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My vestibulectomy adventure

GADgirl

Hello! At the encouragement of Dr. Goldstein (known as Dr. G to everyone), I’ll be writing about my adventures of going through a vestibulectomy surgery. I don’t have a long background story to share because my search for a “cure” has been relatively short in comparison to many women. I was 28 when I got married about 3 1/2 years ago and both my husband and I were virgins. Sex was painful during our honeymoon week, but we thought it would get better with time. By Month 6 of marriage we were ready to start counseling because sex had become such an issue. I felt it was a physical issue with me, and my husband thought it was mental. Have you ever been told it’s all in your head, or that if you think it’ll hurt, then it will? Well, my husband was gentle with his words, but that was basically what he believed. And so did the doctors. “Everything looks fine, just give it time.” Yeah, that’s not really helpful. I really wanted to ask them if they thought they were being helpful but at the same time, I was scared of whatever the physical issue was and didn’t want to have to deal with it yet. Within the first 3 years of marriage I saw 3 gynecologists, 1 nurse practitioner specializing in OB/GYN, and my primary doctor. None could “see” anything wrong. The last gynecologist I saw performed a q-tip test and was able to pinpoint a specific area that I recognized as being the main source of pain during sex. She gave me a dilator to work with at home (to insert at various lengths until I was comfortable inserting the whole thing) and lidocaine gel to use prior to sex in hopes of numbing the area to decrease or eliminate the pain. I had no problem inserting the dilator and the lidocaine gel didn’t help. I let the doctor know the results and she referred me to Dr. Goldstein.

(Just as a side note, I had a severe reaction to the Nuva Ring about 9 months into marriage. The symptoms were all neurological and stumped 13 doctors until I found my current primary care physician, who is an OD (osteopathic doctor) specializing in Endocrinology. She tested for everything under the sun, trying to find the root cause (and not just mask the symptoms!) and finally told me to go off Nuva Ring to see what would happen. Every single test and procedure I had gone through with each doctor came back perfectly fine. I was literally the healthiest sick person for almost 1 1/2 years! Within a month of going off NR, I felt much better and continued to feel better as time went on. No more chemical birth control for me (chemicals are just bad anyway – why ingest them if you don’t have to)! So, had I not been sidetracked with that for well over a year, I hopefully would have been referred to Dr. G much sooner.)

During our initial phone appointment, Dr. G asked a million questions, listened well, and had a diagnosis by the time the call was finished. He said he would wait to tell us the diagnosis at our first in-person appointment. He emailed me a list of patient email addresses in case I wanted to contact any of them with questions. Most of them contacted me first and in doing so, I was able to figure out what Dr. G’s assumed diagnosis was for me and what the likely “fix” would be – a vestibulectomy. I think I just knew that I was going to have to have the surgery, but that didn’t keep me from freaking out about it. Dr. G will tell you how adamant I was at our first appointment about not having the surgery. That in-person appointment consisted of lots of education (I had no idea what a vestibule was until then!), pictures of others and my own anatomy, and tests that were not so comfortable. There wasn’t time for Dr. G to perform the nerve block, the last test. I was very nervous for the nerve block at my next appointment, and it was honestly worse than I thought it would be. Not to scare anyone who might have to have it done, but I don’t tend to sugar coat things. So if you have to have one, expect pain. After all, you’re getting injections in precisely the area that’s already causing you pain. The test is necessary, but it still sucks.

After we got home, my husband and I did our “homework” of attempting sex, which was painless in the area that had always hurt before. I did have some discomfort deep inside, but after explaining it to Dr. G, he said it was most likely due to pelvic floor spasms. The nerve block was deemed a success and surgery was now an option. I’m not sure if this is common or not, but I had some discomfort in the vestibule area for close to 2 weeks after the nerve block. I also experienced a lot of itchiness, which I’d never experienced before, other than an occasional itch here or there. It was bothersome and around the time I was going to contact Dr. G about it, I started my period and the discomfort & itchiness disappeared. After the nerve block, my husband and I spent some time weighing our options and he graciously deferred the decision to me since whatever option we chose was going to “happen” to me. Although there are many non-surgical options, Dr. G felt the vestibulectomy was my best option. At the age of 32, with the thoughts of having kids swirling in my head (I don’t want to be an old mom!), I decided to have the surgery. Sooner rather than later, please, so I didn’t have to stress about it too long! Which brings me to my user name, GADgirl. I have GAD – Generalized Anxiety Disorder – which means I stress about everything :)

