Part 3…

A week or so after the terrifying results of my pelvic ultrasound, Ben and I are sitting in my OBGYN Dr. Bean’s office.  We’ve been really lucky, since the move to Indy, finding really great doctors who take their time, are thorough, and actually read your chart before they come into the room (the hospital network we’re in also has an integrated chart system – which means that I don’t have to replay the entire story every time I see a new doctor – It’s all in my chart).  Dr. Bean is no exception.  He’s prepared and informed.  He’s kind yet direct.  He’s never in a hurry and answers the millions of questions we have.

As Ben and I sit in the room waiting to talk to Dr. Bean, I can’t help but wonder what’s next.  You see, our journey didn’t begin that evening in May with the trip to the ER.  It began even before that.  Ben and I had been trying to have kids since we moved to Indianapolis.  It was now mid-July and we were  now eight months in with no result, ON TOP of the medical issues I was dealing with.

When Dr. Bean comes in, he sat down and started asking questions, “Tell me what happened the night of the ER visit?”, “How did we get here?”, “Are you trying to have children?”, “How long have you been trying?”, “Are you using a calendar to track ovulation?”  “Are you still having pain?” It felt like a million questions, but Dr. Bean has this way about him that makes you feel safe – not like you’re being grilled for information.  Once he was done asking questions, he begins to talk about my ultrasound results.

He tells us what the radiologist put in his report from reading the ultrasound pictures – and it’s the same string of big scary words that Dr. Fletchall’s nurse read to me over the phone weeks ago.  Dr. Bean then said, “the radiologist is recommending a MRI to see what the problem is – it’s the only way to get a really clear picture of what might be happening in there.  That being said, I read your test, too.  Since you’re no longer in pain, I don’t think a MRI is necessary.  It seems like overkill.  I’d like to recommend a Hysterosalpingogram first.  It’s cheaper and I think It will tell us what’s giving you trouble getting pregnant.”

Wait a minute.  Did you catch that?

It seems that no body is concerned anymore about what caused my ER visit.  All of the sudden the attention had been shifted to why a healthy, woman in her early 30’s is having trouble getting pregnant.  So I asked.  “Shouldn’t we be concerned about what caused my pain in May?”  Dr. Bean’s response was, “If you were still in pain, yes.  However you’re not now.  I’d like to focus on what we know is wrong and that is that you’re not pregnant.  I think what might be happening is that you have hydrosalpinx as indicated in the report.”

Hydrosalpinx: a blocked fallopian tube that is filled with fluid causing the fallopian tube to become substantially distended taking on a sausage-like shape and making impossible for an egg to pass through.  Usually occurs on both sides and causes infertility.  Hydrosalpinx is often caused by a infection in the pelvis either as a result of surgery or STD.

Dr. Bean seems to think that what they saw on the CT and ultrasound could be hydrosalpinx so he’d like to test for that first.  He orders a Hysterosalpingogram or HSG, but warns me – the test is extremely painful.  I have a pretty high tolerance for pain so I am willing to give it a try.

Just like every other fertility or reproductive test, there is an exact science to when it needs to be done.  I’m instructed to call when I start my period so the test can be scheduled accordingly.  He also orders an STD test (which of course comes back negative) since hydrosalpinx can be caused by an infection.

In describing the test, Dr. Bean explains an HSG as a test where they fill a woman’s uterus with dye while inflating a balloon a the base of the uterus to ensure that the dye will stay in the uterus.  They then continue to push excess die into the uterus while taking X-ray to watch how the die spills out of the fallopian tubes and into the pelvic cavity.  The dye allows the radiologist to see the shape and size of the fallopian tubes and determine if hydrosalpinx is present.  The filling of the uterus with the dye causes severe cramping and pain – whilst the dye in the pelvic cavity – something that’s not supposed to be there – causes your body to freak out – causing your abdomen to distend significantly.  It causes severe cramping and can be very painful.  It’s definitely not fun.

I can handle it.  It can’t be any worse than the cyst exploding in my abdomen, right?

I call to set up my first HSG test and Dr. Bean’s scheduler – we’ll call her Charity – sets up the test for a few days later.  I told Charity on the phone, “I’ll still be on my period that day.” She let me know that it should be a problem.  From there she gives me instructions about where to go – the main hospital imaging center.

The day of the test, Ben and I show up at the imaging center a little bit early.  At this point, I’ve already worked myself into a tizzy – I’m stressed and nervous and anxious and worried.  We get there – the place we were told to go – and were told we were in the wrong place, that we needed to go to the actual hospital.  This sends my stress level through the roof because now we’re going to be late and I hate being late.  We pile back into the car and drive over to the hospital.

At the hospital, I go to check in and yet they have no record of me.  So we head up to Dr. Bean’s office in same building.  When I get there, they act like I am crazy.    By now I am furious, but we get some better instructions about where I am supposed to go and finally get checked in for the test.  By this time I am a mess.  Stress, nerves, annoyance, worry – you name it.  On top of all the stress of not being able to find the right place and knowing that the test is going to hurt – I’m on my period.  All I can think about is laying on a table with a bunch of doctors – up in my lady parts – while of of that is happening.  It’s humiliating.  I sit there dreading the whole experience, not because of the pain, but because I how humiliated I feel about strangers in my lady parts while I am on my period.  Ugh.

