Massage appointment

I have been in nearly excruciating back and neck pain since earlier this week. I even purchased a handheld percussion massager and while that helped a little, I still really wanted professional help. I was starting to feel desperate and started Yelping massage therapists. Stumbled on one that does in-home massage and that was a revelation: I wouldn't have to navigate an unfamiliar (likely inaccessible) location, or drive (which hurts), or wrestle my scooter. 

I did another search specifically for in-home massage.  In the process, I saw a lot of reviews for prenatal massage, which was sort of a light bulb -- if they can work with a pregnant belly, why not with my big belly? And there was mention of massage lying on one's side, another moment of discovery -- since facedown is untenable and on my back is uncomfortable. Eventually I found one with great reviews. Checked out the website and liked the look of it. Confirmed I'm in their service area. But above all, there was story after story about the owner, Riya, going above and beyond, being compassionate and intuitive, etc.

So...I filled out the request for massage" form on the website. I explained I was a person of size; I needed to know if they could accommodate my need to be on my side during the massage; that I have chronic pain and I was really hoping they could help me. I hoped it might work out but in my gut I really expected them not to have a table that would accommodate me, to be overtly unwilling to work with me, or to reveal subtle fat hate.

Instead, Riya, the owner, called me a couple hours after I sent my email left a message that her table is rated to 700 pounds, lying on my side is no problem, and she was reaching out to learn more about my situation so that she could determine what equipment to bring to best help me.

We played phone tag a couple times yesterday, then connected this evening and spoke for about 20 minutes. I explained I really think massage could help me but I've been reluctant because I am scared of therapists being disgusted by my body. I told her about my various health concerns and pains. She was compassionate and I got a good feeling from her. I really, really hope this is a beginning of a therapeutic relationship that makes a big difference for me. 

Medical Self-Advocacy (and no weight loss talk!)

I advocated for myself today. I have a tooth that had an inadequate root canal last May and it's causing me increasing pain. My dentist sent me to a specialist, who agreed it needs to be re-treated. At the time it wasn't causing much pain, so when we learned my insurance only covers a re-treatment every 12 months and I'd have to wait until May, I sighed, was a little bit disgusted by insurance running my health care decisions, and put a note in my calendar to call the office in April to schedule.

A couple weeks later, my tooth is really bothering me. So today I called my dentist and asked if they could help me advocate to my insurance company that the procedure really needs to happen sooner. Bad news - they were told it's every 24 months, not every 12! Good news - there is a process to appeal this. My dentist is working with the specialist dentist to have them send the required x-ray images and narrative to the insurance company. It could take up to 4 weeks to review but at least the ball is rolling.

In the meantime, ibuprofen is gonna be my best pal.

On a side note, it's really nice to be having a health issue that no one, but no one, thinks is my own fault because of my weight, nor that it could be solved by weight loss. Being treated for my specific health concern with nary a whiff of a suggestion of drastic weight loss tactics is a novel experience, and one I'd love to be able to get used to!!

Cruising while Fat: A Response from John Heald

Welp, I'm awake at 3:15am with intense pain throughout my face and jaw. Never had a head cold *quite* like this (and yes, I went to the doctor yesterday and will continue self-care and medical self-advocacy if it doesn't get worse!)... what better way to distract myself than Bones on TV and a blog post?

You may recall that back on January 9, I posted a letter I wrote to the brand spokesman for Carnival Cruises, asking about accessibility as a fat, mobility-impaired woman on their cruise ships. I never saw my question answered on his blog, so I re-submitted my question on Feb 21. Patience is a virtue, because he responded to me yesterday. Only it was kind of a non-answer answer... but here it is, for what it's worth:

Hello Amanda,
I am very glad that you have written to me and please do not worry because we will make sure you and those traveling with you have a brilliant time. Please, when you read this, can you contact Carnival’s guest access services desk and let them know your cabin number? This will be then documented and sent to the ship. I also ask that one week before you sail if you can please contact me on Facebook at www.facebook.com/johnheald and I will alert the ship and make sure you are well looked after. We have a special needs team on board who will look after you during the safety briefing and in a real emergency and, of course, you will be allowed to stay on your scooter. I am here if you have any questions and I wish you all the best of times.
Best wishes.
John

So.... on the one hand, no answers to most of my specific questions. On the other hand, he told me who to contact now, AND told me that if I contact him personally 1 week before we sail he'll make sure to alert the ship and make sure we're taken care of. So....meh. I'd kinda rather have answers to my specific questions to set my mind at ease and/or give me a course of action now, than a blanket "don't worry, we'll take care of you." But "we'll take care of you" is better than nothing. 

