Appointment anxiety

So I finally called my HMO this morning, and set up an appointment with a gynecological nurse practitioner for Monday.

I am ridiculously anxious about this, for a number of ridiculous reasons:

  1. I only got scheduled to work four days next week, and Monday is not one of them.  And I want/need to work on Monday, because that’s usually the day I write my order (and I also have Sunday off, and Saturday, so forget writing it early), and because I need the money.  And not working enough makes me anxious.
  2. But when the nice lady on the phone said there was an available appointment on Monday, I took it without even bothering to ask what she had later in the week.  So if I do end up working Monday, I’ll need to make another phone call to move my appointment to another day.  And making phone calls makes me anxious.
  3. Of the options, I chose the office location that’s closest to where I live and work.  But it’s attached to a huge hospital.  So it’s not like I’m just going to walk into the right building and look on the little map for the OBGYN Suite and find it right away.  I will probably get lost in the maze of large buildings and parking structures, and end up being late.  And the possibility of getting lost and being late makes me anxious.
  4. I told the nice lady on the phone that I didn’t care whether I saw a doctor or a nurse practitioner – actually, I usually like NPs better.  But as soon as I hung up, I thought, maybe a doctor would be better qualified or have a larger scope of experience and insight as to what my best plan of attack here is.  Hadn’t I originally planned to ask for someone who specializes in fertility, so that I could establish a relationship with them, as I’ll need them in a few years once I actually start trying to conceive?  Hadn’t I wanted to use this appointment to prepare for my obstetric/gynecological future?  And not being prepared for the future makes me anxious.
  5. What if I go in and ask to have my Mirena taken out, and I get the same lecture about how hormonal birth control is best for “preserving the fertility” of PCOS patients?  What had once seemed so comforting, now seems scary, especially since I’ve affirmed once again that I do not want hormonal birth control.  There are so many conflicting opinions and studies on all this, I almost don’t know what to think anymore, and at this point, I just want to trust my instincts and my body.  And the possibility of being told that I don’t know what’s best for my own body makes me anxious.
  6. And about PCOS: I asked to be tested for it again, and for that, as far as I understand, I’ll need an ultrasound of my ovaries.  But maybe that ultrasound will have to take place separately, and I’ll wind up having to schedule another appointment, miss out on another work day, and pay another co-pay.  And knowing I might have to do this all over again makes me anxious.
  7. And, if I remember right, an ovarian ultrasound is one that will require me to have a full bladder, so they can see better.  Which means I’m going to be required to drink a bunch of water before my appointment and then not go pee.  I’ll be sitting in the waiting room practically crying from the pain and the pressure, and there will be nothing I can do about it but wait.  And the thought of having to pee that badly makes me anxious.
  8. Speaking of the waiting room…  Did I really just make an appointment that will take place in the OBGYN Suite?! That place is going to be chock full of pregnant women.  And rooms that are full of pregnant women – do I even need to say it?  Rooms that are full of pregnant women make me want to stab my eyes out.

After I made the appointment, I took a shower.  And as I was washing my face and body, I felt all the breakouts I’ve got as a result of the artificial hormones coursing through my bloodstream.  I looked down and saw my bloated stomach – a stomach that’s been hurting so badly lately, I occasionally have to stop what I’m doing and just focus on taking deep breaths until the pain goes away.  I considered my naked body, and thought of how disconnected I am from it, sexually: in keeping with The Resolution (or its possibility), Doug and I have had sex five days in a row now, but on not-a-one of those days have I been turned on going into it.  “I’m too tired for foreplay,” I tell him.  “Just lube it up and stick it in so we can go to sleep.”  (The act itself is enjoyable enough, but I can’t help but think how much better it would be if I actually wanted to do it in the first place.)

So, aforementioned anxiety or not, the plastic intruder in my uterus has to go.  And I’ll just play it all by ear: if I can pick up a shift on Monday, I’ll call and reschedule.  And then maybe I’ll reschedule at a different location, with an actual doctor, and I’ll ask more specifically for a same-day ultrasound, and I’ll verify the part about the full bladder, and as for the inevitable pregnant women?

I’ll bring a pointy stick, just in case.

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10 Responses to Appointment anxiety

  1. Arohanui says:

    Not sure if you want my advice on this, but I would definitely reschedule with a specialist Gynaecologist (and request the uss and labs in advance). Your case is reasonably complex and I don’t believe a nurse practitioner is the best option for you.

    I know my fertility clinic insists on empty bladders for viewing ovaries (full bladders are more helpful with early pregnancy) but it is best to check with your provider like you said.

    Good luck! Make those phone calls!! xx

    • Marie says:

      Of course I want your advice on this!

