#i had an extremely medically necessary hysterectomy

[james-p-sullivan]

im very grateful for my mutuals and followers alike and all the people ive met on here, i wish you all love and prosperity in 2024

and a kitten, you deserve it champ

[dreamlogic]

2024 year of charlie gets a fucking break (hopefully. maybe. tbd.)

[queerandprochoice]

So I’m about three weeks post-op for my hysterectomy and I’ve been thinking about something a lot lately.

I have O- type blood, meaning I’m a universal blood donor. Anyone can receive my blood, and O- is in constant demand because of this. If there’s no time to blood test in an emergency situation, O- is essential.

I’m nearly 26, and I’ve never donated blood. Why? Because I’ve never been eligible. The guidelines for donation are extremely strict in order to protect both donors and recipients. You have to meet age requirements, weight requirements, sexuality requirements, and can be ineligible because of a host of health conditions, because of certain medications, having new tattoos or piercings, travel to certain areas, etc. You can get turned away for being even slightly anemic.

Blood donations save lives; just one donation can save three people’s lives. It’s relatively quick, mostly painless, and extremely low-risk. But we don’t force anyone to donate; it’s entirely voluntary. If I was required to donate blood as frequently as possible, I theoretically could save a dozen or so people a year, but we don’t do that because that would be a violation of my rights. We don’t force people who are ineligible to donate anyway because it still might save a life. We don’t try and pressure people into donation if they don’t want to. Nobody says “well if you didn’t want to donate blood, you shouldn’t have gotten your blood typed.” There are no fake blood donation clinics that coerce you into donating if you’re ineligible or uninterested. There are no incentives or bribes or remuneration to convince people to donate blood, aside from a juice box and maybe some cookies. We don’t make cis men donate every 56 days, or cis women every 84 days. We don’t let underweight or underage people donate. We don’t deny people certain medications because they might want/have to donate blood. We protect the privacy of blood donors.

Blood donations save lives, but we only allow people to donate under extremely safe and 100% voluntary conditions. Are there some legitimate problems with some of the requirements, especially those related to gender and sexuality? Yeah absolutely, a lot of them are super outdated and homophobic. But the point is that our society values personal choice and bodily autonomy, as well as the health and safety of the donors, over potential lives saved. The same principles of consent and bodily autonomy apply to organ donation. You can’t even remove organs from a corpse to use for transplants unless that person had consented while they were alive.

Before I went into surgery, I also had to sign a consent form that would allow me to receive a blood transfusion if it was necessary.

We don’t allow forced blood or organ donations, and we have pretty stringent requirements for blood donors, because we value safety, consent, and bodily autonomy over quantity of life. And yet, anti-choicers want to force people to undergo pregnancy and birth—a far more dangerous, lengthy, and painful ordeal—because “it’s a life.” A ten year old isn’t old enough to donate blood, but is apparently old enough to carry a pregnancy to term.

It’s pretty fucked up how when it comes to abortion rights, it seems like health and safety, consent, and bodily autonomy suddenly don’t matter anymore.

Also, please consider donating blood if you can.

[ms-revived-frogs]

Anyways, so I've been seeing this gross misinterpretation of my post on unnecessary hysterectomy and I'd like to explain, even though the OP has me blocked (unsurprising).

Gotta love seeing my post resurfacing and being taken wildly ou of context! Anyways @ratbastarddotfuck and @vergess, the meaning of my post was not that hysterectomy should be banned. I know that hysterectomy is oftentimes medically necessary for the health of a woman. And no, I do not believe it should be restricted only until after a woman might have had a child. I am not right-wing and do not believe this is woman's "role".

However, my post was in reference to this new phenomenon of young women trying to get hysterectomies simply because they never intend to have children or because they don't like having periods. Meanwhile there better, less invasive, and less damaging surgeries out there! One example can be tubal ligation. As back-not-broken said on the post, the uterus plays a key role outside of reproduction. New research is showing that the uterus has a role in your cognitive function (removing it is linked to higher risk of Alzheimer's), and plays a structural role as well (removing it is linked to risk of prolapse). In my post, I was attributing this desire for unnecessary hysterectomy to beauty culture and plastic surgery culture. Because yes, these two involve the division of the female body into a collective of parts, rather than one whole human organism. Women are already en masse cutting themselves up, and making the bulk of almost every plastic surgery (nose jobs, liposuction, BBLs). And while men out there do get these surgeries sometimes, they are getting them at a far less severe degree than women. So as feminists, we must inquire as to why women specifically are doing this and not men as much. And the answer of course points to self esteem issues and societal voyeurism into what a woman's body is or should be. It's not a coincidence that all these women are getting surgeries to look like the media's ideal woman. And it's not a coincidence that the media treats women like a collective of parts ("Increase your bust with X product!" "Shave your body hair with X product!" "10 ways to make your butt look bigger!").

I think the funniest part about this extremely liberal interpretation is that the idiot @vergess decided to list... wisdom teeth removal, tonsillectomy, and kidney donation, as if these all were done with the same intention as women wanting to cut out healthy organs because they don't intend on reproducing. Neither of the three above can lead to prolapse or Alzheimer's, and neither of them are male-exclusive either. Almost all of @vergess examples were gender-neutral! Which proves exactly my point that it is mainly women who are encouraged to cut themselves from inside out unnecessarily. Once again, I'm not speaking of medically necessary hysterectomy.

It's feminists' duty to analyse the societal behaviours of man and woman. Why should this be off limits, when it is so invasive and dangerous?

[nerdylilpeebee]

Hysterectomies are one of the most common routine operations with low complication rate. But the thing with complications and low chances of getting them is: When you are that 0.00001 % you have the complications 100 %.

This is not something to be down played. Every surgery has risks. You should be aware of them to make a decision and any competent surgeon will tell you.

That being said in over 10 years working as a surgeon assistant and working in various hospitals I came across ... very unusual patients and doctors.

False diagnoses, purposely withholding information to not scare the patient or encouraging them to take surgeries they do not need yet (or those who would do more harm than good).

Fortunately that was only one hospital I worked in. Most are average to good in what they do and want to actually help the patients not squeezing out their insurance money. (in my experience).

As for the patients. A worryingly amount (mostly elderly) seem to blindly trust whatever the doctors suggest. Maybe it's because they respect their profession or they really believe none have an ulterior motive, whatever. Patients like this are gullible and thus vulnerable to malpractice.

On the other extreme there are the ones who deny every help or suggestions whatsoever, because they do "their own" research. Even medication or surgeries that are necessary. But they deny them because they are unreasonably scared of the possible consequences.

And I say unreasonable on purpose. Doing your own research is fine, but like be aware that the internet is a place with lots of information that is hard to filter and hard to pick out relevant pieces. Would be nice if anyone could just google their symptoms and tell the surgeon "that right there I want done.". No joke some patients be like that.

Like I said in the beginning: Risks and complications should be talked about, not down played but the patients should decide with all available but relevant information and not be scared to a decision. 

A good balance between a little faith that people are good in their profession and not blindly trusting them.

The patients own current state, be it physical or mental discomfort or pain should be weighed against the possible improvement of the surgery/ medication paired with possible complications and long term effects.

And also: what could be done if the worst case occurs.

Of course I support the motto: the less surgeries necessary the better.  Not needing correction or medicine is always better.

But I had also women who wanted hysterectomy where I'd personally say that would be to high risk and "not necessary". Usually the reasons I came across where

fibroids, endometriosis and (ironically) uterine prolapse, things that would warrant a surgery. But some insisted on it as a precaution for being genetically prone to weak connective tissue...when they didn't even have signs of it developing. Or speaking about adnectomy (removal of ovaries) simply because they didn't want their periods anymore or possibly getting pregnant (without mentioning any kind of discomfort like heavy cramping).

But it is their decision. And other than trying to inform them the best one possibly can and making sure they understand the possible outcomes there isn't much you can do. Maybe trying to see things from their perspective. They have to decide if it's worth and improves their quality of life.

Also the procedure changed over the years.

Intestines like the bladder and vagina are attached to the uterus. When the uterus is removed the bladder could sink down. Nowadays they are anchoring the top of the vagina to the pelvic walls. At least that's how we performed majority of them.

Most complications (uterine prolapse) occurred to women who had multiple children, since pregnancy weakens the pelvic floor muscles. 

My mother for example had a hysterectomy just for that reason. After having my brother (so it's his fault) it began to develop. 14 years ago it became critical and she agreed to the surgery. And it did help! But now after 11 years it started to come out again. Now she's contemplating sacrocolpopexy (reconstruction).

So if someones thinks about getting a hysterectomy they should really inform themselves about the exact procedure. 

Though I think now the older method isn't used anymore for that exact reason.

I’m assuming you mean this wall of text since I don’t have any other asks. XD

I do get what you’re saying in this ask and agree 100%. Complications should be talked about, and people should be made aware of them. Hopefully nobody disagrees.

But that’s not what d3nt4l-d4m4g3 was doing. They were scaremongering. Hiding facts among a bunch of lies and exaggerations solely for the purpose of scaring people away from hrt, srs, etc. Spreading awareness of genuine complications is different than what they were doing.

