A pediatrician’s journey into integrative medicine [PODCAST]

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Join us on this episode as we sit down with Kortney West, a pediatrician who shares her personal journey and perspective on the shortcomings of the allopathic medical system. As a physician, mother, and patient, Kortney discusses how her experiences led her to explore integrative and functional medicine to address her son’s health issues. We delve into the importance of recognizing conditions like eczema, asthma, and gut issues as chronic conditions with underlying health problems, rather than considering them normal childhood ailments. Kortney sheds light on the limitations of the traditional medical system and the need for a shift towards comprehensive, root-cause-focused care. Tune in to gain insights into the challenges and transformative potential of integrative medicine, as we explore the evolving role of physicians in questioning conventional practices and prioritizing individualized care.

Kortney West is a pediatrician.

She shares her story and discusses her KevinMD article, “Breaking the cycle of failure in modern medicine.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Kortney West. She’s a pediatrician. Her KevinMD article is titled “Breaking the cycle of failure in modern medicine.” Kortney, welcome to the show.

Kortney West: Thank you so much for having me. I’m excited to be here and share my story.

Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Kortney West: Great. I am a pediatrician. I grew up knowing that I wanted to help children in some form or capacity, and I had always had an interest in autism in particular. Fast-forward: I finished residency, started a traditional outpatient clinic, and decided that the system was not exactly what I wanted. As we all know, going through what should be 30-minute visits in five seconds led me to start my own DPC practice, concierge-style medicine where I was doing house calls. Then my family relocated to Pennsylvania. While I was here, I ended up doing a lot of psych medicine, because the pandemic started, and I had a lot of teens, and we were focusing on mental health issues. From there, I started my own similar DPC practice, where I focus mainly on mental and behavioral health issues in children.

In this whole process, I have two neurodivergent kids, so I have spent a lot of time researching, not only for my patients’ benefit but also for my own children’s benefit, which then led me to finding integrative medicine. And that’s kind of where my article came from.

Kevin Pho: And we’re going to talk about this later, in your article, but when you first came out and started practicing what we’re going to call, I guess, traditional pediatrics, tell me about your day and what about it specifically wasn’t your preferred style of practice.

Kortney West: So I had a lot of patients who were on medical assistance, and it is difficult; their medical literacy is lower, right? So I had to teach them what I felt that they needed to be taught, even just about basic feeding of children. What they know is completely different from what they should be doing, and it takes a lot of time to explain that and offer preventative guidance and appropriate anticipatory guidance, which is what pediatrics is all about. I found myself really trying to spend a lot of time making sure that they knew how to give a medication or how to properly feed their child, and that you shouldn’t put Coke in a bottle when they’re five, just basic things that seemed like common sense, or not common sense to a lot of people, and it just took time. So then, instead of being able to focus on medical issues, we were really just dealing with a lot of social and basic living concerns, and I just couldn’t do that in 5- to 10-minute visits.

Kevin Pho: Now, you made the next step of going to some type of direct primary care practice outside a system. Not everyone would do that. A lot of doctors would just stay in the traditional system because of financial security, job security, and whatnot, but you made the leap to go into something that is relatively less common. So what made you take that leap when so many other doctors would rather just stay with that security in a traditional system?

Kortney West: Well, I have a very supportive husband, so I realize that I am not the primary income earner, which made it a lot easier, and I did have security, a safety net, and his support in being able to do that, and I’m so thankful. The main reason that I triggered it is, you know, it was like the arrival fallacy, right? I was in residency, and I was like, “Oh, I can’t wait to get out of residency. It’s going to be so much better.” And then you get to your first real job, and I was like, “This is not any better.” So I figured I had to do something different, and I had to make a change.

Kevin Pho: All right, and you talk more about your journey in your KevinMD article, “Breaking the cycle of failure in modern medicine.” Now tell us, how did your article come together?

Kortney West: Yeah, so like I said, two of my children have some medical issues, and then my third child actually had a lot more going on. It was just a lot of things that seemed common, right? He had eczema; OK, no big deal. But then he had recurrent croup, which, OK, also maybe he’s got reactive airway disease, but we’re talking like he was in the hospital for it twice, kind of bad. Then he had constipation, and so it’s like all of these little things just kept adding up.

