Tag Archives: women’s health

Perimenopausal Fun: How to Know When Low-Dose Estrogen is NOT for you

Standard

I’ve written a handful of posts dedicated to women’s health and those posts receive the most traffic and comments from internet searches (and likely from Russian bots). This tells me I’m on to something. The one that receives the most traffic is a post dedicated to “PMDD”: pre-menstrual dysphoric disorder. 

Wondering about that third word, are you? It means the opposite of “euphoria.” Disorders can’t be cured. So this one has to be addressed and managed. I feel as though I am cured from it, but I know that I am not…

My style is glib at times, but my intensity and interest in this subject is real because being a cisgendered female is hard. I won’t go into my sentiments surrounding the appropriation of my gender by cisgendered males because frankly I don’t have the required bandwidth nor the belief system to fully engage. To me, men feeling as though they are missing out on being a woman and who get to forgo the hips and the breasts expanding, and the periods (missed or on time), and the unwanted advances and leers of horny old men are out to lunch. I’ll trade a week and you can go through it all — you can:

  • put on a training bra in the dark or in a locker room,
  • deal with feminine hygiene (maybe even in a public bathroom or, say, totally unprepared at your violin lesson for your first time as a WOMAN),
  • barter your lunch for three tylenol to abate your cramps and risk suspension or expulsion from school because of it,
  • birth one of my kids,
  • fight off a drunken asshole’s overtures at a keg party… or
  • sit on a couch waiting for your ride home when your date cools off because you won’t sleep with him… or worse.

Go for it.

I also would be willing to bet that most men who want to appropriate my gender wouldn’t have the stones to endure a week of perimenopause.

This is becoming political… my apologies, but I feel I had to say something.

This post is about females and the shit we go through in our middle-life stages.

First: get an app on your smartphone or keep meticulous records. I use “PLog”: https://itunes.apple.com/app/period-log-free-menstrual/id494474881?mt=8 

With that said, one year ago, well into the end of my ninth year of perimenopause (which is the purgatory between getting your periods every month or so and all the emotions and physical symptoms that come along) and the time of life when all that shit stops, I was suffering. My moods were all over the place, yet I didn’t really dial in to them… I just sort of noticed them, “that was rude of me to say…” I’d say to myself. Or, “Since when do you do things like that?” I’m still there.

The weird thing about perimenopause to menopause is that it’s not a pause. A pause implies a restart. And your cycles don’t stop like a machine would stop, say if you turn off your car’s engine. Short of an oophorectomy, it’s believed to be a “pause” of your “menses.” Let’s be honest here too: it’s not at all a ‘pause,’ it’s a full-on shut down, so even the nomenclature is screwed up here. I’m guessing a man invented the word:

The answer to this mystery is found in the origin of the word. In 1821 a French physician named de Gardanne first coined the term menopause when he published his book “De la ménopause, ou de l’âge critique des femmes” using the term menopause to describe the phase in a woman’s life.

YES! It was a man! Merci, dude! I don’t speak French, but I’m seeing blah french blah french blahcritique” and “des femmes” which is never a good combination.

For menopause, things shut down like a forest fire which starts out slowly because someone didn’t put out a campfire. Or because of the climate or winds or a cigarette was tossed out a window… Then it smolders a bit and it gets oxygen… and it spreads to dry grasses or pine needles (which are basically small vats of kerosene because there is so much oil in them) and then a few yards in one direction and then an acre and then an entire forest, and then a national park…  But that’s fire.

For women, it’s much more subtle, but the experiences can feel similar. Just like some fires are “controlled burns” or a “small forest fire,” the clinical definition of menopause requires that a woman’s periods must stop for a full year.

For me, last year about this time, I was desperate for help. And based on the condition I’m in today, I’m nowhere near that year of cessation.

First: what the fuck is going on?

Borrowing from my immediately previous post, this graphic explains is what’s going on:

screen-shot-2016-03-04-at-5-26-46-pm

I’m 49 now. I started on this circus clown car ride (the middle graph) 10 years ago. Any day can be like that middle graph for me. Sometimes it is an entire day that feels like that.

The changes in hormonal levels as women age cause the following symptoms (lifted word for word from the Mayo Clinic site which is much more reputable than webmd, so take a breath, my comments in red):

Symptoms

Throughout the menopausal transition, some subtle — and some not-so-subtle — changes in your body may take place. You might experience:

  • Irregular periods. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. Oh? If you have a persistent (what do you mean, ‘persistent’? like a child, “momcanihaveacookie?momcanihaveacookie?” persistent?) change (vague, object!) of seven days or more in the length of your menstrual cycle, you may be in early perimenopause (early?! ARE YOU %)(!@&_%@ kidding me?! EARLY?!). If you have a space of 60 days or more between periods, you’re likely in late perimenopause. <– not me, not yet. I’m still in this hang time. 

