Not every patient encounter is a happy one.

Sometimes we have to be strict, or firm.  Sometimes we walk into the room and find out the patient is unhappy with us.  The worst is, when we have to walk into a room and tell someone news they don’t want to hear.

In my electronic medical record, I have little ovals at the top of the screen.  They each designate something different.  One is for patient visits, another for patient phone calls, another for refill requests, and then there is the one for labs and imaging.  That one always keeps us the busiest.  I make a point to get it down to zero every week.  I have time set apart in my schedule, where I don’t have patients scheduled in order to get it done.  Most doctors do this.  We call it our “admin time”.  This week I was scrolling through and saw the results on a patient that I had been waiting for, and I quickly opened the file to read the results, and as you can imagine, by the title of this post. It was not the best of news.

My heart simultaneously sank, and felt heavy.  If you had a heart monitor on me, it would have probably skipped a beat, and raced, and I know my respiratory rate increased. In that short moment of seeing the results a million thoughts went through my mind.  Is this a good day to tell them? Should I wait until after the weekend? Do they have a support system? How easy is transportation for them to all the future specialist visits they are going to have to endure? How is their overall mental health, and how is this diagnosis going to affect them?

I read the results through again… did I miss read it? Did I miss something in the report? No, it was as I first interpreted it.  I had the patient called to come in the next day.

I am fortunate that in my job, it is not common for me to have to share these types of results very often.  Although, even if I had to do it every single day, I doubt it would be easier.  It weighed heavy on me when I went to bed, and it was the first thing I thought of when I looked at my schedule in the morning. And for all the angst I have, I can only imagine what the person waiting for the results felt like.  The worry and fear and uncertainty. They were probably praying that it was really just fine, and that hopefully the doctor just was trying to explain some unusual, but not serious results, that would have been too complicated to discuss over the phone.  They could then go about their day and weekend, and life.

         There really is no good way to give people news they don’t want to hear.

I was always taught to just come right now and say it.  Bluntly, but not abruptly.  Don’t mince words.  State it clearly. Make sure they understand exactly what the diagnosis is.  Give them time to process it.

They are always stunned at first.  For some it lasts a few seconds, for some a minute or two. Once the shock wears off, some start crying.  It is my job at that point to be silent, and give them all the time they need.  When they are ready, we discuss the next step.

Never do I enter the room with out a plan.  It may not be a fully fleshed out plan, but I always have the next step.  That may be a referral, or another test, or a medication.  There is always clear follow up.  Patients are many times afraid to ask about prognosis, but I am always prepared to tell them if they ask. The visit can take fifteen minutes, or it can take an hour, it is individualized, and in that moment, they are my only patient.  When we finally finish up, and they head out to the front desk to arrange that next step, I usually head back to my office. During that time in the room with the patient, I am living their life, and absorbing their fears and worries and pain, and I usually need about 10 minutes to re-center myself after that visit, so that I may be able to focus on the needs and wants and worries of the next person who is waiting in a room for me.  I am sorry if I run late.

And to all of you over the years, for whom I have had to give the worst of news, I am sorry.  I haven’t forgotten any of you, and I am so impressed by your courage and strength and fighting spirit.

You all inspire me.

“The ER told me to follow up with you, but I didn’t see the point if they couldn’t figure it out”

 -Judy*, 82 year old patient of mine, who had finally come in for her ER follow up visit.

 

To be honest, it was a proverbial slap in the face.  It was said very matter of fact, I am sure she had no idea she had bruised my ego whatsoever.  In all likelihood, there are a lot of people with this sentiment. “Why do I need to see my primary care doctor after and ER visit or a hospital stay?”.  We get all kinds of reasons.  Judy’s is just one of many.  For some, it is because they just don’t feel good, and want to rest as home. For others, it’s financial, they don’t want another co-pay, and others just feel fine now and don’t see the point.  Finally, there are the people like Judy, who just don’t think I will be able to figure it if the other doctors aren’t able to.

 

In Judy’s case, she had passed out at home two weeks prior.  Her family (appropriately) brought her to the ED for evaluation.  Fortunately for her, by the time she arrived, she felt fine, and the entire work up was negative.  She only came to see me two weeks later because she was starting to get chest pains and shortness of breath.  When I questioned her about what tests were done, she had no idea (which is also common).

