Agism and our Broken Medical System

Melissa in spinal surgery! Photo provided by herself.

This entry is going to be longer than most, and it’s only going to touch on the issues broached in the title. I brought in fellow writer and medical professional, Melissa Collings, P.A. to flesh out some of what’s happening ‘behind the scenes’ in medicine. Hopefully what my mom went through will at the very least help someone else.

Almost six months ago, my mother went to her primary care doctor for a bladder infection and was put on antibiotics. Weeks later, she still had no relief and her back began hurting. She was put on a new dose of antibiotics and a culture was ordered. The culture came back negative, but her back pain was worse. Every week she was put on a new dose of antibiotics. She stopped exercising due to the pain and she still had no relief.

It was about this time that the doctors that she was seeing began to say, “well, you’re 71.” This infuriated me, as my mom has always been very health conscious and a regular exerciser her entire life. Melissa chimed in about our current pill culture. “There’s so much we can do to prevent & reverse disease, so much we can do to decrease or eliminate pain. But do patients hear about it? No, they get pills because pills are easier than telling your patient they need to overhaul their lives. The thing is, diet and exercise are two HUGE components of medicine that are simply overlooked. It’s the simplest, the most cost effective, but we don’t do it! It’s baffling.”

My mother was referred to a urologist, who threw her on yet another round of antibiotics and some medication for an overactive bladder. The back pain was again put down to her age. I wondered, why all the antibiotics? I mean, the hell?? “A lot of patients don’t feel like you’ve 'cared for’ them unless they walk away with a prescription,” Melissa tells me. “In one of my rotations, a provider told me that most ear infections are viral and resolve on their own, but that he always prescribed an antibiotic because patients get mad if they feel like they didn’t get their money’s worth. Providers get pegged as ‘bad providers’ or get formal complaints, etc, if they tell their patient to just wait it out. So, it’s a broken system with providers and patients to blame.”

Meanwhile, my mom started feeling worse and worse (perhaps because she was on her fifth course of antibiotics?) and began doing her own research and cutting anything out of her diet that could cause bladder sensitivity. This included almost everything in her normal diet.

She still couldn’t exercise because her back was so bad, even sleeping was difficult because it was hard to find a comfortable position. At this point, I was urging her to try functional medicine, her gynecologist, a second opinion, anything. I was concerned that the antibiotics were going to completely eradicate her healthy gut bacteria and the fact that she wasn’t eating her normal foods was going to exacerbate the issue.

She called her gynecologist. They were told that since she didn’t keep her regular check up last year (she canceled all unnecessary appointments because there was a pandemic and she’s over 65) they could refuse her as a ‘new patient’ because … you guessed it, she’s over 65. This was something that Melissa hadn’t heard of. “I am wondering if this had something to do with insurance and age got lumped in there somehow. Difficult to say, especially when the front desk might speak out of turn. The provider might not know this is even happening. To deny someone care based on their age is unethical. I think this requires some more digging.” 

At this point Mom was starting to feel invisible and I was infuriated. She wrote a letter to the gynecologist letting him know how she felt and he called her personally to apologize and got her an appointment. He did tell her that he had some personal issues of his own in the background that had prevented him from overseeing what appointments were being booked as much as he might have liked. Another culture was taken and E.coli was found so… more antibiotics. I personally questioned why they didn’t find E.coli in the first culture, but we were hopeful that this might be a solution. It wasn’t.

“Did you know that the standard of care is to not treat E.coli in the urine unless there are symptoms?” Well, now thanks to Melissa, we know!

Are we just supposed to hang up our bodies after 65 and wait to fade away? Are we not allowed to be comfortable anymore? No one was addressing the cause of these issues. The back pain and bladder issues were never addressed as possibly linked, even when she asked if it could be the case. It was weeks later that my dad recalled they had been hauling limbs around after a storm when all of this started. 

Eventually, her bladder started getting better, but the back pain was getting worse, she went back to her old doctor, who gave her a blood panel and told her that her magnesium was incredibly low but even worse, her cholesterol was up 20 points after weeks of not exercising and avoiding her normally healthy diet. He referred her to a neurologist who had her get an MRI. Mom was starting to feel hopeless. 

I asked Melissa about all the back and forth. “Most primary care docs aren’t comfortable treating ‘specialized’ complaints. Again, this comes down to training. When you’re a PCP, you have to be prepared for EVERYTHING that comes through your door. That’s impossible, which is why there are specialties. A good PCP knows what they can care for and when to refer. Your mom got a raw deal. She was treated unfairly and inappropriately. Some of this may be because of age, but a lot of it is because of a broken healthcare system. A lot of people have this experience. Not all providers are good and thorough. And she didn't even get a proper work-up! they were passing her through quickly, hoping something stuck without much effort. Overtaxed, broken system.” 

The MRI showed a tear, but the neurologist told her that this was incorrect and again, attributed her back pain to her age and prescribed her muscle relaxers. 

She went back to her old diet because she couldn’t stand it anymore. I was now freaking out and sent the breakdown of her MRI to Melissa, who felt that she needed to see an orthopedic surgeon and that she would do best under the care of a physical therapist. My tried to find an orthopedic surgeon to get a second opinion on her back. She called one my dad had used years ago for shoulder surgery, but he specialized in knees and shoulders and gave her the name of someone who could help.

Finally, she found someone who spent some time with her in the office. He told her the tear on her MRI was very clear and also that she had scoliosis, which she hadn’t known. (I also have it and was in a back brace when I was young.) He told her that her age wasn’t a factor. He prescribed physical therapy, told her to avoid bending and twisting and offered her a brace if she needed additional relief. He spent some time talking to her and asking her what she normally does and about when this started occurring. He explained everything in her MRI to her and why certain things might be happening. This was a huge relief! But why did it take so long for her age not to get her swept under the proverbial rug?

“Now this is something that’s common in our culture,” Melissa tells me. “This is the result of ‘sick-care.’ We’re conditioned to think that there’s nothing we can do about our degenerate bodies, it’s just age. There’s nothing you can do to help your pain, you’re just getting older. There’s nothing you can do about your diabetes, it’s just genetic. There’s nothing you can do for your autoimmune disease, you’re just unlucky. So what does modern medicine do in response?  Pills. Pills, pills, and more pills. Because that’s how modern providers are trained.”

She has now been to physical therapy twice. She does her exercises religiously every day. Her therapist has told her that she has definitely seen instances where bladder issues coincide with low back injuries. Right now, my mom is happy to be a little bit active again and is hoping that with physical therapy making her more aware of her movements, she can eventually walk around without pain all the time. If only therapy had been prescribed before the mountain of pills.

I’ll let Melissa have the last word today. “Most providers will tell you to “eat healthy and exercise” because they know it’s what you need to do. What they (and patients) don’t know is how to do that. So why are providers giving pills instead? Because we weren’t trained for anything else. Most medical providers, aside from the upcoming functional medicine providers, are not trained in nutrition and proper, tailored exercise. And with tons of paperwork/documentation requirements and limited appointment times and provider liability, providers don’t have time to sit down and map out a plan for a patient. They give the easiest, fastest, most powerful punch they can give your problem. That’s usually a pill.’

“And when the uneducated patient is left to their own version of a healthy diet and exercise, they turn to what society tells them is healthy, like fat free soup. Patients don’t know what healthy is because what’s available, and fast, and easy is junk, some of it disguised as healthy. No wonder we’re a sick nation!”