S12 Ep4 - Ask an OB/GYN: Audio automatically transcribed by Sonix

S12 Ep4 - Ask an OB/GYN: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Hi, I'm Kristyn Hodgdon, an IVF mom, proud women's health advocate, and co-founder of Rescripted. Welcome to From First Period to Last Period, a science-backed health and wellness podcast dedicated to shining a light on all of the women's health topics that have long been considered taboo. From UTIs to endometriosis, we're amplifying women's needs and voices because we know there's so much more to the female experience than what happens at the doctor's office. With From First Period to Last Period, we're doing the legwork on your whole body so you can be the expert in you. Now, let's dive in.

Kristyn Hodgdon:
Hi, everyone, and welcome back to From First Period to Last Period. I'm your host, Kristyn, and I'm here today with Dr. Caledonia Buckheit. Hi, Dr. Cali!

Dr. Caledonia Buckheit:
Hello!

Kristyn Hodgdon:
Dr. Buckheit has been on the podcast before. So happy to have you back. Today, we're trying something a little bit different. We actually put up a question box on Instagram and got questions from the Rescripted community. The only prompt was you can ask an OB/GYN anything that's on your mind. No topic is off-limits. So exciting to see what people wrote in and happy to have you here to offer your advice and guidance.

Dr. Caledonia Buckheit:
Yeah, no. I love this prompt, and I'm excited to hear what people have on their minds.

Kristyn Hodgdon:
Yeah, absolutely. So for those of you who don't know Dr. Buckheit, she is an OB/GYN practicing in Raleigh, North Carolina. So if you're in the area, hit her up.

Dr. Caledonia Buckheit:
Accepting new patients.

Kristyn Hodgdon:
Yes, exactly. And where can everyone find you on social, before we get started?

Dr. Caledonia Buckheit:
I am on TikTok and Instagram at @CaliBMD.

Kristyn Hodgdon:
Awesome. So go give her a follow. So, jumping right in, and there's not a ton of rhyme or reason to this, which I think is really interesting, and the point, like, as women, we have so many questions all the time. I'm like almost 22 weeks pregnant and I feel like I've been googling more than ever. And obviously, when I was on my extremely long, arduous fertility journey, it was always like question after question. And it's you're getting answers from Dr. Google, and you just wish you had your own personal medical professional to answer all of your concerns. So the first question is, I ended up in the ER yesterday with the most horrendous abdominal pain. The cause: adenomyosis and cysts. Any advice?

Dr. Caledonia Buckheit:
Okay, yeah. So I think as a resident, and when I'm on call, people definitely end up in the ER with abdominal pain, and there may be a gynecologic origin to that, or it could be GI, it could be GU, but in the realm of kind of acute pelvic pain, cysts are super, super common cause of abdominal pain and often just rupture of physiologic cyst. So every single month, our brain is stimulating our ovary, getting ready for that next ovulation. Sometimes after ovulation you can get the fluid-filled structure just grows and sticks around and then can rupture later on in the cycle, and that can be very painful. So, that may have been kind of part of the picture for this individual. And then adenomyosis is an interesting topic on ultrasound, which is probably what this patient had. You can see features that are suggestive of adenomyosis, but it's similar to endometriosis. It's a pathologic diagnosis. So you don't like officially know until you have like the uterus in a bucket and examined by a pathologist. So this is definitely a bad actor when it comes to, like, very painful heavy periods, pelvic cramping symptoms, things like that. So I'm sorry that she had the cyst problem and the adenomyosis, but those are definitely issues that can lead to acute pelvic pain.

Kristyn Hodgdon:
So how do you know, because there's follow-up questions out of my curiosity, how do you know if your pelvic pain is serious enough that you should go to the ER?

Dr. Caledonia Buckheit:
Yeah, I think that pain that's unresponsive to conservative measures and some watchful waiting usually need some evaluation. So if you're having cramping pelvic pain, you're having sharp abdominal pain, doing stretching, position changes, heating pad, taking Tylenol, taking Motrin, giving it a little bit of time. But if you're doing all those things and it's not getting better, then you probably need to get it checked out.

Kristyn Hodgdon:
Yeah, absolutely. And is there treatment for either of these conditions?

