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Recurrent Pregnancy Loss with Elizabeth Park · Reproductive Health, Mostly

• 0:07
  SPEAKER_03: Welcome to Reproductive Health Mostly, where we talk about health, hormones, and everything in between.
• 0:12
  SPEAKER_02: We're your hosts, Leah and Alex, and we're bringing you honest, approachable conversation with the providers and professionals who care for our patients every day.
• 0:22
  SPEAKER_02: Whether you're a patient, a coworker, or simply someone who wants to understand more about reproductive health, you're in the right place.
• 0:30
  SPEAKER_03: Now let's dive into reproductive health mostly.
• 0:37
  SPEAKER_01: One of my children has is having dental had dental work done.
• 0:42
  SPEAKER_01: The saga.
• 0:42
  SPEAKER_01: I'll I'll tell you guys about it later.
• 0:44
  SPEAKER_01: But it w it went fine.
• 0:46
  SPEAKER_01: I'm learning a lot.
• 0:48
  SPEAKER_01: This is coming from someone that has never had dental work.
• 0:51
  SPEAKER_01: I am very blessed.
• 0:52
  SPEAKER_01: I have no idea what she's going through.
• 0:54
  SPEAKER_01: I don't want to ever know, but I'm learning a lot along the way.
• 0:58
  SPEAKER_03: So maybe maybe you're low for the week.
• 1:01
  SPEAKER_01: I know.
• 1:02
  SPEAKER_01: She this one should she's almost 13.
• 1:05
  SPEAKER_01: So yeah, it's a hard age to be doing all that too.
• 1:09
  SPEAKER_03: And then my my four-year-old needs dental surgery.
• 1:12
  SPEAKER_03: So it's like the teeth.
• 1:17
  SPEAKER_03: I know.
• 1:18
  SPEAKER_03: So the teeth.
• 1:18
  SPEAKER_03: That's my that's my low for for this week is uh I do not do not enjoy dealing with teeth on me or my my child.
• 1:28
  SPEAKER_03: Um what about you, Elizabeth?
• 1:30
  SPEAKER_03: Do you have a low or a high for the week?
• 1:33
  SPEAKER_00: I mean it's only Tuesday.
• 1:34
  SPEAKER_03: I know.
• 1:35
  SPEAKER_03: Okay, like past, you know, the past week.
• 1:37
  SPEAKER_00: Oh past.
• 1:38
  SPEAKER_00: Um, my high is that my mother-in-law is in town.
• 1:43
  SPEAKER_00: She helped watch Charlie today while I was at work.
• 1:46
  SPEAKER_00: And um low.
• 1:48
  SPEAKER_00: Sorry, I was not prepared.
• 1:50
  SPEAKER_00: I have one, I just can't think of one.
• 1:52
  SPEAKER_00: I'm sorry.
• 1:53
  SPEAKER_03: That's a that's a good place to be in in life when you can't immediately think of a low, right?
• 1:59
  SPEAKER_00: That's good.
• 2:00
  SPEAKER_00: Oh yeah.
• 2:01
  SPEAKER_00: Well, oh the low I'd say actually is juggling like me and Kaz working, like like my husband trying to like get his work done, and then I'm what and like having part-time child care, and it's just like also working, it's obviously hard for everyone who does that.
• 2:17
  SPEAKER_00: Yep.
• 2:19
  SPEAKER_03: There's a lot of moving pieces.
• 2:20
  SPEAKER_03: Yeah, well, I am really excited that you're here, Elizabeth, because I was kind of briefly telling Alex before this that this is really special to me uh because today we're gonna talk, of course, about recurrent pregnancy loss, and this is something that I went through and Elizabeth helped me.
• 2:37
  SPEAKER_03: Um and now I have two beautiful kids.
• 2:40
  SPEAKER_03: So um here with me because of her.
• 2:42
  SPEAKER_03: So this is very special to me that you get to come on and talk about this for all of our patients or all the women that unfortunately go through this.
• 2:52
  SPEAKER_00: Yeah, yeah, and it's surreal for me that Leah, you're my coworker, first of all, that like yeah, that you have these two beautiful children you get to enjoy life with and you see, and like that I actually helped.
• 3:07
  SPEAKER_00: Like, it's just crazy.
• 3:08
  SPEAKER_03: I Elizabeth is always like liking my my Instagrams, and then I'm like, Elizabeth, it's because of you.
• 3:14
  SPEAKER_00: I don't know.
• 3:15
  SPEAKER_00: Disassociate in like a I think it's like a humility kind of thing.
• 3:18
  SPEAKER_00: Like I just try to like disassociate that I like I had nothing to do with anybody who like has children, and so I like don't even like connect that really.
• 3:29
  SPEAKER_01: Oh that's awesome.
• 3:30
  SPEAKER_01: Well, do you wanna um do you wanna start with sharing like who you are and what your role at RHM is?
• 3:37
  SPEAKER_00: Yeah, um, so my name is Elizabeth Park.
• 3:40
  SPEAKER_00: I'm a physician assistant.
• 3:42
  SPEAKER_00: Um, I started with RHM in 2019 when we opened.
• 3:47
  SPEAKER_00: And at that point I was only part-time.
• 3:50
  SPEAKER_00: Um, and it was just me, Dr.
• 3:52
  SPEAKER_00: K and Kelly, who um is does lots of wears lots of different hats with our practice.
• 3:58
  SPEAKER_00: And then like Carol came out, so it was like very small, and it was just us, you know, seeing patients, and then we were doing well, we were actually having success, and then you know, it's grown, and we have so many coworkers now.
• 4:10
  SPEAKER_00: So then along the way, I'm like, I've been like shockingly promoted.
• 4:13
  SPEAKER_00: So I like had a baby, and I dealt with my own infertility, so it took a while for me too, but finally had a baby, and then I was thinking, okay, I went down to working just one day a week, and Dr.
• 4:25
  SPEAKER_00: Kay is like, okay, well, can you be our medical director?
• 4:27
  SPEAKER_00: So I'm like, um, sure.
• 4:28
  SPEAKER_00: And so then I got promoted, and then like a couple months later, it's like, you know, we've grown so much, and now I'm like chief clinical officer, which is like it's so, yeah, it's just it's fun.
• 4:38
  SPEAKER_00: But it's now I get to do not only like see patients and work on you know the medical side of it, but I also get to help with like growing the practice and seeing it from a business side, which has been a really fun like project kind of thing too, even though actually it feels a lot more stressful because it's like people that you interact with every day, my coworkers and friends whose like livelihoods I also have to like help be responsible for.
• 5:04
  SPEAKER_00: So no pressure, but it's really fun, yeah.
• 5:09
  SPEAKER_03: So, what how did you initially join with Dr.
• 5:12
  SPEAKER_03: K and like what kind of was your journey to to joining RHM?
• 5:17
  SPEAKER_00: It's such a fun story to tell because um in PA school, I wanted nothing to do with women's health, you know, because all you learn is birth control, you know, it's like abortion, like all these crazy things that I'm just like I can't even touch that.
