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Methotrexate: Myths and Realities 

BJC Health
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30 сен 2024

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Комментарии : 150   
@nanou7314
@nanou7314 2 года назад
I have been on Mtx about 5 years now for PsA. I take 20 mg weekly self- injection, and 3 folic acid 5mg tabs a week (not close to injection date). I love this drug, it has given me my life back in spite of suffering pretty much all side effects at one time or another (thankfully not the lung connected side-effects). I am actually here because I was searching for remedies for Mtx hangover as I'm having a tough after-injection day today, but it doesn't happen every week. I'm just annoyed because I planned on working today and my work requires a clear head: the Mtx hangover gives me a brain-fog that would be better spent Netflix binge-watching 🙂I have had hair loss, headaches, exhaustion, nausea, and the worst... mouth sores. BUT, and it's a big but, I am still on it. These side effects are not every time, and the medication stops me being crippled like an old lady and being unable to work. They're worth it for what I get, and very importantly, they have GREATLY REDUCED by self-injecting instead of taking the weekly tablets. Also greatly reduced by taking 3x 5 mg folic acid weekly (for 20mg Mtx). I posted this for an honest, non-dramatic view of the product from a patient. My bloods are OK. I have a little bit of kidney dysfunction but that was there before and hasn't worsened. My liver is alright. I had to skip some injections because of Covid and vaccines the last year (once for booster, once for actual Covid) and the flares & symptoms of PsA remind me everytime how grateful I am for this drug. It's not all rosy, but it works.
@bjchealthAU
@bjchealthAU 2 года назад
Thank you so much for taking the time to share your journey and help others who have these decisions to make. I hope your honesty and genuineness can help many others.
@nickilema1074
@nickilema1074 Месяц назад
I have acne should I take it after I clear it up?
@e.elsibea1518
@e.elsibea1518 5 месяцев назад
I have been on methotrexate for thirty-three years, since the age of twelve. I was diagnosed at age six. I credit it, and the tireless hard working physicians & clinicians of the time period, to saving my life. Before mtx (methotrexate), considering this was the 1980's & I was diagnosed with JRA, I & my family were essentially at the mercy of my disease. Before mtx, there was thirteen 325 mg aspirin a day, which was swithched to gold salt injections, Tolectin, and Trilisate. All of that, almost destroyed my tiny body. Not to mention, the steroids. However, it has because once again a tireless effort to find the right treatment. I only offer this information because coming into contact with those who experienced mtx early on is difficult. The brand name in America back then, or one of them, was Rheumatrex, which I feel is not quite as cool sounding as Methoblastin. Lol!
@bjchealthAU
@bjchealthAU 5 месяцев назад
Thank you for sharing your story. I hope this helps many when they are considering their management collectively with their physicians.
@yasmararivera58
@yasmararivera58 Месяц назад
😊😮
@HappyCatHappyLife
@HappyCatHappyLife Год назад
Great video. I was just prescribed MTX in addition to Remicade and this video addressed all my concerns - leaving me with hope and a bit more confidence in why I’m being prescribed this. Really grateful for this type of literature being shared so easily with people across the world.
@bjchealthAU
@bjchealthAU Год назад
Thanks for the feedback. It's nice to hear something positive. I hope it goes well and thanks for sharing your journey.
@jonnyboi068
@jonnyboi068 9 месяцев назад
Did mtx work?
@MrSteamDragon
@MrSteamDragon 2 года назад
Am 64, diagnosed with RA 5 years ago. Mainly in knees and hands. Been on MTX 20mg/wk with Leflunomide 10mg/day. Folic acid 10mg a week ( 1 day before the MTX) Blood tests every 6-8 weeks - all good. No side effects - apart from some minor fatigue later on in the day. Although this might be due to the RA itself, can't really say. Very good results indeed, changed my life around. AM getting close to retirement so it was important to me that I maintain my ability to continue my hobbies/interests without the crippling effects of RA later in life. It's definitely a drug where you need to weigh up any possible side effects against the benefits (as with all drugs/treatments). Also I think, where you are able, is to find a Rheumatologist who you can trust so that you can really trust the advice being given to you. Of course MTX may not be suitable for everyone, but please don't simply dismiss it because someone else had a less than favourable experience. Finally, a lot of the Dr Googles out there don't have a clue what they are on about 🙂 Good luck.
