Thursday, May 30, 2013

Post Op day 21

There's not a whole lot of change since my last post, which I don't believe is a bad thing. I think I've had a pretty good recovery so far. I'm back home spending time with my family. We actually went "camping" in RVs over the Memorial Day weekend with my immediate family. It was a little bit difficult not to play with my niece and nephew, but it all worked out. Normally I pick them up, run around and let them climb all over me, but this time they knew that Auntie Missy had an "owie" so they had to be easy. I also got to spend the weekend with my newest nephew who is 8 months old. I don't get to see him much so I like to love on him as much as possible. Unfortunately he is well over the 10lb weight limit so I was afraid to pick him up. Normally I would get situated and have someone set him on my lap.

I'm still taking 800mg of Ibuprofen for what little pain I have, typically 1-2 times a day. Using ice during the day makes the itching manageable so I only take the Vistaril at night since it makes me sleepy. I've gotten pretty good at moving while keeping the ice in place. I've consolidated my baths to two 90+ minute sessions. It seems to give me more time with my family as well as conserving water. I'm also still walking 20-30 minutes every couple of hours, but it's not the activity that I'm used to. The decrease in activity has my body a little confused. I've had problems with my left piriformis muscle (in my bottom) for a couple of years that eventually causes hip discomfort that is only relieved by stretching, being active and a chiropractic adjustment. I'm afraid the stretches I have used before may pull a little on my stitches so I haven't been doing them which has my muscle irritated. Hopefully I can restart the stretching and see a chiropractor after I see Dr. G for my 6 week follow up.

Wednesday, May 22, 2013

Post op Day 14

Yay! It’s been two weeks and I’m still going strong. I’m a nurse so I like to take a peek to make sure everything looks okay in between appointments especially if I feel anything abnormal. On Saturday one of my stitches looked odd. I got pretty nervous, emailed Dr G and decided I would just be on bedrest with bathroom privileges until I heard back. It was a Saturday night and Dr G responded saying everything looked fine and just to take it easy. I am so thankful that he is so devoted and checks his email even on a Saturday night. I’ve had a doctor yell at me for calling the advice line before 10pm on a weekday when I was having an adverse reaction to the medicine and the instructions said to call your doctor immediately. Dr. Goldstein really is one of a kind!

I saw Dr. Goldstein and Catherine the NP on Monday, Post op Day 12. They said that everything looks great and that I seem to be doing really well. They told me I was definitely okay to fly home the next day and to keep sending pictures. I’m a little sad I won’t be seeing them every week to hear everything looks okay. I know they can tell by pictures, but it’s not quite the same. Plus, everyone at the office is so friendly that I always leave there feeling happy and cared about.

On Tuesday my husband and I journeyed back to the St. Louis area to spend the next month with our families. I never seem to be able to find a direct flight to St. Louis so we had a layover in Denver. As advised by the other ladies I called the airline ahead of time to set up wheelchair assistance. I know I can walk but not very fast, and our layover in Denver was only supposed to be 30 minutes. If we landed late and our next gate was far away I wouldn’t make it or would be hurting if I did. In actuality, I didn’t need to call, but they did add it on to my itinerary so someone would be waiting for me at each stop for the layover and in STL. Everyone was super nice and helpful, although I did notice a lot of weird look from other passengers probably thinking that I didn’t need a wheelchair. I found it easier just to look down at the ground during transport. It was nice not having to stand in line at security and being the first to board the plane. We were able to sit in the first row with extra leg room and I could easily stand if I needed to. I asked the flight attendant for a couple glasses of ice for my ice pack. She even offered to fill it for me. A word of wisdom: do not use the ice bag from the hospital without placing it in a plastic bag first. I only used the hospital one on the drive home and then we had frozen gel packs that I liked instead. Since the gel packs weren’t refillable I thought I’d use the one from the hospital during the flight. It had a plastic lining and cloth inside so I thought it would work nicely. Halfway to Denver I felt really cold down there. It turns out that the ice pack leaked. My pillow and dress were both really wet and ended up staying that way for most of the trip! I also found that my maxi dress worked really well for comfort and it hides the ice pack nicely.