• 5:30
  SPEAKER_00: Um, and then my first um job out of PA school, I uh took a family medicine job, like a primary care practice.
• 5:38
  SPEAKER_00: And I should have talked about it during my interview, but I didn't even think about it.
• 5:42
  SPEAKER_00: So three months in, I was faced with like a birth control prescription situation.
• 5:47
  SPEAKER_00: And I had asked the um, yeah, I just asked the practice, like I can't do this.
• 5:53
  SPEAKER_00: This is, you know, against my religious beliefs, and they just told me that it wasn't gonna work.
• 5:57
  SPEAKER_00: So I had to leave the practice.
• 5:59
  SPEAKER_00: And so then I um was basically just like going around asking people, you know, trying to like interview with places, trying to find a job.
• 6:09
  SPEAKER_00: Um, I had at the time in Atlanta, we had a different Catholic um gynecologist, and I had reached out to her and and talked to her, and she wasn't hiring, but she told me to post a listing on a website called One More Soul.
• 6:22
  SPEAKER_00: So I guess people can post like they're looking for a job or someone's looking for um to hire someone.
• 6:28
  SPEAKER_00: So I posted that.
• 6:29
  SPEAKER_00: Um, and then I actually got a job with a Catholic pediatrician in the area, and that was I loved that too.
• 6:34
  SPEAKER_00: And like a year later, I get this call from Dr.
• 6:37
  SPEAKER_00: Kingwasa.
• 6:38
  SPEAKER_00: And he's, you know, I pick up and you know, he's just telling me how he found my listing on One More Soul, and he's opening up a practice in Atlanta, and he's looking to hire someone, and and that's how we got connected.
• 6:50
  SPEAKER_00: That was so fun.
• 6:52
  SPEAKER_00: So oh, and he he told me later on, which is a story that I think is so funny.
• 6:57
  SPEAKER_00: He at when I was talking to him on the phone, I asked him, like, what is natural family planning?
• 7:03
  SPEAKER_00: Like, I, you know, at the time I wasn't married, I was not engaged, nothing like that.
• 7:07
  SPEAKER_00: I had just like didn't even know about cycle tracking.
• 7:09
  SPEAKER_00: I didn't know anything about that, and so I didn't, I just knew nothing about it.
• 7:14
  SPEAKER_00: So it's it's funny that this is my life now.
• 7:19
  SPEAKER_03: Yeah, that's so in terms of recurrent pregnancy loss, or you may say RPL, uh, you know, if you want to save some time, um, but how how would you define this?
• 7:32
  SPEAKER_03: Because I know this is a little controversial.
• 7:34
  SPEAKER_03: So what would you say?
• 7:35
  SPEAKER_00: Yeah, um, so I just think of recurrent pregnancy loss or recurrent miscarriage as a miscarriage, like two or more miscarriages.
• 7:44
  SPEAKER_00: Um, and I was actually just looking this up on up to date, um, which is like a medical um search engine thing.
• 7:50
  SPEAKER_00: And they they also now define it as two or more pregnancy losses.
• 7:54
  SPEAKER_00: Whereas I think in the past, I'm pretty sure it used to be three or more.
• 7:58
  SPEAKER_03: Um when I was going through it, uh you guys were the only ones that cared because I had had this was back, so it's been a while now, 2020 uh and 2021, and I had two losses.
• 8:11
  SPEAKER_03: And my regular OB said, Well, just come back if you have another one.
• 8:16
  SPEAKER_03: Um, and that was not super encouraging.
• 8:19
  SPEAKER_03: So that was kind of how I initially got started with RHM um and was really happy that you guys cared enough to actually look.
• 8:28
  SPEAKER_03: And then I also have heard this since that it's kind of they've kind of changed the guidelines, which is really yeah good for women.
• 8:35
  SPEAKER_00: Yeah, I think restorative reproductive medicine in general has like put so much pressure on the typical mainstream OB care that things like that, just the fact that they now say that second loss is is RPL.
• 8:48
  SPEAKER_00: Um, it's been great.
• 8:50
  SPEAKER_01: When should someone seek an evaluation?
• 8:54
  SPEAKER_00: Gosh.
• 8:55
  SPEAKER_00: Um I try to balance it between being proactive but not stressing someone out.
• 9:02
  SPEAKER_00: So like you can have irregular cycles, have all these symptoms of a hormonal imbalance, and you can still have a healthy pregnancy, have no problems.
• 9:12
  SPEAKER_00: But I just knowing what I know, I I would like somebody who is tracking their cycle and you can see that there are things that are abnormal about it, I would recommend seeking care then.
• 9:26
  SPEAKER_00: And then you can conceive.
• 9:28
  SPEAKER_00: And not that you can't try to conceive or be open to it whenever, but if you could catch it from just knowing there's something off, you could prevent miscarriage really early or from happening at all.
• 9:39
  SPEAKER_00: Um, not that we have complete control, but it's just like if you can tell, you know, you ovulate late, your luteal phase is short, you know that that puts you at a higher risk of miscarriage.
• 9:50
  SPEAKER_00: Um, so that just knowing that and getting care for that would be very helpful.
• 9:56
  SPEAKER_03: And if people say they haven't done this and they have one loss, would you, because I guess more typical uh approach would be like, uh, try again, that happens.
• 10:08
  SPEAKER_03: What what would you say?
• 10:09
  SPEAKER_03: Would they, would it like a kind of workup be warranted?
• 10:13
  SPEAKER_03: Or would we want them to kind of wait before doing all the tests?
• 10:16
  SPEAKER_03: What what would that look like?
• 10:19
  SPEAKER_00: Yeah, I I definitely think a workup would be warrant warranted.
• 10:22
  SPEAKER_00: I wouldn't want you to just go out there, have no help, and and because there's always going to be that fear from then on.
• 10:29
  SPEAKER_00: Um, and there are things that you can look out for and things that you can do.
• 10:32
  SPEAKER_00: So, one, learn to track your cycle.
• 10:35
  SPEAKER_00: That's a great, like similar to, you know, you go and get your blood pressure checked.
• 10:39
  SPEAKER_00: You know what your temperature is.
• 10:40
  SPEAKER_00: That's just like a baseline.
• 10:42
  SPEAKER_00: Um, if you have a short luteal phase, so if for after ovulation and then before your next period starts, it's shorter than 11 days, then very likely you have low progesterone.
• 10:56
  SPEAKER_00: And that's already a high, a very common cause of miscarriage.
• 11:00
  SPEAKER_00: So progesterone being the hormone that helps keep your lining stable, it helps prevent you from bleeding.
• 11:07
  SPEAKER_00: If you know you have that, um, even if you don't have any other like interventions, just taking progesterone can help prevent um pregnancy loss when you are pregnant.
• 11:17
  SPEAKER_00: Yeah.
• 11:18
  SPEAKER_00: Yeah.
• 11:20
  SPEAKER_00: But in terms of other workups, so um I like to think of it like if you have low progesterone, your luteal phase is short, that means that your ovulation or your corpus luteum that's producing that hormone is not as healthy as it could be.
• 11:37
  SPEAKER_00: So then we like to look up why is it not as healthy as it could be?
