Heartburn & Heartbeats Reversing Stage 3 Kidney Disease

NATUROPATHIC NEWS WNC Update: Naturopathic Medicine NATUROPATHIC DOCTOR NEWS & REVIEW in the Western Pacific Region ...... >>9 VOLUME 14 ISSUE 4 APRIL 2018 | AUTOIMMUNE / ALLERGY MEDICINE Jon Wardle, ND, PhD Naturopathic medicine is thriving in Western Pacific countries. Dr Wardle explains. Tolle Totum EDUCATION Medical Resources for NDs: A Review of Current Publications Reversing Stage 3 for the Naturopathic Industry ...... >>12 Alethea Fleming, ND Dr Fleming describes the first in a series of herbal Kidney Disease textbooks by Dr Jill Stansbury. Collaborative Teaching & Learning: A Case Study What Mary Goggins Taught ...... >>26 David J. Schleich, PhD Teachers and students can learn a lot about team SHAWNA EISCHENS, ND power of the body to repair itself when work from a 6th grade Irish teacher. provided with the proper conditions to Why is my urine frothy? do so. I was confident and hopeful for What can I do to help my kidneys from this particular patient because he had VIS MEDICATRIX NATURAE being damaged even further? already shown a level of commitment Diverticulitis: Naturopathic Care ...... >>13 What is the cause of protein in my urine? by drastically changing his diet. When Mona Morstein, ND patients are invested in their health, I The vast majority of diverticulitis patients can be successfully treated naturopathically. “ ohn” had asked previous physicians have more confidence and trust in the Jthese questions but had received no body’s ability to heal. helpful or hopeful answers. This patient NATUROPATHIC walked into my office on 8 medications, Background PERSPECTIVE frustrated with his medical team, and This patient is one of the more than Traumatic Brain Injury: scared that death was imminent. 30 million people in the United States Clinical Applications & “Is there anything you can do to help diagnosed with type 2 diabetes mellitus Plausible Interventions ...... >>16 my kidneys and reverse my diabetes?” (T2DM), which accounts for 90-95% of all Cora Stover, ND he asked. types of diabetes.1 In 2015, according to the Diana Zitserman, ND “Of course there is!” I said with CDC, an estimated 1.5 million new cases of Radley Ramdhan excitement, knowing the incredible diabetes were diagnosed among US adults This article details the pathophysiology and naturopathic treatment options for TBI. Continued on page 3 DOCERE st Student Scholarship – 1 Place Research Review Sleep-Disordered Breathing: An Under-recognized Cause of Chronic Disease – Part 2 ...... >>19 David Nortman, ND Heartburn & Heartbeats In Part 2 of his article, Dr Nortman outlines workup Exploring GERD & Atrial Fibrillation and treatment options for SDBs. TOLLE TOTUM Lyme Disease: ANDREW HUBBARD, BSC (HONS) the topic remains rather elusive in both risk of thromboembolic events such as A Whole-Person Approach ...... >>21 ELLEN WONG, BSC (HONS), ND conventional and alternative healthcare stroke, and are often thus relegated to Darin Ingels, ND discussions. Thus, the aim of this paper life-long treatment with anticoagulant The conventional approach to Lyme has pitfalls. trial Fibrillation (AF) is the most is to review these conditions and shed medications.8 AF is associated with heart Here is a better way to manage the disease. Acommonly diagnosed heart light on their connection, discuss what failure, is an independent risk factor for arrhythmia in America.1,2 Most causes mechanisms might be involved, and to early death, and is a significant detriment NATURE CURE are of cardiovascular origin and include evaluate effectiveness and suitability of the to quality of life.8 CLINICAL PEARLS hypertension, coronary artery disease, and current medical treatments. We will also The prevalence of AF in the general A Century After the Spanish Flu ...... >>23 cardiac valve disorders; however, the list discuss how the naturopathic doctor can population is estimated at 1-2% but Sussanna Czeranko, ND, BBE of non-cardiac causes, such as obstructive play a vital role in identifying and treating increases in patients over the age of 60.2 Important lessons can be learned from the 1918 sleep apnea, chronic obstructive patients affected with these conditions Risk factors for AF include but are not Spanish Flu about how not to treat influenza. pulmonary disease (COPD) and electrolyte using non-pharmacologic means. limited to: age, male gender, smoking, 2 imbalances, appears to be increasing. Most hypertension, obesity, obstructive sleep NDNR.COM recently, gastroesophageal reflux disease Atrial Fibrillation apnea (OSA), and cardiac valve defects.5 (GERD) has emerged as a significant Atrial fibrillation is an irregular Patients with AF may be asymptomatic, Register online to read web-only content and access archives. non-cardiac contributor to AF.3,4,5 Equally, heart rhythm that stems from an or they may have brief (paroxysmal) AF and its subsequent treatment may uncoordinated contraction, or “quiver,” episodes of fatigue and an irregular also play a role in the development of of the atrial chambers. This leads to heartbeat. They may also present to GERD, further strengthening suspicions ineffective blood pumping within the the ER with more alarming features, of a bi-directional phenomenon.6,7 heart, which puts additional stress on the such as syncope, tachycardia, and chest Additionally, a large body of research ventricles.2 As clot formation often occurs pain.2 Patients are often treated with has been conducted investigating the in the setting of stagnant and inefficient antiarrhythmic and anticoagulant drugs or potential gastric-cardiac connection with blood pumping within the heart, undergo radiofrequency catheter ablation respect to GERD and AF. Despite this, patients with AF are at an increased Continued on page 6 Available online at ndnr.com

Naturopathic Doctor News & Review PO Box 2968 Scottsdale, AZ 85252-2968 Phone 888.627.8677 Fax 480.275.7712 www.ndnr.com CME

- MD, ND, DC Methylation INTEGRATING METHYLATION 2018 Summit INTO CLINICAL TREATMENT PLANS

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Are your toughest to treat patients not improving even while following your standard successful treatment protocol? Do you wonder why some patients improve while others do not? Why do so many patients experience such difficult Herxheimer reactions? Why can some patients not overcome detoxification challenges?

Matthew Pratt-Hyatt, PhD Think Methylation. Dysfunctional methylation impairs the body’s detoxification process, and it may be the answer to the aforementioned questions. Beyond methylation genetics, many Nicole Bijslma, ND, LAc otherwise “healthy” patients experience methylation issues. This widespread problem is a result of the environmental impact on our methylation pathways, and it impacts a significant number of your patients and the general population. Whatever the cause(s), understanding why it is happening AND how to fix it is essential. Effective treatment goes way beyond just adding methylated B vitamins.

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1:00-1:30 PM Carolyn Ledowsky, ND Why is methylation so important. What is it we do? 1:30-2:15 PM Debby Hamilton, MD, MPH Environmental Toxins and infections in Autism 2:15-2:30PM Panel: Carolyn Ledowsky, ND & Questions Andrew Rostenberg, DC Debby Hamilton, MD, MPH 2:30-3:00 PM BREAK Carrie Jones, ND 3:00-3:45 PM Andrew Rostenberg, PhD Genetic Roots of Stress and Anxiety. How the gut affects your mood. 3:45-4:15 PM Andrew Rostenberg, PhD Gut Case Studies 4:15-5:00 PM Nicole Bijslma, ND, LAc Endocrine Disrupting hormones – Who’s at risk? 5:00-5:15 PM Panel: N. Biljsma, ND, LAc Questions 5:15 PM Carolyn Ledowsky, ND Close

Stephanie Seneff, PhD Saturday July 14, 2018 8:00-8:45 AM Carolyn Ledowsky, ND Genetic SNP’s that affect susceptibility to environmental toxins Carolyn Ledowsky, ND 8:45-9:30 AM Sara Wood, ND Organophosphate and Endocrine Disrupters How to Test & Director of MTHFR Evaluate - Case Studies & Treatment Support Australia 9:30-9:45 AM Sara Wood, ND & Questions Carolyn Ledowsky, ND 9:45-10:45 AM Carolyn Ledowsky, ND Pathway planner & Case studies 10:45-11:15 AM MORNING BREAK 11:15-12:30 PM Matthew Pratt-Hyatt, PhD Organic Acids Evaluation and methylation insights Sara Wood, ND 12:30-12:45 PM Matthew Pratt-Hyatt, PhD Questions 12:45-1:45 PM LUNCH 1:45-2:30 PM Andrew Rostenberg, DC Organic Acids Case Studies (RECORDING) 2:30-3:15 PM David Quig, PhD What is Awry in Essential Methionine and Folate Metabolism Register Early & Save! 3:15-3:30 PM David Quig, PhD Questions 3:30-4:00 PM AFTERNOON BREAK Early Bird Special: 4:00-4:45 PM Carrie Jones, ND, MPH When Hormones, Organic Acids and Genetics Collide: How to Before May 31, 2018: $449 put the puzzle pieces of testing together. 4:45- 5:00 PM Carrie Jones, ND, MPH Questions After May 31, 2018: $549 5.00pm Close Price includes Pre-Conference Methylation Basics Online course, Saturday breakfast & lunch, Sunday breakfast. Sunday July 15, 2018 8:00-9:30 AM Carolyn Ledowsky, ND & Other environmental factors – heavy metals, viruses, lyme, Nicole Bijslma, ND, LAc mold, vaccines, diet. Who’s susceptible Educational grants from: 9:30-9:45 AM Questions: Carolyn Ledowsky, ND & Nicole Bijslma, ND, LAc 9:45-10:45 AM Stephanie Seneff, PhD Glyphosate disruption of methylation (VIA DIRECT LINK LIVE) 10:45-11:00 AM Questions: Stephanie Seneff, PhD 11:00 - 11:30 AM MORNING BREAK 11:30-12:15 PM Carolyn Ledowsky, ND GlyphosateGenetic SNP's and case studies 12:15- 1:00 PM Carolyn Ledowsky, ND Putting it all together for patient assessment– where to start? 1:00 PM Close

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Continued from top of page 1 18 years and older.1 The total estimated people with diabetes include the following: annual cost of diagnosed diabetes in the • Diet: Small changes can have profound ONLINE EDITORIAL EXCLUSIVES United States in 2012 was $245 billion, with effects. Patients may do best with medical expenditures being approximately drastic changes to their current routine, 2.3 times higher than expenditures would yet many patients report feeling Student Scholarship – be in the absence of diabetes.2 Diabetes has overwhelmed at the thought of an 2nd Place been listed as the seventh leading cause of overnight diet overhaul. Educating and 2nd Place Case Study – death, yet the following statistics show that inspiring patients to make multiple, diabetes is strongly correlated with heart small changes – versus scaring them IBS with Obesity Justin Wise, CA, B Comm disease, the #1 leading cause of death: that they can never enjoy a dessert Peter K. Raisanen, NMD, BSc • At least 68% of diabetics age 65 or again – can have a more beneficial Remarkably simple measures resolve a longstanding case older die from some form of heart effect long-term. People are often of obesity and irritable bowel. disease3 shocked to learn that milk, beans, bread, • Adults with diabetes are 2-4 times more potatoes, tortillas, and fruit can have Tolle Causam likely to die from heart disease than a detrimental effect on blood sugar Autoimmune Disease: adults without diabetes3 levels. Encouraging consumption of • Diabetes is listed as the only cause of low-carb, nutrient-rich foods with .com The Role of Gut Bacteria Want more? Check online at Keegan Sheridan, ND death for 79 535 people, yet more than plentiful antioxidants can help heal ndnr.com for these editorial Gut bugs play critical roles in both the pathogenesis and triple that number of people (252 806) the entire person. These include green, exclusives, our mega updated prevention of autoimmunity. have diabetes listed as an underlying leafy and cruciferous vegetables; wild calendar, and so much more. or contributing cause on their death fish such as salmon; organic, grass-fed/ certificates1 finished meat; green tea; and turmeric. Eggs, walnuts, almond butter, flax cells’ sensitivity to insulin.4 The typical concurrent diagnoses with T2DM Regardless of these staggering statistics, seeds, pumpkin seeds, and cheese may body’s natural response is to produce of hyperlipidemia and hypertension were we know that unregulated blood sugar also be beneficial for someone with less leptin and more ghrelin, leading also part of his medical history. Without an levels have detrimental consequences for hyperglycemia. to increased hunger, especially for ideal comparison of urine microalbumin patients’ health and national healthcare • Exercise: Daily movement is key! A carbohydrates.4 Inadequate sleep levels, there wasn’t enough information costs. Medications can help decrease vigorous walk after dinner, bouncing also contributes to elevated cortisol,4 for confirmation; however, according hyperglycemia, which is essential for on a rebounder while watching TV, which can increase glucose and to KDIGO (Kidney Disease: Improving overall health, but they tend to come with or strength-training alternating with contribute to insulin resistance, all Global Outcomes) guidelines, this patient harmful and comprehensive side effects. jumping jacks or dynamic planks for of which are counterproductive in appeared to be in the “high risk” G3bA1 or Medications are not curative, are not ideal high-intensity interval training, are patients with diabetes. G3bA2 kidney disease category. Regardless for health restoration, and tend to instill just a few ideas. Resistance exercise is of his specific diagnosis, the sequela of a dependent, disempowering mentality ideal, as it burns 19 times more glucose Case Study kidney disease the previous summer based on a false sense of security. The road compared to aerobic exercise.4 John, a 62-year-old Caucasian male, came as a worrisome shock to him, and to curing or reversing T2DM requires more • Sleep: Less than 5 hours of sleep per presented in my office after being given a he implemented a drastic dietary change than medications alone. Reversal of any night has been shown to increase a diagnosis of T2DM within the previous 12 immediately upon hearing these findings. disease process requires an investment person’s risk of obesity by 235%.4 months. Diagnosed as pre-diabetic in 2010, John reported his previous health in personal health and a commitment to Sleep deprivation leads to a decrease he likely had uncontrolled hyperglycemia history to include excess weight since lifestyle changes. Foundations of health for in both insulin sensitivity and fat for many months, or even years. The childhood, as well as rosacea, depression,

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anxiety, right-sided renal calculi, and acid chocolate, soda, and cookies, had recently 31 years for acid reflux Acetaminophen is not recommended for reflux. His current health history included and drastically changed to exclude these 4. G Metformin HCL 1000 mg twice daily people with kidney or liver impairment. cataracts, bilateral hand tremors, leg foods, in addition to potatoes and grains. for T2DM This patient’s poor kidney function likely cramps, insomnia, and some occasional He began eating more salads, cheese, fish, 5. R Glipizide XL 10 mg twice daily for put him at additional risk for such side mild, bilateral neuropathy that he steak, and vegetables, while sticking to T2DM effects. described as “itching” or “like wearing his routine of 2 meals a day. He had lost 6. R Sitagliptin 50 mg for T2DM Additionally, various statins had been socks” on his feet. 25 pounds, with little to no exercise in just 7. R D Hydrochlorothiazide 25 mg for prescribed by multiple physicians over He claimed feeling like he was in good over 2 months. He was monitoring his hypertension the years for hypercholesterolemia. Statins health until 2007, although he had some fasting blood sugars in the morning and 8. R Na-bicarbonate 650 mg x 2 weeks come with specific precautions for people weight and reflux concerns before then. At in the evening after dinner. With his recent after low CO2/bicarbonate lab finding with renal impairment or diabetes. This his heaviest, he weighed 295 pounds (BMI dietary improvements, his blood sugars patient reported experiencing flank pain as of 43.6). He noticed his urine could appear were better than previous months, but still Key: a side effect of these drugs, and elected to foamy, and his bowel pattern tended to high, ranging between 101-303 mg/dL in R = Caution with renal impairment discontinue their use. be soft or loose. His sleep was better than the weeks leading up to our appointment. D = Caution with diabetes ever since improving his diet. He was H = Caution with hyperlipidemia Self-Prescribed Supplements sleeping 8-9 hours a night, and expressed PCP-Prescribed Medications G = Contraindicated in people with eGFR <46 1. Vitamin B1, B2, B6 (uncertain dosages) a desire to continue using quetiapine, 1. H D Quetiapine fumarate 50 mg x 7 2. B12, 1000 µg an antipsychotic, for the off-label use of years for insomnia. Patient wanted to Note: One week prior to my patient’s first 3. Vitamin E, 1000 IU insomnia. stay on this medication. visit, he had self-prescribed acetaminophen 4. Turmeric, 400 mg His previous standard American diet, 2. R Lisinopril 10 mg for hypertension for ear pain. Within 1 hour, he experienced 5. Lutein, 20 mg consisting of fast and fried food, candy, 3. R D Ranitidine 150 mg x 2 at night x vertigo, nausea, and gait disturbances. 6. Probiotic

PE Findings • Blood pressure: 112/84 mm Hg

• O2 saturation: 98% MITOCHONDRIA • Pulse: 84 bpm • Weight: 260 lb • Height: 5’9” • Body mass index: 38.4

Integrative Solutions Although labs from various physicians had been ordered, only those done consistently and with comparable units are included in this article for fair comparisons. X Mitochondrial Support Two weeks before our appointment, his labs show clear cause for concern: his kidneys were not properly functioning, X Cytokine Support resulting in electrolyte imbalance (Table 1, N Phospholipid membrane repair* Figure 1). X Antioxidant—Nrf-2 Support N Krebs cycle support* Treatment Prioritizing cost-effective supplementation N Clinically researched to produce beneficial results is a goal with X Detox Support all patients; however, this patient’s extreme financial concerns were expressed and CYTOKINE SUPPORT a modest treatment plan was presented. I commended and encouraged him on his commitment to his recent dietary modifications, and provided a dietary handout to further balance blood sugars. Initial treatment recommendations Tel: 805.693.1802 • Fax: 805.693.1806 • [email protected] included: www.ResearchedNutritionals.com | Available only through healthcare professionals • 10-20 minutes of exercise each day • Hot Epsom salt baths 3 times per week and/or sweating during exercise to ANTIOXIDANT balance elevated potassium levels. (Epsom salt baths were also indicated for his likely decreased magnesium DETOX levels, although we didn’t confirm this N Promotes healthy via lab testing until days later.) cytokine activity* • 5-10 drops per day of a liquid homeopathic combination product N Highly absorbable to promote healthy kidney, liver, and polyphenol blend* digestive function N Nrf-2 support* • 6 caps per day of a proprietary product with kidney extract, to support and restore kidney function • Supportive acupuncture and a blood N Targets hydroxyl radical group* draw for labs were done in office

N Crosses blood-brain barrier & cell John’s lab results arrived days later membrane* showing his blood type (O) and a N Clinically researched detrimental progression of his kidney N Nrf-2 support, which promotes N Supports detox pathways* dysfunction during the weeks prior to healthy glutathione level* our appointment. We discussed the fact N Promotes healthy mitochondrial that hydrochlorothiazide (HCTZ) and function & NK cell function* Joseph Burrascano Jr., MD ranitidine are not recommended for people with kidney disease or diabetes. “Due to the research basis of these formulations, I think these products would be an important part of a practitioner’s arsenal.” HCTZ promotes insulin resistance and diabetes, depletes magnesium, lowers HDL-C, and raises LDL-C, all of which are *These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. antagonizing and created an obstacle-to- cure for this patient. 4 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW AD FORM MUST BE COMPLETED IN FULL

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Table 1. Lab Results Over Time PE Findings Reference 10 Months 9 Weeks 2 Weeks 3 Weeks 9 Weeks Blood pressure: 140/70 mm Hg Interval Prior Prior Prior Later Later O2 saturation: 97% Fasting Pulse: 54 bpm 65-99 mg/dL 240 145 91 110 Glucose Weight: 256 lb Volume 14 Issue 4 | April 2018 BUN 8-27 mg/dL 21 40 56 19 21 0.57-1.27 mg/ Treatment Publisher Creatinine 1.23 1.87 2.2 1.34 1.17 dL Razi Ann Berry • Continue with previous [email protected] >59 mL/ recommendations. Finish current eGFR 63 37.7 32 56.4 66 min/1.73 digestive healing powder; don’t Founders Razi Ann Berry BUN/ 10.0-24.0 17.1 21.4 25.5 14.2 18 replenish. David A. Tallman, DC, ND Creatinine • Begin a supplement that helps balance [email protected] Sodium 134-144 mEq/L 139 137 132 140 141 blood sugars: 1 cap twice daily Medical Editor Potassium 3.5-5.2 mEq/L 5.2 5 5.6 4.1 4.9 • If blood pressure readings are within Mary James, ND range, discontinue amlodipine 2 days CO2 18-29 mEq/L 26 18 19.5 18 24 Associate Medical Editor TC/HDL-C before next appointment David A. Tallman, DC, ND 0-4.4 5.5 5.9 4.7 Ratio Contributing Editor, Education 4.8-6.5% Third Follow-up, 3 Weeks Later David Schleich, PhD HbA1C 9.5 10 7.9 5.4 (AACE) Home-monitored blood sugars ranged Contributing Editors, Botanical Medicine Magnesium, from 77-179 mg/dL. The patient reported Jillian Stansbury, ND 1.6-2.3 mg/dL 1.6 2.1 serum better readings, except after eating pasta or Robin DiPasquale, ND, RH (AHG)