As I sit there and continue to work myself up into a full blow anxiety attack, the radiology tech comes out to the waiting room to get me.  She’s kind, warm, and sympathetic to the day I’ve already had.  She immediately makes me feel better and I start to relax.  When we walk into the room where the test will take place, there is a table with a big X-ray machine and all the test supplies laid out for the radiologist. It’s intimidating and overwhelming.  She then says, “strip down and put this gown on.  I’ll be back in, in a minute.”  I then tell her, “uhhh, I’m on my period should I really strip down completely?”

What I’m met with on her face is alarm.  She then says, “Oh honey, we can’t do the test when you’re on your period.  All the tissue and blood will get pushed into your pelvic cavity and that’s a huge problem.  It can cause a major infection.”

AHHHHHHHH!!!!!!!!!!!

I can feel my head exploding and the stress piling on top of me.  My neck feels like a rocket launcher and at any minute my head is going to take off into space while flames shoot out of my ears.  All I can do is start crying.   I mumble the words, “I told the scheduler I’d still be on my period.”

The radiology technician wraps her arms around me and says, “Oh, honey.  I’m so sorry.  Let’s get you rescheduled for a little later.  I’m not supposed to do that, but we’ll take care of it right now. I know this is really stressful.  It’s gonna be okay.”  I’m rescheduled for the following week and I head home – a ball of tears in the passenger seat – while Ben calls Dr. Bean to complain about Charity’s negligence.

A week later, I head back for my HSG.  This time I know where to go.  This time I’m not on my period.  This time I tell Ben to stay home.  I check in and they don’t have my paperwork from Dr. Bean’s office.  Charity never sent it over.  FOR CRYING IN A BUCKET WOMAN STOP SUCKING AT YOUR JOB.  The lady at registration assures me that I won’t be leaving the hospital without my test.  So I stop worrying about it.

As I sit in the waiting room, I feel calmer.  I’m still a little worried about the pain, but overall, I’m significantly more relaxed than a week ago.  I hear my name called and when I look up, it’s the same technician from last week.  I immediately smile.  She was so compassionate in the chaos of the week before, I was hoping it would be her assisting the radiologist today.  As we walk into the room, she looks at me and whispers, “I’m so sorry, but the radiologist today has zero bedside manner and no personality.  I just want you to know that before we start.  It’s going to be fine, he’s just not my favorite.  I’m so sorry.”

Seriously?  Can somebody throw me a bone?  Why does this always have to be so hard???!?

I change, lay down on the table, put my feet – again – in the stirrups, and prepare for the worst.

They move quickly and efficiently.  Everything happens very fast.  First the speculum to open the cervix is inserted, so the radiologist can insert the catheter (to push in the dye) and the balloon (to keep the dye in).  Ladies, you know that the speculum – the coldest piece of metal in the history of time – being “inserted” into your cervix is the worst feeling on the face of the universe.  It hurts.  Then with no warning, the radiologist shoves in the catheter (to be honest he probably didn’t “shove it” in) and I feel the jab of it on my insides – ouch.  Then, with warning this time, they inflate the balloon.  I felt a little pressure, but nothing I couldn’t handle.  I was just glad that he then pulled the speculum out.  At that moment I thought to myself “Ohhhh, thank God.”  Then, they begin pushing the dye through my uterus.  It’s a type of pain and cramping and pressure and discomfort I can’t describe.  It hurts and feels weird and is uncomfortable, yet doesn’t compare to the pain from May.  So I lay there, grit my teeth and wait for it to be over.

They start snapping X-rays immediately, but I can’t see what’s happening.  Then just as quickly as it started- the test is over.  It took a matter of minutes from start to finish.  The radiologist removes the catheter and deflates the balloon and I take my feet out of the stirrups.  He then turns the screen to show me – and explain to me – what he sees.  A gesture that’s uncommon.  They typically don’t tell you what they see right away.

A normal, healthy woman’s pictures would look like the below.  You can see both fallopian tubes fill with dye and the dye spill out into the uterus.

Normal HSG Test Pictures

In a woman with hydrosalpinx, the fallopian tubes look like sausages, like the picture below.

Woman with Hydrosalpinx

My left side looked completely normal.  My right side – nothing.  You couldn’t even see the hydrosalpinx.  The tube was completely blocked all the way from the entrance from the uterus.  The radiologist said, “As you can see, your right side is completely blocked. The way it’s blocked however is not indicative of hydrosalpinx because it usually occurs on both sides, however what I see here would certainly cause fertility trouble.  I’ll send my report to Dr. Bean and he’ll follow-up.”

I remember leaving the hospital after the test feeling pretty okay with that diagnosis – not a death sentence.  I can still have kids.  My left tube is still open.  In my mind that was good news.  However, we still didn’t know what caused my pain in May – and no one seemed to be concerned about it.

The next day, Dr. Bean called to discuss my results.  We had a long conversation and ultimately he recommended that we keep trying to get pregnant naturally for 6 more months.  If after six months we had no success, we would discuss other options.  Ben and I were totally comfortable with that plan.  We felt pretty optimistic about what was next and were ready to move on – forgetting about everything that had happened

At this point, we had relented that the May episode that prompted the ER visit was a one-time fluke and began to focus my full attention on the task at hand – building our family.  Little did we we know – it wasn’t going to be that easy and what we thought would be a one-time episode was just the warning siren of what was yet to come…