Weight Loss Support - Medical Assumptions




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Altari
10-16-2009, 10:43 AM
Out of curiosity, how many of us "Fat Chicks" are overweight but in good health? And, how often do our health care providers make assumptions based on the weight?

My OB knows that, despite the extra pounds, I'm in excellent health. BP is low, blood sugar is perfect, cholesterol is perfect, etc. However, new nurses, or other docs when I was in the hospital giving birth, didn't just suggest screenings due to the weight. They refused to believe the results.

For example, one nurse took my blood pressure four times citing it wasn't possible for someone with "extra weight" to have such low blood pressure. At the time, I believe it was somewhere around my norm of 70-80/60, maybe even lower.

Another suggested we redo the blood work, because my blood sugar was "so low" considering "other factors."

Then, there are just the little comments. The new nurse at my OB's practice made a comment about my pulse being "surprisingly slow" when she was prepping my chart. "I expected it to be a lot higher!" Now, this may have been meant as a compliment, but..

Now, not only is this rude, it's highly unprofessional. Suggesting tests be redone, simply because the results don't stack up with your version of reality, should be a huge no-no in the medical field.

Just curious if anyone else have ever experienced this in one form or another. How do you handle it? I'm not sure there is a "good" way to handle it!


Fat Pants
10-16-2009, 10:53 AM
I had this happen to me...twice, in fact. I had the slurry of blood work done about 4 years ago... I was overweight then (probably 175 lbs?) and the doctor couldn't believe that everything came back normal. She sounded shocked.

The second time happened earlier this year - I was 205 lbs then. The doctor assumed I would be pre-diabetic, or had PCOS, or at least insulin resistant because I was obese. She wanted to start me on Metformin before the blood test results even came back. Turns out I was, again, perfectly healthy - cholesterol was low, good cholesterol was high, blood pressure low, fasting blood glucose not even CLOSE to pre-diabetes levels. I hesitated to fill the Metformin prescription until I got the test results back, and now I'm glad I waited since there was no need for me to be on it.

beerab
10-16-2009, 11:03 AM
But most people who are overweight aren't in perfect health. I know I have high blood pressure- my doctor is still worried despite my loss that I could get diabetes, and I do have PCOS but obesity is usually a symptom of PCOS- not the other way around.

I think for doctors and nurses, generally they see overweight people who do have HBP, diabetes, and other weight related issues- and I bet there are a good number who think "well I am healthy" so for the doctors and nurses they prefer to check vs. just believe you. It's probably also a liability issue for them to check. I am sure they don't mean to be rude. Though I have met some doctors who are DEFINITELY rude IMO.

THOUGH I think prescribing a medication without knowing 100% isn't the best idea.


Altari
10-16-2009, 11:10 AM
beerab, don't get me wrong. I don't mind when a doc says, "We have to check just to make sure has changed since your last lab. Your weight gives you X, Y or Z risk factor."

I hate hate hate when medical professionals get the results and assume an error. I'm 24. Aside from losing my gallbladder-which was attributed to pregnancy-I'm in perfect health for a 24 year old woman. It just so happens that I'm 50 or so pounds overweight.

However, I've also noticed this on the smoking side. Everyone in my family smokes [myself included]. My 84 y/o grandmother has been smoking forever. When she got sick and developed a cough, her doctor couldn't believe her chest x-ray (and then he couldn't believe the second!). No spots, no signs of any damage from the smoking. It does defy the "norm" of medical science, but that doesn't mean it isn't possible. People miraculously recover from cancer-anything's possible.

But, I understand more with smoking. It's commonly known that losing weight will reverse most, if not all, of the bad side effects of gaining the weight. It's also possible to reverse those effects without losing weight. Many people follow a healthy diet and are in excellent cardiovascular condition, but just can't drop the pounds. I read an article covering a study on this phenomena, and it basically said that extra weight was not a condition but a side effect [of a poor diet and sedentary lifestyle] and shouldn't be treated as a condition.

JayEll
10-16-2009, 11:33 AM
Yes, it is possible to be overweight or even obese but healthy according to those tests. But it usually doesn't last forever--which is why it's better to lose excess weight.

I was very healthy for years, but then one day my blood sugar was borderline diabetic at 109 and my cholesterol was 209. My BP had always been normal to low, so 120/80 was fine.

After losing weight, my blood sugar is 84, cholesterol 194, and BP 106/56. Most of this change, I believe, is due to increasing my exercise while losing weight. I am more fit now that I probably was 20 years ago.

So, rejoice if you still have good numbers, and be glad if you have good genetics! But don't think that that makes you immune as time goes by.

Jay

Havisham
10-16-2009, 11:35 AM
This is a recurring nightmare for me! Last year I contracted pyelonephritis (sp?), which is a 'severe and complicated kidney infection'. Rushed to hospital in pain, with a fever of 104-105. The ambulance guys were 'chatting' about how if I just started doing a little walking, I'd drop some weight. Then the doctors sent me for all kinds of tests, assuming appendicitis - while having discussions on the phones with other doctors over the 'morbidly obese woman, like 300lb, with what's obviously appi, but we can't see clearly because of the weight'. I kept telling them my appi was fine, but the pain was in my kidney. I was ignored in emerg for hours, till finally a nurse realised just how high my fever was, and they started iv antibiotics.