So that’s my story leading up to right now, 8 days post-op! Over the next few posts, I’ll fill you in on my experience of surgery and recovery. Hopefully I can help answer any questions you may have, like the other blogs in the forums have done for me! As Dr. G says, we’re all hear to learn from each other!

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GADgirl

After we had made the decision to move forward with surgery, I wanted to schedule it as soon as possible and we were able to schedule it for only 3 weeks out (10/22). I knew I would stress about it big time, and I also wanted to be feeling good during the holidays, so the sooner the better. To prepare myself mentally for the big event, I tried to get everything in order as best as I could. I have a home-based online business and it was going to be a major thing for me to close it down for a while. I let my customers know what was going on (without too many details though!), tied up loose ends with my manufacturers, then set my store in “vacation” mode. Sounds easy, but it was tough to do. Shutting down your business means no income and with some expensive medical & surgery bills sitting on a credit card, it’s a hard thing to do!

So with my business taken care of, I moved on to prepping the house. I do the bulk of the cleaning around here (admittedly, I’m a clean freak and like things cleaned juuust so) so I spent time washing sheets, doing laundry, cleaning the house and making sure Hubby had everything he would need to fend for himself while I would be recuperating. We went grocery shopping and took a special trip to Bed, Bath & Beyond to get some items that had been suggested for post-op. Since multiple daily baths are a requirement and I’m not a bath girl, I opted for a comfy head, neck & back pillow for the tub (highly recommend!). We also picked up a cushy memory foam neck pillow which will be great for sitting on post-op and for the several road trips we take each year. I honestly haven’t used the pillow too much yet…it’s been more comfortable for my lower back (and surgical site) to sit or lay reclined with my knees bent at an angle. I also found a lap desk designed specifically for laptops – it adjusts to different heights & angles, and has a built in desk light & computer cooling fan. I was thinking ahead for when I start back up to work – the bulk of what I do is on the computer so I thought it might come in handy at some point.

A couple weeks prior to surgery, I emailed with Dr. G and our therapist about getting a short-term anti-anxiety prescription because my anxiety was definitely kicking in! I was breathing shallow and had tightness in my chest as a result. Mentally, I knew everything would be fine with the surgery and I was ready for it, but that didn’t show physiologically. We agreed on a basic Xanax prescription, but I ended up not filling it. I already had an appointment set up with my Naturopathic Doctor a week prior to the surgery and she ended up giving me a homeopathic remedy called Calm-Gen. The appointment I had scheduled with her was originally set up as just a follow up (she’s working with me to eliminate my headaches), but we discussed in detail the surgery as well. I’ll provide information about my ND visits knowing that not everyone believes in NDs and may think what I’m talking about is hooey. It’s okay if you think that, I wasn’t always a believer in Naturopathy either :)

Quick note about my ND – she is a licensed Naturopathic Doctor, not simply a Naturopath. In CA, you’ll find both, but only NDs are licensed and have medical training. 4 years of pre-med plus an additional 4 years of naturopathic medicine school = a licensed ND. A good ND will have excellent knowledge of the body, medical conditions, nutrition and naturopathic as well as conventional medicinal remedies. My ND believes that there is a time and place for both natural and Western medicines, which I think is a good theory.

Prior to the surgery I took a daily probiotic capsule, Holy Basil capsules (for anxiety), and liquid homeopathic supplements (the kind you drop under your tongue – we jokingly call them “witch tinctures”) which were for a variety of reasons, mostly to help with the headaches. I am now a firm believer in probiotics and I noticed a difference in my anxiety levels during the first month of taking Holy Basil. During my initial visit, my ND sent off a blood panel for food sensitivity testing and I tested high in animal dairy, eggs, buckwheat and spelt. The last 2 weren’t really an issue, but the first 2 were hard to eliminate. Although I don’t like eggs and most dairy (hmm, think my body was trying to tell me something?) I realized I was consuming way more of them than I thought. My first couple of trips to the grocery store after learning of the sensitivities were very educational. Eggs & dairy are in WAY more products than you would imagine. I even found some ritz-type peanut butter filled crackers with cheddar cheese in the ingredient list – ew!

