This time, I chose to attempt the prescription route. Looking back, I probably would have gone with suction, if I could know then what I know now. Explanation under the cut: possibly triggering for abortion/termination complications including GI and stomach issues.
I should state up front that the Planned Parenthood location I'm working with has been a godsend. They are as accommodating as possible of my situation, since a history of childhood abuse leaves me dealing with high anxiety re: exams. I knew before I even had a pill bottle in hand that there was a low chance of the medications not working, a likelihood of nausea and vomiting, and would probably be a startling amount of discharge when I took the second pill. The first, methotrexate, is taken about 24-48 hours before the second medication, misoprostal. Methotrexate must be given with a doctor or nurse's oversight in my state, and I took it before noon on a Monday. The Misoprostal, then, couldn't be taken until after noon Tuesday. I followed instructions to the letter, until the part about letting the second set of pills dissolve against the inside of your cheek, which they do, though thankfully they don't taste bad. I just happened to gag on a chunk of pill, nearly spit them all out, and ended up swallowing most of the dose instead of absorbing it through my cheek. This can decrease its effectiveness by a couple percentage points, but I wasn't worried yet.
Two hours later I puked like I have never puked before, not even at college parties. That ebbed just before I started pooping myself stupid. I vowed then that my next bathroom will have a padded toilet seat, for worst-case scenarios. I might also install arm rests and a seat belt, in case exhaustion takes over and someone just can't sit up under their own power any more. (My Other Half likes this idea too.) I now have great respect for those who have survived food poisoning and not gone bibbildy from the misery.
When my Other Half got home around 10 that night, I was out of fluids for my GI system to reject, but nothing else was happening either. Concerned that maybe I'd puked the pills, I called the 24-hr emergency line to see if I was in trouble. No, she said, sometimes the bleeding can take a while to start. If it hasn't started by tomorrow afternoon, call us. So, I hung up the phone and promptly had a strong cramp, with a second hard on its heels. Then the gushing began. I was cold, tired, hungry, in pretty high amounts of abdominal pain in spite of the medicines for it, and stuck on a toilet seat made of beaten plowshares; I declared victory when I realized I hadn't cried, screamed, or thrown anything the entire time. Woo, maturity! My Other Half did a fabulous job of checking on me and keeping me as comfortable as he could, but it was a long wait.
I am regularly a menstrual cup user, but had a few pads on hand, and after scrounging for underwear, attempted to go get a drink, waddling like a penguin wearing a diaper. I made it through my 10' x 12' living room into the kitchen and under the sink for a bottle of Gatoraid when I had to carry it right back to the bathroom and sit down to dribble into the toilet again. The pad was drenched and speckled with clots, and the overflow had soaked my underwear and yoga pants. (A word here for anyone facing this scenario: I eventually found it easier to remove some of the pubes that stuff will stick to. Clean up can get time consuming, and pad stickum will rip those suckers out like a sadistic waxing technician.) I also said "fuck it" and stripped to a bra and undies as ankle warmers, preferring to be a little chilly from time to time than keep sweating through clothing when I wasn't. A slight fever at this stage is expected. I was told not to worry if the clots were larger than I'm used to, "3 or more clots the size of a lemon" is the guideline for problem bleeding this office uses. They didn't say anything about 15-18 clots the size of a walnut. No wonder I was wiped out! But, I thought, that means it's working. I just have to be patient.
I soaked my second pad that hour going from the bathroom to the bedroom to get a book. By midnight, 8 hours after the second medication, I was too exhausted to stand, so I put some hot water in the tub and lay down for a while. It helped. Then, back to the throne, longing for a cushion, to assess the situation. Still dribbling away. By 3 AM, the gushing had become a trickle, and I'd tucked myself into bed wearing my cup, a pad, clean underwear, pants I didn't care if I bled through, and went ahead and laid a towel out on my (thankfully red) sheets. I got a couple of hours of sleep, then went back to the bathroom, when I realized the gushing picked up again while I slept. The towel was a good idea; my 25 mL cup was full, as was the pad, my underwear, and the pants.
I got a call Wednesday morning from the clinic; they'd gotten a report of my late night Tuesday call and wanted to check in. I explained, and all seemed normal though "rough" and I was told, again, to keep taking my pain meds, rest, drink lots of fluids, and don't hesitate to call. So, I dutifully took more ibuprofen and settled into bed with a Gatoraid and my book, and got a couple of hours of sleep, only to wake up flooded again. This happened 3 times total that day, but I was so Bed, Bath, and BEYOND OVER that damn bathroom, I elected to judge by the cramping when I was going to have a surge in flow, and managed to stop ruining clothing and bedding for the rest of the day while resting in bed with a cat on my foot. I was just choosing to breathe through cramps that spiked at an 8 on the 1-10 pain scale instead. But, I was raised conservative Christian, so the sick part in the back of my head that sounds like my judgmental mother and grandmother told me I deserved it for what I was doing and should just accept my punishment. (Btw, hormones can do really weird things to your emotions and thought patterns. Nobody "deserves" that kind of misery for electing to spare herself even greater risk and suffering. There is no sin or crime in taking care of yourself.)
