INTRODUCTION: DR. HERBST’S PERSONAL JOURNEY FUNCTIONAL MEDICINE IN PRIMARY CARE

Over the last nineteen years, I I was implementing functional have worked as an employee in an medicine in pieces, before it was even insurance-based model and on my own in existence. Identifying how all my in a cash-based model, and I am here illnesses and diagnoses were similar to tell you that there are ways you and interconnected was truly my can utilize true functional medicine saving grace. without compromising your current Now as a board-certified family work situation. physician who integrates functional In this book, I promise to share with medicine, in a style I termed functional you a modality of practice that can look primary care, I am pleased to say I at root cause and optimize function am a successful business owner and with practical application. With this mother. It’s funny how life works. Here approach of functional primary care, is my story. you will restore your patient’s hope, It all started when I was eight years which understandably leads directly old. We moved to the country in to active participation in health and Oklahoma. I’m talking living in a tent/ improved patient outcomes and well house and bathing in the creek indirectly results in regaining your true kind of country. My father was building sense of self. It has been the experience a log cabin. And every night’s bedtime for myself and others, whom I have routine entailed what we called a “tick counseled in this practice style, that we check,” a bathtub soap from head to toe can get patients better together. CONTACT US and a dry-off where I’d stand with arms As you traverse through my nine and a open, like a starfish, while my sweet 479.715.4645 half-year health journey to recovery, you mother would check to see if we had salt-health.com will better understand why I practice any embedded ticks. The average was the way I do. usually three per day. 700 SE Plaza Avenue Bentonville, AR INTRODUCTION: DR. HERBST’S PERSONAL JOURNEY FUNCTIONAL MEDICINE IN PRIMARY CARE

My sisters and I were very active We didn’t go to the doctor so because children, all healthy, breastfed, and there was no answer and they were told without any antibiotics. A well- that “this was normal,” we all did our balanced, yogurt-making, garden- best to ignore my constant symptoms. growing family raised us. A few months As proof my body was in a state of into us living there in the backwoods, I immune dysregulation, I had a few started to have severe daily headaches, severe cases of strep throat and poison which persisted and became so ivy during these two and half years. And frequent and routine that I began to so life persisted this way for the next count the days, hoping I would be able couple years. When I was ten, we moved to enjoy the weekend and planning overseas, and my headaches seemed when I would be able to spend the to dissipate. (We were no longer eating night with my friends. dairy from the farm. [Bummer, no more ‘...I started to have severe Knowing my pattern, I often remember homemade butter.] We were eating thinking, ‘Oh good, it’s Thursday, so predominately vegetables and fish.) daily headaches, which I won’t have a headache Friday. I can We were overseas for about six years. persisted and became so spend the night with my friend and not We returned to the United States in have a headache.’ Most nights, I would frequent and routine that 1988. About this time, my menstrual lay in bed, put a pillow over my head, cycle started, and the headaches I began to count days, and hold it as tight as I could until I fell increased in frequency and severity hoping I would be able to asleep. At the same time, I also started again. At school, I was eating typical having severe abdominal pain, often enjoy the weekend and American food, AKA the Standard crying to my mom as I sat on the toilet, American Diet (SAD), which consisted planning when I would be cramping with clammy sweats. I had a of dairy, candy, soda, and fried foods. able to spend the night few bouts of pinworms because, yes, with my friends.’ I played in the dirt and was barefoot I continued to be a go-getter, type-A most of the time. personality with good grades, student council, diving team, and any volunteer As for my sleep, my mother says I’ve activity I could get my hands on. always been a light sleeper, even as a baby. However, I recall at that time During high school, my muscle pain always waking up around two or three became intense, and I seemed to have in the morning and laying there awake muscle strains regularly. My sleep and waiting for morning to come. I continued to be an issue. I didn’t sleep knew it was almost time to get up when as a matter of fact. I found it difficult I heard the ducks and the geese on the to fall and stay asleep. But I didn’t front porch, making their noise below know any better. I thought this was my window. my new norm—just kept fighting and consuming a lot of aspirin, ibuprofen, My parents finally took me to the and Tylenol. Bowel movements now doctor for my headaches, and he were once a week. said it was probably because I was “allergic to my stuffed animals.” Sadly, I went on to college and was very this resulted in a purge of my furry- active; however, my migraines friendly fellows who sat on my shelves continued to increase in intensity, and bed. However, we found out it was especially significant, after I started not the source of my headaches. The on birth control. I really wanted to go constipation and severe abdominal to medical school, but I knew with the pain were written off as “normal bowel severe migraines and fatigue I was habits with slow transit time.” My family experiencing, it would not be possible. was tough. We didn’t complain. INTRODUCTION: DR. HERBST’S PERSONAL JOURNEY FUNCTIONAL MEDICINE IN PRIMARY CARE