Spreading awareness of complications is good. Lying about how severe they are, and adding ones that aren’t complications, but just things that happened in-tandem with getting the procedure (purposefully mistaking correlation for causation) is not. And unfortunately radfems like them rarely do the former. And on the rare occassions they do, it’s usually still for the purpose of scaring people, they just have the integrity to not totally lie about how bad they are.

[juuls]

Pharmacist/Me = 1 🏆 Doctor/Nursing Staff = 0

Thank you in advance for reading this rant. I’ve been really frustrated and just needed to get this off my chest, and today at least I had a wonderful knight in a white lab coat. 🩺❤️‍🩹🥽🥼💪🏻

Content warnings and squicky squicks: (further down there is) an image of a medical vial with a clipped image of a more benign part of a syringe, health conditions (endometriosis, fibromyalgia), menstrual cycles and associated terms such as bleeding and other things, lack of empathy in my specific healthcare system, hysterectomies, pain, swearing and losing patience. Most important warning: self-administered syringes and injection discussions of legal medications (Depo-Provera) approved of by professionals and properly researched. P.S. this may sound rather Karen-like but I would never do this to someone’s face. Online ranting and acknowledging where I could do better is not the same as screaming in public for bossy requests or comps, etc. Ew.

Another ‘warning’… pharmacists being kick-ass allies and giving a damn about their patients.

I’m really annoyed because (and I know healthcare and scheduling is a clusterfuck right now, but…) for over a month now I’ve been trying to get an appointment in person to get this injectable medication that is, yes, birth control, but is also used for endometriosis in my case. And I have severe endometriosis (exacerbated severely by fibromyalgia, siiiiigh) to the point I bleed enough and lose so much I have to go to the hospital when my care is not properly preventative… like in this case, and the pain is unbelievably severe also to the point I’ve spent time in the hospital, including my 11th Christmas Eve and Day. I started this injectable medication at 13 because it was the only thing that came close to helping reduce my endometrial tissue. Even a hysterectomy wouldn’t help as much, unless they decided to go the super invasive route and remove all the organs (or parts of them) that had become ‘infected’ by the tissue. Again, tissue where it’s not supposed to be, and it causes extreme pain as the tissue tries to flush out of my body each period, even if it’s attached to, like, my pancreas. Just no. That does not work at all. No. That is not fun.

SO. I’m 31, nearing 32, and the doctor’s office knows this. I’ve had the same doctor since I was 10. Been on this medication nearly non-stop for just shy of two decades (with appropriate precautions such as bone density tests) because of the absolute severity of the pain and my inability to function when it hits… which can be months at a time of non-stop bleeding and morning sickness-level nausea and vomiting, migraines and the occasional complete inability to move—in other words, it’s debilitating.

My doctor (even the nurses, as it’s in large print at the top of my file in the system) knows all about this. They’re supposed to call me if I’m overdue by a certain margin (I get they’re busy but months and months???). But my doc’s also a bit of an airhead (albeit a smart one when he focuses) and takes forever to reply to anything on time, even when it’s a severe issue, but not severe enough to go to the hospital. But it’s gotten to the point where the nurses say to go to the ER and then the ER nurses and doctors there get SUPER pissed off (AT ME AND SOMEHOW NOT AT MY DOCTOR/NURSES AND THEIR ORDERS) at the ‘waste of time’, and it’s just a clusterfuck.

Oh yeah, and that ER visit while I was overdue for my injection? Internal intestinal bleeding along with a lovely, even if small, perforation in my fucking uterus from the growth of endometrial tissue. I MEAN COME ON — WHAT IN THE HELL. Totally preventable if they fit me in when I called literally over a month ago.

But I will not change my doctor (the other docs at the practice know what is going on and have offered to take me on, but they don’t have the experience with myself and my conditions or the history, but they can do little else because of professional conduct—it’s between myself and my doc) because he is the only one who treats me with humanity and understands fibromyalgia, endometriosis, pre-MS and pre-RhA/PsA, endo-related IBS, (ulcerative) colitis, and other neurological conditions with any degree of empathy. (See, I told you I’m a mess!) There is no way I’m switching offices in the perpetual shortage of doctors in Canada moving elsewhere for m o n e y (plus Covid-19 being a teen hooligan and constantly coming back to wreck more goddamn shit, including everyone’s sanity, then setting things on fire like the real hooligans in my village have been doing this summer — I mean… what in the hell!?!?), so with all that in mind I actually thank my lucky stars. So I put up with a lot of this shit because he treats me, besides him being an airhead, like an actual human being deserving of compassion and care and quality of life despite my severe disabilities and pain. So.

I’m usually treated really well (even if they often think I’m a nuisance for daring to be severely chronically ill/in pain all the time) so I try to be patient and good and understanding when I can.

But his STAFF (I know they’re busy and I’ve been patient but they’ve been so awful honestly to the point I cried hard enough my dad noticed my red eyes and frustration-tear fracks on my face)! And the doc himself’s inability to reply to notes on time even when urgent and when he knows the circumstances (I admit I am a bit of a hard patient so I can understand if he just kinda ignores me sometimes, honestly). But in this case I was THREE DAMN MONTHS LATE for my injection and they’ve always called in the past when I was coming due if it looked like I hadn’t scheduled an injection, so that I was all on time and squared away and didn’t risk severe pain and damage to my already-fucked hormonal system (learning I couldn’t have kids was absolutely heartbreaking, let me tell you, but even a hysterectomy in that case would solve nothing — this is by far the easiest option, especially considering how my fibromyalgia would fuck with my post-surgery recovery and leave me with lasting pain for years if not decades; sigh).

Anyway. So. After some ridiculous levels of back and forth and some truly remarkable levels of lack of compassion (she kept giving me the exact same, word for word response in a bored tone UGH) considering the severe pain I was in (I was told, in front of OTHER PATIENTS AND STAFF, that I could just wait until I talk to the doctor myself at my next phone appointment and then schedule my injection for my next MONTHLY followup — 4.5 months overdue at that point, it would’ve been — because, and I quote, ‘am used to dealing with pain because of my fibromyalgia and years of dealing with it and other conditions’ which they named in front of others!!!!!!!! what. the. fuck. But I kept my cool because I know all these people, my mom taught their kids music, they’re a fixture of the community, etc. and I refuse to be a Karen…. At least externally.

But here comes the nice part that makes me love our new (okay, he’s been here like 5 years but still, in a small town that’s pretty new lmao) pharmacist that much more. Rasik was aware of my frustration with the doctor and nurses and was even the one who brought to my attention that, at the time, I was 2 months late for my injection and he was a bit concerned since he’s privy to how much pain I exist in without throwing in one or more knives directly into my womb, ovaries, tummy, hips, and other areas my endometrial tissue has taken root. He’s such a sweetheart and he really does care for his patients— the work he does with my father’s diabetes (the tricky one where you’re not obese) management is above and beyond the call of a pharmacist and I will forever be grateful for that alone, never mind how he cares for me.

So I went in today to pick up another medication, after yet another frustrating stop-over at the nurses’ desks, and he suggested I ask for my injectable medication (it’s Depo-Provera, by the way) and the syringe plus the two tips necessary — I’m actually familiar with this since I had to learn epinephrine injections from an early age (not Epipen) and how to give testosterone daily to my ex-husband (sorry not sorry, dude, but congrats on your first kid *grouchy thumbs up*). But yeah! Legally he’s not allowed to suggest I give it to myself, but he was getting super fed up with the nurses and doctors dragging their feet and ‘being assholes with little empathy’ in his own words, so I took the hint and requested my vial plus syringe, as well as the drawing and injection gauge needles…. which he gleefully filled for me, and I reiterated that it was ‘fully my idea, not yours, Rasik, because everyone knows I’m dumb and would never think it’s you if something happened’ (I’m not dumb and I’ve given injections to others many times looool).

Long story short: HERE’S TO PHARMACISTS AROUND THE WORLD, BEING AMAZING AND CARING FOR THEIR PATIENTS AND ‘BENDING BUT NOT REALLY BENDING’ THE RULES TO MAKE SURE THEIR CLIENTS ARE CARED FOR PROPERLY. They are amazing and deserve every last bit of your courtesy, especially when they pull double duty every. single. day. because of Covid and their subsequent boosters. (i.e. boosters in the form of humans who are fucking stupid if they have no medical reason not to get the vaccine… I mean JFC.)

Rasik? You are amazing and I am 100% going to find you some Indian-Canadian (or North Indian; I believe that’s where he’s from originally) treats or desserts or make some myself after slyly asking his assistant what he leans toward liking.

Be kind to one another, yeah, but… my goodness: be kind to those who can truly make a difference in your health, sanity, and even life or death.

Pharmacists, volunteers, and frontline health workers: the true heroes of these times.

Thank you so much. So very much.

💜💙🇨🇦���🏽‍⚕️❤️‍🩹🙏🏻

P.S. … now I just gotta stab myself intramuscularly after making sure there’s no air bubbles and etc., and swap out to the proper gauge needle (different, smaller, to draw from the vial, larger to inject so that it goes in more quickly and, oddly enough, hurts less haha). I don’t think air bubbles are as much of an issue as when injecting intravenously (ummm I have a doctor uncle and grandma nurse and nurse friends, so shush 😆). But I’ve done this for others and animals so I should be good! :)

I’m a smart enough cookie even if I’ve lost a few nibble-size pieces around the edges. 😉😘 buahaha

Cheers to my pharmacist!!!! You are amazing and I can’t wait for the pain and months and months of bleeding to settle down.

