How Did It Ever Get This Far?

A young woman in her thirties walked into my shop recently, and I haven't been able to stop thinking about her. She wasn't simply worried about her health or looking for a quick piece of advice; she was genuinely frightened. She was frightened about what was happening to her body, frightened about the enormous number of medications she was taking and, perhaps most worryingly, frightened about what would happen if she stopped taking them.

When I asked her what medication she was currently taking, she couldn't initially remember it all. As we talked, the list gradually emerged: amitriptyline, duloxetine, topiramate, quetiapine, gabapentin, promethazine, montelukast, Spiriva Respimat, salbutamol, Fostair, zolmitriptan, cetirizine, calcium carbonate, HRT and medication for her stomach. As she continued remembering one medication after another, I found myself wondering how a young woman in her thirties had ever reached this point.

One Medication After Another

What disturbed me wasn't simply the number of medications. It was hearing her story and getting the overwhelming sense that somewhere along her health journey, one problem had followed another and one medication had followed another, until she had reached a point where even she was struggling to keep track of everything she was taking.

There were medications for pain and nerve pain, migraines, mental-health symptoms, sleep, respiratory problems, allergies and her stomach. The point is that underneath this unnecessary enormous treatment list was a young woman who was still profoundly unwell, overwhelmed and frightened.

Surely when somebody reaches this position, there has to be a point where we stop adding to the list and look at the whole picture. What was prescribed first? Why was it prescribed? What happened next? Which symptoms were present before medication and which appeared afterwards? Could side effects from one medication have contributed to another symptom? Could there be overlapping effects? ( interactions were most certainly occurring). Could nutrient status have been affected? Most importantly, has anybody sat down with her and gone through the entire story from beginning to end?

She Was Frightened to Take Them — and Frightened Not to

This was perhaps the part of our conversation that affected me most. She had become frightened of the medication itself. She was worried about what taking so many different drugs could be doing to her body, but at exactly the same time she was frightened about what would happen if she didn't take them. She felt trapped between the two.

Imagine what that must feel like. You don't feel well despite taking all of these medications, you're frightened that some of them could potentially be contributing to how you feel, but you're also terrified that stopping them could make everything worse.

With medications like these, simply telling somebody to stop taking them would be irresponsible. Some medicines can produce significant withdrawal or rebound effects if suddenly discontinued, and any reduction may need to be carefully managed with the relevant prescriber. But surely that makes a proper medication review even more important, not less.

She deserves to understand why she is taking every medication, whether the original reason for prescribing it still exists, whether there are potential interactions or overlapping effects and whether the complete medication list has been reviewed as a whole rather than each drug being considered in isolation.

And Then There Was Her Stomach

There was something else that was impossible to ignore. Her abdomen was severely distended. She told me she had previously been around a size 8, and the rest of her body was still very small, yet her abdomen was so enlarged that she appeared heavily pregnant.

I was shocked by the extent of it. Nobody can look at severe abdominal distension and simply know what is causing it, and something so significant deserves appropriate investigation. But what troubled me was discovering that stomach medication had simply become another part of an already enormous medication picture.

It immediately made me want to know when the distension began, what her digestion and bowel function were like, whether anything changed around the time it started, which medications she was taking beforehand and whether medication effects could be relevant. I would want to consider nutrition, digestion and motility while also making sure that causes requiring medical investigation had been properly excluded.

The distension itself is a symptom. It isn't an explanation. I don't want to simply silence another message from the body without asking why that message is there.

This Woman Had Already Survived Domestic Violence

Then there was something incredibly important in her history: she had survived domestic violence. Here was somebody who had already experienced significant fear and trauma in her life, and now she was standing in my shop frightened again — this time about her own body and the treatment she was receiving.

That history matters. It doesn't mean her physical symptoms are psychological and it doesn't mean medication can never be appropriate. It means that she deserved to be approached with time, compassion, safety and understanding. She needed somebody to listen without interrupting, dismissing her fears or reducing her to a collection of diagnoses.

There is an enormous difference between asking somebody, “What symptom have you got today?” and saying, “Tell me what has happened to you from the beginning.” The second question allows us to start seeing the person rather than simply the latest symptom.

When Did We Stop Looking at the Whole Person?

This is where I become frustrated. Healthcare can become incredibly fragmented. One professional may be looking at migraines, another at mental health, another at respiratory symptoms and somebody else at digestive problems. Each person may be doing their particular job, but the patient doesn't exist in separate pieces.

This woman has one body, one nervous system, one digestive system, one nutritional status, one medication list and one life history. Everything is happening to the same person.

When somebody is taking this many medications and remains profoundly unwell, I believe we have to be willing to ask whether the current approach is actually working as I am seeing similar stories everyday in clinic and in my shop. At some point, somebody needs to stop looking only at the next symptom and go back to the beginning.

