06 May, 2011

Take Paracetamol and Come Back in a Week...

...Is the way the story goes when it comes to primary health care here in the Netherlands.  It’s generally accepted that when you go to the doctor he or she will roll his or her eyes, take a certain condescending tone and then send you off with instructions to take paracetamol as there is nothing else that can be done.  If you don’t get better in a week or so, you are allowed to make another appointment.

Now, generally speaking, I am a very healthy person.  I have been admitted to hospital once, on Christmas Eve when I was five, for a broken elbow.  I’d been to sit on Santa’s knee and was given a cup ice cream then thought I should play on the monkey bars.  Like any five year old I was covered in ice cream, so I slipped.  If you knew me as a child (or even now as an adult), you will know that being quiet is not my strong suit.  So the entire town knew that I had hurt myself.  My parents had to rush me to the hospital for x-rays and then proceeded to leave me there overnight.  by myself.  On Christmas Eve.  Did I mention that it was Christmas Eve and I was left by myself?

Wow, this was more than twenty five years ago, you’d think I would have let it go by now!  Just imagine what my parents had to live with...

But my point is, I’ve never been really sick.  Sure, I’ve had colds and the flu and endless bouts of tonsillitis when I was a teenager, but never so sick that I couldn’t get out of bed for months at a time, had to have major surgery, or even had a cool cast for a broken limb (my broken elbow only earned me a sling - ripped off!).

I am, however a very big fan of preventative health care and being pro-active about my own health.  Heart disease is rampant in my family and my dad takes blood pressure tablets each day (although I may have something to do with the elevated levels there!).  As a consequence I like to be on top of what is going on with my body and have regular health check ups.  Well, I did until I came to the Netherlands.

Initially I was very daunted by the system.  My lack of Dutch acted as a bit of a barrier.  I was ashamed to live here but not able to conduct myself at a high level in Dutch.  Plus I had read some of the many complaints and horror stories about health care in the Netherlands by other Expats.  You can see what I mean here and here.  Not to mention the discussion with friends where we would all just joke about travelling home to our respective countries when the time came for some actual health care.  Never minding the extortionate compulsory health insurance premiums we all have to pay living in the Netherlands!

But late last year I had a problem.  I had a sore toe.  I know, I know I'm a whinger, but it really hurt.  Actually, after several days the pain increased to the level where I couldn’t sleep and couldn’t really walk either.  So off to the Doctor I limped.  You’ll never guess what the treatment was.  Yep.  Take paracetamol and if it doesn’t improve in a week, come back in.  Really.  My toe was bright red and twice its normal size and almost visibly throbbing, but paracetamol would do the trick.  Oh, and a washing powder bath.  I actually laughed in the doctor’s face at that.  But, what can you do?  You go to see the doctor putting all of your faith in them that they will be able to help.  At the very least help with the pain, but I was in with the doctor for no longer than five minutes and then ushered out the door.  Now, this was a Friday so of course there’s no option to get health care over the weekend unless you’re in serious problems.  On the Saturday I  had to go to Rotterdam and couldn’t even put my own shoe on, so had to wear one of Maarten’s.  Cue Ronald McDonald impersonations and sad clown faces.

I was back in the Doctor’s office first thing Monday morning (different doctor this time as I refused to see the same one) and it was confirmed:  I had an infected toe.  No shit Sherlock.  From then on I had a completely different experience.  Once we agreed that something was wrong treatment proceeded at a lightning speed.  I was back that afternoon for a follow up, given antibiotics and painkillers, then I was in again every day until they could slice it open and get rid of the infection.  The difference was like night and day.  I was immensely happy with the care, and confident that if something happened to me again, I would be taken care of.

Thank Goodness, because this brings me to my next experience.  A routine PAP test.  I was due for one as it had been three years since my last check.  According to Dutch standards I was still two years early, but by Australian guidelines I was already a year late.  Plus we’ve been discussing the possibility of having children (well, a child - let’s not get ahead of ourselves!) and I wanted to make sure all the Go Gear was in good working order first and not in need of any serious maintenance.

Oh, how wrong could I have been!  The doctor (the good one, not the paracetamol freak) ran the check and told me to call back in two weeks when the results would be in.  No worries.  Ten days later the phone rings.  It’s the doctor.  Can I come in for the results.  It’s not good news.  So, I dropped everything and made a mad dash to the doctor, on the phone wailing to my wonderful mum the entire time (on my mobile.  To Australia.  Not looking forward to that bill!).  Maarten, bless his heart also dropped everything and almost beat me to the doctor, and he had to drive 30km!

We took a deep breath and went in to find out what the results were, and it wasn’t pretty.  I had either cancerous or pre-cancerous cells.  My result was PAP 4 in the scale from 1 to 5 and the GP had booked me into a gynaecologist the next day!  So, there were a lot of worried faces in my family that day.  We weren’t sure if I had cancer and my doctor told me I should prepare for the worst possible outcome.  As an eternal pessimist, you can imagine what the worst possible outcome was in my mind.  And because I have to have contingencies for contingencies, inside my head was not a great place to be.  However, the worst case scenario would be a hysterectomy.  This was a less than ideal scenario, but far better than the alternative that was flying around inside my head!

The rest of the day passed me by in a haze.  I couldn’t tell you what I did or who I spoke to.  I was completely consumed with worry.  What if I’m sick?  What if I’m going to die?  What will Maarten do?  What about the house?  Why me? By the time I arrived at the gynaecologist, I was barely keeping myself together.

