¶ Discovering Rheumatoid Arthritis
Hi , my Spoonie sisters . I am your host , Gracefully , Jen , and I am so excited because I have the honor of talking to Dr . Saimun Singla . is is board-certified triple physician . I feel like I will butcher it if I even try to describe all the amazing work that she does . I'm just going to dive right in and let you take it from here .
But hi and welcome , how are you ?
Thank you , thank you so much for having me . I am doing very well , thank you . There's a lot in there , so I don't blame you for feeling like you're going to butcher something , but it's relatively straightforward .
So, I am board-certified pediatric rheumatologist and most recently I added on extra training in something called integrative medicine , which focuses a lot on lifestyle , incorporating lifestyle things into having a chronic illness . And so I am from Houston , Texas , and I have rheumatoid arthritis as well .
And a lot of people think that I went into pediatric rheumatology because maybe I like kids , I have arthritis , it makes sense . But it's actually not that route at all . So I would say my journey was a little bit of a backwards take .
I love children , I loved immunology , I love the physical exam , so I went into pediatric rheumatology and then , after becoming a full-fledged rheumatologist , is when I got my diagnosis of rheumatoid arthritis . So it was quite backwards , because most people have an illness , get inspired to do research in it or specialize in it and then they become that specialist .
But I was already a specialist before ever getting diagnosed with it . So it's a little bit of a unique take , I would say , on having an illness .
Absolutely , and you said that you were well . We talked about this a little bit beforehand before we started recording , but you actually started having signs and symptoms at an earlier age .
Right , right . So yes , I mean , we all know juvenile rheumatoid arthritis up until 16 , anything after 16 years of age is titled rheumatoid arthritis .
And rheumatoid , and that's the reason for that is because rheumatoid arthritis acts a little bit differently than juvenile idiopathic arthritis , certain subtypes and I started getting symptoms , probably like my first year out of training , where I would get some stiffness in my hands , a lot of fatigue and I think a lot of us just to read that to life like being a
woman . I had my second child at that time . I was trying to balance being a real doctor with a family , a career , so I just thought it's that . But then in the mornings when I couldn't wake up or had trouble bending my fingers and kind of grabbing my hairbrush , that's when I realized that there's something probably a little bit more happening .
And that's when I reached out to an adult rheumatology colleague who kind of squeezed me into her lunch break . I wasn't even . I was like a pseudo patient , you know , like like a drive by , like let's just go in , let's see . You know , we'll give you a yes or no .
And sure enough , she was like I'm concerned , based on your history , based on your exam , let's get some labs . And which led to the full fledged diagnosis of RA . Oh , I can't hear you for some reason .
Oh , that sounds amazing that you have someone in your office that you could reach out to .
Yes , because most people don't have that luxury . I mean , there were two things going on I had , I had the luxury of having an adult colleague and I was also in denial . So I was kind of like , oh , we'll get to it when we get to it , Sure cool , I'll come by and you can take a look at me .
And it turned into like what was probably going to be like it's okay , you're fine , I'll you know , if something happens , call me in six months . It turned into a very long visit of this is a real thing for you and what are we going to do moving forward .
And so it , by the time I got my diagnosis from when I was having symptoms to my actual diagnosis , it was probably six months or so , Six months of just sitting there and kind of thinking this will go away , this will go away , and finally it didn't go away . So I was a bad patient . I was a bad patient from day one .
I should have talked to my PCP and said , hey , I have pains . They would have started the work up . I probably would have gotten into a rheumatologist at that six month mark anyways . But that's essentially when I got the diagnosis .
You know , I think a lot of us start out as a bad patient because we don't want to admit that there's something wrong , right , and so I think there's the stigma out in the world that people that talk about their chronic illness and their chronic pain that we want attention .
And I want people to understand that that is so far from true , because a lot of times we spend even years pretending this is not happening .
Right , no , I agree , and I think , because we perceive it , I think , as a sign of weakness , right , like especially going through medicine or any professional career you don't make a peep when you have issues , you put your head down , you continue working , you just push through it , that grit kind of mindset that you're taught .
But I think it's important to realize what's the difference between me pushing through it and persevering versus . This is a red flag of something actually , that something might be wrong .
Right , and to me I didn't know that , I didn't know what the difference was , and unfortunately I found out later that this is what it was , and we all know that the longer you go untreated , the harder it is to kind of tame the arthritis down the line , and so I didn't know all that .
Now it's all hindsight , right , like I can put the dots together , but I didn't at the time .
So what does your care plan look like now that you're you're full in it ?
So now it's been like 10 years of having this and it's been a roller coaster , I would say . I think my mindset going in was that I have the diagnosis , I'm going to take these medications and boom , like we're in remission .
