A Big Fat Problem

Story Time:

On the 2oth, right in the middle of this Covid-19 pandemic, my throat started to hurt. I brushed my teeth three times that day and used mouthwash after every time I ate something, but the morning of the 21st, I realized I needed to get in touch with a doctor somehow because I was likely coming down with strep throat- swallowing was more difficult than normal, and when I was talking to my cats (I do this, so what?), I noticed I was swallowing a lot more than usual, something that happens when I have strep. I tried to avoid going into a clinic, since I know they're bogged down and stuff, but since my primary care office was closed (it was a Saturday), I had to go to an urgent care clinic. I've been to this location probably seven or eight times at this point, and the clinic itself is lovely, but I did feel bad taking up their time during all of this chaos. Still, I chose this location specifically because they'd have record of a lot of my past bouts with strep and, hopefully, that would expedite the process.

The nurse and I were joking around (I always try to be fun with healthcare professionals) when she was getting my temperature and doing my throat swab for the strep test, and when I told her my history with strep and the exact prescriptions and dosages I was hoping to get from the doctor to alleviate my symptoms, she was impressed. "Wow, you know exactly what you need! You'll be out of here and feeling better in no time!"

She was also impressed with how I handled the throat swab- "Dang, I can tell you've done this plenty of times before, you didn't even flinch!" 

Her confidence in the care I was about to receive had me in a pretty good mood when she left the room with my throat culture sample, and I felt relieved.

Then the doctor came in, and her first words were, "The test came back negative, so you just have a sore throat." She was terse and rather than make eye contact, she was looking me up and down,  lingering on my stomach a lot.

"I was expecting that, but let's send the sample out," I said, trying to be cheery. "Pretty much every time it goes to the lab after being negative in the office, the lab calls me back and says they got a positive result. It's in my chart, if you want to take a look."

"If you insist, we can send it out." Another pause to look me up and down. "Let's check your breath." She spent a long time on this, which I understand, given breathing problems is a big part of Covid-19. When she felt my neck, her fingers barely touched my skin, and it came across more as for show than any sincere effort to find out if anything is actually swollen. When she looked in my throat, it was for less than a second, and she immediately turned her back to me and said, "You don't have spots, so you don't have strep."

"Again, that doesn't surprise me, but I've had positive lab results without spots plenty of times before, so in my experience, that doesn't rule it out. It's all there in my chart, if you'd look at it really quick. If you'd just prescribe me an antibiotic now, I can avoid having to go back to the pharmacy once the lab results come back. The less I have to go out during all this, the better, right?"

"Well I think you just have a sore throat, so I'm not giving you an antibiotic." She folded her arms across her chest while turning back to me to stare at my stomach again, and she pointedly made no effort to move towards the computer to look at my records.

"Ok, well, if you look at my history, you'll see how often the rapid tests are negative and the lab ones are positive, so are you sure we can't just be proactive here?"

Looking me up and down again, still not at the computer, "You don't have strep. You have no fever, no spots, your lymph nodes are barely swollen. You just have nasal drip or something." She shook her head back and forth really quickly a few times to emphasize her frustration.

"Look, it's true, I get nasal drip, but this is beyond that, I can feel it. I know what my body's trying to tell me, I have some sort of infection. Maybe not even strep, but a sinus infection, at least, since they often start out like this, too. Please, just look at my chart and you'll see this happens to me all the time."

She rolled her eyes, unfolded her arms, and stepped to the computer. I let out a little sigh of relief, which she heard and gave me side-eye for. Then a second or two later, "Well I see here you have seasonal allergies, it's probably just that."

"Atually, my allergen hasn't even been pollinating-"

"I'm going to re-prescribe your antihistamines to stop the drip, since it's obvious this is just your allergies acting up, and I'm going to give you a spray to numb your throat." Lazer eyes.

