Do the Obvious Thing First

People get in a highly perfectionistic way of thinking during medical dilemmas; they think, “I need to do the most excellent thing.” They’re always asking, “What decision would be best?” After all, in a crisis, you want to be dead certain. You have to be sure you’re not making a mistake. Nothing seems good enough in that situation, and so rather than asking “What is something I can do?” you’re always trying to find out the impossible: you’re always trying to do the best thing in the world.

This happens when someone is looking for a new doctor. When they’re in the search, no doctor is good enough, not even the one they last had. All the old doctors, all the doctors in the past, are failures, and all the present candidates are too low quality.

Actually, there are no perfect doctors, and all anyone needs to do in a crisis is to do the thing they believe will be effective. They only have to find something that will help right now, to alleviate the symptoms that are present right now, rather than looking down into the depths of the problem in a single glance. The simplest thing is what you should do now, before riskier decisions come on board.

I don’t just mean right now, right this minute—not everything is the decision of a minute—but also three days from now, or a week from now, after other alternatives and other courses of action have come to mind to be chosen. Right now, this minute, you could text someone who could answer a question you have, or you could write a message to your doctor. Three days from now, when you find that, for example, you’re still coughing nonstop, you could actually try the cough syrup with codeine in it. What I mean is: you can actually do something easy, and it will be enough.

Do the obvious thing first. Take the shortest route. If you don’t, you will find yourself circling back on just one engine.

This is how medical diagnosis is supposed to work, anyway. The doctor rules out the most common, most obvious explanations first. But this principle is sometimes ignored, at great cost, because we are all striving for excellence and comprehensivity in all things, and the shortest route gets overlooked. A man with a cannonball wound goes to the emergency room complaining of pain and the nurse, looking for an invading microbe, asks him if he has recently traveled outside the country.

“Obvious,” as a concept, is linked to “basic.” “Obvious” means “evident” or “apparent” or “apparently apparent,” and doing the apparently apparent thing may mean starting with general basics, starting at the bottom. This is particularly important in medicine because healing follows a ladderlike progression. Some rungs must be tried before others. Step one must come before step two, and step two before step three. This is apparent when pain or histamines get in the way: step one is to create some relief or throw a safety net around the situation so that the patient has the confidence to try anything else. But the healing of the cells itself progresses through natural levels; the biggest blocks must be cleared at each stage, and clearing them is necessary to attain the next level and get anything else to work. A doctor recently told me anemia works this way—hemoglobin carries both oxygen and sugar—and you can’t have any other improvement until you address it. Not any major improvement, anyway. Neil Nathan makes this argument early on in his book: “[chronic] illnesses are caused by years of biochemical and medical dominoes….Unless you know with precision that what you are treating is central for this patient (even if the patient has other, correct diagnoses) you will not make much progress.”(1) He gives an example later on, writing that, for instance, working on a virus when the primary problem is mold “will not move the patient toward health.”

It should be noted that Nathan is not advocating only treating one causal factor at a time; there can be two primary issues (or more, I would assume), like both mercury and mold, and Nathan uses immunological and nervous system supports concurrently with treating the other issues. But, at each stage, there will always be major factors and less important factors, and healing follows a natural progression. Sometimes these basic treatments seem too simple to be worthwhile. In the past year, I kept thinking the solution to my problem was esoteric. I didn’t take the importance of glutathione or exercise completely seriously, and honestly, I had some trouble with both, so I tried everything else. But that glutathione and exercise seem ridiculously simple is a terrible pathology of thinking because they are absolutely vital to healing and repair. Glutathione is a master detoxifier and antioxidant and feeds the gallbladder and liver and heals tissue—it’s a foundational therapy. Exercise, on the other hand, ends the danger response so that mitochondria are turned on to fix damaged cells. So I wonder if the basics, once covered, can ever really be dispensed with.

Another way of thinking about the obvious is to see it as the easy thing. Carrying out the apparently apparent solution may mean not having to do a lot of physical or mental effort. Some, but not a lot. Author Tim Ferriss has written that one of the best problem-solving tactics in situations that come with a lot of overthinking is to ask: “What if this were easy?” For instance, someone in my family was recently considering a stem cell injection (stem cells are often harvested from the membrane of a fetus) for knee pain, and they eventually decided they should try something easier and cheaper first, which led them to microcurrent therapy with a chiropractor and then cold laser treatments. Simply looking up common treatments for knee pain like frequency specific microcurrent is the apparently correct thing to do, the obvious thing, and easy. It’s time-saving to try the easy thing first—because it may work—before you involve an unconsenting placenta.

