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Paying the piper too young

This winter break we traveled east to celebrate with friends who are as close as family. Our daughters hit it off immediately as they do every couple of years when we manage to get back together. But the contrast between them had become striking in only two years away: our daughter, although (or perhaps because) she’s Type I diabetic and has to pay attention to what she’s eating, is growing up basically healthy. Our friends’ daughter, a few months older, is shorter but 25 pounds heavier and her mother told me she’s spent the past year taking her to a slew of medical specialists to figure out why she’s suddenly having so much pain in her legs and feet.

This girl is wonderful and energetic, full of beans, a live wire, and smart as a whip, but she doesn’t last long on the the gym floor at school, and worse yet, she had to leave the dance floor at her own celebration just as the dj was getting started because her feet and legs started hurting so much she had to sit down within minutes. The night before, she’d taken four ibuprofens for pain in a single day–just from walking around at school and later at the hotel.

So far nobody’s found much except low vitamin D and iron. The spine guy, the neurologist, nobody’s found anything they think could be doing this. The pain clinic is apparently all too ready to dish out a laundry list of pills nobody should be taking at age 13–among them antidepressants, despite the fact that they haven’t found a cause for what is obviously physical pain, and that nobody’s actually diagnosed major clinical depression. My friend is beyond worried for her daughter and exasperated at what is looking like the classic runaround from an otherwise very highly regarded medical system.

One look at her feet and ankles said it all–they were starting to get a bit swollen already, and she wasn’t wearing heels. And that rang a bell with me–for two of the last three years, I had suffered  much the same symptoms.

None of the doctors who have ever seen my swollen ankles over the years had any hesitation about telling me what was wrong with them or what to do, and they all agreed it was being overweight and sedentary with mild varicosities in my leg veins, and none of them tried to dump antidepressants or mystery diet supplements on me so they wouldn’t have to risk insulting me and my delicate ego with the truth. The prescription I get–from everyone–is what any adult should get: get up, get out and walk, eat vegetables and cut down on salt (which I was already doing, despite my love of serious bread and cheese). Put your feet up when you’re not walking. Gee. Wear support hose if you need it (yuck). Doesn’t cost anything much, and it doesn’t have horrible adverse side effects. And it works. Eventually. If you do it and stick with it.

It also helps (though I wouldn’t wish it on them) that some of the female doctors and nurses my age, including the thin ones, have had varicosities and swollen ankles themselves. Most of them have had kids and some are past menopause. So they know what they’re looking at when they see it, and they’re not afraid to call it what it is. They acknowledge that hormone imbalances can make it worse or make some women more vulnerable to this set of symptoms, but the basic prescription is the same. They make no excuses and don’t let me make any either.

But a preteen shouldn’t have to be dealing with this–should she? And although she’s overweight and showing it, she’s not so far out of the normal range that she should be suffering like this. Except that every time I saw her during the weekend, she had another glass of soda in her hand, or a second plate of hash browns and then a third, or three or four more little desserts. She came down to brunch the last morning, still in pjs, with a can of soda in her hand. And nobody said anything about it.

So the only mystery is why a slew of highly trained doctors apparently can’t find their rear ends with both hands when they see the same signs in an adolescent. None of the daughter’s doctors had said the obvious, or maybe no one in the family actually admitted it to them, but the doctors should have been asking hard questions about diet. For years her parents let her drink unlimited sodas, eat unlimited amounts of salt-loaded processed food, never made her eat vegetables, convinced themselves that her throwing a fit at the table would be worse than letting her have her way.

Of course that’s not the only factor here, because a lot of kids eat processed food and drink soda, and don’t suffer such overt symptoms. And for a long time this girl was more or less within the bounds of ordinary kids. But puberty hit her earlier and harder than most of her friends, and knocked her appetite signals sideways and somehow the unlimited got a lot more unlimited fast. But instead of recognizing that something was  suddenly way off about her eating patterns, everyone sort of glanced away shyly and now at thirteen she’s suddenly got the veins of a 50-year-old and crippling pain. No one deserves that.

At the post-celebration brunch, my friend brought up her worries again. I debated with myself, then decided to just say it–quietly, but say it, because as the mother of a diabetic kid, I’ve been through something similar. As we sat there I thought, if only my husband and I had faced the obvious a month or so sooner than we did three years ago, when our daughter started drinking whole glasses of juice at dinner and going to the bathroom so much more often than usual and complaining of thirst, we might have spared her the ketoacidosis that is the second, less familiar and much more dangerous phase of emerging diabetes. Even though we were seeing blatantly abnormal eating behavior, we lacked the guts to get her glucose tested and face our unspoken fears that she might be diabetic until she was suddenly so ill she might have slipped into a coma at any moment. It still kills me how long we and everybody around us were trying to be so goddamn polite, including the doctor. And for what? To spare us embarrassment?

So I told my friend all this by way of apology for being blunt, and then I was blunt and told her what the doctors she’s been paying for wouldn’t. The vitamin D and iron and even the pain itself were nice but secondary. The swelling and foot pain are classic circulatory symptoms the doctors should all recognize on sight and she should make the pediatrician order her daughter a fasting blood glucose, cholesterol check and blood pressure testing right away, and do a hormone check just to make sure she’s not way out of balance for estrogens or thyroid. Those are the simple things, and the pediatrician really should have started with them before sending her on a wild goose chase to people who would think prescribing high-dose painkillers and antidepressants was first-line therapy for a kid with swollen ankles.

Well, and then what? Her daughter might need medication, depending on what they find, but she also clearly needs a significant and long-term change in lifestyle, as us older sufferers do, to start reversing the damage. She needs to eat fresh vegetables–they’ve started doing this at home, cut down on starches and skip second helpings, and drink plain water instead of all that soda even if she doesn’t love the taste. Those steps will bring her palate and appetite cues back to some kind of order, and they might do it a lot faster than her family thinks. Maybe harder, to begin with, this girl needs to brave walking to the end of the block every day until it gets easier and she can walk two blocks again. And then five. Because there’s no pill for that, there really isn’t.

I only hope they’ll do it, but mostly I hope they won’t wait for the doctors to wake up. Because this is one kid who deserves to get better and I bet you know another.

2 Responses

  1. I’m glad you were there to make some sensible suggestions. I hope her parents follow through, it’s going to take a lot to get through to this set of doctors.

    But how is it that we can say “This kid’s obese and she eats too much sugar and salt, and doesn’t exercise, of course that’s why she’s in pain!” and the doctors can’t see that? Everyone knows that Type 2 diabetes is becoming increasingly common in kids, so why they didn’t go for the fasting glucose first thing is mystifying.

    • Shortly after I started writing this entry I read an opinion piece in the Washington Post by a pediatrician who commented that few doctors are willing to level with the parents of overweight children and with the children themselves anymore, and that everyone’s gotten too “polite” or rather skittish about a growing health problem. Most people, including the doctors, figure they have more time to deal with it before it gets bad. Sometimes they’re right but occasionally they’re really wrong–my daughter and her friend are two of the more dangerous exceptions. I’ve had to think twice about posting this about my own friends’ kid, but the stakes are high and I suspect she’s not that much of an exception anymore.

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