Remind me again why humans are the only mammals (animals?) with monthly fluxes? UGH wtf ever. 🙃

[insipid-drivel]

I need to vent: I’ve wanted and needed a hysterectomy since I was 11 years old, but all I ever hear is “But you might want children someday!”

I'm 27 years old, a lesbian, asexual, and perpetually celibate for religious reasons (It's complicated, but nothing to do with viewing sex as sinful or evil. I don't believe in slut shaming. It's simply a choice I made because it felt right for me). I also have Premenstrual Dysphoric Disorder, severe psychiatric disorders including suicidality, PTSD, severe panic disorder, anxiety disorder, anorexia, severe executive dysfunction, and an entire laundry list of other crippling disorders that have rendered me bedridden for almost 24 hours a day. The only time I leave my house is to see doctors, and the only way I can stand to do that is by heavily medicating myself with a battery of different (legal) drugs.

One of the problems that I've had ever since I started menstruating at age 11 is near-constant spotting and bleeding regardless of the current state of my menstrual cycle. I have been on almost every form of hormonal birth control available, including having received an excruciatingly-painful IUD that I still experience extremely upsetting flashbacks from to this day. There has never, ever been any form of hormone therapy that has stopped my spotting and bleeding, and I've already gone through laparoscopic surgery to rule out endometriosis and PCOS as potential causes. 

When I'm not on some kind of hormonal birth control, my periods are so heavy and painful only opioids can control the agony, and since the United States has begun treating the opioid crisis by denying them to virtually anyone that isn't dying or suffering from a "real disease", I no longer have access to adequate pain treatment. I currently take birth control pills year-round without stopping to menstruate because it's so painful I will self-harm or even attempt suicide to escape the pain. I wind up menstruating anyway, but at least with the BC in my system, the cramping is more tolerable.

The only viable remaining option I have left is a hysterectomy or full-on oophorectomy (where they remove everything, from ovaries to cervix). I have been asking and asking doctor after doctor to please, please, please approve the surgery as a necessary procedure for the sake of my quality of life so my insurance will cover the costs, but I am constantly disregarded, blown off, or fed watery excuses about how it's "too drastic" a step to take. The #1 excuse I always receive is "But you may want to have children someday!"

I am stridently childfree and have been my entire life. If you want to be a parent, that's cool; it's your body and your choice, so more power to you, but I absolutely hate children and refuse to be anywhere near my child relatives, and I am so riddled with disabilities and dysfunction that I could never, ever be a mother. Even still, I am constantly told that I'm too young for a hysterectomy and may someday change my mind about parenthood. Doctors simply will not take me seriously when I tell them that a major detrimental factor to my extremely poor mental and physical health is centered around my reproductive organs. When I start to PMS, I become dangerously suicidal and even less functional than I already am. "But you still might change your mind!" 

I've already been hospitalized on suicide watch once before, but hey, I still might change my mind, right? Because children always thrive when they witness their mother attempt suicide.

I am already regularly seeing a psychiatrist about my mental health, and I genuinely like my PCP. I already hang out around various support groups. I am being actively treated for every one of the dangerous symptoms that I have listed, but I continue to spiral because no one will agree with me that a hysterectomy would be a huge benefit to my quality of life. My PCP has been the only one to ever give me a different excuse besides the possibility of me changing my mind, and her reason for refusing to sanction the procedure thus far is because of a case that happened in my state where a woman agreed to getting a hysterectomy, and then sued her doctors when she later discovered that the surgery made her incapable of having children. There are times where I feel so frustrated and angry that I wish I knew who she was so I could throttle her with my bare hands for kneecapping my chances at ever getting approved for the surgery as a necessary treatment. 

The only chance I have at ever getting these awful, disgusting organs out of me is to try to find a surgeon that will perform an elective hysterectomy, which would cost me $30,000+ out of pocket. 

I say again, I am disabled. I don't have an income. I'm so disabled that I can't even make it into the welfare office to apply for disability benefits. Elective surgery is not an option for me.

I am so sick and tired of living with this, but I can't find help in any quarter. All I ever receive are more and more prescriptions for psychiatric medications, and they never work. I have been around the block with medication so many times that my psychiatrist is just astonished and increasingly at a loss for how to provide me with effective care other than, you know, confirming that this surgery really is the only thing that can provide me with a modicum of relief.

I'm just so tired. I'm tired of the stains. I'm tired of the smell. I'm tired of the pain. I'm tired of the bloating. I'm just so tired, I sometimes wish I would hurry up and hemorrhage out so I don't have to be stuck in this broken body anymore. I don't have any kind of gender dysphoria (I 100% support trans rights and absolutely respect them, no questions asked other than "What are your preferred pronouns?") - I fully identify as female, but being born female has felt like nothing but a punishment and a slow, slow death sentence. 

[altiushospital]

Laparoscopic Cervical Encerclage

Cervical incompetence is characterized by painless dilatation of the incompetent cervix and results in miscarriages and preterm delivery during second trimester.

Cervical incompetence occurs in 0.5% to 1% of all pregnancies and has a recurrence risk of 30%. Patients typically present with cervical dilatation in the absence of uterine activity after first trimester usually.

Cervical cerclage can be placed via transvaginal, open -transabdominal, or laparoscopic transabdominal approach, preferably before pregnancy.

A laparoscopic approach is superior to the transabdominal approach in terms of surgical outcomes, cost, and postoperative morbidity.

A laparoscopic approach to cervical cerclage placement is a potentially effective adjunct to the treatment of women at high risk of recurrent preterm birth.

Laparoscopic and transabdominal approaches both yield similar obstetric outcomes, and laparoscopic cerclage may be a superior method in terms of surgical outcomes, as suggested by several studies.

Laparoscopic surgical techniques have now increasingly replaced traditional abdominal approaches to gynecologic surgery.

laparoscopic cervical cerclage is a minimally invasive, extremely safe , cosmetically better pain and bleeding is lesser, intraabdominal adhesions are less, patient feels better postoperatively effective procedure in properly selected patients and should replace the traditional laparotomy technique.

When To Time Procedure ?

LAPAROSCOPIC cerclage placement can be performed prior to conception or in early pregnancy. Preconception placement provides optimum exposure and reduces risks of excessive bleeding and injury to the pregnancy

Is It better than a vaginal Approach ?

DEFINITELY .Time and again laparoscopy is the best method in treatment of various disease states in this modern medicine.

When the stitch has to be removed ?

The cerclage remains inside till delivery.it is released during the caesarean section in the operation theatre.

Will it harm the fetus?-

No it is necessary for the pregnancy to go on without which patient might end up in preterm delivery.

What Are The Risks Of Having A Cerclage Placed?

The likelihood of risks occurring is very minimal, and most health professionals feel a cerclage is a life-saving procedure that outweighs the possible risks involved.

what anaesthesia is given ?

its general anaeasthesia preferably.

What will be the recovery period?

Generally 2-3 days as with all the Laparoscopy procedures depending on your ability to recover.

who are the candidates for laparoscopic cerclage?

Previous failed vaginal cerclage with scarring or lacerations rendering vaginal cerclage technically very difficult or impossible.

Absent or very hypoplastic cervix with history of pregnancy loss fitting classical description of cervical insufficiency.

Which trimester it has to be planned?

The procedure is planned at the end of the first trimester or the early second trimester, after fetal viability has been documented and initial ultrasound evaluation of the pregnancy and preliminary blood tests have ruled out any major congenital malformation.

When not to have a cerclage?

Active labor.

Active vaginal bleeding.

Abruptio placenta.

Premature rupture of membranes.

Chorioamnionitis.

Prolapsed membranes.

Vaginal spotting .

What Can I Expect After The Procedure?

You may stay in the hospital for a few hours or overnight to be monitored for premature contractions or labor.

Immediately after the procedure, you may experience light bleeding and mild cramping, which should stop after a few days. This may be followed by an increased thick vaginal discharge, which may continue for the remainder of the pregnancy.

You may receive medication to prevent infection or preterm labor.

For 2-3 days after the procedure, plan to relax at home; avoid any unnecessary physical activity.

Your doctor will discuss with you when would be the appropriate time to resume regular activities.

Abstinence from sexual intercourse is often recommended.

what about postoperative care?

Elective cerclage is typically an ambulatory procedure. The patient is discharged after recovery from the anesthetic and when she is able to ambulate and void.

how to follow up?

Frequent visits as informed by your doctor report immediately in case of pain or spotting or bleedind or leaking.

What is the success rate?

Cervical cerclage helps prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in 85% to 90% of cases. Cervical cerclage appears to be effective when true cervical incompetence exists

Why Doesn't Every Woman Who Has Had A Preterm Baby Need A Cerclage?

Only women with an abnormal or "incompetent" cervix can be helped by a cerclage. However, even with the help of a cerclage, other problems can cause labor to begin too early.

What About Future Pregnancies?

Most women who need a cerclage in one pregnancy will need to have a cerclage placed in future pregnancies.

