While I was in the hospital with Quinn, we saw multiple different MFMs, as they changed rotation once a week. There was Dr. Hart, Dr. Jacbos (same MFM I saw when we lost the twins), Dr. Contag, and Dr. Yamamura. Yamamura was amazing, and kind, and the only one who didn’t try to de-personalize Quinn. Contag was the second to last we saw. He was the one who wanted to send me home, despite the heavy ongoing bleeding, and the fact that I was dilated with prolapsed membranes. DH and I had to advocate, HARD, to stay in-patient, rather than go home and travel in twice a week for monitoring. Given my situation, we should not have needed to do that.
Contag also told us that “next time” we should get a prophylactic transvaginal cerclage (TVC). I asked him why I wouldn’t get a TAC, and he was completely dismissive of me. He wouldn’t acknowledge the difference in success rates. He wouldn’t acknowledge that a TVC is so much riskier to the baby. He wouldn’t even discuss TAC as an option, he just shut me down. Because I hadn’t yet given up on Quinn enough to think about ‘next time,’ I mentally placed him in the category of: doctors who are so enamored with their opinions that they won’t even discuss other reasonable options.
I am a member of a group called Abbyloopers. It’s for women who are considering/have TACs. Most women have suffered multiple losses, many have losses after failed TVC. Abbyloopers collects data from members on post-TAC pregnancies. They post it, for other members to see. It’s been a great source of comfort to me, seeing how high the live birth rates are for my TAC surgeon. The other day I was looking at the records from true failed TACs. There aren’t too many of those records, and most are from laproscopic TAC. There was one record where the TAC failed at 17 weeks and the baby was lost. I happened to glance at the doctor’s name. Contag. The spreadsheet also listed state, though, and the state was MD (year was 2009). I’m not in MD, so I assumed it wasn’t him. But that’s an unusual name, so I checked his bio. He was practicing in MD in 2009.
I guess I know why he was so dismissive of TAC: at least one that he performed failed. Rather than acknowledge the stacks of research on the topic, showing TAC is more successful, he decided to cut off that option.
I rely on my doctors to use their expertise, expertise built of knowledge and experience, to guide me. I also rely on them to have the humility to acknowledge their limitations. I don’t think Dr. Contag did that, and it’s highly disappointing. This is just one more reminder that I need to be my own advocate, and not simply rely upon the professionals that are supposed to be the experts, as their judgment may be just as biased as mine!
Showing posts with label cervical incompetence. Show all posts
Showing posts with label cervical incompetence. Show all posts
Tuesday, January 30, 2018
Monday, November 20, 2017
Missing a Few Things
Things that are missing:
1. My period. Can I tell you how worried I am? I've NEVER had a 14 day luteal phase, even with progesterone. There is no chance I'm pregnant. My temp has dropped. There is no bleeding. Does this mean my lining is gone? My uterus is fused shut? This surgery, all this pain, was in vain? I am not in a good place.
2. My ability to know when I have to pee. I guess the swelling is still bad enough that I can't tell if/when I have to pee. This is not good.
3. DH's STD screen. To be fair, this isn't missing, he just hasn't gone to get the blood draw. I guess this doesn't matter - no period means no RE, no RE means he'll never need his STD results. That said, I'm really frustrated, because I've just been fucking cut open and he can't find the 2 hours it will take to get a blood draw. I know he's super stressed and I know he hates needles, but that, combined with the fact that he left me mid-recovery to go to CA for a business trip does not leave me feeling supported. And that's partly not fair, because he took amazing care of me in Chicago and on the first day home, and no one's taking care of him, but it's still how I feel.
4. Seven pounds. I am officially back at middle school weight. Not being able to eat for more than a week is suboptimal. It's not what I want going into trying to get pregnant again, and it's really depressing, because I spent the last few months trying to get back in shape and now I've probably lost what little muscle I gained. Did I mention that I'm not in a good place?
5. My willingness to touch myself between my belly button and my knees! Seriously, between the incision, the abdominal pain, and the digestive pain, plus the history of uterine infection, I get scared each time I have to do things like use the bathroom and take a shower. I don't want to touch myself. It hurts, I'm worried I'll "break" something, and it's so depressing to see my body so trashed for no obvious benefit (see #1). And since we're on the TMI train, I'm sure not ready yet, but I am so scared about having sex again. I know the TAC will have no impact, but I've got this irrational fear of pain or problems during sex. This sucks.
1. My period. Can I tell you how worried I am? I've NEVER had a 14 day luteal phase, even with progesterone. There is no chance I'm pregnant. My temp has dropped. There is no bleeding. Does this mean my lining is gone? My uterus is fused shut? This surgery, all this pain, was in vain? I am not in a good place.
2. My ability to know when I have to pee. I guess the swelling is still bad enough that I can't tell if/when I have to pee. This is not good.
3. DH's STD screen. To be fair, this isn't missing, he just hasn't gone to get the blood draw. I guess this doesn't matter - no period means no RE, no RE means he'll never need his STD results. That said, I'm really frustrated, because I've just been fucking cut open and he can't find the 2 hours it will take to get a blood draw. I know he's super stressed and I know he hates needles, but that, combined with the fact that he left me mid-recovery to go to CA for a business trip does not leave me feeling supported. And that's partly not fair, because he took amazing care of me in Chicago and on the first day home, and no one's taking care of him, but it's still how I feel.
