Another Reason to Move it and Lose it--Doctors Hate Fat Women

Health.com's Ginny Graves offers interesting insight into another reason why it is unhealthy to be obese or overweight in her article "The Surprising Reason why being Overweight isn't Healthy." Being just 13 pounds overweight as a woman (i.e., 13 lbs above your highest healthy weight measured by BMI) can result in health care discrimination based on weight. To put this in perspective, as a 5'9" woman, I could be discriminated against if I weighed as little as 182 lbs.

Beyond the humiliation of being treated with less courtesy or attention, this healthcare discrimination can be harmful or even deadly. Recent studies confirmed what many people suspect through anecdotal evidence: Medical professionals tend to misdiagnose, refuse to treat and fail to detect serious medical issues impacting overweight women. One Harvard Medical School professor commented that doctors tend to be more dismissive and less patient with overweight people, rendering them prone to diagnostic errors as a result of clouded judgment. This attitude also discourages overweight patients from seeking needed preventative care or follow up on a health concern, leading to more serious health emergencies from neglect.

Some doctors refuse to operate on or treat patients beyond a certain weight threshold. They do this to keep their success rates high and to avoid difficult and time consuming procedures. This occurs with respect to needed surgeries, organ transplants, infertility treatments and important diagnostic tests such as heart catheterizations.

Granted, obese patients present practical problems for medical professionals and diagnostic equipment like ultrasound, mammogram and CT scanners. The more layers of fat, the harder to get an accurate image, and the more difficult for a surgeon to operate successfully. Morbidly obese patients may be too large to fit in a machine or pose a large recovery risk from an organ transplant. Larger patients often receive false positives leading to costly tests and treatment for suspected breast cancer.

Perhaps the most startling was in cancer treatment. Because cancer trials are based on average weight people, oncologists do not know how to accurately adjust chemotherapy drug dosages to treat overweight women. This could be one reason why their mortality and recurrence rate is higher than in normal weight women.

Being overweight myself and a person who has struggled with weight issues her whole life, I find myself angry at the injustice of being treated like a 2nd class patient and being labeled as "lazy," "noncompliant," or "undisciplined" when I am not. However, like a smoker, a person who abuses food cannot expect to pay the same insurance premiums as a healthy weight person who does not smoke. But I have to wonder if smokers are denied access to expensive medical procedures, organ transplants, etc., until they successfully quit? Do they experience the same level of derision from their health care providers, leading to misdiagnoses? I do think there are some ethical issues involved--e.g., do you give a needed organ to an obese person when the possibility of a bad health outcome is higher than for a healthy weight person equally in need of that organ?

What do you think about this type of bias? Warranted? An injustice? A little of both?

Medical Decisions for your Children.

The case of Minnesota 13-year-old Daniel Hauser and his parents recently thrust the issue of religious/parental rights vs. a government's right to intervene and prevent child medical neglect in the national spotlight. This article summarizes other, similar cases and their outcomes throughout the years, making it abundently clear that the issue is far from black and white. I found it especially interesting in the article above that one set of parents would get their family dog vaccinated regularly due to legal mandates but would opt out of vaccinating their children and seeking medical treatment based upon their religious convictions.

In my opinion, there needs to be a multi-pronged approach to this medical, ethical and legal question. If the child is mature enough to understand the treatment options, risks and benefits, then the court should defer to the child's preferences as expressed through his own legal representative. However, if the child is too young, uneducated or immature to make this decision for himself, his own legal representative should, together with medical professionals and child welfare officials, collaborate to develop the appropriate treatment plan, regardless of the parents' religious beliefs. To me, doing otherwise is child neglect and endangerment.

Of course, my opinion is colored by the fact that I do not belong to a religion that eschews traditional medical treatment. But I agree that a line needs to be drawn between parental rights and state rights where medical treatment and other issues are concerned. There is a potential slippery slope if the line hovers too far toward state rights. For example, should the state intervene to require vegan parents to feed their children foods it deems more appropriate to sustain their growing bodies? Should the state be allowed to forbid a parent from homeschooling their child or treating a non-life threatening illness with homeopathic or alternative medicine rather than traditional drugs? There are already state mandates regarding child car seat use, school attendance and some vaccinations are required before children can attend daycare or public school.

