(Least)* Complicated

Walking the tightrope between being a current MSII medical student and a Naturopathic Doctor is a delicate balance sometimes. I never know whether my career as an expert in alternative medicine is going to be a blackball or a gold star because of the very mixed opinions people have about my former profession in the medical world. My plan, heading into the first day of medical school was not to tell anyone my (second) degree when I started (my third degree) at UNECOM, but it was announced in orientation so my cover was blown.

Being a ND in general is pretty complicated – working outside of insurance in most states is a financial challenge for patients as well as doctors, and public knowledge about the profession is highest on the west coast of the US and Canada, and in more affluent areas of the NorthEast. Many people get excited when I say I am a doctor, then look back blankly when I tell them what kind of medicine I practice(d). People who know the field have reactions that are pretty love: hate. Lots of lovers, quite a few haters, and an ever-growing population of quiet converts who realize that, as one anonymous Twitter medical student said in my recent Twitter Flaming on the topic: people who are interested in alternative medicine are usually trying to take care of their health and make themselves feel better.

IMG_6031I have recently been made aware of a woman who attended a west coast Naturopathic Medicine College who has turned against the profession “with an inside view” and who is engaging in aggressive muckraking. She is getting recognition and validation as an “insider” to Naturopathic Medicine as she did complete our 4-year postgraduate degree before she quit and moved to Germany. She has started a petition to defame the profession worldwide. The unfortunate thing is she lives outside the US and is not accountable for US or CDN slander laws. What she is doing is poignantly effective because she has inflamed the haters. One doctor in particular is a physician and educator with the influential Doctors in Training Boards Exam Review Series. He has a large Twitter following and has enthusiastically joined in the slander of the Naturopathic Profession. I worry about how his “expert” personal opinion will effect future generations of physicians who have not considered their professional opinions of Naturopathic Medicine due to lack of exposure.

Big media like Forbes has jumped on the “tin foil hat” bandwagon by supporting her claims that botanical medicine, nutrition, physical medicine, homeopathy, mind/body practices and stress management are invalid sciences without evidence. The American and Canadian federal Naturopathic associations have both started a counter-petition against these muckracking efforts.

All of this is personally upsetting for me. It stirs a complicated turmoil of emotions, injustice, pride, and frustration that mixes my own choices with a very clear working knowledge of the weight that “the big lie” technique can carry in the world of propaganda. All of this comes at a time when “Functional Medicine” and “Integrative Medicine” are the new darlings of allopathic medicine alongside epigenetics and the microbiome.

Newsflash: Functional Medicine and Integrative Medicine ARE evidence based Naturopathic Medicines, researched by and for NDs originally.

Naturopathic Doctors are systematically being defamed and slandered while our actual practice techniques are being picked up and renamed and celebrated for their effectiveness.

I feel helpless in the face of this complicated adversity. I made my personal choice to add an Osteopathic Degree to my knowledge base because there was more to medicine I wanted to know – pharmacology, emergency medicine, psychiatry, and other facets of transgender medicine I need additional training on. I know the great value of Naturopathic Medicine and so do a great number of North American consumers. I suppose I need to trust that the greater good will prevail in the end…. but that may not help me or my career path when I am placed in a hospital as an MSIII or resident with an attending like the Internist above who hates everything alternative and Naturopathic medicine stands for.

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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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How to Survive Influenza

Herbal medicine is wonderful for any kind of cold and flu. The key to successful use of herbs is to take them early and often. I began with Gaia Respiratory Defense capsules 2 caps every 3-4 hours with lots of watered down juice. I also drank an entire bottle of Apitherapy Wild Cherry Cough Syrup at 1 tbsp every 2-3 hours for the first 36 hours – this is a New England centric product but any herbal wild-cherry or horehound based product would do. If you live in a bigger city Nin Jiom Pei Pa Koa is an awesome Chinese cough syrup available at many health food stores. Mix 1 tbsp of the Nin Jiom thick syrup with hot water for a soothing tea/cough syrup 3-4 times daily.With these two products I was successful in clearing the lungs, and ended up with only some minor sniffles.

“Feed a Cold, Starve a Fever” is an old saying. When you have a fever, your body does not have energy or attention to pay to the digestive system. Most people do not have an appetite anyways, so it its Best Practice to focus on fresh fruit, juice, water, and soup broth. Apple sauce, popsicles and crackers are also good choices. Follow your intuition when it comes to food. Herbal tea with fresh lemon and honey is also healing and soothing. Echinacea tea, or any “throat tea” or “cold tea” will be beneficial. Don’t be afraid to *not* eat if you are not hungry; however make sure you maintain some caloric intake so your body has fuel to fight (unless it is a stomach flu.) Your appetite returning will be a sign of health.