(BUN=blood urea nitrogen; eGFR=estimated glomerular filtration rate; TC=total cholesterol; desserts, which clearly correlated with higher Contributing Editor, Homeopathy HbA1C=hemoglobin A1C) readings. A total of 3.5 more pounds were Joseph Kellerstein, DC, ND shed. He stopped amlodipine 3 days prior, Contributing Editor, Oncology Figure 1. eGFR & HbA1C Over Time and reported no concerns or symptoms. He Jacob Schor, ND, FABNO reported feeling better overall. Contributing Editor, Nature Cure Sussanna Czeranko, ND PE Findings Contributing Editor, Functional Medicine Blood pressure: 145/80 mm Hg Mark Swanson, ND

O2 saturation: 98% Pulse: 57 bpm Editorial Coordinator Vanessa Wiley Weight: 252.5 lb [email protected] Director of Sales and Marketing John’s labs continued to improve, including Matthew Knapp the best TC/HDL ratio and A1c % he had [email protected] achieved in years. Circulation Manager Tara Hall Treatment [email protected] • Continue treatment plan, minus Epsom Creative Direction salt baths Jaclyn Threadgill [email protected] • Discontinue Na-bicarbonate www.jthreadgill.com • Finish and hold off on buying more Foreign Correspondent self-prescribed supplements S.A. Decker Weiss, NMD, FASA John was on the verge of stage 4 PE Findings • Increase exercise frequency and/or kidney disease. As a result, the following Blood pressure: 156/84 mm Hg duration additional recommendations were made: Pulse: 73 bpm ND News & Review • Take 1 tsp 3x/day of an herbal O saturation: 98% Summary PO BOX 2968 2 Scottsdale, AZ 85252-2968 combination tincture with Weight: 258 lb Even with minor changes and a budget- 888.627.8677 | 480.275.7712 www.ndnr.com nephroprotective/nephrorestorative conscious treatment plan, this patient’s ISSN 2169-1614 benefits Remarkably, just a few weeks after healing was profoundly rapid. Within Our printer utilizes wind-power • Increase kidney extract product to 9 caps beginning treatment, his labs showed a weeks of beginning treatment, he

per day 78% increase in GFR, along with balanced decreased his medication use by 50% and Naturopathic Doctor News & Review

• Eat more wild/organic/free-range meat, electrolytes, BUN, and glucose. was more balanced physically, emotionally, Copyright © 2018 Naturopathic Doctor News & Review. All fish, and/or eggs, and avoid gluten, in and physiologically. Proper diet, sleep, and rights reserved. No portion of this publication may be copied, reproduced, or redistributed without express written permis- accordance with his blood type Treatment exercise patterns create a foundation for sion from the publisher. Reprint information is available by contacting [email protected]. Naturopathic Doctor News & • Stop HCTZ (with no previous or current • Continue previous treatment, and add 1 health, while eliminating obstacles to cure Review reserves the right to edit or reject any submitted editorial or advertising. Opinions expressed by contributors and edema, this was possible without scoop of a powder with glutamine and and supporting the body with restorative advertisers are not necessarily the opinions of Naturopathic weaning); instead begin amlodipine 5 mg curcumin to encourage digestive healing. treatments potentiates healing. Doctor News & Review or its principals. Experiment 1 week later with reducing As Dr Henry Lindlahr stated, “Chronic Naturopathic Doctor News & Review is published and circu- lated as a complementary annual subscription (12 issues) First Follow-up, 3 Weeks Later ranitidine to every other day. If tolerated supposed-to-be-incurable diseases yield to to licensed naturopathic doctors (NDs) and students and graduates of CNME recognized naturopathic colleges in North John reported that his leg cramps and loose without reflux, take 1 ranitidine every the natural treatments, provided there is America, and certain suppliers to the profession. stool had ceased and that he had lost a few third day the following week. enough vitality in the system to respond to Annual subscriptions (12 issues) are available to other health- pounds. His daily blood sugars improved, • Decrease daily amlodipine dose to 2.5 mg treatment and the destruction of vital parts care providers and NDs outside of North America: US $99; Canada & Mexico $129USD; Europe and Overseas $179USD. with a range of 86-206 mg/dL. Since starting • Begin a supplement that helps normalize and organs has not too far advanced.” I amlodipine, his hand tremors had worsened. blood pressure while supporting the appreciate this patient’s motivation to heal Article Submissions He expressed a desire to get off of his cardiovascular system: 1 cap twice daily and commitment to his health before his Articles should be original, previously unpublished, and should medications and reported that his primary • Monitor for any increase of blood sugars diseases were too far progressed. I am filled cover a specific topic, protocol, modality, diagnostic, philosophy, commentary, or case study pertaining to naturopathic medicine care physicians did not plan to run labs or after discontinuing sitagliptin with gratitude to our miraculous body, rather than a general overview. Illustrations, photographs, charts and protocols are encouraged. Naturopathic Doctor News & have an appointment for another 6 months. this patient, and naturopathic medicine for Review does not reprint articles from other publications except He was aware that discontinuing medication Second Follow-up, 3 Weeks Later continuing to amaze me with the incredible, under unusual circumstances. Typical word requirements are 700 to 2000 words per article. Topics of interest include: was not realistic without making lifestyle John’s daily blood sugars ranged from innate ability of the body to heal. • Clinical pearls • Case management/case studies changes and supporting his body to help 89-190 mg/dL, even after stopping • Naturopathic philosophy • Practice building and business management balance blood sugars, cholesterol levels, sitagliptin 2 weeks prior. He had lost References available online at ndnr.com • Current trends and issues that affect naturopathic and blood pressure while also helping his 2 more pounds. Mild heartburn was physicians in your area • News, announcements, and event notices kidneys repair with supportive treatments. observed by the patient nights 3 and 4 of • Development of new techniques or protocols • Abstracts and reviews With a recent loss of his job and health his wean from ranitidine; otherwise, he had Shawna Eischens, ND, (“Dr E”) is a • Discussions pertaining to diagnostics insurance, John was unable to afford cash experienced no symptoms of heartburn. 2012 graduate of SCNM who practices • Public/media relations and networking at Rockwood Natural Medicine Clinic • Using technology to make practices more efficient pricing for sitagliptin or any equivalent. Exercise was still minimal. He had never in Scottsdale, AZ. As a primary-care and profitable physician who focuses on mental and • Educational and grassroots programs that further the natu- Sitagliptin was his most recent medication experienced any irregular heart rhythms, digestive health, Dr E is passionate ropathic cause prescribed for T2DM, is not recommended and his physical exam was consistent about helping people realize their great- • Any other trend, event, or development you believe is ness to achieve physical and emotional pertinent to the profession for patients with a GFR between 30 and 50 with regular heart sounds and rhythms. health. Outside of the office, she enjoys volunteering For more information regarding article submission, or to receive a with Naturopathic Medicine Institute and Big Brothers copy of submission guidelines, please contact [email protected]. mL/min, and does not clinically lower HbA1c Emotionally, he felt more balanced. Big Sisters, as well as exploring nature via foot, bike, Opinions expressed in NDNR do not necessarily reflect those of levels as well as other medications. car, or boat. this publication and its publishers. NATUROPATHIC DOCTOR NEWS & REVIEW APRIL 2018 5 Student Scholarship – 1st Place Research Review

Continued from bottom of page 1 in persistent cases where drug treatment to 14% in those patients with GERD In the second study, 24-hour esophageal helpful.22 If LES function is compromised, has failed.2 as compared to those without GERD.3 pH monitoring and simultaneous or gastric emptying is delayed, clinicians The pathophysiology of AF is complex The authors also found that patients ambulatory ECG (Holter) monitoring may want to consider bitter and prokinetic and uncertain; however, it is generally experiencing more severe GERD symptoms were used to assess 3 cases of GERD and herbs such as Angelica, Zingiber, Gentiana, accepted that changes to cardiac muscle had higher rates of AF. atrial arrhythmias.15 Reflux episodes were and Coleus.22 As nicotine is a strong LES cells (myocytes) take on different electrical Several large population-wide studies strongly correlated with episodes of AF relaxant, smoking cessation should be properties and begin disrupting the have examined prevalence rates of GERD in these patients, which resolved with strongly encouraged. pace-making ability of the sino-atrial node with AF.4,5 In 2009, Kunz et al reported the acid-suppressive therapy. These studies, Structurally similar to PPIs, melatonin (SA), which leads to uncoordinated atrial relative risk (RR) of developing AF in those although small, provide the first real-time has been investigated for its potential contractions.1 As this progresses over with pre-existing GERD to be 1.39. After evidence regarding reflux events and benefits in the treatment of GERD. Studies time, a process of remodeling takes place adjusting for cardiovascular risk factors, atrial arrhythmias and their symptomatic have been promising thus far, suggesting in which irreversible changes to atrial this association fell to 1.19 but remained resolution through PPI therapy. that melatonin may be as effective as PPIs tissue occur that lead to permanent AF. significant. Other risk factors reported in While treatment of AF with PPIs for controlling symptoms of GERD.23 It is unclear what initiating factor causes this study included hypertension (RR 1.75), in patients who have significant reflux Melatonin might thus be an attractive, cost- myocytes to misfire and AF to initially smoking (RR 1.47), and diabetes (RR 1.21).5 symptoms has been shown to be effective effective option for patients who decline or develop, but it is suggested that local Smaller studies, such as those at reducing AF events,14,15 these studies do not respond to initial PPI therapy. inflammation and mechanical stress are conducted by Bunch et al,16 have shown were of short duration and had small Lastly, acupuncture represents a likely involved.1 no association between GERD and AF risk, sample populations. Furthermore, the promising strategy to treat the patient although patients with a higher frequency use of PPIs has been demonstrated to who presents with both AF and reflux Gastroesophageal of reflux symptoms reportedly had a negatively impact nutrient and mineral symptoms. In fact, a recent meta-analysis Reflux Disease slightly elevated risk of AF. Bunch et al also absorption, including B12, calcium, concluded that acupuncture was at least GERD is highly prevalent in North America concluded that patients with esophagitis vitamin D, and magnesium17; some as effective as drug therapy for treating and is one of the most common reasons were at a significantly higher risk of studies suggest that low magnesium arrhythmias and that a further benefit was for visits to primary care providers.3 The developing AF (RR 1.94),16 supporting the status could potentiate moderate-to-severe observed when acupuncture was combined disease is characterized by the sensation of local inflammatory hypothesis. arrhythmias.18 Aside from patients with with drug therapy as compared with “heartburn” and regurgitation of acid from Hwang et al7 and Kubota et6 al have erosive esophagitis or Barrett’s esophagus, drug therapy alone.24 The most commonly the stomach up into the esophagus. Reflux both reported a significantly increased patients who are using PPIs to control used acupuncture points reported in can present as erosive or non-erosive, the this study were Pericardium 6 (PC6), former being associated with esophagitis Heart 7 (HT7), and Urinary Bladder 15 and dysplastic tissue changes, such as (UB15). Acupuncture represents an ideal Barrett’s esophagus, which increases individualized treatment, as it can target the risk of esophageal adenocarcinoma. both reflux symptoms25 and the heart Significant risk factors include smoking, rhythm disturbances seen in these patients. obesity, OSA, and aging.7 Acid reflux It is unclear what initiating factor causes symptoms are induced when sustained Closing Thoughts increases in intra-abdominal pressure (as myocytes to misfire and AF to initially develop, Although still controversial, it appears that seen in obesity) and consumption of large GERD and AF impact one another. While meals decrease lower esophageal sphincter the prevalence of patients suffering from (LES) tone. Increased visceral sensitivity but it is suggested that local inflammation and both GERD and AF ultimately remains and delayed gastric emptying may also low, there appears to be a significant be present.9 First-line treatment of GERD mechanical stress are likely involved. clinical correlation between the two. The consists of an initial therapeutic trial of a strength of this relationship increases proton-pump inhibitor, eg, omeprazole, when esophageal damage is present or and lifestyle modification.10 when reflux symptoms increase, and is dependent on the type and severity of The Small Bridge In Between arrhythmia. Being aware of this clinical Based on the close anatomical relationship risk of developing GERD in patients with reflux symptoms and potential arrhythmias correlation may present clinicians with between the esophagus and the left atrium, newly diagnosed AF. Those experiencing should be treated for a short duration, and an opportunity to substantially improve it would seem plausible that a disturbance an increased severity of arrhythmia, medications should be discontinued once patients’ quality of life and potentially in one tissue might affect the other. Indeed, which progressed from paroxysmal symptoms have resolved. prevent lifelong consequences of AF and only 2 mm separate the esophagus from the AF to permanent AF, reported higher side-effects of long-term drug use. Much left atrium.11 Interestingly, cardio-gastric reflux scores.6 This supports a potential Naturopathic Tools can be gained by utilizing diet and lifestyle interactions are not new. A rare and fatal bi-directional relationship. Based on mechanisms discussed thus far, interventions such as healthy weight complication of left atrial catheter ablation To summarize, the research thus far has naturopathic doctors and other clinicians management, stress management, and is the development of an atrio-esophageal revealed a consistent upward trend for the should start by first identifying and fostering mindful eating behaviors. fistula.11 More commonly, however, prevalence of AF in patients with GERD addressing the underlying factors that patients will develop GERD or esophagitis and suggests that this association increases might be contributing to GERD and AF. As References available online at ndnr.com after this procedure, demonstrating the with a worsening of reflux symptoms discussed previously, these could include potential impact of an inflammatory insult and even more so in the presence of obesity, OSA, inflammation, and smoking. on proximal tissues.12 esophagitis. Conversely, AF appears to Overwhelming benefits of weight increase the risk of developing GERD, management, observed in intervention Reflux, Inflammation, & Vagal and this risk is further increased with trials for both GERD and AF, suggest Stimulation worsening AF. this may be an effective first step in It is postulated that reflux symptoms the appropriate patient.19 It is worth leading to esophageal inflammation Does Suppressing Acid mentioning that adherence to a may disturb neighboring vagus nerve Suppress AF? Mediterranean diet has been shown to Andrew Hubbard, BSc (Hons), is currently studying in his 4th year at CCNM in fibers, which then causes a cardiac reflex. Two important studies have used unique reduce cardiovascular events in AF and Toronto. He has a passion for research- 20 ing, writing, and speaking on topics that This can in turn upset the heart rhythm, approaches for evaluating the effects of may be well suited to these patients. include gastrointestinal, neurological, leading to episodes of AF.13 The heart GERD in AF and the subsequent effects of Gastric motility, vagus nerve, and LES and endocrine health. Andrew plans on opening an integrative clinic with a receives input from both sympathetic and PPI therapy. function may be improved by encouraging special interest in digestive wellness and parasympathetic (vagal) signals, and this The first study used esophageal stress reduction and deep breathing is fascinated with designing future nutraceutical products. In between the clinic and the late-night PubMed balance is crucial for maintaining normal manometry (a technique for measuring exercises prior to and following mealtime.21 searches, Andrew can usually be found sprinting out on the trails or at the gym re-inventing exercise to be more conductivity. The following studies reveal acidity in the esophagus) and heart rate No studies to date have explored the fun and enjoyable. that this balance is altered in patients with variability (a reliable and accurate way potential benefits of adopting mindful reflux symptoms and with AF. In many of measuring sympathetic and vagal eating habits such as appetite awareness Ellen Wong, BSc (Hons), ND, is an associate professor at the Canadian cases, lowering esophageal acid exposure activity) to correlate GERD and arrhythmic and chewing food thoroughly; however, College of Naturopathic Medicine via proton-pump inhibitors (PPIs) results sequences.14 A significant number of this seems like a reasonable approach in (CCNM), where she graduated in 2009 and completed an accredited clinical 14,15 in the resolution of AF symptoms. So, patients demonstrated increased vagal the patient with AF and reflux symptoms. residency in 2011. Currently, Dr Wong teaches an evidence-informed thera- let’s examine this relationship a little closer. responses corresponding with increased If esophageal inflammation is peutics class, as well as supervises esophageal acid exposure. These patients predominant, then herbal medicines with interns at the Robert Schad Naturopathic Clinic (teaching clinic of CCNM). She practices in Ontario, Canada, Exploring the Evidence then underwent PPI therapy, and both anti-inflammatory, demulcent, and mucosal with a focus on cardiovascular disease, its comorbid- A 2014 systematic review revealed a reflux and arrhythmic symptoms were healing properties, such as Glycyrrhiza, ities, and geriatric care. In her spare time, Dr Wong explores the culinary scenes of Toronto, is an avid prevalence of AF ranging from 0.62% significantly reduced.14 Filipendula, Althea, and Ulmus, could be reader, and tries to squeeze in some time for exercise. 6 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW BREATHE BETTER...

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DAVID M. BRADY, ND, DC, CCN, DACBN At the University of Bridgeport, we disastrous ones. The disaggregated Finally, from my direct experience in are fortunate enough to have renowned and cased-based curriculum design trying to affect positive legislative change read with great pleasure the article in Schools of Engineering and Education often seems better in concept, and looks regarding naturopathic medicine’s scope INDNR ’s November 2017 issue, entitled with well-developed STEM programs in better on paper, than it performs in of practice, including the granting of “Rethinking Curriculum: Toward an Integrated various disciplines, including computer reality. This is particularly true when some level of prescriptive authority, one Program in Naturopathic Medical Education,” science, math, and biomedical engineering, institutions are dealing with faculty of the very first things that legislators by Drs David Chandross and Fraser where many of these same issues are who are unfamiliar with this model and public health regulators ask is, Smith. As a university vice-president being grappled with. Learning from and lack the appropriate training in “So, how many credits and courses in overseeing a Health Sciences division one another across disciplines, and by this method of content delivery, with its pharmacology do NDs take in their within a comprehensive university that virtue of our extensive online educational heavy reliance on seamless integration training?” Political opponents – mainly houses a naturopathic medical program experience, has been key for us as we and collaboration with faculty peers and state medical associations – also try to alongside programs in nursing, physician set off to modernize the way we educate program administrators. This design also cite perceived deficiencies in training or assistant, nutrition, acupuncture/TCM, newer generations of students in all of places a great deal of responsibility back competency, strictly based on comparisons dental, clinical laboratory sciences, the STEM and health science fields. It on the student regarding their individual and assessments of professional curricula chiropractic, and doctoral health sciences is absolutely necessary that we train outcomes. While some exceptionally using these outdated measures, including; education, I can assure you that I/we students to integrate information and attain motivated, intelligent, and confident numbers of courses, clock hours, and have confronted exactly these same issues competencies that bridge the traditional students tend to thrive in this model, credits in specific subjects. The task of across virtually all of these professions barriers of any one discipline or profession, others can easily be left behind and explaining the virtues of the trend in and healthcare paradigms. The issues of as we understand that we are actually left wondering why everything they clinical education away from discrete integrated learning, disaggregation of training students for jobs and fields that needed to know was not clearly and courses and credit loads in each “ology,” curricula content, development of novel may not even exist yet. systematically laid out and spoon-fed to and the integration of knowledge and methods of content delivery, and the That being said, I wanted to throw up them. These considerations must filter into skills acquisition within the context of addition of more “soft skills” to clinical several red flags based on hard-learned the admissions process and the selection clinical, case-based learning, systems- education are not novel to the training of lessons and experiences in trying to of applicants suitable for admission into based courses, and clinical experiences naturopathic physicians. However, it may migrate to the kind of new curriculum such programs. With enrollment pressures adds yet another layer of difficulty in be particularly challenging – and critical – and program designs advocated in the facing the profession’s institutions, it emerging successful in these legislative for the naturopathic profession, since the extremely thoughtful and well-presented is a potentially very risky proposition efforts regarding both initial licensure very premise of our modern naturopathic article by Drs Chandross and Smith. for them to consider. This is also a very and/or scope of practice expansion for medicine involves the integration of Firstly, in my 20-plus-year educational faculty-intensive model of educational naturopathic doctors. an amalgam of approaches and sub- career, I have seen other institutions delivery, and therefore very expensive I wholeheartedly support the concepts disciplines within one very large tent (ie, with professional programs – mainly in to properly execute. Once again, with that Drs Chandross and Smith put forth botanical medicine, clinical nutrition, allopathic medicine and chiropractic – enrollment pressures come fiscal pressures in their article, and I aspire to continue to homeopathy, TCM, Ayurveda, physical attempt such changes with somewhat for private institutions in healthcare fields affect such change in the training of the medicine, counseling, etc). mixed results, and, in a few cases, such as naturopathic medicine, without modern ND. I also believe it is critically large hospitals and healthcare networks important that we support the further supporting their academic programs. development and funding of primary The authors also rightly bring up care and other specialty post-doctoral concerns over how programmatic residency experiences as routine elements accreditors may view progressive in ND training and licensure. However, changes in curriculum design and new I also wanted to acknowledge the and innovative forms of delivery. In my significant challenges, as well as potential direct experience across professions, the perils and pitfalls that will be in play as programmatic accreditors have ranged we chart this course. from somewhat resistant to overtly oppositional to the kind of radical changes Sincerely, suggested in the Chandross and Smith Dr David M. Brady article. This puts academic institutions at University of Bridgeport great risk in making such changes, even if they would like to, as they are clearly unwilling to jeopardize their program’s accreditation status in the process. Remember, while the accreditation process is technically “voluntary,” it is essentially a death sentence for a professional program to lose it.

