I’m truly delighted to welcome our newest WholeHealth Chicago staff member, Neeti Sharma, MD, a board-certified internist (like me) who earned additional postgrad training in integrative medicine at Dr. Andrew Weil’s program at the University of Arizona Medical School. She also has a special interest in Functional Medicine.
Any health-conscious patient with reasonable skepticism about our conventional healthcare system will want to know more about both Functional and Integrative Medicine. This becomes especially important if your goal is healthful longevity and you want to avoid premature death during an unnecessary surgical procedure or while dutifully taking an equally unnecessary prescription drug.
The following imaginary case illuminates what’s wrong with the system and how Dr. Sharma can steer you clear of potential disasters.
Remember, Dr. Sharma is a conventionally trained internist, so she can write prescriptions and refer to specialists along with all the other trappings of an internist. She’ll just try other pathways first.
Let’s say you’ve decided to make an appointment with your primary care doc to discuss a new symptom. Deep inside, you’re worried that it might be something serious, even the first sign of the dreaded Big C. Don’t think for a New York minute that doctors don’t have the same anxieties when they feel something unusual in their own bodies.
According to studies that monitor the time spent during an office visit, your doc will allow you to speak for about five minutes before interrupting you and then will do the talking for five minutes more. The remainder of your allocated 15 minutes is spent with your doc entering data into her computer, writing you prescriptions, or referring you for tests or to a specialist.
Aside from the truncated office visit, to my mind immediate specialist referrals for every symptom are a sign of intellectual sloth and one of the main reasons why health care costs have spiraled out of control.
Let’s say you get all three–a prescription, some tests, and a referral. It may follow that the tests don’t show anything useful, the prescription doesn’t work or it makes you ill, and the specialist orders some unpleasant procedure requiring the insertion of something inside you that defines his specialty.
However, bad luck for you. The procedure finds something unrelated to your original symptom. He’s not sure what it is, but further testing and another referral are in order. Now you’re getting really nervous, sound sleep is a distant memory, and oh! you’re taking two more meds and now you’re unsure whether or not your original symptom is gone and wonder if what you’re feeling are medication side effects.
This pattern continues for the next several weeks until finally all your tests and procedures are completed. By now you’ve had so many imaging studies that you glow in the dark and all your orifices have been penetrated, but at least your biopsy incisions are no longer sore.
You hear from one of the doctors, “Well, we can’t find a thing wrong with you. All your tests are completely normal. But if you feel better taking your meds, just stay on them and come back in a few months.”
You stagger across the marble floors of the outpatient area toward the front door wondering if your health insurance will cover what surely must be a bill higher than the market price of your condo. You’ll need the next few months to recover from the PTSD (post-traumatic stress disorder) induced by the healthcare system.
Symptoms more often dysfunctions than disease
To a Functional Medicine specialist like Dr. Sharma, what you just experienced is the major flaw in the education of a conventionally trained physician.
The flaw is this: that the presence of a symptom means the existence of disease. So that all the tests, all the referrals, all the procedures, all that equipment that they love to try out on you is based on an essentially flawed model.
The vast majority of symptoms we experience, both physical and emotional, are dysfunctions, not disease.
Functional symptoms are your body’s response to a situation in which you’ve placed it. The burning sensation that awakens you is more likely the lasagna-chianti you had too late in the evening. It’s neither a heart attack nor cancer of the esophagus.
However, woe betide you if you enter the portals of an upscale emergency room. You’ll undergo testing you didn’t know existed for what you could have resolved with a half teaspoonful of baking soda in water followed by a satisfying belch.
Functional symptoms wax and wane
Functional symptoms come and go, depending on your situation (diet, stress, time of the month). Disease-based symptoms start at a fairly recognizable point in time and steadily worsen.
With functional symptoms, tests are generally negative, except those that reveal some sort of dysfunction. For example, you may need to take enzymes or probiotics for better digestion or start on a supplement for adrenal support.
With disease-based symptoms, there’s a constant, slowly worsening element and tests usually return positive results, which leads to a diagnosis. Using the heartburn example described earlier, if you had cancer of the esophagus you would worsen steadily with symptoms of painful swallowing, food feeling stuck and even regurgitated, and really scary weight loss.
Despite the underlying message of the TV and online drug ads that we all must be treacherously unhealthy, in actual fact serious illness before age 65 or 70 in people who take reasonably good care of themselves is, fortunately, quite rare.
Ah, but functional symptoms are as ubiquitous as dust kittens. Functional symptoms will never appear on anyone’s death certificate (know anyone who died of bloating? PMS? Tension headaches?), but functional symptoms can be profoundly annoying and seriously chip away at the joy in your life.
Quality time with the doctor
When you meet with Dr. Sharma, you’ll get a whole lot more than 15 minutes to tell your story. She’ll listen first and then ask for details that you may never have considered important.
When it comes to diagnostic testing, she’ll review any previous normal test results from other doctors in case something might have been overlooked. Then she’ll order tests that explore an entire system in your body. For example, using stool analysis she can get an overview of how well you’re digesting and absorbing your food and evaluate the balance of bacteria in your gut (your microbiome).
Very likely the first step on your path to wellness will not be a prescription drug, but rather a prescription for nutritional modifications, perhaps some herbs or supplements, and a referral not to a specialist aching to try out his newest piece of equipment, but rather to an acupuncturist, herbalist, homeopath, or yoga therapist.
Specific reasons to make an appointment with Dr Sharma include those listed in her bio at our website.
–If you want to optimize your health and have the satisfaction of feeling that you have lived your best health life.
–If issues with energy, fatigue, and brain fog have not been explained by a conventional medical approach.
–If you have a chronic medical condition that you’d like to take a deeper look into in order to determine the root cause and review treatment options.
–If you want a partner in your health journey who will help you sift through all the information available and focus on what will work for you.
David Edelberg, MD