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[mychemicalmenopause]

5 Weeks Post Op

I'm fucking losing it. Surgery was about 5 weeks ago and I've pretty much been home the entire time. Broke up with my shitty ass boyfriend, but that took a toll on my mental health, self-esteem, etc. I'm so tired, all. the. time. I wish I could figure out something purposeful to do with my time, but I pretty much fill my days with crafts, a little work here and there, and overwhelming self-loathing. I'm bored but I don't want to do anything. When I do things, I usually push myself hard without realizing it, then I'm in agony for days afterwards. #surgicalmenopausesucks

[mychemicalmenopause]

Catching Up

I stopped writing for a while and I’m not really sure why. Work got busy and it felt like every day was the same. I had some really rough days with anxiety, depression, and a couple embarrassing moments of rage. Then, somewhere around week 5, it all started to level out. When I saw Dr. Schneider again on December 14th (6 weeks into Chemical Menopause), I told him that my biggest complaint was fatigue. Although my periods have stopped and hell week in general is gone, I still get full-body pain and extreme fatigue if I’m too hard on myself. He was impressed that I had been doing so well and to my utter shock and amazement, he said we could go ahead and schedule surgery!

I was hesitant to get excited, but I felt really good and surprisingly calm about everything. They scheduled it for January 19th, but we had to wait until January 3rd to hear back from my new insurance company, so it was a very long 3 weeks of waiting. 

In the meantime, I decided I was going to throw a Hysterectomy Party! It’s this coming Saturday and I’m so excited about it. It will be nice to see all my favorite people and thank them for having my back all these years. I have to go, lots to do... will post again soon. 

[mychemicalmenopause]

Day 11

Today is worse than yesterday. One of my girls has Covid, so instead of getting to sleep in and only having 2 visits, I'm working 6am - 11pm AGAIN. It's obviously no one's fault but I can't help being angry. Nothings going right at all, I spent $9 on a fucking latte from Starbucks and they completely fucked it up. Threw it out the car window in a rage then couldn't stop crying for an hour. No time between visits for a nap and I just want to crawl in a hole and die.

[mychemicalmenopause]

Day 10

Today is fucking rough. I felt like shit yesterday, worked 6am - 11pm and took 2 naps. This morning, everything pissed me off immediately. My body hurts, my head hurts, and I threw up this morning. I have zero patience, hella brain fog, and I want to burn the business down. I hate everything and everyone and I just want to crawl into a hole and die. I hate this.

[mychemicalmenopause]

The First Few Days

I took my first Myfembree pill Saturday night, 10/29/22. I’ve been very tired with a headache the last few days, but I was thinking most of that was just a lot of work and lack of sleep. I finally got a solid 8 hours of sleep last night, and woke up with a pretty bad tummy ache and feeling a little nauseous. My mood is mostly good, even with the stress of a busy work week, so that’s a good thing. It is my typical “good week” so I’m not sure what’s “me” and what’s “meds” at this point. I’ve had a few hot flashes and woke up sweating a couple times, but nothing too scary. So far it’s not too bad, but I’m definitely paying attention to my body. 

[mychemicalmenopause]

My Final Hell Week?

Could this be my last one?! With the new meds on the way and my period about to start any second, this could be my last week of suffering, and I can’t believe it. 

I drank last night, which is never a good idea during hell week if I have to work the next day. Luckily I don’t have any visits, but I do have a lot of computer work today and a new client Meet and Greet tonight. When I scheduled that I thought I would be bleeding by now, but of course now. I’ve had a headache since I woke up, so I made breakfast and drank my coffee, but that didn’t help. I’ve been sitting at the computer for the last hour or so and feel like I’ve accomplished nothing. The brain fog is H E A V Y. I can’t think straight or make decisions and the full-body pain is debilitating. Yesterday was a really rough day with one of my sitters and I was angry and stressed all day. My body is still feeling the effects of that - stomach is so messed up. I’m nauseous and exhausted and should probably just go to bed, but there’s stuff I need to get caught up on so I can relax this weekend and enjoy Halloween. 

I’m just really hopeful that the new meds will work. 

