Physical Medicine & Rehabilitation
There are many medical specialties in traditional care such as cardiology, family medicine, surgery, internal medicine, etc. Dr. Herbert's original training is the specialty of physiatry, also called PM&R. PM&R is the only specialty that focuses on maximizing a human being’s ability to function - the capacity to live one’s life to the fullest, in every way.
Patients seek help from a physiatrist in order to optimize functioning that may be impaired due to pain, joint pain, neck and back pain, migraines, arthritis, osteoporosis, sports and spine injuries, and more. Physiatrists help create a personalized recovery program to improve the quality of life. They supervise a therapeutic team that may include referrals to:
physical and occupational therapy
speech and language therapy
special testing, including nerve conduction studies, MRIs, musculoskeletal ultrasound
supervised medical exercise therapy
psychological counseling or mind-body training
surgery, if needed.
Dr. Herbert is a member of the Osteopathic Cranial Academy and has extensive experience in cranial osteopathy, the parent of CranioSacral Therapy.
The core of the integrative medicine philosophy is that there is a healing partnership between patient and physician. This is a way of practicing medicine that, like functional medicine, takes into account the whole human being. Because it does, integrative practitioners take time to get to know you, to learn what your life priorities are and to work in true partnership in your healing journey.
The Arizona Center of Integrative Medicine founded by pioneer Andrew Weil, MD, (see video) defines Integrative Medicine (IM) as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.
Two of the Defining Principles of Integrative Medicine:
Patient and practitioner are partners in the healing process.
All factors that influence health, wellness, and disease are taken into consideration, including mind, spirit, and community, as well as the body.
Integrative medicine training is, as of 2018, taught in 70 medical residency programs. The original fellowship, started in 1997, was the first to formally establish the discipline of IM and now totals 1855 graduates and current fellows combined who have, in turn, started IM programs all over the world. Other programs for providers are being used at over 79 sites around the US, including Alina offering it to its 25,000 employees.
Dr. Herbert is a 2008 graduate and Bravewell Fellow of the University of Arizona Center of Integrative Medicine. She passed the first ever physician specialty Board Examination in Integrative Medicine in 2014.
Functional medicine is part of the medicine of the future. That may be why the Cleveland Clinic has so much invested in its functional medicine center. This approach looks at why someone is ill: a systems-based approach to address the underlying causes of disease by looking at the interactions among genetic, environmental and lifestyle factors that can influence long-term health and manifest as complex, chronic illness. Long before chronic illness appears, there are functional disturbances.
Advanced testing can uncover many of these 'upstream' markers and guide therapy. Often latent infection or undiagnosed nutritional deficits will become apparent. Treatment with nutritional changes and/or supplements provides a low risk, conservative approach. Medication is used when needed. The same approach of looking for the underlying cause of symptoms is used both for complex illness as well as for prevention.
Based on the use of the latest laboratory testing and other diagnostic techniques, functional medicine prescriptions include combinations of medications (if needed) and/or botanical (herbal) medicines, supplements, therapeutic diets, detoxification programs and stress-management techniques.
Dr. Herbert is a member of the very first graduating class from the Institute for Functional Medicine's intensive training program who passed a rigorous certification examination in 2013.
Both functional and integrative approaches may be very useful with systemic illness such as:
- autoimmune issues
- digestive difficulties
- chronic fatigue
- hormones (including thyroid)
- irritable bowel
- Lyme (Dr. Herbert is a member of ILADS)
- environmental exposures, with a specialty in illness from water-damaged buildings
- toxic heavy metals (mercury, gadolinium, lead, arsenic and more)
- degenerative neurological concerns
- digestive malabsorption that leads to
- nutritional deficiencies and more
Our bodies have extraordinary capacities for regeneration of tissue such as growing new blood vessels, restoring injured nerves, toning skin and more. There are many contributors to 'growing older,' including mitochondrial (intracellular energy factories) disorganization and decline that some think are key players in looking and feeling older. Many researchers have started clinical trials first to make sure these are safe substances and then to test them more widely and measure the clinical effect.
There are some very exciting peptides and stem cell signals (called exosomes) that, in addition to prolozone (ozone injected into joints or around painful areas), PRP (platelet-rich plasma) that have been shown to signal the body to regenerate tissue.
First and foremost, is the basic quality of food eaten, chemicals avoided (or not), rest, activity level and personal stress.
Ozone (O(3)) gas, discovered in the mid-nineteenth century, is a molecule consisting of three atoms of oxygen. When it is inhaled, it is considered a lung irritant. However, researchers believe it has many therapeutic effects. Ozone therapy has been used and studied for more than a century. Here is what a 2011 published research paper has to say about its therapeutic potential:
Medical O(3) is used to disinfect and to treat disease. Mechanism of actions is by inactivation of bacteria, viruses, fungi, yeast and protozoa, stimulation of oxygen metabolism and activation of the immune system. (PubMed 3312702). Here is the link to the whole article:
The Canadian-made Longevity ozone generator used at Gesundheit Carolina ozonates drinking water (also seen in biological dentists' offices) and provides the ozone (made from medical grade oxygen) mixed with a patient's own blood and then reinfused. This latter is called autohemotherapy and takes about an hour.
One of the most exciting new healing modalities that hundreds of researchers are studying is peptide therapy. What is a peptide? The short answer is that it is something the body produces from our blueprint, DNA, made up of a string of amino acids, also considered a small protein. They are the ‘work horses’ of the body. There are literally thousands of them in each of us. With age, illness, and/or genetic vulnerabilities, certain functions may be less than optimal.