Cruising While Fat: Doing my research, asking for help...

I've spent a lot of time over the past few days researching Cruising While Fat (and cruising in general), as my fiance and I have decided we'll be doing a short, 4-night cruise as the first leg of our honeymoon. I am, of course, concerned about various aspects of the trip. As a fat person (fat enough to not fit in many standard chairs, etc) and a disabled person (unable to walk/stand more than 3-5 minutes without severe pain), I'm definitely always worried about new/unknown situations and environments. Hence the obsessive researching.

I've learned a lot from various online articles, forums, and blogs I can't possibly hope to reference here. (I started by searching for info about mobility scooters and accessible accommodations, but it's been a series of whirlwind trips down the rabbit hole with 20-30 tabs open at a time as I followed whatever train of thought caught my eye! I will say I think my favorite resource overall is CruiseCritic.com - in particular the forums.)

Along the way, someone pointed me to John Heald's Blog. John is Senior Cruise Director for Carnival Cruises, and it was mentioned that his blog has great info and that he often helps people personally/answers fan questions. I thought I'd send him a quick little note and it turned into a veritable NOVEL as I poured out my questions. Here's hoping he answers!

Hi John,

I stumbled on your blog as I was researching in preparation to be a first-time cruiser this July, and I'm so glad I did!

My future husband and I hope to begin our honeymoon with a Monday through Friday cruise from Long Beach, CA, to Ensenada, Mexico on the Carnival Inspiration this coming July. We're both first-time cruisers, and I've been reading and reading on Carnival.com, on the forums, blogs, etc. I am getting more and more excited - and more and more convinced this will only be the first of MANY Carnival vacations! I can't wait to celebrate the beginning of our marriage on this beautiful ship. I've read tons of advice to 1st time cruisers from longtime cruisers, but I'd love to hear any thoughts you have on this as well. I'm sure you have a different perspective and will have great advice!

I also have a few specific questions, that are far more anxiety-producing and that I really hope you can help me with. I've found tons of great information online but as a fat and disabled woman I have a few concerns that I haven't been able to find answers on. I really hope you can help me.

First off, let me start by telling you the good news I have read online. People say:
--Overall, Carnival has the most spacious standard cabins, so that larger people without additional special needs may be comfortable without needing a handicapped accessible room.
--Carnival has a great bathroom layout, and that because of the way the shower is arranged, even larger people can comfortably shower.
--Hosts and wait staff are always very responsive in accommodating requests for armless chairs in the dining room, and sometimes even anticipate the request without being asked.
--Many theatres and lounges have sofas and bench seats that are comfortable for people of all sizes, in addition to/instead of traditional theatre seats with arms that may not fit all bodies.

This is all GREAT news, and did a lot to alleviate my worries. However, I'm really hoping for your help because I have some worries specific to my size (at the larger end of the large-people scale).
--There are two different types of accessible cabins, "modified" and "accessible" -- which would be the right choice for someone of size with mobility limitations, using an electronic mobility scooter to get around the ship (but able to walk around the cabin)? Also, I was told that accessible cabins are only available for the "inside" and "outside" cabin classes, and not for the Jr Suite. We'd like to do a suite but don't want to get ourselves in trouble with accessibility issues. Can you advise?
--Can you help me locate contact information for approved vendors for rental of electric mobility scooters for use on the Carnival Inspiration?
--I read a horror story about a larger woman on a mobility scooter breaking the gangplank and nearly falling into the gap between the ship and the dock. Can you calm my fears by sharing the weight limit of the gangplank on the Carnival Inspiration?
--Is there a weight limit on the toilets in the rooms? I see that they are wall-mounted rather than supported on the floor. Is this the same in the accessible cabins? I read one story where a self-identified "SSBBW" woman expressed concerns about the toilet in her room and the staff were able to install a block under the toilet to support it. Is this something you've heard of? Can it be arranged ahead of time? 
--Will it be possible to sit during the safety drill? I cannot stand comfortably for more than 2-3 minutes.
--Are there any other things that you've learned over the years that larger cruisers should anticipate/be prepared to do differently?