[mychemicalmenopause]

Dr. Schneider

I can’t believe I haven’t written about this yet, but I met with Dr. Schneider last week, on October 11th, and it went wonderfully. The office was familiar since Dr. Schortz worked there previously, and that may have helped with the initial anxiety I typically feel when I’m seeing a new doctor. The receptionists were friendly, the wait was short, and the triage nurse was fantastic. She was close to my age and was upbeat, very comfortable to be around. She got my history without any judgement or need for further explanation, and didn’t ask me to take off my clothes - which was refreshing. 

Dr. Schneider came in just a couple minutes later and was easy to talk to. He told me he read my chart the night before and that morning and was familiar with Dr. Schortz’s plan, but wanted an update from me. I told him what was going on, that I was at the end of my rope with PMDD and Endo and I wanted to work toward a full hysterectomy and oophorectomy. He got some history and to my surprise was the first OBGYN who has EVER asked me if I’ve been raped. I haven’t, but just the fact that he wanted to make sure that wasn’t the reason for some of my pelvic pain was pretty fucking cool. 

We talked about Chemical Menopause and how I understood that it was basically a “try it before you buy it” kind of test to make sure I would do well with having my ovaries taken out and being on hormonal add-back. He agreed and asked if I had heard of Myfembree before (I had not). Apparently, it just recently received an FDA approval to treat heavy periods caused by endometriosis, but it works the same way other Chemical Menopause meds work - it shuts down the ovaries, but it also adds back the hormones all in one pill. It also has significantly less side effects than Lupron and is super cheap! 

I told Dr. Schneider that my insurance wouldn’t approve Lupron when I was with Dr. Williams because my endometriosis had not been officially diagnosed. He said he was confident that he could word it well for insurance, and don’t you know, he did! The script was called in and his notes were complete in MyChart within minutes, before I even got home. I called the pharmacy on Thursday just checking in and they said they had received an initial rejection from my insurance but to call again on Monday (today). Before I could call them, I got a text with a link to confirm my address. No co-pay and it’s on it’s way to me. I haven’t started my period yet, but I can start the meds 2 days after I do, which will be this week. I’m a little nervous to start it during Halloween when all I want to do is celebrate 5 years in business, but if I don’t I’d have to wait another month and I don’t want to do that either. 

Anyway, I’m super happy with Dr. Schneider and have felt so much relief after seeing him. I’m excited, nervous, and scared as fuck to start the meds, but I’m glad there just might be some light at the end of this tunnel. 

[mychemicalmenopause]

Blah.

After my appointment with Dr. Stevens and deciding I was not comfortable with her treatment plan, I started to do some research on Endocrinologists. I was scrolling through the options on Novant and saw a doctor pop up at Pelvic Pain Specialists in Charlotte - Dr. Schortz’s old practice. I called and sure enough, they finally replaced him with two new surgeons. I asked for the first available appointment and they got me booked for the next day (last Friday, 10/14). I had already been on the road for 45 minutes when they called to tell me Dr. Schneider had been called into emergency surgery and they would have to reschedule my appointment. I handled it well and got it set for Tuesday (tomorrow). 

Today, hell week started and it’s hitting me hard. My head has been hurting since 6am when I woke up. It was a stressful morning at work and that’s never fun on a Monday. Took a nap hoping I would wake up in a better mood, but no such luck and my headache is worse. I’m trying to just chill, but I’m super nervous about my appointment tomorrow. I really want to meet someone who makes me feel comfortable and takes the time to explain things to me. Really hoping that person is Dr. Schneider, but we shall see. If it doesn’t work out with him, my next step will be finding a Reproductive Endocrinologist, so I know I have a backup plan. I just want to be able to keep my cool and ask all the questions, and that’s going to be tough. 

Wish me luck. 

[mychemicalmenopause]

2nd Opinion

Yesterday I had an appointment with Dr. Holly Stevens for a 2nd opinion. My sister came with me for moral support, which was very much appreciated. Check in was easy-peasy, they called me back in a reasonable amount of time, and there were no crucifixes on the walls - thank goodness. The nurse who took my vitals had no idea what PMDD was, so that made me a bit nervous, but she was kind so that was great. 

