My primary doctor has me MAD!! Think it's time for a new one...

[SleeveToBypass2023 2,637]

So my doctor has me seriously ticked off. She told me she'd like to see my weight and bmi down. I said "WHAT???? I weigh 183 and my bmi is 30. What's wrong with it???" She told me she wants to see my weight around 155 or 160 and me at a normal bmi.

I was like "if I do that, I'll look sickly!!! I've always been bigger boned and somewhat curvy, I carry my weight differently. Not one person would look at me right now and think I look like I weigh 183. No way would I look healthy if I went down to 160" and she said it would be better for my health and I should at least think about it. I told her "my blood pressure already runs on the low side of normal. I struggle to keep it up to 103/55!!! My A1c is 5.0 and my glucose is 96. I'm not on any meds except what I take for my MS. All my labs come back perfect. What else do you want??" I told her I feel amazing, I'm really active, I'm able to work as a clinical medical assistant for a busy specialty practice (infectious disease) which has always been my dream, I hike, I work out, literally I'm living the life I only dreamed about. What am I missing here????

I was so mad. And she said we'll discuss it at our appt on the 17th. I said "oh we'll discuss some stuff, alright, but that ain't happening". She's going based off my height, weight, bmi, and their supposed "ideal weight" BS. My bariatric surgeon is ecstatic with my progress. He actually said I've lost more, with both surgeries, than he realistically expected that I would. My neurologist is thrilled because losing all the weight has significantly improved my MS symptoms. My gastroenterologist is thrilled because all of my GI issues have gone away. Just this idiot yahoo isn't happy. I definitely think I need a new doctor. This is just too much.

For reference, here's what I looked like when I first started seeing her, and here's what I look like now, literally this week....as in Monday and yesterday.....

Edited July 3 by SleeveToBypass2023

[catwoman7 11,216]

BMI isn't always the best way to judge for people who've lost massive amounts of weight because even though we've lost muscle and bone mass in addition to fat, we still have more muscle and bone than "normies" who weigh about the same but were never obese. (we needed a lot of infrastructure to hold up all that weight!). The PA at my bariatric clinic said we often look 10+ lbs lighter than the scale would suggest, because of that extra muscle & bone (well, there's the extra skin, too - but skin doesn't weigh very much. I think I "lost" about 4 lbs after my skin surgery - but there's that, too, if you haven't had it removed). Your PCP evidently hasn't worked with a lot of massive weight loss patients....

[MrsFitz 441]

You don’t look the same person!

You’re not a ‘tick-box’ exercise, you’re an amazing person who has managed something so few would ever. Does this physician actually know you? Has she been with you from the beginning of your journey?? Has she cheered you on? Congratulated you? Supported you? If she hasn’t then find another. No one should have such negativity when they have achieved so much success and have other medical professionals being so happy with everything too. Don’t let this person rain on your parade, go out and dance to Celebrate your successful journey instead 😉

[catwoman7 11,216]

I agree with Mrs. Fritz - anyone who started off at well over 300 lbs and is now under 200 lbs should be celebrated..that is an amazing loss!

[FifiLux 464]

I am not surprised you are ticked off. You know what is right and working for you now and stick to that. You are not doing anything wrong and have much such changes in your life to get to where you are, well done.

My surgeon is the opposite and he told my target should be 75kg/165lb and I said 66kg/145lb so as to be in the healthy range on BMI chart. His response was to not fixate on the BMI chart and just be happy and healthy. He said he thought I would look older and less healthy if I lost too much more weight. My GP doctor said similar about being happy and healthy.

We agreed to reduce my target to 70kg/154lb but I seem to be stuck at 72kg/159lb anyway! I do think now that the target I set myself is probably not the best for me, as my bones and brain probably weigh 70kg 🤣🤣

[catwoman7 11,216]

18 minutes ago, FifiLux said:

My surgeon is the opposite and he told my target should be 75kg/165lb and I said 66kg/145lb so as to be in the healthy range on BMI chart. His response was to not fixate on the BMI chart and just be happy and healthy. He said he thought I would look older and less healthy if I lost too much more weight. My GP doctor said similar about being happy and healthy.

this is more a response to what you said rather than the general focus of the post, but I just wanted to say that when I weighed 170ish and told my clinic's dietitian that I wanted to try to get down to 150 (which at 5'6" is within the normal BMI range), she told me that was a bit unrealistic because only about 10% of their patients make it to a normal BMI. The rest end up in the "overweight" or "stage 1 obese" (which is not very obese) categories. Research actually does back that up (I checked). I DID actually make it down to 150 - well actually down into the 130s. But at nine years out, I'm now slightly "overweight". But that's where they wanted and expected me to end up anyway, so I guess I'm OK with that (I'd still like to be around 150 +/- though - but it's hard to lose weight when you're pretty close to a normal BMI!

