Accessing healthcare while fat and female
Jun. 5th, 2019 10:13 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
livIf you don't want to read any further (and there's about to be a pile of content warnings), the important thing is I'm medically fine. But I've had more medical encounters in the last few months than would be ideal for a generally healthy person.
Content notes:
First I had a routine sexual health test, just because it was time for that. The actual check was fine, but arranging it was more annoying than necessary. The local sexual health clinic has an absolutely dire website, which is a consequence of cutting funding for things that are considered not medically essential. It contains almost no useful information for self-education, just links to auto-translated pages from a German sexual health service. It is possible, but massively fiddly, to use the website to book appointments and such, but most of the time it sends you round in circles and you kind of have to end up phoning people.
It tries to direct you to a home-based test if you're not in a high-risk category, which is fair enough. But the home-based kit is really bad; they're asking you to get a ml of blood from a finger-prick, which basically doesn't work, and the instructions as written are really bad, involving setting up part of the collection system after you've already stabbed yourself with the needle. Not surprisingly, I was unable to get enough blood for them to complete the test. So I went to book an in person appointment.
Booking was annoying. They couldn't cope at all with anything more than 'turn up for a standard panel of STI tests'. I was content with that, but ideally I wanted to deal with having had the first half of a hepatitis B vaccine but not the booster dose that's supposed to happen a year later. More than a year had elapsed (which is my fault, not the sexual health clinic's), and also I'd moved area, which is why I hadn't managed to get the booster shot on schedule. I also wanted to replace my IUD, which was inserted 10 years ago, but the clinic were absolutely unwilling to consider replacing it before the exact tenth anniversary. I think probably the best solution to this problem is to lie about the dates, or else to procrastinate for long enough that it is actually a full ten years, not sure.
So in the end I got my standard tests, which were straightforward and negative. And I convinced the clinic to at least measure my hepB titre, and they decided I'm fully immune and don't need a booster. They were a bit annoyed because their guidelines consider the risk that led me to get the vaccine in the first place was low enough that they wouldn't recommend a vaccine at all, whereas my previous sexual health clinic did advise me to get vaccinated.
So that was the planned healthcare. Then I had a massively painful period, suddenly out of the blue. I got scared, and was in too much pain to do anything useful. In this case the health system dealt with it really well. I couldn't get a same day appointment and it didn't seem like an actual emergency, but I did get a telephone appointment with a GP. She took me seriously, and didn't, as I had feared, just assume that period pain is a normal thing that women have to put up with. (I don't expect medics are massively sympathetic towards period pain in men either, but it's definitely an aspect of sexism that women's pain isn't taken seriously.) But her first diagnosis was, maybe it's not a period, it could be implantation bleeding and a symptom of early pregnancy. So she sent me to the pharmacy to get cocodamol and a pregnancy test. She wasn't very convincing on the topic of whether it was in fact safe to take a codeine-based drug if I might be pregnant; I think she hadn't quite connected the two prescriptions, but she seemed to think it was ok.
So I acquired those two things, and the pharmacist was generally not in favour of taking cocodamol if I might be pregnant *shrug*. From a combination of being in too much pain to think straight, and being a bit panicky by this point, I messed up taking the pregnancy test. (It was actually the first time I'd done so, because I long ago decided that with my level of tokophobia, taking a pregnancy test when I might happen to miss a period is going to be too miserable.) And again, not really thinking straight, I was embarrassed to go back to the pharmacy to ask for a second test kit, and instead asked to borrow from a partner who keeps a stash of them. Partner was massively, amazingly supportive; as a general rule, I would never consider telling a partner of a pregnancy scare before taking a test, but in this case I'm extremely glad I did. We had a useful conversation about what we would do if I did in fact get pregnant, which is worth renewing from time to time. I never really seriously believed that I was pregnant, because I pretty much trust my IUD. But I was still somewhat relieved to get a clear negative. I never ended up taking the cocodamol, because I was feeling too nauseous from the pain to be able to eat something with the medicine, and having received mixed messages I didn't want to take it if I was in fact pregnant, and by the time I'd got home, got hugs from partner, and taken the test I was feeling enough better that I was fine with my usual standby of ibuprofen.
