Psyched Out

Riolriri at She Dances On The Sand pleads to know if she is the only person opposed to bariatric surgery in children. This is my reply.

You are not alone.

I am uncomfortable with any cosmetic surgery in children who are not severely disfigured. I think surgeons should wait until teens are at least at the age of consent. I think ethical ones do.

When it comes down to it, though, other cosmetic surgeries are not as dangerous as bariatric surgery. They do not have a 2% perioperative mortality rate (within 30 days of surgery) 4.6% mortality within a year. They do not cause beri beri, with permanent neurological damage. They do not cause peripheral neuropathy. They do not limit the amount of fluid one can drink when exercising or feverish, promoting dehydration. They don't cause chronic vomiting and malabsorbtion of what does stay down.

These surgeries are extremely dangerous for even adults, but adults have a right to mutilate themselves if they want.

Parents should not have free reign to mutilate their children for the sake of appearance. Hell, I oppose circumcision on this ground. And circumcision doesn't cause devastating malnutrition which can stunt growth and result in lifelong neurological damage.

For details on the actual mortality risks of obesity as opposed to bariatric surgery, see this brilliant post from Sandy on Junkfood Science on the actual risks of dying from obesity.

My professor friend Chad gave me a great critique, and this is the result - much better!


“So you're the one with the human bites!” exclaimed the hospital orderly as he wheeled me to physical therapy. My social work career had just been severed as surely as the nerves in my partially detached finger. Like my finger, it healed and regained function with time.

I had chanced into social work on a paraprofessional level eight years before. A job sorting clothes for Goodwill Industries led to promotion when I excelled at supervising my disabled coworkers. Now a job coach, I trained, supervised and worked alongside people with developmental, physical and psychiatric disabilities in a community based vocational rehabilitation program. Vocational rehabilitation provided a good grounding in social work skills. I learned assessment techniques, wrote individual service plans, developed time management skills, supervised people in groups while focusing on their individual needs and goals, and adapted to a wide range of community settings.

Meanwhile, I faced my own challenges. My blue collar parents had never personally known anyone with a college degree and certainly never considered sending a girl to a university. My high school counselors were no more enthusiastic about helping blue collar girls go to college. However, the flood of university recruitment letters after my college board exams had their effect. I blossomed in the dorms, took upper division classes for fun, and flirted with theater before settling on psychology. Then the money ran out. I was determined to continue my education but I would not be eligible for financial aid based on my own income for five years. So like many others, I worked and watched my friends from high school have fun on campus and finish college.

At last my turn came, and I returned to my studies with focus and maturity. My first psychology advisor at the University of Iowa told me to quit school if I needed to work for a living because I couldn't do both well. I firmly believed I could prove him wrong. Serious illness in 1994 affected two grades, but I retook the classes and did well. During my senior year I took loans out, worked fewer hours, made the dean's list both semesters. Ten years after I had begun, I picked up my diploma at the post office and cried for joy in my freezing car.

Armed with my shiny new Bachelor of Science degree and Goodwill's 1996 Employee of the Year award, I became ambitious. In Chicago I found a job life coaching a man who had severe autism. Two weeks into the job I was preventing “Mr. B” from banging his head on the wall when he attacked, biting me all over and nearly taking off my right index finger. Six police finally restrained him, but not before one of them was also bitten. Following surgery and extensive physical therapy I prepared to enter the workforce again.

Injured and humbled, I needed a break from social work. I worked in construction, supervised scorers of standardized tests and chauffeured for a remarkable disability advocate. I got married, birthed twins and moved my family to Grand Rapids. After eighteen months as a stay at home mom, I longed for the comparative peace and low stress of social work. I had emotionally healed from the attack and decided I would give my career another try. Touchstone Innovare hired me in 2002 and I have worked there since.

My five years at Touchstone have widened my skills and perspective. We treat people with serious psychiatric illness and co-occurring substance abuse. The majority of my clients at Touchstone live in crushing poverty. Most are jobless, many are homeless and few have steady incomes or medical insurance. Ingenuity is needed to help fill needs for medication and housing when those resources are absent or pending. My intellect has been challenged as I apply current research in psychology to treatment. Successfully developing treatment plans with individuals requires creativity and the ability to integrate knowledge of psychiatric diseases with unique personal and environmental factors. Teamwork and constructive criticism are valued at Touchstone, and I have learned to consult with peers and supervisors regularly, improving my clinical judgment. Outreach to unengaged clients has honed my investigative and rapport-building skills.