4. Seven pounds. I am officially back at middle school weight. Not being able to eat for more than a week is suboptimal. It's not what I want going into trying to get pregnant again, and it's really depressing, because I spent the last few months trying to get back in shape and now I've probably lost what little muscle I gained. Did I mention that I'm not in a good place?
5. My willingness to touch myself between my belly button and my knees! Seriously, between the incision, the abdominal pain, and the digestive pain, plus the history of uterine infection, I get scared each time I have to do things like use the bathroom and take a shower. I don't want to touch myself. It hurts, I'm worried I'll "break" something, and it's so depressing to see my body so trashed for no obvious benefit (see #1). And since we're on the TMI train, I'm sure not ready yet, but I am so scared about having sex again. I know the TAC will have no impact, but I've got this irrational fear of pain or problems during sex. This sucks.
Friday, November 17, 2017
TAC - Part II
Saturday
Somewhere in the early hours of the morning, after the reglan kicked in, the pain got so bad I gave up and used the pump. I knew it would prolong the pain, but I literally couldn't draw a full breath and was too exhausted to care. It took the edge off, nothing more. That said, I got more pain relief this time than I did when I lost the twins and was on narcotics and NSAIDs, so that was beneficial. Sometime in the morning, the nurse came. I still had a catheter, but really felt like I needed to urinate, so I asked her to remove it so I could go. Initially she just asked me if I'd tried to push to pee with the catheter in - rather than helping to remove. Eventually she took it out, and DH helped me stumble to the bathroom. I peed, which caused burning in my incision, but otherwise was fine. The next time I peed, about an hour later, I got the explanation for why the catheter hadn't worked: a decent amount of air came out along with urine. That would have impacted the catheter, and wasn't good for me. Once again, the UC nursing staff missed something.
Eventually Dr. Haney came in. He said the cerclage itself had gone well - 3 bands placed, but then commented that I had serious digestive system issues. Apparently he thought my colon was the worst he'd seen in 20+ years - it was so bad that he called the intern to scrub in so she could feel it. I'm not going to lie, hearing that some random intern had her hand in me and squeezed my now utterly agonizing colon really irritated me. First, it's rather rapey to do that to an unconscious patient, and second, the last damn thing my poor colon needed was someone else messing with it. Haney commented that his wife has similar issues, and her GI encouraged her to do a colon resection to address it. This is not the first time major GI surgery has been suggested to me. Haney said the same thing my past doctor did - wait until it's a lifestyle issue, then address.
I asked Haney for an ongoing rx for Reglan for the next few days, and he agreed because it would help restart my digestive system. I also asked for ambien, as I find my sleep schedule gets really messed up from anesthesia. He wrote both prescriptions, told me that he'd write me out of work on STD for a month, although I could return earlier, and said I was good to discharge. I badly wish I had felt better so I could have celebrated how well the TAC went, but I was in such bad shape I didn't care.
Originally I had booked a room at the LaQuinta because the Hyatt was much more expensive. At this point, with the agony I was in, I had DH change reservations. The Hyatt was great, got a room with early check in for us. I was discharged around 1. I had been worried that with my "23 hour hold" at the hospital, they might discharge me before I had anywhere to go, but the day nurse said she'd be happy to hold me as long as needed - it meant she probably wouldn't have to admit another patient before her shift ended! My discharge instructions were a hot mess. Despite my chart saying everywhere that I'm allergic to NSAIDs, discharge instructions said to use percocet and aspirin every 4 to 6 hours. There were other errors in the instructions but that one was the truly dangerous one. One more example of how bad the University of Chicago hospital was.
DH had to help me get dressed, between the surgical and intestinal pain, I couldn't even raise my feet up to put my own socks on. A hospital "patient transport" person was assigned and was going to take us directly to the car in the parking structure. Since I get cold extremely easy, and I was terrified of shivering with the abdominal incision, going out into the 30 degree structure seemed a poor choice. DH asked the transporter to please leave me somewhere warm while he brought the car around. That concept took a long time to convey, but the lady was super nice.
The Hyatt had a wheelchair, so DH checked in, got the wheelchair, and then got us and our stuff up to our room. We were in a block with a whole foods and a nearby CVS, so DH left to get some food for me and to get my prescriptions. At this point I was still having to use the percocet every 4 hours, and the tylenol every 6. DH brought back great food options, but all I could get down were a few bites and then the pain was too much and I stopped. I think I watched some Law and Order, and went to sleep. DH went back out and got himself some deep dish Chicago pizza.
During all of this time, the surgical incision was sore, and it burned like mad when I had to pee, but wasn't horrid. The entire length of my sigmoid colon felt like it was being stabbed repeatedly, and my whole abdomen was painful to the touch. I couldn't pass gas in either direction, or get anything moving in my GI system, and it was awful.
