Health and Lifestyle News News and Perspectives about Health, Medicine, and more

Category Archives: Health And Nutrition

Always Trust A Mother’s Hunch: My Experience With a Sick Baby and an Untrusting Doctor

A recent post on KevinMD.com caught my eye. The piece was written by Niran S. Al-Agba, MD, a pediatrician, who was reflecting on a distressing moment during her third year of residency. On a busy night in the hospital, a mother requested a re-do of her 6-year-old daughter’s blood work, which had come back normal the previous day. Al-Agba ordered the new test at the advice of her attending but remembers feeling like the mother was being overprotective. Exhausted, she wasn’t feeling very compassionate that night.

However, the mother’s hunch that something wasn’t right proved correct. The lab had missed something in the first test and the girl actually had leukemia. Al-Agba, understandably shaken, returned to her patient to break the bad news.mother child-1298137_1280

“It was during this trying time I learned one of the most important lessons of my career: the value of trusting a mother’s intuition,” she writes.

That really struck a chord in me, and triggered a memory of an experience I had years ago after the birth of my youngest son. I was living in San Francisco at the time and my son was barely a month old. When he started vomiting after eating, I recognized the signs immediately: pyloric stenosis. My oldest son, then 5, had experienced the same symptoms and underwent surgery to fix the problem when he was 6 weeks old. The condition was in my husband’s family; his brother had the same thing 30-plus years earlier.

Pyloric stenosis is a narrowing of the opening leading from the stomach to the small intestine. The enlarged muscle surrounding that opening prevents normal digestion and often leads to projectile vomiting. It is sometimes hereditary and usually develops in boys in the first couple months of life. Surgery involves making a small incision in the enlarged muscle so food can empty into the intestine. While it’s traumatic to witness your newborn undergoing surgery, the procedure is almost always successful nowadays and resolves the problem permanently. But it has to be diagnosed and treated right away.

The whole experience was fresh in my mind when I went to the doctor with my youngest to get a diagnosis. My husband was away at the time and I had my other son in tow. Like any new mother, I was sleep deprived–perhaps more so due to dealing with the vomiting. I explained the issue to the doctor on duty, including the genetic link, but her response was noncommittal. “Babies spit up,” she said. “This could be just normal spitting up. Why don’t you try ipecac and come back in a few days if it gets worse.”

Her attitude infuriated me. I felt patronized and dismissed. I knew the difference between spitting up and projectile vomiting–babies with intact digestive systems don’t project the contents of their stomach halfway across the room, landing with a loud splat against the wall. Plus, I had been through this before.  The doctor wouldn’t budge, though, seeming to regard me as another overanxious new mother. So I asked to see another doctor. I was, she reluctantly admitted, entitled to a second opinion.

The upshot is that my son received the diagnosis and was admitted to the hospital the same day. (Remembering the sight of his tiny body hooked up to IVs and the sound of his desperate cries still makes me feel physically ill, but it all worked out in the end). I know now that this doctor was probably just young, and perhaps in a similar state of exhaustion as Al-Agba during her residency. But I’ve never forgotten the experience and it has colored my interactions with doctors to this day.

What I learned that day was to trust my instincts, ask questions, and demand answers. While I’ve encountered some thoughtful, intelligent physicians over the years, I believe that taking care of my health is ultimately up to me. I do my research and seek out facts. The doctor’s opinion is one voice of authority to be weighed along with others.

IMG_1095

My sons: all grown up.

So, when something “just doesn’t seem right” about my children or me, I pay attention to that gut feeling and tell my physician in a spirit of shared decision making. That shouldn’t undercut the knowledge and expertise of my doctor but actually help him or her make a correct diagnosis. Isn’t that what patient-centered care and shared decision making–those frequent buzz words in medicine–are all about? Reflecting on her experience that day, Al-Agba says she learned the “importance of listening to the person who knows their child best, their parent.” I couldn’t agree more.

Biggest Loser Study Sends Hopeless Message But There’s More to the Story

Recently the New York Times published a long article about the contestants from the Season 8 of “Biggest Loser.” The timing the article was tied to a new study, published in the journal Obesity, in which researchers followed the contestants for 6 years after the end of the show to monitor how their weight loss affected their metabolisms and ability to keep pounds off. What they found “shocked” them, according to the Times.

At the close of the show, the contestants’ metabolisms had slowed dramatically, which is normal after significant weight loss. However, the rates did not stabilize and in fact lowered further as people gained weight. In the words of the Times, “It was as if their bodies were intensifying their effort to pull the contestants back to their original weight.” The article goes on to interview the study’s author and several other experts with impressive credentials. Some of them try to bring up other points of discussion but the writer sweeps everything into a neat conclusion: there’s no hope for the obese. Nature has sentenced you to be fat forever. You might as well give up. She even includes a quote from one expert who says that the obese “can’t get away from a basic biological reality.”

