Where to start?

Heather writes:

‘ve been pudgy, if not downright fat, my entire life. At my thinnest, I was 125 and a size 10/12 – after months of starving myself because I couldn’t afford to eat. When I stopped growing in fifth grade, I went from 110 to about 135 for the rest of my adolescence. My first sign of trouble was my pediatrician, who poked me in the belly and said kindly that he thought it was probably just “baby fat”.

Since then it feels like nearly every interaction with a doctor involves a “conversation” about my weight. I’m five feet tall – actually, just under – and somewhere around 250 pounds right now. I have stopped allowing myself to be weighed in the doctor’s offices, no matter how much the nurse wheedles me. So I don’t know exactly what I weigh. About eight years (and sixty pounds or so) ago, I was referred to a reproductive endocrinologist. Since my periods began, they’ve been irregular and miserable experiences. I can’t plot myself on a 28-day chart like “normal” women can. Because of my weight, they assumed I had PCOS. I was told to lose weight, that being fat caused PCOS. I was put on Glucophage, which reacts very badly with me. If I eat it with food, it all slides right out the other end inside of a few hours. So I stopped taking it. I allowed the doctors to lead me to believe that I had PCOS and it was because I was fat.

It’s always the same song and dance with doctors – “You eat too much sugar. Too many starches.” But if a calorie is a calorie, and we have to expend more than we take in, why does it matter WHAT form the calories take? The more I ponder these issues the more I am led to believe that the majority of doctors simply parrot what they’ve heard from others.

I have had issues with my gastrological health for about 15 years. I am easily made ill by foods, either in the form of vomiting or diarrhea. I was referred to a specialist, a gastroenterologist, who looked at my labs and announced I had fatty liver disease. She said it was because I ate too much fat. She poked me in the belly and said, “Your liver is fat because your belly is fat. Our organs on the inside look like how we look on the outside.” She was, of course, tall and thin. Humiliated, I haven’t been back to see her.

The worst treatment so far has been from a gynecologist. He was an old-school type, not far from retirement, and somewhat stout himself. I asked him about the Essure alternative to tubal ligation, which puts metal coils in your tubes to create scar tissue to prevent eggs from moving down. He had never heard of it, and assumed I was asking for a uterine ablation, which he told me “didn’t always work” and that pregnancy was still possible. (Not like I’m fertile, but I don’t like to take chances.) I let him talk me into an old-fashioned tubal ligation. We scheduled the procedure in their in-office surgical center. When I woke up after the procedure, my throat was raw and I had phlegm in my throat – my asthma had kicked in, and I had to remove the oxygen mask to cough it up. As I was coming to, the doctor let me know the procedure had “failed”. As I was in the recovery room – filled with other patients – he outright told me that his instruments were not long enough to reach from my belly button (point of entry) to the tubes because I was too fat. “Lose 100 pounds and come back,” he advised. I was sobbing, and my husband was trying hard to comfort me, but all I could feel was failure. It failed because of me, because I was fat. Then the hot anger bubbled up – not only was this asshole telling me he was too incompetent to deal with some belly fat, but he was doing so in front of a room full of other people who by now were ALL staring and listening to my doctor tell me how fat I was and how everything had failed because of that.

I have a wonderful new gynecologist, who never makes me feel like a second-class patient because of my size. I chatted with her, and she expressed sympathy for my dealings with the “old-school” ob/gyn. She is a relatively recent graduate, and keeps current in her field. Even though I am childfree, she suggested that a Mirena IUD would be the best of both worlds – it would stop my periods and be solid, dependable birth control that I wouldn’t have to worry about pills for. She was even able to perform the insertion the same day, saying, “You’re doing very well, and when I say ‘you’re doing very well’ I mean ‘you have an amazingly high pain tolerance’.”

She’s been sympathetic about my fibromyalgia as well, which was only diagnosed in 2007. I suspect I’ve been “coming down” with it for quite some time. Joints, muscles, tendons ache for no reason. My muscles turn into knobby hot-spots of pain. Recently I was having a lot of what I suspected was uterine pain, and I went to see my wonderful gynecologist about it. She poked around, did an ultrasound, and showed me that my IUD was in the correct place, the strings were also in the correct place, and then she took a look at the muscles of the pelvic floor. When I nearly jumped off the table, she popped her head up and announced, “I know what the problem is!” (That’s the first time I’ve heard that phrase in, ever, I think.) She explained that I was having myofascial muscle cramps, and referred me to a local physical therapy location that has a specialization in pelvic pain.

