Monday, May 10, 2010

Endocrinologist & Adipex - Part 2

In  Part 1 I promised I'd finish up my thoughts in a Part 2 post. So here it is.  Here's what I'll discuss:

  • Dr. Diet Pills FIRED me before I could fire him. Damn it!  Apparently I need counseling for my emotional problems and I also need a medical team who can hold my hand since I'm not capable of doing this weight loss diet thing on my own.
  • My discussion with Nurse Linda -- she's an amazing woman and I trust her judgement. So glad she had sane things to say to me last night and confirm that I'm not an emotional wreck.
  • Who to see next?  New Endocrinologist or Hollistic expert to look at the big picture? No matter who I see, I want to get a full work up of labs including hormone levels and determine if I'm insulin resistant or not and whatever else needs to be looked at...
I'm MUCH less passionate about this topic now that I've had several days to cool off.  I feel more resigned, I guess. Anyway, here's the scoop:

THE DOC DISCUSSION -- Yep, I want into the appointment a week ago with the intention that if the doc didn't do anything "endocrinologist-y" that I wasn't going to see him anymore. The appointment started with seeing his PA.  She asked, so I gave her a quick overview of everything and why I was there and how the Adipex was working and what was going on with the glucophage. I told her I didn't want to take the drugs anymore and she asked what else I wanted done.  I laid it out to her --- said I'd expected that I would have been treated or tested or looked at in some special way like a "specialist" typically does. But instead of actually looking at my endocrine system, I was prescribed diet pills from the get-go. I asked why I was never tested for insulin resistance before I was put on a drug to control it -- she said that it wasn't typical to test insulin levels, that it's a "clinical diagnosis" not a lab test.  Which is fine, but the problem is that my clinical diagnosis came when I was 300lbs and before RNY.  And no matter how many times I said RNY eliminates insulin resistance, I was looked at as if I'd grown an extra head. Studies here and here and here and here.   So I asked of the PA - what else could be done to determine why my body wouldn't allow me to lose weight on my own, without diet pills.   That's when she said she'd go find the doctor.... and that's when I started crying... she couldn't retreat fast enough, of course. 

Doc comes in with the PA and immediately asked if I wanted to continue the pills. I told him no. He asked why. I told him I didn't want the crutch of the pills and that they didn't make sense to me and I didn't want to deal with the emotional side effects (which I didn't elaborate on).  He asked me if I wanted to continue the glucophage, I told him no and explained the dramatic increase in low blood sugar crashes. He immediately asked what simple carbs I ate. As before, I patiently explained that after RNY that reactive hypoglycemia is not always related to simple carbs and that for me personally, just like many RNY'ers, that a crash happens when a meal is not balanced with protein, carb and fat.  For instance I can crash after a protein shake if it's 100% protein.  He obviously doubted me, because that goes against what he thinks he knows.  He tried to express his doubt. Thankfully the PA seemed to understand (because she's listened?) that I was strict with my diet and that it was not a compliance issue -- she started to speak up and point to her notes on the conversation we'd just had... but wasn't allowed to talk since the doctor was blubbering about "not possible... blah blah blah."  

FIRED -- so the conversation turns to the fact that I don't want to continue with the diet pills or glucophage/metformin.  And I'd asked if he felt there were any tests that needed to be run to look at how my hormones or insulin levels were and how it might relate to my inability to lose weight.  He said no, there's nothing to check.  And went on to say something to this affect:

Since we've been seeing you, you've lost 10 pounds. But obviously you have higher expectations than what is possible in reality. You also obviously need counseling to help with your emotional problems and would probably do better with complying with a diet if you were part of a team.  You need a team approach for your diet and your exercise because you can't do it on your own.  I'll send a recommendation to your primary doctor that you need to see a different doctor - someone who is able to hold your hand more than I'm able to.  Someone who can follow you more closely and make sure you're complying with the diet and exercise portion of this plan. 

Dang it!  He fired me!  Before I could fire him.  I've never had a doctor fire me before... but geez, he was pretty mean about it, huh?  

Yep, I cried when I left his office.  And the first person I went to was my friend Nikki and immediately asked her: "Do I need therapy so I can lose weight?" ... she laughed because she thought I was making a joke.  Guess that's a big fat no, huh?  I also don't need a team approach to anything - although I'm part of the WLS community, I don't feel that I lean on my friends or the community for my success.  I also don't think I need any doctor to hold my hand to force me to be compliant with a diet and exercise plan.  

NURSE LINDA -- The evening of that doctor appointment was the support group meeting at my bariatric clinic and I attended.  I spoke with a nurse at the clinic, Linda, whom I have grown to think of as a friend. I told her about my experience and asked her advice. I was still in a hyper-emotional state at the time of our conversation, of course.  She knew the doctor by reputation and was shocked by what he'd recommended (from the diet pills all the way down to therapy and hand holding) because she'd never heard but amazing things about him from his diabetic patients. And maybe that's what my problem was, I'm not diabetic.  Thankfully she talked me down from most of my emotional angst and gave me some very sound advice. She's the one who suggested I seek the consultation of a holistic practitioner for a "full work up" and a "complete review of my overall medical situation". Which makes so much sense to me -- individual doctors seem to be looking at individual issues and not putting all the issues together into a "big picture" type of diagnosis.  She also was shocked that I'd been on diet pills for 3 months and couldn't believe that any doctor would recommend that for a RNY person. I think hearing her say that was a comfort to me -- maybe because I was having some of the same thoughts but assumed the medical community didn't think that way since it was his first recommendation, blah, blah.  Anyway. I love Linda and I"m thankful for the conversation we had. 

WHAT'S NEXT? -- I have a follow up appointment with my PCP scheduled for the first week in June. By then he'll have the notes and recommendations of Dr. Diet Pills and we'll discuss some of the changes we made back in December when I saw him last.  That same day I also see my GYN for a review of how my menstrual issues are going since stopping the Depo Provera in January. (Let's just say this:  "Aunt Flo is the devil!")  I'm not going to do anything until I talk to my PCP and we can discuss what should be done next.  I also talked to my brother today and asked about his endocrinologist and if he thought she'd be better than what I'd experienced... he said she's definitely not a "diet pill pusher" and that she's very thorough when it comes to testing and such.  She might be an option. But for now I'll wait.  

PART 3 -- dare I say there'll be a part 3 to this post?  Nah, not really a part 3, exactly.  But coming soon will be my thoughts about where I am right now.  How will I feel if I never losing another pound and this is where I'll be for the rest of my life?  Will I be satisfied?  What if I start to gain weight and have no ability to make it stop? How will I feel and what will I do? Will working out harder make the scale move, like my best friend seems to think it will?  So.... not exactly a part 3, but more like a pondering of how part 1 and 2 relate to where I am today and how I feel about it all. 


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