Thursday, June 16, 2011

Conventional Medicine/Functional Medicine

I've had it.  I have just had it.  Go ahead, diagnose me, nod your heads, make a note in my chart.  Call it noncompliance or transference, depending on the initials behind your name.  Shake your head this time, make another note.  But I have had it.

An Emergency Room Story

We took a friend to the ER.  She takes a complicated med regime with risk of stroke and had the kind of vague warning signs that begin those if only... stories.  She felt *dreadful!!*, an 8 out of 10, and knew that something was desperately wrong.

It turns out her BP was elevated, but evidently not ER worthy.  And *dreadful!!* is not a symptom on a diagnostic protocol.  So the doc (resident?) focused on the headache.  Never mind that it was a 3 out of 10, and she insisted her headache was not her complaint.  He knew what questions he was supposed to ask, which didn't include questions on a 1 to 10 scale about just how **full systems dreadful!!** she felt.  In any case, he hadn't got to the part of the book where they teach you to listen to the answers.

So he gave her a med for the headache, then immediately a med for the side effects that the first med always causes.  Forty-five minutes later, the headache was down from 3 to 2, but the second med was not adequate, and she needed a third med for the jerking legs caused by the first med.

Eventually the doctor/resident's supervisor came in.  This doctor did know how to listen.  She listened even to what was not being said, the rising anxieties and suppressed rage of everybody in the room.  So she asked some more questions, and decided maybe there was a reason for the headache.  They did a CAT scan, which revealed nothing.  So she recommended my friend discontinue the BP med she had started last week, because that med could account for all the vague stroke warning signs that brought us there.  And they were on a roll in ER, having seen three people that day with side effects from this particular BP med.

On the other hand, it could be, and this is what my sick friend really believes, and I am sure she is right, it was a genuine hypertensive incident caused by the interaction of yet another med she takes and some processed chicken she ate for lunch, immediately before she started to feel dreadful.

Modern Medicine Sucks

Yes, I know.  The ER is best reserved for heart attack and stab wound.  But that is where Urgent Care sends people with stroke symptoms.  And you know very well, in any doctor's office, prescribing medicine for the side effects caused by the medicine prescribed for the side effects caused by something else again is standard clinical practice.

It's not just the health care delivery system that is failing.  "Modern" medicine itself has failed me, failed you, failed a whole lot of us, with a whole lot of different diagnoses, including a whole lot of people who even get paid to practice it.

You all know this.  It's just that it's impolite to say it, hypomanic if the person who says it has a mood disorder, paranoid if the person who says it has a psychotic disorder, impolite if the person who says it has thus far dodged the DSM, impolitic if it's your job.  But there it is.  The paradigm is screwed up.

Paradigm: A worldview underlying the theories and methodology of a particular scientific subject.

Here is the short version:

Conventional medicine = Your [fill in the body part] is sick.  Take your medicine.

Functional medicine = Your body heals itself.  Live, so as to be healthy.

Applying The Paradigms

Now let's look at the longer version.  Here is your body:


Lovely.  Of course it's lovely.  And God saw everything that he had made, and behold, it was very good.

Next, here is not your body, but rather a diagnostic tree.  When you don't feel so well, the doctor uses this tree to locate your problem:


This is how a diagnostic tree works:

Conventional Medicine:

You feel dreadful.  So you go to the doctor, during regular office hours, if at all possible.  You tell the doctor how you feel.  The doctor wonders, What system inside this body is causing these symptoms?

So he/she elicits more information about symptoms, takes some measurements, runs some tests to determine which limb up there in the tree is out of order.  Is it the metabolic limb?  Endocrine limb?  Cardiovascular?  Pulmonary?

Next, the doctor sends you to the specialist in that limb, otherwise known as a system.  Doesn't matter which system, same paradigm.  Let's say the symptoms and the tests lead to the conclusion, it's psychiatric.  (We could do this same exercise with the cardiovascular system.  But this is Prozac Monologues...)  Is it mood disorder, psychotic disorder, anxiety disorder?

Then, which twig?  And finally, which treatment is purported to work best to make the symptoms go away on the particular twig your doctor has identified?

God help you if the doctor gets the twig wrong.  Because if you take the medicine that works well (or is purported to work well) for the next twig over, then another limb might pick up a hatchet and chop the sick twig or branch or limb or even the whole trunk right down. 

The thing is, the meds are dumb.  They don't know they are supposed to fix just that one little twig.  It is the rule, not the exception, that the med will also do  something to a different system, maybe several.  Let's just hope it's not something too dreadful.

Functional Medicine:

You feel dreadful.  So you go to the doctor.  You tell the doctor how you feel.  The doctor wonders, What has caused the body, which is designed to balance itself, to malfunction?

In functional medicine, the doctor pays as much attention to the roots as to the limbs.  The tree takes in nutrients, water, air, energy, experiences, toxins from the ground and the air.  It processes the environment through its cells and structures.  It is designed to absorb input, produce energy, rid itself of waste, grow, differentiate, reproduce -- function.  If the body is not thriving, functional medicine looks both to the environmental input and to the individual processing for the source of the disruption. 

Functional medicine is anchored by an examination of the core clinical imbalances that underlie various disease conditions. Those imbalances arise as environmental inputs such as diet, nutrients (including air and water), exercise, and trauma are processed by one’s body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs.

The fundamental physiological processes include communication, both outside and inside the cell; bioenergetics, or the transformation of food into energy; replication, repair, and maintenance of structural integrity, from the cellular to the whole body level; elimination of waste; protection and defense; and transport and circulation.

