Medical care - upsetting

[ShotGal]

First some quick background since I'm not a frequent flyer in the forum.  I used to come here a lot in the 90s during my "hell period".  After taking the reins and transcending into the next life, pretty much everything was left behind other than immediate family.  I re-married (16+ years ago) and we've moved several times due to headhunters/new opportunities for him.  It's a 99% compartmentalized life, which never requires a second thought.  Until I have to go to the Dr.

I'm someone who faints/vomits with needles - especially with blood taking.  This, combined with the fact that one has to disclose medical history (or have it discovered) has me nauseous at the prospect of anything and everything medically related.  It pretty much had me in total avoidance over the past 10+ years but as a baby boomer I'm not getting any younger so started seeing a Dr. last year.  I was in such a tizzy over it last year I wasn't paying much attention and got confronted at the blood lab over an order for a PSA test (prostate) among a zillion other tests for no reason - they pointed it out to me - and I was just like - "I have no idea what's going on with that"....

This year the tests have come around again.  I'm thinking of just scratching off the PSA test - or scan/Photoshop it out and reprint.  I should also mention - the Diagnoses (ICD) section has "F64.1" in there.  Here's what these billing codes mean -  http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-  Dual Role TV - yea, I don't think so.  Maybe the code should have been F64.0?  Or maybe there's really nothing that correctly covers it?  This bit also "outs" someone - not just at the lab but if anyone from my husband's work sees it!

The whole thing has me fuming.  I'm considering just not bothering with any of it and stopping altogether.  The only thing I actually have is very slightly high blood pressure with no other issues - which is easily managed with a pill.   Unnecessary tests are bad enough - ones that "out" you are 1000x worse.   And ultimately we're all going to die anyway, so there's not much point in chasing phantom medical conditions with a shotgun approach to testing for everything on earth.    The providers bankrupt the patients, and the patients all die 100% of the time regardless! 

Before getting bombarded with
"you should really take care of your health" and
"forget what others think - just do it" and
"suck it up Buttercup" responses... 
YES, I know.  Logically that's the thing to do.  It's all just very upsetting to deal with.  I have no one to talk to about this to even vent - so here I am.  :-(

Other than that - life is good!

[AnneK]

I don't know about where you are, but in Ontario, a PSA test is optional and generally done only if the doctor thinks it's advisable.  Are you also upset about the "finger test" for prostates?  A bit on myself, I am currently under doctors care for BPH (enlarged prostate).  Given the high risk of prostate cancer, it's not something you want to ignore.  As for the PSA blood test, if you're in for lab tests anyway, where they generally take blood samples, what difference does including PSA make?  One thing I find makes a big difference about being bothered by blood tests is to just look away, when the blood is drawn.

[ShotGal]

what difference does including PSA make?

Thanks for the thoughts...   Just might have missed the part about it causing one to be outed -  "confronted at the blood lab over an order for a PSA test" and also the bit - "if anyone from my husband's work sees it!" - (as the insurance records always bounce back to employers). 

There's pretty much high risk for everything for everyone.  It's called old age.  There is no cure.  :-)

[AnneK]

Thanks for the thoughts...   Just might have missed the part about it causing one to be outed -  "confronted at the blood lab over an order for a PSA test" and also the bit - "if anyone from my husband's work sees it!" - (as the insurance records always bounce back to employers). 

There's pretty much high risk for everything for everyone.  It's called old age.  There is no cure.  :-)

One should never be outed at the lab.  If they did that, in front of others, then they need a lesson on confidentiality.  At the lab I go to, they have a little an area, away from everyone else, where such matters are discussed, just like the pharmacy I go to.  Again, employers should also be aware of confidential issues.  Regardless, the only way to stop that from happening is to ask the doctor not to include it.  However, they may have reasons to request it.  In my case, due to BPH, it was considered necessary and covered under the provincial health care.  If it wasn't needed, as in general screening, it wouldn't be covered.  There has been a lot of discussion about PSA being useful for general screening or not, but there are certain situations where it's strongly advised, due to higher risk of cancer.

Regardless, the bottom line is how important your health is to you.  Since many trans women still have a prostate, they have to be aware of the cancer or other risks, and not pretend to health care people that they don't have one.

[Gertrude]

My wife thinks that the only doctor one should see is the medical examiner.


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[Julia1996]

OMG, I never thought about a prostate before. It just dawned on me that I have one. Do you still need prostate tests even after SRS???

[sarah1972]

Unfortunately yes. The risk of removing the prostate are pretty high so almost every surgeon I looked into does not touch it. And that means you need to keep having prostate tests / PSA Tests.

Someone on her jokingly asked if they could simply be combined with Mammograms.

OMG, I never thought about a prostate before. It just dawned on me that I have one. Do you still need prostate tests even after SRS???

[AnneK]

My understanding is that castration reduces, but doesn't eliminate the risks.  However, it is something to discuss with your doctor.  They can advise you better than anyone here can.

[Julia1996]

Unfortunately yes. The risk of removing the prostate are pretty high so almost every surgeon I looked into does not touch it. And that means you need to keep having prostate tests / PSA Tests.

Someone on her jokingly asked if they could simply be combined with Mammograms.

Well that totally sucks! 

[Aibhilín]

As far as i'm aware, the risk of prostate cancer in transwomen is very low, due to atrophy of the prostate amongst other hormonal reasons (I'd imagine?). Regardless, one should still get their prostate examined, especially if you're older or prostate cancer runs in your family.

[Kendra]

ShotGal - since your post mentioned potential disclosure of medical insurance transactions to an employer I am going to assume you're in the US.  In the US the federal HIPAA law defines medical privacy - all those forms to sign when setting up an account with any doctor. 

An employer needs to see financial reports for insurance but that information is strictly confidential.  For an exceptionally expensive procedure (for example cancer) it's possible the costs might show up in additional reports sent to an employer and will be more visible.  A lab test will be buried among other transactions.  An insurance company might question a PSA test for a female, but if they deny that particular bill I think the question would be between you and the insurance company - and you have a valid answer if they ask.

If an employer misuses private medical information they are at risk of financial liability and in more extreme cases might be a criminal violation.  I wouldn't forgo a medical decision based on the risk of information being misused.  If that were to occur the law is on your side.

[ShotGal]

Thanks all - it's appreciated.  There's no particular reason or risk factor involved in any of the overzealous testing frenzy.  I think if anything the PSA is either ordered out of ignorance, or some other motive.  Maybe time to change the MD.  Anyway thanks again - cheers!

[rmaddy]

Thanks all - it's appreciated.  There's no particular reason or risk factor involved in any of the overzealous testing frenzy.  I think if anything the PSA is either ordered out of ignorance, or some other motive.  Maybe time to change the MD.  Anyway thanks again - cheers!

The value of routine lab tests is debatable, but generally speaking, the yield of these tests (i.e. how often they are abnormal) rises with time.  Kendra is right that HIPAA outlines very high penalties for misuse of your medical information.  I can't tell you which doctor to choose, but I do think it is important that your doctor fully understand your health history.

I can't count how many times a patient of mine has left out some critical detail that I otherwise had no way of knowing because they decided it wasn't important.  It hobbles my ability to do my job.

I agree that you should never be outed or have to fear that you would be to access healthcare.  As I am sort of a radical discloser, I don't know how it feels to be in your shoes, but I do hope that you find a balance that works for you.  Best wishes.

[Jessica Lynne]

Well that totally sucks! 

If it runs in your family?....yes. If not and your on HRT? ....I wouldn't give it another thought. And fercrissakes, certainly not at your age.