Jaundiced? Weight loss will cure that, no need to look for a reason.

Reader A writes:
This touches on fat health a bit but also queer health and mental health. This was all in one thirty-minute whammy of a visit.

I made an appointment for a pap smear because I have been going through a lot of tests and pokes and prods trying to figure out why I have been jaundiced for years, and where my near-constant abdominal pain is stemming from. Also, this is the first time I have had health insurance as an adult (I’m twenty-four) so I wanted to cover all of my bases.
I had never been to a gynecologist before, and as a rape survivor, I feel that I should have at least googled what to expect. After having done said googling post-visit, however, I know that no amount of background knowledge would have prepared me for this encounter.
The receptionist didn’t know what “PCOS” stood for (my GP had suggested screening for poly-cystic ovarian syndrome due to my irregular periods and weight gain) so I waited in the lobby while she asked the doctor what that would fall under in terms of “reason for visit”. I decided to ignore the gospel radio station and hope for the best. After pulling me into a back room, weighing me, and asking me the usual questions about medications and illnesses, the doctor turned to me and asked “so what is this business about PCOS?” I explained that my GP had suggested getting checked out just in case. With a laugh she informed me that doctors try to use PCOS as a catch-all for overweight women. She asked me about my other symptoms, and after I explained about the abdominal pain and jaundice, proceeded to tell me that every one of my symptoms would go away if I would just lose a little weight.
At this point, I am no longer taking anything this woman says seriously.
When she asks me what type of birth control method I am using, I inform her that I am in a relationship with a woman and that we do not use birth control. “Oh, Lord,” she responds. “Let’s just get you looked at.”
Remember when I said that I have never been to a gynecologist before? Keep that in mind when asking yourself why the hell I stayed through what happened next.
Wearing my paper shirt and blanket, hunched over the edge of the table, I had an idea of what was coming next. I explained that I have never had a pap smear before and that I was nervous about the procedure. She laughed and told me there was nothing to be nervous about. She inserted the metal thingy into my vagina thingy and I immediately froze because of the pain. I stopped responding to her nonsense questions about what I do for a living and whether or not I exercise. Instead of checking to see what was wrong, she just stopped asking them.
When it came time for her to use her fingers to complete the exam, I was feeling numb and dissociated. That ended abruptly when she inserted FOUR fingers into me, causing me to emit a low-grade shriek. After this she giggled, said “I guess we just need one, huh?” and proceeded with the exam with one finger. I could already tell that I was bleeding- this was confirmed for me when I dressed myself and cried after she had left the room.
As the final segment of the exam, the doctor handed me an ipad with twenty or so questions on it regarding my emotional state. After I answered, she looked them over and said: “If you want to have any kind of quality of life, you should really get on a medication. It’s obvious that you are bipolar.”
This has made me so much more cautious about selecting physicians. I know that it’s going to take some work to set foot into any gynecologist’s office again, but I also know that not all of them are like this.

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Migraines, PCOS – “caused” by being fat

SW writes:
About six years ago I moved to a new area with my (now) husband and got a new job. It was my first time living so far from where I grew up, and the first time I had to be totally self-supporting, so I was pretty stressed at the time. I had been having panic attacks, although at the time, I didn’t know that’s what they were, and when I was having them, I thought I was having heart attacks.

I went to a new doctor, who ran tests to make sure my heart was operating the way it’s supposed to (it was), and surmised that I was having stress induced panic attacks. She suggested mindfulness exercises, and other ways to do relaxing self care, which has helped me manage stress in my life. I remember feeling satisfied with the level of care at the time. She suggested I make an appointment to do a full physical workup and a Pap and pelvic exam, since I hadn’t had one in two years. I made the appointment.

