Edit 2: Added link to the review I wrote on Yelp of the Zaxby's we ate at.
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First a little (well a lot of) background, then today's (well yesterday's visit). When I made the choice to transition, one of the first things I did was to decide that I was going to pursue things more or less according to the WPATH guidelines which meant getting a therapist's authorization for HRT. Yes there was the informed consent (IC) option and yes the "do it yourself" (DIY) option, but since I believed I would eventually want surgery I saw no real way around eventually seeing a therapist as I'd need two authorization letters for that. Because of this, my choice was made for me. Once I had settled on a therapist and had my second visit where she told me she was comfortable writing my letter I began to look into who could handle my HRT. Technically my regular GP could, but I doubted that I'd be lucky enough for her to agree to that. My therapist had promised me a couple of names of people that were local - although "local" was more local to her than me since I live in the suburbs and she's more in the city. So in the interim I started looking myself. Some Google searching led me to "Laura's Playground" where a kind woman had posted 3 names of Doctors in Columbia who were handling HRT for other trans-women. One of the three was out on leave, which left two. Reading over their online profiles and researching them, I settled on Dr. Amanda Swenson at Green Meadows Clinic in Columbia, MO.
My research indicated that although she was a GP and not an "Endo", that she was familiar and comfortable handling HRT and was willing to work with a patients regular GP if desired. The latter point really appealed to me as my regular GP (who I *really like*) is five minutes from here and Columbia is 90 minutes each way, so I felt if Dr. Swenson would work with my GP I could have blood work and such done here to save me from having to spend too much time up there. The fact that Dr. Swenson was in Columbia was an appeal as well. I spent a (school) year up there at Mizzou, granted a long time ago, but I liked it up there and it's a nice drive. And while it had been a *long* time, I always felt it was such a friendly town, as college towns often are.
As I suspected my regular GP really wasn't comfortable supervising me going on HRT, but she was very willing to work with Dr. Swenson; so I next contacted Dr. Swenson and confirmed that she was: taking new patients, did handle HRT in the right circumstances (ie therapist authorization and such), and would work with my GP (who was aware of what I was pursing and all). Once she confirmed all of that I made my first appointment, which was late December 2012. It was one of the best decisions I've ever made. I'm sure the Doctors that my therapist suggested are all great, but Dr. Swenson is simply out of this world. I could go on and on about her or my first visit or even visits after that and perhaps I will at some point; but this is really about today's visit since it's fresh in my mind.
Today's visit was approximately six months from my last visit. For the first year of my HRT, Dr. Swenson saw me every three months on average, although once it was at two months due to medication changes. So the last time I had been up to see her was in November of 2013 and at that visit I got her opinion on having an Orchiectomy done which she was very supportive of. Since I had the Orchi in February (2/15/14 if it matters), it had been about 10 weeks or so, so I felt my "levels" should have settled down by now so I asked my GP to order some lab work for Dr. Swenson so we could determine if we were going to up my Estradiol and/or reduce my Spiro dosages. I say "we" since Dr. Swenson always discusses dosages with me - the pros/cons of changing them, the possible effects I could see (especially in relation to my other medications) and welcomes my input on how to proceed. I cannot say enough about the process with her on this since it is my body being affected. I've read plenty of stories from others trans-women especially, where the Doctor flat out dictates things and while they may well have the patients best interests in mind, it is still the patient who bears the burden of the effects of HRT and I strongly feel that they should be involved in things such as this and Dr. Swenson is wonderful about it.
Typically when my GP orders lab work, it is whatever she needs along with anything that Dr. Swenson has specified. While Dr. Swenson is particularly interested in my levels, she also looks at my general health as well, which again I appreciate and is another reason I'm glad she's a GP herself. In this case my GP ran my "levels" as well as some other blood work including my A1C level. At one point perhaps a year ago it was at nearly 10 which is basically "morbid" from what I understand. In fact it was so bad that my GP wanted to start me on insulin via I believe an "Epi-pen". I have a major issue with needles and wasn't sure I could handle that as I had visions of the old school needle and vial of insulin. My GP showed me the Epi-pen and explained how it worked, but it still scared me - *a lot*. I asked her to give me a couple of months to see what I could do about my weight and she agreed. Two months later, the value had dropped into the 8.x range and she backed off the insulin provided I continued to work on my weight.