@ericyou11
@ericyou11 2 года назад
@mrsteamdragon I’m on methotrexate the past year I’m hearing n reading horror story’s about it I’m only 30 I’m on it for arthritis and on cosentyx for my skin psoriasis how are u doing on methotrexate now
@MrSteamDragon
@MrSteamDragon 2 года назад
@@ericyou11 Hi there...well I have yet to have any adverse side effects from either the MTX or the leflunomide - but I am aware a lot of people do have mixed results. Right now the treatment is working very well for me. Personally, I would suggest that if you have not had any unfavourable side effects to date then don't dwell on it. I don't see the point of worrying about things that may not happen. However, you do need to be aware of any possible long term side effects, as you say you are only 30. So my suggestion there is to maintain a dialogue with your Rheumatologist and raise any concerns/questions with them. Initially I saw mine every 3 months to discuss blood work results and progress, now I see him every 9 months. And remember, there are no silly questions 🙂. Good luck.
@mikecheatwood713
@mikecheatwood713 Год назад
chk out mtx methotrexate called chemo drug bad on mind, changing red blood cells from circular to oblong, effects folic acid in cells that is what takes oxygen to all parts of body. wife took it for 6 months 26 mg caused bed dementia symptoms kills good and bad cells in body wicked drug for esp. women over 60 also kill babies in the w. of women with mtx, did not know or never touched it.
@madeline__xx-l7w
@madeline__xx-l7w 16 дней назад
The product monograph says it should be used as last resort medication and not because of dependence on steroids. I think you should go back and read the product monograph in details rather than handing them like candies for anyone with RA
@patkeating8421
@patkeating8421 6 месяцев назад
My sister has been diagnosed Fibromyalgia . Will this drug help her. She also has Ulcerative Colotis which is well controlled. Hoping this new drug doest make her Colotis flare up ??
@JustJulesAgain
@JustJulesAgain 2 года назад
I don't care about the name I can't pronounce half of them. Primary doctor I told, told me I just had arthritis so stop complaining. I ended up crying to my surgeon for help. I had 2 trigger fingers, and now it feels like carpel tunnel -text book. Nothing helps that but sleeping hanging off my bed. I took it for 6 months and the pain went away but I felt like crap, and couldn't wake up. SO, they tried lex-something, that gave me hives. Prednisone helped, but I know it's damaging. I don't know, have a check up coming up. Will see.
@bjchealthAU
@bjchealthAU 2 года назад
Thanks for sharing your journey. It can definitely be complex and every person is affected differently. Good luck with the ongoing journey. Hope you manage to find a little balance with the medications you use.
@trevorjessen8310
@trevorjessen8310 2 года назад
I don't like the drug but it's the only one that really gives relief
@bjchealthAU
@bjchealthAU 2 года назад
Thanks for sharing.
@mckenna9489
@mckenna9489 Год назад
Why?
@trevorjessen8310
@trevorjessen8310 Год назад
​@@mckenna9489 because it makes feel sickly and tired for a few days and also brain fog
@dianehardy9136
@dianehardy9136 Год назад
I have sarcoidosis n some arthritis and MTX was given for that
@jaimeehinojosa716
@jaimeehinojosa716 3 месяца назад
im afraid to use methotrexate any immunosuppressive drug, steroids, & biologics with mctd overlap syndrome im at loss ..soo many goods and bads...so divided
@nickilema1074
@nickilema1074 Месяц назад
Idk what to do
@etcwhatever
@etcwhatever Год назад
Sulphasalazine almost killed me. My liver failed. Im on injectable mtx waiting for the biological med.
@cainrusputin348
@cainrusputin348 Год назад
Helpful video, can I take a 20mg of Tadalafil when taking 20mg of methotrexate once a week orally ? Thanks.
@vernwrites
@vernwrites Год назад
I have recurring pyoderma gangreneosum and take methotrexate with the latest occurrence. It has helped and may be headed to remission again. I also have taken a diminishing amount of prednisone as a combo. Any success with PG will be welcome.
