Category Archives: Medicine

Bartholin the Worst: An Intimate Quest

There are no pictures of fannies ahead. It’s fine and SFW.

It’s been a long time guys. I mean, who wants to see a boring update post every week? I’d rather read a compelling post about vulvo-vaginal surgery. Happy new year!!

Frustrated with the lack of credible information available, and the insane amount of misinformation out there, I’m going to change all of that and talk to you about my Batholin’s abcess. It and I parted some months ago in a rather dramatic way. Ladies and gents, it was a frustrating process. If this doesn’t interest you, no one is forcing you to read it.

For those of you unfamiliar with Bartholin’s glands, let me enlighten you. Bartholin [BAHR-toe-lin] (Full name: Caspar Bartholin the Younger …I know) was a Danish anatomist who first described the “Bartholin’s gland” in the 17th century. Why he would name such an intimate lady part after himself? Probably an oedipal thing.

The following information is lifted from the medical research group Mayo Clinic, as any other Google search result inevitably leads to that side of the internet. The Bartholin’s glands are located on the left and right side of the vaginal opening. These glands secrete fluids throughout the day that help lubricate the vagina, you know, to kill bad bacteria with its slightly lower pH level and help us enjoy all the fun stuff that most mammals like to do.

When the duct or opening of these tiny glands become obstructed, it causes the fluid to back up in the gland. The result is a relatively painless swelling called a Bartholin’s cyst. Omole, Simmons and Hacker in 2003 found that approximately two percent of women have the problem at some point in their life. However, if the fluid within the cyst becomes infected, a Bartholin’s abscess may form. This happened to me.

Trust me, I went through every conceivable scenario to try and pinpoint why this happened to me. But the three doctors I asked and all reputable sources have stated that once STIs and cancers are ruled out, there is no explanation for getting a Bartholin’s cyst. Of course you should always practise safe sex and maintain good hygiene habits like any normal person – these may (or may not) help to prevent further infection of a cyst and the formation of an abscess, but not the initial gland blockage. I just got unlucky apparently. -.-

Sometimes home treatment for the cyst is all you need (regular washes, warm baths for pain relief, antibiotics). In other cases, surgical drainage/marsupialisation of the Bartholin’s cyst is necessary…

This is my story.


Episode One

It all started the week after Professor Boyfriend came back from the Netherlands. Yes, timing hasn’t always been my strong suit. At some point, I noticed a searing pain with a correspondingly large lump and headed straight to the emergency department of my local hospital. After a poke around and yelling politely asking the emergency doctor to refrain from palpating any further, he confirmed that it was a cyst that would require drainage. Unfortunately the gynaecologist was only going to be in at 8:00am the next day, so they sent me on my way home with Endone and an instruction to fast for a surgery.
Professor Boyfriend picked me up the next day and after what felt like an eternity of waiting, hunger and walking through winding corridors, I saw the surgeon. To my horror she asked me, “where is it?” …It had shrunk to half the size of the lump I had presented with the day before. Relieved but annoyed by the whole fuss, I was discharged with a course of antibiotics (Keflex/cephalexin) to help the healing process along. Apart from some surrounding lymph node inflammation which subsided fairly quickly afterwards, I was back to my normal happy self. That is, until three weeks later I noticed that the lump was back.

Episode Two

Although not nearly the same size as before, it was harder and movable. I willed it to get better on its own for a three days and then headed to the GP again who prescribed me the same antibiotic as before. With no improvement after four more days, I was blasted with two more antibiotics concurrently (Cipro/ciprofloxacin and Flagyl/metronidazole) which left me with more side effects than you can imagine. Nauseous and drowsy with a churning stomach, I went to the GP where he told me that my body was now not coping with the antibiotics (“You have thrush now“) and that my lump had reached a “critical mass” so the antibiotic is unable to permeate through the wall of the cyst.
‘Thrush’? ‘Critical mass’? My confidence is SO HIGH rn, doc.