Other things that help fight off influenza – elderberry syrup has tasty evidence based antiviral capabilities. Taking a minimum of  5,000IU of vitamin D and 2000 mg of old fashioned vitamin C will both speed recovery as well. This years flu is highly contagious – please don’t “be brave” and work/shop/be out and about unless you absolutely need to. Ask a friend to pick you up something and drop it off, take time off work, and REST! Everyone else will thank you for it, and you will recover faster in the end, with less complications than if you have suffered through it publicly.

I haven’t had the flu…. ever before. And I had not had a fever since I was a child. Boy, together they make an awful combination! I spent most of the week between Christmas and New Years Eve lying in bed with a face-headache, sweating, chilled, sniffley, and unable to do much more than lay with my eyes closed.However, I did recover rather quickly, without losing more than a couple days of work and a few pounds. During my fever induced vacation, I had time to consider fever medicine, and to mull over how many people have actually died from influenza over the course of history.

Curious as to how this self-limiting virus induced illness could literally wipe out generations, I took to Medscape to better understand why the flu can have such devastating effects.  From the article “Christmas 2009: Years Like This: The Spanish Influenza Pandemic Seen Through the BMJ’s Eyes: Observations and Unanswered Questions” by Tom Jefferson, Eliana Ferron BMJ. 2009;339:b5313 it is clear that it was not a simple case of influenza that killed so many people, but rather a combination of factors including environment, hygiene, medical practices of the times, and a lack of immunity to the European microbial ferment that wiped out staggering numbers of  people. The article states:

” The causes of the high case fatality rate are still unclear, but modern research suggests that the pandemic was a lot more than just a “one germ-one disease” affair. [19] … Agents other than the influenza virus probably played a part. Above all, the environmental explanations of the high [Samoan and Lapp] mortality rates indicate the peril of generalizing across contexts and simplifying causation models. “

In other words, early pandemics were about more than just a flu virus. They were complicated environmental scenarios where subsequent (fatal)  infections developed. Therefore, most of us in modern times are highly unlikely to die from influenza. This is of course, a more serious condition for people who have a defective immune system and for individuals on either end of the age spectrum who are more fragile. So, knowing that one is unlikely to die from the flu or fever, are you more willing to suffer through the symptoms if you knew it would be over sooner?

I was raised with the belief that a fever is an opportunity for “cleansing” on a spiritual and physical level. Fevers up to 102.5 are still considered safe and effective for a healthy person. The heat in the body serves as a natural autoclave, killing bacteria and viruses quickly and effectively. In my upbringing, it was also “burning karma” and an opportunity to cleanse oneself from spiritual burdens. This is what I focused on as my fever climbed from 101.5-102.5. I felt awful and was miserable and in pain. But, I kept telling myself I was in the process of transformation! It seemed to justify the misery in a way. There is of course, a limit to pain and suffering and modern medicine has much to offer. Therefore, I would return to my 400mg of Ibuprofin at night to help me sleep and reduce my pain and fever for the night. After all, sleep is as important in recovery as anything else is. Thus, I do suggest when you or a loved one has influenza, to allow a fever to burn within a safe range up to 102.5 F (Technically a fever is safe up to 104.5F) . Fever reducing medications can always be used as needed when the tolerance level of suffering is reached. Belladonna 30CH is a homeopathic fever reducing medication that can be used safely in children and adults as needed. It acts as a trigger to the body to reduce its thermostat, without actually suppressing the fever like NSAIDS do. This is a great medication to have in your home first aid kit. I was happy to dig mine out at 2:30 am on my second night sick – anything for relief in those sick midnight hours!

A final thought on cold medications – allergy pills, Dayquil, and other daytime cold and flu medications are most likely going to fail in the face of influenza. You are better off lying in bed and letting your fever burn while you try and watch some tv. However, night time is  when I believe some medication can be necessary as most people worsen in the night. No natural cough syrup is going to be as effective a pharmacy brand one. If I am hacking in the night with a cough, I use a pediatric cough suppressant as they contain less alcohol and chemicals than adult ones. Using Nyquil, or Ibuprofen/Tylenol at night to sleep is perfectly reasonable if it actually works for you. (If it doesn’t work, stop taking it and call your Naturopathic Dr for more treatment support.)