The phone GP recommended I should make a routine appointment to see a GP in person, if I wasn't pregnant and if the symptoms didn't recur. Routine appointments usually have a several week wait, so by the time I did see the GP I had been completely fine for a few weeks. The GP took a good history, didn't make any assumptions, and didn't criticize me for being a whiner or wasting NHS resources over nothing. She carried out a small physical exam, just feeling my tummy externally, and not surprisingly couldn't find anything untoward. She decided to refer me for an ultrasound as a precaution, though she and I agreed it was probably just a one-off random thing. As referrals from GP to hospital go, it couldn't have been smoother; the GP filled in a form, I got a letter saying I would be getting details of an appointment, and then I did in fact get an appointment. There was no untoward delay, even though we were pretty certain by now there was nothing seriously wrong.
As it happened, I was due for a three-yearly routine cervical check (what used to be called a 'smear test') and ended up making the appointment for that the day before my hospital appointment. Being prodded with a speculum is never exactly pleasant, but the screen went as well as could be hoped for. The nurse and chaperone were extremely respectful and sensitive, and aware that lots of people have trauma around internal examinations, but also willing to take cues from me to be matter-of-fact about it. The actual procedure was easy and barely even uncomfortable, so kudos to the practitioners for handling that really well. I got a letter in the post fairly soon after saying, there was no HPV virus so they weren't going to bother looking at the cervical cells (this is part of why they're trying to move away from calling it a 'smear', as it's mostly based on looking for viral genetic material these days).
I was a bit nervous about the ultrasound, because although the hospital letter said it shouldn't cause discomfort, some of my uterus-having friends reported that they found the procedure extremely unpleasant, much much worse than taking a cervical sample. In fact it was fine, not something I'd choose to do for fun, and it goes on a lot longer than a cervical test, but for me it wasn't awful at all. Turned up at hospital in good time, got called in slightly before my appointment, again the sonographer and colleague were extremely respectful, talked through everything before they did it, and constantly checked in to make sure I was ok, pausing if I so much as drew breath sharply, let alone winced. The one thing they didn't do was follow the #MyNameIs protocol, and the room was dark to allow the sonographer to see her screen, so I didn't quite work out who the senior colleague was, a nurse or a doctor or a more senior ultrasound technician. And I'm the sort of person who is interested to see scans of my internal organs.
They found a big cyst on the edge of my ovary, and more smaller cysts than are supposed to be within the ovary. They didn't think it was likely to be anything serious; most likely it would resolve on its own, and the only reason they even knew about it was because the GP had referred for a scan as a precaution after my bad experience. They decided to send me for a blood test, and reassured me that it was nothing to worry about, just ruling things out, but didn't really explain what they were looking for in my blood. I pressed a bit, and they admitted that it was a CA-125 blood test, and re-emphasised that I shouldn't worry. So obviously I went and looked it up, and it turns out that this is a not totally reliable, but still indicative, blood test for ovarian cancer. I'm quite impressed, because I don't think there was any blood marker for ovarian cancer even a few years ago.
They clearly weren't worried, I could just make an appointment for a blood draw whenever convenient in the next few weeks. So I don't think I ever had any moment of seriously contemplating that I might have cancer. But anyway, I duly rocked up at the GP for my blood test and it was such an annoying experience. Usually older nurses are the best people to take blood, but this one was dreadful. She opened by nagging me about getting a general health check now that I'm over 40. I said I didn't want a health check because I'm not interested in being told to lose weight. At which point she argued over me saying that it's not about weight, it's measuring your BMI and waist circumference and suggesting that you make lifestyle changes to reduce your risk of a cardiovascular event. I mean, seriously, woman, I *just told you* that I'm not interested in discussing weight loss, don't respond by pushing weight loss using fancy medical terminology. Like telling me to change my lifestyle to reduce my BMI is somehow less bad than telling me to go on a diet because I'm too fat! I find this merely annoying, I don't know how people cope if they have an eating disorder history or are triggered by this sort of fat-phobia. And especially when I was in for a blood test to see if I have cancer; as it happened I hadn't been tearing my hair out worrying about a potential diagnosis, but she didn't know that, it seems absolutely the wrong time to start nagging me about how I'm too fat and I might have an early heart attack.
