Total recovery, p.1
Total Recovery, page 1
A REVOLUTIONARY NEW SOLUTION FOR CHRONIC PAIN AND DEPRESSION
“In Total Recovery, Gary Kaplan offers a potentially game-changing insight: the neurological key to the inflammation that keeps patients in a perpetual cycle of pain and depression. If you have suffered for years without relief, this remarkable book may change your life.”
—ANDREW WEIL, M.D., founder and director, Arizona Center for Integrative Medicine, University of Arizona, and author of True Food
“With cutting-edge science and clinical expertise, Gary Kaplan has identified the source of the inflammation that keeps patients in an endless cycle of pain and depression. He offers profound insight into the way our life experiences have a cumulative effect on our health. I highly recommend this book to anyone who has suffered without relief or wants a deeper insight into how our bodies work.”
—MARK HYMAN, M.D., author of the #1 New York Times bestseller The Blood Sugar Solution, and chairman, Institute for Functional Medicine
“This fascinating book reads like a detective novel, but it’s not fiction. Gary Kaplan is a thoughtful integrative doctor willing to spend hours—even years—getting to the bottom of his patients’ chronic pain and illness. What he has learned could help you.”
—ARTHUR AGATSTON, M.D., medical director of wellness and prevention, Baptist Health South Florida, and author of The South Beach Diet
“Dr. Kaplan’s book draws on his decades of research and clinical practice, offering us paradigmshifting insights into the causes of chronic pain. I highly recommend this book to the millions of people who live with pain and are seeking new answers.”
—BRIAN BERMAN, M.D., professor of family and community medicine, and director, Center for Integrative Medicine, University of Maryland School of Medicine
“By unveiling and responding to the real culprit in chronic pain, Dr. Kaplan’s Total Recovery represents a radical shift in understanding illness and the path to optimal health.”
—TARA BRACH, Ph.D., author of Radical Acceptance and True Refuge
“Gary Kaplan is the Sherlock Holmes of chronic pain. Total Recovery is a must-read at every pain center, by every pain physician, and for every patient with chronic pain.”
—WAYNE B. JONAS, M.D., president and CEO, Samueli Institute, and former director, Office of Alternative Medicine, National Institutes of Health
FOR MY PARENTS
The blessing of their love and support cannot be measured.
CONTENTS
INTRODUCTION THINKING ABOUT ZEBRAS
What Had to Happen First
PART I: ASKING NEW QUESTIONS
CHAPTER 1 THE ONE-TWO PUNCH
What If Assaults Are Cumulative?
CHAPTER 2 LISTENING FOR CLUES
What If Physical Traumas Build Up?
CHAPTER 3 THE CANARY IN THE COAL MINE
What If Pain and Emotion Are Signs of the Same Thing?
PART II: SOLVING THE MYSTERY
CHAPTER 4 EUREKA!
Discovering the Single Point of Origin
CHAPTER 5 HIDDEN CONNECTIONS
How Allergies and Malnutrition Created Panic Attacks
CHAPTER 6 CONFLICTING TRUTHS
How Food, Malaria, and a Fender Bender Led to Fibromyalgia
CHAPTER 7 UNSUSPECTED IMPACT
How Childhood Abuse and Infection Caused Chronic Pain
PART III: THE PATH TO TOTAL RECOVERY
CHAPTER 8 STACKING THE DECK IN YOUR FAVOR
What You Can Do
CONCLUSION A GAME-CHANGING INSIGHT
What It All Means
RESOURCES
ENDNOTES
ACKNOWLEDGMENTS
INDEX
ABOUT THE AUTHOR
INTRODUCTION
THINKING ABOUT ZEBRAS
WHAT HAD TO HAPPEN FIRST
A hundred times every day I remind myself that my inner and outer life are based on the labors of other men . . . and that I must exert myself in order to give in the same measure as I have received and am still receiving.
_________
Albert Einstein
My job is to think about zebras.
