The tail spin - part 1
After being in practice for thirty years you start to pick up on trends in your practice. You start to realize subsets of patients who have similar problems or challenges and share similar outcomes. Any good doctor is going to try to help these patients do better, be more and live a long and productive lives. One of the most challenging subsets of patients that I see are a group of folks who come to me for foot pain, but the foot pain is just the tip of the iceberg. These are patients who are going into what I describe as a tailspin. These patients are fifty years of age or older, need to work for a living and spend long hours in manual labor jobs. They are morbidly obese and are developing arthritis as a result of their long years of obesity. Common co-morbidities, often weight related, include type 2 diabetes and hypertension. They're finding it difficult to work due to pain. And they can't exercise due to their weight. The tail spin is a defining moment in their lives where they need to make some difficult choices. They still have an opportunity to pull out of the tail spin. Let me give you two examples.
Janet is a 58 y/o female. She presented to see me upon referral of her primary care doctor for foot pain and diabetic foot care education. She had a 4 year history of poorly controlled diabetes and a 15 year history of poorly managed high blood pressure. She is employed as a cafeteria worker at our local college. She is married with a husband and 38 y/o son who never left home. She is the sole income earner in the family. Janet stood 5 foot 2 inches tall, weight 265 lbs and had a body mass index (BMI) of 48.5. (greater than 30 = obese)
Sharon is a 62 y/o female employed as a fork lift operator in a local factory. She stands all day. Sharon's chief complaint was chronic foot pain that was consistent with plantar fasciitis. She stood 5 foot 4 inches tall, weight 220 lbs with a BMI of 37.8. She is single and appears financially stable following a divorce several years ago. She lives alone. Additional health issues included a ten year history of hypertension, previous breast cancer with mastectomy, hypothyroidism and a 30 pack year history of cigarette smoking (1 pack a day for thirty years).
Over the next several blog posts, let's take a look at these two patients and see if we can tease out similarities, differences and defining issues that contribute to their tail spin.