• 11:41
  SPEAKER_00: You know, you can get a lot of hormones checked.
• 11:43
  SPEAKER_00: A really common cause of um luteal phase defect or low progesterone is related to insulin resistance.
• 11:51
  SPEAKER_00: Um, there can definitely be like vitamin mineral micronutrient deficiencies, um, other things like thyroid, prolactin, all sorts of things can lead to that.
• 12:00
  SPEAKER_00: Um, and then, but besides progesterone, low progesterone being a cause of miscarriage, there are also a lot of other factors.
• 12:07
  SPEAKER_00: So, like inflammation, blood clots.
• 12:10
  SPEAKER_00: Um, those are other things that we could look into or consider.
• 12:14
  SPEAKER_00: Um usually what I evaluate in the history of pregnancy loss is I find in practice losses that occur before eight weeks are usually due to low progesterone.
• 12:26
  SPEAKER_00: And then after eight weeks, they're usually due to blood clots that happen in the um the small blood vessels that lead to the baby, that lead to the placenta.
• 12:35
  SPEAKER_00: Um, those can occur.
• 12:36
  SPEAKER_00: And so that's actually usually a blood clotting issue rather than a low progesterone issue.
• 12:43
  SPEAKER_00: That's so interesting.
• 12:44
  SPEAKER_03: What what happens at eight weeks that you would say, like, like what is that delineation?
• 12:50
  SPEAKER_03: Because I we were gonna ask you what what kind of just timing, like what can that tell you?
• 12:54
  SPEAKER_00: And so I'm curious.
• 12:55
  SPEAKER_00: So that's when the placenta starts to grow.
• 12:59
  SPEAKER_00: And so as that's forming and growing, um, any issues with like the microvasculature, like the development of blood vessels there, there can be inflammation, blood clots, and so that can affect um uh loss.
• 13:12
  SPEAKER_00: Then another um sign that shows it's more likely a blood clotting issue is if you don't bleed, like if you have a missed miscarriage.
• 13:22
  SPEAKER_00: So low progesterone, you'll you'll bleed, and that's why you miscarry.
• 13:26
  SPEAKER_00: If you don't bleed, but you find out you miscarried on ultrasound, that's a really good sign that there's a blood clotting issue.
• 13:35
  SPEAKER_01: Interesting.
• 13:36
  unknown: Yeah.
• 13:37
  SPEAKER_00: I mean, other causes too could be like infections in the uterus, um, other like inflammatory issues, like autoimmune disease issues.
• 13:45
  SPEAKER_00: Yeah.
• 13:45
  SPEAKER_03: And what of where what role does like genetics play in this?
• 13:49
  SPEAKER_03: Because you know, I think a lot of providers will typically just tell you, oh, like, you know, and I think a lot of them are chromosomal or whatnot, but what would you kind of say on that front?
• 13:58
  SPEAKER_03: Like, is there anything that you can work up there or or do to help that part of it?
• 14:06
  SPEAKER_00: So there are tests that you can do where um when you pass the baby, like you can have biopsies done and test for chromosomal issues.
• 14:17
  SPEAKER_00: And I do recommend that if it's possible, like if the baby's big enough, because that that helps you rule out if was it a chromosomal issue or not.
• 14:27
  SPEAKER_00: Um, we do have patients who their baby had a chromosomal issue and that's why they miscarried.
• 14:32
  SPEAKER_00: But I find that that should be like a that should be actually like confirmed rather than assuming it's genetic because oftentimes it's not.
• 14:45
  SPEAKER_03: I love that.
• 14:46
  SPEAKER_03: I love being able, yeah, like finding out it brings a lot of I think peace and closure to those questions.
• 14:53
  SPEAKER_01: Validation too, you know.
• 14:55
  SPEAKER_00: Yeah, yeah.
• 14:57
  SPEAKER_00: And from what I've seen, the ones that we've confirmed are chromosomal issues, I find they um occur later in pregnancy as well.
• 15:07
  SPEAKER_00: They're not one of the early ones, usually, like from what I've seen, they're not like that eight-week, six-week um loss.
• 15:14
  SPEAKER_00: It's usually like that 12 second trimester loss.
• 15:17
  SPEAKER_03: This is interesting.
• 15:18
  SPEAKER_03: This is my experience.
• 15:19
  SPEAKER_03: Well, I had I had one loss that was a confirmed chromosomal issue.
• 15:24
  SPEAKER_03: And it was it was later, it's like 11 weeks.
• 15:27
  SPEAKER_03: So um, that's interesting that you say that because yeah, it it felt different at the time.
• 15:32
  SPEAKER_03: Um, and so it's it's interesting how you can tell so much by just kind of when when somebody might miscarry.
• 15:38
  SPEAKER_00: I mean, and part of that I might be incorrect because it is very hard to confirm when it's less than eight weeks.
• 15:44
  SPEAKER_00: Like it's hard for you to actually do the test and test for chromosomal issues, but just from what I've seen of actual confirmed pregnancy loss, chromosomal issues, it's always been a second trend or like later pregnancy.
• 15:56
  SPEAKER_01: Yeah.
• 15:58
  SPEAKER_01: Interesting.
• 15:59
  SPEAKER_01: Okay.
• 15:59
  SPEAKER_01: So you you alluded to um to like cycle charting, right?
• 16:05
  SPEAKER_01: So like and fertility awareness.
• 16:07
  SPEAKER_01: So, like how important is cycle charting or a fertility awareness-based um tracking method in identifying a root cause.
• 16:17
  SPEAKER_00: Um, yeah, so helpful.
• 16:18
  SPEAKER_00: I it's gonna be the first sign that tells you there's something wrong.
• 16:24
  SPEAKER_00: Um, just knowing like how is your bleeding pattern, how long is your follicular phase, when do you ovulate in the cycle, how long's your alluvial phase?
• 16:33
  SPEAKER_00: That's just the first easy, like, okay, you can tell there's something going on there.
• 16:38
  SPEAKER_03: Uh-huh.
• 16:39
  SPEAKER_00: Yeah.
• 16:39
  SPEAKER_03: Yeah.
• 16:40
  SPEAKER_03: Because I'm sure there are a lot of people who just want to get the blood work, not go through, right?
• 16:46
  SPEAKER_03: Just give me the tests and don't make me do all this other stuff.
• 16:49
  SPEAKER_03: Right.
• 16:50
  SPEAKER_03: Right.
• 16:50
  SPEAKER_03: Um, yeah.
• 16:51
  SPEAKER_01: And I mean, with the with like fertility awareness based methods, right?
• 16:56
  SPEAKER_01: Like you're seeing patterns over time.
• 16:58
  SPEAKER_01: So it's like if you know your luteal phase is short, you know, like there's things that you can do to work and including progesterone supplement, right?
• 17:07
  SPEAKER_01: You know.
• 17:08
  SPEAKER_01: Um yeah.
• 17:10
  SPEAKER_00: Yeah.
• 17:10
  SPEAKER_00: Yeah.
• 17:11
  SPEAKER_00: And one thing that I often think of too is, you know, we always hear about as you age, you're more likely to deal with infertility and pregnancy loss.