Then she did the blood draw really badly. I half suspect it was deliberate, punishing me for being non-compliant over the weight stuff. She kept asking for "consent" after doing things to me; she couldn't find a vein so she slapped my arm quite hard, and then said, I slapped you to make the vein more visible, is that ok? Then she moved to my other arm by just pulling me about, and again asked afterwards if that had been ok, and jabbed the needle into me before saying, sharp scratch, was that ok? Plus she had long and visibly dirty fingernails, and grabbed the needle out in a way that left me with the worst bruising I've ever had from a blood draw. And that was just a few mL for a phlebotomy sample, not a full blood donation.
So I'm grumpy about that, but not about the rest of the process. The sample was analysed straight away, and the GP called me the next day to tell me personally that it was negative, confirming what we all thought anyway, that I most probably don't have ovarian cancer. She's booked me in for a follow-up scan in a few months, and thinks most likely whatever is wrong with my ovaries will have resolved spontaneously, but she wants to check rather than assume. It is remotely possible that I have endometriosis or PCOS, but given that I've only ever had the one-off symptoms, I don't think that's very likely. I was impressed that both the medical person in the ultrasound, and the GP, mentioned those as possible diagnoses which can't readily be confirmed (or ruled out) by a scan. I've heard a lot of horror stories about the medical system taking forever to diagnose those sorts of conditions, and putting chronic pain and misery down to silly women making a fuss about nothing.
This week I capped it all off by attending an appointment with an asthma nurse, mainly so I can renew my inhaler prescriptions. This nurse was generally helpful, and had a good attitude. It felt like a proper shared decision making consultation, and he was willing to enter into a brief scientific discussion about the relative risks of supplementing asthma medication with antihistamines. He trusted my knowledge of both my own 35 year history with asthma, and my understanding of medical matters. However, he asked to measure my weight and height to calculate a baseline for peak flow. If I'd been more on the ball I would have said, peak flow normal ranges are based on height only, you don't need my weight, but I think he wasn't trying to be sneaky, he just reflexly asked for height and weight. And then he was ~concerned~ because I've put on a fairly big number of kilos since last time I let anyone weigh me.
Well, fair enough, changes in weight are a valid concern. And he backed off when I said I don't normally track my weight and I wasn't interested in discussing it. I had a suspicion that I might have gained some in the last couple of years, since my clothes that used to be snug no longer fit at all. I think the reason is changes in metabolism that happen to people over 40, especially people with oestrogen-dominated endocrine systems. And possibly that phenomenon where people get married and start eating better and gain weight as a result; since I've moved in withjack, we've been cooking proper meals from fresh ingredients multiple times a week, which is much healthier than my bachelor diet was, but I'm also eating a bigger absolute amount.
I'm not worried. My numbers are over a certain threshold sometimes used to distinguish between "really" fat and just a bit curvy. But I'm fairly sure I'm more at risk from medical professionals ripping up my veins because they disapprove of fat people, than from being heavier at 40 than I was at 30. And I will continue to repeat that I'm not interested in being nagged about my weight, and I will not fall into the trap of avoiding seeking medical care because I don't want to be nagged.
Content notes:
- Medical experiences, obviously
- Ruling out cancer diagnosis
- Periods
- Pregnancy scare
- Intimate examination
- Clueless cis person trying to talk about reproductive and sexual health without being cissexist
- Medical professionals pushing weight loss (no numbers, and I am not myself promoting weight loss)
- Mild medical violation of consent
- Needles and blood
- Asthma mention, not much specific detail
First I had a routine sexual health test, just because it was time for that. The actual check was fine, but arranging it was more annoying than necessary. The local sexual health clinic has an absolutely dire website, which is a consequence of cutting funding for things that are considered not medically essential. It contains almost no useful information for self-education, just links to auto-translated pages from a German sexual health service. It is possible, but massively fiddly, to use the website to book appointments and such, but most of the time it sends you round in circles and you kind of have to end up phoning people.
It tries to direct you to a home-based test if you're not in a high-risk category, which is fair enough. But the home-based kit is really bad; they're asking you to get a ml of blood from a finger-prick, which basically doesn't work, and the instructions as written are really bad, involving setting up part of the collection system after you've already stabbed yourself with the needle. Not surprisingly, I was unable to get enough blood for them to complete the test. So I went to book an in person appointment.