At this point, I’m picturing every significantly overweight person in America crumpling in despair. Every diet they’ve tried has been a failure and these experts are revealing why: it’s impossible. The NYT suggests that this might make people feel better in some way because they’ve been released from the guilt associated with overeating (it’s genetic). However, I doubt this revelation makes anyone feel a lot better.

In my opinion, this is irresponsible journalism. Sure, the reporter interviewed experts and quoted studies in scientific journals. But she also leaves out some pretty important points and questions. Most obviously, how does the “Biggest Loser” format affect these results? The contestants lost an astounding amount of weight in an extremely short time, not to mention under contrived circumstances in an unnatural setting. They focused on weight loss 24/7 for 30 weeks in full view of millions of TV viewers. And they were competing against each other for a big cash prize, making the stakes even higher.

According to the Obesity study authors, “the extreme and public nature of this weight loss intervention makes it difficult to translate our results to more typical weight loss programs.” No kidding. this seems apparent but is brushed aside by the NYT as a minor point never to be fully explored. But consider just how extreme this “intervention” was: one contestant featured in the article, Danny Cahill, went from a massive 430 pounds to 191 pounds in just 30 weeks. While on the ranch, he spent 7 hours a day exercising, burning between 8,000 and 9,000 calories, the NYT notes. After returning home, his regime got even more intense as he tried to lose as many pounds as possible in the 4 months leading up to the final weigh-in. To quote the Times,

“Mr. Cahill set a goal of a 3,500-caloric deficit per day. The idea was to lose a pound a day. He quit his job as a land surveyor to do it. His routine went like this: Wake up at 5 a.m. and run on a treadmill for 45 minutes. Have breakfast — typically one egg and two egg whites, half a grapefruit and a piece of sprouted grain toast. Run on the treadmill for another 45 minutes. Rest for 40 minutes; bike ride nine miles to a gym. Work out for two and a half hours. Shower, ride home, eat lunch — typically a grilled skinless chicken breast, a cup of broccoli and 10 spears of asparagus. Rest for an hour. Drive to the gym for another round of exercise.”

Is it any surprise that this man was so sick of diet and exercise when it was over that he collapsed in exhaustion? That he was more than ready to give in to a few food cravings?

But weight loss isn’t hopeless. There are diet plans out there that work. I’m not saying they’re easy or quick but they exist. This whole area is given short shrift by the Times. One expert, David Ludwig, MD, director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital, tries to insert some perspective, pointing out that the results, “shouldn’t be interpreted to mean we are doomed to battle our biology or remain fat. It means we need to explore other approaches.” But those other approaches are barely mentioned and definitely not explored by the Times.

I have not personally experienced intensive weight loss but I’ve witnessed it in people close to me. Someone told me that a similar article that appeared in the Times a few years ago put him off trying to lose weight for a while because obesity seemed to be preordained. However, he’s since successfully lost weight on a high-protein, low-carb diet. There is evidence that cutting out sugary, processed foods and eating a diet rich in protein, vegetables, and healthy fats helps improve weight and health. And when you cut out the unhealthy carbs, you feel less hungry. I’m not advocating a particular diet here, just pointing out that there are options. It still takes work to plan and stick to a diet and make sure you’re getting all the right nutrients. But it is possible to cut calories without feeling constantly hungry–something that the Times article suggests is impossible.

Consider these facts from scientific studies:

  • “A very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.” — from the Journal of Clinical Endocrinological Metabolism.
  • “Compared with an Low Fat Diet, a Low Carb Ketogenic Diet (LCKD) was found to result in significantly less hunger and negative affect” and “there is evidence that an LCKD leads to a stabilization of blood glucose levels; this stabilization might reduce craving for food as well as an improvement in energy levels.” — from Obesity. (The ketogenic diet has been found to lower glucose levels and improve insulin resistance and has been used successfully to prevent seizures in children with epilepsy. You can read more about it here.)

Many other studies explore this topic. The point is not whether one is right or wrong but that other relevant, scientific evidence on weight loss exists.

The Times article is not factually wrong. It is an accurate report on a recent study and includes comments from well-qualified experts. But it leaves things out–important things that could influence how someone feels about their ability to achieve a healthy weight. The impact is significant when an article like this appears in a widely read and respected news publication. I hope those struggling with weight don’t see it as a reason to give up–because this is definitely not the last word on weight loss.

 

%d bloggers like this: