by Dr. Talia Marcheggiani, ND | Nov 16, 2015 | doctor as teacher, Education, Emotions, Endocrinology, Healing Stories, Hormones, Listening, Medicine, Meditation, Mind Body Medicine, Naturopathic Philosophy, Preventive Medicine, Reflections, Women's health, Writing
Premature Ovarian Failure no longer bears that name. It’s not a failure anymore, but an insufficiency. POF becomes POI: Premature Ovarian Insufficiency, as insufficiency is apparently a softer term than “failure”. For me, it’s another telling example of how our society fears the names of things, and twists itself into knots of nomenclature and terminology rather than facing pain head-on. In this case, the pain is derived from the simple fact that the ovaries do not respond to hormones, that they for some reason die at an early age and cause menopause to arrive decades before it’s due, leading to infertility and risk of early osteoporosis.
Insufficiency, for me at least, fails to appease the sensitivity required for naming a problem. It reminds me of a three-tiered scoring system: exceeds expectations, meets expectations, insufficient performance. These reproductive cells have not been up to task. They’ve proven to be insufficient and, in the end, we’ve labelled them failures anyway—premature ovarian disappointments. Our disdain for the bodies we inhabit often becomes apparent in medical jargon.
What expectations do we have for our organs, really? For most of us that they’ll keep quiet while we drink, stay up late and eat what we like, not that they will protest, stop our periods, make us itch or remind us that we are physical beings that belong here, to this earth, that we can sputter and shut down and end up curb side while we wait for white coats to assist us. Our organs are not supposed to remind us of our fragile mortality. When it comes to expectations overall, I wonder how many of them we have a right to.
In one week I had two patients presenting with failures of sorts. With one it was her ovaries, in another it was his kidneys, first his left, now his right. Both of them were coming to me, perhaps years too late, for a style of medicine whose power lies mainly in prevention or in stopping the ball rolling down the hill before it gains momentum. When disease processes have reached their endpoint, when there is talk of transplant lists and freezing eggs, I wonder what more herbs can do.
And so, when organs fail, I fear that I will too.
In times of failure, we often lose hope. However, my patients who have booked appointments embody a hope I do not feel myself, a hope I slightly resent. In hope there is vulnerability, there is an implicit cry for help, a trust. These patients are paying me to “give them a second opinion”, they say, or a “second truth”.
I feel frustration bubble to the surface when I pore over the information I need to manage their cases. At the medical system: “why couldn’t they give these patients a straight answer? Why don’t we have more information to help them?” At my training: “Why did we never learn how to treat ovarian insufficiency?” At the patients themselves: “Why didn’t he come see me earlier, when his diabetes was first diagnosed?” And again at the system: “Why do doctors leave out so much of the story when it comes to prevention, to patient power, to the autonomy we all have over our bodies and their health?” And to society at large: “Why is naturopathic medicine a last resort? Why is it expensive? Why are we seen as a last hope, when all but the patients’ hope remains?”
Insufficiency, of course, means things aren’t enough.
I feel powerless.
There is information out there. I put together a convincing plan for my patient with kidney failure. It will take a lot of work on his part. What will get us there is a commitment to health. It may not save his kidneys but he’ll be all the better for it. My hope starts to grow as I empower myself with information, studies some benevolent scientists have done on vitamin D and medicinal mushrooms. Bless them and their foresight.
As my hope grows, his must have faded, because he fails to show for the appointment. I feel angry, sad and slightly abandoned—we were supposed to heal together. Feelings of failure are sticky, of course, and I wonder what story took hold of him. was it one that ended with, “this is too hard?” or “there is no use?” or “listen to the doctors whose white coats convey a certainty that looks good on them?”
A friend once told me, the earlier someone rejects you, the less it says about you. I know he’s never met me and it’s not personal, but I take it personally anyways, just as I took it personally to research his case, working with a healing relationship that, for me, had been established since I entered his name in my calendar. In some way, like his kidneys, I’ve failed him. Since we’re all body parts anyways, how does one begin to trust another if his own organs start to shut down inside of him? Why would the organs in my body serve him any better than the failing ones in his?