Dr. Stevens came in wearing jeans and a sweater and I liked her casual appearance. My sister and I had practiced what I was going to say, but of course that went out the window and I word-vomited a bit on Dr. Stevens. I told her that one of my biggest issues with my last doctor was a lack of communication and that it was very difficult to get questions answered. She immediately said it usually takes her 10 - 14 days to get back to patients on non-urgent questions, but that if I had a major issue to call and I *should* get a call-back same day or next day. She said, “If you need more communication than that, we’re not the right practice for you.” <insert eye-roll emoji here> 

Then we started talking about a hysterectomy with an oophorectomy, and she cut me off and said, “There’s no way I’m taking out ovaries in someone in their 30s.” I said, “Ok, then we’re done here,” and tried to get up, but my sister continued to ask more questions (which was good that she didn’t play off my immediate annoyance and anger). Dr. Stevens eventually said that she would recommend doing a Laparoscopy ASAP to confirm the Endometriosis. Depending on the results of the Lap, she would then either start me on Chemical Menopause or refer me to either an Reproductive Endocrinologist, or a Gynecologic Oncologist. IF she were to start me on Chemical Menopause, she would want me to be on those meds for 2 years. I asked what happens after 2 years, three times I asked, and all she said was that she still would not take my ovaries out at 37 years old. The fuck? 

This is EXACTLY why I didn’t want to just go see another regular OBGYN. She’s not a specialist in Endometriosis OR PMDD and this whole thing is such a mess. Dr. Stevens did absolutely nothing to make me feel comfortable or cared for / about. She was curt and I did not care for her. I could let her do the Laparoscopy, but because I’m not at all comfortable with her as a person or her treatment options, I don’t think I’m going to. I reached out to Dr. V, who a client recommended, to see if I could pay cash for a 3rd opinion. I’m also reaching out to a couple other practices, because I refuse to stop until I am comfortable with a doctor and their treatment plan. 

[mychemicalmenopause]

I Fired My Doctor Today

Woooow. So, after messaging with Karie this morning, Dr. Williams wrote me back: 

“Stephanie, I think it's very unfair that you have been denied this medication. I do understand your concerns with regards to waiting for this medication especially in the face of a possible repeat denial. However, I also have grave concerns regarding your proposed planned. Removing your ovaries without firm evidence that it would help is not something I can personally offer you. I am willing to continue to argue your case for this medication. With that said, you may be better served by seeing another doctor who would be comfortable with your proposed plan of removing your ovaries. Again, I am happy to submit the external appeal. Please let me know how I can further assist you. Dr. Williams” 

I posted his response on Facebook and a lot of people were upset for me. Some friends even sent links for doctors and lawyers. I called Carolina Women’s Health and have an appointment with Dr. Holly Stevens on October 12th. Then I sent the following message back to Dr. Williams:

“I sat down to write an essay about the research I’ve done that explains how Lupron only works about 50% of the time b/c the side effects are the same as regular PMDD / peri-menopause symptoms and it’s very hard to differentiate. There’s also research which states over 75% of women with PMDD have relief of symptoms after a TAH-BSO. I wanted to ask you to send me anything that can support your decision, but then I changed my mind when I realized you tried to push me off on another doctor before even offering to do the diagnostic surgery my insurance requested, or anything else for that matter.  

When I met you a month ago, you said you were ‘willing to do the hysterectomy and weren’t really comfortable with taking out my ovaries, but’ – and I quote – “I bet you could twist my arm.” You gave me hope that day, and today is a completely different story. If I gave you the go-ahead to submit the external appeal and it was again denied, we’re clearly not on the same page as to what happens next. 

I made it clear during my appt that I was not interested in a hysterectomy without an oophorectomy, and you said you were willing to work with me. All I can think now is that you don’t want to treat me because I unintentionally got your staff in trouble by asking for help. Between the issues with your staff and your refusal to treat my pain at any point in the last month, I’ve decided to find a new practice. 

Thanks for an absolutely soul-crushing experience and a very stressful month.”

For real though, what an absolutely awful month it’s been and shame on him for getting my hopes up for nothing. Men are the absolute fucking worst. 

[mychemicalmenopause]

Insurance Sucks.

 I got a message from Karie on Monday saying my insurance had denied coverage for Lupron. She asked if they could submit an appeal on my behalf and I said yes. This morning, I got a message from Karie saying my insurance denied our appeal. She gave me a link to apply for medication assistance and said, “We can submit an external review with your permission.  This goes to the North Carolina Department of Insurance in Raleigh.   From what I'm reading, these appeals can take up to 30 days but we can submit this as an expedited request.” 

