by Dr. Talia Marcheggiani, ND | Aug 30, 2015 | Acupuncture, Addiction, Community, Healing Stories, Health, Human Rights, Listening, Medicine, Mental Health, Motivation, Philosophy, Politics, Psychology, Volunteering
I was recently told that a benefactor would contact me about the work I’ve been doing for the Evergreen Yonge Street Mission in Toronto—I provide naturopathic services to street-involved youth twice a month in the drop-in health clinic. There is a natural health company that might be interested in sponsoring some of the naturopathic services. However, in order to understand where their money is going, they want to hear some success stories before they consider if and how much to donate. Are the services working? They want to know. Since I, more than anyone, appreciate the power of a story and, since I’m trying to raise some money to expand the services I provide myself, I thought I’d tell one. Names and details have been changed.
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A shift at the mission lasts a few hours. Youth sign up for the adolescent medicine specialist and her Sick Kid’s Hospital resident, dental work or me, the naturopath, represented under the heading “naturopathic medicine/acupuncture”. There is no money for supplements—and supplements can be expensive—and the youth I treat don’t have money to buy food let alone a bottle of melatonin. So I do acupuncture.
Eduardo was waiting when it I called him. He was lying face up on the bench in the waiting area, looking at a pamphlet on “dope addiction”. He was wearing sunglasses. When he came into the visit, he didn’t take them off, despite the low-level lighting of the treatment room I occupy. It felt strange to talk to someone’s dark glasses, not making eye contact with them as we spoke. I wondered vaguely if I should tell him to take off the glasses, and then left it alone—his comfort as the patient should take priority over mine. Why challenge his autonomy and further push the power imbalance by telling him to do something that was not fully necessary? I worked around the glasses, moving them aside slightly in order to needle the acupuncture point yin tang, located between the eyebrows. The glasses stayed on. So be it.
Eduardo and I spoke Spanish, as his English wasn’t strong. He spoke of feeling shaky, showing me his tremoring hand to prove it. When did the shakiness start? I inquired. When I overdosed on crack, he explained. Well, that would do it, I thought to myself, although you can imagine my clinical experience with crack overdose was limited—there aren’t that many crack overdoses in Bloor West Village.
As it turned out, Eduardo had a significant dependence on marijuana, smoking 7 grams a day while in his home country. When he bought pot on the streets in Toronto, however, he found one deal laced with crack. He ended up in the hospital after smoking it. Another time, his weed was laced with meth.
He held his hand up. I watched it shake. He told me his whole body felt shaky. This would be exacerbated further if he stopped smoking marijuana, he assured me. Had he ever stopped before? I asked. Yes, he said. Why did he stop? I asked him, taking a de-centred approach while staying curious about preferred ways of being. In this case I suspected he preferred to be sober—after all, something had made him stop.
The cost, he explained.
Ah, that, I thought. Well, it makes sense.
Eduardo’s experience highlights the complex relationship people have with substances, and the challenges they face when it comes to finding alternatives that suit their needs. For many, the search for a healthier, more manageable way to deal with stress or cravings can lead them down unexpected paths.
Any other reason? I asked him.
He explained that his family didn’t approve. I asked him why. What might they think of marijuana? What did they see him do when he was high that led to their disapproval. Eduardo couldn’t answer. He changed the subject and explained he’d gone back to weed after quitting it that time because it helped him sleep. Since the episode with the crack overdose, though, sleep was difficult. That’s why he was here: to get acupuncture to help with sleep.
Eduardo spoke in a low voice, often responding with a word or two. Despite the glasses shielding his eyes, he kept his gaze on the floor. When I had him lie on the treatment table, I encouraged him to close his eyes and rest while the acupuncture worked.
After a few minutes, I removed the needles. He thanked me shyly and left. Like many of the people I treat, I figured the odds were high I’d never see him again.
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I was surprised, then, that a month later, I saw him in the waiting area again.
The visit went pretty much the same way as the first with one key difference. The second time he came in, Eduardo removed his glasses, meeting my eyes for the first time.
I was touched.
His sleep was still bad. His mood was still low. He hadn’t smoked crack for a while. He was living in a shelter; his family had kicked him out because of his addiction to marijuana. He implied great trauma in his home country, however he didn’t say much more about it. He mentioned regretting that his English was poor—it had been traumatic to come to Canada.
He told me he was applying for medical marijuana. It would be a safer way to smoke, he told me.
He was practicing harm reduction on himself. I asked him if he considered this “taking steps.” He nodded. I asked him about any other steps he’d been considering. He mentioned swimming. Swimming had been a passion of his in his home country. I got more details about his goals: how often did he want to swim? Where? He decided that 3-5 times a week at the local pool would be ideal. I asked him what he’d first have to do to make that happen. Check the pool times, he answered.
I asked him if he’d ever considered quitting marijuana. He said no, he needed it to sleep and to manage his anxiety. But, you know, it was expensive. And, of course, he repeated, his parents had an issue with it. That was a problem for him. I asked him why it was a problem.
It’s a problem… he repeated. He said nothing more.
We did more acupuncture. He went on his way.
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Two weeks later, Eduardo came to see me again. He took his glasses off as soon as he saw me.
He reported his sleep was better. He had been swimming 3 times a week at the local pool. He hadn’t smoked crack in a month. He’d stopped marijuana the last time he saw me. He hadn’t smoked for two weeks. He showed me his hand. It wasn’t shaking.
Do you think these are positive developments? I asked him.
He shrugged nonchalantly but failed to disguise the smile that tugged at the corners of his mouth. He looked down.
I put in some acupuncture needles and asked him what his next steps might be. He answered that he thought he might call his old boss back and get back to work. Then he wanted to save money so he could move out of the shelter he was in.
He then started to talk a little bit about his brother who was killed in his home country and his friends who’d betrayed him to another gang resulting in him having to flee for his life. He talked about receiving premonitions in his dreams. This made sleep difficult, but it had also caused him to act and avoid harm—he’d learned from a dream that his friends were untrustworthy. We wondered together if this was more than a source of anxiety, but a special skill that kept him safe. Maybe he wouldn’t have to be vigilant if important warnings came to him in his dreams. I wondered if marijuana, along with helping hims sleep had hindered that gift. He thought about that for a while.
When he left he asked me how many more acupuncture treatments he might need. I told him to come in as often as he liked but 8-10 was a good starting point.
Ok, he said, it’s been 3 so far.
Right, I said. It’s been 3.
Ok, he said. See you in two weeks.
He put his glasses back on and walked out into the chaos of Yonge Street. There was a street festival going on.
—
At one point in my time spent with Eduardo, one of the staff at the mission inquired about his mental capacities. Apparently the psychiatrist he’d been working with was considering a diagnosis of mental retardation or severe learning disability–it was taking him so long to learn English and he was often slow to answer questions.
No disrespect to psychiatry: the more I work with mental health, the more respect I have for the utility, albeit limited, of psychiatric assessments and medications. For many people, and when applied delicately and sensitively, these things add powerful meaning and serve as important life savers. However, I want to emphasize the importance of lowering practitioner power, understanding the challenges another person may face in their life and respecting the autonomy, decision-making power and special skills of the individual who seeks health care. In addition, rather than looking for the problem in the person, what success stories are they bringing forth? What goals have been set and what steps have been taken already?
I often comment that the stories I hear and the conversations I have in the work I do are not the least bit depressing. Sure, the youth have dark, complicated, often horrific pasts. However, every individual is a collection of hopes, dreams, goals and personal strengths and abilities. Every person that comes to see me wants something more for themselves and has already exercised an ability to move closer to their preferred ways of being in the world, showing me the incredible capacity for human strength and endurance. The only difference, between the perspective I get to enjoy and the one seen by other health professionals, however, is that I look for stories of strength. Because strength is always there, waiting for a thoughtful question to bring it into the light.
To contribute to the Yonge Street Mission naturopathic services and for more information on the campaign, please click here. Donations are made in USD.
by Dr. Talia Marcheggiani, ND | Aug 25, 2015 | Botanical Medicine, Cold and Flu Remedies, Detoxification, Digestion, DIY, Fertility, Herbalism, Hormones, Medicine, Mental Health, Mind Body Medicine, Recipes, Skin health, Women's health
As a student of naturopathic medicine, I didn’t quite get herbs. They were natural, sure, but why would I prescribe them in lieu of homeopathy, dietary changes or nutritional supplements? I didn’t get it.
I liked herbs; I understood the idea of synergy—the fact that the effect of the entire plant is greater than the sum of its parts. Also, I knew that plants often have superior effects to some drugs in that they often contain active ingredients that balance the side effects otherwise caused by most pharmaceutical medications. For example, anti-inflammatory herbs like turmeric and licorice root also support and strengthen the immune system, rather than suppress it, as most anti-inflammatory drugs tend to do. For most drugs that lower inflammation, a common side effect is severe immune deficiency. This is not the case for herbs that lower inflammation, which actually benefit the immune system. So, I knew herbs were cool.
