Relax, no one is leaving RAN central – they’ve deadlocked all the doors (!) but I’ve left another online abode I built and time-shared in last year….The Worm Whisperer…which is exclusively focused on educating the public about worms. Not the compost ones, but the ones that like to inhabit us humans and cause so many health conditions that most people, & sadly many practitioners alike, are not aware of. So back to my wormy tale… In 2018 I started up a Facebook page: The Worm Whisperer. I recognised from the many talks I’d given that there was a need to educate people more about threadworms because the information just wasn’t getting through and affected individuals were basically being grossly medically mismanaged. There are just so many cases where children have been diagnosed with an alphabet soup of physical or behavioural disorders only to discover that chronic treatment refractory threadworms were in fact the culprit. And no…mebendazole is not going to fix that.
Then there are the women, who have had years of sleepless nights and complex disturbing health issues. They visit many different medical & allied practitioners who can’t seem to pinpoint the issue. Or even if the practitioner accurately does diagnose Enterobius they mistakenly use inappropriate anti-parasitic strategies and therefore struggle to get any long-term resolution and reflief. I can’t tell you how many women have discovered The Worm Whisperer Facebook page and told me how they cried with relief when they read the information in our eBook and understood for the first time that this was not in fact ‘all in their head’ and help was on its way.
I’m so glad I started this up. It’s been an amazing privilege to support women, children and whole families from around with world with their worm journey and see such positive results. And it’s only the tip of the iceberg because there are so many more out there being told their pre-pubescent daughter just has ‘thrush’ (impossible by the way in this age group) or referring women to psychologists and telling them they’re ‘hysterical’ (that’s an old chestnut that has made a strong & unwelcome comeback in this area) when they present with myriad symptoms that just don’t fit neatly into other diagnostic boxes. Anyway, together with the joy of being able to help so many came..who would’ve thought (!)…more and more followers…and more and more work…and well..The Worm Whisperer is continuing to grow at a rapid pace and now it’s time to hand over the baton to a team of people who have the time to focus just on this issue and who are just as passionate about worms as me. So I wanted to let you all know, there is a new team at the helm and I have officially left the (WW) building…but you know…they’re cheeky little blighters…so I’m sure they haven’t left me 😉
Check out The Worm Whisperer Facebook page, support this great Australian initiative and let others know. There is a great eBook, resources and products to treat all worm conditions.
Sheesh…who turned down the music and turned on all the lights…are the holidays seriously over??! That’s right, pack away the Christmas tree (somehow), drag yourself away from your (endless tennis/cricket watching) meditation practice and start looking at your calendar because my first tour is kicking off in February! That’s right, you heard me, F.E.B.R.U.A.R.Y So given my computer (the mothership) also didn’t want the holidays to end…staging a pathetic ‘sorry, no power, protest’ for the last week…I too have now got my skates on, getting ready for this juicy and thought-provoking seminar to jump-start all our brains for 2019:
Immune Mediated Food Reactions – What’s IgG got to do with it?
Because let’s face it, identifying, testing and understanding food based reactions, is typically plagued by myths and misunderstandings among the public & can be a source of confusion & frustration for many practitioners. The testing technology has advanced so far, however, that if we combine these improved methods with astute case taking and sound clinical reasoning, well while, food based reactions are always going to be a complex area, now we at last can be systematic in our approach of investigating these and better understand the clinical significance of our findings.
I kick off in Sydney on February 16, Melbourne on February 23 and Brisbane on March 2. Early Bird price of $50 ends 11 January, so don’t miss the early bird discount and email [email protected] to confirm your place.
I hope you’ll join me at the IgG Food Intolerance Workshop. For more details download the flyer here for more details.
Oh no, it’s her again 🙁 I mean the chick in the photostock image not the other ‘her’, me. I know. It’s the end of another mammoth year, you’re tired, worn out, used-up all your brain-power quota (a little projection?) and I can hear you begging for mercy when I start a sentence with…”So you think you know….” followed by, “blah blah blahIron,” but hear me out.
Correctly identifying & managing iron issues is a bread & butter part of our business, right?
With Iron deficiency affecting an estimated 1 in 5 women and Iron excess almost another 1 in 5 – patients with one form of iron imbalance or another tend to be over-represented in waiting rooms.
Anyone can spot overt iron deficiency anaemia or full-blown haemochromatosis but many health professionals find the ‘in-betweens’ confusing and fail to recognise some key patterns we see over and over again, that spell out clearly your patient’s current relationship-status with this essential mineral. This often results in giving iron when it wasn’t needed and missing it when it was. If you’re imagining someone else, i.e. the person who ordered the Iron Studies for your patient, will step in and accurately interpret the more curly results can I just say D-O-N’-T...they’re often as perplexed or even more so than you. After starting this conversation a year ago with So you think you know how to Treat Iron Deficiency, & its baby sister, So you think know the best Iron Supplements, our (imaginary) switchboard went crazy. While practitioners got the message loud and clear about how to improve the likelihood of treatment success in iron deficient patients, hot on the heels of this came email, after fax, after carrier pigeon, with examples of patients’ Iron Studies, the ‘somewhere in between ones’, accompanied by the equivalent of a dog head tilt…aka ‘I don’t get it’.
And this is to be expected.
What were you taught about reading Iron Studies? Was it made out to be all about ferritin? And TSH is a solid stand-alone marker of thyroid health, right? 😉
Were you introduced to the other essential parameters included in Iron Studies, explained how they contribute to your diagnosis and reveal important details about the patient’s ability to regulate this mineral or not? About when to dose and when to hold your fire?
Nah…I didn’t think so. But it’s up to us, people, to hone our skills in Iron Study interpretation…because individualised nutrition is our ‘thang’ and more than any other nutritional assessment, this collection of markers, actually allows us to go beyond the ‘one size fits all’ model…everyone must have X of this and Z of that in their blood tests…and see each patient’s actual individualised need and relationship with this mineral. In the latest Update in Under 30, I introduce you to 3 key players in iron assessment and the insights each offers become so clear, you’ll be able to read any combination or permutation of iron results that walk through your door. To boot, I’ve included a wizz-bang cheat-sheet of those iron patterns that are frequently seen and rarely recognised, including one totally novel one that I’ve never talked about before…to make your job even easier and put you well and truly ahead of the pack in understanding iron nutrition. It’s Christmas…and as the mantra goes…we can always fit just a little more in at Christmas time, right? 😉
Overt Iron Deficiency Anaemia or Haemochromatosis aside…do you understand the critical insights markers like transferrin and its saturation reveal about your patients iron status? Most practitioners don’t and as a result give iron when they shouldn’t and fail to sometimes when they should. This audio complete with an amazing cheat sheet for interpreting your patients Iron Study results will sharpen your skills around iron assessment, enabling you to recognise the real story of your patients’ relationship with iron.