Booking was annoying. They couldn't cope at all with anything more than 'turn up for a standard panel of STI tests'. I was content with that, but ideally I wanted to deal with having had the first half of a hepatitis B vaccine but not the booster dose that's supposed to happen a year later. More than a year had elapsed (which is my fault, not the sexual health clinic's), and also I'd moved area, which is why I hadn't managed to get the booster shot on schedule. I also wanted to replace my IUD, which was inserted 10 years ago, but the clinic were absolutely unwilling to consider replacing it before the exact tenth anniversary. I think probably the best solution to this problem is to lie about the dates, or else to procrastinate for long enough that it is actually a full ten years, not sure.
So in the end I got my standard tests, which were straightforward and negative. And I convinced the clinic to at least measure my hepB titre, and they decided I'm fully immune and don't need a booster. They were a bit annoyed because their guidelines consider the risk that led me to get the vaccine in the first place was low enough that they wouldn't recommend a vaccine at all, whereas my previous sexual health clinic did advise me to get vaccinated.
So that was the planned healthcare. Then I had a massively painful period, suddenly out of the blue. I got scared, and was in too much pain to do anything useful. In this case the health system dealt with it really well. I couldn't get a same day appointment and it didn't seem like an actual emergency, but I did get a telephone appointment with a GP. She took me seriously, and didn't, as I had feared, just assume that period pain is a normal thing that women have to put up with. (I don't expect medics are massively sympathetic towards period pain in men either, but it's definitely an aspect of sexism that women's pain isn't taken seriously.) But her first diagnosis was, maybe it's not a period, it could be implantation bleeding and a symptom of early pregnancy. So she sent me to the pharmacy to get cocodamol and a pregnancy test. She wasn't very convincing on the topic of whether it was in fact safe to take a codeine-based drug if I might be pregnant; I think she hadn't quite connected the two prescriptions, but she seemed to think it was ok.
So I acquired those two things, and the pharmacist was generally not in favour of taking cocodamol if I might be pregnant *shrug*. From a combination of being in too much pain to think straight, and being a bit panicky by this point, I messed up taking the pregnancy test. (It was actually the first time I'd done so, because I long ago decided that with my level of tokophobia, taking a pregnancy test when I might happen to miss a period is going to be too miserable.) And again, not really thinking straight, I was embarrassed to go back to the pharmacy to ask for a second test kit, and instead asked to borrow from a partner who keeps a stash of them. Partner was massively, amazingly supportive; as a general rule, I would never consider telling a partner of a pregnancy scare before taking a test, but in this case I'm extremely glad I did. We had a useful conversation about what we would do if I did in fact get pregnant, which is worth renewing from time to time. I never really seriously believed that I was pregnant, because I pretty much trust my IUD. But I was still somewhat relieved to get a clear negative. I never ended up taking the cocodamol, because I was feeling too nauseous from the pain to be able to eat something with the medicine, and having received mixed messages I didn't want to take it if I was in fact pregnant, and by the time I'd got home, got hugs from partner, and taken the test I was feeling enough better that I was fine with my usual standby of ibuprofen.
The phone GP recommended I should make a routine appointment to see a GP in person, if I wasn't pregnant and if the symptoms didn't recur. Routine appointments usually have a several week wait, so by the time I did see the GP I had been completely fine for a few weeks. The GP took a good history, didn't make any assumptions, and didn't criticize me for being a whiner or wasting NHS resources over nothing. She carried out a small physical exam, just feeling my tummy externally, and not surprisingly couldn't find anything untoward. She decided to refer me for an ultrasound as a precaution, though she and I agreed it was probably just a one-off random thing. As referrals from GP to hospital go, it couldn't have been smoother; the GP filled in a form, I got a letter saying I would be getting details of an appointment, and then I did in fact get an appointment. There was no untoward delay, even though we were pretty certain by now there was nothing seriously wrong.