Dr. Caledonia Buckheit:
Yeah. So, for, if we're thinking about like the physiologic cysts, the cysts that can develop and then rupture, they're not like pathologic in the sense like there's nothing wrong with you or your body. Like this is a natural process, but it can lead to pain and unfortunate symptoms. The mainstay of treatment for recurrent ovarian cysts and cyst rupture is ovulation suppression. And so that would be with, like, combined hormonal birth control like pills, patch, rings. Sometimes, an IUD can be helpful, methods that will tamp down that stimulation of the ovary each month. As for adenomyosis, usually, it's management of the menstrual symptoms and around periods. So, treatments that get at heavy menstrual bleeding are good for adenomyosis, and then definitive management for adenomyosis is hysterectomy.

Kristyn Hodgdon:
Okay. So if you're in your childbearing years, you're trying, you're thinking about trying to conceive, and you have, you write to a fertility specialist. What's your?

Dr. Caledonia Buckheit:
So, I would definitely talk with your OB/GYN about adenomyosis. Adenomyosis on its own shouldn't make it harder to get pregnant necessarily, but it can be tough in those months where you're trying to conceive, where you can't suppress or manage the bleeding with all of the tools in the toolbox, because some of those tools are contraception, which goes against the goal if you're trying to conceive. But there are strategies to use just during your menses to manage pain, symptoms, bleeding that you can talk to your OB/GYN about so that hopefully you get pregnant that cycle. But if you don't and you get your period, you're not, like, totally out of luck for a symptom management standpoint.

Kristyn Hodgdon:
Yeah, awesome. So onto the next, this is a topic that I know a lot about personally: PCOS. So can you have PCOS without any symptoms or I guess, outward symptoms?

Dr. Caledonia Buckheit:
Polycystic ovarian syndrome. The way that most gynecologists are going to diagnose that is with something called the Rotterdam criteria. You have to have two out of three of oligomenorrhea, which just means infrequent periods, so like skipping cycles. So you would notice that, right? The other is polycystic ovaries on ultrasound which you might not know, right? You might not have any symptoms related to that. And then the other is hyperandrogenism, which sometimes people do have outward symptoms of that: excess hair growth, oily skin, acne, cystic acne, things like that. But not always, occasionally, I'll get a patient who, for some reason, we end up doing a pelvic ultrasound. We find polycystic ovaries, and then we do labs. And she does actually have an elevated testosterone level. And maybe some of that is just being mitigated. And so she doesn't have a lot of outward symptoms of that elevated testosterone. But she would technically meet criteria for PCOS because she would have those two features. Does that make sense?

Kristyn Hodgdon:
Yes, those are my two features. I have polycystic ovaries, or you know, it's so confusing because I always thought polycystic ovaries meant you had actual cysts, but really, they're just follicles, right? So, the misnomer there in my mind, but yeah. And then I have elevated androgens, but I don't have a ton of the outward symptoms other than I pretty much never get my period.

Dr. Caledonia Buckheit:
Is that ... with PCOS? Like, I diagnose PCOS most often when someone comes to me saying, Hey, like, I don't get a period every month. Like, I'll go multiple months without getting a period. Why is that? And we start working that up and we find PCOS.

Kristyn Hodgdon:
Yeah, but it's so interesting how it's such a spectrum because I also have friends who have PCOS who are very regular. So it's, I don't know, it's like life's greatest mystery to me.

Dr. Caledonia Buckheit:
Yeah. At its core, PCOS is an ovulatory disorder. And that kind of gets into that. I say, you know, 90% to 95% of people who are getting a regular, predictable period are ovulating every month. But that means that 5 to 10% of people who are getting a regular period actually aren't releasing an egg each month, right? And so some of those people might be those people who have the kind of like atypical, not that obvious PCOS.

Kristyn Hodgdon:
Yeah, that's really interesting to me because I took a year off from fertility treatments quite recently, actually, and I was like tracking ovulation for the first time in years. And I got a positive ovulation using basal body temperature. But I was like, how do I even know if I release the egg? I don't trust my body.