Sunday
We had planned to drive home Sunday. Although I still couldn't take a full breath, and didn't want to contemplate 8 hours in the car, I was terrified that eventually my digestive system was going to let loose, and I didn't want a blow out in the car. DH loaded me up on meds, went and bought Depends and wet wipes as an emergency measure, and we set off around 10-11. Talk about reaching a new low.
The drive was miserable. One side effect of all the swelling was that I couldn't feel the need to urinate. I was also not sure I could make it from the car to a restroom, so I was really worried. About 5.5-6 hours in, the pain got worse despite the meds and worst of all, I started to have muscle spams down the left side of my abdominal muscles, where the pain was already the worst. When it was happening, I couldn't breathe at all. Eventually it got so bad I told DH he needed to pull over. I knew if I couldn't stop the spams, I would need to find a hospital because I wasn't making it home. I legit thought I was at risk of lung collapse or just hypoxia from being unable to draw a breath. I also thought I might need to pee, but there seemed to be absolutely no way I could get from the car to a potty. DH stopped at a random diner somewhere in the middle of nowhere in Wisconsin. I asked him to figure out where the restrooms were, and he did, then moved the car as close as possible and helped escort me in. Standing up and moving, as hard as it was, helped, and peeing helped even more. I still couldn't breathe deeply, but the spasms stopped. Random Wisconsin diner, thank you - I owe you more than you know! We decided I would take an ambien to see if I could sleep, since part of the problem was muscle tension (confession: DH drives a bit aggressively, and when I know that's happening, I freak out and tense up - that was part of the issue).
I texted my family waiting at home to ask for specific food and to ask them to put a sheet on the sofa so I could sleep on the main floor if I couldn't walk down stairs, and to make up our other guest bed in case I could walk downstairs. Our waterbed, in the master bedroom upstairs, was a clear impossibility because it's low to the floor and hard to get out of normally!
We arrived, I had a bit of food, crashed on the sofa, then shuffled downstairs to the guest bedroom and crashed there. DH made himself a bed on the floor next to me, and set alarms to make sure I woke up to take pain meds at all the right times.
Monday
Monday was more of the same. Some pain control with the meds, but still tough to take a full breath. I got my first shower. DH had to help me with my socks again, but I dressed myself otherwise. At this point I'd been on Reglan since Saturday morning, AND been taking peri-colace, miralax, and cirtucel. Still, no movemenet until just before bedtime. I can still no longer tell when I need to pee, and there's still intense burning and bruising along my incision line.
Tuesday
GI swelling is finally starting to reduce on the right side of my abdomen, and the pain is dropping a bit. Surgical site pain is getting better. DH gets busy with work, so I get a shower on my own with no issue. GI floodgates open and I'm constantly using the toilet, which in turn triggers other problems. Stop taking percocet mid-day. Remain on Tylenol 325 every 4 hours. Make sure to get up and walk laps around the house every hour, and it's going ok.
Wednesday
DH leaves for a work trip. GI pain continues to reduce, surgical pain is clearly getting better. Swelling down - can see my hip bones again! Able to move my hips using my ab muscles for the first time when rolling over in bed! Very excited. Constant bathroom trips after severe lack of bathroom trips has resulted in a thrombosed hemorrhoid. Also, the constant wiping gets the skin very irritated. I find myself wondering how in the hell people have/enjoy anal sex. Pain from an entirely new part of my GI system is not wanted! Push Tylenol out to once every 6 hours. Am finally able to take full breaths with only mild pain! No longer burning around incision site and incision bruising is gone, although what appears to be a thumb-sized blood blister remains on the left.
Thursday
Thursday AM goes well. Similar to Wednesday. Hemorrhoid pain getting worse, GI pain getting better. About 5 pm, all that changes, and I'm back to knives stabbing my colon and an inability to take a full breath. At this point I'm only on Tylenol and I don't want to change that and add percocet back, so I try to solider through. I have to cough, and despite holding a pillow to my stomach, I start my incision bleeding. Can't stand to be touched on the left side of my abs. I am unable to sleep because the pain is so bad when lying down that I can't breathe at all. Drowse after midnight while propped up in bed with pillows.
Friday - well, I guess I'll split this into 3 posts! So far I've gotten a shower and been off all pain meds, but still have a stabby colon. I will not be returning to work Monday like I'd planned, nor will I get to cycle again in November. I'm sad, but my body is really jacked up and needs time to heal. Hopefully part three of this note will be better.
Oh - and as a side note, remember the mice? E-gads, they've taken over. :( Dad has trapped 10 since he arrived on Saturday. Bless my amazing family for dealing with me and all of this.
Somewhere in the early hours of the morning, after the reglan kicked in, the pain got so bad I gave up and used the pump. I knew it would prolong the pain, but I literally couldn't draw a full breath and was too exhausted to care. It took the edge off, nothing more. That said, I got more pain relief this time than I did when I lost the twins and was on narcotics and NSAIDs, so that was beneficial. Sometime in the morning, the nurse came. I still had a catheter, but really felt like I needed to urinate, so I asked her to remove it so I could go. Initially she just asked me if I'd tried to push to pee with the catheter in - rather than helping to remove. Eventually she took it out, and DH helped me stumble to the bathroom. I peed, which caused burning in my incision, but otherwise was fine. The next time I peed, about an hour later, I got the explanation for why the catheter hadn't worked: a decent amount of air came out along with urine. That would have impacted the catheter, and wasn't good for me. Once again, the UC nursing staff missed something.
