My husband is getting rolfed. It’s a form of deep-tissue body work (I hesitate to say massage) that releases tightness and adhesions in fascia. Fascia is the tissue that forms envelopes around muscles and attaches them to the skeletal structure. It’s a form of alternative medicine, but after seeing the results of a couple of sessions for my husband, we are huge believers. I’m not here to blog about that today, because that’s his story, not mine. Suffice to say that those before and after pictures you see on rolfing web sites–those are for real.

I like to chat with the rolfer while he’s working on my husband, and we ask questions. One thing that has come up is that this rolfer finds it difficult to work on most vegetarians. He describes the feel of their tissues as “ropey” and it doesn’t respond as well to manipulation. He believes it’s because most are not careful enough with their nutrition, but he does not have a particular theory about what they are missing because he’s not a nutritionist, he says.

He also said he “really hates” working on anorexics. Their tissues are a mess.

It’s a good illustration of how people can look healthy on the outside, but when you take a look inside, things are not that great. He said he once worked on a celebrity. Obviously he couldn’t tell us who it was, but he said that although she looked good on the outside, as celebrities often do, her tissues were in bad shape.

It interests me because, as I’ve said before, the drumbeat public health message of our culture is lose weight lose weight lose weight, by any means necessary. And yet little is said about the organ and tissue damage that can result if the body doesn’t get the right nutrients in the right amounts.

I hope to be able to report more about the rolfing experience from my own perspective, as I’m starting the ten-series Saturday. Based on what I’ve seen so far, I’m looking forward to getting rid of some persistent aches and pains, getting my oh-so-messed-up feet straightened out, and maybe breaking through some roadblocks in yoga. (Even after three years of yoga, I am not really making progress with my forward bends.)

Most people are familiar with how the health care system sometimes discriminates against obese people. Doctors may insist a patient lose weight before they will address a health problem, even if the patient’s weight has nothing to do with the problem. Well, it also happens with cancer. Here’s how it works.

Let’s imagine a 23-year-old lumberjack. He is healthy in every way. While he is out in the woods, cutting down trees with his chain saw, he is attacked by a piranha that latches onto his face and won’t let go. His comrades call 911, and he arrives at the emergency department with the piranha still attached.

The physician examines him and says, “Lo! You have a piranha attached to your face! I will surgically remove it and give you some cream and antibiotic tablets and you will be on your way!”

Now let’s imagine that the lumberjack is 90 years old, retired, and he has recently had treatment for a cancerous lesion. He is feeling pretty well, though, and in fact sustained the very same piranha injury as the young lumberjack while he was out in his back woods trimming some trees with his chainsaw. His 90-year-old wife, who was helping him load the trimmings into the tractor and haul them to the trash pit saw the whole thing and called 911 in a timely manner.

When he gets to the emergency room, however, the physician says, “Ah, there’s something on his face. We see this a lot with elderly cancer patients. Our recommendation is that we make him comfortable and tape a plastic bag over it so that he can shower without exposing the wounds to infection.”

And his family says, “Are you out of your mind? He has a piranha attached to his face. Get it off!”

And the medical team give each other significant looks, and they say, “We’re going to call the social worker up to talk about options for your grandfather. We’re very sorry this happened.”

And that’s what I’ve gone through with my mother, over and over again. Last year I had to listen to doctors telling me she wasn’t going to walk after breaking her hip and had no treatment options left for the cancer and needed to be in a nursing home. She recovered, got back on her feet, and responded well to the same cancer therapy she’d been on before. (Most of her “recurrences” have been triggered by the doctors discontinuing therapy.)

This time, it’s pneumonia, and I feel like I’m in some kind of surreal alternate reality trying to convince the doctors to just treat the pneumonia, when they keep trying to tell me that Mom is ventilator-dependent and simply too weak to breathe. I can’t micromanage the care. I have no idea what types of tests or treatments they may be overlooking because of assumptions made about her condition. But I do know that a person who had no breathing problems before she went into the hospital, and was even a regular exerciser does not go from that to respiratory crisis and ventilator dependence in TWO WEEKS just because she is old and weak.

