Clean-ish bill of health.

[rivka]

I had a complete physical this morning for the first time in... jeez. I don't know. I don't take any ongoing medications and I've been able to have my Pap smears done by my midwives for the last few years, so I've just never been motivated to see my primary care doctor unless I was sick.

I saw her last month for an ear and sinus infection, though, and she pretty much made me sign up for a physical. I worked myself up into a minor state of stress beforehand, figuring that she would lecture me about losing weight and that I would need to figure out what to say to her.

Except for pregnancy - and literally just for pregnancy; I was below my prepregnancy weight a month after Alex was born, thanks to the revolutionary new "extreme stress verging on nervous breakdown" diet) - my weight has remained steadily between 165 and 168 pounds for at least the past seven or eight years. According to the BMI tables, this makes me 21-24 pounds "overweight," and 7-10 pounds shy of "obese." Since physicals are supposed to address ongoing health issues, it seemed likely that my weight would come up. I dreaded it.

"I'm not willing to consider dieting," I told the mirror in her office bathroom. "Research shows that 95% of dieters regain the weight within five years, and that repeatedly losing and regaining weight has more health consequences than staying steady at a higher weight."

Back in the exam room, the nurse checked my blood pressure (excellent) and pulse (excellent). My doctor came in and checked my blood sugar and kidney function with a urine dip test (normal). She went over my family health history, looked at my ears and throat, listened to my heart and lungs, felt my lymph nodes, did a breast exam, palpated my (pudgy) abdomen, asked about some weird little lumps on my feet, checked my standing posture, asked a couple of probing questions about my post-miscarriage mental health.

As we talked, she filled out a lab slip: complete blood count, cholesterol, comprehensive metabolic panel, thyroid level and thyroid antibodies (there's a family history).

I brought up my two health concerns: potential long-term damage from my acid reflux disease, and irregular menstrual cycles since my miscarriage. She was concerned about the first but not the second. Apparently I shouldn't be having any breakthrough heartburn when I take over-the-counter acid reducers - which I do, more often than not. She gave me a booklet on lifestyle changes and a bunch of free samples of Prevacid, and added serum amylase and H. pylori tests to my lab slip. I'm supposed to go back and see her in a month to get my lab results and discuss whether the Prevacid is working - she'll decide then whether I need an endoscopy. I'm relieved that she didn't send me for one immediately. (She's usually very big on precautionary testing.)

Her major concerns:
1. I always need to wear my orthotics, because my feet suck. (She was a physical therapist before she went to med school.)
2. We need to get my reflux under control.
3. I need to try not to be anxious and stressed-out about conceiving again.

That was it. Not a word about my weight.

I suppose that she may be waiting to bring up weight loss until she sees the results of my lab tests. But they weighed me, and that would've been enough ammunition for most doctors. So yay, for now.


("But don't you realize fat is unhealthy?" Before posting a comment to that effect, please click here.)

Comments

[chargirlgenius.livejournal.com]

I hate it when doctors tell me that I need to lose weight. Duh, I'm intimately aware of how much I weigh and how much I should weigh, and how much I could realistically weigh (even considering your article - interesting reading!). "Lose weight". Really? No kidding? I didn't realize that if I ate too much I might be overweight! What a revelation!

[lietya.livejournal.com]

I'm glad that you found a doctor who was more interested in actual health concerns than freaking out at the scale - I was equally pleasantly surprised by my own, that way.

I also want to thank you for that link, which I am saving to fling at anyone else who wants to insist that fat is unhealthy, regardless of science or facts. (Pointing out that I've read some of the seminal studies which are so often cited in the news - including, especially, the Nurses' Health Study - and they *don't* say what people think they do never seems to get me anywhere. Maybe this most excellent collection of supporting evidence will work better.)

[kate_nepveu]

I've gone through a bunch of Stuff with my acid reflux between my GP, gastro doctor, and dentist. If you want to talk about it, just let me know.

[jenett]

My current GP (who's actually a nurse practitioner) is fantastic that way. I think my first appointment with her (6 years ago), I brought it up - in context of my mother having, at best, extremely disordered eating, and being an unreliable narrator about family risk factors.

(As Rivka knows, but others may not, I'm in the 240 pound range, but my sister and I are very close in body type. I say "I come from a long line of European peasants good at surviving famines." when meeting people who've never seen me in person before, and it works every time.)

Unreliably narrator: I mean, yes, my great-aunt died of diabetes. But she died of diabetes in the early 1940s in occupied Vienna during a time of rationing. I'm not sure that this is a particularly good prognosticator of anyone else in the family's future health (especially since it hasn't shown up since.) We test my glucose levels ever year on principle, but otherwise don't stress.

