communication, healthcare, holidays

Today is the first day of the rest of the year…

Happy New Year, y’all. I will do a write up of our personal festivities on my travel blog; because let’s face it, that blog needs some love. For this blog, I’ll just say we had a basically nice time… except for the point where I got into a rather serious discussion with Bill about the logistics of my living in Germany and accessing healthcare. It’s not that I have an immediate need for it… but I’m not getting any younger. Because we’re here at the pleasure of the U.S. military, I could either go to a German doctor, or I could go to Landstuhl (U.S. military facility). And because I never go to the doctor, I literally don’t know what I would do here if the need suddenly arose for me to seek medical care. On the other hand, I do know how to call 112, and that’s probably what it would take before I would willingly go see a doctor.

I think this subject came up because we were talking about what our plans will be after it’s time for Bill to quit working so hard. We were talking about younger daughter, and how her husband has launched a good career. They hope to move sometime soon, because the apartment they live in is too small for their family. Bill mentioned that it wouldn’t be long before they might buy a home of their own. And I kind of wistfully said, “They’ll probably be homeowners before we will.”

I always thought by now, I’d own my own house somewhere, and I’d be settled, perhaps with a family of my own. Instead, I’ve been in this weird kind of limbo, where half my stuff is in the United States, and a lot of my friends and most of my family are there… but here I am in Germany, where I’ve been for close to half my marriage. It does feel kind of like home, and yet I don’t really speak the language… and I don’t have a lot of friends. None of my family, except for Bill, lives here. It’s not a bad thing… It’s just not what I expected for my life. Nothing has really turned out the way I figured it would. Well, except for the fact that I went to graduate school.

I do remember in high school, being asked on some kind of government research thing– maybe it was a standardized test– about the level of formal education I expected to attain. Even back then, I assumed I’d get a master’s degree. However, I thought it would be in equine studies, or something similar. I don’t even know if such a program exists. But I do remember, back then, feeling daunted by the prospect of getting a master’s degree. I thought it might be too hard for me. I sure didn’t expect that I would get two of them at the same time, or that they would be in either social work or public health. When I was a teenager, I probably had a better idea of what I was good at, academically speaking. But when the time came to go back to school, I was simply trying to become employable, so I could launch my typical “American dream” lifestyle. And look what happened! I bumped into Bill online, and became a nomad, which made launching that career very difficult.

So anyway, we were talking about home ownership when Bill retires, and Bill said that he would like to buy a house in Europe somewhere… maybe Italy, Spain, Portugal, or even France. Germany is also, of course, a possibility, although I think it might be more expensive here. We do know Americans who have retired here, though. And Bill said that he wanted us to own a home so I wouldn’t have to deal with renting anymore. He says he thinks he will predecease me. I said I wasn’t so sure. Bill goes to the doctor, and I never do. I was very traumatized by an Air Force gynecologist years ago, so even though I “know” better, it really takes a lot to get me to see doctors. I despise military healthcare.

I understand logically why it would be a good idea to go see a doctor and get checked for certain things, like high blood pressure, cancer, and diabetes. Hell, I even studied public health, where I learned about the value of screenings and preventive healthcare. But psychologically, I just have a very difficult time with it. And it’s even worse in a country where I don’t speak the language fluently, and people tend to be blunt about certain things. I can’t imagine my taking it without getting really upset. I know that putting it off only makes it more likely that I won’t have a choice in providers when I finally see one, because it will be in emergency circumstances. On the other hand, I’m not sure how I would choose a doctor here, anyway. And I’m not even sure if it’s worth the time and energy to go to one.

I know Bill would be devastated if I died before he does… but he has people who will be there for him. He has two daughters, and one speaks to him. She has children who call him “Papa”. I don’t have any descendents. I just have a bunch of cousins and three older sisters, who always felt more like aunts. So, I guess I just don’t see why I’d need to hang around. I certainly wouldn’t want to live as long as my Granny did. She was almost 101 when she died. When I consider how stiff and painful I get in the mornings, I truly dread being that old… particularly with no one around who cares about me. I guess it’s just the pragmatic/depressive side of me coming out again. 😉 I have to die anyway, right? So why prolong the inevitable?

I asked Bill if it bothers him that I don’t see doctors. He said it does, although he never says anything about it. He is respecting my “agency”, I guess. So I asked him what he would do if I told him I’d found a lump in my breast (not that I have). He said he’d want me to have it checked, and would probably insist. The idea of that makes me cringe, though. Because it’s been so long since I last accessed the healthcare system that there are many screenings I’ve missed. I know a lot of them would be suggested and encouraged. Or maybe not. Either way, I’d probably end up stressed out and upset. In fact, thinking about this topic is very unnerving to me, so I think I’ll move on.

So… that’s how we wound up on that topic. Bill would like to settle abroad, because the lifestyle suits us. I wouldn’t mind living abroad, either. I truly think it’s better over here, in many ways. It would come at a cost, I guess… weakening family ties and friendly relations, such as they are. But I can’t see myself wanting to live in an American subdivision somewhere, with homeowners’ associations dictating what color I can paint my shutters or whether or not I can have a garden. 😉 But the truth is, there’s no telling where life will lead us. We have no reason to stay or go anywhere in particular. I don’t see us willingly moving to Utah, which is where younger daughter lives. I know it’s pretty there, but I like my communities less religiously oriented.

Fortunately, the subject soon changed, because we happened to be having it while we were enjoying the last of the evening’s libations. It was almost time for the proverbial ball to drop. And once it did, we went outside to watch the fireworks. There were a lot more of them this year, of course. Our neighbors were in the street, setting them off. They set one off very close to our car, which concerned me a little bit. I’m glad to report that no Volvos were injured during the fireworks display last night.

Well… I’m sure there are other things I could write about, and maybe I will later. But for now, I think I’ll go to the travel blog and write something a little less sobering.

I hope your first day of 2023 is shaping up well. Remember, today is the first day of the rest of the year!

