Bethany Ortlip, FNP from Practical Healing discusses functional medicine and empowering patients with Nick Angelis, CRNA. Cutting-edge TMS, ketamine infusions–or breathing and eating better? What happens when we get too obsessed with our health? Chiropractors, naturopaths, nutritionists, psychiatrists–how much is too much? Transcript below.
[Music]
Nick:
Hello and welcome to the Ascend Health Show. I am Nick Angelis. I’m a nurse anesthetist and one of the owners of Ascend Health Center. And I’m here with Bethany Ortlepp, a nurse practitioner, which I’m so excited that I have a fellow nurse on the show.
Bethany:
Yeah, I know. I was excited to see your name and we can collaborate on that.
Nick:
Absolutely. So instead of this being an interesting show for viewers about functional medicine, we’ll probably just talk shop for half an hour.
Bethany:
Exactly. All our nursing experiences. Right.
Nick:
And everyone will be like, Hmm, maybe I should go watch a cat video instead. This isn’t really doing anything for me. So in order to prevent that, I’ll start right away by asking What’s the philosophy of functional medicine? Because I’ve had several functional medicine providers on the show. I have a background in it myself, nowhere as extensive as yours, but a lot of times it’s not something where it’s like, Oh, the medical doctor believes it, or here is a holistic practitioner or a naturopath. So what is the philosophy of functional medicine for you?
Bethany:
That’s a great question. Functional medicine is root cause medicine, and it’s holistic. So what does that mean? It means that we care about the whole body. We care about the body, mind, soul and spirit. That’s what holistic care means. And then root cause medicine is not just what are you dealing with, what is the diagnosis you have or what are the symptoms you have, But what is the why behind that? Why do you have a headache? Why do you have eczema and how did we get there? So functional medicine really does a lot of investigative work and trying to look at what’s upstream causing these downstream symptoms. What how did we get there to begin with? Where was the root cause? And then rather than just, for example, since I mentioned eczema, putting a topical steroid or a cream on top of the skin to treat that condition, and you have to rely on that for the rest of your life. What could we do to understand what’s the root behind that? Why did the rash present in the first place? So that’s kind of the approach we take and we really do a lot of questions, ask lots of questions and do a lot of listening and try to understand that upstream, cause.
Nick:
That makes sense because I think sometimes in digging for the root cause, you might find out that the answer is not in a medicine, it might actually be in avoiding it. For example, for I think it was in 2008 when I first started hearing hearing about gluten free, I was very exciting. And then within a few years there were so many processed gluten free foods on the market that all of a sudden became grain free. And I was like, Well, what’s next? There Are people just going to be eating solid water, just ice. That’s all your diet, That’s all that you can have. Everything else will cause you all these autoimmune issues. So this is how you have to live. Yeah. So is there an end to it sometimes of like, listen, this is the best we can do. We’ve dug down as deep as we can and you just have to live with this. How do you find that balance?
Bethany:
Yeah, I find that most times patients will come in either with an acute symptom or something going on and we and a lot of patients come in with multiple things, right? It’s like I have headaches. That’s why I’m here. But I also have this rash and these infections that have been recurring for years and digestive complaints and oh, I can’t walk because of joint pain. So it’s a wide variety of symptoms. And when we look at the foundation of our lives. So what are what is our sleep look like? What does movement look like? What is our nutrition? Do we have significant stress in our lives? Are we in community with relationships? And once we kind of address those foundational five pillars, then sometimes a lot of those symptoms will start to go away. And then we identify, well, what remains, right? So okay, the headaches are still there. So we’ve worked on all these things. What’s the next step? So kind of taking a holistic natural lifestyle approach initially can kind of help us narrow down our focus, right?
Nick:
So what you’re saying is that it’s a patient empowering thing because it doesn’t necessarily mean the solution is medicines. And seeing me all the time. Yeah. Because a lot of times, especially with self-care practices like functional medicine usually is the patient say, well, I don’t have that much money. And so you can say something like, Well, you know what? It doesn’t cost that much to have a healthy relationship with your family or to get in touch with your spirituality or to do some of these other things that are 100% in your control.
Bethany:
Breathing is free, right?
Nick:
It is free to breathe. Yes. Although we did have a contract with an oxygen company at our clinic for a while and I was like, you know what? This is very expensive for oxygen.
Bethany:
For something that’s in the air, right?
Nick:
So I bought an oxygen generator instead. Sure, Certainly. But but the point is, like often four out of those five things are completely under the patient’s control. And so then with more authority, we can say, okay, you’ve done this, then absolutely. We need to do this extensive process with medications or supplements or testing because we’ve already taken. Care of everything else, Correct? You’ve done very well. You’ve gotten the ball rolling. And rather than giving up, now is the time that we use our medical expertise to keep going.
