Business Breakthrough Sessions with Rachel

Business Mentoring Breakthrough Session

Have you ever wondered what is the best way to grow your business? Not a cardboard cut-out, off-the-shelf kind of business that every business coach talks to, or somebody else’s business, your business?  Business advice like naturopathy, according to Rachel, is about taking an individualised approach.

The traditional model of a naturopath was based on a one on one clinical practice model, while potentially still a path to success and satisfaction, this requires a totally fresh and contemporary perspective on what works today.  In addition to this, many naturopaths feel a need to diversify their revenue stream in order to work smarter not harder.  The naturopathic path is not always conventional and rarely the same for any two practitioners depending on personality, location, skill sets (including non-naturopathic), passion etc.

Rachel gets it. (more…)

What Does the new RACGP Guideline re Naturopathic Requests Mean?

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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…)

When I Would Give Withania A Miss

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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…)

New Insights into Vulvovaginitis: Getting Species Specific & Sex Hormone Savvy

 

No matter how long I am in practise there is always a group of patients for whom ‘vaginal thrush’ is a major problem.  Most of us have some fabulous tricks up our sleeves to help resolve these issues & reduce their susceptibility – intravaginal lactulose is one of mine thanks to Jason Hawrelak.  And then you come across those clients who vigilantly do every thing you ask them to and yet you fail to completely resolve the issue. Doh!

One of the most important things to do with all clients presenting with ‘thrush’ sooner rather than later is send them STAT (!) for a vaginal swab.

Not only does this clarify if it is in fact actually thrush (2/3 of self-diagnosed women get it wrong according to research!)  but better again it names the actual culprit.  It may come as a surprise but not all vulvovaginitis is due to Candida albicans – increasingly they are the result of other Candida species and this is something you absolutely need to know.

During a recent mentoring session, a practitioner wanted to better understand why she had a group of patients whose thrush seemed so resistant to her usually successful treatment.   Here’s my initial response in a nutshell… (more…)

Is Your Rep a Good Rep?

 

Recently a practitioner lamented that because of her clinic location she didn’t see company reps very often & felt this was a barrier to her staying current with her clinical knowledge.  Of course, I had to beg to differ.

We’re quick to judge the medical profession for their reliance on commercial sources of CPD, overwhelmingly provided of course by the ‘drug reps’ but it seems we’re less fazed or concerned about ourselves being equally reliant, unduly influenced and misguided (might I add) by the people employed by the CAM manufacturers expressly to encourage us to sell more of their products! How does that make sense? 

I go back to my very repetitive mantra: always be mindful of who delivers you the message/information etc. and what their agenda is.

By promoting their company’s products to us, focusing on the products’ strengths, ignoring or simply not making it a priority to know the limitations or weaknesses of the products or the evidence, ignoring or again simply not making it their business to know when superior products are being produced by competitors or when new evidence comes to light that puts into question their products, reps are only doing what they’re employed to do.  But is it helpful and is it ok? (more…)

Avoiding Overwhelm In Clinic

So…a 40 something female walks into your clinic with depression & anxiety…sounds common enough right?  But here’s the twist: she’s already seen another practitioner who ran a range of investigations revealing she has pyrroles, high copper levels & is homozygous for the C677T MTHFR mutation. Her medical history includes significant use of Ecstasy and a partial thyroidectomy due to nodules & she has persistently high TSH.  But wait there’s more!…The first practitioner upon discovering all of this put the patient on 12 different products which included zinc, B6, evening primrose oil, vitamin D, thyroid support etc etc.  And guess what…the patient feels worse!

