After 15 pleasant years with the same person, Marcia David started seeing someone else. As several months of two-timing passed, she came clean: She told her doctor she’d been seeing a naturopathic physician on the side.
It’s not that her doctor was mad. Just disappointed, really — or at least, that’s what she surmised from the awkward silence that followed her admission. But after years of being treated with a high dosage of medication for a chronic intestinal problem, the 59-year-old wanted to explore some alternative, natural options to ease her pain.
Like David, many people are seeking natural approaches to health care, but just aren't comfortable telling their traditional family doctor about it.
Thirty-six percent of adults are using some form of complementary or alternative medicine, according to a 2004 survey from the National Center for Complementary and Alternative Medicine. Many doctors of both conventional and alternative persuasions say they’ve seen a rise in patients who are interested in both forms of medicine.
Some patients hide their newfound approach to health care from their usual doctor, and some just don’t feel it’s necessary to come clean, but keeping that secret can be harmful, doctors warn. Some alternative medicines may produce adverse effects when combined with over-the-counter medications, prescription drugs or other conventional medical approaches.
“What ends up happening is the patients are going to go and do these things anyway, and they're going to do these without medical direction,” says Dr. Mimi Guarneri, medical director for Scripps Center for Integrative Medicine in San Diego.
East meets West
Nationwide, several programs are cropping up that marry western and alternative approaches to health care, such as Scripps and Bastyr Center for Natural Health in Seattle, and doctors are growing more used to seeing patients who try multiple disciplines.
“Every week, I get patients who are coming in for the first time,” says Dr. Jane Guiltinan, a naturopathic physician and clinical professor at Bastyr University in Seattle. “Some of them are nervous. They like their (primary) doctor, and they don’t want to lose their doctor, and they don’t want to make their doctor angry at them.”
For Stephanie Quilao, the apprehension about seeing a naturopathic doctor wasn’t just about disappointing her regular physician — she knew her family wouldn’t approve. She’d been raised in a traditional medical family: Her grandfather was a surgeon, her mom’s a nurse and among her cousins are three M.D.s, a handful of nurses and several medical technicians.
“I just did it covertly for a while,” says Quilao, who lives in Foster City, Calif., and is in her late 30s.
Quilao held out for a year before revealing her secret to her family. But some patients don’t last that long — even the most careful cheaters often get caught.
The jig is up
One of Dr. George Grossberg’s longtime patients, an older man he’d been treating for depression, came in complaining of a disturbing development: he’d recently noticed blood in his urine. He reluctantly agreed to a cystoscopy (an unpleasant procedure that involves inserting a thin probe through the urethra and up to the bladder) after a series of tests failed to reveal the problem.
On a hunch, Grossberg asked if the patient had started taking any new medications. He said no, just aspirin — but then his wife produced a giant bottle of ginkgo biloba from her bag.
“I said ‘Whoa! Before you have this very unpleasant procedure, stop taking this,’” said Grossberg, the director of the division of geriatric psychiatry at Saint Louis University. He explained to the man and his wife that aspirin is a mild blood thinner, and when taken with ginkgo, the interaction of the two can cause bleeding. The patient stopped taking the herbal supplement, and within two weeks, the bleeding had stopped.
“Unfortunately, a lot of doctors don’t ask about those types of things,” says Grossberg. “Patients don’t consider these alternative remedies to be medicines because, after all, they’re available without prescriptions.”
For cancer patients, combining chemotherapy with some common herbal remedies can cause some potentially dangerous side effects, warn doctors. St. John’s wort, an herb used to treat mild to moderate depression, can decrease the efficacy of chemo, whereas something as seemingly innocuous as grapefruit juice can intensify the toxicity of the drugs.
For some, the pressure of leading a double life is too much. One of Grossberg’s patients thought it was time to come clean.
All of a sudden, she’d started having terrible headaches, nausea and heart palpitations, and in an effort to end the pain, the truth came spilling out.
“She ’fessed up to me, that in addition to the medication I was giving her (a low-dose antidepressant), she was taking a modest dose of St. John’s wort,” Grossberg says.
An open relationship
Alternative and conventional approaches to health care can coexist and even thrive in an open relationship, health experts say. But honesty is key.
“You need to have a physician you can communicate with,” Guarneri says.
Tell your doctor what supplements or procedures you’re interested in trying, and ask if it the medication would be a good fit for you. Better yet, have your naturopathic and conventional doctors consult with each other about the best plan for you. And if your doctor doesn’t bring up the subject, it’s up to you to describe the herbal treatments you’re taking.
For the once two-timing David, a combination of conventional and naturopathic medicine now works best. The Seattle-area resident sees Guiltinan now as her primary physician, but for concerns about eyes and ears she still sees an M.D.
“I think it's balanced well for me now,” David says, “because I know how to use both sides.”