Options

We had the post-op follow-up with Dr Swift on Friday.  He ran through the photos he took, what he found, and what pathology told him.  What he thought was a cyst on my left ovary was simply the blown follicle from when I had ovulated last.  There was another small cyst behind my uterus that was benign.  Several spots of endometrial cells.  Lots of adhesions.  Luckily, my fallopian tubes are clear, and there's nothing wrong with the inside of my uterus.  The only thing that hasn't been looked at is my egg quality, but we won't get a chance to do that unless we do IVF.  There's technically no reason why I can't get pregnant that they can see.

And yet, I'm still not.  So he laid out our options:

IUI: Intra-uterine insemination, also known as artificial insemination.  The less invasive and cheaper option: $1020 with about half back from Medicare.  Basically, they stimulate my ovaries to make sure I ovulate, then when they are sure I've ovulated, they inject me with some of Dave's sperm.  It's basically super-charged sex, and makes sure the sperm is in the right place at the right time.  The success rate per cycle is around 10-15%, but about 40% of couples conceive after 4 cycles of IUI, after which the odds drop significantly.

IVF: In-viro fertilisation.  Probably the most well-known infertility treatment.  Much more invasive, and much more expensive: $7,251, with, again, around half back from Medicare.  With IVF, my reproductive system is basically shut down and then rebooted with a super-charger: I'm given medication to make me produce many eggs, instead of the usual one.  Then my eggs are extracted, they take a look at them and choose the best half-dozen or so, then they take Dave's best sperm and fertilise my eggs.  Then, they choose the best embryos, implant one or two of them (it's against regulations to implant more than two in Australia except in very extenuating circumstances), and freeze the rest in case the first try fails.  The success rate per cycle is about 40%.

It seems the best plan of attack will be to try 4 cycles of IUI, and then move on to IVF if that doesn't succeed.  We still need to do some more research, and discuss the options with our parents and others who have been through similar situations.  We can't do anything at all for another 6 weeks or so, to give my body time to heal from the surgery.  So we have a bit of time to consider our options.

If you've been through fertility problems, I would love to hear from you!

Vulnerability

Today I spent 10 minutes crying in the bathroom at work.

I guess my emotional state is not as stable as I thought it was.  Here's what happened: I had a difficult conversation with a customer that left me upset and angry.  Immediately after I got off the phone, I found out that someone I know is pregnant with her second child.

Don't get me wrong, I'm thrilled for my friend and excited about her baby.  But it was just one more thing on top of everything else: recovery from surgery, uncertainty about what our next step is, stress from a busy job that is getting busier, emotional confusion over all the other people I know who are currently pregnant, and the angry customer leaving me raw.  Finding out yet another person is pregnant was all too much.

I was upset because it's not me that's pregnant.  I was angry with myself for letting my guard down.  I was angry with myself for getting over-emotional at work.  I was angry with myself for being upset that my friend is pregnant and I'm not.  I was happy for my friend.  I was embarrassed that I was crying.  I was worried that someone might find out.  I was confused over this roil of emotion that greeted the news.  I felt myself breaking down and ran for the bathroom.

I'm a messy crier.  My face and neck go all red and blotchy.  I'm also a noisy crier.  I was terrified that someone would find out I was crying, because then I'd have to explain, and then I'd have to add worry that they wouldn't understand to the list.  So I hid in the bathroom until the blotchiness subsided, my tears dried, and I could come back to my desk like nothing had happened.

Recovery

It's been nearly a week since my surgery and I think I'm recovering pretty well.  Much better than last time, that's for sure.  I finished my hospital pain meds on Saturday and only took 2 doses of other pain meds before I stopped.  I've been on no pain meds for 2 days now.  There's still a little bit of pain, but nothing unmanageable.

Unfortunately, it seems I am mildly allergic to the Cutifilm brand dressings that they used.  These dressings have a gauze pad with a very thin sticky border, and its this that irritated my skin.  Normally I don't have particularly sensitive skin so it was a bit of a surprise.  I have red, irritated marks all over my abdomen and they're maddeningly itchy!  Dave reckons that I also got itchy when I had my birthmark removed, the last time I used these dressings, but I don't remember.  I wish I'd realised soon that there was a problem because I've been suffering through the itchiness and it's left all these red marks.

