Dr. Rob's Blog post on obesity picked up by NYT

[Sylvia3]

They posted my blog!!!

 

772.July 24th,

2008

11:35 pm I have read through all of this and it is a really charged topic.

 

I want to address this to all of you caring doctors struggling to do the right thing.

 

Talk to us! Don?t hesitate and personally, I don?t really care how you bring it up. Here?s the thing, I might cry, it may be uncomfortable for you because I am crying but I can talk and listen and cry at the same time. It?s not that big a deal.

 

Then LISTEN. Really try to get past the judgement that is stuck in your head from the last patient that looked like me who lied to you about her intake or the one with diabetes that never really followed your instruction. LISTEN. You may learn that I am doing the right things and there may be an endocrine problem or that there is an emotional problem festering below the surface or that my appetite is out of control, these are the things that need to be adressed and these are the things where you can make a life changing difference.

 

I don?t think that obesity is not a disease. It sure is a pretty big symptom though.

 

Imagine I came in to your office, thin, attractive with a really deep tan that can only come from 3 hours a week in the tanning bed. You would say something. You would tell me about skin cancer, premature aging and long term danger. You wouldn?t say I look too dark.

 

Most likely it would be ?So, do you want to tell me about your tan??

 

Same thing.. ?Do you want to discuss your weight?? (Then I burst into tears?) That wasn?t so hard was it?

 

I saw a new doctor who said that very thing? ?Do you want to talk about your weight?? True to form, I burst into tears. Then told her about 5 years of gaining crazy amounts of weight, food diaries, diet doctors, marathon training and was surprised that I was tearing up more out of relief that someone wanted to hear about it more than the shame. Shoot. I KNOW what I look like! I KNOW where I shop!

 

She LISTENED and then sent me for some labs and told me to go home and look up Cushing?s disease.

 

I am one of those, gained all kinds of weight from a little tiny pituitary tumor. I also have all the horror stories of the doctors that lectured and passed judgement. I could have avoided years of pain and abuse if one of the earlier doctors had listened but my point isn?t to bash those doctors. They aren?t reading your blog. They aren?t worried about trying to get it right or do it better. Besides, everyone has a similar story about a bad airline flight or shopping experience. There are a lot of folks out there that don?t help. There are a lot that want to. I see the struggle you are in and appreciate it.

 

On the other side of it. As your patient. I need to do my job. No matter how much I don?t like it, I should be dead honest with you. Hopefully, there is a relationship that is neutral and not judgemental where it feels safe to be honest but we are human. Even if I know you won?t like it, I owe it to myself to be honest and to give you all the data I can so that you can help me. Doesn?t matter if we are talking about pain killers, depression, sleep, sex whatever. As your patient, I know you aren?t psychic. I want to be healthy and if I want to be coddled I can go to the spa.

 

I will keep up my end of the bargain and be as honest as I can no matter how hard. You keep up your end and listen.

 

? Posted by Sylvia

[MaryK]

A few weeks ago I had Mike and his little brother Joe at the primary doctor for some routine things. I wanted a height and weight check for Joe because his weight has started to move to a higher percentile, but not his height. Much the same story as Mike's big change at 5 y.o., but it is just coming a little later for Joe. Mind you, I wasn't looking for any discussion, or lecture, I just want the numbers documented so I can decide when it is time to take Joe for an endocrine evaluation.

 

Well, this primary doc is the one who got me started down the path for Mike back in 2005, so I doing have a basic underlying respect and gratitute about him. When he plotted Joe's current height and weight on the growth chart, he looked at me and said, "This is concerning." The next thing I expected was for him to suggest that Joe be evaluated by the endo, too. Well, no, that wasn't his point. He started in on the diet and exercise speech. He asked me if we have things like chips, cookies, icecream, pop in the house and the way he asked was like he knew the answer was yes and he was trying to get me to admit it! I couldn't believe it, although you'd think I would have learned by now what to expect. . . . Well, I gave him the usual response, my kids only get those things occasionally like all normal kids, we do not keep our shelves stocked, etc. I was so annoyed.

 

Here's my plan for the next time this happens. Either I am going to start a long dramatic rant and say, "Oh yes, you are right, I feed my kid chips, cookies, ice cream, sugar pop, juice, as much as he wants, all day every day and he LOVES it." When the dr looks at me like I am crazy, I will say, "Well that is what you believe, so why do you even ask me these questions? You don't listen to what I tell you, you just assume because you can see that I am fat, too, that I must not provide my kids with healthy food." Or, I am going to politely (or not so politely) tell him that I am only there for a height and weight check and not for a nutrition counseling session, so I will not be discussing this with him today. We'll see how my mood strikes me the next time this happens!

MaryK

[judycolby]

What's really upsetting is when the doctor is as big as the patient, yet insists that size (overweight) is the cause of all the patients problems. Wonder how the doctor still feels good.

Judy

[staticnrg]

Ah....I posted to the medpage article, Sybil. You posted to the NYTimes article. Mine still isn't showing.

 

I doubt it will.

 

Hugs!

