Tuesday, August 23, 2011

Fat Cat Walking

This is our new cat, "Cheese."  We adopted him about six months ago after somebody dumped him on a road in our area.  He's a very affectionate dude and has been a nice addition to the family so far. 

He doesn't really meow, but does this funny little sound, halfway between a purr and a chirp, and it's pretty comical.  He is a bit of a "herder" ─ he likes to herd his humans to where he thinks they ought to be, and he'll just keep chirping at you until you do what he wants. 

He's particularly taken with me; he loves to sit half-on and half-off my lap, purring up a storm, when I sit down on the couch. If he's not on my lap, he often settles between my feet on the floor.  If I don't pet him enough to suit him, he bonks me with his head quite forcefully (way harder than your average cat) until I give him his proper due. He's my little head-banger.

His worst trait is that he sheds like crazy; I've never had a cat that shed so profusely.  And of course, he sheds white hair, and I tend to wear dark colors. So there's way more laundry to do with him around, but in return I get a new lap/foot-warmer and #1 fan. 

Alas, he does bring a difficult dilemma with him. More on that in a moment.

Pet Peeve #1, 462

Before I get to the point of my post, let me just air a pet peeve first, okay?  Let's talk about abandoning animals.  This is one of my many pet peeves, especially as someone who has worked in animal resuce before.

People sometimes take an animal they no longer want and dump them out on a country road (instead of surrendering them to a shelter) because they think that the animal will live a better life, dining on country mice and gophers and sleeping in a nice warm haystack. 

They couldn't be more wrong.  These animals usually die an awful death, ripped apart by a pack of coyotes, dying of starvation because they are domesticated and don't know how to hunt well enough to sustain themselves, or hit by a car as they try to find their way back home.  Abandoning an animal in the country is a terribly cruel thing to do, and it's beyond me how people can do something so awful to a family pet.  If you really can't keep your animal, far better to take them to a shelter where they at least have a decent chance at being adopted by a new family, or could get a quick and comparatively merciful death if they aren't adopted. 

Fortunately, Cheese was one of the very few abandoned animals who got lucky.  Some passing bikers saw him being tossed out of the car (the driver didn't even stop), and they kept him from running out into the road until I came by a little later and stopped to help.  I took him to the shelter to be scanned for a microchip (there was none).  When the mandatory hold time was over, we went back and adopted him because we felt so sorry for him. 

I don't know why this animal was abandoned.  He doesn't have any bad habits (like peeing on the rug, scratching up furniture, or spraying) that we've seen so far.  He was not starving, his coat was clean, and he had a pretty collar with rhinestones on it.  He was well-socialized and usually very friendly, although we've noticed that he can be scared of men sometimes (he's getting over this now).

My best guess is that his family fell on hard economic times and couldn't afford him anymore.  Or perhaps someone gave him away to another family that didn't treat him well and finally abandoned him. Or a ticked-off neighbor or abusive person took someone's beloved cat and abandoned him in order to be cruel.  But really, we'll never know for sure why he was abandoned. 

It's frustrating.  He's such a good kitty, and he did not deserve to be thrown away like that.  He was just lucky we happened by at the right time and could take him in.

However, the hard reality is that we can't take in every animal that gets abandoned.  We had the ability to adopt this one, but there's a limit on how many we can afford.  This one had never had dental work, so last week it cost us nearly $1000 to get his teeth taken care of; a bunch of them had to be extracted because they were in such bad shape.  I'm pissed that his former owners just cost me a thousand bucks that I needed for other things─ but I couldn't let this kitty suffer with abscessed teeth.

So my first point is, please don't ever abandon your animals out in the country because you think you're doing them a favor. You're NOT, trust me.  A very few lucky animals do get adopted by country families, but there are limits on how many can be taken in by most families.  And most abandoned animals don't even make it to a farm; most die painful, cruel deaths long before they could find a new family to love them. They have a much better chance at a shelter, either for a more merciful death or hopefully, for a new family to love them.  And there are no-kill shelters available in many areas.

Augh.  I just hate it when people abandon their animals!

The Fat Cat Talk

Okay, back to the topic.  Why am I writing about my new cat on a fat-acceptance blog?  Well, we took him recently for a check-up and to talk about his teeth, and got the "fat cat" talk as well. 

This is always a difficult moment for anyone in the FA movement.  How do you respond when you get "the talk" from a vet?