I get honest with my patient whose ovaries are deemed insufficient (insufficient for what? We don’t exactly know). I tell her there aren’t a lot of clear solutions, that most of us don’t know what to do–in the conventional world, the answer lies mainly in estrogen replacement and preserving bone health. I tell her I don’t know what will happen, but I trust our medicine. I trust the herbs, the homeopathics, nutrition and the body’s healing processes. I admit my insufficiency as a doctor is no less than that of her ovaries, but I am willing to give her my knowledge if she is willing to head down this path to healing with me. Who knows what we’ll find, I tell her, it might be nothing. It might be something else.
It takes a brave patient to accept an invitation like the one above; she was offered a red pill or a blue pill and took a teaspoon of herbal tincture instead. I commend her for that.
There aren’t guarantees in medicine but we all want the illusion that there are. We all want to participate in the game of white coats and stethoscopes and believe these people have a godlike power contained in books that allows them to hover instruments over our bodies and make things alright again. Physicians lean over exposed abdomens, percussing, hemming and hawing and give us labels we don’t understand. The power of their words is enough to condemn us to lives without children, or days spent hooked up to dialysis machines. We all play into this illusory game. They tell us pills are enough… until they aren’t. This is the biggest farce of all.
I can’t participate in this facade, but I don’t want to rob my patient of the opportunity for a miracle, either. We share a moment in the humility of my honesty and admission of uncertainty. I know my patients pay me to say, “I can fix it.” I can try, but to assert that without any degree of humility would be a lie. How can one possibly heal in the presence of inauthenticity? How can one attempt to work with bodies if they don’t respect the uncertain, the unknown and the mysterious truths they contain? In healing there is always a tension between grasping hope and giving in to trust and honestly confessing the vulnerability of, “I don’t know.”
For my patient I also request some testing—one thing about spending time on patients’ cases and being medically trained is that you get access to information and the language to understand it. I notice holes in the process that slapped her with this life-changing diagnosis.
When her labs come back, we find she might not have ovarian insufficiency after all. Doorways to hope open up and lead us to rooms full of questions. There are pieces of the story that don’t yet fit the lab results. I give her a list of more tests to get and she thanks me. I haven’t fixed her yet, but I’ve given her hope soil in which to flower. I’ve sent her on a path to more investigations, to more answers. And, thanks to more information in the tests, I’ve freed her and her ovaries from the label of “failure” and “insufficient” and realized that, as a doctor, I can free myself of those labels too. The trick is in admitting, as the lab results have done in their honest simplicity, what we don’t know.
For the moment, admitting insufficiency might prove to be sufficient in the end.
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.
—
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.
—
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.
—
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 | 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 | 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 | Mar 19, 2015 | Creativity, Diet, Endocrinology, Exercise, Fertility, Health, Lifestyle, Medicine, Mind Body Medicine, Nutrition, Paleo, Sex, Sexual Health, Skin health, Weight Loss, Women's health
PCOS, or Polycystic Ovarian Syndrome, a condition which affects an estimated 10% of women in North America and is the most common endocrinological dysfunction in women.
Its symptoms and the people it affects are as diverse as there are people affected; it’s one of my favourite conditions to treat.
Signs and Symptoms:
PCOS is characterized by hormone dis-regulation. Oftentimes it presents with cysts on the ovaries, but not always. In PCOS there is often elevated blood glucose and other markers of insulin resistance. There are often issues with menstruation: the absence of periods (amenorrhea), or heavy and irregular bleeding (dysmenorrhea). Weight gain is common—although some women with PCOS can be thin—as is hormonal acne and hirsutism, a nice word for male-pattern hair growth: excess hair growth around the chin and upper lip, the chest or navel region. Pelvic pain around ovulation may occur when cysts rupture. Infertility is common in women with this condition.
PCOS is a syndrome, rather than a disease, which means it presents as a collection of symptoms that can be varied in their presentation and severity. Lab work may read that estrogen, testosterone and LH (a hormone produced by the pituitary gland and ovaries) are high and progesterone and FSH (a hormone released by the pituitary gland) are relatively low. However, what brings a woman with PCOS or PCOS-like symptoms into my office is varied and usually consists of any combination of visible symptoms: hair growth, weight gain, acne, menstrual irregularities or infertility.