@maidamasoud776
@maidamasoud776 11 месяцев назад
I have RA and I was prescribed with MTX only 25mg. I've been using it for 3 years now. I take 5mg folic acid everyday. MTX makes nauseous for 2 days. 😢
@e.elsibea1518
@e.elsibea1518 5 месяцев назад
That much folic acid, in my experience, makes me nauseated. I take 2 mg a day and, sometimes, it can be almost as if I took a prenatal vitamin on an empty stomach. I was taught that 2mg/day was a decently high dose. I might ask your doctor if that is absolutely necessary 🤔. It can help with methotrexate induced nausea, but too much could induce it. Again, from my own personal experience.
@flaneuredits
@flaneuredits 7 месяцев назад
Why do i feel sick-
@gwensimpson4448
@gwensimpson4448 Год назад
I use Methotrexate
@dianehardy9136
@dianehardy9136 Год назад
Just started MTX
@asmrsleepycapricorn9939
@asmrsleepycapricorn9939 2 года назад
How many patients have developed lymphoma after taking this?
@bjchealthAU
@bjchealthAU 2 года назад
I don't have any way to answer that question with an absolute number of course. When they've looked at big series of patients on MTX, there has not been any clear causative link between MTX and lymphoma. Please do understand that the autoimmune conditions where we use MTX as treatment, will have by themselves a higher risk of lymphoma. The classic example would be inadequately controlled rheumatoid arthritis. Hope that helps. Regards, Dr Irwin Lim
@asmrsleepycapricorn9939
@asmrsleepycapricorn9939 2 года назад
@@bjchealthAU Thanks for your response. I was researching this drug for my brother in law and Lymphoma came up as a possibility. It also said lymphoma in some people disappeared after stopping the medication. That was scary. Thanks again ❣️
@patsyhairston8277
@patsyhairston8277 Год назад
77 don't drink smoke do illegal drugs. Got sick told I was fine got sicker had test and I have methotrexate cirrhosis
@mirr1984
@mirr1984 Год назад
Do you not get regular blood tests to check your liver? They should be doing that otherwise it's malpractice.
@maggiepope2171
@maggiepope2171 Год назад
It can be very effective. But for some patients it has very bad side effects, and I have helped some avoid it or come off it with medicinal herbs and diet.
@MrVjt
@MrVjt 9 месяцев назад
Could you tell me more please..
@Snickerdoods.x
@Snickerdoods.x 6 месяцев назад
All the herbs and diet will not fix or reverse something like rheumatoid arthritis. It's a progressive disease.
@celesterosales8976
@celesterosales8976 5 месяцев назад
Right! Looks like no reply
@maggiepope2171
@maggiepope2171 5 месяцев назад
@celesterosales8976 Ooops! I just forgot! Although I change the diet a bit differently for each individual, the basics are; come off all ultra processed foods, this isn't just the newest fad we have been saying this for years. Then I put them on anti-inflammatory herbs, usually in a tincture: meadowsweet, willow, devil's claw, plantain, turmeric. If they have the odd flare up I usually recommend following an antihistamine diet for a couple of weeks.
@celesterosales8976
@celesterosales8976 5 месяцев назад
@@maggiepope2171 hi thanks!
@anastasiajarrell9006
@anastasiajarrell9006 9 месяцев назад
What are the side effects, if any, for a caregiver for someone on lose dose (long term) methotrexate?
@bjchealthAU
@bjchealthAU 9 месяцев назад
Maybe this video can help - ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-UjioXtfyJFc.html
@sonyagair1219
@sonyagair1219 Год назад
I was diagnosed with RA, Lupus and Fibro in 2013. RA was apparently advanced as some of the bones in my hands had already holes in them. Dr's never picked any of this up. I was actually diagnosed with OA and thought...hey maybe I should see a Rheumatologist and not just go on what my GP said. He was hundred percent correct on the OA, but I wanted a Specialist in that field. I have been on MT since then. Combined with folic acid. Plus biologics" Actemra". So once a week I take both injections on a Friday and I am literally man down for the weekend. I know it helps but man it's getting to me! I get all the side effects. 😢 There must be other options out there...
@cassandralangton185
@cassandralangton185 Год назад
Methotrexate is poison to me. They say that everybody is different. However it affected me the same way. I was sick as a dog for 2 days straight from the MTX. No way to live. Nasty drug
@Bichonfrise369
@Bichonfrise369 10 месяцев назад
I was also diagnosed 2013 fibromyalgia lupus RA.
