Latest / The Integrative Clinician by BridgeWell / BridgeWell Briefs #1: What If IBS Is The Wrong Question
Transcript
- 0:00SPEAKER_00: What if I told you that one of the biggest mistakes we make when evaluating chronic bloating isn't missing a diagnosis?
- 0:07SPEAKER_00: It's asking the wrong clinical question.
- 0:10SPEAKER_00: As primary care clinicians, we're trained to localize symptoms.
- 0:15SPEAKER_00: If a symptom is in the gut, we think about the gut.
- 0:18SPEAKER_00: And while that's appropriate, one of the biggest shifts I experienced as I began studying functional and integrative medicine was realizing something much more important.
- 0:29SPEAKER_00: Symptoms occur in organs.
- 0:32SPEAKER_00: Dysfunction often begins in physiological systems.
- 0:36SPEAKER_00: The idea completely changed how I evaluated patients.
- 0:46SPEAKER_00: Welcome back to the Integrative Clinician, the podcast for nurse practitioners who want to think differently about their patient care.
- 0:54SPEAKER_00: I'm Dr.
- 0:54SPEAKER_00: Sherry Irwin, family nurse practitioner and founder of Bridgewell Integrative Education.
- 0:59SPEAKER_00: Today's episode is our very first Bridgewell Clinical Pearl.
- 1:04SPEAKER_00: These are meant to be short episodes where I'll share one practical concept that can change the way you think about your very next patient.
- 1:12SPEAKER_00: Today's Pearl is one I use almost every week in my practice.
- 1:17SPEAKER_00: Imagine a patient sitting in your exam room.
- 1:20SPEAKER_00: They've been bloated for two years, off and on.
- 1:24SPEAKER_00: They've tried probiotics, they've eliminated gluten from their diet, they've increased their fiber intake, they've had a colonoscopy which was normal.
- 1:34SPEAKER_00: Basic laboratory work has been done and it's normal.
- 1:38SPEAKER_00: Someone suggested to them maybe this is IBS.
- 1:42SPEAKER_00: Does this sound familiar?
- 1:44SPEAKER_00: Now here's my question: where does your brain immediately go?
- 1:49SPEAKER_00: For most clinicians, it goes directly to the gastrointestinal tract.
- 1:54SPEAKER_00: Mine used to do that as well.
- 1:57SPEAKER_00: Then one day I realized something.
- 2:00SPEAKER_00: The symptom tells me where the patient experiences the problem.
- 2:04SPEAKER_00: It doesn't necessarily tell me where the physiological beginning is.
- 2:10SPEAKER_00: That's an enormous difference because gastrointestinal tract doesn't function independently.
- 2:17SPEAKER_00: It responds to hormones, your nervous system, the immune signals, the metabolic health, it responds to medications, sleep or the lack thereof, chronic stress, movement, and thyroid hormone, which means bloating may be occurring in the gastrointestinal tract without the gastrone tract being the primary driver.
- 2:44SPEAKER_00: Let me give you an example.
- 2:46SPEAKER_00: Suppose that same patient also tells you they've been experiencing exhaustion.
- 2:51SPEAKER_00: They're cold all the time, their skin feels dry, they're constipated.
- 2:56SPEAKER_00: Now I am thinking about the gut, of course, but I'm also thinking about thyroid physiology.
- 3:04SPEAKER_00: Why?
- 3:04SPEAKER_00: Because thyroid hormone influences gastrointestinal motility.
- 3:09SPEAKER_00: When motility slows, transit slows, constipation develops, fermentation changes, gas production increases, the patient experiences bloating.
- 3:21SPEAKER_00: The symptom is gastroinintestinal.
- 3:24SPEAKER_00: The physiology may be endocrine.
- 3:27SPEAKER_00: That's a completely different way of thinking.
- 3:29SPEAKER_00: Or maybe your patient tells you, my bloating started when I entered perimenopause.
- 3:36SPEAKER_00: Now I'm thinking about hormonal changes.
- 3:38SPEAKER_00: Not because estrogen causes every symptom, but because hormones influence gastrointestinal function.
- 3:46SPEAKER_00: Maybe another patient tells you it all started after a really stressful year.
- 3:53SPEAKER_00: Now I'm thinking about autonomic nervous system regulation and the gut-brain axis.
- 3:59SPEAKER_00: Again, I'm not abandoning conventional medicine.
- 4:02SPEAKER_00: I'm expanding on my differential diagnosis.
- 4:05SPEAKER_00: And that's one of the biggest misconceptions about functional and integrative medicine.
- 4:10SPEAKER_00: It's not about replacing conventional medicine, it's about broadening your thinking before narrowing your diagnosis.
- 4:18SPEAKER_00: That's what systems-based clinical reasoning looks like.
- 4:22SPEAKER_00: So here's this week's clinical pearl.
- 4:26SPEAKER_00: The next time a patient presents with chronic bloating, don't ask only what's wrong with the gut.
- 4:33SPEAKER_00: Ask yourself what physiological system influences the gut?
- 4:39SPEAKER_00: The one question changes the history you take.
- 4:42SPEAKER_00: It changes the differential diagnosis you build.
- 4:46SPEAKER_00: It changes the laboratory tests you may consider.
- 4:50SPEAKER_00: And it ultimately changes how you care for the patient.
- 4:53SPEAKER_00: One of the things I tell my Bridgewell students is this the body doesn't read specialty textbooks.
- 5:00SPEAKER_00: The thyroid doesn't know it's supposed to stay in the endocrine chapter.
- 5:05SPEAKER_00: The nervous system doesn't know it's separate from the gastrointestinal systems.
- 5:10SPEAKER_00: Neither does inflammation, neither does hormones.
- 5:13SPEAKER_00: Our patients live in one integrated physiological system.
- 5:18SPEAKER_00: Our clinical reasoning should reflect that.
- 5:21SPEAKER_00: If today's clinical Perl sparked a different way of thinking, I've created a free resource called the gut workup most NPs were never taught.
- 5:31SPEAKER_00: It's designed specifically for nurse practitioners and walks through this practical systems-based framework for evaluating chronic GI complaints.
- 5:41SPEAKER_00: You'll find your free download in today's show notes, along with additional educational resources from Bridgewell Integrative Education.
- 5:49SPEAKER_00: Thank you for listening, and until next time, keep asking better questions because better questions leads to better clinical reasoning.