Gall Bags, Spring, and Other Mysteries

Has Spring come to your part of the world? Because it is slow to arrive in Maine. Most of our world here is still a monotonous palate of gray, brown, pine green, white, dirty white and cold blue. April has promise, because today the sun felt warm even with the cool wind. And little shoots of yellow-green things are growing in the dirt!

Naturopathic Medicine heralds spring as the season of the liver – like trees stagnant over the winter our saps start to flow too. And our sap in this case in not blood, but bile. The ancient Greeks separated bilious humors into yellow, and black. Yellow bile is what we now call bile, stored in the gall bladder and useful in digestion. Black bile is a far more mysterious, melancholic and deadly humour, and one that I will have to investigate further when I am not studying for surgery exams.

So far this clerkship has been “general surgery” which has been primarily cholecystectomys and hernia repairs. The standard of care is to electively – or emergently – remove every gall bladder that presents with symptoms and evidence of stones or sludge. This makes sense because once one stone has caused problems, its pretty likely another will eventually. Complications can be pretty intense – gallstone pancreatitis with or without ileus is nasty, as is choledocolithiasis and ascending cholangitis. I am on board with this plan.

The best plan of action to avoid having gall bladder surgery is prevention. Inspired, committed lifestyle and nutritional prevention years before the problem starts. Not many people are willing, or have access to the knowledge to practice the kind of prevention that is required to avoidgallstones. By this I mean, too many people are never educated about the impact of food choices on health,  or just dont care enough to make the choices to eat an every day diet with good quality oils, moderate animal proteins and high fiber, high antioxidant, high phytonutrient grains and fruits/vegetables. (This is a whole other conversation about class, nutrition, education, access and economics.) Individuals also need to have the spark of interest to learn about plants as medicine and botanical therapies for liver health, as well as the initiative to either track down someone to act as a herbalist or dabble in self care. Because, once gallstones are formed there are some treatment options but…. not many. And IMHO, not many that are truly effective.

For those out there looking for guidance, herbal medicine combined with nutrition is the best way to maintain long term liver and gall bladder health. According to a PubMed Physiology text, bile is formulated in liver cells and modified by cholangiocytes as it travels through the bile canalicula. It is essentially a watery mix of cholesterol, bilirubin, phospholipids (fats), bile salts (broken down cholesterol bound to amino acids), proteins, bicarbonate, salts, and enzymes like alkaline phosphatase. Bile is classified as a mechanism to eliminate waste from the body, and I suspect it carries dubious products from the CYP enzymes that are not fully metabolized by an overburdened liver as well.


With this in mind, increasing bile flow with bitter alkaloids and other phytochemicals inherent in plant medicine are a logical way to improve gall bladder health. There is one botanical I know that have specific use for stones in the body called peumos baldo, but most of the hepatophillic herbs simply increase bile flow thereby decreasing stagnation and thus stone formation. One well-known liver loving botanicals is milk thistle (silybum marianum), which is insanely hepatoprotective and has multiple studies on it for chemical insults. This will not likely help with bile health directly, but it does protect hepatocytes from repeat insults from drugs metabolized by the CYP enzyme system such as antidepressants, anti-epilepsy drugs, birth control, alcohol, narcotics, and some antibiotics.

Dandilion (Taraxacum officionalis) and artichoke (Cynara scolymus) are often paired for their cholegogue effects. Its very common to see these three together in standardized formulations as they are probably the most well known players – and for good reason because they are safe for most healthy people and have a very long historical use for all sorts of “bilious” afflictions including gall stones. Of note, if you have lots of gall stones sitting in your gall bladder or have already had gall stone attacks,  taking high doses of cholegogues could precipitate an attack of acute cholecystitis. However, if you have already had your gall bladder removed they would be safe. There are many other plant medicines for bilious health employed by Naturopathic Doctors and herbalists world-wide, from many indigenous systems of medicine. Seeing an expert for individualized medicine is always the best choice for safe, effective and appropriate treatment as the liver, like all organs in the body rarely acts in isolation. Thus, the best medicine takes your whole health into account.

Finally, we think of natures medicine as extracted herbal “drugs”, but plain old water is so therapeutic for liver health. If bile is an aqueous solution, then chronic dehydration from caffeine/alcohol soda/sodium must lead to a concentrated and hypersoluble solution, right?

Vegetables are also medicinal plants. Spicy and bitter greens have the same cholegogue activity as dandilion and artichoke and are very safe to consume. Cruciferous vegetables like cauliflower, broccoli, kale and brussel sprouts have documented chemical constituents that improve estrogen metabolism, thereby improving bile flow. The fiber binds excess cholesterol and maintains bowel health, and they have documented anti-cancer properties. Eat your broccoli!  Beets and carrots are rich in carotenoids which give their vibrant colors. These have traditionally been used as healing foods for the liver and although I do not know the exact reason why, can they hurt? Only if you hate beets, I suppose.

I have to stop writing this post, because I have to be up at the crack of dawn for another laproscopic cholecystectomy tomorrow. Its a surgery that definitely needs to be done – the woman has had some significant blockage from a stone that miraculously moved on its own but caused an elevated bilirubin as well as weeks of abdomninal pain and distress. It would be unsafe for her to just wait around for that to happen again, because where there is one stone, there are probably two. And where there is a chronically dehydrated American taking multiple pharmaceuticals and eating the SAD, there will always be another gall bag to take out.

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The Pain Conundrum: Options & Alternatives

I’m a woman with chronic pain. It waxes and wanes, but I have been on flourbiprofen, a prescription-strength NSAID for about 20 years. I take it about a week before and the week of my menses. That is two weeks a month of strong NSAID use. Plus, ibuprofen for occasional headaches or other pains.

