Episode Dr Wada
Blog, Podcast

How to Balance Western Medicine and Alternative Medicine Approaches: Dr. Kara Wada, Allergist & Immunologist and Sjogren’s Patient

February 26, 2021
49 min read
FacebookXRedditPinterestEmail

On Episode 26 of the Arthritis Life Podcast, Dr. Kara Wada shares her journey managing Sjogren’s Disease and provides insight into how to balance alternative approaches with traditional Western medicine. She and Cheryl discuss ways to assess the validity of alternative medicine claims so you can make informed, empowered decisions. 

Dr. Kara Wada is an Assistant Clinical Professor and Associate Fellowship Program Director of Allergy/Immunology at the Ohio State University in Columbus, Ohio. She graduated from the University of Illinois College of Medicine and completed her Internal Medicine and Pediatrics Residency and Allergy/Immunology Fellowship at the Ohio State University and Nationwide Children’s Hospital. 

After having completed additional fellowship training in medical education, Dr. Wada is passionate about building meaningful connection and therapeutic relationships with her patients and inspiring future physicians to do the same. She seeks to empower her patients and coaching clients with a naturally-minded and scientifically-grounded approach to care.  She speaks nationally on topics including medical education, allergic and immunologic conditions. Outside of her work, she is an autoimmune patient, a food allergy mom of 2 spunky daughters, and wife to another Dr. Wada.  

Cheryl Crow is an occupational therapist who has lived with rheumatoid arthritis for seventeen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources. 

Links to things discussed in the episode:

Medical disclaimer: All content found on the Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Here’s the show breakdown:

  •  01:25 – Introduction: Dr. Kara’s job as an Allergist Immunologist doctor at an academic medical center, journey with the autoimmune disease Sjogren’s syndrome, and her role as a mother to a child with food allergy.
  • 4:10 – Dr. Kara’s experience having to advocate to get the blood testing and labs drawn for Sjogren’s disease while she was a medical intern.
  • 6:30 – Reflections on the power dynamics in physician – patient relationships and the importance of two way communication.
  • 8:38 – Dr. Kara’s tips on how to develop a trusting relationship with a physician. 
  • 13:48 – How Dr. Kara uses a shared decision making to work together with patients, rather than the old model where the doctor told patients what to do.
  • 16:28- Dr. Kara explains the difference between an Allergist Immunologist and a Rheumatologist, and explains how allergist immunologists do more than “just” allergies.
  • 20:25 – How Dr. Kara manages her Sjogren’s currently, with an emphasis on the word “and” (western medicine and other “crunchy” alternatives). An explanation of Dr. Kara’s anti-inflammatory living techniques: food, meditation, and most importantly sleep to support health and healing.  
  • 25:10 – How Dr. Kara un-learned her perfectionist tendencies, and Cheryl & Dr. Kara reflect on how parenting helped them lean into “progress over perfection.”
  • 26:28: Reflections on how to accept the reality: you can do everything right, and sometimes your body is going to have a mind of its own. How to accept the element of randomness and move on with an empowered and self-compassionate mindset rather than letting it get us down. 
  • 27:00 – Dr. Kara explains how she finds a balance between conventional and complementary alternative treatments: “weeding out the woo.”
  • 31:10 – The warning signs to look out for when looking at different complementary alternative treatment options
  • 33:10 – Dr. Kara explains how the supplement industry is not regulated and can be dangerous and shares her own experience of experiencing liver abnormalities after taking a “superfood” supplement.
  • 36:44 – The importance of a personalized care plan and getting a variety of specialists on your care team.
  • 38:43 – Just because it’s natural doesn’t mean that it’s healthy. Dr. Kara and Cheryl dive into the balance between being open minded and skeptical about alternative methods of managing rheumatic diseases like rheumatoid arthritis and Sjogren’s. 
  • 41:00 – Dr. Kara and Cheryl’s discuss the importance of an individualized risk / benefit analysis when trying any new approach (including financial risks / investments, time risks / investments and health risks / investments / benefits). 
  • 45:02 – Dr. Kara’s recommended resources for patients looking into alternative options: University of Arizona’s Website. 
  • 46:55- Dr. Kara’s advice about lab tests that are marketed as “the tests your doctor doesn’t know to give you,” particularly for “food sensitivities” or food intolerances. 
  • 48:33 – Cheryl & Dr. Wada reflect on how to still feel empowered when facing the truth that there may be no “magic wand” solution for rheumatic diseases.
  • 49:05 – Importance of making your ordinary routine fun in small ways to add up to larger gains in health over time. Reflections that many people with rheumatic diseases don’t need many supplements. 

Full Transcript:

[00:00:00] Cheryl: 
[Introductory note]  

Hi there! I’m so excited to welcome you to The Arthritis Life podcast where we share arthritis life stories and tips for thriving with autoimmune arthritis. My name is Cheryl Crow and I am passionate about helping people navigate real life with arthritis beyond joint pain. I’ve been living with rheumatoid arthritis for 20 years and I’m also a mom, occupational therapist, video creator, support group leader, and I created the Rheum to THRIVE self-management program. 

I am so excited to help you live a more empowered life with arthritis. We’re going to cover everything from kitchen life hacks, to navigating the healthcare system, to coping with friends who just don’t get it. Seriously, no topic is going to be off limits on this podcast. My interviewees and I share our honest stories of how chronic illness affects our lives. This includes discussions about mental health, sex, shame, pregnancy, body image, advocacy, self-acceptance, and so much more. You’ll hear stories from all ends of the spectrum from a person who’s living in medicated remission from psoriatic arthritis to somebody living with severe mobility restrictions and severe pain from rheumatoid arthritis. 

