If you receive the free Medical Observer newsfeeds you’ll know what I’m talking about.  Here are some recent headlines:

I stand accused of rorting Medicare.  This is what it’s like

A GP is sued after doing everything right — except her notes 

After-hours funding shakeup

‘We’re becoming unviable,’ says GP hit with $22K e-PIP repayment

This Christmas I wish for doctors to feel valued again

So the answer is, probably.  Tales direct from the trenches that I hear from GPs, suggest it is increasingly difficult to make a living without adhering to a crazy volume of <10min appts, without being sued (too often) or dragged in front of AMA or APRHA. I hear them and know that the increased pressure is coming from multiple angles and I think it is very sad that previously such a respected and valued role in society appears to be ‘losing its value’.  Don’t get me wrong, I don’t agree with the old ‘Doctor as God’ model and think it ‘s very unhealthy actually for patients, but I feel like GPs with all their extensive training, knowledge and expertise are in urgent need of an Oprahesque ‘new dawn’!  (more…)

Just because most of us have been on holidays doesn’t mean the thyroid knowledge wagon has stopped or even slowed!  Always amazed at what we continue to discover about the complex working of this amazing gland and how its health impacts so much of the rest of the body and of course our babies’ bodies! So I thought I’d give you a quick recap of an important study published while you were at the beach/in the bush/in bed ;)…

  • A Finnish prospective cohort study of over 3000 pregnancies by Heikkinnen et al has revealed that at 16yo, offspring from these pregnancies, had a 1.56 increased rate of unhealthy weight and a 2.5 greater likelihood of meeting criteria for metabolic syndrome, if their mothers were thyroperoxidase antibody (TPO) positive during their first trimester
  • TPO antibodies affect up to 20% of pregnancies but in this study they defined ‘TPO positive’ as those women with levels ≥ 167.7 IU/mL (the 95th centile in this sample)
  • What adds to the noteworthiness of this news is that:
    • More than half (55%) of the TPO positive mothers were classified as euthyroid during their pregnancy, suggesting that the effect was not driven by maternal  hormone concentrations
    • The offspring of mothers with actual thyroid dysfunction did not show any statistically significantly greater risk of cardiometabolic issues
    • The offspring of hyperthyroid mothers in fact demonstrated significantly better insulin sensitivity at 16yo than children of euthyroid mothers
    • Thyroglobulin Abs over the 95th centile (≥ 47.7 IU/mL) did not correlate with any increase in cardiometabolic risks for their children

When we consider the substantial evidence of poorer maternal cardiometabolic outcomes for women who are hypothyroid during pregnancy – it would seem that the abnormal thyroid hormones are most impacting for mum but in fact the TPO Abs the most detrimental for bub! (more…)

I’m getting a sore neck from this, but looking back at 2017 and looking ahead to how I want 2018 to be, is of course perfectly appropriate for this time of year. 

And if we don’t take this opportunity for a little bit of reflection and review then we risk our growth:  both personal & professional.

Looking back, as always there were both highlights and some lowlights  – highlights for me included receiving the BIMA lecturer of the year award,  being asked to speak in Europe and getting out from behind the computer and coming face to face with more and more practitioners as I toured around – sorry webinar junkies…but long live LIVE REAL PRESENTERS & PRACTITIONERS!  Lowlights? Well they included of course the private health insurance reform in Australia…enough said. (more…)

Recognise your own name or someone else’s on this list?

Dear 2017 Group Minties aka Mentees.   I have always struggled with the term, ‘mentees’…seems too American or something and this morning when I was out walking, I had a light-bulb moment – I am proposing a re-branding to something much closer to home (!)… I propose we rename you Minties!! Because you are always fresh and you give me & your fellow Minties always something; cases, questions, clinical conundrums, ethical dilemmas,  every month to seriously get our teeth stuck into!  Cheesy but true 😉

Congratulations on completing your full year of group mentoring – and if this is your 2nd, your 3rd even your 4th year then I bow to you even more deeply.

Thank you for including me on your support team and entrusting me with helping you grow & develop as exceptional practitioners.

