Anti Health Care

I’ve had these two issues for more than a month now—the outsides of my ankles are weirdly, painlessly swollen and my right knee and shin have been hurting. I had recently increased the distance I walk every day and the speed at which I walk. I did not do this incrementally; I just started going longer and faster. I typically walk two to three miles a day, with an occasional six- to eight-miler every three weeks or so. So I thought I could just load more on without cost. Seems I was wrong about that.

Initially, I thought it would all just go away; it didn’t. I went to the doctor. She ordered multiple x-rays. She thought it might be bursitis. Bursitis, I learned that day, is when fluid-filled sacs in your joints get inflamed, often because of repetitive overuse. I also learned later that x-rays can’t diagnose bursitis, although they can rule out bone-based problems that might be causing swelling.

After I had the x-rays taken, I waited for the radiologist’s report. Gone are the days when a doctor or nurse practitioner calls to discuss the results. Nowadays, you log on to your online chart—in my case, it’s called MyChart—after 48 hours; you read and decipher your test results all aloney on your owny. The radiologist’s report was a combination of junk I didn’t want to know, stuff I already knew, and an absolute absence of insight into the why of the swelling, which is the reason I did the x-rays in the first place.

I called the radiologist’s office. Somebody answered. I explained that what I was looking for was informed discernment about the swellings. I was told that that is not their purview in radiology. All they do is take the pictures and report on what they see. Just the facts, ma’am. Also: X-rays provide information about bones, not so much about the tissues around them. I was told that I would have to schedule an appointment with my GP who would then order more tests. There I was, where I’ve been before: a test that yields no useful information leads to a cascade of other tests that may or not yield useful information. So at that point, I had some tests and their useless results, the promise of more tests, no diagnosis, and no recommendations or suggestions for how to fix the ankles or relieve the discomfort of my knee and shin.

Past experience suggests that this test-taking path can be quite long, and rather fruitless. I had had some kind of weird illness/event a couple of years ago that presented with a very sore throat, mouth sores, and fatigue. My primary care person was stumped. A test revealed that it wasn’t strep throat, although apparently it looked like strep. It wasn’t Covid. Long story short, after many and various tests, my caregiver was like, I don’t know what it is, I don’t know how to figure out what it is, we’ll just treat symptoms. So I did salt water gargles and rested. I got better, but I was left feeling, Why did I bother going to the doctor? Particularly with the $95 copay.

My relationship with that particular primary care person was short-lived, as was my relationship with the primary care doc before her. Neither seemed very good at doctoring, and one of them misdiagnosed a fracture as a soft tissue injury. (This was after a doc at an urgent care facility, who had x-rays taken, mind you, also misdiagnosed that fracture as a soft tissue injury.)

On another occasion, I had a curious, unfamiliar, itchy rash on my neck and torso. I called my dermatologist’s office, she was booked out for six months, I was told to take photos of the rash and upload them to MyChart, that modern online portal for “communication” between “health care” providers and their patients. I did that. When I heard back through the portal a week later from the doctor, she had prescribed a cream for me. By then, the rash was gone; of course I didn’t fill the prescription; I still had no idea what had caused the rash so I didn’t know how to prevent it in the future; and that online “visit” cost $85.

I had a long, golden period of health care where I had the same primary care doctor, the same dentist, and the same eye doctor for 29 and a half years. The primary care doc and the dentist have retired; the eye doctor remains in practice. That primary care doctor was a family physician who saw everyone in our family during those many years for everything. If one of us needed a procedure or more information, our doctor would send us along to the appropriate person at University of California, San Francisco (UCSF) Medical Center. Over the years, he diagnosed and saw us through thrush; heat rash; hand foot and mouth disease; chickenpox; a hernia repair; a hydrocele repair; broken bones; and oodles of other quotidian and off-the-beaten-path ailments and issues. I could talk to him; he listened and heard. You build a relationship over nearly three decades. By treating a whole family, a physician detects patterns and familial health tendencies, as well as individual idiosyncracies.

Similarly, our dentist and eye doctor communicated. They explained what was going on and why. And none of them—family doc, dentist, eye doctor—pushed procedures or tests, or upsold. They recommended what was necessary, not more, and laid out options when there were choices to be made.

