Why I Threw Away My Nuvaring and No Longer Trust My Doctors

At no point does this post become unpleasantly detailed.

Four months ago, I started Nuvaring after more than five years of abstinence. After researching other forms of birth control, this one was the obvious choice for me. Not only would I not have to worry about taking a pill every day, but I’d been on it five years earlier, with no side effects. The only catch was that, with two months until my insurance kicked in, I would have to pay out-of-pocket for this name brand prescription, because drug patents last for 20 years before generics can be produced.* Not wanting to risk the potential consequences of switching my hormonal birth control in such a short period, I bit the bullet and paid approximately $140 for Nuvaring, two months in a row.

Over the next four months, I experienced all of the perks of Nuvaring. I didn’t have to remember to take a pill every day. I had less extreme periods in every way. Neither Jake, nor I, ever felt the ring and it never slipped out. Most importantly, I never got pregnant. It seemed like the dream birth control. Why wasn’t everyone on this?!?

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I told you all about my kidney infection in March, when I discussed the perils of life without health insurance. What started as a bladder infection that I couldn’t afford to treat, eventually led to my waking up alone on the bedroom floor with a fever too high to reach for my phone and call for help. Eventually, the antibiotics took hold, and I got better. Finally, in April, I was officially insured… just in time for my new gynecologist to tell me I had another infection and treat me with yet more antibiotics, despite my lack of symptoms. I thought it was strange, that I’d get two UTI’s in one month. I, of course, looked up preventative measures and took action. So, it was much to my dismay when I recognized the same bladder infection symptoms I’d had two months prior, in the middle of May. This time, I was able to see a doctor for just $20, which seemed worth it to avoid missing more work. Jake just bought the Trojan multipack, because each time I was on antibiotics, we couldn’t count on hormonal birth control. It was becoming frustrating that I was even on birth control, if we were using condoms, anyway. I mean, I knew different forms of birth control came with their side effects, so why was I even taking the risk? Hmmm. On that thought…

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Where were these problems coming from, when I’d never had any similar issues, in my life? Could Nuvaring be the culprit? None of my doctors had suggested there could be any connection between the two. So, I took to the Internet and read all about Nuvaring side effects, only to find nothing relevant listed, even in the rarer cases. Over the course of the next week, I drank my water and waited for the antibiotics to take hold… and then called the doctor’s office to ask if I should’ve seen results, one week later. They verified that I did have an infection, but seeemed surprised that the antibiotics I’d been given hadn’t helped. I wasn’t to worry, though, because the antibiotics they prescribed this time would surely do the trick… until they didn’t and I was told that, at this point, a UTI couldn’t be the problem.

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I took to the Internet again. If it wasn’t a UTI, why was I experiencing so much pain? For a moment, I feared bladder cancer, only to calm myself when I discovered this is a diagnosis usually reserved for the elderly. Upon further research, I found that UTI symptoms can be attributed to chlamydia and gonorrhea, both. No part of me suspected Jake of cheating, but I knew he’d been with women before me and that neither of these STI’s necessarily caused any symptoms in men. So, I made an appointment to get tested. Any frustration I had for Jake, I’d reserve for after I found out I had anything and even then, it would just be for the fact that he hadn’t made sure he was clean. I’ll be honest. At this point, I hoped I had chlamydia. I’d have caught it in time to avoid any long term damage and the treatment was just another antibiotic. Sure, we’d have to use condoms again, but we’d mostly been doing that anyway.

On the Tuesday after Memorial Day, I got the call. I was clean of all STI’s and UTI’s… and I was devastated by this news. Over the next week, I became convinced that I’d never feel better, again. This was just how I’d live my life. Further research had told me that the remaining likely diagnosis was interstitial cystitis, a chronic disorder that may or may not respond to different kinds of treatment. The probiotics my doctor recommended seemed to have helped a bit, but I was still in so much pain, I was trying not to cry in frustration and discomfort in the bathroom at work. I longed for the last time I felt well and started to wonder when that even was. I counted back and made a surprising realization: the last time I felt better was the last time I took my Nuvaring out to have a period. I’d skipped the one before that, after being told by my gynecologist that this was okay, but Jake had disapproved. It didn’t sound healthy to him for me to be stacking my birth control without a break. Since my fertility directly effects him, I complied and took it out… and by the end of the week, the pain was mostly gone. My prayers had been answered, but only briefly, because it quickly returned. At this point, however, I’d just stopped complaining and was suffering in silence.