Fast forward to a week prior to the surgery, my ND gave me some recommendations for post-op. We went over everything, making sure there were no contraindications with anything that I would be taking during and after surgery (anesthesia, pain medicines, etc.). We stopped the liquid supplements as they would not necessarily be beneficial post-op, but kept the probiotics and Holy Basil in the mix. As mentioned before, she gave me a liquid remedy called Calm-Gen that I was somewhat doubtful would work, but it really did help. I didn’t need to fill the Xanax prescription, which I was happy about because I don’t like to consume chemical medications unless absolutely necessary. For post-op, here were her recommendations:
2 probiotic capsules (1 in the morning, 1 in the evening) until my bowels returned to normal, then back to only 1 capsule a day. Anesthesia and most pain meds cause constipation and the probiotics help move those things through your system quicker.

Arnica twice a day to help with pain and inflammation – comes in the form of tiny pellets that you let melt under your tongue and tastes like candy – yum!

Fish Oil (EPA-DHA 720 – a more concentrated dosage than what you usually find in the stores) – 2 capsules in the morning, 2 in the evening – acts as an anti-inflammatory (FYI – don’t take any Fish Oil prior to a surgery – it’s a blood thinner)

So that was it – nothing too wild or crazy. Plus, she told me to take the Percocet when I needed it, that it was being prescribed for a reason! See?
A good ND knows when conventional medicine can be beneficial – it’s not all crazy witch tinctures! :)

GADgirl

I had my Vestibulectomy surgery on Friday, October 22. The day before, my husband and I went to our pre-op appointment at Alvarado Hospital where we signed a few papers and paid the portion of our bill that wasn’t covered by insurance. Melissa (at Dr. G’s office) had gone through the pre-auth process with my insurance company, so I knew the exact amount I would have to pay up front for specific hospital services (not to be confused with Dr. G’s fees, which are separate). Thankfully these fees were lower than we thought they would be. After that, we met with one of the nurses who would be taking care of us on surgery day. We signed more paperwork and talked about the procedure a bit. We were at the hospital for about an hour.
After the hospital appointment, we had the pre-op appointment with Melissa. We went over a few things, had a quick chat with Dr. G, then paid for the infamous surgeon fee that the insurance companies seem to have such a hard time reimbursing us for! I haven’t received the notes from Dr. G’s office yet, so I have yet to submit my claim to insurance. Almost 2 months later, my insurance company is still processing my claim for my original office visit and testing at Dr. G’s office, so I won’t be holding my breath once I do submit the surgeon fee claim!

My anxiety level was high the night before the surgery and I didn’t sleep much at all. We got up bright and early at 4:15, got dressed (wear comfy, loose clothes that will be easy to dress in after the surgery!) and headed to the hospital. In the first pre-op area, they had me change into a gown, took my vitals, brought my hubby coffee, and started my IV. I have tiny little veins that don’t like to come out and play with needles, so it took the nurse a while to find a place for the IV, but once she did, it was quick and practically painless!

The transport nurse came to take us to the second pre-op area, just outside the operating room. He was hilarious and kept us laughing the whole time. The next pre-op nurse was great – she was very comforting, and went on and on about how great Dr. G was. The anesthesiologist spoke to me about my previous anesthesia experience (which had made me really nauseous) and said he would do his best to prevent me from getting sick afterward. Dr. G visited with us for a few minutes, reassuring me that everything would be fine, and passed along well wishes from one of our fellow bloggers who had recently emailed him (thank you Firefly!).

