December 24, 2016

Laparoscopic Bilateral Salpingectomy FAQs

In October 2015 I got my fallopian tubes removed, which is called a laparoscopic bilateral salpingectomy. As I'm writing this it's been 15 months since surgery, and I still get a lot of comments on my previous posts about this procedure. To make one easy-to-reference location for the most common questions I've gotten, I made this post.

Anyone is still free to post here or on any of my other posts with new questions! But now no one will have to read through dozens of comments to find out if their question has been answered.

Best of luck to anyone considering this procedure or recovering from it! I do love hearing your stories, so continue to let me know about your experience.

My experience:
About laparoscopic bilateral salpingectomy:
  • What is a laparoscopic bilateral salpingectomy?
    • Salpingectomy is the surgical removal of both fallopian tubes.
    • Laparoscopic refers to how the procedure is done: through a tiny incision with tools that go inside the body, rather than big cuts into muscle. Much faster and easier recovery.
    • Bilateral refers to both sides: both fallopian tubes were removed, so the procedure was done on both sides of my abdomen.
  • Who needs a laparoscopic bilateral salpingectomy?
    • It's a great sterilization procedure! Removing the fallopian tubes is getting pretty darn close to making it impossible to get pregnant. 
    • If you have an ectopic pregnancy this is what you'll get to save your life.
    • I chose this procedure over a tubal ligation and essure because I wanted the most effective form of sterilization and I didn't want anything left inside me. It was the best combination of pain, recovery time, and long term effectiveness for me.
  • Why did you get fixed?
    • I don't want kids.
    • I don't want to get pregnant.

  • Don't a lot of women regret sterilization?
    • Not as far as I'm aware. So far I sure don't!
    • From what I could find online, the women who regret sterilization tended to never want the procedure in the first place. They were coerced into it during childbirth. Many regretted it after their relationships ended and they realized they wanted more children with their new partners. 
    • I've never heard of anyone who never wanted kids regretting sterilization. Doesn't mean it never happens, just that it seems pretty rare.
  • Why not just get an IUD?
    • Because I wanted something permanent that didn't leave anything inside me.
    • Laparoscopic bilateral salpingectomy is as close to being 100% risk-free as you can get. IUDs are great, but not as great as salpingectomy.
  • Do you still worry about getting pregnant?
    • Nope! It's awesome.
  • So you really don't want kids?
    • I really don't.

November 6, 2016

Getting Fixed: One Year Later

It's been a year since my laparoscopic bilateral salpingectomy. Unless you know that I've had surgery (or are a medical professional, probably), you'd never be able to tell. Now that it's been a year I feel even more secure that it was the right decision. I know I can't get pregnant and will never have to worry about what-ifs. Instead of raising children, I'm in grad school, hoping to use my life to make a big difference in the world.

Here's what I look like now. The only visible scar is on my left side.

