Cue emoji of disapproval
Aug. 13th, 2015 11:48![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
torquillSo, I want to get this out of my head so I can stop looping on it and get on with a (hopefully) productive day.
I went to see my primary care doctor today. I had never met him before, so I was guardedly optimistic. He said that my pap smear came back inconclusive, so I just need to reschedule for a year from now... no big deal. Maybe I'll have Planned Parenthood do it, since I trust their technicians to read it accurately. (A little more concerning was that the sample for HPV was taken, but not run for some mysterious reason, but whatever. I'm protected against most strains anyway.)
Then we got down to business. I'm fine on vaccines. I wanted routine blood and urine tests, since I hadn't had an annual exam in over 5 years. That's fine, he already had them drawn up. What about T3/T4? He saw no reason to do those without an abnormal TSH. Cue my insistence that I have several friends with hypothyroid who have a normal TSH: "oh, that's not typical". I don't think that my thyroid is a problem -- I agree with him, I don't have symptoms that lead me to suspect it -- but he seemed resistant to the prospect of doing a full spread just in case. So, friends who suggested I get my thyroid tested: I did try. A least I'll get a TSH, for what that's worth.
We started talking about my birth control regimen, then he made me back up and recite the whole thing (I wish I'd brought my detailed notes; I thought he would have the ones from my gynecologist). Everything from October onward. While discussing and clarifying things, he tried to separate out when the bleeding issues came up; since the symptoms I had in October (high libido and nausea) were psychological, then it would seem--
I interrupted him and said they weren't psychological, they were hormonal. Oh, of course, he waved, and went on that the bleeding problems had started in April with my visit to the ER, and before that my cycles were normal. So, looking over my history, he thought it was pretty evident that all the problems I was having were medication-induced, and that there was no underlying problem.
...buh?
I asked him why he thought there was no underlying problem. Well, since the constant bleeding hadn't come up until I got the Depo shot and went off the Nuva-Ring, and I had been changing birth control methods every few weeks since then, the effects of one hadn't had a chance to wear off before the next change came, and everything was disrupted. I told him that every provider of birth control I had spoken to had said that the effects of pills (and especially the ring) wore off within a couple of weeks, and he said that I hadn't even given it a couple of weeks each time. After all, hormones have extensive reach, and change DNA expression and a bunch of other things, and that could have lasting effects...
Did he just jazz-hands me? I think he did.
What about the fact that I had been on the ring for several months before I got the really heavy bleeding in April? I mean, go-to-the-ER heavy, out of nowhere, after twenty-five years of average periods? "Oh, that happens." Twice? *shrug*
No, it's nothing to do with menopause. And blood tests for hormone levels aren't really something we do, especially since it's all due to the medication changes -- though your gynecologist ordered an FSH test (which she hadn't told me she requested). Endocrinologist referral? Oh, that's really not necessary. We'll just see you back here in three months. And we'll do a manual blood-pressure test before you go, since you said you react badly to the automatic machines.
Sigh.
I didn't bother bringing up the "Obesity" diagnosis, because I didn't feel like getting my arguments against the BMI dismissed as well.
I told him, during the course of things, that I have had CFS since I collapsed in '96, and we went through a brief history of how I was treated unsuccessfully for depression, then fibromyalgia, then went to my doctor ten years later and simply asked for a CFS diagnosis so that I could get accommodations in college. Maybe I should have been more coy about how I got diagnosed, but FFS, there aren't any tests for it, and ten years of living with it is as good a differential as any. Who knows whether he believed it; he asked about my symptom profile and just nodded. He didn't remark on the chemical sensitivity at all.
I discovered afterward that, despite my efforts to calm my body and mind after that session, as soon as I feel a blood-pressure cuff placed on my arm, I get an adrenaline spike. The nurse read 150/89. So much for the manual method being more accurate; apparently I've been so traumatized by the automatic machines (especially the one in the ER, which was f*cking EXCRUCIATING) that I have a conditioned terror response. Ergo, given that it's the only blood pressure test available, there is no way to accurately measure my blood pressure. I'm sure that my doctor will figure it all out, though, and decide that I really have high blood pressure and I'm in denial, and that I should just take these nice blood-pressure meds...