I also liked the idea that each tincture was individually created for the totality of symptoms a patient presented with. Creating a specific medicine for each individual seemed to fit with the idea of singularity in medicine, which I resonated with. However, for a long time I didn’t get herbs. And I’ve often been reluctant to prescribe herbs in my practice.
First of all, I don’t have my own dispensary so sending patients off to buy tinctures created a kind of disconnection from the source of my prescriptions. Secondly, as many of you who have tried it can contest, tinctures (or herbs extracted in alcohol) taste terrible and make compliance hard, even for myself. Thirdly, tinctures are quite expensive. Each 50 ml of tincture can cost upwards of $5 making a month’s supply of herbs quite costly. This is funny because many of the herbs that are so costly to buy grow like weeds in southern Ontario (dandelion, for example, is often considered a weed) and tinctures aren’t that difficult to make. Fourthly, I didn’t like to prescribe tinctures because, as I understood it, people would only feel better while actively taking the herb. In my mind, the herb worked like a drug in that once you stopped taking it, the positive effects would diminish. This differed from my understanding of homeopathy, which stimulates the body to heal itself, correcting nutritional deficiencies or looking for and treating the root cause of symptoms. I doubted whether the way we were taught to prescribe herbs did in fact treat the root cause. This is important because the guiding principles of naturopathic medicine dictate that we aim to do this whenever possible.
I had no doubt, however, that herbs were effective. Taking a tincture seemed to be far more effective for me and the patients I treat than taking supplements. Herbs are nutritional—they are a food and a medicine and therefore contain a myriad of health benefits beyond treating what they are prescribed to treat.
It wasn’t until I read author and herbalist Matthew Wood’s works on herbalism that I began to internalize the idea that herbs do in fact stimulate the body to heal itself. Plants contain an inherent wisdom, according to Wood and his studies in western and Native American herbalism. Plants eradicate disease by stimulating the healing powers of the body and strengthening the body’s capacity to heal itself from disease. The body is constantly trying to heal itself from ailments and, when these processes become blocked for one reason or another, disease symptoms begin to manifest. Herbs can strengthen the body’s healing processes, when prescribed in a certain way, and large doses for long courses of time are not necessary. Further, once the disease is eradicated, the herbs can be stopped. When prescribed as a healing catalyst, disease doesn’t return once the herbal prescriptions have done their work.
Wood writes, “It should be understood that herbs can be used either way: to stimulate the self-healing powers of the organism to return to health, or to artificially manipulate the organism to fit an artificial goal.” He uses the examples of goldenseal, which at high doses can kill bacteria or viruses that have invaded the body and in smaller doses can increase the mucosa and digestive systems of the body to rid itself of the invaders and, in turn, strengthen the body against future invasions.
In regards to the cost of herbal tinctures, there are relatively simple ways to get the effects of herbs by making your own tinctures.
Read on to support liver detox, hormonal health and cardiovascular health by creating your own rosemary tincture using dried rosemary, one of my favourite herbs of the moment, and a bottle of white wine:
Rosmarinus officinalis, is the latin name for rosemary, a member of the mint family. While better known for its ability to perfectly complement roast chicken, it has a number of health benefits. Rosemary’s energetic actions are stimulating and warming, according to Matthew Wood. It clears up phlegm and dampness, stagnation and sluggishness in the tissues.
Rosemary has the ability to boost metabolism and increase the absorption of sugars and fats, which make it an appropriate nutritional supplement for people with diabetes. It can help drive glucose into the cells, diminishing the need for the body to release large amounts of insulin, re-sensitizing cells to insulin and lowering blood sugar. It can help nourish the entire body and has a special affinity for the heart, lungs, spleen, liver and kidneys.
Rosemary is currently often used to detoxify toxic, exogenous estrogens from the body while promoting the conversion of health-promoting estrogens in the liver. It is a powerful stimulator of liver detoxification. It therefore serves as a cheap and useful remedy for seasonal, full-body detoxes or coming off oral contraceptive or synthetic hormones, such as the fertility drugs given before IVF treatments. It is also useful for promoting circulation and lymphatic drainage, moving sluggishness and excess weight and creating warmth and vitality in the body’s circulatory systems.
Herbalists use rosemary tincture or oil applied topically to the head and neck to treat migraines from tense shoulder and neck muscles. Its scent is aromatic and stimulating and can improve memory and cognition. It is an effective remedy for mental-emotional depression when taken internally, especially where patients feel damp, sluggish, lack motivation and experience feelings of mental dullness.
As a digestive aid, rosemary can help relieve abdominal bloating and flatulence. It also helps stimulates appetite. It helps burn up phlegm in the stomach and can aid in weight loss.
In addition, rosemary contains antimicrobial properties, meaning it can be used to kill bacterial and viral infections, especially when taken at the beginning of a cold.
It is a powerful heart tonic, especially where there is edema and circulatory stagnation, such as early signs of congestive heart failure. It also can help with arthritic pains and joint stiffness when applied topically to joints or taken internally as an anti-inflammatory.
In Matthew Wood’s book, The Practice of Traditional Western Herbalism, he recommends creating a rosemary infusion (infuse fresh leaves and flowers in a pot of boiled water and keep covered) or a tincture using white wine as the alcohol base.
A few days into taking this tincture (mixed with a little water to dilute the strong taste), I’ve noticed my skin clear, my digestion improve, my stomach flatten (I no longer have any bloating and I’ve been experimenting with eating wheat again for the first time in years), and my energy increase. My symptoms of PMS this month subsided before my period even came. I had a canker sore in my mouth that immediately went away once I started taking rosemary wine. I’ll certainly be adding this cheap and effective DIY remedy to my self-care and general health-promoting regime.
Here’s how to make your own.
Rosemary Wine:
Ingredients:
1 handful (approximately 250 ml) of rosemary leaves, dried, cut up as small as possible (you can use a packet of rosemary spice from the grocery store). Extra points for organic.
1 bottle (750 ml) of white wine (Wood recommends a good quality wine, I used a cheap homemade one I was given as a gift).
1 empty glass bottle/jar
Directions:
Put rosemary in the empty glass jar. Pour entire 750 ml bottle of white wine over rosemary and let stand in a cool, dry place for 2-3 days. Then strain out the herbs and store the liquid tincture in a cool, dry, dark place, like a cupboard.
Talk to your naturopathic doctor about appropriate dosing, though most botanical prescriptions involve 1 tsp of tincture 2-3 times a day away from food. This will vary according to your health challenges and health goals, among many other factors.*
Reference:
Wood, Matthew. 2004. The Practice of Traditional Western Herbalism: Basic doctrine, energetics and classification. Berkeley, California: North Atlantic Books.
*This article is not to be confused with medical advice from a licensed naturopathic doctor. If you suffer from one of the above-mentioned conditions and believe rosemary might help, please book an appointment to receive an appropriate assessment.
by Dr. Talia Marcheggiani, ND | Aug 1, 2015 | Botanical Medicine, Detoxification, Diet, Digestion, Education, Food, Health, Home Remedies, Letting Go, Self-care, Weight Loss
I feel sorry for the digestive tracts of this nation, I really do. The owners of these digestive tracts have my sympathy as well—there really is nothing so bad as pooping too much or not pooping enough. Sometimes it’s hard to know which one is worse. Having regular and healthy bowel movements (1-3 times a day) is an essential foundation of good health—regular elimination helps us remove toxins and waste from the body, keeping us energized and well.
A series of patients often come through my office with chronic constipation that is unrelieved by supplements and diet. Most people are getting enough fruits and vegetables or have added more of these foods to their diets and still have a hard time keeping things moving in the lower abdominal quadrants. Since promoting healthy motility is often about daily self-care practices, I’ve complied my list of constipation home-care protocols here, for easy reference. While there are herbs and supplements that can improve motility, add fibre and draw water into the colon and promote healthy elimination, there are also foundational daily practices that must be incorporated as well.
Water:
A no-brainer: we all know that if stools are dry and hard to pass, we need to increase the lubrication of the digestive tract. Gradually increasing your fluid intake by one glass (250 ml) of water per day per week will help your body adjust so that you’re not sent running to the washroom every ten minutes.
Most importantly, however, I like to tell my patients to start the day with a large glass (500 ml) of room temperature water, consumed at once, first thing in the morning. This stimulates the gastrocolic reflex, by filling the stomach with water. In a healthy digestive tract, the contents of the intestine should move through the gut and enter the colon over night where they await the morning meal. Stimulating digestion by ingesting a modest amount of water first thing in the morning can stimulate the contraction of the colon and encourage a bowel movement. Keeping water warm or at room temperature, rather than cold, prevents the water from seizing up the body’s sphincters and allows things to keep moving. This practice also guarantees half a litre of water consumption a day, which we know is essential for proper colon health.