Yes them’s fightin’ words. It’s 6 days til Christmas and we’ve all got way too many things to do before Santa visits, right? But this will take you 1 minute and takes precedence over finding excuses not to attend Christmas parties, half-crazed-mad present buying, watching Love Actually….again and building tension with loved ones in preparation for the big day/fight. I joke but I am serious. I don’t know how you feel about the proposed PHI reforms which are due to come into effect from the 1st April, removing Naturopathy & Herbal Medicine as modalities that can be covered by Private Health Insurance, but in the least amount of words, here are mine:
For me, the financial impact on patients and secondarily on me, is not my primary concern. Our profession represents a significant proportion of the health workforce in Australia and according to 2005 data, a form of healthcare that 69% of Australians engaged with, and according to Wardle & Adams research, often as primary healthcare providers. We provide such an important service, the public knows this better than any political party, and they will continue to come through our clinic door, seeking the kind of quality care we can offer.
No, what really concerns me about this (among other things) is the marginalisation of my profession, my colleagues and by virtue of this, the implied message to both patients and other healthcare professionals alike, that we are not active contributors to the improved health and wellbeing of a substantial proportion of the population…and as a further extension of this – we should not be part of ‘the conversation’. It is yet another step backwards away from any shared care or integrative model that truly puts patient outcomes first or that recognises the importance of an individual’s right to choose in regard to their healthcare.
Now the NHAA have created a petition that is going straight to the health minister, Greg Hunt. Their focus is a little different from mine – about the potential for more ‘fake naturopaths’ to hang up a shingle post PHI reform and therefore increase public risk. This is not my major beef and it may not be yours IT DOESN’T MATTER. We need to all sign this petition – naturopaths, herbalists, nutritionists, integrative doctors and healthcare providers of every persuasion.
Just my thoughts…what are yours?
PS It doesn’t matter if this is your association or not…let’s allsign it...& get some groundswell going
Did you and all your patients survive Spring? Have you had a chance to restock the shelves with all the big-gun-Quercetin-products for the next allergy onslaught…or maybe for patients presenting with other conditions that respond well to this, like leaky gut, asthma, MCAS, Grave’s disease? Either way…can I ask you a Quiet Quercetin Question…how high do you go?
I ask this because I know myself to be pretty heavy-handed at times, especially in those severely affected by traditional allergies..and the results are so impressive for patients and practitioners alike, it’s easy to perhaps get very enthusiastic with this approach, with doses sneaking higher and higher… if a little is so good then a lot must be great!
“Severe eczema and allergic asthma – [Insert preferred big-gun-Quercetin-product] 2 three times a day – STAT!”
And we use it across all patients, right? I love it in kids, teens and adults, men and women. So I kind of stopped dead in my tracks when a colleague recently said…”I do the same…buckets of Quercetin especially over hayfever season but Rach, what about it’s phyto-oestrogenic effects? Should we be worried?” Ah…yup…that’s right…being a flavanoid…it has them. Now let’s be clear about one thing, unlike some practitioners I am NOT, I repeat, NOT against phytoestrogens nor even (ahem) soy 😉 but the question was great because it got me thinking…at high-end supplement doses we are producing levels in the body 100s if not 1000s of times higher than a fruit and vegetable rich diet ever can….is it time we knew a little bit more about what Quercetin does at this level, or is suspected of doing and not just the benefits. Therefore we can be more informed about who we should not be so generous or so long-term with our big Quercetin prescriptions?
So I started busying myself in the literature and it turns out THERE IS A LOT OF LITERATURE!
[Note to said colleague who asked me question, you owe me some sleep] But at least I got an answer!
If you want a bit of DIY drilling then this Andes et al paper is an excellent overview of quercetin supplementation safety concerns…but it doesn’t cover everything. We need to talk. We need to talk about that dang estrogen aspect but it’s bigger than that – you see Quercetin doesn’t just engage with oestrogen receptors like a ‘normal’ phytoestrogen…it messes with levels of this hormone via several other paths…and where does that lead us…? Listen in to the latest UU30 Querctin – Are We Pushing the Limits? and you’ll know exactly our destination. This is important for the Quercetin Queens (both male and female) among us…and that’s like…everyone…right? 🙂
Quercetin has become an absolute go-to treatment for many practitioners faced with patients affected with allergies and high histamine. It is in this context, that often we find ourselves using large amounts over long periods. Supplemental quercetin exhibits a 5-20 fold higher bioavailability than its dietary counterpart, therefore increasing body levels beyond what a diet could ever achieve. This introduces more potent novel actions: anti-thyroid, pro-oestrogenic, detoxification disrupting…are we pushing the limits of desirable effects and introducing some undesirable ones and who should we be most conservative in?
Never say never, right. Back in my old uni teaching days, I scorned the very notion of treating someone with ‘actual melatonin’. Always in favour of upstream approaches over downstream, I was keen instead to give patients the ‘ingredients & cofactors’ so they could whip the right amount up themselves. Well fast forward another decade in clinical experience, and research too, and while I refuse to give in with many other ‘replacement remedies’, melatonin, has snuck well and truly into my list of treatment considerations for some very specific presentations such as silent reflux, treatment refractory GORD and Barrett’s oesophagus, buoyed by some amazing clinical successes. So much so…that in fact I’ve embraced this replacement approach, whose results in this setting especially, can’t be replicated by treating with ingredients and cofactors. Turns out of course I am not alone – melatonin has won a lot of fans over the last decade.
A recent Australian article from 6 minutesrevealed a significant increase in GPs prescribing melatonin for sleeping issues in children and then of course, there is its substantial use in cancer and typically at mega-doses that will make your toes curl.
