Yesterday I went responsibly to my Annual Exam, thinking the whole way there, “At least it’s not the dentist”—which reminded me I have a dentist appointment in a couple of weeks, so I effectively doubled my feelings of dread. Nice going.
It had actually been more like a year and a half since my last annual, because when I called last March, feeling extremely righteous to be calling the VERY DAY the reminder card arrived in the mail rather than after six months a month several weeks several days of phone-related procrastination, they said they had no appointments at all with ANY of the six doctors, and that I should call back in MAY (TWO MONTHS LATER) and they’d “see.” They’d SEE.
I felt so miffed by this (THEY sent ME the reminder card!! THEY are the ones who harp on how important this is!! HOW CAN THEY POSSIBLY HAVE ZERO APPOINTMENTS WHEN THEY HAVE SIX DOCTORS???), I didn’t call back until August, when they again told me they had nothing at all. Just as I was about to hang up in a huff (THEY’LL BE SORRY when I get CANCER and I write them a polite business letter to complain about it!!), they allowed as how they might have an appointment with the nurse-practitioner the next month. So anyway I took it, and then stewed about it for a month wondering if I should have gone to my primary instead (even though last time she did something wrong and I had to GO BACK AND HAVE IT DONE A SECOND TIME), and I’m still stewing now. Goodness, I am SO SORRY for DISTURBING them with my APPOINTMENT REQUEST for an APPOINTMENT THAT IS EXACTLY THE KIND OF APPOINTMENT THEY DO THERE and TIMED TO FIT THEIR OWN GUIDELINES OF WHAT IS APPROPRIATE. I can see how it would be EXACTLY as hard to get an appointment for a PAP as it would be to get a LUNCH DATE WITH ANGELINA JOLIE.
Anyway. It turned out I liked the nurse-practitioner about ten times as much as any of the doctors, so that leaves me in the difficult situation of still feeling like stewing, but about something that turned out better this way. My experience with nurse-practitioners has not been universally successful (the one at our pediatrician’s office is so awful I will not even get into it, because I can feel my brain kicking up the Let’s Stew Fruitlessly Over Long-Past Resentments All Day and Perhaps All Night! gears, and I am already very busy stewing over the six months’ worth of “can’t get an appointment” resentment), but sometimes they are MUCH BETTER THAN DOCTORS. This one was so kind and understanding she made me all teary and happy, and also she gave me a prescription to help prevent UTIs (the “one antibiotic pill Each Time” prescription) that my primary doctor has been extremely reluctant to give me (I’m sure it is unconnected to the $700 it costs each time I have a UTI), treating it as if I’m asking for a monthly supply of narcotics.
Also, did you read Caitlin Moran’s book How to Be a Woman? And if so, were you mesmerized and intrigued by her mentions of using potassium citrate to treat cystitis—cystitis being another word for UTI or urinary tract infection? I immediately looked for potassium citrate at the store, wondering if THIS WAS THE ANSWER, but the store didn’t have it so I ordered some online. And the next time I felt the beginnings of a UTI, I took some, and IT WENT AWAY. Except it didn’t: when the potassium citrate dose wore off, it was back. Also, I noticed that UK sites tended to recommend potassium citrate for UTIs, and US sites said specifically NOT to take it if you had a UTI. It was a bit of a mystery.
After some further research and some consultation with the nurse-practitioner, I think I have the answer: potassium citrate treats the symptoms but not the condition. So if you have UTI, and your UTIs tend to clear up on their own rather than turning into massive raging bladder or kidney infections that leave you wishing you had died instead, then at least for me, potassium citrate worked better than Azo for pain relief (additional bonus: no orangey-yellow stains). But unlike with Azo, if you’re taking an antibiotic (or at least a certain antibiotic, the one I was researching), you can’t take potassium citrate—something about the potential for forming stones. I don’t feel like I have the full story yet, but at least I know it’s not some UK secret for over-the-counter UTI treatment I could have been taking all along. The nurse practitioner said it sounded to her like a product called Prelief, which is for people who get pee-related discomfort from the acids in food.
Also, I told the nurse-practitioner the gist of scattered, irritable, and sentimental, and she asked a few questions about cycle and so forth, and then the word “peri-menopausal” came up. So. Let’s just let that hang in the air for a moment.
