I've started my new website-based organization, Integrative Medical Solutions for three main reasons.
I intend to show the need for a for a place where the public as well as professionals in the medical field can exchange ideas, questions and even debate.
It has been my experience that the biomechanical and neurologic integration of our bodies is evident, measurable and can be tested.
It can, and must be documented and used to establish a scientific basis for further explanation and study.
Patients will benefit from earlier diagnosis and intervention
I am a retired dentist. I retired due to bilateral carpal tunnel syndrome, due to which my hands were cramping and finally became totally numb for four months. At that time, the surgical therapy that was available had a 60% relapse rate. As a physician-dentist and a therapist, I performed tests during patient examinations three times, every time. That made them suitable for presentation in court in my many accident cases, as well as for my own records.
My interest arose out of my experiences when I was dentist specializing in treating Temporomandibular Joint Dysfunction (TMJD.) I observed many interesting and dramatic changes in my patient’s symptoms and felt it was not enough for me to simply observe them.
I soon realized that the shortcomings of a largely insurance driven medical system would continue to prevent my patient’s needs from being covered.
This was true even when the symptoms could be described perfectly according to the then used DSM-3 manual and accorded proper billing codes. After, all, I was “just a Dentist.” I’ll address that issue in a later post!
TMJD was recognized as a medical condition in 1977 when a courtroom in New Jersey decided it was caused by an accident. Yet, it was not covered under medical insurance because it was not given the status of any percentage of injury by the medical system.
In the 1980's it was called “TMJ Syndrome” by both medical and dental professionals.
The derision with which patients suffering from its various “unexplainable” maladies has persisted until recently, with symptoms now being associated with today’s “Fibromyalgia” label. TMJ Dysfunction is a very real comparison.
Fibromyalgia is a nearly useless “name” applied to a wide variety of symptoms. A TV commercial blames it on, “heightened nerve sensitivity.” That’s just like saying “I have a headache.” WHY?
It has a cause. That CAUSE is the diagnosis.
It is my belief that we have the basis for explanations.
Every patient is different. That complicates it.
Myofascial Pain Dysfunction (discussed briefly below, and to be covered in later posts) was also totally unknown, until an explanation was given by President Kennedy’s physician, Dr. Janet Travell along with Dr. David Simons, in their landmark book.
It has not been used to explain “fibromyalgia.” Why? I think that’s because of our current medical system'stendency to prescribe medication to treat dysfunction and a lack of familiarity with Physical Medicine and the power of it's many modalities. I just don't see another good reason.
My Introduction To Integrative Medicine
I researched the neurologic and physiologic basis that was necessary to explain the mechanisms behind my patient’s changed symptomatology.
I disregarded psychological explanations since my patient’s outlooks changed dramatically and a physical explanation did usually exist. I became my belief that changing the input into the Central Nervous System (we keep calling it ("The Brain") results in changes in neurohumoral and neuroendocrine secretions, therefore ultimately enabling changes in thought patterns, moods and energy levels. It may also change other endocrine gland secretions. More about this later.
Typical medical flowcharts for diagnosis go through various categories and finally assign symptoms as Psychological. What about finding an explanation in neurology based on the body’s own feedback systems?
This is the essence of Integrative Medicine; also called by many, Allopathic Medicine or Holistic Medicine. The difference lies in interspecialty communication and cooperation.
It has become my deep-seated conviction that this integrative approach can and should be the first one used for all observed changes.
The First Annual convention of a major group devoted to the field of Integrative Medicine involved purely psychological presentations about patient’s and physician’s psychological issues. I saw no mention of any physical causes.
Not only Psychological aspects, but also the biodynamic, neurological and nutritional aspects must be considered. Functional issues are paramount.
My experience principally included working with but not limited, to:
We learned to form highly effective teams. We formed multi-disciplinary organizations. We took the time to discuss our findings and impressions and to learn from, to respect, and to teach each other what we understood to be occurring from our different perspectives.
The whole “picture” that emerged was fascinating, even wondrous.
I learned that my therapy became much more effective when I learned to test it using accepted orthopedic and chiropractic tests.
