Second opinions count.

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As part of my plan to move on, I scheduled an appointment with an OB/GYN that specializes in laparoscopic surgery and has her privileges through Froedtert.  She came highly recommended by a co-worker of mine who also had cysts removed.  I figured that I might as well take care of Mable since nothing else seems to be working out.  So, I drive down to Lincoln Road in Milwaukee…it only took about 40 minutes.  I checked in as usual and ran into several pregnant ladies as I was led back to the exam room.  I told that nurse that I was there to consult for a cyst removal surgery.  Sitting in the room alone waiting for Dr. Manning, I started bawling.  The tears kept coming and I couldn’t help it.  I used Kleenex after Kleenex hoping that I could soak it all up before the MD came in, but I didn’t make it.  Dr. Manning came in as I was throwing away the first handful of dirty Kleenex.

I apologised for the tears and told her that I didn’t expect to be so emotional, but that having this surgery was part of giving up on becoming a biological mom.  She told me that she reviewed my imaging results and gave me the results of a Japanese study of dermoid cysts.  After following women that did not have them removed, different things occurred over a timeframe of 10 years that did lead the majority to have surgical removal.  So, statistically, I will eventually need it removed sometime during the next 10 years.  However, mine is very small.  It is less than 3cm.  They typically aren’t a cause for concern until they are at least 5cm and don’t cause significant problems requiring surgery until they are 8cm.  Mine has been stable in size over about a year, so there is not any concern that it is cancerous.

She said to me, “If you were my sister, I would tell you not to have surgery.”  Small cysts are difficult to remove in the first place as they need to search for it.  Every cut that they make into the ovary destroys immature egg tissue.  “What if I destroy your firstborn son?”  Also, since the ovary is an organ, they cannot stop the blood supply while performing the surgery.  If there would be any uncontrollable bleeding, they would then remove the ovary to save my life.  So, there’s that risk too.

Bottom line, she does not recommend the surgery now.  We should follow the cyst yearly with ultrasounds, but if I need a c-section in the future, it could always be removed at that time…or whatever.  This is different from Dr. B’s immediate recommendation for removal and when I decided to wait 6 months, she ordered repeat ultrasounds EVERY 3 MONTHS.

Dr. Manning then asked what my other history was.  This is how the conversation went:

  • Me: I also had a LEEP procedure earlier this year.
  • Dr. M: For what?
  • Me: CIN 1
  • Dr. M: What?
  • Me: *unsure if I said the right thing* CIN 1
  • …..Long pause and look of shock on Dr. M’s face……
  • Me: I’m guessing that you don’t normally do that for CIN 1.
  • Dr. M: (something along the lines of:) We don’t do that until its CIN 2 or CIN 3.  Don’t let anyone touch your cervix anymore!

She then pulled up a flowchart which I’m assuming is from some OB/GYN professional organization regarding the recommendations for managing cervical dysplasia.  If you are HPV negative and CIN 1, the recommendation is for a follow-up PAP.  LEEP procedures are not recommended for CIN 1 because there is only a 1% chance that it will progress to cancer.  She said that the problem with LEEPs is that you are only given 4cm of cervix to begin with.  Each time they do a LEEP, they remove on average, 1cm of cervix.  She said that what’s happening is that young women are having multiple LEEP procedures and then they end up getting pregnant and are literally having their babies fall out of them extremely premature (around 24-27 weeks gestation) because there is no cervix left to hold them in.  I told her that Dr. B has been having me come in every 4 months for alternating Colposcopies and PAPs…to which Dr. M said, “Don’t do that.”

  • Dr. M: “Don’t let anyone touch your ovary, and don’t let anyone touch your cervix.”
  • Me: “Will you be my new OB?”

Since my repeat pap was normal in June, I don’t need any further follow-up until a pap in June 2015 and then if that’s normal, I don’t need another pap for 3 more years.  I loved her.  I was very glad that she gave ME information about statistics and it is obvious that she is practicing evidence based medicine.  She is not just doing the same thing that she has always done because that’s the way she has always done it.

Dr. M also provided me with some emotional support about the whole infertility situation.  She told me, “Don’t give up.  Take a break for 6 months or a year, but if you want to have a child, don’t give up. ”  She told me of how she and her husband struggled for 3 years to get pregnant and they had both male and female factors for infertility.  She said that there was 1 month in those 3 years that she told her hubby that she couldn’t get pregnant because 40 weeks later, she had to take her OB/GYN boards.  Sure enough, that was when she got pregnant!  She told me that she ended up having her son a week early so that she could take her boards as scheduled.  Since then, she’s been blessed with 2 more children.  “Don’t give up.”

Although I am very grateful to have had this consult, it infuriates me that Dr. B’s recommendations were so far off.  As a patient and medical professional, I place my trust in doctors.  And now, I feel like that trust has been betrayed and taken advantage of.  Since Dr. B is leaving at the end of the year, I don’t feel it necessary to complain or bring attention to the vast difference in recommendations….basically, good riddance.

Dr. Davis never returned my phone call last week.  However, at 10:30pm on Saturday, I got a reply to my online chart.  In short, no to returning to Clomid because Femara works so much better for PCOS.  Although I responded slowly to the Femara, I did respond.  “Most people ovulate when the follicle is 18-20mm or larger and most follicles grow 1-2mm each day. Based on this rate it is possible you would not ovulate for 5 days after your ultrasound, which makes sense with your negative ovulation kits.”  Since Femara lowers the levels of estrogen to stimulate natural FSH, it can also prevent the lining of the uterus to thicken.  My lining was 5mm and although it will likely continue to grow until ovulation, a higher dose of Femara may cause further problems with the lining and is not recommended without an ultrasound to monitor.

So, Dr. Davis gave me a few options:

  1. One option is to take the same dose and monitor for ovulation a little later in the cycle.
  2. Another is to monitor for ovulation and plan for an ultrasound a little later in the cycle (day 16-17).
  3. We can also consider increasing the dose of letrozole but with the thin lining on your last ultrasound I would not recommend this without planning for another ultrasound to make sure the lining is not too thin with the higher dose.

I think that I will stay conservative for now and just monitor with the OPK (option #1).  It also saves me at least $500 for 1 ultrasound.  Maybe I will get an ultrasound done in the future, however this is not the time.  This month’s work hours are slim and that trend continues into the beginning of December.  As of the end of December, I don’t have a job at the hospital anymore and I haven’t been hired on as an RN yet.  NCLEX (boards) are going to be on an unknown date in January and I will likely not start working as a GN/RN until after that.  So, thankfully, I’m still a paramedic on the side and can do that for a bit until I get in somewhere.  I’m still holding out hope to get hired at Sinai in the NICU, however I haven’t heard back yet.

Hubby and I need to spend some serious time together to rekindle and reconnect.  We just need to come back together as a family and talk about our future and “mangos”  (aka. main goals…we came up with that in Jamaica, lol).  We’ve spent so much time doing our thing lately that I just can’t wait to be done with school so I can nuture our relationship more.   T-40 some days!!!  The time is coming!!!

nclex

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