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Stone Turtle Health Blog

Another reason to stay active

April 8, 2015

According to the U.S. census, over 25% of our population will be over 65 by 2030. There are many reasons for adults to stay active throughout their life, and the NY Times has another: staying active protects brain cells from dying, preventing brain shrinkage. And a common outcome of brain shrinkage is a chronic subdural hematoma (SDH), or bruise in the space surrounding the brain, which puts pressure on the brain and interferes with its function. The Times' article discusses the increasing incidence of chronic SDH in older populations, even without a head injury or fall, and how it mimics other neurological conditions. Symptoms such as sudden and severe headache, weakness on one side of the body, personality or cognition changes, and confusion or difficulty speaking are a sign of immediate need for medical care to rule out SDH or other serious concerns, such as TIA, stroke, dementia, Parkinson's disease, migraine, epilepsy or psychiatric condition. In many cases, chronic SDH can resolve on its own or with medication but about 1/3 of patients require surgery.

So, in addition to cardiovascular and respiratory health and prevention of weight-gain related diseases such as Type 2 Diabetes, staying active works to protect brain function and cognition and to prevent chronic SDH. Don't know where to start? Try adding an after-dinner stroll to your daily routine, check out some yoga or dance classes at your neighborhood community or senior center, or visit one of Seattle's beautiful parks for a walk along the beach or a forest path. Wear proper footwear to support your ankles and prevent injuries. Now is the season to get out and enjoy the fresh air. Your brain will thank you for it later!

Alternatives to Antibiotics?

March 29, 2015

The White House has just released a 63-page report that sets 1-, 3-, and 5-year goals for adderssing antibiotic resistance and overuse. The report focuses on slowing resistance, having a single point of integration for multiple health information networks, to accelerate research, testing, and treatments for current bacterial infections to stay a step ahead of the resistant bugs. By 2020, the report goals include a 50% reduction in inappropriate antibiotic use in outpatient settings, including family practices like ours. 

Where do antibiotics fit into naturopathic medicine and how does this plan affect naturopathic doctors? Any treatment, including antibiotics, vaccines, and surgery can be done "naturopathically" if it is utilized within our Hierarchy of Interventions (lowest to highest, as appropriate) and if it is performed in accordance with the tenets of our profession. These pillars, discussed in earlier posts, include "treating the cause" (something antibiotics do well) and "prevention" (vaccines, check!) as well as "first, do no harm", "treating the whole person", "doctor as teacher", "wellness" and the "healing power of nature". Naturopathic medicine is not a proscribed set of herbs or nature therapies to the exclusion of advances in medicine, it is a philosophy that takes these tenets into account when treating each patient as an individual. Sometimes, antibiotics are the right choice. Sometimes, an herbal remedy with antimicrobial properties would be a better, lower-level intervention for a less serious bacterial illness. NDs (naturopathic doctors) work to support the patient's own immune system in addition to appropriate interventions to address the cause of the illness, whether it is lifestyle-related, genetic, bacterial, viral, fungal, or environmental.

As a parent, it is difficult to take a sick child into the doctor and NOT come out with something tangible, like a prescription for antibiotics. Many doctors feel pressured to "do something" by the parents, aside from recommending rest and hydration. However, antibiotics do not address causes that are not bacterial, such as viruses, and should not be given unless there is a strong indication for need. In addition, there are a number of antimicrobial or antibacterial herbs that can be used in place of antibiotics in milder illnesses. Many viral illnesses are self-limiting and sometimes the best thing we can do is to support the immune system with natural antivirals (like elderberry and licorice) and help to relieve symptoms that are the body's way of attacking the virus (cough suppressants like cherry bark for example). Common hygiene practices, such as proper hand-washing technique, can slow or stop the spread of viruses and bacteria in many cases. Naturopathic medicine has multiple treatment choices that can help minimize our reliance on antibiotics, allowing them to be reserved for more serious bacterial infections and slowing the progression of antibiotic resistance. It is my hope that some of that research money will be used to replicate earlier studies on antimicrobial herbs as an alternative to antibiotics for resistant bugs. 

Fakin' it!