But in reality it took me eight different medicines biologics to get to the where I am , and to say that like failure is not really a comfortable feeling for me is an understatement . Right , like for anybody , you don't feel good when you try something and then you fail .
You try something , then you fail times eight and it's been a learning curve and I think I've had to give myself grace and patience through the process and that it's not really anything wrong with me . It's just , unfortunately , this is the way it is , but I shouldn't give up .
Absolutely . It just happens to be . This is how your body works , and there's several of us that are in positions like that and and all we can do is go from here and do the best that we can . Right Remission is possible , but it doesn't necessarily mean it's possible for everyone . Yeah , and we're okay too .
You know , we can still live a seemingly normal life .
That's the thing I think the bigger picture is . I mean , you cannot have arthritis and make a life that's not fulfilled either , like let's look at the opposite end . So , yes , this is kind of annoying no one likes to have a road bump but at the same time it's not limiting me in pursuing what I want to do .
I'm still the pediatric rheumatologist I want I set out to be . In fact , this journey has changed the way I think I handle the illness and teach patients these ups and downs that will happen Like , but they don't represent the entire lifespan of of your diagnosis .
Absolutely . So . I have a question for you , and since you're on kind of both sides , you know , I think there's questions that sometimes we don't think to ask . You know once , once you're a rheumatologist comes back and says , okay , this medications not working for you , right ? What does that look like ?
How do you decide that a medication is just not the right fit ? It's time to move on ?
Right . So I never I always give a medicine a full try , because it's very hard to ditch a medicine and go on to the next class or cousin of the medication that you're on . So I always look for this is kind of I spell it out for my patients and I say this is what I'm looking for . We're looking for remission . What does that mean ?
That means when my hands touch your joints I'm not feeling active arthritis . Your range of motion is good . That might mean that we hit partial remission Right . So that might . It might not be to the point that I like it , but I might use the word partial remission . That's still not good enough for me .
So either I add on a different medication or at that point we say , okay , we've maximized the dose , We've maximized the frequency . This is the longest time I've allowed your body to be on this . Now it's time to move on to something else . So we just we kind of have to play by ear . That's the annoying part about this .
And you know a lot of times many of us are on , you know , a collection of medications . Do you want to explain what that looks like and and why we do that right ?
So you , you know , according to the American College of Rheumatology , which is like our , our guiding Group , that kind of tells us what medication to start and whatnot , depending on the type of arthritis you have .
You start with one medication Typically that's like your methotrexate and proxen steroid , something like that and then , if that doesn't work , then we go up the pyramid , and and by up the pyramid I mean we start adding biologics . Now some Rheumatologists are trained differently . Depending on where your arthritis is and how aggressive is Aggressive it is .
You go straight to a biologic , you go right up the pyramid and If that one biologic doesn't work , then we add on methotrexate . Typically you don't layer two biologics together because it can suppress your immune system way more than we'd like it to . But methotrexate plus biologic is okay .
So for some of my more aggressive ones , yes , you're on two injections a week , or two , you know two injections here and there , but it's just . I always say we have to be as aggressive as your immune system . There's no , it's not an even playing field , unfortunately .
There's not much we can do about that , but it is what we have to do to put you into remission .
Yes , and what works for you might not work for me , and what works for me might not work for you , and that's okay right .
That's interesting that you say that , because a lot of people I do integrative medicine , so a lot of people think that mean that means that I'm not gonna go to biologics , you know , and try all the herbs and supplements out there and diet , and it's not a black and white thing . What I say is it's not a black and white thing .
So what works for you works for you , congratulations . But the immune system is built , our genes are built in a certain way . Where that might not work for me , you know , like maybe blue hair won't look good on me , so sorry , that's my One of my three little's in the back . Okay , yeah , but realize .
But and it's not so black and white we live kind of rheumatologist in general , live in the gray area . It's whether it's your diagnosis , whether it's the medicine we're treating . We kind of play it based on what your response is , and so we got to find what that risk , what that combo of meds is .
Maybe it's one , maybe it's two , maybe it's lifestyle plus these medications , that you just need it all .
Yeah , yeah , absolutely Okay . So I'm trying to figure out here , because there's so much I can ask you . It's so fascinating . So what sparked your interest to go into this field ?
Well , in pediatric rheumatology it was the pure love for kids having that longitudinal connection with families when you're dealing with a chronic illness , seeing them from beginning , you know , to transition to adulthood obviously I can't take care of him forever and kind of seeing that whole process I really enjoyed .
And rheumatology is just fascinating to me because it's one of the few fields where Labs and imaging are there but your hands and your ears are what gives , gives you more and more clues , because we need to be really good At the physical exam , we need to listen to the story to kind of figure out what's worrisome , what's not .