Etiology:
We are uncertain how the collection of symptoms that is PCOS arises. One prominent theory is that issues with blood sugar and insulin regulation create ovarian cysts or disruptions in the secretion of sex hormones. This causes the ovaries to release more LH, which has the power to raise testosterone. High insulin, testosterone and estrogen can cause weight gain, hair-growth, acne, absence of ovulation (anovulation) and the inability to maintain the uterine lining and therefore carry a pregnancy to term.
Diagnosis:
PCOS is diagnosed by symptoms. It involves a combination of symptoms: amenorrhea (or absence of menstrual periods), infertility, hair growth on the face, acne and insulin resistance. The presence of ovarian cysts, as detected on an ultrasound were once diagnostic, but many patients present with symptoms and are cyst-free. An increase in LH and testosterone, with lab values indicating insulin resistance and metabolic syndrome, can also lead doctors to suspect PCOS, when appearing in conjunction with other symptoms.
Because it is a syndrome, patients often come into my practice with a variety of complaints. Some come in to deal with their skin health, others want help with fertility or menstrual cycle regulation and many others come in with weight loss goals.
Conventional Treatment:
Treatment in conventional medicine is simple: oral contraceptives. If your testosterone is high and estrogen and progesterone are out of whack, the conventional medical system tells us to simply override natural hormone production, or lack thereof, with synthetic versions of the same thing. For my professional opinion on regulating hormones with oral contraception, see my post on the birth control pill (which I no longer take). These birth control pills often contain chemicals that prevent the secretion of male hormones. This helps clear up acne and hair growth.
Medication for type II diabetes, Metformin, is used to help regulate insulin. Patients experience weight loss on Metformin, as it helps control insulin resistance, however it also depletes vitamin B12, which means that regular injections of B12 are necessary to avoid deficiency symptoms. Further, Metformin doesn’t address the root cause of insulin resistance, which is most likely lifestyle and hormonal imbalance. This means that patients will be medicated (and therefore receiving B12 injections) for life.
I do not mean to negate the fact that oral contraception and Metformin have helped countless women. I respectfully acknowledge the fact that the lens I look through is one of a different, more natural and whole-bodied approach to medicine that aims to treat the individual by addressing the root cause of disease.
In short: I prefer to try it the naturopathic way first.
Naturopathic Treatment:
Lifestyle. Naturopathic remedies are very effective, but often quite involved. They begin with lifestyle modifications—a low glycemic index diet like the Mediterranean or the Paleo diets, that emphasize whole foods, like fruits, vegetables, healthy fats and lean protein and eliminate sugar, white flours and white carbohydrates. Exercise is important in treating PCOS. One of my professors advocates intense cardio, such as high-intensity interval training, or weight-lifting 5-6 days a week. This must be done for several months before effects are seen and blood sugar and other hormones are regulated.
Supplementation and botanicals. Myo-inositol, a B vitamin, is a first-line treatment for PCOS in the natural health world. The amount of research steadily growing behind its use should probably make this gentle and effective treatment first-line for treating PCOS in all healthcare fields. Studies show that, when dosed properly, inositol can regulate blood sugar, assist with weight loss and regulate menses, even promote fertility.
Herbs like Vitex agnus-castus, or chaste tree, can help regulate the balance between estrogen and progesterone. Spearmint and Serenoa repens, or saw palmetto, can help decrease male hormones in the body. Gymnema and berberine are other therapies useful for regulating blood sugar and helping with weight loss.
Ensure that you are receiving counsel from a licensed naturopathic doctor before supplementing. The dose and quality of supplements and herbs is essential to feeling better—don’t hack it in the health food store alone!
Acupuncture. Acupuncture has been shown to be effective for promoting fertility. I have had some good success in promoting pregnancy and fertility with acupuncture in my practice. Fertility clinics in Canada now use acupuncture before and after IVF treatments to ensure treatment success. It also helps to relieve stress and lower cortisol, which helps with insulin-lowering and blood sugar management.
In Traditional Chinese Medicine, PCOS can manifest as dampness, Qi or yang deficiency or issues with the Spleen or Kidneys. Acupuncture can help tonify and balance these patterns.
Homeopathy. I have had success using homeopathy in conjunction with lifestyle and supplementation in treating PCOS. Homeopathy acts deeply on the energetic level of disease, working on the level of emotions and sensations and working to address the energetic cause of disease. It involves a thorough interview and an individualized prescription from a licensed naturopathic doctor or homeopath.
