Patient Exam – Functional Medicine Back to Basics

Patient Exam – Functional Medicine Back to Basics

In this episode of Functional Medicine Back to Basics Dr. Rutherford discusses the importance of doing a proper exam on the patient.

Note: The following is the output of a transcription from the video above. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.

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Hi I’m Dr. Martin Rutherford certified functional medicine practitioner author of power, health back to basics. You’ll, see I’m, a back-to-basics guy and and clinic director here at power. Health wellness & amp Rehab in Reno Nevada, and we’ve, been we’ve started a series on functional medicine.

I believe this is the fourth in the series we did an introduction. We talked about what’s. Functional medicine was this was the answer. The questions of? Why can’t? You’ve got 600 hours online. Talking about all these different diseases, but what but you don’t tell us how to get better, and I’m explaining why we can’t do that by doing a series of of presentations on functional medicine and functional Medicine and and and how it was how it’s, been classically taught how it’s taught in the classic functional medicine, universities, functional medicine Institute – and I’m doing this, because the vast majority people who are doing functional Medicine, it may not be following this to the enth degree.

A lot of people come in here want to know why we have to do such a therapist like thorough history and thorough exam. So the last one was on history, the one before that was on obstacles to cure things that you can know about a patient before they ever even open their mouth or before they ever even get into an exam, or should they even be examined, obstacles secure.

That’s, an interesting one. We talked about that. This is going to be about examination. I have I’ve had an interesting week on that. I know if it’s, just because I’m focused on this, but I’ve. Had several patients in here.

One yesterday was a nurse from Southern California and she came in and – and she is a nurse and she was great at Shh and and at the end she said you know. I know that we learned how to do examinations in school, and I know her doctors.

There, but nobody does so anymore, and she said I’m gonna – have to rearrange my practice and start doing exams again because it brought back to her how much data you can get out of an exam and understand.

I went to school before when I was going to school to learn how to be a chiropractor and/or doctor. You know it’s, it’s and you may not know, but like the very first half or whatever of medical school chiropractic is almost identical.

You’re learning how to diagnose, and you’re learning. How to do histories and exams, and when we went back when I was going, there was no such things as MRIs. There was no such thing as cat scans. There was no such thing as nerve conduction velocities, and we understood we understood that even the blood testing was ballpark and even today the blood testing is ballpark and that’s, something we may or may not get into in too extensively either now or Maybe in the future, so so we do an extensive history and extensive exam back.

Then we had to make a diagnosis and we had to do it by doing and it used to take at least an hour an hour, long history exam. And then we were expected to come up with a what. We call the differential diagnosis, which, which was the three most likely options.

That is wrong with that person and then, ultimately, that was supposed to guide your testing. It wasn’t about okay. We have a chest in the pain, a pain in the chest chest in the thing we have a pain in the chest and so let’s, and so let’s.

Do let’s. Do an EKG! Let’s. Do an echocardiogram, let’s. Do an MRI, let’s. Do a cat scan, let’s. Do it, and oh my all that’s like all that’s, normal? No, you, you would do you would do an exam. Maybe it’s, a chiropractor.

We would find out that the person has a rib out of place actually sticking up here. Maybe it’s, a functional medicine doctor. We might find out that that maybe the pain is is because somebody’s got to go all bladder problems before we even did a gall bladder test.

So so this is the reason we’re going through this. This seems to be a big issue with a lot of patients that come in here are usually pretty pleased or usually like pretty blown away and all the data that you get from exam.

And I wanted to go over this because we we went through the history and how important that was. I want to go through the exam, so you see what kind of data could be gotten from the exam and again this goes to your question of why aren’t.

You telling me what’s? What how to fix my polycystic ovarian syndrome or my blood sugar, my diabetes or my fibromyalgia, or whatever it is that you come in with, and it’s because everybody’s different! It’s because there are a lot of moving pieces to it and that’s, something I explained in our initial two episodes in which we talked about whack-a-mole medicine versus functional medicine.

Now functional medicine I’ve, been the classes. I know many of the people who were the developers of function, mice and they all, although, although all the manuals all have functional medicine exams in there, our exam is a combination of a functional medicine and functional neurology exam, because we practice functional medicine.

We practice functional neurology, but the exam is incredibly important and and and so our exam sheets in front of me here as a as a guide – and I’m just going to walk through this with you. And as I talk about the different areas of examination, gonna find, most of them are examination procedures that you’ve been through okay, but you’re gonna, but I’m gonna go through.

