Tuesday, November 15, 2011

Using NAC with Trichotillomania

The use of NAC with Trichotillomania: Trichotillomania is a psychiatric condition characterized by repetitive hair puling that produces noticeable hair loss. The preferred treatments and those most studied in the past have been cognitive behavior therapy and SSRIs (Sertraline). Both have shown improvements in patients with a combined CBT and SSRI the most beneficial (2). A recent study in 2009 showed promise with using N-acetylcysteine for the treatment of trichotillomania (1). NAC is a non-essential amino acid that is precursor to glutathione (the “mother” of all antioxidants that mops up free radicals in the brain) in our bodies that appears to restore the extracellular glutamate concentration in the nucleus accumbens. Therefore, offering promise in the reduction of compulsive behavior in patients. NAC is used for acetaminophen toxicity, chronic bronchitis as well as a mucolytic agent by inhalation in Mucomist I use NAC daily in my practice for my Hashimoto’s patients as a precursor for glutathione and to decrease inflammation. I had never used NAC for trichotillomania until recently. I had a patient in her 20’s present with a history of trichotillomania that developed while pregnant two years ago. When she came to see me she had completely plucked her eyebrows and eyelashes out. No prior history whatsoever of trichotillomania. I was at a loss for what to do. On exam she had barely any eyelashes left on top or bottom and a few stray eyebrows. Exam otherwise was completely normal. She explained how plucking felt “good” and there was no pain involved with it. She has no prior psych history. She is unsure what provokes the plucking but was clearly seeking help with stopping this clearly physically scaring condition. A recent article that Dr. Kalb was familiar with discussed the research on using NAC during a double blind placebo controlled study for trichotillomania (1). The study showed that using NAC (1200-2400 mg/d) had led to statistically significant reductions in trichotillomania symptoms. We started her on NAC 1200 mg daily as well as an herbal anxiety control supplement. On her 12-week f/u appointment she reported pain with plucking for the first time and therefore a decreased desire to pluck. Her eyelashes and eyebrows were growing back in as well. She continues to take NAC as well as the herbal anxiety control. 1. Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2009 Jul;66(7):756-63. 2. Dougherty DD, Loh R, Jenike MA, Keuthen NJ. Single modality versus dual modality treatment for trichotillomania: sertraline, behavioral therapy, or both? J Clin Psychiatry. 2006 Jul;67(7):1086-92.

Saturday, July 16, 2011

"I have air in my testicles"...and yet another translation situation in Honduras!

Honduras July 14, 2011
“I have air in my testicles”

Today was our last day in the clinic in Duyure. I was blessed to go on a food delivery trip to 6 of the families in the village. That was an amazing experience to be welcomed into the homes of these sweet, sweet people. I had several patients I had seen in the clinic that hugged my neck and one even pulled out of her bra my notes that instructed her to return today for her repeat blood pressure!! It was precious.

My little boy patient with the 544 blood sugar yesterday returned this morning with a fasting BS of 99! I was thrilled….but the reality is that this was just one day with increased insulin….and no way to get the insulin on a regular basis. The reality of his situation and so many others breaks my heart.

The patient that stole my heart today was an 83 year old cowboy that came in with a big sombrero, plaid shirt, jeans and a big buckle on his belt . He came walking in and sat right down and plainly said that “I have air in my testicles”! As he very graphically continued to show me, as if I didn’t know where his testicles were located. I happened to have two observers from the education team in my room at the time that were sitting there with their mouths open, about to laugh out loud! My sweet, sweet MaryLeigh the interpreter, never flinched and continued to ask him the questions I was asking. He flat out stated that “I pee straight, but there is air in my testicles”. We don’t do prostate exams, but I symptomatically treated him for a prostate infection

The next patient had a “bump in her anus” and it hurt to sit on the chair, and had told us that she had not had a bm in 15 days!! On further investigation, she has had a bm recently but there was pain and a “bump”. This is an elderly lady and I was worried there might be a fistula or the very least a large hemorrhoid . She had a tiny, tiny external hemorrhoid. We had no Preparation H or Tucks for her. When she left she hugged my neck and said “Mucho Gracious for looking at my butthole”! Of course Maryleigh translated exactly what was said!! Everyone in the room busted out in laughter!

The clinic was being broken down and myself and another provider were still seeing patients that had waited for 10 hours to be seen. We didn’t turn one patient away during our 4 days.