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Figure 2. Newspaper Mention of WNF Update Benno Hermann, 1903 Naturopathic Medicine

The first specific naturopathic reference in in the Western Pacific Region Australian newspapers was published in The Age (Melbourne) on May 16, 1903. JON WARDLE, ND, PHD, MPH, LLM outside of those countries (Australia international practitioners listed (and and North America seem to be the major some contributing to) Lust’s Universal and have viewed naturopathy as a subset hile the World Health Organization source of practitioners). There have been Naturopathic Encyclopedia Directory.4 In of the herbalism tradition in Australia, or W(WHO) maintains a truly global some attempts to develop local training addition to the United States (the home have confused the longstanding system focus, much of its practical work is institutions (most notably at several country of the publication), this list of naturopathic medicine with the more conducted in its regional offices. One of institutions in the Philippines), and the included naturopathic practitioners in recently emerged “natural medicine” those offices is the Western Pacific Regional first intake of students into the new Australia, Fiji, Japan, New Zealand, and movements.7 However, the presence of the Office (WPRO), headquartered in Manila, naturopathic program (modeled on North the Philippines. The preponderance of profession in WPRO is longstanding. in the Philippines. The WPRO consists of 37 American and Australasian curriculum) European names in that list of practitioners The earliest Australian newspaper country members (see Figure 1). As occurs at Thailand’s Surin Rajabhat University2 – both from the Continent and the British mentions of naturopathy as a specific in other WHO regions, representation at in 2014 may change this intake (Thailand Isles – suggests that naturopathic practice form of medicine date back to 1903, and a regional level is open to autonomous is in the WHO SEARO region, but is entered the WPRO region from both North they highlight both the early entry of territories, whereas only full countries the closest university program to many America and Europe simultaneously. naturopathic medicine in Australia and the can maintain WHO membership. As such, countries within WPRO). In many of these Then – as now – the Australian various international influences that helped membership of WPRO also includes the countries strong indigenous traditional contingent of naturopathic practitioners to establish the medical system. Multiple Chinese special autonomous regions (Hong medicine cultures make it difficult for was dominant (representing more than newspaper entries of “naturopathy” Kong and Macau), the French Pacific other medical systems to make traction. half of all listed practitioners in the occurred during 1903, and can lay claim island territories (French Polynesia, New For example, professional associations region). There again the development to being the first specific and official Caledonia, and Wallis and Futuna), the are prohibited in China unless sanctioned of the profession appears to have been mention of naturopathic medicine in US Pacific territories (American Samoa, by the government, but strong support influenced early on by both European Australia. However, it should be noted that Guam, and the Northern Marianas), and for Traditional Chinese Medicine in that and North American developments. references to core naturopathic modalities the British dependency of the Pitcairn country has made it difficult for other The first named naturopathic doctor in such as “nature cure,” “water cure,” and Islands. The region is geographically medical professions such as chiropractic Australia was German immigrant (and various elements of homeopathic, herbal, disparate, including the Pacific Islands or naturopathic medicine to gain anything student of Kniepp) Benno Hermann von and dietetic medicine can be found much communities, Australasia, most of South- more than a tokenistic foothold. Koenigswerder, who advertised his lectures earlier – and the controversial question of East Asia (except Indonesia, Myanmar, the provenance of naturopathic medicine and Thailand) as well as China, Korea, as an evolution of the Eclectic medical the Philippines, and Japan. The absence tradition may also mean that some of Indonesia (which is located in WHO’s earlier naturopaths may have categorized SEARO [South-East Asia Regional Office] In many of these countries strong indigenous themselves as other therapists. The region) physically separates the Southern first mention of naturopathic medicine and Northern countries of this region. traditional medicine cultures make it difficult for was a health column published in the Toowoomba-based Darling Downs Gazette, Naturopathic Presence in other medical systems to make traction. authored by an anonymous naturopath the Region (signed off as “The Naturopath”) on the The World Naturopathic Federation importance of sleep and exercise as a (WNF) has 3 full members representing restorative agent for health.8 These were practitioners in 3 WPRO countries – followed up that year by advertisements Australia, Hong Kong, and New Zealand. In other WPRO countries a small from 1903 and practiced in Melbourne and for individual practitioners in newspapers In general, naturopathic practitioners in naturopathic practitioner workforce exists later in Brisbane (see Figure 2). However, Brisbane (Queensland), Melbourne the region follow a similar practice model but remains unorganized. For example, many other newspaper articles referenced (Victoria), and Lismore and Armidale (with a broad therapeutic scope) to that of Singapore – like Hong Kong – has a nascent early Indian naturopathic developments (New South Wales). naturopathic doctors in North America, naturopathic practitioner community (usually based on British training) as Despite often incurring the wrath which has been the primary contemporary largely made up of North American and well as North American developments. of the medical profession, it appears influence on practice (though WPRO Australian naturopathic graduates due to For example, newspapers began quoting that naturopaths did enjoy broad practitioners may have more educational its permissive immigration policies. Unlike North American naturopathic journals as support and recognition from the emphasis on ingestible medicines and less Hong Kong, however, the Singaporean sources in health stories; an article by Dr public, albeit somewhat hampered by on physical therapy compared to their naturopathic community has not coalesced Erieg from the Naturopath and Herald of their small professional stature. Dr von North American counterparts). Australia around a single professional association. Health was cited in a story on overeating Koenigswerder’s position as a naturopathic and New Zealand are undoubtedly the In some countries, legal recognition of and mental acuity in Toowoomba’s Darling physician in Brisbane was considered powerhouses of naturopathic practitioner naturopathic medicine has come prior to the Downs Gazette.5 sufficient to draw on his expertise as an representation in the WPRO region – presence of an established local practitioner Australia is also the country where expert witness in several Court cases in representing over 90% of the estimated workforce. For example, in the Pacific most historical records exist, and the the Queensland legal system.9 In 1905 the 10 000 naturopathic practitioners in the Islands nation of Vanuatu, an Australian naturopathic community appears to have Victorian village of Mansfield advertised region, as well as the majority of the naturopathic graduate (Dr Alan Profke) has been politically active early on. Lust, its attraction of naturopathic services as a profession’s historical presence – with the been granted recognition as a registered himself, spoke positively of legislative and sign of its progress.10 Maurice Blackmore profession only beginning to emerge in primary care provider in his Paradise Clinic, professional developments in Australia, – one of Australia’s most well-known many of the other countries of the region. which provides care to the residents of stating in the Universal Encyclopedia that “we naturopaths and founder of what is now Small (often solo-member) naturopathic Aore Island.3 While initiatives such as these look to Australia to inaugurate legislation to Australia’s largest pharmaceutical company practitioner associations have been are essential to expand the profession into make poisoning the sick with drugs a penal (which although classified as being part identified in a number of countries – Japan, new areas, they do not create a sustainable offence.” However, the extent to which of the pharmaceutical sector, actually Malaysia, and the Philippines – though profession, and more efforts are needed the history of naturopathy in the WPRO solely produces natural medicines) – was have not regularly interacted with the to ensure that local naturopathic capacity region (or even its most studied nation, often the subject of attacks of the medical broader (or even regional) naturopathic is also developed so that countries are not Australia) has been studied is dwarfed by profession, which often sent investigators community. In some of these emerging reliant on overseas practitioners. the scholarship that has been extended from the Medical Board of Queensland nations (eg, Malaysia) the government has to the profession in North America and to charge him with practicing medicine announced its intention to regulate and History of Naturopathic Europe. In Australia, for example, some without a license. After one such instance develop naturopathic education in that Medicine in WPRO academics have incorrectly assumed the in 1951, the Queensland Parliament country,1 even though the relatively small The precise history of the development of profession was largely absent from early debated the veracity of Blackmore’s size of the profession in that country has the naturopathic profession in the WPRO Australian history, and its entrenchment practice and whether such actions were not made it a priority. region is difficult to ascertain. From its was really only spurred by the growth of appropriate. In addition to noting the large The emerging nature of the profession outset, naturopathy was an international the counter-cultural and natural healthcare number of testimonials to Blackmore’s in much of the region means that profession. The American Naturopathic movements of the 1960s and 1970s.6 Others treatment from patients, Blackmore was naturopathic graduates practicing in Association had identified naturopathic have conflated the history of naturopathy also enthusiastically defended by 3 future many WPRO countries have been trained doctors in 20 countries in 1918, with with Western herbal medicine in Australia, Queensland Premiers.11 This reflects the NATUROPATHIC DOCTOR NEWS & REVIEW APRIL 2018 9 Naturopathic News

contemporary scenario, whereby, despite the “new-style flower children” began The naturopath is a graduate However, as the profession remains lack of integration and recognition by to join the “old-style straight-backed of a naturopathic institution. His largely unregulated or self-regulated in government, naturopathic medicine nature cure adherents.”16 While this preparation for the professional careers the region (although training exists that is remains enthusiastically supported by the undoubtedly rejuvenated the profession as a naturopath consists of a four- within the highest quartile internationally), public. In Australia, for instance, studies in terms of growth in practitioners and year course of study, which includes several unaccredited colleges still exist that suggest that approximately 10% of the public utilization, it also created some what are known as the basic sciences. do not meet WHO (or WNF) standards population regularly use a naturopath,12 dilemmas for the naturopathic profession These sciences are: (1) Biology, for naturopathic education. As such, the with one-third of patients using their in the region, as it began to be subsumed (2) Chemistry, (3) Bacteriology, movement towards statutory regulation and naturopathic provider as their primary into a broader “natural medicine” (4) Anatomy, (5) Physiology, (6) recognition remains a priority area within care provider.13 Naturopathic medicine is movement. As naturopathic medicine Embryology and Obstetrics, (7) the region. There is also a movement to also the primary complementary medicine was the only major complementary Pathology, (8) Physical Diagnosis, enact regulations that allow growth in the discipline in New Zealand. medicine discipline not regulated, one (9) Psychology, (10) Nature Cure, naturopathic profession. For example, while of the practical consequences of this (11) Hygiene and Sanitation, and the New Zealand naturopathic profession Professional Naturopathic was that its associations began to absorb other therapeutic subjects such as training institutions enjoy government Development in the WPRO other natural medicine professions that (1) Mechanotherapy or Physical funding and degree minimums, they are Naturopathic development in the WPRO were also experiencing growth as part Manipulation, (2) Hydrotherapy currently banned from adding an additional region occurred early. The Australian of the holistic health movement (such or Water Cure, (3) Electrotherapy, fourth year to their program by legislation. WNF member celebrates its centenary in as acupuncture and homeopathy). This (4) Biochemistry [this was an However, as in Australia, despite such 2019, when it will host the WNF Annual led to a situation where previously early term for vitamin and mineral barriers, the New Zealand profession General Meeting. The first association for naturopathic associations became broader supplementation], (5) Dietetics, etc. remains committed to increased standards, naturopaths in New Zealand occurred in natural medicine associations (as was The naturopath does not study materia including an active research agenda, and 1940, when the New Zealand Association the case in Australia, where the National medica or the prescribing of drugs, coordinates with international profession in of Naturopaths and Osteopaths was Association of Naturopaths slowly evolved but he is taught phytotherapy or the research initiatives such as the International formed, an association which still exists into the Australian Natural Therapists use of herbs in the healing of the sick. Research Consortium of Naturopathic (though in a different iteration) to this Association),17 or naturopaths began to In addition to the four years study of Academic Clinics (IRCNAC) – a North- day.14 In 1925 the South Australian look towards other discipline associations naturopathy or drugless healing, the American and Australasian collaboration association (the Botanic and Naturopathic that aligned with their professional naturopathic student spends one or leveraging clinical data from college Medical Association published the first interests better than multi-disciplinary two years at a naturopathic sanitarium training clinics. Research has more generally Australian naturopathic journal, Nature associations (for example, in New Zealand or clinic. At the completion of his been one of the key accomplishments of Cure and Medical Freedom. This was where the New Zealand Association of studies he obtains the degree of N.D. the naturopathic profession in the WPRO followed by the Ivaline Harbinger of Health Medical Herbalists became a natural (Doctor of Naturopathy).18 region, with Australian (particularly) and (1925-1927), Nature’s Path to Health (1930- home for many naturopaths). The lack of New Zealand practitioners punching well 1950), The Australian Naturopath (1936- a distinct naturopathic voice in WPRO Eventually, naturopathic education above their weight in terms of research 1964) in Australia, and Health and Sunshine regions is only being remedied recently, began to be brought into the university output both internationally with respect (1930-1937) in New Zealand. However, in large part due to the catalyst of the sector (where possible), and as private to the research output of the broader beyond Australia and New Zealand, little is formation of the WNF. institutions began to be allowed to offer naturopathic community, and nationally known about professional development of accredited degree programs, the standard of when compared to other complementary the naturopathic profession in other WPRO Naturopathic Education education in WPRO has been degree-level. therapy disciplines (such as chiropractic, countries. This is in large part because, in WPRO There appears to have been some interaction osteopathy, or Chinese medicine) within although early naturopaths have been As in many other regions, early training between the Australian and international their own nations. identified, much of the profession outside of naturopathic practitioners focused naturopathic education sectors. In 1971 it While several challenges exist, the of Australia and New Zealand was lost on clinical apprenticeships and teaching was announced in The Health Leader, for naturopathic profession in WPRO has during the international post-war decline clinics, with training and practice often example, that after numerous years, Maurice numerous opportunities: relatively few of the naturopathic profession and has taking place in institutes of naturopathy Blackmore had managed to convince Dr practice restrictions, a developing education only recently begun to develop again. For that also treated the public.18 This was Paul Hoffmeister, an eminent professor from sector (including recent legislative changes example, naturopathy in Hong Kong, the often borne of necessity, as naturopathic the now defunct Sierra States University in that have banned non-degree education in third WNF member, was only reintroduced training was not only unable to Los Angeles, to teach naturopathic medicine naturopathic medicine), popular support to that territory 2 decades ago, when an be accredited in formal education at the Australian College of Naturopathy, among the general population, and a Australian graduate began practicing in institutions (which were – and remain – Osteopathy and Chiropractic in Sydney (1 of naturopathic profession that is holding its that territory.15 largely public government institutions the 3 constituent colleges – based in Brisbane, own in the international health research Although the naturopathic profession in the WPRO region), but naturopathic Sydney, and Melbourne – of the National community. However, much of this success entered the WPRO region relatively medicine itself was often discouraged or, Association of Naturopaths, Osteopaths has occurred despite, rather than because of, early, the development of the profession in some cases, even illegal. In an article and Chiropractors).19 These relations have government recognition and assistance, and has not been consistent. Despite early published in 1938 in Nature’s Path to continued over many years, with the WPRO the fragmented nature of the profession successes, the naturopathic profession in Health, the content of what such a course naturopathic profession having a long has often hampered efforts for greater WPRO declined in the period following may have looked like was described by history of collaboration with other regions. recognition and integration. Developments the Second World War. During the 1960s Frederick Roberts. (This description was The first official foray of naturopathic such as the WNF have helped to serve as and 1970s, naturopathy was rejuvenated followed by an advertisement for Robert’s education into the university sector a catalyst for greater cooperation – both by the growth of the holistic health own college, the British and Australian was a partnership between Northern within and between countries in the region – movement when, according to Evans, Institute of Naturopathy.): Territory University (now Charles Darwin and will hopefully provide the professional University) and the Queensland Academy voice and leadership the profession requires Figure 3. Nature Cure and Medical Freedom; 1925 of Natural Therapies to develop a 4-year to fully realize its potential in the region. degree course through an institution called the Darwin Academy of Natural Therapies Additional figure and references 7-20 available (DANT), which was announced and online at ndnr.com supported by the Northern Territory health minister of the time.20 In the mid-1990s, reforms in Australia led to the ability of REFERENCES non-government universities and colleges 1. Ministry of Health (Malaysia), Traditional and to establish and offer degree courses, with Complementary Medicine Division. National Policy of Traditional and Complementary Medicine. 2003. the Australian College of Natural Medicine Available at: http://tcm.moh.gov.my/en/index.php/ (Brisbane), Southern School of Natural policy/national. Accessed November 1, 2017. Therapies (Melbourne), and the Australian 2. Wiwanitkit V, Kaewla W. Public hearing on the first naturopathy curriculum in Thailand. Educ Health Institute of Applied Sciences (Canberra) (Abingdon). 2015;28(3):213-214. offering 4-year degree programs by 1995; 3. Profkes Naturopathic Clinic. Available at: https:// profkesclinic.squarespace.com/missions/. Accessed Southern Cross University offered the November 1, 2017. first naturopathic program in a public 4. Lust B. Universal Naturopathic Encyclopedia Directory and Buyers’ Guide: Year Book of Drugless Therapy university in 1996. Wellpark College and for 1918-19, Volume 1. New York, NY: American South Pacific College of Natural Therapies Naturopathic Association; 1918. in New Zealand also have longstanding 5. Plain Living and High Thinking. February 6, 1906. Darling Downs Gazette. Toowoomba, Queensland. degree programs in naturopathic medicine, 6. Baer HA. The drive for legitimation in Australian This was the first issue of the first local Australian (and WPRO) naturopathic journal, with ”What is which are supported by government- naturopathy: success and dilemmas. Soc Sci Med. Naturopathy” as the lead article. 2006;63(7):1771-1783. funded placements. 10 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW It doesn’t get any fresher than this...