Why, from the functional perspective, they may be a little bit more important to delve into so first thing we do when a patient comes. Is we take their vitals? Do you go to, though you got a doctor and your vitals are taken, but the difference between functional medicine and medical medicine is pathology.

Okay, the medical community, although small parts are starting to morph over towards towards what we’re doing it’s, mainly about pathology, it’s. Many of that look. Your tests are okay, your kidneys. Okay, you’re only in stage 2 or stage 3.

A dysfunction of shut down will wait until it’s like gone, and then we’ll, do in dialysis, it’s. It’s about you. Having pneumonia, we’ll, give you a medication for it, and I am not anti medicine. Those of you know me have watched me and know that, but but they are, it is about pathology and it’s, a meaning.

They’re waiting until you have developed something that can be cut out, radiated medicated or something in in. In the air of their toolbox, we’re looking for function so like, for example, first thing we do is we take your blood pressure? We take it’s.

Seated, we take it standing, we take it laying down there’s reasons for that there’s there. There are conditions that we have called pots that we that we’ve seen, but also we treat people for adrenal problems and if a person gets lightheaded when they go from sitting to standing, we know if they’re, not having a Ti a stroke which they usually aren’t because that usually be checked by the time they got here.

Usually that’s, a sign of poor adrenal function. Usually it’s, a sign of low adrenal function, the blood pressure. Also could be high, we might I’ve. Had I’ve, so many patients have come in here and and and we took their blood pressure and their blood pressure was significantly low like significantly and they were on blood pressure, medication and it turned out what had happened was every time they go To the doctor, they have white like coat syndrome and meaning that they got nervous when they went to the doctor.

The doctor gave them blood pressure medication and then it drove them into low blood pressure. Why is that important? Whether they’re in low blood pressure because of that or whether they’re in low blood pressure because they have low blood pressure, that’s, not good doctor tells you it’s great! You’re, not gonna dive, a stroke or a heart attack.

I’m gonna tell you. We need normal blood pressure yeah. If you have a low blood pressure, you’re, not getting yeah. You know your heart’s here. You know your heart’s here and your and your brains here you’re, not getting you’re, not getting enough blood to your brain.

You have low blood pressure. You’re, not getting enough blood pressure to your extremities, so you’re, not getting oxygen to your extremities. If you have a low blood pressure, it’s more difficult to get nutrients to your brain nutrients to your extremities nutrients to push into your cells.

So a blood pressure does a lot crusher pushes things in through to the to the extremities and it pushes nutrients into the cells. Well, if you’re trying to fix somebody with herbs and botanicals or your online here, goes to one of those reasons why you might not be telling you what to do.

Okay, if you’re, if you’re online and you’re, taking all these supplements and they’re, not working, and you have really low blood pressure and somebody’s told you that that’s. Great low blood pressure is not great.

Low. Blood pressure usually leads to long term types of conditions that that just don’t get better. You don’t, get better as well when you have low blood pressure, so low blood pressure from a functional perspective in a place where you’re using nutrients and diet, and you’re using these types of things.

If it’s air, it’s, important it’s, got to come up, and and and I’m – not gonna get into all the ways that you do that, but that’s. It’s, it’s. Actually in most cases it’s, not that hard and you can.

Then you can do your internet search. For that. We do same thing. We do. We do the we actually do tissue perfusion. We actually try to find out. We put it, we put a a device on your finger that measures how much oxygen you’re, getting into your finger and and and we and we test the lungs to how much so most of you may be familiar with testing oxygen.

We’re gonna talk about the basics and foundation of getting better next time, and one of those things we’re going to talk about is having proper oxygen, which means having proper blood pressure and and and and a number of Other things this all goes to the exam.

So if we find out that your tissue perfusion into your fingers and your toes is not good, we immediately start looking towards the fact that if this is something a patient decides to do or we decide to extend care to, we’re gonna Have to we’re gonna have to get we’re gonna have to get blood into those extremities, because I have news for you.

If you’re, not getting blended, your extremities, you’re. You’re, probably not getting it to your brain and you’re, probably not getting it to your intestines and so and and you could have a normal lung perfusion.

So you can have like for those of you who, maybe from the with that you’re gonna in the into the doctor, and they teach you and they and they they check you for it and and they’ll, say: oh, It’s, 93 %, and that’s great and nine anything about ninety percent of oxygen perfusion into your lungs.

