I’ve been digging around in the scientific literature all about appendicitis and I’ve ended up here. Long gone are the days when medicine foolishly considered the appendix without purpose – a dispensable ‘extra’ of the GIT and now, thanks to genetic PCR bacterial identification, gone also is its more recent portrayal as something sinister – a potential harbourer of ‘bad bugs’. The current consensus about this apparently complex little sac is that it constitutes a ‘safe house’ for the microbiota within the GIT, making one of its key roles the healthy recolonisation of the gut following diarrhoeal episodes and even oral antibiotics. Amazingly, antibiotics that can quickly sterilise the rest of the digestive tract, fail to clean out the appendix, due in part to its specialised and exaggerated biofilm as well as its more diverse and environmentally tough species. Wouldn’t you know it, the strange little sac has a critical role in keeping us well?!
Given this radical rethink of the healthy appendix I wondered whether medicine’s understanding of appendicitis and in particular what causes it, had also undergone a revolution. This condition, which was first described over 100 years ago has confounded scientists and clinicians ever since – I love this quote from a 1972 paper in the Medical Journal of Australia (Williams):
“It is interesting and humiliating that a small organ which in man performs no useful function can so frequently give rise to problems which, if not treated, may have fatal complications, and of which we still do not fully know the cause.”(more…)
Yep, I’ve had them…and made them. I often hear practitioners say they cringe when they think back about the patients they saw in the first year because of the vastly greater knowledge they have now. I do too. But my mistakes are more recent than that!
I know more this week than I did last, and that is a good thing…right?! For me and most practitioners, there is acknowledgement that our learning is infinite, ongoing, without end. This is a source of excitement for me, not a negative. The light-bulb moments are deeply satisfying – those moments when I become enlightened about a mistake I’ve been making, or a misunderstanding I have had.(more…)
Sheeeeeshkebab I squirm at the whole premise of new year’s resolutions. If you understand a little about the process of behavioural change, you’ll appreciate that there’s no magic dust (or firework pollutants!) you are going to get sprinkled with between pre and post midnight on any one day of the year, not even NYE, that will create a ‘new you’. Therefore to set ourselves or our patients up with such an expectation just leads to another big red rubber stamped ‘FAIL’ and guess what impact that has on your next serious attempt…yes…you guessed it…it diminishes your chances of future success because it provides evidence of our inability to change.
So my message to people during this annual transition is: Don’t Change.(more…)
Ask me to name a lymphatic herb other than Cleavers and Poke Root and I might struggle (sorry Sue!) but some other things stay with us forever.One of my stayers pops into my head every time I eat a carrot. Every time I make my partner or my kids eat a carrot. Every time I see those kids in shopping trolleys slurping on those awful yoghurt squeeze pouch thingamabobs and I want to ask their parents…does your child have teeth? Well when was the last time they ate a carrot?!. A whole carrot. Yup.
Want to start 2017 with some good news? Sometimes working with patients challenged by mental health I get scared. A well-known colleague of mine introduced me to the notion of the ‘clinician in crisis’. The practitioner who, in the face of their patient’s extraordinary pain & distress feels overcome by the need to Do Something…Anything. Over time I have learned to spot, what we call a ‘desperation prescription’, the patient who is on 3+ psych medications all from different drug classes and still remains tragically symptomatic. It is potentially frightening stuff. I’ve had the same experience with patients using herbs and nutrients. The patient’s biological drivers may seem straight forward on paper, but they fail to respond as predicted. Nobody has a 100% success rate…not me, not Ben Lynch, not Kelly Brogan…as much as their marketing machines might make you think otherwise.(more…)
The standout gift I got this year for Christmas without a doubt was my very own copy of Sarah Lantz & Tabitha McIntosh’s, One Bite at a Time – Reduce Toxic Exposure & Eat the World You Want. Every time I walk past it on the table a strange force compels me to run my fingers over the cover, reach for it to pour over some more pages whenever I have moments to myself and show it to everyone who crosses our doorstep. This strange force…I think is called pride. I experienced a tsunami of this at the Australian Naturopathic Summit and now here is another wave.(more…)
I’ve decided to resign, to quit, to call it a day. It’s a big decision and it may come as a surprise to some of you but it’s a timely one. You see, it’s actually good business practice to figuratively or literally quit your job at the same time each year. Schedule it in, pop it into google calendar with a big flashing reminder that shouts “RESIGN TODAY”. For me, it’s an annual event and it coincides with the festive season so while others are unwrapping pressies, I’m unwrapping the finer details of my new career. The call to quit should prompt you to spend time – perhaps a full dedicated day or several focused installments over a week – asking yourself, “What do I want to do…now?” (more…)
It’s officially official!The Rachel Arthur Mentorship Program for 2017is in the loading dock ready to launch & we kick off with our first session on January 30. We are soooooooooooo excited & we have just a few spots left. If you haven’t heard as yet we have embraced … ok I admit I was pushed! 😉 … an amazingly user-friendly cloud based group platform…(it’s like a new language isn’t it?! Who knew all those words went together!)
