Friday, April 9, 2010

Medical Assertiveness Part I

“Two roads diverged in a wood, and I – I took the one less traveled by, and that has made all the difference.” Robert Frost

My recent shoulder and knee issues have me thinking about the side benefits of weight loss. As you all know, I started losing weight in 2005 because I’d spent the good part of 2004 figuring out what I wanted for myself. Two roads had diverged: Did I want to lose weight or stay where I was? Either way, I was going to commit to my decision because I was tired of the guilt trips and the hemming and hawing. After journaling it out, I realized that I loved myself and wanted to change, and so I took the road less traveled.

130 pounds later, roads diverged again, but the decision about which path to choose was easier to make because the self love that got me to lose weight got me to my doctor to start unraveling the mystery of my joints. At 300-pounds, I was afraid to seek help; afraid of being told to simply “lose weight.” But at 160 pounds, I’d gained the confidence I needed to not only find answers, but to work proactively for solutions.

In my last blog, Lori commented: “Can you imagine how you would be feeling today if you had not lost the weight? It's mind boggling, isn't it?”

Yikes! I’d probably be in total agony, still refusing to see a doctor, of if I'd seen a doc, I’d probably be taking pain killers like candy. Instead, I chose the road less traveled.

After reading Lori’s comment, I searched my files and found two essays I’d written regarding finding my voice in the medical world - a voice I’d not have found without the confidence that came with losing weight. I truly admire people who can be advocates for themselves no matter what their weight, but what I’ve learned through years of writing about weight loss is that most folks who are obese and overweight struggle, as I did, to find respect in the medical community. That’s why these essays are so important to me. (I’ll post part two next week.) They remind me just how much self-esteem and self-respect play into how we deal with our health.

From April 2008:

Hyaluronic acid has been a godsend to my dilapidated knees. Every six to eight months, I have a series of three injections in each knee over a three-week period (six injections in all). The medication replaces the synovial fluid I lack, providing a cushion for my kneecaps.

The injections can be painful when not administered properly because the needle must go between two joints and deep into damaged tissue. When done right and slowly, it’s not too bad. I go to my happy place and relax and it’s over in less than two minutes. Most of the time, my favorite orthopedic assistant/specialist, Steve, gives me the injections. He calls me things like “Scooter” and “Buddy” and makes me feel relaxed and safe.

During one of the series of injections eight months ago, “Doogie Howser” walked in the room with Steve and I immediately tensed. “Doogie” was a med student, Steve explained. I asked the young pup skeptically, “How many of these have you done?” He answered enthusiastically, “I’ve been doing this for two weeks!”

“Um, son?” I said, rolling my eyes. “I have underwear older than you.”

He laughed nervously, but thankfully, he listened to Steve’s advice and the injections went smoothly.

Last week, however, Miss Barbie Med Student walked in with my doctor, not Steve, and took control of the needles. She jabbed each one in – two inches deep – without saying a word to me or a breath of a warning. I was pissed. But did I say anything? Heck no. I went home, limping, and wondered how I’d tell my doctor next week that I didn’t want Barbie within 10 feet of me.

Why is it so hard for me to be assertive with doctors? Probably because most of my life I've been so passive. All week before my next injections I played a scenario in my head of me in which I was kind yet firm if another Newbie walked in the room ready to stab my knees like they were porterhouse steaks.

On appointment day, my doctor walked in the room followed by a tall lanky young newbie who nervously stuttered, “Nice to meet you” and shook my hand. His hand was sweaty. Great. My doctor said Newbie had been taking ribbing all day and was feeling a little “off.” Off? OFF? Some kid who couldn’t handle some teasing was going to put needles in my knees?

I didn’t think so. That’s when something that felt like courage bubbled up inside me.

“How many of these have you done?” I asked Newbie.

“A few,” he said, smiling.

“Doc, I gotta tell you,” I said. “Last week, that girl really hurt me. I didn’t walk right for 24 hours.”

In response, my doctor actually apologized. He asked me if I’d feel better if he did the injections. I said yes, but if he’d talk Newbie through one, I’d be OK with that.

I looked at Newbie and said, “Here’s my advice. Go S – L – O – W. Don’t attack my knee like it’s dinner.”

He turned 20 shades of red and I’m sure he was close to wetting himself, but god love him, he found the joint, injected the needle slowly, and it didn’t hurt much at all. My doctor did the other knee and all was well. Tonight, I’m walking without holding on to the furniture throughout my house.

Walking out of the doctor’s office, my stomach wasn’t hurting from the stress, my shoulders were relaxed, and I sang a Peter Frampton song all the way home. I was assertive. I told my doctor what I needed.

I took the road less traveled…and it made all the difference.

7 comments:

  1. I have probably 40 pounds to lose (but it looks more like 20), and I have always been an advocate for my health ever since I was in my early twenties. I have a neuromuscular disease and another chroninc diseas, and now I have complicated knee issues. I know when my body feels "off," and while I was willing at 20 to have a doctor tell me I was depressed and that was why I had a hard time with strength (my depresssion actually turned out to be my neuromuscular disease), I am not willing to listen to such explanations at 39.

    I want to lose more weight, and I am proactive in dealing with my knee issues. I tried physical therapy and injections before telling my doctor that I was not happy with the results--and that led me to have surgery in January, which I needed to have.

    I am now learning to be proactive with physical therapists and asking for the one who can deal with my personality and my specific issues. We are all different, and I truly believe we all need personalized care. I believe life is too short to settle for a bad doctor or bad medical care.

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  2. The road less traveled often appears to be the harder one, but a lot of times it ends up being if not the easier one - the one with the better end destination.

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  3. really good post.

    I have a problem finding the middle ground - I either don't say anything at all - or I say too much, too strongly.

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  4. I had been unable to conceive and was really getting worried as the months turned into years. I knew the only fertility expert in my town was a bastard and I knew he'd tell me to lose weight, then dismiss me. So, instead of seeing him, I went on a protein fast and lost 160 lbs in 9 months. (that's another story). In the end, it worked and I got pregnant.
    When I delivered, the bastard was dr on call--and yup, he treated me coldly (I had regained 100 lbs), insulted me, and made what should have been the most beautiful experience of my life just another fat joke.
    The funny thing is, I got pregnant twice more at an even higher weight! 50 lbs higher. Weight is NOT the end all, be all for every disease out there like we are constantly told.
    As a nurse I take care of many, many people with heart ds, COPD, arthritis, joint pain, dementia, cancer, etc. and all at "normal" weight. Hmmph. Go figure.

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  5. I've worked in the medical field since I was 20 [that 27 years] and I still become the "patient". Great post about your learning to be assertive.

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  6. That assertiveness came with age, for me. When I turned 50 I started saying, I'm fifty years old, as in, you're not the boss of me--I'm fifty years old! And along with that came the confidence that allowed me to be assertive without being aggressive.

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  7. I wish I could find my voice sometimes too! Especially with work. Kudos to you!

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