Back in September/October, when I refused to have a total abdominal hysterectomy, the OB/GYN I had been seeing refused to treat me any further and referred to to a gynecological oncologist.

It took a bit of “squeaky wheel-ism” on my part but I finally got the appointment. It was yesterday.

Or rather, I had an appointment with the nurse and the fellow. I only saw the doctor for about 45 seconds–and part of that was walking back down the hall on the way out. Apparently he’s a very busy man.

My appointment was supposed to be at 1:45, but I was told to be there at 1:15. The waiting area was packed, which is never a good sign. I overheard two people talking–one saying that her appointment was supposed to have been at 11:00 and she was still waiting at 2:00. I settled in for a long wait. Fortunately there is a Tim Horton’s about every 10 feet here in Canada, especially in hospitals, so I got myself a coffee and grabbed the least antiquated magazine I could find.

After about 45 minutes, the receptionist called me up to give me the clipboard with the medical history forms to fill out. A 4-page health questionnaire. She assured me that if there was anything on the form I had a question about, to leave it blank because the nurse would go over the whole form with me before the doctor came in. I did have some questions and I did leave some blanks.

They finally called at about 4:30. I was weighed and blood pressure was taken. The nurse, bless her, looked like she had been run off her legs. She said the doctor had started late and the whole day had gone badly. She apologized profusely. But she never even looked at that medical history questionnaire. Oh well.

Next was the Fellow. A nice enough fellow (pun intended) with a lovely Antonio Banderas accent. Nice guy. He asked me to provide background on why I was there so I gave him a very short recitation on past events and diagnoses. I told him my chief concern was the proper treatment of Complex Atypical Hyperplasia beginning with the least invasive method and moving forward from there. He nodded and took notes.

I told him I still had not had a Pap smear through all of this so he agreed that was the first order of business. He did a Pap and a brief pelvic exam. And don’t you know, he got a spot of blood. Rats. I’m still on the schedule for a Pap with my family doctor at the end of the month so I guess it’s back in the stirrups at that time. Maybe.

After the exam, I dressed again and waited some more. “Antonio” came back in, armed with a diagram of the female reproductive system, bless his hear. He thought he was going to have to explain it all to me. He began by saying that of course hysterectomy is the standard treatment for Complex Atypical Hyperplasia. At the very least, he said, I should contemplate removal of the uterus because 25% of women (in some frigging study I’ve already read) who had the hysterectomy, were found to have a previously undiagnosed cancer.

I countered with, “Okay, but if that’s the case then 75% of the women had their uterus removed unnecessarily, right?” You should have seen his face. It was the classic “oh-this-one-is-going-to-be-a-pain-in-my-ass” face. I am proud to say that for every statistic he handed me about the side effects of hormone treatments, I was able to hand him one or two on the permanent side and after effects of hysterectomy: weight gain, osteoporosis, depression, bladder prolapse, loss of sensation, loss of libido, etc, etc. He was, to his credit, much more forthcoming about the surgical risks involved with hysterectomy than the first doctor who suggested it: bladder or bowel leaks or nicks and the like, scar tissue, issues with incisions, infection.

We discussed the whole thing: I asked it it was true that endometrial hyperplasia can, and often does, go into a spontaneous remission with menopause. He confirmed this. I’m 50. Presumably menopause is upon me. He pointed out that it is not in my favor that I already have the complex atypical cells but he was forced to agree that it might still go away even if I do nothing. I made it clear that doing nothing was not an option. I felt it was necessary to proceed with a treatment but that I am not in favor of surgical castration as a first and only treatment option for “atypical” cells and a “maybe” cancer.

After we discussed all the pros and cons, I said that I felt the hormone treatments posed an acceptable risk. The permanent, possibly debilitating risks associated with hysterectomy I am not yet willing to take.

“Antonio” excused himself again and about 20 minutes later came back with the Doctor Himself.

He’d had a bad day, he said. Could he “cut to the chase,” he wondered. “Of course” I said. “Please do.”

He had already written me a prescription for….Provera of all things!  Common, garden variety Provera!

Provera!

Nothing exotic; nothing new. Provera has been around for a long, long time. I don’t understand why none of the other doctors could do this 5 or 6 months ago. Or a year ago? What the hell? Why all the screwing around and referring me all over hell and back and the phone calls and the aggravation? Provera!

I’m to take it at two week intervals for four months and then go back for a repeat ultrasound to check on the thickness of the endometrial lining. Ultrasound mind you–not D & C like the other one said! The transvaginal ultrasound only takes a few minutes and certainly doesn’t require anesthesia, unlike D & C, which is a surgical procedure!

But this oncologist, this MAN, could not resist one parting shot at me, the troublesome, argumentative female: “You may already have CANCER.” Gee, really? Did I have cancer 6 months ago? A year ago? or back in 2006 when I started looking for a Family Doctor in this ridiculous place where health care is “free” only if you can FIND IT and only if you can WAIT FOR IT? Such BULLSHIT! Of course I might already have cancer. So might you, Pal. So might you.

………………

This is not to say I ran right to the pharmacy and filled my prescription for Provera. Oh no. I’m much more troublesome than that. I have appointment on Thursday with a rather well-known and outspoken physician who has dropped out of the medical mainstream to run a “private” women’s clinic. He advocates the use of bio-natural hormones rather than the synthetic versions such as Provera. I’m waiting to see what he has to say. Of course if he tells me I need a hysterectomy, I’ll be gobsmacked again, but I’m betting he doesn’t say that at all. Stay tuned.