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The long-lost appointment report

March 15, 2010

OK, ladies. You may have forgotten I ever even went to Dr. S. and may have given up on me ever writing a second post about the appointment. And maybe I forgot for a while too. But here I am, finally posting it — in painstaking detail. Hopefully this may still be useful to those of you who will be visiting Dr. S soon, or anyone else who would like to size him up with another doctor.

So, it took us two hours and 15 minutes to get to Camp Hill from DC, but we were also travelling in the middle of the day with no traffic. It was a pretty drive, at least the route we took. And fairly enjoyable. I read some of “The Magician’s Nephew” (CS Lewis Chronicles of Narnia — love it) aloud to my hubs, who was driving.

As I mentioned before, we waited forever. This was because Dr. S spent a really long time with one of his first appointments of the day, so he was running behind schedule the rest of the day. Tip: If your appointment is in the afternoon, bring reading material and clear your evening schedule.

But to the great credit of this man, he spent just as long with us as he would have if he were running on time, staying late, until the rest of the office was dark and the cleaners were waiting to get in.

This is how the appointment went down: Eventually Mr. Good and I were ushered into an examining room. Dr. S. came in a little while later. He did not look *anything* like I thought he would — it’s funny how you get a picture in your mind of someone.

He sat down next to us and said, “So, what’s going on?”  I was not quite prepared for such a general opening question. Tip: Be prepared to launch into a speech about your health status and treatment. If you are like me and need notes to remember things, you may want to keep a list in front of you (I did not have one, and I regret it). He had not looked at any of my papers and did not reference them until much later in the appointment.

I had typed out a three-page history of my treatment, etc. It was in the folder along with a copy of my charts and test results, which had miraculously arrived from my other doctor’s office the night before. But I think Dr. S. is an auditory learner, so he wants to hear things from you, not just read your charts.

We chatted for a while. He listened and asked questions and did not vocally judge my previous treatment…although at one point when I described medication (estradiol ointment) I was taking he gave a pointed, “and why were you taking that?” Ha! I don’t know! Because I was a testing ground…?

He then left the room for me to change into a hospital gown for an exam. I actually thought the talking-about-stuff section was over and was disappointed, but in fact, there was another hour plus of talking-about-stuff after my exam.

I was due for another pap smear, so he did that and also tested for chlamydia and something else, gonorrhea? I’ll note that he did not ask any questions about my or my husband’s sexual history and said he just orders these tests regardless. (and you can be born with chlamydia, so it makes sense).

There is no polite way to describe the rest of the exam. But I am going to endeavor to do so, so those of you wondering, “what goes ON at these exams?” can know. So, basically, he poked around my insides with his hands to see if I felt pain anywhere. This does include — well, I’ll just go ahead and say it — a rectal exam. Unfortunately, I am someone who has the glamorous distinction of having had hemorrhoids in the past, so I’ve had backside exams before. Honestly, they sound much worse than they are.

While Dr. S was poking around, he would ask if different things hurt or if I just felt pressure. There were several moments where it hurt, including a couple where I winced before he had an opportunity to ask.

And that, my friends, is why we think I have endo. He might have recommended a lap anyway to look around. He basically described the lap as a fact-finding mission, a normal part of the infertility diagnosis process.  But when I asked him how often he does a lap and does *not* find endo, he said, “Based on your exam, I would say I am 80 percent to 90 percent sure you have some endometriosis.” (Note that was not the answer to my actual questions. Good PR avoidance skills, Dr. S!)

Now, it was probably wise for past bloggers to avoid describing this exam, because thinking about it is probably worse than experiencing it. But besides the “ewww “factor — which is significant, I admit — the exam was actually much less painful or uncomfortable than, say, an HSG or even a pap smear. I wanted to get the description out there because it is actually such an extremely simple exam. Why have none of my previous doctors done this before? Is this an unusual exam in IF circles?

Anyway, after all of this exam fun, Dr. S. left the room, saw another quick patient and came back in when I was dressed and sat down to talk with me and my husband. (He did, by the way, give my husband the opportunity to leave during the exam …in case you have a squeamish husband.)

The second conversation was even longer than the first and included reference to my Creighton charts and other paperwork. He also showed me some truly disturbing photos of endometriosis and of effaced cervixes.

