Everything Is Perfect!

My blood pressure was 133/86. That is the highest it's been. Ever, I think. This was Monday morning at my appointment to have my IUD removed. But I wasn't just anxious about the removal of an embedded IUD. I was terrified that I was pregnant. Ever since my NP told me that I'm not protected, my mind has been running rampant with tons upon tons of thoughts. What if I'm pregnant? Will I still have this IUD taken out? Will it cause me to miscarry? I don't want to go through another miscarriage. I don't want to be high risk. Can we afford another baby? We're definitely not in the right place to have another baby right now. OMG, am I at risk to lose this job too, if I have to go on maternity leave early?! I can't lose this job. Will Matt want me to get an abortion? I know he doesn't want anymore kids. Would he really want an abortion? I know he would be disappointed. Could I mentally go through ending a pregnancy because we're not in the right place right now??

I kid you not. The above is only a fraction of what went through my mind all weekend. As the weekend came to an end, Matt's and my anxiety went through the roof. When we got into bed on Sunday night, I sobbed. I haven't sobbed like that since my miscarriage. I sobbed because I was terrified. Terrified of this damn IUD not coming out despite my NP trying. Terrified I'd need surgery to have it removed. And terrified that I was pregnant. You see, my period was due this weekend. Roughly Saturday or Sunday, based on the 31 day cycle I had the month before (and the 33 day cycle the month before that). So by Sunday night, when I had not yet started my period, I was Late. I knew I had to ask for a pregnancy test before the NP tried the removal. If I hadn't started my period by the time of my appointment Monday morning, I would be requesting a pregnancy test.

That Sunday night, Matt held me tight as I sobbed. I finally told him what I was thinking. What made me finally lose it. I told him that I wouldn't be able to end a pregnancy just because it wasn't wanted. The thought is absolutely killing me. To that, he simply said "Ok baby". He could feel my body shaking as I cried, and he could hear me crying. As you're reading this, I'm sure it's hard to not pass judgement on us. I'm sure this all seems so dramatic considering we didn't even know if I was pregnant. But you have to understand something. When you get an IUD that's supposed to be good for 12 years, you don't plan on getting pregnant. So when we were faced with a possible pregnancy, our minds just started racing.

Now before you pass judgement, Matt would never make me get an abortion. He knows whatever I say goes, and he wouldn't try to change that. He's simply trying to look out for our family the best way a man can. He is so understanding, and I know he was worried, stressed and anxious about all of it, just like I was.

Early Monday morning came and went, and still no period. At this point, I was basically telling myself I was pregnant. I was already planning on how I was going to tell my manager. Yes, I'm crazy. Very crazy. Anxiety will do this to a person. Anyway, I left work, and went upstairs for my appointment. The nurse took my blood pressure, and I asked her if it was possible to do a pregnancy test before removal, since I hadn't had my period yet. She said absolutely, and I went and peed in a cup. I came out of the bathroom, and there was Matt with Cael in the waiting room. He surprised me and showed up to the appointment. It made me feel so much better that he showed up and surprised me. I know he was just as worried about everything as I was.

The nurse told me from over the counter that the test appears to be negative. Halle-fricken-lujah! At this point, Matt went back to the waiting room with Cael so I could get undressed for the removal. I quickly texted Matt, "It was negative!". Then I sat back and relaxed on the exam table and waited for my NP to come in. She and the nurse who took my blood pressure came in. My NP asked the nurse if she gave me the results of the test, and she repeated it, "I told her it appeared to be negative." The NP told me that if I was still uncomfortable with the idea, that I could have blood work done. The pee-test was good enough for me. Let's get this thing out!

Luckily and fortunately, the removal was a cinch! I was really anticipating a problem with it coming out, but on the second pull of the string, it came right out. She showed it to me, and it was intact, which is good. They left, I got dressed, and then my NP came back in so we can discuss birth control. I had already decided on the NuvaRing. I had used it previously before we got pregnant the first time, and I didn't have any problems with it. She gave me 2 samples, a prescription, and sent me on my way. Matt and I said bye, and I went back to work, not even missing an hour.

I am so happy to have this behind me. What a stressor this whole thing turned out to be, from the IUD being embedded, to the possibility of being pregnant. At least now I can sigh a deep breath of relief.

Not Where It Should Be..

