Tuesday, June 30, 2009

Family Matters

Curiouser and curiouser. When I said that I figured my vag wasn’t all that weird after pap smears passed without comment, on the grounds it’s not the sort of thing people talk about, it turns out I was more right than I knew.

One of my many maternal aunts called me the other day. It seems that my mother had told her about my HSG but not the reasons for it. I came clean. She said “Yay!” about the baby-plans (especially nice since she’s the only one married to a bona fide conservative) and then casually mentioned that her uterus wasn’t normal. Wha??

I put Mom on the case, and it turns out that two of her sisters have “heart-shaped” — bicornate, I assume — utes (and children without surgery, I might add). Of the remaining four women in the sib-ship, three have had hysterectomies for endo. No telling what shape theirs were. Time to put in a call to maternal aunt number five....

Oh, did I mention that my father is a geneticist? I suppose I should call him and let him know that maybe there’s something to this heredity business, after all.

Friday, June 19, 2009

Totally Tubular

What did that mean, exactly, anyway? I remember that the connotation was positive, so I can only assume it had nothing to do with yesterday's "totally tubular" HSG adventure.

An HSG, for the blessedly uninitiated, is an X-ray of your more internal lady-parts, in particular your uterus and (if you're lucky) your fallopian tubes. Only if you're really lucky, you won't have to do this at all because let me tell you, it pretty much sucks.

Listen, before I go into my story: If you're reading this because you have to have one and you're scared about it, do be aware that your experience will NOT be like mine. The part of my procedure that hurt was the part concerned with getting through my cervix, and that was because of the double-vag action. If you have the ordinary number of vaginas and cervices, then the speculum part might be ouchy and the dye might give you cramps, but that's it. And if your set-up is irregular, take heart: I survived. The anxiety was way worse than the pain. DO take a bunch of Advil beforehand, DO BYO maxi pad, and DO get someone to come with you, if you can.

Now back to our whiny story, already in progress:

It goes like this, in principle: You take a whopping amount of Advil and maybe some antibiotics and then report to Radiology, where you strip down and hop up on a table, all pap-smear style, except there are no stirrups. I have it on authority from several other victims patients that there are never stirrups. You didn't think the stirrups mattered, but you find yourself annoyed at holding your legs in place without them. Then the doctor gives you something to be annoyed about, and by "be annoyed" I mean "cry".

The next step is a yawning speculum, followed by a catheter through your cervix. Dye through the catheter into your ute and hopefully your tubes -- the idea is to see if the tubes are open -- quick X-ray shot of all that business, everybody out of the pool vag, and you're on your way, sorer but wiser, and leaking dye into the pad you brought with you or else one of those throw-pillow-sized hospital ones.

Aren't bones pretty? This is not me, by the way, but the internet says it is normal.

The speculum is not a picnic -- it has to be open more than for a pap -- and some people get some cramping from the dye. I didn't. Instead, I got endless horrible pinchingburning from the many attempts to get through cervix number one, followed by more stretchingaching from cranking open vag number two, followed by more digging around on that cervix. Holy crap, that sucked, not least because it was so damn demoralizing listening to the X-ray go off again and again and again and again, only to see no uterus onscreen, only the end of the speculum and a sad little pool of dye stuck outside.

Me, after watching nothing happen for the third time:
I promise you I have a uterus.

Dr. BF: I know you do. I've seen it on ultrasound.

Me: I've seen it on the MRI.

Dr. BF: Yes, I know you have a uterus.

More burrowing around in my nether regions. More nothing happening on the X-ray.

Me: I further swear that I do get my period, every month, and that it comes out of my cervix.

Dr. BF:
I like your logic.

My Cervices, after tries 1-5 (or 6? I lost count):

Eventually, door number two yielded. Not without some burning pain, though, and I wish I hadn't glanced at the instrument tray later, because there was rather more of me on it than a girl would hope. And the news is good: though Dr. Baby Factory describes my endometriosis as "significant" and brings up IVF every time we talk, he says the tubes are open enough to give it a go on our own first.

Thank you, Nice Nurse, for patting my shoulder while Dr. Baby Factory cranked the speculum in my bigger vag up to 11 or so. I know you were right to stop me massaging my poor tum when he went for door number two, so I hope I didn't give you a very dirty look. Sorry I dissed your pad when it was all over, but seriously, by the time those things take two hands to carry, they are too big. Please tell the hospital to enter this century (or even the final decade of the last one).

When Hospital Pads Attack

Thank you Dr. Baby Factory for telling me when things would hurt, for apologizing repeatedly, for not sounding panicked or annoyed when nothing would get through cervix number one. It's a real pity the catheter would never go through. Thank both of you for not calling the extra clamps, pinchers, pipe-wrenches, and jaws-of-life required to get a catheter syringe into cervix number two by their names, instead saying things like, "Could you get me...one of the green things? Do we have one of those?" I bet this whole thing took much longer than you had scheduled, so thank you for sticking around to talk with me. If I'd known going into this that my procedure would be "what makes it interesting to keep doing these, even after 20 years," I would have run for the hills, but it was still nice of you to say something like that instead of acting like I was bad for having a difficult anatomy.