I wrote back and said, “Good morning Karie, thanks for letting me know. I'm wondering if we can just move forward with surgery, including taking my ovaries.  Waiting another 30 days for them to possibly say no again is not really something I want to do. I've explained to Dr. Williams that my my cycles are killing me and the longer we push off surgery the more stressful it is trying to just survive. I just want it all out, and I'm not worried about it "possibly shaving years off my life," because that's what's happening right now with my cycles - they are killing me. Can we do that?” She wrote me back and said she was with me 100% and would forward my message to Dr. Williams. 

I’m just so frustrated that the insurance company has the right to say no! I’m definitely not applying for assistance. Each injection is $3,000 and I need it SIX times. No way. Really hoping my doctor comes back and says yes to surgery. I’m gonna flip the fuck out if he says no. 

[mychemicalmenopause]

Whoops, I meant to update the other day when I heard from Dr. Williams after speaking with Dr. Lipscomb. He started off the conversation by saying, “So, what’s this I hear about the front desk and a Google review?” The way he said it was more annoyed than intimidating, like he had gotten in trouble and he had absolutely no idea why. I told him that I had left several messages for him, his staff, and the Regional Manager and I hadn’t heard back from anyone. He told me that the front desk was trying to “cover” for Karie by not delivering my messages, when they “really did need a push” to get things done. As a former receptionist, it really makes me wonder if that’s what actually happened, or if they used the front desk as a scapegoat for Karie. Either way, shame on them. 

Dr. Williams repeated what Dr. Lipscomb said earlier in the day, “We can do better,” and asked if I was willing to continue treatment as planned. I told him that I’m nervous about not being able to get questions answered in a timely manner when I do start meds, especially now that I’ve gotten Karie in even more trouble, unintentionally. He said, “Well, everyone in the office knows who you are now, but if you need anything, just send a message through MyChart instead of calling in.” I told him that I tried that the first time I had questions and it took eight days just to get an acknowledgement. He apologized for that and tried his best to assure me that it won’t happen again. He promised that the Lupron had definitely been called into the pharmacy and that they should just be waiting on my insurance to authorize it. I told him I had talked to them earlier in the day and they said to call back on Friday if I hadn’t heard anything. 

I talked to my therapist on Thursday and told her that I still felt very unsettled about the whole thing. I felt a little guilty that the apparent “big boss” doctor had to get involved and that everyone got in trouble, but damn - do your job and give a shit about your patients and maybe that won’t happen again. I did apologize and told Dr. Williams that I didn’t mean to be a bitch or a difficult patient, that I wasn’t being hostile when I called and have been kind to everyone I’ve spoken with. Ariel (my therapist) told me not to feel guilty for advocating for myself, but I still did. She asked if I was comfortable moving forward with Dr. Williams and I said I wasn’t sure, so she advised me to continue as planned. I value her opinion and advice, so that’s what we’re doing.  

This morning I got a message from Karie saying my insurance had denied coverage for Lupron. “Their letter stated that approval requires the diagnosis is confirmed by surgical or direct visualization or histopathological confirmation in the past 10 yrs.” Because we’re doing things a little backwards, it would not benefit me to have surgery to diagnose Endometriosis and then go back in, in 6 months to take everything out. So Dr. Williams filed an appeal explaining why he’s wanting to prescribe Lupron and we’ll see what happens. 

I’m just flabbergasted as to why my insurance would approve a total hysterectomy (around $50,000), but not a medication. Why do insurance companies have the right to override a doctor’s prescription? Who the hell are these people to say yes to SURGERIES but not meds? It’s absurd and mind-blowing and fucking exhausting. Not one single thing has been easy with this and I just want the surgery already.  

_______________________________________________

PMDD is so freaking weird, man. Today was a typical Monday - didn’t get enough sleep last night, got an extra visit added to my schedule, had to run errands, introduce a sitter to a dog, and did an interview. For the last 2.5 - 3 weeks I’ve felt like shit, but I’m not in a bad mood today. So much so that it caught me off guard a little until I was like, ‘This is what you’re supposed to feel like,’ bit of a headache from the day but overall OKAY. 

