Sunday, August 7, 2011

A weighty matter

My first post covered most of my past medical history: Turner's Syndrome (xi variant), hypothyroidism, hypertension, osteopoenia.  I may not have mentioned the eye muscle corrective surgery I had in infancy (familial cranial neuropathy), the five (incidentally very painful) corneal abrasions I had, my bilateral tubal myringotomies, or my giant-cell tumor of the tendon sheath.

And then there's something I know I didn't mention: my weight.  I've never been considered overweight by anyone other than me.  I've always been significantly under my so-called Ideal Body Weight of 122 pounds.  But I can't remember a time I didn't feel fat  I remember being a little girl, not yet weighing 50 pounds, and hoping I wouldn't ever weigh that unimaginable amount.  I remember ballet class as early as fifth or sixth grade, feeling so ugly compared to the other girls.  There was seventh grade when I would wipe the grease off fries or pizza at bar/bat mitzvah parties.  I remember in eighth grade reaching one hundred pounds and feeling so frustrated with myself that I had let myself weigh that much.  And let's not even get started on the ballet classes I took in undergrad where half my classmates were prepubescent or barely pubescent and stick-thin.

Basically, you can see how this is the setup for constantly trying to lose weight through a combination of diet and exercise since age twelve or thirteen.  And through a combination of iatrogenic hyperthyroidism, vigorous exercise, and willpower I finally did in the first two years of med school.  I made it back down to one hundred pounds and then held steady at 103-104  after discontinuing the diuretic that made me hypokalemic.  I gained a few more pounds over third year but got back down to 104.

I know it makes no sense.  A medical student - I guess doctor now -- should theoretically realize that a BMI below 18.5 is associated with increased morbidity and mortality.  But I have the ability to hold two completely contradictory ideas in my head.  And so I continue to exercise and restrict my diet.  And it upsets everyone around me: my parents, my grandmother, my husband, my doctor/mentor...

They keep telling me it will make me unhealthy.  But it's not as if I intend to go really low.  I don't want to weigh less than one hundred.  I just want to get down to one hundred pounds and stay there.  And I felt fine when I weighed one hundred pounds!  I could jog six miles a day!

It's not that I am complacent.  Causing grief and frustration to people who care about me, worrying my amazing wonderful grandmother and my sweet caring husband and my mother who does so much for me, is wrong.   Even my doctor/mentor tolerates my melodrama without complaint or showing how sick of me she must be, and gently urges me to build up my reserve so that I can better handle infections and -- most importantly -- so that I am prepared for the wonderful stress of motherhood.

But instead of listening to anyone, I keep at it.  I don't understand.  And I'm not asking for sympathy or pity.  I'm simply telling the story and thinking aloud, metaphorically speaking.  A simple URI last week completely knocked me out and you'd think that would be a clear message.

Why is it my appearance is so important to me?  Why can't I listen to medically sound advice?  Will I ever change?  People always say children change everything; maybe that will do it.  What if I never change?

I'm not even sure exactly why I decided to post this chronicle.  I don't want to change right now and I don't want to think about changing in the future, but I feel tortured about what I'm doing to people who care about me because I know it's wrong.  And my dilemma is completely of my own design and I have all the power to end it if I were to choose to do so.   

Incidentally, there are only ten or eleven case reports of girls with Turners Syndrome and Anorexia Nervosa.  so if I would actually accept the diagnosis somebody could maybe get a publication out of me.  Has anyone ever written a case report where he or she is the patient?  I am curious

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