A thorough history and a careful and detailed physical examination are of primary importance in the evaluation of abdominal pain, with well selected diagnostic tests to complement these. As with chest pain, or headache or shortness of breath, the patient’s story is primary, physical examination secondary, with clinical testing providing the factual data. Each aspect of the examination is equally vital.
Dr. Cooke still has her well-worn copy of one of the cornerstone medical texts on the evaluation of abdominal pain, “Cope’s Diagnosis of the Acute Abdomen”. Years spent in the emergency room helped to hone her diagnostic acumen. Abdominal pain presents a particularly broad differential diagnosis due to causes ranging from the benign to the sublime to the catastrophic.
From time to time, Dr. Cooke receives patients who come with an expectation that only alternative therapy will be offered. One woman came several years ago, not having seen a physician in many years, with a complaint of several days of abdominal pain. Within 20 minutes of questioning, Dr. Cooke was quite certain that her symptoms suggested appendicitis, although her physical exam was in no way typical for appendicitis. Delicately, she expressed her suspicion to the patient and the patient’s husband. She contacted the emergency room, transmitted her assessment, and gave recommendations for further evaluation. The lack of physical findings postponed diagnosis in the ER. Fortunately, by the time the patient’s exam evolved, the surgeons were able to remove the diseased appendix. That patient, now the proud owner of a Bikram yoga center in Minnesota with her husband, still maintains contact with Dr. Cooke.
Sometimes the doctor’s most challenging task is to convince a patient or their family of the value of conventional diagnostic or therapeutic procedures. Dr. Cooke strives for a balanced approach, bridging the interface between the conventional and the complementary.
Non-scarring alopecia is a type of hair loss without permanent destruction of the hair follicle. This may result from hormonal factors, chemical exposures, infectious causes, autoimmune conditions, hereditary factors, and nutritional factors.
There are 3 phases in the life of the hair follicle: growth, involution and resting phase. Under normal circumstances, about 75 hairs are shed daily at the end of the resting phase as about the same number enter the growth phase. Telogen effluvium, a massive loss of hairs in the resting phase, is the most common cause of diffuse hair loss. High fever, pregnancy, psychological traumas, thyroid disorders, or a major illness, among others, may all predispose to diffuse hair loss.
Nonscarring alopecia is typically diagnosed by scalp biopsy and laboratory review and treated by withdrawal of offending agents, reassurance with “tincture of time”, and sometimes medication. Dr Cooke takes conventional modes of diagnosis and treatment into account. She reviews the nutritional profile in depth, with examination of the multiple nutritional and hormonal factors such as hidden thyroid disorder and sex hormones which may influence hair loss. Nutrition and dietary supplementation, hormonal management, and acupuncture for stress reduction, may all play a part in the treatment plan. She has helped a number of women on their return to hair regrowth.
Nutrients which may play a part: Biotin, zinc, iron, protein content and assimilation in the diet, sea vegetables, and others.
Arthritis & Joint Pain
Arthritis is a term which simply denotes joint inflammation. The causes may be many, from autoimmune processes (e.g., rheumatoid arthritis), to degenerative bone disease (osteoarthritis), to metabolic causes (such as gouty arthritis). Its symptoms may range from aches and pains to debilitating immobility.
Conventionally, arthritis is treated with any of a range of medications, both over-the-counter and prescription. Physical therapy, glucosamine-chondroitin supplements and even injectables and surgery are among the options in therapy today. All of these have there place.
In addition to the complete history and physical examination, Dr. Cooke reviews the diet history carefully for pro-inflammatory elements. A trial of dietary simplification alone has helped many patients reduce pain and regain mobility. One gentleman in his late 60s regained his hand grip with one month of dietary modification. Other supplements and foods can be used to aid elimination of toxins and reduction of inflammation. Fish oils and cherry concentrate have gone a long way toward helping others. Here, too, acupuncture is a boon for arthritis sufferers.
Broadly speaking, autoimmune disease is a situation in which the body fails to distinguish between “self” and “other”, and as such, makes antibodies against its own cells and tissues. These diseases span a gamut of organ systems, ranging from autoimmune disorders of the connective tissues (e.g., rheumatoid arthritis and systemic lupus erythematosus), to those affecting the gut (celiac disease, ulcerative colitis, Crohn’s colitis), the endocrine system (Type1 diabetes mellitus,
Hashimoto’s thyroiditis, Addison’s disease of the adrenals), the skin, the blood, and more.
Conventionally, treatment is aimed at either immunosuppression (e.g., methotrexate in rheumatoid arthritis), anti-inflammation (corticosteroids or nonsteroidal anti-inflammatories) or simply to reduce symptoms – palliation. In other instances, replacement therapy is the key (eg. insulin replacement in type 1 diabetes).
Dietary review and assessment of gut function is primary in Dr. Cooke’s assessment of autoimmune disease. An elimination diet is introduced and the patient is monitored. Also, stress reduction techniques tailored to the patient’s needs are helpful here. The approaches espoused by functional medicine (detoxify, restore, rebalance) are utilized by Dr. Cooke through the use of diet
Brain Function, Memory & Mental Vigor
As we are compelled to adapt continually to new technologies, changing lifestyles, changes in the environment, not to mention information overload, and as more seniors are postponing retirement, many are seeking creative ways to optimize and preserve optimal brain function and general vitality.
Conventional medicine recognizes the importance of the basics: diet, exercise, avoidance of cigarettes and drugs which compromise circulation, to name a few. However, in the modern world, preventive and therapeutic strategies for maintaining and even improving cognitive function,
emotional health and physical well-begin are in great demand.
The research evidence is mounting in support of the notion that we are much larger than the body we inhabit and that the mind and emotions reach beyond the brain. From Proverbs, “A merry heart doeth good like a medicine.” From Carolyn Myss, “Your biography becomes your biology.” Dr. Cooke brings a sound knowledge of physiology and nutrition as well as a rich background in mind-body techniques, hypnosis and medical acupuncture to the mix. She wants you to enjoy the same growth, vitality and joy which she seeks on her journey.