Bethesda, MD 20894, Web Policies My cervix did not reduce to 25mm at any point, but I have been on progesterone until 34 weeks just in case / to put my mind at ease. Anyone fallen pregnant after having a lletz procedure? 2007 Jul-Aug;27(4C):2743-6. You will be asked to lie down and put your legs on a padded support. Xx. eCollection 2017. Is there anything I need to know? Yes, they have suggested I continue with cyclocest pessaries beyond 12 weeks for this. 8600 Rockville Pike Will keep my fingers crossed for you. Results: But slowly slowly I'm adjusting to the idea this is actually happening. Hope to read in 9 months your precious arrival. Quite overwhelming, unbelievable almost like what now A stitch has been mentioned and my midwife has referred me for a scan. When the cells are removed from the cervix, they are further sent in the lab to check if it contains any cancerous properties. You must be due your 12 week scan soon? Has anyone here had a LLETZ for abnormal cervical cells and now in early pregnancy? Unauthorized use of these marks is strictly prohibited. So, treatment is required for it. Twenty-four were positive for high-risk human papillomavirus. Even if it means you arent able to have a home birth which would be a shame, the main thing is having a healthy baby which Im sure you will. I had the procedure done when I was 18 and was pregnant at 18. Together with the team at ExactlyHowLong, the aim is to provide useful and engaging content to our readers. I am 12 weeks pregnant and I had a huge blood discharge last Wednesday. If the doctor or nurse needs to remove a large piece of tissue, they may recommend a cone biopsy. If you have any bleeding, discharge and pain: Page last reviewed: 24 May 2022 xxx, Thanks so much London_lady! Awhh man Im waiting for the midwife to call me still, I had my coil removed in September but it was a massive ordeal getting in inserted because of scar tissue and it was even worse having it removed! https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.1989.tb03380.x, https://europepmc.org/article/med/19583712. That is a really good question. Win A Years Supply Of Batiste Dry Shampoo! Not sure what they do in public, but if they think you are high risk they will do extra monitoring or you can request for it if you feel anxious at all. i have my first scan early tomorrow morning and also I get my blood work results tomorrow afternoon from my doctor. The https:// ensures that you are connecting to the Getting brown spotting. The #1 app for tracking pregnancy and baby growth. Accessibility I bled last Thursday (couple times when I wiped) which would have put me at 7dpo so Im assuming it was implantation as I had that with my son but my son is 8 and obviously had the LLETZ after him so Im not 100% what that was down to. eventually did it for me. Has anyone, or do you know of anyone who has had a lletz procedure ( removal of pre cervical Cancer calls from the cervix) and then had a successful pregnancy? 2017 Jan 4;12(1):e0165276. Yes this was similar with me. You'll be asked to sign a consent form. Epub 2019 Aug 6. LLETZ and cone biopsy are both treatments to remove abnormal cells in cervical area. There were positive resection margins in 15 (55.6%) cases. I had a look online and a lot of places say cervical one and the result! Although the abnormal cells grow very slowly, they can develop into cancerous cells. 8600 Rockville Pike After the operation, you can suffer from pain, bleeding of the vagina, and a change in the discharge from the vagina. In short, if its creative and you can make it digitally, I love it. The infected area is removed in the surgery. 2005 Jul;272(2):109-12. doi: 10.1007/s00404-005-0727-1. You may need more local anaesthetic. A nurse or doctor will explain the possible risks of having a colposcopy. Bookshelf If you had a biopsy or LLETZ (large loop excision of the transformation zone) the bleeding can last longer. I never had it come up as a concern in pregnancy, thank God. I hope your pregnancy is going well xx. Breastfeeding: the trick to a comfy latch. After cutting and completing the surgery, the surgical area is sewed or stitched using a medical stitch so that the skin connects with the cells and the skin fibers. If the cancer is detected, the process is treated to tackle cancer with required medical efforts. Enter your email and a password below to post your comment and join MoM: Would you like to add a written rating or just a star rating? So sorry to hear you have more to worry about, but hopefully it's just something to keep a eye on and monitor and no extra intervention is needed. Xx, Of course all I want is my healthy baby. What is the best way to maintain a healthy weight? If the