My least favorite diagnosis (sigh)

[squash_blsm]

Really....I don't even want to hear it anymore...
client:
"My doctor says I have arthritis"
me (because I'm just mean...)
"Oh, that's interesting. Where do you have arthritis and where are you experiencing problems?"
client:
"Oh, all over, my doctor says it's arthritis."
me (because I'm feeling particularly mean...):
"What diagnostic tests where done that led your doctor to this diagnosis?"
client (blank stare):
"Why my doctor didn't do any tests, but he says it's arthritis."
me (because I'm just gonna push the envelope here):
"And what treatment did your doctor prescribe for your condition?"
client:
"Why, nothing. My doctor says it's arthritis."
me (inside):
"ARRRGGhhh gahhh."

[TouchofGrace]

Bad thing about that is... probably not even the same doctor seeing all those arthritic clients.

[JasonE]

Yeah, I get those too! How about we channel our frustration into a useful dialogue about how to handle these cases? Here's how *I* might continue from where your example conversation left off:

Me: Okay, is it rheumatoid, psoriatic, osteo, or some other form of arthritis?
Client: Oh, just arthritis.

Me: Okay, then - if your doctor didn't tell you what type or where it is, we can reasonably assume it isn't a severe form. Where is it most affecting you?
Client: Oh, it's all over.

Me: What are your symptoms?
Client: Well, it hurts.

Me: Show me where it hurts.
Client: (Points at a bunch of different areas, shows me their hands and feet.) Pretty much all over.

Me: Are you disabled by it?
Client: No! It just hurts.

Me: Okay, can you... (turn head, raise arms, make fist, etc. - a variety of very simple functional tests common to ADLs)?
Client: (performs tests, occasionally making a face or otherwise indicating more discomfort in certain movements) Yes, but I feel sore.

Me: Okay, I can see that you have more discomfort in certain positions and movements than in others. Your range of motion in many areas isn't bad, but we clearly have some areas that are more limited. One of the few things guaranteed to make arthritis and its associated symptoms worse is lack of movement. We need to get more movement into the areas that are most affected so your body can recover and feel less discomfort. It may be possible to eliminate most of your discomfort, and we can talk about some things you can do at home after today's session. Other than your arthritis, what else can I help you with today?
Client: I just want to relax, I've been very stressed recently...

And the dance goes on...

[moogie]

This is also a pet peeve of mine and as a matter of fact it came up in conversation tonight with a client. Sometimes the doctor in question might have even taken an x-ray but seriously, what does that prove? As I've explained to many of my clients, if you x-ray 100 people over a certain age who have no pain at all, I'd bet that the majority of them would show at least some arthritis in one of their joints.

Just because you have pain and some degeneration in a joint, doesn't mean that the wear 'n tear is what's causing the pain.



Angie

[JaeMarie]

This reminds me of all the clients who self diagnose with carpal tunnel syndrome.

I mean if your wrist hurts, it MUST be CTS... right?

[Rose of Sharon]

Oh yeah, BIG pet peeve of mine!!! Doctors make lots of "diagnoses" without any testing whatsoever, but that is by far the most common. I handle it basically like Jason does - I can't do a thing about arthritis, but if we can get more mobility in the muscles, they won't be pulling on the joints and increasing the arthritis pain. Fairly often, the "arthritis" pain goes away, too.

I do ask about what type of arthritis and what diagnostic processes were done for the doctor to come to that conclusion. That question alone will cause some to realize that they don't KNOW that it's really arthritis.

Usually the conversation reported to me goes like this: Patient: "My knee hurts." Doctor: "You are over 60, you have arthritis. You'll need it replaced at some point."

[Talenyn]

I had a lady once who said you can't touch my thumb, i have severe arthritis there. Ok... well I'll work on you and I'll avoid your thumb and then you can tell me how you feel. (I was doing hand or foot massage in a dental office) So I worked her forearm, paying attention to the attachments near the elbow. Then asked her how her arthritic thumb was. OMG, the look on her face was PRICELESS! She was pain free in the thumb for the first time in 2 years!

She thought I had magic hands! LOL

[JasonE]

This reminds me of all the clients who self diagnose with carpal tunnel syndrome.

I mean if your wrist hurts, it MUST be CTS... right?

Yeah, this one irks me, too. Ask least most physicians have stopped recommending CT surgery... it's a step! Unfortunately, massage is rarely utilized as an early intervention, particularly in cases of musculoskeletal pain that are not yet severe enough to require surgery or PT.

I have a recent case involving trigger finger in both hands. There is extensive medical documentation from the year+ of hand therapy she went through, plus she saw a massage therapist for other things. She is now symptom-free, with her dexterity and hand strength improving rapidly. If I remember to write the case report, it should make for interesting reading.

[softy515]

You didn't know any pain was just arthritis? LOL

Yeah, I love doc's and there diagnoses. BUT often the client (patient) doens't really pay attention to the doctor and they just want to know what they have, it needs to have a name. So the doc gives it a name and sends them on their way.

You get the "Doc said I pulled a muscle."

What muscle?

The rotator cuff muscle.

WHICH RC muscle?

I don't know, he didn't say.

[moogie]

You get the "Doc said I pulled a muscle."

What muscle?

The rotator cuff muscle.

WHICH RC muscle?

I don't know, he didn't say.

I can top that one.....I once had a client who insisted that the doctor told him that he'd fractured his rotator cuff!!



I tried to explain to him that his rotator cuff was a group of muscles and that you can't fracture a muscle but he didn't want to hear that and insisted that he'd broken it.



Angie

[TouchofGrace]

Maybe he was so insistent because he was talking about his rotator CUP being broken lol

[JaeMarie]

I have a client with myofascia. You know, the condition where everything hurts?

She comes to me for myofascial release.

Makes sense, right?

[GreenDragonfly]

I have a client with myofascia. You know, the condition where everything hurts?

She comes to me for myofascial release.

Makes sense, right?

This kind of ignorance regarding one's own health is what makes me feel bad for Dr's and why many of them probably 'dumb it down' to giving such generic answers as 'you've torn your rotator cuff'. Dr's are only human also and I imagine many do give the least complicated answer possible. Also, probably more Dr's DO give the correct information, only to have their patient not be able to understand what they have been told and remember (or mis-remember if that is even a word LOL) what they were told. Kind of like the game of telephone.

It is pretty common in my experience to talk to people who have no idea what is wrong with them or what they could or should do about it after a visit to the Dr.

Me: so what did the Dr. say at your appointment?
Them: oh i've got this stomach thing, I don't know what it is called. I got a prescription.
Me: what kind of pills? what are they called and what do they do? what else are you supposed to do or not do to help get better?
Them: oh I just take these pills. I don't know what they are, I just have to take them 2 times a day.
Me: for how long do you take these pills? forever?
Them: Oh I don't know. I have another appointment in 4 weeks and the Dr. will tell me if I have to stay on these pills or get different ones.

Seriously. I've had these conversations... with people in my own family.

[JasonE]

Seriously. I've had these conversations... with people in my own family.

Yeah, me too. => Relevant Forrest Gump Quote

*sigh*

[GreenDragonfly]

Seriously. I've had these conversations... with people in my own family.

Yeah, me too. => Relevant Forrest Gump Quote

*sigh*

I love Forrest Gump and I love that quote! So true!

[softy515]

Thank god it isn't just me! LOL