For practitioners working with clients and patients who struggle with exhaustion, feeling burnt out, and a long list of other symptoms, it can be a real challenge to feel like you are helping at all!
The Big Challenge
The big challenge is to guide them from POINT A—feeling totally run-down and having a deeply dysregulated body—to POINT B—where the mind, body, and spirit are in balance and they celebrate feeling fully alive again!
We all want this path to be smooth, linear, and, well, QUICK (if we are honest!).
Yet the path to real health is rarely smooth. I find that patients and practitioners alike get discouraged when things are not progressing with ease or speed. We get stuck in our own expectations and critical mind.
The Process can be bumpy
Truth is, the process can look and feel pretty bumpy—AND patients can still be doing massive healing beneath all the commotion.
I have spent years working with patients who suffer from chronic illness, and I have started to see some recognizable patterns in their healing journeys. I want to share those here.
Back when I was on the clinical faculty at the naturopathic college, I shared these observations with my students. I drew everything out on a chalkboard with a graph and the anticipated pitfalls. VIDEO version is here!
I am fortunate—in my practice, I spend hours with my patients. This allows me to see and understand certain patterns, and I am able to share these clinical pearls with you.
Patients who have complex chronic illness, may have multiple root causes that lead to a dysregulated system.
But WHY? And HOW?
Figuring this out is part of the healer’s job, so you can help your patients get back to a more-regulated state.
Physicians and patients alike have the expectation that this journey of discovery and healing will be linear, a steady path to the patient’s and practitioner’s health goals.
And sometimes that does happen!
We’ve all had that experience where the process is fast, like magic. I certainly have. And I’m sure you have as well.
It is exciting when that happens, but it is also rare.
It’s far more likely that the patient’s journey will go up and down, and plateau now and then. More like going around the mountain instead of climbing straight to the top!
We all want to get to our health goal—the summit. This is what we call wellness, remission, full vitality.
What I want to share is what’s happening in these dips and plateaus, in order to make the journey to the health goal easier. But first I need to provide some context.
When I talk about “treatment,” I’m speaking from the perspective of a naturopathic functional medicine doctor.
Treatment for me is lifestyle.
Treatment is nutraceuticals.
Treatment is botanicals.
Treatment is pharmaceuticals.
Treatment is working on the subconscious mind.
I have a huge tool kit to choose from when I want to find the right treatment for a patient. For me, treatment may mean that the patient is working hard to retrain their limbic brain.
So when I talk about treatment, I’m not saying, “Here’s your script—go fill it, and let me know how you feel in a month.”
I’m saying, let’s change the way your whole body functions. And maybe that’s through diet, maybe it’s through moderating your sleep, maybe it’s even through transforming the way you perceive your being to be.
In my experience, many patients feel better after the first visit. I think this is because somebody finally believed them, heard them, saw them—and isn’t freaking out at the complexity of their situation.
They experience hope. They feel relief that someone understands them. Humans like to be seen and to feel heard. It makes us feel better.
And then they start on the protocol.
If you get it right on the first visit, they will continue to improve, and it can be smooth sailing up the line of health—they’re feeling so good!
Until they aren’t.
Around the third, fourth, or fifth visit—uh-oh. They often start to plateau, or maybe even dip.
“I was feeling so much better, doc, but now I’m more tired.”
And this is when the unaware practitioner may start freaking out and thinking or saying,
“Oh, no, what am I doing wrong? What is the patient doing wrong?”
Now, of course, you DO have to check in.
Did I miss something? Check in with your DDX. Is something else happening in this body that I need to pay attention to? Is the patient following the protocol or not? Was something misunderstood or missed?
Assuming you are still clear on your diagnosis and treatments, these dips can be due to a couple of different things.
Dips and Plateaus are caused by different things
- They may have done a very human thing: They started to feel better. So they went off the diet that you put them on. They started having a little bit of wine, a little bit of dairy, a little bit of gluten, a little bit of sugar, and whatever else they shouldn’t be eating because it causes inflammation. They started eating these things again because it was their birthday, or because they were feeling better. This is a very human thing to do, and very common!
- They may be a super compliant patient who did everything perfectly, but they still present with this pattern. But WHY? The way I see it, the body is saying, “Thank you so much for all this work that you’re doing! Now that you’ve gotten the inflammation down so that my digestive system is finally working, I’m going to release all of this toxic junk that I’ve been holding in the joints.” And the body starts dumping heavy metal, or clearing a latent infection, or something else.
(I realize this might sound weird to you, depending on your training. I would love your thoughts and comments—do you see things like this happening, too? Or is it a new concept?)
But one of the things we need to be most careful about is NOT assuming that this is why your patient is not feeling well.
