Found And Lost, Part 2

 (B4 - Jerry Goldsmith)

I used to hate doctors.

I spent the first five years of my life in and out of hospitals, operating theaters, and doctors' offices.  Doctors hurt me. They poked my eyes, prodded them, cut on them, flooded them with light, filled them with chemicals. Ran tests on them.

They hurt me.

There was a reason, of course.  My parents were doing everything in their power to give their child a better life.  That didn't really register to me until I was in my '30s.  I still hated doctors. Sitting here thinking about it still makes my hands shake.  40 years later, and it still hurts.  The light still hurts.  The chemicals still hurt.  The tests still hurt.

I understand why it's necessary.  And it is very necessary.  And I am very grateful.

And I still hated doctors.

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My dislike of medical professionals migrated away from the fears of a child into the mistrust of an adult.  Sir Francis Bacon suggested that knowledge is power, and he wasn't wrong.

Yes, I know that the phrase originates in the Latin, but there's no real strong source for who said it first, and most people attribute it to a man whose last name is 'Bacon' so that's absolutely who I cited.

What?

Doctors have a lot of knowledge.  They go to school, they have fellowships, they have internships, they practice, they study, and then they practice some more.  They have a lot of knowledge.  Which means they have a lot of power.

Then they get a white coat, and depending on who your doctor is, shit can get real.

A good doctor is invaluable.  They go way beyond a resource and become a friend. A treasure.  Someone you can trust.  This being the real world, there is a proven corollary that suggests that finding a 'good' doctor is a gigantic pain in the ass.  What constitutes a 'good' doctor goes way beyond medical knowledge itself and into the realm of how that knowledge is applied.  A good doctor knows YOU.  They understand you, how you want to be treated, and works with you to find the most effective treatment that also respects your personal preferences.

A good doctor is INVALUABLE. 

A bad doctor is...yeah.

It took me nearly 40 years to find a good doctor.  Then said good doctor told me she was referring me to not one, not two, but THREE other doctors.

Great.

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The Bariatric Center of Kansas City is nestled within a medical complex about 25 minutes from my residence.  It's the kind of medical 'Mall' that I try to avoid like the plague.

I was adamant with my PCP that I wasn't interested in bariatric surgery.  I wasn't losing weight, and we had no idea why that was.  Having someone fillet me in spite of that seemed foolish.  "I agree with you.  I'm not suggesting you have surgery.  The specialists at BCKC have deep knowledge about weight loss and management.  If someone can give you next steps, it's them."

My doctor hadn't steered me wrong thus far.  If I was ever going to trust her, it would be now.

By the time my initial bloodwork and food diary shenanigans were over, we were into May of 2019.  The weather had started getting warmer when I waddled up to the third floor of what was an admittedly well-appointed medical building and went inside.

It wouldn't have been a visit to a doctor's office without intake paperwork. The person that invents a way around that without running afoul of HIPPA or any other privacy laws will make a mint.  

Eventually, the paperwork was done, and then the Marleys rose up from behind the receptionist's desk, their chains rattling, and declared, "You will see three doctors this night!  A bariatric physician, a bariatric dietician, and a bariatric psychologist!"  Then they laughed at me and sank back into the ground.

What?  It's -the- best version of that story that's ever been told.

The receptionist at BCKC was a ball of sunshine on a fall afternoon.  She was soothing and warm, and knew your name, and was one of the most unthreatening, accommodating people I've ever met.  Because I have issues, I was immediately suspicious of her.  My issues did not phase her one bit.  In a brief amount of time, I was greeted by a nurse who took me back for the visit before the visit.  I stood on a scale, which dutifully reported that I was still fat -- excuse me, morbidly obese -- and then we went back into an equally well-appointed exam room.

There were several chairs in that exam room that were designed for Keepers Of The Big like myself.  They were wide, well-cushioned, and very comfortable.  Because I have issues, I was immediately suspicious of them as well.

The chairs didn't care either.  The nerve.

The nurse made polite conversation with me while she took my temperature, and continued to do so while slipping a Blood O2 monitor on my index finger and wrapping a blood pressure cuff around my arm.

Then, because it's me, and I cannot have a normal doctor's visit, the weirdness started.

"No offense, but you have...really good blood pressure."
"Yeah, I get that a lot.  Runs in the family.  My mom likes to pass out in Wal-Marts to get attention.  We keep telling her there are better ways to go about that.  She keeps doing it anyway."

