My Trans Health 9 Years Into Transitioning

It starts with my lower jaw, neck, shoulders, back, and chest feeling tight like someone squeezing me, a numb tingling sensation rushes from the base of my spine down to my left arms. I'm gasping for air out of my will and trying to draw breathe feeling like I'm not getting enough oxygen while my chest feels heavy. My vision is blurred, experiencing vertigo because of dizziness, and very fatigued. I'm disoriented or I'm not altogether there in the present moment while feeling confused and anxious as to why my chest feels tight while my heart palpates harder than usual and there's a throbbing sensation on my lower left side of my rib cage and my back. It feels like my heart is about to burst out of my chest.

What is this feeling?
I'll tell you one thing, it can't be indigestion or IBS, I didn't eat anything and all I had was a cup of coffee that morning.

It was March 19th on a Sunday morning at about 7:30am-8:00am, when I experienced these symptoms again and it was in a moment where I was about to collapse, that I went up to my supervisor on shift and requested for an ambulance to get me to a nearby hospital to evaluate my symptoms. I have had these symptoms before, the first time was a few weeks back, where I had to request a sick day so my boyfriend can take me to the ER at Zuckerberg SF General Hospital. The first visit was inconclusive, they ran bloodwork, EKG, and didn't do much for me but one male doctor insisted that I undergo surgery due to a blockage. All the nurses and the doctors were very vague, non specific, as to the diagnosis. The speculation at the time that we did as far as any piece of information was that my symptoms were probable cause of chest wall inflammation (musculoskeletal), strained chest muscle (left pectoral), or panic attack where the male doctor advised that I seek a primary health care provider to further get evaluated for my symptoms. The doctor and nurses that day, decided to turn me away and overlook my systems. They only suggested that I stop smoking and drinking alcohol. My partner convinced me to refuse the suggestion of surgery because they weren't giving me any or enough information as to WHY surgery of any kind was suggested that day. That was the first occurrence. However, I had to admit that due to being in and out of consciousness or not altogether alert while experiencing chest pains, I didn't understand the full scope of what was going on then and didn't take any advise or suggestion from the doctor's seriously because the diagnosis were very vague.

This time around was very different. It was a bit more serious than the last.

While I was in the ambulance, my EKG blood pressure was really low which was unusual. According to my boyfriend, low blood pressure is when your blood pressure level falls under 90/60mmHg reading, mine was 90/50mmHg, and it can cause dizziness, fatigue, confusion, disorientation, faint spells, and black outs due to lack of blood cells flowing through the heart to release oxygen to the brain. I also got to see it on the monitor while I was placed in the Emergency Department, Room 10, when I passed out a few times and the monitor started to beep slowly like I was dying or about to go dead. I looked at it and it was 97/56. I could be reading it all wrong but the digit that read 56 was the one on the left side, the green one, and the one on the right was 97, the red one. I honestly don't know what this means for me at Zuckerberg SF General Hospital or how they read their heart beat monitors. However, my partner was saying that he did saw my heart rate go up and down a few times, so when he saw that, he immediately requested the doctor to run a CT/MRI on my heart and lungs. To him, it was considered abnormal especially when I would pass out when my heart rate fluctuated and would dropped from 70 down to 50 and the monitor would start beeping softly and flashing red lights. He was watching the heart beat monitor the whole time while he was with me and I heard him say out loud to me that I had signs of arrhythmia. I'm obviously not a doctor and don't know any terminology so I had no clue what he was talking about. 

So what happened to me that Sunday morning?

