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Francesca comes up with a Good Line | Manolo for the Big Girl

Francesca comes up with a Good Line

Francesca has dropped her former primary care physician like a hot potato, after said “doctor,” in response to Francesca’s suggestion that she (Francesca) might have sleep apnea, said “Sleep apnea isn’t important. If you are snoring, it would be annoying to anyone else who might be sleeping with you, but it’s not a risk to your health. Since you live alone, I wouldn’t worry about it. It’s not worth testing for.”

Setting aside the idea that a person who lives alone gets different health care from someone with a regular, uh, long-term sleeping partner, sleep apnea causes metabolic problems, which Francesca has. Francesca mentioned to some doctor friends about the sleep apnea, all of whom said without blinking “oh, yeah, sleep apnea is bad. It causes depression, metabolic disorders, and besides, you are tired all the time.” Hello?!?

Anyhow, this means that Francesca has to “break in” a new doctor. Francesca brought the new doctor a letter outlining her health history and issues and what she is doing to manage them, and explaining the “health at every size” outlook.  He spent the first few minutes reading the letter, and then asked me questions, such as the following:

Doctor: You’ve been exercising 30 minutes a day and haven’t lost weight?

Francesca: That is correct.

Doctor: For weight loss, I’m going to recommend 40 minutes.

Francesca: I’m sorry to interrupt, but want to make it clear that I’m not interested in weight loss. I’m interested in staying healthy.

Doctor: But to be healthy, you have to lose weight.

Francesca (with forced patience): Well, I’ve been trying that for 30 years, since I was 6 years old, and it hasn’t worked. I’d rather focus on healthy behaviors than on my weight.

Doctor: I’m very confused because over here (pointing to letter) you say that you’d like a referral to a new nutritionist, but you don’t want to lose weight?

Francesca: I want some support in adding more fruits and vegetables to my diet [Francesca’s note: even though it contradicts the HAES “intuitive eating” model], because I’m not good at that and I want to make sure my body gets the nutrients it needs. But I don’t want it to be that if I eat healthy and exercise but don’t lose weight, that I’ve failed. I want it to be that if I eat nutritious food and exercise regularly, I’ve succeeded, whether I lose weight or not.

This absolutely “clicked” it for the doctor, and he said he might even use that line with other patients. I was so proud! My first thought was “I hope Kate Harding sees the post about this!”

It takes a little time and effort to treat one’s doctor!

19 Responses to “Francesca comes up with a Good Line”

  1. Twistie July 2, 2009 at 10:19 am #

    Wait a minute, there’s a doctor out there with a license to practice who DOESN’T think sleep apnea is an important health issue if you’re not waking up a partner with the snoring??????

    Folks, if you ever meet a doctor that incompetent, RUN do not walk to the nearest exit.

    Yay for Francesca’s new doctor who is listening!

  2. Mrs. Hendricks July 2, 2009 at 11:05 am #

    Excellent job, Francesca! I was pleasantly surprised by the doctor’s response, and hope that he not only shares his recently acquired insights with other patients, but with his colleagues. Twistie’s right: if something sounds crazy, get out of there.

  3. marjorie July 2, 2009 at 11:50 am #

    what a HUGE mitzvah you did for his other patients by EDUCATING him (and continuing to try after it seemed he wasn’t getting it) rather than simply cut-and-running. i’m not sure i would have had the patience.

    it’s awesome to watch someone actually have that “click” moment.

  4. Jen Anderson July 2, 2009 at 11:56 am #

    I’ve had to switch doctors after discovering that my current one was an idiot. The worst part is not knowing whether or not the next one is an idiot too. I’ve put off finding a new GYN for just that reason.

    That line is brilliant! I’ve written it down and I’m going to use it whenever I’m breaking in a new doctor in the future.

  5. Christina July 2, 2009 at 12:05 pm #

    Sleep apnea is a HUGE problem. Keith, my husband, stopped breathing 120 times an hour. That’s right–twice per minute. It created strain on his heart, lungs, liver and all kinds of other internal organs. His cholesterol was 400. All of his male relatives snored and ALL of them died before collecting a Social Security check from massive heart attacks. He got into more than one car accident because he fell asleep driving. He always looked a little gray but no one really noticed it because that’s just his skin tone, right?

    He spent one night with a CPAP machine and came home sore in every joint because he actually slept so hard he didn’t move. His body was starving for sleep. And he was PINK. Really pink.

    Two weeks on the CPAP, with no other changes in diet or medication, his cholesterol was down to 180. Cut in half.

    Recently, he had a scope put in his heart to look for a blockage the cardiologist just KNEW had to be there*. The cardiologist said, “Wow. I hope my arteries are as clean as yours.”

