Thursday, February 02, 2006

Testing, Testing: The HSG

I have some good news and bad news about my hysterosalpingogram (HSG) test.

The good: my fallopian tubes and what they could see of my uterus look clear and unblocked.

The bad: it hurt like a motherfucker to find this out.

If you are scheduled to have an HSG and are reading this, know that it was the speculum used, and not the test itself, that caused me so much pain.

My HSG was yesterday, rescheduled from Monday when the radiologist told me I had too much dye from an earlier CT scan still in my body. Once again, I downed 800 mg of Advil an hour before the test, left the office to get to the hospital in time, and signed in at the front desk. The receptionist nodded at me.

"You were here the other day?" he asked.

"Yep, they had to reschedule the test."

He gave me two johnnies to change into, but when I got into the changing room, I realized he'd given me one gown and one pair of pants. Considering that this test has you lying in stirrups like a typical gyno exam, I knew the pants would only get in the way. But these hospital johnnies require an advanced degree to figure out how to wear one without having it fall open in the front, or have your ass hanging out if you're wearing it backwards. Typically, they give you two to wear: one forwards and one backwards, and it's like wearing a loose nightgown: shapeless but comfy.

With only one johnnie, I tied some oddly-placed ties as best I could, then held my winter coat in front of me to try to avoid inadvertently flashing anyone in the waiting area.

A nurse I'll call Seattle came to get me and brought me to the same testing room I'd been in two days before. We went over an explanation of the test, what brought me here, and a few other details. I pointed out that I'd been here two days before, that I had an insulin pump that I needed to clip out of the way, and asked if I could take more Advil.

"800 milligrams should be plenty," she said. "Some people don't experience any discomfort during the procedure, but others do."

(I am no medical professional, but this is my recollection of the test. For legal and any other purposes, my description only constitutes my experience and shouldn't be considered a doc's opinion or advice).

During the test, the patient lies on her back with her legs up not in stirrups, but in braces that hold your legs up, but let you bend at the knee so your feet hang down. A speculum is inserted so the doctor can see a clear path to the cervix. Once sighted, a small tube is inserted through the cervix and a small balloon is inflated, opening the area up. The doctor then injects a small amount of dye through the cervix to see if there are any obstructions in the fallopian tubes or at the first part of the uterus. They say the patient may experience cramping during the test or afterwards, and that infection or bleeding is a side effect. I signed a consent form for this procedure.

Besides nurse Seattle, I had a woman I'll call Barbados sitting in on my procedure. It was her first day training to be a medical assistant. I also had Dr. Radiology Fellow, a small woman with a cold-fish handshake, and Dr. Radiology Resident, a guy with glasses. Fellow and Resident were the same from Monday's aborted procedure.

"You're back again? I thought it was too late in your cycle," said Resident.

"My IVF doctor said day 11 of my cycle was fine," I replied.

Resident again had the same limp handshake. And again, she did an initial X-ray to see if there was still dye in my body. There was. It looked the same as the x-ray from two days prior. In fact, said Resident, it looked more concentrated than Monday's test because I had had a lot more water in my body that day.

Not again.

The radiologists consulted with the Attending, more senior radiologist outside of the test room, and decided to call Dr. IVF himself to ask whether it was worth it to continue the test, considering it was day 11 of the cycle, this was my second attempt, and I was lying there on the table ready to go.

During that time, I chatted with Seattle and Barbados.

Finally, Fellow and Resident came in and said Dr. IVF gave the go-ahead for the test, saying to just forge on and hopefully, the dye wouldn't get in the way.

Seattle positioned me on the table, and Fellow instructed me to keep my pelvis down, my legs opened wider, and my knees down while she inserted a speculum. Gyno tests have never been comfortable for me, so I clutched Seattle's hand with the first attempt and said, "Just talk to me about anything so I can take my mind off of this. Anything."

I learned that Seattle came from Seattle, now lived in my hometown, and had looked at 12 apartments in one day before settling into the one she lives in today. Her husband is a social worker that works in a drug rehab facility. We talked about the recent brouhaha over James Frey's A Million Little Pieces book and how Oprah had blasted him. (As an aside, I find that entire situation fascinating; I just read the book for the first time in December, and as a journalist, accuracy and fact checking are paramount to my career.)