I have established and maintained therapeutic rapport with hundreds of people with psychiatric disabilities, but I lack the necessary education to fulfill my career goals. A master's degree in social work from Grand Valley State University would give me the knowledge and credentials to practice social work at an advanced level. I could work intensively with women experiencing mental illness during pregnancy and postpartum. Poor women face challenges in getting adequate and humane psychiatric treatment and I would like to help solve that problem.

Grand Valley State University stands out as the best choice for me. It compares favorably to other programs in important ways. I would not need to move my family to another part of the country, find another job, and build a new network of supports to attend. Grand Valley has been highly recommended to me by coworkers who are alumni. The emphasis on social justice and diversity appeals to me because I share it. GVSU offers part time study completed during the day, which would allow me to spend more time with my family than a night program would.

The most compelling reason to choose GVSU is the chance to study with faculty members whose areas of expertise would be very helpful to me. Joan Borst could teach me much about addressing barriers to health care. Dianne Green-Smith's focus on family therapy, pregnancy and infant adoption dovetails with my interest in reproductive health. I find David Lehker's study of male parenting important because he could expand my knowledge of men's reproductive lives. Shelley Shuurman's work in parenting issues and advocacy could be valuable to me since I want to develop advocacy methods myself. No other MSW program I have considered can compare with Grand Valley State University in terms of professors who could foster my professional development.

I once thought that being bitten by a client would ruin my social work career. Time and a sincere dedication to helping others brought me the strength and courage to return to the work I love. Earning an MSW at Grand Valley State University would seal that choice and prepare me for advanced practice. I hope you will invite me into your department.

“So you're the one with the human bites!” exclaimed the hospital orderly as he wheeled me to physical therapy. My social work career had just been severed as surely as the nerves in my partially detached finger. Like my finger, it healed and regained function with time.

I had chanced into social work on a paraprofessional level eight years before. A job sorting clothes for Goodwill Industries led to promotion when I excelled at supervising my disabled coworkers. Now a job coach, I trained, supervised and worked alongside people with developmental, physical and psychiatric disabilities in a community based vocational rehabilitation program. In the 1980's sheltered workshops flourished and placing workers with disabilities at regular businesses radically challenged the status quo. I was proud to be one of the first job coaches in Iowa promoting diversity in the workplace and visibility of a stigmatized group. Vocational rehabilitation provided a good grounding in social work skills. I learned assessment techniques, wrote individual service plans, developed time management skills, supervised people in groups while focusing on their individual needs and goals, and adapted to a wide range of community settings. Early on I emphasized basic social skills such as saying “please” or “excuse me” and zipping one's own coat, since many of my employees had led isolated lives in institutions or at home before coming to Goodwill. Employed in teams at stores, hotels, factories and museums my workers approached jobs usually regarded as menial with dignity and enthusiasm.

Meanwhile, I faced my own challenges. My blue collar parents had never personally known anyone with a college degree and certainly never considered sending a girl to a university. My high school counselors were no more enthusiastic about helping blue collar girls go to college. However, the flood of university recruitment letters after my college board exams had their effect. My parents could only afford loans for three semesters, and I will always be grateful to them for financing those despite their doubts about the utility of college. I blossomed in the dorms, took upper division classes for fun, and flirted with theater before settling on psychology. Then the money ran out. I was determined to continue my education but I would not be eligible for financial aid based on my own income until age twenty four. So like many others, I worked and watched my friends from high school have fun on campus and finish college.

At last my turn came, and I returned to my studies with focus and maturity. My first psychology advisor at the University of Iowa told me to quit school if I needed to work for a living because I couldn't do both well. I had gained confidence as a social worker and firmly believed I could prove him wrong. I did encounter stumbling blocks as I worked up to 60 hours weekly and studied full time for six semesters. At the end of spring semester 1994 I fell ill and did not recover in time to finish two incompletes, resulting in F grades. I later retook the classes and did well. I believe that the lesson I learned about respecting my limits and overcoming mistakes taught me more about life success than passing would have. In addition, I only earned C's in classes that I would have sought tutoring in given time and money, which lowered my overall GPA to 3.11. In my psychology major I earned a 3.76 GPA. During my senior year I took loans out, worked fewer hours, made the dean's list both semesters and earned a 4.08 GPA in my final classes. Ten years after I had begun, I picked up my diploma at the post office and cried for joy in my freezing car.

