Balancing with Ayruvedic Medicine – from Womens Power to Heal

510fafgjdbl-_sx336_bo1204203200_I am doing an Integrative Medicine Scholars program through the AMSA and we have to do a project to explore some aspect of Integrative Health. Ayurveda is a practice of medicine I don’t know much about, so I decided to do a personal practice incorporating lifestyle, nutrition and herbal medicine principles for the month of January. My friend Cathleen Miller helped me to figure out what my Dosha is (constitutional type) and lent me this amazing book, and …. here we go! Below is an outline taken directly from this text for (my) Pitta-Vata type.

Balancing Pitta-Vata Rhythms –

  • Rise with the sun and go to bed by 10 pm – maintain steady eating and sleeping routines
  • Ease yourself out of all stressful activities and maintain only those projects that create ease – allow adequate time to complete projects
  • Take ample rest
  • East wholesome, fresh, moderately warm, moist substantial and calming foods.
  • Avoid bitter, cold, raw, hot, spicy, oily, salty, fermented or stale foods and stimulants.
  • Shield against hot, wet, humid, cold, damp, or stressful environments.
  • Embrace serenity, love, warmth, healthy rituals and calmness.

Nutrition Principles

AVOID: caffeine, refined sweets, alcohol, saturated fats, excess salt, oily and spicy foods, and commercial dairy projects, as well as highly processed junk foods, meats, additives, frozen, canned, commercially grown, bioengineered, transgenic refined salts, sugars, flours and hydrogenated oils.

CHOOSE:

VEGETABLES Broccoli Brussel sprouts cabbage Cauliflower
Artichokes Asparagus Bamboo Bitter greens Black olives
Celery Cucumber Green beans Dark greens Parsnips
Peas Potatoes Sprouts Summer squash Sweet potato
Winter squash yams Watercress Bok choy Carrots
Daikon Beets Leeks

 

FRUITS Apples Apricots Coconuts Dates
Fresh figs Oranges Pears Pomegranate Tangerines
Mango Plums Raisins Quinces Limes
pineapple Avocado Banana Grapefruit Kiwi
Lemon Peaches Tamarind Rhubarb

 

LEGUMES Aduki beans Mung beans Kidney Lima
Lentil Navy Pinto Chickpeas Tofu
Black beans

 

NUTS Coconut Roasted sunflower seeds Roasted pumpkin seeds Poppy seeds
Water chestnuts Macadamia nuts Sesame seeds Pecans Walnuts
Pine nuts Pistachios

 

DAIRY Unsalted butter Cows milk Cottage cheese Sweetened yogurt
Buttermilk Whole cows milk cheese Cream Ghee Sour cream

 

OILS Sunflower Almond Olive Coconut
Dark sesame Light sesame

 

SWEETENERS Maple syrup Dates Sucanat

 

SPICES Coriander Cumin Cardamom Cilantro
Curry leaves Dill Fresh basil Fennel Turmeric
Saffron Peppermint Spearmint Ginger Anise
Mustard seeds Sage Nutmeg Thyme Ginger
Cloves Rosemary Tarragon Oregano parsely

 

Practices

  • New moon journalling with saraswati mantra – Aim Sarasvatyai Namaha
  • Ginger compress one week before the new moon (unless bleeding)

1 gallon water

1 handful grated fresh ginger

1 lg stainless steel pot with cover

2 stainless bowls

  Bring water to a boil, and add ginger secured in a ouch with a drawstring. Squeeze the  pouch to release the ginger juice and drop into the water. Simmer 30 minutes. Let sit 5 minutes before uncovering when taken off the heat. Create a compress towel and apply to lower back for 4-5 minutes or until lukewarm. For full instructions, see text p. 264.

  • Rose Oil Pichu – for headaches, hair loss, pain in the eyes, poor vision, mental fatigue and nose bleeds. Pichu: a powerful lubricating and loving therapy that helps maintain mental calm, emotional equanimity and helps balance the doshas. Best time: waxing moon phase. C/I bleeding. Best time: morning or early evening.

¼ cup dried roses

1 c sesame oil

Bring to boil over low heat and remove from heat, Add rose flower, cover and let steep 4-6 hours. Strain and use.

PICHU instructions: need pottery bowl, 12 “ clean cotton square and cotton hand towel.

  • Wash hair a few hours before
  • Release all stressful thoughts and details from the mind
  • Assemble the supplies on the floor close by
  • Soak the cloth in oil and lie down; place the cloth ear to ear. Press down on the cloth and wipe away excess oil
  • Rest quietly for 30 minutes and rise slowly, use hand towel to wipe away excess oil and maintain a peaceful attitude for the rest of the day.
  • Shakti Mudra – should be daily but 3 times per week seems doable – enhances sense of self, reinforces femininity, self esteem and restores vital energy to the womb.