Mind-Body Medicine. The ovaries are located at the level of the second chakra, which is an energetic centre in the body associated with sexuality and creativity. Christine Northrup, MD, asserts that the presence of ovarian cysts represents an energetic blockage in our creative power and unmet emotional needs. Louise Hay, author of “You Can Heal Your Life” tells us that ovarian cysts represent some sort of past hurt that we can’t let go of. Crying, journalling and identifying repressed emotions can help to remove these energetic blockages. In many women with PCOS, there is an imbalance in the identification with their femininity, or what it means to be a woman.
Sometimes our bodies alert us of imbalances in our emotional lives through the presence of physical symptoms. As a naturopathic doctor, it is essential I address all levels of the person—mentally, emotionally and spiritually, not simply physically.
PCOS is a diverse and challenging condition to treat that can cause a lot of hardship for the women who suffer from it. However, a diagnosis of PCOS can be an opportunity for growth and transformative healing through naturopathic medicine. For this reason, I find it can be one of the most interesting and rewarding conditions to treat. Contact me to find out more.
by Dr. Talia Marcheggiani, ND | Jan 4, 2015 | Balance, Canadian College of Naturopathic Medicine, Diet, Evidence Based Medicine, Health, Medicine, Nutrition, Preventive Medicine, Robert Schad Naturopathic Clinic, Science
My family waste no time making illusions about their lack of acceptance of my form of medicine. If left unchecked, dinner table conversation can quickly lead to arguments about the efficacy of the flu shot, why Cold FX is unnecessary and whether “eating in moderation” includes microwave pizza. Lately I’ve decided it’s not worth the bother to champion my cause; I now simply remain silent, keeping my eyes on my gluten-free toast. Having a family that is not well-versed in natural medicine, however, is educational. It removes me from the naturopathic medicine bubble of my colleagues and ex-classmates and brings me back to reality. The truth is that many people don’t know or can’t appreciate what we naturopathic doctors do. There are several myths I’ve been confronted with, ranging from critically negative to unknowingly innocent, that need to be destroyed.
1. Naturopathic Medicine is not scientific.
The main criticism against naturopathic medicine is that it is unfounded and unscientific. “If alternative medicine worked, it would just be called medicine,” once said Tim Minchin, a comedian that skeptics love to quote. While there are several political reasons for the fact that there are not as many studies on natural therapies as there are on conventional medical therapies, the body of evidence that supports natural therapies is growing. Naturopathic doctors use conventional medicine to diagnose, request laboratory tests and perform physical exams on our patients. We follow many conventional medical guidelines, all of which are evidence-based. In naturopathic medical school, we were taught to consult a wide range of scientific journals for developing our treatment plans. Throughout our education we were required to write research reviews and case studies. The Canadian College of Naturopathic Medicine and its affiliate centres such as the Ottawa Integrated Cancer Centre conduct many research studies and offer research residency programs for graduates of the naturopathic medicine program.
Further, the notion that nutrition is unscientific is ridiculous. We know that what we put in our bodies can either improve or diminish our state of health. Herbal remedies and therapies, such as acupuncture, have been used for millennia. Most drugs are derived from the medicinal properties of herbs.
Additionally, there is an increasing number of medical doctors employing natural therapies in their practices; the reasons being that they are safe, gentle and they work.
2. Naturopathic doctors are anti-pharmaceutical, anti-surgery and anti-vaccine.
The practice of naturopathic medicine involves adhering to the Therapeutic Order. This order is a loose guideline for developing a treatment plan that begins with establishing the conditions for health: a healthy diet, lifestyle and environment, and ends with more invasive therapies not performed by naturopathic doctors, such as powerful medications and surgery. For example, if you break your arm, a medical doctor will set the bones back into place, manage your pain and immobilize the bones by using a cast and sling. However, drugs and surgery do not fuse your bone back together. This magical feat is performed by your body, or what we naturopathic doctors term the healing power of nature. Surgery would not work without it. Our job as naturopathic doctors is to help your body do its job of healing, enabling your bones to heal faster.
Like natural therapies, some conventional therapies are better than others. Some heavy medications are necessary for temporarily managing pain or stabilizing life-threatening acute conditions, such as anaphylactic shock. However, preventing these health crises or working alongside conventional medicine to help the body better recover is the job of the naturopathic doctor.
