Counter to…

I read an opinion piece today in the New York Times titled “How to Counter the Circus of Pseudoscience”.  As a practitioner of “pseudoscience” who aspires to go to medical school, many conflicting thoughts ran through my head, ranging from defensive to sympathetic.  The author is a medical doctor who is highly critical of naturopaths and Goop-inspired natural medicine.  Her main problem seemed to be the overconfidence of many “practitioners” (her quotation marks, not mine) in their scientifically questionable knowledge and methods.  While dismissing and invalidating the entire field of natural medicine and it’s “practitioners”, she also enthusiastically trumpets her own fields ability to reflect on their mistakes and know their limitations– “especially the good ones”.

What about the good practitioners of natural medicine?  Are they allowed to exist in this doctor’s paradigm?  Are we all quacks, with medical doctors alone holding the light to the afflictions of humanity?

What I found this author failed to acknowledge was a very common situation when a person goes to their doctor, and the doctor either can’t find anything medically wrong with them, or possibly even fails to address their needs.  It is here where natural or complementary medicine can be quite effective.  In my own practice over the years, I’ve seen many people with unresolved health problems, whose tests come back from their doctor negative, but who then find results through acupuncture and Chinese medicine.    Can I explain my treatment scientifically?  No, not completely.  Do people find relief from it?  Many times yes, and sometimes no.  And if I can’t help them after a couple of session, I refer then to someone who I think can, and suggest terminating the treatment.

Where I feel like this author went astray is her failure to recognize that people want help with their problems, and if doctors don’t have the softer tools to help them, they’ll look for someone who does.  Neither does she differentiate between natural health “practitioners” who are reckless with their belief that supplements and right living are cure-alls, and those of us who know the limits of our chosen medicine.  We do exist as a breed of natural medicine practitioners, who refer people back to their doctors, who don’t feel comfortable treating people without having the diagnostic testing to rule out more serious underlying conditions, who keep a vigilant eye out for red flags, and who are aware, for better and for worse, that the medicine that they practice isn’t and can’t necessarily be validated by science.

Like many in my field, I got into natural medicine because I wanted to help people, just like many M.Ds.  I thought natural medicine would make a good tool with which to partner with patients to find a preventive healthcare regiment that worked to keep them healthy, and would enable me to spend more time with patients than the average doctor.  I envisioned partnering with a patient’s primary care provider and any specialist they had to help keep track of the patient’s total wellness, each field complementing the others.  This was idealistic and somewhat naive of me, as that sometimes doesn’t even happen within the medical field itself.    So often, we find ourselves “counter to” the medical establishment, and the medical establishment often counters us.  But what if we worked with each other?

Opposition often breeds estrangement, resentment, and lack of trust.  The more the allopathic medical profession fails to see what natural medicine has to offer, the more natural medicine in inclined to dig in their heels and put blinders on.  What would things look like now, if instead of prescribing opioids as a blanket remedy for pain, doctors took the time to really investigate which types of pain issues tended to respond well to acupuncture, massage and chiropractic? What if instead of dismissing the entire natural medicine field as full of  “practitioners”, MDs, ARNPs, and PAs and nurses worked to find the ethical practitioners in the field?  Both fields have their bad eggs, but neither does itself or its patients any favors when it dismisses or downplays the other.

Grit and Your Health

 

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Angela Duckworth is a bit of a hero of mine.  Her book at TED talk on “grit”  has dramatically changed the way I look at myself and whether or not I’m “good” at something.

“Grit” is a funny word to stand in for tenacity, perseverance, determination and belief in oneself.  Before I came across her work, when I heard the word “grit”, I would think of sand in my swimsuit when I was a little kid, not a positive character attribute.  Now as someone who is trying to become “grittier”, the part of the word that implies an abrasive surface has become lessened.

As I’ve been thinking of grit recently, I’ve started to wonder about other applications for it than simply achievements.  What about grit in terms of health and healthcare?  What can patients, doctors, and other practitioners do to cultivate grit in the face of health concerns?

It’s easy when we’re told we have a health problem by a doctor or other medical provider to feel discouraged.  Why did it happen, we wonder, could it have been prevented, did we do something wrong?  It may feel like an affliction and cause us to feel depressed, or become an irritant that we try to ignore.  This may be part of the process of coming to terms with a health problem, but how can we as patients and practitioners shorten that time of grief and start building grit?