Cynical? Did that sound cynical to you? I wonder why.
I'm supposed to make an appointment with him in three months. I think I'll conveniently forget to call to make one. He wants me to get my blood pressure taken again in two weeks; god knows whether I'll keep that appointment. I'm not sure there's any point. I mean, I could desensitize myself to blood pressure cuffs (and then assiduously avoid the automatic ones), but that would take months. An easier solution is to just add blood pressure to weight, and refuse all vitals when I go into appointments. If I do have high blood pressure, I'll take my chances.
All of this stomped all over my triggers of "person in charge does not believe me" and I ended up driving out Marsh Creek Road and back again, alternately crying and laughing hysterically. The most absurd part? When I said that I had no fertility plans, and that if I could have gotten a tubal or hysterectomy earlier without paying out of pocket I totally would, he said, "Oh, do you want me to refer you? I could do that right now." My jaw dropped. It turns out that he is the first doctor I've encountered who is willing to approve sterilization for women without hesitation, and says he'd do it at any age. So I guess if I want to get a tubal (once the hormone crap is sorted out) I know where to go... assuming, of course, I'm not menopausal by then. And assuming I'm willing to talk to him, and haven't told him off to the point where he won't talk to me.
So: not only do I not have a partner in healthcare, as it stands I have something of an opponent. I'll see about trying another doctor once the test results are in -- maybe in Martinez, where the pool is larger -- but it's looking like even more of a crap shoot than Kaiser was. I'm pretty disillusioned, and convinced that the only person competent to supervise my health care is me.
And in three months, or two years, or at whatever point from now that I figure out what the hell is going on, I'll write a nice letter to Dr. Chun and tell him that he was wrong, and that maybe he should review sexual hormone function again. Because there's a difference between "mid-cycle spotting" and "bleeding which does not respond to treatment", and hormones are meant to be quick signals which dissipate quickly. I know a snap diagnosis when I see one -- but it's not like I'm a diagnostician or anything. I'm just a fat chick with hypochondria. #notbitter
I went to see my primary care doctor today. I had never met him before, so I was guardedly optimistic. He said that my pap smear came back inconclusive, so I just need to reschedule for a year from now... no big deal. Maybe I'll have Planned Parenthood do it, since I trust their technicians to read it accurately. (A little more concerning was that the sample for HPV was taken, but not run for some mysterious reason, but whatever. I'm protected against most strains anyway.)
Then we got down to business. I'm fine on vaccines. I wanted routine blood and urine tests, since I hadn't had an annual exam in over 5 years. That's fine, he already had them drawn up. What about T3/T4? He saw no reason to do those without an abnormal TSH. Cue my insistence that I have several friends with hypothyroid who have a normal TSH: "oh, that's not typical". I don't think that my thyroid is a problem -- I agree with him, I don't have symptoms that lead me to suspect it -- but he seemed resistant to the prospect of doing a full spread just in case. So, friends who suggested I get my thyroid tested: I did try. A least I'll get a TSH, for what that's worth.
We started talking about my birth control regimen, then he made me back up and recite the whole thing (I wish I'd brought my detailed notes; I thought he would have the ones from my gynecologist). Everything from October onward. While discussing and clarifying things, he tried to separate out when the bleeding issues came up; since the symptoms I had in October (high libido and nausea) were psychological, then it would seem--
I interrupted him and said they weren't psychological, they were hormonal. Oh, of course, he waved, and went on that the bleeding problems had started in April with my visit to the ER, and before that my cycles were normal. So, looking over my history, he thought it was pretty evident that all the problems I was having were medication-induced, and that there was no underlying problem.
...buh?
I asked him why he thought there was no underlying problem. Well, since the constant bleeding hadn't come up until I got the Depo shot and went off the Nuva-Ring, and I had been changing birth control methods every few weeks since then, the effects of one hadn't had a chance to wear off before the next change came, and everything was disrupted. I told him that every provider of birth control I had spoken to had said that the effects of pills (and especially the ring) wore off within a couple of weeks, and he said that I hadn't even given it a couple of weeks each time. After all, hormones have extensive reach, and change DNA expression and a bunch of other things, and that could have lasting effects...