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For one final bout of research, I Googled “Nuvaring and UTI”… only to find numerous mentions of women who’d experienced both UTI’s and general urinary problems without diagnosis of an infection. Over and over again, I read stories on medical forums of women being in such pain that they couldn’t function or having multiple UTI’s in just a few months, only to find that discontinuing their usage of Nuvaring almost immediately relieved the symptoms. I was torn. If I’d had these problems and there was even a chance they could be related to my birth control, surely my doctor would tell me. I’d just wait until my current Nuvaring was finished and then try something else.

That night, as I lay in bed crying, knowing my symptoms would keep me up all night, again, I texted Jake to inform him that we’d be using condoms for awhile. I was sorry I hadn’t discussed it with him beforehand, but I couldn’t do it anymore and was willing to try taking out my Nuvraing on the hopes that my symptoms would clear up. I’d have taken an unplanned pregnancy over the pain, at that point. After sending that text, I trashed my $140 value birth control, that I’d only had in for two weeks. The next day, I called my gynecologist, requesting a different prescription. When I told the nurses my symptoms, however, they scoffed at the idea that my Nuvaring could be the culprit. The most I was able to get anyone to admit, was that women had complained of increased discharge and there was a possibility that that might cause an infection. When I picked up the new birth control, I got a more reasonable response from the pharmacist, with a bit less eye rolling. She said she hadn’t heard of these symptoms, but it made perfect sense to her.

It has been one week since I tearfully trashed my Nuvaring and I thank God numerous times a day that the pain is gone. I finally feel well, for the first time in over a month. I can go hours without having to pee, only getting up once or twice in the night. I no longer experience any pain. The only time I’ve had any such persistent symptoms in the last several days was when I tried to use my menstrual cup, because taking out my ring started my period. I am not a doctor. I cannot substantiate my claims that there is a connection between my urinary problems and my use of Nuvaring. I cannot say that this is even common enough that Nuvaring should say so, when it might be a dream contraceptive for other women. What I can say is that Nuvaring and the menstrual cup are both held in by pressing against the walls of the vagina and both caused me pain. I can tell you that I have had three substantiated UTI’s since March. I can tell you that I have never had any problems, such as these, until one month after starting Nuvaring. I can tell you that my doctors, the people I am supposed to trust with my health, never even suggested that the new prescription I was on might be the cause of the sudden problems I was experiencing, in a related area. When suggested this, I was gaslighted and treated as another obnoxious Web-MD reader. What I can tell you is that I will forever take my doctors’ opinions with a grain of salt, after this miserable experience. What I can tell you is that the pain is gone and I will no longer be using my vagina as a pocket for my birth control.

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http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079031.htm

Living in Fear: A Millennial without Health Insurance

I don’t have health insurance.

horrified-dean

That’s right. I’m 28 years old. I’ve had a house fire, a miscarriage, a divorce decree with my name on it, a bachelor’s degree, a teaching certificate, a master’s degree, more student loan debt than I’m willing to admit here, and a car payment. I’m an adult in all these ways, but I’ve spent most of my adult life without health insurance.

To be clear, I am not blaming anyone. That’s not the point of this post. I made my choices, starting with the decision to marry at 19, kicking me off of my father’s insurance and continuing with the decision to pursue a master’s degree, rather than enter the workforce as a full time teacher, earning me benefits. Just as the aforementioned student loan debt is no one’s fault but my own, so goes my lack of health insurance… and it sucks balls.

You hear the statistics of uninsured Americans and occasionally someone posts a Go Fund Me link on Facebook telling the horrifying tale of a 27-year-old melanoma victim who just wants to live until her son’s fifth birthday. No one ever talks about what it’s like to just be uninsured. No one really mentions the people who simply can’t justify paying a $200 monthly premium for government mandated coverage with a $3,000+ deductible, just so they can get a couple of asthma inhalers every year. The penalty for not doing so, by the way, is still less than two months of this worthless “insurance.” Personally, I’m a professional researcher and found a loophole, so I’ve never paid the penalty, but it would still be my preferred choice… which means living without health insurance.

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During college, I didn’t feel the effects of my lack of coverage so much. My mother did fund a root canal, after the dentist refused to start pulling teeth from a 20-year-old (glad it wasn’t a broken arm, Mom), but despite my morbid obesity, I was generally pretty healthy. I suppose the most profound healthcare issue I had was my miscarriage, but my state government actually has a fair resource for low-income pregnant women… emphasis on the word fair.

