“Hey Mike, you’ve got a little bulge in your stomach,” I heard, as I reached to the base of the final climb to Larison Rock. At this point, I had climbed 2000’ in 3.5 miles. As hike leader I had bushwhacked around an impassable blowdown, found an alternative route, and made sure everybody got around it without difficulty. I wasn’t even breathing hard on this hike.
Douglas fir blowdown, Larison Rock Trail; November 2016
Sun through trees, top of Larison Rock Trail; November 2015
I knew I had a waist bulge. I have an apple pattern of weight distribution, and while I have never been overweight, and my Body Mass Index (BMI) is about 23 and change, I have a problem. Turns out that waist circumference is an important risk factor for cardiovascular disease, more than weight itself. Indeed, the waist:hip circumference ratio is more important than just being overweight. This is relatively new on the obesity scene, but it wasn’t just discovered yesterday.
The realization bothered me. I looked for all the stats that said I was healthy, and I came up short each time. I started to lose weight, from 170 to 165 at least. I did it the way I have controlled my weight in the past— I looked at my diet and started finding how many calories I could easily remove. In the past, it has been peanut butter, which I love, olive oil, fatty veggie hotdogs, all cookies and cake, and adding low calorie yogurt. It takes a while, but I’ve always lost weight. This time around, it was removing evening cheese, substituting dark chocolate for scones at lunch, again stopping the peanut butter, and changing the decaf white chocolate mochas I was having to decaf sugar free. The last cut out 240 calories right there. My weight started to fall. I was hungry at night; hell, I was hungry a lot. It was the holidays, the worst time to lose weight, but each morning I got on the scale, I liked the numbers.
In 3 weeks, I weighed 165. I don’t know if my waist had changed, because I didn’t measure it originally. My contour looked better, but still not right. But I had reached my first goal, and I planned to go further.
During this time, I had my annual cardiology appointment. I was weighed with my clothes on, and because there was freezing rain, I wore a lot, for I took the bus to the clinic. I weighed 170, which isn’t bad with clothes on, but my BMI was listed as 23.71, which isn’t true. It’s fine for doctors to weigh patients the same way each time, but if they are going to use that weight for BMI calculations, to two decimal places even, they either have to get rid of the clothes or subtract a few pounds. That was only my first issue.
Everything had gone reasonably well this past year. My Afib had recurred, as I knew it would, but I was doing well enough that the doctor didn’t think he needed to see me in a year. I wondered, however, why he called the echocardiogram of my aortic root, 40 mm, “dilated”. First, if it is a problem, I need to be seen annually. Second, many don’t think it is dilated at that figure. Third, if one looks at the recent literature using height, weight, body surface area, and age, I am below what is considered dilated. Fourth, while I agreed we needed a second data point to see if anything has changed, he decided I didn’t need another echocardiogram for a year. Yet, I am labelled as having a dilated aortic root, a big deal if I have a thoracic aortic aneurysm. I don’t think I do, but I don’t like treating myself. Nor do I like having my BMI measured to two decimal places with my clothes on and having to look online to learn about normal aortic root size. What do people do without a medical background?
I was told I was doing everything right. True, I’m active, seldom drink, never smoke, don’t use caffeine, am vegetarian, not diabetic, have good cholesterol, normal weight and BMI (to 2 decimal places), and my systolic blood pressure is 110. But I am concerned. My waist-hip ratio is high, 1:1.035, and it should be less, the reciprocal. My waist-height ratio was 0.538, and it ought to be closer to 0.5, less than at least 0.533. I asked for a dietitian referral and at this point am waiting for a call back. It’s the holidays, and maybe they don’t believe anybody is really serious about losing weight during the holidays. Well, I am.
My weight continued to drop, holding at 165, and I counted all the calories I was consuming daily: I measured the sunflower seeds on my salad, I was eating more carrots, cauliflower, and broccoli, not corn and peas, I ate apples, blueberries, strawberries, and tomatoes, and I watched the croutons I was putting on my salad, although how one measures a crouton using tablespoons is a mystery. They are about 3 cal a pop. I used a teaspoon of olive oil on my salad. I found ways to cut calories I had never found before.
I think the cardiologist missed an opportunity. He was busy. I knew that as soon as he came in the room and stayed standing. Bad form. I always sat when I talked to patients. Sitting conveys a sense of having time. I realized I needed to say what I wanted and be quick about it. The waist issue didn’t bother him. It should have. This stuff should be posted in the cardiology clinic, along with “know your BMI,” “Ready for the ratio test?” “risk factors to try to reduce,” rather than “we care about every mile of your blood vessels.” Dietitians should be available, and frankly Medicare would do well to cover the cost, instead of only for diabetics and those with kidney disease or transplants. Health is health. I now know my Basal Metabolic Rate (1540 calories), how much walking for 3/4 an hour or hiking for an hour burns. I know how to get a decaf sugar free White Chocolate Mocha and a 120 calorie Peppermint mocha at Starbucks. I know how many calories many fruits have and that sunflower seeds have 170 calories per 2 tablespoons. Hell, I should be counseling people.
I’m serious about weight, and it’s important to know what matters and how to count it properly. BMI is almost always a good predictor of being overweight, but it is not a good predictor for wrong fat, fat in a bad place. There are other numbers that address that.
I had showed up early for my appointment, but I knew the time was up. The cardiologist didn’t even have to start walking towards the door. I have become good at reading people’s body language when they don’t want to talk to me. At that point, I quit, because they likely haven’t been listening to me for some time.
This is now the fourth business day and I haven’t heard from the dietitian yet. That worries me, because my original referral with the cardiologist got lost. How difficult is it to pick up the phone and take care of scheduling an appointment? If nothing else, a guy whose numbers most people would love to have thinks he should be even healthier. Wouldn’t that be refreshing to be able to advise him, if you were a dietitian?
Maybe I will have better luck with my internist. I will have to prepare carefully, however, needing to make sure I have all my ducks in a row and get through all my questions. I’d bring a list, but when I was in practice I hated it when patients brought in lists of things to ask.
Then again, I sat down when I talked to patients. I listened without interrupting, too.
Boreal B[l]og 
December 13, 2016 at 21:46 |
Gosh you are sounding a little OCD.
Denise Helmkay helmkay@aol.com