So sperm! We're gonna buy some! ...in August or September, finances permitting, because, frankly, I want to enjoy my week at the beach in July, not run around peeing on things and not getting to drink.

Right now, it's hard to think about putting anything in my hoo-has, though, because everything is still pretty ouchy. I'm on Cipro for the weekend, on account of all the digging around, and my poor old left ovary, the one that aches for days after dildo-cam-ings, is talking about moving out and getting its own place.

Friday, June 12, 2009

At The Baby Factory

Last week, Sugar Mama and I made our way over to the Kips Bay Baby Mill...and I'm a little in love. Our doctor is The Right Sort. He listens well, seems genuinely interested to know us, and Sugar Mama was particularly impressed by how naturally he treated her as my partner, not just as a more-or-less invisible friend. (In fact, the more I think about Dr. Baby Factory, the less I like the gyn who couldn't find my second hoo-ha.)

I was a little worried about the transvaginal ultrasound they do as a regular part of new patient intake, though it was inevitable that I would have one this month, since the gyn wanted one as follow-up on the ovarian cysts found on my MRI and I was glad enough not to have his hand on the dildocam, considering how uncomfortable I found his pelvic exam. Dr. Baby Factory was very gentle -- even the double-pap (the first pap of the rest of my life...) wasn't bad. Sugar Mama stayed with me the whole time, as did some new PhD who I took to be a med-student sort but turned out to have studied Zebra Fish embryology? (Why was he there? Oh well. It's getting so I don't care that much who sees my hoo-has.)

The bad news is that the cysts haven't moved -- or maybe that's good news, since I was a little convinced I had the Big C -- so I had another u/s this week. This one was with Dr. Demure, who managed the whole thing without even seeing my uncovered legs. He passed me the wand under the paper sheet and had me insert it, then daintily reached his hand underneath to maneuver it, eyes always on the u/s screen. It was a little reminiscent of the scene in Kandahar when the doctor can only advise female patients through a sheet, since he's not allowed to see their bodies.

The other bad news doesn't really count as a surprise: I, like every other woman in my family, have endometriosis. (Screw spell-check for not knowing that word, by the way.) I was hoping that if I just kept my complaints about my excruciating periods sub-medical, I avoid my fate, so chalk up another loss for magical thinking. Sigh. This will make conception harder, but I keep telling myself it's not impossible. My mother has endo badly enough that she had a laparotomy years before I was born, after which the doctor said her ovaries so badly messed up from intrusions that "we scraped together all the ovarian tissue we could find and pushed it into a roughly ovarian shape". And yet, here I sit.

So now it's an HSG to discover how messy my tubes are. I am terrified at the thought of this -- not only does the set-up sound bad (catheter through the cervix?? CLAMP if the cervix is shy????), but getting pumped full of X-rayable dye apparently hurts quite a bit if the tubes aren't open. Plus, Sugar Mama will be out of town for the only day the procedure can be done this month, and I'm scheduled to teach that night. Friend With Baby will probably come with me. Apologies in advance for any infertiles in the Bad Place who have to see the cute baby, but I've decided I'm looking out for number one this time, and Friend With Baby is the best choice for company.

Enh, sorry for the lack of funny pictures. I'm not feeling it.

Tuesday, June 9, 2009

I don't have a kid yet...

...so I can say FUCKITTY-FUCK FUCK!

No gay marriage for us in NY, because an embezzler, a domestic abuser, and a plain ol' liar just had a coup of the state senate.

Don't worry; they didn't do it over any real issue. It's just about money.

From the NYT:

But money also played a major role. Mr. Espada said he was angered that a top aide to Mr. Smith had threatened to hold up his legislative earmarks, known as member items.

Fuck you, New York. Guess Connecticut will get our money after all.

Wednesday, June 3, 2009

Getting to Know You, Lady Business

A long post, but it’s about my hoo-ha!

On the list of awkward conversations I’ve had with my parents, “I have two vaginas” is right up there. Not quite as bad as coming out, but certainly rather weird. “How do you know?” my mother asked. Um, I have fingers and a brain?
To be fair, though, I didn’t know until recently. Not really.

Here’s the deal: the fallopian tubes, uterus, cervix, and top section of the vagina all form from fetal structures called Mullerian ducts. Given what I’ve learned about Mullerian anomalies in the past couple months, I should really have written that list as “fallopian tubes, uterus/uteri, cervix/cervices, and top section(s) of vagina/vaginae,” though, because it turns out anything can happen and frequently does. Ordinarily, the fetus grows two symmetrical systems that then merge in some parts but not others, so that you end up with two fallopian tubes but only one of everything else.

The usual set-up is like this:


…Sometimes you only end up with one fallopian tube and a half-sized uterus, like this:

Unicornate Uterus

…Or two half-sized uteri that didn’t join, like this:

Uterus Didelphys

…Or one uterus, but a heart-shaped one:

Bicornate Uterus

…Or one uterus with a septum dividing the top part of it in two:

Septate Uterus

There are some other possibilities, too, but these are the main ones. (For lots more on this and a link to a great support group, please see http://mulleriananomalies.blogspot.com , which is also where these lovely pictures come from.)

Some people don’t know about any of this until they have difficulty conceiving or, as is often the case with septate uterus, have enough miscarriages that someone takes a look up there to see what’s going on. I, on the other hand, am one of those whose anomalies extend to parts of my anatomy that, while not strictly speaking external, are nonetheless more easily available to the, erm, layperson. Ahem.

Basically, everything looks ordinary from the outside. A little Our-Bodies-Ourselves-style exploration reveals what feels like a slightly smaller duct higher up there, down-there, which worried me a great deal as a younger person. It seemed (and was) way too high up to be a hymen, which was the only thing I’d ever heard of that this was at all like. I was terrified of going in for a pap smear and put it off for years, since I was convinced I’d be told I was a freak of nature.

Eventually, I could put it off no longer, and…nothing happened. Nobody ever said anything. I didn’t say anything, either, because, after all, the expert is down there with a speculum and can actually _see_, so everything must be fine. I figured my shape was, if anything, only a little unusual, the kind of thing you don’t hear about because how often do you hear about anyone’s vagina, really? And it didn’t make much of a difference in my life — tampons have never worked well for me, but I always thought that was because I had too heavy a flow or they were designed badly or whatever. Everything else a person might think to do with the ol’ equipment — not to put too fine a point on it — worked fine, so why worry?

Then we decided to really do this baby thing, and I figured it was time to google “double vagina”. And FREAK. OUT. Not only was it freaky to realize I had no idea what dwelt beyond my cervix, but also it turns out that the usual uterus shape is pretty dang good for baby-making, and these variations…well, it’s not like you _can’t_ have a baby, but it’s a tougher row to hoe. (If this is you, get thee to the Mullerian Anomalies blog, stat! Join the Yahoo! Group or at least read the personal blogs linked there. They kept me from nervous collapse, for reals.) Surgery to remove a uterine septum means micro-scissors through the cervix, which is way better than cutting the uterine wall, but still: Scissors! Cervix! Ack! And Incompetent Cervix (add that tot the list of frickin' obnoxious medical terms, please) is common, so hello, bedrest.

Off to the gynecologist — I’ve always gotten my GP to do my paps, so first there was the great doctor/insurance matching game — where I had this conversation during the consult:

Me: I’m here because I’m pretty certain I have a vertical vaginal septum.
Mr. Doctor-I’ve-Never-Met: I’m sure you don’t.
Me: I can put two fingers in myself and they don’t touch.
[Awkward pause.]

Later, in the stirrups, with a small crowd peering up my special lady parts:

Mr. Dr.: I don’t see anything….
Me: Hm.
Mr Dr: OH! Oh. Oohhhh…you’re right.

Yes, folks, it turns out I know more about my hoo-ha than some guy who’s never seen it before. Sheesh.

Doctor proceeds to rattle off a bunch of fun facts I’ve already found online (“some women can use this as birth control, if you only have one cervix.” Thanks, but I already have very good birth control, in the form of Lesbianism….) and then announces that I also have two cervices and will have to get double pap smears for the rest of my life. Super-yay. (At least he did not announce that he was going to cut the divider out, which I was afraid he would. I am very opposed to knives in my tender regions.)

A couple more weeks of hardcore freak out, one MRI, and one annoying consult to get the results (which they had lost) later, and it turns out that my ute is fine and dandy! Mullerian anomalies can also affect kidney formation, so there was some question of how many (1-4) kidneys I’d have. Turns out I’ve got the usual two, but I do have 3 ureters, so there’s that.

When Mr. Doctor-guy gave us the report and said everything was okay, I couldn’t believe it. I had considered every possibility in the preceding weeks (I had plenty of time, since Lord knows I wasn’t sleeping) except normalcy. Part of me still doesn’t believe it, but I’m bringing my MRI films into the RE’s office next week, so there’s a second opinion coming.

(Oh, in case you’re wondering — the extra cervix and vag is apparently no problem for childbirth. The baby just comes out one side or the other, and everything stretches. So no knives up in my business, for which I am profoundly grateful.)

So that’s the Story Of Baby Mama’s Hoo-Ha. When Sugar Mama is around to help with the scanner, I’ll see about posting some of the MRI films. They’re pretty nifty, if I do say so myself.