Armed with my shiny new Bachelor of Science degree and Goodwill's 1996 Employee of the Year award, I became ambitious. I went to the big city and found a job working with a man who had severe autism living in a specialized group home. I said goodbye to good friends and Goodwill, and moved to Chicago. Two weeks into the job I was preventing “Mr. B” from banging his head on the wall when he attacked, biting me all over and nearly taking off my right index finger. Six police finally restrained him, but not before one of them was also bitten. Following surgery and extensive physical therapy I prepared to enter the workforce again.

Injured and humbled, I needed a break from social work. Several years passed. I worked in construction, supervised scorers of standardized tests and chauffeured for a remarkable disability advocate, keeping a foot in the door for social work by volunteering with her group of disabled teen girls, the Empowered Fe-Fes. I got married, birthed twins and moved my family to Grand Rapids. After eighteen months as a stay at home mom to infant twins, I longed for the comparative peace and low stress of social work. I had emotionally healed from the attack. I missed professional work and decided I would give my true career another try. Touchstone Innovare hired me in 2002 and I have worked there since.

My five years at Touchstone have widened my skills and perspective. Although the main focus is treating people with serious psychiatric illness, co-occurring substance abuse is common. The majority of my clients at Touchstone live in crushing poverty. Most are jobless, many are homeless and under half have steady incomes or medical insurance. Ingenuity is needed to help fill needs for medication and housing when those resources are absent or pending. My intellect has been challenged as I apply current research in psychology to treatment of individuals in an evidence based manner. Successfully developing treatment plans with individuals requires creativity and the ability to integrate knowledge of psychiatric diseases with unique personal and environmental factors. Electronic record keeping and resulting high standards have improved my documentation skills, allowing me to form thorough and accurate client files. Teamwork and constructive criticism are valued at Touchstone, and I have learned to consult with peers and supervisors regularly to my clients' benefit. I gained an awareness of my strengths and weaknesses which has promoted objectivity and successful treatment approaches. Outreach to unengaged clients has honed my investigative and rapport-building skills.

I have established and maintained therapeutic rapport with hundreds of people with psychiatric disabilities, but I lack the necessary education to fulfill my career goals. A master's degree in social work from Grand Valley State University would give me the knowledge and credentials to practice social work at an advanced level. This would afford an opportunity to work with women experiencing mental illness during pregnancy and postpartum. (See social justice essay.) Poor women face challenges in getting adequate and humane psychiatric treatment and I would like to help solve this problem. Completing graduate work at GVSU could enable me to pursue that goal through several possible avenues. It would allow me to address the problem individually by giving therapy to women in that situation. I could network with fellow students in the macro program and develop a community agency specializing in mental health services for women in their reproductive lives. Or I could pursue further academic work, earn a Ph.D. and research reproductive mental health needs on a state or national level.

Grand Valley State University stands out as the best choice for me. It compares favorably to other programs I have looked at in important ways. GVSU operates in and contributes extensively to my community through faculty activities and the education of new generations of social workers. I would not need to move my family to another part of the country, find another job, and build a new network of supports to attend,a major consideration. Grand Valley has been highly recommended to me by coworkers who are alumni. Your high quality social work program with an unapologetic emphasis on social justice and diversity appeals to me because I want to right inequality and prejudice to the best of my ability. GVSU offers part time study completed during the day, which would allow me to spend more time with my family than a night program would. Your program allows specialized micro study, allowing me to focus on the area where my personal skills fit best but maintain contact with peers with administrative talents.

The most compelling reason to choose GVSU is the chance to study with faculty members whose areas of expertise would be very helpful to me. Joan Borst could teach me much about addressing barriers to health care. Dianne Green-Smith's focus on family therapy, pregnancy and infant adoption dovetails with my interest in reproductive health. I find David Lehker's study of male parenting important because he could expand my knowledge of men's reproductive lives. Similarly, Shelley Shuurman's work in parenting issues and advocacy could be valuable to me since I want to develop advocacy methods myself. No other MSW program I have considered can compare with Grand Valley State University in terms of professors who could foster my development in my particular area of interest.

I once thought that being bitten by a client would ruin my social work career. Time and a sincere dedication to helping others brought me the strength and courage to return to the work I love. Earning an MSW at Grand Valley State University would seal that choice and prepare me for advanced practice. I hope you will invite me into your department.

An often overlooked issue of social justice is the disparity in treatment for psychosis during pregnancy between poor or underinsured women and middle class privately insured women. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet doctors often will not prescribe the same medications for potentially deadly psychosis that they give for inconvenient nausea in pregnancy. This leaves pregnant women committed in locked facilities for weeks or months untreated, fully psychotic and incapable of directing their own medical tereatment. Incarceration is not treatment.

