Lower back/hip pain? Pain specialist says home remedy will cure it, along with losing weight

JG writes:

After a few years of pain in my lower back and hips, and a long history of mobility oddities, health issues, and struggle with weight, I was referred to a Pain specialist, in the hopes he could pinpoint the cause, and suggest treatment and pain management techniques so I could return to being active.
On Monday, I woke up many hours before my appointment, and left plenty of extra time to get to the clinic. This extra time was wasted, as I went to the wrong medical center (multiple clinics in town share the same name). I’ve been to both in recent months, and I became confused. I called right away, and told the 1st receptionist what happened. She said she’d page the doctor to see if he’d still see me, and in the meantime, I headed over. The two clinics are near each other, it was easy to turn around, get back on a bus, and walk the briskest pace I could to make the last several blocks. I showed up 20 minutes late. The 2nd receptionist said “Did you get the reminder phone call about the time for your appointment today?” I had. The 1st receptionist said “This is the woman who just called!” The 2nd receptionist “Oh. It’s your first time here. I see.” I don’t find it entirely implausible that people make this mistake once in a while, I felt rather frustrated by the brusque response.
While I wait for the doctor, I finish up notes on the illustrations I’d made of myself and areas of pain and how the correlate to various activities – I brought them as suggested by my primary care physician.
I lost about 28 minutes of the appointment, so I understand a rushed exam and a lack of patience. What I do not expect is that he asks me questions, and never lets me answer a single one, he cuts me off every single time. He doesn’t have my medical history or records other than the form I filled out as a first time patient. He glances at the illustrations over my shoulder but won’t look at the documentation of pain and what it correlates to (or take them to review later). He pokes exceedingly hard in places he’s examining, and seems surprised that I can’t tell what hurts anymore (The physical therapist I’d seen with her full weight on an elbow never hurt like his prodding did.). He further ignores me repeated statements of “But that is not where it hurts!” It still hurt to touch the areas he pressed hours later.
He said I have “Degenerative Disc Disease” and “Sacroiliac” problems. Now, with him not having looked at the x-rays, or even talking to me about what the problem is with the pain (or where the pain is!), how can he diagnose so quickly? Then he tells me stuff I already knew (based on my PCP and PT doctors, and research), no surgery will fix it, no medication will help, Physical Therapy is the only thing that’ll do it (and apparently, I can do it myself with some stretching, and maybe a home TENS unit, according to this new doctor – So what, how dare I waste his time when a home remedy is all I need?), and says I don’t need an MRI or other exam because there’s no nerve damage (I have no reflexes in my right leg, and both legs will go limp periodically when I walk, my hips experience pins and needles… that’s not nerve related?). He suggests loosing weight, I give a somewhat spotty response since he keeps interrupting me. Then he gets on the phone, dictates over several minutes everything I wrote on the form, his evaluation, and a request to send it back to my doctor.
Then the real trouble starts. He gets off the phone and says I need to loose weight, it’s all about expending more calories than I take in (I would LOVE to expend calories, that’s why I’m here, sir!). I tell him I’ve been to 2 nutritionists, and that eating well is too expensive when I’m out of work. He repeats himself before I finish. I remind him of my history of PCOS – and he says “Oh, well, you could eat a matchstick and gain weight!” and repeats the other part again. I tell him mobility is a better help to me. Then he suggests starvation. I point out that I’ve done that too [1], as a precursor to a specific diet and exercise plan and it resulted in 60lbs. of weight loss, but that mobility was key. I try to explain to him that when I’m mobile, I can and do loose weight. He then says I should consider starving myself to get the weight off.
His expression, his attitude, it’s like he seemed to think I only needed to be confronted about being fat, or like none of the dozens of doctors I’ve seen in my adult life ever told me I was fat and that I should do something about it, or like he’s the first person to tell me my weight is killing me. He acted like I never before heard about weight loss options, and really, if I would just consider not gorging myself I’d be perfectly healthy!
[1]When I was 19, and living with my ex-husband in our first apartment hundreds of miles away from everyone, I ended up starving, and lost 25lbs. It wasn’t on purpose, it wasn’t instant, we had no money, and finally after a week without eating anything but 3 oranges I was eating skin from the sides of my fingernails without even noticing it. In 1999, I discovered the low-carb diet as a treatment for PCOS, and against the advice of everything I’d read, I ate about half of the minimum, starving myself for an ugly month full of hysteria, panic attacks, and extreme fatigue. Since then, having developed difficulties with hypoglycemia, and putting on much more weight than I had back then (recent surgery recovery tells me if I get weak, I’m going to seriously injure myself the first time I fall down, trip, or pass out from dizziness because the weight will get in the way), and the mental side effects (I would probably need a suicide watch at some point, I was quite suicidal during the second starvation episode), I can’t imagine this is even remotely safe to do without immediate medical supervision. It seemed highly inappropriate for him to suggest a dangerous home remedy without having looked at any test or evidence, or consulting my medical history. It also seems inappropriate for him to offer this advice outside of his specialty and experience.
On Tuesday I was in more pain than I’d had in weeks, and on Wed. I was in more pain than I had been in for several MONTHS, I had clear swelling around the spots around my spine and neck where he pressed so hard, and spots that feel like lumps in the tissue. Touching the area is still quite painful. I feel it bears repeating, even with the most severe pressing, exploration and deep tissue work done by my physical therapist, I never left her office injured. I am currently awaiting a response from my PCP, I expect I will file a grievance with the clinic.