My own gp routinely tells me that if I lost weight I'd cure everything from my torn Achilles to my chronic, treatment resistant depression. She suggests every time that I reduce my anti-depressants (which my psychiatrist absolutely won't do as it's just waiting for a relapse) and just start walking....then I remind her that SHE told me not to walk or run for fear of fully rupturing my achilles. She blithely says things like, 'eat more fiber, no fat, no junk, drink only water'....like that's so easy only an idiot couldn't follow it. She's skinny and Croatian - she believes all North American's are spoilt slobs and she needs to educate us about how we should live. She can't understand why anyone would choose to drink caffeine drinks - tells me how half a can of pop will have her bouncing off walls. This is all stuff I know - if it were easy to drop weight, I'd not be fat in the first place.

My bp is constantly in the lower end of the healthy range, even a little low. My heart rate is fine. I tend towards low blood sugar but it's always been taht way, and it's under control with diet.

When I had my last child (he's ten now) I gained 14lbs. My dr kept telling me I'd have a tiny baby (my first was 10lb 10oz) and I'd be fine. I kept saying it was bigger and I needed a c-section. Turns out, just by eating small and often (and totally unintentionally) I'd actually lost weight - my post delivery weight was 50lbs less than my pre-pregnancy weight. My son was 11lb 03oz, and nearly died because he was too big for them to deliver normally. If, instead of just assuming because I was fat, my pregnancy weight was correct, and if he'd listened to me, my son and I would both have had a lot better time of birth.

I get extremely fed up with people telling me all the wrongs would be right if I just lost weight. I'm breathless going upstairs because I'm fat - I know that. Being constantly nagged about everything and having everthing dismissed because I'm fat, drives me insane!

Sorry - that's a bit of a soap box for me - I'll climb down now! :)

Jacquie668
10-16-2009, 11:47 AM
I'm well beyond "over weight" and my blood pressure is perfect, blood sugar is perfect, but my cholesterol is to LOW, my doctor ordered me to eat more good fat to get my HDL well above 23. I have other medical issues, allergies, intolerances, and I have a skin disease, but the rest of me is in good health. Even my blood tests showed my nutrients were great for me being a vegan lol. I still need some improvements though.

I've had one nurse take my blood pressure a few times because she didn't think it would be "perfect" as she said lol. Both of my doctors were pleasantly surprised and I got my blood tests done when I was around 285 pounds. I'll probably get a second round when I go back for my yearly checkup, but my blood pressure was on target a few weeks ago when I went to the OBGYN (that is where the nurse was who took it a few times lol, I didn't mind though.).

I don't consider myself "healthy" because if I stay at the weight I am now I run the risk of future problems and I even have problems now because of my weight, mostly the skin stuff. However, I do think people tend to look at us big people and assume we are going to keel over any moment, when in fact I'm stable. I think the lesson I learned, as I thought my stats and things would be horrible, is that just because I'm obese doesn't mean that I'm going to automatically have high blood pressure and yadda yadda. Saying that, being thin doesn't mean that you aren't going to have those problems either.

I think generally people assume, but a lot of the reaction I have gotten was more of "YAY" and "GOOD NEWS" not rudeness. That is too bad that you've had experiences, or people have, with rude behavior. :(

nelie
10-16-2009, 11:53 AM
Personally, I think habits including diet and exercise are a better determining factor than your weight. There are a lot of obesity related issues but I think it is more or correlation than causation. A poor diet is a major cause of obesity (although not the only cause) and I also believe it is a major cause of obesity related diseases.

So I think your blood tests and what not can be perfectly fine and you can be obese. It is either 'good' genetics or a good diet that would result in that. Of course excess weight can be hard on the body as your heart and cardiovascular system does have to work harder and your joints/ligaments/etc are under more stress.

Fat Pants
10-16-2009, 11:57 AM
I should have added what Jay said in her post - I have a family history of diabetes and heart disease so I knew in the back of my mind that, while at 26 I was in very good health, it was probably only a matter of time before my obesity started catching up with me.

I would be hard pressed to find someone who is healthy and obese and could make a good argument for staying obese. ;)

JulieJ08
10-16-2009, 12:23 PM
For example, one nurse took my blood pressure four times citing it wasn't possible for someone with "extra weight" to have such low blood pressure. At the time, I believe it was somewhere around my norm of 70-80/60, maybe even lower.

Well, at least in the case of the blood pressure, it was entirely appropriate to re-check a number that low. But her comments were certainly not appropriate or even logical.

JulieJ08
10-16-2009, 12:28 PM
I read an article covering a study on this phenomena, and it basically said that extra weight was not a condition but a side effect [of a poor diet and sedentary lifestyle] and shouldn't be treated as a condition.

I think that might be true for some. I think different people are healthy at different weights. But it turns out fat is not inert. It's metabolically active and some would call it an endocrine organ

kaplods
10-16-2009, 12:45 PM
To me, it seemed that I was healthy and obese, until I suddenly wasn't (healthy), but in truth, it was a slow cascade.

Every attempt at dieting only ended with me fatter, so for a few years, I did choose obesity over crash dieting. The endless weight gain stopped - it seemed to prove what I'd encountered in the "Fat Acceptance" literature. Their main theories at the time, were that eating did not make you fat, dieting did, and that fat did not make you sick - dieting did. It was rather difficult to find a fat person who had never attempted to lose weight through dieting, so theories difficult to prove either way. However, my weight gain stopping did seem to support the equation dieting = fatter. I do believe it wasn't dieting, but dieting as it is usually done, which means for the most part, crash dieting.

