June 16, 2001
Health
Well it's certainly been a very active Saturday, at any rate. I finally decided it was past time to get off my ass and start some sort of exercise (more on that in a moment), so I went to an aqua aerobics class this morning. At 9 am. It was quite enjoyable, actually. The funny thing was, I didn't think I was especially tired until I got out of the pool, then I wondered if the rec center would mind if I just collapsed in a heap on their pool deck for a couple of hours.
As much as I wanted to, I couldn't stick around to find out, because I'd planned to go see Tomb Raider and Atlantis this afternoon. Ironically, Tomb Raider was the one I'd wanted to see most (because Angelina Jolie is goddess-like, despite horrendous taste in men -- one can only hope her taste in women is better), but I ended up enjoying Atlantis more. Tomb Raider isn't bad, it just isn't great. It isn't much of anything, once you get past Angie duplicating Lara Croft's moves from the video game and shooting up everything and the very nice accent. I enjoyed it, but I imagine I'll forget huge chunks of it by tomorrow. Atlantis, in contrast, had considerably more personality. Also not a perfect movie -- it could have stood being about twenty minutes longer -- but more engrossing than Tomb Raider. Both movies, however, just made me want to go see Moulin Rouge again. Or Memento.
So, the exercise thing. I've said for about a year now "Boy, I really need to start exercising. I'm a slug!" I've also said, "Hey, I should go to the doctor for a checkup. It's been a while." I did neither. Then, over the past nine months or so, I've started to develop a few symptoms that were worrying me. Could be nothing, could be something serious. My calves and ankles are almost always swollen -- that's why I don't like wearing shorts anymore. I sometimes have a problem catching my breath. There are a few others, but basically, after researching a bit, I got worried, as I have several symptoms of developing congestive heart failure and/or asthma.
So I decide to go to the doctor. My appointment was yesterday. For the most part it was typical. I brought up my concerns. I was given a very brief exam. Then it started, the bit I dreaded so much that it kept me away from the doctor for all this time.
"Well, the swelling in your legs and the shortness of breath are both due to your weight." Then she went on to explain what I already knew, about how the heart doesn't push the fluids out of my legs. I listened politely, then asked why this problem should have suddenly cropped up, when I have been large all of my life. "Oh, well that might be that your weight is catching up to you." (My mother used to always warn me about that. "Your weight's going to catch up with you someday, so you'd better lose it while you're young!" I get this mental image of me, dragging about 250 lbs. along behind me, my ass literally dragging, until I pass a signpost that reads "thirty", then it all rebounds like a rubber band and hits me in the back of the head, catching up with me.)
Again, still trying to be polite but assertive, I smiled and said, "So what you're saying is that the problem is with my heart, not my weight." Well yes, she said, but my weight was causing the problem with my heart. (And I didn't say this at the time because I didn't think of it, but according to the JAMA and NEJM, my lack of activity is far more a contributing factor of whatever my trouble is than my size.) She asked if I wanted to meet with their nutritionist, and I said no. I explained that I had been quite healthy when I was active, and wanted to reach that point again. I also explained that I had no interest in losing weight. She was rather taken aback, but didn't push. Finally she said that as far as my symptoms were concerned, she wanted to wait and see if increased activity on my part would resolve the problem.
That surprised me. I have been terrified that I might have CHF, and all she's telling me is that I should exercise more. Finally, I took a deep breath and said, "I'm not asking this to be rude, but if an 'average-sized' person came to you with my symptoms, would you simply tell them to exercise more?" Again, she was startled. She answered after a pause, "Well, yes, if their blood pressure was also fine." (Mine was 114/70.) I explained that I had to ask that, as I'm aware of the bias in the medical community, and that while I understand the risk factors of being large, I also did not want all of my health problems to be solely attributed to my size. Things got a little tense, and she said that I needed to see things from their point of view as well.
Then we went on to talk about my anti-depressants, as I want to go back on them. I told her of my success with Zoloft, and she recommended Wellbutrin. "It's a gentler drug," she explained, "and it often helps with compulsive behaviors like drinking and overeating." I am not compulsive when I am depressed, and I explained that to her. "Okay," she said, "but it helps with compulsive overeating." I repeated that I do not compulsively overeat when I am depressed. In fact, I don't eat much at all -- fixing food always seems like far too much work. "Oh," she said, then pressed on. "But you didn't have any problems with weight gain on Zoloft?" By now I'm thinking 'Okay lady, you made your point. I'm fat, and by god you want to find out why.' But I just smiled and said no, I didn't gain weight on Zoloft. "Oh," she says again, looking at me somewhat dubiously, "then we should probably stick with what worked the last time." What a brilliant idea. I'm so glad she thought of it. We wrapped things up before they got actively confrontational, and I left.
So on the one hand, I held my ground, and I feel damn good about that. Maybe, just maybe this particular physician's assistant will think next time about how she works with large people as opposed to "normal" people. But on the other hand, my legs are still swollen, I'm still worried about it, and I'm not sure that after a year of this a "wait and see" approach is the best. Not to mention that she didn't even tell me when I should schedule a follow up. I feel dismissed. I have a feeling this particular score reads: Lisa's Self-Esteem 1, Lisa's Physical Well-Being 0.
Posted by Lisa at June 16, 2001 04:39 PM