Dr. Caledonia Buckheit:
And sometimes, you can get a bit of an LH peak, but it's not quite enough to release that egg. So I'll have patients, they'll be monitoring either basal body temperature or LH strips, what have you, to see if they get that LH surge. But then I'll have them come in a week later after we suspect they ovulated to check blood progesterone level to check on. Did you, in fact, release an egg? Because sometimes you can get a little bit of a fake out there.

Kristyn Hodgdon:
Yeah, that's really good advice to ask your OB/GYN to check your levels after the fact. Just to confirm, because you could be trying to no avail.

Dr. Caledonia Buckheit:
Exactly. I know I'm always trying to prevent that. I'm always like, Okay, yes, you can try to conceive for six months to a year before doing fertility. But I'm like, that's assuming everything is totally normal. Let's make sure things are normal.

Kristyn Hodgdon:
Exactly. So, someone actually asked about the insulin-resistant side of PCOS, which is like the hot topic of 2024, as I'm sure. So, what is your take on Ozempic for PCOS as an alternative to metformin?

Dr. Caledonia Buckheit:
I think for patients, if they have diabetes, if they have obesity, if they have reasons where Ozempic is better for them than metformin, like by all means; it's going to work to address some of that insulin resistance. And because of it addressing the insulin resistance, it'll be helpful for PCOS. That's why metformin is helpful for PCOS. So I think that that's why we're seeing all these pregnancies after Ozempic, because the insulin resistance that was inhibiting normal ovulation, as that gets better, there's less and less insulin resistance. Your ovaries are able to produce that dominant follicle and ovulate. Then you can get pregnant, get cycle regularity back. I'm trying to get pregnant, that kind of thing.

Kristyn Hodgdon:
Can you explain quickly how someone can tell if they're insulin resistant? Because I am not insulin resistant, and I almost like, I hate to say this, but wished I was because I felt like that was something I could reverse in some way, or like work on.

Dr. Caledonia Buckheit:
About it, yeah.

Kristyn Hodgdon:
Yeah. But yeah, so what are the labs to ask for?

Dr. Caledonia Buckheit:
So do doing an A1C is the best. So hemoglobin A1C. And so what that's looking at is it's looking at glycosylation of your hemoglobin in your blood. And so it actually gives you an average of what your blood sugar was like over the previous three months. So it's a nice test. You don't have to check your blood sugars throughout three months, but you can, and still get like the benefit of that data just with from a single blood drop. And so you can diagnose insulin resistance or what we call prediabetes on that. And then you can diagnose diabetes with a hemoglobin A1C as well. Other things that you can do, like if you're getting fasting blood work done, say you're like going to your primary care for fasting blood work, a fasting blood sugar is also helpful to determine insulin resistance or diabetes. And then there's also like glucose tolerance tests similar to the ones we do in pregnancy. You can also do those outside of pregnancy in certain cases to test as well.

Kristyn Hodgdon:
Okay. Interesting. Someone actually also asked: Are these Ozempic pregnancies safe? Is there any research?

Dr. Caledonia Buckheit:
So I don't think we really know yet. For example, there's definitely going to be in the next year or so, like these babies that are born and they were exposed to Ozempic during at least early pregnancy, right? Because people may not have known that they were pregnant and they continued to take the Ozempic? So I'm definitely worried.

Kristyn Hodgdon:
If you find out you're pregnant.

Dr. Caledonia Buckheit:
... you go off of it, if you find out you're pregnant. Yeah, we're definitely, we're going to have those patients who didn't know, right? Maybe they weren't getting a period anyway, right? They'd never. And they were on Ozempic. And then later on they find out they're pregnant. So I think we should have more data. Is there an increased risk of birth defects, preterm birth, blood pressure issues, blood sugar issues? I don't know at this point if there are adverse effects to pregnancies that are on or exposed to Ozempic. I'm not sure. But Ozempic certainly helps people get pregnant.

Kristyn Hodgdon:
Amazing. Awesome. So this is a good one. Why don't OB/GYNs, and this is not speaking super generally, I guess this is this patient's experience, thyroid levels at the annual well visit?

