The bad news is that this still isn't easily fixed. I'm in for more "helpful violence" that's going to be painful and require some recovery. Here's the problem, with illustrations.
The most common method for treating what I've got is a conization, or cone biopsy. (That's right, I'm not done with biopsies yet.) This is a procedure in which a cone of tissue is taken out of the center of the cervix. In this illustration, a scalpel is used to cut on the dotted lines.
The problem is that conization won't remove all the tissue I need removed. The lesion I have is large enough that one side of it stretches outside the area that would be removed. Quite far outside, in fact, to around where the blue arrows point. Nor is this the least problematic of the tissue to be removed. It's still classified as CIN 2–3. Those cells need to die before they become cancerous.
The next step is to meet with an oncologist to decide whether this can safely be done in a less-invasive manner, probably with lasers in addition to the conization or whether I'll need to lose enough of the cervix that I'll have to have a hysterectomy. The discussion, of course, will be complicated by my tolerance for this sort of risk--and what my insurance company is willing to pay for. Yes, they have a certain say in this as well.
So that's pretty much it for the information I added today. It's all good news, really, given the restrictions I knew about after the biopsy. Since I dragged my readers into the waiting with me, I'm happy to answer nosy questions in the comments as well.
26 comments:
Well you'll get a chance to take the drugs in any case, right?
Actually, I'll probably be under a general instead of the fun sedatives, if my reading is correct. Almost a pity, as I know a number of people who would probably love the chance to see me babble that much.
This seems like better news, so that's good. Not fun, but at least it's good news under the circumstances. Let us know what Sara & I can do for you guys. We're here for you.
-jh
OK, good, get the general! Probably safer all around (but thanks for the Buster Keaton moment you gave me there). :)
I wish you lasers - and diminished pain - and am relieved by the news in some measure proportional to that which you are. Thanks for sharing before I had to bother you with asking. xoxoxoxoxo
As far as the drugs go, you can ask for pre-op sedatives, right?
cryo?
Could be cryo, but if I don't get the sedatives, I want to at least keep the YAG laser the doc mentioned.
Now just a small bit of advice from an old friend that happens to now be a nurse. The acceptable level of pain, should you be asked, is ZERO!
Good news but complicated, indeed. But you don't know how much better I still feel. I am unhappy about the pain that the helpful violence will entail, but at least I feel vastly more certain that you will come out hale and live at the end of all this.
There was something about wanting kids?
I'm just hoping that's still an option.
I am glad to hear it...
Stephanie,
I'll be in your corner cheering for a speedy recovery.
If I ever have a choice between surgical methods, I'd go for lasers all the way. Not because I know *anything* about the medicine behind it, but because they're FRICKIN LASER BEAMS.
In either case, despite it being complicated, and despite all our misgivings over coverage (and yeah, mine are probably out of proportion), this is good news all around. You already know what kind of sigh of relief everyone's breathing on your behalf.
I do not play a doctor on the Internet. However ...
There was something about wanting kids?
I'm just hoping that's still an option.
At the very least it would be ... complicated. At a guess: IVF, surgical (instead of simple syringe) implantation, and Caesarean delivery.
The cervix may not be quite as essential to motherhood as ovaries and a uterus are, but it's way up there.
No worries about kids, folks. If I'd wanted to be pregnant, I'd have done it years ago.
My dear, I hope all goes smoothly, as painlessly as possible, and gets you healthy and hale asap. Let me know if there's anything we can do for you over at the cantina.
Hi. I only know you from various SciBloggers' comment sections, but I just wanted to express my sympathy - I had an anomalous smear a few years ago and had a single punch biopsy, which was not pleasant, but my mom had a conization and it was unfun, although I don't think she got a general. Twilight sedation, maybe? Regardless, it was fine, in the long run, but it sucked that it had to happen at all, for either of us and for you. I am so very glad there's a vaccine so that the next generation, or at least the one after that (sigh), doesn't have to deal with this.
(Also, when you're preoccupied with this and can't concentrate on anything else, but want to try to refocus, you could look up the Cartwright Inquiry - it's New Zealand's answer to Tuskegee, with women with abnormal cervical smears playing the role of men with syphilis. Fascinating, horrifying story.)
gingerest, you're not kidding about the Cartwright Inquiry. Gah. Does every country with detailed human experimental standards have one of these stories?
And no, I'm not obsessing, just giving in to an oversized curiosity. :)
I'm so glad things have turned out this well for you! Not that they are great, but better than they could have turned out.
Now since no one else seems to have jumped on it, I'll ask the nosey questions (mostly just because I'm naturally curious about things I know nothing about). Will all this removal of tissue in any way affect sexual intercourse/pleasure? I think I remember reading once that the 'old' way of doing hysterectomies (what ever that was) left everything messed up down there, but now the 'new' methods are better? Sorry about being vague.. very tired. Either way, I hope everything continues to function the way it's supposed to!
Hey, Jodi. From what I've read, there aren't any lasting effects from the conization, although there is a 4-6 week period of healing involved.
After a hysterectomy, the answer is a little more complicated, mostly by the fact that there are lots of different ways of doing a hysterectomy. For the most part, although some women report things being "different," they aren't worse. This appears to be a book chapter, which isn't the most scholarly reference, but it's a good discussion of the topic and it doesn't contradict anything I've seen on the more scholarly sites.
Just wanted to wish you well. I caught up with this over at PalMD's place today. Glad it's not the really nasty thing, at least. And thanks for writing about this. If it encourages more young women to take the HPV vaccine, you will have done the world a service.
I'm late, but I'm here.
My inbox is available should you need it.
First time on your site...you are incredibly brave, and I do hope you continue to post about this-as much as you feel you can emotionally, that is. No one ever talks about what could happen, and what an abnormal pap smear means. Wishing you all the luck and a quick and safe recovery.
Oh, and I'd ask for morphine. You might still feel some pain, but you won't care!
Stephanie, I am glad to hear that the news are good, even though they are complicated.
Thank you for this and the original post. I need to show they to a friend of mine who has chosen to not receive a HPV vaccine, even though she could.
Yikes!! I hope this goes well for you. May your recovery be quick and smooth.
i really admire you. Im terribly sorry that you of all people have to deal with this. My best wishes go to you and ben, and i know everything is going to be okay. hey, no one ever said life was easy. if anyone can pull through something like this it's you. Our family is filled with tough, independent women who dont give up. like they say the tough times are the judge of your character, i look forward to hearing every single little detail about this. and i can't wait to show up at your house one day with a gallon of ice cream, a bottle of vicotin, and an awesome movie(i know, comedy). :)
love you with all my heart, and i want you too feel much better & smile.
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