Robin

[casperslove]

I read through more of the replies. This is really more of a one person at a time ordeal. Because as a whole, even tho it's become a huge deal - they still don't seem to get it. I saw one post that struck out at me.

 

If a person smokes, the doc should tell them not to smoke.

If a person drinks, the doc should tell them not to drink.

If a person has bad teeth, the doc should tell them to brush/floss more.

If a person is fat, the doc should tell them to quit eating so much and exercise more.

 

Sad thing is it's still not about those specific things all the time. Maybe people smoke and drink to feel better about something. Maybe a person has bad teeth because there's something else going on that's causing their teeth issues? And then of course the whole fat thing. If they look BEYOND the obvious and see if there's something more, they might get answers. But most docs aren't willing to look that deep. And yes there are exceptions. It's those exceptions that are hurting the rest of us.

 

I actually got from my dentist recently that my teeth in the back are not doing so well and they told me it's cuz I don't take care of them. Uhm. Excuse me? I have NEVER had a cavity and am very conscious about my teeth. I explained to them about the steroids and what it does to your body - including teeth/gums. They didn't care and thought I was just making excuses. Talk about makin' someone feel bad.

 

One person at a time. That's all *I* can hope for.

[buchlais]

I haven't read the blog or the articles, but judging from your comments here, I can say that I have fallen into the 'mental illness' basket, and I can't get up! basically, I have been taking antidepressants for about 15 years or so... if my ADD memory serves me right... and I have been treated for hypo-thyroid for 22 years. unfortunately, in the last 4 or 5 years, my symptoms overlapped, or the causative agents did, or maybe I had a nervous breakdown or temporary cortisol sickening... or something - but because I was so sick, and under a great deal of stress, partly from no longer holding down a 55k/year job... or any job... I was on state assistance...and I wasn't getting to the Dr like I should have...

 

my thyroid t3, t4, tsh came back in the range of normal... So rather than looking for other sources of my problems and symptoms, I was determined (randomly) to be having some sort of stress event, or psych thing... and no-one but Dr. F thought to check for hormone imbalances and Hashimotos. I think I was actually as close to death as I could ever hope to be with out actually seeing the white light and the outstretched arms of my mother and grandparents...

 

I was sent home, still sick and getting sicker, and finally y partner - out of town caregiving my mother in law, asked, and My sister with acromegaly came and helped me, and I started to get better, We ate real meals, and I think I took my medicine every day.

 

The stress, though, continued, in the form of an awful 'horror' of 5 brother-in-laws launching a full scale 'gas-lighting' campaign against my partner and I and their mother - and if that wasn't bad enough, they also started a legal attack, trying to rob her grave before she was even dead! ... the legal battle ended last week on July 22!!! three years and 3 months to the day after it began, and one year & 3 months after my mom in law succumbed to the combined effects of high dose, long term prednisone treatments , the side effects of which were then exascerbated by stress, mrsa infection, the treachery of her sons. I was there for the death of a wonderful lady - my mother-in-law, and I can say this, I would never recommend a person of 82 years of age embark upon a 2 year treatment of prednisone starting at 60mgs per day... especially if you had to defend your sanity to your sons and a judge....

 

Anyway, maybe my point here is that prednisone is a deadly cure, 'matricide' lives, and stress and depression don't always point away from endocrin disorders.

 

I don't know what many in the medical profession think, and frgive me, and correct me if I am wrong, but I believe that so many are taught, or quicky learn, that a sort of medical diagnostic short-hand is expedient, and they can feel good about their 'diagnosis', which will certainly fit in with statistical significance, the bills will be paid, and they can move along to their next patient.

 

Like any of us, they have a hundred other issues on their mind, valid or invalid, right or wrong... and to find the quicker way, the usually correct way, the way that worked fine last time, that will save them from pretending to listen for the five milliionth time to another drawn out story/fib/exaggeration/outright lie... It doesn't fit a good business model to take the time to listen to 6 - 10 years of shame, heartache, loss, confict, resentment, confusion, fear, desperation, and doubt, from each and every patient. The bottom line has become the maginot line, the Berlin Wall, the Iron Curtain, The Great Wall of China...

 

But the shining golden light, the hope and the belief that truth and goodness live on: There are Drs like Dr. F, and I am sure many others, and many nurses, office staff, and folks I wouldn't even know to mention, who are extraordinary, who do care, and who do listen. They are out there, and many of them live on these posts, and answer our questions, and look up things for us all, and work all hours to make this incredible web site... and for that, I am truly grateful, and for sisters with rare and painful, and incurable diseases, who come to the desert in the middle of the hot summer, and bring me out of my stupor and insist I see Her Doctor, the one who wasn't afraid to diagnose her, and treat her, and use tape recorders, and email, and faxes, and work with labs local and across the country... who wasn't in competition with anyone, had nothing to prove to anyone, but if they needed proof, he had plenty... There are those people, and ;peole like you, and maybe even me, who really want to help, and want to be helped. anyway, It must be getting late and my ADD medicine must ave worn off, since I am running on at the mouth here.... Thanks for reading this all.... It matters, it matters alot, to me!

 

Thanks a bunch