Skip to main content

To Treat or Not to Treat...

I'm a big fan of memes, and I came across this one the other day via chronic illness cat:

Side effects may include...poignancy.
I'm going to guess that almost everyone who lives with a chronic medical illness has dealt with this problem at one point or another; the treatment feels worse than the symptoms.  I've certainly heard this from many of my clients over the years, and it leads to an internal struggle over the question "To treat or not to treat?"  This can be for a specific treatment option, or the use of pharmaceutical medications altogether versus a more "natural" route with diet, exercise, stress management, herbal supplements, or all of the above.

And then there's this conundrum:  maybe there's another medication you can take to help with treatment A's side effects?

Behold! The power of memes to get a point across.
Much of my research focuses on something called health related quality of life, and it is what it sounds like.  How much does your illness and its treatment affect your day-to-day activities?  Does your illness and/or treatment keep you from getting things done as you normally would?  Add to feelings of sadness or worry?  Limit your social interactions?  Are there potential serious side effects that keep you from taking a certain medication? It can feel pretty overwhelming to have to make these types of decisions. So what do you do?

[That drug has a black box] Warning, Will Robinson!
Unfortunately there is no easy, one-size-fits-all answer.  But there are a few things I can recommend.
  1. Evaluate your relationship with your physician.  Do you feel like a part of the treatment team or is he/she driving the ship?  We know that patients who are on board with their treatments are more likely to adhere to them, and this is related to open communication and a collaborative approach between you and your doctor.  If you don't feel good about your treatments, talk to your doctor.  If he/she isn't open to your concerns, consider getting another opinion.
  2. Weigh the pros and cons to each treatment option.  It's cliche, but it works.  Write them down and look over each column.  Then rate each pro and each con on a scale of 1 to 5 - 1 being very minor to 5 being very major.  Is one list longer than the other?  Does one contain more 5s than 1s?
  3. Purposefully Problem Solve.  If you're unhappy with your treatment, write down all the possible alternatives without judging any of your ideas.  Just brainstorm, putting everything on the table.  After you come up with your list, then evaluate each option in terms of how feasible it is and how acceptable you find it.  Remove items from the list that don't meet these criteria.  Once you've reduced your list, pick one and go with it.  Then, after some time, evaluate the results.  
This is a really tricky problem for people and what's best for one person may be very different from the next, even if they share the same medical diagnosis.  You can feel in control of your medical decisions and not captive to side effects or other worries that come from your treatments.  It may be a case of finding the lesser of the evils, so to speak.  If that's the case, and problem solving strategies are no longer needed, we shift to something we shrinks call "emotion focused coping" which basically means finding ways to weather the storm and acceptance of the situation.

More on that in a future blog post.

Best,
Dr. T


Popular posts from this blog

The Long Shot

I don't even know where to begin as my head is still spinning with the news I received today.  So I'm just going to put it out into the ether:

Entyvio (vedolizumab), which I started for my Crohn's disease about 6 months ago, did what no other approach has:  cleared my eosinophilic esophagitis. 

But wait, isn't Entyvio a drug for inflammatory bowel disease?  Yes.

Is Eosinophilic Esophagitis a type of inflammatory bowel disease?  Nope.

Are IBD and EoE related at all?  As far as we know today, no.  There are very few overlapping cases.

So WTF happened?

Without getting into the biomechanics of a drug that's way over my pay grade in medical understanding, my gastroenterologist had a theory that the way Entyvio works would block the cascade of eosinophils (a part of your immune system, a type of white blood cell) through it's magical way of selectively keeping my immune system from attacking my digestive tract.

She was fucking right.

Since being diagnosed with EoE in ear…

Bubbles

I've been thinking a lot about how we live in an era of infinite access to infinite information (thanks, internet tubes!) yet we still fall into many of the well-established psychological laws, if we can call them that, of human behavior.  Don't worry, this isn't going to be some drawn out post on social psychology. Wikipedia is great for that.

I want to talk about bubbles.  Information bubbles, that is. And how each one of us lives in one to some extent, no matter how educated or enlightened we see ourselves to be. And even if we know we live in said bubble, it takes being shown information that directly conflicts with how you think things are, or should be, and the result is you feel kinda ew - the technical term for "ew" being cognitive dissonance.

I live in a bubble.

In my bubble is the world of academic medicine, academic health psychology, and a circle of psychologists dedicated to people living with chronic digestive illness.  I live in Chicago, a major me…

Everyone Can Fall Down the Rabbit Hole

A few months ago my 3 year old son uttered the words, "I hate you, mommy."  It was after I yelled at him for doing something wrong, which I've long forgotten what exactly the source of our exchange was. But I certainly can remember those words. I can hear them in my head if my brain decides, at random moments, to replay them.

My intellectual, clinical psychologist brain can explain this for days. He's 3, he doesn't know what he's saying, he learned the word hate somewhere else, presumably at preschool, as I discourage its free use in our house. He's using it to express his anger not his true feelings toward me because once he self-regulates (psychobabble for calms the F down) he tells me he loves me.  Blah blah blah.

Regardless of all that knowledge and shit I have from too much education, those words destroy me emotionally.  Maybe they hit me harder because of my profession because my head goes to all the subsequent pathology he'll surely go on to de…