Six Blind Men, An Elephant and My Dad

Once upon a time, there lived six blind men in a village. One day the villagers told them, “Hey, there is an elephant in the village today.”

They had no idea what an elephant was. They decided, “Even though we would not be able to see it, let us go and feel it anyway.” All of them went where the elephant was. Everyone of them touched the elephant.

“Hey, the elephant is a pillar,” said the first man who touched his leg.

“Oh, no! it is like a rope,” said the second man who touched the tail.

“Oh, no! it is like a thick branch of a tree,” said the third man who touched the trunk of the elephant.

“It is like a big hand fan” said the fourth man who touched the ear of the elephant.

“It is like a huge wall,” said the fifth man who touched the belly of the elephant.

“It is like a solid pipe,” Said the sixth man who touched the tusk of the elephant.

They began to argue about the elephant and everyone of them insisted that he was right. It looked like they were getting agitated. A wise man was passing by and he saw this. He stopped and asked them, “What is the matter?” They said, “We cannot agree to what the elephant is like.” Each one of them told what he thought the elephant was like. The wise man calmly explained to them, “All of you are right. The reason every one of you is telling it differently because each one of you touched the different part of the elephant. So, actually the elephant has all those features what you all said.”

“Oh!” everyone said. There was no more fight. They felt happy that they were all right.

My mother told me this story while I was in Austin and she was in El Paso. The phone laid on my bed, her voice through speakerphone so my boyfriend could hear too. She said that everyone sees different parts of the elephant, my dad, but no one sees the entire picture. I finally understood her argument. My sister, my nieces, his doctors, me, we all saw different parts of my father and had our own perspective, but only my mother knew the whole story.

My father has Alzheimer’s and leukemia, which causes the death of his red blood cells leading to anemia. Every time he gets his blood drawn, his red blood cells are low. This prompts his blood specialist to order a transfusion so his labs can be normal, this is the standard of care.

Here is the thing about the standard of care, it’s only part of the elephant. What his doctor doesn’t understand is that my dad was finally manageable, he was actually the sweetest I’ve experienced since the onset of his Alzheimer’s and had more moments of lucidity than I remember him having in a long time. He wasn’t running away or refusing to take his medicine, he wasn’t belligerent or threatening to kill anyone or himself or constantly on edge and pissed off or having hallucinations like he was after the first transfusion. As an adverse effect of his treatment, he was often uncontrollable, a completely different person, not someone I would want to spend too much time with. And yet, my mother had to spend 24/7 with him. Even taking him to day care became impossible, as he was belligerent with the staff, would run out the door, and occasionally get physical. One time, the scariest time, my mom said that he didn’t recognize her and just kept walking, angrily until he almost got hit by a car. She had to call my cousin, a police officer, to come help her reel him back to calm and finally get him home safely.

His triggers during certain stages of the disease were unpredictable. He would get angry if there was a new person in the house or he would runaway at the sight of a suitcase or the sound of a shower. I had moved back home for seven months and wrote about it constantly. My father did and acted in countless other ways that I did not witness, but my mother did, day in and day out, she lived the entire elephant.

So when my momma told me his blood count was low again and that his doctor wanted to transfuse him, I panicked. The only thing that had changed when he had his first 180 was the transfusion. I’ve done the research, there are no studies on blood infusions and worsening delirium. But this case study, a real life example of what could happen if you make a life saving change in someones biology or chemistry, was too palpable to ignore. And though this is anecdotal evidence, it doesn’t take away from any of the validity.

Many of my colleagues will say I’m crazy, that its just coincidence that my father regressed after the transfusion. I don’t really care what others say. I care about what the caretaker says and when I called to check on them yesterday after the transfusion, sure enough, the devil had taken over. I asked to talk to my dad on the phone and boy was he a poopy pants, total 180 from the night before when he said “life is good sweetheart, you just have to believe that and keep on chuggin” and “of course I’ll take care of my girl” when I asked him to take care of mom. This morning was no better. He didn’t sleep until 1 am and just went up and down the stairs acting manic and restless, which means my mom was left sleepless as well.

In medicine, we see the parts of the elephant, every day with every patient. We’re not privy to their home environment, their relationships, every single one of their past traumas, their diets or cheat days. We base our treatment or intervention on populations of people, on scientific studies in medical journals, rather than on the individual. And to be fair, some patients expect this from us, they demand we ‘fix’ them after we get minuscule glimpses into their life and disease.

I think its time we start evaluating the entire elephant. As it impossible as this may sound in the current healthcare market, it’s imperative to the system and to any change that we want to happen. Perhaps we ask our patients what they think is manageable and possible from the toolbox that we have available and then engage and empower them to make those changes, rather than getting upset with them when they are non-compliant.

So I’m going back home in a few days to have this exact conversation with his doctor. To ask him to reconsider the standard of care for this particular individual, my father. That the standard of care that improves his physical body is destroying his mental, spiritual and emotional one. Not to mention the toll it is having on my mother and her quality of life. If his doctor wants to question this possibility, then I will ask him to spend a few day with us at home and then see what he thinks. 

