I begin each relationship with every patient in an information gathering session. During this visit we take the time to explore symptoms, habits, daily activities, nutrition, sleep and other areas of living. Additionally, a diagnostic treatment is given. Outside of the office hour's time I spend a period of time in meditation and research to fully absorb the information I have gathered during the first and subsequent visits. In general, after the first, second or third visit a treatment map can be developed. The time it takes to cover the map, the directions a patient might choose to travel, and the time for healing vary based on many factors, the most important of which is the understanding that your healing process is guided by you.
What really is Cause? When you sprain your ankle was the uneven curb the cause? The shoe you wore that day? Your distraction while you walked? Was it that your gait was already uneven because you stubbed your toe that morning or broke a bone years earlier? If your hip hurts and you are given a diagnosis of bursitis (inflammation in the bursae of the hip) you have a label, not a cause. If you are told that your lumbar vertebrae are subluxed causing your hip to hurt, you are given a piece of the puzzle but not cause. Our society, culture and medical training are based on the idea that we are made up of parts and, that we can label and that we can break those segments and that we can fix them. We segment our lives – work, play, meditation, exercise, chores, family time—and we segment our bodies. There is currently a great interest in holistic medicine because doctors and patients are feeling the loss created by this separation into parts. In addition to the loss separation creates, each symptom is treated as something to be named and abolished. The result is that if you feel heartburn you are given a medicine. If you feel sad, you are given a medicine, if you have trouble sleeping, you are given a medicine. You now have three medicines and if you don't take them your symptoms will recur. If you do take them, you are likely to develop new symptoms. No one has stopped to ask, "what is the cause? Is it possible that these symptoms have a related cause?" While you may never know the one true cause, searching for it is part of the practice of Osteopathy and in this search, as we move closer to Cause, healing deepens and becomes more lasting and more sustained.
Though it is unwise to segment the body to find true healing, to understand how Health can optimally manifest, it is helpful to examine five major systems. The first is the Fluid or Circulatory system, including intra and extracellular fluid, blood, lymphatic and cerebrospinal fluid. This system also includes the vessels and pumps that move the fluids. The second is the neuro-endocrine-immune system, including the voluntary, autonomic, and enteric nervous systems the endocrine glands and transmitters. The immune component has both transmitters and glands. The third is the digestive system, which is actually your interface with the external world. In so far as it is controlled by the enteric and autonomic nervous systems, and functions only with the support of the circulatory or fluid system, it is inseparable from these systems. The fourth system is the Breath, which includes both primary and thoracic respiration and the structural body parts that move in inhalation and exhalation patterns. Finally, the fifth system is the overall structure of the body, which includes fascia, ligaments, bones, muscles, joints and other forms of connective tissue. Each of these systems is intricately connected to the other and affecting one positively will cause healing in the others. The first doorway to optimize health in these systems is using Osteopathic manual treatments. Osteopathic treatments are profoundly effective because they never isolate a single system. Release of the diaphragm, as a way to treat the breath allows freedom of the major blood vessels that supply the heart, ease of movement of the fascia and spinal bones and better drainage of the lymphatic vessels. By treatment of the breath in this simple way, the lymphatic fluid flows more freely and in turn this allows improved immune function and transmission of all neuro-chemical and electric signaling. A sense of ease is felt throughout the entire organism; sleep improves, anxiety decreases, energy lifts.
When a patient receives an Osteopathic treatment that balances their Autonomic nervous system, or settles their gastrointestinal disturbance or synchronizes their fluid system, healing from within is stimulated. Even small changes in these critical systems allow patients to make choices and changes (sometimes voluntary and sometimes somatic), which ultimately lead to lasting healing. Once this shift begins, changes in food choices can often propel healing forward. A continued monitoring of the Health of the patient through balancing these systems allows for continued healing which manifests as vitality and whole person health.
Decision making in medicine is a complex process based on multiple factors such as the chance of causing harm, the cost of the treatment, evidence to support the treatment and many, many other issues. Most often when doctors discuss why they have chosen a treatment they talk about “standard of care.” Ideally standard of care is based on reproducible studies, which have also stood the test of time. Quite often studies are flawed or evidence has changed or the circumstances of a study are different than your circumstances and in this situation a doctor must use other tools to determine the best treatment.* In the case of classical Osteopathy there are very few studies simply because the method of treatment is too complex and individualized to actually study effectively using the scientific method. Two critical factors are often not discussed in an analysis of why a treatment is chosen or recommended. The first is physician experience (both personal and with patients) and the second is culture of training. Because medicine is more art than science, these are viable tools in decision-making – if they are used consciously.