As it happened, I was due for a three-yearly routine cervical check (what used to be called a 'smear test') and ended up making the appointment for that the day before my hospital appointment. Being prodded with a speculum is never exactly pleasant, but the screen went as well as could be hoped for. The nurse and chaperone were extremely respectful and sensitive, and aware that lots of people have trauma around internal examinations, but also willing to take cues from me to be matter-of-fact about it. The actual procedure was easy and barely even uncomfortable, so kudos to the practitioners for handling that really well. I got a letter in the post fairly soon after saying, there was no HPV virus so they weren't going to bother looking at the cervical cells (this is part of why they're trying to move away from calling it a 'smear', as it's mostly based on looking for viral genetic material these days).
I was a bit nervous about the ultrasound, because although the hospital letter said it shouldn't cause discomfort, some of my uterus-having friends reported that they found the procedure extremely unpleasant, much much worse than taking a cervical sample. In fact it was fine, not something I'd choose to do for fun, and it goes on a lot longer than a cervical test, but for me it wasn't awful at all. Turned up at hospital in good time, got called in slightly before my appointment, again the sonographer and colleague were extremely respectful, talked through everything before they did it, and constantly checked in to make sure I was ok, pausing if I so much as drew breath sharply, let alone winced. The one thing they didn't do was follow the #MyNameIs protocol, and the room was dark to allow the sonographer to see her screen, so I didn't quite work out who the senior colleague was, a nurse or a doctor or a more senior ultrasound technician. And I'm the sort of person who is interested to see scans of my internal organs.
They found a big cyst on the edge of my ovary, and more smaller cysts than are supposed to be within the ovary. They didn't think it was likely to be anything serious; most likely it would resolve on its own, and the only reason they even knew about it was because the GP had referred for a scan as a precaution after my bad experience. They decided to send me for a blood test, and reassured me that it was nothing to worry about, just ruling things out, but didn't really explain what they were looking for in my blood. I pressed a bit, and they admitted that it was a CA-125 blood test, and re-emphasised that I shouldn't worry. So obviously I went and looked it up, and it turns out that this is a not totally reliable, but still indicative, blood test for ovarian cancer. I'm quite impressed, because I don't think there was any blood marker for ovarian cancer even a few years ago.
They clearly weren't worried, I could just make an appointment for a blood draw whenever convenient in the next few weeks. So I don't think I ever had any moment of seriously contemplating that I might have cancer. But anyway, I duly rocked up at the GP for my blood test and it was such an annoying experience. Usually older nurses are the best people to take blood, but this one was dreadful. She opened by nagging me about getting a general health check now that I'm over 40. I said I didn't want a health check because I'm not interested in being told to lose weight. At which point she argued over me saying that it's not about weight, it's measuring your BMI and waist circumference and suggesting that you make lifestyle changes to reduce your risk of a cardiovascular event. I mean, seriously, woman, I *just told you* that I'm not interested in discussing weight loss, don't respond by pushing weight loss using fancy medical terminology. Like telling me to change my lifestyle to reduce my BMI is somehow less bad than telling me to go on a diet because I'm too fat! I find this merely annoying, I don't know how people cope if they have an eating disorder history or are triggered by this sort of fat-phobia. And especially when I was in for a blood test to see if I have cancer; as it happened I hadn't been tearing my hair out worrying about a potential diagnosis, but she didn't know that, it seems absolutely the wrong time to start nagging me about how I'm too fat and I might have an early heart attack.
Then she did the blood draw really badly. I half suspect it was deliberate, punishing me for being non-compliant over the weight stuff. She kept asking for "consent" after doing things to me; she couldn't find a vein so she slapped my arm quite hard, and then said, I slapped you to make the vein more visible, is that ok? Then she moved to my other arm by just pulling me about, and again asked afterwards if that had been ok, and jabbed the needle into me before saying, sharp scratch, was that ok? Plus she had long and visibly dirty fingernails, and grabbed the needle out in a way that left me with the worst bruising I've ever had from a blood draw. And that was just a few mL for a phlebotomy sample, not a full blood donation.
