Dr. Amy Tomlinson has spent over 20 years working with people who have experienced a variety of traumas. What has happened to us in the past can affect how our bodies and minds react to the present. Her mission is to deliver nurturing, empowering care for everyone entering her office. Every human being deserves this. Especially those that have experienced trauma.
There are many techniques that she uses to make the medical experience more comfortable. Talking before examinations is very important for establishing trust, making sure that you feel comfortable with your provider, and coming up with a coping plan. Everyone who sees Dr. Tomlinson is asked the optional question “have you experienced trauma”. You can disclose your history or not–it is completely up to you. If you check yes then she provides detailed counseling to come up with a comfort plan. You will not need to disclose the nature of your trauma. She will offer you the option of having your “taking” visit on one occasion to make sure that you feel ready to proceed–and then having your “exam” visit at a different time.
She only recommends examination or testing when it is absolutely needed. Evidence-based practice has shown that 1) pelvic exams for pap testing are only needed every 3-5 years 2) you do NOT need a routine pelvic exam on years when you don’t need a pap 3) breast exams can be indicated but often they are not 4) often, there are alternatives to examination in people who seek care for a medical problem. Many providers do not practice these evidence-based guidelines because they are more comfortable doing what they have always done.
Dr. Tomlinson pays attention to physical comfort. The gowns and drapes at Peak Wellness and Gynecology are cloth. The gel is warm. And stirrups? Forget the stirrups! She is able to complete a gentle, thorough speculum exam without them. Procedures too–with the exception of colposcopy.
Here are some tools that you can use. Some you can do in any stressful environment–even if you want to be subtle and not to disclose a history of trauma. These can include keeping your eyes open, tapping the side of the hand, pinching the hand between the thumb and forefinger, and wiggling the toes. Distraction is a helpful technique as it gives the brain other stimuli to focus on. It can take the focus at least partially away from the exam. Distraction methods can be tactile (tapping, pressure, movement), auditory (music, affirmations), visual (keeping the eyes open), and cognitive (gaming, scrolling, writing). Keeping your eyes open is one of the most powerful tools. It really helps you stay grounded in the “here and now” and not “somewhere else at some other time”. There are many tactile tools that can help. You can firmly pinch the muscle between the thumb and index finger with your other hand. EFT tapping can be very soothing. Using the Emotional Freedom Technique, people tap parts of their upper body to activate the calming pathways of the nervous system. The formal EFT tapping process involves tapping along with affirmative statements like “even though it feels overwhelming, I choose to relax and feel safe now”. During times of stress it can be hard to remember it all. That’s OK! Tap anywhere you remember, use an affirmation if you remember one, and it still helps. A great time to do EFT is when you are waiting for the doctor to return to the room after you’ve dressed for the exam. Here is a video showing the EFT technique: https://www.youtube.com/watch?v=02bN4JFx10Y
Movement is a valuable stress-reliever for some people, as long as it doesn’t result in muscle tension in the area being examined. You can wiggle your toes or your fingers or move your eyes from side to side. Auditory stimuli via music or affirmations can be helpful. Some people bring headphones but keep in mind that you may not be able to hear Dr. Tomlinson talking if you use headphones. She can play these through a bluetooth speaker if you prefer. Cognitive techniques like getting on your phone to play games or scrolling through silly videos can help. Some people want to write or draw or scribble.
Relaxed muscles are helpful during examination. When muscle tension is present, more pressure is needed to accomplish the visualization that is required. It generally makes for a longer exam which increases the amount of time that you are experiencing discomfort. For a speculum exam, it is good to relax the knees open as much as possible. While this can feel awkward, it really helps to release muscle tension. When the knees are tensing up and moving together, it creates muscle tension in the pelvic floor. Some people find it helpful to squeeze the pelvic floor before the exam begins. This can help to remind the brain how to control the muscles in that area, giving the brain better control of how to relax those muscles. Then try to let your buttocks “melt” into the surface below you.
It is very important that you feel that you are in control of your exam. Dr. Tomlinson will not rush you into the process–you can take all of the time that you need. She will work with you to come up with signals to pause or to stop the exam. Sometimes the “freeze” response is powerful in people and they have a hard time speaking up. She can establish non-verbal communication methods–like a raised hand–to indicate that you need something. Some people prefer to stop the exam completely when they use their communication cue. Other people will prefer to “pause” the exam, and Dr. Tomlinson will freeze in place and not proceed until you are ready. This can be helpful to limit the time that you are undergoing the exam. Some people say “just go fast” and prefer not to be “talked through” the exam. It’s whatever works for you.
A support person can be a very soothing presence. Whether it’s a friend, family member, or partner, you can bring them to your visit. Some patients will opt for their support person to be present for counseling but not the exam. Other patients want the support person physically by their side. They can sit in the area near your head to offer comfort. Some people prefer that their support person provide touch, affirmations, or eye contact in a certain way. It can be helpful to establish that plan in advance.
Some patients choose to use medications for their exam. The medications work the best when distraction and relaxation techniques are used as well. Oral (pill) methods are usually taken about 45 minutes prior to the appointment. Ibuprofen (motrin) or naproxen (aleve) help to reduce cramping that can happen with a pap or with a procedure. They also help to prevent “prostaglandin surges” which can cause nausea, weakness, diarrhea, and fainting in some people. Narcotics have pros and cons. The cons can be serious. Even one dose of narcotics can cause the potential for addiction in some people. They can just love the way that it makes them feel and they will continue to seek that medication. These people may not have become addicted if they had never taken the medication in the first place. For people in addiction recovery, taking narcotics can trigger the restart of addiction. Driving after taking the medication is unsafe and is a DUI. You would need a driver to and from your appointment if you choose to take narcotics. Decisions should not be made after taking narcotics. For that reason, Dr. Tomlinson will require two visits for people who want to have an exam utilizing oxycodone or diazepam. During the first visit she will discuss your medical care, coordinate the plan for your examination, and perform informed consent for any procedures. This first visit can be done via telemedicine (video) if you prefer. The narcotics that she may prescribe include a pain medication (oxycodone) and/or an anti-anxiety medication (valium). Some people will feel less in-control when they are medicated, which can be triggering. Similar to when people drink alcohol, narcotics can affect your emotions making you feel more sad or irritable. Everyone should know that narcotics have NOT been shown to improve the experience of pain during GYN office procedures. But that information has been assessed by evaluating groups of people who are studied together. This does not take into account individual experiences. Some people find the narcotics to be very helpful in improving their comfort during examinations or procedures. Please note that Dr. Tomlinson only prescribes one pill of the narcotic to be taken prior to arriving to the appointment. She does not prescribe narcotics for ongoing pain or anxiety. She can work with people with chronic pain or anxiety to find other helpful therapies.
Nitrous oxide (laughing gas) is available for procedures. This is begun in the clinic and wears off by the time that people drive home. For that reason, people can choose to have their nitrous-assisted examination at the same visit when the counseling is done. You may be most familiar with nitrous given at a dentist’s office. The nitrous that Dr. Tomlinson offers is the same. It is delivered via a soft mask that you hold to your face. You have to deliberately inhale the nitrous–which allows you to control how much you take and when you take it.
Finally, Dr. Tomlinson allows appointment scheduling for the amount of time that you want. If you feel like you need an hour to discuss your issues, then you can schedule an hour. You won’t feel rushed like you can during 15 minute visits to other doctors. Remember that this office experience is controlled by you. The pacing, coping, communication, and medication are all your choices. Dr. Tomlinson is here to counsel you through your options and then to provide you with gentle, respectful care.
Wherever you are on your healthcare journey, Dr. Tomlinson would be honored to care for you.
