Healthy respect or unhealthy fear

Published 2:50 pm Tuesday, April 14, 2009

My office nurse, Vicky Newton, RN, reached out to me in frustration this week.

She was arranging to give a patient a dose of Reclast, which is a medicine given once a year to help rebuild bone in patients with osteoporosis. It is a great addition to our weapons that we use to battle this very pervasive problem.

As so often is the case, the patient was balking, worrying about side effects, worrying about possible ill effects the medicine may cause.

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Osteoporosis is a very debilitating and even deadly disease. According to the National Osteoporosis Foundation, Osteoporosis was responsible for more than 2 million fractures in 2005. Of these fractures, 297,000 involved the hip. Of those who develop hip fractures, as many women in this community do each year, 10 to 20 percent die within the year. Only 20 percent or so of those who suffer a hip fracture ever resume an activity level comparable to that they pursued before the fracture.

Osteoporosis is real, it is silent in its early phases, and it results in devastating disability and, yes, even death.

I am passionate in pursuing osteoporosis prevention and treatment.

I’ve seen too many women who suffer chronic back pain, lose their self-confidence or end up in nursing homes as a result of ignoring the reality of this disease.

A few years ago, we recognized that a particular side effect can occur when certain medicines called bisphosponates are used to treat low bone density. The complication, osteonecrosis of the jaw (ONJ) is rare and is most commonly seen in patients who have cancers and are undergoing high dose intravenous bisphosponate therapy to corral the cancer.

We never use such high dosages in non-cancer patients. In fact, the medicines most commonly prescribed for osteoporosis, Fosamax, Actonel and Boniva, are very rarely ever associated with ONJ. Yet somehow the perception that these treatments cause jaw trouble is rampant.

These are not the medicines that were first associated with the side effect of ONJ. Notably, a study that came out in 2008 reported that of patients taking one of these oral medicines, approximately 1 in 1,700 developed ONJ. The occurrence with Reclast is also very uncommon.

Now I wouldn’t want to suggest that ONJ is not significant, but in all my years of practice, I’ve never seen a case.

On the other hand, I can’t count the numbers of my patients who I have watched literally suffering and dwindling from the ill effects of osteoporosis. As I prepare this article for the paper, I note that announced in my church today were the names of two women in the hospital due to fractured hips. There has never been an announcement of anyone with ONJ.

I’d like to address what I think is the bigger issue here, trust or the lack of it.

I don’t know if it is our litigation-dominated culture, the general skepticism that we have all developed watching the modern political realm, or the lack of professionalism of some of my colleagues, but doubt is a pervasive problem everywhere you go today.

It is strange the way it has developed.

When I recommend a medicine these days, many of my patients act as though I’ve conjured up a poison particularly for them. As I attempt to preserve bones, I have to run the gauntlet of fear and doubt. Even more so, when I prescribe medicine for lowering cholesterol, everyone has a story of someone they know who had a problem they suppose was related to cholesterol medication.

Pay attention here: Cardiovascular disease, not drug side effects, is the No. 1 killer of women, I plan to try and fight it with every tool I have available.

Even when women seek contraception and I suggest the birth control pill, many young women just don’t believe me when I tell them that it shouldn’t cause them to gain weight. I do know what will predictably cause weight gain, an unplanned pregnancy!

Additionally, I have grown perceptive with my patients. I can often tell when anxiety, overwrought emotions or depression are interfering with the relationships in their family. When I suggest consideration of medicine and/or counseling, patients are often suspicious and skeptical.

It is certainly true that every drug therapy we commonly recommend can have potential side effects, effects that we are trained to screen for. It is also true that many who refuse medication out of fear of the very low risk of a side effect are running a very high risk of disaster from the disease process they ignore.

I contrast this doubt and denial with the daily encounters I have in my office with patients who take multiple supplements.

I often ask them what it is in what they are taking. Usually they don’t know. I frequently hear, “(so-and-so) told me this was good for (this and that).”

It is bizarre for me to consider the number of things people are taking without a concern in the world for harm, when the most proven benefit of the supplement may be that you can use the plastic container for another purpose when it is empty.

Don’t get me wrong, not all supplements are worthless. Some are useful, but be careful and seek advice from your physician. You can waste a lot of money on supplements for no benefit. As a general rule, the more ingredients listed on the side, the less effectiveness you can expect. So-called “proprietary mixtures,” in my opinion, are primarily moneymakers, not health generators.

It is true that the FDA is a federal bureaucracy, that physicians don’t know it all, and that any drug powerful enough to help a problem is going to have some potential side effects that are real to the people they impact. Nothing in this world is perfect.

There is nothing wrong with questioning; I do it all the time. My questioning is done for the benefit of my patients. I want to know what is best, what is safest, what will improve function, and what will prolong an active and healthy life. I certainly don’t mind when patients ask questions about medicines or surgeries I suggest. In fact, I hope they ask questions. I want them to truly understand why I suggest what I do.

Your job is to try and understand your condition and the treatment options you have.

One of those options will always be to do nothing. I don’t really mind when people are informed and then decide to do nothing. What I do mind is when they make decisions based on rumor and irrational fear.

Instead of fear, we need to find trust again.

I have been practicing medicine for many years now. Like other physicians, I have pursued a life-long journey of learning. The medicine I practice is constantly changing as I try to provide the best updated care for my patients. I wish I had guarantee cards, but as I tell my patients, God just doesn’t give those out.

Form a relationship with your physician. Make sure he or she is someone you have a rapport with and then decide to trust. Faith in our father, love for our family and trust in those you ask to provide you assistance, will go a long way to make your life joyous and positive.

Don’t let rumor, sensationalist journalism from CNN, et. al., or something that once happened to somebody that was a friend of a friend, related to a cousin by a prior marriage, etc., etc., derail your way to a health future.

Pick your sources for their reliability and then trust!