The featured photo was taken last night. For some reason, I always seem to think I can capture fireworks on camera. It very rarely happens.

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family, musings

On being a black sheep who isn’t missed…

This is kind of a depressing post… but although I wrote it a few years ago, I found myself saying almost the exact same things last night. And although we had a fun evening at the wine stand, I started thinking about this stuff that I probably shouldn’t. I also think I need to see a doctor… but I can’t bring myself to make an appointment. The thought of seeing a doctor fills me with dread and anxiety. And, to be honest, I also don’t really feel like I’m worth the effort. Just the idea of asking for an appointment and getting there seems overwhelming and pointless. I worry that it will set off a cascade of other appointments that I don’t want to deal with. I probably feel this way because of the way I was treated when I was a lot younger.

For much of my existence, I’ve gotten the message from various important people in my life that who I am isn’t okay.  I was always too loud, too opinionated, laughed too much, weighed too much, said too many weird things, overshared too much, offended too much, and simply needed to be taught how to be a lady of some sort.  Many of the people who shared this message with me, either verbally or non-verbally, were close relatives.

I don’t know what Joanna Connor’s life is like, but I relate to her.  I suspect people have the same opinion about her they did about Susan Boyle, before they heard her sing… and the way some people do about me before they get to know me.

The most hurtful messages came from my own father, who often criticized me.  More than once, he left me with the message that no man would find me attractive and I would never make more than minimum wage.  Then, sometimes he’d reverse that comment and say I was “good looking” (after assuring me that he didn’t have to say that even though he was my dad) and, sometimes with surprise, he’d say I was smart.  Although I do remember a few times when he genuinely seemed proud of me and my accomplishments, other times, he acted like I was an embarrassment and a huge pain in his ass.  

Far from having a protective attitude toward me, my dad sometimes actually put me in danger.  I still have physical scars formed in childhood that were a direct result of his boneheaded decisions.  I have a deep scar on my left arm caused when he forced ten year old me to use a box cutter to break down cardboard boxes.  I wasn’t very adept at using the box cutter.  It’s not like he gave me a safety lecture beforehand.  Before long, there was an accident.  The blade slipped from the cardboard and punctured clean through all of the layers of skin on my arm.  I should have gotten stitches, but he didn’t bother to take me to the hospital.  I said I didn’t want to go, and he didn’t insist.

A couple of years after that, my dad took me bike riding.  He wore a helmet and I didn’t.  I had a pretty bad accident when my tires hit some gravel on the side of a busy road (Rt. 14, for Gloucester people who know the roads).  I fell and slid on the pavement, in front of several cars.  I got road rash, sprained a pinky, and had gashes on my face and legs.  I still have a three inch linear scar on the back of my thigh caused by the large sprocket on my bike cutting into my skin.  A nice lady picked me up in her car, while another passerby put my bike in their truck and drove me home. 

Dad rode home on his bike and, once again, neglected to take me to the hospital, even though I had also hit my head.  The next day was the first day of school and I went, looking and feeling terrible.  I remember I made a bad decision to wear an angora sweater.  Little hairs from the sweater were stuck to the huge road rash I had on my side.  There were other situations like this, where I was either neglected or forced to do things that weren’t age or experience appropriate.  I suffered the consequences while simultaneously hearing that I hadn’t been wanted and was a source of shame.    

I also think my dad was very jealous of the fact that I can sing.  In fact, I think he sometimes tried to compete with me.  Like, for instance, in 1998, when I decided to start studying voice privately again, he decided to take lessons from the same person.  He’d bring my mom to his lessons.  When I left the area to go to graduate school, he quit the lessons.

When I first told my dad about Bill, he made jokes about the fact that Bill was LDS.  In fact, everyone in my immediate family seemed to have doubts that I could be dating a really nice, good looking, gainfully employed man.  They also seemed concerned about my competence in picking my own mate.  I got comments from family members who said things like, “I’m surprised at how cute Bill is.” and “Are you sure you want to be dating an Army guy?”  More than once, I heard from my sisters about how unhappy my mom was as an Air Force wife.  They apparently wondered if I had considered her unhappiness when I made the decision to marry Bill.  

Evidently, despite seven years of post graduate education and two years spent living abroad, I wasn’t competent to think about these potential issues.  My mom was nineteen years old when she married my dad.  I was thirty when I married Bill.  Curiously, I don’t remember anyone in my family being concerned about Bill’s psycho ex, who has been the real source of any discontent I’ve experienced (and it’s been pretty minimal, actually).  Later, after we did get married, they mostly seemed to like Bill better than me.  Especially, my dad, who toward the end of his life, clearly preferred Bill’s company to mine.  I don’t blame him for that.  Most people prefer Bill to me.  I’d rather spend time with Bill than almost anyone else, myself.

Later, I’d hear criticism about how Bill and I spent our money (Are you sure you can afford a Mini Cooper?), my looks (Oh my God, you’ve gained weight), my behavior at age 30 (You’re causing a disturbance!), and how I spent my time (Why don’t you get a job while Bill is deployed for six months?).  Sometimes, family members would try to manipulate me into doing things instead of making respectful requests (How long does it take to drive from Atlanta to Durham, North Carolina?).  This was a question I was asked by a sister who felt she knew how I spend my time and wanted me to hop in the car, drive to North Carolina, split a hotel room with another sister, and put in an appearance at my dad’s hospital bedside so she’d feel less guilty about living in Minnesota, where plane tickets and time off from work are too dear.  Instead of asking me directly, she tried to be manipulative.  When I called her on it, she got nasty and accused me of being selfish.  

I’d also get criticized for the things I wanted to talk about beyond trivial subjects like the weather (Why do you always have to talk about such personal things?) or the way I dressed (Why don’t you put on some makeup and fix your hair?  Wear something nicer than what you have on?).  Often, when I’d call home to talk to my mom, I could tell she wasn’t interested.  Then, they wondered why I didn’t want to spend time with them and quit calling home so often.  Oh… and a lot of people in my family hate the way I laugh.  My dad said I sounded like a witch.  My sisters said my laugh sounded fake.  Even my grandmother complained about my laughter, which I will admit is distinctive.  I can’t help it, though.

