Friday, December 7, 2018

A Very Personal Post: My Hysterectomy and Sub-Par Treatment of Women and Larger Patients

Ragen Chastain of Dances With Fat, a blog which people of every size should read

I normally try to keep my money-saving and life hacks blog confined to products, recipes, and apps which can help put money in your pocket and keep it there. However, sometimes I feel it is important to share personal and societal issues. This is one of those times.
I have blogged recently about having my eldritch horror of a uterus removed on December 17th. My uterus is full of polyps and benign fibroid tumors. There are other treatments for this (ablation, breaking up the tumors with ultrasound, hormones), but they tend to have to be repeated down the line. I no longer have a need for my uterus in this life. I feel that the most efficient course of action at this point is a once and done option: take it out and be done with it. Then there will be no future ablations, no future d and c's, and no more pap smears ever again in this lifetime. Weighing the pros and cons, I believe this to be the best option in my case.
Reflecting on the situation, my uterus probably should have come out ten to fifteen years ago. I always had brutal periods. I do not joke when I say I didn't bleed, I hemorrhaged. However, due to past trauma (sexual assault) and fear of being shamed for my body type (I am built similarly to Ragen, but am nowhere near as beautiful and graceful), I avoided having any sort of "well woman" type of exam for close to thirty years.
I feel like the current approach to focusing on a patient's weight first and, often to the exclusion of all else, is lazy medicine. Doctors fail to take into account that weight is only one part of the equation and correlation is not causation. There are multiple factors at play in a person's body type. DNA is the first and most powerful of these. 


