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…)
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…)
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…)
Ever got to the end of a day or a week and felt like this? Or woken up to find your skin looking like this?! Just quietly, me too. When my son was about 3 he was sitting in the back of my car with my mum (she would have been in her early 70s) and he asked how people get wrinkles. We told him it was from having a fun life with lots of laughter, to which he replied out loud while still staring intently at my mother’s face, ‘Wow Grandma! You must have had the best life ever!’ I digress.
I personally am not a crusader of anti-ageing (seen my pics recently?!!) but my recent research into effectively reducing Advanced Glycation End-products (AGE) via the diet, to in turn potentially lower both my risk of tuckshop arms AND just about every other disease you can name (cardiometabolic, neurodegenerative, psychiatric, malignant, you name it), got me sitting up and paying attention! (more…)
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…)
Setting: Local cafe
Scenario: Run into friends of friends who join us in the sunshine for a cuppa & we’re discussing the finer details of chai (western version V the real streets of Delhi stuff), tumeric lattes etc etc. as you do. I comment on how unpleasantly strong I found the cow’s milk in those downtown Delhi chais we had when we were there.
50 something man: Oh I LOVE that – I just LOVE cow’s milk. I drink loads of the stuff. I used to drink 2L a day but now it’s more like 1L a day.
50 something man: Absolutely. Then there’s the cheese as well – I would eat at least 1kg of that a week. But it’s good for my bones, right? I have that thing, you know, before osteoporosis…brittle bones. (more…)
I am frequently asked what scientific journals I subscribe to and often by the same practitioners over and over, because they can’t reconcile my answer: “None”. Yet I constantly have my head in the scientific literature, right? The two are not mutually exclusive, it’s just about knowing which free scientific and medical news-feeds are worth their weight in gold! If you really are digging into the itty-bitty detail of things these won’t answer all your questions on all your topics but they do a great job of 1) keeping you up to date with the big headlines in general medicine, or, with the use of alert systems and filters, just the areas of health you’re particularly interested in and 2) offering you a huge highly credible resource database that is easily searchable.
Point 1, Exhibit A 😉 :
Here’s just a few examples from the last month that popped into my inbox from Medscape that got my pulse racing:
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…)
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.
Remember to Chew. (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…)
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 🙂
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?
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…)
Recently, while I was touring around the country talking all things Acid Base (!), I spent a bit of time talking to practitioners about the limitations of our current protocols and assessment tools for detecting ‘Bad Bones’. I was surrounded by a sea of nodding heads and when I offered a solution in the form of additional bone health markers, I could see light bulbs going on all over the room 🙂
We all appreciate that osteoporosis develops over a lifetime not overnight, yet the current screening recommendation in most countries suggests that women at the ripe old age of > 65yrs and men >70yrs undergo their FIRST (!) BMD scan! The only exception to this rule is that they recommend an earlier scan in those individuals at high risk…ahem….does anyone here not have their hand up?? (more…)
I like to fancy myself as a bit of Supplement Sleuth! I love working with herbs, nutrients and nutraceuticals rather than pharmaceuticals but I am not blinded to the fact that manufacturers and suppliers, whatever their form of medicine, are large competitive businesses that ultimately need to sell product and want to sell more. Often practitioners & patients are surprised when I say things like, ‘It’s vitamin C not something sophisticated – go buy something cheap as long as it ticks these boxes…”. In contrast, there are some nutrients and nutraceuticals at the other end of the spectrum, that evoke my compete attention around form, delivery method etc. and I would never send my patient out the door to get these anywhere else.
A few times recently, I’ve been asked by praccies, ‘What’s the deal with CoQ10 and ubiquinol V ubiquinone/ubidecarenone forms?’ and I can hear in their tone that they posses a healthy skepticism when being sold the latest and greatest supplement! ‘Should all my patients be using the ubiquinol form or just some?’, ‘Is it really worth the premium price?’. Great questions all of them 🙂 (more…)
I know my busy mum patients think I am probably not to be taken literally when I say, ‘Cook buckets of extras every time you step foot inside the kitchen’, but I am. My slow cooker and my ‘buckets’ are two of my favourite kitchen resources I couldn’t live without. Check out my fridge. These ‘buckets’ can keep a family of up to 6 or 7 (yes my family size changes at each meal) going for almost a week. There are additional buckets of main meals (soups, slow cooks, curries) waiting in the wings in our freezer for when the shelves start to look bare.
