Request for Care
When repairing and optimizing your health becomes a priority in your life, it is important to have a dream team of professionals to help you. This will include a primary care physician you trust and who understands and supports your health priorities. You might have or choose someone conventionally trained, a functional medicine doctor, a naturopath, or an osteopath. Also on your team should be any specialists relevant to conditions you have (endocrinologists, cardiologists, therapists, oncologists, hematologists, orthopedists, etc.) and other health-care providers who can give you what you need or help you learn. These helpers could include massage therapists, physical or occupational therapists, acupuncturists, herbalists, homeopaths, chiroprac-tors, or other natural or complementary health-care professionals. You may not be interested in anything but a good massage therapist, and that's fine, but if you want to learn more about some of these alternative health modalities, add experienced natural health providers to your team.
Individuals who carry titles such as naturopathic doctors, osteopathic doctors, functional medicine doctors, acupuncturists, massage therapists, neurofeedback therapists, and occupational and physical therapists are all likely to support your efforts. Keep in mind that a lot of people think they can't afford these kinds of providers but look at your health insurance. Many plans provide for these healing modalities. I had a client who told me she couldn’t afford physical therapy but when we looked at her insurance we realized she was covered for twenty-five physical therapy appointments every year. Become savvy about your insurance resources and support resources available to you, such as through your college , place of employment, or a local school.
YOUR DOCTOR
Of course, first and foremost is your primary care doctor, who should be able
• Guide you and answer your questions without getting impatient or rushing you out the door. This is why it's so important to find someone you can talk to and whose beliefs are in line with yours (or at least not in opposition). It also helps to understand a little bit about how doctors think, how to talk to them, and how to ask for the tests and procedures you know you need. You are the best authority when it comes to your body, and it's your choice who plays on your team. Think of yourself as a consumer, not a patient.
The concept that food is your number-one therapy may be foreign to your doctor, who probably didn't receive a lot of nutritional training. (This is why doctors often send their clients to nutritionists-this is our specialty.) If you have a health issue or want help in preventing one, you need your doctor.
Your doctor can diagnose your health issues, run lab tests, write prescrip-tions, and give you good general health advice. When you and your doctor aren't on the same page, this can be a real problem.
I've been working with doctors for many years now, and I have learned some things. Here is my advice for developing a productive relationship with your doctor.
• Ask questions. When you know you will be seeing your doctor, write down a list of questions and make two copies. When you see your doctor, hand her or him a copy at the beginning of the appointment and ask that it be added to your file. Do not let your doctor give the paper back to you. Say, "I have a copy—that is for my file, please." Then, with your notes to give you confidence, ask what you want to know! If your doctor is rushing you, just ask, "Can I ask you a couple of questions that are really important to me?" A good doctor will stop talking and let you voice your concerns. Don't be afraid. No question about your health is stupid or a waste of anyone's time. If you feel rushed, ask the doctor to help you make a second appointment within that week or the next week, when she or he will have more time to talk. This will let your doctor know that you are serious about getting your questions answered and, typically, many doctors will either make the time for you right then and there or help you set a follow-up appointment just for questions. Emphasize that the follow-up needs to be no further out than a week from your current appointment.
• Put it in writing. If one of your questions is to ask for a lab test, put this in writing and state the reason you believe the lab test is necessary and/or why you are requesting it (don't worry; you'll know what to ask for after reading this book; see page 258 for a sample letter). Doctors are often required to justify lab work to insurance companies, and your written request can help your doctor determine the reason to put down on the paperwork.
• Get copies. After you have the lab results, always ask for a copy of the results and don't leave the office without it. Many doctors' offices now have online portals where you can access your lab results 24/7, which makes this even easier. Also, when your lab tests are run and you get the results back, always bring along the list of the tests you requested.
I can't tell you how many times my office has requested, for example, seven tests to be run, and then we get the results back for five of them.
Make sure when your doctor's office gives you the lab request, you take your list of requested tests and the lab requisition when you go to get your blood drawn. Ask the staff at the lab to review both and make sure that every box has been checked. It is very easy for a lab to call the doctor's office and confirm an additional lab is needed, should it have been missed on the requisition. It is much more difficult to justify going back for another blood draw four to six weeks later, after the results have come in and you have discovers some of what you requested wasn’t run. Keeping good records and being diligent on your behalf can save you a lot of time, trouble, and money.