People with no health problems often don't go to the doctor - so the numbers of healthy thin and healthy fat people may be difficult to count. Our assumption may be that fat healthy people do not exist, where it's simply a matter that healthy fat people (like many healthy thin people) just don't go to the doctor, so are never "counted." Fat people who are healthy (or think they are) and even those who aren't, often have doctor phobia, afraid the doctor will rag them about their weight. Medical treatment avoidance, is not good for long term health. So are fat people unhealthy because they are fat, or because they avoid early medical treatment? Social ostracism is also known to be extremely bad for your health, it can even kill, often by impairing the immune system. Are fat people sick because they're fat, or because they have been mistreated or ignored by people?

Personally, I believe that obesity can cause several health problems. I think though that many of the health-effects aren't from obesity itself, but other factors. Some independent of the obesity, and some a cause of both obesity and the specific health problem.

I think the problem of medical staff being unable to treat "the individual" is a problem that sadly isn't unique to obesity. My sisters' husband is African American, and while he would never suggest that he received inadequate medical care because he is black, I will say it for him. I have witnessed some of the horrific medical care for myself, and I can't believe it was anything else. In one of the best cardiac hospitals in Illinois, he went in for surgery to "repair" his heart defect as best they could, and was discharged with medications that he would be on for life. We all went to see him, we all talked to the doctors. Two years later, we found out that the surgery repaired absolutely nothing - it had been a diagnostic test, nothing more.

To me, that's medical malpractice, but my BIL would not sue. I wish I could sue FOR him, because I am outraged on his behalf. Looking over the course of his life, his medical care improved dramatically when he got good medical insurance (unfortunately, not a huge surprise there) and even more dramatically when he became a store manager. To me, that says NOW they see him as an educated, professional black man (who can only now understand the medical treatment he needs?)


Many doctors and nursed also don't know how to deal with obese patients adequately or with respect. Yelling doesn't work. Ignoring problems doesn't work. Contempt doesn't work.


It's amazing how many doctors and nurses don't know how to take an obese person's blood pressure. That has gotten MUCH better over the years, but even 10 years ago, I had to tell doctors and nurses that I needed a larger cuff, or my bp reading would be high. I told them if they used the right cuff it would be normal (at the time, it was).

I'm starting to rant and ramble, so I'll try to calm down. There's no way to get around medical assumptions. Doctors and other medical professionals are flawed human-beings like the rest of us, and they tend to act according to their own assumptions and biases. We all make thousands of assumptions every day about the people we encounter. In medical situations, it's very important that those assumptions don't get in the way of appropriate treatment, but the reality is that sometimes it does. I think it only makes it everyone's job to decrease the odds. That means medical staff being aware, educated, and open to feedback - but also patients speaking up, asking questions, giving feedback and even criticism, not just on the medical issues but on the socal ones as well - "bedside manner" is often just as important as medical knowledge.

nooch
10-16-2009, 01:55 PM
Like a lot of other posters here, I am perfectly fine with doctors or other medical professionals being concerned about issues that are correlated with being fat. What I am absolutely never okay with is being talked to like I'm subhuman, having medical professionals express disbelief that a fattie could NOT have diabetes, high blood pressure, or high cholesterol (to the point of, like other posters, having tests repeated), and being denied things because of my weight with no other reason given (when I was 19 I was told I could no longer have birth control pills because I was fat - not because of high blood pressure, I've never had that - the doctor just said "you are fat, and fat women can't have birth control pills, find another method").

yoovie
10-16-2009, 02:20 PM
This happens to me alot too. I have very very very strong legs and I know that I carry most of my weight there. I mean, I can leg press 2 sets of 5 reps @ 700lbs. I may be 207 but I can wear a medium shirt and I just bought a size 11 pair of corduroy pants- but when they see my charts and they see that over 200 weight and they start getting all these ideas in their head about what is wrong with me. Even when they see me they take my pulse (resting pulse is around 50) and they give me this shocked look.

Its very aggravating.

ubergirl
10-16-2009, 02:20 PM
I can put on my health care provider hat here and weigh in with the doctor/nurse perspective....

This is a hard thing.

I can personally vouch for the fact that in general it is much harder to care for the obese patient. It is harder to do a good physical exam, it is harder to use medical technology appropriately, it is harder to manage complications.

The poster above who mentioned the possible appendicitis is a good example. Ultrasound can be helpful to rule out appendicitis, but ultrasound is a MUCH LESS USEFUL TOOL when dealing with obese patients. Why? Simple... the excess adipose tissue (fat) makes the images of the internal organs less clear. The ultrasound's waves don't bounce as well through a thick wall of fat.

Who does that put at risk? YOU.

If you are obese and you have a health problem, the tools that doctors and nurses use to treat you may be less effective-- it will be harder to get a diagnosis and harder to get a good treatment.

That stresses out doctors and nurses, whose job it is to try to help you.

It's especially hard because obesity is a medical problem that is associated with lifestyle.

Like it or not, the smoker who has emphysema, the alcoholic with cirrhosis, and the obese person with diabetes or hypertension or heart disease are considered to be contributing to the very problem for which they are coming and asking for help.

Ok. But of course, a good health care provider understands that people do want help, and they DON'T want to cause problems for themselves, and they WOULD fix the problem if they knew how, but usually they don't feel successful at fixing the problem.

So, I think that compassionate understanding on the part of the health care provider is key. You DO have to watch what you say. You DO have to be sensitive to the needs of your patients, and you DO have to care for obese patients with compassion and skill and NOT blame them for them for their problems, which obviously, are causing them problems that they don't want.

On the other hand, I'm hearing quite a bit of denial on this thread. You might be a young healthy person right now, but that does not make you immune to the health problems associated with obesity. The problems accumulate and become more and more severe with age. A healthy obese thirty year old may turn into a fifty year old with heart disease, or such severe arthritis that she is unable to walk.

