DISEASE VERSUS A FUNCTIONAL HEALTH ISSUE???

Welcome back to Medicine Health. I'm Dr. Paul, and this is Dr. Pro Tips. The next one is, what is the difference between a pathologic disease state and then what we in more modern times might consider a functional disorder? And I think this is a really important distinction to make because it— especially the more doctors you get involved in your life, and sometimes with complex chronic illness and cancer and other things, you may have a whole lot of healthcare providers all, you know, playing in the same field. And so sometimes there is a distinction in, uh, what might be being worked on between a disease, which is going to be fairly simple to define, and then something that is maybe pre-disease prevention-oriented or a functional problem, which is maybe partly pathology and partly non-pathologic. So what does all that mean? Well, one way to think about it is diseases are things that we've identified in the science of pathology. and pathophysiology. We know generally why they occur. We certainly know what happens to the cells or the body when we have that disease. You know, in modern times, we have codes for these diseases. And we usually have some sort of diagnostic and therapeutic algorithm that says, well, if we're looking at this disease, here's how we diagnose it. And if it's diagnosed and that truly is your disease state, then here's the— options for treatment that are available. So it's pretty linear, it's pretty straightforward. A dysfunction or a functional problem can be anything along a pretty long road. Now, one way to think of it is a functional problem can be a non-disease state because it's actually a precursor to the disease state. So for example, you've probably heard of people who are diagnosed with prediabetes. Well, what your healthcare provider's really saying is you have the, you know, all of the factors that go together to make, let's say, type 2 diabetes in an adult, but your lab values haven't reached the critical point where we're gonna call it type 2 diabetes. We're gonna say you have prediabetes. This is an excellent time to do a lot of preventive things. And we've had a lot of people, you know, who are diagnosed as having prediabetes conditions, which really means your body's already on the way there, it's just not so bad off. And they were able to change their diet and exercise and all that, and they never became full-blown, you know, type 2 diabetic, for example. So that's an idea of a preventive or a functional problem. Now, some of these things— now, I was mentioning coding and all of that, and that's usually what, you know, gets it paid for on your insurance. Some of these pre-states or these preventive states now actually have diagnostic criteria and entities. Another one that we see a lot of is early diagnosis of macular degeneration, a degenerative eye condition that's quite common. And it used to be not commented on or not diagnosed very early. It wasn't until you started to have vision loss. And now they are doing a much more aggressive job diagnosing people younger. And what they will tell them, it's kind of like the diabetes story. Well, it's not fully changing your vision, it's not doing these things, but it's in your future. And so you don't really qualify for the drugs that we would normally give somebody with that or whatever. So, this is a really good time because it's a precursor disorder to look into things that would be preventive for that. And again, You know, in our practice, we work with people who have early stage or pre-macular degeneration, and we look at a large number of other factors that may feed into that and help them to either forestall or slow down the onset of the actual disease state. Now, another thing that happens is a little more complicated, and that is, I mentioned that some functional problems are— have a component of disease to them. And usually what that means is the component is at a lower level, and so it might be diagnosed or it might not be diagnosed, but because it's at a lower level, it doesn't look like a big part of the problem. But what I would sort of describe to patients is you could have a lot of symptoms from a disease, and let's say that disease, you know, is a stack of quarters That's, uh, you know, 3 inches tall. So it's pretty much above the radar. The labs are going to be weird and you're going to need treatment there. Well, what if you had 3 1-inch stacks of quarters? So you had 3 different body systems that were all a little deranged, a little abnormal, but not fully pathologic, or maybe a little bit, maybe not. you'd still have the same amount of problems. They just wouldn't be sticking up above the radar. So a lot of the screening tests, etc., might not test or check those things. And that's a really important thing to keep in mind too. So in a lot of our chronically ill patients, sometimes in our recovering cancer patients, many times in people that aren't getting— they go to their doctor and they don't feel well. doctor says, well, your labs look fine, so, you know, let's just keep an eye on you. A lot of those types of cases are these cases where they're a little more complex, or there might be little, you know, little baby-level pathologies, but there's a bunch of them going on. And in the primary care acute medicine model, we're not always taught to look for more than one thing. So, for example, you know, you might be feeling tired and fatigued, And