Sometimes finding cure isn’t the goal

DEAR DR. ROACH: My husband is a disabled Vietnam veteran. He was heavily exposed to Agent Orange, has PTSD, is an insulin-dependent diabetic, has had heart bypass surgery and has rheumatoid arthritis. He spends most days on the couch, sleeping. He has a lot of pain, even though he does take pain medicine and prednisone. He has taken methotrexate for his RA for many years, and he tried Humira, which didn’t help him. He is not interested in trying new drugs.

As you can imagine, he already takes a ton of medicine for his many chronic conditions. No doubt they, too, impact his situation. We have been to many doctors, and honestly, he has lost all faith in the medical community.

We also live in a rural area without a lot of doctors, and seeing a specialist in the closest city (100 miles or more) is difficult for him; he just doesn’t have the stamina or desire to take these lengthy trips. He is treated at the Veterans Affairs clinic, about 15 miles away.

I’m writing to you as a last resort. I’m not asking for a diagnosis. All I really want to know is the truth: Is his situation normal for someone with all his medical issues? — M.W.

ANSWER: All of his conditions can cause fatigue. Rheumatoid arthritis almost always causes pain, which can be exacerbated by his other conditions. His medications can cause fatigue.

I can’t answer what is normal, but I can say that his degree of impairment is not unusual. The sad truth is, despite improvements in our ability to manage these conditions, we do not always get the success we would like to see and that you see on TV. If his doctors have not been as forthright as they could have been about the limitations of our treatments, perhaps he wouldn’t have lost faith in them.

Improvements in function, maybe small, maybe more than small, are possible, even probable, when the goal of care is switched from “cure” to “improvement.” It is, in my mind, the most beneficial intervention your husband can have.

Keith Roach is a columnist. Email Toyourgoodhealth@med.cornell.edu.