Am I being completely reckless? Pap smear story *LONG!*

  1. Today I went from pleasant patient to difficult PITA patient in one 10-minute grueling visit with my perinatologist. We'll call him Dr. B.

    2 weeks ago, when I last saw him, he wanted to do a pap smear. I've had one every year since I was 18 (am now 29) and am well aware of the benefits of regular screening, but am nontheless hesitant to have one done while pregnant.

    So, 2 weeks ago , I refused the pap and said I would do it later. The nurse copped an instant attitude and told me that I MUST do it without fail at the next appointment. No discussion. I grew up in a family of physicians, so I'm not taken aback by the sometimes brusque attitude of medical personel, but this was different. She was downright shrill and commanding and, what's worse, not at all willing to allow for the remote possibility that I may want to play an active role in the management of my own gynecological health.

    So, today, I saw Dr. B. He walked in ready to do the Pap and I told him I wanted to wait until the fetuses were viable before having the smear done. The room was silent for a moment. Then, Dr. B started schooling me. Never mind that I already know about the benefits of screening. Never mind that I've been vaccinated (Gardasil). Never mind that I've never had an abnormal Pap in 11 years... I'm OK with physicians educating their patients, but this was "schooling". He was dripping with annoyance and condescending to both me & my husband (neither one of us is a physician, but
    I am an attorney and my husband is a college professor, so we do --by and large-- understand why screening is important!).

    At the end of the speech, Dr. B made it a point to tell me that he did not mean to scare me but that he had had a patient who was diagnosed with cervical cancer in pregnancy and refused treatment. She died a year after delivering a healthy baby!

    When I asked how this story pertained to me, he explained that waiting another 3 months could affect my treatment options if something abnormal was found!

    He left the exam room in a huff, my husband looked at me and asked "What was that all about?", the nurse saw me outside and gave me "that look".... and now here I am a bit scared and wondering if I am making the most reckless decision of my life.

    Am I? Has anyone else refused a Pap during pregnancy and did you survive? Has anyone not had a Pap during pregnancy and survived just fine? Am I off my rocker for saying no? Should I just have it done it at the next appointment in 2 weeks? And, if you read this far, thank you, thank you, thank you!
     
  2. I thought having a pap smear was a standard test to have during pregnancy. I had one at 8 weeks with this pg. It was uncomfortable (and there was some bleeding), yes, but I was never told that there were any risks or anything to the baby to have one done. I understand your situation with IVF, etc. and don't blame you for being extra cautious. If you've had a pap in the past year I don't see why there would be a problem to wait.
     
  3. Sanguar, yeah that's precisely it! I know the test simply entails scraping a cell culture from the base of the cervix and I know it's standard and probably risk-free, but it's very hard for me to think about seeing spotting at this point in the pregnancy.

    I've had a rocky first trimester (where we lost the triplet) and I've been dreading the possibility of bleeding. Now, the pregnancy is finally as low-risk as it'll ever get with twins and they are healthy and measuring ahead of their gestational age so I just want some time to relax without another wait for test results and "what ifs?" So, it's mainly a decision based on psychological comfort and not anything else and I told the peri. that I would have it done as soon as the twins reach viability. I just want to make sure I won't potentially compromise my health over some emotional anxiety by not doing it right now vs. in 7 weeks...


    OH, I just saw what you embedded in your ticker!!! CONGRATULATIONS on your little girl!!! :love::love::love:
     
  4. Thanks!!!! From what you said it also seemed that your doctor was trying to imply that he would recommend that you terminate to 'save' yourself from the cancer (if there was any). I can safely say I would not.
     
  5. Well...here is the thing, say the worst thing on Earth happened and ___ forbid that you do have cancer, would the treatments affect your pregnancy?

    Something tells me that most cancer treatments cannot be good for pregnancy. Also, the hormones associated with pregnancy sometimes makes cancer spread faster so they might make you choose between yourself and your babies.

    Also, you had one last year, what difference will 3 months make? Cancer takes time to spread and it is only in stage 4 or 5 where it is life threatening. So unless you developed cancer right after your pap last year and it is very aggressively spreading, I doubt it was a reckless decision.
     
  6. Sanguar, no, he made it clear that I'm too far along to terminate and he did say that if the woman had accepted treatment she would have been alive AND had the heatlhy baby. The more I think about his story he + about how vehement he was about the Pap, the more I think he's perhaps a bit "haunted" by the fact that he lost that patient that way.