Frequently our patients are just as complex as this case & sometimes our attempts to narrow the treatment focus through thorough investigation instead leaves us feeling we now have even more things we need to deal with than before! Feeling overwhelmed?? Often! At risk of completely overwhelming the client as well?  Definitely!  And a reflex to throw your whole dispensary at a client never ends well. (more…)

Iodine Excess in Action

 

I’m only human & there are some questions that do make me silently groan & invisibly (I hope!) roll my eyes.  One is the old chestnut:  “but the Japanese consume on average 7mg of iodine a day!” which is typically offered up as a rationale for the need for mega dosing of iodine in everyone.  This is of course only a partial truth & the missing bits make all the difference!  The Japanese have some of the highest rates of thyroid disease in the world & this is in part, attributed to their high iodine exposure.  Secondly, it’s simplistic & flawed to isolate one characteristic of a whole diet & not appreciate that its effect or impact is mitigated by the context of the entire diet & lifestyle of that population.  In the case of the Japanese, for example, this includes relatively intake of isoflavones, key goitrogens which will reduce the bioavailability of the iodine both within the gut & at the thyroid. Harrumph!  I love iodine & am frequently suspicious of a deficiency in my clients, however, like many nutrients feel that our ultimate objective is for optimal nutrition…not excessive.

Am I just a conservative scaredy cat perpetuating fear around this topic in the industry?  Well…..no.  There is accumulating international evidence of big spikes in autoimmune thyroid disease diagnoses following the introduction of iodine fortification programs in previously iodine deficient countries such as Greece, Turkey & Brazil.  There is of course evidence as well that iodine supplementation in Grave’s & Hashimoto’s disease can lead to delayed recovery or worsening of the condition. (more…)

Bad Patient Days (BPDs)

I was chatting with a colleague today about a complicated & interesting case of hers, severe hypothyroidism coupled with overt hypercortisolemia (salivary cortisol up to 230!).  This is a distance patient & she’s sharing care with a couple of other health professionals with conflicting ideas…tricky!!

So when my friend received an email last week to the tune of… “things are bad, everything is terrible if not worse”, then naturally she starts worrying: What has she missed? What’s gone wrong?  What more could/should she have done? Is this some sort of aggravation to the treatment she’s recommended?

This is the place our minds naturally go when faced with these scenarios however one of the things I have really learned over years in clinic is that patients, like me, like everyone else I know, are labile, in the moment kind of creatures & we’re all vulnerable to having BPDs. (more…)

What Do You Do For Post-Partum Hashimoto’s Thyroiditis?

 

Like all thyroid disease, post-partum thyroid conditions seem to be on the rise – and often they rewrite the rule book when it comes to thyroid pathology & its management. Therefore for many of us it can add an extra element of uncertainty about how to help these clients.

One of our graduate practitioners has a great example of this, a 33yo female who developed late gestational diabetes and is now struggling with a new baby and an autoimmune thyroid disease!  What would you do?  Does post-partum thyroiditis have unique triggers/drivers that require specific treatment? What can you/should you be doing differently because she is still breastfeeding?  What’s the likely progression/prognosis?

This is your invitation to come along and find out the answers to these questions and more.  During our live graduate mentoring session on Monday 15th June at 3.30pm AEST we’ll work through all aspects of the case, from history to presentation and from looking for clues in her pathology results to where to start with treatment. (more…)

Do We Need to Relearn Something Old about Addressing Iron Deficiency?

 

These days it seems like patients can almost be divided into two groups: those that have a tendency to iron overload and those that struggle most of their lives just to keep ferritin in the red…and what a struggle it can be. So many clients have spent years taking every form of iron there is in high doses, trying to improve their intake of dietary sources, working on their digestion etc etc but still those numbers can fail to really pick up. (more…)

Top 10 Investigations in Mental Health Patients

One of the most common questions I’m asked is whether I have a ‘set list’ of tests that I request for every patient.  Of course there is no ‘one size fits all’ in health & each patient presents with their own novel combination of issues & investigative challenges, however, years of clinical experience have taught me which pathology parameters are the most clinically meaningful.

Asking yourself, ‘Will the results of this test determine my thoughts about treatment & therefore ultimately the clinical outcome for my patient?’, before referring for any investigation is a good habit to get into.

Many of us are increasingly aware of the changing environment around pathology testing, which includes reduced access to some tests in mainstream pathology.  Rbc folate has had its subsidy withdrawn which means if we request this we’re now likely to receive a serum value or nothing.  But does this matter? (more…)

Learning the Language of Men’s Endocrine Health

 

We should all be as skilled in investigating & treating male hormone imbalances as we are female ones, yet this is often not the case.  A lack of confidence in this area, which seems to be an issue for many, in particular will compromise our ability to question male clients comprehensively and effectively about their reproductive health and ultimately reduce our capacity for making good clinical decisions and achieving the best outcomes for them.  If you’re female, how would you feel seeing a male practitioner who doesn’t ask you about your menstrual cycle in detail?

