Dentist wouldn’t take my blood pressure properly

Simms writes:
I recently had an experience at my dental clinic that reminded me why I end up avoiding medical professionals. I came in for a routine exam and teeth cleaning and it is policy for them to take their patients’ blood pressure since they are students and are still learning to do things properly. I’m always fine with this since even for my weight at 286lbs my blood pressure was always good and in fact I had it checked just two days before and it was great.

The problem came when I saw the cuff she was going to use. I could already tell it was going to be too small and immediately spoke up since a too small cuff will give a high blood pressure reading. She didn’t believe me until she tried to put it on and it barely closed. I asked where their larger cuff was since they had never had a problem before having one on hand. She said it had been broken for a while. That was a bit odd I felt and asked her if she could ask around and see because she was not going to get an accurate reading with a cuff that could barely close around my arm.

So she went off to her teacher and asked about it. After a fairly long time she came back with a slightly larger electronic cuff. Of course as she was putting it on my arm, it too barely closed properly and I could feel the stuff in side not linging up properly. I asked again about a larger cuff. She said that was it and we should just try it and see. Of course it read as dangerously high. It didn’t help that it tightened far too hard on my arm as well, to the point that the next day I had slight bruises from it.

I knew it was going badly though. I have had my BP taken alot from the various clinics I go to so I’m fairly familiar as to how a proper reading should look and feel. I brought up that nothing in my records showed I had no history of high BP and that it was obvious the cuffs were not fitting proper so the reading was obviously not going to be accurate. She went back to her teacher and came back with a wrist cuff. That one couldn’t even close all the way and yet she insisted on trying with it. After getting one last lower reading they decided to “risk” my teeth being cleaned.

I’m glad I stood up for myself about the cuffs but I am still offended that they kept trying despite seeing the equipment not fitting properly and refusing to get the proper sized cuff. Next time I make my appointment there, I’ve got to figure out how to politely make sure there is the proper sized cuff. Though what’s even more galling is they probably wrote down that bad reading with no notes about it into my records.

Chris Christie fires back at doctor who diagnosed him from 2,400 miles away

Brian writes:
I know First, Do No Harm, is primarily about private patients’ stories, but today’s Chris Christie spat is such a perfect example to bring up.

Dr. Connie Mariano, a former White House physician, went on CNN and made the following comments about Chris Christie:

“I like Chris Christie a lot, I want him to run, I just want him to lose weight.”

“I’m a physician more than a Democrat or a Republican, and I worry about this man dying in office. I worry that he may have a heart attack, he may have a stroke…it’s almost like a time bomb waiting to happen unless he addresses those issues before he runs for office.”

A doctor looking at nothing more than our weight and telling us we’re going to die? We all know that story. But what’s amazing is that Christie responded with probably the strongest statement against fat discrimination and doctor prejudice I’ve ever heard from a national politician, and it’s one we should all feel free to borrow when dealing with our own prejudiced doctors:

“You know, I find it fascinating that a doctor in Arizona who’s never met me, never examined me, never reviewed my medical history or records, knows nothing about my family history, could make a medical diagnosis from 2,400 miles away. She must be a genius. She should probably be the Surgeon General of the United States, I suspect, because she must be a genius. I think this is just another hack who wants 5 minutes on TV”

“And it’s completely irresponsible. Completely irresponsible. My children saw that last night. And she sat there on TV and said ‘I’m afraid he’s going to die in office.’ I have four children between 9 and 19. And my 12 year old son comes in last night and says, ‘Dad are you going to die?’ This is irresponsible stuff. And people who have a medical license, who have the privilege of having a medical license, should in my view conduct themselves more responsibly than that. If she wants to get on a plane to come here to New Jersey, and ask me if she wants to examine me and review my medical history, I’ll have a conversation with her about that. But until that time she should shut up.”

If anything it’s too nice to the doctor (the sarcasm covers up the fact that she was grossly wrong even on statistical analysis–a 50 year old “morbidly obese” man with no comorbidities (I assume), who doesn’t drink or smoke, and is reasonably fit is fairly unlikely to die before 62, the age Christie would be when he leaves office if he runs and wins in 2016). But still, it’s pretty damned impressive to see a politician fire back with righteous anger at a bigoted doctor rather than abase himself and apologize for his weight.