• Keep your chart. Get a copy of your chart and bring it with you to each doctor's appointment, even though the doctor's office keeps a copy of your chart as well. Always sit and review your chart while you're waiting for your appointment. You need to be 100 percent up to date on what's going on with your body and on what is in that chart before you walk into the examination room. You cannot ever assume that the doctor knows you as well as you know yourself, or will remember everything you've done and every test you've had run.
• Don't ask for drugs. Even though the commercials on national television beg to differ, do not walk into your doctor's office asking for a specific medication (or any medications). Ask for lab tests and other diagnostic tests, and ask for medical advice and educational knowledge about what is happening to you, but don't be in a rush to get on medication. If you need medication, your doctor will tell you. If you don't, you are lucky and are better off tackling your issue with a food prescription and lifestyle changes. There are many undesirable and even permanently damaging side effects to medications. If you need the medicine, you need it, but this is not your ideal scenario.
• Tell all. Make sure you tell your doctor everything you're doing. It's okay if the two of you don't agree. A good doctor doesn't have to share your exact opinions on, for example, supplements or holistic health practices, like acupuncture. You're looking for a person who is going to bring fresh ideas to the table—ideas that maybe you haven't thought of. Your doctor is part of your health-care team, but not its leader. That's your job. If your doctor is in serious disagreement with a therapy that you're doing, ask for studies or research that back up his or her objections. If this is then provided, take that information and look at it honestly. Does your doctor's opinion fit with your model of care for your health? Maybe your doctor has a good point, and the thing you are doing isn't good for you; or, maybe your doctor doesn't understand what you are going for or is simply of a different mindset. A doctor's educated opinion is always worth considering. As you can imagine, I have strong opinions when I walk into a doctor's office, and I've chosen incredibly intelligent physicians to help me in my health journey. I welcome their opinions, even when they are in complete opposition to mine, because this gives me either a new way to look at things or a stronger conviction in the path I am taking.
• Don't give up. Remember the word NO is just an acronym for "Next Opportunity." If you try a protocol and your issue doesn't change, it's an opportunity to try something else. Ask about an alternative approach... and never be afraid to look for a doctor whose goals for you are more in line with your own. If your doctor tries to intimidate you out of getting the answers, tests, or treatment you know you need, you always have the right to go elsewhere.
There's a book by Egyptian writer Wael Ghonim about revolution, subtitled The Power of the People Is Greater than the People in Power. You are the consumer, and just as when you ask the manager of your grocery store to start carrying a product you like, you can ask your doctor to do the tests you want or to respect your preferences in treatment. I drive my doctor crazy, but
I have learned over many years as both a patient and a colleague that you have to create relationships with your caregiver. The only way to do that is to let the individual know something about you. If you don't do anything else, the next time you visit a new doctor or specialist, introduce yourself. Tell him or her something interesting about your world. Also, you can't sit by and be passive.
My fifteen-year-old nephew was recently given a narcotic in a doctor's office, and nobody even asked for my sister's consent. He had an ear infection, his ear drum had ruptured, and they administered oxycodone. He wasn't in the emergency room or even in the hospital. My sister called me in a panic because when they got home, the poor kid was completely out of it.
Your doctor will not necessarily tell you everything you need or want to know, and will also not necessarily customize treatment for your situation. Your doctor might not even know all the details of your individual situation, if he or she hasn't run all the tests or thoroughly examined your history. I can't tell you how many clients I have-bright, intelligent people, the kind who run companies and organizations and households, who form charities and sit on boards— who are on medications and have no idea why or what the medications do. Or, how many of those same folks were on medications that negatively interacted with other meds, or that weren't suited for the client's manifestations of the health issue.
It can be difficult to talk to a doctor who isn't hearing you, and it can be difficult to stand up for yourself when you aren't an expert and you don't have all the information. But you must put yourself back into the equation (the
"me" in metabolism), and that means taking 100 percent responsibility for communicating any health issue to your doctor. To do that, you need information, and that's what I'm giving you in this book-the tools and resources to put yourself in charge of your health. Don't be afraid to have your lab tests run. If you have a disease, you need to know what you can do to give your body every chance of healing. If you have a predisposition to a health condition, you need to know the best way to prevent it happening to you. That's power, not helplessness.
Don't let anything or anyone define or dictate how healthy you can be.
LISTENING TO YOUR BODY IN THE LAB
Another very important thing a doctor can do for you is to order lab tests. I utilize the lab frequently with my clients because, although you know your own body better than anyone else, lab tests can give unique insights into where things are getting out of balance. You might think you feel just fine (especially if you aren't yet accustomed to listening to your body) and not realize that cholesterol is pooling in your blood or your blood sugars are too high, or any number of other small changes that can happen in your body; a lab test can help to reveal and validate.
