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?


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  2. I am fortunate not to have actual anxiety about gyn issues per se, but I do have some difficulty tensing up my muscles with the discomfort of the exams (which then makes them take longer). When I had an IUD inserted, I took an anti-anxiety med ahead of time (Xanax); it did indeed help me stay relaxed through the discomfort. The gyn commended me on coming up with that idea when I told him.

  3. i have had two colposcopies (the follow-up to the PAP), and go for my third in a few weeks. i have a smattering of autoimmune diseases, so we aren't really surprised that my cervix wants to join the party.

    [edit: this comment gets long. there is frank discussion about my experience and opinion. if you think that would make you more anxious, feel free to ignore/delete/whatever you want without reading. my goal was to make you feel a little more comfortable with the thought of this whole garbage. hopefully it does.]

    they aren't as bad as you imagine. i mean, yeah, speculum and a big scope that looks like a modified version of what you rest your head on at the eye doctor, except the gyn uses it to look at your business.

    you are already doing amazing things for yourself in this process. having your husband there for you to help with anxiety is so great. if you're able to take xanax or something similar, do it. if you can continue an email conversation with Dr. W and he can get a prescription for you prior to your appointment, even better.

    it's uncomfortable-feeling. the actual process of obtaining the samples feels different than a PAP. it's more cells than PAP, so it's a different feeling. if you find the discomfort of a PAP unbearable, make sure you tell Dr W this as far in advance as possible. he might be able to prep you with a heavy-duty dose of tylenol or similar. if he doesn't, take your favorite OTC pain reliever 30-60min before the procedure, take some more after --- unless of course you have other medical considerations that bar you from these kinds of drugs. if this is the case, ask Dr H for help in this area.

    oh, and they might not tell you about the stuff they put on to inhibit bleeding afterwards. unless they have the superfancy new stuff (that my gyn does not have, but only told me that it exists), it's kinda gloppy and looks like coffee grounds. so if you see coffee grounds in your underpants for up to a week afterwards, you are okay, it's just your body discarding the goop.

    um. this comment has gotten epic. sorry about that. if you're on twitter, feel free to tweet at me with questions or anything. <3

    good luck!

    1. You rock. Thanks for the epic comment... love knowing others have gone before me and survived. I'm realizing this is so hard not just because of my particular issues, not just because of an anti-fat world, but more generally because even in this supposedly enlightened age this stuff is stuff we don't talk about with each other. So thanks for engaging in the dialogue with me! Many hugs! <3

    2. i'm so glad you found it helpful! the first time i was a little terrified, but now i'm just like, "okay dr. c., let's see how many times my cervix jumps out of the way of your little hole punch." i may sort of place bets with myself on it.

      the first time i had it done, the gyn said it looked like i had malar rash (the "butterfly" shaped rash on the face of most lupus patients) on my cervix. my rheumatologist didn't believe it. :P i am more than willing to believe my body does all sorts of shit it isn't supposed to. ha!

      if you want to talk more, feel free to email me (maggiemunkee (at) yahoo dot com). <3