Fat Bias and Health Care

Just over two weeks ago, I had to make an unscheduled visit to my local health care facility.  And by local, I mean the hospital that’s literally across the street from me.  At 1 am.  After waking up my roommate who had to be at work at 8 am that morning.  D’oh!

The night before, my stomach had felt uncomfortably full to the point where I wasn’t able to sleep at all.  I had vomited early that morning.  Not an immediate concern, but something that catches my attention.  Throughout the day I felt a little better but couldn’t even think about food.  When I got up off the couch to go to bed around midnight, I noticed that the all-over uncomfortable feeling had settled into some serious pain right along the bottom of my stomach.  I thought perhaps it was just some serious PMS cramps and decided to try to go to bed.

I tried some home methods of managing pain, under the assumption that it was cramps.  That….didn’t help.  In fact, it might have made it worse.  So an hour later, in intense pain, I woke up my roommate and had her drive me to the Emergency Room.  Yes, the one that is literally across the street.  She was thoroughly unimpressed until she saw me try to walk.  When we got into the ER, I knew it had to be serious when the receptionist did little more than get my ID and pull up my medical records from when I had been a patient of theirs before.  They immediately took me back to a treatment room, offering me a wheelchair.  I declined.  I shouldn’t have.

Because I try to follow a Health at Every Size (HAES) approach, I usually decline to be weighed at the doctor’s office.  This time, I allowed them to weigh me because there was a strong chance they’d need that information for medication or treatment.  I’m fairly used to the old fashioned balance type scales and typically step on them and find a point on the wall to stare at after getting the nurse or CNA in the right ball park.  Now, the hospital I went to is brand new, it only opened a couple of months ago.  The ER didn’t have a balance scale.  The only scale in sight was a wheel chair accessible digital scale (pretty cool actually, it folded up against the wall when not in use).  Not a peep from the person gathering this information.  In the treatment room, some pertinant information was written on a large white board next to my bed so that any of the nurses, doctors, or other staff had urgent information readily available.  My weight was included in that information.  But it was written down in kilograms rather than pounds.  It’s fairly unusual to see weight noted in kilos here in the US.  And for some reason, it didn’t cause the mental stress that it normally does seeing my weight in cold hard numbers.  Like many Americans, kilos just don’t mean very much to me.  If asked, I could probably give a rough estimate of a kilo to pounds conversion, but it might take a minute or two.

No one mentioned my weight at all in relation to my current health care concern.  Not even when it became clear that I would need to have surgery.  Abdominal surgery at that.  Before we go any further, be aware that I’m going to be very matter of fact regarding my physicality and health concerns.  Some of the following descriptions may be “too much information”.  The anesthesiologist didn’t paint a doom and gloom picture of what might happen putting a “morbidly obese” person under for surgery.  It’s not unusual for fat people to be given such a bleak picture that even routine procedures seem like life and death.  Mine was just super happy that I hadn’t eaten anything for more than 12 hours prior to surgery.  They didn’t waste time once appendicitis was confirmed, they immediately began calling in a surgery team to take that appendix out as soon as possible.  And they gave me lovely drugs to make the wait bearable.  🙂  They were wheeling me into surgery by 6 am.

Once I woke up, they got me up to a hospital room fairly quickly.  I never had to ask for the right size blood pressure cuff, or a bed or chair wide enough for me, or when I left, a wide wheelchair.  When I was unable to bend far enough to clean myself after using the bathroom, I was never made to feel uncomfortable by the staff assisting me.  And when I vomited all over myself and the bathroom the next morning, the staff went out of their way to make the experience less awful, getting the OK for me to have a shower rather than just a wipe down.  I loved that rather than getting whoever happened to be wandering by each time I needed assistance, I got either my CNA or my nurse.  And I’m not sure if it was coincidence or not, but my CNA was always female, which is my preference.  Day two I struggled with the return of nausea and a raging case of heartburn.  Despite my requests, the most I could get was a single tums-type tablet.  But I had to hold down food before they would release me to go home.  So I struggled to get some jello down, ignoring that my stomach was yelling at me, with a plan to get some pepto once I got out of the hospital.  Sure enough, once I got out of there and got some antacid on my stomach, I felt much better.

Two weeks later, I had a follow up appointment.  I might have just cancelled and let them know I was feeling fine, but one of the instructions I had been given was to avoid exercise including riding my bicycle for a full month.  As you might know from my previous entries, I don’t have a car anymore, and I’ve come to rely on my bicycle for getting around my neighborhood.  Not having it was a serious hardship.  So I went to the follow up appointment mostly to get that all clear.  They didn’t even ask to weigh me at the appointment.  The assistant was in something of a rush and did take my blood pressure with a standard size cuff on my forearm rather than connecting the large size cuff that was present with the machine.  Thankfully my blood pressure wasn’t something we were looking closely at for this appointment.  Now that I’ve done some research, I’ll decline that in the future.  Anyway, I got the approval to start riding my bike and had a nice (quick) conversation about listening to my body as I return to normal tasks to avoid injury.  I looked through my after appointment paperwork today and noticed there was some generic information about being active in the paperwork, probably something that prints for all patients.  It started with talking about how exercise can lower risk for diseases… but it didn’t list obesity as a risk or weight loss as a goal.  In fact, the whole thing was really sensible and HAES friendly advice!

Overall, I was extremely impressed with how my weight was a total non-issue through this whole process.  I’ll soon have to purchase health insurance, and I’m doing some research on local health plans to find the most HAES friendly plan.  The hospital I was treated at is part of a HMO, and initially I was skeptical of getting HAES friendly care from them.  After doing some further digging, this HMO is moving towards the top of my list of options.  Rather than having “obesity” as one of the major health issues they have special treatment and management plans for, they list “weight management” under their healthy living initiative.  All of the advice is reasonably sensible and inline with HAES, but of course they expect weight to go down.  I don’t really expect much better than that at this point.  The only downside for me is that the fantastic naturopath I’ve been going to for my healthcare needs for the last year wouldn’t be covered under the plan.  Lots of pros and cons to consider.