After spending a week observing a nephrology office in January, I started thinking about my own NSAID use and  kidney health. After getting some lab evaluation (creatinine, BUN and GFR) it turns out I have stage 2 kidney disease. WHAT!! I consider myself an extremely healthy woman, and no doctor has ever mentioned kidney issues, much less had a conversation with me about the well known, scientifically proven ways that NSAIDS like ibuprofen, alleve, midol, and aspirin damage kidneys.

Here is the science: The kidneys receive about 25% of the blood flow from the heart, and filter blood through their delicate & intricate filter and tube mechanisms.

 It is prostaglandins that increase pain and inflammation. All NSAID medications work by inhibiting the cyclooxygenase (COX) enzyme, thus decreasing prostaglandin synthesis.However, ibuprofen and all NSAIDs also interfere with the body’s natural blood vessel constriction and dilation hormones through this system, ultimately affecting the kidneys. In the long term, this damages the delicate kidney structures from irregular blood flow. It can also lead to chronic high blood pressure.

To make matters worse, there is a second way that ibuprofen, aspirin and other NSAIDs damage the kidneys. The immune system can react against these drugs and cause an inflammatory reaction right in the matrix of the kidneys. This is called Acute Interstitial Nephritis and can happen after only one week of use. It can also become a chronic, simmering problem that is definitely underdiagnosed.

So, what to do? We cant use opioid pain medication like we used to because it is extremely addicting, and now ibuprofen, aspirin and products like Motrin or Alleve are also harmful. Sadly, acetaminophen, or Tylenol is a centrally acting medication with little anti-inflammatory action and it doesn’t work well for most pain although it is great for fever.

First of all, I would argue we as a culture need to become a little more tolerant to living with some discomfort. Pain is often a sign that something else needs to be addressed: like, hydration, nutrition, posture, or drug/alcohol overuse.

Second, the practice of prevention goes a long way to decreasing the duration and quantity of pain medications needed. WE ARE LAZY!! Simple stretching and at-home exercises can do wonders for back and body pain as can weekly yoga. People who don’t know basic stretches can be referred to physical therapy for individual assessment; this is covered by most private and federal insurances. The newest guidelines from the American Academy of Family Physicians recommend:

“Nonpharmacologic treatment, including exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, cognitive behavioral therapy, or spinal manipulation, should be used initially for most patients who have chronic low back pain.”

Finally, botanical medicine has an evidenced role in combating pain. Most herbs are better used proactively for prevention of pain and inflammation than acutely when symptoms are already present. Turmeric, ginger, black pepper and boswellia all have a long history of use for muscle and joint issues. New Chapter has a herbal Zyflammend product line that specifically addresses pain and/or age-related joint disease that is worth trying. Take as directed on the label, 2 tabs daily for at least 6 weeks to assess your response.

DLPA is a less used supplement for chronic pain and depression. This is DL-phenylalanine, an amino acid that gets converted into tyrosine. Rather than directly addressing pain, DLPA slows endorphin breakdown by decreasing enzymatic function. This results in higher endorphin levels for pain control as well as increased adrenal hormones such as norepinephrine. The dosage varies from 1500mg on an empty stomach each morning to 200mg twice daily. For gynecological pain like mine, cramp bark is another option. This needs to be taken in moderately high doses (3 caps 2-3 times per day)  just before menstrual pains begin, and continued throughout the pain window.

These are all good options for all kinds of pain, not just back pain. If we as a consumers were willing to put the same effort into treating & preventing our various pains proactively instead of just popping 3 Advil every 4 hours, we may live longer and healthier. The effect on the kidney is also real, and needs to be talked about more. I see patients dying of kidney failure in the hospital every day, and it is not pretty. I know that I am forcing myself to be more tolerant of the low grade pains I live with, and I just started using herbs (Vitanica’s cramp bark) and (walking and stretching) exercises in an attempt to minimize the pain medications I may really need in a few days. I am hoping it makes a difference, because my kidneys aren’t really up for another 10 years of this.

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Insomnia is the Worst!

luxury-hotel-rooms-pamilla-cape-townI was on vacation with my sweetheart this past week, and spent two long nights in a hotel room when I could.not.fall.asleep! What to do? It was so exhausting, and of course set my mood and energy levels off for the remainder of the trip.

When I evaluate sleep from an Integrative Medicine perspective, I usually break it into –

  1. unable to fall asleep
  2. unable to stay asleep.

The former tends to have a different set of causes and therefore medications than the latter. Sleep is complex and involves multiple body systems working together including endocrine, neurological, immune, musculoskeletal, and mental/emotional at the very least! Each person with chronic insomnia will benefit most from individualized treatment, but here are some generalizations to improve sleep.

First, as boring and arcane as it sounds, sleep hygiene is important. Hygiene is a strange word to associate with sleep, IMHO. It sounds weird and uncomfortable, but “sleep hygeine” is a general concept that encompasses the environmental and behavioral aspects that are known to improve sleep quality and promote restful sleep. For example, my hotel room was too hot both nights. Maintaining a comfortable room temperature preferably cool with fresh air, is known to improve sleep quality. A darkened room without blinking or other lights within eyesight and a peaceful bedtime routine are also examples of sleep hygiene.

untitled     To fall asleep, sedatives are the key. Valerian is the strongest herb for sleep support. This herb was mentioned by Hippocrates in his writings, and is one of the oldest sedatives known. It has numerous studies supporting its use for sleep. The essential oils in valerian appear to provide its sedative activity, while the valepotriates exert a regulatory effect on the autonomic nervous system.  Although more than 150 constituents have been identified, none appear to be solely responsible for valerian’s effects, suggesting many compounds may act synergistically. Valerian’s mechanisms of action are not completely understood.  Valerian interacts with neurotransmitters such as GABA and produces a dose-dependent release of GABA. Valerian also inhibits the enzyme-induced breakdown of GABA in the brain.

