Thursday, January 22, 2009

Cause You're Just Not Trying Hard Enough

So, I went to an orthopedist for the first time this week. I was in a car accident last spring...a guy rear-ended my car at a high speed, and my car was totaled. Did a number on my body too, including my knees.

I have been concerned about a distinct decline in the function of my knees (and increase in pain level) since the accident. I've been seeing a chiropractor and acupuncturist regularly for most of this time, which have helped my other problem spots dramatically. There's still some residual issues, mind, but I've had a lot of improvement in those areas. Not so much in my knees. So my chiropractor suggested that perhaps it was time to see an orthopedist to check things out further.

I was surprised by how anxious I was about this visit. I'm usually a good advocate for myself and my size with doctors and I generally don't take crap from anyone, so I was surprised to have so many nerves about this visit.

On the other hand, I know orthopedists can be very fat-phobic, and I was worried that I'd be severely lectured or even yelled at about the need for weight loss, yadda yadda. I knew I'd have to have my youngest child with me at the appointment and I was worried about getting into this kind of crap in front of her, I think. She's young, but she's old enough now to "get" a lot more of what she hears, and I didn't want her to pick up on this kind of crap.

Also, I looked up the bios on the practice I was seeing and saw that they were all mega-athletes; the particular doc I was seeing went on and on about his training for the Iron Man Triathlon during medical school and residency. Great, someone who judges everyone else's exercising by his own quasi-compulsive standards. I knew I'd never measure up there either, even though one of the reasons I was there was because the knee issues were keeping me from getting back into exercising. Crap.

Well, the appointment was both better and worse than I expected. The doctor was nice, at least. That always counts for a lot with me. They didn't weigh me (which I was prepared to battle over). There was no yelling, no nasty over-the-top lecturing, none of the really hard-sell tactics you often see. So that was refreshing, and frankly, quite a relief. But that doesn't mean there wasn't size bias, just that it was couched more nicely. Sigh.

They did have me do an x-ray, and while they did have a pair of shorts in my size for me to wear for the x-ray and exam, they were pretty tight and not comfortable. If I'd known, I would have brought a pair of my own shorts so I could at least be comfortable. [Hint: If you ever think you might need knee/leg x-rays, bring your own shorts. I wore pants that easily pull up above the knee but that wasn't enough. Next time, I'll bring my own shorts.]

The x-ray showed arthritic changes, which I expected. I'm well into my 40s and we knew a little of this had started. My concern was that something else must be going on too, because my knee function had gone down so quickly. Well, the arthritis has certainly progressed (how depressing to write that, ugh) and the x-rays showed that. However, what was upsetting was that he wouldn't consider that something ELSE might be going on too.

When doctors see fat people with body pain, arthritis is their automatic assumption, to the extent that they get tunnel vision about if nothing else could be going on too. How often do fat people get misdiagnosed or underdiagnosed for non-fat-related issues because their doctors have this kind of tunnel vision?

He mentioned in passing that I "might" have a small tear in my meniscus, but that I wasn't a great candidate for surgery because of the arthritis' narrowing of the gaps. Okay, I understand I may not be the best candidate for surgery (I didn't go there wanting surgery anyhow) but the meniscus idea deserves a little more exploration, doesn't it? But it was mentioned so briefly, in passing, that I really didn't pick up on it until after the appointment was over. Now I'm kicking myself for not pressing him more on that possibility.

Of course, at one point, weight loss was mentioned. I knew it would be. I tried to fend it off ahead of time by telling him my main concern was feeling better and getting back to exercising (and mentioned prominently that I didn't do exercise for weight loss but simply to improve fitness).

Of course, then he brought up later that even though I don't exercise for weight loss, losing weight would reduce the pressure on those arthritic knees. Well, okay, that's a legit point, and I don't think it's improper for docs to mention that.....extra weight is harder on your joints. But that doesn't alter the grim statistics on losing weight and keeping it off. Chances are losing weight would be my best ticket to actually worsening the situation because of the rebound afterwards, so I mentioned that as why I wasn't interested in losing weight.

His response was to question whether I'd really tried to lose weight....not in a mean way, mind, but still, clearly dubious about whether anyone could do it "right" and not lose permanently. He asked whether I'd ever really worked with a nutritionist or worked with an exercise specialist, and started to go off about how he could set me up for that. I shut that line of discussion down fast, laughingly noting how I'd DEFINITELY worked with specialists like that before, rolling my eyes, and noting I wasn't going down that path again.

At that point he dropped it, not because he was convinced but because the appointment clock was ticking and this clearly wasn't going anywhere with me. In the end we agreed I would give Physical Therapy a try (which is fine with me; it's why I was there) and he offered me a cortisone shot for the pain, which I declined because acupuncture has been pretty successful at helping with the worst of the pain.

After the appointment was over, I was mostly relieved that it didn't turn into some giant lecture fest (especially in front of my daughter), and disappointed in myself that I didn't more aggressively question him about the possibility of a meniscus tear. I'll be looking into that further later.

But later, after I'd had time to really think about the experience, two things about it really struck me. First, the doctors are SO focused on your weight and the possibility of arthritis that they literally cannot see any other possibilities for your joint issues, even when something like a car accident is on board. Hello?!!?? Fat people get trauma-related injuries too!

And second, there was this big underlying assumption that if I hadn't lost weight up till now, it HAD to be because I hadn't REALLY tried. I might have dieted, sure, but not hard enough, not intelligently enough, not with the "right" experts, the right program, yadda yadda.

Cause, ya know, we're all just not trying hard enough.


Anonymous said...

