Robert Bransfield MD DLFAPA likes to start off his presentations with a full and frank disclosure about potential conflicts of interest. After all, he is a well known psychiatrist andAssociate Clinical Professor at Rutgers-RWJ Medical School, who is frequently also asked to lecture to doctors and psychiatrists on the causes & treatment of mental illness, so the need for transparency about commercial links & potential financial gain is essential. I’ve heard Robert’s disclosure and it goes like this:
“Patients pay me money in return for trying to help them.”
Cute, hey! No links to bigpharma that happen to have a new med for CNS infections, no patent pending, not even a book he wants to sell you! You see Robert, or Bob as he prefers to be called, lives and practices in an area of the US that has a very high rate of Lyme disease and came to be regarded as an international expert in tick borne diseases/ illnesses simply as a result of trying to understand and resolve his patients increasingly complex presentations. Based on his extensive clinical experience & research he is now regarded as the brain’s trust when it comes to the role of actual pathogens (spirochetes, viral, bacterial, fungal etc.) in the brain and their ability to cause every psychiatric diagnosis.
Sorry if I’ve been quiet for while but I promise have been very very busy!The Australian Naturopathic Summit is getting tantalisingly (& frighteningly!!) close, and I’m just back from a great Aus/NZ tour with Professor Vormann talking my heart out about Acid Base Balance. Now we’re in full flight organising the final details of our Access the Experts Webinar series in July and just this morning, I was chatting with William Ferguson, my most impacting personal mentor, who is presenting the first webinar on 7th July.
Actually while I was chatting with William I wanted to scream…’Oh my goodness! Everyone has to hear this!!’
If you’re reading this you already know how much I love a good set of blood test results, right? It’s always (tragically!) a bit of a high point of my day when they spit out of the fax machine or become available through some other more modern little IT miracle! 😉 But joy turns quickly to frustration when I look through the results and can take an educated guess that patient wasn’t fasting at the time of the test – there goes the validity of most nutrient levels (Zn, Fe, Se etc), the acid base markers etc. etc. What a waste of time and money! While we have a rough idea about the impact eating might have generally on some parameters e.g. increasing HCO3 levels & lowering plasma zinc etc., this is not quantifiable, we don’t know by how much exactly and therefore we are left guessing. 🙁
But food intake isn’t of course the only confounder that can mess with your patient’s blood test results and lead you to erroneous interpretations. There are several things that with good patient education and better record keeping, we can control for, which would otherwise jeopardise the accuracy of our patients’ pathology results.(more…)
“Access the Experts with Rachel Arthur” is a month long intensive webinar series focusing on the best of Mental Health Education. Every Thursday night for the month of July, Rachel will be interviewing a hand-picked guest speaker about a particular area of expertise in Mental Health.
Each speaker is a clinician with years of experience (from a psychologist, to a GP, to psychiatrists) who Rachel has worked with and/or been mentored by and she is thrilled that these interviews create an avenue to share their incredible & very practical knowledge with a wider audience.
Rachel’s role as the interviewer will be a feature of the webinar series – ensuring you get the best of each speaker; translating the complex into easy-to-understand concepts and clinically relevant content that you can start applying immediately. (more…)
The New Practitioner Drop In Class is a monthly drop in class that focuses on providing an easy to access drop in opportunity for integrative health practitioners to participate in some of the most accelerated form of post-graduate education and clinically relevant skill development.
The group mentoring class takes place via Skype on the last Tuesday of every month so that’s at 1:30pm (NSW time) on Tuesday 31st May. The session is also recorded, so you can listen at any time – a perfect option for those who are interested but unable to make the live session or for those who like to listen twice and get the most out of mentoring!