Repeat after me: a rhino is not a unicorn. A rhino does not even know what a unicorn is. I doubt there is a rhino anywhere in the world that dreams of being a unicorn. Also, unicorns aren't real, much like the ridiculous appearance ideals that we learn to impose on ourselves from a very young age.
Dr. Oz (Oprah's pet snake oil salesman) once said that he never sees a fat person who doesn't have cardiac problems. What he neglected to mention is that he never sees a thin person who doesn't have cardiac problems either. He's a cardiologist. But there isn't a big market for weight gain products. There is a multi-billion dollar industry built on convincing people that their bodies are wrong and it's their fault that diets fail time and time again.
Doctors don't tend to see (or notice) healthy fat people, because when a person avoids the doctor's office like the plague for fear of being shamed and lectured about their weight, they tend not to seek medical treatment until the situation becomes catastrophic. Further, poor people regardless of size often can't afford medical treatment and thus avoid seeking medical treatment until the situation becomes catastrophic.
Teaching doctors to shame and scold patients for their physique (or anything else) leads patients to avoid seeing doctors. This is counterproductive. The Western medicine focus also tends to be on treating illness rather than maintaining health. This is counterproductive. The U.S. medical system is broken, and the definition of insanity is insisting on doing something that doesn't work and hoping it will work this time. It doesn't work and it isn't going to work this time. The dead horse needs to be replaced rather than flogged and shocked in hopes that it will wake up and gallop around the pasture like a healthy young colt.
In any case, after many years of going to a doctor who wasn't the worst but seemed to be burned out and going through the motions, I was doing a search for doctors with a Health at Every Size approach. I hope the future will present with many, many more such doctors, but currently, such a search can be extremely frustrating. I happened on a doctor in my general area who stated that she provides a safe space for patients of any race, sex, orientation, or size. I made an appointment right away.
Even though I got on well with this new doctor and trusted her, she had a difficult time examining the plumbing, so to speak. However, we got through it. The results of the dreaded pap smear were normal. But there was more to come.
I see my doctor quarterly because of my endocrine problems. During my April visit, I told her that I'd had my "yearly period." I said it was frustrating to me because I thought I was completely done with the blasted thing, but every year for the past couple years I had a really dreadful, heavy, but fortunately painless period. 
My doctor said that this wasn't normal and referred me to a gynecologist. I was extremely worried, but this incredibly kind and wonderful woman never once shamed me about my body. She focused on the issue at hand and was compassionate about my fears. After performing a biopsy and examination of the inside of the troublesome organ, I was informed that it was housing numerous fibroids and polyps and was sent for a consultation with a surgeon who specializes in gynecologic surgery.
My case is a walk in the park for this fellow. He has a lot of patients dealing with various cancers and severe pathologies. I present with a straightforward, uncomplicated condition, and the surgery should take less than an hour. I'm still terrified and want to run screaming. I hate going under anesthesia. 
The doctors involved in this chain of events have all done things right. They have treated me with respect and not shamed or scolded me for having a body which does not fit society's definition of "ideal" by any stretch of the imagination. This means that I listen to them rather than saying: "well, fuck this shit, I guess I'm going to just have to live with my problems because I don't want to deal with these assholes."
I worked in the medical field for most of my working life. There are patients who are frustrating to deal with. They are noncompliant and expect miracles. There are patients who demand antibiotics for the treatment of viruses. There are patients who seem to believe that doctors are hiding secret cures in their doctor arsenal. There are patients who can't stop smoking even though it's killing them. All of these people need to be treated with kindness and respect, even if the medical staff feels the need to headdesk repeatedly following a visit with said patient.
I've known more than one person who was so addicted to smoking that even though it had serious negative health consequences, they were unable to stop. One was my maternal grandmother, who died in 1992 at the age of 75 from complications of alcoholism. She had emphysema and couldn't make herself stop smoking. She successfully stopped drinking once, but then my cousin (a very broken person) brought over a six-pack one night, and she was right back at it. 
My grandmother had a hard life. It would be frustrating to treat a patient who is committing slow suicide, but it would never be appropriate to belittle or berate such a person. My grandmother only had an eighth-grade education, but she was by no means a stupid person. She had a lot of "horse sense." She was also deeply conflicted and had a very low self-esteem and untreated mental health issues.
I don't know the other person's backstory. She was a customer who came into a restaurant where I worked as a bartender and waitress. She would get coffee and stay for a long time in the afternoon, chain-smoking, reading, and drinking her coffee. She was a social worker who was getting ready to retire. She had a daughter who had borderline personality disorder.
This woman eventually had to have part of one lung removed. She tried to quit smoking, but people would see her around town hiding behind buildings for a puff, even though she had to carry an oxygen tank at that point. She died within a year of the surgery.
Scolding this woman would not have made it easier for her to quit smoking. She wasn't stupid. She knew that smoking was causing her health problems. Addiction is a complicated and misunderstood issue.
Some people equate having a large body type with addiction. This is erroneous. Some people with larger body types have binge eating disorder, as do some people with slender and medium body types. Binge eating disorder is not an "addiction to food," it is a pathological relationship with food. Even if it was "an addiction to food," scolding and shaming a person suffering from said disorder will do nothing but make that person withdraw and stop listening. Nothing good ever comes from scolding and shaming a patient.
What I am getting around to is that I have a health issue which should have been dealt with years ago, but I avoided exams that might have revealed the problem sooner because I was embarrassed and afraid of being shamed for my body. This should never be the case. All patients have the right to compassionate, respectful treatment. 
Pathologizing certain body types doesn't work. Health at Every Size does.
This is why I am committed to never deliberately advertising or promoting weight loss products on the Deliver Me blog. I struggled for 33 years with disordered eating and low self-esteem because of society's attitudes towards people with larger bodies. I went on diet after diet and "failed" every time. Any weight lost always came back with friends. I literally had to stop dieting so I wouldn't gain more weight. 
It wasn't until I discovered size acceptance and Health at Every Size that I realized I hadn't failed, the diets failed. The diet industry thrives on two factors:
Diets don't work
Dieters believe that they, not the diet, are at fault for the diet not working.
I will never knowingly sell snake oil or false promises. 
I will only promote products and services which I believe can be helpful in some capacity. Diet and weight loss products never are.

~Cie~




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