We haven’t had internet for 2 days in the pasada and I find myself grumbling about it. This morning as I am typing yesterdays events I realized that as I silently grumble about the 1 ½ hour ride each way up/down the mountain, the lack of vegetables, the heat, the critters in our cabin etc, and the lack of internet, that in reality I am nothing but a spoiled baby. I didn’t walk 4 hours to get to the clinic with no water to drink, I have enough money to feed my children, and buy their medicine, a car to drive with air conditioning… and thank God I do, so that I can use my resources to be able to serve others that can’t.

"I feel like a cow"...and other funny translations from Honduras 2011

Honduras 2011
Day 3, July 13, 2011
“ I feel like a cow today”

I cried today for a patient that only has salt wrapped in corn tortillas for food. Her son was in the area beside of us with malnutrition and they were working on getting him a nutrition consult and a delivery of food bags that will feed him for one month. I learned from Meridith the local Missionary with Mission Lazarus that salt wrapped in corn tortillas is the food for the “poorest of the poor”. The salt gives them a feeling of fullness and there fore they can continue to work and do their chores. I was devastated and had to look away to keep from breaking down in front of her.

The other patient today that broke my heart was an 11 year old boy with a blood sugar of 544!! Over 126 is not acceptable with a fasting BS check. He is an insulin dependent diabetic and only has ½ vial of insulin left to use until his doctor appointment in September, 4 hours away!! He doesn’t have strips to check his BS daily due to cost. We have no insulin in our formulary. I went to get Dr. Stephens, Meridith and another provider to assess him. No DKA or dehydration. We are working on getting him insulin, but with his newly increased dose twice daily, his ½ vial will not last long at all. Another story that is very difficult for me to absorb!! My heart broke for the mother as we told her we didn’t have insulin but would do our best to find some in the pharmacy in San Marcos. He is coming back in tomorrow for another check to see if his increased insulin was sufficient. I can’t imagine the pain that these mothers experience daily knowing that they are unable to meet the needs of their sick children. We are so very blessed to be able to pick up our prescription at the local pharmacy and go on our way!

The funny story of the day was when my interpreter was giving me the symptoms of my patient and then all of a sudden with headache, stomach acid, low back pain she says “and she feels like a cow today as well”! I guess my face was frozen and then I burst out laughing! Margaret said she swears that what the patient said, but with further questioning, somehow “I vomited today” was translated into “I feel like a cow today”. A much needed burst of laughter indeed! I told her that I too feel like a cow with all of the carbs that I have been fed since arriving in Honduras!!

I am typing this in the dark, since the power and the internet are down tonight, a nightly occurance apparently. At least I didn’t walk 4 hours each way to get here with nothing but a salt tortilla and no water to drink along the way…..and I complain about no hot water! Looking forward to what tomorrow brings. Keep praying for the people of Duyure, Honduras and our safety each day.

Blessings, Dani

Tuesday, July 12, 2011

Duyure Honduras: Day 2

Honuras Medical Mission Trip
Day 2: July 12, 2011

We are in Honduras in the rainy season and had a torrential downpour last night that made travel up the mountain today scary for our bus of gringos….but we made it without a hitch! We started a bit earlier today and had 250 scheduled to see.

I had a new translator today and it takes a while to get in sync with each other and find a flow that works for both of us…but we came together quickly and I was thrilled with our day of seeing patients. I saw lots of ringworm on the body and scalp today as well as fungus on the feet (athletes foot). We had a patient with blood sugar of 408 and BP of 160/102 who walked 2 hours to get to the clinic today! I brought Dr. Stephens in on her consult and we are so limited in diabetes medication that we gave her what we had, but are hoping that Mission Lazarus can find her the Metformin that she needs to help bring her diabetes in control….the Honduran diet is not diabetes friendly at all. Therefore speaking to the patient about a low carb high protein diet is not beneficial. They don’t have fresh vegetables like us and have a bean, rice, corn tortilla diet. The teaching is challenging and frustrating as a provider!

My favorite patient today was a little boy whose mom is very concerned because he doesn’t’ seem to “focus” in class and has a hard time getting his homework. She has taken him to several doctors and no one has addressed his issues. She wanted to know if he was “born this way”? He was clearly not focusing on our visit, but when I asked him what he wanted to be when he grew up he told me a “pilot” and wanted to learn his lessons. This is another case of no way to really change his diet, and put lots of good vitamins and minerals in his body as well as get him the help he needs to be able to focus. I felt so sorry for the mother who clearly wants to help her child learn and do well in school.

Of course as we were getting ready to leave the clinic today, we had another downpour and we were all piled in the bus for our 90 minute ride back down the mountain when we got stuck!!! All the men got out, the women went to the back to weigh the bus down (no jokes please)….and 20 minutes later, several wheelbarrows of sand, some wood planks later we take off and then slide sideways and busted the top off the water line and up shot a flow of water that who knows how long it took to turn it off! When we pulled out of the clinic, the men were working frantically to turn off the water from the street! Seems that nothing is easy!! And we slid back down the mountain!