A sneak peek into tomorrow’s case: 26 year old female presenting with an unusual diagnosis of Erythema nodosum, a hypersensitivity reaction on the skin … but what can we all learn from this case? This case will be an interesting investigation through presenting health complaints, concomitant conditions and pathology test interpretation.(more…)
During a mentoring session this week a practitioner asked me, ‘How could paracetamol relieve anger?’. After the initial, ‘What the..??.’ reflex, I thought well the placebo response is really a wonderful thing, the potency of which should never be under-estimated. I mean this is just one of many ‘afflictions’ I have been told by patients can be rectified by a popping a Panadol! But just to ensure I wasn’t missing something I went digging into the scientific literature about the latest understanding of its mechanisms and actions and lo and behold (!!!) several RCTs have shown paracetamol can “blunt emotional pain” and reduce the negative effects of “social rejection” specifically!
Back to my…’What the…????!!!!’ reaction 🙂 While Michael Berk (ie NAC pioneer) did co-author a huge paper on the potential application of aspirin in a range of mental health conditions https://www.ncbi.nlm.nih.gov/pubmed/23506529 given what we now know about the inflamed brain model of psychiatric illness, this one is easier to grasp than perhaps paracetamol for the pain of emotional interactions & experiences.
I really enjoy mentoring practitioners in business – it’s a real privilege to be able to hear about each practitioners’ aspirations and challenges. A few weeks back I had the good fortune to speak with a fresh one! A practitioner who has only been in business for a short period of time. As always before our session, I looked over all aspects of her online presence from her website, to her practice newsletters, Facebook presence etc. Goodness how things have changed from when I graduated and you literally just hung out your shingle!! As much as the online world has created incredible opportunities for people working in integrative health and the public who use our services, I think it has also of course brought the ‘competition closer’.
Perhaps you’ve been keeping abreast of the bone broth debate? The practice of preparing broths made from slow boiled animal bones and made popular by the GAPS diet as well as many Paleo advocates, has come under scrutiny thanks to a small pilot study that evaluated the lead content of bone broths prepared from chicken. The likelihood of lead leaching out of the bones and into the broth after prolonged boiling is quite high of course, given that, just like us, animals are tricked into thinking it’s calcium, and accordingly store this heavy metal in their bones. This study by Monro et al and published in the journal Medical Hypothesis in 2013, suggests that regular bone broths could contribute significantly to the lead exposure of an individual given the lead content of the 4 samples they analysed:
(i) organic chicken-bone broth: 7.01 mcg/L
(ii) broth from organic chicken meat without bones: 2.3 mcg/L
(iii) broth made from skin and cartilage off the bone of organic chicken: 9.5 mcg/L
(iv) control (tap water): 0.89 mcg/L
Due to popular demand and increasing interest, I am so pleased to announce that I will be starting a secondRachel Arthur Mentorship Program (RAMP) from May until November 2016!
RAMP is a program that focuses on providing practitioners with the most accelerated form of post-graduate education and clinically relevant skill development. RAMP will be commencing in May, on the last Monday of every month at 10:30am until the final call in November (a total of 7 skype call mentoring sessions).
RAMP group mentoring is a great way to build a supportive networkamongst likeminded practitioners, whilst refining your skills in areas of pathology interpretation, differential diagnosis, shared care navigation, research skills, and nutritional & naturopathic interventions.
How many of your clients are on a combination OCP?
Do you know the full extent of the physiological impact in each? Are you able to identify to key pathology indicators regarding the magnitude of that impact?
Like you I see a lot of clients who are on the COCP – whether it’s for contraception, skin, dysmenorrhoea or ‘hormonal balancing’ (interesting concept!!). It’s typically the case that these clients are aware that, beyond contraception, it’s not really a ‘solution’ & ‘isn’t ideal’. They have, as all patients (un)consciously do, carried out a little risk benefit analysis though and here they are. I really feel reluctant to make more difficult, an often already difficult decision for women, and I always want to respect people’s autonomy and choices, so whenever possible I simply go about my job, supporting them naturopathically in light of the impact it is likely to have on their nutrition & physiology.
However, there are occasions when I look at their pathology results and put it together with their symptoms and realise that the ‘danger signs’ are flashing & the COCP is not playing nicely with their unique biochemistry.
