Bridging the Gap between
Conventional and Alternative Medicine
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Many people find that blending conventional with alternative medicine can be challenging. Although conventional practitioners have a spectacular array of high-tech diagnostic and treatment modalities to choose from, they usually have precious little time to spend with their patients to really get to know them and put together a comprehensive treatment plan.
If a diagnosis meeting well-defined criteria doesn't suggest itself or turn up in a battery of "usual" lab tests, then your symptoms may well be considered to be stemming from depression or simply dismissed. Often a drug like Prozac may be prescribed so that the doctor may feel that he or she as "done" something to help you. If you are seeking a more integrative or alternative approach to your healing--or have not been satisfied with your care--here are some common examples of how you might begin to bridge the gap between types of medical care.
A number of diagnostic tests have been developed as part of the medical field known as "functional medicine." Seldom used by conventional physicians, they are the territory of integrative physicians, including certain MD's and DO's, nutritionally-oriented chiropractors and holistic nutritionists. Functional medicine seeks to change the terrain in your body so that the "why" of the problem is addressed to enable you to improve your health in the long term.
Although seeing one of these "alternative" or "integrative" practitioners may be your best bet in getting a more extensive analysis as well as the knowledge to interpret the tests, many people choose to go to the doctor in their HMO or the doctor covered by their insurance. With a little prompting, you may be able to open some treatment doors not usually considered by conventional doctors. First, speak up and ask for what you want. Become a partner in your health care. Then, do some research and remember that it is your body and you may be able to develop a team where your doctor learns from you too. To follow are some common health issues and tips for getting the best care.
One of the most common complaints is fatigue. It may be related to many things, but it is important to check out your thyroid, adrenal, or sex hormone levels. Conventional physicians will often order a Thyroid TSH blood test, and when it comes back normal tell you that your thyroid is fine. This is not adequate information. Ask for a free T3, free T4, and thyroid antibody test.
If you are diagnosed with a low thyroid, most doctors prescribe a synthetic T4 called levothyroxine. Many people don't start to feel better until they try something else, such as Armour or Naturethroid. These are derived from animal thyroid, which also includes T3, the active thyroid compound. So it's beneficial to speak up, do some research, and ask for what you want.
Your adrenal glands, located above your kidneys, are your powerhouses of energy. They are depleted by chronic stress, lack of sleep, and some medications. Most conventional practitioners don't pay much attention to subtle degrees of adrenal dysfunction. Ask for a lab that does 4-point saliva cortisol tests (4 separate samples throughout the day) such as Neuroscience or Diagnos-Techs, and DHEA-s blood or saliva tests.
Fatigue can often be helped with supplements of DHEA or small doses of natural cortisol. There are adrenal support herbs which are very helpful as well. Once again, your practitioner may not have heard about these treatments. Take the time to educate them.
As we age, our sex hormone levels often drop and contribute to fatigue. For men, androgens should be assessed with blood tests for total and free testosterone, and DHEA-s. Low levels can be supplemented with testosterone injections, skin cream, or DHEA tablets.
Women are more complex. Ask your doctor to check your levels of estrogen, progesterone, testosterone, and DHEA-s. This will give you an idea if low sex hormones could be part of your fatigue. Remember that the studies which showed an increased risk of cancer with hormone treatment were all done with synthetic progesterone and estrogen from horses-not a good match for the human body. The alternative community often uses bio-identical hormones which are believed to be safer, and manyconventional physicians are making the switch.
Irritable Bowel Syndrome (IBS)
Complaints such as diarrhea, abdominal pain, bloating or constipation are often called Irritable Bowel Syndrome by conventional practitioners. They treat symptomatically rather than getting to the cause of the problem.
Ask for a comprehensive stool analysis looking for abnormal organisms such as yeast, bacteria, and parasites, and measuring the amount of beneficial bacteria present as well as efficiency of digestion. This will often uncover treatable causes. Local labs may fall short here. I recommend getting a home collection kit ordered by your doctor from Genova or Metametrix, which will give more complete information.
Sometimes symptoms can be caused by overgrowth of small intestinal bacteria, not diagnosed on these tests. In that case a breath test for gases produced by excessive small intestinal bacteria should be obtained (also from Genova). A few conventional gastroenterologists perform the breath test in their offices, but they're few and far between. The bacterial overgrowth can be treated with combined conventional therapies and integrative approaches.
Also, don't overlook the possibility of food allergies and gluten sensitivity. A blood test for the latter, called a celiac panel, may diagnose it, but gluten loading for a week or more before collection is necessary. A better and more sensitive indicator is a stool sample for gluten sensitivity, offered by Enterolab.
Joint and Muscle Pain
Pain of all sorts is a very common complaint. Conventional practitioners prescribe pain medication and muscle relaxants. In an integrative practice, you might see an osteopath for manipulation or an acupuncturist for pain management. Remember that Western trained practitioners may send you for expensive hi-tech testing, but asking for a referral to a great hands-on therapist may make a much bigger difference in how you feel. The condition NOT to be overlooked by you or your doctor is chronic lyme disease. Many physicians are skeptical of the prevalence or even existence of this potentially devastating condition. Don't rely on the widely-used screening test for Lyme--the IgG/IgM antibody test. It has too many false negatives. Instead, use Igenex's Western Blot and DNA PCR tests, or Medical Diagnostic Laboratories LLC Lyme antibody testing.
Our world is full of unhealthy pollutants. Among the most important are heavy metals, such as mercury and lead. Mercury-containing dental fillings and ingestion of mercury-containing fish are common sources for this metal.
Lead comes from exposure to lead-based house paints (now outlawed), solder, stained glass, and imported food and toys from countries such as China. Exposure even decades ago can leave toxic residues in the body, affecting neurological function and promoting inflammation. A simple blood test for metals is inadequate as it provides just a snapshot of recent exposures. A better method is to perform a timed urine collection after a single dose of a chelating agent such as DMSA, which mobilizes metals for excretion in the urine. This allows for a more accurate reading. Heavy metals can be chelated out of the body with well-researched protocols of natural and prescription medicines.
Conventional lipid panels overlook important information that can seriously impact how this "condition" is treated. A more thorough evaluation is done with a VAP panel, available through most conventional labs. When it comes to treatment, instead of taking a statin drug, work with your practitioner to develop a plan for lifestyle changes that might include diet, weight loss, exercise, and stress reduction. There are herbs and vitamins which help as well.
This is not a comprehensive list of all tests that might need to be ordered in a particular case, but will go a long way towards getting you started on uncovering the "missing pieces." With a little assertiveness and knowledge of what you need, you should be able to move your medical encounters from frustration, with too many questions left unanswered, to a more collaborative venture with many more possibilities for healing.
Developing a healing relationship with your practitioner may be the most important and powerful medicine of all. If you feel supported, empowered and filled with optimism, you are on the right track. If your practitioner, by his or her words and demeanor, makes you feel disempowered and dismissed it may be time to find a new practitioner.
Brian Bouch, M.D. is Medical Director of Hill Park Medical Center in Petaluma. He works with a team of functional medicine physicians, osteopaths, acupuncturists, nutritionists, and bodyworkers to help people with complex or difficult to treat conditions find comprehensive and "out of the box" solutions to long lasting healing. For more information visit hillparkmedicalcenter.com or call (707) 778-3171.
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