on a supplemental Calcium + D (that I take separate from my PNV so the iron doesn't inhibit absorption). My mom was diagnosed with osteopenia (considered by many doctors to be a precursor to osteoporosis) at 52 so my dr wants me on extra calcium earlier rather than later to hopefully prevent the same. I know I don't get enough calcium in my diet to avoid having to take it as a supplement.

[Sparkly]

Feb 18, 2015 11:44:07 GMT -5 LadyNymeria said:

Feb 18, 2015 11:35:43 GMT -5 Sparkly said:

I'll just add the reason for less of certain vits (eg A and K) in a PNV is you do want to avoid excess quantities of the fat-soluble vitamins when pregnant - but you're also not really that likely to OD on them - you really would have to consume a lot. Almost ALL women from puberty through post-menopause do not get enough calcium, and should never consider the amount in a multi or PNV enough unless you are absolutely sure you're covering it with your diet. Most people aren't.

I'm already on a supplemental Calcium + D (that I take separate from my PNV so the iron doesn't inhibit absorption). My mom was diagnosed with osteopenia (considered by many doctors to be a precursor to osteoporosis) at 52 so my dr wants me on extra calcium earlier rather than later to hopefully prevent the same. I know I don't get enough calcium in my diet to avoid having to take it as a supplement.

Separate supplement is the best way to do it! I have taken calcium + D + magnesium (also helps with absorption) for years.

[Lollipop]

Feb 17, 2015 22:54:01 GMT -5 kariann12 said:

I didn't have a separate appointment. I got my IUD out and my doc said call me when you're KU. End of story. Waste of time IMO unless you have pre-existing issues.

That's what's going to happen for me. I'll get the IUD out, and she'll say see you at 8 wks. The only real question is if I can see the same OB as I did with Smudge

[pismoduo]

Feb 18, 2015 8:22:28 GMT -5 Ray said:

I went in for a pre-TTC appointment and had my immunizations checked and ended up needing a tetanus shot, an MMR, 5th disease and toxoplasmosis titres done because I'm a teacher and we can't work in school if there's 5th disease and toxo because I had a cat at the time. They also confirmed my blood-type because it wasn't on file and they didn't believe me when I told them I checked it myself (yay for access to labs lol) Other than that they just told me not to smoke, limit drinking, eat properly etc. etc. and to come back in 6 months for a pap smear (apparently I wasn't due for one yet).

I asked her a whole bunch of questions about what was safe/not safe during pregnancy. What happens with the Rh incompatibility I knew I'd have with baby and a whoooollllee bunch of other stuff that totally could have been googled or could have waited until I was actually pregnant which, surprise, did not happen in the first couple tries like I so naively thought it would lol.

Hope that helps!

Apparently there's new guidelines out and unless you've had an abnormal pap before or have family history that would warrant it, you only need to get a pap smear every 3 years after a certain age. My PCP will still do one annually if you want it, but it's nice not to have to do it every year, for me.

[cnf2013]

Feb 18, 2015 13:02:41 GMT -5 pismoduo said:

Feb 18, 2015 8:22:28 GMT -5 Ray said:

I went in for a pre-TTC appointment and had my immunizations checked and ended up needing a tetanus shot, an MMR, 5th disease and toxoplasmosis titres done because I'm a teacher and we can't work in school if there's 5th disease and toxo because I had a cat at the time. They also confirmed my blood-type because it wasn't on file and they didn't believe me when I told them I checked it myself (yay for access to labs lol) Other than that they just told me not to smoke, limit drinking, eat properly etc. etc. and to come back in 6 months for a pap smear (apparently I wasn't due for one yet).

I asked her a whole bunch of questions about what was safe/not safe during pregnancy. What happens with the Rh incompatibility I knew I'd have with baby and a whoooollllee bunch of other stuff that totally could have been googled or could have waited until I was actually pregnant which, surprise, did not happen in the first couple tries like I so naively thought it would lol.

Hope that helps!

Apparently there's new guidelines out and unless you've had an abnormal pap before or have family history that would warrant it, you only need to get a pap smear every 3 years after a certain age. My PCP will still do one annually if you want it, but it's nice not to have to do it every year, for me.

It's the new CDC guidelines. I think my OB/GYN told me every two years, but either way it rocks. I can't wait to NOT get my vag prodded this year for the first time since I was 16. Gonna be awesome. 