Do the doctors listen to me? No, they never listen, because it’s new doctors every time. If we could work with the same team from one crisis to the next, they might get it. But instead every crisis has a new team, and from their point of view, my mother is just some kind of anomaly or exception that does not disprove their overall philosophy of treating older patients with cancer.

And if other patients don’t have stubbornly aggressive families full of health care professionals who will advocate vigorously for them to get that damn piranha off, then their practice of giving up on cancer patients can become a self-fulfilling prophecy.

The thing that gets me is that these doctors who are specialists in other fields like pulmonology or orthopedics or whatever don’t actually know shit about cancer. They try to tell me that the lung problem is maybe cancer related. What?!? No, it f—ing isn’t! This is multiple myeloma–it does not cause respiratory failure, most especially when there isn’t one single bone lesion. (If not for the chemo, she might be getting a bit anemic by now because her bone marrow isn’t producing enough healthy blood cells. She would certainly not be suffering complications from advanced cancer or be at the terminal stage.)

Same thing with the kidney failure. The nephrologists, who got paid something like $300/minute to consult on the case, said that the kidney failure was probably cancer related, and would not get better. Cancer related? No, it f—ing isn’t! Myeloma can cause kidney failure, but only in very advanced stages of the disease, when the blood levels of calcium are high from all of the dissolved bone. Fortunately, I ignored that asinine consultation, and Mom’s kidney function began improving literally the next day, and has been improving every day since then.

Why didn’t the nephrologists diagnose her with kidney injury from the chemotherapy treatment she’d just had, which is a common, well-known complication of the treatment, and instead reached for a lame-ass cancer explanation? I don’t know! I wish I did.

I’ve been told that doctors don’t want to get families’ expectations too high, because we might be disappointed. But what are we, FIVE YEARS OLD, that we are worried about disappointment, here? If my mother dies, I am going to have larger grievances than having had unrealistic hopes during her illness. I’m going to, you know, actually miss her and stuff. It’s really kind of a self-centered attitude among doctors to think that a family’s grieving process is really all about them. Are we going to be angry? Yes. You know why? Because people get angry when they go through a major loss. Are they going to be angry at the doctors and hospital that didn’t save their loved one, even if it doesn’t make sense? Yes, they are. I’ve seen it before. Get over it. As a physician, you can’t expect to be loved and appreciated all the time, and pre-emptively stomping on people’s hopes is not the same as doing right by them.

(Paradoxically, I’ve been told by someone who was a caregiver for a younger cancer patient that doctors were unrealistically positive about that patient’s prognosis, so there’s definitely an age element. And also a “doctors are making shit up as they go along” element.)

All I can do about this is refuse and redirect when it seems like what I’m hearing doesn’t make sense. But doctors have a great deal of power to set the tone and frame a discussion, and it’s really hard to gainsay them when they get into that mode. It’s stressful and exhausting and frustrating, and there’s no payoff when they’re wrong. They don’t come in and say, “Wow, I totally called this thing wrong. I almost sent your loved one home with a piranha stuck to his face because I thought it was a cancer lesion.”

Noooo…instead, they come in and say, “Wow, we never expected your loved one to pull through. This is obviously an inexplicable miracle or possibly due to my brilliant doctoring and there is no lesson here that I need to learn for the future.”

Maybe some doctors can learn from patients, but when it comes to the conduct of clinical practice, only doctors can really influence other doctors. They need to get started on that.

