The start of a journey

So, about 8 years ago I was diagnosed with Hashimoto’s thyroiditis, which means my body has created antibodies that decrease the effectiveness of my thyroid. I take levothyroxine daily because of this. It helps with my mood (I get really depressed when I don’t take it for a period of time), as well as increasing my metabolism.

That’s the problem with this medication, though. There was a time when I was a svelte 165lbs. I gained nearly 30 by the time I was diagnosed. You see, Hashimoto’s is more common in middle-aged women, not 21 year old men. No one looked for it. It was my diet, they kept saying. Changed things, but the pounds kept coming.

When I started on levothyroxine, however, I noticed that my metabolism kicked into overdrive. Yes, I was theoretically burning what I was consuming, but then I was constantly hungry. And the weight continued to add up.

When I started intern year, I more or less stopped the levothyroxine because it was hard to stay on schedule. Well, I restarted it after about 7 months away when the mood symptoms were creeping back and becoming a nuisance.

Guess what? The constant hunger came with it and the weight kept coming back up. I’m not going to stop medication that has such an important impact on my day to day wellbeing.

I tried eating a high protein diet, which helped control some of the hunger, but it was still very much present and still I was gaining weight.

In short: I need to control the food cravings. So I took a step I hadn’t before: I spoke with my doctor. Being a physician myself, I know of the various medications and treatments available to help with obesity, and given the myriad negative health outcomes linked with obesity, it was time to take action.

So I started taking phentermine yesterday. This medication is definitely not for everyone, and I am very hesitant to recommend it to many people. After a day and a half, I already can say there is a difference in the hunger. I still need to eat, obviously, but I’m not feeling that urge to snack.

Starting weight: 232.8 lbs. Goal: 200 lbs. I’m not looking to be rail thin, but I need to be closer to a healthy weight.

After everything my wife went through these past few months, she decided to get a tattoo to celebrate conquering her personal mountain. This is the result.

“While we at the AAFP represent family physicians, our highest priority is improving the health of patients, families and communities. When the top public health agency in the country is - in an unprecedented move by the administration - required to temper its reliance on evidence-based medicine, the health of the public is at risk.”

Fuck them. Fuck them all. I previously have been a very measured voice of opposition, but now it becomes personal. “Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden words at a meeting Thursday with senior CDC officials who oversee the budget, according to an analyst who took part in the 90-minute briefing. The forbidden words are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.” In some instances, the analysts were given alternative phrases. Instead of “science-based” or ­“evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes,” the person said. In other cases, no replacement words were immediately offered.”

Me, Too

Every day we learn of a new man who has been accused of sexual misconduct. It is sad to see how rampant it is, but at the same time, it is no surprise. Yes, I am a man and frankly was mostly blind to it, but more and more in the last few years, I have seen the blatant sexism throughout my professional sphere.

There was the urologist who turned to the nurse after doing a penile implant and asked if it “looked good enough” for her.

There was the surgeon who directly stated to me that the female students on service with me were good, but would be better nurses.

I have literally stood there and watched my senior resident be called a nurse despite her having introduced herself as Doctor.

I personally know women who have been pressured into sexual acts as part of their job.

Unfortunately, I am complicit in standing by and not speaking up when these things happened. And that makes me guilty as well.

I really do regret not standing up for my female colleagues more. Even though I knew that none of what I saw was acceptable, I was also in a position where speaking out could hurt me professionally as well.

THIS IS HOW MISOGYNIST CULTURE PERSISTS.

When we stand by and don’t speak up, despite the risks to our own careers, we perpetuate the situation.

So I will be more assertive in fighting back. Because in order to build the society we want, we all have to work together.

Sunset in 3 Pictured Rocks National Lakeshore, May 25, 2017

On being a patient

Someone once told me that the best doctors have also been patients. This, I believe, is very true.

It helps build empathy when you send your patient for a test. You can better explain what certain tests feel like, or help dispel fear about that CT scan. You can better relate to taking medication every day and understand how/why people forget doses.

I am 28, just shy of 29. When I was born, I had a congenital deformation of both of my legs where they were internally rotated at the knees by 90°. The surgeon who fixed them said that it was a chance I wasn’t going to walk normally, but that fortunately never panned out.

I used to have numerous incidents of reactive airway disease. I was hospitalized usually twice a year from it when I was in primary school. There was one case where I was at my pediatrician’s office and had a coughing spell so serious that I went apneic. I was about 7 at the time. I remember starting to cough and then being in an ambulance. I don’t remember the interim where I turned pale and cyanotic per my mother.

When I was 15, I discovered a lump in my left testis. Freaked me out, understandably. Fortunately it was a varicocele that was easily repaired. But then I developed a hydrocele that had to be repaired. Then I had a surgical site infection. That was brutal.

At 21, I was diagnosed with Hashimoto’s thyroiditis. I had gained 40 pounds in a matter of 3 months. My TSH was 33. I have been on replacement hormone ever since. Still haven’t lost that weight sadly.

In short, I understand the fear in my patients. I have had nearly every test a male could have done. I take daily medication (when I remember).

Being a patient can be very scary, but having true empathy for your patients can be just the thing they need to get them through.

“Rest” Indiana Dunes State Park, May 13, 2017

Virology: A Primary Care Tale

Our marriage summarized in 2 pounds of ham