Sit facing east

Bring palms together and separate slowly

Form the Shakti mudra hand position – see p. 192 text

Breathe deeply into pelvis and breathe out slowly, tracing the exhalation from the base 0f the perineum, circulating through the uterus and belly

Maintain for 15 minutes

Take a deep breath and make a commitment to a life of non-hurting

 

  • Yoni Mudra – 3 days before the new moon and full moon to revise Shakti prana.Not when bleeding.

Sit in meditative practice with palms facing up

Create the yoni mudra hand positions – see p. 155 text

Hold the hand gesture for 5 minutes

Allow breath to flow freely throughout the body, keeping the mind centered

HERBAL MEDICINE

Herbal Teas for PMS – Vata type predominant – take for 3 days of the new moon as well as the 5 days before menses

Helpful herbs: nutmeg, valerian, triphala, ashwaganda, shatavari, cinnamon, turmeric, fennel, dill and wild yam.

CINNAMON, CLOVE AND CARDAMOM DECOCTION (VATA) for PMS

2 c water

2 c organic milk

1 tbsp cloves

1 tsp cinnamon

1 tsp cardamom

½ tsp ginger

1 pinch saffron

 

LAVENDER FENNEL GINGER TEA DECOCTION (PITTA) for PMS

I c water

1 c organic cows milk

1 tso roasted fennel seeds

1 tbsp lavender petals

1 tbsp hops

½ tsp ginger powder

1 pinch saffron

bring water and milk to a boil. Toast the fennel seeds, then add all herbs and spices and simmer on medium for 15 minutes. Remove from heat, add saffron and stand 3-5 min before drinking.

 

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Heartbreak and Heart Failure

screen-shot-2016-11-06-at-2-48-11-pmSometimes life, work and study all seem  to dovetail and everything makes sense for just a few glorious moments. Cardiology was like that for me, in between the Frank Starling curves.

Last year we had a case study of a woman with congestive heart failure (CHF.)  Her husband had renal failure and needed dialysis, and she worked at a job she didnt love. She slowly developed worsening heart failure over the course of the case, with  shortness of breath, edema, high blood pressure, and poor circulation, eventually dying from it. I was impacted by the apathy she displayed in her efforts to recover – unwilling to eat more grains and greens, decrease salt,  get outside, exercise regularly, investigate psychotherapy, or better her personal life in any way. Instead, she just declined in health, adding a new prescription per year to mange her symptoms until she  – drowned. In her grief. Of heart disease.

This. Story. Happens. Every Day.

And not only in the US, or Canada or Europe. World-Wide.

The multitudes of meta-analysis risk factor evaluations like the Framingham, Whitehall and Rekjavic studeis have concretely illustrated important evidence about the facts of heart disease: atherosclerotic fatty streaks in arteries, high blood sugar, and  inflammation are the undeniable Holy Trinity of heart disease. What is not being avidly reported is the rate of divorce, or mood disorders in these same subjects. The sexual dissatisfaction. The childhood trauma. Socioeconomics and race are sometimes studied, and African Americans and Latinos have higher rates of heart disease. Nobody is surprised. Russia has the highest rate of ischemic heart disease in the world, along with some African nations and Indonesia. These countries also have horrible human rights records, with well documented transphobia, homophobia and police brutality.

screen-shot-2016-11-09-at-9-01-58-pmIf we are going to turn around heart disease, do we not need to acknowledge the humanity of the heart? The same  epidemiological study quoted deep within the content:

“Additional reports from this study have shown inverse associations between fair and respectful treatment at work and CHD [Congestive Heart Disease],and job control with future CHD risk.

Similarly, hypertension, which is the harbinger of heart disease through its effect on cardiac structure and function,  is hugely mediated by the stress response.

screen-shot-2016-11-09-at-9-11-31-pmI was talking to Dr. Stein, an internist specializing in HIV and also our OMS II course director, about this theory that heart failure is so rampant because we have no real medicine for soul-problems like dissatisfaction, grief, sorrow, envy, loneliness and such. He said the links between depression, elevated cortisol, hypertension and CHF are well documented and clearly evidenced.

He reiterated that it is known that People of Color have higher blood pressures because their lives are more stressful due to systemic and personally experienced racism aka “stress.” It is also well evidenced that African Americans with CHF respond better to different medications than other races – Hydralazine, a vasodilator that decreases resistance,  improves survival with  isosorbide dinitrate rather than the ACE inhibitors and Beta Blockers commonly used. Ha, decreasing [systemic institutionalized] resistance as a keystone in improving survival? I need to know more about the MOA of these drugs to understand why decreasing the catecholamines isnt enough for this population; maybe its because of the deleterious and constant push and pull the sympathetic blockers have on the heart receptors of someone living in the actual adrenergic rut of an unsafe society.