 

 So, why did I want her to come see me in follow up?

 

Not all patient conditions are obvious at the time of presentation.

Sometimes it takes time for the condition to progress for it to be able to be diagnosed.  Timely follow up can ensure that we are able to accurately diagnose the problem.

 

EDs and hospitals run tests.

They certainly review those tests, but are really only searching for abnormalities that could be related to your presenting condition.  If another blood test is incidentally out of range, they aren’t going to necessarily address that. (For an example, an elevated calcium in the blood may have nothing to do your chest pain, but could be a sign of hyperparathyroidism, which is more of a long term problem. (I.e. something that the ED doesn’t have time to address).  Furthermore, when it comes to imaging studies, like X-rays and Cat Scans, the ED physician is only getting a preliminary report from the radiologist.  For example, if they were to order a chest X-ray for someone with chest pain, the preliminary report would come back telling the ED doctor the basic yes or no, is there anything on there that would cause that chest pain.  Later on, when the radiologist has more time, they will dictate out a much more detailed report.  Sometimes that report has findings on it that are important to your health, but not an emergency.  (I can’t tell you how many times there have been lung nodules on chest CTs that patients didn’t know about, that needed further follow up). I don’t always get copies of those results.  But when you come in for your ED or hospital follow up appointment, we find out what you had done, and review it to make sure that there is nothing incidental noted on it, that could become a problem for you years down the road.

 

Emergency Departments are for emergencies.

In Judy’s case, I would definitely consider her condition an emergency at the time she went in, but (again, fortunately for her), by the time she arrived, she had recovered.  The ED is not going to be able to do a full work up for a condition that had resolved.    In Judy’s condition, there were a lot of further tests that we needed to do, that would never have been done in an emergency department.  (Like a stress test, and echocardiogram, and a holter monitor). These are all indicated follow up tests that would have to be ordered by your primary care doctor.

 

ED doctors don’t have the kind of time that a primary care physician has to get to the bottom of the issue.

We just have more time to spend with you, and be able to ask the right questions, and hear your answers.  We know you well, and have the benefit of that long term relationship.  And that helps us tremendously in figuring out what is wrong.

 

Finally

The last reason she should have come to me sooner, or understood the importance of following up with me after her ED visit: I am pretty smart.   I graduated from a top tier medical school, and could have chosen to go into any speciality I wanted, but I love primary care.  Sometimes I can figure things out that others haven’t been able to.  I’m pretty proud of that. I could have taken a job anywhere in the country, but I grew up here, and I love Northern New York. (Except the endless winters… spring, where are you?)

 

I think it can be helpful to think of EDs like doctors do.  The ED doctor’s primary job is to stabilize you, then to determine your disposition.  (Home, admission, or transfer).  They specialize in the first one hour of care, (and they are fantastic at it), but then they pass the baton.  Allow us to take that baton, and move forward in giving you the best care you could possibly deserve.

 

We all want to know as soon as possible what our test results are.  It is human nature that we worry about these things and want to get the answers as soon as possible.  It can be tempting to ask for those results from the wrong person.  Sometimes the wrong person can seem like the right person at the time.  As a primary care office, it is our job to help you sort out these things.

Jenny is a 59-year-old woman who had a mammogram done a few weeks ago.  She has been relatively busy in her life lately, so she didn’t give it much thought.  Her husband was ill, and she was spending a lot of time taking care of him.  It took a couple weeks to get her to return our call that she needs ultrasounds done on both breasts.  She scheduled that and got it done promptly.  That is where the worry set in.  Now, for most of us women, we don’t think too hard about a mammogram.  It is routine, we are feeling fine.  It is the rare woman who calls us up frantic the next day asking for their results.  But once we have something abnormal, we start to get worried, so I am not surprised that this woman’s initial response was to ask the ultrasound technician what it showed.

It showed that she needed a biopsy.  When we called her with this result, she was incredulous.  “I’m not going to do that”, was what she told my nurse.  This woman has been a patient of mine for a long time.  We have what I would consider a great doctor-patient relationship.  She is anxious and worried.  I looked at her chart and saw that she had an appointment with me a few weeks away.  I decided to talk to her about it in person during that visit.

