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Smackdown Updates IV: Botox, Wonky Periods & Depression

By Amalah

Not just your average cut-and-paste update-y job here, folks, if you’ll indulge me by reading on. One extra-fascinating update, one request for advice as one girl’s quest to maybe possibly get knocked up enters Chapter Two, and one email that proves that you guys are the best and that good things CAN happen when advice columns collide with the blogosphere.
Links to original columns are in the bolded headers, although I’ve bolded the updates as well and left my yakking un-italicized because I do a LOT of yakking in this one and I don’t want it to be too hard to read.
UPDATE ON: To Botox or Not To Botox?
Hi Amy,
I am updating from the “To Botox or Not to Botox” column, which, by the way, thrilled me to no end to see published. OMG, is this what fame tastes like? I want more, more, more!
Kind of a funny twist to this one. After your column and the great advice and comments, I decided to revisit the topic in another year and push my Botoxy thoughts aside for the time being. However, at my annual checkup, my doctor once again suggested removing two moles (one on my face and a big whopper on my arm). Previous dermatologists seemed unconcerned and told me that removing them would leave considerable scars, so no thank you to that (unless I’m in danger, of course). But this year my primary care doctor gave me a referral to a plastic surgeon who she assured me would be able to handle the job of removing my moles with minimal damage…
…and that is how I wound up directly inside the Botox den! The plastic surgeon also runs a med-spa, and he’s the guy who handles a lot of the boobs and Botox around here. I did take one of their pretty brochures just to see my options, but I have to say, the whole joint just icked out my inner feminist. And the doctor was a major ass. Perhaps in an ill-guided effort to comfort me about my mole removal, he said in a kind of snotty tone, “If you were my wife, no WAY would you be walking around with those things on you,” as if I were so hideous with my two imperfect moles (and I’m not! I swear!). And that’s when it hit me that this man, this industry, earns its living through low self esteem and the promotion of perfection as the new standard, and frankly, at this point in my life, I want no part of that. Talk to me next year.

Go you, dude. And your inner feminist. That’s a really interesting story, especially since I wonder if our places had been reversed, if I would have responded in a similar way or just sort-of crumpled a little bit under the blow of the doctor’s words. He’s a doctor! White coats = exalted status of rightness.
I have a few moles I’d like to get removed for cosmetic reasons only too, but like you, if I’m not in danger, I can certainly live with them just fine. But if a doctor were to POINT THEM OUT as some kind of hideous pox and then eye my lopsided A-cup boobs because THE HORROR, THE HORROR, I hope my inner feminist would also step up to the plate and flip that doctor a perfectly manicured bird.
Speaking of doctors who deserve to be slapped, read on…
UPDATE ON: Irregular Periods After Birth Control
Hey Amy,
I wrote to you before-with the on again off again periods. I finally went to the doctor because the periods went on their ‘normal’ off cycle, and then just didn’t come back for the next one.
Let me back up for a second…I’m 20 years old, married for over a year, (please look past the age, something that most people seem to be incapable of). I’m along the lines of healthy but not super-fit. I went on birth control when I was 17 and went off of it just over six months ago. So like I said-periods have been happening every other month since I stopped. Took your advice, went to the doctor (I’m living in a foreign country, without the comforts of my own doctors…) and had the worst experience ever.
Within two minutes of sitting down with the woman she diagnosed me with PCOS. There was no examination, no pregnancy test even! Nothing… I sat with her, and told her exactly what I told you-off birth control, irregular period. I felt like she just wasn’t listening to me. I told her that we weren’t actively trying to have a baby, but that we aren’t doing anything to prevent it (even though in my mind I am totally actively trying!).
So yadda yadda, it goes on and on, she draws up a little picture to show me what my ovaries look like, and what tumours I have (like I said…no tests, no blood taken, no ultrasound). Then she continued to tell me that she is generally 90% accurate in diagnosing this.
She tells me that she is going to send me to a special fertility clinic to have an ultrasound done, and wants to do blood tests whenever my period does start. Then, getting up as if the appointment is over-she asks about my last smear test. (It was around a year ago and completely normal.) She then reaches over and grabs a pamphlet about cervical cancer, says ‘here, this is for you! have a nice weekend!’ and out the door.
Oh sorry-forgot to mention the part about telling me to use condoms whenever I have intercourse. Hello! I just told you that we want to get pregnant! (I know…she was trying to inform me about cervical cancer blah blah blah–but I’ve only had one sexual partner-my husband, and I am his as well…)
Am I over-reacting about this?!! I’m left in an even worse position than I was before…I don’t really know where to go from here.
I came out in tears–the husband was completely shocked–thinking that I had cancer, and also just completely amazed at the ignorance of this doctor. I’m so upset, confused, angry…I feel so alone.
I know that women with PCOS can still get pregnant-and as I don’t know if that even relates to me, I just want to know that there is still hope for me to have a completely normal, healthy pregnancy.
Sorry for putting you through that rant!