I had acupuncture again today, the second time since the surgery, and he stuck a LOT of needles around my 4 surgery wounds - 16 in total, more than I've had in at once before I think.  My belly is still quite sore, so they didn't do any on my back, luckily.  I'm certain that at least partial credit for my quick recovery goes to the acupuncture.

I'm getting sick of having to sleep on my back all the time.  I'm going to try sleeping on my side tonight and see how I go.  I don't normally sleep on my back, I find it quite uncomfortable, and I've had to requisition 2 additional pillows to get comfortable each night, which is annoying.

I'm back at work tomorrow, which I think will be fine.  I'm glad I didn't have any less time off and that I could take the whole week to recover and get my healing well underway.  Post-op follow-up is in two weeks, so I probably won't update until then.

Surgery

While I have a generic warning on this blog that I'll be discussing things people might find unpleasant, this post in particular is going to discuss surgery, hospitals, and bodily functions.  You have been warned.

Monday

We get up early to squeeze in an acupuncture appointment before my pre-op consult.  I tell my acupuncturist, John at CompMed Southport, that I'm a bit stressed about the lapo.  He focuses his acupuncture on relieving my stress and preparing my body for the lapo, and puts in earpoints to help with my stress.  Earpoints are teeny acupuncture needles attached to little round band-aids that you can leave in for days.  I've had them before, during exams, and I think they really do help with my stress.  John says that I shouldn't have to take them out for the surgery, but his assistant, Paige, says that she's heard people have had to take them out.  I decide that I should ask at the hospital when I'm prepping for the lapo, just to be safe.

After acupuncture, we head to the pre-op.  The nurse from Fertility Gold Coast, Karen, is lovely.  She runs through the lapo and hysteroscopy process with us, but I don't ask too many questions...Partly because I've been through this before, and partly because I don't want to know more, for a change.  I'm normally a person who wants as much information as possible, but in this case, I just want it to be over.  She does tell me that I have to do a bowel prep, to reduce the risk of infection, which I don't think I had to do last time, and also that I'll get some stylish compression stockings to wear afterwards that I'll have to wear for a week, to reduce the risk of blood clots.  Karen says that my surgery is scheduled for 10:30am, and I have to be at the hospital at 9am.  Once the pre-op is done, we go next door to Dr Swift's office to sign the consent form, but he's in surgery, so the receptionist says I can just sign it at the hospital the next day.

The rest of the afternoon I'm on a special no-solid diet and have to take a bowel prep solution, which tastes DISGUSTING.  There's a reason the human body rejects salt water - it kills you!  I only manage to drink about two-thirds of it, I simply can't drink any more or I'll just throw it up.  I try to drink as much fluid as possible, but even just water makes me feel ill.  We also get a phone call from Fertility Gold Coast - my surgery has been moved forward to 9am, and I have to be at the hospital at 7:30am.  We book a taxi to pick us up at 7am and I go to bed early after packing an overnight bag, just to be safe.  I wake up at 3am feeling very dehydrated but already past the time I have to start fasting for the anaesthetic.

Tuesday

I wake up to the alarm at 6am.  I feel really thirsty but can't even have water.  The taxi turns up right on time and we head to the hospital, Pindara Private.  The receptionist asks if I'll be staying overnight, I say "I hope not" but she charges me the overnight fee anyway, and from then on everyone assumes I'm in overnight.  I'm glad I've packed my overnight bag.  We go through to the day surgery admissions and the nurse, Dot, runs through the forms and paperwork.  She asks how much I weigh and I tell her I have no idea, so she gets me on the scales and doesn't bat an eye at the number.  Through my whole stay, all the nurses are like this - I never get any negative looks or comments about my weight, for which I am grateful.  She takes me to the waiting area and they put me in an overnight bed while we wait for the theatre.  She gives me a stylish robe and some paper knickers to wear.  I look at the knickers with apprehension, but they do fit - just.  Another nurse brings me a blanket that's been somewhere warm, and it's lovely.  We wait in the waiting area for about an hour before an orderly finally comes to collect me and Dave heads to the cafe.