Women’s responses to the COCP are not one-size fits all. Apart from the fact that there are multiple combination OCPs available with varying ingredients and actions, we know that each individual can respond to the same formula differently based on a range of factors we might not completely be aware of until they start taking it. For example, all oestrogen (whether it’s yours, synthetic or bio-identical) causes mobilisation of copper from the liver. So when we see blood Copper levels rise following OCP initiation, it’s not because these women are suddenly absorbing or being exposed to more, rather it’s as a result of the liver mobilising a large proportion of the copper that it previously stored, for use by the [imaginary] foetus. The question is – how much does each woman have in the wings, ready to go? And does this result in a blood copper rise that’s mild (S Cu levels < 20 mmol/L) or severe (S Cu levels >20 or even > 30 umol/L). What would be the consequence of being someone in the last group? Apart from the significant increase in oxidative stress and the jump in glycosylated haemoglobin (a particular issue for those with pre-existing IR or T2DM) how would this disproportionately high copper impact your mental health in relation to its role in neurotransmitter synthesis? What about the COCP’s additional effects on each individual woman’s SHBG levels (and therefore available TT), HPA axis, glucuronidation etc. etc.?
We’ve all come across women who’ve stopped the OCP because ‘it didn’t agree with them’ but what about the ones whose biochemistry is really battling with the COCP but they’re none the wiser? We can identify this quickly via reviewing standard blood tests & help the client to understand their individualised reasons to be look for other alternatives.
Research continues to clarify the physiological impact of the combination OCP & individualised responses – we live in a world where the COCP will continue to dominate as a contraceptive choice but surely a step towards an individualised approach & improved patient education & informed decision making, are steps in the right direction?
We’re all aware that in theory OCP use correlates with a range of elevated risks but in reality many females will make the decision that the pros, in terms of contraception or control of acne etc., outweigh the cons. What if we could provide more individualised advice by looking to their pathology results and identifying and quantifying specific danger signs for each individual? This approach enables us to better support patients who chose this form of contraception but accurately identify those that might want to consider safer or more suited options and equally reassure those for whom it remains a sensible choice.
I’ve been sick – real sick just for a couple of days…an acute exotic respiratory thing that the northern Rivers and specifically the period around Bluesfest (!) seems to specialise in. Anyway, apart from it being terrible timing (I ask my patients ‘when is it EVER good timing?’) it has been a quick gruesome but instructive reminder about what’s called ‘sickness related behaviour’. This is a cluster of behaviours that come as part of the package with being unwell. They’re usually short-lived as a result of acute infections like colds, flus, gastro. Trust me – you know them well 😉 they include: loss of appetite, social withdrawal, fatigue, amotivation, anhedonia or depression etc.
These behaviours are thought to be critical to our individual preservation and that of our community and at a physiological level are attributed primarily to the rise in pro-inflammatory cytokines (PICs) that are part of being ‘sick’. It makes sense right? If we’re sick we need to lie in bed, be still, rest up, stop working and most importantly, if it is contagious, stay away from everyone to prevent the spread! So really this sickness related behaviour is a very clever adaptation.(more…)
I was recently asked to speak at an ACNEM conference on ‘Clinical Pearls in Paediatric Practice’ and I talked about 3 key things that have proved to be absolute game-changers in my understanding and better management of children…and guess what one of my topics was…threadworm!!?? Yup. I am convinced some people who’ve heard me mention this before may start to think I have some sort of perverse interest in these little blighters because what could we possibly need to know about kids being infected with worms that we don’t already know? However the answer is….HEAPS!
I have spoken on this topic previously (basically when anyone will let me! ;)) and I can tell you that it’s this information specifically, what I’ve learnt about the myriad presentations, the individual susceptibility and fresh perspectives on treatment, that attracts the biggest ‘Wow!’, lightbulb moments and ‘oh my goodness you’ve just explained a riddle in half a dozen of my patients that I’ve been unable to solve’ kind of comments more than anything else. I just experienced this again at the ACNEM conference in NZ. It’s so wonderful to be able to spread the word! (no pun intended!)
