A Tale of Five Catheters

I don't know about you, but a speculum is my most favorite medical instrument in the entire world. I was so lucky, that I got to be speculumed twice in 10 minutes today. I also got to experience having no less than 5 catheters threaded up through my cervix. Aren't you just dripping with jealousy? Apologies in advance for the absolute "TMI" nature of this post.

It doesn't matter how many times you put on that flimsy little doctor's office nightgown, pop your feet into the stirrups, and display your lady parts in all their glory for a pap smear-it never gets any less awkward. Now, take yourself out of the comfort of your regular gyno's office, put yourself in cold and sterile hospital environment with people you have never met, and multiply the weirdness of a pap smear by 10, and you have yourself a delightful little procedure called a Hysterosalpingogram (HSG). 

I was terrified to have this done. I know several people who have a had a range of experiences with the HSG, and 98% of people who post about theirs online sum it up with a description like, "it was worse than childbirth," and "I wanted to die," and "I felt like my entire abdomen was on fire." So naturally, as a person with some fabulously convenient anxiety issues, I have spent the last 10 days freaking out about this procedure. I expected the worst pain of my life. I expected to kick the doctor in the face with my rubberized sock-clad foot, leap off the table, and tear down the hallway, knocking carts of medical supplies over as I made my great escape from the hospital wearing only a flimsy johnny. I am happy to report that this did not happen.

It was awkward as all get out. I would even venture to say that next to the bladder infection/UTI from hell last summer, it was my least favorite medical experience ever. But I did not want to die, or have a flaming uterus, although I did come close to kicking the doctor in the face. Thank heavens I didn't actually do it. But it was sort of a comedy of errors, bordering on, "you have got to be freaking kidding me!" 

BJ took the day off from work and came with me. Which was both for support, and necessary, since I was buzzed on 1000 mg Ibuprofen, 1000 mg of extra-strength Tylenol, and a 1 mg of Xanax. My OB realized how completely freaked I was about doing this and was very willing to help me be as medicated as possible. By the time we got to the radiology department at LDS hospital, I was enjoying not being able to feel my lips or tongue, and definitely grateful that every attempt by my stomach to do flips was quelled by the effect of benzodiazepines. Thank you, drug companies the world over for that little slice of heaven. As soon as I was called back into the changing area and instructed to put on the johnny, scrub pants and grippy, rubberized socks, I was keenly aware of everything that was going on. Instead of having a panic attack freak out, I just got super emotional and started streaming tears down my cheeks. The cute x-ray technician was very sweet, offered a lot of comfort and support, and fetched hubby from the waiting room to accompany me through the rest of the procedure.

My OB was supposed to perform the HSG, but was called out for a delivery, so a PA in the radiology department did it, assisted by the nice x-ray tech, Toni. They were incredibly gentle and sensitive and explained everything that was going to happen and were incredibly respectful of my modesty and obvious discomfort. But it doesn't matter how many times you have someone use a speculum on you-it never, ever becomes less awkward or unpleasant. And today was no exception.

After the first speculum insertion, they went ahead and inserted a long, thin catheter with a balloon on the end that is used to push the dye into the uterus. As the PA worked with the catheter, she said that "my cervix wasn't happy about this." Um, yup. Definitely not. Last time I checked, no cervix is too happy about getting snuggly with a catheter. Ugh. So the catheter goes in, causes a bunch of super-uncomfortable pressure and cramping, and then, the balloon on the end breaks. Oh yes. That's right. So out it comes, and in goes another. Everything is good, the dye goes in, speculum comes out, I am slid under the x-ray imager, there is a lot more cramping and discomfort as I feel the dye surge up and through my lady parts, and as I watch the screen above me, my uterus fills with the contrast dye and the left tube fills and spills beautifully. I can see my ovary and tube perfectly, and it's great. The PA adds more pressure to force dye into the right tube. I clench BJ's hand because it hurts and cramps like the dickens, and what happens? The catheter comes out. Just pops right out. The pressure chose the path of least resistance, and just popped the danged thing out of me.

