Interview with Dr. Isabelle Amigues, Integrative Rheumatologist
Recently, I had the pleasure of sitting down to chat with Dr. Isabelle Amigues, an integrative rheumatologist here in Denver, CO. She and I bonded over collaborative care, past lives in New York City, raising kids in this complicated world and, of course, holistic approaches to patient care.
Isabelle Amigues, MD trained both in Paris as well as Columbia University, in New York City. She is the author of multiple book chapters and scientific articles. At age 40 she was diagnosed with stage IV metastatic breast cancer. A timely meeting with a non-traditionally trained practitioner taught her a different approach to disease. She experienced the power of meditation, visualization, energy healing and love. Her journey through cancer inspired her to learn more about these alternative techniques, and she has now integrated them into her own practice. At Tendwell’s Denver functional medicine practice, we take a deeply integrative approach, similar to Dr. Amigues’, combined with the best that conventional medicine has to offer. It is always a great learning experience to discuss medicine with other professionals.
Here is my interview with Isabelle:
Tendwell: What drew you to practicing in an integrative approach to rheumatological care of your patients?
Dr. Amigues: I believe it offers a more holistic and patient-centered approach to managing the complex conditions that affect my patients. Rheumatological diseases can be challenging and multifaceted, often involving chronic pain, inflammation, and various systemic manifestations. Traditional medical treatments, such as medications and surgeries, are undoubtedly essential, but they may not address all aspects of a patient's well-being.
Integrative care takes into account not only the physical symptoms but also the emotional and psychological impact of these conditions. It recognizes that a person's overall health is influenced by their lifestyle, diet, stress levels, and even their mental state. Moreover, an integrative approach encourages patients to be active participants in their own health, promoting self-care and empowering them to make lifestyle changes that can improve their quality of life. I believe that this approach fosters a stronger doctor-patient relationship and helps patients achieve better outcomes and a higher level of satisfaction with their care.
Additionally, my own personal history (I was diagnosed with stage IV breast cancer at 40) as a patient made me realize that high tech medicine can be so isolating. I loved my integrative practitioners the most because I felt that they really “saw” me and not just the condition I had. Ultimately this is the feeling I want my patients to have when they come to the UnabridgedMD practice.
Tendwell: What is your general approach to treating patients with rheumatic conditions?
Dr. Amigues: I love this question! The first and most important point that I want to share is that if a patient has a rheumatic condition, there is SO much hope! The field of rheumatology has had so many breakthroughs in the last 20 years that it is really the most exciting specialty to work in (I may be a little bit biased…).
When I treat patients with rheumatic conditions, my approach is centered around providing comprehensive care that combines evidence-based medical interventions with a patient-centered, holistic perspective. I believe that the first encounter is one of the most important times with a patient. We need to establish a diagnosis and in rheumatology, to do so, we need
to perform a thorough evaluation. One of my favorite things at UnabridgedMD is that we have a 90 min first visit evaluation. This has proven to be one of the most valuable added benefits of the practice. Indeed, diagnostic tests, such as imaging and blood work, are used to confirm the diagnosis and understand the extent of the condition but will never replace time with patients. In medicine school, I was taught to “listen to the patient, they tell (us) their diagnosis” and this could not be truer than in rheumatology.
I also believe in actively involving patients in their care. I listen to their concerns and preferences, ensuring that their individual needs and goals are considered when developing a treatment plan.
I also take the time to educate patients about their condition, its causes, and the available treatment options. This empowers them to make informed decisions about their care. In fact, I recently even created a YouTube Channel to make sure that my patients can review some of these topics (Rheumatology 101 by Dr. Isabelle Amigues).
Medication Management: Medications are often a fundamental part of rheumatic disease management. I prescribe appropriate medications to control inflammation, manage pain, and most importantly aim for disease remission.
I also work with patients to identify and address lifestyle factors that can influence their condition, such as diet, stress management, and smoking cessation.
Finally, depending on the patient's preferences and the specific condition, I may incorporate complementary therapies like acupuncture, dietary supplements, and mind-body techniques to enhance overall well-being and symptom management.
Overall, my goal at UnabridgedMD is to provide comprehensive and compassionate care that addresses not only the physical symptoms but also the emotional and psychological aspects of living with a rheumatic condition. By combining evidence-based medicine with a patient-centered approach, I aim to improve the quality of life and well-being of my patients.
Tendwell: How do you balance conventional medical treatments with holistic therapies in your practice?
Dr. Amigues: Balancing conventional medical treatments with holistic therapies in my practice is essential for providing comprehensive care that addresses the unique needs and preferences of each patient. Here's how I approach this balance:
- Individualized Treatment Plans: I start by getting to know my patients, understanding their specific rheumatic condition, medical history, and lifestyle. Based on this information, I develop individualized treatment plans that incorporate both conventional and holistic approaches.
- Evidence-Based Medicine: Conventional medical treatments, such as disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and biologics, are well-established and backed by scientific evidence. I use these treatments as a foundation to aim for disease remission, manage the underlying disease, reduce inflammation, and control pain.