I'm taken through to the theatre waiting room where the anaesthetic nurse runs through her questions and paperwork.  When she asks me if I have any metal anywhere, I ask her about my earpoints, but she's not sure and says I should ask the anaesthetist.  Dr Swift comes in and asks if I have any questions, then the anesthetist, Dr Cameron, comes in.  He asks if he's anaesthetised me before, which sounds like the world's worst pick-up line, but it turns out he was my anaesthetist for my first lapo 5 years ago!  I wonder what I did to be so distinctive.  I ask him about my earpoints, but before he can answer Dr Swift comes rushing back in with my consent form and runs over it with me, then ducks back into the theatre.  Dr Cameron tells me I can leave my earpoints in, and we chat about acupuncture - he says there's a lot of scientific research behind it and most anaesthetists support it, which is nice.

Finallly, I'm wheeled into theatre.  They move me on to the operating table, which is quite narrow but still comfortable enough.  Dr Cameron distracts me from all the other prep by running through my anaesthetic - he gets me to rest my left arm on an armrest, then tells me as he cleans my hand with disinfectant, then injects me with a local anaesthetic.  Then he starts the general and says "you'll probably start feeling woozy about now."  I'm lying with my head turned to the left, looking at my arm.  I try to turn it to look up at Dr Swift but it's like moving through honey.  I say "I feel a bit woozy, yes..."...

...And then a nurse is calling my name in a voice that sounds half-exasperated, half-worried: I'm in recovery, and taking longer than I should to wake up.  My first, bizarre thought, is "where's my teddy?" - then I realise I'm an adult, I don't have a teddy with me, and I'm in recovery.  The nurse tells me the op took two hours - longer than the one hour estimate, but still better than the four hours of the previous op.  I realise I need to pee and the nurse offers me a bedpan, but I can't get past the psychological barriers against peeing while lying in bed, so she takes it away again.  A little while later, at 12:30, she tells me I'm going to be in recovery for at least another half an hour, because the orderlies are going through a shift change and there's no one to take me to my room, and that yes, I will be staying overnight.  Dr Swift appears, tries to talk to me, and gives up when he realises I have no idea what he is saying.  The nurse offers me the bedpan again and I manage to use it this time.  Then I doze until the orderly comes.  He's Maori, and I feel thankful for what sounds to me like home, as he chats while he wheels me to my room, although I don't remember what he says.  Dave is already there, looking a bit antsy - he'd been told I was on my way just before 12:30, and then not updated that I wouldn't be delivered to my room until after 1pm.  The recovery nurse runs through my op results with the ward nurse in a rush, I don't really understand everything she says, but I hear "cyst" in there somewhere and feel a bit worried.

I've missed lunch but don't feel that hungry.  I manage to clamber out of bed to use the bathroom.  Dave asks if I would mind if he goes home now that I'm out and will be staying the night.  I'm too woozy to think straight, and just say I don't mind.  His sister comes to pick him up and deliver some chocolates from our nieces, and I feel guilty for feeling thankful that she doesn't bring the girls - I just don't think I can face them.  She takes Dave home.  Shortly after, Dr Swift appears again and I realise why I didn't want Dave to go home - he should be hearing what the doc has to say, but it's too late now, so I face the music by myself.

Dr Swift delivers the results: lots of adhesions, meaning all my internal organs were basically stuck together, which explains why I was getting pain all the time; new patches of endometriosis on my right ovary; a cyst on my left ovary that he's not worried about but will still go to pathology.  No fibroids or anything else wrong with my uterus, and my tubes are clear.  He also explains why I have to stay in overnight - he's pumped me full of a liquid that is supposed to help reduce the chance of more adhesions forming, and so my drain from my wound is clamped and has to stay clamped until the next morning.  Then they'll unclamp it and let it drain a little, but I'm still going to be quite bloated for a few days.  He says there's no obvious reason why I can't get pregnant, and that the next 12-18 months, while everything is still cleared out, is the ideal time to try, but because we didn't manage to do so after my first lapo, he recommends IVF.  I ask him about whether drugs like Clomid (to boost my ovulation) would be helpful, but he doesn't think so for our case.  However, he says that he'll go through all our options with both of us at the post-op followup in a couple of weeks.

