One thing that you need to know about me is that I consider myself pretty healthy…surprise! :0) As in, I wake with energy, I love exercising and on a typical day I am blissfully ignorant of my digestive system..as in it doesn’t speak to me via oohs aahs gripes and groans. I don’t experience unexplained headaches, body aches or anything else that a lot of people tend to consider ‘their lot’. I put this down to some genetic luck and of course to a diet, lifestyle & minor supplementation regime that on the whole works for me (late nights for 11th hour work deadlines aside!). The last month however has made me realise that this has probably lead me to grossly underestimate the power of those core diet and lifestyle choices that have become so automatic as to risk being forgotten. (more…)
I’ve just come across yet another woman who has developed an unprecedented fungal nail infection (Onychomycosis) in her toenails following a trip to Bali. This infection is usually due to a species of tinnea that has managed to infiltrate the nail structure. According to good old naturopathic theory we might wonder about what has made this individual susceptible e.g. high sugar diets and dysbiosis however my experience tells me that often these infections are directly the result of exposure to the fungi and don’t necessarily point to a bigger story.
In several patients recently who have presented with these, each one had recently returned from Bali where…yes you guessed it…they had a pedicure or ten! Multiple uses of nail scissors, clippers or any other pedicure equipment without proper disinfection in between will frequently lead to infection subsequent clients.
These infections are extremely difficult to treat due to poor penetrance of any remedies through the nail in which the fungi is thriving. Effective treatment needs to be started very quickly and necessitates vigilant daily administration of a topical anti-fungal (be that herbal, essential oils or otherwise). Patients also need to understand the basic ways to prevent the spread of infection to other nails which includes using a separate pair of nail scissors for infected nails only. Commonly these acute nail infections progress over weeks to months leading to loss of the entire nail and typically regrowth of a permanently infected and deformed nail – hence why treatment needs to taken so seriously early on. At that stage surgery, laser therapy and pharmaceutical oral antifungals become the only treatment options.
Just thought it was worth spreading the word on this one as it seems to be increasingly a case of Bali (or any other Asian country offering cheap pedicures) Beware! 🙁
Medical Observer recently highlighted the increasing issue of Erectile Dysfunction amongst males and specifically made some points that I think we can all be in agreement about:
Initiate the discussion – the more comfortable the practitioner is in asking about this issue, the more comfortable male patients will be in sharing their problems & the less likely they will be to buy dangerous meds etc. online (DIY medicine) which is becoming increasingly common
Don’t treat without proper assessment first– erectile dysfunction (ED) is potentially a warning sign of serious co-morbidities e.g. diabetes, HBP, cardiovascular dx, treating without thorough investigation is essentially shooting the messenger
Investigation should encompass:
Medical history including medications esp. antidepressants and specific attention paid to any cardiovascular risks
Drug and alcohol use
Physical trauma to the reproductive area which can include things such as cycling, or working in hot environments
Discussion pertaining to the sexual health of partners & psychosocial impact or context
Physical examination should include blood pressure, heart rate, abdominal aortic aneurysm, carotid bruits, foot pulses, and an assessment of body weight.
“Examination of the penis and testes is mandatory.”How many GPs do you know of who do this? Not our job but interesting to know that it is theirs!
Pathology testing should include:
Fasting lipids, glucose & morning fasting testosterone (don’t forget about asking for Calculated Free Testosterone or the Free Androgen Index instead which is regarded as more reliable)
Offer simple solutions first– don’t reach for PDE5 inhibitors but think more holistically all about the factors playing into this presentation & all the ways we might need to support
Following on from my Men’s Health tour earlier this year I have had so much incredible feedback from practitioners about what they’ve discovered about their male patients since starting to a) have the conversation about sexual health & b) knowing how to thoroughly investigate men’s hormonal health…with this new insight comes more targeted treatment options and ultimately better patient outcomes. Sounds like doctors and integrative health professionals are on the same page with this one at least! 🙂
If you missed the Men’s Hormones Seminars – you can now purchase the 3hr DVD with the notes direct from our website
I know…it’s unbelievable right but it’s that time of year again! While we’re all madly finishing off our to-do lists for 2015 you might want to cross the ‘Attend a Group Mentoring Session with Rachel Arthur’ one off the list? We have limited sessions left before the end of the year & next year we will be re-structuring group mentoring so now is a great time to get on board and have a taste! Come along and find out what other practitioners are talking about and how accelerated learning looks and feels.