Pretty soon I was kissing Hubby goodbye and they were wheeling me down the cold hallway to the even colder operating room. They ended up taking me back before the anesthesiologist had a chance to come back with my “cocktail” so I was freaking out a little bit. He stopped us in the hall and pushed the drugs into my IV right there. I was awake for long enough to say hi to Dr. G in the operating room. I think I might have asked if he was wearing a suit under his scrubs because it was so strange to not see him in a suit. If I didn’t ask it, that’s what I was thinking before falling asleep!

The next thing I knew, I was being fed ice chips in the recovery area. Apparently they had a hard time waking me up – I was so tired! I’m pretty little, so maybe the anesthesia affected me a little more? I remember the nurse kept saying “Ok, sweetie, it’s time to wake up now” over and over, but I didn’t wake up until I was back in the original area – I don’t even remember being wheeled back there. They kept me there for a little bit before they brought my husband back in. I did get a little nauseous from the anesthesia, but they brought me some meds when I asked for them and eventually felt okay. I hate feeling nauseous and really hate throwing up, so I was determined not to get sick!

Before we could leave, I was required to pee. It was weird – everything was numb and the normal sensation & pressure you feel when peeing wasn’t there. I wasn’t expecting it to be normal, but with the grogginess from the drugs I couldn’t think of anything other than it felt “weird”. At the end of the surgery, they put mesh briefs on you and pack the area with gauze. When I headed to the bathroom, the nurse gave me a pad to replace the gauze with. I don’t use pads, so this was really uncomfortable for me. After that, I dressed back into my own clothes and was eventually wheeled down to the entrance where my husband had brought the car to. Getting in the car was awkward, but not painful. Thankfully we only live about 10 miles from the hospital, so I didn’t have to endure the car for long.

Because of the nerve block Dr. G gives at the end of the procedure, there wasn’t pain for a while, but moving and walking was still awkward. When we got home, I got settled in bed and stayed there for the rest of the day. As promised, the pain set in within a few hours and it was definitely painful! I experienced a dull, throbbing pain, as well as a sharp, stinging pain at the surgical site. We had started ice packs when we got home from the hospital, and continued those throughout the day. I took Percocet when I reached a level 4 pain (keep in mind, pain is relative – my 4 may be your 2 or 7). The nurses had instructed me to take the Percocet when the pain set in, NOT to wait until I couldn’t bear the pain anymore. If you wait until that point, the Percocet doesn’t work as well, and you end up taking more than you would need to than if you nipped it in the bud. Dr. G had said the Percocet would really only take the edge off the pain because the surgical site is at such a sensitive part of the body. So I was pleasantly surprised when the meds helped bring my pain down to about a 2-3 – very tolerable. I originally thought maybe the pain hadn’t set in all the way, but the meds continued to keep my pain at that level whenever I took it.

For the remainder of the day, I stayed in bed, laying on my back and sleeping a decent amount. Because of the diet restrictions (liquids only until you have a BM) and my sensitivities to dairy and eggs, I only had soup or broth when I was hungry, which was not often at all. Around 9:00pm I took a Percocet along with an Ambien and was asleep for the night within an hour. I woke up around 4:00am with pain and my husband brought me a Percocet and new ice pack. I fell back asleep relatively quickly and was able to sleep for 4 or 5 more hours.

All in all, the surgery day wasn’t as bad as I thought it would be. Yes, I was nervous and there was pain and I wish I didn’t have to go through it, but I have to say it was easier than I thought it would be to handle.

GADgirl

Post-Op Days 1-4

The first 4 days after surgery were all very similar for me. I quickly fell into a routine… Upon waking, I would go to the bathroom. Expect peeing to burn the first few days. Part of this is due to the urine coming into contact with the surgical site and the other part is due to the fact that this area of your body has just gone through the trauma of surgery. I also felt pressure during urination for the first few days. The stinging and pressure dissipated over the first week. After that I would try to get in a half-hour shuffle (you won’t be walking normal for a little while) by doing laps around the interior of my house. The first couple days I would break this up a bit with breakfast, which consisted of Cream of Wheat. Because of my milk & dairy sensitivities, this is just about the only thing I could find to work for breakfast because of the liquid diet. I would take a couple bites, do a few laps, and repeat this cycle until I hit at least half an hour.