IVF.  The spectre has been looming there, over my shoulder, for a while, and I knew that this was probably the route we would have to take, but to have him come out and recommend it as our best option is still a blow.  I text Dave the news but am still so drugged out I don't really feel that upset about it.

I spend the rest of the afternoon watching the cricket and updating Facebook and Twitter because I'm a bit lonely.  I finally get something to eat at afternoon tea, and then dinner is surprisingly good - the food at Pindara is really quite excellent, for hospital food.  I realised after I'd filled out my menu options earlier in the morning that I'd chosen small portions for everything, but I'm glad that I did because I still am not that hungry. I swing between sleepy and wide awake - every time I get up to use the bathroom the pain stops me feeling sleepy.  I'm also getting nightmares, from the anaesthetic or one of the cocktail of painkillers I'm on.  As soon as I close my eyes, a parade of people walks into my room - nurses, friends, family - and as they walk in they melt and turn into horrifying monsters.  I'm also being having observations done every couple of hours, so I don't get much sleep.  I finally give up on sleep altogether about 5:30am.

Wednesday

I wake up early, and am in quite a lot of pain.  I can hear the nurse doing her rounds, though, so I don't press the call button.  She arrives a little before 6am and gives me more painkillers and does my obs.  Shortly after, an orderly delivers a fresh jug of water.  I get breakfast about 7am, and then my wound drain is unclamped and I'm ordered to move about.  I don't feel very comfortable doing that, partly from the pain but also because I'm pantsless, but I try to move about a few times for short periods.  They say I can go home after lunch, so I let Dave know.  I watch the news and the Simpsons and zone out for a while.  Dr Swift drops by again to check that my wound is draining ok and that I'm feeling alright, and confirms that I can go home when the nurses think I'm up to it.  When my lunch arrives, I let Dave know and give him a list of things to bring me.  I manage to give myself a shower, which makes me feel much more human, and I'm dressed and ready when Dave arrives with his sister.

I talk about the results of the op with my sister-in-law.  She seems surprised to hear that we had been trying to get pregnant after my first lapo, and in fact have been trying for the entire time since then - five years.  I thought most people knew that already, but it seems not.  I'm reminded again why I really want to start talking about this whole issue more - so that our friends and families know what we are going through, and so we can reach out to others that are also going through the same thing.

The nurse brings me my discharge meds, and we head home.  I spend the rest of the evening on the couch, in the aircon, watching the news coverage of the impending cyclone that is hitting our State further north.  Dave makes nachos for dinner and I find I still can't eat much.  I manage to get several hours of straight sleep and a bit of a sleep-in after he gets up to watch the soccer at 5:30am.

Thursday

I ensconce myself on the couch again for the morning, watching the news and the Simpsons once again, but I get up quite a few times to do short shifts at my computer and feel quite woozy.  I think I'm pushing myself too hard.  About 11am, I have a shower and get ready to go out - Dave's sister is picking us up to take me to acupuncture and Dave to Australia Fair for some shopping.  By the time I get to acupuncture I'm feeling very woolly and having trouble stringing together a sentence.  It's not my usual acupuncturist, but my naturopath has already given him the rundown and he works around my pain and lack of mobility.  I feel like I'm only there for about 10 minutes, but it's a full 45 minute session, so I must have dozed off a couple of times on the table.  Afterwards, my head feels much clearer and I feel like I have more energy.  The acupuncturist warns me that I will be hungry, but that I should only eat cooked foods - no salads or anything like that, because it is more work for my body to process.  Which is fine, Dave is making lemon chicken for dinner.  I'm still feeling kind of weak, so I spend the rest of the afternoon on the couch, with a couple of short breaks for writing.

Now, it's Thursday evening, two days post-op.  I'm feeling uncomfortable more than in pain - it's hard for me to sit up for very long, I can't bend over, and I shuffle around like an old woman - but I'm still fairly dosed up on pain meds.  I just need to take it easy and get through the next few days, giving my body time to heal.

Our post-op followup is on the 18th.  By then I should have stopped bleeding and be pretty much back to normal.  We'll discuss our options and see what the next step is then.