Psychosis is the most severe form of mental illness, often robbing its sufferers of recognition that they are ill. 4-10% of psychotic patients commit suicide. Unmedicated pregnant psychotic women run four times the risk of psychiatric hospitalization as those who take antipsychotics. Hospitalized women have twice or more the rate of stillbirth, infant death, premature birth and low birth weight. Antipsychotics are proven safe throughout pregnancy; several are routinely used to treat nausea. Mood stabilizers are safe after the first trimester, and one is proven safe throughout. The fact that middle class women with private insurance are not routinely committed and left untreated indicates that the lack of treatment of impoverished women is a case of social injustice, not prudent medicine.

This travesty could end. Widespread advocacy and education on the safety of antipsychotics and risks of witholding them would protect doctors and benefit patients. Networking could link women with doctors who will prescribe medications during pregnancy. Volunteer medical guardians enforcing the treatment preferences of psychotic women incapable of consent could be provided. Universal health care could reduce discrimination based on insurance and give poor women access to doctors with ethical treatment standards. This would prevent a woman from being held in a locked unit rather than medically treated until she gives birth, simply because she is poor.

So apparently it's been almost three months of silence here. I have been binging on other people's blogs and ignoring my own. Maybe I should feel guilty, but I've lived with myself for a long time and have come to accept certain character flaws. :)

We've been having a lot of snow days here, and I'm hoping to have ANY vacation time left come April. There was a sixty car pile up in my state today, and the roads are packed snow frozen over with a layer of ice. It's very dangerous driving.

I watched most of a program on the Little Ice Age from the 14th to 19th centuries, and going over what happens with just a bit of a temperature drop (4 degrees F) makes me aware of the devastation a similar temperature rise could do. Massive drought for years on end, increased storms, killing off of staple crops. In the first part of the little ice age it rained virtually every day for five years straight in England. Many thousands of people died from starvation because it killed the grain crops they depended on.

That's one reason that I'm opposed to eating local. I don't care if sometimes people choose to do it, but I am concerned that Congress is considering making it a requirement for public schools. Being able to eat tomatoes in February is one of the marvels of modern living. If I were eating local, there basically wouldn't be vegetables after October and before June. How that's healthier is beyond me.

We need to join the rest of the world in the global effort to minimize damage to the ozone layer and prepare for global warming. I was neutral for some time but I'm convinced at this point that it is happening, though I'm not entirely convinced that we are causing it. The little ice age happened without human input. This is clearly a version of Pascal's wager, though. Even if we don't believe in global warming, the prudent course is to believe in it and behave as if it does exist.

Here's a popular meme in the fat rights community. The rules: Type the answer to the questions into google images and post your favorite from the first page.



1. Age at next birthday




2. A place you'd like to travel:




3. Your favorite place:




4. Your favorite objects:




5. Your favorite food: (This one's a tie)






6. Your favorite animals:



7. Your favorite color:




8. Town where you were born:




9. Town where you live:





10. Name of a past pet:





11. First name of a past love:



12. Best friend's nickname:




13. Your screen name/nickname:




14. Your first name:





15. Your middle name:




16. Your last name:




17. Bad habit of yours:




20. Your college major:

Dear Ms. Principal,

We're concerned about the "red ribbon" program the school is
engaging in. Is the school teaching the children that all alcohol,
tobacco, and drug use is bad?

Tobacco is unhealthy but legal. We don't smoke and we hope our kids
don't choose to, but hope they will make an intelligent choice
about it, and doubt that signing a pledge in first grade is going
to help them make an intelligent choice as teenagers. If anything,
signing pledges because everyone else is doing it is going to have
the effect of teaching them to "go along with the group" with
regards to drugs and alcohol when they're teenagers... and their
peers might be a "group" which would push them in the opposite
direction at that time!

Drinking alcohol -- communion wine -- is part of a sacrament for
Catholics. I doubt the school intends to have the children pledge
not to be Catholics like other members of the family. Of course
we also drink moderately outside of church, and we don't think
that there is anything wrong with that either.

Both of us take drugs every day, such as Singulair for a
respiratory condition. We hope the kids are not being taught
that this is wrong, and that they should never take medicine?

Many drugs are illegal in one context and legal in another.
Oxycontin is a harmful and addictive street drug but also a
beneficial painkiller when used under medical supervision.

We're not really happy with the way this is being
addressed -- and we're not sure that it is possible to give
the issue of harmful and addictive substances the treatment
it deserves with first graders.