Well, it felt like a typical Sunday morning that day despite experiencing neck, back, and chest pains in the past two weeks since the first hospital visitations at the same facility. I had enough sleep but that morning when I woke up, my chest felt unusually heavy but I proceeded to head to work anyway assuming that whatever this ailment was that it would pass like always and that I would be fine if I just keep pushing through it. I was wrong! My body was telling me something and it was a warning sign. I noticed my energy started to fade after the second hour of my shift and suddenly my chest was feeling tighter and tighter that I find myself massaging it, my movements were slower and slower, and time was shifting left and right, and I was sucking air into my lungs while also letting out deep breaths. I wasn't understanding what was going on with me or what was wrong with me but I knew that I didn't feel right. When I was admitted to the Emergency Department, there was a male nurse after asking several questions in regards to my medical history, he was unkind and said, "If you're having a panic attack due to your stress or anxiety then you shouldn't be here, you should be making an appointment with your primary health care provider..." And he said this to me because I explained to him the first time I was admitted here for the same symptoms in regards of the results of the previous male doctor who had sent me off with no care or a lick of concern. He asked me where my pains were. I told him that I had a migraine in which he gave a smart ass comment in return, snidely saying to me, "You know migraines are tension headaches right?" As if whatever pains or symptoms I was telling him was all irrelevant. They only took an EKG screening of my chest, which they told me that it was normal.

For the next three hours, they kept me unattended in the room and I was alone. 

Adam J. Adler, my boyfriend, of 10 years, he's been with me since before and after my gender transition, who is also an M.D. in Pediatrics and has a Ph.D. degree as a doctor in psychology via Dr. Adam J. Adler, M.D., arrived to my room at about 11:00am, where he found me neglected by the staff. Adam asked me what had they done for me so far. I told him everything. He wasn't too happy about it. A lady nurse then came in to get my paperwork in order, asked about my health insurance coverage, etc. Adam asked her where the doctor was and when will they run more screenings and tests on me to find out what my diagnosis were. She was a bit sassy with him and well, knowing my Swedish boyfriend, who behaves like a mad Englishman sometimes when he gets upset, he gave her sass right back. Eventually, after he had waited for a doctor to check up on me further, what seemed like 30 minutes to an hour, he noticed my heart beat monitor was reading abnormally while I had passed out and eventually had to sleep off some of the pain. I told Adam that there was a male nurse before who said he would get me some Tylenol for my migraine, but I never got any, and of course all the mean things he had said to me when I was alone. That infuriated Adam even more. At that point, I was feeling very weak and had to sleep off the pain that was floating in and out below my rib cage. I heard Adam talking a lot with a female doctor, who sounded like a total valley girl, you know like girls who say, "totally", and used words, "like-and-like" in almost every sentence. I also noticed by the sound that she was also flirting with my boyfriend but that's expected from both other men and women, gay or straight.

Adam is handsome and he is charming but if you cross him, he could almost be Gordan Ramsay's twin but he's not angry and shouting to an extreme like Ramsay, because Adam gets verbally combative with poise and grace.

The female nurse, whom I don't even remember her name, she's Hindu descent, via her name was really long and it was a Hindi last name. She woke me up to let me know that she will have my blood drawn and scheduled a CT/MRI and will give me Tylenol after my blood was drawn. They took 6 vials of blood from me. Sad face. While I was still awake and somewhat conscious, Adam was telling me what the female nurse had told him and that this time around, he would make sure that they get a proper diagnosis and not some whack ass guesses as to what's going on with me then send me off. The CT/MRI scan occurred at around 12 noon and the results didn't come out till about 2:00pm. This time the results were conclusive. I was asleep, actually I knocked out after they ran the CT/MRI scan and was asleep throughout after. I didn't hear anything discussed between my boyfriend and the flirty female doctor. I did hear a few conversations that went off tangent because he disclosed he had worked at UCSF as a pediatrician and would deliver babies prior to becoming a law enforcement officer. It was a short 5-10 min conversation about that since Adam wasn't there to befriend a female doctor who was clearly trying to hook up with him. Adam woke me up and I find him and the female doctor by the gurney. She begun to explain to me what was going on and what the diagnosis were as well as treatment. I wasn't freaking out. Adam was freaking out for me. 

Due to a poor diet, smoking and drinking habit, being on hormones, long-term emotional stress, anxiety, and lack of proper trans healthcare to monitor my blood levels, unbeknownst to me, the symptoms that I have had were a combination of angina, musculoskeletal, a swollen diaphragm due to prolonged and major stress/anxiety that contributed to angina.

