AUTOIMMUNE ARSENAL: Medication

This might sound a little contradictory because most of what I’ve been advocating on this blog is about natural methods of healing like natural supplements and products but believe me, there is a place for conventional medicine too. A holistic healing approach should not discount any kind of treatment, especially if it leads to progress.

Background Story

From the beginning, I’ve been very resistant to the use of any synthetic medication, choosing instead to rely on natural alternatives like fasting and changing my diet. I was convinced that the side effects I experienced were bad and only served to make things worse. This meant that I was hell-bent on not taking any medication at all unless absolutely necessary. A rather narrow-minded and somewhat biased approach now that I think about it.

The result was a roller coaster ride of improvements and regressions with regards to my symptoms. My symptoms would get better with drastic methods like fasting. However, a few days after breaking fast, the pains would return. This was not real progress.

Most recently, I gave myself 2 months from the previous rheumatologist appointment to test the efficacy of these self-experimentations on fasting as I found they were the most effective but a double-edged sword as fasting can be very stressful for the body. I did a 14-day fast followed by another 16-day fast a week later. Despite my efforts, the inflammatory markers in my blood like C-Reactive Protein and ESR were still very high (8-10x the normal human level) and showed no signs of climbing down. One could argue that I did not fast long enough and the type of fast I did was incorrect but we will save this for another post.

It was also during this period that I went through cycles of great pain. This came in the form of a strained psoas muscle that would get better after a few days then I would somehow “randomly” strain it again. This cycle repeated for almost 6 weeks. I guessed the high levels of inflammation, coupled with the low nutrition and stress from fasting were hindering my recovery. Eventually I had to take over the counter NSAIDs (Ibuprofen) because the pain was too much to bear and I could not sleep when it was acutely bad. I also took them whenever I had to leave the house for something important like my convocation.

This got me curious to find out about any damage I might be doing to myself by taking NSAIDs so often and eventually to my decision to resume conventional medication.

Chronic Pain and the Pain-Stress Cycle

Pain cycle
Source: http://www.cadabamshospitals.com/service-for-chronic-pain.html

My research led me to this wonderfully written article by Eileen Lard who describes how the pain cycle (illustrated above) can be an obstacle to healing. That article opened my mind and opinion to the good that conventional medicine can do.

By refusing to take medication, I was constantly in a state of pain and consequently, my body was chronically stressed. That does not benefit me in any way and probably exacerbated and hindered the healing process as I will explain further below.

The Physiology of Pain

When you experience acute (short-term) pain, your body recognises it as a form of stress. Ordinarily, in the face of physical or psychological stress, Cortisol levels in your body surge to mobilize blood glucose to provide the energy to cope with the stress-provoking stimuli or escape from danger. Hence, Cortisol is also known as the “fight-or-flight” hormone. Cortisol also aids in the inhibition of non-vital body systems and, together with adrenaline and noradrenaline, inhibits pain. [1]

However, in response to pain, cortisol secretion intensifies the pain experience in order to form a fear-based memory and condition a sensitized physiologic stress response. [2] “Prolonged or excessive cortisol secretion may result in cortisol dysfunction. Cortisol is a potent anti-inflammatory, and its failure to function results in an unmodulated inflammatory response to physical pathogens, unrecognized proteins, or psychological stressors. [3] Inflammation induces oxidative and nitrosative stress, free radical damage, cellular death, aging, and systemic tissue degeneration. Signs and symptoms of stress-induced cortisol dysfunction include bone and muscle breakdown, fatigue, depression, pain, memory impairments, sodium-potassium dysregulation, orthostatic hypotension, and impaired pupillary light reflex. In humans, stress-induced inflammation has been implicated in diseases such as osteoporosis, rheumatoid arthritis, myopathy, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, temporomandibular joint dysfunction, chronic low back pain, sciatica, and more. Furthermore, stress-induced widespread inflammation may be the final straw in a multifactorial chain of events contributing to hundreds of idiopathic inflammatory autoimmune diseases.” Read more here.

Returning to Conventional Medication

Thus, by avoiding pain-relieving medication, I my body was in a state of chronic pain and stress. This set up a perfect condition for cortisol dysfunction which inevitably hinders healing and may have exacerbated my symptoms and disease. Thinking back, this might have been one of the causes of my autoimmune disease too.

I discussed this with my rheumatologist on my latest consultation with him at the Singapore General Hospital and he heartily agreed. Furthermore, he emphasised that I am still very young. The uncontrolled inflammation, if left unchecked, would wreak havoc over many years and this would eventually cause degradation of the joints in my spine and hip bones, causing them to fuse together and limiting my mobility significantly. I was already beginning to feel some of these effects in my hip and lower back region which have become very tight and ache badly especially in the mornings and late evening when our body’s cortisol secretion is low.

I decided to take his advice and he started me on the starting dose of 2 tablets of Celecoxib. This is an NSAID but unlike other NSAIDs, is a selective COX-2 inhibitor. COX-2 is expressed in cells involved in inflammation. COX-1 is traditionally defined as a “housekeeping” enzyme and plays a role in the protection of the gastrointestinal mucosa, kidney hemodynamics, and platelet thrombogenesis. Thus by being 10-20 times more selective for COX-2 inhibition over COX-1, Celecoxib  reduce inflammation (and pain) while minimizing gastrointestinal adverse drug reactions (e.g. stomach ulcers) that are common with nonselective NSAIDs. [4] I would still take it after food to minimize these gastrointestinal side effects.

Best of Both Worlds

It has been 20 days since I started on Celecoxib. It gives me substantial pain-relief about 30 mins after taking it. However the effects don’t last forever and by late afternoon the pain will start to slowly creep back. I’m happy to say I no longer pull my hip muscle and the hip is recovering very slowly, but surely. Coupled with consisted stretching and mobilization every day, multiple times a day, I am regaining mobility in my hip and lower back region. The intense aches in my joints early morning and late in the evening has also slowly waned away with each passing day. I count all of this as progress.

Despite this, I haven’t given up on natural medicine / alternative medicine yet. I still believe the basis of health stems from many factors in our daily life which are in our control such as diet, lifestyle and mindset. I still follow a nutritious, anti-inflammatory diet, exercise and move regularly, avoid environmental toxins and unnecessary stress as best I can and get plenty of rest. Finally, I’m currently experimenting with alternative medicine like supplements one at a time to see if it aids in recovery.

If you are like me and not particularly fond of conventional medicine, I hope this post has opened your mind/view a little and that you have found it useful. Please feel free to comment and let me know your thoughts and opinions and better yet, your experiences on your own healing journey.

God bless.

References and further reading

  1. Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation

IMPORTANT DISCLAIMER: I’m no physician and what I write about is mostly from my own research and experience. Please do not take it as medical advice. Do consult with an appropriately-licensed physician before adopting any advice.

Never dis­re­gard pro­fes­sional med­ical advice or delay in seek­ing it because of some­thing you have read on this blog or in any linked materials. If you think you may have a med­ical emer­gency, call your doc­tor or an ambulance immediately.

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