Spinning Straw into Gold: Taking Marginal Doctor’s Advice and Finding the Beneficial Aspects

I saw a new specialist last week. The appointment didn’t go very well. I went for specific advice, but received only general advice. In fact, it’s the advice many doctors give when they don’t know or don’t care how to help you: diet and exercise.

Don’t get me wrong, diet and exercise are fundamental to good health. But I already know that. That’s not why I drove for hours and spent money to see a specialist.

Of course, the specialist had no way of knowing she was seeing me at my worst – I had a strong allergic reaction to something on my way to the appointment, and was very bloated. All she saw was a technically obese patient with knee problems who should obviously lose weight.

But, as you know, I committed publicly here on May 21st (weeks prior to the appointment) to lose weight. It has been three weeks, and I have lost 6 pounds, which is a very healthy rate of weight loss. According to my home scale, I was not obese when I committed to losing weight. I was just barely still in the overweight category, but not obese. But in the specialist’s office, on her scale and very bloated from an allergic reaction, I was obese. C’est la vie – that’s how it goes.

The specialist was not an allergist, a dietician or a nutritionist, but she felt qualified to tell me that I should try removing dairy, gluten, sugar, and processed foods from my diet for three weeks and then see how I felt. I tried to pin her down on specifics, but she was very disjointed and hopped around a lot. She didn’t actually say it in so many words, but she implied that this would reduce my chronic systemic inflammation.

Again, there is nothing wrong with the advice that she gave me. Except that she has no knowledge of my specific allergies, nor did she ask what types of diets I have already tried under doctors’ supervision. She told me to reintroduce the types of foods (dairy, gluten, etc.) individually after three weeks and see how I felt. I told her I’d already done a very strict elimination diet under the supervision of an allergist and with advice from a nutritionist, and that I did not currently have dairy in my diet – was she advising I reintroduce it? She did not answer my question. I told her that I had already determined that I felt better without grains (except rice) – did she want me to try reintroducing them again anyway? Again, she did not respond.

Telling a patient with known allergies to haphazardly tinker with their diet is irresponsible. And telling a patient to try an elimination and reintroduction of foods without a protocol detailing the most effective way to do so is frustrating for the patient and may lead to inconclusive results.

And yet, her advice was not wholly bad. I do need to lose weight, and inflammation is very bad for one’s body. In fact, research links chronic inflammation to the following diseases: cancer, heart disease, diabetes, arthritis, depression, and Alzheimer’s. And research suggests that certain foods or types of food may cause or reduce inflammation, although this research is still in early stages.

The specialist told me to eat lean meats, Omega 3 fish, fruits, and vegetables. There is plenty of research that supports this advice. It was unclear what her advice was regarding grains, although research supports eating whole grains as part of a healthy diet. She also recommended the meat come from grass-fed animals. According to the Mayo Clinic (my research, not hers), grass-fed beef “may have some heart-health benefits…[but] it’s generally more expensive and there is limited long-term research to definitively prove that grass-fed beef is better for you.” So, does it really matter if you eat grain-fed or grass-fed beef? That’s up to you to decide. One important thing to know is that grain-fed cattle typically are fed corn or soy. If you are allergic to either of these, you might want to avoid grain-fed meat. This really informative Healthline article breaks down the differences between grass-fed and grain-fed beef, including differences in fatty-acid composition and vitamin content, if you’d like to know more. Their conclusion:

Most people are beginning to agree that the most important thing is to eat real food.
Some people like to take this idea a step further and only eat real food that eats real food. After all, grasses and herbs are a more natural diet for cows than corn and soy.
At the end of the day, the choice depends on your preferences and values.

Healthline (see previous link)

After a cooling off period (during which I was thinking “Such a waste of time and money!! She didn’t help me with the problem for which I went there!”), I was able to admit that her advice wasn’t bad, per se. She recommended diet suggestions that are in line with current research (except the gluten-free part – if you’re not celiac or gluten-intolerant, there’s nothing wrong with gluten in your diet, and excluding it might lead to nutritional deficiencies). It sounded like fad advice, initially – “no dairy! no gluten! no sugar! Nothing from a can or bottle.” But it wouldn’t hurt me to try it for three weeks, like she recommended. So I have been. Today is day seven, and I haven’t noticed a difference yet, except that my joints are more loose and painful, which could indicate that the inflammation in my body is decreasing. Inflammation is the body’s way of stabilizing a loose joint and reducing pain caused by rubbing.

The specialist also recommended that I walk 20 minutes minimum per day (in water, if necessary/preferred) and try mat pilates to strengthen my core and build muscle strength. Again, this advice is in line with recommended exercise guidelines for people with my conditions. I have not tried pilates before, so that will be something new to explore. But, like with diet, she didn’t ask what I was already doing.

Along with improving my diet, I had also already committed to more cardiovascular exercise, muscle strengthening, and resumption of physical therapy exercises. Since my baseline health has improved after our move to Florida, I have been walking periodically, as my knees, ankles, and S/I joint pain permits. As a result of seeing the specialist, I have increased the frequency of these walks to every night (except one, so far, when the pain was too much). I have also begun kayaking in Florida. To begin with, I have only been able to kayak on calm days, as battling the wind and waves causes my left hand to go numb and depletes so much energy that it takes days to recover. Baby steps – it’s still better than lying on the couch all day in Colorado, unable to do anything.

I have also resumed the PT exercises my excellent Colorado PT had assigned. I do those daily. After I finish those, I have added foam roller exercises I learned from The Malleable Mom and *her* physical therapist, Jennifer Balducci:

I have found that these foam roller exercises have reduced my neck and lower back pain, help fight my hyperlordosis, and reduce the occurrence of sprained ribs.

Additionally, I have resumed therapeutic yoga, using routines created for me by a restorative/ therapeutic yoga instructor. In my case, too much flexibility is a bad thing, but I do mat-based exercises (laying down) to strengthen my muscles, improve my range of motion, and release stress.

After I have completed this morning routine, I try to end with meditation, if my body isn’t too uncomfortable. Some days the pain or discomfort doesn’t allow me to lie there and relax. I am gradually working my duration back up to at least 15 minutes. I’m averaging about 6 minutes so far. [As I was writing this, I remembered that I like to meditate to music. Time to find the iPod!] I don’t personally use guided meditations – I prefer mindfulness meditation. I just lie on my yoga mat with a yoga bolster under my knees and focus on my breathing and how my body feels. If something hurts (my knee, for example), I focus on that for a while, until it starts to feel better. I try to observe my thoughts and then let them go – much easier to do when I’m listening to music. If When I find my mind wandering, I just re-focus on my breathing and check back in with my body. Not only do I feel better when I meditate every day, I also find I can call on those skills to calm myself when I am in pain or when something makes me upset (like bad drivers!) or anxious (like being in pre-op).

Will I take the specialist’s advice and add mat-pilates or planking to my daily routine? Probably. But only after I’ve established a solid routine (and habit pattern) of exercises I’ve successfully used in the past, which I worked with therapists and other specialists to create for my specific needs.

My takeaways from this appointment:

1. As always, write down exactly what I want to discuss with the doctor and make sure it all gets covered. Didn’t do a very good job of that this time.
2. Non-impact or low-impact core and muscle strengthening exercises are best for me. [Already knew that.]
3. I need to lose weight to relieve stress on my joints. [Already knew that.]
4. Diet is thought to impact systemic inflammation. Learn more about this.
5. No one cares more about your health than you do. A good specialist can fill in pieces of the puzzle for you or point you in a new direction, but you always need to do your own due diligence. [This visit was a harsh reminder.] [This also applies to your finances.]
6. Just like a bad supervisor can motivate you to perform better out of spite (“I’ll show you!”), a dismissive doctor can motivate you to renew your commitment to take better care of yourself.

Has anything changed as a result of my visit to the specialist last week? Yes. I decided to play along with her diet recommendations – no dairy, no gluten, no sugar, no processed foods for three weeks. So far, this has prevented me from eating fast food for convenience sake at least twice in the first week. I have also been much more diligent not to eat potato chips and sweets. [It would have been easier to rationalize eating them without the clear line of “no sugar, no processed foods.”] My GI symptoms have not yet improved, and I still had a major allergic reaction to dinner one night. I have also increased the frequency of my walks to daily, as mentioned above.

The same week I saw this specialist, I also read an interview with Dr. Lisa Mosconi about brain health. She is both a neuroscientist and a certified nutritionist, and I found the article fascinating, so I bought her first book, Brain Food: The Surprising Science of Eating for Cognitive Power. I’ll be devouring the book and anticipate reviewing it here on the blog. While I am not aware of a hereditary disposition toward Alzheimer’s in my family, I am interested in discovering if diet can improve the severe cognitive disfunction (brain fog) that is a symptom of several of my conditions, and that is responsible for my medical withdrawal from grad school.

Although this disappointing specialist’s visit was a good reminder to stick to a Mediterranean diet for good health, I anticipate, based on the article by Dr. Mosconi, that I will reintroduce dark chocolate to my diet once the three weeks are up, because I don’t anticipate that giving up sweets entirely is a sustainable lifestyle for me.

I guess the appointment was a reminder that:

1. Managing chronic illness/disability is difficult.
2. Doctors have a wide range of levels of competence, and just because they’re a specialist doesn’t mean you’ll get good care or good information.
3. You gotta do the work yourself.