I'm going to break this down as to what this means for me and the overall bigger picture of my current health condition. First off, I'm 38 years old, and I never thought that I would have any major health problems so therefore I had an all American diet where I eat anything and I ate big because testosterone makes me hungry. My cholesterol levels are a bit high, I've been eating too much fried foods saturated in fat, junk food, and I eat a lot of fish and meat, but not enough fruits or vegetables. I don't have diabetes but due to genetics, I can be diabetic. I drink soda a lot, specifically root beer and red wine, not enough water, so I do get dehydrated. I would also drink a glass a red wine almost everyday until about 2-3 weeks ago, my boyfriend took me off it because of my current health symptoms. I also smoke, just cigarettes but it's four sticks a day so not too avid or a heavy smoker. I am on a .5cc testosterone injection every week, I schedule my injections on Tuesday. I am aware that being on synthetic hormones may cause health problems such as cardiovascular risks were the blood can thicken and can clot if my dosage is not monitored to my current health conditions. I never had a healthy, happy, or productive childhood growing up and up to my adult hood, I have always had to deal and cope with mental and emotional form of abuse from my biological family members and their in-laws. This contributes to emotional stress and sometimes, anxiety.

What is angina?
Angina is a build-up in one or more arteries called plague. Not sure what the substance is made up of but it's fatty buildup either from diet with high cholesterol or other factors like genetics. The plague either blocks or restricts blood vessels traveling through the arteries to the heart that allows blood flow and oxygen. What I have is stable angina which means it can be treated with medicine and a few lifestyle health and dietary changes. I am being told by the female doctor and my caring loving boyfriend who is worried the fuck out of me at this point that, if I do not make changes to my health or diet or follow treatment, my angina can turn into a heart attack or stroke, risk cardiovascular failure, and if my heart fails, it will require a bypass surgery where they will cut me up, open the affected artery, place a wire mesh in the affected artery in order to assist in keeping the artery open so blood can pass through. It's considered a life threatening and major surgery and it would put me out for more than a month because the heart is the main body's organ that allows humans to function second major organ to that of the brain. 

What triggers my angina?
Major sudden shift in weathers especially cold weathers. It has been cold and the cold gives me pain because my muscles contract to keep warm and regulate temperature due to previous traumatic injuries inflicted on my body from a car and a motorcycle accident with a metal rod  in my right hip to a left rotator cuff injury to a slip upper and lower disc. I also experience residual phantom pains from my top surgery. Another trigger is physical over-exertion and emotional stress and anxiety (panic attacks). I'm taking too much on with pastry class, violin class, fencing class, and being physical at work. Every end of my day, my physical commute also requires me to walk uphill from the Daly City Bart Station. I would be completely almost out of breath by the time I step inside my home. Smoking cigarettes is a number one contributing factor. Unbeknownst to me, all of these attributes triggers angina.

At this point, I knew this was something I couldn't take lightly. I took it seriously this time, now knowing that the results and diagnosis is officially conclusive and confirmed. Upon my release, the female doctor gave me Tylenol and suggested that I take an OTC aspirin specifically Bayer to combat angina. She then put in a prescription for Beta-Blockers to counteract the hormone level that causes anxiety that can aggravate my angina. She suggested that I seek a primary healthcare provider and scheduled a follow-up appointment for further screening the next day. 

Adam was doing way too much when he demanded for a wheelchair so he could wheel me out of there. I had to chuckle. Amusing enough. They did acquiesce his request (probably because his looks and English accent was too handsome to resist lol) and let me in a wheelchair where he wheeled me all the way to the member services department to make sure that I had access to a primary health care provider or doctor there, name of doctor, time, appointment date, etc. and so forth. He's all about legit details. After that, my boyfriend took me home and picked up the OTC and Beta-Blockers at the pharmacy. Realizing we both hadn't eaten, he got me a vegan food at Whole Foods, and I ate it because I was hungry and couldn't run on an empty stomach with aspirin and Tylenol in my system. 

