Posts Tagged ‘healthcare’

I finally got around to getting in for the physical therapy my doctor told me to get!

It was an interesting experience. Number 1 thing I learned- I suck at relaxing. Every time the physical therapist told me “now relax your muscles and just let me move you” I would try but my muscles didn’t seem to understand “relax”.

More on topic the physical therapist said that I have a significant strength imbalance between my left and right side which she thinks is causing pain. Though I wonder whether that is a cause or an effect, since I’ve spent a long time now favoring my right side because of the pain on my left foot.

Also found out I need to work on my glute strength more.

For the time being though, she also says that the most important thing is that my foot needs to rest and I haven’t been resting it enough. I am not supposed to use any heavy weights for the time being, limit walking, no running.

She didn’t say I can’t do Krav Maga, but classes usually involve running during the warmup and I’m not supposed to do that :\ But I don’t want to have to completely avoid it for at least a month if not longer. So I don’t know how to handle that yet.

I’ve mentioned before on here having problems with foot pain, but let me try to give a history of how things went.

It started out with some pain in both heels of my feet, I looked up info and decided it sounded like plantar fasciitis and started doing some stuff to help that I found online. I did stretching, massage, I got this thing that you can freeze and roll under your foot, and I used kinesiology tape, particularly when running. I can’t remember when this started but… come to think of it, it must have been about 2 years or longer ago I think.

For awhile this worked pretty well and I was still running and not having major issues due to the pain. But then it started getting worse in my left foot and none of what I was doing was helping. It continued to get worse until I couldn’t run anymore because I ended up limping when I was running. Then I started limping just trying to walk on it. This started happening even when walking short distances, like the distance from my car into my desk at work.

I realized I needed to see a doctor, but that realization came about during a period when I didn’t have health insurance.

Then I had insurance but I was working during the day when doctors are available. So I waited until after I was able to take time off from my job (90 days from when I started) to make an appointment to see a doctor.

I finally got in to see my PCP about it and she had an x-ray done and referred me to a podiatrist.

The x-ray showed a heel spur and also a small tumor on my foot. When I got in to see the podiatrist he told me that the tumor thingy was nothing to worry about and most likely was unrelated to my pain. He said the pain was plantar fasciitis and that the PF actually causes the heel spur. He recommended icing it, stretching, super expensive insoles (I had been using some that were like $10 from the store, he had me buy brand that was $50/pair -_-), told me to always wear shoes in my house (boo), and had me get a night splint to wear. He also prescribe naproxen to be taken twice a day, and told me he could give me a cortisone injection. He said that he is usually hesitant to give the injection because he doesn’t want patients to think that the shot takes away the  pain so that’s all they need, saying that the shot will wear off so you need to do the stretching and so on to resolve the underlying issue to keep it from coming back. However, since I had been doing stretching and all for months he said he would leave it up to me if I wanted to do the shot too. I said I did and he gave me a cortisone injection. He kept asking if I was ok throughout, because it takes awhile to slowly administer the whole dose, but I’m actually pretty good with needles and have a high pain tolerance. Didn’t bother me watching him do it either.

I chatted with him during it and told him about the last time I saw a podiatrist, years ago, for ingrown toenails. That doctor numbed my foot with a local anesthetic and started cutting into the flesh around my toenail and I could feel him cut into me. He gave me more anesthetic and asked if it hurt when I went to the dentist. Well, yeah, of course it hurts when I get stuff done at the dentist! Isn’t that why everyone hates going to the dentist? He informed me that actually I shouldn’t feel any actual pain after being administered a local anesthetic. Seriously blew my fucking mind!  I seriously thought that experiencing pain even after a local anesthetic was normal, I thought it reduced the pain but didn’t realize it was supposed to completely eliminate pain. I’ve become a lot more vocal at the dentist now if I feel pain asking for more anesthetic!