So I'm grumpy about that, but not about the rest of the process. The sample was analysed straight away, and the GP called me the next day to tell me personally that it was negative, confirming what we all thought anyway, that I most probably don't have ovarian cancer. She's booked me in for a follow-up scan in a few months, and thinks most likely whatever is wrong with my ovaries will have resolved spontaneously, but she wants to check rather than assume. It is remotely possible that I have endometriosis or PCOS, but given that I've only ever had the one-off symptoms, I don't think that's very likely. I was impressed that both the medical person in the ultrasound, and the GP, mentioned those as possible diagnoses which can't readily be confirmed (or ruled out) by a scan. I've heard a lot of horror stories about the medical system taking forever to diagnose those sorts of conditions, and putting chronic pain and misery down to silly women making a fuss about nothing.
This week I capped it all off by attending an appointment with an asthma nurse, mainly so I can renew my inhaler prescriptions. This nurse was generally helpful, and had a good attitude. It felt like a proper shared decision making consultation, and he was willing to enter into a brief scientific discussion about the relative risks of supplementing asthma medication with antihistamines. He trusted my knowledge of both my own 35 year history with asthma, and my understanding of medical matters. However, he asked to measure my weight and height to calculate a baseline for peak flow. If I'd been more on the ball I would have said, peak flow normal ranges are based on height only, you don't need my weight, but I think he wasn't trying to be sneaky, he just reflexly asked for height and weight. And then he was ~concerned~ because I've put on a fairly big number of kilos since last time I let anyone weigh me.
Well, fair enough, changes in weight are a valid concern. And he backed off when I said I don't normally track my weight and I wasn't interested in discussing it. I had a suspicion that I might have gained some in the last couple of years, since my clothes that used to be snug no longer fit at all. I think the reason is changes in metabolism that happen to people over 40, especially people with oestrogen-dominated endocrine systems. And possibly that phenomenon where people get married and start eating better and gain weight as a result; since I've moved in with
jack, we've been cooking proper meals from fresh ingredients multiple times a week, which is much healthier than my bachelor diet was, but I'm also eating a bigger absolute amount. I'm not worried. My numbers are over a certain threshold sometimes used to distinguish between "really" fat and just a bit curvy. But I'm fairly sure I'm more at risk from medical professionals ripping up my veins because they disapprove of fat people, than from being heavier at 40 than I was at 30. And I will continue to repeat that I'm not interested in being nagged about my weight, and I will not fall into the trap of avoiding seeking medical care because I don't want to be nagged.
(no subject)
Date: 2019-06-05 09:25 pm (UTC)(no subject)
Date: 2019-06-05 09:47 pm (UTC)(no subject)
Date: 2019-06-05 09:58 pm (UTC)I'm glad the other things seem to be pointing in non-worrying directions.
(no subject)
Date: 2019-06-05 10:38 pm (UTC)There was definitely a blood marker for ovarian cancer in 2016, but they often don't like to use it in younger people -- as I understand it there can be false positives etc. (It's one of the things I think they should have checked when I was having problems, but they didn't.)
(no subject)
Date: 2019-06-05 11:12 pm (UTC)(no subject)
Date: 2019-06-06 05:59 am (UTC)(no subject)
Date: 2019-06-06 06:44 am (UTC)(no subject)
Date: 2019-06-06 08:22 am (UTC)Liv, your symptoms honestly sound to me quite a lot like the unusually bad pain I get when an ovarian cyst bursts. Not having any remaining trace of same in ultrasound a few weeks later would be entirely expected. Would you like any more words about this?
(no subject)
Date: 2019-06-06 09:28 am (UTC)And do get me or other partners to support you if there's something you're a bit panicky about and it would help. I know it may not, but remember circle theory, that's something partners are for, I would always rather be helpfully supportive than have you feel like you have to wait until you *absolutely* need support. (I know I'm bad at that as well *hugs*)
(no subject)
Date: 2019-06-06 02:55 pm (UTC)(no subject)
Date: 2019-06-06 06:01 pm (UTC)(no subject)
Date: 2019-06-06 07:03 pm (UTC)Glad you’re OK and that only two? of the encounters involved fatphobic staff.
(no subject)
Date: 2019-06-17 12:39 pm (UTC)Which surgery are you at? The Arbury Rd nurse I had my health check with was lovely and very apologetic/eye-rolly/practical about weight and BMI stuff.
(no subject)
Date: 2019-07-14 08:22 am (UTC)... what? Why? Aren't there English pages they could link to?