  • Hot flashes and sleep problems. Hot flashes are common during perimenopause (I have been spared the recognizable hot flashes, mostly and so far). The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats (DING! now we’re talking: the intensity of my night sweats for 10 years have rivaled those of my immediate postpartum weeks when the hormones females use to create and sustain life inside the uterus and the rest of her own body, which is effing exhausted from the process, but it’s really only just the beginning), but sometimes sleep becomes unpredictable even without them. <–OMAIGAAAD! I would literally trade all of my Cap’n Crunch for just ONE NIGHT of uninterrupted sleep. I realize the flip phrase, “I’m so tired I could take hostages” is no longer in vogue, but my kids get it.  

  • Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause. The cause of these symptoms may (y’think?!) be sleep disruption associated with hot flashes (fuck yes). Mood changes (muuuuahhhahaahaaaaaa boooohooowoohaaaaaaaa… waah… grrr… what? me? grr… your mother sews socks in hell… ) may also be caused by factors not (NOT?!) related to the hormonal changes of perimenopause (um: no, highly doubtful).

  • Vaginal and bladder problems. (Oh what fun it is to ride…) When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making (you feel as though your privates have been replaced by 03-grade sand paper and generic brand tissues – or so I’ve heard) intercourse painful. Low estrogen may also leave you more vulnerable to urinary or vaginal infections (thankfully not there yet: word to the wise, ladies from my doctor: PEE IMMEDIATELY after sex, not in the bed, but y’know, within a few minutes as your urethra needs to flush itself) . Loss of tissue tone may contribute to urinary incontinence. Do those kegels and pelvic floor exercises! Yoga! Find your psoas muscle (no, it’s not a sex muscle).

  • Decreasing fertility. As ovulation becomes irregular, your ability to conceive decreases. However, as long as you’re having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you’ve had no periods for 12 months (and even then: watch it. I have friends who’ve welcomed a new member into the family thinking they were good to go).

  • Changes in sexual function. During perimenopause, sexual arousal and desire may change (and not just a little… ). But if you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond. (Stay in communication with your partner. That’s the important part… so smoke signals from the other wing of the house are always a good idea, that way your man will know when it’s safe to approach.)

  • Loss of bone. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones. This is JUST as important and really, a serious issue. Watch the caffeine intake, take moderate walks for resistance exercise, use weights (even low weights) to maintain your bone mass health.

  • Changing cholesterol levels. Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — which contributes to an increased risk of heart disease. My mom’s went through the roof as she aged; mine has always been about 157 so I need to keep an eye on it. That said, Mom ate cheese like you read about (I just read about eating cheese) and indulged in lots of sedentary, unhealthy behaviors and addictions and basically no did not exercise ever / at all / ever / constantly / never. At the same time, high-density lipoprotein (HDL) cholesterol — the “good” cholesterol — decreases in many women as they age, which also increases the risk of heart disease (you can encourage your HDL levels through exercise and diet. My mom died of a massive cardiac arrest — not a heart attack which (broken down by me) is a major incident and spasm of the heart muscles — but the cessation of electricity to flow to her heart causing her heart to no longer function; coming back from a CA, for a woman in her condition [not good at all] would have been a divine miracle).

More from the Mayo Clinic site includes:

When to see a doctor

Some women seek medical attention for their perimenopausal symptoms. But others either tolerate the changes or simply don’t experience symptoms severe enough to need attention. Because symptoms may be subtle and come on gradually (like a thief in the night), you may not realize at first that they’re all connected to the same thing — rising and falling levels of estrogen and progesterone, another key female hormone.

If you have symptoms that interfere with your life or well-being, such as hot flashes, mood swings or changes in sexual function that concern you, see your doctor.

This is where it gets fun for me. Because I went to my doctor. She put me on a low-dose birth control pill, “Lo-Estrin 1/20” because of my complaints:

Wanting to punch people, exhaustion, brain fog, emotional projection, confusion, inability to take a joke, complete viper-like mood swings, appetite disruption, back aches, headaches (which I simply never get), sleep disruption, fantasies of running off to Cabo (still never found a cure for that).  

I took the pill. For the first cycle, it’s 21 days of the drug. Within two days, I felt like I was 26 again: super able, focused, interested in sex, I had an appetite for food, I was sleeping like a dog (that’s a good thing because we all know babies don’t sleep) and other stuff. I felt great. As is the case in a standard birth control pack, on the first Sunday of the fourth week, you take a sugar pill (or just skip a week and start back up on Sunday with the new pack) and that starts a period. 

I did that. 

Halfway through my second cycle on the pill, when I was supposed to be “ovulating” I started to spot. I made a note. It lasted five days. On the first Sunday of the fourth week, I took my sugar pill to begin the standard pill-induced menses.