You know , labs and imaging are always there to support , to support what we're thinking . So that led me and I'm very detail oriented , like to just in general have always
¶ Integrative Medicine and Managing Chronic Illness
been . So . Immunology , like the joint count and all that kind of stuff I was fascinated by it makes for very long visits , but it's okay , I'd rather know everything about my patients than kind of guess .
So that was , that was the pediatric rheumatology kind of route , traditional route , and then , after my own diagnosis and after failing , medicine after medicine after medicine , I felt like maybe there was a little bit more to my overall wellness other than just the silo of rheumatology , right like I'm a person at the end of the day .
I have Kids I you can hear them in the background I I like to go out and eat with friends . I'm a social person , you know . I in that might mean that I stay up later than normal and but I never understood how those Interplayed with my overall illness and integrative medicine kind of allowed me to have that lens of Maybe .
If you don't sleep eight hours a night , you know for most nights You're gonna flare like . This is not good for your overall health and that is something that you can control . Right , that's not somebody else giving me the locus of control . I decide when I go to bed . So just changing my mindset around .
This is kind of what works for me , this is what doesn't . It was game changer for me . Game changer .
So it looks like you're in a pretty good place . Do you consider yourself in remission ?
I am , I would say I've finally gotten into remission . After my third pregnancy I flared again and then I got the culvert booster , which caused me to flare again , I think , like many of us . So it's been a rough road since 2020 , but I think I'm finally kind of settling down again .
And that's been hard for me to kind of swallow because I came from a point where , yay , I'm in remission and this is getting boring , right , like , I take my medicines , do my labs , it's all good .
But then , after the flares , I kind of felt very Defeated almost , and I had to Retrain my brain and to think , like this is part of the process , we're gonna get back to remission .
I need to do my part in adding to that right , so that meant getting to bed on time , eating better , leaving parties at a certain time , right , so I can get home , and that was just kind of a real talk with myself . And now I'm finally at a place where I can predict when I'm gonna flare .
I know exactly what I need to be doing , or even like , even through different social media outlets or support groups , it's what are some other things we can do besides just take medicines for the aches and pains , because that's , I think , part of the long haul right .
So , like epsom salt baths or paraffin dips or yoga , those are all things that no one taught me , other than people who had it or myself , and I think that sometimes people think if we , if we bring up the word yoga , if we bring up anything like that , they're like oh , you're saying that's a cure and people are offended .
But I think what we need to do is look at the bigger picture and it's so important . Right movement , in that our bodies can handle right , is important to get that stretching in . If we just sit around all day , we're going to hurt that much more .
Yeah , no , it's true , being inactive isn't great . You know , I these aren't things that .
That's probably why I pursued integrative medicine , because these aren't things that were taught To view in like it's either this or this type of route is where we live currently , and it's mind-blowing to think that you can have the best of all the worlds of therapy out there , I I like the idea of acupuncture for patients that need it .
There's good data for patients with osteoarthritis or just low back pain or muscular musculoskeletal pain in general . Like , if it's going to help your symptoms , why wouldn't you try it and notice ? I said help , not treat everything Right , and so I think wrapping your head around this works and being open-minded about it is what matters .
Definitely , what would you consider to be the top five things in your spoonie tool kit to help you ?
I think for me it's getting rest . So that might mean like the , especially the days of my methotrexate or day after I time it to where it's on a weekend , so I have the grace to nap right like my husband watches the kids , even if it's like 30 minutes , so I'll nap and listen to my body . That's number one Part of that .
I try to get massages when I can . Obviously it's financially and like time-wise it's . It's a big commitment , but if I could do it like once a month , I I try to get that in because it helps me also just from a relaxation standpoint , so that really helps me . Yoga is a big one for me , just like you said , to keep that range of motion going .
That stretching Also hits the mindfulness component of just kind of being still because I'll go into yoga , like I need to do this , I need to do that , and then I come out and it's like so that was . That'd be number three .
I think Number four of having the mental discipline of knowing when to say yes to things and when to say no to things , especially like having my own practice . Now you just want to be a yes woman and say yes , yes , yes , yes , yes to everything . But that's just , it's not the reality .
And I , I did that initially and I realized what a Detriment that was , to my help , because mentally and physically , you know , trying to fit in a bunch of things , I couldn't do that , so I had to put some boundaries in place . That was number four , number five , I think . We did the physical stuff , the mental stuff .
But I think the social support is also critical , like being around people who don't understand why you don't want to be out till Midnight , probably not . Or like they judge you or they're like oh , come on , you're too young not to be out till midnight , you know , like I don't , you don't need that energy , I don't .
I also shouldn't feel like I need to explain myself to you . I 100% .
Do you feel like that's affected your relationships and friendships ?