When I got pregnant, I received WIC and state funded doctor’s visits, so I could eat well and get the prenatal care I needed. God had other plans, though, and at 11 and a half weeks, I lost the baby. According to americanpregnancy.org, after 10 weeks, the chances of an incomplete miscarriage rise. I was nearly to my second trimester, but after a tearful few hours in the emergency room, I was sent home. I wasn’t referred to a physician, who could prescribe me pain medication. I wasn’t told to report for an ultrasound in a week to make sure pieces of my dead baby weren’t left behind, which could potentially kill me. I was sent home… without instructions of what level of pain to expect or how long I would bleed. That’s what it’s like to miscarry on low-income health insurance.

About a year later, I received a call from my step-mom telling me that I would once again qualify for my dad’s Blue Cross Blue Shield, until age 26. At this time, I was 23, so three years with insurance was a saving grace after five without.

As my 26th birthday neared, I made a half dozen doctors’ appointments. I got a pap smear and an eye exam and a final teeth cleaning. I visited the chiropractor as many times as I could and made an arrangement with one to let me pay cash after my coverage expired. Thankfully, when I hurt my back at 24, I was insured, because there’s no other way I could’ve afforded the treatment to gain the ability to fully straighten my right leg. On the eve of my 26th birthday, I prayed. I asked God to please grant me my health until I got a full time position and the benefits it afforded… as I did for the next two and a half years.

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When you don’t have health insurance, you live in constant fear of injury. live in constant fear of injury, regardless, because I regularly hit my head, but without insurance, everything is a risk. A trip to the wildlife refuge reminds you of the story you read about the guy who was bit by a rattlesnake there, while hiking. A day of swimming makes you question every mole you’ve ever had. An ice storm has you envisioning the bills attached to a fractured wrist. When your best friend buys you a heat gun for Christmas, you vow to save it for the day you get your insurance card. Even dating has you wondering about how much birth control will cost out of pocket and what to do in the case of an unwanted pregnancy. Every single sickness, no matter how normal, calls to mind the fundraiser for the woman who found out she had breast cancer at age 25. When your long-term boyfriend asks you to go on a romantic ski weekend with him, you recall the article about the woman who’s in debt for the next fifty years after being airlifted to a hospital.

It doesn’t improve your nerves that every concerned family member tells horror stories about people they’ve known without health insurance. Over Christmas, I had to explain to an aunt that, no, I wasn’t lucky I hadn’t gotten leukemia like her first husband did at 29; I was a statistical norm. Awkwardly, I also had to note that it wasn’t worth paying the premium because I was of “prime childbearing age,” because I’m not a candidate for the Mother of Christ.

I’m a pretty consistent blogger, y’all. I know there are times when I’m a bit more reliable than others, but I can usually be counted on to post every week or two, but I’ve been terribly ill. Last Monday, I woke in the morning to feverish chills and shaking. I called in to work, thinking it was a one day thing, happy I at least had paid sick leave. The next day, I woke feeling worse, after a night of getting up to pee every few minutes. After calling in sick, I pulled up my trusty physician Google, who reported I had a bladder infection. It wasn’t urgent, I read. I just had to drink a lot of water and it would be over in a couple of days. What a relief. I had an important training Wednesday morning. As long as it didn’t get to my kidneys, I was fine. Y’all, I literally felt the moment the infection entered my kidneys, during that training. After 30 minutes of sitting in rapidly increasing pain, I asked to speak to my boss in the hall… where I broke down and told him I had to go to the doctor.

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I drove 80 miles an hour to the Urgent Care clinic, sobbing to my Gramma, who told me to go and she’d pay for it. When I arrived, I was informed that my visit, which took all of 15 minutes, would cost $130. A nurse took me to the back, took my temperature, asked my weight instead of weighing me, and put me in a room. A doctor came in, asked my symptoms and agreed with Google. He literally did zero research and just prescribed an antibiotic and something for the pain.

I keep telling people that I was really sick, but no one seems to get how far the infection had apparently progressed. While the doctor seemed to think I might be able to make it to work the next day, the increasing pain seemed to disagree. My body didn’t seem to be responding to the antibiotics at all… not that I could afford to get a second opinion. That night, the pain was so intense that I went through my medicine cabinet and found some muscle relaxers, hoping they’d help me sleep… because I’d developed a sharp pain in my right side.