In summary – Rest, liquids, soups, belladonna 30ch, wild cherry cough syrup, vitamin C, vitamin D, elderberry, and a herbal formula that treats your constellation of symptoms are all components of successfully navigating a bout of influenza. Allow the fever to burn, whether you view it as a natural autoclave or a spiritual cleansing (or both) is up to you. A cough that lasts more than 7 days, fever above 102.5, or consistent vomiting for more than 36 hours are all good reasons to call your primary care provider and check in.

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A Note from Behind the Curtain

So many patients are looking for answers. As a doctor I know that the best answers are in each individual. Usually, we do not want to know the real answer. We want a pill, or a cream, or a smoothie containing the essential nutrients that will add up to the ultimate results. Dont get me wrong – products will help. Testing can uncover imbalances and deficiencies to be corrected and appropriate formulations to improve symptomology. However… until you are actually ready to change something – that thing- – which needs changing in your personal landscape, it is unlikely that you will find your own true answer to health. I will use myself as an example.

After I graduated from Naturopathic Medical School in 2000, I opened a clinic in downtown Toronto with some of my classmates. Over the next 12 years I developed my professional identity, grew my patient base, and pursued my personal passion of fertility medicine. I had a wonderful partner, a beautiful home and fantastic friends. I was never fully content, despite my abundance. I doubted my career and profession, and was constantly seeking something outside of myself to fill the inherent void. No amount of adrenal supplements, detox regimes or magnesium quieted the inner voice. This was not an organic condition, it was a calling that took me many years to acknowledge.

Eventually, I moved to Portland Maine in March 2011. I sold my clinic, left my clinic faculty position, and my sweetheart and I parted ways. Here, life is different. I smell the ocean every day. I do yoga (occasionally.) I walk the dog. I drink green tea. I am redefining myself as a Naturopathic Doctor and am inspired by the new turns my professional identity is taking. I am becoming a better doctor – the best version of myself. It has been a massively stressful process to redefine my life in my late 30’s. However – the gray hairs are worth the evolution. I am happy in a way I have never been. And it is not because my physical, emotional, or mental health has changed drastically. It is because I have found my own answer.

Not everyone’s answer will involve so many miles and such upheaval. The answer to your own health and wellness questions may simple or complex. Part of my job as a Naturopathic Doctor is to look beyond pills and dietary restrictions to see your truth behind your curtain, and support you in finding your own evolutions. If I can do it, I am sure to believe in you.

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Resolving an Arthritis Flare – for My Dad

Chronic inflammation can cycle into snowballs of pain that catch us off guard. For those with a familial tendency towards rheumatism, arthritis can become quite severe. Joint inflammation usually takes the autoimmune form of rheumatoid arthritis or the inflammatory/ immune joint presentation of osteoarthritis.

An acute osteoarthritis presentation can be effective managed with Naturopathic Medicine. To follow is a recipe for resolution of an acute (meaning, immediate or aggressive) flare up of arthritis that may be causing moderate to extreme pain and inhibiting mobility.

1.You will need to rest as much as possible for 7-10 days. Plan to stay home and lay low whenever possible. Get up every 2-3 hours (except while sleeping) for 10-20 minutes of stretching and gentle exercises like walking in nature, Pilates, or gentle yoga. Wii Fit balance and core strength exercises are fun and support rehabilitation.  Plan your life accordingly. You may need to work from home if possible, reschedule activities, and modify your lifestyle during this time. Remember that this is necessary to address the pain. It is likely your pain and inflammatory levels will be up to 50% resolved by the tenth day of treatment. During this time, also take a daily bath, soaking the affected joints for up to 20 minutes.  I recommend using Epsom magnesium bath salts with 10-15 drops of lavender essential oil or a bath salt of your choice. Follow with 20 minutes of icing the affected joint.

This plan will not cure your arthritis. Your will continue all conventional medications used during the treatment although you may be able to decrease pain medication as needed. This does not replace the need for surgery or other scheduled plans prescribed by your physicians and specialists.