On Tuesday, I began to have thoughts that can be best described as sympathetic to suicidal ideation. I’m not kidding. 

I practice mindfulness (it’s how I’ve avoided becoming an alcoholic or other addict). I have spent years on a therapists’ couch so I understand emotions, and I get how powerful they are. Being a writer I was able to back out of this “sympathetic interest” and write a script, in my head, or a narrative about a woman who resembled me (but was taller, natch, and blonde) and my station in life who woke up and decided she didn’t want to live anymore. 

The depths of this transient depression were unlike anything I’ve ever experienced before, maybe I can equate it to the loss and ineffable grief I felt after I was dumped by a boyfriend, with whom I thought I would spend the rest of my life, when I was in college. Maybe. It was deeper than the grief I felt after my mother died — but maybe it was just faster and more intense. My grief surrounding my mother’s death lasted months and wavered in intensity. This moment hit me hard and fast. Out of nowhere. One minute I was pouring my coffee and the next minute I thought of suicide. 

I knew what was up. I did the math: this is a new deep and ugly feeling. I’m taking this pill, this is supposed to be my period, and I have PMDD but it’s under control…

So I grabbed my dogs and we took a very brisk walk for an hour. Charlie was all about it, but poor Murphy, who was 8 at the time, was frequently looking up at me and saying, “Can we take a break now? Please?” I was so grateful for their company. They kept me present. I have said twice to myself that my dogs are keeping me alive and this was the second of those times. The first time was when Murphy vocally persuaded a man, whose intensity and energy was palpable from 50 yards, to turn and cross the street away from us. Murphy is a golden retriever, he doesn’t bark warnings to humans; it’s not part of his breeding.  

Halfway through the walk, I started to feel better. I worked out the scene and projected it on to a false character. I put her through her paces from ideation to the moments of and the grief of her surviving loved ones and the days, weeks, holidays and life’s milestone moments which would undoubtedly follow because LGO: life goes on.

After I worked all that out, I did take a break in my walk and I called my doctor. I told her assistant what was up and she asked me if I needed emergency assistance and I told her I was ok. That I was outside. That I had no weapons or agents of harm with me. That the sun was on my face and my dogs were by my side and I was ok, really. Because I was and I thanked her for her concern, but I was calling to let her know what was going on because it was really scary when it first started. I asked, “Should I take the real pills now instead? Should I continue with the sugar pills?” (I felt like the patients who took L.Dopa in Awakenings; I didn’t want to stop the pill!) 

She relayed my message to my physician who said back to the assistant, “Tell her to stop the Lo-Estrin and call us after her periods stop for a year…” That doctor, is Joanne Herrmann, MD, and I don’t think I’ll be crossing her threshold any time soon. I understand it was a game of “Operator” going on, and you can call me weird and codependent, maybe, but if I had a patient who told me what I told her assistant, I’d be calling back that patient myself. She certainly practiced Primum non nocere. I guess.     

Later that day, I had lunch with a friend and I told her everything that happened. She listened intently; but I think I scare people because I’m so vivid and in-tune with how I’m doing. That was the last time I saw her.

Since that last pill, I’ve gained a new respect for estrogen and progesterone. I’ve learned that any time I’m feeling shitty and allowing it and noting it is a good thing because it means the process is still happening. It means I’m here.

I had a very high-level understanding of the phrase “mood swings” until that day. The take-away: investigate your options. Lo-Estrin 1/20 might work for you… just be ready for those sugar pill days.  

Causes

As you go through the menopausal transition, your body’s production of estrogen and progesterone rises and falls. Many of the changes you experience during perimenopause are a result of decreasing estrogen.

Risk factors

Menopause is a normal phase in life. But it may occur earlier in some women than in others. Although not always conclusive, some evidence suggests that certain factors may make it more likely that you start perimenopause at an earlier age, including:

  • Smoking. The onset of menopause occurs one to two years earlier in women who smoke than in women who don’t smoke.
  • Family history. Women with a family history of early menopause may experience early menopause themselves.
  • Cancer treatment. Treatment for cancer with chemotherapy or pelvic radiation therapy has been linked to early menopause.
  • Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn’t cause menopause. Although you no longer have periods, your ovaries still produce estrogen. But such surgery may cause menopause to occur earlier than average. Also, if you have one ovary removed, the remaining ovary might stop working sooner than expected.

Complications

Irregular periods are a hallmark of perimenopause. Most of the time this is normal and nothing to be concerned about. However, see your doctor if:

  • Bleeding is extremely heavy — you’re changing tampons or pads every hour or two for two or more hours
  • Bleeding lasts longer than seven days
  • Bleeding occurs between periods
  • Periods regularly occur less than 21 days apart <– that’s one I will now begin to keep an eye on

Signs such as these may mean there’s a problem with your reproductive system that requires diagnosis and treatment.