Listening to the body:
Slow motility is often a response to lifestyle. Our bodies send gentle cues to our conscious brains that it’s time to have a bowel movement and oftentimes these cues are ignored. Perhaps we’re in traffic, or rushing out the door, or in a meeting. Perhaps we’re afraid to use the washroom at work, where the acoustics are less-than-ideal. However, when we ignore the calls of nature, we often miss our chance to have a bowel movement for that day. If this has become a reality for you, some bowel retraining might be in order. Bowel retraining involves picking a time of day when it would be most convenient to have a bowel movement—right after breakfast is often a good time—and sitting on the toilet for 10 to 20 minutes. This daily practice will help teach your bowels when a good time to go is, as well as make you conscious of making daily elimination a priority. Think of it as “potty training” for adults.
Fibre:
We all know that regular bowel movements require an adequate amount of dietary fibre. Fibre creates bulk in the intestines, feeds healthy gut bacteria and increases stool weight. A healthy diet contains at least 25 grams of fibre a day from whole food sources. However, when it comes to constipation, not all fibres are created equally. While soluble fibre, from things like chia seeds, oats and legumes has been shown to decrease cholesterol absorption in the gut, it can actually serve to bung us up more. Insoluble fibre, like the kind found in apple skins, flax and wheat bran, can help bulk up the stools and keep things moving smoothly along the digestive tract.
To increase insoluble fibre in the diet, I recommend 2 tbs of ground flaxseed (you can add it to smoothies, morning cereal or the morning 500 ml glass of water) a day. This not only helps promote bowel movements, it also provides healthy omega 3 fats and estrogen-balancing properties for healthy hormones.
As fibre needs to absorb water in order to promote healthy excretion, it is important to prioritize fluid intake. A study involving 63 participants showed that the more fibre they consumed, the more constipated they became. The researchers likened this phenomenon to a traffic jam—add more cars and you simply worsen the traffic jam. Therefore, it’s important to keep the gut sufficiently lubricated to encourage proper motility.
Castor oil packs and self-massage:
Castor oil can help promote smooth muscle motility when applied topically to the abdomen. I instruct patients to massage a liberal amount of oil over the entire abdomen (bra-line to underwear line) and either place a hot water bottle over the area for one hour or leave the oil on overnight. Self-massage paired with castor oil are effective at helping things move more regularly throughout the night. A word of caution, however: castor oil should not be used in pregnancy and before an expected menstrual period as it can stimulate the contraction of the uterus. Castor oil also has the potential to stain clothes and bedsheets, so take extra care.
Pelvic tilt:
A few years ago, the Squatty Potty was all the rage. This new, rather expensive tool, claimed to change the angle that the legs make with the torso, encouraging pelvic floor muscle relaxation and relaxation of the muscles around the anal sphincter. The principles makes sense—we humans have evolved to evacuate our bowels in a squatting position. This increases abdominal pressure and causes puborectalis muscle relaxation, allowing us to have a strain-free experience. The modern toilet, however, does not encourage this angle, which the makers of Squatty Potty claim is the reason that constipation issues are so rampant in Western society. I encourage purchasing a 1-ft high washroom stool to place under the feet while going to the washroom to promote proper posture and sphincter opening.
Exercise:
Daily exercise promotes bowel movements by increasing metabolism, increasing intra-abdominal pressure and strengthening abdominal muscles. Getting 30 minutes of moderate exercise (walking, swimming, cycling, etc.) and performing squats are excellent ways of promoting healthy elimination.
Talk to your naturopathic doctor:
Supplements such as magnesium, vitamin C, probiotics and certain herbs such as burdock, peppermint, chamomile and chicory can also help with constipation. Talk to your naturopathic doctor about what doses, brands and supplements are right for you. Acupuncture and hydrotherapy are also useful treatments. Try to avoid methods that only offer temporary relief from constipation, such as laxative use. These can help in the short term, but like most short-term treatments, can worsen symptoms in the long term and further exacerbate your efforts to promote healthy bowel movements over time.
by Dr. Talia Marcheggiani, ND | Jul 31, 2015 | cancer, Detoxification, Endocrinology, Fertility, Health, Hormones, Preventive Medicine, Sexual Health, Weight Loss, Women's health
I’ve been noticing a trend in my practice, which places an emphasis on women’s hormonal health and mental health. Many women are consulting me for treatment of anxiety and panic attacks that have shown up in addition to other hormonal symptoms: painful periods, PMS, headaches, loss of libido, acne and weight gain. It just so happens that these women have also, for either treatment or contraception purposes, inserted a Mirena IUD, an intrauterine device that secretes small amounts of progestin (a synthetic form of progesterone) into the uterus.
The monograph for Mirena—produced and supplied by Bayer Pharmaceuticals—claims that Mirena is 99% effective for preventing unplanned pregnancy. Bayer informs us that Mirena can last in the uterus for up to 5 years and eliminates the need for daily pill-popping or condom use (although it does not protect against STIs). In addition, it is also an effective treatment for heavy menstrual bleeding. This explains why many women with gynaecological conditions, like endometriosis or fibroids, are recommended the Mirena IUD for alleviating symptoms of painful and excessive menstrual flow. Bayer’s claims, which are backed by evidence, make sense, especially when we consider that fibroids and endometriosis are estrogen-dominant conditions—adding more progesterone to the mix should help to “balance” things out. Incorporating a progestin-secreting device that acts on the uterus can help oppose the estrogen dominance that exacerbates the symptoms of these conditions.
The problem (of course there’s a problem, we’re talkin’ Pharma here) with Mirena is this: while the progestin exerts its effects locally, it does not act on the rest of the body. This may not be a “problem” with a capital P, if we understand that oral contraceptives that contain high progesterone are usually responsible for the “crazy” feelings women have when going on birth control—a lot of the “irritability”, weight gain, water retention and depression that women experience premenstrually is due to high levels of synthetic progesterone. However, we also know that progesterone, whose primary job is to maintain the uterine lining during pregnancy, has positive systemic effects. These effects include promoting mental relaxation and opposing estrogen dominance symptoms, which include weight gain, anxiety, panic attacks, fatigue, PMS, breast tenderness, acne, fibrocystic breast changes, cervical dysplasia, infertility, risk for certain cancers including breast cancer and cervical cancer and worsening of endometriosis and fibroids, which ironically happen to be the two conditions that the Mirena IUD is prescribed to treat.
Estrogen dominance is often not about having high levels of estrogen, but normal estrogen levels with insufficient progesterone to oppose some of its effects. Progesterone deficiency can look like estrogen dominance, when we examine a patient’s symptoms.
In my practice as of late, I’ve had a stream of women presenting with anxiety, panic attacks and heart palpitations that I strongly suspect are hormone-related. When I send them for blood work or salivary hormone tests I find that their progesterone levels are very low. They also may have symptoms of painful menstrual periods, stubborn weight gain and acne. And, you guessed it, all of them have the Mirena IUD. Many patients vaguely remember that symptoms began to rear their ugly heads, or worsen, after they got the IUD. Other colleagues have commented on observing the same trend in their own practices. Could the phenomena be linked?
There are several possible explanations for the progesterone deficiency/estrogen dominance phenomenon in clinical practice—these include, but are not limited to, chronic stress, vitamin deficiencies, impaired liver function or bowel function and exposure to exogenous estrogens such as BPA (found in plastic bottles, personal care products, the lining of tin cans and receipts, to name a few). Yet it seems that Mirena is a common factor in the majority of the cases I’m seeing. The possible reason is that, although Mirena provides progestins to the uterus, its hormones do not reach progesterone receptors in other areas of the body, for example the breasts, adipose tissue or brain, where progesterone normally will have an effect. While oral contraceptives act by preventing ovulation (some women don’t even menstruate while using the IUD), which in turn prevents the secretion of natural progesterone from the corpus luteum (formed in the ovary after ovulation), many of them also supply a dose of synthetic progesterone. Since the Mirena IUD only secretes progesterone to local tissues and therefore only acts at local receptors, it may be turning off the body’s ability to secrete natural progesterone—negative feedback loops might instruct the pituitary gland and the adrenal glands to stop making the body’s own progesterone.
As an naturopathic doctor, it can be hard to know where to proceed! I can try to balance hormones naturally with herbs that help promote an increase in progesterone production. I can also treat the adrenal glands so that they are able to produce more natural progesterone, rather than favouring cortisol production. However, not only might my efforts be fruitless, they may interact with the IUD’s contraceptive effects. I can try to promote the healthy excretion of estrogens by promoting liver detoxification and colon elimination, but the practice calls to mind an image of cleaning a dirty river while sewage pipes deposit their waste into it. How can my patients help their bodies clear out excess hormones while we both ignore the fact that the cause of hormonal deficiency may still persist?