GABA is my other secret weapon for falling asleep. There are two on switch neurotransmitters (dopamine and acetycholine) and two off switches (gaba and serotonin.) When the off switch is stuck on, sleep becomes difficult. Taking GABA as a supplement improves GABA levels in the brain, quieting the mind. Benzodiazepenes like Attivan and hypnotics like Ambian also work to increase GABA levels, as does Valerian. *Don’t use these all together as they can depress respiratory function as a cocktail.

images7OHBNK29Difficulty staying asleep can be more complicated to treat than falling asleep. Taking sedatives at 2 – 4 am can result in morning grogginess. From my experience, early waking (3am) is often related to a dysregulated cortisol clock, or, put simply, stress. Cortisol is the primary stress hormone produced by the adrenal glands. It runs on a 24 hour clock, and should be highest at 8am, and slowly drop during the day and rise at night. With emotional and/or physical stress, travel to different time zones, or shift work, the cortisol clock can become dysregulated, peaking earlier and earlier, creating an too-early wake up signal. Adrenal support is key. I often use herbs like ashwaganda, L-theanine, rhodiola, relora, and more to help regulate adrenal hormone production and heal imbalances. Cortisol is complicated, and balancing requires an in-depth look at ones lifestyle, mental health, stress coping techniques, exercise patterns, blood sugar and more. Therefore, treating stress and adrenal health in relation to sleep is best with an individualized approach, as “cookbook” medicine rarely gives optimized results.

For really tough sleep cases, NeuroScience labs makes a neurotransmitter panel to assess what is causing the night time wakefulness. Blood sugar disorders, sympathetic nervous system activation, cortisol dysregulation, hormone imbalance, anxiety, depression, grief, and more can all be part of the “perfect storm” of insomnia. Find a Naturopathic Doctor in your area to unravel the depths of your sleep mystery.

Umbrella_GraphicFinally, energetic medicines like acupuncture and homeopathy can be invaluable for unlocking sleeps depths. We are quantum physics humans, we do not operate in straightforward paradigm. Sometimes sleep issues go back to childhood dysregulation or other “never been well since” life events. These more energetic medicines can work to correct these deep imbalances by integrating unresolved issues that plague your subconscious when your guard is down. Psychotherapy and cognitive behavioral strategies can also be used to unravel sleep and stress mysteries.

I was lucky: once I was able to come down from the stress before my trip, and relax into my holiday my sleep improved, and I even got to sleep in for a change! What do you need to get that beauty sleep you so desire?

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Fertility is the New Holy Grail

Resolve to know more about the underling factors affecting conception and alternative family possibilities. * This article was originally written for the February 2015 Digital Issue of Essential Living Maine*

I had two stepmothers who were infertile for various reasons, and have an adopted baby brother. Several of my close friends and family member have used IVF to conceive, and I have my eggs cryopreserved. A few of my good friends have fostered and adopted, and others have intentionally chosen childfree lives. As lesbian and gay marriage has normalized, and divorce rates have climbed, more and more alternative families are being created using sperm banks, surrogates, egg donors, known sperm donors and more. The quest for fertility is all around us, and has been for the past 30 years in ever-increasing numbers.

The Internet has an enormous amount of information available on this topic, as the World Wide Web offers an enormous cross cultural support network for women trying to conceive (#TTC.) Infertility is usually a silent disease without any visible disability associated; however, it draws deeply on the mind/body and soul in underground ways that cannot be explained to those who do not have to undergo its trails and tribulations. Thus, the web is a great way to connect, share information, and do research while maintaining public anonymity.

220px-Sangreal-1Integrative Medicine is key to enhancing fertility. Integrative Medicine combines the best of modern medicine (reproductive technology) with time-honored complementary and alternative medicines (botanical therapies, clinical nutrition, homeopathy, acupuncture, and stress management support.) The quest to get pregnant (and stay pregnant!) has been a calling of doctors and midwives since the beginning of time and across all cultures.

After ten years of fertility specialization, here are my Top Ten Integrative Medicine Fertility Fundamentals to know about when mapping your journey:

