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The Multifactorial Approach to Healthcare

Every day that passes by sees an increase in the amount of new pharmaceutical interventions, diagnostic tests, and diagnoses. Pressure to make a firm diagnosis and to establish a quick and effective treatment pushes doctors to focus hard on the imaging and laboratory results in order to make sure we are ruling out any alarming causes for a patient’s symptoms.

Unfortunately, this trend in medicine may be distracting doctors from the underlying causes of these diagnoses and diseases. More and more time is spent on diagnostic testing rather than on a thorough physical examination and history. Not only are these tests expensive and time-consuming for the patients, they often come back with negative results. Then, the physician sees a negative result on the test and may give the patient reasons such as, “You have this problem because you are stressed,” or sometimes even, “It’s just in your head, nothing is wrong.”

In these cases it is important that the doctor reflects on the possible reasons this patient can have the symptoms in the first place. Very often the answers we need to give our patients are very simple and very straightforward… but we need to remember the basics.

For optimal health there are some essential needs that must be met: Good nutrition, safe drinking water, and restful sleep. In addition to those three essentials we also need to be active, take time for ourselves, and spend time with friends and loved ones. Someone who fulfills all of these facets of life will find themselves happier, healthier, and more durable during hard times.

To illustrate this idea, I’ll outline a patient case that presented to our clinic:

A young woman presented to us with low back pain of roughly 7 years duration. This pain increased during menses. Pain also increased with exercise at the gym (which caused this young person to avoid activity). In 2012 this patient had an MRI performed and there may have been the possibility of a disc herniation in the low back, but this wasn’t completely confirmed. X-Rays of the lumbar spine were negative. Rheumatologic testing was negative. Magnesium levels were normal. The only significant finding on all of her testing done previously was a moderately low Vitamin D level. Patient noted difficulty moving around in the morning due to pain for up to 1 hour every day. Pain killers are ineffective.

Upon examination was a young woman who seemed anxious and depressed. Her mood seemed as if she was very tired and she moved around as if her body was frail. She noted a history of some digestive problems and also chronic dermatological conditions. The pain always increased during menstruation, but gynecologic treatment has not ever changed that. As we had a long discussion it came out that there was a history of personal struggles that were worsening her quality of life.

Since she noted she has a history of digestive problems, diffuse pain in the low back, neck, and some other areas I chose to focus on the basics that we mentioned above. She drinks plenty of water. She noted her sleep at night was not very restful. She didn’t take much time for herself. Her pain had lowered her activity levels to nearly nothing, and she was having trouble having meaningful conversations with family and friends due to her other problems.

We then went on to discuss her nutritional habits. As with most diets in the 21st century, there was a high intake of refined carbohydrates (rice, breads, sweets, and pastas) as well as a heavy intake of Omega-6 Fatty Acids (vegetable oils, fried foods, and dairy products).

Alongside these two problems we saw that the diet had almost no dietary fiber (whole fruits and vegetables), no nutrient-rich foods (whole fruits and vegetables again), and almost no protein (eggs, sprouts, quinoa, meats, fish).

When we overload on sugars and Omega-6 fats we put our bodies into a Pro-Inflammatory State. This means that the body is constantly filled with inflammatory chemicals produced in the digestion of these foods. Over time this can create a chronic condition that leaves the patient vulnerable to fatigue, obesity, and chronic diseases such as diabetes.

Knowing this, and considering the patient’s other complaints such as depression, bloating, and fatigue+pain throughout the body the first step in treatment was to explain the Anti-Inflammatory Diet. This would be her homework until the next visit. She was also asked to discuss this change with her dermatologist and psychologist who were very supportive. Without performing any type of manual therapy, the patient was sent home and returned the next week.

Without performing any change other than reducing her amount of sugars she already noticed that her pain was reducing. At this stage we felt
ready to move onto treatment of her mechanical complaints of low back and neck pain. These were treated with some simple exercises, manipulation, and some mild soft tissue work. These techniques were used a total of 3 times over the duration of one month. During that time she continued working with her psychologist while maintaining a healthy diet. The patient also noted that she benefited from energy healing techniques. On the third visit the patient was dismissed as she did not seem to have much a mechanical problem remaining- she noted that “life is enjoyable”.

Three months following that visit the patient contacted me to let me know that she is doing well and living life normally.

So, what do we learn from this patient?

Listen to the patient. What are their needs? What are they missing fromlife?

Remember the basics. More people suffer from bad habits and nutrition than rare diseases.

Treat the patient, not the test. If we saw all of the negative laboratory and imaging tests and told this woman she had nothing wrong with her, she may have continued to suffer.

Work as a team. It took a combination of a psychologist, energy healers, a chiropractor, and a very motivated and wonderful patient in order to get these results. Each of us had an important role to play.

Chronic pain and disease has many factors. There is no one best treatment. A team of practitioners working together within their respective scopes of practice may be what you need to really benefit from medical treatment. Always ask your doctor about alternative treatment routes and/or possible methods of co-management.

In the end our goal is to give the patient every opportunity they can to improve. We want you to get well and get well quickly

Wishing you a happy and healthy week,

Dr. Stephen Shinault

Here is some evidence for the use of many different practitioners for treatment of complex conditions:

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