1 April 2011 - I had trouble sleeping the night before. I went to work with the intentions of telling my supervisors what had been going on with me. I was constantly using my lunch break for dr's appointments and wasn't myself. I felt like I was letting down our team and being rather flakey. I was relieved to hear them say that they were sincerely worried about my health and understood if I needed time. I explained that too much time to myself would cause me to go crazy. I can't be left alone with my thoughts. I did however take the afternoon off and the next day.
13:10 - Took Zofran.
I had an appointment at 13:45 for vaginal insertion of 800mcg of Misoprostol. It's a prostaglandin so I knew what I was in store for. The previous day when I asked Dr. K's office whether I needed to prepare or what to do about pain medicine or take the day off I was met with, "You can take Motrin and go back to work afterwards." Now I'm very familiar with this drug and we usually tell women to 1. take the day off 2. we will prescribe Vicodin 3. have a support person. The most common side effects that we tell patients about include: vaginal bleeding, cramping, fever, chills, nausea, diarrhea. It's not a very pleasant medication and I even joke with patients that you may have liquids coming out of every orifice. I was absolutely dumbfounded and in shock when I saw how much Misoprostol was being prescribed. So when I went in for the insertion I laid out my demands and made sure to have confirmation before proceeding with the insertion.
14:00 - I left Dr. K's office, sad and nervous, analyzing every little discomfort, wondering if that's what I'm supposed to experience. I didn't receive any explanation or walk-through of what to expect, but lucky me, I already knew. As I was driving home I wasn't really thinking. I was just relieved about not getting into an accident. I felt numb. I arrived before Maund who had been out and about gathering supplies from the list I had left on the fridge:
He even called to ask what I meant by pads. I said maxipads and he thought I meant additional pads for the heating pad. When Maund finally got home he displayed the bounty of items and with eagerness began to describe each item. "48 pads, BAM! I splurged on the heating pad and thermometer...9 seconds! I got the BIG bottle of Ibuprofen." I chuckled and said, "You splurged on everything BUT the pads!" He was looking at quantity and opted for the Wal-Mart Equate brand. "They all looked the same to me. Sorry, " he replied.
14:22 - Took 800mg of Ibuprofen. I then calculated when to take another...in 6 hours. I went to lie down on the couch and this pain, a sharp shooting pain like a lightning bolt, shot through my vagina and then into my vulva. "Fuck! Is this what it's gonna be like," I wondered. I also had Maund take off again to pick up my Vicodin prescription. When he got back to the house with it I looked over the label. I wasn't sure whether to be thankful or offended. Dr. K had prescribed 20 pills! We normally prescribe only 5. Did he think I was an addict? Or did he just not want to get a call in the middle of the night asking for more meds? I was furious, I don't think my demands were outrageous. It kinda felt like a slap in the face. That prescription of Vicodin will last me another 10-20 years.
14:00-15:00 (Hour 1): Mostly mild menstrual type cramping. Not too annoying. Soothed by Ibuprofen and the heating pad. I was wrapped in a blanket on the couch, but that could be due to the A/C on too low. We like it cold. No bleeding
15:00-16:00 (Hour 2): Not too much activity. Some of the same as the first hour. No bleeding. Nothing noticeable.
16:00-17:00 (Hour 3): The cramps are starting to resemble those of a bowel movement. At 16:38 I get up to use the bathroom. Much to my relief it's just a bowel movement, but afterwards I keep feeling the same pressure and can't tell if these are uterine cramps or stomach/bowel cramps. So I stay put a little bit and wait it out. Before the hour was done I had been to the bathroom 3 times. Diarrhea, check. Nausea, super mild thanks to the Zofran, check. Spotting, check.
17:00 - Maund suggested that I take some pain meds just in case. I had taken Vicodin before and gotten nauseous, so I decided to only take 1/2 of the 5-500mg tablet.