• 17:21
  SPEAKER_00: And and that is true, just the fact of just aging alone.
• 17:25
  SPEAKER_00: But it is also true that a lot of it has to do with how our metabolic health also worsens as we age.
• 17:34
  SPEAKER_00: And there are things that we can do to reduce that decline of metabolic health.
• 17:40
  SPEAKER_00: So to keep us in a healthy, fertile stage of life longer.
• 17:45
  SPEAKER_00: You know, and I'm sure, yeah, Alex, you, I'm sure you talk about it a lot, but it's like the, you know, the keeping muscle mass up and the eating whole foods and the fiber, the protein, all those things.
• 17:54
  SPEAKER_00: But I for women who can focus on that, your healthy reproductive age will last longer.
• 18:03
  unknown: Yes.
• 18:04
  SPEAKER_03: Right.
• 18:04
  SPEAKER_03: I think we I feel like I've seen a lot of patients lately who are more like 40 plus, and you know, they're coming to us because they might have exhausted some other options.
• 18:14
  SPEAKER_03: And I feel like they're they're constantly being told, like, this can't happen for you.
• 18:20
  SPEAKER_03: Um, so yeah, I don't know.
• 18:22
  SPEAKER_03: Do you have any like success stories for those maybe like kind of older patients that are or patients that are just kind of turned away from like maybe the regular route, so to speak, yeah, um, that come to mind.
• 18:37
  SPEAKER_00: Um, yeah, I mean, we definitely do.
• 18:40
  SPEAKER_00: Um, I can't think of specific ones because there's a couple of them on the spot.
• 18:45
  SPEAKER_00: Um and it's so different because so we can have some women in their 40s who've been having babies and they're still having babies and they're, you know, not having any trouble except the fact that like we are supporting them with progesterone and trying to monitor pregnancies carefully.
• 19:00
  SPEAKER_00: Um, but there are even some younger women who are struggling with conceiving and like it, you know, it just doesn't seem like at their age it would be a problem.
• 19:12
  SPEAKER_00: Um I I think in all cases, just back to what I was saying about metabolic health, you can always improve your fertility with just trying to do the lifestyle routines.
• 19:26
  SPEAKER_00: And it doesn't have to be an overhaul of your life, but just like the one one thing at a time, you know, like making sure you are eating breakfast if you never were before, and you know, trying to like add in more of that fiber, just all the different things.
• 19:40
  SPEAKER_00: Um, I've seen a lot of success with, oh, actually, I just spoke to somebody who told me she was dealing with infertility, and then she met with me for the first time.
• 19:50
  SPEAKER_00: And this was years ago, or maybe over a year ago or so.
• 19:54
  SPEAKER_00: And um, I told her about like the glucose revolution book to like read about blood sugar.
• 19:59
  SPEAKER_00: And she like that next month she got pregnant, and like I had no idea, I didn't see her again, and like just like little things like that.
• 20:07
  SPEAKER_00: But I often also see a lot of patients who like every time I'm like talking to them about these things and they like don't want to do it, don't do it.
• 20:14
  SPEAKER_00: And and it's just like this constant, like, come on, it's yeah, it's but it's just trying to improve a little bit at a time, yeah.
• 20:21
  SPEAKER_01: Yes, I feel like I say that all the time too.
• 20:23
  SPEAKER_01: I'm like one step at a time, and I always say, like, I I none of us want to overwhelm you, like as patients, right?
• 20:29
  SPEAKER_01: Like, we do not, that's not the goal here.
• 20:31
  SPEAKER_01: We want you to succeed so one thing at a time.
• 20:35
  SPEAKER_00: But and then there are also medications, which it's really nice sometimes to just rely on the medication.
• 20:41
  SPEAKER_00: I mean, you should be doing the lifestyle things too, but then the medications really do help too, like the ovulation induction ones, like the trigger injections, and um, even like say you've done all the things to improve your health and lower inflammation, it still is very helpful for a lot of people during pregnancy to be on a blood thinner, to like have that short course of a steroid or like those these other immunomodulators, like a lot of different medications that just help you have a healthy pregnancy when your body is just a little more inflamed or prone to blood clots and lower progesterone.
• 21:17
  unknown: Yeah.
• 21:18
  SPEAKER_03: This makes me think of what we we talked with Katie last week and a lot.
• 21:23
  SPEAKER_03: She talked about how she loves Dr.
• 21:25
  SPEAKER_03: K's approach of what does what does she want?
• 21:28
  SPEAKER_03: What does she want?
• 21:28
  SPEAKER_03: Right?
• 21:29
  SPEAKER_03: Does she want the meds?
• 21:31
  SPEAKER_03: Does she want to to jump to that and be really hardcore, or does she want to start slower?
• 21:36
  SPEAKER_03: And um, I think it's beautiful that we all kind of have all the options here as opposed to only doing lifestyle or only only medication.
• 21:45
  SPEAKER_00: Um yeah, because a kid can feel like a lot of pressure if if you're only doing lifestyle, it's like that means it's like all on you to get things perfectly right so that you can get pregnant or you can avoid miscarriage.
• 21:57
  SPEAKER_00: And sometimes it's just like, man, it's impossible.
• 22:00
  SPEAKER_03: Or like a time crunch, I feel like too.
• 22:03
  SPEAKER_03: Because I feel like I've had this conversation with some of our providers of like, I feel like I have this dead, like this kind of deadline that this needs to be fixed by or whatever, or like, especially with fertility, like I don't want to wait two years for my insulin resistance to completely resolve.
• 22:17
  SPEAKER_03: I I need some help or whatnot.
• 22:19
  SPEAKER_03: Um but on that note, when or when or like what would you say to somebody who's had a two plus miscarriages, not seeing anyone like us, and and kind of not, you know, maybe done like a couple blood tests but not found anything, and they're just told, like, well, keep trying, or try IBF or or or whatnot.
• 22:44
  SPEAKER_03: I guess what like when when would you encourage them to have a second opinion or or how would you kind of encourage them in that situation?
• 22:51
  SPEAKER_00: Yeah, um, I would I encourage everybody to come see us.
• 22:55
  SPEAKER_00: If like we're in a state, like if you live in a state, we can see you.
• 22:58
  SPEAKER_00: It's like I just because we take insurance too, you know.
• 23:02
  SPEAKER_00: So like what's you pay a copay, you know, like to make an appointment.
• 23:06
  SPEAKER_03: Real quick Georgia, Alabama, Florida, DC, Maryland, Virginia.
• 23:11
  unknown: Yes.
• 23:12
  SPEAKER_00: And then Dr.
• 23:13
  SPEAKER_00: K is licensed in South Carolina, I think Texas.
• 23:16
  SPEAKER_00: If we can get providers in Arkansas, oh yeah, so we have provider license in Arkansas, yeah.
• 23:21
  SPEAKER_00: Um, but yeah, so I would just highly recommend getting a second opinion coming to see us.
• 23:27
  SPEAKER_00: But usually what I find, like I see somebody who's had multiple miscarriages, oftentimes I ask them, like, you know, I'm going through their cycle history, and oftentimes they don't know when they ovulate either.