As I got older, I started to recognize the same attitudes I got from my immediate family expressed more subtly by my dad’s side of the family.  Most of them are Christian Republicans who engage in very black and white thinking.  I didn’t used to notice it because I was surrounded by it all the time.  Then I moved away and started getting to know other people outside of the family.  It changed my thinking and a lot of my previous attitudes.  I started clashing with certain people in my family.  Others just simply seemed to stop talking to me.  In fact, the last time I went “home”, I literally felt like a stranger.  Like… there were family members who literally didn’t seem to recognize me.  Who wants to spend thousands of dollars on a plane ticket and hours of uncomfortable time on a plane to be treated like that?   

Some time ago, I noticed that a beloved cousin of mine, close to my age and someone I used to play with when we were little kids, kept commenting and responding to posts by other family members.  But she ignored me.  Like, I’d see her “like” something posted by one of my sisters or even one of their friends, but I never got so much as a “fuck you” from her.  It made me feel shitty to have to keep seeing that.  It’s not even like it could have even been a “two way street” situation, since she clearly looks at social media, but doesn’t post anything herself.  Or maybe she has me restricted.  In any case, repeatedly seeing her respond to other family members’ posts and not mine made me feel bad, so I decided to delete her.  It wasn’t easy to do that, but I think it was the right decision.  In fact, I doubt she’ll miss me.  

I deleted another cousin for whom I’ve had some hard feelings for a long while.  Some years ago, I discovered she inexplicably had me blocked on Facebook.  I’d see her at family events and she’d be nice to my face, but then I’d notice some shittiness leaking out that she thought she’d kept well-hidden.  In this case, I think it’s yet another situation where there’s some jealousy and insecurity.  Like me, she’s a musician and used to be the only “singer” in the family.  I sense she resents that I am also a female musical type and, while I don’t play guitar or write songs like she does, I have a much better singing voice.  That sounds like bragging… and you know what?  I don’t really care.  It’s the truth.  (ETA: I wrote this in 2018. This cousin died in 2020. I don’t miss her.)

A few years ago, when my dad was on his death bed, this same cousin, who once had me blocked, re-friended me on Facebook.  It didn’t take long before I began to realize that she mainly did it because my dad was her uncle and I was the most active Facebook poster in my immediate family.  It was like she wanted in on this particular chapter of family drama– to make a show of caring, probably because she thinks it’s the “Christian” thing to do.  I soon realized that even though she’s my cousin, she doesn’t like me.  And frankly, the feeling is mutual.  If we weren’t relatives, I definitely wouldn’t choose to be friends with her.

There were a couple of other cousins and relatives by marriage I deleted mainly because of a total lack of engagement or a subtle air of disapproval.  They’d become names on a friends list rather than “loved ones”.  A few years ago, I deleted a couple of cousins because they refused to do anything but argue with me about politics.  They weren’t interested in anything else.  Or they’d post smarmy, condescending bullshit about my being “loved and respected” while they proceeded to insult my intelligence. 

For instance, one cousin wanted to know what my master’s degree in public health (with a health administration focus) has to do with knowing how health insurance works.  He insisted that his time as a former life insurance agent meant he knows more about health insurance than I do, despite my having an advanced degree in the subject.  I certainly wouldn’t discount his experience and basic knowledge about how insurance works, since he used to sell it, but why couldn’t he acknowledge that I also have knowledge of the subject?  Maybe he’s just one of those people who thinks college is for chumps.  But you’d think he could at least recognize that I do know something about health insurance.  I didn’t buy my degree from a diploma mill.  My guess is that he sees me as a simple female, which automatically makes me inherently dumber than he is.  

For years, I’ve tried to be a bigger person about this stuff.  I’ve ignored subtle disses from family members.  Except on this blog, I’ve not really acknowledged that no one from my family of origin values any input from me.  I’ve tried to detach from the drama and mostly tried not to take things personally.  I think I’ve finally just gotten to the point at which I’m ready to be done with the stupidity.  Maybe there will be no one at my funeral.  Maybe I won’t even have a funeral. 

It makes me sad to see people with loving family relationships because I don’t really have any myself.  What I’ve had is basically a facade of a loving family.  Underneath that facade is the unspoken message that in order to fit in, I need to change who I am.  I’ve tried to do that and it just leads to major depression and anxiety.  So I’ve decided that the picture below is my new motto.  

Seriously… because a lot of the stuff that pisses me off is stuff that shouldn’t matter.  It’s better to cut bait and be done with it… and them.

I’m done with swallowing criticism from other people, especially those who aren’t even involved in my life.  From now on, I’m going to do what I want to do.  It may mean I’m done with attending all family events, once and for all.  But, I’ve had it.  I live thousands of miles away and it costs a lot of money and time to visit my relatives.  They don’t value my presence in their lives, so fuck them.  I’m going to spend time with people who actually want to spend time with me.  So far, that seems to be mostly Bill and my dogs.    

You probably have to go to YouTube to listen to this, but this song pretty much sums up how I feel today…

And here are the lyrics by James Taylor… a man who knows the trouble I’ve seen.

I was raised up family, man, I’m glad I’m on my own.
I was raised up family, man, I’m glad I’m on my own.
I mean, God bless the child that can learn to live alone, yeah.

Thinking about my cousin, what it was that did him in.
Could it have been that whiskey, rotgut, bootleg, bathtub gin?
It’s like it took a lot of liquor just to let him live in his own skin.

Back in Raleigh, North Carolina, you got to ride it on back in Raleigh, North Carolina.

The ship set down on the shore of this uncharted desert island,
me and my people fanned out, I guess we settled down a little while.
Ah, but the devil came with the dark days of winter, man, the children ran wild.