He recommended surgery, in which he is going to do three things:
1) A lap to look around for and hopefully remove any endometriosis.
2) A selective HSG (is that the right name?) for a more precise look at my tubes. It can find problems the general HSG cannot. People get this without being sedated, but his thought is if you’re sedated already, might as well do it then, so you don’t notice how unpleasant it is.
3) A third thing. I don’t remember what it is. I just remember there were three. This seems like a major gap. Oops.

He also ordered another round of bloodwork, basically every other day for a whole cycle. I am almost at the end of that — thank goodness. An interesting side note: he prefers Quest Diagnostics to other labs.

I asked about doing an ultrasound series at the same time, but he said that is for “fine-tuning” and he wants me to get the big stuff — namely, the surgery — out of the way first.

He also asked about PMS, and when I started to describe the wonderful complex pattern of crying, rage and phantom abdominal pain, he left the office for a few minutes and came back with his handy PMS chart,  where I can check off the pattern of side-effects on cycle days. I thought at the time that this was a special chart he brought out just for the particularly emotionally unstable people, but Jeremiah got one too, so I think it is standard issue. I can scan it and email it to anyone interested.

So that’s what *happened.* But the really amazing thing was how patient and kind and explanatory he was. I wish I had recorded the whole thing, because it was so much information at once! Since then, his office has also been really responsive to my questions about bloodwork/surgery schedules — it’s like night and day between them and the practice I went to in Virginia.  I am really grateful …

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9 comments

  1. I knew you would have a good experience….I’m not sure VA is equipped for IF cases. 😉

    Can you scan that chart to me…. 🙂 I would love to have it! Gosh, I need PMS regulation like nobodies business…HCG isn’t cutting it… 😉 But this will be the first cycle with seemingly more energy. So we shall see…Enough about me….

    When is your lap?


  2. Would you mind e-mailing me that chart as well? Thank you for this post. I’m dreading the exam. Was the r exam the most uncomfortable? Was the other exam worse than a standard Pap?
    I just might need to cancel!!


  3. great news, glad you had a good appt. I have to say the exam doesn’t sound like my cup of tea…….if I you must you must I guess……..


  4. Yay! Very thorough description of everything. Was the 3rd thing a hysteroscopy/D&C? He did this during my surgery, I think it goes hand in hand with a lap and selective HSG. (BTW, my regular HSG revealed free and clear tubes in Nov ’07, and his selective HSG showed partial blockages on BOTH tubes in April ’08. Less than 6 months later. And 1 tube was more than DOUBLE the pressure it should have been.)
    I am very much looking forward to my appt! I hope he takes a good amount of time with me, even though it’s not my 1st appt… maybe I should make my “list” of stuff to talk about now…


  5. Every obgyn I saw since having endo pain has included that in exams. Maybe most doctors don’t think to look for endo in IF patients, though?
    When do you plan on doing surgery? The nice thing about doing the HSG during surgery (I had that done) is that they can also tell what your tubes look like, not just if they are clear – if they’re twisted or stiff from scar tissue or endo adhesions, they’re less likely to be able to bend and grab the egg.


  6. I was wondering what it was that everyone else was holding back. LOL! OK, now it makes sense. Honestly, I can see the diagnostic value of a rectal exam, but I can also completely understand why other practitioners wouldn’t perform it standard. Good grief. Well, anyway, kudos to you for braving it all, and being so chipper into the business! And very glad to hear you now have a practice you feel comfortable with. (Why WERE you prescribed topical estradiol??? And by whom?)


  7. Wow!!! What a thorough doctor!! I’m so glad that you had a good appointment!


  8. Thank you for sharing about your appointment! It’s really helpful to read – even after mine. I’m thrilled to be under his care and I hope I can get my insurance straightened out.


  9. The cool part about the HSG during the lap is that he can see how the dye from the HSG flows into your abdomen. This can help diagnose other issues as well.

    I have had more exams from Dr.S than I can count. And from a fellow friend with the hemmorroids, well, it just stinks. Sometimes I have to use my sterioid supposoitories after which really help.

    He probably also looked for a ureaplasma infection as well as the C&G. I am glad he is doing these.

    Please keep us posted!



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