One scorpion on the back of one of our leaders at dinner and a nice thunderstorm later….we are ready for bed and day 3 of this adventure!!

Honduras Day one July 11, 2011

Honduras 2011
Mission Lazuras and Crosspoint Community Church

Day One: July 11, 2011

Our team over 30 arrived yesterday after a 4 hour bus ride from the airport in Tegucigalpa. As we were pulling into our ranch in San Marcos that is owned by Mission Lazuras we had a flat tire! So we entered the ranch by walking the rest of the way! What a beautiful location we are staying at. I was expecting something like Haiti last year. The pasada (lodge) is the center or our ranch and where we eat our meals, gather to talk, hang in the hammock, have devotionals and can connect to the internet. Our cabins hold ten and have hot showers and a toilet that flushes!! I am thrilled! It is the rainy season here and currently the tin roof is alive with the sound of pouring rain and thunder!
Our clinic is in Duyure and is a 1-1 ½ hour school bus ride up to the top of the mountain. The roads are hairpin turns and I learned quickly to NOT look down! Our lives are in the hands of our driver who is not only navigating the narrow road, but attempting not to hit any number of cows or donkeys that are in the road.
When we arrived today at the makeshift clinic there were probably already 200 villagers waiting for hours and most had walked for at least 2 hours to see us. By the time our day was ending some patients had waited 10 hours or more to see us. No one was angry, mean or rude. We have 5 providers: 2 NP’s, 2 PA-C’s and one MD. The pharmacy is set up with a formulary that is small, but efficient to treat the kinds of cases we are seeing over and over.
We saw over 250 patients today with various chronic and acute problems. I did get to see one pregnant patient today! She was nine months pregnant, and travels two hours to a hospital for delivery! Maybe this week she will come back in labor and I can deliver a Honduran baby!
The poverty is great here, but the spirit and the pride is even greater. I am impressed with how well kept and clean the children are we saw in the clinic today. We are exhausted and a bit smelly indeed, but the smiles and hugs make it all worth while….and give you the motivation to get up tomorrow and do it all over again!

Thursday, July 7, 2011

Heading to Honduras! Sign up to follow the journey with my blog!!

Just a quick note to let everyone know that myself and a medical mission team will be heading to Honduras on Sunday for 7 days in the mountains in San Marcos De Colon. The medical team will be traveling to Duyure each day to set up a clinic in the village.  We expect to see several thousand patients while there.   There will be a construction team  as well going to a different location each day.  I am going with my church www.crosspoint.tv and feel blessed to be able to use my skills in one of the 3 poorest countries in the world.   We will be teamed with www.missionlazuras.com and staying at their ranch in San Marcos Del Colon at night. Please read their website and learn about all of the amazing work they are doing in Honduras and beyond!!

I am asking for your prayers and support while we are gone on this trip. Although this trip will not be as long or as tiring as my 21 days in Haiti last year, it will be challenging non the less.  Please pray for peace, safety and healing during our journey!!

                                                  Last years Haiti Medial Mission Trip
                                        Delivering a sweet baby boy that they named Daniel!
                                          Check back here often to see updates on my journey!



Deuteronomy 31:6-8

Sunday, June 26, 2011

Gloria's Testimony on her healing journey at Cool Springs Family Medicine


Over the years I have found by veering away from traditional medicine
and prescription drugs, I would become much healthier. A search to find doctors
who treat you holistic and alternatively before resorting to traditional
medicine is very difficult to find.

Recently I found myself getting more and more depressed about aging and dreaded getting older. I began seeing my body looking old and I was loosing the
high energy that I had always had. I have been blessed with outstanding
good health all my life because I always tried to take good care of my
body. So believe me, I was beginning to feel hopeless and puzzled by
what was happening to my body.

The search was on when I found Cool Springs Family Medicine.

At Cool Springs Family Medicine, I was treated like I was very important
and cared for by all the staff. Dani Williamson, nurse practitioner, did some very extensive blood test and quickly found my problems. I was so thankful
and I began to have hope again.

One of the tests that Dani did was to test my Thyroid Antibodies. No other doctor had tested it because my Thyroid Panel had always been normal. I was shocked to discover that I had Hashimoto’s disease. The level was 1490.3 and normal
Is 60. Everything I have read about Hassimoto’s disease is that there is
nothing you can do about it. The only thing is wait under the antibodies destroy you thyroid and then you start taking hormone pills. Well, I knew in my heart
that that would NOT be my fate! Also I knew that once you begin taking thyroid medicine, then your thyroid completely stops making the hormones.

