Laparoscopy

Hey... what happened to the intestines?

Next Thursday I'm scheduled to undergo a laparoscopy. I was referred to a gynaecologist after having constant, unrelenting (albeit fairly mild on a scale of 1-10) pelvic pain and abdominal bloating for nearly a month, which I assumed was another ovarian cyst. An ultrasound revealed no cyst, urine tests revealed no chlamydia or gonorrhoea or urinary tract infection, so that left the possibility of endometriosis.

I'm not in constant pain any more, but I've only been pain-free for about 2 days since late July. The bloating is weird- I always get a bit of pre-period bloating (not gas) but this hasn't cleared up at all since July, hasn't even gotten slightly better after I've had a period. Sometimes I feel like I'm carrying around a rockmelon in my abdomen. A slightly bouncier rockmelon, I suppose.. After a meal it's so bad I practically look pregnant. It's like there's no room for food on top of whatever else is going on in there. Even if I don't eat all day, it's like there's a solid mass in my lower abdomen, not that empty feeling you get when you don't eat.

I've never had any kind of surgery before- the closest I've come to being under the knife is having my Implanon replaced, or perhaps having that horrid abcess on my arm drained. But I was awake for both of those. I like to know what's going on. The idea of being under a general anaesthetic scares me. A laparoscopy is a really simple surgery, but I don't like the idea of being completely out of it for the duration. Nor do I like the idea of someone making an incision in my bellybutton. I have a very nice bellybutton (well, I like it). I'm not squeamish about having holes cut elsewhere, I just object to my bellybutton having a scalpel stuck in it. I also don't like the idea of having to wait a week after the surgery to find out what the heck is going on, if anything. I know I'll have some idea from the number of holes they cut in me (if there's any endometrial tissue and they burn/chop it out, I will have more incisions), but I want to know what's going on straight away! I know there's pathology and stuff to wait for (they scrape out some of the lining of the endometrium and send it away for tests- what kind of tests I don't know), but I would at least like to be told whether or not there was anything obviously wrong, like visible endometrial deposits in places where they're not supposed to exist.

During the wait for the pathology results, after I found out what a laparoscopy involved, I actually found myself hoping I had chlamydia (which can present as pelvic pain), however implausible that might be. Yep, wishing for an STD... how low can I go? Because with treating chlamydia, all that's involved is taking a few antibiotics- no general anaesthetic, no choppity-chop, no holes cut in bellybuttons. Endometriosis, on the other hand, can be treated but not cured. I have a friend from high school who has had endometriosis for years- she's about to have a baby. She and her partner decided to try for a baby because she was told it was pretty much a now-or-never proposition, given that the endometriosis was affecting her fertility. Given that Gam and I are in no position to have a kid right now, my fertility is not something I want to have to worry about. Oh and I'd rather not be in constant pain either, thanks.

My biggest worry, though, is that I'll undergo the laparoscopy and they'll find absolutely nothing visibly wrong. I'll still be in pain, my stomach will still be bloated to twice its normal size, and there'll be no indication what's causing it. The gynaecologist I saw said that in that case she would treat me for irritable bowel syndrome- she practically admitted it's a bit of a catch-all for women who present with undiagnosed pelvic pain. I suppose I'll worry about that if it ever comes to that point.

Looking on the positive side of my health, at least those heart palpitations I was having aren't happening nearly as frequently. There were a few weeks when I wasn't getting them at all. It's weird- in the week after seeing a doctor, I was feeling progressively better each day, almost like I was recovering from an illness I never realised I had. I did go for a stress test, and apart from presenting with a resting heart rate of 110 and feeling really faint at the end of the test due to a sudden drop in blood pressure, I scored as having an excellent level of fitness, and only 2 points off a 'superior' level of fitness. That made me laugh- I wonder what it takes for a couch potato like me to present as unfit? I'm still getting the odd disconcerting flutter, but not the kind of heart racing and pounding that lasted up to a couple of minutes and left me feeling like I'd been running a race.