[mychemicalmenopause]

Dr. Lipscomb

I left a 1-star Google review for Novant Triad OBGYN earlier this afternoon: 

“I was a new patient transfer from the ER for severe pelvic pain. It's been a month and my medications have still not been called in. I have called twice a week every week and have been promised call backs that I never receive. I keep getting told that they are short staffed and to "just be patient," but there is no excuse for no communication, and I'm still in an extreme amount of pain. Hoping this review might prompt someone, anyone, to give me a call. Please help me.”

I spent the afternoon updating my records and trying to post a complaint on the Better Business Bureau only to find out the practice is not accredited. I wrote out a message to send to Dr. Williams and I was juuust about to do that when I got a call from Dr. Lipscomb, the main doctor at Triad. He said phone calls are not usually what he does, and that today was his day off, but he got a call from a friend saying someone posted a “cry for help” review on Google and he wanted to reach out to see what’s going on. 

I explained to him, kind of sporadically, that there has been a serious lack of communication and that I’m terrified to move forward with treatment because I’m sure I will have questions or concerns throughout the process and I need to know I can get answers in a reasonable amount of time. He seemed to understand my concerns and said, “We can do better.” He asked if he would be ok for him to call Dr. Williams and have him call me this evening to “regroup,” and I said yes. I’m really hoping this works because this has been a nightmare and I just want to move forward. Sigh. We shall see what happens from here...

[mychemicalmenopause]

Update / Timeline

The last week has been non-stop hell between my mental and physical health and the business. I haven’t been able to post as much as I’d like, so I’m going to try to recap as best as possible: 

After not receiving a call from Dr. Williams last Tuesday, 8/30/22, I sent another message in MyChart following up: 

“Hi Dr. Williams,  

I sent a message last Wednesday 8/24 and wanted to follow up to make sure you received that message. I called the office yesterday and they said you weren't there, but assured me you'd get back to me today. I would really appreciate some kind of response from anyone, especially about when to start Lupron (and if I need to set an appointment for that or how it works).

Thank you.” 

I received an acknowledgment message from Stefanie at 9am saying, “I have forwarded your message to Dr. Williams and I will make sure he looks over it today. I'm sorry for the delay. “

Around 10am, I received a message from Dr. Williams:

“Hi Stephanie,

I'm sorry I'm just now getting back to you. Good questions. I would actually start the lupron in the luteal phase (after ovulation). I would look at your prior cycles and try to time the lupron such that you're taking it approximately 7 days prior to the start of your menstruation; alternatively, taking it on cycle day 21 probably would pinpoint the luteal phase fairly well. 

2.   You can stay on your current vitamin regimen.

3.   Let's see how you do on the lupron first. I would be using the naltrexone for PMS symptoms and I'd like to see how you do with the "medical menopausal" state alone. Thank you for the information on your grandmother. It is good she did not have ovarian cancer.” 

After receiving that message, I immediately called the office and explained that I was currently 7 days from the start of my period and wanted an appointment to get the Lupron injection. I was then told by Erica, the same nurse I spoke to on the 29th and we specifically spoke about Lupron, that the Lupron was a prescription that would be MAILED to me, and then I would come in for them to give me the injection. I was taken back by the new information and asked if it was already on it’s way to me and she put me on hold. She came back to tell me that Carrie was currently on the phone with them getting it called in, which was at that time, 7 days after Dr. Williams had asked her to. I asked Erica if Karie was the same nurse who read my message to him a week ago and she said yes. She says that they are very short staffed and that Karie is Dr. Williams’s only nurse. I told her that I own a small business and we’re short staffed too, but we stop taking on new clients when we know we can’t handle them. I asked to speak to a manager and she told me they don’t currently have an office manager, but that she could have the Regional Manager give me a call that day. 

It was at that point that I realized who Karie was - the hateful nurse from my first visit there. So I need to rewind even further, sorry to anyone who may or may not read this and good luck keeping up. 

8/15/22: Ashlyn spent the night so she could go with me, and we arrived in Winston Salem at 10:45 for my 11:00am appointment. We checked in and all was well until we walked into the exam room with Karie, the NP, and another nurse who was training who’s name I didn’t get. As Karie was getting my history, Ashlyn was able to take everything in, and as soon as I mentioned the abortion I had when I was 19, Karie immediately shut down and couldn’t get out of the room fast enough. She told me to get undressed and that the doctor would be in shortly. When she closed the door, Ashlyn pointed above the door frame at the crucifix on the wall. I knew they were a pro-life clinic from their website, but I decided I wasn’t going to let politics get in the way of my medical care - boy, was I wrong. 

