Identify – The First Pillar of a Unique 5 Pillar System at Sharlin Health and Neurology (Part 1)
If you’re like most people, you’ve probably tried a variety of different remedies and treatments to address your neurological or health issues with mixed results. Maybe it’s time to try something new.
At Sharlin Health and Neurology, we offer a unique 5 Pillar System that may be able to help you find relief from your symptoms. Our approach starts with identifying the root cause of your problems, rather than relying on a one-size-fits-all solution. We believe that this is the key to success in restoring your health and well-being.
We are a pioneering neurology clinic that focuses on a combination of cutting-edge traditional neurological approaches, emerging neurological concepts when it comes to patient care and functional and regenerative medicine, and bringing all of those pieces together to really help our patients.
One of my mentors would say traditional medicine is about “The pill for an ill.”, and there’s a lot of truth to that statement. Sometimes it’s necessary to take this approach. But we should not end our efforts with only that approach.
Our 5 Pillar System
This is the approach to patient care at Sharlin Health and Neurology. This means, if you were to come and see me as a patient, you would be guaranteed that we would be using this approach with you.
The first of these five pillars is called Identify. In general, this should be the part of medicine and neurology that you, as a patient, being familiar with the experience of going to doctors, should generally be most familiar with. Identify is about clearly understanding what the problem is, giving it a name, and finding a diagnosis.
Too often, patients come to see me and they have a spectrum of symptoms, from brain fog to numbness, to weakness, to dizziness, and they don’t understand what is going on with them. There are a lot of things you might hear about if you are familiar with functional medicine. This includes things like mold, toxins, and Lyme disease. There are also heavy metals, nutrient imbalances, food sensitivities, and more. There is some truth to that, of course. But those are more about root cause imbalances.
We must understand the big picture of what is going on. Those are the things that influence that downstream disease.
My friend Dale Bredesen talks about 36 holes in the roof when he describes the various causes of Alzheimer’s disease. This means, there isn’t simply one cause, there are many. In reality, the causes for one person are likely to be different from the causes for another. And that’s absolutely true whether it comes to Alzheimer’s disease, Multiple Sclerosis, amyotrophic lateral sclerosis, migraines, and more.
How does Identify work?
It begins with a proper medical history.
We absolutely cannot skip history. Be prepared to answer questions like:
- What brought you here?
- What are some of the things you’re dealing with?
- What are your symptoms? You’ll go through them one by one.
- When did it start?
- How did it progress?
- Did something trigger all of that or did it start out of the blue?
- Has it gotten worse over time?
- Are there things that make it better? Worse?
- Have you had any testing up to this point, like an MRI or blood test, for example?
This is a pretty traditional medical history, but it is so important not to skip this part. It turns out, about 80% of the diagnosis when it comes to our health or illness is in our medical history.
One of the big differences at Sharlin Health and Neurology is that these are not five-minute encounters. Nothing gets solved in five minutes. There’s that old expression, “Rome wasn’t built in a day,” which is absolutely true when it comes to diagnosing complex neurological conditions. We have to put on our best listening ears and take a proper history while listening to the patient.
Besides looking at your past medical and family history, we also look at your allergies and any medications you’re taking. We also do a neurological exam. This is a crucial part of the process and includes a mental status examination.
Mental Status Examination
In this case, we must ask you questions such as:
- Are you awake and alert?
- Is your speech slurred or clear?
- Do you know your words?
- Can you come up with the right words?
- Are you oriented to time, place, and situation?
The Cranial Nerves
The cranial nerves are a group of 12 pairs of nerves that originate from the brain. These nerves provide sensation and control the muscles of the face and head. Examining these nerves is an important part of the physical examination, as they can provide information about the function of the brain.
The cranial nerve examination is a critical part of the Identify pillar at Sharlin Health and Neurology. This examination should not be skipped, as it can provide information about the health of the cranial nerves and can help to identify problems with them, such as cranial nerve palsy.
