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APRIL 7-9, 2009

MY LITTLE DISCLOSURE

It has taken me some time to sit down and write this entry. I certainly couldn’t do it the day of the procedure. It is now a few days later, and I am feeling much better, physically and emotionally, and am ok to recap.

Let me disclose by saying that my experience was less the norm, more the exception. There are women who have a hard time, some harder than I did. For the most part, I am told that the pre-op valium, vicodin and accompanying IV fentanyl does the trick. But you know me…I can never be the norm…so, let me take you through it, as the procedure and as the experience

A VIDEO I LIKE

I found this video on YouTube before my surgery. I think it is pretty thorough, and after going through the process, pretty accurate. A little cheesy? Ok, yes. But worth a watch.

GETTING THERE, CHECKING IN, ETC.

I was late leaving to pick my husband up, I couldn’t get off the toilet. I was anxious. (Oh, I have found that instead of reading in the bathroom I can type on my laptop.) Every time I thought I was okay, back I went. I was surprised to be so anxious and uptight. By the time I got to my husband, I felt pretty ok. He wanted to drive, but I said no. I prefer to drive. He drags the clutch in my car, makes me nuts. I didn’t want to break into some argument about his driving because I was edgy about the procedure.

TAKING MY MEDICAL HISTORY

We arrived at UCSF and checked in on our regular place on the 7th floor. The nurse came out and took my vitals, which I thought were pretty good:

  • BP: 107/53
  • HR: 66
  • Weight: 172

My eyebrows raised at my low blood pressure. It is usually 115/65 or so. I couldn’t understand how it was so low when I was antsy, but better than high. I was very happy about my weight, fully clothed. I was down 13 lbs! My initial weight in February was 185 lbs. I have been working hard to get to my wedding weight of 162 lbs, and I am close. (Actually, for those weight watchers out there, my weight on my scale at home was 170lbs that day, and I am really only 8lbs from my goal, yay!!!)

After my vitals were taken, my husband and I were taken to an exam room to wait for the doctor to come in to complete the pre-op history, procedure explanation and consent. We did not know this was going to take place. So, while a bit surprised, in the end, I think a good thing that we had some time to review the procedure with the doctor.

After about 5 minutes, the Fellow entered the room. I had a moment. One that I think a lot of people have around our age. The one where you realize that one of the doctors treating you looks like Doogie Howser. M.D.. I suppose I shouldn’t be so dramatic, he wasn’t THAT fresh-faced. He was, however, not any older than my husband or I. I don’t know why I need someone older to treat me. I actually, now that I give it more thought, think that someone younger may be more on top of it. Like in one of the last “ER” episodes of the season…Carter was getting a new kidney and Benton just happened to be on staff at Northwestern (of course, Carter was too good to get his kidney transplant at County General)…well, Benton makes the old time surgeon go through the surgery “checklist.” The guy gets all ticked off that he makes him do it, as if he is being questioned, and all the years of skill that this surgeon has are invalidated because Benton wants to review the “checklist.” Well, you know, something goes wrong, and damn if they didn’t need something off that checklist they wouldn’t have had if Benton, the young guy, hadn’t reminded the old guy to get. Rambling moral of the story, it’s ok for my doctor to be my same age. Or even younger. Maybe just have the experienced guy on standby? 🙂

OHHKKAAYY, back to the history…The Fellow pulled my profile up on the computer and did a comprehensive review of my personal and medical history. My history was complete and correct in the system already, I could see all of the fields he was looking at. He did, however, make a note in each field that we reviewed and all was current. I appreciated this as it not only shows the next user that I am current, but when it was most recently reviewed with the patient. I know some of you may say, isn’t that an oxymoron? If it is current, what does it matter what date(s) you are current on? I say no! The more discussion the better.

PROCEDURE REVIEW & RISKS

At this point, the Fellow reviewed the risks of the procedure with me. He did this rather routinely, and quickly, stating that all risks had “well less than a 1% chance” of occurring.

