My Doctors Failed Me, by No Fault of Their Own
written by Emily Kahoud
Each day in the United States, (according to data from a 2012 National Health Interview Survey by the Centers for Disease Control and Prevention) approximately half of all adults are suffering the effects of at least one chronic disease. One in four suffers from multiple chronic conditions. Medical students and residents know chronic diseases as rote batteries of symptoms that capitulate to an unending barrage of procedures and pills.
ACLM Member Saray Stancic, M.D., owner of Stancic Health & Wellness, is unique in having known the insidious progression of chronic illness, first as a physician, and then, suddenly, as a chronic illness patient. While working as a medical resident, Stancic shockingly woke up from a brief nap to numbness in her legs. Like in a nightmare, she was transformed from the role of physician to sick patient, with its requisite isolation and insecurity.
Diagnosed at 28 years of age with multiple sclerosis (MS), Stancic understood that she was on the precipice of a disease whose course is both progressive and degenerative—her neurologist had painted a moribund picture of dependence on a wheelchair and diapers by the age of forty. Stancic comments, “I felt vulnerable and life was largely unpredictable. The medical community responded with a flurry of recommendations to slow the progression. The answer was always hidden in a prescription to treat a symptom. In my early thirties, I couldn’t leave home without my fully stocked pill box. A dozen drugs later, the disease progressed and life was unraveling.”
“I could see myself losing a little bit every day,” Stancic said. In an account of her struggle, Stancic wrote for the Forks Over Knives website:
I was no longer Dr. Stancic, making early morning rounds on her patients. I was now the newly admitted MS patient, lying in a bed as a flock of medical students and doctors took turns assessing my deteriorating neurological status. … I had become a drug-dependent, sick young woman struggling to accept her fate. MS had swiftly swept away my dreams and aspirations, and left behind a shadow of my former self.
Unhindered by the grim projection of her disease, Stancic continued to treat severely compromised infectious disease patients even as she was experiencing the disabling effects of MS. Many of these patients had poorly controlled diabetes and developed foot ulcers. With their immune and cardiovascular issues, compounded by poor perfusion, Stancic says, “I knew where [these patients] would be in 20 years,” as they were heading towards amputation and becoming more sedentary, setting them up for a stroke or comparable disaster.
Stancic recalls one patient in particular, a poorly controlled diabetic with complicated osteomyelitis. This man, an artist, had reached a standstill with this terrible disease by his late 50s, and ultimately succumbed to it. Yet the conviction he shared with Stancic in earnest is indelible. He said, “If I had known that I could do anything to change the course of my life…that would’ve been worth everything to me.”
Intense suffering makes us more open to fate’s fortuity. In Stancic’s case, the impetus for change arrived in such humble packaging, she may have easily missed it. An undistinguished “throwaway” medical journal plopped on her desk with her mail proposed a possible connection between blueberries and the improvement of MS symptoms. Although the study was rife with scientific blunders, the concept of nutrition in medicine sparked her intrigue. Stancic asked herself, “Could this theory be viable?”
“This fueled a relentless search for evidence to substantiate this budding awareness,” Stancic says. “Why had this topic never been mentioned by any of my physicians or throughout all those years of medical education and post-graduate training?” she wondered. For the first time, she became cognizant of lifestyle and how our choices influence disease.
Recalling her “typically American diet” of Diet Coke, Chinese food, and Subway sandwiches, Stancic says, “I had a lot of cleaning up to do.” She gradually began to introduce “simpler, cleaner foods,” including the “power foods”: fruits, vegetables, legumes, whole grains, and nuts and seeds. She cut out the highly processed foods. She also introduced exercise, despite the barrier of dependence on the cane or crutch she used to get from her car to her office. She started out on a stationary bike, initially doing very little, and even this would briefly exacerbate her symptoms. Yet she kept at it, determined to build it up: “I had faith that this was going to be my path to improvement. I did it every day, no matter what, even if I didn’t feel good.”
I trusted and chose to adopt these changes, and over time I freed myself of the pharmaceutical drug dependency, the cane, the crutch, and the disabled person identity that had become my existence. I reclaimed control of my life by simply adopting the principles of lifestyle medicine, nothing more, nothing less. This was such a powerful defining moment that I was convinced I needed to find ways to share this message with as many people as possible. Impassioned by this revelation I decided to commit my professional career to lifestyle medicine in clinical practice.