She recommends vitamin B-6 supplements, 100 mg a day. She says they can help somewhat with mood fluctuations. She mentioned that she had the unfortunately-not-at-all-rare privilege of going through menopause at the same time her daughter was going through adolescence (nice planning, SPECIES), and one day she was like, “That’s it: we are BOTH going on B-6!” She said they still had their moods, but there were fewer “Crud, did I say that out loud?” moments for both of them. She also recommends the early books (“the earlier the better, before they got so…celestial”) of Christiane Northrup, for information and comfort.
She sounds like a GEM and I don’t think I would ever go back to your primary again. Ask for her! your FRIEND! Heck, invite her to read the blog so we could all benefit from her friendship/wisdom!
(nice planning, SPECIES, is prefect. *counts on fingers the years… hmm, daughter is five now carry the 1*…. oh crap. )
“So. Let’s just let that hang in the air for a moment.”
Ha! My new favorite phrase. I woke up in the middle of the night having just written, in my head/dreams, a complete post on how to deal with hot flashes, but then I realized if I actually internetted that post I’d have to plan a quintuple funeral because Husband and all four Boys would die from embarrassment. It’s a shame, really, because I have HINTS.
WE WON’T TELL THEM. Here: whisper in our ears.
Fans. It starts with fans everywhere, including three pointed directly at your side of the bed because OH NO! Here comes a flash! Five minutes later, you will be freezing and crawl back under the quilts that probably led to the original power surge. Also, carry a pretty cotton hanky in your purse/pocket/wristlet; it looks so much more put-together than the handful of napkins you’d otherwise be grabbing from the Wendy’s dispenser to mop your face with. Also, if you are not a candidate for HRT (as I am not–clotting issues a few years ago) your doctor may suggest Prozac. Do not turn that down because you think it makes you look like a crazy person. You already look like a crazy person and it will make you feel calmer about that fact, even if it does not make you sweat less.
I’ve seen various cooling neck packs sold for people who run long distances in punishing heat. I was thinking I might acquire one of those. Or perhaps several: one in the freezer at all times, or however those work.
“difficult situation of still feeling like stewing, but about something that turned out better this way” – YES. This is my life, sometimes. What a concept – preventative medicine rather than letting a UTI becoming something that makes you feel like death would be nice.
So. The PM word. I think that’s me, because my cycle is all over the damn place and then when I do get my ladies’ holiday, it’s vicelike cramping and pain. That never used to happen. Fortunately I only have boys so when I’m going through menopause they can just go hang out with their dad somewhere, leaving me to sob/scream in peace.
LADIES’ HOLIDAY HAHAA best/worst euphemism ever.
I love that nurse practitioner. At my last “annual” visit (in quotes because it had really been something like three years for me), I had a nurse practitioner, and a student, too. There was great potential for awful, but instead I left feeling wonderful. They were so kind and funny. Anyway, I hope this prescription gives you some relief from your ongoing UTI thing which sounds so terrible to go through.
I’m in peri-menopausal hell over her. YOUR experience with this stage of life may be wildly different from mine, so yours might not be hellish, but as one who is having a difficult experience with it, I second her book recommendation. It sits on my bedside table and I consult it regularly. I tried B vitamins and they didn’t work for me, although I know they work for some. I am experimenting (I’ve had 3 appointments so far) with acupuncture and am having good initial results. She’s also using acupressure balls (tiny little gray/silver balls that are taped in my ear, 4 or 5 at a time) so I’m not sure if it is one or the other or both, but my insomnia is better and so are my mood swings. Unfortunately, my period is as flaky as ever so I haven’t had a cycle since I started but she said it might also make those more even, not so heavy at times.
Anyhow, I just wanted to share my experience in case it helps you. Even though women talk more about peri-menopause than they did back in my mom’s day, I still found I was woefully uneducated and unprepared, which led to a lot of confusion (haha) about my symptoms.
Oh! Tell me which of her books you like! I’m having trouble figuring out which one to to get. Is yours low on the celestial?
I have “The Wisdom of Menopause: Creating Physical and Emotional Health During the Change” and it is quite long. There are 636 pages, excluding the “Resources” pages. I have not read it cover to cover. I read certain chapters when I got it and then read more as I encounter issues. I also use it as a quick reference manual because I’m scared of Google, or rather, am scared Google will scare me! Certain parts of the book are a little bit heavy-handed for me, but not overly so. I tend to skip the parts that don’t interest me.