Wish me luck guys, I’m challenging the system once again. I have no expectations, I only have hope.

How many times have you made an a diagnosis or decision on just seeing part of the elephant?

Thank you for reading.

Inflammation: The Usual Suspects

A few weeks ago my nephew asked me what causes inflammation and I tried my best to explain to him the process and it’s usual triggers in the most simple non-medical terms, but didn’t feel like I did a good enough job. Since then inflammation has come up so much outside of the clinic setting, I thought I would write about the most common triggers and how it manifests to cause you all types of pain including joint, bone, back, pelvic, head as well as pimples, bloating, colds, allergies, eczema, reflux, thyroid disease, and pretty much any other discomfort you have in your body.

Inflammation is definitely not a bad thing. If we get a cut, we hope our body launches an inflammatory attack with macrophages and clotting factors that help heal the wound so we don’t bleed out or get rancid infections. The process of inflammation allows us to fight bacteria, viruses, and other foreign invaders. It’s a beautiful system. It’s when we have chronic, constant low-grade inflammation that the beautiful system becomes a disaster causing a disturbance of our health.

When people come into the office who have any of the above issues and are ready for a lifestyle change, we first look at their diet. Food as medicine is HUGE right now and rightly so. Thomas Edison said, “The doctor of the future will no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.” This was so prophetic for someone who wasn’t even in the medical field and now we’re focusing towards prevention and proactive care in medicine, using the right foods as medicine.

The first three foods we look at are sugar, dairy and gluten and ask if the patient is ready to cut one or all of these know inflammatory culprits.

Sugar: This comes in about 40 different forms from coconut sugar to honey to agave to corn syrup, it’s all sugar. Sugar is ubiquitous, it’s found in chips, ketchup, processed meat, even baby formula! Scary isn’t it? We know sugar causes tooth decay, but now we know it also leads to obesity, type 2 diabetes, arthritis, poor memory, heart disease, wrinkles and acne. We know from MRI’s that sugar lights up the same part of the brain as heroine or cocaine, so as Dr. Mark Hyman says, eat sugar recreationally, as a special treat every once in a while, not on a daily basis, four or five times a day.

Substitutes to sugar: Dates, figs, persimmons, kiwis, tangerines and various types of berries are good substitutes for sweeteners.

Dairy: My mom was telling me today that in her early 2o’s she would drink milk and be violently ill with stomach issues and discomfort, but never linked the two. Now of course she avoids milk at most costs. Dairy is the second most inflammatory food in our modern diet, right behind gluten. Most people suffer from digestive issues like gas, bloating, diarrhea, or discomfort when they consume dairy products, but it has also been linked to acne and allergies, asthma and eczema. The protein casein is usually to blame. You’re probably saying, “but I need dairy for strong bones and teeth!”, well we now know that milk is acidic in the body and actually leaches calcium, potassium and magnesium from the bones increasing risk of fractures and osteoporosis. Isn’t that a kicker?!

Substitutes to dairy: About 16 different milk substitutes are available, try them all!

Gluten: This may seem like a trendy one and I guess it is, but with good reason. The wheat and some grains we’re eating today are not the same of our ancestors. The way we grow it, process it, prepare, even its DNA is completely different, so much so our modern bodies are unable to process it and in turn it causes inflammation. There may be a day when our bodies will be able to digest without having an inflammatory effect, but that doesn’t happen now and we know that gluten has strong statistical association to many autoimmune diseases, including thyroid disease, Type 1 Diabetes, and Multiple Sclerosis. It’s also been linked to arthritis, chronic pain, IBS, and many other common Western diseases. 

Substitutes to gluten: Endless substitutes exist in the gluten-free isle of the grocery store, but I recommend using less of the substitutes and more of the plant-based foods or getting creative. If you do need a ‘flour-like’ source try chickpea or coconut.

Excess Weight: Physiologically, if you have too many fat cells your body they send a signal to the brain saying that it’s too stressful. This in turn launches an inflammatory attack sometimes causing resistance to insulin. Insulin is a hormone necessary to  get food into your cells for energy. If you have increased resistance to insulin it can eventually lead to type 2 diabetes.

Stress: Oh stress, the unquantifiable symptom. The chronic symptom of most Americans who participate in modern society. We operate on stress so regularly, it’s almost undetectable. I know many people who come to my office seemingly chill and controlled who have C-reactive proteins (a non-specific inflammatory blood marker) or blood pressures or heart rates through the roof. Stress sucks, plain and simple. We all know it, we al feel it, some people thrive on it and it doesn’t do us any good. How do you manage stress? I’m a big advocate for mediation and it’s endless benefits, but you can do just about anything that calms your breath and eases your anxiety from cooking to walking to zumba to petting your dog. Inflammation from stress doesn’t have to be in the present moment. Emotional, mental, physical, and sexual trauma from your past deposits on your nerve cells and gets fired up to cause inflammation too. Every time I see a hooded man walking towards me, I get physically ill and my sympathetic nervous system kicks-in. Then for days, sometimes weeks, I’m on edge, easily startled and just a little bit off balance, every time I think about the incident.

