Tuesday, November 30, 2010

It pays to be proactive with your health

Ok, I made my ex-doctor (before I fired her) give me a referral to an endocrinologist (one that I picked out), and it's a damned good thing I did. Even though all my thyroid hormone levels are normal, my thyroid is enlarged enough that, with the family history of thyroid cancer, the endo thinks it's a good idea to have my thyroid removed.
Dr A and I had a long talk about my weight, and she really understands, a lot better than Dr W ever did. Dr A agrees with Dr W that calories in/out works, but only for some people. Dr A said that genetics can interfere with that, and if there are a lot of fat people in your family, you can end up being fat and there isn't much you can do about it other than eat healthfully and exercise, which isn't going to make you lose weight, but will help you stay healthy. When I told her that all the women in our family, both sides, start out average-sized, then get fat when they have kids and get fatter as they age, but live to their mid/late-80s, she said that I shouldn't worry so much about my weight, but worry more about whether my other numbers are good and if my heart and lungs are functioning the way they should. Which was rather refreshing to hear, ya know? And that was the first doctor's office I've ever been to that actually had gowns that fit me and chairs that didn't dig into my hips/thighs when I sat in them. It was a totally awesome experience.
There isn't any way to shrink my thyroid and it will only keep getting bigger, which can cause a lot of problems farther down the road. She scheduled me for another thyroid ultrasound, which I had done yesterday. They called with the results today, and if it weren't for the fact that I have a consultation with a surgeon next week about removing my thyroid, they would want to do a biopsy of the mass they found at the back of my thyroid. It's not a nodule, they aren't sure what it is, but since the thyroid is coming out, no biopsy is necessary. Thank you Dr W for blowing off my concerns about my thyroid.....NOT. And thank you, Dr A, for taking me seriously and checking things out further.
I also saw Dr J today, he's my orthopedic doc that takes care of my arthritis. He couldn't believe that Dr W wouldn't prescribe anything stronger than relafen for my knee. So he gave me a prescription for Celebrex to see how that works for me. He did say that I'm looking at having my knee replaced some time in the near future. He told me that it would be 3 days in the hospital, then maybe a week in a nursing home. I told him I thought I could probably come home from the hospital, after all, we have a handicapped toilet and shower, I have a walker already, and I can sleep in my recliner until I can do the stairs to the bedroom in the basement. And there are no other stairs in the house that I would have to do right away, and no steps into the house. Best of all, my weight isn't even a concern for him as far as doing the surgery (is he an awesome doctor or what).
I also have an appointment next week with the gynecologist to check out the bleeding. Now that's been going on for 2 1/2 years, and started back when I was taking Cymbalta and relafen (and vaginal bleeding is a side effect of those two drugs interacting with each other). Even though I quit taking the Cymbalta 4 months ago, the bleeding didn't stop (it's been an on-and-off thing all this time and Dr W has never followed up on it since I first mentioned it to her, other than having me see the gynecologist 2 1/2 years ago for an endometrial biopsy, which came back negative). So, even though that biopsy was negative, and bleeding is a side effect of the 2 drugs I was taking, she's just sure I have endometrial cancer and need another biopsy done. Yeah, having one of those done is just so easy with a stenotic cervix (it hurts, let me tell you). But I'm having it done, just in case something has changed. And if the gyno recommends a hysterectomy, I'm demanding that it all come out, ovaries too, since ovarian cancer killed my mother and several other relatives on her side of the family. I'm not going to piss around with it, if he wants to take out part of it, it all comes out. I'm done taking advice that I don't think is good for me.

Wednesday, November 24, 2010

Letter to my ex-doctor

I've had time to think since I walked out on my doctor on the 10th, and I composed a letter to her today. I'll be sending it to her on Friday. I don't expect a response from her, but I want her to know why I won't be coming back to see her anymore. The letter follows:

Re: Office visit Nov 10, 2010

Dr W,

I've had some time to think since I saw you on November 10th, and there are some things I think you need to hear. Since you don't seem to listen to me when I'm talking to you in person, maybe you'll listen to what I have to say when I'm putting it down in black and white and you can't interrupt me with your preconceived lipophobic ideas.