Oh, good, my library has that one!
Same here – they send out a letter that says to call immediately for an exam and that it might “take several weeks due to the schedules of our practitioners.” You call the SAME DAY you get it, thinking it will help, but no. 6 months out. Then the Dr. tuts at you for having delayed coming in. Once they called me to reschedule twice and I finally asked the woman on the phone if there wasn’t something she could do. I got in that week. Huh.
BUT! I have the same situation with NPs. at the Peds, they are not so great, but at the OB/Gyn, the 2 they have there are actually preferred over the doctors among people I know (I know about 6 people that go to the same practice). and the bonus is that despite being more in demand than the doctors (as far as I know) they are almost infinitely more available for appointments. Because they don’t have to be at the hospital on call?
NPs typically have more availability than MDs because people don’t really know if/when it is appropriate to use us. An uncomplicated annual exam is a fantastic time for an NP. I would like to say an uncomplicated illness is a great time too, but man, the NP at my pediatrician’s office ALSO sucks, and it really, really pains me to read about all of these bad experiences because I actually *am* a peds NP. I work in a hospital setting, but still. I will not even see the NP in our practice, and like I said, I actually am one.
I could go off on a tangent about how every new grad RN eventually goes back to school to become an NP and the programs aren’t selective enough and they don’t practice long enough, so that a role that used to be filled by experienced, clinically strong nurses is slowly being filled by…well, anyone. Woops, I DID go off on a tangent. Sorry. As you were.
All I am taking from this is you had your annual lady doctor appointment yesterday and I also had MY annual lady doctor appointment yesterday, so basically we are Pap smear buddies. (We can work on the name.)
Okay but really, your practice is nuts. It’s irresponsible care of women! I am going to get my soapbox! But I’m also glad it worked out and you liked her better. She sounds like my ARNP, who actually listens and wants to fix things! VERY NOVEL I WISH MORE DOCTORS WOULD TRY IT SOME TIME.
My sister drinks amazing amounts of water every day–she says that if she slacks, she notices her UTI symptoms coming back. And my PA says that he thinks a major component of the helpfulness of cranberry is the water in the juice–hydration helps a myriad of ills. Now, is that an easy thing to accomplish? Hah!
They don’t schedule appts for more than 2 months out? Ugh. I am fuming on your behalf. So glad the NP was awesome. She sounds exactly like my OB who I was missing so much I went and got myself pregnant again so I could see her more.
My primary care doc was asking about the last time I had had a ob-gyn physical. I told her it had been less than two years so that was okay because the new guidelines say that every other year is the new standard. She said that actually the new NEW guidelines mandate a visit every THIRD year and that this is what insurance will cover, not every year or every other. Fewer doc visits for the win!
Hrmm – I thought it was now “Have an annual exam so they can take a look-see, plus quick breast exam. But, actual pap smear every 3rd year.” I imagine switching from one standard to another takes them awhile, and once they do, they’re told to switch to yet another standard!
I’m in Australia and our standard is a pap smear every two years.
I want your nurse practitioner. This is all very helpful info now that I’m into my fourth UTI for this pregnancy. I keep wondering exactly how many of these I have to have in quick succession to rate the preventative meds – but so far zilch. And no matter how many doctor appointments I have, they always seem to strike at the time that maximizes the days of discomfort before I finally get to see someone. So yeah..grumble grumble. Looking forward to the return of normal bladder function in a month or so (should probably knock on wood about that).
Oh I quite like this NP.
I got a KIDNEY INFECTION about a month ago and it was awful. I think…I think I almost died. And I didn’t have any lead up UTI symptoms so it just…no really, I think I almost died. Ended up with the urgent care doctor telling me that if I’d waited one more day I’d be in the hospital, and I had to get a shot of antibiotics in my butt, and big bottle of narcotic pain killers. Apparently having a fever for four days along with intense lower back (aka KIDNEY) pain is not normal. The more you know.
Oh. The yearly. I’m a pro at putting this off. I made an appt in July (100% convinced I was riddled with cancer) thank goodness all was well. I vowed then & there no more procrastinating. I made an appt for the next year before I walked out the door!