Ok here’s a gripe I’m having currently. I have a number of patients who are taking anti-epileptic drugs (AEDs) and most of these are children who require them for seizure control. Naturally, working alongside such serious pathology and these critical medications requires a conservative and evidence based approach to ensure the safety of any added intervention. Fortunately, this is something I would like to think is one of my strengths. When these patients present seeking nutritional support, I typically refer them for investigations that can help to clarify what, if any, nutrients are imbalanced because of their long-term AED use or perhaps because of other independent reasons that may compromise they’re overall wellbeing. I feel that in such a vulnerable population I need to confirm nutritional deficiencies to check my assumptions, prove a need for supplementation and prevent against any excess or creation of further imbalance…and by doing so, I can adhere to my motto of least medicine, is best medicine.
The fact is AEDs are notoriously associated with a long list of potential negative nutrient interactions and the evidence to support this is extensive, this includes but is not limited to: folate, B12, B3, B6, zinc & vitamin D and the deficiencies potentially produced by the AEDs can be quite severe depending on a range of individual factors. For many of these nutrients, the research goes further and has shown that correction of the deficiency leads to better drug efficacy – therefore adjunctive nutritional monitoring and correction would seem like a real ‘win win’ situation.
(Stargrove,MB. et al. Herb, Nutrient & Drug Interactions – Clinical Implications & Therapeutic Strategies. 2008)(more…)
It’s taken a little while for me to collect my thoughts on this one. Initially there was a little flash of anger, frustration and a good deal of huffing and puffing when I heard about the RACGP guidelines recommending GPs say no to any requests from naturopaths for further investigation of their shared patients… but I’m over that now. In an interview on 702 ABC Sydney radio last week, Stephen Eddy, the vice president of ATMS, responded to these guidelines by suggesting that a blanket directive for GPs to ignore all requests from all naturopaths about all testing didn’t really sound sensible or appropriate. Here here! Surely, in the pursuit of evidence based medicine and discerning practice decisions, each case should be considered on an individual basis. I think Stephen Eddy gives GPs more credit for being able to make these judgements than their own association! (more…)
Well here’s a thought…the ‘Superfood’ nutrition movement has just about eaten the South Americans out of quinoa and the Pacific Islanders out of coconuts..isn’t it time for a local hero? I get a bit despondent when any new food is touted as a ‘Superfood’ anyway for all the obvious reasons but this is heavily compounded when this so-called ‘Superfood’ and the bankable gross exploitation of this foodstuff comes at a huge cost: whether that be in terms of food-miles, another population’s access to their food staple or the radical change in land management in these countries that often follows, e.g. think palm oil plantations.
“I need a (Local) Hero!” – cue Bonnie Tyler soundtrack & wind machine 🙂
We kicked off mentoring this year with some great cases last week. One was a pregnant hyperthyroid client. During the session the wonderful practitioner mentions that the client is using Withania somnifera as required for anxiety.
Insert sound of brakes screeching to a dangerous squealing crash! Here’s a situation where I would give Withania a miss. (more…)
There’s taking a break and then there’s taking a break.
For most of us Christmas does not fit the definition of a break but rather simply an altered version of our escalated pre-Christmas frenzy. The crazy end of year work wrap up replaced by the equally crazy Christmas to do list…the same underpinning mantra pervades both…” I must, I must”. But when all the pressies and eating is done the pace usually eases off a tad. I felt a wave of relief just having Christmas day behind me. Suddenly it seemed I was on holidays…still upright, still going through all the usual paces of looking after kids and elderly parents and occasionally attending to a work issue but the relative slowness was noticeable and welcome.
Then something radical happened. I went away.