Right away Dani put me on some vitamins that support the thyroid and that settle the antibodies down. She also told me to start on a Gluten Free Diet. There is a book that was just printed that she recommended I read and would give me hope also: Hope for Hashimoto’s by Dr. Alexander Haskell, N.D.

After three months, Dani did another blood test and the Thyroid Antibodies was
Down 540 points to 950.3 from 1490.3! I was beyond excited and so happy. I knew Dani and Cool Springs Family Medicine was a God sent.

Having gone through menopause about 15 years ago, my hormone levels
were depleted; which explained my lack of interest in sex, dry vagina,
lack of energy, lack of enthusiasm for life, my skin looking wrinkled and
saggy in a lot of places on my body.

Dani suggested I do the Testosterone Pellets that could be inserted under
my skin and would last for 3 months. Since my testosterone level was
zero, I was anxious to receive this treatment. She also subscribed Progesterone Troches that I would let dissolved in my mouth at bedtime.

Within a week, I began to feel better, my endurance level was coming back and I began to feel younger and like a woman again. Within two weeks, my sex drive was back and I was feeling that desire I used to have for my husband. Believe me, he was very happy about that because he wasn’t feeling rejected by me anymore!

Another thing I was seeing was that when I would go work out, my trainer was amazed because I was getting stronger and she was able to add more weights to my workout. I was feeling a lot stronger during the spinning classes too.

I cannot believe the difference in my health and life now. I will continue to
work until I get my Thyroid Antibodies down to normal and I will continue to
get the testosterone pellet inserts regularly and continue with the progesterone troches.

Thank you Cool Springs Family Medicine and Dani Williamson for giving me
my life back. (My husband thanks you too).

Saturday, June 25, 2011

Two Deaths in One Week: Life and Love

Webster’s dictionary defines death as “a permanent cessation of all vital functions or the passing or destruction of something”….precisely what I experienced this week with the death of MeeMaw Smith and of my very own 6 year love (affair): both deaths occurred within hours of each other. One was rather sudden the other had been hanging on for dear life while praying for a miracle of sorts for several years (the miracle came in the form of a letter). It’s true that when it rains it pours indeed. The synonyms for death such as curtains, decease, demise, dissolution, end , exit, expiration, expiry fate, grave, great divide, passage, passing quietus, sleep I have decided all are fitting for the loss life or love.
As I sat at the funeral today thinking about my own loss this week I commented “I have had a really bad week Ella Kate” I was reminded not so gently by my 13 year old daughter that “your week has not been nearly as bad as PeePaw’s mom”! Out of the mouths of babes one can always expect to be slapped back into reality. Gosh no, my week had been nothing like PeePaw Smith’s who lost the love of his life that he was married to for over 60 years! His world revolved around MeeMaw and he took care of her to the very end of her life with such grace and dignity that it amazes and inspires me! He never complained, never acted ugly or acted like he was tired of the constant work that an outspoken woman like MeeMaw required. He married his best friend and dedicated his life to making her happy. For better or for worse.
I was sent a letter this week written to someone other than me that devastated me yet ironically describes the love that MeeMaw and PeePaw Smith had, and what I and everyone I know must long for in a partner. It stated that he had always been told that “a man should marry his best friend and only then would all the pieces of the puzzle fit and the good times would be twice as good and the bad half as bad”. Devastating words to read (since they weren’t written to me or about me or apparently for me to ever read) yet no truer words have ever been written. What he wrote and desires to have with another woman other than me is exactly what the Smith’s shared. They were never “wandering around searching for something they (I) let go, because they never let go of each other in the first place. They built their “castle in the sand together” as he so beautifully wrote and I am fairly certain that even though it may have been washed away a few times during the years, they kept on rebuilding “together”……as the letter read.
I can’t imagine what PeePaw was feeling today as he looked at his best friend and bride of many years for the last time on this earth. I can only say that it broke my heart imagining what he will feel like in that house without her in it. I am sure their life was not perfect by any means, but love overcame any obstacle they ran up against. I want and deserve that kind of love (as does everyone), with a man that adores me enough to forsake all others and treat me the way God intended a man to treat a woman as well as how he would want his very own daughter to be treated by her boyfriend/lover/husband.
I could get married tonight and most likely never be married 40, 50 much less 60+ years to my best friend, lover, husband that adores the ground I walk on while making the “good times twice as good, and the bad half as bad”…. I decided tonight on the drive home from Kentucky that although 50 or more years of marriage are probably out of the picture for me, true, committed, honest love is not. And just like MeeMaw and PeePaw Smith, I plan on holding out for that kind of love in the future! Simply because I deserve it!

the LORD giveth, and the LORD hath taken away; blessed be the name of the LORD.
Job 1:21

Thursday, May 19, 2011

Bio-identical Hormone Replacement

Bio-identical Hormone Replacement for:
Fatigue, weight gain, depression, decreased muscle mass, decreased libido, PMS, apathy, erectile dysfunction, hot flushes, vaginal dryness, hair loss, memory loss, mood swings, night sweats, irritable, bone loss, thin skin.

