RE: Doctors

[TooMuchBoob]

I am getting quite tired of medical doctors and their ivory tower attitudes.
- Right here you lose all credibility. You don't respect the people who have actual expertise because of your attitude.

I don't respect people telling me how to live when they have NEVER been in my shoes. Go out and wear multiple layers of clothing while working 12 hour days in 110 degree heat - advice coming from someone that lives, breathes, and works in a climate controlled environment. When they can do it, I'll listen to them.

Doctor:  Have you tried compression stockings?

Me; Briefly. They didn't seem to work and they were way too hot at work.
- Which means you don't know how to use them

Medical advice for hot weather is: wear lightweight, breathable and loose fitting fabric in single layers. Compression hosiery meets none of those. Or are you going to fabricate some story about loose fitting, lightweight compression pantyhose?

Doctor: You need to try higher compression ones.

Me: Will it improve my condition?
Yes, by improving your symptoms - Don't lie by writing what you did below.

Why aren't you getting this simple concept? There is a medical condition. That medical condition has symptoms. The condition, the symptoms, or both can be treated separately or together. This "doctor" didn't want to treat the condition, only relieve symptoms. Kinda like prescribing morphine for a broken arm instead of putting a cast on it - here, it will relieve your symptoms.

Doctor: No, but it will improve symptoms.

Me: Since I can only wear them 6 months of the year it seems pretty pointless.
- Because you know nothing and are not willing to actually do anything you should do. You want a quick fix. You are lazy.

Again, you are missing all the relevant points, My work dress requirements are long pants and closed leather shoes or boots. Compression pantyhose results in 2 layers below the waist and 3 closed layers on my feet. That is not what should be worn during high heat and humidity. Someone here mentioned that they wick moisture away. Great, let's make the body's cooling system STOP working. If sweat cannot evaporate from the skin, it cannot cool the skin. So now there's the added thermal layers AND no way for the body to cool itself.


Me. Then what's the point?
- No, you're right, smoking is a very smart thing to do.

There are a lot of unhealthy things I could be doing, but I'm not. The doctors cannot find any health issues with me to make their point. I don't drink or take drugs, I'm not overweight, and I don't partake in any risky behaviors. So yeah, I know it's never going to  be healthy for me, but it's also apparently not doing me any harm after 40 years.

Doctor: It *might* slow the worsening of the condition.

Me. But it won't stop it getting worse?
No one believes that this was the back and forth of the conversation

Too bad for you, I was there. And was it as simple as this? No, this is the distilled version, but the conversation happened. I even lodged a complaint against the "doctor" because he was so arrogant. First bad experience with a doctor in my life.


Doctor: How about getting more exercise?

Me: I walk several miles per day already.
Walking is not exercise buddy, exercise is exercise

Really? Are you that effing ignorant? "

Aerobic exercises, such as cycling, walking, running, hiking, and playing tennis, focus on increasing cardiovascular endurance. ..."

Google is wonderful if you've never heard of it.

Doctor: No. It *may* improve symptoms though.

Me: So what you're saying is that nothing I do will improve my condition?
No, what you did was miss every critical point because you have a terrible attitude towards reasonable advice. The reason for this is your arrogance,

Where are you getting arrogance? Seriously? This "doctor" was telling me to waste my time doing things that would have zero effect on my medical CONDITION. I wasn't arguing whether they were good or bad in general, but I didn't see him for advice on improving my already good health. I went to get treatment for one specific condition and he provided ZERO advice for improving that condition - because once the veins and valves go bad, there is no way to improve them.

Me: You didn't answer my question.
Yes he did, I'm sure the doctor did not say what you wrote below.

Doctor: The condition cannot be improved.


Basically, yes. See directly above.

The saddest part about all this is I have to PAY for this kind of crap.
Then don't go the doctor, he doesn't want to waste his time with you either. You seem to have all the answers anyway.


I at least know the difference between treating symptoms and treating the condition causing the symptoms.


When you post non-sense like this you prove one thing- you are beyond help.
- I would suggest patience with your treatment plan, and a little respect for the medical professionals.  Based on your posting you would be a terrible candidate for any invasive procedure.


You are getting so good at being wrong - good job! I have had 2 hernia surgeries (one in the last year) that went absolutely fine. Great surgery, great recovery, great result.


Especially if it's venous ablation as it sounds like- that is not curative. Very few surgeries are.


Venous ablation is about the only cure there is, and it has a very high success rate as well as a very good long term prognosis. Does it always work? No, but how many things in life are 100%? Try that Google thing, you may learn something.