3f0a8388-0078-4c4f-88ef-36078365eae5Our cardiologist professor Dr. Glass stated that the average person with hypertension is on 3.4 medications to manage it. These are usually layers of diuretics to decrease the blood volume and drain edema (decreasing preload), and beta blockers to decrease cardiac work and improve cardiac output,  and/or other meds like diphydropyridines and nitrates. But guess what – it just came out recently that hypertensive medications may be CAUSING depression/ mood disorders while working to decrease blood pressure.  What a double whammy.  This was a big study from a database of a single hospital containing 525,046 patients over 5 years. This 2016 article stated:

Major depressive and bipolar disorders predispose to atherosclerosis, and there is accruing data from animal model, epidemiological, and genomic studies that commonly used antihypertensive drugs may have a role in the pathogenesis or course of mood disorders.”

  • Patients on angiotensin converting enzyme inhibitors or angiotensin receptor blockers had the lowest risk for mood disorder admissions
  • those on β-blockers (hazard ratio=2.11; [95% confidence interval, 1.12–3.98]; P=0.02) and calcium antagonists (2.28 [95% confidence interval, 1.13–4.58]; P=0.02) showed higher risk
  • those on no antihypertensives (1.63 [95% confidence interval, 0.94–2.82]; P=0.08) and thiazide diuretics (1.56 [95% confidence interval, 0.65–3.73]; P=0.32) showed no significant difference.

To summarize the findings,  calcium antagonists and β-blockers may be associated with increased risk, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be associated with a decreased risk of mood disorders. (Hypertension. 2016;68:1132-1138. DOI: 10.1161/HYPERTENSIONA HA.116.08188.)

It appears, the drugs that most directly affect the heart muscle itself are thus linked to more mood disorders, while those that work indirectly and decrease the work for the heart seem to have less impact on mood.

This is such a broad topic and there are so many layers to heart failure – blood pressure, kidney regulation of blood pressure, nutritional effects, blood lipids, blood volume, inflammatory mediators, free radicals and antioxidants, sleep quality and more – but I think that too often we lose sight of some of the most basic truths of happiness and heart health. And we also forget the deeply sensitive creatures that most of us are and fool ourselves that pharmacy could possibly be enough to cure a heart that is systemically broken, or the effects of a chronically hypervigilant nervous system.

imagesWIDJJQD2I am going to need to become proficient at cardiology as an Internal Medicine doc. But without a degree in psychiatry, or soul medicine, or archangel intervention, how can I possibly hope to help people recover their failing hearts when the intersections cut so deep? I am scared of all of those people that have no willingness, or ability, to look deep within and make the simple and profound choices towards life. This is the part of being a physician I most fear. The medical failures; the broken hearts.

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The Pitfall of Alcohol

I’ve been avoiding writing this post for at least a week, probably two. Mostly because it has personal meaning to me as alcoholism runs in my family on both sides – My mothers father was one of the “Mad Men” of the 50’s, worked in advertising and died of liver failure due to alcoholism. I guess he got pretty ugly in the end. My paternal grandparents didnt drink at all (which leads me to wonder if their parents were alcoholic) but all of their children have a penchant for the sauce.

Before I was a medical student, I thought the damaging effects of alcohol could be traced directly by measuring liver enzymes – and as long as those harbingers of hepatic cell death stayed within a reasonable limit, one was “getting away” with whatever one was doing. Enter: neurology. Boy was I wrong. Oh and Ps. Dead liver cells cant release ALT or AST, so good liver enzymes in the face of chronic alcoholism is actually a pretty bad sign.

The blood brain barrier is an effective barrier to most things except: nonpolar and lipid soluble molecules. Enter: CO2, O2, and ETOH (alcohol.) This means that as soon as alcohol is in your blood, it is seeping into your brain. And brain cells/ neurons are permanent cells – they don’t have the ability to divide, so they don’t replicate. You get what you started with – some axons can be regenerated, but once the cell body dies, your numbers start to decrease.

gait-ataxiaThe cerebellum is one of the parts of the brain most affected by alcohol cell death; this is why people become unsteady and clumsy anterior-vermiswhen drunk – inhibition of cerebellar function! There are multiple and complex inputs to this lower brain region from almost every aspect of the nervous system, so it can compensate for loss of neurons (when sober) for a long time. Up to 80% of cell death can happen before symptoms become noticeable! Unfortunately, once this is happening in the sober state, the cells are dead and there is no ability to recover balance or coordination.