Anyways, he said it would take about a day to feel the effects of the cortisone injection and sure enough a day or 2 late the pain was massively reduced. I was a bit disappointed that pain didn’t go away completely, but it was reduced to the point where I didn’t limp when walking. I could feel pain when walking, but not enough to impact my walking. But after a few days even that wore off.

I kept up with stretching, bought the expensive insoles, try to wear shoes in my house, and tried to wear the night splint but would end up taking it off halfway through the night because my food would start going numb.

I was supposed to follow up in 2 weeks but put the appointment on my calendar on the wrong day and then just kept forgetting to make appointments so I didn’t get back in until just the other day. I told him how things hadn’t improved much and my experience with the cortisone injection. He said that sometimes it takes building up the cortisone injection so he gave me a stronger dose. He was telling me how most people complain about getting the shot but I couldn’t feel it at all. Even though he would inject some and then go deeper, inject more, go deeper, inject more, and so on and it looked creepy how far that needle went into my foot, but only once did I feel any pinching type feeling from it, otherwise I wouldn’t even know he was doing it if I hadn’t been watching.

He told me to continue stretching and he looked at the night splint. He adjusted the straps and made them much looser, and told me that should make it better. I had the straps tight because I was trying to get my heel as close to being against it as possible but according to him I guess it’s ok with my heel isn’t against the bottom of it, it’s still more flexed that it normally would be while resting.

He also recommended that I start physical therapy, so I’ll be doing that soon.

This time the stronger cortisone injection actually has taken away the pain! I’m 2 days now with no pain when walking and it’s amazing!

Would be great if it lasted but I’m not expecting it will.

This pain is particularly rough this time of year. It’s getting nice out and I really want to go running again, but haven’t been able to yet. I’m hoping that finally all this stuff will get me to where I can walk without pain and then start back to running again eventually. Not sure how long it will take though.

So I think I mentioned before that my new job is working in integrated healthcare- integrated physical, mental, and substance abuse healthcare.

And so at work there is a lot of talk about people dealing with chronic physical illnesses, and also mental illnesses. Both of which I fall under, and feel a little awkward at times about because I’ve never had cause to mention these factors at work, and particularly when talking about people with them it brings to mind my typical awkward feelings around the fact that coworkers looking at me would likely assume such things don’t apply to me.

In a recent training we talked about this 4 quadrant model for physical health and mental health.

(phrasing here is all mine, so I may be off in terms of what the official terminology is meant to be)

Quadrant 1 is people with low physical health problems and low mental health problems- someone who is generally healthy but may need to see a doctor for an injury, acute illness, and may see a therapist to deal with depression or stress during times of particular upset in their lives but does not have a severe and persistent mental illness.

Quadrant 2 is people with low physical health problems but high mental health problems.

Quadrant 3 is people with high physical health problems, but low mental health problems.

Quadrant 4 is people with high physical health problems, and high mental health problems.

As we are talking about this, and the trainer makes a comment how we may be people who fall in quadrant 1 and how that is a very different experience with the healthcare system than someone in quadrant 4… and I’m like, actually I would say I alternate between Quadrant 3 and Quadrant 4 as my depression is somewhat intermittent (typically dependent on how my physical health is), but certainly at times quite severe.

Which is also interesting to me, in mental health there are positions for peer specialists, and in my required trainings when I started the job there was a lot of talk about how peer specialists were created to recognize the benefits consumers bring to the table, and having someone who understands these experiences. Now, I wouldn’t fit the role of a peer specialist in a community mental health setting because I’ve never been a community mental health patient/consumer/client. But one thing that stands out to me in how this is talked about is there seems to be this idea that people are either mental health professionals with advanced degrees and licensing, or people with mental illnesses (or in integrated care, you could say physical illnesses as well). There still doesn’t seem to be any recognition that the people with degrees, and professional licenses, may also themselves have chronic illnesses.