My Other Half got home from work that afternoon clearly worried, but armed with jello fruit salad. I'm usually a vegetarian, but I needed nutrients, so down the hatch it went, and stayed. Yay! That seemed to be the turning point. The cramping eased, the bleeding slowed, I was able to get back to work on Friday (with three scheduled days off and one half day interrupted by "Uh, yeah, don't mind those blood spatters on the floor. It's mine, I'll get the bio kit." half way through.) But the next Friday I really didn't feel up to going out anywhere, and Other Half went to our weekly karaoke spot by himself. He couldn't have been there more than 10 minutes when I felt a by now familiar and entirely unwelcome added heat in the crotchular region and hoofed it into the bathroom in time to turn the entire bowl opaque with matter. I wasn't a fan of cranberry sauce before this, but now... just NO. And, since I'd left in such a hurry, my cell and the cordless phone were both in other rooms. So I stayed there in the bathroom, waiting and praying to any deity listening that I not simply keel over on the john until Other Half got home. From 9:30 that night until 1 AM the next morning, I waited, half dozing, reading my book, and trying not to weep in frustration, still hearing that snide "You deserve it! We weren't so lucky!" in the back of my mind. Other Half was shocked when he came home; apparently I matched the not quite white tile floor, but by the time he got back, it had slowed again. He was able to help me up and help me dress and tuck me in and cuddle me a little while I finally lost it, all the while cursing himself for not being here. I tried to tell him it wouldn't have stopped the surprise!reprise, but being out with friends while I sat at home still added to his layers of guilt and worry. It was a long week for both of us, but I felt on the mend by Friday.
So, the following weekend I took a house/dog sitting engagement to offset some of the work I'd lost (because retail is super forgiving about schedule changes). What I didn't anticipate was the Other Half getting food poisoning on the Monday of my follow up appointment. Had to call and reschedule, but wasn't worried about that; I was terrified about the IUD insertion, as my most recent post to this com illustrates, so I took the opportunity to do even more research than I had when my county clinic had refused to discuss it with me months before.
I'm beginning to think that I really *should* worry when I decide not to worry about something. In we went for the follow up and IUD, past protestors with signs that piss off my Other Half to no end, expecting to hear "Yes, some spotting is normal, let's get your IUD in place." Then, the transvaginal ultrasound, again (my third for this set of procedures), and instead "Well, it looks like we won't be doing an IUD today. Is it okay to show you the ultrasound and what I'm seeing?" Sure. And there, clear as day, was a little black bubble with a bunch of white noise around it. There was no heartbeat or movement of any kind, but the corona that forms around the zygote was still attached.
So, we were told, we had 3 options: "watchful waiting," aka go home and hope that "this too shall pass"; another dose of the Puke like it's College Graduation & Shite Yourself Stupid pills and check back in a week with another wand in the hoo-hoo; or schedule a suction D&C for that Friday, which would have required both of us to miss 8 hour days at work, drive 3 hours one way, and get a hotel overnight in the town where the Planned Parenthood clinic does suction. (And did I mention this is in a blue state?)
We talked, my Other Half and I, who thankfully has a medical background, but enough sense to know that it's my body and he can't really demand a lot. He thought that "watchful waiting" didn't seem like a great idea, but knew the other two choices were going to be hellish on me. I just wanted this shit over with. So, we chose option 2-- more of the pills that made me so sick the last time, hoping that it would be just one more week and less intense than before.
They did it again; I gagged again as the pills dissolved, I puked again as they started to work, I crapped myself limp as a noodle again until the stabbing cramps started, and spent most of the next two days a short waddle from the Iron Throne. I went to last Monday's appointment bolstered by Ativan and the mantra "It's gotta be done by now." Then again, the vitals check, onto the table, under the drape, transvaginal wand pressing and pinching and a breathless moment of hope and dread all tied together while I tried not to cry.
"Well," Mary said. "It's a judgement call. There is still tissue there, but it's not attached any more from what I can see. It looks like it'll come out on its own in a couple of days. So I think it's safe to do the IUD today if you want."
We wanted. She did. It did not trigger me as badly as I feared. It did hurt, but no worse than the practice rounds of hell I'd just been through. There was pinching, and the sharper burning pain I always get from a speculum or something through the cervix, but I got through it okay.