"I'll take the allergy meds, since I can always use more of those, but my allergies aren't what's causing this, I know it, so I don't really NEED-need them right now. And ma'am, I'm going to have to say no to the spray. Those don't do anything to reduce swelling and only hide inflammation, not get rid of it. I want something to actually stop the swelling and inflammation, and if you're not willing to give me an antibiotic, can I at least get a steroid to do that for me? Prednisone has always worked to actually end the symptoms, especially when paired with Amoxicillin or something." (Amoxicillin is a fairly strong antibiotic; Prednisone is a steroid.)

"I'm not giving you Amoxicillin, but I can give you Prednisone if you don't want a spray."

"Ok, thank you."

"I'll go put that in and be right back."

The door closed exponentially louder behind her than it had the nurse.

It wasn't until I was home with my Prednisone that I realized it was the weakest dosage I've ever received. And since I wasn't even very congested at that point, and no, my allergies were not acting up, the allergy meds did nothing. The lab results did come back negative, but that weak steroid dosage wasn't strong enough to even reduce, let alone eliminate, the swelling.  So here I am, six days later, and I feel worse. My throat is more swollen, I have some spots on my throat now, the inflammation has spread to a larger area, and I'm pretty sure I have at least a bad sinus infection, if not also strep, because now I am congested and I've had a constant sinus headache since yesterday morning, plus that kind of mildly foggy feeling that accompanies either strep or sinusitis. There was even a little blood in the gunk I coughed up this morning (something I'll get to in a second). 

Exposition Time: 
I mentioned before that strep is a Thing I deal with a lot, but didn't go into the nitty-gritty as to why. There's a sort of long history that's catching up to me, now that I live in a place with grass, so if you don't mind....

When I was a kid, I got various throat infections a lot, likely due to my crappy sinuses. I've had nasal drip pretty much my entire life, to some extent, and it comes as no surprise that this leads to inflammation or worse in my throat. In particular, I came down with strep throat a few times a year, without fail, but for this, that, and the other reasons, my tonsils were never removed. So, every infection led to more scar tissue and damage on my tonsils. By this, I mean that while a healthy tonsil looks more like a golf ball, mine look more like peach pits now- lots of deep crevices and literal holes in which anything going down my throat (nasal drip or otherwise) can get stuck. Add to this the recent revelation from an ENT that my tonsils never shrank, it's pretty easy to understand how a small sinus issue can turn into a big throat one- I have abnormally large tonsils, each with their own networks of Grand Canyons in which bacteria can fester and multiply. And unfortunately, there's only so much that a good oral hygiene regimen can do for me to reduce the gunk- it helps, but it can't prevent infections entirely. My tonsils are just too messed up and there's just too much drip for that. I cough up a glob of mucus every morning (and during the day, if I need to) and use alcohol-free mouthwash to kill bacteria, but I can't get everything out of my tonsils all the time. I take expectorants like Mucinex to thin the stuff out a lot, too, but that only does so much, as well.

I'm also severely allergic to grass. So much so that multiple allergists have said if it gets any worse, I would need to carry a rescue inhaler- and I've never had anything resembling asthma in my life. Now, this wasn't a huge problem for me when I was growing up, since I lived in Las Vegas, where it's just, y'know, dirt. But once college happened and I moved to greener areas, my sinuses got exponentially worse, and I was diagnosed (again, multiple times) with varying forms of chronic sinusitis/sinus infections as a result of constant exposure to grass pollen. So, my sinuses are making more mucus now, which means more gunk is sliding down my throat, which means more gunk is getting stuck in those crevices, which means more throat infections. For the past three years, I've had strep on average about a half-dozen times- each. Not overall, each. Each year.

Me, trying to sleep on the couch to
elevate my head and reduce the sinus pressure

Due to the nature of the infection, strep isn't the kind of thing I can anticipate and schedule an appointment in advance for (at least no more than twenty-four hours), nor are sinus infections. And since I work hourly and have hardly any sick time (the state of Washington mandates it for everyone, but it's reeeeeeeally slow in accruing), the best I can do is bounce around urgent care clinics. And thus I have never seen the same doctor twice for throat issues. This is why I've made a concerted effort over the last year to go to the same one every time, so that they'd have an ongoing record of all of this crap to use as a reference. But, even though I've been there a bunch of times, for whatever reason, I still keep seeing a different doctor every visit.