You’ll hear how people manage their conditions in different ways like medications, mindfulness, movement, social support, work accommodations, and so much more. You’ll also hear from rheumatology experts who just get it. We’ll dive deep into the science behind chronic pain and what’s the latest evidence for lifestyle changes that can help you thrive with arthritis, including exercise, sleep, nutrition, stress reduction, and more. This is your chance to sit down and chat with a friend who’s been there. Ready to figure out how to manage your arthritis life? Let’s get started.     

This episode is brought to you by Rheum to THRIVE, a brand-new support and membership community that I created in order to help people build a life they love despite rheumatic disease. I’ll be teaching you how to develop your own THRIVE toolkit, which is the exact process I use to live a full life despite rheumatoid arthritis. Check out the show notes to learn more. 

Hi, my name is Cheryl Crow, and I am passionate about helping people navigate real life with arthritis. I’ve lived with rheumatoid arthritis for 17 years, and I’m also a mom, teacher, and occupational therapist. I’m so excited to share my tricks for managing the ups and downs of life with arthritis. Everything from kitchen life hacks to how to respond when people say, “You don’t look sick.” Stress, work, sex, anxiety, fatigue, pregnancy, and parenting with chronic illness – no topic will be off limits here. I’ll also talk to other patients and share their stories and advice. Think of this as your chance to sit down and chat with a friend who’s been there. Ready to figure out how to manage your arthritis life? Let’s get started. 

Hi, everyone! I am so excited today. I have Dr. Kara Wada, The Crunchy Allergist to help us all understand a little bit more about allergies, immunology. What is an allergist, actually; what are they not? And also, she’s gonna share a little bit of her own personal journey with autoimmune challenges. So, welcome, Dr. Kara. 

[00:03:05] Dr Kara:
Thank you so much for having me on today. I am so excited to be here. 

[00:03:12] Cheryl:
We’re very, very excited to have you. Can you just tell the audience a little bit about yourself and what is your relationship to autoimmune disease? 

[00:03:20] Dr Kara:
Yeah, so my name is Kara. I am a practicing allergist immunologist, which means I see both kids and adults. I work at Ohio State University. I’m in academics teaching medical students, residents, and fellows too through my practice. And I, because I’m at the university, I see the gamut and a real breadth that we see in our field. So, there is everything from allergies that affect, runny nose, asthma, food allergies. But then, things that also delve into autoimmune or immune deficiencies. So, chronic hives and swelling called angioedema. Then immune deficiencies that sometimes people are born with or other times will develop over time and happen many times along with autoimmune conditions too, which sounds a little bit bizarre when you consider that the immune system may be underactive and overactive in the same human. 

I am a mom to two girls and wife to my husband Akira. And two years ago in May of 2018, I was diagnosed with Sjögren’s syndrome, which is an autoimmune condition that I think is most known for drying out eyes and mouth, but can affect other parts of the body too. And they’re so many different kind of flavors of Sjögren’s. For me, I’ve had a lot of stiffness in my low back that I’ve dealt with, and fatigue tends to be a big issue with Sjögren’s in particular, and had a particularly bad flare that decided to affect my liver, which thankfully has recovered. 

But all of that was a real eye-opening experience to go from seeing these things in my professional realm to then seeing them in my personal realm. And to add a little bit of insult to injury. The same month I was diagnosed with Sjögren’s, my youngest daughter, Josie, was diagnosed with food allergy. And I was like, wow, our family just really needs to get our act together. Not that we had a ton of control, you know, a ton of control in that initial diagnosis. I think there’s always — not always, but I think many times there’s a sense of blame or feeling of guilt or other things, especially when something affects your child. So, that was an interesting month to say the least. 

[00:05:37] Cheryl:
I can’t imagine. And I always find it fascinating if someone is both a patient and a provider in the same specialty, when you don’t actually get your — you don’t find out about your medical condition until after you’ve already self-selected into that specialty. So, that’s so interesting. Did you self-diagnose or how did you get the diagnosis? 

[00:05:59] Dr Kara:
So, it’s interesting. I think for a long time, I was that picture of the ostrich with their head in the sand. I remember seeing my primary care doctor as an intern, so it would’ve been 2010, and complaining of some low back stiffness and we did some labs and there were a couple things that were a little bit askew, but we brushed them off. I was exhausted because I was doing 24-hour, 30-hour calls, and then blamed it on being a new mom, you know, and that fatigue that comes with pregnancy, postpartum. And I had a couple other little quirky things happen along the way that I thought maybe there was something not reading the textbook with my immune system. That’s how I commonly describe things that maybe aren’t diagnostic but aren’t normal. 

And eventually, I went for a dental checkup after I had my second child. And the dental hygienist said, you know, your mouth looks really dry. I wonder, do you use any biotin? And I was like, no. I have been dealing with dry eye. I can’t wear my contacts anymore, and I probably should get that checked out. And I think that was really what pushed me to finally advocate to get labs drawn. And so, I made an appointment with my primary care and I explicitly had to ask to have the labs drawn. I’m trying to look at this situation from the outside in, but I had to advocate a little bit more for having those labs drawn than was maybe ideal. 

And I think about how I came into that conversation; informed, a pretty, confident, educated woman, you know, all of this privilege into this dynamic of the patient and the physician. And I think that’s really now very much informed how I try to interact with my patients too, of if you’re worried about something enough and it’s not going to hurt me thing, let’s just check it. Well, let’s check the lab or whatever. If there’s something we can do that is not unreasonable and we can work together to come up with your care plan, then let’s do it. Because if it adds to that ability to validate your experience or help you understand what’s going on, or we can talk through it, I think it’s important just to have it power dynamics equalized as best as we can. It’s never going to be equal. But I think there probably needs to be increased recognition of that and appreciation for that and care from the physician side in particular.

[00:08:53] Cheryl:
Yes. Okay. That’s what I — I was like, am I being biased in how I’m hearing this? But yes. No, the physicians need to recognize the patient. The patient has a valid right to state what they want. 