I used to know why, no, I don’t know why anymore.
I used to know why, no, I don’t know why no more.

I get to wonder at the Kundalini thunder, down under my floor.

You got to ride it on back, take me back.
Back in Raleigh, North Carolina, yeah, do you wanna go?
Way back in Raleigh, North Carolina.

Well… in my case, it’s Natural Bridge, Virginia.  But you get the idea.

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healthcare, mental health, psychology

“Please, Doc, don’t weigh me unless it’s really necessary!”

Yesterday marked the first day of National Eating Disorders Week 2022. Fittingly, a few days ago, I read an interesting article in the Washington Post about a new trend in U.S. healthcare. It involves special cards that one can hand to a physician. See below:

I like this idea.
From the More-Love.org Web site.

I haven’t seen a doctor since 2010. One of the main reasons I don’t visit doctors is because I once had a very traumatic and unnecessarily physically painful and humiliating experience with one. I did see doctors a few times after the traumatic experience, but as I’ve gotten older, it’s gotten even harder to make the phone call for an appointment. I know very well that this isn’t the greatest policy for promoting my personal longevity. I could definitely use a check up. However, for many reasons, visiting medical people causes me a great deal of stress. One of the main reasons it’s stressful is because of that goddamned scale, and my long history with eating disorders. No, I don’t mean the obvious ones that might put a person in the hospital. There are actually a lot of eating disorders out there, and most don’t get diagnosed. But they do exist, and I’ve struggled with them for years. I have less of a problem with them now, mainly because I have a very loving and understanding husband who doesn’t body shame me. I would be lying, though, if I said those problems have gone away entirely. There isn’t a day that goes by that I don’t think about it.

I know I usually have less of a problem going to see a doctor if I know I won’t have to be weighed. For instance, in 1999, I had facial cellulitis that almost put me in the hospital. I had to see an ear, nose, and throat doctor for treatment. He was a great doctor, but one thing that I especially liked about him was that he didn’t force me to get on a scale. He simply looked at the mess on my face and prescribed antibiotics. The family practice doctor who sent me to the ENT guy was kind of an all knower, but he actually reassured me that my weight wasn’t that bad. At that time, it wasn’t that bad, since I was waiting tables and lost a lot of pounds because of that. However, I was never so sick, so often, as I was in those days.

Although I know weight is an important measure for some health issues, I think it’s pretty cool that someone has realized how absolutely mortifying getting on the scale is for some people. The above cards were offered at Element Primary Care in Omaha, Nebraska. A 30 year old woman named Dani Donovan, who is an attention deficit/hyperactivity advocate and suffers from binge eating disorder, happened to see the cards at the office. Donovan reportedly avoids going to see physicians because of the stress of being weighed. She happened to find a practice where, apparently, the staff recognizes this issue, and how it prevents people from seeking care. According to the WaPo article:

“I didn’t even know that saying ‘no’ to being weighed was a thing you could do,” said Donovan, 30, an attention-deficit/hyperactivity disorder advocate who has a binge-eating disorder and often avoided doctor’s appointments because being weighed was so stressful. The card led to a good conversation with her doctor, Donovan said, that helped build trust and make her feel empowered.

Donovan took a photo of one of the cards and posted it on Twitter. It’s caused quite a stir.

These cards were developed in 2019 by a Los Angeles area eating disorder coach named Ginny Jones. Jones is a survivor of several eating disorders, including anorexia and bulimia. Jones came up with the cards after many experiences she had when visiting physicians. A lot of them would praise her for losing weight, even when it was noted in her records that she has had eating disorders. She now offers the cards for sale on her Web site. When Jones was contacted for a statement about her cards, she said:

“I wish I could say I was surprised by the ‘controversy’ around the cards. I created them to address weight stigma, and it’s basically fatphobia to jump to conclusions and say blanketly that asking not to be weighed is unhealthy.”

Personally, I think these cards are great, although I can’t imagine presenting one to any of the military doctors I’ve seen in my lifetime. But then, again, I haven’t been to see a doctor in about 12 years. My blood pressure shoots up whenever I’m in a military healthcare facility, and they usually take one look at me and assume I have any number of health issues just by my appearance. I have found that a lot of doctors aren’t good listeners, either. That is especially true with military providers, in my experience.

In 2007, before we moved to Germany the first time, I actually wore an ambulatory blood pressure monitor for 24 hours to prove that I didn’t have hypertension, because my blood pressure readings were so high in the office. As soon as I stepped out of the military hospital, my blood pressure was completely normal and stayed that way. I came back to the office the next day with a bruised arm and documentation in my file that I have white coat hypertension. That may no longer be true today, given my family history, but the way the providers acted during that last visit put me off of going back, even though the person I saw was actually very kind to me when I told her what had happened to me at the hands of an Air Force gynecologist back in the 1990s.

The Air Force gyno I saw back then gave me my very first (of two in my entire lifetime) gynecological exams. It was so painful and distressing that I left her office traumatized and horrified, and actually felt violated on the level of sexual assault. Besides really hurting me with her instruments and not apologizing for the pain she caused me, this doctor also fat shamed me and predicted that when I went to Armenia, I would gain tons of weight. In the 90s, I was dealing with eating disorders more acutely than I do today. Today, I seem to have replaced eating issues with drinking issues. Again… not healthy, and I probably should see a doctor, but I just can’t bring myself to do it. Even having these cards probably wouldn’t get me into the office, although I do think they would help, if I found a kind and understanding physician who was sensitive to these issues.

According to the Washington Post article, as well as my own anecdotal experience, there are a lot of physicians who have a bias against obesity. They seem to take obese patients less seriously, especially if they’re women. The article reports, “one piece published in the British Medical Journal found that weight stigma actually led to increased mortality and other chronic diseases and ‘most ironically, (weight stigma) actually begets heightened risk of obesity.'” There have been a number of articles about how the medical community tends to focus on weight, even when a medical issue is clearly not related to the patient’s weight. Like, for instance, someone comes in with a broken arm and gets told that weight loss would benefit them. There’s no doubt, weight loss would be beneficial, but that’s not why the person came in to see the doctor. In that sense, I can see how these cards could be useful. If you’re going to see the doctor for a specific issue that has nothing to do with obesity, perhaps it wouldn’t be a bad thing to skip the scale, at least for that visit.