I didn’t know that memory loss is also a component of chronic alcoholism. There are two halves to the cognitive decline that will happen eventually called Wernicke-Korsakoff syndrome, and these are from alcohol related destruction to two more areas of the brain.

confusionThe first set of symptoms is reversible, and is related to a deficiency of vitamin B1 aka thiamine. The mammillary bodies are wee nubs on the underside of the brain that are part of the social and emotional brain. They take information from the hypothalamus and hippocampus, and run it to the anterior nucleus of the thalamus. nrhpth08

 

 

 

 

This is a critical loop in emotional and social behavior integration at a cognitive level. I guess this is partially where the numbing effect of alcohol on the emotions could occur? With a deficiency of B1, the mammillary bodies hemorrhage and cause Wernickes encephalopathy, characterized by confusion and your eyes not tracking properly, as well as the unsteadiness from the damaged cerebellum. This is why in hospital treatments, alcoholics are first given thiamine/ B1 to see if it can reverse the symptoms. From a prevention standpoint, taking a good quality capsule (not tablet) daily multivitamin seems like a good idea for anyone drinking on a regular basis.

This condition can progress to irreversible memory loss for the past, with an inability to make new memories, plus psychotic symptoms. This is called Korsakoff psychosis. As people lose their ability to remember, they start making things up to fill in the blanks called confabulation. This can be really depressing for friends and family members as it becomes clearly evident that the damage is permanent.

and THEN, there is the metabolic damage that is occurring below the neck. (This next section is biochemical mumbo jumbo, but since this is my review exercise, I’m going to include it for my medical interest:)

screen-shot-2016-09-26-at-12-32-00-pmEthanol/ your drinks/ are 80% broken down by cells (cytosol) of the liver. 15% of alcohol is broken down by microsomes in the brain and liver, and this pathway is upregulated in chronic alcoholism. The remaining 5% are converted to fatty acids and phospholipids that are thought to play a role in tissue damage. Both primary pathways break down ethanol to acetaldehyde, which is metabolized  down to acetate…..Acetate, where have you heard that before? yes, NAIL POLISH REMOVER, flooding your liver and brain.

The major metabolic consequence is from the elevation of NADH that occurs in the cell and in the mitochondria in steps one and two with excessive and continual amounts of alcohol intake, because this NADH will inhibit the TCA cycle from running. No TCA = no glucose metabolism = no fuel for the cells. The brain will still need fuel, so the liver cleverly shifts the glucose from the alcohol (which can no longer be metabolized) to ketone production + free fatty acid synthesis (aka fat storage.) This explains, in painful detail, why alcohol makes you gain weight and affects blood sugar levels.

screen-shot-2016-09-26-at-12-36-56-pmFinally, I wanted to add this last slide for an important prevention note. This is the process of the 15% microsomal pathway that is upregulated with chronic high alcohol intake. Note the second step produces ROS – this is reactive oxygen species aka free radicals which are known to cause cell damage and cell death. Higher levels of ROS are bad in general and associated with greater inflammation and cellular damage across the board. This points to another potential place for prevention – with use of high dose antioxidants like CoQ10 200-300mg, resveratrol (500mg), alpha lipoic acid (200mg) and vitamins C (1000mg) and mixed tocopherol E (400IU).

screen-shot-2016-10-08-at-4-29-14-pmWhen alcohol intake gets high enough to start causing brain damage, obviously the primary treatment goal is to reduce the intake. Our first case study had a 37 yo male drinking 12-16 beers PER DAY. How many drinks, realistically speaking, are you having per day? How many does that add up to per week? Does that seem reasonable to you?

I don’t know enough about addiction to know how to address real chronic alcoholism. I imagine it is incredibly hard to quit, and even to reduce daily intake without a pure and strong internal directive to do so – no one can be told to do it,  the drive Must Come from Within. Treating underlying depression, anxiety, or life stressors are surely part of the picture, but what if you just drink to have fun? Sometimes, the party needs to stop, or gets out of control. I guess we all need to grow up sometime and learn to tolerate whatever it is we harbor inside our minds (before they get destroyed.)

Alcohol is a depressant, so withdrawal symptoms are the opposite – agitation, irritation, worse case scenario people can have seizures. Benzodiazapines, some sleep drugs and alcohol all work on the GABA-A receptor in the brain. Chronic alcohol use downregulates the expression the neurotransmitter GABA, one of the “off switches.” Once high levels of alcohol start to lower, it takes time for the brain to start making enough GABA again, resulting in foul moods, irritability and general unpleasantness.