There are 12 cranial nerves in total. Some of you may have heard of the vagus nerve, the 10th cranial nerve. It’s the longest nerve in the body and it gets its name from the Greek and roughly translates to mean “the wanderer.” The vagus nerve is very important in functional medicine.
Motor System Examination
This includes testing strength in all four limbs as well as muscle bulk. In some cases, people lose muscle mass. We see that, for example, in Lou Gehrig’s disease or ALS (Amyotrophic lateral sclerosis), but also in other peripheral neuropathies as well.
We want to feel the muscle tone and check if it’s normal. When I passively move your limb, is it rigid like someone with Parkinson’s disease? Is it spastic, perhaps, like someone who’s had a stroke?
Then we go through all the muscle groups and grade strength. We use a scale from 0, meaning you can’t move at all, to 5 meaning it has full strength.
A few may chuckle a little bit during this part of the exam because they’ve seen policemen pull people over on the side of the road having them walk heel to toe, like on a tightrope. You may have seen them have people touch their fingers and then touch their own noses.
This is a neurological exam, really, and not just a police interrogation. We also want to look at rapid alternating movements. We ask you to take your heel and ride it down the shin bone. Coordination involves your upper extremities and lower extremities. These are also evaluated when I watch you walk.
In some cases, there may be some additional aspects to this exam. We may need to look at fine motor control or fast motor movements. These are what is often affected in people who have Parkinson’s disease. We may ask them to tap their fingers or pat their hands quickly.
We also need to examine deep tendon reflexes. When I pull out my reflex hammer, our patients will prepare to position themselves so I can tap on their knees. This is an area where the deep tendon reflex is vital to test. But I’ll be looking at that in your arms and legs as well.
This tells me about how healthy the nerves that control your muscles are. It also tells me about how healthy the nerves that come down from your brain to your spinal cord (corticospinal tract) are. These nerves will send a signal to the nerves that control your muscles.
Test Sensation, Temperature, Vibrations, and Proprioception
We will do an examination of sensation, temperature, and vibrations. We will check your ability to discriminate a fine point from a dull point. I may hold the end of the finger or the toe in my hand and have you not look and then bend that digit up or down to see if you can tell if the finger or toe is going up or down. That’s called a test of proprioception.
This test is crucial as it translates into things like if you were to stand at attention and close your eyes, normally you shouldn’t fall over. If you have proprioceptive or position sense difficulty, you might lose your balance. Doing that test means you are to stand up straight and close your eyes. This is also part of the neurological exam called the Romberg Test.
With this, you have to stand up, walk across the room, heel to toe, and turn. What I’m interested in is:
- Are you able to get up from the seated position?
- What does your stride look like?
- Is it shuffling?
- Is there what’s called “steppage gait” (the inability to lift the foot while walking due to the weakness of muscles that cause dorsiflexion of the ankle joint, most likely because of Foot Drop)?
Before we even talk about the cause of the problem, we need to talk about where the problem is coming from. It is called localization to a neurologist.
Localization is a way of finding out where a problem is coming from in the nervous system. This is important to know because, for example, weakness can be caused by more than just muscle problems. You might be weak because your nerves and muscles are not communicating correctly. Or you might be weak because your peripheral nerves are not working right. Or you might have a problem with your spinal cord or brain.
Without localization, we can’t really talk about the cause.
In the second part, we will talk more about how functional medicine approaches identifying what you are going through. In this way, it’s not just a matter of treating symptoms but rather getting to the root cause and origins of those symptoms so they don’t come back again later on down your road.
If you’re looking for help and don’t quite know where to start, Sharlin Health Neurology may be the perfect place for you. Our 5 Pillar System is designed to identify your problem and provide a solution tailored specifically for you. We understand that every individual is unique, which is why our system takes a holistic approach that considers all aspects of your health—not just your symptoms. If you’re curious about how we can help, please schedule a discovery call with us today. We would love to hear from you and answer any questions you may have. Thank you for reading!
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DISCLAIMER: The information in this email is not intended nor implied to be a substitute for professional medical advice, diagnosis, or treatment. All content is for general informational purposes only and does not replace a consultation with your own doctor/health professional.