  • Puncture of the uterine wall
  • Severe pain causing inability to complete
  • Discovery of item causing need for extended surgery
  • Infection

The Fellow explained that the hysteroscopy is one of the safest, minimal risk procedures they can perform to determine if there are any issues preventing a successful pregnancy. It is rare for the pain of this procedure to be such that general anesthesia is required. Although a risk, it is also rare that the hysteroscope, once inserted into the uterus, can completely perforate the uterine wall. The uterus, which acts like a muscle, he said, quickly heals around where the probe punctured…much like a sea anemone. Interesting analogy. However, that could cause immediate termination of the procedure.

At this time, Dr. S, who would be performing the actual procedure, entered the room and did a quick review of the procedure again for my husband and I. I was happy that Dr. S was going to be executing the procedure since he had done the Saline Sonogram and was the one who saw the “foreign body” in the first place. Also, my uterus is retroverted and, apparently, my cervix is a bit difficult to navigate. Dr. S was quite mindful of that and remembered my case specifically. As he discussed inserting the camera to view my uterus more clearly, we talked about the possibility of increased difficulty navigating, maybe needing to dilate my cervix. We also reviewed the different options / potential need for additional surgery based on findings. Dr. S was hopeful that whatever was showing on the ultra sound would be scar tissue or something equally benign that he could easily and painlessly remove during the exploration.

Honestly? No real questions by now. They did an excellent job describing, prepping, reviewing everything as far as I could tell. It’s funny, in that way things are funny but not funny, that you feel prepared, all questions asked, but you don’t really know what to ask. Not that anything really catastrophic happened. I am not leading up to the worst news ever. It was simply excruciatingly painful. You just don’t know the little parts of the procedure that are going to take place that if you did, you may have had questions. Example, the cervical block…they don’t really tell you they are going to stick a very long needle into your cervix, multiple times. They just say, then we perform the cervical block. You are led to believe that the IV drugs will eliminate all the wrongs in the world. Not the cervical block. I think I would have asked more questions about how that was done. Also, the video…there must be one from the camera, right? Where is that? I would have asked to watch live streaming video.

Moving on.

The Fellow turned to me and asked if I had the pre-op meds, I said I did. He gave me a dixie cup of water. I took a valium and two vicodin. Herein lies the genesis of the problem. The pre-op meds should have included one toradol. For whatever reason we found out, much later in the day, Walgreen’s never filled that part of the prescription that was called in. Somehow, I missed it…that this was a 4th drug in the instructions for pre-op. I don’t know how that happened. I am ususally SO organized and buttoned up. That I missed it…for some reason, looking back on it, I thought that toradol was the generic for valium. At the same time, the Fellow should have reviewed the pre-op medications specifically, as opposed to asking if I had the pre-op medications with me. All in all, in my mind, we all kind of screwed that one up. And, as a result, this was the most painful thing I have ever felt. The pain manifested itself in several ways—pinching, cramping, burning, stabbing—which honestly leads me to think that this would have been a painful experience for me no matter what. The toradol is a NAISD used to control cramping of the uterus. Ultimately, the cramping was the residual pain I had, but the pain I had during the procedure was beyond cramping pain and discomfort.

PRE-OP PREP

On to the procedure…after taking the pre-op meds, we were told to go upstairs to the procedure floor and wait for the nurse to get us. As we sat in the waiting area, I could feel the valium and vicodin take effect. It was good, though. Not good in a, dude, this is gooood way. More, good in a “I was paying less attention to my anxiety” good way. My husband and I started chatting about silly stuff instead of IVF stuff. I can’t remember what, but I remember distinctly thinking that it was so unimportant. And that it was totally ok. Have I said recently how much I love my husband? I couldn’t ask for a better partner in life or IVF.