February 26, 2013

Dr. Ted Kaptchuk of Harvard, who has his doctorate in Chinese medicine, is at the forefront of studying the placebo effect and its place in medicine. For many folks, the term "placebo effect" has a negative connotation, used to describe why many people get better with treatment, in the absence of any measurable therapeutic chemical interaction (as in homeopathy or in drug studies where the control group is given sugar pills). However, an article released in the latest Harvard Magazine discusses how doctors can use the placebo effect to positively affect patient outcomes. Whether it's a sugar pill or sham acupuncture (as in this study), who wouldn't feel some symptomatic improvement just from feeling respected and listened to by their practitioner, rather than dealing with a curt professional who dismisses your concerns abruptly or who doesn't seem to have enough time for you? There is a very interesting and, to me, exciting field of research surrounding patient-doctor interactions and the effects that they have on care outcomes and I look forward to reading more about how I can improve my patients' health by taking the time to listen and care for them. It also inspires me to ask the following questions (please post your responses below): what makes a doctor effective? Why do you return or choose another doctor?

60% of the time, they're right 100% of the time..

July 10, 2012

A friend of mine posted a screenshot of Fox News' latest propaganda attempt. Across the screen was the large print shocker: 83% DOCTORS CONSIDER QUITTING OVER OBAMACARE it screamed out. What? First of all, 83% of doctors can't even agree on basic healthcare screening guidelines like when to get a mammogram or how frequently your cholesterol should be checked, much less something as "controversial" as national health care. There was a survey done by DPMA, a conservative lobbyist group that is trying to raise funds to overturn the National Healthcare Act. 83% of their survey respondents were "considering quitting", but it wasn't linked directly to the passage of the bill. This sort of bogus "reporting" is part of what created the political divide today between states, neighbors, and even families. When all anyone hears is vitriol spewed about members of the opposing political party, other countries, our own government, and about people who earn more or less than us, it's bound to overthrow our reason and our critical thinking skills. 

That being said, I'm for "Obamacare". As a physician, I try to avoid getting too political for fear of alienating any of my patients. But coverage and healthcare for everyone does have a nice ring to it. I want to see more patients. I want to provide patients with preventive care and early interventions that keep them from seeking care at the emergency room for non-emergent medical problems. I want to be covered by Medicare and Medicaid- I would take more Medicare and Medicaid patients if I could. Right now, I choose to see them on my sliding fee scale because Medicaid and Medicare do not cover naturopathic physicians. I have committed myself to improving the lives of people in my community and that means seeing sick people who need care, not just sick people with insurance.

But, it would be easier to do that if I could get paid better. 

Part of what "Obamacare" does is to require insurance companies to use more of their member's premiums to pay doctors instead of their own CEOs. Yet Cigna's CEO made over $19 million last year. Last month, I got $37 from them for a patient visit that lasted 30 minutes. And the patient had a $40 copay on top of that. Any complaints about the unfairness of this to the patient or to the provider are met with cries of "free market economy" and "who are we to prevent businesses from making money" and "socialism".  And I am free to do as many of my colleagues do and not accept insurance or be an out-of-network provider. But I rely on insurance directories for some of my referrals and to allow more people to take care of themselves and to see a naturopathic doctor than might otherwise be able to. Yet there is a sharp divide between how much insurance companies are making and how much they are reimbursing doctors and patients are stuck in the middle (see my blog article on "The Insurance Secret" for more). 

Obamacare also provides subsidies for patients who can't afford policies on their own. Covering more of our vulnerable populations will keep them out of emergency rooms. Covering naturopathy would aid this and shift their burden of care to doctors who are willing and able to provide preventive and primary care medicine to reduce the numbers of people suffering from chronic conditions like diabetes, high blood pressure, asthma and allergies, etc that are a huge percentage of healthcare costs. A small study in Vermont showed that members of a professional association that joined a preventive healthcare program run by an ND were able to lower their direct healthcare costs by $21 for every $1 spent. This is phenomenal and, at the very least, should provide impetus for studies on a larger scale about the potential impacts by naturopathic medicine on the national healthcare debate.