You should  be celebrated for your commitment to your own learning & your endeavour to always improve your knowledge and skills. (more…)

And then you don’t, right? Because if my experience is anything to go by, there are some patients that just don’t respond to the usual iron repletion strategies. Depending on how low their ferritin is, this can then precipitate ‘practitioner panic’ (we’ve all had it right?!) where we’re inclined to go higher & higher with the dose and number of doses per day. Typically, this also fails. I hear about this from other practitioners all the time and I see the ‘normal’ doses of iron sneaking up and up.  Remember the days when we couldn’t get a non-pharmacy supplement with over 5mg elemental iron in it and now we have > 20mg?  But still, I hear you say, this fades into insignificance when you think about the standard medical model for iron correction which provides 100-200mg/day and you’re right. 

Gee… after hundreds of years of knowing about this deficiency and being the most common deficiency word-wide, you’d think we had our supplemental regime nailed.  

But that’s where you’d be wrong. (more…)

Are you hearing me?  Yup, it’s been a BIG year..and to think I don’t even have the ANS technically to blame this year!! How about you?

But listening to myself say this to people, in my wrap-up of the year-that-just-was, I am thinking….Has anyone EVER got to the end of year and exclaimed, “Wow! That was a small one?!” 

Not me, not ever, well not in my living memory! But somehow I forget.  I get to December and I think, ‘Geez, I’ve never felt this spent before!  I need to go on holidays and never come back, retire from work and retreat from the world’, until someone who loves me, and who has a longer memory than a goldfish says, ‘Love, you always feel just like this.’  The upside to this annual amnesia is, it pushes me to make very conscious choices for my holidays. (more…)

Following a huge co-ordination and curation effort we have finally confirmed all of our group mentoring positions for 2018 EXCEPT:

Tuesday 10.30am (AEST) Group has 3 positions left!**

Tuesday 1pm (AEST) Group has 1 position left!

Wednesday 10.30am Group has 3 positions left!

**Note this 1st group is only offered to those individuals who have previously undertaken mentoring, either group or individual sessions with Rachel (more…)

No this is not a joke. The room they enter happens to be the clinic space of a practitioner I mentor.  The older women are friends, both originally from the UK and they sit in on one another’s consultations sharing many of the same experiences: grief over loved ones lost, memories, laughter and both describe waking in the morning with a sense of dread, because they’re tired, feel they’ve lost their oomph, their motivation, their chutzpah…that’s mostly why they’ve come today.

But know what else these two have in common?  (more…)

Standing at the podium, I looked down at my notes & slowly read out the title of my presentation to the hundreds of people attending, ‘Paediatric Digestive Issues & Neurocognitive Abnormalities’ and briefly froze thinking, Holy Heck (!) this is someone else’s presentation!  Seriously. No, this is not one of my work stress dreams.  This happened. I thought…oh my how am I going to deliver this, it sounds very complex and lofty and scary!!

Then I saw my scribbled hand notes on the page, the unofficial name I had affectionately given this presentation as I researched, compiled my case studies and brought it into being, months prior and I instantly relaxed…oh…Kids’ Guts Are Mental…now that I have some serious experience with and something to say about! (more…)

Have you been a bit vitamin D trigger happy?  Does a patient’s low blood 25(OH)D test result have you reaching for a vitamin D supplement like the rest of us?  Yes…you might need to listen up then. Sunshine doesn’t come in a bottle.  That’s right, if your patient’s problem stems from inadequate sun exposure, have a guess what the best remedy is.  I’m not meaning to sound flippant but I think in all my ‘complex highbrow nutritional understanding’, occasionally (ahem), I have lost sight of the simple truths. (more…)

We’ve got a Brand New Specialist Mentoring Group starting up in 2018!  Due to a growing number of medical doctors participating in individual mentoring and our group program we have decided to offer a group entirely dedicated to integrative doctors or any medical doctor interested in incorporating wellness models and nutritional interventions into their practice.  Across all of the mentoring groups I always try and ensure a ‘good fit’ for participants, with shared levels of experience, areas of interest wherever possible and over the years of mentoring doctors, I have come to appreciate there are unique educational needs and a clinical context that is clearly distinct from the naturopathic practice model and reality. So, this new 1hr our monthly online meet up with like minded doctors across the globe to go over cases, offers us an opportunity to meet your mentoring needs in the best way possible and truly accelerate your knowledge and skills in integrative medicine. (more…)