The way I’ve been thinking about it, “grit” in terms of a health problem is a steadfast determination to not remain limited by whatever condition you’re diagnosed with.  A condition like chronic pain can be extremely difficult to live with, and may lead people to depression and, as we’ve seen with the opioid epidemic, drug abuse.  We don’t want to have to deal with it, we want it gone.  However, this may not be realistic for everyone.   The road to minimizing pain in daily life may be long and arduous.  To deal with this optimally, multiple changes in how the pain is thought of may have to occur.  It may no longer be realistic to think of being entirely pain free.  Instead, days of minimal pain need to be appreciated for the relief that they are.  Multiple modalities of therapy may need to be consulted–physical therapists  and yoga to build up strength, massage and acupuncture for relaxing areas of tension and pain, and possibly even nutritionalists to make sure the body is being nourished in the way it needs.

Most of all, the spirit needs to be fed.  This may sound hokey, or possibly even new age-y, but it’s something essential in cultivating the belief that we as people in our bodies are worth working for.  In whatever spiritual context that fits most with an individual’s world view and paradigm, we need to tell ourselves that we can do it, that we have what it takes to make the most out of our lives whatever obstacle comes our way.  If we don’t have something that nourishes our spirit, it’s so easy to flag, to start off strong only to wind up feeling defeated.  To combat this, we need to find ways to inspire ourselves and keep our motivation going.  It’s a hard prescription, as its so individualized, but a necessary one.

Happiness?

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I think there is a general misconception about the state of happiness.

Here in the US, written into one of our founding documents, we find the phrase : “We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness.”

These words have had a profound effect on the psyche of our country.  While originally, as the phrasing implies, the word “happiness” meant more the pursuit of wealth and a good situation in life, it’s meaning has morphed as time has passed.  Now that many of us take finding a decent situation for granted, the meaning of “the pursuit of happiness” has become something less tangible, more of a state of mind than anything else.  We should be joyful, we think, it’s our right to feel happy most of the time.  We want to follow our bliss, find endless affirmations around us, employ positive thinking to attract what we want in life.  After all, “happiness” is our right.

The thing is, life in the world isn’t a streamlined experience.  If you expect conditions that are conducive to your happiness to be present all the time, you’re going to be let down.  Crappy things can happen out of the blue, “ruining” what may have started out a good day/week/month/year, regardless of the positive thinking you’ve employed.  Nature is not predictable, and rarely is thinking things will continue on as they are indefinitely a good long-term strategy.  I don’t mean to sound bleak or like a downer.  If you look at it scientifically, a static system is a dead system–we’re all meant to exist in a continual dance of finding equilibrium.

In less obvious ways, I think this “pursuit of happiness” can affect the way deal with our health, physical and emotional.  Rather than a long hard slog to feeling mostly alright with a few crappy days every now and then, we want our pathological symptoms to go away, the sooner the better.  We want to be cured from what ails us, to overcome our flaws and endlessly improve ourselves.  Then, maybe, we can start getting down the the business of being happy.

But what if happy is learning to work with those symptoms, of accepting our limitations, and within those confines, appreciating, if not loving, our strengths?  What if happiness is that moment we stop trying to be this glowing, radiant magazine cover version of ourselves and reinvest that energy inward to taking a good long look at ourselves and being ok with that, however messy?

I’ve lately started to re-work what I consider to be “happy”. Maybe this is odd, but personally, I’m not a big fan of feeing giddy happiness–it feels too fragile, like sumptuous dessert to be enjoyed only every so often.  I much prefer to feel a calm sense of resiliency, the feeling that regardless of what happens, good or bad, I’ll be able to assimilate and adapt as needed.  Happiness as an appreciation of inner strength.  That way if today happens to be a cruddy day, or if illness befalls me, it becomes less of a catastrophe or set back than something that I can deal with, moment by moment, without feeling like I’ve been pulled away from my previously happy state.

This is a work in progress, an aspiration, but it feels useful.  It gives the sense that, bar anything horrible, I’ll be ok, and that’s a good place to be.  And the thing is, most of us are already there, if we just let ourselves appreciate that fact.  We’ve got this.