I’ve been spending a lot of time with nurses lately. Intensive care is all about the care, and more so than any other unit I’ve observed closely, the nurse reigns supreme. My mother has had her own nurse most days, and each one has been terrific. I am awed by the skill and intellect they demonstrate in managing 3-6 pumps, hanging half a dozen medications in bags, deftly loading up food tubes and emptying what come out the other end, and being the hub of a wheel with spokes connecting to ten or more doctors, specialists, and other care providers. Unlike nurses on other floors, the critical care nurses have the responsibility of making minute-by-minute decisions about which meds to use and how much to dose based on a doctor’s guidelines, and is an integral part of every team meeting for her patient, even outranking the more junior doctors.

Imagine my surprise, then, when my mother’s amazing, highly skilled nurse, Tina, mentioned that she felt a migraine coming on, and was fending it off with Excedrin because she couldn’t afford her migraine medication. I overheard this exchange between her and another staff and butted in. “Wait a minute. You work in an intensive care unit. You are a care provider. And you can’t afford your health care?”

That’s right. The copayment on her medication is $100. She can’t afford it. The hospital is busting the nurse’s union, decreasing their benefits, increasing their patient loads (beyond the point of safety). It is more economical for her to use cheaper over-the-counter meds as a frontline measure, and the emergency room when that fails than it is to manage her migraines with the latest technology that her physician prescribed her and wants her to use. I’m gobsmacked and vastly disappointed.

Right now, the government is trying to cut Medicare. If successful, that will mean job losses in the health care industry. This is supposed to be okay because it will increase jobs elsewhere in the economy. I can’t see the point of robbing Peter to pay Paul, myself. More importantly, it will cost jobs like Tina’s, further increasing the pressure on already overworked nurses, and increasingly slashing the benefits they depend on to support their lifestyles as people passionately devoted to health care.

Most of us will end our lives in hospitals, and increasingly with technological advances, the lifesaving devices and procedures we’ll depend on will require skilled nurses like Tina to manage. But Tina’s not going to be there for us. Because Tina has a migraine that could be managed for the cost of a cup of coffee a day.

I caught a comment over at Blogher on my post, A Year Without Dieting, that said it did not agree with the “defeatist” tone of the piece. I’m not sure that person clicked through and read through the whole post, but either way I am not surprised that some people find such ideas unappealing. Accepting your body and not dieting are the cornerstones of the fat acceptance movement–a social phenomenon with all of the charisma of a plain bowl of broccoli.

Consider: according to Google adwords, there were more than 11 million global searches for the keywords “weight loss” last month. In the same period, there were only 9,900 searches for “fat acceptance.” For comparison, “rabbit farming,” a keyword combination I came up with at random, had 27,100 searches. That means nearly three times as many people are interested in raising rabbits for meat as the number that want to learn more about fat acceptance. Another randomly generated keyword combination, “recipe ants,” generated 4400 searches last month. So apparently fat acceptance is only about half as obscure as the desire to find out how to cook ants.

I know fat acceptance was a hard sell for me. First, there was some kind of hearing or reading problem I had. Every time I came across the phrase “fat acceptance,” my brain would turn it into “fat denial.” And I knew all about fat denial. Denial was the reason that so many overweight people were living such tragically miserable lives, trapped inside their bulky suits of flesh. If only they knew they were actually fat, they could go on a diet, and be happy and healthy.

If that makes you wince, well it should. It’s an ugly attitude. In my defense, it’s nothing more than the logical result of health and beauty information that’s been drummed into my head since I was too young to remember. Most of my life, I effortlessly maintained a weight that was within guidelines for my height and frame size, and I assumed that since it was easy for me, it must be easy for everyone, and that people who were overweight must not be making the same good choices I was. How was I to know better?

I wasn’t a monster. Of course, I understood that lots of people had a hard time, and that many had chronic illness and life circumstance that made diet and exercise impossible. But I still believed that diet and exercise were the universal solution, if only people would make the effort.

My attitude started to change when my weight began to creep up around 2005. At that time, I was eating healthy and exercising regularly. I had been a competitive athlete in high school, and had remained active. I maintained a gym membership, and was perpetually training for a theoretical 5k or triathlon (or something). And yet in spite of all of the “right choices” I’d been making, my weight was trending up and up and up. It occurred to me that it might be a lot more difficult than I thought for many people to control their weight.