Of course you're not trying hard enough. None of us ever try hard enough--duh--that's why we're fat! If we were really trying, we would never have gotten to be in such terrible shape to begin with! (/sarcasm)

I hate this attitude that says if we would just lose some weight, everything would be fine. The thing is, even if you did lose weight and kept it off, you would still have arthritis. You would still need treatment for that. He thinks the damage or the pain may be lessened if there were less weight on the joints, but he really has no way of knowing that. So why not just treat it now?

I'm glad you at least got a referral for PT. I hope things go well for you.

Anonymous said...

It really sucks that you have to present your I've-busted-my-ass-to-get-thin-but-no-dice card even to get a lot of doctors (not mine, whew) to take your problem seriously. (And women of ALL sizes have problems getting doctors to take them seriously when they come in with pain issues; we're presumed by many of them to be whining for attention. But certainly, middle-aged and fat doesn't help in getting them to take you seriously.)

Doesn't it ever occur to them that all the trying is more of a problem for most of us than actually being fat? And if you can't work out, how does he expect you to lose the weight, by waving a wand?

(I can just imagine how my aspie brain would handle a "have you really tried?" question from a doctor. "If you mean, have I tried throwing up everything I eat and running ten miles a day, no, and that's what it would take for me to be thin, since moderate diet and exercise don't do it. And by the way, I can whine for free, I don't have to pay you for the privilege." Maybe that's why they don't ask me.:-P)

Anonymous said...

Here via SP-

I tore the medial meniscus in my left knee a while ago. Mine was a more significant tear, and my arthritis is minimal, so the doc had to focus on that.

The physical therapy did a lot of good. Make sure they evaluate you thoroughly on the first day (see you stand and walk as well as testing range of motion), and set you up with exercises you can replicate at home fairly easily. I was in for 6 weeks and it helped but if I'd stopped at that point it would've undone all the progress I'd made.


moxie3 said...

The only time I had a bad experience was when I had hurt my back reaching for a mattress and helping my husband bring it down stairs. I had also had a baby about 4 months prior.

The pain was excruciating and one of those situations where you couldn't get up in bed. All I probably needed were a few muscle relaxers but went to a back doctor and he had a "med student" with him to observe. I felt like an object of fat and not a person as the doctor went on about how I needed to lose weight in order to fix my back problem etc... all the time discussing that situation with his observing student. I was humiliated and it was part of the start of my decline in self worth especially when it came to taking care of my own health by going to doctors when I needed to. Nancy

Bri said...

I have just been told I have arthritis in my fingers. It will be interesting to see if they try to blame my fat for that! Or even say that losing weight will help it. My hands are one of the places I am not fat! lol

Stef said...

I am currently under treatment for patellafemoral pain syndrome, which is a cartilage disorder in the knee. If you haven't had an MRI, you might consider bringing it up with your doctor. The advantage of MRI is that it can categorically rule out whether or not you have a meniscal tear. Some tears heal themselves, but others need surgical repair. I was glad for my MRI b/c it ruled out any tears, and confirmed what was really wrong (I am in physical therapy for it, as my MD doesn't think it needs any surgical attention.)

Good luck - knee problems can be frustrating.

Noelle said...

Thanks for your post. I found your blog through the Fatosphere, and read it because of the title. That phrase is one of the things that finally put me on the FA team, because I realized that I had been trying my damnedest for 20+ years to lose weight but instead was going the other way.

"You are not really trying" (during) or "you did not try hard enough" (after) were some of my EX-husband's favorite things to say as I yo-yoed up in weight across 19 years together. And I believed it, too, until last year when I actually considered major surgery to "fix" my fat problem and finally decided to try to let my anxiety about trying to be skinny go and try to be content as is.

Elaine St. James (Simplify Your Life and other books) suggests that if something seems too hard to do, maybe you should stop - that the things that are good for you and you enjoy should not be painful to accomplish. I hope that's true, because that's how I'm trying to live :~).

Anonymous said...

At my recent gastroenterologist appointment, after I'd told the doc all about how I have one diagnosed and at least one other potential diagnosis of autoimmune conditions that cause severe fatigue, malabsorbtion/malnutrition/deficiencies, slow metabolism, pain, breathing difficulties, and various other symptoms, she said "The thing I'm most concerned about is your obesity." I can't even remember what I said, something about how well, if I didn't have these condition(s) then I might be able to exercise, blah blah I'm such a good fatty blah. (I get pretty severe medical anxiety and tend to blather on.)

And then they tried to sell me a frakking lap band. If it wouldn't take me six months to get an appointment with another gastroenterologist, I'd dump her. Frankly I find it unethical and alarming for someone supposedly as knowledgable about the GI tract as that to recommend deliberately messing with it. Especially to someone who already has a digestive disorder.

Unknown said...

What an unpleasant experience. I fell on my knees a few months ago and my doctor told me that all women my age have bed knees and I should lose weight. As if there had been no injury.

The orthopedist I went to was much better and so sympathetic and diagnosed severe tendonitis. Also, the PA who saw me first was a big guy, so that was nice.

I feel the same way as you whenever going to see a new doctor. I went to see my new general practitioner this morning, and even though she had been recommended to me, I was a worried about the weight issue. She was mostly OK, but did attempt to show me what my BMI is. Um, lady, did I not just tell you that I haven't been able to exercise much because of the injury and I'm aware I've gained a whole buncha weight because of it? She backed right off and is even sending me for a few tests to make sure that the weight gain wasn't only caused by the lack of exercise. But I find it hilarious that she though I didn't know I was more than a bit hefty.