The nurse had the decency to laugh.  Then she stepped out of the room, and a very short while later, the doctor came in.  Because I have issues, I was immediately suspicious of this as well.  Doctors never just...come in right after the nurse leaves.  That does not happen.

I closely scrutinized her face to be sure she did not have a pig's nose and was not in black and white.  She did not, and was not.

"I know this is going to frustrate you, but I need you to start at the beginning and tell me why you're here."

Well, she wasn't wrong.  So I did.  I started at the beginning, relatively speaking.  And because I started at the beginning, we talked about my current weight, my food diary, my bloodwork, and my CPAP.

"Wait, you use a CPAP?"

Shit.

"Yes.  I have sleep apnea.  Badly.  And no, before you ask, it's not structural, it's centralized."
"So...you're not losing weight, you have strange bloodwork, you have the requisite calorie deficit that should have triggered weight loss, and you have an extremely rare form of sleep apnea as a result of your brain not sending strong enough signals to your respiratory system to keep you breathing once you fall asleep."
"...I'm very fun at parties."
"Oooookay."

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I can see the comments already. "That's the kind of information you should have shared with your PCP!"  Relax.  I did.  That only made the situation worse.

Turns out, when you have -really- bad sleep apnea and you don't treat it for well over a decade, it can have adverse side effects on things like your brain chemistry, your hormones, your emotions, your appetite, your metabolism, your digestion, your bowel and bladder habits, your eyesight, and...well, everything.  Including your ability to lose weight.

Because air is important, apparently. 

I know, right?

Turns out, when you're oxygen-deprived for a really long period of time, stuff breaks.  I was very broken.  I've got paperwork from a sleep specialist, a cardiologist, and a neurologist to prove it.  Plus, I've got a buddy who's a respiratory technician that tells me I'm damaged on a regular basis, so...you know, the news wasn't exactly a shock.

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My bariatric physician took the news about the whole 'sleep apnea' thing really well, all things considered.

"Please tell me you're using your CPAP every night now."
"Absolutely.  Being able to breathe is actually pretty cool, so I figured I'd keep it up, see where it took me."

Then she took a deep breath, and in keeping with all of the other medical appointments I'd had about this subject, said, "So, I know this isn't what you want to hear, but you're an edge case.  A big one, figuratively speaking."
"Why is that?"
"You need to understand that most people who have been your size for as long as you have been don't end up in this office by choice.  They end up here because something has gone wrong.  Usually something has gone very wrong.  You're extremely fortunate in that you're here because you want to be.  The mystery of your weight loss aside, you're...fine.  You should be diabetic, at least pre-diabetic.  You're not.  You should have cholesterol problems.  You don't.  You should have joint pains.  You don't.  Your heart should be in bad shape because of your weight and your apnea.  It's not.  You. Do. Not. Make. Sense."
"God, please don't say that in front of my wife."

She had the good grace to laugh at that.  Everyone at this office was laughing at my jokes.  Because I have issues, I was suspicious. 

"So, good news, bad news.  Which one do you want first?"
"Good news, I guess?"
"The good news is that nothing's wrong with you, generally speaking.  You have the luxury of choosing to do something about this situation before you are forced to.  You have no idea how lucky you are."
"I agree with you, generally speaking.  The bad news?"
"The bad news is, as I said, you're an edge case.  There is no book for you.  There is no protocol."
"So does that mean we're at the end of the line here?"
"Not at all, no.  It just means that we're going to have to make some educated guesses and see what happens.  That's why they call it 'practicing medicine'.  We don't always have the answers."

Somehow, that simple statement made me like her a great deal.

"This is the part where you tell me I'm going to have to go on a diet, right?  Start going to the gym?"
"Not even close. If you're telling me the truth with your food log, you don't need to go on a diet, per se. And until we know why you're not losing weight, I'm certainly not going to suggest you work out.  What happens now is you get to go see our dietician.  She's going to have a discussion with you about nutritional macros: fat, carbs, and protein."
"Let me guess: Less meat, less fat, more veggies, and no carbs.  Sounds an awful lot like Keto."
"I don't ever suggest that any of my patients cut carbs out of their lives."
"Because it's not sustainable long-term?"
"...No, because it sucks.  Carbs are delicious.  If we do this right, you won't have to moderate your carb intake drastically at all."

Wait, WHAT?

I must have made a face, because she promptly laughed again, stood up, and said, "Come on.  Let's go meet your dietician.  If you liked that,  you're gonna love this next part."