It's not what you are eating, it's what's eating you…

Archive for the ‘Obesity Bias By Physicians’ Category

How an episode of #HouseMD on You Tube, can give life saving insight on how pervasive and damaging #Obesity bias and bigotry is, way more than the disease of Obesity in itself, not just bariatric patients but in the case of #gastricbypassreversals …

 

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Important Disclaimers: WHY DO I KEEP DOING THIS???

Nope… The above is an unfinished, crappy and nonsensical disclaimer.

I’m going to try again.

Important Disclaimers: I’m an ASBMS and ABMS board certified bariatric surgeon and also a licensed attorney specializing in tort law, where I concurrently hold licenses to practice medicine and law  in CA, MA, MD and MN.

Graduated high school at the age of 12, 1st in class at Harvard Law, 2nd at Harvard Medical School (which I had to sue, to block public access to my academic records and the age that I achieved them), surgical residency John Hopkins and employed as a physician at Mayo Clinic, while on sabbatical, as I just finished up my residency at Stanford, in Neuropsychopharmacology.

I believe though that patients and clients need both in person evaluation and plan of action by a licensed  practitioner   who oversees them in person…

Okay… Above 2nd attempt at disclaimer and CV is PURE fiction.

And was WAY more FUN to write!!!

As well as real life human stuff, as heartbreaking to write about, is way more interesting, at least to me, especially given the fact I’m doing this for free, but when I help be a part of saving someone’s life, that’s the reward.

IMPORTANT DISCLAIMERS: I am NOT a clinically trained medical or mental health professional, nor in public safety or law enforcement. IF you or someone you know is in medical and/or mental health crisis, please seek immediate help in an appropriate facility by an appropriate credentialed expert and/or contact emergency services.

Alright, 3rd attempt I got out what I needed to.

Now, I can start this blog.

YAY!!!

NO, not really!!!

It kind of sucks, that the activism that I’m good at, that my attempt to arrest bias and bigotry which can be deadly to someone, is like trying to empty out the ocean with a freaking thimble.

***

“Not many people would have the guts to admit that they would rather be PRETTY than HEALTHY… “-  the awesome fictional  Dr. Gregory House- from t.v. show House M.D. Season 5 Episode 10 “Let Her Cake”.

“All I need to start with, is patients who are ALIVE, in my specialty of medicine, and by the time my patients find me, they’ve already been quite medically and mentally compromised by medical interventions that were meant to help save their lives, if not make them much better off in quality of life, both physically and mentally.

And if that medical intervention failed them and most of the time, a ton of psychological duress, circumstantial trauma that proceed interventions that usually led to their obesity, and/or continue on after them and most of my patients due to stigma and how people have no idea of how pervasive and damaging Obesity bigotry and bias REALLY is, but horrifically still quite awfully, still so acceptable, unless they’ve suffered it, that the suffering by post bariatric surgical patients, in dire circumstances, pales against it.

AGAIN, even in bariatric surgical patients who had the most catastrophic bariatric surgical complications.

BECAUSE, no one wants to hear how Obesity bias, even by the most well intentioned person, whether they be a physician, family member or friend, can be soul crushing in certain circumstances and in others, such as in my specialty can be deadly to a patient, if not then cause them irreversible physical and psychological harm. ” ajk/UnstapledLisa

If you think so far, this blog is a wordy nonsensical trainwreck, like I am, think again.

Most people if they choose to do activism, especially medical, where to the degree that I am, that I am trying to help save people’s lives, they had to fight an enormous medical (and usually mental health) battle by the time they find me.

The reason why I posted above House M.D. clip, is that it highlights some of the biggest obstacles that I face when I help people when dealing with the medical and psychological ramifications of serious, potentially life threatening bariatric surgical complications.

It also in the worst way possible, shows why I will never NOT be supportive of a bariatric surgical intervention, as a last resort.

I get that House M.D. , is a fictional medical drama that’s meant to entertain.

Unfortunately, there’s quite a few of us, who have in common in the episode, with the character Emmy, where we’ve been told that we need a gastric bypass reversal to save our lives or dramatically improve it.

And while like Emmy, I found exercise to be a great thing for me, as I found I got endorphin highs with intense exercise, thought I could help others with their medical and mental health find some kind of exercise could help people and that’s why I got my certification, as a personal trainer, 14 years ago, that’s all that I have in common with her.