Usually I just tune such things out. I make non-committal noises and change the subject and move on.  It's not worth arguing over with the vet.  Mind, I do make an effort to give my kitties reasonably healthy food in reasonable amounts, and they get plenty of exercise catching mice on my property.  Beyond that, I'm not going to get too worked up about their weight most of the time. 

However, with this cat, I do think there's some reason for concern.  He doesn't have any particular conditions (no, he's not diabetic), but in the six months we've had him, he's gained 3 lbs.  He was no lightweight when we got him; he already weighed 12 lbs.  Now he's up to 15 lbs. That's no small gain for a small animal in just a few months of time, and that concerned us all.  I don't care if he's a big guy already, but I'm doubtful that a big further gain would be healthy for him, and especially over such a short period of time.  So what to do?

Clearly, he is a much bigger kitty than our other kitties (who were adopted from the Humane Society a few years ago).  One of them is your average-sized kitty, around 7-8 lbs.  That makes Cheese nearly twice as big. The second kitty came to us "overweight" but has since stabilized at a lower weight that seems to suit her, slightly higher than what the vets want but which seems reasonable to us. 

But this new kitty?  He's HUGE.  Clearly a much bigger kitty in natural build than the others; he has huge paws and a large frame.  It's hard to see it from the picture above, but he really is a BIG guy.  To expect him to weigh the same as my small-framed kitty is ridiculous.  On the other hand, to be fair, his weight is not just all from his large frame, and that 3 lb. weight gain in six months really added to his belly.  At the very least, we want to arrest that gain trend.

Yet we are puzzled as to what, if anything, to do about it. I think this cat has experienced food insecurity, because he is a bit of a chowhound. He's always trying to convince us to give him more food, and you can't leave food out on a counter around him. And yet, he doesn't eat that much. His intake really doesn't explain his size.

Now, in my cat rescue work, I've seen kitties who are chronically underfed or starving gain a disproportionate amount of weight once given regular access to food.  Years ago, I had a group of cats that were a mix of shelter kitties and rescued ferals.  The ferals were usually very big cats once they finally were fed regularly.  They ate pretty much the same as my shelter kitties, but they were usually much heavier.  My theory was that their metabolisms weren't programmed for regular food intake. 

So I wonder if a recent bout of being underfed was the source of this rapid weight gain in Cheese, yet when we got him he didn't look or act starved. The vet didn't seem to think that this was a likely source of his gain, but she didn't have a good alternative explanation either.

To be fair, this vet was better than most; she handled the subject of weight loss pretty sensitively and was obviously a kind person.  I usually feel defensive when vets press this topic; it seems like there is an underlying accusatory tone when you are a fat owner with a fat pet.  The assumption is that you must be feeding them human food scraps (not good for animals), or just overfeeding them in general (as you obviously must be doing to yourself).  She didn't seem to assume that, which was refreshing.  But she did want us to reduce his caloric intake gradually. 

Her recommendation was to feed him 2 small cans of wet food per day, one in the a.m. and one in the p.m., and to switch him to reduced-calorie wet food. 

But the ironic thing is, we already feed him less than this.  We feed a small can of wet food in the morning and one in the evening....for all three cats.  That seems to be enough. 

We could go to high-quality reduced-calorie food, but I always wonder if these really have sufficient nutrition for active cats.  My kitties are not indoor, sedentary kitties; they go out and hunt and run around.  Cheese is really an excellent mouser and mole-killer; he brings us many "presents" (but doesn't seem to eat them). A reduced-calorie canned food might be okay for indoor kitties who don't get much exercise, but for a farm cat?  I wonder.  Or maybe he'd just start eating his kills.

What we've done so far is to mostly take away the dry food. Dry food tends to be high in carbs.  A cat's natural food is meat from animals, so carbs from dry food can add to a cat's weight. No, I'm not putting my cat on a "low carb" diet, just recognizing that the grains in dry food are not part of the food his body evolved to eat.  Going back to a more natural diet might stabilize things for him. 

Only time will tell if this will make any difference in his weight but hopefully it will keep him healthier overall.  I've never been very convinced of the value of dry cat food (would they eat grains in the wild?) so eliminating dry food doesn't really seem like a "diet" to me, just common sense. 

Honestly, I'm not sure how much concern to have about this gain, what might have caused it, or what to do about it. I normally don't get too worked up about a pet's weight, as long as I'm giving reasonable food in reasonable amounts. And this cat is clearly built along a much larger frame than many other kitties, so I think it's ridiculous to compare his weight to a smaller-framed kitty and say he's too heavy based on that.