Do you just not feel as good as you believe you should? You simply don’t have that “get up and go” that you had a few years ago? Have you gained weight (especially around the middle), lost your desire for sex, feel more fatigued, have interrupted sleep, feel anxious or short tempered more than you used to, don’t handle stress as well as you are used to handling? These are all signs of hormonal imbalance. Hormones can be imbalanced during birth control pill use (synthetic hormones in birth control pills can cause hormone imbalance) peri-menopause (anywhere from 2 or more years before menopause), menopause (12 months without a menstrual cycle), and for the men simply aging as well can cause hormone imbalance (3). I have treated several teenage girls with bio-identical low dose progesterone 2 weeks out of the month pulsed with there menstrual cycle and had great results with balancing their PMS symptoms.
As women age our ovaries become less active and we produce less estrogen. During this aging process progesterone also declines. Since the majority of the symptoms of menopause are related to declining hormone levels, doesn’t it make since to replace those hormones with bio-identical hormones derived from plant sources? These hormones have the identical molecular make-up as our endogenous estradiol, progesterone, and testosterone. The synthetic hormone Premarin is an estrogen made from pregnant mare’s urine!! PRE-MAR-IN….I may not be a doctor, but I am certain that pregnant mare’s urine is NOT bio-identical to humans, although it may be just what the veterinarian ordered for a horse going though menopause! Studies have shown that women have and increase in breast cancer when using high doses of synthetic estrogens. (3). Bio-identical hormones are dosed on an individual basis (there are no “one size fits all” dosing), and therefore the patient receives physiological versus super physiological doses of the hormones needed. The bio-identical hormones I prescribe are 10-20 times lower in strength than the estrogens in birth control pills!
Using Bio-identical hormone replacement with cream, pills or pellets will relieve the symptoms of peri-menopause, menopause, PMS greatly. Bio-identicals have been proven to reduce the risk of heart disease, osteoporosis, memory loss and cancer (2, 3).
And for the men, bio-identical testosterone can increase libido, help with erectile dysfunction, increase muscle mass, stronger bones, improve energy (3, 4). All from either testosterone cream, gel or pellets placed under the skin to dissolve over 3-4 months. I use tesosterone in women with great results. And can personally attest to the testosterone pellets!
I have had incredible response with bio-identical progesterone in cream or pill form. My patients report more regular cycles, less cramping, shorter cycles, less PMS and an overall feeling of less anxiety. Progesterone is a calming hormone and when we are low on it, it is possible to have more anxiety and less restful sleep. I use creams and capsules for my patients that are compounded at special compounding pharmacies. The creams bypass the first pass effect in the liver and may deliver more active hormone. I prefer to use creams, but if a woman is postmenopausal or having insomnia related to hormone imbalance I may give a capsule to help her sleep at night since progesterone is calming. It also has a mild diuretic effect that women appreciate. I always pulse the dosing with the menstrual cycle or 3 weeks out of the month for post-menopausal women. (1, 3)
DHEA is a precursor to testosterone and estrogen in our bodies. I have had good results if a patient is low in testosterone and DHEA I will begin a low dose DHEA 5-10 mg for women and 25-50 mg for men for a few months to see if testosterone levels increase and low androgen symptoms begin to resolve.
Vitex Chaste berry twice daily has decreased PMS symptoms of agitation, irritable, anxiety, and even increased libido in some of my patients. We use a Metagenics brand that has chaste berry, cohosh, and ashwaghanda in it. And I can speak from experience that PMS symptoms are greatly reduced. I even have one patient that wrote a blog on it in Nashville Parenting magazine after only one month of use. I usually tell patients to give it 3 months to begin to decrease symptoms.
Finding a practitioner that is skilled in BHRT is key to resolving your symptoms. If your practitioner is not willing to work with you then find another one! This is your health and I can attest that as health care providers we are not taught the use of bio-identical hormones, or nutritional medicine at all for that matter! My women’s health class was given a multi page article on the “dangers of bio-identical hormones” and how the practice was basically hocus pocus (I can’t remember the term used). Clearly, the instructor that handed that article out has big pharma in their back pocket. And come to find out, that is true!! There is absolutely nothing wrong with pharmaceuticals if needed, and there isn’t a natural way to get the same and most likely better result! I was once told by an MD in Atlanta, Dr. Eldridge Taylor who wrote the book, “Are your Hormones Making You Sick”, that “Doctors are down on things they are not up on”!! That goes for any healthcare provider!!
Testing is critical to finding out your hormone levels! I prefer ZRT saliva testing. Unfortunately, insurance has made serum blood testing standard of care, and therefore insurance is more likely to pay for serum blood testing. Saliva testing actually tests the true DNA that is in the tissues (that’s why we do saliva DNA tests). I prefer those results, and they run around $299.00 for a complete panel including thyroid with a blood spot finger stick. Insurance is getting better at reimbursing patients for their cost. There are also urine tests that I have not used as of yet.
Getting hormones in balance is much more than testing and ordering up some bio-identical hormones. We have to begin to look at food sensitivities, toxins in our bodies by stating a detox program and eating as organic and “real” food as much as possible. Environmental toxins need to be addressed: the cleaning supplies you use, the makeup we buy, lotions, hair dyes, nail polish, light bulbs they are just a few of the toxic things our body absorbs daily!! And we wonder why there is an epidemic of autoimmune disease! I diagnose at least 5-8 Hashimoto’s patients weekly!! Clean is a fabulous book by Dr. Junger that addresses the toxic world we live in and offers reasonable ways to begin to clean up our bodies that are riddled with toxins and killing us slowly. If you don’t believe me, take a look at any waiting room at any doctor’s office on a daily basis! Look at the people that are barely getting by, all the while drinking those diet cokes, eating that processed food from fast food chains and taking more and more medications that most likely could be greatly decreased by simply putting the nutrients back in their bodies that they have depleted. We are treating symptoms and not the cause of the problem!!
If you are experiencing signs of hormonal imbalance and are interested in testing and treatment then by all means make an appointment and come see us at Cool Springs Family Medicine! I would love to work with your and begin the journey of balancing not only your hormones but your health with our wellness center offering colon hydrotherapy, infrared sauna, hyperbaric treatments, acupuncture as well as a complete supplement store. I used to tell my yoga students at True North Yoga that the hardest part of class is simply SHOWING UP! Not always true with healthcare, but it’s you first step to wellness!

