This fat lady ain't singin

February 3, 2010 8:53 PM

Not my doctor filter: Help me come up with questions/ask for tests from my doctor.

Ok, I'm a fat lady who could technically probably be considered middle aged. I am tired of being a fat lady. (There's not much I can do about being middle aged, given that the other option would have been to die young.) So, since November, I have been going to the gym 5 times a week. I treadmill/elliptical/bike for 30-45 minutes, getting my heart rate into the 135-150 range and keeping it there for the majority of the cardio workout. I also do a round of the weight machines, low weights - high reps. (average 40 pounds, 100 reps in sets of 20). As well, I work in a couple of belly dance sessions or yoga each week.

I hired a nutritionist to help me review and tweak my diet to an average of 1200-1500 calories a day. I eat almost no white foods, I don't drink alcohol, I don't drink sodas or fruit juices, although I do drink coffee and tea with sugar and fat free half and half, but that was built into my calorie "budget". I use fitday software to track calories in vs calories out, and according to it, I'm burning way more calories than I'm consuming.

I hired a trainer to review my workout, and according to her; unless I was going home and eating an entire cake every day, there is no logical reason why I'm not losing weight.

But I haven't lost any weight. In fact, I've gained weight. I've not lost size either. I've gained inches in my calves and waist, and lost about an inch around my biceps. (which is nice, I don't have that scary bingo wave thing going anymore.)

There has to be something physically gone haywire here. Other symptoms:

• I am probably perimenopausal.
• Since I started working out, I seem to have lost my voice; it's become very low and hoarse sounding.
• My dentist mentioned that I have an extraordinary amount of bone loss in my jaw and that I should have my bone density checked; he seemed to think I would lose teeth in the next couple of years because the loss was so dramatic.
• I'm developing a beard. Well, I would be if I weren't using an epilator/tweezers on my chin every day.
• I'm ridiculously forgetful now. Seriously, I have whiteboards everywhere just to remind me what I'm supposed to be doing at any given point in time.

My doctor, whom I adore, has been my doctor for a very long time, but he seems to reach for the anti-depression prescription pad as standard operating procedure - which is not something I want or need. That said; I thought I should probably start with him, but perhaps what I really need is an endocrinologist?

I know we've been trained to not ask for tests, assuming that doctors know things that we don't - and they do, but doctors are also overworked and carrying a heavy patient load. I've become increasingly scatterbrained, and I find that I need to write things down and check things off my list, or I won't remember them while I'm there.

Help me define what I should ask my doctor to check.

posted by SecretAgentSockpuppet to health & fitness (24 answers total)

I wouldn't worry about the weight loss / fitness issues - the other symptoms you mention sound a lot more serious. If your doctor is a pill-pusher who sucks at diagnosis, try to get a referral to a specialist - as you mention an endocrinologist seems like a good fit.
posted by benzenedream at 9:08 PM on February 3, 2010

I don't know what you should ask your doctor to check, but based on the "I haven't lost any weight" statement and the "whyamistillfat" tag:

You're doing a lot of exercise and you're not eating much food. You're almost certainly losing fat and gaining muscle. This could easily result in your weight remaining constant, or even increasing, while you're getting healthier. I wouldn't necessarily worry that you haven't lost weight yet, and the fact that you haven't lost weight yet does not imply that your diet and exercise regimen is not working.
posted by Flunkie at 9:12 PM on February 3, 2010

I think all the talk of "you're just replacing fat with muscle" talk doesn't explain anything. You should be losing weight according to everything you said here. Sure, some of your fat is becoming muscle but after three months, I'd expect to see the scale down a bit, at least. I would definitely get your hormone levels checked. Your doctor can do this but it does sound like an endocrinologist may be in order.
posted by otherwordlyglow at 9:18 PM on February 3, 2010

Except for the comments about your doctor, what you should do is tell him exactly what you have told us and ask for his medical opinion. If you don't like what you hear, ask him to arrange for a second opinion or a specialist consult. He is used to this and will not be offended. If he is offended, time to move on anyway.
posted by Old Geezer at 9:19 PM on February 3, 2010 [1 favorite]

Help me come up with questions/ask for tests from my doctor.