Dr. Caledonia Buckheit:
At an annual exam. This is a good question. So I don't know. Like in the OB/GYN world, it's not part, at least in my residency training. And then in my current practice, when we're doing women labs or like a wellness panel of blood work, you're correct. A thyroid is not part of that. And I don't know, like I checked a heck of a lot of TSH because I am checking it for symptoms. So if somebody has skin changes, hair changes, weight changes, menstrual cycle changes, things like that that they're worried about, thyroid is something I will screen for no matter what, right? If there's any signs or symptoms that could point towards thyroid disorders. But I think in a completely asymptomatic patient, I don't believe that like screening for thyroid disorders is standard.

Kristyn Hodgdon:
Yeah, I'm assuming the question might come from it feels like such low hanging fruit if that is something that's like affecting your fertility or like that can be prevented.

Dr. Caledonia Buckheit:
Yeah. I think that if you have an indication, though, like most providers would just go ahead and get it if they're like, hey, I've been trying to get pregnant for a while, right? That's going to be one of the labs I order. So it is in my world. I feel like it is low-hanging fruit. I check it all the time because I'm like, it would be a silly thing to miss.

Kristyn Hodgdon:
Exactly. Yeah, it was 2020, and I had COVID not too long prior, so I'm like, oh, I must just be, I must just have the long COVID. And I also have 18-month-old twins. So I'm probably just a tired mom. And my TSH was like through the roof. So big advocate of getting your TSH checked if you feel.

Dr. Caledonia Buckheit:
Low threshold to be like, hey, I don't feel right, or I have, you know, any symptom, you name it, it could be associated with thyroid dysfunction.

Kristyn Hodgdon:
The perfect example of how we gaslight ourselves. Oh, I'm probably just tired.

Dr. Caledonia Buckheit:
I feel like a line I say all the time is like two things can be true, right? You can be a tired mom of twins, and you can have.

Kristyn Hodgdon:
Exactly, yeah. Someone just got diagnosed with chronic endometritis, which I think it's important to distinguish that between that and endometriosis because I think people get those confused. So she's asking, How rare is this?

Dr. Caledonia Buckheit:
I don't know, off the top of my head, like the percentage, but I don't know, maybe 1 in 100. It's rare, but it's not like a, like incredibly rare.

Kristyn Hodgdon:
What that is for everyone who might not know?

Dr. Caledonia Buckheit:
Yeah, so chronic endometritis is diagnosed on an endometrial biopsy. So this would be like either somebody had a DNC or they had the office ... biopsy. And so you actually have a little piece of the endometrial lining that the pathologist looked at. And they're seeing signs of either overt infection or, more common with a chronic endometritis is just signs of chronic inflammation. And so usually with that you'll treat with a course of antibiotics to see if there is any underlying infection there to make sure you've treated that. And then rebiopsy, if indicated it can be important in the fertility world. And then sometimes we'll see it when people just have irregular bleeding, abnormal bleeding. It can be a cause of that. Yeah, not incredibly common, but we do see it here and there.

Kristyn Hodgdon:
Got it. And then the next question. So it's about endometriosis. That's why I wanted to make that distinction. We actually have an entire mini-season on endometriosis if anyone wants to go back and listen. But someone's asking, how can I go about getting diagnosed with endometriosis?

Dr. Caledonia Buckheit:
Yeah. So, endometriosis it's a pathologic diagnosis. So you've got to have tissue in order to officially diagnose endometriosis. The other way that endometriosis can sometimes be found or suspected is with ultrasound findings. But again, until you like actually say you find a cyst on ultrasound that's characteristic in its appearance with an endometrioma, which is pathognomonic for endometriosis. Technically, until you take it out laparoscopically and send it to the pathologist, it's not official. But what I would say. So, for patients who have signs and symptoms that are concerning for endometriosis, talk to your OB/GYN about it. And usually, at least, my approach for these patients is taking a really good history, seeing what they've already tried for management. And basically, if you've already tried some kind of like first-line management for their symptoms and it's not working, doing a diagnostic laparoscopy, like going in and actually looking with a camera, taking biopsies of anything that's suspicious, that's going to give you the most answers.

