September 25, 2017

My Turn: Or, Why You Shouldn't Ask Rude Questions

After a year and a half of being engaged and 8 years together, my sister got married this weekend. She planned a gorgeous ceremony and reception with countless small details and personal touches. The DJ and photographers were amazing, family friends expertly coordinated, and the venue was stunning. She asked both sisters to walk her down the aisle and I could not have been more proud to play such an important role in helping her start this new chapter of her life. We partied well into the night, she got a bus to take us back to the hotel, and even booked out a whole boutique hotel for her closest friends and family for the whole weekend. They took care of everything and everyone for two whole days. I couldn't stop hearing about what a wonderful wedding it was, and how fun it was, and how beautiful we all looked (especially my sister). Unfortunately I also kept hearing some variation of "so when is it your turn?" The Boyfriend and I have gotten this question more than once. Weddings bring out the best and worst in people, and my well-meaning relatives just want the next event to be excited about. It didn't help that The Boyfriend was the officiant... Normally I shrug and say we're not in a rush - and I did tell a few relatives to focus on this one before thinking of the next one. Fortunately also my youngest sister had eyes for the DJ and made it known she might be next. Being older, in a serious long term relationship, and both of us being in this wedding added more pressure. This is probably the most un-feminist thing I've ever written. I'm embarrassed by what I'm about to write, but am going to because we have this culture where it's not acceptable for women to talk about all this. This time it bothered me more because I actually really want to get married. I always liked the idea of getting married and figured I would as long as I was sure it was right. I've known for a very long time that I want The Boyfriend to someday be The Husband, but because we aren't having kids there's no pressure to hurry. Plus, my sister and her husband have been together longer, I'm in grad school and do not have wedding-planning-level free time, and I really wanted to not get married in my 20s. But "boyfriend" makes the relationship seem temporary or unimportant. We live together, have animals together, our families and friends know this is it. But if we decided to not get married and simply be together without the formality I'd be fine with that, too. I don't need to be legally married, and part of me thinks that might help with the bit of anxiety I have over the permanence of marriage. So why did it bother me this weekend? The only answer I have is the timing. The Boyfriend and I talk about getting married all the goddamn time. He's a wedding photographer so he's seen the intimate details of of hundreds weddings. When he tells me about them he'll say why he would or would not want to do that for our wedding. We've basically already planned our wedding through these small conversations - all we'd really need to do is book the things. We also couldn't do anything until my sister was married, which I didn't think she would take a year and a half. Now that the coast is finally clear, I'm about to head into my last year of grad school which is going to be the busiest. If we get married in the next year I probably won't be able to enjoy much of it - I'm already stressed to the max between work and school, how could I fit a wedding in? But the alternative is waiting at least another year, and we've talked about moving away when I graduate because there aren't jobs for me in San Diego. We'd either have to plan a wedding long distance or ask everyone to spend a ton of money flying for it. There's one more reason this bothered me this weekend. I can't help but wonder if getting married is actually a priority. We talk about it and I know it is, so why these doubts? I didn't like not having an answer for the questions. It's frustrating to be asked that, like we haven't talked about it. What do people expect me to say when they ask when I'm getting married? My sister told everyone she was waiting until she got her master's - but I don't want that to be my answer. Not only is it not true necessarily, but I don't want a wedding to follow my degree like I checked a box. My generation is more educated than any other generation so a master's is almost at the same level as a bachelor's was: first you get your bachelor's then you get your master's then you marry your live-in boyfriend. I'm not just checking some box - this degree really matters to me. Maybe no one else actually thinks this way, but it still bothers me.

June 23, 2017

A bad kind of weird

Sometimes I morbidly look at my pets and think about how I will feel when they die. I not so secretly hope that my cat will live forever. Or at least another decade. Same with the dog. There's no reason they can't - they're both super healthy. But even the rabbits, who haven't been easy pets, I know I'll be devastated. I would get so attached to my rats, even though they only lived a couple of years. When they died I was heartbroken. Sobbing, sadness, guilt, anger, true heartbreak. So much more than I've ever felt for a boy.

I've never lost a person that I was very close to. I don't have any living grandparents and have been to quite a few funerals, but still no one that made a real impact on my life (other than reproducing so that I might exist). I know the day is coming, but sometimes I think about what my reaction might be when that day does come, and I can't help but wonder if I'll feel the way I do about my pets. If I'm being honest, probably not.

And then I think I just shouldn't exist among people.

