Important ConceptsPain

Dr. NO

I often refer to myself as Dr. No or the Doctor of No, because I find myself telling patients more of what they can’t do than what they can do. It doesn’t feel good to do it, and other than dictating charts and dealing with electronic medical records, it’s one of the most unrewarding things I have to do on a daily basis.  Occasionally I start out the day promising myself to tell more patients about the things they can do rather than focusing on what they can’t do. But it doesn’t last for long. At the end of a long day in the office…I’m Dr. No.

And I’ll stand by my words, because when it comes down to it…we keep doing a lot of things we shouldn’t be doing. Now I’m not talking about cigarettes, drugs and alcohol, even though I’ll just take a moment to say “NO” to that for sure. I’m talking about our activities; our work, our chores and our play. Many of the things we do today are going to wreak havoc on our bodies later on in life and make us wish we had never done them.

Even glorious football. As much as I love that sport, it remains high on the list of things which wreak havoc on the human body and I’ve had more patients tell me they wish they had never played, than those expressing the opposite. Sorry. Simply put… football players suffer later on in life. And you can only hope that the glory or the money make up for the suffering.

We’ve got to look at things from a risk-benefit standpoint too. There are many activities which afford us great benefits; like championship belt buckles, money, prestige and warm fuzzies. I fully understand, and in my role as your doctor I will never be judgmental. Your priorities are yours. You own them and only you can judge their value. I guess I’d have to say that no matter what the risk, high benefits suffice for most. Evil Knievel made a lot of money. But as your doctor I must remind you of the risks to your health.

Some of the things I’m going to tell you not to do are completely elective activities. You don’t have any reason to do them other than the thrill it gives you. Some of the obvious ones; sky diving, bull riding, and riding motorcycles. The activities which come with the saying, “It’s not IF, it’s WHEN…” I ride horses and I’ve been tossed off more often than I’d like to admit. With horses, it’s not IF you’re going to get tossed off, it’s when. I’ve done damage to many bones and joints and yet I still feel compelled to ride…and ride dangerously. And there’s no NEED to ride horses. So trust me, I’m not going to judge you in any personal way when I tell you it might be better for you not to do something. I just want you to understand the realities. I certainly understand them for myself.

I completely understand why you want to keep doing the things that cause you pain and injury. But I’m still going to say “no” if I think it’s harmful to you. It’s not a law and you’re not going to get arrested. I’m not going to charge you more money and your insurance company is not going to hold payment on your bills.

I’m just going to remind you that someday you will pay for the injuries past, present and future. In rare, severe and disastrous cases, you may know immediately just how bad you’re going to pay. But in most cases we can fix you up for the time being. You can return to your normal activities and you won’t pay for it for many years. But pay you will.

There are some things we do which may not cause direct and apparent injury, but can contribute to the repetitive injury of our bones and joints. I’m big on trying to convince my patients to modify their activities, especially the ones that don’t matter. If you read my blogs on Be Kind to Your Hands and Be Kind to Your Feet, you’ll know what I’m talking about. There are a lot of things we do on a daily basis which we could really do a different way, with no downside to the quality of our lives. Look at the simple act of opening a jar. We struggle with those darned things and finally it pops open. Why not just knock it against a counter top and use a little rubber pad to gently pop it open. It’s a lot less stressful to your wrist and fingers. And you do it hundreds of times over a lifetime.

How about pill, potato chip and cereal packaging? It’s like they really don’t want you to get at the product. Scissors and box cutters are your friends.

Move heavy pitchers and milk cartons to lower shelves in your fridge.

Are you getting the idea? So the Dr. of No doesn’t have to stop you from doing the things you love to do just yet. Think of each joint, tendon or bone as having a finite amount of stress it can take. Maybe you use all of it up when you dislocate your knee playing football. Maybe you use it up over time when you do squats for exercise. And maybe you get a little more time out of it if you just do limited squats, avoid climbing a lot of stairs and stop high impact exercise after you’re thirty years old. None of us knows the limits of our parts. We can only guess and do what we intuitively think is the right thing.

But our intuition is markedly affected by what we see and hear. We see football players come back to playing football a couple of months after knee arthroscopy so we think it’s a minor thing to have knee surgery and our fifty year old knee should recover in the same fashion. We see an eighty year old complete the Boston marathon and so we think we all have the potential to run marathons if we just condition ourselves to that exercise. We read that orthopedic surgeons do surgery to help us get back to doing what we were doing before. We’re told that more exercise is better. Our children get kudos for participating in three sports at one time…and doing it year round!

Think of yourself as you would a vintage car. Exercise your body more gently as you age. Give your body breaks.

When possible try to get yourself into a less physical job description as you age. It’s rare to make it to retirement doing an extremely physical job like carpentry, welding and stocking shelves. Do you know people who do? Sure. But I know more who can’t. Have a plan. Start working toward that plan when you’re forty-five, not when you’re sixty and have arthritis in your knees and a rotator cuff tear.

I’m going to suggest that you not play two rounds of golf, or start using the golf cart and discontinue walking the course.

I’m going to tell others to change their tennis serve and start playing doubles.

Some of you fifty year-olds are going to have to stop playing pick-up basketball with the twenty-year-olds…

Some of you are going to have to wear a brace or take anti-inflammatories.

It’s just a fact of life, and having some peace with that process will go a long way. But we live in a world of go-go-go. We see a story regarding that octogenarian who completes the Boston Marathon, but the thousands who couldn’t do it don’t make the news. You see a seventy year-old playing tennis, but you don’t see all the fifty-five year-olds having total knee replacements because of injuries they sustained in college.

You see a college football player get back on the field a month after knee surgery, so you assume your fifty year-old knee will have the same outcome following knee arthroscopy. I want to be Dr. Yes, but it’s better for both of us if I talk about your expectations and how I might have something else in mind. Of course no posse will come arrest you if you return to running five miles three days a week and playing pick-up basketball twice a week and then doubles tennis on the weekends.

Trust me. It’s a lot easier to be Dr. Yes.

Now Dr. No might get you out of some chores as well. To be honest with you, a lot of people enjoy doing chores; like feeding horses or working in the garden. A lot of people have no choice but to do chores; vacuuming, dusting and mowing the lawn. And there are chores and there are chores. There are also choices regarding chores.

There’s no guarantee in life that you are going to be able to lift 80lb. bags of feed for cattle and horses for the rest of your life. Really. NO guarantees. And after I’ve done rotator cuff surgery on someone, they tell me all they want is to be able to do is go back to feeding their horses. They won’t listen to options. Get smaller bags. Get help. Disabilities can make the difference between living independently at a ranch and simply having to move in to town or get help with those heavy chores. Folks don’t want to hear this.

The less overhead lifting and reaching you do, the better. At forty you should just start bringing heavy things you lift on a regular and repetitive basis, down to lower shelves. Especially when it just doesn’t matter. Why not put large milk cartons and heavy pitchers on lower shelves in your refrigerator. Who cares? Your shoulders and elbows do.

Why not move items you use on a regular basis, and store in low cabinets up to higher cabinets? Who cares? Well, your knees do. And they’ll thank you for that!

I remain,

Dr. No




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