Sometimes I think people that don't understand the illness I would say they don't get why I can't just push through , just like we've done everything else in medical school and whatnot . It's like , well , why can't you just push through ? You didn't residency . You had 36 hours of no sleep and you were fine . Actually , I wasn't .
I don't think any of any human is okay after not sleeping . It's not normal . It's not normal . We normalize these things and they're really not , and so for me it's a lack of understanding . I don't think they mean it personally . I think it's more of a lack of understanding on their end , and so I just move right along from that .
I think that's a really good point . I think sometimes we let that get into our minds and it's not worth it . We need to let it go , and if they're not going to understand , they're not going to understand .
And like why fight the battle ? Because it's going to keep coming up in different ways .
Absolutely , and stress isn't going to help how you're feeling either .
No stress is a huge . I think most people don't realize when .
Stress is good to a certain point because it pushes us to do things like finish tasks and get stuff done and be a certain way , but at the same time , when you live with it chronically and the worries it's not healthy for our immune system , it kind of pushes you over into this inflammatory state that people with arthritis it's the last thing they need in their
life is more information .
Yeah , and I think it goes back to where you said boundaries . Boundaries are such a huge part of our lives and we have to have them . It's important .
I mean I come from a culture where really you're not taught boundaries or you're not taught to talk about it . My parents came as immigrants and they did whatever they needed to to succeed , and their vision of success looks very different of mine .
I'm very content with a tea and a blanket on my couch on a Saturday night , and that's okay for me , like I have no problem , just kind of slowing life down because I realized that where I need to put energy in is with the people that understand me and care about me , and so that's where my efforts are .
Well , and to my understanding , with your culture , isn't there a big excitement about parties too ? Yeah , and there are probably a lot of people .
Yes , I mean , have you ever been to an Indian wedding ? It's like a week long .
I could always wear a shirt . I could go to one . That sounds amazing .
Not when you have arthritis . I got married pre-diagnosis but it was like a seven day affair and you're just like constant . It's a huge deal . It's not just to me and my husband affair , it's like a family affair , right . So everyone's hanging out . It's fun , I get it , I totally get it .
But at the same time , like when I'm looking at my kids and like if they want to do that , I'm all for it . If they don't want to do that , I'm all for that too , because you determine what your values are . That's , I think , where things got lost in translation coming over from India to here .
Yeah , yeah . Not everybody can handle a week long party with thousands of people . No , no , maybe in another life I would really love to try it out , but I would probably go to bed pretty early every night , oh yeah .
Yes , it took me probably two weeks to recover from that whole thing . Oh , wow .
Okay , so why don't you tell us a little bit about room to grow ?
Sure , sure
¶ Integrative Medicine Approach to Arthritis
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So I , after my diagnosis , like I said , I pursued integrative medicine fellowship and just last year I decided to kind of be brave and I thought , you know , day to day , I was living my life as an arthritis patient , but I was also living a very parallel life to my own patients and I realized that we were both wanting the same thing , which is someone to
not just listen to our joint problems and our fatigue problems , but also our whole life . Like how is this going to fit into our whole life ? Because I wasn't going to do the other way around , I wasn't going to dance around the arthritis , right ? So I decided I need to create a practice where I give that space for families .
So they come to me yes , of course we're treating the arthritis . However , we need to right , we're doing labs , imaging all that . But then I also do the practical stuff . Like , okay , what are you going to do when you have a flare ? You're traveling abroad , or you're traveling for a Christmas break , for a week , what are you taking in your bag ?
Like , so the real , real life stuff I address . We do a lot of mindset work as well . So what are you going to do when you flare and you're because you're stressed . How are you handling your stress ? Are we brushing it underneath the rug or are we doing something daily ? So I address like the mind-body component .
We also talk a little bit about the diet In kids . I most definitely don't like to restrict or push any sort of specific diet . We just talk about kind of what the anti-inflammatory foods are and how we expose children to that kind of daily . And then also the sleep component . How do we optimize sleep habits with the era of iPhones and screen time ?
That's been very difficult . And then in aromatherapy I incorporate as well Kids love that right before bed . I do that with my own kids . Supplements , you know I do .
I don't do it to treat the overall condition , it's more the things that I think are missing from your life , and for most people that's vitamin D , especially if you've been on steroids for a while . I'll check a level to see where you are . There's some newer data coming out about probiotics as well and the gut microbiome . So it's .
I always think about risk benefit analysis , like what's the benefit of taking it versus the risk ? So as long as the benefit is higher , I'm all game for it , say .
The third one I think about is fish oil as well , because , again , it's not that it's going to fix all your inflammation right away , but for the long haul it helps lower decrease of things like heart disease , stroke , hypertension , all those kind of things .