I've always had kind of a weird reaction to death that really, really unnerves people. I smile. It's because it's that uncomfortable, because I usually know how much other people are suffering (like my mom when her parents died) and I don't know how else to react. As a kid I didn't realize I did it until someone would angrily point it out. As an adult I am extremely conscious of my facial reactions and words so that I don't seem like I"m happy someone is dead. But I've still been accused of callousness around death.

How will I react when it's someone I love? Will I cry? Will I care? Will I maybe go back to work to focus on something else and be accused of moving on too quickly? If I don't care about wills or inheritance or legacy, does that make me a bad kid? If my world doesn't stop, did I ever really love them?

My dad and I don't speak anymore (long story) but other relatives have said that he has cancer. I truly don't know if I believe it, but even if he does I don't really care. He hasn't been in my life for over 6 years and my peace is made. Will I suddenly be hurt when he dies? Will I regret our estrangement? Will I wish I had made amends, even if it meant apologizing when I wasn't in the wrong? Maybe, but I really don't think so.

But then I think about those who I do value, who I am very close with. Assuming I live long enough, surely I'll be devastated at the loss of my sisters, my boyfriend, and my best friends. Right? I think I will. 

But what if I'm not? What if I do move on? What if I move on too quickly? If I don't I'm just normal. But if I do I'm a bad kind of weird. A kind of weird that people think of when they hear about sociopaths. Am I a sociopath? Should I go live in the woods with a dog and a cat and lose my phone?

I'm not religious. I'm not romantic. I'm not maternal. I'm barely even sentimental. People wouldn't describe me as warm. So, what is it about me that makes me human outside of biology? I love, deeply even, but I don't think that's an emotion exclusive to humans (and I'm not talking about cats, though I'm pretty sure deep down my cat does at least like me). Maybe reincarnation does exist, and I was a snake in my last life and I haven't quite shed those tendencies yet. 

I recently took a strengths assessment for school and discovered to absolutely no one's surprise that I'm a strategic thinker: intellectual and analytical. The only outlier was harmony, which basically means I don't assert myself (also true). I love being alone, I miss living alone, I worry that I'll always miss it. I believe I could be alone my whole life and not miss people too much. But do I want to be?

I don't think so. But maybe that's my problem.

December 24, 2016

Laparoscopic Bilateral Salpingectomy FAQs

In October 2015 I got my fallopian tubes removed, which is called a laparoscopic bilateral salpingectomy. As I'm writing this it's been 15 months since surgery, and I still get a lot of comments on my previous posts about this procedure. To make one easy-to-reference location for the most common questions I've gotten, I made this post.

Anyone is still free to post here or on any of my other posts with new questions! But now no one will have to read through dozens of comments to find out if their question has been answered.

Best of luck to anyone considering this procedure or recovering from it! I do love hearing your stories, so continue to let me know about your experience.

My experience:
About laparoscopic bilateral salpingectomy:
  • What is a laparoscopic bilateral salpingectomy?
    • Salpingectomy is the surgical removal of both fallopian tubes.
    • Laparoscopic refers to how the procedure is done: through a tiny incision with tools that go inside the body, rather than big cuts into muscle. Much faster and easier recovery.
    • Bilateral refers to both sides: both fallopian tubes were removed, so the procedure was done on both sides of my abdomen.
  • Who needs a laparoscopic bilateral salpingectomy?
    • It's a great sterilization procedure! Removing the fallopian tubes is getting pretty darn close to making it impossible to get pregnant. 
    • If you have an ectopic pregnancy this is what you'll get to save your life.
    • I chose this procedure over a tubal ligation and essure because I wanted the most effective form of sterilization and I didn't want anything left inside me. It was the best combination of pain, recovery time, and long term effectiveness for me.
  • Why did you get fixed?
    • I don't want kids.
    • I don't want to get pregnant.

    FAQs 
General
  • Don't a lot of women regret sterilization?
    • Not as far as I'm aware. So far I sure don't!
    • From what I could find online, the women who regret sterilization tended to never want the procedure in the first place. They were coerced into it during childbirth. Many regretted it after their relationships ended and they realized they wanted more children with their new partners. 
    • I've never heard of anyone who never wanted kids regretting sterilization. Doesn't mean it never happens, just that it seems pretty rare.
  • Why not just get an IUD?
    • Because I wanted something permanent that didn't leave anything inside me.
    • Laparoscopic bilateral salpingectomy is as close to being 100% risk-free as you can get. IUDs are great, but not as great as salpingectomy.
  • Do you still worry about getting pregnant?
    • Nope! It's awesome.
  • So you really don't want kids?
    • I really don't.

