Finding Common Grounds and Goals

Thomas DePuydt is an M.D. who specializes in Sports Medicine, and recognizes the importance of taking an integrated approach to treating musculoskeletal injuries.

In an interview with The American Chiropractor (TAC), Dr. DePuydt discusses the “paradigm change” which he sees taking place in modern day medicine.

TAC: Give our readers some background information about yourself.

DePuydt: I grew up in Northern Michigan wanting to become a professional football player.  I was an all-state fullback, middle linebacker in football my senior year and I had a full ride football scholarship at Michigan State University.  I was on my way to achieving my goals and dreams, when, during my last game and on the last play of the half, I received a career ending knee injury.

When this occurred, I redirected my energies to academics at Michigan State University.  After completing my undergraduate degree, I was accepted into veterinary school at MSU. Three years into the program, I decided that human medicine was where I wanted to focus my energies.  My primary goal was to become a sports medicine physician.

My initial practice was in Petoskey, Michigan, doing family practice with an emphasis on prevention and sports medicine. By 1980, I had joined my current colleague, Steven T. Bramwell, MD, in founding the second sports medicine clinic in the state, Washington Sports Medicine Clinic. Currently, we are team physicians for the professional ice hockey team, the Seattle Thunderbirds, and the professional soccer team, the Seattle Sounders. I also continue to be the team physician for the Cedarcrest High School Redwolves.

TAC: What influenced you to become a sports medicine physician?

DePuydt: At the time of my career ending knee injury, there were no true team physicians at the high school level.  Generally, if there were an injury on the field, a call would go out to the stands for a doctor to come out to the field. Consequently, a player might be seen by a surgeon, a pediatrician or even an obstetrician, if his or her son was on the team. 
Today, an athlete would be evaluated by the sports medicine physician and certified athletic trainer. With this type of injury, he or she would be taken out of the game and referred to an orthopedic surgeon for appropriate surgical intervention. After surgery, referrals for physical therapy and acupuncture would be appropriate. For a back injury, referrals to physical therapy, massage, chiropractic and acupuncture would be made, if appropriate for the injury.

After transferring to the College of Human Medicine at Michigan State, I wanted to prevent this from ever happening to another athlete by focusing my medical career on prevention and sports medicine for all patients but, particularly, at the high school and university levels.

TAC: How do you apply the principles of prevention and sports medicine in your practice?

DePuydt: Emerson said, “The first wealth is health.” Good health is a direct result of a healthy diet, a regular exercise program and pharmacy grade supplements.  No one can perform at the highest level for an extended period of time without these three things.

I think that the single most important thing that I do to apply the principles of prevention in my practice is to live them and to talk about them on a continuing basis with my patients. This allows me to build the trust and confidence that my patients have in me and in my advice.

I also use an inclusive approach in my practice. When a patient comes to me with a musculoskeletal injury, I use as many different types of medical intervention as are appropriate to bring about optimal results for that patient, be it an athlete, housewife or business executive. These could include a referral to a chiropractor, acupuncturist, physical therapist, massage therapist, podiatrist, clinical psychologist or nutritionist. I have used all of these or just one or two, depending on the nature of the injury. I am also very careful about who my patients see. These practitioners must also want to work using a multidiscipline approach. 

TAC: What is the role of allopathic and holistic medicine in chiropractic medicine?

DePuydt: In my opinion, it is imperative that both allopathic and holistic practitioners develop a wellness format that addresses the total health and fitness of the patient, not just a presenting symptom, like “low back pain.”  It would be, in my opinion, negligent for me to treat such a patient with just prescription medications and nothing else. The same is true of a chiropractor who treats with just adjustments or an acupuncturist who only uses acupuncture.

A patient with low back pain has other issues than just pain that need to be evaluated.  Why is the pain occurring? Does the patient need to be referred to a physical therapist to deal with the underlying instability of the low back muscles and posture issues or a chiropractor for adjustments and stabilization of the spine? If the patient is having radicular pain, an MRI, epidural injections and possibly massage and acupuncture need to be added.  Does the patient smoke?  Explaining to a patient that nicotine causes atherosclerotic vascular changes as well as oxidative free radical injuries to the intervertebral disks could result in the patient’s making the decision to quit smoking and to take a more active role in his or her health and well being.