We do have conversations about exercise - but as my NP points out, I am generally eating sensibly, and the one concern she has (LDL is a little low) improves as I get more exercise. (I'll be interested to see how I'm doing this year: I'm eating in the same general patterns, but getting generally more exercise, due to having lung foo under better control over the winter.) She's very clearly on the ball about weight loss not being the answer or even the correct discussion.

[wcg.livejournal.com]

Looks like things went pretty well. I hope she can come up with a way to get the acid reflux under control.

[pameladean]

I had the same concerns when I first saw a doctor after a long hiatus. The clinic even has big "KNOW YOUR BMI" charts up all over the place. But nobody has ever said a word to me except when it was relevant -- "being heavy," as they put it, is a risk factor for something they already thought might be a possible explanation for various symptoms. When I turned out not to have that problem, that was the end of that. They always weigh me and they never say a word. No, I tell a lie. They got anxious when I lost weight one summer because sudden weight loss can be a sign of type 2 diabetes. I am so grateful for this sensible approach.

P.

[erbie.livejournal.com]

I've been on Prevacid for 6 years and it works very well at controlling my GERD. I've been told I'll be on it for the rest of my life. I've had no side effects from it and I only very rarely get breakthrough symptoms, and that's usually if I've been very cavalier in what I've been eating. I know what not to eat, and on some occasions I can handle it and on some I can't.

[cheesepuppet.livejournal.com]

I've never understood why people can't see a middle ground with fat. Why does it have to be either healthy or unhealthy? The reality is that some people seem to be relatively immune to any negative effects of being overweight, and other people aren't.

[selki.livejournal.com]

I'm hoping that as we get better at targeted/customized diagnostics, we get better at recognizing this.

[cheesepuppet.livejournal.com]

Yeah, that's a good point. I think so many people have had the experience (I know I have) of a doctor who blames extra fat for everything, that now the fat acceptance movement has flown to the other side of it and blames fat for nothing. Which also isn't very useful (nor realistic).

[kcobweb.livejournal.com]

Great link, thanks.

I recently posted a comment in someone else's LJ that I recently stepped on a scale and it was 3-4 pounds less than usual. I was delighted, and then instantly ashamed of my delight.

I'm not really trying to lose weight either. I need exercise, not diet changes.

[dornbeast.livejournal.com]

I've been skeptical about the BMI tables for some years now, partly because I'm almost exactly on the line between "healthy" and "overweight."

[aquaeri.livejournal.com]

That's exactly where I am, and yet, I keep getting complimented for my "slim" figure and shop assistants under-estimating my size. Foo!

What I mean is, I believe I am healthy and my current size is appropriate for me. But attractive == slim is so entrenched in society people literally cannot see what size I am.

[telerib.livejournal.com]

Junkfood Science is another very interesting obesity blog. The author is an RN and apparently knows a lot about statistics and how they're used, abused, and misinterpreted.

(Not to be confused with Junk Science, which I think mainly focuses on global warming.)

[nex0s.livejournal.com]

At my last physical I was worried about my weight too - I'm back to 161 and I was 151 the last time I'd gone.

My doctor looked at the comparisons, looked at the scale, looked at me and my workup and said, "You look nice and healthy. The numbers look good, your weight looks good."

And that was that.

Also, I always try to remember that what BMI considers an optimal weight for me is when I am so underweight I stop menstruating.

BMI = Bullshit.

N.

[redbird]

That sounds like a good physical, and I'm all in favor of those.

Did the doctor have any advice on how not to be anxious about conceiving again? (I just spent some time telling various medical people that I could either relax or do whatever other thing they were asking, but not both simultaneously. After some sleep, I hypothesize that "relax" was intended as gentle reassurance, not as an instruction that needed to be followed. However, they knew how much sleep I'd not been getting.)

[rivka.livejournal.com]

Did the doctor have any advice on how not to be anxious about conceiving again?

Sadly, no - beyond encouraging me to think over the long haul. I know that even with appropriate timing there's only a 20% chance of conception per cycle; she wants me to wait at least six cycles (not counting the first couple post-miscarriage cycles) beefore I start to worry that something is wrong with me. But mostly she just exhorted me to put it out of my mind, which, fat chance.

[aquaeri.livejournal.com]

Considering the number of stories I've heard about women conceiving after adoption or after many years of marriage (one of whom was my grandmother) I sometimes wonder how often it takes believing one can't conceive at all, in order to reduce anxiety sufficiently.

Can you put it out of your mind for a couple of months at least?

[lynsaurus.livejournal.com]

Your reference to Kate Harding's Shapely Prose goes into my list of favorite links of all time. Thank you!

[rivka.livejournal.com]

Kate Harding is made of awesome.

