Comments from another doctor

On Monday, I went to the walk-in clinic.  My primary care provider was out of the office for several days, and I needed to be seen.  I saw a doctor whom I knew somewhat.  While my anorexia (in partial remission) diagnosis is listed in my list of current conditions, I have a lot of conditions, and she may not have read or remembered them all.

She looked over my electronic medical records to try to figure out why I was having trouble, and she commented on my recent dramatic weight changes.  I stayed calm and explained that I’d developed severe insulin resistance from a medication, and that it had taken us over a year to determine which medication was causing the problem.  I felt proud about how I handled it and thought that part of the conversation was over.  I normally would worry about my propensity to explain away and justify the weight gain, but since I was in a doctor’s office, I thought it was okay.

Then she said, “No, I’m talking about how you’ve recently lost X pounds.”  She tried to continue, and I’m not sure what else she was going to say.  I interrupted her and explained that I struggled with anorexia and I needed her to stop talking about my weight.

She seemed confused, though she did stop.  Maybe she thought that because I was in a larger body, hearing the weight loss amount would be good encouragement for me.  Perhaps she thought it would motivate me to continue.

In fairness, she never commented on it as a good thing (thank goodness!) or made a spoken value judgment about my weight at any point.  I might think I know what she was thinking, but I really can’t say that I do with any confidence.

My dietitian told me recently that I had lost enough weight that she felt like it wasn’t a random fluctuation.  I haven’t changed my diet significantly, so it seems that going off the medication has caused my body to start to tend toward a size I’m more accustomed to.  I’ve been warned by many people that I shouldn’t expect to get back to where I was, and I know that I probably won’t, but I’m hoping I’ll get somewhere where I feel more comfortable.

Finding out the number, though, was hard.  It was double what I had hoped I had lost, which was exciting for a few seconds.  But then I realized so many problems.

My body is still unacceptable.  I saw myself in the mirror the other night and had my little crisis two days after I was last weighed.  That awful sight came after X pounds of weight loss.  What must I have looked like before?

My surgeon told me the morning of my top surgery that for best results, I should lose about Y pounds before surgery rather than possibly losing some after.  I told her that was a terrible idea for someone struggling with anorexia, and that I wanted to proceed with the surgery anyway.

I’ve probably lost a bit since the surgery (not counting the slight artificial weight loss from the surgery itself), but still—that means the surgeon thought I was about X + Y pounds overweight.  (Sorry… my math professorness is showing.)  In other words, I would need to lose X + Y pounds from my max just to get to something acceptable to her.  I’ll need to lose even more to be at a “good” weight in her mind.  (Yes, I’m definitely projecting.  But I might not be wrong!)

Not only that, but my weight from last week was after a few days of nausea.  While I wasn’t dramatically undereating, it was probably suppressed by a couple pounds.  In other words, I haven’t really lost X pounds.  I tricked that doctor, even though I didn’t mean to.  I deceived her.

But now that that doctor, whom I probably won’t see again for a very long time, thinks I’ve lost X pounds, I can’t backtrack.  I can’t be weighed again until I know my number has gone down further.  Having a higher weight recorded would show that I’m not truly making progress.  That I don’t have the commitment and discipline I need to keep up this weight loss.

Disordered thoughts all around.  I brought many up with my dietitian already, and I plan to bring up more today.

I sent a note to my dietitian regarding my reluctance to be weighed today at my follow-up with my normal provider, as well as my reasons for that reluctance.  She asked that I be weighed anyway, for her reference.  Not only will I do that, but I’m going to try to eat lunch before I go in at noon.  I want her to have a real weight, even if it’s gone up.

I do plan to ask the nurse to not record my weight in my chart, however.  She’s been good about keeping it on paper for the most part, so other doctors don’t slip up like this doctor did.  Looks like we’ll have to be a little more vigilant about it, but I know she’ll help me and be on my side.

Update: I saw my primary care provider today. I managed to be weighed, and I didn’t even restrict food or liquids beforehand. I told my primary care provider what the other doctor had said, and she said she was glad that I advocated for myself and interrupted her.

Then I saw my dietitian, and she said that she doesn’t know where the other doctor got the X pound difference. It’s not true. I thought it couldn’t be true when I first heard it, but the doctor seemed so matter-of-fact about it that I assumed she was correct.

So now I really did trick that doctor, somehow. She thinks I’m doing “better” than I really am. I feel like I need to correct my body so that it does match what she thought she saw.

On the one hand, I do feel a little better about some things. My brain isn’t quite as off as I thought it was about perceiving myself. My weight hasn’t gone down as much as I thought it had, so it will be easier to keep future weights below it. I wasn’t X pounds heavier than what I am now.

But this is still really hard.