So this is all good, and I’m thankful for it. But the bottom line for all of us in this situation is symptoms and how we manage them.

About three years ago, Dr. Herrmann suggested I take something called “Brisdelle” which is a subclinical / super low-dose (7mg) of Prozac. The idea is that it will calm you down enough to sleep at night and abate next-day anxiety which is increased because of night sweats which happens because you’re anxious…? I’m still a little fuzzy on that. So I tried it for four days. It made me feel like I was a narcoleptic game show host. I stopped after a week. Some people have doubted my claim, that the drug needs to be in my system for six weeks before it takes full metabolic effect.

Mmmmmkay. Survey says….?! Znnngngzzzgngn! Where are you from, little lady….? Znnnngngngnnnznzzng.

I take herbal supplements: Estroven AM and Estroven PM; they help. Maybe they’re doing an insanely bang-up job and I have no idea because I’ve been taking them for about a year. Before that I took something called “Herbal Equilibrium” but Dr. Herrmann told me to stop taking it because she doesn’t believe in supplements… well, she believed in that Lo-Estrin 1/20 enough to prescribe it and it made me very sad, so maybe she’s wrong.

But we address problems by understanding what they’re made of. In this situation we need to dial in: WHAT does estrogen do??? Since we all know how we got here, thanks estrogen, we need to know what is going on and what estrogen regulates because it’s super subtle stuff.

A year ago, I did not know that estrogen played a major role in digestion. Did you?

I did not know that estrogen is involved in the sleep process and the release of other hormones which help us get a good rest. Did you?

So I went back to the web, and I blew off Webmd again and went straight the alma mater of one of my besties’: Northwestern University, for help. This page and its title, “How Hormone Depletion Affects You” was exactly what I was looking for. It will have all the information about WHAT estrogen and progesterone mean to you and why this crazy circus clown car is in your life.

Here we are ladies:

Screen Shot 2017-03-17 at 12.26.20 PM

That feels about right…? Doesn’t it?

Oddly, I am comforted by that image.

It tells me, “Sigh. Finally. Someone out there understands. I’ll have that Nescafé International Coffee now… Vienna Font Brick Caramel please… yes, I’ll wait… ”

The paragraph accompanying that DaVinci -esque image does a great job of introducing content that I simply can’t improve upon (for many reasons, the foremost of which is because I’m not a doctor), and it will behoove you to read it and learn about what is going on because all I can do is commiserate with you:

Hormones are the messengers in the body that travel through the blood stream to start, stop, speed up or slow down your physical and chemical functions and processes across all body systems. Your ovaries are the source of estrogen and progesterone, the two key hormones that control the reproductive system, including the menstrual cycle and fertility in women. You are born with all the eggs you will ever have. The eggs are in the follicles, which are found in the ovaries. During menopause, the number of ovarian follicles declines and the ovaries become less responsive to the two other hormones involved in reproduction—Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). As your ovaries age and release fewer hormones, FSH and LH can no longer perform their usual functions to regulate your estrogen, progesterone and testosterone. These inevitable changes in your hormones and natural decline of estrogen levels during menopause can significantly affect your health for years to come. Click on the bars next to diagram to discover how estrogen depletion can affect each part of your body.

We’ve got this, sisters. Keep the conversation going.

Thank you.

 

 

Because You Can’t Make this Shit Up. #Customer #Service #humor #insurance

Standard

I went to my gynecologist for her annual spelunking appointment and she wrote me a new prescription today to help with (men, you can come back in a paragraph if you want) my hormone-induced perimenopausal symptoms such as hot flashes, bloating which mimics the USS Dallas (as seen in “Hunt for the Red October”) spontaneous melodrama, night sweats, in-the-basement reason forgetfulness, brain fog, insomnia, inability to make sandwiches, and laundry neglect (that last one’s a gimme).

The medication is relatively new, so I’m relatively freaked out about it. There isn’t too much data on it. It’s a super low-dosage cousin of some rather storied and potent shit out there, so I’m not sure I’m dedicated to the cause yet. I mean, what’s (sorry men, I lied, come back in another paragraph) wrong with some really heavy cramps, ennui, intense bleeding, possible anemia (isn’t the harpie look in this year?), totally inconsistent period arrival and the occasional urge for solace by digging a hole to China under a crescent moon with my bite guard?

Other than Flonase and antibiotics for the occasional lapse of taking my Flonase, I don’t take many prescriptions. I like to go the herbal route. The supplement route. The what-the-fuck-is-in-this?, but-at-least-it’s-not-linked-to-inducing-suicidal-thoughts route. It might not always be efficacious, but I also believe in the placebo effect.

So today, because of this new script, I called my insurance company to learn the ropes about costs and copays and deductibles. Before I got too deep into the details, my very helpful Aetna rep told me I needed to call CVS / CareMark whose wizards would know the answers to all my prescription-based questions.

