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This Week’s Weight Stigma Special: Prednisone with a side of Keflex

September 26, 2012

All this week we will be celebrating National Weight Stigma Awareness Week, as discussed by Dr. Deah earlier this month.

In the wee hours of the morning yesterday, I found myself in an urgent care center, that place you go to when you can’t take it anymore, but it’s not life-threatening enough to go to the ER. It’s also much less expensive than the ER, a plus for the uninsured or minimally-insured.

My complaint: A rapidly progressive allergic reaction involving hives and puffy eyelids, but no edema or difficulty breathing. Some of the hives were breaking open, oozing and bleeding.

Now this is nothing new to me. I have had eczema all my life, with my flare-ups running the gamut from mild to severe. This reaction had been going on for three days, but I didn’t know initially because it looks like a normal seasonal flare-up to me.

Boy was I wrong.

Long story short, I drove to the nearest clinic early in the morning to avoid a long wait, filled out my paperwork, and sat around for about five or ten minutes. When I told the woman who checked me how long I had the hives she immediately gasped and asked, “Any difficulty breathing?” I told her no and waited for the nurse.

M, the nurse, calls my name and chats me up while she’s taking my temperature, my blood pressure, and measuring my O2 volume. (All of them were normal, which meant no anaphylaxis or ER treatment. “Thanks be to God,” sayeth my wallet.)

We talked about my symptoms, my history, possible triggers, all the normal things that medical professionals discuss with their patients. Since I have a history of these flare-ups, she asked me what treatments I had received before and which ones I preferred. (Now THAT’S customer service!) Then she leaves to go get the nurse practitioner or doctor on staff to make an official diagnosis and get me my meds. All was well.

Then I noticed that something was missing.

I went to another room to be examined. It turns out the only person on staff at the time was the doctor. He took a look at me, asked me some questions, and told me what prescriptions he would write for me. (I ended up getting exactly the meds I was expecting.)

But something was still missing.

He leaves and I get seen by someone else who wants to collect demographic information on me and get me registered into the computer. (Single or married? Insurance? And so on.)

All right and good. But something was missing!

You know what it was? I was not weighed. I was not asked about diet or exercise, except to discuss what foods, if any, might have triggered my symptoms. (None. It ended up being a seasonal flare-up combined with an allergic reaction to a cosmetic I was using.)

No lectures.

No comments about my weight or my appearance (something I was worried about when I was examined, as I have a lot of hives on my trunk and thighs.)

No scoffing at my request for prednisone because it makes you fat, it makes you eat, or not want to exercise because of the side effects.

No joking about my using Doxepin to lose weight. (Doxepin is an old-school anti-depressant, and as you all know, lots of people think being fat causes depression and that curing the depression will make you Take Care of Yourself™.)

When they tested my blood pressure, it was actually slightly elevated, but not anywhere near the point where it would be a problem. And no, they didn’t blame this on my weight, either. They correctly assumed that I was under stress from my symptoms, anxiety, and lack of sleep. She says to me, “Well, it’s just a little high, but of course! You’re itchy! It’s annoying to be itchy!”

I asked, they examined, they served. No other, irrelevant questions asked.

The drugs I got were:

  • Keflex, an anti-biotic (eczema patients with open sores are at high risk of secondary infections, especially staph)
  • Doxepin, which is used off-label to suppress itching,

And the most Holy of Holies for treating inflammation, as well as one most maligned by our fat-hating culture…

Prednisone.

Yes, long-term corticosteroid use has nasty side effects and I certainly wouldn’t recommend it unless you truly needed it. But if you need it short-term to end your misery and get your condition under control, then use it!

The best part? The meds altogether were cheap to begin with, and even cheaper when the pharmacist gave me the generic versions. Altogether, the meds were 13 bucks.

I know this place has a stellar reputation, and that I was fortunate to have good people working for me. That explains much of the curious lack of bias in treatment, but I can’t also help but feel there were other factors. Although I am “obese,” I appear to be average-sized. I dressed nicely for the appointment (but still comfortably, as I was not aggravating those hives any further.)

I guess my medical condition had something to do with it, too. I was so obviously inflamed and allergic. There was no denying that I had an actual problem or explaining it away as being a side effect of being fat. Even if that medical team was full of raging fat-haters, they’re smart ones. (And I truly don’t think they are fat-haters. They probably have some biases against fat, like most people in our culture, but I am opting for faith in humanity here and guessing that they really respect their patients.)

There should be no need to have a medical condition like mine and get lectured for your weight. There is no need to fear an exam because of your weight. There is no need to be denied much-needed treatment, like prednisone, because of your weight. There is no need, nor any excuse.

The oft-repeated lie that obesity causes illness and death is Exhibit 1 of the correlation vs. causation error. Yes, obesity is often found, in studies, to correlate with poor health outcomes, but they rarely, if ever, control for social stigma (probably because they don’t think it exists). When fat people are afraid to seek treatment, are abused for seeking it, or denied it, then no one should be surprised that they have poorer health outcomes. When fat people are assessed using medical equipment that is inappropriate for them, no one should be surprised at flaws in diagnosis and hence treatment. (Blood pressure cuffs are a prime example of how to get the wrong answer and blame the patient for it.)

So here’s to an end to life-hindering and life-ending stigma, and here’s to the York Hospital System of Maine. We love you!

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5 Comments leave one →
  1. Kala permalink
    September 26, 2012 12:41 pm

    Your hives burst open? God, that sounds awful. I get random hive attacks that can get pretty bad, hives on top of hives, but I’ve never had one open on me.

    • September 27, 2012 11:26 am

      Oh, yes, they did! Hope it never happens to you, but if it does, I definitely recommend the Keflex (unless you’re allergic to Penicillin, of course.)

      That’s another pet peeve of mine-most antibiotics seems to be allergenic to people that can’t have penicillin. Damn it to hell!

  2. Jennifer permalink
    September 26, 2012 1:28 pm

    Yay! It feels weird to me when I get out of a place without body shaming. It’s rare!

    I’ve had a skin condition for 25 years and no doctors would diagnose it, instead focusing on my fatness, saying that’s the real problem, not my aesthetics. It turns out I have celiac disease with dermatitis herpetiformis, and that presented as eczema, blisters, hives, and acne-like spots, and we’re all slow healing (cuz of my fatness of course). I’m sure if I’d been a thin patient, a doctor would have cared sooner (as it is, I had to figure out the gluten connection myself) because what a tragedy it is for a socially acceptable body to have such a visible disfigurement. I’m already disfigured with my fatness so who cares?

    I’m glad you got ACTUAL care and I hope those delightfully affordable drugs help soon!!

  3. September 26, 2012 7:14 pm

    I love the no nonsense nurses and doctors. They get the info that truly matters, and treat accordingly. These people have no time for bull, they don’t care what you look like, they get the job done. God Bless them for it too.

  4. October 9, 2012 11:10 am

    It’s so sad that a routine doctor’s visit should be seen as a victory, but it’s a victory nonetheless. 🙂

    Peace,
    Shannon

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