First of all, I have been fat for over 30 years of my life, and every doctor I've ever seen has told me that, like I'm stupid and can't tell that I'm fat.

Second – I've dieted and lost weight, that's not the hard part. The hard part is maintaining that weight loss, and that's where medical science, doctors, diets, drugs, and surgery have failed me (note: I'm not the one who failed here, I tried, it was the methods used that failed, not I that failed). In the end, all those methods of weight loss did nothing for me but make me fatter and worsen my health and well-being in the long run.

Third – You tell me that it's just a matter of eating less and moving more. Fine. I want to know how I'm supposed to exercise when I'm in excruciating pain after standing for less than 5 minutes or walking for less than 1 minute when you refuse to prescribe anything for pain that's stronger than relafen (which doesn't even begin to touch the pain I have).

Fourth – You say I probably have fibromyalgia, but you aren't willing to do anything to try and treat it. I asked for a referral to a rheumatologist, and you told me there was a 6-month wait, and I got no referral and I'm still in pain. You haven't suggested a pain clinic or anything but weight loss.

Fifth – You said you would send me to an in-patient weight loss clinic. You act like I don't have a life, that I can just up and leave my husband, my house, and my pets for a couple of months. My husband has type 2 diabetes and I'm the one who plans the meals and the grocery list to control his diabetes. I give him his insulin shots and I'm the one who knows how much he needs of each insulin. I also do the budget and pay all the bills for the household – my husband doesn't have a clue how to do any of that. I balance the checkbook online. If I'm gone for a month or more, there is no one to do any of that for him, but you seem to think that's fine, as long as I lose weight. No thank you, I'm not up for another failed diet attempt, been there done that too many times.

Sixth – Did you even realize the congnitive dissonance in your statement that you know that weight loss surgery doesn't work for everyone but you think that putting me on another diet will work? What part of “I had a VBG, lost weight, and gained back more than I lost”, which is definitely a plan with calorie deficit in mind, do you not understand? Why do you think that another diet will work when weight loss surgery didn't? Do you just keep pushing “calories in/out, eat less/move more” because you don't have any other ideas? Look up the study that Stunkard and McLaren-Hume did back in 1959 about the efficacy of weight loss diets. Look up the studies done by Kramer, et al, Stalonas, et al, and Graham, et al. Every one of those studies shows that diets don't work for at least 95% of people in the long term. The Stunkard study has been around for more than 50 years, probably longer than you've been alive, and you're still recommending something that doesn't work, along with most of the other doctors out there. Talk about insanity. If you don't have a solution that works better than a diet, then I suggest you don't push diets and focus more on what can be done to improve your patients' health. Are they eating a wide variety of foods, do they move their bodies in ways that they enjoy, are their numbers good? If the answers to all those questions are yes, then they don't need to lose weight, and you need to look for the real cause of whatever problem they're presenting to you instead of blaming it on their fat.

The definition of insanity is doing the same thing over and over and expecting a different result every time. Sorry, I've stopped the insanity of dieting. Every time I've dieted, no matter what method I've used, it's failed. Why should I keep trying the same thing over and over again, when I have more than enough experience to know that, in the long run, it won't work? Have you ever had to diet to lose weight? And I'm not talking 5 or 10 pounds here, I'm talking 50 pounds or more. If you haven't had to lose that much weight and try to keep it off forever, you don't know what you're talking about when you say it's calories in/calories out, eat less/exercise more. I don't care that you're a doctor and went to medical school, you haven't lived it so you don't know what it's like to be called a liar and told that your experiences don't matter or aren't real.

When this is what one hears from doctors one's entire life, is it any wonder that one gets fed up and says “No more, I've had enough!” and walks out? This is why I hadn't been to a doctor for so many years when I first came to see you, and it's why I won't be back to see you again. I'm tired of being discounted and told that if I would just lose weight, all my problems would magically disappear.
Been there done that, and guess what? I was still in pain.



