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Wednesday, July 23, 2014

Dilemma on talking to patients about weight issues contributing to foot / ankle pain

Funny, as a physician we are supposed to make sure our patients stay healthy and free of aches and pains. Obesity is a big issue in some areas and when it is the cause of our patient's problem, most will not listen or even criticize the doctor via email for, "How dare you tell me to lose weight when all I had was pain all over my body and feet, which is why I came to see you in the first place. I did not pay for you tell me to lose weight." This email caused me to reflect on my role as doctor or learned friend. In my years of practice, I have had the most pleasure not correcting a clubfoot or reconstructing an unusable limb due to trauma to one where the patient can walk on it, no. The one case that brought me the most pleasure was a 350 pound man with collapsing ankles and flattening feet / arches in a disease known as posterior tibial tendon dysfunction. I have known this wonderful gentleman for 2 years, every time he comes in is the same complaint, doc my ankle hurt I'm having problems walking on it, can you please do surgery on me. For 2 years I refused to do surgery on this fellow and the main reason I gave him is that if I did surgery on him, it would fail due to his weight. The goal for him was to lose 100 lbs or I would not operate on him. Don't get me wrong, I did treat the fellow with medications, braces and physical therapy orders as a temporary solution. The final straw for him was when his pain returned this year, I referred him to a weight loss physician as well as getting him a custom Ankle Foot Orthosis commonly known as AFO. He lost 40 lbs with the doctor and discovered that he was eating for pleasure and living to eat instead of eating to live. Suddenly his foot / ankle pain is gone and he is happily wearing his brace. With all this talk about the ACA, obamacare, ACO's, how about a good dose of self responsibility. Most physicians are too busy these days to help monitor weight loss, etc. They would just say lose weight, see you at your next checkup. Or write a pill for your type II diabetes is  much faster and easily accepted by patients nowadays vs a good prescription of diet change and workout regimen with a trainer. If I had to do it again would I tell this obese female who sent me an email degrading my doctoring skills to lose weight? Of course I would, she will go from doctor to doctor who will bandaid her problem if at all possible. Or seek gastric surgery only to fail without proper mental / psychological preparation. Having trained at a center where they did a lot of bariatric surgery, I can tell you that counselling is essential as the mentality towards foods have to changed and reprogrammed. Food is an addiction and must be treated as such in order to succeed.

Eat your veggies, keep a healthy weight, lifestyle, don't smoke, drink in moderation all the stuff your grandmother would tell you.

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