Pretty much everything at Shapely Prose is worth reading, but here are two of my other absolute favorites:

The Fantasy of Being Thin (http://kateharding.net/2007/11/27/the-fantasy-of-being-thin/)
Devouring the World (http://kateharding.net/2007/08/03/devouring-the-world/)

[ailbhe]

I'm glad that went well for you - sensible doctors are such a boon. Though "don't worry" is not useful advice for me, perhaps it will help you - presumably they meant that there's nothing to worry about really and their medical opinion is that you'll be fine next time?

I maded Shapely Prose an LJ feed one day. I have never regretted it.

The BMI charts in the UK hospital said I was officially "overweight" at the same time, weight and height as the ones on the wall in the Swedish hospital said I was in the middle of "normal." I have never trusted BMI since.

[the-siobhan.livejournal.com]

I've been dealing with a lot of acid reflux as well. I did a lot of dietary testing and found out that I'm sensitive to something in commercial bread. I can eat home-made bread no problem, but if I eat too many store-bought, the reflux comes back.

Good luck with finding a solution.

[rivka.livejournal.com]

Individual foods are not necessarily triggers for me. (Although, now that I think of it, gosh, I guess there was a reason why I quit coffee cold-turkey in the middle of writing my senior thesis - I had an ulcer. But that barely comes to mind anymore - it's been 14 years since I've had a cup of coffee.) What seems to cause the most trouble for me is eating late in the evening, eating too much at one time, and skipping meals.

I have a hiatal hernia, which means that the valve that connects my esophagus is weak and tends to let a bit of my actual stomach poke up into the esophagus. Which is obviously bad news for the esophagus.

[curmudgn]

I'm on board with kate_nepveu and erbie. GERD is a nasty, scary disease with several possible complications. I've been on either Prilosec (40mg, which is script strength and twice the OTC dose) or Prevacid (30mg) since somewhere around 1995. When I started taking it, I had Barrett's esophagus, a precursor for esophageal cancer (which is usually fatal, because by the time you diagnose it, generally it's already in late Stage III or Stage IV) and aspiration issues. Once I started taking proton-pump inhibitors (that's what both drugs are) my reflux went AWAY. COMPLETELY. And it didn't come back for nearly ten years; when it did begin to come back, it was still miles less bad than when I began. I'm starting to have a little more trouble controlling it with Prevacid--don't know whether diabetes is inhibiting the drug's effect, or whether I've been on it so long I need to move to Nexium. But my last 'scopy, my Barrett's esophagus is just plain gone. I have little problem with aspiration asthma, and when I do, I usually did it to myself by eating or drinking injudiciously.

[minnehaha.livejournal.com]

If you want to try something that increases your body's ability to protect itself from stomach acid (as opposed to affecting the acid), try DGL, about which Google knows a great deal.

K.

[rivka.livejournal.com]

Google indeed has a great deal to say. PubMed, unfortunately, says a lot less. There are a handful of published articles from the 1970s and virtually nothing more recent, other than a double-blind study finding no effects.

So I'm a bit skeptical. As I'm sure you know, complementary/herbal medicine providers are under no obligation whatsoever to prove that their products work, and their health claims don't need to be backed up with any kind of actual research. So I don't put much weight there.

[aquaeri.livejournal.com]

Sing it, sister! (from another fan of PubMed).

[minnehaha.livejournal.com]

I find it works at least as well as antacid at controlling reflux, so I recommended it. Unfortunately, the medical model doesn't have all the answers (as you noted above re: anxiety). Life would be so much simpler if it did.

K. [and I'm sure you didn't mean to insult me personally with your choice of icon, right?]

[rivka.livejournal.com]

I'm sure you didn't mean to insult me personally with your choice of icon, right?

I meant it as a commentary on the laws about "natural medicine," which I find extremely frustrating. But I can totally see how it came off as a personal insult. I'm sorry.

[minnehaha.livejournal.com]

I was sure you didn't mean it as a personal insult and said so, but I didn't want to leave it hanging there because I *could* have read it that way, and I know The Listening Audience could have as well. And why leave a place where someone could get a negative and wrong idea?

It truly wasn't necessary or expected that you would apologize, but I thank you for it all the same.

K.

[(Anonymous)]

I think you would likely enjoy reading and might even learn something interesting from Gary Taubes' amazingly well-researched "Good Calories, Bad Calories." I was surprised to discover that a large amount of what we think we know about nutrition is not backed up by research. Also the story of how it has happened that so much misinformation about diet has been intentionally propagated is fascinating (if depressing).

I still weigh quite a bit more than you but have recently hit a 20-year low weight by eating low-carb for the last 4 months. I decided to try to lose weight primarily so I could move more easily and it's working! BTW, carbs can cause GERD so it is something to consider.

Grandma Susan (Age 67) (BTW -- my husband has Barrett's which has stayed stable for years on Prilosec.)