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Persistent ankle pain? It’s not incomplete healing after a sprain, you’re too fat and need to lose weight.

Sarah writes:

‘The most common cause for a persistently painful ankle is incomplete
healing after an ankle sprain. When you sprain your ankle, the
connecting tissue (ligament) between the bones is stretched or torn.
Without thorough and complete rehabilitation, the ligament or
surrounding muscles may remain weak, resulting in recurrent
instability.’
So says the American Orthopaedic Association, but what would they know?

Fifteen years ago, when I was still in secondary school, I sprained my
ankle badly. In line with NHS standards, I wasn’t given physio, or
even crutches, and eventually I recovered.
Ten years ago, I went to university. I had tutorials and friends
scattered all over the city; I did a _lot_ of walking. In the middle
of walking to lectures, I experienced sudden pain down the back of the same ankle I had injured previously. This persisted for a couple of
weeks before subsiding, but from that point on I started to regularly
experience minor sprains and ankle pain.
I went to my doctor, who examined the joint briefly and told me there
was nothing wrong with it, and that I just needed to lose weight and
the pain would go away.
I didn’t really believe him, but I had a number of issues and didn’t
have the emotional reserves to fight that battle, so I went away and
tried to avoid putting so much strain on the ankle.
It gradually got worse. I went to a different doctor, who again told
me there was nothing wrong with me and that I should just lose weight.
How I was meant to do this when the repeated spraining was preventing me exercising, I don’t know.
The ankle gradually got worse. I saw yet another doctor. This one
accepted that the ankle was damaged, but (without anything but a
cursory examination) told me there was nothing they could do about it
even if it was, and I should just take ibuprofen and try not to limp.
Last year I moved house, and the condition of my ankle substantially
deteriorated, to the point where I had to rest with my foot up for an
hour after walking to the post box two hundred yards down the hill. I
went to my new doctor.
My new doctor asked me what investigation and treatment I had had
previously. He asked me three times, apparently finding it hard to
believe the answer of ‘none’. He sent me to X-ray, just as a
precaution, with the intention of referring me for physiotherapy
afterwards.
Well, I’ve had the X-ray, and I’m not going to physio. I’m going to a surgeon.
Apparently my tibia and fibula are much-chipped about their ends from
all the spraining (it seems that if you really bugger up a tendon, it
breaks off a little bit of the bone it’s attached to) and the surfaces
of the joint itself are, in his own words, ‘manky’ (probably as a
result of the repeated trauma). All of which indicates that the
ligaments that connect the tibia and fibula are damaged, which would
destabilise the entire shebang and cause it to sprain at the drop of a
hat (which is exactly what it’s been doing). And of course, the more
it sprains the more damaged the ligaments get.
My best chance is to have the joint cleaned out and a screw put
through the tibia and fibula to tighten it up again. Sadly, my weight
makes it unlikely that the surgeon will be willing to put me through a
general anaesthetic.
If anyone in the last ten years had sent me for X-rays and physio
rather than telling me to lose weight, I might not now be looking at a
lifetime of pain.