Thyroid, thyroid, thyroid. A big-ass thyroid panel would be where I would start. Get all your numbers and the lab's range.
posted by DarlingBri at 9:22 PM on February 3, 2010 [3 favorites]

It hasn't necessarily been three months. It's the very beginning of February; if "November" meant "the end of November", then it's only been about two months.

If she's doing that much exercise and taking in that few calories, and doing so consistently, she's pretty much got to be losing fat. It's just physics.

I'm not saying not to worry about all the other stuff. I'm not even saying necessarily not to worry about the lack of weight loss. I'm just saying that the lack of weight loss in and of itself is not necessarily indicative of a problem.
posted by Flunkie at 9:24 PM on February 3, 2010

I highly suggest you see an endocrinologist for a Glucose Tolerance Test (or whatever the current equivalent is) to check for Insulin Resistance.

Symptoms that match IR:
Storing weight around your middle
Mysterious inability to lose weight
Hair on face (possible connected to PCOS)
Menstrual issues (possible connected to PCOS)
Deepening of voice (possibly connected to PCOS)

While IR and PCOS are often connected, they are not always, so you may have one without the other. IR can lead to diabetes.

IANAD.
posted by sallybrown at 9:33 PM on February 3, 2010 [2 favorites]

IANAD but... You should either find another doctor or DEMAND a whole slate of lab tests including: blood glucose, cholesterol, thyroid, bone density, CBC (complete blood count), BMP (basic metabolic panel), Vitamin D test...basically test everything both to find out what's happening to you and for a baseline since it doesn't sound like you have had any of these tests recently.
posted by MsKim at 9:48 PM on February 3, 2010

Flunkie: "It hasn't necessarily been three months. It's the very beginning of February; if "November" meant "the end of November", then it's only been about two months."

Nope started on the first day of November. Motivated by the sheer volume of candy in my house. Heh. That day, before I went and got a membership at our local community gym, I weighed myself, and then did tailor's measurements on chest, ribcage, natural waist, abdomen (pregnancy pooch that never went away) hips, thighs, calves, biceps.

Subsequently, at the first of each month, I remeasured. Then just a few days ago I had myself professionally measured for a bespoke outfit, and their measurements were very close to mine, so I feel pretty accurate.

Before my c-section a few years ago, I had a lovely hourglass shape. Now, I look constantly 5 months pregnant. This just shouldn't be, given 15 hours a week of working out I've been doing.
posted by SecretAgentSockpuppet at 10:22 PM on February 3, 2010

Are you me in 2009? Because you are living my old life.

Get a full thyroid panel - all of it, not just TSH. You may need both total and free levels to get to the bottom of this. My original doctor basically said, "You're in the normal thyroid range. You're just getting fat like most women your age." He conveniently ignored the fact that I'm a marathon runner and follow a nutrition plan. He suggested that I start parking further away and walking more. Because running a marathon isn't burning enough calories, but that walk across the parking lot will do it. He also helpfully (?) offered some anti-depressants.

Eventually a friend who's a physician asked to refer me for some additional tests, because he was sure it was a thyroid problem. Guess what, my original doc was just not very good. My thyroid was trashed.

It's not always thyroid and I don't want to ram my diagnosis into your endocrine system. Thyroid is tricky and getting the correct Rx isn't a cakewalk. However, you can't get things fixed until you know what the problem is. If your doctor is mostly the anti-depressants cure-all type, then you may need to be a bulldog about getting to the bottom of this.
posted by 26.2 at 10:28 PM on February 3, 2010 [1 favorite]

DarlingBri: "Thyroid, thyroid, thyroid. A big-ass thyroid panel would be where I would start. Get all your numbers and the lab's range."

What does "and the lab's range" mean? What am I asking for, and to what do I compare it?
posted by SecretAgentSockpuppet at 10:29 PM on February 3, 2010

What does "and the lab's range" mean? What am I asking for, and to what do I compare it?