Many of us are at risk of committing similar crimes but we need not be. (more…)

Managing Your Random-Regulars

So often in mentoring I hear about patients practitioners have struggled to treat primarily because of irregular points of contact….you know the type, the client who is an Irregular Regular or Random Regular, booking in to see you just once or twice a year or just in acute situations & never doing the follow-up you so want them to do, in order to address the real underpinning causes.  A case I heard the other day would sound familiar to many of us, about a patient who saw the practitioner only when she experienced cramping.  Each time she’d have an appointment, buy some magnesium which relieved the issue and then disappear again, only to re-emerge with the same issue at a later time.  During one of these subsequent visits, the patient mentioned that she was ‘exhausted’.  Following the practitioner’s insistence that the patient bring in any pathology she had had done, the practitioner realises much to her horror, the patient has been suffering from macrocytic anaemia for some years but no one had bothered to tell the patient and accordingly, the practitioner has been none the wiser as well.  The practitioner of course felt terrible because she’s thorough and conscientious but is she to blame?  Where does the patient’s autonomy end and the practitioner’s duty of care begin?

Sometimes patients themselves can be a big barrier to their own wellness for all sorts of reasons and we can’t always resolve this but perhaps we need to consider introducing clinic protocols to try and better manage the Irregular Regulars.   (more…)

A Great Time To Be A New Practitioner

“Health issues are rarely one individual textbook condition like they were during my studies.  The interaction of the body is complex, and Rachel has given me valuable insight into how to link various pathology markers & physical aspects together.  Test interpretation has been a huge focus for me.  The letters and numbers now mean something, and I can work with “true” reference ranges, and see how different values affect others. The sessions have been great to get assistance with cases and learn how to break things down & prioritise treatment, and also to connect with other practitioners, and hear their cases as well.   I really feel like my career has received an invaluable leg up, and I’m so thankful for Rachel’s knowledge and assistance.”

Rohan Smith, Graduate Group Mentoring Participant, Adelaide.

We began our Graduate/New Practitioner Group Mentoring sessions in March 2014 with just a few keen newbies but the sessions have gone from strength to strength since then, with an ever-growing group of new graduates participating in case presentations every month.  Every session I’m reminded that people are now graduating with much more sophisticated knowledge than I did.  Not because the education standards have improved (ouch!) but actually because the research-backed knowledge base of our whole industry has progressed & improved so dramatically… & that is really exciting & changing the marketplace for all of us.  (more…)

Do you mind if I record our appointment?

I read an interesting news item in Medical Observer this week about the increasing number of patients either overtly or covertly recording medical appointments on their smart phones.  Have some of your patients already asked if they could do this?  Mine have and I’m also aware of some patients getting into hot water when asking their ‘old-school’ medical specialists if they could do the same thing. For me, I have always understood the patient’s desire to do this, as the information they’re being given might be complex, considered critical and they may need to hear it several times in order to grasp the details, instructions etc. In other situations I’ve experienced it’s because the patient needs someone else, who couldn’t be present at the appointment, to hear the discussion ‘firsthand’ e.g. another parent, a partner.  In my mind this all makes good sense.  Does it make me speak differently, think more carefully about my words etc…You bet it does!  (more…)

The Sleep Prescription

How often do you find yourself writing sleep prescriptions for your patients?  I do – frequently. I’ll include in my recommendations something like – ‘nap for 20 minutes every alternate day’ or, ‘commit to getting into bed 1 hour earlier 3 nights this week’ or ‘establish a bedtime routine for yourself – something that loosely follows the winning formula of bath, book, bed’.

You see I reckon we humans have tricked ourselves into thinking we can negotiate our way out of almost everything: good food choices, adequate clean water, perpetual motion etc. I mean often people come to us looking for the shortcut let’s be honest…e.g.  “I’m not great with the food side so what should I be taking??”

But when it comes to matters of slumber I explain to my patients that sleep sufficiency (both quantitatively & qualitatively) is non-negotiable in the health equation. To put it another way, sufficient sleep is Wellbeing 101, step 1! 