That number on the chart means everything else I’ve said was a lie?

Bridget writes:

I skate on my local roller derby team. This is my second season. Roller derby changed my life, broke my old feelings of dislike for physical activity and realigned my belief system: I now equate exercise with pleasure and have learned to enjoy the satisfaction of working through pain and overcoming exhaustion and pushing myself a little further than I’ve ever gone, a little at a time until I’ve accomplished things beyond anything I ever dreamed I could do. I have the best friends of my life. I have taken many proactive steps to empower myself, from finally getting fitted for the right size bra (34GG/H instead of buying 38DDs and wondering what was wrong with me) to quitting a job I hated and beginning to get serious about all the dreams of being a writer I had never truly had the courage to pursue. I started skating in July of ’06 and have never regretted any of it for a second.

In March of ’07, I had a waitressing job. I was on my feet a full 40 hours a week, carrying heavy trays and literally running for hours, it would get so busy. The floors were awful, hard and slippery, and several of the other bar staff had leg/foot/joint problems. On top of that, I was skating, hitting, blocking and falling between 10 and 15 hours a week; it was our first bouting season and we were all completely overzealous.
My knees began to bother me, to the point that I had serious trouble with my normal 8-hour-shift straight to 2-hour skate practice routine. I would rather have died than given up skating, or even cut down on it, so I bought knee braces and tried to “work through it”, but finally it just hampered me so much I was driven to go to the doctor. I’ve never liked doctors much, but my team was worth it.

I went and had a decent visit. The doctor looked my knees over, commented on how muscular my legs were, said it sounded like I really was exercising far too much. She recommended the basic things. Drink more water, rest when there’s pain, stretch thoroughly; get new sneakers, try some ibuprofen to keep possible swelling down, and she also recommended I get X-rays to rule out any joint deformities or bone spurs. Fine.
The problem came at the end of the visit. She glanced over my chart just to see if she’d missed anything. And her eyes stopped on my weight.
“190,” she said. She looked up at me, frowning. I had no idea what was coming, because I was in the best shape of my life at this point and even my lifelong worst critic, my mother, had laid off me for once. “How tall are you?” she asked.
“Five-seven,” I said, puzzled. It was in the chart; the somewhat cavalier nurse had actually marked me down at five eight.
“You’re dangerously obese!” she exclaimed.
“What?”
“You must diet and exercise,” she said. “This is terrible. You must know you are at risk for diabetes, liver failure, and heart disease, even a stroke. You must get your weight down– you should lose thirty or forty pounds to start with. You must exercise more!”
“But,” I said bewilderedly, utterly blindsided, “I already, you just– you just told me to exercise less. And I– I have an excellent diet, we talked about that already.”
“Well,” she snapped, “cut down on your carbs, then. And exercise more.”