But we'd be willing to give it a shot. I work with substance
abuse every day in my social work position, and would be willing
to come into the classroom and talk about the nature of addiction,
with questions and answers, to try to give the kids a simple but
compassionate understanding of the issue.

Is that something that the school would be interested in? We'd be
much happier with that kind of education than children signing
pledges which they don't understand. (They don't understand them.
We asked them if they understood what they signed.)

What do you think about these issues? We would be interested in
discussing them with you.

Sincerely,

Mary and Ed

Psychotic Disparity: Low Income Women and Mental Health Treatment in Pregnancy
by Mary H

An often overlooked issue of social justice is the disparity in treatment given to impoverished uninsured/publicly insured and wealthier privately insured women who experience psychosis during pregnancy. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet doctors sometimes hesitate to prescribe the exact same medication for potentially deadly psychosis that they give for inconvenient nausea during pregnancy, leaving pregnant women committed in locked facilities, untreated and fully psychotic for many weeks.

Psychosis is the most severe form of mental illness, often robbing its sufferers of even the ability to perceive it as a disease with treatment available. Suicide is a serious risk among psychotic patients, with research showing a 4-10% death rate. Compared to pregnant women treated with antipsychotic medication, women diagnosed with psychosis without medication had four times the risk of psychiatric relapse and hospitalization. Psychiatrically hospitalized psychotic women experience markedly worse pregnancy outcomes. They have twice the rate of stillbirth, infant death, premature birth, low birth weight and small for gestational age babies compared to psychotic women treated outpatient. All antipsychotics are proven safe throughout pregnancy, several are used to treat nausea. Mood stabilizers for manic psychosis are safe after the first trimester, and one mood stabilizer, Lamictal, is shown to be safe even then. Try to imagine a middle class woman with private insurance committed and left untreated, and the primary cause of this social injustice is clear: social class.

Wealthier, privately insured women enjoy several key benefits from their social status and personal power. They often have better access to information about their illness and medications before pregnancy and more access to other pregnant women with psychosis through the internet. Privately insured women obviously have better access to health care and more choices. Privately insured women tend to have more collaborative relationships with their doctors, more time in office visits and they are free to “doctor shop” if they are denied treatment with medication by one physician. Certainly many poor women enjoy rich social networks and supportive partners, but overall these benefits are more available to richer women. If a doctor does try to commit a privately insured wealthy woman, she is likely to have a medical guardian to approve medications when she cannot consent to treatment herself due to the psychosis.

Several solutions could improve care for impoverished uninsured/publicly insured women. Improved education for both doctors and women of childbearing age could be provided along with the popular campaign giving information about postpartum mental health. Universal health care would resolve some disparity in care because many more doctors would accept a national insurance and discrimination based on ability to pay would be greatly reduced. Finally, community efforts to establish volunteer medical guardians for psychotic women that do not depend on intact families, perhaps through Le Leche League and local childbirth assistants, would prevent a woman from being incarcerated rather than medically treated unless she chooses that path before she becomes ill.

An often overlooked issue of social justice is the disparity in treatment given to impoverished uninsured/publicly insured and wealthier privately insured women who experience psychosis during pregnancy. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet medication treatment is at times withheld in favor of long term committment for this population due to a blend of limited choice as well as poor access to care and information.

Psychosis is the most severe form of mental illness, often robbing its suffererss of even the ability to perceive it as a disease with treatment available. Suicide is a serious risk among psychotic patients, with research showing a 4-10% death rate. Compared to women treated with antipsychotic medication, women previously diagnosed with psychosis without medication had four times the risk of psychiatric relapse and hospitalization. Psychiatricallly hospitalized psychotic women experience notably worse pregnancy outcomes. They have twice the rate of stillbirth, infant death, premature birth, low birth weight and small for gestational age babies compared to psychotic women treated outpatient.

Doctors often hesitate to prescribe medications for potentially deadly psychosis when they prescribe the exact same medication for inconvenient nausea during pregnancy. With the exception of mood stabilizers, all antipsychotics are safe throughout pregnancy. Even mood stabilizers are safe after the first trimester, and one mood stabilizer, Lamictal, is shown to be safe even in the first fourteen weeks. In uninsured/publicly insured inpatient and outpatient psychiatrists have been known to withhold pregnancy safe antipsychotic medications, instead leaving pregnant women committed, untreated and fully psychotic for many weeks. Try to imagine a middle class woman with private insurance treated this way, and the primary cause of this social injustice is clear.: social class.

