Should I give up returning to Spain (medical issues)?
September 10, 2018 8:29 AM   Subscribe

I just got some confusing medical results the doctor wants to explore further here in the UK - but I’m due to return to Spain, where I’ve been living a week today. Thoughts?

I’ve been living in Spain, on and off, for a few years now. I have been doing a job I love, the climate is much more to my likening and the city feels more like home. Slowly but surely I’m improving my grasp of the language, but still have a long way to go.

Although I have good friends here in the UK, I’ve also developed a great circle in Spain. I’ve been offered a writing opportunity in theatre there this coming year which I’ve felt hugely excited about. But...

The medical spanner in the works - due to on-going acne & other PCOS-like symptoms, I had a blood test done. The result was I have low levels of FSH & LH (something strange going on with the signals my brain are sending to ovaries) which the doctor wants to explore further. She says she has never seen this before, it’s usually always high levels (signifying menopause). So she wants me to have another blood test and a discussion with the gyno.

I asked her honest opinion about the urgency of getting to the bottom of this (as opposed to next summer when i return from Spain) and she said she wouldn’t describe it as urgent, because my periods are working normally, as is the rest of me, but that it should be explored.

Do you think I should say goodbye to living in Spain and get a job here at home/pursue this medical issue? I was surprised by the result and I’m a little upset about what it all means for my life right now. FYI, it’s not possible for me to take the job in Spain next year, so it would be now or not at all.
posted by Willow251 to Human Relations (13 answers total)
 
Can you access the Spanish medical system at a low cost? That will ascertain your likelihood of staying. Find out, then decide.
posted by parmanparman at 8:34 AM on September 10, 2018 [3 favorites]


Having read your other recent questions, I think that living in the place that makes you happy, with job that makes you happy, is very very important.
posted by sheldman at 8:36 AM on September 10, 2018 [6 favorites]


I just want to say that I feel like dealing with this medically in Spain is out for me at the moment, because I am only B1 level and the extra stressor is understanding what is going on when it’s vital to know would be too much.

I’m coming back to the UK next year to do an MA at uni.
posted by Willow251 at 8:38 AM on September 10, 2018


Absolutely not! Take the job! Don't stay in the UK for vague medical follow-up of what may be a non-issue. If the doctor thought something was extremely wrong you would know that. Doctors don't hold back if they see something really alarming. She told you it wasn't urgent. It would likely take months to sort out anyway (and in the end, they might not even have any sort of answer for you). You don't appear to be suffering from really bad symptoms either (not to underplay it, but an important point).
posted by yarly at 9:01 AM on September 10, 2018 [13 favorites]


Ring your doctor or visit & ask specifically the same question you asked us, not just "is it urgent". Give them a timeline. Can it wait until x? Should I keep an eye on it in Spain? Is this OK to check next summer when I return from Spain? What signs should I look for if it's getting worse or better? etc. Seriously they'll have more idea than us. Yes it's hard to ask them when you're scared the answer is going to be don't go to Spain, but at least you'll have all the facts to make your decision with.
posted by wwax at 9:11 AM on September 10, 2018 [5 favorites]


Do you know exactly what these proposed further explorations would involve? Unless they require long-term or repeated medical stays/visits, could you not do both? Budget flights booked in advance can be reasonably cheap, if 'further investigations' turned out to mean 'a couple more blood tests and come back if we find something terrible', you might be able to bottom it out and hold down the job.
posted by penguin pie at 9:38 AM on September 10, 2018 [2 favorites]


No way in a million years. PCOS and hormone issues typically don't get 'solved' anyway (well, lots of people come pretty darn to solving it through a Keto diet, but that's another story. Worth looking into though, but anyway...). I can't see how this doc is going to find some miracle solution to this vague issue. If you were 39 and trying unsuccessfully to have kids, then yeah maaaybe. But otherwise? No way, in my opinion. Go enjoy your cool new opportunity and worry about some wonky hormones later, if its even still an issue then.
posted by thegreatfleecircus at 9:50 AM on September 10, 2018 [2 favorites]


Important question: Are you on a combined oral contraceptive pill? The type that have oestrogen in as well as progesterone?

I ask because suppression of FSH & LH is a normal effect of any oestrogen-containing medication but many many GPs don't know this. If you're on a COCP those results are normal for someone on a COCP and you don't need any further investigation.

If you aren't on oestrogen then low FSH & LH can be caused by pregnancy (could you be pregnant and has this been checked?), excessive exercise and/or losing a lot of weight or being very thin or a problem with your pituitary gland. It's also normal for levels to be lower later in the cycle - they should be timed to be done on day 1 - 5 of your cycle.

Pituitary gland problems (usually benign tumours) are much rarer than all of the other potential causes I've mentioned but they can be serious because you produce a hormone called ACTH in your pituitary that in turn causes your adrenal glands to produce cortisol. Cortisol gets a bad rep but you absolutely need cortisol to maintain your blood pressure and blood sugar. The good news is that it's usually the part of pituitary gland function preserved the longest after the onset of problems so if you still have regular periods you're almost certainly not in immediate danger but because of this if you do have a pituitary gland problem its important to find and monitor. If they get large enough (very very rare) the tumours can also damage your optic nerve and affect peripheral vision.

If all the common causes I mentioned above are not relevant then pituitary problems do need to be investigated which would included blood tests, possibly an MRI of your pituitary and to see an endocrinologist. That might well take a few months with the NHS and could likely be done in Spain of you're able to access healthcare there.

Don't feel you have to answer my questions publicly if you would rather not, but

TLDR: It's most likely something common and not a big deal but it could be something that's
posted by *becca* at 11:15 AM on September 10, 2018 [1 favorite]


Sorry I both missed the end of my post and your follow up about it not being possible to get follow up or treatment in Spain.

Last bit of my post should have been: "important to find and treat but not necessarily urgent."

If you carry on having regular periods that likely means that your pituitary is functioning so safe to wait until you're back in the UK but I'd advise getting your GP to discuss your results with an endocrinologist and doing any further blood tests they recommend now and also getting advise on the kinds of symptoms that should trigger you to seek medical attention if needed.
posted by *becca* at 11:26 AM on September 10, 2018


You could easily wait a year for a non-urgent referral to a gyno. Go to Spain, live your life, deal with it in a year.
posted by DarlingBri at 1:29 PM on September 10, 2018


I would expect you to be able to find doctors in Spain that speak excellent English. If you want to pursue this in Spain use expat forums to get recommendations for doctors who speak English. Get your doctor to give you the concerning test results. Follow up on the issue at your leisure.
posted by koahiatamadl at 2:54 PM on September 10, 2018 [2 favorites]


If it were urgent, the doc would've said so. Thanks to low-cost airlines, you can always go back to the UK for a couple of days to get a blood test and then again to meet the gyno. If your health deteriorates, you can deal with it when/if it happens.

I would absolutely not put my life on hold (and even miss important opportunities) due to some nebulous blood-test concerns.
posted by gakiko at 4:43 AM on September 12, 2018


Having had a few days to reflect, I'm going to go to Spain and continue with the investigation next year.

The fact the doctor was pointing at my brain saying 'we need to find out what's going on in here' did concern me slightly but as some of you have noted, it could take months to resolve. I'm a little worried about what this is going to mean in terms of fertility but I guess I'll need to wait and see - it is what it is. Thank you.
posted by Willow251 at 3:55 PM on September 12, 2018


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