[/quote][/quote][/quote]

[yankee421576]

Actually I perform venous ablation. So I don't need to google it. I engaged you because you have very little understanding of what you are talking about and clearly misrepresented your physician interaction. I'm the first to admit that ablation is not curative and sometimes many treatments are necessary- sometimes accompanied by complications. You are incapable of understanding simple concepts or heading the advice of your doctor which make you a poor candidate for any invasive procedure. Improving symptoms is the goal in venous insufficiency and only if you fail that would you be a candidate for ablation. Even with ablation you should be elevating your legs and using compression. Ablation is not a cure, it may improve symptoms and in some patients may improve them a lot. And your point about smoking for 40 years and doing no damage simply proves that you are delusional. But hey good luck to you.

[yankee421576]

And yes one more thing- I'm glad you walk, but IT IS NOT EXERCISE. Aerobic exercise requires much more than walking. And yes it will improve your condition by forcing venous return through muscular work. Don't try to debate me on it. You have zero credentials to challenge me. You can dislike the facts, but that doesn't change them.

[TooMuchBoob]

Actually I perform venous ablation. So I don't need to google it.

For the sake of this discussion I will assume you are telling the truth here. However, a person can be anything they want on the anonymous internet...

I engaged you because you have very little understanding of what you are talking about and clearly misrepresented your physician interaction. 

That interaction is very accurate in distilled form.

I'm the first to admit that ablation is not curative and sometimes many treatments are necessary- sometimes accompanied by complications. 

Hmmm.. I just read a long term study of it. They list a 97-100% initial success rate. They also listed a 20-30% recurrence in the 10 - 20 year range. Sorry, but let me at that initial success rate, and I'm quite happy to take 70% odds out to 20 years!

You are incapable of understanding simple concepts or heading the advice of your doctor which make you a poor candidate for any invasive procedure. 

On the contrary, I have followed ALL doctor advice for all of my invasive procedures and will do so again if I can get the venous ablation surgery.

Improving symptoms is the goal in venous insufficiency and only if you fail that would you be a candidate for ablation. 

That's completely backwards to the way it should be approached. If someone has a growth (non-cancerous) that is causing pain, do you just prescribe pain medication - up through morphine - then, if the pain medication fails, and only then would surgery be an option?


Surgery has a very high success rate and very low risk of complications. If successful, it also restores quality of life - unlike compression pantyhose.


Even with ablation you should be elevating your legs and using compression. Ablation is not a cure, it may improve symptoms and in some patients may improve them a lot.

Surgery is as close to a cure as there is, why immediately rule it out?

And your point about smoking for 40 years and doing no damage simply proves that you are delusional. 

I said "apparent" damage.

And yes it will improve your condition by forcing venous return through muscular work. Don't try to debate me on it.


That statement is wrong. Once the veins and valves are damaged they cannot be improved, so the medical condition cannot be improved. You are referring to it improving SYMPTOMS.


I have no desire to ONLY improve symptoms. If surgery fails, I will worry about the symptoms.

If you are truly a vascular surgeon, have you worn compression pantyhose all summer with no access to air conditioning - or are you the type that leaves a climate controlled home to go to a climate controlled car and then to a climate controlled work environment?


For me, I don't have the luxury of being in AC 24x7. Even if I was retired, I would have to give up all outdoor activities during warm weather. Having half my body covered in 2-3 layers of clothing during hot humid weather is just not doable in a healthy way.

I won't even get into the other loss of quality of life issues

TMB

[yankee421576]

Again, you have very little understanding of your 'medical condition.' It's venous insufficiency and it is more or less a chronic issue. Sorry but google isn't a replacement for medical training. Ablation is promising but should never be used as an initial treatment and exercise will improve your symptoms which is equivalent to improving your condition. Doesn't matter what you believe the venous valves may or may not be doing. There is much more to venous return than that. As someone who trained with the physicians who invented this procedure I know what I'm talking about. I know the success rates, failure rates and complications. The doctor gave you sound advice. Your statement about doctors in ivory towers said it all and since I'm not your doctor I'm calling out your blatant arrogance and stupidity. No one would want you as a patient if you don't appreciate sound medical advice- it doesn't mean the doctor is in an ivory tower. Have some respect for the people who are trying to take care of you. And FYI, I wear compression daily and I don't work with ac 24x7. I do stand and operate for hours at a time while saving lives. I'm just not a whining complainer who wants a quick fix. And what does 'apparent damage' mean? You smoked for 40 years and you think there is no apparent damage? Are you serious? I won't waste anymore of my time on this. Good luck to you.

[hammer]

I'm going to add my $2.55 worth in again!

I know this was all said before,  but the post were deleted when the forum was having issues.

I've been wearing compression for over 20 years and I started before going on disability.  I worked construction and in weather with days of 90 plus.  We've had days with the heat index over 100 degrees at times and it didn't kill me, I've also said that I do better, that I feel better with them on, then I do without them! I still stand behind that statement.

I've gone for about a week without them due to a fall, (heads up, you don't want to fall on prosthetic knees) and I put them on again this morning for the first time since the fall, and it was like having a cold beer after mowing the lawn!  My legs feel that much better!