My pain is still well under control. I’ve been taking 800mg of Ibuprofen, typically every 8-10 hours. The itching got pretty intense and was not relieved by Benadryl so I opted to get the Vistaril. The ice during the day makes the itching manageable so I only take the Vistaril at night. Between the Vistaril and the Percocet I sleep pretty well. When I wake up in the morning I grab Ibuprofen, a heat pack or an ice pack and try to sleep in a bit longer. I can’t seem to fit the 4 baths in, so I’ve been taking 2-3 longer baths. I usually stay in for 60-90 minutes at a time. It doesn’t really help with my pain (primarily because my pain is already well managed), but it is supposed to help dissolve the stitches. Dr Goldstein keeps reminding me to have a quiet recovery so I take slow walks throughout the day usually about 20-30 minutes every 2 hours. I’m really trying hard to be a good patient since I know medical professionals can be the worst!

Wednesday, May 15, 2013

Post Op Day 7

It’s hard to believe it’s been a week since I had my surgery. Sometimes it feels like it was only yesterday, while other times it seems like it was so long ago. I had my first post-op appointment today with Dr. G and Catherine the NP. They assured me that everything looked great and was healing nicely. It was nice to have some re-assurance - I’ve been trying to follow the rules, but I sometimes get nervous that I’ve messed something up.

For the most part, my pain has been completely under control. Monday was the worst so far – in addition to the additional pain I was extremely tired and grouchy. Thankfully, I was able to sleep most of the day. Dr Goldstein was very encouraging, reminding me it would get better. I’ve still been taking 800mg ibuprofen every 8 hours and sometimes a Percocet at bedtime. I’ve been walking about every 90 minutes for 20minutes at a time; it feels so much better than sitting! When I’m not walking I rotate ice and heat which keeps most of the pain at bay. Sometimes I put ice on and decide it’s not working and switch to the heat pack. Today I took a Percocet before my appointment in preparation for the pain that was sure to come with the exam, but between the car ride and the Percocet I ended up nauseated and decided I’d prefer not to do that again.

While I was at the office I walked a few thank you cards over to the nurses at the hospital to show my appreciation for taking such good care of me. I typically work at well known teaching hospitals and was a bit nervous about going to a smaller hospital. They did an excellent job, and I just wanted them to know.

Since I haven’t been using the pain medication regularly, I didn’t need the miralax for help with bowel movements. I found that making fresh apple or grape juice works better anyway. I’m still trying to have fruit and Greek yogurt smoothies daily in addition to taking a fiber supplement twice a day. So far it seems to be working well.

The itching from my stitches has been getting worse. I don’t feel it as much with the heat or ice on. Dr Goldstein’s team gave me a prescription for Vistaril if I need it, but I am fairly sensitive to medication so I think I’ll try Benadryl first. The last time I took a single Benadryl I slept for 19 hours and woke up very groggy.

We will be in San Diego for almost another week before we go home for a month to our families. I really wanted to have a handle on my pain before staying with our parents because I don’t like to show pain or emotions to anyone other than my husband. I’m trying my best to enjoy my recovery per Dr. G’s guidelines, but sometimes it’s hard. I like to spend my time being active, but hiking, biking, running (when I can convince myself to do it) swimming and chilling in the hot tub are all off limits during recovery. I enjoy making cards, painting and scrapbooking, but can only sit comfortably for so long. I really can’t sit up right for more than 30 minutes without pain which makes things difficult. It’ll take some adjustment, but I’ll figure out exactly how to enjoy it. For now the things I look forward to are the quiet walks with my husband in the beautiful San Diego weather and watching movies each night together. Here’s to another week of progress and healing!

Saturday, May 11, 2013

Apron Mother's Day Card

My inspiration for this card was seen on Flickr. The mom sentiment is from Microsoft word that I traced onto the card stock with pencil. I then covered the pencil writing with my Versa Marker pen and Embossing Powder. It's my first time using embossing powder and I think it turned out nicely.

Simple Anniversary Cards

Black and white layers with Microsoft Word Sentiments topped off with Stickers. Super Simple and Super Fast.


Triple Hearts

My inspiration for this card was found at Paper Trey Ink. I just used random scraps that I had.

Large Flower with Rhinestone Accents

Very simple Cricut card accented with rhinestones.