What happened at that appointment was vastly different from what I had previously experienced with this doctor. I am not sure why she didn’t fat shame me at the first appointment, but at the second one, she made a point of telling me over and over that I needed to follow the plate diet (eating food off of smaller plates, and portioning the plate with veggies, a small amount of meat, and an even smaller amount of grains), needed to exercise more, and that she was very concerned about how much I weighed (190lbs., 5’7″). I had actually tried talking to her about migraines, but she didn’t seem interested in hearing about them, and expressed that if I just lost weight, I would have less “headaches”. I had also asked her about birth control options, since my partner and I wanted to have sex without condoms. I explained to her that I had been on the pill in the past, and that the ones with estrogen made me feel very sick, and that I didn’t like taking them. She prescribed a pill to me that has estrogen in it.

On subsequent visits, this doctor would not listen to me about any health issues I was having. Even though my sex drive had diminished to nothingness, my migraines had gotten more frequent (from about 6 a year, to one every month, like clockwork, around the time I got my period) and more intense, I was feeling depressed and anxious, and had a high level of fatigue a good portion of the time (all side effects of the estrogen based borth control pill). None of that mattered, she just wanted to talk about ways I could lose weight. No matter that I told her I ate a well balanced diet, and exercised on a regular basis; she just thought I was lying.

Anyway, fast forward a year and a half. I had lost my health insurance because I quit my job to finish my Masters degree, so I had to stop seeing that doctor whether I wanted to or not, and I had run out of BC pills. I ended up going to Planned Parenthood to get a new prescription, because they have a sliding scale of fees for people who are low income (the appointment ended up being free). The doctor asked me about my migraines. The ones I have tend to be accompanied with an aura, which, as it turns out, means I should not have been taking birth control pills that had estrogen in them. Because they can significantly increase my chance of stroke. So the first doctor I saw was so blinded by my fat, she prescribed me medication that could have killed me, or caused devastating brain damage. Awesome.

I have a new job and different health insurance now, and a couple of months ago, my husband and I decided to start trying to get pregnant. I went to the doctor to make sure all my stuff is healthy. The new doctor asked me many questions and was suspiocious of my infrequent and irregular periods, and decided to run some tests. She suspected I may have polycystic ovary syndrome, and wanted to check things out to make sure. Welp, my test results came back, and yes, I do, indeed, have PCOS. Which is a big reason why I am fat, and why I carry most of that fat in my midsection. She has started to treat my PCOS, and has never once shamed me for being fat. In fact, she was sympathetic to me, and even contemptuous of the treatment I had received because I am fat (she rolled her eyes when I told her how the last doctor had treated me). She expressed that she knows it must have been difficult for me to not know what was causing all my strange symptoms that all suddenly made sense, but have people just assume it was because I was fat. I am 31 years old, and have never had a doctor treat me as kindly as the one I have now. She even gave me a hug when I cried over my diagnosis (because it can cause infertility and I was very upset by that)!

I am still angry at the incompetence and fat-shaming of the first doctor, but I am really grateful to finally have a doctor who seems to understand and actually care about me, the person, rather than my fat.

Fat-shaming happens, even if you aren’t “fat”

EB writes:

I have never been anything that anybody could reasonably call fat. At 5’5.5″ I stayed around 125 from the ages of fourteen through 26. At 27 I weighed myself (usually a bi-yearly event or so) and discovered my weight had crept up to 135. This didn’t bother me because I was getting fat (because I wasn’t) but I thought maybe I was consuming more calories than I needed. I hadn’t noticed because at this time I wore mostly drawstring-waist clothes and hadn’t seen a change in the way they fit. I kept a cursory eye on what I ate, keeping in mind that I was clearly getting as many calories as I needed and maybe a few more. With no further effort on my part my weight came down to 130.

Then I found out I was pregnant.

And then I got hungry. Constantly, crushingly, insistently hungry. This was not the normal First World hungry or even the “I’ve been hammering boards together all day and boy am I famished” kind of First World hungry. This was something different. And I had to feed it. So I adapted my diet as best I could, in the interests of staying a functional human being.

