Why Health Exceptions Aren’t Enough

I made the mistake once again of arguing about abortion on Facebook. I pointed out that SB5, if passed, would harm or kill women who have unhealthy pregnancies. (And gave a couple examples of issues that can occur.) The guy I was arguing with waved that off because he’s talked to more than one doctor who says he’s never seen any reason a woman would need an abortion to save her life, and that it’s just an “excuse.” (I’m sure he’s operating with *no* personal biases whatsoever.)

Well, there you have it. These two medical professionals (and no, he didn’t say that they were even OBs) said it, that must settle it. I’m glad I never have to worry about having an ectopic pregnancy, or pre-eclampsia or hyperemesis gravidarum (extremely severe morning sickness that causes malnutrition, dehydration, and weight loss) because they apparently don’t exist. Though, I’d love to know what Savita Halappanavar actually died of, since it totally couldn’t be the pregnancy.

This is why, even if you think that abortion is immoral if the pregnancy isn’t going to kill or seriously injure the mother, abortion for any and all reasons still needs to be legal. (That’s not my position, but for this particular post, I’m going to focus on health only.) Because if you just have a health exception, those same doctors will be the expert witnesses testifying at some woman’s trial when she ends her pregnancy so she can have chemo. Or speaking to Congress about how those exceptions should be worded.

Not to mention, limiting abortion to only “medical necessity” does not mean that every woman whose pregnancy is likely to kill or cripple her will have an abortion. What it means is that you need to:

  1. Find a doctor willing to bet his medical license and his freedom that not only are you really at that much risk, but that a court of law will back his decision. (That’s a much higher bar than just a doctor’s opinion that it’s necessary.)
  2. Jump through all the hoops set up by a legal system that doesn’t want you to get an abortion—maybe a waiting period, maybe multiple doctors’ sign-off, maybe a court order.
  3. Get all that done and actually have the procedure while there’s still actually time, before the condition that made an abortion necessary in the first place worsens.

I bring up Savita very deliberately, because it was supposed to be legal, even in Ireland, for doctors to complete her miscarriage and save her life. And yet, that didn’t happen, and she died unnecessarily. Just the fact that something is technically legal is not enough to mean that it really is available when it’s needed.

Edit: I added a couple more examples of fatal pregnancy complications, because putting “ectopic pregnancy” and Savita in the same sentence made it sound like that was the condition she had, when in fact it was septicemia that resulted from the hospital’s refusal to complete her miscarriage.

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Well, that went better than expected

So, I had my appointment with my new endo today, which I was more than a little worried about.

It went surprisingly well. No weight lecture whatsoever, even though I’ve gained 4 pounds in the past year (which the doctor said was “probably normal fluctuations.”)

My blood pressure was a tad bit higher than it had been the last time. Probably mostly the stress. The way being in a less privileged group interacts with having anxiety disorder is really unpleasant. I mean, I know I’m paranoid, but they kind of *are* out to get me. “They” in this case being the 60 billion dollar a year weight loss industry, most doctors to some extent, and even the freaking First Lady. So it’s difficult to use the techniques I would use to talk myself down from other worries, because this one is more grounded in reality.

On my patient consent form, I did cross out the “Pictures or video may be taken of me and used for educational purposes” line. I have no desire to be the headless fatty accompanying their Facebook post of some article on gastric bypass. (Odds are those are stock photos rather than their patients, but still, “education” covers a lot of ground that I may or may not be comfortable having my image used for.)

I hope this wasn’t a fluke, and that my follow-up in six months goes the same.

Doctors, Power, and Honesty

So, I have to make an appointment with a new endocrinologist, which I’m dreading the heck out of. (My previous endo finished her fellowship program and isn’t going to be at Hopkins anymore.)

With the previous endocrinologist, I pretty passively sat through a lot of weight lecturing because I really need someone to actually treat my thyroid issues. The previous one hadn’t, and I knew that if I got written off as the “non-compliant fat chick” there, I was pretty thoroughly screwed.

Since my current endo was extremely knowledgeable, polite, and helpful, I figured sitting through a yearly weight lecture and giving lip service to the idea of losing weight was a fair price to pay.