[BigSue 1,389]

Wow... You are absolutely right that you need to find a new doctor, because this one clearly has no understanding of extreme weight loss patients or about weight/BMI in general. I could almost understand if she didn't know how big you used to be, but if she knows you went from 421 pounds to 183 and still doesn't think that's enough, she is woefully ignorant. It's not just a matter of principle, here, but the question of whether she is knowledgeable enough about extreme weight loss to treat you effectively. She should be embarrassed that you, the patient, had to educate her on the fact that the number on the scale/BMI chart means nothing on its own. The only hope here is that this could prompt her to educate herself on weight loss.

[ShoppGirl 4,879]

I would ask her what specifically does she think will improve if you lose weight but I am pretty confident she wouldn’t be able to come up With one thing. . She sounds like one of those people that does cookie cutter medicine and it’s better ypu find that out now then when you have an issue that is outside of the box because we are all unique And she obviously doesn’t see you that way.

[SleeveToBypass2023 2,637]

Thank you all so much. I was so taken aback by this entire conversation. She even had the gall and AUDACITY to ask me if I wanted to try phentermine!!! PHENTERMINE!!! I told her that not only would I never ever take that, I would be finding a new doctor. For her to KNOW about the cardiac issues I had after my hernia surgery in December and then suggest a medication with known cardiac implications....I can't fathom what was going through her mind.

She said to me that if I felt better at maybe 170 instead of 155 or 160, she could maybe see if that would be ok. I said "Ok with WHO?? It's MY body, and I'm ok with it as it is now". She said I've come so far and made so much progress that it seems like such a shame to not get myself to a healthier and more normal weight and bmi. I explained AGAIN that I lost 238 pounds from my highest weight, which is what I weighed when I first came to her. I reminded her that SHE REFERRED ME TO THE BARIATRIC SURGEON. I reminded her that I've lost 205 pounds since my first surgery.

I've done enough. I've gotten off all of my meds that I wanted to, started the career I wanted, became active and started doing all the things I wanted to. I have my life and health back. There is NOTHING else I need or want to accomplish, besides plastics in a few years.

She didn't use to be like this. She was an amazing doctor. But for some reason, she's jumped on the BMI bandwagon and decided that it's the only way to judge if someone is healthy. I can't get behind that, and I can't tolerate this from her anymore. Definitely looking for a new doctor.

[ShoppGirl 4,879]

Your bmi is 30.45. I looked it up. And if you lose just 3 pounds you would be 29.95 (below 30) Do you know the prescribing criteria for that drug.according to several websites your iBMI has to be over 27. From 27-29 you must have a comorbidity. Only at 30 can they prescribe it without a weight related issue. Unless your heart issue is considered one of those comorbid issues that losing weight would help with then you just need to lose three pounds and she will have to leave you alone. lol. I joke but my point is that you are so close that even if BMI was accurate representation for everyone for her to be pushing this is just so absolutely absurd. I mean three pounds could be a bowel movement. It would be one thing if you were driving this but for her to push it under these circumstances doesn’t make any sense to me.

This is copied from the package insert posted on drugs.com

Phentermine Hydrochloride is a sympathomimetic amine anorectic indicated as a short-term adjunct (a few weeks) in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity for patients with an initial body mass index greater than or equal to 30 kg/m 2, or greater than or equal to 27 kg/m 2 in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia).

Oh and also, I took that stuff when I was like 19 and I had no history of heart issues in myself or my family and they still made me do an ekg so I hope she at the very least planned to do that?? I totally understand why you are mad I would be too

Edited July 4 by ShoppGirl

[Arabesque 7,335]

Doesn’t she know that BMI is widely discredited these days? All it should be used for is as a guide not a rule. One of a number of tests & data sources to inform a person’s health & risk for health issues including waist size, height to waist ratio, blood & glucose tests, dexa scan & any other relevant medical tests.

I found these 2 articles with a simple google search (BMI efficacy). There were lots.

https://www.urmc.rochester.edu/news/publications/health-matters/is-bmi-accurate#:~:text=Studies%20have%20also%20shown%20that,is%20inconsistent%2C”%20Russell%20says.

https://www.medicalnewstoday.com/articles/265215

[Dchonlee 212]

What!?? Youve made major strides and look amazing!!!!!!!!!!! I agree, if you go any lower you may not look like yourself.