Vertical Flowers

This is a very simple card. All the cut outs are created on my cricut. The strips were created using satin ribbon and the sentiments are a simple stamp I found at Michaels. The flowers are topped off with glitter glue or rhinestones (which I think look nicer).

Mickey Mouse Card

My inspiration for this card was found on no other than Pinterest. The Mickey Mouse shapes are made from thin foam. The swirls are fabric paint and the stickers are from the dollar tree. An instant hit with any Mickey Mouse Fan.

Basketball card

My inspiration for this card was seen at Split Coast Stampers. My brother in law loves basketball so I thought I could make a simple version. I think it turned out pretty good and once again it's quick and easy just the way I like it :)

Hoppy Birthday

My inspiration for this card came from Stampin Pretty. The circle and frog are cut using my cricut. I attached googley eyes for fun and the sentiment is wrote in fabric paint. My nephew loved the card.


My inspiration for this card came from The Bright Side of Life. The hearts are cut using my cricut and the edging are satin ribbon strips. Love is written in fabric paint and the Happy Anniversary is just printed on the card. Once again a simple card.


Word Find Birthday Card

My husband's grandmother loves word find puzzles. It's how she spends most of her days. When I saw this on Flickr I was inspired. I wanted a simple easy to read card since she is in her 90s. I created the word search puzzle in Microsoft Word. I had the flower from a clearance sell at Micheal's and I thought the rhinestone would add a little something extra. It's sweet, simple and to the point, but she liked it and that is all that matters :)

Birthday Candle Card

My inspiration for this card was found at Stampin Mom of Four and on Pinterest. The candle pieces are scraps that I had saved from previous projects. The orange flames and rectangle base are from thin foam that I bought at the dollar tree. The sentiment was just printed from Microsoft word. I really liked how the candles were embossed on the cards that I saw, but I did not have an embosser at the time, but I did what I could.

Argyle Card

I saw this Argyle card on Pinterest that looks as if it was sewn. I didn't want to devote quite as much time so I came up with this version. I used my cricut to cut the diamonds from some colored scraps that I had on hand. I wrote celebrate with fabric paint and let it dry. I think I'll use a stamp next time, but not bad since I'm new to this card making stuff.

Halloween Card

I saw this sign shared on Facebook and thought that it would be a cute concept for a Halloween card. I used my cricut to cut the orange circle. I found a shadow image of the witch that I traced and cut out by hand. The inside was just created on Microsoft word text and clip art. Needless to say both of my sisters loved it!

Post op day 2 and 3

Post op Day 2

I’m still trying to get a schedule down for walking and baths, but otherwise I feel great. My pain is still minimal which I assume will change as the exparel wears off. I know it’s coming, but I just don’t know when. I am passing lots of gas, but I still haven’t had a bowel movement and it has been over 3 days. Dr G recommended that I listen to my bowel sounds to see if I need to medically intervene. I’ve been taking Miralax twice a day…I know I know the bottle says once a day, but one of the docs that I work with said it’s totally fine to take it twice a day for a short period of time. Plus, I’ve been walking, drinking fruit smoothies, made a large glass of fresh grape juice and am taking fiber tablets. My bowel sounds were pretty sluggish so I opted to do the Fleet’s enema. I’ve given to it patients, but something about having it myself was not pleasant. Dr Goldstein was right of course…it’s really the only thing that works at this stage.                

Post op Day 3

Well it’s been over 72 hours since I got the Exparel so it should be worn off by now. Surprisingly my pain is still pretty good at 3-4 out of 10. I’ve gotten my routine down mostly with waking, eating a light meal, bathing, and repeating. Today I even found time to sit outside in my lawn chair and soak up some wonderful San Diego sunshine. I’ve just been taking 800mg Ibuprofen every 8 hours for my pain. I only want to use the Percocet if I need it. I use the peri-bottle after I pee each time just to keep things clean and then of course pat dry. Throughout the day I rotate between an ice pack and a heat pack for pain relief. I really like the heat at night since I use a rice sock it stays warm for a long time while I’m asleep. I usually wake up around 6am with pain 4 out of 10. I grab an ice pack take 800mg of Ibuprofen and head back to sleep. My ambien is still sitting on the counter untouched. I’ve found that sleeping on my side with a pillow between my knees is the least painful. I’m still taking miralax once a day and eating a fruit smoothie to help prevent constipation. I’m slowly advancing to a regular diet. Here’s to hoping things continue. All I can say is God is good and has things under control.