And while I’ve never talked about it at work, I do think I have a benefit in this work being someone who has chronic illnesses, not struggled with not being able to afford care for them as well. Many of the things I’m told about what clients may do are things I’ve been through too. I understand all too well when you decide you just aren’t seeing a doctor anymore for your chronic illnesses because they never seem to help and the only thing you see from it is less money in your wallet/bank account. I’ve not had prescriptions filled or been inconsistent in taking them because I couldn’t afford them. Et cerera, et cetera. And I think really understanding that situation is a benefit, compared to someone whose never been through that.

Random closing thought though, whenever I think about this topic, I also think about my pill organizers, and so I have to say, for anyone who takes a lot of medication- especially if some are rather large- I highly recommend these 7 day organizers.

My 7 day 4 compartment pill organizers after my weekly pill prep

These are the ones I have, which have 4 sections each day. They also have ones with 3 sections, or 2 sections for each day. For the record, I am not being paid or asked to promote these by the company, though if they would like to pay me for promoting their products I would be totally amendable to that. But this is just my own love for these containers, and wanting to let other people who may benefit from them know about them.

What I like them are that each day is separate and so I can carry just one day with me in my purse, compared to most weekly pill organizers you see. I’ve had people recommend those really big organizer that are one big thing with 7 days in the week and 4 times slots for each day- but that’s only really convenient if you are home all day to take them. And it may be the best option if you are, but for someone like me- I’m often out of my house at times I need to take my meds, and I can’t carry around that big, whole week organizer with me! Also most pill organizers have small compartments! Which is fine if you take a few small pills, but if you are taking pills that are large (as I do) they don’t all fit in those typical small pill organizers. These are an inch deep and really do hold a significant amount of pills for each time slot. Also they are colorful and that’s always fun 🙂 Oh, and they are easy to fill. You can pull the plastic tops off completely to fill them.

Unfortunately they don’t have any for over 4 times a day- which is something that is really lacking in pill organizing products. My grandmother used to have to take medicine 6 times a day and I remember what they did for her was use one of those week organizers and just relabeled each compartment for a time instead of a day and had to set it up for the next day each night.

I read a comment online recently from someone saying they would not be as bothered by doctors “prescribing” lifestyle changes- diet or exercise changes, if they were actually done in a very specific way.

It got me thinking about some of the issues with these lifestyle prescriptions, and more specifically how we treat health.

Now, if you’ve read my blog before you know I’m not fan of measure the success of such lifestyle changes by weight loss, but I certainly think that diet and exercise have a tremendous impact on overall health.

The first problem I think this person did touch on- doctors are often vague about what it meas to eat better or exercise more, doctors don’t often get a lot of training on those topics, which also means that even if they are more specific they may not be basing those recommendations on any research demonstrating the effectiveness of that. If for example, there is research indicating exercise can help with condition X, we would need to know exactly what sort of exercise was shown to be effective- type, intensity, duration, and frequency. Otherwise what is implemented by the patient may not line up with what the research shows to be helpful at all.

An even bigger problem I think though, is the financial issue. A doctor can “prescribe” these changes, but for the most part insurance won’t pay for it. So if you have someone with condition X and research showing that 30 minutes of moderate intensity exercise a day is just as effective at reducing symptoms as the standard first line medication Y. But if the patient with condition X would be paying much more for a gym membership or exercise equipment than generic medication Y that insurance pays the majority of the cost of, that creates an incentive for the patient to just want to take medication Y.

I hear people complain that people are just lazy and want the easy solution- “just give me a pill”. But this completely ignores the structural influences. People don’t exist in vacuums. I think it is better to try lifestyle adjustments like diet or exercise changes that are shown to be effective before medications, cutting out a food allergen, or walking 30 minutes a day, typically has fewer side effects than pills. But for people to choose these over pills, we really need structural changes to how we approach healthcare. If our healthcare systems favor pills over lifestyle, then how can we expect that patients as a group will be different?