      In fact, tell me what you make of this… The reason I doubt my previous PCOS diagnosis is that it’s 10-12 years old, and I have no symptoms other than irregular periods: I am not overweight, hairy, diabetic, etc. After my m/c, I got my hormone levels tested, and the doctor told me again they indicated classic PCOS. But then at my most recent physical in August, I had them tested again, and that doctor told me they looked perfectly normal, and that hormone levels vary depending on where I am in my cycle (I currently have NO cycle with the IUD though), and the only way to tell whether I have PCOS or not is to u/s my ovaries. I remember having an u/s a decade ago, but it was a full-bladder type (maybe they didn’t want to do internal since I was young and a virgin?).

      I’m basically at a loss, and hoping and praying that I do NOT have PCOS, because it will make my future so much easier. I will call tomorrow to reschedule on a different day, at a different location, and with a specialist if I can.

      • Arohanui says:

        Eek! I have only just seen this. Have been catching up with reading blogs today.

        You can have PCOS without the weight, hair growth signs (and certainly without diabetes). There are standard labs that should be done that include sex hormones but are not limited to them and do not tend to change with your cycle. I am not sure if the second doctor looked at all of these, so hard to say. Results may be affected by the Mirena, so it is possible that if they are normal it may be useful to have them repeated in a few months when you are off treatment. The ovarian uss will then contribute further info to the diagnosis (and yes, it should be a vaginal uss to get a good view of the ovaries, and yes, you prior one would have been external for all those reasons & thus requiring full bladder). Sometimes it can be a difficult diagnosis, and it may be the case that you do not, after all, have it.

        I don’t know about “preserving fertility” in PCOS with hormones, in fact I believe that the evidence for this is quite weak. Get the mirena out, and see how your body’s menstrual cycle normalises. Generally the treatments we use here for PCOS include anti-androgen rx which may consist of a type of BCP (you don’t appear to have problems with excessive androgens) and metformin. It really depends on your individual case and symptoms. I have not seen mirena used for PCOS, but that’s not to say it isn’t helpful.

        I’ll comment on your more recent blog too.

  2. mommyodyssey says:

    I second Arohanui! But way to go for sucking it up and listening to your body.
    Each time I know I’m about to be confronted with a bunch of preggos I make sure to bring my ipod with me and either listen to harry potter on audiobook or watch a funny movie. Better to just look away!

    • Marie says:

      Right? It’s like a train wreck though. I can’t look away. I think they should have separate offices – or at least second waiting rooms – for preggos verses can’t-get-preggos. Honestly.

      • mommyodyssey says:

        Agreed!
        I do have one thing to say about the PCOS vs non-PCOS diagnosis. Having it, at the end of the day is not that terrible if it’s managed. Some doctors (particularly American docs) tend to make a much bigger deal about it than it really is.
        I was diagnosed in the states and was MEGA stressed out about it. Then I went back to Israel and saw 4 – yes 4! gynos and one endocrinologist specializing in fertility. They all confirmed my diagnosis – but NONE of them recommended birth control as a must. The only confirmed problems with PCOS are problems ovulating and all of the fun associated health risks (plus the need to invest in stock for hair removal doo-dads). And you said yourself – not everyone even has that.
        Basically the endo – i.e. the super mega specialist basically said manage your weight (I have way more symptoms than you – including weight gain), and when the time comes to conceive, if you’re not ovulating regularly, there are hormone supplements to help that along.
        And he was basically right. Funny enough – I had to take provera immediately before my wedding to time my AF with my mikveh (silly arcane jewish tradition), so it straightened out my ovulation (that’s how I got my first BFP), and despite the MC’s my AF has been regular ever since. (and I only took the provera for three days back in may)
        Plus – all the gynos I’ve seen have basically ruled out PCOS as the reason for my MC’s. I think the problem with american doctors is that they’re prescription-happy and don’t get that sometimes the body can regulate itself much better than drugs can. Don’t let them scare you into something you don’t want. Your instincts are always the best guide.

      • mommyodyssey says:

        Sorry one more thing to add – I’m not trying to minimize PCOS – it does cause problems when you are TTC – but my point is that each and every one of those problems are MANAGEABLE. Ok. I’m really done now. 🙂

      • Marie says:

        Thank you, for all of that 🙂

  3. Hillary says:

    I totally get the appointment anxiety, but I think you’re doing the right thing here. Hopefully all of us cheering you on will get you through it!

    I agree with pp – the ultrasound will most likely be internal and will not require a full bladder. As far as I know for PCOS, they will count your antral follicles and a lot is indicicate of PCOS. I also believe there is some bloodwork you should have done to get a clearer picture of the PCOS.

    • Marie says:

      Thanks Hillary 🙂

      The cliffs notes to my PCOS story are in my response to pp, above. The part that scares me most is if I DO have it, that then they’ll tell me again I need hormonal b/c to preserve my fertility. Because how can I say no to that?

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