While I sympathize with the allure of a hassle-free family-planning method and relief from the symptoms of heavy and painful periods, I can’t help but shudder when I see the often debilitating anxiety that my patients who use Mirena are presenting with. With regards to birth control, I have written in the past about healthy OCP practices and finding the right hormonal fit. There are also other, natural methods of family planning available, copper IUDs (however, there are other issues with the secretion of copper to local uterine tissue as well) and physical barriers. While other options may not be as convenient, or even as effective, they may promote a healthier hormone balance and improved overall health. It’s worth having a conversation with your doctor about options.
With regards to treating heavy menstrual bleeding with Mirena, natural alternative solutions are abundant! Naturopathic medicine offers a large array of therapies and treatment protocols aimed at treating the root cause: promoting healthy detoxification and elimination, supporting adrenal glands and balancing hormones through diet and nutrition. Not only does Mirena pose the potential for furthering hormonal imbalances, it covers up and even potentially exacerbates the underlying cause of why the symptom is happening in the first place, which is likely a case of estrogen dominance.
For treatment of hormonal conditions—endometriosis, fibroids, heavy and painful menstrual bleeding, PCOS, acne, weight gain and so on—I encourage you to explore natural options. In the meantime, I’ll have to figure out how to address my patients’ concerns while navigating against the current of synthetic hormones.
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If you’re reading this because something about your experience with Mirena hasn’t been fully explained, and you want a clearer, calmer way to understand what your hormones are doing over time, I created Rhythm & Flow, an integrative hormone education course.
It’s not about fixing yourself or chasing symptoms. It’s an orientation to how hormonal systems work across cycles, contraception, stress, and life stages, so changes stop feeling random and start making sense.
by Dr. Talia Marcheggiani, ND | Jul 20, 2015 | Art Therapy, Community, Creativity, Docere, Education, Emotions, Empathy, Finding yourself, Healing Stories, Health, Medicine, Mental Health, Mind Body Medicine, Mindfulness, Narrative Therapy, Philosophy, Politics, Psychology, Relationships, Self-reflection, Treating the Cause, Volunteering
As a child, I was obsessed with stories. I wrote and digested stories from various genres and mediums. I created characters, illustrating them, giving them clothes and names and friends and lives. I threw them into narratives: long stories, short stories, hypothetical stories that never got written. Stories are about selecting certain events and connecting them in time and sequence to create meaning. In naturopathic medicine I found a career in which I could bear witness to people’s stories. In narrative therapy I have found a way to heal people through helping them write their life stories.
We humans create stories by editing. We edit out events that seem insignificant to the formation of our identity. We emphasize certain events or thoughts that seem more meaningful. Sometimes our stories have happy endings. Sometimes our stories form tragedies. The stories we create shape how we see ourselves and what we imagine to be our possibilities for the future. They influence the decisions we make and the actions we take.
We use stories to understand other people, to feel empathy for ourselves and for others. Is there empathy outside of stories?
I was seeing R, a patient of mine at the Yonge Street Mission. Like my other patients at the mission health clinic, R was a young male who was street involved. He had come to see me for acupuncture, to help him relax. When I asked him what brought him in to see me on this particular day, his answer surprised me in its clarity and self-reflection. “I have a lot of anger,” He said, keeping his sunglasses on in the visit, something I didn’t bother to challenge.
R spoke of an unstoppable rage that would appear in his interactions with other people. Very often it would result in him taking violent action. A lot of the time that action was against others. This anger, according to him, got him in trouble with the law. He was scared by it—he didn’t really want to hurt others, but this anger felt like something that was escaping his control.
We chatted for a bit and I put in some acupuncture needles to “calm the mind” (because, by implication, his mind was not currently calm). After the treatment, R left a little lighter with a mind that was supposedly a little calmer. The treatment worked. I attributed this to the fact that he’d been able to get some things off his chest and relax in a safe space free of judgment. I congratulated myself while at the same time lamented the sad fact that R was leaving my safe space and re-entering the street, where he’d no doubt go back to floundering in a sea of crime, poverty and social injustice. I sighed and shrugged, feeling powerless—this was a fact beyond my control, there wasn’t anything I could do about it.
The clinic manager, a nurse practitioner, once told me, “Of course they’re angry. These kids have a lot to be angry at.” I understood theoretically that social context mattered, but only in the sense that it posed an obstacle to proper healing. It is hard to treat stress, diabetes, anxiety and depression when the root causes or complicating factors are joblessness, homelessness and various traumatic experiences. A lot of the time I feel like I’m bailing water with a teaspoon to save a sinking ship; my efforts to help are fruitless. This is unfortunate because I believe in empowering my patients. How can I empower others if I myself feel powerless?
I took a Narrative Therapy intensive workshop last week. In this workshop we learn many techniques for empowering people and healing them via the formation of new identities through storytelling. In order to do this, narrative therapy extricates the problem from the person: the person is not the problem, the problem is the problem. Through separating problems from people, we are giving our patients the freedom to respond to or resolve their problems in ways that are empowering.
Naturopathic doctors approach conditions like diabetes from a life-style perspective; change your lifestyle and you can change your health! However, when we fail to separate the patient from the diabetes, we fail to examine the greater societal context that diabetes exists in. For one thing, our culture emphasizes stress, overwork and inactivity. The majority of food options we are given don’t nourish our health. Healthy foods cost more; we need to work more and experience more stress in order to afford them. We are often lied to when it comes to what is healthy and what is not—food marketing “healthwashes” the food choices we make. We do have some agency over our health in preventing conditions like diabetes, it’s true, but our health problems are often created within the context in which we live. Once we externalize diabetes from the person who experiences it, we can begin to distance our identities from the problem and work on it in creative and self-affirming ways.
Michael White, one of the founders of Narrative Therapy says,
If the person is the problem there is very little that can be done outside of taking action that is self-destructive.
Many people who seek healthcare believe that their health problems are a failure of their bodies to be healthy—they are in fact the problem. Naturopathic medicine, which aims to empower people by pointing out they can take action over their health, can further disempower people when we emphasize action and solutions that aim at treating the problems within our patients—we unwittingly perpetuate the idea that our solutions are fixing a “broken” person and, even worse, that we hold the answer to that fix. If we fail to separate our patients from their health conditions, our patients come to believe that their problems are internal to the self—that they or others are in fact, the problem. Failure to follow their doctor’s advice and heal then becomes a failure of the self. This belief only further buries them in the problems they are attempting to resolve. However, when health conditions are externalized, the condition ceases to represent the truth about the patient’s identity and options for healing suddenly show themselves.
While R got benefit from our visit, the benefit was temporary—R was still his problem. He left the visit still feeling like an angry and violent person. If I had succeeded in temporarily relieving R of his problem, it was only because I had acted. At best, R was dependent on me. At worst, I’d done nothing, or, even worse, had perpetuated the idea that there was something wrong with him and that he needed fixing.
These kids have a lot to be angry at,
my supervisor had said.
R was angry. But what was he angry at? Since I hadn’t really asked him, at this time I can only guess. The possibilities for imagining answers, however, are plentiful. R and his family had recently immigrated from Palestine, a land ravaged by war, occupation and racial tension. R was street-involved, living in poverty in an otherwise affluent country like Canada. I wasn’t sure of his specific relationship to poverty, because I hadn’t inquired, but throughout my time at the mission I’d been exposed to other narratives that may have intertwined with R’s personal storyline. These narratives included themes of addiction, abortion, hunger, violence, trauma and abandonment, among other tragic experiences. If his story in any way resembled those of the other youth who I see at the mission, it is fair to say that R had probably experienced a fair amount of injustice in his young life—he certainly had things to be angry at. I wonder if R’s anger wasn’t simply anger, but an act of resistance against injustice against him and others in his life: an act of protest.
“Why are you angry?” I could have asked him. Or, even better, “What are you protesting?”
That simple question might have opened our conversation up to stories of empowerment, personal agency, skills and knowledge. I might have learned of the things he held precious. We might have discussed themes of family, community and cultural narratives that could have developed into beautiful story-lines that were otherwise existing unnoticed.
Because our lives consist of an infinite number of events happening moment to moment, the potential for story creation is endless. However, it is an unfortunate reality that many of us tell the same single story of our lives. Oftentimes the dominant stories we make of our lives represent a problem we have. In my practice I hear many problem stories: stories of anxiety, depression, infertility, diabetes, weight gain, fatigue and so on. However, within these stories there exist clues to undeveloped stories, or subordinate stories, that can alter the way we see ourselves. The subordinate stories of our lives consist of values, skills, knowledge, strength and the things that we hold dear. When we thicken these stories, we can change how we see ourselves and others. We can open ourselves up to greater possibilities, greater personal agency and a preferred future in which we embrace preferred ways of being in the world.