A capacity into your lungs is good. We like to see it at 98 % functionally that’s. What makes everything works better, that’s? What makes people get better? That’s more oxygen, that’s? What makes nutrients work better? Okay, most of our patients are in and around you know the 90s.

Most of them are good, some of them come in, they’re, not, but then we look at their tissue perfusion. Is it getting from the lungs to your extremities? And if your tissue perfusion is like almost gone like most of our patients are because they’re stressed because they have a thyroid problem because they have a little blood sugar, because their t2 is low.

Their t3 is left there’s, not even a t2, because there’s. Thyroid hormone is love if they’re active thyroid, oh and so, and a number of other things smoking a number of other things that do it. It depending on severity to that case, we might even we might not even take the case if the person is not willing to stop smoking depending on the severity of the case.

If it’s a less severe case, we might take them, but it’s. It’s, a big factor. It’s, a big factor to understand what’s going on there. So, of course, we Charlie we check height weight. Obviously we want to know if the person is overweight and that leads to different things about looking for diabetes, looking for insulin resistance over weighted.

This also causes high blood pressure. So people come in here for high blood pressure. They lose the weight a lot of times. It goes away that person comes in here and that’s. What they want to do that’s.

What they’re in here for is because weight loss, then you know it. It starts to. Let us put the puzzle together as to as to what’s going on. We auscultate the heart. I do believe so. I’m, not a I’m, not a medical doctor.

I don’t. Try to be. We do a very thorough evaluation exam. I work very well with the medical community, where I am very good relationship here. We do a full evaluation, so we checked the heart. Actually, the heart is not something that we directly, even though people might come in here with coronary artery disease.

The heart’s, kind of like at the affect of everything else. So you know we’ll check the heart. It may or may not be something valuable for us to know, but if we find something that the person that’s, a problem with, we have a hospital about six blocks from here.

The ten blocks from here. Whatever it is, we look for so we look for things along those lines. We’ll. Look for. We check people’s veins. We check people’s arteries because we want to know if there’s. Blood flow getting to different people now, one of the bigger things we do is is we palpate the thyroid? Now this is functional.

I’m talking that we’re in the world, a functional though, but we palpate the thyroid. A lot of people are surprised. A lot of people come in here for thyroid problems. A lot of my mentor doctor duties.

Kasnian was the original Hashimoto’s guy I don’t know if it’s out of the picture, but it’s book sitting right up here. Why do I still have thyroid symptoms when my lab tests are normal, he could have called it.

Why do i? Why do I still feel like crap, when I’m, taking all my medication and and my lab tests are normal, but but thyroids complex? The vast majority of them clinical pearl for you, the vast majority of our Hashimoto’s, whether you have come to that to embrace that or not or you’ve ever heard of it, and so we palpate the thyroid.

People are shocked. A lot of times that no one’s touched theirs library yeah. If it’s enlarged. If it’s got nodules. There are certain things that would alert us to the fact that maybe it’s, pathology and maybe it needs to go and and and be checked.

But if it’s enlarged and it’s tender. And we look at the sheet that we had that we went over last week and we look at that at that history sheet and and they have 18 out of 20 symptoms of Hashimoto’s and they’re thyroids tender there’s, a about a 99 percent probability that person has Hashimoto’s and that’s, something really valuable to know, because when we move into the testing at some point we’ll talk about testing! You can test for Hashimoto’s and you could be full-blown Hashimoto’s in your test.

Come up normal, like the book says, okay, so in that world, fine art! Well, because we don’t use drugs. We use herbs. We use botanicals, we use diets, we use brain rehab exercises. We’ll talk about that later, because we we do functional medicine and functional neurology, but I think most of you listening here are interested in the functional medicine that allows us to start to advance our treatment, because, even though the the test would be Normal because we would have the history is where we start to understand.

We would have a history, it says 18 out of 20 things say the person’s got thyroid problem. We have a palpation here. That says you have a thyroid problem. Maybe we need to send you out for a nodule that feels like it might be a potentially 100 chance of cancer, but for the most part, if you’re inflamed the chances of you having Hashimoto ‘

S is high. We can start in that direction safely and and and frequently get you know some sort of results in very early on now we we palpate people’s, lymph nodes. What do we do for a living? We treat our office is kind of like the kind of tree we try to treat mystery diseases.