@MICHAELCAMPBELL69
@MICHAELCAMPBELL69 10 месяцев назад
Have been prescribed it
@alijawad2042
@alijawad2042 2 месяца назад
Very good. Thanks
@bjchealthAU
@bjchealthAU 2 месяца назад
Thanks for the positive feedback
@agaragar21
@agaragar21 2 года назад
That was a wonderful explanation !
@bjchealthAU
@bjchealthAU 2 года назад
Thank you for your feedback. Love the support
@visichinappa8531
@visichinappa8531 2 года назад
Currently on methotrexate
@jonnyboi068
@jonnyboi068 9 месяцев назад
Did it work?
@visichinappa8531
@visichinappa8531 2 года назад
Polymyalgea rheumatica
@visichinappa8531
@visichinappa8531 2 года назад
Sore stiffness in hands and body
@0seve291
@0seve291 10 месяцев назад
Im prescribed and never used it... thinking about it tho
@jonnyboi068
@jonnyboi068 9 месяцев назад
Did you try it?
@0seve291
@0seve291 9 месяцев назад
@@jonnyboi068 yes im taking it for chronic constant autoimmune eye inflamation and havent flared since starting :) luckily no side effects besides waking up thirsty or sore throat day after taking so im just drinking more water 👍
@shahreebell5897
@shahreebell5897 8 месяцев назад
Me too. Im too scared of the horrible side effects people talk about. I get unwanted side effects from most meds I take, even nausea from simple panadol.
@0seve291
@0seve291 8 месяцев назад
@@shahreebell5897 i started right after i posted this and havent had issies besides dry mouth next day so i drink extra water im taking it for chronic iritis amd havent flared since
@jeffreyaccardi5689
@jeffreyaccardi5689 Месяц назад
My wife passed away due to the missed diagnosis or the failure to recognize or diagnose Methotrexate toxicity.
@PaperclipProphets
@PaperclipProphets 26 дней назад
So sorry for your loss😢
@puritynkatha8058
@puritynkatha8058 Месяц назад
I have been on mtx for a while now and the disease has slowed down.Am able to move with ease and the pains are zero.The problem is the U T I infections,nausea and fatigue.
@bjchealthAU
@bjchealthAU Месяц назад
It’s great to hear that Methotrexate (MTX) has helped slow down your disease and brought relief from pain! However, it’s understandable that dealing with side effects like UTIs, nausea, and fatigue can be frustrating. I recommend discussing these symptoms with your rheumatologist, as they may need to adjust your treatment plan or prescribe medications to help manage these effects.
@mother548
@mother548 4 месяца назад
Developed nodules arms and hands dark skin hands and feet skin patches thighs and legs
@arunagupta5015
@arunagupta5015 11 месяцев назад
One of my Doctors started Methotrate but the Second Doctor asked me to stop it and started Sulfasalazine and Iguratil. Then I showed to a Rheumatologist he told me to stop all the medicines. 16:46 Itoo
@arunagupta5015
@arunagupta5015 11 месяцев назад
I took 10 mg of Methotrate for 8 weeks. Should I stop it as no proper diagnosis is made
@arunagupta5015
@arunagupta5015 11 месяцев назад
Nausea
@bjchealthAU
@bjchealthAU 11 месяцев назад
We have a bias towards rheumatologists for obvious reasons. If you do not have a diagnosis, I would work with your rheumatologist until you can figure it out then appropriate management can take place@@arunagupta5015
@ratneshshrivastava6444
@ratneshshrivastava6444 Год назад
ILD can be a adverse effect
@jmanuelforero3850
@jmanuelforero3850 2 года назад
if you are a man planing to start a family, what's the alternative to MTX? thanks
@Wooburnmusic
@Wooburnmusic 2 года назад
Methotrexate almost killed me.
@jennifer7648
@jennifer7648 2 года назад
How? What happened? I am super sensitive to medicines and am kind of afraid to go to a rheumatologist for this reason. Here in America they seem to prescribe it like it's a cure-all.