[ghostmonkey]

Feb 18, 2015 13:26:07 GMT -5 cnf2013 said:

Feb 18, 2015 13:02:41 GMT -5 pismoduo said:

Apparently there's new guidelines out and unless you've had an abnormal pap before or have family history that would warrant it, you only need to get a pap smear every 3 years after a certain age. My PCP will still do one annually if you want it, but it's nice not to have to do it every year, for me.

It's the new CDC guidelines. I think my OB/GYN told me every two years, but either way it rocks. I can't wait to NOT get my vag prodded this year for the first time since I was 16. Gonna be awesome. 

You still have the rest of the exam, including the manual portion, you just don't have a pap.

[cnf2013]

Feb 18, 2015 13:33:19 GMT -5 ghostmonkey said:

Feb 18, 2015 13:26:07 GMT -5 cnf2013 said:

It's the new CDC guidelines. I think my OB/GYN told me every two years, but either way it rocks. I can't wait to NOT get my vag prodded this year for the first time since I was 16. Gonna be awesome. 

You still have the rest of the exam, including the manual portion, you just don't have a pap.

Dream crusher =P

[daisy818]

Feb 18, 2015 13:38:02 GMT -5 cnf2013 said:

Feb 18, 2015 13:33:19 GMT -5 ghostmonkey said:

You still have the rest of the exam, including the manual portion, you just don't have a pap.

Dream crusher =P

Yep - sadly all that you get to skip is the dry cotton swab all up in there. 

[pismoduo]

Feb 18, 2015 13:33:19 GMT -5 ghostmonkey said:

Feb 18, 2015 13:26:07 GMT -5 cnf2013 said:

It's the new CDC guidelines. I think my OB/GYN told me every two years, but either way it rocks. I can't wait to NOT get my vag prodded this year for the first time since I was 16. Gonna be awesome. 

You still have the rest of the exam, including the manual portion, you just don't have a pap.

That may depend on the doctor. Mine did everything she'd normally do at an annual, except nothing to do with my vag at all. I got to keep my panties on the entire time. That might be because she's a PCP and not an OB/GYN, though.

[ghostmonkey]

Feb 18, 2015 14:03:31 GMT -5 pismoduo said:

Feb 18, 2015 13:33:19 GMT -5 ghostmonkey said:

You still have the rest of the exam, including the manual portion, you just don't have a pap.

That may depend on the doctor. Mine did everything she'd normally do at an annual, except nothing to do with my vag at all. I got to keep my panties on the entire time. That might be because she's a PCP and not an OB/GYN, though.

That is part of a well woman exam. Your PCP isn't doing her job.

www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Well-Woman-Visit

[joy]

Feb 18, 2015 13:26:07 GMT -5 cnf2013 said:

Feb 18, 2015 13:02:41 GMT -5 pismoduo said:

Apparently there's new guidelines out and unless you've had an abnormal pap before or have family history that would warrant it, you only need to get a pap smear every 3 years after a certain age. My PCP will still do one annually if you want it, but it's nice not to have to do it every year, for me.

It's the new CDC guidelines. I think my OB/GYN told me every two years, but either way it rocks. I can't wait to NOT get my vag prodded this year for the first time since I was 16. Gonna be awesome. 

Wait, you haven't had a Pap since 16?

::HPV-researcher's heart breaking::

[moutonrouge]

Someone mentioned a booster 10 years ago...I know I haven't had a booster in a long time. I think the last vaccine I got was for meningitis before I went to college. I know I'm due for a Tdap shot. I am gonna guess I need to have MMR done or looked at or something. My appointment won't be until May and we won't be trying for more than 30 days after that, so I will definitely ask about this. This was a good reminder

[cnf2013]

Feb 18, 2015 14:29:01 GMT -5 joy said:

Feb 18, 2015 13:26:07 GMT -5 cnf2013 said:

It's the new CDC guidelines. I think my OB/GYN told me every two years, but either way it rocks. I can't wait to NOT get my vag prodded this year for the first time since I was 16. Gonna be awesome. 

Wait, you haven't had a Pap since 16?

::HPV-researcher's heart breaking::

Noooo, of course I have! Every year SINCE I was 16! I meant I was excited to not get one for the first time in over a decade. 

[mainewifey]

Feb 18, 2015 14:33:48 GMT -5 cnf2013 said:

Feb 18, 2015 14:29:01 GMT -5 joy said:

Wait, you haven't had a Pap since 16?

::HPV-researcher's heart breaking::

Noooo, of course I have! Every year SINCE I was 16! I meant I was excited to not get one for the first time in over a decade. 

LOL, I also read it as no pap since you were 16. I was also pretty shocked!