I think it is ENTIRELY appropriate to mention it to a health care provider if you feel that his or her comment was insensitive about your weight.

beerab
10-16-2009, 02:26 PM
Oh Altari I totally agree some doctors have terrible attitudes- assuming error isn't cool- I mean if you test twice and it's the same then trust the test!

I have had some horrible doctors in the past tell me DUH things to lose weight that really upset me. I've had the "just drink water"- uh YEAH- that's the ONLY thing I drink... "Don't eat sweets like cake and candy" yeah I don't do that- I don't even like cake!

Before I was diagnosed with PCOS one doctor basically flat out told me I was lying about my diet when I showed her my log. I tried telling her there is something wrong with me (I was counting 1200-1300 cal's a day and STILL gaining- now I realize I ate a lot of carbs) but she refused to listen. Finally I changed doctors and she took ONE look at me and said "I am very sure you have PCOS." *sigh*

ETA: How do you know they are using the wrong cuff size? I feel mine is uncomfortably tight when they do it and my doctor just put me on HBP meds.

JulieJ08
10-16-2009, 02:36 PM
This site has a chart for cuff size
(http://www.wellsource.org/product_sheets/BP%20Cuff%20Size.pdf)

The BP cuff will normally be uncomfortably tight when inflated, especially if your blood pressure is high. It has to be inflated high enough to cut off flow - and that being uncomfortable is a good thing :)

QuilterInVA
10-16-2009, 02:37 PM
Saying you are overweight but in good health is an untruth. I'm overweight and I can say it isn't healthy although I don't have closterol, bp, issues. Just because they haven't showed up, doesn't mean they aren't looming. Being overweight is hard on the body.

Havisham
10-16-2009, 03:28 PM
I just wanted to add that I agree, those of us who are morbidley obese are not healthy. How we got here is one story - how we lose it is another - and it's a much harder one, but even if we're comparatively healthy, we're definitely on our way to bigger problems.

I don't object to being told I'm fat, or that I need to do this, this and this to lose the weight. I object to being disregarded and ignored while someone assumes they know better than me. This is MY body and if I feel there's something wrong, I'd like someone to at least look in to it for me. If it is that I'm fat, then fine, thank you for checking.

I don't want to be fat, and I'm working on it, day by day. But I also know that obesity is a factor in the risk for cancer. As a woman who's family is riddled with cancer, I know that my risks are increased exponentially. The weight will come off, eventually, but in the meantime do I ignore possible health issues until the day when my weight magically makes me perfect again?

I think that healthcare providers need to be more sensitive to the needs of the obese. If they think that judging and condemning us will help, they obviously haven't any idea how much we judge and condemn ourselves. Just tell us what's going on..what they think, and why they think it. Tell us why it's difficult to do the testing, make us partners in our health care.

I'm fat....I'm not stupid, or suicidal or masochistic...I'm a work in progress, and if I'm treated as an equal, then I'm much better able to feel confident in my own health and the care provided me.

Altari
10-16-2009, 03:41 PM
I think many posters in here have taken what I originally said to a logically conclusion it wasn't meant for. If this comes across as hostile, don't take it that way. I get pretty passionate about certain things (this being one of them) and have been told I come across as aggressive when I'm passionate. I am honestly writing this with a light spirit and cordial tone. :)

First, I have read more and more studies which come to the conclusion that obesity, in and of itself, is not a condition (in most cases, see note later). It is a side effect of poor diet and exercise, just like high blood pressure, cholesterol, diabetes and liver/kidney problems are usually side effects of the same. A 120 pound woman who eats ho-hos and ding-dongs all day may not gain weight due to a great metabolism, but it will eventually catch up to her.

Unfortunately, my husband is this way. He eats about 5,000 calories a day of not-the-best food but stays thin as a rail. On the rare occasion he goes to the doctor, they never run tests. Why? He's thin and looks to be in general good health. He has no idea what his blood sugar, cholesterol or liver functions are. No one has ever tested him. He's 24, thin, muscular and has a slightly-high BP. They listen to his chest, knock on his knees and send him away. Never once do they discuss his diet!

Now, contrast that to my usual office visit. Disapproving head shake at the scale. Repeated blood pressure testing. Suggestions for unnecessary blood work (unnecessary because I've probably already had it that year!) and comments about what my weight is going to do to my health. If I've lost weight, I get a sigh and a reminder to keep it up!

Again...do we ever discuss diet and lifestyle?

Yes, the extra weight can cause complications down the road. If I'd needed a c-section, it would have been tricky with the extra flub. Ultrasounds were harder. Over the long term, the extra weight will cause knee, back and hip problems, and may even contribute to breast cancer with the extra estrogen. In all of these, being "fat" is the reason. You can be overweight and in otherwise good health, but have terrible knees from carrying around even just 20 extra pounds.

But, that wasn't my point. My point was that, at this moment, I'm in good health. It isn't denial to say that it's rude and unprofessional for health care providers to insist the test "must be wrong" because I'm carrying extra weight. They haven't looked at my diet and my lifestyle. It's ridiculous. Just as ridiculous as assuming my thin husband has good cholesterol because he's young and...what?...THIN. IMO, it's bad medicine. The body operates on what you put in it. My 140 pound husband is operating on on-the-go Chicago food - refined carbs, sugary drinks and caffeine. Health care providers should also look at that factor before making sweeping statements, since we now know health is more than just a numbers-from-the-lab game.