[00:09:07] Dr Kara:
Yeah. And have a conversation about it and try to have some dialogue as to, okay, this is why — and I think that comes up sometimes. And I can see the contrary side also of why you may not want to order something. It comes up more often with food allergy and we were talking a little bit before about this idea of food allergy, food intolerances, and sensitivities, And there is a distinct role for particular food allergy testing. And so, that’s where I could see the need for a greater conversation surrounding how will this test help shed light on a situation or not. But it really all comes down to that ability to listen and communicate and try to build that therapeutic, trusting relationship that sadly is missing, I think, in our current environment. Everything is so rushed.

[00:10:02] Cheryl:
Yeah. Yeah. And what do you suggest, if a patient does feel like they’re being rushed by their doctor or that they’re not being maybe listened to or validated, what do you recommend they do to have a better, either have a better relationship? Or maybe seek a second opinion? 

[00:10:23] Dr Kara:
Yeah. I am a big fan if you don’t feel like you have a good trusting relationship, or that trust has been broken, that it is very reasonable to seek a second opinion or to see if you can find someone who’s a better fit. I think if you know that you have a situation that may entail a longer visit, you may talk with the staff that’s scheduling and see if there’s any ability for that particular doctor to put you at maybe the end of the day, or the first patient appointment, or the first one after lunch. Or if they have the ability to double book — or not double book, but do two sessions together. 

[00:11:06] Cheryl:
That’s something that I didn’t know. I didn’t know about that until I became an occupational therapist, that there’s different minutes, amounts of minutes. And it’s different for physicians and doctors than occupational therapists, but I realized, wait, what? I don’t even know ever what the amount of time I was supposed to have with my doctor. I just, you’re told what time the appointment starts, but you’re not told when it’s supposed to end. So, I think you’re right. I know that I think in rheumatology there’s ways to code it with more complexity. So, if you’re like a highly complex, you can get like 30-minutes or 40 I think, or don’t quote me on that, but does that sound familiar?  

[00:11:41] Dr Kara:
No, absolutely. So, in there are always ever evolving changes in how we’re able to bill and it’s sad that it comes down to that, but many times its power is much higher than us. We’re in a similar ways we’re cogs in a wheel like most of us are in our positions. And there’s different amounts of pressure and different styles of practice in different locations. And I think that’s one of the neat aspects about direct patient care or these direct primary cares that have come up, is that there is that flexibility. That said, that’s not accessible for most of us because it is all out of pocket and usually insurance is not in the equation. 

[00:12:28] Cheryl:
So, a direct care is like private. Is it the same as private pay, like concierge type thing? 

[00:12:33] Dr Kara:
Correct. Yeah. Yeah. It’s the new concierge and there are some practices that are rheumatology practices. I know of two or three allergy practices that function in this way and I’m intrigued to buy it, but I also love that at the university, I get to see people from all different walks of life, from patients who are on government health plans, university professors, executives, kids, adult, you know, the whole thing. People are new to the country, like, it’s just a really cool mix of everyone and all the conditions. I love talking with patients and so I tend to fall behind a little bit in clinic. But I try my best, if I know someone’s going to take that extra time to book it accordingly. But I also am very lucky that I’m in a department that hasn’t given me a hard time for doing that. 

[00:13:28] Cheryl:
That’s really good. And yeah, I know that some patients figure out over time, wait, if my doctor, if I want them to spend a lot of time with me, I have to know that they’re gonna run late sometimes ’cause I’m not the only one they spend extra time on. 

[00:13:42] Dr Kara:
Exactly. And I think allow that grace giving in both directions a little bit. The other tip I would say is I think it’s always helpful to write down questions ahead or things that you might be thinking about, and I think you’ve written about this a lot too. I get nervous when I go in to see my docs. I have a really lovely care team that I think it’s hilarious that I get nervous, but I think it’s, again, that power dynamic. You’re kind of on the spot. You have that 15, 20 minutes and so I try to write notes down in my phone and I think that’s helpful just so you can guide the conversation. You also may ask the scheduling team when you schedule, how long are the appointments, and that kind of will give you an idea too of okay, can I be long-winded or do I need to give the short story? 

[00:14:36] Cheryl:
Oh, I really have to practice that. Yeah, because I love talking the long story and yet you just don’t have the time in the session. So, that’s really, that’s great. And I think it’s just really normalizing for patients to hear that like even other doctors get shy or nervous to talk to their doctors. I think it will help people feel less alone or less, ‘Oh, it’s just me, or I can’t believe I’m so nervous’. Even other doctors get nervous, so I’m glad you mentioned that.

[00:15:08] Dr Kara:
Yeah. I think it’s just important to remember we’re all humans. And I know for many years there has been this kind of patriarchal fatherly type culture within medicine. But as increasingly more and more docs are women and we have this greater diversity within the workforce, I think we’ll continue to see hopefully a lot more of — and I think this is a big push as I was going through school, but shared decision making and less of that ‘Do as I say’.

[00:15:44] Cheryl:
Yeah. Can, you tell the audience what ‘shared decision making’ means? 

[00:15:48] Dr Kara:
So, it’s this idea that the healthcare provider and the patient work together on a solution. So, for instance, if I’m talking with someone about — we’ll pick something kind of simple — their allergies. Maybe they have seasonal allergies every spring. We talk about some of the options. So, some of the options include avoiding your triggers. You could use like a daily antihistamine, you could use a nose spray like Flonase. Sinus rinses are great. Natural treatment, nice crunchy treatment. And then, there’s immunotherapy. So, things like allergy shots, drops, or tablets that make you less allergic over time. 