The first few times (in the past couple years) I was diagnosed with strep, I waited until the symptoms were all-consuming before seeing a doctor, until the fever and full-body aches and being unable to swallow or talk was making me basically non-functional and "look like death" (according to a boss that sent me home on one such occasion). So, understandably, the rapid strep tests done in the office those times came back positive, and I was immediately prescribed steroids to reduce the swelling and inflammation (once even given a shot right then and there, which was just. MAGICAL.) and antibiotics to get rid of the infection. But I'm a grown-ass woman, and I know my body. So I've become pretty damn adept at telling when it's starting to fester, and now I go the moment I start suspecting it's happening. I don't think it's a coincidence, then, that I haven't had a positive in-office rapid test result in two years.

But.

Only twice did the result once my sample was sent to the lab (something you can request if you think it was a false negative, or if there are symptoms pointing to strep but the original test was negative) remain negative. In other words, I've become good enough at detecting when my body is coming down with strep that I get into the doctor before it's severe enough for the quick test to show it, but once they let it grow in a Petrie dish, my samples come back positive. And those two times it didn't come back positive, I was still diagnosed with a sinus infection, so I was still on the right track. 

And this, friends, is where it gets hairy. 

Because in all these times (at least a dozen at this point) that the rapid test came back negative, there's been a pretty even split between doctors that took me seriously and doctors that didn't. This has led to a direct correlation between how seriously I'm taken and how quickly I feel better. And I think a major contributing factor is

BECAUSE I'M FAT, I'M FAT, COME ON,
YA KNOW!

I'm overweight; it just is what it is. And I genuinely believe this is impacting the quality of care I've been receiving. 

It's a known fact that there are myriad biases in medicine. Gender, race, and general heuristics/shortcuts  can impact how a doctor interprets symptoms and how well they actually listen to their patients, as well as influence the steps the doctor decides are necessary. There is a reason black women are more than twice as likely to die giving birth than their white counterparts.  

And unfortunately, weight is another basis for discrimination in the doctor's office. Life-threatening issues unrelated to weight get ignored in favor of diagnoses more easily linked to obesity; discussions, no matter where they start, always get looped back to how losing weight will fix the problem; overweight patients don't even get the chance to explain what they're going through before doctors assume their only problem is their size. This leads to not only inadequate care, but also frequently results in disengagement with and avoidance of the healthcare system on the part of overweight and obese patients. 

So in light of this, think about that interaction I described with the doctor at the urgent care. While sure, I have no doubt she was at least partly frustrated because some crazy lady insisted she had strep during a global pandemic and oh! look! the rapid test was negative; her body language and the way she kept looking me up and down (especially the lingering on my stomach) left no room for doubt in my mind that my weight was a huge factor in her treatment of me. She made hardly any effort to really check to see how swollen my throat actually was and wanted to prescribe me something that has nothing to do with swelling (the spray), even though I was there because my throat was swollen and I was having a harder time swallowing and talking than normal. She was visibly annoyed at my insistence she simply look at my medical history. She would not listen when I tried to explain to her why I was certain I had some sort of infection. She prescribed me allergy medicine I explicitly told her I did not need, and gave me a super low dosage for the one thing I asked for that she was willing to give, the Prednisone. And even though she insisted it was allergies, she never even bothered to ask me what I'm allergic to, even cut me off when I tried to tell her. 

She's not the first doctor to insist all I had was just a "sore throat." She isn't even the first to prescribe me a numbing spray, which is why I knew it wouldn't work and put my foot down with her. Other doctors, even if they admitted my lymph nodes were swollen, have fallen back on my allergies and nasal drip and said all I needed was to numb my tonsils and it will pass. Never mind the fact that, again, sprays like that don't reduce swelling or stop inflammation- they literally just numb the area, hiding the symptoms, not ending them. Twice, when I was feeling sicker than I did with this most recent doctor and thus didn't have the energy to fight the doctors on those occasions over the spray, I called my pharmacy as I was leaving and told them not to bother with it. Both of those times, I got a phone call two days later saying my lab result was a positive strep test. THEN I went to the pharmacy, to get my antibiotic. Both those times, it was around two weeks before I felt entirely normal again. 