    *Patient history: 6’5″, 375lbs, heart disease in family, complaining of chest pain. Obviously, it must be a heart attack. Yeah, not so much. Three days in the hospital and several thousand dollars worth of tests later, turns out it was anxiety but they refused to look for anything but a heart attack due to his weight and what happened to his dad. /sigh/

  6. Abbe July 2, 2009 at 12:42 pm #

    Wow, that’s so great that the new doc got it. So nice when a doctor doesn’t see weight as the only thing worth looking at. And it is amazing what treating sleep apnea can do. I saw a friend seem to lose 10 years after a week with a cpap machine.

  7. Margo July 2, 2009 at 2:15 pm #

    I left my husband, among many other reasons, for his refusal to take action on his sleep apnea. I didn’t want to wake up next to his dead body some morning.

    They guy I’m with now also has apnea, and uses a C-Pap machine every night. I actually find the sound of it very soothing, it makes a swooshing noise like ocean waves.

  8. Margo July 2, 2009 at 3:12 pm #

    I left my husband, among many other reasons, for his refusal to take action on his sleep apnea. I didn’t want to wake up next to his dead body some morning.

    They guy I’m with now also has apnea, and uses a C-Pap machine every night. I actually find the sound of it very soothing, it makes a swooshing noise like ocean waves.
    Sorry, forgot to add great post! Can’t wait to see your next post!

  9. jojokaffe July 2, 2009 at 3:37 pm #

    Yeah for Francesca, on putting your health first and for finding a trainable doctor.

  10. Lisa July 2, 2009 at 3:37 pm #

    Kudos to Francesca for getting what she needs and for helping the doc see the person instead of the chart and the rhetoric.

  11. La BellaDonna July 2, 2009 at 5:38 pm #

    Yay you, Francesca! I’m glad he listened!

    I could do with some internet comforting and there-thereing; I’m trying to find a new pain management doctor, and I brought carefully typed up lists of problems, prescriptions, past history, everything I could think of. I tried to tell the doctor what had been tried in the past and not worked.

    He called me “uncooperative” because I told him there were treatments that hadn’t worked.

  12. Sarah July 2, 2009 at 7:40 pm #

    Yay, Francesca!! What a wonderful explanation. I have also found that starting a nutrition/exercise program with the ultimate goal being weight loss doesn’t work for most people (or me, anyway). It’s short-sighted. Even though I would love to lose weight, and I feel physically better at a lower weight, it doesn’t WORK to have such tunnel vision, and it only makes things worse (read: heavier). Better to work with what you’ve got and focus on what’s important.

  13. bridget loves July 2, 2009 at 8:05 pm #

    This is such a fab blog post. I am The Un Diet Coach here in LA, California. I teach people to quit dieting for life to find their “Skinny”. The magic of this is they learn to love and enjoy food AND love their body. I encourage tossing out ALL numbers! So I am totally anti fat discrimination and am so annoyed with doctors who think it has everything to do with your “weight”. Oh boy. Okay well look forward to reading more!

    Bridget Loves

  14. Kate July 2, 2009 at 8:51 pm #

    May I use that line with my patients, too?

  15. silverpatronus July 2, 2009 at 9:35 pm #

    I have a friend who was misdiagnosed by not one, but several doctors who refused to listen to her when she said her hypermenstruality was NOT anemia, and the pill made her faint. Turns out she has PCOS and them putting her on the pill the last time she was in the hospital gave her DVT. If they had LISTENED to her, she would not have been so ill for so long and spent so much time in hospitals over the years.

  16. silverpatronus July 2, 2009 at 9:37 pm #

    Oh, might I add that part of the reason that the doctors didn’t listen to her is because she was overweight and they refused to consider that her weight might be a symptom of a larger problem. No, it’s because she needed to be on a diet innit?


  17. silverpatronus July 2, 2009 at 9:40 pm #

    While I’m recalling, my young cousin, who is also a big little girl, has been shunted from doctor to specialist to herbalist to aromatherapist to dietician to dietician to dietician. She’s big, must be food-related, right? Turns out she contracted some kind of tropical blood disease from a mosquito bite when she was very young. The doctors, of course, didn’t even consider it as a possibility.

  18. Mim July 3, 2009 at 7:07 am #

    yes. bastards.
    my docs are mostly okay right now, but my last primary care doc was so frustrating. ugh! !! and i had another one who made me cry.

    i hate that many doctors have their heads so far up their tushies that they cannot respond to “i tried this treatment and **it didn’t work**” with anything but ‘you must be noncompliant/uncooperative’. like it’s my *fault* that i experience known side effects and find them debilitating and the whole thing not worth it! clearly i could just think healthy (thin) thoughts and then everything would be fine!

  19. Peaches July 4, 2009 at 7:25 am #

    at needing a lumpectomy, my former surgeon said “dont worry honey, we will take out the size of a lemon and with the size of your breast, you wont miss a thing.” He was as sensitive to my feelings as Gov Sanford to his wife. Yee