1. For the 7-10 days spent at home, you will follow an Anti-Inflammatory Diet. This is best continued until joint replacement is successful; however, it is crucial during the initial rest window. Studies have proven that nutrition is directly linked with inflammation. By eliminating foods known to increase systemic inflammation, you can reduce your own inflammatory load. This allows your body to begin healing. For more information on The Inflammatory Diet set up an appointment with Dr. Masina Wright ND. http://thewrightdoctor.com/contact-information/

2. Zyflamend Nighttime- 2 capsules 3 times daily. This is a modern formulation of 6-10 botanicals to treat inflammation, joint pain and rheumatism using herbal medicine. New Chapter has combined these into an effective and well researched formula called “Zyflamend.” http://www.newchapter.com/zyflamend The PM version also contains a small amount of relaxing herbs which are helpful for supporting a restful attitude during your healing. You may continue this for up to one year’s duration before a break is needed.  This product is safe to take with most narcotic and non-narcotic pain medication including Vicodin, Oxycodone, Ibuprofen, Tylenol 3 and Ibuprofen. However, do not drive while taking this formulation. If you must drive, use the Zyflammend original formula.

3. Nordic Naturals Omega Joint Plus – 3 capsules daily with or without food. This is a premium joint care formula containing the required daily 1500mg of glucosamine sulphate as well as anti-inflammatory levels of EPA and DHA. The product is expensive at ~$50/bottle for one month supply however, it is worth it. Switch to this product during your first month of resolution treatment for best results, even if you have other fish oil or glucosamine supplements. http://www.nordicnaturals.com/en/Products/Product_Details/514/?ProdID=1548

During your 7-10 day rest time, you can take your other supplements as well, or take a supplement vacation and focus on the above products only to streamline your protocol.

This is the skeleton treatment plan. This is a great place to start! As a Naturopathic Doctors, we individualize every treatment plan to fit each patient’s unique identity. If you do not get the results you are looking for or have trouble adhering to the program, consider seeing a ND in your area. In addition to the above protocol, specific neutraceuticals to address sleep, anxiety, digestion, or other issues may also be prescribed in a consultation. Classical homeopathy is also extremely useful in complex cases. It is safe with complicated pharmaceutical treatments and provides lasting results.

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Alternative Medicine

A friend of mine recently asked me what Alternative Medicine was. Ask 50 people, and you may get 50 answers! I can tell you my answer. It is intricately tied in with Sociology, Cultural Studies, and Anthropology. To understand a cultures medicine is to have a clear window into their worldview. Modern American “Alternative Medicine” is a broad spectrum of many cultures traditional medical practices – Asian Medicine and Acupuncture, Indian Aruveda, Native American and “Eclectic (European western) Herbalism, German Homeopathy, and many others.

Alternative Medicine is the other side of Allopathic Medicine. Allopathic Medicine is the current model of western medicine implemented in 1909 by Flexner and the newly formed American Medicine Association at the turn of the century. Alternative Medicine and Allopathic Medicine differ in their basic model of patient care. The former is patient-based, where an individual story, environment, life experiences and constitution all play some role in the current health problem. The latter is based on symptom assessment and diagnosis, with an emphasis on pharmaceutical and surgical management. Truly – both are needed in modern medicine. The best care comes from a marriage of the two.

When this friend asked, I answered her with a reply of what Naturopathic Medicine is.  I believe Naturopathic Medicine represents the best of Alternative Medicine! It combines evidence-based medicine with a body of knowledge that is evidenced by time. Naturopathic Medicine is an umbrella term that relates to an Alternative Medical practices that all adhere to a general principle of care that is combined with modern cutting edge diagnostic and clinical-medical training. Naturopathic Doctors must complete a 4-year post-graduate program with licensing and board exams to ensure that the skills needing to be a “Doctor” as well as “Naturopathic” are met.

The basic theory of Naturopathic Medicine is in the Latin phrase vis medicatrix naturae. The vis is the inner ability of the body to heal itself – the guiding inner principle that all Alternative Medicines have (and most traditional cultures recognize.) Medicatrix is medicine. And naturae is Nature. The body has the inner medical ability to heal itself, with the help of nature. The Naturopathic toolbox assists in returning one to a state of health, and includes Asian medicine, botanical medicine, homeopathy, lifestyle counseling, massage (and other hands-on bodywork techniques), and nutrition. In some states and provinces ND’s are also able to prescribe some pharmaceuticals and perform minor surgery.

To summarize – Alternative Medicine is a broad term that includes many different cultures traditional medicines. Naturopathic Medicine is a branch of Alternative Medicine that unifies the practices under a licensed scope of care. A Naturopathic Doctor is the Alternative Medicine Physician, providing patient-based care founded on the theory that your body has an innate ability to heal, when given the proper nature-based treatments.

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