[sdgal]

When I asked about TTC at my last annual, my OB/GYN wanted me to get screened for cystic fibrosis.

I wish she would have mentioned vaccine boosters. I'm probably good on my Tdap, but who knows about my MMR or chicken pox titres.

And I take the gummy PNV with an extra calicum gummy and an iron supplement at another time of day, because they don't put any iron in gummies.

[joy]

Feb 18, 2015 14:33:48 GMT -5 cnf2013 said:

Feb 18, 2015 14:29:01 GMT -5 joy said:

Wait, you haven't had a Pap since 16?

::HPV-researcher's heart breaking::

Noooo, of course I have! Every year SINCE I was 16! I meant I was excited to not get one for the first time in over a decade. 

oh, thank goodness.

[wowcheezits]

Feb 18, 2015 14:16:16 GMT -5 ghostmonkey said:

Feb 18, 2015 14:03:31 GMT -5 pismoduo said:

That may depend on the doctor. Mine did everything she'd normally do at an annual, except nothing to do with my vag at all. I got to keep my panties on the entire time. That might be because she's a PCP and not an OB/GYN, though.

That is part of a well woman exam. Your PCP isn't doing her job.

www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Well-Woman-Visit

Right. While a pelvic exam is no longer necessary, the pap smear still saves lives. The smear is different than a pelvic.

The smear swabs your cervix which can help with early detection out cervical cancer and the CDC recommends you can wait up to three years for another test.

Pelvic exams, or bimanual exams, are where they put two fingers in your vagina and with the other hand they go around the outside. There's no evidence indicating that helps detecting ovarian cancer in asymptomatic patients.

TLDR; get the pap, skip the pelvic.

[Ray]

Feb 18, 2015 13:02:41 GMT -5 pismoduo said:

Feb 18, 2015 8:22:28 GMT -5 Ray said:

I went in for a pre-TTC appointment and had my immunizations checked and ended up needing a tetanus shot, an MMR, 5th disease and toxoplasmosis titres done because I'm a teacher and we can't work in school if there's 5th disease and toxo because I had a cat at the time. They also confirmed my blood-type because it wasn't on file and they didn't believe me when I told them I checked it myself (yay for access to labs lol) Other than that they just told me not to smoke, limit drinking, eat properly etc. etc. and to come back in 6 months for a pap smear (apparently I wasn't due for one yet).

I asked her a whole bunch of questions about what was safe/not safe during pregnancy. What happens with the Rh incompatibility I knew I'd have with baby and a whoooollllee bunch of other stuff that totally could have been googled or could have waited until I was actually pregnant which, surprise, did not happen in the first couple tries like I so naively thought it would lol.

Hope that helps!

Apparently there's new guidelines out and unless you've had an abnormal pap before or have family history that would warrant it, you only need to get a pap smear every 3 years after a certain age. My PCP will still do one annually if you want it, but it's nice not to have to do it every year, for me.

yeah, it used to be every 2 years here and when i went in is when i found out it had changed to 3. She told me to just get one when I became pregnant or march, whichever came first (looks like march...) lol

[daisy818]

Feb 18, 2015 14:45:18 GMT -5 sdgal said:

When I asked about TTC at my last annual, my OB/GYN wanted me to get screened for cystic fibrosis.

I wish she would have mentioned vaccine boosters. I'm probably good on my Tdap, but who knows about my MMR or chicken pox titres.

And I take the gummy PNV with an extra calicum gummy and an iron supplement at another time of day, because they don't put any iron in gummies.

My OB brought up that cystic fibrosis screening existed, but said that unless I have a family history or other reason to think I was at a higher risk (other than being white), it was probably not worth the $$ as my insurance doesn't cover that test.  But she just wanted me to know it existed.  I'm surprised yours mentioned that but not the MMR titer.

[ghostmonkey]

Feb 18, 2015 15:50:12 GMT -5 wowcheezits said:

Feb 18, 2015 14:16:16 GMT -5 ghostmonkey said:

That is part of a well woman exam. Your PCP isn't doing her job.

www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Well-Woman-Visit

Right. While a pelvic exam is no longer necessary, the pap smear still saves lives. The smear is different than a pelvic.

The smear swabs your cervix which can help with early detection out cervical cancer and the CDC recommends you can wait up to three years for another test.

Pelvic exams, or bimanual exams, are where they put two fingers in your vagina and with the other hand they go around the outside. There's no evidence indicating that helps detecting ovarian cancer in asymptomatic patients.

TLDR; get the pap, skip the pelvic.

