Putting the doc on notice

Part 3 of 3 (CONTINUED from earlier 2 posts):

So a week-plus after that initial conversation, bolstered by the intervening email with my doc and an in-person follow-up scheduled for Monday, I felt brave enough to actually reach out for that appointment with Dr. H's recommended gynecologist, Dr. W.

ASIDE: Can I just say how AWESOME it is to be able to send an email appointment request, so I know that my words will be received and recorded before I even step into that office? Love it!

Here's the email I wrote:

...please note that I will be accompanied by my fiance and will need him to be with me in the exam room in order to help me cope with the anxiety this appointment causes.

**IMPORTANT**    
This appointment is for a follow-up to an abnormal PAP. I have been referred to Dr. W by my Primary, Dr. H. Dr. H has already spoken with Dr. W about my case.
Please put a note in my file that there is to be absolutely no discussion of weight or other general health issues by Dr. W or staff (aka your belief that I need to lose weight, eat less/differently, exercise more/differently; or any other non-gynecological issue). I have a history of eating disorders, anxiety and depression which are easily triggered in a medical setting, causing bouts of relapse.
I will see Dr. W to deal with the gynecological concerns raised by my recent physical, but will be fighting through significant fear and anxiety to do so. My overall health is being satisfactorily addressed by Dr. H, my psychotherapist, and other members of my health team. If Dr. W has any general health concerns, please relay them to Dr. H, who can deliver them in a manner that will not upset my other health progress.

NOTE: Please communicate by email only, NOT phone. I do NOT feel comfortable discussing gynecological issues during business hours, while I am at work. 

I just hope that it will be received in the spirit in which it was intended (firmly requesting/insisting on care that will not cause me harm, NOT being some sort of demanding, entitled diva type). I don't actually know if the doc will respect my wishes or not, think I'm cool and self-advocating or high-maintenance and non-compliant. But I've decided it's a WIN just to send the email. How the doc responds is another concern, for another day...

How do you think a doctor would respond if you sent an email ahead of time stating your needs, such as what I wrote? Do you have any other tips and tricks for managing fraught or fat-shaming situations?

Dirty

Part 2 of 3 (CONTINUED from my earlier post of moments ago, where this little tidbit just didn't quite fit.)

Possible trigger warning (same as before): I'll be discussing gynecological issues and some sexuality shame that snuck up without warning and whacked me on the head like a ton of bricks... but so far no fat hate to warn y'all about (yay for small favors!)

Later in the evening, as the "You have an STD" portion of the conversation sunk in more, I began to feel really yucky. As in dirty, tainted, ashamed; feeling that my fiance would not want me - and should not; ugly stuff. For those of you not in the "mean voice in Amanda's head" club, you may have noticed we went from fact-land (per my doc, HPV is very common and hard to detect, no way to tell when you got it because it can lay dormant for years, no way to tell whether I or my partner brought it into our relationship, etc. etc.) to OMG BAGGAGE & SHAME in about 5 seconds flat.

I know that my sexuality hangups are all entangled and chicken-or-egg-y with my general body issues and hangups. When you grow up mistrusting your body, feeling undesirable, ungirly/unwomanly, diseased, etc., as I did - it seems only logical that dysfunctional relationship with my body generally would seep into a dysfunctional sexuality. this is a part of my personal self-work and my fat poz explorations that I've just begun to look into; I'm pretty sure I'm still just barely scratching the surface.

You may be interested to know (perhaps even proud of me, as I am a little of myself) that when I calmed down and realized all these nasty thoughts weren't just going away, I emailed my doc and told her some of my concerns. I asked her for some facts to help clear the cobwebs. Here's what she said:

HPV is a very common diagnosis. Unfortunately, there are typically no symptoms at all which is why we screen for it. In general, condoms are not very effective at preventing transmission... In most men, it causes no symptoms or problems at all. The one exception is that sometimes men can develop genital warts from this. Only if genital warts develop are we able to biopsy diagnosis HPV in men. Just to give you an idea, over 80% of women with more than a total of 5 lifetime partners will have HPV sometime in their lives. Over 95% of women with HPV will clear the infection on their own. I definitely think we should talk about this more, however. I'm hoping you can make an appointment for later this week.

I'm not totally sorted out, but it helped. 

Takeaway from round 2: Asking for help really does help. Being surrounded by people who care about you and feel strongly about you not feeling sh*tty about yourself helps, too. 

Have you asked for help recently (on a fat-poz issue or any issue)? How did it go?

Abnormal

Possible trigger warning: I'll be discussing gynecological issues and some sexuality shame that snuck up without warning and whacked me on the head like a ton of bricks... but so far no fat hate to warn y'all about (yay for small favors!).


Last week, in the midst of possibly the worst 'vacation' of my life (another story for another day!), I got a call from my primary care doctor, Dr. H. Super sweetie that she is, she had left a message earlier in the afternoon but didn't reach me, so she tried again around 5:30 or 6 in the evening to make sure she connected with me. She needed to tell me the mildly concerning news that my most recent PAP test had come back with some abnormal cells. She calmly and soothingly informed me that this does NOT mean I have cancer; that even if I do end up having pre-cancerous cells or cancer, it is super treatable and should NOT have any long-lasting effects, affect my ability to have children; etc. So far, so good.