There are medications like naltrexone and acamprosate that can help reduce the cravings for alcohol, and medications to treat the side effects of withdrawal, mostly aimed at these same parts of the brain. These are definitely worth exploring with a psychiatrist or addiction specialist to figure out what approach will work best for you. Complete abstinence does not need to be the goal. GABA as a supplement is not absorbed well, but is readily available and might be worth a try for someone who is just cutting down on daily intake, and has addictive enough a personality that switching to benzos instead of alcohol could exacerbate rather than relieve the problems. However, it is unlikely GABA alone would be enough to support sobriety. Making the very personal and often terrifying choice to look at one’s habits and face trauma/addiction is the place to begin. A comprehensive medical assessment with an empathetic and respectful health professional who has experience in addiction is next step. (if you are in Maine, I highly recommend Dr. Merideth Norris!)

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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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The Lost Art

I am sick in an invisible way that people cant really see, and I don’t really feel – much. I can take a pill and make it mostly unnoticeable. Except for the fact that my hair falls out in handfuls with a certain kind of stress…

I consider myself an expert in self-care. And yet, I can hardly find the time to do the “little” things that I know could help. Like, nettle hair rinses, getting at least 8 hours of sleep every night, taking my fish oil, and eating more protein. Instead, I keep myself too busy and dull myself with things that make me feel better for a few hours, but never in the long run. I have fallen into the mindlessness of  modern health care where I want a pill to do the work of healing for me. Dammit!

We all have levels of health maintenance we are willing to do on a regular basis. Vitamins, exercise, water, organics, therapy, whatever. We each have a certain degree of self care required to maintain the status quo of daily function. But, what happens when that balance is tipped and we need to actually recover from an illness, injury, or accident?

I offer you an invitation to step off the rat wheel of everyday living, and create a luminal space for healing. A luminal space is an anthropology term that refers to a period of time “outside of time” – a step out of everyday living. Some health crisis force this through body fluid effluvia that ties one to the bathroom, or physical disability that prevents mobility. Too often we are able to power through a cold, or anxiety attack or injury and do not engage in the art of self care to allow actual healing. This is what snowballs into chronic illness / disease or chronic pain.

I have been “sick” for at least 9 months, but I haven’t made more than a few half-hearted efforts to engage in deep self care. I have taken lots of prescriptions and had lots of blood tests, but is that truly healing medicine? I finally broke my baby toe last week, and have been suddenly forced to slow down by immobility. I am doing hydrotherapy, making castor oil packs, cooking and eating good food, meditating, saying no to social engagements I don’t deeply want to do, and getting sleep. These are some of the cornerstones of deep self care.

It is very difficult to give ones self approval to close the door on society and expectations and family, and friends, and chores, and domestic duties, and distractions, and choose to do something solely for the self instead. We are culturally programmed to take care of business, pleasure, family, kids, dogs, and our homes before we take care of the inner self. If you are sick, at any level, you will heal faster, and better if you take the time to practice deep medicine by taking the time to take care of your self.

I am here to help you do that. And, I give myself permission to offer that same wisdom and practice for my self. The pills and the maintenance are not enough. We must engage the luminal, lost art of deep self care for complete health and healing.

 

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Ideal Weight Program

photo 3Welcome to a new way of working with body image, metabolism, eating patterns and ultimately, weight management. This is not a diet. Let me repeat. This is not a diet.

Study after study have shown that only 2% of people who lose weight by dieting are able to keep it off for life; 98%  of dieters gain back the weight they have lost plus more. This endless cycle slowly but surely adds pounds while eroding your sense of self worth. It also creates chaos within the blood sugar, hormone and neurotransmitter system that leads to further metabolic disruption.

Now is the time to change the old patterns. With awareness and a commitment to change, you can rewrite the story of your body. Your cells are constantly regenerating themselves; with direction from your mind and an individualized, functional medicine approach to improving structure and function you can reach your ideal metabolism, energy, and physique.

This program is divided into four phases. Each phase is at least 90 days long. Some people will need more time in an individual section, and can stay in each section as long as needed. The four sections are like a wheel, and where you start depends on your health, area of interest, and life circumstances. Some people will move in a linear direction through each step, and others will hopscotch from one area to the other. The secret to success is that we follow your body, your life, and your needs to unlock your ideal.

The four treatment sections are: FOOD, DIGESTION, STRESS, HORMONES

FOOD:  It only makes sense to work with food when addressing weight. Food is actually a very complicated topic, and one that most people have layers and layers of  complex conditioning around. We will start with a comprehensive 200 food ALCAT sensitivity test that will empower and educate you to make food choices based on YOUR immune system reactions to food (food sensitivities.) There are so many diets, so much information, so many food gurus and opinions out there! This test allows you to claim your own power around food choices based on your body’s unique message. In this section we will also teach you how to identify when you are hungry, and when you are full. These simple intuitive eating approaches build awareness and compassion, connecting you to your own primitive need for food as fuel.