Naturopathic doctors are not anti-vaccine. Some vaccines are more effective than others and, like many therapies, some vaccines carry with them risks, however small. Naturopathic doctors have medical knowledge and time to spend with patients. We believe in taking the time to share our knowledge and research with patients to help them make informed choices about their health and what goes into their bodies, vaccines included.
3. Patients need to choose between naturopathic and conventional medicine.
There are numerous studies that show that, when practiced together, naturopathic medicine and conventional medicine achieve better outcomes than conventional medicine alone. Naturopathic cancer care, for example, is not about curing cancer with green smoothies; it aims to keep patients feeling healthy and strong while undergoing chemotherapy and radiation so that they can complete their treatment. Many patients with cancer experience negative outcomes because the treatment cannot be completed due to diminishing health or debilitating side effects. For any condition, naturopathic doctors work alongside medical doctors to benefit our patients. The job of the naturopathic doctor is to help strengthen our patients’ health and support their bodies through disease, not compete with medical doctors. Many people term naturopathic medicine Integrative Medicine because it aims to integrate the existing body of medical knowledge, both conventional and natural, to better help patients.
4. You can go to a supplement store; you don’t need a naturopathic doctor.
Natural health products are a complicated issue because, like Advil, they can be acquired without a doctor’s prescription. However, this means that patients become consumers, subject to marketing schemes and misinformation. A naturopathic doctor is a doctor. We take your health history (spending up to 90 minutes doing so) and then spend time developing a comprehensive treatment plan that fits you as an individual. This is far more powerful and effective than simply buying health products on a whim or shooting in the dark. We recommend products at the correct dose and for the appropriate duration. We can also tell you which products have the most evidence behind them. We have studied medicine for 8 years and develop treatment plans, as doctors, to treat your condition. This is vastly different from self-prescribing fish oil because you heard it’s good for you.
5. You should only visit a naturopathic doctor if you’re willing to make drastic lifestyle changes.
There was a time when naturopathic doctors put all of their patients on an extreme diet, such as the Anti-Candida Diet or some facsimile. While many people felt better on this diet – it eliminated many noxious foods such as fast food, processed foods and sugar – it served to intimidate many who didn’t feel ready for such a drastic change. Fortunately for patients, those days are over. While the practice style of the naturopathic doctor can vary, my personal style is to start slowly and not overwhelm. The treatment plan your naturopathic doctor prescribes you will depend on your readiness for change; you will not be pushed into doing anything you are unready for. Naturopathic doctors are also trained in counselling and are able to assess your readiness for change and help motivate you to make health changes at a pace that you feel comfortable with. We are also trained to support you through the process of making changes, ensuring your success and health outcomes.
6. Naturopathic medicine is for the rich.
It is an unfortunate truth that naturopathic visits are not financially accessible for all Canadians. I charge between $95 to $150 for a visit and, even if the visit lasts 90 minutes, this is certainly not cheap. However, the cost of medicine is not cheap, even if it is covered by the government. There is evidence to show that naturopathic medicine saves the individual and the tax payer money; it is far cheaper to prevent disease than treat it. The average patient at my clinic spends $500 a year on naturopathic visits, most or all of which is covered by extended health benefits. In 2014 the Ontario government removed the need to charge HST for naturopathic visits, slightly reducing the cost of naturopathic medicine. Lastly, while supplements and therapies need to be paid for out of pocket, naturopathic doctors tailor their supplement recommendations to your treatment plan and are trained to take your financial situation into consideration when designing a treatment plan.
When we consider all of the things we channel our money towards, I believe that we as a country could afford to dedicate a little more of our salaries to our health. The average Canadian woman spends $1200 a year on cosmetics and personal care products. However, real beauty comes from being healthy—cultivating a healthy glow from the inside out. Health is your greatest asset; perhaps we should invest in it if we have the means. For those who simply cannot afford naturopathic medicine there are free satellite clinics staffed by interns and cost-effective options such as community acupuncture that provide natural medicine at a more affordable price.