• 23:39
  SPEAKER_00: So needing to learn that because that tells us so much.
• 23:43
  SPEAKER_00: Um, one of the first tests I order is usually that oral glucose tolerance test with insulin, because insulin resistance is such a root cause of infertility, um, inflammation, recurrent loss.
• 23:55
  SPEAKER_00: Um, so that is a very common cause and that we start treating.
• 24:00
  SPEAKER_00: So that's something you can, you know, lifestyle can help with it, metformin can help, uh GLP1 can help.
• 24:06
  SPEAKER_00: Um, GLP1s, I'm a huge fan of, to be honest.
• 24:10
  SPEAKER_00: I think it's a miracle drug.
• 24:12
  SPEAKER_00: Um, but yes, so that um if they've had if they've gotten pregnant, then I usually don't think we need the like HSG to check fallopian tubes, really, but unless it's been say they're trying again for six months and they haven't gotten pregnant again, or if there was a history of ectopic pregnancy or infection symptoms after a pregnancy, um then I will usually we usually will order, so we have two recurrent pregnancy loss panels.
• 24:43
  SPEAKER_00: One is a protein panel that checks for autoimmune markers, it checks for markers of thrombophilia, so you're more prone to blood clots.
• 24:54
  SPEAKER_00: Um, there's antiphospholipid syndrome we're checking for, which is an autoimmune disease that makes you more prone to blood clots.
• 25:01
  SPEAKER_00: Um, and then there is a genetic panel we can check for, but that one is not covered by insurance we found.
• 25:08
  SPEAKER_00: Like that one can be a very expensive test because it's checking your genes.
• 25:11
  SPEAKER_00: Um, so but that's something we can check, like factor five ligin and um other genes that could increase your risk of blood clots.
• 25:19
  SPEAKER_00: Um one rare test that we can do, we don't, I don't usually do it because I'm already prone to trying to decrease your inflammation, but there is like you could check like natural killer cells, your cytokines, those types of things that are your immune system reacting um just more than it should.
• 25:40
  SPEAKER_00: So that can cause you to miscarry as well.
• 25:43
  SPEAKER_00: Um, I often don't have to check that because we usually will check like other autoimmune stuff and um like thyroid antibodies as well.
• 25:52
  SPEAKER_00: And usually those will pop up really easily.
• 25:55
  SPEAKER_00: And so we start uh working with the immune system as well.
• 25:58
  SPEAKER_00: Um, yeah.
• 25:59
  SPEAKER_00: So there's just lots of tests, lots of things to look into.
• 26:03
  SPEAKER_03: Yeah, and what what are your thoughts on on um when people with recurrent loss are told to pursue IVF?
• 26:11
  SPEAKER_03: Because this was always something that frustrated me as a as a patient.
• 26:15
  SPEAKER_03: Was like, well, I don't have trouble getting pregnant.
• 26:19
  SPEAKER_03: Like, why would I do that?
• 26:21
  SPEAKER_03: That feels like a very expensive thing that might like not help me at all.
• 26:26
  SPEAKER_03: So is that an accurate perception?
• 26:29
  SPEAKER_03: Um, obviously I have some bias there as the patient, but it always kind of frustrated me that that was even suggested to me.
• 26:36
  SPEAKER_00: Yeah.
• 26:37
  SPEAKER_00: I think the idea is that they can pick a genetically normal embryo if that's a cause.
• 26:44
  SPEAKER_00: And then they also would be, they usually are also having you on a blood thinner, an immunomodulator, like all these things that I don't find you have to do IVF to be on.
• 26:56
  SPEAKER_00: And yeah, you don't have to do IVF to be on.
• 26:58
  SPEAKER_00: So these are things that you could conceive naturally and then use these medications to help you have a healthy pregnancy.
• 27:05
  SPEAKER_00: Um, but I I think that most people thinking of infertility clinics, they just know of IVF.
• 27:13
  SPEAKER_00: So like those are the people that will help somebody with recurrent loss and to conceive.
• 27:19
  SPEAKER_00: That makes sense.
• 27:21
  SPEAKER_00: A charitable interpretation.
• 27:23
  SPEAKER_00: Yeah.
• 27:24
  SPEAKER_00: Yeah.
• 27:24
  SPEAKER_00: I mean, I have never worked for one of those clinics, so I don't know exactly their thoughts, but I imagine their their line of thinking is like the the embryo that they know is genetically healthy and all these drugs.
• 27:37
  SPEAKER_00: More control.
• 27:38
  SPEAKER_00: Yeah.
• 27:38
  SPEAKER_00: Right, right.
• 27:40
  SPEAKER_01: Yeah.
• 27:41
  SPEAKER_01: How do you how do you preserve hope without promising a certain outcome?
• 27:49
  SPEAKER_00: Yeah, yeah.
• 27:51
  SPEAKER_00: Um, so I think I go about it by talking about all the things that haven't been explored yet that we also know can improve fertility.
• 28:02
  SPEAKER_00: So you, you know, a lot of women haven't looked at these different hormones or these inflammatory things or like the nutrition lifestyle things.
• 28:11
  SPEAKER_00: And so those are always things we can look into and improve.
• 28:15
  SPEAKER_00: And that does improve your chances of getting pregnant and having a healthy pregnancy.
• 28:19
  SPEAKER_00: Um, so it's not a promise, you know, and I we can't guarantee, but there are things that we can do.
• 28:27
  SPEAKER_00: Um sadly, right now in practice, we're walking with multiple women actually right now, multiple patients who are pregnant, who've had recurrent loss, and whose numbers are like low, like they their ultrasounds are showing, like the heartbeat and babies growing.
• 28:45
  SPEAKER_00: And so it's kind of this we're still supporting and we're still doing all the medications we can we can that we know help and we're watching it.
• 28:53
  SPEAKER_00: Um, I don't know where these pregnancies are gonna go.
• 28:56
  SPEAKER_00: I have hope for them and I'm praying for them, but yeah, we're kind of in that that place right now with a lot of patients.
• 29:04
  SPEAKER_03: And the joy that we all get to celebrate with our patients when when they do get a baby here, when they do finally get pregnant is so nice.
• 29:16
  SPEAKER_00: Yeah, it's it's funny because when I first started, and maybe this is my temperament, like I'm very like a tenacity person.
• 29:23
  SPEAKER_00: Like, I there's a problem, I solve it, okay, I'm done.
• 29:26
  SPEAKER_00: So when I initially I thought, like, okay, I was helping these women get pregnant.
• 29:30
  SPEAKER_00: I'm like, great, they had their baby, we're done.
• 29:32
  SPEAKER_00: But then I didn't realize, like, oh, they actually like continue to come back, and like, oh, I just like keep seeing them and we're like still working together, and it's great, it's wonderful.
• 29:40
  SPEAKER_00: I just like didn't and I didn't imagine that from the beginning.
• 29:44
  SPEAKER_00: I thought it was like a you want a baby, we help you.
• 29:47
  SPEAKER_00: Okay, bye, we're done.
• 29:49
  SPEAKER_00: That's awesome.