Wealthier, privately insured women enjoy several key benefits from their social status and personal power. They often have better access to information about their illness and medications before pregnancy and more access to other pregnant women with psychosis through the internet. Poor women usually have limited public and no home access to the internet. Privately insured women obviously have better access to health care and more choices. In addition, privately insured women tend to have more collaborative relationships with their doctors, more time in office visits, more liklihood of consults, and they are free to “doctor shop” if they are denied treatment with medication by one physician. Very few doctors accept medicaid,or take uninsured patients, and in any place but a large city there may be only one game in town. Certainly many poor women enjoy full and rich social networks and supportive partners, but overall these benefits are more availible to richer women. If a doctor does try to commit a privately ensured wealthy woman without offering treatment instead of containment, richer women are more likely to have people in their lives to authorize treatment when the actively psychotic woman cannot consent to treatment herself.

Several low cost solutions could improve care for impoverished uninsured/publicly insured women. Improved education for both doctors and women of childbearing age could be provided along with the popular campaign giving information about postpartum mental health. Universal basic health care would resolve some of the disparity in care because all women would be publicly insured and many more doctors would accept a national insurance. Discrimination based on ability to pay would be greatly reduced. Finally, community efforts to establish medical guardians for psychotic women that do not depend on intact families or present fathers, perhaps through groups Le Leche League and local childbirth assistants would prevent women from being incarceated rathed than medically treated unless the lack of medication was the woman's choice before she became psychotic.

I'm working on a social justice essay for my graduate school application. Please give me input. :)
More will be coming later. Here's part one of a one page double spaced essay.


An often overlooked issue of social justice is the disparity in treatment given to publicly and privately insured women who experience psychosis during pregnancy. This disparity has existed in all five states where I have practiced, and may very well be a national trend. An impoverished, pregnant and actively psychotic woman is among society's most vulnerable citizens. Yet treatment is at times withheld in favor of incarceration for this population due to a blend of limited choice, poor access to care and defensive medicine. This despite the fact that medications for psychosis are as safe as or safer than medicines routinely prescribed for nausea and hay fever.

Psychosis is the most severe form of mental illness, often robbing its targets of even the ability to perceive its nature as a disease with treatment available. Suicide is a serious risk among psychotic patients, with research showing a 4-10% death rate. Hay fever and nausea in pregnancy are rarely, if ever, deadly. Compared to women treated with antipsychotic medication, women previously diagnosed with an episode of psychosis who did not take medication had four times the risk of psychiatric relapse and hospitalization. Women who are pregnant during psychiatric hospitalization experience notably worse pregnancy outcomes. They have twice the rate of stillbirth, infant death, premature birth, low birth weight and small for gestational age babies.


So what do you think so far?

I had my very first ever salon facial today.

Oh.

My.

Word.

I had a stressful day at work. I'd heard that facials are pretty relaxing and I was going for a haircut anyway, so I decided to get one on the spur of the moment. So I left work early with the help of coworkers and checked myself in at Panopoulos Salon. I knew nothing about facials and figured you sat in the chair and had some nice cream put on your face.

I am now regretting my tomboyish ways and bitterly resentful that nobody told me what a facial is REALLY like. Pure bliss, that is. So I'm going to share what actually happens.

I was led to a small dim room with a luxuriously made up bed that was really a cushy massage table. The blanket was velvety and textured over crisp sheets. I changed into a wrap for my top half to allow for shoulder massage. I climbed under the covers and relaxed until the gentle young woman doing the facial knocked and entered. A warm steam blower wafted moist air toward my face as my hands were massaged and placed in warming mitts. Relaxingly schlocky Victorian music played on Celtic instruments quietly set the tone. Fragrant cleansers, toners, deep scrubs with apricot pit or similar emollient (amid other lotions I can't identify) pampered my face in turn, separated by removals done with a steaming washcloth after it had rested on my face soothingly. With every application my tight, tense muscles loosened and softened. Then followed a facial and shoulder massage that must have lasted 20 or 30 minutes. I was a puddle of grateful ectoplasm by the time the final moisturizer went on.

After everything that has been going on, discovering a wholly unimagined pleasure in life came as a joyful surprise. It astonished and deeply affected me. This has cheered me and chased off some of my mounting depression. Ahhh, I needed that!

I do not have cancer!

I do not have an unusual form of emphysema!

I don't know what IS going on, but that beats the hell out of having cancer.

I was at the point of signing up my twins for the next available kids
yoga dance class. Fortunately, I looked at the general class calendar
and noted your hostility toward fat people before I made that mistake.
The suggestion that the point of exercise is to get rid of that "jelly
belly" or "lose that belly by belly dancing" rather than to increase
fitness is disturbing. You have assured me through your class
descriptions that my daughter would not be welcome in your classes.