But always in the back of my mind is the old me. Whispering things like, ‘ but melatonin isn’t a nutrient, nor a herb, so it’s not naturopathic’ – hence we can’t even prescribe it, needing to refer patients to others for access and yet more pressing, ‘what do we really know about the full implications of replacing such a potent and ubiquitous neurotransmitter?’ I know. This old me, she’s annoying, right.
But she’s also important.
So absolutely perfect timing then to hear about a homegrown (2 Aussie Naturopaths in fact) systematic review on the adverse effects & safety of melatonin which is full of important and surprising info and I think ….everyone…single…one…of…us needs to read it:
“While this review reveals a high degree of safety for melatonin with few adverse events that cannot be easily avoided or managed in most populations, it also reveals lack of clarity regarding melatonin’s relationship to endocrine processes, and its effect on hypertensive patients and potential drug interactions in this population.”
But the devil is in the detail.
So here’s a newsflash for you – 4 human studies found melatonin had negative effects on key aspects of reproduction, like sperm counts and ovulation and not at mega-doses my friends, no…at 2mg/d over several months. We shouldn’t be surprised, right, melatonin is critical to fertility cycles in all other animals…but how many health professionals know this, or not just know it…but make our recommendations with this in mind? Other studies reported fascinating impacts on insulin sensitivity (5mg) and amazingly, (or not being the king of all things circadian), opposing effects depending on the time of administration. Then there’s the drug interaction with anti-hypertensives…a negative one, I must add. No information still unfortunately about the impact of long-term replacement on our own endogenous production. Anyway…enough spoilers… READ THE ARTICLE. This hasn’t wiped melatonin off my list of potential recommendations all together but it has given me some serious food for thought and much greater clarity about in whom this suggestion should be off the menu.
‘Melatonin – Misunderstandings and Mistakes’ – this important 2017 clinical update about what we are getting right and wrong with Melatonin answers in particular, one of the most common sources of fascination & frustration for clinicians, the reasons behind the Melatonin non-responder. We’ve all encountered patients who have taken Melatonin for sleep problems and reported no benefit, or initially responded and then lost efficacy quickly, or even patients who experienced insomnia after taking. What does this tell you about your patient and what should you do to resolve this and better still, prevent it? This UU30 from 2017 reveals all!
Well who’d have thunk?! I had no idea cigarettes contain sugar and turns out about 95% of smokers don’t either, according to this recently published article! Now while we’re not purporting this is going to be of caloric significance enough to prove a deal-breaker for the ‘I Quit Sugar’ devotees and others watching their waistlines 😉 its presence in cigarettes is far from benign for other reasons…
“Sugars naturally occur in tobacco leaf but are also commonly added to cigarettes by tobacco companies.
Added sugar increases levels of toxic chemicals in cigarette smoke. “
Never mind that we have a long list of much more terrifying chemicals more commonly known by smokers to be found in their affectionately-named, cancer sticks! Maybe our current overwhelming fear (for some!) of sugar might be the great tipping point in their decision-making process?! I’m not sure but it’s worth a try…one final factor to build on the already impressive impact of our anti-smoking public health campaign here in Australia? I still meet clients who eat ‘organic’, regularly do pilates or yoga but still confess to slipping in ‘social ciggies’ on the side, – do you?! So for this popular patient paradox anything is worth a try…perhaps tell them about the sugar! 😉
What is this thing you call, Update in Under 30?!
Update in Under 30 are dynamic power-packed podcasts that will help you keep abreast of the latest must-knows in integrative medicine. Focused on one key issue at a time, Rachel details all the salient points so that you don’t have to trawl through all the primary evidence yourself. All topics are aimed at clinicians and cover a range of areas from patient assessment to management, from condition based issues to the latest nutritional research. Most importantly, each podcast represents unbiased education that can contribute to your CPE points. Subscribing (Standard or Premium) offers you a fast efficient and inexpensive way to stay up to date in under 30 mins a month!
Don’t find yourself sad come November 15th when we close applications for Group Mentoring in 2019!! You still have a week left to to jump in! (if you haven’t already) and make this investment in building your incredible naturopathic skill-set and subsequently, your clientele.
So let’s recap what your group mentoring options are for 2019… Which one will you choose?
– STANDARD GROUP – Nothing ‘standard’ about being in this group. You’ll be plugged into 11 other practitioners and together with Rachel’s brain, you’ll receive the knowledge and confidence to assess, investigate and manage no matter who and what walks through the door. We are adding some enhancements to our already successful formula – structured follow up on client cases presentations; a 30% discount on Update in Under 30 Subscription; using Zoom platform; serious supplement sleuthing; and CPE Certificates. (read more)
“I would pay a million dollars for her brain but instead I just pay
for my mentoring which is just as good.” –Tess
– NEW GRADUATE GROUP – The New Graduate Group Mentoring Program will give you an exceptional advantage, help you to grow as a professional and take some serious edge off being a newbie! This way you’re able to set yourself and your clients up to succeed! This group is designed specifically for the new (or newish) practitioner, with a combination of tutorials and active participation. You’ll be able to bring your own clinic case, patient pathology results, referral letters etc into these interactive sessions and take home mini-assignments to work on. (read more)
“I went from nervous newbie to confident and capable practitioner in 1 year” – Georgie
– MENTAL HEALTH GROUP – This group will help you get building on what you already know and help you gain more confidence when working with clients who present with myriad mental health issues. We’ve attracted practitioners from mixed disciplines: naturopathy, nutrition, IM GPs, psychologists, psychiatrists so that we can draw from our collective knowledge base and clinical experience while familiarising ourselves with a ‘team approach’, so essential to mental health management. (read more)
“I really love the cases and listening and seeing how you interpret complicated presentations and methodically break them down in a way that digs down to the core/genesis of the issues.” – Deborah
But Wait There’s More!!….. If you work in a clinic environment and have a team of practitioners (minimum of 5), you can have your own monthly mentoring sessions that best supports your clinic.
Email us at [email protected] for more information.
Can you see yourself in one or more of these groups?
Just a couple of important friendly reminders…
In those groups involving case presentations, you can present any kind of condition EXCEPT (!!) patient who present with fertility concerns and cancer diagnosis – for these two areas there are better mentors, who specialise in these areas, out there and so these cases are not suitable for the RAN groups
The Mental Health and New Graduates Groups are self-selecting, we’re happy to give you input now, help you to be better informed about each group, but ultimately you make the call about which group seems the best fit for you and we’re then unable to shift groups…so once you’ve signed up for these, you are committed for the 12 months
Time is running out to be a part of Group Mentoring in 2019!