I personally often turned to “Orthopedic Neurology” by Dr. Hoppenfeld and “The Anatomical Atlas Of The Human Body” by Drs. Manter and Gatz. I also used a book called “Functional Neuroanatomy” whose author I cannot now recall.
We physicians then found a common basis from which we could treat our patients. We had a better way of communicating and of working together that enabled us to more quickly assess and treat our patients.
I learned how important it is for therapists to actively seek out the information that is available. I found we could explain many things that we would otherwise not have been willing to accept.
I believe we need to change the training programs within the professional universities and schools so that the students learn to think more flexibly.
They need to seek out the assistance of other professionals more frequently and much earlier during their process of making a diagnosis.
A recurring example which caused me frustration involved children suffering from ear infections, known to physicians as otitis media.
Dr. Harold Arlen wrote an entire chapter for the book “Temporomandibular Joint Dysfunction,” by Dr. Harold Gelb, a pioneer in the field of TMJ Dysfunction. The chapter was called Otomandibular Syndrome.
In it he discussed the intimate relationship between craniomandibular function and the proper functioning of the eustachian tube, which permits drainage from the middle ear to the upper throat.
In the book Myofascial Pain Dysfunction Dr. Janet Travell and Dr. David Simon discussed involvement of spasticity of a particular muscle that overlies the opening of the eustachian tube. I will discuss both of these situations in more detail in later posts.
It was NOT a deficiency of Penicillin-like medications, as it's been generally treated!
New Concepts in Integrative Medical Solutions
In my continuing posts I will present information that shows how important this approach was to making the appropriate diagnoses in patients who had remained a mystery to their physicians.
That is the point behind Integrative Medical Solutions as a philosophy and as a specialty in medicine, as real and necessary as all other specialties.
Example 1: My WHY
This case still disturbs me so much that I finally decided that a forum about possible Integrative Medical Solutions is absolutely necessary.
A young man had a significant speech impediment and a tongue thrust. He was brought in to me by his two speech therapists, who were members our local multidisciplinary organization. They explained the difficulties in therapy.
He was unable to perform the lip and tongue exercises that they asked him to do. After changing the position of his mandible (lower jaw) he was immediately capable of performing all of the requested exercises.
The improvement was also immediately reversed without the induced repositioning. They were both totally amazed by the response. I then explained the Fifth Cranial Nerve involvement to them.
This young man had been evaluated and treated from the age of two years old by many kinds of physicians. No therapy ever helped him. I finally had a chance to examine him fully when he was 11 years old.
Those physicians and dentists who did examine them him believed that he was tremendously prognathic; that is, he had a huge lower jaw.
I took a lateral radiograph of the head and jaw and I discovered that his mandible was absolutely normal.
His problem was that his entire midface was underdeveloped.
Without going into further detail here I will say that appropriate therapy instituted much earlier could possibly now correct much of this dysplasia.
Changes in medical and dental knowledge and procedures are important, but combining the two can be even more critical.
Example 2: My WHY
A teenage young man was referred to me by his physician, an ear nose and throat specialist(ENT.)
He suffered from severe chronic sinusitis for nine months. His face looked like he had bad “hay fever,” (Adenoid Facies) in winter, in Massachusetts, USA. (Red nose, puffy eyes, sniffles.)
All of the normal medications had been given including drying agents, antihistamines and even a few different kinds of antibiotics. I evaluated the history, took appropriate radiographs, and performed a complete examination.
I noticed that the young man was wearing braces for orthodontic therapy. I asked the mother when the braces were put on she told me almost the exact date. It was nine months ago!
I asked her to bring the young man back in for examination and a new set of radiographs while he was wearing his orthodontic headgear.
While he was wearing the headgear there was displacement of the second cervical vertebra. It was sensitive to palpation.
His nose was running so badly that he went through 3-4 tissues within the first half hour sitting in my chair.
Comparing the radiographs disclosed that without the headgear in place his second cervical vertebra was in an absolutely normal position.
I then requested that he not where any headgear for three or four days and asked the mother to call me to let me know how he did.
She called me on the third day and reported that all of his symptoms were totally gone by the end of that day.
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