I’m so inspired by your journey!!!

[SleeveToBypass2023 2,637]

Even though it's 4th of July and everything is closed, I'm doing some research today on new doctors that actually have knowledge about massive weight loss in patients who have had bariatric surgery. I plan to make some calls on Friday and set up a new patient appt or 2 (this time around, I'm interviewing them before I commit...neve ever thought I'd be doing THAT, lemme tell ya).

I wasn't going to go to my appt on the 17th, but I think I still will to get my blood work done and my vitals, and to tell her that I'm seeing a new doctor and why. Actually, I want to tell the medical assistant because she'll put it in my chart. At this point, I'm not sure if the doctor will. I know I'm due for my 6 mo ekg in office, my full vitals, my meds refilled, and my blood work. I want all of that done before I go to a new doctor so they have the most recent and up to date records on me and the most accurate place to start.

I will NOT be entertaining any discussions about phentermine or losing more weight. I may go ahead and lose those 3 pounds that @ShoppGirl mentioned, that way nobody can say anything either way. But still.... I'm leaving that practice no matter what. I'm not happy or comfortable there at this point.

[ShoppGirl 4,879]

2 hours ago, SleeveToBypass2023 said:

Even though it's 4th of July and everything is closed, I'm doing some research today on new doctors that actually have knowledge about massive weight loss in patients who have had bariatric surgery. I plan to make some calls on Friday and set up a new patient appt or 2 (this time around, I'm interviewing them before I commit...neve ever thought I'd be doing THAT, lemme tell ya).

I wasn't going to go to my appt on the 17th, but I think I still will to get my blood work done and my vitals, and to tell her that I'm seeing a new doctor and why. Actually, I want to tell the medical assistant because she'll put it in my chart. At this point, I'm not sure if the doctor will. I know I'm due for my 6 mo ekg in office, my full vitals, my meds refilled, and my blood work. I want all of that done before I go to a new doctor so they have the most recent and up to date records on me and the most accurate place to start.

I will NOT be entertaining any discussions about phentermine or losing more weight. I may go ahead and lose those 3 pounds that @ShoppGirl mentioned, that way nobody can say anything either way. But still.... I'm leaving that practice no matter what. I'm not happy or comfortable there at this point.

Good for you. If you find a resource that helps to find the doctors with relevant experience, please post it. I would love to find a new dr but wasn’t really certain how to go about searching. I went to my primary when I started this journey again (for my revision) to ask her for info and her opinion about the SADI surgery and she had to ask me how to spell SADI to put it in my chart. I thought okay well this is fairly new so I guess I can’t really blame her BUT when I asked her if she felt like the bypass was a good fit she asked me what the specialist said and that she would defer to him. Plus, the first SADI was done in 2007. For us lay folk that is fairly new but for someone in the medical field who is supposed to be doing continuing education we are coming up on 18 years since it’s been around.

Anyways, I asked if I need to find someone else to treat me post op and she said well, for a few months if you have any issue at all you just go to their office first and make sure it’s not possibly related to the surgery or If you should come see me. Well, that strategy may have worked with some of the other surgeries but this surgery has more long term complications associated with it. I foresee myself paying for and wasting time and frustration enduring a number of unnecessary tests and appointments all the while getting worse if an issue is related to my altered anatomy If I stick with her. Is it sad that what I was expecting for her to say something along the lines of Well, now that I have a patient that is undergoing that procedure, I will be doing my research on how best to treat you? It’s so sad that is just not how it works anymore. I feel like they need to replace the word “refer” with “defer” in primary care. As in defer the responsibility to someone…anyone else. That’s what it feels like most doctors seem to want nowadays, more and more money and none of the responsibility. Must be friggin nice.

Anyhow, Having a good primary that’s has knowledge of these surgeries would be huge asset and i really hope that you do find it. I fear that in my tiny town, especially with my newer surgery I won’t have very good luck with it. I do plan to ask the surgeons office if they know or anyone though. That may be a good resource for you too if you hadn’t thought about that.

Edited July 4 by ShoppGirl

[SleeveToBypass2023 2,637]

2 hours ago, ShoppGirl said:

I do plan to ask the surgeons office if they know or anyone though. That may be a good resource for you too if you hadn’t thought about that.

I actually hadn't thought about that at all....I may give them a call on Friday, as well, and see what they say. I have a feeling my surgeon's office is going to LOSE IT when they hear what she has been saying and what she wants.