by Carol A. Westbrook
I walked into an examination room, introduced myself, and shook the hand of a 32-year old man whom I will call Fred. One of the biggest people I have ever met, Fred weighed in at 485 pounds.
“What can I help you with?” I asked.
“I'm here for three reasons, Doc,” said Fred. My left shoulder just started hurting me, and it's getting so bad I can't lift my arm. I also have a back problem that's going on for a couple of years. It's so bad I had to quit my job at the lumberyard. And I have a rash on my skin.”
His shoulder pain, he said, began about three weeks ago. After a quick exam I diagnosed him with adhesive capsulitis–frozen shoulder. He will need physical therapy, maybe surgery, but would eventually recover.
The back pain is another story. It started slowly about two years ago, shooting down his right leg. The side of the leg is now numb, and he has difficulty walking. It was easy to recognize that he had an advanced case of lumbar disk disease, which damaged his sciatic nerve. This condition will need back surgery.
Back and shoulder pain are among the most common problems we see here in the Care and Concern Free Medical Clinic, where I have been a volunteer physician for the last two years. Many of our patients work at blue-collar jobs, doing manual labor or heavy lifting. They have lost their health care insurance because they had to quit their jobs due to these injuries, and that is why they seek free medical care. But Fred was awfully young for these problems, no doubt because of his massive size.
“I can give you something for the rash.” I said. “The shoulder pain and back problem will take a bit more doing. You should have physical therapy for your shoulder, and you need to see a back specialist as soon as possible before it's too late to do anything. And you have a fourth problem–your weight.”
“At 485 pounds you will be lucky to live to age 40,” I continued. “You need to lose about 300 pounds. Realistically you can't do this on your own. You should consider bariatric surgery.”
Fred was discouraged because he knew that our free clinic does not have funds to pay for surgical specialists. He was caught in the middle, like many of our clinic patients. He has no health insurance because he is unable to work in a full time job with benefits, but he can't fix his medical problems and get back to work without insurance. It's a vicious cycle of poverty.