  1. First, while on oral contraceptive pills, rings, or IUD’s and for at least 6 months coming off them, it is important to supplement with a good quality multivitamin that contains at least 10-20mg of all of the B vitamins, magnesium, vitamin C, and 800mg folic acid. These are depleted by synthetic estrogens, and a deficiency can cause long term fertility issues down the road.
  1. If you have a family hx of miscarriage, have had a miscarriage yourself, or have any anemia or high homocysteine on lab work, you may want to test for a genetic defect called MTHFR that leads to a folic acid absorption issue. http://www.apothecarybydesign.com/blog/archives/332
  1. DHEA is a fat-soluble antioxidant and hormone precursor produced by the adrenal glands. DHEA is also a key player in egg health, showing improved embryo quality and higher live birth rates than controls. Studies have used 75 mg of DHEA daily. 1 DHEA supplementation also evidenced higher rates of spontaneous pregnancies in long-term poor responders to IVF in another study using 25 mg three times per day. 2 DHEA supplementation slows the aging process by preventing lipid oxidation while improving energy and metabolism.
  1. CoQ10 is imperative to egg health. Egg division from 46 to 23 chromosomes requires effective mitochondrial function. 3. It has been suggested that mitochondrial DNA defects that effect metabolic capacity may be a cause of failure in egg maturation, fertilization, or early embryonic development. 4. Aged eggs have decreased mitochondrial energy which can result in deficient energy to divide properly resulting in Downs’s syndrome and other genetic anomalies. All women over 30 who are still considering pregnancy should be on 100mg of ubiquinol daily to maintain efficient mitochondrial activity.
  1. Test your hormones early, and keep testing every few years for an objective measurement of fertility reserves. Follicle Stimulating Hormone (FSH) levels must be tested on day 3 of the menstrual cycle with Anti Mullerian Levels (AMH) levels before beginning fertility protocols. FSH reflects the relationship between the ovaries and pituitary and higher levels indicate perimenopause and poor ovarian function. Therefore, levels of FSH under 10 are best. AMH is also called the “egg timer” as it gives an accurate level of the follicular reserves of the ovaries. AMH levels do not fluctuate throughout a cycle and can be tested at any time. Serum AMH levels decline throughout ones reproductive life cycle, and are undetectable after menopause; therefore, higher levels are more desirable.
  1. Don’t wait too long to consider IVF. If you have been #TTC for more than 9 months and have not become pregnant with regular, timed inseminations, IUI’s or intercourse, make appointments with a fertility clinic and an Integrative fertility specialist. Having a Plan B will decrease stress, and it takes time to consider the financial and medical burdens associated with reproductive technology. However, it is worth it to have that baby in your arms! If IVF is needed, committing to the process earlier in your fertility journey can increase your chances for that #BFP (Big Fat Positive) on your first attempt.
  1. Don’t forget the men! At least 30% of infertility is male factor. Too often one half of the couple is doing everything possible (yoga, clean eating, no caffeine, no alcohol, meditation, support group, acupuncture, etc) while the other half is the root cause of the issue. Getting a sperm analysis is one of the first steps in a fertility evaluation, and can bypass months of angst from non-conception.
  1. Sperm need fertility enhancing supplements too! Omega 3 fats, 15 mg zinc, and stress busting herbs like Maca or Ashwaganda will improve sperm health, tonify libido and boost fertility.
  1. Have your thyroid hormones including TSH, Free T3 and Free T4 and your progesterone levels tested. Low thyroid function leads to low progesterone, which leads to frequent miscarriage in a classic vicious cycle. Some Endocrinologists and Family Docs may have conservative opinions on these levels and may use outdated reference ranges or be unwilling to test for Free T3. Consulting an Integrative Medicine Doc, Naturopathic Doctor or anti-aging Hormone Doctor may give you more information about optimizing your hormone levels rather than operating at a subclinical deficiency.
  1. Consider alternatives to the traditional nuclear family. There are many beautiful babies who want safe, stable, loving homes and need fostering and adoption. I know three amazing families of beautiful fostered babies! There are also women able and willing to carry babies to create families that are not their own. While a biological birth is what we are taught to dream for, this is not the answer for some. Infertility is tragic and real for people who have always assumed they would be able to birth when they are ready. Allow your self to grieve as a couple, but do not close the door on other options even if they seem inconceivable at first.

On another note, childfree living also has many blessings. Our culture is slowly shifting away from the definition of having a (nuclear) family as the ultimate success. Childfree living allows for a more relaxed and abundant lifestyle with more freedom, ability to travel, and heightened romance for a couple. We are an overpopulated planet, and I know from my life, having an auntie that is invested and involved in my life is incredibly valuable. Here are many ways to be a part of a family, and each version needs to be recognized as equally valuable and important!

I could keep typing another ten set of treatments supports, and probably another ten after that,  I am so passionate about fertility! However, as I said earlier the Internet is a rich resource. Some other articles I have written on the topic include:

I wish each of you success on your Holy Grail of Fertility. May your journey connect you to your own Divine nature as you experience one of the great, uncontrollable mysteries of life: Conception!

References

  1. Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500Accessed September 13 2013
  1. Leonidas mamas, Eudoxia Mamas. Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results. Current Opinion in Obstetrics and Gynecology 2009, 21:306-308.
  1. David Meldrum, MD. Aging gonads, glands, and gametes: immutable or partially reversible changes? Fertility and Sterility 2013; 99:1-4.
  1. The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5.

To book an appointment:

http://www.agemanagementcenter.com/contact-amc/  or call 207-774-1356

Clinical Practice:

www.agemanagementcenter.com

www.facebook.com/AgeManagementCenter

For more information about Infertility see:

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DETOX 2015: Start the New Year With A Clean Metabolic Slate

tabula rasa – the latin term for “erased slate” referring to the emptiness of a slate sheet that was previously written on by chalk.

 To start the New Year with a fresh clean slate we need to erase the old clutter from our internal metabolic “chalk board”, which means DETOXIFICATION.

Why detoxify? Intermediate metabolites build up like desk clutter from all of the work that our liver has to do to break down hormones, pesticides, pollution, cholesterol, medications, bacteria, viruses, alcohol, caffeine, and everything else that we inhale or ingest. Symptoms of this “clutter” include allergies, skin disorders, constipation or diarrhea, heartburn, irritability, fuzzy thinking, headaches, low energy, fatigue and many more low grade but uncomfortable signs of poor health.

I do not believe in crazy diets, water  fasting, purges, enemas, or other “heroic” efforts. An effective detoxification process can be simple, inexpensive, easy to accomplish and leave you feeling fresh, renewed and in many cases with less weight! The focus is on fresh, whole foods, clean water, daily smoothies and supplements to improve liver detoxification.

