Sunday, June 24, 2018

Post-Op: Life After Essure

It was a little past six in the morning when my husband and I drove to Platteville for my surgery/salpingectomy on June 6.  (If you are interested in the medical and procedural details of a salpingectomy, please read my previous blog post.)  I had been bumped up to second surgery of the day from third, and was required to be there at 7:30 for pre-op.  We straight-lined it on 18/51 the whole way, bypassing opportunities for pastoral side trips. Even so, I saw two old barns from the highway between Mineral Point and Platteville that I desperately wanted to photograph.  One had an old metal roof that had taken on a lovely brown patina, sheets of metal loose like a spread of cards, barn slouching and sinking back into the earth, unsalvageable, organic, like a bittersweet memory of a bygone era.

The staff was faultlessly polite and kind.  The woman in charge of my care while I waited to go into surgery asked me to provide a urine sample so they could test whether or not I was pregnant.

I had recently become fiercely self-advocating.  I declined to pee into a cup for the purpose of proving that I wasn't pregnant.  I knew for sure that I wasn't.

We went back and forth on this a couple of times. I was not persuaded by her argument that I should comply because it was part of their formal procedure.

She would discuss my refusal with the doctor.

"That's okay," I said, not willing to back down, but not intending to be confrontational.  I was sorry if my refusal was going to make her look or feel less effective.

When the doctor came by, she did not mention the urine sample.

I was the oldest Essure-removal patient she had had--of many dozens of women.  I had the coils in  the longest--six years, the last five of which had been marked by the onset of fatigue and neuralgia, and a tentative diagnosis of Lupus that held out the promise of struggling to maintain a life that was necessarily physically active.

I live on a 5-acre farm. I have three horses.  (Full disclosure: One of them is a mini-horse.) I have three dogs, five cats.  I have a 14-year-old son.

For the past year, I struggled with fatigue that now cut most days in half.  After 12pm, I labored to finish what I wanted to accomplish before exhaustion and fever set in, driving me to bed to rest or nap for hours.  I had finally arrived at a point where I knew that I was kidding myself if I assigned any serious task to the second half of the day.  Everything had to be finished by 1 p.m., or it simply wouldn't get done.

In year six of housing Essure coils, I began to give thought to my limitations.  How long would it be before I no longer had the energy to work with horses?  Beyond their daily care (mucking stalls, sweeping the barn, hoisting water buckets and tubs of manure, pushing a wheelbarrow, stacking up 400 bales of hay), if I planned to actually ride my Palomino, for example, I had to work with him consistently or, like an unweeded garden, he went to seed. I don't have the kind of horse that I can saddle up once in a blue moon and expect good results.  Few people who have horses have that kind of horse.

I thought, maybe it would be better for Tanner if I gave him to someone who would work with him and ride regularly.

I comforted myself with the thought that Charlotte would take Fire if I couldn't care for him.  I didn't have to worry about that.  I wasn't sure who would take Cooper, the mini, who had been rescued and didn't have the best manners.  I could pay my friend to train him to where his behavior did not undercut the charms of his appearance.  Then we could find him a nice home.

My dogs were old and would not outlive my usefulness, so I didn't have to worry about them.

I would be left with cats.  Cats were easy.  With cats, I could face an uncertain future with a mischievous disease that could suddenly infect my kidneys or pericardium...Pleurisy, vasculitis, stroke...Increased risk for heart attack, blood cancers....

The doctor did not scold me about the urine test.  As before, she was smiling brightly, energetic, brimming with optimism that this would mark a turning point in my health.

"Six years," she said, for the third or fourth time since we met.  "That's a long time."

She was sorry I had been sick for so long.  On the other hand, there were many women who loved their Essure implants.

Really?  I wondered how long they had had their Essure implants.  Sometimes it took a while for side effects to kick in.  For most women like me who experienced Lupus-like symptoms, the  the coils had a cumulative effect.  It got worse over time.

Would they still love their Essure coils after five years? Or ten?

At 52, I was her oldest patient. Would those women still love their Essure implants at 52?

The anesthesiologist settled into a computer station beside me.  He typed into a keyboard and asked questions.

"Is your hair naturally red?"

"Yes," I said. "With a lot of gray mixed in."

"Red hair doesn't go gray," he said.  "It goes from red to blonde to white."

"Oh," I said.  Yes, technically, my gray hair was white.

"Redheads experience more pain and nausea than everyone else."

Really? Everyone?   I was prone to motion sickness.  It is a great sacrifice for me to sit in the back of a sedan, unless I am wearing pressure-point bracelets on my wrists, which I never travel without.

Was my pain more acute than everyone else's?  Pain had become so much a part of the fabric of my life--from extreme cramps to hammering migraines.

Recently, I learned that one good way to deal with pain was to focus in on it--to engage with it, rather than shrink away, like a dream in which I'm running but can't move forward.

It was one of my son's YouTubers who gave me the idea.  He ate a raw ghost pepper--you know, the way YouTubers are prone to do--so he was in agony.  As he explained in the course of his suffering, he focused intently on the pain and then, suddenly, it went away.  He was fine.  So, I tried that.  It didn't always work, but it usually did.

The anesthesiologist made me feel special, as a redhead.  I  have read the stuff my friends send me on FB about redheads being 2% of the population, having more acidic skin, absorbing extra Vitamin-D, and how people around the world generally fear and loathe us...But I don't really subscribe to any of that.

