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Calling Out the Medical Profession

Friday, February 17, 2012

Okay, so I'm trying to decide if I should write this now, or wait until I cool down a bit, and I've decided screw it, I'm going to write while I'm good and mad. Not my usual course, but you know what? I don't care.

So a few folks might know that for the last couple of months I've been dealing with a bum knee. I tore my meniscus in mid-December stepping up on a bleacher. It hurt like heck, I waited a couple of days to see if it felt better, which it did not, so I went to see an orthopedic physician's assistant, who examined me, and told me the best thing to do would be to rest it and ice it and take anti-inflammatories and see if it got better within 2 weeks or so, but he did nonetheless immediately offer me a cortisone shot. I passed on the cortisone and told told him I see how it felt in a couple of weeks. Well, I waited more than a couple of weeks and though it felt much better, I still was feeling pain when I walk down stairs and if I spent too much time on it. So back I went, and again, the PA offered a cortisone shot. I said, well, don't you think we should look and see what's wrong with it before we start shooting stuff into it? And he apparently agreed, because he then sent me for an MRI. So I had the MRI, and then had to wait 2 weeks for my "results" appointment, and at that appointment, also with the PA, I'm told I have a torn mensicus, a little bit of arthritis, and now, it's time for me to meet with the surgeon.

So today, I met with the surgeon. In he comes, friendly and ready to dispense the best advice he can. He asks me how the knee feels. I tell him much of of the time it's fine, but I can't walk down stairs on it with a bent knee because that hurts, and that this week while riding the exercise bike, it popped and was kind of painful as I increased the resistance on the bike, which has not been happening at all since I got back to exercising. So he says , well, you know, the biggest problem is your weight, do you and your doctor have any plan for dealing with that? Why yes, doctor, we discuss it all the time and I work on it all the time and have worked on it for a lot of my life. So doctor, what about the tear? Will it heal itself? Does it have to heal? If I don't have it repaired, can I make it worse by being active on it? Well here, let me examine you.. So he examines my knee, and as he is I say to him, I guess one of my biggest questions is whether I am going to do further damage to the knee by expanding my exercise repertoire. And he stops and looks at me and says: any weight loss program must include cutting calories. You know, when you watch shows like the biggest loser and they have these people, many of whom are even heavier than you, doing all this running and pounding, well, that's okay if the joint isn't compromised, but once the damage is done.. That's why lap band surgery isn't an option for someone who can't exercise, that's why the only way to go is gastric bypass.

Ah. So the real question he was asking is: when is your doctor going to get you on the table to staple your stomach so you'll stop eating?? That was his real question, wasn't it? So I pass on pointing that out to him and I tell him: you know doctor, I'm not an idiot, I perfectly understand what you are saying and am fully aware that decreased caloric intake is part of a weight loss program, but I'm not asking you about a weight loss program, I have plenty of knowledge and experts in my life who can help me with a program, my question is, are there activities I must stay away from, or is this a situation where I can do whatever I can do without pain without fear of further injuring my knee? So he says, well, what would you like to do? And I tell him that I had asked for and received a new exercise DVD for Christmas that was a choose your own intensity movement one, but that would include some kind of dance type movement, and I had not done it because I felt like I needed to get the knee issue resolved. So he tells me that anything that involves change of direction could be an issue. Maybe you should try walking, but don't walk too far, I wouldn't want you to walk too far and strand yourself. So, I patiently say, once again, doctor, I think you are completely and totally underestimating my mobility here. I am actually quite active, though I am fully aware that I don't look it. I play baseball with my son in the summer, and have been known to pick up a hockey stick and play that with him, too. I walk on the treadmill, I do the elliptical, and do strength training. So I don't need to be told not to walk too far and get myself stranded. So once again, doctor, my question is, will I further injure my knee, or is it a tolerance issue? He then actually had the nerve to tell me he thought he had answered that question already, and said that he didn't know. But that he thought I should try it, but be smart and gentle and not push it if it hurt.

