Monday, January 28, 2013

Big Boy Bop

Big Boy Bop, oil on canvas, 1985, by diner painter extraordinaire John Baeder

Every once in a while I read something that just makes me want to go off on a bit of a rant, and today was one of those days.  The article in question is a weekend opinion piece in The Washington Post, "How 'Size Profiling' Harms Overweight Patients," by a UCLA professor called Abigail Saguy.  It talks about how doctors can overlook symptoms, misdiagnose them, or without reason attribute them to a patient's weight, if the patient in question is overweight.

Now, I have mentioned more than once hereabouts that I am in fact a stout party, and moreover one increasingly of what is referred to diplomatically as A Certain Age.  As some of you may remember, as a last kicker to what was otherwise a marvelous vacation last summer, I had a small health scare.  I'm not one to concentrate unduly on unpleasant things, so I haven't written much about the experience, or its aftermath.  In light of what happened, however, I can absolutely attest that when it comes to American healthcare, the phenomenon that Saguy describes is very much an Actual Thing.

Here's the deal:  I'm large; not grotesquely so, but definitely rounder than I was a decade ago.  Living in the unforgiving climate of the Sandlands means you spend too much time inside; its culture (such as it is) means that you spend too much time eating and drinking.  Add in a job that is both sedentary and time-devouring, and you are liable to end up fat.  Once upon a time I lived in cities where you walk miles a day as a part of everyday life, and on weekends you go dancing and playing tennis and all sorts of comparatively healthy pursuits. Here you drive everywhere, you toddle around malls, and you sit and eat and sit and drink and sit. Someday, I hope to live in a real city-city again.  Until then, while we're making efforts, it's not likely that Mr. Muscato and I will be seeing anything like lithe, svelte, or slender any time soon.

Moreover, I come from a very spherical gene pool - but one that is almost unnaturally vigorous and longevitous (is that a word? It ought to be: long-lived).  My paternal grandparents glowed with the kind of rotundity bestowed by a full-cream dairy diet, good country produce, and plenty of lovely lard-laced homemade baked goods, and both were in generally excellent health throughout their long (89 and 96) lives. Mother's side may have been slightly less extravagant, but was nonetheless sturdy and almost uniformly reached great age.  Our family photos all have a vaguely Botero air, and its rare to see a group picture that isn't posed around a table or with a groaning picnic in the middle distance.  We live well, and on the whole we live long.

But anyway, back to health care, and why remembering last summer made me so mad this morning.  When I got sick last August, it was with absolutely classic signs of heart trouble: shortness of breath, chest pain, and even shooting pain down the left arm.  When it got bad enough, a week or so after the first signs (denial runs strong in my people), we went to the emergency room, where the care was superb.  You want to see people in a metropolitan emergency room move, just try walking in as a middle-aged man, panting and sweaty, and tell the nice lady at the desk that you think you might be having a heart attack.  They were fast, and thorough, and within a couple of hours it was determined I wasn't in fact in immediate danger of anything they could find.  I was referred onward to a specialist, and that's when things, in retrospect, went awry.

Part of it may just have been that when you're a cardiologist, everything looks like heart, but for the next week or more, the doctor - who was well-meaning, I have to grant - put me through every conceivable test at her disposal to determine the state of my heart.  I was scanned and stress-tested and radioactive-dyed and God knows what, and every test result showed exactly what the first emergency room ones had: that I have an extremely healthy heart.

As a result, I was at long last sent on my way, with the last (and and longest) of the lectures that had started with my first appointment, about my weight.  From the moment I walked in, I suspect I was something of a frustration to the doctor.  The tests kept showing I was okay, but intermittently the symptoms continued.  She took family history and visibly wilted as I walked through the list, going back three generations, of fat and happy Muscati.  She brightened only when I mentioned my maternal grandfather, dead, sadly, at 46.  "Heart disease!" she exclaimed.  "No," I said - and I really almost felt sorry for her - "hit by a trolley." (a too early passing, and an ironic one - he was at the time commissioner of streets).

Only briefly fazed by her inability to establish a genetically-determined doom for me, she sent me on my way (which was, remember, halfway round the world) only with a recommendation that I lose weight.  Because my blood pressure was slightly high, I got blood-pressure medication; because my cholesterol was also borderline, cholesterol-lowering tablets.  Although she was deeply interested in signs of early morbidity in my family history, the fact that high cholesterol runs through it as well (with no apparent impact on lifespan - Grandmother Muscato's was something like 425) seemed much less interest.  She warned me I might be on meds of various sorts the rest of my life.

Throughout, I had tried to raise other possibilities with her and her colleagues - that the shortness of breath really seemed to be the problem, that it really only came on after meals, that just the day before the worst of my attacks I had walked five miles with no problem - to no avail.