Current nutrition and fitness research includes an approach known as
Health At Every Size (HAES). You might want to look into it if you
don't want to alienate potential customers.

Mary -------

I am scared of what is happening to my body.

Of what is happening to me.

Despite getting up at 5:30 every other morning to work out, albeit at a pathetic half of my usual (is it really former already?) pace, I am making grocery decisions based on which store has the best motorized scooter carts. I'm in burning pain during workouts, exhausted afterward and sore the next day as if I'm pushing myself hard instead of slacking.

I'm getting tested for cancer and emphysema.

For months I've been struggling with thoughts that I am making a mountain out of a molehill and hence won't be believed. I'm over that now. There's really something wrong besides laziness or deconditioning or hypochondria. I wish I could go back to the comfort of doubting myself.

Thanks to Susan Palwick for publishing Haunted and Ashamed in Grand Rounds this week, and to Sandy Szwarc for all of her praise and for linking Psyched Out from the best science blog I've ever read, Junkfood Science. I feel honored by their recognition, especially considering that I adore both of their blogs and read both every time they post.

UPDATE:

My stress test and a CT revealed no heart disease or cornonary artery disease. I do have a pulmonary nodule but after confirming that I have never smoked Dr. Godling seemed unworried and told me he'll be monitoring it every six months to be sure nothing's wrong, but they are usually benign. If he's not worried I'm not. I am upping my asthma meds and being scheduled to see a neurologist.

So someone at work anonymously posted the following NYT article
at work the other day, with pertinent sections highlighted. It addressed the culture of secrecy and frustration in the health care community since HIPAA has been ridiculously overinterpreted. This panic has been going on since about 2000. Even when it would benefit a patient, I can't talk to their relatives or partners who *regularly attend appointments with them* without a signed release "because of HIPAA." Check this out:

Hipaa was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply Hipaa regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information.

Experts say many providers do not understand the law, have not trained their staff members to apply it judiciously, or are fearful of the threat of fines and jail terms — although no penalty has been levied in four years.

Some reports blame the language of the law itself, which says health care providers may share information with others unless the patient objects, but does not require them to do so. Thus, disclosures are voluntary and health care providers are left with broad discretion.

The unnecessary secrecy is a “significant problem,” said Mark Rothstein, chairman of a privacy subcommittee that advises the Department of Health and Human Services, which administers Hipaa. “It’s drummed into them that there are rules they have to follow without any perspective,” he said about health care providers. “So, surprise, surprise, they approach it in a defensive, somewhat arbitrary and unreasonable way.”

I have believed what I've been told about HIPAA requirements, but apparently the extent of the law has been exaggerated. We take HIPAA privacy so far that we aren't even allowed to use full patient names in our internal emails to need to know staff. It's not like I'm going to argue with our corporate compliance officer, who can fire me. But it's good even in the abstract to know that the law isn't as short sighted and harmful as we've all been led to believe.

I was nervous all morning and downright anxious by the time I got to the office. Would my usually fat friendly doctor dismiss my problem as weight when my weight has been steady?

All the worry was in vain. Dr. A was his usual thoughtful, kind self. He listened to me seriously, thought, wrote out some referrals and explained that he was having me checked for heart trouble. Oh, and he tossed in a mammogram too because I'm forty now. Yippee. :/ So I got six tubes of blood and two xrays taken today and have appointments being made for me for the other tests. His description of the stress test relieved me somewhat because he said all they do is get your heart beating at a high rate and then you're done. He also said he had one and it was hard for him and everybody else he knew.

And then he said things no doctor has ever said before as far as I can tell from personal experience, media and the fatosphere.

"Weight is only a very minor risk factor for heart disease."

"Overweight people know they're overweight, why should I harp on it?"

" I only really address it with people when they are in immediate danger of dying. And there is only one disease that's true of, fatty liver disease."

"When I was just out of medical school I practiced with a doctor who didn't treat overweight people for their problems. He just said, 'You're fat. Lose weight.' That was so wrong."

So he officially No Ordinary Mortal. :)

My DH helped me put together this list for the doctor tomorrow, in case I get too embarrassed to talk about my health issues. One of the things I'm doing to cope with my shame and embarrassment is to blog it and kind of out myself. The best cure for shame is sunlight, I've found. Hiding it makes shame stronger, exposing it shrinks it back to a manageable feeling. So here's what I'm ashamed of:


1. I have to pause during even fairly trivial exertion, like
walking out to the car after shopping.

2. There is some shortness of breath with it, but nothing like asthma.

3. My stamina has gotten progressively worse since last year. I was
working out at Curves for the past year and had to quit because I was able to do
less and less. It's gotten so bad that I'm getting some sit down home exercise videos to keep
working out at a level I can handle.

