Saturday, March 31, 2012

Why You Know More Than Your Doctor

On its face, that seems crazy, that you could possibly know more than your doctor. After all, that person examining your knees completed a long and grueling education in his specialty, has probably probed hundreds of bad knees, and is most likely pretty smart to boot.

So how do you know more than this medical professional?

In one very important way: you know more about your bad knees because they belong to you, they’re attached to your body, and you’re getting signals from them 24 hours a day. A doctor, on the other hand, has to play 20 questions with you on that initial visit, trying to figure out what’s going on with a pair of knees he’s never laid eyes on before you walked into his clinic.

This has huge implications, especially for certain kinds of problems where the diagnosis tends to be elusive or uncertain or nebulous (e.g., you're told you have "patellofemoral pain syndrome") and the treatment protocol isn’t very good. Which brings me to my second story from South Florida about “Sara.” Last week I talked about how she fixed her knees. This week is about how she fixed her cough.

Sara had an occasional cough that wouldn’t go away. It got to the point where concerned friends would say, “You really need to do something about that.” But her doctor was stumped about what was causing it.

I don’t know what kind of tests she had done, if any. I do know that coughs can be frustrating to troubleshoot, after a few anxious months last summer and fall when our 2-year-old daughter developed a persistent night-time cough that was bad enough to interfere with her sleep. We eventually even had a chest X-ray done, just to rule out the really bad stuff. Shortly thereafter, the cough cleared up on its own.

Sara’s didn’t though. So she started thinking about what could be causing it. Could it be something in the South Florida environment? She often started coughing after she went outside at night. Hmmm.

Then she had a breakthrough: At night, after her husband got home from work and before they went out, she would spritz on a little perfume. Could it be? So she decided to try not putting on the perfume.

And guess what? The cough went away.

This is an interesting story for what it suggests about the limitations of doctors’ knowledge and the power of that of patients’. I’m guessing Sara could have seen a hundred doctors and none of them would’ve been lucky enough, even after skillful questioning, to uncover the perfume as the culprit for her cough. But when she became her own “medical detective,” she figured out the reason.

Similarly, in Saving My Knees, I told the story of a bout with adductor tendinitis. At the time I was riding my bike more than 100 miles a week. The doctor I saw immediately zeroed in on that. He prescribed various stretches to do before riding, but he never tried to answer the big question, “Why this tendinitis now when I had been riding the same long distances for years?”

Doing my own “medical detective” sleuthing, I found a reason: Not long before, I had moved my bike seat forward, just a couple of inches, to try to improve my sprinting muscles. What I didn’t realize was how much it changed the use of my leg muscles, and how the strains increased on certain tendons and muscle groups, amplified by some 30,000 turns of the pedals each week. I moved my seat back, and the tendinitis gradually disappeared.

So there you have it. You can make a big difference in how your knees feel (and heal).

Keep a knee journal and start figuring out what you need to do for your knees to improve them, and to lessen your pain. Don’t sit around and wait for a doctor to hand you the answer on a plate. Doctors are great, but when you’ve got a pair of bad knees that just grumble a lot, and you’ve already seen a bunch of doctors, it becomes clear there’s only so much they can do. After that, it’s up to you.

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