Thank you for your patience in reading this long email, and I appreciate any thoughts and advice you can share to make this truly the honeymoon we are hoping and wishing for!

My sincere thanks in advance for your help,

Amanda

Have you gone on a cruise as a fat person? What advice can you share?

Fat Poz Zone

Howdy folks,

Just a friendly reminder that this is a fat-positive zone. Or - if you can't quite manage that - at the very least, a weight-neutral zone. No discussion of intentional weight loss is welcome here, even if "you're just concerned about my health." That's called Concern Trolling (1) and it's not welcome here.

But how can you support me, if you can't tell me to lose weight, or share your inspiring story of how you lost half your body weight and have kept it off for 10 years and will sleep better at night knowing you've done everything you can to avoid the cancer that killed your mother? Read on, friend... read on.

A) Encourage me in my efforts at adopting weight-neutral, HAES(r)-based strategies for managing and improving my health and encourage me in those BEHAVIORS rather than in some perceived or "should" weight-loss goal.

• Studies abound which show that the positive health outcomes commonly attributed to weight loss will be achieved regardless of weight loss, if the healthy behaviors (movement, nutritious eating, etc) are adopted. (2)
• Studies also show that when weight loss is the motivating factor to exercise/eat healthfully, motivation tapers and the behaviors are abandoned when weight loss is not achieved or plateaus. On the other hand, when "feeling better" is the goal, incremental improvements provide positive reinforcement on an ongoing basis. 

B)  Even if it seems like weight loss might be the only way to improve how I feel, or if you cannot bring yourself to believe that my weight is not a causal factor in how I feel, resist the urge to suggest weight loss. Long-term, sustainable weight loss is just not possible for the vast majority of people.(3)

• The reality that doctors and diet programs fail to acknowledge is that somewhere around 95% of weight-loss diets fail. So by having weight loss as a goal, I'm very likely to be setting myself up for failure. 
• Still believe that I should be striving to be part of that 5%? Fine. Keep it to yourself, and see Point 1 -- you can encourage all the healthy behaviors you think I should be doing, and you are welcome to think to yourself that they'll lead to weight loss if that helps you support me. (Though hopefully you'll go out and read the research for yourself so you can continue to support me even when I don't "succeed" at becoming thin.) 

C)  For me personally, the suggestion that I need to lose weight is particularly harmful due to my medical history.

• If you really care about me, you will resist the urge to suggest weight loss for the simple and very personal reason that I have a history of eating disorder and the suggestion of weight loss from people I care about is very likely to bring on a relapse. I am tired of throwing up, depression, anxiety, etc. Seriously tired.

Footnotes: 
(1) On Concern Trolls: 
http://danceswithfat.wordpress.com/2012/01/11/dont-cry-for-me-well-meaning-concern-troll/
http://fatheffalump.wordpress.com/2012/01/04/genuine-concern-vs-concern-trolling/

(2) On positive health outcomes independent of weight loss:
http://thinkmuscle.com/health/obesity-health-metabolic-fitness/
http://danceswithfat.wordpress.com/2011/01/19/why-health-at-every-size/

(3) On long-term, sustainable weight loss being highly unlikely for the vast majority of people:
http://thinkmuscle.com/health/obesity-health-metabolic-fitness/
http://danceswithfat.wordpress.com/2012/04/21/for-fat-patients-and-their-doctors/
http://danceswithfat.wordpress.com/2012/06/12/do-diets-fail-or-do-dieters-fail/

Apparently fat causes uterine cancer...

The following is a letter I sent to the Fat Studies Group in hopes that I can get some answers on this issue. I wanted to go ahead and post it here, because I'm sure anything a doc has told me, other docs have told other fatties. Any helpful responses I get, I'll post here as well (if I can get permission) or at least summarize so that others can benefit from whatever wisdom the Fat Studies Group members are kind enough to share.

Also, hey, I know there are plenty more smart and wise people in the world than can possibly be contained in one Fat Studies Group (even as awesome as this group is)! So if you have thoughts/wisdom/knowledge to add, please do! :)

TO: Fat Studies Group
DATE: 11/16/2012

Hi folks,

I need your wisdom and your knowledge, please. I am in a great deal of distress over some medical stuff and accompanying weight blaming, and I need to arm myself with information in order to navigate my way through.