So I definitely like to keep the regimen as simple as possible but for certain people , based on kind of their lifestyle I do talk about the various supplements for them , and some people are open to acupuncture for pain or yoga or things like stretches . I make sure that we have .
We work with a good PT who understands arthritis as well and what type of exercises you could be doing for that .
I think that's really important . I think a good physical therapist that understands it is crucial because , you know , I had surgery back in April and I saw two different ones and I hated one of them .
I absolutely hated her , and part of it was she wouldn't touch me and part of me was like you need to touch my shoulder , you need to feel where the problems are . And the other one , that's what I was used to her doing , but she was fully booked out after my surgery for two months .
So I had to go see this other one and as soon as I could , I went back to my original . And you know , I think it's important to find a good fit for you that understands what's going on with you .
Right , no , and I'm , you know . One of the other things I've really pushed for now is I'm on the board of the arthritis foundation here and I think for kids having that sense of community that you're not the lone wolf kind of going through this , there's other kids just like you .
So we try to do kind of quarterly events to get all of them together to do something fun , like not sit around and talk about their joint pains , but they'll go cook , they'll do bowling , they'll do you know , something fun .
So they realize that we're all normal and the parents go talk , and so I'll mingle amongst both groups and kind of get the low down on . You know what they're talking about , yeah .
Okay , so I wrote a couple notes down based on what you were talking about a second ago . Okay , so , as far as AIP goes , are there certain foods you would recommend to stay away from because they can cause more inflammation ?
Yeah , the two . And then these are no brain errors . It's going to be your processed food and sugary foods . Those are your two biggest culprits for any disease across the board , Inflammation is going to be there .
So anything frozen that you can pull out of the freezer and you cook for dinner , you know , other than a frozen vegetable or fruit , probably a little modified , the sugar component ? For sure , like we're , they're hyper palatable foods for a reason for us to kind of crave it and keep going back to it and creating habit loops right .
So those are the two big ones . Sometimes people will ask me about gluten tomatoes , nightshades and whatnot . If you , gluten is its own little world . So , though , if you have filiac disease , yeah , you should absolutely be staying away from gluten . Now I have a big chunk of patients , I would say , who , whenever they eat gluten , they don't feel great .
Whether it's manifested as headaches , belly pains , joint pains , I'll say , okay , let's limit it , let's because I or find gluten free options .
And then what I closely monitor is the weight and height for kids , to make sure that , even though they're restricting that , but they're still growing , Because I don't , I want them , I want there to be a balance between them growing and not feeling horrible with what they're eating , so that that I kind of talk about .
And then the other part is with the nightshades . The data really comes to us from osteoarthritis patients . So whenever you see a title that says this is treats your arthritis , you know , be very careful . There are different types of arthritis .
You need to make sure they're referring to inflammatory , immune mediated rheumatoid arthritis , Because osteoarthritis is a very different beast . That , yes , we might all be destined for osteoarthritis at some point , but that that is a different mechanism , right ?
So wear and tear , and there was some data saying that people with that eat tomatoes , or the lycopene component of tomatoes causes them to have pain . And so if your outcome is pain , I don't want it to be causative , like tomatoes equals pain you have . There's a big path in between , and so it's always trial and error , trial and error .
I won't say don't eat this . And then some people also ask me about lectins . It's like the new thing with with certain types of vegetables that they have this outer layer that can irritate the gut lining . It's a little . Does that food cause you to have joint pains or belly pains or worse than anything ? Right ?
If the answer is no , then we continue , and if it is , then we try to modify it . I was like , okay , let's pressure cook your beans , or you know things like that , and see how it works . It's very much trial and error . There's not a black and white yes or no . This is going to lead to this .
Yeah , yeah . And you know , I think for me personally , if , if I eat a nightshade and shortly thereafter my stomach's upset , well , maybe that means that my stomach really just doesn't tolerate it that well Right .
Right . And then you've learned , and there are tons of other vegetables for you to try , outside of the nightshades too , right , it's just . All that matters is that you're getting in the ones that your body likes .
Yeah , yeah , and I'm not . I'm not going to lie either . I still eat some of those things because tomato , I love tomatoes on pizza , it's so good , it's so good , right . But my stomach does not like tomatoes , and so I try to , I try to limit .
You have to listen to that part too , right ? Just like sleep for me . If I don't get enough sleep , I don't feel too great . So I have to listen to that , because I know what the flip side holds , Exactly , Exactly .
So you know if you know a tomato , or even milk or whatever it is , is going to upset your stomach , but you still want to enjoy it . Really try to limit it . That's what I would say .
Right , or is there a way that you can have it in a modified setting that you can still say you can enjoy it ?
