Category Archives: Medical experience

Laparoscopy Experience in the NZ public system

I’ve written this post based on notes I took 3 days after my surgery, and now, 8 weeks after and having been given all the information from the procedure/s.

While the process itself is the same, the information I often see regarding surgeries and some other procedures are often from the private system perspective thanks to insurance. I’ve learned that infertility is not for poor people which is a situation I find myself in currently due to some pretty extreme outside forces. Anyway, I thought it would be good to have an account for those using the public health system and looking for experiences.

On the Day:
I went into hospital at 9.30am on the day and was admitted almost immediately. I was given a gown and paper underwear to put on and then sat around for.. around 2hrs. During this time I had blood pressure and heart rate taken, was given panadol and generally just regretted all my life choices which brought me to this place. My blood pressure and heart rate was high which seemed to be a concern, but I feel like I was fairly justified being that someone was about to cut me with a knife.

This was in a shared room within the Day Surgery until. Each cubicle was closed off by curtains, which is good because one person was snotting into the sink, and the other person was waiting for her mum after surgery (when mum turned up, there was a lot of abuse because staff didn’t let her sit in the comfortable chairs in the area for patients waiting to be discharged).

My surgeon came in about 10mins before they took me in  to just reaffirm what the procedure was. Fun fact – my surgeon ended up being the gynae I chose to stop seeing due to his manner, so I was feeling a bit awkward about that! He vaguely recognised me but didn’t stick around. I was surprised to be told they may not do anything! If they looked and decided it was too much work, they would reschedule for another day so the surgery wasn’t too long. I assume this may be to do with having other procedures at the same time and fitting everything in.

I was wheeled to theatre, then in one set of doors while they organised things in the room itself. Here I was given an IV line (successful 2nd attempt, but not sore), and waited around for about 10-15mins. I had a nurse and the anasthesiologst in this area with me, the nurse kindly using such cliched stories and phrases of “I struggled with infertility, but then I just relaxed” and “at least you can get pregnant”.

When they were ready I walked into the room and hopped up on the table where I was covered with a warmed blanket.

Almost immediately they gave me some sort of drug to help with relaxation and the room started moving around a bit. I was still quite anxious but it was like it didn’t fully compute and my body wasn’t responding to my brain signals. The best way I can describe it is that I knew I was anxious but I didn’t care. I didn’t feel trapped by my heavy body not responding. I think they might have put an oxygen mask on me a this point but that is a vague memory and the last thing I can recall.

Post Op
I woke in recovery, and while I felt fairly alert at the time, I don’t remember much now except the nurse telling me they’d call mum and I was on my way to the ward.

Pain wise, I had three lots of panadol that day on the ward (last at 11pm that night), I wasn’t offered any more after that and didn’t feel any need to ask for more. They did ask frequently about pain in case I needed something else so it was purely preference for me.

I first got up about 8.30pm that evening (about 5hrs after getting to the ward), and I did get the shoulder pain that is talked about a lot. It felt like a cramp in my shoulders and was probably the most painful part, but still a lot less than I was expecting. I only had this pain when standing so it was quickly relieved on lying back down. It lasted about 1-2 days.

I was hoping to go home that same day, and pain-wise I would have been fine, but I had quite low blood pressure and I was being given fluid via an IV until quite late that night.

As far as tiredness went, I didn’t get to sleep again until about midnight that night. I then woke up about 4am and was awake until I was at home that afternoon when I had a little nap. I didn’t feel particularly tired or wiped out, and the noises of being somewhere unfamiliar, plus a shared room with an extra visitor who had to be forced out at midnight and was back at 6am made for not a relaxing atmosphere! I’m sure a private room would be an upside to being in a private hospital!

The next day I couldn’t wait to leave, but it was definitely a slow process! I had to pee 3 times after catheter removal, so I drink a copious amount of water to make that happen as quickly as possible. I then sat and waited for about 2 hours while nobody did my paperwork, and in the end (after chasing them up), was discharged without it. It was supposed to be sent out along with a follow up appointment, but that never arrived.

I walked down 3 flights of stairs carrying my things and jumped in the car, ready to escape! I don’t like elevators much so skipped that, and had no problem being on my feet.

Recovery
Mild pain when changing positions for about a week.

I had a “jiggly” tum for a wee bit, like my muscles forgot how to hold everything in place. This only happened when I was moving faster (like quicky crossing the road!)

Bleeding – light for about 2 days.

After about a week I felt fairly normal, by 2 weeks I was completely back to normal.

Incisions had dissolving stitches – I have 4. The lowest one was about 3cm, the ones on each side about 1cm, and the belly button was mostly invisible as it’s in a crease. The belly button one was the only one I ever felt with a pulling sensation sometimes. Any pain was more muscular feeling.

Something I didn’t know about until it happened – first period afterwards was awful! I nearly cried from the cramps, even with pain killers. I tend to take them too late, so make sure you’re on the ball about taking them before the pain kicks in too much.