Well, JEEZ. I am so sorry you went through that. That’s just…gobblreagrary I don’t even know what to say. Diagnosing PCOS during an initial visit? BEFORE blood tests and ultrasound? On a young woman who is only reporting irregular periods since going off of birth control? Without stopping for a second to consider the many, MANY other things that could be causing irregular periods? (Including possibly the STRESS and EMOTIONAL TURMOIL that would result from a doctor randomly bringing up major health conditions like she was commenting on the color of your shirt?)
And the whole cervical cancer thing. Well, that was just weird. Bad, hamfisted bedside manner all around.
I cannot tell you how many invisible people inside the computer have diagnosed me with PCOS during my years of writing about fertility struggles. On the one hand, it shows an increased awareness of actual physical conditions that can be behind infertility (rather than “just relax! it’s all in your head!”) but on the other hand…um, thanks, but I don’t have PCOS. Sure, I have the irregular periods and always have, but I have a complete lack of any other symptoms (evidence of high male hormones, like male-pattern hair growth, weight gain problems, etc.), and I have, in fact, HAD the blood tests and the ultrasounds. My blood test revealed I do not have elevated levels of male hormones, and while I have had the occasional ovarian cyst, my ovaries are NOT polycystic. (I’ve read that a pretty decent percentage of women get cysts on their ovaries each cycle, but even this alone is NOT a solid indicator for PCOS.)
So…as I am not a doctor, I will refrain from openly saying that doctor was full of shit, but…don’t go back to that doctor. Will your health insurance allow you to go somewhere else, or will that fertility clinic do a consult and run diagnostic testing WITHOUT you actually having to see her again to discuss the results? (The Big Clinic around here just takes your case completely over once you’re referred there, releasing you back to your regular OB/GYN once you’ve achieved second-trimester status of a healthy, non-high-risk pregnancy, and if your insurance doesn’t require referrals you can really just call them up and refer your own damn self in.)
I would love to repeat my earlier advice of “don’t worry, your irregular periods are SO SO NORMAL” — and I still believe you’re still in the realm of very typical post-birth-control wonkiness that’s possibly being compounded by worry and stress — but I know that realistically, there’s no way to put your mind at ease after an appointment like that.
So…maybe consider getting the blood tests and ultrasounds — doing everything you can to have them done under the supervision of SOMEONE ELSE — just to put your mind at ease. The doctors at a good, reputable fertility clinic will listen to you and while they may certainly present PCOS as a possibility, the experience should be much less…weird and rushed and not so much of a lone doctor pushing her pet conditions on every patient who walks in the door. (90% accurate at diagnosing PCOS? A notoriously HARD-to-definitively-diagnose condition? Whatever, lady.)
One bit of bonus advice-you-didn’t-ask-for, though. I’m getting the sense from your emails that you and your husband aren’t really on the exact same page in the baby-making quest. He’s open to “not preventing it” while you seem to be ready to be a bit more proactive about it. This is EXACTLY where Jason and I were quite a few years ago, and once things started getting difficult and the Clomid talk started, it caused some real turmoil in our relationship. He was NOT ready to take active steps to get pregnant (for some reason, I think men in general like the the idea of it just “happening,” like this absolves them of the need to be Totally Prepared for Fatherhood). I was, because dammit, I wanted a baby! Let’s make one!
So…before you go any further with the testing or doctors or anything, please make sure you and your husband talk about the possible outcomes and what the next steps are. If, say, you DO get diagnosed with condition X and treatment plan A is recommended, is your husband ready to jump on board with that, or will he be kind of surprised to hear that you are, in fact, already a couple steps ahead of him and mentally “actively trying?” I really hope my initial hunch was right and your periods will get back to normal all by themselves and you guys can make a baby the old-fashioned way and it will happen when it’s meant to happen and all, but I would also hate to see a newish marriage between two young people get put under additional strain if things don’t turn out to be what you expect. (I know, you asked me to ignore your age but…heh, I’m old. You have to listen to old people.)
UPDATE ON: Seeking Inpatient Treatment for Depression
Hi Amy,
You requested updates on your Smackdown advice, oh, around nine years ago, and here I am, getting to it now. (As if it was a specific call-out to me, because you know, I am important like that.)
Firstly, I just reread the Smackdown post, and possibly cried a little bit at the overwhelming support it garnished.
Secondly, I cannot emphasize how the outpouring of support and compassion and empathy was 3/4 responsible for getting me through that time. I cannot thank you, and your readers enough.
And now for the update: I went to partial inpatient treatment – 6 days of 9-5 intensive therapy and medication management.
It saved my life.
I went back on medication, continued therapy, answered some very scary questions about my life and my past, and miraculously got past it all. My work was unbelievably supportive, and though I left that job some months later, I still today am quietly grateful to my direct boss for being such a total rockstar about the situation.
Now, though unexpectedly and vaguely terrifyingly, I am pregnant right behind you. Nine weeks, to be exact. And I’m getting married in two months. (Yeah, ok, shotgun wedding, blah blah, but we have been together for four years, and the dude did put up with the Crazy, don’t I owe him something besides a fat, pregnant belly and a suspicious trail of WaWa wrappers?) I am off the medication for this reason, and coping relatively well. (I cry when the DVR doesn’t record shows about high end call girls, but dude, pregnant.)
I am inexpressibly grateful to you, and your readers, for your support.
So thank you, thank you, for your advice, and your ability to command a force of 3,000+ readers to go support some crazy chick, and if you’d send me the link for your registry, I’d love to send you (and Tivo) something as a pitiful show of gratitude. Also, I was reading your archives (only during work hours, when it’s totally acceptable to do such things!) and feel compelled to mention that I, too! am from Bucks County, and totally think that makes me cool like you! That is all.

Oh, SNIFF. What was that about pregnant ladies and inexplicable crying? I’m glad we could help you get the help you needed to get yourself, or something. Congratulations on all of it, and I hope everything continues to go swimmingly well for you all.

About the Author

Amy Corbett Storch


Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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