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[daniellepstevens-blog]

Soon You’ll Get Better

I haven’t talked much about my experience with anyone in my life. So this should be healing. I was 21 years old.  I remember the moment my mom called me to tell me she was sick. I was at work, opening up a store alone. She said calmly, “I have something that I need to tell you. I have cancer.” I said “what?” My mom is one of the strongest people I have even met and private until necessary. I remember sitting in my store, customers coming in, my face beat red from crying, and them turning around and leaving the store. The next person wouldn’t arrive for an hour. This was an hour of absolute torture. I finally was able to leave. Forty minutes from her, I rushed home. I remember seeing her face, which was unusually relaxed for someone who had just found out they had cancer. Personally, I am someone who holds in my emotions and takes action. I called my boss and immediately started a leave of absence. I had made the decision on the spot that I was not going back to work till my mom was better. Days later, we walked into the doctors office to find out all of the information of what to expect. My mother had stage 3 throat cancer. She wasn’t even a smoker. The doctor said “The good news is I think we will be able to beat this cancer, the bad news is this is the most painful, demon of a cancer treatment.” Just before treatment started, she had to have a feeding tube placed directly into her stomach due to the fact that the radiation would completely stop her from being able to eat naturally. Radiation begins, Monday through Friday for months, and months. Chemo on Wednesdays each week. The pain was unimaginable. At 21 years old, I was completely in control of all of her medications which included extremely dangerous drugs. I fed her through her feeding tube as she laid there asleep. I fed her slowly for 8 hours a day so that she wouldn’t feel nauseous. Later into the treatment she was virtually unable to swallow. Buildup of thick saliva would get stuck in her throat and she would choke on it. I would reach in her mouth and literally pull it out. I realize this is a little dark, but cancer is dark. We are a few weeks away from the end of her treatment. Her doctor wants to start weening her off some of the extremely rough drugs she is on and up her Fentanyl patch. I asked them if they would keep her in the hospital if they were going to make this huge change of drugs because I just did not feel like I was capable of handling it. They assured me her body would be fine with the change. Boy they were wrong. I woke up every couple hours to check on her as usual, and early that morning I just felt like her coloring was a bit off. She was TURNING BLUE. My mother was overdosing in front of my eyes from the dose of the patch they had put on her. I called my brother and aunt to get over and they were there in minutes. We all made the decision to call 911 immediately and thank god we did. They got there, she was minutes from death. They stuck her with Narcan and all of the medication that she had been on for months and months all were shocked out of her body which is extremely dangerous. She started projectile vomiting blood and had a look of absolute confusion and fear in her face as they wheeled her by us into the ambulance. And don’t forget, she is vomiting out of a throat that she can barely swallow out of. Imagine the pain. My mom ended up in the ICU for over a week, then bumped to a normal floor for days, and eventually came home. To say this was the scariest moment of my life doesn’t even begin to explain my feelings. Working so hard day in day out 24/7 to keep her alive and then a change of her medication being what could have got her is absolutely insane. Mom is officially home. We as a family are exhausted. We just took everything one day at a time. And slowly she improved and got her functions back. Fast forward, I am 30, and I still have my mom.

I had a boyfriend at the time who I have to say was very supportive of me leaving my job and taking on the responsibility of bills which was so kind. But ultimately the ptsd I had from the whole experience put a huge dark cloud over our relationship. Understandably so, he was young, had never been through something like this before. I guess our relationship just was not strong enough to handle such a life altering situation.

It took years for me to be ready to be with anyone again. The pain from my mother and my breakup was just too much to handle at such a fragile age. After some serious healing, I met a guy who would be a friend for over a year before we decided to date. He was supportive on every level and so easy to be with. A year into our relationship, we got a call from his mother that his dad had went into the hospital and it didn’t look good. We drove six hours to the hospital to see him. After some testing had been done, the doctors told us that he had pancreatic cancer and wouldn’t ever leave the hospital. And he did not. He passed away 18 days later. Which on that day, we found out his mother had breast cancer. His mother ended up doing months of radiation and beat hers.

Two months later, my boyfriends cousin, a 21 year old Army Ranger took his own life. My poor boyfriend had never experienced pain like this in his life. But thankfully I know what its life to live through such hard times, and I was not going to abandon him like what had happened to me. He was a wreck for about a year. He didn’t feel like it was okay to be happy. Slowly, after many unwarranted fights, and moodiness, he began to see light again. We stuck together through it and at that point we knew we would be able to get through anything.

Fast forward, we got married in June of this year. The day after our wedding, his mother came to our hotel room to tell us that she has extremely aggressive uterine cancer. She had a full hysterectomy but still needs highly aggressive chemo and four radiation treatments. Our current goal is making her laugh and keeping things light. I bought some fun colored wigs and brought them to her before she lost her hair. We both put them on and went to the store to be silly. It made the though of losing her hair less scary. We spend every third Monday, Tuesday, and Wednesday together as she gets her 6 hours of chemo.

I am not even sure if anyone will read this. But if you do, know that life is scary. There is just about nothing someone can do to make you feel happy when someone you love is sick. You just have to take things day by day. And if you are like me, when things get rough you internalize your feelings, have some sort of outlet. Mine has always been listening to music. Soon you’ll get better inspired me to write this novel to release my pain.

If you are ever in pain, feel free to reach out to me. <3

Taylor, thank you for writing a song that hits so close to home.<3 And I am so sorry for all that you have been through. @taylorswift​  @taylornation​

You’ll get better soon,

‘Cause you have to

<3

[divine-ruin]

Chaos that is life

I was willingly let go from my job because I wasn't going to lie and compromise myself just to fit a corporate narrative when my Army customers are quite happy with my work. Ah, the life of being a contractor in today's society. However, I didn't go out like a bitch and actually stood up for myself and my integrity because I was going to be fired whether I stood on my own two feet or groveled like I was clinging to life crawling on my belly over broken glass. The fact is that I was quite unhappy in my job since I was forced to take short term disability last summer when my company had a "small oversight" and was shorting me 2 hours of leave every pay period for the last two years. They told me to do that to "save my job". Following the recommendations of my own supervisor's, while well-meaning, was ultimately my downfall during a period of auditing and no one, and I mean NO ONE, should ever have to put up with an f-bombed laden phone call from a corporate superior at an ungodly hour with a sick child. The "HR" department was aware of this and did not a damn thing. Thankfully I have another job lined up to start in two weeks back in the old IT department I came from with people who are practically family and basically naming my own salary. I'm going back to my roots, where my career started, with nurturing people who have been asking me to come back for years and it feels pretty fucking good to feel wanted and loved and missed. Not to get religious because I respect all beliefs and walk a fine line between being Catholic and Buddhist, but I feel like this was absolute divine intervention and God was looking out for me and my family. My husband is thrilled to death because we are once again only a cubicle wall away from each other and this will be the highest paying job I've had in the almost 15 years I've supported the Army. I still need prayers/good vibes/positive affirmations and as much love as I can get because I'm renewing all my certs right now and all the material has changed in the 5 years between when I left my first work family and now. I was also told that apparently I must've fabricated all my internal bleeding issues even though I have numerous surgeries and medical images to support that I was the walking dead at one point. They even questioned my hysterectomy to "make sure I wasn't just finding an excuse to skip out of work".

(I also have a cute new kitty boy named Io (eye-oh) and he's been the perfect family fit for both my kids and puppy princesses.)

Don't ever let anyone tell you that you're worthless or that you don't matter. My credentials working at this previous place came highly even from the highest DoD officials and they are extremely upset I'm no longer there to support them with loving kindness and the best tech support they ever had. They've already sent this company a nasty letter about how they don't treat their employees this way.

So while life has been crazy, I promise to get back to asks this week and finish clearing out the inbox for all my characters. I just felt like I needed to explain the necessary procrastination and that you guys needed to understand that my grandmother didn't raise me to lie just to get ahead in life. When one door closes, another opens and hard work and dedication is what helps us get ahead. I would be a shit example to my two amazing children if I allowed myself to be compromised in such a disgusting way. So here's to a brighter happier future for my little family!

Just know that I'm always and absolutely grateful to you all for the precious memories and that I love you.

Pax, all!

--jessie

[morepopcornplease]

Random question: does that mean that, according to Catholic doctrine, gay sex is EXACTLY as taboo as het married sex where the guy has had a vasectomy, or the lady had a hysterectomy?

Not necessarily. 

Vasectomies and hysterectomies are indeed sinful, unless absolutely medically necessary—like if the uterus contained cancer that could only be removed through a hysterectomy. 

Barring that, they’d be in a state of mortal sin and would have to confess. Every time they had sex without having gone to confession and done their penance would be another sin. If they withheld that information from their partner that would be another sin. And if they got married without one of the partners knowing, that’d be grounds for annulment of the marriage.

Again, Catholics do kinda hail from a religion with stories of women getting pregnant even when infertile. Or, in extreme cases, virgin births! (an outlier which should not have been counted). Interestingly, the eunuch and the impotent man who is unable to perform any sort of vaginal penetration is forbidden from marriage.

I will say this, even though I’ll almost certainly be mobbed for it:

If you’re unable to perform unity or procreation, marriage should be your last option, and should actively be discouraged by the Church.

It’s pretty clear that the elevation of marital life has so overpowered the actual point of marriage (have kids, teach them the Faith) that this can seem harsh and unduly cruel, even to other Catholics. I bet even priests would likely shame me for this. I sympathize with their pain. But they can be contributing to the Faith far better in other ways than marriage.