What concerned me most about the Hauser case was that, although he was 13, Daniel was homeschooled, illiterate and could not even identify the word "the" when tested by a teacher for entrance into a charter school. In addition, doctors testified that chemotherapy had an over 90% success rate in curing his type of Hodgkins lymphoma. In fact, the cancer was responsive to the one treatment he previously had and grew larger once treatment stopped. I think the judge in this case did an excellent job of weighing the issues and crafting a reasonable resolution that did not separate a scared child in extreme pain from his concerned, but perhaps misguided, parents during his next set of chemotherapy treatments.

Gettin' Lucky.

This article from The O Magazine really got me thinking about re-training your mind to unravel your own happiness. I am certainly no expert on cognitive psychology, but I have had life experiences to back up its recommendations. There really do seem to be folks in our lives who seem inordinately burdened with misfortune or blessed with good luck. Most of it appears out of their control, but is it?

It sounds cliche, but the saying "your attitude affects your altitude" could not be more true. Folding your arms across your chest, avoiding eye contact and standing in the corner during a social event does not attract interesting conversation or new friendship. Something as simple as a friendly smile and eye contact can make all the difference. Being a joiner and keeping an open and aware mind also helps increase the chances of positive interactions with others.

I recall admiring extroverted people in my life who invite others into their circle everywhere they go. At the extreme end of the spectrum are people like my Aunt Linda who strike up conversations with bank tellers, grocery store cashiers and passengers on planes, even though they will likely never meet again. Most people decline to make the social investment in such situations when the investment could actually reap unimagined dividends. The more people you know, the more opportunities for happiness and connection (professionally and personally) you create. See--Facebook, LinkedIn and its ilk really do have a positive purpose!

I also took to heart my Dad's advice that you can learn something from everyone--from the uneducated farm hand to the Harvard-educated Wall Street maverick. Everyone has a story to tell and a lesson to teach, which is perhaps best personified by the StoryCorps oral history project. Featured on National Public Radio (NPR) broadcasts, since 2003, it has recorded conversations between two people who are important to each other connecting and talking about things that matter. Sometimes it is a Grandson interviewing his Grandfather about an important or life changing event or an older couple reminiscing about their years together. This called to mind my audiotaped interview with my Papa about his experiences during WWII and the recordings my Aunt Elaine made of my Great-Grandmother about her experiences as a child during the Armenian Genocide, which occurred contemporaneously with WWI.

My good friend, Nobuko, also gave me a book (newest version here) that compiled written essays from the This I Believe national media project. It is based on a popular 1950s radio series hosted by Edward R. Murrow. The essays, read by the author, are often broadcast on NPR and share personal philosophies and core values of writers from all walks of life. One of my personal goals is to some day write something worthy of this project. Would you?

Child Safety Seats

C and I have been navigating the complicated market for convertible child car seats, since Kate is nearing her infant car seat's height limit, and we want to keep her in the safer rear facing position beyond the 20 lbs and 12 months old recommendations. Note: At 6 months old, Kate, my petite flower, is already 20 lbs. She is also tall with long legs that are reaching the end of her infant seat.

Like my search for the best initial car seat, there is a dizzying array of options on the market catering to different heights, weights, uses and budgets. So far, I mentioned Baby Bargains as a good resource for buying all things baby. I also stumbled upon this resource from the American Academy of Pediatricians. Thank goodness for charts with height and weight comparisons as well as some guidelines for when a child can transition to a forward facing seat, a booster seat with harnesses, a booster seat without harnesses and finally just a seat belt in the back seat.

So far, I think we are buying the Graco ComfortSport (up to 40" and 40 lbs for about $80 at Target), unless we decide to spring for a model that will last beyond 3-4 years, like the First Years True Fit Convertible Car Seat (up to 50" and 65 lbs for about $180) or the Evenflo Symphony Convertible Car Seat (all-in-one rear & forward facing plus converts to a booster seat up to 100 lbs for about $200.) We are trying to avoid the ultra expensive but well reviewed Britax models that cost $300+. Hmmm....how big will you be at 3 years old, Kate?

Most states now have a child safety seat and booster seat law that requires all children to be restrained until they reach a certain height or weight and/or age. In Michigan, all children must remain in a safety seat until they are 4'9" and 8 years old, effective July 1, 2008. See MCL 257.710e.

Childhood Vaccinations.

This is such a hot button topic on nearly every internet-based parenting board or magazine. Some parents are adamently against vaccinating their children for any disease, others selectively vaccinate their children (usually omitting or delaying the MMR vaccine) and still others strictly follow their pediatrician's advice and the CDC Immunization Schedules.

