Posts Tagged Uterine Inversion

5 years later… and endometriosis

On and off for the past year and half, I’ve been dealing with significant shoulder pain (right shoulder).  I tried my primary care doctor, I went last fall, because I thought I had a joint problem in my shoulder, especially when the pain started shooting down my arm and up my neck and basic ibuprofen was doing little to dull the pain.  She diagnosed me with a spasm in my upper trap muscle, gave me muscle relaxers and sent me to physical therapy.  My PT was awesome and I completed several weeks with techniques to remedy the pain.  It helped… somewhat, until I started my period again the next month.  Every step along the way, I asked them if there was any logical connection to the fact that the pain intensified with my period.

The doctor and the PT weren’t aware of anything that could be triggering it… maybe hormones triggering stress that was triggering the muscle tightness triggering the pain?  I was given a battery of exercises, stretches, and ideas to help me manage the pain whenever it flared up and ways to ideally prevent it from flaring up.  However, no matter what I have done since the fall of last year, after getting physical therapy, nothing has kept the pain from creeping back in each month.  Exercising, drinking more water, eating healthier, etc has helped a little bit, but never really has resolved the problem.  I always know when my period is coming, as the pain in my shoulder starts a few days before.

I finally decided enough was enough last week when I woke up, first day of my period, and my shoulder pain was far worse than my menstrual cramps.  That’s ridiculous and clearly there is a connection if both are hurting so badly at the same time.  So, I decided it was time for Dr. Google!  And, thankfully, Dr. Google did not let me down this time.  I immediately called my OB/GYN office (seriously, it was pretty much as soon as they opened their phone lines) and had to explain to the person handling scheduling that “Yes, I’m calling for an appointment with my gynecologist about my SHOULDER, yes, just hang with me here, I read something on the internet that suggests it is a form of endometriosis”.  My husband thought I was a little crazy and I’m pretty sure that the scheduler that I was totally bananas, but the pain has gotten disruptive in my life to the point that I’m willing to have people thinking I’m crazy for the sake of getting a solution.

Thankfully, the doctor who delivered both of my babies, and is a bit of a super hero in my world, knew immediately what was wrong with me and what was causing my shoulder pain.  He overheard me talking with the nurse at the nurse’s check in (you know, where they check your weight, blood pressure, etc), and popped his head in to say “I know what it is, it’s behind your shoulder right?  You’re bleeding in there.”  My reaction – “Oh, Thank God, you don’t think I’m nuts.”

I went into the actual exam room and had a chance to sit down and discuss everything.  Turns out, in addition to the shoulder pain being indicative of diaphragmatic endometriosis, the spotting I’ve been experiencing a few days before my period is also a symptom of endometriosis.  Our game plan is to start birth control pills and skip the sugar pills in the packs so I never get my period.  The goal being: to shut down the tissue that is in places where it doesn’t belong that is causing the bleeding/scar tissue/pain/whatever the hell it’s doing in there that is so awful. (Side Note – I’m probably preaching to the choir here, but that pain is absolutely awful.  I think I have a fairly high threshold for pain – I think anyone who’s had a UI can claim that – and when it flares up I’m extremely limited in what I’m able to tolerate comfortably).

My doctor suspects that the endometriosis may be from the surgery to put my uterus back in my body after the inversion.  It’s also likely that I inherited it, as I have a cousin who had a hysterectomy at age 30 to combat it.  Could be both.  I’ve been doing a little more searching online and have come to realize the pelvic bone pain after my first born during my periods is also indicative of endometriosis.  I assumed the pain in my pelvic bone was due to the inversion some how… the down side of not having a great idea of what is “normal” when you have a rare complication like an inversion.  I’m sure I’ll discover other things that I didn’t make a connection to as I look into it further.  The hope being, the pills will keep surgery at bay for me for a significant amount of time.

This would be a significantly more difficult diagnosis if we were still hoping to have more children.  I had my tubes tied during the c-section with my second, so we already knew we were done.  At this point, I’m far more relieved with the knowledge that I know the reason why I’ve been combating this chronic pain and I have a solution to the problem to try for now.

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Let’s go ahead and talk about it – PPD/PPA

I may have touched on this in earlier posts but I wanted to dedicate a full post to Postpartum Depression and Postpartum Anxiety.  Baby CJ’s delivery rocked my world – in wonderful ways, and in some ways that sent me feeling out of control.

Having survived a life threatening complication made me feel like I should be only feeling grateful for each and every day with my son.  And, honestly, I do genuinely feel grateful for each moment that I get with him (and I think most parents share that gratitude for their kids, regardless of any sort of complications).  However, in the midst of my new life as a mom, something was wrong.  Outings regularly sent me into a tailspin that only my poor husband got to witness.