Oh , yeah , yeah , Because you know , I think if they're stewed or baked during a spaghetti sauce , it doesn't bother me . For some reason , if I pick a tomato , wash it and cut it up within a couple hours , my stomach's just not happy , and that's it is what it is . So I have to think outside the box , right ?
Right , and you wouldn't have never known , probably , to pay such close attention until you're dealing with your own health issues .
Yeah , yeah and I , you know , I and I think for anyone that has stomach problems , you start to really pay attention to those foods every single time . And I mean it's a little outside of the arthritis issue , but you know , sometimes those of us with the arthritis problems have stomach problems too .
So you want to really pay attention to every little aspect Exactly , exactly , until you start talking to other people and asking questions you won't know . To look for that .
Yeah Well , and then medications sometimes affect our stomachs too .
Yeah , yeah , absolutely , absolutely . You kind of have to time things accordingly . You know , take this at night , don't take this on a Monday morning .
Yes , yes , if I have a big day tomorrow , it's probably not a good idea to take my my mesotrexate tonight if I know it's gonna upset me .
Right , right , exactly , you learn .
Oh , wow , okay , so aromatherapy , what would you say is your favorite ?
My favorite . Everyone is so different . Some people just hate aromatherapy , by the way , it's too like overly stimulating for them . But for me I like , I'm very basic , I like the Bath and Body Works like Eucalyptus , peppermint one , right before bed especially .
Just , I think what we're trying to do is use all , engage all our senses , so sight , sound , smell , especially right before bed , to cue in the brain to let them know like , all right , this is the time to go to bed . We're going to let go of all our thoughts and just let our brain rest , because rest is very critical for us .
And so I like , I like the peppermint eucalyptus on my pillow , I just spray it . Some people like diffusers that's fine too , or candles , or incense , whatever floats your boat .
Yeah , and you know , my husband also loves all the minty things . He even has peppermint oil that he puts in his bathwater . Yeah , and my daughter , she's a huge fan of lavender . Oh , and then I am a huge fan of combining peppermint and orange . Yeah , yeah , you can do that . It feels like just such a cheerful combination .
I love it . Yes , and actually aromatherapy also helps for nausea . On methotrexate days too , Like right before , I'll take like the citrusy ones too , like the orange .
It helps taking a deep breath , doing the injection and then exhaling , and so whenever I do get a little bit nauseous I'll do deep breathing with a little bit of the orange essential oil in front of me .
That's a wonderful tip . Yeah , I'm going to try that .
Yeah , try it . It's better than having to take Zofran every seven days . You know I don't want to do that forever either , so I try to do what I can before getting to the anti-nausea medicines .
I do a lot of ginger . I always carry bags of ginger juice because they're phenomenal and I love the flavored ones Right .
Ginger is great too . I mean they use it for like nausea and pregnancy . Ginger is great data , to the lozenges especially .
It helps . Yeah , and well , I just love the taste in general , but I carry them whenever we travel . I have them on hand for the day after Methotrexate . I love them and I know not all people love the taste of it , but I love it .
Yeah , you got to find what works for you . There's a lot of options out there Definitely Okay .
So my next question is collagen Is collagen at all helpful ?
You know , if you look at the data for collagen , I mean collagen is everywhere in our skin , in our hair , in our nails , in our . It's a major protein but it's such a large molecule that if you're eating collagen I don't really know that all of it's being absorbed . You're essentially giving your body the ingredients to make collagen .
So I don't know if taking collagen and then breaking it down in the stomach is going to add anything to it . Because collagen is helpful for , like , if you have osteoarthritis a lot of times because it's the building block of thing between the bones . The collagen it's like the little pillows between the bones , and so in that case I would say collagen may
¶ Managing Arthritis Symptoms and Complementary Therapies
be helpful . But if you're taking it orally for rheumatoid arthritis , I don't know that it's going to offer much symptom relief . Hey , if you take it and it works for you , great Congratulations to you . But there's no reason in my head that I would prescribe it to everybody .
Yeah , absolutely . I know that for me specifically . I take it because of my psoriasis . I feel like it helps my skin , but I wouldn't know if it actually helps with my joint .
Right , right , and so that's a plus or minus in my head . Again , you always look at the risk benefit analysis . If somebody really wants to try it , I'm not going to stop them , as long as I know it doesn't increase their bleeding risk . Liver enzymes , you know things like that .
What would be your top recommendations for supplements ?
I think the vitamin optimizing vitamin D is very important . The fish oil is important again for the long haul probiotics . If you can handle it , those would be kind of my top three that I take those myself as well .
And fish oil also helps because I have dry eyes with the arthritis and recently I went to the ophthalmologist just last week and he's supposed to be like a top dry eye person .
I waited like seven months to get into that appointment and the top two things he said were fish oil , GLA , which is gamma-linoleic acid Start with that and see how I do and then supportive eye drops as well .
