What if we asked a different question about disease?

When something goes wrong with our health, one of the first questions we tend to ask is, “What can I take for this?” We have a headache, we reach for something for pain. Our blood pressure rises, we may be prescribed a medication to lower it. Our blood sugar becomes elevated, and medication may be prescribed to control it. We develop reflux, inflammation, sleep problems, or another chronic condition, and naturally we want something that will make the problem better.

There is nothing inherently wrong with that. Medications can relieve suffering, prevent complications, control dangerous conditions, and save lives. After more than 30 years working as a respiratory therapist, much of that time in critical care, I have seen modern medicine do extraordinary things. I have watched medications open airways, control dangerous heart rhythms, treat severe infections, lower dangerously high blood pressure, prevent blood clots, and help keep critically ill patients alive.

But I have also come to believe that there is another question we need to ask much more often:

What is contributing to this problem in the first place, and is there anything I can change?

That question isn’t anti-medicine. It isn’t suggesting that every illness is caused by lifestyle or that every disease can be reversed by changing what we eat or how we live. Genetics, aging, infections, autoimmune disease, environmental exposures, injuries, medications, hormonal disorders and countless other factors can contribute to disease. Sometimes we do everything “right” and still become sick.

But many of the chronic diseases affecting people today have at least some modifiable risk factors. When those factors exist, simply controlling the symptom or the laboratory number without asking what may be contributing to it can leave an important part of the health picture unexplored.

Think about high blood pressure. If someone’s blood pressure is dangerously elevated, lowering it is important. Untreated hypertension can damage the heart, kidneys, brain and blood vessels. Medication may be absolutely necessary. But lowering the number with medication doesn’t make the question of why that person’s blood pressure is elevated irrelevant. Excess body weight, sleep apnea, smoking, alcohol, dietary factors, certain medications, kidney problems, endocrine disorders, genetics and other factors can all play a role. Sometimes several are operating at the same time.

The medication may be controlling the blood pressure while one or more contributors to the hypertension are still present.

That doesn’t mean the person should stop taking the medication. It means we shouldn’t necessarily stop asking questions just because the medication worked.

Type 2 diabetes provides another example. A person generally doesn’t go from completely normal glucose regulation to type 2 diabetes overnight. Metabolic changes can develop gradually over years. Insulin resistance may increase while the body compensates by producing more insulin. Eventually that compensation may no longer be enough to keep blood glucose within the expected range. By the time an A1C or fasting glucose finally crosses a diagnostic threshold, the underlying metabolic process may have been developing for quite some time.

Medication can be an important part of treating diabetes, but wouldn’t we also want to understand what modifiable factors may be contributing to the metabolic dysfunction? Nutrition, physical activity, sleep, body composition, certain medications, alcohol and other medical conditions may all be relevant depending upon the individual. Genetics may also make one person much more susceptible than another.

Again, the question shouldn’t automatically be, “How do I get off my medication?”

A better question is, “How can I improve my health enough that my body functions as well as it possibly can, while using medication when I need it?”

There is an important difference between those two goals.

I think one of the problems in the way we sometimes view healthcare is that we mentally separate medical treatment from everything we do outside the doctor’s office. We think of a prescription as healthcare, while food, sleep, exercise, alcohol, smoking and other daily behaviors somehow belong in a different category.

Your body doesn’t recognize those categories.

Everything that enters your body and everything you repeatedly do affects physiology in some way. Food affects physiology. Sleep affects physiology. Physical activity affects physiology. Smoking affects physiology. Alcohol affects physiology. Stress affects physiology. Medications affect physiology. Your body composition, hormones, genetics and existing diseases affect physiology.

And all of those things can interact.

That is why I think we need to become much more curious about what was happening before a diagnosis appeared.

What changed?

Was the change sudden or gradual?

What was happening a year before the diagnosis? Five years before it?

Did weight change? Did activity decrease? Did sleep deteriorate? Was a medication started? Did eating habits change? Did alcohol consumption increase? Did blood pressure, glucose or other measurements gradually begin moving in the wrong direction?

Sometimes there will be an obvious connection. Sometimes there won’t be one at all. And sometimes the answer will involve several factors rather than one neat explanation.

The purpose of asking these questions isn’t to blame ourselves for becoming sick. Blame isn’t useful. The purpose is to identify something we can potentially change.

If something we’re repeatedly doing is contributing to a health problem, continuing to do it while adding treatments for the consequences doesn’t make much sense if that exposure can reasonably be changed.

Smoking is perhaps the easiest example to understand. If someone with chronic lung disease continues to smoke, an inhaler may help open the airways and reduce symptoms, but it doesn’t make continued smoke exposure harmless. The medication has an important job, and stopping the damaging exposure has another important job. Those aren’t competing treatments.

The same principle can apply elsewhere in health. If excessive alcohol consumption is damaging the liver, we need to address the alcohol exposure, not simply watch the liver enzymes. If untreated sleep apnea is contributing to other health problems, treating only the downstream consequences while ignoring the sleep apnea leaves an important contributor untreated. If metabolic health is deteriorating, controlling blood glucose doesn’t suddenly make nutrition, physical activity, sleep and body composition irrelevant.