I will be offering an all-inclusive program for one week in January – The tentative dates are January 10-17, 2015. One week is enough time to begin the detoxification process in the liver, but not so much time as to interrupt our busy lives. This program will be a group event, with individual introductory sessions to troubleshoot potential obstacles during the detoxification process.  This program will consist of:

  • A 30 minute detox interview and consultation to assess your personal needs. (The interview can be bypassed for Dr. Wright’s current patients.)
  • A 60 minute group meeting to introduce the program, review the basics of detoxification, and get you ready to start!
  • One week of detoxification with daily email support and a Facebook group for recipe sharing, troubleshooting and cheerleading.
  • A 30 minute group program review at the end to assess the effects, with suggestions on supplements and lifestyle options to maintain the beneficial effects of the detox.

Some people may choose to repeat the detox cycle for 1-3 more weeks in order to really delve into metabolic restoration; however this is an independent option.

Call Age Management Center today at 207-774-1356 IMG_1420or email Dr. Wright at thewrightnd@gmail.com and find out how our New Years Metabolic Detox program can help improve focus, increase energy, decrease allergies and enhance metabolic balance.

Cost: $250 inclusive, prepaid new patients or those needing individualized 30 minute support session.

Cost breakdown: 30 minute consultation: $75, Core Restore Detox Kit $100, 60 minute initial group consultation $50, 30 minute review session $25. Administration, daily emails during the detox program, Facebook group monitoring and detox troubleshooting included.

Current patient & friend/family rate: $175. (Does not include the 30 minute individual consultation.)

Some patients may choose additional Integrative Medicine consultations for more personalized care; individuals who choose to become patients of Dr. Wright’s during or after the program will have $75 taken off her initial consultation fee.

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Vanquishing Fat Improves Weight Loss

12428062215_8a3fa42d45_zI dreampt I was lying on a comfortable table in a private office, with a machine sending warm Infra-Red rays into my abdomen, melting away my belly fat. I was dozing, and imagining the fat cells bursting and my body’s lymphatic system scooping them up and leaving me with a trimmer waistline as I  thought about my life for 45 minutes…. Oh Wait! That wasn’t a Dream! That is the Vanquish machine!

It must be the 21st century because medicine has finally found a way to literally melt off fat in targeted areas like the belly, hips and thighs. This revolutionary selective radiofrequency technology is non-invasive, safe and effective. Heat penetrates deeply into the body targeting adipose tissue (fat cells) while protecting other neighboring organs and skin layers with cooling air flow.

The Vanquish experience is relaxing, pain free and requires no medication or recovery time. It requires lying still for about 45 minutes. Best results are obtained when repeated twice per week for at least 3 weeks (six sessions). Clinical results are visible within 3-4 weeks after your last session – do not expect immediate results! Physiologically, your fat cells are melted and slowly die, spilling their contents into local tissue to be cleaned up by the lymphatic, immune and circulatory systems. This process takes a few weeks, which is why results are not immediate.

A little science on fat cell physiology. It is now recognized that a fat cell is not just a glob of fat. Adipose tissue is a metabolically active, highly functioning part of the endocrine (hormone) system.

When your energy in (food & alcohol) is greater than your energy out (activity, intellectual work and exercise) insulin directs the body to store fat. The capacity to store fat is seemingly endless,  as individual cells can grow quite large while chemically signalling neighboring undifferentiated cells to turn into new fat cells. Energy deficit (energy out greater than energy in) stimulates the adipose tissue to release free fatty acids and become smaller fat cells, or the cells can die through apoptosis.

Centrally located adipose tissue is used as a storage area for many fat soluble hormones and chemicals like estrogen, pesticides and THC. When fat cells spill their contents, these are also spilled. Adipose tissue also independently synthesizes chemicals like adipsin that activate the inflammatory cascade. (This is why heavier people can have more inflammatory disorders than thin people.) As the Vanquish machine melts away the fat cells, stimulating apoptosis (cell death) your body will have to clean up these excess chemicals and inflammatory mediators as well as the free fatty acids released. Fortunately, a healthy body is designed to effectively remove cellular debris like this through the lymphatic and circulatory systems.

Drinking extra water is essential during this process. We also recommend using herbal teas like the Traditional Medicinal Daily Detox Tea, nettle tea and organic green tea for free radical/antioxidant protection. Taking a good quality multivitamin provides minerals and B vitamins to support liver detoxification while daily exercise will also stimulate fat burning metabolism and support free fat elimination. Nutritionally, a meal plan focused on weight reduction principles will enhance the slimming effects of Vanquish. I suggest small amounts of whole fiber rich grains a few times a week, daily leafy greens and raw vegetables, low sugar fruits like apples and blueberries, lowered carbohydrate intake, no processed foods, and grass-fed meats, vegetarian proteins and fish.

Some individuals with compromised health or congested lympathic or liver systems may benefit from additional Integrative Medicine alongside Vanquish treatment plans to optimize results. Integrative Medicine combines the best of botanical medicine, clinical nutrition and evidence-based nutraceuticals with modern diagnostic, laboratory and pharmaceutical expertise. This style of medicine is patient-centered; no two patients will get exactly the same protocol with our highly individualized care. Targeted therapies could include reducing systemic inflammation, improving detoxification pathways, clearing lymphatic channels, or tailoring nutrition to promote fat elimination.

Dr. Wright will be offered a group metabolic detoxification program at Cosmetic Enhancement Center in January 2015 and again in March 2015. This 7 day detoxification program is the perfect complement to a Vanquish Fat treatment plan. Ask Dr. Wright or Dr. Atkins for more information about the Vanquish Fat treatment plan, Integrative Medicine, or our upcoming Metabolic Detoxification program.

References:

Integrative physiology of human adipose tissue. K N Frayn, F Karpe, B A Fielding I A Macdonald and S W CoppackInternational Journal of Obesity (2003) 27, 875–888.