Insulin was the first peptide to be manufactured in a lab. Insulin is required to carry energy in the form of glucose into cells. Lack of, or low, insulin is called diabetes. There are currently dozens of peptides recreated in specialized pharmacies to address issues such as cardiovascular health, wound healing, acute lung injury or illness, tendon and muscular repair, thinning bones (osteopenia, osteoporosis), autoimmune disease, endocrine issues, weight management and to replace those peptides that have decreased with age (including additional therapies for sexual issues for women and men).
The International Peptide Society (IPS) regularly trains physicians all over the world in peptide therapy and provides a forum for physicians to consult each other for complex conditions like neurodegenerative disease, cardiovascular issues, altered immunity and more. There is no claim being made here about curing these conditions using peptides, only that they may be part of a protocol also being used by other physicians.
Dr. Herbert, a member of the IPS, works exclusively with arguably the premier peptide compounding pharmacy in the US – Tailor Made Compounding Pharmacy.
Pain is defined as an unpleasant physical and emotional experience. Many parts of the body and brain contribute to pain. While chronic pain is incredibly complex, the many potential contributors to pain in turn offer many targets for treatment. Since each person is unique, often a customized plan created in partnership between patient and physician can return a sense of control in many areas.
For instance, anything that causes systemic inflammation in the body may be part of what is holding the pain at its current level. Treatable sources may include poor gastrointestinal function, food sensitivities or allergies, excess stress, toxins in the body tissue and nutritional deficiencies. Body biomechanics may have been altered due to scars, trauma or an old injury, either physical or emotional.
Integrative and functional medicine approaches offer testing and treatment of many areas not accessible to traditional medicine. A combination of addressing digestive dysfunction, food intolerances, reducing inflammation, biomechanical malalignments and heightened stress responses often is successful in reducing pain, lessening flares and giving a person more control over that “unpleasant experience.”
In addition, prolozone injections (into joints or painful muscles), with or without PRP (platelet-rich plasma) may provide significant relief and postpone or replace a surgical procedure.
Please note this practice does not prescribe opioid pain medication.
One of the reasons to take a detailed history for all patients is to see the many historical influences on their health. These include environmental exposures such as pesticides, heavy metals, mold from water-damaged buildings, industrial waste or electric power lines near home or residence and much more. Often any one exposure can be handled by the body's incredible systems of detoxification. A lot of DNA is devoted to that.
However, when there have been multiple, extensive or long term environmental insults to the body, symptoms will be present. They manifest as many different diseases, eg, allergy, asthma, brain fog, joint and muscle pain, hormone disruptions, autoimmune disease, digestive problems and much more.
There are specialized tests, some from traditional labs, some from specialized ones that are more useful, especially when looking for the total body burden of toxins. If your body's 'elevator' has too many passengers, it is not going to work well. The passengers on that 'elevator' are allergies, toxins, infections and stress of all kinds. Lighten that total load and in almost every case, your elevator will start working better.
Tick-borne disease is an underappreciated and unrecognized epidemic worldwide.
There are new species of Lyme (Borrelia), Bartonella, Babesia and more bacteria, viruses and parasites being discovered all the time. Global warming has also had the effect of changing the geographic range of ticks, mosquitoes, lice and other biting insects that can carry the infectious 'vectors.'
While testing is improving, sometimes these infections can hide in tissue (Bartonella especially as a 'stealth' pathogen) or inside biofilms that make it hard to get definitive answers in the beginning of treatment. Treatment often consists of therapies designed to attack the infection in different phases (actively dividing, round or cystic forms, inside the cell or behind a protective biofilm).
Inside the biofilm, different bacteria can exchange DNA (such as for drug resistance) as easily as people shuffle cards. In addition the bacteria can alter how they are folded and thus fool the immune system.
Using both clinical diagnosis and advanced testing, we at Gesundheit can often reduce the infectious load, and identify and treat other obstacles to healing. These might include exposure to toxins, water-damaged buildings (mold), allergies, gut dysfunction, adrenal fatigue and other factors, including hormones, stress and physical injury. Each patient is treated using a personalized approach.
Treating according to osteopathic principles means treating the whole person. Historically preceding the advent of integrative and functional medicine by over a century, osteopathy is a comprehensive medical philosophy that includes addressing lifestyle, biomechanical alignment and prevention in addition to treating illness and pain.
Hands-On Medicine treats patients according to osteopathic principles and almost always includes manual diagnosis in addition to testing and imaging, if needed, and manual therapy using gentle osteopathic manipulation.
These are the basic Tenets of Osteopathic Medicine from the American Osteopathic Association:
The body is a unit; the person is a unit of body, mind, and spirit.
The body is capable of self-regulation, self-healing, and health maintenance.
Structure and function are reciprocally interrelated.
Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.
Plants have been used to treat illness and to maintain wellness since before recorded history. Using plants medicinally is called herbal medicine, botanical medicine or phytomedicine. While herbalism has not been used much in the US in the recent decades, advances in research and better quality control of products are changing that. In Europe, botanical medicine is already well integrated into medical practice. Other medical traditions (Traditional Chinese Medicine, Ayurveda) use botanicals extensively. Almost a fourth of prescription drugs are derived from plants.
Herbs or combinations of different herbs often have fewer side effects than prescription medications. In that way they may be seen as a more conservative treatment option. However, they may have side effects and may also interact with medications.
In addition, botanicals offer other benefits including immune boosting function (Echinacea and astragalus), stress reduction without sedation (lemon balm, milky oats) and prevention or lessening of symptoms (butterbur for migraines).