Bethany:
That’s right. We you know, once we address those foundational principles and we continue to do that, the next layer up is, okay, well, maybe there’s some nutrient deficiencies we need to supplement or correct or in our diet or through supplementation or both or testing additional testing. Do we need to do some more investigative work behind the scenes of what’s our cortisol levels throughout the day and adrenal function? And so, yes, there’s definitely layers to it as we go.
Nick:
Now, granted, I’m talking about an ideal situation because my own practice at ASCEND, we’ve noticed it often works the opposite way where we’ll use a Ketamine infusion or a new psychiatric drug or some intense EMDR therapy and then because the ball is rolling, then the patient is like, You know what? I am willing to try all these things.
Bethany:
Sure, Yeah. And sometimes it takes just stabilizing someone and showing them, hey, you know, magnesium and omega three seconds and a good multivitamin that can might help to decrease the amount of headaches that you’re having. And then you’re able to do more walking outside because we’re addressing a symptom where we always want to look at the root cause. But it’s okay to treat a symptom that may give us a clue as to what the underlying cause is. Okay.
Nick:
So then and this is all great topics, but I think because So you work at Practical Healing, which is inside Marigold Wellness. Yes. Which they have, I assume, infrared saunas. Correct. Who wouldn’t have one of those? And massage therapists and a lot of other holistic modalities. Probably some yoga classes too. I’d imagine.
Bethany:
They do. Yep. It’s you think of it, they’ve got it, pretty much. Right.
Nick:
Because I mean and I think that is the future model of health care, like in a collaborative team. Yeah. In Fairlawn we have Doctor McElrath and the chiropractor at Healthsource. Yeah, Doctor Bob as well. And then we work closely with them and massage therapists and we say, look, between the three of us, we’ll get this figured out because in the past I would try to send patients to exotic specialists and they nod and smile, but they weren’t really go. So it helps to have a very close connection right there.
Bethany:
Yeah.
Nick:
So how does the process start for a patient like they have some issue, usually they’ll see their doctor first, they’ll go primary care. It doesn’t get better. They might go to a specialist or to realize, Oh, this is covered by insurance, but not really. And I’m no better and I’m confused and have a few extra meds to take every day. So then I assume they show up at your doorstep. What happens next?
Bethany:
Yeah. So if they come in as an initial patient, we sit down with them for about an hour and a half and really just dive into their entire history and let them speak freely about what’s going on. We often create a timeline and really look at their whole life as a whole to address where did things start to go off the bandwagon. So we do a long initial appointment and then at the end of that, after we’ve been able to speak for a long time, develop a relationship and identify some areas to work on right from that appointment. That might include referrals within our team. So within practical healing, we have a wonderful nutritionist and dietitian. We have a pelvic.
Nick
She’s been on the show before.
Bethany:
Lindsay, she’s wonderful. A pelvic floor therapist. We have counseling. We often do referrals to health coaches. And there’s a chiropractor at Marigold. There’s infrared sauna, magnesium float pools. We have a lot of different modalities to use right at right at our fingertips, right in that space.
Nick:
Okay, that makes sense. So, and again, I usually don’t bother doing this during the show because it’s kind of boring, but in this particular episode it actually makes sense. At Ascend Health Center, you just start with a therapist or with a psychiatrist. They go over all your meds and then they decide, You know what? All you need is a simple antidepressant and you’re good. Or you actually just need therapy. Why don’t you continue seeing a therapist every week or in this particular case, Ketamine infusions, although they’re mostly self-pay, is going to be what helps with all these troubling symptoms of fibromyalgia and depression and just this huge web of interconnected issues or hey, you know what? Spravato which is paid for by insurance is a Ketamine product that you should look at because it’s more sustainable or yet again, transcranial magnetic stimulation because it doesn’t involve any pills. It’s just an electromagnet helping your brain get over anxiety and depression. That’s what’s going to help, especially if there’s digestive issues or strange responses to meds because we can do gene site or other testing that will say, okay, this med and this med works with your genetics. But as you’re aware, because functional medicine does take genetics into account, it’s one thing to say, okay, here’s a gene that’s triggered. It’s something else to say, well, here’s the exact pathway to inactivate it or activate it. A lot of that sounds great, But again, your guys’s name is practical healing. Yeah.
