Like all thyroid disease, post-partum thyroid conditions seem to be on the rise – and often they rewrite the rule book when it comes to thyroid pathology & its management. Therefore for many of us it can add an extra element of uncertainty about how to help these clients.
One of our graduate practitioners has a great example of this, a 33yo female who developed late gestational diabetes and is now struggling with a new baby and an autoimmune thyroid disease! What would you do? Does post-partum thyroiditis have unique triggers/drivers that require specific treatment? What can you/should you be doing differently because she is still breastfeeding? What’s the likely progression/prognosis?
This is your invitation to come along and find out the answers to these questions and more. During our live graduate mentoring session on Monday 15th June at 3.30pm AEST we’ll work through all aspects of the case, from history to presentation and from looking for clues in her pathology results to where to start with treatment. (more…)
Ever noticed that thing called RDW (red cell distribution width) reported in your patients’ haematology results? Given that this parameter is currently regarded as one of the most important & earliest markers of a wide range of serious diseases, you might start paying some more attention to it from now on!
Dr. Michael Hayter, cleverly refers to RDW as being a reflection of the ‘Quality Control’ of an individual’s red blood cell synthesis.
As it’s a measure of how similar or dissimilar our rbcs are in terms of size, smaller values (suggesting homogeneous rbcs) are regarded as healthy, while higher RDWs suggest that some part of rbc synthesis and/or clearance process is faulty.
This makes perfect sense in the context of nutritional anaemias like iron and B12/folate which all produce elevated RDW results but new research proposes that this rbc size disparity is also a common linking feature in just about every major disease, often predating diagnosis or in cases of established pathology signalling progression and warning of imminent poor outcomes for the individual.
There have been 100s of papers published just in the past 4 years on this topic and the findings are nothing if not dramatic. One of the biggest things I’ve realised is that, while Australian pathology companies suggest that all RDW results < 16% are acceptable, in the light of these new associations, a more accurate cut-off is probably around 13.5%! The big question now to answer is, is the increased RDW a passive marker of pathology or actively involved in the pathogenesis of these major diseases. For now, we should be scrutinising our patients’ RDW results more closely and being alert to what these markers are telling us about our clients threats & risks. I’ve recorded a 30min audio summarising all the information I’ve come across on this topic and how to apply it in your patients which you can access here.
Alternatively, if you’re happy to chomp into some juicy journal articles yourself then check out these ones to start with
These days it seems like patients can almost be divided into two groups: those that have a tendency to iron overload and those that struggle most of their lives just to keep ferritin in the red…and what a struggle it can be. So many clients have spent years taking every form of iron there is in high doses, trying to improve their intake of dietary sources, working on their digestion etc etc but still those numbers can fail to really pick up. (more…)
Last weekend I attended the Science of Nutrition in Medicine Conference in Melbourne https://nutritionmedicine.org.au/enews/2015-02-06-Program.html and for those of you that didn’t make it I can tell you, it wasn’t your regular CPE event. I’m not sure if the debate inside the presentations or outside in the breaks was more interesting but I can say that I haven’t seen this much stimulated thought, heated discussion and passion at company run events. Why? (more…)
One of the most common questions I’m asked is whether I have a ‘set list’ of tests that I request for every patient. Of course there is no ‘one size fits all’ in health & each patient presents with their own novel combination of issues & investigative challenges, however, years of clinical experience have taught me which pathology parameters are the most clinically meaningful.
Asking yourself, ‘Will the results of this test determine my thoughts about treatment & therefore ultimately the clinical outcome for my patient?’, before referring for any investigation is a good habit to get into.
Many of us are increasingly aware of the changing environment around pathology testing, which includes reduced access to some tests in mainstream pathology. Rbc folate has had its subsidy withdrawn which means if we request this we’re now likely to receive a serum value or nothing. But does this matter? (more…)
I regard myself as integrative which means working collaboratively with other health professionals to get the best outcomes for our shared patients, sometimes that means my patients are taking psychiatric medications & there have been instances where I have seen the necessity and benefit of the right drug at the right time. This might be in the form of short term use of atypical antipsychotics, so a recent article linking higher rates (approx. 50%) of diabetes with the use of atypical antipsychotics specifically in teenagers, caught my eye. (more…)
It seems like K2 is the supplement on everybody’s lips right now and for good reason. This is particularly true in Australia where we’re seeing a flurry of new K2 products on the market thanks to a relatively recent TGA approval for this particular form of the vitamin. But what do you need to know to make the therapeutic most of this nutrient?
Vitamin K got about 20 minutes in my undergraduate degree, and shamefully I don’t think I gave it much more as a lecturer! The buzz just wasn’t quite around then like it is now. Reading the latest RCTs & metanalyses on K2, however, you can almost hear (or is that just me??? 😉 ) the excitement researchers are feeling being part of this extraordinary wave of discovery about its therapeutic applications.