This was the nagging stream of consciousness going through my head:  Is this from the lack of sleep?  He is sleeping through the night now… Was it breast-feeding wearing on me?  Maybe… let’s see if I start to feel normal after weaning (which, unfortunately, was something that happened way earlier than I’d planned on).  OK, still feeling weird after weaning… Maybe it is because I’m still vitamin deficient, let’s make sure I’m taking a vitamin and eating well…  OK, maybe it’s because I’m still out of shape… Let’s join the Y and see if that helps…

Finally, the chat with my OB the first week after I had CJ, when he was removing my staples, kept sneaking in, specifically, after a particularly bad episode of my son crying in the car while I flipped out because formula powder spilled everywhere.  The OB’s words, which were actually more directed at my husband, telling us that he would more likely notice changes in my before I even noticed.  Those comments, along with my husband’s comments about how freaked out things were making me for no reason, made me think, “Something is actually wrong with me.”

My life is great – I have a great husband, a healthy son, I was healthy, we are financially stable, I am enjoying our set up with being able to stay home… Why the heck do I feel so different?  And, it wasn’t a “good” different either.  I also had remembered my mom telling me about family members who’d suffered chemical imbalances after bad hemorrhages, that triggered mental illness.  Before telling my husband that I wanted to talk with the doctor, I reached out to a friend who has always been very open with me about her own struggles with PPD/PPA after having her daughter (and having a bad hemorrhage).  Her words to me were, “Girl, you are textbook – go see your doc now.”  I was also given this link: http://www.postpartumprogress.com/the-symptoms-of-postpartum-depression-anxiety-in-plain-mama-english

I’d always envisioned PPD or PPA looking like it does in those commercials for antidepressants.  The ones where the mom can’t get out of bed, she cries all the time, doesn’t eat or can’t stop eating, ignores her baby, etc.  And, maybe those are true symptoms for other people – but I was none of those things.  Also, my son was 9 months old before I went to see the doctor (finally!) about what was going on.  The link above made everything click when I read this:

  • “Maybe you’re doing everything right. You are exercising. You are taking your vitamins. You have a healthy spirituality.  You do yoga. You’re thinking “Why can’t I just get over this?”  You feel like you should be able to snap out of it, but you can’t.”

Most of the other things she detailed were starting to hit home as well, but that bullet point nailed it for me.  And, it gave me a way to articulate to my doctor how I was feeling.  It turns out, my OB’s wife suffered from an almost identical case of PPD/PPA for months as well after their child was born.  She, like myself, managed to hide it from all of her close friends and family too, but just felt so angry and frustrated with everything all of the time.

I went on a low dose antidepressant for about 6 months, had a lot more open conversations with my husband, and finally started to catch a break from whatever that was lurking around in my head.  The meds can have their own drawbacks, but I was very grateful that I was able to regain a bit of balance back.

I do worry about having a repeat performance of this after I have Baby #2, though I feel better knowing that I know what to look for ahead of time.  I refer back to the page I linked here often as a bit of a reminder (and resource to share with other friends) of what to look for.  I also owe a huge thanks to a few of my closer “mommy-friends” who opened up with me enough about their own experiences and made it OK for me to talk with them about how I was feeling as well.  PPD/PPA are so common, but are still considered somewhat taboo – hence my motivation to post about it here.

Resources:
http://www.postpartumprogress.com/

http://www.babycenter.com/0_postpartum-depression-and-anxiety_227.bc

http://www.postpartum.net/

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Post-Op Recovery

You know that show “The Doctors”?  A teaser for an episode was, “Who has a harder recovery, mothers who have a vaginal delivery or a c-section?”  I was curious, so I tuned in to see what they said.  Their response: could be either one.  The vaginal delivery recovery is bad if you had to get stitches (Check! But, thankfully, no major tearing) and c-section recovery is bad if you have to get cut up and down instead of side to side (Check!).  So, the real answer is, it’s actually terrible if you have a baby vaginally and then get emergency surgery that slices you up and down.  Winning!

Chances are, if you have stumbled across this blog, you know exactly what this sort of recovery is like (I’m sorry).  However, I promise, you will feel pretty close to normal at some point.  It took me a little longer than most women do postpartum, but most women don’t go through crazy complications during birth.

It was amusing to watch my nurses process through my chart.  The doctor’s orders were: vaginal delivery recovery protocol, c-section recovery protocol, and a transfusion protocol.  A couple of times, my nurses would just stop reading, come in, and say, “OK, what happened to you?”  I appreciated being able to tell them what was going on myself.  Inversions are fairly rare, so I was a first time case for many of them.

