Category Archives for Surgery

Prepared to Pluck Polyps

After some juggling of schedules, I’m finally having surgery today because last Spring the results from my follow-up abdominal ultrasound scan showed that I have a uterine/endometrial polyp. My Gynecologist decided it was best to remove it, and not leave it alone and subject me to abdominal scans every six months to monitor it for changes. If I had demanded he leave it alone – say because I feared extreme post-surgery pain – any changes that showed up in later scans could have signalled cancer. Even the slimmest chance of that happening was enough for me to accept my Gynecologist’s decision.

To be honest, I expected to have the surgery in the fall, but I had to place a priority on the treatments and programs I already had scheduled for my chronic pain during those months. My continued pain was also a big part of the focus for my surgery pre-admission appointment last week. I spent about four hours in the hospital’s Pre-Admission Center on Friday, meeting with nurses, technicians, and doctors to discuss my medical history and identify any current health issues, have blood drawn for tests, and get a general physical. The nurse was the first person I met with and at one point, while looking through my electronic medical files; she rightly stated that I spend too much time in hospitals.

During my meeting with the nurse, I had to recount the history of my illness, the outcome of my last surgery and recent treatments, and the long list of medications I now take to cope with my pain. As pleasant as she was, while I sat there and went through all those details, the interaction put a sharper edge on the pain I was feeling. At one point, she noticed my creased forehead and asked if I was all right. There wasn’t much I could say in response, except that it was just my usual pain, which thankfully she couldn’t tell was a lie. Before I moved on to the next stop in the pre-admission process, she gave me some literature on my surgery, a Hysteroscopy, and although I’ll be under general anesthesia, will not require any abdominal incision(s) because it will take place entirely within my uterus. Oh, joy!

Next, I met with the blood technician who took three or four vials of blood. I’m rarely sure about how many vials get filled for blood tests because having my veins pierced by the needle always hurts like hell and I never look. I am concerned about what the results from the blood tests might be because recent tests have uncovered that I have low iron – which means I’m anemic – and I have low blood (hemoglobin) levels. If I have below normal blood levels again, my surgery might be rescheduled until I get a boost. Thankfully, when I later met with the doctor for my physical, the session was short and didn’t cause me any extra pain.

My last stop, in the pre-admission process was with an Anesthesiologist, who is a member of the hospital’s Pain Team. I had to meet with someone from the Pain Team to discuss the possible outcomes of the surgery with respect to my pain. The type of surgery I’m having is usually a Day/Ambulatory Surgery procedure, meaning that you get to go home once you wake up and don’t show any adverse reactions to the anesthetics. In my case, the chronic pain I live with daily is factored into when I might be allowed to go home. If, when I wake up, I don’t have unmanageable pain I can go home on the same day. However, if my pain can’t be controlled I’ll be kept, at least overnight, until my pain reaches a level I can cope with at home. I’m hoping for the former because I want to come home and sleep in my bed after it’s all over, but knowing what I do now about my pain’s unpredictability I have to prepare for anything.

♦

This is what I was listening to as I posted this morning…

The Beatles – Hey Jude

Another Scan, Another Problem

My illness is starting to feel like a long meandering river that you might see photos of in National Geographic Magazine, with a caption describing how it formed over centuries under the pressure of slowly receding glaciers. I know that probably sounds overly dramatic but the curves my body can throw at me seem endless. The farther I fall into life with chronic pain the more my body changes and the more I learn about the human body – my body especially – that I never could have imagined needing to know three years ago. Each test, scan, or invasive procedure reveals another unexpected facet of what could be THE SOURCE or at least a contributing factor to what is happening within me.

I recently had a series of appointments with one of my specialists. He’s the gynecologist who has been an incredible advocate for me. He managed many of my referrals, even though he didn’t have to, when I became his patient a few years ago, to make sure that I connected to the right doctors. He’s also the doctor who removed the offending growth from my pelvis last summer when it turned out that my MRI results were misleading and I didn’t have a rare congenital condition which could have led to the removal of most of my rectum. I suspect that as long as my pain continues, I’ll be in and out of his office a lot in the coming years.

The first appointment with him was at the beginning of April for my bi-annual check-up. After I detailed how things were progressing – or had not shifted at all – in the preceding six months and since the removal of my pelvic growth, he ordered some tests for me. He wanted to rule out the possibility that he missed any small growths during my surgery that could now be growing larger; or that the one removed was regrowing and causing me to have continued pain. The most dreadful of the tests he ordered was the abdominal ultrasound series. This ultrasound consists of two parts: an abdominal scan that starts near the diaphragm in the area just below my rib cage and works down to the lowest point of my pelvis; and a transvaginal scan, which requires the insertion of a condom-covered probe into the vagina. I dare anyone to guess which of the two scans is my least favourite – and probably so for most women. Just saying the word “transvaginal” makes my skin crawl, and having to endure the procedure with my existing pelvic pain feels indescribably cruel.