So finally, I looked at him and said, so are you telling me you can't help me other than to tell me to lose weight? And that's when he launched into the options I had, which for now will include injecting some kind of lubricant in the knee to see if that will alleviate the pain from the arthritis, and see where that leaves us with the meniscus pain. If these shots don't work, I guess we move on to surgery.

So, why do doctors think that fat people are stupid, or have never tried to lose weight? Maybe they don't really think that, but I've come into contact with more than my share of doctors, both my own and others whose patients tell stories like this, or even doctors that I know, that think that the only soluction for an overweight person is gastric bypass surgery. Never mind that even with gastric bypass surgery, you need to do many of the same things you need to do on a non-surgical weight loss intervention. I understand that when someone's life is in jeopardy and perhaps getting moving is not an option, surgical intervention is called for, but it is not a panacea. It cannot cure the ills of the overweight world. It does not fix the things that got you fat in the first place!!!

Why will I continue to go to this doctor? Well, by all accounts, based on my research, he is good. He now understands I view him as I view a mechanic, and my expectation of him is to do what he can do for the knee, and don't worry his little head about the rest of it. Point taken that I need to lose weight, and I am working on it, but I'm not going to promise it to you like I'm seeking your approval, and it's not going to happen overnight anyway, so put me in the best position you can to let me live my life and do what I need to do.

But what about the people who go to these judgmental doctors who don't feel comfortable pushing back when they are faced with the attitude I dealt with today? Understand, I am not lumping them all together, because my very own PCP is wonderful and I know there are many, many great doctors out there. But even some of the best doctors don't seem to understand the myriad of issues that underlie what makes people overweight, and that in many instances, cannot be "fixed" by having gastric by-pass surgery. It is a complicated issue, and one that does NOT have a simple answer, why does so much of the medical field think it does??

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Member Comments About This Blog Post
    And while I think of it - yes, you can do additional damage to your knee by continuing to exercise or by upping the exercise (whether reps or resistance or what-have-you). That's how the arthritis developed in mine. The good news is - there are knee-STRENGTHENING exercises that will still help you with the fitness but at the same time improve the muscles / tendons / ligaments supporting your knee. There will also be some you should avoid. If you can consult a physical therapist who specializes in things like joint injuries, so much the better. If not, you will have to be your own researcher / scientist / trainer / physician. I don't walk anymore than necessary: walking impacts the joint, tho not as much as running. I do ride an exercycle, every day, with increasing time / slowly increasing resistance. Non-weight bearing. easier on the knee, strengthens the right musculature (sp). There are ways to improve it; the PITA is find which ones will work for you. (And notice, 'bariatric surgery' is nowhere to be found in this advice, lol).
    3200 days ago
    Oh - Em - Gee, you have really hit the nail on the head - several nails, actually. I'm so sick and tired of feeling as tho I have to be my own doctor, but I guess that's what it comes down to. 'Pushing back' has given me some kind of 'Avoid her whenever possible' reputation at the local GP's office. I don't know whether to bawl or throw things, so - I do neither. But things ain't pretty.

    Re the knee: I too refused the (repeated / increasingly vehement) suggestions for cortisone shots. I had a classic football-style twist-and-fall injury eight-and-a-half years ago. Knee swelled like mad but it was nearly two days before I realized 'Maybe I should try some ice on that.' Whether more prompt action would've made a difference or not I'll never know. Point being - I didn't. Slowly, gradually, the knee has gotten worse. Even losing weight hasn't helped much; perhaps it helped delay the inevitable, but the inevitable has arrived. (Stoopid gastric band or dieting or upping the workouts won't solve everything, not permanently, anyway.)

    This year, FINALLY, the doctor thought 'maybe' an xray was due. All that showed was arthritis. Last week, FINALLY, the doctor decided 'maybe' an MRI was due. The results are pending. (Like yours, it's a two-week process. As if.) What do I think they'll find?