Off I went to the emergency room very early the next morning to get the blasted thing cut out. In the interim, paracetamol, ibuprofen, codeine were given for the pain and then stomach acid inhibitors (Nexium/esomeprazole) to stop the gastric pain from the antibiotics. Most of this was given intravenously because I needed an empty stomach for surgery in the afternoon.

Make sure you get the nurses to take their time with the esomeprazole through the cannula – my gag reflex was so sensitive that I spent following 30 minutes dry heaving my saliva.

 

A different gynaecologist saw me this time, since the regular one was lucky enough to be on holiday and not stare at ladies’ vulvas all day long. She told me that she was going to “incise” and then do a “marsupialisation”. What? Thats all I got from her. I asked for further clarification re: the procedure, aftercare, return to work. She rushed off and said she needed to find an anaesthetist. ANAESTHETIST? I was going under general anaesthetic?! I’ve never been knocked out for surgery in my life!

This is where my frantic Google searching started. The surgery looked damn painful. In the end, I was so annoyed by the lack of information and the unhelpful forums that constantly talked of reoccurrence, I just sort of gave up and accepted my fate.

I moaned and started getting worked up about how shitty the whole situation was, but Professor Boyfriend miraculously managed to bring me back down to earth. This stuff isn’t fun; not only is it painful, we’re also talking about an area that is not an easy thing to speak about. I can make light of it now, but at least in my case, you can feel like a right nong getting your privates prodded and stared at by people all day in white coats. Trust me, despite everything, it helps to have someone close tell you that you’re still pretty cute to look at.

And nothing makes me feel sexier than the idea of having surgery in the lithotomy position.

 

Surgery and the day after

I don’t remember any of the surgery, thank god; I was transferred to a freezing steel table in a room with theatre seats above me like in Grey’s Anatomy (peep show, anyone?). A nurse squeezed my shoulder as I was knocked out following a very aggressive administration of IV benzos by the anaesthetist. This resulted in a pesky vein injury which was still healing 3 months later.

I woke up, mouth dry and disorientated, which is totally normal. I had a sore and hoarse voice for a couple of days after, likely because of being intubated during surgery. This is a problem if you work as a voice clinician …like I do.

Once they knew I wasn’t going to die post-op, they sent me back to the ward to recover fully. I was then told that the doctor ordered that I go home that day.

Like, a  really, really big fat one.

 

I couldn’t even walk to the bathroom because I felt like I had razorblades in the diaper they had given me. WHO SENDS A 20-SOMETHING YEAR OLD PERSON HOME IN A DIAPER?! I also had a gauze packed into my surgical wound which would require removal the next morning. Furious and with the nurses from the ward on my side, the Nurse Unit Manager made sure a bed was free and she let me stay the night.

It was the job of one poor nurse the next morning to remove the gauze wound pack. I should probably note here that my tolerance for pain is moderate. Millimetre by millimetre, the pack came out. The pain was excruciating, like what I imagine the surgery would have felt like if I wasn’t anaesthetised. Sorry ladies, the truth – like wound packing – hurts. I couldn’t imagine doing it myself at home with no medical help. The pain was slightly worse afterwards at rest, but walking was a bit more tolerable.

What about after-care? I wouldn’t know because my surgeon didn’t say anything about it. The nurses suggested that I stage a sit-in until the doctor called me and told me what the hell I’m supposed to do with the wound infection risk that I am sitting on. Two hours of waiting later, the doctor called and said that I can go back to work as soon as I feel comfortable doing so. No sitting in baths, do not touch the wound, a gentle shower in the area (superficially you can use warm water from a shower head on low intensity), do not use products like soap or creams and sex is fine again in 4-5 weeks.

Ladies, just a quick tip I learnt; pads will feel like sandpaper. Between your pad and the wound, non-woven combines (9x20cms) are the way to go to avoid nasty friction.

Recovery

The aftermath was a pain in the butt (not quite my butt, but you get the picture).

For the two weeks following, I did all the right things (and more). I didn’t wash with harsh products. In fact, I knew that just water was quite harsh on my skin generally, so I went and got a sinus wash with an irrigation bottle to gently wash the outside with a solution that wasn’t harsh on my skin. This was a game changer.