• 29:50
  SPEAKER_00: So, so it's sweet.
• 29:52
  SPEAKER_03: I feel like it speaks to to like you and Dr.
• 29:55
  SPEAKER_03: K and all our providers now that we do have these patients.
• 29:59
  SPEAKER_03: I mean, I think of the people who told me about RHM when it had just started, and like they're still patients, like it's so like you know, like all of those hardcore.
• 30:08
  SPEAKER_00: Yeah, I didn't know we were gonna get like long-term, lifelong patients, you know.
• 30:13
  SPEAKER_00: I just thought we were like, I don't know, I felt like an urgent care or something for pregnancy.
• 30:19
  SPEAKER_00: Yeah, right.
• 30:20
  SPEAKER_03: Uh I well, I yeah, I think it just speaks to you guys and the care that you give.
• 30:24
  SPEAKER_03: What I would always tell people before I worked here, and I still do, but I'm like, okay, I work here now, but I promise I mean this, is that the care that I because I remember specifically seeing you a lot, Elizabeth, and then Laura, who used to work with us and no longer is with us.
• 30:38
  SPEAKER_03: And I was like, it's the first time I felt like someone cared.
• 30:41
  SPEAKER_03: Like I just could tell every every appointment, even though it was all virtual at the time.
• 30:46
  SPEAKER_03: And like, it's just like the I felt like these women like cared about what was happening to me.
• 30:51
  SPEAKER_03: And like I remember once like Laura like crying with me on the point, and I was like, this is crazy.
• 30:56
  SPEAKER_03: Like, I can't believe a doctor cares that much about me and like what's going on.
• 31:01
  SPEAKER_03: Um, so I think yeah, I think it really just speaks to y'all's care.
• 31:04
  SPEAKER_03: So that's me just fluffing you up that you are.
• 31:09
  SPEAKER_00: No, it's it's the beauty of our church and our faith and like how it's formed me, you know, and formed all our a lot of our providers.
• 31:16
  SPEAKER_00: And um also it's it's beautiful too to then be able to work with women in our community and like the women we see at church, the women like you know, we're friends with, and we get to help all our friends out, and it's it's really beautiful, you know.
• 31:33
  SPEAKER_00: It is.
• 31:34
  SPEAKER_03: Well, to wrap up, we have a little fun thing we were gonna do is uh I like true or false.
• 31:41
  SPEAKER_03: Okay.
• 31:41
  SPEAKER_03: So for you, and not necessarily all about uh RPL, but just kind of our approach in general.
• 31:48
  SPEAKER_03: So I'll hit you with a a statement and you tell me if it's true or false and why you might agree or disagree.
• 31:54
  SPEAKER_03: Okay, so first we we touched on this, but after after a few losses, everybody should be offered IVF if to go that route.
• 32:04
  SPEAKER_03: Very false.
• 32:05
  SPEAKER_03: Very false.
• 32:06
  SPEAKER_03: Yes.
• 32:07
  SPEAKER_03: Um, and then the next one, maybe, maybe a little more controversial.
• 32:12
  SPEAKER_03: Unexplained infertility is not a diagnosis.
• 32:18
  SPEAKER_00: I think that's true.
• 32:19
  unknown: Okay.
• 32:19
  SPEAKER_00: Yeah.
• 32:20
  SPEAKER_00: I I don't believe in unexplained infertility.
• 32:24
  SPEAKER_00: I I don't say that that means if we explain it, you will definitely get pregnant.
• 32:30
  SPEAKER_00: But we can explain why people are not getting pregnant.
• 32:34
  SPEAKER_00: Um, and there are things that like, so for instance, um back to the insulin resistance.
• 32:39
  SPEAKER_00: That is the most common cause of PCOS, or now called PMOS, which is the most common cause of infertility.
• 32:46
  SPEAKER_00: Um so we know that treating that can help improve rates of fertility or conception.
• 32:53
  SPEAKER_00: But there are gonna be women who treat their insulin resistance, are super insulin sensitive, do really great, and still don't get pregnant.
• 33:02
  SPEAKER_00: Um so, and maybe there's other issues then to explain that, but it's it there is no such thing as unexplained.
• 33:09
  SPEAKER_00: It's just that you don't always get pregnant, even if you figure it out.
• 33:15
  unknown: Yeah.
• 33:16
  SPEAKER_03: And then the last one is that a regular cycle, so you know, bleeding every month means that your cycle's healthy.
• 33:24
  SPEAKER_00: False.
• 33:25
  SPEAKER_00: I mean, I guess that depends what you um define as a regular cycle.
• 33:29
  SPEAKER_00: It's just a monthly bleed.
• 33:30
  SPEAKER_03: Yeah, I would say, I would say like like a regular period, I guess.
• 33:33
  SPEAKER_03: A regular period, yeah, means that everything's good in your cycle.
• 33:39
  SPEAKER_00: It's funny, yeah.
• 33:40
  SPEAKER_00: I think back to like myself in high school and just thinking, okay, I had a period every month, but like there's so much going on I know now that like, gosh, I wish I had known then, especially the acne I had.
• 33:52
  SPEAKER_00: Like, I just I could have done so much.
• 33:55
  SPEAKER_01: Right.
• 33:56
  SPEAKER_01: I know.
• 33:56
  SPEAKER_01: I was just telling a patient this, uh, she's in her mid 30s.
• 34:02
  SPEAKER_01: She's like, why didn't anyone tell me this?
• 34:03
  SPEAKER_01: So I'm like, I know.
• 34:06
  SPEAKER_03: I feel like we hear this all the time of yeah, they're coming because yeah, they're on like their last leg of the journey sometimes, and they're like, no one told me this until now.
• 34:17
  SPEAKER_01: I know, I know.
• 34:18
  SPEAKER_01: I was like, we should have all learned this in seventh grade.
• 34:22
  SPEAKER_01: Yeah, you know, when you're like looking at your underwear and the discharge on the toilet paper and you're like, what is this coming out of me?
• 34:30
  SPEAKER_01: You know, like we should.
• 34:31
  SPEAKER_01: Yeah, why aren't these conversations being had?
• 34:34
  SPEAKER_01: Now we're having them with our daughters, right?
• 34:37
  SPEAKER_01: We are having them constantly.
• 34:39
  SPEAKER_01: I'm asking my my girls, I'm like, guys, what's going on with your cervical mucus?
• 34:43
  SPEAKER_01: Please tell me.
• 34:44
  SPEAKER_01: And they're like, okay, mom.
• 34:47
  SPEAKER_03: That is so funny.
• 34:48
  SPEAKER_03: I'm looking forward to that because right now my daughter just like, what's that for?
• 34:52
  SPEAKER_03: I'm like, it's my hormones.
• 34:55
  SPEAKER_01: Mommy tests her hormones.
• 34:57
  SPEAKER_01: Yes, it's so good.
• 34:59
  SPEAKER_01: A whole new generation of women that are gonna understand their bodies much sooner than than we did, than the majority of us did.
• 35:06
  SPEAKER_03: As a funny anecdote to maybe wrap up, my my four-year-old once I recently heard her under like the table.