And, let’s be honest, I was freaking terrified. The power doctors have over you when you’re sick is a scary thing. I remember thinking, before I went to Hopkins, that if they blew me off like the last endocrinologist did, that my best option was probably to crash diet to lose 50 or 100 pounds, in the hopes that if I got down to a socially acceptable weight and was still showing hypo symptoms, someone would actually listen to me.

So, now that I need to make an appointment with the new fellow, I’m trying to figure out whether I’m brave enough to actually say I’m trying to approach my health from an HAES perspective, or if I’m going to just smile, nod, and get out with a prescription for the synthroid that keeps me functioning.

I may take a middle approach where I ask about research and studies without flat-out saying that I don’t plant to attempt weight loss under any circumstances. Because if you can show me a study where even half the participants lost a significant amount of weight, kept it off for five years, and didn’t experience worse health outcomes than the control group, I might be convinced to try *that* diet. To my knowledge, no such studies exist. But if I approach it from an angle of asking questions and being interested in evidence, I may be at least a little less likely to be blown off.

I’m also planning on going into the appointment dressed nicely and groomed as thoroughly as I would be for a job interview, make-up and all. It kind of is a job interview, where I’m applying for the position of “vaguely intelligent grown-up who’s allowed to make her own medical decisions.” And fat people, being supposedly stupid, lazy, and low-class, are generally disqualified from that position. So I’m going to shamelessly work on the markers that I can manipulate to be seen as a person worth helping.

I also have another medical thing going on. Polycystic ovarian syndrome, which seems to be preventing me from getting pregnant, despite a whole bunch of trying. (I kind of wish I’d known I had a condition that’s linked to infertility before I spent hundreds of dollars on BC pills that made me feel like shit, when we probably could’ve just used condoms and been more than fine.)

It’s been six months, which is the point at which you’re supposed to go to the doctor if you’re over 30. I’m thinking the first step will be to go back on metformin. I should also find out what other options are available if that doesn’t do it. I’m not keen on the idea of fertility drugs, since i really don’t want multiples. I also have my doubts that anyone would do IVF on someone with my BMI.

The one nice thing about the fertility stuff is that I don’t *need* to have a baby, not in the same way I *need* to have my hypothyroid managed. I want to have a baby, I will be very sad if I can’t have one, but my life will still be good. My awesome husband will still love me, I will still have a fantastic group of friends and a house full of furry critters. It would suck, but ultimately it would be okay.

That knowledge is a good thing, because it means that if any doctor I deal with in my quest to get knocked up is rude, or bullying, or manipulative, I’m completely free to walk away, in a way that I’m really not with my endocrinologist. I mean, I can walk away, obviously, but it’s not a risk I want to take unless I really have no choice.

It does make me wish doctors had a little more respect for their patients, particularly fat patients, and that they were a little more aware of the power they have over them.

A Medical Rant

A friend of mine has a medical problem that has nothing to do with her weight, but her weight means doctors refuse to treat her. She was in a car accident and had her knee replaced years ago. the replacement is now shot, though it lasted much longer than it was expected to.

The orthopedic surgeon she sees wants her to lose *130* pounds before they’ll replace her knee. Not just come down under 250 pounds or out of the “obese” BMI category. They want her to drop more than half her body weight and get into the middle of the “normal” category.

Keep in mind that she can’t fricking exercise because her knee is shot. She’s doing good to walk around a mall or amusement park for an afternoon without needing a scooter.

The kicker, though, is the reason they give for not doing the surgery. It isn’t that she’s at a higher risk of complications or anything like that. No, it’s that the replacement will wear out a little faster. Really? Seriously? So you guys are okay with having her in continuous pain for the next couple *years* (assuming she can maintain what’s considered a healthy rate of weight loss, a pound or two a week) because otherwise she might need another new knee in twenty years rather than twenty five?

Not to mention how they can really think someone who can’t exercise is going to lose weight without pretty much starving.

It just boggles the mind that doctors can see someone in pain and instead of helping, basically go “Oh well, sucks to be you.”