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.

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.

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.