• 35:13
  SPEAKER_03: She's playing pretend as as they do.
• 35:15
  SPEAKER_03: And she was like talking to this imaginary friend, and she was going, Hey, estrogen, estrogen, can you do this?
• 35:22
  SPEAKER_03: And I said, Where did you learn that?
• 35:26
  SPEAKER_03: And she was like, I don't know.
• 35:27
  SPEAKER_03: I said she definitely learned that from me.
• 35:30
  SPEAKER_03: She did.
• 35:31
  SPEAKER_03: I love that estrogen as the girl's name.
• 35:35
  SPEAKER_03: So good.
• 35:37
  SPEAKER_00: Add it to your baby list, right?
• 35:40
  SPEAKER_00: That's good.
• 35:41
  SPEAKER_00: Could I ask you guys?
• 35:42
  SPEAKER_00: Sorry, I had a quick question for you.
• 35:44
  SPEAKER_00: Um, yeah, what are y'all seeing in patients you're seeing with like who have recurrent miscarriage and and what you're seeing in being their cycle educators?
• 35:55
  SPEAKER_03: That's a good question.
• 35:56
  SPEAKER_03: I know.
• 35:58
  SPEAKER_03: I don't feel like I've seen anybody with recurrent loss lately.
• 36:03
  SPEAKER_03: Yeah, okay.
• 36:04
  SPEAKER_03: Um which is good.
• 36:06
  SPEAKER_03: Yeah, that's great.
• 36:07
  SPEAKER_03: Um, but I think in in general, just thinking back, like I feel like it they just get so discouraged.
• 36:16
  SPEAKER_03: And that like that that's what I recall the most is like I think most of them have, I feel like pretty regular cycles, at least that I've seen, and then they're just like, wow, like uh, and I I just have so much like empathy because I I know what that feels like, and it's terrible, but I try to encourage them.
• 36:33
  SPEAKER_03: Like, this is a slower process than we might want to try all the things, believe me, I know.
• 36:40
  SPEAKER_03: Um, but like you're in the right spot, we're on the journey, and we have to just get through it.
• 36:46
  SPEAKER_03: So I don't know, that's not not medical, but what I feel like I see the most is just they're usually dis I feel like discouraged that their cycles are usually like fairly good.
• 36:59
  SPEAKER_03: I think because you know they're getting pregnant mostly, so like you know, they're able to do that, and they're not like the craziest cycles we've ever seen.
• 37:06
  SPEAKER_03: And so I feel like they're kind of discouraged when they meet with me sometimes because I'm like, wow, this looks great.
• 37:12
  SPEAKER_03: Like sorry.
• 37:13
  SPEAKER_00: I think that's actually a really great point, then, because hopefully that gives anyone listening hope that you might think that like your cycle might look very healthy, but they there still are things that we can do to help you have a healthy pregnancy if you're having loss.
• 37:29
  SPEAKER_00: So just because your cycle looks healthy also doesn't mean that there's nothing to do to help you.
• 37:34
  SPEAKER_00: Um, because there's still stuff we can look into and still things that we can address that do help um you to have a healthy pregnancy.
• 37:41
  unknown: Yeah.
• 37:42
  SPEAKER_00: Like we're not gonna give up.
• 37:43
  SPEAKER_00: We're not gonna give up.
• 37:44
  SPEAKER_00: That's what I tried to tell.
• 37:46
  SPEAKER_00: I don't I don't believe in unexplained.
• 37:48
  SPEAKER_00: There's so much we can look into.
• 37:50
  SPEAKER_00: Even this past year, we've there's been new like medications and new things that have been shown to help with um recurrent loss and that we've started implementing too.
• 38:02
  SPEAKER_00: Um, so that's been really great.
• 38:04
  SPEAKER_00: Yeah.
• 38:05
  SPEAKER_01: Have you seen anything else, Alex?
• 38:07
  SPEAKER_01: I don't know.
• 38:08
  SPEAKER_01: Mostly people trying to get pregnant.
• 38:11
  SPEAKER_01: Yeah.
• 38:12
  SPEAKER_00: Okay.
• 38:12
  SPEAKER_00: Okay.
• 38:15
  SPEAKER_01: They want to get pregnant.
• 38:16
  SPEAKER_00: Yeah, right.
• 38:18
  SPEAKER_00: Um and Leah, can I ask, like, how was your journey then with all that?
• 38:23
  SPEAKER_03: Oh yeah.
• 38:24
  SPEAKER_03: Um, it is it is very surreal now, being let's see, I'm this year, yeah.
• 38:30
  SPEAKER_03: Now I'm five years past my last loss.
• 38:33
  SPEAKER_03: So it feels almost like a different lifetime um now that I have two small kids and like life is very chaotic and busy.
• 38:41
  SPEAKER_03: And praise God, like I've had no issues since you guys kind of figured out um what was what was going on.
• 38:47
  SPEAKER_03: Uh, but I I definitely felt very like discouraged in that time.
• 38:51
  SPEAKER_03: And that was why after my first loss was when I came to RHM because I thought, okay, I've been tracking my cycles and I kind of had some spotting and I knew, oh, it's probably like not great to have a few days of spotting before my period.
• 39:05
  SPEAKER_03: But then I got pregnant and was like, oh, everything's fine.
• 39:08
  SPEAKER_03: Um, so then when they just told me essentially, like, it happens, see you when you get pregnant again.
• 39:14
  SPEAKER_03: Um, and you know, we're not very great about it.
• 39:18
  SPEAKER_03: Um, I said, okay, I'm gonna see these people that because I feel like there's some warning signs here.
• 39:24
  SPEAKER_03: And and then we started that journey, and I was very lucky that I was able to get pregnant easily.
• 39:29
  SPEAKER_03: Um, but yeah, and like struggled to figure out why.
• 39:32
  SPEAKER_03: And it was that was my experience was it was just like a long journey of okay, after the second loss, we're gonna do some more tests, and then after you third, we're gonna do even more.
• 39:40
  SPEAKER_03: And it was like, oh, like I wish I wish we could have done that all at the beginning, but that's not how it works.
• 39:45
  SPEAKER_00: Um I mean, but we can, it just oftentimes, yeah, it's oftentimes not necessary, but yeah, right, right, right.
• 39:53
  SPEAKER_03: And I I totally all the decisions make total sense in the time.
• 39:57
  SPEAKER_03: It was just it's hard, it's hard to be like, now there's more, and now there's more bills that, but I always felt very supported by the team at RHM again, like just felt like when I was grieving that everybody was kind of grieving with me, um, and as sad as I was about about what was happening.
• 40:15
  SPEAKER_03: And then like when I was able to have my babies very like everyone was just as joyful as I was.
• 40:21
  SPEAKER_03: Um, so I don't know.
• 40:22
  SPEAKER_03: I don't know if that answers what you were looking for, but overall, like it it was a really good experience, and that's why I'm so grateful to to you and to to Dr.
• 40:31
  SPEAKER_03: K and everybody that just helped me along the way that still works at RHM, and now I get to work with.