@Wooburnmusic
@Wooburnmusic 2 года назад
Hi there Jennifer, thankyou for your message, well, when I began to suffer symptoms it was soon diagnosed as rheumatoid arthritis, they put me on methotrexate and something else, in time I began to suffer symptoms of brain fog, blurred vision, hair falling out and general being not with it. It did work though, but one night overnight, I couldn't breathe too well and that was my decision to stop taking it, I went on to leflumonide which also helped but to the cost of those side effects I stopped taking it as well, (. Blood tests were needed every two weeks or so ) I had a bad relapse in my left hand, wrist and fingers, the hand became so swollen that it looked like two big Mac burgers put together, the pain was so bad that I couldn't even pick up a sheet of paper ! Well, It did die down after around a week or so, the stiff ess in my legs and knees remains and varies, the only meds I am taking now are just the occasional pain killers but nothing drastic, so I am in some sort of remission at this time, who knows when the next flare up will happen? Could be months or even years with luck but as you say, they seem to hand these medications out as tho they were candy and we are the guinea pigs ! Those meds have definitely affected me and although I stopped the leflumonide a k in October 2021 I fear it will take time for it to be completely out of my system, being a gigging guitarist it devestated me when I just couldn't get my left hand around the guitar Neck properly and I really thought that it was the end of playing 🎸🎵 but things have improved for now and am playing sessions again if reduced times.🙂👍 Yes those meds did help but just be aware of those side effects should you need to go them. Best wishes to you.🌷 🎼🎸🎵🎶
@jennifer7648
@jennifer7648 2 года назад
@@Wooburnmusic Thank you so much! I am digging in and doing a lot of research so I can be well educated on all of it so I can choose what is best for me. Prayers for you 🙏
@Wooburnmusic
@Wooburnmusic 2 года назад
@@jennifer7648 hello Jennifer, thanks again for your message, I would advise you to see your rheumatologist it will be good to get a professional opinion, not everyone is the same of course and any potential prescribed medication will be tailored to your particular needs. Very best wishes to you and remember that it isn't all bad. 🌹
@mohansinhjhala9754
@mohansinhjhala9754 2 года назад
I'm using MTX for 16 years.For last two years I've experienced some side effects that are worse than avoiding deformities.At the age of 82 they're just unbearable.It is a monstrous drug.
@dennisunfft
@dennisunfft Год назад
My Doc let me have 3 pills of 2,5 mg TWICE a week (3 Monday & 3 Tuesday) is this normal? I am diagnosed with RA
@bjchealthAU
@bjchealthAU Год назад
Usually, the dosing is once weekly. However, rheumatologists will occasionally deviate from this (typically to reduce side effects). However, please confirm this with your doctors. It would make sense that you actually ask them why it's that way in your case.
@HYoung777
@HYoung777 Год назад
do i really have to take ana, rf and anti ccp all at the same time to know if i had ra?
@omgediter1292
@omgediter1292 Год назад
currently on mtx
@zitasolidum3850
@zitasolidum3850 Год назад
Currently used MTX
@lynebenoit5124
@lynebenoit5124 2 года назад
I took it for three weeks and no way I am going to take this, no, no, no
@utahnick
@utahnick 2 года назад
What happened? I just started
@lynebenoit5124
@lynebenoit5124 2 года назад
I took it and the back of my head was completely numb, couldn’t feel it no more and I was so dazed out and I started itching all over my body this medication is from hell, I decided that I was going to follow a strict diet, water and lemon in the morning then fruits and finish my day with a vegetable salad and take prebiotic and probiotics. Been doing it for a month know and no more pain in my knees and neck and arms it’s working. Go listen to this old guy on RU-vid it’s called fruit n sports
@Navistar-cu2po
@Navistar-cu2po 2 года назад
Methotrexate causes liver disease and pancreatic cancer
@utahnick
@utahnick 2 года назад
@@Navistar-cu2po Ugh
@Navistar-cu2po
@Navistar-cu2po 2 года назад
@@utahnick I have observed many cases of people (some I know personally) that took Methotrexate within 1 month developed liver disease and within a year or two manifested into fatal pancreatic cancer. They are all dead, and many new cancer centers are finding new patients from its use. Cumberland Pharma is committing genocide.
@omgediter1292
@omgediter1292 Год назад
Ra
@MICHAELCAMPBELL69
@MICHAELCAMPBELL69 10 месяцев назад
Num 2
@zitasolidum3850
@zitasolidum3850 Год назад
RA
@ranveerranveer6557
@ranveerranveer6557 2 года назад
I have been using mtx with hydroxycloroqunane past 4 month , so how long I have to use this medicine plz tell me
@bjchealthAU
@bjchealthAU 2 года назад
Sorry this is difficult to answer. It is best to approach whomever prescribed the medication as they should know you the best and your specifics. It would not be appropriate for us to comment.