And better to remain celibate and chaste instead of being occupied with the things of this world. 

NOW, I imagine your real question is: are there forms of het sex that are just as invalid as gay sex??

Answer: oh, yes. LOTS.

Things that are taboo to Catholics:

Anal

Oral (well, restricted to foreplay anyways)

Masturbation

Pulling Out

Dildos

Whatever the fuck those fake vaginas are called

Ben wa balls

Vibrating panties

Pretty much any toys

Pornography

Nudes

send nudes

i’m catholic

we’re married

YOU’RE catholic!!

Things that Catholics do in the bedroom to make up for this:

hardcore BDSM, probably…

what? you think the inventors of self-flagellation didn’t somehow move this to the bedroom??

Catholics can come at me for saying all this, but I quite literally didn’t make the rules here.

[willowhaven-blog1]

2018 was a year of ups and downs for me. In January I went back to college at Benedictine College to work towards my bachelors in sociology. I was working full-time at night and attending school full-time during the day. Exhausted doesn’t begin to describe it.

As busy as it was, I felt such a great sense of accomplishment everyday as I worked towards such a difficult goal. I enjoyed the classes I was taking and  the challenge excited me. Then everything changed. Cancer took that all from me. The excitement, the motivation, the incredible sense of accomplishment. With three words, that all was gone.

When I was no longer able to work or go to school, I lost my sense of purpose. I laid in bed for days and weeks feeling in credibly sorry for myself. I began to give up on myself, and to give up in life in general. During this time I was talking to a friend of mine about my younger sister who had recently moved to Arizona. I was talking about how proud I was of her for moving so far away to chase a dream. It was while we were talking that my friend suggested that maybe I should take a trip to visit her. My initial response was are you kidding? I can’t even get out of bed, let alone make a trip halfway across the country. But my friend told me that it would be good for me, to get away and see something new.

Suddenly I had a goal to work towards. I began pushing myself to get out of bed, even if just to walk around the house and get my own meals. In the beginning it was incredibly hard. I was extremely weak and couldn’t walk without a walker. But I kept pushing. Soon I graduated to using a cane, and finally I was able to walk short distances unassisted. I was so proud of myself. It’s amazing how much you take for granted in life until it’s gone.

In late November I had a hysterectomy to stop my body from producing the hormones that were feeding the tumor in my breast. While this surgery was incredibly necessary, I was a little sad because I figured my recovery would set my trip plans behind but I had a goal. I decided I wasn’t going to let something as minor as surgery stop me.

I pushed myself more and more each day. I became more active. I started driving again. Surprisingly enough, the more active I became, the pain that had become a part of my life began to fade. During my worst days I had been taking as many as 24 Percocets a day without relief. Suddenly I realized I was down to as few as four during a 24 hour period. Slowly I was taking back control of my life. Cancer wasn’t winning the war anymore. I was. The sense of pride I felt couldn’t compare to anything I had ever done before. I felt as though I had just won the Boston Marathon.

I had an appointment with my oncologist scheduled for December 10th. My goal had been to leave for Arizona the Wednesday following if my doctor felt I was healthy enough to go. He was so pleased to see the progress I had made since my first appointment when my pain was so bad that reduced to using a wheelchair because I was unable to walk. Now I was walking again and had actually driven myself so my husband didn’t need to miss a day of work. Much to my delight, my doctor told me he thought the trip would be great medicine for me.

Having received my oncologist’s blessing, I began to make the final arrangements to take the bucket list trip of a lifetime. I had considered flying into Phoenix to shorten my trip, but after much deliberation I decided that driving would offer me the opportunity to see more of the world and with no real time table in my head I planned to take my time and see what there was to see.

As I left Atchison on December 12 I began to have second thoughts. Would I be able to make such a long drive after being bedridden for so long and having only been getting up and around for such a short time? Would my back hold up to the strain of the trip? I was facing a 21 hour drive, the longest drive I had ever made in myself. I almost changed my mind many times as I set out for Arizona, but I kept telling myself I can do this.

The further along on my trip, the better I felt. For the first time in months, the weight of my stress and anxiety began to evaporate. With each mile I drove, a happiness and calm settled over me. Normally when I am driving I become so focused on the road that I miss everything around me. For the first time, I opened my eyes to everything around me taking in each little detail seeing the world with a childlike wonder.

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I had my first daughter two days before 19th birthday. I had spent my entire adult life caring for my children and had never really had the opportunity to travel. While my peers were traveling to Europe and going to college, I was changing diapers and burping babies. I had never really made it outside of the midwest and this was one of the few times I had ever taken a vacation that didn’t involve a soccer tournament. Normally those trips were rushed and there was very little time to relax and enjoy the sights around me.

The further I got from home, the more I saw all of the beauty in the world. As the miles passed, I began to believe in myself and for the first time I believed that cancer wasn’t going to beat me. I was going to fight with everything I had in me and I was going to live whatever life I had left no matter how long or short as though each day was my last. I decided that I refused to die with regrets.

When I reached the mountains of Arizona and my sister’s home, I was overwhelmed with everything I had seen. I was excited to see my sister, her husband, my adorable niece and my favorite floofer (code word for dog). I spent four days relaxing in the warm Arizona air, far from the cold of Kansas. The days with my sister were lazy and simple and incredibly calming. My mind was clear and free of worry over my future. I took each day as they came without thinking about whether cancer would beat me.

As my days with my sister came to a close I made the decision to head further west since I was only four hours from the sandy beaches of San Diego. I was amazed as each mile passed and I drove through the mountains and palm trees. I was amazed by the mild weather and when I reached San Diego  I fell in love with the sights all around me. I walked through the beautiful winter wonderland of Balboa Park at night, and dipped my toes in the ocean during the day. I enjoyed the tastes of authentic Mexican and Italian food, and let my mind clear from any of the negative thoughts that had held me hostage since my diagnosis.

As I returned home I had a new goal. My journey had given me a new purpose. My passion for nursing was still there and I realized just how much I missed taking care of and spending time with my patients. But I also realized that my time might be short and I wanted to experience as much as I could for whatever time I might have left. The more I thought about this, the more my mind wandered back to an idea I had a few years earlier. I wanted to move on from my staff hospital position and become a travel nurse. I realized that travel nursing would offer me the opportunity to combine my love of nursing with the ability to travel and see all that the country has to offer.

I celebrated New Years Eve by mailing my applications to Arizona and California to obtain my nursing licenses. In the weeks following I began discussing opportunities with recruiters, and began the initial process to build my file for submission to future employers.

As excited as I was, a cloud of fear hovered over me. Would my body be strong enough to return to work? When I had my appointment with my oncologist on January 10th, as terrified as I was to hear the answer I asked my doctor if my career was over. He looked at me and told me he didn’t see why. In one moment all my fears evaporated. I will be able to return to the work I love so much. Cancer didn’t take nursing from me.

2018 brought a lot of pain and fear as I was forced to accept my new reality. 2019 is going to be a year of adventure and discovery for me. Some days I am angry for all of the changes that have come to my life since I heard those terrible words ‘you have cancer.’ There are still days that I want to cry when I think about possibly not being here to watch my nieces and grandchildren grow up.

Even with all of the sadness and uncertainty cancer has brought to my life, some days I am thankful for the things I have gained. I have realized how very precious life is and how important it is to appreciate the gift of each day. I live more fully, I love more deeply, and I appreciate each moment I have. I’m living with cancer, not dying from it. I’m LIVING. Each minute of every day.

Jennifer – Extensive mets to bones. Diagnosed de novo at 43 on 9/25/2018. Cancer won’t win. I won’t let it. Life’s too short not to fight for every minute. Dx 9/25/2018, invasive ductal carcinoma (IDC), left breast, 1.5cm, Nottingham Grade 3, hormone receptor positive, ER+ (estrogen receptor)/PR+ (progesterone receptor), HER2- (human epidermal growth factor), BRACA- (genetic mutation), Stage IV, metastasized to bones First CA 27.29 10/9/2018 83 (goal <38) Hormonal Therapy 10/12/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy 10/12/2018 Xgeva injection (Denosumab) Hormonal Therapy 10/19/2018 Lupron Depot injection (Leuprolide Acetate) Surgery 11/29/2018 Vaginal hysterectomy with bilateral salpingo-oophorectomy First CA 27.29 post hysterectomy 12/10/2018 73 (goal <38) Hormonal Therapy 12/11/2018 Femara pills (letrozole) Targeted Therapy 12/23/2018 Ibrance pills (palbociclib) First CA 27.29 post medication change 1/10/2019 60 (goal <38)

New Year, New Me! 2018 was a year of ups and downs for me. In January I went back to college at Benedictine College to work towards my bachelors in sociology.

[gordonwilliamsweb]

Retiree Living the RV Dream Fights $12,387 Nightmare Lab Fee

Lorraine Rogge and her husband, Michael Rogge, travel the country in a recreational vehicle, a well-earned adventure in retirement. This spring found them parked in Artesia, New Mexico, for several months.

This story also ran on NPR. It can be republished for free.

In May, Rogge, 60, began to feel pelvic pain and cramping. But she had had a total hysterectomy in 2006, so the pain seemed unusual, especially because it lasted for days. She looked for a local gynecologist and found one who took her insurance at the Carlsbad Medical Center in Carlsbad, New Mexico, about a 20-mile drive from the RV lot.