I won't deny that it take time to get used to wearing them, but the benefits outweigh everything else!

[TooMuchBoob]

Again, you have very little understanding of your 'medical condition.' It's venous insufficiency and it is more or less a chronic issue. Sorry but google isn't a replacement for medical training. Ablation is promising but should never be used as an initial treatment

Why not? It is the only treatment that is a potential cure.

and exercise will improve your symptoms which is equivalent to improving your condition. Doesn't matter what you believe the venous valves may or may not be doing. There is much more to venous return than that. As someone who trained with the physicians who invented this procedure I know what I'm talking about. I know the success rates, failure rates and complications. The doctor gave you sound advice. Your statement about doctors in ivory towers said it all and since I'm not your doctor I'm calling out your blatant arrogance and stupidity. No one would want you as a patient if you don't appreciate sound medical advice- it doesn't mean the doctor is in an ivory tower. Have some respect for the people who are trying to take care of you. And FYI, I wear compression daily and I don't work with ac 24x7. I do stand and operate for hours at a time while saving lives. I'm just not a whining complainer who wants a quick fix.

Honestly, I have no idea what you do for a living, but if it's surgery, I have yet to be in a doctor's office, hospital, or OR that was not cool - if not freezing, during warm weather. There's a reason they keep warm blankets handy.

And what does 'apparent damage' mean? You smoked for 40 years and you think there is no apparent damage? Are you serious?

Doctors have harassed me about quitting for decades, but they have never been able to point to a health issue caused by smoking, or a health issue that would be improved by quitting, They have not had a carrot or a stick.

As for me being a patient, I am probably a very good one. I do not have any psychosomatic problems, and other than this ONE issue, I am compliant with doctors' advice and orders. But then again, other than this one issue, my doctors have given logical and sensible advice/orders.

TMB

[TooMuchBoob]

I'm going to add my $2.55 worth in again!

Inflation?

I know this was all said before,  but the post were deleted when the forum was having issues.

I've been wearing compression for over 20 years and I started before going on disability.  I worked construction and in weather with days of 90 plus.  We've had days with the heat index over 100 degrees at times and it didn't kill me,

Were you also wearing long pants and socks?


I know in theory that should be possible, but I sweat a LOT. Most warm days I have to hang up my dirty clothes to dry because if they go straight in the dirty laundry, they are so wet they start to grow things.

On top of a day working in the heat and humidity, I have a minimum 1 hour drive at the end of my day in a car that has been pre-heated to 140 degrees and does not have AC.

I've gone for about a week without them due to a fall, (heads up, you don't want to fall on prosthetic knees) and I put them on again this morning for the first time since the fall, and it was like having a cold beer after mowing the lawn!  My legs feel that much better!


I just find that hard to believe... I tried some the first time they were prescribed and they were awful. They were thrown away after 4 months of not using them.

I won't deny that it take time to get used to wearing them, but the benefits outweigh everything else!

Let's say I had surgery and it didn't work or the condition recurred. IF I managed to somehow cope with working while wearing them, any outdoor activities outside of work would never happen. It would probably take hours to cool down once I got home, and I sure as hell wouldn't want to go back out in the heat to walk the dogs or do any other exercise.


I don't yet have a choice whether to work or not, so if I'm miserable at work, I would have to suck it up and hope I didn't get heatstroke. At home though, as long as the temp was above 80 or so, I would be housebound.

One thing that I find very odd is that the "medical advice" I've been getting regarding CVI is the exact opposite of "medical advice" regarding dressing for hot weather.


Dressing for hot weather: Wear loose fitting, light weight fabrics, and keep it to only one layer wherever possible.


Compression pantyhose violate ALL 3 parts of that advice.


TMB

[TooMuchBoob]

Even though a certain person here has the opinion I am ill-informed and believes Google doesn't have any valid information available, I have to add the following.

I have done a TON of research on CVI. I have read opinions and reports form individuals, hospitals, surgeons, and research facilities.

I know my options, and I don't want to suffer "conservative treatment" unless it is the last resort.

In consideration of the last resort, I have also researched (or attempted anyway) how to survive hot and humid weather while wearing compression pantyhose. It's just wonderful, ALL the information I could find is about how WOMEN can wear compression hosiery during the summer. Shorts, skirts, choosing fashionable pantyhose, sandals, etc, etc. NONE of which is the least bit helpful to a male.

Overall, the advice is to have the hosiery be the only layer on the legs - something that ain't ever gonna happen with me. I don't even own a pair of shorts (or a skirt for that matter).

The last pair of shorts I bought was way back before "shorts" went ghetto and became basically baggy capris.

TMB

[hammer]

Yes, inflation plus years of experience as well!

I always wore Carhartt bib overalls!