Dani Williamson, MSN, FNP
Integrative Family Medicine


1. Leonetti HB, et al. transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet Gyecol 1999: 225-228.
2. Lee JR. Osteoporosis reversal with transdermal progesterone. Lancet 1990;336:1327.
3. Wright JV, Lenard L. Stay Young and Sexith Bio-identical Horones: the Science Explained. Smart Publications, Petaluma, California, 2010.
4. Katznelson L, et al. Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism. J Clin Endocrinol Metab 1996;81:4358-4365.

Saturday, March 5, 2011

You Can't Control How You Die....But You Can Control How You Live!

Just an update to let you know that so far my heart is looking good. A tiny bulge in the atrial septum (which could be something I was born with), which is the reason for the "bubble test". I can tell you that as a nurse, you are taught to NEVER push air through a patients veins intentionally....so to watch a nurse (even a seasoned cardiac nurse) push saline/air 3 times in your body while watching for bubbles in the heart is a strange experience!! I still haven't figured out what keeps you from having an embolism! I Will find out the results of that test hopefully Monday (which tells me that if there is a hole, if so, it must not be huge since they let me go home last night)!

But other than that, I seem to be heart healthy!! The EKG was not totally normal, but seems to be an age related change. All in all, it was a scary 24 hours, but I feel certain that I have been checked out well!! Vanderbilt Heart did not let me down (other than when the intake nurse told me to remove my "training bra" and shared that the kind of stress test I was having was the "big one before the heart cath!)!! They took good care of me, and put up with me asking a million questions and wanting to see every picture they were taking! Apparently I nailed the treadmill test! They told me that if I was flying within the next 3 days the radioactive material would show up on the detectors at the airport, so I would need a note! Very comforting that all that work I have done to DETOX my body has now been messed up with radioactive isotopes! Looks like I am back on the DETOX Monday!

Lessons learned:

1. DON'T wait until you think your are having a heart attack (or stroke etc) to find out your family history! It may just be too late to do anything about it at that point. You can't fight genetics!!