3D image of my uterus and my displaced/embedded IUD. Fun times.

My IUD, that is. The ParaGard has failed me. I've had it only since June 2012, and it's malpositioned. After months of heavy, heavy periods lasting about 10 days or more, and bad cramps, I finally listened to Matt and went to see a doctor. She said that the ParaGard is known to cause heavier, longer periods, and that is most likely the cause of my issues. But just to make sure, she wanted to get an ultrasound done to check my uterus and make sure there isn't an underlying problem. I was on the fence about getting it done, because I had (briefly) looked at my uterus a couple months ago, and everything seemed fine. Of course, I'm a know-it-all when it comes to this stuff. Plus, my facility just started collecting deductibles upfront, prior to doing the exams. So I would have to pay a good amount of money to have my ultrasound done there. But it would be cheaper than getting it done at my GYN office - plus, I don't know who reads them at the doctor's office. At least if I get it done in my department, I know our docs will look at it.

So I went ahead and scheduled the ultrasound, and had blood work done for a CBC and thyroid levels. I spoke to a coworker who deals with insurance and deductibles, and she said it would be fine if I brought in whatever I could for the deductible. I'll most likely get a bill for the rest, but that's fine.

Despite what I thought, it wasn't weird having my ultrasound done by a coworker. I was able to watch too, which I liked. Long story short, my ParaGard is low in my uterus, and the "T" arms look to be embedded in the myometrium of my uterus. IUD's are supposed to be contained within the endometrium - which is the lining of the uterus. Outside the lining, is the myometrium. Fun times. I asked to have one of the docs look at it, and he dictated the report as that. And yes, I followed the HIPAA rules, and signed a release for my images and report.

So yesterday, my NP called me and told me that the IUD is not where it should be, and that it has to be removed. She also said that I'm not protected, and need to use a backup form of protection. Say what!? Who knows how long this thing has been out of place for, and how long I've been "unprotected" for. So of course, I'm terrified that I'm pregnant. My mind starts racing about the what-ifs. Fortunately, I'm due to get my period in the next couple of days, so hopefully it comes. Unfortunately, this IUD could have been displaced a few weeks ago when I was ovulating.

My mind also starts racing about the removal of this thing. I'm legit terrified. The NP said that the report was very wordy, and therefore confusing (which I disagree, because I read it myself), so she showed it to a doctor in the practice. She said that they both agree that the IUD isn't perforated into the myometrium, and the removal should go easily. Umm, ok. I know she's the NP, and I'm the patient, but she also hasn't seen the images. She only got the report. I hinted that I was afraid it was indeed sticking into the myometrium, and she said that we will just go ahead with the removal, and go from there. I hope she's right, because if she goes to yank that thing out, and it hurts like hell, she'll certainly know about it. I hate to sound nasty and like a know-it-all, but even the Radiologist who looked at my images agrees it's sticking into my uterus. Oh well, I guess we'll see on Monday.

After Googling "ParaGard malposition and pregnancy", as well as IUD removal, my nerves are on edge. I need to take my own advice, and stay away from Dr. Google. But I did learn the correct term for what's going on is "embedded". The IUD arms are embedded into my myometrium, not perforated. Perforated would be if they poked through my uterus entirely. I've read that the removal of an embedded IUD can be difficult. I'm really hoping my appointment goes smoothly on Monday.

Officially "Garded"

By the ParaGard, that is. Thursday, I finally got to Planned Parenthood while Matt watched Cael. I really didn't know what to expect, but it was really weird going in there. I don't want to be judgy, but some of the women who came in were..uh...trashy. But it's good that there's a place that they can go to get help. I seriously felt like a minority there, being married, and looking for ways to prevent pregnancy, and limit our family size. Of course there were women there who were picking up condoms (you could tell, because they handed them out in paper bags), but there was also a woman there who picked up condoms, but also wanted a pregnancy test. I won't go into details, but the gist of what I got from overhearing her, is that she was 3 weeks post-partum, but she wanted a pregnancy test because a condom broke a week ago. Say what!?! Yikes!