17:00-18:00 (Hour 4): The cramps are getting stronger. I was glad to have taken the Vicodin, but it hadn't really kicked in. I turned up the heating pad, but it wasn't helping as much anymore. I start wriggling and writhing and it's really hurting. At this point my cramping on a scale of 1-10 is at a 7 or 8.
From the beginning of the hour, the cramping intensified rapidly. We joked that this is probably a fraction of what contractions feel like and if that was the case then "count me out!" It feels like an invisible hand has got my uterus in it's clutches and it's strangling it. The grip is constant and at this point Maund catches me whimpering. I know he saw the pain in my eyes and face; I saw the worry in his. My husband suggests I take the other half of the Vicodin and I give in. For another good 30 mins I'm clutching the couch in one hand and my husband's hand in the other. I'm cold and still wrapped in the blanket, but now I'm sweating profusely. Maund was thoughtful enough to run and grab a damp paper towel and dab me with it. The coolness brought such relief to my skin, but nowhere near enough for my uterus. Towards the end of the hour is where I notice the cramping has gone away. Or better yet, the discomfort has gone away. I remember looking at the clock at 17:55 because it felt like a veil or a curtain closing on my uterus. I envisioned a velvety burgundy theatre curtain closing and blocking the light from the crowd so all I could see was the stage in the darkness. I felt pressure or motion of my uterus, but it didn't hurt anymore. Kinda like the stage crew moving around props, but no pain. That relief also brought sleep and Maund went outside to play with the dogs.
*sidenote - There are plenty of women who choose to terminate a pregnancy using this similar method. Misoprostol is usually taken 24-48 hours after Mifepristone. We tell women to make sure to have a support person and have their children somewhere else. I understand why now. My dogs are my children. Gizmo was a great alternative to a heating pad and stayed next to me. Bear was worried and stayed by my side. Had these been young human children they would not understand why mommy is in pain. Having my husband there to tend to the dogs and let me rest was a luxury. I can't even begin to think about women who agree to a dr's protocol knowing full well that they don't have the luxury of sending their kids off to daycare or having someone to nurture them. But then again, I'm well aware that women are strong individuals and will go to the ends of the earth to either save or terminate a pregnancy.
18:00-19:00 (Hour 5): I slept for the most part. I did get up once to use the bathroom and the minute I stood up it felt like the flood gates had opened. I waddled to the bathroom, checked my pad, and just waited until the blood that had pooled during my nap drained. There were some clots, nothing large but similar to clots during my period. I lied back down and napped again.
19:00-20:00 (Hour 6): By 19:30 I noticed that my cramping had come back and was counting down the time to when I could take some more Ibuprofen. I went ahead and took another 1/2 tablet of Vicodin. Julie called to check-in and see how I was doing. We chatted a little and once I hung up I made a beeline for the bathroom yet again. More flood gates, but this felt different. I clenched my muscles a bit and I lowered my underwear making sure to have my bottom over the toilet seat. Mostly my bottom is touching the seat and I am able to relax, but this time, in mid air I have blood streaming into the bowl. I've never had that before. I was relieved to not have missed. I did a perimeter check and luckily there was no mess on the floor. I start to pee and out of nowhere I feel something drop. It was a clot and it felt big. I can't really see it in the bowl so I shrug it off and go lie down.
20:00 - Took 800mg of Ibuprofen.
20:00-21:00 (Hour 7): Not much activity. Some bleeding, but nothing like before.
21:00 - Took 1/2 of the 5-500mg of Vicodin.
The rest of the night was mellow. I expected to have a lot of bleeding through out the night, but that's not the case. I barely had any bleeding...same thing for when I woke up the next day.
Saturday - No cramping, light flow.
Same for Sunday.
4 April 2011 - Today I woke up with a little gush. I had some cramping so I took some Ibuprofen. After my morning walk, shower, and breakfast I went to pee and felt 2 large clots fall out of my vagina. It was unnerving, but I quickly snapped out of it. I was more relieved that they hadn't fallen out in the shower when I was cleaning myself.
I imagine the next 2-4 weeks will be like this. I'm ready for it...I guess.