As I understand it, the "lab's range" refers to the reference values the lab considers to be "normal," based on the parameters of the test and clinical research and often based on your age, gender, and other characteristics. Usually they are calibrated such that about 95% of the "population" (people with similar ages and gender) receives results that fall into the reference range. Instead of just being told "everything was normal," it is often helpful to obtain the full set of lab results and investigate whether some values are close to the edges of the range or indicate unhealthy levels. Usually, when you get a copy of your results from your doctor, the range is printed right next to the results.

Of course, it's important to realize that reference ranges are just that--references--based on the results that most people get when taking a particular test. A value within the reference range isn't necessarily healthy and one outside the range isn't necessarily unhealthy, but it's often an indication that further investigation is warranted.
posted by zachlipton at 10:51 PM on February 3, 2010

How Doctors Think by Jerome Groopman, M.D. will give you insight into how doctors decide on a diagnosis and what can go right and wrong during the process.
posted by mlis at 10:54 PM on February 3, 2010

You should ask for a FSH level test to see where you stand regarding menopause. I was quite young when I asked for mine (something like 43). My memory was awful! My doctor didn't want to do the test, because he felt I was too young. I begged for the test..sure enough--when it came back it was clear that I was entering menopause. The doctor was surprised!

If you are still having menstrual periods, the best time to have your FSH level tested is on the third day of your menstrual period. All it means is a simple blood or urine test and there are now home FSH level tests which are increasingly widely available so you may not even have to visit your doctor for a FSH menopause test.
posted by naplesyellow at 1:10 AM on February 4, 2010

Assuming all your labs come out within normal limits, I think it would be helpful for you to check out the Health at Every Size (aka Health at Any Size) movement. It sounds like you're doing everything right.
posted by IndigoRain at 1:20 AM on February 4, 2010

With your comments about bone density loss, facial hair, and deepening voice, I expected lots of people to mention estrogen levels. Either way, I recommend getting information from your dentist (x-rays, notes, whatever -- your dentist thinks its more bone density loss than normal for perimenopausal) to give to your doctor. If it were me, I'd find that to be the most alarming symptom, and something from the dentist could be useful for the doctor.
posted by Houstonian at 3:48 AM on February 4, 2010

"Thyroid, thyroid, thyroid." were exactly the words I was going to type here, but DarlingBri beat me to it. Your doctor (endocrinologist or not) will most likely know all the thyroid function tests to run, but there's some info here.
posted by citywolf at 6:13 AM on February 4, 2010 [1 favorite]

It's been mentioned above, but you might want to ask your doctor or endocrinologist about PCOS, as well as getting your thyroid checked out. SoulCysters is a good site for general information and community support for women with PCOS. sallybrown makes good points about insulin resistance, too.

IANAD, but I went through some similar health issues a few years ago. My reproductive endocrinologist thought I might have PCOS or a thyroid problem. As it turns out, I have elevated testosterone levels, which caused me to have some, but not all, of the problems you describe (inability to lose weight, hirsutism). Some of these disorders have similar symptoms and are tricky to diagnose, so finding a good endocrinologist is really important.
posted by zoetrope at 7:44 AM on February 4, 2010

If your doctor isn't proactive, smart and thorough -- and if your doctor doesn't fill you with a sense of confidence -- you should find a new one.

I had a lot of troubling health issues (constant nausea, vomiting, exhaustion) that my doctor let linger for a year. I switched doctors and my new doctor ran tests and got answers within a few weeks. Finding a new doctor was kind of a pain in the ass (I'm in Ontario, where many primary physicians aren't taking new patients), but holy shit, the difference between my old doctor and my new, highly competent doctor is like day and night. Your doctor should be concerned about the problems you're having and have suggestions to fix them. That isn't your job.
posted by kate blank at 7:58 AM on February 4, 2010

"Before my c-section a few years ago, I had a lovely hourglass shape. Now, I look constantly 5 months pregnant. This just shouldn't be, given 15 hours a week of working out I've been doing."