The next day, we had to wake up early at 7:00am to be at the follow-up appointment at the cardiology screening department at 8:00am but knowing public hospitals like Zuckerberg SF General Hospital, they make you wait for max 2-3 hours before you're called in but it went rather faster than I expected. They took me in about 35 minutes after checking in. First, they ran a stress test where they put stickers all over my chest and made me walk on a tread mill. Second, they ran an ultrasound on my chest. Third, they took more blood, 4 vials this time, urine test, throat, and nasal swab. At that point, I was like, wow, this is the first time General Hospital ran thorough tests on me but that's all thanks to my boyfriend, Adam, who simply loves to advocate for me. After they ran all the tests, it was a brief discussion of some of the results and once again, confirmed, that I do have angina. They gave me paperwork on, "What is angina?" The causes, the treatment, and other information related to it. Basically information that my boyfriend already doesn't know. Adam likes to call it your "medical headline", the "this just in, you have fucking angina" and typical medical news anchor of what you're diagnosed with because these nurses and doctors don't want to have an open conversation to explain it you as a patient. Adam and I made a joke about what we are to do with the paperwork of the diagnosis that doctors give you once they confirm what's wrong with you and Adam chuckled when he was reading it saying to me, "Looks like they Googled it, copied, pasted, and then printed a hardcopy for you to collect...Lucky you babe!", and then just gave me a hearty smile which made me laugh because it was true. Since I didn't have a legit primary healthcare provider, they kept suggesting that I seek one and follow further treatment with my assigned primary health care provider. At this point, on the way home, my boyfriend, Adam, went through my health insurance papers from the mail, and only found one letter from Aetna, where a primary health care provider was indeed assigned for me but it was at another facility located on Valencia.

On Tuesday, I skipped my weekly testosterone shot to give my body a bit of break due to all the medical and physical stresses that my body was going through. Adam already contacted the number to the facility of my assigned primary health care doctor on Valencia, managed to book an appointment for the afternoon. At the facility, I only disclosed my transgender status, briefly told him of my experience on Sunday with my angina symptoms, however, the doctor seemed to ignore that and was more focused on mental therapy and prescribing Xanax and Nicotine patches to assist with my smoking cessation. Adam was expressing how he felt it was going to be a challenge for me all over again with the battle for my transgender health care and just health care in general because truthfully, none of these doctors or facilities were adequate and only write things on paper then write me off to send me away. Adam felt that none of these nurses or doctors truly cared and that I was constantly going to get treated as a patient that they can milk health insurance from. This is why I said to him weeks ago and didn't care to make any changes to my health and diet because I felt that my life was already short from the moment I was born. I was meant to die early. This life of mine, it's a tragedy, sure, but I told my boyfriend that regardless, I would be ready to die if that time came and if that time came, today, tomorrow, next day, next month, or next year, etc. That I only wanted him to promise me one thing, that I would be buried or cremated as a man! 

My boyfriend, Adam, still feels overly emotional about this and me saying this to him but the truth is, although I may be in pain, I may be visibly or invisibly ill, I already knew all the risks upon transitioning and genetics of my family's medical health and history, that I would die young but to me, as long as I lived a good life, as long as I lived a life that was well-lived regardless of the tragedies or traumas in my life, I have lived knowing that I was true and had loved being me. That's all that matters! It's the lives that I've left an imprint on and the lives that I've touched, the memories that I have had, the foundation and relationships that I have built, those are the everlasting moments where I know I have been survived, in the memories of other people, and if death comes at me and grips me in to its vices, its the memories of me and the imprint I leave behind that makes me invincible and alive. Remember, in my previous post expression, nothing can kill me, nothing can really kill me, my spirit will always linger on. It's life. Death is life too. I know this and therefore is unafraid. My boyfriend may not understand my sentiment around death but whatever time that there is now, we're going to spend it each moment together while I'm still around.