New treatment plan: ‘Scared’ weightless

Christine writes…

When I was 16, I caught a cold that developed into a nasty respiratory infection.  Our family GP was out of town, and his office referred me to another doctor who was covering his patients.  My mother took me.  The first thing the nurse did was weigh me and take my vitals.

As soon as the doctor came into the exam room he started berating me for being fat and having high blood pressure – nothing about the respiratory infection that had brought me to his office. I tried to tell him that I had never had high blood pressure before, but he wouldn’t listen.  He went on and on about my weight, my “high blood pressure” and how I was a heart attack or stroke waiting to happen.  “It can and does happen, even to people your age when they’re as big as you are.”  (I was about 190 at the time.)

My mother also told him my blood pressure had always been normal and perhaps – just perhaps – it was high at the moment because I was sick and feeling nervous about seeing a new doctor. (She has “white coat hypertension” herself, so it was a valid concern.)  He was just as rude and dismissive of her.  He told her she wasn’t helping me by “protecting me from the truth”, and that he was doing us a favor if it “scared some weight off” me because it would save my life. He was absolutely vile to both of us.

He then grudgingly wrote a prescription for antibiotics and cough syrup, and sent us off with a standard 1,000 calorie diet from a tear-off pad.  He even told us to make a follow-up appointment with his nurse and he’d get my “health under control.”  As if.

I left the office in tears.  My mother, normally a mild-mannered, non-confrontational sort of woman, was furious.  When we followed up a week later with our regular GP, he confirmed that my blood pressure was back to where it had always been – perfectly normal.  He said my temporary high blood pressure could have been caused by any number of things, including the OTC cold medicines I’d been taking to treat my symptoms.

So why did Dr. Scaremonger apparently never consider this possibility? Raised blood pressure is a well-known side effect of the most popular decongestant, which is why those with actual hypertension can’t take it.  You’d think this would occur to a doctor, right?  Apparently not when treating fat patients.  To him, I was in denial, a liar, and on death’s doorstep at 16, all because of the fat.

Memo to medical doctors

Many of you may be familiar with Sally Squires’ Lean Plate Club at the Washington Post. Squire describes the community as a “virtual” club – not a diet – with the primary focus of promoting healthy eating and increased fitness. The expectation, of course, is still that weight loss will naturally follow.

In a column reprinted today in The Oregonian, Squires recounts meeting a physician at a conference who expressed great anger at a patient who had lost 18 pounds only to regain the weight. His story inspired Squires to ask readers via her e-mail newsletter for their opinions on how doctors ought to approach weight loss with their patients. Some of the submissions are worth reprinting here:

Lean Plate Club member from South Portland, Maine, commenting in the chat about the doctor who lost his temper, said this was “exactly why so many overweight people avoid going to their physicians. Doesn’t this doctor realize that most people regain the weight they lose? They need support, not recriminations. The doctor’s temper tantrum didn’t do anything except make him feel better. He wasn’t helping his patient at all. Shame on him.”

“I dread seeing my primary-care physician because I have heart disease and I am 60 pounds overweight,” wrote a Fairfax, Va., member. “Every visit is about how I must lose weight or else I will have a heart attack or stroke. I lost 25 pounds in one year only to quickly gain almost all of it back. I am now trying to quickly lose it again before I must visit my doctor and have him find out that I have regained instead of losing more weight.”

“Very few people respond well to being yelled at or scolded,” a Lean Plate Club member from Pasadena, Calif., noted. “They also do not respond well to being demeaned or put down. Providers also need to remember that the patients’ behavior is not a reflection on them and that it isn’t personal. Lastly, providers need to, at all times, stay professional with their patients.”

And my personal favorite:

“My aunt’s doctor told her to lose 25 pounds, and she informed him that he needed to lose at least 50. Neither has lost weight, and now he doesn’t mention her weight, which is not a favorable medical practice for an internist dealing with older patients. So, docs, get skinny and talk about the weight.”

How do you feel doctors should approach issues of weight with patients? Should weight even be an issue? What are your thoughts?

Binging? Purging? Vomiting blood? Try dieting…

Katydid writes…

Two years ago, I landed myself in the ER at around 2 AM. I’d been puking my guts up multiple times per day, every day, for months—binges, meals, mere snacks all found themselves subject to the perverse First Law of Bulimia: what goes down must come up. The night of my ER trip, as I paid homage to the porcelain goddess yet again, I found that along with my stomach contents, the toilet was filled with blood.

The doc in the ER was compassionate and thorough, if somewhat clueless about eating disorders. Aside from being somewhat anemic and dehydrated, all my tests were clear, and as I coincidentally already had an appointment with a new internist in the morning the doc apprised my internist’s office of my situation and released me.