What Came First?

This is exactly what I want to understand with her. What did her health look like before all of this began? What was her first symptom? What was the first medication prescribed? What happened afterwards? When did the next symptom develop, and what was prescribed for that?

Creating this chronology can be incredibly valuable because medication doesn't exist separately from the rest of somebody's health. Medicines can have side effects, medicines can interact and some can affect nutrient status, digestion, alertness, cognition, bowel function, appetite or mood.

When somebody is taking this many medicines, how could we possibly investigate their current symptoms properly without considering the complete medication history?

What Was Her Body Trying to Tell Us Before All of This?

This comes back to something I say repeatedly in my work: symptoms are messages from the body. They don't necessarily tell us exactly what the underlying diagnosis is, and sometimes a symptom is warning us about something serious that requires medical investigation. But a symptom tells us that something deserves our attention.

Pain, exhaustion, digestive disturbance, poor sleep, migraines and changes in mood are all information. When these things begin, I believe that is the time to become curious. What is happening nutritionally? How is the person eating? What is happening with blood-sugar regulation? Could deficiencies be involved? How is digestion functioning? What about hormones, thyroid function, sleep, stress, trauma and the nervous system? What do their actual blood results show? What medications are they already taking, and what changed before the symptoms began?

Controlling a symptom isn't necessarily the same as establishing why that symptom developed. The message the body is sending is rarely simply that it is lacking another medication.

Sometimes People Have Never Been Taught How Their Body Works

One of the things I find both frustrating and hopeful is how many people I meet who have never been given basic information about how their body functions. They may have spent years believing that their body has simply failed them, yet nobody has properly explained blood-sugar regulation, nutrition, digestion and absorption, nutrient status, sleep or the effects that prolonged stress can have on the body.

Some people have never even seen their actual blood-test results because they have simply been told that everything is “normal”. They don't know what was tested, what wasn't tested or whether changes have occurred over time.

I have repeatedly seen how powerful it can be when somebody begins understanding their own body. They start recognising patterns and understanding why we are making particular changes rather than simply being told what to take.

It makes me wonder how different some people's lives might have been if they had received this knowledge when their first warning signs appeared, rather than years later when their health picture had become enormously complicated.

This One Affected Me Personally

I won't pretend that I walked away from this conversation unaffected, because I didn't. Her fear stayed with me. Perhaps part of the reason it affected me so strongly is that elements of her story resonated with experiences I have had in my own life, particularly around trauma and what it feels like when somebody is suffering but doesn't feel properly heard.

I had to consciously look after myself afterwards and find some quiet because I couldn't simply switch off what I had heard. I kept thinking about this young woman going home, still feeling terribly unwell, with this enormous medication list and feeling frightened about both taking the drugs and not taking them.

It made me angry and incredibly sad. I understand that individual healthcare professionals may only see one part of somebody's health and may not realise what is happening elsewhere. But that is exactly the problem. Somebody has to see the whole person.

I Want Her to Feel Safe in Her Own Body Again

When I spoke to her, I told her I would help her as far as I appropriately could. That does not mean telling her to throw away her medication. With a medication list like hers, doing that is not the answer it has to be done in a controlled way.

What I want to do is help her begin understanding what has happened to her health. I want to look at her nutrition, digestion, blood-sugar regulation, nutrient status, sleep, hormones, nervous system, blood results and symptom history. I want to understand the chronology of her symptoms and medications and begin identifying what may actually be driving or contributing to the way she feels and what requires further investigation.

My goal is to help her become healthier. If we can improve somebody's underlying health to the point where their treatment requirements change, surely that is something worth working towards as I see vitality and optimal health come back when people take natural informed choices to help their body naturally.

She Deserves More Than This

Underneath that enormous medication list isn't a migraine patient, a mental-health patient, a respiratory patient or a digestive patient. There is a young woman. A woman who has already experienced more fear than anybody should have to, and who came into my shop frightened about her body and frightened about the very medications that were supposed to be helping her.

Despite medication after medication being added, she still didn't feel well. That is the part I cannot accept as an endpoint. When somebody is this frightened, this overwhelmed and this unwell, surely we have to stop and ask whether simply continuing down the same road is enough it certainly is not and no other options are given to people.

I don't yet know where her health journey will take us, and I would never promise somebody that nutrition or supplements can fix everything. But I can promise her something very simple: I will listen to her. I will ask questions. I will look at the whole picture and help her understand what her body may be trying to tell her taking away fear is a big step towards optimal health.

With the understanding and cooperation of the other healthcare professionals involved in her care, my hope is that we can gradually help her rebuild her health, confidence and trust in her own body.

Because nobody should be left terrified of taking their medication, terrified of stopping it and terrified of what is happening to their own body.

And when somebody reaches that point, I think we have to ask one very uncomfortable question:

How did it ever get this far?