More doctors
Nov. 9th, 2015 14:18![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
torquillNot the Time Lord kind, just the regular kind.
I finally got in to see the "when we don't know, we ask her" gynecologist. It was, in summary, the best experience I've had since I left Davis... she was extremely pleased to have a trans patient, asked me what my transition path was (since it might affect anything going on with my hormones), and we chatted a little about how society views gender now. That was a good start.
The first thing I noticed was that when she came in, she seemed to have read my file. Then, when what she had gathered from my file was immediately contradicted (no, I wasn't having extremely painful periods), she threw out the rest of her expectations and just listened. I handed her my timeline, and she scanned all three pages, then came back with good questions. It's what I've come to expect from a good doctor, and I had gotten so few experiences like that in the last five years that I was starting to question my standards.
She looked over my test results and agreed that a couple more, to update them, might be interesting -- but she said, right out, that the reference ranges for female hormones are totally bogus. They brought in 60 women who said they felt normal and tested them, she said, and that's where the ranges came from. So she ordered another set to compare to my previous ones, but didn't put a lot of stock in the reference numbers.
She pegged me for a scientist off the bat, and wasn't at all surprised when I admitted that I was a plant pathologist; I did clarify that I'm a field pathologist, though, and don't spend a lot of time in the lab, but I still know how to read papers. She hadn't heard of grapeseed extract as an aromatase inhibitor, but she took my word for it, and I promised to send her the papers I found on it (I need to do that). She was curious about everything, which is refreshing.
The bottom line is that she hasn't run across a case like mine, but she agreed with my conclusions, especially after learning my family history. This may just be the way menopause happens in this family. She said that I did indeed seem to be reacting badly to estrogen, but couldn't say why, nor whether my symptoms will resolve on their own. For the time being, I seem to have it under control -- I upped my GSE dosage after that, as I don't feel like I have to keep it at minimal levels anymore -- and she'll check in in January.
I am relieved not to get a "OMG, they didn't TEST you for that??" reaction. I am also relieved to have someone who listens, believes that I'm capable of assessing a situation correctly and making reasonable decisions, and who knows enough about the subject to be a sounding-board. When she said she wasn't sure how to help, I told her that all that was enough, and it's a weight off my mind to know that if I do come up with more information or a bright idea, I can discuss it with her.
A couple of the test results have come in, but I'm not expecting any epiphanies there. So we're back to wait and see, but a more relaxed wait than it was.
Meanwhile, today I went for a follow-up with my PCP (at her request). The contrast after the gyno was striking. She had to read over the notes in my chart (during the appointment) to familiarize herself with my case, then I had to go through the same song and dance about vital signs. She stated that I have a history of hypertension, and I had to correct her (again); she was the one who put that in my chart last time, despite my explanation as to why my readings were high. I'm afraid that label will haunt me for years and I'll end up explaining to every doctor I meet that no, I'm not hypertensive, and no, I'm not going to let you check it just to make sure. Sigh. (I even got the "silent killer" lecture.)
She made hints (again) that my weight is what's causing my estrogen levels to be high. I went a couple of rounds and dropped it, because I'm tired of that game.
She suggested a flu shot. I said no. She laughed dismissively and said "why am I not surprised." I'm sorry I'm so willful, my lady, but I have a 90% chance of getting laid up by the shot and about a 20% chance of catching the flu this season. Those close to me are immunized and I'm not in public regularly. And you stopped listening to my reasons because you're not interested in the fact that I actually think about this stuff rather than nodding obediently and taking your advice.
I'm headstrong and stubborn and I like to think (and advocate) for myself, which doesn't mesh well with the patriarchal jackasses I keep getting as doctors. I don't expect them to roll over and cater to my whims, but not feeling like every doctor's appointment is a heated debate would be nice.
I'm done with the appointments for now, but I think that next time I need a primary care doctor, I'll roll the dice again and hope for better. There's got to be better out there, somewhere.
I finally got in to see the "when we don't know, we ask her" gynecologist. It was, in summary, the best experience I've had since I left Davis... she was extremely pleased to have a trans patient, asked me what my transition path was (since it might affect anything going on with my hormones), and we chatted a little about how society views gender now. That was a good start.
The first thing I noticed was that when she came in, she seemed to have read my file. Then, when what she had gathered from my file was immediately contradicted (no, I wasn't having extremely painful periods), she threw out the rest of her expectations and just listened. I handed her my timeline, and she scanned all three pages, then came back with good questions. It's what I've come to expect from a good doctor, and I had gotten so few experiences like that in the last five years that I was starting to question my standards.
She looked over my test results and agreed that a couple more, to update them, might be interesting -- but she said, right out, that the reference ranges for female hormones are totally bogus. They brought in 60 women who said they felt normal and tested them, she said, and that's where the ranges came from. So she ordered another set to compare to my previous ones, but didn't put a lot of stock in the reference numbers.
She pegged me for a scientist off the bat, and wasn't at all surprised when I admitted that I was a plant pathologist; I did clarify that I'm a field pathologist, though, and don't spend a lot of time in the lab, but I still know how to read papers. She hadn't heard of grapeseed extract as an aromatase inhibitor, but she took my word for it, and I promised to send her the papers I found on it (I need to do that). She was curious about everything, which is refreshing.
The bottom line is that she hasn't run across a case like mine, but she agreed with my conclusions, especially after learning my family history. This may just be the way menopause happens in this family. She said that I did indeed seem to be reacting badly to estrogen, but couldn't say why, nor whether my symptoms will resolve on their own. For the time being, I seem to have it under control -- I upped my GSE dosage after that, as I don't feel like I have to keep it at minimal levels anymore -- and she'll check in in January.
I am relieved not to get a "OMG, they didn't TEST you for that??" reaction. I am also relieved to have someone who listens, believes that I'm capable of assessing a situation correctly and making reasonable decisions, and who knows enough about the subject to be a sounding-board. When she said she wasn't sure how to help, I told her that all that was enough, and it's a weight off my mind to know that if I do come up with more information or a bright idea, I can discuss it with her.
A couple of the test results have come in, but I'm not expecting any epiphanies there. So we're back to wait and see, but a more relaxed wait than it was.
Meanwhile, today I went for a follow-up with my PCP (at her request). The contrast after the gyno was striking. She had to read over the notes in my chart (during the appointment) to familiarize herself with my case, then I had to go through the same song and dance about vital signs. She stated that I have a history of hypertension, and I had to correct her (again); she was the one who put that in my chart last time, despite my explanation as to why my readings were high. I'm afraid that label will haunt me for years and I'll end up explaining to every doctor I meet that no, I'm not hypertensive, and no, I'm not going to let you check it just to make sure. Sigh. (I even got the "silent killer" lecture.)
She made hints (again) that my weight is what's causing my estrogen levels to be high. I went a couple of rounds and dropped it, because I'm tired of that game.
She suggested a flu shot. I said no. She laughed dismissively and said "why am I not surprised." I'm sorry I'm so willful, my lady, but I have a 90% chance of getting laid up by the shot and about a 20% chance of catching the flu this season. Those close to me are immunized and I'm not in public regularly. And you stopped listening to my reasons because you're not interested in the fact that I actually think about this stuff rather than nodding obediently and taking your advice.
I'm headstrong and stubborn and I like to think (and advocate) for myself, which doesn't mesh well with the patriarchal jackasses I keep getting as doctors. I don't expect them to roll over and cater to my whims, but not feeling like every doctor's appointment is a heated debate would be nice.
I'm done with the appointments for now, but I think that next time I need a primary care doctor, I'll roll the dice again and hope for better. There's got to be better out there, somewhere.