This is how that call went…

CareMark: Thank you for calling CareMark, may I have the member ID?

Me: Hi, this is Molly Field. I’m calling to find out cost and copay details for a new prescription. The ID number is  1234567.

CareMark: Who do you work for? >slurp<

Me: Uh, myself. My kids. I don’t have a job that provides insurance. I’m a … yoga teacher…?

CareMark:  Are you Daniel?

Me: No. I’m me. I’m his —

CareMark: Why are you calling about Daniel? Are you calling on his behalf?

Me: No. I’m calling on my behalf. My name —

CareMark: Why do I have Daniel’s information then? >clichslurk<

Me: You asked me for the account number.

CareMark: Who is this?

Me: I’m his wife. He’s my husband. I’m calling on my own behalf for me about … me.

CareMark: What is your name and date of birth?

Me: (relieved: now we are getting somewhere.) My name is Molly Field my date of birth is ___ ___ 1829.

CareMark: Ok. Why are you calling? >slurk<

Me: sigh. To get cost information on our policy and how much a new prescription will cost… When I dropped it —

CareMark: What is your account number?

Me: I just gave it to you and it seemed to confuse —

CareMark: Account number please. >skicch< I can’t look up anything without that… Do I have your consent…

Me: Yes. You have my consent. The account number will give you … it’s 1234567.

CareMark: Am I speaking to the spouse?

Me: Yes. On my own behalf about medication prescribed for me.

CareMark: How may I assist you?

Me: Ok. I’d like to know cost and copay information about a medication called STOPSHITTYSYMPTOMS.

CareMark: That’s the 7.5mg dosage, correct? >skicch.<

Me: (after memorizing the promotional crate it came home in, complete with two obscured magnets to keep it closed, what the what is this? a Michael Kors bag?? Now I know where the money is being spent by this pharma) Yes, 7.5.

CareMark: A 90-daysupplyis$97. Untilyoumeetyourdeductible. >skich.<

Me: What is the deductible?

CareMark: Thereareseveraldeductiblelevelsonyourplan. >slurp.< Oneis25anotheris35andthefamilyis65. Per year. >clitch<

Me: (what the fuck is that sound?) Ok. So what’s the copay?

CareMark: What are you talking about? What copay?  >shlink<

Me: (irked and confused and super curious about what’s in her mouth) Ok. You just said … if I’m following you, why would I pay the full $97 for the 90-day supply seeing as how I’d met at least one of the deductibles you mentioned? I mean, even at the 65, I’d only need to pay, what… $32 and so then, what would the copay be after that?

CareMark: You >sklurk< wouldn’t have met the deductible.

Me: But you said the deductible was three levels. You said “25 and 35 and 65.” Those are the figures you gave me. So if I pay $97 for a 90-day supply, I would have already met the deductible. Yes?

CareMark: >slurp< No. Nowhere near the deductible.

Me: (slamming face with desk, wondering about the need for this medication when all I think we need to do is rid ourselves of idiots at call centers) But … that’s close to $400. A three-refill 90-day script, which is what I was given, will cost … $388, way beyond the deductible you quoted me. You just said, “25, 35 and 65 are the deductible levels…”

CareMark: (audible groan) >querlk< HUNDRED. TWENTY FIVE HUNDRED, THIRTY FIVE HUNDRED. SIXTY FIVE HUNDRED.  (you freaking idiot.) That’s your deDUCTible levels.

Me: (oh hell NO you didn’t…) HUNDRED?! As in Twenty-five hundred dollars for a deductible? Is THAT what you meant? (CareMark Mistress of the Dark is >sklerking< in the background…)

You said “twenty-five, thirty-five and sixty-five” and didn’t say “hundred” after any of those figures. So naturally, I thought you were talking about an entirely different denomination… >pausing to listen< Um, (with obvious bitter disgust) are you eating something? Because I can’t unders–

CareMark: >pause< No. I am not eating any — I am SUCKING on a COUGH DROP. I am SICK today. >SLERK SKECK CRUNCH<

Me: >pause.< Oh. I ask if you’re eating something because I’m having a hard time understanding you. You aren’t speaking clearly. And, that you left out of that deductible information by a factor of one-hundred.

So, then, yes, doing the math that I understand now, I would not meet the deductible. That’s fine. It is what it is.

Now, since CareMark has been our prescription program provider for several years, can you tell me what my family’s history was last year on what we paid for prescriptions so I can get a sense of whether or not we even came close to meeting those deductibles? You know, so I can get a ballpark on —

CareMark Viper from Hell: You want a WHAT? >sklerk< From WHEN?