Then she explains the plan from here:

1. Go to an actual gynecologist (she's just a family medicine doc) for a biopsy to get a better sense of what we're dealing with. She explains this will feel like a "really long, more painful PAP". Joy. I'm starting to get anxious now. 
2. You tested positive for HPV, which we know causes changes in cervical cells, so at least that explains why this has happened. AKA, I have a sexually transmitted disease. *(see note)
3. What happens now? Well, even if everything comes back normal after the biopsy, you'll have repeat PAPs every 3-6 months (with the gynecologist stranger, not my beloved Dr. H).
4. If it comes back precancerous after all... some sort of procedure where they freeze off the offending cells, blah blah it all becomes a blur at this point. I'm trying to cry quietly so she doesn't hear me losing my cool.

So Dr. H asks me how I'm doing. Poorly concealing that I'm losing it, I wobble out a watery, "Ok." I tell her that it's not actually the diagnosis freaking me out; it's the series of invasive-feeling medical appointments and procedures... it's been 3 years since I last got a PAP for a reason! She knows me well enough to know this is a Big Yucky Deal. I concede that if she'll refer me to a gynecologist she feels good about, AND if she'll call said doc ahead of time, that I'll go get this done. I need her to call and explain to the gynecologist that he/she is to discuss gynecological issues only with me, that I have a history of depression and eating disorders and they are NOT to discuss weight or weight loss in any way, so as not to trigger these issues. Dr. H agrees, saying she'll call as soon as we hang up.

Jealous of my amazing doc yet? As a sidenote, you should know that my relationship with this doc has only gotten to this point after YEARS of work and continual self-advocacy and reminding her of the principles of HAES that I need her to go with. She's still not perfect, but man, she totally cares about my overall wellbeing, and that's worth SO, SO much.

Take-away WIN from round 1: I was able to do self-advocacy in the midst of a crisis, in a stressful context (medical stuffs) which has tripped me up in the past.

What self-advocacy WINs have you scored lately? What self-advocacy opportunities do you need to practice up for so you're ready next time?

Two victories in one little gym trip = WIN

Making this a quick, run-by blogging as I have much to do today... but had to set down in text and in my memory the awesome experience I had this past Saturday morning:

I went to a new-to-me YMCA, and for the first time in my life was totally comfortable walking around in the locker room nude. There were so many diverse bodies (though mostly age diversity, no other super size gals were there at the time I was), and everyone was so naturally at ease, that it was easy to be at ease too. Of course the years of work and struggle I've put in learning to be happier in my own skin probably helped too. So I'm taking a moment to revel and feel proud!

Another reason to feel proud... We had meant to go for the deep water aerobics class, which I thought was at 8:30. However, it was actually at 8am, and already well underway when we arrived... but instead of giving up, I grabbed my workout buddy (aka fiance) and dragged him to the shallow pool where we could do some water walking instead. 

PS - I am painfully aware that this is not my best writing. More along the lines of a FB status than a "real"/"good enough" blog, says my inner critic. So please be gentle and support me in taking a risk in posting it anyway, because I don't have time today to refine it to where I'd like it to be. And posting something rough is WAY better than waiting until I can post something "real", which will lead to never posting anything, and losing this great moment from my memory!

Appreciation and privilege

I just want to say that although I've largely stayed quietly on the sidelines through the various discussions I've seen lately in various corners of my fat activism world about race, discrimination, and privilege, I've appreciated them.

I appreciate the work of activists of color who are enduring silently the racism within our movement; I know I cannot understand fully how hurtful it is, but I do feel sad about the hurt you endure. And I appreciate your willingness to hang in there in the face of ignorance and spite and other negative stuff.

I appreciate the voices of activists of color who are willing to speak their concerns about racism they feel, and face, and endure. I know you often get negativity back when you share your criticisms and concerns, and I feel so disappointed and angry when that happens. I appreciate that you share them anyway. 

I appreciate the humility and grace of those who possess white privilege and are willing to be on a journey of dialogue and learning about what that means and how to best be a Fat Lib voice for justice, liberation, and positivity for ALL the members of our Fat Lib community and fat people everywhere.

I aspire, and strive, to be one of the latter. I know I'll fail sometimes, which makes it hard for me to speak up at all. And I recognize that not speaking up at all can, in itself, be a failure to be the activist I want to be. So I thank the folks who are willing to take the time, the energy, the patience to educate, or point towards education, or in any other way help those of us who are white, who do have privilege, and who want to understand it and try never to abuse it. Thank you for doing the work you do, so that I and others in my situation can take steps on the journey of an inclusive Fat Lib movement with less fear of making a hurtful misstep.

ED issues - do they ever go away?

I love how our Fat Acceptance community can come together to support each other when one of us is feeling less fierce than usual... I'm hoping to find a bit of that support today.

Trigger warning for eating disorder issues, ok, y'all...?