Did he just jazz-hands me? I think he did.
What about the fact that I had been on the ring for several months before I got the really heavy bleeding in April? I mean, go-to-the-ER heavy, out of nowhere, after twenty-five years of average periods? "Oh, that happens." Twice? *shrug*
No, it's nothing to do with menopause. And blood tests for hormone levels aren't really something we do, especially since it's all due to the medication changes -- though your gynecologist ordered an FSH test (which she hadn't told me she requested). Endocrinologist referral? Oh, that's really not necessary. We'll just see you back here in three months. And we'll do a manual blood-pressure test before you go, since you said you react badly to the automatic machines.
Sigh.
I didn't bother bringing up the "Obesity" diagnosis, because I didn't feel like getting my arguments against the BMI dismissed as well.
I told him, during the course of things, that I have had CFS since I collapsed in '96, and we went through a brief history of how I was treated unsuccessfully for depression, then fibromyalgia, then went to my doctor ten years later and simply asked for a CFS diagnosis so that I could get accommodations in college. Maybe I should have been more coy about how I got diagnosed, but FFS, there aren't any tests for it, and ten years of living with it is as good a differential as any. Who knows whether he believed it; he asked about my symptom profile and just nodded. He didn't remark on the chemical sensitivity at all.
I discovered afterward that, despite my efforts to calm my body and mind after that session, as soon as I feel a blood-pressure cuff placed on my arm, I get an adrenaline spike. The nurse read 150/89. So much for the manual method being more accurate; apparently I've been so traumatized by the automatic machines (especially the one in the ER, which was f*cking EXCRUCIATING) that I have a conditioned terror response. Ergo, given that it's the only blood pressure test available, there is no way to accurately measure my blood pressure. I'm sure that my doctor will figure it all out, though, and decide that I really have high blood pressure and I'm in denial, and that I should just take these nice blood-pressure meds...
Cynical? Did that sound cynical to you? I wonder why.
I'm supposed to make an appointment with him in three months. I think I'll conveniently forget to call to make one. He wants me to get my blood pressure taken again in two weeks; god knows whether I'll keep that appointment. I'm not sure there's any point. I mean, I could desensitize myself to blood pressure cuffs (and then assiduously avoid the automatic ones), but that would take months. An easier solution is to just add blood pressure to weight, and refuse all vitals when I go into appointments. If I do have high blood pressure, I'll take my chances.
All of this stomped all over my triggers of "person in charge does not believe me" and I ended up driving out Marsh Creek Road and back again, alternately crying and laughing hysterically. The most absurd part? When I said that I had no fertility plans, and that if I could have gotten a tubal or hysterectomy earlier without paying out of pocket I totally would, he said, "Oh, do you want me to refer you? I could do that right now." My jaw dropped. It turns out that he is the first doctor I've encountered who is willing to approve sterilization for women without hesitation, and says he'd do it at any age. So I guess if I want to get a tubal (once the hormone crap is sorted out) I know where to go... assuming, of course, I'm not menopausal by then. And assuming I'm willing to talk to him, and haven't told him off to the point where he won't talk to me.
So: not only do I not have a partner in healthcare, as it stands I have something of an opponent. I'll see about trying another doctor once the test results are in -- maybe in Martinez, where the pool is larger -- but it's looking like even more of a crap shoot than Kaiser was. I'm pretty disillusioned, and convinced that the only person competent to supervise my health care is me.
And in three months, or two years, or at whatever point from now that I figure out what the hell is going on, I'll write a nice letter to Dr. Chun and tell him that he was wrong, and that maybe he should review sexual hormone function again. Because there's a difference between "mid-cycle spotting" and "bleeding which does not respond to treatment", and hormones are meant to be quick signals which dissipate quickly. I know a snap diagnosis when I see one -- but it's not like I'm a diagnostician or anything. I'm just a fat chick with hypochondria. #notbitter
no subject
Date: 2015-08-16 02:26 (UTC)And finally, ""What is the one thing we could have done better to most improve your experience with this visit?"
The one thing that would have made it better would have been to speak with a doctor who was not so accustomed to being right that he made snap diagnoses and then explained away the discrepancies with handwaving.
Let's see what they do with that.