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Monday, November 17, 2014

The Art of Medicine and MS

As I have mentioned, I am a classically trained, western medical health professional. I am not a physician, however, I am a Nurse Practitioner. We are trained a bit differently than physicians, and in a way that I feel is more holistic. We are trained from day one to see the humanistic side of medicine, to view the patient as a whole being, rather than the sum of the parts. The body cannot be healed without addressing the spiritual, emotional aspects of the human being.

The human body is an amazing machine, and with great consistency, it works flawlessly. Most people live their lives to the ripe old age of 80 something, without any major medical problems. Most medical issues will simply resolve on their own regardless of treatment. Most minor issues such as sinusitis, ear infections, minor lacerations, viral illnesses such as colds/flu, and seasonal allergies are self limiting, and the body does an excellent job of healing. These issues almost always resolve with what we refer to as "tincture of time." People do not like to accept that answer, however. Many want an immediate, quick and easy fix.

Our society is very quick to assume that modern medicine has a "secret book" of treatments, available only to those who have attended medical school. This magic book contains all of the recipes for treating illness, and is kept hidden, under lock and key. The providers of the world are assumed to have the ability to fix anything, to treat anything, and if they do not offer a fix, they are assumed to be withholding treatment intentionally.

I can tell you, this is not the case. One of the most shocking things I learned while transitioning from a registered nurse to a nurse practitioner was the absolute limitation in options we have as providers. We only have a few things to offer, a few laboratory tests, an x-ray or two, a few medications that may or may not be effective. Most medications also go along with an enormous list of potential side effects that have to be taken into consideration. Many prescription medications are not necessary, and can lead to a variety of new problems. The risk vs benefit of any treatment needs to be considered.

We are making progress in many areas of medicine, but we are still far from able to treat many conditions effectively enough. MS is a wonderful example of this. MS, and many other autoimmune diseases such as type 1 diabetes and lupus, remain major medical mysteries. We have come a long way, but we haven't gone far enough. We have our handful of treatment options for RRMS, but the benefits are not that impressive from a statistical standpoint. Reduction of relapses at about 30-50% are about the most we can hope for, and this is better than the "zero options" that my grandmother had with MS in the 1950s.

When you visit your provider, keep in mind that they may not have an answer for every question you may have. Your provider is doing their best, I am sure....but the answer "I do not know" is an acceptable one sometimes. I always trust providers who admit that they do not have an answer, because this is honesty. If your provider says, "well, if you really want to take something you can try this..." this is code for- "you really do not need this."

Disease modifying medications can make a major difference in the life of an MS patient. I have chosen to take Tecfidera myself, and I am happy with it at this point. None of these medications are perfect, and many come with a host of side effects that range from unpleasant to deadly. The price of these and other new prescription medication is an outrage, in my opinion. I have serious issues with the way our pharmaceutical system works, and I would change it if I could. These are our options at this point in time however, and I am grateful that we have them. You should have a frank discussion with your provider before selecting a medication for yourself, and I would highly recommend being on one of these DMDs if recommended.

Trust your body to be able to handle most minor issues. Your body is an intricate, well constructed, dynamic machine that is much wiser than we are as health providers. Now and then, the body might need an extra hand at combating an infection, but not always. Listen to your body! Prevention is the key! Get your immunizations, get some exercise, eat healthy foods, and obviously avoid smoking and alcohol. MS aside, we all need the same basic advice on remaining healthy and living the best life possible.

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