This doesn’t mean every person can simply “lifestyle” their way out of disease. That is an oversimplification, and it can become dangerous when people are persuaded that needing medication represents some kind of personal failure.

It doesn’t.

I have watched medications save too many lives to pretend otherwise.

The objective isn’t to choose between medicine and lifestyle. The objective is to use every appropriate tool available to improve health.

Sometimes that will mean medication for life. Sometimes improving modifiable factors may allow a healthcare provider to safely reduce medication. Sometimes lifestyle changes can dramatically improve a condition without eliminating the need for treatment. Sometimes they may reduce the likelihood of complications even when the underlying disease cannot be reversed.

The goal should be better health not earning a trophy for taking the fewest medications.

There is another part of this conversation that I think patients need to understand. We place enormous confidence in laboratory testing, and laboratory testing is extremely valuable. But your laboratory report is not a complete biography of your health.

It is information collected at a particular point in time.

A blood draw tells us what the tests that were ordered showed at that moment. It doesn’t automatically tell us everything that happened in the months or years leading up to that blood draw. Routine laboratory panels don’t test for every possible disease or every physiological abnormality. Some conditions fluctuate. Some abnormalities may not appear until a disease has progressed further. Other conditions require completely different testing.

So hearing “your labs are normal” should not automatically be translated into “there is absolutely nothing wrong with you.”

At the same time, patients shouldn’t attempt to diagnose themselves from individual laboratory values they find online. Laboratory results have to be interpreted in context by qualified healthcare professionals.

What patients can do is become better observers of their own health.

You live in your body every day. Your healthcare provider sees you periodically, sometimes for only a short appointment. You know whether something has changed between those visits. You know that six months ago you could walk through the grocery store without becoming exhausted and now you need to stop and rest. You know whether a symptom occurs every morning or only after certain circumstances. You know when your sleep changed, when your appetite changed, when your weight started moving, when you began a new medication, or when something simply stopped feeling right.

That information matters.

Instead of walking into an appointment and saying only, “I don’t feel good,” imagine being able to explain that the problem began approximately four months ago, has gradually become more frequent, occurs primarily in the morning, became noticeably worse after a particular change, and is accompanied by two other specific symptoms.

You aren’t diagnosing yourself.

You’re giving your healthcare provider better information to work with.

That’s a major distinction.

The same is true when laboratory results come back within the reference range but the symptoms continue. You don’t need to argue with your healthcare provider or announce that the laboratory is wrong. You can simply say, “I understand that the results from the tests we ran are within range, but these symptoms are continuing and they’re affecting my daily life. What else should we consider?”

That’s an informed patient asking an appropriate question.

Healthcare professionals need information. Patients possess an enormous amount of information about what happens outside the clinic, but we often don’t recognize its value until we learn how to observe and communicate it.

This is one of the reasons I encourage people to pay attention to patterns rather than waiting until something becomes severe. We shouldn’t become obsessed with every fluctuation in our bodies, but we also shouldn’t ignore meaningful changes simply because we haven’t yet crossed a diagnostic threshold.

Disease doesn’t always begin on the day it receives a name.

Sometimes the diagnosis is simply the point at which enough evidence finally exists to identify what has been developing.

And even after a diagnosis has been made, prevention still matters. Prevention doesn’t only mean preventing yourself from ever developing a disease. If you already have hypertension, diabetes, cardiovascular disease, chronic lung disease or another chronic condition, there may still be opportunities to prevent progression, complications, disability, hospitalization or additional disease.

There is still something worth protecting.

After spending decades caring for patients—many of them during the sickest moments of their lives—I believe we need to become interested in our health much earlier in the process. The emergency department and intensive care unit are remarkable places when we need them, but they are not where we want to begin thinking about the choices that affect our health.

So the next time you’re given a diagnosis or another medication is added, don’t automatically assume the conversation should end there.

Ask what the treatment is intended to accomplish.

Ask what may have contributed to the condition.

Ask whether any of those contributing factors are modifiable.

Ask what you can safely work on yourself.

Ask what you should monitor.

Ask how you and your healthcare provider will determine whether those changes are helping.

And don’t stop prescribed medications or alter treatment on your own. Significant changes in diet, weight, activity or other factors can sometimes change blood pressure, glucose or other measurements enough that medication requirements also change. Those adjustments belong in a conversation with the healthcare professional managing the medication.

The point isn’t to reject medicine.

The point is to become curious about the “why” while we’re treating the “what.”

Because if something we’re doing, consuming, ignoring or repeatedly exposing ourselves to is contributing to a disease, we deserve to know that. And if there is something within our control that can improve our health, we deserve to know that too.

Medicine can be part of the answer.

But sometimes we also need to stop doing the thing that is helping create or perpetuate the problem.

Informed Patients. Better Questions. Better Health.

Christine Blalack [ Health Educator • Speaker • Author]
Respiratory Therapist 30+ Years Critical Care Experience
PORVA Path of Resurgent Vitality & Autonomy