My take on this is that the good doctor isn’t taking into account the amount of stress that anyone who is POTUS has to face on a daily basis. And it’s that stress that has a more deleterious effect on one’s health than only being fat ever could. But how many of our doctors ever ask about the stress in our lives? How many of them look at us, see a fat person, and automatically assume that we’re lazy and eating nothing but junk food? How many of them ignore things that could help improve our health in favor of prescribing the Nightmare On ELMM Street? This doctor isn’t any better or any worse than any of the doctors we’ve had to face who looked at us and saw nothing but their prejudices about fat people, she just happened to pick on the wrong man – a governor who has the guts and the media attention to strike back at her and tell it like it is: “You aren’t my doctor, you don’t know me, you don’t know my family history, you don’t know what I do or don’t do, you don’t know anything about my health, so you need to shut up and quit diagnosing long-distance.” I may not agree with his politics, but I say “Hooray for you, Governor Christie, hooray for standing up to a fat-phobic, bigoted doctor.”

Sleep apnea? Just lose weight, it’ll go away……..no sleep study needed.

Circumlocuting writes:

A few years ago I realized that my husband had sleep apnea. I would sometimes hear him stop breathing in the middle of the night and then make a horrible choking/gasping sound when he started breathing again.

Around the same time, my snoring was getting louder and louder (according to my husband). He said he never heard me actually stop breathing, but the volume of noise I produced at night was louder than anything he’d ever heard me produce during the day, even when screaming at the kids. (Just kidding! :-))

We were both in our late 30s and both obese, with BMI’s of around 35. We knew that if we lost weight, our sleep apnea would probably improve, but after close to a year of failed attempts to lose weight, we realized we just needed to see our doctor and be checked for sleep apnea.

I had the first appointment with our GP. The doctor very helpfully told me, “Well, I COULD send you for a sleep study . . . they’d get you set up with a CPAP machine that you’d have to use for the rest of your life. OR, you could just lose weight.”

I told him I hadn’t had a lot of success with that and was concerned about being treated NOW.

He said that I were just determined enough to achieve a healthy weight, I could do it. He had another patient who had been obese, taking meds for high blood pressure, high cholesterol, etc., but one day he just determined he was going to achieve a healthy weight, and he did it. And I could too.

(So much for evidence-based medicine.)

So, I went home and tried some more to lose weight, with predictable results. My husband was so discouraged by what the doctor had told me that he didn’t even make and appointment.

Another year went by. And then something happened to make us take charge of our own health. A couple in our church lost their son-in-law. The man had sleep apnea and used a CPAP machine every night, but he was at a friend’s house one Saturday afternoon watching a basketball game on TV, and of course he didn’t have his CPAP machine with him. And he happened to doze off while watching the game. AND HE JUST DIED.

Luckily, our insurance allowed us to visit a specialist without having to go through our GP. We both made appointments with an ENT doctor, who sent us both for sleep studies. My husband turns out to have VERY severe sleep apnea. “Severe” is defined as “stops breathing more than 30 times per hour.” My husband stops breathing 90 (!!!) times per hour! I, on the other hand, do not have sleep apnea exactly — I have sleep “hypopnea,” which means that my obstructive snoring do not cause me to actually stop breathing, but it causes my blood oxygen levels to decrease to a dangerously low level. The treatment is the same — CPAP machines for both of us. The machines work incredibly well and are comfortable.

So, it’s not sexy, but we both sleep with our masks on and sleep much better and aren’t going to die in our sleep now.

We no longer go to that GP.

Migraines? Caused by being fat, lay off the chocolate, wine, and cheese.

A reader writes:

