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Patrick Baptiste had a different assessment from that of the endocrinologist about the risks and benefits of his treatment. He returned to his primary care doctor, who at his request referred him to another endocrinologist. “This doctor laid out all three options and gave me the pros and cons on each.” The physician didn’t immediately present one way as the best. “Instead, he asked me what I thought about each option.”

The new doctor explained to Patrick that antithyroid medication could control the hyperthyroidism until the Graves’ disease entered remission. But he also made it clear there was no guarantee that he would go into remission or that remission would be permanent.

“If I have at least a chance of going into remission and not have to add another pill and another chronic condition to my life, then to me, it’s worth a try,” Patrick said. “I realize that if it doesn’t work, I may need to have radioactive iodine or surgery. But I’ll deal with that if and when I get there.”

Four

Regret

Lisa Norton walked quickly down the corridor to the classroom. A forty-two-year-old teacher of English as a second language in South Florida, she made it a point of pride never to be late for her students. As she neared the door, she was stopped by a knifelike pain in her foot. Lisa took a deep breath, composed her face, and entered the classroom, trying to hide any sign of discomfort.

That was eight months ago. At the time, an orthopedic surgeon had examined her foot, taken an X-ray, and told her that there was a bone spur at the first metatarsal joint, as well as a ganglion cyst and arthritis. “It needs surgery,” the doctor said. “There is extensive degeneration there.” He explained that in addition to removing the bone spur and cyst, he would place two small titanium screws and fuse the adjacent bones. The fusion would prevent the joint from moving, since any friction in such an arthritic joint would cause pain.

Lisa, a slim, athletic woman, had been a distance runner in college. She knew many runners who’d had joint pain and improved after receiving cortisone shots. Lisa asked the surgeon if she could try such a steroid injection.

“It won’t work,” the doctor said flatly.

But, Lisa told us, she had pressed him to give the shot, and it had worked. “I walked for eight months without any discomfort at all after the cortisone injection.” But then the pain returned.

Lisa had strong ideas about treatment. At the age of twenty-four, at the peak of her performance as a runner, Lisa had developed severe fatigue, pain in her joints, and a rash on her cheeks. She was diagnosed with lupus, an autoimmune disease that can affect many of the body’s tissues. She initially approached her therapy with a deep naturalism orientation. “I rested in bed for four months,” Lisa said, “reading my wacky books, hoping that I would go into remission spontaneously, that my body would heal itself.” But the symptoms did not improve, and “finally, I had so much pain and was so fatigued I could hardly move.” She consulted with a rheumatologist, a specialist in autoimmune diseases, and was treated with high doses of prednisone and Imuran, drugs that inhibit the immune system.

Lisa regained her energy, and the pain in her joints and rash subsided. But, as often happens, she suffered side effects from these potent medications. Her face swelled, her appetite became voracious, and she couldn’t sleep. She also worried that Imuran, which is toxic to blood cells, might make her more likely to develop cancer. “I kept trying to wean myself off the treatments,” she told us, “only to have the lupus return and then have to go way back up on the doses of the drugs.” Her rheumatologist “understood where I was coming from,” acknowledging Lisa’s concerns about the side effects of the potent medications and her desire to let the body heal itself. After several years, the autoimmune disease went into remission, and she no longer needed to take any medication. She hasn’t required any further treatment for her lupus since then.