Tag Archives: diagnosis

Fat and Bad Knees

naughtyknees

This ad for moisturizer suggests you use their body creme ” for sexy knees”.

One of the things I am constantly told as a fat person is that for fat people, knee pain is inevitable.  And in fact, I am told, I can expect a lifetime of “bad knees”.  Now, given my somewhat skewed view of the universe, rather than scaring me silly, the threat of “bad knees” usually make me think of an image like the one in the body cream ad above, or this silly image below:

BadKneesBut putting the silly pictures aside for a moment, I am an athlete who has had some problems with knee and leg pain my entire life.  I have been lucky enough to have some doctors who are great, but have also run into the all-too-common problem of fat-phobic doctors diagnosing me with having knees while fat.

My feet and leg problems started at birth.  When I was very young, and quite skinny, I was severely pigeon-toed.  As a result, I wore a brace with bars connecting my feet to bed every night.  It looked sort of like this:

footbraceNow I wore this brace to bed back when I was too young to untie and tie my own shoes.  I’m fairly sure that the need to get in and out of bed to go potty while wearing these things has shaped my sardonic view of the world, but I digress.

When I was in high school, and I was going through one of my thin periods, I ran track.  I ran the mile and the 2 mile races (mostly because nobody else wanted to…).  When I first started running, I had severe problems with shin splints.  Because I was thin, nobody thought that the solution was simply to tell me to lose weight.  We tried a variety of things including elaborate taping, different icing regimens and a lot of aspirins before somebody figured out that I just needed tennis shoes with a different sort of arch support.  For an investment of $25 the problem was solved.

Later in life, I suffered a few injuries.  I had a fairly severe meniscus tear in my knee as a result of leaping onto a pile of mats to adjust some audio equipment at the gym.  I also tore a ligament in my foot because I tripped on the front of my sandal and landed wrong.  Each of those injuries netted me a month or two on crutches.

So when I got midway through my most recent jaunt of marathon training, it’s not surprising that I found myself coping with some knee pain.  Luckily I had a great GP at the time who referred me to a sports medicine doctor.  He confirmed that I had a whole lot going on in the lower-extremities department.  He noted the flat feet (that I’ve had since birth) the fact that my feet pronate (also had since birth) and prescribed some custom shoe inserts and a few specific exercises I could do to strengthen my knee joint.  Problem solved.  Marathon finished.  Cheap medal and sweaty finish line photos earned.  And even though I was about the same weight then that I am now, neither my GP or my sports medicine guy gave me any flack about my weight.

444pmI didn’t realize then just how lucky I was.

Since then, I have moved and changed insurance and have had other doctors.  These doctors were not so great actually.  One of them asked about knee pain (I didn’t bring it up).  And I said, that yes, sometimes after a tough workout, my knees will be a little sore.  “Aha!” the doctor cried. “This is proof positive you need to lose weight.  If you lose weight, your knee pain will go away.  If you stay this weight your knees will hurt all the time!”

Okay.

The fact that my knees function at all, given the foot problems I was born with as well as the athletic injuries I’ve suffered is pretty amazing.  And at no point, did this doctor ask about any medical history regarding my feet, shoes, injuries, sports activities or anything else.  He simply predicted that I would be in pain as long as I was fat and that the remedy was simply to lose weight and keep it off.

Never mind that I didn’t come in there asking about knee pain.

Never mind that there is no method, and I mean NONE that is proven to be successful for long-term weight loss in most people and that even if I was one of the 5-10 percent of people who are able to lose weight and keep it off, there is no guarantee that it will do anything at all to relieve knee pain.

Never mind that there are successful methods of coping with knee pain that are widely considered effective for people of all sizes and that these methods have nothing to do with losing weight.

Nope, once this doctor diagnoses you with fat knees, the treatment is a single piece of paper with a diet on it.  According to Doctor Know-It-All, the way to fix your knee problems is, Breakfast: One egg (boiled), one piece of wheat toast (dry), one cup of coffee (black) and 4oz. orange juice, etc…

And my story is so mild compared to the other stories that I hear from folks about this subject.  People who are suffering from knee pain and told that all they have to do is lose weight and their knee pain will go away.  And they are told that their doctor won’t bother to try any other treatment for knee pain until after they lose weight.

