The importance of being thorough!

Just a blog about one of the many patients I see (no names), but it was a very rewarding interaction.

26 year old woman comes in –being referred for ‘endometriosis that is not responding to treatment’.

Before me is a young lady–dressed in her funky style, with a few tattooes and piercings—giving a first impression as a “don’t mess with me” woman.  I kind of like this new age confidence.

I am in and out of my exam room, and like to watch people–so I saw her out in the hallway–a little stooped over, and not happy looking-her partner hovering close by–looking worried.  She didn’t know who I was I don’t “look like a doctor”.  I watch the way people sit, and walk–I figured she was in some pain–as her hands were pushing into her lower abdomen quietly kneading.

I ask her to tell me what is going on.  She says that from the time she started her periods, they have been “killer”.   I felt for her-I remember those periods myself–massaging deep into your pelvis wishing God would strike you dead before another cramp came along–puking from the pain.  Doctors back 40+ years ago telling you that it was all in your head!  “No–it’s in my PELVIS!”

She tells me she has been prescribed so many different types of birth control pills that she has lost track, and now is off the pills-hoping to get pregnant–and cannot stand the pain!

BUT–she says she is in pain just about the entire month!   HMMMM—-the uterus?  hurting when it’s not bleeding??  “Yes”, she says—“All the time”.  “I had a laparoscopy that showed endometriosis” (Ah–so she has been ‘confirmed as having endometriosis’–got to get that path report and make sure-because this pain ALL month is not typical!)

How is your bladder with peeing?   “Fine”

Are you often treated for urinary tract infections?  “All the time”   Hmmm–got to get those urine results.

She had to go to the bathroom quite often for just a few drops of pee, felt pressure to pee all the time, and the stream was dribbly.

How  is it when you are having  sex?  hurt?  “Yeah”

We chat some more–she is thinking that she wants a hysterectomy –she wants children but “can’t take this”.

So, no pain along vagina, or the ligaments–good sign—uterus is not tender. Bladder is YEOWWWWW!!!   She rates pain at 9/10!

I tell her there is a condition called PAINFUL BLADDER SYNDROME—and the pain can be severe.  I asked permission to put a catheter in her bladder (she agreed–and it hurt to have that catheter put in, as her bladder was so tender).  I put in our magic ‘bladder numbing cocktail’, and had her lay in bed for 45 minutes.

During that 45 minutes, my wonderful nurses tracked down the path report from the biopsy taken at the time of laparoscopy–and the surgical report.   I called the lab to see if anything had ever grown on culture.  Managed to see three patients for recheck visits, then back to this girl (I call 80 year old women “girls”)

No bacteria had ever grown from urine samples.

The operative note was very good, and the surgeon had noted there was ONE spot that “looked like endometriosis”, and a biopsy of that spot was done–sent to lab.  The surgeon left practice shortly after surgery so results never discussed.

Under the microscope, there was “no evidence of endometriosis”!!!

Make no wonder all the birth control pills were not working!

After 45 minutes, I re-examined, and her pain was GONE!!!!!   GONE!!   She was in tears–she couldn’t believe it!   Her pain was NOT due to endometriosis–it was her bladder–for 10+ years!!

She and her partner listened carefully to plans to treat bladder—diet, meds and learning how to do bladder instillations herself.

She broke down, saying she was ready to give up and was so close to getting a hysterectomy as she couldn’t stand the pain–she felt life was hopeless.

That girl–with all her bravado–was just a girl–hurting and looking for relief!

She asked it she could hug me, and gave me the most wonderful hug, and said she was a bit scared at first, but was so thankful that I took the time to VERIFY what she was telling me.  I called her the next day–and she is still pain -free–and she knows she can call me if she needs another bladder instillation–that is when we teach women this–so they can be independent  and in control!

I hope she gets pregnant–she’ll be a hoot to go through pregnancy with—no hysterectomy needed!!!!  Meanwhile, I’ll be seeing her for follow up soon!

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