doctor or nurse finds abnormal cells in your cervix, they may recommend removing them. LLETZ stands for 'large loop excision of the transformation zone'. But if this happens the coil can still be removed safely without the threads when needed. I will send you a private message xxx. Wishing you all the best. All normal pregnancies with no issues, also pregnant now, so Im not worried. Good Luck. Clipboard, Search History, and several other advanced features are temporarily unavailable. Can I ask if your in the UK and if so where abouts?? doi: 10.1371/journal.pone.0165276. Yeah I was really worried with my last pregnancy aswell so I understand. Hope that helps alleviate some of your fears (of which I have had the same!) Pregnancy test more faint the day after a stronger positive. Loopik DL, van Drongelen J, Bekkers RLM, Voorham QJM, Melchers WJG, Massuger LFAG, van Kemenade FJ, Siebers AG. Pregnancy after LLETZ 22 replies Anyone fallen pregnant after having a lletz procedure? I think, if I remember correctly Scarlett13 had a stitch and if I remember correctly it was due to a LLETZ or a cone biopsy. If the state of cancer is small, then it can be killed with the medication. It can form blood clots, itching, and irritation, with many everyday activities coming to a halt. The pain reaches the peak in one to two days of the procedure and starts to subside thereby. official website and that any information you provide is encrypted Try not to worry yourself, Im sure everything will be absolutely fine , I havent but my midwife did ask this question at my booking appointment which I found odd x, Hi, Three (11.1%) women had invasive or microinvasive cancer, 22 (81.5%) had cervical intraepithelial neoplasia (CIN) 3, and 1 (3.7%) had CIN 2. and transmitted securely. Out of a cohort of 1000 women who underwent LLETZ for the treatment of CIN, 653 women replied to a postal questionnaire. Yes definitely helps to know that others have been through this. The procedure is very safe, but afterwards there is a small chance of: If anything like this does happen, the healthcare team will be there to look after you. Individuals under the age of 50 years of age with HG CIN (CIN2+) on LLETZ or loop specimens at the deep lateral and, or endocervical canal margin do not need to have extra levels or the end blocks . Xx, Yes they specified to me to take them vaginally. Hi Kelly i had lletz treatment back on 2017 and i was told that in any subsequent pregnancy I was at risk of early Labour.. a little advice from my midwife to all the bleeders out ther Abnormal cells on cervical smear whilst on Buserelin. But you might be at the hospital for several hours from getting there to going home. My OB checked cervical length at each scan and I had an extra special scan just to check length- may of been around 21w from memory. Still, many activities like heavy cardio, exercises, and swimming can come to a halt for a few weeks. Two controls were matched for each of the 149 women who had a singleton pregnancy progressing beyond 20 weeks of gestation following treatment, with regard to age, parity, height, husband's or partner's social class and smoking habits to account for common independent risk factors for adverse obstetric outcome and cervical intraepithelial neoplasia. What happens after treatment? Kyrgiou M, Athanasiou A, Kalliala IEJ, Paraskevaidi M, Mitra A, Martin-Hirsch PP, Arbyn M, Bennett P, Paraskevaidis E. Cochrane Database Syst Rev. Really worried my cervix is incompetent, any advice from experience would be appreciated. It may well be that your cervical length hasn't been too affected by the LLETZ and you don't need it but better to be checked over.xx, Scarlett13 hopefully she'll see this now. About Us | Contact Us | Privacy & Cookie Policy | Sitemap, We help people get the right information about everything related that takes time. To comment on this thread you need to create a Mumsnet account. Epub 2017 Mar 1. About intimate examinations Progesterone strengthens the cervix without being so invasive. Questionnaires were used to obtain information about peripartum and postpartum data. Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked. Published by Elsevier Ireland Ltd. All rights reserved. If anyone puts anything on their vagina, then the process to heal the cervix gets affected heavily and can damage the more. On 4th day also there is effect of anaesthesia on me that is being drowsy. Objective: She had a perfectly healthy bub. Diagnosis and treatment of cervical cancer in pregnant women. This involves removing a cone-shaped section of tissue from your cervix. Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. BJOG. I have two scans on my cervix to check everything ok . falling apart pregnant was unexpected but just wondering if anyone else has had similar? 