Me: (fuck you; you work for me) I’d like to know if you can provide me with a … report, yes, a report of what we paid last year for prescriptions so that I can understand how that shaped up… I know some systems won’t give access to data so maybe you need to transfer me (please o please o please transfer me…), but I’m just looking for a snapshot, if you will, of how much we paid —

CareMark succubus: I don’t know what YOU’RE talking >slurk< about, but I can give >sklech< a COST REPORT (you moron) of your prescriptions from last year. I can send it to you …

Me: (incredulous) Mmmmmm Nnnnnooooo. That won’t be necessary; you don’t need to print it out and mail it to me, I’m just looking for a quick-and-dirty here (still trying to be niccccce….) so that I can .. can you just look at it and tell me?

(envisioning bats pipping and fluttering about her head; her face slack, with green from the reflecting the screen) Is there a screen you can click on? Do you have that (carefully choosing my words) ca-pa-bil-i-ty on your sys-tem that will show you that his-tor-ic in-for-ma-tion so you can just tell me the cost report from reading it on your screen? (SMILING a TOOTHY GRIN but with narrowed eyes.) 

CareMark demon: (likely hunched over one of those ancient monolithic IBM 8600 desktop computers we used to call “machines” back in the 90s) You didn’t meet it. >slerk< You didn’t reach your deductible last year.

Me: (oddly proud that we didn’t need that insurance but pissed we paid for coverage for it) Oh. Did we come close? I mean, would have this addition of this STOPSHITTYSYMPTOMS last year, hypothetically of course, would it achieved the deductible? (at this point, i’m not sure of why i’m asking about any of this; something about this woman made me want to pick at her though…)

CareMark: No. >sklerrrrk<

Me: Ok. Well, that’s that. (sincerely) Thank you. You’ve been very helpful.

CLICK.

Me: hello?

She hung up on me. Not a “Thank you for calling CareMark and giving me a job to do and keeping my wages coming in…” or “Is there anything else I can do for you today?” or, I don’t know, “Good bye.”

I think she needs the medicine more than I do.

So then I called Aetna and told them what happened to me. They took a full report.

You’re allowed to be sick. You’re allowed to sklerk on a lozenge. But you’re not allowed to be viperous. You’re just not.

Here’s the final thing: I’m a big girl, I’m healthy, I’m happy and living a very wonderful and stable life. But I couldn’t shake the feeling that this puff adder would somehow meet up on that phone line with someone who’s really in need. Maybe a mother of an infant with a blood infection; a father who’s son is in rehab, y’know: PEOPLE. I was concerned that she would affect a person who’s rattled, whose spouse just had a stroke, or who needs to know about his or her new health plan and that this agent would treat that rattled spouse or parent or patient so horribly that the day would be ruined. 

Truth be told, I thought of my father, who’s 84 now, and if he needed to call CareMark to ask about his prescription benefits. I thought about my mother-in-law, who’s 29, and considered her situation with that agent and I decided I couldn’t let it go. 

So I called CareMark later on and spoke with management. The manager I spoke with was mortified by Elvira’s behavior and grateful that I called back. 

CareMark redeemed itself to me on that second phone call. It turns out it’s not a “deductible,” it’s a Maximum Allowable Benefit (MAB), which is the exact opposite of a deductible. A deductible is threshold you must meet by paying into it, and  it would eventually reduce your out-of-pocket expenses as you go forward. When you reach your deductible, your costs go down. The MAB is an already established account, with funds already in it, that when you buy your medication, that sum is deducted. When you run out of the MAB, you pay more. It’s like a bet the insurance is taking, that you will try to meet. 

I don’t know how that rep has stayed employed.

Why am I in the basement and what am I looking for down here? Geez, I hope it’s not for the laundry.

Thank you.

No Ordinary Day

Standard

So today, I got more than I gave and I gave a lot. I received more than I could ever hope to provide.

We talk in mysteries sometimes, about how “the universe provides.” How things work out, no matter what, even if the end result (so far) is not what we would have preferred. We talk about being “less-than” or “good enough” or “better than we deserve to be.”

Today, I was a moth, drawn to the inextinguishable flame of Survivor-hood.

Today, I participated, on some infinitesimal scale, in a program to give to a group of women who have never given up; to women who have kept on keeping on.

Today, I felt like a faker because I was able to supposedly give a gift to these women, Survivors all of domestic violence and sexual violence.

I thought I was brave.

I thought I had guts.

I thought I had seen suffering, survived it, eclipsed it. And in my ways, I have. But I was never PROUD enough to come out, as these women did, and said (without uttering a word) that they experienced it and are winning.

These are proud women.

These are strong and fierce women but they are fierce in a way that rejects aggression, fear, anger and self-pity; they don’t have time for pretense. They are on their way.