So how can you tell if you are on the right path with them and the dip is due to the natural healing process—or if, instead, you are missing something?
You have to start asking questions: a review of symptoms, or whatever format you use to assess. You did it at the first appointment, and now you do it again.
I had a patient who I’ll call Patty.
She had ME/CFS, IBS, anxiety, depression, ADHD, insomnia, and PTSD.
P: “I was doing so well. And now I feel bad again, and I’m so disappointed because I had so much hope!”
I started asking her my questions:
Me: “How is your digestion?”
P: “Oh my gosh, it’s still been really good.”
Me: “OK, great. And how’s your sleep?”
P: “It’s still challenging, but I’ve improved. I can fall asleep most nights and stay asleep a few nights a week.”
Me: “OK, and how’s your mood?”
P: “Well, I’ve noticed that it’s actually been a bit better. I’m not depressed anymore, I feel more hopeful in general, and I can focus on things for part of the day before I take a nap.”
To me, this is a clear signal—we are on the right path. We just need to reassure the patient and urge them to keep going!
Why else do people plateau?
3. The body is doing just fine.
Maybe, just maybe, the plateau happens because the body is working!
I think it’s easy to forget how much energy it takes to heal. Maybe your patient feels more tired because the body is spending time and energy on actually remodeling, rebuilding, recalibrating.
4. The protocol is pushing the body and it’s dumping toxins—a Herxheimer reaction is happening, or there’s increased inflammation.
You may be thinking, “Oh, that’s terrible—we must be going in the wrong direction if we’ve increased inflammation.”
Not necessarily! Some inflammation is part of the body’s natural response to infection.
If your patient is harboring a chronic virus—or if they’ve got a chronic fungal infection or a chronic bacterial load—their body may be having an appropriate infectious response.
And that may make them feel worse.
Here we have a choice: either support their body in this reaction and let them release and react, OR slow it down and let the fire cool a bit.
Now, I’m not talking steroids. In most situations, I’m talking about natural ways to support the body to reduce inflammation.
At this point in the process, once the inflammation has gone down, patients will start feeling and doing much, much better.
And then you know what? They’re gonna plateau.
There’s another level of healing for them.
Maybe now that they’re not stuck with a virus or a burden of heavy metals, their body can start to deal with some deeper mental or emotional issue that’s been there for a long time. Now they’re working with that. And that takes energy too, and it makes them feel kind of rough for a while. But they’re doing their deep work. They’re doing exactly what they need to do. And they just need to be held there.
Again, you go through your questions to make sure you haven’t missed something. Review your DDX. See if there is some way you can support them through this process to make it a little bit of a shorter line.
In truth, you may just need to hold space for them. Let them know that it’s OK that they’re plateauing in this way, because you can see that they’re healing on a deeper level, and it’s going to serve them over time.
My Personal Experience
Personally, I’ve been through this several times. I’m pretty sure I had the H1N1 flu years ago. I’ve never been sicker from an acute virus. I’ve been sicker in other ways, but not from a virus. I had a fever of 103.5°F.
I had this fever off and on for two months! I had a chronic cough, dual ear infections, secondary fungal and bacterial infections—it was terrible. I was really out of it for about two months.
But I have to say, when I came out of that, something shifted in my body. I was the healthiest I’d been in forever. It’s like that fever burned through a whole lot of different viruses in my body.
And on an emotional level, something else was going on when I was sick. I really noticed that I was in a very different place when I came out of that illness.
"I believe there can be a gift in every single situation."
Once a patient feels much better and has already gone through a lot of healing, it’s common for them to start taking another dip.
This dip can lead to relapse. Relapse is very, very common with chronic fatigue syndrome and many other chronic illnesses.
What can trigger it?
- Additional trauma or illness. A car accident may happen, or a death in the family. Or there’s another toxic exposure—maybe there’s mold in their home again.
- Human nature. They felt so much better. They went on vacation. They ate dairy and sugar and started drinking alcohol again. They stopped investing in supplements, and now they have dysbiosis, gut permeability, increased inflammation. There may be a shift in their viral load or the expression of their virome.
Whatever the reason, now they are back in your office, worried and feeling terrible again.
And THIS is when I feel SO EXCITED for my patients.
Honestly, I kind of love it when my patients are here.
Assuming nothing new is happening, the plan is simple:
“Take your supplements, do your mindset work, go to bed at a good time. And get yourself back on the wagon before you DO fall all the way back down to the place you started!”
Why do I love it?
Because this is when breakthroughs happen.
NOW they’ve realized how much their choices impact their own health, and they become empowered.
Phew! Did you make it all the way down here?? I hope that was helpful to you!