Tales From a Physical Therapy Practice

Word Cloud Medical Diagnosis

Mrs. Goshen had a long history of increasing pain and numbness in both legs. When she came to physical therapy, she told the physical therapist that she had consulted with nine medical doctors, but she still did not have a proper medical diagnosis, that explained her symptoms. The feeling of numbness in her legs started about 8 months ago and there was no particular event that seemed to have triggered the onset. The numbness slowly increased and at times made it difficult for her to walk.

The first doctor, a general practitioner, assured her not to worry about the numbness. “At 72 years of age, it is not unusual to have some numbness every now and then,” she was told. “Since you have no family history of diabetes, you probably do not have peripheral neuropathy,” the doctor informed her, but he did not explain what peripheral neuropathy was all about. Next, Mrs. Goshen consulted with an orthopedic surgeon, who suggested she may have a nerve impingement in her low back. She ordered an MRI of her low back and pelvis. After getting the MRI, Mrs. Goshen returned to the doctor to learn that her “spine looked pretty good for a lady your age.” In the meantime, she had canceled a luncheon with friends, a concert she was really looking forward to attending, and had second thoughts about going to her high school reunion in a few weeks. She had never missed a high school reunion since she graduated now many years ago.

The doctor had no other suggestions and recommended a rheumatologist, who ordered x-rays of her back, another MRI, and laboratory studies to rule out any infectious diseases. The x-rays showed mild degenerative changes and on the MRI the doctor diagnosed mild spinal stenosis or narrowing of the spine. The doctor did not think that the stenosis was severe enough to explain the numbness. As her blood work was basically “within normal limits,” the rheumatologist suggested swimming, because some other patients in his practice really enjoyed aquatic exercise. Swimming may help with the numbness. Again, Mrs. Goshen left the doctor’s office without a diagnosis that explained her numbness. The thought of going to a swimming pool was not very appealing to her and she wondered why swimming would help her. How did the doctor come to that conclusion without knowing what was wrong with her?

In the meantime, her symptoms slowly got worse and she became increasingly concerned. At one point, she thought that perhaps she had a tumor in her pelvis or legs. One of her dear friends was diagnosed with cancer and she suggested seeing her oncologist. Mrs. Goshen called the office and set up an appointment. The oncologist had a 2-month waiting list. After two long months, Mrs. Goshen finally got to see the oncologist, who examined her abdomen and pelvis, but he did not find any red flags for cancer. He did order a CT scan of the pelvic area just to be sure.  As with previous doctors and tests, the CT scan was negative. “Many people are worried about getting cancer, but be happy, that you do not have cancer,” the oncologist assured her. “All your tests are negative, and perhaps it is time to get on with your life.”

Because she had much difficulty taking the first few steps after sitting down for a while, Mrs. Goshen did not go out with her friends as much as she used to. She could no longer rely on her legs to support her. Before the numbness started, she would have lunch a few times a week with various friends and go to the movies once or twice a week, but now she did not want to embarrass herself and more and more came up with excuses about why she could not go out. While her friends were having fun together, she would be at home wondering what the problem could be. She knew that she was not imagining the numbness.  Several times a day, she barely could feel her legs when she first got up from a chair. Yet, the last doctor seemed to suggest that perhaps the symptoms were in her head. “It is time to get on with your life, Mrs. Goshen.”

Mrs. Goshen went to several other doctors, who ordered more tests, suggested that, at her age, she should not make such a big deal of a little numbness every now and then, or barely listened and spend less than five minutes with her. Mrs. Goshen started losing faith in the medical profession.  Her symptoms slowly got worse and no one seemed to know why.

When an old friend invited her for dinner, she decided to go as sitting home alone did not get her anywhere either. During the dinner party, her friend noticed that she had some difficulty walking after the party moved from the dining room to the living room. She suggested seeing her physical therapist, as he had helped her a lot with a longstanding shoulder problem. Her friend insisted to make an appointment. Mrs. Goshen did not think that a physical therapist would be able to shed light on her situation, as she had already consulted with the best doctors in town, but she did call to set up an appointment anyway, mostly to satisfy her friend.