“I think joining this mentoring group is the best thing I’ve done since graduating! The way Rachel presents made me feel very comfortable to ask questions and I didn’t feel foolish at all. She is obviously a genius but explained concepts in such an accessible and easy to comprehend manner.” – Melissa
Get a taster before the end of the year so you can decide if group mentoring is for you & therefore be first in line to be offered our special packages for 2016 when group mentoring will be taking on an exciting new format!(more…)
In walks a patient with recurrent episodes of swelling (lips, fingers), hayfever and hive like eruptions all over – it’s got to be an allergy right? Not necessarily. Of course we should follow the classic allergy investigation path but what happens when you discover that your patient doesn’t have raised total IgE nor raised basophils/ eosinophils. This means it absolutely is not allergy. I’ve seen quite a few clients like this, some have even gone to the trouble of extensive skin-prick testing only to discover absolutely no allergens and no sign of allergy yet again…what is going on??
So with the classic features of swelling, itching, rash, +/- wheeze the presentation looks like an allergy, sounds like an allergy but you know…it simply can’t be a classic (IgE) allergy without these markers. What now? This is often the point at which practitioners might reach for IgA/IgG food allergy tests…but you know what…even though patients might produce some positive reactions in these, this is not the answer either! Because IgA and IgG allergies do not tend to produce these symptoms.(more…)
A few weeks ago I was camping with my kids in rural northern NSW. We’d gone there for a long weekend to sail on the glorious Clarence river… yes that is literally what floats our boat! Anyway, thanks to a public holiday we all planned to stay on for the Monday, still sailing, lolling about on grass under gorgeous trees etc. Not observing the sacred public holiday thing completely though I started my Monday with a run. I noticed how quiet everything was, the siren for the boatyard had sounded but of course none of the workers were there to respond to the call… this small town had become a bit ghost-like. Further on I ran past several huge farms and I noticed that of course they were ‘business as usual’, full of workers going about their usual work and a very simple realisation hit me… (more…)
Howdy hard working praccies 🙂 well I received a very interesting email this week from someone asking me if I thought her urinary iodine result was accurate or if, as I have written about previously (https://rachelarthur.com.au/concentrating-concentration-getting-urinary-iodine-right/), it needed to be corrected for the creatinine content of her urine. Her raw iodine result was 24ug/L which suggests severe iodine deficiency. Her referring doctor however had also asked for creatinine and applied the creatinine correction formula I have previously described:
Iodine (mcg) ÷ Creatinine (mmol) X 8.85 = Corrected Iodine –which changed her result to 265 mcg/gCR which suggests she is NOT iodine deficient at all
She then asked another doctor to review the result who had told her 24ug/L was correct in the first place as ‘pathology companies automatically correct for the concentration of the urine’. Naturally the individual found the difference in opinions and results absolutely striking and ultimately disconcerting so she thought she’d ask me.
