Ageism and sexism in my medical care.

Sorry for long post but this is a cautionary tale about sexism/ageism in medicine . I have aggressive rheumatoid arthritis so many of my joints are not in good shape.  Focussed intervention and pain relief efforts have been on my spine, knees and hands. And my compromised immunity. But last year I began with chronic shoulder pain. I sucked it up and just dealt with it as I am used to living with pain.  People with chronic illness know how you have to triage your issues that you address with doctors etc.

My right shoulder had been getting worse and worse and I finally thought "hmmm, I better see a shoulder guy". But before I got around to it, on November 5th of 2023, it gave out with terrible pain that sent me to emergency room. They said there was nothing they could do beside give me an ibuprofin (!) and refer me to an orthopedic doc. So I go see a specialist. I got a cortizone shot and orders for an mri. And he referred me to a shoulder specialist, suspecting a rotator cuff tear. 

My insurance denied the MRI twice because, as my doctor explained, "women my age all walk around with shoulders "worn out'".  It was not deemed necessary. I was told it was just part of aging and needed to keep moving it (even though I could not without great pain). 

So I am sitting  in shoulder specialist office and he reiterates that same and sends me to physical therapy so that I would not get frozen shoulder, citing it is another condition plaguing women over 60. He reiterated that as woman over 60, this was normal. He repeatedly (on every one of my 4 visits to him), cited a study which concluded that 80% of women over 60 are walking around with partial tears in their shoulder and do not even know it. (the message: toughen up, it is normal.)

I was dumbfounded and told him repeatedly 'well that is interesting but clearly that does not apply to me as I know I have an injury and my function is limited and I am in great pain'. He orders an MRI for third time and finally it is approved. But off to physical therapy I go.

That first MRI in January showed partial rotator cuff tear with  lots of other things like bursitis, tendinitis, bone spurs, fluid buildup, and several partial tears of tendons. Orthopedic surgeon told me that “it is regular wear and tear for  woman my age, live with it. Do your exercises"

So against my inner voice, I went to PT. Each time telling the therapist that it was terribly painful, more than I thought it should be as I have had rehabilitative PT on other joints before and know how rehab should feel. They said they were operating with surgeon's diagnosis of "impingement syndrome" and the exercises recommended for that were to prevent frozen shoulder. I do believe my nerves were impinged but I believe that was because of what was really going on. And the PT was making  it worse with each passing session.

One week later I experienced a terrible shoulder 'episode (?)' (my surgeon kept telling me 'that is not an injury")  simply reaching for something at CVS. It was way  worse and I returned to see doctor and asked for second MRI as I was in even more pain. He denied ordering a 2nd MRI request and sent me away saying to stay the course. 2 weeks later , another episode happened while showering and I was left in worse excruciating pain with even less mobility. 

I suspended my PT for a week and was taking pain pills and living with ice on it. I tried to resume PT after a week off and then the therapist suspended my PT because I had drastically declined instead of improving, it was swollen, hot to touch, super painful and I had lost almost all mobility.

Back to doctor and I then demanded another MRI and he ordered it. 2nd MRI showed worsening decline. I now had a new type 2 SLAP tear that was not found in my MRI one month previous. But most importantly, my bicep tendon had now detatched from my shoulder! Plus more other bad stuff.

NOW, I have to have a fairly big shoulder surgery. I have to have both an arthroscopic rotator cuff repair. But I have to also have a SLAP repair and partial open (in front of shoulder) tendon reattachment which involves drilling holes into my shoulder and making new anchor for tendon. I will need to be immobilized four to six weeks and rehabilitation four to six months. Motherfucker! Of course I got a second opinion and changed surgeons. 

If I had been listened to and not written off as "a woman over 60 with the usual complaint of worn out shoulder" I believe it would not have gotten so bad. And I wouuld not have been in terrible pain with increasing lack of function for four months. More sexism and ageism occurred but I will spare you those details. The important thing is I finally believed what I had been seeing and left that doctor. He had scheduled me for the surgery when I went for a second opinion and scheduled the surgery with the second opinion orthopedic surgeon. It was such a good feeling to call surgeon #1's office and say I was cancelling my surgery because I am going with another doctor. They were stunned and I was gleeful as I smiled and said goodbye1

The moral of this story: be vigilant and an advocate for yourself in the world of healthcare.