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Inconclusive diagnostic results lead doctor in new direction

Part 2 in a 2-part series

Shelby Ramsey

Special to the Village News

It can and does make a difference when a physician treating a patient goes the extra mile, spends a little more time listening, and is whole-heartedly dedicated to helping that individual.

Dr. David Clarke, an expert in gastroenterology and internal medicine, discussed methods he has found successful when medical tests aren't very revealing.

In just his eighth year of formal medical training, Clarke was referred a patient from another university "where they absolutely could not figure out what was wrong with her [as] she had a very severe gastrointestinal problem," he said.

After performing the usual specialized testing (which was normal), and during the "exit interview" with the patient in which Clarke felt frustration about not being able to help her, he began asking her about stress.

In the conversation, "She started telling me about stress she had as a child. She had been sexually abused as a child by her father on unfortunately multiple occasions, but nobody had touched her against her will in 25 years. She was well into her 30s at this time."

What baffled Clarke the most was the possibility that those ACEs (adverse childhood experiences) and this "completely unexplained illness ... could be connected to each other," he continued.

He decided to refer the patient to a psychiatrist who was well-versed in mind-body connections. Fast forward a few months, Clarke ran into the psychiatrist and asked how the patient was. It was then that he found out the "patient was cured."

"[At that time] my mind was blown," he said. "That just by talking to somebody you could alleviate a serious physical symptom that had been going on for two years and had defeated the best efforts of two top universities," he said.

Being proactive early on in his medical career, Clarke asked the psychiatrist to teach him her method. The logic behind it was "I'm going to be a complete gastroenterologist who's going to be able to help anybody who comes through my door ... I should know what to do."

To his surprise, after learning the framework from the psychiatrist and while in practice in Oregon, "there were five to six patients a week coming in" to his office where "I would do the tests and the tests would be normal." He then "would ask them the questions [the psychiatrist] had taught me and lo and behold they would have these issues: childhood issues, they would have current stresses, they would have traumas – over and over again," Clarke said.

"Nobody else was doing this work," he said. Clarke pivoted and was approaching treatment in a way that wasn't being done by mental health professionals. He said, "Even the mental health community was uncomfortable working with people who were physically ill as opposed to having mental health challenges."

Clarke made the conscious decision to do what he could to aid his patients' health. He said to himself: "These people deserve to be helped just as much as my patients with hepatitis, ulcers, or growths in their colon."

Through trial and error, time, and experience – he said he "got better and better at it." Five years later, he received the Doctor of the Year award from a big HMO group.

He was changing lives and it wasn't going unnoticed.

I inquired as to what gastrointestinal symptoms patients experience that may come back inconclusive on diagnostic testing. I wasn't expecting Clarke's answer.

"Symptoms that people get are literally from head to toe," he said. A few he mentioned include:

• Itching of the skin

• Migraine

• Back pain

• Diarrhea

• Constipation

• Vomiting

• Acid reflux type symptoms

• Spasm of the rectum

• Neuropathy type symptoms (nerve involvement)

• Various rashes

• Chronic cough

• Bladder spasms

• Ringing in the ears

"Almost every gastrointestinal symptom you can think of, short of hemorrhaging can happen," he said. "The only common denominator is people often have more than one symptom at a time [often] in different locations in the body [and/or] move from place to place."

"These are all very characteristic of brain-generated symptoms," Clarke said.

The impact and results of the new psychotherapy treatments Clarke revealed in the first article of this series "is incredibly dramatic."

He provided a snapshot of a study performed at the Veterans Affairs Hospital in Los Angeles, of "older male veterans of chronic pain ... average age in their 70s."

He underscored that the VA population "has a reputation of being a very difficult group of patients to help."

Applying one of the new psychotherapy treatments (Emotional Awareness and Expression Therapy) the results were as follows:

"'The group that got cognitive behavioral therapy, only 5% of them achieved even 30% pain relief. It was extremely unsuccessful.

"The group that got Emotional Awareness and Expression Therapy, 42% got at least 30% pain relief. It was eight times more effective."

Clarke dissected this, "When it comes to reading pain research studies, you just never see anything anywhere close to that [success]. An 8-fold higher level of impact from a new form of treatment that has no opioids involved, it's just talking to people. That's what the public needs to hear."

When asked what symptoms he felt deserved more attention or he finds most under-represented in his specialties, his response was without hesitation – "All of them do."

"Brain-generated symptoms deserve more public attention," Clarke said.

Many resources are out there for those who are interested in learning more. Clarke recommended the non-profit: http://www.endchronicpain.org which offers resources that are science-backed.

Dr. David Clarke has many roles, including at Oregon Health & Science University, Arizona State University, Pacific University, Cummings Graduate Institute, and at the Stress Illness Recovery Practitioners Association. He is well-published, has had many television appearances, and has lectured widely to medical professionals and the public across North America and Europe.

Shelby Ramsey is the author of the blog, thehonestmigraine.com, which also features interviews with patients and medical experts.

 

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