Let’s break this down into terms the rest of us understand… this new fancy platform we have, called ‘Basecamp’, is an incredible way you and me and all the other practitioners in your group can share resources, communicate between sessions, keep tabs on ongoing patient updates and results etc…ultimately, this means the ongoing practical support, skill development and network building you receive is BIGGER & BETTER THAN EVER BEFORE!
Right, now I have that off my chest 🙂 I have to tell you that all our groups are full…except for a few spots in one!(more…)
Language is such a powerful thing and the art of ‘reframing’, to express a concept differently in order to facilitate a fresh perspective, can be the difference between engagement and disengagement. I see the power of this in my clinic and with each year of practice I pay more and more attention to this aspect. I’ve come to appreciate, that the way I describe what’s happening in someone’s health and the way I articulate what their role is in their own recovery, is such a key determinant of what my patients leave with and ultimately the success of treatment.
Recently at a conference I heard an international speaker, a doctor and researcher, take a blow torch to the language we use around insulin resistance and diabetes. It went something like this:(more…)
I think of you most mornings. You see I’m totally in the habit of checking abc online news when I wake and frequently expel several ‘Oh my goodnesses’, before even getting out of bed. Here’s one that made me want to jump out of bed and instantly share them with you…better late than never 😉
In case you haven’t heard about it yet, Gary Fettke is an orthopaedic surgeon in Tasmania and an advocate of a low carbohydrate diet.He got that way after dedicating a fair chunk of his surgery hours to amputating the limbs of diabetic patients and is now famous for virtually telling some of his patients ‘cut out carbs or die’! That catch-cry has made the headlines of course but Gary Fettke’s less punchy take on diet goes something like this: “It’s just eating lots of vegetables, pasture-fed meat and the right amount of oil in the form of things like nuts, avocado, cheese, olive oil and fish.” Sound familiar to anyone?
Can you guess what happened next? Well an anonymous complaint was made against him (note not by a patient but by one of the dietitians at the hospital!) which prompted a 2 1/2 year investigation by the Australian Health Practitioner Regulation Agency (AHPRA). They recently concluded that he was “working outside his scope of practise and was not qualified to give specific nutritional advice, and he was ordered to stop speaking about the low carbohydrate, high fat diet.” They have issued him with a caution. (more…)
Often we assume our patients know at least the basics about health – especially about things soooo seemingly basic…that we fear mentioning them would offend and make us look like someone trying to teach grandma anything! But there are some instances where I’ve found I have simply assumed too much.
I think the issue of what I affectionately call ‘Vag Care’, is right up there as an example.
Soapy water? Female deodorisers, daily panty liners, re-enacting bad movie scenes with soapy suds sex…what the??? It’s been my astonishing discovery that women of all ages, but especially a frightening majority of younger females (<30 yo), in this time of increasingly unreal ideas about sex and sexuality, feel inclined or pressured to adopt these practices in order to erase all trace of natural odour and healthy discharge. The abnormal has become normalised. (more…)
The other night my 16yo daughter was reading through bits of reading matter that had made it home from the recent ASLM conference – one in particular was all about contrasting dietary guidelines of key western countries and comparing these using a more naturopathic lens. The materials were glossy, gorgeous in their design and quickly conveyed some basic truths about healthy eating. The fact that she picked it up and voluntarily read the thing attests to it’s aesthetic! Anyway, about 2 minutes in she says, “Eat a rainbow of colours!” [snort], “Seriously? Are you really supposed to do that?!” Like either these naturopaths have been munching on the wrong kind of mushrooms or, even more outrageous, I had forgotten among my mother duties to mention this quintessential truth…either way she was momentarily taken aback.