In medical school, they used to tell us, “When you hear hoof-beats, think horses, not zebras.” It’s a version of Occam’s razor: “The simplest answer is the best.” And it’s good advice. Swollen lymph nodes and a high fever might be Kawasaki disease, but it’s far more likely to be a strep infection.
By the time I see most of my patients, the simplest answers have already been explored. They’ve already been tested by 8 to 15 specialists from Johns Hopkins, the Mayo Clinic, and other excellent medical centers. If it were a horse, they would’ve found it.
The patients I see are mysteries: a healthy, athletic 14-year-old boy who plunges into years of excruciating pain after an ACL tear and a flood in the basement; a high-powered consultant for international conglomerates who suddenly finds herself standing in a conference room with 15 executives, a migraine, and no idea how she got there.
My strategy has always been to treat the whole person, not the symptoms. But as a medical scientist, I was convinced that, when patients in chronic pain had a history of emotional, physical, and infectious assaults, all of those assaults must somehow be working together. They were all happening within the ecosystem of the body.
There had to be a single point of origin that connected them all. The question plagued me: What was the underlying mechanism?
In the end, I found it. This book tells the story of the clues that led up to that discovery, the Eureka! moment when I suddenly understood what we’d been missing, and the aftermath where I confirmed, in patient after patient, that all of their apparently unrelated symptoms actually had a single neurological basis.
It all came back to Occam’s razor, after all.
Steve Jobs once said that people who come up with groundbreaking ideas often feel reluctant to take any credit for them. “They just saw something,” he said. “It seemed obvious to them after a while.”1 Their insights are based on their ability to see a connection based on the experiences they’ve had. I feel exactly the same way.
All of my education, my patients, my mentors—every experience I’ve had in medicine and in my own family—had to happen first, or I would never have seen this connection.
PLACEBO AT BEST
In the 1970s, a lot of people were starting to realize that, as impressive as it was, conventional medicine did not have all the answers. Alternative practitioners of every ilk were springing up around the country. People were going to health food stores for vitamin supplements and organic food and getting treatments from chiropractors and acupuncturists, despite the fact that their medical doctors were telling them it was pointless.
From a conventional medical perspective, alternative medical treatments were quackery at worst, placebo at best. Little distinction was made between acupuncture, chiropractic, homeopathy, herbal prescriptions, magnetic therapy, aura cleansing, and faith healing. At the end of World War II, physical therapy carved out a tentative place on the fringes of respectable medicine,2 but it would be decades before doctors would stop associating massage therapy with hookers and happy endings.
Then, when Richard Nixon went to China in 1971, an amazing thing happened. A New York Times correspondent covering President Nixon’s historic visit had an emergency appendectomy. James Reston was rushed to the Chinese Anti-Imperialist Hospital.3 At first, his treatment was similar to our practices in the West. Doctors gave him a standard injection of Xylocaine and benzocaine to anesthetize the area, though Reston was surprised to be kept awake for the whole surgery. A few nights later, when he complained of pain, things began to seem foreign.
Li Chang-yuan, a doctor of acupuncture at the hospital, was sent to treat him. Reston was slightly reluctant but decided to consider it an experiment. When Reston agreed, the doctor inserted three long, thin needles into his right elbow and below his knees, then manipulated the needles. Within an hour, his pain was gone and never came back.
To his surprise, Reston learned that Professor Li Pang-chi, the medical doctor responsible for his case, had initially been reluctant to accept acupuncture as a viable treatment, too. Despite his reservations, he had come to recognize that “the body is an organic unity, that illness can be caused by imbalances between organs and that stimulation from acupuncture can help restore balance.”4
In his seminal piece in the New York Times, Reston wrote, “It has been suggested that maybe this . . . was a journalistic trick to learn something about needle anesthesia. This is not only untrue, but greatly overrates my gifts of imagination, courage and self-sacrifice. There are many things I will do for a good story, but getting slit open in the night or offering myself as an experimental porcupine is not among them.”5
If Americans winced, it wasn’t for long. What they saw for the first time was a brave journalist subjecting himself to long, thin, strange-looking needles. And then, without the full body blow of narcotics—without so much as a second needling—his postoperative pain went away. When Reston quoted Dr. Hsu Hung-tu as saying, “Diseases have inner and outer causes. The higher nervous system of the brain affects the general physiology,”6 Americans were listening.