Bethany:
It’s named that for a reason. We talk about that in our visits. A lot of we want to develop a plan that the patient is going to be able to do. The best plan, the best nutrition plan is one that you can commit to. So we kind of meet the patient where they’re at. But yeah, it’s it’s a pleasure to be a part of. And I really think that it’s like you said, I think you mentioned earlier how needed it is in our world today, conventional medicine, you know, we work alongside them and we’re not against conventional medicine by any means. We’re thankful for life saving services and surgeries. But I think we could do a lot better on the preventative side of things and longevity and quality of life. And I think that’s where functional medicine comes in.
Nick:
And I think part of that is probably educating the patient because so this is just me. It’s not really my patients. I really shouldn’t do it as often as I do, but I often talk about the economic portions of the care of like, here’s how much this will cost you or here’s where it’s worth it because for me, if I go to a restaurant, I’m like, Well, yeah, I do think these cheese sticks are worth $6. So a lot of times things are financial. But I feel that your health should be actually because whether it’s your time, your money, the risk of a medicine actually making you worse like these are all actual issues that should be evaluated when you’re deciding a treatment. And 40 years ago the doctor would say, here’s what you’re going to do. And the patient would say, Yes, sir, because it was usually a sir and they’d go do it and that was the end of it. But now, like the patient say, Yeah, I’ll do this prescription. And then they look it up on the Internet and then they look at their bank account and then things sort of get muddled. So in order to have that kind of agreement between patient and practitioner, it does take a, okay, here’s your alternatives or here’s the specialist that may be covered by your insurance. Although even though we take insurance at ASCEND, usually I refer to to insurance as a Groupon for restaurant you don’t want to go to. Yeah, it’s a discount, but we’ll actually do what you need it to do.
Bethany:
Will it cover what you really need done?
Nick:
Yeah. So do you all use any conventional medicines or is it usually supplements?
Bethany:
Yeah, we definitely try to focus initially on as natural as we can. If we can avoid using a medication, great. But we’re not against it. We will prescribe medication if it’s if it’s needed. My background is in primary care family nurse practitioners, so it’s within my scope certainly. But we we definitely take more of a holistic traditional approach but work with medicine too, if we need to.
Nick:
That makes sense. So like you mentioned a steroid cream for eczema, so you usually not bother with the sort of quick fix type of medications.
Bethany:
I would yeah. I would say usually patients have tried that By the time they come to us, patients have gone to their primary care, referred to dermatology, have this cream and then didn’t work or it’s working, but they want to get to the underlying cause and then they come to us and that’s where we can look at gut health or look at inflammation in the body or what are the food triggers that potentially are causing this inflammation inflammatory rash. So that’s kind of what most patients are coming to us looking for. And, you know, certainly if you’re at work and you can’t stop itching and your hands are inflamed, use the cream while we’re working on all these other things. So we’re not going to say throw it away, but we want to do both if we can.
Nick:
So what you’re saying is that the the functional health philosophy is holistic, not in a way like we’re going to use natural things, but holistic in the practical way of like what’s working. And if you really believe this is the way but it’s not working, then you have to abandon it, which I think is very important because having been in the natural world for many years, I’ve seen so many people who are like, Nope, I’m not going to eat gluten ever again. And they’re the ones eating the gluten free cracker corner of the party while everyone else is enjoying themselves. Or another example I give to my patients is it’s often too much of a cost to be 100% well meaning that, for example, if you want to be vegan and you believe in the philosophy and then same party. So in one corner is the person with the gluten free cracker and the next corner is a person with a stick of celery. Like again, you’re missing so much. On the other holistic things that you talked about, spirituality or relationship with your friends. And I’m not saying that well, I guess I’d better go to all those cookie parties and eat all the cookies. But there is a balance there where sometimes here’s a wellness that I need to function and have a fulfilled life, not necessarily the wellness. I need to have an easy life.
Bethany:
Yeah. And you know, it’s different for somebody who has celiac disease. Avoiding gluten is is a must for them. But for if we have gluten sensitivities, we know that we can take that out of the diet temporarily and reintroduce it maybe just at the birthday party but gluten during the week and throughout your normal life you might be able to tolerate. Things much better and be able to enjoy yourself. It’s it’s reality. It’s practical.