I returned to the Sandlands thinking that since the heart was fine, perhaps the lungs were the issue (one other forebear who shuffled off the mortal coil relatively early did so as a result of consumption, so things pulmonary were always an issue at home).  I found a good pulmonologist here, and the difference in how he approached the situation couldn't have been greater.  He reviewed the cardio records from a couple of months earlier, heard me out about the shortness of breath and the sometimes conconmitant pain (mostly low-grade, sometimes less so), and did a basic lung-function test.  Along with a teenager's heart, it turns out, I have a pair of lungs to match.

"Yes," he said, "you should exercise more, and if you do that you'll probably lose weight.  But you've got a great family history, and I'm surprised that they would go through all those tests based on the symptoms you present and not recommend that you try an antacid.  If this is mostly coming on after you eat, it's probably more or less heartburn."

So now, after literally tens of thousands of dollars in medical care (blessings on Golden Handcuffs' gilded insurance plans), a two-week delay in getting home last summer, and all the joy of fearing that my heart was on the verge of giving right there on the spot, I've started occasionally taking what is more or less a designer-pharmaceutical version of Tums.  And nothing else.  My blood pressure was a tad high?  If you'd been in the middle of a rolling heart-attack scare for a week, so would yours.  Now it's fine.  Cholesterol?  I checked the numbers myself, and mine is high only on the most current, draconian charts; ten years ago it would have been solidly normal.

What the doctor and her colleagues in Washington saw, I'm convinced, was a fat guy, and not much more.  "Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment," writes Saguy, "medical providers often blame patients for their weight and blame their weight for any health problems they have."  What gets lost is the simple fact that just as not every thin person is healthy, not every person who is less so is cruising toward an early grave.  If I hadn't seen that second doctor, I'd still be downing those expensive meds and coping with their unpleasant side effects, which ranged from headache to sleep interruption to constipation (pleasant!).  I'm glad I'm not.

Meanwhile, to end on a lighter note - isn't that painting of the Big Boys just terrific?  The artist, John Baeder, has a passion for American vernacular architecture in general and for diners and diner-abilia in general, and I think his work is enormous fun.  Maybe I should get one to go with the Boteros...


  1. Is it your gall bladder? Seriously. Have them check your gall bladder.

  2. You hit the nail right on the head with this one, sweetie! Medics as a whole (whether insurance-led as in the US, or national as here in the NHS) appear to have devloped a paranoid agenda driven by years of political manoueverings. You're gay? Can't give blood because you're all diseased. Fat? Can't adopt, can't be who you are 'cause you offend the rest of us and cost us money with your supposed heart attacks. Smoker? You have no right to exist at all, and are confined to a list of "desirables" next to "Iranian" or "Gary Glitter". Bollocks to all of them, I say. Live your life - and thank heavens for a sensible Sandlands opinion (for a change). Jx

  3. How very maddening. Also, odd. All of our doctors appear to be firmly in the pocket of the evil Prevacid mafia; it seems to come up in every examination by any specialist.

  4. I'm a thin guy who had a likely indigestion driven episode about 7 yrs ago. Emergency room. No heart attack, but "we want to keep you in for a stress test". It was Friday night. They kept me until the test on Monday morning. After I passed that with flying colors, they wanted to do a nuclear stress test, and then a few other tests. And then a TEE - the very worst - like drowning on dry land. And then cardiac catheterization. Electrodes everywhere. I had so many shaved spots on my hairy chest that I looked like a family of moths had spent a few months feeding. 6 days and tens of thousands of dollars later, everything looks fine and we're not sure what it was. But come back in a week for a Holter Monitor for a 48 hr EKG. And then come back to the cardiologist every 3 months where we will take your vitals, tell you all looks good, and come back in 3 months. I quit after my second return to the cardio guy. Oh, and some meds, and take a baby aspirin everyday for eternity. Throughout, I mentioned a stressful period (mgmt change at work, moving, friend having a breakdown) and drinking an after dinner beer too quickly...indigestion. No one listened. Now, when I try to get life insurance, I have this big heart episode that wasn't all over my records that puts my rate through the roof.

    Seven years later, I shovel snow, move furniture, unload trucks, etc just like always. And I still get suspicious looks at the annual physical though I am the picture of health.

    Like you, Muscato, the paternal Curtis/Egel and maternal Walsh/Woods stock is generally long lived. The only thing that gets anyone early is cancer, and I already beat my go round about 13 yrs ago.

    My take on American medicine is its all applesauce. If I find the rare reasonable, sensible, hands off doctor, I stick with him. At this point, I get the bet medical advice from my buddy the vet.

  5. All the doctors in the USA are in the back pocket of pharmaceutical companies. They want everyone to be on some medication for the rest of their lives and once they get you into the system, it's pretty much just that. You have to take this one to combat that one etc. and the highly engineered genetically modified food manufacturers are in cahoots with the medical industries. It's a vicious circle.

    BTW my relatively healthy slightly overweight 50 year old brother had a heart attack several days ago while exercising. Two more heart attacks in the ambulance followed by defibrillation and he was diagnosed with 100 % blockage on both sides. He's recovering after stents but now he will be on medications for the rest of his life. He blames Sonic not Big Boy.