01 Jan It Doesn’t Always Have to be Complicated
by Alan R. Gaby, M.D.
With the many advances in both conventional and integrative medicine, we have a wide range of options available for assessing and treating our patients. In some cases, particularly in those who are chronically ill and have complex problems, a comprehensive laboratory analysis might help identify treatable conditions that would not otherwise be suspected, and a comprehensive treatment program might be more successful than a simpler intervention. It is important to remember, however, that not all cases are complicated. In many instances simple, low-cost, low-tech, low-risk interventions can be quite successful. Following are a few examples.
Nature will castigate those who don’t masticate
A 26-year-old male had a long history of heartburn. A gastroenterologist had performed an upper GI endoscopy and diagnosed gastroesophageal reflux disease. Treatment with proton pump inhibitors and other medications had provided only partial relief. When the young man consulted me, questioning revealed that he ate his food extremely rapidly. He was advised to chew each mouthful thoroughly, and this change alone resulted in an 80% improvement in his symptoms. Subsequently he removed most of the “junk food” from his diet, and became symptom-free.
Temporomandibular joint (TMJ) syndrome
Temporomandibular joint (TMJ) syndrome is a common disorder of the joint that connects the mandible (jawbone) to the temporal bone of the skull. Symptoms may include pain or aching of the jaw or surrounding muscles; difficulty chewing; locking of the jaw; and a popping, clicking, or grating when the mouth is opened or closed. The cause of TMJ syndrome is multifactorial, and may include chronic teeth grinding, trauma to the area, arthritis in the joint, or displacement of the articular disc that is present between the mandible and the temporal bone. Treatment may include anti-inflammatory medications, analgesics, muscle relaxants, mouth guards, and physical therapy. In severe cases, surgery may be recommended.
Several years ago I took my 11-year-old daughter to a chiropractor for various minor musculoskeletal problems. During the visit, I mentioned that she had been experiencing uncomfortable clicking and popping sensations on both side of her jaw for about 3 months, along with a feeling that her jaw was out of alignment. I was not aware that there was a chiropractic treatment for TMJ disorders. The chiropractor examined the area and then used an “activator” to deliver a gentle force directly over each of the TMJ discs. This maneuver resulted in immediate and complete resolution of the symptoms. My daughter has had to return a few times over the ensuing 3 years, but each time the benefits of the adjustment lasted at least 6 months.
The chiropractor told me he has seen about 50 TMJ patients (mostly acute cases) over an 18-year period, and about 80% of them experienced very good results. Another chiropractor I have spoken to reports similar results. Presumably, patients with more advanced disease, significant arthritis, or various other predictors of a poor outcome would be less likely to respond to this type of TMJ adjustment. However, more widespread use of this intervention (particularly in early cases) would likely decrease the need for high-cost, invasive procedures.
A case of chronic fatigue
A woman in her 30s had a chief complaint of longstanding fatigue. She had previously seen another “alternative” doctor, who told her she had an increased body burden of heavy metals, as demonstrated by a 24-hour urine collection following an EDTA challenge. She underwent 15 sessions of EDTA chelation therapy, which cost a lot of money and appeared to make her fatigue worse.
Questioning at my office revealed that the fatigue was better when she did not eat and was often worse after eating. That observation, as well as some aspects of her past medical history, suggested the possibility of hidden food allergy. Her fatigue disappeared on an elimination diet and recurred when she reintroduced soy, which had been a regular part of her diet. She remained symptom-free as long as she avoided soy-containing foods.
Anxiety in an elderly woman
A 77-year-old woman had a 6-month history of persistent anxiety. She had tried several anxiolytic drugs, which were not well tolerated and not particularly effective. When she consulted me, I ascertained that her symptoms had begun about a month after she started treatment with a thiazide diuretic for hypertension. Thiazide diuretics are known to deplete magnesium, and magnesium deficiency is in my experience a common cause of anxiety. She was advised to take 400 mg per day of supplemental magnesium. Symptomatic improvement was noticeable within a couple of days, and the anxiety was markedly better within 2 weeks.
These case reports are presented to remind us that the practice of medicine does not always have to be complicated, and that simple and straightforward solutions to problems are often available. A famous medical philosopher (whose name escapes me) once said that, all else being equal, we should try the least heroic interventions first.