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HALT SAD

“Winter is coming…”

I’m not a Game of Thrones fan, but I did watch the first season before the brutality and violence towards women turned me off.  One of the facts of the world that this author created is that winter comes only every so many years, but it also lasts for years.  Even as a Pacific Northwesterner, where the winters are more dreary than freezing cold, the thought of a winter that stretches for years is slightly horrifying.

Here, more than enduring months of subzero temperatures and having to protect ourselves from the dangers of frostbite or hypothermia, we have Seasonal Affective Disorder, or SAD.   Today, when I was thinking of SAD, another acronym popped into my head, one taught to me by my godmother, who happens to be a therapist: HALT, which stands for Hungry Angry Lonely Tired.  The acronym is there to help people remember that if they’re feeling any permutation of those four sensations, it’s probably a good idea to stop and check in with yourself  before you act on how you’re feeling right then and there.  It’s interesting to think of how SAD and HALT are linked.  Both have a central commonality, which is to forget how things are when we’re not in the current state we’re in.  So, for my breakdown of how to deal with SAD here in the grey Northwest winter, I’ll divide it into H A L T.

Hungry:

Winter is so often a time of comfort food.  We crave the warmth and insulation that starchy, carb-y, fatty foods give us.  While I don’t believe in stressing out too much about what we’re eating unless it’s a radically unhealthy diet (check out this article from the New York Times), it is a good idea to check yourself to make sure that some of those warm, nourishing comfort foods are well-balanced.  Warm salads and soups are a good way to get in the vegetables that we might get in the summer through a nice crunchy lettuce based salad.

Angry:

Taking care of your emotional self during the winter months is incredibly important.  When it’s cold and rainy outside, we’re less likely to go out and exercise, which can negatively impact our mood.  Though not really anger, depression can feel worse in the winter when it’s dark at 4 o’clock and the world outside the four walls of our home is uninviting.  Depression, anxiety, and other mood imbalances can throw off our reactions to the outside world, and we can be reactive in ways we’d otherwise be able to work through.  Seeking the appropriate therapy for this is essential to being able to actually enjoy the seasonal introversion that winter promotes.  Talk therapy, exercise, art, herbs, meditation, or drugs can all be helpful, depending on the severity of the mood disorder you’re experiencing.  Too often people put a stigma on seeking the level of help they need either from a therapist or taking the medication they need.

Lonely:

Ah, loneliness.  Even worse than the stigma asking for psychological help, admitting to loneliness, even to oneself, can be hard.   Human beings are a strange species, both trapped in the essential isolation of their own minds, while simultaneously being completely dependent on one another to care for each other.  The internet age has offered us the illusion of social contact via websites like Facebook or Twitter, but for many people, social media can also be a trigger.  This wonderful article from Psychology Today gives some excellent tips on how to deal with loneliness whenever it rears its sad face.

Tired:

The dark days of winter can make some want to hibernate, but be aware of any overall drops in energy levels.  Vitamin D deficiency here in the Pacific Northwest can be a real problem for people.  The lack of sun and being outside in the winter can deplete the levels you spent the summer building up, so make sure to talk to a healthcare practitioner about what dose of D.

Cold Season Prevention

 

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The weather patterns have been shifting these past few weeks, alternating between the last warm days of summer and the first long rains of fall.  As the temperatures vacillate, confusing our bodies, viruses start to make their rounds.

It can make a person feel helpless when they see their friends, family, and co-workers one after another succumbing to a particularly virulent strain of a cold or flu.  Unlike bacterial infections, there is little that can be done by conventional medicine for the temporary misery of a cold or flu.  Fortunately, this is where herbalism can excel–if you catch it on time!

The difficult and wonderful thing about Chinese medicine is that it weighs in the fundamental differences between people.  What works for me may not work for you, and so we need to pay close attention to what exactly the symptoms are when we very first start to feel a cold or flu knocking at our door.  The best time to reach for an herbal or natural remedy is the moment you notice you’re feeling a little off.  Take a minute to assess the sensations.  Are you a little chilled, and can’t seem to get warm?  Exhausted?  Does your nose tingle or throat feel scratchy?  Are you feeling flushed and uncomfortable?  Or are you alternating between hot and cold, with a clammy feeling?

