Missing in healthcare
Treating the whole story.
Healthcare as it exists today is about getting the facts on what the patient is suffering from, getting some tests done, making some sort of diagnosis, and prescribing some drugs to alleviate those symptoms.
But how can you really know what’s causing the problems if you don't know anything about the patient or their lives? If you don’t know the whole story?
Often times I am amazed to find that when things go wrong with peoples' health, they think there is something wrong with THEM; that they are inherently broken.
Many people feel they are on an island by themselves and no one will understand their issue or they are embarrassed to discuss it, so they don't.
The natural progression of people seeking relief from suffering looks like this:
1. Do nothing and hope it goes away
2. Get an OTC (over the counter) drug and try to alleviate the symptoms at home.
3. "Google it."
4. Ask someone you trust about a recommendation
5. Go seek care from a professional to help
Sally was up again tonight.
That familiar warmth in her belly that quickly became an uncomfortable burn didn't happen right away this time. After dinner, she thought maybe she was going to have a good night’s sleep.
Tonight the first thing that bothered her was this new shoulder pain.
This strange achy pain on the left side that just seemed to be getting more constant.
She thought maybe it was from her workouts?
But this didn’t feel like that satisfying burn after a challenging workout. This felt more like someone was pulling your head back too hard and in the wrong direction.
It just hurt.
Had she been overdoing it? She wasn’t sure but she didn't think so.
What she was sure about was that taking aspirin or ibuprofen wasn’t helping at all. If anything it was making the burning in her stomach worse.
Was the shoulder and stomach pain related?
She was tired.
Ugh, another night of suffering.
The following morning Sally was exhausted.
She had tossed and turned all night trying to find a comfortable position. She finally fell asleep at around 3am from pure exhaustion. The worst thing was waking up to a familiar pain. Or more like waking up BECAUSE of a familiar pain.
On top of the shoulder pain and burning stomach, her back was hurting from trying to sleep propped up all night.
She would have to cancel her workout today, again.
And tonight she was supposed to go over to her friend's house for dinner.
What was she going to eat?
Even if her stomach wasn’t burning right now, she had no idea what triggered it.
What if dinner made her reflux worse?
She wasn’t sure she could handle that.
And she didn't want to be “that” friend who had all these food restrictions and made it a hassle for the host.
Ugh. Looked like today was going to be a rough day and yet another poor night's sleep.
This was getting old.
“So, let’s take an accounting of what I’ve tried so far,” she thought.
Pain relievers for the shoulder seemed to help a little until it started to make the stomach pain worse.
Took out gluten and dairy. That had helped at first but that relief didn't last long.
She was now working with a naturopath. Hopefully she would help with the reflux.
And she just got a referral to this chiropractor.
Maybe he could do something about this shoulder pain.
“God, I hope my son is getting a clue,” her mind drifted to thinking of her son.
His confusion about his future was stressing her out. He was 26 years old and had no idea what he wanted to do with his life.
She didn't want to worry but how does a mom not worry about her kid?
“I need to stop worrying,” she thought.
Sally’s and I develop a connection
When Sally came to see me, she did what most patients do; she told me where it hurt, how long it had been hurting and what she had tried so far to find relief. Typical.
Now it is important to know those things but that doesn't give you the whole story.
We (the doctors) need to understand the other factors of your life.
As a doctor, we need to know more about you; more about your life habits; more about your life's stressors. And we can only know that by spending some time with you and building a relationship.
So when I met Sally, I told her exactly that.
I let her know that I might be able to provide a little relief today but it was going to take time. Figuring out all the elements that contribute to something that seems simple, like shoulder pain, takes time.
We needed to talk.
I needed to learn about her family, her work, her habits.
We need to build a connection.
We got started.
My thought process
There was no history of injury so why would her shoulder just spontaneously start hurting?
Was Sally’s shoulder pain related to her reflux?
Issues with the stomach will often refer pain into the left shoulder and neck area. Also, as we age, production of stomach acid actually decreases which leads to poorly digested food that will off gas and create organic acids, leading to reflux. So, the reflux is a symptom of NOT ENOUGH ACID.