Alarm

PPIs are one of the prescribed medications in Australia but the concerns are escalating.  Not just from a naturopathic or nutritional perspective regarding the extraordinary concept of lowering gastric HCl by approx. 80% but much much more worrying concerns.  I talked about some of these back in 2014, I remember making an executive decision at the time not to mention concerns that their long term use produced higher rates of gastric cancer, that even conservative medical news-feeds were starting to mention… I didn’t want to be alarmist.  But the mechanism for this correlation is highly plausible – PPIs only inhibit acid production but they do not control the gastrin release by these cells and in fact the gastrin release rises with their use…and guess what gastrin is a trophic agent, it stimulates growth in the stomach and in other tissues(more…)

Grunge and gritty portrait of sick woman laying in bed and coughing

Chronic coughs, rhinitis, postnasal drip or even asthma?  Have you ruled out silent reflux? Aka laryngopharyngeal reflux. Patients experiencing silent reflux don’t present with heartburn or any typical GORD features but ultimately suffer from a similar failure of the lower oesophageal sphincter (LOS) – with their complications manifesting higher up, into the upper digestive and respiratory systems.  An overlooked and under-recognised condition, medical opinion has fluctuated about its name, prevalence, significance, management…you name it…however there is now a strong body of evidence that says this condition should be diagnosed and investigated as a cause of many of these otherwise unexplained chronic symptom pictures.

Take this case from group mentoring last month: (more…)

this is an announcement

I had the privilege of presenting at the Integria GIT Symposium last weekend.  For those of you who attended, you’ve gone back to your clinic with a bunch of new ideas and inspiration I hope…oh and a new respect, terror and watchfulness for threadworm thanks to me!  In my presentation I outlined the many presentations of this infestation, what to watch for and the risk of chronic recurrence due,in particular, to a reduced ability for some individuals to produce chondroitin sulfate which renders the GIT environment hostile to worms. 

Chronic threadworm is a huge & grossly under-recognised issue in paediatrics, often presenting as behavioural & cognitive disorders (and these can be severe), bruxism, enuresis etc. of course, but another presentation typically missed is vulvovaginitis, vulval pain or UTI like sx in young girls. (more…)

Woman confused thinking seeks a solution, paper card with question mark on her head. Doubtful young female in glasses studio shot on black

Can you help me out here?  My memory has failed me.  Someone, somewhere (Mel? Syd? Auckland? Online during a mentoring session? In a Mullumbimby supermarket?!), in the past month asked me for this paper documenting the increased pain perception reported by subjects given IV saline with a slightly acidic pH compared to a neutral preparation. Quite an extraordinary illustration of the potency of small pH changes in the ECF and the impact this can have on our pain perception.  This study is one Professor Vormann has previously talked about and as I’m touring with the fabulous German Professor right now I said, ‘Sure!’…then seemingly instantly erased from my mind who made this request! Is it you?

This month is a fabulous blur of travelling & speaking, getting back face to face with everyone at a bunch of seminars & conferences, which I love but I do forget some days where I am, who I am and exactly what I have promised and to whom! (more…)

celebrate

I’ve been known to give calcium more attention than most and now I feel vindicated. Serum calcium, of course is not a reflection of your calcium intake, calcium losses nor overall calcium status. In this regard it is totally useless.  But my fixation is about what even slight variations away from healthy levels of this mineral can reveal.

You’ve probably heard me openly scorn the parathyroid glands

“How hard can it be?  These glands have just 1 job: keep the blood calcium in range! Snort!”

And that is exactly why it is so meaningful when this appears to be a ‘big ask’ and the serum calcium slips under 2.2 mmol/L or over 2.45 mmol/L & so potent given the huge chain of physiological reactions that follow from such a small shift – producing profoundly negative effects on vascular dynamics, neurological function etc. (more…)

hair

…Chronic Kidney Disease (CKD) that is! That’s the ad we really need broadcast on prime time tv.  On par with osteoporosis and other conditions that ‘seemingly appear out of nowhere’ in people’s 60s and beyond, there’s a potent combination of ignorance (patients) and denial (health professionals) at play it seems, when it comes to discussing the earliest signs of CKD that typically start decades before you’ll ever get a ‘diagnosis’. Being specialists in preventative health care – this is something we need to have firmly on our radar in terms of early identification and also in our repertoire when it comes to risk reduction.  Most of us know about water intake and all the medical risks for renal impairment but are we equally onto the critical role that mild acidosis plays in driving this condition?