Of course, some physicians will never be onboard with avoiding weigh-ins. In the WaPo article, a physician named “Umbereen S. Nehal, a former chief medical officer for Community Healthcare Network in New York and a board-certified pediatrician,” reported that she strongly believes patients must “be weighed every time, regardless of when they were last weighed or why they are in the doctor’s office.” The doctor claims to be have sympathy for patients like Donovan, but she’s not convinced that avoiding the scale will improve healthcare outcomes. She says, “Is the hypothesis that somebody who is obese, let’s say, if we don’t weigh them, fatphobia will go away? Those visual cues will not go away. So my beef with this is that it disrupts processes in the system for efficient data collection and that data are used for a variety of things.”

My answer to Dr. Nehal is that a lot of people avoid the doctor entirely because of this issue. She may be getting more data when she weighs patients at every visit, but a lot of people won’t even come see her because of the mortifying prospect of being weighed, the psychological stresses that come from that experience, as well as the potential humiliation that comes from a fat shaming doctor. Seriously… if you’re feeling fine, and you don’t want to deal with the discomfort of being weighed, how likely are you to schedule screenings? Is that the outcome Dr. Nehal wants? For people not to come in to see her at all? Then she won’t get ANY data, and the person will show up in the emergency room instead. And that will not only lead to poorer healthcare outcomes, but it will also lead to much higher medical bills.

Another doctor who was quoted in the article, Fatima Cody Stanford, an internist who specializes in obesity medicine, also insists that weight is an important measure. She notes that U.S. medical schools do a terrible job teaching students about weight, and that many people don’t visit their doctors very often. Stanford says she would tweak the card to something that says:

“I’m happy to get weighed but please do not provide any negative or derogatory comments associated with my weight.”

That way, the doctor gets their data, and the patient doesn’t have to deal with fat shaming. I would add, though, that in my case, it would not be true that I am “happy to get weighed”. I hate being weighed every time. It causes me a lot of distress, and that’s why I avoid doctors unless I’m about to croak. So I think Dr. Stanford might want to rethink that wording, although I appreciate that she recognizes how upsetting being weighed is for some patients.

I looked at Element Primary Care’s Web site, and it appears that their approach to care is different on many levels. For instance, I notice they offer telemedicine appointments, focus on keeping their practice small, and it appears that instead of using a traditional insurance model, they provide care for a monthly fee. This eliminates co-pays and insurance deductibles, and allows patients to access care when they need it. The direct primary care membership plan can be combined with a high deductible/less expensive insurance plan which would cover hospital care or other unforeseen care needs that still use the traditional insurance model. I have heard of a growing number physicians’ practices eschewing traditional insurance coverage, which allows them to be able to make medical decisions that don’t have to go through third parties at insurance companies. I think it’s a great idea, although it will probably take some time for it to catch on nationwide. Change can be slow, but I do think overhauling our health insurance model could be a game changer for a lot of people.

At Element Primary Care, about half of the patients decline to be weighed, but some will weigh themselves at home and report their weight that way. Or, if they have a condition that requires their weight to be monitored, the patient can turn backwards on the scale, which is how many eating disorder patients get treated. That way, they don’t have to know that number, and it won’t affect their psyche. The cards allow the patients to advocate for themselves and be more of team member in their healthcare. It may also make them feel “safer” from judgment and humiliation. Personally, I don’t weigh myself at all anymore, and when I have gone to see the doctor, I don’t let them tell me how much I weigh. I know from personal experience that knowing the number can lead to distress.

I think the pandemic has caused a lot of issues with weight and mental health. I recently read that a number of young people have developed eating disorders during the pandemic. Even President Biden is addressing it, which is very fitting, since National Eating Disorders Awareness Week begins today. Kudos to Mr. Biden for bringing this up, since I know Trump doesn’t care about helping people with eating disorders. I recently read that doctors are seeing a lot of adolescents in emergency rooms, dealing with eating disorders. There’s also a lot of depression and anxiety being reported, due to the pandemic. I think any measure that makes seeking help easier is commendable.

While it may not always be medically appropriate to skip stepping on the scale, I like the fact that some healthcare professionals are noticing and addressing this issue. And I think it’s amazing that some people are empowering themselves by presenting these cards, although I would not be surprised if some people get lectured by their doctors for not being weighed. I would like to see less lectures from doctors as a general rule. People need to take ownership for their own health, and physicians need to stop seeing patients as people who need to be given orders or lectures about taking care of themselves. Especially if they are competent adults.

Anyway… I probably won’t be going to see a doctor anytime soon, and in fact, I hope I don’t live to be super old. I think it’s overrated. But I definitely think the cards are kind of cool, even if I’m sure they don’t always go over too well with more traditional physicians. I know that if I had given one to my ex psychiatrist, for instance, he probably would have laughed me out of his office. And he never weighed me once– but he did fat shame me quite a few times before I told him to stop. He also gave me a prescription for Topamax off label, hoping it would slim me down. Is it any wonder why I hate seeing doctors?

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complaints, condescending twatbags, healthcare, rants

Where is Richard Simmons when we need him?

Yesterday, I read an article in The New York Times entitled “Breaking Down the ‘Wellness-Industrial Complex,’ an Episode at a Time“. It was a surprisingly interesting and disheartening read. I wasn’t attracted to it because of the title, though. I decided to read it because of a quote that was used to draw attention to the article.