In regards to diabetes, I'm hypoinsulenic hypoglycemic (sp?). I am in constant fear that, if I don't control it with diet, I'll burn out my pancreas and become insulin-dependent. I also know that excess fat excretes hormones which affect metabolism, but, once again, the fact that I'm overweight is not the cause. Contributing factor? Yes. Root cause? No. I'd be in the position even if I didn't have an ounce of fat on my body. Genetics, diet and exercise play an equal role.

Anyway, if that made any sense, that was my point.

((Oh, and I'm happy to announce that I have 1 less pound of estrogen releasing fat on my body today. Huzzah!))

ennay
10-16-2009, 03:48 PM
Yes, but on the flip side when I was merely overweight but not obese and under 40...

I have had borderline high cholesterol since I was 21(work screening, not in my medical charts), I have a family history of VERY high cholesterol. But since I was NOT obese, I couldnt get insurance to pay for routine cholesterol screenings without a fight.

I have a high family history of diabetes. My blood sugar tests were always borderline but.....again, too young, too "thin" to be tested regularly. I had gestational diabetes which makes my likelihood of developing diabetes MUCH higher. Still had to argue to get screened EVEN when I was borderline obese. Still do.

Family history of hypothyroidism. Struggling with weight regain but since I am trying to deal withit at 140 lbs instead of 180....you guessed it had to argue a bit to get my thyroid checked. (guess what!)

In someways it is a blessing to be nearing 40 since these tests will be "allowable". As long as my numbers remained borderline, no one thought I needed to check to make sure they remained borderline.

Insulin resistant, but until i fall off the cliff to diabetes no referral for nutritional counseling or to an endocrinologist. Heavy friend got that referral with much lower numbers as a preventative measure.

ennay
10-16-2009, 03:50 PM
and to further the OP feelings. My friend who is obese was having bad sudden onset of joint pain, body aches etc. They just told her to lose weight and wouldnt run any tests. She has Rheumatoid arthritis and had ALL the risk factors but was ignored because she was obese. She missed a year of treatment and with RA treatment time lost is joint degeneration that can never be recaptured.

kaplods
10-16-2009, 04:08 PM
This site has a chart for cuff size
(http://www.wellsource.org/product_sheets/BP%20Cuff%20Size.pdf)

The BP cuff will normally be uncomfortably tight when inflated, especially if your blood pressure is high. It has to be inflated high enough to cut off flow - and that being uncomfortable is a good thing :)


Yep, uncomfortable is normal, pain is not. My arm circumference is off the chart - 22" (and that's currently, at my highest weight, it was 23.5") - far too large for a standard cuff, yet that's all that was available in most offices even 10 years ago. I still run into it occasionally.

kaplods
10-16-2009, 04:33 PM
and to further the OP feelings. My friend who is obese was having bad sudden onset of joint pain, body aches etc. They just told her to lose weight and wouldnt run any tests. She has Rheumatoid arthritis and had ALL the risk factors but was ignored because she was obese. She missed a year of treatment and with RA treatment time lost is joint degeneration that can never be recaptured.

This is what I faced, when I started having mystery symptoms that I knew were abnormal, but every doctor I saw (in Illinois) attributed the symptoms to obesity, and dismissed my concerns. They would refused to do any tests or provide any treatment, just advise "lose weight." Others would prescribe drugs (but again, no diagnostic tests).

I ASKED for a CT scan of my sinuses (based on the suggestion of an ER doctor), and was actually LAUGHED at by my gp. About 2.5 years later after moving to Wisconsin, my ENT ordered an MRI of my sinuses - one I did not ask for, but he felt the symptoms warranted - and found a large fungal mass growing in my sinuses. He said it had been there at least two years, probably much longer. He wasn't able to culture the fungal ball, so that tended to rule out the really nasties (he said though that it was consistent with autoimmune disease, the body is so busy fighting itself, it misses invaders like fungi).

It took years of complaining before doctors found an autoimmune disease destroying my sinuses and connective tissue (probably by attacking small blood vessels). I understand that autoimmune disease symptoms are even difficult to detect in slim patients, because the early symptoms are so generic and nondescript until damage is being done - but the frustration in KNOWING that something is seriously wrong and doctors are dismissing you as a hypochondriac is beyond frustrating.

So while I can appreciate that my obesity can obscure test results, and make diagnosis more difficult - the dismissiveness and oversights of doctors I trusted makes me insanely angry. For example, I was told that I developed asthma because of my weight, only to find out it was an NSAID sensitivity (a fairly common reaction). Instead of suggesting I go off the NSAIDs and see it if relieved the asthma symptoms, I was just given stronger and stronger asthma meds over the ten years I was on NSAIDs. Only being unable to afford even OTC ibuprofen, and having to go off NSAIDS until payday, did I discover the interaction. I suddenly and dramatically found myself able to breath - when I told my doctor, he said it was not an uncommon problem (so why wasn't I told).

In general, my medical care in North Central Wisconsin has been astonishingly better. I've received more respect and open communication with my doctors here. And it's not because they keep their mouth shut about my weight. The opposite is true - it's discussed, but not ignored or dismissed as a cause to all my problems. I've had some doctors, I swear who would find a way to blame my weight if I walked in with a dagger in my eye.

I always bring up my weight FIRST in any appointment with any new doctor. I tell him/her what I'm doing to lose weight, and if they have any better ideas I'd be glad to hear them. I also say "I know losing weight will likely help, but we've got to treat the body I have today, not the one I may have in two years, or even six months."

I have three doctors now, My GP, my ENT, and my neurologist. I trust them, but I don't trust them to know everything. With autoimmune disease, most doctors aren't very knowledgeable. Patients often have to educate themselves first and then their doctor (and finding a doctor willing to BE educated by a patient, is a very rare thing), but I still have some lingering resentment over the years I went undiagnosed because doctors only saw the fat and not the patient underneath it.

