Paging Dr. Fat-Friendly in Denver, STAT.
July 20, 2010 1:50 AM   Subscribe

Need recommendations for an internist and/or endocrinologist in the metro Denver area, for myself and my husband. Difficulty: We want someone who will skip the weight loss lecture because they realize we've heard it a million goddamn times already and the only thing it's ever done is make us not want to go to the doctor. We don't want the "OMG don't you know fat is bad for you, hurf durf buttereater" crap from here either-- go kick a puppy or something. We only want to know about doctors that will respect our wishes.

More details: We have Blue Cross, so most doctors should take it. Doctor's gender, orientation, ethnic background, etc. is not a concern, only their competency. (Well, the doctor should be fluent in English because we're only fluent in English, but other than that...)

NW Metro area (Thornton, Northglenn, Westy) preferred, but we'll go further for someone good. Denver Tech Center is also good.

We've both been fat all our lives. We've both had gastric bypasses (roux-en-y), him for much longer than me. All that we've got from those are vitamin deficiencies and our teeth falling out. We're both still fat, and I'm still diabetic. I only had the surgery because a doctor told me "Type II Diabetes is a surgically curable disease." Yeah, apparently not, pal. We feel we've pretty much exhausted every weight loss option at this point, and don't wish to hear about it or discuss it anymore. WE KNOW ALREADY. Heard it, tried it, didn't work any better for us than it did for everyone else, THANKS. We make an effort to eat healthy nutritious food, cook at home (not just heat up) most of the time, and reduce the amount of processed junk. (Basically, HAES.)

We're both sick and tired of doctors assuming we lie about what we eat and pushing ridiculous "Diet Tip Sheets" at us. (One gem from one of these: "Don't eat a varied diet! More variety just means more calories!" The whole thing sounded like he got it off a pro-ana blog. Oh, and the Starve Yourself Every Other Day Diet! That was a good one, too.) We would just like to be treated like human beings for a change, please, and not get a bunch of crap from the medical assistant if we ask for a large cuff so our blood pressure can be measured properly. The doctor doesn't even have to be NICE as long as they don't bring up dieting.

I'm particularly interested in someone who will treat my hypothyroid symptoms, not just my test results. I don't CARE if my TSH is "normal", I still feel tired, constantly cold, and have thinning hair and eyebrows! My husband also has thyroid issues (newly discovered and quite puzzling to Dr. Pro-Ana Diet Tips), although he's got perfect blood sugar and lipids, despite being the heavier one by quite a bit. Please help us find a decent doctor who won't treat us like crap!
posted by Shoeburyness to Health & Fitness (16 answers total) 4 users marked this as a favorite
I'm not at all familiar with the Colorado area, but the first thing that came to mind was the fat-friendly doctor list - here is the link to the Colorado lists. It seems a little heavy on therapists instead of doctors, but there is a nutritionist listed who also does diabetes education - if nothing else, she might have recommendations.

Colorado listings

Good luck! I know how difficult it is to find a doctor who will listen without the lecture.
posted by Neely O'Hara at 2:00 AM on July 20, 2010

It's clear from what you write that you're very, very frustrated, and it is obvious that (at least some of) your previous health care experiences haven't been terrific. However, reading this objectively, it sounds like you're asking for a couple of things from Jane-average or Joe-average internist that are not realistic.

You absolutely deserve to be treated with respect by any physician you see, as well as her staff. But at the same time, it sounds like you're expecting a new physician, meeting an overweight or obese patient for the first time, to completely ignore what may be one of the underlying causes of your symptoms or illnesses. It is that physician's professional obligation to run through the differential diagnosis and address all of the possibilities. It would be like my going to an oncologist with a big lump and intractable weight loss and asking for them to treat my symptoms, but demanding that they skip over the whole "you have cancer crap". Remember, if you go to a physician with high blood pressure, type 2 diabetes, high cholesterol, and that physician never ever mentions diet and exercise to you and you were to (god forbid) keel over of a heart attack, that physician is going to worry (justifiably so, in these times) that a plantiff's attorney is going to be pursuing the chart while she/he is on the stand saying, "So, Dr. So-and-So, where exactly is it documented it you counseled my client's spouse on proper diet and exercise?"

As for trying to find someone to treat your hypothyroidism symptoms in the absence of hypothyroidism (e.g., normal TSH), you should definitely find someone who can walk you through the diagnostic process for hypothyroidism and if you've got it, you should be treated for it, and if you don't you should have someone explain to you your test results, and walk through possible explanations for your symptoms (if possible). But finding someone to treat symptoms of a possible endocrinologic disorder when there's nothing to substantiate the diagnosis of the disorder may be rough.

