Doctor tomorrow
Serene
annual physical, but it's also a follow-up on both my thyroid
surgery (six months ago) and my recent heart tests.
I've been working on educating this guy about fat stuff for years.
Some days I feel really good about this -- he's a really good
doctor, and I just want him to see his fat patients as something
other than candidates for weight-loss surgery.
Other days, I wonder if I'm hurting my own medical care by not
changing doctors, and still other days, I go looking for a new
doctor. So far, though, I'm with this one, and it's going fairly well.
showed some problems (I'll find out what kind of problems tomorrow),
and he's already mentioned my weight in passing with regard to this.
He knows weight-loss talk is off-limits, so I think he's getting me
ready for a big WLS push, but we'll see.
Here's what I plan to do for tomorrow:
1) Print out some studies about the ineffectiveness and danger of
diets and WLS (he cares a lot about studies, and is always pushing
studies on me that talk about how obesity kills, etc.)
2) Make a list of the questions I want to ask and medications I'm
taking, so that I don't have to expend a lot of energy trying to
remember stuff
3) Play the broken record of "I don't want to talk about weight
loss. I want to talk about what I can do to be healthier in the body
I have now."
4) Ask for a copy of all my test results so that I can look at them
and think about them while I'm not feeling pressured by the doctor
5) Tell him, if he continues to push about weight loss, that I've
run out of energy for that, and plan to find another doctor
Can you think of anything I'm missing? I'm feeling an
uncharacteristic-for-me need for lots of cheerleaders.
Serene
Serene Vannoy
> I have an appointment tomorrow with my regular doctor. It's my annual
> physical, but it's also a follow-up on both my thyroid surgery (six
> months ago) and my recent heart tests.
>
> I've been working on educating this guy about fat stuff for years. Some
> days I feel really good about this -- he's a really good doctor, and I
> just want him to see his fat patients as something other than candidates
> for weight-loss surgery.
The visit went better than I could hope, and he sent me to a
cardiologist, who was *amazing*. The story's below, but it's long. The
short version is that I left the cardio with some more testing to do and
NO prescribed medications. Yay!
Story #1: The GP:
First of all, we went almost the entire visit, and the ONLY thing he
said about my weight was "and your weight is an issue, but you are aware
of that and can make up your own mind about that." I was very pleased
that he'd decided to honor my position on that. Then he noticed the
sheaf of papers I'd set down -- I took them in case he started
haranguing me on the weight-loss surgery (WLS) thing.
D: *starts reading "Why I will not have WLS" that I ganked from Stef and
edited to fit my circumstances*
S: Yeah, that was in case you were gonna try to talk to me about WLS.
D: *grinning* Well, I am *now*!
And I laughed, and we had this fairly long conversation about my history
and feelings about weight and fat. He said "It's my firm belief anyone
can lose weight. If I put you in a forced refugee camp, I guarantee you
you'd lose weight, but thank god we live in a society where we can
choose these things, and that's not what we want for you."
At one point, he said, "I know you're afraid" and I stopped him -- "I'm
NOT afraid. I'm just fine with my body whether it's fat or thin, as long
as I'm treating it well and it's reasonably healthy."
I told him about the year I lost 100 pounds way too quickly and got sick
(I admitted I didn't know if that was a coincidence or not). He said
"Well, you didn't do it the RIGHT way," and I said "Doctor, 95% of all
diets fail. ALL." and he admitted that was true.
I told him about my sister's disastrous recovery from WLS.
I told him about my eating disorder in young adulthood.
He stopped me and said two things that I really respect:
1) "I'm going to read all this research you brought me. You can quiz me
on it next visit"; and
2) "I just want to say that you have my word that I won't bring it up
again. You have given me information I didn't have before, and you're a
bright woman, and if it's not for you, it's not for you."
I told him that many of my friends think I should drop him as a doctor
because of this constant battle we have, but that I think he's a good
doctor in general. He said he thinks our conversations are productive
and meaningful, and he really respects that I ask questions and do my
homework.
It was a very good visit.
Strangely, it may be his drug pushing that makes me go find another
doctor, but I really respect his willingness to look outside of his
comfort zone on a subject that clearly means a lot to him.
(My cardiologist and gynecologist have both used the words "well, he's
an athlete" and "obsessed about weight stuff" about my GP.)
Story #2: The cardiologist:
So my cardiologist stopped just short of telling me my GP is on crack
for prescribing me all those heart meds. ;-)
Blood pressure was normal (124/80 left arm; 128/82 right arm). The
cardiologist took my history and did an exam. All in all, I think we
talked for 30-45 minutes.
Basically, my first treadmill test was good, and he's not sure why they
stopped me so early (this is something my GP wondered, too, and is why I
was sent to the second test). He showed me some images from the second
test. There's a spot on the rear wall of my heart that's a little bit
darker on the film than normal under stress, which means a little less
of the radioactive isotope made it to that part of my heart -- enough
less that I could see it on the picture, but not enough to believe any
more than one blood vessel could be involved. Importantly, even if
that's accurate, the most he might do is put me on a baby aspirin for
that level of heart risk.
Thing is, that test is only about 80% accurate, and there are 10% false
positives, and he thinks I may be one of them. In some women, the
diaphragm gets in the way of that specific area of the image. He looked
at all my numbers and said they're in the range he'd want them to be in
even if I were a known heart patient, with the exception of my
C-reactive protein, which is an indication of inflammation somewhere --
could be the heart, could be a bad tooth. So he'll have me do an
echocardiogram (not under stress, just a routine one, which will measure
the thickness and stiffness of the heart walls), and then a thing called
a calcium score, and I kind of blipped on what that's all about, but
it's highly accurate, and if my calcium score comes back as zero, he
basically says Have a nice day and sends me home.
I was very happy about how well he listened to me. I am of course happy
with his conclusions, but more than that, I was happy with how well he
treated me as a person, not as a number or a fat person.
I was VERY happy about his attitudes about fat and meds. Basically, he
said being fat isn't a risk factor on its own -- it's a signal to look
for other risk factors, such as high cholesterol and high blood
pressure, and I don't have those. He said *not* to start the meds my GP
prescribed, not even the baby aspirin. He said that women my age
shouldn't take that unless it's really necessary, as it may raise the
risk of stroke, and that it's not a good idea to throw powerful
medicines at a symptom-free, young woman with only one mildly abnormal
test result that may be a false positive.
He also agreed that my GP is a bit weight-obsessed. Heh.
He said clearly my mom has good genes that she passed on to me -- her
siblings all have heart disease, and so does my dad, and I appear to
have dodged the bullet.
Stef helped me get this guy (Dr. Richard Terry, Cardiovascular
Consultants) onto the fat-friendly professionals list.
Not bad, huh?
Serene