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the vital concept – found in most systems of medicine – that a patient’s ability to detoxify well is a critical component of Medical Resources for NDs health. It is thus fitting that this is the focus of Dr Stansbury’s first volume; subsequent A review of current publications volumes will build upon this base of knowledge and health. Particularly helpful for the naturopathic industry is the chapter on skin issues, as herbal treatment of dermatological conditions is generally discussed much less in other ALETHEA FLEMING, ND explanation of how to expand upon it. She book for cookies, the reader would learn books compared to liver, gastrointestinal, recommends first selecting an appropriate how to make simple chocolate chip, sugar, and urinary health issues. Herbal Formularies For base herb upon which to build a formula and oatmeal cookies, but would also gain Although grouped under different Health Professionals, – an herb that is nourishing, tonifying, the confidence and inspiration to dig disease conditions, Dr Stansbury’s formulae Volume 1: Digestion and and safe for long-term use. Next, she deeper and try a cocoa nib shortbread or a are specific to individual presentations, and Elimination suggests selecting an herb that is specific lacey almond wafer. she emphasizes the importance of treating to the presentation of the patient and their The formulae themselves are broad the individual, not just the diagnosis. It’s fter reading this first volume from Dr illness, and then selecting a third herb that as well, encompassing different forms delightful to see a clear embodiment of the AJill Stansbury, my immediate reaction serves as a synergist for the formula and of herbal treatment. Dr Stansbury tenets of naturopathic medicine throughout was that I can’t wait for the remaining which may also address other conditions recommends imbibing teas, rather this book. 4 in her series. Herbal textbooks are not or energetic considerations, such as a than pills or even tinctures, for more widely available, to begin with, and this tendency to cold/damp or dry/heat. direct application in the case of some Just the FACTS series promises to be a cornerstone not Simple, but clear. One of the goals of this gastrointestinal and urinary issues or Title: Herbal Fomularies for Health only for students, but also for working volume (and the series) is to make herbal when cost is a big concern. Traditional Professionals, Volume 1: Digestion and professionals who rely on clinical formulation accessible to a wider audience tincture formulae abound, but with enough Elimination, Including the Gastrointestinal recommendations when treating patients. of health professionals. Dr Stansbury’s encouragement of variation that even a System, Liver and Gallbladder, Urinary System, and the Skin Dr Stansbury’s many years of teaching easy-to-follow structure gives this book an simply stocked dispensary lends itself come through clearly in the structure and excellent chance of extending beyond an to the creation of some of her suggested Author: Jill Stansbury, ND style of her writing. This book is designed ND-only audience. options. Pleasingly, she also includes Publisher: Chelsea Green Publishing to be useful to a wide audience, not only Patients of all ages are considered with suggestions for topical applications Available from: Widely available as a quick reference, but also as a teaching care in her formulations; recommendations such as salves or lotions, as well as oral Pages: 352 tool to help those who are less familiar for infants, as well as for conditions lozenges and medicinal vinegars. A wide Style: Hard Cover with herbal medicine, helping them to commonly seen in our geriatric population, variety of treatment options ensures that Copyright: 2018 understand the basic concepts of how and are included. Although this book is the practitioner can successfully meet the MSRP: $59.95 why to create a specific formula. Chapter 1 not an exhaustive exploration of all needs of the individual patient. is about the art of herbal formulation, and possible herbal formulae in the digestion Early in their clinical training, all it provides an excellent guide or refresher and elimination systems, it serves as naturopathic medicine students learn the on the fundamentals. an excellent starting point with clear saying “When in doubt, treat the liver.” The illustrative use of a triangle model examples, and it provides the skill-set for This first volume focuses on the organs allows for simplicity as well as a tidy going much further. If this were a recipe of digestion and elimination, supporting Visit Our Website

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Authorized Signature: Date: Vis Medicatrix Naturae Diverticulitis Naturopathic Care

MONA MORSTEIN, ND, DHANP Clinical Presentation There are several categories of diverticular iverticular disease is the fifth most disease: Dimportant gastrointestinal condition • Diverticulosis (asymptomatic) in Western countries.1 • Diverticulitis (symptomatic): Diverticulosis is a condition featuring o Simple DS features inflammation small herniated pouches, generally around without complications, and 5-10 mm, in the colonic mucosal layer. is readily controlled through They can occur deep within the mucosa conservative measures, such as pain and submucosal tissue where blood vessels relief, antibiotics, and bowel rest. lie. Diverticulosis usually occurs in the A naturopathic physician can feel sigmoid colon, but diverticula can develop comfortable treating a patient with anywhere in the large intestine. simple diverticulitis. Diverticulosis occurs in around 5% o Complicated DS can feature of people under 40 years of age, but perforation, peritonitis, fistula, this number climbs to 65% by age 85.1 However common diverticulosis may be, 80-85% of diverticulosis cases remain asymptomatic; only 5% of patients tend to develop diverticulitis (inflammation of diverticula), and around 10-15% of these patients will suffer complications requiring surgical intervention.1 Support Etiology There are several etiological factors related to the development of diverticular the healthy disease (DD): 1. Abnormal slowing of colonic motility, and active excessive colonic contractibility, and either normal or increased resting intracolonic pressure lives of your 2. Decreased colonic tensile wall strength, ie, reduced strength of collagen and muscle fibers due to cross-linking of patients abnormal collagen fibrils; this weakens the colon wall, allowing the pouches to develop more easily with our 3. Chronic mucosal low-grade inflammation 4. Imbalance in the colonic microbiome professional 5. Visceral hypersensitivity, ie, excessive perception of physiological stimuli, such probiotics. as colonic distention

DD is seen less in vegetarians, and more in those who eat a low-fiber diet and higher meat/fat diet. It is seen more in those who struggle with chronic constipation, and in patients with Ehlers- Danlos syndrome or Marfan syndrome. ® Breaking from a long-held mistaken TheralacPRO contains both Lactobacillus bacteria dietary view, nuts and seeds do not cause and Bi dobacteria for DD and do not need to be avoided by those Supports Colon complete intestinal coverage 2 who have had an episode of diverticulitis. Digestive Speciﬁc which helps balance Diverticulitis is inflammation of 1 or Health* Support digestive and immune more diverticula. Diverticulitis may result health*. TruBiﬁ doPRO® from fecal matter or undigested food Boosts Immune contains ve scienti cally * * particles becoming stuck in the diverticula, Immunity Regulation referenced Bi dobacteria causing swelling, vascular compromise, strains for colonic Broad and possible perforation. It may also Targeted colonization, helping those Spectrum Deep be caused by intraluminal pressure with an over-active immune Colonization Release * or thickened food particles that cause response . Both products erosion of the diverticular wall, leading to have patented delivery through harsh inflammation, focal necrosis, and possible stomach acid and perforation. patented prebiotic Diverticulitis (DS) is more prevalent stimulation. in Western countries, particularly in individuals over 60 years old; obese individuals are also at higher risk. A younger patient (less than 45 years old) who develops DS is more likely to have To try FREE sample: complications and require surgery.1 e-mail [email protected] In Caucasians, left diverticulitis master-supplements.com 800-926-2961 with fistulation is most common. Asians experience more right-sided DS, and a *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. greater tendency to bleed.1 NATUROPATHIC DOCTOR NEWS & REVIEW APRIL 2018 13 AD FORM MUST BE COMPLETED IN FULL

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obstruction, bleeding, abscess, and pyelonephritis, OB/GYN conditions (eg, Treatment perforation,6 and promote inflammation phlegmon. Fistulas can develop pelvic inflammatory disease, ovarian cysts, Conventional Approach in IBD,6 and low cortisol does not trigger between the colon and the vagina, ectopic pregnancy), colorectal carcinoma, Conventional care of uncomplicated the brain to reduce the overall body urinary tract, or the skin. A inflammatory bowel disease (IBD), colitis, DS consists of a clear liquid diet with inflammatory response.7 A CSDA can naturopathic physician should refer pancreatitis, urinary tract infection, viral antibiotics; however, antibiotics may reveal challenges to the microbiome, this patient to the ER. gastroenteritis or food poisoning, and also be selected on a case-by-case basis.1 dysbiosis, and uncover any short-chain irritable bowel syndrome. Commonly used antibiotics include: fatty acid deficiencies that compromise Diverticulitis can become recurrent, In the office visit, conduct a thorough ciprofloxacin with metronidazole; the health of colonic cells. either as a low-grade manifestation or intake, take vitals, and do a physical trimethoprim-sulfamethoxazole The most dangerous medication as actual repetitive and overt clinical exam. A CBC (perhaps STAT) is indicated; with metronidazole; moxifloxacin; or for DS patients is non-steroidal anti- appearances. After the first occurrence it’s also good to check liver enzymes, amoxicillin with clavulanic acid. Food inflammatory drugs (NSAIDs).8 These of acute DS, managed without surgery, and pancreatic amylase and lipase. You can be reintroduced in 2-3 days as clinical drugs are devastatingly damaging to the 5-year recurrence rate is 20-50%. Of should do an in-office pregnancy check improvement occurs. Mesalazine has been the entire gastrointestinal tract. I easily those that do recur, 25% will develop in female patients (if sensible), and a shown to improve symptoms and prevent found a key study stating that NSAIDs complications, 1-2% will require urinalysis. During the physical exam, recurrence of diverticulitis.3 are associated with a higher risk of DD. hospitalization, and 0.5% will require do a good in-depth abdominal exam; NSAIDs are more strongly associated surgery.1 complications requiring referral to the Naturopathic Approach with causing complicated DS than Seventy percent of patients with ER may present as abdominal distention, Naturopathic medicine can be enormously uncomplicated DS.8 NSAIDs cause a acute diverticulitis will present with left decreased/absent bowel sounds, rebound effective in treating uncomplicated greater occurrence of bleeding with DS. lower-quadrant (LLQ) pain.1 If the patient pain and guarding, or abdominal mass. diverticulitis. Treating the acute condition The use of aspirin for 4-6 days a week is Asian or actually has appendicitis, it The main imaging lab for diagnosis is fairly easily done in most patients, and significantly increases the risk of DS; even may be RLQ pain. The pain is generally is a CT scan. A double-contrast barium then long-term prevention can also be daily low-dose aspirin will increase DS worse from eating and may be better enema is also a useful tool, but is used comprehensively established. risk.8 NSAIDs have been found to cause with defecation or flatulence. There may less frequently than CT scans. If this was a Naturopathic physicians do not have intestinal permeability within 1 hour be nausea and vomiting, though in my patient’s first DS episode, it is helpful after to use antibiotics to treat acute DS cases. of ingestion and to cause inflammatory experience this is not common. DS patients treatment to get a colonoscopy in order to At least 2 studies4,5 shows that antibiotic changes throughout the intestinal tract, can have constipation or diarrhea, and ascertain the number and size of existing treatment can be avoided in simple, although aspirin may be less problematic the pain often spreads out over the entire diverticular pouches. non-complicated diverticulitis and that than other NSAIDs.9 transverse area of the colon. As noted, fever is an instant ER outpatient management is safe. Alcohol should also be avoided. As with many gastrointestinal referral. Also consider a referral Naturopathic medical testing Alcohol, in and of itself, can significantly conditions, the “red flag” is fever. If a when the patient cannot handle oral for DS should include a 7-day diet increase the risk of diverticulosis.10 I have patient presents with fever, a referral to the hydration, when the patient does not diary, IgG Subsets 1-4 food sensitivity had an adult male patient, an oenophile, ER is required, as a colonic perforation has significantly improve with naturopathic testing, salivary cortisol testing, and whose recurrent diverticulitis episodes (4-6 likely occurred. If no fever, a naturopathic care within 2 days, if the patient is a comprehensive stool and digestive per year) ceased when he stopped drinking physician can feel safe and responsible immunocompromised or has significant analysis (CSDA). Food sensitivities his beloved wine. treating a DS patient. comorbidities, or when the patient can promote inflammation in the gut For an acute episode, have the patient has severe enough pain that narcotic lining, leading to recurrent DS. High rest at home and only drink water, tea Workup analgesia seems necessary (or, think or low cortisol can cause intestinal or broths. Consider using a non-tincture, The differential diagnosis in the gut homeopathy!). inflammation; high cortisol may comprehensive antimicrobial product. is extensive: Acute appendicitis, be associated with gastrointestinal Dose it aggressively – hourly for the

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first 1-2 days – and then reduce the dose high dairy intake, 1-2 glasses of alcohol a After a few months, we reduced his to 5-6/day until the patient has entirely day, low vegetable intake, daily sugar in supplements to a multiple vitamin/mineral; REFERENCES recovered. If such a product is not used, desserts, and rare omega-3 food intake. fish oils; slippery elm once a day; and the 1. Shahedi K. Diverticular Disease: Practice Essentials. antimicrobials and immune stimulators The stool analysis showed low beneficial mixed formula to once a day. He has done August 15, 2017. Medscape Web site. https:// emedicine.medscape.com/article/173388- include high-dose vitamin A drops, bacteria but was otherwise WNL. His well since. overview#showall. Accessed January 3, 2018. liposomal or regular vitamin C, vitamin cortisol was low at 1 point during the 2. American Gastroenterological Association. Management of Acute Diverticulitis. AGA Web D3 (in thousands of IUs per body weight), day. We discussed many significant References 8-10 available online at ndnr.com site. http://www.gastro.org/guidelines/acute- Echinacea/Hydrastis canadensis (goldenseal) dietary changes. diverticulitis#sec1.5. Accessed January 3, 2018. capsules, and anti-inflammatory products I prescribed a probiotic (100 billion 3. Petruzziello L, Iacopini F, Bulajic M, et al. Review article: uncomplicated diverticular disease of the colon. such as Curcuma longa (curcumin), CFU per day); a gut-soothing formula Aliment Pharmacol Ther. 2006;23(10):1379-1391. 4. Boermeester MA, Humes DJ, Velmahos GC, Søreide K. Boswellia, and bromelain. Do a containing L-glutamine, NAG, citrus Mona Morstein, ND, DHANP, is con- Contemporary Review of Risk-Stratified Management sidered an expert in both gastroenterol- homeopathic case; look closely at Bryonia, pectin, DGL, and other herbs (1 tbsp in Acute Uncomplicated and Complicated Diverticulitis. ogy and hormonal conditions, especially World J Surg. 2016;40(10):2537-2545. which comes up often in my practice. twice daily); slippery elm gruel; NAG diabetes. Dr Morstein taught gastroen- terology for 11 years at a naturopath- 5. Brochmann ND, Schultz JK, Jakobsen GS, Øresland Add in demulcents to sooth and help (700 mg); a multiple vitamin/mineral; ic medical school. She is a frequent T. Management of acute uncomplicated diverticulitis heal the tissues: and fish oils. He was also told to stop the lecturer on webinars and at confer- without antibiotics: a single-centre cohort study. ences, including the first and second Colorectal Dis. 2016;18(11):1101-1107. 1. Slippery elm gruel: 1.5 tsp to 1-2 cups of NSAIDs. SIBO SOS™. She has numerous lectures archived 6. Hara T, Akutsu H, Yamamoto T, et al. Cushing’s water: Take 3 times daily Around 2.5 months later, the patient had at MedicineTalkPro.org. Her book, Master Your Diabetes: disease presenting with gastrointestinal perforation: A Comprehensive, Integrative Approach for Both Type 1 a case report. Endocrinol Diabetes Metab Case Rep. 2. Mixed gut-soothing formulas (eg, no more colonic or arthritic pain. He noticed and Type 2 Diabetes is a highly regarded publication for 2013;2013:130064. both the diabetic patient and medical practitioners. A L-glutamine, N-acetyl-glucosamine, that drinking alcohol while socializing senior vitalist in the Naturopathic Medicine Institute, she 7. Mayer EA. The neurobiology of stress and citrus pectin, deglycyrrhizinated licorice would cause a small flare-up of pain, as did practices in Tempe, AZ, at Arizona Integrative Medical gastrointestinal disease. Gut. 2000;47(6):861-869. Solutions: www.drmorstein.com. [DGL], and other soothing herbs): Take the NSAIDs when he took them. 1 tbsp 2 times daily 3. N-acetyl-glucosamine (NAG), 700 mg: Take 2 capsules 3 times daily (This is an under-used nutraceutical for gut healing) 4. Fish oils: 2000-4000 mg EPA per day 5. Probiotics: >100 billion CFU/day

Recommend that the patient apply castor oil packs over the lower inflamed colonic tissue – 45 minutes in the morning and evening. I’ve never had these therapies fail in acute and preventive diverticular disease.

Case Study 1 A 62-year-old woman presented with acute LLQ pain. She had a past medical history of diverticulitis 2 years prior. She experienced acute pain in response to touch or movement; however, all vitals were WNL, and she had no fever or other signs of complications. PE revealed abdominal pain in the LLQ and QUICKER HEALING. NATURAL BLOOD FLOW. NORMAL SCARRING. across the transverse colon. Blood was drawn for a CBC, which was shown the DON’T LEAVE IMPROVED RECOVERYTO LUCK. next day to be WNL. The patient was sensitive to gluten Serretia is one of the world’s strongest but was eating it regularly. She was also Serrapeptase supplements, an enzyme eating a lot of refined sugar. She also had a with the inherent ability to digest dead stressful work schedule, seeing students 10 tissue and successfully aid in supporting hours per day for 5 hours Monday through Friday, and for 5 hours on Saturday for normal scar tissue formation, normal piano lessons. blood clotting, and allow for more natural I told her to stop the piano lessons, not blood fl ow throughout the body. Serretia’s eat, drink only water, tea, and broths, and ability to aid in normal fl uid retention and to rest. a normal infl ammatory response can help Using the above protocol, she expedite the healing of sports injuries, joint responded within a day, and by 4 days problems, muscle tears and pulls, surgical later the diverticulitis was gone. A cortisol test had shown elevated cortisol at 2 recovery, and swelling. points during the day, so we discussed getting her back to swimming, which she Learn more about how science, stats, loves and does well, working less, and and standards play a role in supplement doing some meditation. selection and why you should always It took her another year to commit to CHECK3 at arthurandrew.com/check-three. avoiding gluten and refined sugar, and she had some recurrent diverticulitis due to her problematic eating, but it was all controlled with naturopathic care.

