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 it....as 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.