Health-conscious “fitness nuts” in California and elsewhere were already jogging, going to chiropractors, and eating tofu. They had never liked the idea of taking heavy narcotics for pain or general anesthesia for minor surgeries. After Reston’s article, they started to become curious about what acupuncture could offer.
Previously, people had believed that acupuncture was either pure bunk or placebo. From a Western medical model, sticking needles into the body made no sense at all. It was laughable. But the counterculture movement at home and abroad was gradually making Americans aware that people from all different ethnicities and backgrounds might actually have something to offer. The white American patriarchy was not the only source of knowledge and authority. Both patients and doctors were beginning to think that either millions of Chinese people had been duped for 2,500 years or there was something to the practice of acupuncture.
At first, when American doctors tried to use the techniques, they got highly unreliable results. Chinese medicine is premised on a network of energy meridians that correspond to different organs. Taking a practical approach, the doctors merely stuck the needles in the designated points, without understanding any of the principles behind the practice. They might as well have tried to take blood by stabbing a syringe into the patient’s body at random. Doing acupuncture with a Western approach was just as unlikely to work.
As a result, acupuncture was branded “an experimental medical procedure” in 1978. Under this designation, it could only be performed by authorized doctors under experimental protocols. But by that time, the public was so enthralled with acupuncture that many people went to England, France, or China to study it. I went to Monterey.
OFF ON THE RIGHT FOOT
Internal medicine specialist Hector Prestera, MD, was one of the first physicians in the country to use acupuncture. When I graduated college, I drove to California to meet him and ended up studying acupuncture with him for a year before I went to medical school, expecting to be a neurologist.
As I explain in Chapter 1, that aspiration was doomed from the start. After learning to see the body as a whole, the idea of treating individual symptoms as if they had nothing to do with each other—which Western neurology teaches—was as appalling to me as operating with a blindfold on.
Acupuncture opened my eyes to a different and fascinating way of viewing human health. Its diagnoses sounded vague and poetic. In an effort to become more scientific and precise, Western medicine had long ago abandoned poetry and metaphors. So on the surface, the Chinese meridian system seemed whimsical, perhaps even dangerous.
Because it was looking for patterns of disharmony, rather than discrete dysfunctions, it might identify a “liver disorder” that would never show up on clinical laboratory tests. From a Chinese medicine perspective, premenstrual syndrome, for example, is frequently “a disorder of the liver with an invasion of spleen.” This kind of diagnosis understandably might sound like nonsense to Western medical ears. I might have thought so, too, except its effectiveness had given me a profound respect for this point of view.
And yet, in the early days of my training, it was my very understanding of Chinese medicine that constantly brought me back to Western physiology. I could see that it worked in ways that Western medicine was not yet addressing, but I couldn’t figure out what that meant from a Western perspective. Driven by the need to find a unifying whole, I ultimately added a number of specialties. I was constantly investigating new techniques, learning to evaluate patients from as many directions as possible, since no medical approach explained everything I was seeing in my practice.
When it came to choosing my residency, the only specialty I could find that came close to treating the whole person was family medicine, so I began a residency at Georgetown University in Washington, DC.
It was 1982. As it happened, Joe Helms, MD, who created the Medical Acupuncture for Physicians program through the UCLA continuing medical education office, also invited me to be one of the first students. His was the first comprehensive acupuncture training program created for physicians in the United States. Eager to learn more about a system that treated the body as a whole, while building a strong foundation in Western medicine, I arranged with my Georgetown residency director to spend part of my elective time training in Dr. Helms’s program. The basic program started out as a 3-month commitment. As he continued to build the program, adding advanced training and bringing in master acupuncturists from around the world to teach us, my 3-month commitment turned into 8 years of regular 2,300-mile commutes between coasts.