And so, we can talk through all of those options and think about their goals and their preferences, and come up with a game plan together thinking about those and the risks and benefits. And knowing their symptoms too, I can kind of guide, okay, you’re more stuffy. I know you don’t like the Flonase, but really that’s going — I don’t have anything, I should say Fluticasone. I don’t have any preference for the name brand, but that’s gonna work the best if you’re really stuffy. So, being able to talk those through 

[00:17:03] Cheryl:
That makes a lot of sense. But it’s ironic that as the length of visits have gotten shorter, I know the shared decision making is the bigger priority, which I think is the — it’s right to have shared decision making. But it’s hard to do it in a short amount of time. 

[00:17:19] Dr Kara:
Absolutely. And especially as the complexity of what you’re talking about increases. And that’s what’s really challenging with am immune system problems or when the immune system is misbehaving because the immune system is so — I obviously nerd out because this is what I chose to study and I find it absolutely fascinating, but it gets really complicated really quickly. And if you’re trying to talk about working up someone for an immune deficiency or autoimmune problem, sometimes you have to skip over some of the technical aspects or try to really hone your discussions or your chalk talks to try to work within those time constraints too.

[00:18:03] Cheryl:
Oh, absolutely. And I wanna make sure I cover — so, an allergist, an immunologist, sometimes people just call them or you an allergist. You don’t just deal or with or help treat allergies. Correct? 

[00:18:18] Dr Kara:
Correct. Yeah. The training is really broad and I was really amazed because interestingly, most med students don’t get much exposure to allergy immunology as a field. Our kind of sister specialty is rheumatology immunology. And I say we’re looking at the same coin, we’re just coming at it from slightly different vantage points. And so, perhaps we’re looking at it from the head side and they’re looking at it from the tail side, but it’s the same coin. And so, as allergists, we tend to focus on the immune system’s ability to make a response to things in the environment that it should not. So, different pollens, dust, other allergens, food. And we’ve also focused on immune deficiency. So, low immune system or trouble fighting off infection, typically with the exception of HIV and AIDS, because that has traditionally been cared for by infectious disease doctors since it’s caused by a virus.

[00:19:24] Cheryl:
I see. Okay. 

[00:19:25] Dr Kara:
But weirdly enough, so chronic hives is this overlap where it looks like allergy, ‘cause we think of hives, rashes, and swelling as an allergic process. But interestingly enough, more often it’s triggered by something internal, so something of an autoimmune flavor. And so, there’s this natural overlap with gut condition. And then, we know in one of the more common immune deficiencies I care for, which is called common variable immune deficiency, there are a significant portion of those patients who have autoimmune issues that go along with that condition too. 

And so, there is this. I share so many patients with the rheumatologists and a lot of patients with gastroenterology, with inflammatory bowel disease like Crohn’s and ulcerative colitis. There’s just a lot of overlap. When the immune system decides not to follow the rule book, it doesn’t divide down the line of saying, okay, this is outside the body or inside the body necessarily. It may just recognize things as the enemy that it shouldn’t, from several different ways. It’s more of a problem with I’d say dysregulation, but maybe the brakes are off or the gas pedal is on. 

[00:20:42] Cheryl:
I love that analogy. And yeah, I mean, my personal patient experience has not included allergy and immunology except for just brief testing at one point to rule out like an allergy that might’ve been causing some of my issues. But so, I never honestly had sat down and thought to myself, yeah, you can have issues with your, autoimmunity that are not — that you wouldn’t go to a rheumatologist for ’cause in my mind I’m like, well, I have an autoimmune disease, I go to the rheumatologist. So, you’re explaining that you can have an immune system issue that has to do with maybe outside allergens or something internal or genetic that could be for, that you need to seek help from the allergist immunologists.

[00:21:27] Dr Kara:
Yeah. And I think each practice, each allergist immunologist has a little different flavor to his or her practice. Many in private practice will see primarily nasal, sinus, eye allergies, food allergy, asthma. And I think though, as you, especially if you are in academics or maybe have a niche practice, then you’ll see a little bit more of that overlap with immunology. And there are some allergist immunologists who their sole focus is on bone marrow transplants for these kids that are born with immune deficiency. It can get pretty super specialized. That was never — I was never that into immunology. 

[00:22:09] Cheryl:
I wanna make sure I tie up at one quick loose end, which is I’m guessing people are gonna wanna know, how do you manage your Sjögren’s currently? What are some of the things that work for you? 

[00:22:21] Dr Kara:
So, I love the whole concept of the word ‘and’. So, I love using my Plaquenil or my hydroxychloroquine, which is hopefully going to keep my Sjögren’s relatively chill. The problem with Sjögren’s in particular, and I think that actually pushed me into this crunchy endeavor is there aren’t really great treatments. So, it’s wonderful what we saw with rheumatoid arthritis in the last 15, 20 years with the advent of all of these different biologics, which have really been life changing. Sjögren’s has not had that development quite yet, and so for the most part, we have Plaquenil until things really hit the deep end, and then sometimes they’ll use something called Rituximab, which essentially wipes out about half of your immune system. 

I tend to see patients who have longstanding problems after Rituximab, so I personally have a little bit of a hesitation concern just from my experiences kind of projecting onto that. But very helpful medication when it’s needed. So, I’m on that. And then, I have found that as I grow and evolve, I have been trying to set up my daily habits as best able to support my health and to support my healing. And so, I’ve really looked to the framework of anti-inflammatory living techniques. And there are — it’s not the sexiest stuff to talk about. 

It’s those things of trying to wake up at the same time every morning so that I give myself enough time to stretch, to get a little bit of meditation time in because I know that helps keep my attention and my brain fog better in check. It also helps keep my anxiety better controlled. I try to keep a meal plan and batch prep because I know if we have healthier foods around — or not healthier, but more nourishing foods around. I otherwise will sometimes make some poorer decisions in takeout that I know will tend to flare up symptoms. And, I worked with a dietician who I think we both know well. Jennifer? 