On the other hand, such a large gain in such a short period of time is a bit worrisome to me.  It seems abnormal. It's unclear to me why he experienced this, unless he was being starved at his previous home ─ though he certainly didn't look starved when we got him.  We checked for diabetes and thyroid issues and he was negative.  Yes, he is a bit of a chowhound, wanting more food than he really needs, but despite this, I don't think his intake has been excessive.  We keep an eye on it.

So the question is whether this gain is a cause for alarm, and if so, what to do about it.  The rapidity and scope of the gain is what seems most worrisome to me, especially if that trajectory continues.  So I made the decision to try and stop that trajectory. But neither am I willing to put this cat on a major diet or give him a compromised-nutrient food if I can avoid it.

What seems least harmful is to take away the dry food (since it's probably not part of what he's biologically meant to eat anyhow) and see what happens. I don't know if it's going to make much difference but it seems worth a try.  Other than that, we're not willing to get too drastic with him.

I'm sure other fatosphere bloggers have encountered a similar issue before.  What do you do when you have a fat cat? How do you respond to the "fat cat talk" with a vet? What's reasonable and what's not?

*One other interesting tidbit that came out of the "fat cat" talk was her admonishment not to reduce his calories too quickly or too severely.  Apparently, this can cause a fatty liver syndrome in cats that can be fatal.  I have no idea if it's comparable at all to fatty liver disease in humans, but it certainly did make me go "hmmmmm."  I know that fatty liver disease is one of the risks associated with obesity in humans, but like gallstones, is it associated with obesity or with dieting or a little of both?  An interesting side question. Anyone know the answer?

Wednesday, August 10, 2011

The Fat Vagina Theory Strikes Again

Here is a story someone left as a comment on my post on Soft Tissue Dystocia.  The story, unfortunately, is all too common.

As I explain in the Soft Tissue Dystocia post, some care providers believe that very fat women have so much fatty tissue in the pelvic area around their vaginas that a baby is unlikely to get out safely. 

Officially this is called "Soft Tissue Dystocia" but sometimes in the birth world we cynically call it the Fat Vagina Theory, based on a term that has actually been used by some doctors to explain to women of size why they had a cesarean.

Unfortunately, Fat Vagina Fear is yet another factor helping to drive the high cesarean rate in women of size.

Attack of the Killer Vagina

As I note in my previous post, there's little scientific evidence about soft tissue dystocia; it's mostly a dogma that has been taught to care providers over the years as if it is a hard-and-fast truth.....without the inconvenient detail of actually having proof.

But it's a dearly-held dogma, and one that care providers rarely even question. And the belief in it leads to many questionable interventions in women of size.

Providers who subscribe to this dogma believe that vaginal birth in very fat women is unlikely because of so much soft tissue in the way, or that the combination of a big baby and this "compromised" pelvic space will cause the baby's shoulders to get stuck, resulting in injury and lawsuits.

Therefore a common response to Fat Vagina Fears is to either schedule a cesarean or to induce labor early while the baby is theoretically more able to fit. 

Unfortunately, research shows that inducing early for a big baby leads to a higher rate of cesareans, not a lower one, and may actually increase the rate of shoulder dystocia. 

Let's say that again.  The intervention they use to supposedly lessen risk may actually cause the very outcomes they are trying to avoid─yet they still do it anyhow.

The results are no better for a planned cesarean before labor.  Babies don't do any better and moms' outcomes are worse.

To be fair, some of these care providers may have good intentions.  Those who routinely section high-BMI women often do it because they are convinced that labor is likely to end in a c-section anyhow, and because they feel it's better to do the "inevitable" c-section under planned conditions instead of emergency ones. 

Those who induce big moms early often do it because they feel inducing at least gives the mother a chance at vaginal birth, and because they feel they are less likely to get sued if they can show they took proactive measures ─ like inducing early.

Their intentions may be benign, but their interventions are not.  They don't improve outcomes, and often cause MORE complications than they avoid. 

Yet early inductions or planned cesareans with "obese" patients remain a very common practice, often with "soft tissue dystocia" as part of the reason.

Some providers are even beginning to be hassled if they don't follow these practices with women of size, as if they are behaving dangerously by not inducing or doing a cesarean.

One Mother's Story

This story sadly illustrates this scenario. The mother was induced at 37 weeks because of her size and the doctor's fear of shoulder dystocia. 