Every sixty minutes, from 10am to 3:30pm today, I was able to show (because I can’t say “give”) these women another gift they can give to themselves: the gift of gentle, loving, simple yoga and the gift of mindful meditation and self-awareness. What I was humbly offering, on behalf of The Duffy House Project (http://www.theduffyhouse.org) at its 5th annual “Day of Pampering” was facing stiff competition from other amazing services: complementary hair styling, mani/pedis, massages, housewares, shopping spree for mom and kids (clothes, shows, hand bags, suits), toy store, book store, child care and activities during these services, and prayer, but I was thrilled to be able to offer my services to even one person. Every ounce of everything today was donated by people like me and local businesses.

I prepped last night. I didn’t know what to expect. It was the first year I’d committed to The Duffy House (twitter @TheDuffyHouse). I was uncomfortable the first time they asked, I didn’t feel like I would be of value, I felt like I wouldn’t know how to talk to the women; like that their situations meant I wouldn’t be able to relate to them, that just because I wasn’t a survivor of the trauma they surmounted, that I wasn’t kin; that we were separate.

I know that might sound wrong, separatist, detached, even snobby, but the opposite could not be truer. I simply wasn’t being honest with myself. I am no luckier than they; I just had trouble admitting truths to myself. I’d spun my experiences to assuage my pain and hide my shame, shame that didn’t belong on me and shame that has no place on anyone but the man who’d taken advantage of me years before I cleared my head, made healthier choices and met my husband. But I am not here to talk about that; I’ve made peace with it all.

Nothing changed from then to now, other than my willingness to see my truth, walk in it and honor it and then when the time was right, as it was today, to give myself to these women and take the chance to move my own insecurities out of the equation. If I couldn’t muster the confidence and self-belief to give myself to these women, then I was not worthy of their time. I could not be a healer.

So I packed up eleven yoga mats, nine books, my Tibetan singing bowl, a stick from my yard that I found first step out the door this morning to strike the bowl, my iPod, my sound system, my truth and my courage.

the yoga mats are courtesy our school PTA. i use them to teach yoga to some 6th graders in the spring.

the yoga mats are courtesy our school PTA. i use them to teach yoga to some 6th graders in the spring.

The room they gave at the church for the yoga was sublime: it was cozy, dark and away from the joyful noises upstairs. The lamp in the room needed a light bulb, so I borrowed one (and just remembered I forgot to put it back) from a lamp in a meeting room down the hall. It was IDEAL, it was like a dream mini-studio to me. The lamp with the borrowed bulb cast a loving warm glow in the tiny room. I couldn’t believe how lucky I was.

Another yoga practitioner, Sheila (fake name), was lined up to join me in leading the women and we were going to alternate every 30 minutes. After the first round, Sheila and I had determined that 30 minutes was OK, but 40 minutes would be better. We were not as busy as I would have hoped, so if the women had more time between the other services they were offered, we took advantage of the cushion and spent more time with them.  I would say the other provider and I practiced yoga with about 20 women and all the while, it was me and Sheila who got the gift.

My iPod played meditation music all day and I used only one book. I used the bowl three times and I unrolled five yoga mats that Sheila and I shared for the Survivors. I read a meditation on “assertiveness” to the women as they laid in the darkened room, their palms facing the sky to accept peace and give strength and when I stopped, I heard sniffles and I was honoring my own throat’s lump. Some women told me that reading was exactly what they needed to hear. So I made copies and handed them out after lunch and left them on the tables. They were all taken up when the day was ending.

As the afternoon wore on, the lobby of the church where these Survivors stepped in to receive their services was getting crowded. Gift bags and backpacks and balloons and trinkets were waiting for all the women and their children who’d honored us with their courage and trusted our hearts and hands and thoughts and energy.

IMG_0481

IMG_0482 IMG_0483

IMG_0484

I had the opportunity to speak with some Survivors; some were so transformed by changing their own lives, I’d mistaken them for service providers. Some were still quite broken and sad and I just sat near them in silence and honored the guts they’d shown me by not only persevering but by getting up and getting out and coming there. They could have stayed in; they could have stayed away, but all of them, just by being there, helped everyone else under that roof. The energy was authentic and spirited; the women were in their own way already in their peace.  The other women in the neighborhood, many whom I’ve known for years, were on hand to help out, drive, be logistically available, run errands and keep the kids in check. This wasn’t an event for just the Survivors, this was an event for all of us and its effects are long-lasting, cementing, and so nurturing. I can’t wait for next year.

I’m not here to talk about Mother’s Day. Having a productive uterus does not a mother make. You can “mother” another human being, even a man can, just by being decent, nurturing, kind, patient, genuine and forgiving. As I said in another post about mothering long ago, “If your person [mother] wasn’t there for you to begin with, become the person You’ve Been Waiting For.”

Today, was no ordinary day and I am all the better for it.

Thank you.

UPDATE: Mind officially blown. Read what happened on Mother’s Day: https://mollyfielddotcom.wordpress.com/2013/05/15/check-writing-angels-growing-up/

For the Ladies — Do You Pee When You _____?

