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As I entered a patient care room one Friday morning, I was greeted by a lovely young woman who sat patiently waiting to speak to me about her illness. She related that she had heard that I was a holistic physician who thought outside of the box. I smiled as I answered, "Not really." She had a puzzled look on her face as she contemplated my reply. She responded, "But I heard you were holistic. Well. What kind of medicine do you practice?"

That question has come up and more recently. One patient referred to me as a functional medical doctor. Another patient labeled me as an integrative physician. Another thought that I could best describe myself as an orthomolecular physician. I was told several years ago that CIGNA had labeled me as a new age doctor. I looked at this bright young woman, “I am just a doctor. You can call me Doc."

She was not satisfied with my answer. She continued to ask me about my label because she wanted to have some way of identifying me with something she had already visualized in her mind. Her neocortex was fast at work trying to find some sort of classification. It was interesting to hear her different spins on the same concept: holism.

After about ten minutes of discussion, I realized she was uncomfortable with no real medical subspecialty in which to place me. So I thought it wise to describe how I work to diagnose and treat illness.

The human body is an amazing machine that is profoundly influenced by the environment. Not just the wind, water, fire and temperature, but the psychosocial climate of our lives. Our body constantly receives input from our personal habitat and our brain responds to those messages. We are constructed to respond to the all of it. Our responses are emergent, like an ant colony or a bee hive. We have a multitude of hierarchal networks that function both independent of each other and cooperatively. Each cell has a duty to perform, and each one has its personal receptor mix that allows it to perform differently when certain molecules bathe its outer membrane. These molecules come from different origins in the body such as glands, specialized tissues arranged into individual organs, bone marrow, and traumatized or infected tissue. There are certain rules that the body follows in order for it to stay in accord with survival. Each cell has an intrinsic individualized need to sustain itself as long as it can given the constraints of the body's internal and external environment.

When we are developing fetuses in our mother's womb, we imprint a number of metabolic, immune and cognitive processes that are specific to our own individual maternal environment. If our maternal environment is stress filled, our fetal bodies will prepare itself for the anticipated stress. There are different imprints for different stresses. If the environment is harsh and food is scarce, the fetus will imprint a metabolic pattern that is best suited for starvation. If the environment is filled with fear and anxiety, the fetus will imprint a cognitive pattern that is best suited for psychosocial stress. When a child is born, it will have all that it needs to exist in a world in which his/her mother was living. Our fate has been determined by the time we are born. We will live out our lives under the imprinted constructs we developed in utero. But our destiny unfolds as we place ourselves in situations that are in accord with our imprinted self or not. When we stray from our preset conditions regardless of what they are, we will become unhealthy. It would be unwise to drive your two ton pick-up truck in a NASCAR event, just like it would be unwise to drive a highly tuned dragster down a pot-hole ridden dirt road. The human machine is built to handle the environment from which it was created.

Science has uncovered thousands and thousands of physiological facts that are arranged in schemas that pertain to the human body and how it functions. These facts change over time and are subject to both bias and ignorance. The bias is rooted in what has been shown before and becomes accepted and truthful dogma. The ignorance is that researchers may be closed to the endless possible solutions associated with a function of a cell in stress. Physicians are notoriously closed to newness. I recently heard a well respected physician tell me that Rocky Mountain Spotted Fever will always have a rash associated with it. He told me that the microbe that produces this disease always causes a rash when it infects a human. Although he asserted his worldview of Rocky Mountain Spotted Fever with authority, he was profoundly wrong.

I believe physicians need to be able to recognize healthy schemas in order to know when something is out of accord. Seldom is one particular symptom or physical sign diagnostic for a specific disease. Rarely is one single blood test diagnostic of a known disturbance. For hundreds of years, physicians have been falsely told by their mentors that certain individual blood tests can be used in and of themselves to rule in or rule out disease. Without a context in which the test was taken, the results are most times useless. There are physiologic schemas which require grouping multiple tests to determine what each test result means in context with each other test result. That is why I look at blood glucose levels, insulin, cortisol, triglycerides and leptin together as one specific schema. Another schema is TSH, Free T3, Free T4, Reverse T3, Anti-TPO, Anti-TG and Anti-TSH to assess thyroid function. These schemas change as scientists update basic science. I could list hundreds of schemas that I have found useful, but that would go beyond the scope of this blog. The bottom line: we exist in soup of hormones, immune modulators, neurotransmitters, vitamins, minerals, enzymatic cofactors and growth and repair factors that function together at one time. All of which are responding to the environment as it changes each second. I try to see them relationally at one moment in the illusion of time.

Nothing in the body is linear. That means we are not straight lines. None of these schematic relationships are straight lines either. We are fractal. Therefore our physiology is fractal like all other schema in nature. There are elements of random occurrences that force us to mature over time. Many times we have to be susceptible to these random occurrences in order for them to have an effect on us. This holds true for the physical, the cognitive, the emotional and the psychological. In the realm of the cognitive lives religion, in the realm of the emotional lives the spiritual. We are feeling machines that think, not thinking machines that feel.

I practice medicine looking for the primitive and modern schemas of health and illness. In some ways, it incorporates the all of it. What we eat, why we eat that way, what we drink, how we see ourselves and others, how we envision our health, why we think we are healthy, what makes us think something is wrong with our health; the list of questions is infinite. There are also infinite physiologic, emotional, cognitive and psychological schemas. Some of these combinations are found by simple observation. However some schemas are much more mysterious and require much deeper thought and investigation. Some schema may only be seen in one individual, others may be common to all of us. Individual variation in both health assessment and disease diagnosis is what makes practicing medicine difficult.

For those of you who feel that it is necessary to label me or what I do, perhaps we could create the field of Medical Schematology with an emphasis on fractal physiology and emergent systems. Perhaps I should tell patients I am a Schematologist. Perhaps not. I like just being a doctor. Call me Doc.

Thank you Larry, Andrea and Geordan. I listened.

Posted by Amanda Sanders at 9:03 AM
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