Nick:
Well, and that’s a practical thing. You’re saying that you avoid it when you can, but maybe you won’t avoid it to the point where you’re trying to get that lunch meat in a lettuce wrap and it’s just not really working. Okay, that makes sense. Like for myself, what I do is I don’t buy any sweets for myself in the house. Like I can go without it. It’s not a big deal. And then if someone’s giving me free cookies, I’m going to eat their free cookies, right? So that makes sense. And even the example of eczema. So this is a personal example for me. When I worked as a nurse anesthetist at hospitals 60, 70 hours a week, I’d get eczema. So I did all the natural things and they helped for a while and then it went to medications. I actually had a probably a every seven years. It’ll get bad enough for the natural techniques. The supplements won’t work. And I go back to dermatologists and it’ll improve and then it’ll get worse than it did before. And I go back to natural things. So I did that three times every seven years or so. Yeah. And at the end I realized, well now I’m using Tremfya, which is a biologic injecting my leg and I’ve used natural, I’ve used the cutting edge medical therapies and all of these sort of work. But here’s another solution. Maybe I don’t work 70 hours in the hospital. So even though it’s difficult, sometimes the root cause is like, Nope, we’re not going to solve it. We can keep on trying to make this happen or we can just take something out of our lives even if it’s precious to us because it’s not worth our health.
Bethany:
Yeah, and environment is huge and a lot of patients come in and and their work life balance or their stress at work or in an environment that they’re in is part of what’s exacerbating their symptoms. And so we do a lot of conversations about how can we restructure things or how can we we can’t always take stress out of our life, but what are things we can do to take a scoop out of that bucket of stress that that boils up and to prevent it from overflowing, right? Like breathing and meditation and calming things for the body and that switch us out of a constant fight or flight mode into parasympathetic.
Nick:
Yeah. Which I believe was supposed to be our original topic anyway.
Bethany:
But that’s fine.
Nick:
Neither here nor there. But I’m thinking of it because of the bucket, because usually for Mast cell activation syndrome or a lot of histamine disorders, it is considered a bucket where you’re doing fine. Maybe they’ll eat some restaurant food. You’ll do this and often the bucket overflows and you have all these symptoms.
Bethany:
Yes. Yep, that’s right.
Nick:
And I think one way to think of that is instead of this bucket analogy, it is, well, how can I start living this life? And that is one reason why our clinics work so well together, because a lot of times it is that mental health aspect of, okay, if I can see myself and who I am and my strengths and weaknesses better and not have this almost like this desire to be healthy for the sake of other people or for looking good on social media. If I instead have a healthy relationship with with my own health instead of a civil war of like, Oh, I can’t believe I have this issue, I must destroy it with We see this a lot in Lyme disease where I must destroy these hidden invaders with every single thing. And then they’ll say, Well, am I or is this just a reaction of the medication? And I’ve seen patients for years. They’ll try toxic herb after toxic herb and continue to get worse. But they’re like, Nope, this is just my body fighting it off. I just got to stay strong. It’s like, Well, if you’re worse off than you were before, maybe we need to reevaluate. What are we really doing here? Yeah.
Bethany:
And I think we live in an imperfect world where there’s no way we can get to 100% perfection in our health.
Nick:
At least not with still having some friends. Because I don’t want to hang out with anyone without.
Bethany:
Living in a box on your own. Yeah. And so, you know, realizing what you personally are, what you can handle and what level of extreme you’re willing to go to accomplish that perfection. And I think at practical healing, we really try to have a balance of that and say, okay, we want you to live a quality life and a long life and how can we get there? But we also want you to enjoy it along the way.
Nick:
So yeah. That makes sense. So you’re saying it’s a mixture of precision and good enough, for example, the mast cell disorder, I think I mentioned to you previously there’s a new medicine out for Cyanophilic esophagitis, which I see a lot because I do a lot of anesthesia for endoscopies that actually inhibits mast cells. I think it’s the salib or we can say whatever we want. It’s community TV. So obviously they didn’t sponsor this, but but it has some promise for other mast cell disorders or other disorders where the immune system isn’t working right and it won’t work as poorly as some of the humira’s or other drugs that just, you know, they’re very expensive and all they do is take out your immune system. It’s like, well, of course I feel better because my immune system isn’t working anymore. But sometimes you can take those very precise medical cutting edge steps and realize, Nope, still don’t do it. Okay, now I need to go back to the basics what you were saying. Let me work on my mental health. Let me get some good relationships. And also it doesn’t help you at least have some good support systems. All of a sudden.
Bethany:
And it’s a both and right. It doesn’t have to be either or with conventional medicine and functional medicine or holistic medicine, It’s both. So try the cutting edge medication. But you know, are we working on shifting your brain out of a fight and flight response, which is going to increase the histamine production from mast cell activation in your body trying to flush out everything? Can we shift it to a rest and digest state and are we doing that while we’re taking the medicine? And could it be even more effective because of that? So we like to come alongside people wherever they’re at with that.