I feel like this is nearly insignificant compared to some of the horror stories up on the site. In fact, I nearly didn’t send it. In the end, I am, because I feel like it’s significant for several reasons – it has made me much less likely to seek medical attention, it’s made me much more body conscious, and it’s an indication of how little some practitioners trust their patients – to tell the truth about their diets or their bodies or their experiences.
I was diagnosed with migraines when I was twenty. I have classic symptoms, although only occasionally do I get an aura. Migraines differ dramatically between people, and mine vary dramatically between episodes – sometimes I can grit my teeth and bear through, and sometimes they are incapacitating, and very occasionally I can only rock back and forth and weep. I’ve always, always been uncomfortable around doctors, and this got much worse after several bad experiences in college, where the doctors at the health clinic refused to prescribe cough medicine for me, despite my nearly retching coughs, because they were afraid I’d sell it on the black market. Combined with a lack of health insurance, this made it much easier to avoid doctors.
When I got my current position, it took 6 months for health insurance to kick in, but I scheduled an appointment and went anyway. I chose a nurse practitioner, because I believed they were generally less blinded by their own egos. I wanted drugs for my migraines, and I wanted to discuss my difficulty with weight loss. I was 192 at 5’2″, my highest weight.
When I told the nurse practitioner I had migraines, she nodded, and told me that “of course” they were caused by my obesity, and triggered by certain foods and overeating. She used the word “preventable.”
In real life, my migraines are actually not triggered by foodstuffs – I’ve kept a journal, and food is not one of the things that triggers them. So I told her that, no, my triggers are mostly barometric pressure changes, fluorescent light overexposure, sun stroke-type conditions, where I exercise too hard in hot conditions, and exercising very strenuously. Some of these things are easy to avoid, but good luck with barometric changes and fluorescent lights.
She didn’t acknowledge this, and repeated advice to stop eating chocolate, red wine, and cheese. These *are* triggers for *some* migraineurs. Just not me. But I think she assumed that because I was giant size 16/18, I couldn’t knock off the dessert, booze, and cheesesteak long enough to see if that would stop the blinding pain behind my left eye. (Fish can also trigger migraines in some people, but notice this wasn’t on the list. Hmmm.)
I told her I’d worked myself down to 1500-1800 calories a day, and anything less than that and the hunger was overwhelming. I thought about food all the time, and I felt miserable about my weight. I was also exercising some, although less since I’d started my restrictive diet, because I was hungry and tired all the time.
It was clear she didn’t believe me, but she let it go for a while. Then she asked if I was eating greens. I told her I was trying, even though I’m not really a big fan. She told me I was going to get osteoporosis, “especially with your body”, and instructed me to start drinking 2-3 glasses of milk a day. Apart from the fact that I don’t really like milk that much, I was concerned about the increase in calories.
“Well,” this medical professional said, “just cut back on the desserts.”
After I agreed, and begged her for drugs, she gave me a prescription for the migraines, but urged me to “move more, eat less.”
I walked three miles home in 95 degree weather (developing a severe migraine), and didn’t eat for a day. I also did not go back for blood tests on cholesterol and pre-diabetes.
I’m exercising much more now – and eating more, including bad food and good food and green food (but no milk – I may never drink the stuff straight again). I have a doctor who doesn’t discuss my weight unless I bring it up, and, despite suggesting Weight Watchers, nods understandingly when I tell her I’m afraid it will only exacerbate my already disordered eating. Despite the fact that I should have been losing weight then, it’s only after eating more like what I want that I’ve begun (very very slowly) to lose weight. I’m 186 now, and every time I have a migraine, I wonder if it’s my fault, even though I know it’s not.

Abdominal pain? We can’t find it, you’re a hypochondriac or depressed.

Toni writes:

Let’s back up 20-odd years.

While I was in college, I went to several doctors about the pain I occasionally experienced. Every test done showed there was nothing wrong, and I was treated as a hypochondriac. One doctor told me I was allergic to feather pillows and gave me prednisone. Several doctors told me it was all in my head, and I needed to lose weight.

I finally went to another doctor, who assured me that we’d figure it out. He sent me to a gastroenterologist, who did all kinds of tests and ended up telling me there was nothing wrong other than me being fat. Given that at that moment I was at my lowest weight since 5th grade, I was astounded.

I was tired, I was worn out, I was getting used to being married and having a new job, I was stressed to the max.

I went back to see my GP, the one who assured me we’d figure it out. I trusted him totally, especially since he’d been Dan’s doctor since birth. That day, we discussed how I was feeling, and he gave me some pills that I took without asking what they were or what they did. I didn’t care, as long as they helped.

The next morning, as I took my first dose, Dan asked me if I knew what the pills were. He was reading the patient information from the box, which I hadn’t bothered to do. When I said no, he told me it was an SSRI.

Anti-depressants?! I swallowed hard.

And decided that since I didn’t know what else to do, I’d take the Zoloft and see what happened.

The next few months are very dim in my memory. I do know that I worked, slept, and ate. I also gained around 100 pounds during the 5 months I was in Zoloft. I was a zombie. I had technicolor nightmares. I was just kind of existing, not living.

I went off of Zoloft cold turkey, because I couldn’t deal with how it made me feel anymore. After the headaches became unbearable, I called my doctor and he told me the right way to wean myself from it.

I don’t deny I was depressed. It runs in my family. I was off anti-depressants for several years before things got bad enough that I asked my newer doctor for them. I’m still on them.

But remember, the original reason I was put on them was to deal with the pain that no one could diagnose, that was considered to be all in my head.

The same pains have come and gone over the years, and every test that was done showed no issue. No gall stones, no disease. Eventually the pain would ease up and I’d give up getting a diagnosis yet again. The fact that the pain would be triggered by a HIDA scan apparently never registered on the tech who gave me the tests, because none of them ever recorded that fact, and my doctor always blew that part off because the HIDA scans (for gallbladder) showed normal operation.

In October, I had severe pain again, bad enough to go to the ER. Of course, as usual, the tests they did showed nothing wrong. But this time, for the first time, I was referred to a surgeon. After I told him what I had gone through for YEARS, he offered to take my gallbladder out. Given that I was going to ask if he would anyway, I said please do.

