In medicine doctors usually work toward a diagnosis. Diagnosis at its best implies finding the cause of the disease. Thinking in linear cause and effect mode was reinforced by advances in surgery for traumatic injuries, and in the discovery of antibiotics for infectious disease. The ingrained habit for doctor and patient is to find the right diagnosis and then the correct treatment will be straight forward and hopefully effective.
Chronic complex illness does not follow this pattern. The problem is not just the inciting event or the viral or bacterial trigger. In chronic illness it is the variety of the person’s genetics and environmental experience that often matter more than the triggering event. Environmental experience includes the totality of our life experience: our physical environment, our chemical and electronic exposures, our socio-economic cultural group, and our psychological and spiritual issues and beliefs.
The problem with all symptoms is that they are internal experiences we all struggle to express in ways that another person can understand. This is difficult even when we agree on basic definitions, but doctors are trained to think about symptoms in very specific ways, while patients are not. So often, a stomach ache means one thing to your doctor – a pain somewhere in the area just below your ribs in the midline, or a bit to the left, or maybe to the right of midline of your abdomen. To the patient it could mean a pain below the belly button, or a generalized ache in the entire abdominal area. Maybe the word ache itself doesn’t mean the same thing to patient and doctor, as there are so many types of pain, each indicating something different could be wrong.
How does the diagnostic thinking proceed when you complain of stomach pain? The doctor’s first priority is to rule out, as we say in medical jargon, whether the cause of the pain is life threatening in origin. The appropriate questions and physical exam usually deal with this issue 90% of the time, and depending on your age and sex, may or may not require more in depth investigation. The problem we face with chronic illness is that the stomach pain that you have is usually not the mild gastritis seen on endoscopy, usually attributed to excess acid or H. Pylori infection. For people with chronic illness there may be multiple small stressors to the stomach that can add up to severe stomach problems, but often fail to show up when our focus is ruling out “serious “ problems.
Things that may contribute or even cause severe stomach pain include mild forms of Mast Cell Activation Disorder (MCAD) or (MCAS), intestinal dysbiosis, elevated but “normal” porphyrins, vagal nerve irritation from tight muscles or fascia along the vagal nerve’s course, and musculoskeletal problems – especially of the mid thoracic area, fascial strain patterns in the chest and abdomen or pelvis which affects proper blood and lymph flow to and from the involved organ. Infectious contributors can include low grade infections with Lyme or Bartonella, which would be missed if all you are looking for is H. Pylori. Viral infections, or gall bladder and pancreatic dysfunction can also be missed if you are not looking deeper.
Notice I refer to dysfunction. This includes the mild decrease in function from age and toxins that most of us take in stride. When another mild low grade problem is also present, let’s say a tendency to hypercoagulability, along with being chronically dehydrated, maybe a little low in calcium, and a tendency for your mast cells to over react and release chemicals that cause a bit of swelling, and all come together with a low grade infection, then suddenly the blood supply and lymph drainage hits a tipping point and you have stomach pain. You may also begin to react to foods that never bothered you before, or even to inhaled irritants that end up affecting your stomach.
What is the diagnosis here? All your tests are within normal limits, but you are at the high end of normal in some of these, and the low end in others, or just a bit out of range for normal, but not quite showing a disease. Symptomatic, but all tests “normal.”
We tend to blame the immune system, but there is only the body system. We made artificial groupings of bodily functions in order to study and learn how it works. The problem is, we keep forgetting the whole body is a system. We investigate its parts, but it works as a whole.
Our job as medical practitioners isn’t just to look for the inciting cause, the bullet if you will. With chronic complex illness we have to peel back the layers of over and under function of your whole body. We have to find what imbalances in you allowed an insult, whether infection, toxin exposure, physical or emotional trauma, to have caused persistent ongoing symptoms rather than the usual short term illness and recovery.