The tipping point for me, though, was totally failing at losing weight after repeated honest attempts. I then realized that our entire societal belief in the moral weakness of fat people was predicated on the idea that they somehow had a choice–were making a choice to remain fat! Why would anyone do that in the kind of culture we have? I began to be aware of and really understand a statistic I had heard many times. 95 percent of diets fail. What other medical treatment has a 95 percent failure rate? And why do we have so much collective denial of that fact? What if, instead of repeatedly attempting a medical treatment that has a 95 percent failure rate, and significant non-zero risks, we instead tried to optimize our health and happiness independently of size?

Thus, a fat accepter was born. By becoming one of a small group of people actually interested in fat acceptance, I’ve learned surprising things, such as the fact that you can be overweight, or obese, and be totally metabolically healthy. That means no plaque in the arteries, no incipient diabetes or coronary artery disease. Healthy. And thin people can paradoxically have total crap arteries and be metabolically unhealthy.

Here’s another surprise. The healthiest weight range of BMI is not below 25, as the establishment would have you believe. Studies show that the people with the least risk of death are those with a BMI between 25 and 30. People who are categorized as “overweight” in our society. What’s up with that? Could an entire industry that wants to make billions of dollars selling us diet books, supplements, gadgets, and systems actually be wrong? Yes, my friend. Yes, it could.

Here are a couple of links to get you started:

The Fat Nutritionist

Ten Rules for Fat Girls

My post, A Year Without Dieting, from Sept. 12, is featured at Blogher today. If you have a response or experience to share, feel free to jump in here or over there. I’ll be following the conversation with great interest.

My year without dieting is complete, and I find myself enlightened and pleased with the results. I began the quest not to diet in August of 2010, after gaining around 10 pounds on prednisone for an out-of-control poison ivy reaction. Prior to that, I had found my weight creeping up uncontrollably, and struggled to lose it, even when consuming quite low calories. Low carb was no solution. Exercise was no solution (my body clung to fat anyway). So found myself heavier than ever before, and realized something was really wrong with my metabolism and the way my body was handling fat.

I was influenced by author and endocrinologist Diane Schwarzbein. I didn’t end up following her diet, though, because it’s insanely restrictive. You have to count your carbs AND your protein. You have to avoid all refined flours and starches. You have to avoid “damaged fats” which makes it all but impossible to ever eat in a restaurant, etc., etc. Instead, I tried to follow a reasonably healthy diet according to the 1970′s “four food groups” principles I grew up with, as well as common sense.

The surprise to me was how difficult it would be to resist “going on a diet” for a whole year. My eyes were opened to all of the pressures society puts on you. There’s media pressure in the form of magazines, television, and newspapers, where “health” columns endlessly promote diets as the solution for just about any medical problem you could imagine. Women’s magazines feature diets in every issue. There are even “health” messages in your doctor’s office reinforcing the idea that you have to go on a diet. And when you get together with friends and family, you’ll almost always find out someone’s on a diet, and the conversation will center on that subject. I found that I had to wrestle with my resolution on a daily basis, in order to stay on track.

Like I said, I’m pleased with the results. I’ve achieved:

• Improved body acceptance and a wardrobe of clothes that actually fit
• Increased awareness of harmful messages in the media and the culture about body image
• “Detox” from a constant sense of urgency over body image and weight loss
• A concept of health that is orthogonal to the size of the waistline
• More time to pursue hobbies and interests, since it is not spent obsessing on diet and/or exercising to excess
• Experiencing a normalizing of appetite, outside of the rollercoaster of being “on the wagon” and “off the wagon”
• More “other-centered” focus and less “self-centered.” (Dieting is an inherently self-absorbing activity, and when you’re chronically dieting for years or decades, it has an effect)