Tall and Skinny, No Whip

The Empire State Building

“Your patient is on social media Tweeting about it.”

“Tweeting about what?”

“The weight thing that prints out on the after visit summary for the patients.”

Come to find out she had also called and spoken to my office manager and my practice administrator. 

Good for her.

When we first moved to this electronic health record last fall one of the most annoying things was that on everyone that the program deemed “overweight” or “obese” got a large bright yellow box on the screen that alerted to me to the fact that I needed to add weight loss to their goals. 

I always hit the ignore button but it annoyed me that now I had to click an extra button because it stood between me and each patient’s active problem list. Not everyone needs to have “obesity” on their problem list and I would argue that NO ONE should have “overweight” as an official diagnosis. People who are “overweight” and  “obese” know good and well where they fall. They certainly do not need a computer “diagnosing” them with it, too.

I growled inside each time I saw that yellow box.

Then sometime in March I noticed that all of my “overweight” and “obese” patients were getting detailed weight loss instructions printed on their end of visit paperwork. It was going so far as to tell them exactly how much weight they needed to lose to reach a BMI of 25.

WHAT? I didn’t tell it to do that!

It was autopropagating. Someone flipped a switch somewhere which meant a good many other someones approved the change.

What were they thinking?

Shouldn’t I have control over that? Shouldn’t I be the one to decide? I am the doctor. I know the patient. 

I complained.

Nothing happened.

I mentioned it again.

Still nothing happened.

Some of my patients have eating disorders. A number of my patients have serious emotional issues wrapped up in their obesity. These people for sure should not end up with that kind of stuff on their handouts.

I messed around with the program for a while and discovered that I could manually remove it from the print outs if I clicked an obscure “X” box on the wrap up page at the end of the visit. I have to scroll down to the bottom of the screen to find it. That meant that on every patient I see every day I would have to scroll down to that area and click a box to remove weight from their goals.

I should not have to do that. There are literally 30 million other clicks I have to remember on each patient at each visit. Give me a busy day and things will slip through the cracks. This is something where the cost of human error is too great in my opinion.

For this patient, I was running 30 minutes behind. On hers I forgot to click the button. The print out told her she needed to loose over 30 pounds and detailed the diet and exercise changes she needed to make to get that accomplished. So she went to social media with it.

Suddenly, everyone downtown started scrambling. There will be a meeting now to discuss this.

And I am so very angry.

But not at her.

What does it say about a system that responds to social media pressure before it listens to its own physicians? And why would you ever pick a BMI of 25 and set it as the automatic weight loss goal for every single patient? What about the studies that show that people who are in “normal” BMI range do not live as long as those in the overweight range? That a decrease in life expectancy does not occur in obesity except for the extreme morbid obesity range?

Obesity isn’t killing people. Diabetes is. Cardiovascular disease is. We have put such a focus on weight that we have sabotaged the patients who are most vulnerable and as far as I am concerned we are killing them.

“I can’t lose weight so what’s the point of exercising and eating healthy?” 

I hear this every day.

Weight is not the point. It should not be the point. Healthy lifestyle is. But rather than use those things as the goals they made weight loss THE goal.

Fine.

Maybe I cannot change their mind. Maybe I cannot change yours. But do NOT force me to participate in a game that I do not want to play.

Next time I see that woman I am going to give her a great big hug and a high five.

A Supporting Role

Bridge in NYC

“She just won’t eat healthy stuff! If I give her a cupcake and some broccoli she always eats the cupcake.”

“Think back to when you were eleven. If you have a cupcake and some broccoli in front of you, what do you pick?”

He shrugged. “The cupcake.”

“Right? Me, too. We’re not idiots. We pick what tastes best to us. As kids that’s the sugar. So you cannot put them both in front of her and expect her to pick the broccoli. That’s just cruel. She’s eleven. YOU have to make that decision for her until she is able to make it on her own and that is not going to be for a great many years. Get the cupcakes and junk out of the house. She is beautiful no matter what size she is but you and mom both have diabetes so she is at higher risk herself. Be the parent. Don’t sabotage her. Help her learn healthy habits that will last the rest of her life.”

We had this conversation every summer for five years running. Each year the same thing, like it was her fault. But this time? This time, somehow, was different….

This time he listened.

What made the difference? I don’t know.

It gets discouraging, saying the same things over and over again. There are days when I open my mouth to say, “Stop smoking!” for the millionth time and wonder if there really is any point. You never know, though, when the seeds you sow will fall on fertile ground and take hold. 

Taking The Lumps

“You should probably wear a girdle with that,” my mother said, poking at my lumpy bits. 

