Thinking Outside The Box

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Thinking Outside The Box

As a new physician, I thought I knew it all. However, I quickly learned in those first few years that medical school simply gives you the tools with which to evaluate the thousands of different patients you’ll see in your career. Even with those great tools, you must pursue ongoing medical education or you quickly become outdated. It’s definitely a stressful life, but gratifying when you find answers and relieve suffering. When faced with a sick patient for whom standard treatments are not working, physicians feel compelled to look for other options to relieve that patient’s suffering.

I saw such a patient in the 1990’s who caused my practice to take a turn in the road. I had a very busy managed care practice at that time. I had acquired a reputation among my colleagues as someone who was a very good diagnostician. Jane was a very pleasant patient sent to me by her family doctor. She complained of generalized symptoms of severe fatigue, poor concentration, irritability and joint pains which were making it difficult to care for herself and her family. She had been given pain pills for the joint pains that only made her fatigue and poor concentration worse. She told me her doctor said, I don’t know what you have, but I want you to go see Dr. Johnson. If she can’t help you, then you’ll need to go see a shrink! I did an endocrine evaluation and her test results all came back normal. I felt very badly for her because I knew she wasn’t making up the symptoms but yet I had no idea what was going on with her or what to do to help her.

I could have referred her back to her doctor saying I didn’t see an endocrine problem. However, I knew that if I did that she would just be prescribed an array of psychotropic drugs. In no way am I disparaging the important role that psychiatrists play in managing psychiatric patients. It’s just that sometimes in a busy practice, when the medical physician doesn’t know what’s going on with a particular patient, there’s a tendency to write the patient off as being “crazy.” In my opinion, this patient had neither a psychiatric nor an endocrine problem but I didn’t know what to do for her or where to send her. I wanted so much to help her that I had to start thinking more creatively.

It turned out while Jane did not have an endocrine problem, she did have a very significant, digestive problem and was having frequent, loose bowel movements each day. She had previously seen a gastroenterologist who had done a colonoscopy and told her everything was normal. He diagnosed her with irritable bowel syndrome (IBS). IBS is a “catch all phrase given to patients after serious pathology has been excluded. Gastroenterologists tend to focus on treating seriously ill patients with colon cancer, bleeding ulcers and other digestive conditions that often require hospitalization. Since IBS is regarded as a chronic, benign condition, such patients are generally referred back to their general practitioner. Because patients are reassured by the benign colonoscopy, they may resign themselves and think these symptoms are normal for them. This often occurs, especially with digestive problems because many people are embarrassed to discuss their bowel habits with friends or family so they don’t know what constitutes normal bowel habits.

Since every endocrinologist is first trained in internal medicine, I did have training in digestive disorders in my residency program. However, it wasn’t until I studied integrative medicine and functional medicine that I became aware of the importance of the gastrointestinal (GI) tract to good health.

The GI tract contains 60% of your immune system and produces 90% of your serotonin, the feel-good neurotransmitter which contributes to energy, good sleep and a sense of well- being. I did diagnostic tests and determined she had an intestinal bacterial infection causing her IBS. Once her infection was treated with an antibiotic, she had resolution of her loose stools. The GI tract is essential for absorption of nutrients that serve as building blocks to repair cells and make new ones. After restoring normal GI function, all her symptoms resolved and both of us were delighted with her recovery!

Excerpt from “Outliving Your Ovaries” © 2012 by Marina Johnson MD.

Dr. Johnson has no financial conflicts of interest or ties to any pharmaceutical company.

Her only objective is determining the most effective, safest therapy for patients.


To obtain a copy of “Outliving Your Ovaries” click here



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