Kristyn Hodgdon:
Yeah. It's crazy to me how the average is still like 7 to 10 years to get diagnosed. Like people just think that painful, heavy periods are normal, and same thing goes if you feel like something's wrong.

Dr. Caledonia Buckheit:
Yes, I know, I'm always like, stop suffering. I'm anti-suffering. Because it does, it is amazing. Like I have people come and tell me they're like, Oh yeah, just ever since I've gotten my period, I just missed four days of school every month and I can't go to my sports activities. I can't do X or Y or Z, I soak through products overnight or whatever it is. I'm like, oh ...

Kristyn Hodgdon:
Thankfully, I do think that, obviously, social media is like a blessing and a curse sometimes, but I think younger people, Gen Z, are really starting to educate themselves more about their bodies and not taking any of that BS.

Dr. Caledonia Buckheit:
I think it's how I'm seeing it in like the menopause world, too. Like I'm seeing it in like teens and people in their 20s, but then also in the menopause world, women being like, Hey, like I've been suffering. And I just heard that wasn't maybe normal. And I'm like.

Kristyn Hodgdon:
Yeah, actually, the episode directly prior to this is all about perimenopause and menopause. We're really excited to break into that in 2025 because my mother-in-law's been suffering for like over a decade. And so many people think that hormone replacement therapy is like the devil.

Dr. Caledonia Buckheit:
I know I spend my day telling people it's not right.

Kristyn Hodgdon:
Yeah, so there's just so much misinformation and just lack of information. So it's definitely high time to talk about it all. Let's see. Oh, speaking of periods, can you please talk about PMDD? This person says, I'm affected by this, and I don't really see people talking about it, and it sucks.

Dr. Caledonia Buckheit:
Yeah. So premenstrual dysphoric disorder, or PMDD, this is a disorder that's characterized by severe mood symptoms that impact, like your ability to function in your day-to-day life that happens either during or right before your period and then gets better afterwards. So it's this very like predictable pattern. And that's what distinguishes it from other mood disorders that are more like pervasive. That might be like always have symptoms. Maybe they get a little bit worse during your period, but they're always there. That's probably not. PMDD versus it's very predictable. Yeah, I just know that I'm going to have a bad week and a half out of every month right around my period, and then it gets better. That's like classic PMDD. I think again, like if you are noticing that pattern, bring it up. Mainstay of management for that is going to be like ovulation suppression, menstrual suppression, keeping hormones like a steady state because it's believed that those mood symptoms are caused by the fluctuation, right? Because in a normal, healthy menstrual cycle, you've got like this high estrogen phase at the beginning of the cycle and then the high progesterone phase at the second half of the cycle, and then that drops down. And it's thought, it's that those fluctuations are what's precipitating the mood symptoms. So, if you keep everything at a steady state, you're less likely to have those symptoms. So that's like usually first-line management. And then there's also you can use some of the SSRIs, SNRIs things like that can also be helpful as well.

Kristyn Hodgdon:
Got it. Yeah, that sounds really awful. Like amplified PMS.

Dr. Caledonia Buckheit:
Yes. No, and it's about how like the, your quality of life and like your ability to, like, function. I think that's always like also a really good check to yourself. Hey, am I changing plans because my mood symptoms are so bad each part of the cycle? Am I or am I, Oh, I know not to plan a trip or plan and make any plans around my period because I'm going to be in so much pain, right? That's like a good check for yourself. That's not normal to have to plan your life around things like that.

Kristyn Hodgdon:
I agree. 100%. So, the next couple of questions are all about pregnancy loss. I've been there. It sucks. I'm so sorry if you've experienced it. This person saying, I've had three pregnancy losses, all at eight weeks, due to low, no heartbeat. What are some possible causes of recurrent miscarriage that I should ask my doctor about?