While there are many Western and Chinese herbal remedies for colds, I want to focus on the more accessible and available remedies.  The easiest to find are the ones that you can buy in most supermarkets: echinacea tea and garlic.  Both can be effective, but especially with echinacea, timing is essential.  Echinacea should be used right when you first start to feel off.  If what you’re feeling progresses into an outright cold or flu, stop drinking it.

Raw garlic is my favorite cold and flu preventative, but it is a tough sell.  The spicy pungency of raw garlic can be tough on peoples taste buds and digestion, but it can do a world of good to knock a nascent cold or flu out the door.   My favorite thing to do is crush about three medium size cloves and wrap it in bread or cheese, or make my own pesto to insure the freshness of the raw garlic–basil also has it’s own healing properties.  For those who don’t do dairy or gluten, substitute bread and cheese with the savory treat of choice.  I do this three to four times a day if I’m feeling like I could get sick, and often it works.

The above two are more general remedies.  The next ones are specifically for when you feel chilled and can’t get warm.  Make a soup out of broth and miso paste, and add two raw chopped scallions to the soup.  Or, boil a pot of water and add 10 slices raw ginger.  Boil for 10-30 minutes.  Or, find a Chinese herbal remedy in pill, granule or raw herb form called Gui Zhi Tang and make as directed.  For all of the above, while you are drinking them, wrap yourself in a warm blanket while the heater is turned on until you break a mild sweat and no longer feel chilled.

If you’re feeling fatigued and on the verge of getting sick, or are going to take an airplane trip full of recycled air and germs, my favorite remedy isn’t one that you’ll find at the corner store.  It’s a Chinese herbal formula called Yu Ping Feng San.  It’s a fairly common Chinese formula, so if you’re lucky enough to live in a town with some well stocked herbalists, you might be able to come across this herbal formula in pill form.

If you’re flushed and uncomfortable, there is a Chinese herbal remedy that has a surprising popularity and tendency to pop up in natural food stores–Yin Qiao San.  While it’s advertised and sometimes used for all types of colds and flues, it’s meant more for the types where you feel hot with a scratchy throat.  Otherwise you may not find it as effective as you’d like!

If you’re pregnant, you might feel a bit wary of taking herbs, but still worried about getting sick.  Make sure you’re taking your prenatal vitamins and eating as healthfully as possible–though the latter applies to anyone wishing to keep from illness!  If you’re still curious about your herbal options, only one of the above mentioned herbal remedies, Gui Zhi Tang, is not advisable for pregnant women.  Yin Qiao San is not contraindicated, but neither would I recommend it if you’re pregnant.

If you have any questions, or would like further information, please, email me or consult your local herbalist.  Though the widespread availability of herbs makes it easy for anyone to self-prescribe remedies, for the best results, it’s helpful to talk to people who’ve spent some time studying the craft of herbalism.   Keep healthy and stay well!

Philosophy of health and healthcare

I’ve been thinking for a while about what the word “health” means.  As always, when wondering what’s behind a word, I consulted the dictionary for the first interpretation.  Mirriam-Webster defines health as: “the condition of being sound in body, mind, or spirit.”  The Oxford English Dictionary takes a slightly less holistic approach and defines it as: “The state of being free from illness or injury; A person’s mental or physical condition.”  The root of the word is of Germanic origin, having migrated over to the English centuries ago as “hǣlth”, and is related to the word for “whole”.  This seems more like it.

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The thing is that like defining “happiness”, it becomes a little dicey when applying it to individuals.  In college I took a lot of philosophy, and one day in class we were discussing happiness or the good life in terms of the Epicureans.  The modern usage of the word “epicurean” is often used to mean someone of cultivated tastes who appreciates the finer things, especially as pertaining to food and drink, and can run close to hedonism.  This is far from the intention of the Greek philosopher Epicurus, who, while placing pleasure high on the list of what constitutes the good life, also preached a gospel of everyday temperance, advocating that his followers drink watery beer and porridge as their main sustenance.  This would make it so that when one did have good food or drink, it would taste all the better.