I take a cranberry pill every day to ward off UTIs. A pharmacist told me that the regular cranberry cocktail doesn’t help (except the fluids) but you can drink a stronger straight cranberry juice from a health food store. I stuck with the pills. I used to have frequent UTIs and I think I’ve only had one in a few years since I started the pills. I get them at Costco in a giant bottle. Bonus: fewer yeast infections since I’m not on antibiotics so often!
Yes, I take the pills too. Also the straight 100% cranberry juice, which is astonishingly bitter but I’ve gotten used to it.
Oh darn. Sorry to hear that isn’t enough!
No advice on the UTI I am thankfully not prone to them but I just had to comment because I love coincidences. Two days ago I was listening to a podcast interview of a woman who was going on and on about growing up with a very well known mom and the pressure and blah blah and the mom is/was Christiane Northrup and I had never heard of her. And then today this post and now I’m all in the know on Dr. Northrup ;)
Oh and I tend to like NPs. at our pediatrician one is fantastic and one is awful so I try to schedule carefully but the good one is better than most of the docs for my kid and her various ills.
And finally, your doc sounds like my dentist with scheduling. speaking of which I need to reschedule an appt so will likely get a cleaning in early 2014 if I call today. Hmm
I too would rather get a pap smear than go to the dentist. MUCH RATHER. I’d rather get a mammogram than go to the dentist, too. (I even wrote a post about it.)
And you people had me laughing so hard the mascara’s running down my face.
hmm, I need to know more about this b-6 mood swing thing, can anyone take b-6? is it bad if you take it and don’t need it? I would love less mood swings
Anyone can take b6, it’s a water soluble vitamin, which means if you get too much of it, you just pee it out. (So worst case scenario, and you DON”T need b6, you waste money, but you don’t build up toxic levels in your body). Hope it helps you!
Wikipedia has decent info. on the toxicity of B6. Basically, even though it is a water soluble vitamin, you CAN have too much so beware of going crazy with supplements. Staying within the RDI limits is fine for anyone. Disclaimer: I’m not a doctor.
Oooh! Elizabeth makes a fine legal point. I too am not a doctor. It is possible to overdose on most things, including water. Please do not spend hours a day swallowing b6 pills because some stranger on the internet implied you it would be hard to suffer negative effects from doing so!
As a family nurse practitioner, I’m so happy to hear that your appointment went well. Yes, there are “good” and “bad” in every profession, but it’s always nice to hear when a patient is happy about the care they received from an NP!!
UTIs. Ugh. If you ever have UTI symptoms with no bacteria, make them give you anitbiotics anyway! I had a ‘light’ infection that was six months of misery before I got a positive test and got it cleared up. This is very possibly what triggered me developing Overactive bladder, which was awful and now I’m on Ditropan for the rest of my life. Ugh, indeed. At least it’s not just me.
Oh yeah… when I finally got that last genuine UTI treated, I still had trouble getting rid of the symptoms. Clever doctor told me to rinse my crotch with cold water after peeing to soothe the nerve endings. Heaven. Lingering symptoms were gone in 2-3 days. Saved me from going totally insane…
I would just like to leave another little comment in praise of NPs. I have basically switched most of my care to them (even specialists! I have an endocrinology NP who is FAAAABULOUS and basically the reason my second daughter exists!) Obviously they are not all wonderful, but I have in general found them so. Three cheers for the mighty nurse practitioner!
Also, maybe you have already read this book, but if not, well, do. It is excellent.
http://www.amazon.com/Womens-Moods-Hormones-Emotional-Health/dp/0380728524
The only time I’ve seen a nurse practitioner for my annual here in the US, she stayed in the room while I was trying to wiggle back into my underwear and trousers (having, you know, cunningly hid my knickers under my folded trousers because God forbid that the medical practitioner who’d be looking at my cervix see my underwear) and told me that I seemed really nice, and would I be interested in her church’s women’s ministry? Because she was really keen to share her faith in Jesus Christ with me! I actually AM fairly devout, but in a very quiet Church of England sort of way, and I was so horrified at somebody trying to save me after putting a speculum up me that I can’t EVEN TELL YOU. (Did my vagina seem in need of saving? What exactly about me seemed nice, and OPEN to this sort of thing? AUGGGH.)
My last annual was a surprise. I showed up for my 10-week pregnancy ultrasound, husband in tow, and the nurse told me since I was due for an annual last month that they’d just go ahead and combine it. “Take off all your clothes and put on this gown!”
And that is how I got a pap and a breast exam with my husband sitting right next to me.