I was in such a good mood after seeing her, that I went to go get blood drawn for my labs that had been ordered by my rheumatologist. For the past several years, I’ve been trying to take care of my liver. I’ve stopped drinking, and I cannot eat fatty foods anymore. Anything with grease runs right through me. I subsist on yogurt and granola bars, trying to keep probiotics in my intestines. I work a full-time job as a UNIX systems administrator, and am exhausted when I come home from work. I snack, and lie down by 8pm every single night. My blood sugar, my blood pressure, all my labs are usually normal. But then I got diagnosed with fibro, and have been on vicodin ever since. Vicodin includes paracetamol both to increase the efficacy but also to “safeguard” against taking too much; you’ll screw your liver. I was in so much pain when I had my blood drawn, I had taken four vicodin the day before. I also had not eaten in 18 hours. But my doctor sent me this note on the online service yesterday:
I saw on your recent labs blood sugar and one liver function test were minimally high.
As a reminder, try to should exercise 1/2-1 hour most days of the week, lose some weight, and limit sweets and starches such as bread, potatoes, rice, and pasta to keep the blood sugar down and avoid diabetes in the future. We should recheck these tests in 3-6 months.
Let me know if you have any questions.

I was utterly livid. I left a profanity-laced voicemail for him, blasting the “doctor boilerplate”, and reminding him of what he had told my diabetic husband a couple weeks ago – if you don’t eat, your liver will pump out sugar to keep you UPRIGHT. I even made it into bullet points:
1) I’d love to be able to exercise like a normal person. Please tell me where in the working a full-time job, being sick, and being so exhausted I go to bed at 8pm I can schedule an hour of exercise every day.
2) Lose some weight. How about you… grow some hair? Extend your penis size? Can’t do either of those permanently? Gee I wonder why.
3) EATING SUGAR DOES NOT CAUSE DIABETES FFS.
4) I CAN’T EAT ANYTHING ANYWAY. I eat yogurt and granola bars and anything with FAT in it causes me to be on the can for 18 hours afterwards.
5) In this particular incident I had hardly eaten the day before and hadn’t eaten at all that day, and after a while the liver does a desperate dump of sugar into the blood so as to help the body remain upright.
6) I take paracetamol EVERY DAMNED DAY and you think it’s my WEIGHT causing my liver enzymes to go up?
7) To sum up, FUCK YOU VERY MUCH.

I am not sure I can go back to this doctor. Originally he had been saying things like, “We’ll get you working on your weight when you can exercise,” so the bullshit he sent me was even more of a slap in the face. I wistfully asked my gynecologist if I could just see her as a general physician; she suggested my current doctor would be better than her. After this, I don’t think so.

I am sorry for the length of this. I’ve been dealing with this for so long, FatHealth is one of the only things that keeps me from believing that it’s “all in my head” or that if I bought into the FOBT everything would be okay. I’d still be a clinically depressed fibromyalgiac, I’d just be a thin one.

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8 Comments

  1. CL

     /  August 3, 2009

    A doctor should never poke your belly ever. It’s demeaning and rude and inappropriate touching — doctors should only touch us when it is medically necessary, not to emphasize their comments about weight. And it has happened to you twice! I’m sorry you have been treated with disrespect by these doctors. You deserve better.

    Reply
  2. I’m glad you found ONE doctor (your gyno.) who respects you. Too bad the rest of your “medical team” should be “traded” to the minors and replaced. 🙂

    Did the Glucophage cause the fatty food intolerance? Or has it been always there and has just gotten worse over time?

    Anyway, you told the doctor that you cannot eat fatty food–metformin or no metformin–or your body reacts as if it’s “mainlining” Orlistat (Alli)? If I were a doctor, the last thing I would be worrying about is “fatty liver disease”, especially since the labs don’t necessarily show that at all (he only said there is some signs of liver damage).

    Did he check into there being possible damage from all that paracetamol (acetaminophen in the U.S.) in the Vicodin, which is common when this pain killer is chronically used. After all, you took four of them just before the tests. That in itself would affect the results, likely in the wrong direction.

    Also, where was the recommendation to find another pain killer for the fibro since your liver appears to not like the Vicodin/paracetamol? (I assume you are where the use of SNRI’s/SSRI’s is not approved for that use.) I see no such thing.

    Neither do I see any concern about nutritional shortfalls due to the inability to digest fats properly (see B-12 deficiency). Did he test for that?

    And now that you can’t eat much of anything, no wonder you are wiped out: Starvation does nobody any good.

