Welcome to Functional Medicine Update™ for May, 1999. It is a privilege to be with you, act as spokesman for colleagues around the world, and share insights into the evolution of health. I sometimes have a feeling of great responsibility about the accuracy, clarity, and excitement in the research, clinical discoveries, and breakthroughs. I hope that tone comes through in this month’s issue of FMU.
I often get letters, and I thank those subscribers who communicate your desires, likes, and dislikes about Functional Medicine Update™. I recently received two interesting letters from individuals who have been successful in the process of functional, healthy aging. Both are retired physicians I have known for many years. Their comments are noteworthy relative to making life transitions. The first letter is from Dr. Bayard Coggeshall (February 1999), a retired pediatrician and a long-standing FMU subscriber. He writes:
“As a pediatrician now living in a retirement community and witnessing results of the aging process, cause and effect deserve reflection. It influences my counseling efforts in a community clinic in Dover, New Jersey from the pediatric viewpoint.
“A journey of 41 years in pediatric practice followed by participation as a volunteer in the Dover (NJ) Community Clinic involved a gradual change in both focus and conviction. Following, a few markers, or events, are mentioned which for me illuminated the way.
During a lecture at McGill in 1942, Dr. Vineberg, psychiatrist, included a reference to the occasional benefits of administering vitamin B to patients afflicted with cognitive and behavioral disorders.
“While I was interning at the Montreal Children’s Hospital in 1943, Dr. Alton Goldbloom demonstrated the therapeutic effect of direct sunlight on the arm and neck rash of a four-year-old child—pellagra!
“In the mid 1950s Drs. Allan Butler, Nathan Tabbot and others stressed the role of potassium in parenteral fluid therapy.
“One Christmas Eve in the late 1950s on a house call to an impoverished family in Morristown, I examined a 15-month-old child in acute distress. The child was lying immobile in the ‘frog legs’ position and screamed when touched—scurvy! That morning I had received a bushel basket of oranges from Florida as a Christmas present. There was no fruit or juice in their refrigerator, so I brought the basket in from the car, taught the mother how to squeeze oranges, and left instructions as to daily use. By the following day, Christmas, the child was much improved.
More recently, in 1989 on ward rounds, Dr. Kim Burlingham introduced me to an Hispanic mother and her hospitalized child. Mother and child, over a two-year span, were afflicted with recurring outbreaks of furunculosis and abscesses. These bouts involved frequent visits to emergency rooms and the administration of oral antibiotics, as well as two admissions for the child to receive intravenous antibiotics. In the hall, Dr. Burlingham and I discussed the family circumstances and dietary exposures. The recommendations we decided on included: eliminating simple carbohydrates—soda, candy—as much as possible; eating more fresh fruits and vegetables; and supplement (both mother and child) with ascorbic acid (vitamin C) and zinc—30 mg per day. Six months later the resident called me to say there had been no further outbreaks of staphylococcal infections.
“Incidentally, the child now 11 years old, appeared at the Dover Community Clinic for an unrelated minor problem, the mother relating how grateful she was for Dr. Burlingham’s care when the child was four.
David Perlmutter, MD
Commons Medical and Surgical Centre
800 Goodlette Road, Suite 270
Naples, Florida 34102
In the FMU Clinician of the Month interview, we take the past, present, and projected future information I’ve reviewed and apply it to clinical experience with clinicians who are doing the work, seeing patients, and watching how the concepts of functional and nutritional medicine work in practice. In this context we are very pleased this month to interview Dr. David Perlmutter, a neurologist who practices in Naples, Florida, and my friend and colleague. I admire his ability not only to do high-quality medical work in the field of neurology, but also to keep his mind, eyes, and ears open to new developments, and new concepts. He finds ways of applying that information to effective clinical management—crossing the bridge between the world of research and the hard, daily work of dealing with patients.
JB: Dr. Perlmutter, it’s a pleasure to have you as our Clinician of the Month. I know your father was a neurosurgeon, and you come from a rich intellectual heritage in the field of neurology. How did you decide in the past few years to expand the boundaries in the area of complementary, nutritional, and functional medicine?
DP: Thank you for that very kind introduction. Perhaps nowhere in medicine does a physician feel more limited in his or her abilities to effect change than in neurology. The problems we deal with are very challenging, and from a conventional medicine point of view, we are really reduced to simply the prescription pad, and the options available to us often do nothing more than provide symptomatic improvement, at best. Based on the work you have allowed to evolve over the past decade, we have come to understand, at least with respect to many neurodegenerative conditions, that there are many opportunities to intervene biochemically and functionally to allow an individual to begin to feel that he or she is participating in actually getting at the root of the problem and allowing a functional improvement.
JB: I know that at one time you were an instructor in microneurosurgery at the University of Florida. When we speak of neurosurgery, we often think of some of the highest, most technically sophisticated surgery. Has it been difficult for you to make this transition from what might be considered the ivory tower of medicine into what some people might think of as a lower-technology form of medicine, the functional medicine approach?
DP: Not at all. I wouldn’t say there’s been any significant jump in terms of level of understanding and level of complexity. We are now participating in therapeutic programs that are as biochemically advanced as is available. The work that is going on with respect to applying functional medicine in day-to-day practice really relies on the most sophisticated biochemical information that’s just coming out in research. It is still very fulfilling, and we still feel we’re way ahead of the curve and very much on the cutting edge.
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