Eventually Dr. Haney came in. He said the cerclage itself had gone well - 3 bands placed, but then commented that I had serious digestive system issues. Apparently he thought my colon was the worst he'd seen in 20+ years - it was so bad that he called the intern to scrub in so she could feel it. I'm not going to lie, hearing that some random intern had her hand in me and squeezed my now utterly agonizing colon really irritated me. First, it's rather rapey to do that to an unconscious patient, and second, the last damn thing my poor colon needed was someone else messing with it. Haney commented that his wife has similar issues, and her GI encouraged her to do a colon resection to address it. This is not the first time major GI surgery has been suggested to me. Haney said the same thing my past doctor did - wait until it's a lifestyle issue, then address.
I asked Haney for an ongoing rx for Reglan for the next few days, and he agreed because it would help restart my digestive system. I also asked for ambien, as I find my sleep schedule gets really messed up from anesthesia. He wrote both prescriptions, told me that he'd write me out of work on STD for a month, although I could return earlier, and said I was good to discharge. I badly wish I had felt better so I could have celebrated how well the TAC went, but I was in such bad shape I didn't care.
Originally I had booked a room at the LaQuinta because the Hyatt was much more expensive. At this point, with the agony I was in, I had DH change reservations. The Hyatt was great, got a room with early check in for us. I was discharged around 1. I had been worried that with my "23 hour hold" at the hospital, they might discharge me before I had anywhere to go, but the day nurse said she'd be happy to hold me as long as needed - it meant she probably wouldn't have to admit another patient before her shift ended! My discharge instructions were a hot mess. Despite my chart saying everywhere that I'm allergic to NSAIDs, discharge instructions said to use percocet and aspirin every 4 to 6 hours. There were other errors in the instructions but that one was the truly dangerous one. One more example of how bad the University of Chicago hospital was.
DH had to help me get dressed, between the surgical and intestinal pain, I couldn't even raise my feet up to put my own socks on. A hospital "patient transport" person was assigned and was going to take us directly to the car in the parking structure. Since I get cold extremely easy, and I was terrified of shivering with the abdominal incision, going out into the 30 degree structure seemed a poor choice. DH asked the transporter to please leave me somewhere warm while he brought the car around. That concept took a long time to convey, but the lady was super nice.
The Hyatt had a wheelchair, so DH checked in, got the wheelchair, and then got us and our stuff up to our room. We were in a block with a whole foods and a nearby CVS, so DH left to get some food for me and to get my prescriptions. At this point I was still having to use the percocet every 4 hours, and the tylenol every 6. DH brought back great food options, but all I could get down were a few bites and then the pain was too much and I stopped. I think I watched some Law and Order, and went to sleep. DH went back out and got himself some deep dish Chicago pizza.
During all of this time, the surgical incision was sore, and it burned like mad when I had to pee, but wasn't horrid. The entire length of my sigmoid colon felt like it was being stabbed repeatedly, and my whole abdomen was painful to the touch. I couldn't pass gas in either direction, or get anything moving in my GI system, and it was awful.
Sunday
We had planned to drive home Sunday. Although I still couldn't take a full breath, and didn't want to contemplate 8 hours in the car, I was terrified that eventually my digestive system was going to let loose, and I didn't want a blow out in the car. DH loaded me up on meds, went and bought Depends and wet wipes as an emergency measure, and we set off around 10-11. Talk about reaching a new low.
The drive was miserable. One side effect of all the swelling was that I couldn't feel the need to urinate. I was also not sure I could make it from the car to a restroom, so I was really worried. About 5.5-6 hours in, the pain got worse despite the meds and worst of all, I started to have muscle spams down the left side of my abdominal muscles, where the pain was already the worst. When it was happening, I couldn't breathe at all. Eventually it got so bad I told DH he needed to pull over. I knew if I couldn't stop the spams, I would need to find a hospital because I wasn't making it home. I legit thought I was at risk of lung collapse or just hypoxia from being unable to draw a breath. I also thought I might need to pee, but there seemed to be absolutely no way I could get from the car to a potty. DH stopped at a random diner somewhere in the middle of nowhere in Wisconsin. I asked him to figure out where the restrooms were, and he did, then moved the car as close as possible and helped escort me in. Standing up and moving, as hard as it was, helped, and peeing helped even more. I still couldn't breathe deeply, but the spasms stopped. Random Wisconsin diner, thank you - I owe you more than you know! We decided I would take an ambien to see if I could sleep, since part of the problem was muscle tension (confession: DH drives a bit aggressively, and when I know that's happening, I freak out and tense up - that was part of the issue).
I texted my family waiting at home to ask for specific food and to ask them to put a sheet on the sofa so I could sleep on the main floor if I couldn't walk down stairs, and to make up our other guest bed in case I could walk downstairs. Our waterbed, in the master bedroom upstairs, was a clear impossibility because it's low to the floor and hard to get out of normally!