    Now, about that idiot gastro:

    “I was referred to a specialist, a gastroenterologist, who looked at my labs and announced I had fatty liver disease. She said it was because I ate too much fat. She poked me in the belly and said, “Your liver is fat because your belly is fat. Our organs on the inside look like how we look on the outside.”

    Does she think you are a five-year-old special ed. student? That explanation is some of the most insulting talking-down to anyone I have seen in some time. It also reveals just how well she did in human anatomy and physiology (not very well). After all, fat tends to deposit on its own first and only goes into the organs later on if the organs are working normally. If she ever dissected a fat cadaver? There would be a lot of padding around the organs but, unless the fat patient was diseased, not a lot IN them.

    Anyway, back to the topic: Someone’s being fat is not why fatty liver disease happens. The fat one eats has nothing I know of to do with that. Yes, non-alcoholic fatty liver disease IS associated with fat (it’s also associated with diabetes), but fat on the belly is NOT the cause (thin people get it too…like her).

    Nor does, as far as I know, does losing weight cure the condition. All it does is remove some of the liver’s “generous” fat stores in response to starvation a.k.a weight loss diet. If eating goes back to normal–or when the body adjusts–there is nothing I have seen that would say the previous weight loss results in permanent non-fatty-liver-disease states.

    Never you mind telling the wife of a diabetic that not eating is good…

    Is fat that blinding to these medical nincompoops??

    Reply
  3. Heather

     /  August 3, 2009

    I think that fat really is that blinding; my diabetic husband ranks as “obese” on the charts but looks like a normal guy – 5’10” and maybe 180. His extreme weight loss occurred at the onset of his diabetes! Doctors tell him to eat less sugar and exercise more, but it actually has an effect on his health and makes him feel better when his blood sugar is under control.

    I’ve tried talking to doctors about my restricted diet. That’s when I got to see “Ms Pokes-a-Lot”, the “doctor” who told me I had fatty liver. She wanted to do a liver biopsy to confirm but I was so ashamed I haven’t gone back to see her.

    My rheumatologist sent me an online message today, saying that she thinks my liver tests are because of the vicodin, and that if I had unmanaged pain, we should look at oxycontin and other pure painkillers *without* the “addiction safety net”.

    I have had so many negative experiences with doctors based on being fat. And then I get worse, because I don’t want to run the gauntlet of having to “prove” myself as a fat woman – good fattie vs bad fattie. Which makes me sicker, and gives them more to lecture me for when I see them.

    It’s like being afraid of the dentist, so the build-up makes the visit terrifying and painful and you never want to go back.

    I am so tired of having these doctors assume I do nothing but lay back and eat baby-flavored donuts and bon-bons. 😦

    Reply
  4. Amy

     /  August 3, 2009

    I’m sorry to hear about your ordeal. Every time I read a story like this, I shudder to think that these people have a medical license! Maybe its because I live in a country where being fat is still considered a status symbol…

    I just wanted to comment on something you wrote:

    “It’s always the same song and dance with doctors – “You eat too much sugar. Too many starches.” But if a calorie is a calorie, and we have to expend more than we take in, why does it matter WHAT form the calories take?”

    I’m not a doctor, and I don’t really understand clearly how it works, but if you *actually* have PCOS/Insulin Resistance, too much glucose or refined carbohydrates can cause you to put on more weight than a person without those conditions would.

    And by the way, being fat does not cause PCOS. Having PCOS can cause one to be fat. My best friend also has PCOS and she is thin, and a vegetarian. PCOS is highly genetic, and is not something you can “give” yourself by being fat.

    I’m glad you found a good gynae who you can trust. Good luck with the fibro – hope you can find a good treatment that works for you.

    Reply
  5. Meems

     /  August 4, 2009

    I’m so glad you have at least one doctor who treats you like an intelligent, adult, human being. Best of luck finding a good GP!

    As a side note, most recent studies have found that a history of hypoglycemia is actually not considered to be a risk factor for diabetes.

    Reply
  6. Meems

     /  August 4, 2009

    Oops, sorry – that last comment was meant for a different thread!

    Reply
  7. Ask your friendly gyn if she can give you a recommendation of a doctor SHE likes. She’s likely to know doctors who have similar outlooks to her.

    Reply
  8. southwer

     /  August 29, 2009

    being overweight does not cause PCOS. abnormal weight gain can be a side-effect of PCOS, which is a metabolic disorder. Doctors need to get their facts straight.

    Reply

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