Part II...Hydatidiform mole

(Link to part I)

Although the situation is kinda depressing, we had to accept it. The dilatation and curettage at least gave a sort of closure...or so we thought.

After my D&C, I still continued to bleed. I still had nausea and vomiting, and I still detest the smell of garlic and other strong smelling foods. In short, I still feel like I was in my early pregnancy. Well, I just had my D&C, so my HCG (human chorionic gonadotrophin) was probably still high, accounting for the nausea, vomiting and anorexia. Slight vaginal bleeding or spotting is also common after undergoing D&C. My follow up 10 days after seem to be ok. There was nothing untoward noted during the transvaginal ultrasound. There was still blood, but it was not an unusual finding for a post D&C.

My OB and I both expected that the bleeding and symptoms would most likely fade away in time...But 1 month after my D&C, I was still having the same symptoms. Also, my tummy still looks pregnant. On follow up, a repeat TVS showed some cystic spaces. My OB also noted that my uterus looks a little larger than it should be. She ran a pregnancy test. Lo and behold! It was weakly positive! That's at one month post D&C. She requested for a serum B-HCG to be done at St. Luke's Medical Center. Result: 324,000! (Normal is up to 6 only.)

When the B-HCG results came out very high, she had me undergo blood tests and other lab works. She was already thinking of a trophoblastic disease, either hydatidiform mole, invasive mole or choriocarcinoma!

Since the ultrasound in my OB's clinic is low resolution, she asked me to have a higher resolution ultrasound with doppler at PGH. Results of this ultrasound leaned more towards a hydatidiform mole rather than a choriocarcinoma. Whew! However, unless we had a biopsy, we can't be totally sure yet.

With all the results in hand, we went to see a trophoblastic disease specialist. She was referred to us by our original obstetrician. She confirmed that I was suffering from a trophoblastic disease. Since it looked more of hydatidiform mole rather than the more malignant (but still very highly curable choriocarcinoma), battle plan would be to do a suction curettage to remove the mass. Since the level of my serum beta HCG was very high, she also deemed it prudent for me to have prophylactic chemotherapy.

My husband and I went to PGH on the morning of September 9, 2007, hoping to get a private room. None were available except for the ward. We opted to wait. I really wanted privacy and am willing to wait and pay a higher price for it, but more importantly, I had to be isolated since I will be undergoing chemotherapy and my immunity will be compromised with the drugs. We had to go home first. We just called and grabbed the first room that was available. Good thing it was a Sunday and there was not much traffic.

That evening, laminaria was inserted in my cervix to help it dilate and prepare it for the suction curettage. I was then put on complete bed rest with NO bathroom privileges--had to use the bedpan. I was totally dependent on my husband's assistance in everything because I was not supposed to leave the bed. I also had my brother pick up 2 units of type A+ blood from Children's Medical Center. My family all had type O (except for my late father and my toddler son) so they can't donate to me, and for some reason it was so hard to find type A blood! Some hospitals had more type AB than type A! Imagine, I even called up the Philippine National Red Cross and they also ran out of type A!

It took more than 24 hours for my cervix to dilate to the point that it was deemed necessary for the suction tip to be inserted. Just lying in bed for that period of time was definitely boring. Good thing there was cable TV. :) Oh, and since I had to be prepared to go into surgery anytime, I was only allowed light meals after an examination would show that cervix was not yet okay, then nothing by mouth after the light meal. While waiting, I was already started on the first dose of chemotherapy (which was supposed to be for 5 days) injected intramuscularly. I was also hooked to the IV since I won't be eating much while waiting.

Finally! On the morning of September 11, 2007, I was ready to undergo the procedure. Since PGH is a high volume hospital, though, I had to wait a while because the delivery rooms were all occupied. September is really a peak month for new babies. :) Well, they started blood transfusion already while I was waiting since we're expecting blood loss from the procedure.

Once there was a vacancy, I was brought to one of the delivery rooms. Spinal anesthesia was administered, I was then put in the lithotomy position (like a mom about to give birth), prepped and draped.

For about the first hour and a half of the procedure, I was awake. My gynecologist and the other doctors in the room (I include myself here) had a scare moment when she did not seem to get any tissue that looked like the grapelike cysts found in hydatidiform mole. She had some tissue sent to the pathology lab for frozen section. That's because she was thinking that it might be choriocarcinoma! Yikes! If that happens, we can't go on with the curettage coz we have a different treatment plan if that is the case! Good thing the path results came out as placental fragments. No malignant cells. Whew!

Because she had difficulty with my case, she called in a sonologist to help out. Turns out that my case was a partial mole and not a complete one, and the characteristic grapelike cysts were facing AWAY from the cervix. What's facing the cervix was the smooth portion of placental tissue. No wonder! There was some technical difficulty in removing the whole thing because of this, hence the surgery took longer than expected. They finally had to knock me out since the spinal was starting to lose its effect and I am starting to feel something.

Next thing I knew, I was already in the recovery room with A LOT of other patients. I was still high from the sedatives and was seeing things move around in circles and psychedelic patterns. I vomited. I was cold. I was in a bad temper and like a spoiled child, kept asking when I could go out to my own room.

Finally, I was brought to my room. I had a moderate fever, probably because of dehydration. It went away as soon as I was able to drink a substantial amount of fluids and the IV fluids were increased. I was given antibiotics as a precaution though.

I was given the needed doses of chemotherapy the next few days. I went home on the evening of September 13, 2007.

More info on Hydatidiform mole here.

The aftermath in the next post!