Thursday, November 08, 2007

Because I Don't Have A "Too Much Information" Filter

So, like I said yesterday, I went back to the OB/GYN. More specifically, the reproductive endocrinologist who performed my total hysterectomy last year (the hysterectomy I'm still kind of ticked off about, even though I don't have anyone at whom to direct my anger, or even a strongly-worded letter of complaint). I sat in his office and boo-hooed for several minutes about all the things that are wrong with me, particularly the dry skin, weight gain, errant hairs, "panic attacks" and general malaise and sleeping disturbances, etc. And to every symptom I'd mention, he'd nod sympathetically and opine that yes, that could be a problem caused by low estrogen levels, particularly due to my (relatively) young age at the time of surgical menopause, the high level of estrogen I was producing before, and the fact that I also don't have even my one single little ovary any more.

But before I get to all that, let me assuage the concerns of the VERY many of my virtual and real-life hyster-sisters who have written and spoken to me about the fact that I was told, after my surgery, that I'd no longer need to have annual Pap tests. Now, I had not researched this topic previously, and to me, it made perfect sense, seeing as how a Pap smear is a test which screens for cervical cancer, and, well...I no longer had a cervix. Fine, I figured--it made as much sense for me to be screened for testicular cancer every year. BUT THEN. Then I heard from seemingly every other woman on the planet who'd had a hysterectomy, who told me that THEY were certainly still having regular Pap smears, and that I'd better talk to my doctor about that! So I did. I told him that most of my family and friends plus the female half of the Intarwebs were concerned about this whole Pap smear issue, and could he give me a source to back up his seemingly heretical claim that this was something about which I need not be worried? He could, he said, and he did--in the form of the American Cancer Society.

While I was busy changing out of my dee-lite-ful lady-exam outfit (oh, great sneezing heffalumps, there MUST be a more dignified alternative--get on that, wouldja, medical community?) back into my street clothes, the doctor went to his office computer and printed out this article from the front page of the ACS website, titled, "Millions Get Unneeded Pap Tests." This article is dated 2004, but I guess things still haven't changed much. Some key quotes:

Researchers from the VA Outcomes Group in White River Junction, Vermont, estimate that 10 million American women who have had a total hysterectomy are still getting Pap tests. They published their findings in the Journal of the American Medical Association (Vol. 291, No. 24: 2990-2993).

"We were quite surprised by these results because women are getting screened for cancer in an organ they no longer have," said lead author Brenda Sirovich, MD, MS.

Such unnecessary screening not only wastes money, it takes up valuable time that could be better spent discussing other health concerns a woman may have, she added.

Women who have had a total hysterectomy, however, fall into a different category. Because this operation removes the cervix in addition to the uterus, most women who've had it are no longer considered to be at risk of cervical cancer. (Women who've had a partial hysterectomy, which leaves the cervix intact, are still at risk and still need to be screened.)

ACS screening guidelines say that women without a cervix no longer need to get Pap tests unless they have a history of cervical cancer or precancerous conditions. The US Preventive Services Task Force, an independent panel of experts, also recommends against Pap tests in women who have had a total hysterectomy for a noncancerous condition, as does the American College of Obstetricians and Gynecologists.

At last count, at least 69% of women who've had total hysterectomies are still having annual Pap tests...that's about TEN MILLION unneeded Pap tests a year. I can't help but wonder how that translates into dollars, and how those dollars affect the bottom line of our health-insurance premiums. You should still have an annual pelvic exam (along with a breast exam and the ever-delightful rectal exam) with your OB/GYN, so I'm sure a lot of people would just think, "Hey, the doctor's in there, anyway, what difference does it make?" And I'm OK with that, if that's your choice, or you have reason to be concerned, but again, I do wonder about the financial impact of those millions of tests on phantom organs. What do you reckon that would equal in billing to insurance companies? A BILLION dollars (assuming each test costs $100)? More? How might that money be better spent, or how might our health-insurance premiums be affected if we could shave a billion or so smackeroos off our HMOs' payouts?

Do read that article in its entirety--there are interesting points to be made about how doctors must practice "defensive medicine," (there is a very rare form of vaginal cancer that could be picked up in a post-hysto version of a "Pap" test), and the tip of the "treatment quotas" required by HMOs to keep doctors eligible for inclusion in their programs is revealed. It's fascinating stuff.

Me, I'll probably get the occasional scrape once every few years, and have those vaginal cells checked out...but I won't be demanding that my doctor scrape an imaginary cervix annually.

Moving my hormones increased. Despite my psychiatrist kind of dismissing the idea of hormonal imbalance (of course, he's MALE, so whatever) out of hand, I went ahead and had blood pulled for thyroid and sex-hormone tests yesterday. My doctor phoned me this afternoon, and guess what? MY ESTROGEN LEVEL IS LOW. How about that? And yes, I could have saved, what--a YEAR of grief and angst by just listening to my mother? Yes. Anyway. Now, instead of wearing one .1mg Vivelle Dot patch, I'll be wearing one and a half. Or two of the .078s. Whatever. A 50% increase in dosage for the next three weeks, and if I don't just feel like dancing a jig at that time, I'll go right on up to double the dose. And since I'm not of menopausal age, had sudden surgical menopause, and do not have ovaries, I have little to fear from estrogen replacement.

So, even though I'm not feeling it yet, there is hope on the horizon. Maybe I'll be able to go grocery-shopping without busting out into an all-over burning-hot sweat amidst the frozen peas? Could it be true? That I won't collapse into tears over that particularly poignant Cheerios commercial, or fall apart every morning (mornings seem particularly hard, until well after noon) when my daughter hugs me goodbye when leaving for school? That, on those rare days that I actually make it IN to work, I won't become so lightheaded and fainty that I have to close my door and face-plant on the carpet of my office for twenty minutes?