ETA: I added some information about studies to item 6 in the letter, and changed it from probably won't be back to see her to won't be back to see her before I printed and sent the letter to my ex-doctor.

Wednesday, November 10, 2010

My doctor sucks and is no longer my doctor

Well, I made an appointment to see Dr W today and ended up walking out before it was over. I went to see her because I've been having vaginal bleeding, off and on, for the last 2 1/2 years. I saw the clinic's gynecologist 2 1/2 years ago when the bleeding first started, after the dildo cam couldn't find anything. The gynecologist didn't find anything either when he did the endometrial biopsy.
I've been taking Relafen for arthritis pain, and Cymbalta for depression/fibromyalgia for almost 3 years, and last week I googled drug interactions for those 2 particular drugs. Guess what one of the side effects is? Vaginal bleeding. Now, I quit taking the Cymbalta about 4 months ago because of the side effects it has on one's sex drive (and most antidepressants will kill your sex drive, so you get to choose between being depressed and having sex, or not being depressed and not feeling like having sex - some choice). But the vaginal bleeding, off and on, didn't stop. So I googled Relafen and side effects from it, and vaginal bleeding is one of them (granted, it's not a common side effect, but it does happen).
So I go in and tell my doctor all this, and what does she say? "I don't think the relafen is causing the bleeding, I think you need to see the gynecologist for another endometrial biopsy to rule out endometrial cancer." I ask her about the fact that the gyno said my cervix was stenotic, and she said that's not a factor, that I could still be bleeding from my uterus (all this without doing an exam). I told her that I had stopped taking the relafen, and hadn't been taking any NSAIDs that acted as blood thinners because of the bleeding, and would she prescribe something else for the arthritis pain. That I was tired of being in pain all the time and the relafen just wasn't working all that well. She said she wouldn't prescribe narcotics - I wasn't fucking asking for narcotics, I was asking for something that worked better than relafen or ibuprofen and she wouldn't even consider anything else. She said maybe it was time to see the orthopaedist again and see what he had to say about my knee if the cortisone shots and Syn-Visc shots weren't working, maybe he needs to scope my knee. WTFE, I'll make an appointment with him and see what he'll prescribe for the pain, he may be more reasonable than she is (he usually is pretty good, and doesn't seem to be fat-phobic).
So I asked her about the fibromyalgia pain too. I told her my body felt like one big bruise and that it hurt for the cat to walk across my legs, and that shouldn't hurt (granted, Marty is a 15 lb cat, but still). That I was tired of being in pain all the time. By this time, I was in tears, because she was basically ignoring anything I had to say, like I didn't know my own body, and didn't know what I was talking about. She said that I could get mad at her, but my weight was causing a lot of my pain and if I would just lose weight, the pain would go away. I asked her what more I was supposed to do - diets hadn't worked, phen-fen hadn't worked, and the WLS hadn't worked. I want to know since when has it been that being fat caused fibromyalgia and arthritis? If being fat causes those diseases, then why do thin people get them?
She said she'd send me to an in-patient program to lose weight, and I lost it. I said "I've had it, I'm done with this." I got up and walked out and I'm not going back to see her ever again. I'm done being blown off and treated like a child who doesn't know shit from shinola. She doesn't seem to give a shit that I'm in pain all the damned time, all she sees is a fat woman who refuses to diet and get thin to suit her idea of "healthy" (BTW, my blood pressure was 124/67 this morning and my weight was the same as it has been for the last 3 years). So fuck her and the horse she rode in on and the fleas that rode in on it. I'm looking for a new doctor and she can take her "healthist" attitude and shove it up her ass.

ETA: For the privilege of being treated like a child and having my concerns blown off, and being told that if I'd just lose weight my pain would go away, my insurance is being charged $135.00 (and we wonder why health care is so expensive.....)