However, I still couldn’t lift my anxiety. I had a sharp pain every time I would do a kegel-like movement around the site and I appeared to have a small enlarged lymph node appear. This went on for a month.

GP said it was fine, it will pass. Gyno #1 said it was fine, it will pass. Gyno #2 (the one who did my surgery) had a feel and said my pelvic floor muscles were in overdrive. I had hypertonicity and anxiety following surgical trauma and now I needed to retrain my body to relax and that everything was fine again – no cyst, no scar, no worries.

She suggested a pelvic floor physiotherapist (job of the year lel) but I kindly opted out – surely this was mind over matter? Professor Boyfriend and I were about to embark on a wonderful trip around Eastern Europe and I had to refocus. I couldn’t spend five weeks worrying about muscle spasms. How boring that would be.

So I took time off work. I went swimming a lot. I listened to music. I completed writing my article for publication.

Things finally stopped weighing me down.

Debrief

Why did I feel compelled to write this? Because I got completely conflicting information on presentation, management, surgery and aftercare. I hope this helps people out there who (wrongfully) consult Dr. Google and come across this page.

Remember, everyone will present differently! Seek help, multiple opinions and trust your gut. If something feels a little NQR, investigate. Better safe than sorry.

~ Lil

P. S. More on my trip to Europe to come!

Hit Me With Your Best Shot

Or; ‘An Ode to Lori Borgman
NB: Anti-vaxxers, I guarantee that you will not like the following. Because, you know, I make informed decisions based on empirical evidence.
This is my manifesto.

Today we mourn the passing of a beloved old friend, Common Sense. Sense’s health began to deteriorate quickly after the introduction of denim pantsuits and the publication of Wakefield‘s 1998 article. The following is a three part obituary for our dear friend and his sad, slow, painful demise. Lets begin.

Part I: 19th Century Natural Philosophy
(Or, ‘Reject Science, Give Me Homeopathy’)

I recently went to a personal development conference
(because, yes, sometimes I like to develop personally). After a long day of making amazing progress and getting emotional energy sucked out of me by ridiculously happy people, all I wanted to do was go to the lunch hall to eat hummus on bread (because carbscarbsgimmecarbs). You couldn’t wipe the grin off my face until an aromatic staff member (henceforth known as Patchouli) mentioned ‘measles outbreak’, ‘vaccines’ and ‘autism link’ in the same sentence. Dammit, Patchouli.

bianca-del-rio

You see, like Common Sense, I often bump into people I don’t get along with. Sometimes you have to take Sense’s example and bite your tongue so that you and others can enjoy the meal. But sometimes you just can’t help yourself. I told Patchouli that Wakefield was funded to do his research by lawyers who had represented parents in lawsuits against vaccine-producing pharmaceutical companies without stating any conflict of interest. Patchouli looked like I had killed the last remaining South African white rhino. Her nostril-widening, blood pressure elevating response was was akin to: “HOW DO YOU KNOW? DO YOU EVEN SCIENCE BRO?”.

FullSizeRender-1
Yes, yes I do. Been rockin’ labcoats, mice and John Howard eyebrows since 2006.

Thankfully, no hummus wrap was harmed in my vice grip. Conveniently another staff member appeased her, so… I left it. Sometimes you have to pick your battles; Common Sense would have wanted me to.

Part II: Correlation Does Not Imply Causation
(Or, ‘Check A 16 Year Old’s Statistics Homework’)

Common Sense lost his will to live when parents started thinking that a strong (and deranged) link exists between vaccinations and autism.

I can take anything (ANYTHING!) that has had a steadily growing trend over the last three decades and use that to play a dodgy blame game. In fact, as much as it pains me to reproduce the following table (below left) on my blog, I promise it is to make a point:

Untitled
HEADLINE: ‘Pricey crops cause Autism’ …Oops, I may have started something.
I adapted this image from here and here. Caution: Reading the latter link may lower your IQ. You have been forewarned.