As have so many of us, I have spent a lot of time, energy, and resources working to unlearn the paradigm that fat=health risk and that lose weight=better health outcomes. I know to ignore docs when they tell me to lose weight to improve my blood pressure, cholesterol, prevent diabetes, etc. I know it's about healthy behaviors, not a weight or a BMI on a chart. I know that when the myriad medical voices and social pressures get too overwhelming and gastric bypass starts to sound like a magic wand, I need to turn to my support system and recharge and remind myself that it is SO NOT the answer. I am a believer in Fat Lib, HAES, the whole shebang.

And yet... I've gotten a new argument thrown at me that I haven't encountered before, and it's thrown me for a loop. Apparently now I need to lose weight or I'm going to get uterine cancer. Let me 'splain...

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?

Self care... it's a right, not a privilege

The New Year's Revolution Challenge for Thursday, January 20, is: 

Pick up the phone today and make that medical or self-care appointment you keep meaning to schedule!

When we don't feel good in our own skin, or we have had the experience of being humiliated, lectured, and scolded time and time again by medical professionals, or we feel ashamed of parts of our bodies, it's easy not to feel worthy of, or entitled to, medical care or self-care or those little physical luxuries like massage or pedicures. 

I'm here to remind you, and myself too, that we are all entitled to compassionate medical care and decadent pampering. Our bodies do not disqualify us! I have finally, after 10 years of searching, lined up a Primary Care Physician and a pedicurist (two of my most crucial care providers - more on why pedicurist is on that short list later!) that make me feel I can get medical care when I need it, preventive care before I need it, and regular pedicures so my chronic ingrown toenails are kept under control - and my feet look pretty and make me feel all girly and happy.

It actually takes two doctors to make one Primary Care Physician to see to my needs. First, there's my official PCP - a family medicine physician I'll call Dr. H, who practices at the local giant non-profit full-service medical clinic (think Kaiser, but local not national). Dr. H is a lovely woman, and seems to care about me deeply. I like her, too, and always ask about her kids and really feel I have a relationship with her. Unfortunately, I've been seeing her for years, and despite trying again and again to bring her up to my HAES standards, she can't or won't get on board. When I tell her about problems she doesn't know how to solve for me with a pill or a needle, she resorts to recommending weight loss because she's so desperate to do something to help me. I even had her talk to my HAES-expert therapist, and all Dr. H got from it was "Dr. B thinks you should exercise, too." Uh-huh... not exactly the full picture of Dr. B's explanation of HAES.

So why do I stay with her? Well... it comes down to the devil you know. I considered leaving - actually tried another doc - and the new one was WAY worse than the old. She actively pushed the issue of WLS! So I did some soul-searching, and decided that I just didn't have the sanity points in my life (or the money or the time to take off work!) to try meeting with a dozen - or a hundred - possible PCPs in order to find the one in a million who truly 'gets' HAES. Or more likely, is incrementally better than Dr. H but still not the HAES guru of my dreams. In the meantime, I've thrown away a person who truly cares about me and my health and happiness, who has a (admittedly major) blind spot but is otherwise really helpful and good to me.

The reason I'm able to settle for less than perfection in my official PCP is because I have another person on my team. I've been working with a naturopathic doctor, Dr. J-L, for the past six months or so. She, too, is less than my perfect HAES guru. (What can I say? I have high standards...!) But she's less indoctrinated in Western medicine, obesity-epidemic-booga-booga than a standard doc - to the point where she understands that a "morbidly obese" person such as myself can also have an eating disorder, and because of that understanding, she will not cross the line and give me weight-loss focused nutritional advice. In fact, she's so careful that several times I've had to explicitly say, "Please, go on... I'm totally open to your advice on nutrition. The only thing I don't want to hear is calories or pounds. General nutrition guidelines are welcome!"

So after one too many weight-loss discussions with Dr. H, and the terrible WLS discussion five minutes after meeting Dr. E (that's the new potential PCP I met with once - the 'E' is for evil!), I went to Dr. J-L and proposed a deal. I told her I'd like us to agree that as far as the two of us are concerned, she's my *real* PCP, and Dr. H is my Western Medicine Liason. We can't tell Dr. H this, of course. But I realized that if I 'manage' Dr. H by avoiding talking to her about things that will trigger her fears and stereotypes about "obesity" (back pain, knee pain, foot pain... things she associates with curing by weight loss, or has no good way to help with other than prescribing weight loss), she can give me great care on other issues, the kind Western medicine is good at (sinus infections, PAP smears, etc.). And now, I have Dr. J-L to help me with those issues Dr. H isn't so good at, so I had the luxury to do so.