My argument in the class was is that this isn’t the good or happy life for all people.  Some people might be miserable eating porridge every day, and the rare occasions when they didn’t eat it they might be even unhappier for thinking that they would have to go back to porridge.  For whatever reason, my classmates weren’t buying it at the time, but as I’ve gotten older, it seems all the truer.  Each person has their own life paradigm: their core set of beliefs, what makes them happy, and how they choose to live their life.   What I’ve realized as a healthcare provider is that this extends to what constitutes “health”.  For some people, it’s worth it to do something typically regarded as “unhealthy” because of what it brings to their life.

Going back to the root of the word, what makes us healthy is what makes us whole.  Healthiness is being at peace with your body, mind and spirit.  Whatever brings you more in alignment with that should be taken in mind as a key component of your health, even if it’s outside of what a more common definition of “healthy” looks like.  If it’s something that isn’t good for your body to function long term but it brings you joy, the pros and cons should be carefully weighed out without value judgement.  It’s better to examine carefully what is going to bring us closer to an individual feeling of wholeness rather than dismiss it because it doesn’t fit into the mainstream paradigm.  It is up to both patient and provider to hold that seeming paradox, and to make a plan for wellness that is realistic and aims to optimize the patient’s overall health while accommodating for their life paradigm.

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Precious sleep

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I was listening to someone talk about their sleep issues yesterday.  They were speaking about the aches and pains they experienced at night, about how their sleep was shallow and frequently disturbed, and how they went to bed rather later than they should.  Since I wasn’t their practitioner, I only had once question, poised to satisfy my curiosity: did they have a screen in their bedroom?  Yes, she replied, they usually watch TV before bed, and that’s why she goes to sleep so late.

For people with chronic sleep issues, it can be hard to uproot old habits.  Still, what is known as “sleep hygiene” is scientifically proven to help improve sleep.  The Division of Sleep Medicine at Harvard Medical School has published this list of simple things you can do to improve your sleep.   This includes, among many things, removing screens from the bedroom and taking the time to wind down with quiet activities before you go to your bed, making sure you’re fully tired and ready for sleep.

I’m well aware, however, that what seem like easy changes can incredibly difficult to implement.  We’re creatures of habit, even if those habits are maladaptive.  Sometimes, before we implement any change, we have to just think about it, ponder what it might mean for our lifestyle, see how it sits with us, and feel comfortable with it on our own terms.  It can feel invasive when someone else tells you how to live your life, and as a healthcare practitioner, I often need to remember this and step back, respecting that everyone has their own way of doing things.

Sleep hygiene is a good way to set up your pre-bedtime routine, but what about those of us who wake up in the middle of the night and find themselves unable to fall back asleep?   Insomnia, meet the audiobook.  Audiobooks can be a great way to help lull the reluctant sleeper back into slumber.  However, there’s a catch.  The book must be a familiar one, something you’ve read or listened to before, and that won’t engross you.  I used to watch “Spirited Away” every night before bed.  Yes, I was disobeying my own rules about screens, but eventually I stopped watching it and just started telling myself the story of the movie, and this helped my brain switch off from thinking.  Audiobooks are a way of doing the same thing.  You’re able to keep the room dark and quiet, not switching on the light and opening a book, which can serve to wake you up further.  Find a comforting and familiar story, like the first book of Harry Potter, Huckleberry Finn, and the like, or something slightly meandering like Moby Dick, and listen to it.  When you find yourself drifting off, turn it off and often times you’ll drift off.  If not, put back on the headphones and listen a little longer.

Sleep is one of the most important things we need to stay healthy.  If you’re having trouble sleeping, one of the best things you can do for yourself is spend some time figuring out something that works for you.  It can be tricky, and take some time, but it’s worth it.  If you need someone to help you troubleshoot it, make an appointment with a sleep specialist or a healthcare provider that you think might have some insight and won’t immediately reach for the Ambien.  Sleep medications are fine short-term solutions, but many lead to dependance.  When habit and routine are so much a part of a good nights sleep, sleep meds can easily become part of that routine, and weaning off of them is painful, sometimes near impossible.

Whatever you do before bed, I wish you a calm mind and tired body.  Sweet dreams.