A man named Scott Cave, who lives in the Appalachian Mountains region of Virginia and has a doctorate in history, is a regular listener of the podcast, “Maintenance Phase”. The popular podcast, which has existed for about a year, is named after the concept of maintaining weight loss after a successful diet. The hosts, Aubrey Gordon, and Michael Hobbes, “spend each episode exploring what they call the “wellness-industrial complex,” debunking health fads and nutritional advice.” Gordon got started because she collects vintage diet books, and realized that a lot of them were full of ridiculous ideas that ultimately don’t work in keeping people slim and fit.

Cave says he listens to “Maintenance Phase” because “he appreciates the way the podcast examines and evaluates primary sources in a way that’s fun.” He also relates to some of the topics, since he himself has a weight problem. One time, “Maintenance Phase” did a show about how people who are overweight or obese are more likely to avoid seeing healthcare professionals. Cave identified with that, as once he visited an urgent care practice because he thought he’d broken his finger. He was told, “We don’t think your finger is broken. It might be, but you’re very fat, so you should probably deal with that.”

Mortified by the shaming comment about his weight, Cave ignored signs and symptoms of an autoimmune disease for a long time. He didn’t want to deal with more negative stigma about his size. So he suffered in silence with his swollen finger, and felt ashamed. That negative comment, while based in truth, dealt a terrible blow to Cave’s self-regard and trust in the medical care system.

I can relate to Cave’s reluctance to visit doctors. I haven’t seen one myself in about eleven years. In my case, it’s partly due to not wanting to be lectured about my size or my bad habits. It’s also due to some legitimate trauma I experienced at the hands of an OB-GYN who physically hurt me as she examined me, then fat shamed me.

This doctor’s pelvic exam was so painful that I cried out, and she basically told me to shut up as she stuck me with another, smaller speculum that also hurt. I bit my lip and gutted through the rest of the exam, hoping I wouldn’t pass out. I had to complete the exam so I could join the Peace Corps. Afterwards, the doctor told me I was too fat and would gain weight in Armenia. Then she basically shamed me because she wasn’t able to get a “good look down there”. She claimed I wasn’t “cooperative”. She offered me birth control, even though I was a virgin at the time. I left her office feeling completely violated, humiliated, and frankly, like I had just been assaulted.

It took twelve years for me to have another gynecological exam by a much kinder, more understanding, and professional physician’s assistant. She let me cry, and heard my explanation about why I was so upset and anxious. Then, when she did the exam, it didn’t hurt at all. I remember being so relieved that I wasn’t in pain. Then I was very angry, because the doctor who had done my first exam had hurt me without reason. I hadn’t thought to complain about her. I now wish I had.

I was so upset and stressed out during that second exam that the P.A. thought I had high blood pressure. I ended up having to visit her several more times before she was convinced that I had white coat hypertension. Sadly, we had to move out of the area. The P.A. also changed her practice, and now only works with cardiology patients. So even if we had stayed in the D.C. area, I wouldn’t have been her patient for long.

I last saw a doctor in 2010 at Bill’s insistence, because I thought my gall bladder was giving me issues. It’s probably full of stones. But the ultrasound didn’t show that the gallbladder was so inflamed that it needed to come out just then. And then we moved a bunch of times…

So no, I don’t go to doctors. I know I should, but I don’t. Aside from mycophobia (fear of mushrooms), I also have a touch of iatrophobia (fear of doctors). And I can understand why Cave doesn’t go to doctors, either. The experience is often demoralizing, expensive (for those who don’t have Tricare), and just plain awful.

As you might have guessed, after I read the article, I read some of the comments. Naturally, they were full of people who hadn’t bothered to read the article. Some were very unkind and lacking in empathy. One guy wrote that the article was “stupid” because it was full of people “making excuses”. In his comment he wrote that “all I see” are people justifying being fat. Then he added that he’d lost 100 pounds.

He got some blowback for that comment, including from yours truly. I wrote, “All I see is a guy who is a judgmental jerk. Congratulations on your weight loss. Looks like you also lost your ability to empathize.”

I got many likes for that. The original commenter came back and wrote that he DOES empathize, but Americans are all eating their way into diabetes. And I wrote that while it’s true that obesity leads to a lot of health problems, it’s not helpful to accuse people of “making excuses”, particularly if you’re a total stranger. I didn’t see any “kindness” or actual concern in his comments, only judgment. And then I wrote…

“If you truly do empathize and want to help people, you should be kinder and more empathetic. Instead of insulting and judging, you could be encouraging and enthusiastic. You could learn a lot from Richard Simmons on how to motivate people. Richard Simmons used to be fat, and like you, he lost a lot of weight. But instead of being mean to people, he encourages them. He actually CARES about them.” Of course, I wrote that taking the commenter at his word that he’s really trying to “help”. A lot of people who make comments about “personal responsibility” and concern troll the overweight are really just getting off by acting superior and being jerks.

As I wrote that comment, I couldn’t help but remember an old episode of Fame I recently watched. The character, dance teacher Lydia Grant (Debbie Allen), decides to teach an exercise class for some extra money. She thinks it’s going to be a “piece of cake”, since these were just middle aged women trying to get into a new dress. But when she teaches, using her usual demanding style, she finds that the women in the class aren’t successful. One woman in particular, name of Renee, is about to give up because Lydia is just too demanding.

But then Richard Simmons interrupts and shows Lydia how it’s done. He asks Renee if he could have this dance. Renee nods and the two proceed to work out. Richard is encouraging, enthusiastic, and kind, and Renee responds in kind. And not only does she complete the workout, but she also leaves with a big smile on her face!

Lydia says there’s no way Renee can meet her “impossible” goal of losing twelve pounds in two weeks. So Richard says, “That’s okay. Let her lose six pounds!” I think that makes a lot of sense, don’t you? There’s nothing that says Renee can’t meet part of her goal and take a bit longer to get where she wants to be.

I’m not saying I love Richard Simmons. In fact, I used to cringe when I saw his ads for Deal-A-Meal and “Sweatin’ to the Oldies”. And I laughed when I read about how he slapped some guy who mocked him at the airport. I did like his 80s era talk show, but it was always on when I was at school.

