Saturday, May 08, 2010

Adding Insult to Injury

A while ago, I had some abnormal bleeding and some pre-cancerous cells were found. I was referred to a women's clinic where I had a colposcopy (making a cut and putting a camera through it to examine the outside of the uterus and related structures in the abdominal cavity), a biopsy of the endometrium (the lining of the uterus) and the insertion of a Mirena coil. The Mirena coil releases progesterone slowly for several years, and it is used to stop bleeding, and this helps to stop endometrial cell changes because the endometrium no longer proliferates due to the action of the local progesterone.

This is all done without anaesthetic and is very painful. So far, I have had three annual visits and the endometrial biopsy has come back 'clear' every time. No more pre-cancerous cells, so the treatment is having the desired effect.

My doctor's surgery keeps reminding me to come for cervical smears. When I last saw my GP, I told her I was having these biopsies at the Women's Clinic and that was the reason I was not attending the screening at the surgery. Last week, I received a form to fill out to 'withdraw' from the screening program, together with a leaflet explaining the advantages of having the smears done. I wrote back to say that I expected to be discharged from the Women's Clinic next February if the biopsy was clear yet again, and that after that I would like to have routine screening at the surgery.

The receptionist phoned me. The doctor had spoken to the Women's Clinic and found out that endometrial biopsies do not include cervical smears and that I should make an appointment to have one at the surgery in order to be kept on the books. Ask any woman - cervical smears are a necessary evil, but no fun at all. I was still reeling with shock and dismay when she asked if a male trainee doctor could do it as he has to do a certain amount under supervision as part of his training. It was the wrong psychological moment to ask me that, and I said NO and that I wanted a Nurse to do it if it had to be done at all.

But - bloody hell!! Why aren't smear tests done at the same time as the endometrial biopsy while the practitioner is in the area anyway? The cervix is only about an inch away from where they collect the endometrial biopsy sample. In fact, they have to go through the cervix to get to the endometrium anyway.

So I go through all that, in all innocence, only to find I've been labelled an unco-operative patient who ignores advice to have screening done at the surgery. It never occured to me that I had to have the smear tests as well as the indignities of the Women's Clinic. And I'm not looking forward to it. The only comfort is that the nurse will do the necessary and no Doogie Howser sort is going to have anything to do with it.

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