We treat fibromyalgia, preferably chronic fatigue. You can look online, vertigo dizziness bouncing, but all of these have have unique components by the time patient gets here. Usually they have unique components of autoimmunity and they usually have unique components of chronic stress responses, one or the other, or both we’re gonna palpate, the lymph nodes, and if we have a history of person, has their tonsils out their adenoids have Been out or they keep conflating their throat, their lymph nodes are swollen all this came on after a baby or if they had an accident or have something yeah.

We know that we know they have a lot of unity’but my doctor says I don’t have it. My tests came back normal well, we we, we can’t afford that here I mean we by the time patient gets here. They’ve, been told everything is normal and all their testing is normal.

There’s, nothing wrong with them here. Take these drugs palpating. The lymph nodes can be very, very valuable and it’s, something that we do on every patient and if it’s correlative with their disease.

But they’ve already been checked by their doctors and they don’t, have any pathological diseases, guess what they probably have an autoimmune problem going on, so that’s, valuable to us. We pat, we look at their eyebrows.

It seems like now a lot of folks know that if the outer third, your eyebrows are gone or if your eyebrows just kind of go away, there’s, a good chance that you have a thyroid problem, that’s, a it’s, a very cardinal sign of thyroid and it used to be considered a cardinal sign of hypothyroid and it still is, but the statistics are that if you’ve been diagnosed with hypothyroid there’s about a depending on who You’re following there’s, an 85 to a 95 % chance.

You have Hashimoto’s, and so again this is diagnosis. You have a person sitting in front of you. You know what the research says you’ve got the history, you ‘ Ve got the exam. You should be able to come up with those three differential diagnosis still today, even though we have all these wonderful things to confirm, you should be able to come up with those differential diagnoses for the functional medicine patient so that you can delve into their case with A with an organized approach and organize understanding the probability of what’s going on to them and know more or less precisely what testing you should do that not having standardized testing.

This helps us to do that. We auscultate the we inspect the abdomen. We inspect it for for to see if there’s any surgeries there. We ask about surgeries stretch marks, I’m, not sure if you’re aware of this, but stretch marks frequently indicate autoimmunity.

There are women who get stretch marks and they’re women, who don’t get stretch marks they’re guys who get stretch marks when they lose a lot of weight. But basically this goes to the patient, who has had surgeries.

They get a surgery and then, like a year later they have scar tissue and then the scar tissue comes back and they have to keep getting it cleaned out. It’s similar to what happens with those stretch marks.

So if we see those stretch marks again right, then in there we’re thinking. Okay, we may have autoimmunity here, so this is. Hopefully, this is kind of a new Under standing to you, because a lot of people come in here in durka.

They’re confused, rightfully so about autoimmunity, because autoimmunity is confusing that it’s. It’s. It’s. What has complicated our life here over the last probably thirty years, and and it’s, and it’s, something that the testing is still in its infancy.

It’s, we everybody comes in here, says. Well, it was my task. My room toward arthritis test was normal, but then it wasn’t when that was normal, but then it wasn’t. My lupus test was, I have all signs, but my lupus said: look if you have the signs and and and and you have the symptoms and you have and you’re and you’re having the rash and you’Re having all those things you have it, but doctors will be hesitant to diagnose you with it and thus, if they won’t diagnose you with it.

They’re, not gonna hit you with a bunch of steroids because they’re gonna be afraid. If they make a mistake, they’re gonna get sued, so the functional medicine we’re, not going to do anything. It’s going to earn anybody.

We can take those steps forward, so we inspect the abdomen. We auscultate the abdomen and the, and what i mean is we listen to the abdomen and basically, in the end, we’re. Looking for we’re. Looking for the churning the gurgling sounds, we’re listening to see if they’re there or not.

If they’re, not there globally, okay, if they’re, not there throughout the entire test ins, that person is in a chronic stress cycle, because basically their brain is shutting down, something called the vagus nerve and then, when you’re in fight flight.

There’s a there’s a there’s, a part of your brain that’s, going really really really really really really fast, but there’s. Another part of your brain that’s, that’s supposed to be making you relax. That’s, not at that point in time.

So it’s being overwhelmed that part of the brain that’s being overwhelmed as part of the brain that makes you have nice bowel movements, it’s, part of the brain that makes you sleep, the parasympathetic nervous system.

If you don’t have auscultation of sounds in there, then you are in it’s. If we know you’re in fight flight, if we shake your hand during the exam and and your hand is moist in some of your cases, Sliney I’m.

Not you know not to be derogatory, but I mean most of the patients who have that actually will describe it. That way. We know you’re in fight flight. We know that you have a chronic stress response going on this is in this is incredibly important to both functional medicine and functional neurology practitioners, because functional medicine practitioners will start to use herbs and botanicals to try to get it under control.