Well M and I went into the lab on Saturday morning (5/17/14) and got right in for my blood work. From there we went grocery shopping and grabbed lunch and I sort of put the lab work out of my mind so I didn't worry about it. Well that Monday afternoon (5/19/14), my Doctor's "assistant" called and said my lab work was back and my A1C had dropped all the way down to 7.1 - still high, but significantly down. I had hoped it would be since by then I was down about 40lbs from where I had been when it was at 10.0, but even so this was more of a drop than I expected since I'm still significantly overweight. She told me my GP was very happy with the progress and that she could either send the lab work up to Dr. Swenson or send it to me. I opted for the latter as I wanted to see the rest of the results and sometimes it seems that when my records get sent back and forth they don't always make it. I suspect because my GP has me on file now as Madison, but Dr. Swenson's office didn't since my license had not been changed as of my last visit. Now they *ALWAYS* refer to me as Madison up there, but since my records all have my old name I suspect that it was an issue because of that.
Now that I've bored you with six paragraphs of background information, lets get to today's visit. It was initially scheduled for last week, but about a month ago Dr. Swenson's office called and said she'd be out of the office that day so we rescheduled for today at 6pm. That meant we'd need to leave no later than 4 so I could be there a few minutes early to get my name issue fixed, as it's a 90 minute drive and we'd be dealing with "rush hour" in Columbia. Since I didn't have to leave any earlier than that I was able to avoid taking time off of work as I normally do and just take my "lunch" at 4pm which was nice. Additionally, despite me initially being confused about her schedule, it allows J to go with me which is not usually the case. Below is a picture of my outfit, not one of my best pictures for a few reasons - the sun was really bright, my makeup has been better, and as much as I love J she just can't seem to listen to me about the camera and doesn't let it fully focus first, but I'm not complaining about that as she's the best thing that ever happened to me. :)
We ended up leaving a touch early for a change as we needed gas along the way. As we neared Columbia we had a bit of a scare on the highway as a truck - a larger truck, but not a semi - blew a tire in front of us and nearly ran off the highway. As it was rubber pieces were flying everywhere as were pieces from his right front wheel well. I think the noise was the worst part of it as I was looking at my phone when it happened, thankfully J handled it gracefully and kept us out of harm's way. Due to the fact that we left early we were able to drive fairly carefully and arrived at Green Meadows about 20 minutes to 6pm. From the "board", Dr. Swenson was running about 15 minutes late - that's another great thing about Green Meadows, they keep the status of the Doctor's updated in the waiting area so you're not guessing as to what's going on, greatly appreciated. I went up to "sign in" and get my name corrected. The particular receptionist I had, well she had a little trouble understanding that I needed my name corrected, but we eventually got on the same page and she took care of that and I joined J in the waiting area. We chatted and watched the fish as a couple of them were a touch angry from the looks of things. Right about 6pm, Dr. Swenson's assistant called me back - I can't think of her name to save my life at the moment, but she's as wonderful as Dr. Swenson is. She took my vitals which were incredibly good. My weight was down to 216lbs which seemed to match what I had weighed at home (214lbs), I figured the 2lbs was about right for the clothes I had on there. So that made me happy as that mean I was about 45lbs down give or take from when I started working on my weight. She then took the rest of my vitals and I got my next big surprise. My blood pressure was 108/66. I've *NEVER* seen it that good, in fact before my prior GP put me on blood pressure medicine it had been as high as 180ish/110ish which is definitely not good. I think this excited me more than the weight loss as I knew I had lost the weight, this on the other hand was a complete surprise. She took the balance of my vitals, offered me a bottle of water, and then told me Dr. Swenson would be in shortly.
As I'm prone to do in these situations, I started taking silly selfies to pass the time until Dr. Swenson came in. One day I'll have to post a few as some of them have been a bit funny. :) A few minutes later, Dr. Swenson knocked on the door and came in. There's very little as nice as hearing your Doctor tell you how wonderful you look when they walk into the room. I mean I felt good, but hearing it from somebody else is always nice and was appreciated. We discussed my weight loss, she then proceeded to look over my lab work and discussed how wonderful it looked - every value but the A1C is now in the "normal" range and as I said above the A1C is getting there. She also noted that my gender had been updated to "Female" - which just added to how good the day was going as I had been so intent on getting my name corrected I had forgot to mention that to the receptionist, so I guess she noticed it on my license and got that fixed as well. She then spent a few minutes talking to me about how my Orchi went, how I was feeling since then, and my general state of mind. That's basically how every appointment with her is, and I so appreciate that she takes the time to do that. I know that pretty much every Doctor "cares" about their patients, but the fact that she takes the time to worry about my state of mind with things means a lot to me as it's not something she has to do. We discussed J for a bit and I mentioned that I had brought her with me, but I had not brought her back since I knew they were running a bit behind. She then asked if she could go meet her when we were done which I thought was a great idea. J is obviously not only a huge part of my life, but she has played a huge role in my transition and I like to keep her as involved as I can. We then discussed my dosages, at my last visit we had talked about upping my Estradiol from 4mg to 6mg per day, but had decided to hold off until after my Orchi. Looking at my lab work my levels were fine, but on the lower end of where she felt we could have them so we decided to up the dosage as we had previously talked about. As far as the Spiro, we discussed lowering the dosage (200mg down to 100mg) or even dropping it, but her recommendation was to stay on it until at least the next visit so we could have a bit more data prior to making that decision, I felt that was a prudent thing to do so we were in complete agreement.