    I think they'll find I tore the meniscus and that the resultant increased stress on the joint actually either caused the arthritis to develop or speeded it up considerably. I think they'll either dismiss me with a shrugged 'You have to learn to live with it' or else 'You need a replacement knee joint.' I doubt there'll be much in-between.

    In the grand scheme of things, it's not a catastrophe: it's not heart disease, or cancer, or CKD, or any of the myriad of health disasters it could be. But that doesn't alter the fact it didn't have to happen, it wasn't inevitable, and if it had been addressed - correctly - at the outset, it might have been 'fixed' with a minimum of effort, cost, time, resources.

    No wonder patients are ill. If they weren't sick when they went to the doctor's, they'll be sick just from the BS thrown at them.

    p.s. One of the recent GP's said 'Oh, if you'd torn the meniscus, you'd have known. You'd have been rolling on the floor, screaming in agony.' She's obviously never given birth.

    p.p.s. GP as mechanic: I had the temerity to tell one (years ago, one I no longer see, lol) that 'If I called in a plumber who failed to diagnose the problem or who fixed it incorrectly, I wouldn't expect to have to pay for that. If I take my car to a mechanic and s/he says they can't repair the car, I don't get charged as if they'd done major work. Why should seeing a doctor be any different? I'm paying for a commodity. I pay you for your time and expertise, you are providing said service. You don't deliver, I don't owe you anything.' Gee. He didn't like that. LOL.
    3200 days ago
  • PICKIE98
    Nice that science CAN do bypasses, too bad they have not perfected the "brain transplant for themselves. I went to an ortho guy that walked in the room and told me he NEVER puts anybody on disability!! I asked him if he was the janitor. HE never introduced himself, so I told him I assumed he was there to empty the wastebaskets.
    I waited for him to give me his name, and then I told him that I had heard many good things about him, but did not hear the part about his rudeness and narcissistic attitude.
    HE stared at me, apologized and we got down to business.
    THAT is how to wrestle a bear!

    3203 days ago
    just because they are "good drs" doesn't mean they are "good people". In fact in my many years of working with lots of different ones it seems to be indirectly proportional. Sad but true. Not sure why and idiot can get a medical license. There are some exceptions (friends). don't let him discourage you in any way, he sounds like a bug on the windshield of life (some cartoon movie)
    3203 days ago
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    I've also been on the receiving end of condescending doctors, T. I'm sooo PROUD of you!! I don't know what happened to the REAL medical profession, but... anymore, it's just a batch of egotistic conceited self-important- - - ::huffin' n' puffin' here:: uncalled for, impolite JERKS with total disregard for another human being!! I think the REAL ones were shut out for their humble, modest, polite & respectful bed-side manners & they may even be on the brink of extinction!! I read Ramona's post & can also identify with being *fired* for lack of a better word- for not hanging on to every so-called *golden* word spoken- - - for not worshiping these mini-gods. You are the *B*E*S*T* girlfriend & it makes my heart ~sing~ to hear you tell him (in so many words) you are NOT going to be patronized- you are NOT stupid!!
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    3203 days ago

    Comment edited on: 2/17/2012 3:16:20 PM

    ...you know some of my experiences with the medical profession... been 'fired' by doctors for speaking my mind... and I haven't run into anyone who has specifically focussed on my weight instead of the problem at hand... so I won't give you any specific advice. Just know I'm here in solidarity... I think you handled yourself admirably, and I'm certain that whatever you do by way of follow up will be just the thing.

    3203 days ago
    I want to go slug the doctor! It's almost like he wasn't even listening to you. I feel your anger! I'll keep sending prayers your way Tina, it's almost like you really didn't get any answers.
    3203 days ago
  • JR0124
    That is horrible to be faced with such an attitude from someone that is supposed to help you. I am so proud that you pushed back and set up the boundaries. I had a bit of the same situation with my ankle and finally told my doctor that "I've already explained I hurt it running and am working on it so let's move on. Can you help me or not?"

    I'm really hoping he wasn't telling you that gastric bypass is your only option because we've seen a ton of people on this site who have done it without GB. I'm so mad for you!
    3203 days ago
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