Functional neurologists will try to do, will do brain rehabilitation exercises in our office. We’ve chosen to complicate things. The only thing I do that’s, not simple and and put the two of them together and that for us, that seems to work better in getting that fight/flight under control.

But you can tell you know in an exam: is the patient sweating? Are their feet cold? Are their hands called? What is oh, yeah? Okay, I told you that you’re, not getting blood there when your hands and feet are cold or when they’re, not getting enough oxygen in there.

But what causes that two main causes of that is chronic stress responses and chronic and thyroid and and misdiagnosed or mismanaged thyroid. So again, this goes back to you know you’re telling us all about the thyroid, and you ‘

Ve told me about the thigh or why can’t, you tell me, you know how to take care of it. Well, what’s causing that call is it thyroid? Is it stress responses that requires a little further investigation and then each one would require different treatments? So if you tell me – and I got a headache in my hands and my feet are called and – and I got a migraine – I can’t tell you a whole lot from that online.

Although I know people that would be happy to shove about you know five or ten or 15 and supplements that you know here’s, what you take that’s, really not the way functional medicine was designed. This is the way it was designed, so so so a decrease and by the way for those of you who are who are astute diagnosticians.

I am aware that if we do have an absence of bowel sounds in one part of the bowel, but not the others, that’s, a bowel obstruction and – and you should go to the hospital like right at that point time, we do a palpation Of the abdomen, we actually palpate every single thing in the AB people.

Again, people are shocked. They’ve, been to gastroenterologist, they’ve, been to their GPS. They’ve, been everywhere. Nobody’s, touched arrived in there, they’re, they’re in here, and they have all kinds of abdominal symptoms and sometimes they they might not have a lot of bed.

Donnell’s symptoms and then we palpate, we palpate. They’re large intestines. We palpate they’re small, all of their small intestines. They’re ileocecal valve their liver, their gallbladder. We there’s.

The bottom part of their stomach all the things you can palpate if they’re and if they’re inflamed completely there. That is, that that’s diagnostic, we know there’s. Gon na be inflammation. We’re gonna be looking for inflammatory markers, but there’s a lot.

It tells us there. You cannot have that much inflammation without having a leaky gut. You can’t, have a leaky got without developing food sensitivities, and and so so from a functional perspective. That starts to give us insight into the case.

Now, if it’s, just parts of the intestines that are are its head tender that tells us something because a tender large intestines tells us different things then attend their small. Intestine tells us, and and and one causes, different types of symptoms from the other one one might be small intestine back to your overgrowth.

One might be irritable, bowel syndrome, one you might be in an area where you go whew, we better start looking for all sort of colitis or celiac or Crohn’s, disease or something along those lines. And yes, you can tell things you can tell a lot of things from palpating them a lot.

We we we observe people do they have do they have like alligator skin. Do they have places that are there? Are there are there? Okay, do they have alligator skin or do they have flaky skin on their shins, okay, flaky skin on the shins folks is, and now we live here in the high desert.

So here in Reno we’re like right, where the high desert starts. We have these beautiful mountains on one side that have all these trees and we have mountains on the other side that are totally barren.

It’s, the desert, okay, and we’re were five thousand four thousand were four thousand feet, or something like that, and and so everybody thinks it’s. The desert. Everybody thinks it’s, it’s, the dry air that we get, but it’s.

Not the vast majority of the time is their climate or it’s, a lack of essential fatty acids and you’ll understand why essential fatty acids are important to us in our next episode, because gonna talk about foundational things.

For you to get better central fatty acids is one of those, so that can tell us we compare that to their history and we oh whoa, we may have. We have to pack these people full of fish oil before we get going to to be able to get their essential fatty acids up, something which we’ll talk about before.

But we saw that we saw that and we’ve already palpated their thyroid. Then they have a thyroid problem or not. Well, look it looks like it might be, tired might be essential, but we can test for it. We now know: okay, we should test them for essential fatty acid deficits or we or we don’t.

They’re. Fine, we look at their feet or their feet. Turn blue and cyanotic. There’s, a change when they go from sitting the standing. If it does, we know again that we’re, looking at a stress response, so we look at their nails.

We look at you. We look at your nails if you know if you’re, if you’re, if your nail health isn’t good, we look at that. That has a number of different meanings which I won’t get into Alma at this point in time.