Traditionally, we’ve focussed on the K1 form, abundant in all the green leafy vegetables, but turns out we’ve been looking in the wrong direction. While K1 is still important for the clotting actions it can’t get to the bones and arteries to run the other important K dependent enzymes. In order to get these happening we need the K2 form which means we need the specific types of meat, eggs and ferments. (more…)
“Health issues are rarely one individual textbook condition like they were during my studies. The interaction of the body is complex, and Rachel has given me valuable insight into how to link various pathology markers & physical aspects together. Test interpretation has been a huge focus for me. The letters and numbers now mean something, and I can work with “true” reference ranges, and see how different values affect others. The sessions have been great to get assistance with cases and learn how to break things down & prioritise treatment, and also to connect with other practitioners, and hear their cases as well. I really feel like my career has received an invaluable leg up, and I’m so thankful for Rachel’s knowledge and assistance.”
Rohan Smith, Graduate Group Mentoring Participant, Adelaide.
We began our Graduate/New Practitioner Group Mentoring sessions in March 2014 with just a few keen newbies but the sessions have gone from strength to strength since then, with an ever-growing group of new graduates participating in case presentations every month. Every session I’m reminded that people are now graduating with much more sophisticated knowledge than I did. Not because the education standards have improved (ouch!) but actually because the research-backed knowledge base of our whole industry has progressed & improved so dramatically… & that is really exciting & changing the marketplace for all of us. (more…)
I read an interesting news item in Medical Observer this week about the increasing number of patients either overtly or covertly recording medical appointments on their smart phones. Have some of your patients already asked if they could do this? Mine have and I’m also aware of some patients getting into hot water when asking their ‘old-school’ medical specialists if they could do the same thing. For me, I have always understood the patient’s desire to do this, as the information they’re being given might be complex, considered critical and they may need to hear it several times in order to grasp the details, instructions etc. In other situations I’ve experienced it’s because the patient needs someone else, who couldn’t be present at the appointment, to hear the discussion ‘firsthand’ e.g. another parent, a partner. In my mind this all makes good sense. Does it make me speak differently, think more carefully about my words etc…You bet it does! (more…)
You might have heard me talk about using an ‘upstream’ rather than ‘downstream’ approach in nutrition – the concept is very naturopathic… look at the water source and address things there rather than just tweak things downriver! One of the most important upstream influences on patient health & wellbeing I can think of is systemic pH – the body’s constant struggle to neutralise its overwhelmingly acidic input, which comes from both metabolism, inflammation, stress and of course unbalanced diets.
It’s a war out there and most of our patients aren’t winning! (more…)
I’ve booked my flights and packed my bags (at least in my mind!) already. The annual Science of Nutrition in Medicine Conference is on 2-3rd May in Melbourne & there’s one name on the bill that alone I would be attending for – Dr Robert Loblay. He’s the head of the Immunology unit at RPAH which specialises in the management & treatment of every possible type of food & chemical reaction (including all the ones the average medico would suggest are impossible/unreal or psychosomatic). By the way he also a strong interest in bioethics so this makes for a great combination in this field. He helped put together the RPAH diet and book ‘Friendly Foods’, which is such a great clinical resource for patients with food intolerances.
The way I approach food reactions in clinic has been heavily influenced by his work and because the RPAH unit is working everyday with some of the most severe, complex and unusual reactions, when he talks I listen! (more…)
How often do you find yourself writing sleep prescriptions for your patients? I do – frequently. I’ll include in my recommendations something like – ‘nap for 20 minutes every alternate day’ or, ‘commit to getting into bed 1 hour earlier 3 nights this week’ or ‘establish a bedtime routine for yourself – something that loosely follows the winning formula of bath, book, bed’.
You see I reckon we humans have tricked ourselves into thinking we can negotiate our way out of almost everything: good food choices, adequate clean water, perpetual motion etc. I mean often people come to us looking for the shortcut let’s be honest…e.g. “I’m not great with the food side so what should I be taking??”
But when it comes to matters of slumber I explain to my patients that sleep sufficiency (both quantitatively & qualitatively) is non-negotiable in the health equation. To put it another way, sufficient sleep is Wellbeing 101, step 1!
I don’t have anything I can prescribe that can make up for a shortfall…seriously…just a prescription for more sleep!