She came in for that visit to talk about it.  She said: “when I was there for the ultrasound, I asked the technician how it looked, and she said: While I can’t tell you the results…. I don’t see anything on here that would make you have to come back.”

At that moment I realized what had happened.  She got her “results” from the technician.  By the time my staff had called to tell her the news, she had already gotten an answer she wanted to hear, and her nerves and worry were (incorrectly) soothed.  While the technician was surely trying to be kind, she did a huge, if not cataclysmic disservice to this patient.  By trying to ease her mind, she inadvertently convinced her she had nothing to worry about and made her much more resistant to believing what the radiologist actually saw.  I truly believe that if it weren’t for the close relationship we had over the years, she wouldn’t have eventually gone to get the biopsy done.

As a primary care doctor, these are the sorts of conversations I have every day.  It is my job to guide you and advocate for you, and yes, I sometimes worry along with you.  Please consider your source when you ask for advice, or test results, or look online.  And if you don’t understand your results, please call for an appointment.  We are always happy to explain things to you in person.

 

 

We all know that doctors offices are notorious for running late.  We know it drives you crazy… and it drives us crazy too.  We don’t like it and are constantly brainstorming ways to improve things.  Here are the things you can do to help us achieve that goal.

 

1. Review your medications prior to coming to the appointment.

Feel free to bring the bottles in.  At least write down a list at home, and review it to make sure the dose on your bottle is the same on your list.  How many tabs, (or puffs) are you taking, and is it once a day or twice a day.  Do you need any refills? If so, write them down.

 

2. Write down all the questions you have.

We don’t want to spend precious minutes while you try to think of them.

 

3. Let the person rooming you know of all of your concerns.

Don’t wait for the doctor to come in the room to share them.  This allows us to (sometimes) get some of the work up done while you are waiting to see the doctor.  (For example, if you let the nurse know it is burning when you pee, she will have you collect the urine sample in advance.  If you wait and tell me, then we have to break up the visit for you to go to the bathroom, and then come back to the room and that will automatically put us 15 minutes behind schedule).

 

4. Arrive 15 minutes early.

30 minutes if it is a preventative (yearly) visit. Yes, we need to verify your insurance every visit.  Yes, we are required to collect your copay.   We have lots of questions we have to ask, either on paper or on a tablet, (like have you been to the ER since your last visit, are you depressed, or are you in pain.)  These take time, and if you arrive at your appointment time, or late, we will run late.

 

5. If you come in for a sick visit:

Please don’t expect us to discuss your chronic health issues, unless it is directly related to sick visit concern. (For example, you have pink eye, but want to know if you really need to come back to discuss your diabetes next week… Yes you do… we are likely squeezing you in for this visit, and don’t have the time on the schedule to address these other things)

 

So that is the big stuff. We appreciate all the help you can offer to keep us running on time for the people who come in for visits after you.  Thank you for being our partners in health care.

It was tough heading into work today.  I knew there were seven.  All in various conditions.  I also had 5 routine to see, and then there were about 4 with minor issues.  I knew it was going to be a long night.

 

I pulled up in the parking lot, and the rain settled in like a mist. Hazy and dewy and gray.  Scattered cars were around, but no one was outside.  The construction crew had been sent away, and the remains of their half-finished work was visible from the parking lot.  I reached into my bag and grabbed my face mask.  It looks like a CPAP mask, thick, heavy, and straps around my head in three places.  I keep my hair in a braid now, and have for the past 18 months, as it is the only way to gain some traction on any of the various masks Ive tried.  Regardless, it slips down, and wisps of hair emerge from my braid, giving me a disheveled appearance.  I don my safety glasses, that are straight from a lab, they complete the look.  I grab my rolling laptop bag, and stand tall, and start walking towards the building.

 

I can’t say I am confident when I walk in there, but I choose to smile, and say hi to those that recognize me.  Lately I have been wearing a white coat with my name on it, and it seems to help the residents know who I am.  With many encounters I see them look me in the eye, then immediately turn their vision to my left to see the name, and words M.D. written after it.

