(gentle music)
Joanna: I joined the Navy at 18.
I went to bootcamp, I went to A-school.
And I was attached to the USNS Comfort.
I started having seizures at 19.
And they gave me a medical discharge for my epilepsy.
I was devastated.
I didn't know what to do,
my career had ended before it started.
What do I do with my life now?
And after that I thought about kids.
(gentle joyful music)
Dr. Lopez: It's important to think about women with epilepsy
because women can get pregnant.
So when we are treating women with epilepsy,
the goal is to plan the pregnancy ahead of time.
Joanna: Hi. Dr. Lopez: Hello.
Joanna: How are you Dr. Lopez: Hi Joanna, how are you?
Good, how are you?
Joanna: Good. Dr. Lopez: It's good to see you.
Number one, if you don't want to get pregnant what type
of birth control is the best that can work for you.
Number two, if you wanna get pregnant, let's establish
a plan how we can get you ready for that pregnancy.
Yira: I think birth control is very important
for a Veteran who has epilepsy
and she's in her reproductive years.
Dr. Lopez: Birth control pills
are indicated for women with epilepsy.
However, these medications might have interactions
with the anti-epileptic they are taking.
Yira: So I educate them on other forms of birth control
that way it doesn't affect the therapeutic level of the
anti-epileptic medications.
Those other forms can be condoms
or the intrauterine devices.
(gentle melancholy music)
Joanna: Before I stated seeing Dr. Lopez,
I was under the impression that, you know,
basically there was no hope.
I'm sort of worried because of the side effects
because my husband and I want to have a baby.
The medications that I was on which were Depakote,
has severe side effects on fetuses
and the baby could be born with you know,
malformations or Spina Bifida.
And all these other things
that sound horrendous when you wanna be a mom.
Dr. Lopez: Women who are diagnosed with epilepsy
they might have the fear that they won't be able
to have a normal baby, or they might not be able
to become pregnant.
Yira: So how long has it been since you had your last EEG?
Joanna: Maybe about a year ago.
At first we were just trying to get
my seizures under control.
And we sort of got them better not completely under control.
And then I told her that my husband and I wanted
to have babies and she told me,
don't worry about it we can do this.
Dr. Lopez: The ideal scenario
is to have those patients seizure-free
by the time they are ready to conceive.
However, when that doesn't happen and the patient really
wants to get pregnant, we can move along,
trying to get that pregnancy as an option.
But as you can imagine, that carries a risk.
(gentle pondering music)
Yira: The number one risk is, if she has a seizure
while you know, she's in gestation.
The fetus can suffer from hypoxia, meaning lack of oxygen.
They also have risk factors of
the baby having malformations.
Most of the Veterans with epilepsy
are taking more than one medication.
So the goal is to taper her down to just one medications
at it's lowest dose to prevent seizures
and prevent the baby from getting malformations.
Dr. Lopez: So of these women,
they stop taking the anti-epileptic
once they know that they are pregnant.
And there's a huge mistake because the risk of having
breakthrough seizures during the pregnancy is much higher
than having side effects with that anti-epileptic
that they are taking.
(gentle pondering music)
Some women can have a type of epilepsy that is genetic.
So what it means is that there is a possibility that
the baby will have epilepsy at
some given point in their development.
They're other type of epilepsy syndromes
that are not genetic.
So the babies won't have epilepsy.
(gentle guitar music)
Ideally, it would be better to have
at least six months prior,
to getting pregnant to have a
better control of the seizures.
That time is very crucial because it will help
the provider and the patient to establish the level
of the anti-epileptic that is actually working for this
patient that is keeping her free, because that level
is the same level we need to achieve once they get pregnant.
I want to see you on a monthly basis.
We want to monitor your seizure frequency.
Yira: Once the Veteran finds out that she is pregnant.
She will be making monthly visits to see her Neurologist,
just to check the level of her anti-epileptic medication.
They'll do blood work to check for Folic Acid
or the levels of Vitamin D.
Because some of the anti-epileptic medication causes
deficiencies in these vitamins.
Dr. Lopez: It's a very important thing to
keep in communication
with her obstetrician.
They need to be aware of
the current medication they're taking.
The screening that these patients need to have,
to detect malformations.
This type of population of women with epilepsy
might be better off being taken care by obstetrician.
who is specialized in high risk pregnancies.
(gentle piano music)
Women with epilepsy can have a normal vaginal delivery.
Interestingly though, if they do have a higher number
of C-sections.
Once the baby is delivered we start tapering down
the medications so that that patient doesn't have any
toxicity or toxic side effects.
Most of the anti-epileptics that are used right now
are okay to be used
when the woman is lactating the baby.
Some anti-epileptic may cause sedation.
So it is important to monitor the baby,
that they don't get sleepy.
But they can breastfeed.
(gentle guitar music)
When women reach menopause,
seizures can go in different ways.
30% of the seizures can get better,
30% of seizures can get worse,
and 30% of them are not going to change.
Also it's important to know that the hormonal replacement
pills are contradicting women with epilepsy,
especially if they are smokers
because that carries several risks.
Number one, seizures can get worse
because the estrogen is higher.
And number two, they might have risk of having strokes.
So it is important to counsel the patients about the effect
of these anti-epileptic in bone health.
The key of that is working before the problems occur
instead of treating osteoporosis.
(gentle hopeful music)
Joanna: I had a suspicion.
and so I took a pregnancy test,
and when it came back positive I took three more.
And they all came back positive.
Rogelio: And I'm sitting there on a Saturday.
Out of nowhere my sister comes in with a big cookie
and she goes, you're gonna be a father,
and I'm like no way.
Joanna: And I was excited at first.
Then I got nervous.
Then all I wanted to do was see my doctor.
Dr. Lopez: She was so thrilled
and the thing that she says is,
guess what Dr. Lopez -- those were her eyes.
And she gave me a hug and we didn't need to say anything.
Now we got there, let's move along
and make sure that this goes smooth.
Joanna: I had a perfect pregnancy.
No seizures, any kind of seizures.
It was perfect I couldn't have asked for better.
I had to see the doctor every month, since is was considered
a high risk pregnancy.
I had a Sonogram every month.
They did extra blood work,
every month I had to have blood work in order to see levels
of my medication.
We had to up the dose every month.
In the sonograms they would never seen any defects,
any stress upon the baby,
and I was 100% fine.
I was not able to carry the baby to term.
I spent,
eight months of a perfect pregnancy
and all of a sudden I had high blood pressure.
The doctor wanted a C-section, in order not to stress me out
because he didn't want me to have a seizure
while I was giving birth.
(gentle piano music)
My son is a very happy kid.
He loves to smile, he is very active.
And beside that he's like any normal two year old.
Rogelio: He's crazy.
He tells me what to do.
He tells me no, he tells me yes, come here, milk.
He tells me what to do -- and you can be dead tired,
once you come into it, dude you're not tired anymore.
He tells you Popi, and you're happy and he give you a kiss
and he goes like, love you.
It's beautiful.
Joanna: Being a Mom is what I always wanted.
I am grateful to Dr. Lopez that everything came out great.
Dr. Lopez: I think even the word of joy or happiness
is not good enough to describe how she feels.
She feels like a whole person, complete human being,
a mom, a caregiver.
She feels that nothing is left out.
Joanna: I would tell
other women, Veterans, who want to have kids
that it is possible.
You research, you take your time, you listen to your doctors
and you do what you have to do, and you can do it.
Dr. Lopez: My advice is, do not give up.
Fulfill your dreams and keep working on it
because it's worth it.
(joyful music)