- Complementary Therapies: Holistic therapies, such as acupuncture, dietary modifications, and mindfulness techniques, are considered as complementary to conventional treatments. I discuss these options with my patients, ensuring that they are safe and evidence-based.
- Patient-Centered Decision-Making: I engage in open and honest discussions with my patients. I really believe that a doctor is here to be the witness to their patients’ healing. It really is all about patient empowerment.
- Monitoring and Assessment: I closely monitor the progress of each patient and regularly assess the effectiveness of their treatment plan. If holistic therapies are incorporated, I evaluate their impact on the patient's symptoms and overall well-being.
- Adjustment and Collaboration: If a holistic therapy is not producing the desired results or if the patient experiences adverse effects, I am open to adjusting the treatment plan. Collaboration with other healthcare professionals, such as nutritionists, physical therapists, and acupuncturists, is vital in ensuring the safe and effective implementation of holistic therapies.
- Safety First: The safety and well-being of my patients are paramount. I ensure that any complementary therapies are provided by qualified practitioners and do not interfere with or harm conventional treatments.
- Regular Reevaluation: As a patient's condition and needs change over time, I regularly reevaluate and adjust the treatment plan as necessary, ensuring that it remains aligned with their preferences and the best available evidence.
Ultimately, balancing conventional and holistic therapies in rheumatological care allows me to provide a more well-rounded and patient-centered approach, ultimately leading to better outcomes and improved quality of life for my patients. It's all about finding the right combination of treatments that work best for each individual while prioritizing safety and evidence-based care.
Tendwell: Would you mind describing some holistic or complementary therapies you might recommend for rheumatic conditions?
Dr. Amigues: Certainly, holistic or complementary therapies can play a supportive role in the management of rheumatic conditions. It's important to note that these therapies are often used in conjunction with conventional medical treatments and should be discussed with a healthcare provider before implementation. Here are some holistic or complementary therapies that I might recommend for patients with rheumatic conditions:
- Acupuncture: Acupuncture involves the insertion of fine needles into specific points on the body. It is believed to help relieve pain, reduce inflammation, and improve overall well-being. Some patients with rheumatic conditions report a reduction in pain and increased joint mobility after acupuncture sessions.
- Dietary Modifications: A balanced and anti-inflammatory diet can be beneficial for managing rheumatic conditions. I may recommend dietary changes, such as increasing the consumption of foods rich in omega-3 fatty acids (e.g., fatty fish), antioxidants (e.g., colorful fruits and vegetables), and reducing processed foods and sugar. Some patients find relief from inflammation and joint pain through dietary adjustments.
- Mind-Body Techniques: Techniques like mindfulness meditation, yoga, and tai chi can help manage stress, improve flexibility, and reduce pain. These practices can be particularly useful for patients with rheumatic conditions, as they promote relaxation and enhance overall well-being.
- Massage Therapy: Massage therapy can help improve circulation, reduce muscle tension, and promote relaxation. It may provide temporary relief from muscle and joint pain associated with rheumatic conditions.
- Physical Therapy: Physical therapists can develop personalized exercise programs to improve joint mobility and muscle strength. These exercises can help patients maintain functional independence and reduce pain.
It's important to emphasize that the effectiveness of these holistic and complementary therapies can vary from person to person. Before starting any of these treatments, it's crucial to consult with a healthcare practitioner who is knowledgeable about your specific rheumatic condition to ensure that these therapies are safe and appropriate for your individual needs. Moreover, they should complement, not replace, conventional medical treatments.
Tendwell: What lifestyle and dietary changes do you typically recommend to support rheumatic health?
There are more and more studies that are looking and supporting lifestyle changes in patients with rheumatic disorders. Some of them include:
- Smoking Cessation: If patients are smokers, I strongly recommend quitting smoking. Smoking has been linked to an increased risk of rheumatoid arthritis and can exacerbate symptoms of rheumatic conditions. I am a former smoker and have some tools that I share with my patients. Probably because I am a former smoker, “my” (really it’s my patients) success rate is super high and I am so proud of my patients!
- Regular Exercise: Encourage patients to engage in regular, low-impact exercises such as walking, swimming, or cycling. These activities help maintain joint mobility, muscle strength, and overall physical fitness.
- Weight Management: For patients who are overweight, weight loss can significantly reduce the stress on weight-bearing joints, which is especially important for individuals with conditions like osteoarthritis. There is also a relationship between adipose (fat) tissue and inflammatory arthritis, so losing weight can have a direct impact on patients with rheumatoid arthritis or psoriatic arthritis.
- Stress Management: Chronic stress can exacerbate symptoms of rheumatic conditions. I encourage patients to explore stress-reduction techniques such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation.
- Dietary Changes: this could be a full blog post by itself. Overall, I encourage patients to eat an Anti-Inflammatory Diet and to limit Processed Foods.
Tendwell: How do you approach pain management for rheumatic conditions, especially if patients prefer non-pharmaceutical options
Dr. Amigues: It is important to realize that If a patient has an inflammatory rheumatologic condition, the pain will go away once we get them to minimal disease activity or disease remission. So, our aim for treatment is to get to disease remission! And getting there will absolutely get rid of the pain. Using anything else would be like a band aid hiding the real cause of the pain.
