Saturday, August 23, 2008

shot day

I'm a day late on my shot, because I was too crazed yesterday to remember that it was Friday, the day to pause after my morning shower to scrounge together some alcohol wipes, needles, syringe, find a spot on the edge of the bed with plenty of light, deliberate over which spot on which thigh to choose, so as not to run into any 'tough spots' (mysterious sections of my leg that feel harder to inject through than others- I suspect perhaps scar tissue is building up from these 52 shots a year I've been giving myself) or brush a nerve, which makes my leg twitch weirdly while I'm giving the shot and then sometimes aches deeply for 2-3 days afterwards.

It was so exciting at first to learn how to give myself shots, to take my oily agent of change into my own hands, and have control over my own destiny. Now, that excitement hasn't quite morphed into resentment, though I can sense that on the horizon, but it's definitely turned into a chore, one that I have to work to remind myself of rather than look forward to each week.

Ive got a doctor's appointment next week, my yearly gynecological visit. I intend to ask the nurse to show me where I can self-inject on my hips/butt area. I know lots of guys use that spot, and it'd be nice to have four injection sites to rotate through. Also, I'm trying to brainstorm any other medical attention I might need to see if I can get it then- such as my next testosterone prescription refill, though it's a couple of weeks early- because I'm moving up to New England in ~6 days, and I'm not really looking forward to trying to track down a doctor up there.

I've definitely been spoiled by being in NYC and having Callen-Lorde and its dedicated HOTT program available to me, chock full o' knowledgeable, respectful and experience providers. I know that being an LGBT clinic isn't always a guarantee that the providers will live up to the T on the end of that acronym- and in fact, my experiences with providers in other departments at C-L were regularly less than stellar, with them not immediately reading me as trans, and so making assumptions, and then making insulting gaffes when trying to cover up their surprise...much like any 'regular' doctor, I'd imagine! But the staffers in the HOTT program have been consistently fantastic, and I'll miss them.

I'm going to be living within semi-reasonable driving distance (less than two hours) of both Boston and Northampton, so if necessary, I can probably dig up a reasonably experienced doctor in one those two hotbeds of LGBT stuff. But I'd prefer to find someone closer to home, and I don't know what the range of my new health insurance is going to be. So this may well be an opportunity to start from scratch with a brand new doctor who's never had a trans patient before, and the thought does not fill me with any particular joy.

It's frustrating to have a medical condition for which I need medical supervision but because of which I'm nervous to speak to a doctor. I don't know of a lot of other situations for which that's the case. Doctor-patient relationships are always fraught, of course, but I just don't know if there is another kind of medical condition which would cause the same kind of worry that I have right now- that I just won't be able to find someone competent or (more worrisome, actually, since it's not that hard to right a prescription for T) willing to treat me. And that I might face hostile or derogatory attitudes in my search.

Now, Captain Optimist in me realizes that it probably won't be that big of a deal. Most doctors are reasonably openminded people (right?) who are bound to do no harm (right?) and I am confident in my own knowledge about my medical care, and my ability to advocate on behalf of myself. Of course, I'm well aware that I have had the good fortune to have good medical care in the past, access to plenty of information, and a more-forceful-than-average personality, so it is still rather unfair that I as a trans person may need to draw upon various personal resources that not all trans folks have.

It reminds me of things that I hear about in the Fatosphere, of folks who are fat activists and who work to empower people of size. They often have to struggle to get appropriate, respectful healthcare from a medical establishment that doesn't respect them or consider them normal. It's a tiring, disheartening thing to have to convince one's own doctor to stop focusing on whatever is shocking about oneself (being fat, being a dude with a vagina) and instead look at me as a patient with needs that may be related to those issues, but may not! Fat folks often have to remind their doctors that hey, not everything can be fixed with the advice of "Well, if you just lost some weight...." and likewise, while I am going to need trans-specific health care, that mostly boils down to monitoring my hormone levels, and I may very well health care for things that have nothing to do with my being trans (allergy medicine! eye doctor! whatever!), and it'd be nice to have the security of knowing that I could present with a medical issue and not have to worry about the doctor getting sidetracked by Teh Tranz.

You never know. I could get lucky and find someone who is, if not experienced, at least happy to work with a new kind of patient, and intelligent enough to listen to me and not say anything too asinine. "Wow, I'd have never guessed you had a sex change!"

And I'll see how my gyno visit goes on Wednesday. I hear that once you've had three normal paps in a row, and if you're not, er, interacting with anyone new and unusual, you can go down to once every other year for the gyno visit. Two years from now, I may well be leaving New England, so I might not have to find out what the OB/GYN in my new town would think of a dude in his or her waiting room.


Anonymous said...

Here's my thought on this: I would call the new doctor's office and just bluntly state the situation, and see what they say. If they seem hesitant/shocked/etc then call someone else.

Anonymous said...

