Sunday, December 21, 2008

TMI question

Major TMI, don't say you weren't warned.

Little gushes of bright red bleeding two and a half weeks after a D&C. Not a lot, maybe a teaspoon a couple times a day, but it's happened consistently every day for five or six days now. Some cramping, nothing too major, just enough to keep reminding me that hi, I'm your uterus. No fever. Normal at this point, or time to call the doctor tomorrow?

Or, more properly, time to call the doctor and yell until someone pays attention? I mentioned that I was spotting when I saw her for my post-op visit last week, and she said spotting was normal. At that point, I had only had some pink spotting for a couple days, and a single gush of red the day before, so I thought, okay, fair enough. However, this is getting beyond what I consider spotting -- it's more like a light period, and it's bright red, and it's happening every day. And honestly, I'm not overly trusting of her right now, not after the infection debacle, and I'm not that inclined to take her word for it.

I know a little bleeding probably isn't all that big a deal in the grand scheme of things, but I'm gun-shy now.

ETA: they said it was normal (OF COURSE THEY DID) unless I'm having a fever or severe pain along with it. I'm letting it go for now, but if I have to call again, there will be a stink made, oh yes indeed.

Friday, December 19, 2008

Christmas scorecard

Win: Christmas tree decorated
Lose: On December 17

Win: Christmas shopping completed
Lose: Wrapping? AHAHAHAHAHA.

Win: Knitted one lace shawl and three socks for Christmas gifts
Lose: Three socks left, and men have really big feet

Win: Baked awesome chocolate chocolate chip cookies
Lose: Ate three-quarters of awesome chocolate chocolate chip cookies

Win: Worked out a reasonable holiday in-law visit schedule
Lose: Said plan probably does not include the presence of my husband. Curse you, holiday deadlines.

Lose: I have no outside decorations this year, not even a wreath
Win: The girls are so impressed with the neighbors' lights that they don't care

Lose: No Christmas cards sent this year
Win: Sanity and fresh scar left intact after choosing not to drag all three kids to the photo studio

Monday, December 08, 2008

On zebras

You know you made the right choice when you already feel better, just three days after major abdominal surgery, than you did beforehand.

Even though the surgery turned out to be a bigger deal than previously foreseen, I'm recovering quickly. I have a 2" incision in my CS scar as well as the laparoscopy ports, which I assume is where the tube was removed, so I have some lifting restrictions and incision pain that we hadn't anticipated. However, it's still better than the pain I was having in that junked-up left tube, and I think in a couple days I'll be feeling like a new woman.

Right now, I have to say that I'm a little angry. Losing the tube shouldn't be a big deal to me, since I was having it tied off anyway, but I'm upset nonetheless. It's not so much that I lost the tube, but that the tube was diseased enough to need removal. I'll know more when the pathology comes back, but it certainly suggests the infection wasn't treated adequately. If I'd been given the right antibiotic or an ultrasound when the infection was first diagnosed, if I'd insisted on a D&C when we found all that stuff in my uterus, if I'd gotten IV antibiotics after the first recurrence, if we'd gone to surgery in early November instead of waiting around until an elective tubal ligation could get scheduled, could it have been avoided?

I understand that my doctor is conservative by nature, and that I didn't have a very high fever or highly elevated WBC. I know she didn't want to rush into potentially complicated (and expensive) surgery or IV antibiotics unless she were positive I needed them. Thing is, apparently I did need more aggressive treatment than I got, because the infection took root and ate up my tube. It might have turned out the same way even if we'd gone after it sooner and harder, but what we did wasn't enough. And I had to fight to get even that much -- she had originally wanted to wait another week after the first antibiotic failed before proceeding to ultrasound, and didn't want to do the lap unless I were having a tubal anyway.

Maybe my presentation really was unusual, and infections which do that much damage generally have more outward signs. To be fair, it's not like she ever suggested it was psychosomatic, just that she didn't see any indications to proceed, other than the pain. Still, she blew the pain off, even when I made it clear that it was affecting my life, and that I felt something was really wrong. And so I lost my tube, maybe my ability to have children, because of it. No, I didn't want to have any more, but what if I had? I shouldn't have lost that option, or have had to push so hard to get the pain taken seriously. If I hadn't wanted to get my tubes tied, this would have gone untreated for months more, and yeah, I'm not happy about that at all.