Nick:
Because they’re kind of also especially once you start more natural techniques that can also be guilt like, Oh, I’m really going to pay for that cheeseburger. I shouldn’t have done it. I knew better. And look, the consequences of my actions are all all over my face in the case of eczema. So I think and this goes into the spiritual component of right and wrong. It’s not a it’s not the idea of like, I can do whatever I want and my own health is more important than anything else because again, we said you should still have friends and family around you and you won’t for very long if you have that sort of attitude. But instead it’s okay. Well, in this case I was out with friends and the enjoyment that we had together made it that it was okay to do this at this point. So it’s not this very rigid guilt system because that itself will cause a multitude of mental health problems where, you know, maybe they came in with one problem to see you and then all of a sudden they have to come to my clinic because now the pervasive issue is this perfectionism of I must do better, I must be better.
Bethany:
Yeah. And we’re on a health journey continually and we’re always learning new things. And that’s what medicine does and science does. And we’re always researching a new cutting edge products. And just because you didn’t do something in your past and you say, Oh, I wish I knew, know where you’re at is where you’re at and it’s a health journey. And we often say when patients come to our door, we say, you know, this is this is a start of a new journey for you. And there’s going to be ups and downs along the way. There’s going to be two steps forward, one step back. And it’s okay to have the have the cheeseburger and not say I’m deviating from my journey, but this is part of it. Right. And but giving patients the tools, like you said earlier, to empower them, giving them the education, the knowledge and the tools to when they don’t have to always come see us. Like, right, let’s get to the point where, okay, you’re you’re feeling well, you are empowered. You have the tools to leave our office and live a a quality life.
Nick:
That’s what I think of too. When you said journey that a lot of times in the standard health care system, it is the idea of like come here often so we can build your insurance often and you’re always going to be stuck with us because we’re giving you medicines and.
Bethany:
Obviously we need to see you all these labs.
Nick:
And so it becomes this whole system that you get stuck in forever. But I think with both of us, we share the philosophy of like, this is a journey. You won’t hurt our feelings if at some point during the journey you’re like, I don’t think I need them because you’ve got our number. If you’re wrong, you can call us if there’s many patients where I’m like, You know what? I haven’t heard from them for a year, This is so great. I’m glad that we got them to where they needed to go and they didn’t need me anymore.
Bethany:
That’s exactly right.
Nick:
And also for the patient, it’s a much more relaxing journey of health, knowing that you’re still in control, knowing that you’re perceiving how you’re getting better and you can make an informed decision of I actually don’t need to make that next appointment. I’m good. And again, being with providers like you and I who are not letting our ego get in the way of it, where if you can get better without me or just with a few tools, that’s the best case scenario.
Bethany:
It’s a partnership. It’s not like you said, sir. Yes, sir. It’s not me telling you what to do. It’s developing a plan together and having a shared partnership in health. Okay.
Nick:
And then. So where are you all located? Because this is one of the rare instances where one of my guests here on Wadsworth Community Television is actually very close to Wadsworth.
Bethany:
Yeah, we’re on Sharon Center Circle in Wadsworth. That’s where Marigold Wellness Collective is and practical healing is located Within that. The best place I say to you to get a hold of us or to kind of start your health journey with us is look at our website. It should be listed on the screen Practical Healing center.com and that will give you next steps and a lot of information about our services, who we are, our philosophy, what we believe and information about each practitioner. And there you can schedule a 15 minute complimentary curiosity call with a practitioner and so you can find if this is the right fit for you. If we there’s something that you are coming in with that you need help with and if we can help you. And so I would recommend patients go to that website if they need more information.
Nick:
Absolutely. And for us, we’re about 15 minutes east near Copley High School and it’s the same. Thing because both of us have continued to make inroads in finding different practitioners in this area. It may be that, hey, you know what? I don’t think we’re the next step for you. For example, we do a lot with ketamine infusions for migraines. It’s not something I’d ever do on a patient unless it tried and failed 3 or 4 different things because there’s plenty of options. And it’s that same idea of like, okay, are you at the point where this is the right step for you or do you need to go make more friends? Go talk to Jesus. The many things that are what should be involved in holistic care where it’s not necessarily like, okay, I found all these supplements at Walmart and I’ll take them all and then I’ll feel better. Or here’s what WebMD taught me. But instead of partnership where here’s what we feel, here’s the next step. So yeah, absolutely. Wonderful. Yeah. Well, it’s so great having you on the show today.
Bethany:
Yeah. Great to meet you, Nick, and get to know you more.
Nick:
And absolutely this is such a practical way to meet new practitioners. We can all pick our brains together. Let’s do it again. Absolutely. Well, thank you all for joining us once again. I’m Nick Angelus and this has been the Ascend Health Show.
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