7. Naturopathic medicine is for granola-munching hippies.
Even though my website and business cards are covered in flowers (flowers are beautiful!), naturopathic medicine aims to include everyone, no matter what their value system is. Naturopathic medicine is for people who value their health. It is for those who believe that healing is more than suppressing symptoms and remaining medicated for the rest of their lives. Naturopathic medicine offers an option to anyone who wonders how their lifestyle and diet may be affecting their health. We believe in empowering people to lead healthier lives and to take a more active role in how they feel mentally and physically. We use science, clinical experience and traditional therapies to help people feel better. You don’t need to be a vegan to appreciate what good health is worth.
What other natural health myths have you heard that require destroying?
by Dr. Talia Marcheggiani, ND | Jan 3, 2015 | Gratitude, Health, Holidays, Medicine, Mindfulness, NPLEX, Professional Development, Relationships, Volunteering
2014 has been a year of beginnings and endings. I ended two major relationships: one with the school I went to for 4 years and another with a long-term boyfriend, and began two new ones: I embarked on my own career as a naturopathic doctor and started a new relationship. The past year for me represents the tail end of several important life-cycles and the promise of exciting new beginnings.
It was the year I turned 28, starting a new 7-year karmic cycle. I broke up with my now ex-boyfriend of 5 years and finished my studies at the Canadian College of Naturopathic Medicine. I dedicated a large portion of my time to social activities, self-expansion and personal growth. I got out into the world and made new friends while strengthening old friendships. I became a little more daring and a lot more open. These changes helped groom me into a better doctor.
I spent the summer working, dating and studying for NPLEX II. I embraced new opportunities and made many new friends with co-workers, ex-classmates and complete strangers. I became more artistic.
I went to India in August and September after finishing NPLEX II. After 4 years of constantly doing, it felt wonderful to relax into the chaos of India and become an observer for a month. Simply being felt foreign and very uncomfortable at times, but also balancing. I relished the long train rides, the heat and the variety of cultures, smells and colours – especially the food. India contains a furious energy about it. It was a wonderful experience and a brilliant way to open myself up further to new experiences while exploring a different corner of the world.
When I arrived home from India I was ecstatic to find that I had passed NPLEX II and my Ontario board exams. I applied for my naturopathic licence and began looking for clinic spaces. When I met Heather Osler at the Bloor West Homeopathic & Wellness Clinic, I immediately knew that the space was an excellent fit. So far, I’ve been right. The calming, healing energy of the space and the wonderful staff have been amazing. I have been blessed with a practice that has been slowly and steadily building from my first week. I am grateful for the wonderful patients that have booked with me in 2014. I have learned a lot from them and have had the opportunity to help them feel better, something that I love to do.
2015 brings with it the promise of more successes in private practice as I grow my existing patient base and eventually add more practice days to my week. I look forward to connecting with my ex-classmates and new colleagues, to giving talks and writing blogs and connecting with the community. I will be taking a course in Motivational Interviewing (MI) at OISE at the University of Toronto this January and February. I also hope to take more courses in psychological methods to strengthen my ability to treat mental health conditions; I plan to find ways to bring my love for art and writing to the therapeutic experience.
I have the opportunity to volunteer 1-2 days a month at the Yonge Street Mission health clinic and am looking forward to spreading naturopathic medicine to the community, a passion of mine. Between my private practice and volunteer work, I hope to quickly expand the number of people I help with naturopathic medicine.
2015 will bring with it creativity, in the form of exciting new writing projects and an effort on my part to make time for painting and consuming art.
I hope 2015 will be a year of love, bringing with it more fulfilling relationships and the opportunity to strengthen my existing ones with friends, my significant other, my family and, of course, my Colombian yorkie, Coco. I learn so much from my relationships and they remain the most important part of my life. They encourage me to grow and continue to challenge me to become a better person, writer and doctor. I hope to find mentors both inside and outside my profession that challenge me to continue to grow and provide me with needed guidance on my journey.
I plan to travel in 2015, to Puerto Rico, to visit the home of a dear friend and his growing family and back to Guatemala, to see my best friend in her tiny, bohemian village. I would also love to do a silent meditation retreat this year, finding more centring and balance.
I also know that 2015 will be about my own personal health. I have resolved to cut out sugar, drink more water and dedicate myself to becoming physically fitter by engaging in more yoga and strength training. I also resolve to strengthen my mindfulness practice and meditate more regularly, which I believe will help me become more conscious and present, both as a human and as a healthcare practitioner.