In this respect, it is important for all professionals in the health field to discuss negative lifestyle issues with patients before they become medical problems.  By focusing on issues like smoking, obesity, strength and flexibility, alcohol intake, diet and exercise, not only can we prevent a whole host of medical conditions, but also our patients will feel comfortable with coming to us for advice based on science, not the latest headline in The Enquirer.

TAC: Which supplements do you recommend to your patients?

DePuydt: First, I would like to state, most emphatically, that supplements do not and should not replace a healthy diet.  It is a supplement to a healthy diet not a substitute or replacement for a poor diet.

The cornerstone of any supplemental nutritional program should be pharmaceutical grade multivitamins, antioxidants and phytonutrients.  A pharmaceutical grade supplement will provide bioavaible vitamins, minerals and antioxidants to the cells of the body.

I recommend fish oil supplements to provide the body with essential omega 3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid.  Scientific evidence documents that these have multiple health benefits to the cardiac system, the brain, the immune system and they decrease the cellular inflammatory response. I use this, specifically, to decrease the inflammatory PGE-2 prostaglandins when treating patients with musculoskeletal injuries and patients with osteoarthritis.  By decreasing the systemic inflammatory response, the patient can help to decrease the risk for myocardial infarction and cerebrovascular accidents.  Omega 3 fatty acids, EPA and DHA are essential for the synthesis of phospholipids.  Phospholipids are the essential components of all cell membranes, which are particularly important for healthy neurons and cells within the brain.

For my osteoarthritis patients, I use a pharmaceutical grade glucosamine sulphate and a new arthritis supplement called ASU (Avocado-Soybean Unsaponifiable).  ASU is a supplement made from phytosterol oils extracted from soybeans and avocados. ASU has been used in Europe for the past 15 years with excellent results.  The Europeans have conducted basic science studies and controlled clinical trials that support its ability to decrease enzymatic destruction of articular cartilage and increase synthesis.

I also prefer to use herbal NSAID supplements for patients with chronic conditions in place of the potentially toxic Cox-2 NSAID.  Vioxx is an excellent example of the harmful effects that can occur with long term use.

TAC: What recommendations would you have for chiropractors who aspire to be sports medicine physicians?

DePuydt: Chiropractors are a vital and integral part of a multidiscipline sports medicine team.  For chiropractors aspiring to become sports medicine physicians, I have the following recommendations.  First and foremost, you must have the desire and the passion to be a part of the athletic community and be willing to donate hundreds of hours of your time and expertise as a community service for school and recreational athletic programs.  As a sports medicine physician, you must also want to be part of the team by being involved with the coaches and athletes, both on the field and in the locker room, and by being a student of the game.

The next step is to contact a colleague within your community who is already involved and make a commitment to help them. Learn your limits as a physician and develop a core group of physicians who have different areas of expertise for injury referral and then use them.

Make yourself visible to the community as a physician who is willing to donate your time and expertise to help the athletic community by contacting recreational soccer, baseball, and football leagues or any other athletic organization and offer your services. Enroll in courses that are available through the chiropractic colleges to become certified as a chiropractic sports medicine physician.

If you make a commitment to providing quality professional care to athletes as a community service, not only will you benefit your practice, but you will be rewarded in knowing that you have made a real difference and provided a valuable and valued service for the community in which you live.

TAC: Do you have any final words of advice to our readers?

DePuydt: I strongly encourage you to look at your patients in a proactive wellness manner and not just as patients with back or neck pain. Look at positive and negative lifestyle issues and spend time with your patients educating, not just adjusting their spine. Providing education to your patients on the importance of a healthy diet and exercise program will help not only their spines but all of their other systems as well, and they will return to you time and again for your guidance and expertise. 
I also encourage you to practice, in your daily personal lives, what you profess in your professional ones.

I firmly believe that medicine, as we know it, is on the cusp of a paradigm change.  It is time for each of us to expand our horizons, stop worrying about losing patients and start thinking outside of our security blankets.  Allopathic and alternative medicine physicians need to start forging alliances. We need to stop defending our turfs and use a proactive integrative wellness approach to treat our patients.

After twenty-five years of utilizing an integrative approach in my practice of sports medicine, I have seen its power to heal. I have also seen what happens to patients when their physicians do not use this approach and they, then, come to me through sheer frustration. Our patients are demanding integration, and we must, if we are to remain in practice, embrace it. As a collective unit, we can help our patients to lead healthier, happier and more active lives.

Dr. DePuydt may be reached by email at [email protected], or call 425-820-1221.

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