2021 Jun 4;18(6):e1003665. At least you should then know whether your cervix is capable of carrying a baby to term. After LLETZ, some people have bleeding for up to 4 weeks. My niece had the same procedure before her 2nd pregnancy & the Dr put a suture internally so the bub was secure & removed it at the onset of labour. A heated loop of wire is then used to remove the tissue. I had no issues at all and ended up giving birth vaginally at 39week. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). doi: 10.1136/bmj.i3633. Above 25mm is generally okay. Results: Hygiene products such as sanitary pads and tampons can halt the other activities. My private clinic were fab though, did a mock transfer and draw a little map so they knew how to do the transfer, which was straightforward. Yesterday 22:20. If all ok they then discharge you etc. Did you need a stitch? Xx 0 comment comments ( 5) l Lulu19842 Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. 20052023 BabyCenter, LLC, a Ziff Davis company. Which of the following is NOT a symptom of the common cold? 2015 Jan 6;1(1):CD010757. I guess it depends on how much was taken. I have made over. Hey i am thinking of trying for another baby but have been told that there is a risk of having a pre-term baby and risk of miscarraige! PLoS Med. Sensitive post- positive pregnancy test after FET. Ive put so much effort writing this blog post to provide value to you. Epub 2014 Mar 16. Which organ is responsible for producing insulin in the body? Is direct large loop electric excision for the transformation zone reasonable in the investigation of high-grade squamous intraepithelial lesions in cervical smears? X, Thanks so much for this Nat! But have suggested a 32 and 36 week scan to keep an eye on baby. I contacted the fertility clinic to inform them about the results and An update with a thank you and a sorry to everyone. Zebitay AG, Gngr ES, Ilhan G, etin O, Dane C, Furtuna C, Atmaca FFV, Tuna M. J Clin Diagn Res. This is known as a biopsy, You may feel a mild pinching or scratching sensation as the tissue is removed, do not have penetrative sex or put anything inside your vagina if you had LLETZ you may be told to avoid sex for 4 weeks, do not use tampons or menstrual cups, use sanitary pads instead, avoid activities that could make the bleeding or pain worse, such as vigorous exercise that makes you breathe hard and fast, heavy bleeding from your vagina which is more than you would expect during a heavy period, unpleasant smelly discharge from your vagina, stomach pain that does not get any better after taking painkillers or keeps coming back. After the LLETZ, the womens cervix cells are electro-coated and cut to avoid further infection spread. She had a natural birth, the Dr removed the suture when she went into labour! They will ask you some questions about your general health and your medical history. One thousand women who had undergone large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN) between 1989 and 1991. 2014;2014:296253. doi: 10.1155/2014/296253. A thick, oily, dark, liquid that forms when tobacco burns is ___________. Your cervix length will be measured regularly usually until 24 weeks. 01/04/2009 11:37 Hi - I am 11 weeks pregnant and had a loop cone biopsy back in July. I had a lletz procedure in late 2018. Please enable it to take advantage of the complete set of features! The incidence of low birthweights in pregnancies progressing to at least 37 weeks of gestation was 3.1% in the treated group, compared with 3.2% in the control group (P = 0.98). Careers. Thank you lovely xx. In women with LLETZ this effect of increased early miscarriage was shown to be . I've just posted about this. Whereas, most studies show that LLETZ has no adverse effects on pregnancy outcomes. Yeah Im in the midlands. A case-control study. I hope youve found reassurance god luck. Leep/lletz and pregnancy. Then, there will not be any continuous cramping; it may come and frequently go along with mild fever, low energy, the moderate feeling of flu, and nausea. The midwife said they dont do scans unless youve had it more than once witching the last 3 years, I do think all trusts have their own rules though! Get the days best CHAT sent straight to your inbox, I have read and understood Netmums' Privacy Notice and Terms & Conditions, Could it be possible that I'm pregnant if I only had sex 4 days before ovulation, How soon after Implant removal can you get pregnant, Hey ladies, I had a LLETZ procedure in 2015 (CIN3) Ive recently found out Im pregnant (4weeks) has anyone else had one and been pregnant after? Following LLETZ, 9.4% of deliveries