Adipsin and an endogenous pathway of complement from adipose cells. Choy LN1, Rosen BS, Spiegelman BM.J Biol Chem. 1992 Jun 25;267(18):12736-41. http://www.jbc.org/content/267/18/12736.long  Accessed 24/10/2014

Adipose cell apoptosis: death in the energy depot. A Sorisky,  R Magun and AM Gagnon. Department of Medicine and Biochemistry, Microbiology and International Journal of Obesity (2000) 24, Suppl 4, S3±S7 http://www.nature.com/ijo/journal/v24/n4s/pdf/0801491a.pdf  Accessed 10/22/2014

 

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5 Steps for Fertility Preservation Over 35

1Rope_Cross. CoQ10 preserves the quality of the eggs mitochondria  – essential for replication and good “egg energy” aka ATP for cell division. 100-400 mg daily prevention, 400 mg twice daily during a stimulation cycle.  ( The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5. )

2. DHEA is a lipid antioxidant and youth-reviving hormone precursor. I suggest 10 mg daily for prevention,  25 mg daily 6 weeks before stimulation cycle. Up to 75mg daily is evidenced to improve egg and embryo quality and enhance spontaneous conception. (Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500 Accessed September 13 2013)

3. This is your individualized medicine step – what do you need to tonify your specific reproductive patterns and enhance the chances of conception?

4. Fertility Massage is key for addressing muscular and ligament stress lodged deep in the pelvis that could mechanically impair the ability to maintain pregnancy. Concomitant castor oil packs clear debris from the ovaries and fallopian tubes, flushing lymphatic channels for a more balanced local immune response. The self massage/ hands on aspect maintains a connection between the cerebral, medicalized experience of ART and the physical sensations of the lower belly while reducing emotional stress. http://natural-fertility-info.com/fertility-massage.

5. Optimize your nutritional status with: extra leafy greens on a regular basis; superfoods especially in smoothies;daily  fresh vegetables; and choosing clean meat and dairy whenever possible. Reduce or eliminate sugar during high intensity hormone treatments including birth control pills.

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Advanced Maternal Age

IMG_0560I did not think I would be single and 41. I was pretty sure at 25, 27, 33, even 35 that kids were unconditionally on the horizon. I was not concerned that I would have kids later – after all I didn’t even graduate from medical school until I was 27. Then, I broke up with my long term love at 35. A quick trip to the fertility clinic at that time told me I was still good to go, and gave me info on my options.

I have been a lesbian for most of my adult life,  so assisted reproduction was  a necessary part of the planning. I  had considerable time to collect information on the legalities of sperm donors vs sperm bank options, and to become familiar with the insemination options that both gay and straight couples use in the quest for pregnancy. As a fertility specialist, I have supported many people through natural conception, IUI, and IVF. Now, well, lets say it could happen accidentally as I have switched teams. But, at my “advanced maternal age” natural conception is quite unlikely. So, after a second trip to the fertility clinic to confirm my continued fertile-ability, I am 3 days away from cryopreserving my eggs.

What this means, is I am doing the first half of an IVF cycle, and then instead of fertilizing  and transferring them, the eggs are put on ice for a later date. I am choosing to suspend the eggs instead of pre-made embryos, because  as referenced above, I am not in a relationship ready for babies. Its a logical choice for a single woman who is reaching the end of the #fertile years. It is also exciting to foil time, and have the possibility of a young family in the next few years. The miracles of modern medicine 🙂

Fortunately,  I decided around 33 to become an expert in #enhancingfertility and Assisted Reproductive Technology (ART) as an Integrative Medicine doctor. I studied  TCM/ acupuncture and fertility support from 2005-2011, and switched my focus to botanicals, endocrine function and anti-aging medicines in 2012. Read my published article about Integrative Medical support for the follicular phase of #IVF here.

I have quietly been preparing for this date in case I did not end up with a kid on my hip during my rather tumultuous 30’s. I will gracefully accept a child-free lifestyle if that is what is meant to be, as it has a freedom I value and I have wonderful children in my life. I may also choose to foster and adopt locally in Maine. The point of this cryopreservation is not only to end up with a child,  it is to preserve my choice to work towards conceiving within the next few years.

IMG_0672For those in the know, I am on day 8 of a stimulation cycle. I took 450 IU of Gonal-F for the first 6 days, and have ramped down to 300 for the next 2 days. I started 0.25 mg Cetrotide yesterday and will be continuing that for the next few days. Then, the trigger shot and retrieval Tues or Wed. My response is good and side effects minimal, which I am very grateful for. It really does pay to prepare for an event like this even years ahead. (PS. I had 21 eggs collected! 12 mature and 8 immature)

Here are my Top 5 steps for Fertility Preservation in Women over 35

1. CoQ10 preserves the quality of the eggs mitochondria  – essential for replication and good “egg energy” aka ATP for cell division. 100-400 mg daily prevention, 400 mg twice daily during a stimulation cycle.  ( The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5. )

2. DHEA is a lipid antioxidant and youth-reviving hormone precursor. I suggest 10 mg daily for prevention,  25 mg daily 6 weeks before stimulation cycle. Up to 75mg daily is evidenced to improve egg and embryo quality and enhance spontaneous conception. (Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500 Accessed September 13 2013)

3. This is your individualized medicine step – what do you need to tonify your specific reproductive patterns and enhance the chances of conception?

4. Fertility Massage is key for addressing muscular and ligament stress lodged deep in the pelvis that could mechanically impair the ability to maintain pregnancy. Concomitant castor oil packs clear debris from the ovaries and fallopian tubes, flushing lymphatic channels for a more balanced local immune response. The self massage/ hands on aspect maintains a connection between the cerebral, medicalized experience of ART and the physical sensations of the lower belly while reducing emotional stress. http://natural-fertility-info.com/fertility-massage.

