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To find health should be the object of the doctor.
Anyone can find disease.
âAndrew T. Still, M.D., Founder of Osteopathy 1
1. What Brings You Here?
âWHAT BRINGS YOU HERE?â This is the question I use to begin every consultation, so itâs the question with which I begin our time together in this book. If you were sitting across from me in my office, we would try to get to the bottom of the following questions: Why have you come to me? Are you suffering from a particular condition or ailment? Are you trying to understand why youâre feeling a certain way? Are you frustrated with the contradictory information and limited guidance youâve been receiving from others? Have you gotten too much information, and has that confused you about where to begin? With all that you read and are told by others, do you really understand what it means to be healthy? Unlike most doctors, I am a doctor of slow medicine, meaning I really want to spend time on your questions. They show me where you are on the road to health.
Are you asking good, skillful questions? Think of it this way: you might have the intention to get to New York City from rural Pennsylvania, but by asking for directions to âthe big city with all the buildings,â you might very well wind up in Philadelphia. Phillyâs a good town, but itâs not where you intended to go. Similarly, if you donât know where you are right now, it will be impossible to find the right road to where you want to go.
The fact is, you probably donât need to think too hard about whatâs bothering you right now, but you do need to refine your questions in order to reveal the path to true health. So, we start our consultation together with a series of intelligent questions. In general, they can be answered yes or no. This first one, for obvious reasons, is different. As you gain more insight by asking and answering these questions, youâll get a glimpse of a much more optimistic framework for living your lifeâon a much more interesting journey, I might add. Ultimately, youâll find a more sensible path toward healing.
Iâve spent a long time walking and studying that path. Iâll tell you more about my journey later. For now, I want to get straight to you. Why have you come to me? Like millions of us, youâve probably got some health âissues,â and some of them might seriously diminish your quality of life. You might suffer from diabetes, hypertension, cancer, arthritis, headaches, ulcers, back pain, or a host of other very common and very unpleasant chronic conditions. Youâre not alone. According to the Centers for Disease Control and Prevention, more than 133 million Americans (one in every two adults) suffers from at least one chronic illness. The percentage of children and adolescents with a chronic illness has more than quadrupled since the 1960s. And chronic diseases cause seven in ten deaths in the United States each year.2 Youâve probably tried a lot of solutions: several doctors, several specialists, several drugs, several âalternative cures,â and maybe even several invasive procedures or even surgeries. If youâve been suffering for years, youâre probably like the vast majority of Americansâa whopping 72 percentâwho believe the health care system in America is facing both âcrisis and major problemsâ3 in part because it canât seem to help you and those other millions.
In any case, if youâre dealing daily with chronic conditions, you donât need much in the way of reminders and statistics. Whatâs wrong with this picture? How is it possible that we live in the most technologically advanced period in history, in the richest nation in history, where research, science, and the quest for health and longevity reign supremeâyet so many of us go on suffering needlessly with nasty conditions that are largely within our control? Is it really okay that 16 percent of our countryâs wealth is spent on medical careâmore than any other nationâyet thereâs precious little evidence that our extra spending makes us healthier?4 Indeed, we rank only average or below average for health among highly industrialized nations! Why is it okay that so many new drugs were approved by the FDA in the past several years, billions were spent on medical research, doctors got supposedly better and better educations, but the rates of chronic ailments like diabetes and obesity are dramatically rising rather than falling?5 Iâm trying not to sound shrill here, but itâs hard. The system is not serving us well, and itâs on the brink of collapse.
Meantime, youâre still sick, and thatâs the most important thing. There are several reasons youâre sick and why conventional medicine hasnât helped you get well. But I want to focus on a major one thatâs in your sphere of control: the slow medicine notion that we need to address all the aspects of your life, rather than just trying to âfix a broken part,â in order to create the best health possible.
2. Are You Free of All Aches, Pains, and Chronic Diseases?
THE BIG 8 AND THEIR COMMON CULPRIT
So what does bring you here? Are you free of all aches, pains, ailments, and chronic diseases? This is the first of the yes-or-no questions designed to get you thinking about the bigger picture of health. I hope youâre free of all these maladiesâbut thatâs not likely.