I didn't see that the ACP had come out with that stance last year until now. Interesting.

[getzystark]

Feb 18, 2015 15:50:12 GMT -5 wowcheezits said:

Feb 18, 2015 14:16:16 GMT -5 ghostmonkey said:

That is part of a well woman exam. Your PCP isn't doing her job.

www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Well-Woman-Visit

Right. While a pelvic exam is no longer necessary, the pap smear still saves lives. The smear is different than a pelvic.

The smear swabs your cervix which can help with early detection out cervical cancer and the CDC recommends you can wait up to three years for another test.

Pelvic exams, or bimanual exams, are where they put two fingers in your vagina and with the other hand they go around the outside. There's no evidence indicating that helps detecting ovarian cancer in asymptomatic patients.

TLDR; get the pap, skip the pelvic.

Correct.

In the ACOG guidelines, the same link ghostmonkey linked, it says, for patients over 21 "No evidence supports or refutes the annual pelvic examination or speculum and bimanual examination for the asymptomatic, low-risk patient." "The decision whether or not to perform a complete pelvic examination at the time of the periodic health examination for the asymptomatic patient should be a shared decision after a discussion between the patient and her health care provider."
It is up to the discretion of the patient and provider regarding this recommendation. There are a lot of factors involved including family history. The USPSTF also does not recommend ovarian cancer screening (which includes the bimanual exam).

However, if symptomatic, with a history of issues, or before a procedure such as IUD placement, a bimanual exam is recommended.

Maybe there's different information out there that I'm not aware of, recommending something against ACOG? In my gyn clinical rotations, we used the most current recommendations (2012/2014), which did not include a bimanual if low risk.

[teachermomtobe]

Now I'm wondering if I should talk to my doctor about an MMR booster. I had MMR shots in 1987 and 1997 but neither my PCP nor my OB/GYN mentioned it when I told them both I was TTC in the near future.

[sdgal]

Feb 18, 2015 16:22:43 GMT -5 daisy818 said:

Feb 18, 2015 14:45:18 GMT -5 sdgal said:

When I asked about TTC at my last annual, my OB/GYN wanted me to get screened for cystic fibrosis.

I wish she would have mentioned vaccine boosters. I'm probably good on my Tdap, but who knows about my MMR or chicken pox titres.

And I take the gummy PNV with an extra calicum gummy and an iron supplement at another time of day, because they don't put any iron in gummies.

My OB brought up that cystic fibrosis screening existed, but said that unless I have a family history or other reason to think I was at a higher risk (other than being white), it was probably not worth the $$ as my insurance doesn't cover that test.  But she just wanted me to know it existed.  I'm surprised yours mentioned that but not the MMR titer.

Yeah, no family history other than being white and DH is white. I waited until I knew I had excess FSA money to burn before I went for the blood draw since I knew about insurance not covering. So no real loss. Not a carrier BTW

But since being here, I'm better educated and I will have more questions at my next annual which would coincide with 6 months TTC (I'm 35).

[wowcheezits]

Feb 18, 2015 16:23:22 GMT -5 ghostmonkey said:

Feb 18, 2015 15:50:12 GMT -5 wowcheezits said:

Right. While a pelvic exam is no longer necessary, the pap smear still saves lives. The smear is different than a pelvic.

The smear swabs your cervix which can help with early detection out cervical cancer and the CDC recommends you can wait up to three years for another test.

Pelvic exams, or bimanual exams, are where they put two fingers in your vagina and with the other hand they go around the outside. There's no evidence indicating that helps detecting ovarian cancer in asymptomatic patients.

TLDR; get the pap, skip the pelvic.

I didn't see that the ACP had come out with that stance last year until now. Interesting.

Lol I'm trying out the website from my phone and it's not working as well as I'd like it to.

I got the smear part from the CDC, but yes you can get the smear done more than once every three years if you want. Who doesn't like a little speculum in the morning? (sarcasm)

[lemoncupcake]

Feb 18, 2015 16:27:49 GMT -5 teachermomtobe said:

Now I'm wondering if I should talk to my doctor about an MMR booster. I had MMR shots in 1987 and 1997 but neither my PCP nor my OB/GYN mentioned it when I told them both I was TTC in the near future.

If you received two MMR shots as a child, you are more than likely immune. It's worth a call IMO to see what they say about getting tested. 

From the CDC: 


Pregnant women should not get rubella vaccine. They should wait until after they have given birth to get vaccinated.



