Wednesday, February 11, 2009

All Patched Up

Okay, I went to the doctor on Friday. Was a hassle just getting there. We had to wait an hour while they dynamited avalanches in the canyon before we could even leave. Then it snowed the whole darn way. Mark, bless his little heart, took the day off and drove me over. He said he had a "vested interest" in this doctor's appointment. Ya think he is tired of me yelling at him? Anyway we arrived intact and on time.

I was a nervous wreck. I have issues about anyone peering at my private parts except my husband. AND I have major issues with health care in general and in particular. I had a list of demands for the doctor so as not to be fobbed off with the usual medical jargon and procedures. I was determined to understand and agree with everything done to me before I acquiesced to a "treatment plan." In my anxiety I still think I may have been semi-fobbed. But, over all, I believe I got what needed.

For fobby starters, She, physician does not prescribe compounding pharmacy made bio-identical hormones. She does not do blood tests to ascertain current hormone levels. She does not prescribe hormones based on blood tests. She does not prescribe thyroid meds with both T4 and T3 components. So I got none of that.

For semi-happy enders, She did the most thorough intake interview I've ever experienced. I had an opportunity to relay all my symptoms and have them explained to me. She did a gentle pelvic exam. She addressed each of my requests and explained her rationale for not using a damn one of them. The exam room was warm and the gown fit. Oh, they did not weigh me. The nurse told me they had decided it was a waste of valuable time as almost every woman could tell you what she weighed down to the ounce!

I was prescribed a low dose non-synthetic transdermal estradiol (estrogen) patch. It is the lowest dose possible. I change it weekly. I was not prescribed progesterone as I have had a hyster and "do not not need it to protect my uterus." The office visit was covered by my insurance and so was the patch. The patch cost me out of pocket $11 for three weeks.

I am not anxious or unhappy about my "treatment plan" but I think it could be better.

I believe the blood tests would have given a clear picture of where I am hormone wise and I would not have to use the trial and error method to determine the correct estrogen dosage. At present I use the patch for three weeks and if I am still having hot flashes and night sweats the dosage is increased in small increments until my symptoms abate. This is the usual and accepted medical model of treatment and one I am very familiar with. But...wouldn't it have been lovely to get an individualized dose immediately.

I think I may need some progesterone. The blood tests would have told me this. In the mean time I will study up on it, and wait to see if the estrogen alone does the trick.

I would have liked to have had a more specific thyroid blood test. I pushed for this and was told that my insurance would not pay for it as She (the physician) did not believe it was needed. Not a very subtle coercion.

So, that is my story. As of today I do not think I have noticed any changes from the patch. Maybe a few less hot flashes. She told me I might have to wait the full three weeks before noticing any changes. I told Mark this and he looked crestfallen. Come to find out the only symptom he really wants to go away is my lack of libido!

Markovian theory:
1. Every time you walk past your wife rub that estrogen patch on her bottom real hard. It might be heat activated.
2. If one patch is good, five would work much faster. Gluing them to the bottom of her feet while she is sleeping will guarantee they will not be noticed as quickly.
3. Do not inquire on the hour "Are we there yet?" It just makes her mad.

Sigh, Love Bea


Cindy...154 said...

Wow, I have been thinking about estrogen ever since Friday night when researching Alzheimer's and seeing something about it helping stave off the disease in women or something like that. Plus I need it. I am wondering if I can afford it when the New Deal takes effect but I want to go get some now. maybe they have a generic or something. Thanks for writing about it. It blew me away to see you talking about it - see -- I told you we are the same!! And thanks for your encouraging words today on my post..AND HAPPY BIRTHDAY weeks late..

Annimal said...

I think what's needed for the libido is testosterone. Did she address that at all?
I think you need to find a different provider.

Helen said...

I agree with Annimal. The testosterone (I put a teeny bit of cream on once a day) is for the libido. It works! ;-)

For me, I have found that I get nearly instant improvement in symptoms when I get the correct cream prescription. (It's a continuing process since your levels change all the time...forever). Personally, I am against the one-size-fits-all hormones...while I hate having blood drawn, I appreciate the ability to see how what I am taking affects me.

A problem to be aware of is that different compounding pharmacies produce different levels of hormone even when they are supposed to be the same. For example, I had a problem a few months ago where I just didn't think the cream I had was working...I had switched compounding pharmacies and, sure enough, when I went back to the other place's cream, things were better. You probably don't have that problem with drug company hormones which are probably federally regulated?

Another thing to be aware of: the compounded bioidenticals are EXPENSIVE. My insurance fights paying for them. :-( But I really feel better putting this into my body than the other alternatives. And I refuse to use Premarin...what they do to the horses makes me sick.

OK, this is totally rambley, but I'm having a discombobulated week and I wanted to get back to you on this somehow.

Here's what I take (all compounded and prescribed specifically for me):

- Estradiol twice a day all month
- Progesterone twice a day for half the month
- Testosterone once a day all month

I up my estradiol a little bit when I go on the progesterone. Seems to work better that way. I almost never get my period -- if you read Suzanne's book, it seems to say that means they hormones are not working, but my doc says it's ok. If they are working properly, you allegedly get your period forever. I have a friend who has been on bio-identicals for 20 years and still gets her period at 62!! (I'm 47.)

Wish I had your phone number because it seems like all this would be better by phone!!! ;-)

Hope this helps...feel free to ask any other specific questions you have... :-)

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