When the surgeon removed it, he noticed that the valve from the gall bladder to the duodenum was small, and the pain I had been experiencing for years was more than likely due to that.

Everything I went through, everything that was considered to be all in my head, was the result of a congenital deformity. I’d been complaining about it since childhood and was treated like a hypochondriac because no test showed the problem.

When I was 8 years old I had an upper GI done looking for ulcers because I complained constantly that my stomach hurt. It wasn’t until college that I pushed for an answer, and still didn’t get the right one till I was 41.

I don’t know where to put the failure at on this one. Me, for not pushing harder? My doctors over the years?

One thing that I wonder about is whether or not being put on that first round of SSRIs didn’t screw me up more than anything else. I’m now on an SNRI and bupropion. It’s possible I would have ended up on them anyway, but figuring out I was started on them because something physical was assumed to be “all in my head” just makes me angry.

High blood pressure? It’s not a side effect of any drugs, it’s because you’re fat!

Melissa writes:

I was reading your website and have a story that I think is important to share with physicians (if they are reading) and overweight patients who may, like me, have the cause of an illness missed because the first assumption is to blame the fat.

In my 20s I developed depression and was prescribed a popular but relatively new drug treatment. The medication was at least partially successful in treating the symptoms of depression but I gained a great deal of weight (which everyone assumed to be associated with the depression) and developed high blood pressure (which everyone including my doctor assumed to be associated with the weight gain). I was encouraged to work on improving my diet and exercise, which I did, but I struggled to lose any weight. My doctor talked about putting me on another drug (beta blockers) to deal with the high blood pressure. I resisted this as a side effect of these drugs is to increase lethargy which makes it harder to exercise and was likely to see me gain even more weight.
My doctor was very reluctant for me to go off the antidepressant medication for fear that I would spiral back into my depression – and this did happen the first two times I did this. Last year, as I wished to try and get pregnant, I went off the antidepressant medication for a third time and have now been off it for more than a year. It’s been tough but I’ve coped. I lost a few kilos but am still very overweight. Recently I was hospitalised for an unrelated issue. During a week of constant monitoring it emerged that my blood pressure had reverted to a very healthy normal range. I was delighted but puzzled. Everyone claimed that this was probably due to the fact that I had lost some weight and was regularly exercising. I thought that this was unlikely to be the case as I am still about 10-15 kilograms heavier than when I was first diagnosed with high blood pressure.
I started researching the antidepressant drug I had been on for the best part of a decade and discovered that a known possible side-effect was hypertension (high blood pressure) along with weight gain. In other words, it was the prescribed drug that caused the high blood pressure, rather than the fat (and in fact a fair bit of the weight gain may have also been due to this drug). And this was never picked up because everyone, including the medical profession, assumed that the fat was the cause of the problem rather than a symptom of the problem (that I was experiencing dangerous side effects from a popular drug and should probably not be taking it).
I am trying not to be angry about the fact that for 10 years I experienced a condition that in the long-term can be life-threatening due to the doctors’ misguided assumptions about the cause of my high blood pressure. I would rather people, especially GPs, learn from my experience. My doctor is a good and experience practitioner who I know has my welfare at heart – but he made a mistake that could have had a major impact on my health and I’m sure there are many other doctors and patients in the same situation.
I urge anyone who has been diagnosed with a medical condition such as high blood pressure to seek a second opinion as to its cause and to specifically request a review of any prescribed or over-the-counter medication they are taking (there are pharmacists and other specialists who are particularly good at the latter). Even the best doctors can make mistakes or be unknowing victims of fat prejudice.

Battling medical bullies

MSNBC.com has a story out today on ‘medical bullies’ – medical professionals who browbeat patients, ignore questions, act impatient, insult patients and/or colleagues or even yell, cuss and throw things.   Now the Joint Commission, a national hospital accrediting agency, warned that there’s mounting evidence that such disruptive behaviors are tied to medical errors that can cause patient harm — and called on hospitals to adopt a no-tolerance policy.

Starting in January, the agency will require hospitals to establish codes of conduct that define inappropriate behaviors and create plans for dealing with them. Suggested actions include better systems to detect and deter unprofessional behavior; more civil responses to patients and families who witness bad acts; and overall training in “basic business etiquette,” including phone skills and people skills for all employees.

The AMA has had a policy calling for zero tolerance for disruptive behavior for all workers for years.  The Joint Commission standards and suggestions will offer hospitals a clear model for establishing guidelines and consequences that will help decrease disruptive behavior.  Official warn that it could take years however for a major culture shift.

The MSNBC story includes a sidebar on bullying behaviors.  How many reader submissions featured here echo the very same behaviors listed?

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