Connecting the Dots: Taking the Time to Listen (& Be a Sleuth)

 

Often when explaining how Oriental Medicine differs from standard allopathic (i.e. “Western”) medicine to a new patient, we acupuncturists like to use the metaphor of a tree with broken or diseased branches. Most are accustomed to going to a different specialist for each symptom they have, and more often than not the doctor only has time (more on this below) to put a band-aid on the problem, or mend the broken branch as it were, usually with a prescription. In Oriental Medicine we are always trying to get to the root of your problems/symptoms – i.e. nourishing the roots of the tree to cure and prevent disease. That isn’t to say we don’t try to get your chief complaint(s) feeling markedly better from the time you arrive in our office to the time you leave. But by asking the right detailed questions, feeling your pulse, looking at your tongue, palpating your abdomen (and sometimes areas of pain), as well as observing your speech, gait, complexion, etc… we strive to “connect the dots” and figure out why you have IBS, arthritis in your knees, eczema, migraines or occasional insomnia. Then we develop our treatments and herbal formulas and/or nutritional recommendations to address to root cause of all of your issues for the long-term.

Many of you reading this are established patients, so you might be saying, “Duh Alison – tell us something we don’t know!” Okay, I will. I will tell you a little story, a recent new case actually, that the patient has agreed for me to blog about, anonymously of course…

“Margot” had been having many digestive symptoms, mostly upper GI in nature, over the course of the last year. She had the full work-up and barrage of tests ordered by her gastroenterologist. Their only solution so far was to give her a tricyclic antidepressant which made her so drowsy she couldn’t tolerate it. She had also tried many dietary changes/eliminations with little results.

A young woman of child-bearing age, I then went on to inquire about her menstrual history. She had been on one form of oral contraception or another since menarche. Knowing young woman are usually started on these meds at such a young age (as I myself was) if they have extremely heavy and/or painful periods, I asked her if this was the case for her. Yes, it turned out, she had God AWFUL menstrual cycles, and she was missed so much school because of them they really saved her life at the time. Since then, anytime she tried to go off them, the same symptoms would return. So she never really stopped. Had any gynecologist ever discussed the possibility of fibroids, cysts, PCOS or endometriosis? No, not that she could recall. Do her digestive symptoms get worse in the days leading up to her period? Yes, always. Hmmm…

Though I couldn’t be sure, this was starting to sound a lot like endometriosis. And I was starting to become irritated that her gyno hadn’t taken the time to ask her a few more questions about her PMS symptoms, BCP history, or her recent digestive issues; AND the her gastro hadn’t thought to ask about her gynecological history. To a degree, you can’t really blame them either. I realize I may be opening a can of worms here, but most insurance-accepting doctors have 10 minutes per patient on average. It also seems they’ve become so reliant on lab and diagnostic testing, they sometimes forget to ask fairly logical questions.

She had also been to see an integrative practice recently and they had done a lot of lab work, including food allergy testing. Great – I often refer my patients to integrative practitioners to get more extensive testing done that will be covered by their insurance (as it won’t be with me). But they too had missed this. I’m sure they were operating with the best intentions, but they got such tunnel vision with her digestive workup and treatment plan, they kind of missed the forest for the trees.

So where did this leave me, and her? First I recommended that before she do anything else she get her gyno office on the phone and request a transvaginal ultrasound to rule out any uterine abnormalties, and discuss the possibility of endometriosis. She spoke to her mother that weekend, who had never before mentioned that she had endometriosis very badly as a young woman, which was part of the reason Margot did not have siblings. In fact, there was a strong family history of this female autoimmune disorder. Hmmm…

Margot finally got her ultrasound results back – negative for fibroids or cysts (just some “fluid behind the uterus” – a possible fibroid which may have self-resolved). She did review an ultrasound report she found from a few years ago (she keeps meticulous records of all her labs, diagnostic reports, etc. – I love these patients – and such a good idea these days for all of the reasons I’ve given above). She had forgotten about this ultrasound and who wouldn’t in her position with all the doctor appointments she’d had? Anyways, that one said “possible uterine fibroid” though no one had ever mentioned it to her. Arghhhhhh. She has also decided (under the recommendation of her gyno, after my prompting) of having a laparoscopy in a couple of weeks to rule out and treat (if present) endometriosis.

What’s the moral of this story? The take home I want to share with you – whether an established patient, potential patient, or merely curious reader – is to share ALL the details of your medical history with your allopathic specialists and primary care MDs. And if you get the sense you are being rushed through an intake, barely examined, too quickly referred for testing or labs, or that your practitioner is showing signs of tunnel vision around their speciality – then please speak up, or switch up – and go see a practitioner such as an acupuncturist who has the time and training to connect all the dots! Our new patient visits are typically 1.5-2 hours for this very reason.

Please feel free to post your feedback. I am thrilled and relieved to have finally started a blog and open up a dialogue about important issues important to me, and to you.

In health, healing & humor, Alison

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