Wednesday, March 17, 2010

Loving-kindness Meditation

My friend, A-Team cheerleader, and meditation enthusiast, Stef, graciously sent me a CD of some of her favorite guided meditations to help me meditate when my pain is so distracting, I can't even stay with one breath. It has been a few days since I meditated, and I noticed the effects on my spirit. I am so imperfect about my practice, yet I feel like it is an integral part of my spiritual life, so I keep trying.

After a few days of whining that I hadn't left adequate time for prayer or meditation in my busy mornings, this morning I turned words into deeds and sat down to listen to Jack Kornfield's loving-kindness meditation that was on Stef's compilation. This is a traditional Buddhist meditation that is designed to help us have a compassionate and loving heart toward all. For the record, I am not a Buddhist, but loosely consider myself a student of Buddhist meditation. The loving-kindness meditation first had me focus on repeating phrases that would open my heart and encourage compassion and love for myself. Then, I repeated the process, first focusing on people who are dear to me, and then later, extending the loving thoughts toward strangers and even enemies (which I gratefully do not have).

I felt fantastic after this, getting up from my meditation and the prayer that followed it, feeling truly at one with the world (Dan Brown fans: at-one-ment). My body and soul felt harmonious. Then it was time to walk Kacy before my chiropractic appointment, and I was trying to lead her out of the shadowy side of the block and onto the western side of the street, which was bathed in sunlight. Being a terrier, she wanted to go east, to Wisconsin Ave., so she was reluctant as I led her across the intersection of 33rd and Volta. At this point, a lunatic ignores the four-way stop at the intersection, and rolls through, stopping just two feet away from hitting Kacy and me, yet staring me down with a clear "Hurry up!" look. "What the fuck?!" I say, and my body and soul fill with rage. So much for my loving-kindness meditation! He then rolls down his window and says something vitriolic to me; luckily, I couldn't hear his phrase over my iPod, but I distinctly caught the f-bomb and the word "puppy."

So this rage-a-holic dude was mad at my dog for being slow when he was rushing through a residential intersection. I seethed for a few minutes, beating myself up for letting the harmony get away from me so quickly, while simultaneously laughing at the idea of this guy "ruining" my loving-kindness meditation. Then I stopped and did two crucial things: first, I decided Mr. Jerky Driver wasn't going to take away any more peace from my day, and I let it go. Really. Then I decided that there was nothing to "ruin" from my meditation, that I could accept myself for the volatile, imperfect human that I am, and more importantly, that I could extend loving-kindness to other people I would encounter over the course of my day.

And I have: I had compassion for the ridiculously slow and frustrating receptionist at my chiropractor's office, as well as for his assistant who carries a boatload of attitude toward anyone she perceives as "privileged," which she deems me. I complimented the receptionist on something she did well, and I asked the assistant how her kids were and how old they are now. These actions were not for show; they were sincere, and I believe they emanated from the intention of my loving-kindness meditation. Even with the jerky driver, I'd say this is a very good day indeed.

Saturday, March 13, 2010

Doctors: Your Patients Know Obesity Is A Problem

I have no doubt that my obesity compromised my health care. I'm not referring to my health, but to my actual health care. When I weighed 250 pounds, I felt dismissed and looked down on by many doctors. I felt disrespected. So it was gratifying to see that my experience was not unique, and indeed is quantifiable: scientists reported in the November issue of the Journal of General Internal Medicine that the higher the patients' body mass index (BMI), the less respect doctors have for them. The irony is not lost on me that the patients with the highest BMIs might also be the people most likely to be in dire need of quality health care from an empathetic practitioner.

Being an obese patient caused me enough anxiety that I searched online databases of "fat-friendly" doctors to try to find a practitioner who wouldn't make me feel like a freak. Some of my concerns were very tangible and practical: Would they have a gown big enough to fit me? Would they weigh me in a public hallway? But what really worried me was the disdain that I often encountered.

Upon seeing an internist for the first time, he chided me about my weight and told me. "If you just reach for baby carrots instead of Oreos when you're hungry, you'll lose weight." I nodded sheepishly, my cheeks burning. What I really thought was, "You dumbfuck. Congratulations! You just solved America's obesity crisis. Who knew it was that simple? Wow, carrots instead of Oreos. What a chiddush [insight/epiphany]!"