Dr. Caledonia Buckheit:
So, with three miscarriages, she should definitely have a recurrent pregnancy loss workup. The basis of that, we do some lab testing, Antiphospholipid antibody syndrome. So it's been like the autoimmune world. That can be a cause of recurrent pregnancy loss. Other things can be like structural problems in the uterus. So sometimes, like, if people have a septum or like polyp, fibroid like problems within the cavity where you're not getting good implantation, things like that. So, you want to investigate like the structure of where the pregnancy is trying to implant. Then, the other is like genetic causes. So sometimes like mom and dad are like fine, normal. They have no reason to suspect they have anything genetically going on with either of them. But one of them might actually have a balanced translocation. So some of their chromosomal, like their genetic material and their chromosomes, is actually switched over to a different chromosome. So when they're trying to pass on a copy, they don't pass on like the full normal complement of genetic information. And so then you get these recurrent miscarriages because when the genetics are trying to combine, you actually don't have like the right amount of information, and it can't continue to develop. So that's like the very kind of basic early workup of recurrent pregnancy loss that should be done or at least talked about with your provider. If you've had two consecutive miscarriages or if you've had three at any point total.

Kristyn Hodgdon:
No, you don't have to keep suffering. There are doctors that will get to the bottom of it.

Dr. Caledonia Buckheit:
Yeah, and we don't always find an obvious cause necessarily. But at a minimum you've got to start that process, start that workup, see if we can find a reason for sure.

Kristyn Hodgdon:
Absolutely. Another question about loss is: Any tips for preparing for pregnancy after two back-to-back losses?

Dr. Caledonia Buckheit:
So that's hard. I would say like talking with your provider. Are there any, is there any suspicion as to why based on like how, and when, and what we know about those losses? Do we have any like understanding of potentially why it happened? Because obviously, if we know that, then maybe there's things we can do differently this time around. Otherwise, if there's no apparent cause, I would just say general health and well-being. Things like taking your prenatal, exercising moderately, eating a healthy diet, minimizing stress, all those things as best you can, and then just really close follow-up with your OB/GYN. Sometimes patients like that who have a history of, say, ectopic pregnancy or recurrent pregnancy loss, we may do some additional check-in visits, depending on when the losses were in the past, for added reassurance and closer monitoring.

Kristyn Hodgdon:
Yeah, this hits really close to home for me right now because I am pregnant after infertility, miscarriage, pre-term labor, etc., etc., and I feel like I need to be, like, handled with care. It's so hard. And I like, the best advice I have, which is really, I'm not even practicing what I preach right now, but I'm just trying to set, like, really small goals. Okay, I just need to get to this appointment. Or right now, I just really want to get to 24 weeks and viability and then 28 week. But it's so hard in the moment because you're, when you're conditioned for bad news, it's so hard to think, Oh, this pregnancy is different. It's going to work out this time. But as my therapist says, There's like productive worry, which is like taking your prenatal vitamins, going to your prenatal appointments. And then there's unproductive worry where it's like stripping you of the joy that you should be experiencing, which I'm totally guilty of. But it's hard to be like in that celebratory mode after that.

Dr. Caledonia Buckheit:
Yeah. It's hard to be in that celebratory mode as like an OB/GYN. I feel like I, like, didn't enjoy either of my pregnancies because I just had, like, crippling anxiety the entire time because I had seen every possible bad outcome along the way. So it's just, yeah, really hard. It's really hard. I do think, like, one thing that I have found in my practice to be helpful is, like, with those patients, like a patient like you, like making a plan that's like reasonable, that's going to like, be able to, okay, is it helpful that we check-in every two weeks instead of every four? Is it helpful that we do an extra ultrasound between this appointment and this? Like, you know, like making a plan.

Kristyn Hodgdon:
A massive weight off my shoulder. I started crying when my OB like actually recommended we, I go in every two weeks instead of every four because the last pregnancy, this is a completely different pregnancy. It's a singleton. I was pregnant with twins last time, but I literally went into a routine 26-week appointment, and my cervix was non-existent, and they were like, Go straight to the hospital. So, thankfully, everything ended up working out. But when you have that trauma, no, I want to check at least until 24 weeks when they really can't do a lot of interventions at that time, like a Cerclage or anything like that, but it'll just give me peace of mind, like why not?

Dr. Caledonia Buckheit:
Yeah. And I think it's, I think it's very reasonable to just be open about that with your provider. These are my fears. Some are rational, some are irrational. What do you think we can do as a plan to mitigate that and make it as less stressful as possible?

Kristyn Hodgdon:
Exactly, and if your doctor is not hearing your concerns, maybe not the best fit to deliver your baby with them, I don't know.