Poor or Little Sleep: Sleep deprivation, even just for a few hours, can have a monumental effect on the body. It produces the inflammatory reaction we’ve been talking about and can turn against you increasing risk for heart disease and autoimmune disease. People with chronic pain have reported less pain with good, high-quality sleep. Poor sleep also affects your hormones, causing decreased glucose intolerance and even weight gain! Cortisol is also a big player and we know that the cortisol schedule gets thrown off with sleep deprivation causing all sorts of metabolic changes including the abdominal weight gain.

So now that you know the usual suspects, which ones are you willing to cut out?

 

 

Image courtesy of iosphere at FreeDigitalPhotos.net

 

Provider as Placebo

A few weeks ago my nurse came to me to give report about my patient: “she looks terrible, vomiting non-stop for 3 hours, horrible abdominal pain and she’s allergic to the medication that we usually give for vomiting”, she said, “could you go see her before the other patients please?”.  I walked in and immediately recognized her face “You again? What happened? I just saw you last week.”  I had just seen her for the same symptoms. That time she was writhing on the exam table and I immediately called 911 to have EMS transport her to the hospital as we could do little there at the acute care clinic. This time she was sitting down, pale, shaking her head, bent over arms crossed over her belly in obvious discomfort. I sat down next to her and talked to her about what had transpired after our last visit. Her diagnosis was not horrible, but no ulcers. She had been diagnosed with gastritis, an inflammation of the gut. As we talked, her discomfort softened as she told me about her pending appointment to the gastroenterologist (GI) the following week. “They say the GI doctor will be able to fix me and they told me to change my diet”. I prodded her about the diet and got to hear some of what I had hoped. “It’s hard to follow a diet doctor, I ate ice cream last night”. Then a few hours later she woke up with her symptoms. We talked about how it’s not the doctors role to ‘fix her’ if she isn’t willing to make the changes that are necessary to help herself. I let her tell her story about the past weeks and what she had experienced.

When she was done, I felt a slight calm come over her. We talked a little bit more about her diet and I encouraged her to make the food changes that would heal her gut, with time, instead of allowing us to prescribe bandaids. “You’ve been eating this way for three decades, your health isn’t going to change over night, but with slow, steady steps towards transformation, you’ll get there and we’ll help you”.

Continuing to talk, her posture improved, her arms moved from across her belly onto the shared desk in front of us and she laughed a few times. We discussed her almost lifelong journey with these symptoms and how no one has ever told how to eat or what the cause could be or that she could actually live a life without pain. Twenty minutes later, she was smiling, her color was improved and she said her pain was gone. I had her move to the exam table, examined her thoroughly and found nothing that would require further workup or evaluation in the ER again. We developed a plan together, I refilled her ‘bandaids’ and made sure she had a primary care doctor to follow-up with after she saw the specialist.

After she left, the nurse came to me and said “what did you give her, you didn’t order anything for me to give her?”. I said I gave her a dose of love, compassion and real, easy to understand steps towards getting better and we collaborated towards a working plan. She looked at me like I was crazy and then said “she was a different person leaving from here, I thought for sure we were going to send her to the ER again”. I didn’t think anything of her statement, I was just excited that my patient had some hope of getting better.

When I was up at a meditation as medicine conference at Harvard Medical School a few weeks ago, they talked about the medical providers words and energy as placebo towards the benefit or detriment of the patient. Then later in the week at another conference, Dr. Aviva Romm mentioned it in her talk in relation to how we punish our patients for being ‘non-compliant’ when we should be praising them for being ‘engaged’ and the power of our thoughts surrounding our patients and their success.

The New England Journal of Medicine published a study in 2013 where 146 adults with chronic knee pain caused by a torn meniscus underwent arthroscopy of the affected knee followed either by removal of portions of the damaged meniscus or by simulated surgery in which no tissue was actually removed. None  of the patients knew whether or not they’d actually undergone surgery, and all received similar post-operative care and follow up. Remarkably, the patients in both groups reported significant improvement in their symptoms irrespective of whether or not any meniscal tissue had been removed.

Another study by Benedetti talked about how doctor’s words affect the neural processing of the patients brain. There is scientific evidence that show dopamine and endorphins (natural pain killers) are released from the brain when saying that a patient is getting a pain pill, even if its placebo. In Love, Medicine and Miracles, Dr. Bernie Siegal, talks about a cancer treatment called OPEH that was being used in multiple locations that was getting same results through all the different centers except for one. They questioned this particular center and found that the doctor rearranged the letters of the chemotherapy and told his patients they were getting HOPE, hence increased numbers of success. So simple and yet so amazing!

There is countless anecdotal evidence of this happening as well, but we usually just chalk it up to coincidence.We have to recognize there is major magic in our words and that thoughts become things, so choose your words and your thoughts and even your demeanor carefully when interacting with people. This is absolutely imperative when it comes to us as medical providers, have faith in your patient and engage them and you’ll see miracles happen sometimes faster than any pill could ever produce.

‘There are only two ways to live your life. One is though nothing is a miracle. The other is as though everything is a miracle.’ – Einstein

Thank you for reading.

Image courtesy of naypong at FreeDigitalPhotos.net