Hello, I would be happy to help you today with your question.
Please give me several minutes to review your question.
How long was the IUD in place?
A year and a month. I believe that my extreme stress level threw my good bacteria and bad bacteria off, and my immune system is down. I have lost ten lbs due to stress with nursing school. All Std tests were negative.
Please describe the IUD insertion itself. Was it painful?
Yes, insertion was quite painful. I have had the IUD put in three times and all times painful. This last removal was the only time I even felt it come out.
Did any of the cultures performed come back positive for anything?Why do they think you have PID exactly?
No, the only things that grew out of the cultures were normal vaginal bacteria. I went to the ER with severe abdominal pain and back pain. The DR that examined me said that I had cervicitis. My cervix was inflamed with a mucopurulent discharge. He gave me a shot of Rocefin and a week's worth of doxycycline. I went to my Obgyn... Pain was subsiding, but not gone. I have pressure in my abdomen still etc. She gave me another week of doxycyline and left the IUD in at this point. I went on exercising and living my life and still in pain, so got the IUD out.
Have you ever had an ultrasound of your uterus?
Yes.. Normal.. this has been very frustrating and painful
Okay, here is what I think - please give me several minutes to type:
1. An IUD insertion should never be painful - I have put in 100's of them and I would describe the experience of the patient as "minimal discomfort".2. This makes me think that there was either something about the persons inserting the IUD (inexperience) or something about your uterus that makes insertion of the IUD difficult3. Given the exam in the ER describing a mucopurulent discharge, obviously you have an infection4. The infection is NOT related to stress or a suppressed immune system - it is simply related to a difficult IUD insertion and "draggin" of the normal vaginal bacteria into the cervix with the insertion itself5. It is concerning that you have now had pain for 2 months with a poor resolution of your symptoms and a poor response to antibiotics
Do you have an OB/GYN currently?
I do, but I also have had three IUD inserts and all of them painful. The IUD was in over a year. I believe that with my immune system being down, the normal bacteria turned pathogenic on me. I have talked to Dr's about this, but since my IUD was put in so long ago with absolutely no problem, I don't see that as being the cause. I know you are the Dr, but I do know a good deal about this and have spoken with quite a few Dr's. What would be the best type of antibiotics to cure a hard to treat infection caused by my own normal flora? Doxycycline didn't work, but I think my vigorous exercising didn't help either. No one told me to rest. :( I am seeing an Obgyn. She does not know why my probs persist and I am going for a second opinion next week.
Ahhh.. My uterus does not lay the correct way.. Not sure if it's retrograde or not, but that could cause it to be a bit more painful/
Okay - I have some thoughts for you, but first - why exactly do you think that your immune system is 'down'?
I'm in nursing school. I work fifty hours a week and have two kids. I had a panic attack and lost ten lbs in about three weeks so that I could keep my A's in school. I'm not eating right or getting enough sleep. Stress has thrown my body totally out of whack.
When exactly was the ER visit?
I quit my job so that I only work on Saturdays now. ER visit was about 4 weeks ago. I think the IUD should have been taken out then. I am assuming only a laproscopy will lead me to the answer I need :/
Okay, here is my honest opinion - again, please give me a minute to type:
You are a 32 year old who had multiple prior difficult IUD insertions and an even more difficult IUD removal, who was seen in the ER and diagnosed with PID based on a cervical purulent discharge and pain. You have been diagnosed with PID that is NOT responding to antibiotics. I will state emphatically that even with the stress of two kids and a demanding job / school does NOT cause PID. You have PID because something went wrong with the IUD insertion itself. The IUD was NOT in the correct location and the infection is a real and dangerous issue in your case. Your doctors keep treating you but are not really addressing a potentially bigger problem. With as little as you have told me, you need:1. A CT scan of the abdomen and pelvis to rule out a pelvic abscess2. Probably a laparoscopy to look at the uterus and pelvisPID that is not responding to antibiotics is often treated as an INPATIENT. I have been consulted on more than a few botched IUD insertions and in the interest of future fetility and pain problems, you need to get this sorted out as soon as possible!!
Does this answer your question?
Are there any antibiotics that will help at this point? And yes, this is what I figured needed to happen.
Upon review of the antibiotics that you are on, in a patient such as yourself, a regimen of Augmentin and Flagyl would be appropriate while you wait to get this sorted out.
You should talk to your OB/GYN as soon as possible about a CT scan and possible surgery.
Thank you...and I agree, now I just wish I could get an Ob/Gyn to listen to me about all of this. I am getting brushed away, because it is not a typical case, and I should be "cured." :(
I get so frustrated by hearing about OB/GYN's that do not listen and are not willing to take responsibility for problems that they might very well have been responsible for!! So frustrating. You have to be an advocate for yourself. It is no longer personal - it is about your health and remind them that YOU are the customer. We get paid well to take care of patients like you, but they must be willing to take care of the problems that arise too!! You probably need to find a new OB/GYN and keep pursuing this further. If you have to go to the ER to get attention, then so be it.
I really wish you the best of luck.
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