My night nurse was amazing though.  I was her 3rd inversion case AND she had abdominal surgery herself at one point.  She was the one who had to remove my cath, get me out of bed, and make me pee the first night.  She made sure to jack up my morphine right before moving me.  She didn’t get frustrated with me when I was terrified to pee, and made sure that, after the first night, she and the nursery nurse came at the same time (4 am) to prevent interrupting my sleep unnecessarily.  I missed her after we got home!

My nurses also helped me come up with a pretty genius way to wrap my belly and protect my vertical incision.  I had a belly binder, so we took a maxi pad and laid it over my incision before binding me up.  Then, after being all wrapped up, we put those diaper size pads in the mesh panties, which I pulled up over the bottom edge of the binder.  Not the sexiest ensemble, but it did the job!

I wore the binder at home for a while.  They took out my staples over the course of the week after delivery.  The OB then super glued the incision and taped everything to be sure everything stayed super secure.  After the incision was healed better, I switched to an Ace bandage wrapped around my stomach for a while.  Pants were painful for a long time, especially anything with zippers, so I got cozy with loose waist band pants in my closet!

The trick to recovering at home was keeping up with pain meds.  Pure and simple.  Don’t be a hero, your insides were forcibly moved outside your body.  My OB warned me that those pesky RLPs would be a problem because everything was so pulled and so stretched during the inversion.

WARNING: If they give you narcotic pain meds, start taking Colace ASAP.  Pooping after surgery is miserable.  Pooping after surgery, having taken narcotics, and not taking a stool softener is terrifying.  I thought I was reopening all of my stitches.  Take Colace, end of story.

The other trick to recovery is moving around.  This part blows.  Walking is not fun, and stairs are a nightmare.  Shoot, sitting up is a nightmare.  But, the silver-lining is, the sooner you get blood flowing properly, the sooner you will feel better.  It took me a good 3 months or so to be completely pain-free, but the pain was significantly lessened after about 3 weeks.

The last thing I wanted to say about my recovery was, it really did take about a year to 18 months to feel 100% “myself” again.  Every nurse and doctor I’ve spoken to in this field has echoed this principle, “It really does take 18-24 months to fully heal your body after that sort of trauma and surgery.”  I run, eat well, take my vitamins, and all of those other things essentially to feeling good, but giving myself the time to really feel “recovered” was the most important piece of the puzzle.

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Birth and Inversion Story – Where this all began

Birth Story

On Wednesday, in Feb 2011, I had my 39 week check up, and my OB took the opportunity to strip my membranes, to get things going for my scheduled induction for the next morning.  Earlier that week, I’d had an ultrasound that showed I had roughly 3.85 cm of fluid – a healthy range being anywhere from 5 – 25 cm of fluid – and they were concerned about the baby due to the low fluid.  Fortunately, my body was already initiating labor on its own, so the doc’s plans and baby’s plans seemed to be perfectly in sync.

Wednesday evening, after my doctor’s appt, we checked in the hospital they started me on cervidil.  We stayed overnight and I started having regular contractions around 3 am Thursday morning.  At about 6:30 am, my nurse let me take a hot shower (which I wanted to hug her for) and they started me on pitocin at about 7 am in order to make sure my labor was progressing.  From there, my contractions became very frequent and intense, which is normal with pitocin.  I got an epidural around 10 am, which was wonderful and definitely something that I would do again.  The epidural allowed me to take a nap and rest up until about 11 am.  At around 11, I called in a nurse because I thought maybe it was getting close to time to push.  They had me wait for just a little while longer, but sure enough, it was getting to be time to push.  I started pushing at 11:44 am and delivered Baby CJ at 12:17 pm.

Baby CJ was absolutely perfect from the beginning.  He had great/strong lungs and the cutest little cries and he peed on the doctor right after he was born (oops!).  They laid him on my chest for a minute before cleaning in him up, which was the best moment.  After they took him to get a little more cleaned up, they handed him to my husband for some bonding time as well.

Uterine Inversion Story

As you might already have guessed, this was the point where I had to unexpectedly go to the OR.  As my husband says, this is when “it got real” in the delivery room.  As mentioned earlier, Baby CJ was delivered at 12:17 pm.  At 12:24, I suffered a complete uterine inversion, and was in the OR (or, as I called it, the “Oh Shit!” Room) by 12:27 pm.  The inversion occurred immediately following the strongest contraction I’ve ever felt – and that is saying a lot having JUST delivered a baby and having an epidural in at the time.

