How does one know if medication should be thrown into the mix?

Life isn’t fair.

Jack can smoke, drink, live off ding dongs, mocha chokas with extra yocas and dance across the finish line. Jane has a gluten free oreo once in a blue moon and will crawl across the finish line.

Some fortunate souls acquire their diagnosis quickly, the less fortunate years after inflammation brews and stews. Mary has a little arthritis… Mack has dangerous vasculitis or lupus nephritis or scleroderma.

Setting realistic goals

People come to me with the expectation that things will be done without medications. Some already have a sense of what they need and a balanced perspective. Others do not, and this is not a conversation I take lightly or shy away from.

If one knows anything about the history of rheumatology, one knows that we have made leaps and bounds. Little is rheumatology the practitioner watching their patient become further crippled year after year or dying younger because of human ingenuity and pharmacology.

Patterns to consider in setting realistic goals…

It is an evolving item list for me, but patterns I look for when considering medications (biologics, DMARDs, low dose steroids, etc) in the patients I work with.

We’ll take a rheumatoid arthritis case as an example:

How long has one had it?

6 months? 10 years?

What type of rheumatoid arthritis is it?

Strong positive Rheumatoid Factor and/or CCP?

Do you have joint damage? How extensive is that joint damage?

What is the status of the disease?

A high VECTRA score?

ESR/CRP/Complements low or high?

Vitamin D low despite supplementing?

Morning stiffness for minutes or hours?

Do you have 16+ puffy joints or just a few?

Is the disease organ threatening or non organ threatening?

Does your RA flavor come with vasculitis, ILD, eye disease, heart disease, splenic disease, hemolytic anemia, etc?

What are the triggers and obstacles, how many of them are there?

Seasonal change? Food? Pet dander? Sunlight? Activity? Chemicals?

Do you have the capacity and resources to address these triggers and obstacles?

How resilient are you?

When the triggers have been identified how long do, they flare you?

Do you have a corn chip and your disease is off to the races for days to weeks?

Or is it just 24-48 hours?

Is there a perpetuating factor that turned things on?

Can we identify it and address it?

The decision is ultimately yours, but you should know where you stand…

This is in essence, informed consent. I tell patients I’m their dumb employee and the decision is ultimately theirs. Here’s my opinion of where and are and how best to move forward. You are the final arbiter.

My perspective

I love natural medicine and I detest it. I’ve seen magical things happen, but I’ve also seen folks misled chasing the magical- never appropriate as a stand-alone for their case in the first place. And they pay for it, out money and out quality of life.

Our goal as Naturopathic physicians is to always find the root cause. But sometimes we cannot find it or it is too late to address it. That is reality. Believe me, I wish I had a magic wand.

My intention is not to be discouraging. Those of you who know me know I’m an optimist.

As you navigate this world of healthy living and alternative medicine PLEASE, minimally have someone rheumatology focused on board.

A good one is hard to find, I know. KEEP SEARCHING.

Know that the clock is ticking with your body. And if you’re going to select a functional/alternative/methylation wizard John, Sally, Sue whatever, feel them out for a balanced perspective.

No shame in relying on medicine, I do it myself. Write those off that shame as infantile adults and move on.

How did your case go? Did you ultimately commit to a medicine? Do you find the secret sauce without it?