To explain the first issue I often use the example of a New Yorker cartoon that was given to me years ago by my grandfather. In it a rabbit wearing a white doctor's coat and stethoscope is speaking to a man in only a hospital gown and his underwear, sitting on an examining table. The rabbit says, "I think you need more carrots." This comical cartoon is in fact the way many practitioners make decisions about health care. In some cases the decision is based on a personal or family experience with a treatment. In other cases it is based on a mentor or organizations recommendations. Sometimes this is in fact the best way to make a decision but what is most important, when using this method is that the physician is conscious that his or her personal experience is directing action.
The second factor is “culture of training.” The cause of this method of decision-making is often an effort to deal with shear volume of information available. It is impossible for any human to research and know all treatment options and to know all the evidence or data that supports each option. As a result doctors often follow the lead of a respected mentor or physician with whom they have practiced. Although these may not seem like the best ways to make important decisions, at times they are the only option available to your doctor. It is up to you to be informed about your health care and how your doctor makes decisions. In the end, it is important to understand that in most situations there is not a single standard treatment that will work for all people. Exceptions to this generally include conditions that are emergencies, like trauma and heart attack and fractures, which usually have clear treatment protocols. The ratio of risk to benefit is ultimately the basis of most decisions in medicine. Osteopathic manipulation using the Biodynamic Model is unique in that it has an extremely low risk potential. Second to Biodynamic treatments in low risk are changes in nutrition. For this reason and because they are profoundly effective in many situations, these two treatment modalities are my first choice for most patients.
Another important issue to understand is that doctors and patients often have different agendas. Doctors generally have a series of conditions and lab values, which they are trying to correct – primarily these have to do with potential development and consequences of diabetes and cardiovascular disease. Doctors look at risk factors such as your weight, your cholesterol, your blood sugar and your family history and determine what medical treatment you should receive. Meanwhile patients usually don’t go to doctors because they noticed their cholesterol was high but rather they are concerned about how they feel, how much energy they have, and of course if they are experiencing pain or many other symptoms. It is important to be clear about what a treatment plan is going to address – lab values, potential disease or symptoms. It is equally important to know what health goals a patient has. Do they simply want to be relieved of their knee pain, or are they interested in improved vitality? Is it enough to be able to get through work or are mood changes powerful enough to warrant attention. This focus on goals is most importantly in the hands of the patient, but if the physician is not aware of them it is impossible to align agendas.
The current climate of medical care is strained to the point of breaking. Doctors are frustrated with insurance limitations and time limitations. Patients feel that they are not heard or seen and that they are waiting too long for too little. Communication between doctors and patients is so limited that no one is satisfied. Change is not easy but these issues have informed how I practice medicine. Communication and partnership are key and open honest discussion of treatment options and agendas for healing are the basis of how I make decisions.
The choice to use pharmaceutical prescriptions, nutritional supplements and bioidentical hormones is not exempt from the complicated process discussed above. To simplify the discussion I will group physicians into conventional, functional and restorative models. These are arbitrary and most physicians do not practice in a way that falls neatly into these categories.
A conventional physician relies most heavily on pharmaceutical prescriptions to treat symptoms and prevent disease or disease progression. Common prescriptions are for high blood pressure, cholesterol, diabetes, depression and pain. A conventional physician, in treating hormonal disturbances such as thyroid disease or menopause treats using FDA approved prescriptions in the lowest dose possible to return labs to normal and alleviate intolerable symptoms.
A restorative medicine doctor focuses treatment on hormones and lifestyle modification. Lab normal ranges are different than the normal ranges used by conventional doctors and the goal of treatment is to improve as much as possible your health and energy to youthful levels. Generally bioidentical hormones are used, which are not always FDA approved, but which do require a prescription. (see section on Hormones for more details about types of hormones available). Finally, functional medicine doctors use a variety of alternative tools, such as alternative lab testing, nutritional intravenous supplementation and herbs, as well as bioidentical hormones, and other prescription medications to treat conditions that are often chronic and poorly defined and ignored by conventional physicians.
I study and incorporate some of each of these modalities because I believe there is some value in each approach. I am also board certified in conventional family practice medicine and so I understand the choices made in this model and often suggest continuing with a treatment plan developed by your primary care doctor until changes in other areas of your life make it unnecessary. While I choose to do both conventional and alternative lab testing and may suggest herbal or bioidentical hormonal support, I use these tools judiciously. I spend a good deal of time researching sources with opposing views on the use of each option and part of my practice is to help educate you on these opposite views. I spend time in meditation and research on your particular situation, your lab results and your response to treatments. I explain how a conventional or a restorative doctor or a functional doctor might approach your results and your situation and engage you in the process of choosing treatment options. From experience and research I offer you choices and do my best to explain the risks and benefits of each option. There is no treatment protocol followed for all patients and your input is required in the process of choosing treatments.