Not surprisingly, it led to a cesarean.  However, because the baby was not ready to be born, he had to go to the NICU and the mother didn't get to even hold her baby─for nearly a week. 

Although most care providers now wait longer than 37 weeks to induce for suspected macrosomia, the story often ends very similarly.  Mom's body is not truly ready for labor, baby is not in a good position yet, a long hard induced labor follows, and the mom ends up sectioned for "failure to progress," fetal distress, or fear of infection after a prolonged induction.  Women are told their babies were too big, their vaginas too fat, or their pelvises were too small ─ but the real reason was that inducing before the mother/baby dyad is ready often ends in cesarean.

Afterwards, Mom and baby are often separated, sometimes for hours, sometimes for days, which is one of the most difficult and heartbreaking things for a new mother.  Breastfeeding often gets off to a rocky start, and mother has to try and learn to care for her new baby while she is recovering from surgery.  Not a recipe for an easy transition into motherhood, and one which probably negatively influences the rate of breastfeeding in women of size.

Alas, the Myth Of The Fat Vagina is alive and well in obstetrics, and combined with Fear Of The Monster Baby, helps drive the cesarean rate in women of size. 
I had a c-section with my first baby seven years ago.

I was "warned" by my OB that since I was so big, 330, and had more fatty tissue in my vagina, that I could put my baby in jeopardy trying to deliver him naturally. She told me that i could break his collarbone, dislocate his shoulders or he could just get stuck.

I went against my gut and allowed myself to be induced 3 weeks early. When my doctor came in to check on me after the first couple of hours, she broke my water without my consent and the clock started ticking. After 24 hours of labor, I was so close and my doctor ordered me into an emergency c-section because my water had been broken for too long, putting my baby at risk.

Adding insult to injury, I had not had any pain medicine (I'm kind of granola). The anesthesiologist came in to give me the epidural and took one look at me and said that it is really tricky to do on such a fluffy girl. I begged for her to try. She told me that she was going to give me some oxygen before she started and put me to sleep. I woke up so confused. And worst of all I feel I missed the birth of my son.

He was very sick and had under developed spots on his lungs, he was taken away to the NICU immediately. I didn't get to hold him until he was 6 days old.

I really wish that I had trusted my instincts and had had a provider who listened. I am pregnant again. I am prayerful that this time around I will be able to have a natural birth free from all of the bullying that I experienced before. I have to believe that my body, big or not, would not grow a baby that it could not deliver.

*I hope this mom contacts ICAN, the International Cesarean Awareness Network, which can help her work through her feelings about her cesarean, find a more size-friendly provider, and support her as she works towards a VBAC. 

Thursday, August 4, 2011

Automatic Cesarean Section for Everyone with BMI Over 40?

People don't always fully believe it when I tell them about the tendency of many doctors to just schedule an automatic cesarean for "morbidly obese" women these days, but it's really true in some practices.

Of course, it's important to point out that not all care providers do that......but quite a few do, and more and more providers are starting to feel the pressure to do so.

Here's yet another example.

This is from My OB Said What?!?, in the comments section of the entry, "Because of Your Weight, We'll Just Schedule Your Cesarean."
When an anonymous survey was conducted, 100% of the OBs at this hospital (yes, every last blinkin’ one of them) admitted that they would schedule a c-section automatically if a woman’s BMI was over 30 and there were any other risk factors, or BMI over 40 with no other problems!!!
As a woman with a BMI over 40, I find this trend offensive and troubling in the extreme.  I know it's not routine everywhere, but this is becoming the "standard of care" in many places, and woe to the caregiver who doesn't do it, or who dares to try and support one of these women for a natural birth. 

I'm hearing now about care providers who are being hassled for daring to attend "morbidly obese" women at all (instead of sending them to the high-risk Bariatric Obstetrics practices), or even for not automatically sectioning those they do see.  Really.

I know there are still good doctors and midwives out there who don't practice this way (and thank goodness for them!), but the birth politics around obesity in some areas are becoming so extreme that even the good care providers are feeling pressure to not attend women of size for normal birth. 

This is a very ominous and deeply troubling trend.   If this trend becomes firmly established as the "standard of care," it will be very difficult for the good providers to fight against it because it opens them up to increased legal vulnerability. 

If that happens, heaven help women of size.

Where is the outcry against such things?  Where are the birth professionals willing to stand up for women of size and speak out against this?   How can we reverse this trend?