I will disclose that we fall squarely within camp #3 after researching the research on this issue. Also, my husband is a scientist. All of the reliable medical evidence is on our side in addition to a recent court ruling that there is no link between mercury-laden vaccines and the MMR vaccine and autism in children. Reporter Campbell Brown from CNN recently summarized our sentiments on the research and court ruling here.

I want to emphasize one of Brown's points and my largest concern. The more people either refuse to vaccinate or delay vaccinating their children, the more once arrested communicable diseases will experience resurgences and spread among our population. Keep in mind that immunizing your child is not the only intended consequence of the vaccination program; immunizing everyone protects your child before she receives each vaccination from encountering someone who could transmit that disease to her. The more non-immunized living amongst us, the more risk to everyone's infants and toddlers of diseases once fatal or permanently debilitating to those populations. In addition, sometimes the vaccination dose given is insufficient to prompt a strong enough immune response from a particular child. Instead, we must rely upon other successful immunizations to help protect her from exposure to the disease. Anecdotally, my dentist told me that her one-year-old, despite adherence to the immunization schedule, contracted the Rotavirus from a daycare setting.

In addition, the Times of London recently conducted an investigative report concluding that the scientist who published the study linking the MMR vaccine to autism was found to have improperly altered his data to derive the result he desired. This offends principled scientists and researchers who spend much of their time painstakingly testing hypotheses in a manner that can be replicated.

So, we immunize our children not just to protect them but also to protect others from potentially life threatening diseases. And the science behind Dr. Wakefield's 1998 paper should not be trusted. I choose to rely upon the mountain of scientific evidence that contradicts his findings instead. I can only hope that other parents' decisions not to immunize do not adversely impact my child or other children. What do you think?

I Want my Mummy!

Here is a cute photo taken by her day care provider, Ms. Cyndi, last week. You cannot see it, but her onesie underneath the bib reads "I Want my Mummy!"

Unfortunately, we found out that Kate had an ear and sinus infection to add to her upper respiratory infection around Halloween, so we have been busy administering medication, going back and forth to the pediatrician's office and wondering how many times it is appropriate to call their 24-hour help line to ask a sick baby question. It also turns out that she does not fuss that much when she is in pain, so we have to be super vigilant in picking up on her signs of discomfort.

We did not find out she had a problem, until day care called to tell us she had mucus oozing out of her eyes. You may be thinking--how appropriate for Halloween. It can indicate infection elsewhere in the body. Cue anti-bacterial eye drops and antibiotics. Unfortunately, we were back in the doctor's office a few days later only to find out that her ear infection was likely Amoxicillin-resistant. Hopefully, the stronger antibiotic will do the trick. She has been sleeping and eating well; she just gets fussy at times, and we give her infant Tylenol to help with the ear ache. It broke my heart a few days ago when I discovered her whimpering and taking short, quick breaths. Luckily, she is no longer doing this. Le sigh.

She did manage to paint a mini-pumpkin and a piece of art work in day care, to watch her Daddy carving our big pumpkin and to help us pass out Halloween candy (if lying snugly wrapped in her blankie on Daddy's lap counts as helping.)

Birth Day

While on maternity leave, I often watched the Discovery Health Channel to avoid the many talk shows, soap operas and mind numbing female-centric TV movies that dominate daytime television. They have a string of shows concerning pregnancy and child birth. One called "Birth Day," http://health.discovery.com/tv-schedules/series.html?paid=62.5711.107816.14984.13, chronicles a pregnant couple's big day in the hospital and never fails to make me cry at the moment of birth, especially if it was a difficult or risky delivery.

Our own birth day experience was also beset with difficulties and risks. Early on in my pregnancy, I was diagnosed with chronic hypertension and put on a blood pressure lowering medication. For several months, the medication worked to keep my blood pressure within the normal range. Although everything else was normal, I had to have more frequent ultrasounds and fetal non-stress tests to monitor fetal growth and activity, because it was considered a high risk pregnancy.

At my 36 week appointment, the doctor discovered a significant amount of protein in my urine for the first time. In addition, my blood pressure was elevated. That day, I was given a large jug and what looked like a plastic helmet to collect all of my pee for 24 hours. On the morning I was to turn in my pee project for testing, my blood pressure spiked higher than it had before, prompting a call to the on-call doctor. He wanted to see me at the hospital to triage the situation. A couple of hours later, they discharged me, because my pressure stabilized, and my blood work came back normal. A couple of hours later, the doctor called with the news that they found even more protein in my big jug, meaning that I had preeclampsia. He scheduled an induction for the following evening, and we began making phone calls.

