Thursday, August 9, 2012

Putting the doc on notice

Part 3 of 3 (CONTINUED from earlier 2 posts):

So a week-plus after that initial conversation, bolstered by the intervening email with my doc and an in-person follow-up scheduled for Monday, I felt brave enough to actually reach out for that appointment with Dr. H's recommended gynecologist, Dr. W.

ASIDE: Can I just say how AWESOME it is to be able to send an email appointment request, so I know that my words will be received and recorded before I even step into that office? Love it!

Here's the email I wrote:

...please note that I will be accompanied by my fiance and will need him to be with me in the exam room in order to help me cope with the anxiety this appointment causes.

This appointment is for a follow-up to an abnormal PAP. I have been referred to Dr. W by my Primary, Dr. H. Dr. H has already spoken with Dr. W about my case.
Please put a note in my file that there is to be absolutely no discussion of weight or other general health issues by Dr. W or staff (aka your belief that I need to lose weight, eat less/differently, exercise more/differently; or any other non-gynecological issue). I have a history of eating disorders, anxiety and depression which are easily triggered in a medical setting, causing bouts of relapse.
I will see Dr. W to deal with the gynecological concerns raised by my recent physical, but will be fighting through significant fear and anxiety to do so. My overall health is being satisfactorily addressed by Dr. H, my psychotherapist, and other members of my health team. If Dr. W has any general health concerns, please relay them to Dr. H, who can deliver them in a manner that will not upset my other health progress.

NOTE: Please communicate by email only, NOT phone. I do NOT feel comfortable discussing gynecological issues during business hours, while I am at work. 

I just hope that it will be received in the spirit in which it was intended (firmly requesting/insisting on care that will not cause me harm, NOT being some sort of demanding, entitled diva type). I don't actually know if the doc will respect my wishes or not, think I'm cool and self-advocating or high-maintenance and non-compliant. But I've decided it's a WIN just to send the email. How the doc responds is another concern, for another day...

How do you think a doctor would respond if you sent an email ahead of time stating your needs, such as what I wrote? Do you have any other tips and tricks for managing fraught or fat-shaming situations?


Part 2 of 3 (CONTINUED from my earlier post of moments ago, where this little tidbit just didn't quite fit.)

Possible trigger warning (same as before): I'll be discussing gynecological issues and some sexuality shame that snuck up without warning and whacked me on the head like a ton of bricks... but so far no fat hate to warn y'all about (yay for small favors!)
Later in the evening, as the "You have an STD" portion of the conversation sunk in more, I began to feel really yucky. As in dirty, tainted, ashamed; feeling that my fiance would not want me - and should not; ugly stuff. For those of you not in the "mean voice in Amanda's head" club, you may have noticed we went from fact-land (per my doc, HPV is very common and hard to detect, no way to tell when you got it because it can lay dormant for years, no way to tell whether I or my partner brought it into our relationship, etc. etc.) to OMG BAGGAGE & SHAME in about 5 seconds flat.

I know that my sexuality hangups are all entangled and chicken-or-egg-y with my general body issues and hangups. When you grow up mistrusting your body, feeling undesirable, ungirly/unwomanly, diseased, etc., as I did - it seems only logical that dysfunctional relationship with my body generally would seep into a dysfunctional sexuality. this is a part of my personal self-work and my fat poz explorations that I've just begun to look into; I'm pretty sure I'm still just barely scratching the surface.

You may be interested to know (perhaps even proud of me, as I am a little of myself) that when I calmed down and realized all these nasty thoughts weren't just going away, I emailed my doc and told her some of my concerns. I asked her for some facts to help clear the cobwebs. Here's what she said:

HPV is a very common diagnosis. Unfortunately, there are typically no symptoms at all which is why we screen for it. In general, condoms are not very effective at preventing transmission... In most men, it causes no symptoms or problems at all. The one exception is that sometimes men can develop genital warts from this. Only if genital warts develop are we able to biopsy diagnosis HPV in men. Just to give you an idea, over 80% of women with more than a total of 5 lifetime partners will have HPV sometime in their lives. Over 95% of women with HPV will clear the infection on their own. I definitely think we should talk about this more, however. I'm hoping you can make an appointment for later this week.

I'm not totally sorted out, but it helped. 

Takeaway from round 2: Asking for help really does help. Being surrounded by people who care about you and feel strongly about you not feeling sh*tty about yourself helps, too. 

Have you asked for help recently (on a fat-poz issue or any issue)? How did it go?


Possible trigger warning: I'll be discussing gynecological issues and some sexuality shame that snuck up without warning and whacked me on the head like a ton of bricks... but so far no fat hate to warn y'all about (yay for small favors!).

Last week, in the midst of possibly the worst 'vacation' of my life (another story for another day!), I got a call from my primary care doctor, Dr. H. Super sweetie that she is, she had left a message earlier in the afternoon but didn't reach me, so she tried again around 5:30 or 6 in the evening to make sure she connected with me. She needed to tell me the mildly concerning news that my most recent PAP test had come back with some abnormal cells. She calmly and soothingly informed me that this does NOT mean I have cancer; that even if I do end up having pre-cancerous cells or cancer, it is super treatable and should NOT have any long-lasting effects, affect my ability to have children; etc. So far, so good.

Then she explains the plan from here:
  1. Go to an actual gynecologist (she's just a family medicine doc) for a biopsy to get a better sense of what we're dealing with. She explains this will feel like a "really long, more painful PAP". Joy. I'm starting to get anxious now. 
  2. You tested positive for HPV, which we know causes changes in cervical cells, so at least that explains why this has happened. AKA, I have a sexually transmitted disease. *(see note)
  3. What happens now? Well, even if everything comes back normal after the biopsy, you'll have repeat PAPs every 3-6 months (with the gynecologist stranger, not my beloved Dr. H).
  4. If it comes back precancerous after all... some sort of procedure where they freeze off the offending cells, blah blah it all becomes a blur at this point. I'm trying to cry quietly so she doesn't hear me losing my cool.

So Dr. H asks me how I'm doing. Poorly concealing that I'm losing it, I wobble out a watery, "Ok." I tell her that it's not actually the diagnosis freaking me out; it's the series of invasive-feeling medical appointments and procedures... it's been 3 years since I last got a PAP for a reason! She knows me well enough to know this is a Big Yucky Deal. I concede that if she'll refer me to a gynecologist she feels good about, AND if she'll call said doc ahead of time, that I'll go get this done. I need her to call and explain to the gynecologist that he/she is to discuss gynecological issues only with me, that I have a history of depression and eating disorders and they are NOT to discuss weight or weight loss in any way, so as not to trigger these issues. Dr. H agrees, saying she'll call as soon as we hang up.

Jealous of my amazing doc yet? As a sidenote, you should know that my relationship with this doc has only gotten to this point after YEARS of work and continual self-advocacy and reminding her of the principles of HAES that I need her to go with. She's still not perfect, but man, she totally cares about my overall wellbeing, and that's worth SO, SO much.

Take-away WIN from round 1: I was able to do self-advocacy in the midst of a crisis, in a stressful context (medical stuffs) which has tripped me up in the past.

What self-advocacy WINs have you scored lately? What self-advocacy opportunities do you need to practice up for so you're ready next time?