Many of my clients go to the doctor for a physical exam and some basic lab tests. Although it's not required-because through self-discovery and self-assessment we can forge a clear path—it is an option for you. If you want to establish a baseline of health and you want to know test results, go ahead and have those done before you begin, or at any time during the process. A baseline check-up and some standard tests to measure your health right now will give you the means to monitor how well you are doing on your nutritional prescription. If you are working to metabolize cholesterol more efficiently, for example, you'll get to see where your cholesterol numbers are at an initial test and then see them go down after a repeated test once you've completed your first month's prescription. Then you get to watch them go down even more with every monthly test, until your cholesterol is right where you and your doctor want it to be (in other words, until your body is metabolizing cholesterol properly).
Although your doctor may recommend some additional tests depending on your physical examination, these are the general tests I recommend all clients do at least once every year, to keep track of what is going on inside and o best tailor nutritional prescriptions and lifestyle activities. These tests are all likely covered on health insurance policies as part of a basic yearly physical examination, but be sure to tell your doctor all your symptoms so he or she can justify any additional tests your insurance company might not automatically cover:
• Complete blood count (CBC): This test is often used as a general health check. It looks at your red and white blood cell counts and other components of your blood. Abnormal results can indicate many different things, so this is a level-one screening that any doctor should be happy to perform at an annual physical.
• Blood chemistry: This test screens your blood for a wide range of substances that could be abnormally present or absent if you are having health issues. This is a very general test, but is a good way to catch problems before they go too far.
• Liver panel: This is a series of tests that checks for any abnormal liver values and can indicate if your liver is overburdened or not functioning as it should.
• Lipid panel: This test looks at different kinds of fat in your blood. It checks your cholesterol levels, including HDL, LDL, and triglycerides.
More advanced lipid tests break down cholesterol into even more cat-egories, for further investigation of cholesterol or lipid issues that could signify heart disease risk or presence.
• Hemoglobin AlC: This test is useful to detect unstable blood sugar levels or potential problems with the interaction between blood sugar and insulin, which can occur in prediabetic conditions.
• C-reactive protein (CRP): This test measures inflammation in the body.
When repairing and optimizing your health becomes a priority in your life, it is important to have a dream team of professionals to help you. This will include a primary care physician you trust and who understands and supports your health priorities. You might have or choose someone conventionally trained, a functional medicine doctor, a naturopath, or an osteopath. Also on your team should be any specialists relevant to conditions you have (endocrinologists, cardiologists, therapists, oncologists, hematologists, orthopedists, etc.) and other health-care providers who can give you what you need or help you learn. These helpers could include massage therapists, physical or occupational therapists, acupuncturists, herbalists, homeopaths, chiroprac-tors, or other natural or complementary health-care professionals. You may not be interested in anything but a good massage therapist, and that's fine, but if you want to learn more about some of these alternative health modalities, add experienced natural health providers to your team.
Individuals who carry titles such as naturopathic doctors, osteopathic doctors, functional medicine doctors, acupuncturists, massage therapists, neurofeedback therapists, and occupational and physical therapists are all likely to support your efforts. Keep in mind that a lot of people think they can't afford these kinds of providers but look at your health insurance. Many plans provide for these healing modalities. I had a client who told me she couldn’t afford physical therapy but when we looked at her insurance we realized she was covered for twenty-five physical therapy appointments every year. Become savvy about your insurance resources and support resources available to you, such as through your college , place of employment, or a local school.
YOUR DOCTOR
Of course, first and foremost is your primary care doctor, who should be able
• Guide you and answer your questions without getting impatient or rushing you out the door. This is why it's so important to find someone you can talk to and whose beliefs are in line with yours (or at least not in opposition). It also helps to understand a little bit about how doctors think, how to talk to them, and how to ask for the tests and procedures you know you need. You are the best authority when it comes to your body, and it's your choice who plays on your team. Think of yourself as a consumer, not a patient.
The concept that food is your number-one therapy may be foreign to your doctor, who probably didn't receive a lot of nutritional training. (This is why doctors often send their clients to nutritionists-this is our specialty.) If you have a health issue or want help in preventing one, you need your doctor.
Your doctor can diagnose your health issues, run lab tests, write prescrip-tions, and give you good general health advice. When you and your doctor aren't on the same page, this can be a real problem.
I've been working with doctors for many years now, and I have learned some things. Here is my advice for developing a productive relationship with your doctor.
