26 September 2010

Just Another Pin Prick

Thinking that everything would move swiftly in the right direction by switching to a new doctor--and one that specializes in fertility-relalted issues--was probably a little dumb on my part.  The last doc had the personality of a wet rag, so I figured that switching to a new hand-picked doc would be a step in the right direction.  As of Thursday afternoon, I'm left wondering if I made the right decision.

The second-guessing began when I showed up for my first appointment just a few weeks ago.  I took a half-day from work to allow for travel time to Athens.  I ended up being very early, but my teacher bag full of papers to grade kept me company.  Since I was a new patient, the receptionist had asked for my insurance card and ID.  Over the years, I have discovered that if you stand by the sliding glass doors while they complete this task, they usually ask you to have a seat.  Then the moment your butt hits a chair, you're being called back to retrieve your plastic.  I bee-lined for the waiting room's plush off-white sofa, but was slow to get too comfortable.  A minute passed.  Then another.  When the receptionist hadn't called me back to the window within the first 5 minutes of my rear making contact with the sofa, I whipped out a stack of papers and commenced checking student work.  I had marked scores across roughly 12 math quizzes before the receptionist finally walked my cards to me.  That's right--she walked them to me instead of calling me over to get them myself.  The corners of her mouth were turned down and her eyes averted my gaze.  Her chin was tucked low.  She rubbed her fingers across the back of my driver's license, searching for an appropriate delivery of obviously bad news.  It was as if she were preparing herself to reveal that my dog had died.  Her deliberate movements from the door to the spot beside me on the couch made my stomach do a flip.  What could she possibly have to tell me?

"Victoria, we know your medical records arrived from your former clinic," she began, "but we can't seem to get our hands on them.  I remember seeing them, and I know I've handled them recently, but we must have accidentally put them in someone else's file."

I tried to digest what she had just admitted.  Do I blow my stack because yet another item on the lengthy list of what-else-could-possibly-go-wrong?  Or do I take a deep breath and realize it's a minor issue as compared to 130-day stints between periods?

Hmmmm…I definitely should go with the latter.

"Look, it's just paperwork.  It's not the end of the world."

"Not the response I was expecting," she exhaled, "but I'll take it!"  She went on to explain that I would have to answer a slew of questions for the nurse practitioner I was to see for this visit that would have been in my file.  My response reassured her that was fine with me.  And since getting their hands on my records required asking for them a second time from the old office, she promised to make the phone call and pay for the transfer fee.  That was acceptable to me.

I finally met with the nurse practitioner, who hurled all kinds of questions my way: family history, list of current meds and vitamins, stress levels, past surgeries, levels of physical activity.  Nothing was difficult to answer, but it was time-consuming.  It was all questions and no physical examination.  They didn't even check my BP or weight.

The NP then had me explain my concerns in getting pregnant.  I went over cycle lengths and negative pregnancy tests from the last 15 months.  Shocked at the extreme irregularity I have endured, she suggested a couple of possibilities.  First, she said it could be  a hormone imbalance, which would cause oligomenorrhea (having only 4-9 periods a year).  Yep, that sounds about right.  Second, she felt I may be experiencing difficulties with conception due to being underweight.  This was based on her visual head-to-toe assessment of my five-foot-four-inch frame.  A very real concern, yes, but I told her I eat 5-7 times a day and burn through every calorie I consume.  So we went back to the hormone idea.

She suggested I come in for a hormone test to be taken via blood sample on the 3rd day of my next period.  According to the NP, my last doc should not have tested my hormone levels in the midst of a menstrual desert, as he did back in December.  (Add that one to the list).  Estrogen and other hormones peak early in menstruation, so testing on the 3rd day would give a more accurate reading.  I told her I would call when I started my next period so I could schedule an appointment to have blood drawn, and she said she would call me once my medical records showed up--for the second time--at their office.

(Which just means I'm downstairs getting a snack, so go make a bag of popcorn!  There's a bit more to plow through…)

So I go back to the new doctor's office on the third day of my cycle.  The receptionist is also a registered nurse, so she happens to be the one who takes my blood sample.  She and I make small talk, mostly about the mysteriously disappearing medical file.  We share a laugh about it, and she openly admits she was afraid I would be "one of those" patients who would blow her stack over their lack of organization.

Sure am glad I didn't.  She was now the one sticking the needle in my arm.

I'm tremendously queasy around blood--even my own--so this isn't just another pin prick to me.  It's another internal battle of mind over matter, another moment of, "Holy crap, they are bottling my life juice into a see-through tube!"  With my eyes turned toward the lab room clock and focusing my physical sensations on the fist I have squeezed, I recited silent mantras: I must do this for a medical answer.  I must do this if Michael and I want a baby...

Strap removed and tube of plasma out of my sight, the promise is a phone call with the results a week later.  A phone call was a welcomed form of sharing test results.  No more plain copy paper that merely stated: THYROID NORMAL.  This had me thinking about chunking that list.

Then the phone call came while I was at work, so the NP left a voicemail:

"Victoria, everything looks normal.  Your estrogen levels are good, but give me a call when you get this so we can discuss a gameplan."

I ran to the classroom next door to talk about it with my teammate, Tamela.  Having grown close to her since I had been recruited to teach 5th grade, she had let me bend her ear about my uncertain fertility.  "They said everything was normal," I started.  "I should be happy, so why so I feel let down?"

"Well, you thought you would get an answer so that you might have the chance to fix it," she responded.  "It just ended up being anticlimactic."  She is like the voice inside my head that I never hear: it's to the point, but abounding with sagacity.

I called the NP back once I got home the same afternoon.  She repeated the same idea of how all hormonal levels were normal and that she wanted to do a progesterone level check at the end of my cycle.  Now, she said "all hormone levels".  I had assumed she checked my testosterone levels, but I asked her anyway.

"What about my testosterone?  Was that normal, too?"

"We don't test for that on the first run.  That's for patients when there is suspicion the PCOS might be the culprit.  You don't seem to have any of the signs anyway, like facial hair, acne, sweating…"

"Ummm, actually, I do."  Someone bring that damn list back!  "I have been getting laser hair removal for the last 2 years, I break out with every period, and I sweat like a sumo wrestler in a sauna.  That one didn't start until I went off birth control!"

"Oh, I guess I forget to ask about things like laser hair removal," the NP scrambled.  "I should know to ask since you can't always see those things.  Well, let's go ahead and order that progesterone level test and we can gauge from those test results if we should check your testosterone levels."

I calmly scheduled yet another test, thanked her for all of her help and hung up.  I was ticked, but I didn't want to have to go through switching doctors and starting new tests all over again.  My hope is that this will be where the oversights end.  So I will endure a few more pin pricks and other miscellaneous testing, and maybe soon we will be seeing a little blue plus sign.

Here's my laugh for the day!

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