It’s lazy and it’s unethical.

If you are coping with knee pain, there are some things you can do.  Very often, knee pain can be improved by correcting underlying muscle imbalances.  You can get help from a physical therapist or sports medicine specialist.  You can supplement this therapy with simple at-home exercises like those offered by my colleague Cinder Ernst.  Also, you may need to see a foot doctor to get custom inserts made for your shoes.  Sometimes simply switching to a good sturdy shoe with good arch support can make all the difference.

You may also find help, as I did from somebody who teaches Alexander Technique and can help you figure out what you are doing in your every day life that exacerbates your knee pain.

Exercise can really help folks coping with knee pain, but it’s important to do it the right way.  Make sure you get the help of an exercise instructor or personal trainer to make sure that you are working out in a way that strengthens and doesn’t threaten your knee joints.  I offer a few simple tips in this video.

Not all fat people have knee pain.  Not all thin people are free from knee pain.  But whatever your size, there are things you can do to protect your knees and help you cope with knee pain should it arise.  Make sure you get the help you need, and don’t let anybody scare, threaten or intimidate you by diagnosing you with having knees while fat.

Love,

The Fat Chick

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Teenage Boy “Diagnosed Fat”–Infection Missed

chart2How many times have we heard this same story?  A vibrant, active young man goes to the doctor, in this case, with knee pain.  The doctor does a routine test and doesn’t see a problem.  The doctor does see a young man who fits into an “undesirable” segment of the BMI chart.  The solution, the young man is diagnosed as fat, is told that his “extra weight” is probably causing the pain in his knee and sent home.  Now Kaleb is an active kid.  He plays rugby, and he loves to sail.  But once the doctor sees Kaleb’s place on the BMI scale, he just might think something like this: “Aha!  I don’t have to say that I don’t know what’s wrong with this kid’s knee.  I can write obesity in the kid’s chart and then we have a diagnosis!”

Unfortunately, in Kaleb’s case there was another diagnosis besides “fat” to be found.  A short while later, he was taken to the hospital via ambulance after he fell down some steps.  At that point, he was referred to a specialist that he saw two weeks later.  The specialist ordered an MRI and during the scan they found a serious bone infection.  Kaleb was scheduled for emergency surgery the same night.  He is recovering well.  So thankfully, the story has a happy ending.

But how much pain could have been avoided without the “fat diagnosis”? It appears that had this infection been detected earlier, it could have been treated with antibiotics rather than emergency surgery.  Now there’s no guarantee that had Kaleb been thin, they would have found the infection sooner.  They might have still sent him home and told him to take some aspirin and take it easy.  Thin people are misdiagnosed too.  But I’ve heard time and time again about people who are “diagnosed fat” and sent home.  Remember this guy who was diagnosed fat, and it turned out to be a brain tumor?  Remember his emergency surgery?  I wonder if doctors, frustrated by a lack of diagnosis and discouraged from ordering expensive tests don’t lean on the BMI chart as a way to have something to write in their diagnosis box.  I imagine in many cases, once patients are “diagnosed fat” and are shamed and blamed, they stop asking annoying questions.  They stop demanding that doctors figure out what is wrong with them.  In some cases, they stop going to the doctor altogether.  This is part of the collateral damage and opportunity costs in the “war on obesity”.  This is another example of the casualties that arise from singling out a body type as unacceptable and trying to eradicate it.

And we’re not just dealing with misdiagnosis here.  We’re dealing with fat people suffering and dying from the mutilation of otherwise healthy tissue via gastric bypass and banding surgeries.  We are seeing the development of more and more new strategies for trying to make fat people “healthy” by making their digestive systems mimic eating disorders and limited blood flow to the gut.  We are so focused on helping fat people get healthy by making them thin that we are willing to make them really, really sick to help them get there.  And sadly, in so many cases, the fat people who undergo these treatments end up fatter or sicker or less happy than they were in the first place.

