If you’re fat, it’s sleep apnea, not an illness of any kind. . . .

Katie H writes:

I consider myself to have been lucky in finding my current physician. Dr. Cat (not her real name) can be pretty blunt, and there is always that mention of weight, but it’s never been the focus of one of my visits. She knows I’m working to get my weight down, and rarely comments aside from “How’s the weight going?” I’m 25, 5′ 9″, and 235lbs, so we both know that my weight might put me at risk for other conditions. She knows that my other numbers – blood pressure, temperature, cholesterol, etc – are always either good or low, so it’s never been an issue. The few weight focused discussions usually involve something along the lines of “Keep doing yoga, watch for changes in mobility, and try not to gain.” Unfortunately, it’s sometimes hard to get an appointment with her because she is a good and thorough doctor.

In the spring of 2012, I had to go in to the urgent care centre on the first floor of Dr. Cat’s shared practice because I just couldn’t wait for an appointment. I’d been having some trouble breathing during the day, and I would go into yawning fits, usually when I started moving or after activity. I also was having trouble falling asleep because I felt like I was breathing too quickly; it had been going on for about two weeks. At the time, I worked in an elementary school, so I thought I’d just picked up some little bug from one of my students.

The problem began when I went back for the preliminary pre-exam tests. My temperature was in it’s normative range, which is kind of low (97.2), but not unhealthy. Then came blood pressure, which, I thought, was in a nice range: 118 over 68. The systolic was actually higher than normal – my normal is around 110 – but I figured it was okay because I was sick. The nurse, on the other hand, was not so accepting. No, she thought that she was getting an improper reading; my blood pressure couldn’t be that low. “Someone your size usually doesn’t have such a low bp,” she told me. She must have been getting an improper reading because of the fat on my arm, which meant she had to take it again on the same arm. And again on the opposite arm. And, when, by the third time, she was still getting the same number, she finally decided it was just a fluke. She concluded that it must be low due to whatever was making me sick, and ushered me in to wait for the consulting physician.

After donning a lovely paper dress, I was seen by a man who barely even glanced at my chart, despite having access to my entire medical history since tenth grade because the urgent care shared a database with Dr. Cat’s practice. He listened to me breathe for less than a full breath, the put his stethoscope around his neck and began the questions. Where did I work? Did I snore? Did I sleep on my back? Had ever been tested for sleep apnea?

I told him I was an elementary school aide, and that I spent a lot of time around very young children. I told him I’d caught one of my student’s colds about a month ago, but that it had cleared up pretty quickly. He interrupted me and repeated the questions about how I slept. “I sleep on my side,” I answered, “everyone in my family has a deviated septum; we all snore, but none of us have sleep apnea.”

Well, was I sure because, he said, “with your weight, it’s probably sleep apnea. That would make you tired during the day, too.”

I repeated that I wasn’t tired during the day, or at night; I was yawning uncontrollably, sometimes for nearly a minute, and couldn’t stop. I told him that I hadn’t been coughing or sneezing. I told him I felt like I wasn’t breathing in enough, and that it made it hard to sleep.

He told me to wait, and left the room. I waited for fifteen minutes. He came back in, and all but glared at me. “We’re going to give you a breathing treatment, just in case it’s something else. It’s probably apnea due to weight, though. The nurse will be in with the breathing treatment.” And he left, again.

The nurse came in a few minutes later with a large portable nebulizer and breather, and instructed me in using it. “You might cough a little, so here’s a cup.” She handed me a little paper cup in case I spit anything up, and left me to wait after the treatment was finished. Well, I did cough. I coughed until I had to abandon the tiny cup and run to the prep sink. I coughed loudly enough that both my mother in the waiting room and Dr. Cat, two floors up, heard me. I coughed until the attending physician and both nurses came in to the room, and then called in a second physician.

The second doctor looked in the sink, then back at me – still coughing – and asked if I could try to just take a steady breath so he could listen. I managed a few short, breaths for him before coughing, again, and he shook his head. “She has pneumonia. Put her on a z-pack.”

After a chest X-ray, the second doctor, who actually focused on my symptoms instead of my size, determined that I had walking pneumonia in both lungs, and that I’d probably gotten it as a complication of dealing with so many little kid germs at work. The yawning, he said, was my body’s attempt to get more oxygen. The second doctor told me that fluid had built up to the point where coughing too difficult on my own, and that was why the breathing treatment had triggered such violent, loud, and painful coughing. He put me on antibiotics, wrote a sick note, apologized for the how long everything had taken, and told me I could get dressed and go home. It fifteen minutes, the second doctor accomplished what the first hadn’t done in over an hour and a half. He even went so far as to chastise the first doctor for not noticing anything when he’d listened to me breathe.

I did meet with my usual physician, Dr. Cat, about a month later for a follow up, and she did have a recommendation for me: get a flu shot. I haven’t seen the size-focused doctor at all since last year, though the nurse still works there. I’m only glad that doctor tried to misdiagnose someone as stubborn as I was. I could have wound up in hospital or worse if I’d listened to his advice because both he and the bp nurse only saw me as a number on a scale.

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1 Comment

  1. mbnh31782

     /  June 25, 2013

    Well for one thing, hopefully it gave that doctor a wake up call to watch symptoms and not weight and other external factors. I rarely run a fever when i’m sick, so I face it all the time where i get brushed off.

    Reply

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