I am really struggling the past couple days with a strong urge to binge on sugars, fats, and carbs. All the stuff I've been taught my whole life is "bad" (which I've struggled, with limited success so far, to re-define for myself in a HAES and intuitive eating framework). I've struggled with a tendency to have disordered eating - and disordered thinking about eating - for what feels like forever. Certainly since middle school, when I'd make up elaborate lies about wanting something to do, being so bored, surely my mom wanted me to go to the store and get some milk or something just so I could go to the store to buy a candy bar and devour it in a fear- and forbidden-food rush of shame. (I wasn't allowed to spend my allowance on candy, cause, ya know, so fat.) I also got caught once stealing chocolate chips out of the deep freezer in the garage... and the shame, wow... I don't think I'd have been more ashamed if I'd been caught masturbating. (Yeah, no body issues there. Why should masturbation be a shameful thing either? But that's another story for another post.)

I think I'm being triggered these past few days because a) I've learned that I'm gluten-intolerant, which means I'm constantly telling myself "no" to things I want to eat, and restriction/the forbidden are huge triggers for me... and b) I had a conversation with a friend who is a 10-year WLS survivor with pretty much the best imaginable outcome. I forget how it came up, but I tried to neutrally respond saying I was glad she had such a good experience and was healthy. Somehow this turned into her recommending other mutual acquaintances I could talk to who also had good experiences, and wham - I was triggered.

Not sure the above two items can possibly explain completely why last night I ate 2 corn dogs and a bacon-wrapped hot dog (after a full meal 2 hours earlier) and this morning a turkey sandwich and a muffin (both v. gluten-ous) and for lunch Taco Bell and then a 3-pack of Hostess orange cupcakes AND a pack of Twinkies. And why I'm feeling so much like a failure and so much frustration and some shame for eating all these things. I know I'll be kicking myself for DAYS as all this grease and sugar and most importantly gluten wreaks havoc on my poor tummy and gut. Why do I do this to myself? How can I give my body the food I know is good for it when intuitive eating says eat what I crave, and what I crave is sugar when my genes give me a high chance of diabetes and gluten which makes my tummy hurt? This is too hard to navigate.

Help me, wise fatties! What have YOU done to struggle through these issues and come out the other side?

Medical Care Update

I 'met' (on the FatStudies List) a HAES-based naturopath today. It spurred me to reflect on the state of my medical care in the last year.

I've been seeing a naturopath in Los Gatos, CA for about a year now. I was struggling with chronic, intense sleepiness and I'd exhausted all my options with traditional medicine. The last option they offered me was to prescribe "uppers" -- with the caveat that they have side effects AND may or may not help. I was not a fan of this idea, but didn't feel like I had any other choices. My boss/colleague told me about this naturopath that had really helped her, and she was so convincing that I checked out her website. I was immediately concerned, because she offers weight loss support as one of her services... which would normally disqualify her from my life. But I'd gotten such amazing, passionate reviews from my boss, and I was out of options with regular medicine, so I wanted to try.

I did a phone consult with her before ever meeting her in person or paying out any money.On the phone, I explained to her that I wanted to see her if she thought she could help me with my medical needs, but that I did not want to hear anything about weight/weight loss. I went ahead and pulled out the big guns and shared with her that I struggle with disordered eating, depression/anxiety, and other issues that are triggered by weight loss focus in my medical care. (I wish I could have just said, "I prefer weight-neutral medical care," and that would have been enough. But past experience has taught me that even if they're open to that at the beginning, when we get into the various issues I have that are conventionally thought to be associated with weight, they cross that line.) I was pleasantly surprised to find that she took me at my word, and has diligently avoided any weight talk and has even been careful not to give food/eating rules until I ask her to. (For instance, she'll say my sugars are looking a bit high, and talks about supplements we can use to help with that. She didn't mention anything about avoiding certain foods/making dietary choices until I asked whether there were nutritional strategies we should be using too. Once I asked, she said she didn't know whether she should say that part because she didn't want to trigger me. I said I was open to general guidelines, just not pounds and calories.)

I hesitate to list her on a HAES website such as the Fat Friendly Health Professionals List or the HAES Community Resources page, because I think the only reason she's so careful is that I shared my particular issues. I don't know that she is generally HAES in her thinking. If I didn't have specific mental health issues that I had shared with her, I don't know that she'd be so careful -- so I'm inclined to think she's not generally HAES, but rather responding to a specific patient's needs. Still, that's better than the regular docs I am used to. They don't have any qualms stomping all over me with weight loss and even WLS recommendations despite -- or even directly in response to -- my sharing that a weight loss focus makes me sick, literally. Just being treated with compassion, as an individual, and having my eating disorder taken seriously, is a big darn improvement!

All of which is to say, she may not be 100% HAES, but she's 100% better for me than my supposed primary care physician. I've told my naturopath she's my *real* primary care physician. In my head, that is. I just keep the regular PCP on call for the few prescriptions my naturopath and I have decided I should continue.

I hear that in Oregon where she trained, she could actually be my PCP and I wouldn't have to mess with someone else for med management. That would be just grand! Hope California catches up someday...