The core clinical imbalances that arise from malfunctions within this complex system include:
  • Hormonal and neurotransmitter imbalances
  • Oxidation-reduction imbalances and mitochondropathy
  • Detoxification and biotransformational imbalances
  • Immune imbalances
  • Inflammatory imbalances
  • Digestive, absorptive, and microbiological imbalances
  • Structural imbalances from cellular membrane function to the musculoskeletal system

Different Questions Lead To Different Treatment

The italics above are quoted from The Institute for Functional Medicine.  Here is the next paragraph, on the difference between how conventional and functional medicine solve problems:

Imbalances such as these are the precursors to the signs and symptoms by which we detect and label (diagnose) organ system disease. Improving balance – in the patient’s environmental inputs and in the body’s fundamental physiological processes – is the precursor to restoring health and it involves much more than treating the symptoms. Functional medicine is dedicated to improving the management of complex, chronic disease by intervening at multiple levels to address these core clinical imbalances and to restore each patient’s functionality and health.

Functional medicine is about the relationship between parts, relationships between macro/big and micro/little (systems and cells), the relationships between the systems themselves (cardiovascular, neurological...) and the relationships between the whole body and what is acting upon it.

There is nothing weird about functional medicine, nothing foreign to what anybody learns in medical school.  It's just that it notices what people forgot from that one hour in med school on nutrition, one hour on circadian rhythms, one hour on the connection between one system and another.  They forgot because after that one hour, conventional medicine never expected them to ask a question or listen to an answer about it again.

To become a functional medicine doctor, you learn conventional medicine and then learn to notice how it all connects.

Do-It-Yourself Functional Medicine

People in recovery are figuring this stuff out on our own.

Back To BDNF, Serotonin and Cognitive Remediation

So once upon a time, some brain scientists noticed that people with depression generally have lower serotonin levels than people without depression.  The conventional medicine solution: squirt some more serotonin into those synapses.

It didn't work near so well as we all were taught to believe.  Okay, so it worked very well for the pharmaceutical companies.  One out of every ten people in the United States of America is taking an antidepressant right now.  Ca-ching.  It's just, it didn't work so well for the people with depression.

Now the tune has changed.  Serotonin increases BDNF.  BDNF is the real hero.  Since SSRIs cause so many side effects, and they don't really work so well, and the patents have expired anyway, let's skip the serotonin squirting and find a different pill to stimulate more BDNF.

The National Institute on Mental Health (NIMH) has figured out there is something wrong with this approach, and won't fund it anymore.

Meanwhile, while you are waiting for the next miracle drug, which will be a long time coming, because the pharmaceutical companies have lost interest in antidepressants, you should know there are lots and lots and lots of things that improve BDNF production and at the same time improve the functioning of every other system.

Try aerobic exercise like walking, swimming, bike riding, mental exercise like sudoku and computer brain games, learning a new skill like a musical instrument or language or drawing, losing weight, eliminating refined sugar and diet soft drinks, eating leafy greens, fruits and fish, falling in love.  These things do not come in pill form and don't make anybody any money.  It's just that they make us healthy. 

Notice that these interventions replace toxins with healthy input.  That is functional medicine.

Here Comes An Opinion About Government Spending

Go back and reread that of ways to stimulate production of BDNF, absolutely essential for learning.  Then think about the cuts in your local school board budget.  Were they by chance funded by cutting physical education, sports, music, languages, and by placing snack machines in the schools?


The doctor's office is not the only place where our brains go bad.  Schools themselves are making us stupid.

More To Come On Cognition and Functional Medicine

Lots of topics web out from Getting My Brain Back.  Next up, mitochondria...


photo of emergency room by Thierry Geoffroy and used under the Creative CommonsAttribution-Share Alike 3.0 Unported license
photo of tablets, medical waste by Pöllö and used under the Creative Commons Attribution 3.0 Unported license
L'arbre de Vie by Raphaël Toussaint is used under the GNU Free Documentation License
graphic of tree with roots created by Vectorink and used under the Creative Commons Attribution 3.0 Unported license
flair from facebook
graphic of Brunnian link in public domain
photo of fruits and vegetables from Pike Place Market by Eric Hunt and used under the terms of the GNU Free Documentation License
photo of Bb school trumpet by Roy Benson and used under the terms of the GNU Free Documentation License

1 comment:

  1. Hi there, I think what you are referring to as functioalistic medicine is what was taught as wholistic medicine when I was in nursing school about 20 plus years ago. Now I have BP2 and am not nursing at all.

    When I was doing my hospital clincals at nursing school the doctors were trying to figure out how to get around some new medicare diagnostic thingie the government was instituting to control medicare costs. In order to insure a long enough hospital stay to truly recover, doctors were having to churn out multiple active diagnosis per elderly patient. Pretty soon everyones' private insurance had implemented similar systems and things have been going down hill as far as wholistic care is concerned ever since.

    The trouble with the concept is medicine at present is NOT run by doctors. It is run by accountants at hospitals, clinics, insurance agencies and the government. What you are advocating would be better but it would take more MD time and hence cost more. Why, a person's doctor might have to spend more than 20 minutes with them for an appointment. And clinics might have to hire (gasp) RNs who are legally allowed to do actual patient assessments, taking BP pulse and weight does not an assessment make (LPNs and Medical Assistants are not) and who are obliged to advocate for their patients by law. I can hear the accountants fainting now.

    The other thing, persuading people to make lifestyle changes is HARD---I taught enough new diabetics to know that. Sometimes meds are indeed better than the no changes you get.

    And I'm not sure about the science to back up some of your systems listed, but I've been out of it long enough that you are probably more current than I am.

    ReplyDelete