Most of all, I hope that 2015 will be about gratitude. As I become older, time seems to pass all the more quickly and I find this to be an alarmingly unpleasant realization. As a lifelong student and now a professional running her own business, I often find myself consumed by future goals, wants and needs, which interferes with my ability to live in the present moment, be reflective of and grateful for all the blessings I have been given in my life and currently enjoy. Dedicating myself to counting these blessings helps to anchor me to the present moment and feel happier with the wonderful life I’ve been given and the wonderful people who surround me.
2014 was an amazing year of transformation and growth. While Back to the Future II promised us a 2015 of flying cars and 80’s-style sneakers that automatically lace themselves, I believe the real 2015 will be an even better year filled with strength, opportunities for further growth and development and love. I hope to build more confidence and wisdom this year, develop more confidence in myself and add more stability to my life. 2015 will be about building strength and foundation.
I wish all of you the best this 2015. What are your reflections, hopes and resolutions for the coming year?
by Dr. Talia Marcheggiani, ND | Dec 8, 2014 | Diet, Health, Medicine, Mental Health, Nutrition, Stress, Vitamins, Weight Loss
One of my favourite vitamins, after B6, is vitamin B12! (Magnesium is my fav mineral). I have recently bought 1000 mcg and 5000 mcg bottles of injectable methylcobalamin for my clinic. The vitamin contains no preservatives or additives. $15 gets you a quick burst of energy in your deltoid muscle.
Here are 12 things you should know about this snazzy, red vitamin.
1) Vitamin B12 is a water soluble B vitamin. It is excreted through the kidneys.
2) It is found naturally in animal products (meat, eggs, fish, dairy). Vegans do not get this from their diets and need to supplement.
3) Excess amounts of B12 are stored in the liver for up to 10 years.
4) B12 deficiency can result in neurological symptoms such as neuropathy: numbness and tingling, depression, dizziness, anemia and fatigue. Suboptimal levels can result in fatigue.
5) B12 absorption can be impaired in the elderly, those who have had gastrointestinal surgery and those with low stomach acid. It requires intrinsic factor, excreted in the stomach to be absorbed in the intestine.
6) B12 is cobalamin. Supplements of B12 come in three main forms: cyanocobalamin, hydroxycobalamin and methylcobalamin.
7) Methylcobalamin is the active form of B12, which is easily absorbed and passes the blood brain barrier, making it an effective treatment for depression and mental fatigue. Cyanocobalamin must be converted to hydroxycobalamin, which is then converted to methylcobalamin. Many people have inadequate enzymes to convert cyano and hydroxycobalamin to the active form. Therefore, supplementing with methylcobalamin is the best option. It also helps support methylation, which our bodies need for detoxification and mental functioning, among a myriad of other biological pathways. Getting a dose of methylcobalamin is like a 2-for-1 deal: you get a bioavailable form of vitamin B12 AND a methyl donor. Who wouldn’t want to get in on that?
8) B12 levels of under about 200 umols/L of blood is termed a B12 deficiency, where neurological symptoms begin to appear. However, for health, naturopathic doctors prefer B12 levels to be at least above 600 umols/L of blood, ideally 1000. Symptoms are often used as the primary guiding force for B12 supplementation. Some genetic variations result in impaired absorption of B12, resulting in high blood levels, but low levels available to cells. Therefore, testing serum B12 is not a very reliable marker of B12 status in the body. Other markers such as homocysteine and methlymalonic acid can help tell more of the story, or you can choose to supplement and listen to your body, seeing how B12 injections make you feel. B12 is non-toxic and there is no known upper limit.
9) Injections of B12 can be used to treat depression, obesity, weight gain, fatigue, fibromyalgia, autoimmune disease, multiple sclerosis and dementia among other conditions. In most people, B12 injections provide a welcome energy boost. A series of shots of 5000 mcg of methylcobalamin is a powerful treatment for depression; B12 helps the body make serotonin, the happy neurotransmitter.
10) People taking Metformin (a glucose-lowering medication for type II diabetes) should supplement with B12 as this medication depletes the vitamin.
11) Vitamin B12 is required to make red blood cells. Deficiency can cause anemia.
12) B12 also keeps homocysteine low. High homocysteine is an independent risk factor for heart disease and can cause inflammation in the body.
Contact me to learn more about getting B12 injections and injecting some energy into your holiday season!