But in fact, we actually do feel super nauseous.

So, I get premium anesthesia:  Total IV, no gas.

Going into surgery: It's just like going to a party.  For the first five minutes, you're the center of attention.  Everyone's gathered around you, solicitous of your needs.  You manage to make one or two witty comments, everyone laughs, ha ha ha, and then you pass out and wake up at 2:30 in the afternoon, having totally blacked out, back in your hotel, ready to order room service.  

My husband told me the doctor said the operation went well.  They took out both coils.  Neither had broken, nothing was perforated.  The coil on the right side protruded further into the uterus than the left, so they cut out a bigger part of that corner of the uterus, and removed the coil with all of its surrounding tissue, which is exactly what they're supposed to do.

Maybe I imagined it, but it seemed like I felt better--specifically, cleaner in my head--as soon I woke up.  But, I realize, this could have been purely psychosomatic.

When I weighed myself the next morning, I had gained seven pounds in 24 hours.  This was surprising, given that I didn't eat anything the previous day until I woke up at 2:30 pm, when I had a small bowl of chicken noodle soup and two pieces of seemingly innocuous toast.  For dinner, I  had had a couple slices of pizza.  Okay: Maybe three.  But still: Seven pounds?

I was reminded of leaving the hospital after my son was born, and weighing more than I weighed before my son was born.  It took two weeks to filter all that saline out of my body.

For the rest of the day after my salpingectomy (let's call it a gecko spaghetti) my stomach was bloated and I looked and felt six or seven months pregnant.

It was weird, to say the least, feeling pregnant again at that juncture in my life.  But there's no better way to describe the feeling of a distended belly and the squidgy, loose structure of abdominal contents.  My viscera, which had been pushed up out of the way for surgery, were settling back into their basket like a sleepy half-charmed snake.  I walked gingerly, so not to rattle, and pressed my hands against my belly to hold it all together.

I wondered if that jangling looseness was a sign of impending prolapse.  Were things detaching?  Would they fall out?  Were they floating around and bumping into each other in  those seven pounds of foreign broth?

I wished I had been awake to ask the doctor questions after surgery.

By the second day, I felt five months pregnant.  I was still tired, but I could attribute that to having had surgery, according to my discharge papers.  

By the third day, I was back to my normal weight.  My belly was almost normal.  I still had moments of feeling loose inside, but they were fewer and farther between.

I wasn't supposed to lift anything heavy, but I did.  Tubs of manure.  I tried to avoid it, but manure keeps happening and has to go to the shit-pile promptly, or it will attract flies.

I lifted bales of hay and plastic blocks of shavings.

I did not lift a fifty-pound bag of barn lyme.

Every time I felt a twinge, I worried that I had done too much and ripped my uterus.

My feet were bothering me in the days before the surgery.   Things that I had used to think of as part of a life-long condition, that I felt confident I could tolerate indefinitely, were not so easily shrugged off.  They were the pricks and poison of a foreign invader. Every brushstroke of neuralgia that kept me awake, every flash of pain sheering across my foot,  every lost hour without energy to do anything, became pretty damn intolerable.

Because I wasn't supposed to be this way.  This was not my destiny.  This was the product of a mistake, of shoddy product testing, of aggressive marketing.  This was the fault of a giant greedy corporation named Bayer, which just bought up Monsanto, by the way, that notorious purveyor of carcinogenic weed killer and insecticide that's doing God-knows-what to our bodies and environment. (I say this as one who lives adjacent to fields of corn.)

That ramshackle barn with the rusted metal roof, the one I wanted to photograph?  That was me. That's how I felt: sinking into the soil under a weather-beaten patina, deteriorating and decrepit.

But, this past Thursday, the fatigue, like a rain cloud, lifted and departed.

On Friday, I was aware that I still felt good.  The fatigue was gone,  at least for now.  I might reasonably expect to do something with the second half of my day.

So, my son and I went to SummerFest in town on Friday night.  (I never go out on Friday nights. I am always exhausted at the end of the week.)  We left the house at eight and returned around nine-thirty or ten.  At no point did I feel like a martyr.  My mood never flagged.  I didn't have to make an effort to be cheery or patient.  I did not have to lie down as soon as I got home.

Compared to how I had been feeling for more than a year, normal felt amazing.

I see my rheumatologist in a week.  I'll be interested to find out how my labs compare now to what they have been: borderline anemic.

Who knows?  Maybe I'll find out that I have Sjogren's but not Lupus. Or maybe I don't even have Sjogren's.  Or maybe nothing has changed, it's all in my head, and history will show that the whole Essure-Sisters movement was a case of mass hysteria...but I doubt it.

I had my post-op meet with the doctor last week.  She assured me that fallopian tubes play no role in structurally supporting the uterus. There are lateral  muscles that do that, which are intact.  I have no reason to worry about prolapse.  The uterus was cauterized, it will not rip open.  Communication of hormones between ovaries and uterus has not been cut or diverted; the fallopian tubes never were a string between two cups.  They were only a path for an egg to travel from ovary to uterus.  The hormones commute through the blood.

So, that's it: it's done.  I feel solid and strong.  Who knows what the future will reveal?

Life goes on.