Friday, May 10, 2013

Post Op Day 1

It’s the first day of post-op recovery and I actually feel fantastic. I have hardly any pain thanks to the Exparel they gave me. I’m a little nervous about what the pain will be like when the medicine does wear off. I know it’s coming… I’ve also been trying to fit in 4 sitz baths in and slowly walk a bit, but I need to figure out a routine. Dr. Goldstein and his staff have contacted me multiple times today just to check in. I can’t say enough positive things about their follow up and bedside manner. I’ve worked with numerous medical staff, and this is far from the normal experience.

Things to consider after surgery:

  • Complete Pelvic rest for 3 months
  • No exercise for 3 months other than walking
  • Avoid stimulating situations – Arousal can cause problems such as Skenes or Bartholin’s cysts
  • If flying call the airline ahead of time to set up a wheelchair pickup

Surviving a Full Liquid Diet – Things you can have:

  • 6-8 glasses of liquid per day: juice, water, milk, carbonated beverages, coffee, tea, or gatorade
  • Soups – cheese, tomato, pureed potato, etc
  • Broth
  • Yogurt – Greek vanilla is great and has extra protein
  • Jello
  • Oatmeal
  • Ice Cream and milkshakes
  • Honey, Jelly, or Syrup
  • Liquid meal replacements – carnation instant breakfast, slim fast, ensure, etc
  • Blended fruit smoothies

Day of Surgery

I wasn’t nervous until the nurses began wheeling me into the OR, but that was short lived. Dr. Goldstein introduced me to all the nurses, scrub techs and anesthesia. Soon enough, I was completely unconscious. I don’t remember much except the last few minutes in recovery. I had really only been worried about being a needy patient, and sad enough that it was I became. I was overcome with nausea from the anesthesia. The anesthesiologist did give me a nice cocktail in the OR, but I still ended up incredibly nauseated which got worse with each movement. I tried to wait it out in the hospital, but realizing that it wasn’t getting much better I opted to go home instead of taking up a valuable bed. When we finally got home, I just crawled into bed. I woke up a few hours later and the nausea was mostly gone. Dr. Goldstein called a couple of times to check on me before the day was over.

Preparing for surgery:

  • Remove all metal and jewelry – leave it at home or have your family member keep it
  • Leave all valuables at home or let your family be responsible for them
  • Don’t wear dark colored nail polish – it can mess up the oxygen sensor reading (pulse ox)
  • Dress comfortably – something that’s easy to change in and out of
  • Check with the doctor to see if you can wear your contacts. Bring glasses & a case just to be safe.
  • Do not use lotion, oils or creams before your surgery
  • Make sure you have someone to drive you home or set up an appointment with a medical transfer van
  • Make a list of all medication you take, the dosage, and the last time you took them
  • Make a plan with your doctor about when to stop taking your prescriptions
  • Do not take any herbal medicine for 2 weeks prior to your surgery
  • Stop taking medications like Tylenol and Ibuprofen 5 days before your surgery
  • Follow the diet order – don’t eat or drink anything after midnight the night before

Surgery and Preparation

We arrived in San Diego on May 5th to prepare for the surgery. On the 7th we had all of our pre-op appointments at the hospital and with Dr. Goldstein’s team. This involved another Q-tip test. I wasn’t really worried about the surgery. I mean, I didn’t want to have surgery, but it was the only option left. It also probably helps that I work in a hospital and am familiar with the OR.

Things to gather before the Vestibulectomy:

  • Sitz Bath – a small tub which will allow your sensitive parts to be submerged
  • Soft Ice packs
  • Mesh panies
  • Maxi pads
  • Donut pillow – an inflatable child’s inner tube is a cheap alternative
  • Comfortable clothes – tight fit clothes will not feel good
  • Ted hose or thigh high support hose – keeps you warm and your blood flowing during inactivity
  • Squirt bottle (Peri-bottle) – Spraying water while you pee will relieve pain & keep you clean
  • Fleet Enemas – In case you haven’t had a bowel movement after a few days
  • Miralax – To keep your stools softer while on pain meds
  • Chewable Fiber – Might help since you aren’t eating normally
  • Lots of entertainment – TV, movies, books, crafts
  • Meal Plans – you will be on a full liquid diet until your first bowel movement

History, Diagnosis and Treatment

No matter how I try to avoid the subject, rephrase the issue, or forget about the problem all together, there is really no way around it. For a long time now I haven’t been able to have sex without experiencing pain, but more on that later. I suppose I should start at the beginning.

