Summary
I had my doctor's appointment this morning, and got a lot of information. We had a lot to follow up on and didn't get through everything, but we did get most of it. We had a recent ultrasound searching for 4 issues, as well blood work at life labs for possible fatigue causes and blood count levels, and 2 hospital visits (the surgery and the fall).
About the cyst or fistula we were searching for in the buttocks region with the ultrasound — there was nothing at all found, although that's an expected possibility. Thanks to the MRI (which is what they really wanted for this) we will know by October 2nd about it.
About the fibroids searched for in the ultrasound — the size was found and it was confirmed that they have been growing in size since Aug. 2nd, but the precise angle and positioning was not found. So, it cannot be yet be totally confirmed that the fibroids have been the cause of my dramatically increased menstruation and bladder irritation problems (although that logically appears to be the case). But thankfully, the pelvic MRI can help with that too, and although it was only for the fistula / anal search, it could possibly give enough info for my gynaecologist who I'm being referred to, so that I won't need another MRI to delay that process.
Also, mysteriously, no findings came out about the hernia or cyst in my lower right abdomen, and the doctor's best guess is that that means it was indirectly caused by the appendicitis having not been acute (sudden and immediate) after all and having been developing for many months. However, that's very strange considering the location — so we'll continue to search in the MRI just incase for some obscure reason it was missed in the ultrasound despite the doctor's understandings that ultrasound should be enough.
Also, the ultrasound thankfully found no internal bleeding in any of my organs so that hasn't been the cause of my fatigue. As for the bladder infection, it turns out I may have confused that with bladder or cervical irritation from the fibroids after my UTI had cleared (and there seems to be no infection but just increasing pain). And finally, I got some great advice about my shoulder and ribs.
Fibroids
The ultrasound was able to fully confirm 2 large fibroids which are oversized enough to warrant removal, both of which had increased in size since the previous CT scan in the first week of August. Unfortunately my doctor was not able to know exactly their positioning and angle, and so wasn't really able to confirm my theory about the connection between their positioning and my increased bladder irritation and increased menstrual bleeding issues. Instead, now that the ultrasound confirmed their size was large enough to be addressed, sae initiated the referral to a ghynecologist which will take 2-4 weeks before I hear back from them.
Also, one piece of awesome news is that according to my doctor, the pelvic MRI that I just got last night for the possibly fistula in the buttocks region will likely be able to also provide answers about the fibroids more precise positioning and angle to clarify for my ghynecologist who I'll be referred to, which could prevent the need to wait for another MRI. There's no guarantee that this MRI will tell my ghynecologist everything sae needs to know about how to treat the fibroids in the end (so another MRI may be ordered) — because there were only higher res photos taken of the buttocks area. But the regular resolution photos of the whole pelvic area could be enough to at least confirm my theory that it's the source of the bladder and bleeding issue.
One very interesting thing that came through in our talk was that actually, there is a chance that I may not have to have the fibroids removed surgically, depending on a number of factors. At the hospital, they had informed me that surgery will be required — but my doctor clarified that there are various possibilities aside from an operation. I researched these potential treatments after the appointment and this led me to learn more about the surgical options. I found that the surgery referred to at the hospital was most likely a myomectomy or hysterectomy. In a myomectomy, the fibroids alone are removed from the uterus and the uterine wall is repaired. This can lower future chances of pregnancy. In a hysterectomy, the entire cervix is removed, making menstrual bleeding and pregnancy impossible permanently (although normal hormones from the ovaries remain, causing monthly PMS).
Essentially, less invasive procedures are possible, although they do not prevent future fibroids — and these procedures are still very painful afterwards and take a long time to recover from. Also, their success at completely shrinking the fibroids by blocking blood supply or killing the fibroid cells varies according to the intensity (and invasiveness) of the treatment and varies person to person. There are good chances of recovery from the fibroids shrinking due to UAE, RFA or HIFU (shown in the coming table), but that leaves the concern that more fibroids will continue to constantly develop afterwards, forcing the whole process to repeat and continual serious treatment being needed. That's why the people at the hospital thought it would be a surgery, because quite often it's recommended as a one-time solution to prevent ant more future treatment. It's just that now that I'm pre-menopausal, it's reasonable to assume that more fibroids will keep coming.
Since I already have a permanent tubil ligation surgery done (19 years ago at the age of 24) to block the fallopian tubes in order to make pregnancy impossible, I'll very likely prefer the hysterectomy. The benefit of no longer menstruating at all is amazing and even the least invasive surgery has almost as much severe pain and recovery time afterwards with less chances of success and no future prevention. I'll definitely need to talk to the ghynecologist more to understand my options better, but from this point it's looking like the best choice.