Three hours later (approximately one of which was spent sleeping) I made my way into my new doc’s office. I explained that recently I had lost about a bunch of weight starving and puking nonstop and that now I was restricting much less but still bingeing and throwing up constantly; I told her that I’d had an active eating disorder for about four-five years and I filled in the details of the previous night’s ER episode. She asked about my highest and lowest weights—despite several times losing dramatic amounts of weight quickly and unhealthily, I’ve never been “thin,” and when I told her my highest weight, she said it was “great” that I’d lost the weight, even though I told her I’d only lost it restricting and purging.

Then she put me on the scale. I told her I didn’t want to know my weight, and that she at least respected, but then I got off and she said to me, “well, you’re overweight, but I’m sure you knew that. What are you, like five-two?” (I’m five-four, but telling her that didn’t seem to give her pause at all though it would most definitely change the point at which “overweight” came into play. I’d also now been sitting in her office waiting for about three hours, mainlining water—as per the ER doc’s stern instructions—to the point where I thought my bladder would explode and she decides to weigh me fully clothed including my SHOES and then acts like the number she has is real.)

She goes on to tell me that what she wants to do is put me on a modified Weight Watchers plan and have me come back in a month and weigh me again. (I am 5’4” and 145 pounds—which is 30 pounds less than I weighed six months ago, though I lost the bulk of it in six weeks—and I am so sick with an eating disorder I am barfing up blood and she’s talking about a DIET?!)

I tell her that I’m really not interested as I’m already working with a nutritionist. She then asks me, in a hostile tone, what exactly I want from her; I’m at a loss for words since I figure it’s pretty self-evident that, um, she’s a doctor and I want her to…monitor my health?

She takes my stupefaction as a sign that perhaps I’m looking for an amateur psychologist, as she then asks why I have an eating disorder—“were you raped or abused or something, or is this just kind of a going-off-to-college/growing up thing?”

She did not do a physical exam other than weight and blood pressure; she did not discuss the ER incident. She did not bring up the possibility that, given that I was puking blood, more tests might be necessary, nor did she discuss that though I seemed fine I was fairly anemic and had just barely avoided spending the previous night hooked to IVs. I’m not sure what level of insensitivity or stupidity you have to reach to actually think that the most important thing you can tell a 21 year old with an eating disorder is that she should lose weight. Clearly those few extra pounds I was carrying were FAR more threatening to my health than whatever other damage I was inflicting on my body.

The medical community needs a serious wake-up call: not only can there be health at a range of sizes, there can also be illness at a range of sizes. WEIGHT IS JUST A NUMBER!!!

You’re fat – See a dietician

Kake writes…

I needed to visit my [general practitioner] to get some more birth control pills, but unfortunately she was on holiday so I agreed to see a locum [Editor’s note: a locum is a doctor who fills in for another doctor, a substitute doctor so to speak].

Birth control pills mean you need your blood pressure checked, so the locum put the cuff around my arm, started inflating, etc.  I wasn’t expecting anything unusual, since I’ve always had blood pressure on the low end of normal.

While she was doing this, the locum suddenly blurted out: “so, while you’re here, would you like me to make you an appointment to see the dietician”? Remember, she was in the middle of taking my blood pressure at this point. I _could_ have just said “no, thank you”, which in hindsight might (or might not) have made her shut up, but I did go on to say “I don’t see any need to” – because I didn’t see any need to.  I know plenty about nutrition, I have a very varied diet, and my regular GP has never had any concerns with my physical health.

Locum took this as a cue to start a rather blustering argument with me – a patient with her arm in the blood pressure machine.  (She wasn’t very good at the arguing; she did seem to get quite upset that I was actually scientifically literate.)  Unsurprisingly, the machine correctly noted that my blood pressure was high.  The locum decided this meant I couldn’t have my pills; I told her this wasn’t acceptable, and she caved in and gave me them.

My next few blood pressure readings all went wrong too, though – to the point where the GP/nurse said that it was obvious they were inaccurate. The whole business soured me so much that I didn’t bother registering with a new GP when I moved house several years ago, so I haven’t seen once since.

Luckily, as I said, I’m pretty healthy, so this is no great loss for me, and my partner doesn’t mind using condoms _too_ much.  I can only imagine how much it sucks to be unfashionably unthin and actually _need_ regular contact with a GP.

Forget the debilitating illness — let’s talk about your daddy issues

Cory writes…

When I was in my teens I developed IBS. It was pretty debilitating and, combined with the anxiety and depression I was already experiencing, it turned me into something of a shut-in. I didn’t have a name for it, because it took me about ten years to get a diagnosis. In that process, I saw a lot of doctors. One, who I went to see on the recommendation of a family member, was particularly awful.

I came in for an introductory physical, and after weighing me, taking some blood, etc. he asked me why I was there. I had told him that my main compliant was IBS (I had found the term by then, and suspected that was what was wrong) and that I wanted a medical opinion on
what I could do about it. We went into his office after I got dressed and when I sat down, he asked me if I had ever heard of something called “The Atkins Diet.” Uh, yeah. I was gobsmacked. What was he talking about? I was 22, weighed about 240 lbs and was 5’7″. I had heard of every diet that had existed since the beginning of time. And I wasn’t going on any of them. Despite being at various degrees of fat my entire life, I had attempted dieting only once and had hated it so much that I stopped after three days.