DIGESTION: Effective food breakdown and waste elimination is crucial to a healthy body. Nausea, bad breath, appetite fluctuations, heartburn, indigestion, gas, cramping, bloating, constipation, hard stools, soft stools and diarrhea are all signs that your body is not digesting effectively. We will use a CDSA (Comprehensive Digestive Stool Analysis) to investigate all parameters of digestion including beneficial and pathogenic flora levels to truly repair and restore your digestive tract. This will have multiple health benefits including a more balanced immune response, increased energy,  regular bowel movements, potential pain relief and much more. As your digestive system is renewed you will be able to maintain your ideal weight more effectively as the body processes the food you eat with ease.

STRESS: Our brain decides when we are hungry, and when we are full. It also decides when we will eat. These two actions are not neccessarily in harmony. By looking at neurotransmitter levels that are intricately linked to food and well-being, we can understand some of the complexity of the mind-body-food relationship. During this time we will assess the stress in your life, and build stress management skills. Using botanical medicine we will tonify your endocrine system, enhancing your capacity to experience stress with ease and resiliency. At the same time, awareness exercises continue the weight-related exploration of finding and maintaining your ideal physical body with a healthy, relaxed mind.

HORMONES: Most people gain weight when their hormones begin to decline. This usually refers to reproductive hormones like estrogen, progesterone and testosterone, but  thyroid and adrenal hormones are also crucial to a vibrant and efficient metabolism. Finally, Human Growth Hormone levels dictate the speed at which we age.  This section utilizes the Age Management comprehensive hormone blood work panel to thoroughly investigate the state of your hormones. Using cutting edge anti-aging therapies and Bioidentical hormone treatments we will optimize your hormones, rejeuvenating your sex life, cognitive function, energy levels and more.  Some participants may also choose to do a 26 day HCG diet as part of this personally tailored hormonal wellness program for more radical weight loss.

Each of these components make up the whole that is your living body and each have a profound effect on weight. Whether you want to lose 10 lbs or 100lbs, or even want to learn how to maintain your current weight in a more relaxed fashion, our Ideal Weight Management program will bring you closer to that which we all seek – your ideal Self. As your awareness of the triggers behind your disordered eating patterns come clear, your need to medicate with food will shift. Functional issues like constipation, heartburn, and nausea will transform into easy, successful elimination of your body’s waste, allowing a more effective fuel-burning metabolism to emerge. And, you will feel more energized and better able to handle the stresses of everyday living without food as a crutch.

This program is not for the faint of heart. It is for people who have dieted all their life. It is for all genders and all ages. There is no standardized program that you must sacrifice and change to be accepted into – this is a truly individualized series of sessions that unearths the inner you …that you will adore.

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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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September 2013

IMG_1626Apples are in season again, so it must be time to go back to school. This year, I will be the one in front of the classroom! This is completely new for me, and I have been anxiously preparing mentally (and literally) for most of the summer. Academics are an important part of a doctors CV, and an area that I have studiously avoided in my career thus far. But when Corinne Martin at University of Southern Maine Nursing School contacted me about the program she has been developing as a holistic health minor for USM the fear was less than the excitement. I am honored to be teaching CON 284 Botanical Therapies for the fall semester. The course is an introductory level exploration some of the issues that surround medicinal plant use including historical dynamics, ecological effects and cultural perceptions of herbs. I will also be teaching practical clinical use of commonly used botanicals. We have guest speakers coming in, a practical how-to workshop on medicinal preparations, and a diverse reading list. Plant medicine has been foundational to my practice, and I am grateful for the opportunity to expand my own understanding and become more of a community resource!

I work primarily at the Age Management Center these days, with a strong focus on hormone health. I work with Dr. Michael Bedecs who is a Men’s Health expert, and is extremely experienced in hormone replacement. I am grateful to say he has taken me under his wing, and I have found a permanent place for my private practice here in Maine (and beyond.) It took almost two years to find the right work environment and business associate after owning my own clinic for 11 years in Toronto. Stay tuned for new articles on fertility,  perimenopause and transgender/transsexual health care. When working with hormones, it is impossible not to consider trans* health care, as this is a population often dependent on hormone use. Dr. Bedecs and I will continue to merge his extensive knowledge of hormone use with my specific integrative medicine training, community commitment, and health care activism to create a concierge style medical practice to serve all genders equally with cutting edge comprehensive treatment plans.

The other work I have been doing is more personal, learning how to trust my gut. Who is good at this? Tips? Strategies? It is so hard in this mixed modern world for me to be able to sift through the messages that come from outside vs. those that come from inside. What I have learned, is that if the inner messages are not heeded, outside havoc will soon result. Or, an event will occur with a big “I Told You So” tag on it. This is part of my process as a human – what is your process? We all have evolutionary issues that we work though, each as unique as stars. Having good guides – as partners, therapists, teachers, doctors, friends – is key to actually learning from our process and not repeating the same mistakes. I am lucky to have all of the above right now – except a good Dr. That is next on my list!