I never asked R why the anger scared him, but asking might have provided clues to subordinate stories about what he held precious. Why did he not want to hurt others? What was important about keeping others safe? What other things was he living for? What things did he hope for in his own life and the lives of others? Enriching those stories might have changed the way he was currently seeing himself—an angry, violent youth with a temper problem—to a loving, caring individual who was protesting societal injustice. We might have talked about the times he’d felt anger but not acted violently (he’d briefly mentioned turning to soccer instead) or what his dreams were for the future. We might have talked about the values he’d been taught—why did he think that violence was wrong? Who taught him that? What would that person say to him right now, or during the times when his anger was threatening to take hold?
Our visit might have been powerful. It might have opened R up to a future of behaving in the way he preferred. It might have been life-changing.
It definitely would have been life-affirming.
Very often in the work we do, we unintentionally affirm people’s problems, rather than their lives.
One of the course participants during my week-long workshop summed up the definition of narrative therapy in one sentence,
Narrative therapy is therapy that is life-affirming.
And there is something very healing in a life affirmed.
More:
The Narrative Therapy Centre: http://www.narrativetherapycentre.com/
The Dulwich Centre: http://dulwichcentre.com.au/
Book: Maps of Narrative Practice by Michael White
by Dr. Talia Marcheggiani, ND | Jun 9, 2015 | Art, Balance, doctor as teacher, Evidence Based Medicine, Medicine, Mind Body Medicine, Naturopathic Philosophy, Naturopathic Principles, Patience, Patients, Philosophy
In most service industries, there are certain guarantees. If you go to a restaurant, your soup is guaranteed. At the GAP, you will get a pair of chinos, guaranteed. In lots of instances, you get what you are paying for and in most cases, you get to see if before you hand over your credit card—a coffee, a massage. In many cases, if you’re not satisfied, you can get your money back—guaranteed.
This is not the case in medicine. We cannot legally guarantee results. There are no guarantees.
Everybody and every body is different. Contrary to what it might seem like in our age of paralyzing fear of uncertainty, no one has all, or even most, of the answers.
Dr. Google makes it seem like we do, though.
When I see a new patient who is worried about their health and their future, I want to be able to promise them. I want nothing more than to say, “these breathing exercises will eliminate your anxiety, just like you asked for: poof! gone.”
I want to guarantee things.
I want to tell someone that, if they follow my instructions, they’ll never have another hypertensive emergency again. I want to, but I can’t. No one can. And our job is not to guarantee. It is to serve.
A $10,000 bag of chemotherapy pumped into your arm will not guarantee that the cancer goes into remission no matter how many studies show it has an effect. I can’t promise you’ll get pregnant, even though I’m doing my best, you’re doing your best and science is doing its best.
That’s all I can guarantee: that I will try my very best.
I can be your researcher, teasing out the useful scientific information from a sea of garbage and false promises—false guarantees from those who have no business guaranteeing anything. I can provide my knowledge, culminated from years of study and practice and life. I can sit with you while you cry and hear you share your story. I can let you go through your bag of supplements, bought in a whirlwind of desperation, and tell you what is actually happening in your body—something that doctor didn’t have time to explain. I have time to spend with you. We can have a real conversation about health. I can also make recommendations based on my clinical experience, research and millenia of healing practices. These recommendations will certainly help—virtually everyone sees some kind of benefit—but I can’t guarantee that either.
I watched a webinar on probiotics recently. The webinar sent me into a spiral of existential probiotic nothingness. I’ve been prescribing probiotics for years. I’ve seen benefits from them with my own eyes. Patients have reported great things after taking them and I feel better when I take them: my stomach gets flatter, things feel smoother, my mood gets lighter. Probiotics are wonderful. However, according to the research that was being presented by this professional, which he’d meticulously collected and organized, many things we thought about probiotics aren’t true. I’d have to change my whole approach when it came to probiotics, prescribing certain strains for certain conditions where they’d seen benefit. I remember feeling hard-done by by the supplement companies and the education I’d gotten at my school. How could we be so off base on this basic and common prescription?
At the same time, some skeptics were harassing me on Twitter, telling me that I’d wasted 4 years, that naturopathic medicine is useless and doesn’t help people. Besides having helped numerous people and having been healed myself, their words got to me. What if everything I know is as off-base as my previous knowledge on probiotics was?
The very next day, I called a patient to follow up with her. She’d kind of fallen off the radar for a while. She was happy to hear from me. I asked her how she was feeling, if she’d like to rebook. “I don’t need to rebook,” She told me, excitedly, “I’m completely better!”
After one appointment.
I was astounded and intrigued. Of course, we expect people to get better, but it takes time to heal, and I rarely go gung-ho on the first appointment, there was still lots left in my treatment plan for her. She’d been experiencing over seven years of digestive pain, debilitating fatigue, life-changing and waist-expanding cravings for sugar. It takes a while to reverse seven years of symptoms. It takes longer than a couple of weeks. But her symptoms were gone. She felt energized, her mood was great and she’d lost a bit of weight already. She no longer had cravings.
And she’d just started on one remedy.
Which was, you guess it, probiotics.
Sure, you might think. Maybe it wasn’t the probiotics, maybe she would have just gotten better on her own. Possible, but unlikely. She’d been suffering for years.
Ok, then, you say, maybe it was a placebo effect. Maybe it wasn’t the actual probiotics. Again, it’s possible. She’d tried other therapies before, which hadn’t worked, however and she “believed” in them just as much as the probiotic. And the probiotic made her better.
The point is this: we don’t know. Science is magical. People are magical. Medicine, which combines science with people, is the most magical of all. There are no guarantees.
The point is that anything can make anyone feel better: a good cry, a $10,000 bag of chemotherapy, journalling for 12 weeks or popping a probiotic. Some things have more research behind them. Some things we’ve studied and so we know some of the mechanisms for why things work. But we still have a lot of why’s and we always will. Everybody and every body is different. No two people or two conditions should receive the exact same protocol or supplement or IV bag or journalling exercise or cry-fest. We have no guarantees what will work or what will make you feel better. Just some research papers, some experience, maybe the odd dash of intuition or interpersonal connection and a firm resolve to want our patients to get better. And that’s a guarantee.
by Dr. Talia Marcheggiani, ND | Jun 8, 2015 | Canadian College of Naturopathic Medicine, Clinical Science, Evidence Based Medicine, Preventive Medicine, Professional Development, Research, Robert Schad Naturopathic Clinic, Science
Sigh… I just finished reading a rather annoying article in the Globe and Mail (don’t even bother to click and add more Google street-cred, seriously) that doesn’t really warrant a response but… here we go. It’s my day off.
The article was written by one Carly Weeks, who doesn’t seem to have a very positive view of naturopathic doctors. I don’t know Carly and have no idea about her health history, but I’m going to take a shot in the dark and imagine she hasn’t suffered from chronic eczema.
Let me know how that steroid cream works out for ya, Carly!
But, ad hominem aside, her issue with naturopathic doctors this week(s)—pun intended, aren’t I hilarious—is, what else: we’re a bunch of quacks who use nothing but false therapies and smooth-talking to coax our patients into thinking they feel better. Well, if that worked, I wonder why more healthcare practitioners don’t try copying those moves too. It might save the government some money, which is what, coincidently, naturopathic medicine is already doing and it’s not by false therapies and smooth-talking. (But we do make time for a lot of talking).
The Globe piece begins with a story about how physicians (not naturopaths, for the record) prescribed radioactive water in the 1920’s. It’s a cute and tragic story about limited safety profiles. And other than its juxtaposition in an article about NDs, I’m not sure what the writer’s point was. We don’t use radioactive water to treat anyone. If you want radiation, which is a therapy, a cancer treatment, then you must see an oncologist. Talk about throwing out babies and bathwater.
The article is largely about how naturopathic doctors are moving under a new regulatory board, under the Regulated Health Practitioners Act. This limits our scope compared to that of provinces like BC or certain US states, where naturopathic doctors have been prescribing drugs and even performing minor surgeries safely where it’s warranted.
Here are some facts:
Naturopathic medicine is incredibly safe. We are trained in conventional diagnosis, anatomy, physiology, physical exams, including gynaecological exams, breast exams and digital rectal exams. We have the ability to perform acupuncture in Ontario and give intramuscular injections. With additional training we can provide IV treatments. We are trained to order and interpret labs and to take blood. I will not deny that conventional medicine and pharmaceuticals have saved millions of lives. However, we know that 10,000 yearly deaths in Canada (and 100,000 in the US) are due to pharmaceuticals alone. A year ago I wrote a post talking about the off-label birth control pill Diane-35. Let’s not start comparing safety profiles here.
Naturopathic doctors are highly trained and educated: We have completed a 4-year very rigorous program that includes a 12-month internship where we treat patients in an out-patient facility. In our training we performed over 100 practical and written examinations. After our second and fourth year we complete two licensing exams, which span a course of 5 full days of examinations combined. Ask anyone I know if what I did was easy. Trick question: they wouldn’t know because they didn’t hear from me for the past 5 years–I was studying the WHOLE time. It’s ok, though, because now I know a lot.
