Discusses the pragmatic approach to ruling out issues and conditions using
a tried and true logic that applies across the board
NursesGeneral NursingArticle
In all aspects of life, a wise adage of "when you hear hoofbeats, think of horses and not zebras" truly applies. If you are not familiar with this approach to observing and responding to problem-solving it’s worth exploring.
Health care, and to a large extent the rest of the working world, is focused on listening for the zebras - that is, looking for the pathology, the disease, the exotic condition, something to diagnose. Rather than taking a simple, practical and common-sense approach to assessing cause and effect and practicing health care, we continue to associate the hoof-beats with zebras, or the exotic pathology we have all been trained to look for.
Common-Sense Approach Beginning to Disappear
This meaningful approach to care has been lost within this modern “expert medicine” era. We can even see today that this common-sense approach is even beginning to disappear from "alternative" health care practices, as well. Using many forms of supplementation or non-toxic treatment modalities are often used in place of drilling down to the causative factors in a patient’s symptom complex.
For Example...
Here is an example from one of my recent office visits with one of the patients. A very gifted, physical therapist, someone I have had treatment from myself, called upon me after having intractable muscle pain for a week. He could not lie down, could not sleep was in great discomfort, and was also concerned about what this could mean. He had spoken to a wide variety of practitioners who normally deal with musculoskeletal conditions and at the end of his exploration was still in pain and becoming rapidly more concerned. His doctors and practitioners were looking for the dysfunction or pathology that was causing his symptoms and treatments were not working.
When this happens to us we start to think, "do I have something really wrong with me?", if you're older you think "this must be what getting old is about", or if you are an active, healthy person who takes care of yourself you might ask, "how could this be happening to me, I take care of myself." This individual said he called me because he "didn't know where else to turn" to understand his pain and condition and isn't this what I did in my practice – look at the big picture and figure things out about the cause and effect?"
Start with the Basics
Being a Whole Health educated practitioner and patient educator, I started with the basics:
What specifically had he been doing prior to this onset?
What had he been feeling or avoiding feeling before this happened
Where is the specific discomfort?
Has he experienced this before and under what circumstances
What makes it feel better?
What makes it feel worse?
Did he experience any other symptoms along with this pain?
He explained that he just joined a gym and was working out for the past week, but that he wasn't doing that much exercise to cause this discomfort and it wasn't just in one muscle, it was all over his body. He is in very good physical condition so the idea of mild exercising causing this full body pain didn't resonate.
He reported that he hadn't changed his diet, work habits, taken any unusual supplements, changed beds, changed shoes, or had any upset or stress over the past week. He tried a series of natural remedies and treatments to no avail. He was both personally and professionally stumped and so were the practitioners he had spoken with about his pain.
Having been called by several of my patients, the "Sherlock Holmes of Whole Health", I knew the task at hand was to find out the missing piece of information that would unlock the cause of the problem. Looking at the 5 Aspects of Whole Health ™ - the physical, environmental, chemical and emotional possibilities of what could cause this is where we started. We discussed his new membership at the gym. Logic told me that there was something connected to his activities at the gym that was the causative factor in his pain experience because it was after joining the gym that his pain began. It was just a matter of putting our finger on it.
Having suffered chronic back pain myself, I have been a fan of John Sarno, MD, who practiced from a causative perspective targeting the emotional roots of back and body pain. He had cited much research and evidence-based information on the subject but did not take a whole-person perspective, which is how we approached this patient.
After a few minutes of detailed review, one factor that surfaced seemed the right solution to the problem. After his workout, he went for a swim in the gym's pool. After questioning him about the swimming experience, he shared that the pool was heavily chlorinated and he could tell because the water made his eyes burn. Interesting and a major clue.
Now some of you who are practitioners reading this might think, "Ah-ha, he has a virus from the pool water", or “he swallowed pool water and had a bad reaction, or “his immune system must have had a toxic reaction to the chemicals in the pool". Sorry, but no cigar - these are all zebras.
Having comprehensive, evidence-based, health information and understanding of the How and Why of body function is critical in truly serving our patients/clients and being able to empower them with the knowledge they need to take control of their health. Demystified health information is absolutely critical to empower your patient to take control and retain control over their health.
What does chlorine do to our body? It draws out minerals, most importantly calcium and magnesium. Because chlorine molecules have double negative bonds it is wildly attracted to double-positive bonds, as found in calcium. What minerals are significantly involved in muscle function? And, what minerals are likely to be diminished with repeated exposure to chlorine – Ca and Mg!
I recommended that he go to Whole Foods or CVS and purchase a calcium and magnesium powder, take a dose am and pm over 2 days, and see if that helped. I received an e-mail about 24 hours later with the subject title "WOW" - it dramatically took away most of his discomfort, he got a great night's sleep and felt much better. He is swimming away, but mindful to take his calcium/magnesium before and after each swim.
A Simple Horse - Not an Exotic Zebra
This is the perfect example of thinking horses and not zebras in our practices. I do hope you found and encourage you to become a health detective using a whole health approach.