[00:24:44] Cheryl:
She’s been on the podcast. Yeah.

[00:24:47] Dr Kara:
She’s fantastic because she has, she’s filled my tool belt with additional tools where for a while I was getting pretty caught up in elimination diet things and food triggers, and had developed some maladaptive behaviors and just frankly, some fear of foods. And so, that has been really helpful to get me back on track and balance things out. And I try to really stick with my bedtime. I think sleep is huge. 

[00:25:15] Cheryl:
It’s like the unspoken — sleep is like the fatigue of lifestyle, like, in the sense of fatigue is the thing people forget to look at for autoimmune disease. And then, sleep is the thing people forget to look at in their lifestyle. I need to do a diet and exercise, but you’re preaching to the choir about sleep. 

[00:25:32] Dr Kara:
Oh, and I just finished reading a book and I’ll have to send you the name of it because of course it’s escaping me right now. But it was really great ’cause it had some good practical tools and tips and it wasn’t a super dense read. It’s relatively new. I’ll shoot the name over so you can have that handy. 

[00:25:51] Cheryl:
[Intermission begins]
Hi, everyone. I’m interrupting really quickly to remind you that this podcast is brought to you by the Rheumatoid Arthritis Roadmap. It’s a comprehensive online education and support program that I created from scratch to help people learn how to live a full life despite rheumatoid arthritis. In the course you get to learn how to manage everything from physical symptoms like pain and fatigue, to social and emotional aspects of living with rheumatoid arthritis. I even cover the logistics of things like how to track symptoms and how to advocate for yourself in medical appointments. To learn more, go to myarthritislife.net.
[Intermission ends]

So, for you, it sounds like going to bed at the same time is one of your habits. That helps a lot. And you can stick with it when you can. Well, with two small children, how does that go? 

[00:26:40] Dr Kara:
Yes. I mean, that’s the thing, right? I have a five-year-old and a two-and-a-half-year-old, so it’s as best we can, like, no one is perfect. And I think trying — I get into this trap, especially with eating of trying to seek perfection. I think being a pretty driven Type A person my whole life like that I think is an easy trap to fall into. And so, I’ve really just tried to tell myself progress, not perfection. I am a big believer in growth mindset, so always trying to continually be a better version of myself, but that’s going to evolve and change as I grow and change as a human.

[00:27:18] Cheryl:
Totally. And I’m just, I’m projecting for a second, but I found that becoming a mom was helpful for me. It was painful, but then helpful in not being a perfectionist. ‘Cause there’s no perfect way to be a parent, right. Have you found that too?

[00:27:34] Dr Kara:
Absolutely. I think that was a huge lesson for my husband too, quite honestly. It’s interesting seeing how we all grow and evolve in that role. 

[00:27:45] Cheryl:
But it’s ultimately the best humbling lesson, right? Because we actually can’t control anything in life. Control is an illusion. 

[00:27:53] Dr Kara:
No, absolutely. And I think that’s so important as we think about autoimmune because just because, and I think this is what’s humbling and frustrating and really can tick me off sometimes. Like, we can take our meds on schedule as we’re supposed to. You can do that perfectly. You can eat perfectly, whatever that means. 

[00:28:14] Cheryl:
Yep. 

[00:28:15] Dr Kara:
There is no perfect eating, by the way. I think you know that, but to share with the group. There’s no perfect eating. You can go to bed at the right time and everything. All that said, sometimes your body is gonna have a mind of its own. And so, I think what I’ve realized is preparing myself that is a possibility, but also realizing that if I worry about that all the time, it does me no benefit. Because if I focus on the what if’s, could have’s, or what if’s, could have’s, maybes, it may or may not happen. It’s a lot of wasted energy. 

[00:28:57] Cheryl:
Yeah. And also, I forget where I heard it. Someone wrote something like, you can control the actions you take around managing your illness, but you can’t control whether or not they work. And I thought that was a really new — it sounds deceptively simple, right? But it’s like, when I chose to go on Enbrel, it’s not my fault the Enbrel worked. Like, I just sat there and injected it like anyone else, and it worked really well for five years and then it didn’t. Someone else I talked to worked really well for 11 years. Did they try harder? And is that why it worked for them for 11 years? For someone else, it worked for two months and then it stopped working. 

Am I better than them, because it worked for me for five years? Totally not, it’s random sometimes, but randomness is what people — it doesn’t comfort people. They wanna feel like they can exert control over everything. But it’s this balance of we wanna empower people to know that you can make choices in your life that can help you, but also have that self-compassion and that understanding of acceptance that even if you do all these lifestyle things perfectly — which doesn’t exist — but you can’t necessarily achieve a perfect result.

[00:30:11] Dr Kara:
Yeah, and I think it’s really all about finding a balance between all of this. And I don’t think anyone ever is always at that balance point, right? We’re always in flux, but it’s always seeking out that balance. And I’m so intrigued by, for instance, traditional Chinese medicine, Ayurveda, a lot of these more ancient time-tested traditions. Their focus and their philosophy is on putting the body back into balance. And so, it all ties together. 

[00:30:47] Cheryl:
Yeah. Let’s dig into that more. ‘Cause I love your, one of your taglines on social media.  

[00:30:54] Dr Kara:
Oh, weeding out the woo. I think what I was seeing personally was I was exploring a lot of these different lifestyle techniques and different elimination diet plans and so forth. And many would come out with very science-y sounding things. But as I dug into, in particular, with my background in immunology and allergy, and seeing some of people who I guess would be considered colleagues with particular plans or supplements or whatever with their names on them, not seeing the proof in the literature. So, I’d go back to PubMed or some of these other resources that I’m lucky enough to have access to and would dig into the actual need of the science. 

