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May 11, 2010 / Katie

The doctor, part one

For months, I’ve been starting posts about the doctor and then stopping midway through.  The posts ended up relegated to the draft folder, eventually to be deleted months later when I saw them and thought, “yeah I’m never really going to publish that.”

I think part of the problem was that I felt like I had to say everything in one post, but I realized that that’s not true.  So I will focus on one aspect of my experience with going to doctors in this post, and no doubt there will be more bits and pieces to come over time.

For the first time in my life, I feel empowered at the doctor.  I feel respected, believed, and supported.  And it’s all because a doctor actually said to me: “your weight doesn’t really tell me anything about your health.”

He’s an endocrinologist to whom I was referred after telling my women’s doctor that I wasn’t menstruating and had been diagnosed as “pre-PCOS” by a women’s clinic about 10 years ago.  She asked if I’d ever had a full lab run, looking at hormone levels, and I said no.  So she gave me the card of an endocrinologist, told me to go off hormonal birth control, and make an appointment for about a month out (so that the hormones from the HBC would be out of my system and give the endocrinologist a more accurate picture of what was going on for me).

In my first meeting with him, he spent an hour with me.  He asked me questions about my weight history and that of my parents and siblings.  He asked me questions about history of other physical and emotional disorders in my family.  He listened to me vent that I was at the end of my rope after having been told by a string of doctors that if I lose weight all my problems will go away, meanwhile no matter how healthy (or unhealthy!) my choices are—no matter what I do—I keep putting on weight, at an amount that had become alarming (about 30lbs in 6 months).  To be completely clear here, I was not concerned about being fat, I was concerned about the rate of change in my weight.

After asking me questions and listening to my story, he gave me some recommendations about food and told me that he suspected I was experiencing insulin resistance.  He explained what that meant and it sounded exactly like what I experience.  He said that he wanted to run a full lab of blood work and then would call with the results.  I went back the next day and they took seven vials of blood (sorry for you who are squeamish!).  The lab tech apologized and joked about how this particular doctor was often referred to as being “more of a scientist than a doctor.”  I’m okay with that—I’m a scientist at heart myself.  He ruled out thyroid problems, diabetes, and all kinds of other things I have never even heard of.

In the end, just as he suspected, it was insulin resistance.  So he started me on Metformin.

I had some nausea from the Metformin for a little while but it seems to be going away after a couple weeks.  I can already sense a major shift in my appetite.  I didn’t realize my appetite had become larger than it needed to be, because it happened slowly, but with this change I’m eating in a way that now feels much more normal to me.

I don’t know if I’ll lose weight on Metformin—some people do, but I don’t really care as long as it just stabilizes my weight.

And I feel like a gigantic emotional weight has been lifted from my shoulders just because a doctor finally—finally, after 28 years—actually said to me, “your weight doesn’t tell me anything about your health.”  The context in which he said it was that losing weight should not be a goal for me—I need to get my insulin resistance under control to help with other numbers like cholesterol but once it insulin is under control through medication, movement, and eating intentionally, those other numbers will be my health indicators, not the number on the scale.

This of course brings up other issues about the power we give doctors, and it helps me to think and talk about other (almost exclusively negative) experiences I’ve had with other doctors in my past.  But those will be posts for another day, because I’ve written enough for now.

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6 Comments

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  1. Heidi / May 11 2010 4:09 pm

    I definitely need to give him a call – I’m pretty sure I need a good endo workup at this point!

    I felt the same way when I first met my nutritionist and it was the best feeling in the WORLD to just have my size be a complete non-issue. When I think what a relief it would be to go through the world feeling that way…

  2. Hidi / May 11 2010 7:06 pm

    I love your endocrinologist; I need to meet him. LOL
    “your weight doesn’t tell me anything about your health.”<–This is what people need to realize; it's just a number. We are not numbers on a scale, chart, measuring tape, etc. :)

  3. The wellrounded mama / May 12 2010 10:01 am

    Glad you finally got diagnosed and are getting treatment. Yay for finding a doc who actually listens!

    Find out and keep records of your EXACT lab results for future reference. it’s not enough to know “normal” or “not normal.” Find out just HOW normal or not-normal you are and keep track of that over time so you can track trends.

    Also, what was your TSH? Lots of insulin-resistant fat folk have TSH levels above optimal but less than the diagnostic cutoffs currently used by many docs, yet still benefit from a trial of meds if they exhibit symptoms of hypothyroidism. You might want to read up on this more.

  4. seriouslysamantha / May 12 2010 4:13 pm

    Where did you find this doctor?

  5. Christine / May 12 2010 7:21 pm

    WOW. I only went to an endocrinologist once. He spent about 5 min with me and suggested bariatric surgery. I seriously nearly punched him. It was at a teaching hospital and the intern (who, by contrast, was simply wonderful and actually discussed my issue, which was PCOS/insulin resistance) looked concerned the minute he said it. I have a feeling this was a common issue!

  6. AcceptanceWoman / May 13 2010 3:30 am

    I have had several really friggin’ good endocrinologists, but I know others have had not so good interactions with them. I live about 50 miles south of you off of I-5 and would love to meet you someday.
    If you get used to the metformin, the nausea will likely subside unless you start and stop it or increase the dose — that’s the experience of most people who can tolerate it. Those who can’t tolerate it — it makes them feel really ill and doesn’t get better over time.
    I’m so glad you found a doctor you can work with. I think that metformin does reset things a bit and increases insulin sensitivity, so the hunger part doesn’t happen in the same way because nutrients are actually making their way into our cells. Not our fault.

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