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Update: things are looking up

November 29, 2012

Thanks again for all the support at that low point. I am, thankfully, feeling much better now. Not too surprisingly, I had gradually gotten more depressed and trapped-feeling than I realized.  Just articulating some problems and feeling more like I could look for solutions, instead of just feeling helpless, actually made a big difference.

We’ve also had more sun lately, and I’ve been remembering to use the replacement light box more, in spite of the immediate sensory badness there. (It’s just too glary and headache-inducing to tolerate at all, used as recommended right after I get up. But, better later in the day than not at all. It’s still unpleasant with the sensory issues, but just about bearable–and totally worth it, from past experience.) The seasonal factor was bad enough at about 37°N; the exaggerated version still sneaks up on me sometimes at about 51°N, with the relatively rapid changes in available light. 😐 And Mr. U keeps half-joking that I need to see Stockholm in the winter! I have also gotten back on the Pill*, to help straighten out the hormonal weirdness that was going on, and that has already helped my general mood. Besides reducing pain levels, which also–surprise!–improves mood and frees up spoons. Including for things like, erm, eating better/enough, which should help get my own hormones back on track.

But, thanks to all of this, I have even been able to get out more often, which has also helped cheer me up some more. Plus, I managed to finally pick up things like a new winter coat (after at least five stops, to find one that actually fit) and decent ankle boots to help keep my feet dry and toasty when I do go out, with heels that shouldn’t bother my knees or back. I actually like the bit of added height from about a 2″ heel, but my musculoskeletal system does not these days. At all. Hard to find boots without even that, right now, but thank goodness for Clarks! They even stock half sizes, which seems unusual in the UK. A UK 7 fit in the ones I picked, but I often need a 7.5 (about a US 9.5/European 41). I may go back and look for some taller boots, too. Their sizing actually seems pretty consistent, but I am still not about to order any kind of shoes without trying them on.

OK, this is not really relevant to anything else (though it did prompt me to want to do another post on finding clothes), but finally being able to get out and do things like find appropriate clothes for, erm, going out did provide more relief than I would have expected. While I’m still dealing with some depression and the practical problems that helped get that going, things are looking up.

I haven’t been able to get as much discussion going with Mr. U as I would have liked, yet, but I have fought feeling like a nag and kept mentioning some things I needed help with until he remembered and actually did them. And said that we really need to turn clearing some clutter so that we can get the boiler and washing machine fixed into a cooperative effort. To agreement. And I plan to just hand him trash bags and set him to collapsing some of the pileup of empty cardboard boxes after he gets back from a trip to Dublin. (Well, maybe after a little rest.) So, I’m also feeling a bit more optimistic there, if still pretty frustrated.

I was just going to add a couple of update paragraphs onto the beginning of the post I set out to write, but it grew. Especially the parenthetical bits turned into endnotes. As usual. 😉 The “keep the rambling down” spoons are still in pretty short supply. *wry smile*


* Even if, thanks to a variety of reasons, I had to do like s.e. smith (and so many other people) again, and order from Dodgy Pharmacy. (Not so much for gender-based physical dysphoria, but “try not to vomit and/or pass out”-level pain and some other dysphoria which is honestly helping build up more of the other kind of dysphoria.) This time I found that it was actually cheaper–not to mention quicker–to order from a UK-based one, under the “oh yeah, I just couldn’t get to the doctor’s for a refill!” dodge. That was only like £20 all told, for three months’ worth with next-day shipping (FYI, for anyone in the UK who might be able to use the info), but here you really can get free (taxpayer-funded!!!11!) birth control through the NHS if you can deal with the gatekeeping.

And, erm, don’t have a reasonable expectation of getting treated like shit and openly insulted, even before you mention menstrual suppression as a goal or try to explain that it should help the sacral fracture heal if it isn’t getting yanked on and displaced monthly.** I got denied combined pills by two different doctors on the basis of age, “high” (lean) BMI of 27 or 28, and smoking before I hit 30. Seriously. Now I’m 37, and not even going to try that again. (Actually, after my last pap smear appointment, I couldn’t even make another one when I got the notice in the mail. And am still having anxiety attacks thinking about it. I couldn’t even write about all of the badness, partly from unwarranted shame over “not handling the situation properly”, but yeah. When I can force myself to even try that again, I am going to take someone else into the examining room whether the medical personnel like it or not. It was that bad an experience.) I know there is a higher risk of cardiovascular problems, and am totally willing to deal with that as part of the cost-benefit analysis here; that should be good enough. It’s called informed choice/consent, and having a uterus (plus assorted xenophobic reactions) doesn’t somehow cancel out that bare minimum necessity.

** I can find absolutely no medical mention of this problem, even with the number of people who get pelvic fractures in labor from exactly this kind of strain, often with underlying vitamin D deficiencies. And the number of “women of childbearing age”, as they put it, with osteomalacia. It’s thrown under the women’s health umbrella, after all, so a low priority to even investigate. 😦 Much like the prevalence of brushed-off “try not to vomit and/or pass out”-level pelvic pain, in general, and the common endometriosis brushoff. (I suspect that I’ve got that, too, like an estimated 1022% of people with an endometrium. My mom had symptoms, too, so I just thought it was normal. No urge to try to get it checked out, on the whole, especially since the most common treatment is combined pills and I am not about to let anybody cut on me. I didn’t even know there might be a link to allergies, as mentioned in the last link, but sometimes it seems like every medical issue I’ve ever run into has some connection with allergies!) That brand of medical neglect of half the population is another story entirely, but it does piss me off.