The upside? Dr. J-L is helping me feel better on a day to day basis. Dr. H is there to prescribe me antibiotics when my sinuses go haywire. Everybody wins.

The downside? Dr. J-L isn't covered by insurance. Not even a little bit. And I have good insurance through work! And of course, I still don't have my HAES guru. Or rather, I have many HAES gurus, but none of them is my PCP.

But hey... it's working for me. At least until I come up with something better. Now if you'll excuse me, I need to plan my next pedicure.

Wow, this Marie Claire thing...

Ok, so by now you've prolly heard about the Marie Claire thing. If you haven't, I'm sure you can Google "marie claire fatties" and learn more than you ever wanted to know. Other fatosphere bloggers have already posted tons about it, so I won't rehash. But that's the context if you need it for what comes next...

One cool thing that came out of the MC thing is that someone I've never connected with about Fat Acceptance/HAES posted about it on FB, with a link to a blog railing against the MC article. So I commented on the post:

I invite you to blame the horrible author instead of blaming yourself/your body. I am part of the Health at Every Size and Fat Acceptance movements and I would love for all my beautiful friends to love themselves just as they are. ...

If you ever are interested in books or blogs or other resources to learn more about these movements I would love to share them.

She posted back that she thanked me, that she had a long way to go on self-acceptance, and that while she hated what the original article writer had to say, said writer had a right to her opinion.  I replied:

She may be entitled to her opinion, but that doesn't make it ok. Just think if someone had written an article about how disgusting they find it when gay people, or Asian people, or disabled people kiss. We'd be absolutely morally outraged. Why is fat different? (I would argue it shouldn't be!)

And very soon after, I received this letter by FB Message (NOT on the comment string, but to me alone):

Hi!

I just wanted to comment and didn't want to seem like I was starting a flame war or anything...

I would argue that being fat is different. I do not agree with Ms. Kelly's sentiment at all, please believe this. But I do, as an overweight person, feel that being fat is different from being different ethnically or sexually, I know, cause I'm Hispanic, too. All I need is to be gay and I would hit the social outcast trifecta!

I am not at all saying we actively make this choice (though, arguably, there are those who do). There are a myriad of issues at hand. Things that we, as individuals have to work through. Things we, as individuals, have to take accountability for. Is it easy? Not at all. That's why it's called work when we seek a healthier life style. But, in my opinion, to compare our fat-ness to say, our ethnic-ness is not a just comparison. At the end of the day, I can diet, but cannot change the color of my skin....

Please don't think me insensitive, because I know well the trials of being overweight in an overly skinny centric culture. What Ms. Kelly wrote was simply wrong, and completely unfair. And made worse by her admission of having been anorexic in her apology.

It is horrible and dichotomous, this society we live in....we make each other feel bad for how we look, yet try to convince ourselves it doesn't matter.

I think people in general are beautiful in and of themselves...regardless of what they look like.

I hope this made some sort of sense....

And again, I'm not looking for a fight, just offering perspective...

I hope you are having a great day.

cheers,
name

I felt weird about getting this message privately/individually. It was from someone I've seen around, but don't know personally. If he feels strongly about this matter, he should post it in reply to mine so that I could then refute it openly. What's the point of sending just to me, unless he's either a) afraid to look mean/afraid more people will agree with me (gawd, I wish!) or b) ambiguous about his feelings on some level, and subconsciously hoping I'll say something that will allow him to accept his own fatness. Now, my knee-jerk reaction was to say, "yes you're insensitive. And weird and a jerk for sending this privately. Never contact me again." Seriously, I typed that. But then I deleted it, took a deep breath, and after some false starts, sent this:

I don't think you're particularly insensitive, however I do think you are (as most Americans are) uneducated on the failure rate of diets. You have bought into the prevailing misconception that we do, in fact, have control over the size of our bodies. And that biodiversity in body shape and size is "different" than other kinds of diversity. Not too long ago, homosexuality was considered completely controllable and an illness, and prior to that, doctors prescribed skin lighteners to enable African Americans to pass as white. These things were seen at the time as controllable, but more education has shown they are in fact genetic and part of human diversity.