Case Study 2 A 67-year-old man presented with recurrent diverticulitis – 2-3 times per year for the last 2 years. It presented as LLQ pain. He had been on recurrent antibiotics. He also took ibuprofen or naproxen daily for osteoarthritis. I had him do a diet diary, and I ordered food sensitivity *These statements have not been evaluated by the Food and Drug Administration. testing, a cortisol test, and a CSDA. This product is not intended to diagnose, treat, cure, or prevent any disease. Learn more by calling (800) 385-2091. He was sensitive to dairy and ate a very pro-inflammatory diet, including NATUROPATHIC DOCTOR NEWS & REVIEW APRIL 2018 15 AD FORM MUST BE COMPLETED IN FULL

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Myelin basic protein (measured in blood) Traumatic Brain Injury is also associated with TBI. Another promising marker for acute neuronal damage is CSF measurement of γ-enolase, Clinical Applications & Plausible Interventions also known as neuron-specific enolase (NSE); this is a glycolytic enzyme in CORA STOVER, ND CTE is a distinctive disease, and often Lacerations of the scalp, fractures neuronal cell bodies and is also present in DIANA ZITSERMAN, ND a sequela to TBI. Clinically, CTE presents of the skull, cortical lacerations or erythrocytes and endocrine cells. Calpain RADLEY M. RAMDHAN as a combined syndrome featuring mood hemorrhages – except for occasional and caspase (breakdown products of disorders, behavioral and/or cognitive pia-arachnoid hemorrhages – were neuronal spectrin α chain [αII spectrin]) raumatic Brain Injury, or TBI, has impairment, and occasional sensorimotor not found. Microscopic examination tend to increase in the CSF during acute- Tbeen noted in history, literature, and involvement. CTE is caused by “single, showed these punctate hemorrhages to phase brain injuries.10 Serum S-100β may medical societies for quite some time. episodic, or repetitive blunt force trauma be located around the blood vessels in the be a useful marker of astrocyte injury or Boericke noted it in one of his “Never well to the head, with repeated acceleration- perivascular spaces of Virchow-Robin [an death and correlates with the Glasgow since…” rubrics, along with other rubrics. deceleration forces to the brain.”5 A immunological space around an artery Coma Scale; however, it is not useful in In 1924, Cassasa was recognized as the CTE patient’s brain appears largely and vein – not capillary, and pia mater children under 2 years of age.11 first to describe the phenomenon and what unremarkable; however, microscopic that may be expanded by leukocytes].1 repeated traumatic injuries might do to examination of post-mortem brains reveals Pathogenesis of a person, and coined the term dementia primary and secondary proteinopathies. Clinical Manifestation, Neuroinflammation pugillistica (or DP). Cassasa observed that Dr Omalu found that the primary Diagnosis & Testing In order to understand CTE, it is helpful to boxers who were being used for training proteinopathy of CTE is tau protein- Diagnosing brain injury can be extensive first explore the pathogenesis of TBI-related purposes would eventually display a related, whereas secondary proteinopathies and expensive. Two scales which should neuroinflammation. TBI is generalized into particular pattern of symptoms.1 include amyloid plaque and other be used in any case of brain injury 4 categories, as follows: “1) primary injury These symptoms first appeared in the abnormalities. Dr Omalu and his team include the Glasgow Coma Scale and that disrupts brain tissues; 2) secondary extremities, as a slight flopping of the foot have pioneered the study of CTE-related the Ranchos Los Amigos Scale. Imaging, injury that causes pathophysiology in or leg, only noticeable upon walking or at proteinopathies by developing an in-vivo including angiography, computed the brain; 3) inflammatory response that intervals, or as a slight unsteadiness in gait PET scan named FDDNP-PET, which tomography (CT), magnetic resonance adds to neurodegeneration; and 4) repair- or equilibrium. A peculiarity was the fact measures tau tangles and amyloid plaque imaging (MRI), and X-rays, should be regeneration [of neurons].”12 A primary that these fighters could fight exceptionally deposition in living tissue.5 utilized to observe patterns of brain injury to the brain initiates the secondary well, but as soon as they stopped or walked injury due to external and internal forces injury, or the cascade of multiple molecular back to their corner, the abnormality events that lead to neurodegeneration. became apparent. Further symptomology In the first hours after TBI, in cases of included confusion and muscular slowing. TBI is often associated with a breached focal injury, damaged cells are found in Other terms historically associated with clusters. In cases of diffuse injury, these this phenomenon, which were generally blood-brain barrier. changes are more diffuse in the brain. Sites applied to an intoxicated person, included: of injury contain both necrotized neurons Punch Drunk, Cuck-coo, Goofy, cutting and non-neuronal cells, and hemorrhagic paper dolls, and slug nutty.1 Cartoons areas can become intraparenchymal often served to depict the syndrome; some Gross Morphology & or other possible traumas. Functional hematomas in cases of more extensive famous sayings and characters were based Pathophysiology imaging, such as electroencephalography injury.13 High ventricular intracranial on this association. Areas within the brain that are thought to (EEG) and transcranial doppler, may be pressure after TBI can indicated a poor be damaged in CTE include: the corpora utilized to observe communication and outcome.12 Varying degrees of edema and Chronic Traumatic striata (part of the basal ganglia comprising neural patterns. Because biofeedback can cellular swelling can also be present, and Encephalopathy the caudate nucleus [which contains pick up changes in autonomic nervous a broad, asymmetrical distribution of Dr Bennet Omalu is world-renowned endorphins] and the lentiform nucleus, system function that can occur during axon swelling can indicate diffuse axonal physician and neuroscientist who has been which when probed produce sensations of inflammation and encephalopathy, it might damage.13 TBI and cellular responses are investigating the effects of repetitive brain thirst; its function is essentially motor); the assist in our understanding and treatment Figure 1. TBI & Cellular Effects 7,8 injuries in professional sports players. corona radiata (a sheet of white matter that of TBI/CTE. on Brain Tissue13 It was a Professor Henry Miller who in runs ventrally as the internal capsule and Clinical manifestation of TBI sequelae 1966 coined the term Chronic Traumatic dorsally as the semioval center – the corona may include the signs and symptoms Encephalopathy (CTE) for the progressive radiata is responsible for most of the neural shown in Table 1. neurodegenerative syndrome due to traffic to and from the cerebral cortex); In addition, signs and symptoms in repetitive concussions and/or traumatic the cerebral cortex (gray matter, which young children may include persistent brain injuries.2 Omalu was the first to plays an important role in consciousness, crying, inability to be consoled, listlessness, publish evidence of the syndrome in 2005.3 thought and action; it includes 4 lobes: refusal to nurse/eat, irritability, and CTE is 1.5 times more likely to be seen in frontal, parietal, occipital, and temporal) behavior changes.9 males than females.4 First discovered in the or below the tentorium cerebelli (extension Suggested biomarkers include a brain of NFL Hall-of-Famer, Mike Webster, of the dura mater that separates the CSF:serum albumin ratio (which can in 2002, CTE was subsequently identified cerebellum from the occipital lobes).6 reveal blood-brain barrier dysfunction); in NFL players, wrestlers, hockey players, The pathology of DP and CTE are neuro-inflammatory cytokines such as (Image courtesy of Rovegno et al, 2012) deceased military veterans, domestic thought to involve hemorrhages that are interleukin (IL)-6, IL-8 and IL-10 (typically abuse victims, motor vehicle accident later replaced by gliosis, a degenerative increased after severe TBI); and other outlined in Figure 1. sufferers, and others.5 Bennet Omalu’s story progressive lesion. In 1924, Cassasa acute-phase response proteins.10 Acute Secondary mediators are known to be was portrayed in the 2015 cinematic hit, described these areas like this: axonal injury biomarkers include total tissue-destructive, involving inflammation Concussion, and his growing foundation At autopsy, sections of the brain tau and neurofilament light polypeptide and apoptosis.14 TBI is often associated and published work has continued to showed multiple usually punctate (NFL), which tend to increase 4-10 days with a breached blood-brain barrier (BBB), spread throughout the scientific and hemorrhages scattered over various after injury; these 2 tests are considered which can be accompanied by endothelial medical community. parts of the parenchyma of the brain. most accurate and to correlate with injury. activation and recruitment of white blood cells, as well as microglial activation and Table 1. Possible Clinical Sequelae of TBI6,7,8 migration toward the injury. This can result Unconsciousness (left side injury lasts longer than Behavioral/mood changes (display of pathological Difficulty with memory, concentration, attention, from a number of mechanisms, such as right side) jealousy/paranoia) thinking chemoattractant protein-1 (MCP-1) and cytokines, eg, transforming growth factor- Difficulty with processing speed and executive Cushing’s Triad: Depressed HR, irregular Dilation of one or both pupils (anisocoria) functioning respirations, and increased BP beta (TGFβ). Release of tumor necrosis factor- alpha (TNFα) and IL-1-β in turn promote Alexithymia (inability to identify, understand, Lack of motor coordination/balance Nausea/vomiting process, and describe emotions) increased expression of an intermediate filament called glial fibrillary acidic protein Blurred vision/double vision Ringing in ears Confusion (GFAP). Leukocytes and activated cells Bad taste in mouth Fatigue/lethargy Headache release proinflammatory cytokines, nitric Convulsions Dizziness Sleep pattern changes oxide, and free oxygen radicals, which introduces phenotypic changes called Slurred speech Aphasia, dysarthria Weakness/numbness in limbs “neuroplastic remodeling,” in which Social judgment deficits Concussion, post-concussion syndrome increased branching of dendrites occur to 16 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW AD FORM MUST BE COMPLETED IN FULL

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form new synaptic connections.13 progressive neurodegenerative state in rest, medication, and a gradual transition and Helleborus. Arnica is useful in those Other common features include which tau and amyloid beta proteins back into playing.7 Cognitive rest involves who deny any problems following the intracellular increases in free calcium, accumulate within the tissues over time. avoidance of activities that require extra trauma. Belladonna is useful when there disturbances in ion concentration (eg, These molecular mechanisms have been attention, such as text messaging, video is significant heat, redness, throbbing, increased potassium or decreased shown to be initiated by the extrasynaptic games, television, computer use, or school and fullness in the head after an injury. magnesium), acetylcholine deficiency NMDA activation that produces work. Physical rest is encouraged to avoid Hypericum can be effective in patients (particularly in chronic cases), dynorphin soluble amyloid-beta, and caspase-3 exacerbation of symptoms. NSAIDs, with sharp and shooting pains, spasms, or (an endogenous opioid receptor correlated activation that leads to formation of tau acetaminophen, or amitriptyline may seizures after a head injury. Cicuta is useful with regional neurodegeneration), nitric neurofibrillary tangles.15 As we know, be used for persistent headaches; sleep in cases where seizures occur following oxide (induced by ischemic damage), and amyloid proteinopathy is associated with medications, anxiolytics, and SSRIs may the head injury, or the head injury is severe calcium-dependent cysteine proteases Alzheimer’s disease (AD), and tau-related be utilized for depressive symptoms. enough to have caused mental retardation. including calpain and caspase-3 (which neurofibrillary tangles are associated with Transition back to play is also an important Nat Sulph is useful for long-term are contributors to cell death following Parkinson’s disease (PD). Therefore, CTE part of the process, where it is a step- symptoms following a head injury that TBI).12,15 In more severe TBI, astrocytosis post-TBI can be a concomitant condition by-step process from non-impact to full includes personality changes. Helleborus can lead to tissue scarring, impairing with dementia, AD, and PD. contact over a period of days, with the is useful in a patient that develops severe structure and function of the brain areas patient being in a symptom-free state.7 mental dullness and may talk very slowly involved in the trauma.13 Treatment of TBI after the head injury.17 Another key player is the excitotoxicity Treatment of TBI varies, based on its Naturopathic Approach Hyperbaric Oxygen Therapy (HBOT) and spread of apoptosis endured by the severity. These range from simple measures Our focus as naturopathic doctors is also a useful treatment for TBI. HBOT traumatized tissues. NMDA receptor such as rest in mild TBI cases, to surgery should be on treating with natural involves the medical therapeutic use of activation is responsible for excitatory in more severe cases. Additional acute and anti-inflammatories, adaptogens, oxygen at a high atmospheric pressure. signals. In fact, it has been documented that chronic treatments exist, as well as long- neuroprotective and neuro-regenerative It can be used for both acute and chronic TBI-induced glutamate excitotoxicity is the term rehabilitation options. Initial acute agents, and analgesics. This can be TBI patients; however, some studies have initiating signal for apoptosis of damaged treatments for TBI may include clearing the accomplished through herbs, diet, revealed that it has been more effective in cell membranes. Increased extracellular lungs to aid breathing, maintaining healthy nutraceuticals, homeopathy, and other the chronic TBI patient groups.18,19 glutamate levels activate glutamate circulation to support and protect the brain modalities. Treatments can also be Historically, the Roman Army utilized receptors, leading to intracellular calcium and other vital organs, monitoring heart approached with different strategies herbs as part of their treatment plan for overload, which stimulates mitochondrial rate, medicating the patient to reduce risk in mind. These may include reducing soldiers with TBI. Tea made from Glaucium oxidative stress and activation of the of secondary damage, and removing any the short- and long-term impacts of corniculatum was sometimes used because caspase-dependent and independent blood clots that may result in the patient’s inflammation on brain tissues; supporting it acts as an acetylcholinesterase inhibitor.20 apoptosis, ie, delayed cell death.15 Other life being compromised. Chronic treatment regrowth of brain tissues and optimal A decoction of the roots of Asparagus studies also suggest that a heterodimer and long-term rehabilitation measures can neuronal function; managing peripheral officinalis was used to reduce edema. A formation of pro-apoptotic transcription include assistive technology, counseling symptoms such as tremor, palsy, or mixture of acetum (vinegar) and the juice factors, such as c-Fos and c-Jun, can regulate and/or therapy, medication, physical neuropathy; optimizing circulation to the of the plant Glaucium flavum was used to the expression of genes coding for opioid therapy, or speech therapy.7 brain to reduce inflammation and promote clean the wound area; this was followed by peptides, amyloid beta protein, and nerve regeneration (especially in cases involving a dressing containing a mixture of honey, growth factor, which have been shown to be Allopathic Approach hemorrhage), and managing any associated lint, and Aloe vera. Diet and hydrotherapy overexpressed in TBI.12 Management of a sports-related concussion neuropsychiatric symptoms. also played roles in the treatment plans. TBI and CTE appear to represent a often includes cognitive rest, physical The short- and long-term impacts of In more severe cases of TBI, Papaver inflammation on the brain can be reduced somniferum or Mandragora officinariumwas by plant flavonoids such as anthocyanidins used for analgesia. In patients with weaker from blueberry (Vaccinium macrocarpon), constitutions, Hyoscyamus niger combined glycosylated flavonoids such as ginkgo with Papaver somniferum was sometimes (Ginkgo biloba) flavone glycosides, used as an anesthetic.20 The Wise Choice curcumin (Curcuma longa), boswellia In addition to support with herbs, (Boswellia serata), and omega-3 essential nutrition, homeopathy and hyperbaric For Allergy Relief* fatty acids. Oats Avena( sativa), rich in oxygen therapy, it is important to support calmodulin and phosphatidylinositol, the natural healing process by ensuring can be used to improve nerve function that patients get ample rest and have a and promote regrowth of the brain gradual phase of return to the sports that tissues. Mullein (Verbascum thapsus) they were playing prior to their TBI. And, We Begin contains piscicide, which has analgesic of course, it is vital to initially take a proper effects. Valerian (Valeriana officinalis) has case history and perform a comprehensive With Nature anticonvulsant effects, and Huperzia serrata physical exam in order to gather the has nootropic and neuroprotective effects information that will help determine the and has been seen to potentiate the effects best treatment plan. of acetylcholine. These are all herbs that can be used internally to help manage any References available online at ndnr.com peripheral symptoms.16 External application of St John’s wort Cora Stover, ND, is a doctor of Naturopathic Medicine who provides (Hypericum perforatum) or chili pepper services to the New Haven and Fairfield (Piper frutescens) have both demonstrated counties and is bringing medicine back into the home via home-health. She effectiveness in treating neuropathy. enjoys working with a variety of patients and conditions. Her passions include Herbs such as hawthorn (Crataegus spp), laughing, gardening, learning, and being rosemary (Rosmarinus officinalis), linden mystified by nature and our experiences. (Tilia spp) and ginger (Zingiber officinale) Diana Zitserman, ND, is a licensed naturopathic phy- can be utilized to optimize circulation, sician and acupuncturist, specializing in Whole Person helping to reduce inflammation and Wellness at Collaborative Natural Health Partners in Manchester, CT. After completing her studies at promote regeneration. Rhodiola (R rosea) Pennsylvania State University, Dr Zitserman pursued and ashwagandha (Withania somnifera) may a 7-year research career at Fox Chase Cancer Center, which included 8 journal publications. Furthering her be utilized for their adaptogenic properties medical studies in naturopathy and Traditional Chinese Medicine at the University of Bridgeport, she combined as well as their ability to support the brain her love of science with an innate passion for under- in the case of associated neuropsychiatric standing human interaction, nature, and alternative Allertea supports healing. Dr Z uses natural therapies to create balance symptoms. St John’s wort can also be used and health restoration for people of all ages. a normal healthy for its antidepressant effects. Skullcap (Scutellaria lateriflora), lemon balm (Melissa Radley M. Ramdhan is currently work- response to irritants.* ing toward a Doctorate of Naturopathic officinalis), kava kava (Piper methysticum), Medicine and a Master of Science in Acupuncture at the University of wisewomanherbals.com and Bacopa monnieri are all herbs that can Bridgeport; he anticipates gradua- (800) 532-5219 be utilized as nervines and to manage any tion in May 2018. Serving in the New 16 York Army National Guard since 2012, associated neuropsychiatric symptoms. Radley recently returned from a deploy- Homeopathic remedies that can be ment to Kuwait/Iraq for Operation Inherent Resolve *This statement has not been evaluated by the Food & Drug Administration. 2016/2017. Radley has a passion for and desire to work This product is not intended to diagnose, treat, cure, or prevent any disease. useful for TBI include Arnica, Belladonna, with veteran and pediatric populations. Writing, travel- ing, and playing sports are some of Radley’s pleasures. Hypericum, Cicuta, Natrum sulphuricum, 18 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW AD FORM MUST BE COMPLETED IN FULL

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DAVID NORTMAN, ND sleep study is sometimes ordered in place (MAD), can be used to reposition the Surgical of PSG for the sake of cost-savings and mandible anteriorly in order to expand Surgical options for OSAS may be art 1 of this article covered the convenience. It can detect obvious apneas the airway. Compact and convenient, it is resorted to when other approaches have Ppathophysiology and clinical and hypopneas but may miss subtler compatible with drinking and speaking, is failed or not been complied with. [For presentation of obstructive sleep-apnea airflow restrictions such as RERAs. Its unobtrusive and much simpler to use than a detailed overview of surgical options, syndrome (OSAS). Below, we continue with main drawback is the lack of brainwave a CPAP machine, and can be implemented you might check the book by Fairbanks a description of the sleep study and an monitoring, which means that none of even without a sleep study. It is most et al.2] A popular soft-tissue surgery overview of treatment methods. the findings can be correlated with the effective in milder forms of OSAS and is uvulopalatopharyngoplasty (UPPP), sleep stages, and sleep length (critical in patients with low body mass index although it has a high recurrence rate Laboratory Diagnosis for calculating both AHI and RDI) can (BMI). Although typically less effective and is ultimately not very effective. The primary tool for studying all sleep only be estimated. Thus, it is a suitable than CPAP in reducing arousals, the Maxillomandibular advancement (MMA) is disorders is the Level 1 sleep study, or screening tool for those likely to have higher compliance rate makes it a serious a radical but highly effective surgery that polysomnography (PSG), during which moderate-to-severe apnea, but it cannot contender to CPAP. Oral appliance therapy can be considered when all other options cerebral, respiratory, cardiovascular, be used to rule out OSAS, due to its can be a standalone treatment or a useful have been exhausted. A growing array positional, and other measures of sleep limited accuracy and sensitivity. adjunct to CPAP therapy, as expanding the of surgeries is available depending on quality and behavior are recorded and Another test sometimes used in airway allows for lower CPAP pressure the precise location of airway restriction, interpreted during the subsequent scoring evaluating OSAS is the multiple sleep latency settings and a reduction in pressure-related including septoplasty (deviated-septum of the raw data. PSG reliably detects test (MSLT), which quantifies the degree of side-effects such as mask leakage and correction), tonsillectomy, superficial apneas, hypopneas, respiratory effort- daytime sleepiness. airway dryness. implants to stabilize the soft palate, related arousals (RERAs), and a wealth A MAD is custom-fitted by a dentist radiofrequency ablation of the base of the of other information relevant to OSAS Treatment trained in sleep medicine. The adjustment tongue, and bariatric surgery to address and other sleep disorders. Like all tests, OSAS is readily treatable through a variety period, during which the jaw is gradually morbid obesity. PSG is subject to inter-test variability, so of methods; however, there is no universal protruded to the treatment position, may a single night of testing can occasionally solution for all patients, and the most involve temporary temporomandibular Positional miss OSAS and may need to be repeated.1* common therapies involve an adjustment joint (TMJ) discomfort. Tooth movement The simplest thing a patient can do to If a continuous positive airway pressure period that limits compliance. CPAP resulting in bite alteration commonly improve OSAS symptoms is to manage (CPAP) machine is prescribed, a follow-up therapy is the most popular approach and occurs in the long term, but this can usually one’s sleep position. Moderate neck titration PSG is often performed in order is usually the first and only one offered be managed successfully, and in some cases hyperextension in the supine position, to establish the baseline flow-pressure that to patients. But it need not be the last may even be a desirable outcome. Do-it- using a “contour” or “anti-snore” pillow eliminates arousals; however, since the one, nor does it or any other treatment yourself devices marketed for snoring or or a suitable neck brace may offer relief. advent of automated CPAP machines, this need to be used on its own. A successful sleep apnea should be avoided, as they are Encouraging the patient to side-sleep may step is sometimes omitted. approach to OSAS may require multiple usually ineffective and may cause harm in be a partly effective solution to mitigate The severity of OSAS is commonly solutions, and, as naturopathic physicians, the long term. the effects of gravity on the airway, and graded by the apnea-hypopnea index (AHI) we are perfectly positioned to encourage various worn devices that discourage sleep – a score that reflects the night’s average patients to seek further treatment when the hourly number of apneas and hypopneas; prescribed one has proven inadequate. <5 is considered normal, 5-15 mild, 15-30 moderate, and >30 severe. The respiratory CPAP Therapy disturbance index (RDI), introduced once CPAP was introduced in the early 1980s, upper-airway resistance syndrome (UARS) revolutionizing the treatment of OSAS. was recognized, incorporates (on the Yet despite its unrivaled efficacy among same severity scale) the impact of not only non-surgical solutions, CPAP is poorly apneas and hypopneas, but also RERAs tolerated by many patients. Concerns (ie, RDI = AHI + RERA). Although both include claustrophobia, airway dryness or ALLER G PLUS™ FORMULA AHI and RDI are in current use, the more congestion, increased risk of respiratory standardized AHI remains popular with infection, mask leakage or pressure points, physicians (for guiding treatment) and restriction of movement during sleep, Quercetin, rutin, and citrus bioflavonoids inhibit insurance providers (for determining tooth movement from mask pressure, antigen-stimulated histamine release eligibility for treatment). Yet, just because noise, aerophagia, and, last but not least, Stinging nettle leaf increases antihistamine activity detecting RERAs with sufficient sensitivity interruption to the sleeping partner. and aids healthy immune function is technologically challenging, their impact The required equipment maintenance Bromelain is an excellent anti-inflammatory and should not be ignored, lest “non-OSA” further decreases long-term compliance. OSAS be left untreated.** Ultimately, most patients require weeks of reduces nasal mucus The arousal index (AI) is a measure acclimatization, and many never learn to of sleep fragmentation as reflected in tolerate the treatment. arousals from any cause, so it is up to CPAP comfort has improved over the clinician to interpret the meaning the years, thanks to better mask design, of spontaneous arousals that are not automatic pressure settings, built-in secondary to respiratory or other humidification and heating, and virtually detectable reasons. Some degree of sleep silent operation. In recent years, automatic- S u p p l e m e n t F a c t s Serving size: 1 capsule fragmentation is normal and is likely pressure (Auto-CPAP/APAP) machines Servings per container: 90 Amount per serving %DV aggravated by the polysomnography and bi-level (BiPAP/VPAP) machines, with Vitamin C (as Ascorbic acid) 500 mg 833% Quercetin granulation 150 mg * setup, but it may also be reflective of independent exhalation and inhalation Stinging Nettle leaf (Urtica dioica) 100 mg * Bromelain (2400 GDU/gm) 50 mg * chronic pain or other neurological or pressures, have become available. These Rutin 50 mg * psychological causes. The AI is known to have further improved patient comfort, but Citrus Bioflavonoids (90%) 40 mg * Percent Daily Values are based on a 2,000 calorie diet. increase with age in normal subjects, but access is still limited by knowledge on the * Daily Value not established. definitive normal values have not been part of sleep specialists and by insurance Other ingredients: vegetarian capsules (cellulose and Water) established. In general, sleep data should considerations. Given its high efficacy be interpreted holistically, as the severity when tolerated, CPAP users should be of sleep disturbance depends also on the encouraged to receive proper training and clinical presentation and other factors follow-up, proactively seeking optimal such as severity of hypoxemia, length of settings, masks, and machine types until arousal events, time spent in slow-wave compliance is achieved. Learn more and download information at www.mpn8.com sleep (SWS) and rapid-eye movement To order call toll free (877) MTN-PEAK , (877) 686-7325 (REM) sleep, and frequency of arousals Oral Appliance Therapy [email protected] 1 during these deeper stages of sleep. *** Oral appliance therapy, typically in the These statements have not been evaluated by the Food and Drug Administration. The contents are not intended to diagnose, treat, cure or prevent any disease. A home-based (typically Level 3) form of a mandibular advancement device NATUROPATHIC DOCTOR NEWS & REVIEW APRIL 2018 19 AD FORM MUST BE COMPLETED IN FULL