Me, to these doctors

In contrast, when doctors listened to me and understood, even if the lab result took three days to come back as positive, by then I would at least already be feeling a little better, since they had prescribed me much stronger courses of Prednisone- one even scoffed at the idea of a spray when I brought it up with him, asking him why he didn't try that ("Those don't do shit for swelling, as you know!"). Each of those times, I felt fine and was more frustrated I had to stay home for twenty-four hours while the antibiotic kicked in (twenty-four hours is the standard time for an antibiotic to eliminate the possibility of infecting others) because I was feeling mostly normal by the time I even started said antibiotic.

How I felt every time I left these doctor visits

So What?

I would think it's fairly obvious why this upsets me. On a personal level, I'm in pain and feel like crap because that doctor wouldn't listen to me. Because at the very least, if she had given me a stronger course of steroids, my throat wouldn't hurt nearly as much as it does right now. And it also felt super shitty to be so overtly judged and dismissed for my size by someone who is supposed to want to help me, especially when in direct contrast with the positive way the nurse responded to my needs- she seemed totally confident I'd walk out with antibiotics and a steroid, and she verbally praised my knowledge of my body's needs. Going from the nurse to the doctor was a complete 180, and it was emotionally harrowing. 

On a greater level, like I said before, it's common knowledge that this is a Thing, even if it doesn't get, like, huge coverage in the media. And I stand by all my fat brothers and sisters in declaring this unjust. I shouldn't have to say this by now, but there are lots of reasons for people's being overweight, and it's not always lifestyle choices. At one point, my primary care doctor told me I would never be under a size twelve, which is considered "plus-sized," because of my build, genetics, and metabolism. I had been dieting and exercising "like I'm supposed to," according to the cultural zeitgeist, but she told me to stop because I would never get down to a size close to what I wanted (I was hoping for a six or eight), and there was no point in being miserable about my body AND my desire to eat a fucking cheeseburger- I may as well eat the cheeseburger, she said, otherwise I would just be more miserable, plus could actually put myself in danger, since my body is not set up to be that small. And I know this is a factor that often gets glossed over, that some people are just bigger by nature.

Discrimination like this is unkind at best, and dangerous at worst. And I use that word deliberately- discrimination. Because us bigger folks, our rights as patients are being ignored or flat-out denied simply because of how we look. We deal with marginalization in so many other areas of our lives, and having it take place in the area that is meant to keep us living is tragic. We shouldn't avoid care because we're afraid of being judged. We shouldn't get sicker because we're being ignored. We shouldn't die because we weren't taken seriously. Nobody should, for any reason.

Caveat(s):

1) Ok, so I know the timing of this rant is pretty shitty- there's literally a global pandemic on the loose, yeah. And believe me, I am 100% on the side of healthcare workers in the face of this Covid-19 crisis. My heart goes out to them now, and if there was ever a time to make the argument health care workers deserve hazard pay, now is it. 

But. A clinic being busy is no excuse for discriminatory service. I would hope this isn't a controversial statement, but who knows? I can totally see a bunch of death threats coming my way because I'm not supporting our troops healthcare workers right now. But honestly, if they do, it would just prove my point, that people don't give a shit about fat people, and that the biases and prejudices that lead to this uneven care are justified by society as a whole.

2) There's hope for my immediate recovery. I have to jump through some hoops, but provided my throat doesn't swell shut before then and I end up in urgent care once more, I have an appointment with my primary care doctor Monday morning and that aforementioned ENT Tuesday morning. Between the two of them, I should be able to get what I need. It's just shitty it's going to take this many talks/visits to get what I could have had from day one. 

You, right now

I know, and that's kind of the point. I'm lucky I'm going to (eventually) get what I need, and it shouldn't be that way. But it is what it is. Sucks, doesn't it?

Fin.