The nurse came to get me, and brought both of us to the prep area, where my husband helped me change into a gown, surgical cap and booties. I was CUTE! At this point, I was a little woozy, and certainly needed the help. I was also a little disappointed I had to wear booties since I went for a cute pedicure that morning 🙂 Oddly enough, they told me to undress only from the waist down, even with the gown. I was happy I had a comfortable bra on and a soft, long sleeve thermal tee shirt on. Indeed, it was cold in there, so it was nice to have the shirt on.

From here we moved into the prep area where I sat in a very comfortable lazy boy-like recliner, very comfy. The nurse, Kathy, inserted my IV and started giving my fluids. They brought the wheel chair, I kissed my husband good-bye, and off we went down the hall to the procedure room.

THE HYSTERSCOPY

Once in the room I moved onto the table, slid down and placed my thighs in the stirrups. I felt a split in the table right where my tooshie was. Dr. S dropped that part of the table out from under my toosh, and I was essentially suspended by my thighs and the tension of my back on the rest of the table. I was unsuspecting of this, so it took a moment to relax and get comfortable. If there is anything I have learned, it is that the less tense and anxious I am, the more accessible I am physically for the doctor. While it can be trying on me, the doctors and nurses, and my great husband, all work to get keep me breathing and as loose as possible.

Lying on the table as they set up, I looked around, thinking I really wanted to take in the equipment and instruments in the room. It was quite dim in there, and I was feeling a bit dim myself, but do remember a few things distinctly.

  • The nurse was on my left side next to my IV.
  • Next to the nurse was a sterile tray with vials of medication. I later learned this was fentanyl.
  • There was a set of monitors also on the left capturing my heart rate, blood pressure and oxygen levels.
  • Above me was a large, round light on a swing arm. Very stereo typical of what you would see on ER or Grey’s Anatomy.
  • At my feet was a large machine that had a color monitor and a printer. This was a new piece of equipment that the doctor and nurse were very excited to use. In fact, the technician for the machine was there, and in and out of the room when I was covered up to make sure it was functioning properly.
  • Also at my feet was a sterile tray with a speculum, the hysteroscope and betadine to clean my cervix.
  • The one thing I did not see, thankfully, was the syringe and needle that were to be used for the cervical block.

As he began the procedure, Dr. S told me that he would be talking me through every step, likely OVER talking. He said that some people didn’t like all the talking, but he wanted to make sure he was communicating as much as possible throughout so I knew what was going on. As I have said before, I am down with this approach.

He began by placing the speculum in my vagina, and really cranking that puppy open! He wanted to be able to have wide and full access. He then took the betadine and swabbed my entire cervix to sterilize the area. (Prior to swabbing, he asked if I was allergic to betadine. I really like the centers’ thoroughness when it comes to checking and double-checking for allergic reactions.) The swabbing felt like a wet, prolonged pap smear. I am not sensitive to pap smears, so this didn’t bother me…I know it gets to some people.

Following the betadine, it was time for the cervical block. Here, the doctor injects a local anesthetic around the cervix. Once the anesthetic has taken full effect, the cervix will dilate to allow the lighted scope to be inserted. Dr. S told me to expect a “little pinch” as he numbed my cervix. He also said that some people reported a metallic taste in their mouth from the medicine. HOLY COW! I didn’t just have a metallic taste in my mouth…I felt a buzz all the way up to my jaw. Yikes. But, it is done, SO I THINK…Dr. S then says, Ok, another “little pinch” on the other side. That was it. There were two injections, one into each side of my Phew, by this point I am in a cold sweat. I hear the nurse ask him if she should give me 25 of fentanyl. He says yes. I feel the drug wash over me like sun breaking through parting clouds on the beach. Yet, I still feel the pain. I am trying to think of things that relax me. Being at the beach. My husband kissing me on my shoulder. Laughing with my nephews. Going to s great spin class. Singing in choir. I still feel the pain.

I felt Dr. S place his hand on my thigh, apparently I am shaking pretty hard at this point. He tells the nurse to give me 25 more fentanyl. And, we’ll wait a few minutes to let the cervical block take effect.

