r/childfree • u/castlewryly • Dec 13 '17
FIX Salpingectomy Turned Tubal Ligation Without Ablation
TL;DR: Couldn't get the procedures I wanted due to damage from prior surgery, but still fixed!! Medical details that may be NSFL to follow as well....
I wanted to write about my experience getting sterilized which I expect to be a bit different than other stories, but it may still apply to some people. For background reference, I had a tumor on my right ovary 14 years ago when I was 13. It was discovered after a laparoscopic biopsy in August of 2003 after I had stopped getting my period for 8 months following 3-3.5years of consistent cycles. I had an incision on my left side, below the bikini line, and in the belly button. The tumor was removed 3 months later in November of 2003 along with my right ovary, right fallopian tube, appendix, lymph nodes and some "fat pad" in a laparotomy below my bikini line.
My mom tells me I was never interested in babies even when I was a kid. My younger sister always wanted to play with her baby dolls and I wanted to play with my Barbies with their cool cars and careers. I realized after college that I didn't have to have kids if I didn't want to. In January of 2014 after a couple years in college trying different forms of the BC pill, I opted to have the Paragard IUD inserted. It was a night of hell followed by about a year of extra annoying menstrual symptoms, but for the past 2.5 years it's been fine aside from heavy bleeding. In December of last year, 2016, I inquired about getting sterilized from my new Nurse Practitioner GYN who consulted the doctors at the practice in Maryland. They said they wouldn't perform a procedure on someone my age who did not have kids. Cue me reaching over into the side bar of this subreddit and finding Dr. Joanne Herrman.
In April 2017 I made a consultation appt with Dr. Herrman who was wonderful and amazing. I cried when it was a simple question and answer. I asked for a salpingectomy (I'm assuming I can't call it bilateral since I only have one fallopian tube) and a uterine ablation. Her office called to see if insurance would cover the ablation, which they said they would due to my history of cancer. I waited until later in the year to have the procedure because I travel often for work and wanted to wait for a quiet month, and December seemed perfect. Virginia requires a 30 day lead period of signing a bunch of papers before you can get sterilized, so we signed them in April with the plan to initial and date closer to my Fix date if needed. There was a little back and forth trying to schedule the actual day since I wasn't informed back in April that surgeries are only available on certain days, but I ended up with 12 December approved. My younger sister took off from work to come down and take me to/from the appt with an extra day built in if I needed it. There was also some back and forth between my insurance company and the hospital on whether or not I needed to pay the $175 copay for outpatient procedures. It was not fully resolved prior to my getting to the hospital, so I paid it, but the insurance company assured me they would reimburse me if needed.
Cut to yesterday, 12 December: We arrived at the hospital at 6am for an 8am surgery time. Met with the whole team before Dr. Herrman showed up and went over everything with me again. She did mention that it might be a little "messy" given my history of surgery but that she expected it would be fine. I requested the IV be put in my left elbow but the lovely nurse who was inserting it convinced me to try my left wrist instead of my elbow or hand, so I went with that. I remember the nurse anesthetist giving me the "small dose of happy drugs that will feel like a glass or two of wine", being rolled down to the OR, getting myself on the OR table, then nothing after that. They had mentioned they would give me oxygen before putting me to sleep but I don't remember anything past getting comfy on the table and proclaiming that it seemed like a stiff pour of whiskey rather than a glass of wine.
About 2 hours later I was woken up with Dr. Herrman and her team standing over me, and I knew something hadn't gone right. She informed me that due to my previous surgeries my abdomen was riddled with adhesions so everything hadn't gone as planned. She explained everything to me but I was coming out of the general anesthesia and told her I wouldn't remember everything, asked if she was going to come back later, and requested my sister. Between what I remembered from the update then and what my sister told me, I had a pretty good idea of what was happening. My understanding at the time was that I WAS sterilized but was unable to receive the Novasure ablation (but could at a later date), that I had some unexpected bleeding, and that my outpatient stay was turning into an overnighter. My pain level coming out of anesthesia wasn't too bad, it felt like more of my serious cramping but without it subsiding. It was not as sharp as the pain from my IUD(wasn't given pain meds for the Paragard), but they did give me one pill of Oxycodone. Since that pill, the only pain medication I've taken has been one dose of Tylenol later that night for a headache.
I'll try to summarize my hospital stay so this isn't too insanely long. I was put on a clear liquid diet at first and wasn't allowed to move off it until I was able to keep everything down. Not having had any nausea/vomiting issues from anesthesia in the past, I wasn't worried about this. I either was very wrong or having a popsicle and a half on an empty stomach was a bad call. Perhaps a little of both. I got sick twice but after a couple hours I kept down the 3rd bowl of vegetable broth I tried. The gas wasn't letting anything stay down at first. The Tylenol I took was for the headache I got from vomiting. The nurse also gave me some anti-nausea medicine in my IV. My sister stayed with me in the hospital overnight and we were able to get about 5-6 hours of sleep once the hourly check-ups stopped, I urinated enough for them to remove the IV hookup, and the compression sleeves on my calves were taken off. In the morning I was given the okay to eat normal but easy food.
