Thursday, February 25, 2010

Knee diagnosis

So today I saw a new orthopedist, Dr. S, for my continuing saga of knee pain. I know that with any type of joint stuff I'm always running a higher risk of being told it's all my fault cause I'm deathfatz, and I also had found out this particular guy's specialty is sports medicine, so I went in armed. I brought a printout of Dr. Jon Robison's excellent "10 Things People Can Do Right Now To Ease Their Concerns About Their Weight and Improve Their Health." When he walked in and greeted me, I offered him the packet and told him I wanted to share with him the approach I take to weight and health and that I don't want to hear about weight loss. He was taken aback, and said, "Wow... opening with a shot across the bow!" Oh great, I think. Clearly not too receptive. But I forged on. I told him how we know that only 5% of people who lose weight keep it off over 5 years, and that being told to lose weight makes my depression spike so I really just can't have it. He was like, "OK." Didn't seem excited but didn't insist that it is his moral duty to tell me to lose weight either. Better than nothing...

So of course the concern I had with having opened that way was that he'd assume I changed away from the previous orthopedist because of weight loss talk - which actually is _not_ the reason, in this case. I didn't like the other guy because he wanted to blithely prescribe medications without ever examining my knee, and when I asked him why he recommended a given course of treatment he couldn't/wouldn't explain his thinking. So best I can tell I wasn't mistreated cause I am fat, per se, he's just a crappy doctor. Luckily, the new guy starts asking me about my history and I tell him I was sent for an MRI and he's looking at my chart at the same time and he says, "Did you want to see Dr. M?" And I say, "NO," very firmly. He looks surprised so I give him the summary of my last visit to Dr. M, ending with, "And I just really need someone who can explain the decision process and give me all the information about what's going on with my body." And he seemed to take that to heart - he was very thorough and informative throughout the visit.

I was really proud of myself for advocating for myself throughout the visit. Not only did I throw out the ground rules about health focus not weight focus, but I told him what I want in a doctor in terms of being thorough and informative, AND I continued to push for explanations, information, why this and not this treatment, what can I do to get better, and of course the old standby, "If I were an average-sized person, is there anything that you would be telling me that's different, or any other treatment paths we'd be exploring?" In this case, he said no. I don't always believe them when they say that, but at least I've asked - both for myself and to hopefully plant the seed in their thought process in general. I'll never know if one of the docs I've asked this question of may think back and see, "my gosh - I really did think differently about that patient because of her body size! Shame on me!" It's a fantasy, but it could happen... and I'll never know if it does. I have faith that things we say can have lasting effects because I've seen it as a teacher and with other teachers I've known. It's often the kid you least expect who is the one who comes back years later and say you changed his/her life. You just never know at the time. And for every kid who comes back, there are probably a few others you'll never know about at all... it's a good reminder because you don't have to wait to see your impact directly in order to feel that continually trying and putting your stuff out there in the world is worth doing.

EDIT: I forgot to share the actual diagnosis, which I probably should since that's the headline...

So my left knee, the one I fell on back in July of 2009 and which continues to be tender and have numbness spread down the leg, should get better. The fall most likely damaged a nerve which wraps around the kneecap and down through the area that's numb. When I fell on that edge of pavement across my kneecap it crushed that nerve and that's the cause of the numbness and tenderness. There's also some arthritis inside the knee, but that's separate. The fallout from the fall should heal with time. Or it may not, as nerves are fussy. But it's not anything that needs surgery or further action - just time.

The right knee is a different story. It's been hurting since I did a major organizing/cleaning/dejunking project the week after Christmas. Due to favoring the left knee, I overused the right and irritated it, and it has been acutely painful on and off (mostly on) since. My primary care doc, Dr. H, diagnosed bursitis on the inside face of the knee, but that didn't explain the pain inside the joint or behind the knee or in the muscles above and around the knee. Dr. S examined the knee briefly and said he didn't think it was bursitis. He said that he thought it was much more likely arthritis. I was a little unsure about this since he came to the conclusion so quickly. It seemed like he might have decided it based on my body size more than anything else. But the fact that there's pain inside the joint not just outside, there are signs of arthritis in the other knee that he had shown me on the MRI, Dr. H has mentioned that I have the beginnings of arthritis in the other knee before, too, etc. made me willing to accept it. He explained that bursitis is much less common than arthritis, and invoked that thing about if you see hoofprints you should look for the horse before the zebra. He said there's an easy way to check his theory: he could give me a cortisone shot and see if it helps. I asked, don't you only get three of those in any one body part in your life? and he said it's not a hard rule, more just that after 2-3 they will stop working. I was reluctant to use up one of my 3 when I'm so young, since this is going to be a lifelong problem, and he seemed to agree.

He sent me for x-rays to see how bad the arthritis is. According to the x-ray it's only mild... I just can't *wait* to feel how bad it's going to hurt when it gets worse, since it's already pretty bad now. According to him, there's nothing you can do preventatively for arthritis, it's just part of your genetic makeup. Of course, he said, (and here's the one weight-phobic comment he made), "You're making it worse by not..." and I nodded like, "I get it, let's not have the weight loss talk." But apparently my acknowledgment was too cursory, because he reiterated, "significantly worse" and I'm like, "OK - but there's no particular diet or exercise regimen that is specifically shown to alleviate arthritis?" And he says no diet is better than any other. And then I realize of course that I said the magic word and he's thinking I am willing to weight-loss Diet, when what I meant was to ask about adding things nutritionally to my diet-as-in-the-foods-I-eat. Le sigh.

So in summary: arthritis in both knees, plus slowly-healing contusion with nerve damage in the left knee. And the arthritis is a life sentence and there's nothing I can do about it. Good grief, such an uplifting appointment. I've gotta talk to Dr. L the naturopath and Dr. D the Chinese sports medicine doc to get a less-bleak prognosis.

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