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in the supine position are available for this somewhat, it remains important to inform 5 is considered normal and treatment Mind, Body, and Spirit purpose. The effectiveness of side-sleeping parents of the benefits of maintaining a will normally not be offered; however, In reflecting on the deeper meaning of should ideally be evaluated through PSG, degree of continuity with ancestral child- in the presence of symptoms related to sleep apnea and breathing difficulties, especially if it is relied on exclusively. As rearing habits. sleep fragmentation, it may be beneficial broadly speaking we may say that it an adjunct to CPAP treatment, positional The growing skull of children offers to reduce the index to <1 through reflects a throat-chakra issue; however, therapy often allows for lower pressure further treatment options beyond those conservative treatment such as oral the fascinating book Messages From The settings and greater comfort. available to adults, namely orthodontic appliance therapy or positional therapy. Body7 offers more specific clues. Here is a expansion of the palate and dental Finally, when diagnostic results are sampling of rubrics: Behavioral arches, with the aim of enlarging the inconclusive, CPAP, oral appliance, or • Sleep apnea: “Maternal deprivation.” They Various behavioral therapies may be upper airway. Orthotropics, an emerging positional therapy can be attempted on are intensely sensitive, fearful and longing effective for addressing OSAS. First and subfield of pediatric orthodontics, aims an empirical basis. for mother love… they dare not express or foremost is weight loss. In overweight to prevent both dental and airway 5. Being offered only a limited range of even acknowledge these feelings out of fear of patients this is a reliable method of issues by optimizing facial growth. On CPAP machines and masks: The patient total rejection and abandonment… they are improving or resolving OSAS, although in the other hand, outdated orthodontic should insist on access to the most so self-suppressing that they are suffocating some cases addressing OSAS first might be methods that involve removing teeth in appropriate setup in order to achieve themselves. [Note that inadequate necessary. order to reduce crowding – a symptom compliance. breastfeeding is a potential contributor Myofunctional therapy (retraining of an underdeveloped arch – can further 6. Not being offered combination therapy to OSAS.] of oral and facial muscles), sometimes exacerbate an already restricted airway. when indicated: CPAP is commonly • Inflammation of the palate: “Life sucks!” combined with a tongue-tie release, is a Certain surgeries available to adults are combined with an oral appliance, and They have intense resentment of their lot in promising and still-evolving approach that not appropriate in children because of the there is a growing array of minimally life. They do not find what has been dealt is highly compatible with naturopathic likelihood of spontaneous resolution over invasive surgical procedures and other them at all to their taste… principles.3 On the do-it-yourself front, time, and mandibular advancement is not potentially useful innovations.6 • Suffocation: “Self-revulsion.” They are nocturnal mouth breathing in adults and usually applicable in a developing jaw. 7. Not having proper follow-up, and “choking to death” on their own guilt older children can be both diagnosed stopping effective therapy: The and shame. They feel that they should be and addressed by taping the mouth with Navigating the System patient may need to be reminded on thoroughly punished or even destroyed for medical tape, ensuring first that the nasal Polysomnography is a reliable and an ongoing basis of the importance of their “sins”… passages are clear. comprehensive diagnostic tool for OSAS, persisting with treatment. Also, patients but due to its cost, access to PSG is tightly considered to have only mild OSAS Such patterns are vital determinants of Pediatric Considerations regulated. Family physicians and dentists are less likely to be supported by the psychic health and well-being. As we hold No age is immune from sleep-disordered continue to be poorly informed about medical system. space for them, let us make room for sleep breathing (SDB). OSAS is more common the prevalence of OSAS and its atypical quality and airway integrity as crucial than supposed in children, and along presentations, and dentists are generally Successful treatment of OSAS factors in the optimal health of the entire with snoring and mouth breathing, not trained in detecting its telltale signs in may precipitate its own psychological human organism. should always be addressed promptly the oral cavity. As naturopathic physicians, challenges, including depression due to the because of their considerable long- we should consider that untreated OSAS, permanent lifestyle change, regret about References available online at ndnr.com term impact on development and even when mild, may be an unrelenting not having begun therapy sooner, and even * Factors such as insufficient REM sleep due 4 behavior. In infants, sudden infant death obstacle to the optimal health that we seek overwhelm from the newly found ability to to sleep disturbance associated with the syndrome (SIDS) may be a consequence for our patients. interact with the world once sleep quality test setting, insufficient sleep in the supine position, variations in neck tilt and head of undiagnosed SDB. Suffice it to say In this vein, sleep dentist Mark has been restored. These will require position, avoidance of medications or alcohol that infants with unreasonable sleep Burhenne has proposed that sleep ability be appropriate counseling support. normally taken at home, and variability of the dysregulation or perplexing ailments considered among the chief determinants condition from night to night, may all conspire to produce a falsely normal score. should undergo a sleep study as part of of health, alongside such measures as Discussion ** In fact, in cases where arousals are detected their overall evaluation. blood pressure and BMI.6 [Burhenne’s Vis Medicatrix Naturae with no corresponding respiratory disruptions The following may be indicative of compact book is a useful initial resource As naturopathic physicians, we tend to (such that not only AHI, but even RDI, is OSAS in children: about OSAS, both as a patient guide and believe that the body possesses a deep normal), it may be worth retesting using more sensitive means. Intraesophageal- • Unusually restless sleep as a basic resource for family physicians.] intelligence that promotes optimal health pressure monitoring is the gold standard, as it • Behavioral issues (including ADD/ Until such a cultural shift takes place, we under optimal conditions. While this is true measures respiratory effort directly; however, ADHD and autism spectrum disorders) can play a valuable role in informing our when these conditions are met during early because it requires a specialized esophageal catheter, it is not performed routinely. Most • Decline in school performance patients about OSAS and helping them development, when they are not it becomes commonly, airflow limitation is measured • Bedwetting to navigate the system. It is also worth apparent that the vis medicatrix naturae using a pressure-sensitive nasal cannula, • Cardiovascular problems developing a proficiency in interpreting operates within constraints set by evolution. where increased respiratory effort is implied by a “flattening” of the roughly sinusoidal sleep reports rather than relying on the Recognizing that nature’s intelligence is normal curve of the nasal-pressure channel. Mouth breathing in childhood may interpretation of a specialist who may be not omnipotent may help us to become An older technology based on a temperature- affect craniofacial development and alter less informed about the patient’s overall more attuned to undiagnosed OSAS in our based flow sensor is still in use, but it is not sensitive enough for detecting subtle airflow the shape of the airway at any point clinical condition. patient population, as well as motivate us limitations.A “normal” AHI or RDI may at times up to early adulthood, such that even a to prevent airway abnormalities in the next mask an abnormally high frequency of arousals during REM sleep; this information is available previously well-formed jaw may fail to Common Obstacles generation through proper education and from a full sleep report. complete its proper development if it The following obstacles are commonly pediatric care. *** In order to perform an independent goes unchecked for a long enough time. encountered: assessment of the sleep data, it is worthwhile When enlarged tonsils or adenoids are to 1. The patient refuses to accept the Tolle Causam obtaining access not only to the sleep report but also to the graphs that summarize the blame, their removal should be considered possibility of having OSAS: Mobile apps From the preceding discussion, it arousal patterns and related metrics. For unless the issue can promptly be that record snoring or restless sleep should be apparent that the etiology of example, a normal AHI or RDI may mask an addressed by other means, as the negative sounds are available and provide more OSAS is complex. The patency of the abnormally high frequency of arousals during REM sleep, or – conversely – the absence of SWS immunological consequences of removal persuasive evidence than the testimony upper airway can be compromised by or REM sleep during the unfavorable sleep- are far less significant than those of mouth of a spouse, although not all cases leave inflammation, tissue enlargement or study conditions may mask respiratory events breathing. Allergies should likewise be an audible trace. laxity, and inadequate development of the that would otherwise have occurred during these stages. promptly addressed for the same reason. 2. Being refused a referral to a sleep study: surrounding bony structures. When we † Along with Mark Burhenne’s aforementioned Habitual mouth breathing that arises The patient may need to find out the consider that each of these is in turn caused book, an excellent introduction for both after a cold, or persists after addressing relevant local regulations and educate by multiple factors, opening the airway patients and physicians is: Park S. Sleep, some other underlying cause, can be the family physician about OSAS.† through naturopathic means alone is often Interrupted. New York, NY: Jodev Press; 2008. addressed through behavioral retraining or 3. Being offered a home-based sleep study: impractical. While it may be tempting specialized dental appliances. This is an acceptable starting point, but to improve sleep quality through the

There is evidence that, much like PSG should still be pursued in case of great variety of tools available to us, the David Nortman, ND, studied at the dental caries, dental malocclusion and a negative result. In addition, despite treatment of OSAS should be focused on University of Toronto before graduat- ing from CCNM in 2004. More recent- palatal underdevelopment are diseases of advances in CPAP machine automation, the airway, even when its compromised ly he completed a master’s degree in 5 Philosophy of Science from Tel-Aviv civilization. The widespread substitution PSG is still considered the gold standard condition might be construed as a University. Dr Nortman has completed of breastfeeding with bottle feeding for calibrating treatment and ruling out symptom of some other underlying cause. extensive training in classical homeopathy, utilizing it to address the full (whether with mother’s milk or formula), more complex SDB. Anatomical causes are generally not spectrum of chronic conditions. He practices locally in Toronto and worldwide on a long-distance basis, and the subsequent consumption of pureed 4. Being told that the PSG result is correctible in adults except surgically, and and serves as a homeopathic consultant and mentor and soft foods that do not require chewing, negative for OSAS: This is a common inflammation, excessive weight, and other to naturopathic colleagues. Dr Nortman has published numerous articles in homeopathic journals and has deprive the jaw of the mechanical forces occurrence and should not be taken soft-tissue concerns are exacerbated by lectured to both lay and academic audiences. Currently, necessary for its proper development. at face value, for reasons discussed the sleep disorder itself and may not be he is writing a book on homeopathy and its interaction with modern science and philosophy. Website: www. Although these trends are reversing above. Moreover, an AHI or RDI of < correctible unless sleep is addressed first. homeopathyzone.com. 20 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW Tolle Totum

Lyme Testing: Pitfalls of the 2-Tiered System Lyme Disease Adding to the challenge of Lyme disease is making a correct diagnosis. According to the CDC, Lyme disease is a clinical A Whole-Person Approach diagnosis, which means it is based on symptoms and other factors rather than DARIN INGELS, ND, FAAEM Chronic Lyme Disease • Cardiac problems: mitral valve prolapse, solely on a lab test. Lab testing for Lyme People suffering from chronic Lyme heart block, heart palpitations, chest pain disease has been woefully inadequate for yme disease has become the fastest- disease can look clinically different, and • Balance or coordination problems decades, due to the poor sensitivity and Lgrowing insect-borne infectious may present with symptoms such as3: • Endocrine disruption: hypothyroidism, specificity of the testing itself. Currently, disease in the United States, Europe, and • Fatigue irregular menses, etc the CDC recommends a 2-tier testing Asia. In 2018, we are already hearing • Abdominal pain and bowel changes system, starting with a Lyme screen test.5 about the rising tick population and the • Memory loss or cognitive impairment The Centers for Disease Control and One study found that in 55 people with expectation that Lyme disease will only • Numbness or tingling of extremities Prevention (CDC) states that up to 10% known Lyme disease, <46% of them had become more epidemic than it already is. • Sensory distortion of skin (burning of people with acute Lyme disease will either IgG or IgM antibodies on their Lyme More than 300 000 Americans and 65 000 sensations), especially in hands or feet go on to develop chronic Lyme disease screen. A good screening test should pick Europeans are affected annually by this • “Wandering” joint or muscle pain or Post-Lyme Syndrome4; however, many up at least 95% of the people being tested epidemic – and these numbers seem to • Light or sound sensitivity Lyme-literate physicians feel this number is for their condition, according to the College climb every year.1,2 • Dizziness or vertigo grossly underreported. of American Pathologists.6 The Lyme The conventional medical • Sleep disturbances screening test does not meet this criterion. understanding of Lyme disease is somewhat limited to those who have acute Lyme disease. In contrast, chronic Lyme disease, or post-Lyme syndrome, has become controversial and has poor consensus among physicians regarding the Supplement Inventory & Dispensing best way to diagnose and treat it. An acute case of Lyme disease consists of symptoms that develop within days Simplified or weeks of a tick bite and which may be treated relatively easily at the outset. A chronic case occurs when Lyme makes its way deep into the system and keeps recurring, possibly with periods of remission. However, both types of Lyme Your customized are misunderstood. online pharmacy Acute Lyme Disease The early acute phase of Lyme disease generally occurs 3-30 days after a tick bite. • Zero shelf space and no overhead Symptoms may include3: • Fever • Ability to earn incremental revenue • Chills • Improve patient outcomes • Pounding, throbbing headache • Persistent, noticeable fatigue • Numbness and tingling • Muscle and joint aches • Swollen lymph nodes Launch your virtual pharmacy • Facial or Bell’s palsy • Erythema migrans (EM) rash (“bull’s-eye today rash”)

The most well-known and characteristic symptom of the acute phase is the EM, or bull’s-eye rash. It begins at the site of a tick bite, and expands until it reaches a diameter of 12+ inches. Rarely itchy or painful, this rash sometimes clears as it enlarges, such that it resembles a target or “bull’s eye.” The presence of the EM rash is pathognomonic for Lyme disease. Although a bull’s-eye rash and flu-like symptoms are classic early signs of Lyme, many people never experience either of these. Some people get vague symptoms (or none at all) and may harbor the infection for years without knowing it. And hundreds of thousands of people have the typical symptoms of npscript.com Lyme without even knowing that they have the disease, until long after it has deeply entrenched itself into their bodies. Lyme disease is called “The Great Mimic” because it resembles numerous other BROUGHT TO YOU BY Natural Partners provides more than 14,000 premium products from hundreds of trusted brands delivered to illnesses. As a result, it is not uncommon you in an efficient and friendly way that you’ll love. for physicians to overlook Lyme disease as they attribute symptoms to something For a complete listing of our trusted brands visit else. Lyme disease has been misdiagnosed naturalpartners.com. To speak with a client care as chronic fatigue syndrome, fibromyalgia, representative call toll free 888.633.7620. multiple sclerosis, mononucleosis, Parkinson’s disease, Alzheimer’s disease, and many other disorders. NATUROPATHIC DOCTOR NEWS & REVIEWNDNR_JR_Ad_7_625x11_NPS.indd 1 APRIL 20182/2/18 3:2721 PM AD FORM MUST BE COMPLETED IN FULL