After having to reschedule the appointment for my scans because my body refused to cooperate long enough for me to make it to the hospital to have it completed, I was finally back in the gynecologist’s office at the beginning of June for my results. It was the same day I ran into the Doppelgänger of a former friend while trying to cope with some difficult feelings. Of course, the scan results added an extra layer of angst to that day. The best news was that there were no new growths clinging to the walls of my pelvis to cause concern, but images of my uterus told another story: the report detailed two objects in my uterus. The first is a small fibroid, a noncancerous growth found in the uterus that often appears during childbearing years, which my gynecologist said is so small it doesn’t merit much concern. Of course, my body being my body, there is another growth about an inch in size I do have to worry about, a uterine polyp. Uterine polyps “are growths attached to the inner wall of the uterus that extend into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of uterine polyps, also known as endometrial polyps. These polyps are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer (precancerous polyps).”

This polyp could explain some symptoms I have in addition to my chronic pain that originated in my pelvis: my unpredictable and excessively heavy periods, and severe period cramps. My gynecologist believes that removing it can help to relieve these symptoms, which are probably my body’s way of trying to expel the foreign body in my uterus. So what are my options to deal with this inch-long polyp? I could continue to have it monitored at 6-month intervals to make sure it doesn’t grow or change in any other way or I can have it removed now. That’s right, more surgery. Because, although “[m]ost uterine polyps are noncancerous (benign)… some precancerous changes of the uterus (endometrial hyperplasia) or uterine cancers (endometrial carcinomas) appear as uterine polyps.” The procedure to pluck the polyp from my uterine wall can take place during day/ambulatory surgery, which means I shouldn’t have to stay in the hospital overnight. However, if my ongoing negative responses to physical stimuli and my body’s alarming reactions immediately after my surgery last summer are any indication I will most likely need to stay in the hospital at least one night for observation.

I have an appointment later this week to schedule the polyp removal and discuss the possible outcomes of the procedure. After the surgery, the polyp will be biopsied to make sure it’s benign. Then I’ll probably have a series of uncomfortable transvaginal ultrasounds scheduled to monitor whether the polyp makes a comeback or any others spring up. Plucking it out might not mean it goes away forever – there’s a rare chance it can recur –, but at least the physical symptoms, and the pressure and anxiety I feel while thinking about it taking up space in my uterus should lift – until the next thing shows up…

 

Billy Joel – Pressure

 

The Last Post-Surgery Check

I’ve hit the six-week mark since having surgery without any major complications: my incision is healing well and I didn’t have any infections. I had my last check yesterday with the gynecological specialist who pushed to get something done to get me better and was a part of my surgical team. From his perspective, everything looks good. He reviewed the pathology reports he requested on the growth he removed from my pelvis, my fallopian tubes, and all the adhesions that stuck that growth to my rectum and my fallopian tubes to my ovaries. All the reports came back with no sign of cancer, endometriosis, or any other diseases for concern. He also assured me that there is very little chance of the growth recurring.

However, he wasn’t happy to hear that the surgery didn’t help to reduce, or what he had hoped, end my pain; or the fact that I’m now taking three times the level of pain medication I was taking before the surgery. He examined my incision; ordered some tests, and then scheduled my next appointment for six months from now. We also discussed the pain clinic’s plan to manage my pain moving forward. In the near future, my pain specialist will attempt to manage my pain with acupuncture. The gynecological specialist assured me that my pain specialist is a very skilled acupuncturist. As much as I like her, feel comfortable with her, and trust her many years of experience; it was comforting to get that vote of confidence in my pain specialist from one of her colleagues.

I left my appointment feeling confident, which has only happened a handful of times during the past two years. Everything isn’t perfect, but now that my surgery is behind me, the growth is no longer in my pelvis, and it was clearly benign; my doctors and I can focus on my pain. We can focus on finding a solution to eliminate it because now we know that the growth may not have been the direct cause of my chronic pain, although, it might have been the catalyst that triggered it. The discovery of the growth also raised awareness about the unusual way my body processes high levels of pain. Now my doctors just have to figure out what to do to make me pain-free again.

 

The Police – King of Pain