Over 20 years ago (ouch!) while studying at Southern School of Natural Therapies, I heard for the first time that calcium perhaps had a ‘dark side’! At the time, and still to a large extent now, calcium is publicly portrayed as something you simply can’t get enough of and 20yrs ago this idea was almost heresy! Certainly in the eyes of the dairy corporation at least 🙂 Yet there had been a long-standing concept in naturopathic nutrition that the distinction between calcium’s healing and harm all came down to where it resided in the body, e.g. bones Vs blood vessels. Last week Medscape ran an editorial espousing the same concept. (more…)
Howdy everyone, thanks to popular demand (and perhaps something some people have against Tuesdays!! 🙂 ) we’ve opened up a new group on the 2nd Monday on every month at 1.30pm NSW time for mentoring. It’s brand-out-of the bag-kinda-new with a small group of practitioners signed up so far, so there’s room for you if you’re keen to give group mentoring a bash this year. We’ve had an exciting start to the year with all all mentoring groups, with lots of juicy cases, great discussion and important networks building before our eyes. If you’re interested in being a part of this group or any of our others please just email us at firstname.lastname@example.org. The next Monday session will run on the 9th March. Hope to hear from you 🙂
Thyroid function is critical to successful conception, healthy pregnancies, babies and mum’s post-partum wellbeing, so we need to take the time to ensure we’re monitoring it properly.
First of all you need the right tool for the right job & that means we need trimester specific reference ranges – which unfortunately many pathology companies don’t use in Australia. Due to the thyrotropic action of HCG (acting a bit like TSH), TSH should actually decrease in the 1st trimester and while TSH is less affected in 2nd and 3rd trimesters it should still actually sit lower than in non-pregnant females. (more…)
Ever had those patients… young, slim, fit…I won’t go so far as to say ‘well’ or otherwise they probably wouldn’t be seeing us right? But not overtly inflamed and yet when you measure their CRP, it registers. The average CRP of ‘healthy’ adult populations is reported to be between 1 and 3 mg/L but we know that even values within this range positively correlate with long-term CVD risk and most of us believe that unless there’s a good reason for immune activation at the time of the test, we’d like to see values < 1mg/L.
I saw one of my patients who fits this bill just the other day – an updated CRP and there it was again bubbling away at 1mg/L. This guy is young (20s), slim (BMI of 19 kg/m2), non-smoker (another classic driver of this sort of brewing CRP), doesn’t report any acute illness e.g. URTI, at the time of each test (we would expect a much higher value with this anyway)…so why is there any CRP? (more…)
We now suspect that many of the drivers behind PCOS are heritable components – a genetic vulnerability passed from parents, possibly one but often both. This growing understanding has identified a phenomenon referred to as ‘PCOS families’ i.e. a family in which at least one female has confirmed PCOS.
Being a primary biological relative of someone with PCOS, it would seem, suggests a shared risk, even if you are a son, or brother or father.
So beyond the very high rates of undiagnosed PCOS in sisters of someone already diagnosed, there is much talk now about a male PCOS phenotype equivalent. (more…)
We’ve had a lot of inquiries regarding our end of year CD special. So just to clarify – here’s the deal and below that how to make it happen! 🙂
Purchase any 2 CDs before Jan 31st and receive one complimentary Premium Audio Recording of your choice OR purchase 4 CDs and receive a 3 month Premium Audio subscription for free.
If you’d like to take advantage of either offer – please go to our RAN store https://rachelarthur.com.au/product-category/audio/?orderby=date & simply select the CDs you would like & complete the online payment as per usual. On receipt of your order we will then email to let you know you’ve automatically been subscribed to the Premium Audio for 3 months OR ask you which single premium audio download you would like to receive as your bonus gift.
Apologies for having a one-track mind currently but yes I’m still banging on about the thyroid this week. You see, this year in my own clinic I connected up some dots I hadn’t connected before via a series of young female patients. Each of these women presented with some hypothyroid features, most notably, low basal body temperatures, fatigue and weight gain and while their thyroid hormones (TSH, T4 and T3) were all technically ‘within range’, their T3 levels were very low (low 3s) and the TSH seemed to sit low as well (<1.5). Normally of course, when T3 levels drop we expect TSH secretion from the pituitary to rise in response, as a means to correcting this dip, however, this part of regulation appeared ‘blunted’ or even ‘broken’ in these women.
So why would their pituitary be sleeping on the job, allowing them effectively to experience long term suboptimal thyroid function? (more…)
I learned to drive more than 20 years ago in a mustard yellow VW beetle with my ageing father beside me playing the dual role of instructor and slightly hysterical passenger. The one catch-cry that he screamed over and over again was, “Where’s the fire? Where’s the fire?” In case you require translation, this was his way of indicating that I was almost travelling at 60kmph & essentially meant, ‘unless you are part of the emergency services & on your way to a crisis there is no reason to be travelling this fast!’ I know, it’s a wonder I ever learned to drive! But I’ve actually come to love that catch-cry, “Where’s the fire?” because for me it has become a pressing question in clinic every day. (more…)