When a major university like UCLA started training doctors in acupuncture, it was a sign that people were beginning to recognize that this ancient Chinese practice had something significant to contribute to our own impressive achievements in Western medicine. Eventually, my acupuncture work led to my helping to create the American Academy of Medical Acupuncture (AAMA), where I served on the board for 5 years. My involvement in the field was such that I later became president of the Medical Acupuncture Research Foundation (MARF).
THE CUSP OF CHANGE
By the 1990s in America, things were changing. We were on the cusp of exciting new discoveries that would lead us to radically alter our understanding of medicine and the nature of the brain itself.
One of the tools we needed had already been invented. In 1990, Seiji Ogawa, PhD, a research scientist at Bell Laboratories in New Jersey, came up with a way to take images of the brain in action.
Magnetic resonance imaging (MRI) had been providing us with still images of the brain since the 1970s. Positron-emission tomography (PET) scans (affectionately known as “head shrinkers”) with radioactive tracers were used to determine how the organs and tissues in the body were working.7 With MRI and computerized tomography (CT) scans, doctors had the ability to see the brain to identify tumors and other abnormalities, but not to see how the brain actually worked. Then Ogawa improved on the design. Once he figured out a way to create functional magnetic resonance imaging (fMRI), doctors no longer needed to guess what was going on in the brain. We could see how the brain worked—live, for the very first time.
In that same year, the Hubble Telescope was launched into space. It was like turning on a light in a dark room. Astrophysicists, like brain research scientists, could see what they were studying in a completely new way.
Technological breakthroughs in the early 1990s gave us access to an unprecedented magnitude of information about our bodies, our world, and our universe. Soon after the World Wide Web was launched in 1991, search engines were developed to help us sift through vast amounts of data.
With the advent of 24-hour access to such enormous banks of knowledge, startling new medical insights began to emerge. The Human Genome Project was launched at National Institutes of Health (NIH) in 1990. By June 2000, scientists were able to see a map of all the 20,000 to 25,000 genes in the human body. The DNA sequence was readily available on the Internet.
When the National Library of Medicine in Australia went online, physician Barry Marshall began to research his hypothesis that stomach ulcers were caused by bacteria, not stress. “I found very widespread, dispersed references to things in the stomach, which seemed to be related to the bacteria, going back nearly 100 years,”8 Marshall said.
Without a computer, he estimates he may have spent 20 years collating data without ever seeing a connection. Instead—to the relief of everyone infected with Helicobacter pylori (H. pylori)—he was able to complete his research and prove his theory in only a few years.
Although he had been laughed off the stage by the medical community when he first presented his ideas, Marshall won the 2005 Nobel Prize in Medicine. His insight into ulcers ultimately saved 500,000 lives a year and rendered a multibillion-dollar drug market obsolete.9 (Astonishingly enough, the new treatment for peptic ulcers turned out to be antibiotics, not Valium.) By proving that diseases could be infectious in origin, using evidence that was impossible to ignore, Marshall made a discovery that had huge implications for medicine in general. A paradigm shift was beginning to take place.
BREAKTHROUGHS IN PAIN
A pioneer in recognizing the need for a more compassionate and humanistic approach to medicine, Norm Shealy, MD, created a physician’s organization in 1978 to bring together the leaders in the emerging area of holistic medicine. As a Harvard-trained neurosurgeon, Dr. Shealy had originally viewed pain as a nervous system disorder. When he saw that our existing medical knowledge had left us without enough treatments for pain, he looked for ways to get the brain to ignore the messages from the pain receptors. This led to his groundbreaking work in the development of two of the most widely used treatments for pain: dorsal column stimulation and transcutaneous electrical nerve stimulation (TENS).