I just think that when it comes to motivating people to lose weight, Richard is onto something that actually works. Fat people are people, too. Just like everyone else, fat people want to be valued and accepted. Nobody enjoys being insulted, shamed, and judged, especially by total strangers! Moreover, nobody wants to PAY for that experience, especially when the doctor dismisses the patient and says all of their health problems are brought on by a lack of discipline and willpower. And while the commenter on the New York Times piece may actually empathize and care about others, he has a really shitty and off-putting way of showing it.

I got another comment from another person who praised the first commenter for promoting “personal responsibility”. I think personal responsibility is all well and good. But you don’t know why someone is fat. You don’t know what their story is, or if they’ve actually done anything to lose weight. What if that overweight stranger you see has actually been losing weight? What if they’re out and about for the first time in weeks because they’ve lost twenty pounds? How do you think they would feel if you lectured them about personal responsibility and admonished them to slim down? Do you think those words would motivate them to keep going? Or is it more likely that they’d get depressed, say “what’s the use?” and go out for a double cheeseburger?

Besides being cruel and rude, fat shaming people is potentially very damaging. And a person’s weight is also none of your business.

The fact that fat people have to work up the gumption to see doctors is a serious issue. I recently read a horrifying story about a 27 year old woman in Los Angeles named Amanda Lee who visited a doctor because she had lost 35 pounds, was having abdominal pain, and couldn’t eat. Instead of getting to the bottom of why Lee was losing weight and experiencing pain, the doctor said that maybe it was a good thing she was in pain and couldn’t eat. He continued the horror by saying that only being able to eat things like pureed apples was a “blessing”. And he added that she didn’t look “malnourished”. I would add that according to the photos and videos I’ve seen, she doesn’t appear to be that overweight, either. But then, it is Los Angeles. In any case, the doctor refused to do any testing on Lee, and she left his office in tears.

@mandapaints

“Maybe that’s not such a bad thing” not a time to joke.

♬ original sound – Amanda Lee

After her appointment, the mortified young woman recorded a TikTok video in her car. She was sobbing hysterically as she recounted what had happened during her appointment. Commenters encouraged her to see another doctor, so she did. That doctor did a colonoscopy on Amanda Lee and discovered a large tumor. She had surgery to remove it, and was diagnosed with stage 3 colon cancer!

As of June, she was receiving chemotherapy. I hope she also looks into suing that first doctor for malpractice! I’m grateful that the commenters on her video were kind, rather than fat shaming. I’m also glad she shared her story, because I think it will help a lot of people on many different levels.

Well… that about does it for today’s fresh content. We didn’t go out yesterday, so I suspect Bill will want to do something this afternoon. Enjoy your Sunday.

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healthcare, mental health, musings

Death of a head shrinker…

A few days ago, I read an article in The New York Times about new drugs that can help treat obesity and perhaps “end the stigma” of being overweight. I’m old enough to have seen a lot of so-called magic bullet obesity drugs on the market. I remember in the late 90s, there was Meridia, which used to be advertised on TV all the time. This ad showed pleasingly plump women in loud prints, breezily lumbering along with smiles on their faces… The ads promised that the drug would help fat people control their appetites and lose weight. Then it was voluntarily withdrawn from the U.S. market in 2010, because it was shown to increase risk of heart attacks and strokes.

I remember this ad so well…

In the 1990s, there was also the Fen-Phen combo of drugs, which was said to be very effective in helping people lose weight. Bill says his ex wife took that combination for awhile. Apparently, she was very upset when it was taken off the market. I remember that combination of Fenfluramine and Phentermine was removed because it supposedly caused heart valve problems as well as high blood pressure. Ex, indeed, reportedly had issues with her heart, other than the fact that it’s so small. She had to have surgery at some point.

And then there was the drug my former psychiatrist gave me. For some reason, my former shrink felt besides the antidepressants I definitely needed, I should also take Topamax to help me lose weight. Topamax is a drug that is used for stopping seizures, curing migraines, and treating bipolar disorder. My shrink didn’t give it to me for those purposes, though. He prescribed it because one of the side effects of Topamax is decreased appetite. He felt I was too fat, and Topamax would help me lose weight.

Granted, I wanted to lose weight… and I was tired of hearing him harp on my body when I went to see him for prescription refills. So I tried Topamax for awhile. I often got the third degree from pharmacists, since I was also taking Wellbutrin, which is said to cause seizures in some people (but not me). Pharmacists would become alarmed at the drug combination and question me, and I would have to tell them that I wasn’t taking Topamax because I have seizures. It was embarrassing.

The Topamax did kill my appetite, which Bill didn’t like, because I didn’t want to cook or eat dinner. It also made carbonated beverages taste terrible, which wasn’t a bad thing, since I was addicted to Diet Pepsi at the time. But even with health insurance, the drugs were expensive, especially since I was also taking name brand Wellbutrin (the generic version didn’t yet exist). I also didn’t lose a lot of weight, much to the psychiatrist’s dismay. He wondered if I had a slow thyroid.

I remember feeling really horrible about his comments. At the time I was seeing him, I had actually lost a lot of weight because I was waiting tables and didn’t have time to eat or sit down. The pounds came off pretty easily and most people thought I looked pretty good. However, I was constantly sick during that time, partly because I was fresh from the Peace Corps and kept getting skin infections and also because I was run down because I was always working. I developed a distinct disdain for that shrink because even though I suffered greatly from body image issues, eating disorder issues, anxiety and depression, this guy kept harassing me about my figure… even after I was happily married to Bill, who didn’t care that I wasn’t skinny.

I was reminded of this shrink the other day, as i read the article in The New York Times the “new” magic bullet drugs that could help people shed pounds and the scorn and harassment that comes from being overweight. I shared the article on Facebook and my former therapist, who is now a friend, commented that the article is interesting. I wrote that I thought his “friend”, the psychiatrist, should see it. My former therapist wrote, “Yes, but he’s dead.”