Standard

Hi there.

Yup two posts in one day.

Guys, you get a pass today unless you feel like reading about how women regardless of their child-bearing experience (but it affects it for sure) can leak some pee when they sneeze, cough, run, jump, dance, laugh … you know: exist.

I am coming out right now: I had a surgery back in 2007. It was called a “transurethral sling implant” because I leaked when I did any of the above living behaviors.

I did a lot of research. I did a lot of investigating. If you know me, you know how absolutely tenacious I can be when it comes to research. So, when it comes to research for an elective procedure (which conversely did affect the quality of my life) I’m slightly insane. Not that I’ve had any other elective procedures. Other than a brain transplant. It failed; they had to give mine back.

So the “brand” of device I had was called the “TVT-O” and here’s why I needed it: despite years of stoplight kegels, pelvic floor exercises, weight loss (to reduce the pressure on the bladder and urethra) I still leaked.

I wanted to stay in shape, but that meant I had to make arrangements. No matter how many arrangements I made: it didn’t work. I’m 5’5″, 135#; pretty average. I couldn’t run. I couldn’t dance. I couldn’t laugh without a >splee!< down there.

IT SUCKED.

The final straw came at a major family event that I attended. I wanted to shake it up on the dance floor. Cut a rug. Get my groove on. I am active! But I ended up dancing like a 92-year-old post-op fitness instructor. My feet shuffled, they never left the ground. My youngest son wanted to do the preschooler dance, the constant “jump and hop” with me: nothing doing. My legs were fine, as were my lungs, heart and attitude but my urethra? That freaking TINY little tube the length of a small paperclip was my master.

I was out. It was awful. I couldn’t dance at this huge, glorious event.

It’s technically called, “Stress Urinary Incontinence” (SUI). I called it freaking embarrassing and utterly frustrating.

I put up with this condition for seven eight NINE  years.

I was determined then to investigate.  After finding a doctor thanks to a good friend, and then interviewing her good friend who had the procedure I was looking into, I called the doctor (not all doctors are certified to perform this procedure, by the way).

why is it that when i searched for urethra i got mostly male anatomy? are we SO closed up about this highly common issue with women? (http://www.thirdage.com/files/cond/female-urethra.jpg)

why is it that when i searched for urethra i got mostly male anatomy? are we SO closed up about this highly common issue with women? (http://www.thirdage.com/files/cond/female-urethra.jpg)

We had to go through a couple phsyicals, tests, and some sort of exam she gave me to determine my candidacy for the surgery. Apparently I pissed (ahahahahahhaaaa!) with flying colors.

It was my anatomy. My urethra was positioned in such a way that it managed to hold on to some urine despite my efforts to fully empty my bladder.

After literally looking at me without even physically assessing, she said, “Yup. You’re a candidate. Your bladder is empty. But due to age, weight changes from carrying babies, gravity and the tilt of your uterus, you have a ‘dip’ or ‘pocket’ in your urethra which holds urine that didn’t void. So when you run, laugh, jump: it leaks for you. Your pelvic floor is strong, there’s no doubt of that because it’s what’s putting the pressure on your urethra which causes the leaks, but what you need now is a sling to hold it up or reduce the dip… Does that make sense?”

She could’ve been saying “doggie go boo-boo in the banana tub running heartaches with lollipops and salad casserole carpools” and I wouldn’t have cared. But when she said ‘You’re a candidate.’ I stopped listening, even though I didn’t stop hearing.

Three weeks later, I went in. The procedure was outpatient in her office and it took all of 20 minutes. Local anesthetic here, there, “Blabitty blah, how’re the kids? Do you have any plans for the weekend? No, I haven’t seen that movie, I hear it’s great. I can’t believe they made a third ‘Shrek…’ I know right? Yes, it’s incredible that Brad and Angelina are having twins… Try not to laugh … annnnnd we werrrrrrrre done. Scoot up, get dressed, come see me in my office and we’ll talk about after care and recovery.”

Super.

Six weeks of no heavy weights. I couldn’t run. But I was allowed to laugh.

The benefits were INSTANT. It took a little while for me to trust it, to get used to not having to suppress my laughter or cross my legs when I’d sneeze or cough or shout, but I got the hang of it pretty quickly.

I’m sharing this because I hear about this problem for many of our sisters. I learned about the procedure when I started to open up, talk about it candidly and ask for help. Here’s where I am: I’m here to help you. You don’t have to ask me any questions, you can chat me up privately or simply share the info with someone you love who’s talked about it.

I’m six years post-op today, as a matter of fact, and I’ve never regretted getting this done. There are contraindications (if you’re planning to have a baby is the first and yo-yo weight fluctuations is another) you should consider.

Let’s talk.

Thank you.

ps – here are other posts I’ve written For The Ladies

Living and Thriving with PMDD

Yes Ma’ammogram