Flotsam

Once upon a time, last Wednesday, in a pair of stirrups far, far away, I had my first appointment with my spry and youthful RE.
My new RE doesn’t get a snarky nickname. I would call her Dr. Where Have You Been All My Life, but Pru has already taken that one, so I will just call her Dr. Doctor. Why, you ask? Because (unlike the H&IBOML) my new RE is precisely what a doctor is supposed to be—a learned medical professional who genuinely cares about her patients. And she is amusing, to boot. She didn’t have all of the answers, and nothing definitive came out of my appointment, but she spent more time with me than a doctor ever has, listened to my every suggestion and question, and seemed more invested in finding out what is wrong with me than in being right. And she obviously knew her LH from her FSH, if you know what I mean. So in that respect—the finding a doctor I like and trust respect—the appointment was a success. But in the finding-out-what-is-wrong-with-Alexa-and-fixing-it-respect…oh well. She was so sweet and smart. And did I mention how amusing she was? Can’t that be enough?
I am too tired to go into exhaustive detail, my ducklings, and also I am in the process of finishing a bottle of wine I got on sale for $7 called “4 Emus” (for days when 3 Emus simply are not enough) and my sentence writing faculties are a bit impaired. But here are the highlights:
1. Dr. Doctor sided with all of my doctors previous to the H&IBOML—she thinks that I very likely do have endometriosis
2. And PCOS
3. Though she is not comfortable diagnosing me with PCOS definitively because my testosterone level was lower than she would expect to see
4. My elevated LH is bad for egg quality, but no longer used as a PCOS diagnostic criteria
5. My elevated insulin was “Very Troubling”
6. But my elevated insulin could be due to my family tree, the branches of which hang heavy with diabetics
7. My previous ultrasound report was the only ultrasound report Dr. Doctor had seen in her career (although, she is young enough that had she been less admirable her nickname would be “Doogie Howser, RE,” so perhaps she hasn’t seen that many ultrasound reports) that mentioned PCOS by name, rather than simply nattering on about my multiple follicles and increased stromal echogenicity
8. The ultrasound performed by Dr. Doctor prompted more comments about the bizarre, tilty angle of my cervix and uterus
9. Dr. Doctor was surprised I could have sex without yelping in pain
10. My right ovary had a cabal of immature follicles loitering along its edges
11. But my ovarian stroma was not as thickened (the thickening is a function of testosterone) as she would expect
12. My left ovary was hard to find because it had moved behind my uterus
13. Probably it was hiding, and I don’t blame it one bit
14. It was exceedingly unattractive
15. Nearly twice as long as a normal ovary (or, indeed, my own right one), it had so many follicles ringing its periphery that they ran together in a hideous black channel
16. We had an exasperating circular conversation much like the one Akeeyu had with Dr. Debate Team—my polycystic ovaries could be caused by anovulation, which could be caused by polycystic ovaries which could be caused by anovulation…
17. In Europe, these ultrasound findings would be considered indicative of Polycystic Ovarian Syndrome
18. In America, Polycystic Ovaries are not a consideration for diagnosis of Polycystic Ovarian Syndrome
19. So, somewhere over the Atlantic Ocean I transform from just another wonky, anovulatory girl into a PCOS patient
20. Dr. Doctor looked at my BBT charts, which were, apparently, a waste of time
21. Out of 10 charted months, I ovulated twice, both months coming off the pill
22. Twice. That is how many times I ovulated
21. Even if I had ovulated other months, on my shortest, most regular cycles (35 days), it would be considered Late Ovulation
23. Tardy eggs are sullen, uncooperative, and not “quality”
24. Still, the only way to be certain I am not ovulating would be a monitored cycle with progesterone draws
25.Which we will do, along with a New! Improved! Testsosterone level
26. But not for at least 30 days, because the H&IBOML put me on Yasmin, and it must be out of my system for a month

Here is my favorite part: Let me pause for a sip of my Four Emus (when five Emus are one too many)
27. The last time I got pregnant, it during a cycle I was taking the pill
28. So we were delighted, but surprised, especially as we knew I had ovulation problems
29. Dr. Doctor confirmed what others had suggested:
30. I most likely got pregnant because of the pill—the hormones regulated my cycle/cystiness, but I either missed one, or it was metabolized differently due to the meds I took after my colposcopy and endocervical curettage that month, and I managed to ovulate
31. Had I been on no birth control, I almost certainly would not have ovulated
32. For 11 years I have been paying 10-30 dollars a month for something my own pixilated endocrinological system does for free

I left the appointment without any action plan, except to immediately stop taking the Yasmin and make an appointment for 30 days hence.

And then, on Friday, things got a spot more complicated…

TO BE CONTINUED

*Copyright Biggie Smalls