Despite this, I was physically active, I naïvely thought this would help The muscle pain I felt was intense and walking many miles a day to class my bowel movements become more persisted for the next two years despite and working out. My diet consisted regular. Not! my many visits to specialists. All their of “healthy,” so I thought, Pop Tarts recommendations were failing me. Eventually I married and soon became because they had strawberry filling pregnant. This was the best I’ve felt in I was also carrying the burden of guilt in them. (Sigh, I knew better, but I my entire life. The last two trimesters and failure. I felt guilty, as if I had failed was trying to tell myself they were of my pregnancy were amazing. I slept my husband and everyone around me. somewhat healthy.) I pushed through well, my pain was gone, and I had no I was no longer able to participate in as much as I was able. migraines. Some speculate this was due physical activities, like bike riding and I wasn’t eating anything nearly as to the higher levels of hormones. At the family hikes. Intimacy and intercourse healthy as my mother would cook at same time, I received news that my Pap was incredibly painful, which was home. I was now on my own, living smear had returned abnormal. discouraging for both of us. Here I on Ramen noodles, canned tuna, was, newly married and a mess. I was A well-meaning physician called me microwave popcorn, and the occasional becoming desperate. For almost two into the office and told me that I should roast and potatoes I would make, along years, I tried anything and everything terminate the pregnancy, as it was early. with added frequent treats of ice cream the doctors were suggesting. I was I had cancer cells, and the estrogen and milkshakes. I would buy apples feeling as though I was a failure because would likely exacerbate the cancerous on occasion and dip them in caramel, I wasn’t getting better. growth. I had no idea what they were thinking this was healthy as well. It’s a talking about since I wasn’t in medicine Thankfully, my personality did not fruit after all! at that time, and I was in a bit of allow me to give up. My final visit I also continued to swim. I was in a shock. I naïvely ignored his advice and with a renowned specialist for vulvar chlorinated pool almost daily from continued on with the pregnancy. vestibulitis at the University of Michigan the age of fifteen to twenty-one. As a was the straw that broke this camel’s I had a beautiful, healthy baby girl. But lifeguard and swim instructor, I swam back. This doctor had tried everything as soon as I delivered her, my health on a swim team and was a springboard from medications to hormones and crashed. Throughout the pregnancy, diver. This is a possible environmental laser removal of the mucous membrane. I had three biopsies taken, and the exposure with negative health effects. And out of frustration, she said, cancerous cells remained stable after a “Maybe you would benefit from I graduated college and moved to loop electrosurgical excision procedure an antidepressant.” She callously South Carolina. At that time, my (LEEP) procedure. implied this was a mental condition identity was that of a no-quitting, I was breast-feeding on demand and and not a physical one. She handed I-can-do-anything, confident, take-care- not sleeping. My hormone fluctuations me a prescription for a tricyclic of-others-before-yourself, rest-is-for- were drastic, and my migraines were antidepressant. the-weak kind of person. I was pushing so intense that I was nonfunctional for myself hard, working in the field of I left the office crying and frustrated, the most part. My fatigue amplified. research and striving to maintain an though I realize she was partially I could barely do anything. Then I image of health, strength, and beauty. correct. There was possibly an element developed a symptom that was even I’d end most days with intense physical of depression but definitely a large bit more inconvenient and devastating, activity after work, usually riding bikes of hopelessness. After that visit, when vulvar vestibulitis. The mucosa of my for hours with my soon-to-be husband. my husband picked me up, I kept saying vaginal lining and vulvar area became All the while, my body was telling me through snots, snorts, and tears, “My ulcerated. It was extremely painful to to slow down. Internally I remember vagina is not depressed!” urinate, sex was unbearable, and I was thinking I was exhausted. not able to wear pants or open and Admittedly, I did have postpartum Soon after I moved to South Carolina, close my legs without pain. This meant depression for twelve weeks after my appendix nearly ruptured, likely basic everyday activities like walking delivery, but not at the time of this a result of years of constipation, and urinating were excruciating. My appointment. I did not agree with her and I ended up in the hospital with body was falling apart. diagnosis or recommended treatment emergency surgery. because once the postpartum depression resolved, all my other symptoms persisted. INTRODUCTION: DR. HERBST’S PERSONAL JOURNEY FUNCTIONAL MEDICINE IN PRIMARY CARE