• Ask questions. When you know you will be seeing your doctor, write down a list of questions and make two copies. When you see your doctor, hand her or him a copy at the beginning of the appointment and ask that it be added to your file. Do not let your doctor give the paper back to you. Say, "I have a copy—that is for my file, please." Then, with your notes to give you confidence, ask what you want to know! If your doctor is rushing you, just ask, "Can I ask you a couple of questions that are really important to me?" A good doctor will stop talking and let you voice your concerns. Don't be afraid. No question about your health is stupid or a waste of anyone's time. If you feel rushed, ask the doctor to help you make a second appointment within that week or the next week, when she or he will have more time to talk. This will let your doctor know that you are serious about getting your questions answered and, typically, many doctors will either make the time for you right then and there or help you set a follow-up appointment just for questions. Emphasize that the follow-up needs to be no further out than a week from your current appointment.
• Put it in writing. If one of your questions is to ask for a lab test, put this in writing and state the reason you believe the lab test is necessary and/or why you are requesting it (don't worry; you'll know what to ask for after reading this book; see page 258 for a sample letter). Doctors are often required to justify lab work to insurance companies, and your written request can help your doctor determine the reason to put down on the paperwork.
• Get copies. After you have the lab results, always ask for a copy of the results and don't leave the office without it. Many doctors' offices now have online portals where you can access your lab results 24/7, which makes this even easier. Also, when your lab tests are run and you get the results back, always bring along the list of the tests you requested.
I can't tell you how many times my office has requested, for example, seven tests to be run, and then we get the results back for five of them.
Make sure when your doctor's office gives you the lab request, you take your list of requested tests and the lab requisition when you go to get your blood drawn. Ask the staff at the lab to review both and make sure that every box has been checked. It is very easy for a lab to call the doctor's office and confirm an additional lab is needed, should it have been missed on the requisition. It is much more difficult to justify going back for another blood draw four to six weeks later, after the results have come in and you have discovers some of what you requested wasn’t run. Keeping good records and being diligent on your behalf can save you a lot of time, trouble, and money.
• Keep your chart. Get a copy of your chart and bring it with you to each doctor's appointment, even though the doctor's office keeps a copy of your chart as well. Always sit and review your chart while you're waiting for your appointment. You need to be 100 percent up to date on what's going on with your body and on what is in that chart before you walk into the examination room. You cannot ever assume that the doctor knows you as well as you know yourself, or will remember everything you've done and every test you've had run.
• Don't ask for drugs. Even though the commercials on national television beg to differ, do not walk into your doctor's office asking for a specific medication (or any medications). Ask for lab tests and other diagnostic tests, and ask for medical advice and educational knowledge about what is happening to you, but don't be in a rush to get on medication. If you need medication, your doctor will tell you. If you don't, you are lucky and are better off tackling your issue with a food prescription and lifestyle changes. There are many undesirable and even permanently damaging side effects to medications. If you need the medicine, you need it, but this is not your ideal scenario.
• Tell all. Make sure you tell your doctor everything you're doing. It's okay if the two of you don't agree. A good doctor doesn't have to share your exact opinions on, for example, supplements or holistic health practices, like acupuncture. You're looking for a person who is going to bring fresh ideas to the table—ideas that maybe you haven't thought of. Your doctor is part of your health-care team, but not its leader. That's your job. If your doctor is in serious disagreement with a therapy that you're doing, ask for studies or research that back up his or her objections. If this is then provided, take that information and look at it honestly. Does your doctor's opinion fit with your model of care for your health? Maybe your doctor has a good point, and the thing you are doing isn't good for you; or, maybe your doctor doesn't understand what you are going for or is simply of a different mindset. A doctor's educated opinion is always worth considering. As you can imagine, I have strong opinions when I walk into a doctor's office, and I've chosen incredibly intelligent physicians to help me in my health journey. I welcome their opinions, even when they are in complete opposition to mine, because this gives me either a new way to look at things or a stronger conviction in the path I am taking.
• Don't give up. Remember the word NO is just an acronym for "Next Opportunity." If you try a protocol and your issue doesn't change, it's an opportunity to try something else. Ask about an alternative approach... and never be afraid to look for a doctor whose goals for you are more in line with your own. If your doctor tries to intimidate you out of getting the answers, tests, or treatment you know you need, you always have the right to go elsewhere.