I went, utterly confused, and got my X-ray. I came back dutifully three weeks later for my general physical, which I had scheduled along with the followup on the X-rays because I hadn’t had a physical in three years. I’d come in, in the interim, to get blood drawn for routine physical tests.
I asked about the tests. “They’re fine,” she said dismissively. When pressed, she gave reluctant details: “Good blood sugar, excellent liver function, low cholesterol.” I also had excellent blood pressure and a nice low resting heart rate.
I asked about the X-rays. She waved them off. “They’re fine,” she said.
“But my knees hurt,” I said.
I know you’re all expecting her to claim that my knees hurt because I was fat. I was kind of expecting it, too. I probably wouldn’t be telling this story if she had, because at least a diagnosis, however poor, would’ve done something to help me, or given me some ideas to work with even if I still had to treat it on my own. But she didn’t even try to make the connection. That would have meant acknowledging that I had a body, or that anything existed besides those numbers on my chart. 190. Five feet seven.
That’s a BMI of 29.8. It’s just shy of obese. With comment-worthily-overmuscled legs. And 34GG/H breasts. Broad shoulders and a wide pelvis. An hourglass figure (not to be vain or defensive, but my waist is very defined, and waist/hip ratio is the #1 risk factor for heart disease). And I can skate hard for 3 hours at a stretch and like it. But she kept using two phrases, “dangerously obese” and “grossly obese”.
It’s all she talked about, how I needed to diet and get some exercise. She seemed disgusted that I existed, and never looked into my face, which she had done frequently early in the first visit. She seemed angry that I was even there. So I never went back. (This is probably only tangentially relevant, but she was not exactly willowy herself. Not to knock it– who am I to judge, given my dangerous obesity?– but it made the irony slightly more bitter.)

Almost a year has gone by. I’ve continued to skate. The knee pain eased after I quit my waitressing job (and took a 50% pay cut for a sit-down office job), but it’s come back this season, aggravated by a boneheaded attempt at doing a few warmup laps without kneepads (and, of course, a hard landing). Today (February ’08) I finally sucked it up and went to see another medical professional– but this one is a physical therapist who is a friend of one of the employees of our skating rink. He’s come to our practices and seen what we do. He immediately said “That sounds like patellar tendonitis.” He did not weigh me or measure me, he just looked at my knees, in great detail. He spotted that I have a problem with my posture, possibly related to the uneven overdevelopment of some of my leg muscles; I stand with my knees bending inward, slightly knock-kneed, and I most likely skate this way too. This would cause the problem, in conjunction with the wrong sort of exercise. He also suspected that the prolonged irritation had roughened the cartilage behind my kneecaps, but seeing as I am only 28 it was unlikely to be serious yet.
He made pads for me to put in my shoes and gave me theraputic exercises to do daily. He complimented me on how hard he could see the team was working, and how impressive the sport was. The only comment he made about my weight was when I told the story of the doctor who had consigned me to nearly 12 more months of this pain from a condition I could have been correcting. “Well,” he said, “higher weight never really helps joint problems, but it’s hardly the only risk factor.”

Now, I can take some of the sting from her awful words and make myself feel better [for whatever that’s worth] by saying, “By her own chart, I’m not obese, so she’s wrong,” but that’s not remotely the point. That’s just transferring fat-shame, and is almost as bad as the original offense. The real point I am making with this story is that my weight became the only issue she could see. She did not even make the bad excuse of blaming my condition on my weight; she simply ceased to care that I had a condition at all. I disgusted her, and she was simply not interested anymore in my health. Even though by her own chart I did not meet the arbitrary criteria she was going by, the fact that I was even near it was unacceptable. I can only imagine what she’d be like with someone who was actually in the obese BMI category.

Interestingly, telling this story at practice brought all sorts of unexpected size-positivist solidarity out of the woodwork. I want to do my own version of Kate Harding’s BMI project with my roller derby league, as besides the expected (and awesome) badass big girls there are a lot of extremely athletic and slender girls who have been told they’re “overweight”. And, for the record, joint and recurring-injury problems seem to be distributed fairly evenly across the size spectrum, not clustered around the higher-BMI girls. The bigger they are, the harder they fall, sure, but they’re also a lot harder to knock down in the first place.