There I was, sitting in the car with my Though intercourse remained painful, I At one point, regular activities of kind, young, new spouse looking at me used numbing cream, and this resulted daily living were exhausting. If I did as if I had truly gone mad. When the in the conception of our second child. more than one household chore, I was tears flowed down, my left brain kicked guaranteed to be in bed at least for This pregnancy, however, I was very in. I asked my husband to drop me off the next twenty-four hours. What had aware of what I was eating. My vaginal at the medical library for a few hours, my life become? Lack of sleep and pain was improving. However, my and I started researching. the stress of life was not helping, but fatigue and generalized muscle pain there had to be more. I was happy I scrapped all my diagnoses, like were extreme, except again in the last to be a mom, and I looked forward fibromyalgia. (What the heck was that two trimesters of my pregnancy. to our family life. I knew this was not anyway? No one even knew about it. By this time, I realized the high levels postpartum depression. I was happy, The neurologist who suggested that of progesterone in the latter two thirds but just exhausted. diagnosis was ahead of his time). I also of pregnancy was anti-inflammatory, scrapped vulvar vestibulitis, migraines, likely part of the reason I felt so well. I was done. I was exhausted and wanted IBS, and insomnia. I decided to look for Later in my studies, I learned it is also so badly to feel vibrant again. My commonalities, overlapping symptoms. very sedating, which is why I was primary care physician (PCP) decided As I sat there, the only thing I knew sleeping better. it was because I was a new mom and for sure was I was once healthy and the vaginal pain and migraines were The answer seemed so simple to me, progressively since I was eight years hormonal. A neurologist diagnosed it as as I was naïve to the complexities of old, my health deteriorated. Something chronic fatigue, but my PCP remarked the endocrine system. I thought I had was wrong, and these diagnoses were that it was not a true diagnosis. I was symptoms of low progesterone; thus, I a sign of that! This started me on my again confused and alone. thought replacing progesterone would new journey. I decided once again to fight. I knew be the answer. Like many physicians I improved a bit with dietary changes In my hours at the library, I stumbled and patients, I was thinking linear. In and journaling, so I drastically changed upon a researcher, Dr. Solomon, from other words, I thought I could just take my diet in an attempt to reduce Colorado, who was researching and high-dose progesterone after delivery inflammation.2 treating vulvar vestibulitis by using and continue feeling well. two supplements, calcium citrate and I cut out sugar, dairy, and meat, and I However, after I birthed my second N-acetyl glucosamine, in conjunction saved my money for a juicer. I began child, my health again deteriorated. with a low-oxalate diet. Following his reading more and more, actually I was humbled. The high-dose recommendations, I embarked on a copious volumes of books, which led to progesterone prescribed by my OB/ new diet and a few supplements. At an online naturopathic course. I knew GYN did not work. The fatigue and the time, surprisingly within about there was something to this natural generalized muscle pain were so severe two weeks, I was noticing some approach because slowly I was getting that I recall having to pick and choose improvement in my vaginal pain. This better. All the while, I was persistently my activities during the day. Migraines was more improvement than I had seeking the treatment, that is, still were frequent. Triptans were not had in two years. This was the boost I linear thinking. working and easily triggered by fatigue. needed. It was a sliver of hope.

1 Rotational probiotics means consuming different strains by taking one supplement with several strains for two to four weeks and then changing the species for the next two to four weeks and so on.

2 A diet high in processed foods, grain-fed meats, and high-sugar foods has shown to be a cause of increased oxidative stress/ free radicals.