5. Optimize your nutritional status with: extra leafy greens on a regular basis; superfoods especially in smoothies;daily  fresh vegetables; and choosing clean meat and dairy whenever possible. Reduce or eliminate sugar during high intensity hormone treatments including birth control pills.

It is the grit of everyday living that builds the pearl of one’s career. In the process of enhancing my own fertility, I have learned as much from the patients I have treated and supported as they learned from me. This primal biological drive has helped me to become a much better doctor in this field as I experience the nuances of treatment myself. I look forward to continuing to support all patients seeking conception, especially those of us above 35 that have lived full complicated lives and have had to balance the biological desire to have children with the real-life tensions of sex, gender, career, finance, and relationship.

 

 

 

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The Longest Night of the Year

December is not always mistletoe and gingerbread. It can be one of the hardest times of the year for many people. People aren’t supposed to die on Christmas and relationships aren’t supposed to end around the holidays…. but they do. The myth of the happy family is only a reality for a portion of the population; and even those who do celebrate Christmas with family can have significant stress and sorrow around money, relationships, and more.

So, for those who are alone this month, or in the midst of tragedy or change or trauma, I wanted to offer some self-care advice. From a metaphysical perspective, no matter what your religion is, this time of year IS about the miracle of returning light. The first few weeks of the month bring ever increasing darkness. Light some lights in your own home, whether they are candles or Christmas lights, reflecting your own inner flame. No matter how dark the world appears, each of us has the light of our soul to guide us. Connect with yours.

broken_heart_remedy_compoundFor those with heartache, there are many botanicals that offer gentle physical and emotional support. Avena botanicals makes a Broken Heart herbal tincture and a lovely sweet Rose Petal Elixir. The elixir is in a glycerin base and is used to gently lift the spirits and open the heart. It tastes like a rose smells on a hot summer day! Many herbalists make their own rose petal elixirs at the summer solstice, in preparation for this dark time of year. Herbal medicines like these affect our body, mind and spirit. By using self-care medicines we are making a commitment to our Self to move through this time of change with as much gentle strength and internal fortitude as possible. http://www.avenabotanicals.com/rose-petal-elixir.html 

Many people have seasonal affective disorder (SAD) or just simply hate the cold. We have had a particularly cold pre-winter here in Maine, which makes getting out to enjoy our gorgeous local landscape more difficult. Prevention is key for SAD – once it takes hold it is harder to manage. Adequate levels of Vitamin D3 are especially important. I generally recommend 2,000-5,000 IU daily depending on your body weight and Vitamin D reserves. Have you had your blood levels of Vitamin D checked yet this fall? High quality fish oil is a good adjunct to Vitamin D, enhances its absorption and can help with mental health. Fish oil contains two chemical constituents – EPA and DHA. The EPA is the part that helps with depression. Aim for a minimum of 650 mg of EPA daily, taken with your D3.

Saint Johnswort is another classic treatment for SAD. This herb affects the metabolism of many medications. Therefore, I only suggest using St Johnswort if you are not on any other meds. Dosage must be 900 mg per day, taken *every day.* This herb acts like SSRI antidepressants in that it takes about 4 weeks to get the full effect, and it needs to be taken daily for best results. This herb has evidence of use back to 400AD by Hippocrates. It is an ancient and magical herb with an association to light. It is no mistake that it is useful for SAD! If you do take medications like birth control, daily pain medication or blood pressure medication but would like some mood support you can consider 5-HTP. This is a serotonin precursor that is naturally produced in the body, and is available in supplement form. It can be helpful for anxiety, depression, insomnia and “the blues.” It is quite safe in general, although it should not be taken along with antidepressant medications unless specifically advised by an Integrative Medicine Dr. Typical dosage for 5-HTP is to start with 50 mg twice a day, and increase to up 150 mg twice a day as needed.

Exercise and meditation are two other valuable tools for getting through hard times. Exercise releases endorphins which simply make us feel good! It can be a walk around the block or a cross-fit class or hot yoga. The type of exercise does not matter as much as the act of getting into your body and out of your head. Meditation offers ways to step outside the constant chatter of our ego. I recommend a guided meditation for beginners. I use this Buddhist body-focused beginner set by Reginald Ray, but there are many more available! http://www.soundstrue.com/shop/promotion/1047.pd

At the end of the day, we each need to get through our darkest times in the ways we know how. Alcohol, television and drugs are all effective in their own way, but they also exacerbate the feelings of isolation and despair. Connecting to your inner light source and fanning your fires of spirit and confidence and strength will help grant you the courage to move through these difficult times. Some of us need more help than others to connect to our strengths, and supplements like herbal remedies, vitamin D, fish oil, St Johnswort and 5HTp can be great support systems. I love the rose petal elixir for its sweet uplifting taste of summer in these harsh cold days of winter.

For personal support on transforming your own journey or connecting to your inner strengths, book an appointment with Dr. Wright. She is available for consults during the month of December including December 27, 2013.

Call 207-774-1356 now.

References:

The ABC Clinical Guide to Herbs. American Botanical Council, Thieme Publishing 2003. Currently out of print.