When we first meet, I encourage each patient to tell me the answer to this question about themselves, their health, and their life. In part, this is to help me understand your history, the particular circumstances of your baseline state of health, and your needs. But it has another, perhaps even more important function: to help you better understand yourself and your state of health. Obviously, this particular function is critical in my relationship with you, the reader, because Iâm guiding you through a process youâre doing at home.
Your health is complex and multifaceted. Symptoms and syndromes are part of a whole web of body and life aspects weâll explore in this book. But letâs start at the beginning, on a purely physical (symptom-based) level. Most people first come to me with a concern about a physical problem. The most common presenting complaints fall into one of eight broad categories. Chances are your immediate and initial health concern falls into one of these broad groups, too, some of which overlap:
3. Do You Understand the Causes of Your Chronic Physical Conditions?
You might have other ailmentsâand donât worry, Iâll address as many as I can throughout this book. But the list above encompasses the main complaints. And this is a very interesting list of symptoms and conditions, from a medical point of view. Can you tell what the common denominator is for essentially all of these?
If you guessed inflammation, youâre right! It might not be the sole cause, but I can tell you from long experience and solid science thereâs a good chance that some form of inflammation is at the root of all these physical challenges. Itâs even implicated in Alzheimerâs disease and aging itself.
Inflammation happens to be one of the bodyâs natural protective healing processes. Inflammation is an automatic reaction to an injury or a disease state that precedes it. So a conventional doctor might be satisfied that inflammation in the colon (colitis), for example, has some physical cause, such as a blockage or infection in or around the colon. When they see colitis, they go in search of this cause: Whatâs attacking the colon, causing the inflammation? Notice that their search will focus on the physical cause. In an acute state of inflammation, there often is a physical cause. But the inflammation can persist for a long time without the original insult being present anymore. This is a chronic state of inflammation, during which some internal imbalance in the body keeps the inflammation going despite the absence of the original physical insult.
Itâs also important to note that in many cases of chronic inflammation, some X factorâoften outside the involved organ, and maybe even outside the body in some other aspect of the patientâs lifeâsupports and maintains the inflammation in the system, settling in the colon, in this example. Iâd call this secondary inflammation, but itâs inflammation nonetheless.
Either way, when I see colitis as a symptom, I will, of course, like your doctor, look for evidence of injury, underlying disease, infection, and so onâbut then I will go beyond, using a holistic approach that is helpful for all the inflammatory conditions on the Big 8 list. If youâre reading this, itâs likely that the primary approach youâve experienced in conventional medicine has not done the trick.
Indeed, itâs this holistic approach to inflammatory conditions thatâs really instructive as a model for the way slow medicine works. Inflammation is likely to be at the root of many health problems, but the wisest and best approach for treating it must take into consideration that these conditions will defy straightforward, physical remedies in isolation. The patient needs to work on reducing inflammation with a comprehensive plan. In other words, as a rule, âTake two ibuprofen and call me in the morningâ is not going to be enough. While that treatment plan might help mask symptoms of acute inflammation, it will fall far short of getting to the bottom of the chronic condition and its causes. If you have colitis, weâre going to have to address the inflammatory processes both in your colon and in the rest of your life.
Before we get to that, though, letâs look more closely at the standard of care in conventional medicine. How do most doctors deal with these kinds of conditions, and why do so many patients feel theyâre not being helped?
DOCTORS WITH MYOPIA
In my practice, the most common answer to Question 1, âWhat brings you here?â is: âThe doctor Iâve been seeing really isnât helping me.â Itâs remarkable, but almost every patient says something along those lines. They often add, âI donât think my doctor really gets it.â Part of the reason for this is that your doctor doesnât believe you can change. Dr. Tracy Orleans, a health psychologist at the Fox Chase Cancer Control Center in Philadelphia, found in his research that two out of three physicians were pessimistic about their patientsâ ability to change. Thatâs perhaps because of poor âcomplianceâ by patients in the past. The doctor tells you to quit smoking and you donât. The doctor tells you to lose weight, yet you ârefuseâ to change your diet and start moving. Dr. Orleans writes, âThis pessimism is the single biggest obstacle to getting physicians to help their patients with their health problems.â Yet studies show that if doctors took preventive medicine more seriously, they could double the number of patients with better results, like quitting smoking.6 Thatâ...