After breakfast, I would take my first bath of the day. The first few days I needed my husband to help me get in and out of the tub. He also had to help me dry off – bending over to dry my legs was too painful in the beginning. I’m not a bath person, so taking 3-4 baths a day was a challenge at first, but after a couple days, I grew to tolerate them. During these first days, my bath time mostly consisted of playing solitaire on my phone. I was pretty light-headed the first week after the surgery, so I couldn’t read at first, which was a bummer because I had a big pile of books ready to go.

After the bath, I would roll back into bed with Hubby’s help and enjoy a fresh ice pack. I watched quite a bit of TV throughout the day – mostly HGTV. We’ve been remodeling our house slowly ever since we got married (doing almost all the work ourselves!) and I love any show involving home décor or reno. I recently fell in love with a Canadian HGTV show called Sarah’s House – she’s made me want to be an Interior Designer. In fact, I’ve decided to take a class or two next semester! I love, love, love remodeling & decorating our house and this show just reaffirmed my desire to work in this field. My husband is a real estate broker and we’ve been tossing around the idea of house flipping for a while. We live in an older, transition neighborhood and we’d love to help fix it up. So with Hubby’s broker license and my future design expertise, we’re going to rock the house flipping eventually!

When lunch-time rolled around, it was time to start the above cycle again. Walk, bath, rest/ice. Do that 3-4 times a day and that’s what post-op is all about! I took 3 baths each day for around 45 minutes each. I wasn’t as good about walking as some of the other women. I walked for the length of time I was supposed to, but don’t feel like I walked nearly the length that others did. I averaged 3-4 Percocets per day and took lots of naps as a result – I slept through most afternoons! Each night I took a Percocet and an Ambien and was able to sleep through most of the night. I woke each morning between 4:00 and 5:00 because of the pain. The pain was never too bad, mostly really uncomfortable. My husband was great about getting up whenever I would need him to. He would bring me a Percocet and a new ice pack, and I was usually back to sleep within a half hour. I generally slept until around 9:00 each morning. I was happy to get as much sleep as I did. I thought I would be in so much pain that I wouldn’t be able to sleep, but the Ambien & Percocet combo worked well for me. I found that eating half a banana before taking a Percocet helped reduce the nausea it would cause. The nurses had told me that some people do better taking Percocet on an empty stomach, while others do better taking it with food. It seems most people do better when taking it with food, but it really just depends on the individual.

As suggested by my ND (Naturopathic Doctor), I doubled my probiotic pill dosage to 1 in the morning and 1 in the evening until my system returned to normal. I also took 1 stool softener tablet twice a day for the first few weeks, and eventually tapered to 1 per day. On Day 3 post-op I had a BM, which meant I was able to eat solid food again! I went back to 1 probiotic pill per day, and have been “regular” ever since. No constipation or difficulty going. I also took the other supplements my ND had suggested (see 2nd post), although I haven’t been consistent in taking the Fish Oil pills because they’re huge! I hate taking pills.

Throughout the first several post-op days, Dr. G stays in excellent contact with his patients. He called us multiple times a day to check in on me. I was often asleep when he called, so he spoke to my husband most of the time. He was very encouraging and really helped to make the post-op process a little easier to go through!

GADgirl

Day 5 Post-Op

Day 5 was the day a lot of things changed for the better. In general, I felt much better and although I still had some pain, it was only a 3 throughout most of the day. I spoke with Dr. G that day and asked if I could switch from Percocet to Advil. I had been really light-headed since the day after the surgery and was getting increasingly nauseous after taking a Percocet, with or without food. I wanted to see if discontinuing Percocet would make a difference with those symptoms, plus I didn’t feel like my pain level warranted taking it anymore. Dr. G said that Day 5 seemed a little early to stop taking Percocet and recommended switching to Vicodin before stepping down to Advil, but I was pretty stubborn about it. I just felt like my body was telling me it didn’t want any more heavy painkillers. Dr. G came up with an Advil regimen and it worked well for me from that day on. He also said that the light-headedness could be my body’s way of responding to pain – in other words, pain can make you dizzy. I’ve experienced a lot of headaches with a side of dizziness, so I believed him!