were preterm (< 37 weeks of gestation), compared with 5.0% in the control group (p = 0.12). I think whatever happens they will look after you well and so many people will have been and are in the same boat and have healthy babys. Yes I had the Procedure twice but yearrrs ago (maybe like 7&8 years ago). endometrium and cervix can be checked out fully. Sounds good that your midwife is on the case which is reassuring. In game development, I love playing with every different engine, toolset, and framework I can find. I am having the ltez treatment as i have had these cell changes for over 4 years now and i have had it cauterised befor aswell. I am already 9+3 weeks pregnant with twins so looking to see if people had experiences of managing this when pregnant x, Hi. I was Really anxious about miscarriage and also going pre term because I google searched so much!! Also, as told by the doctor, you can go to your previous diet plan, but it should be healthy. I had this procedure about 7 years ago and now quite worried about having a weaker cervix. I am a professional full-time blogger, a digital marketer, and a trainer. Test your knowledge about topics related to Health. Thanks for this Meghan, was everything ok afterwards? It should usually take 15 to 20 minutes to have your colposcopy and you should be able to go home afterwards. Take care. An area of tissue about the size of a fingernail is removed. eCollection 2021 Jun. LLETZ stands for Large Loop Excision of the Transformation Zone. Arch Gynecol Obstet. To comment on this thread you need to create a Mumsnet account. Setting: Thank you so much for your reply, I am really nervous and I know Im only early but everytime I go to the toilet I feel the same way also with intercourse I dont know if I should or no?? Fingers crossed it's a good length and you don't need it xx, Hi Peanutchips! Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia. I feel kind of relief that I know I will be monitored and if not I will demand it, what CIN were you? Acharya G, Kjeldberg I, Hansen SM, Srheim N, Jacobsen BK, Maltau JM. A colposcopy is usually done by a specially trained nurse (colposcopist). doi: 10.7860/JCDR/2017/22996.9495. The procedure has a diagnostic intention but can also be a curative therapy in pregnancy, with low intraoperative, postoperative, and peripartum complication rates. Its one thing waiting to get scanned to see if baby is in correct place and everything is okay and then another to not know what the future holds with premature labours etc making us worry so much and they arent even here yet! When socio-epidemiological factors associated with the development of cervical intraepithelial neoplasia are controlled for, LLETZ does not appear to exert an independent adverse effect on subsequent pregnancy outcome. I had little bleed at 14 weeks ( due to rough patch on cervix )and it was picked up then . Careers. How Long After LLETZ Can I Get Pregnant (And Why)? Hope youre ok xx, Im doing ok hun thanks for asking x we shall see next week as iv booked a private scan xx , Sounds like a good idea. Pregnancy after LLETZ procedure h HLaurenD Posted 24/9/21 Hi all, A few years ago I had a LLETZ procedure to remove pre-cancerous cells from my cervix. as it should be. Around 220,000 women a year are diagnosed with a cervical abnormality. sharing sensitive information, make sure youre on a federal Follow-up strategies after treatment (large loop excision of the transformation zone (LLETZ)) for cervical intraepithelial neoplasia (CIN): Impact of human papillomavirus (HPV) test. National Library of Medicine When you arrive at the hospital or clinic, you'll speak with a nurse about what's going to happen during the colposcopy. xx. Conclusion: I've since found out that this can increase the risk of pre-term birth, which is obviously a scary thing to hear! Im only 24 and with my son my pregnancy was text book. Xx, Hi Peanutchips. They see no reason why I cant just plan for a natural birth despite the lletz, my age (38) and IVF pregnancy. I tested again this morning and although positive, the lines were a lot more faint. Hi Peanutchips,I had cervical stitches at 14th week of pregnancy. There are no risks after treatment with LLETZ for women who are concerned about getting pregnant after it. My dr was a bit crap today and didn't know about any complications it might cause so told me to speak to the midwife at the booking in appointment. You will be put to sleep (general anaesthetic) for the cone biopsy and for this reason you may need to spend the night in hospital afterwards. The most common way to remove abnormal cells is using a procedure called large loop excision of the transformation zone (LLETZ). If you had a colposcopy