I was already away, in the sense I was interstate at my parent’s house but we travelled just 30 mins further down the coast to an unknown little rental house by the Rye back beach just with my kids and one of my oldest nearest and dearest mates for a few days. Out of the familiar and all the ‘musts’, ‘shoulds’ and habituations that come with it, off the grid with no computer, no phone (by chance I had forgotten my charger) and to boot the clock in our little hideaway didn’t work! Aaahhhhhh timelessness found.
We sat, we lay, we read, we wandered the back beach for hours exploring rockpools and caves and I had a wonderful sensation as if my feet were sinking into something that I can only describe as the Awake Delta Wave Experience 🙂
I am reminded that of course taking a break is a bit like sleep, we need to progress through the more superficial stages where we remain semi-vigilant, always ready to jump up into action if necessary, until after staying with this slowed relatively restful state for long enough we can progress into deeper stages of relaxation and finally….ahhhhh… hit the delta wave experience of true restoration.
I am wishing you all a truly restorative Awake Delta Wave Experience this festive season and remember it’s not about how long you stay there, it’s just about having one at all 🙂
It is with great excitement & enthusiasm that today I can announce the launch of our crowdfunding campaign for the first independent Australian Naturopathic Summit to be held in Byron Bay on the 27-28th August 2016 (check out our campaign video below!).
This Summit is the creation of myself, Nirala Jacobi and Kathryn Simpson, who all individually noticed a big gap in the support available to Naturopaths striving to carve out their careers in a variety of areas (practice, education, medicinal herb growing and manufacture, corporate health, public health etc.). We’ve been working hard over the last few months to bring to fruition something that fills this gap & offers a truly unique educational experience and platform for our Naturopathic community. (more…)
Come along and be a part of the final case of the month session this Monday at 3.30pm AEDT.
A 47yo male initially presents with anxiety, panic and depression. He also has had chronic sleep disruption for 4 years due to vivid dreaming and nocturia and works in a high stress job. He has a BMI of 27 and in spite of a being a non-smoker, non-drinker & exercising regularly he has a high blood pressure. While he has marked psychosocial risk factors for mental health problems but what else are we missing or could we do to support?
Come along and see what we make of the case as we dig deep with detective work. What were the key questions we needed to know the answers to? What other investigations are relevant? What other treatment approaches might be effective? To get the answers and more book in via our mentoring calendar here. 🙂
We’re so excited to announce the new mentoring program for 2016, specifically designed to add more value and provide greater skills and knowledge acceleration to Integrative Nutrition Practitioners.
RAMP is Rachel’s first incubator 11-month program that focuses on providing integrative nutrition practitioners with the most accelerated form of post-graduate education and clinically relevant skill development. This personalised approach supports practitioners to ‘gap fill’ their underpinning knowledge & strengthen their clinical skills ‘Achilles’ while providing comprehensive support for all aspects of case analysis, client management & treatment. As usual, the sessions involve dynamic detective work and discussions lead by Rachel and contributed to by all mentees.
Some things have changed and some things remain the same.
All the good stuff remains (dynamic monthly group Skype sessions which are case based and run by Rachel) but our session times and the commitment we’re asking from practitioners has changed. In order to ensure the best outcomes for all practitioners via a constant and collegiate group we are asking for a year long commitment. All sessions will be recorded in case you are unable to attend some live and for established practitioners there will no longer be a ‘drop in’ or casual attendance option.
To read more about this truly one-of-a-kind new program that is stepping up practical post graduate education, head over to the RAMP page here.
If you’re interested in joining the program, make sure you apply quickly! The program is capped at 11 practitioners to ensure that all mentees present a case at least once in the year and all of our groups are already half full and we expect to fill them in the coming weeks pre Xmas.
Keep in mind, if the time is unsuitable for you we are collecting names and will potentially open a second RAMP group if there is sufficient demand.
New Practitioner Drop in Class
We will also be continuing Graduate Mentoring with the new name, new look, New Practitioner Drop in Class. This very affordable class is a monthly drop in class that focuses on providing newly graduated, or returning from break, integrative nutrition practitioners with the most accelerated form of post-graduate education and clinically relevant skill development.
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