Results:
I’ve just had my follow up appointment and was surprised to find I had “severe” endometriosis. I knew they had removed some but not the extent of it. This would also explain being in surgery for about double the time expected. Being that I had no over the top pain I assumed it was a little, and I think I probably have a higher pain threshold which can make my assessment of pain inaccurate.

Something that has been mentioned and was in my surgery notes was “almost certainly adenomyosis”. I remember reading Robert Winston’s The Essential Fertility Guide and thinking that I hoped I was never diagnosed with that. It’s harder to diagnose as it needs to be done via biopsy (and they often don’t know *where* to biopsy), but regardless, there is little that can be done to treat it apart from hysterectomy.

I haven’t looked into it much, but I know it lowers the chance of pregnancy and heightens the chance of pregnancy problems like premature labour. It’s something that is playing on my mind but doesn’t really change my reality, which is that I hope my body can play ball, but it has to decide that on its own.

I can’t share any experiences with hysteroscopy or the dye test because I was asleep, so I can only recommend that having them while asleep is excellent 😉  But these both also came back with no problems.

A year is what I’ve been told, the timeframe of what I guess is typical before endometriosis takes over again for many. A year doesn’t seem very long when we’ve been at this multiple of years.

The Doctor was excited, spouting feel-good phrases about “good chances” and being “very optimistic”. I’m happy it’s been done and I’ve turned this stone over, but I also heard this speech 2 years ago when I started clomid. I’m realistic. We have a timeframe.

This is the best chance we’ve got.

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Finally – a step forward!

I finally braved going back to my GP for a referral.

I’ve seen 3 GP’s at my small doctors surgery in 3 visits.  The first suggested going on the pill (a bit counterproductive, but hey), and that I was “still young” so not to worry.  A few months later, the second referred me to a specialist because my symptoms clearly pointed to a problem, despite only being trying to conceive for less than a year.

I was hoping to see the second doctor, a woman, again.  However being a small town, a woman GP is apparently a rare thing, so while she’s usually there ONCE a fortnight, this time she was on holiday so it would be months if I was to wait.
After my dealings with the specialist I saw, I was anxious.  I made the appointment then cried.  I worried about it but I pushed through because I was continuing to get nowhere fast.

So I went there and saw him, and he was happy to do a referral.  But still subtle digs and arguments about my decisions, and a slight smirk after taking my blood pressure, which was slightly high because I was “a bit upset”.  There is a lot to me said about sexism from doctors surrounding “women’s issues”.
I know my anxiety wasn’t just about that visit, but I had worked it up to be a big thing in my head.  Not only that, but because it ultimately stemmed from how I was treated around my miscarriage, the anxiety was all tied up with grief around the loss and was a huge tangle of emotions.
So a month or so later, I saw the new specialist.  I felt much more calm about this, even though this relationship was likely the most important part of where we went from here.

I needn’t have worried.

He was so great.  He was thorough, he asked questions, he believed my answers.  I had another internal scan (yay!), we talked through options, he was understanding about my situation regarding my husbands involvement.

The good news:
Ovulation!  My last blood test showed good progesterone numbers (44), and the scan showed a 16mm follicle on my left ovary on day 8.  It’s looking like my body is doing ovulation on it’s own so no need to worry about clomiphene again at the moment.  This is such a relief, just knowing that I’m not reliant on anything to get over the first hurdle of having an egg available.

We have a plan!  I’m hesitant to call this good news, but I’m also pleased to have a direction.  He was tossing up between a laparoscopy and dye test, but in the end decided the lap is the way to go, with the dye test while I’m there, and he added in a hysteroscopy and D&C for good measure.

I’m not looking forward to it of course, but it will be such a relief to hopefully have some answers.  I want to know that there is nothing ‘major’ to worry about, and while I think he’s probably right with tentatively guessing endometriosis (despite a lack of typical symptoms), it’s a load of my shoulders to have a thorough investigation to rule out anything nasty.  In almost three years I have been unable to align my symptoms with any typical diagnosis, either gynecological or infertility related.  That has weighed on my mind this whole time.

I have some concerns regarding this, though none related to the actual surgery.  Work-wise, I’m self-employed so taking time off is basically an impossibility, but something I will have to work around for a day or two.  I won’t really be able to take recovery time off, but I can take it a bit easier and can have help.

My husband won’t be able to be with me, and I worry about his stress levels on the day.  He does find this sort of stuff really hard so I’ve not given him much details and have tried to reassure him it’s pretty minor.  This means I either have no support person with me, or I ask my mum which is a challenge all in itself.  In doing that, I know everything she knows and hears is going to be spread around anyone who will listen, and that she will feel her involvement is important going forward.  I don’t really want this to happen and I don’t mind going into this alone really, but I would like someone there who can contact my husband and reassure him as soon as I’m out of theatre.

Plus I’m sure some food won’t go unappreciated during the overnight hospital stay!

Anyway, status quo for now until the surgery is scheduled (likely in the next few months), and then I will make a decision.

Have you had a laparoscopy or hysteroscopy? Any tips?