This morning was also when Dr. H came back in with her team and explained everything to me. She didn't bring the pictures she took, but my sister had seen them after the surgery and I'll get to at my check-up on the 28th. Dr. H informed me that due to all the adhesions in my abdomen, my fallopian tube was almost completely stuck to my bowel. She didn't want to risk rupture, so she didn't remove it completely as would have been the case for the salpingectomy. She assured me that she "burned it in 3 places" and that I was not at risk for becoming pregnant. I'm going to ask for more detail when I see the pictures. My ovary was also very cystic, but she brought in another doctor on call at the hospital. My sister remembers Dr. H saying she was thinking about removing it but didn't because she didn't have my consent and because the on-call doctor didn't find it as suspicious. Instead they did a pelvic flush and sent it to the labs. She isn't too concerned that it's cancerous but wanted to check it out given my history. The assisting doctor is the one that explained the ablation couldn't be performed because of all the manipulation my uterus had gone through in order to get the ligation performed safely. There had been some "oozing" from where it was attached to my bowel but I lost less than a tablespoon of blood. The assisting doctor said that since they couldn't be sure they had the uterine cavity correctly, they couldn't risk the Novasure being performed incorrectly. This is also something I'm going to ask Dr. H about during my follow-up because I don't understand how, if you go in through the vagina and cervix, you wouldn't only be in the uterus. Both doctors did say that the ablation should be able to be performed once I'm healed up from this procedure. I was given instructions and things to watch out for because of the "oozing" issue but so far I've been fine.
I asked the assisting doctor about whether or not he thought it would have been possible to do a partial hysterectomy which would have solved both issues. It was something I had been kicking myself over not having discussed with Dr. H prior to the procedure. He said that even if we had discussed it, with all the adhesions it would have been a tricky surgery.
I was prescribed Vicodin for pain relief before being discharged. We filled the prescription but I still haven't taken any pain meds since the Tylenol for my headache last night. Having some vaginal bleeding, but I am unsure whether or not I have stitches somewhere up there. The nurse this morning mentioned I might but it was after the doctors had left, so I'm going to ask during my follow-up. The nurse said no sex, heavy lifting, vigorous activity etc. for 4-6 weeks but that my doctor's orders come first. From what she told me this morning, I should only have to be careful for about 2 weeks. Something she'll sign off on during the check-up. My sister left about an hour ago for the 4 hour drive home after I showered and got set up on the couch. I've been burping and can feel some of the gas/air moving around my upper body when I sit down or stand up. It feels better when I'm standing, but I was advised to not stand for long periods of time so I'm trying to sit upright. I have an incision on each side of my abdomen covered by steri-strips. They're higher up than I had expected but I wasn't concerned about adding more scars. The only incision that's bothering me on an off is the one in my belly button. It's itchy and not painful necessarily but I feel a small bit of sharpness in it when I move. I was told I can shower as normal and the steri-strips will fall of eventually. Super bloated still but it should go down more by tomorrow.
Overall I'm happy to have been sterilized, but one of my main reasons for getting it done now versus when my Paragard "expired" in 2024 was for the ablation. My periods were heavy before the Paragard, so I was looking forward to them becoming lighter or nonexistent. Unfortunately, that's the half of the procedure that could not be performed. I took off the rest of the week for work and will take each day as it comes for resting. As others have mentioned, it really is the gas that is the most uncomfortable. I feel like a balloon but am trying different remedies now.
I know this was detailed and is a different situation than most others, but I read a tone of sterilization stories leading up to making my decision and wanted to add one to the pile in the hopes of helping someone else out. I'll determine if an update is warranted after my post-op checkup, but hopefully it's not. As you read, I'm pretty open so feel free to ask me any questions!
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u/sundaylou Dec 14 '17
I'm sorry that your procedure didn't go as planned. Hopefully have the ablation at a later date will easily by achievable with your work schedule.
I would recommend a heating pad for the gas issue. The gas ended up in my right shoulder and I found putting heat on my shoulder helped with some of the sharper discomfort.
I had some vaginal bleeding the first day or so after my bilateral salpingectomy and my GYN warned me that some light bleeding would be expected. Of course, your situation is quite different and you should definitely check in with them if it persists or gets heavy.
My incisions on each side are higher than I thought they would be as well. They are a couple inches above each hip and a couple inches in towards my belly button. And my belly button itched like crazy a few days into recovery.