Until I sat up, saw stars, and laid back down. Low blood sugar, we thought, so after some juice and a lie down, I was stable enough to leave. We got back home and slept, and the bleeding slowed to brown sludgy stuff. I got through work okay and started catching up on the things around the house that have been neglected for the past month.
Then Saturday the 13th brought the Other Half's class reunion. I felt less than well that morning; I hadn't slept well and had body aches and a little scratchiness in the throat that made me think I might be getting a cold. I went on with the day as usual, simply taking it easier than I normally would have, thinking again that it wasn't anything to worry about. In the middle of the cocktail hour Saturday night, I felt a familiar surge of gooey heat and thought "sonofabitch" as I tried to seem casual in my hurry to the bathroom. A clot the size of a walnut dropped into the bowl as I sat down, so I had to clean up and get back to the party knowing I was bleeding again when I shouldn't be. The next half hour is a haze, but apparently I paled as well as losing all energy and going into the same surge-rest-surge bleeding pattern I'd had the entire last half of June. I got through dinner and asked my Other Half to call friends of his that live in town to see if I could just hang out on their sofa (near a bathroom!) while they went to the band/bar portion of the event. "No problem," friend A1 said, and I was tucked in on the couch with a crash course in the Tivo remote and admonitions to call anybody if I needed anything. The dogs and I planned to watch Animal Planet.
Once they left, I realized, I was freakin' freezing. A quick trip to the bathroom didn't show any signs of more intense bleeding, and the cramps were mild and intermittent, maybe a 2-3 of 10. Yep, I assumed, I'm definitely getting sick. So I did what any sane person confronted with 3 hours by herself with a comfy sofa, a working tv, and two attention hounds would do: passed the heck out. At some point their teenaged son came home and headed straight to his room. I went back to sleep. At another point, A2's dad came in to walk and feed the dogs. I... went back to sleep. Finally as Other Half came to get me, I woke up kicking off covers. I'd finally warmed up. Maybe it was over.
"Honey, you don't look good," he said as he reached the couch. "And you're burning up. What do you want to drink? Where's your medicine?" And I wanted to answer him, but between the cotton mouth and inability to wake up all the way, I couldn't at first. A1 came home then, and went fully into Mom mode. Thermometer, cold wash cloth, ibuprofen, and number for the ER. Temp: 102.6. After a glass of juice and some time to screw in my brain, we were off to the hospital.
Now, I don't like hospitals for a number of reasons, mostly the abundance of sick people, but our local hospital has recently earned a reputation for messing up because they're understaffed. In the 3 hours we were there, we saw why. Rather than crowded, it was empty, and yet, it took 45 minutes for a nurse to take blood and start an IV, and another 45 after that for the doctor to come in. After looking at the intake paperwork the first thing he asked about was the IUD. "Well," he told me, "here's the problem. There are 7 ways those things can kill you," and rattled off a list of side effects that all of my research claimed are "possible" including increased risk of blood clots and cancers, which are known from all types of HBC. But, then he pissed me off with, "And it increases weight gain, which, as a woman, I'm sure you want to avoid."
I was too wrung out to fight, and for me, that says something, so I pulled from my customer service background and smiled and nodded. But then, he asked about the tooth I've been saving to have filled and crowned, and said that, while the IUD "isn't healthy" the tooth is probably what caused the fever and sent me home with an antibiotic and instructions to drink lots of fluids. I never even noticed that they never said a word to Other Half, or told him what was going on with me. My first line of defense-- my advocate-- might as well have never been there. Silencing my bullshit detector, I slept late Sunday and drank a bunch of liquids, then we went for pizza, and instead of getting the bathroom cleaned up, I passed out asleep again. When my Other Half came home, I found I was bleeding pretty heavily again with clots the size of walnuts again and got a little worried. But, we had a broken light in the bathroom and no way to use it otherwise, so it was off to the store for a replacement and a few groceries... where I spent 40 minutes on two trips to not gush through my pants. I was sleepy, sick, cramping, and just generally not connected between the ears, but in one of those trips I noticed a small yellowish white blob in what I'd passed. I wasn't sure, but I thought maybe that meant it was over. Until I kept bleeding.
So I thought it might be time to think about worrying, and when we got home, I put away groceries while the Other Half changed the bulb, gave it a little time dribbling into the Iron Throne to see if this was just my uterus's last big "FUCK YOU!" then called the Planned Parenthood emergency line. The strings of my IUD were actually visible outside my vagina, hanging just past my inner labia. "Well, it sounds like your IUD made it past your cervix, so you might be more comfortable for the night if you go ahead and take it the rest of the way out," the nurse said. Seriously? You're telling me to tug it out like the seasoning bag in a Thanksgiving turkey? But, it was clearly not where it belonged, so I gave a little pull, much to the Other Half's horror, and there it was, a little white plastic T-shape with a guitar string through the end dangling from my bloody hand. He had to leave the room for a minute to get over the shock, while I calmly handled the rest of the phone call. 800 mg Ibuprofen, Tramadol if the pain got worse. Monitor for fever. Drink plenty of fluids. Call the clinic in the morning if you're still bleeding that heavily.