I wouldn't compare the way a doctor (or anyone) looks at being overweight to the way they look at being trans. The fact is that being overweight is a serious health issue, one which effects nearly every other aspect of the person's health, and a doctor who would overlook that and not advising an obese person to lose weight is simply not doing their job. Health is really more of an art than a science, and therefore your entire being has to be taken into account - lifestyle being a major factor. Find a doc you feel comfortable with, push yourself to be honest and open with them, and you'll get better care.

kkryno said...

Maybe your current physician can recommend a suitable replacement among their colleagues in your new city. I hope someone sensitive to your situation; and with the mind-set that people are what's represented in their heart and actions will be available for you. Good Luck.
Love, Vikki.

Tynan said...

Hi Eli,

I found your site through Mimi (whom I've been reading forever, it seems). I live in Northampton and just wanted to put in a quick word to say that yes there are great doctors in this area, but also there are lots of folks here who might be able to refer to someone wherever it is you're moving.

Let me know if you want some phone numbers to try in this area.

(And welcome to New England, in advance.)

kkryno said...

BTW: I can totally relate to the not wanting to go to the doctor thing. Just not for as unique circumstances as you. I just fear the doctor! So good luck to you!
I'll go if you will,(my kids will thank you for it. I've been avoiding a simple check-up for years!)

Eli said...

hey Bonnie and Vicki and Tynan, thanks for your encouragement re: finding a doctor! I'm hoping that it turns out to be a smooth process, but I'll definitely keep y'all posted, and if I run into too many roadblocks, no worries, I'll have no shame about asking for advice in this forum!

Eli said...

Anonymous, while I appreciate the good advice in the last sentence- comfort with a doctor is super important, and you're right, even when it's uncomfortable, it's really important to be honest and open with one's medical providers- I've got to disagree with some of your other statements.

Being overweight CAN be a serious health issue, but there are two major things wrong with that common blanket statement that we hear ALL the time from the media and our doctors:

1) 'Being overweight' is so loosely and arbitrarily defined. We have these wack BMI charts, or, in non-medical settings, just our own eyeballs, which are growing more and more conditioned by various media to a more and more unrealistic body type as being 'normal.' So vastly different folks end up getting classified as overweight, and in some cases it is a serious health issue, and in other cases it's not.

2) When it is a health issue, I do think it's appropriate to suggest that a person change their lifestyle. But too often, health and weight get wrongly and unfairly conflated, such that people are told "Get healthy! Lose weight!" when really, the goal is to increase activity, decrease blood pressure, lower blood sugar, etc...a set of concrete goals that are in fact more complex than just "lose weight" and should be evaluated by a more complex rubric. Folks who lose wight in unhealthy ways (purging, etc) will look skinnier and will be "losing weight!!" but are not getting any healthier.

leander said...

Although I don't have personal experience with fatphobia in the doctor's office, I actually do think it's a pretty appropriate comparison. I often think that in the back of my doctor's mind is "if he would just stop trying to mess with his hormones and get off the T, he would be perfectly healthy" Granted, that's just a suspicion, but I think it's valid.

Also, Eli, concerning finding a new doctor. This year in Portland I went the route of educating a "novice" MD about trans stuff. He also took the initiative and educated himself a bit by asking his peers and stuff. ...But really, I would recommend trying to find someone with real experience working with transfolk. It was wearying to have to deal with even the smallest amount of his naiveté. And I just always found myself wondering about his competence. In the end, it was probably a little bit unfair to him and was definitely somewhat uncomfortable for me.

Steph A said...

Best of luck with this. Finding a supportive doctor is very important to dealing with any stressful health issue. Despite being lucky enough to have been born in the right gendered body, I really understand this comment: "
It's frustrating to have a medical condition for which I need medical supervision but because of which I'm nervous to speak to a doctor." I also think fat phobic doctors is a good analogy and am very sympathetic to those who experience it. I myself have the opposite problem, being very underweight, and have had years of anxiety about seeing new doctors due to dealing with them assuming I'm anorexic or ill. I once had a dermatologist want to send me to a psychologist and dietitian instead of checking the mole I was there about! Such ignorance and fear of anything "other" astounds me in anyone but in doctors in dangerous. I am educated and resourced and able to advocate for myself but it still took me years and many doctors to get a proper assessment for a personally distressing health issue (infertility) beyond an uniformed "oh just gain some weight". Which I have tried to do and can't. So I really hope you find someone great to look after you and your special body.
And by the way, Eli, they won't let me give blood either, based purely on my weight, and can't or won't give me any explanation why (and I would accept a genuine reason)! So I understand why you are upset about that issue.
I'll stop commenting now. I'm sure you don't need a random, overtalkative australian monopolizing your blog! Take care.

Anonymous said...

I've experienced the anti-fat thing in a doctor's office, and it's super frustrating, on many levels -- I am otherwise healthy; I know being overweight is unhealthy; I might have non-fat-related issues, but all they see is a fat person. Thank you, Eli, for your empathy. I hope everyone treats you like a person and not a Certain Kind of person, and that you get the decent responses and excellent medical treatment you hope for and deserve.