We arrived, I had a bit of food, crashed on the sofa, then shuffled downstairs to the guest bedroom and crashed there. DH made himself a bed on the floor next to me, and set alarms to make sure I woke up to take pain meds at all the right times.
Monday
Monday was more of the same. Some pain control with the meds, but still tough to take a full breath. I got my first shower. DH had to help me with my socks again, but I dressed myself otherwise. At this point I'd been on Reglan since Saturday morning, AND been taking peri-colace, miralax, and cirtucel. Still, no movemenet until just before bedtime. I can still no longer tell when I need to pee, and there's still intense burning and bruising along my incision line.
Tuesday
GI swelling is finally starting to reduce on the right side of my abdomen, and the pain is dropping a bit. Surgical site pain is getting better. DH gets busy with work, so I get a shower on my own with no issue. GI floodgates open and I'm constantly using the toilet, which in turn triggers other problems. Stop taking percocet mid-day. Remain on Tylenol 325 every 4 hours. Make sure to get up and walk laps around the house every hour, and it's going ok.
Wednesday
DH leaves for a work trip. GI pain continues to reduce, surgical pain is clearly getting better. Swelling down - can see my hip bones again! Able to move my hips using my ab muscles for the first time when rolling over in bed! Very excited. Constant bathroom trips after severe lack of bathroom trips has resulted in a thrombosed hemorrhoid. Also, the constant wiping gets the skin very irritated. I find myself wondering how in the hell people have/enjoy anal sex. Pain from an entirely new part of my GI system is not wanted! Push Tylenol out to once every 6 hours. Am finally able to take full breaths with only mild pain! No longer burning around incision site and incision bruising is gone, although what appears to be a thumb-sized blood blister remains on the left.
Thursday
Thursday AM goes well. Similar to Wednesday. Hemorrhoid pain getting worse, GI pain getting better. About 5 pm, all that changes, and I'm back to knives stabbing my colon and an inability to take a full breath. At this point I'm only on Tylenol and I don't want to change that and add percocet back, so I try to solider through. I have to cough, and despite holding a pillow to my stomach, I start my incision bleeding. Can't stand to be touched on the left side of my abs. I am unable to sleep because the pain is so bad when lying down that I can't breathe at all. Drowse after midnight while propped up in bed with pillows.
Friday - well, I guess I'll split this into 3 posts! So far I've gotten a shower and been off all pain meds, but still have a stabby colon. I will not be returning to work Monday like I'd planned, nor will I get to cycle again in November. I'm sad, but my body is really jacked up and needs time to heal. Hopefully part three of this note will be better.
Oh - and as a side note, remember the mice? E-gads, they've taken over. :( Dad has trapped 10 since he arrived on Saturday. Bless my amazing family for dealing with me and all of this.
TAC Experience - Part I
This will probably be long, so I'l split into two posts, but I wanted to capture what I remember from my TAC experience. Please be warned, I had some unusual complications, so this isn’t an easy/happy or normal story. Unless you have digestive issues like me, don't assume this will happen to you!
Tuesday
This was our twins’ first birthday. I had wanted to recognize the day by writing a letter to them and burning it in our wood stove after having dinner out with DH. Instead, DH decided over the weekend that we need to recaulk/re grout our huge master shower. We limited it to caulking, but it was still a four day project. I spent most of my day getting the house ready for my dad and step mom, stripping caulk from the shower, and then trying to clean some of the innumerable bits of stripped caulk from the bathroom floor. I didn’t have time to get ready for dinner and never vaguely had a chance to think about my letter or the fire. The priority was having a shower when I got home from the hospital and wouldn’t be able to move. As it was the bathroom was a complete mess when we left, with tools, chemicals, and bags of supplies everywhere, plus caulk scrapings everywhere but the floor. Not a good day.
Wednesday
I got one last good workout in, and we headed out to Chicago. Just to add to the fun, as I went to throw out all the trash in the house before leaving, I discovered that we had mice who and apparently arrived en-masse and chewed through our trash bags. Sent an apology note to dad and SM and left anyway, as there wasn’t much we could do.
I drove for the first 4-5 hours while DH worked, then he took over. Chicago traffic was awful. We got to our hotel around 6, and got upgraded. Highly recommend the place: The Guesthouse, in Uptown. We walked to dinner. I got a rice, kale, and sweet potato bowl with Thai peanut sauce and it was terrible - inedibly salty. I was too hungry/hangry at that point to find a new place to eat (it was also below freezing, windy, and a 3/4 mile walk to our hotel), but the manager refunded my meal. DH took me to Baskin Robbins, and then we returned to the hotel for the best night of hotel sleep I’ve ever had.
Thursday
I had grand plans to do something fun in Chicago this day. Instead I had a two hour work meeting, we got breakfast at this amazing cafe, then spent way too long driving to find the hospital complex and the hotel for afterward. We got Thai for dinner and it was good. Side note: it’s really hard to find gluten free vegetarian food in Uptown. I was really disappointed. I was NPO after midnight.