 

The entrance is empty sans the receptionist.  I ask her how her day was, and she says, “not good”.  I know that nothing in particular happened today that would be considered catastrophic, I am kept aware of all things that could affect the health of the residents, so I suspect that she is just simply stressed.  She confirms my suspicions when she says “We are up to seven, when I got here this morning, I wanted to turn around and go home”. I knew how she felt, I knew of the seven before I went to bed last night, and knew they were waiting for me for when I got here.  She is always shy, reserved and quiet, and people describe me that way too, so its no surprise we have never really chatted before.  This moment though, I felt a shared connection, and comisserated with her: “yes, I know the feeling, I wish I could have stayed home too”.  I gave her an encouraging smile, checked my temperature, and headed to the nurses station, where my inbox laid.

 

Rifling through the stack of papers that are inevitably there, I was approached to see a patient with leg pain.  We chatted briefly.  I had 12 people to see, I had to determine if this issue required an actual, need to be documented, visit.  The nurse had put some muscle rub on it that we had called in, and it was working, so I decided that her issue was settled, and didn’t need to be formally addressed.

 

I made my way through the semi-lite halls towards my office.  The walls are painted a neutral tone, with a mint green trim along all the doors.  Lighting, while in no way poor, would not be catergorized as bright.  Fluorescent shadows fall onto everything I see.  I don’t know if this is real, or if my mood is projecting sad tones through my vision.  It is true that this section hasn’t been updated since probably the seventies, and there are big plans for a facelift, but the construction team has been sent away.  It’s been two years in limbo.

 

My office is a converted storage room, down a dead end hall.  On the left are the patient bath and shower, and to the right is the communal toilet.  Then there is my door.  It just barely fits two desks.  There is a large window that has three spider webs, and an A/C installed up top.  It’s either too hot or too cold.  There is a crevice to the outside somewhere, as in the summer a scattered yellow jacket would find its way in and buzz around confused.  My view is of an alcove, I can just barely make out the dumpsters, and the grassy edge of where the patients are able to take their daily smoking excursion.  I was able to get a phone installed, and bring my own computer and monitor and printer.  I hook up my laptop and pull out my to do list, circling names on lists.  One discharge, two with chest pain, five that need their routine monthly check ups. Then there are the seven.  I save them for last.

 

The discharge takes longer than I anticipated, but about as long as it always takes. As I work on my notes I  get a knock on my door.  It is the DON, the Director of Nursing.  One of the 7’s family has not returned any of her calls, one of the 7’s family has refused antibodies, and one of the 7 was returned from the ED.  Another is looking ill, she isn’t sure he will make it.  He is DNR, and she is not sure if his family will want him sent to the ED if he gets worse, or just keep him comfortable here.  We talk about various treatment options for all of the seven, and I find out that she was here until almost 2 am last night.  It’s five pm now.

 

I shuffle off to see the rest of the “healthy” residents.  The hallways are empty, the dining/activity center is bare, they are all in their rooms,  doors closed.  Masks on.  I see nurses and aides coming in and out of rooms, seated at the nurses desks, gowned up, masked, trying to coordinate care.  No one smiles, and their eyes look weary, exhausted, and even a little frantic.

 

I make my way down to the wing where the 7 are.  Doors are closed,  the hallway, again is dim.  Warning signs are draped over doors.

 

 DO NOT ENTER.

PLEASE CHECK WITH CHARGE NURSE

 

It’s an option I do not have.

 

This mask is new,  it has a silicone seal, its softer on my face, but it makes me sweat.  It bounces as I talk.  It has made me a little hesitant since I bought it , maybe I should go back to the disposable duck face N95s that I wore all last year.  It’s too late for that decision now.  Mr F.  is not doing well,  he needs assessing.

 

First I head into Mr L and Mr D’s room.  Yesterday Mr L begged me not to let him die.  He wasn’t ready, he said.  This morning he didn’t eat, and I was worried, but now he is feeling better.  He has ordered a second supper.  His lungs sound good.  It’s too soon to be sure, but I am feeling pretty good about his chances.  His roommate, Mr. D. On the other hand, is lying in bed, and doesn’t even acknowledge me when I first enter the room.  That isn’t like him.  He has energy.  He moves,  everywhere.  For him to not be getting out of bed is a concern.  His supper tray is sitting there untouched.  Mr. D I said, it’s time to eat. He perks up and i give him a hand to sit up in bed.  I help him swing his legs around and show him the food.  He thinks I should eat it, not him.  I help him with his utensils.  He can’t make up his mind if he wants to use his spoon or fork.  Mostly he doesn’t want to eat without me.  I tried to feed him like a toddler, and he was not having it.  Mentally, he was acting his usual self, and his lungs sounded fine, so I got up and ripped off my gown, and as I left, he started to eat.  I was pleased.  He is eating, He is alert, if not trying to wander the halls like his typical self.  This is progress.