The doctor asked if Rogge was sexually active, and she responded yes and that she had been married to Michael for 26 years. Rogge felt she made it clear that she is in a monogamous relationship. The doctor then did a gynecological examination and took a vaginal swab sample for laboratory testing.

The only lab test Rogge remembered discussing with the doctor was to see whether she had a yeast infection. She wasn’t given any medication to treat the pelvic pain and eventually it disappeared after a few days.

Then the bill came.

The Patient: Lorraine Rogge, 60. Her insurance coverage was an Anthem Blue Cross retiree plan through her husband’s former employer, with a deductible of $2,000 and out-of-pocket maximum of $6,750 for in-network providers.

Total Bill: Carlsbad Medical Center billed $12,386.93 to Anthem Blue Cross for a vaginosis, vaginitis and sexually transmitted infections (STI) testing panel. The insurer paid $4,161.58 on a negotiated rate of $7,172.05. That left Rogge responsible for $1,970 of her deductible and $1,040.36 coinsurance. Her total owed for the lab bill was $3,010.47. Rogge also paid $93.85 for the visit to the doctor.

Service Provider: Carlsbad Medical Center in Carlsbad, New Mexico. It is owned by Community Health Systems, a large for-profit chain of hospital systems based in Franklin, Tennessee, outside Nashville. The doctor Rogge saw works for Carlsbad Medical Center and its lab processed her test.

Medical Service: A bundled testing panel that looked for bacterial and yeast infections as well as common STIs, including chlamydia, gonorrhea and trichomoniasis.

What Gives: There were two things Rogge didn’t know as she sought care. First, Carlsbad Medical Center is notorious for its high prices and aggressive billing practices and, second, she wasn’t aware she would be tested for a wide range of sexually transmitted infections.

The latter bothered her a lot since she has been sexually active only with her husband. She doesn’t remember being advised about the STI testing at all. Nor was she questioned about whether she or her husband might have been sexually active with other people, which could have justified broader testing. They have been on the road together for five years.

“I was incensed that they ran these tests, when they just said they were going to run a yeast infection test,” said Rogge. “They ran all these tests that one would run on a very young person who had a lot of boyfriends, not a 60-year-old grandmother that’s been married for 26 years.”

Although a doctor doesn’t need a patient’s authorization to run tests, it’s not good practice to do so without informing the patient, said Dr. Ina Park, an associate professor of family community medicine at the University of California-San Francisco School of Medicine. That is particularly true with tests of a sensitive nature, like STIs. It is doubly true when the tests are going to costs thousands of dollars.

Park, an expert in sexually transmitted infections, also questioned the necessity of the full panel of tests for a patient who had a hysterectomy.

Beyond that, the pricing for these tests was extremely high. “It should not cost $12,000 to get an evaluation for vaginitis,” said Park.

Charles Root, an expert in lab billing, agreed.

“Quite frankly, the retail prices on [the bill] are ridiculous, they make no sense at all,” said Root. “Those are tests that cost about $10 to run.”

In fall 2019, The New York Times and CNN investigated Carlsbad Medical Center and found the facility had taken thousands of patients to court for unpaid hospital bills. Carlsbad Medical Center also has higher prices than many other facilities — a 2019 Rand Corp. study found that private insurance companies paid Carlsbad Medical Center 505% of what Medicare would pay for the same procedures.

The bundled testing panel run on Rogge’s sample was a Quest Diagnostics SureSwab Vaginosis Panel Plus. It included six types of tests. Quest Diagnostics didn’t provide the cost for the bundled tests, but Kim Gorode, a company spokesperson, said if the tests had been ordered directly through Quest rather than through the hospital, it was likely “the patient responsibility would have been substantially less.”

According to Medicare’s Clinical Laboratory Fee Schedule, Medicare would have reimbursed labs only about $40 for each test run on Rogge’s sample. And Medicaid would reimburse hospitals in New Mexico similarly, according to figures provided by Russell Toal, superintendent of New Mexico’s insurance department.

But hospitals and clinics can — and do — add substantial markups to clinical tests sent out to commercial labs.

Although private health insurance doesn’t typically reimburse hospitals at Medicare or Medicaid rates, Root said, private insurance reimbursement rates are rarely much more than 200% to 300% of Medicare’s rates. Assuming a 300% reimbursement rate, the total private insurance would have reimbursed for the six tests would have been $720.

That $720 is less than what Carlsbad Medical Center charged Rogge for her chlamydia test alone: $1,045. And for several of the tests, the medical center charged multiple quantities — presumably corresponding to how many species were tested for — elevating the cost of the yeast infection test to over $4,000.

Toal, who reviewed Rogge’s bill, called the prices “outrageous.”

Resolution: Rogge contacted Anthem Blue Cross and talked to a customer service representative, who submitted a fraud-and-waste claim and an appeal contending the charges were excessive.

The appeal was denied. Anthem Blue Cross told Rogge that under her plan the insurance company had paid the amount it was responsible for, and that based on her deductible and coinsurance amounts, she was responsible for the remainder.

Anthem Blue Cross said in a statement to KHN all the tests run on Rogge were approved and “paid for in accordance with Anthem’s pre-determined contracted rate with Carlsbad Medical Center.”

By the time Rogge’s appeal was denied, she had researched Carlsbad Medical Center and read the stories of patients being brought to court for medical bills they couldn’t pay. She had also gotten a notice from the hospital that her account would be sent to a collection agency if she didn’t pay the $3,000 balance.

Fearing the possibility of getting sued or ruining her credit, Rogge agreed to a plan to pay the bill over three years. She made three payments of $83.63 each in September, October and November, totaling $250.89.

After a Nov. 18 call and email from KHN, Carlsbad Medical Center called Rogge on Nov. 20 and said the remainder of her account balance would be waived.

Rogge was thrilled. We “aren’t the kind of people who have payment plans hanging over our heads,” she said, adding: “This is a relief.”

“I’m going to go on a bike ride now” to celebrate, she said.

The Takeaway: Particularly when visiting a doctor with whom you don’t have a long-standing trusted relationship, don’t be afraid to ask: How much is this test going to cost? Also ask for what, exactly, are you being tested? Do not be comforted by the facility’s in-network status. With coinsurance and deductibles, you can still be out a lot.

If it’s a blood test that will be sent out to a commercial lab like Quest Diagnostics anyway, ask the physician to just give you a requisition to have the blood drawn at the commercial lab. That way you avoid the markup. This advice is obviously not possible for a vaginal swab gathered in a doctor’s office.

Patients should always fight bills they believe are excessively high and escalate the matter if necessary.

Rogge started with her insurer and the provider, as should most patients with a billing question. But, as she learned: In American medicine, what’s legal and in accordance with an insurance contract can seem logically absurd. Still, if you get no satisfaction from your initial inquiries, be aware of options for taking your complaints further.

Every state and U.S. territory has a department that regulates the insurance industry. In New Mexico, that’s the Office of the Superintendent of Insurance. Consumers can look up their state’s department on the National Association of Insurance Commissioners website.

Toal, the insurance superintendent in New Mexico, said his office doesn’t (and no office in the state does that he’s aware of) have the authority to tell a hospital its prices are too high. But he can look into a bill like Rogge’s if a complaint is filed with his office.

“If the patient wants, they can request an independent review, so the bill would go to an independent organization that could see if it was medically necessary,” Toal said.

That wasn’t needed in this case because Rogge’s bill was waived. And after being contacted by KHN, Melissa Suggs, a spokesperson with Carlsbad Medical Center, said the facility is revising their lab charges.

“Pricing for these services will be lower in the future,” Suggs said in a statement.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).

Retiree Living the RV Dream Fights $12,387 Nightmare Lab Fee published first on https://nootropicspowdersupplier.tumblr.com/

[stephenmccull]

Retiree Living the RV Dream Fights $12,387 Nightmare Lab Fee

Lorraine Rogge and her husband, Michael Rogge, travel the country in a recreational vehicle, a well-earned adventure in retirement. This spring found them parked in Artesia, New Mexico, for several months.

This story also ran on NPR. It can be republished for free.

In May, Rogge, 60, began to feel pelvic pain and cramping. But she had had a total hysterectomy in 2006, so the pain seemed unusual, especially because it lasted for days. She looked for a local gynecologist and found one who took her insurance at the Carlsbad Medical Center in Carlsbad, New Mexico, about a 20-mile drive from the RV lot.

The doctor asked if Rogge was sexually active, and she responded yes and that she had been married to Michael for 26 years. Rogge felt she made it clear that she is in a monogamous relationship. The doctor then did a gynecological examination and took a vaginal swab sample for laboratory testing.

The only lab test Rogge remembered discussing with the doctor was to see whether she had a yeast infection. She wasn’t given any medication to treat the pelvic pain and eventually it disappeared after a few days.

Then the bill came.

The Patient: Lorraine Rogge, 60. Her insurance coverage was an Anthem Blue Cross retiree plan through her husband’s former employer, with a deductible of $2,000 and out-of-pocket maximum of $6,750 for in-network providers.