Let’s, see so the I think those are the main ones from a general functional medicine perspective. You know, you generally will. Will you would generally observe the patient for? Do they have energy? Are they slumped? You’ll? Look, Oh, will we do a neurological exam too, but some things crossover, the one thing that we did do or that we’ve done from the beginning in in functional medicine, is look in people’s eyes with a with a little Penlight and if your eyes dilate and they stay dilated or they don’t contract.

When we put that when we put the pen the pen light in there, then that means that your brain is in chronic fight flight. For those of you who watched us know us that’s, a big deal for those of you who don’t know us.

What we have found is being in a chronic stress cycle is the x-factor. We’ve, been doing this a long time, so we tend to get people who’ve, been too the practitioners and and many other other practitioners who may have found the gut problem and and did the right thing with them.

They they gave him the right herbs. They gave him a right botanical, they put him on the right diet and the person ‘ S got either felt better for a little while and that didn’t or or never got better, and there there are a number of reasons for that, and, and it can be confusing for the practitioner, if they don’t realize that That a fight flight mechanism will flood your system, which stress hormones it’ll cause inflammation.

It’ll cause constipation, it’ll cause decreased blood supply and you’re fighting that brain okay, so you so you need to you need to have more than just the form or you are just an adrenal stress test To know if that person’s, brain is in fight, flight journal, stress test or laser.

You’re more school than these. Things tells us about the brain, but it tells us more about something called the hippocampus and how and and the amygdalin the hippocampus, mostly hippocampus, and how that’s affecting your adrenal glands and that’s.

For those of you who already schooled into that for the other ones, I’m. Sorry for for going off into that area, we do reflexes. Okay, we do well. If a person has global reflux decreases, usually it means to us usually means they have a lack of oxygen and, and so these are physiological aspects.

You hear me talk about oxygen. You didn’t, hear me talk about blood sugar today, but that’s foundational. We talk about essential fatty acids. We talk about picking up thyroid, we talk about picking up a probable leaky gut picking these things up on the exam, and we ‘

Ve already talked about the history. History and exam are supposed to go together. Now I’m, not going to go into this extensively. We also do functional neurology and in our world we have found that doing the brain rehabilitation exercises in more significant stress cases tends to be very successful and well contributes to success.

Let me put it that way and we do peripheral neuropathy too, and peripheral neuropathies, largely neurological problems where you’re having abnormal there, paying mostly in your feet and chins, and sometimes into your and sometimes into your hands.

So we do a classic neurological exam for that which is appropriate, but I am surprised that how many people come in here and they don’t know whether they have perform off there or not because they went to their doctor and the doctor did A nerve conduction velocity test and an EMG, so for those of you, aren’t familiar with Brooklyn off there, that you might get numbness, tingling burning and your hands or your feet mostly on your feet.

You might get numbness and then these tests stick needles in there and they find out if electricity is going through your muscles wherever or they find out. If your nerves not working right, these tests are they’re, not real, accurate, so they can.

They can tell you, if you have it: sometimes they can’t tell you where it is and they can’t tell you what kind it is and there’s 80 different types of peripheral neuropathy. You can get enormous Lemoore data out of an exam, so, for example, is, and the exam is so simple: it’s like ridiculous.

You can you can put you, can you can do hot and cold temperature testing other person to see if there’s not sensitive to it or too sensitive to it to heat the cold either? One of those means your small fiber nerves.

If they’re abnormal means your small fiber nerves are breaking down. If somebody’s, sending you with a pin and your uber hypersensitive, you’re in the early state. You may be in the early stages of small fiber neuropathy.

If you don’t feel it at all. You may be in the later stages of it. If you’re at reflexes are absent, you probably burn or apathy. If you, if somebody puts a vibration plate on a vibration tuning fork on your toe and it doesn’t work, I mean you don’t, feel it that’s, a large fiber and and but it also happens to Be something that is involved a lot forth in small fiber neuropathy.

So the point is not that I expected you, like. I’m, not saying this, so that you grasp each one and write it all down. That’s, a small fiber, neuropathy evaluation. You can actually make a diagnosis off of doing an exam.

I go back to the fact that day that’s, how we had to diagnose a small fiber, neuropathy and – and there are other things that will tell you if it’s a large by Marathi that exam further will tell you. Is it the low back that’s, causing that person’s like problem or is it is it or is it that they actually have a neuropathy and a small fiber neuropathy is in the low back it’s? It’s, either thyroid or it’s or it can be thyroid or it can be Believe It or Not gluten.