    I do think he's projecting a bit otherwise his strong reaction makes little sense... after all, I had all normal Paps including last August's and cervical cancer is very slow to progress... so waiting 2 months to screen will likely not kill me.
    Strange.
     
  7. Sounds like some kind of scare tactic. In August I saw my gyn to discuss getting pg, at that time she said then lets get a pap so we dont have to do it when you are pg. I took that to mean that she would rather not have a pap during my pregnancy. Maybe you can comprimise with them and at your next appt ask if you might wait until the 3rd trimester. Whats a couple more months?
     
  8. Liz, I think the treatment of choice would be to wait until viability of the twins, have a C-section as soon as they are viable and able to probably live and be reasonably O.K. (so, at the earliest, 26 weeks)... and then folow whatever protocol they chose based on how advanced the cancer would be. My guess is hysterectomy following the C-section (and radiation if needed)...

    (But yeah, we're talking stage 4 or 5, like you said)...
     
  9. If you had a recent normal smear I don't know why he would be so adamant unless as you say he is a bit paranoid about the loss of the patient. Surely if I am correct they pick up pre cancerous cells first & you had none of those so whats the big deal, I doubt that you would have full blown cervical cancer by now. I really cannot see how waiting two months is a problem especially as you have had a worrying time with the pregnancy. Sorry about the loss of the triplet. Hope everything goes well for you.
     
  10. That's what I offered. I thought 24-26 weeks would be fine. After which, he told me about the patient who died because she postponed treatment.

    (I guess I'm so thrown by this, because there did seem to be a lot of emotion in the room and I didn't feel it belonged in there. And I guess that's part of what I'm asking: is my reaction to the Pap totally extreme or did the doc project a bit onto it because of that sad experience he had? I didn't think I was being that unreasonable in wanting to wait, but I sure was made to feel that way. So that's why I'm checking in with you guys...)
     
  11. Roz, that's my understanding, too... that they can pick up a lot of cervical changes in between a perfectly normal Pap and a catastrophic Stage 5 cancer... and thank you for understanding what I meant to say about the rocky first trimester :heart:.
     
  12. Emma, I understand perfectly, I lost a twin in first tri & it was very traumatic. I can totally understand you not wanting to do anything that might compromise your wonderful twins. While I am not a doctor I really think that you will be fine to wait until after the birth. You have had regular tests all normal, I never had one while I was pregnant, it was never even suggested & I am still here to tell the tale :smile: & yes the purpose of regular smear tests is to pick the abnormal cells up at a precancerous stage, I don't think they progress to dangerous stages that quickly especially if there was nothing there so recently. Why don't you take a second opinion, talk to another doctor as your peace of mind has now been challenged. You have been left with a probably totally unfounded fear that by not having this test you will fall ill & die after the birth, this is very bad of that doc to frighten you like that!
    You do not need that added worry in pregnancy!
    I remember at my 6 weeks check up my gynae panicking over a mole like thing on my thigh, now I had this checked several times & was told it was nothing just a nevis. Well this guy almost went hysterical he said "I meant to say this to you before, Melanoma can go malignant, can go malignant" I will never forget driving home, the very steering wheel was shaking with me. I thought I was going to die & leave my 6 week old baby. I was completely frantic until I went & had it off & thank God it was nothing so you see these over careful docs can drive you crazy :smile: I remember the surgeon putting me at ease saying look this is nothing the worst thing it will ever do is catch in your tights LOL he wasn't even going to remove it but I had gone through that much I said get it off LOL
    Hope that helps to reassure you :heart:
     
  13. Oh Roz, the mole over-reaction was just brutal... oh, man. If it's not one thing, then it's another....ugghhhhh!

    (though thanks for telling me they never screened you while pregnant and nothing came of it, now that's reassuring).

    And I have no words for your loss. I've been there and am at a sad loss for words at how painful it is...
     
  14. ^^^

    Thanks Emma. With all this pain of loss you do not need any more worry so try to relax & talk this through with another doctor who doesn't have the baggage of the lost patient also discuss any risks of having the test to put your mind at ease, then make an educated decision,
    Going to bed now but will check in tomorrow. Think positive thoughts & look forward to enjoying your lovely babies :smile:
     
  15. I have no experience of pregnancy & pap test durring this time so I really don't have any advice for you on that.

    I think it was pretty irresponsible of your doctor to react that way telling you that story at this time just isn't right. I'm so sorry for your loss and I'm sure the last thing you needed to hear is that kind of scare tactic

    Here's wishing you a very healthy pregnancy