I was like I can't believe these words are coming out of his mouth , but I'll take it , you know , to do these type of oils and I had already started fish oil prior to seeing him and I will say I noticed a little bit of an improvement in the dry eyes from taking those .
Did he give you a timeframe for how long it will take you ?
Yeah , he said about two months . Okay , two months to fully , like consistently , be taking it , and you're looking at higher doses . You mean 1000 milligrams of EPA plus DHA combined . Some people go even higher to like two to four grams , but you want to be really careful going over .
I would say around three and a half to four grams because there's newer data linking it to , like , cardiac arrhythmias . So you don't you don't want to be in that boat . We just need the right amount .
Absolutely Okay . Well , I'm going to check back with you in two months because I want to know how you're going ? Yeah , absolutely Okay . I have all kinds of notes based off of your website . I know , and some of them you've already covered , but I want to make sure I don't forget anything important . Sure , Okay . Okay , this is based off of one of your posts .
What is the difference between joint pain versus joint stiffness ?
Right . So that's an important one , because we get a lot of consoles for , oh , my child or I have joint pain . The first thing I will try to differentiate between is joint stiffness versus pain , and what I mean by that is when you are stiff in the joints , they feel stuck . Stiffness is just hardening right and it's .
They feel stuck and you're going to feel that worse in the morning . Or if you're sitting in a long car ride . And the reason that happens specifically in arthritis that's more indicative to me of something inflammatory like rheumatoid arthritis or psoriatic arthritis it's because overnight , when your joints move , they kind of crystallize .
They sit there , I think of it like Jell-O , so you feel stuck and you can't move very well in the morning , but then as the day goes along , you move a little bit , you wiggle and jiggle , you feel better . First is somebody who's in pain . I need to know is it a sharp pain ? Is it a dull pain ? Is it only in the morning ? What makes it better ?
What makes it worse ? If you're telling me your pain is worse at the end of the day , it kind of makes me think opposite of arthritis . It makes me think is this more mechanical ? Is there something going on in your how you're aligned . Do you have hypermobility ?
Because that's one of the more common things I see , and so we'll try to differentiate between arthralgia versus arthritis , which is the joint stiffness .
Oh , wow , okay , that's a lot to unpack , it is so you ever see people that have both yes absolutely , and that's where kind of the water is a little bit muddy .
You need to do your best as a historian to kind of help the doctor differentiate between the two . And so I'm going to ask you guys how are you feeling in the morning ? What makes your pains worse ? Because if you're having the stiffness plus , you're still having pain during certain activities , I'm still going to work you up for arthritis .
Right , it's the stiffness that clues me into something inflammatory going on If you're pain . So then we do a pain diary and we really try to figure it out . We might do be doing the blood work up in the background or imaging in the background , but in the meantime I'm going to be asking you to keep a diary of your pain .
Triggers , alleviators , aggravators how often are you taking Tylenol or an aproxen or Ibuprofen , things like that ? But yes , most definitely you can see both , I will say , for certain types of arthritis , like erosive arthritis can be very painful . Soriatic arthritis can be very , very painful as well .
So for me the pain is going to be there , Sometimes even no matter how much I've put the arthritis into remission . It's just the pain can be a lingering thing . So then we try to look for supportive ways to help with the pain .
Okay , all right , I think that's super important . So what would you do with somebody with hypermobility ? That's ?
a good question . So hypermobility is a tough one because that means your joints are just double-jointed , they're limber . Physical therapy to kind of recondition the brain , to teach yourself like whoop , I've gone past my endpoint , I need to go back .
I need to bring it back because your body has lived in this position where it thinks it's okay to go past the range of motion and we need to bring it back .
So physical therapists or occupational therapists have creative ways to do that , whether it's through splinting , bracing , taping , strengthening the core as well , so you're really engaging the core and not overworking or over-extending your joints . It's a trial and error process again , trying to learn what works for you and what doesn't .
Well , I'm assuming that people like that probably have to be extremely careful with things like yoga .
Absolutely yes . So there's certain moves that you should be careful about , or when your body starts to ache in a certain way , it should probably clue you into okay , what I just did , it wasn't right , like it doesn't sit right with me , just like food . It's like I probably shouldn't do that again or eat that again . So it's the same .
It's about learning what moves work for you and what doesn't , and what's critical . Critical is core , always core .
I'm reading my last question and I think you already covered it . I can ask you anyway and you can tell me how do complementary therapies help treat arthritis ?
Yeah , so that's an important thing to note . It's not necessarily treat , treat but manage . So when I say treats or arthritis , it's probably the symptoms of that you're helping treat . The arthritis or the inflammation itself is going to be different based on each person .
