Saturday, August 15, 2015

The Tale of my Ectopic Pregnancy

This is a guest post from a patient. I am very impressed by how well organised she is. It's because she did so much homework and research, that she could manage her own ectopic pregnancy ( with some help from her doctors !) She remained in control of her illness, and her life. This is my model of an expert patient, and doctors need to learn to respect their patients, and to partner with them, if they want to make the most of them.

I took my first HCG test 12 days after embryo transfer by Dr. Malpani.  I was traveling for work and was at Jamshedpur for the first HCG test.  The diagnostic facility in Jamshedpur is small and because of an unexpected curfew, I do not get my results until 5 days later.  I was so excited to get my first positive pregnancy test at the age of 44.  I took another HCG test a week later in Delhi and the value had risen well.  A week later when I travelled to Hyderabad, I had severe stomach ache and vomiting and started bleeding a little bit which prompted me to get an ultrasound scan immediately.  The HCG had again risen well but the uterus did not show any pregnancy sac inside the uterus.  Dr. N who did the ultrasound told me that the embryos were taking a long time to implant and I needed to take a week’s rest and then return for another scan.  However when Dr. Malpani heard about the result of the scan he suspected an ectopic pregnancy and urged me to take another ultrasound immediately. 

The next day I went to a reputed diagnostic facility in Hyderabad and the scan showed an empty uterus and an unknown mass near the right ovary.  Dr. Malpani immediately referred me to his colleague in Hyderabad Dr. D who is very well known and an experienced fertility doctor.  Dr. D was kind enough to see me right away and after taking another scan was clearly able to see, confirm and measure the ectopic pregnancy.  She called Dr. Malpani and they discussed next steps.  She was very worried and wanted me to do a laparoscopy immediately to remove the ectopic pregnancy.  As the yolk sac and fetal node were very clearly seen she did not feel that any other options were available to me.  Since the measurement of the ectopic pregnancy was not bursting size yet and would not be for a few more days, Dr. Malpani wanted to take the more conservative route which involved giving me a methotrexate injection instead, to kill the pregnancy. It was a Saturday and Dr. D was going to be away for the weekend so she referred me to Dr. P who is part of a big multi-specialty hospital in Hyderabad.  Dr. P and her assistant Dr. G looked at my ectopic diagnosis and insisted I get admitted into the hospital from Saturday evening until Monday morning. 

Looking at the worried and serious faces of Dr. D, Dr. P and Dr. G, I started getting a bit panicky.  They looked at me like I was fragile and likely to collapse any second.  Dr. P would not examine me as she said the ectopic might burst if she touched my stomach and also suggested I get a laparoscopy immediately.  The severe stomach pain and vomiting returned that day.  Dr. Malpani was calm and on the phone explained to me that the severe pain and vomiting was most probably food poisoning and that the ectopic was not large enough to burst and I should get the methotrexate injection.  When I told Dr. G about the severe pain she said I should get a laparoscopy immediately, but when I checked with her about the size of the ectopic she confirmed that it was not large enough to burst.   I asked for the methotrexate injection and not the laparoscopy and was given the injection. I stayed overnight in the hospital and realized that I was fine the next morning and got myself discharged on Sunday.

The next few days I talked to Dr. Malpani on the phone or e-mailed him regularly and while the tenderness and soreness in my stomach had gone up I wasn’t having any other pain.  Three days after the first methotrexate injection, the HCG levels had gone up again but hadn’t doubled this time which gave me some hope.  Dr. Malpani prescribed a second dose of methotrexate injection.  I went to Dr. N (the first doctor I visited for a scan) since her clinic is very close by for the injection.  However when she saw the results of the HCG test she panicked and insisted that I get a laparoscopy immediately.  She made me sign a waiver that I was refusing a laparoscopy and only then gave me another injection.  My mother also started counselling me to go ahead with the laparoscopy.  At this point I wasn’t very sure what was going on with the ectopic mass in the tube, but after a few days of seeing worried expressions on doctors and family’s faces, I packed my overnight bag and asked Dr. Malpani about what symptoms to expect if the tube burst in my stomach.  I monitored my symptoms carefully and reported them to Dr. Malpani daily who also monitored my condition long-distance.

A week after the scan with Dr. D, I went back to her for another scan.  The tenderness and soreness in my stomach had steadily gone up for a week and since the HCG values had also gone up, Dr. Malpani prepared me for the possibility of a laparoscopy.  However the scan showed that the ectopic was resolving and all of us breathed a sigh of relief.  I baked a cake to celebrate.  The next two HCG tests have shown that the value is coming down and the ectopic is since resolving.

I learned a few lessons from this experience.  Different doctors, each with many years of experience, will prescribe different remedies for the same problem.  For my personality, I prefer having options and data.  Also I am able to accept a certain amount of uncertainty, can monitor myself and focus on the data even under stressful circumstances.  With four experienced doctors telling me I needed a laparoscopy immediately it took all my will power and patience to focus on the data and stay calm when I sometimes felt like there was a bomb ticking in my stomach.  I also ask a lot of questions and want information which some of the doctors were reluctant to give.  Having a doctor like Dr. Malpani who was willing to take a conservative approach unless a laparoscopy was unavoidable worked in my favor.  Also Dr. Malpani invested a lot of time in remotely monitoring my condition daily, answered my questions, focused on the data and kept a cool head throughout. The other doctors I consulted with in these past two weeks would have much preferred getting a laparoscopy done immediately and knowing for sure that the problem was taken care of rather than waiting for a week for it to get resolved.  I am however very happy that I didn’t have to get an invasive laparoscopy done.  I am also very impressed with Dr. Malpani’ s ability to remotely diagnose a problem, prescribe an appropriate solution and monitor my condition until it was resolved.  The moral of the story is to choose a doctor who matches your personality, keep your eye on the data, seek opinions from other doctors and choose medical options that make sense to the symptoms you are feeling.

My HCG plot is below with the points where doctors insisted I get a laparoscopy marked in red

If you want to learn more about how to make the diagnosis  of an ectopic pregnancy early, please check out !

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