Let me just give you some context, unless I’m assuming too much. (more…)
As an add on to my recent blog, I thought you might find this other detail about prolactin levels (PRL) interesting. Several studies including a one published in 2009, have demonstrated a positive correlation between PRL and increased CVD risk in both men and menopausal women. This correlation, which is believed to be the result of PRL’s vasoconstrictive effects, was evident while PRL levels remained well within range!
Women in early menopause with a PRL level just > 170 mIU/L (or 12.6 ng/mL) had 100% sensitivity in predicting a high peripheral blood pressure.
These researchers concluded that “Prolactin may play a role in accelerated arteriosclerosis in early menopause by affecting central/peripheral blood pressure and arterial stiffness.” Similarly an earlier study in men, again found PRL in the slightly upper end of a ‘normal’ range correlated with increased blood pressure and hypertension rates.
So keeping an eye on PRL levels may also be a good inclusion in CVD risk monitoring and again, lowering even slight elevations, could prove highly beneficial according to the study by Sowers et al 1981. Good food for thought perhaps.
It’s Friday…I thought you might need some reading matter for the weekend 🙂
Back a few weeks ago I had the pleasure of presenting at the Integria Symposium and the even greater pleasure of listening to some of the fabulous speakers …you see I’ve heard my stuff before! 😉The ‘Mosaic of Autoimmunity’ was delivered by the very funny and knowledgeable Professor Yehuda Shoenfeld, who reiterated the sequence of events now well recognised to precede and precipitate autoimmunity: genetic susceptibility + endocrine context + environmental trigger –>autoimmunity.
Clinicians know that overwhelmingly women dominate when it comes to autoimmune disease epidemiology and most understand that this is a consequence of oestrogen’s immunostimulatory effects. Professor Shoenfeld, described the female, or E2 dominant, immune system as being ‘super charged’ and that increased rates of autoimmune diseases were a reflection of this. Sometimes practitioners do initially great work with a/immune clients – clearing up the diet & gut, ensuring vitamin D adequacy etc and then get ‘stuck’ or plateau with antibody levels that ‘won’t budge’. Going back and checking the hormonal contribution in the case is often indicated. If the patient has an unhealthy E2 dominance and /or impaired detoxification and clearance of this hormone then working on this aspect often kickstarts the next stage of improvement.
A new thing to me (I know I’m a bit slow sometimes 🙁 ) was his mention of the potential link also with high prolactin (PRL). The literature on this is extensive and hyperprolactinemia (HPRL), even just mild elevations, have been correlated with a very long list of both systemic and organ specific diseases including: (more…)
While I am a sponge for new information I do have my moments… delusional moments when I think, ‘I am done learning’. These are usually very short lived, maybe an hour, half a day? Inevitably, patients and the practitioners I have the honour of mentoring snap me out of that complacency real fast.
In the mentoring sessions I run, I am surrounded by like-minded beings: passionate practitioners (naturopaths, GPs, psychologists, physios), who challenge themselves every day to learn more & grow more in order to help more…of the people who walk through their door.
And guess what? That means that I have to keep learning and growing too, so we can grow together. Based on this incredible growth in knowledge and confidence I have witnessed in my group mentees this year and over the past 4 years, I’m excited to be opening up applications for 2017 group mentoring right now!
Does your brain feel like it’s going to explode, spilling brain-juice everywhere, when you do 2 weekend conferences in a row? Or is that just me? I have returned to my desk after the Integria Symposium and then the Australasian Society of Lifestyle Medicine conferences with ants in my pants. I can barely sit still. No caffeine required.