Friday
I had to check in at 7:30, and we were worried about traffic, so I was up early and got a shower. Didn’t hit any traffic. Parked in structure A ($18/day with validation) and went in to the DCAM same day/ambulatory surgery for check in. They gave me a number so DH could track my status on the monitors, and then I waited.
Just after 7:30, a pre-op nurse came and got me. She confirmed my name, dob, allergies, and had me give a urine sample for a pregnancy test. I got three bracelets - one for allergies (it just said “multiple” since she didn’t write them all down), two identifying me. Then I changed and put all of my clothes and belongings into a plastic garment bag. Next up was an IV. I’m allergic to adhesives and they had very few choices for me, far less than my local hospitals. That was suboptimal. I was told my temperature was 99, which is very high for me, but not high enough to postpone surgery. I suppose that might have been a harbinger.
Once I was set with a warm blanket, DH came back and kept me company. First a resident came in, confirmed the surgery I’d be having, and then had me pull up my hospital gown so she could write her initials on my abdomen. Apparently they do this to make sure they’re operating on the right part of the right patient? Either way, I’m not thrilled still having her initials on me as I don’t really want to scrub hard that close to the incision site and the ink is. . . Tenacious!
A research assistant came in and asked if they could take a tissue sample during surgery for research on ovarian cancer. I asked what the risks were and she couldn’t answer. That lack of professionalism plagued my stay. I felt oddly pressured, but as the daughter of a breast cancer survivor, agreed.
The anesthesiologist came in and told me that since I’m not pregnant, I had the choice of general or spinal. He also said that if I was pregnant, Haney would require general, to make sure I didn’t move at all. Most importantly, he told me that if I did the spinal, he could still use enough profofol that I wouldn’t know what’s going on, but he wouldn’t have to intubate me. That sounded good to me.
Haney came in, and reiterated a lot of what he’d told us during our consult. Then it was go time. I got one last hug from DH, and was wheeled into the OR. Everyone kept talking about what an ideal patient I am - I guess I have a nice spine for a spinal! :) I met all the OR nurses, got moved onto the operating table, got the ekg leads placed. A nurse set up a surgical instrument tray/stand with pillows, and the anesthesiologist had me sit up and lean over it. I remember him asking about glove sizing and that’s it.
Dr. Haney tells me that at one point during the surgery when they were tugging very hard, they heard my voice from over the drape asking to be knocked out further. I’m thrilled to report I don’t recall.
To be honest, I don’t recall waking in recovery, either. The first thing I remember is the feeling of being wheeled somewhere. Someone told DH or I that I had a pain pump to use, and then I was left in my “observation” room.
When I was lucid, I was in an insane amount of pain. Not from the surgical site, although I could sure feel that, but from my digestive system. It felt like someone was stabbing knives through my colon, constantly. I know my body well enough to be aware that’s what happens when my colon shuts down and gas starts to build. It was so bad I couldn’t draw a full breath. I knew that narcotics would make it worse, so I didn’t want to use the pain pump. DH and I asked, over and over again, for hours, for an alternative, and were just repeatedly told to push the button on the pump. It was an awful frustrating experience, to be in absolute agony, unable to breathe, and we couldn’t even get a doctor to come tell us there were no other options than narcotics.
Somewhere in there, I started throwing up. Puking with an abdominal incision is a special kind of hell. They wanted me on zofran, but that causes the same digestive problems, so that was a no-go. There are three things I know I can't have if I want my digestive system to work: sudafed, zofran, and narcotics. The hospital had me on two of the three.
After hours, the resident on call came in and told me to take the pain pump and the zofran, in a pissed off tone. I told her the problem wasn’t surgical pain, it was digestive, that zofran and narcotics would worsen it. She didn’t say anything useful. I asked for reglan instead of zofran, because reglan will cause the digestive system to speed up, doing exactly what I needed, and will reduce nausea. She agreed to that and left.
That was my night.
Tuesday
This was our twins’ first birthday. I had wanted to recognize the day by writing a letter to them and burning it in our wood stove after having dinner out with DH. Instead, DH decided over the weekend that we need to recaulk/re grout our huge master shower. We limited it to caulking, but it was still a four day project. I spent most of my day getting the house ready for my dad and step mom, stripping caulk from the shower, and then trying to clean some of the innumerable bits of stripped caulk from the bathroom floor. I didn’t have time to get ready for dinner and never vaguely had a chance to think about my letter or the fire. The priority was having a shower when I got home from the hospital and wouldn’t be able to move. As it was the bathroom was a complete mess when we left, with tools, chemicals, and bags of supplies everywhere, plus caulk scrapings everywhere but the floor. Not a good day.
Wednesday
I got one last good workout in, and we headed out to Chicago. Just to add to the fun, as I went to throw out all the trash in the house before leaving, I discovered that we had mice who and apparently arrived en-masse and chewed through our trash bags. Sent an apology note to dad and SM and left anyway, as there wasn’t much we could do.