And there wouldn’t necessarily be anything that was in humans or in humans with this condition, or it’s this idea that there may be theoretical science behind certain things. But what happens in a cell or a mouse may not happen in a human. And so, that kind of gave me more interest in kind of digging in and really trying to weed out, okay, what has some decent evidence, thinking about what has potential to frankly be harmful in some ways, and where can we find that middle point or that balance point within conventional and complementary alternative type treatment modalities.

[00:32:29] Cheryl:
Yeah. What are the — since the primary audience that listens to this podcast, to my knowledge, there might be a silent majority that hasn’t talked to me — but are patients. What are some good kind of rules of thumb maybe that they should be looking for? ‘Cause it is so easy to be sucked into some of these too-good-to-be-true sounding things.

[00:32:51] Dr Kara:
Some of the warning signs where my little internal alarm bells are just like, oh, let’s pump the brakes. Maybe not full on stop, but at least pump the brakes. I think anything with sensationalized marketing, I always pump the brakes a little bit. 

[00:33:08] Cheryl:
And sensationalized would be like ‘Guaranteed to cure your rheumatoid arthritis forever’, or Sjögren’s.

[00:33:14] Dr Kara:
Yes. Anything that seems to portray itself as the one-size-fits-all solution, I think, in the big picture, is shortsighted. We are all so absolutely unique. You were just talking about the situation, for instance, with Enbrel. I think we’re realizing more and more certainly, our DNA is unique, our own personal history. And then, increasingly we’re realizing that it may not just only be our own personal history, but that of several generations back with like epigenetic type changes. And then, our microbiome on top of it. So, you added in all of those layers of, and potential for uniqueness, individuality, and it’s really hard to say that one size fits all is going to fit for everyone. It’s like that dress that doesn’t look good on anyone except for what Heidi Klum maybe. 

So, I think that’s another thing. Anytime I see a doctor in particular, I’ve seen a lot of physicians and docs do this, but with their name on the bottle of the supplement. I always just do a little timeout because where I come from, or from how I understand medical ethics and it just gives me pause to at least go back to the literature and check it out because they have a pretty significant financial investment and reasoning for selling you that product. In particular, for those who are in the US that are listening, anything that is a vitamin or supplement, what is actually on the bottle is not necessarily what’s in the bottle. So, there’s no one looking out for you for that. And there’s very minimal oversight in the safety. 

And I have gotten sucked into — to tell a little story. We’ll go back to that liver episode. So, I, after my diagnosis, I was like, okay, we’re gonna get healthy. I’m gonna do green smoothies. It was summer. I love smoothies. In the summer, it’ll be a great way for me to get some extra veggies in, and for breakfast that has to be healthy. And so, I saw some really awesome marketing on Facebook because I wasn’t on Insta yet. And it was for some supplements that were food-based. They were superfood-based. And so, I thought, oh, well, this has to be safe. It’s food-based, right? ‘Cause I knew to be a little bit cautious of supplements and so forth. And I got, it actually tasted delicious. That was doing okay. 

But then, six to eight weeks later, I had developed fevers, like daily fevers. And about two weeks into that, whatever that was, I figured it was viral or something. I was really fatigued, fever, and I turned yellow and got itchy. My liver enzymes were through the roof. I ended up with an ultrasound, a biopsy, a liver specialist. And the pathologist, so the docs who look at a little chunk of my liver under the microscope looked at it. They’re like, well, we’re not a hundred percent sure. What’s going on? It’s not like Hepatitis A, B, or C. It’s not the typical viruses. We wanna send it to the NIH. Anytime they say they wanna send something out, let alone to the NIH, I was like, okay, so — 

[00:36:41] Cheryl:
That might mean it’s really serious?

[00:36:44] Dr Kara:
Well, it just meant that they were scratching their heads and I knew — 

[00:36:46] Cheryl:
Oh, that they don’t know. 

[00:36:48] Dr Kara:
Yeah. And I knew the pathologist at the time, I had met through some, like, women leadership things and I knew she was really great. Like, she had actually was one of the authors for a GI pathology textbook. And I was like, oh, geez, if she doesn’t know what’s going on, what’s going on? 

[00:37:03] Cheryl:
Oh, yeah. If the textbook author doesn’t know. Yeah. Who do you go to? 

[00:37:08] Dr Kara:
I know. So, they sent it out and what ended up coming back was, we’re not exactly sure. It doesn’t look like you have permanent damage or scarring, so that was a relief. But they said this very well could have been from either medications or supplements or vitamins you were using. And I was only on the Plaquenil, which is known to be pretty darn safe for the liver. And so, in the meantime, my liver specialist had said stop these damn supplements, superfoods or not. And I reported it to the company, but they just paid me lip service. 

[00:37:41] Cheryl:
Wow. And so, it went away when you stopped? 

[00:37:45] Dr Kara:
Yeah. And but admittedly, during that time though, I also decided to try AIP and did some other things too, because I was desperate to try anything. 

[00:37:57] Cheryl:
And AIP stands for Autoimmune Protocol, yeah, which is a paleo based, and I just, yeah. And I’ve said this so many episodes, but that’s so hard. I had gastroenterology issues prior to my RA diagnosis because of my history with GI issues. I find all these, the diets, very overwhelming because I’m also have developed SIBO twice, or SIBO, like, small intestine bacteria overgrowth. And so, they don’t, they’re not all compatible with the way I have to eat from my stomach. 

[00:38:29] Dr Kara:
And that’s where I think this idea of really needing a personalized care plan is so important. And I think it’s really interesting, like, I did a little bit of extra training in medical education just to try to be a little bit better teacher to students, but there’s this concept that I’m sure comes up a whole lot more in more, like, educational like programs like education majors, but this idea of sometimes you don’t know what you don’t know. And like I felt like I knew a good amount about nutrition. but I didn’t know what I didn’t know. And so, then working with someone who that’s their jam was really, really helpful. And that’s where I think having a team-based approach is so important as you are navigating through some complex stuff. 