 

The gowns have to placed on your body prior to entering a room, and then there are the gloves.  They fit under gown, but I don’t always remember the correct order.  its an easy correction, even if it takes an extra step.  These gloves are never ideal.  My face is getting red under this mask, I am feeling hot with my white coat, I haven’t gotten a cool fresh breath of air since I left my office, about  an hour ago.  The gloves stick. They won’t go on easy, they tear, I am weary and drop one.  As I struggled I see the kitchen staff donning gowns as well, in and out of rooms to deliver and pick up food trays.  Reach into the drawers outside the room.  The plastic drawers you could find from any Walmart or Target.  One drawer has disposable gowns in neat little rows, wrapped in plastic.  Another has the gloves, and little odds and ends.  Gowns and gloves on before you enter the room.  Goggles or face shield in place, remove gown and gloves before you leave the room in the red receptacle.  This dressing is a ritual, and it takes time.  The medical and nonmedical staff are exhausted from it, I can see it in their eyes, and it is only day #2, of many. Housekeeping is leaving the room I am about to enter.  Both hands gripping tightly to the bags of used gowns and gloves.  She is a thin petite woman, but she has to go sideway out the door to get the bags out without tearing them.  The garbage must have been full of disposable gowns in this room I am heading into.  There has been a lot of need in this room.   I can feel her exhaustion, I can see it in her eyes, she sighs, and heaves the bag into the larger receptacle, and moves on to the next room, the one I just left.  Finally, I have the gown and gloves on.  I think, if someone was coding, they would be dead before I could get myself fully gowned up.

 

I am not sure why it didn’t affect me last night when I entered the rooms, or even with the early visit.  Maybe it has all just sunk in, seeing the wing, seeing everyone bone tired and scared.  Exhausted from taking gowns and gloves off and on.  Not knowing how it got in here.  But this time I take a deep breath, and put my hand on the doorknob.  I feel a little dizzy, a little nauseous.  I selected a door, a door that leads somewhere.  A door with a sick person, a door that I do not know what it will bring.  It’s almost like when you watch a TV show and a person chooses between three identical doors, and when they open their door, this white bright light shines down on them.  It was like that.  I was thinking “Here we go”. I sighed.  My face was burning, and glistening with sweat, my feet felt like they were weighed down in sand.  Instead of the bright light, it was a gray narrow corridor.  I stepped into the room.

 

Directly facing me was Mr. B.  Sitting up in bed, eating his supper.  He presented me with a smile, and all the kind pleasantries you would expect of a gentleman of his generation.  I asked him how he was feeling, and he looked at me with astonishment, “fine, why would you ask”. I told him that he has the virus.

 

I don’t think I will ever forget that look he then gave me.  Naturally, he had been told multiple times by staff, but as with the dementia patients, they remember very little.  His look, it was bright eyed, smiling, rosy cheeked and yet shocked.  Incredulous.  His head cocked to the side just so as he said it.  I admit it was cute.  I think he is sweet.  Like so many other residents here, he remembers very little from day to day.  I don’t know why, but I find him endearing. His energy, and brightness of attitude has for a fleeting moment, taken away all the gray I have seen around me.  He makes me smile, then he makes me laugh.  It wasn’t a loud laugh, not a guffaw, no audible sound would be perceived, but enough air pushed out of my mouth, almost the pressure of when you are suppressing a cough.   My mask is not used to this movement.  Every so slightly, ever so suddenly it slips, and I feel the rush of cool, fresh air sneak into my mouth and into my lungs.

 

It was a moment that lasted a nanosecond.  I stopped laughing.  Every four-letter word I knew raced through my skull.  I think a part of me knew this moment was inevitable.  There is just no way you can deal with this perfectly all the time.  This virus finds a way.  It managed to find a way into this building despite all the testing, all the vaccines, all the boosters, and all the limited contact with friends and family.