What really triggered the investigation was that I walked downstairs one morning and he was pretty much non-responsive, limp like a noodle. We took him to the ER, and his glucose level was 38, and then he got an idiopathic ketotic hypoglycemia diagnosis, which, you know, I had actually never seen in residency, but I will tell you, now that I’ve been in practice, it’s not super uncommon, and we do see it. I was just not happy with the diagnosis of idiopathic in a child who also had a lot of other issues. And I didn’t mention it, but we were having significant behavioral problems with him as well. So it just seemed like, you know, we’re taught that there’s got to be some sort of reason, or we try to find a unifying cause, and I was really anxious to do that. I had done a lot of different genetic testing, and nothing was coming back positive.

And so I went down the functional medicine route. I actually started doing an integrative psychiatry fellowship so that I can incorporate some of these tests and philosophies into my own practice, just knowing and seeing all of the research that’s coming out on the importance of your nutrition, your microbiome, and our brain health. And in doing so, anyway, long story short, I found that he had really elevated mycotoxin levels in his urine, which led us to investigating our house, and we had had a leak in the bathroom next to his room, and there was just mold all inside the drywall. I would have never known had I not started looking into this.

And now this has opened up this entire journey, which is just phenomenal, and it’s fascinating that we aren’t taught this in medical school and it’s not really discussed. But now it’s kind of like the veil has been lifted, and I see everything through a different lens. There’s so much that we don’t talk about in our environment that contributes to our health that I would love for the traditional allopathic system to just even be open to listening to and investigating.

Kevin Pho: Now, when you were taking your son to the traditional medical system, trying to find a reason for these disparate symptoms, tell us a little bit about your interactions with the traditional medical system.

Kortney West: It’s sad, because I felt like I had to be guarded, or else I would be looked at and judged, honestly. I can recall there was one situation where we were in the hospital and I asked them to add on some nutritional labs, and the physician looked at me and was like, “Well, I don’t know what to do with that, so I can’t order it, because it’s not really going to change anything.” I was like, “Well, I mean, I’ll do it, or can we look at it?” But it just kind of got dismissed, and I felt like I was crazy or being judged. And yeah, that’s just sad.

Kevin Pho: Now, before you went down this integrative medicine pathway, let’s say you’re on the other side of the curtain, and the patient’s family asks you to order labs that you may not have learned about in medical school. What do you think your reaction would have been?

Kortney West: Similar, so not judging, you know. I have a distinct memory of a patient who had gone to a naturopathic physician, and they asked me to order these labs, and I went and I looked at them, and I was like, “I don’t know what this is going to do. Let’s not do this; let’s do this.” I did order most of them, just because I was curious, and I actually did go and do extra reading, but that takes time. And then I realized, and recognized, that I don’t have that time now, with four kids, that I did when I was first starting out and had a DPC, or direct primary care, practice with a limited number of patients. So there is no judgment, but I also think that if we were taught this in our education, and to be more open to alternative types of methods and testing, then it would be a lot easier for us to collaborate with other practitioners who are not allopathic physicians.

Kevin Pho: Now, you use terms like integrative medicine and alternative medicine, and to a lot of people these are kind of nebulous terms that can mean a lot of things. So in your case, what do you mean when you say integrative medicine or alternative medicine?

Kortney West: Yeah, so when I say integrative medicine, I like to think of it as bridging other philosophies, right? So there’s Eastern traditional Chinese medicine, Ayurvedic medicine, herbals, mindfulness practices, and just looking at nutrition, that sort of thing. So in my mind, it’s all-encompassing of that. And then when I say integrative, I want to integrate that into my traditional training. I’m not saying, “Let’s throw out everything that I learned.” I know that antibiotics are going to be really important when you have full-blown sepsis. But I’m more approaching the overall healing and preventative aspect of it, with things that we don’t necessarily do in traditional medicine, or unfortunately have time to do in traditional medicine.

Kevin Pho: So give us a common case study or story from your practice that could really illustrate that integration between allopathic medicine and some concepts from other philosophies.