Altari
10-16-2009, 04:56 PM
Oh, kaplods, that's terrible! Apparently, docs here in Illinois suck. I'm very happy you found better treatment behind the Cheddar Curtain.

I went through a similar, but much less severe, thing with my gallbladder. Doctor after doctor chalked my severe abdominal pain up to IBS - something "common in someone your size" - and put me on all sorts of medications to handle it. It wasn't until I was in the ER, with yellow skin, eyes and gums that someone thought, "Hey, let's check her liver!"

Had the docs listened in the first place and accepted that the pain was my only symptom of IBS, that I wasn't under-reporting other symptoms, maybe they could have caught the gallbladder before my liver began shutting down. Or, even, before I spent three weeks with nothing but water and plain soda crackers, writhing in pain every night with no sleep. Or, better yet, before I lost the first 2 months of my daughter's life because I was too preoccupied with the consistent, burning pain in my gut.

ubergirl
10-16-2009, 08:03 PM
This is MY body and if I feel there's something wrong, I'd like someone to at least look in to it for me. If it is that I'm fat, then fine, thank you for checking..

Havisham, your story is very interesting and instructive and there is a lot of truth in it.

You might find it interesting to learn that there is good scientific data indicating that women's estimate of their own baby's size during pregnancy is MORE accurate that getting an ultrasound done.

In other words, if a health care provider doesn't listen when a pregnant mom says "I think my baby is really big" then that health care provider isn't just failing to listen, he or she is also not following the best available scientific evidence.

I think many health care providers are not as good listeners as they should be, and I think they are lazy and short-sighted if they provide less thorough care to obese people on the principle that weight causes every ill.

I think a lot of the failure stems from their feeling of helplessness. Obesity causes many health problems, but they don't feel like they have good tools available to help them help their patients fight obesity.

I guess I have a special interest in this topic because I see it from both sides-- provider and obese patient.

Altari
10-16-2009, 08:18 PM
You might find it interesting to learn that there is good scientific data indicating that women's estimate of their own baby's size during pregnancy is MORE accurate that getting an ultrasound done.
I can say from anecdotal experience, this is so true! I guessed my son would be 8 pounds 10 ounces, the ultrasound said he would just barely break 7 pounds. He was 8 pounds 15 ounces at birth.

Women are very very good at saying "this kid is huge!" or "eh, he's just floatin' around in there."

Havisham
10-16-2009, 08:53 PM
Havisham, your story is very interesting and instructive and there is a lot of truth in it.

You might find it interesting to learn that there is good scientific data indicating that women's estimate of their own baby's size during pregnancy is MORE accurate that getting an ultrasound done.

In other words, if a health care provider doesn't listen when a pregnant mom says "I think my baby is really big" then that health care provider isn't just failing to listen, he or she is also not following the best available scientific evidence.

I think many health care providers are not as good listeners as they should be, and I think they are lazy and short-sighted if they provide less thorough care to obese people on the principle that weight causes every ill.

I think a lot of the failure stems from their feeling of helplessness. Obesity causes many health problems, but they don't feel like they have good tools available to help them help their patients fight obesity.

I guess I have a special interest in this topic because I see it from both sides-- provider and obese patient.


Thanks, Ubergirl, it's something I found out the hard way. For the last six weeks or so of the pregnancy I couldn't move with pelvic separation and my GP (who was shortly thereafter made head of Ob in our local hospital) just kept telling me it was normal and telling me to take tylenol 3....which I wasn't about to do. I couldn't turn over in bed, couldn't get out of the bath, out of a chair, in the end my husband rolled my pj pants down to the floor - you know like you do for little kids - and I couldn't lift my leg high enough to step in to them.

This same doctor then came in for the delivery - when it was apparent that my son was stuck in the birth canal (huge shoulders - neither of my boys was fat, just really long) they had nurses pushing and pulling....and ultimately broke his collar bone to get him out. Almost 14 hours later I stopped a nurse and said that something was wrong - he was looking at me desperately. God bless her - she told the trainee with her, if a mom says there's something wrong, there's probably something wrong. Turns out they'd punctured his lung during the delivery and hadn't realised. If I hadn't found a nurse willing to listen - like my dr wouldn't - he'd have died.

My doctor (who complained that he had to stitch in the middle of the night when he thought it would be an easy birth) said that with babies that big, they often don't make it because they get stuck and suffocate.

All long and boring - but ultimately, he dismissed my feelings and concerns because I was obese. Because he messed up the measurements and told me I was over reacting, and after a 10 10 baby, I could do 11lbs 'easily', he nearly cost me my son.

I know I'm not healthy - and I want to lose the weight. But there needs to be more education for health care providers - and I know they're only human...but there needs to be at least a willingness to remain open minded. Sounds like you have a unique perspective, and I'm sure your patients benefit from that. :)

JulieJ08
10-16-2009, 09:27 PM
All in all, I think this is a fascinating thread with various experiences and inputs.

kaplods
10-16-2009, 09:27 PM
As Americans get fatter, so do American doctors, and I think sadly that may actually be a lifesaver in the long run. When doctors don't suffer from the same complaints they treat, they often lack compassion. Before women doctors, women's doctors often ignored or dismissed "female complaints," as primarily "hysterical." I truly believe that because men didn't suffer from PMS, and menstrual cramps, many of them believed those conditions only
existed in the minds of women with nothing better to occupy their time.