Once the cervical block had taken effect, Dr. S threaded the hysteroscope through the cervix up to my uterus. At this point, I was seeing stars. I don’t recall if I was saying much, but I think there must have been a look of intense pain on my face. The nurse kept asking if I was ok, I was shaking my head and saying no. I was feeling an all-consuming, exquisite cramping I had never before felt. At the same time, I had sharp pain in the cervical area that the block did not eliminate. My sister-in-law reminded me she had a similar issue with her epidural not taking, and she felt her contractions down one side of her body.

Around this time, I remember lots of discussion between the nurse, Dr. S and myself, but not necessarily in sequence. Gas was released through the hysteroscope (to expand my uterus to give Dr. S a better view of my insides)…Dr. S was viewing my uterus through the scope, which was also visible on the video screen. I didn’t know where to look for it, and was distracted by my pain level. In retrospect, I would have liked to watch the video, it may have distracted me FROM my pain.

Once all the “prep” work is done, and the scope is in, the procedure is finished fairly quickly. I would say the entire process took about 30 minutes. For me, it was likely on the shorter side as there was not much to do once they were in there, and my pain level was so high. I was pleasantly surprised at how quickly they were done.

I must say, that through it all, Dr. S and Nurse Kathy were amazing, compassionate human beings. They did not treat me like a number, just another patient. They did not work the procedure like it was routine and commonplace. They were acutely aware of my comfort and pain the entire time. And, as objectively as I can say, I feel as though I was as tough as I could be. I was not complaining, whining or bitching at them. I remember clearly one moment when I felt hot tears streaming down my temples. I was unaware I was even crying. I was biting my lip, not speaking or making a sound, working to focus on anything but the cramping. The nurse quietly stroked my hair and gave me additional fentanyl.

POST-OP

I lay on the table for about 15 minutes waiting for the cramping to subside. The movement of the instruments in, out and around caused the most intense feelings. When I was able to get up, Kathy took me in the wheel chair back to the comfy lazy boy. Another nurse named Kathy was waiting with a heating pad, so nice. I was still in tremendous pain, doubled over, warranting, apparently, more IV fentanyl.

At this point, I asked for my husband. They wouldn’t let him in yet. Not until they had my pain under control. It would seem that many husbands become a but unruly seeing their wives in such pain. And, in turn, the wives become even more amped up. What the nurses didn’t know, is that my husband is so Zen. He would have brought such a great presence to us all, and it would have really helped me. BUT, I was in no condition to push it. They finally brought him in about 20-30 minutes later.

To end this very long story, it took a few hours for us to be released. My cramping was uncontrollable, and my pain level consistently at a 7-8. We maxed out the fentanyl I could take as my blood pressure was pretty low (somewhere around 80/45). After a couple of hours, we realized that I had not taken the toradol, the muscle relaxant. Fortunately, they were able to give me an IV dose, and after about an hour or so, I was on my way to feeling better. The other option was to stay the night in the hospital for pain management. I really felt that the fentanyl wasn’t doing the trick anyway, so I would rather be home. It is SO HARD to get rest in a hospital room. We were discharged around 5:30pm.

THE NEXT FEW DAYS

Dr. S prescribed me vicodin for the pain. This was helpful. However, I continued to have pretty bad cramps for 3 days following the procedure. Definitely worse than a regular period. I was just really nice to myself, laid on the couch, and waited until I felt better.

RESULTS

There was a bright silver lining to this experience…what had illuminated on my saline sonogram was a calcification that Dr. S was able to break up. It was nothing serious that required additional surgery, I was able to just grin and bear it. This meant there would be no healing time needed and we were clear to start our IVF cycle immediately.

PERSONAL TIPS & THOUGHTS

Pre-op Instructions & Medications.

Attire.

Post op care.

Relaxation during procedure.

Questions.