I don’t have anything I can prescribe that can make up for a shortfall…seriously…just a prescription for more sleep!

(more…)

What to make of long-term low CRP

Ever had those patients… young, slim, fit…I won’t go so far as to say ‘well’ or otherwise they probably wouldn’t be seeing us right?  But not overtly inflamed and yet when you measure their CRP, it registers.  The average CRP of ‘healthy’ adult populations is reported to be between 1 and 3 mg/L but we know that even values within this range positively correlate with long-term CVD risk and most of us believe that unless there’s a good reason for immune activation at the time of the test, we’d like to see values < 1mg/L.

I saw one of my patients who fits this bill just the other day – an updated CRP and there it was again bubbling away at 1mg/L.  This guy is young (20s), slim (BMI of 19 kg/m2), non-smoker (another classic driver of this sort of brewing CRP), doesn’t report any acute illness e.g. URTI, at the time of each test (we would expect a much higher value with this anyway)…so why is there any CRP?  (more…)

PCOS families – are your male patients affected?

We now suspect that many of the drivers behind PCOS are heritable components – a genetic vulnerability passed from parents, possibly one but often both. This growing understanding has identified a phenomenon referred to as ‘PCOS families’ i.e. a family in which at least one female has confirmed PCOS.

Being a primary biological relative of someone with PCOS, it would seem, suggests a shared risk, even if you are a son, or brother or father. 

So beyond the very high rates of undiagnosed PCOS in sisters of someone already diagnosed, there is much talk now about a male PCOS phenotype equivalent. (more…)

End of Year CD Clearance

As we head rapidly towards the change over of our calendars we would like to offer you a special on the very best educational recordings from 2014 – buy 2 CDs before Jan 31st and receive one complimentary Premium Audio Recording of your choice  OR purchase 4 CDs and receive a 3 month Premium Audio subscription for free

It’s been a busy year during which Rachel has delivered 7 very successful new seminars in the area of mental health and  beyond, most notably fortifying her role as a leader in the field of diagnostics and pathology interpretation.  This has included collaborations with ACNEM, Biomedica, Health Masters Live, MINDD and Nutrition Care, however, each recording is classic Rachel – full of fresh perspectives on diagnosis & treatment, colourful analogies  & humour.  In case you missed some of these this year or want a copy for keeps – here’s a quick summary of the 2014 recordings included in this end of year offer: (more…)

Recognising A Tendency to Iron Overload Earlier

We’ve just had another mentoring case in which a 40 something female with deficiencies of almost all other minerals but ‘pretty normal ferritin levels’  presented with a range of endocrine problems and arthralgia.  Sounds as if iron’s not the problem right?  Except that in this case her iron studies also tell us that her transferrin saturation % on last check was 48%.  The diagnostic criteria for hereditary haemachromatosis  (HH) necessitates elevated ferritin – to indicate that the iron stores are reaching saturation, however, while this becomes evident at relatively young ages in men (20s-40s), who have no specific excretory pathway for iron, is this still appropriate in menstruating female, whose monthly periods may mask the HH tendency with regard to ferritin?  I’m guessing you know what my answer is already! 😉

Some would argue that HH, in spite of being an inherited disorder, is only clinically meaningful once the ferritin is elevated ( earlier and more potent elevations are seen in people possessing the C282Y genotype) but again this is very much up for debate in the current scientific literature, with a lot of research concluding that the transferrin saturation (also referred to as the transferrin ratio) being an important prognostic indicator for various chronic diseases including CVD.

When we go back to basics and remember the higher the transferrin percentage the more iron is being delivered to tissues around the body (whether they like/want it or not! so we refer to this as being ‘iron dumping’) and the higher the serum iron, the more unbound iron is in the system – a key source of oxidative stress..it becomes patently clear that these two parameters are important early warning signs of a tendency to iron overload, increased risk of heavy metal toxicity and already active mineral imbalance.  So in future keep your eyes open for women with fasting transferrin saturation values that consistently sit above 35% and men, > 40% and if you do see a series of suspicious values – consider the genotype test through mainstream labs.