The gynaecologist.  What a marvel of a man.  He was happy to speak to me in English and he might possibly have been The Fonz in a past life.  He managed to allay my fears in about two sentences.  I kid you not.  He said (and I’m paraphrasing here), “This is the problem.  It could be cancer, but I seriously doubt it.  This is the result I expect and good job for having your regular checkup because it’s nasty and would definitely become cancer years down the line if untreated.”  

He also said something that shocked me to the core.  This was most likely caused by the Human Papillomavirus, which is what you and I know as warts and the reason behind the creation of a controversial vaccination now given to girls with their MMR shot.  There are up to 40 different strands that affect people and of course I wasn’t so lucky as to just get the warts strain.  He actually laughed at me when I gasped about having an STI.  I was more prepared to be told I had cancer!  He rattled off some extraordinary statistics re infection rates.  According to him, around 80% of women in the Netherlands carry the virus at one point and using condoms is not a great guarantee against the virus.  As a rule 90% of cases are cleared up within two years, but a very small percentage of women can go on to develop pre-cancerous lesions and cervical cancer.  Lucky me.  I never seem to find myself in the majority, ever!  It should also be noted that while cervical cancer rates in the Netherlands is very low (around 500 cases per year), it is the biggest woman killing cancer in developing countries.

Then the time came to address the elephant in the room.  The stirrups.  Attached to a big screen.  This was going to make for entertaining viewing.  Up I climbed and then before I knew it, there was my magnified cervix being displayed for all to see.  Did I mention Maarten came along for moral support?  Poor guy.  After a bit of poking and prodding it was time for me to cough while he took the biopsies.  It went something like this:  
Dr: “Okay, cough.”
Me: “Cough”
Dr: *chunk* goes the biopsy forceps
Me: “Fark! Oh sorry, I said Fuck”
Dr:  “That’s okay, fuck’s fine.  Cough again?”

After three coughs we had enough tissue and I was allowed to put my knickers back on.

He explained that he expected I would have a CIN grade 3 result, which is defined as severe dysplaysia and that I would at least have to have the LLETZ procedure to remove the cells.  Once this is done I will then have follow up PAP tests at six monthly intervals for two years (or for as long as necessary).

I was back in the gynae’s office a week later for my results, and yep, all of the above predictions came true.  I have a CIN 3 result and will need the LLETZ.  I’ve opted for the procedure under a general anaesthetic rather than a local as there is some cauterisation and it’s something I don’t want imprinted on my memory for all time.  This will all happen some time in June.

But, what actually made me sit down and write about this experience was my own GP.  Last week, while I was waiting for the biopsy results, she called me out of the blue to see how I was doing, that I should stay positive and to let me know she was thinking of me.  Because there is so much ranting and vitriol against the primary health care system in the Netherlands I wanted to stand up and say that I had a good experience and that I couldn’t have been happier with the care and support that I’ve been given by my GP and by my Gynaecologist.

I know it can be frustrating when it seems like your doctor is not taking you seriously and I can’t stress enough, if you’re not happy with the outcome from one doctor, you should insist on seeing somebody else.  One doctor may insist that Penicillin is the work of the devil (Dutch doctors are notorious for refusing any form of antibiotic prescription, not just penicillin), but another will understand and see its worth and understand that preaching bed rest and paracetamol is not always the appropriate treatment.

I could have waited for Cervical Awareness Month, but that was way back in January and this is just too important to wait until next year.  If you’re due for a screen, please don’t put it off.  If you’re embarrassed for your own doctor to do the test this week when you’ll be back in next week with a child and an ear infection, make the appointment with another doctor.  Besides, your doctor (or nurse depending on where you live) has done the test so many times in the past and have better things to think about than what your hoo hoo looks like!

Stop making excuses and do it.


Unknown said...

Well, I'm glad that you are now happy with your GP and the Gynaecologist... thank God for that! And Thank God for the fact that it's nothing irreversible. I've just had my PAPscan this week and I'm hoping that everything will be fine.
I have to say that my GP is also very nice and understanding - no complaints about her. But I have had bad experiences with other specialists... so much so that I ended up going back to my country for a treatment. Fortunately my GP here was willing to cooperate by writing prescriptions and following the instructions of my Argentinean doctors.
I wish you all the best with the procedures and hope that you'll be soon as good as new! :D

Wizardress said...

I had this same thing in 94 and so I empathize with the stress of waiting to hear what's going on. Its not pretty- Mine was in the US- but regardless of where you are- it's important to be persistant if you aren't happy with what you hear. Everything will be A-OK It does come from the HPV and my doc told me the same back then- that most of the time it goes away on it's own, but sometimes it doesn't.. I haven't had any problems since- and the procedure sounds like the one I had.. I was awake- had a local and was done in 15 minutes- I never had any pain- so hopefully that can offer some sort of comfort.. *hugs* Hang in there!

Kate @ Displaced Nation said...

How scary. Glad you're receiving good care and support. x

Unknown said...

Thanks for the comments ladies. All is going well now, I'm scheduled for my little nip/tuck at the end of this month. I'm looking forward to the little rest.

@Aledys, I hope all was clear with your own check up a couple of weeks ago!

@Wizardress you do bring me comfort, thank you!

generic paracetamol said...

Ingest more water, take care!

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