As in my case, by the time I was told by my surgeon who suggested a gastric bypass reversal was necessary to save my life, I was ready to die and I’ve touched upon where I was medically and mentally in 2010, at the time of my reversal and will blog update how I am doing almost 9 years status post gastric bypass reversal, shortly.

But not today.

This is the deal though, in most cases, it won’t help a bariatric surgical patient who had a long term positive outcome or even a person who’s bigger, who would never have bariatric surgery watch the video.

And it will be soul crushing for anyone who’s sensitive to fat shaming and thin shaming to watch the video and read the comments on You Tube.

And this is where we are as a society, as I know full well both personally and professionally of how damaging, if not deadly the pervasiveness of fat shaming can be to anyone, but especially when someone is already in medical and/or mental health crisis after a surgical intervention for Obesity went wrong and they find either my blog or me on the internet.

Because I am to an extent, practicing both medicine and psychology without formal training and licensing, while I consider people like that, “my patients” , in the way it matters the most (to help save their lives and I don’t tell them I think of them as patients, except now you all know) , I also ask of them to be under the care of physicians, surgeons and mental health clinicians, which usually by medical crisis alone, they are.

As while I can help them navigate the unchartered experience they are having, but I don’t have the experience to have their lives soley in my hands, I don’t have the right to do that to anyone (nor do they have the right to do that to me, as it’s a enormous responsibility), no matter how well intentioned I am, no matter how high the standards I have for their lives and care.

The above paragraph would be in direct violation ethically of everything that I try to stand for as an activist and someone who wants a clear division, as physicians, surgeons, psychiatrists, psychologists and/or all or any kind of licensed/credentialed professionals who have extensive education, training before they treat patients, is what a patient in medical and mental health crisis, bariatric related or not, needs the most .

Here comes the BUT why I still do it anyways (online ONLY and with major warnings about my limitations, by not only being NOT a clinical professional but that they will need care and support from their families, friends and the reversal community that’s now online but wasn’t when I had my reversal, as well as a professional credentialed care team of physicians, surgeons and possibly psychiatrists and psychologists)  :

After dozens of times of having gastric bypass (most of them, a few of had bpd/ds, vsg, adjust lap gastric band and open non adj gastric banding) patients tell me they have major complications and their labs are in the toilet, find me because they have no quality of life or think they are going to die and their bariatric surgeon won’t perform a reversal.

Even if they have other physicians in their care team suggesting it.

Because their surgeons are afraid of them getting fat again, in physician/surgeon speak “great concern of the co-morbdities Obesity becoming a factor in declining health”.

OR

Patients who find me, where their experiencing potential life ending medical complications and want to know my reversal experience and have no problem admitting they are terrified of getting fat again.

Remember, where I said at the beginning of this blog, about 1000 words ago, I need “my patients” to be alive???

There’s only a few of us, I’m guessing, I’m really the ONLY person I know, on the internet, who’s discussing in great detail, the medical and psychological ramifications of gastric bypass complications and reversals.

There’s others, but only a few, who blog and vlog about their gastric bypass complications and/or their reversals.

The House M.D. video, could really hurt someone, if they are researching gastric bypass reversals and see the video and/or  the hateful comments directed at fat people and bariatric surgical patients, if they find that video first without finding support that exists, first.

I’m not sorry though the video exists, it gives people a terrifying glimpse, if they care about human beings and aren’t aware of trauma that usually factors in to Obesity and Anorexia, not just in the bariatric surgical community, but outside of it. It just doesn’t tell people what led to their personal experiences prior to an intervention.

You can’t legislate or hate that away and when people are hated for appearance issues, especially when it comes it comes to bariatric surgical patients, those comments on the video, are shockingly accurate of the frequency and level of hate that people experience everywhere else on social media and online and off it, as well.

Not just from their peers and family but sometimes innocently and not so innocently licensed physicians, surgeons and psychiatrists who took an oath not to do any harm.

I shouldn’t be the only to be terrified, that a fictional diagnostic team, even with a ton of snark, in the end, handled a bariatric surgical patient in medical crisis, sometimes better than they are treated in real life.

Even in the most well intentioned people, physicians or not, who do not know how to appropriately address the complexity of emotions, as well as the complexities and medical and mental health issues, that have to  be addressed in this population of people, makes it so much harder on those of us, physicians or not, who are trying to save these patients’ lives with them having the best possible short and long term outcome medically and mentally.

I’m not saying that Obesity doesn’t provide a valid reason for their to be health discussions for prevention and treatment when it happens, if a patient wants it.