By the date of my induction, I was at an estimated 37 weeks--3 weeks before my estimated due date and not an ideal time to induce. We were aiming for at least 39 weeks, given the risks and the apparent large size of the fetus. At 35 weeks, she measured between 7 and 7.5 pounds already.

Because of the fear that my mild preeclampsia could develop into toxemia and lead to organ failure and/or seizures, my doctor put me on magnesium sulfate at the start of the induction. They inserted cervical ripening drugs at the same time, explaining that, unfortunately, the magnesium sulfate may work against the ripening and contraction-inducing efforts, because it is also used to stop contractions. In addition, it brought nasty side effects like weakness, sweating and breathing problems. Twenty hours later, after 3 cervical ripening drugs and 5 hours on Pitocin, I was still only dilated to 2-3 centimeters. I developed a worrying pain in my chest and had to be hooked up to oxygen. I could no longer find a comfortable position to lay in, and I was hungrier and thirstier than I ever remember being, having not eaten or drank for about 29 hours, except for ice chips and Popsicles.

And no one told me how much their efforts to check my cervix for dilation would hurt! Each time left me breathless and sobbing. When the once strengthening and 3 minutes apart contractions came to a screeching halt, despite the administration of Pitocin, I asked for my options. The doctor explained that some patients continue trying to induce for 3 days. Another option would be to insert some kind of balloon device up my vajay-jay to stimulate my cervix to ripen further. That works even less often than what we had already been trying and sounded, frankly, unpleasant. The last option was to have a C-section.

For some reason, I thought choosing door #3 seemed like the easy way out. However, the drugs they were giving me were showing no signs of progress, and we could wind up doing it for days and still opting for a C-section in the end. I was tired, concerned about the chest pain and nervous about the preeclampsia and magnesium sulfate having negative effects upon me and Kate.

As soon as I said, "Yes, C-section!" they had C in scrubs and me wheeled into the operating room. My whole body trembled as they administered a spinal that worked in minutes to numb my abdomen and lower body. I felt some pulling and tugging but no pain as they made their incisions. At first, I wondered if I should be feeling anything and grew anxious, until I got used to the weirdness. Minutes after they cut through my abdomen and uterus, they were lifting a white liquid covered being out and suctioning her mouth and nose. She barely cried while the pediatrician and nurses assessed her, so I became nervous as they invited C to come over to take her first photographs. I heard the pediatrician explaining that her oxygen levels were low, probably because of her gestational age and that awful magnesium sulfate. As a side bar, the OB/GYN practice group apparently has doctors who disagree about when to use it, and the OB I saw the day before did not recommend its use for me, but the one on call at admission disagreed.

The longest part of the surgery consisted of the next 35 minutes or so to deliver the placenta and stitch me closed. I overheard the doctors discussing a nodule or nodules they found on my ovary. Ah, the pitfalls of being awake at your own surgery. I was too scared to ask anyone about it until my six-week doctor appointment postpartum. Fortunately, they removed the nodules, sent them along with my placenta to pathology, and everything was normal.

While they finished up, they placed Kate on my chest while C snapped away. His tears started earlier when she was first born. I just stared at her in disbelief. Was she really ours? They are going to let us take her home? Her navy blue eyes wide open and seemingly alert, she stared up at me while blowing tiny bubbles of fluid through her mouth. She was not as big as we thought at 7 pounds, 2 ounces and 19.3 inches long.

They wheeled me into recovery just as I started feeling some mild pain at the incision site. Pain meds, please! Kate only had to stay overnight in the nursery to monitor her oxygen saturation, so they brought her to me again briefly. This time, I felt dizzy shortly afterwards and asked C to take her. Even after all that Vicodin and morphine, I still felt normal and not that out of sorts. However, each time the nurse pushed on my uterus, I reflexively tried to smack her hand away because of the intense pain. I remained on magnesium sulfate for the next 12 hours while I negotiated with the new on call doctor to take me off it before the recommended additional 24 hours. I must have eaten 12 Popsicles by morning. Good thing I am not diabetic.

The next few days in the hospital were a blur of visitors, attempts to breastfeed, and learning the ways of this squirmy newborn. I even thought her cries were unique and cute--"Laaaa, Laaaa!" By the 5th day, I was ready to go home and muddle through with our little family. An orderly ceremoniously wheeled me downstairs to the car with Kate draped across my lap trying to stare at the overhead lights whizzing past her field of view. Gaggles of female strangers were cooing and remarking about the amount of hair on her head as we passed. I felt like I won a prize and was taking a victory lap. I suppose I have.