Anyway, I was there for a total of about 3 hours. I ended up getting a pelvic exam, pap smear, breast exam, and the IUD in. Initially, when the nurse was interviewing me, she was explaining what would happen. I would answer questions, have a pap and pelvic done, and then come back when I had my period so that they could put the IUD in. Uh, hold up a second nurse-lady. I informed her that I was still breastfeeding, and haven't yet had a period at 9.5 months old. I re-asked her, and said, "so even if I'm breastfeeding, and haven't had a period yet, and don't know when I'm going to have a period, you're going to make me wait?" She said yes, and I told her I wasn't happy about that, and if I'm going to have to wait potentially several months, I might as well leave, and pretend like I didn't come. She said that she would ask the NP to make sure.

She left before finishing the questions to ask the NP about what they would do. She popped her head in to ask how old my baby was, and then left again. The NP came back in with the nurse this time, and confirmed that I haven't had a period yet. She said that it was odd, and asked the last time we had sex. I explained to her about my granuloma and how sex was painful, and then about how my husband can't use condoms during sex. So therefore, it had been about 3 weeks since we had sex. She said ok, and then said that they would do a pregnancy test, and that they can actually insert the IUD at that visit! I was thrilled. Now, they just had to call the insurance company to see how much they would cover. Great. So I went out into the waiting room, trying not to get my hopes up.

I'll spare the details, but eventually they came out to get me to ask more questions. A lady from the front desk came in, and explained to me that they couldn't get a clear answer from the insurance company, and that they may cover it up to 50%. I chimed in, telling her that I already called the insurance company, and they told me 50% after the deductible was met. So we don't know. So she said that what they would do, would charge me half today (which I needed to pay in full), and then bill the insurance company for the other half. And based off our income, we qualified for a discount, so instead of $800, I would have to pay $575. So I owed $285 at that visit, plus a $20 copay for the exam. She explained that if the insurance covers the other half, then fine - I don't owe anything else. But if they don't, I'll get a bill from PP for $285, in which I can set up a payment plan.

I asked to call Matt so I can talk to him about it. We just had a lot of bills come out of our account, so we had less than $500 in our checking account. Plus, Matt is going to Virginia on Sunday for a week, and we wanted to make sure he had enough money. We got into a little argument over the phone, but in the end, he said to just do it so that it's taken care of. Whether we have to pay for it now, or in a month, we're still going to have to pay it.

I came out and told the nurses that I was going to go ahead with it. I finished the last of the interview questions, and the nurse gave me an Ibuprofen. She then scared me by saying that even if they can't get the ParaGard in, that I would still be charged an insertion fee of $140. That made me really nervous, but as I was passing the NP, she said, "Don't worry, we'll get it in."

Twenty minutes later, I was in the exam room, and having the exam. Much to my surprise, the pap didn't hurt at all. Especially when she inserted the speculum. The last time I had a speculum inserted (at the appointment with the midwife for my granuloma), it hurt so bad it brought tears to my eyes. This time, I didn't feel anything except for the normal pressure of a speculum being inside you. Just proof that the silver nitrate worked!

The nurse told me that I would feel a pinch when the NP tried to get my cervix open. I felt this weird pressure, and feeling inside my uterus. I learned that the NP was measuring the length from the fundus of my uterus to my cervix. Mine measured 6 cm. Normally it's 6-9 cm, and if it's less than 6 cm in length, then they wouldn't be able to insert the IUD because it would likely be expelled. That's something that I didn't even know. I'm very lucky that my uterus was long enough to put the IUD in. I then felt this moderate discomfort, pressure-like twinge. It was uncomfortable, but definitely bearable. I asked if that was the "pinch", and the nurse said yes, and I told her that was nothing. I said that after the pain I had with the granuloma, this was a piece of cake, and definitely manageable. I did experience some cramping when she was putting the IUD in and measuring the length, but it was quickly gone after it was all done.

The whole things was done in less than 5 minutes. The NP couldn't tell me for sure if I was going to experience bleeding, because normally they're inserted when you have your period. She also said that the insertion might trigger my period to start, but again, she wasn't positive. I don't know how it would trigger my period to start, since it's non-hormonal, but I guess I had to wait and see. She gave me a wallet card that had the date of insertion, and said it had to be removed no later than June 2024 (12 years). Normally, they have you call back in 2 weeks, after your first menses with the IUD in, so that you can come back in and be checked that everything is still in place. But since I have a different situation, she said not to worry about it. It kind of left me with clue as to what to do, but I figured that after I had a period - whenever that would be - that I can always call them, tell them when I had it in, and ask if they need to see me. I paid the $305, and was on my way.