There are weapons we can use in this war.  One of them is to ask the doctor if thin people also experience the same problem.  In Kaleb’s case, he or his mom might have asked, “Do thin people also have knee pain?  What tests might you do if I were thin.  Can we do those tests please?”

Another weapon is to help make doctors and other medical professionals more aware of the pain and repercussions of fat bias.  And it just so happens that we have some terrific tools to do that.  The Association for Size Diversity And Health (ASDAH) along with the Size Diversity Task Force are compiling videos about fat bias in healthcare.  The project is called RESOLVED.  Some folks at ASDAH have informed me that the deadlines are being extended.  You can hear more about the project and see my sample video HERE.  In addition, the Size Diversity Task Force has a unique opportunity through one of our members to help train medical advocates about fat bias in healthcare.  But in order for your video to be used in both places, you need to submit your video by March 18.  If you’re interested in participating in the project and/or have any questions or concerns, please leave me a note in the comments below.  Or send me an email at jeanette at thefatchick dot com.  I’d be glad to help.

Let’s do what we can to limit the number of casualties in the war on fat.  Let’s help kids like Kaleb get the attention and care they need at the first doctor’s appointment–not the third.  Let’s see what we can do to have “diagnosed as fat” be a thing of the past!

Love,

The Fat Chick

Feeling Poopy without Feeling Guilty

Over the last few days I haven’t been feeling very well.  I’m not saying this because I want you to feel bad for me and try to make me feel better.  (Well, okay maybe a little.)  After all I don’t have a man flu.  But as I was trying to get a little rest yesterday, I found myself thinking in a familiar pattern.

I started thinking, “Well maybe I’m not eating the right stuff and that’s why I’m sick.  Or maybe I’m not feeling well because I have too much repressed anger.  Maybe this is because I didn’t get enough sleep.”  And in my rambling way, I went on to think, “Maybe it’s nobody’s fault I’m sick.  Maybe I just AM.”

I remember now that I used to often think that if I lost weight I wouldn’t be sick any more.  I used to think that no matter why I was ill, it was my fault because I was fat.  And then for a while (like a minute) I got thin.  And you know what?  I still got sick.  And so did all of the rest of the thin people I know.

And you know what else?  While it’s a great idea to do everything you can to be healthy there are no guarantees.  You will still get sick from time to time.  While it can be tempting to believe that we can control whether or not we get ill we can’t.  We can give ourselves a good chance of being healthy by doing healthy things–but we are still likely to feel lousy from time to time.  And unless you’re talking about a hangover, or going without sleep for four days, you aren’t going to know exactly why and there isn’t much point worrying about whether or not it’s your fault.

It’s especially important to get this straight in our own heads because there are plenty of people out there ready and waiting to tell us that it’s our own fault for being sick or even that we deserve to be sick because we’re fat.  They rail about the costs we “add” to their health insurance.  Doctors do the slow, sad head shake and tell us that we wouldn’t “have this problem” (whether it’s strep throat or carpal tunnel syndrome) if we weren’t so darn big.  Our friends and family seize on every illness as “proof” that they are “right” about the fact we need to lose weight.  And before you completely lose your Zen and want to stop talking to these folks, let me remind you of something.  Remember when I said, it’s tempting to believe we can control whether or not we get ill?  Well it is.  It’s comforting to think that if we don’t drink too much and we don’t smoke and we don’t get fat and we eat our broccoli that we will never get sick and we will live forever.  We know intellectually and rationally that this isn’t true.  But who the heck is going around being intellectual and rational all the time?

The truth is that people get sick and while there are certain issues that make certain populations more likely and less likely to be sick, nobody knows for sure why we get sick when we do.  After all, one of the greatest risk factors for illness is getting older but I’m not sure the alternative is a health path I want to follow.

So my little chickadees, by all means eat your broccoli.  Sleep well and go out and play with your friends.  Do your best to manage stress and anger even when your friends and family drive you crazy trying to “help you lose weight”.  But when you get sick, and you will get sick at some point, my prescription is to stop worrying about who’s fault it is and just worry about feeling better.

Love,

The Fat Chick