Tendwell: Talk about a patient success story or case study where holistic/integrative approaches were particularly effective?
Dr. Amigues: With pleasure! I just had a patient that saw me at UnabridgedMD and is a great example of a success story!
Let’s call that patient Mick. Mick was diagnosed with rheumatoid arthritis (RA) several years ago but did not follow up with any rheumatologists for many years as he never left heard and did not want to be taking medications. He presented to me with severe RA, with painful and swollen joints and inability to do anything with his hands. We started by discussing his goals and his interest in exploring non-pharmaceutical options to manage his RA. We agreed that given how severe his RA was, non-pharmaceutical options would not be enough to get him to remission, and we also discussed how he could use them to complement his care.
He started treatment with conventional antirheumatic drugs AND also did some work that included the following: 1. mindfulness meditation 2. Yoga and 3. Dietary Modifications.
He is now in disease remission. Mick is certain that he achieved disease remission thanks to the combination of his medication and the complementary techniques. I support his view. By combining evidence-based conventional treatments with non-pharmaceutical strategies, we were able to improve his overall health, reduce pain, and enhance his quality of life. His success story underscores the importance of considering each patient's individual needs and preferences when creating a treatment plan for rheumatic conditions.
Tendwell: What type of patient do you just love to work with? Who is a great fit for your practice?
Dr. Amigues: I value and appreciate working with a wide range of patients, on the top of my head here are certainly certain qualities and characteristics that make a patient an ideal fit for my practice. A great fit for my practice typically includes:
- Someone with a medical puzzle: I really see myself as “Dr House without the attitude”. My double training both in France and New York City at Columbia University, really is an advantage. I love complicated case and finding answers at medical mysteries.
- Patient with inflammatory arthritis such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Lupus, gout or pseudogout.
- Patients who want to get to disease remission or at least minimal disease activity. As one once said, my mission is remission! And it really is. With UnabridgedMD I feel that I Finally have the ability to offer the best rheumatologist care, and this is why I am for the best outcome for my patients.
Tendwell: Collaboration with other medical professionals can be crucial for comprehensive care, especially if you have multiple health conditions, do you tend to work collaboratively with other healthcare providers or specialists when needed? What does this look like?
Dr. Amigues: Absolutely, collaboration with other healthcare providers and specialists is crucial for comprehensive care, especially when patients have multiple health conditions, including rheumatic conditions. I strongly believe in a multidisciplinary approach to healthcare. Here's what collaboration with other medical professionals typically looks like in my practice:
Referrals to Specialists: If a patient has a rheumatic condition that requires specialized care, such as rheumatoid arthritis or lupus, I will refer them to a rheumatologist. These specialists have expertise in diagnosing and managing autoimmune and inflammatory conditions. I also collaborate with other specialists like orthopedic surgeons, physical therapists, and occupational therapists as needed.
Regular Communication: I maintain open lines of communication with specialists and other healthcare practitioners involved in a patient's care. This communication ensures that we have a complete understanding of the patient's medical history, current condition, and treatment plan.
Shared Care Plans: In cases where a patient has multiple health conditions, such as rheumatic disease and diabetes, I collaborate with the patient's primary care physician to develop a shared care plan. This plan addresses how to manage both conditions effectively without causing conflicts in treatment.
Joint Consultations: In some instances, I may coordinate joint consultations with specialists to discuss a patient's treatment options. This can be particularly helpful when complex decisions need to be made, such as whether to proceed with surgery or to explore non-pharmaceutical therapies.
By collaborating with other healthcare providers and specialists, I can offer my patients a more comprehensive and coordinated approach to their care. This ensures that all aspects of their health, including their rheumatic condition and any coexisting conditions, are addressed effectively and with a focus on their overall well-being.
Tendwell: What are some of your self-care practices that you find helpful in your own life?
Dr. Amigues: Self-care is essential for maintaining my physical and mental well-being and providing the best care to my patients. Here are some self-care practices that I find helpful in my own life:
Regular Exercise: I love rock climbing and do so at least 2-3 times a week.
Healthy Eating: I prioritize a balanced diet that includes plenty of fruits, vegetables, lean proteins, and whole grains. I avoid processed food even though sometime it could be easier.
Mindfulness Meditation: Practicing mindfulness meditation helps me manage stress, improve concentration, and maintain emotional well-being. It's a tool I recommend to my patients, and I use it in my own life as well. In fact, when I miss my 10 min daily session, I feel it now.
Self-Reflection: I regularly engage in self-reflection to assess my work-life balance, set goals, and evaluate my overall well-being. This practice helps me make adjustments and improvements as needed.
Seeking Help When Necessary: Just as I encourage my patients to seek help when needed, I also recognize the importance of seeking professional help if I experience challenges or stressors that I cannot manage on my own. When I was dealing with cancer, I had 5 “coaches”!
Self-care is not just about setting a good example for my patients; it's a fundamental part of my own health and resilience. It allows me to provide the best care to those who rely on me while maintaining my own well-being and balance in life.
Website: www.UnabridgedMD.com
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