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MONDAY, MARCH 2, 2009

I am set today for my Saline Sonogram. From what I have read, it should be a really easy, painless procedure. In fact, so much so, that I told hubbo not to cancel his important meetings and that I could take myself. And, to be honest, the HSG was SO painful, I can’t see how this will be painful. Instead of dye, this is simply saline injected for contrast. The saline sonogram is used to evaluate the inner cavity of the uterus (endometrial cavity). It can also be used to discover whether either of the fallopian tubes is open. This test does not reveal any abnormalities on the outside of the uterus or on the ovaries, such as adhesions or endometriosis. From what was explained to me, I was told they would be looking for polyps, fibroids, or any “foreign matter.”

This is what we hope the sonogram looks like…dark with no light streaks or spots!

Normal Saline Sonogram

Normal Saline Sonogram

Okay, off to the procedure! More later…

Hey gang, it’s the next day, last night was ROUGH, to say the least. I am coming to learn that I am incredibly sensitive—and that my retroverted uterus makes it tough to get up in there.

The procedure was performed by Dr. Sohn, who couldn’t have been more kind, knowledgeable and gentle. In the practice they rotate docs, so this was my time to meet Dr. Sohn. Unlike many, he talked me through the entire procedure, which I appreciated. The procedure is performed as follows:

  • The procedure is performed in the office
  • A speculum is inserted into the vagina.
  • The cervix is swabbed with an antiseptic to help avoid infection that can be caused by insertion of a small, balloon-tipped catheter through the cervix.
  • The speculum is removed and a transvaginal ultrasound probe is inserted into the uterus, providing a picture on a monitor.
  • A warm saline solution is injected through the catheter, expanding the fallopian tubes to allow for better visualization.

The doctor and nurse will tell you to expect mild cramping, and to take 800mg ibuprofen an hour before the procedure. If there is any pain, it should go away after the probe is removed.

THAT IS THE EXPECTATION. I, of course, could not be the norm, and had to be in dire pain. It wasn’t as bad as the HSG, but we ran into a few issues that created more pain than anticipated. Due to my retroverted uterus, Dr. Sohn had to manipulate the cervix in several ways to insert the catheter. My opinion is that the balloon on the end of that sucker is what hurts. Following that, there was some resistance flushing in the saline. When it did flush through, it felt like the most incredible menstrual cramp where you would expect an enormous flow to exit. I felt the cramp swirl from the bottom of the right of my uterus and flow up around the top around to the bottom of the left. I visualized a large marble in there. Then I started thinking about roulette. Then I started thinking about the movie Casino Royale…then I wondered if I would ever design anything as amazing as the opening credits for that movie. ANYTHING to distract, I suppose. I laid back on that table crying silent tears down the sides of my face.

Very Cool. I pulled it together. I got to watch the whole thing on the video monitor. I didn’t actually know what I was looking at. Kind of like Rachel on Friends when she can’t see the baby on the ultra sound. At that moment, Dr. Sohn showed me a bright white spot on the monitor. It kind of looked like a AA battery. Maybe an air bubble? He asked, Have you ever had an IUD? Uh, no. Are you sure? I laughed. He said, yes, you would likely know better than I would. So he, in his words, rooted around in there for a while to see if he could change the size, shape, position…an air bubble shouldn’t remain that long.

After about 45 minutes he removed the probe, sat me up and said, I think you have a “foreign body” lodged in the lining of your uterus. Uh, EXCUSE ME? He suggested I have a hysteroscopy to determine what it was. This is where they insert a camera into the vagina to get a better look. Want to know something funny? THE FIRST THING I ASKED? Do I get any pain medication for that procedure? I was not doing one more thing that was going to hurt that much. He said he would discuss with Dr. F and they would call me later.

I WILL TRY TO GET THE IMAGES OF MY SONOGRAM SO YOU CAN SEE WHAT IT LOOKED LIKE.

MY TIPS FOR THE SALINE SONOGRAM

Procedure Time. 20-45 minutes depending on size, shape and position of uterus. Additionally, any findings can increase time to take additional images. It seemed to pass quickly for me.