Bee Ling Tan, Mohd Esa Norhaizan and, and Winnie-Pui-Pui Liew, “Nutrients and Oxidative Stress: Friend or Foe?” Oxid Med Cell Longev (2018), doi: 10.1155/2018/9719584.

Frederick D. Provenza,1* Scott L. Kronberg,2 and Pablo Gregorini,3 “Is Grassfed Meat and Dairy Better for Human and Environmental Health?” Front Nutr 6 (2019): 26, doi: 10.3389/fnut.2019.00026. INTRODUCTION: DR. HERBST’S PERSONAL JOURNEY FUNCTIONAL MEDICINE IN PRIMARY CARE

It may sound like I was full of , So I did just that: part-time lifestyle but I was very conscious of my counselor and full-time mommy. It was energy… or lack thereof. If I pushed too 1999. My health had improved so much much, I would land in bed for a day or that I was ready to give back. so to recover with a few days of severe One of the most significant healing muscle and joint pain. episodes for myself was during this I was so desperate that I was trying time when I was able to participate in most anything and everything. One of a homeopathic psychology3 course. I my most diligent focuses was on gut volunteered because I thought I had health and nutrient support. I found no emotional baggage. My family life rotational probiotics1 was best for me. was amazingly well without any trauma Some of the herbs I consumed were and abuse. My left brain, a research- broad-spectrum antimicrobial. So it is oriented personality, was doubting very possible that I was stimulating an this whole philosophy of medicine. immune reaction for a possible viral There I was, pompously sitting in front burden. Who knows? of a hundred people while a British psychologist asked me, “Of what are I had no testing done as I was self- you most afraid?” treating with nutrition and I found no physician willing to help or listen Humbly, I may not understand the exact 3 Homeopathic psychology to my theories. However, I am 100 mechanism of action of ; philosophy: Symptoms, percent certain, at the end of those nor am I an expert in this field. But I including psychological ones, months, I made a step in the right know in my heart the process I went are presumed to be ways that direction. I had a marked improvement through that day was incredibly healing. the body-mind is trying to adapt in my health. Even now, I continue I was afraid of failure. I was afraid of to and deal creatively with to appreciate the complexity of disappointing people I loved. This fear various internal and external the human body and its dynamic played a huge role in my day-to-day stresses. Psychotherapeutic interaction with our environment. choices, and my internalization of techniques tend to elicit that manifested itself in many ways the patient’s symptoms in a Ultimately, I believe that juicing turned physically, I believe. controlled manner in order to my health path around for the better. I heal the patient. Such is the case started juicing from the beginning, right As a result, after many tears and in cognitive, behavioral, and after I had my ultimate breakdown. It amazing professional support in that psychoanalytic treatments. In is my theory that the readily available room, this too became a part of my his article, Davidson discusses vitamins and minerals and enzymes healing journey. I realized then that other points such as the self- in the vegetable drinks were easily emotional components to disease healing principle, the micro-dose assimilated and absorbed, replacing exist. Over the years as an osteopathic effect, disappearance of the nutrients my body needed to repair. physician, I have often seen this to symptoms in reverse order of be the only etiology of a person’s We eventually moved to get close to their appearance, and diagnosis presentation. family, and by this time I had studied by pattern recognition of the integrative/ for By now, it had been four years. I was symptoms (Davidson 1994). approximately three and a half years, not 100 percent, but I was sleeping including an online naturopathic regularly, my bowel movements were certification through Trinity Natural getting more regular, and my headaches Health College. I understood lifestyle were only on day one of my menses. was key. Each time I offered some I was feeling fantastic! My business advice or suggestions for people, I flourished. My lifestyle counseling heard the same comment over and practice was successful. I was able to over, “You should make this a business.” help my clients change their eating habits and focus on more self-care. INTRODUCTION: DR. HERBST’S PERSONAL JOURNEY FUNCTIONAL MEDICINE IN PRIMARY CARE

