I have endometrial cancer. My current gynecological oncologist told me if I didn't lose weight, she couldn't remain as my doctor because she had no way to do in-office pelvic exams. 6 months earlier, another provider did an in-office pipelle biopsy with hysteroscopy and PAP, no problems. When I asked my current provider "what gives?" she was forced to look at my health records and found out that the gyn onc I was seeing previously had used an appropriately sized speculum. I then asked my current doc why her office didn't have the same tools, and she said that she didn't need them with her other patients. I offered to purchase appropriate sized speculums for use when in her office, to which she just blanched and didn't reply.
The same thing happens with blood pressure cuffs. I have an appropriately sized blood pressure cuff and take my own blood pressure at least once a week. My doctor's office does not have a cuff large enough for my arm, so when they put it on me, they get readings that are off-the-chart, send me to an ER for immediate help "high." I now have to bring my own blood pressure cuff with me to doctor's appointments so I can hook it into their machines and demonstrate to them that I do not have high blood pressure, do not need to go to the ER, and do not need to be taking BP medicines. Every. Single. Time.
As a side note: I live in a very rural, remote part of New Mexico, which already has some of the worst health outcomes in the country. We literally have fewer than 10 gynecological oncologists in the state, and I am required to drive 2 hours each way for my appointments. It's not a simple matter of finding a new doctor for me as the one that I had that I liked and knew how to use appropriately sized speculums moved out-of-state.
I just wanted to say that I see you and I hate how much labor you need to do just for substandard care. I hope your treatment is successful and that you are able to have as much comfort and happiness in other aspects of your life as possible.
I just wanted to say how sorry I am that you are having to do so much to get healthcare. This should, of course, never happen and you deserve far, far better.
I am so sorry you're in that situation. I'm about to move to acres of isolated ranchland in an area I'm unfamiliar with, and this is my exact nightmare. I haven't had amazing health outcomes where I live now, or ideal doctors (I was forced through that same ER process over 'high' BP here!), but I know it's likely to get much worse next month. We deserve better, but you are not alone.
Congrats on your move. Rural life has other benefits such as lots of fresh air, access to nature, and (usually) a slower pace of life that can help with mental health. At least it has for me. If I had a chance to do my move from a larger metro area to remote New Mexico, I would have started compiling a list of local PCPs and calling to get on waitlists in advance of my move. Small-town docs are critical and are in increasingly short supply. I had to wait on a waitlist for over a year to get a local doctor, and I soon realized that the one person who was available was it, and that I needed to make peace with that. No HAES approaches, no comfy chairs, no large sized bp cuffs, but I see myself as an advocate for other rural people by trying to bring my PCP around to HAES principles. It requires a different kind of engagement and self-advocacy, and though it is frustrating, I try to think about myself as a local health activist.
This is a really helpful perspective, thank you for that. Without a firm move date yet, just knowledge of where I'll be, I hadn't started looking into the system there--but I will.
My first cynical reaction is, and yet when it comes to WLS and bariatric treatment suddenly the correctly sized equipment is available.
My more considered reaction is exasperation with the continued ethos of healthcare that fat people are merely placeholders for future thin people. In which case why bother providing accommodation, researching how drugs might effect fat patients differently or be ineffective for fat patients, how to have better surgical outcomes for fat patients, etc. It seems like every year there's hand-wringing about how there's more fat people than ever (hi, New York Times) and yet healthcare blatantly refuses to account for the existence of fat people in anything outside of weight loss.
I recently broke my tibia during a hurricane evacuation. My first bone break. I was picked up on the sidewalk where I fell after I broke my leg and the first responders did a good job getting me on the stretcher but the stretcher was so narrow, I was convinced I was going to fall off. I was in the hospital for the surgery and three days afterwards. They put me on a vacuum urine collector so I didn’t have to “struggle to use a bed pan”. I was then transported to a rehab facility for four weeks. When I arrived there, the bed was not made yet and I had to wait for them to put sheets on. I wondered what a hospital bed was doing sitting around unmade but then I found out. Prior to my arrival, the facility had sent out for equipment and rented it for my stay. They rented the over size bed, a very sturdy and wide bedside commode, an oversized rolling shower chair and a bariatric walker. I probably wouldn’t have known any of this, but the aide didn’t know how the bed worked and I asked well aren’t the same in all the rooms and that’s when I found out they rented the special equipment. I was thankful they took the time to examine my info for the transfer and take care of that without me having to ask. I had PT and OT both five days a week and was able to go home after four weeks. I know the access to properly sized equipment helped. I have learned this does not happen at all rehab facilities.