Total Bill: Carlsbad Medical Center billed $12,386.93 to Anthem Blue Cross for a vaginosis, vaginitis and sexually transmitted infections (STI) testing panel. The insurer paid $4,161.58 on a negotiated rate of $7,172.05. That left Rogge responsible for $1,970 of her deductible and $1,040.36 coinsurance. Her total owed for the lab bill was $3,010.47. Rogge also paid $93.85 for the visit to the doctor.

Service Provider: Carlsbad Medical Center in Carlsbad, New Mexico. It is owned by Community Health Systems, a large for-profit chain of hospital systems based in Franklin, Tennessee, outside Nashville. The doctor Rogge saw works for Carlsbad Medical Center and its lab processed her test.

Medical Service: A bundled testing panel that looked for bacterial and yeast infections as well as common STIs, including chlamydia, gonorrhea and trichomoniasis.

What Gives: There were two things Rogge didn’t know as she sought care. First, Carlsbad Medical Center is notorious for its high prices and aggressive billing practices and, second, she wasn’t aware she would be tested for a wide range of sexually transmitted infections.

The latter bothered her a lot since she has been sexually active only with her husband. She doesn’t remember being advised about the STI testing at all. Nor was she questioned about whether she or her husband might have been sexually active with other people, which could have justified broader testing. They have been on the road together for five years.

“I was incensed that they ran these tests, when they just said they were going to run a yeast infection test,” said Rogge. “They ran all these tests that one would run on a very young person who had a lot of boyfriends, not a 60-year-old grandmother that’s been married for 26 years.”

Although a doctor doesn’t need a patient’s authorization to run tests, it’s not good practice to do so without informing the patient, said Dr. Ina Park, an associate professor of family community medicine at the University of California-San Francisco School of Medicine. That is particularly true with tests of a sensitive nature, like STIs. It is doubly true when the tests are going to costs thousands of dollars.

Park, an expert in sexually transmitted infections, also questioned the necessity of the full panel of tests for a patient who had a hysterectomy.

Beyond that, the pricing for these tests was extremely high. “It should not cost $12,000 to get an evaluation for vaginitis,” said Park.

Charles Root, an expert in lab billing, agreed.

“Quite frankly, the retail prices on [the bill] are ridiculous, they make no sense at all,” said Root. “Those are tests that cost about $10 to run.”

In fall 2019, The New York Times and CNN investigated Carlsbad Medical Center and found the facility had taken thousands of patients to court for unpaid hospital bills. Carlsbad Medical Center also has higher prices than many other facilities — a 2019 Rand Corp. study found that private insurance companies paid Carlsbad Medical Center 505% of what Medicare would pay for the same procedures.

The bundled testing panel run on Rogge’s sample was a Quest Diagnostics SureSwab Vaginosis Panel Plus. It included six types of tests. Quest Diagnostics didn’t provide the cost for the bundled tests, but Kim Gorode, a company spokesperson, said if the tests had been ordered directly through Quest rather than through the hospital, it was likely “the patient responsibility would have been substantially less.”

According to Medicare’s Clinical Laboratory Fee Schedule, Medicare would have reimbursed labs only about $40 for each test run on Rogge’s sample. And Medicaid would reimburse hospitals in New Mexico similarly, according to figures provided by Russell Toal, superintendent of New Mexico’s insurance department.

But hospitals and clinics can — and do — add substantial markups to clinical tests sent out to commercial labs.

Although private health insurance doesn’t typically reimburse hospitals at Medicare or Medicaid rates, Root said, private insurance reimbursement rates are rarely much more than 200% to 300% of Medicare’s rates. Assuming a 300% reimbursement rate, the total private insurance would have reimbursed for the six tests would have been $720.

That $720 is less than what Carlsbad Medical Center charged Rogge for her chlamydia test alone: $1,045. And for several of the tests, the medical center charged multiple quantities — presumably corresponding to how many species were tested for — elevating the cost of the yeast infection test to over $4,000.

Toal, who reviewed Rogge’s bill, called the prices “outrageous.”

Resolution: Rogge contacted Anthem Blue Cross and talked to a customer service representative, who submitted a fraud-and-waste claim and an appeal contending the charges were excessive.

The appeal was denied. Anthem Blue Cross told Rogge that under her plan the insurance company had paid the amount it was responsible for, and that based on her deductible and coinsurance amounts, she was responsible for the remainder.

Anthem Blue Cross said in a statement to KHN all the tests run on Rogge were approved and “paid for in accordance with Anthem’s pre-determined contracted rate with Carlsbad Medical Center.”

By the time Rogge’s appeal was denied, she had researched Carlsbad Medical Center and read the stories of patients being brought to court for medical bills they couldn’t pay. She had also gotten a notice from the hospital that her account would be sent to a collection agency if she didn’t pay the $3,000 balance.

Fearing the possibility of getting sued or ruining her credit, Rogge agreed to a plan to pay the bill over three years. She made three payments of $83.63 each in September, October and November, totaling $250.89.

After a Nov. 18 call and email from KHN, Carlsbad Medical Center called Rogge on Nov. 20 and said the remainder of her account balance would be waived.

Rogge was thrilled. We “aren’t the kind of people who have payment plans hanging over our heads,” she said, adding: “This is a relief.”

“I’m going to go on a bike ride now” to celebrate, she said.

The Takeaway: Particularly when visiting a doctor with whom you don’t have a long-standing trusted relationship, don’t be afraid to ask: How much is this test going to cost? Also ask for what, exactly, are you being tested? Do not be comforted by the facility’s in-network status. With coinsurance and deductibles, you can still be out a lot.

If it’s a blood test that will be sent out to a commercial lab like Quest Diagnostics anyway, ask the physician to just give you a requisition to have the blood drawn at the commercial lab. That way you avoid the markup. This advice is obviously not possible for a vaginal swab gathered in a doctor’s office.

Patients should always fight bills they believe are excessively high and escalate the matter if necessary.

Rogge started with her insurer and the provider, as should most patients with a billing question. But, as she learned: In American medicine, what’s legal and in accordance with an insurance contract can seem logically absurd. Still, if you get no satisfaction from your initial inquiries, be aware of options for taking your complaints further.

Every state and U.S. territory has a department that regulates the insurance industry. In New Mexico, that’s the Office of the Superintendent of Insurance. Consumers can look up their state’s department on the National Association of Insurance Commissioners website.

Toal, the insurance superintendent in New Mexico, said his office doesn’t (and no office in the state does that he’s aware of) have the authority to tell a hospital its prices are too high. But he can look into a bill like Rogge’s if a complaint is filed with his office.

“If the patient wants, they can request an independent review, so the bill would go to an independent organization that could see if it was medically necessary,” Toal said.

That wasn’t needed in this case because Rogge’s bill was waived. And after being contacted by KHN, Melissa Suggs, a spokesperson with Carlsbad Medical Center, said the facility is revising their lab charges.

“Pricing for these services will be lower in the future,” Suggs said in a statement.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Retiree Living the RV Dream Fights $12,387 Nightmare Lab Fee published first on https://smartdrinkingweb.weebly.com/

[teachmixerofficial]

Complications during labor and distribution

Complications in labor and childbirth are relatively uncommon, but they do occur, and they are increasingly frequent. To ensure the delivery is secure, most complications can be detected and handled. For a pregnant person and their infant, however some complications during labor are serious, even life-threatening.

It's natural to feel nervous about the possibility that when you go into labor, something might go wrong. You may already know that you have risk factors that when you give birth, may make a complication more probable. Your health care professional may also have clarified to you that even though you do not have an elevated risk, certain problems may happen.

Depending on your particular health history and current pregnancy, the likelihood that you will encounter a complication during labor or childbirth will depend. During your prenatal appointments, your health care professional will explain your risk factors. During labor and childbirth, you can also ask them how they track and handle complications.

Here are a few of the more common complications of labor and childbirth you might want to inquire about, as well as what your care team is going to do to keep you and your baby healthy.

Common words used during labor and distribution

Popular complications of labor and delivery

There are a few forms of complications in labor and childbirth that are more common than others. A few examples are early labour, complications with the placenta, bleeding problems, and fetal distress.

Preterm labor starts before the 37th week of pregnancy. Sometimes, it can start as early as 20 weeks. According to the Centers for Disease Control and Prevention (CDC), about 1 in every 10 births was preterm in 2018.

Before the 37th week of pregnancy, preterm labor begins. It can start as early as 20 weeks, sometimes. In2018, around 1 in every 10 births was pre-term, according to the Centers for Disease Control and Prevention (CDC).

Very premature babies have a number of challenges to overcome. Even after they leave the hospital, some will have developmental disabilities and persistent health problems.

At your prenatal visits, talk to your provider about the signs of premature labor and get instructions on what you should do if you experience them.

How to Cope With Preterm Labor

Labor That Does Not Progress

Having contractions and your water breaking are typical indicators that you are in labor. Sometimes, however, the process can come to a grinding halt. If you went into labor but are not progressing through the stages, your provider might want to give you medication to speed up your labor or restart it if it stopped.

Your baby's descent through the birth canal slows or stops (in some cases, this occurs simply because your baby's head is too big to pass through your cervix—a condition called cephalopelvic disproportion)

Your cervix is not dilating

Your contractions aren't strong enough or are infrequent

You might need to have a C-section if your labor does not progress enough for you to deliver vaginally.