A complete inversion is when your uterus is delivered out of your cervix and vagina, whereas a partial inversion involves the uterus collapsing on itself but not actually exiting the body (or, as I like to say, abandoning ship).  My uterus tried to abandon ship by hitching a ride with the placenta.

My doctor was right there as the uterus and placenta were being delivered and knew immediately what was happening.  It is a rare complication, and the key to survival AND keeping your uterus is having a doctor who knows immediately what is going on and can act without delay.  Thankfully, my OB happened to have seen a UI (uterine inversion) during his residency and another several years later and knew exactly how to act.  It is rare to have a OB/midwife who has even had one UI case.  Unfortunately, my husband was also RIGHT there went my uterus inverted and was delivered.  Needless to say, he was terrified.  It didn’t help that, when they rushed me out, he was left standing in the delivery room, alone, holding our 7 minute old.

As soon as the inversion happened, my doctor tried to manually place it back.  This is always the “first line of defense” and the preferred way of correcting the problem.  It was very clear that manual manipulation wasn’t going to work at all, and he then told me, “You need surgery now, and you may lose your uterus.”

Nurses seemed to appear out of the walls at this point (I suspect the “Oh Shit” button was pushed, calling all available to help).  I signed 3 release forms, gave the nurse my glasses, and fought with everything I had to remain conscious.  This is why inversions are so bad and potentially deadly – the placenta, which is still attached to the uterus, is a blood factory for baby.  I literally saw the blood pooling and bubbling in my uterus walls within seconds of seeing my uterus out of my body.  I was bleeding out, and fast.

I knew if I passed out in front of my husband, he would really get scared, so I did my best to stay alert.  I told the nurse, whose name is Angel (how perfect, right?), that “I was getting VERY light-headed,” and thankfully, she knew immediately that I meant “I’m bleeding out.”  Since my husband was right that, I was trying to keep him from realizing how fast I was losing blood.  I also reminded her that my blood type was A+ (of course, they already knew it, but I’m a control freak and was trying to help them every way I could).  Unfortunately, once I lost a fair amount of blood, I started to lose my vision, but was still fighting for consciousness.  The nurses ran me down the hall, I felt like I was in a scene from “ER” (which, coincidentally enough does feature an inversion in the series finale episode).

Once we got to the OR, everyone got to work immediately.  They started IV anesthesia, started a blood transfusion, and got the mask over my face.  I heard my nurse from the delivery room say, “She already had an epidural,” which likely means they were able to start cutting my belly open immediately.  To this day, I’m still so, so grateful that I had an epidural and had generally been as surgery-ready as possible.

I heard them say, “grab the O+!”  When the guy doing the transfusion crammed the needle in my arm, not realizing I was still “with it”.  I cringed and heard him say, “Oh, I’m sorry!”

When the mask was put on my face, they said, “Take a deep breath.”  The only thing I could do to help was breathe deeply, so I took the biggest, deepest breath I could muster.  I didn’t want to know what was happening anymore and I wanted to go to sleep and let them fix me.

A redheaded nurse woke me up from the best nap ever.  Going to surgery immediately following birth wasn’t what I’d hoped for, but man, that was a good nap.  She told me that my doctor had saved my uterus and successfully corrected everything.  I responded with “Hey, I’m just happy to be here.”  My anesthesiologist from surgery was the same one who did my epidural.  He looked at me and said “What are you doing here???” and I responded with, “I wanted to lose the baby weight as fast as possible and thought dumping off organs and blood would be a great way to do that.”  He thought I had lost my mind, I thought it was hilarious.  I mean, if you can’t laugh in these situations, you have to cry, and I was not in the mood for tears.  I was happy to have survived and wanted my baby so, so badly.

Fortunately, for my husband, the surgery was quick and they told him as soon as they could that I was doing great, which was around 1:00 pm.  He went and held Baby CJ, watched him get a bath, took a ton of pictures, and got our stuff situated in our recovery room.

I was able to get back to my recovery room a little after 2 pm to be reunited with Baby CJ.  The rest of the day was a fog, but I was able to nurse immediately, and I was given a morphine pump for the pain as all of the other meds wore off.  The anesthesia made me vomit and sleepy, which wasn’t so great.  To my doctor and nurses’ credit, the pain management I was given was wonderful and very effective, making the whole experience much easier to cope with.

I stayed in the hospital until Sunday, which was entirely my call.  Saturday was rough, as all of the stronger meds had worn off and I was having to move around more and more to help the healing process.  I was on a combo of Ibuprofen and Percocet, along with wearing a binder on my belly to protect my staples/stitches on my incision.  All of which is pretty standard, from what I’ve heard.

Next up: Post-Op Recovery

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