(From conventional to lifestyle medicine doctor)
The last Consultant meeting. Five more working days to go, not that I am counting. I am leaving my substantive NHS Consultant job at Barts NHS and am both terrified and very excited. I feel as though I am coming out of the closet, on a professional level.
There is a ‘last’ every day. The last time I would see a particular patient. There are tears and hugs and understanding and frustrations and at times I let my boundaries down, and I hug my patients or let a little tear loose. I had seen some patients regularly for eight years and beyond the undetectable HIV viral load, I know their children’s names, their pets, hobbies and mostly had the privilege of walking alongside them in their HIV journey, from receiving a diagnosis, the shock and grief and into acceptance and thriving health again, rebuilding relationships and giving back to others and society. I learned so much in 20 years in the HIV/sexual health world. From working on Broderip ward at the old Middlesex hospital in 1998, when planning for death and discussing living wills was an almost daily routine to then being able to prescribe life-saving antiretrovirals, albeit in handful of pills and nasty tasting liquids to finally now being able to sit in my new air conditioned office in a brand new clinic and explain how you can’t pass it on if your viral load is undetectable and yes, it has a normal life span if you adhere to treatment, mostly one or two pills daily. For all this to have happened in my ordinary doctor career is a blessing and mind-boggling astounding and I feel so grateful to have chosen this path.
Academic learning aside, the biggest gift has been the love and connection that I shared with patients over the years. And whilst I have always encouraged them to live true to their identity- sexual or otherwise and saw them live with courage in uncertain times and I know I can talk a good talk, I feel that now is my turn to walk the walk.
(The dawn of awareness)
Three years ago, I a rough patch. I had an operation followed by complications that required intravenous antibiotics and delayed healing; serial MRI’s; loose bowels, low blood pressure and last but not least fatigue. I saw the best of the best in the conventional medicine world, but my symptoms were somewhat not fully explained by the tests available to me. The answers were few and yielded even fewer practical solutions. The rough patch turned into a black hole in my universe as I knew it. Was it my hypermobility and ‘funny collagen” structure that came with it or was it peri-menopause, burn out, stress or the deep grief at my mum’s terminal illness? The operation had been the last straw in an otherwise perfect storm. Another grief was that nothing I had learned in conventional training seemed to have prepared me for this, except for my analytical skills, ability to review research and willingness to be my own guinea pig.
It was during this time that I found functional medicine, which held many answers within it. Functional medicine is rooted in the latest science and looks at the biology of our systems.
Take stress, for example. In conventional medicine, you are taught that you need to remove yourself from the circumstances that are causing it. But how can you do it? Bread needs to go on the table, socks need to be paired up and there’s the daily emotional management load to be tackle. In functional medicine, you can break it down in components, based on systems biology (hormones, gut and microbiome, inflammation- to name a few). You measure your salivary cortisol at four time points throughout the day and look at its pattern (circadian rhythm). Is it disrupted from normal, when it is highest in the morning, dropping throughout the day to lowest at bedtime to allow for a good night sleep? How can you hack this from a biological perspective? You may start by balancing your blood sugars better by increasing the protein intake at every meal, tackle inflammation (remove inflammatory foods, such as gluten) or consider phosphatidyl serine – a supplement that helps breakdown cortisol to lower levels before bedtime. Do you know how good your metabolic pathways are for breaking down adrenaline? Are your enzymes in good shape or do you have a polymorphism in one of the enzymes (COMT- cathecol-O-methyl transferase) that may slow down its breakdown? If so, you may benefit from methyl donor supplements. You can also quantify your neurotransmitters, and although the validity of such tests is still being investigated, we also know that most of your serotonin, the happy hormone, is produced in your gut. Your lovely gut has 5 times more the number of nerve cells than your brain, ready at a moment notice to divert blood to your limbs for a fight and flight response in case of danger. The gut also hosts your microbiome, which can work for you or against you and can be characterised by a stool test. And can you still hear the whisper of your gut feelings or has it been drowned under the never ending to do list? Sometimes you can rebalance physical issues, but if there is a longing or an emotional hole in your heart, you may need to listen to it and engaging your right sided creative brain helps connect with it.
What about the astounding discovery of neuroplasticity - our ability to rewire our brains, grow grey matter and strengthen synaptic connections throughout life? What work does this involve and how can you build the determination, focused attention and implement the nutritional changes required?
I have now been back to work for 18 months after that rough patch, and whilst I have been able to help a few patients lose weight or even diminish their fatty liver appearance on liver ultrasound in my brief 20 min appointments, I was left feeling that I wanted to do more of this. I am leaving behind a HIV world that is stable and new diagnoses halved in London last year thanks to preventative therapy (PREP). More can be done to prevent metabolic syndromes, tackle cognitive decline and promote healthy ageing and I wish I was a part of that. For now, I am moving on into functional medicine at the Marion Gluck Clinic. I will also be joining forces with Akesio.com to further deconstruct stress and find personalised solutions for the individual. And if you still think stress it’s all in your head and you are in a rough place, I would love to listen to your story, because the likelihood is, I have already been there.