The time for rational and intelligent merit-based and well-thought out discussions about where our country and our planet is going is rapidly dwindling as news outlets push their ratings up at the expense of the common good. Turn them off. Think for yourself. Teach your children (as my parents taught me) the power of emotional appeals and the importance of critically parsing statements to discover verifiable facts and how to make decisions based on those facts and how they impact our families, communities and our world.

Guest Blog: Faith Franz for The Mesothelioma Center

June 21, 2012

 

What is Mesothelioma and What Causes It?

Caused primarily by exposure to a natural mineral fiber, mesothelioma is a rare but complicated cancer that affects around 3,000 Americans each year.

Asbestos is responsible for nearly all mesothelioma cases. When disturbed, the naturally occurring fibers can become lodged in the lining of the lungs, stomach or abdomen. Internal damage occurs over a period of several decades. Eventually, cancerous changes may occur, and mesothelioma tumors may develop.

Although asbestos is the cause of most mesothelioma diagnoses, several other risk factors have been identified. These include:

·        Exposure to non-asbestos mineral fibers (i.e. erionite and taconite)

·        Exposure to SV-40

·        Exposure to radiation

When a genetically pre-disposed person is exposed to one of these risk factors, the cancer may begin to develop.

As it progresses, the cancer causes few to no symptoms. Once it has reached its later stages, however, the asbestos-related disease can trigger a number of uncomfortable symptoms, such as coughing, chest pain and difficulty breathing.

What to Do if You Think you Have Mesothelioma

Mesothelioma is notoriously difficult to treat – especially when it is diagnosed in its later stages. Surgery, chemotherapy and radiation therapy are the most common mesothelioma treatments, but patients can also turn to naturopathic solutions.

Alternative therapies such as acupuncture, aromatherapy, massage therapy or chiropractic care may also be used in the treatment of mesothelioma. These treatments are typically palliative rather than curative in nature.

To be prime candidates for curative mesothelioma treatments, patients should be diagnosed in the earliest stages of the disease.

 Since mesothelioma grows without causing many symptoms, early diagnosis is most common in patients who have been scheduled for asbestos-related disease screenings. To help detect the cancer as soon as possible, anyone who suspects they have been exposed to asbestos (or another mesothelioma-causing substance) should register for regular disease screenings.

Author bio: Faith Franz researches and writes about health-related issues for the Mesothelioma Center. One of her focuses is on living with cancer.

 

 

 

Oral Cancers and HPV

February 22, 2012

While listening to Dan Savage's podcast the other night, I heard a head and neck specialist discussing the throat cancer and how an overwhelming percentage (70%!!) of them are caused by HPV, instead of tobacco use (study link here). Although vaccinations are an issue that many people feel strongly about, the HPV vaccine (which is currently being recommended for both girls AND boys) specifically focuses on HPV-16 and HPV-18, the two types of HPV that cause throat cancer, anal cancer (in both sexes) as well as vaginal and cervical cancer (in women). I've included a few links here, from the Oral Cancer Foundation and the CDC. While no one wants to think about children having sex, the window between vaccination age (beginning at 11 years old) and sexual experimentation may be, unfortunately, not that long. 

http://www.oralcancerfoundation.org/hpv/index.htm

http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm

 

As young adults in our late teens and early twenties, we can be exposed to HPV through oral sex or transference from another partner who has it in their throat (from performing oral sex on their previous partner) and the oral cancer will not show up in us until our late 30's or early 40's. Given that oral sex is generally seen as a "less risky" sexual behavior when discussing HIV and pregnancy, these findings are quite concerning because they may lead people to go back to more risky, penetrative intercourse to avoid exposure to a cancer-causing virus. As always, condoms, condoms, condoms!

Everybody's Free to Wear It...

July 5, 2011

Sunscreen. Sun block. Suntan lotion. What exactly is SPF? How much is enough? What is the FDA doing about it?

Now that we've (finally) got some sunshine in Seattle, it's time for a talk about sunscreen. Sunscreen is formed of organic and inorganic particles that are designed to block and/or absorb ultraviolet (UV) light from ths sun. Physical sunscreens reflect light, Chemical sunscreens absorb light. Many products have both forms inside. Blocking sunlight also blocks vitamin D creation, an issue that many patients have concerns about.