Our ‘buckets’ mean that our kids, who don’t really ‘do’ snacks or a lot of (ab)normal processed foods, can see the menu for breakfast (yes, their absolute favourite breakfast is soup), self-serve leftover options to take to school and satiate themselves during the after school feeding frenzy! Gold. (more…)
Fresh faced students, new graduates and seasoned practitioners alike, are forever reminding me of the challenge we experience as practitioners when it comes to instigating real change in our patients health related behaviours … the change we KNOW will make a difference to their health and wellbeing. ‘If only they actually listened to us!?!’ has been screamed by the novice and seasoned practitioner alike. With an overwhelming desire to share our wealth of knowledge, the discovery that information ≠ change can lead us to despair at times.
In a recent interview with Dr. Azita Moradi (Consultant Psychiatrist) as part of our Access the Experts webinar series, I was quite surprised (and pleased) to hear that Azita sometimes spends a whole session with a patient discussing the possibility of change, before even touching on the reality of change. Azita’s discussion surrounding the neuroscience of change and the challenges this may pose in the therapeutic relationship was fascinating, and certainly resonated with the practitioners taking part in the webinar. Azita’s interview was full of clinical gems reminding us that just as in other settings, if we give a man a fish he eats today but if we teach a man to fish we feed him for life. Hand and in hand with this, we need to have a strong understanding and appreciation of how to engage clients in making positive changes to their lives, often when it seems most difficult to do, such as in mental health patients.
Knowing how to improve behavioural change in patients generally, is integral to everyday practice, and its value cannot be underestimated. (more…)
All health professionals are aware of increasing resistance in bacteria as a result of our overuse of broad spectrum antibiotics in both prescriptions and our livestock industry but increasingly we’re hearing about evidence of resistance in microbes of a variety of flavours – take the recent report on head lice that featured in the national news just this week. I am also frequently hearing from mentees about patients being affected by bugs that traditionally have been relatively easy to resolve e.g. helminths, candida spp, tinea spp, that are proving in some clients very hard to budge! A praccie said to me just yesterday, when discussing a patient with recurring resistant oral thrush who was otherwise young, fit and well (!) – ‘Is it possible that these pathogens are actually getting harder to treat.’?..Absolutely! (more…)
Cheesy I know! 😉 However, recently the issue of knowing when to use Withania somnifera & when not to, came up again in mentoring so I thought it’s probably a good one to share. Withania, aka Aswagandha or Indian Ginseng, has become a favourite adaptogenic prescription for many practitioners, myself included. I remember learning specifically (about a million years ago!!) that this herb is ‘warming’ & ‘nourishing’, thanks in part to its iron content. In a traditional medicine context, it’s used for those particularly vulnerable populations such as children, the pregnant, the elderly and the malnourished, boiled in milk as a tonic. These ideas always stayed with me, and lead me to only use Withania in similar patients and presentations with good results. (more…)
During mentoring sessions over the last week I’ve been prompted to ask a few practitioners if their patient had any signs, either clinically or in their pathology results, of high oestrogen. Each time it kind of caught the practitioner off guard because their patients weren’t presenting with conditions overtly related to an oestrogen excess and they hadn’t specifically ‘tested’ for this. However, in each instance the information was already there in the case, it was just a matter of knowing what markers to look for.
So some patients scream ‘high oestrogen’ right from the minute they enter the room? But often others present with health problems that don’t necessarily appear related at first glance. Regardless, their condition absolutely could be being compounded by this background imbalance – think thyroid & other autoimmune conditions for example.
There are plenty of patients who don’t have the exaggerated clinical presentation but still have this imbalance as a significant compounder or perpetuating issue in terms of their pathology.
Relax – I am not suggesting salivary hormones or any form of expensive testing all round (!) – in fact what I am saying is before you even consider yet another pay out of pocket test, costing your patient more time and money, we should look to the clues that are already there, in standard blood tests. Amazingly, you can infer a lot not just about the overall oestrogenic load but also pick up some clues as well about where the excess might be coming from.
In this Update Rachel brings together her 10 quick tips on how to recognise either high oestrogen and/or the potential underpinning reason behind the excess, in a range of easily accessible markers. A great refresher and synthesis of ideas on this important aspect of diagnosis and clinical management. This Update in Under 30 is now available to purchase as a download, click here to find out more or if you’re interested in a 12mo subscription click here