Adipose Animosity: The Doctor Will Humiliate You Now

When even those who are simply average sized can be subject to fat jabs from the media, the climate is set for an open season on prejudiced behavior towards larger people. I have said before and will say again, with the vehemence I have seen expressed towards plus sized individuals, I think that if those making the hateful comments dared to be truly honest, they would state that they think that the heavies among us should be sent to the showers, and I'm not talking about the showers at the gym.

I'm talking about Zyklon B, and this is no exaggeration. Today's world promotes the idea that anyone who isn't rail-thin is a vile abomination, the antithesis of all that is good and beautiful. And then it is open season for everything from mean jokes to vicious judgmental assessments of larger individuals. Were similar remarks to be made against persons of a given race or with a visible physical handicap, it would rightly be deemed unacceptable. But we still have a long way to go when it comes to not making life miserable for persons of larger size, for those with mental illness, and for homosexuals and transgendered individuals.

While I do not expect to see enlightenment from Twaddlehead Troll slinking around the Internet making hateful statements wherever s/he/it can, I would like to see some enlightenment from the medical community. For my own part I tend not to seek medical attention because I am humiliated by the way I am treated regarding my size. I stand approximately 5'5" tall and weigh about 250 pounds. I am not pleased by the fact that things got to this point, but there are various reasons for it. I am not attempting to deny my own responsibility when it comes to my weight either. However, at this point, it is what is, and no-one should be denied courteous and compassionate medical care.

First, Do No Harm is a blog addressing the ways in which fat prejudice in the medical community harms larger patients. People send in their stories of how doctors have misdiagnosed them due to blaming whatever their complaint is on their size. As I mentioned before, for my own part, I am extremely reluctant to go to the doctor, because the first words out of their mouth are inevitably going to be "you need to lose weight."

I recall on one occasion going to the doctor because I had a sinus infection and my sense of smell had completely disappeared. After telling me that the standard operating procedure no longer involved use of antibiotics and giving me some sample decongestants, the doctor proceeded to bring up my weight and the fact that I really needed to start working on weight loss. I was not there for diet advice and I was certainly not there for humiliation, although I did receive these. I was there about my sinuses. Period, end of story.

I was first diagnosed with hypothyroidism when I was 16. My thyroid levels are slightly low. A normal TSH reading is .5 or less. Mine is .7 and when looking further into the situation, it is found that I produce adequate T4, but it does not properly convert to T3. I took Synthroid for a while when I was younger but went off it at the same time as I went off Propranolol, which I had been taking since the age of 16, as prescribed for a fine tremor in my hands. Not surprisingly, I had no energy. So when I was 32, I decided to discontinue both of these medications.
At the age of 42, my current doctor again put my on Synthroid, which seems to be the standard prescription for almost all hypothyroid issues. Synthroid, however, is T4. After three months on .25 mcg of Synthroid, my labs showed no change in my TSH, so the dose was raised to .50 mg. In another three months there was still no change and the dose was raised to .75 mg.

It was two or three weeks after beginning this new dose when a frightening thing happened. I was driving my son to school when I began having the worst panic attack of my life. I was sweating and shaking and my heart was pounding. I had to pull the car over. I thought that I was going to have to go to the emergency room. There was nothing to precipitate this panic attack. I had been feeling fine. Fortunately the attack subsided enough that I was able to get my son to school. When I got home, I used my blood pressure monitor and found that my blood pressure was elevated to 152/98. A normal reading is around 126/84. I immediately telephoned the doctor for an appointment.

To this day I am appalled that the doctor never looked at my medications to determine whether or not they could be causing a problem. Instead, he told me that the elevated blood pressure was due to my weight. He prescribed Propranolol for the blood pressure and Clonazepam (Klonopin) for the panic attacks. Far from making things better, the Propranolol tanked my heart rate to around 40 BPM and I began having respiratory difficulty. The Klonopin turned me into a zombie and when it wore off, the panic attack I'd had while driving my son to school seemed like a walk in the park. This one nearly drove me to my knees and had me wishing that I'd die. Rather than running screaming down the hallways of the retirement community where I work night shifts, I somehow found the presence of mind to go into the med room and take my blood pressure.

The monitor showed it to be 198/102. After about 20 minutes, the panic attack began to subside and I took it again. It had gone down to 152/98. I was horrified. I knew that I could never again take Clonazepam. I had actually asked the doctor for Diazepam, which is the only benzodiazepine that does not cause me to either have rebound panic attacks or to become suicidal. Instead, it just makes me stupid as a box of rocks. But because I asked for Valium, the doctor assumed I like it a little too much and refused to prescribe it to me. The facts are, I do not like anything that makes me feel like I have the IQ of roadkill. The last prescription I had for Valium ended up expiring. That's how seldom I take it.

I will always be grateful for the day that I had a conversation with my mother regarding my situation and she told me that when the doctor had increased her thyroid medication, her blood pressure had gone up. I was elated because I now knew the reason for why I was suffering this way but furious because the doctor had never considered that my elevated blood pressure was being caused by my medication. He instead assumed that it was being caused by the fat cells on my butt. I called the doctor to make an appointment and I ceased taking all the medications. I felt better within the week. When I went in, I told the doctor what had happened. He never apologized, but he agreed with me that I should never take any of these medications again and indicated this in my chart. It took a month for the panic attacks to completely subside and three months for my blood pressure to return to normal.

The upshot is that the Synthroid caused me to go into a state of artificially induced hyperthyroidism. The symptoms of hyperthyroidism include elevated blood pressure, heart dysrhythmias, temperature elevation, and panic attacks. At worst, this situation could have developed into a life-threatening crisis called a thyroid storm. The symptoms of thyroid storm can be found on the page at E-MedicineHealth.

I find the number of stories by larger people describing problems that could have been resolved within a reasonable time frame had medical personnel looked at something besides their size very discouraging. In my eyes, this is medical malpractice.

I was once asked if there were "very many fat old people" where I worked, the assumption being that large people do not live to old age. I said that there were about an equal number of people on the more extreme ends of the spectrum, either very large or very slender, and that there was about an equal incidence of diseases such as type II diabetes, heart disease, hypertension, high cholesterol, and respiratory problems in both the slender and the large people, which would indicate to me that these are diseases in which there are higher incidences as people age and that size does not have a great deal of bearing on whether or not a person will be affected by these conditions. The difference that I've found is in diseases affecting the skeletal system. Very slender people tend to be more prone to developing severe osteoporosis and very large people tend to develop problems with osteoarthritis in the lower extremities. Carrying around excess weight causes problems in the knees, hips, and ankles, but tends to forestall osteoporosis.

For my own part, I realize that I have issues relating to food and that I would be better off if I ate less and exercised more. This aside, I would also be more likely to seek medical attention if I did not have to fear humiliation for my size every time I stepped into the doctor's office. My basic readings are always fine. I do not have hypertension, high cholesterol, heart problems, or type II diabetes--which, by the way, are problems that should be screened for in people of any size.

I wish there was a way to get the message out to medical personnel: your patient is a person, not a number. Treat him or her the way that you would like to be treated, and he or she will be more likely to hear what you have to say. However, when the first words out of your mouth are always "you need to lose weight" regardless of the presenting problem, the listening usually stops. And if the person has come to see you regarding weight loss, then s/he already realizes the need to lose weight. No need to state the obvious--instead, present the potential solutions.
Perhaps one day it will be recognized that condescension is not an effective tool in motivating people to make positive changes. Until then, larger people will continue to dodge the doctor. Because no-one likes being made to feel bad about themselves.