Dr. Caledonia Buckheit:
Yeah, you need to trust your provider and feel like they're listening to you. I feel like I'm lucky where I live because I live in Raleigh, North Carolina. We have so many great OB/GYN practices. I feel very strongly if a patient comes and sees me, it's not a good fit. That's okay. We've got great practices. You're going to find your people, I think, not to look around until you find someone who's a good fit.

Kristyn Hodgdon:
Absolutely, yeah. So, someone else I feel so bad wants to know about HG and pregnancy. And so on for like my entire first trimester. Thankfully, I didn't have HG, but that's rough.

Dr. Caledonia Buckheit:
So rough. It's so rough. I remember, like my first pregnancy, I didn't really have any. And then my second, like I was just so sick. Luckily, only for a month and a half at the beginning. But, like, when I experienced that, I was like, Oh my gosh, there are people who experienced this for their entire pregnancy. Like just even as an OB/GYN, like I didn't really fully get it until I was there. It's just such a horrible feeling and a horrible disorder. So hyperemesis gravidarum is basically severe nausea and vomiting of pregnancy, leading to like weight loss, nutritional deficiencies, sometimes hospitalizations, a really tough condition. At least, I feel like for most OB/GYNs, like we have a protocol that we go through escalating, like the medication management and medical management of severe nausea, vomiting, and pregnancy. It's a tough disorder to manage. What was her exact question about it? Just like any tips or?

Kristyn Hodgdon:
How do I know if it's HD?

Dr. Caledonia Buckheit:
So I would say so, it depends on like gestational age, like duration of symptoms like percent body weight loss, things like that. So, definitely, it's like unique to each person. But I would say like typical nausea and vomiting of pregnancy gets better with advancing gestational age. Like the vast majority of that will resolve by 10 to 14 weeks. Usually does not result in weight loss. So that would be more like nausea and vomiting of pregnancy, which is like what I experienced. And it sucks, but it like gets better and eventually goes right. The hyperemesis gravidarum like does not go away, does not get better. You're at a place where you're like actually really struggling to get in adequate nutrition and fluids.

Kristyn Hodgdon:
Yeah, prayers and prayers for everyone dealing with that. So, lastly, I would like to ask, what would you rescript about the way people think about asking their OB/GYN questions at their appointments? Because I know a lot of people like get cold feet. I've forgotten my questions when I get there. Oh man, I wish I asked that. How would you rescript that whole way of thinking?

Dr. Caledonia Buckheit:
So one thing, this is like slightly tangential, but one thing as we were talking about like making a plan, like shared decision making, a follow-up plan, things like that, that work specifically for you. Like a lot of that, it's not hard for me to do those appointments, right? Like you might think, oh my gosh, like I'm trying, I'm asking this. It's such an unreasonable thing to ask. Like a lot of that, just no. For us, it's easy. For me, it is easy to check heart tones in extra time, right? It is easy to do that extra visit for reassurance, things like that. So I would rescript that assumption that what you're asking is really a lot of extra work or out of, not reasonable from your provider. That's one thing. And then asking questions in general. I think one challenge is the time constraints. So I think like you can ask and you should ask like whatever questions you have, but be open to having to come back another day to like fully delve into it. Be like, Hey, I don't know if we have time for this today, but these are the questions I have. What do you think? And your provider will tell you like, Hey, that's a super easy question. Here you go. Or I want to really go into that; let's have you come back. Let's get labs. Let's like dive in.

Kristyn Hodgdon:
I remember you saying that on the last episode we did together about the fertility consult and have a kind of a separate meeting about that, because it's really important, and you want to get all your questions answered.

Dr. Caledonia Buckheit:
Exactly. But yeah, I would say don't be afraid to ask. It's okay to ask. And usually, you can make a plan for that question to make sure it gets answered and investigated appropriately.

Kristyn Hodgdon:
Love it. Thank you so much, Dr. Buckheit. This was awesome, and I hope everyone got their questions answered. I think we'll be doing more of this in the future, so appreciate your time as always. Talk to you soon. Thank you.

Kristyn Hodgdon:
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