By Kara Fitzgerald, ND
Without a detailed, accurate timeline, we as clinicians can waste a lot of time spinning our wheels - guessing, testing, treating - without identifying the key events that made the patient sick. For myself, when I added a timeline into my chart template, rather than continuing to count on my memory to guide me through the questions, the improved utility and clarity of the information I collected was immediately obvious for myself and my patients. Here are a few recent examples:
- A patient I saw just this week, who had been diagnosed with idiopathic Parkinson's disease in 2000 at 39 years old, had a compelling history in that there seemed to be no obvious predisposition for disease. Everyone in her family was well - no neurological diseases, parents healthy and hearty at 80 - and no issues during her childhood. However, she mentioned that she has a daughter with Asperger's. When I explored this period of her timeline, it turned out that in the 1990s, she had rehabilitated a 100-year-old Chicago house over the course of 10 years. She gave birth to her daughter while in the house in 1998, around the time she first noticed a tremor. When urine lead levels were assessed, they were more than 10-times the upper limit. Lead toxicity is a well-known cause of essential tremor, and a pivotal piece in this case. Lead exposure (including in utero) has also been associated with autism. Unfortunately, without a detailed timeline, it took many years before the dots were connected in her case.
- Lastly, I recently consulted with a mother regarding her son, who has severe, chronic migraine headaches almost daily. He's a bright 17-year-old boy, but he has missed so much school, she isn't even sure what grade he's actually in right now. The migraine headaches started when he was 18 months old. Digging into the son's timeline, I found that just prior to this, it was thought that he had a hearing problem. Upon evaluation, it was determined that he actually had otitis media. The timing of the otitis and the onset of the headaches coincided with the introduction of new foods into his diet, including dairy. Dairy is a recognized trigger for both otitis and migraine. Now, I can't say with certainty that milk is an underlying cause of the boy's migraine, but I would be remiss as a good functional medicine doctor if I did not do a dairy-free trial with him.