It’s not just me. Promise.

Check this out. (more…)

 

Another young female presents in my clinic with a newly diagnosed thyroid cancer and has been recommended urgent thyroidectomy.  Her story is increasingly common. If you’re not seeing it in your clinic, you will, because thyroid cancer, and almost exclusively papillary thyroid carcinoma (the form my patient and most young patients have), is dramatically increasing.  Since the 1970s there has been a 67% increase in the incidence in women and a 48% increase in men documented in 5 continents (Peterson et al 2012).  Australia, though less up to date with its data collection, found a similar increase between 1982-1997 (Burgess 2002). The question begging to be answered is why.

Increased screening and more effective detection of smaller tumours was the going theory for years.  New research rejects this absolutely and concludes instead this is a ‘true increase in occurrence’.  Increased radiation exposure?  Mutation studies say no.  Many researchers are pointing to is a ‘new environmental chemical and/or dietary factor’ and EDCs (Endocrine Disrupting Chemicals) that target the thyroid such as perchlorates, phthalates, parabens and phenols are the likely suspects. And, more than likely, with iodine deficiency to explain the increased susceptibility to these EDCs.

But wait there’s more. These ‘new goitrogens’ aren’t only implicated in thyroid cancer, a large number of human studies confirm the higher your urinary metabolites of these, the lower your thyroid function. More worryingly is that they might be doing this ‘without a trace’. With myriad impacts at the receptor level, altered hormone excretion rates, impaired peripheral conversion etc. the data to date suggest these patients TFT results might only look ‘slightly low’ or even ‘normal’ but the reality is they are suffering hypothyroidism. Sound familiar?

There is a HUGE body of scientific evidence we can pull from to understand the role of EDCs in thyroid problems in our patients, how to maximise prevention and minimise impact – even when your patient, like mine, is perhaps already in the full grip of the consequences.  I’ve read all the papers and summarised them in this 30min recording:  Hypothyroid without a trace – the role of EDCs.

Have you got patients with hypothyroid symptoms but normal results?  Or results that suggest the HPT axis just seems to be broken? Could it be the result of a combination of Endocrine Disrupting Chemicals (EDCs)? How do you assess  for these ‘new goitrogens’, which act more potently and more insidiously, inducing hypothyroidism ‘without a trace’. How do you maximise prevention for all of your clients and the most at risk sub-populations or minimise impact for those already in the full grip of their consequences.
 
This latest Update in Under 30 audio comes with 3 key related scientific articles and a bonus larger powerpoint presentation that Rachel presented at the ASLM 2017 conference.

dang sarah

Last week I threw down a challenge.  Following on from the ruffling of many feathers regarding Jason Hawrelak’s report that dietary saturated fat increases uptake of endotoxins from the gut,  I provided his reference list in support of this claim, effectively saying, “if you don’t like his findings, then make your own informed conclusions but make sure you read all the evidence first”.  I offered a prize to everyone who made an attempt and a year’s free subscription to Update in Under 30, to the person who produced arguably the best summary.

I’ve said it before and I will say it again, and again, and again: Our professional community abounds with extraordinary individuals. 

People’s response to this challenge proved that once again. (more…)

 

Screen Shot 2017-09-21 at 10.03.10 am

 

Ever wondered where on earth (or Mars?!) I came from?  As much as I can’t keep quiet on some topics, my personal journey to here has been a bit of closed book to many.  Recently during an interview with Andrew Whitfield-Cook from FxMedicine, which was supposed to be strictly about postgraduate education paths and the desperate need for mentoring, internships etc for naturopaths, the sneaky devil got me to spill the beans on a whole lot more!  

Having been involved in so many aspects of naturopathic and integrative health care education over the past 15 years, of course I do have a lot of ideas about how practitioners can best accelerate their learning and development, the need for more independent education and the importance of fostering critical thinking.  

I think you already know that I feel passionately about this but do you know the whole story?  Who I have been mentored by and how I continue to tread the path of the ‘student’? (more…)