November 6, 2016

Getting Fixed: One Year Later

It's been a year since my laparoscopic bilateral salpingectomy. Unless you know that I've had surgery (or are a medical professional, probably), you'd never be able to tell. Now that it's been a year I feel even more secure that it was the right decision. I know I can't get pregnant and will never have to worry about what-ifs. Instead of raising children, I'm in grad school, hoping to use my life to make a big difference in the world.

Here's what I look like now. The only visible scar is on my left side.



If you need a recap of my tube removal experience:
One year later, and here's what changed:
  • The Boyfriend and I don't need to think about pregnancy prevention anymore. I still do sometimes, but I was taking pills for 10 years and habitual worrying takes time to die off completely. The panic that I didn't take my pill subsides as soon as I remember I don't need to.
  • This means we've been able to have more spontaneous sex. 
  • This also means sex has been better because we aren't worried about the time of the month or that slim chance pills and/or condoms will fail. I went off birth control pills 10 months before getting spayed and we relied on condoms, which unfortunately meant we used them on occasion and tried to time sex for when I wasn't fertile the rest of the time. Since I had just started tracking my cycle, this was recklessly dangerous and I 1000% do not recommend it. Not to mention, it made both of us worry a lot about sex (mostly me, since I'd be the one actually pregnant).
  • I use an app to track my period now because I'm in less control over when I get it than when I was relying on a pack of pills (meaning I have no control). Fortunately it's crazy regular (more on that below) but it's been helpful having an app.
  • I've been extremely personal on this blog. Before I tried to be pretty vague and not use it as a completely personal platform, but I've since shared about being cut open, my personal decisions for not wanting to be a parent, details and advice about pooping, discussed my period in depth, shared photos with my face in them, shared photos of my bloaty and scarred belly, and now I've shared more details about my sex life than I thought I ever would on the internet. But, you know, I've said before I wanted to shout this from the rooftops and now that I've seen how helpful the previous two posts were to women considering this I'm more than happy to have been as candid and personal.
More importantly, some things haven't changed.
  • I still don't want kids. I got fixed 10 days after turning 30 and I'm 31 now. My biological clock didn't magically start ticking. In fact, my beliefs have strengthened. People in our lives are starting to have kids or talk about having kids and while they can have nice moments they are still so much work. Every time someone we know talks about how challenging it is being a parent I'm like, "...yep." 
  • My period hasn't changed. I've always been fortunate in the monthly cycle department. It came right on time when I was 13, is usually very light and cramp-free (I know, lucky), and is extremely regular, even without hormonal birth control. My first period post-surgery kind of skipped - I had all the symptoms of being on my period without any bleeding, but then it showed up a few weeks later. It took a few months to return to its normal mid-month cycle but now I can depend on it within a few days. I did have one period that was really crampy, but on rare occasion that would happen before surgery, too.
  • My hormones haven't changed. Because the only thing that changed was my fallopian tubes were removed, and they don't affect hormones, everything else has and will continue to happen normally, including menopause. That's also why my period hasn't changed. No weight change, no mood change, no change in appearance, nothing.
  • I can still wear bikinis. Not that I wear bikinis often due to circumstance (more of a mountain person than a beach person) and I would have even if my scars were bigger (because judgmental people can fuck off), buuuut my scars are totally not noticeable. In fact, on 4th of July The Boyfriend took a photo of me in a patriotic bikini and my belly button ring hole is more visible than my surgery scar. (Can you see it? I can if I squint.)
Quite a few women looking for information on laparoscopic bilateral salpingectomy as a sterilization method have found my previous posts, and I'm so very glad to have helped them. The biggest selling point for salpingectomy for me was there would be nothing in my body - no copper or plastic IUDs, no clips, and no metal coils. Even the stitching dissolved and glue came off. My risk of ovarian cancer is potentially reduced, my risk of pregnancy is essentially gone, and I won't have to think about having an IUD removed in 5 years. Win-win-win-win-win.

Edit: Now that we know the election results I'm even more happy I've gotten this taken care of. The next president could, and likely will, significantly roll back access to and affordability for procedures like this (and birth control and abortion access). I would be quite worried for my future if I was still dependent on temporary birth control. 