Encyclopedia of Natural Medicine. Michael Murray ND and Joseph Pizzorno ND. Prima Publishing, Rocklin, CA 1998

www.avenabotanicals.com

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Using Herbal Medicine in Pregnancy

pregnancy-tonic-tea-220x231There are always questions about which herbs are safe to use in pregnancy. There is considerable historical and clinical information on the use botanical medicine for enhancing fertility, treating common conditions of pregnancy, and supporting postpartum care and lactation. The modern push for evidence-based studies to confirm safety of use is hindered by the ethical issue of conducting clinical trials during pregnancy. Therefore, there are very few if any double blind placebo controlled studies to reference for this population. For this reason, most online and allopathic resources will list herbs as “not safe in pregnancy” even if they have been safely used for centuries as part of maternal medicine. Furthermore, the World Health Organization label requirements for botanical medicines includes information on the use during pregnancy and lactation. As there is insufficient evidence-based studies on botanicals in pregnancy, almost all products will say Not Safe in Pregnancy or Lactation. This is good in some ways, because it protects the fetus from harmful herbal constituents accidentally taken by an unsuspecting parent. On the other hand, it limits many people from accessing safe and effective supportive herbal therapies during this unique time of life.

As a general rule of thumb, almost all herbs are best avoided during the first 12 weeks of pregnancy unless specifically prescribed by an expert in this field. Ginger is one exception to this, as it has significant clinical evidence to reduce nausea of pregnancy. Still, even ginger can be too stimulating and is best taken in moderation. *Dosage for hyperemesis gravidum could be 5-10 drops of a ginger glycerite tincture as needed, up to 70 drops daily. Ginger tea or  chrystallized ginger can be used 2-4 times a day, and ginger candies up to 10 daily. Roobios is another herb that is a safe tea in early pregnancy. This is a traditional pregnancy medicine in Africa, and a very common tea base. Nettles are also very gentle and provide a mineral-rich tonic for the newly pregnant mom. Nettle is a lovely tea base to use throughout pregnancy and lactation for hydration and nourishment. As every person’s body is different, it is sometimes best to stick with what your body knew pre-pregnancy rather than trying new things in these sensitive weeks to avoid unexpected allergic reactions or other physical repercussions.

There are some herbs which must be completely avoided throughout pregnancy as these are known to be harmful in some way. For a complete list see:  http://thewrightdoctor.com/womens-health-2/herbs-not-safe-in-pregnancy/

Herbs with strong alkaloids (identified by a bitter taste) are to be avoided. These often have a strong action on the body, whether digestive or cardiac. There are many gentle herbs and nutritional supports which are safer digestive tonics for pregnancy. Laxative herbs exert their effects through muscular contractions and can stimulate uterine contractions as well. Most herbs with strong hormonal activity are to be avoided completely , as are all anti-parasitic formulas. Certain herbs that are to be avoided in pregnancy can be prescribed by experts in this field in the last few weeks of pregnancy to prepare the uterus for labour.  These are only to be used under the guidance of an experienced midwife or prescribing professional with obstetric training in botanical therapies.

There are many herbs which help pregnant women connect to their body and the environment in a grounding, tonifying way that are safe and effective. Some women will make their own creations from local plants, and others will buy them. When purchasing plant remedies, it is important to buy from reliable brands. Gaia, Apollo herbs, Herb Pharm, Vitanica, Wise Woman and Avena Botanicals are all ethical and responsible manufacturers of high quality herbals. If you are concerned about whether or not a product is safe for you, simply do not use it! Or, find a local Naturopathic Dr, Midwife, or Herbalist to guide you in your pregnancy care.

These are some herbs which are safe to take. * Alfalfa is very high in chlorophyll and rich in minerals and vitamins. This is a great greens powder in smoothies. Burdock can be used in small doses of 20 drops 1-2 times a day after the first trimester. Burdock supports women with blood sugar difficulties or constipation later in a pregnancy. Dandelion greens are a great tonic for women pregnant in the spring. They are robust in vitamins and strengthen the urinary system. Dandelion root can also be used in small amounts like burdock, for sour stomach, nausea and itchy skin. Oatstraw is a soothing tea or tincture which calms an overstimulated nervous system. This is a must have for pregnant moms with other small children! Up to four cups of Oatstraw tea daily is safe or use in tincture form 40-60 drops in water 2-3 times a day.

Rose hips are safe throughout pregnancy. These have abundant vitamin C to support collagen production in skin and help maintain vascular wall integrity.  They have a sour zip, and make a yummy tea with nettle and honey. Saint Johnswort herb is a safe and gentle mood support during pregnancy as well as a safe option to treat herpes outbreaks both topically and internally. It should not be used with other medications, but is a reliable ally for women during this time of life. Red raspberry leaf is very well known as a late pregnancy tonic. This silvery-green leaf strengthens the uterine muscle without stimulating contractions, preparing the body for the adventure of labour. It is rich in iron to support the increased blood volume in later pregnancy. It is best drank as a tea 1-3 cups per day for the third trimester. Finally, Valerian is a safe sleep support. It is best to use the smallest dose needed for therapeutic value, so start with 1 cup tea before bed or 10-30 drops of tincture and increase as needed.

Pregnancy is a time of life when so much is unknown, and so much can go wrong – there is so much responsibility for both parents and care providers. For this reason much of modern medicine has erred strongly on the side of caution when it comes to using herbal medicines in pregnancy. This caution is compounded by the high cost that many IVF assisted pregnancies carry. Every move becomes highly medicalized, and simple acts like a cup of herbal tea are forgotten as effective therapeutics. The bottom line when it comes to using herbs in pregnancy is: if it makes you nervous, dont do it. You cannot rely on the internet, on your OB,  or on labels to tell you what is safe to take during this time of life. However, there are some very reliable books on using herbs in pregnancy, and many Herbalists, Naturopathic Doctors and Midwives have expertise in this area. Enjoy!

http://apps.who.int/medicinedocs/en/d/Jh2945e/9.5.html

http://www.ahpa.org/default.aspx?tabid=70

*ABC Clinical Guide to Herbs. M. Blumenthal p. 174

*The Natural Pregnancy Book. Aviva Jill Romm

*Herbal Childbearing Year. Susun Weed p. 19, 51

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