Naturopathic medicine is a regulated profession: In order to practice in Ontario naturopathic medical graduates who have passed both licensing exams, must pass a series of board examinations that are both written and practical. We then must enter into a month-long application process, which includes a police background check and character reference check. If I try to delay treatment of an emergent condition or treat an emergent condition with something like homeopathy or acupuncture (effective treatments for other conditions, but not emergent, life-threatening ones), which is something we are often accused of potentially doing, my licence will be removed. It’s not something we do—it’s that simple. We are held accountable and have a lot of responsibility to deliver safe care.
Naturopathic doctors are health experts: In order to complete the naturopathic medical program we complete 1200 hours of clinical training and 3000 hours of classroom training. This does not include study time for our board exams and pursuit of side interests or continuing education credits that are required to maintain licensure. We are trained in nutrition, which many medical professional, including medical doctors, are not. Naturopathic doctors often see patients that have been failed by the conventional medical system, which means we deal with complex cases on a regular basis. This demands that we keep our skills sharp and our knowledge current.
Naturopathic medicine provides the public with an amazing service that patients are willing to pay for: We spent up to two hours at time with our patients, educating them on any topic of their health picture: the medications they’re on that their doctors don’t have time to discuss with them, their health conditions, their prognosis and what else they can do about it. I spent half an hour talking about an STI a patient of mine had been diagnosed with. She’d seen two doctors and a specialist. None of them had talked to her about it. Patients have told me their doctors no longer perform physicals. Well, we do. And, it turns out, people pay for excellent care. Naturopathic medicine provides the much-needed service of patient education, human-centred care and prevention of disease. It’s an excellent complement to an effective whole-person healthcare strategy.
Naturopathic medicine works: I could say more on this but let’s keep it brief: if it didn’t work, people wouldn’t pay for it. The Globe and Mail, more than anyone should know to “let The Market speak.” (Amiright?) I lied, I will say more. If you don’t think naturopathic medicine works, then call my patients who no longer have chronic pain or allergies or chronic constipation. Ask my patient who couldn’t conceive how her daughter is doing. Blah blah, we help people.
Naturopathic doctors prefer to work in collaboration with other healthcare professionals: Ideally each patient should be managed by a healthcare team. When I start seeing a new patient I immediately establish a relationship with his or her medical doctor. I refer out for labs and to specialists if necessary. Medicine should be integrative, not alternative. Patients shouldn’t be forced to choose.
In addition to accusing us of being a bunch of unsafe quacks, the author writes, “Ontario should have created a regulatory system based on the principle of evidence first.” So, there you have it. Only medicine that is based in evidence should be regulated by the province.
Wow, what a ridiculous statement made by someone who I imagine knows little to nothing about how medicine and so-called “evidence” works.
Firstly, there is more than one type of evidence. In fact, evidence is a hierarchy. At the bottom we have things like clinical case reports or expert opinion, what my friends the skeptics love to call “anecdotal evidence.” Sigh. If you’ve seen something work, you keep doing it. It’s not the best evidence we have, but it’s still evidence. The better forms of evidence, randomized control trials, are being done on naturopathic therapies and naturopathic therapies have been found to hold steady. Actually, many of the therapies we prescribe are done precisely because there is evidence to support it: fish oil for depression and bipolar disorder? Inositol for fertility in patients with PCOS? Evidence, evidence, evidence.
Secondly, only 10% of medical guidelines are based on the type of “evidence” that our friend Carly Weeks is likely referring to: the Randomized Control Trial, which involves comparing two groups: a treatment group to an inactive group that gets something like a placebo. Well, it turns out, we just don’t have that much “evidence” of this sort to dictate what happens in medicine. A tourniquet for a bleeding wound? Using general anesthetic rather than nothing? These things haven’t been compared against placebo. What is the other 90% of medicine based on? Expert opinion: a nice mixture of clinical expertise, intuition, common-sense, “what the heck, might as well try it it couldn’t hurts” and research. I don’t see Carly questioning the use of SSRI for mild and moderate depression or beta-blockers to prevent cardiac events as a result of high blood pressure, both of which have “no evidence” to support their use. Nope, just crickets when it comes to those topics.
Thirdly, the father of EBM, or Evidence Based Medicine, himself, Dave Sackett, said, “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.” (Emphasis mine). Individual clinical expertise from both modern and traditional medicine, the best available external evidence and tailoring treatments to individuals patients needs and preferences? Sound like naturopathic medicine to me.
Naturopathic medicine is safe and effective. We have a patient-centred approach and offer wonderful service for the cost, which is often covered by insurance benefits. Naturopathic doctors take the time to listen to your story and educate you on what is happening in your own body. We treat the root cause of your condition, rather than masking symptoms. We are highly-trained healthcare professionals and we are regulated. Soon we will be moving to different regulation. However, the government will be removing some of the rights we’ve had, which include ordering certain lab tests that we’ve safely ordered for years. If you use or support naturopathic medicine, please click the link to sign the petition to maintain the current naturopathic scope of practice in Ontario and support safe and effective natural healthcare for all Ontarians.
Quack.
by Dr. Talia Marcheggiani, ND | May 24, 2015 | Art, Balance, Canadian College of Naturopathic Medicine, Creativity, Education, Exercise, Family, Finding yourself, Happiness, Healing Stories, Health, Ideal You, Letting Go, Listening, Medicine, Meditation, Mental Health, Mind Body Medicine, Mindfulness, Motivation, Patience, Personal, Psychology, Relationships, Self-care, Self-reflection, Stress
According to James Altucher, author and entrepreneur, it is possible to reinvent yourself in 5 years. In his book, The Power of No, he tells us how to reinvent our lives by first saying a big, fat No to all the things that don’t serve us—toxic friendships and relationships, stagnant 9-5’s, harmful behaviours, negative thought patterns and, well, just things we simply don’t want to do—in order to free up our lives for greater happiness, abundance and creativity.
It is now the end of May. For me, May has been a month of reinvention. For the past 10 years it has been the month of closing and good-byes, specifically the end of the school year. The Canadian College of Naturopathic Medicine class of 2015 has graduated, as I did last year. Last week my Facebook feed was infiltrated with pictures of flowers, long black gowns and tearfully heartfelt thank-yous to the friends and family that got my colleagues through their gruelling 4 years of naturopathic medical education. Last year that was me—I remember the black gowns, the face-ache from smiling, drinking a little too much at grad formal and winning an award (“Most Likely to Write a Best Seller”—complete with misspelling of “bestseller”) while eating Portuguese chicken at my house afterwards with my friend F and his family. This year, one year later, I watch these events from afar. May 2014 offered new beginnings and chance for reinvention. I was dating, enjoying the sunshine, looking forward to a trip to India, looking forward to beginning a practice as a naturopathic doctor. Mostly, last May was about the death of one life—that of a naturopathic student—and the birth of a new one: a complete reinvention.
This year the rest of my life stretches before me like one long expansive road. My career is underway. My dating life is stagnant. The next steps are more like small evolutions rather than massive, monumental milestones. I most likely will not don a black gown again, but I can reinvent myself by following the 20 steps below. I can always check back into these practices when I’m feeling stuck, alone or afraid. When life is not going my way, there is always a chance to begin a reinvention of some sort. And, I remind myself, my current reinvention is likely well underway. Since I graduated last May, I have been in the process of reinventing: just 4 more years left until I complete my obligatory 5. While 4 years sounds like a long time, I know from experience that 4-year cycles turn over within the blink of an eye.
What stage are you on in your own personal reinvention? Wherever you are, follow these steps to reinvent yourself:
1) Say no. Say no to all the things that you don’t want to do. Say no to things that cause you harm: emotional harm, mental harm, physical harm, loss of time, loss of money, loss of sleep. We need to say no first before we can free up the time and energy to say yes to the things that we actually want. In fact, say “no” to all the things you aren’t saying “F#$% YES!” to. Read this article for more information.
2) Re-examine your relationships. Who doesn’t make you feel good? Who makes you doubt yourself? Who do you feel will reject you if you act like your true self around them? Gracefully begin to distance yourself from these relationships. You might feel lonely for some time, but loneliness is sometimes a good thing.
3) Clear out your junk. Get rid of everything you don’t use, don’t like and don’t need. Marie Kondo, in the Life-changing Magic of Tidying Up, tells us to donate, trade, sell or dispose of everything we own that doesn’t bring us joy. I think that that is a wonderful litmus test to decide what we should be holding on to. Personally, one thing that did not bring me joy was an awful old desk in my room. It was uncomfortable and ugly. I replaced it with a free desk someone I knew was throwing away. I also donated 7 garbage bags of things: books, clothes and keepsakes from when I was a child. Since then, I feel like my room has been infused with a little bit more joy. Remove all your joyless items from your life and observe how your energy changes.