Right now I want to talk ASLM because it’s fresh in my mind from the weekend but geez where to start? I was testing the water going to this one. What would a conference about ‘Lifestyle Medicine’ pitched primarily at doctors look like? Would it be a bit light? Would it be token lip service to CAM with no recognition of the need to also make a paradigm shift? Well strap yourselves in guys because what I heard from their outstanding keynote speakers (Mark Wahlqvist, Michael Berk, Bob Brown…yes you heard right..I said Bob Brown!) were some of the most holistic naturopathic teaching points about individual, population and global health that I have heard in a long time. These 3 speakers in particular were mesmerising – to naturopaths (yes there were a smattering of nats there) as well as to GPs, specialists and other attending allied health professionals (more…)
Most practitioners are pretty knowledgeable about Zinc and are quick to recognise a deficiency and the opportunities for zinc supplementation as an effective therapy and those same practitioners are often plagued by nagging questions that come up, in spite of loads of clinical experience, like:
Are plasma and serum zinc levels interchangeable?
What does zinc adequacy look like? Is it just a single number on a page or do we always have to factor in copper levels and get the ratio right as well?
What can I expect from zinc supplementation in terms of changes to the patient’s plasma zinc?
What should I do when a patient’s zinc marker is refractory to the intervention?
Is there really a significant difference between the different supplemental forms available?
Probably not news to anyone but I tend towards busy then bust! If I lived in the pages of a Vogue Living magazine, I would of course have a stunning Japanese water feature located somewhere centrally in my work space & abode to antidote this very Western madness but alas… instead what I have is one very slow water filter tap!!
I can hear my disgruntled kids filling their water bottles everyday, exclaiming loudly about how slow the tap is, finding clever ways to prop up their bottles at precarious angles underneath it so they can continue to multi-task in the midst of the morning rush. In sharp contrast, I find that the long full 2 minutes it takes me to refill my glass at the sink, offers an unexpected oasis, 2 minutes of stillness, a cognitive break in the broadcast in an otherwise frantic schedule.
While the positive ripple effect of the ANS is still being felt (and – yes the video package is just about to be released, so prepare for another big ripple!!), there is another inaugural education event trailing hot on its heels! Hopefully you’ve already heard about the conference being run by the Australasian Society of Lifestyle Medicine in Melbourne in a few weeks. The subtitle of this conference is, ‘It’s time for change: reframing medicine, clinical practice and health policy’ and offers an extraordinary eclectic mix of speakers and topics including: (more…)
I became interested in working in mental health not entirely of my own free will. I guess you could say, it had made it’s way into my world via family members and friends as well as my own problems when I was younger. So when I was at uni and I came across any information about mental illness, whether it was pathology or prescription, it was when I undoubtedly resonated most strongly with what I was learning. I’ve had some great opportunities throughout my career to feed my interest, met some wonderful mentors and some other powerful teachers who were often my patients. It’s now become a running joke among my teenage children that all my friends are either psychologists or have some sort of mental health diagnosis, ‘…and what does that say about you?’ they love to add teasingly. Well it says a lot probably: that I enjoy people who are comfortable talking about the psychology of our lives and ourselves, that I deeply appreciate that to be human is to suffer and we all suffer it’s just a question of degrees and the bravest of us share that with others. Lastly, I think it tells you that I live in the real world with real people 🙂(more…)
Yep, I’ve had them…and made them. I often hear practitioners say they cringe when they think back about the patients they saw in the first year because of the vastly greater knowledge they have now. I do too. But my mistakes are more recent than that!
Often we assume our patients know at least the basics about health – especially about things soooo seemingly basic…that we fear mentioning them would offend and make us look like someone trying to teach grandma anything! But there are some instances where I’ve found I have simply assumed too much.
While I am a sponge for new information I do have my moments… delusional moments when I think, ‘I am done learning’. These are usually very short lived, maybe an hour, half a day? Inevitably, patients and the practitioners I have the honour of mentoring snap me out of that complacency real fast.
Does your brain feel like it’s going to explode, spilling brain-juice everywhere, when you do 2 weekend conferences in a row? Or is that just me? I have returned to my desk after the Integria Symposium and then the 
Probably not news to anyone but I tend towards busy then bust! If I lived in the pages of a Vogue Living magazine, I would of course have a stunning Japanese water feature located somewhere centrally in my work space & abode to antidote this very Western madness but alas… instead what I have is one very slow water filter tap!!