2. You ARE what you eat!!! So don't be on your way to the hospital thinking about all of the years you ate processed, fast, not REAL food and wondering if the damage done is too much to reverse!!

3. If you are reading this (doesn't matter how old you are).....MAKE lifestyle changes NOW and take your life back! I am a poster child for believing I am bullet proof and famous for too many years of burning the candle at both ends and thriving on more, more, more!! It will kill, kill, kill you!! I promise!

4. Get out an move!!! Even if you are only walking 10 minutes at a time, do that 2-3 times at least 3-5 days a week and start pumping some blood through your veins!!!

5. Realize that no matter what, ultimately we are not in control of when or where we might take our last breathe! But it IS in our control to live the best, cleanest, most pure life we can while we are given the GIFT of life (and yes, it is a GIFT)!! Kiss/hug/ your kids and anyone your love daily...because you don't know that when you leave the house that morning that you will be returning that evening! (and yes Jackson, I am preaching on death again!)

6. You can't control how you die....but you can control how you LIVE!!!

7. Breathe!!!

I have been telling my patients daily to pick up Dr. Josh Axes new cookbook called : The Real Food Diet ! It is loaded with EDUCATION and amazing REAL FOOD recipes! If you are not familiar with Dr. Axe, I would highly recommend that you find his Facebook page and also sign up for his newsletter! He is a chiropractor in town that is a genius in my opinion on nutrition and living a CLEAN lifestyle. He sends us patients weekly as I do him! Check him out! You won't be sorry! I am making his famous Kale chips today!

Thanks guys for the prayers, calls, texts, emails.....I am doing well! But, you can bet that this encounter with my mortality has opened my eyes and my heart to what it really means to LIVE LIFE....and I intend to do a better job it it......starting NOW!



Friday, March 4, 2011

Note to Self: Know your family history BEFORE you have a cardiac event!!

Note to Self: Know your family history BEFORE you have a cardiac event!!

I learned first hand yesterday that BEFORE you think you are having an heart attack or you have an EKG that says you have had some sort of cardiac event happen to you it would behoove one to have knowledge of one’s family history. I can speak from experience that the time to find out about major (as in sudden cardiac death) life altering events with one’s ancestors is ideally not when one is driving themselves to the cardiology department at Vanderbilt for a sudden visit with the cardiologist!! I can assure you that if I was going to have 4 hours off yesterday afternoon and all day today off, I would prefer to be doing something other than heart studies!!
I have had a few episodes the past three months of some pretty intense chest pain/pressure and diaphoresis that lasted for several minutes. The first one was on the acupuncture table with Dr. Wu out of the room and I had 60 needles in my face! I thought at one point I was going to have to get up and get help, but eventually the pain subsided. I was visualizing me stumbling into the hall at the office with little children there and me holding my chest with all those needles in my face like Pinhead from Hellraiser! Those parents would be paying therapy bills for years after their kids witnessed that! I had 2 more incidents like that and the last one was yesterday morning.
As usual our day was busy, busy, busy at the office. But eventually I got my nurse to do an EKG on me. Words can’t describe Dr. Kalb’s face when I asked him to read the EKG for me, and when he was told it was mine. He immediately had Maggie redo it thinking that the leads must have been switched. Same results, different nurse. I had a new patient waiting to be seen, and as we all know….hormones trump cardiac events in a time like this! When the patient ask me how I was doing I thought it best that I not tell her “I think I’ve had a heart attack recently and all hell is breaking lose outside this door”, instead I smiled and said “great, and you?” Dr. Kalb proceeds to tell me in his diplomatic way after I saw the patient that “it seems you have had one major or a few minor heart attacks at some point.”. What the heck? Apparently as I was meeting the new patient he was on the phone with cardiology and when I came out of the room he had an appointment for me to get to Vandy stat! I am driving down the road with my EKG that says something about at a left anterior block etc…..and wondering who the heck will get my kids after school!
Decided to quickly call my parents to get a family history, since I had never really thought much about it in my 45 years of life. First shocker and cause for 2 more cardiac events in my heart was that my maternal grandfather was the 13th person in the US to have open heart surgery here in Nashville, and both of his brothers (my uncles) died suddenly of cardiac arrest before the age of 49! My sweet mother says, didn’t you know that he died “in the middle of Kentucky Fried Chicken delivering milk”…well hell no I didn’t know anyone died of cardiac arrest, much less 2 uncles! My mother does have pretty severe mitral valve prolapse as well (which I was aware of). My father proceeds tell me that his father died at the age of 49 in the backseat of the car as grandmother was driving on vacation of a sudden cardiac arrest! None of these relatives had any idea they had heart problems!!! For crying out loud….here I am driving on I65 to get to Vandy and suddenly find out that I have 5 relatives (and not distant ones at that) and 3 of them had no warning at all, with heart problems!
I was in the exam room within 5 minutes of walking into the cardiology department….divine intervention indeed! Dr. Irani was impressed with my family history (his words, not mine). He is impressed and I am horrified! He said that with a history like that I automatically have 3 risks factors for heart disease no matter what my EKG says. My repeat EKG shows some sort of event, but not as bad as the one at the office showed! Praise God, but he did send me for an ECHO and told me we would either be going directly to have a heart cath or have a nuclear stress test today. Thank God, I am off to have a stress test and not the cath! Besides, I argued with him that I would prefer to have the cath in the daytime when the doctor and staff are fresh and not in the evening when everyone is tired! He wasn’t amused and let me know that I was not in charge of when or if I get the cath!
Moral of this story is that it’s a good idea to have a good family history for all disease!! Not just heart disease….the time to find out your family is riddled with sudden cardiac events is not when you are on your way to the cardiologist!!
The kicker to this is that I am healthier now than I have ever been! I have been detoxifying my life and body for the past year. Working on my adrenal glands and hormones as well as well training for the ½ marathon. My life has been focused on my children, my God and my health since getting out of school and burning the candle at both ends for way too many years! My hope is that it’s not too late to reverse whatever is going on! But in case it is, I am getting a mani/pedi today and my house is clean…just in case! All joking aside, when it’s time to go, doesn’t matter if your toenails are painted or your toilet is clean….when it’s time it’s time! Better be ready!!