[00:39:24] Cheryl:
Yeah, and so many patients don’t even know to ask for referrals. I’m telling people constantly for even occupational therapy, physical therapy, maybe if you’re having a hard time with exercise or range of motion, you might get referred to a physical therapist, but occupational therapy is we help you with your activities of daily living. And if you’re like, let’s say, a new mom who has like back pain from Sjögren’s or rheumatoid arthritis, hand pain, and is struggling with literally daily tests like folding laundry or holding your baby or like that, we can actually help you with that. Like, you can get your insurance to pay for a session with the somebody to just guide you through. And a lot of times, people just don’t know. They think they have to navigate it all on their own. So, yeah, and you’re right with nutrition too. People think, “Oh, I’ll just try these diets,” not even thinking, oh, I can go to a registered dietician, nutritionist.

[00:40:16] Dr Kara:
Yeah, absolutely. And thinking about a pharmacist too is another great person to help you with medication interactions. That’s the other potential issue with supplements is they are just because it’s natural doesn’t necessarily mean it is healthy. And so, there are potentials for medication interactions, and that’s something else to be conscientious of too.

[00:40:43] Cheryl:
Yeah. And then, and back to the laundry list of things patients should be thinking about when they’re seeing these claims about alternative medicine approaches online. One of the ones I’ve seen stated with like health, they call it like patient information literacy or health literacy, is to look at who’s the author and what their stake is. So, is it in terms of, you know, is this an article that was written for let’s say the Arthritis Foundation where it’s an educational nonprofit versus, Joe, whoever doctor, who a hundred percent makes all the profits from you buying the book or whatnot. 

[00:41:24] Dr Kara:
Absolutely. Yeah, absolutely. Just thinking about that motive piece, which is really, it’s unfortunate, but it is to some degree human nature that we have to deal with, and we have to think about those things too as we’re navigating other consumer, you know, you’re going to buy a new car or other things, or you have to just be whatever else. 

[00:41:51] Cheryl:
Oh, I always get sucked in. I’m like, I’ll pay you to stop talking to me about cars. I’m so tired of talking to you about cars. No, I think it’s a very tenuous balance and I, in my little Rheumatoid Arthritis Roadmap online course, I talk about balancing being open-minded and skeptical because you don’t know if something — especially if it’s new, right? A brand new thing might come out and you don’t at the time — ,aybe there’s not a ton of evidence for it, but you, it might benefit you to be open-minded in that case to say, well, the evidence hasn’t mounted a lot yet, but maybe it’s going to come soon, the evidence is just starting. Or is it that this is actually just gonna be a flash in the pan and not help me? Like, how — balancing skepticism with open-mindedness, that’s been one of the hardest things for me with living with this for 18 years. Is that also hard for you?

[00:42:48] Dr Kara:
Absolutely. And thinking aboutm, okay, what’s the potential for harm or good, and that’s what I talk about with patients. And it’s come up a lot in particular in discussions about the vaccine right now too and talking through risk benefit. And I think if you can go through with your doc or a pharmacist, okay, the chances of this particular supplement interacting with your medications as well, the real risk is to your pocketbook. And maybe you give it a try for a month or two, see if you find benefit from it, and then if you don’t stop it. And so, that’s, I think, how I try to approach things in using some of that shared decision making, like risks, benefits, what’s our decision? 

[00:43:35] Cheryl:
So, true. And the risks, I think a lot of times we think about looking at what are the claims, what are the claims around this? Whether it’s CBD or around acupuncture or something else. But you’re so right to look at also, what’s the cost? What’s the investment? Is it time? Is it money? And then, how much do you as an individual have? I remember I, my, again, my background being in like pediatrics more and, like, developmental disabilities. I had one client that was extremely wealthy and the parents were, they were just looking to — they had a child with a severe disability — and they were just looking to throw, they said, we wanna throw the kitchen sink at it. We don’t really care if it has a ton of evidence, but when it comes to what they’re gonna invest in on their own time. 

And, I’m like, well, if it’s not gonna hurt your kid, you literally have like unlimited, to a certain degree, finances and time. Then in that case, if it’s not harmful, try it. Versus someone else who’s well, in order to afford this, I would have to, like, take on a second job or put my kid in some sort of like unsafe environment or something and you’re like, wait a minute, no. So, it’s very, like you said, individual. It’s hard to hear, right? ‘Cause I, and I see this all the time online in patient communities, “Why can’t the doctors just tell us?” Like, why can’t they, why can’t they just tell us? Especially like with the vaccine. I just saw that today. Why can’t the doctors just tell us all, every single patient with a rheumatic disease? And I’m like, I understand that feeling. Like, I empathize.

[00:45:11] Dr Kara:
Yeah. But that’s why I have 20 plus messages every day in my inbox that I’m messaging each one back to try to help, because each person’s circumstances are different. Their allergy list is a little different, their medications they’re on, if they’re able to quarantine, and that’s just for that particular circumstance. But it gets muddy really quickly. 

[00:45:35] Cheryl:
Yeah, it does. And I just, I do hope that, I think with chronic illness or chronic challenges like allergies and obviously rheumatic diseases that people over time, I do really think a patient’s evolved to have more empathy for the providers as well. Because you have a big job, and every patient should deserve a really great provider they have a great relationship with and they shouldn’t have to settle for somebody who they feel like doesn’t answer their questions. 

But also, we have to recognize, like you said earlier, a little bit like we’re all in this, we’re subject to external forces, like, we’re subject to the insurance companies, we’re subject to the forces of just our lack of knowledge about the human body. That at a certain point there’s a ceiling of information that we know, right. That you as a physician, you don’t have all the answers. And it’s scary to think about that, but it’s the truth, right. 