The PA apologized multiple times, said the tube filled partially, but she would like to do it again to see if it can fill and spill completely. She asked if it is ok. I am laying on a table, gown hiked up, husband holding my hand, cramping like the worst period of my life times 10, and she wants to put that danged speculum back in and try again? GAHHHH. Of course, I said yes, because I was NOT coming back for another test unless hell froze over. So a bunch of pillows get stuck under my back to change the angle, the speculum goes back in, the catheter is reinserted, and it breaks AGAIN. Another catheter goes in. Breaks AGAIN. I flippin' kid you not. At this point, I am starting to cry, my uterus hates me, and all I want to do is kick the very nice PA in the face (and she was honestly so, so nice) and leave an imprint of the rubberized sock on her cute face. 

The PA asks for a different type of catheter that is smaller and has a c-shaped clamp on it to make is stay inside of my cervix. I felt that one going in like a razor blade. But it stayed. Out goes the speculum, in goes the dye, the cramps and pressure surge again, and my right tube spills. It wasn't as intense a flow as the dye through the left tube, but it was spilled and both tubes were declared open. The PA said there could have been a mucus plug or something blocking it, but it was flowing freely when we were done. Out came the catheter, and the cramps surged for several minutes while I lay on the table, totally exhausted. She explained that because of the clamp on the last catheter, I would have some significant bleeding. They covered me with a nice, warm blanket, swaddled my bottom area with a Gandhi-like towel diaper, and went over the images with me. 

My left tube looks great. The ovary was visible and nicely shaped. The right tube is also open, but took a lot more effort and pressure, and may have been cleared by the contrast material. The ovary doesn't look as well-developed, and that could be playing a role in my irregular ovulation. Both tube structures looked great. Your uterus should look like an upside down pear, and mine had a dip at the top. She said she needed to do an official measurement as she wrote her report for my OB, because that can be problematic, but that it was mild and more likely than not is nothing to be concerned about. If it is a concern, it would make my pregnancy a bit more risky and I would need closer monitoring and possibly a C-Section for delivery. It all depends on that official measurement. I will know more about that next week.

After resting on the table for a while, I sat up and let some of the dye work it's way out. Then it was off to the bathroom in my Gandhi-getup to deal with the blood and dye, and to get dressed and put on a lovely diaper-like pad, which I get to continue sporting for a good 24-48 hours. Awesome. 

Overall, it was less horrible than what I was prepared for, but it was no walk in the park. I am so thankful for my supportive husband and proactive doctor. I am beyond grateful for answers. I know my tubes are functional. I probably have one that works better than the other. We have information to move forward with a cycle of Clomid in September/October. I don't have any adhesions, growths, or anything majorly wrong. I can deal with having a twice-inserted speculum, five catheters, some bleeding nasty cramps, a diaper to soak up the leaking dye and Xanax haze if it helps us get closer to having a baby.

I received a number of blessings from my husband and a good friend to help heal and comfort me before the procedure. I totally loaded up on the drugs. I hate to think about what it would have been like without them. I am still feeling the effects of the Xanax and have been popping ibuprofen all day to help with the residual cramping. My best friend received the next best thing to a drunk dial from me after the procedure, and as she said so eloquently, I was clearly trying to outdo Lindsay Lohan with my pill consumption. I definitely felt like a loopy, drugged up person for the afternoon, and slept for several hours when I got home.

So, HSG. I fought you, and I definitely feel like I won in the final moments of the battle. But I NEVER, EVER want to do that again. Five catheters. Five stinkin' catheters. Blech. 

Answers and Elephants

Yesterday, my afternoon ended with a phone call to my best friend. At some point during the call, I busted this gem out:

"I have this fear that the doctor is going to tell me my uterus is eating itself from the inside."

After appropriate laughter and snorting from best friend, I felt better. See, yesterday was D-Day. Doctor Day. It was also job interview day. Which was probably a bad scheduling move on my part. I am pretty sure that when I told the interviewers that the one piece of information I wanted them to know about me, and I said "I'm a really awesome teacher. I am excellent at my job, and I need to be teaching again. I need to be in your classrooms, and I want to spend my time and talents here" I had tears in my eyes and was .5 seconds away from hyperventilating. They scribbled on their interview sheets and for the love of all that is good and holy, I pray that they didn't write down that I was a basket case. The thing is, I totally was. Sigh.