It can be autoimmune, it can pick it most commonly it’s pre-diabetes and, and there’s and there’s, a handful of other things that can be. It could be bad bacteria and your god. It could be food sensitivities there’s only about eight things.

It is so now you ‘ Ve done a diagnosis through it. Through an evaluation. You’ve found that the person ‘ S probably got small fiber neuropathy. You double-check it with their history and you go yes, small fiber neuropathy, let’s, go or we can.

There are actually better tests for that. They’re extremely expensive. They’re, not completely accurate yeah. So we can decide with the patient whether we go and do those tests or not. I have a little bit more, I think, willingness to go with the exam and and and the history and and and targeted testing simply because that’s the way I I grew up, that’s.

The way I was taught it was normal to me and, and I’ve, been through the the world of all, the tests are normal, or even I am a chiropractor or two, and and so even he, when I was doing strictly musculus Co can Tell you the number of people who came in here and they had a nine millimeter disc in their back, that the doctor was pointing out.

That was said that’s, the problem they took the surgery and and nothing changed. We did an evaluation on him and found out. He was muscle and put the person through. You know a mini two three four week rehab and they were fine.

So, just looking at the MRI in that case was a disaster, the PERT they did not do an exam to find out that all of the testing for disc problems would have been not would have been normal, they would not have been, they would have not have Shown they probably n and they and they shouldn’t, have taken out the disk.

In that case, this goes like 10 times for functional medicine, because we’re working with things a lot more vague than that a back problem or an obvious disk problem. So and one thing we do and the one thing we do in in functional neurology and again I realize most of you are probably here for functional medicine, but but this kind of crosses over the one thing that we do there.

That really translates to – and this is not there’s – not something that’s commonly taught out there. So I’m, so don’t go asking your functional medicine doctors! Why? I didn’t. Do this well yeah, we actually evaluate the cerebellum okay, you can look at the cerebellum, it’s like 80 % of the brain function is is, is is directed by cerebellum.

It’s, our, I should say 80 % of the neurons in your brain are like in the cerebellum. It directs brain function. It has projections into every area of your brain. Okay. If your cerebellum is off, you can get and you’re the person you can get dizziness vertigo balance migraines.

You can get the chronic neck problem, that’s that stiff neck. That causes that causes suboccipital headaches, that the tension headaches that people get you can get blurred vision because it controls your eyes.

You can get chronic stiff neck and and chronic back pain that won’t go away because it controls all of your spinal posture muscles all things which we treat right. This is one of those why don’t you tell me how to fix it.

When you tell me that the condition and you talk about vertigo and dizziness and balance, why don’t, you tell me how to fix it cuz. It might be your cerebellum. How would I tell you that, over on line like this and the cerebellum and the reason it’s so important to us and the reason it should be important to more functional medicine, doctors, all the ones, all fairness? This is not taught in the functional medicine classes.

Is that if you have Hashimoto’s thyroiditis or autoimmunity, there’s, an awfully big chance that your cerebellum is going to get attacked? I’m, not going to get into that. We have. We have we have hours on line on all of these things.

I’m talking about on power, he’ll talk calm and we have all the peer-reviewed references and all the journal references attached, thanks to my former colleague who did all of this research and and and so it’s.

Pretty solid and we see it every day, so it tells us if that person is already been to the year doctor or they’ve, been to the brain doctor. They’ve had the MRIs, they have the cat scans. Everything’s normal and all your so they thought my doctor told me my cerebellum is normal them our eyes.

Normally cat-scans normal. It’s, all normal. If we have and then we have the patient close their eyes, we have a foam pad here. So a lot of your a lot of your balance comes from your ankles. Believe it or not.

A lot of your stability comes from your ankles, so we have people stay on this foam pad to take that ankle stability out. We have them close our eyes and put their hands next to them and half of our patients.

We have to catch them before they hit the ground. They’re in shock when they win that I’ve had Olympic athlete actually do that and he was majorly in shock. That’s, a bad cerebellum, and if you have a bad cerebellum, it can be a contributor all those things I just got done talking about, and and sometimes it’s because of all concussions, but much of the time it’s, because there’s, been an autoimmune attack against the cerebellum.

Now these are the types of things now I ‘ Ve talked you through this and I can talk you through a little bit more. But basically I know this is the most exciting subject. But but basically I ‘

Ve talked a lot about and if you went back and looked at the history and all that all of the things that you get out of history and then you look at all the things that you get an exam. I could stand here and actually treat most cases without going any further in doing any testing and and because you have a pretty solid understanding of what you’re, dealing with and functional medicine.

