Dr. Folckomer is the owner of the wellness facility, I.D. Lab New York, in midtown Manhattan. She is also the co-founder of the international seminar series, Immaculate Dissection, and an adjunct professor at Seton Hall University School of Medicine and Pacific College of Medicine. She focuses on a unique combination of functional anatomy, acupuncture, rehabilitative exercise, and manual therapies that she creates via assessment, treatment plan, and most importantly, an educational experience for the patient, to better understand and respond to any given condition.
In particular, I asked her about nickel allergies, since I’ve blogged about that before (here and here) and received so many responses from people suffering but who can’t find adequate assistance:
EIBBB: Tell us a little about you, your background and what you do.
Dr. AF: I’m a licensed acupuncturist, board certified herbalist, and anatomy teacher. I have a clinical doctorate and I get to teach a lot of anatomy! I teach gross dissection at Seton Hall School of Medicine, Anatomy and Physiology at Pacific College, and I co-founded a continuing education seminar called Immaculate Dissection with two of the greatest people I’ve ever had the pleasure of knowing. My background was actually in dance, but then I sort of became obsessed with the choreography that gets everyday people through life, and shifted my focus to learning more about how to understand the human body. Also, to be fully transparent, I wanted to be a dancing doctor when I was little, which as far as I knew wasn’t a real thing, so I’ve had a wonderful fulfillment in attempting to achieve that! I own a clinic in midtown where I have the pleasure and honor in seeing my patients and sharing it with brilliant practitioners.
EIBBB: What is the difference between a holistic physician, such as yourself, and a conventional physician?
Dr. AF: I’m not confined to a compartment or set of conditions the way that other physicians are. It’s unfortunately not uncommon for people to see 5+ different doctors for different areas of their body and none of them are communicating with each other. I’m typically the 8th or 9th specialist a person will see for a condition, so the challenge is on to think outside of the box and get to work. My job is to put all of the puzzle pieces together, but then also to communicate with and refer to the rest of a patient’s healthcare team. I’m lucky enough to get to view the body from multiple lenses- western medicine, functional anatomy and biomechanics, lifestyle influences, and eastern medicine, and somewhere along the way it paints a really nice picture of the patient. My approach becomes more about using problem solving strategies within the art of healthCARE for the individual.
EIBBB: How do you recommend finding a good holistic practitioner?
Dr. AF: It’s about a team effort! If you’ve got someone on your health team that you like, ask them who they work with and refer to. There are some really great types of practitioners out there. Of course you can look at their background, education, and inquire about their experience with a certain collection of symptoms and that’s a great start. I’ve worked with so many different types of healthcare practitioners that continuously impress me in terms of what they’ve done with their professional experience and continuing education. People expect to be great practitioners right out of the gate from school and that’s just not true. It’s called clinical PRACTICE for a reason, so I like working with folks that have embraced that! I’m much more interested in what they’ve done in their professional career to keep up, form networks and working relationships with other healthcare practitioners, and continue to learn about how the human body works. We’ve all heard the phrase “the more you know, the more you realize how much you have to learn” and I like to work with professionals who really get that because it limits dogma and ideology. No one knows all there is to know, but a good practitioner knows that and is willing to problem solve, advocate, and learn more for you. Being confident and wrong is a scary thing in medicine and unfortunately it happens sometimes. I love co-managing with professionals that stay very present, ask questions, and avoid just relying on protocols. Protocols have their time and place, but need be kept in check by the fact that all patients are individuals. Regardless of the type of physician, the word “doctor" means teacher, (to indoctrinate) and so proper, good quality, healthcare absolutely must include time for education, explanation, and communication.
EIBBB: What are the top 3 areas of concern patients come to you with and how do your treatment plans differ from what one might expect from a conventional Western physician's office?
Dr. AF: I see a lot of pain management, digestive issues, and hormonal issues. But to be honest, people rarely come in with just one area of concern. Typically, people come in with a handful of symptoms that are all related, whether they realize it or not. My number one area is helping people put all of their puzzle pieces together, which sets me apart from some conventional medicine approaches. So many people are told their symptoms aren’t related, but of course they are! How could they not be? I love a good assessment and intake process. It breaks my heart how many people get less than 10 minutes with their doctors. That’s not enough time to feel heard or to problem solve. My initial appointment is 90 minutes, because I want that time that to assess and get acquainted with the patient’s symptomatic expression.
EIBBB: As you know, I blogged awhile back about nickel allergies that could cause systemic dermatitis. There is an emerging body of research suggesting nickel from foods - e.g., nickel ingested internally - can cause dermatitis, however, a nickel-restricted diet is pretty difficult and seems unhealthy since it eliminates huge swathes of "good-for-you" foods like veggies and legumes. Have you treated patients with dermatitis caused by nickel (from ingestion) allergies? Do you have any thoughts or suggestions on this topic?
Dr. AF: Yes, you are correct. Allergic contact dermatitis commonly occurs as a localized reaction to topical nickel and systemic reactions can occur from dietary nickel ingestion and there is fantastic peer-reviewed research on this. Ingestion of nickel triggers an immune response that often correlations with an exacerbation of contact dermatitis. Nickel, like so many other natural occurring minerals, is necessary in the body in small amounts. We have to assess this from a wide angle though and be mindful to not just place the blame on the wrong culprits here. Before we just blame the veggies and legumes, lets consider other factors. First of all, region, water supply, and soil conditions are going to play a role in a lot of mineral issues. Equipment used in food processing, faucets, and cookware can all contribute, as can the presence of other vitamins and minerals that effect the absorption of nickel like Vitamin C and Iron. Also, nickel is excreted through sweat and stool, so we have to ask what is the patients ability to sweat, digest, and have a normal bowel movement like? If it’s not coming out, of course it’s building up! Also, what is the person’s general immune response like? What is their inflammation like? Acidity also plays a role in nickel allergies. I don’t think step one should necessarily be cut all nickel containing foods, especially since so many of them are high in fiber and are going to cause you to excrete more nickel through your stool anyways. Let’s start by getting to know the role of nickel in each individual and the factors that go into their response of it’s presence. Those are bound to be unique to each case.