they check you for anemia, they look at your liver and kidney functions, they take a look at your thyroid function. Everything looks okay, you're not profoundly anemic, your thyroid's not that bad, etc. And what will, what will happen a lot of times is that person will continue to feel bad and they'll say, well, these things look good. Then what you have to do is take a step back and say, well, haven't we looked at Uh, could there be other hormonal influences that are creating my fatigue? Could I have a sleep disorder, you know, obstructive sleep apnea or something? Uh, could I have other, you know, biological things going on that are all feeding in? And so then in that case, what you would wind up with would be, um, you know, maybe a little bit of a thyroid issue and a little bit of another thing and some sleep disorder, whatever. The point is that that's more of a functional collage of a problem giving you these symptoms of maybe fatigue or sleep disorder or something. And that functional collage has to be dealt with, but it can't be dealt with with the same intensity that one big disease does. So this is where a lot of times, uh, things like, uh, the, the functional medicine approach or naturopathic medicine or integrative medicine kind of shines in these areas where there's not one big shining disease state, but there's a lot of little things that are wrong, and you can look at them functionally and try and, number one, do what you can to make them go away or minimize them. And if you work on all of the parts that might be contributing to you not feeling well, then you can feel better with a lot of times less medicine and, and not wait till you do get, you know, a big thyroid problem or a profound anemia or whatever other pathology that you're looking at. Now, as we wrap up here in a minute or two, I want to talk about real quickly that a lot of times the idea of a functional problem is not going to be a totally new idea to most of your healthcare providers. But if they don't do that approach to medicine, it's going to be sort of, well, yeah, I guess, you know, that can exist. So sometimes looking at it and discussing it as more of a preventive approach. So, you know, I don't— I'm still having my symptoms, but I obviously— these labs you did look pretty good to you. What are other things that I could explore, you know, that might be non-pathological or subthreshold? And sometimes, you know, they'll be really great with that and they'll give you ideas. And sometimes they'll say, well, well, usually when it comes to these things, we'll refer you to XYZ practitioner because they do the functional approach or they do whatever. And that's getting to be a little bit more common. It's not completely common, but it's getting to be a little bit more common as you go around. Now, you do still have some healthcare providers that'll say, well, functional medicine's a bunch of crap, or functional problems don't exist, or whatever. And it's— that's really more of a worldview and a perspective issue than anything else. One of the things that you do want to keep in mind, though, is that if you're not getting the help that you need from the provider that, you know, you're dealing with for most of the things, and maybe they have referred you to a specialist and the specialist said the same thing, look, your thyroid's fine, we're not going to do anything about it. In those cases, if you're still carrying around a lot of symptoms and you're not recovering, or like I say, we see this a lot with our recovering cancer patients, or they're trying to recover after chemo or surgery or something, and it's just, you know, it's, it's not the, you know, the purpose of the medical oncology folks or the surgeons to give a ton of advice about just healing and getting over things, etc. They'll give you some. So Then the next thing is, can you seek out information and/or healthcare practitioners who are trained to look at this sort of bigger picture, more functional approach? And they can fill in that piece for you. So it doesn't mean that you have to get rid of your other doctor or doctors or your healthcare providers, but it might just be that, you know, you need somebody to take a step back and take a broader look, more of a 360 look. So all in all, work with your providers. There is a difference between a disease state and a pathology and a preventive state or a precursor state, or what we're calling maybe a functional illness. And a lot of times your primary care is going to be really focused on disease state, and they're not going to verge— because they don't have time and they don't have a lot of other things going on— verge out into these functional areas or preventive areas beyond a little bit of preventive stuff they already do. So again, if you're more in the functional state and they've told you, you know, your labs or your imaging looks fine, you're not going to die, great. But I still feel horrible. Either ask for a referral or look around for people who do integrative medicine, naturopathic medicine, functional medicine. Make sure that they're duly licensed and qualified and able to do what they are supposed to do. But you can get help in the area of functional and preventive medicine. All right, well, we're out of time for this one. Please like, share, and subscribe. Check us out on CTR Radio and the YouTube channel, and then we're on all the pod burners. I'll see you in the next one. Thank you.