If you need a recap of my tube removal experience:
One year later, and here's what changed:
  • The Boyfriend and I don't need to think about pregnancy prevention anymore. I still do sometimes, but I was taking pills for 10 years and habitual worrying takes time to die off completely. The panic that I didn't take my pill subsides as soon as I remember I don't need to.
  • This means we've been able to have more spontaneous sex. 
  • This also means sex has been better because we aren't worried about the time of the month or that slim chance pills and/or condoms will fail. I went off birth control pills 10 months before getting spayed and we relied on condoms, which unfortunately meant we used them on occasion and tried to time sex for when I wasn't fertile the rest of the time. Since I had just started tracking my cycle, this was recklessly dangerous and I 1000% do not recommend it. Not to mention, it made both of us worry a lot about sex (mostly me, since I'd be the one actually pregnant).
  • I use an app to track my period now because I'm in less control over when I get it than when I was relying on a pack of pills (meaning I have no control). Fortunately it's crazy regular (more on that below) but it's been helpful having an app.
  • I've been extremely personal on this blog. Before I tried to be pretty vague and not use it as a completely personal platform, but I've since shared about being cut open, my personal decisions for not wanting to be a parent, details and advice about pooping, discussed my period in depth, shared photos with my face in them, shared photos of my bloaty and scarred belly, and now I've shared more details about my sex life than I thought I ever would on the internet. But, you know, I've said before I wanted to shout this from the rooftops and now that I've seen how helpful the previous two posts were to women considering this I'm more than happy to have been as candid and personal.
More importantly, some things haven't changed.
  • I still don't want kids. I got fixed 10 days after turning 30 and I'm 31 now. My biological clock didn't magically start ticking. In fact, my beliefs have strengthened. People in our lives are starting to have kids or talk about having kids and while they can have nice moments they are still so much work. Every time someone we know talks about how challenging it is being a parent I'm like, "...yep." 
  • My period hasn't changed. I've always been fortunate in the monthly cycle department. It came right on time when I was 13, is usually very light and cramp-free (I know, lucky), and is extremely regular, even without hormonal birth control. My first period post-surgery kind of skipped - I had all the symptoms of being on my period without any bleeding, but then it showed up a few weeks later. It took a few months to return to its normal mid-month cycle but now I can depend on it within a few days. I did have one period that was really crampy, but on rare occasion that would happen before surgery, too.
  • My hormones haven't changed. Because the only thing that changed was my fallopian tubes were removed, and they don't affect hormones, everything else has and will continue to happen normally, including menopause. That's also why my period hasn't changed. No weight change, no mood change, no change in appearance, nothing.
  • I can still wear bikinis. Not that I wear bikinis often due to circumstance (more of a mountain person than a beach person) and I would have even if my scars were bigger (because judgmental people can fuck off), buuuut my scars are totally not noticeable. In fact, on 4th of July The Boyfriend took a photo of me in a patriotic bikini and my belly button ring hole is more visible than my surgery scar. (Can you see it? I can if I squint.)
Quite a few women looking for information on laparoscopic bilateral salpingectomy as a sterilization method have found my previous posts, and I'm so very glad to have helped them. The biggest selling point for salpingectomy for me was there would be nothing in my body - no copper or plastic IUDs, no clips, and no metal coils. Even the stitching dissolved and glue came off. My risk of ovarian cancer is potentially reduced, my risk of pregnancy is essentially gone, and I won't have to think about having an IUD removed in 5 years. Win-win-win-win-win.

Edit: Now that we know the election results I'm even more happy I've gotten this taken care of. The next president could, and likely will, significantly roll back access to and affordability for procedures like this (and birth control and abortion access). I would be quite worried for my future if I was still dependent on temporary birth control. 

I doubt there will be much to report back on but maybe I'll do a 5 year or 10 year follow up or an update if there's anything to update on. Until then, I've been really enjoying the comments on the previous two posts and love hearing all of your stories. Please continue to leave comments! I may not always respond right away, especially over the next couple of years as grad school takes up most of my time, but I will respond. This has been a fantastic experience and I'm so glad to be in the company of the many, many women out there who decided they don't want (any more) kids and are sick of dealing with temporary and inadequate birth control. Much love to you all.

Photos in order of when they were taken:
Day of surgery

6 weeks after surgery

1 year after surgery

August 7, 2016

Dealing with Insurance for my Laparoscopic Bilateral Salpingectomy

The least fun part about getting spayed has been dealing with insurance.

Let's start with the end: I lost.

Backing up a bit, before you go and get this or any surgery call your insurance company and ask what your costs will be. First, get the precise codes from your doctor. Make sure to get all codes, all of the codes that each doctor will use (I had two), the code the anesthesiologist will use, the code the hospital will use, and any other code they might need. Second, tell that code to the insurance company, have them read it back to you so you know you're on the same page, and ask what your total costs will be. DO NOT ASK IF IT'S COVERED. "Covered" in medical insurance language does not mean the insurance company will pay for it, it simply means it's an approved procedure (wtf an unapproved procedure is I have no idea). This was mistake #1 for me. Third, before you actually go in for this surgery call your insurance company again and make sure they're giving you the same answer as before. If your plan suddenly changes and they don't inform you (cause they're dicks like that) you'll be on the hook.