Talking to Seattle and later, Barbados, helped me deal with the uncomfortable procedure, but Fellow kept muttering to my spread legs that she couldn't get the speculum in the right place to get a clear view of my cervix. "Please keep your pelvis down." "Please open your legs wider." Over and over again.

The speculum just hurt too much at times, and I asked if Barbados could stand at the foot of the table and hold my leg open wider, but Fellow said no. Finally, FINALLY, Fellow got the tubing inside me and started to inflate the balloon. This part I did not feel at all and there was a screen right near my head that showed what my insides looked like with the tubing and balloon within. It looked like a mass of gray and white to me, and not something I could identify clearly, but the radiologists knew what they were looking for.

But then Fellow said there was a problem.

"The balloon isn't inflating fully. We're going to have to do this again."

Can you believe it? I still can't. 

The second time I clutched Barbados' hand and asked why she would choose this kind of job as a second career. (It pays better than her administrative job at a nearby hospital.) Barbados came to the U.S. in the 1970s and has a 17-year-old son who's a basketball star. He doesn't have a girlfriend yet. I was just starting to ask Barbados about whether she was seeing anyone (she's separated from her son's father), when Fellow really started causing pain downstairs with her damned speculum. Like FUCK. For the first time, I addressed the male Resident, who wandered into my field of vision.

"Dude, why would you possibly want to learn these kinds of procedures as a guy," I spat through gritted teeth and anguish. He calmly replied that this was just one radiology procedure he was part of, and that there are all kinds of tests besides this one.

I moaned some more. YOUCH! I am hating speculums and the limp-handshaking Fellow right now. Where's her limp touch now?

Seattle told me to breathe in and out and try to relax, but it wasn't working. I was now crying and asked if we could just try this again next month. A new woman rushed into the room.

"Who are you?" I cried.

I don't remember her name, but she repeated that I really needed to try to relax, and that Fellow couldn't get a clear view. "Could you give me some kind of drug to relax?" I asked. The new woman, who turned out to be the Attending, or most senior radiologist, said there was nothing she could give me to relax the vaginal area. "What about a Xanax," I begged. "Will that calm me down?"

The new woman said no, she couldn't prescribe anything for me. But then she told the Fellow to try a smaller, more narrow speculum. "This one doesn't always allow us to get in to see the entire area," she told me, "but we'll try it."

Apparently the narrow speculum worked fine, though, because Attending got it inside, then threaded the tube and a new balloon into me without a problem.

"Your tubes and uterus look fine," the blessed Attending said. "There's nothing there."


I was so relieved that I didn't think to ask if they could see everything with the smaller speculum. I didn't think to ask if the dye in my body obstructed any view. And it was only later, walking out of the hospital, feeling physically fine, that I wondered if perhaps the attending was just telling me everything she could see looked fine, just because my case had been difficult.

At that point, and today, half a day later, I don't care.

I called Mr. Lyrehca and told him the test fucking hurt, but that my tubes were clear. And to celebrate, I had a prosciutto-and-mozzerella grilled sandwich for a late lunch and later, for dinner, four slices of a pepperoni-and-sausage pizza. I haven't eaten that kind of pizza in years. My blood sugars were super low at bedtime, but super high when I woke up 12 hours after the pizza, but I still don't care.

At that point, I was more concerned about comfort than blood sugar control. I know I can live with a day of wacky blood sugars after that ordeal, but damn, if that's any indication of what it's like to give birth vaginally, just give me the epidural right now.


J said...

You experience sounded painful, but your writing is refreshing I was right there holding your hand and thinking hurry the fuck up and help this woman. Cold Fish hands sounds like she did not know what she is doing.. being in and out of the hospital myself I would not be surprised if she was just as new.. Good luck I am adding you to my links to make sure I keep up I love your writing style

Lyrehca said...

Thanks, J!

Anonymous said...