Until I bought my 1995 dodge van I didn't have AC either, at home or vehicle!

I worked construction from the footings to the roof, so I was outside in the heat, or the cold. The last 10 years that I worked I owned the company, so if I had people out on jobs, out sick, vacation or we were running be hide it was me that was out there at any hour or weekends making sure the job was done and the customer was happy! So I worked in any and all weather conditions!

Sometimes a man has just got to jump through hoops to get to the other side, then things just might move forward! 

[TooMuchBoob]

Honestly hammer, I don't know how you managed it, There are so many days where even in the evening, sitting in the shade, I sweat like a pig - and I'm not even doing anything!

And then, the thought of having 2-3 layers for cool air to get through, makes me think I would spend hours attempting to cool down.

I just can't see it. I did try them while the weather was still decent, and they are HOT under long pants. The heat and the uncomfortable feel coupled with the fact they didn't make my legs feel any better made the entire process a waste of time - even though it was only a couple of days.

I just don't understand the thinking behind treating ONLY the symptoms. I can't think of any other potentially fatal medical condition where NOT attempting a cure is considered acceptable.

It's very minor surgery, with a very high success rate, and a very low risk of complications. It doesn't even require general anesthesia, only a local, so why the big refusals?

TMB

[hammer]

My problems were different,  I had swelling to deal with so compression and elevation was all I could do! I also wore shorts when I could after work. We got AC in the house shortly after I went on disability as well. There was a time I could handle extreme temperatures, heat did not get to me, however I did sweat like a pig, and in the winter I wore nothing more then a jean jacket. Those days are long gone being hypothyroid I can no longer deal with the extreme weather as well however I do what I need to, to try and feel better!

[TooMuchBoob]

I think it would be a lot easier to deal with if they felt - as you said - as good as a cold beer after mowing the lawn - but they don't.

They feel hot, tight, and constricting, and they don't seem to do anything positive.

Unfortunately, my research leads me to believe the VA is going to say the same thing. :-(

I lose quality of life either way, so I'm not looking forward to hearing it a third time.

Between the 2 choices, doing nothing results in a better quality of life - until it sends me to the ER that is...

TMB

[yankee421576]

Venous insufficiency is not fatal. It can be painful and frustrating but rarely fatal. Pretty much only the way to have true mortality is from formation of deep venous thrombosis which would lead to clot in the lung - pulmonary embolism. How is this treated? You guessed it- by compression stockings and movement and in some cases with blood thinning medicine. Ablation has no role in reducing that and therefore not a treatment for complications from venous insufficiency. Venous ulcers and infections can also occur - almost all of them are in patients who refuse the standard treatment measures. Venous insufficiency is a very common problem and very rarely fatal. Again venous ablation is promising, but as someone who knows about it I can tell you that the 'cure rate' is not 97%. In fact it is not indicated as a 'cure.' The actual goal is improvement in symptoms and appearance. Unfortunately in medicine there are very few cures. A basic tenet of medicine is to do no harm. That is why conservative treatment options are often advised initially and many times in chronic diseases. The refusals from insurance companies occur because these are expensive procedures- whereas a pair of compression stockings are less than $50. Almost everything that you can google has significant limitations when it comes to medical issues. Everything should be taken with a grain of salt. While this is obviously a tangent issue on this forum, I think all patients should be wary of any physician who opts to do surgery first without attempting the conservative options. In fact the best surgeons are the ones who know when not to go for a procedure. Case selection is most important which also requires the right patient. Many people are simply poor candidates because they either have poor anatomy, other chronic medical issues which complicate the surgery, or are non-compliant and are their own worst enemy. This initial debate is because one of you decided to criticize very reasonable advice from a physician and that position is completely flawed. Is it uncomfortable to wear compression stockings initially?- yes. Do they work if you give them time?- Yes. Do they always control the problem? No. Is venous ablation a cure? NO.

[hammer]

On another note, I know that you are not even thinking of giving up the smoking, but I know that you've heard it all and I'm going to give a little testament myself. I've never been a smoker,  but Copenhagen snuff was my habit!  Did it for a little over 17 years, and the hardest thing I did was give it up! I tried in 1988, but my son was killed and I needed  it then more then ever,  but then in January of 1995 I had my 37th birthday coming and I decided that on that day I was stopping for good! Debbie didn't want me doing it then as I had a surgery scheduled in February, but I said no, this is it! I needed the patch to help but man, I think of what it would cost now!!!!!

Fast forward to today!

We just returned from a weekend of camping with our toy hauler camper that we bought this year. We bought a toy hauler so I can carry my ATV deer hunting as I have a "hunt from the vehicle permit". If I hadn't given up that nasty habit I may not have those toys as well as all the other man toys in my carpenter/welding play pen or my gun cabinets!

It's All about choices my friend!


Bob