Kortney West: Well, an example of that: I got a message thanking me the other night from a parent whose daughter had really bad anxiety. She had been dealing with it, and the pediatrician appropriately referred her for therapy. Therapy wasn’t working, and they came back and started her on Zoloft after the therapy wasn’t working, which is of course what I would do, and I think that is a fine approach. Mom was leery of starting the medications and wanted to know more, so she came to see me. We did lab work and found that she had some nutritional deficiencies: Her iron was really low, and her vitamin D was low. So we started her on vitamins and some probiotics. We’re also in the process of doing a gut health test. And we started inositol, which is a supplement that has been shown to be effective in anxiety, in addition to continuing her therapy and starting a meditation series specifically for kids. And she’s better without needing the Zoloft, and that’s just so far.

We also talked about her nutrition and exercise, and I’m sure her pediatrician did talk about all of this, but it’s a lot different when you can talk about it for an hour, in the context of everything, and explain why it’s so important and why it’s needed, as opposed to being rushed through the mill and then being given a medication when these other things weren’t addressed.

Kevin Pho: So tell us what your practice is like now. Your experiences allow you to practice more integrative medicine, and you have a practice that kind of focuses more on that. So give us a sample of a typical day and what type of patients you would see.

Kortney West: Now I see a lot of different patients. My days right now are a bit hectic, because we did recently discover mold, so there are a lot of personal things going on in terms of house remediation, and still trying to help and heal my children. So that’s another benefit of having my own practice: I can schedule around all of those things. But I will typically see four to five patients a day. Sometimes I’ll concentrate those into the morning. But that really allows me to dig into their particular needs.

I’ve started using a genomic-based test called IntellxxDNA, which is phenomenal. It’s a clinical decision support tool, so it’s not an FDA-approved test, but it does test your genes. Then I can really go in and say, “This particular patient has this SNP, which affects how they process pesticides, so in their treatment regimen, we’re really going to have to focus on buying organic food, or the Dirty Dozen at least, and avoiding different pesticides.” So I’ve been able to learn a ton and really apply that very precisely to different patients. So that’s kind of what I spend my days doing. And then I have a lot of interactions with patients in between their appointments, so daily messaging with patients in between their appointments.

Kevin Pho: Now, you also mentioned that there are a lot of things that simply aren’t taught in allopathic medical school. So if you’re in charge of the allopathic curriculum, what changes would you make, and what would you teach medical students that’s not being taught today?

Kortney West: Yeah, I think it’s important to expose them to integrative physicians and have at least one or two classes with somebody who has formal integrative or functional medicine training. It is very scientific and very evidence-based. And one of the things is the mycotoxins, for example, in mold. That’s just not really addressed. I had a patient who I saw had aspergillus on a bronchial specimen, and they just classified it as a contaminant. But if you look and you talk to most integrative or functional medicine practitioners, and this patient is having significant respiratory symptoms, that’s not a contaminant; that’s a reason. And we don’t learn about that at all.

So I think just talking to somebody, and having some of these case studies shown in medical school to at least introduce students to these concepts and show that they are evidence-based, would be helpful. Unfortunately, there are a lot of physicians who are, you know, in functional medicine and do things differently and may take advantage of the system, but I would say that’s few and far between, and the vast majority are actually really interested in healing patients.

Kevin Pho: Now, if patients wanted to look for an integrative clinician, or if I, as a primary care physician, wanted to refer someone to an integrative clinician, what kind of questions should they ask? Because there are some, like you said, that are less than scrupulous and perhaps do it to sell whatever brand that they want to sell. What are some things that we need to look for to make sure that an integrative clinician is legitimate?

Kortney West: Yeah, I would ask for their training, right? There are a lot of different integrative fellowships that you can look at that are certified. At the Institute for Functional Medicine, they have different certification programs. I, for one, am not certified in anything yet, but I am actively taking these courses, and so I disclose that to all of my patients and tell them, “I practice medicine. I have a medical degree, but I am very interested in this, and so I’m learning these things.”

And a lot of times, you can also ask where they get their supplements from. You can get the supplements from anywhere, and if they’re pushing them specifically from their own, I would think that would be a red flag for you, because if they’re doing that, then obviously they may be wanting to try to make money, as opposed to really helping.

Kevin Pho: And my final question, Kortney: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Kortney West: Be open-minded. Just because we don’t learn something doesn’t mean that it doesn’t exist. And always keep learning.

Kevin Pho: Kortney, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Kortney West: Thank you so much.

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