In 2001, I decided I wanted to go to FAST FACT: I am not taking any routine prescription medical school. I sold my business and For some susceptible medications. I have had three small went to medical school in 2003. This flares in the last nine years. I made it is where my lifestyle training played a individuals, mycotoxin through business start-ups and job huge role. In the following chapters, I exposure is life threatening. changes. I even made it through a will share lifestyle practices I was able For others, it can be a year of hell. I discovered infidelity and to uphold in the four years of medical endured the resulting divorce without a school that helped me maintain my noxious stimuli for the major setback. So there it is, my journey. health. My routine was not limited to immune system.4 I am glad you hung in there with me. but consisted of juicing, sauna, and As you know, I did many things to get healthy eating habits. For my erosive lichen planus, the specialists informed me there was no well, some not found in science and My journey continued through residency, cure. I was offered steroids and a new others strongly supported in prominent as I had a pretty significant flare of biologic infusion that was so expensive scientific literature. I do not know if a rare autoimmune disorder. (I now that my PCP suggested we take out a there is one particular thing I did that realize this autoimmune disorder was second mortgage to cover the cost. was really the big turnkey; however, I what presented as vulvar vestibulitis The cost was one consideration, but will say all of it cumulatively served a many years before.) The diagnosis in this time of year was the height of cold purpose. I understand that everyone’s 2009, verified by multiple biopsies, was and flu season, and I was working at the body is different. We are complex unique severe erosive oral lichen planus, a rare Children’s Hospital. One of the risks of creatures who thus require a unique immune disorder that attacks mucous this medication is progressive multifocal approach to our health challenges. membranes, joints, and skin. leukoencephalopathy (PML), most often To translate my life lessons into advice 2009 was my last year of medical a fatal attack on the brain secondary for you, the first, and in my opinion, training. I was elected chief resident and to a common virus. That didn’t sound the most important is diet, as you working many hours. I had very irregular appealing to me. heard above. If I had to pick a second sleep patterns because we were I did the only thing I knew to do, go life-changing treatment, I would doing night shifts and frequent calls. I back to the basics. With supported emphatically say deep breathing, developed ulcerated and severe sores in gut health, I did the best I could with quiet time, and honoring the body’s my mouth. I was unable to smile at the immune modulation. (I studied the needs. From a biochemical standpoint, end of the day because my mouth was disease process and which immune the improvements in my internal so swollen and painful. On top of the pathway was most involved.) I replaced health resulted from bowel health pain, I was not able to eat. Everything, nutrients and went heavy on the improvements, genetic support for even water, burned my mouth. My antioxidants. (Now I know why I did so biotransformation (detoxification), and tongue was raw. My joints hurt. I had well with glutathione supplementation. restoration of immune balance. strange itchy rashes on my legs, arms, It has to do with my genetics. I will In the following chapters, I will dive into and back. I lost weight rapidly, a total of explain this in detail later.) I also did the the science behind such transformative eighteen pounds. best I could at removing and reducing treatments and give tools for clinical As if I needed more stress, at this same my exposure to environmental toxicities implementation. With clear approaches, time, we had a huge flood, and we had and made my mental and spiritual well- you can tailor your treatments to the the house repaired with big commercial being a priority. individual and watch as the systems fans and replacement of Sheetrock. And now in 2019, I can happily say I work together to achieve homeostasis The contractors discovered black mold have been in full remission for ten years. with proper support. in the bathroom wall, which was also torn out and remediated. Though now, I know this was not properly done.

4 Winnie-Pui-Pui Liew and Sabran Mohd-Redzwan, “Mycotoxin: Its Impact on Gut Health and Microbiota,” Front Cell Infect Microbiol 8(2018): 60, doi: 10.3389/fcimb.2018.00060 PMID: 29535978. INTRODUCTION: DR. HERBST’S PERSONAL JOURNEY FUNCTIONAL MEDICINE IN PRIMARY CARE

REFERENCES

1. J. Y. Lee, M. E. C. Abundo, C. W. Lee, “Herbal Medicines with Antiviral Activity Against the Influenza Virus, a Systematic Review,” Am J Chin Med 46(8)(2018): 1663–1700.

2. Jiang-Hua Li, Zhi-Hui Wang, Xiao-Juan Zhu, Zhao-Hui Deng, Can-Xin Cai, Li-Qiang Qiu, Wei Chen, and Ya-Jun Lin, “Health Effects from Swimming Training in Chlorinated Pools and the Corresponding Metabolic Stress Pathways,” PLoS 10(3) (March 5, 2015).

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