PS: I got a new patient yesterday while waiting to see the cardiologist! Dr. Irani’s nurse asked for my card and is making an appointment! Whoohoo!!

Tuesday, February 8, 2011

Adrenal Fatigue

Are you hitting the snooze alarm continually, feel sluggish until mid-morning, wiped out when you get home in the evening or possibly get a burst of energy when it is time to go to sleep? You could be adrenally fatigued. A condition that is treatable with the proper lifestyle modifications, supplements, nutrients and herbal adaptogens.
I have patients on a daily basis that are experiencing high levels of emotional, mental, family and work stressors on a continual basis. Some have “burned the candle at both ends” for way too many years, and some have simply been under chronic stress for a multitude of reasons. They come to our office oftentimes after having sought help from various practitioners, simply to be told that their “lab tests are normal” and they just need to exercise more, lose weight and/or “start saying no” to commitments!
It has been my experience that most people have never heard of adrenal fatigue, much less know where their adrenal glands are located or exactly what their function is in our lives! Adrenal glands secrete cortisol in times of stress, exercise, low blood sugar (we will address low blood sugar and cortisol later)! Cortisol is your “fight or flight” hormone. Adrenal glands become compromised and sluggish when stress is not well managed and the adrenals are constantly pumping out cortisol. Eventually, they simply “poop out” and cortisol is unable to rise to meet our daily needs. Therefore, causing fatigue, sluggishness, anxiety, craving for sweets, allergies, reduced tolerance for stress the “tired but wired” feeling, sleep disturbances that many of us are experiencing.
At CSFM we can help you overcome adrenal fatigue by evaluating your cortisol levels with saliva testing that test 4x during the day (cortisol should be the highest it will be in a 24 hour period when we wake up). Cortisol slowly declines as the day progresses, it is low cortisol that allows us to go to sleep at night. I see all levels of adrenal fatigue weekly.
Adrenal fatigue is best treated with lifestyle modifications such as:
1. At least 8 hours of sleep a night (sleep beginning before midnight is a must). The bed is for sleep and sex only….if you aren’t sleeping or having sex, get out of the bed!
2. Meals at least every 4 hours with adequate protein and complex carbohydrates.
3. Exercise at least 4-5 days a week of 20-30 minutes. No strenuous exercise: preferably yoga, stretching, breath work.
Nutrients: Supplements
1. High doses of vitamin C 2-3 times daily
2. Vitamins B5 and B6
3. Vitamin E
Adrenal adaptogens:
1. Ashwaghanda
2. Holy Basil
3. Licorice (used cautiously for elevated cortisol)
4. Rhodiola
5. Ginseng (used cautiously for elevated cortisol)

Adrenal Cortex or Cortisol is reserved for the most severe of cases.

For a complete saliva testing evaluation make an appointment at Cool Springs Family Medicine to see Dr. Kalb or Dani.

PS: The good news is that adrenal glands are easily treated, but can take months to a year or more to recover completely….be patient and consistent in your journey to better health!

Integrative Family Medicine