The Hernia or Cyst
Now, I thought it was very strange when the doctor said that they did NOT find a hernia or a cyst in that particular zone of my right, lower abdomen, which had been recurrently swelling to a lump for many months, long before the appendix removal surgery time, and causing recurrent pain whenever I stuff myself with more bready foods. Keep in mind, the appendix is on the lower left and my lump had been on the lower right. My doctor said that it's quite possible that the appendicitis I had was not actually acute, but gradual. Sae said it's possible that this pain could have been just a randomly located symptom of the appendicitis perhaps, which had been slowly having ongoing problems for many months leading up to the perforation which required surgery.
The thing that confused me is that the day of the fall on Sept 9th (before the fall happened), around a week and a half after the appendix surgery, I noticed a very severe, acute pain in that spot on the right specifically and I had to take Tylenol to calm it down, but it wasn't even getting fully better. That was a very different feeling than the pain I had been used to throughout the recovery from the appendix removal surgery. After the appendix was removed, I had many different pains everywhere, all around the pelvic and stomach area, but every day it was getting noticeably better. I was tracking and noticing the fact that all these little pains kept getting overall better and better. This specific pain right in that one spot that used to get a lump was by far more severe than I was now used to in pains around that area, and in contrast was more specific to that exact spot rather than feeling like the pain would jet around to here and there.
So I told my doctor I thought that was really weird, and sae said that sae will check it out on the MRI to double check that. That all said, it seems to my doctor a bit absurd to imagine really needing an MRI to go further on this test. Sae really felt the ultrasound should be enough. So who knows, perhaps my doctor is right :) !!
Ongoing Severe Fatigue & Low Blood Count Concerns
Unfortunately, this appointment was very cramped with a lot of information. I was not able to ask, unfortunately, about my blood results in the search for the cause of my ongoing fatigue over the past 6 months or so and my concerns about any dangerous low blood levels. However, it's comforting to know that internal bleeding in the organs has been found by the ultrasound to not be the cause and I will have another appointment soon to follow up on that question of what we should do next to search for answers about it. Also, I think if my blood results had come back alarmingly low in hemaglobin, the doctor would have flagged that to definitely get back to me.
Possible Bladder Infection
I had wanted to ask my doctor if sae could provide me with the results of the bladder infection culture that was done at the hospital but unfortunately there wasn't time for that either. But the hospital promised to give me a call with results within 3 days — and I have not received a call — so I assume that means no infection was found. So I'm starting to suspect that what I thought was a bladder infection may have only been increasing symptoms and bladder irritation from the fibroids pressing on the bladder. What happened is, I got the burning sensation (which would not be caused by fibroids) associated with a UTI. Then I drank water, hoping it would naturally heal. The burning healed over the course of days, but what came next was a very increased pain in my bladder after that. It was not a burning pain in the bladder but it was an increased pain. I thought the UTI had shifted to a bladder infection. But actually it may well only be that somehow the bladder was irritated more at that time from fibroids, causing confusion.
Rib & Shoulder Injuries From Recent Fall
Thankfully, my doctor was interested in addressing the fall and those injuries and had some great advice for me which I hadn't gotten elsewhere. I was advised to avoid heavy lifting and never put grocery bags over my right shoulder for the next 4 weeks to ensure best possible recovery. I wished I had gotten that warning sooner. I haven't always done that so far and it did worry me a bit sometimes. Also sae asked me to please call for an appointment if the pain in my ribs worsens more, because that was viewed as a concern. So I'll watch for that.
Benign Cyst Found In Kidney and Benign PolypsIn Galbladder
I was informed that a 4mm sized polyp was found in my galbladder, and thankfully this is not seen as a cancer risk, or in need of any ongoing imaging or monitoring to judge if it is growing and potentially could lead to a cancer risk. That's why it's called benign. I didn't manage to write down the size unfortunately of the cyst that was found in my kidney, but it too was so small that it was also viewed the same way. At this size, Canadian radiology guidance sees the potential threat of it becoming cancerous incredibly tiny.
Follow Up Appointments Planned
I have a new appointment for October 2nd with my family doctor to discuss the MRI findings and catch up on any issues we've discussed before that required follow up. At that point, my doctor can pass on the MRI data to the colorectal surgeon who'll be advising me on the possible fistula or cyst in the buttocks region. I've successfully rescheduled my appointment with the colorectal for October 6th. Today, my doctor started a referral to a gynaecologist who can continue the process with me about the fibroids. That will take 2-4 weeks before I receive a call or can call them. Also, it's nearly time for me to give a call to the surgeon who performed my appendicectomy for a follow up.
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