only, then the bleeding and discharge may pass after a few days. If a smear test shows an abnormal result, you may be invited to have a colposcopy, a further examination where a doctor looks at your cervix and often takes a biopsy, a small sample of cervical tissue. official website and that any information you provide is encrypted Conclusion: LLETZ during pregnancy can be performed if invasive cancer cannot be excluded by colposcopy, cytology, or biopsy. Sandeep Bhandari is the founder of ExactlyHowLong.com website. A woman must wait for eight weeks after LLETZ to get pregnant. How long After LLETZ Do You Bleed For (And Why). Im in the same boat. xx, Congrats on your BFP! Next review due: 24 May 2025, A smooth, tube-shaped tool (a speculum) is gently placed into your vagina to open it. I have an appointment to talk to my doctor about it today but want real life stories. You should feel back to normal within 6 weeks. I hope all goes well with you and the problem can be sorted fairly easily, Thank you! If you have any physical or emotional effects after LLETZ, it is important to speak with your doctor or nurse so they can give you support. But you might be at the hospital for several hours from getting there to going home. and transmitted securely. I just read about your scare too. 2019 Sep;8(12):5425-5430. doi: 10.1002/cam4.2435. Xx, Hi I dont have any advice on this in particular but I will be having an app this week on possibly getting a stitch put in place due to my first loss, so I can send more info on the stitch as and when i get it x not sure if that helps on your particular situation tho xx, Hello! Good luck! Sorry you had a scare. LLETZ is often done at the same time as your colposcopy. How can you distinguish between normal and not? Thepelvic pain, which is the common side effect, lasts over a couple of days to around two weeks, but this is a clear indication of recovery. Best of luck to you xx, Thank you! doi: 10.1002/14651858.CD010757.pub2. Epub 2016 Aug 9. Did they tell you these had to be taken vaginally? One (3.7%) patient had a postoperative missed abortion. 2017 Feb;124(3):495-502. doi: 10.1111/1471-0528.14247. I had cin3 letz procedure march 17 then had my first baby Feb 19. Finally, it can be concluded that LLETZ prevents the development of cells into cancer in the cervix. Diane, Hi I had LLETZ procedure and am now in third trimester. Before sharing sensitive information, make sure youre on a federal The .gov means its official. If it gets to below 25mm they will discuss a stitch. Home PregnancyHub Premature labour and birth At risk of premature birth About premature birth Cone biopsy and LLETZ Clinical management and follow-up of squamous intraepithelial cervical lesions during pregnancy and postpartum. nothing was mentioned during my procedures to suggest that it would be a problem. I had my LLETZ done 22 years ago now (I'm 42) and just had my embryo transferred last week (positive according to HPTs). I hope your 32 and 36 scans go ok and all is well. When you arrive at the hospital or clinic, you'll speak with a nurse about what's going to happen during the colposcopy. The cervix is really a muscle that keeps the entrance to the womb closed unless a woman is in labour. Wow! MeSH I wonder whether it might be an idea to have a hysteroscopy so that your womb. So exciting you're carrying twins! Those who had LLETZ when compared to cold coagulation miscarried more often in the first trimester (33.7 vs 17.3%; p = 0.01) than in the second trimester. It is found cervix heal within six weeks. 2017 Nov 2;11(11):CD012847. A lot of the women on it discuss LLETZ and how their body was during pregnancy / treatment. Kleenmaid DW6030 Eco Sensitive Stainless Steel Dishwasher, Feel Foot-Tastic And Put A Spring In Your Step With A Scholl Prize Pack Valued At $325, A School Mum Has Been Selling The Clothes I Donate To Her, Were Having A Love Affair With Amazon Prime (And You Should Too!). The procedure has a . And I dont see any difference of having stitches at cervix actually ( I dont have more physical activity other than cooking from FET). You will first have an injection of local anaesthetic to numb your cervix so you should not feel any pain. For the 149 women from the case cohort, the mean birthweight was 3380 g compared with 3373 g in the control group (P = 0.88). I only have cin 1 so very early stages and cant see it changing over the next year, what does anyonelse think? Hi lovely, yes me! Ive since found out that this can increase the risk of pre-term birth, which is obviously a scary thing to hear! Just quite nervous about it xxx, It's just not what you need is it!! It takes that long after LLETZ to get pregnant because the cervix needs