@utahnick
@utahnick 2 года назад
I'm taking both now myself. Are you feeling relief from it? I feel like crap today
@trevorjessen8310
@trevorjessen8310 Год назад
I have been on it for 7 years
@juliehammond5822
@juliehammond5822 Год назад
I found this very reassuring. Had some trepidation about starting mtx three weeks ago but feel much better about it now. Thank you.
@bjchealthAU
@bjchealthAU Год назад
Glad we could help. Good luck with it.
@todorstoyanov1111
@todorstoyanov1111 Год назад
Start it, nothing wrong with this drug!!!
@juliehammond5822
@juliehammond5822 Год назад
@@todorstoyanov1111 Thanks for the reassurance.
@todorstoyanov1111
@todorstoyanov1111 Год назад
@@juliehammond5822 I have been taking methotrexate 15mg for 1 year.I hope you don't mind if i advise you to take it on a day followed by an off day. I take it after food together with famotidine(drug lowering stomach acid production). This way i have the least problems with my stomach. Some times i get headache or feel a bit dizzy on the following day. Drink more water , rest, and everything will be fine.Good luck!!
@juliehammond5822
@juliehammond5822 Год назад
@@todorstoyanov1111 Many thanks.
@roxannestento173
@roxannestento173 6 месяцев назад
Great info!!!
@bjchealthAU
@bjchealthAU 6 месяцев назад
Thanks for the positive feedback. Appreciate it
@mohansinhjhala9754
@mohansinhjhala9754 2 года назад
I've been taking MTX for over 16 years. Important benefit is prevention of deformities of fingers. Side effects are problem of overthinking,skin infections,cartilage degeneration of Right Shoulder.Perpheral Neuropathy of feet , Prostrate problem and so on. Is doze of 15 mg /week optimum at the age of 83 ?
@tricia-leewairau4229
@tricia-leewairau4229 2 года назад
I have been on this medicine for 22 years, this was the best explanation I have ever had. Why do some specialist only recommend 1 does of folic acid a week, I have been told to have once a week, 3 times a week and now 6 days a week? Why is this.
@utahnick
@utahnick 2 года назад
I just started last night. The Dr has me taking folic acid every day. Are you taking MTX still?
@mohansinhjhala9754
@mohansinhjhala9754 2 года назад
I've been on MTX for 16 yrs.For 2 yrs 2018&19 the doze was 7.5 /wk, then for next 2 yrs 15mg and now in 2022 it's 20 mg per week. I'm 83 yrs of age.Isnt it too high?
@utahnick
@utahnick 2 года назад
@@mohansinhjhala9754 I feel like that is what they'll do with me as well
@mohansinhjhala9754
@mohansinhjhala9754 2 года назад
MTX causes no. Of side effects namely skin infections, overthinking, disturbed sleep etc. Got peripheral neuropathy 2 yrs back.Neourologist says it is due to RA.And lots of other problems.The only advantage of RA is prevention of deformities.
@odetemartins1103
@odetemartins1103 2 года назад
Methotrexaate taking for lupus and fibromy For 10 Years and all ready lost my colon now kidneys now lungs take 6 tablets a day🌹💜
@Rautelakimi
@Rautelakimi 2 года назад
Can I take methyl folate with vitamin b12 instead of folic acid which is a active form of iron
@bjchealthAU
@bjchealthAU 2 года назад
We don't quite understand your question as we feel the compounds you have stated are unrelated. I would suggest speaking to your treating physician or pharmacist to gain clarity.
@visichinappa8531
@visichinappa8531 2 года назад
Polymyalgea is much better lately so taking 3 to 4 mtx tabs once per week. Question ...is what dosage do I take of folic acid and directions of taking this?
@lorettaturner9144
@lorettaturner9144 Год назад
Hi, I have been diagnosed with Sarcoidosis of my lungs and have been prescribed this medication at 7.5 mg. I just picked it up today. I live in California and I am worried about taking it. Any advice?
@bjchealthAU
@bjchealthAU Год назад
It is not appropriate to give specific advice on this platform. I would suggest listening to your treating physician/s especially if you trust them and given them feedback as to how you are doing. Important to work with them collaboratively if possible.
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