About 10 minutes later, Karie came back in and told us that the doctor had been called to the hospital and that we could wait a little bit to see what happens, but that they would probably need to reschedule. Ashlyn and I were shocked that this could happen, but we tried to be patient. About 20 minutes later, Karie came back in and said I would need to go ahead and get dressed and she would take me up front to get rescheduled. I was pretty upset at this point, as I had to pay one of my sitters an extra $100 to cover for me at work that day and we were never told he was on call. Karie immediately became frustrated with us and said we could “voice our concerns up front.” I got dressed and she came back in, I kept my cool and asked if there was any way we could just wait for the doctor to come back, or we could come back at 5:00 and be the last appointment for the day, anything! Karie said no to every single one of my suggestions and was very rude about it. I reminded her that I was a transfer from the ER and in a lot of pain and she had zero compassion whatsoever. 

We explained to the front desk that we had not been told the doctor was on call, repeated how much pain I was in, how we took time off and drove an hour to get there, and I begged them to do anything they could to get me in the same day. Meanwhile, Ashlyn was behind me asking for names and threatening to call the Better Business Bureau. They told us to have a seat and that they would see if there was anything they could do. About 45 minutes later, the “Office Manager” came out to the lobby and apologized for the confusion. He said the doctor had just delivered a baby and was on his way back to the office, and that they’d get me back in a room shortly. We thanked him profusely and before he walked away, Ashlyn asked if there was anyway we could get a different nurse, as Karie had been rude and we were no longer comfortable with her.

A few minutes later, the nurse who was training came to get us and put us in a different room, with another crucifix above the door. A couple minutes after that, she came baring drinks to kiss our asses, which we appreciated. Eventually, Dr. Williams came in and we spent about 45 minutes talking to him about my history, what’s going on now, and how badly I’m ready for a full hysterectomy and oophorectomy. Here’s Dr. Williams’ notes from MyChart: 

“GYN Office Visit CC: pelvic pain   

HPI: Stephanie is a 35 y.o. female who presents for the above complaint. Pt has had painful periods since 10 years old. ocp at 12 yrs old. At 19 yrs old, got pregnant. Had abortion. Doesn't do well on ocp's. Has psych concerns when on birth control. Was on depo when was 29; didn't do well on it, psych wise. Had IUD and didn't like it. Has PMDD.  She sees a correlation between her mood and fluctuations in her hormones.  Is followed by psych at this time.  Believes that ovarian removal may give her benefit.  She does report a family history of ovarian cancer with her aunt.  Her mother may have been tested for BRCA but she is not sure.  She is can ask her.  Told she might have endometriosis by another doctor. Never had surgery. Saw pelvic pain doctor in Charlotte. Went to pelvic floor pt; didn't help. Has pain with sex; every time in all positions. No pain with urination or bowel movements. Some diarrhea with menstruation. Ended up in ER on 8/3 due to pain and vomiting along with heavy bleeding. Bleeding lasts for 9 days when she does have flow. Cycles are about 20 days apart. Pain starts about 7 days before the flow. Does not have interest in fertility. Not in relationship currently. Has tried anti-inflammatory supplements. She is 100% sure she does not want a baby and wants a hysterectomy; knows this may not help her pain. She is tired of the bleeding.   

