Meet Ella: She is 33 years old, feels tired all the time, has gained 10 lbs in the last two years and struggles with depression and anxiety. Her sleep has been suffering due to increased job demands. Although she used to enjoy giving presentations at work, she now feels panicked before presenting.
She sees her primary care doctor who diagnoses her with depression, anxiety and insomnia. Her visit is over in less than 20 minutes, as Dr. Primary has 22 patients to see that day. Ella is given Lexapro for depression and anxiety, Ambien as needed for insomnia, and Xanax as needed for anxiety – an addictive medicine that can be potentially deadly when combined with opioid medications or alcohol. Her thyroid function tests come back and she is found to have an autoimmune condition causing hypothyroidism, for which he prescribes levothyroxine (synthetic thyroid hormone).
Ella’s energy symptoms improve slightly on thyroid hormone, but she is still not back at baseline and can’t shed the weight. She is still mildly depressed and starts using Xanax daily for her anxiety.
She is concerned about side effects of all of the medications she is taking but feels there is nothing else she can do to help herself. One morning, she finds her fridge has been emptied, only to later learn that sleep eating can occur on Ambien.
Ella runs out of Xanax while her doctor is away and feels anxious when told she may have to wait a day or two for her refill. She goes to an urgent care to try to refill her medication, feeling her panic spin out of control.
These events were Ella’s wake up call. She makes a decision to be an active participant in her healthcare and seeks approaches that will give her the tools to understand and manage her symptoms.
Enter Dr. Integrative. Prior to meeting with Ella, Dr. Integrative’s office sends Ella a comprehensive intake form to fill out, outlining her health and life goals, past medical history, family history and toxin exposures, as well as lifestyle and nutrition habits.
Dr. Integrative prepares for her visit with Ella, reviewing the intake form and taking notes. During their initial 90-minute visit Dr. Integrative gets to know Ella as a person, understand her values and health goals, as well as her readiness to change some of the habits that are not serving her. She educates Ella on underlying causes that may be triggering inflammation and autoimmunity in her body. They carefully review Ella history and nutrition, talk about Ella’s stressors and what brings her joy.
Dr. Integrative shows Ella how to use the 4-7-8 breath to cope with stress and prevent panic attacks, and the HeartMath biofeedback app to influence her physiology and stress response, cognitive performance and emotional states each day. They practice guided imagery and a daily meditation that Ella can access on her phone and discuss the role these evidence-based practices have in alleviating anxiety.
The doctor orders a complete thyroid hormone lab panel, evaluates key nutrients and gut health. They discuss key pillars of health and how they affect different systems in our body. Ella agrees to adopt a gluten-free dietary plan, as this has been demonstrated to reduce thyroid autoimmunity. She and her doctor talk about getting sufficient selenium, vitamin D and iodine, among other key nutrients for thyroid function.
Ella’s doctor and health coach create a nutritional plan for her based on these findings, as well as an exercise regimen that involves spending time in nature hiking with friends and dancing – both of which bring her joy. Her health coach provides regular support, and within a few months, Ella’s autoimmunity against her thyroid significantly decreases.
Her doctor starts a low dose of an additional hormone, T3 thyroid hormone, to add to the T4, given ongoing mild depression and fatigue. Her energy and depression improve on this combination.
Dr. Integrative discusses sleep hygiene with Ella, and comes up with a routine she can adhere to with methods for winding down and parameters around checking work email and exercising too close to bed time. Ella is able to decrease her Ambien use and stops using it after a month of this new regimen. Breathing techniques allow Ella to minimize panic attacks. Using these new skills, she’s eventually able to come off Xanax!
She stays on Lexapro for a few more months, slowly tapering it off with the close guidance and assessment as she settles into her new routine. She sees a therapist and does EFT tapping to help resolve stressors and prior traumas that continue to hold her back.
As a result of this journey, Ella is now off of medications, apart from thyroid hormone treatment, she has more energy than she has had in years, she feels vibrant, alive, at her ideal weight, and free of the limiting beliefs and worries she had when she was in the anxious, constricted state. She has not only overcome panic associated with public speaking, but she now thrives and enjoys the challenge. As a result, she gets promoted and her colleagues start asking her for public speaking advice.
Now, a question for you: Which Ella would you prefer to be, the one pre or post the wake-up call?
Conditions or symptoms are often treated separately, problem by problem, rather than considering them as multiple manifestations of the same root cause. A functional medicine provider seeks to find the cause(s) of pathophysiology responsible for symptoms and conditions that we have and addresses these directly. An integrative medicine provider combines evidence-based modalities from conventional and complementary approaches, to create a customized plan, based on patient and condition factors, that will effectively deal with the given condition.
When determining which approach is best suited to your needs, consider your values, your health and life goals.
Check the credentials, board certification(s) and experience of the physician or practitioner you are working with. Do they collaborate with other providers and share knowledge or ideas? Do they teach students and doctors in training?
Ask yourself whether you feel that your provider makes the effort to get to know you as a person and takes into account your social and emotional circumstances when creating a plan for you. Does your provider offer health coaching services or work with a health coach? Does your provider do everything to ensure you are not on medications unless they are absolutely indicated?
The patient-physician relationship plays an important role in determining the outcome of conditions, adherence to the treatment plan and global health status of patients, so it is important that you choose the provider who is the right fit.
Work with a provider you can relate to, who can help provide a path for you to achieve your health goals. This will require an investment on your part in adhering to lifestyle habits that will support your healing. That being said, this approach will give you the highest chance of achieving sustainable physical and mental wellness and being your best self.
***Please note that although the patient in this story is not based on a real person, the story illustrates the successes and outcomes that are achievable by using integrative and functional medicine modalities.
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