If someone is choking on a walnut, you would perform the Heimlich, not stand around talking about their high-fat diet. But in a crisis everyone leaps to the most remote, outlandish and difficult solution. They reach for the best, bringing everyone with them. During the pandemic, even my Washington State naturopathic doctor fell into this excellence trap. She told me I needed to fly to New York to see a famous leading specialist in Mast Cell Activation Syndrome (MCAS)—a histamine problem—but I couldn’t fly, because it was a global pandemic. For months, I called all over the country to find a leading specialist we could drive to, with no result. Finally, my doctor asked the colleague of the doctor in New York if that colleague could treat me remotely and, after much deliberation, the colleague of course said no—another long shot that failed when swift, simple action was needed. A year went by in this manner and then, because the situation involved food and had, as a result, become life-threatening, it became necessary to actually do something. At just that point, I found an allergist and immunologist in Salt Lake City who could treat me remotely; not the simplest solution but not quite as complicated either. I will admit that he was trained by the New York doctor, but he told me that whether the problem is MCAS or something different, if you’re having painful reactions, the treatment is the same: an antihistamine, perhaps with a soupçon of mast cell stabilizer.

He eventually saved my life, but before he could do that there was a lot of discussion about what was best to do. I could react to the very medication I needed and so he suggested a “medication challenge” which means trying the medicine in the office: you take something you might react to, and when the nurse comes back in the room she resuscitates you. So we were going to go to Salt Lake and do the challenge in the office with him as soon as possible.

After I finished writing out my packing list, I thought, Wait a minute; there are allergists with offices here in New Mexico. My Utah allergist then called a peer from the University of Michigan who currently practices immunology in Santa Fe, and we did the challenge there. Again, of course, Santa Fe was not the simplest and easiest place to do it, but we had all been caught up in striving for excellence for so long that nothing could stop us. Doing the challenge an hour away in Santa Fe, it turned out, was not necessary, and it prolonged the entire ordeal by a couple months. Also, during the challenge in Santa Fe, I was alone in the room for most of the time, except for the company of Monet in the form of his nympheas, so it was not the armored space I had envisioned at all. An allergist in Albuquerque had told me he would allow the challenge to be done in his office, even though he was short-staffed and recommended using a different antihistamine. I imagine we could have worked with him and persuaded him to let me try the Ketotifen instead: the Santa Fe doctor also maintained a different diagnosis and recommendation than his Utah peer, but he ultimately let me make the call to try the Ketotifen. In the final analysis, the “best” was not really best and we succeeded in stoking the flames of the problem by further delay. Anxiety leads to perfectionism and perfectionism leads to death.

Done is better than perfect. This is not to suggest that quick and easy action should come from ignorance. If I had known what I know now, that all I needed was an antihistamine and mast cell stabilizer at a low dose over time, I would have done the right thing the first time and gone to someone local. The gathering of information is itself a basic step.

If my naturopathic doctor had known this, if she’d had the right information herself, then, armed with new information, she could have called someone nearby. Even my Utah doctor overcomplicated things and avoided the obvious. That’s the trap of excellence: we’re all in it together. None of us will allow mediocrity, and, as a result, this pulls us all down. No choice is actually perfect, and, sometimes, with a doctor’s help, you can adjust the treatment to fit your needs. Do the obvious thing first, even if it seems too easy to be the solution. Alive is better than perfect.

(1) p.12 and p.22 Toxic by Neil Nathan, MD, 2018

Medical Disclaimer

The content provided on this blog is for informational purposes only and is not intended as medical advice. The information presented here is based on personal research, general knowledge, and publicly available resources, and should not be construed as professional medical guidance or treatment.

I am not a licensed healthcare provider, doctor, or medical professional. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition, diagnosis, or treatment. Never disregard professional medical advice or delay seeking it because of something you have read on this blog.

The blog’s content is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect that you have a medical problem or condition, please consult a qualified healthcare provider immediately.

