Friday, July 23, 2010

Appt with NaPro surgeon: RECAP

Yesterday was my last blood draw!  Yippee!  And the hubby and I went to see the sout.hern Cali.for.nia version of Dr. Hil.g.ers.

Background:  This appointment was a referral from the delightful Dr. D.  The plan was to do the full hormone panel (done), a pelvic ultrasound, hysterosonogram, selective HSG, laparoscopy, and follicular ultrasound series.  He also told me to take 500mg of Vitamin D every day (doing), and Mucinex (did for one cycle but it thinned the mucus out so much I did not want to keep taking it).

The appointment yesterday was just a consult to talk about the surgical options laid before me and to confirm what the surgeon thought about my charts and other medical records.

The Game:  I had all my records including the charts already copied and paper clipped.  The nurse asked some cursory questions like how long are your cycles, average days of blood, how many times have you been pregnant?  I could have just said "zero" but I was sensitive to this question so I inflated the answer, "I've never gotten pregnant, ever."  In response to the cycle questions, I handed her my cycle analysis which you can see on the blog.  I posted it a few days ago.  The the nurse took all my records and said the doctor would review them right now.

By the time the doctor did come in, she'd already looked at the charts and figured out in her mind what the possible issues were.  She spent a good 45 minutes talking with us in the examination room but it would have been more appropriate in an office.

From looking at the charts, she said I had diminished mucus and my cycles were irregular (in the last two years, I've had a 23 day cycle and several cycles later, a 33 day cycle), and I had a problem with tail end brown bleeding.  She then laid out a surgical plan: hysteroscopy, endometrial cultures with a biopsy, selective HSG, and a laparoscopy.  This would all be done at once under general anesthesia.

What I Discussed with the Doctor:  At first, I was really into the idea of exploratory surgery.  However, after reading this post and the comments it generated on Blondie's site, I was not supportive of the endometrial culture idea.  I haven't seen anything that would indicate this condition would cause infertility.  And I'm still not convinced the TEBB is that big of a deal.  And I told the doctor as such.  She said she'd be willing to tailor the surgery to what I wanted to do.  That made me feel better.

For the diminished mucus cycles, she suggested I start taking FertileCM.  And I should give the Mucinex one more try.

On the topic of my "irregular" cycles, she said that I will likely show low estrogen and low progesterone.  I'm very eager to see the results of the now complete blood tests.  While the NaPro booklet talks a lot about variable luteal phases being a problem, it doesn't say much about possible indications of the variability of entire cycles.  But, I'm emotional enough to think maybe my hormones are out of whack.  So, Dr. D and the surgeon will look at that and if I need progesterone supplements, she'll prescribe it.

I asked about the redundancy of doing a hysterosonogram and then a hysteroscopy.  She said it doesn't make sense to do the sonogram so I'm just going ahead with the pelvic ultrasound.

I did tell her that I have no physical symptoms of endometriosis, no pelvic pain anytime, anywhere.  Nor have I ever had irregular bleeding suggesting to me no fibroids.  These conditions don't run in my family.  Also, I've had regular S.T..D testing for fifteen years (I was obsessed) and I've never tested positive for anything (with the sad exception of H..P...V) so that ruled out any pelvic scarring for me.

The surgeon said she's booked out for surgery until September which seemed fine to me.  Then my husband piped up and said, "I think we should wait until we get the blood results back before we schedule surgery."  I kind of protested but then we all decided hubby and I should talk it over and call the office back when I wanted to schedule the surgery.  And then we went on our merry way.

Post-Game Analysis:  I'm very excited to get the blood results back because I'm tending to believe hormones are my issue.  I don't want to commit myself to an expensive procedure right now (in the next six months) that might be completely unnecessary.  And I want to do the ultrasound series before invasive surgery is done.

I like the surgeon, don't get my wrong and I think she spent lots of time listening to my concerns and working it out.  However, since she is the So..Cal version of Dr. H, she presented the procedures as, "this is what we do at NaPro."  And not, what is the most likely cause of your infertility, if I'm infertile at all?  I'm cognizant to the fact that I'm more educated on my condition that the majority of the population.  This issue is very important to me and I'm going to find out all I can.  Doctors might not be prepared for that.  I want to do what's smart, cost-effective, and is going to help keep/boost my serenity.  Lord knows that's what I need the most.          


  1. Sounds kindof similar to my letter/surgery with Dr. Keefe in Omaha. I had TEBB and when she did my lap she saw some of the endometrial lining was inflamed and took a biopsy (I wonder if that is the same thing that was talked about in your letter? It seemed more of a game-time decision in my case). After the surgery I still had the TEBB bleeding, Dr. K had me take amox but that didn't clear it up. Turns out that there was uterine strep B. I guess we all have strep B some place, but mine was actually causing inflammation. Usually it doesn't really affect anything. It wasn't until she had DH and I on biaxin for 21 days that I think it cleared up (don't know for certain because that was the cycle we conceived and it was really the only substantial change in the treatment plan that cycle!). Also, I didn't have any symptoms of endo (with the exception of the infertility- we already knew I had PCOS though) and Dr. K found mild-mod in there and zapped it out.
    Not sure if any of this helps.

  2. Chasing, I very much appreciate your input. I know that if I still can't get pregnant after a year or so, if I want to conceive a baby, exploratory surgery is the best answer. It's not easy for me to accept this is my reality but humility is a quality I long for. :) Thanks again!