Why you can’t help them all now

Back in 2008 when I was diagnosed with psoriasis I was depressed, angry, ashamed and many other emotions, but I was a man on a mission for remission (Note to self: consider using that as my catchphrase).

As I left the dermatologist consulting room I knew there must be an answer and thankfully for me, I found it.

I can still vividly remember the feeling of relief as the skin lesions slowly receded, the joy was overwhelming.

So now when I see clients with psoriasis in my Chiropractic practice I find it hard not to tell them the truth about the cause of psoriasis.

Ultimately you need to have a genetic tendency to get psoriasis – we are primed with an immune hair trigger.

Now you can’t change that, but what we can change is the environment around the genes (epigenetics) aka you can change your internal environment.

Unfortunately those of us with pro-inflammatory genes that ultimately give us an immune system with a hair trigger, we need a relatively small provocation to produce skin inflammation we call psoriasis – these are the drivers that pull the trigger.

It is well established within the scientific literature the role of bacterial and fungal infections in the development of psoriasis.

Case studies showing the development of psoriasis after severe throat infections and the subsequent remission of psoriasis upon removal of the tonsils have been published for many years.

Thanks to a team of clinicians and researchers in Tennessee I knew I had to go looking for the offending organisms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2607638/pdf/jnma00404-0073.pdf

Having angry red psoriatic plaques on my hand’s legs and feet was bad enough but thankfully it never attacked my joints.

Last week I provided chiropractic care to long-term patients, who slowly developed psoriasis over a period of years and this has evolved into psoriatic arthritis.

The pain in their hands and feet has been crippling for them and both of them are now on disease modifying drugs (methotrexate).

Are they better than they were? Definitely yes.

Are they in remission? No.

Both still suffer pain, stiffness, significant fatigue and low-level depression.

Plus they have the medication side effects.

For one of them, methotrexate has poisoned her system to such an extent that her white blood count is now dangerously low.

As a consequence, she is now being lined up for the so-called biologicals, which are cytokine blockers (usually TNF- alpha).

There is nothing right or wrong about the treatment being offered by medics and accepted these patients.

However, I personally feel that given the overwhelming scientific literature on the role of infections in the development of psoriasis/psoriatic arthritis, it is on unethical for a registered health care professional to offer a pharmaceutical monotherapy solely involving the suppression of the immune system and subsequent inflammatory system, without discussing with the patient all of their potential therapeutic options.

The central tenet of “evidence-based medicine” is that it should be a patient-centred experience.

In my opinion, simply delivering one form of therapy that you have been solely trained in and ignoring a substantial body of scientific research is a doctor centred experience, is not evidence-based and is thus unethical.

I also think the same way about chiropractors simply delivering the same form of care irrespective of what may be in patients best interests or the results they are achieving.

So it breaks my heart when I have mentioned on a few occasions my own history, even shared the photos and explained the process I went through, and yet they choose to continue the standard medical route and continue to suffer and deteriorate.

I can’t be sure I could help them, but it’s a low-risk treatment with diet change and supplements and high potential reward of complete remission.

But number 8 of our Core Commandments is:

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I have offered my opinion & experience, and they have chosen to take another path.

As much as it saddens me, I accept it.

To be truly patient centred is to be flexible, to bespoke your care and to give you patients the security to come back to you in the future and change their mind.

It is all too easy to badger a patient trying to help them and turn them off Chiropractic care altogether…..

I have definitely been guilty of that in the past.

For these two patients, I care for them on their terms, I give them comfort and they know my position.

As long as they are not coming in and complaining about something I have given them advice on and they have ignored, then we are clear.

ACTIONS TO TAKE:

– Deliver your message with a personal touch: bespoke the information and the delivery style.

– Honour the patient’s decisions and care for them the best you can.

And as always don’t waste those valuable adjustments,

Speak soon

Simon

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