Neck MRI results

[ny biker]

I find that it's hit or miss in terms of finding doctors who know what to do with a patient who exercises. The exception is my gynecologist, because we both work out with the same personal trainer. Otherwise there seems to be no reliable information available before making the appointment. I was just lucky to find a pulmonologist who is unphased by my activity level. When I had the paralyzed vocal cord problem last year I would have been lost without him, since the ENT I went to had no concept of how to treat an active patient and refused to believe me when I said that it was affecting my ability to breathe when I rode my bike. When I went to an orthopedic surgeon some years back for a knee problem, two days prior to a riding a very hilly century, I was relieved that he said "let's give you something to get you through this weekend" rather than "I'm sorry but you can't do that bike ride" -- when I made the appointment I had no idea how he would treat me.

Great news about the meniscus, Catrin.

[Catrin]

I've been pretty good in recent years at not meeting that attitude, but my PCP is an OD and my chiro specializes in sports medicine. Of course that still doesn't mean they don't look at my birthday, and my chiro DOES remind me that I don't have the neck of a 26 year old. All in all I feel fortunate. So now I'm faced with figuring out how far to push my exercise until we get more information - enough but not too far. I just CAN'T sit on the couch until Feb and however long it takes to get those tests completed.

[Aromig]

I always find the sports medicine people the best. I'm in my mid-40s, work at a professional desk job, and am "curvy" (my nice way of saying overweight) but still really really active. I'm always relieved to find someone who helps me maintain my activity levels, without just having the knee-jerk reaction of saying "don't be so active."

[salsabike]

So one thing I did when I went to see ankle surgeons two years ago about the posterior tibial tendon dysfunction might interest you all, because it's very germane to everyone's concerns. I wrote a one-page summary and asked them to read it before we talked. The summary basically said:

"I have recently been diagnosed with posterior tibial tendon syndrome, stage 1 or early stage 2. My goal in coming here is to get a comprehensive understanding of all of my options for treating this, before it deteriorates further. It is very important to me that I be able to stay as active as I am now....

(description of symptoms, MRI results, etc.)

I am a 60-year-old athlete who is 40 pounds overweight. I have worked very hard to take the weight off, and several times have lost 20-25 lbs., and have gained some of it back. I am very aware of the weight effect on my body, care about it, and work to change it, with variable results. It is just as important for me to say here that I am nonetheless very active and plan to be very active as long as I possibly can until the day I die...

[a list of what I do annually since 2005: ride 2500-3000 miles a year, 8-9 miles hikes with 1500 ft. elevation gain. That I've done 8 sprint triathlons and three Olympics since 2008, and maintained a typical weekly triathlon training schedule with a coach, until this injury in 2014. That from about 1976-1991, I took 6-12 hours of ballet class a week; had to quit because I developed fibromyalgia; took medication for the resulting severe chronic muscle pain that made me gain a huge amount of weight and ended up changing my weight set point, so it is harder to lose and keep off weight now.]

And ending with this:

I can’t imagine not being able to hike and ride, especially...I write this so you will understand that being very active is a huge part of my life and that conversations about posterior tib tendon syndrome treatment need to recognize that as a priority concern of mine. Thanks."

The ankle surgeons I saw--one who is on the Seattle Seahawks' orthopedics team and one who is on the Washington Huskies' orthopedics team--took me very seriously and treated me with respect. I am not sure that would have happened without presenting this letter first.

So...just a tool for you all to think about using when the stakes are high and you're really worried.

[OakLeaf]

That's a great way to go. Still, I think the #1 effect would be to screen out the 75-80% of doctors who (in my experience) wouldn't bother to read it before walking into the exam room.

(To be fair - some doctors really do want to do better, but insurance companies constrain almost all of them. The choice in today's world for a doctor is either to administer a treatment code that matches the diagnosis code in the insurance company's flow chart - which, treatment codes encompass the duration of a visit - or, to stop accepting insurance entirely, and treat only those who can afford it. That works for some specialties just fine, particularly primary care, but not so much for a surgeon. I've talked with my psychiatrist quite a bit about this. After several bouts in and out of corporate medicine, once she'd paid off her student loans, she took a sabbatical and then came back to practicing but not accepting insurance. It distresses her a lot, not to be able to treat middle and low income patients, but not as much as giving poor care to all her patients distressed her when she did accept insurance.)


My massage therapist was asking me about my resting heart rate yesterday, which made me think of a way to characterize people like us:

"My age is greater than my resting heart rate."

[Aromig]

Such a letter is a GREAT idea!

When I started having pain while running last year, I went to a new ortho doctor. I decided to try someone new because the ortho doctor who was treating my broken leg four years ago (a torsion fracture of my tibia from stepping in a hole after running out a parachute landing :-)) repeatedly just told me that I might not ever be 100% again. The first thing this new doctor did was ask "so tell me about your typical week, what do you do?" I told him about running and cycling and yoga. He asked how many hours of each. Instead of judging me by how I look or what my job is, he said "well, endurance athletes are sometimes the hardest to treat because all of you seem to run/ride right through the pain and aren't good at judging when to stop. I will make you a deal, I promise you that I will get you out there and up to normal activity levels as soon as I can if you promise me to be honest about your pain."

I was tickled pink that he called me an endurance athlete (and then I wondered why I didn't call myself that? I do 4 or 5 centuries each summer and a lot of longer rides as well).