THE BLOG
08/10/2012 09:45 am ET Updated Oct 10, 2012

Diagnosis Before Treatment

I have a particular fondness for my compost bucket. It's really more of a pail, shiny silver with a sturdy handle and a fitted lid. Recently, I toss my scraps on the backyard pile and the handle comes loose; one of the screws holding it in place falls out and I can not find it. A small screw is what I need to replace it. I look in the cellar, having recently and somewhat pathetically organized our screw and nail collection, and as might be predicted, the width and length I need is nowhere to be found.

In the aisles of my local hardware store, I stumble around and come close to finding what I need but alas, nothing seems quite right. I ask for help and the nice gentleman comes to assist me and goes directly over to an otherwise-unseen-by-me wall chart. Those of you more familiar with hardware stores and building supplies know what I mean, but I have never seen something like it. The chart had little holes in it so you can actually test the screw you need to be sure it is exactly the right match for the job.

It dawns on me that medicine and healing can be quite similar. Sometimes we are not even aware of the tools available to us -- both as the patient or as the doctor. Sometimes the treatment is wonderful but it is just the wrong match for the patient at hand, like a perfectly functional screw that does not fit the hole you have. Sometimes there's a very obvious problem but no one thinks of a seemingly -- in hindsight -- obvious solution.

Enter Gladys. She comes to my office without an appointment in a state of pain and frenzy. She is petrified that she is having a heart attack. Mind you, she had driven over four hours to see me, she is very afraid of doctors and hospitals and thought maybe I could help. As ridiculous as this sounds, it is not that uncommon and always scares me to no end. And of course a patient like this is a terrible liability to any doctor. Next step: emergency department and STAT. At the hospital over the course of the next four days she has the so-called million-dollar workup including all the lab work, physical exam, diagnositic imaging, EKG and stress test, etc., that would be performed for a middle-aged woman presenting with a possible cardiac event.

I went to visit her as a courtesy, even though I had yet to treat her. Funny thing was, all her diagnostic tests were pristine, her heart and lungs were in fine order and she had blood chemistry that anyone would admire. And the kicker was, she still felt exactly the same pain as she had two days before when she showed up somewhat disoriented at my office.

While I was there I asked if I might feel her back. Naturopathic doctors learn spinal manipulation. Some NDs choose to specialize in physical medicine, though it has not been a strong focus of mine. In my current practice I do very little in this realm, instead I refer to the capable chiropractic and osteopathic physicians in my area and other bodywork practitioners whose work I admire. Likewise, these practitioners refer to me when they feel a patient might benefit from my expertise. Nonetheless, her thoracic spine was terribly out of alignment and I wondered if perhaps her chest pain and overall disorientation could be due to her back. Once she was discharged from the hospital, after additional GI workup, which also revealed nothing, she came to my office and I did a naturopathic adjustment on her back. Lo and behold when she sat up from the exam table, her chest pain was gone. She breathed a strong sigh of relief and scratched her head -- could that have been it all along?

I have often used Gladys as my example of extreme lack of seeing what was wrong, and how the very best state-of-the-art diagnostics revealed nothing and treatment attempts did not offer relief. All treatment falls short if not applied correctly, whether allopathic or naturopathic. A proper diagnosis always precedes a proper treatment. It is true that in an emergency situation the differential diagnosis must include the most serious possible pathology and of course the emergency department is exactly where I would want to be if I had chest pain. All kinds of doctors must be aware of the situation our patient is in, the limits to what we personally can do and the appropriate referral when necessary. Finding the right treatment for the right patient at the right time remains our highest goal and sometimes it is the simplest things gone awry that need to be addressed.

For more by Amy Rothernberg, N.D., click here.

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