Not worshiping at the good doctor’s feet.

You Just Leave The Place Now.

 

I’m going to tell you a story. Not all stories are good I’m afraid. You know this, you’re here reading. But I’ve been reading about gender bias in the medical field and I want to share my story.

This involves a Doctor who is an obstetrician and gynaecologist.

A little over a year ago I was chasing my Doctor for blood test results. Specifically, hcg results. I’d had my first blood over a week before which included testing my progestertone as I had been testing low and I knew it could affect early pregnancy. I’d since done a second beta test with no results, the only communication I had was to repeat the beta.

After the second one and feeling frustrated at no results (I knew they’d be in by then), I called to find out what was going on. I did not know if my progesterone was fine and nothing to worry about, nor that status of my pregnancy. He hadn’t looked at it so his receptionist was going to call back the next day.

She didn’t.

I called again the day after, he still hadn’t looked at the piece of paper nearly a week later. He was too busy. But I’d had bleeding and this was my baby we were talking about, so in order to get some news I made an appointment (see $$$$).

When I got in the room, he made a dig about me calling. Twice in two weeks, after I’d had two blood tests. Like I was stupid for wanting an answer. Like I was just a silly little girl, a nagging woman who was hysterical and over the top. Like it wasn’t my right to know what the blood taken from my own body was saying. Like my miracle wasn’t important.

And then he told me I was losing my baby, and how ‘it wasn’t realy what we wanted to happen’, but that he’d suspected as much for TWO WEEKS and didn’t bother telling me.

That was two weeks of fear, of trying to stifle excitement, of coming to some sort of acceptance and even starting to feel brave enough to browse baby gear.  All for no reason.

Every time I saw him last year he made me feel stupid. He ignored my symptoms, he told me “they might not be a problem”, even though that was the whole reason my GP referred me to him in the first place. He’s never told me anything specific, he’s never mentioned a single number to me when looking at results. He’s never asked me specific questions, like the first cycle when I told him I’d ovulated already, and instead of asking how I knew, he disagreed. (FYI, the blood test said yes).

He used words like ‘tummy’ when he spoke to me.

He took hundreds of dollars off me for a prescription I’m not even sure I needed because one cycle when he tested me I didn’t ovulate (which is one of two annovulatory cycles I’ve had since coming off birth control, in the realms of normal). Maybe he’s right, but he wouldn’t listen to anything I said, nor tell me his thought process.

He touched me every time I walked into his office. I mean, of course he has to sometimes and it feels like an intrusion, but I mean as I walked past him into his office, every time. Maybe he thought it was friendly and comforting, but the fact that it sits in my brain means I feel differently.

In other inappropriate behaviour, he records his notes out loud with the door to his waiting room open. He chats to his receptionist about patients, and she asks inappropriate questions (“will we see you back!?”, just after I’d been told I was going to lose my baby… what do you say to that?). He finds it humerous that my husband has a severe anxiety disorder, with a big trigger being anything medical, and that I will not push him to give a sperm sample. Because that’s what I really want, to link anxiety, medical procedures and sexual activity.*

I have not taken the last four rounds of clomid prescribed to me because I don’t think it’s really making much of a difference, and whatever issue I have is unrelated to ovulation. It’s frustrating talking like this after so long, in general broad terms.  I’m not unexplained but I have no explanation. I have a group of symptoms that he basically didn’t even ask me any questions about.

I am wounded by this. It took me a full year after the miscarriage episode to realise how angry I am about how I was treated, and to understand why I would come home and cry after every appointment with him. Every time I saw him, he took my confidence, he took my sense of knowing myself by undermining what I told him. I know what I know about myself, I am an expert on my body and it’s happenings, and every time I tried to bring up my concerns he made me feel like I was some pathetic creature who should just worship at his all knowing feet.

When I got home after the last time I saw him, I got mad at the stupidist thing. I was stomping around and huffing and sighing when my husband pulled me into his arms. The tears came out of nowhere, and I told him that with every appointment it seemed like having a family was slipping further and further away. There was never a plan or a direction, the last two visits were basically him printing out a prescription and telling me he wasn’t interested.

This is why I can’t go back there, and when I have the money to start from scratch again, I’ll be looking for a female doctor. I need to feel safe, I need to feel listened to. I need someone to understand that I may not fit into a box and to work with me on that.

I need to feel like I am not a pay cheque, and that I am valuable and have knowledge. I need to not be talked down to and I need to be informed.

I need to feel like I have control of my body and my choices.

I need to feel like I have a chance.

 

*I know this is an important step, but I obviously have something wrong with me. If I was good as gold and we still weren’t getting anywhere, perhaps I’d get into this more. But at this stage, we know I need some fixing. Even if my husband had a low count (and bear in mind his sperm has done their job once, kind of), I would not be open to IUI or IVF with my current symptoms as I believe it would just be a waste. Aside from that, my husbands anxiety would definitely make it impossible for him to give a sample AT a clinic which basically rules us out of going down this route.