Thank you for reading through, for listening. My health story is mirrored in my life, and I know all of yours are too. It is the details of life that illustrate the pathways of disease and also those of health. Find yourself a Dr that will listen for the details, and trace paths. Take a new course. Call someone you miss. Step outside your comfort zone and do something professionally that scares you! It is September 2013, the time is ripe!

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Reflections from the Philadelphia Trans Health Conference 2013

What a phenomenal catalyst for change. June 13-15 was the 12th annual Trans Health Conference in Philly. It was a massive collection of workshops on many different aspects of Transgender, Transsexual and differently gendered health and healing including medical, legal, spiritual, practical aspects, self-empowerment and so much more. I was honored to be a presenter this year on Naturopathic Medicine and Trans Health. It was my first time attending the conference, and I am so impressed by the caliber of the event. I primarily attended medical style workshops including presentations on the most recent research being done with the trans community.

My talk was a great learning process for me. Not only from the questions asked by the diverse and well informed crowd, but also as a reflection of self. I am very comfortable in the trans community, consider myself an ally, and am aware of the multidimensional and sometimes fragile nature of trans identities. And yet, twice during my presentation I wrongly identified someone as a woman and a man when calling on people for questions. Under pressure, my highly educated nervous system switched back to my reptilian brain of the binary He-She world – and this with all the *knowing* that I have of the great diversity of gender expression. I was disappointed in myself.  It is a lesson that in working with this community, it is especially important to be conscious of language. The old ways of thinking are simply not progressive enough to enter the dialogue. For example, when referencing  people, we as a society need to step outside of classifying people by sex (and race.) Instead of saying “the woman in the yellow shirt”, say “the person in the yellow shirt is ….” The majority of the time our binary classification may be right, but there is a significant proportion of times when our 2D classifiers are actually incorrect, and those can be very painful moments for the individual inhabiting the misread gender identity.

I also talked about adrenal health, and was pleased to learn of new research that evidences salivary cortisol levels are indeed raised higher in the transitioning trans population than in controls. Meaning – stress is huge. Everyone working with trans people of all identifications will need to do stress management and adrenal support. Adrenals are also a source of endogenous hormones including DHEA, which could be a resource for transmasculine and transfeminine people not taking hormones as it has the potential to shift to both testosterone and estrogen internally.  There were many questions about the use of botanicals that have been evidenced to have steroid-like action. This is an area I need much more clinical experience in.

I was heartened to meet 3 other Naturopathic Doctors and two herbalists working in this field at the conference, all of who gave presentations as well.  They reminded me of some of the important preventative medicine aspects of working with people on hormone therapies like hypertension, osteoporosis, calcium quality, high cholesterol and so much more. There were also acupuncturists, and ayruvedic practitioners offering other traditional perspectives. Next year I hope to cultivate a workshop where we all meet to share information! I know I was left with more questions than answers.

I learned important information about our trans youth, and ways to support them better from both a practical level in schools, around mental health, and medically. Dori Midnight, a Massachusettes healer and fairy witch did workshops in mental health, herbalism and ancestral trans magics. I also got to share a room with her, which was a delightful meeting of the minds with gluten-free snacks. There were many sessions on identity development and closed meetings for specific gendered health care needs that looked inspiring and transformational. There were many fantastic workshops I did not get a chance to attend, including a 2 day medical training stream which I will certainly do next year.

Overall, the experience was one that provoked intense introspection and profound leaps of knowledge. It was an event that is crucially important to modern medicine, to understand not only the vernacular but also the urgency of the need for competent health care providers AND self care within the transgender, transsexual and gender non-conforming communities.

A few links and resources from the conference:

http://www.trans-health.org/

http://www.dorilandia.com/html/home.html

http://thirdroot.org/

http://www.rainbowhealthontario.ca/admin/contentEngine/contentDocuments/Gender_Independent_Children_final.pdf

www.riverstoneconsult.com

www.gendercreativekids.ca

www.fenwayhealth.org/transhealth

 

 

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#TTC – Safe Treatments for Fertility & First Trimester Anxiety

The work of becoming/being pregnant marks a time in a woman’s life when the game changes. Alcohol is no longer an option for stress management. Most herbs and even common teas are viewed with suspicion, and many medications are frowned on. Many of our crutches for managing the stresses of daily life are taken away, and the stress of in/fertility is added. However, there are natural treatments available for this time period to reduce stress, ease anxiety, and support a healthy first trimester.