Group Mentoring is fast becoming a popular choice (going by the landslide of expressions of interest coming in for 2019!) and could be an integrative part of your practice & your career progression.
Applications close on 15 November, so make sure you complete the registrations form by sending us an email at [email protected]
“Certainly picking up some great pearls with the biochemistry. Love the research papers you add in after each case. I’ve also started using your flow charts helps put everything in perspective. Every case presented teaches and guides me. They also remind me what I do know and have forgotten. Being mentored builds confidence with those difficult cases. Thanks so much.” – Joanne
While this ABC article is written for the public it’s a great checklist to have written up somewhere to prevent against placing your confidence in the wrong sources of info.
Just recently, I had a practitioner ask about the ‘risks’ of B12 dosing…& while B12 is considered to be free of a toxicity profile in just about any textbook or in-depth review paper you can find, a ‘methylation’ expert had made mention of there being demonstrated increased oxidative stress.
My response, ‘Have you checked their references?’ Their response,’No’
I get it, right, we’re all busy people and don’t have the time for a full literature review of every claim made by every educator, ‘expert’ or company… BUT sometimes a credibility check can be lightning fast!!!! As was the case in this instance.
I did check this expert’s reference (singular). I read the full article just out of interest but actually, I didn’t need to. I had my answer just by reading the title and abstract…the study was conducted in genetically altered rats made alcoholic and injected with B12 or something to that effect. Relevance?? Which is in stark contrast to the absolute consensus from 100s of human studies concluding that B12 toxicity is NOT a thing.
That also means this particular expert’s references probably need to be checked every time of course…until you can be more confident in the quality of their claims – tough but true. Below are the 7 top Qs to try and answer to determine the quality of any claim – and remember you rarely have to complete the list to get your answer…just start with reading the title of their key reference!!!
1. Who says? (….and what agenda/bias might they have) 2. Sample size ( a response rate of 20% might mean something in a sample of 10000 & nothing in a sample of 10!) 3. Lab-bench or real world 4. Correlation V causation 5. Statistically significant V clinically significant (…if something was shown to reduce people’s migraine pain by a rating of 0.5 – but most people rate their pain at 10/10…is it actually clinically meaningful?!) 6. Does the dose relate? (…watch out for animal studies where they are using doses at mg/kg body weight…that we could never match with oral dosing in humans because they would be eating buckets of the stuff!) 7. Got some time?…then dig a little deeper…if your article has passed all the above checkpoints and you’re still dubious (and this does happen!) check out who has cited this paper (easy via Google Scholar) and whether other researchers are in agreement or not with their findings. What’s been published in this area since then?
Oh and this article is also handy for the occasional misguided patient – who’s found some incredulous online info about something that contradicts your contrastingly well-sourced & quality-checked knowledge! 😉
Our new – New Graduate Mentoring Program kicks off in late January and offers an incredible opportunity for successful applicants to develop their core clinical competencies in record time during their transition into practice. Real world research cheat tips, is just one of the many practical competencies covered across the year’s curriculum. But if you’re interested in applying, jump onto it! Applications close on the 15th November
Oral sex. There I said it. Last month when I talked about Helicobacter pylori and where people might ‘catch’ this – if they didn’t inherit the little critter from their mum or family as an infant – we thankfully were able to rule out kissing as a source of transmission between couples P.H.E.W…but I sort of got shy (Who, you, Rachel?!!) and danced a little bit around the question of whether other forms of sexual contact represent a possible route of exposure (pardon the pun). Until a lovely colleague after listening to Blowing the lid on H.pylori-who gets it & why – said, ‘Now seriously Rach, are you trying to say, oral sex may be an issue?’ Well…ahem…maybe. You see, remember what I said about candida being a vector for H.pylori and therefore H.pylori being present in the vaginas of women who have this bacteria residing in their stomachs. Ok…enough of that now I am blushing..but if you want to read more on this grab this article in BMJ from 2000 by Eslick who discusses (and seems a little too interested in, can I just say), the risks of H.pylori transmission via a myriad of sexual activities.
A month has passed since that last UU30 edition and it’s time for another instalment. This month, I’ve taken the giant leap forward many of you requested, into the fascinating realm of how best to manage H.pylori positive patients, in whom this bacteria really does constitute a pathogen.
Do we just try with multiple relentless antimicrobials to blast holes in this critter, a lot like the conventional approach…which, thanks to its significant capacity for developing resistance, is like aiming at a constantly moving target,…or…?
I’ve got a very different suggestion and approach. Increasingly we realise that the GIT microbiome is a vulnerable & dynamic balancing act and as a result, when treating patients with confirmed parasites, or worms or potentially (but not always) pathogenic bacteria such as H.pylori, most of us are doing much less ‘weeding’, less ‘eradicating’ and definitely less ‘shooting at things only to hit others’, these days. Instead we think about how we can best change the environment. So, what is it about someone’s stomach that opens the door to H. pylori and lets it in, and then perpetually ‘feeds’ it to ensure it stays longer and wreaks some real havoc, we identify & treat what about this over-friendly stomach is amenable to rehabilitation? As it turns out…that’s a lot.
And surely if add to our antimicrobials a larger focus on rejuvenating the gastric environment of H.pylori patients, to control the growth and activity of this bacteria, and in some cases even kick it out of the big brother house altogether…the chances of relapse and reinfection (a big one in this condition) will be dramatically less..not to mention the broader benefits on the greater GIT function, now the stomach has been remediated.
Or you could just keep trying to hit the moving bulls-eye?
For a bacteria identified just a few decades ago as being a cause of chronic gastritis, atrophic gastritis and gastric carcinoma, the escalation of number of antibiotics used to eradicate it (4 at last count + PPI) has been nothing short of breathtaking. A management approach more consistent with both integrative medicine and with an improved understanding of the delicate microbiome includes a bigger focus on changing the gastric environment to ‘remove the welcome mat’. What do we know about how to do this successfully? It turns out…quite a lot.