• 40:37
  SPEAKER_00: Yeah, sorry, sorry to put you on the spot.
• 40:39
  SPEAKER_00: I just don't know.
• 40:41
  SPEAKER_00: I I yeah, I never yeah, I've never heard it from your perspective, and so it's since you've experienced it, that's um really.
• 40:48
  SPEAKER_03: Yeah, and I I yeah, I just felt like that was the the persistent thing was that I felt like like yeah, we would never like you guys wouldn't give up.
• 40:56
  SPEAKER_03: Whereas I did actually have one provider after my second loss who was like, yeah, like we could do so, like I've seen this thing on up to date.
• 41:03
  SPEAKER_03: We could do some more, like we could do a little more when the the OB had said, Oh, whatever.
• 41:07
  SPEAKER_03: And then the midwife said, let's let's do a few tests.
• 41:10
  SPEAKER_03: Um, but like only probably like whatever the standard RPL is, like, not a lot.
• 41:15
  SPEAKER_03: And then it came back to you guys, and you guys were like, we need to do a lot more.
• 41:19
  SPEAKER_03: Like, this is not enough.
• 41:21
  SPEAKER_03: Um, and I felt like, okay, so there is gonna be an answer, like we are gonna find out why.
• 41:26
  SPEAKER_03: And then we did, and that was really like wonderful and has given me so much peace to feel like yeah, I'm not just having that eternal question too, also like spiritually and emotionally, like all those things of why, like that why is just so persistent, and so it feels really good to know, like and have that closure.
• 41:46
  SPEAKER_00: Yeah, oh I'm glad, yeah.
• 41:49
  SPEAKER_00: Yeah, and now I now have my two kids.
• 41:51
  SPEAKER_03: That's crazy.
• 41:53
  SPEAKER_03: And how old is your oldest?
• 41:54
  SPEAKER_03: She's four, four and then two.
• 41:57
  SPEAKER_03: Yeah, and I'll never forget too.
• 42:00
  SPEAKER_03: This is just we can totally cut this too.
• 42:03
  SPEAKER_04: No, I mean I love hearing it.
• 42:05
  SPEAKER_03: Uh when when I found out I was pregnant with with my daughter who's four, I had just moved up here to Virginia, and I was like panicked because it was like a month after my last loss, and I didn't, I had just moved to like another state.
• 42:20
  SPEAKER_03: I knew no one, I knew no doctors, and then I was like, I don't even know if they'll like take me anymore.
• 42:26
  SPEAKER_03: Like, because I had moved out of Georgia, and so I just remember calling the office, like so upset.
• 42:31
  SPEAKER_03: And like, I think even Dr.
• 42:33
  SPEAKER_03: K called me back and was like, here's what we're gonna do.
• 42:35
  SPEAKER_03: Like, you're gonna do this, and here's why.
• 42:38
  SPEAKER_03: Like, and we're no, you can still be a patient.
• 42:40
  SPEAKER_03: And I just like felt again so supported of like, okay, like everything's falling apart, but like maybe, maybe this will go okay, and then and then did, and like she was there nine months later, so just makes me kind of emotional to think about.
• 42:54
  SPEAKER_01: That's amazing.
• 42:56
  SPEAKER_00: You know, even as a boss, he's so great.
• 42:58
  SPEAKER_00: It's like I'll come to him with a problem.
• 43:00
  SPEAKER_00: He's really good at just like immediately addressing something, I think.
• 43:04
  SPEAKER_00: I I have found.
• 43:06
  SPEAKER_03: And then like very compassionate.
• 43:07
  SPEAKER_03: And I felt I felt that like you know, ultimately, I think I had to like I'll I was put on prednisone, and I was like, why?
• 43:15
  SPEAKER_03: Like, why do I need to do this?
• 43:16
  SPEAKER_03: Um, like and like it's like the nurse in me, like, I don't want to be a Sarah, like, and like I don't think we had done any tests that showed anything.
• 43:22
  SPEAKER_03: So I was like, Do I really need to do this?
• 43:25
  SPEAKER_03: And I think that's when he had called me and was like, I think you should do this because I don't want you to lose another baby.
• 43:30
  SPEAKER_03: I like I remember him saying that and being like, wow, like, you know, and then I was like, okay, I'll you know, like obviously I don't want that either.
• 43:39
  SPEAKER_03: So, but it was just like it wasn't um he's like, you can do it, but like I think this is worth doing, and and I just being like, wow, I can't believe he's like fighting for me for me to do this so much.
• 43:50
  SPEAKER_00: Yeah, yeah, I will say, we at our practice, we fight for these babies, like we really fight for these babies.
• 43:56
  SPEAKER_00: So, like, yeah, I tell patients all the time, it's like some of them with all the medications, everything they have to do, it can be it can cause a lot of anxiety, it's a lot to keep track of.
• 44:07
  SPEAKER_00: Oh my gosh.
• 44:08
  SPEAKER_00: And so I'll tell some of them like you don't have to worry about any of it, like I'm gonna keep track of it for you.
• 44:13
  SPEAKER_00: Like when it comes to 10 weeks and you need to taper off that predatone, like I'll let you know.
• 44:17
  SPEAKER_00: Like when you need to do this, like I'll let you know, you know.
• 44:21
  SPEAKER_00: But no, it's we really fight for those babies.
• 44:25
  SPEAKER_00: Yeah.
• 44:26
  SPEAKER_03: Oh, thank you so much for talking to us, though.
• 44:30
  SPEAKER_00: Oh, it's so good to talk with you guys, and thank you for having me.
• 44:35
  SPEAKER_00: And yeah, I hope this reaches a lot of people because yeah, it's just my dream.
• 44:39
  SPEAKER_00: Like, we have this care, I want people to know it exists.
• 44:42
  SPEAKER_00: Like, I don't want people to suffer if they if they have options and the ability not to.
• 44:48
  SPEAKER_03: Yeah, everybody go online to RHM.
• 44:52
  SPEAKER_00: I go pyn.com.
• 44:54
  SPEAKER_00: Book an appointment, right?
• 44:56
  SPEAKER_00: So good.
• 44:58
  SPEAKER_00: If you are a you know nurse practitioner or PA in states that we don't see, and you want to do our fellowship so that we can bring this care to your state, let us know.
• 45:08
  SPEAKER_00: Yes, reach out.
• 45:10
  SPEAKER_03: Yes, there's our plug.
• 45:14
  SPEAKER_03: All right, thanks, guys.
• 45:16
  SPEAKER_03: Have a good rest of your have a good night.
• 45:20
  SPEAKER_02: A huge thank you to our guests for joining us and helping make reproductive health a little easier to understand.
• 45:26
  SPEAKER_03: If you're a patient, we hope this conversation gave you something to think about or a question to bring to your next appointment.
• 45:32
  SPEAKER_03: And if you're part of our team, we hope you learned something new about the people, practices, and perspectives that make reproductive healthcare what it is.
• 45:40
  SPEAKER_03: Thanks for listening to Reproductive Health Closely.
• 45:43
  SPEAKER_03: We'll see you next time where reproductive health is the topic, but the conversation is always bigger.