It was good to get this email because it made me go and check my facts, get in touch with all the major mainstream pathology companies we deal with and ask their labs ‘Do you or do you not automatically correct for creatinine when you report urinary iodine results?’ I was worried I had given you guys some bad advice 🙁 …here’s what I found out:(more…)
We have a case being presented on Monday at 3.30pm EDST on a 32yo Female presenting with hives, swollen lips and eyelids but minus the classic biochemical markers of allergy (IgE and eosinophil elevation)..what’s going on? To boot she has very high stress levels, difficulty settling, being still and has a tendency to anxiety. Is it possible she is an under-methylator and that correction of this might go some of the way to settling her immune system? Or could there be food intolerances rather than allergies at play?With a history of an unusually high number of broken bones – what else is going on that requires our attention? (more…)
No matter how long I am in practise there is always a group of patients for whom ‘vaginal thrush’ is a major problem. Most of us have some fabulous tricks up our sleeves to help resolve these issues & reduce their susceptibility – intravaginal lactulose is one of mine thanks to Jason Hawrelak. And then you come across those clients who vigilantly do every thing you ask them to and yet you fail to completely resolve the issue. Doh!
One of the most important things to do with all clients presenting with ‘thrush’ sooner rather than later is send them STAT (!) for a vaginal swab.
Not only does this clarify if it is in fact actually thrush (2/3 of self-diagnosed women get it wrong according to research!) but better again it names the actual culprit. It may come as a surprise but not all vulvovaginitis is due to Candida albicans – increasingly they are the result of other Candida species and this is something you absolutely need to know.
During a recent mentoring session, a practitioner wanted to better understand why she had a group of patients whose thrush seemed so resistant to her usually successful treatment. Here’s my initial response in a nutshell… (more…)
Recently a practitioner lamented that because of her clinic location she didn’t see company reps very often & felt this was a barrier to her staying current with her clinical knowledge. Of course, I had to beg to differ.
We’re quick to judge the medical profession for their reliance on commercial sources of CPD, overwhelmingly provided of course by the ‘drug reps’ but it seems we’re less fazed or concerned about ourselves being equally reliant, unduly influenced and misguided (might I add) by the people employed by the CAM manufacturers expressly to encourage us to sell more of their products! How does that make sense?
I go back to my very repetitive mantra: always be mindful of who delivers you the message/information etc. and what their agenda is.
By promoting their company’s products to us, focusing on the products’ strengths, ignoring or simply not making it a priority to know the limitations or weaknesses of the products or the evidence, ignoring or again simply not making it their business to know when superior products are being produced by competitors or when new evidence comes to light that puts into question their products,reps are only doing what they’re employed to do. But is it helpful and is it ok?(more…)
It’s not sexy but it is one of my favourite deficiencies. Favourite because it’s incredibly common…make no bones about it (tee hee)! Favourite because a deficiency is actually reasonably easy to recognise once you know how (watch increasing phosphate levels especially over 1.2 mmol/L in particular in adults) rather than wait for a recognisable clinical deficiency picture because if you wait for this your patient will have probably had osteopenia if not osteoporosis for a decade already! Favourite lastly, but most importantly, because correction of a calcium deficiency has led to some of the most diverse but impressive improvements in people’s health that I have seen – from better menstrual regularity and less luteal phase symptoms (see the fascinating research on this also by Thys-Jacobs 2007 https://press.endocrine.org/doi/full/10.1210/jc.2006-2726) to improved pain control in fibromyalgia.(more…)
A 33yo Female presents with severe long-standing diarrhoea, weight loss, fatigue and generalised musculoskeletal pain. Initially without a medical diagnosis, however she’s been told by an ‘integrative practitioner’ that unusual African parasites were the cause of her sickness and then subsequently independently diagnosed with Giardia which was treated with Flagyl. By the time she returns some 6 months later for her next appointment, she’s now got an official medical diagnosis of Myositis, which is producing crippling pain requiring hospitalisation at times and is not relieved by standard pain meds. While the acute diarrhoea is less of an issue now there are still significant GIT problems in spite of a restricted diet and when we zoom out to take in the whole case there is still a significant dysbiotic, immune story of repeat UTIs, thrush and her white cells counts bounce from high to low. Doctors have now switched her from steroids to methotrexate to try and address her myositis at least.