I drove for the first 4-5 hours while DH worked, then he took over. Chicago traffic was awful. We got to our hotel around 6, and got upgraded. Highly recommend the place: The Guesthouse, in Uptown. We walked to dinner. I got a rice, kale, and sweet potato bowl with Thai peanut sauce and it was terrible - inedibly salty. I was too hungry/hangry at that point to find a new place to eat (it was also below freezing, windy, and a 3/4 mile walk to our hotel), but the manager refunded my meal. DH took me to Baskin Robbins, and then we returned to the hotel for the best night of hotel sleep I’ve ever had.
Thursday
I had grand plans to do something fun in Chicago this day. Instead I had a two hour work meeting, we got breakfast at this amazing cafe, then spent way too long driving to find the hospital complex and the hotel for afterward. We got Thai for dinner and it was good. Side note: it’s really hard to find gluten free vegetarian food in Uptown. I was really disappointed. I was NPO after midnight.
Friday
I had to check in at 7:30, and we were worried about traffic, so I was up early and got a shower. Didn’t hit any traffic. Parked in structure A ($18/day with validation) and went in to the DCAM same day/ambulatory surgery for check in. They gave me a number so DH could track my status on the monitors, and then I waited.
Just after 7:30, a pre-op nurse came and got me. She confirmed my name, dob, allergies, and had me give a urine sample for a pregnancy test. I got three bracelets - one for allergies (it just said “multiple” since she didn’t write them all down), two identifying me. Then I changed and put all of my clothes and belongings into a plastic garment bag. Next up was an IV. I’m allergic to adhesives and they had very few choices for me, far less than my local hospitals. That was suboptimal. I was told my temperature was 99, which is very high for me, but not high enough to postpone surgery. I suppose that might have been a harbinger.
Once I was set with a warm blanket, DH came back and kept me company. First a resident came in, confirmed the surgery I’d be having, and then had me pull up my hospital gown so she could write her initials on my abdomen. Apparently they do this to make sure they’re operating on the right part of the right patient? Either way, I’m not thrilled still having her initials on me as I don’t really want to scrub hard that close to the incision site and the ink is. . . Tenacious!
A research assistant came in and asked if they could take a tissue sample during surgery for research on ovarian cancer. I asked what the risks were and she couldn’t answer. That lack of professionalism plagued my stay. I felt oddly pressured, but as the daughter of a breast cancer survivor, agreed.
The anesthesiologist came in and told me that since I’m not pregnant, I had the choice of general or spinal. He also said that if I was pregnant, Haney would require general, to make sure I didn’t move at all. Most importantly, he told me that if I did the spinal, he could still use enough profofol that I wouldn’t know what’s going on, but he wouldn’t have to intubate me. That sounded good to me.
Haney came in, and reiterated a lot of what he’d told us during our consult. Then it was go time. I got one last hug from DH, and was wheeled into the OR. Everyone kept talking about what an ideal patient I am - I guess I have a nice spine for a spinal! :) I met all the OR nurses, got moved onto the operating table, got the ekg leads placed. A nurse set up a surgical instrument tray/stand with pillows, and the anesthesiologist had me sit up and lean over it. I remember him asking about glove sizing and that’s it.
Dr. Haney tells me that at one point during the surgery when they were tugging very hard, they heard my voice from over the drape asking to be knocked out further. I’m thrilled to report I don’t recall.
To be honest, I don’t recall waking in recovery, either. The first thing I remember is the feeling of being wheeled somewhere. Someone told DH or I that I had a pain pump to use, and then I was left in my “observation” room.
When I was lucid, I was in an insane amount of pain. Not from the surgical site, although I could sure feel that, but from my digestive system. It felt like someone was stabbing knives through my colon, constantly. I know my body well enough to be aware that’s what happens when my colon shuts down and gas starts to build. It was so bad I couldn’t draw a full breath. I knew that narcotics would make it worse, so I didn’t want to use the pain pump. DH and I asked, over and over again, for hours, for an alternative, and were just repeatedly told to push the button on the pump. It was an awful frustrating experience, to be in absolute agony, unable to breathe, and we couldn’t even get a doctor to come tell us there were no other options than narcotics.
Somewhere in there, I started throwing up. Puking with an abdominal incision is a special kind of hell. They wanted me on zofran, but that causes the same digestive problems, so that was a no-go. There are three things I know I can't have if I want my digestive system to work: sudafed, zofran, and narcotics. The hospital had me on two of the three.
After hours, the resident on call came in and told me to take the pain pump and the zofran, in a pissed off tone. I told her the problem wasn’t surgical pain, it was digestive, that zofran and narcotics would worsen it. She didn’t say anything useful. I asked for reglan instead of zofran, because reglan will cause the digestive system to speed up, doing exactly what I needed, and will reduce nausea. She agreed to that and left.
That was my night.
Friday, October 20, 2017
Fetal Membranes and Alpha Lipoic Acid, Continued
Before I end my treatise on fetal membranes, I thought it would be helpful to share an image of the layers of the fetal membrane. This is from a journal article, Extracellular Matrix Dynamics and Fetal Membrane Rupture (2013), Strauss, J. F.