Hear all about it by listening by my latest Update in Under 30: H.pylori – Eradicate or Rehabilitate? For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.
Finally a systematic review puts paid to the nonsense that ‘withdrawal from antidepressants’ is problematic only for a few, is ‘mild’ & ‘lasts only 1-2 weeks’ with no treatment necessary other than reassurance, which is still being perpetuated by current prescribing guidelines both here and overseas. In fact their review found that 56% of patients experienced problems with stopping antidepressants and the majority of these rated these as ‘severe’. Back in the good/bad old days when I worked for a pharmaceutical company who made psych meds the phenomenon of an ‘initiation phase’ during which time suicidal risk was heightened, was acknowledged and freely discussed…in-house at least. However, the concept of a ‘withdrawal syndrome’ was less clear. Anyone who has witnessed patients coming off ‘even the cleanest’ SSRIs will speak to a potential myriad of worrisome experiences including…
“Typical AD withdrawal reactions includeincreased anxiety, flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Dizziness, electric shock-like sensations, brain zaps, diarrhoea, headaches, muscle spasms and tremors, agitation, hallucinations, confusion, malaise, sweatingand irritability are also reported (Warner, Bobo, Warner, Reid, & Rachal, 2006, Healy, 2012). Although the aforementioned symptoms are the most common physical symptoms, there is also evidence that AD withdrawal can induce mania and hypomania, (Goldstein et al., 1999; Naryan & Haddad, 2011) emotional blunting and an inability to cry, (Holguin-Lew & Bell, 2013) long-term or even permanent sexual dysfunction (Csoka & Shipko, 2006).”
Previously termed ‘discontinuation syndrome’ by expert panels – to distinguish these inconvenient effects from the more seriously viewed (read nasty) benzo-associated discontinuation problems – was an act of smoke and mirrors, according to this scathing and insightful review by Davies and Read, who argue strongly this is a clear cut withdrawal picture and it deserves as much consideration and concern. In particular they point out that of course, patients can experience these symptoms even without ‘discontinuation’ – but simply as a result of a delayed or skipped dose, an intentional dose reduction etc. And they provide the alarming context that one third of people in the U.K. (and likely similar developed countries) who take antidepressants for more than two years have no evidence-based clinical indications for continuing to take them. But wait..I’m just getting to the worst bit, this is the part that gets me personally…having been a peddler in the past of these meds and in certain patients still spruiking their benefits, I am in no disagreement about them being necessary, helpful & even life-savers in some patients…yes I have seen this too many times to ignore it…BUT…and now this is where I start raising my voice a tad….
Patients need to make informed choices, and having a clear understanding of what you are likely to experience on any given medication has been shown to improve outcomes but according to the 2 largest surveys conducted to date,< 2% of antidepressant users are being told any of this. Do you know why? Well, let’s start with the misleading guidelines… if the RACGP says it isn’t so…then can we expect their GP to know or say any differently?
Grrrrrrrr…. yes that’s me…not a wild animal in the room with you.
Because you know what happens in the absence of this?! And let me say I have also seen this too many times to ignore as well, people feel compelled to stay on them & this is truly heartbreaking to witness. The experience of a reduced dose or a period without is so terrifyingly disconcerting to that poor unsuspecting individual, and without explanation, is misinterpreted by them (and according to this review often by their doctor as well!!) as being either a sign of their inherent mental instability and need for ongoing medication, or misdiagnosed as a separate condition. Ok…apologies, this is over a decade of pent up frustration…resurfacing as a result of reading this incredibly important and disturbing review. I think I need a little lie down now 🙁
Helping patients off anti-depressants is a challenging and important function that must be initiated by the patient with the full support of the prescribing practitioner, however there’s a role for complementary medicine here too. Rachel walks you through a range of strategies and when you might consider each. Listen to thefree samplehere from the Update in Under 30 from 2013 – Leaving Anti-depressants Behind. Or perhaps you’re interested in all things Mental Health and should find out more about our specialist mentoring group running in 2019.
Forever fascinated by the neurobiology of various mental health presentations, addiction included, two medical news items caught my attention this week. If you’ve ever heard me speak on addiction, in somewhat simplistic terms, it is very much about the reward centre of the brain and how strongly all recreational drugs hit on this. Think rats tapping levers with their feet to continually self-administer cocaine…to the exclusion of all else….kind of magnitude of reward hits. You may have also heard me quote or misquote (!) someone famous who once said something to the effect of….and I am totally paraphrasing poorly here: if we can’t seek pleasure legitimately, we will seek it illegitimately.
So thisstory from ABC newsabout a Newcastle addiction group support program showing some early signs of greater retention and engagement and therefore potential success with addicts…because they incorporate prizes…well that makes so much sense!
The article is important to read in its entirety as it creates the context – especially for many people suffering from addiction who tell tragic stories of lives where the only rewards/prizes and even gifts they’ve ever known, being drug-related – even from a young age. So to normalise reward to some extent, and give individuals an experience of constructive legitimate versions of this, is actually desperately needed and ground-breaking.
How can we incorporate some element of this in our interactions with these patients?
The second ABC news item touts ‘a new generation drug that restores balance to the brain’ but is actually just a teaser about…wait for it…cue stage right…a not so old favourite…N-acetyl cysteine! Although this is effectively a recruitment drive for methamphetamine addicted individuals into a new 12 week trial of NAC, run by the National Drug Research Institute, taking place in Melbourne, Geelong and Wollongong, it gives NAC a great wrap and rationale for being a good adjunct in addiction, of course. Just a reminder folks that naturopaths belong on that multi-modality health care team for people struggling with addiction, and we do have some potent therapies to contribute.
A couple of years back I was asked to deliver an educational session to a group of hospital based mental health specialists on the merits of NAC. My favourite question/comment at the end of my detailed presentation from a very experienced psychiatrist was, “Well if N-acetyl cysteine is so good for mental health…why haven’t I heard about it before now?!”
I hope they follow the ABC news 🙂
Want to Get Up Close to N-acetyl Cysteine in Mental Health? Previous ideas regarding the pathophysiology of mental illness have been profoundly challenged in recent times, particularly in light of the limited success of the pharmaceuticals that ‘should have worked better’ had our hypotheses been correct. Novel drivers such as oxidative stress, inflammation and mitochondrial dysfunction are on everyone’s lips and N-acetyl cysteine is in prime position in this new landscape, to be a novel and effective therapy for mental illness. This presentation brings you up to date with the current NAC research in a large number of mental health conditions & translates this into the clinical context.