I have always had vaginal issues. From a young age, I suffered with recurrent urinary tract infections for no apparent reason. Later on, I was diagnosed with and treated for endometriosis, although no official tests were ever performed. This treatment consisted of medically induced menopause at age 16 which lasted for 9 months. With the lingering endometriosis and irregular periods, my OBGYN prescribed oral birth control. I continued to use birth control to regulate my periods for 9 more years. 

It was in college that I met my best friend. We lived in the same dorm only one floor apart. After a year of hanging out it became apparent that we went meant for something more, and we began dating the following summer. The two of us were inseparable, depending upon each other for everything. What can I say - we were young and in love! A few years passed; we both graduated and finally married in October of 2009. Believe it or not, we had abstained from sex until we got married. I had the Mirena IUD placed about a month prior, but it didn’t really start to kick in until a bit later. That’s when the real problems began.

I started to feel burning during intercourse. At first, we thought this had everything to do with the type of lubricant we were using or was related to my endo, but as time went on, it got worse no matter what we tried to do differently. We took our “real” honeymoon in March of 2010, and by then the pain (burning) was so bad we could not have intercourse again. As a last ditch effort I had the Mirena removed after reading various reports that it could be the cause, but the pain persisted. I also noticed a severely diminished sex drive. I saw a couple of physicians and a physical therapist who diagnosed me with vaginismis and recommended various exercises, but none of them helped. Thankfully my pain was only related to intercourse. I could still wear whatever I wanted, ride my bike, and maintain an active lifestyle.

In late 2010, I started working as a travel nurse in labor and delivery, and we moved from the Midwest to California. It was one of the nurses from my home hospital in St. Louis who saw Dr. Andrew Goldstein on TV and told me I should look him up. Upon searching I found the book “When Sex Hurts.” I read the book and realized that the second author, Dr. Irwin Goldstein, at San Diego Sexual Medicine was just a few hours from my current travel assignment. I set up a courtesy call, and he recommended I find a new physical therapist in the area through the APTA website She prescribed various exercises and dilation which did help to strengthen my pelvic floor and relieve the pain, but it was still there. I also tried using 1% topical Lidocane as recommended in the book, but it only made the pain worse.

I first saw Dr. Goldstein on November 1, 2011. He reviewed my lab results, checked my pudenal nerve, and completed a Q-tip test. My testosterone was really low so he placed a pellet implant and had me apply Estrace cream to my vagina twice a day. Slowly, my sexual drive increased, and my husband and I were able to have pain free sex for the first time in quite a while. After a few more times we started to feel hopeful, but unfortunately, once the pellet dissolved the pain returned. Dr G. recommended using Testim too as a source for testosterone because I couldn’t make it to San Diego for another pellet placement, but the Testim did nothing but cause my body hair to grow and acne to flair up. I went back to see Dr. Goldstein in April of 2012 and had two pellets placed. Again we managed to have a few weeks of enjoyable, pain free sex, but once again it dissolved quickly and the pain resumed. In September, 2012, two more pellets were placed and I was given Axiron to use as well. This proved to be too much testosterone at once, causing hypersensitivity without really reducing the pain at all. Since this was no longer a hormonal issue, my diagnosis was changed to provoked vestibulodynia.

In December of 2012, my husband and I made another trip to San Diego for the VAT test which would numb my vestibule area – the cause of my pain – so we could attempt intercourse. Unfortunately, I didn’t stay numb for long from the VAT, but it did indicate that a Vestibulectomy – surgery to remove my vestibule – was the next step since we had exhausted all other options. We tried to delay the surgery to save money because it would not be covered by my insurance. We were also trying to figure out the timing for the recovery to coincide with work and time between assignments. However, after much thought, prayer and advice from our parents we decided it was best not to wait. My surgery was scheduled for May 8, 2013, and we headed back to San Diego a few days early to prepare.