By using this blog, you agree that the author of this blog is not liable for any actions you take based on the information provided herein.

Keep the Steps Close Together

Are you making significant progress in the problem you’re trying to solve? Are you? How do you know?

Let’s say you’re doing neuroacupuncture after being told that for some people it can reset brain inflammation after just two months, ending all your migraines forever. Just for the sake of argument, let’s suppose. Once a week, a man who smells like incense and rubbing alcohol sticks small needles in the top of your skull. It’s just like being in Heaven.

After two months, however, you only have a slight improvement. You’re only having one less migraine a month, making a total of four severe headaches every month on average. Well, the doctor says, for some people it may take as many as three months to start seeing bigger results. But at three months you find that you are only having two fewer migraines per month, and this could also be due to the fact that the Spring allergies have passed, that you’ve stopped drinking coffee, and are swallowing fish oil at breakfast and dinner.

Or, in another scenario, maybe you’re having nerve pain in the bottoms of your feet. Your doctor tells you that your B12 is low, perhaps that’s the problem. But after a month of taking pink liquid drops of the vitamin, your pain is only one-fifth reduced.

It’s not so easy to know whether you are solving your main problem: you become afraid that you aren’t, and wonder why it’s taking so long, and then start worrying and try another doctor in desperation. Or, a more common scenario, you’re convinced that you’re seeing the improvement you desperately want, that the recovery, like a photograph, is in development, and then you wait too long. You keep adding a month here and a month there, thinking that the solution is time, and all of a sudden a year has gone by and your feet still hurt.

It’s hard to define what enough improvement should look like, and the results are never what you expect. You scan the surface of your symptoms, trying to make out the causes. If your pain is a musical chord, tiny hammers beating under it, it’s not possible to lift the piano top and catch the hammers at their work, putting a finger once and for all on the factors.

What I have only recently realized is that a relatively small number of causes have the majority of influence in a problem. The Pareto Principle means that roughly “80% of effects arise from 20% of the causes.”* After reading the work of Italian economist Vilfred Pareto, the engineer Joseph M. Juran captured Pareto’s rule of factor sparsity in a single phrase: “the vital few and useful many.” There are big causes and there are little causes. Big solutions and little solutions. For each problem, certain causes are far more important than others, and certain solutions much more important. Some treatments will turn out to be vital, and others, light and feathery touches, will reveal themselves as merely helpful. This simple principle explains everything that will come later.

Is the B12 you’re taking going to fix the stabbing sensations in your feet, or is it another small drop in a very large swimming pool? There could be a bigger cause lurking out of sight. Time helps in understanding what a treatment is doing but you also can’t afford to wait long. Even though it’s hard to know if you’re making real progress, answering the question as quickly as possible puts you on the shortest track. You have to get fast at it. The faster you can answer the question of whether you are getting better, the faster you can get better. Answering this question is essential to progress because it forces you to take the next step. The sooner you realize that the neuroacupuncture did not work for your migraines, the sooner you can move on to the next step and add or substitute something that does work. The longer you spend on something that doesn’t work, the longer you spend sick.

There are a few ways to help identify whether there is any real progress. Define the problem you are trying to solve and track the progress by taking notes. Write down everything you’re taking and doing for the next thirty days in a protocol with a start date.

But there is more to it than this, more that can be done to move forward as rapidly as possible and not waste time. In spite of the fuzziness of results, I’ve found that a few key habits promote progress.The first way, already introduced, is to keep the steps close together. The second is to distinguish between necessary and sufficient treatment, and the third is to seek real change rather than be beguiled by a modicum of improvement. It took me sixteen years to figure this out.

To increase the pace of progress, keep the steps close together. Conduct regular reviews—I’ve done it every six weeks or more. Each problem needs its own length of time, so I won’t dictate the time frame. The main principle is to conduct regular reviews: there are no deadlines in medicine, not enough, and doctors, like God, exist outside of time. One day to a doctor is to a patient thousand years. Look at the signs and notice where you are. Is it time to try something new, test something new, or learn something new? Don’t stop what you’re already doing if it’s worth it to continue, but move on to add something or do something different when it’s warranted. Don’t skip lightly from step to step either—try as much of the doctor’s recommendations as you can—but when you have finished, move on. Even if the treatment only makes the pain worse, the sooner you complete the step you’re on, the sooner you can move on to the next step. Notice when it’s time. Drive with your headlights on.