Another barrier to health care for the obese is the presumption that anything wrong with you must be directly or indirectly related to your obesity. I saw a jerk of an orthopedist shortly after a car accident in which I sustained whiplash. After ruling out major injuries with an MRI, his #1 recommendation to me was to follow the South Beach Diet. My pain persisted, and I sought follow-up care from him, but he was very dismissive. "If you'd just lose the weight, your back wouldn't hurt," the mean orthopedist said. Here I am, 102 pounds lighter. To be fair, my back is substantially better, but I still need chiropractic care. By the way, I ran into the aforementioned orthopedist on the street last year. He didn't recognize me at my new weight, and I seriously considered pulling him aside to tell him how hurtful and harmful his derision was to me, and to tell him how I finally did get a handle on my eating disorder (not with the South Beach diet). I chickened out.

Before losing the 102 pounds, I asked my ex-chiropractor if he thought my weight was causing my back problems. He replied, "Look around my waiting room. Most of my patients are not overweight." I'm not arguing that obesity does not cause or aggravate some health problems; just that the assumption that this is always the case is erroneous and damaging. I have run into this assumption so many times, it's infuriating. I feel like obesity is the biggest scapegoat in health care; it's far easier for a doctor to say "lose weight" than to take the time to address the complex factors that might be causing the complaint.

I'm sympathetic to health care providers who have to walk the fine line of counseling patients on their health -- which includes information on attaining or maintaining a healthy body weight -- but who risk angering their patients. I think whether or not a doctor broaches this subject with patients depends on their relationship, the patient's health, and other factors. However, if doctors choose to go there, they have to be tactful when broaching the subject, and I have some tips for them:

1. Context is everything. If I'm going to a dermatologist because of an acne flare up, it would be inappropriate for her to offer unsolicited advice about my weight.

2. I think doctors need to acknowledge how difficult weight-loss is, especially for obese people. I give my old internist, Dr. Graves (no, that's not a made up name!), a lot of credit in this area: he would suggest that I lose weight but always said, "I know it's so hard, Sarah. In fact, I haven't had any patients who have really been successful in the long run, but please keep trying." I found this simultaneously comforting and discouraging at the same time, but I appreciated his candor.

3. Providers should be prepared with suggestions beyond trying Weight Watchers or the latest fad diet. Those might be helpful tools for some people, but I personally believe that most people who are as obese as I was are true food addicts, not merely people who need a cheerleader and a public, weekly weigh-in to motivate or shame them into compliance. Many of you know that the Overeaters Anonymous-H.O.W. Concept was and is my gateway to recovery. I don't think it's an answer for everyone, but I do my best to educate my doctors about OA-HOW and its role in my recovery. Therapists and nutritionists with specialties in binge-eating disorders are other resources doctors could refer patients to.

4. Doctors in glass houses should not throw stones. It was very hard for me to take seriously any exhortations for me to lose weight when the doctor nagging me was overweight or obese himself.

5. Finally, health care providers should approach obese patients with the understanding that no one in this country thinks that his/her obesity is not a problem. Often doctors would speak to me as if they were the first person to bring this up, when in fact, they were the hundredth. This is akin to smokers; there are no smokers left in this country who don't know that smoking is dangerous to their health and their social lives. The same is true for overweight people. They understand the danger, but don't know how to control the compulsion that leads them to overeat, or how to overcome the deeply ingrained lifestyle habits that contribute to their body mass.

I am grateful that Dr. Huizinga published her research on doctors' disdain for obese patients. I hope that it sparks some soul-searching on the part of doctors to think about how they relate to their fat patients and how their attitudes might compromise the care of this already vulnerable population.

Thursday, March 4, 2010

Health Update

I had my follow up appointment with Dr. F and Gladys, my nurse practitioner and got some interesting lab results. I am still positive for Lyme Disease and Bartonella, one of the co-infection I'm presenting symptoms for. This wasn't surprising, but it was gratifying. We added the Rifampin back in, but at half the dose I took when the flaky naturopath prescribed it for me; the hope was that I wouldn't have the Herxheimer reactions I describe in this post. Unfortunately, I have. My symptoms are exhaustion and burning in my forearms. Additionally, my forearms feel like they're in a vice.

Dr. F is taking me off the Rifampin, and I'm trying Factive instead. If this doesn't work, I'm not sure what we'll do, but I'll cross that bridge if and when I come to it.

So, here's how my antibiotic regimen looks now:

Sundays: off
Mon./Wed./Fri: 300 mg Azithromycin
Tues./Thrs./Sat.: Minocycline
7 days of Factive (320 mg) followed by 7 days off

My energy is very low, and my mood is crummy: it's hard not to get sucked into self-pity when I'm this incapacitated. All I know is that we have to get this sorted out before Passover, because I can't cook for a seder if I'm in this condition. More later when I can type with less pain.