Thursday, September 16, 2004

Get Some

All I knew before going in to see my fourth patient of the day was that she "desires change in birth control," and that she has been receiving Depo-Provera shots since she gave birth in 2003. The following dialogue (or one close to it) ensued:
Me: Good morning, my name is Emily, I am the student working in the clinic today.
Patient: I seen you before. (She had, in fact, six weeks ago at a pediatrician's office whre she had taken her older child for a kindergarten physical. At that time she informed me that she didn't like students, and that she didn't really care for her children, either).
Me: Oh, yes, hello. So, you want to switch from the Depo shot to another form of birth control, right?
Patient: Hell yes.
Me: What is it about the Depo shot that makes you want to switch?
Patient: I be bleedin' all the damn time, girl, and I can't get no ass when I be bleedin'. I ain't gonna got his whole winter without no ass.
Me: So you are bleeding in between periods?
Patient: Damn straight.
(We continue the conversation to get more info about the nature of the bleeding)
Me: Have you been having any weight gain or mood changes since you've been on Depo?
Patient: No weight gain. I maybe been in a bad mood, though, but probably because I can't get no head and no ass and that make me crabby.
Me: What kind of birth control do you think you would like to switch to?
Patient: Whatever don't make me bleed, but I ain't puttin' nothin' in my coochie.
Me: So you wouldn't be interested in the Nuva Ring? You just insert it in the vagine once a month and leave it there, then you don't have to take a pill every day, and you only have to think about it every four weeks.
Patient: Hell no, ain't nothin' goin' in my coochie. You know how it be when a man got a big ol' dick and you don't know how it be rockin' around in there movin' shit around.
Me: Do you want to try oral birth control pills?
Patient: Yeah, I'll do those. I been on 'em before, but this time I'll remember to take them everyday because before I forgot and that's how I ended up with him (pointing to her 13 month old running around the room).
Me: So you know how important it is to take it every day at the same time?
Patient: Every morning when he wakes me up at 7:30 the first thing I'm gonna do is take that pill. Also, can you look down there and check everything out and make sure I don't got no infections or diseases? It been a few months since a doctor checked me.
(We wrap things up and I go to wait for my attending to come in so we cn complete the physical exam and counseling. Before we go in, I let the doctor know about the patient's concern over her lack of ability to get any ass or head)
Doctor: So, Emily has been talking to you about some birth control and I hear you aren't happy with the Depo and want to try the Pill again?
Patient: Doctor, like I told her, I be bleedin' all the time and can't any. I got a birthday comin' up and the holidays and you know how we be, I don't wanna go without.
(Most of the conversation I just had with the patient is then repeated with the doctor. I am then instructed by the doctor to do the genital exam, which I am really looking forward to connsidering the lovely things I may be about to find.)
Me: Have you had any increase in discharge? (There is a plentiful amount.)
Patient: There been a little more discharge. I think it stinks, too.
(As I am in the prime location, I can verify the odor)
Me: How long have you had the increased discharge and odor?
Patient: I don't know. I just think it smell like a dead racoon.
(I have heard those "female odors" compared to many things, but this is the first time road kill has been used as a descriptor. I do the pap smear and then take specimens I need for the STD testing. That concludes the physical exam.)
Once the doctor and I finish the exam, write the prescription for a drug to treat the bacterial vaginosis (source of dead racoon smell), and give her a sample of Seasonale (the Pill you take for three months in a row without any placebo weeks so you only have you period once every three months), and a prescription to have the birth control refilled (please please please let her get this prescription refilled and use it, daily, for a very long time), we send our lovely patient on her way, off to merrily begin her pursuit of ass.









Monday, September 13, 2004

Yuzpe

I am sure there is something borderline illegal about my dispensing of medical advice on the internet, but there are just some things I need to share with people. Also, I was recently told by one of my attendings that he thinks all sexually active women need to know the following info, and that if they don't know it, the medical community has failed them.
Since I don't want to contribute to that failure, today I will share a recipe for emergency contraception, known as the Yutzpe Method.
This recipe uses your basic birth control pills to prevent pregnancy after unprotected or unplanned sex.
There are just a few rules you need to follow:
1. You have to do this within 72 hours of sex to have the best effect
2. You have to take the second dose promptly 12 hours after the first dose for maximum effect.
So, here you go.
Each dose is either:
2 pills of Ovral or Ogestrel, OR
4 pills of Cryselle, Levlen, Levora, Lo/Ovral, Nordette, Tri-Levlen, Tri-Phasil, Trivora, Lo-Ogestrel, OR
5 pills of Alesse, Aviane, Lessina, or Levlite.
Take the first dose ASAP after the sex. Then take the second dose (identical in quantity to the first) 12 hours later.
The most likely side effect will be nausea and vomiting (due to all the estrogen you just swallowed).
If you throw up, take something for nausea (dramamine is available over the counter) and then repeat the dose an hour after taking the anti-nausea meds.

Of course, there are some other handy products, such as Plan B, that are "available," but that lots of chain drug stores have decided not to carry, so they may be hard to find. If you can get it, though, then the advantage is that you only take one pill in each dose, and the pills have no estrogen, so you won't get nauseated. For more info, go to www.go2planb.com

These methods are 80-90% effective in preventing pregnancy. They will NOT end an already established pregnancy, and if you happen to have conceived from the unplanned sex, then this won't affect that, either. This is why you want to take the pills as soon as possible.

Also, my attending recommended that we ask all our patients if they would like a prescription for PLan B so they can get it filled and have it around for the "just in case." If your doc hasn't offered it, and you are interested, then demand your Plan B, ladies! If you can't find Plan B in your area pharmacies, then ask to have an extra pack of pills so you can do the Yutzpe (your doc can also prescribe you a more powerful medicine to prevent the nausea that might come from taking the regular birth control pills).

Let me know if you have any questions!

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