Last August, one year ago, I had been using a gentle electrical current called Frequency Specific Microcurrent (FSM) believing it would be the cure for my pain. The pain could be triggered by almost anything. I had experimented with many frequencies to find out if one kind was better and seen three different FSM practitioners. In my quest to find the correct frequency, I even called a German practitioner from Santa Fe as she waited in a layover for a flight to Switzerland. “Run 40 on 534,” she told me.

After two months and one week of FSM, I told my doctor over video that although much of the pain in the esophagus was gone and some of the pain that felt like bruising was better, the pain in the rest of the body was nearly the same. I was much stronger and calmer, but starting to doubt if it was enough. “You haven’t given it enough time,” my doctor said. “Two months is not much out of eighteen months of pain. Calming down the alarm system could take six months to a year. It’s not uncommon to take that long to calm down the nervous system.” (My doctor was talking about the specific frequencies we had chosen for the brain, but the FSM also increases cellular energy, fueling healing. He is a practitioner and even worked on me himself.)

Well, I thought, the pain is still almost intolerable. I told him, “We seem to have dramatically improved every symptom except the pain.”

My doctor said, “Sometimes that happens.” I could tell he was beginning to wonder. He continued: “Maybe there is no solution.”

“There is a solution,” I said, “and I am going to find it.”

The next day I listed the pros and cons of leaving my doctor in my brown notebook. It had been six months and one week, and I had searched him for every answer and idea. I would still continue doing the FSM, as I depended on it for my energy.

In September, I became a patient of a different doctor, in Salt Lake City. He ordered hydrocortisone. And in late May, after much experimentation and failure, I realized that he had found a significant answer to the pain.

In leaving my doctor after six months, I had kept the steps as close together as I could, moving on to add something new as soon as I realized that we were not doing enough. In order to decide whether to move on after exhausting all his ideas, I had asked myself: “Do I want to keep doing what I’m doing with the same results, or do I want to try something new and open up the possibility of getting different results?” This, I’ve found, is a useful question more easy to answer than “Am I getting better?”

To stay longer with my doctor would have been spreading out the steps too far, failing to take action at the right time. Nonetheless, he had wanted me to stay, to keep waiting for different results, as had the male doctor before him. It is not always the right time to leave your doctor, but it was right in this case in order to hear new ideas.

It’s also helpful to recognize that a treatment (or group of treatments) can be necessary but not sufficient. Take the case of a patient with high histamine who is so reactive to the Cholestyramine resin for mold that she can barely take the medicine supposed to make her well. Mast cell stabilizers like Ketotifen, and antihistamines like diamine oxidase and Famotidine are a necessary treatment, but they may not be sufficient to achieve her desired goal. The sleep problems and fatigue may linger until cholestyramine, glutathione, and phosphatidylcholine are introduced to push the sticky burr-like mycotoxins out of the liver and lymph.

My German FSM practitioner told me in my first treatment with her that my phase angle, the cell’s ability to hold an electrical charge, was measuring at 5.14—too weak, and treating me with any supplement or nutrition would be slow or impossible. To raise my charge, she recommended FSM, Brown’s gas, hydrogen gas, or the ocean. I realized why the supplements and drugs had only seemed to work after beginning the microcurrent: the electrical recharging of each cell had been necessary to pull in the other treatments, and when I waited too long between microcurrent treatments I became weak. The FSM had channeled oxygen and other nutrients into every cell, like an Atlantic breeze on an epiphyte. Some treatments and groups of treatments are necessary but not sufficient to solve a problem, and other treatments or groups of treatments are enough. On its own, the microcurrent could not heal the tissues. Feeling better may come as a series of steps rather than a ride to a final destination.