 

I readjust.  I keep chatting with Mr B.  His lungs are good, his heart sounds fine.  I encourage him to eat more protein with his meals and finish out our visit.

 

My mind now, for this short moment, is on the cool air that got past my defenses, because I smiled, and laughed.

 

There is no time for further deliberation.  Mr. F is in the corner of the room.  He is bed ridden with Parkinson’s, and dementia.  On a good day, Mr. F can be wheeled out into the hallway, and will be able to answer yes or no questions with a nod of his head.  Today, for him, was not a good day.  He could not speak, though he tried.  He wanted something, and I couldn’t make it out.  He was not able to answer any of my yes/no questions.  His hand quivered, so I reached down and held it.  His eye locked onto mine, and I listened to his lungs.  A rattle.  In and out, fair air movement, but this sound.  This is the sound of secretions.  This is not good.  I give him a smile and tell him we are going to take good care of him.  He coughs.  Not directly at me, I had turned my head to the side to check for swelling in his legs.  But I felt the air blow past me, past my cheek and my ear.  My mask held, and for that I am grateful.  There was no smiling with this visit.  There was nothing more I could do for him at the bedside. So, I tore off my gown, and moved on to the next patient.

 

I’ve been home for a few hours now.  Someone else is on call, and covering the 7, and all the others in the facility.  Now I wait, and wonder, in five days, will it be my turn?

 

Like some many other health care workers in the past 18 months, I have tried hard to educate and help everyone in their decision to get vaccinated.  Living through days like these make me want to give up.  To just run away.  Quit. Bury myself in a hole.  Because what can I do? I am doing everything I can, but it seems like very little.  Knowing this past six months of illness and death could have been largely avoided if people had been brave, courageous, or just not suspicious of our intentions.  I have two days off.  I don’t know when I come back on Monday if the seven will be 14, or 50.  I don’t know if we will have lost any.  I don’t know if it is going to be my turn.  I am tired, weary and scared.  I am exhausted, and almost beyond hope.  But I still show up for work everyday, because if not me, then who? I know the nurses, aides, maintenance, administration, housekeeping, dietary, and all the other support staff feel the same way.  When will it stop? When will we be able to go back to our jobs as we knew them? When will we be able to let these residents see their families? When will we not be scared for our lives, and our children’s lives everyday?  When will it be our turn?  I just don’t know.

 

-written in 2021

 

What a loaded question.  But it goes through so many people minds as they try to navigate the diet industry, the Instagram perfection, the looming summer swimsuit season.  Why can’t I lose the weight? Why do I keep sabotaging my diet?  What is wrong with me?

 

A lot.  A lot is wrong.  But not what you think.

 

I am going to give you a variety of reasons this isn’t working for you.  I don’t have all the answers, and I haven’t put all the pieces together yet for myself, but I have come to one BIG conclusion for myself, and for all of you.

 

 

You are doing your best.

 

 

How do I know this?  Because very few people choose to be overweight.  Some do, they are fine with it, they like to overeat, they equate it with bonding time with family, or perhaps they just like the way their body looks in that shape.  And that is okay.  If you are good with how your body looks, no matter the size, I am so happy for you, and you keep being you, and you can move on.  This conversation is for the people who are struggling.  Who feel upset, ashamed, guilty, overwhelmed, and feel like it is never going to get better.  I am here for you.  I am speaking to you.

 

So why is it so hard?

 

1. Our bodies are designed to store food. They don’t know food is so plentiful now.  They don’t know that we aren’t starving peasants anymore.  It has fine tuned calorie preservation into a biological art form over millennia.

 

2. Processed Foods: Preservatives are killing us.  I can’t back that up with any facts.  It is strictly my opinion.  If you are company that sells preservatives don’t come after me.  But I can’t see how these microscopic molecules can do what they do to food, and not affect our cellular chemistry in some way that isn’t harmful.