The patient has a very long history of chronic pelvic pain.  Statistically she has a very high chance of having endometriosis.  We did discuss fertility preservation and an evaluation for endometriosis and appropriate treatment with excision given her age however the patient declines this option.  She seeks definitive treatment of her abnormal uterine bleeding.  She has utilized multiple modalities to improve her bleeding & pain and she has not seen benefit.  She therefore wishes to have a hysterectomy with bilateral salpingectomy.  Given her long history of abnormal uterine bleeding and pelvic pain along with multiple failed medical management, I think it is reasonable to proceed with this surgery.  Of note she has no interest in future fertility.  We did have a very long discussion specifically on fertility given the permanency of this procedure and she is adamant that she desires no future pregnancies. She also inquires into a bilateral oophorectomy given her PMDD.  We are going to discuss this further at her next visit.  She has not tried Lupron in the past and this could be utilized to see if she would gain any benefit from a oophorectomy.  She is aware of the permanency of a surgery such as this.  She is also aware she will go into surgical menopause which increases the risk of osteoporosis along with all the menopausal symptoms including hot flashes night sweats insomnia vaginal dryness, etc. She would need E2 for bone health.  Patient states she is well aware of these risks and has been thinking about this for a very very long time.  She wishes for a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy.  She will return for a preoperative visit and we will discuss this further in detail.  I did review her ultrasound imaging which she is completed at an outside radiology department on August 3.  There are no concerning findings; there does seem to be some asymmetry between the posterior and anterior myometrium which could be consistent with adenomyosis however this is certainly not definitive.  I did mention utilizing naltrexone to assist with her psychiatrist and get back to us.  I also asked her to speak with her mother to see if she had genetic testing given her aunt has had ovarian cancer.”

I left the visit feeling a ton of emotions, but overall I was SO happy to have finally received a green light on surgery, and texted my family, “He said yes!!!”  

Ok, so let’s recap:

August 4th - ER visit for extreme pelvic pain and vomiting

August 15th - Exam with Dr. Williams, he agrees to surgery. 

August 22nd - I call the Surgical Coordinator to see when the first available surgery is, and she schedules it for January 5, 2023. 

August 23rd - I get a call from Dr. Williams saying he changed his mind and wants to do Chemical Menopause for 6 months to make sure I’m going to benefit from him taking out my ovaries, before we do surgery. Although I’m frustrated that he didn’t mention this during my appointment, I’m willing to “try it before I buy it,” as Dr. Williams phrased it. He calls in estrogen patches and progesterone tablets to my pharmacy and I pick them up the next day. 

August 24th - I send Dr. Williams a message in MyChart asking when to start the Lupron, if I should continue my supplements, and told him I  spoke with my mom and it was cervical cancer, not ovarian. 

August 29th - After not hearing anything back, I called and spoke with Erica who said Dr. Williams was not in the office but that he would definitely get back to me tomorrow. 

August 30th - I sent another message in MyChart following up

August 31st - I get a message from Dr. Williams saying to start the Lupron 7 days before my next period, which happened to be that same day. Called the office, was told the prescription needed to be mailed to me and that Karie was currently on the phone with the pharmacy calling it in. I was given the number for MedImpact to follow up with them, and Erica said she would leave a message for their Regional Manager to call me (since they don’t have an office manager). 

September 1st - I call MedImpact and was told there was no information for a prescription. I explained to them that my doctor’s office was calling in Lupron was I was on the phone with them and was told Lupron is a specialty rx and requires a prior authorization, which had not been given. Still no phone call from the RM. 

September 7th (today) - I call Dr. Williams office and spoke with Dana. I told her that I was really frustrated because I have no meds, there has been zero communication, and I’m still in a LOT of pain. She gave me the short-staffing spiel and told me to “just be patient.” I told her I had been patient, but no one should have to wait this long for meds when they are in this much pain. She put me on hold and confirmed with Karie that the meds indeed were called in with a prior authorization.

I just got off the phone with MedImpact and they are now showing that the meds were called in yesterday, but they’re still waiting on insurance. She said to call back Friday if I still haven’t heard anything. 

The thing is, I’m so frustrated with the level of care I’m receiving and I’m terrified to start on meds, especially progesterone, without knowing I can contact my doctor. I’m not sure if Karie has it out for me or if they’re actually that short-staffed, but waiting weeks for meds is unacceptable. 

[mychemicalmenopause]

Fire

Today’s been rough. All I see is fire. 

Harmon came over to watch House of the Dragon last night and said he was worried about me because I was burning up, but I didn’t have a fever. Didn’t get much sleep between hot flashes and nightmares and woke up with full body pain. TMI for anyone who isn’t experiencing the same thing, but I’ve had FIVE bowel movements today, so far, and it’s 4:30pm. My boobs feel like they weigh a thousand pounds each, I’m grumpy, impatient, irritable, and just freaking exhausted, man.