Still, I feel I'm at an age where I shouldn't ever have to see a doctor, let alone show up complaining of a problem only a month or so after presenting with a different problem. I'm young (and fit, apparently!). It's only when I hit middle-age or even old age that I'm supposed to start having health problems and being in pain all the time, and having to take naps and painkillers every day (even if it's just panadol most of the time). Jeez. After this, I don't want to see another doctor until I'm 50.


Oh, another pertinent fact- I'm having the operation done in the private system.

Gam and I don't have private health insurance (can't afford it). The gynaecologist I saw does work in both the public and private systems, and offered to put me on the public waiting list. I said yes, because the only other option was to ask my parents for money to pay for the operation private in a private hospital, and I figured at least I could find out how long it would take through the public system. Also, because my parents have helped us out so much financially already this year (by not charging us rent, by helping us with a deposit for our car), I really preferred to avoid burdening them again.

However, when I told them what was going on, they were keen to help out. They know what the waiting lists in the public system can be like, and they didn't like the idea that I could be waiting months (or years) for an initial appointment, let alone the surgery, while whatever it is that's causing my pain continued, potentially doing damage. I am very lucky that I have parents who are in a position where they are able to help out (although I wouldn't say things are easy for them at this point, most of their savings for retirement being invested in the stockmarket). Why is it such a lucky thing? Here's an excerpt from the letter I was sent by Queensland Health two weeks after my appointment with the gynaecologist:

WAITING TIME NOTIFICATION:

Dear Ms [Sarah]

Your doctor has asked us to arrange for you to see a Specialist. The information sent by your doctor about your condition has been reviewed and your condition has been classified as 'semi-urgent' at this time. You have been placed on the Gynaecology New Clinic waiting list until an appointment becomes available. When an appointment becomes available, you will receive an offer six (6) weeks prior to the appointment date.

So I don't even have a waiting time yet, let alone an appointment. I went ahead and made arrangements to go private. I was allocated a date for the operation itself on the day I made the phonecall. The date for the op was in 3 weeks. Yesterday I had my pre-op appointment. This time next week I'll have been sewn up and sent home with some panadol and examination of the specimens sent to pathology will be under way.

If my parents were in a similar financial situation to the one Gam and I are in, I could be waiting months, even years, for this op. Constant pain and tiredness. If it was endometriosis, my ovaries or fallopian tubes could become scarred to the point where I would be no longer able to conceive. If it was something worse... well. And that is how it is for some people. A lot of people.

There is something really, really wrong here. What do they say to someone who has gone through the public system, waiting god knows how long, only to find out that their condition has progressed in the time they were waiting to the point where the consequences have become extremely serious? "I'm sorry, if only we'd caught this 12 months earlier things might have been different...". That's not fair. A first world country should not have a second-rate public healthcare system. Australia can, and should, do better. Queensland can, and should, do better.

My parents, and Gam and I, are paying roughly $7000+ altogether to avoid the public health waiting lists . Only about $1500 of that will be recouped through medicare. That's still $5500 or more in out-of-pocket expenses. Why I am any more deserving of immediate care than any other young woman in the same situation just because I'm fortunate enough to have family that can scrape together the money for me to go private, is beyond me. And yet we have governments, at state and federal level, that seem to think the two-tier system, where wealthier people get the help they need in a timely fashion and poorer people rot away while waiting for their initial appointment, does not warrant urgent attention. How can that be? Sure, the Rudd government has a better attitude to the the public health system than John Howard did (i.e., they are not actively trying to destroy it), but they don't seem to look upon strengthening it as being a matter of urgency.

Finally, here's a link to a blog post by a woman who had a laparoscopy to treat her endometriosis. I don't think mine will be exactly the same (although I don't know whether I'll be having a tube stuck down my throat or a catheter stuck up my urethra... please god no?!), but I found it a useful read, particularly with regard to what to expect after the op. It pretty much agrees with everything my friend who has endo told me to expect from the surgery... which was quite a lot worse than what the gyn told me to expect (i.e. 'most women are fine with a bit of panadol', hardly feel any pain afterwards etc. etc.)