I went for my ten-week checkup and was scheduled with a nurse practitioner who I had not seen before that day. She walked in, stood by the door, didn’t bother to introduce herself, and asked me how I was feeling. I didn’t feel much like discussing how I was feeling, since I’d discussed it to death with everybody, including having discussed it five minutes prior with the woman who took my blood pressure, but I answered dutifully with a response along the lines of “I’m making it”. She queried me more closely and I told her that I was constantly hungry, eating all the time, and kind of fatigued.

She told me this was normal for pregnancy. Which I already knew, which was why I didn’t want to discuss it because what was she going to do to fix it? I told her I wasn’t really feeling nauseous but mostly it was just that I got sick of certain foods because of eating them when I had no desire to eat them. She didn’t seem to understand this concept and I said “You know how sometimes you’re like ‘Man, a sandwich would be really tasty?’ Well, it’s the opposite now. It’s more like ‘Man, I really don’t want a sandwich, but I’m starving and I have to eat SOMETHING.'”

She asked me how often I ate and I told her honestly that I would eat five times a day and snack in between.

She then proceeded to jump to conclusions about how MUCH I ate at each of these meals, telling me I’d gained 10 pounds since before I was pregnant and that during the first trimester I was only supposed to gain about a pound a month. [Let’s not discuss here how much of that might be breast tissue; I’d also gained a couple of cup sizes by that point.] Wait. WHAT? I challenged this and she said that my record said I had weighed 125 before I was pregnant.

Now let’s discuss the poor data-gathering I observed at this office. At the first prenatal appointment the provider asks how much you think you weighed prior to getting pregnant. You answer and that, apparently, gets added to your record. If you happened to be wrong about that, then how are you going to know? My guess would be I said my pre-pregnancy weight was 125, 130 or so, and she wrote down 125. They would then weigh you at each visit and the medical assistant taking the weight seemed not to care if you leave your shoes on or take them off or if you’re wearing your coat or who knows what all else. So you have to figure any reported weight could be off by 2-3 pounds. Add in the effects of, say, wet hair, a full bladder, having your wallet in your pocket, or having just eaten breakfast. That’s another 2-3 pounds that you could be off. Therefore, if you are the provider and looking at this number, you need to bear in mind that it is a ballpark figure.

But what the heck. Look at a garbagey number, compare it to an equally garbagey number, and criticize a starving pregnant woman and tell her to eat less.

Anyway, she said that I’d weighed 129 at my last appointment a month previously. So if I was supposed to gain a pound a month, I was 5 pounds over and apparently deserving of this lecture? I was distinctly irritated by this point and commented about full bladders, and she dropped the mention of specific numbers but then said something about how if I was eating five meals a day and snacking in between that was probably too much, as if she knew how big of meals I was eating. Then she started to say something about how maybe if I wanted a sandwich I could just eat a really small sandwich, which I cut off by saying “I know about portion control.”

Then she shifted gears to talking about exercise. I admitted that I didn’t exercise much because I felt lousy most of the time. She asked, in the same sort of perky voice that she had been using through the entire conversation, what I liked to do. I said walking and she said I should shoot for walking 30 minutes a day. I pointed out for the second time in two minutes that I feel lousy, fatigued, not up to it, and she pointed out that exercise produces endorphins that make you feel better (which I knew, but I so did not need this lecture on this particular day). I cut off this conversation too and said that this wasn’t even what I wanted to talk about and I had other questions, and she mercifully dropped the subject.

So, short version, I got criticized for supposedly gaining too much weight, for almost no reason whatsoever, after I’d just told her I was hungry constantly.

I ended up switching practices. I never reported this lady, though I wish I had. I ended up gaining almost 50 lbs before delivering my daughter, and the new providers I saw never said word number one about it—at each visit they told me my weight was fine. My daughter was an average weight, neither of us had any complications, and I was back to 125 by six months postpartum. Apparently whatever horrible thing was supposedly a risk because of those extra 5 lbs never materialized. I wonder if it is worth reporting this provider as this was 2 1/2 years ago. I shudder to think of the effect of this conversation on someone who actually had an eating disorder or even food issues (since aside from food aversions in pregnancy I have the least food issues of anyone I know.)