I was maybe twelve or thirteen. I had no idea what a girdle was. 

She explained.

When I had put the dress on, a hand me down from some unknown person, I had felt beautiful. Now? Not so much. I hid in my room and took it off, never to wear it again.

My mother did not mean to be mean, I suspect. She had her own her serious body image issues, but it still stung something fierce and those words stuck with me for many, many years. 

Food in my house was torture. My father was obsessed with feeding us as cheaply as possible. For breakfast we ate slimy gruel every morning that he would concoct and which made me gag. My siblings and I would choke down bites, watching with extreme envy as my mother chowed down on a bowl of Cheerios.  To this day even oatmeal is hard for me to eat. He would bring home cans of salmon and forbade my mother to take the spine bones out. A salmon patty, which might have otherwise been tasty, was punctuated by chalky bits of vertebrae. I could go on, but I won’t. It was driven by a certain degree of poverty at one point but even as that improved, the food torture did not.

When I could get good food, edible food, I over ate. 

After my mother’s comment, I stopped eating much of anything, skipping meals whenever I could get away with it, even the things I liked to eat. As I saw it, I did not deserve to eat tasty things if I could not control my weight.

Thus began my issues with food and weight.

I have been blessed to have love in my life that does not see me for my weight, whatever it happens to be at the time, but that does not stop me from being hard on myself. For decades I have struggled with the fact that I have a curvy butt and fuller thighs. I still struggle but it is a losing battle. My body shape is in my genes. I cannot change that without plastic surgery. Even when I lose weight, even when I exercise like crazy, my butt and thighs are always “disproportionately” larger than the rest of me.

Who determines correct proportions?

You know what has helped the most? Finding jeans and pants that fit ME right. It seems so silly. It would appear obvious that women are not made the same. It was not until these past several years, though, that the clothing industry really began to embrace this fact. Thank God, because I feel less shame when my pants fit right. 

Go figure. 

Now, I am starting to like me better. I don’t feel like I have to punish myself by withholding food or exercising. I don’t have to squeeze myself into clothes that don’t fit. Exercising is fun. So is food. And the weight is fixing itself.

Is this going to be the end of my issues? 

Maybe not. 

But it is a very good start.

Wavelengths 

Tiffany stained glass window at Chicago Navy Pier

My microwave died and went to appliance heaven. 

Well. More like fell apart. 

The door plastic started cracking and then the tempered glass front exploded all over the kitchen one evening as I was about to heat up water for tea. Freaked the kids out. Personally, I thought it was super cool. Did you know tempered glass can still pop and explode even as the pieces are lying on the floor? 

It might seem like a simple thing to fix, right? Just order a new door. Except they no longer make this model of microwave. There is no door replacement. We will need to replace the whole dang unit.

However, this is not a microwave that sits on the countertop. Oh, no. It is mounted under a cabinet over the stove/oven and also serves as the stovetop ventilation unit. Apparently, it is also hard wired in, meaning there is no plug to unplug. Getting someone to take this out and install a new one when it is hardwired in is no small feat as it turns out. 

So, for a number of weeks I have been forced to go without a microwave. 

And you know what? It has not been the end of the world. 

In fact, I have found that I prefer heating things up in my toaster oven. Reheated bacon is crispier. Pizza is heated evenly. Corn dogs are yummier. Left over scones taste like the first day they were made. Tea? There is something nice about a whistling tea kettle as opposed to a microwave ding and I swear the tea actually tastes better steeped in water from my kettle. 

The other thing I have found? The couple of extra minutes it takes to use those other methods? They don’t really make a difference in my life. Schedules have not come crumbling down. We have not run late, we haven’t had to make cuts elsewhere. 

Never would I ever have believed I would ever say this: I can live just fine without a microwave. Not only can I live without a microwave, I now choose not to have one. 

That is incredibly liberating.

Makes me wonder what else I can live without…

Move Over Childhood…

Trestle bridge through a car window
It happened, folks. 

My son decided that he does not want to wear his PJ’s to go into the donut shop anymore.

“Mom, someone might see me.”

A lump immediately lodged in my throat and has not yet let go. My baby is growing up, entering that self conscious stage where his life will forever be filtered through perceived societal norms. 

Next, he’s going to stop believing in Santa. 

I am not ready for this…

*Please note, I was not driving when I shot that photo and yes, the windshield IS a bit dirty. 

The Deviled Inside

img_2933

What food do you love the most at Thanksgiving or Christmas, or any other holiday for that matter? What do you look forward to being on the table? 