You should be dealing with global issues. You should be dealing with feedback loops. You should be dealing with vicious cycles. You should be dealing with organ systems. You’re, dealing with big global systems that are spreading out and causing a lot of problems, and so you should have a very, very clear idea of what those systems are by the time you’re done with this.

The reason why am I going through this – I’m kind of going through this, so that you understand this whole series. So they understand, you know I what what you beginning, I think, if you, if you’re, going to a functional medicine doctor and and and they’re charging, you what they’re charging and and and and they’re treating you you might want to know.

This feels like well like I’m, getting the full. I’m, getting the full service that you know or or or somebody starts like feeling like they’re there. Maybe guessing or stuff it’s likely, because this hasn’t been done because by the time you’re done with this.

You should have an extremely good idea of what’s wrong present and I do do testing, but our testing is very targeted. We just have one test and I’m, not gonna talk about that this week. I may talk about it in the future.

We have one test that we do for everybody. It’s. A comprehensive blood panel that we put together for our patient population, which is people who are chronically ill, usually have bought immunity and usually are under chronic stress and and and beyond that.

The rest of the testing is based off of what we find here and it and on art, and the testing should in functional medicine should tell you what you need to know to treat it. Shouldn’t, be I got to test this to find out what’s wrong with you in cajon’s.

You certainly need testing to confirm, but, as you could probably understand, you have a pretty good idea of what of what you’re testing for as opposed to you walking to the doctor. You talk to them for seven minutes.

You got a rash on your face. It goes let’s test you for lupus. Well, I can be like ten different things or fifteen different things, and if you did this exam, you would probably narrow that down dramatically.

This changed in the 1990s. When the HMOs came in and we started having I mean I mean I remember – I was in I’m sitting here in Reno, and I have a nurse in Chicago telling me how I need to treat this patient at that time.

We were doing insurance and that’s. Why we don’t, do it anymore? Okay, and I’m thinking. This is malpractice, but, and it was malpractice, but they ‘ Ve changed the laws to where it’s, not malpractice anymore, to treat somebody that you’ve, never seen haven’t done an exam on ER.

I’m, taking history on it’s insane, but that’s, another story for another day, so that is generally what I wanted to share with you. I wanted to get a gist of an exam. Why it’s, important, why people should be doing it.

Sorry use your dog, you should be doing it. Your GP should be doing it. Everybody should be doing. They know they should be doing it because they were taught that they were taught to a medical school.

They were taught in chiropractic. They’re taught that in naturopathic College, functional medicine, doctors were taught that in functional medicine classes, if they take a functional medicine, University function, Medicine Institute, Arizona, has a nice program or if you’re to a naturopath, they’Re, all of them teach to do exams, okay and – and so so I’m, not talking out of school.

Here we do have. We do talk in previous seminars about maybe checking your functional medicine practitioners out and making sure that they actually have a at least a couple of hundred hours in this state.

You can’t, say your functional medicine practitioner. Unless you have, I think it’s, either 220 hours or 120 hours or it’s. But you have to show that you have gone through all the basics passed some tests, that you have a grasp for the foundation of functional medicine, and this is part of that.

So that’s going to be so that’s. Gon na wrap it up for this episode now next week we’re gonna start to getting, and we’re gonna start, getting into quote-unquote treatment, okay and and and we’re gonna start, laying the foundation Classic functional medicine is not treating people if the foundation has not been set.

This is the cause of more failed cases than I can even begin to tell you about, and next week we will share some of those cases with you and we ‘ Ll talk about the foundational aspects of getting well probably period, but for sure the foundational aspects of getting well and functional medicine.

So that’s it for this week and if again, you have any questions. If you have anything that you think you’ve watched these you there are things that you think you might be interested in that I can wrap within the framework of this series of teachings.

I’m open to that. If you have any comments, don’t comment to me: I’m, not you know, sharp or tight or anything like that. I’m. Not you like do a show. I’m here to share with you what we have found over the years.

This is my 40th year coming up in practice, so I’m, just sharing with you what we know what we’ve done, what we see, and so it can help you out there. This is the request I ‘ Ve got this is our answer to it, so we ‘

Ll, see you next week and I hope that I hope that was interesting to you. I i i i hope it was i it should be. It should be saying if it wasn’t, maybe watch it again, because maybe you missed something we ‘

Ll, see you next week, you

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