4. A similar thing afflicted mom at about the same age. It was never
looked into or explained; she was diagnosed with COPD about 10-15 years
later, but was never really treated for it. They sent her to some
special COPD-oriented exercise classes, which helped a lot, but insurance
wouldn't pay for it, and it was too expensive to continue.

5. It's all-over-body weakness: exhaustion affecting upper body as well
as lower, torso as well as extremities, not a matter of just the muscles
that were exercising. At time it is so bad that lying down would be
better than sitting down for dealing with it.

6. But overall energy level isn't affected at all -- once rested,
it's easy to get back to normal. Overall I feel energetic and healthy.

7. There is no *general* fatigue affecting all of life -- *only* with
exertion. Not even a lasting fatigue from exertion; after a rest,
everything is back to normal.

8. It's all about stamina.

Now was that so bad to admit? :)

My mom's middle age overflowed with health issues dismissed as weight,and her death at age 63 was a result of one of them. I might write more about that in another post. Because my immediate concern is that history is repeating itself. When she was about 35, she started wearing out easily with minor exertion. She was increasingly slower and more out of breath doing everyday activities such as walking from the parking lot into a store. She was naturally told that it was because she was fat and dismissed. Like most fat women, mom was full of self hatred over her size. This went on for fifteen years until she had a stroke and was sent to specialists after recovering. One specialist noted her exhaustion upon exercise and diagnosed her with COPD, but DIDN'T TREAT HER FOR IT! He did refer her to exercise classes for people with similar symptoms, which she benefited from, but insurance stopped paying for it and it was about $400 per session. My parents could not afford it. So mom's condition was ultimately still ignored.

Now at age 40 it is happening to me. It's actually been coming on for over a year but it's getting bad. I can barely stay on my feet for grocery shopping. I have to stop and rest, ideally sitting down, during a short walk of a block or two. I feel ninety years old. I actually had
to stop my regular Curves workout because of the fatigue getting worse and worse. And it's bringing up fear and shame that I thought I'd overcome.

I've scheduled an appointment with my fat friendly doctor about it. I'm petrified that he'll dismiss it as a weight problem. This is actually unlikely, but as much as I trust him there will likely be other fat hating medical staff involved if he sends me for some kind of workup. I
feel humiliated at being such a stereotype of a fat person as doctors usually view us. I'm not sure I can stand the embarrassment of going through a stress test that I am sure to fail spectacularly. I am dreading the contempt of the testers as they view me as lazy and weak
willed. It brings back all of the hatred of my gym teachers watching me struggle and fail to be athletic, and encouraging other kids to tease me while I tried my best. And of course the best possible outcome is that it really is my weight. Because the other things it could be are not
pretty. So I fear either outcome.

The only thing that is making me go through with it is paranoia. And the only fact I know about my mom's bio dad other than that he abandoned her as an infant is that he died of a heart attack in his fifties. Mom saw his obituary in the paper. So I'm facing my fears and seeing the doctor. The price is shame and embarrassment and the dread of humiliations to come.

This despite my devoted fat acceptance activism and basic belief that my size is okay and not biologically subject to change. My family did not teach me to hate myself or put me on constant diets. I looked at magazines and in the mirror in seventh grade and decided with a shrug that the beauty rules did not apply to me, so I focused on things I could control like my education and music. So I'm even feeling ashamed of my shame.

I don't know what to do with all of this emotion, but I thought people might be interested how quickly my fat acceptance falters when I am faced with the hatred promoted by the "obesity
epidemic" warriors.

I started this as an anonymous blog, but I haven't really written anything requiring that anonymity. So I'm putting myself out there. Rather than freeing me to post whatever I wanted, the anonymity focused my blog too narrowly and made me reluctant to write about some of the things I care about. I didn't want to risk blowing my cover. Which made my posts infrequent and cautious. That's about to change.

I'm a dedicated social worker, but there's more to me than my job. I've decided to add my voice to the fatosphere, for one thing. There are few enough of us as it is. So this is officially a fat acceptance and health at every size (HAES) blog now. And I have deeply held moral and political convictions that I would like to write about. I've expressed some of them rather indirectly as they apply to work, but that's not the same as a straightforward political post.

Thanks to those of you who have read my blog even when I was slacking, your comments have meant a lot to me.