Even so, it was time to tell her what I thought was wrong. “There’s no doubt that you have inflammatory arthritis,” I began, as I closed her chart, “but some viral infections can affect the joints severely. The good news is that they gradually wind down and resolve completely. But there’s also the high likelihood this represents early rheumatoid arthritis.” I paused.
Questions? Shock? Disbelief? Nothing: She was hard to read. “I want to draw further labs, and here’s a pamphlet to review on rheumatoid arthritis. It’s published by the Arthritis Foundation, and I’ll set aside time next visit to answer any questions you might have.
“In the meantime,” I pulled out my prescription pad, “for a few weeks, I want you to take a low dose of a medication called prednisone.” I handed her the prescription. “No matter what the trigger for your arthritis, it should quiet down the pain and swelling. But first, let me tell you about potential …”
Her eyes widened. There was a distrustful tone to her voice. “Prednisone? Isn’t that a steroid?”
“Yes …,” and without skipping a beat, I reviewed the potential side effects of prednisone, how it was safe to take in small amounts in breast-feeding mothers, but that taking high doses of the drug long term often leads to weight gain, elevated blood sugars, hypertension and even brittle bones. “At the dose I’m recommending, it’s the most effective medication we have to quiet down severe arthritis inflammation.”
She asked, “Do I have severe inflammation?”
“I’m afraid so.”
She exhaled. “And, my baby? I’m breastfeeding. You can’t, I mean, it’s going to poison him too, isn’t it?”
It was my time to exhale. After a successful pregnancy and the miracle of an uncomplicated delivery, a doctor she barely knows wants her to take a medication that goes against every maternal instinct, every fiber of her being, but “poison”? I flipped through the patient information sheet she’d filled out and ran my finger down her history. Vegetarian. Hmm, this is going to be challenging.
The Patient’s Perspective
I’m fully aware that bias has crept into my evaluation. I agree that eating a natural plant-based diet is undeniably healthier than the diet many of my patients consume—top heavy in red meat, loaded with fat and processed snacks—but some vegetarians operate in a rigid belief system in which disease, whether it’s cancer or heart disease, or in this case, inflammatory arthritis, can be treated by adhering to a strict vegetarian diet.