Ask for meds. If you had a hard time with anything else, get a valium or vicodin or something more than advil.

Wear granny panties. I don’t know about you, but I am a thong wearer! I have found that for these appointments I need to wear full undies to wear a sanitary napkin.

Wear loose clothing. They shoot you up with TONS of saline/water. You will be bloated for about 24 hours. Since it is not in your bladder, it will need to be absorbed or leak out, so fun.

Sanitary napkin! They gave me one, but it was short. When I took a few steps, I GUSHED saline and blood. I had to stop in the lobby and change out. Be prepared.

Recovery Time. Take it easy. AS ALWAYS…I say take it easy that day, and don’t over-exert the next. The doctor will tell you that you can resume normal activities within 3 hours. Having had it done, IF you can, relax. Let someone take care of you. My hubbo made me really fresh swordfish, cous-cous and my all-time favorite SO bad for you dessert of vanilla ice cream with magic shell chocolate. He is the best.

IMPORTANT NOTE: I was completely ok to drive myself home. I had terrible cramps, but nothing worse than a very bad period by the time I left.

MONDAY, FEBRUARY 16, 2009

So we notified UCSF we were ready to get started with the IVF process. We had questions, but wanted to go to the Orientation, see how many were answered there, then follow up with Dr. F. A few days later we received a large manila envelope in the mail with our startup goods:

  • Orientation confirmation
  • IVF prep checklist
  • Set of prescriptions for both hubbo and I
  • Blood work order for both hubbo and I

Holy Cow! It was really a lot to take in. And honestly, coming as a checklist, not enough explanation for me. There was some explanation as to when some of the tests needed to be complete, but not others. I didn’t hesitate to call our coordinator Janet for questions. We are developing a very good relationship over the phone!

I’ll scan the checklist so you can see what there is, but a quick recap:

Bloodwork—Female

  • Rubella
  • Varicella (chicken pox)
  • Infectious disease screening (HIV-1, RPR, VDRL for Syphillis, Hep B surface antigen, Hep C antibody and HTLV I/II Ab) NOTE: This test is absolutely mandatory before you can proceed by federal to protect the lab employees handling sperm, eggs and embryos.
  • Cystic Fibrosis
  • CBC with platelets
  • Fasting Glucose
  • TSH or Prolactin Levels
  • Cycle Day 3 FSH and Estradial
  • Blood type and RH Screen
  • Fasting Lipid Panel

Bloodwork—Male

Infectious disease screening (HIV-1, RPR, VDRL for Syphillis, Hep B surface antigen, Hep C antibody and HTLV I/II Ab) NOTE: This test is absolutely mandatory before you can proceed by federal to protect the lab employees handling sperm, eggs and embryos.

Testing—Female

  • Pap Smear
  • Baseline Ultra Sound
  • Saline Sonogram

Testing—Male

  • Semen Analysis with Strict Morphology

Medications—Female and Male

  • Multi Vitamin with Omega 3 and Folic Acid for female
  • Doxycycline Pre-treatment (this is a one time 10 day anti-biotic treatment, as long as you remain monogamous, to be taken twice daily at the start of menses.

PHEW!!! All of this, plus the orientation and a financial consultation need to be completed prior to even starting hormone therapy.

TUESDAY, FEBRUARY 24, 200

I have never been SO excited to get my period. My husband, not so much. Before we started TTC, I was on continuous bcp, so we never had a break. THEN, when we were really trying naturally, we were on it all the time. POOR GUY. Do any of you really feel for him? No, I don’t either. 🙂 I do love him more than anything, though. Like I said before, even more than the Valentino handbag I want 🙂

As instructed, I called our coordinator, Janet {we LOOOOVE her} and got our instructions:

  1. Day One: Begin taking the Doxycycline
  2. Day Three: I needed to have all bloodwork done (dude, that is a lot of blood)
  3. Day Seven: We scheduled the saline sonogram

Okay, I feel like I am on my way. Happiness.

happy happy

happy happy