ample time to rest and recover. Did they say theyd put a stitch in if needed then? After all these years trying to get pregnant Im now worried about this. How Long After LLETZ Can You Have A Bath (And Why)? Hey just looking for some advice I had a LLETZ procedure done three years ago and Im now pregnant I had 15mm removed when I had it dont just wondering if this caused any problems for anyone else? My doctor did it because i got only one blastocyst from my previous round and she didnt want any risk of miscarriage. Cervical intraepithelial neoplasia in pregnancy. The surgeon starts with giving local anesthesia to numb out the pain in the cervix. Hello lovely, hope you're doing ok! She won't contact me until I'm 8-12 . Yes, my niece had pre cervical cancer cells removed and she went on to have 2 successful pregnancies. An official website of the United States government. 2016 Jul 28;354:i3633. I found m/c to be the saddest thing to happen. Thanks so much. He arrived on time weighing a hefty 10lb 4oz! I mentioned it to my midwife and she said Ill get a scan to see how short the cervix is. Disclaimer. I'm going to mention this at my six week scan- thanks for asking the question! i was diagnosed with cin 2/3 in January and had surgery in March. Cervical intraepithelial neoplasia and the risk of spontaneous preterm birth: A Dutch population-based cohort study with 45,259 pregnancy outcomes. The colposcope does not go inside your vagina, You may feel a little uncomfortable, but you should not be in any pain, The doctor or nurse will put liquids on your cervix. I fell pregnant in 2019 but I was under the worst hospital in the UK and they wasn't **** about it so didn't check me, anyways my baby died at 21 weeks die to an abruption obviously completely unrelated but we never knew if my cervix was incompetent or not because I had Maisie very early. One of the most common treatments that women receive following diagnosis is a loop biopsy, usually called LLETZ, which stands for large loop excision of the transformation zone, or LEEP, which stands for loop electrosurgical excision procedure. And congratulations to you too! 6 weeks pregnant pinkish discharge sorry for TMI. On Facebook theres a group called incompetent cervix UK - pregnancy related you might find useful. Hope you're keeping well!xx, Thanks so much Cinderella! Hope your ok, Thanks so much lovely, I really appreciate that. Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study. doi: 10.1371/journal.pmed.1003665. However I dont think its that common to have issues (from my experience and my OB being super chilled about it). 2014 Sep;180:51-5. doi: 10.1016/j.ejogrb.2014.06.011. This risk can depend on the amount of cervical tissue that has been removed. A total of 199 pregnancies from 178 women was identified from the cohort of women. Last month I experienced my first chemical miscarriage. It's the most common treatment for removing cell changes in the cervix. The site is secure. All rights reserved. I love all the twin stories on here. Hi hun just thought Id update you on info about the stitch , my consultant said they would give me further information when I need to actually have it done So sorry just thought id let u know that I hadnt forgotten. I love anything related to the Web and I try to learn new technologies every day. Hopefully next month he will make his appearance. A microscope with a light attached (colposcope) is then used to look at your cervix. Sageekins I replied to your Question yesterday but I cant see it. Did you have this symptom? Case Rep Obstet Gynecol. Hi lovely I had a lletz in 2019 and had my 28 week appointment today with consultant as the pregnancy is classed as high risk (because of IVF and my age) I specifically mentioned the procedure and he said he wasnt concerned and my midwife throughout hadnt been either as cervix has been closed and the correct length etc. Methods: Apparently there are different ones that you can have but the safest is a TAC stitch which is high up. i was diagnosed with cin 2/3 in January and had surgery in March. Unauthorized use of these marks is strictly prohibited. The https:// ensures that you are connecting to the Accessibility lol i am trying to explain that at the mo i dont have those risks if we tried now and that if we wait till after the treatment i could be worrying more with the risks! MeSH Conclusion: Small lesion size measured by colposcopy may predict absence of cervical intraepithelial neoplasia in a large loop excision of the transformation zone specimen. Unable to load your collection due to an error, Unable to load your delegates due to an error. My first transfer on the NHS was a nightmare because they couldnt get the catheter in.