I had one visit this morning at 8am and went back to bed for a couple hours when I got home. Then I had an interview with a girl who had a bunch of red flags, but she reached out to us and I was just giving her the benefit of the doubt, I guess? Not really sure what I was thinking. It was awful. She cut me off several times, didn’t smile once, and was very argumentative. She didn’t have her own car or a smart phone, which she said she did on her application. Just a total waste of time. 

At this point in the business, I’ve had MANY bad interviews, so I really tried to just laugh it off and salvage the rest of my afternoon. Until I checked my phone to see a message from one of my Sitters saying she couldn’t work due to an injury. We’re already short-staffed and I’m having a hell of a time trying to figure out how to get her visits covered without killing myself. 

I’m in so much pain and I’m still not done for the day, I have a Manager Meeting to get to shortly that might make me cry if my manager quits. Tomorrow just turned into a 12-hour day and I’m not happy about that either. 

OH, AND I STILL HAVE NOT HEARD BACK FROM DR. WILLIAMS. He called me around 6pm last week, so maybe there’s still a chance that he’ll get back to me today, but if not... Ugh. I’m just gonna have a really hard time being nice when I call the office tomorrow morning. 

[mychemicalmenopause]

Communication

I got the call from Dr. Williams about chemical menopause last Tuesday. I sent a message on Wednesday wanting to know when would be the best time to start everything. I read a few different articles and personal experiences saying it was best to start within the first couple days of my next period. I also asked if I should continue on my supplements and if I should switch to the 50+ multivitamin. 

I also told him that I spoke with my psychiatrist about the Naltrexone he wanted to prescribe and that she gave it a thumbs up. I asked if that was something he wanted to do before or after surgery. 

I’m frustrated because I already picked up the Estrogen patches and the Progesterone pills, but there were no instructions as to how I’m supposed to get the Lupron. Dr. Williams did say that Lupron is expensive and he wanted to see if my insurance would cover it or not, so maybe he’s waiting on an answer there, but something tells me probably not. I also feel like there’s a lack of communication from Dr. Williams and his staff, and I’m worried that I’ll have a question or an issue on the new meds and not be able to get any answers. 

I decided to call and see what’s going on. I spoke with a nurse who said the message had been read by his nurse and forwarded to him for follow up, but that he’s not in the office today. I explained why I was frustrated and she agreed, but she didn’t have the answers either. I had to ask twice if she could please leave him a note or just remind him herself tomorrow to get back to me and she said she would. After I got off the phone with her, I thought, “Why didn’t the nurse send me a note last Thursday when she read my message saying, ‘Hey Stephanie, got your message and wanted to let you know Dr. Williams is out of the office til Tuesday’?” I mean really? Zero communication. 

All of this is just really scary and I don’t feel very well cared for. 

[mychemicalmenopause]

I’m not ok

Today has been overwhelming. It started with one of my sitters calling to tell me a senior cat we were taking care of had passed away overnight. In my 13 years of pet sitting, this is a first. I felt bad that my sitter had to handle it, but I couldn’t move and had to ask her to take the cat to the animal hospital to be held until her moms get home. She was horrified at first and tried to say no, but I told her it was my only morning off this week and she said ok. Sigh. I went back to sleep but had a headache that hasn’t gone away all day. 

I also received my new insurance card in the mail and that’s a whole big mess. I called last week to update my income, as I gave myself a raise in May and was overdue to call. My conscious weight heavy as I was getting prepared for what I thought would be a hysterectomy, so I took 3 hours out of my day and made the calls. I was told I was keeping the same plan, but because I was now making $2600/month instead of $1600, I was only eligible for a $373 tax credit instead of $400-something, and my monthly payment would go up from $24 to $116. Fine. I figured open enrollment is soon anyway, so I’ll be able to look at different plans next year. So tell me why I got my new insurance card with the following changes: 

PCP visit went from $0 co-pay to $30 Specialist visit went from $5 copay to $30 Conv Care went from $0 copay to $15 Urgent went from $5 to $30 ER went from $200 to $750 Max Out of Pocket went from $900 to $6,950 $0 deductible / 10% co-ins went to $0 deductible / 40% co-ins

Seriously, what the actual fuck? Clearly I need to make another call, but I just couldn’t do that today. My entire body hurts, I still have not heard from Dr. Williams, and I can’t help but let this impending doom of menopause consume me. I’m losing my cool, I can’t relax, can’t work... this is literal hell.