These little blighters are getting a lot of airplay this month and rightly so…..! Oh Em Geeeeeeeee….so much misinformation out there!! It’s time to set the record straight
Worm infestations never conjure up a pretty picture in our minds although a video of humans trying to bum slide across the floor like some dogs we know would get a fair few laughs (…will share that vid later)
Despite much talk of the potential therapeutic activity of helminths for things like autoimmune diseases and allergies due to their immuosuppressive effects, there’s nothing nice, friendly or ‘good for us’ about a chronic Enterobius vermicularis (threadworm) infestation in a child or adult (YES! You heard me). Oh and don’t forget the possible link with your D.fragilis patients…you just might need to treat these guys instead.
It was great to get down and dirty on worms with Andrew at FX Medicine. This podcast has us uncovering and debunking myths on these creepy critters that have more to answer for than you probably realise…
The outcry from the public is enormous, in terms of their need for help and the gaps that are there at the moment in terms of getting it. There is an online resource called thewormwhisperer.com.au, which is primarily there for the public to meet this need and practitioners can learn a lot by going on there as well.
You know I’m not one to raise my voice and make scene.
Ok, I always raise my voice and make a scene, but only when I think something really warrants our attention and the issue of under-recognised, under-estimated and mismanaged chronic worms, demands our attention. I’ve been talking about this ever since the first patient stepped into my clinic, a young girl with severe mood issues who just happened to also have treatment-resistant chronic threadworm, and since then, as the volume of patients I see affected by this has grown, so too has the volume of my message. And there’s actually so much to say.
Chronic worm problems don’t always come with an itchy bottom calling card. In fact, many individuals don’t have any of the telltale signs you might be used to screening for. Recent research suggests adult men, in particular, are commonly asymptomatic when infected with them (Boga et al 2016)
So what alerts us as practitioners to the possibility of chronic worms – so many things…but here’s just some thought bubbles to get you started.
Are you treating patients with recurrent or treatment-resistant Dientamoeba fragilis?
Are you seeing women who have thrush-like symptoms, in spite of negative swabs and no benefit from antifungals?
Are you faced with families coming undone because of one child’s behaviour whether that’s aggression, defiance, emotional lability or just serious sleep problems? (more…)
Sometimes we wonder who put the invisible sign up out the front of our practice, right? The one that says…absolutely everyone with Condition ‘Z’ come and see me, now! I’m sure you know what I’m describing. Well this week I have hit the trifecta, performed a neat little hat-trick and diagnosed 3 patients with Gilbert’s Syndrome who all present in their own individual way but actually each one also with quite a textbook Gilbert’s picture, it almost beggars belief. Have a little look
70yo Female says: Since childhood she has felt like she has had a rock in her stomach after she eats. This ‘rock’ is there for hours. Her stools are never the same in spite of a regular diet and she has always been uptight and anxious. All her bilirubin results are in the 20s & she reports she’s ‘always’ had high values
55yo Male with severe ‘constitutional anxiety’ and surprisingly high oestrogen and a worrisome profile of oestrogen metabolites. His bilirubin is in the 20s
30yo something Female presents with unexplained severe unwellness for 20yrs that mostly involves nausea, bloating, a functional gut disorder without a real diagnosis, anxiety, depression and poor stress tolerance. Her bilirubin fluctuates between 30 to high 40s. (more…)
I have a good friend…who happens to be a naturopath…who happens to also be a patient of mine. Have you got a few of these as well? A month ago, looking over her recent bloods which included fasting lipids that had been steadily climbing for the last couple of years, post-menopause, she said, ‘do you think I should take something for that?’ Ahhhhhh no. My reasoning went like this:
“You love saturated fat right? You eat butter and cheese and and and…and the type of elevated lipid pattern you have LOOKS like it is at least partially the result of this, your triglycerides are low, your HDLs are good it’s just this LDL component that is too high. You could add in another supplement…and take it…forever…or you could do a little n=1 experiment and just lower your butter, cheese & coconut oil intake for a month and repeat the test.”