[00:46:30] Dr Kara:
Yeah. And I think one thing I try to empower the trainees that I work with too is being okay saying, “I don’t know.” Because I think that’s really powerful. It may be frustrating for some patients to hear that. But I personally would rather someone say, “I don’t know,” than try to talk out their butt.

[00:46:51] Cheryl:
Is there anything more you wanna say about advice for patients who are looking into maybe alternative options, whether that’s like Chinese medicine or supplements, anything else you wanna say about that?

[00:47:05] Dr Kara:
I think there are some great resources out there that I like to point patients towards. I, for my continued learning, I love going to the University of Arizona’s website. They have a very well-respected fellowship in integrative medicine. I’ve used some of their coursework for continuing medical education. And they really do base a lot of their recommendations and how they train their docs is based in evidence and knowing how good or not good evidence is for particular treatments and interventions, and so forth. So, Dr. Yu is great and I love, well, we talk usually a couple times a week. There’s also an OBGYN who’s functional, or who’s integrative medicine trained, Dr. Anne Kennard. She wrote a book called ‘Nourish’, and it’s a cookbook, but it also has some other lifestyle suggestions and techniques. I’ve found her book to be really helpful in a nice, pretty quick read. So, that’s another resource. And she’s not as active on social media, but does give presentations and everything pretty often.

[00:48:21] Cheryl:
So, nice to know. ‘Cause again, the places that are not valid have gotten so savvy nowadays to try to make their websites look really valid and look really nice. 

[00:48:33] Dr Kara:
And I think the other thing that I am wary of when I hear docs talk about, oh, these are the lab tests your doctors never order. Sometimes there’s a reason for that. 

[00:48:48] Cheryl:
Oh, like ‘Your doctor doesn’t want you to know that there’s this special thing ‘cause it will put them out of business’ or something like that’. 

[00:48:56] Dr Kara:
Correct. And this comes up quite a bit with, for instance, we were talking a little bit before we started, but food sensitivities and food intolerances. And you can go to Target now and you can pick up a food sensitivity test. The problem is the technology, especially in particular with that one, is it looks for proteins in our blood called IgG proteins or immunoglobulin-G. In a lot of our food allergy research that is coming out and is really rapidly evolving area of study, we’re actually seeing that IgG for foods may indicate tolerance to particular foods. So, the science just doesn’t pan out when you look to see how well does this help me figure out, do I need to take this food out or not? You still either need to think about an elimination diet or a food symptom journal to figure out what those trigger foods are. If there was a quick and easy, relatively inexpensive test for me to order for patients, I would’ve ordered it for myself months ago, years ago, and I would be ordering it every day in the office. It’s just not there. 

[00:50:13] Cheryl:
It’s hard. It’s hard because I like, I feel like I’m often giving people like truth bombs, that they don’t wanna hear, like, we all wanna hear that someone out there has the answer. Someone’s figured out the magic wand. But how to, and continue to empower patients to say, there isn’t a magic solution, but here is what we can do that we know works. We know that anti-inflammatory overall patterns are, it’s helpful. 

[00:50:43] Dr Kara:
Yeah. And there are ways to hack our ability with behavior change and thinking about ways of making it easy on ourselves, making things fun. And like I said, it’s not sexy, but it works. 

[00:51:00] Cheryl:
No, I love your idea about pre-making the meals ahead of time, making it just easy and convenient to pick up a healthy snack and yeah. Making it fun. I love that. Anything else you’d wanna share just about any topic? I know people are gonna have a million questions for you after listening to this. 

[00:51:19] Dr Kara:
For the most part, I think one of the things I really have learned and come to appreciate, most of us don’t need a whole bunch of supplements. You can get most of what you need out of what you’re eating, with some exceptions. And, you know, being on particular medications especially for RA like methotrexate or corticosteroids, that may require some supplementation, but for the most part, we don’t need much. So, I think that’s helpful. I love helping people save money. So, I love talking about skipping the food sensitivity testing and maybe think about working with, your doctor or a registered dietician to think about what supplements you actually really do or do not need. 

Sometimes it’s that little bit of money and time investment that really helps provide you the different tools in your tool belts so that you’ll be able to tackle some of those ups and downs that inevitably we’re going to experience throughout our journey with autoimmune issues or allergy issues, misbehaving immune systems as I like to just refer to all of it as. I think of my 2-year-old as I say it every time, who despite best efforts might have a tantrum. 

[00:52:39] Cheryl:
Yeah. And that’s just that emotions are part of life. They come over us like waves and then they’re gone eventually. Oh, I love this. I wanna talk to you so much. I wanna talk about being a mom and all that stuff, but I do wanna respect your time and maybe we’ll have to maybe do a Part Two at some point. So, where can people follow you online?. 

[00:52:59] Dr Kara:
So, my main hub, I do have a Facebook group called, the Crunchy Allergist Anti-Inflammatory Community, and then I’m over on Instagram at Crunchy Allergist. Those are the main hubs. And then, I have a website, crunchyallergist.com. 

[00:53:17] Cheryl:
Awesome, and I will put all these in the show notes. I just know that some people like to hear it. They might be listening with their phone out just ready to enter that in. 

[00:53:27] Dr Kara:
Absolutely. Well, thank you. Look forward to connecting, and thank you so much.

[Ending note]   
Thank you so much for listening to another episode of the Arthritis Life Podcast. This episode is brought to you by the Rheumatoid Arthritis Roadmap, an online course that I created from scratch to help people live a full life with rheumatoid arthritis, from social and emotional aspects of coping with rheumatoid arthritis to simple physical strategies you can use every day to manage things like pain and fatigue. You can find out more on my website, myarthritislife.net, where I also have lots of free educational resources, videos, and more.