Today was my trip to the gynecologist. It was a very long day, oddly NOT because of the gynecologist and NOT because of how the system worked; it was incredibly effecient. It's just that I went in sure that all that was wrong was the onset of perimenopause, and I left having been tested for that but also a lot of other things and if not of those are positive I will have to have a uterine biopsy. It seemed as though they think polycystic ovaries are most likely and that's fine if it's true. I am at a much, much greater risk for that because of meds I take/have taken, so it would not be a surprise. However, it also doesn't match my symptoms well, at least not unless PCOS has oddball sx that I'm not seeing. I know I thought about PCOS way back when this started, because I knew my meds put me at risk. But it didn't fit well then so even if I have it it wouldn't make a ton of sense as the reason for all this female craziness. On the other hand, I'm praying for it. For one reason it is easily treatable with just one med that also helps lose the weight etc. that goes with that diagnosis (with side effects, of course and a big diet change). I also had about a gallon of blood taken, to see what my hormones are thinking, and an ultrasound that was both abdominal and transvaginal (yeah, that was not on my list of things to do ever) done. The potential answers at this point range from hormonal imbalance of some kind to having contacted HPV when I was molested (tI've been tested for STDs twice at least but she wants to check that again; I don't know if she sees something (I think she did based on when she decided to do this but I can't imagine I've had that hanging aroung for almost 20 years) to uterine cancer. And there must actually be some risk of that because she said I had to have a biopsy if the other tests are normal and she also told me that while she did the pelvic she was assessing whether she felt she could do it with me unsedated and that thanks to some little anatomical glitch she thinks I can. Good to know I guess.
I am not worrying about it (at least any more than you do when cancer or biopsy is even a possiblity). I think she knows I prefer bluntness and probably was just telling me the whole plan so that if things are all normal she's not calling me to say 'um, you need a uterine biopsy as this can be cancer'....I think she was also trying to fix the blunderings of her resident who had trouble following my story, and then insisted 2 things were important: exercises, which I'd love to be doing but first I have to be able to breathe and then I have to have energy to do more than sleep and work, and the fact that I am not a candidate for birth control. I kept explaining hormones don't help me and she kept saying if there is an imbalance that's the only way to fix it and I kept saying then fine, we won't fix it or perhaps we can try ________ instead. She was really insistent that the Mirena IUD would be great but I pointed out that I thought some people only recommend it after having a child and that since I've never even had sex it might be a bit hard to insert, especially with vaginnissmus that is significant enough I can't use any tampon and the fact that pelvics are highly traumatic for me, much less forcing something into my uterus that might have to just be removed if it had the effects previous treatments have had. (And that if I am going on hormones we want the thing that will get out of my system fastest, and that i can't start hormones until my asthma stabilizes which seems to be a ways off. She had clearly not bothered to read the notes from my real doctor. I kind of think my real dr. chewed her out because she came in and took over. No more mention of hormones. My dr. did the exam, which I was going to request anyway because she has a magic trick that makes it not hurt and totally, totally removes all anxiety. After knowing she would do what she did last time to make the vaginissimus better (and ladies, FYI, there is a muscle or group of muscles at the bottom of the vaginal canal that if you are shown where to relax takes away much of the discomfort of a pelvic and she says this is true for everyone but that few practitioners know/use the technique.) I had no problems with her doing it at all. I also thanked her for removing the fear from something important for me. The resident stood and watched and was quiet.
I don't mind the residents. I've griped before on her about them and I want that clear. They are there to learn and I am there to help them learn. I've been a student therapist. My problem is that they consistently want to not listen to the specifics of my condition and history and this results in them trying to force things upon me that are not appropriate for me. My situation is complex so therefore listening to me a bit about what I can and cannot do is reasonable, and they need to meet me with the knowledge that my set of issues makes me different. I'm probably not the best practice patient, although one of my favorite psychiatrists ever was a resident/fellow when I was in the clinical trial before I started seeing Dr. Brain. I think as a student you want people to fit into a box. I don't fit. I remember having this man with an undefined rapidly progressive neurological disease when I was a student. His plan was to go home so I started treating him the way we treated everyone going home: time in the morning working on dressing, bathing, etc. and time in the afternoon in the gym. Problem was that he simply wasn't capable of putting on pants and I was too inexperienced to know this, or to know that sometimes every trick in the book wasn't going to help when the problem was too complex or the pt. too ill to succeed. I made him cry, and that made me learn the hard way to always consider not only what they can't do, but is it reasonable for them to do it at all at this point. I apologized, but I have felt bad since and whenever I have a resident who won't listen I feel the same.
I need time to think about all this. And sleep.