Physician-patient relationships are two-way streets. As much as you deserve a doctor who treats you with respect, your doctor deserves a patient who doesn't come in pre-angry, or with a huge chip on their shoulder, or who is a priori dismissive of the way that physician addresses complex medical problems. If you've been frustrated with prior attempts at weight loss, or if you don't want to hear "the same old thing", then I'd suggest the following:

1. Get your medical records from all of your previous doctors sent to your new doctor in advance and send a cover letter saying that you've got a complex medical history, and you've done A, B, and C, with no success.

2. Ask the doctor or her staff to block out a longer slot (1h) for your initial visit, or find a doctor who will make themselves available for an extended consultation.

3. "Interview" a small number of doctors (kind of what new parents do with pediatricians) and explain what you're looking for to a few before planning your first "real" visit. Look for internists who listen more than they talk.

4. Consider a practice that employes nurse practitioners (disclaimer: my wife is an advanced practice nurse and is a way better listener than me sometmes). They may have less harried schedules.

5. Let go of your previous experiences - whoever your next doctor is, he wasn't your last doctor, so give him/her a break.

6. Explain things in a non-emotional, objective manner, with specifics. Have symptoms of hypothyroidism but have normal thyroid labs? You'll get a lot more milage out of a diagnostician by keeping a symptom diary (when did hair loss start? how much? daily? when did cold intolerance start? every day? same time? when during the day are you most tired? every day?).

Again, I hear your frustration, and I worry that it could block your ability to get the care you need. All doctors are suppose to be "fat friendly". And "skinny friendly". And "short friendly". And I suspect that most are. With a better approach towards communication (on both sides), I suspect your choices of doctor won't be as limited.

Best of luck.
posted by scblackman at 3:14 AM on July 20, 2010 [34 favorites]

Seconding scblackman - I agree with pretty much every point he made. You absolutely deserve a physician who treats you with respect and doesn't lecture you like a child. But since you will be new to this physician, they are obligated to assess your condition and any confounding factors. Simply leaving out an important factor in your treatment is unprofessional and not doing anyone a favor. So I think the advice of getting your past records - which will include many references to "counseled patient on weight loss," will show that you've reported trying, and will report on your surgeries - is your best bet to touch on the subject of weight with the new MD and then respectfully move on to topics that you are comfortable with.

Physician-patient relationships are two-way streets. As much as you deserve a doctor who treats you with respect, your doctor deserves a patient who doesn't come in pre-angry, or with a huge chip on their shoulder, or who is a priori dismissive of the way that physician addresses complex medical problems.

This. You go to a physician to get treatment from a professional, not to validate your self-diagnosis.
posted by Tehhund at 4:16 AM on July 20, 2010

Response by poster: What "Self-diagnosis"? I was diagnosed hypothyroid six years ago, but the thyroid pills I am currently taking are not relieving my symptoms, despite "normal" labs. Interesting how you assume I'm trying to score thyroid as if it were Vicodin. Would you make such an assumption if I weren't fat?
posted by Shoeburyness at 4:38 AM on July 20, 2010

It's incredibly hard to find endocrinologists who don't make fun of you for weight issues. It took me years and quite a few doctors before finding one I liked. What helped with the most recent one was that I said to her at my first visit, at the very start:

"I've had a really hard time finding a good doctor with whom I can feel comfortable, because my previous doctors all harped on my weight at every visit. I already know I'm overweight; I have a mirror, and I'm not stupid. I try exercise, diet control, everything I can think of, and it doesn't work. I'm otherwise strong and healthy, anyways. So please, don't bug me about it more. I don't want to talk about my weight here. Ever. At all. And at this point, I'm just looking for a doctor I can actually talk to."
posted by Eshkol at 5:39 AM on July 20, 2010

I think Tehhund is referring to this:

I still feel tired, constantly cold, and have thinning hair and eyebrows!

If your TSH is normal, these could by symptoms of something else, and if you don't "care" what the doctor says and relate it to your condition on your own, that's a self-diagnosis.

I think that has absolutely nothing to do with your weight and everything to do with your mindset. I know you're frustrated, but largely doctors and mefites are trying to help, not gang up on you. Best of luck!
posted by Hiker at 5:43 AM on July 20, 2010

Best answer: I agree with scblackman, and while I don't know any endo practices out your way, I used to work for a Diabetes and Obesity Institute at a large state medical school. A lot of the endo docs and fellows there were used to dealing with stranger, more complex cases, so you might get more mileage if you try to find a university-affiliated doc. Here's the site for the Endo department at CU.
posted by The White Hat at 6:16 AM on July 20, 2010

You sound really stressed out, and looking through your AskMefi history you mention you've had a history of panic attacks, driving phobia, shortness of breath, and some thyroid issues. There's extensive research documenting co-occurrence of depression and anxiety with thyroid problems (Google Scholar) and some of the problems you have had--shortness of breath, difficulty losing weight even with extreme efforts, hair loss--could definitely be exacerbated by anxiety or depression. Have you considered talking to a counselor or being evaluated for depression or a mood disorder?