I really do like my doctor. I think she's very capable, and conservatism is usually a good quality in a physician. However, if we'd been more aggressive at any point along the way, I might have had less damage. Of course, it's a much easier call to make with the benefit of hindsight, and I do understand why she wanted to proceed with caution. Still, she and I are going to talk about whether she should not have been so quick to dismiss my symptoms, just because there wasn't a strikingly obvious cause.

Friday, December 05, 2008

The end of the fertility journey

So, now it's conclusive: I will never be pregnant again.

Yesterday, I got all teary-eyed about knowing that I would never hear another newborn baby's first cries, and I had a moment where I thought about backing out. What if I might change my mind someday, when the trauma of my last pregnancy and birth has faded?

I'm currently.. not overwhelmed exactly, just whelmed, with the three children I've got, but I imagined changing my mind when Andrew goes to preschool in a few years. I love babies, and I'm having such a good time with him right now -- those wide gummy grins make me melt. And I've discovered that I love toddlers just as much, and that there will soon come a day when nobody in the house thinks that being chased around the living room with a plastic duck is the height of entertainment. So I feel some loss to know that those stages will pass away and never come again.

Since Andrew's birth, I've been wrestling with the question of whether I've had a mild form of PPD or even PTSD. I literally get the shakes at the idea of being pregnant again, and sometimes I feel so short-tempered and emotionally fragile. I've been through a lot, so I think I'm justified in feeling this way, but I've had to ask myself if I think I can manage, or if I need to get some therapy and/or meds. I've come down on the side of trying to manage, at least until we got through this diagnostic process and found or didn't find an explanation for the chronic pelvic pain. Given all that, I've wondered if I decided to have my tubes tied out of fear, rather than for good and rational reasons, and if I would regret it in five years.

Now that it's done, I might still have regrets in five years, but I know it was the right choice. Given what they found, I might have had a very hard time getting pregnant again, and my chances of an ectopic would have been non-trivial in that messed-up left tube. The tube and the adhesions and the endometriosis would have continued to give me pain until I'd had them fixed, and I would not have done well with an IUD. Plus, in five years from now, I'll be 37, and advanced maternal age + one lost tube + internal scarring and adhesions + a history of infertility adds up to make it a moot point. So I'm really at peace now that I know another pregnancy would have been a long shot. I made the decision not to have any more children, rather than holding out hope and going through the emotional rollercoaster of infertility, and being able to make the choice makes all the difference.

This may not be the end of my reproductive troubles. Adhesions come back, and so does endometriosis, and I might get another infection from this surgery (my temperature's slightly elevated right now, which I'm watching like a hawk). There may be another lap, or even a hysterectomy, in the future, because this is my crappy body we're talking about. But we took a big step toward being done with it today, and I feel good about it now.


I went in this morning for a laparoscopy, D&C, and hysteroscopy to explore the chronic pelvic pain, plus a tubal ligation. Going in, I was concerned they wouldn't find out what was wrong, or be able to fix it, but that turned out not to be the case.

Hysteroscopy revealed a lot of endometrium, which the D&C removed, and that's being biopsied. No retained placenta, so that's good news. When Dr. Pro got to my ovaries, she found that the left fallopian tube had several cysts, extensive scarring, plus there was some nasty stuff coming out of it. Clearly, that one got badly damaged by the infection, and now we know why I had pain on my left side. She removed that tube entirely, and clipped the other one. I also had some adhesions at another point where I'd been hurting, and she snipped those out.

The big shocker, though, is that I had quite a few endometriosis implants, on the back of my uterus, on my bladder, and attached to my pelvic wall. Nobody has ever even suspected I might have endometriosis, so both Dr. Pro and I were pretty surprised about that one. She also pronounced herself "concerned" that they are already there, given that I'm hypoestrogenic from breastfeeding. She hopes that nursing will keep the endo under control until I'm ready to wean, but we may have to address that again at some future point.

I'm groggy and sore, but not too miserable physically, and very relieved mentally. I KNEW there was something wrong, and that it wasn't in my head, and I feel very vindicated at the moment. I'm not especially overjoyed about having endometriosis, but at least now we know it's there. I'll take known unpleasantness any day of the week, so even a bad diagnosis is better than none.