I kinda knew we had a good thing going on, but I didn’t realize how good it was until we were cut loose when our family physician and dentist retired, within a couple of years of each other. “Health care” is different now, crummier, less community-based and much more impersonal. I don’t even know how to find a family physician that’s not connected to big hospital machinery. I want another practitioner that’s in private practice, that accepts my insurance, that makes time for patients and for getting to know them, somebody I can commit to who will commit to me, somebody who cares about my health. Given what I’ve seen in these past few years, that last statement sounds borderline delusional.

To situate myself: I’m a cancer survivor who had radiation, chemotherapy, and two surgical procedures during my treatment. One of my oncologists was a great doctor, a skilled practitioner with an excellent bedside manner. I’m not averse to traditional medicine or its interventions when called for. I am averse to this piecemeal kind of “care”—your ankles are swollen; we’ll take some ankle x-rays; never mind that the issue may be originating in your hip or your knee or have something to do with your vascular or lymphatic drainage systems. (I’m spitballing; I don’t know what’s going on, but honestly, it seems possible that lymphatic drainage might be involved.) Health care with my old family physician was the opposite of piecemeal—I was a whole, connected body and mind situated in a whole family and a whole community. All of it was relevant not only to diagnosis but also to treatment. I acknowledge that sometimes there’s an obvious pathology—your arm is broken; you’ve got chickenpox; you need a hernia repair. But when diagnosis is more nuanced, complicated, or even mysterious, I want that more global, interconnected perspective.

Because I suspected that faulty or incomplete lymphatic drainage might be playing a role in my weirdly swollen ankles, I asked around if anybody in my world knew a lymphatic massage therapist. One name kept coming up. I emailed her to schedule; her first opening was July 9. (!) But she phoned me to discuss what was going on; I was grateful for that degree of interest and engagement. I had told her in my email that I had stopped walking, even though I really missed it, because I was afraid it might be contributing to my issues. She said it was always a bad idea to stop moving and suggested I might try walking in water. She said walking in water was different from swimming, that it was important that I was vertical. I tried it. The pain in my knee dramatically abated. I did it for the next few days and found that my knee pain reduced more and more. (It did not affect the ankle swelling, but I was grateful for something proactive I could do, and exercising again was important to me. For one thing, my sleep immediately improved.)

I also saw a restorative exercise specialist with a deep understanding of biomechanics, how the muscles and skeleton arrange themselves and work together for optimal, healthy movement. She had done gait and posture work with one of my sons and I knew her to be knowledgeable, skillful, and compassionate. She introduced me to a lot of exercises, positions, and self-massage techniques to help both knees and ankles. She also said bursitis hurts, so, in her opinion, it was unlikely that my ankle thing was bursitis.

When I left her studio, my knee didn’t hurt at all. (The discomfort returned the next day in much milder form, but now I had a viable way to address it.) I still didn’t have a diagnosis, but I had things I could do to help myself and most importantly, to reduce the pain. This was huge. It cost $120 to see the restorative exercise specialist for a little over an hour. I left with relief and hope, which I consider hygienic for both spiritual and physical health.

The restorative exercise specialist shared that she had marked her seventy-fifth birthday earlier in the year. To celebrate, she had walked 75 miles during her birthday week. We discussed a little what we would like our eighty-eighth birthdays to look like, if we get to live that long: horseback riding, swimming, dancing, and of course, walking 88 miles during that birthday week.

And that’s what I want my “health care” to do for me. I want it to support and enable my optimal functioning, now and as I grow older, and I’m willing to do the work on my end to increase that likelihood. Does that sound unreasonable? I don’t think so. I mean, if not that, what’s the point? If all “health care” has to offer is: Take this test, we don’t have any answers for you, here’s a pill, we’re not going to offer you anything more significant that will improve your quotidian functionality or your ease and comfort in your body—and I get that changes in “managed care” (what a phrase!) and modern doctoring have pinched physicians between a rock and a hard place—but if that’s all there is, why bother?

I’ll continue to do the colonoscopies and skin checks and other cancer screenings—and I’m grateful for those tests. And I’ll continue looking for a family physician that operates on the model I enjoyed with my previous doc. But if there’s no arterial blood or other clearly life-threatening issue, with these more uncomfortable or minimally painful health concerns, I’m becoming more and more inclined to tough it out on my own, or seek the input of other practitioners with specializations that might reasonably be helpful. I’ve kind of been left to tough these things out anyway; this new tack would simply be an acknowledgement of the reality of my modern “health care” experiences. If you don’t have anything for me, why would I waste your time and mine, and my hard-earned money?