In the not too distant past, were you wearing your Sunday-best when you were ceremoniously handed a special piece of paper to say, ‘You’re officially qualified to see patients!’ And did you, or have you since then thought…’Wow! Really?!’ Does the certificate come with my favourite clinic supervisors to boot??’ So where to from here? You’ve got all this incredible knowledge, ideas and motivation bubbling around and having that first, or maybe the tenth, client sit in front of you, it can suddenly seem like you need a bunch of completely new skills or that the gems, which you know are gems, are harder to apply in practice because patients come in such challenging packages. So many things going on in each individual, such incredibly complexity, the antithesis of a ‘one size fits all’ model – does it feel a bit like you are performing trapeze without a net?
Taking the leap into practice can be a Grand Canyon-esque one for most.
Developing practical systems that support you in the real world as opposed to help you pass exams – is a whole different objective.
Patients not paper cases. Time now = Money
But why should we all be out there doing this in isolation?
Trying to figure out where to start, where the best information and resources are, what are some tools that are going to rock your practice that have already been created and are available for your use this should be a five year path of rocky self-discovery. Ok there are still going to be some rocks but perhaps going completely barefoot is not the best idea! 😉
The New Graduate Group Mentoring Program will give you an advantage, help you to grow as a professional and take the edge off being a newbie! This way you are able to set yourself and your clients up to succeed! Oh, we can her you exhale just a little already, knowing that you could have people supporting you through this transition, who understand exactly where you’re at! You’ll be creating your own collegiate group by having what feels like your own pit crew, cheer squad, research team, your sounding board, and yes some serious clinic supervision in your corner, as well as access to an extensive library of knowledge, resources and experience. (OMG! Wishing I had this when I stepped out into the big wide world those 20 years ago)
This group is designed specifically for the new (or newish) practitioner, with a combination of tutorials and active participation. You’ll be able to bring your own clinic cases, patient pathology results, referral letters etc into these interactive sessions and take home assignments to work on. “Oh Yay,’ we hear you say…I was so going to miss the homework! You will also be learning how to:
Develop Mind Maps – the best ones will write the prescription for you
Develop patient timelines that help establish causality
Get yourself started with reading basic Pathology results.
Write a referral letter for doctors and other health practitioners
Know what patient screening tools and questionnaires to use.
Learn supplement sleuthing to easily compare your treatment options.
Get friendly with patient driven research using real world tips and being shown the best online resources.
Plus it contributes to your CPE points while building a support system around you.
YOU’VE GOT THIS! This is an investment in you – building your reputation, skills and your clientele. Oh and this is just not all talk here….just listen to some of our current mentees – check out Georgie’s video who went from “nervous newbie to confident and capable practitioner in 1 year” or listen to Tess’s video testimonial “I always come away from those sessions with so much more knowledge. Always apply straight away to clinic”.
INTERESTED? Drop us an email at [email protected] to get yourself on the list for this specific group offering in 2019. Applications open 15th October and close mid-November. Find out what all the goodies you get with the New Graduate Group Mentoring Program here.
So we already know that thyroid problems can start in utero, right…but a recentMedscape review(the fountain of thyroid information that I frequently drinketh from 😉 ) on Hypothyroidism in childhood taught me a couple of big things I hadn’t known before!
The diagnostic criteria for subclinical hypothyroidism are raised TSH levels in combination with a normal concentration of free serum thyroxine (FT4) but because there are some differences between accepted ranges in TSH assays, high-risk groups should be screened, especially babies with malformations, whose mum received steroid treatment during pregnancy or in the neonatal period, or who had existing thyroid dysfunction, TFTs (or at the least TSH as part of what’s called the Neonatal Screening test) should be repeated 2 weeks later. But now comes the couple of big light-bulb moments: the incidence of eutopic thyroid in twin births is nearly double compared with singletons! As you know, I’m a mother of twins and I’m guessing at 18yrs old now (and multiple peachy TFTs 😉 ) the horse has well and truly bolted for my two but geez…I had no idea of the dramatic increase in risk. And it keeps going…monozygotic twins very commonly show a delayed TSH rise and those numbers are even more prominent in multiple births. The other not-so-fun-fact is the discovery that subclinical hypothyroidism in IVF babies is approx. 10% which is noteworthy considering none were observed in the control group.
This obviously left me thinking “W.H.Y?” And of course…the first place my head goes with the latter…is iodine.
The reasons behind our increasing rates of thyroid dysfunction across the life-stages are multifactorial (and don’t get me started on the very real contribution of EDCs!) and how, in spite of iodine adequacy being the first thing on the checklist for thyroid health, so many health professionals ignore this, at their patients’ peril… But now at least we know that patients with IVF babies, twins, and preterm bub, who are currently not included in the prioritised screening groups should be…and of course we should keep asking the questions, “what are the mechanisms behind this, why is it so?”
So if this has made you even more curious about the incredible butterflied-shaped gland and you’d like to go for a stroll on the vast plains of “thyroidisms” you can click on this link Thyroid Assessment in Kids and Teenagers and get completely “thyroided” up. There is always more research to come our way so keep your eyes and ears peeled.
You may have already heard whispers about some great things happening in our Group Mentoring program next year but it’s ok we can hear your silent screams!! The ones that say, ‘BUT WE LOVE IT ALREADY!’…or…’But next year was my year to finally find out what everyone else has been talking about!’ Nobody panic.We’re absolutely continuing to offer our regular groups mentoring in its current format AND adding some amazing extras, increased resource sharing, a system for supplement sleuthing, structured follow up on client case presentations and bonus Update in Under 30 discounts to help you drill deeper into particular topics (just to name a few).
But don’t listen to us! What would we know??!
Just listen to Tess Doig who’s been in our group program for 5 years!!
