Crying in the Exam Room
A patient I’d known for twenty years called to let me know her daughter was coming in to see me. She reminded me it had been eighteen years since I’d delivered her “baby girl.” I began to feel old, and I knew right away this was going to be a difficult appointment. For me. Baby Olivia had just returned from her first year of college. After gaining the traditional “freshman fifteen,” she had begun to suffer the effects, with her menstrual cycles becoming painful and irregular. One month she would miss her period, and the next bleed heavily for fifteen days. The cramps were so severe, she sometimes had to stay in her dorm room in bed. Her grades and social life had deteriorated. An ultrasound confirmed the obvious culprit, ovarian cysts. But I knew the underlying problem was her weight gain. Fat tissue can throw off a woman’s menstrual cycle; it introduces excess estrogen into the hormonal milieu. A high school cheerleader, Olivia had entered college almost underweight, so she wasn’t medically obese – just overweight for her small figure. As I reviewed the photos from her ultrasound, I debated with myself about how to broach the subject. No woman responds well to critical conversations about her weight, particularly a young woman struggling emotionally with the reflection she sees in the mirror. But I was confident that my extensive experience as a board certified OB/GYN, coupled with a natural soft touch with the opposite gender, gave me the requisite skill set to negotiate the conversational landmine. Olivia’s mom would be grateful she sent her daughter my way. Olivia began to sob as soon as I opened my mouth. Every exam room has a box of tissues for when my “conversational skill set” falls short. I handed Olivia some tissues and apologized for hurting her feelings. She reassured me it wasn’t what I had said that bothered her. She told me her story. Roommates Share Olivia and her roommate Sara started the year best of friends. They studied and ate together and went to parties with each other on the weekends. They even shared each other’s clothing. The stress of schoolwork and being away from home took its toll on Olivia. Sara was always ready to listen. Sara always had had snacks in the room – Oreos, Pop-Tarts, Doritos, Hershey’s chocolate and Coke. Olivia was free to help herself anytime she wanted. The comfort food made Olivia feel better. Any time Olivia was upset, Sara handed her something yummy. As the months went by, Olivia’s weight crept up, and her clothing became tighter. In her second semester when her periods began going haywire, she resigned herself to wearing sweats and baggy shirts. Sara kept her petite figure the entire year and took full advantage of Olivia’s unused clothing. It was toward the end of the school year that Sara made a shocking confession. She had filled their dorm room with snack food and encouraged Olivia’s overindulgence so Olivia would not fit into her clothing. “You had such nice things to wear, I couldn’t resist,” Sara told her with a laugh. Olivia’s problem wasn’t just weight gain; it was also an evil roommate. Life is painful enough without betrayal from those you trust. And yet betrayal is at the root of many of our medical problems. Making You Feel Good Smoking is a good place to start this conversation because most of us know it is the number one lifestyle choice that adversely affects our health. We know cigarettes are bad, but many continue to smoke. That’s because cigarettes are addictive. Yes, they lead to cancer and heart disease, but there is undeniably something about them that makes us feel good. Despite thirty years of evidence showing that the tobacco industry was not only purposefully increasing the addictive properties of their product, but also marketing them directly toward children, the tobacco industry successfully fought off all litigation. By the 1990’s, astronomical amounts of money had been spent caring for patients whose illnesses were the direct result of tobacco abuse. These were dollars often directly funded by the taxpayer as Medicare or Medicaid expenses. Finally, Attorney Generals from multiple states successfully brought a class action lawsuit, and in 1998 the tobacco industry agreed to pay 206 billion dollars to the states over twenty-five years. They also agreed to get rid of advertising icons, such as the Marlboro Man and Joe Camel, specifically designed to attract and addict the next generation of smokers. After smoking, what we choose to eat is the number two lifestyle choice that adversely affects our health. The typical American diet leads directly to obesity, heart disease, cancer and stroke. Many of the products sold on the shelves of our grocery store or in restaurants are virtually addictive. They don’t create a physical addiction in the same way that nicotine does, but in the book Salt Sugar Fat, author Michael Moss details exactly how the food industry has focused on creating mouth-watering products that are essentially irresistible. In 1990, Philip Morris, the tobacco giant responsible for almost half of the cigarette sales in the United States, purchased food giants Kraft and General Foods, and with these acquisitions began to control ten cents of every dollar Americans spend on groceries. Consuming salt, sugar, and fat, in the right combinations, with the perfect “mouth feel,” is like smoking cigarettes. And that’s why it’s impossible to eat only one Dorito or Oreo or McDonald’s French fry. The Pillsbury Doughboy, the Keebler elf, and Ronald McDonald smile like old friends but are actually evil roommates. New Choices I recommended a plant-based diet for Olivia, so she would become healthy again. I alerted her that if she didn’t lose the weight, she might suffer from infertility or eventually need surgery. Anything wrapped in plastic, containing sugar, fat, preservatives, or artificial flavors, was off-limits, no matter how delicious. The change would be tough at first, but the choice would prove life-changing. I also began