According to Google, I could be suffering from a number of things, from an appendicitis to an ectopic pregnancy to kidney stones… all of which would cost a fucking fortune to treat at the hospital and could be fatal if ignored. I found an old wives’ concoction that was supposed to help kidney problems and got up early in the morning to make it. The fever had gotten so bad that after mixing my apple cider vinegar/water/baking soda drink, I started to feel woozy, rushed to make it to the bed… and woke up on the floor, not sure where I was or how long I’d been there. I couldn’t tell up from down. I couldn’t stand. Thank God himself that I couldn’t reach my phone, because there is nothing more terrifying than waking up on your floor alone, with no idea where you are or what’s going on and no one to help you. In that moment, the possibility of financial ruin from an ambulance ride or emergency surgery meant nothing to me. I was petrified and had read nothing of these symptoms online. I’m also pretty sure Jake wouldn’t have appreciated the horrifying 6:00 am call of me incoherently telling him I needed help and couldn’t afford an ambulance. I mean, it’s not like my Gramma could help me down my stairs.

As a woman without health insurance, though, I did the only thing I could. I don’t know how long I lay there bargaining with God that I’d accept any emergency surgeries he had in mind, if he’d just wait until I was insured. Eventually, I was able to rise to my knees. Somehow, the glass of vinegar and water hadn’t entirely spilled. I downed it and crawled into bed in my vinegar soaked shirt… where I simply prayed I didn’t need to go to the hospital, now that the fear had subsided, and I went to sleep. A few hours later, I woke to find the pain in my side was now bearable. By God’s amazing graces, the vinegar concoction had worked.

I didn’t get well as soon as the doctor told me I would. On Saturday morning, Jake woke to me crying, because I was never going to get better. On Monday night, I left work early. On Tuesday evening, I still had a fever. At times, I wondered if perhaps I’d been misdiagnosed. I thought about returning to the Urgent Care clinic, but it was just too expensive, unless I was sure. I’d just have to wait it out.

Yesterday, I actually felt well enough to go shopping, on my day off. By the end of the trip I was exhausted. I’m still recovering from what was apparently an epic infection… not that I knew that, because the doctor I saw asked few questions and ran zero tests. I got lucky… and God gave me one last glimpse of life without insurance before mine kicks in on April 1st.

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At 27, I am too old to protect myself from cancer.

I was 21 when the Gardasil vaccine was widely released in 2008, amidst controversy over its microsecond of testing; it had only been approved by the FDA two years earlier*. At the time, I was married and like anyone who marries at 19 for all of the wrong reasons, I assumed I’d never be single again.

Couple this fact with my lack of health insurance and some of the more unnerving reports of the vaccine effects and I didn’t find it worth the cost or risk. Don’t misunderstand me. I am by no means an anti-vaccer. I plan to pump my children full of life saving hormones the second they enter the world. There is a reason we’ve eradicated diseases like polio and, until recently, measles. I wasn’t against vaccinating for HPV, but rather doing so with a formula concocted in some dude’s garage last week. I assumed that by the time had children, there would have been more tests verifying the safety of the vaccine, but for me, it wasn’t necessary, cuz happily ever after and all that jazz.

Then… I got divorced. At 23, with my divorce finalized and now with health insurance through my dad, Gardasil was once again on the table. It still scared me, though. I mean, this was only 2011. It had been widely distributed for only three years. How many times have we watched public service announcements about some miracle drug causing irreparable harm or even death? So, once again, I passed on the vaccine. I was in grad school and working two jobs. I wasn’t getting laid any time soon. In time, when I actually had the energy and desire to date, I could reconsider. Even when my health insurance was about to lapse, I still wasn’t comfortable getting the Gardasil shot. No. I wasn’t sexually active. I’d really only even kissed my ex-husband. I could private pay and get the shot later… or so I thought.

Things have been going really well with Jake, y’all. Like, he’s the bees’ knees and all that other nauseating sentiment. There have been fucking Eskimo kisses. It’s disgustingly cute and unquestionably white. I think I’m really falling for him and I’m getting a lot better at this making out thing, particularly since I’ve stopped apologizing for my lack of skill. At this point, he’s got to find the awkwardness endearing, because there’s absolutely no ignoring it. As patient and sweet as Jake has been over my lack of experience, though, he’s had a far more typical sexual history. I don’t want to know how many people he’s been with, and I’ve told him as much, but he’s admitted that he wasn’t always the poster boy for safe sex. In short, he’s been exposed to HPV, which according to the CDC most men and women will have at some point in their lives.* As there’s no way to test for this like other STI’s, it appears it would be time for me to schedule that private pay vaccine course for Gardasil. Sure, it’s expensive, but I’m willing to pay for my sexual health… if someone will let me.