As always, she then asked me if I had any questions, which I had two. The first was my nails, I've found them to be tearing a lot more than they used to. We discussed supplements in general and specifically calcium as well as Biotin, I think I'm going to try the Biotin first and see what happens. My second question had to do with my right foot. A bit over a week ago I went with one of our resellers to a customers site. It was a customer I had installed many years ago and was now very unhappy. I was sent out to help upgrade the site and to ideally help smooth things over. Well at one point I set my laptop bag down - a little too hard I guess - onto my foot. As the day went along it swelled up and starting hurting to the point that it was hard to walk. It's gotten a bit better over the last 7-10 days, but still hurts so she looked at that for me. She said it was likely a soft tissue issue, but there could be a fracture so she suggested x-rays to confirm one way or the other. I readily agreed so she quickly arranged for that and got me some sort of funky "shoe" to use for the next several days to try and alleviate the pain. I say "shoe", but it's more like a sandal of sorts and was a bit difficult to get used to, but if it helps - well it's worth it. She then showed me to the x-ray area which is through a door at the back of their offices, and told me she'd call me with the results tomorrow. Getting the x-ray took about 5 minutes and I returned to "check out" with the receptionist and get my discharge paperwork.
I had neglected to ask when Dr. Swenson wanted to see me next, but had already taken care of that - 6 months again unless there was an issue with my HRT (anything else and I would go see my regular GP as normal). I got my discharge paperwork, which is yet another thing I like about Green Meadows as it has all of my vitals on it, my medications, my next appointment, and so on. I keep these in a file folder here and it's easy to see what has changed over time. I then went out and got J to leave. I had assumed when the x-ray of my foot Dr. Swenson had moved on with her next patient, but no - she had taken the time to come out to the waiting area and introduce herself to J and chat with her for a few minutes. It probably sounds silly, but to me it was among the nicest things I've ever had a Doctor do, and I really appreciated it. Per J it was a general chit chat as to how things were going and that I was getting my a x-ray on my foot and such, but I know J appreciated her time as well.
From there we drove down the block and tried Zaxby's for the first time. We have had Raising Kane's a few times which is similar but there are no Zaxby's in/near St. Louis. There are two in Columbia though that have opened in the last six months and we wanted to try it. The food was good to great, here's a link to the Yelp review I just posted: Zaxby's review.
From there we ran down the street to Wal-Mart - we could have went to one by the house, but it was on our way home and I needed a HDMI<>DVI connector - long story - and we needed cat litter (seven cats will do that) and a few other things. I will say that the ladies room in the back of this store was among the nicest and cleanest ones I've ever been in - and I'm not limiting that to Wal-Marts. It's funny, I've had my new license for maybe six weeks, and one of the reasons I wanted my gender marker changed was so that I'd feel more comfortable using the ladies room, but I hadn't had the occasion to since I got my new license until tonight. I've obviously done it before as I've mentioned here, but tonight was the first time I actually felt comfortable in there. It probably sounds silly, especially to any cis-woman who might read this, but for me it was actually almost a milestone to be able to do that *AND* feel completely comfortable doing so. We dawdled around the store for a while, just enjoying each others company until we finally decided we needed to head home. The drive home was just as wonderful as the drive up, albeit without the blown tire incident. I've used the phrase before, but "it was a good day" - no it was a "great" day, and a large portion of that is due to J. She's so very wonderful and supportive, I could not ask for a better wife/partner/"husband"/confidant/etc than her. I know I've been a little mopey/crabby lately and I needed a nice day. Today definitely fit the bill and for that I'm so very grateful to J, Dr. Swenson, and everyone else that I came into contact with. Days like today really confirm that I've made the correct decision to be Madison. :)
- M
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