Tag Archives: Integrative Medicine

(Least)* Complicated

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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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Fertility is the New Holy Grail

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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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LGB Trans HRT ~ New Program, Fresh Vision, New You

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imagesWIDJJQD2The flame of Trans* Health has been burning steadily brighter in my life over the past 3 years. I was keen on the practice while still living and working in Toronto, ON but without a scope of prescribing hormones, my work with the Trans* community was peripheral medicine – acupuncture, restoration of transman fertility, anxiety support etc. I continued to take trainings in the hormone and lab protocols to better understand the medical aspects of transition, without the vision of guiding transition myself.

Once I moved to Maine in 2011, my scope of practice as a ND changed. Naturopathic Doctors have different abilities to prescribe and order diagnostic lab work in each state and province. Most of the west coast states plus British Columbia have full prescribing rights, can do IV therapies, and can act like primary care docs for their patients. In the more conservative middle North America and east coast, Vermont and New Hampshire are the only states/provinces with a full scope of practice. However, for me, from Ontario, the ability to prescribe most hormones and antibiotics was a big change of pace!

I mentored and practice with Dr. Michael Bedecs, an Osteopathic Doctor specializing in hormone therapies for the past  3 years. Under his guidance (plus several conferences on trans health, anti-aging and hormone optimization) I have come to better understand the intricacies of the endocrine system, and how they interrelate through reproductive, thyroid, adrenal, pancreatic and pituitary pathways. All this time, my brain has been making subtle connections in Trans* health, drawing pathways to hormonal optimization the bridges the cultural and gender fluidity required with treating the LGBT community with medical advancements in metabolism, subclinical hypothyroidism, fertility, adrenal exhaustion, cortisol excess, insulin resistance and more.

Dr. Bedecs and I have created a new program called LBGT HRT that includes the dynamic possibilities of gender and hormone variation, bioidentical hormone replacement, transsexual transition and transgender health. We will be offering this through our concierge style practice at Age Management Center in Portland, Maine.

Age Management Center is a cash based practice. We do not accept any insurance plans for visits, medication or laboratory services. Some patients are able to pay for our services through Health Savings Accounts, or get third party reimbursement. Working outside of insurance allows us to provide a standard of care far above  the norm. We offer blood work here in our clinic, at physician pricing. Because we are not limited by the current scope of insurance, we are able to test for and evaluate metabolic parameters that are essential to our complete understanding of hormonal health and wellness.  We spend an average of 90 minutes for first visits, and offer a free 30 minute consult before any commitment is required. Furthermore, within our framework of concierge medicine, each visit is not priced and ticketed; rather, the ongoing support of our doctors, nurses and medical staff is included in the program, allowing you unlimited access for questions, concerns, and follow up until your program is fine tuned and ship shape.

We know this style of medicine is not accessible for all members of the LGB and Trans community. Therefore, I created a monthly sliding scale clinic at Justice in The Body the first Monday of each month from 9am – 12pm to meet the needs of the lower income members of the gender queer and Trans* community here in Portland, Maine, and beyond. This clinic is limited in that a prescribing MD, NP or DO is still required to Rx the Testosterone for FTM and Spironolactone or Cyproterone for MTF; however, I am able to order lab work through insurance in Maine and can work with your prescriber to optimize current hormone protocols and work on supporting the Integrative aspects of general health and wellness that come with transitioning. Many of my patients at the Trans* Health Clinic have been fully transitioned, and we are working on other aspects of preventative medicine and optimized health through the lens of Trans* medicine. I am currently working on expanding the scope of the JITB Trans * Health Clinic by finding a prescriber to work directly with us in house. Stay Tuned!

Follow me on Twitter for Trans* Health @LGBTHRT

Follow me on Facebook for monthly updates about the Trans Health Clinic at JITB

Note: Trans* is a new-ish term. The asterisk denotes that the term is encompassing the entire transgender, transsexual and gender fluid spectrum of individuals without having to write all of that every time.

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

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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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The Longest Night of the Year

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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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