Some people are blessed to be able to just control their arthritis with diet or certain supplements right , but not everybody is like that . We're all on a spectrum . So the complementary stuff if it didn't work to treat your arthritis or control your arthritis or manage your symptoms , then that's going to have to be accessory to the medications .
So , yes , the crux of your therapy is unfortunately going to be these medications that we all have to take , right to manage it . Then the complementary stuff is going to be to control the stuff that the medicine is not going to help with .
So that's going to be things like aches and pains that you get after yoga or swimming to help loosen up your joints a little bit , or what else is there Yoga , acupuncture , mindfulness techniques especially working through pain flares and whatnot .
Or if you're about to go into a stressful period of your life , you better know that you probably need to journal every morning or every night , just kind of knowing when to kick those into high gear and when you can just kind of coast on medications or maybe no medications , Okay , I think you have answered everything so wonderfully .
Oh , thank you . Is there anything that we have not covered that you think we need to talk about ?
No , I think you know , like me , going into this as a doctor like the brain of a doctor in the body of a patient is kind of a . It's good and bad , because I know what I'm looking for when it comes to doctors , as I know exactly what they're going to ask me . Great , okay , I'm the best patient in that realm .
But at the same time , I'm also not the best patient , because I think my expectations for myself are different . Just knowing what the doctor is looking for , right . So , if ever , if I hear the word partial remission , I think automatically oh , I'm such a failure . I've tried everything and it's still not working right .
I think it's important to give yourself grace , because it's not that you're not doing what you're supposed to be doing . It's not right for you , the combination is not the right one for you . So we're going to keep working until we move in that direction . And what are we going to do in the meantime to help you kind of cope ?
It's all about the coping in between . So it's tough , it's one , it's not a sprint , it's definitely a marathon what we're dealing with here .
¶ Navigating the Challenges of Chronic Illness
I think also in the beginning I had some wishful thinking that this was a one and done deal .
Don't we all ?
Totally not the case . It's not nobody's textbook . Just , even if you are for now , you might not be later . That's just to tone down the expectations .
Absolutely . We need to just bring it back down a little notch , and that's OK , because there's so many amazing people , there's people like you and all these other in our community that can help support you and lift you up and help walk you through this .
Right , we're all in this together and it's really as awful as it is to have to go through it , right ? My experience is your like . I want you to share my experience . So whatever worked for me , yeah , I'll tell you like , if it works for you , great . If it doesn't , we'll move on to the next thing . But if it worked at work , I hope it works for you .
Keep our fingers crossed , oh yeah .
Oh , yeah , I have people come to me all the time and they're like OK , someone told me to talk to you . I found out you have psoriasis . I'm in so much pain . What are you doing ? How is it working ? How is it helping you ? And I'm like OK , I will tell you every product I try .
Right , I will tell you the medication I'm on , but I can't guarantee it's going to work for you . Right , we're all different . And some people have come back and they're like , oh wow , the lotions you use and all these different things are wonderful . Yeah , some come back and they're like I tried it , it worked for a while . It's back again with a vengeance .
Yeah , yeah , that is the reality and that is something you have to be OK with or know , going into this whole process , that this could be a 50-50 shot here . But why ?
not try it , and we may try 10 things out there that we just wasted our money on and they didn't help us . We might try three , and all three work perfectly , yeah .
Yeah , and in that process , I think the most beautiful thing out of that whole process is the grit and perseverance and acceptance that you start to build , because that is the most powerful thing that's going to carry you day in and day out moving forward , because you're like it's OK , I know this , we're going to get right back up and keep moving forward .
We're not going backwards . It's a book that we don't read backwards , we keep going forwards .
Absolutely OK . I'm going to ask you one last thing what would be your best piece of advice for anyone out there struggling ?
Depends on how you're struggling , right ? So if it's more of a physical pain , I would say , if your doctor is not giving you great input on how to help that pain , maybe reach out to people who have a similar diagnosis as you and see what's worked , just like you said how other people reach out to you .
If it's the mental part I think of just dealing with the chronic illness I think it's important to realize that there's tons of help out there .
First of all , at any price point in network , out of network , whatever it may be , I recommend that you go see if talking to somebody would help , because sometimes releasing that through words or writing or art or whatever it may be , is what you need right , and grappling with the fact that there are things you can control about this and there are things you
cannot control about this . And so once you settle in with that feeling and really understand that , I think for a lot of my patients that's worked wonderfully .
¶ Thankful Farewell and Future Possibilities
Well , thank you , you have been such a joy to have come here . Oh , my goodness , I feel like I could geek out and ask you a million times . I could always come back . Not a problem , Absolutely . I will make a list of everything we did not for All right ? Well , thank you so much and listeners until next time . Don't forget your spoon .