Yesterday was my first appointment with my new OBGYN. I hate the gynecologist. I mean, going to get a pelvic is outranked on my list only by getting a root canal without anesthesia. Or having bamboo shoved under my fingernails. After 18 months of trying to have a baby with no success, my rational brain kicked in and I made the appointment and canceled my hotel room at the Hanoi Hilton.

I actually really liked the Avenues Women's Center. The people were very helpful and kind. The office setup was sort of strange, but the overall experience was really positive. I especially liked the Nurse Practitioner, Hillary, that I saw for my first appointment to get me established as a patient. She was an older woman with a really gentle tone and approach, and talked to me with a lot of compassion and empathy. As a mom of adopted children, I think she has been in my shoes before.

We talked for a long time about everything I filled out on my patient history. Hillary had read all of it before the appointment, which really put me at ease. We discussed all of the trials of the past year and a half, the necessary tests needed for my husband, and the possibility of PCOS being a factor. She wrote a referral, and ordered a round of blood-work and tests to check for some signs and markers. We discussed prenatal vitamins, genetic testing, two months of temperature charting, and all sorts of things that I can't remember anymore. After the inevitable awkwardness and discomfort of the usual happenings of an exam, we hit the big, rotund elephant in the room. Weight.

I have struggled with my weight since puberty. It went something like this. Hormones flooded my petite body, and all of a sudden, I wasn't a flat-as-a-board girl anymore. Between 5th and 6th grade, things developed and I shot up in sizes, reasonably at first, and then at a rate that I am sure raised parental and doctoral eyebrows. And it stayed that way through high school. Never on the really bad side of things, but enough to be a concern. Then, I went to college, lost a bunch of weight because of lifestyle changes, and I worked really hard to keep it off. Too hard. To the point of not eating nearly enough and killing myself in the gym to satisfy the image my then-boyfriend desired. Since then, I have fluctuated up and down. A few years ago, I lost a lot of weight again, to once again satisfy the image of a guy I was seriously dating. When that relationship blew up in my face, I realized how fabulous and healthy I felt, because for once I had lost weight the right way-an awesome, balance diet and consistent, healthy exercise.

And then, I got married. And everything in my life changed. I left a job I loved. I moved. I remained unemployed. I had very few friends or social supports. I became pretty discouraged and depressed. My husband worked his tail off and was so stressed trying to support us on one income that I think his stress entered my body as weight and kept packing on. For a variety of reasons, I haven't made the healthiest choices over the past year or so, and now, I am confronted with their consequence: They may be impacting my fertility.

So in the kindest, gentlest way possible (and only after she told me I had to take off the awful open in the back robe and put my regular clothes back on because being almost naked while discussing weight was a bad idea), Hillary told me that to maximize my chances of getting pregnant, losing weight is important and is a factor. That really, really sucked. And it's not like I didn't know already. And I am grateful that she was so gentle and honest in her communication. And she is right. But that doesn't make it hurt any less. As hard as I have tried to move past this connection, weight and worth have always been tied together for me.

Last night I just cried myself to sleep. I am going to make the changes I need to, because not only is a baby worth it, my health and quality of life is worth it. But that doesn't mean that this experience didn't rip every bandage, split every stitch and burst open every scar connected to how I feel about myself and my weight.

So while we remain in a holding pattern for two months, wait for test results, make more appointments and I take my temperature each morning to chart my cycles, I am holding onto this self-talk I had in the car yesterday as I drove to my interview: You do not need to be ashamed of yourself. You are not bad. You have made choices that have not been the best. All you can do now is make better choices. If you do your part, the doctors will do their part, and Heavenly Father will do His.

I feel all twisty and jumbled inside right now, but I feel pretty good about that self-talk. If my appointment gave me anything, beyond the answers I will get from my tests and the help from medical professionals, it was the gift of honesty and reality. I can deal with that versus the unknown, especially with the help of my Heavenly Father and my Savior.

So here's to early morning gym workouts, green smoothies, mindful eating, and living a truly healthy life. Here's to prenatal vitamins. Here's to temperature-taking. And being teary and overly honest in job interviews. And being able to call your best friend to tell her you are pretty sure the doctor is going to tell you  that your uterus is going to try eating itself from the inside.