I don’t really care for turkey or dressing. Or congealed cranberry “sauce” from a can. Green bean casserole? Ick. My personal favorite holiday food is deviled eggs. In fact, I ran an extra four miles this morning just so I could eat 4-5 eggs and not feel guilty about it. Oh, who am I kidding? I will probably try to eat six or more…. Of course, I have to sneak them. Most people judge you for openly putting that many deviled eggs on your plate.

For my international readers who may not know what deviled eggs are exactly, they are hard boiled eggs that are shelled and cut into halves. The yolks are popped out and mashed with mustard and mayonnaise, some salt and pepper, and then piped back into the egg halves. They are then topped with a dash of paprika and a slice of pimento stuffed green olive.

Mmmmmmm…..

There are countless variations out there. Some with bacon. Capers. Dijon. Schiracha. I haven’t met a single one I didn’t like. 

I first discovered deviled eggs when I was a kid. Thanksgiving at my grandmother’s house, to be more precise. She would boil up about three dozen eggs and assemble several platters of deviled eggs, one for the elder adult table, one for the lesser adult table, and one for each of the kids tables. Fortunately, the kids at my kids table hated deviled eggs. More for me….

Here’s the thing, though. The eggs are hard work. I would much rather make a key lime pie with a homemade graham cracker crust and fresh squeezed lime juice from dozens of those teeny, tiny limes without the help of a juicer or garlic press, my finders bloodied from trying to get a tablespoon of zest off of the awkward rinds, than make deviled eggs.* 

Why do I love something so much and yet hate to make it? Dunno, but there it is. Probably a good thing because honestly, I cannot control myself. Twice a year, if I am lucky, I can get my fill.

So, what are YOU eating today?

*I made a key lime pie once and I promise you it will not happen again!

Squashed

wooden bridge in a forest

One of the things that I love about fall is the food. Particularly, winter squash but more specifically butternut squash tossed in a bit of olive oil, dusted with sea salt and fresh ground black pepper, and roasted until the edges are golden….

Delicious.

Generally speaking, though, I am lazy when it comes to prepping winter squash so I don’t eat it often.

I was home with my kids yesterday since school was out so we went to the grocery store to stock up for the week. As it turns out they now have cubed butternut squash in containers ready for your cooking sheet. I jumped for joy right there in the produce section. Then I looked at the price. $4.95 for a container with approximately two cups of raw cubes. 

My breath caught. 

Dang. That’s pricey.

Still. I really wanted some roasted butternut squash. But for that much? I hesitated for a moment but still plunked a couple of containers in my cart. 

Then I made my way through the rest of the produce section. At the end of an aisle was the butternut squash. The whole squashes. For less than one of those containers. That would make what, 8-10 cups? The frugal angel that sits on my shoulder won out.

Alright, I decided. I have a sharp knife. I can make cheese. I bake my own bread. I make my own humus and pesto. I make and can my own jelly and so far no one has died from it, knock on wood. Why am I letting a tasty squash get to me? I can DO this! 

Well let me tell you… that was some work.

I spent almost two frickin’ hours peeling and dicing that thing. My hands are still cramping. The force required to cut through the flesh is such that if you slip up, it isn’t going to be a simple cut finger you end up with. Oh, no. It will be a full on amputation. 

What I want to know is why we can genetically engineer maroon carrots and clone sheep but we cannot make a more friendly butternut squash.

It was worth it, though…

Torpedo

 “I thought you were engaged?” I had caught sight of her bare finger.

“Yeah. Well. Not anymore.” She gave a noncommittal shrug. 

“Oh, no! I am so sorry.” I searched her face looking for clues as to whether this was a good thing or a bad thing. 

She smiled. 

I felt relieved.

“Honestly, I feel like I dodged a bullet, Doc.” She stared at me for a second gauging wether or not she should share the rest of the story, then shrugged again. “One day he tells me that he has sworn off carbs. No more bread, rice, pasta, potatoes. He gets mad if I cook anything with carbs.” She laughed. “I have always made bread. From scratch. Fresh homemade pesto for my pasta. Roasted herbed potatoes. I love carbs, for crying out loud! So I wait, thinking this is just a phase. Months pass. He makes comments about how much weight I will lose if I just give up those carbs.” She laughed again. “Then I realize, this isn’t about the carbs. It isn’t about him. It’s about me. He thinks I’m too fat!” 

“Ouch.” I could feel the sting of that realization. 

A torpedo to the heart. 

She nodded. “After I sat down and thought about it for a bit, I could not imagine giving up carbs. Not for him, anyway. I would rather be a bit more… voluptuous… and happy with my carbs, than skinny and starved for love with him.”

Amen.