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In fact, the Lyme screen test may only fighting infection. Long-term antibiotics my clinical practice. I have also found that that help modulate the immune system are pick up about 56% of people who have can also lead to kidney and liver damage, herbs are generally better tolerated than ideal for correcting immune dysfunction. I Lyme disease.7 To make matters worse, the as well as many other harmful side effects. antibiotics, and come with fewer adverse have used low-dose immunotherapy (LDI) CDC guidelines do not recommend doing Although there is evidence that side effects. The 2 herbal protocols I have successfully with hundreds of my Lyme a Western Blot when the Lyme screen is antibiotics can be effective in acute Lyme used the most are Dr Zhang’s Modern patients. Developed by Ty Vincent, MD, negative. Research shows that the Western disease, studies on long-term antibiotic Chinese Medicine protocol and a modified LDI uses homeopathic dilutions of a Lyme Blot is more accurate in diagnosing Lyme use either show no effectiveness at all or form of Dr Lee Cowden’s protocol. nosode to downregulate Th2 responses disease because it looks for very specific limited benefits that stop when antibiotics Dr Zhang is a Chinese medical doctor to Lyme, essentially “turning off” the antibodies often seen in Lyme disease are discontinued. and licensed acupuncturist in New autoimmune reaction to Borrelia spp. This patients but not found in healthy controls.8 York City who developed a series of isopathic approach has helped numerous The Western Blot is the second stage Naturopathic Treatment Chinese herbal formulas to help eradicate Lyme patients overcome their symptoms. of the CDC’s recommended 2-stage In line with the tenets of naturopathic Lyme, boost immune function, improve To learn more about how to do LDI, please testing. This test is also an antibody medicine, the treatment of Lyme circulation, and modulate autoimmunity. visit progressivemedicaleducation.com. test, but measures multiple antibodies disease should encompass the whole When I myself had Lyme disease, his Other forms of immunotherapy, such as associated with Borrelia infection. In 40 person, including diet, lifestyle habits, protocol helped me to get off antibiotics sublingual immunotherapy (SLIT) can help years of research, we have learned that comorbid conditions, immune status, and and dramatically improve my health. Dr modulate regulatory T cells (Tregs) against some antibodies are specific to Lyme, environmental exposure, in addition to Lee Cowden, a cardiologist in Dallas, TX, mold, pollen, dust, or foods, and lower the while others are not. The presence of 23, treating active infection. A whole-body prior to retirement, developed a series of total body immune burden.14 I have found 34, 39 and 93 kd antibodies are strongly approach to Lyme disease addresses many liquid tinctures made from plants from this to be a useful adjunctive therapy in associated with exposure to Lyme and may of the underlying factors that keep people the Amazon rainforest in South America. treating Lyme disease, especially in those suggest infection.9 But since antibodies can with Lyme disease ill. His protocol has been studied at the with a history of allergies prior to being hang around for years, and even decades, University of New Haven by Dr Eva Sapi infected with Lyme. the presence of antibodies does not Diet and has been found to be more effective Detoxification is a limiting obstacle necessarily indicate a current infection. Although many diets have been reported than antibiotics.13 His protocol also helps for many chronic Lyme patients. The Western blot is also highly prone to to help people with Lyme disease, I have eradicate infection, reduce inflammation, Although some patients are genetically false negatives, ie, negative for antibodies personally found an alkaline diet to and improve detoxification. predisposed to being slow metabolizers, despite active infection. This occurs help most Lyme patients. This involves I have also used protocols from Stephen many naturopathic therapies can still because it can take weeks for the body to eating foods that promote better cellular Buhner, Byron White, and a specialty help promote better detoxification and develop antibodies against Lyme, which is alkalinity. There are no specific studies on herbal formula company with unique elimination. Research shows infrared why the CDC does not recommend doing an alkaline diet and Lyme disease, but the products. I prefer the other protocols, as sauna can help eliminate toxic metals a Western Blot test on anyone whose illness few studies published on alkaline diets, I’ve observed greater clinical effectiveness and chemicals stored in the tissues and occurred within the previous month. Other organs.15 The temperature and length of labs tests, including PCR testing and direct treatment should be modified for each staining, have poor sensitivity and poor person according to what they can tolerate, reliability in screening for Lyme disease. The Lyme screen test may only pick up about but regular sauna therapy can improve So, the bottom line is that a negative test many Lyme symptoms. does not exclude the possibility of having 56% of people who have Lyme disease. I also highly recommend colon Lyme disease, but a positive test confirms hydrotherapy, for many of the same exposure to the organism causing Lyme reasons that I recommend sauna therapy. disease. It is important to evaluate lab in general, have observed health benefits, with Dr Zhang’s and Dr Cowden’s It is an effective way to promote better testing in conjunction with a patient’s clinical including reducing inflammation.12 Note protocols; I’ve also seen fewer die-off bowel function and improve motility and symptoms. An individual could have been that following an alkaline diet does not reactions using these protocols, which are elimination. I have had some Lyme patients exposed to Borrelia and never developed change blood pH, as has been purported by common with any Lyme treatment. that failed every therapy they tried except Lyme disease but may still have antibodies some individuals. colon hydrotherapy, which helped them in their bloodstream. This is why it is I recommend eliminating all processed Lifestyle & improve. I recommend 1-2 sessions per necessary to always consider your patient’s foods, sugar, and coffee, and primarily Environmental Control week for the first 4 weeks and to then adjust symptoms before starting any treatment. eating organic fresh vegetables, legumes, In addition to taking antibiotics or herbs the schedule based on clinical response. and nuts. It is also necessary to limit animal to treat the active infection, it is also Conventional Treatment protein to less than 20% of total dietary important to manage lifestyle habits than Summary The conventional medical treatment for intake for the week, as animal protein can undermine your patient’s immune Early detection and treatment of Lyme Lyme disease is a course of antibiotics for breaks down into acid-forming byproducts. system, making it harder to overcome disease gives your patient the best chance up to 3 weeks after diagnosis. This has been For patients who have difficulty making an infection. Getting good-quality sleep, of recovery without future complications. the recommendation of most government, dietary changes, it may be helpful to have getting plenty of exercise (as tolerated), and Many naturopathic therapies can be medical, and public health organizations them work with a nutritionist for meal managing stress all play significant roles as or more effective than conventional in the United States for almost 40 years. planning and guidance. in immune system function. I encourage antibiotic therapy, as antibiotic therapy While mainstream infectious-disease anyone with Lyme disease to eliminate only addresses eradication of the doctors do not generally deviate from Intestinal Health from their home and work environment organism and fails to address underlying the CDC recommendations, others feel Research shows the intestinal tract accounts all toxins and toxicants that are known immune, autoimmune, and detoxification that the standard 21 days of antibiotic for 70-80% of immune function; thus, immune disruptors, in order to optimize dysfunction. Lyme disease is a complex therapy is not enough to defeat Lyme maintaining healthy intestinal permeability, their immune function. illness with more than 100 associated disease. Many doctors who are members balanced microflora, and optimal digestion One of the biggest external factors symptoms, and its prevalence continues to of the International Lyme and Associated is essential for overcoming any chronic influencing Lyme disease is mold. rise. Most naturopathic physicians in North Diseases Society (ILADS) will use longer infection. It is important to ensure proper Mycotoxicity and mold allergy can cause America are likely to see Lyme patients courses of antibiotics, both oral and intestinal motility to prevent dysbiosis symptoms that are almost identical to in their practice at some point, and they intravenous – for weeks, months, or even and mucosal inflammation, which in turn Lyme disease, and many people with mold are well suited, in general, to treat Lyme. years.10 Concurrent use of 3-4 antibiotics is can disrupt normal intestinal function. problems are unaware of their exposure. Following basic naturopathic principles, now common. Comprehensive stool analysis and/or I highly recommend Lyme patients have along with some understanding of Lyme- Most bacteria replicate every 20 organic acid testing can help provide insight their home tested for mold using spore- specific protocols, can greatly improve the minutes, but Borrelia species replicate into specific areas of intestinal function trapping and ERMI (Environmental health of Lyme patients and help them to much more slowly, every 1 to 16 days.11 that are imbalanced. The treatment in this Relative Moldiness Index) to help identify overcome their illness. Since many antibiotics commonly used to area should be specific to your patient, hidden sources of mold, so that it can treat Lyme disease only work when the but I often consider herbs and nutrients be remediated if present. Additionally, References available online at ndnr.com organism is replicating (bacteriostatic), that help promote better motility, reduce urine mycotoxin testing or mold allergy they are not effective when the organism inflammation, rebalance gut microflora, and testing can help establish whether mold is Darin Ingels, ND, FAAEM, is a is in a dormant state, and therefore would treat overgrowth of pathogenic microbes. contributing to one’s health issues. respected leader in natural medicine, take longer to eradicate the infection. Some specific considerations include with more than 26 years of experience in the healthcare field. He is board-cer- Current guidelines from the CDC only magnesium salts, probiotics, glutamine, Immune Modulation & tified in Integrated Pediatrics and is a Fellow of the American Academy of address acute Lyme disease and do not curcumin, and fish oils. Detoxification Environmental Medicine. Dr Ingels has address post-Lyme syndrome at all. Research shows that Lyme disease can been published extensively and is the author of The Lyme Solution: A 5-Part Plan to Fight the Long-term antibiotic use kills off a large Treat Active Lyme Infection trigger an autoimmune reaction against Inflammatory Autoimmune Response and Beat Lyme Disease – a comprehensive natural approach to treating portion of the friendly gut bacteria, which Several herbal protocols have been used to certain neurological proteins, which may the disorder. He specializes in Lyme disease, autism, are necessary for maintaining the health of treat both acute and chronic Lyme disease, account for many of the symptoms of and chronic immune dysfunction. He uses diet, nutrients, herbs, homeopathy, and immunotherapy to help the microbiome and immune system and many of which I have used successfully in post-Lyme syndrome. Therefore, therapies his patients achieve better health. 22 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW Nature Cure Clinical Pearls A Century After the Spanish Flu

SUSSANNA CZERANKO, ND, BBE increase “visible/tangible examples of the the motivation needed to fill the queues Crawford Green, MD, noted, “We saw seriousness of the illness (e.g., pictures at flu vaccination clinics and pharmacies. many sad cases of influenza-phobia among The very old and the very young of children, families of those affected The increased number of billboards and adults, but the fear reached the children, showed themselves, on the whole, less coming forward) and people getting signs this year in my own city, Portland, too. In many cases when they were stricken susceptible. vaccinated (the first to motivate, the latter OR, suggests that we might be faced with a with the disease, they were literally almost Dr Bernard Fantus, 1918, p.635 to reinforce).” (Nowak, 2015) The language repeat epidemic such as the one Americans scared to death.” (Green, 1920, p.1103) used in the media is designed to evoke fear faced a century ago. Eli G. Jones, MD, commented that those None are so blind as those who and terror. An example: “Ten more children who harbored fear were most likely to cannot see that the average mortality have died of influenza in the United Scared to Death contract the flu. (Jones, 1918, p.553) A. H. of influenza patients treated by States this week, bringing the total to 63, Fear as a precipitating factor in the 1918 Waterman, MD, noted, “As in all panics the homeopathic physicians was actually federal health officials with the [CDC] said flu epidemic was noted by many who emotion of fear seemed to kill judgment.” only about one-thirtieth of the average today in their weekly flu update. This flu lived during its reign of terror. At the same (Waterman, 1919, p.379) mortality reported by all physicians. season is shaping up to be a historically time, there was a global war in full throttle, This year marks the 100-year Dr William A. Pearson, 1919, p.11 severe one with no end in sight.” (Brooks, tearing apart families and ravaging Europe. anniversary for the Spanish Flu that 2018) Brooks, an MD who appears to be Within this turmoil the broad spread of effectively terminated WWI and left, by The German aspirin has killed more contributing to this fear generation, has the Spanish Flu took an equally shocking some estimates, between 50 and 100 million people than the German bullets have. posted many similar statements fueling toll. Shortly after this dreadful period, dead. WWI was responsible for 9 million Dr C. J. Loizeaux, Des Moines, ID, 1919, p.589

century ago, the “Spanish Flu” Each softgel ™ Adecimated populations globally. contains: Peak-EPA Flu season 2018 is reminiscent of that 700 EPA NPN 80073318 event, already breaking records, so the 350 DHA Available in 90 & Evidence based highly therapeutic dosing to : claims go, with more North Americans 180 bottle sizes than ever affected, according to media • support the development of brain, eyes and announcements by the Centers for and nerves in children up to 12 years of age Disease Control and Prevention (CDC). • support and promote The H3N2 virus strain has been reported cognitive health by the CDC to cause severe symptoms healthy mood balance that are potentially deadly, especially for • maintain cardiovascular health and reduce vulnerable populations such as children serum triglycerides and the elderly. What’s more, the reports Natural add, the flu shot developed is showing lime • reduce the pain of rheumatoid arthritis essential signs of being less effective this year. oil ﬂ avour (in conjunction with conventional therapy) Messages like these dominate the media, undermining health by spreading fear and worry among the public. However, is this any surprise? This pattern repeats every year, sounding the alarm that every man, woman, and child needs a flu shot.

CDC Fear Mongering Fear of harm is the driving thrust implemented by the CDC and other health system authorities to ensure compliance with the annual flu shot ritual. The flu shot is the colloquial term; however, the CDC refers to it as “immunization,” which is a sanitization of its actual character, a “vaccination.” In this regard, Robert Kennedy reports, “Every year, the Centers for Disease Control and Prevention (CDC) and pharmaceutical companies mount an aggressive campaign in the mainstream media to persuade Americans to get their flu shots.” (Kennedy, 2018) Not surprisingly, “flu shots are big business: industry analysts estimate that within the next five years, the U.S. flu vaccine market will be worth High potency, almost $3 billion annually.” (Kennedy, 2018) Kennedy continues, “As pharmaceutical molecularly distilled EPA:DHA companies bombard American consumers with ubiquitous billboards, drugstore enticements and radio announcements to marine lipid complex ‘get your flu shot now,’ the CDC has advised the industry to hike demand through the use of a ‘recipe’ of scare-mongering messaging.” (Kennedy, 2018) The CDC’s strategy for fostering public interest and high vaccine demand Improving health and wellness…naturally was implemented by Glen Nowak, PhD, Associate Director for Communications at the CDC. In a PowerPoint presentation, he www.cyto-matrix.com formulates the necessary steps required of medical experts and public health authorities to stress the danger of the flu and to urge the American population to get their flu shot. He cites the need to NATUROPATHIC DOCTOR NEWS & REVIEWCyto_PeakEPA_7.625x11.indd 1 APRIL2017-01-10 2018 9:0023 PM AD FORM MUST BE COMPLETED IN FULL

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casualties. Concomitantly, the Spanish Flu chronicles the players who promoted “fever protein. No two treatments could be more during the Spanish Flu was the lack of left behind in its wake devastating and phobia” and who paved the way to view a diverging and opposite than the allopathic drug intervention. Using hydrotherapies unequalled colossal collateral damage fever “as injurious to health, and treatment treatment protocols and those used by the and fasting and hydrating patients – a never before experienced in the world. with antipyretic medication came to be Naturopaths and Homeopaths. reflection of respect for the fever’s role in The symptoms accompanying a considered a necessity.” (Saine, 2017, p.2) When we review the letters and the resolution of illness – was so effective flu are malaise and fever. Both of these The diverging views held by Homeopaths, testaments from Naturopaths reporting that only about 1% of patients died under symptoms cause concern and often initiate Naturopaths, and Allopaths regarding the on their flu cases in Benedict Lust’s the care of a Naturopath. a rapid response by a patient to treat these fever and its treatment were present on the publications, we get a glimpse of what symptoms. Fear of fever is the compelling world stage during the Spanish Flu of 1918. some of their methods entailed, and are Naturopathic Protocols motivation. Infection or other pathologies Different theories, approaches, and statistics soon reassured that flu epidemics are not Lust published letters from practicing accompanied by fever are often the most reveal much when we look at the Spanish destined to resolve in gravesites. Benedict Naturopaths who treated influenza in visible and the target for treatment. Flu, most particularly when we compare Lust published many accounts from his 1918. One such letter from E. P. Kondis, Dr André Saine outlines the historical how this pandemic was respectively colleagues in 1918 and the following ND, a practicing Naturopath from controversies regarding the fever that still handled by these different groups. year. There is a resounding message that Waterbury, CT, who reported that he saw persist after centuries of discourse and Naturopaths had no trouble treating the “58 patients [with the flu], of whom five debate. Naturopaths and early doctors Opium, Ipecac, and Aspirin Spanish Flu patient. In fact, their patients developed pneumonia and no deaths.” responded to the presentation of fever in the The standard of care established by the usually recovered. The typical death toll (Kondis, 1919, p.44) Kondis outlined his spirit of the Hippocrates school, where fever “regulars” included excessively large doses of the regular doctors was colossal; those treatment protocol, which relied upon was “often encouraged and celebrated, as it of aspirin, Dover’s powder, consisting of documented by naturopathic doctors hydrotherapy, dietary recommendations, was seen as the most important of the body’s opium and ipecac, and a strengthening was significantly less. What stands out and herbal remedies. He writes, “For fever, natural defenses.” (Saine, 2017, p.1) Saine diet composed of large quantities of animal in naturopathic patient care outcomes cold application to the head. Hot or cold applications to the body. Cold or hot drinks as lemonade, elder flowers or chamomile tea, etc. Enemas. Sponge bath. Gargle with common salt.” (Kondis, 1919, p.44) His treatment for pneumonia also used cold compresses to the head and chest, and hot applications applied to the feet. (Kondis, 1919, p.44) These treatments used by Kondis supported the patient’s own healing mechanisms, exhibited by the acute symptoms of the flu. William Havard, a Naturopath, writes, “We cannot state too often nor too emphatically that acute diseases are forms of the reaction which the body makes to poisonous or irritating substances and are in themselves healing efforts of Nature.” (Havard, 1918, p.866) He continues, All acute diseases are for this identical purpose, and will only occur in a body containing foreign substance. To endeavor in any manner to suppress the reaction would be working counter to Nature’s method of destroying and eliminating the trouble maker, and will either cause death or at the least serious impairment of organic function and lay the foundation for chronic disease. (Havard, 1918, p.866)

Havard strongly warns against some of the recommendations of the health boards who were so eager to suppress fever with gram-doses of aspirin. (Havard, 1918, p.865) James C. Thomson, ND, DO, a Naturopath and Osteopath from Edinburgh, writes that he saw 87 influenza cases. His treatment protocol included… the application of cold compresses TAKE A DEEP BREATH to the kidneys; the compress was and breathe clearer this allergy season.* changed hourly. In individual cases, compresses were also applied to the Over 50 million Americans suffer from allergy symptoms each year. throat, chest, etc., with occasional Vital Nutrients is proud to offer Aller-C®, a potent combination osteopathic attention. As to the diet, this was reduced while any symptoms formula aimed at supporting respiratory and sinus health, while of discomfort were present―usually promoting a healthy immune system.* Aller-C’s gentle formula two to three days complete fast followed encourages a balanced histamine response and strong, stable by fruit and gradual return to normal. capillaries, without unwanted side effects such as drowsiness.* All recovered quite rapidly, usually in from five to seven days. (Thomson, 1919, p.100) SKU: VNALL Thomson reports that he lost one patient whose “wife and family were very hostile to the Nature Cure treatment.” (Thomson, 1919, p.100) The man was given suppressive drug treatment and hospitalized, and died.

