Wednesday, March 20, 2013

An Interesting Case

I had just started my first round of fertility medication. I was taking 25mg of clomid for five days. Right after I started the medication I would have my first test, a sonohysterogram (also can be called a sonohys, or a sonohystogram). The reason this test was ordered was that there was a defect in my uterus on a prior ultrasound that my new doctor wanted to see the degree of. I knew this defect was there only because my friend who had done my ultrasound at the previous office showed it to me. Those doctors never even mentioned it, much less that it could cause a problem with me conceiving in the future. But my new doctor was way more thorough... and cautious.

Initially the test was scheduled with the nurse practitioner at my new office who performed these tests quite a bit. When I arrived at the office, I was immediately taken to the secondary waiting room while the sonographer set up the room for my procedure. She took me back, I got undressed and she did a transvaginal ultrasound before the procedure began. I was only slightly nervous about this exam, I had learned about it in school, I knew how things would go... and everyone made me really comfortable there.

A few minutes later the nurse practitioner walked in and said "I'm sorry but I won't be doing your exam today," --oh that's weird, I thought-- she continued "Dr. Williams was able to be here today after all and she would prefer to do the test and see everything herself." I was caught off guard, but in a good way. Oh! Well, great!!

The doctor came in and explained the procedure to me. I wasn't prepared for what she said next. "We have a student studying to be a nurse practitioner here today and I was wondering if you would mind if she and our NP watched?" "No, that's fine, I was a student once too, I understand." So there I was.... in stirrups, spread eagle on this table when the two walked in. "Thank you so much for letting us watch Mrs. Jewell... it's just that you're such an interesting case, we don't get to see cases like this too often." Great... I remember being a student... getting excited about the "interesting" cases. NO ONE wants to be an interesting case however. An "interesting" case means you have something wrong with you that most people don't. I never realized until that moment just how uncomfortable it felt to be that "interesting" case. Especially on a gynecology table where they were face to face with my goodies... But it was what it was. I really didn't particularly mind being the subject their learning experience, however I wished I didn't have to go through any of it. Honestly, I just didn't want anything else to be wrong with me.

Based on previous ultrasounds, they thought I had a partially septated uterus. A septate uterus is a congenital malformation, where the endometrium is split to some degree, this can range from a mild septation to a complete septation. In some cases this causes no problems... but in others it can cause implantation issues, miscarriages, preterm labor, etc...

Initially I was told that this procedure might be a little uncomfortable. Whoever said that has never had this procedure done. It HURT. It was not your normal pap smear speculum. This thing felt like a 16th century torture device. Then the catheter was inserted through my cervix. "You might feel a little pinch"... yeah, I almost came off the table. Tears ran down my cheeks... I wasn't crying, it was just a reaction from the pain. She was so sweet about it though when I told her it hurt. She talked me down and I was OK. The speculum was out and the fluid was about to be inserted. She warned me that I could feel heavy cramping as my uterus filled with saline. Oh boy... I did. They let me watch the screen though, and that occupied my curious mind enough to finish the procedure. All in all, the procedure didn't take too long. When I was done, I was SO uncomfortable. She gave me some Advil and a sprite.... and I waited for a diagnosis. At that point, I wished I had taken Mike up on his offer to take me to this appointment. I was not prepared for how uncomfortable I would be... and I was not looking forward to the 30-45 minute drive home.

After she looked over everything, she brought me into her office to talk to me about a diagnosis. I actually had an arcuate uterus. This was good news. An arcuate uterus is an anomaly where there is only a mild indention in the endometrium, and not a septation.

More good news... I was told this type of mild defect is not commonly associated with reproductive issues, although she warned me that although it is not common, it could become a problem. If it was to be a problem in the future she said it could be surgically repaired. The risk in that instance is that scar tissue can form in its place and theoretically cause the same kind of problem that the arcuate uterus could possibly cause in the first place. So which is the lesser of two evils? We would move on as planned from here on out. I was praising God for this not being as bad as she initially thought. More good news? I had follicles forming within my ovaries on both sides... she said this was a good sign that they were being stimulated by the clomid.

I left very achy... very ready to be home and called Mike and told him (once again) "you were right... I should've let you drive me... that was awful!" But we were both happy for the good news. We were cautiously hopeful that this would not become a future problem. I was exhausted. I went home... took some pain meds, a bubble bath and waited for a new day.

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