4) Sit in silence. This could be meditation, staring at the wall, chanting or simply breathing. Do it with eyes closed or open. I start at 20 minutes of meditation—a meditation teacher I had told me to always use a timer to increase self-discipline—and work up to 30 some days and an hour on really good days. Start with 5 minutes. Sitting in silence helps to quiet the mind and bring us back to the present. You’ll be amazed at what you discover when you sit in silence. Read some books on meditation or take a meditation course for specific techniques, but simply sitting in silence can offer amazing benefits as well.
5) Explore the topics that interested you as a child. When I got back into painting in 2008, after getting a science degree when I’d always been interested in the art, my life changed a little bit. I started a blog in 2011; it happens to be the one you’re reading now. Get back into whatever you were passionate about as a child, even if it’s just a cartoon you used to watch.
6) Start a gratitude jar. Once a day write down something that you are grateful for—use as much detail as possible—and toss it in a jar or shoebox. When you’re feeling low, open up the jar and read the messages you’ve left yourself. I also tried a similar exercise with things I wanted to manifest or achieve. A few months later I read my entries and realized I’d achieved every single one. It’s amazing what kind of energy glass jars can attract.
7) Read. According to James Altucher, you need to read 500 books on a given topic in order to become an expert on something. You have 5 years to reinvent yourself, so start your reading now. Read one book and then, from that book, read another. It’s interesting where reading trails can lead us. I read one book, which mentions another book, read that book and then end up in a new world I never knew existed. I personally feel a little anxious when I don’t have a book beside my bed, but if you’re new to reading, start small. There are two books that I’ve already mentioned in this blog post; start from either of them and then go from there. The next on my list is The Artist’s Way, by Julia Cameron, which was mentioned in The Power of No. Who knows where that one will lead me.
8) Get 8-9 hours of sleep a night.
9) Eat your vegetables, especially leafy greens. Avoid sugar, moderate alcohol and caffeine. Eat healthy protein and healthy fats (if you don’t know what those are, welcome to my blog! browse more of my articles on healthy eating or book an appointment with a naturopathic doctor like me!—shameless self promo).
10) Exercise. Enjoy some movement every day.
11) Exercise your idea muscle. According to James Altucher, creativity is a muscle that we need to exercise lest it atrophies, like any other muscle. He recommends getting a journal and writing 10-20 ideas in it every day. They don’t have to be good ideas, just any ideas. Removing the filter of self-judgement is important for allowing creativity to flourish. We need to strengthen that muscle.
12) Get some psychotherapy. Start dealing with childhood wounds and meeting your inner critic. Address your erroneous beliefs about yourself, the world and the past. Contact me to learn where to get quality psychotherapy in Toronto at an affordable price.
13) Expand your social circle. If you find that after following step 2 your social circle has gotten smaller, start to find ways to expand it. My favourite way to reinvent my social interactions, and thus begin to reinvent my life, is to look up a meetup.com group and start attending. If you’re not sure about a meet-up group you’ve attended, give it 2 more tries before deciding not to go back. In 3 tries, you’ve either made new friends and connections or decided that the energies of the group aren’t right for you. Online dating is another cool place to start meeting people outside your social sphere and getting over social anxieties.
14) Establish a self-care routine. What would someone who loved themselves do every day? Try to do at least some of those things every day. It could be going for a 15-minute walk before doing the dishes. It could be doing the dishes rather than leaving a messy kitchen for your more tired future self. Think about what things will make you feel good and then do them. Most of the time this involves bubble baths—light some candles while you’re at it. Read this article on self-care to learn more.
15) Write a Have-Done List. Instead of writing a list of things you have to do today—your standard To-Do List—write a list of things you’ve done at the end of every day. This fills people with a sense of accomplishment from looking at everything they’ve done. It definitely beats the stress and anxiety of looking at the list of things that must get done looming before them.
16) Treat other people as if it were their last days on earth. We’ve all been told to “live each day on Earth as if it were your last.” But what if you lived as if each day on Earth were everyone else’s last? You’d probably treat them a little more nicely, be open with them, be honest with them and not gossip or speak badly about them. You might appreciate them more. The idea is James’, not mine, but I like it. I think it’s a good rule for how to treat people.
17) Pay attention to what you’re jealous of and what you despise in others. The things we are jealous of in others are often our disowned selves. If I’m jealous of my friend’s Broadway debut I’m probably disowning a creative, eccentric and artistic side of myself that it’s time I give love and attention to. The things we’re bothered by in others often represent our shadow sides, the negative things we disown in ourselves. I used to tell myself the story that my ex-boyfriend was selfish; he took care of his needs first. However, maybe I just needed to start taking care of my own needs or come to terms with my own tendencies towards selfishness. Our negative emotions in relation to others can provide us with amazing tools of enlightenment and prime us well for our own personal reinventions.
18) Let go of the things that were not meant for you. Past relationships, missed opportunities, potential patients that never call back, “perfect” apartments, etc. Say good-bye to the things you don’t get. They’re for somebody else. These things are on their own journeys, as you are on yours. If you miss one taxi, know that there are other, probably better, ones following it. So, rather than wasting time chasing after the missed taxi, meditate on the street corner until the next one comes along.
19) Listen. Ask questions. Show curiosity. When someone finishes speaking to you, take a breath and count to 2 before responding. It’s amazing how your relationships change when engaging in the simple act of listening. I love the Motivational Interviewing technique of reflective listening. In reflective listening, we repeat back the other’s words while adding something new that we think they might have meant, looking for the meaning between the person’s—your friend’s, patient’s or client’s—words. I find that this has helped the person I’m speaking with feel truly listened to. If I get the meaning wrong, it gives the other person a chance to correct me and thereby ensure that we’re really communicating and understanding each other. This one simple tool—reflective listening—has transformed my naturopathic practice and interviewing skills.
20) Be patient. Personally, I’m terrible at this. But, like you, I’ll try working on the other 19 steps while I wait for the next stage of reinvention to take hold. I’ve ordered my next book from the library. See you all in 4 years.
by Dr. Talia Marcheggiani, ND | May 16, 2015 | Autoimmune, Beauty, Diet, Digestion, Education, Food, Food Sensitivities, Hair, Health, Hormones, Natural Body Care, Nutrition, Self-care, Women's health
This is likely one of the shallowest posts I’ll ever write—it’s about hair. However, what is so shallow about hair? We all know the importance of having a good hair day. It seems from the moment we wake up, look in the mirror and notice that our top bun has left proper, succulent waves and not weird, irregular angles of frizz, that the rest of the day will be infused with magic. Our hair plays a huge role in who we are and how we see ourselves. When movie characters want to change their identities, the first thing they do is stash themselves in a truck stop bathroom with a box of hair dye and go to town on their manes. Further, and admittedly sticking to the shallow side of things, I’m often suspicious when every photo of a man on Ok Cupid shows himself wearing a hat—what on earth is he hiding? At any rate, concerns about hair health gets people, namely women, into my office. Sometimes seemingly shallow, trivial health concerns act as gateways to lifestyle changes and a journey to health and wellbeing. Since our bodies don’t really require hair for survival, hair health, along with sex drive and energy, is one of the first things to decline when we enter into a state of imbalance. It therefore becomes an important initial warning sign that things have gone array with our health.
Hair holds a significant place in our self-perception and daily routines, often influencing our confidence and identity. When hair health falters, whether due to genetics, hormonal changes, or lifestyle factors, individuals may seek solutions like Hair Restoration Therapy to regain a sense of normalcy and well-being. While the desire for lush locks may seem superficial to some, it often serves as a catalyst for deeper introspection and lifestyle changes, underscoring the interconnectedness of physical appearance and overall health.
Hair loss is often a concern for many women and men. It’s normal to notice a few strands of hair in the shower—the average woman loses about 50 to 100 strands of hair per day. However, when patches of hair seem to be missing, areas of thinning are present or a reduction in overall hair volume (usually indicated by a decrease in thickness of the pony tail), this can point to possible pathological hair loss.
In the quest to address concerns about hair loss, the choice of shampoo becomes a crucial element in maintaining scalp health. Opting for a sulfate free shampoo for oily scalp emerges as a thoughtful strategy to navigate this common challenge. This type of shampoo not only gently cleanses the hair but also ensures that the scalp’s natural oils are preserved, striking a balance that is particularly beneficial for those experiencing issues like thinning or reduced hair volume.
While losing a few strands daily is normal, unusual patterns of hair loss can signal pathological conditions that may require medical attention.
History and Labs:
When coming in to see your naturopathic doctor, he or she may ask you the following questions:
Do you notice any itchiness or flaking of the scalp? These symptoms could indicate a number of skin conditions of the scalp that contribute to hair loss: seborrheic dermatitis, infection by a fungus called Malassezia furfur that causes dandruff, or psoriasis of the scalp, an autoimmune condition. The ND may diagnose via trial-and-error or perform skin-scraping to rule out a fungal infection. A skin biopsy may be indicated to provide a definitive diagnosis, however this test is invasive.
