Integration is Key...

On a typical day in my office, it is not uncommon for me to see a patient seeking integrative naturopathic support during their cancer treatment. Imagine a patient named Carey. Let's say Carey is a 55 year old female presenting with metastatic colon cancer, currently undergoing chemotherapy. The first thing I might observe is that Carey is under a lot of stress. She was recently diagnosed with cancer and quickly started treatment with her oncologist. She presents in my office today with a bag of supplements recommended by friends, family and health food store clerks. She is not sleeping well and states she lost her appetite since being diagnosed. She shares that her dad died earlier this year, which has been a tremendous loss for her.  Now being diagnosed with metastatic colon cancer, she worries about her own children losing their mom. She's doing her best to juggle work, to stay strong for her family, to care for her mom, and to cope with the side effects of her treatments. She has been severely constipated and hasn't had a bowel movement in two weeks!  She needs her job because she depends on it for her health insurance. Carey states she hasn't had time to exercise or care for herself the past several years.

The viewpoints of several health paradigms spin in my head as she shares her story. The impact of stress, inflammatory cytokines, and their role in cancer progression comes to mind. Lowering these inflammatory cytokines by addressing her stress will help her outcomes. I imagine what her visit with her oncologist might have been like and what the oncologist might have considered in selecting a treatment for my patient. I reflect on what I have been taught about safety of combining chemotherapy with dietary supplements as I go through each dietary supplement in her bag. We discuss supportive options to help address the chemotherapy side effects she now faces, while I weigh what we can safely use with her prescribed treatment. Her lack of sleep can be contributing to low melatonin levels and decreased functioning of her immune system. I know that cancer survival rates drop with malnutrition, lack of exercise, and poor performance status. I think about what my Chinese Medicine professor taught me about the connection between grief and the organ systems of the lungs and large intestines (colon). 

She is under the care of a medical oncologist and now me, a naturopathic doctor. In our first visit, I know she will have better outcomes if we can get her further integrative support. Ninety minutes was barely enough time to hear her story and collect her medical history, review all the supplements she has been given, recommend some functional tests, and address side effects and overall naturopathic recommendations. Getting assistance with healthy and appetizing meals would do her well. Social support could aid her in her mother's care, time management, and find community and financial resources to support her through her own treatment.  In her efforts to "stay strong," she's holding in a deep amount of grief and fear that comes pouring out in our appointment. Who can she share these feelings with on a frequent and regular basis so they don't build up so large inside of her? Exercise would help decrease her stress, improve energy levels, and contribute to improved survival outcomes; an exercise specialist with knowledge of oncology could help safely get her started without wearing her out and contributing to further fatigue. She could also benefit from a restorative yoga and relaxation exercises. Given the relationship between the colon and grief, a Chinese medicine approach might be synergistic in her treatment. These are areas I have a basic working knowledge of, but she would thrive working with a specialist in each of these areas. I see a village of support that could greatly improve the quality of her life and potentially her cancer outcomes. I worked for a place that offered all of these services under one roof and I witnessed how patients benefited from this integration of care. 

I love that I have been exposed to all these different paradigms of healing--conventional medicine, naturopathic medicine, Chinese medicine, mind-body medicine & counselling, physical medicine therapies, nutrition, yoga. I can appreciate that each of these paradigms will look at this patient with a different set of eyes. I know that Carey needs more than I can alone provide and that she will thrive if her practitioners work and communicate together. Carey, like many patients, may not be able to utilize all these different professionals, but she will benefit from adding what she can. In the meantime, I will point her to books, resources, and give basic recommendations to get her started.

Whether it is cancer or any number of other chronic diseases, there is synergy to be gained through integration.  It is a situation where one plus one is more than two. One practitioner may see something the others don't see. Each paradigm has its limitations, even mine. It goes back to the old saying that goes--"If all you have is a hammer, then everything appears as a nail." Bring in the other tools, because we've got more than nails here.  We have the beautiful intricacy of human life.