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 on...got 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?
So, What Is It With Me, Anyway?
Yeah, Scratch That