I have said many times, why am I to blame for my body size, maybe medical practices should adapt to everyone! Stop making me feel inadequate or flawed when it’s shameful that in 2024 there are still size limits on medical equipment and procedures. We are supposed to be so advanced in the medical field yet the are very few accommodations for people of ALL sizes.
A follow up on the radiology piece that I'd love an expert opinion on is what are certain technicians learning/being taught with how to use imaging equipment on fat patients vs others? As much as the snip you included in your article insinuates experience, I think there's more to it from personal experience.
I have PCOS and have been having both external and/or intervaginal ultrasounds since I was 13, every 1-2 years, sometimes multiple in a year bc issues lol. I've always been fat/ob*se, though getting larger over the decades (bc weight cycling 🙄 and medical issues). I still remember the first time, out of no where, my imaging results came back as "suboptimal due to body habitus"--burned in my memory bc it was by far the most medically coded labeling of my being fat. But also bc of the fact I'd had tons of ultrasounds before and after with no issues. One thing I noted was the imaging tech was utterly horrible, just kept pressing into my abdomen painfully, even called in a supervisor to help but did the exact same--the first time any techs hurt me while imaging. I was young and less of an advocate at that time, but it definitely made me think there's something not being taught about how to use the technology when larger/thicker amounts of tissue lay between the imager and the desired organ/s to be imaged. Not being a tech, I have no idea why most are successful with no pressure and these two techs were atrocious 🤷🏼♀️
I have endometrial cancer. My current gynecological oncologist told me if I didn't lose weight, she couldn't remain as my doctor because she had no way to do in-office pelvic exams. 6 months earlier, another provider did an in-office pipelle biopsy with hysteroscopy and PAP, no problems. When I asked my current provider "what gives?" she was forced to look at my health records and found out that the gyn onc I was seeing previously had used an appropriately sized speculum. I then asked my current doc why her office didn't have the same tools, and she said that she didn't need them with her other patients. I offered to purchase appropriate sized speculums for use when in her office, to which she just blanched and didn't reply.
The same thing happens with blood pressure cuffs. I have an appropriately sized blood pressure cuff and take my own blood pressure at least once a week. My doctor's office does not have a cuff large enough for my arm, so when they put it on me, they get readings that are off-the-chart, send me to an ER for immediate help "high." I now have to bring my own blood pressure cuff with me to doctor's appointments so I can hook it into their machines and demonstrate to them that I do not have high blood pressure, do not need to go to the ER, and do not need to be taking BP medicines. Every. Single. Time.
As a side note: I live in a very rural, remote part of New Mexico, which already has some of the worst health outcomes in the country. We literally have fewer than 10 gynecological oncologists in the state, and I am required to drive 2 hours each way for my appointments. It's not a simple matter of finding a new doctor for me as the one that I had that I liked and knew how to use appropriately sized speculums moved out-of-state.
I just wanted to say that I see you and I hate how much labor you need to do just for substandard care. I hope your treatment is successful and that you are able to have as much comfort and happiness in other aspects of your life as possible.
I just wanted to say how sorry I am that you are having to do so much to get healthcare. This should, of course, never happen and you deserve far, far better.
I am so sorry you're in that situation. I'm about to move to acres of isolated ranchland in an area I'm unfamiliar with, and this is my exact nightmare. I haven't had amazing health outcomes where I live now, or ideal doctors (I was forced through that same ER process over 'high' BP here!), but I know it's likely to get much worse next month. We deserve better, but you are not alone.