My family physician is slightly overweight - not obese, but he has some health issues for which weight loss would benefit. He's tried - and failed to lose weight repeatedly, and "huh, what do you know?" he's the most sympathetic, encouraging, yet realistic physician I've ever met. He admits it's hard, and he admits he doesn't have all of the answers.

Two doctors can give the exact same advice, but it's alot easier to hear from someone who says "I know it's hard, I'm trying too and not always successfully," than a doctor who treats you like an imbecile when you find putting his advice into practice isn't as easily as HE had hoped, and treats you like an inconvenience. If a doctor acts OFFENDED to see a patient (and I have had that experience), there are a lot of patients who won't come back - and not only may not return to that particular doctor, but may refuse to seek medical treatment in the future.

DCHound
10-16-2009, 09:42 PM
I can leg press 2 sets of 5 reps @ 700lbs.

Yoovie...Holy Guacamole!!! I had men at the gym standing in awe of me because I can do one set of 5 reps at 500#. 700???? That is un-effing-believeable. Wow!!! (please don't ever kick me, LOL)

---------

I've always been extraordinarily fortunate, health-wise. I had leg, knee and ankle pain directly related to the super morbid obesity, and other random aches-and-pains, but my bloodwork, bp, everything else has always been shockingly normal although my body temp runs high--normal for me is 99.5. I'm lucky, I inherited the genetic predisposition to extremely good health. It's even better now. And will continue to improve, as I lose weight. The doctors are always very, very surprised.

nelie
10-16-2009, 10:18 PM
Yoovie...Holy Guacamole!!! I had men at the gym standing in awe of me because I can do one set of 5 reps at 500#. 700???? That is un-effing-believeable. Wow!!! (please don't ever kick me, LOL)


Women have strong legs and if you have ever weighed over 300 lbs then you are constantly lifting a lot of weight. When I first started doing weight lifting, I got up to 12 reps @ 600 lbs. I had a guy come up to me irate since he had been watching my progress and couldn't believe it.

kaplods
10-16-2009, 11:38 PM
In college, I had to take two semesters of P.E. I opted for independent study (supervised by the department chair - the head coach of the women's department), swimming the first semester. I love swimming, and the pool was usually fairly deserted. The coach supervised the first several sessions, and was unusually impressed with my swimming ability (I weighed about 260 - 290 during college), and told me that she had given my routine to her younger sister (in a neighboring college), and her sister (thin) was having trouble keeping up. I know the coach meant it as a compliment, but it did annoy me somewhat that she was SO impressed.

I can't swim like I did then, I don't have the lung capacity anymore, but swimming is still my all-time favorite activity. I would live in the water, if I could. I know part of the coach's surprise was a fat girl being able to do anything better than a skinny girl, but there's also the anti-swimming phobia that is almost demanded of anyone overweight. If you're over 190 lbs and willing to be seen publicly in a swim suit, you're automatically something of a freak. Which is terribly sad, because the water is one of the only places where extra weight doesn't necessarily work against you, and where even a super, morbidly obese person has a chance of keeping up with thinner peers.

The water is the only place I can get my heart rate up and keep it at an aerobic level without feeling as if my head and heart is about to explode. On land, 5 minutes of intense exercise, and I feel like I'm going to drop dead - in the water I can really push myself. The second thing I'd buy if I ever won the lottery would be an indoor infinity pool (the first would be a house in which to put the pool - as I don't think the landlord would appreciate my having a pool installed in the spare bedroom).

the slim me
10-17-2009, 08:58 AM
I'm in the health care profession too, and I totally agree with Ubergirl. And i've seen the problem first hand. My sister is very over weight. And she was fine....untill she wasn't. It's very hard to diagnose an obese person. And after a certain size, they don't fit into an MRI machine either. My sister now has problems with her joints caused by the excess weight she has carried around, and she will need replacement in the near future.

Most of my family is over weight and i love them dearly. But i've seen a lot of medical problems pop up over the last few years. So, great for you that continue to be healthy. But don't count on it. Look at the statistics. And don't get upset with the medical people who are trying to keep you from getting serious complications later in life.

oh, and a BP of 70/60 is not a good thing

Jacquie668
10-17-2009, 09:27 AM
I'm in the health care profession too, and I totally agree with Ubergirl. And i've seen the problem first hand. My sister is very over weight. And she was fine....untill she wasn't. It's very hard to diagnose an obese person. And after a certain size, they don't fit into an MRI machine either. My sister now has problems with her joints caused by the excess weight she has carried around, and she will need replacement in the near future.

Most of my family is over weight and i love them dearly. But i've seen a lot of medical problems pop up over the last few years. So, great for you that continue to be healthy. But don't count on it. Look at the statistics. And don't get upset with the medical people who are trying to keep you from getting serious complications later in life.

oh, and a BP of 70/60 is not a good thing

There is a clear difference between helping and not listening and being judgmental. My doctors listen to me, they really do, and are very pleased with my progress as well as happy with my blood work. However, they never told me to stop losing weight, in fact they are very supportive. I even went as far as typing out all my issues and handing it to them in a detailed list lol. Both of my doctors were thrilled with that and made copies for my file lol. They didn't tell me that my skin was because of my weight, they said it MIGHT be, but the facts are I have a skin disease and as my OBGYN put it, you know you would have this no matter what (she is right, I was showing signs when I was a teen). So my point is they didn't write me off because of my weight. Had they written off my condition as a "fat condition" I wouldn't have gotten any sort of help, even through in my case there isn't much help professionally to get lol.