Placental Issues

Many placental issues are identified before a baby is born, though this is not always the case. Problems with the placenta can also occur once labor has started. Certain issues with the placenta are more common after uterine surgery, such as a C-section.

Possible problems with the placenta include:

The placenta covers all or part of your cervix (placenta previa)

Before the 37th week of pregnancy, preterm labor begins. It can start as early as 20 weeks, sometimes. According to the Centers for Disease Control and Prevention (CDC), in2018, around 1 in every 10 births was preterm. The sooner the labor begins, the more dangerous the birth would be. The health effects of your baby's preterm birth are increased, even though they are born just a few weeks early.

The placenta tears away from the uterine wall too soon (placental abruption)

If they are not addressed, issues with the placenta can cause severe blood loss (hemorrhage) that can put the health of a pregnant person and their baby at risk. Before and during your labor, your care team will monitor you to ensure that any placenta problem is quickly identified and treated.

Umbilical Cord Problems

Problems with the umbilical cord can also cause labor and delivery complications. The cord might be wrapped around the baby's neck (nuchal cord), or the cord will come out of the vagina before the baby (prolapse).

While it can be frightening to think about the umbilical cord being wrapped around your baby's neck, a nuchal cord is not often dangerous.

In most cases, the cord is only briefly around the baby's neck and is not tight enough to interrupt their breathing or descent through the birth canal. Having a nuchal cord rarely has any long-term effects on a baby's health.

Before the 37th week of pregnancy, preterm labor begins. It can start as early as 20 weeks, sometimes. According to the Centers for Disease Control and Prevention (CDC), in2018, around 1 in every 10 births was preterm. The sooner the labor begins, the more dangerous the birth would be. The health risks of your baby's preterm birth are increased even if they are born only a few weeks earlyYour cervix is not dilatinYour conMany placental issues are known before a baby is born, but this is nThe placenta develops into the lining of your uterus (placenta accreta) The placenta covers all or part of your cervix (placenta previa) When labor has begun, complications with the placenta can also happen. After uterine surgery, some complications with the placenta are more common, such as a C-section. If your labor does not advance enough for you to deliver vaginally, you will need to have a C-section. Acts are not good enough or I am

What Happens If the Umbilical Cord Is Around Your Baby's Neck?

Perineal Tearing

Tearing of the tissues of your vagina and the perineal region (between your vagina and anus) can occur during vaginal delivery. The severity of a tear is categorized by a grading system. In some cases, it can be quite extensive and your provider will need to repair it with sutures (stitches) or another method.

Your provider might decide to make a cut in these tissues (episiotomy) as you are delivering to prevent them from tearing. Whether you have a tear or an incision is made, the wound will need time to heal and recover.

The American College of Obstetricians and Gynecologists (ACOG) does not support the "liberal or routine use of episiotomy." ACOG recommends that providers only use the procedure when strictly necessary.

When Is an Episiotomy Needed?

If you experience excessive bleeding after giving birth, your provider will diagnose you with postpartum hemorrhage. There are certain risk factors for postpartum hemorrhage. You might be more likely to experience the complication if:

You are pregnant with more than one baby (twins, triplets, etc.)

You have had more than 5 previous deliveries (grand multips)

You have a complication such as preeclampsia, anemia, or a problem with the placenta

Your labor is prolonged or needed to be induced

Postpartum hemorrhage can also occur in someone who has no known risk factors.

Ask your provider how they handle bleeding in the postpartum period. Depending on what is causing the bleeding, your provider might start by massaging your uterus or giving you a medication to help stop the bleeding.

If these more conservative measures do not work, you might need to have surgery to remove the placenta and the uterine lining. In extreme cases where there is no other way to stop the bleeding, the uterus might need to be taken out completely (hysterectomy).

How Much Will I Bleed After Giving Birth?

Fetal distress can have many causes, including umbilical cord issues, medications used during labor, and infections, as well as induction. If your baby is experiencing a complication such as perinatal asphyxia, breech positioning, or shoulder dystocia, they might also show signs of distress.

External fetal monitoring allows your care team to check on the baby and see how they are coping with labor. Other tests can also be used, including fetal scalp pH sampling and internal fetal monitoring.

If your baby is in distress and you are not close to giving birth, your provider might use forceps or a vacuum extractor to help you deliver. In some cases, a C-section might be required to ensure your baby arrives safely.

How to Read a Fetal Monitor

Labor complications are uncommon but they can happen to anyone, in any delivery setting, and under the care of any type of provider. Certain risk factors can make it more likely that complications will develop, but if you have had a healthy pregnancy you will likely have an uncomplicated childbirth experience.

Even if you do not have any risk factors, it's important that you talk to your provider about what would happen if complications developed during your labor. Ask them how they handle emergency situations such as excessive bleeding and when they would recommend a C-section if your plan was to have a vaginal delivery.

Your care team is there to monitor you and your baby and ensure that you have a safe labor and delivery. You can start talking about any concerns you have during your prenatal visits. Discussing the possibility of complications during your labor might feel scary, but having a plan is one of the best ways to empower yourself.

Everything You Need to Know About Pregnancy Complications

[phalloplastyaustralia]

A little about me and why I’m starting this blog

I’m 26 years old, I live in NSW Australia, and I began my medical transition when I was 17 years old. I was lucky enough to get the green light to start hormones when I was 16, however sporting commitments prevented me from doing so until I was 17. I was incredibly lucky to have a psychiatrist who believed that I was able to give informed consent, despite being the youngest person he had ever treated, which I will be eternally grateful for. It’s much understanding that at that time (2008/2009), you were required to attend the Family Court to be granted permission to do this. I don’t know how I got around it, but I’m happy I did.  I had chest reconstruction surgery with Dr Megan Hassall in Sydney in 2010, a few months after I turned 18. I had double incision WITHOUT nipple grafts. At the time of consultation in late 2009, this was the only procedure Dr Hassall offered. Between my consultation and surgery date, this changed, and I was given the option on surgery day to keep my nipples. I followed through with my original decision and had them removed. I do not regret this choice and I am very happy with my decision. I had my nipples reconstructed 10 months later, in addition to having a revision. I have not had my areolas tattoed at this stage, and likely never will. I often toy with the idea of getting them, but honestly have no issue with the way that they currently are. I am incredibly happy with my results and choice to see Dr Hassall - you would be pressed to find incisions (without tooting my own horn) that have healed as nicely as mine have. This is a testament to not only her level of skill, but also my aftercare.  I know there are many people out there who have their opinion on Dr Hassall, but I wouldn’t change my decision if I had the opportunity have surgery again, and highly recommend her.  I had a ful lapro hysterectomy with Dr Jospeh Elbeaini in Liverpool/Campbell town in 2010. I specifically chose him as I knew another guy had seen him for their hysto, and that he had not requested to do an exam prior. This may not be important to some people, however this was extremely important to me. I don’t feel it necessary to go into the full details of my experience with having a hysterectomy here, however if you do wish to know more, feel free to message me. I had no issues with seeing him, he was respectful and understanding, 99% of nursing staff were amazing and made what was a rather traumatic experience a lot more bearable.  I have essentially lived the last 8 years of my life comfortably not having to disclose my medical history to anyone I meet, unless it has been a sexual partner and in few very instances, medical professionals. I do not agree that this is considered ‘living stealth’, as that suggests that I am hiding something. I am simply living my life the best way that I can and if my medical history has no impact or relevance to the interaction and relationships I build with someone, it is information that they don’t need to know.  I spent years and years convincing myself that I could put lower surgery off in hope that one day a better, more advanced option would become available. That one day soon the option of a transplant would be available for all men requiring penis surgery, not just cismen. I grabbled with the loss of my forearm and additionally scarring and what that would mean about disclosure and who and how I interact with people. I’ve spent countless morning having panic attacks while trying to get dressed, being late for work because I haven’t been able to stop crying, avoiding public bathrooms, etc. all in the hope that one day my waiting would pay off. A few months ago, in the midst of my lowkey crippling depression pertaining to my genital configuration, I came to the realisation that all the things I had been hoping and waiting for are very unlikely to become apparent within the timeframe that I need lower surgery. Around the same time, I learned that a friend of mine had not long had surgery in USA and that there was now a surgeon operating in Australia - Dr Hans Goossen, who is based in Queensland. Following a morning meltdown, I made the decision to bite the bullet and book a consult, which is now 3 weeks away. Between then and now, I have spent countless hours on the internet trying to find out whatever I can about Dr Hans Goossen and his work, but there’s very little aside from one blog (https://mytransitionftm.wordpress.com), and a few recounts of consults. So I guess my primary reason for creating this blog is hopefully being able to build on the little information that is available about what options are available for men looking to have lower surgery in Australia - something that previously only appeared to be something that was achieved by going abroad. Within the last week, I have also come across Dr David Caminer, who is based in Sydney. I sent through an email enquiry, which I received a very prompt reply to, stating that Dr Caminer is very experienced with performing phalloplasty on transmen. I am yet to book a consult, however I will likely organise that within the next week or so.  For personal reasons, I am only interested in having a phalloplasty performed. I am uninterested in anyone’s opinion on the appearance of phalloplasty vs. metoidioplasty. That is not the purpose of this blog and I am well and truly past that point in my decision making. I hope that this can become a resource for other men and I will endeavour to update it as frequently and as informatively as possible.