I just read your review of the evil HSG...I had one yesterday and was expecting a rather benign experience after 3 of my friends reported "a lil cramping but no big deal"...since I turned "pro" at the age of 16 in dealing with cramps..I didn't think twice about fact while the xray tech explained the test as we waited for my ob/gyn to show I wasn't even anxious...then the large, cold, silver speculum came out...and it was awful..the pressure...the feeling of the dye...the odd unrecognizable cramps..and the sweats and black spots as I almost passed out but managed to hold on. I was miserable and vaguely recall telling my doctor that she had to stop because it just didn't feel right...I guess the balloon deflated so she had to try again...I was told to take deep breaths and to stay still...which is weird because all I wanted was to sit up and get all that was in inside of me out! Next thing I knew they were feeding me apple juice and commenting that my lips were red again...after turning white. I am glad I read your "review" since many others told the same tale as my friends "lil big deal". I survived and my tubes looked fine...I saw the screen after my beverage break...I never even knew it was there for my viewing pleasure. take care! kpg

Anonymous said...

hello, I am posting after seeing your thread on Stirrup Queens.

I had an HSG in 2004 and it was horrible! I wrote about it on a TTC website that I visit often.

PS: Since then I had my son vaginally and the HSG is worse than childbirth!

Anonymous said...

I am so sorry you all had such a bad experience. I routinely do these and Here is what I do.
I explain the procedure,
Take a preliminary image so we have a comparison, Have you slide down to the edge of the imaging table ( not in stirrups), I use a plastic speculum and open it just wide enough to see the cerix. Next I use a flexible baloon catheter and insert it between the Inside of the Uterine cavum itself and the cervical openning (less nere endings), and then inflate the baloon to make a seal ( checking with you if you cn handle the discomfort). I have even done some people without the bloon being even 20% inflated. As long as the dye doesn't leak out it's fine.
Next we slide you up toward the head of the imaging table and take pictures. Nexat we take the speculuma dn catheter out. Most of my patients don't feel much at all.
So the moral of teh story is not all HSGs are created equal and they do not have to hurt. Also, insistona plastic speculum if you can.

Anonymous said...

I had an HSG Aug 19th 2011, I didn't really know what to expect but I can say this was the worst pain I have ever felt in my life.. The good thing is that it was over before u can really get a chance to think about it too much.. I started to cry the the assistant was extremly kind, held my hand and continued to say that everything would be ok.. My results showed my left tube is no good but I still have great hope that I will be able to one day by a mom... Wish me luck, New York..

Anonymous said...

Such a refreshing article. I have low tolerance to pain and will soon be scheduled for HSG. But you gave a comic spin to this entire thing and that makes me feel better. There are people like me and you, who are not given anything to relax their muscles and the peeps in blue and white uniforms just dont get it. LOL. Thanks for sharing this experience.

Anonymous said...

I'm not even sure if this blog remains active but I found your post as I was researching HSG tests. I had my own test only 4 weeks ago and my experience was identical to yours (minus the kind nurse holding my hand). I had no idea there was a monitor where I could see what was happening. Nor was I able to see as I removed my glasses as I spread my legs and pretended to be anywhere else. I was fine until after the pinching sensation when the catheter was inserted. Then I suffered 5 mins of intermittent agony. I had the sweats, I cried out (without actual crying), I felt pain I had never experienced in my life.

The technician/doctor/whoever the fuck that was showed me the dye was pooled in my uterus and did not flow through my tubes. I was too shell-shocked from the pain to understand nor care what that meant. I just wanted to get the fuck out of dodge! Following the procedure, I changed quickly and found a washroom further away so that I could sit on the toilet and pray for death until I was able to stand for more than 3 seconds without feeling as though I was going to vomit.

I return to the fertility clinic in 10 days for my followup appointment to find out the results of all my intial testing. If the HSG test is worse than labour, maybe I can endure a natural delivery if I was able to get pregnant.

Thanks for sharing your experience. Whenever I read examples of those for whom the HSG was no big deal, I want to scream!

Jon said...
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Unknown said...
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