Tuesday, June 11, 2019

Rant: doctors, depression, and grief management.

Tl;Dr doctor completely disregards everything I say to discuss my recent weight gain.

I had heard about this sort of thing happening. I had even quietly doubted the stories shared by others a tiny little bit... thinking that surely they MUST be exaggerating reality or are young and oversensitive. I subscribe to /r/fatlogic and laugh whole heartedly while I cringe inwardly at the entitlement some show about their weight. I try to remind myself that no matter what shape I am or am in, it is my job to manage it and make amendments for it.

Truth time. I am pretty damn fat right now. I know it. I don't shy away from the fact, or pretend that those around me don't see it. I have lost considerable amounts of weight through diet and exercise in the past. (112 lbs!!!) I have recently put on exactly 50 pounds. It is knowing the process so intimately that allows me to own my current weight and how I got here. I literally accounted for every damn cookie, brownie, and slice of pizza since my mom died. I watched it happen and I let it happen. It was part of the healing process for me. And it still is. When I reached the 50 lb mark back in February, I knew I had to cut the shit. So, I stopped gaining. And I really do know how to go about losing it. Every now and then I skip a meal or snack to the greater good, and somehow it kinda evens out by the end of the week. Recently I accepted that the food was making me feel good and skipping it or skimping on it didn't make me feel better. So. I decided to start moving around more. I dusted off my Fitbit and joined a workweek challenge. I haven't lost much, but I saw the scale kinda trending downward. Like from reliably at 232-234 to reliably between 227-229. So, it's slow but I'm in no big hurry. I have other things to conquer. Like my debilitating social anxiety since mom died. Or my slowly disintegrating job and growing stack of bills. Or the full time job of looking after my widowed father who is fighting stage 4 lung cancer. You know. Ths shit life throws in your way when there is more than your goddam waistline to worry about.

Two weeks ago, I woke up with a sore neck. After two days of rubbing it, stretching it, treating it with lidocaine and muscle relaxer at night, I noticed that a lymph node in my collar bone area was kinda swollen and tender. By the next day three more had joined in and were the size of grapes. I realized this might actually be causing the neck pain and treating the symptoms could be delaying me identifying a bigger problem. (You know, like how my dad ignored coughing up blood for 6 months and was surprised to hear he had lung cancer) I reluctantly made an appointment with my primary care physician. What a fucking mistake that was.

When getting on the scale in front of the nurse I made a joking comment on how I thought I liked her until then. Then I said, "seriously, I've gained 50 pounds since the last time I was here, but I've got it under control now. My mom died and I didn't stop eating cookies for a few months. But I think I'm over that part of the grief." She lamented how when her mom died she lost a scary amount of weight and isn't it funny how grief manages to damage us all differently, yet terribly just the same? It was a nice sentiment and we moved on with the health histories. Enter the doctor.

I won't use quotations because I'm tired and angry and this was last week. But. She immediately commented on the weight gain. I was expecting it. Then she offered strategies for losing it. I agreed with her whole heartedly. She said that at 230 pounds I had a BMI of 34. I said, yup, same as my age and kind of laughed but admitted I knew that was smack in the middle of the obese category. But my neck hurts and... but I couldn't finish. Because she interrupted me. She told me that the weight gain was putting me at risk for... and listed all the things we all already know like being at a higher risk for diabetes and heart attack. I agreed with all of this too, and actually apologized for myself because I didn't really know what else to do/say. It felt like she wanted me to argue with her but I just kept on agreeing because of course she was 100% right about all of these things.