888.328.9992 | vitalnutrients.net Homeopathic Successes Homeopathic doctors practicing in *This statement has not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. 1918 offered patients a hope to survive 24 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW AD FORM MUST BE COMPLETED IN FULL

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the ravaging claws of the 1918 flu. most frequently used remedies: chief medical officer as having the lowest (1919, p.1190) This census, comparing the Homeopaths saved hundreds of lives by Gelsemium 3x: Controlled the death rate in the hospital.” (Harkness, 1919, treatments and outcomes of Homeopaths following and trusting their homeopathic fatigue cases having chilliness, p.587) The effects of aspirin were noted and and Allopaths, was never published. teachings. Dr Green writes, “The moderate fever, sneezing, watery nasal discontinued in this particular hospital, Today, we have the luxury of hindsight homeopathic physicians throughout the discharge. No thirst. Yawning. Drowsy causing a huge decline in the death rate. to see that aspirin was prescribed in toxic country were not following some empty but often sleepless. Deep-seated, dull (Harkness, 1919, p.588) doses, resulting in hiking the mortality fad or fancy that so frequently leads even aching in the limbs and joints. Banded rate of pulmonary edema and pneumonia. homeopathists astray, but by the nature of feeling around head or occiput fullness. Liquid Diet The reliance upon pharmaceuticals has things, were constrained to fall back upon Eupatorium 3x: Marked chill Homeopaths also made dietary not lessened but rather has increased the faith of their fathers, similia similibus followed by fever 103° to 105° F/39° recommendations consisting principally over the past century. Will we one day currentur, and it served them well.” (Green, to 41° C. Pulsating frontal or occipital of fasting or liquids. Green comments, find ourselves scratching our heads and 1920, p.1102) headache. Intense aching in back. Deep “The dietetic treatment of influenza is of mumbling, “What were the scientific Dr William Pearson reports on a survey bone aching. Nausea. Vomiting. Larynx great importance. I know of no disease, doctors thinking?” Dr Andrews of West of Homeopaths who treated influenza, rough, scraping sensation producing not even typhoid, in which a strictly liquid Virginia saw the correlation between a conducted by the Bureau of Homeopathy cough. Oppression of chest with diet is of more importance.” (Green, 1920, common allopathic vaccine, antipyrin, of the American Institute of Homeopathy soreness. p.1102) McCann prescribed an egg white and the increased incidence of pneumonia in June 1919. Two-thousand Homeopaths Bryonia 1x: Much chilliness, with orange juice every 3 hours for the first and fatalities in the 1889 flu epidemic. were sent the questionnaire and all of the frequently with heat in head. Flushed 2 days, adding a vegetarian diet of fruits, Thirty years later, the same pattern repeats reports received were tabulated. The results face and much thirst. Heat more vegetables, and some cereals. Dr J. Johnson with aspirin use and pneumonia and indicated that 26 795 patients were treated internal. Transient sweats of single of Michigan put patients on “a strict diet fatalities. (Andrews, 1918, p.720) There is by the 88 Homeopaths who replied to the parts. Dry cough which yields to blood [keeping] the patient in bed and not allowed a French expression which captures this survey, and the number of deaths totaled specked expectoration. Constriction of to sit up until about two days after the fever sad outcome: “Plus cela change, plus c’est 273 – a 1.06% average mortality. (Pearson, chest and pressure on sternum. The was gone.” (Johnson, 1919, p.1097) toujours le même chose.” 1919, p.11) The homeopathic success symptoms all aggravated by motion… compared with the average mortality rate Desire to but unable to take deep Lessons Lost References available online at ndnr.com of 30% demonstrated that those fortunate breath. (Ward, 1919, p.856) With the remarkable success that enough to be treated by a Homeopath had a Homeopaths had during the 1918 Spanish higher chance of survival. Dr Dudley Williams reports that fellow Flu epidemic, it is puzzling and even

Dr Edward Davis provided a list of Homeopaths practicing in Rhode Island incomprehensible that during the ensuing Sussanna Czeranko, ND, BBE, a hygienic and preventative measures of “found very little variation in the remedial century, Homeopathy – with all of its graduate of CCNM, is a licensed ND in Oregon. Sussanna is a frequent pre- personal cleanliness. He writes, “Urge the treatment of influenza. Arsenic, bryonia, journals, schools, hospitals and MD-trained senter, nationally and internationally. As Curator of the Rare Books Collection at importance of fresh air and the avoidance eupatorium perfoliatum, baptisia, and Homeopaths – would vanish from the NUNM, she is the author of The Hevert of chill and overheat. In fighting the gelsemium seem to be in pretty general healthcare terrain. In the April 1919 issue Collection, a 12-book series about naturopathic medicine, the ninth volume of epidemic give no medicine and use no use, and the opinion was that if the case of the Journal of the American Institute of which is now complete, Mental Culture in Naturopathic Medicine. Sussanna founded The Breathing Academy, treatment which may depress the vital was seen early enough it seldom ran into Homeopathy, a notice posted by the Bureau a training institute for naturopathic doctors to incor- forces, especially the heart of the patient.” pneumonia.” (Williams, 1919, p.1003) Dr of Census appeared, announcing, “A Joint porate a scientific model of breathing therapy called Buteyko into their practice. Her next large project is (Davis, 1918, p.552) Harry Baker, of Richmond, VA, dubbed Influenza Committee has been created to to complete the development of her new medical spa Pearson reported on the nurses “gelsemium as the genus epidemicus and study the epidemic and to make comparable, in Manitou Beach, Saskatchewan – Manitou Waters Centre. She is the co-founder of the International attending to the flu patients that were covered 95% of the cases.” (Baker, 1919, so far as possible, the influenza data Congress on Naturopathic Medicine and the inaugural conference chair of the Healing Skies Naturopathic treated at the Hahnemann Hospital. All p.682) McCann cites his 4 remedies gathered by the Government departments.” Medicine Conference, in Saskatchewan. the nurses “were working day and night that covered uncomplicated cases as without any consideration for their own “gelsemium, bryonia, eupatorium and health, a total of 57 of them at different arsenicum.” (McCann, 1919, p.845) times had to finally go to bed, and a large The complications arising from proportion of these had influenza, but not a allopathic care often prolonged recovery single one of them developed pneumonia.” or else, sadly, compounded the virulence (Pearson, 1919, p.13) of the bacterial infection and escalated Dr T. McCann of Dayton, OH, treated high levels of fatalities. The indiscriminate 1000 cases of influenza. He writes, “I have use and reliance upon “salicyclates, had no losses. I want no credit given me for including aspirin and quinine were almost these results.” (McCann, 1919, p.845) He [Allopathy’s] sole stand-bys.” (Williams, continues, “Given an individual in a fair 1919, p.1003) We now know that the aspirin degree of health when stricken with this dosages during the Spanish Flu exceeded malady, there is no reasonable excuse for safe levels. “On 5 October 1918, The a homeopathic physician losing a single Journal of the American Medical Association case.” (McCann, 1919, p.845) recommended aspirin: ‘The acetylsalicylic Dr E. Jones, a Homeopath who practiced acid may be given in a dosage of 1 gm. (15 in Buffalo, NY, writes, “There is an epidemic grains) every three hours…or a smaller of this disease [influenza] in Buffalo; from dose combined with 0.1 gm. (2 grains) 75 to 100 deaths are reported within 24 acetophenetidin, until symptomatic relief hours.” (Jones, 1918, p.553) Like many of is secured’ (p 1137). These recommended his homeopathic colleagues, Jones had doses (1000–1300 mg), with frequencies considerable experience treating influenza ranging from hourly to every 3 hours, epidemics and had never lost a case of resulting in daily doses of 8–31.2 grams, are influenza in nearly 50 years of practice. above the maximum safe dose.” (Starko, He writes, “[Influenza] is one of the easiest 2009, p.1407) Dr W. A. Dewey of Ann diseases to cure if a doctor knows his Arbor, MI, witnessed cases of “pulmonary Materia Medica.” (Jones, 1918, p.553) edema suddenly brought on by aspirin.” In his paper, which was published by (Dewey, 1919, p.1005) “Cases overdosed 3 principle newspapers, he provides a few with aspirin have most all required sulph. suggestions for treatment: in high potency.” (Gier, 1919, p.1100) If you should have chilly spells, and Dr Charleton Harkness of Chicago, IL, your nose feels stuffed up, great thirst, was one of the medical doctors stationed at very restless and feverish, put five Camp Lee with 60 000 recruits. He writes, drops Tincture Aconite in half a glass “About 15,000 cases passed through the of water, take one teaspoonful every Base Hospital and … there were between hour. Put your feet in hot water, as hot 700 and 800 deaths.” (Harkness, 1919, as you can bear it, keep them in the p.587) Harkness did not use aspirin and water for 15 minutes. Drink plenty of did not have access to his homeopathic hot lemonade. (Jones, 1918, p.553) remedies. He relied upon a few tinctures in his possession, such as gelsemium Dr James W. Ward reports 100% that he diluted. “I had 13 deaths in the recoveries in 182 patients and reveals the 3 six weeks, and was complimented by my NATUROPATHIC DOCTOR NEWS & REVIEW APRIL 2018 25 AD FORM MUST BE COMPLETED IN FULL

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DAVID J. SCHLEICH, PHD O’Neill weighed in at that same family Bonicci could sing “Dark Moon” like Pat trying to understand “kinetic energy” and meeting too. She added, “May the roof Boone. Diane Belaysis liked boys with “latent heat.” I could not get the concepts, ike all professional education above you never fall in, and may your team brains, but the only boy in the class as tall for some reason, and was horrified when Lpreparatory programs, medical never fall out.” Miss Goggin was teaching as she was, was Philip. My point here: she told me to teach “latent heat” back education has 3 tiers, elucidated well by us that day those around us make the best after all these years I remember my Grade to my own team group the very next Donald Schon in his seminal 1986 book, – and sometimes only – teams we have. 6 classmates vividly and we changed, day. Good grief. Educating the Reflective Practitioner. The the whole lot of us. I attribute it to those Let me tell you, though, that in doing tiers include the basic sciences, applied The Team Habit hard-working teams. We were challenged what she advised, I got it. Because I had to sciences, and a practicum of some sort. In It went like that all year long. Mary Goggin for 40+ weeks and the bonds were strong. get ready for the questions and quizzical our field, this translates into discipline- frequently called on the legendary wisdom Early rivalries shifted into very enduring looks of team classmates, I drilled down specific classes in tier 1, such as anatomy, of the O’Neills and others who seemed friendships. Mary Goggin went back to into the topic and was as prepared as I physiology, histology, pharmacology, to have wisdom available to apply to any Ireland at the end of that school year and could be for explaining the notion of how and so on; and applied sciences in tier problem. She admired them so much that was a pen-pal with many of us for years melting (or freezing, if one thought about 2, like botanical medicine, homeopathy she had affixed a picture of a group from and years. I even went to visit her as a it backwards) worked. Miss Goggin had as a medical system, physical medicine, Ireland to the class bulletin board. There young man with long hair on a long trek told us that it was possible to have water etc. In the final tier or stage of medical were 7 in that group, including the O’Neills through Europe. in solid state, and water in liquid state, at education, we conjugate our senior and stolid, unsmiling County Cork farming I remember the very first team task. exactly the same temperature. That it took interns through a challenging clinical people standing in front of a mossy rock We were all poised, thinking we were extra energy to convert water as a solid into regimen. The least common denominator fence. In the center, surrounded by her going to be competing with the other water as a liquid, but that same energy did throughout this process, though, was “life team,” was Mary Goggin holding her teams on some task or challenge. Not! not necessarily increase the temperature a framework designed for individual newly minted teaching diploma, all smiles Miss Goggin announced, on that first of the resulting water, baffled me and, as learners. Translation: “sage on the stage” and light. We didn’t understand the words memorable day when the “team talent” it turned out, baffled most everybody else teaching, passive individualized delivery on the diploma she was proudly holding, got launched, “the best way to learn is in the class too, except Wilfred O’Donnell, and receipt of information and content, but we knew it was official and that the to teach.” She explained that if there was the resident brainiac who invariably and clinical training choreographed by entire group was celebrating: Bilingual something one person didn’t get on any tormented me with questions. By the time autonomous supervising physicians. Clinic I had “taught” this to my team, I had competencies were tested individual by experienced an epiphany. The epiphany individual. We have, though, learned much was in getting it that the heat which broke in the ensuing years about team learning, the force of attraction between particles teaming up teachers, and teaming up We have learned much in the ensuing years was not siphoned off to increase the program design and delivery. A half- kinetic energy of the particles themselves, century back, my Grade 6 teacher, Mary thus no rise in temperature in the melted Goggin, knew that. about team learning, teaming up teachers, and water. Easy. I recall this phenomenon to Miss Goggin was a Commonwealth this very day. Exchange Teacher from Ireland. She had teaming up program design and delivery. A It went like that all year. One time many tales and related counsel gleaned we were debating the notion of “might is from characters who worked the farms half-century back, my Grade 6 teacher, Mary right” in the history of nations. Different and little shops in and around Cahera, teams had different approaches to the Drimoleague and Meenies, tiny villages Goggin, knew that. affirmative and negative of that particular back then in County Cork, where she was conundrum. Miss Goggin often asked from. Our teacher would always draw on one of us to “teach back” to our team that such wisdom from those whom she called week confounding topics like that. Clever “my life team,” and she wanted us to get pedagogy. We all got used to responding in the “team habit” as soon as we could. Certificate, National Schools, AN ROINN particular day, then every team leader had to our classmates’ questions and gradually Smack dab in the first week of that school OIDEACHAIS 1954. She gave us a copy of to “teach” it back to his or her team the kinder teasing. We got so used to not year, in fact, she was introducing us to that picture at the end of the year. What day after she taught it. Duh? She polished learning alone that year, that when Grade 7 the importance of collaborating with each is useful to note is that Miss Goggin came the assignment with, “Mr. O’Neill says rolled around and Mr Whitney Humphrey other. As part of her pitch, she referenced out of a very repressive and controlling that Quinn had to teach him the next sidled into his “sage on the stage” routine, Mr Teagan O’Neill from her own personal educational system at the time. She became day what he didn’t know how to do the we responded by creating learning teams “life team.” We knew that he and his wife a certified teacher, but found her voice and day before.” Duh again. “Like what?” of our own. He didn’t like it too much. Nola were real because their picture was her style as a teacher with the help of many Philip Bonicci wanted to know. But what What that Grade 6 cohort internalized on our class bulletin board. They were local mentors. She had written “Life Team” above if he couldn’t ever get it, we complained? was that we were best together, helping farmers from Cahera who had unerring that picture. She also had affixed a map of “There’s always the next day for teaching each other. We had to get good at figuring advice on most matters. In this instance the County Cork to our class bulletin board, it back, until you do get it,” Miss Goggin out our differences, navigating conflicts, O’Neills’ particular wisdom was related above which map were the words, “The assured us. Teaching it back? talking clearly, avoiding any kind of to Miss Goggin’s comments about how we Centre of The Known Universe.” What? Another of her magic tricks was to have bullying. We got pretty flexible, and would be working in teams all year. She From the get-go, Miss Goggin 2 teams debate an issue, 5 people doing the definitely got good at shifting gears. We further explained that that specific advice organized our class of 35 into 7 rotating research, and 2 people doing the debating did have our wobbles, but because we about teams, when she first heard it back in “teams for life,” as she called them. She from each respective team. We had rotated through many team configurations Ireland, had been directed by “mother and routinely assigned tasks of all kinds to Friday round-robin debates on all kinds that school year, we came out the other father O’Neill” toward their son, Quinn. those constantly shifting teams. Of course, of questions. The winning team, though, side as confident individuals who knew Quinn listened and learned because his we snubbed the Grade 5s and the Grade didn’t get a trophy or something. The how to get together on a task. This parents were very much part of his own 7s and 8s who weren’t doing teams. winning team got more work. They had to attitude and those skills stayed with me. “life team.” Because our teacher was very cool, we also “coach” the losing teams in how they won. For example, the very next year I made the Apparently, Quinn did not want to wondered how long she might last, given At the time we didn’t know that what high school basketball team, even though I farm like his parents and his grandparents the ultra-conservative place our school was. we were doing was learning how to value was short and couldn’t dribble a ball up or before them. Rather, he and his new bride, We recognized that we were lucky to have the concept that collaborating with others down the court very well; what I had was Kate, wanted to open a pub to make their such a different teacher, lucky to be doing was a lifetime skill. We did not know how great accuracy in sinking the ball from living. Miss Goggin reported that Mr and things differently than others in the same special it was, but we did know that it was almost anywhere. I convinced the coach Mrs O’Neill were disappointed. Even so, school. And, as we began that year of teams fun. One day, somewhere along this happy that the team could count on me to deliver they proffered counsel, as any good team and groups, at first we squabbled about continuum, though, I must have exhibited hoops from anywhere. I asked him, member might. Teagen is reported to have which team was on top, which team was on a particularly corrugated brow during one though, if I could count on them to dribble said, “Shearin’ fleece, servin’ beer; s’all the bottom, and who got whom for the team of Miss Goggin’s science lesson on “states the ball and fake out the other team. The same, lad. Don’t matter which, ‘cause you of the day. Gary Enright could do fractions of matter.” She busted me (and others who, tutelage of that 5-foot Irish woman from and Kate’ll be needing a new team who and decimals like nobody’s business. though more skilled at not giving away Cork and all those “sticking together to know what you’re about. They will shorten Wilfred O’Donnell knew history like crazy. their terror at being found out to be not get the work done” stories from farmer the road.” Miss Goggin said that Nola Eileen Demarco could spell big-time. Philip getting it, sighed relief) as I struggled with O’Neill are with me yet. 26 APRIL 2018 NATUROPATHIC DOCTOR NEWS & REVIEW Education

Team-Based Education performance where mutual, rather than reinforcing of what is learned. naturopathic), pharmacists, nurses, social At university I chose a business degree individual, accountability in the landscape The lessons in our health system’s workers, and others sharing responsibility program and brought Mary Goggin’s of medical education obtains. I wondered delivery habits are very tough to for patient care. Team approaches are more magic with me. I soon discovered that team more than once about how to take the grapple with. Solutions include team- valuable than ever. training and team work were hallmarks best of Mary Goggin’s ideas, learned from training, of both teachers and students, You’d swear that some of those who of curriculum delivery in that business Teagan and Nola O’Neill and the other all along the path of their learning have been thinking and writing about the school. Over the years I became aware of farmers near Drimoleague, and apply them and credentialing. For example, power of teamwork in medical education, manifestations of team-based education to what we do in colleges and universities multidisciplinary and team-based groups in fact in education generally, had been and training in all kinds of corners of with teams of academic choir soloists all need to be encouraged more broadly. A in Mary Goggin’s Grade 6 classroom in society, such as the military, emergency over America? splendid example of this is reported by southwestern Ontario back in 1957. responders, community policing teams, Morrison et al (2010) who remind us about fire and rescue squads, event coordinators, Four Stages in Team such a process from the aviation industry,

sales teams, and even political parties. It Development called “crew resource management” David J. Schleich, PhD, is president was, though, when I found my way into Tuckman taught us that the 4 stages in the (CRM). CRM has been very successful and CEO of the National University of Natural Medicine (NUNM), former the medical-education field a quarter- development of a team (forming, storming, in reducing severe aviation errors and president of Truestar Health, and former CEO and president of CCNM, where century back, that I realized there might be norming, and performing) apply as much enhancing industry safety – great goals for he served from 1996 to 2003. Previous some catching up to do. to students as to their teachers. Students medicine too. Clancy and Tomberg (2007) posts have included appointments as vice president academic of Niagara Tuckman’s (1965) early work about in their study groups can assimilate all remind us that this kind of approach is College, and administrative and teaching positions at how teams take shape is as valuable now that information in digestible chunks more very present in American health systems St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic creden- as it was over a half-century ago as a handily, and into the bargain, retain more in something called the “TeamSTEPPS™” tials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s guide to how to incorporate Goggin Magic of it. Furthermore, if we build into the program (Team Strategies and Tools University (BEd), and the University of Toronto (PhD). into medical education, in the sense of process of our delivery opportunities for to Enhance Performance and Patient encouraging such team design, delivery, our learners to reconcile in their own heads Safety). Morrison et al, though, point out and continuous improvement. Whether what they weren’t sure about, we’d be that because students in medical schools REFERENCES our intention is to move toward the notion optimizing learning. The teacher becomes are not officially on hospital teams, they Baker, D. P., Gustafson, S., Beaubien, J., et al. (2005). of “patient-centeredness” as the norm by the student and the student becomes don’t benefit from early team-training Medical Teamwork and Patient Safety: The Evidence- Based Relation.Agency for Healthcare Research and eschewing individual clinicians motivated the teacher, as Miss Goggin used to put and can’t contribute easily to the units Quality, Rockville, MD. Available at: https://archive.ahrq. gov/research/findings/final-reports/medteam/. Accessed by individual achievement, or whether we it. Gagne (1970) and Weber and Karman and departments (such as ORs, labor and January 16, 2018. need principal investigators to collaborate (2005) confirm with their research that such delivery, ICUs, medical center clinics). Duh. Clancy, C. M., Tornberg, D. N. (2007.) TeamSTEPPS: with others to get research questions collaborative learning stimulates more What are those team skills, again, assuring optimal teamwork in clinical settings. Am J Med Qual, 22(3), 214-217. answered, team skills can help. What lies active engagement and better retention that are so important to coordinated Dunnington, G. L., Williams, R. G. (2003). Addressing the before us, notwithstanding the bruising than passive learning anytime. What care? Dunnington and Williams (2003) new competencies for residents’ surgical training. Acad Med, 78(1), 14-21. being applied to the Affordable Care Act’s Teagan O’Neill would say, as reported by summarize them beautifully: “effective Gagne, R. M. (1970). The Conditions for Learning. 2nd Ed. notions of coordinated care and medical Miss Goggin, “If you’ll be wanting to get communication with patients and families, New York, NY: Hold, Rinehart and Winston. homes, is a brave new world of medical more wool from that sheep, ask around patient counseling and education, Schon, D. A. (1987). Educating the Reflective Practitioner: Toward a New Design for Teaching and Learning in the education (and research) where common and go deep; there’s farmers here what cooperative work-sharing with health Professions. San Francisco, CA: Jossey-Bass, Inc. commitment coupled with shared skills, know and will be showing you if you care professionals, and the ability to Tuckman, B. (1965). Developmental sequences in small shared information, and shared goals ask.” In-depth learning, in other words, instruct students and other health groups. Psychol Bull, 63, 384-399. Weber, M. D., Karman, T. K. (1991). Student group can be hugely effective. As Baker et al can be beautifully reinforced by teamwork, care professionals” (p.257). The ACA approach to teaching using Tuckman model of group NDNR 2018-04 (Focus on allergy relief-autoimmunity) - half page.pdf 1 23/03/2018 3:30:41 PM (2005) put it, there is a place for collective collaborative knowledge-sharing, and contemplates doctors (allopathic and development. Adv Physiol Educ, 261(6 Pt 3), S12-S16.

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