If you are planning to get pregnant, make sure you are protected from rubella beforehand. A blood test—an antibody titer—done by your doctor can tell you if you are already immune to rubella. If you are not immune, you should get vaccinated. Wait at least four weeks before getting pregnant.

www.cdc.gov/features/rubella/

[daisy818]

Feb 18, 2015 16:27:49 GMT -5 teachermomtobe said:

Now I'm wondering if I should talk to my doctor about an MMR booster. I had MMR shots in 1987 and 1997 but neither my PCP nor my OB/GYN mentioned it when I told them both I was TTC in the near future.

It seems that a lot of doctors don't mention it - I asked mine about it up front because I'd been doing a lot of reading up on stuff, so don't know if she'd have mentioned it or not.  I think to some extent it's not mentioned a lot because rubella, the main concern, is currently quite rare in the US (9 cases in 2013, 9 in 2012) and CRS (the rubella caused syndrome that harms babies) has only had a handful of cases in the last few years combined.  In the late 90s/early 2000s it was much worse, with several hundred cases of rubella annually in the US.  So it's one of those things where the risk of getting rubella is very very very low, BUT titers are relatively simple blood tests and the damage inflicted on a fetus IF you get rubella is very severe. 

[squeakyduck]

Feb 18, 2015 16:27:49 GMT -5 teachermomtobe said:

Now I'm wondering if I should talk to my doctor about an MMR booster. I had MMR shots in 1987 and 1997 but neither my PCP nor my OB/GYN mentioned it when I told them both I was TTC in the near future.

I have the same question. I had an MMR booster in 2000. My pcp gave me a tdap booster at my annual when I said we were going to ttc, but no mention of MMR. I did have blood work done, but I can't see what they tested becausethe portal is broken.

[LadyNymeria]

Feb 18, 2015 16:42:15 GMT -5 lemoncupcake said:

Feb 18, 2015 16:27:49 GMT -5 teachermomtobe said:

Now I'm wondering if I should talk to my doctor about an MMR booster. I had MMR shots in 1987 and 1997 but neither my PCP nor my OB/GYN mentioned it when I told them both I was TTC in the near future.

If you received two MMR shots as a child, you are more than likely immune. It's worth a call IMO to see what they say about getting tested. 

From the CDC: 


Pregnant women should not get rubella vaccine. They should wait until after they have given birth to get vaccinated.



If you are planning to get pregnant, make sure you are protected from rubella beforehand. A blood test—an antibody titer—done by your doctor can tell you if you are already immune to rubella. If you are not immune, you should get vaccinated. Wait at least four weeks before getting pregnant.

www.cdc.gov/features/rubella/

I mentioned to my primary that we were planning to TTC later this year and she indicated that since I had 2 MMR shots and that I would be fine, without any mention of the titer to check to see if my immunization was still effective. I may call my Gyn and see what her office says. 

[ghostmonkey]

Feb 18, 2015 16:40:49 GMT -5 wowcheezits said:

Feb 18, 2015 16:23:22 GMT -5 ghostmonkey said:

I didn't see that the ACP had come out with that stance last year until now. Interesting.

Lol I'm trying out the website from my phone and it's not working as well as I'd like it to.

I got the smear part from the CDC, but yes you can get the smear done more than once every three years if you want. Who doesn't like a little speculum in the morning? (sarcasm)

You know how I like it. 

I hadn't need that there was a push to get away from that for women that are not showing unusual symptoms. Makes sense really. Doesn't save me from that fun, but if everyone doesn't have to get it every year, then no no reason for it. So now the question is pismoduo's doctor just up on research or did she just get lucky

[pismoduo]

Feb 18, 2015 17:33:07 GMT -5 LadyNymeria said:

Feb 18, 2015 16:42:15 GMT -5 lemoncupcake said:

If you received two MMR shots as a child, you are more than likely immune. It's worth a call IMO to see what they say about getting tested. 

From the CDC: 


Pregnant women should not get rubella vaccine. They should wait until after they have given birth to get vaccinated.



If you are planning to get pregnant, make sure you are protected from rubella beforehand. A blood test—an antibody titer—done by your doctor can tell you if you are already immune to rubella. If you are not immune, you should get vaccinated. Wait at least four weeks before getting pregnant.

www.cdc.gov/features/rubella/

I mentioned to my primary that we were planning to TTC later this year and she indicated that since I had 2 MMR shots and that I would be fine, without any mention of the titer to check to see if my immunization was still effective. I may call my Gyn and see what her office says. 

My PCP said the same thing, that I should be good since I had the two shots as a kid.