Flower Essences are very safe for all expecting and #TTC moms, and are especially useful for women using multiple fertility and metabolic medications as they have no interactions or side effects! Flower remedies are literally essences of the particular flower in a brandy solution. Bach flower essences are the most commercially available. FES (Flower Essence Society,) Alaskan Essences, Perelandra and more are other well respected flower essence brands. Bach has 38 different flower remedies available; however the following are especially pertinent for fertility and first trimester. Dosage is 3-5 drops in water 2-4 times daily or as needed. The very small amount of alcohol in these medications will not cause any fetal problems as it is so minute a dose.

Aspen: For apprehension and vague fears

Gorse: Brightens perspective and increases optimism.

Holly: For envy or jealousy of others

Larch: Gets one out of the success/failure paradigm and increases self-confidence

Wild Rose: Restores interest and joy when feeling apathetic or resigned.

White Chestnut: Restores a peaceful mind when caught in repetitive thoughts

Botanical Medicine: Some herbs are appropriate for this time period, however most herbs are best set aside until the pregnancy is well established or beyond breastfeeding. One herb that is a #TTC and first trimester best friend is viburnum prunifolium otherwise known as black haw. This is different from viburnum opulus aka cramp bark – do not mix the two! Black haw quiets an “irritable” uterus, and prevents miscarriage. It is very safe and quite effective. I recommend 1/4 to 1/2 tsp daily for the first trimester as needed. For questions and concerns, refer to your local Naturopathic Doctor who can take your full history and prescribe according to your individual health care needs. Oatstraw or avena sativa is also a wonderful tonic that is nourishing to the body and calming to the mind. This herb is best taken as a tea. It is gluten free, hydrating with rich minerals (therefore great for morning sickness) and soothing to frazzled nerves. Valerian is perfect for nighttime anxiety. It is safe in pregnancy, breastfeeding, and for pediatrics. This is Mother Nature’s truly sedative herb. Used in doses of 5-30 drops before bed, this can help quiet the mind and improve the duration and quality of sleep. I like it as an alcohol free (glycerite) tincture as the taste is slightly sweeter than the alcohol based formula. Capsules are also an option although I prefer the smaller dosing options of the liquid form. (Valerian is very well researched, please contact me for a formal monograph if desired.)

imagesFinally, lavender essential oil has a time honored place in the treatment of anxiety.  For those whom lavender has a calming effect you can use lavender products liberally that have the real essential oil in them – avoid synthetic fragrance analogues. There are now lavender essential oil capsules that are quite effective for treating occasional or situational anxiety. These act quickly and safely to diminish feelings of panic, irritability and stress. Typically essential oils should not be used internally during pregnancy, so these lavender caps are best used only until the day of ovulation. There is a lavender glycerite tincture also available which can be used sparingly while pregnant in doses of 1-2 drops for anxiety and panic as needed. There is some (internet) controversy surrounding the use of lavender in pregnancy; however, it is not listed in any of the classic literature as a herb to avoid in first trimester.  My opinion is that if this botanical medicine is the one thing that works to soothe your fears, use it in moderation. If it increases your anxiety due to the multitudes of internet opinions, avoid it! Here is a link to a well researched blog post on the safety of lavender essential oil in pregnancy: http://roberttisserand.com/2011/07/lavender-oil-and-pregnancy/

Acupuncture and Registered Massage Therapy are also fabulous safe care therapies for anxiety and stress while #TTC. Acupuncture has a proven track record of efficacy when it comes to enhancing not only assisted reproduction but also all conception. Studies have shown that weekly acupuncture greatly reduces the rate of miscarriage during first trimester, especially for women with a previous miscarriage. This is in part due to its ability to support the expectant mom through the first 12 weeks. The therapeutic touch offered by massage therapy also has the ability to soothe anxiety, ease depression, and support the physical changes of pregnancy. The resulting relaxation offers an anxious expecting mom a few moments to quiet the mind, which can have great positive effects overall. It is important to see an acupuncturist or massage therapist trained in pregnancy massage as there are specific techniques and positions used for this treatment.

All in all, this is such a time of mystery, of waiting, and of trust that it can be overwhelming to have to “go with the flow.” Every couple experiences some level of anxiety, and some have a very hard time as #BFN’s happen again and again.  Flower essences, black haw, oatstraw and lavender glycerite are natural remedies that any couple can use to support their own mental and emotional wellness on the road to becoming a family. There are many more herbs, vitamins, and therapies available for #TTC and expectant moms that are based on the individualized medicine offered by a licensed Naturopathic Doctor.

Links and Resources:

http://www.gowonderworks.com/flower_essences

http://www.bachflower.com

http://www.fesflowers.com

http://www.biomedcentral.com/1472-6882/12/20

http://www.fertilityfactor.com/infertility_acupuncture.html

http://americanpregnancy.org/pregnancyhealth/prenatalmassage.html

 

 

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