One of my patients with long-standing rheumatoid arthritis always came to clinic with her puffy feet stuffed into golden shoes. Some patients have a certain outfit they always wear for visiting the doctor, and her outfit included gold shoes that cruelly dug into her fat feet. Foot and ankle pain were a big part of her problems, and this came up visit after visit. I was at a loss for what else I might do to ease her suffering. I kept my fashion opinion to myself, but in retrospect, I guess I might have told her to change her shoes, but instead I came up with the bright idea of suggesting a visit to an orthopedist.
My golden shoe lady was very skeptical. She told me that she had already seen an orthopedist, and she hadn’t gotten any relief. She summarized that visit for me. After the orthopedist found out that she was on prednisone, "He said, ‘Oh prednisone, that’ll really pork you up’, and then he charged me $600." Her husband’s only point of disagreement with his wife was over the bill. "He didn’t charge you $600," he noted in a matter of fact voice, but he did not dispute that the orthopedist had told his wife "prednisone will really pork you up." I’m sorry I wasn’t a fly on the wall for that epitome of clinical insight and bedside manner. I could have told her the same thing for free, but pointing that out after the fact would have been like stepping on her golden shoes.
Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind. You may reach him at rheumnews@elsevier.com.