But Obesity is just NEVER an acute issue in pre-operative gastric bypass reversal patients.

Note: Constructive feedback is welcomed. Please don’t waste my time or yours with not honorable intentions. Thanks!!!

Edit Note: Update on 5/25, blog needs to be overhauled, I get that it’s kind of wordy. It would be less careless for me to pull it though until it’s reworked than for me to leave it up.

Unless you’ve had to on multiple occasions have to coach a bariatric surgical patient in crisis medically (and sometimes mentally) who even after a weight loss of 200 lbs, has a bmi of 20, but that’s only because they didn’t have any reconstructive, they have a clinically trained professional in their care team, whether it be medical or mental health not show a level of compassion or actually believes that Obesity is the acute medical issue in these patients, when it’s clear that it’s not, you’d understand better why I had to go and be so hardcore, of what at stake with all this body shaming both in the bariatric surgical community or where I’m having a conversation with someone is in recovery or struggling with Anorexia who thinks everyone hates them, including fat people, which isn’t the case.

And if you haven’t done this kind of work, you wouldn’t understand just how complex it is to try and be of some kind of help to save someone’s life, in these circumstances.

Just saying be kind isn’t enough, sadly.

 

 

 

 

 

 

 

 

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Physicians with biases ARE physicians who HARM, even if it’s unintentional…

 

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Disclaimers: I am NOT a clinically trained or credentialed medical or mental health professional. NOTHING I say should EVER be taken in lieu of professional medical and/or mental health evaluation or treatment of ANY condition.

I can ONLY put my opinions, where I hope to help people, where I have in guiding them, at the very best, simultaneously,  at the same time to get the best medical or mental health treatment, from trained clinical professionals, in an appropriate setting , such as what I do with gastric bypass patients in various scenarios with gastric bypass reversals, among other things.

BUT,  what I have to say about how various biases carried by physicians and the potential for physical and emotional harm, still needs further civil, respectful and responsible but sometimes when appropriate, critical discussion, not ONLY by patients but the actual medical and mental health professionals within their own  communities.

I ONLY believe though, when dealing with a provider who one might feel is showing bias that effects one’s care,  of discussion of potential  misbehavior, if  one feels that they’re being treated unfairly or unreasonably, because of that bias (I’m talking about appointments, not to the point where blatant physical or emotional malpractices have occurred) of filing a grievance, if a discussion doesn’t resolve the issue and/or finding another physician.

It is NEVER okay to threaten the emotional or physical wellbeing of anyone, including a physician or any provider, for biases and if depending on the degree of physical and/or emotional harm has occurred, if that’s an actual issue, there’s legal remedies one can look into and/or take.

That’s it, making or threatening a physician’s physical and emotional safety and wellbeing is NEVER okay (more will be elaborated about that, in the content of this blog).

Also note, I have people I associate with where they may find my communication style at best, offensive, because I’m kind of open with my various disabilities and with those disabilities, it’s difficult for me to be concise or write well, even if this topic definitely needs discussion and resolutions.

***

All I wanted to do last weekend,  was to  have an okay weekend.

Let me explain, as most people know, that due to my disabilities, that I don’t have anything normal in responsibilities, like people my age do.

But in my case, I kind of dread weekends, while my blogs have been both personally and as an activist, VERY serious as of late, it’s kind of scary where I live, because on weekends, when staff isn’t here, people are more likely to act out.

Even with cameras, unannounced drug sniffing K9s and security during nights and weekends.

While I explain to those few about explaining where I live,  that 1/2 the building where I live are good to have as neighbors, the other half is people who have issues with drug addiction and what it takes to support an illegal drug addiction (dealing and/or other illegal and unsafe behaviors to support an addiction of themselves and who they associate with) , if one’s on their way or headed to rock bottom, especially for poor people, it’s not a fun thing to live amongst, even if I have some empathy for non violent addicts.

The best way I can describe where I live is my building is like a stupid drug cartel that’s badly managed and a church had a baby.

Seriously and it’s NOT funny or fun to live in, even though I’m grateful for my housing.

Also as a serious activist, if I’m going to point out where doctors fail patients in under medicating patients or being afraid to use opiates as a last resort, I also have a responsibility as an activist, to do no harm, myself.

To either patients or providers or to anyone.

The last thing I’d want to give the impression, as an activist,  is that people can be complacent nor would I want to enable, when it comes to the potential of drug addiction or feed into a denial pattern, if they actually are in the midst of drug addiction or heading into drug addiction with either prescription or  illegal opiates.

