shock

I’ve managed to befriend a microbiologist.  I know it wouldn’t excite everyone, but it’s my big good news story of the month and I can’t wipe the smile off my face when I announce this to friends and colleagues. Friends don’t get it. Yet another Rachel weirdism. But colleagues…every single praccie I’ve told says, “Oh wow!!!! Where can I get one of those??!!”

What’s even more special, is that my new BFF is not just any pathology lab scientist – she’s a passionate one, describing herself as, ‘the only one in the lab who would get excited about things, write down ideas and thoughts about how this patient might be presenting and remember to chase up doctors notes to see if I’d come close!’ 

I know…I’ve met my match 🙂 …we could talk for days without drawing breath! And wouldn’t you know it, the more I learn, the more questions I have, which is always a good sign.

As a result of her patient answers to all of my seemingly infinite and annoying, ‘But Why?’ questions – I can confirm I am in total Culture Shock!  Some of these gems I have already shared with other naturopaths, doctors and of course my poor loved ones (really we need to know this as well??)…and the Culture Shock it seems is unanimous.  Jason Hawrelak has been trying to educate practitioners for a long time about the limitations of bacterial culturing with regard to stool samples, but if these issues are about the culturing process per se (which many seem to be) what does that mean also for the accuracy and validity of our patients’ vaginal swab and urine culture results?  How often do you get a ‘no pathogen isolated’ result back from one of these when the patient’s picture is absolutely consistent with infection?  What should we believe?  Better still how can we get better answers from the lab?

So to date, my Culture Shock is the result of lightbulb moments such as:

  • Lab scientists aren’t mind readers and they can’t ‘Supersize’ your order or ask you if you want fries with that!!  – that means they can only (usually) perform exactly the test that has been requested by the doctor on the form.  Even when they might think, oh they’re looking for ‘X’ and they’ve requested the wrong test, or taken the swab from the wrong place (see below) they can’t act autonomously and go perform the more appropriate or valid test.
  • Swabs ain’t swabs – many practitioners, unfortunately GPs included, don’t necessarily know the best location to swab for specific organisms, so for example a high vaginal swab is perfect for BV but hopeless for Chlamydia. Most patients are just getting the one site swabbed which means the infectious organisms could be easily missed
  • ‘No pathogens isolated’ ≠ no pathogens always  –  there are 7 reasons why the ‘pathogen’ might not have been identified by the lab, we need to improve the language we use when we request the culture, help the patient to be mindful of the collection technique and look for other secondary markers that offer more information about what’s really going on

I’m on a mission this year.  Determined to find out as much as possible about what goes on in the lab that would change the way we refer for tests and interpret their results.  So far, I’ve experienced a bit of a Culture Shock in relation to urine specimens, vaginal swabs and stool samples (mainstream MCS not CDSAs) and it’s going to radically change my practice. You can hear about all these pearls in our latest Update in Under 30 podcast called, Culture Shock! and stay tuned for more to come…as long as I can hold onto my new BFF ! 😉

‘Taking care down there‘, was recorded late last year as part of the Update in Under 30 podcast series, in which Rachel summarises new evidence about how to support and maintain vaginal eubiosis, along the way explaining the dramatic rise in vaginal dysbiotic presentations such as Bacterial Vaginosis, Candidiasis and Trichomonas. Covering explicit issues such as, ‘to douche or not to douche’, as well as why, just like in the gut, we need to refocus on a seed and feed approach with less emphasis on the weeding and how.  This is a very practical take on recognising vaginal microflora disturbance and knowing how to make lasting sustainable change in women caught in an unhealthy cycle.