What do you labs look like? Comprehensive lab work is necessary in patients with hair loss. It’s important to see what iron status is, as well as thyroid health. Low iron or under-functioning thyroid can be the root cause of hair loss as can high androgens, the male sex hormones.
Which medications are you taking? Oral contraceptives can cause a deficiency in vitamins and minerals, such as zinc and B vitamins, that can cause hair loss. Other medications that can cause hair loss include, and or not limited to, blood pressure medications, antidepressants, antibiotics, acne medications, chemotherapeutics agents, immunosuppressants and pain medications. An ND can work with your doctor to decrease your list of medications by addressing the root cause of concerns, if possible, or collaborate in switching medications. This, of course, will only be done in collaboration with the prescribing doctor.
What’s bugging you? Stress can contribute significantly to hair loss. The mechanism of action is varied, but a decrease in circulation to the scalp, protein deficiency and depletion of vitamins used by the adrenal glands, can be possible causes of hair loss. Telogen effluvium is a condition where the body pushes the hair follicles into a “resting phase” so that they no longer grow and produce hair. This is done because when under stress, the body enters survival mode and does not dedicate precious resources to non-survival entities such as hair health. Alopecia areata an autoimmune condition in which the immune system of the body attacks the hair’s follicles, causing large patches of hair to fall out. This is said to be cause or aggravated by severe stress. Trichotillomania is a mental health condition in which the individual plucks out hair as a self-soothing mechanism.
What are you other symptoms? Weight gain, irregular periods, acne and hair growth on the face can indicate PCOS, which also can cause loss of scalp hair due to higher-than-normal testosterone levels. Men with high testosterone will also experience more hair loss. Digestive symptoms can indicate malabsorption of important fat-soluble vitamins or iron, which can contribute to hair loss if resulting in deficiency.
What hair products do you use? A sensitivity to sulphates and/or other chemical additives to hair products can contribute to hair loss or a decrease in the lustre and overall health of hair follicles.
Treatment:
The naturopathic treatment for hair loss, involves identifying and treating the root cause of symptoms, not the hair loss itself. A potential treatment plan might consist of the following:
Restoring health by replenishing depleted or deficient vitamins and minerals.
Eliminating infection or scalp fungus if necessary.
Managing stress in healthy, constructive ways.
Balancing hormones and the immune system via herbs, supplements and dietary changes.
Nourishing the hair by adding in vitamins that support hair health, such as fish oil. This also involves changing shampoos and conditioners to more natural, sulphate-free forms.
Castor oil hair mask:
Once a week, when my hair starts looking drier and duller, I do a castor oil hair mask and scalp massage. Castor oil is an anti-fungal and anti-inflammatory oil. It has the added benefit of increasing blood flow to the area it is applied to, in this case the scalp, which can increase hair growth. It is also a wonderful moisturizer and nutrient-rich hair supplement. It can help fuse together and moisturize split ends. Performing a self-scalp massage is a great way to increase body love by performing self care and has a grounding effect on the body, which reduces mental-emotional stress.
Apply a liberal amount of castor oil to palms. Rub oil into palms to warm it. Starting at the scalp, work oil into the hair follicles, applying a firm pressure and moving the fingertips in circles. Massage for 5 minutes, moving the oil through the shaft of the hair to the ends. After performing massage, leave oil in hair for at least an hour or overnight. Finally, shampoo and condition hair as usual to remove oil. Warning: castor oil can stain fabrics so sleep with an old pillowcase and wear an old t-shirt while performing castor oil scalp massages.
Epilogue: If you haven’t noticed, this seemingly shallow subject matter is the perfect segue into talking about a basic naturopathic approach, which involves taking a thorough history, ordering lab work to find the root cause of symptoms and then treating accordingly using non-invasive therapies that aim to treat the cause, not just the symptoms themselves. Notice how this is vastly different from walking into a supplement store and purchasing a product called “Hair Loss Formula” or some other facsimile. While this formula may replenish some deficient vitamins, it is masking the real cause, which may be PCOS or celiac disease, and delay effective treatment for these conditions. Hopefully this highlights the importance of seeking a professional opinion rather than self-diagnosing and self-prescribing!
by Dr. Talia Marcheggiani, ND | May 8, 2015 | Balance, Canadian College of Naturopathic Medicine, Clinic, doctor as teacher, Emotions, Finding yourself, Personal, Reflections
It seems like the only thing I can focus on right now is negative space.
Like the obsession with the space between a model’s waif-like thighs, affectionately termed the “thigh gap”, I have seemingly been attributing way too much time and attention to the lack of things in my life. Life is up in the air right now—a freeze-frame of dust particles that someone has stirred up, and we all wait breathlessly to see where they will settle on the ground.
That’s it: I feel unsettled.
And this unsettled feeling has the tendency to sharpen the focus on the things I don’t have in life. The search doesn’t need to go far. I lack stability in my career, a romantic relationship, my own apartment—the typical signs that life is moving forward. I don’t know what two months will bring, let alone the next few years and, as someone who spent all but two years of their waking adult life in academia, not having a future laid out before them in the form of assignments, tests and other externally imposed milestones leaves me feeling uncontained. There is no one conducting evaluations on my life but myself.
And what an astute evaluator I’ve become:
How am I doing? The best way for the masochist to answer this question is to look at how other people are doing. There are plentiful points of comparison if I want to feel fully inferior. Everyone seems to have more patients than I do, nicer apartments and fulfilling relationships. They seem to be moving somewhere. I just feel stuck, not at a crossroads, but at the edge of a cliff. Am I just supposed to jump? Did everyone else jump? Or did they end up hitching a ride on some lucky parachute that happened to pass by a few minutes before me? Why are they lucky? What are my eyes closed to? When will it be my turn? Or am I simply cursed? The mind stirs up more dust. Sense of personal injustices prevail.
This unsettled feeling can’t last.
So I strive. The answer must lie in working harder. After all, it’s what we’re told to do. Push on. Move forward. Just do it, as Nike says, sweat beading on foreheads. There’s always sweat beading on the foreheads of the mentally unsettled.
I hand out business cards, but no one calls me. I try calling them. I look for other jobs that are poor fits. I take more shifts at the day-job I’m holding on to for secure cash. I go to business networking meetings that I don’t connect with and try to convince myself that I should just force myself to make it work. I search desperately for an apartment, and despair when I don’t get the one I finally love. I hold on to past relationships well past their due dates and complain and obsess and analyze what went wrong to my friends, whose patience can’t possibly last much longer. I notice myself compromising my values and dreams in order to get away from the edge of the cliff.
Still I get nowhere.
So I turned to the only thing I know how to when the mind is desperate and despairing and the spirit is looking to the future for salvation—I turn to the present. The dust in up in the air, so to speak. Everything is unsettled. And yet, how am I? I’m more or less alright. I’m warm. I’m fed. I’m rested. My plight is ridiculous when compared to tiny Vietnamese hands sewing buttons on Banana Republic blouses. Who taught me this sense of entitlement?
I have a place to live and some money coming in (the longer it takes me to find an apartment, consequently, the more I end up saving). I have friends who are genuinely concerned about me and a generous, loving and supportive family. I have hobbies and social events to attend. The blessings in my life are numerous.
Why am I so intent on speeding down the highway of life? What will happen when I arrive at my destination? When I have a beautiful apartment, patients booked months in advance, when I’m in a wonderful, loving and passionate relationship with someone who inspires me, what will I do then? Once the dust is settled, won’t I eventually, decide to stir it up again? If I can’t be content in the present, when will I ever find that elusive contentment that always seems to slip out of our grasp?
Most of all, I ask myself, what is behind my longings? Are the reason I long for these things pure? Or, like a perfume or Coca-Cola ad, do I really want what’s behind what they’re selling me: the beauty, enchantment, lightness, freedom and magic that life often promises us but we seldom encounter in the places we’re told to look.
I wonder if, with eyes closed and mind settled, I’ll be able to breathe clear air again. Perhaps then I’ll find a path down from this cliff, a creative alternative to the already available options: jumping, backing down or sitting and waiting for a magical parachute to come and save me.
Between all the wants, needs, dreams and aspirations, between the striving is space. In that space I might find a little room to breathe. But who can really breathe with dust in their lungs?
I was recently told that a benefactor would contact me about the work I’ve been doing for the Evergreen Yonge Street Mission in Toronto—I provide naturopathic services to street-involved youth twice a month in the drop-in health clinic. There is a natural health company that might be interested in sponsoring some of the naturopathic services. However, in order to understand where their money is going, they want to hear some success stories before they consider if and how much to donate. Are the services working? They want to know. Since I, more than anyone, appreciate the power of a story and, since I’m trying to raise some money to expand the services I provide myself, I thought I’d tell one. Names and details have been changed.