I hadn’t known the former head shrinker had died. I went looking for his obituary, and lo and behold, there it was. He actually died two years ago. I had no idea. Several people had left kind comments about his memory. If I’m honest, I could see how they came to their conclusions about him. On the surface, the former head shrinker was “nice” enough. I remember thinking he had kind of a gentle, steady air about him. But he also really pissed me off on a regular basis by calling me “kid” when I was a grown and married woman, making comments that were belittling, and giving me a hard time about not being thin when I already had terrible issues with self esteem. I got the impression that he had a personal bias. I also didn’t like it when he acted in a paternalistic way. He was very much an old school kind of doctor who treated me like a child. It wasn’t very helpful at a time when I was trying to launch.

Fortunately, I only went to see that doctor for medication. I saw my therapist, a younger, hipper, and more empathetic guy, for psychotherapy. I will give the head shrinker credit, too. He was a competent psychiatrist in that he found the right drug for me. Wellbutrin changed and maybe even saved my life. Within just a few days of taking it, I felt like a completely different person. After taking it for several years and then getting off the drug, I still haven’t gone back to the awful way I used to feel every day… the way that was normal for me, but made other people think I was legitimately crazy. People used to ask me if I was bipolar all the time. They don’t anymore, although I don’t spend much time around other people anymore.

In 2007, before we moved to Germany the first time, I requested my records from the shrinks. I needed them because the Army required all of my medical records so I could be evaluated for the EFMP (Exceptional Family Member Program). This was supposedly a must before they would send us to Germany, but as it turned out, the National Guard (Bill’s official employer– he was a full time “federalized” Guardsman) didn’t give a fuck about my EFMP status the way the regular Army would have. I was forced to join the EFMP, but it turned out that I could have skipped the whole process and the National Guard wouldn’t have been the wiser. It would have been nice if I had known that, since the whole EFMP screening process was traumatic for me on many levels. I won’t get into that now, though. I think I reposted about my experience with the whole EFMP business. Thank God Bill is retired.

Unwisely enough, I read the notes my shrinks wrote about me. My cool therapist wrote positive, affirming notes. The dead head shrinker wrote things that upset me… like, for instance, I had a “garish” appearance. I was a bit taken aback by that. People have described me in a lot of ways, but never “garish”. That implies that I looked tacky, gaudy, or like a clown. And I didn’t see what my choices in makeup and clothing had to do with my mental well-being. Isn’t it better if someone with depression isn’t wearing black? He also made comments about my weight in his notes… and on more than one occasion, seemed a bit frustrated that his chemical cures weren’t slimming me down. I know very well that I’m not a thin person… but he made it sound like I was just disgustingly obese. When I was seeing him regularly, I wore a size 14 or 16… which is pretty average among American women, even if it’s not ideal in terms of most women’s most attractive body size.

It was a little strange reading about this man’s death. I mean, I know it had to happen… he was old enough, although he was several years younger than my father was when he died. I noticed the obituary didn’t mention a wife. I remember he was married when I saw him. I’d heard she was his third wife, and she had been about my age, while the shrink was old enough to be my dad. He’d had a young daughter back in the late 90s, which would mean she’s a young adult now. He also had four other children. I remember thinking that I hoped his youngest daughter didn’t have weight issues when she was growing up. I had a feeling he would ride her about them. And I guess, just based on his obituary, that his wife was no longer married to him when he passed a couple of years ago. He was a tall, somewhat handsome man, and he didn’t have a weight problem. But that didn’t stop him from having problems of his own.

I don’t like seeing doctors. I haven’t seen one since 2010, when Bill made me go because we thought my gallbladder might need to come out. It turned out it wasn’t bad enough to be yanked. One of the reasons I don’t like seeing doctors is because of that shrink… as well as the horrible OB-GYN who did my very first (of only two) gynecological exams. She physically and mentally hurt me so bad and shamed me so much that I became a bit phobic of medical people, even though I have a background in healthcare. Now I don’t go to doctors unless I’m about to die.

But maybe I shouldn’t blame these doctors for turning me off of their services so much… They’re only human, right? I’m sure they had my best interests in mind when they fat shamed me. The OB-GYN wrongly predicted I would get very fat in Armenia. I actually lost a lot of weight there. I did gain it back, but then I came home and waited tables and lost even more weight. And then I gained it back when I quit waiting tables… which was a good move for my overall health– especially my mental health– even if I didn’t have as pretty a package for people to look at. I’m glad to hear about the new drugs that might help people lose weight. I think it’s a good thing to think of obesity as a medical problem rather than a character flaw. However, this is not the first time I’ve heard about drugs that can help with weight loss… and so many of them turn out to be harmful.

Well… one more week to go before Bill is home. I continue to try to keep the faith. Last night, I was thinking about places I might like to visit when we’re finally able to travel again. Funnily enough, I’m planning based on whichever place is the least likely to give me a hard time rather than where I’d really like to spend time. One of the many luxuries of living in Germany is that there are plenty of places to see, and a lot of them are not so hard to drive to. Last night, I was thinking about visiting Krakow, Poland. It’s about a 9 hour drive from where we live. Maybe we can go there this year… after my second vaccine next month.

Also… I guess I’ve now arrived. Yesterday, I was made aware of someone having made a cloned account from my Facebook profile. It had one of my photos from last year, a cover photo using a picture I took in Rothenburg in 2018, and claimed I was a Mexican living in Nashville. I reported the profile, but Facebook naturally says they can’t do anything about it because it “doesn’t violate standards”. Meanwhile, they can give me bullshit warnings because they claim one of my comments was racist hate speech when it was really a criticism of a racist game being pitched on Facebook. They really need to get some real people evaluating these reports again. Facebook sucks, and is becoming more of a joke by the day. Anyway, I left several more complaints, along with a profane comment on the cloned profile. I doubt it will amount to anything. I changed my passwords, just in case.

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