After listening to her story, the physical therapist offered Mrs. Goshen a gown to change into. He told her to wear the gown with the opening in the back. She could leave her undergarments on. The therapist left the room and Mrs. Goshen changed into the gown. A few minutes later, the physical therapist returned. He asked her to stand up and moved behind her back. “Is it OK to open your gown to have a look at your back?” he asked. She confirmed and he quickly opened the gown. Mrs. Goshen expected his hands to touch her back, but nothing happened at first. The therapist explained that he first had to inspect her back and overall posture. He asked her to bend forward, sideways and backward.

“Can I ask you a rather strange question?” the physical therapist asked. Mrs. Goshen replied, “sure, how strange can the question be?”  But the therapist did surprise her. “When is the last time you purchased new panties?”, he wanted to know. Mrs. Goshen did not know what to think. Why in the world would he be interested in her underwear? Her friend had strongly recommended this therapist, but now she started to question her judgment. “When is the last time I bought new underwear? Is that what you are asking?”  The therapist replied, “I know it is a weird question, but it may have something to do with your symptoms.” “Well, I guess that it is at least 20 or maybe even 25 years ago that I bought my underwear,” she reluctantly admitted. The physical therapist did not seem surprised. “Can I ask you another question?” and without waiting for her answer, he asked, “is it possible that perhaps you put on some weight during the past 25 years?” Mrs. Goshen recalled how wonderful she looked in her forties and early fifties. People always estimated that she was at least 10 years younger. Had she gained weight since then?  “Sure, I may have gained a few pounds over the years. You should have seen me twenty years ago.”

The physical therapist closed her gown and asked her to sit down.  “Before we do any other physical therapy tests today, may I recommend we stop right now? I suspect that your panties are the likely cause of your symptoms. Feel how tight your panties are around your thighs. Can you even get a finger in between the material and your skin?” he proceeded. Mrs. Goshen did not know what to say. Was he taking her for a ride or was he trying to get rid of her? She looked at her thighs and did notice that her panties did seem more than a little tight. “I suspect that your panties are compressing the major arteries and nerves in your legs, especially the femoral artery and the femoral nerve” the physical therapist continued, “When you leave here today, I would like you to go to a department store or a specialty lingerie store and purchase new underwear, that actually fits you. Feel free to ask the ladies who work there for advice. Wear the new panties all day today and tomorrow and call me tomorrow toward the end of the afternoon.” “Are you serious?” Mrs. Goshen replied, but looking at his face, she could tell he was not kidding.

She left the practice and wondered whether he could be right.  After seeing so many doctors and after having so many tests, could it be this simple? When she started her car, she made up her mind. “What do I have to lose?” she pondered, and she drove to the nearest mall to buy new panties. In the store, she was surprised to see the enormous variety of panties. She asked the lady behind the counter for advice and thirty minutes later she left the store wearing new panties for the first time in at least 20 years.

Much to her surprise, the numbness seemed to disappear as the day went on. That night, she had only a hint of numbness and seemed to be stronger in her legs. The next day, she woke up without any numbness in her legs. In the afternoon, she called the physical therapist and confirmed that all day long, she had had no numbness. The physical therapist started to laugh and told her that she probably did not need any more physical therapy. “If the problems return, please come back to the practice,’ he said, “so that we can complete the initial evaluation and look for other possible causes or contributing factors.”

Mrs. Goshen did not return to the physical therapist until seven years later. She had tripped coming down the stairs and had injured her left shoulder. She called the same physical therapist and was pleased to see that he was still at the same location. On the day of the appointment, she waited in an exam room. When the physical therapist came into the room, she said with a wry smile, “I am not sure you remember me, but I am the underwear lady…….”

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