I don't want a fight either but I do invite you to get educated on the Health at Every Size movement and the absolutely abysmal success percentages of each and every supposed "diet" or "lifestyle change" out there. Once we acknowledge that the promise of safe and effective long-term weight loss is a false promise and a myth, it is a much shorter step to accepting the diversity of bodies in human society and ending blame and shame. 

Now, if he writes back with more fat hate, he gets blocked. I don't have enough Sanity Points to deal with that any further. But maybe, just maybe, he'll do some reading.

And that, my friends, is my Activism Deed of the Day. I couldn't stand to stay hidden in the closet of FB Private Message Land. So I am sharing it with you.

EDIT: His response, received within minutes of my message, after the jump. I will _not_ be responding. I've spent enough spoons on him. On a positive note, I got a chuckle from the amusing image of people "loosing" weight. "I will loose my weight upon the world..." watch out - it's like a tiger "loosed" from the cage!

Keep your assumptions off my body

So over the past 24 hours, I've had a catastrophically yucky initial meeting with my (potential, violently rejected) new primary care physician, followed by (admittedly mild, but I'm sensitive to this sort of thing) Facebook drama. I posted on Facebook shortly after I left the office, because I was upset and distressed by the horrific 5 minutes I'd spent with the doctor. Unfortunately, in addition to several supportive comments, one friend (whose partner is a WLS "success story") posted a finger-wagging comment basically scolding me for overreacting, saying that it was probably appropriate for the doc to act as she did. Then, some other rad fatties and allies posted vehemently anti-WLS comments. Which felt good to read, but they in turn prompted the pro-WLS friend to spring to the defense of WLS. All of this in comments that started to feel like a flame war on my FB. It was to the point by this morning where each FB notification was making me feel sick, because I dreaded what it was going to be...

Finally, I decided to respond. But I'd been doing so much thinking that it became far more blog-length than comment-length. So I'm posting it here instead. I'm sure some rad fatties and anti-WLS people will think my position is not strong enough. While on the other hand, my friends and acquaintances who have positive ideas about WLS will probably feel I'm being unreasonable in my resistance. I can't please you all. I can only try to think this through and navigate it the best I can. I am torn, caught in the middle between the hordes and masses of society who think my body is an abomination, a disease to be "cured" by any means necessary, and by the small, quiet voices of fat acceptance and HAES and the tentative reaching instincts of my own body and soul, which tell me that fat is part of my biology and my identity and it's the world that needs to change, to stop treating me badly and seeing me as a problem and an intrusion.

There's so much to respond to in what everyone said on my FB. I agree with the strong negative feelings that many of you have about these surgeries. On the other hand, I understand where my friend who said the distressing stuff was coming from (even though the way he said it really hurt!). I know several "success stories" for whom the surgery was really wonderful and they are feeling great / much improved / it was all worth it / etc. Which only serves to confuse me because I feel even more pressure to accept the pressure of medical professionals. However, I simply must stick to my own gut feeling/intuition/confidence that this is NOT the right path for me - at least right now. I won't say never, cause who knows?

What truly pisses me off about this doc is that, as I said in my initial FB status post, she had met me LITERALLY 5 minutes before stating that bariatric surgery was really my only option. She had not had me fill out any new patient paperwork. It's almost certain that had not reviewed my medical record extensively, if at all, given how overworked clinicians are these days and the fact that I had not scheduled a full physical, just a 15 minute appt. When she walked in, she asked, "What can I do for you today?" I stated that I am looking for a new primary care physician, and she repeated, "But what do you want today," or something. She didn't ask me any questions or move to initiate the getting-to-know-you conversation I was hoping for. So I said that I am looking for a team captain, that I see a variety of specialists for different concerns, including a naturopath, chiropractor, psychologist, occasionally podiatrist. I went on to express that I was seeing her because I am looking for a new primary care doc who will NOT insist on constantly recommending HMR (my medical group's in-house version of Weight Watchers) or bariatric surgery, as those recommendations aggravate my eating disorder and depression. I explained that I believe in focusing on changing behaviors, not focusing on weight (working my way into explaining HAES). But before I could elaborate, she said that that was just it, we can't change behaviors, and that for someone in my "category" the only viable option is bariatric surgery.