Here's a quote from the article that I found telling: "It has been hypothesized that fetal membrane rupture involves a sequence of events that starts with distension and loss of elasticity, separation of the chorion and amnion, disruption of the chorion, distension and herniation of the amnion, and finally amnion rupture. This proposed sequence of events appears to be the result of structural alterations in ECM with resulting biomechanical changes in the membranes, primarily the amnion, which is the strongest component of the fetal membranes. Since cervical insufficiency is often associated with PPROM, it is likely that preterm cervical changes facilitate the unscheduled rupture of membranes in PPROM."
There are other articles out there that talk through specific dynamics of what happens to the various layers, if you're interested.
Finally, let's talk alpha lipoic acid (ALA) again.
I realized it might be useful to list the dosage that I've found in the research for alpha lipoic acid as it relates to prevention of pprom. The best study I've found so far is actually focused on prevention of PTL, and it found a massive reduction in risk from a daily dosage of the following: magnesium 225 mg, alpha lipoic acid 100 mg and vitamin B6 1.3 mg - 1x/day. Now, let me say that the reduction is so massive that I am really suspicious of the article. Either they're not correctly describing the population of study participants, or this is too good to be true. But it's probably worth a read if you're interested in research on this topic. Study: Efficacy of Magnesium and Alpha Lipoic Acid Supplementation in Reducing Premature Uterine Contractions (2014), Parente, et. al. I'll probably do a lot more reading on this topic and post anything I discover in the future.
The majority of studies I've found looking at alpha lipoic dosage in humans related to patients with diabetes. In that case, I am routinely reading dosages of 600 mg/day.
I also found a study that made my heart go pitty-patter: pregnant women with subchorionic hemorrhage. Those given both alpha-lipoic acid (300 mg 2x/day) resbsorbed the SCH more quickly than those on progesterone alone. See: Alpha Lipoic Acid (ALA) effects on subchorionic hematoma: preliminary clinical results.
I also found a single study looking at ALA with IVF patients. It found a higher number of grade 1 embryos in patients taking ALA plus myo-inositol . See: Effect of myo-inositol and alpha-lipoic acid on oocyte quality in polycystic ovary syndrome non-obese women undergoing in vitro fertilization: a pilot study. While that study is interesting, the population is small and using the patients as their own controls is really problematic - so take the results with an entire shaker of salt.
Beyond that, there are many studies using rats and suggesting that ALA protects against reactive oxygen species (ROS) which are correlated to damage to DNA and RNA and are considered agents of cell death. All sounds good, right? Sure, but be aware that ALA is also associated with effects on fetal hormones (protective effects, but effects none the less). In other words, do your own research and think very carefully before you consider taking it.
Here's a quote from the article that I found telling: "It has been hypothesized that fetal membrane rupture involves a sequence of events that starts with distension and loss of elasticity, separation of the chorion and amnion, disruption of the chorion, distension and herniation of the amnion, and finally amnion rupture. This proposed sequence of events appears to be the result of structural alterations in ECM with resulting biomechanical changes in the membranes, primarily the amnion, which is the strongest component of the fetal membranes. Since cervical insufficiency is often associated with PPROM, it is likely that preterm cervical changes facilitate the unscheduled rupture of membranes in PPROM."
There are other articles out there that talk through specific dynamics of what happens to the various layers, if you're interested.
Finally, let's talk alpha lipoic acid (ALA) again.
I realized it might be useful to list the dosage that I've found in the research for alpha lipoic acid as it relates to prevention of pprom. The best study I've found so far is actually focused on prevention of PTL, and it found a massive reduction in risk from a daily dosage of the following: magnesium 225 mg, alpha lipoic acid 100 mg and vitamin B6 1.3 mg - 1x/day. Now, let me say that the reduction is so massive that I am really suspicious of the article. Either they're not correctly describing the population of study participants, or this is too good to be true. But it's probably worth a read if you're interested in research on this topic. Study: Efficacy of Magnesium and Alpha Lipoic Acid Supplementation in Reducing Premature Uterine Contractions (2014), Parente, et. al. I'll probably do a lot more reading on this topic and post anything I discover in the future.
The majority of studies I've found looking at alpha lipoic dosage in humans related to patients with diabetes. In that case, I am routinely reading dosages of 600 mg/day.
I also found a study that made my heart go pitty-patter: pregnant women with subchorionic hemorrhage. Those given both alpha-lipoic acid (300 mg 2x/day) resbsorbed the SCH more quickly than those on progesterone alone. See: Alpha Lipoic Acid (ALA) effects on subchorionic hematoma: preliminary clinical results.
I also found a single study looking at ALA with IVF patients. It found a higher number of grade 1 embryos in patients taking ALA plus myo-inositol . See: Effect of myo-inositol and alpha-lipoic acid on oocyte quality in polycystic ovary syndrome non-obese women undergoing in vitro fertilization: a pilot study. While that study is interesting, the population is small and using the patients as their own controls is really problematic - so take the results with an entire shaker of salt.
Beyond that, there are many studies using rats and suggesting that ALA protects against reactive oxygen species (ROS) which are correlated to damage to DNA and RNA and are considered agents of cell death. All sounds good, right? Sure, but be aware that ALA is also associated with effects on fetal hormones (protective effects, but effects none the less). In other words, do your own research and think very carefully before you consider taking it.
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