She’s one straight-talkin’ sister and she reckons group mentoring is the bomb in terms of saving your clients money, developing discernment so that the latest: product, test, other bright sparkling thing, and increasing your skills in solid, sensible, sophisticated naturopathic practice. So getting plugged into 11 other practitioners and Rachel’s brain can give you theknowledge and confidence no matter who walks through the door. Group Mentoring is fast becoming a popular choice (going by all the expressions of interest coming in for 2019) and could be an integrative part of your practice. As Tess shares in her video below “I would pay a million dollars for her brain but instead I just pay for my mentoring which is just as good.” Whether it is her case or other practitioners throughout the year, she always comes away from the sessions with so much more knowledge that she can always apply straight away to her clinic.
So next year when you sign up, you will continue to receive live monthly sessions on your cases and facilitated by Rachel, with each session an opportunity to take the leap from theory to application in a safe place, supported by similarly skilled practitioners, while using the incredible Basecamp platform for communication and support between sessions. We just couldn’t help but add some further touches for 2019:
Zoom – we’re looking at moving to Zoom as the platform for delivering the case presentation sessions – simpler, easier to use. And we can record the video as well as the audio for you to watch later.
Structured follow up on client case presentations – New format to follow up on how the client is going after the session – what’s working, and what’s happening now? Sharing ideas and discussing the outcomes.
30% discount on Update in Under 30 Subscriptions (UU30) when you join the Group Mentoring Program. Having access to the additional information from UU30 while participating in the Group Mentoring program is a huge bonus. When certain topics arise in each of your the case presentations, you can then go and listen to the relevant podcast to drill down deeper and build on your knowledge in that area at your own pace and leisure.
Serious Supplement Sleuthing – Introducing some very exciting tools to help you better discern between supplement choices for patients
Certificate of Mentoring Hours for your CPE points at the completion of the year
We’d love to have you join us. Only two weeks until registrations open, so send us an email on [email protected]to let us know your interested and be on the list to receive more information on how to apply on 15 October.
This mentoring community that I am a part of, I absolutely love and together we make good companions on this road that too often we often find ourselves travelling In isolation. So I wanted to put together this little fun video here to get across that mentoring isn’t about a conversation between just two people. It might feel that way when you are in a mentoring session with me but there is so much more connected to this one conversation and this video shows the bigger picture!
Over the years I’ve received amazing feedback on my mentoring services and the perception that my knowledge is really huge!! Yes I am a journal junkie and I do have 20+ years practice under my belt but…I believe a good mentor has their own mentors. Your mentors may change over the time to strengthen different skills sets and it’s knowing where to look for answers, how to always apply critical thinking and developing your own brains trust.
I am privileged to be able to share what I have learnt, so the mentoring I continue to receive, benefits everyone I mentor. Whenever I mentor someone, whether it’s individually or in a group, I am not just relying on what I’ve been taught or what I have managed to come across firsthand, especially when I get a doozie of a question or a condition that I have never personally encountered in practice! Then the sharing circle continues as the practitioners I mentor are more than likely passing on this with other practitioners – strengthening our collective knowledge and our profession.
So if being part of the community excites you and if the thought of learning and benefiting from a collective knowledge base that is strong and pulls on expertise outside of our own, now’s the time to join the conversation through Group Mentoring.
In 2019, in addition to our tried, trusted and applauded regular group mentoring format, we are introducing some new specialists groups – one for practitioners working extensively in Mental Health and another online program for New Graduates.
Read all about it here or email [email protected] to let us know you are interested.
A few months back I seriously ‘blew over’. Not on an RBT but on a UBT (Urea Breath Test). In spite of it being not the kind of test you want to score top marks for, my result was in the high 2000s, when all I needed was around 800 to confirm, and anything over 50 to be suspicious, that Helicobacter pylori had taken up residence in my stomach lining. I tell you, I knew it when I blew it! 😉 After ingesting the radioactive urea and waiting to blow up my sampling balloon, I felt like I could still fill a room full of balloons with all the gas being produced in my stomach and those balloons, I imagined, would all rise to the ceiling as if full of helium! Yep…I burped all the way home, which was representative of what I’d been experiencing daily for a month beforehand and what lead me to get the test done.
But initially, it wasn’t so clear.
The very first symptom I experienced was a sudden onset of severe tightness around my throat that lasted for minutes but started to happen multiple times in a day. Yep..no one panic. Together with a strange sensation of ‘extreme emptiness’ in my stomach on waking or delayed meals, and then mild nausea both with an empty and full stomach…only some days or weeks later the fabulously-unprecedented-&-socially-adorable-burping started, proper.
So a month or so later, I’ve solved my own mystery. Happy? Not in the least…where the heck have I picked up H.pylori from? Yes…that’s what I said because it had to come from somewhere people…right? I think there is much we have misunderstood about this bacteria with an incredibly long and interesting human history. Animals don’t and can’t carry this bacteria. The evidence suggests that it can’t survive for very long in the environment either (approx 4 days) but that is long enough to get into our food and water and maybe even onto shared chopsticks…just saying (listen in to hear the lowdown on all these and more!) Essentially hoomans are the traffickers, people! In fact one of the things that surprises people the most is the very high prevalence in young children and the clusters of positive tests & identical strains within families…but once you learn a little more about this bacteria…it won’t surprise you at all.(more…)
We are looking at establishing a Mental Health Focus Group to support practitioners in mastering the maze of mental health. This is such a growing health issue, with a recent survey of Australian doctors identifying psychological issues as the number one presenting complaint in general practice and one in five (20%) Australians aged 16-85 experiencing a mental illness in any year. It is likely all health practitioners are witnessing a similar shift…but not everyone chooses to work in this complex area of health. Some practitioners might refer these clients, or only deal with this when it’s not the primary issue, and this is understandable, often appropriate and ok. For those integrative health professionals, however, working predominantly with mental health presentations, our need for specialist knowledge, skills, supervision and support jumps exponentially. How could we support one another’s practice and therefore the patients, in this capacity?
Over the last 16 years I’ve had a special interest in Mental Health and have seen a lot of patients who present with this as their primary issue. We have so much to offer mental health in our dispensary that we canuse, however, there are inherent complexities and challenges – none more so than really being able to identify the ‘red flags’ and knowing when you are not the ‘right tool for the job’
If it sounds like I am talking your talk and speaking directly to you, then I am. And this is your opportunity to let me know you’re interested so that we can continue to work towards establishing such a group. We are looking for practitioners who already have significant knowledge in this area and are looking to take their mental health skills and experience to a new level. This group will help you get building on what you already know and help you gain more confidence when working with clients who present with myriad mental health issues. Ideally we are hoping to attract practitioners from mixed disciplines: naturopathy, nutrition, IM GPs, psychologists, psychiatrists so that we can draw from our collective knowledge base and experience while familiarising ourselves with a ‘team approach’, so essential to mental health management. Can you see yourself in this collective?