I hope that's not an offensive question, but I see a ton of depressed or bipolar clients who have thyroid issues and weight issues, so much so that I suggest to any of my clients with depression have their thyroid level checked. I've seen some amazing turnarounds in well being and physical health after people have started to work on emotional problems, medical problems, and stress levels as related issues instead of isolated sources of unhappiness.
posted by Benjy at 6:31 AM on July 20, 2010 [1 favorite]

Best answer: When you do decide on a doctor, you might want to send a letter in advance explaining your issues as a fat patient. Here is an example . There is also a fat-friendly doctor listing, although I didn't see any endos in CO.
posted by kimdog at 7:11 AM on July 20, 2010

What "Self-diagnosis"? I was diagnosed hypothyroid six years ago, but the thyroid pills I am currently taking are not relieving my symptoms, despite "normal" labs. Interesting how you assume I'm trying to score thyroid as if it were Vicodin. Would you make such an assumption if I weren't fat?

It wasn't clear in your original post that you do have a diagnosed thyroid issue, just symptoms that could be thyroid-related but could also be related to any number of other issues.

What are you taking at the moment? Just T4?
posted by crankylex at 8:03 AM on July 20, 2010

Response by poster: Yep, just T4. I'd be more than happy to try any non-weight loss related thing a doctor would suggest for my symptoms, but they never suggest anything. I tell them of my symptoms, they check the bloodwork and say "Well, your TSH is normal." Basically, what I get from these exchanges is either they think I'm making up the symptoms (even though that is easily disproven by just looking at my hair, for pete's sake) or they just plain don't care that I still feel like crap.
posted by Shoeburyness at 9:53 AM on July 20, 2010

Response by poster: I might try the letter thing that kimdog suggested as well, although the being weighed part doesn't really apply to me. I don't find weighing all that traumatic, for whatever reason, and I think doctors ought to pay MORE attention to weight in terms of dosing. I was reading recently how they used to think fat women died more often from ovarian cancer than thin women. But someone decided to try giving fat women chemo in a dosage based on actual weight, rather that their "ideal" weight, and whaddya know-- fat women die from ovarian cancer at the same rate as thin women when given the proper treatment! Things like this are why I find it pretty ridiculous that I shouldn't be angry about how fat people, fat women, and this fat woman in particular are treated by doctors. You'll just have to forgive me if I'm not deferential enough to the almighty doctors-- I'm kind of trying to not die before I have to, here.
posted by Shoeburyness at 10:36 AM on July 20, 2010 [1 favorite]

Really stupid question here, but since you say you have thyroid problems and vitamin deficiencies and transient anxiety, have you ever been checked for gluten intolerance, a.k.a. celiac disease? It's a simple blood test to check for the antibodies. You can follow it up with a small intestine biopsy afterwards, which is the gold standard for diagnosis, or just cut out the gluten and see how you feel in ~60-90 days.

In my case, my gluten intolerance popped out of nowhere when I was in college, and wreaked havoc on my thyroid levels and my menstrual cycle (I went 45 days between periods, which seems counter-intuitive given my hypothyroidism, but there you go) and my skin (cystic acne flared up and was unresponsive to dermatologist treatments) and my energy level and my general mental health. The classic stomachaches and poop issues and such, from the small intestine damage, were actually the last symptom to show up. Cutting gluten out of my diet (not 100%, but maybe 95%) changed my life -- but it took nearly six months for my thyroid levels to slowly get back to normal.

In any case, I thought I'd throw this out there as something simple to check out with your doctor. And I wish you good luck with your health care search, regardless.
posted by Asparagirl at 12:10 AM on July 21, 2010

Response by poster: Asparagirl, I was actually tested for celiac a few years ago-- it came back negative. I was surprised; I was figuring since bread is about my favorite food and baking bread is a hobby of mine (to the extent that I'd like to build a mud oven in my back yard so I can bake in the summer without making the house hot), that naturally I'd be forced to give it up. For once, things went my way.
posted by Shoeburyness at 4:28 PM on July 21, 2010

Lucky. :-)
posted by Asparagirl at 12:13 AM on July 22, 2010

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