Everyone was so nice to me there. I told Matt when I got home, that I was probably a breath of fresh air for them, compared to the people they normally see. Especially 3-week-postpartum-possibly-pregnant-woman. It sounds mean, but it's true.

I must have started bleeding right after I left PP, because by the time I got home, my pantyliner was filled with red blood. As of today, I'm still bleeding, but it's more like spotting. I don't need a pad or tampon, but it's still coming out, more lighter with each day. I researched it, and found that bleeding and spotting is normal after IUD insertion. I'm not going to consider this a period, because I'm not cramping, and when you think about it, my cervix had to be pried open, and there's a foreign object in my uterus. The combination of these things is most likely what's causing me to bleed.

Although it was expensive out of pocket, I don't regret getting it done. Plus, now we're protected for 12 years! It's the best decision for us, and hopefully now we can have normal (condom-free) sex again. It's been a long time, that's for sure. Of course, there's a list of possible side-effects, and problems. They include: ectopic pregnancy, infertility, expulsion, perforation of the IUD through the uterus, pelvic infection (which I'm scare to get. Mostly occurs within the first 20 days of insertion), breakthrough bleeding between periods, increased menstrual cramps, heavy menstrual bleeding, etc. I'm most afraid of it coming out on it's own, because my uterus is so short. Mainly because of the cost of getting it put back in. Hopefully that won't happen.

Overall, I'm thrilled to have an IUD, despite the cost. Hopefully it works well for us, and I don't have any complications.

Finally, My Doctor Update

This is a long time coming, but I figured I would still post an update. I went for my follow-up appointment on May 31st to check the granuloma site. I was pretty sure it fell off the day after the silver nitrate application a week and half before the follow-up appointment. So I was convinced that this would be just a simple check. My best friend S came along this time, so that she could help me watch Cael. It was a great help.

So after telling the doctor that I haven't had any spotting or pain since the last appointment, and that I think it fell off, he started to examine me. Actually, correction - the resident examined me while the doctor oversaw. This resident was very twitchy, and kind of rough, so it was a rather uncomfortable exam. Much to my dismay, the doctor and resident said that there was still a little piece left. The doctor then gave me a choice of what I wanted to do. He said that it can easily be snipped off with some local anesthetic, or he can put another application of silver nitrate on. I cringed at the thought of both ideas, so I told the doctor to do whatever he thought was best, that I knew it was going to hurt either way.

He decided that the silver nitrate would be best, so the resident applied it. I was ready for the horrid pain I felt last time, but to be honest, it wasn't that bad. It also helped that the same nurse who was in with me last time let me squeeze her hand. He said this application should take care of it. And that in one week, he wanted me to use some KY or Vaseline, and massage the area where the granuloma was. This will help stretch the scar tissue, and make it easier/less sore when I have sex. He said to also wait a couple days after that to have sex. He didn't want to see me for a follow-up, but said that if anything was wrong, or if I was having any problems, to contact them and he'd see me again.

It's been almost 3 weeks since my follow-up appointment, and we've had sex twice. We're having some issues with condoms, which is why it's so few. But both times, it wasn't uncomfortable for me at all, and I enjoyed it. Speaking of condoms, I cannot wait to get an IUD. I'm really looking forward to getting the Paragard, which is a non-hormonal IUD. It's copper, and it can last for 12 years, which is perfect for us since we don't plan on extending our family. The only problem is the cost. After calling our insurance company, I found out that they cover it only after our $500 deductible is met, and then it's only covered 50%. The Paragard itself is roughly $500-600, so that would be a total cost of roughly $700-800 if I went through my OB/Gyn. So I decided to call Planned Parenthood, to see what their costs would be.

PP still bills the insurance, and it's more of a process than I thought it would be for PP. I have to have a consultation appointment first, which consists of a PAP smear, pelvic exam, and figuring out if the Paragard is "right for me". That appointment is subject to our $20 copay. Then they set me up with another appointment  to have the IUD put in. But before that, they will give me the approximate total cost. Basically, they contact the insurance company, and whatever they don't cover, I'll be subject to pay at a reduced price through a sliding scale. I really want to have the Paragard put in, so I hope it's not that expensive in the end. They have walk-in hours tomorrow, so I'll go while Matt has off. We'll see what happens.