Thursday, June 03, 2010

"A Healthy Lifestyle which I myself is practicing"

I grew up in the Philippines and did my residency in internal medicine in New York. I enjoy learning from people, and that's why I became a doctor; every patient has his or her own story to tell.
About my practice
I feel that healthy living and preventive care are the best ways to stay healthy, but I'm also here to help you when you are sick. I want to be your partner in health, and it helps me better care for you when you are taking good care of yourself.
How I thrive
I go to the gym at least three times a week. I like to go to the spa to revitalize my body and spirit. Going shopping helps release all the tension from work. I also play the piano and read books to unwind when I have some spare time.

There is nothing that gets fat people like me more irritated than when skinny people moralize about diet, exercise and healthy living. I suppose you have to expect it from doctors--it's their job. But this doctor fucked up.

I went to get two big ugly lumps on my head, which I'm told were "sebacious cysts," checked out and, since I was going to see a doctor, to ask for quit-smoking pills that a colleague recommended. The doctor took a look at my head and referred me to a surgeon but said she couldn't give me the quit-smoking pills unless I went through Kaiser's Healthy Living anti-smoking program. She then asked me if I'd like a mammogram, a pap smear and earwax removal, all of which I declined and gave me a lecture about my weight, including some advice (which was actually very good) about my exercise program and put me onto a very nice iPhone app, GymABC.

I got into the Kaiser website and found the Healthy Living anti-smoking program. There was, it seemed, an online program and a corporeal version involving classes at Kaiser's Healthy Living facility--a program Kaiser maintains in a building near the Mira Mesa Landfill to accommodate health hobbiests. In order to deflect hypochondriacs and whiners from wasting the valuable time of doctors and nurses, Kaiser operates this program through which they can attend classes and support groups, poke around an extensive website, and work through pounds of glossy hardcopy materials that Kaiser sends through the mail.

I had been through the quit-smoking program several years ago, and had flunked. This program was not for the faint-hearted: it selected for truly desperate smokers who were prepared to pay for the program, sacrifice an evening every week to go to the facility near the city dump and be humiliated. We had to tell our Stories. One I remember was by a woman who'd been in a bad auto accident. Waking up after being unconscious for a day her first thought was, "Where are my cigarettes?" She managed to bribe someone to get her a pack and, bandaged up like a mummy, in a wheel chair with an IV in her arm, was able to wheel herself out to a fire escape where she could smoke. We all understood. On the meeting before Quit Day we had to write farewell notes to our cigarettes. The success rate for the program, we were told, was 51% and that was better than any other quit smoking program available. We believed it. And 49% of us, including me, failed.

I wanted those pills. So I sent through the website, ordered the glossy Materials and got to work. I took a test, like ones I'd taken innumerable times before to determine when and why I smoked. Did I smoke in the morning? Yes. After meals? Yes. When I was happy? Yes. When I was stressed out? Yes. Did I sometimes find I was smoking 2 or more cigarettes at the same time? Often. When I scored the test, the result was the same as always: I smoked for every conceivable reason at every possible opportunity.

I managed to work my way through the website to get the packets of Materials and, after a couple of weeks, managed to get through to a living human being to apply for the Pills. Had I gone gotten the packets and filled them out? Yes! I'd gotten two packets loaded with glossy materials and forms to fill out and had diligently done all the tests! Well, she would apply to my doctor and see if I could get a prescription for the quit-smoking pills. My quit day was set for April 13. I would start taking the pills in advance and then, on the Day stick on a 21 mg nicotine patch and go from there.

The quit-smoking pills, as it turned out, were flat-out magic. I took them for 2 weeks, quit on April 13, kept on for another week and then was done with the pills. I haven't smoked since. Un-fucking-believable!

Encouraged, I emailed the doctor for to ask for weight-loss pills but she wouldn't go for this. Here is our uncensored and unedited correspondance:


Sent: 4/28/10 9:31 AM

To: Harriet E Baber

Subject: diet pills

Miss Baber,
I do not advocate diet pills, I would like my patients to observe a healthy lifestyle, eat right and exercise which I myself is practicing. What you can do is count your calories and make sure you do not eat more than 2500 calories a day which is recommended to a normal person. I would like to know your exercise regimen so I can make recommendations to promote weight loss. 
Unfortunately, we do not have any blood tests so I can recommend a certain diet for you. A thyroid abnormality can also cause weight gain or difficulty losing weight, this is determined by blood tests as well. If you would like me to do blood tests to determine a specific cause of your weight problem or so I can recommend a diet, please email me back. Have a good day.

From: Harriet E Baber
Sent: 4/28/10 12:46 PM
I AM observing a healthy lifestyle, eating right (and not much) and exercising--currently 4-5 days a week--aerobic + assorted weights, 30 - 45 minutes. At your recommendation I've cranked up the weights considerably--which I like a lot. I'm now also doing 20 minutes pretty vigorously on the elliptical trainer at the gym and have also gotten back into running outside. I'm also not eating anywhere close to 2500 calories a day, but I cannot lose weight. I've been counting calories and dieting since I was 10 and it just doesn't work. If I get a blood test, can I get pills?

From: Harriet E Baber
Sent: 4/29/10 3:06 PM
Can I set up to get this blood test? I'm certain that I have an abnormality that makes it impossible to lose weight and I don't care what kind of pills I get as long as they make it possible for me to lose weight.


Sent: 5/13/10 6:14 PM

To: Harriet E Baber

Subject: thyroid test

Miss Baber,
Your thyroid tests indicate that you have hypothyroidism (low production of active thyroid hormone) which may be responsible for your weight gain, the additional blood test is also abnormal, at this point, I feel that you need a specialist. I have sent an Endocrine referral for further evaluation and management of your hypothyroidism, plase call the Kaiser operator 619-528-6050 and ask for the endocrine appt line so you can schedule an appt. Have a good day.

From: Harriet E Baber
Sent: 5/13/10 6:42 PM
Told-ya-so :-). Thanks!

From: Harriet E Baber
Sent: 5/14/10 11:34 AM
Miss Baber,
Aren't you glad I asked you to do those blood tests instead of going for the diet pills? Have a good day.

For the record, I asked you for some real medical intervention--for medication, not puritanical moralizing--and for that test. And that, BTW, is of record in this email correspondence.
I've been taking these thyroid pills for 2 weeks now. I haven't felt this good in 10 years and I'm losing weight without even trying.

I'm outraged by this Healthy Living puritanism. There are pills that make it easy to quit smoking, but Kaiser won't dispense them to smokers unless they're prepared to jump through the hoops. Smokers have to be punished. There are pills that make you feel great and lose weight, but Kaiser won't give you the test to see if you need them unless you demand it. I would bet that at least 80% of overweight people have a real medical problem, as I have, but Kaiser isn't going to buy that because the prevailing view is that overweight people are morally deficient--vegging out in front of the TV gorging on Doritos--and deserve to suffer.

Well, well, well the moral is clear: diet, exercise and healthy living are bullshit; pills work.