Love the blog, am hugely inspired by reading it, and think you are doing a tremendous service here.
— B-17
#17 Nickel City Knockouts, Queen City Roller Girls, Buffalo NY

Rx: Lose 100 pounds

Becky writes…

The background: I am 5’6″ and 245 pounds. I have been this size (or close to it) for years, losing weight after giving birth to my two kids, but gaining it back fairly quickly each time. Having had gestational diabetes and joint pain, I was concerned about my health, and began working out and eating healthier to get in better shape. This was interrupted by a serious hip problem; my right hip would pop out of place, causing excruciating pain and incapacitating me for days at a time. My doctor prescribed massive amounts of ibuprofen and physical therapy, which worked for a while, but then the problem returned (worse than ever) and I got an ulcer from the ibuprofen, so I couldn’t take any kind of pain medication.

Enter the hip specialist; Dr. Jerkhead (not his real name, but it should be). I limped into his office, MRI report and pictures in hand, and waited patiently. Dr. Jerkhead listened to my description of my hip problems, said, “There’s no way it’s popping out of joint, or you’d be in the emergency room all the time.” Then, he looked at the report (not the pictures) and said that there weren’t any issues (although the report clearly said that there was evidence of arthritis and potential bursitis) and that I just had to lose 100 pounds and I’d be fine. When I said that I couldn’t exercise due to the pain, he told me to just go on a strict diet, and I’d see results. He pulled out a prescription pad, wrote, “potatoes, rice, sugar, pop… No!” then handed it to me, and walked out. The whole “consultation” took less than ten minutes, and did not involve any sort of physical examination (other than his judgment of me as an ignorant fat woman). I walked out feeling attacked and worthless, then I got angry.

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Crippling pain? Try strenuous exercise!

Contadine writes…

5 years ago, at 230 pounds, I decided to go on a diet. It started off typically: planned meals, calorie journal, joining the gym. Before long, I was restricting myself to no more than 500 calories a day, and exercising upwards of 3 hours a day, 7 days a week. I was biking, running, lifting, doing yoga. I dropped 70 lbs in 5 months. Down to 160 lbs and a size 12 from a 20.

At about the 6 month point, I started having all these aches and pains. First in my wrists, then my shoulders, then my hips. Pretty soon, I was in horrible pain all the time, all over my body.

I went to the doctor to check out what was wrong. I got around 10 seconds to describe my pain. Her response? “That’s what happens to people your size. You’re putting too much pressure on your joints. Try eating less, and start exercising.” We hadn’t talked at all about my food intake or exercise routine. She handed me a flier for an Overeaters Anonymous group that met at the hospital and showed me out of the room.

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You’re too fat to have surgery

This isn’t an emailed submission, but it’s definitely relevant to the scope of this site. An article, “Where Fat Rules Out Surgery,” reported today in the Monterey Herald reveals a growing trend in the numbers of patients being denied nonessential surgeries by British health authorities because of their weight.

For two years, Frances Kinley-Manton says she lived with arthritis pain in her hips, a condition that kept her in a wheelchair. She wanted hip replacement surgery. But doctors at Britain’s National Health Service said she was too fat for the operation

Read more…

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“It’s only been in the last year I’ve found a doctor that looks at me as a person”

Branwyn writes…

I have so many stories, years and years of being treated as just “fat” instead of a person with real, physical problems.

My first time with the prejudice doctors have against overweight people was when I was 16.  I’d had amenorrhea for a year at that point.  My grandmother (who I was living with) took me to the doctor, who, after doing a pregnancy test and a cursory pelvic exam, told my grandmother that I was just fat, and that if I lost weight, I’d get my menses back.  Oh, I weighed 165lbs on a 5’2″ body.  I was in a size 16, which yes, is overweight, but not what is usually considered normal to interfere with menses.

That started my hate of doctors and my utter loathing of my body.

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