Now before you all run screaming from the room…let’s just stop for a minute and ask ourselves a couple of ALWAYS IMPORTANT QUESTIONS:
Is there a beneficial role that I can play for this client? i.e. is there anyone else taking a whole systems approach to her health
While I may not KNOW what is going on exactly and precisely WHY – are there enough clues to point to the systems that need support, processes that seem aberrant that I could put back on track etc.
About a decade ago there was a lot of excitement about using fish oils in the management of mental health, so much so even the American Psychiatric Association developed recommendations suggesting that people with mood, impulse control & psychotic disorders should all consume 1g EPA + DHA per day… but then what happened?
Ask most health professionals (GPs, psychiatrists, naturopaths & nutritionists alike) today whether fish oils are their first choice in mental health nutritional interventions and you’ll frequently get a, ‘No’ and I include myself in that.
Let’s retrace our steps to find out how we got here. The epidemiological evidence linking low omega 3 intake to myriad mental health problems in terms of susceptibility, incidence and severity is almost overwhelming. For example, depression rates are 10 times higher in countries with limited seafood intake and post-partum depression 10-50 times higher (Kendall-Tackett, 2010).
Noaghiul & Hibbeln postulated that countries where individuals consumed less than ≈ 450-680g of seafood per person per week demonstrated the highest rates of affective disorders (2003). One study of 33 000 women with low omega-3 intake were found to have an increased risk of psychotic symptoms (Goren & Tewksbury 2011) and it goes on. Then, we have other evidence also pointing in the direction of fish oils, such as the general consensus that excess unchecked inflammation is evident in many mental health conditions (Maes et al 2013). Numerous intervention studies using fish oils as stand-alone or adjunctive treatments have been published. Interventions have included high dose omega 3 (no specific EPA/DHA breakdown), EPA alone, ethyl-EPA, high DHA, blends with high DHA:EPA ratio, flaxseed oil etc. etc. (more…)
Lots of great conversations with practitioners following my recent post on the need to specialise – really thought provoking & clarifying ones which makes me think it’s been a good conversation starter. Key things that have come up for people are:
How do I choose my area of speciality…e.g. is a spin the bottle approach required?
Is specialisation sensible when you’re only just starting out or should you be taking everyone and anyone to begin with?
Is specialising even naturopathic given we have a holistic approach to health?? …e.g. I might say, I only do gut but for my IBS patients there’s a whole lot of stress management & mental health stuff that needs addressing along the way
Great questions 🙂 Now remember, all I’m offering here is my opinion, I don’t think there is a definitive answer to these but I think we should keep the conversation going as a way of keeping us thinking about theway we choose to practicerather than assuming there’s only one way to be a naturopath in clinic.(more…)
It’s just been reported on Medical Observer today that because of a ‘worldwide shortage of food fortification folic acid’ all Australian commercial breads covered by the mandatory fortification laws, will potentially be without this additional synthetic folic acid for up to 12-18 months.
This is unlikely to take effect for another few months, however, is important for people (& their practitioners!) to know that their food will be changing. In light of this women aged 16-44 are being encouraged to increase their consumption of other folate rich foods such as dark green vegetables, citrus fruit, legumes & other whole grains.
This wordwide shortage (fortunately/unfortunately..?!) will not effect the supply of synthetic folic acid supplements or the inclusion of SFA in infant formulas.
“According to the Health Department, the shortage came about as the result of Chinese folic acid supplement manufacturers slowing down production in response to the introduction of new pollution emissions regulations there this year.” (more…)
Using products that contain synthetic folic acid (SFA)? Worried about this? There’s so much misinformation, fearmongering and hysteria out there I’m not surprised! I’ve been bombarded this year by really experienced & cluey practitioners who have been losing their confidence around using folate, treating methylation issues etc. and it is incredibly frustrating and disheartening to see.
My big message is be mindful whose messages you’re listening to!!