Unrelated to the other issues -- have you done exercises specifically to pull your midsection muscles back together? If you have a separation (which is very common after pregnancy and harder to heal after a C-section), things like crunches will actually make it poofier, not flatter. And it isn't fat, it's a lack of muscle wall due to the separation. It's called a diastasis recti for your googling ease, and there are specific exercises to do to correct it.

I had a C-section last spring and this line caught my eye because I have exactly the same thing -- I look constantly 5 months pregnant, despite the fact that I have lost considerable weight and inches. It's hard work getting the separation fixed.

Good luck with everything! I hope this helps with at least the one little thing.
posted by Eyebrows McGee at 8:12 AM on February 4, 2010 [1 favorite]

You can either go right there or ask your doc to refer you, but my suspicion based on your symptoms is that you have something hormonal going on (PCOS; thyroid; menopause or something else lady-hormone-related) and you will probably end up seeing an endocrinologist. These things can be fiddly to diagnose and treat but the difference in how you feel is night and day.
posted by oblique red at 8:19 AM on February 4, 2010

The c-section thing is sort of discouraging as that's my issue, too. However, unless you've been diagnosed with diastasis recti, I wouldn't jump to conclusions on that. I was checked for DR at my post-delivery appointment and didn't have it but the CNM mentioned that lots of people *think* they have it but don't. It's a bit of a popular mis-diagnosis lately. Anyway, I hope you get some solid answers for what's going on! Try not to get too discouraged as it sounds like everything you're doing is good for you, regardless of the fact that the your measurements aren't changing as fast as you would like. A better diet and exercise are great things to be doing for yourself!
posted by otherwordlyglow at 9:20 AM on February 4, 2010

I'm male, so obviously there's different factors at play for me here. I was 228 lbs last summer and I decided I'd had enough. I changed my eating and dropped myself down to 2000 calories a day. I was exercising for a whole but my work schedule put a stop to that. I still lost 30 pounds in five months. When you say that you have changed your eating and are in the 1200-1500 calories a day range, have been doing this for a while, and aren't losing significant weight, that right there to me is enough to see a doctor and start pressing for answers. Something in your body isn't working right. You say your doctor isn't really attentive enough to investigate (and boy howdy, a lot of us have been there with our doctors) so you're going to really have to push this guy and not just let him do the drive-by "howareyou, ohthatneedshelp, here'saprescription, kthxbai" visit. Don't worry about making him uncomfortable or annoying him - this is his job and you are paying him to do it. If it comes down to it, you may need to see a new doctor.

I didn't even touch on the other symptoms you listed either. Like I said, just the fact that you're not losing weight is enough to assume there's an issue. You've also already taken the diet & exercise approach that many doctors will take first. Here's wishing you good luck as you go after this.
posted by azpenguin at 9:20 AM on February 4, 2010

Look up thyroid deficiency and low estrogen, and write down the symptoms that apply to you. You might have some that you don't even think are out of the ordinary, like dry skin or feeling cold in a warm room.

Show the list to your doctor. If s/he doesn't want to test thyroxin, thyroid-stimulating hormone (from the pituitary) and estrogen, bring those up yourself. If that doesn't prompt the tests, then see someone else.

Once you get the bloodwork results, you still might have work to do in order to get help. You can be in the "normal" range for thyroid and estrogen and still have less than you need. Some doctors like to just go by the numbers. My own gynecologist used my low 'normal' numbers as an 'okay' to try supplements. If your doctor thinks it means you're fine, go to a different doctor.

Even if you do need and take supplements, they only take you so far. I'd love to be thinner, but it's not happening, even though I take estrogen and synthroid and eat and exercise the way you do. My doctor likes to point out how much lower my blood pressure and insulin resistance are because of diet and exercise, and the fact that joint pain is no longer a problem for me. She also reminds me on every visit that nobody really understands hunger, satiety, metabolism, and weight loss, and that if it were simply a calories in/calories out equation, then obesity wouldn't be so prevalent.
posted by wryly at 11:01 AM on February 4, 2010 [1 favorite]