 

 

3. American Wheat: It’s been modified and refined. It is different than European wheat, and seems to cause more insulin resistance.  There is a some evidence to this, it isn’t solely my opinion, but I am too tired and exhausted to look it up and fact check myself.  We will call this my opinion too.  I haven’t figured out a way to get European wheat into my diet. But it makes sense to me why us Americans have worse health and more central obesity than Europeans.  They eat different wheat, and they eat more fresh foods.

 

4. STRESS: It raises our cortisol levels, which causes us to slow our metabolism, and store more calories as fat.  Stress can be physical, but for most of us, it is mental.  I can’t tell you how many people I see in my office everyday overwhelmed by their work.  We are not managing our stress very well in this country.

 

 

5. Lack of Exercise: This isn’t a lesson in expend more energy than you take in… Though I love to tell my patients that you can’t out-run a donut.  (Meaning it can take a few seconds to eat 500 calories, but takes an hour to walk off 500 calories,).   This is about improving your metabolism.  It also improves your mental health.  And it doesn’t need to be a run.  Walking for 30 minutes a day is really a tremendous achievement we should all be aiming for.

 

6. Lack of Sleep: Supposedly, we burn more calories when we sleep.  It is also restorative to our cells.  Our bodies need sleep to be at peak performance.  Lack of sleep affects our concentration, and our mood.  A good night’s rest also helps us handle stress better…. And most importantly, it improves our metabolism.

 

7. Water: If you are dehydrated your body is in panic mode.  It doesn’t know that you have a water faucet three feet away from you.  It is still thinking back to peasant times.  If you are dehydrated your body is going to go on high alert, and raise your cortisol level.  It is going to slow down your metabolism and hold onto all resources.

 

8. Hunger: I saved the best for last.

 

Thin people just say, push the plate away, put down the fork and walk away.  There is a lot of judgment there.  What they don’t realize is, fat people (and I am generalizing here), don’t eat when they are full.  They eat because they are still hungry.  They can be hungry all the time.  Thin people eat a “reasonable” portion, get a cue to be full, and they stop eating.  It doesn’t work that way with fat people.  They don’t get that cue.   They still feel hungry.

 

If you are a thin person reading this, and have gotten this far, ask yourself this: Remember the last time you were starving, and just wanted to eat until your stomach stretched beyond it’s limits? Imagine feeling like that ALL THE TIME.  Starving.  Hungry.  It takes about 1-2 hours to digest your food.  Imagine having that feeling coming back every 2 hours.  To where you were constantly thinking about food.  It is an uncontrollable urge.  Only eating gives it relief.

 

 

There is a new class of medications that have come onto the market in recent years.  They are getting a lot of buzz.  They have their pros and cons, and I am not going to get into all of that here.  If you are interested in them, we can have that chat in person at my office.  But what I will tell you is that for the people that go on them (and are able to tolerate them), they are GAME CHANGERS.  Yes, people lose weight on them, and that is of course fantastic, and the reason that I prescribe them.  But what is most striking to me about them, is the comments I hear from the people who take them.

 

“I don’t think about food all the time”

 

“I finally know what feeling full is like”

 

That is AMAZING.  It was really eye opening for me to hear those words.  For so long fat people have been judged for eating too much.  The entire world blames them for lack of self control, with this holier than thou attitude, of why can’t you stop eating? The rest of us are perfectly able to put the fork down…  but in reality, people with a weight problem are getting INTENSE internal signals to eat that the average weight person has never had to overcome.

I haven’t found a solution to this hunger problem.  The meds seem to work well for a lot of people.  Working on reason 1-7 above can also mitigate hunger for a lot of people as well.  I think we all need to take a look at this list and see what in there is changeable for each of us individually.  I am very grateful that scientists are trying to solve this problem.  In the meantime, we need to give grace to ourselves, and those around us struggling with this.

 

So please PLEASE stop judging yourself.  And stop judging other people.

 

They are doing the best they can.

 

Hello and welcome to our New Blog!

I am really excited to share my ramblings with you all on a monthly or perhaps on an even more frequent basis.  It all depends on my mood.  I have labeled it “Oh by the way”, as that is a very common phrase we hear in primary care medicine… or really all medicine.  sometimes there is so much to cover in a primary care office visit, that patients hold back that last question or worry until the very last minute.  More frequently than not, it requires a bit of conversation to answer it…. So this is my chance to have an oh by the way moment with all of you.  Stay tuned!