Then she asked what I was going to do about it? I explained that I already was doing something about it and had stopped gaining weight four months ago. She asked if I was satisfied with my current weight and of course I said no, because really who is?! Then she asked why I was satisfied with maintaining a weight I was dissatisfied with? I really didn't know how to answer that one, so I replied with what felt like an excuse, but upon reflection was the truth. My mental health is more important to me than cutting calories right now. She said next, and totally out of the blue that my back pain was a result of the weight gain (I know I sound like something from fatlogic but the pain I have is from a slipped disk injury I sustained by improperly lifting at my most physically fit point. I gained all this weight post spinal surgery, when even walking with a cane was hard work. I hadn't even mentioned it at all during this visit.) I didn't even bother arguing. I thanked her for her concern, and drew her attention once more to my neck. She wasn't done yet, though. She then asked if I thought weight watchers or something similar would help me? I reiterated what I had said earlier, that I was quite capable of losing the weight without a costly program and that I just had other things on my mind right now.

Then. And I fucking wish I was making this up, she wrote me a prescription for Zoloft. Taken aback I asked if perhaps a referral to a mental health professional might be more appropriate? Someone I could really take the time to open up to and talk with before getting medication? She simply stated that I was depressed, and if I took these pills for 3 weeks I could focus on my weight loss because my depression would be fixed. It was just that simple.

She ordered a sonogram of my neck without examining the entire area. The sonogram showed a "severely swollen lymph node." I was asked to return a week later for follow up if the lymph node didn't get better. On my printout was a summary of the visit. The diagnosis? Obesity. The procedure I just paid 30 bucks outta pocket after insurance for? A 15 minute behavioral counseling on obesity. No mention of my lymph nodes anywhere. I didn't really get mad until then. I vented to my SO at home abou it and moved on with my life.

When I went to pick up my prescriptions at the pharmacy I wasn't even going to fill the Zoloft. The tech accidentally charged me for all 3 scripts so I just shrugged it off and figured I'd talk to my grief therapist and get his opinion before popping them. Then the pharmacist told me that the Zoloft could cause intestinal bleeding when partnered with the meloxicam I take for my back inflammation. Great. So there's my answer about that. I kinda forgot about it.

Until my followup today. The doc was beyond PISSED that I wasn't taking the Zoloft yet. Like she accused me of knowing better than her and wanted to know who authorized me to disregard her orders. I got kind of emotional here and said that she barely even knew me (this was our second visit ever) and she was ready to give me medication that might have made my grief even worse! That I had done research with my psychologist and found that while Zoloft is great for classic depression... I am not the cold, dead, emotionless kind of depressed that lacks in joy or excitement. I am the angry, screaming, yelling, crying, kicking things out of rage and taking it out on myself kind of depressed and that Zoloft could actually increase these extreme behaviors because it reduces the reabsorption of those kinds of brain chemicals in addition to serotonin. And also the bit about intestinal bleeding because what the actual fuck?! I didn't swear, but I did cry. Because I really just wanted to know why my lymph nodes were swollen. And I didn't want Zoloft. Or to lose weight right now. I just wanted relief from my pain so I could go back to my miserable life. I stood up for myself. I told her that I didn't mind her counseling me in obesity at all, but that I didn't think she was listening to me as a patient. She asked if I trusted her? I said I trusted her with my physical health but I would prefer my mental healthcare to be up to a mental healthcare professional.

So. She dropped me as a patient. I asked if there was anyone else in the office I could see because it is hard to find a new doctor with my insurance and that I really liked the office/staff/location. I apologized numerous times for not taking the meds. She said she couldn't trust me to follow her orders and that I wasn't a good fit for anyone in that office. Basically that she wouldn't refer me out to anyone either. She just closed my case with her office and walked me out to reception.

My neck still hurts. And now I have no doctor. I knew someone here would understand my frustration. I am flabbergasted, angry, and totally have nothing healthy to do with all of my emotions. I never said I wouldn't take the Zoloft. Only that I wanted a second opinion before I started a medication to alter my brain chemistry. Fuck.

So. Please share your frustrating fat stories. Or even maybe a justice boner story? Because man, I am so angry and there is literally nothing I can do about it. I never denied anything she said. I just wanted help for my neck pain. I'm so sick of this shit. Also, I'm sorry if I ever doubted any of you. The fat shame was real this week.

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