But that can’t be it on it’s own. The diaphragm also has to weaken.
There is usually a trigger.
We needed to find out what was happening in her life that was causing her to have the reflux in the first place.
Has to be stress related.
Maybe it was emotional?
I would find out that she worried a lot about her adult son who wasn’t quite “settled.”
Ok. Now we are getting somewhere.
Worry is associated with the stomach. And stress from worry will reduce normal stomach acid production and reduce digestion.
After a few more discussions, we were able to align some of the symptoms of reflux starting around the time that he had moved out of state.
Then, she told me about her role as a caregiver.
No easy task.
She described her worry about an elderly parent she was caring for as well as the frustration she experienced regularly trying to deal with the facility staff.
Frustration is associated with the gallbladder.
That would explain bloating and gas and reacting to fried and fatty foods.
When I asked about if she had tried anything to alleviate her worry and stress, she laughed.
She admitted she worried a lot.
She had tried meditation and failed.
She wasn't sure what to do.
But the picture was getting clearer.
During her examination, she had quite a bit of muscle tension in her neck and upper shoulder muscles.
The neck muscles are associated with the Stomach meridian in Traditional Chinese medicine/ Acupuncture. And the nerves that control the diaphragm are at the middle of the neck. (C,3,4,5)
There were trigger points along the biceps which are related to the stomach.
Her diaphragm was super tight and painful when touched; especially on the left side. (Where the stomach is located). Tightness in the diaphragm will lead to increased tension in the neck to help with breathing.
There was also tension along the hip and knee area.
The calf muscles are associated with the adrenals (stress hormone glands), and the outside part of the leg is associated with the gallbladder meridian in traditional Chinese medicine.
And finally, being worried and stressed makes you breathe faster and increases tension in your diaphragm, neck and shoulder.
It was clearly more complicated than just simple neck and shoulder pain.
She had to tell me about her son.
She had to tell me about her role as a care giver.
She had to tell me about her nights suffering.
She had to tell me about all the stress she was under.
Now we had to put a plan together to start sorting all this out and getting her back on the road to health!
First, get the neurology right.
You cannot make good progress if the information coming and going to your brain is not optimal. Obviously that is done with chiropractic manipulation treatment. The manipulation resets the neurology of the whole spine, joint range of motion and improves muscle function.
Next, we needed to reduce all that muscle tension.
There are many ways to do this but I felt the focus of WHERE was more important than the HOW. We would focus on releasing the diaphragm and neck tension so that we could get the most relaxation possible. If we were right, then the rest of the tension in other parts of her body should follow suit.
Speaking of the diaphragm, it had to be retrained.
We needed slow, deep breathing exercises.
The beauty of slow breathing is that it also shifts your brain from stressful “fight or flight” (sympathetic) to the relaxed (parasympathetic) state. Win-win!
We also had to address the dysfunction in the stomach that was causing the reflux. In order to support better stomach acid health, we added diluted apple cider vinegar- 50/50 with water- 1 tablespoon per meal.
This was a good plan. A solid starting point.
She totally agreed and I got her buy-in to “trust the plan.”
So what happened?
Sally felt much worse at first.
That was a little hit to my ego but I have been doing this long enough to know not to lose faith in the plan.
After the first few weeks, things were getting much better.
By the 5th visit she no longer had reflux. And more important, she began to understand what her triggers were that set her up for reflux symptoms.
Her headspace around her worries was improving.
She became more aware of which foods exacerbate reflux symptoms.
Now, is the resolution of symptoms all that matters in this story?
Yes and No.
Everyone wants to feel better but just alleviating symptoms is the OLD model of healthcare.
The NEW model of health care has to be about creating a relationship between patient and provider; a relationship that helps us understand what is happening in our lives and that all of it matters; a relationship where we become aware of the things in our lives that support our well-being and what things do not.
Sally and I are still working together.
I have become a part of her regular health care regimen. We work as a team and she continues to share with me the progress she is making as well as the new (and old) challenges she is taking on.
Working as a team, Sally was able to ta