The SPF number reflects how well a sunscreen protects against UVB light, the type of UV ray that causes squamous cell carcinoma and basal cell carcinoma. It does not measure protection against UVA rays which cause melanoma or infrared light which also affects sun damage levels. UVB causes the most common types of skin cancer, but UVA causes the most deadly. SPF is, unfortunately, very inaccurate because most people don't put on enough. Also, wiping it off, swimming, and sweating all minimize its effectiveness, regardless of whether it is labeled "sweatproof" or "waterproof". Plus, we're supposed to be reapplying it every 2 hours, right? An SPF of 15 means that, theoretically, you're protected for 15 times longer than you would be without sunscreen. This, of course, doesn't take into account the changes in sun exposure throughout the day as the sun changes position in the sky.

The FDA has passed new regulations recently which will go into effect next year. These will require sunscreens to show that they block UVA and UVB rays in order to be labeled "broad spectrum" and only products with an SPF of 15 or higher can claim to prevent sun damage, wrinkles, and skin cancer. Further, no sunscreen manufacturers can label products as having an SPF higher than 50 because there is not enough evidence to prove that going above an SPF of 50 increases the benefit. The term "sunblock" can no longer be used, nor can "sweat-proof" or "water-proof". Instead, a product can be labeled "water-resistant", but then must state for how long, 40 or 80 minutes.

As always, staying out of the sun, avoiding tanning beds, and covering up with hats and long-sleeved clothing are very important in order to prevent sun damage, wrinkles, and cancer. If you're concerned about your vitamin D levels, talk to your doctor about alternate sources or about safer ways to get vitamin D naturally.

For more info:

Understanding Sunscreen Products - FDA

FDA Cracks down on Sunscreen Claims, bans 'sunblock'

What IS Sunscreen?

Skin Cancer, Sun, and Sunscreen

Can marijuana be used to treat cancer?

April 11, 2011

Last summer, the state of Washington amended our medical marijuana laws to include naturopathic physicians and nurse practitioners as providers who are legally permitted to write "authorizations" for medical marijuana use for patients suffering from a few very specific conditions. Since that time, I have worked with a number of patients who have had qualifying conditions and turned away even more folks who may have been suffering from pain but who just did not qualify or did not have the documentation to back up their claims of having qualifying conditions. Authorizations basically state that the doctor has advised the patient on the risks and benefits of medical marijuana and it is the doctor's opinion that the patient could benefit from using it. The law explicitly states that doctors cannot help patients obtain medical marijuana. Oddly, it's not illegal for the patient to possess medical marijuana, but it is illegal federally for anyone to buy or sell it. There are dispensaries, etc out there, but I can't tell my patients where to go. It's just a "Here you go, now you are allowed to treat yourself. Good luck finding some medication!" kind of thing.

One of my patients from last fall showed up in my waiting room last week. When I last saw her, my patient was recovering from brain surgery to remove a prolactinoma with associated pituitary apoplexy. In English, she had a prolactin-secreting tumor in her brain that had been causing bleeding in her pituitary gland, a tiny gland that sits behind the eyes and regulates most of the hormonal signals in the body. She was maybe 100 pounds, soaking wet, appeared very dizzy and disoriented, and was relying on her family to take care of her. She was only 28 and after I saw her, I went into my office and cried. I didn't think I had been able to do anything for her and she looked like she didn't have much longer to live. I wrote her an authorization, thinking that I would have written someone who was suffering like that as many authorizations as there are days in the week if I thought it would have done her any good.

Cut to 6 months later. She had been in to her oncologist's office to get fitted for a radiation crown, to begin irradiating the tumor that they couldn't remove surgically. A few weeks ago, in preparation, she had completed some imaging. When she got to the doctor's office, with a plan to see him every 3-6 months for the foreseeable future, she was told that he couldn't do anything for her. They had checked and re-checked, sent out for a second opinion and finally determined that there were no errors- there was simply no tumor visible in any of her scans. She was told by her oncologist that she no longer had to worry about radiation, about coming in every 3 months to poison her body in an attempt to gain a few more months. He said to come back in a year for a re-evaluation.