Really? You don't want to hear more about the eating disorder I just mentioned? But of course fat women don't have eating disorders, do they? If you have an eating disorder, it makes you skinny. After all, the same thing we diagnose as an eating disorder if you're below a certain weight (severely limiting calories, obsessively planning meals and reading nutrition labels, working out to excess, etc.), we prescribe to fat people, don't we! You don't want to know if I exercise or not, or what I eat, before making such a sweeping statement? But of course not; you know exactly how I eat (poorly) and whether I exercise (obviously not even a little) from looking at me, right? It may be - it probably is true - that I will never eat or exercise "perfectly."  But you don't even ask the questions??? It was blatantly clear that this woman thought she knew everything relevant about me just by looking me up and down. And so I told her, "ok, well that's what I needed to know. We're done here." She protested, "But don't you want a flu shot or a whooping cough booster?" "No, I don't want anything from you." Not exactly the ringing, persuasive speech I might craft if I were a character in my own movie... but I didn't cry. I didn't give her that. At least, not til I got to my car.

I have done a lot of thinking on this in the last 24 hours and I've come to believe that my feelings on WLS and abortion are somewhat parallel. In both cases, I believe that everyone has the right to choose to go through that procedure, but it is emotionally complex and has long-lasting physical and emotional consequences and should not be taken up lightly. In both cases I would not personally choose that procedure but respect others' right to make their own personal decisions about what is best for their bodies and their lives. And just as I would be offended by a doctor who recommended abortion just because I was visibly pregnant and single, I am offended by a doc who recommends bariatric surgery just because I'm fat.

Pro-choice folks have the slogan, "Keep your laws off my body." While there is no law that one must have bariatric surgery (though it's getting scarier and scarier in terms of de facto weight loss requirements embedded in ability/non ability to access health care in this country), there is a TON of pressure out there, especially for folks like me who are in the very far right (not politics, math - on a graph, bigger numbers are to the right!) portion of the weight bell curve. So it may not be as catchy, but I say it with gusto:

KEEP YOUR ASSUMPTIONS OFF MY BODY. Yes, I mean you, Dr. And you, well-meaning friend. My body is mine. In this day when fatness increasingly IS a choice (if you believe bariatric surgery is a viable option, which so many seem to), it becomes increasingly difficult to stand up and say, "I am fat. I don't believe thinness is a choice for me. So I am going to live in this fat body" without getting some pretty forceful push-back.

Ok, now I have all sorts of interesting thoughts percolating about how just when we thought people might accept that diets don't work, and therefore fatness really is biological and not a "choice"... in walks bariatric surgery, and in just a few short years goes from experimental to frighteningly mainstream. Coincidence?

But that's a subject for another day... This post is already exceedingly long. Kudos and thanks, if you're reading this. You've made it to the END OF THE POST. Leave me a (positive, no meanies allowed!) comment and you get a gold star. :)

Knee diagnosis

So today I saw a new orthopedist, Dr. S, for my continuing saga of knee pain. I know that with any type of joint stuff I'm always running a higher risk of being told it's all my fault cause I'm deathfatz, and I also had found out this particular guy's specialty is sports medicine, so I went in armed. I brought a printout of Dr. Jon Robison's excellent "10 Things People Can Do Right Now To Ease Their Concerns About Their Weight and Improve Their Health." When he walked in and greeted me, I offered him the packet and told him I wanted to share with him the approach I take to weight and health and that I don't want to hear about weight loss. He was taken aback, and said, "Wow... opening with a shot across the bow!" Oh great, I think. Clearly not too receptive. But I forged on. I told him how we know that only 5% of people who lose weight keep it off over 5 years, and that being told to lose weight makes my depression spike so I really just can't have it. He was like, "OK." Didn't seem excited but didn't insist that it is his moral duty to tell me to lose weight either. Better than nothing...

So of course the concern I had with having opened that way was that he'd assume I changed away from the previous orthopedist because of weight loss talk - which actually is _not_ the reason, in this case. I didn't like the other guy because he wanted to blithely prescribe medications without ever examining my knee, and when I asked him why he recommended a given course of treatment he couldn't/wouldn't explain his thinking. So best I can tell I wasn't mistreated cause I am fat, per se, he's just a crappy doctor. Luckily, the new guy starts asking me about my history and I tell him I was sent for an MRI and he's looking at my chart at the same time and he says, "Did you want to see Dr. M?" And I say, "NO," very firmly. He looks surprised so I give him the summary of my last visit to Dr. M, ending with, "And I just really need someone who can explain the decision process and give me all the information about what's going on with my body." And he seemed to take that to heart - he was very thorough and informative throughout the visit.