The horror on her face! You see I didn’t know exactly how much she loved butter but it all became clear with the first text a few hours after I had thrown down the gauntlet…which included a sobbing emoji and the comment that her afternoon snack will never be the same…turns out it was a shortbread biscuit with butter on it!!! But as a practitioner who does pride herself on walking the talk…off she went determined to give it a good go for a month. But boy did it hurt! (more…)
They’ve just come from the immunologist, having presented with extensive vitiligo in dad and early stage vitiligo now in their primary school aged son. The immunologist, without running a single blood test, told them, ‘Bad news, you both have autoimmune issues and watch this space because the vitiligo is just the first presentation, there will be more to come’. Slightly unsatisfied with this dead-end conclusion and non-existent management plan, the family then presents at a long established naturopathic clinic to see Anna Sangster, a fabulously sleuth-like detective, who takes her patients’ health very seriously and has the knowledge and skills that make her one of the best at what she does. I can say that because I’ve been mentoring Anna for a long time & she is one of the clueiest practitioners I know.
For example, she knows about the substantial research demonstrating the overlap between thyroid autoimmunity and vitiligo and, in addition to comprehensive case taking, decides some blood tests may provide valuable insight that would help to understand the degree of self-attack from their immune systems, identify if there are in fact already concurrent autoimmune targets and perhaps even provide a clue as to underpinning drivers. Well, look what she found! (more…)
Is this the way of the future for health practitioners interested in patients’ digestion…?
“The team developed an ingestible electronic capsule to monitor gas levels in the human gut. When it’s paired with a pocket-sized receiver and a mobile phone app, the pill reports tail-wind conditions in real time as it passes from the stomach to the colon…The authors are optimistic that the capsule’s gas readings can help clear the air over the inner workings of our intricate innards and the multitudes of microbes they contain. Such fume data could clarify the conditions of each section of the gut, what microbes are up to, and which foods may cause problems in the system. “ (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…)
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…)
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…)
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…)
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…)
…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…)
On Sunday there were deafening bells going off in my brain. By Monday they were going off in 11 others.
Alessandra: “Holy s#*t this has just ticked so many boxes for a couple of Rx resistant patients. Thank you!”
Tess: “Me too – finally the gut and pain connection explained”
Let’s play a little word association game:
I say ‘Fibroids’ – you say, ‘Oestrogen’.
I say ‘Cyclic Breast Pain’ and you say, ‘Ouch!’ [because it just slipped out] but then you say, ‘Prolactin’, right? Me too.
Prolactin driven breast pain’s most characteristic form is the premenstrual ‘oh my goodness get these off me!!’ kind, with patients experiencing anything from burning, aching, bruised feelings and acute hypersensitivity to touch, which builds in intensity for days leading up to their bleed. Of course cyclic mastalgia can progress to being full-time mastalgia in women whose breasts start to exhibit structural tissue change in the form of cysts, fibrosis and ultimately fibrocystic breast disease. If you’ve ever experienced even a day of mastalgia it is truly hard to conceive there are so many women (about 50% of premenopausal women!!) living with it daily.
Adding to our concerns about this so-called ‘benign breast disease’ (BBD) is that researchers are now certain it’s a significant risk factor for breast cancer, with women with any form of BBD experiencing at least a doubling of risk of a subsequent breast cancer diagnosis, while those women with proliferative BBD exhibiting a risk of 3.5X that of women without BBD. Castells et al 2015 (more…)
Watch the gap! You know I love a good diagnostic test probably (way!) more than the next person but I am slow to come around when there’s suddenly a ‘new-kid-on-the-block’ that every functional testing company wants to offer you. This is how I felt about serum zonulin testing as marker of intestinal permeability too. In spite of Fasano’s important work, identifying this molecule and its role in the reversible opening of tight junctions in the small intestine – I didn’t embrace the test. Why not? Didn’t I love Fasano’s ability to add this piece to the jigsaw that had been missing til now? Well I did. Does that make it an accurate and reliable marker of intestinal permeability in every client with any kind of digestive issue…? Well heck no! That’s not how science works friends and I suspect we may have really jumped the gun a little on this one. (more…)
May was the month of teenage girls presenting with severe digestive problems, especially ‘food intolerances’, leading to avoidance of specific foods and at times significantly reduced food intake overall. As integrative health practitioners, validating and creating insight for clients on the nature and source of their food reactions is our bread and butter, right? Is it wheat? Dairy? Gluten? FODMAPs? Salicylates? Oxalates? We are not surprised by how many ‘sick’ patients we see in spite of a theoretically ‘healthy diet’ – healthy for others perhaps but not for the individual in front of you, right? But what if I told you that each of these teenage girls had a BMI < 18 kg/m2, does that change your opinion about your role? Would you assess, monitor and manage these teenage girls differently? You should.