When she walked into my office last week, I hardly recognized her. There was no disorientation, no dizziness. She had put on enough weight and had such a healthy glow about her that she now looks like any other young woman walking down the street on a sunny afternoon. My patient told me that the only change she had made to her medication regimen had been to start creating and consuming capsules of hemp oil and hash oil mixed with powdered marijuana leaf. She told me of her oncology visits, that her doctors had told her they were going to launch studies searching for a link between tumor regression and medical marijuana. Most importantly, she told me that she is determined to enjoy life, to live each day in awe of the beauty that surrounds her, that she can find in little, everyday joys. We cried together a bit, and she promised me that she will be doing everything she can to get her story told, to bring more research money to help other cancer patients. Before she left, I was the one thanking her.

The good news is, she's not alone. Norml's blog entry talks about other research, dating all the way back to the 70's.

The Dark Night

October 27, 2010

We're entering the time of year when many people get up and dressed in the dark, drive to work in the dark, and then drive home in the dark, after sitting all day in an office with fluorescent lighting. Many of us are exhausted all the time, regardless of our sleep habits. We need sun, really need it. Our bodies use sunlight to activate vitamin D, which is used in so many chemical reactions, from absorbing calcium in the digestive tract to supporting immune function and brain health. Without vitamin D, we find ourselves lethargic, depressed, with poor digestion, low back pain, and not functioning at our best mentally.

In the state of Washington, something like 80% of people are clinically vitamin D deficient, the highest rate in any of the 50 states, including Alaska. Washington also has the highest rates of MS, depression, and certain kinds of cancers. Not only that, but in many cases, people who test within the normal range (lab values between 30-100 are a typical normal range), may still not be getting enough vitamin D to adequately absorb all their dietary calcium. Values greater than 50 are necessary to properly absorb calcium, which is used in bone health (as we all know), brain function and also in muscle contraction and relaxation (skeletal, smooth, and cardiac). Without adequate absorption, our bodies begin to break down bone cells to release calcium, leading to osteopenia and, in some cases, osteoporosis. This bone damage begins in our 20s and women are particularly susceptible although it can happen to men, too. Weight-bearing exercise, such as walking or weight training, is also important to help maintain healthy bones, but without the calcium to lay down over the lattice of bone cells, bones become brittle and more prone to fracture.

 The vitamin D test is a very simple, cost-effective blood test that can be performed at any time of day (you don't have to be fasting) and is covered as a standard laboratory test by almost every insurance plan. Supplementation with vitamin D is an essential tool for getting through the dark winters of the Northwest and should be done under a doctor's care. Most over-the-counter supplements are either in a poorly absorbable tablet or are in insufficient dosages to have any significant effect on vitamin D deficiency. It is a fat-soluble vitamin that should be taken with food to aid in its absorption. Adults, pregnant women, and children all have varying recommended dosages and should seek professional testing and advice from their family naturopath before beginning supplementation.

And the most important caveat: Don't use tanning beds to try to ramp up your D levels. They project both the vitamin D- enhancing UVB light as well as the skin cancer-inducing UVA. Stay out of the tanning beds!

Not just heart disease anymore..

September 8, 2010

An article in the Telegraph, a prominent UK newpaper, states that the rate of throat cancer in men over 50 has increased by over 67% since the mid-80s. Being overweight is a significant risk factor for adenocarcinoma, the type of throat cancer studied by Professor Janusz Jankowski, a Cancer Research UK funded clinician at the Barts & The London School of Medicine & Dentistry in England.

The full article on increased rates of throat cancer  goes on to state that, while it is the 9th most common cancer in the UK, it is the most difficult to detect and treat, with only an 8% survival rate after 5 years.

Since cancer seems to be a bogeyman for so many people (wherease diabetes, heart disease, and other sequelae of poor lifestyle choices and obesity seem to elicit a resigned shrug), maybe this article, and the study, will garner more widespread attention to the difficulties ahead for overweight and obese people and help to motivate changes in lifestyle, diet, and exercise.