There's a book by Egyptian writer Wael Ghonim about revolution, subtitled The Power of the People Is Greater than the People in Power. You are the consumer, and just as when you ask the manager of your grocery store to start carrying a product you like, you can ask your doctor to do the tests you want or to respect your preferences in treatment. I drive my doctor crazy, but
I have learned over many years as both a patient and a colleague that you have to create relationships with your caregiver. The only way to do that is to let the individual know something about you. If you don't do anything else, the next time you visit a new doctor or specialist, introduce yourself. Tell him or her something interesting about your world. Also, you can't sit by and be passive.
My fifteen-year-old nephew was recently given a narcotic in a doctor's office, and nobody even asked for my sister's consent. He had an ear infection, his ear drum had ruptured, and they administered oxycodone. He wasn't in the emergency room or even in the hospital. My sister called me in a panic because when they got home, the poor kid was completely out of it.
Your doctor will not necessarily tell you everything you need or want to know, and will also not necessarily customize treatment for your situation. Your doctor might not even know all the details of your individual situation, if he or she hasn't run all the tests or thoroughly examined your history. I can't tell you how many clients I have-bright, intelligent people, the kind who run companies and organizations and households, who form charities and sit on boards— who are on medications and have no idea why or what the medications do. Or, how many of those same folks were on medications that negatively interacted with other meds, or that weren't suited for the client's manifestations of the health issue.
It can be difficult to talk to a doctor who isn't hearing you, and it can be difficult to stand up for yourself when you aren't an expert and you don't have all the information. But you must put yourself back into the equation (the
"me" in metabolism), and that means taking 100 percent responsibility for communicating any health issue to your doctor. To do that, you need information, and that's what I'm giving you in this book-the tools and resources to put yourself in charge of your health. Don't be afraid to have your lab tests run. If you have a disease, you need to know what you can do to give your body every chance of healing. If you have a predisposition to a health condition, you need to know the best way to prevent it happening to you. That's power, not helplessness.
Don't let anything or anyone define or dictate how healthy you can be.
LISTENING TO YOUR BODY IN THE LAB
Another very important thing a doctor can do for you is to order lab tests. I utilize the lab frequently with my clients because, although you know your own body better than anyone else, lab tests can give unique insights into where things are getting out of balance. You might think you feel just fine (especially if you aren't yet accustomed to listening to your body) and not realize that cholesterol is pooling in your blood or your blood sugars are too high, or any number of other small changes that can happen in your body; a lab test can help to reveal and validate.
Many of my clients go to the doctor for a physical exam and some basic lab tests. Although it's not required-because through self-discovery and self-assessment we can forge a clear path—it is an option for you. If you want to establish a baseline of health and you want to know test results, go ahead and have those done before you begin, or at any time during the process. A baseline check-up and some standard tests to measure your health right now will give you the means to monitor how well you are doing on your nutritional prescription. If you are working to metabolize cholesterol more efficiently, for example, you'll get to see where your cholesterol numbers are at an initial test and then see them go down after a repeated test once you've completed your first month's prescription. Then you get to watch them go down even more with every monthly test, until your cholesterol is right where you and your doctor want it to be (in other words, until your body is metabolizing cholesterol properly).
Although your doctor may recommend some additional tests depending on your physical examination, these are the general tests I recommend all clients do at least once every year, to keep track of what is going on inside and o best tailor nutritional prescriptions and lifestyle activities. These tests are all likely covered on health insurance policies as part of a basic yearly physical examination, but be sure to tell your doctor all your symptoms so he or she can justify any additional tests your insurance company might not automatically cover:
• Complete blood count (CBC): This test is often used as a general health check. It looks at your red and white blood cell counts and other components of your blood. Abnormal results can indicate many different things, so this is a level-one screening that any doctor should be happy to perform at an annual physical.
• Blood chemistry: This test screens your blood for a wide range of substances that could be abnormally present or absent if you are having health issues. This is a very general test, but is a good way to catch problems before they go too far.
• Liver panel: This is a series of tests that checks for any abnormal liver values and can indicate if your liver is overburdened or not functioning as it should.
• Lipid panel: This test looks at different kinds of fat in your blood. It checks your cholesterol levels, including HDL, LDL, and triglycerides.
More advanced lipid tests break down cholesterol into even more cat-egories, for further investigation of cholesterol or lipid issues that could signify heart disease risk or presence.
• Hemoglobin AlC: This test is useful to detect unstable blood sugar levels or potential problems with the interaction between blood sugar and insulin, which can occur in prediabetic conditions.
• C-reactive protein (CRP): This test measures inflammation in the body.