[mjlayman.livejournal.com]

Good doctor! Mine don't say anything about my weight because they know I got sick first and then gained weight. And now that my kidney labs are getting better, I'm losing tiny bits of weight (the primary checked to make sure I didn't have a disease causing the weight loss). Of course, at 310 after losing 48 pounds, it will take a long time to get anywhere that the average person doesn't think of as gross and my fault.

[dubiousprospects.blogspot.com (from livejournal.com)]

Glad your doctor is being sensible.

Mine, thankfully, is so sensible that he doesn't worry about my diet so long as my bloodwork is good, which, thankfully, it is.

The thing that did it for me about BMI was looking up the table and realizing that it considered me morbidly obese. (Admittedly, just edging into morbidly obese, but that's where 110 kg and 190 cm came out on that chart.)

And then I found out that BMI was created off of actuarial charts related to insurance payouts, and, well. It's not about health and never has been, then.

[guruwench.livejournal.com]

Great doctor, Rivka! I'm glad things went so well.

I've been taking Nexium for reflux for a few months; I think my esophagus has healed a ton, because I'm not getting pain like I was, and I'm able to eat more normally for me again. I don't think I have nearly the issue you do with it, but I still sympathise. I hope you find some relief soon.

I also adore Kate Harding. I'm 5'4ish and the other side of 200lbs from you, and my doctor never says a word about my weight. I know how bad it is to yo-yo diet, and I refuse to. I could use more exercise, but I'll figure that out somehow.

Take care. :)
Kenora

[juthwara.livejournal.com]

Hooray for a sensible doctor! And I adore Kate Harding. It says quite a lot that I have a medical condition that is greatly affected by how much I weigh, yet reading her has significantly shifted how I view my weight and health.

[(Anonymous)]

I've been reading more about low-carb and GERD. Here's a good summary:
http://www.proteinpower.com/drmike/uncategorized/heartburn-cured/

Apparently if low-carb is going to stop your GERD, it works in just a few days. That means you'd only have to try out a low-carb diet (say no more than 7 grams of carbs per meal or snack) for a long weekend to learn whether it would work for you.

[rivka.livejournal.com]

Please don't recommend diet fads to me. Your own diet is your own business, but I'm very much not interested.

[mjlayman.livejournal.com]

I always want to shake strangers who recommend the "South Beach" diet to me. Yeah, my kidneys would love way too much protein!

Congrats on a good physical-exam experience!

[jinasphinx.livejournal.com]

I had problems with stress-induced GERD in grad school and then continued having it while taking Zantac and after a course of Prilosec. Then my dentist (of all people) mentioned to me "did you know that the symptoms of *low* stomach acid are the same as for high stomach acid?" and I tapered off the Zantac and actually felt okay. Just something to consider, that I think isn't much out there in the general awareness of doctors or anyone else.

[(Anonymous)]

This is your blog and I try to respect your wishes. On the other hand, I can't help caring about you and wanting to help when you mention problems.

Low-carb is NOT a diet fad and I am pointing you to respectable medical information that you as a health researcher should be able to quickly evaluate. I've selected this as the best from a larger body of information, that I, a research scientist, have spent a lot of time carefully evaluating before accepting.

Also, I only recommended this because of my personal knowledge of the seriousness of GERD.

Grandma Susan

[rivka.livejournal.com]

Any diet which eliminates an entire major category of nutrients is a fad diet. I note with interest that in the comments to the post you linked above, the "protein power" guy casually mentions that there is no nutritional need to ever eat fruits or vegetables, either. This is not the nutritional mainstream.

The article you linked explains a lot about heartburn/reflux, but never says a word about how they think carbohydrates are linked to heartburn. There's an assurance that 100% of reflux patients will be cured by eating low-carb (there's a warning sign of quackery right there) and directions to buy a book which will reveal all. The only actual medical information anywhere on that page - unless I missed something - is an ordinary explanation of what reflux is and what problems it can cause. There isn't any evaluable medical information at the linked website to the book's author, either.

I know that you are motivated by wanting to help me, but this is not the way.

[jerusha.livejournal.com]

Yay! to your doctor for being sensible about weight.

One thing that I know is a major reflux trigger for me is fatigue. It's as if, at a certain level of fatigue and/or sleep-deprivation, my lower esophageal sphincter just goes, "Right, then, I'm off-shift, call me back when you've slept." Great. So now I'm exhausted and muzzy headed, and I have heartburn bad enough to light up downtown Chicago *too*!?

Of course, this is a diagnosis without a fix, since between a three-year-old (eep! already!) and a bouncing baby grant I'd expect that you're already getting all the sleep you can make the time for. (OTOH, knowing this is a cause (assuming that your LES is on the same "Hey, this is a good time for a vacation!" plan that mine is) may be reassuring, even if the only thing you can do for it is bomb it into submission with H2 blockers and PPIs.)