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After my conversation with Jake, I began to look into getting the vaccine. I discovered that, had I received the shot when I had insurance, it would’ve been Gardasil-4. This year, they’re switching to Gardasil-9, which includes protection from five more types of cervical cancer. Score! I can be even better protected for my money! I soon realized, however, that not only does the FDA only recommend vaccination up to age 26, under the assumption that most have already been exposed by this age, but many doctors will not approve the shot for “off label use” in anyone older. That’s right. Because it’s assumed that everyone over 25 has had more than four sexual partners, anyone who hasn’t is just too old to protect themselves from cancer.* Thank you, Food and Drug Administration. That is an awesome reward for my self-restraint and concern for my own sexual health.

Despite the many discouraging stories I found online, I decided to see if my general practitioner might make an exception, based on my personal circumstances.

Me: “… and I was wondering if Dr. Davidson might be willing to give the HPV vaccine to a 27-year-old. I know that the FDA only recommends it up to age 26, but I can pay for it out of pocket.”
Receptionist: “Well, I’ll have to discuss it with him and call you back.”
::calls back::
Receptionist: “You are over age. The FDA only recommends the vaccine up to age 26.”
Me: 
::Didn’t I just…?::
“I understand, but I’ve only had sex with one person five years ago, in a monogamous relationship. I’ve had less sex than most 24-year-olds. I’m trying to find out if the doctor will let me private pay for the vaccine as my own personal choice.”

The back and forth went on for an unreasonable length of time, before the receptionist finally told me that the doctor might give me the vaccine, but I’d have to pay for an office visit first. Having no health insurance, this was going to be $80 for a possible no, but I made the appointment with the PA anyway, for one hour later. I was so nervous and terrified that I’d be denied, that I arrived 30 minutes early and feared my blood pressure alone would disqualify me. I tapped me foot and read story after story of women being told no by doctors, on my phone, unable to find any with different results. This didn’t help the nerves, bee tea double ewe. Finally, my name was called, 15 minutes earlier than my actual appointment, but it felt like an eternity.

I’m lucky, y’all. As I sat, near tears over my own procrastination, I explained to the nurse why I wanted the Gardasil vaccine and why I felt I was still a good candidate. Though she gave me some information that I knew was incorrect, from having just read the entire CDC website, (the vaccine does so protect from genital warts, and quite effectively at that, as confirmed by the PA*) she also gave me some wonderful news: my doctor’s PA loves Gardasil and encourages anyone who wants to get vaccinated to do so. In no time at all, she arrived to tell me so herself. She agreed that I had little chance of previous exposure and while she couldn’t legally guarantee effectiveness, she saw no reason why Gardasil would not benefit me just as much as a 24-year-old in the same situation. If I was willing to private pay, I could receive the Gardasil vaccine. The consensus all over the Internet seems to be the same. Gardasil is effective as a vaccine against HPV for anyone with little sexual exposure, as HPV is primarily an STI and an extraordinarily common one at that. Having only slept with my ex-husband and having received normal results on all my gal exams, it’s unlikely I’ve been exposed. Yet, the FDA refuses to approve the use of Gardasil in the 26+ sexually inexperienced. Once again:

I thank my stars that I found a PA who is more considerate of individual circumstances, because she agrees that at 27, I still have every right to protect myself from cancer. Am I still afraid of the Gardasil vaccine? A little. I’m more afraid of cervical cancer and genital warts, though, so I had my first shot on Wednesday and I’m not dead yet. In fact, as frustrated as I am with the FDA, I’m also pretty irritated with the fear mongering anti-vaccers who keep insisting Gardasil would have killed me five years ago. I feel fine. Most people who take this vaccine feel fine. The one in a million outliers really aren’t a sound reason for me to risk cancer, which has a much higher likelihood of killing me.

So, fuck the FDA for telling me that statistically I should’ve put out more by now and fuck the granola-eating helicopter parents who insist that one of the best decisions I could’ve made for my sexual health would end me. Thank you, though, to the medical professionals who are willing to consider each patient’s story, because in no time at all, I’ll be protected. Speaking of which, there is one caveat that I hadn’t really discussed with Jake when I was doing my research.

::text message::
Me: So, the good news is, they’ve ordered the INSANELY expensive shot. The bad news is, no matter how well things go for us, I’m not having sex with anyone for like 7 months.
Jake: Good things come to those who wait. Lol.

He’s just… keen.

Citations

https://en.wikipedia.org/wiki/Gardasil

http://www.cdc.gov/std/HPV/STDFact-HPV.htm#a7

http://www.theatlantic.com/health/archive/2012/06/left-out-why-is-it-so-hard-for-older-women-to-get-the-hpv-vaccine/258611/