One of my greatest fears is telling someone who’s supposed to be there to help you about a problem and being blown off. I sometimes feel my troubles aren’t valid or important enough to bring up in the first place. Even when I know intellectually I need to speak up, it is hard for me. Being non-confrontational to the extent I am, making my needs known feels like confrontation. Aware of my difficulties, I screw up my courage to do what I have to do. The experience is seldom as bad in reality as in my anxiety imagines.
Once in a while, it is every bit as bad as I fear.
When something is hard for me to write about, I know it’s also important to write about it. So, here goes:
I had an appointment Friday with my primary care doctor. I had seen her only twice before, once for a new patient appointment (or please, doctor, refill my prescriptions) and for a pap smear/pelvic exam. I don’t like going to the doctor in large part for the reasons explained in the first paragraph, plus I wasn’t raised going to the doctor for every little complaint.
When I scheduled the appointment in question, I used the office’s online appointment system to leave a detailed note about the things I hoped to discuss. I’m better at explaining myself in writing. It was comforting to think the doctor might already have an idea of the symptoms and what I thought of them in light of my medical and family history.
The major catalyst for making an appointment was pain I’ve been experiencing in my right shoulder and, to a lesser extent, my elbow and wrist. It started a few weeks before Christmas. I’d been shaking it off, taking Motrin, and living from hot shower to hot shower. Now, I knew full well part of the problem was all the sewing projects I’d been working on. If I didn’t do anything for a couple days, it got better, but I mean laying off computer use and not being at work, too. Not practical. Even if medical science couldn’t do more than diagnosis the problem and tell me to continue taking inflammatory medications as needed, it hurt enough I wanted to know what is going on.
I had also been putting off doing something about my quality of sleep. I have sleep apnea. Getting diagnosed and bring home a CPAP machine in early 2009 changed my life. I never imagined it was possible to wake up refreshed. Based on snoring, we can assuming I’ve had apnea since I was a child. I can remember being fatigued in middle school. I suffered migraines. Lately, I’ve been tired after a full night sleep and waking up with headaches far too often. It’s time for new equipment or, my preference, following up with an ear, nose, throat doctor as recommended in my original sleep study reports to check for physical obstructions. At my first appointment with my current doctor, she commented on my large tonsils and she was not the first medical professional to take note of them. If it is possible getting my tonsils removed could resolve my apnea, surgery is a no brainer, but I need a referral to the appropriate medical professional.
I told my story about the shoulder, elbow, and wrist to the nurse and then the doctor. I explained I was concerned by my family history of osteoarthritis with likely connection to dwarfism in our direct familial line. My mother had both of her hips replaced at forty-seven years old. Every joint in her body is impacted. At the time of her diagnosis, around ten years before her hip replacement, doctors told her she had the hips of an eighty year old, nearly bone on bone. Maintaining the privacy of the rest of the family, I will not give additional details here, only to say I have second and third degree relatives with even more serious cases beginning at extreme young ages. Simple logic, looking at family history and similarity in body type, tells me it is likely I will inherit some level of difficulty with my joints. I do experience stiffness unusual for a thirty-one year old woman, as I explained to the doctor, but the pain is new.
The doctor listened to what I said, then examined me by testing flexibility and strength in my hands and arms. I’ve always been pretty darn flexible for a fat chick, so I have a full range of motion. It doesn’t all feel good all the time, but I know enough to know gentle stretching, even when it’s uncomfortable, is good for my long term mobility prospects. I let her know, at a couple points, what she was doing didn’t feel good.
After the physical part of the exam, she asked about my working conditions. I answered and volunteered the fact I spend a substantial amount of time on the computer and explained about my sewing projects. She suggested rest. Again, impractical. She did not seem interested in my commitment to make costumes by a certain date. She asked which pharmacy I wanted her to send an order for prescription strength Motrin. I would have declined anything stronger, so that was fine. I have no desire to be doped up.
What wasn’t fine was how finished she was with my concerns. No mention of what I’d told her or even a suggestion something other than arthritis. Carpel Tunnel Syndrome or simple tendinitis, perhaps. You know, a diagnosis or speculation on a diagnosis with follow up testing.
At this point, I’m sitting on the exam table wishing I’d hadn’t booked the appointment in the first place.
I felt foolish. My opinions and insight weren’t even worthy of discussion. Am I blowing things out of proportion? Is it all in my head?
Instead of shrinking back, I asked her again about the possibility of arthritis.
She preceded to tell me I was too young to have arthritis, but if I don’t loose weight I may eventually develop trouble with my hips and knees. Hips can be replaced, she agreed, but “natural ones last longer, don’t they?” All I could muster to say in response is “that depends” thinking of Mom how long she was in pain before she got her hips replaced. As if to humor me, she offered to order an x-ray of my shoulder.
Already frustrated, I was still determined to handle both problems I’d come in to handle, so I brought up how tired I’d been and requested a referral to someone to evaluate me for getting my tonsils’ removed. Again, I felt like what I said didn’t matter when she referred me to a sleep specialist and told me they would let me know about that. Not as bad as the “if you stay fat, you’ll hurt your joints” dismissal, but insult to injury. The assumption that sleep apnea is caused by excess weight is common and sometimes true especially in those who carry fat around their necks. My situation might be exacerbated by weight, but I was an average size child who snored like a bear with a sinus infection.
For me, it was the last straw. I didn’t tell anyone at the doctor’s office, but I am not going back.
I am not in denial about my weight. I understand my health problems, statistically, would improve if I lost weight. I live in modern America. The message is rammed down my throat constantly: thin equals healthy. I don’t buy into the message in totality, but I want to work on my fitness level and eat better.
I also know myself and my body. When I am not sleeping well, I use food and caffeinated beverages to keep functioning. When I’m well rested and in a positive frame of mind, I make choices which lead to pounds dropping. Science supports both the sleep deprivation in general and sleep apnea specifically as leading to weight gain. I also have low thyroid function and several other markers for polycyclic ovarian syndrome. Even with medication, it makes loosing weight more difficult. Obviously, my poor eating habits are a factor I need to overcome and I do accept responsibility for them.
What I find unacceptable from a medical professional is a judgement based on weight. All the more frustrating when my medical problems are one of the reasons I’m overweight. I don’t expect a layperson to understand, but a doctor should be interested in treating medical causes of weight gain. Even if I looked her in the eye and told her I’m perfectly content to weight 230 pounds, those medical conditions require attention and impact my quality of life.
It was as if my medical issues weren’t worthy of investigation or treatment because I am fat.
The worst part, still, was those fears coming true, that in the eyes of the powers I don’t need what I think I need, my problem isn’t important, my experience isn’t valid.