I know it sounds like I’m digressing, please be patient, I will make my point when it comes to physicians and their biases and how it harms.

Because of all the clinical data I have to read, both as a patient and as an activist, who’s trying to find answers both to opiate addictions and obesity surgery complications, is by using Google.

So when last Saturday night,  it was in my suggestions on Google,  to check out a physician driven site to support and educate medical providers, especially as it applies to interventional pain management or obesity related issues (among many other medical topics but those were the 2 most talked about ones, as well as ones I’ve discussed ad nauseum in this blog in the past) , I didn’t need that site, to know that bias among physicians was horrifyingly pervasive and permanenting who apparently were WAY unaware that they had a few of these awful biases that I’m going to discuss in this blog.

I just didn’t need to see it on Saturday night, when my building was a hotbed of not life threatening criminal behavior due to drugs, but it still was scary because you don’t ever know when that’s going to escalate.

I happen on that physician site to read an article a blog that  a pain management specialist wrote,  who was trying to make a point on how tricky it is to do pain management using a popular stereotype that’s perpetuated not only with non physicians, but within the medical community.

Patient #1:  was a morbidly obese patient who misused opiates claiming she was under medicated, that she was treating who had  needed a double knee replacement and severe  back pain  due to a disc issue (and apparently her inability to stop eating for more than a minute)  and had mental health issues and when the physician pulled her meds due to her non compliance and her quite clearly expressing the patient having NO willpower whatsoever, that patient trashed her online, so she thought, as right after that happened, she received a bunch of negative reviews on a bunch of medical websites.

Patient #2: Very friendly thin patient perfectly compliant dying of cancer, who used a moderate amount of opiates sparingly, despite her severe intractable pain due to terminal cancer with mets and in this instance, the pain management doctor had a nauseating borderline reverence, for.

I will admit, that I’ve had that kind of prejudice similar to patient #1 even though I’m not known for compliance with most meds, other than narcs due to high tolerance (and how I’m resolving that, will be in another blog, soon).

But that blog by that pain management doctor, hit me way harder as an ACTIVIST.

This is what I know to be true, due to the  activism that I do.

Bias can kill patients not only from physicians even if it’s not intentional, due to stigma, as well as by,  non physician peers.

I get that all the time, when I have to talk to a gastric bypass patient with catastrophic complications, into what may be right for them, such as a a gastric bypass reversal, who’s going to die, has a BMI of 19, even with weight loss of 200 lbs and NO surgery to correct extra skin, so their BMI is actually even lower, when that’s taken into consideration, but they’re afraid of and what’s worse, is their current bariatric surgeon is afraid of doing a reversal, in case they become morbidly obese, again.

Where they are more likely to DIE from their catastrophic complications, before Obesity again could put them in mortal danger.

Or in the case because I’m a body diversity activist and find thin shaming repugnant, if I say that someone who’s thin, they’ll usually share their skinny shaming stories and if they’ve had a past or current history with bulimia and/or anorexia.

Or when I see within the weight loss surgery community, patients who get very thin because they’re terrified they’ll be fat again, not realizing that it’s not ideal, it’s actually unhealthy,  to be exercising intensely like an athlete, on 400-1000 calories a day, not only does that make them more at risk for exercise related injuries, it kills their metabolisms, in the long run, if not creates other health risks.

So doing behaving that way is no insurance policy that a bariatric patient won’t gain weight again or have any other severe health problems.

Or if they have bariatric surgical complications, quite a few bariatric patients actually think they deserved them, because they were fat in the first place and had to resort to bariatric surgery.

Or when patients who are morbidly obese to medical and mental health issues and want bariatric surgery or to lose weight, they sometimes become obese due to inactivity due to their health issues and their medications, they can’t have their total knees without losing weight or their bariatric surgeries and they can’t lose weight without either surgeries and are absolutely in a no win situation.

With weight stigma, especially when it comes to Obesity, it hurts both fat and thin patients.

With fat patients, they hate getting medical care, because if they go the doctor for strep, it’s going to be blamed on their weight.

And it shouldn’t be any surprise but it will be to providers, if they have fat bias, the patients who they are treating are FULLY aware of that and that’s why people of weight loathe to seek medical treatment which can sometimes kill a patient, but even at unfortunately, at best,  unnecessarily makes getting any kind of medical treatment, a lot harder than it should be.