I remember years and years ago when I was a teenager and I had a swollen throat, fever, and my weight was slightly over the "norm." I felt so ill and KNEW it was different and KNEW I probably had mono as it had been going around my school. I walk in, the doctor there ignored my information and said I had tonsillitis, which I have had before and believe me this didn't feel like tonsillitis. I said "I don't think that is what it is, can we do a mono test just to make sure?" He said "no" and laughed at me. I went TWO weeks without treatment and was almost in the hospital. In fact when I went back to see another doctor, desperate, he looked at me shocked and said had I not gotten treatment now I would have been in a hospital bed, I was that sick. I mean he was shocked himself that the other doctor didn't listen to me and he said "he should have run a test." So, not listening to patients is a problem for a lot of people as kaplods pointed out, not just the fat. Since we were in a small town he ordered me home, but said if I didn't show signs of improvement within a few days then I must go to the hospital for better care. So, after getting those darn horse pills in me, felt like it as I was so swollen, I did start to feel a tiny bit better. Of course three months later I was well lol. Mono does take it out of you.

I guess my point is just because I'm this weight doesn't make me "healthy," but it does, based on my blood work as well as my physical examinations, make me stable. I also know that being at the weight I am now would totally complicate my future and it complicates things now, so I NEED to get the weight off for a variety of reasons, some health related. I'm not upset at a health care provider helping me, but it is upsetting that people are treated poorly or just ignored. Like Havisim with her baby, why didn't someone listen to her before she had her baby?

I guess I'm lucky to have found two medical professionals that I trust and do listen to me and not only that are excited and thrilled with progress. I also do think, and this is my own personal opinion, that my attitude makes a little difference. Had I gone in with a "yeah I'm this weight what of it" attitude I don't know how they would have reacted. Instead I went in with this attitude of "here I am, this is what I've done and what I'm doing and I have questions." haha...so I think that DID make a difference as they do see someone who wants to help themselves. I dunno, maybe that is just me though.

Havisham
10-17-2009, 03:03 PM
In college, I had to take two semesters of P.E. I opted for independent study (supervised by the department chair - the head coach of the women's department), swimming the first semester. I love swimming, and the pool was usually fairly deserted. The coach supervised the first several sessions, and was unusually impressed with my swimming ability (I weighed about 260 - 290 during college), and told me that she had given my routine to her younger sister (in a neighboring college), and her sister (thin) was having trouble keeping up. I know the coach meant it as a compliment, but it did annoy me somewhat that she was SO impressed.

I can't swim like I did then, I don't have the lung capacity anymore, but swimming is still my all-time favorite activity. I would live in the water, if I could. I know part of the coach's surprise was a fat girl being able to do anything better than a skinny girl, but there's also the anti-swimming phobia that is almost demanded of anyone overweight. If you're over 190 lbs and willing to be seen publicly in a swim suit, you're automatically something of a freak. Which is terribly sad, because the water is one of the only places where extra weight doesn't necessarily work against you, and where even a super, morbidly obese person has a chance of keeping up with thinner peers.

The water is the only place I can get my heart rate up and keep it at an aerobic level without feeling as if my head and heart is about to explode. On land, 5 minutes of intense exercise, and I feel like I'm going to drop dead - in the water I can really push myself. The second thing I'd buy if I ever won the lottery would be an indoor infinity pool (the first would be a house in which to put the pool - as I don't think the landlord would appreciate my having a pool installed in the spare bedroom).

Kaplods, I can relate to this. I used to swim a mile (64 lengths) three times a week, and did yoga daily and I was in amazing shape. This was BF (before fat), but I still love to swim.

I can't swim the way I did before, but I figure if I can get back in to it, I'll rebuild that lung capacity.

My 'must have' in a house (after lottery win) is a lap pool...having a pool to myself to swim in in peace sounds like heaven! :)

Altari
10-17-2009, 07:02 PM
I'm in the health care profession too, and I totally agree with Ubergirl. And i've seen the problem first hand. My sister is very over weight. And she was fine....untill she wasn't. It's very hard to diagnose an obese person. And after a certain size, they don't fit into an MRI machine either. My sister now has problems with her joints caused by the excess weight she has carried around, and she will need replacement in the near future.

Most of my family is over weight and i love them dearly. But i've seen a lot of medical problems pop up over the last few years. So, great for you that continue to be healthy. But don't count on it. Look at the statistics. And don't get upset with the medical people who are trying to keep you from getting serious complications later in life.

oh, and a BP of 70/60 is not a good thing
I shouldn't even be responding to this post but...

1) You missed the point. This isn't about what will happen in the future. It's understandable for health care providers to say, "You really need to lose weight." It is NOT understandable for them to request repeat testing because the results don't match up with their reality, without first looking at lifestyle.
2) Take it up with my doc. She thinks my BP is great. Mostly because it's been in the 70-80/60 range for 10 years. When it jumped to 110/80 while I was pregnant, it was a sure sign something was wrong. I just checked MayoClinic to confirm what she told me. My blood pressure is "chronically low" with "no symptoms." There is almost never a problem associated with that. Considering the battery of medical tests I've undergone in the last 6 years, I'm guessing if my "chronically low" blood pressure was a real problem, someone would have piped up.

yoovie
10-18-2009, 11:42 PM
Yoovie...Holy Guacamole!!! I had men at the gym standing in awe of me because I can do one set of 5 reps at 500#. 700???? That is un-effing-believeable. Wow!!! (please don't ever kick me, LOL)

hahaha :P no i just have extremely muscular legs, I know alot of my weight has got to be there. Gigantic quads and a 37" inseam, its all just a big fat simple machine.