Treatment Selection For Chronic Medical Disorders
Most people believe symptoms are the disease so they often take drugs, herbs or supplements to suppress symptoms in the false belief that a medical or psychiatric problem is resolved if symptoms disappear. These myths may stem from deep, unconscious fears handed down to us from ages past when diarrhea was equated with typhoid fever or a cough could mean that one has tuberculosis. TB did kill about one billion human beings in the 1800s, so one can understand why people are afraid of symptoms and believe they are the disease itself.
Only recently have we come to understand that symptoms suggest something very different. Symptoms are actually the result of the body trying to heal itself in some way. Diarrhea and cough could very rarely signify a lethal problem and should be investigated if they become chronic problems, but actually these symptoms are protective detoxification mechanisms which the body employs to remove toxins from gastrointestinal and respiratory tracts respectively.
Fatigue can signify malnutrition and therefore tiredness could be a natural response of the body to conserve calories. Nausea is a protective signal from the body instructing us to fast, because the GI tract is dealing with something toxic or infectious and does not want to devote its limited resources to digesting food. Joint pain is a clear protective signal to rest an inflamed joint. Depression could result from overdoing our fight/flight sympathetic nervous system and the consequent burnout protectively forces us to rest.
Symptoms are the result of the body trying to heal itself in some way, but those symptoms can be maladaptive. If diarrhea causes severe dehydration, or if a cough prevents sleep, obviously these symptoms, however valid as healing mechanisms, are maladaptive and may need to be suppressed with herbal or drug therapies. But usually, symptoms are perfectly adaptive attempts of the body to heal, and should be understood from that perspective and modified only if they spill over into a maladaptive pattern.
For instance, fever is a protective mechanism designed to injure infectious organisms which do not reproduce as well at higher temperatures. However, brain injury or seizures can occur if fever gets too high, so medication may be needed to keep it under 104 degrees to prevent such adverse maladaptive responses.
Three Main Kinds of Chronic Symptoms
Chronic symptoms are usually not lethal, but they can be life-limiting. The three main kinds of chronic symptoms are:
2- pain (emotional or physical) and
3- dysfunction (occupational, social, academic, interpersonal).
I am often asked, “Doc, how should these be treated?” Or, “What can I take to make these symptoms go away?” This is the wrong question, and the age old dictum – if you ask the wrong questions you get the wrong answers – applies here. Many chronic medical and psychiatric problems never resolve because the wrong questions are asked about how to resolve them.
First of all, if you want to solve a chronic medical or psychiatric problem, and now that you know that all symptoms are an attempt (adaptive or maladaptive) of the body to heal, before rushing off to find a suppressive remedy, take a few moments to contemplate why your body is expressing its healing mechanism by generating the symptoms you are dealing with. The suggestions concerning some common symptoms above could be a helpful starting point.
If you have symptoms, why is your body doing this? What is it trying to tell you? There are practical benefits of asking these questions before rushing off to taking a remedy, because symptom suppression with drugs and herbs without understanding the underlying purpose of symptoms, can frustrate the attempts of your body to heal and make the problem worse.
Secondly, diagnostic testing can be helpful to pinpoint the cause of the symptoms. For instance, inflammation and pain could signal your body’s attempt to fight off Lyme or some infection, and diagnostic testing can determine if an infection is present and what the proper treatment should be. Even if an infection were present, remember that even the best antibiotic only shifts the balance of power 10% or so in favor of your immune system, and for chronic infections, the strengthening of your immune system remains the most important option. Preventing inflammation with drugs like prednisone and methotrexate can frustrate your immune systems attempts to kill the causative germ, and allow the infection to spread even as symptoms seem to resolve.
If molecular therapies (drugs, herbs, supplements) are going to be used to treat chronic medical or psychiatric symptoms, consider the rational strategy I have mapped out below. Generally speaking, the value of any intervention is based on 4 criteria: safety, efficacy, expense and difficulty.
In other words; what is the potential harm, how well does it work, how much does it cost, and how much of a hassle is it to use? Based on these 4 criteria, next consider the four main kinds of molecular treatments for chronic medical and psychiatric disorders; 1) nutritional supplements (orthomolecules(1), 2) bio-identical hormones and neurotransmitters, 3) herbal remedies and 4) drugs. These can be listed as treatments of first resort, treatments of second resort and so on down to treatments of last resort (see table below).
4 Kinds of Molecular Treatments
This strategy can be further refined to take into account detoxification, which usually has a greater effect on healing than mere nutritional restoration for healing of chronic medical and psychiatric disorders. Antibiotics, cancer chemotherapy drugs or chelating agents (binders of heavy metals) are potentially toxic chemicals, but they can result in detoxifying an individual from much more serious toxicities (caused by germs, cancer cells and toxins), and thus their use can be justified.
The four treatments of resort should be adjusted to take this detoxification strategy into account, and this produces 6 types of molecular treatments listed below as treatments of first resort down to treatments of last resort.
6 Kinds of Molecular Treatments
To be complete, I should close with a reminder that molecular interventions are only one of the 4 main types of modalities in integrative medicine. The other 3 are structural interventions (e.g., chiropractic, massage, surgery), energetic treatments (e.g., acupuncture, surgical lasers) and psychoemotional approaches (e.g., psychotherapy). Remembering again that symptoms are only an attempt of the body to heal, and that safety, efficacy, expense and difficulty are the factors which justify any treatment, the 6 kinds of molecular treatments listed above, from first to last treatments of resort, can help you organize a rational molecular strategy to intervene in any chronic medical or psychiatric problem.
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(1) “Ortho” means to straighten or correct, as in “orthopedist” (corrects the bones) or “orthodontist” (corrects the teeth). An orthomolecular medicine practitioner corrects or straightens out the molecules which are used to construct and run the machinery of the human body.