I doubt there will be much to report back on but maybe I'll do a 5 year or 10 year follow up or an update if there's anything to update on. Until then, I've been really enjoying the comments on the previous two posts and love hearing all of your stories. Please continue to leave comments! I may not always respond right away, especially over the next couple of years as grad school takes up most of my time, but I will respond. This has been a fantastic experience and I'm so glad to be in the company of the many, many women out there who decided they don't want (any more) kids and are sick of dealing with temporary and inadequate birth control. Much love to you all.

Photos in order of when they were taken:
Day of surgery

6 weeks after surgery


1 year after surgery


August 7, 2016

Dealing with Insurance for my Laparoscopic Bilateral Salpingectomy

The least fun part about getting spayed has been dealing with insurance.


Let's start with the end: I lost.

Backing up a bit, before you go and get this or any surgery call your insurance company and ask what your costs will be. First, get the precise codes from your doctor. Make sure to get all codes, all of the codes that each doctor will use (I had two), the code the anesthesiologist will use, the code the hospital will use, and any other code they might need. Second, tell that code to the insurance company, have them read it back to you so you know you're on the same page, and ask what your total costs will be. DO NOT ASK IF IT'S COVERED. "Covered" in medical insurance language does not mean the insurance company will pay for it, it simply means it's an approved procedure (wtf an unapproved procedure is I have no idea). This was mistake #1 for me. Third, before you actually go in for this surgery call your insurance company again and make sure they're giving you the same answer as before. If your plan suddenly changes and they don't inform you (cause they're dicks like that) you'll be on the hook.

Another important point: the Affordable Care Act states that all birth control costs are 100% provided by insurance companies, including female sterilization. HOWEVER,
 sterility is only a side effect of a bilateral salpingectomy. Fallopian tubes were historically removed as part of a hysterectomy in order to reduce the risk of ovarian cancer, and only recently are women turning to the procedure because of how effective it is at stopping pregnancy (no tubes, no babies). Compare this to a tubal ligation, which is only done for birth control purposes. This makes sterilization an off-label use of bilateral salpingectomy. Some insurance companies have this procedure labeled as sterilization because of its quickly growing popularity (up to 33% of sterilization procedures are bilateral salpingectomy), but mine did not. In principle I felt that insurance should have covered it because my primary reasons were for sterilization. 

Further, and this is an argument I had with many people at my insurance company over many months, is that even if laparoscopic bilateral salpingectomy is used for other things, I used it for birth control, as a preventative measure, so why isn't it paid for? The only answer I got was the code didn't specify either of those things.

What I learned is that there are generally two codes a doctor can use for laparoscopic bilateral salpingectomy: one that says it's birth control, and one that doesn't. There were two codes in my paperwork: one that described it as "female surgery" (no shit) and one that described it as a "medical procedure" (imagine that). The super weird thing was when I asked the insurance rep to read the codes back to me she said it "tubal ligation." Which would be paid for. When I asked why it said tubal ligation and they still weren't paying for it she said that's where that second code comes in, the one that called it a "medical procedure." Apparently, in order for Blue Shield to pay for this surgery, it would need to have a code that indicated it was a "preventative procedure." What differentiates a medical procedure from a preventative one is something I still don't know. 
Call your insurance company and find out what their rules are. If they consider it birth control, awesome. If they don't, do your best to find out what your costs are going to be when all is said and done (hospital fees, doctor's fees, anesthesiologists fees, medical waste fees, administrative fees, any and all fees they can throw at you). Honestly, I'm an educated person and am used to talking with medical professionals and I feel insurance is needlessly and possibly intentionally complicated so people will just pay to avoid the headache.


Since this was the surgery I wanted and I wasn't going to get a less-effective surgery with a longer recovery period and more potential for risk because it would be cheaper (some things you just need to pay for), I didn't try too hard to determine all these things. Plus, I knew my company would pay my deductible so my risk of actually paying anything out of pocket was pretty small.
I had my surgery in October and finally paid up in April. When all was said and done, it cost just over $2,000 (less than my deductible, which my employer pays as part of our medical benefits package). The upside was the hospital was very understanding and worked with me to try and get Blue Shield to reconsider. They resubmitted the paperwork twice, I talked everything over with both my doctor and the billing department multiple times, and they put several holds on my fees to give me time to get it sorted out. I still can't believe it took 6 months. 


Here's my six week update, the official "back at life" time for anyone currently considering this procedure and the recovery period. And here I am one year later. Good luck to anyone considering a salpingectomy! Despite the struggles with insurance, it has been 100% worth it.