“I really love the cases and listening and seeing how you interpret complicated presentations and methodically break them down in a way that digs down to the core/genesis of the issues.It helps me to provide more laser focus to my own complicated cases with your guidance.Love the mind maps!Thank you for all your energy, incredible knowledge and enthusiasm in skilfully educating mein a way that makes difficult cases easier to understand!” – Deborah Miller
There are so many great things about being part of a formal peer group focusing on Mental Health including:
Monthly hour- long meet-ups online via Zoom with a group of like-minded practitioners with a special interest in mental health
Opportunities to present your own case – and receive guidance on all aspects: from diagnosis to management
Structured follow up on client case presentations – in 2019 we’re introducing a new format to follow up on how the client is going after the session – what’s working, and what’s happening now? Sharing ideas and discussing the outcomes.
Sharing of multiple resources via our online locked learning platform
This will be a self-selecting group, so once you’ve applied to being part of this group for 2019, you will be committed for the full 12 months.
Serious Supplement Sleuthing – Introducing some very exciting tools to help you better discern between supplement choices for patients
Certificate of Mentoring Hours for your CPE points at the completion of the year
For more information on Group Mentoring and how to apply click here. Express your interest now by sending us an email on [email protected]!
But in setting up a dedicated new grad group mentoring platform for 2019, designed to help anyone who wants support transitioning from student to Naturopathic SuperPower (!)…here are some more details
Monthly live, interactive, online tutorials covering key core skills e.g. naturopathic differential development, pathology orientation and interpretation, referral letter writing, supplement sleuthing and lots more juicy stuff!
Supervised formal learning community of like-minded and similarly skilled grads
An online curated shared resource centre – yours and mine!
Introduction and sharing of key clinical tools to assist with screening, case work up and client management
Lots of opportunities for structured Q & A on specific topics, both during our live Zoom sessions and between sessions via our online learning platform
A year-long opportunity to immerse in a collegiate network – find your tribe
An annual subscription at an accessible price point for new graduates – paid in quarterly instalments
“This mentoring and access to Rachel is my lifeline!! There’s no one else who comes close to the level of education,
dedication and mentorship with such generosity and humility. Thank you!!”
KATE POWE | Naturopath
Interested?
Drop us an email at [email protected] to get yourself on the waitlist for this specific group offering in 2019. Applications open 15th October and close mid-November.
Want to read more about what practitioners have to say generally about their experience of RAMP (Rachel Arthur Mentorship Program)… well check these out:)
Alright, so I can’t teach you how to leap tall buildings in a single bound but I can show you how you can make big leaps towards uncovering your Naturopathic Super-Powers! I often marvel on what I now know, that I wish I had been privy to as a new graduate and while it’s true some things can’t be rushed and only come with time and firsthand experience – my career path and those of so many others was made harder by the silo-esque way we were all encouraged to transition into the clinic: unsupervised, in solo practice, and without a formal support network. Each one of us trying to reinvent the wheel over and over again. Twenty years later, what I do know now, is that there’s a better way.
There is a bucket load of resources, skills, short-cuts and tips that can be shared with you by a good mentor and good practice supervision, can radically accelerate your progression to becoming the best clinician you can be.
I believe that one of the true strengths of our profession is our sense of community and connecting with that community. When I see this power leveraged to the benefit of the newest, and in some ways the most vulnerable members of our profession, it is a community of which I am genuinely proud of.
When you first start your clinical practice (suddenly now without a net!) you’re full of enthusiasm, overloaded with theories and have a heavy sprinkling of hopes but at the same time,often a tad overwhelmed by the very realness and responsibility of being, ‘the one they came to see and pay (!) to help them’. Making the transition isn’t always easy. Belief in your knowledge and trust in your own competency doesn’t come with your certificate of completion. Nor should it. You’ve still got training wheels on. But how reassuring to know that you can be amongst others in the same position & that together you can build skills and confidence with the help of one another and me. I’ve been there too and I know how important it is for me to share my 2 decades worth of experience (ouch!), not just for the benefit of you, the clinician but for every individual that sits in front of you. Because that’s why we took on this role in the first place, right?
“I am so happy my younger graduate Naturopath self had the insight to invest further in my knowledge and skill set and join RAN mentoring. As a baby naturopath of just over 5 year clinical experience, I have been able to grow my confidence in my clinical skills at an exponential rate thanks to mentoring. Rachel, thank you so much for being an amazing mentor and sharing your knowledge with us. I will continue to do group and individual mentoring for the rest of your career! (if you will have me of course!)”
Tess Doig, Group Mentoring 2018
Our profession thrives when we thrive as individuals and central to this is building networks of ‘similar others’ in order to find your tribe and benefit from the ‘collective’. Group Mentoring allows you to connect to a community of like-minded, similarly-skilled practitioners in a structured teaching environment. You’ll be learning core clinical skills that you can apply in realtime to your practice and be able to ask questions along the way. The most valued aspect of the mentoring is the ability to discuss practice experiences with the mentor and to hear and learn from all the group members, sharing experiences, knowledge and learning as we go during the sessions.
Joining Group Mentoring is a great way to develop your confidence, skills and knowledge. The bonus of these sessions is you’ll find your tribe, gain support and radically build your toolkit through…
additional resources – Mind Maps, Timelines and Mental Health & other screening tools.
quick accessible tools for discerning between supplements.
the basics in pathology interpretation including introducing you to our pathology template for recording and analysing your patient’s labs
the best places to access specific online resources for reference ranges, research etc. for free
If you’d like to hear a little about my own journey from the seeds of my childhood (yes seriously we went waaaaaaay back) that helped me make the decision to pursue this career path, through to teacher and now mentor…but the eternal student as well. Check out the FxMedicine podcast “The Value of Naturopathic Mentoring with Rachel Arthur”.
Have you put your name down on the waiting list for 2018 group mentoring? Read here for more information on the programme.
Applications open mid October, but you can put your name down first by emailing [email protected] today.