Take the example of one of my clients: 14yo female with a BMI 16.3, who had her first confirmed food reaction under 2yo with failure to thrive, which was attributed by a paediatrician & dietitian at the time to severe salicylate sensitivity. She underwent jejunal biopsy at 3yo for suspected coeliac disease, due to ongoing concerns and a primary relative with CD but it was NAD. In the 11 years since, there have been a couple of other digestive diagnoses based on solid evidence, such as mainstream stool PCR testing. So surely, the fact that she is underweight & that she skips lunch at school due to digestive discomfort is proportionate and explained by her organic digestive issues. Or is it? (more…)
This year has been a steep learning curve but this is exactly as I had hoped and planned for. I strapped myself in for my roller-coaster ride, a series of intensive upskilling initiatives undertaken with mentors and experts in specialist areas, and I haven’t hurled yet or screamed loud enough to make the operator stop the ride (seriously this happened to me in about 1997 on a Pirate Ship in Rosebud!)…but I have come close 😉
One of the really big lessons has come from getting more into the science behind pyrroluria and urinary pyrrole testing again. What motivated me to tackle this spikey beast? Well, like many people who have been introduced to the concept of pyrrole testing and pyrrole driven mental health presentations – I had a lot of questions that hadn’t been adequately answered. Those gaps left me with some uncertainty about the validity of this investigation and about the interpretation of the results. I also have introduced this pyrrole theory to many naturopaths and hence feel a responsibility to polish up my knowledge on this and set the record straight.
Last but not least, in our local area we reputedly have a ‘pyrroluria plague’ at play – every man woman and their dog is getting this diagnosis and it had added not only to my misgivings about testing but also my concern about misdirected & unsafe treatment. (more…)
Whenever I talk to practitioners about thyroid health, like I recently did at MINDD, I can guarantee I’m going to get 2 questions:
- Shouldn’t we aim for the high iodine intake of Japanese?
- Can we use the patch test for testing iodine levels in our patients?
I am so glad you asked. The answers are no and no.
I am a nutter for minerals and iodine just won’t go away right now. Too little = a problem, too much = often the same problems. To boot we are faced with radically contrasting views on assessment and dosage and just about everything iodine related. It’s not you – it’s iodine. Trust me it’s a complex little mineral that requires some extra thought and caution. If you imagine the Japanese have no thyroid problems – correct that big myth right now by reading this scientific paper that refers to health problems that result from too much dietary iodine. It also explains that the typical first step in treating hypothyroidism in Japan is to reduce their iodine intake! (more…)
Got any patients on Natural Thyroid Extracts (NTE)? Me too…and I am finding it’s on the increase. What’s the deal? What do we need to understand about this form of thyroid replacement therapy to best monitor and manage those patients already on it or contemplating taking it? Does it really offer advantages to all hypothyroid patients or just to a subset of those and how would we recognise these people who might benefit the most?
NTE are marketed as being superior to synthetic thyroxine primarily based on the fact that they provide the patient with some T3 as well as T4 and in addition to that, being extracts of pig thyroid glands, there are other thyroid and iodine based actives e.g. mono and diiodotyrosine, present in the extracts. So in essence this is giving us more iodine and more of the other ingredients we need to make our own thyroid hormones. Based on this, many proponents of NTE say this is a major advantage over synthetic thyroxine replacement because it is more ‘holistic’ and it supports the patient’s gland in its own hormonogenesis. (more…)