Instead, I sat up bleeding in gushes until 7:30 the morning of Monday the 15th, and finally dropped off, exhausted, still sleeping on a towel.
Mary, the regular hours nurse, called me at 9:45 after the on call nurse finally got a report over to her. (It's a little reassuring to know fax machines give everybody shit when something's important.) She checked in with me, half awake, and suggested that I get up there ASAP. I set the appointment for 3 PM to give me and the Other Half some time to sleep, and prepare for the 45 minute drive. I woke him at 12 to get some stuff done and mainlined another 20 oz of Gatoraid. (Christ but I'm sick of Gatoraid.) Then I got a text from a coworker. "How close are you?"
Apparently there was a schedule "update" while I was off Friday/Saturday/Sunday and I was due in at 1 PM. Clearly, not gonna happen. Another 8 hour shift shot in the foot. At the appointment, I was given another medication (Methergine) which is used after a delivery to shrink the uterus back to a more regular size. If it didn't stop the bleeding in combination with the minipill, I was on the docket for suction Friday the 26th. Thankfully, it worked, and I haven't bled since Thursday of last week. Suction was cancelled, and an appointment scheduled for the 12th of August to check my iron. Incidentally, *both* clinics called me within 24 hours of that cancellation, the one I'd been to 5 visits before and the one at which I was scheduled to have suction. "Are you alright? How are you feeling? What happened?" I have never had a private practitioner match The Concentrated Awesome that seems built into these offices. I'm considering signing them up for the Wine of the Month club. :)
I need that follow up appointment, however, because at one point my iron was at 9.1; the healthy level for women is 11.5 or higher. I'd lost so much blood over the course of a month, I'd become anemic. The ER doctor asked why I was so pale, but didn't mention my levels being off or low. He didn't even come back into the room after the blood tests tests were run, so I have no idea how low it might have been when the fever started. But I do know, and have confirmed from the Planned Parenthood nurse, that with that many signs of IUD expulsion, I should have been checked for it. I wasn't ever told about it, only told that "the rhythm method" is the safest birth control available and I should use that instead. Tuesday, a survey came in the mail asking about my emergency visit. I was honest. I didn't swear. (Woo, maturity!) I will also never use that ER again.
So, now that the crisis is over, I find myself struggling to wrap my brain around the whole scenario. And the billing notices have come trickling in: Aetna paid $112 for this visit, $40 for this procedure... all together, over a thousand dollars of tests, procedures, medications, and visits, not counting lost time at work for the two of us, extra wear and tear on a POS car (+ fuel!)...
I can't imagine how we would manage if I were able to carry safely. I don't know what we'll do if this ever happens again. I don't know how we'll pursue more permanent means of birth control for both of us (ablation? tubal ligation? vasectomy?) to keep this beast from rearing her ugly head again. But I do know one thing--
I could have had suction done 7 weeks ago and been over this shit by the end of June.
It's Pandora's Box.
My house is a disaster; my laundry's stacked hip high, we've less than $50 in the bank, and I've only just found the energy to begin addressing any of it; but I'm breathing and finding ways to laugh where I can. That's a good first step. I can't say I'd even be alive right now, after 7 weeks of this chaos, if I hadn't had *somewhere* to turn and someone with the patience of Job to help me at home. I'm also pissed. Pissed at the system, pissed at that ER doctor for choosing a soap box instead of my health, pissed that my entire way of life was put in danger because of a health problem, pissed at the attitudes of so many legislators that think this process needs to be made even harder.
It was hard enough on me, a grown woman with health insurance and friends that love me. When I think of a teenager going through all this, possibly with no one at all to support her, I want to scream down walls.
Please don't take this to mean that everyone who chooses to terminate, or terminates in this way, or chooses an IUD in spite of the risks will go through what I have. This is simply what happened to me, a string of "bumps in the road" as some would say.
I do caution you, however, to think carefully about the seat you purchase for the toilet in your first apartment. Think carefully about the furniture in the bathroom as well; something on which to rest your feet may one day turn out to be a good idea.
And finally, don't overlook or underestimate the depth of care you can get from a Planned Parenthood or similar reproductive health clinic. Knowing how your reproductive system works, how you *want* it to work, and owning it is one of the most precious rights we have as humans.