I also know my body; my muscles are huge, my bones are dense. I am always going to weigh a lot, and I don’t care about that number. Before I could get a word in edgewise, he managed to ask me if I had trouble with my father (!?) because that’s where a lot of girls my age ran into trouble with getting fat and he also suggested the “half” diet to me. That’s where you can eat anything you want, but you just have half of it! Oh joy! Why hadn’t I thought of that! Just chuck the food in the garbage!

Not once did he mention the IBS. I asked if he had any advice on the problem I came in with. He said no, but maybe he could recommend a specialist. I walked out and never went back.

The worst part was, when I tell people that story, they don’t really get what was so awful about it. Because teh fat killz, right?

“Being Fat Isn’t Good for Your Self-Esteem, You Disgusting Fatty”

Irfon-Kim writes…

Once, when I was in University, I worked at summer job at, of all places, the Ministry of Health. I was working there as a temp and was shunted around between desks at one point. As soon as I started at my new desk, which came with a new chair, I started to get horrible back pain. Fairly early on, I suspected the chair. During the week, the pain would get to the point of being nearly unbearable, where I would go home and try to lie still and grimace, but on the weekend, when I was not in the office in the chair, it would slowly get better — such that by the end of the weekend I would be feeling okay.

After a couple of weeks of this, I decided to try out my theory. A co-worker was on vacation, and I borrowed their chair. The pain went away almost right away, and all week I felt great. Then they came back and I swapped the chairs back. The pain returned.

I went to see my boss about it. My boss was quite sympathetic but said that I had to get a doctor’s note that they could attach to the requisition for a new chair. I figured that that was fair enough — government and all that — and I went down to the campus health centre to get a note. I was expecting it to be a pretty quick and easy thing given all the evidence that I’d amassed.

When I was admitted, I got not half a sentence into my explanation when the doctor waived his hand at me dismissively and pronounced that I was too fat.


“You’re Going to Die Any Minute Now — Why So Tense?”

Jelly-filled writes…

After the birth of my second child, my OB (who was wonderful) sent me to a family physician because I had developed severe pre-eclampsia at the end of my pregnancy and turned out to be one of those women whose blood pressure, which had been 110/60 until the last part of my pregnancy, never returns to normal.

When the new family physician walked in, he stopped me in the middle of filling out my medical history and told me I could finish it later. The first thing he said was, “Your second pregnancy must have been unplanned. I can give you birth control.” I corrected him — no, my children were only eighteen months apart, but they were both planned. And no, I wasn’t there for birth control pills. He then took my blood pressure, said it was up a bit, and then told me without even the slightest bit of kindness that I was going to be out somewhere and just “stroke out.” You know, because thin women with chronic high blood pressure after pre-eclampsia are just unlucky, but fat women with chronic high blood pressure after pre-eclampsia have only themselves to blame.

I was already reeling from having gone so quickly from being a “healthy” person to an “unhealthy” one with the pregnancy complications, so his remarks really upset me. I reminded him about the pre-eclampsia, but he didn’t respond. Instead, he looked at his notes and said with skepticism, “And you didn’t have gestational diabetes?” I said no. “And you’ve never had problems with your blood sugar?” He said it with a tone that told me if I said no, he would just assume I was lying.


Cushing’s Syndrome? Go on a Diet.

“Nancy” writes…

I was sick with steroid-caused Cushing’s Syndrome. Another doctor had overdosed me with Flovent (an inhaled steroid), and I developed this disease. I saw Dr. H. very early in my illness. Cushing’s Syndrome causes muscle to turn to fat, especially in certain areas (face, back of shoulders, etc). I was a classic case. Dr. H. noted that I looked like I had Cushing’s. He sent me off for tests. But since my case was caused by a drug, and not by a tumor, the tests didn’t come back the way he expected. FYI, I was 5 feet, 8.5 inches tall and weighed 165lbs. I had shot up from 130lbs.

He refused to call me with my test results. I was so sick, I couldn’t walk to my classes at school and had to take medical leave (from muscle wasting). I got a letter in the mail telling me that there was nothing wrong with me, and I needed to see a dietitian. He even provided me with the number of the dietitian in his clinic.

There was no mention of my symptoms. I had dizziness, migraines, severe fatigue (muscle wasting), etc. Yes, I had gained a sudden amount of weight, with no changes in my diet. And with my height, I wasn’t even considered medically overweight.

I called his nurse when I got the letter and rudely told her that I was sick, not fat, and was going to see a real doctor that would address my symptoms.

I shudder what would happen if someone saw him with a real medical problem that was overweight.

I ended up seeing 8 other doctors in my area who couldn’t diagnose me. But at least they never called me fat.

I ended up going to the Mayo Clinic in Rochester, MN to get diagnosed. The delay in treatment caused great damage to my body – brain damage, severe muscle wasting, scaring over most of my body from connective tissue breakdown, and my marriage ended from the emotional stress.