Another important point: the Affordable Care Act states that all birth control costs are 100% provided by insurance companies, including female sterilization. HOWEVER,
 sterility is only a side effect of a bilateral salpingectomy. Fallopian tubes were historically removed as part of a hysterectomy in order to reduce the risk of ovarian cancer, and only recently are women turning to the procedure because of how effective it is at stopping pregnancy (no tubes, no babies). Compare this to a tubal ligation, which is only done for birth control purposes. This makes sterilization an off-label use of bilateral salpingectomy. Some insurance companies have this procedure labeled as sterilization because of its quickly growing popularity (up to 33% of sterilization procedures are bilateral salpingectomy), but mine did not. In principle I felt that insurance should have covered it because my primary reasons were for sterilization. 

Further, and this is an argument I had with many people at my insurance company over many months, is that even if laparoscopic bilateral salpingectomy is used for other things, I used it for birth control, as a preventative measure, so why isn't it paid for? The only answer I got was the code didn't specify either of those things.

What I learned is that there are generally two codes a doctor can use for laparoscopic bilateral salpingectomy: one that says it's birth control, and one that doesn't. There were two codes in my paperwork: one that described it as "female surgery" (no shit) and one that described it as a "medical procedure" (imagine that). The super weird thing was when I asked the insurance rep to read the codes back to me she said it "tubal ligation." Which would be paid for. When I asked why it said tubal ligation and they still weren't paying for it she said that's where that second code comes in, the one that called it a "medical procedure." Apparently, in order for Blue Shield to pay for this surgery, it would need to have a code that indicated it was a "preventative procedure." What differentiates a medical procedure from a preventative one is something I still don't know. 
Call your insurance company and find out what their rules are. If they consider it birth control, awesome. If they don't, do your best to find out what your costs are going to be when all is said and done (hospital fees, doctor's fees, anesthesiologists fees, medical waste fees, administrative fees, any and all fees they can throw at you). Honestly, I'm an educated person and am used to talking with medical professionals and I feel insurance is needlessly and possibly intentionally complicated so people will just pay to avoid the headache.

Since this was the surgery I wanted and I wasn't going to get a less-effective surgery with a longer recovery period and more potential for risk because it would be cheaper (some things you just need to pay for), I didn't try too hard to determine all these things. Plus, I knew my company would pay my deductible so my risk of actually paying anything out of pocket was pretty small.
I had my surgery in October and finally paid up in April. When all was said and done, it cost just over $2,000 (less than my deductible, which my employer pays as part of our medical benefits package). The upside was the hospital was very understanding and worked with me to try and get Blue Shield to reconsider. They resubmitted the paperwork twice, I talked everything over with both my doctor and the billing department multiple times, and they put several holds on my fees to give me time to get it sorted out. I still can't believe it took 6 months. 

Here's my six week update, the official "back at life" time for anyone currently considering this procedure and the recovery period. And here I am one year later. Good luck to anyone considering a salpingectomy! Despite the struggles with insurance, it has been 100% worth it.

January 17, 2016

Texts from Dad

I'm keeping these here so I have a record of proof that can't be tarnished by a faulty memory. My extended family got very involved in this because my dad alienated himself from so many people over the years, and they've been trying to get us all back together.

Over 5 years ago my dad started seeing this new woman. Things moved pretty quickly between them and she was living with him after 6 months, while he was still legal guardian to my underage sister and our other sister was living there, too. His new girlfriend's sparkling personality aside, we were concerned she was taking advantage of him (he had a house, a successful business, and was financially comfortable, while she owned very little and wasn't making much money - when she moved in she lived rent free, which is something his own daughters weren't even allowed to do). Our dad had a track record of letting women use him and he has never been the one to see a relationship for what it was, much less break one off.

In one instance, his girlfriend made a list of rules for my sister to follow if she was going to be living in "their" house. The rules were absurd, and one was medically irresponsible, so I agreed to be there for a conversation between my sister and our dad. I had a pretty good relationship with my dad. We had what I thought was a great talk, where a lot of issues were brought to light and my sisters and I walked away from it feeling much better. Now that we were able to talk openly about the rules and some other lingering issues, things were looking up. However, a few days later my dad called me to ask me to never do that again. He said by being there I was both robbing my sister of the ability to speak for herself and disrespecting him and his girlfriend. I told him I couldn't agree to that – if either of my sisters asked for my help or presence in any issue, I would do it. I suspect that his girlfriend had a private conversation with him after we left, because he seemed perfectly happy with my presence and what I said at the time. Only later did he change his mind and claim to have felt disrespected.