Those will be good times, indeed, and I look forward to them.

OH, and get this! (What, you were just feeling relief that this post was over? GOTCHA, sucka.) When I checked out at the gyno's office, where I haven't been for the last year, and was preparing to pay my 10% co-pay for the visit, the clerk tapped on her keyboard and said, "Oh, you had a credit, so today's visit is taken care of." I found this odd, since I hadn't been there in over a year, and asked her, 'Um, how much of a credit did I have?" The answer was, enough to pay the co-pay on my annual visits for years--about $300. I nearly fell over. I said, "Uh, since it will take me years to spend that here...could you just, you know, give me my money BACK?" She tapped a little more, and told me she didn't know how to do that, and would have to ask someone in accounting. I very nicely told her that, yeah, she'd better go on ahead and do that. I'm wondering, if I had OWED the doctor's office $300 for the last year, do you think accounting would have been just letting THAT slide?


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  1. This is why I go to a lady doc. And hell no, they wouldn't have let you slide with a $300 bill for over a year. Call them every day until you get your moolah. Kick some ass!

  2. Great sneezing heffalumps is right. I have PCOS, and take shiteloads of high dose pills to keep it under control so I can still get my period which is kind of stupid since I am not going to have biological children anyway and since ovarian cancer runs in the family, BUT it does keep my moods more in line with my psych meds. I hate crying at OnStar commercials while driving.

    Thanks for the Pap info. I have a few folks to pass that onto.

  3. I had rotator cuff repair surgery about a year ago and they overcharged me almost $600. I fought for almost 6 months to get the damn money back. Good luck. (And dude, why don't they make at least decorative paper gowns? Let us choose what one we like while we bare our ass and other bits to the entire office.)

  4. Coupla things, cuz I'm nothing if not handy with the assvice.

    First: My (old, because my new one is an idiot) doctor told me that a pap every three years is sufficient, but not to skip THAT, because of that rare vaginal cancer you mentioned. I have noticed that the cervix-free pap is equally as uncomfortable as the former kind, but I guess it beats dying of coochie cancer.

    Second: I wonder if you are, for some reason, just not a good match for the patch? .1 should be plenty, and if you need a higher dosage to keep you out of meno-hell, personally I'd be asking if it's possible that your absorption isn't what it ought to be. Did you discuss other options with your doc? There's the Nuvaring, there's a topical gel (that's what I'm using now, and having better luck with it than I did with the Vivelle Dot)... there's even oral hormones, although that would be a last choice. Just curious if there was any talk of changing delivery method, is all. Because I care. About your lady bits.

    Wow, that wasn't creepy at all.

  5. Makes sense to me. How and why would you biopsy for a disease of parts that have been removed?

    As for the gowns, I think you should arrive for your next appointment in a silk dressing gown....and refuse to take it off.

    Hope the increase in replacement hormones helps quickly.

  6. Totally makes sense about the less-frequent paps, Health Canada has changed our guidelines here recently and healthy women with no history of or excessive risk factors for cervical cancer are now only recommended to have a smear every two years. So I can see why full hysto patients wouldn't need one annually.

    Loved the 'great sneezing heffalumps' line. I may use that in conversation. A residuals cheque will be mailed.

  7. Moral of the story: Always listen to your mother.

    Hope the new hormones work wonders!!

  8. hmmm I have my annual next month and now I am thinking I can avoid my butt being seen for another year. I mean I don't even look at my butt. I don;t want others having more information that me.

    But I was thinking of secretly having my IUD taken out during the appt. I asked my hubby if I could and he looked at me perplexed and said "For what reason?" So I guess if i cancel the appt I might save my soul or marriage.

    Hope your feeling more chipper soon.

    Your a funny one missy! I am sure my life is as amusing as yours but these dang black lenses don;t let me see it.

  9. Since my total laparoscopic hysterectomy, I am supposed to get a pap test every six months, which is twice as often as normal. My lady doctor told me that because I had had cervical cancer, she wanted to make sure that it hadn't gotten into the surrounding tissue to resurface. I'm all over not having to deal with cancer again.

    I hope the extra estrogen does the trick. Kudos for circumventing the stupid doc and taking control.

  10. Wow, I had no idea there was so much involved in hysterectomies. Yikes. glad your hormone level is up, though.

    "Since the doctor is in there anyway..."? Lol, lol.

  11. Both my mom and best friend had hysterectomies at 25 - and I don't think my mom has had a pap since then, but quite frankly, we don't chat about that.

    BUT, I will tell you that at a pap I had a few years ago, they told me my co-pay was $40, because the doctor was a SPECIALIST, every other pap I had was $20. I argued a bit with the girl - but then reluctantly paid the $40. Guess what I got at the end of the year? A check for $20 damn dollars from the doctor's office.

    Also, I once had a pap smear at the Student Health Center when I was in college and right when I was IN THE STIRRUPS, we had an earthquake. Nice, right?

  12. CROOKS! I hate how every time I go to pick up a prescription it's a different story - copay one time, full payment one time, NO payment another time. MAKE UP YOUR MIND, INSURANCE COMPANY. AND PLEASE CHOOSE NO PAYMENT. OR COPAYMENT.

    I feel for you on the hospital dress thing. I feel really gross in those things. Really naked and gross. Maybe I'm just a total prude!

  13. Schmutzie -- Right--that was the important distinction, if you had a history of cervical cancer or even precancerous cells/abnormal paps), then YES, you still get the smear.

    Interestingly, you can still get a cancer that presents exactly like ovarian cancer, if you've had your ovaries removed. No screening process for that, unfortunately.