I was really proud of myself for advocating for myself throughout the visit. Not only did I throw out the ground rules about health focus not weight focus, but I told him what I want in a doctor in terms of being thorough and informative, AND I continued to push for explanations, information, why this and not this treatment, what can I do to get better, and of course the old standby, "If I were an average-sized person, is there anything that you would be telling me that's different, or any other treatment paths we'd be exploring?" In this case, he said no. I don't always believe them when they say that, but at least I've asked - both for myself and to hopefully plant the seed in their thought process in general. I'll never know if one of the docs I've asked this question of may think back and see, "my gosh - I really did think differently about that patient because of her body size! Shame on me!" It's a fantasy, but it could happen... and I'll never know if it does. I have faith that things we say can have lasting effects because I've seen it as a teacher and with other teachers I've known. It's often the kid you least expect who is the one who comes back years later and say you changed his/her life. You just never know at the time. And for every kid who comes back, there are probably a few others you'll never know about at all... it's a good reminder because you don't have to wait to see your impact directly in order to feel that continually trying and putting your stuff out there in the world is worth doing.

EDIT: I forgot to share the actual diagnosis, which I probably should since that's the headline...

So my left knee, the one I fell on back in July of 2009 and which continues to be tender and have numbness spread down the leg, should get better. The fall most likely damaged a nerve which wraps around the kneecap and down through the area that's numb. When I fell on that edge of pavement across my kneecap it crushed that nerve and that's the cause of the numbness and tenderness. There's also some arthritis inside the knee, but that's separate. The fallout from the fall should heal with time. Or it may not, as nerves are fussy. But it's not anything that needs surgery or further action - just time.

The right knee is a different story. It's been hurting since I did a major organizing/cleaning/dejunking project the week after Christmas. Due to favoring the left knee, I overused the right and irritated it, and it has been acutely painful on and off (mostly on) since. My primary care doc, Dr. H, diagnosed bursitis on the inside face of the knee, but that didn't explain the pain inside the joint or behind the knee or in the muscles above and around the knee. Dr. S examined the knee briefly and said he didn't think it was bursitis. He said that he thought it was much more likely arthritis. I was a little unsure about this since he came to the conclusion so quickly. It seemed like he might have decided it based on my body size more than anything else. But the fact that there's pain inside the joint not just outside, there are signs of arthritis in the other knee that he had shown me on the MRI, Dr. H has mentioned that I have the beginnings of arthritis in the other knee before, too, etc. made me willing to accept it. He explained that bursitis is much less common than arthritis, and invoked that thing about if you see hoofprints you should look for the horse before the zebra. He said there's an easy way to check his theory: he could give me a cortisone shot and see if it helps. I asked, don't you only get three of those in any one body part in your life? and he said it's not a hard rule, more just that after 2-3 they will stop working. I was reluctant to use up one of my 3 when I'm so young, since this is going to be a lifelong problem, and he seemed to agree.

He sent me for x-rays to see how bad the arthritis is. According to the x-ray it's only mild... I just can't *wait* to feel how bad it's going to hurt when it gets worse, since it's already pretty bad now. According to him, there's nothing you can do preventatively for arthritis, it's just part of your genetic makeup. Of course, he said, (and here's the one weight-phobic comment he made), "You're making it worse by not..." and I nodded like, "I get it, let's not have the weight loss talk." But apparently my acknowledgment was too cursory, because he reiterated, "significantly worse" and I'm like, "OK - but there's no particular diet or exercise regimen that is specifically shown to alleviate arthritis?" And he says no diet is better than any other. And then I realize of course that I said the magic word and he's thinking I am willing to weight-loss Diet, when what I meant was to ask about adding things nutritionally to my diet-as-in-the-foods-I-eat. Le sigh.

So in summary: arthritis in both knees, plus slowly-healing contusion with nerve damage in the left knee. And the arthritis is a life sentence and there's nothing I can do about it. Good grief, such an uplifting appointment. I've gotta talk to Dr. L the naturopath and Dr. D the Chinese sports medicine doc to get a less-bleak prognosis.