The next time I was in my hometown I asked him to have lunch with me so we could talk about things. I told him about my concerns about his girlfriend and suggested he could do better. He reaffirmed his love for his girlfriend, told me how the life he had had when he was married was never what he had wanted, kids were never what he wanted, and essentially that he had the chance to live the life he felt he always deserved. I was given the option of getting on board or not.

A couple months later I turned 25. I spent it with my best friends on vacation, my sisters called to wish me happy birthday, my mom, a few relatives, and I got lots of texts and messages from friends that day. When I woke up the next morning I realized my dad was the only one who missed it (and it's not like he forgot, my mom and I share the same birthday, that date is engrained into his head). I was pretty crushed. 

Several other birthdays came and went without so much as a text from him, and multiple holidays, too. A few times he would group text my sisters and I to say "merry christmas, love dad and [girlfriend]". And it was fine, after a while. I accepted that this was the way he wanted it and watched my dad alienate his own siblings, close friends, and several other family members. Turns out I wasn't the only one who brought up concerns about his girlfriend, and he responded to them the same way he responded to me. 

Could I have done more? Absolutely. I could have promised my dad I would respect his authority and not support my sister if she asked. I could have apologized for even hinting that his girlfriend was not the most wonderful partner. I could have sent him happy father's day wishes even when he wasn't speaking with me. But I'm a pretty strong and often headstrong person with solid self esteem and an undying loyalty to my sisters. I would never choose my father's ridiculous need for approval and authority over my sister asking for support. I would never sit by while I thought my dad was being taken advantage of and say nothing. And I'm just not the type of person who is going to force another person to have me in their life.

I've been hearing a lot from other relatives who have still been trying to make amends lately. To he honest I'm not sure what is a rumor and what is fact because my dad hasn't told me anything, even through all this texting (below). Apparently he married his girlfriend after being told he had cancer (or a non-carcinogenic tumor? Honestly I don't know). My dad has chosen to not share these parts of his life with any of his daughters, but he reached out to our mom. To be honest, I was hoping he wouldn't do this, and after the following texts from him I wish he hadn't. To be cut out of someone's life because you said your piece and meant it is one thing, but to be cut out because someone has delusions about what actually happened is another.

The gist of our conversation was he doesn't want to acknowledge (or doesn't remember) any of the things he said to me, but by not reaching out anyway this is my fault. He's only interested in starting over if it means he doesn't have to take responsibility. The only apology in here was sorry for being wrong about me not wanting him in my life. And the shitty thing? I don't want a relationship anymore. It would be shallow and fake and I couldn't trust him and I don't think I could be civil to his new wife. So what's the point? 

A few days later he started up again.

And again a few days later. I'll give him the persistence award, but god damn at this point he's beating a dead horse. I've explained in direct words exactly what happened, twice. If he doesn't remember or won't believe me I can't help him. If he doesn't believe me and doesn't remember (or is choosing to remember a version of events that doesn't make him seem as shitty), then what's to stop this from happening again? This is not how a fresh new relationship is made, dad.

After that he texted on my birthday. I didn't respond. 

Bullies don't remember the things they say to others, but the people who get bullied sure as hell remember what was said to them. The simple reason is because you remember how you feel when hurtful things are said to or about you, but you don't remember saying hurtful things to or about others because it didn't impact you. If this were anyone other than a father saying these things no one would be encouraging me to bury the hatchet (after taking it out of my own back, no less). I think that's an awful double standard. What sort of message does that send? That it's OK to say hurtful things and tell your kids they're less important to you than your new girlfriend as long as you give a half-assed apology later? No gracias.

Maybe one day I'll forgive him but for now the anger is a good reminder to not get into a situation like this again. Feeling used sucks. Feeling unwanted by your parent sucks. I have wonderful people in my life and I'd rather not have a superficial relationship with someone who wrote me off for five years for apparently being late on a father's day wish.