And it’s hard to avoid sounding essentialist here, even as a nonbinary person; that’s society for you. 😐 Prompted by a good recent post at Binary Subverter: 

2 Comments leave one →
  1. December 1, 2012 10:18 pm

    Why would they deny you a combination pill for having a high BMI? When I was pursuing contraception, I found that single-hormone pills are less effective in big people! A combination pill would be the thing it would make the most sense for someone your size (or mine) to use.

    I can’t imagine what their rationale was — were they trying to get you to pick a different contraceptive method, like an IUD, an implant or an injectable? Or were they just saying, “Nope, sorry, no contraception at all for you until you’ve made yourself smaller!”

    And denying it to you because you’re too old is just stupid.

    (I read your other post about all the risks associated with the contraceptive implants — yikes! I had no idea. I was already ruling out all IUDs because I *knew* I wouldn’t be able to stand the pain of insertion — I can only sometimes tolerate pelvic exams. And injectables have the problem of how are you going to get to the doctor’s office every three months or whatever …. but pills aren’t exactly optimal for me either, because I forget to take them sometimes. They seem to be the best of what there is, though, until I can get myself sterilized for good.)

    • urocyon permalink*
      December 3, 2012 3:19 pm

      Basically, one way of dealing with people you don’t like for whatever reason (or, erm, no obvious reason whatsoever), especially if they get assertive, is to get overly rigid in applying NICE guidelines. Which are easy enough to substitute for actual clinical judgment anyway, though that’s another “managed care of steroids” story. “Women with a body mass index (BMI) greater than 30 should be counselled regarding an increased risk of venous thromboembolism (VTE), and consider contraceptive methods other than the combined oral contraceptive pill (COCP).”# My numbers also tend to startle people here, more than I am used to running into, even–with an awful lot of emphasis on straight BMI going. So, if you’re feeling shitty, you can decide that frankly inappropriate medical treatment is justified on the basis of not even actually fitting more than one of the risk factor guidelines. Age and BMI both about 28? Suddenly a problem. I never got that in the US, even with running into some pretty awful-acting fatphobic doctors with God complexes.

      To be less charitable, that can provide a good excuse for bullying a female patient you don’t like on the basis of their being fat and old. And escalate when that doesn’t shut them up. (Yeah, those were both doctors who, for whatever reason, just didn’t like me and got openly bullying with it. It was not subtle.)

      Yeah, I’d realized that there were dosage appropriateness problems with multiple hormonal methods, for people with higher weights/BMIs. The guideline summary linked above (I couldn’t easily find one straight from NICE) actually includes a couple of very relevant ones: “The absolute risk of pregnancy using both COCPs and progestogen-only pills (POPs) has been shown to increase in women having a BMI greater than 27.3, suggesting a possible reduction in efficacy of hormonal contraception.” and “Weight greater than 70 kg: POPs, except desogestrel, may be less effective in women who weigh more than 70 kg.” (They are also less effective than combined pills, already.) Yep, I weighed probably 75-80kg at the time, and the first doctor put me on POPs, after I’d said that I had very bad reactions to progesterone-only methods in past. (I decided to try Depo Provera before, for the convenience factor, and it was absolutely awful, with nonstop cramping and bleeding and total sex drive loss among other things. I did get the exact same reactions to Cerazette, because marginal estrogen levels thanks to continued high prolactin.) ETA: That was actually the doctor my mom ended up needing to see for blood pressure med refills while she was visiting, and she lit into him over applying racist standards when he started lecturing her about her size. That actually shut him up from then on, surprisingly enough. /ETA

      The second doctor was the one responsible for my avoiding exams at all. Go in for a regular exam, get outright bullied and treated very roughly, come out with a Mirena IUS you repeatedly said you did not want. (Yeah, I still haven’t been able to talk about all the awfulness there. And was too ashamed to even try to file any kind of complaint, what with being an adult and all, with a bipolar diagnosis at the time which set off some of the awfulness. That was also before I figured out the whole autism thing, so, yeah, I felt more shame over getting bullied.) They also seem to be pushing Mirena hard without much mention of possible risks, as I have seen from discussion about it elsewhere. Also end up with similar bad reactions to the unopposed progestins. Get brushed off, put up with it for about a year, then end up removing it yourself. (Which is actually easy, once I looked it up, but I’m not recommending that anybody else try it at home!) And be glad that condoms will suffice for the unusual occasions that you actually do need contraceptive effects rather than, oh, general hormonal therapy.

      And I apparently still need to rant about this crap. Not the way to deal with patients, at all.

      I did run across an interesting (if triggering to me) experience post on that recently, though: Getting a Mirena IUD. Comments there are interesting. My own experience may have been more like this person’s (plus a deliberately rough doctor, serious body tension, and no pain relief in advance), but it’s apparently not nearly that bad for most people. I would still consider trying again with a copper IUD, if I could find a doctor I halfway trust. Most of my problems seemed to be from the hormones and deficiency-related tendency toward OTT muscle spasms, but yeah. Even if the actual insertion were that bad, I’d be willing to do it once every seven to ten years. :/

      BTW, have you considered patches or the ring? That might be one way to cut down on the forgetting factor. I’ve gotten into a firm enough routine of taking supplements after supper that throwing the pill in there too is a good workaround, but I have considered trying that anyway. I am a bit put off by some reports of a possibly higher risk of clots with them, though.

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