EIBBB: As a former professional dancer yourself, you probably are familiar with and see a lot of patients with back, hip and foot pain. What are some of the typical modes of diagnosis and treatment you use for these types of patients?
Dr. AF: I watch them move because I don’t know why they have that pain until I see the way they move through life with those structures. I’m not going to give them an ideologic label just because it’s one I “know a lot about”. There is not and should not be a “hip pain protocol”. Pain can be such a gift into our understanding of how we get through life. I have to do a gait assessment, I want to know what their choreography is like when they go up and down stairs, go from sit to stand, walk across the room, bend over, etc. Our bodies are BRILLIANT and extremely impressive at compensating. If I watch someone move, they’ll show me why and where they are likely to have pain. It’s suggestive of a strategy that has served us well, but may not have been anatomically correct, which will create some discomfort. So much pain comes from just using that area too much and pain is like an alert that says “hey you’re using me too much, and this wasn’t necessarily my job in the first place!” Once I get to know the way their body moves and compensates, I use acupuncture and other manual therapies to help calm the area of awareness, and prescribe corrective exercises to help recreate new strategies that don’t generate discomfort. Holistically, I have to also consider other factors in their life that might be encouraging inflammation through diet, etc.
EIBBB: What are some of your favorite general tips for maintaining good health?
Dr. AF: Moderation. Emphasis on basic physiological processes. Sleep well, eat well, breathe well, move more, get sunlight, and stay present with your thoughts. This seems like such a simple thing, but I think we often overcomplicate things and try to hack our way around just keeping it simple. We should observe our own mental awareness and our relationships with all of these physiological processes as well. This is so important for people who are in pain or have a symptomatic expression of some sort. It consumes their thoughts and we get so caught up in just making it go away because it’s wired to our limbic system and considered a perceived threat. But if we change our relationship to symptoms, especially pain, we can start to ask why. Why does my knee hurt? No, it’s not because you’re broken, it’s because you’re so amazing you’re probably using your knee to pick up slack from your hip or ankle that’s moving slightly less than optimal, etc. Meditation and awareness does wonderful things to our ability to check in with ourselves. Symptoms and pain are expressions of the body, and we need a clear state of mind, (and a good assessment!) to start to understand those expressions. When you look at it like that, the goal shifts from “make it stop” to “let’s understand this, listen, and respond.”
EIBBB: In recent health news, 3 supplements have been touted for "everyone" - Vitamin D3, probiotics and Omega-3's. What are your thoughts on that and, for those who enjoy a plant-based diet, what are the best ways to get Omega-3's without consuming animal parts?
Dr. AF: They’re touted for everyone, because they’re necessary in our bodies, but we should remember not everyone is operating at a deficiency and we’re all individuals. What I need and what you need are going to be different, and may not require the same problem solving strategy. The father of modern medicine, Hippocrates, said “Let thy food be thy medicine”, so it makes sense to at least start there. Vitamin D is created in your skin when sunlight hits it, so it doesn’t make sense to me to cover myself in clothes and a skin barrier and sit inside under flourescent lights all day, and then take a manufactured high dose of a fat soluble vitamin that I’ve got to make sure I can even digest in the first place. There’s a wide range of normal for Vitamin D and recent research has also shown that theres no therapeutic difference in lower ends and higher ends of that wide range. I want to be clear that I’m not encouraging people to stop their supplements, nor am I suggesting these things are bad, I’m encouraging people to ask questions and keep it simple. Vitamin D is necessary for many physiological processes and Vit D deficiencies are a real thing that creates problems. But we do not all need to be on a supplement of it, when you can get it free outside and through food. Probiotics are great and also necessary, but you also may be supplementing the wrong one. If you’ve been on Lactobacillus acidophilus for years, but you actually have a deficiency of Bifidobacterium bifidum, then that Acidophilus supplement isn’t helping. There are great stool sample tests that can help you determine your individual needs. Omegas are also necessary for good functioning, Alpha linolenic acid is an Omega 3 found in many nuts, seeds, and plants. Our bodies will convert a small amount of that ALA into DHA and EPA, so it’s a great idea to boost ALA rich foods in general. Algae derivatives are a vegan source of EPA and DHA, that actually hold up in research in comparison to fish versions.
EIBBB: What does "Ethical is Beautiful. Be Beautiful" mean to you?
Dr. AF: I really love this! The word “ethical” means a lot to me as a person in healthcare and as a person who has followed a plant based diet for over 20 years. Like my other colleagues in medicine, I took a Hippocratic oath when I graduated, where I promised to first and foremost, “Do no harm”. That phrase to me is beautiful because it suggests transparency, authenticity, care, and good intention. God knows I am so far from perfect, but I get to learn a lot every day, and so I make every attempt to prioritize this statement in all professional and personal decision making, because that’s the promise that I made. As long as I hold that sacred, I can be proud of each day when I go to bed each night, and that feels like a beautiful thing to me.
EIBBB: For those interested in learning more about your holistic medical practice in NYC, how can they contact you?
Dr. AF: You can contact me through my website at www.drannafolckomer.com. I would love the opportunity to help, learn, and grow with anyone who is interested! For more interest in the continuing education seminar series, please visit www.immaculatedissection.com.