While she began to build a practice that would serve as a testament to the efficacy of lifestyle medicine in preventing, and treating chronic illness, she also sought answers from her physician colleagues. She wanted to know why the current medical education model fails to teach students the scientific rationale for endorsing simple lifestyle adjustments such as a whole foods plant-based diet; better sleep hygiene; regular physical activity; and healthy weight maintenance—all of which have only benefits with no harmful side effects.
The scientific literature strongly advocates for lifestyle amendment to prevent and ameliorate disease. A NEJM article (2002) suggests that in persons at high risk for the development of type 2 diabetes mellitus, lifestyle intervention may be more effective than metformin in preventing or delaying this disease. So why are these factors rarely emphasized in a doctor’s office? Is it because the physicians, by no fault of their own, do not receive formal training in this lifestyle methodology? Is it because the physicians do not believe the patients want anything beyond the quick fix?
Stancic’s insatiable desire to find answers was not tempered by the unenthusiastic responses she received from some of her colleagues, many of whom are resistant to incorporating healthy lifestyles into their own lives, and with whom this message does not register. As someone who has faced far more insurmountable challenges, Stancic was inoculated against discouragement from setbacks; she knew this was her path and she merely had to decide how best to make it materialize.
Then one day, as she spoke with a friend of a few years about chronic illness, she learned that this woman, Marcia Machado, was an esteemed documentarian. Within a month of meeting with Marcia and conjuring up a possible idea for a documentary, a passionate young man about to start medical school named Saul Bautista appeared at Stancic’s office unannounced, asking to learn about lifestyle medicine.
Together, Stancic, Machado, and Bautista sowed the seeds for code blue.
code blue will explore the question of how to reshape the current practice of medicine in order to empower both physicians and patients to take control of their personal health outcomes by prioritizing prevention. It will be a feature length documentary that reveals insufficiencies in the current state of medicine and provides a common sense solution by featuring the practice of lifestyle medicine to prevent, treat, and manage disease. It will present the hurdles to the proposed shift: why is this not an integral component of the curriculum taught in medical schools? Why does this not resonate with the majority of current day practicing physicians? What is causing the lapse in communication to the general public? The unwillingness of some to believe that the American public—addicted to the quick fix—will embrace lifestyle changes is also addressed, as well as the undercurrent influences of the pharmaceutical and food industries that help shape public policy.
The project will include footage of medical students learning culinary medicine and growing vegetable gardens, a hospital and a doctor using farms to promote healthy behaviors, a cardiologist walking with patients, a lifestyle medicine physician food shopping with her patient, scientists in research labs, as well as the uniting of patients, medical students, and doctors who walk and run races together to promote exercise.
The code blue team plans to film the efforts of those who are already implementing initiatives for change, and interviewing experts who are pioneers in the discipline. This will include leaders like Dr. Dean Ornish of the University of California, San Francisco; Dr. Neal Barnard of The Physicians Committee for Responsible Medicine in Washington D.C.; Dr. Elizabeth Frates at The Institute of Lifestyle Medicine at Harvard Medical School; Dr. David Sabgir of "Walk with a Doc" program; and Dr. Jennifer Trilk at University of South Carolina Medical School in Greenville, where they have already integrated a lifestyle medicine core curriculum. These trailblazers, including Stancic, hope to redefine the culture of medicine, and their spring fruits tell us their success is imminent.
Today, more than 20 years after her initial diagnosis, Stancic’s wellness practice in Ramsey, NJ continues to thrive. As Stancic once directly experienced the debilitating effects of chronic disease, she now indirectly experiences these through the eyes of her patients. Yet unlike most physicians, Stancic knows exactly what it takes—the battle of body and mind—to uproot our intimate habits to whose familiarity we cling. In tandem with her growing practice, what once was an inchoate desire to shape the culture of medicine has now evolved into a film production campaign that recently raised over $30,000 on Kickstarter.
Stancic is perseverance incarnate, and with personal experience and success, she coaches her patients to carve out a different path from the misleading one of popping pills without steps to shake up the status quo. Hope did not arrive quickly enough to save the former artist who had once proclaimed he would have done anything to change the course of his life; yet Stancic is committed to ensuring that hope in the form of lifestyle medicine will be a formidable weapon in our future chronic disease arsenal.