Here’s where I’m grateful that I payed attention to high school maths and research/stats class in first, second and third year university. If I couldn’t recite the following off by heart, I’d be a disgrace to my physicist father and educator mother.
There are three (general) requirements to infer a causal relationship:
1. A statistically significant relationship between variables.
2. The causal variable occurred before the other variable.
3. There are no other factors that could account for the cause.

The problem is, we get so excited when we fulfil the first criteria that we forget or don’t even bother to check for the others. Maybe its convenient, or more believably, a way to get rich quick. Governments and financial institutions notoriously manipulate data by using seasonal adjustment, latent drivers, etc. What is even more horrific is that this trend is insidiously creeping into systems surrounding healthcare worldwide. And at the expense of who? My generation’s future offspring?

I can’t dismiss the rise of autism diagnoses over the years… Naturally we have to wonder if there is a real threat of increased cases or is it a case of semantics? But think about it this way; according to the DSM, kids 25 years ago that would now be diagnosed with autism were just regarded as the slow or weird kids. They were never given the opportunity to be supported, to express themselves or prove to people that they were capable of anything extraordinary.

Graphs and visual rhetoric in general have always been incredibly persuasive tools, which is why thankfully I was taught to always be skeptical (not cynical!) of any kind of data put in front of me. Throughout time I like to think that Common Sense would have liked to see his apples compared to apples; not apples compared to bullshit.

Part III: Anti-Social Responsibility
(Or, ‘Knowledge Is Merely Opinion’)

As if the social stigma around autism wasn’t bad enough, the message surrounding the anti-vax movement unconscionably puts having a suffering (possibly dead) kid as a preference to a live healthy one that may need more care and understanding. Can you believe what message that sends to young people with autism or even those who have grown to thrive and find success in society today?

Oh, but it gets worse. People who refuse to get the polio vaccine and use the argument ‘we just want to see our chemical-less kids run free, like in the old days’ need to be institutionalised… or simply pick up a book on 20th century history. Because, of course, nothing said ‘fun!’ like children with respiratory failure in the 1950’s. How many pleas for reason do we need to hear? For goodness sake, this was a time when echoes of children saying “thank you for the new dress mummy, but I don’t think it’ll fit over my iron lung” may not have been as farfetched as you think.

See this? Epidemics actually used to be a thing. A thing that parents dreaded.

What about the cases of the immunocompromised who get sick that can’t be vaccinated? You don’t just vaccinate for your children’s safety, you do it because it is the socially responsible thing to do. Herd immunity is the only way to reduce the probability that a vulnerable individual will come into contact with an infection. The point isn’t to protect the unfortunate children of uneducated morons; it is to protect those most vulnerable. Its even worse when the morons ARE educated

And a word about the types of people that contribute to this debate. Just because a person has an opinion and a social media account does not mean they have the right to spread unsubstantiated lies. A mommy blog here on WordPress (that I refuse to link to) has the tagline; ‘because knowledge is the key to making informed decisions for your family’.
But really, all I see is ‘I’m giving you my non-expert opinion and ignoring my paediatrician’The author of this blog wants to kill my future children whilst giving me a fabulous sleeping schedule for a restless baby.

I’ll leave you with this little gem which came from the mind of a smart lady of my acquaintance:
If you or someone you may know doesn’t know the difference between mitosis and meiosis, sit the heck down and shut your mouth. – S. S.

To that, I say:

image

And let me pre-empt a bully (or five) by saying that no, I do not know what it is like to have children and to take care of them. But thanks to Common Sense, I use evidence based practice and know not to fill a goldfish bowl with orange juice.

http://fc02.deviantart.net/fs48/f/2009/184/a/3/Goldfish_orange_juice_by_Fenixys01.png
Google ‘goldfish’ and ‘orange juice’. I cannot believe this picture exists.

Ladies and gentleman, sadly Common Sense is survived by his three wicked cousins; I’m a Victim, I’ll See You In Court and TMZ. Not many attended Common Sense’s funeral, because perhaps not many people realised he was gone.

~Lil