It also hurts and potentially harm  thin patients, because they may less likely to think they could have health issues, and their physicians feel the same way, because if they’re a “healthy” weight, it’s presumed, that they’re actually healthy,  when they may not be.

With opiates due to stigma, if a physician has a patient who’s in intractable severe pain, there is a risk they will self medicate and possibly harm if not accidently kill themselves,  they engage in unsafe and unhealthy behaviors to treat their pain and/or they kill themselves, if they aren’t appropriately medicated and/or suddenly taken off their medication.

Especially now, with the opiate epidemic, patients who are compliant, but have been on opiates for a long time are now starting to die, because they find a dealer and/or patients are actually commiting suicide, becoming collateral damage because of the opiate epidemic,  due to unbearable physical pain, because they don’t feel they have any other options and they have no quality of life and they have no options as a last resort for pain.

Absolutely NO physician should be congratulating themselves or encouraging as a positive behavior,  that a terminal patient has great “willpower” by not using opiates for severe intractable pain, if medications are working properly, when the risk of addiction in that patient is next to nothing and the patient is ONLY afraid to take opioids, because of stigma due to drugs, and would rather die a horrifyingly  painful death than be considered a drug addict due to stigma , even if the patient is going to DIE.

NONE OF THIS IS OKAY!!!

I’ve said this before, as a medical activist.

HOW and WHY, in this evolved technological era, why are people becoming MORE backwards in our society, has to be discussed openly, without stigma.

BUT medical and mental health professionals take an oath to try and not do harm.

IF they have personal biases, regarding fat patients, challenging patients to treat or mental health patients and/or any other kind of  biases, who are coming to them for any kind of treatment, they OWE it to their patients, to give them the best possible care.

And they can’t do that, if they have ANY kind of  preconceived particular bias towards ANY population of people.

In the defense of physicians or any medical or mental health provider, while I’m not excusing bias that limits their ability to care for their patients, they shouldn’t have to worry about physical or emotional harm, either.

Also patients LIE, like all the time or don’t even realize the dangers if they are aren’t lying a lot, but about things that may seem trivial to them but it’s not and it makes them a liability to both themselves and possibly their providers, especially one who is prescribing narcotics to them.

But even if 9,999 out of 10,000 patients are lying, especially about what they’re actually ingesting, all of them deserve to be given the benefit of the doubt, especially if the 10,000th patient may be, if not, is actually telling the truth

Every patient deserves an individual patient tailored approach to their unique physical makeup being able to feel safe with their medical and mental health providers.

Every provider should feel that they don’t have to worry about being physically or emotionally harmed, because they say something or take a course of an action that a patient doesn’t agree with.

Patients should just stop seeing that provider in that case, in case of negligence or harm, consider a legal remedy, that’s it, if a reasonable (as patients can be respectful, responsible and critical at the same time) discussion or resolution is NOT possible with a provider and/or seek a different provider, if possible

But pretending that bias doesn’t exist, that it can harm patients in their ability to get appropriate (and sometimes lifesaving) treatment of their health conditions,  that resolving one addiction and not addressing the nature of addiction, can lead to another, is harming people, both patients and providers, alike.

Because we aren’t having the responsible and respectful dialogues we need to, as as society,  because of STIGMA.

So while I will hold a physician to the hippocratic oath, it couldn’t hurt anyone, if we actually all took it.

Note: Constructive feedback, only.

Also note: Again, I believe in both any of the obesity surgeries AND opiates, as an absolute last resort. I’m not against any weight loss surgery, I just have a unique situation in being one of the more long term gastric bypass reversal patients out there, of being asked about that, a lot.

As it applies to opiates, I have lost people I’ve cared about due opioid addiction as well as see it in other case, such as described above, ruin people’s lives, so again, it bears repeating, I’m not trying to feed into or enable the opioid epidemic, as an activist.

Although, I’m also not going to apologize for being supportive of invasive medical treatments for different health issues, i.e. both obesity surgeries and opiates, but I will always strongly urge people when you take drastic action, make sure you have a long term plan, are well educated and are well supervised, medically (and mentally), life long.

Nor am I going to apologize for the length of this blog, due to the sensitive nature of what I addressed in this blog,  that I had to so  comprehensively and fairly, to do  justice both to patients and providers, alike.

And if you saw at times, what frightening words or phrases sometimes end up in search engines for my blog, well you’d understand better, why I have to have such a lengthy in depth disclaimer.

Thanks!!!

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