Seriously though…if you’re being told by someone that SFA is toxic for everyone and they just happen to sell a range of products specialising in other forms of folate and methylation education galore…ask yourself is this unbiased reliable information? Equally, when you have companies telling you not to worry about SFA at all, that it’s perfectly safe in all doses for all clients and they happen to have a lot of products on the market that contain SFA, ask yourself the very same question!
Let’s face it the truth is probably somewhere in between. 🙂(more…)
Well now’s your chance! Due to some of our regulars being away, suddenly a group mentoring session has opened up for tomorrow that offers you this fabulous opportunity!
Running at 11.30am tomorrow at EST via Skype for 1 ¼ hours, Rachel will be holding a Q & A session on your key questions and topics. Big or little, case based or theory… you can pose the questions you’ve been meaning to or needing to & get the answers you’re really after. Your questions should be submitted via email in advance of the session to ensure they get adequately addressed and if you have any accompanying information (e.g. test results) you want Rachel to look over then send these to us as well prior to the session at [email protected]
For the standard price of a group mentoring session you will also receive one free ‘Update in Under 30’ download of your choice from Rachel’s extensive library!
I will never forget a conversation I had with a GP colleague many years ago now, he looked tired and we were chatting about workloads etc. and he said to me, “If I had have known in uni what I know now about general practice I would have specialised!” He then went on to describe the stress associated with fulfilling the role of the ‘one stop shop’, “I never know what’s about to come in my door and whatever it is: cardiology, obstetrics, oncology…I have to know what to do and how to best treat the patient”. His overwhelm was palpable and he in fact was one of the most conscientious & competent doctors I knew.
Ithink, I’ve replayed & retold this conversation so many times because it translates readily into naturopathic practice.
When I qualified a squillion years ago, we all assumed general practice was the only option and the training with all its modalities left many of us fearing we would be ‘jack of all trades & master of none’ but nowadays, specialising, thankfully has become more common. If you’re not yet doing this then it’s possibly time to have a serious think about it. Perhaps it’s a demographic (paediatrics, men, geriatrics) rather than a system and your specialisation does not have to be absolute…you get to make the rules 🙂
It’s my belief that with the ever increasing popularity of integrative medicine there is enough business out there for everyone and if we can each narrow our focus and become better at our given area, then the whole profession and industry will ultimately benefit.(more…)
We had a great case in one of our graduate mentoring sessions the other day (thanks Kate 😉 ) , about a 40 something mum of 3 who reported to have cyclical mood and depression. Further investigation of the case, however, revealed that some of the key characteristics of the mood disorder were actually anger, aggression, irritability, hyperactivity, vivid nightmares etc. This particularly came to light with her responses to a mood survey that the practitioner had asked her to complete. I think validated tools like this (esp. DASS), when used appropriately, can give us enormous insight – often revealing things we might not have thought to ask about or that the client might not have voluntarily offered up, particularly if they are not socially accepted or attractive qualities.
If you practice anything like me, then Vitex is an absolute reflex response (think the very funny reflex paper ad – that’s me in my clinic!) & godsend for most cyclical mood issues. However, apart from the fact that this woman’s key period of mood aggravation, although clearly related to her menstrual cycle, was day 5-14 rather than during the late luteal phase, there was another stand out reason for me why I definitely wouldn’t use Vitex.(more…)
So…a 55 year old female walks into your clinic only recently diagnosed with Graves disease but when you look through her old blood work it looks like actually she has had hyperthyroidism (or at the very least suppressed TSH) for some time prior. She is experiencing a lot of the common features with stinging eyes, thinning hair, shortness of breath, broken sleep, as well as fatigue and depression. Problem is you’ve done all the right things (Selenium, Rhemannia & Hemidesmus etc.) and yet you’re not seeing significant improvements.
Your mind starts going further afield… worrying about what you might have missed…she has lots of amalgams, parietal cell antibodies and very high ESR and copper levels. What are you missing??