My walking upgraded a little from the shuffle I experienced the first 4 days because it wasn’t quite as painful to walk, but I intentionally walked slow because of the dizziness. I have to say I really don’t enjoy the walking part of recovery, so it was a struggle for me to get in 3 walks a day when I was still in pain, but I did it because I knew it was important to my recovery.

By Day 5, I was able to get myself in and out of the tub, as well as dry myself off when finished with a bath. I don’t like relying on other people to take of me or do things for me, so gaining back my self-sufficiency in this area was a milestone in the recovery for me. It was around this day that I started adding baking soda to the bath water because the eczema spots on my arms were starting to flare up from so many baths. I just have a mild case of it, but still have a couple of problematic spots. When I first saw my dermatologist about it a couple years ago, she recommended I only take showers every other day unless I really needed to bathe more often. She said the average person doesn’t really need to shower every day and that in doing so, you strip your skin of the natural oils it produces which help moisturize and protect your skin. My skin has always been very sensitive and pretty dry, so only bathing every other day has helped keep the eczema under control. By the 5th day of 3 daily baths, I had to add the baking soda to help soften the water, which helped calm my skin, but made me stink like baking soda.

I continued to be diligent with the ice as it provided the most relief for me. I also continued taking the Ambien so I could fall asleep more easily. I would usually fall asleep within 15 minutes of taking one so I had to be sure to brush my teeth and get ready for bed beforehand. I tried doing that once after taking an Ambien and I could barely walk straight, let alone keep my toothbrush in my mouth. It apparently also made me snore, which I don’t normally do. My husband knew I wouldn’t believe him, so he recorded it on his phone and played it back for me the next day. I also supposedly talked a lot of nonsense before falling asleep, which I don’t remember.

This was also the day that I was able to start doing small things around the house. I washed a couple dishes, did a little bit of laundry, fed our pets. It was nice to not be stuck in bed, but I was careful to not overdue it for fear my pain level would rise from a 3. I was careful to listen to my body, knowing it would tell me when it needed rest, so thankfully my pain level never rose, but it did let me know if I moved in a way that wasn’t good for the surgical site.

Day 5 was a good day!

GADgirl

Post-Op Days 6 – 12

During this second week of recovery, the worst thing I had to contend with was the itching. It set in big time on Day 5. Of course, my first inclination was to scratch, but obviously that’s a no-no, so it was difficult to refrain from that. Baths didn’t really do too much to help relieve the itching, but ice helped some. My husband learned pretty quickly that if he saw me making a fist, it was because things were particularly itchy at the moment. :)

My recovery seemed to go well during this time and the pain seemed to plateau at around a 3 this whole week. I did notice that the more activity I did, the higher the pain level would rise. I still only took Advil during this week and learned to just space things I needed to do throughout the day, so that my body could rest between activities. This helped prevent the pain level from rising too much, although by evening time each day, I was pretty tired. I continued baths 3x daily with baking soda, and iced often.

On Day 7, I re-opened my online business with a limited inventory. I only made active the part of my inventory that didn’t require any preparation or lifting. So all I had to do was package up really easy orders. I’m glad I re-opened because it gave me something else to focus on during the day besides surgery and recovery. I have a hard time when I’m required to be still, or rest, so I was actually happy to be working for a change!
By this second week of sleeping on my back, I was starting to feel it. I’m normally a side sleeper, so lying on my back was taking its toll. My lower back and eventually my hips started aching, like I knew they would. I felt very stiff during the day and was uncomfortable in most positions, but I lacked the flexibility to work on stretching exercises. I was given great advice by some of the other girls to sleep with a pillow or two under my legs. It definitely helped with the pain, but I still really just wanted to sleep on my side.

On Day 7 I didn’t take an Ambien before going to bed and I was awake until 2am before finally getting up and taking one. I guess my body wasn’t ready to give it up just yet and I figured sleeping was better for my body at that point, than stopping with the sleep aids.
All in all, Post-Op Week 2 was okay with each day getting better.

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