Congrats on your move. Rural life has other benefits such as lots of fresh air, access to nature, and (usually) a slower pace of life that can help with mental health. At least it has for me. If I had a chance to do my move from a larger metro area to remote New Mexico, I would have started compiling a list of local PCPs and calling to get on waitlists in advance of my move. Small-town docs are critical and are in increasingly short supply. I had to wait on a waitlist for over a year to get a local doctor, and I soon realized that the one person who was available was it, and that I needed to make peace with that. No HAES approaches, no comfy chairs, no large sized bp cuffs, but I see myself as an advocate for other rural people by trying to bring my PCP around to HAES principles. It requires a different kind of engagement and self-advocacy, and though it is frustrating, I try to think about myself as a local health activist.
This is a really helpful perspective, thank you for that. Without a firm move date yet, just knowledge of where I'll be, I hadn't started looking into the system there--but I will.
My first cynical reaction is, and yet when it comes to WLS and bariatric treatment suddenly the correctly sized equipment is available.
My more considered reaction is exasperation with the continued ethos of healthcare that fat people are merely placeholders for future thin people. In which case why bother providing accommodation, researching how drugs might effect fat patients differently or be ineffective for fat patients, how to have better surgical outcomes for fat patients, etc. It seems like every year there's hand-wringing about how there's more fat people than ever (hi, New York Times) and yet healthcare blatantly refuses to account for the existence of fat people in anything outside of weight loss.
I recently broke my tibia during a hurricane evacuation. My first bone break. I was picked up on the sidewalk where I fell after I broke my leg and the first responders did a good job getting me on the stretcher but the stretcher was so narrow, I was convinced I was going to fall off. I was in the hospital for the surgery and three days afterwards. They put me on a vacuum urine collector so I didn’t have to “struggle to use a bed pan”. I was then transported to a rehab facility for four weeks. When I arrived there, the bed was not made yet and I had to wait for them to put sheets on. I wondered what a hospital bed was doing sitting around unmade but then I found out. Prior to my arrival, the facility had sent out for equipment and rented it for my stay. They rented the over size bed, a very sturdy and wide bedside commode, an oversized rolling shower chair and a bariatric walker. I probably wouldn’t have known any of this, but the aide didn’t know how the bed worked and I asked well aren’t the same in all the rooms and that’s when I found out they rented the special equipment. I was thankful they took the time to examine my info for the transfer and take care of that without me having to ask. I had PT and OT both five days a week and was able to go home after four weeks. I know the access to properly sized equipment helped. I have learned this does not happen at all rehab facilities.
I have said many times, why am I to blame for my body size, maybe medical practices should adapt to everyone! Stop making me feel inadequate or flawed when it’s shameful that in 2024 there are still size limits on medical equipment and procedures. We are supposed to be so advanced in the medical field yet the are very few accommodations for people of ALL sizes.
Say AMEN!!! Maybe it's just the way I feel today but I read that with a lot of spice and I liked it!
Thank you for this! All so true.
I sure wish your newsletter was mandatory reading for all physicians in order to keep their certifications.
A follow up on the radiology piece that I'd love an expert opinion on is what are certain technicians learning/being taught with how to use imaging equipment on fat patients vs others? As much as the snip you included in your article insinuates experience, I think there's more to it from personal experience.
I have PCOS and have been having both external and/or intervaginal ultrasounds since I was 13, every 1-2 years, sometimes multiple in a year bc issues lol. I've always been fat/ob*se, though getting larger over the decades (bc weight cycling 🙄 and medical issues). I still remember the first time, out of no where, my imaging results came back as "suboptimal due to body habitus"--burned in my memory bc it was by far the most medically coded labeling of my being fat. But also bc of the fact I'd had tons of ultrasounds before and after with no issues. One thing I noted was the imaging tech was utterly horrible, just kept pressing into my abdomen painfully, even called in a supervisor to help but did the exact same--the first time any techs hurt me while imaging. I was young and less of an advocate at that time, but it definitely made me think there's something not being taught about how to use the technology when larger/thicker amounts of tissue lay between the imager and the desired organ/s to be imaged. Not being a tech, I have no idea why most are successful with no pressure and these two techs were atrocious 🤷🏼♀️
Like another commenter, I read this and thought 'amen to all of this'--and I'm not even religious. An excellent reminder for us all.