Last of all, if it’s not apparent by now, progress happens when you seek real change rather than be beguiled by a modicum of improvement. Small ripples may be mistaken for the tide coming in. Doctors and patients see any happy change as a sign that the solution has been found, if only the patient will keep going. Everything in the body is connected, and it’s easy to see how many things, the “useful many,” can make a problem better. But if the solution cannot go far enough, if it’s not enough, your main symptoms may improve at first, and then later the improvement may come to a halt. If it’s not enough, new symptoms may begin cropping up. Before the hydrocortisone, I tried artichoke extract, red light therapy, and NAD. Each gave me more energy and a little improvement in the pain. I did not know everything that was causing my symptoms and several things produced similar results, making it difficult to distinguish a winner. Any improvement was a relief, and my powers of observation fall below average. In the area of scientific empiricism, I seem to always be late, never on time. I was so encouraged with the results that I convinced myself I was on the right track until, in late Spring, the pain flamed up just as bad or worse than it had been in December.

New symptoms may even come from nowhere. Tiny improvements are like a runner-up in a foot race: for most of the race the runner-up is winning, until he is overtaken in the final moments by the real winner. In medical treatment, if the treatment is not enough, entropy, in the final moments, catches up and wins the race.

In 2016, after a long period of illness, I ended up in a wheelchair. I could still walk but needed a chair to get around a hotel or a park. There is more than one reason why this happened; it is enough to say that it was a case of hearing the notes but not recognizing the melody. I had seen the best doctors for my condition, and initially, I had improved. The pain and sleep deprivation had come down just slightly. I gained the ability to make some meals for myself, and thought we were on the right track even though, year after year, the pain and sleep and my housebound life remained basically the same. I failed to recognize the signs even when I developed a recurring appendicitis-type problem and began having episodes of difficulty breathing. When I finally ended up in a wheelchair with life-threatening symptoms, I was haunted by something my doctor had said years before: “I can tell you are getting better.”

A tiny bit of improvement may not be enough, but it is tempting to believe in, like the early AIDS patient who, after receiving one blood transfusion, was convinced he would get better. The hammers strike the notes, and no one can see the instrument working.

Look for big events, and believe in the existence of earth-shattering improvement. If you are not looking for it you may never find it. You may spend the next ten years repeating the same day. Temporary results are eagerly accepted by the half-dead patient too oxygen-starved to know the difference. Give me real change: change that shakes the trees and jumps the needle on the graph.

It is not easy to know if you are getting somewhere. If it were, I expect people would be getting better faster. Information is often grey in color, not black or white. Many things may be useful and give a little relief, and this can convince you that you’re on to the cure. Certain causes, however, are dramatically more influential than others. In spite of the confusion, to move forward steadily you must make regular reviews of the situation and keep the steps as close together as possible. Identify the most important treatments as quickly as you can. Complete each step, and the sooner you do, the sooner you can progress. Deciding you want something new to happen may be easier than agonizing over the results, trying to determine if there’s real change or not. It’s also helpful to distinguish between necessary and sufficient treatment, realizing that some treatment is necessary but not sufficient and that clearing a health problem may come as a series of steps rather than an escalator ride to the final floor. Progress also happens when you refuse to be beguiled by tiny changes and, instead, review the actual facts of the situation to look for real improvement. These are just a few of the things I’ve learned in sixteen years. I am no longer in a wheelchair. I now also own my own FSM machine, for which I paid two thousand dollars, and it has earned every cent. But sometimes I think my inductive reasoning is really rock bottom. If I can just have a little more time and a few more tries maybe I’ll finally get what real change is: a scalpel cutting the ground, slowly, slowly, on the edge of sight.

*“80% of effects arise from 20% of the causes”: “Pareto Principle (80/20 Rule) and Pareto Analysis Guide” March 12, 2019 https://www.juran.com/blog/a-guide-to-the-pareto-principle-80-20-rule-pareto-analysis/

For a more detailed explanation of power laws and how to find outliers please see https://www.benkuhn.net/outliers/, including the section beginning “The most important thing to remember when sampling from heavy-tailed distributions is that getting lots of samples improves outcomes a ton.”

Medical Disclaimer

The content provided on this blog is for informational purposes only and is not intended as medical advice. The information presented here is based on personal research, general knowledge, and publicly available resources, and should not be construed as professional medical guidance or treatment.

I am not a licensed healthcare provider, doctor, or medical professional. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition, diagnosis, or treatment. Never disregard professional medical advice or delay seeking it because of something you have read on this blog.

The blog’s content is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect that you have a medical problem or condition, please consult a qualified healthcare provider immediately.

By using this blog, you agree that the author of this blog is not liable for any actions you take based on the information provided herein.