Wednesday, June 26, 2013

Big Round Numbers & Getting Doctored

I saw my endocrinologist this morning.  She's busy, in the manner of research-hospital doctors, and so her nurse does the check-in stuff before she arrives for the consultation.  Weight, blood pressure, pulse.  I got on the scale, and the nurse, whom I like, put the big slider in the 150 notch.  Lady, are you kidding?  I got flustered, and managed to convey in some agitated precaffeinated sentence fragments that it was in dramatically the wrong place—it needed to be two notches up.  I've been hovering just over 250 for the last couple months.  She moved it up, then tapped the top slider down, and down, and down.  The balance didn't budge until it hit the far left side of the bar.  So she moved the big slider back down a notch.  Tapped the top slider up to the right of the bar.  "Looks like that's 250 even," she said.

That number is a big deal for me.  It is the bottom of my adult range, one of the foci of my elliptical weight cycles.  Seeing it gives me a flare of the old sense of thrilled achievement, and a more contemporary uncertainty about the unknown (what happens now?), and a sense of dread: the ghost of the historically-accurate sense that what comes next is that I gain fifty pounds.  After the appointment, I sat on a bench outside Central Park and it was this number that occupied my brain.  The big round number, the broad strokes of its categorical divisions.  And the absolute blank of being smaller than this.  I haven't been since I was maybe 14, 15.

"You lost a big chunk of weight," my endocrinologist said, when she sat down with me.  It had been a year since last I saw her.  I said, "I think it's more like a little chunk."  She said, "Looks like a lot."  She looked back at the chart.  "Thirty-something pounds?"

And again, when we were discussing the possibility of adult growth hormone therapy (my growth hormone levels are quite low, which they have been since I was a child—I had to give myself  daily injections of growth hormone for several years, without which I might never have had the adolescent growth spurt the delay of which triggered the diagnosis), she said that "It would make it easier to gain muscle and lose fat—which is always good—and you'd probably notice an increased sense of physical well-being."  "Which is always good," I added.  She turned towards me and leaned in when she spoke that aside, "which is always good," and her tone changed, became more colloquial.  It sounded like lady-to-lady talk, just the usual sort of stuff.  She said it the way someone would say, "I'll order dessert if you will," looking conspiratorial.  It was social bonding.

I have to fight my tendency to feel warm and complimented in these situations, when I am on the right side of the weight-loss talk, when someone's patting me on the back for being a little smaller than before.  I try to do that because obviously the fat-bad-thin-good thing is bad for me (and for you too!), and because I'm (still) a fat person.  Because as a fat person, even a somewhat-smaller-than-before fat person, I am necessarily negatively affected by a medical environment that substitutes treatment of weight for treatment of specific health conditions (some thin people are also negatively affected by that substitution).  That substitution enables what's actually wrong with me to be blamed on fatness, and ignored until it is more serious.  This has happened to me before—my cholecystectomy would have been way less painful, dangerous, and life-disrupting if it had not been an emergency surgery, and it wouldn't have been an emergency if my doctor at the time had diagnosed it correctly when I took my symptoms to her the first time.  (She thought it was binge-related acid reflux.  She felt really bad afterwards.  I was not, incidentally, binge-eating at the time.)

Because this weight-loss back-patting felt social rather than medical, I don't actually think that this will negatively affect my medical care, which is why I didn't feel inclined to press the issue (also because I'm not invested in my social relationship with my endocrinologist).  This doctor has been quite skeptical of the lose-weight recommendation for polycystic ovarian syndrome (which syndrome is the reason I see her).  Our very first session, I asked directly what the relationship between body fat and PCOS symptoms looked like.  She was frank: she said that we did not really know.  That fatness is one of the diagnostic criteria of PCOS because it frequently co-occurs, but that in fact the medical definition of "syndrome" specifically means that causality is ill-understood.  That I could try to lose weight, but that it might or might not help, and that the syndrome would make it more difficult.  (She also mentioned that it would be good for my hormonal regulation to add muscle mass, which is when I started precontemplating lifting.  Bless her for this.)  And in this appointment, there was no sense that, well, weight loss, good, everything must be in order.  In addition to the GH thing and the usual check-in exam and blood testing, she wanted to do a thyroid test and to start me on a vitamin D supplement.

The only place that I felt a potential overlap of fat stuff and actual treatment was when she was looking over the history of my blood tests: "Your glucose has always been fine.  Your cholesterol's been rather impressive."  I don't think any of my signals of good health—blood glucose, cholesterol, triglycerides, blood pressure, pulse—would be "impressive" if I were not a fat person.  They are "impressive" because they are surprising.  But for whatever reason, maybe because she was engaged in a close examination of my actual (good) health indicators, this did not ring my bell too badly.

So I am not going to soapbox if it doesn't feel necessary.  I'm at a place where these kinds of remarks don't shake me up (at least in this situation, where I have a doctor whose medical judgment I trust and who I know likes me)—they don't feel degrading or dismissive, they just feel like a little irritation, easily sloughed off, created by a routine stupidity to which doctors are as vulnerable as the rest of us, being, though doctors, still humans in the social world.  I don't need to change this woman's mind like I needed to change my high-school doctor's—both because the misdiagnosis thing demonstrated the consequences of her beliefs and earlier and perhaps even more significantly, because she was responsible to my parents, not to me, and when she fueled their fears of my fatness, my life got increasingly unpleasant.  But, happily, I'm a grown-up now, and I can pick my doctors, and I can pick my battles.

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