Like many others in Massachusetts and elsewhere, I’m thinking of Teddy Kennedy this week.  As a physician, I admire his unwavering stance on our duty to provide good-quality healthcare to every American. As a long-time constituent, I am deeply grateful for the decades of service he offered our state.

But as I think about Teddy, I realize it is his bravery strikes me the most.  His life and demons were always on display for the world to dissect, and were picked at mercilessly by his many enemies and detractors.  And yet he never hid from public exposure.  Instead, he took unpopular positions and championed them loudly and forcefully.

Teddy vocally opposed the Iraq war at a time when it was unpopular to do so.  He fought for legislation on behalf of poor and underprivileged people in the face of a national drumbeat to cut government programs.  And he went to his grave battling for good, comprehensive healthcare for all, impervious to the politics of distortion and scare tactics.

Teddy was a cynosure of classical liberalism, unapologetic and relentless.  The public stage will miss him.

There’s nothing new about teenagers doing anything they can to stay up all night and get their work done (remember No-Doz?). What’s so worrisome now, though, are the reports surfacing about the huge surge in teen abuse of ADHD medications, with sometimes fatal results. Of course, lots of kids take prescription drugs just to get high, and that’s a hugely disturbing problem. But what worries me in a different way are the kids who aren’t necessarily on people’s radar — the high-achieving students with no history of drug use who are taking the ADHD meds as study and performance aids, and putting themselves at enormous risk.

The New Yorker did a disturbing piece on this subject recently that focused on college-aged students’ off-label use of medications like Adderall and Ritalin to become hyper-focused and hyper-productive. What these students don’t realize, according to multiple studies cited by the article, are the unpleasant side-effects these medications carry, and their real potential to create dependency.

Clearly there’s more education to be done. I have talked to my own kids about this before, but I’ll be bringing it back up again for sure.

There’s a promising new study suggesting that Chinese herbs are an effective treatment against endometriosis, a disease that threatens fertility and effects an estimated 5.5 million women in the US. This is exciting news, since women who suffer from endometriosis are generally given two treatment options – powerful medications with side-effects, or surgery. Most feel they have no choice, particularly if they are facing infertility (and some don’t, depending on the stage of their disease).

For years I’ve been referring patients with early-stage endometriosis to acupuncturists, and I know they’ve been helped. I hope the word gets around about this latest study, as I believe it’s the first of its kind in the English language, and it will be the first that many women hear of this treatment option. For the right patient, Chinese herbs can mean significant improvement with no side-effects and no surgery.

As an integrative medicine specialist, I tend to see a lot of patients who have spent years trying to figure out what’s making them sick. With certain conditions like thyroid imbalance, or chronic Lyme, there’s often no easy answer to diagnosis or treatment. And even clear-cut diagnoses like Multiple Sclerosis can’t offer patients a single answer when it comes to the disease’s pace or progression. There are few things more potentially frustrating, or isolating, than chronic illness.

While the internet can sometimes paralyze with information overload, it’s great for patients who want to find others like them to break that isolation and compare notes. I’ve already mentioned that I am starting an online community for thyroid concerns called ThyroidBalance (named after a book I wrote several years ago).  Patients Like Me is another wonderful resource for people who have been diagnosed with an illness and want to share stories and read about the latest treatments.

There continues to be a lot of misinformation out there about the availability of Armour Thyroid. Pharmacists are telling my office today that supplies are back-ordered 6 months, which is not accurate.

I called the Forest Pharmaceuticals hotline this morning to get the very latest information. The 120 mg, 240 mg, and 300 mg doses are available now; the 15 mg, 30 mg, 60 mg, 90 mg, and 180 mg doses are back-ordered and will not be available until late September 2009.

Again, this is the latest as of today; I recommend that you keep checking in with the manufacturer until your dose becomes available. The toll-free number is 866-927-3260.

The latest study on kids and Vitamin D is truly astonishing, claiming millions of children between the ages of 1 and 21 exhibit dangerously low levels, potentially increasing their risk of heart disease, bone problems, diabetes, and other illnesses. Of course, we all know kids have too many reasons to stay indoors (I would have barely seen the light of day if Halo had been around when I was 13). And we are all conditioned now to never neglect sunscreen. So how do we ensure that our children are getting this vitally important nutrient?

No supplement or fortified food is going to take the place of sunlight. There’s a range of opinion about SPF levels and sufficient protection, and of course so much depends on the fairness of your child’s complection. Your goal should be to achieve a level of adequate protection that allows for safe sun exposure ( The Vitamin D Cure covers this topic pretty well).  And here’s a no-brainer for kids old enough: if they are headed somewhere that’s safe to walk or bike to, don’t climb back in the car. Let them walk or bike in the sunshine, and get a little exercise while they’re at it.

When sunshine is scarce, it’s tough to rely on Vitamin D-rich foods – even fortified ones – to give your child enough Vitamin D. An entire quart of milk only contains 400 units, for example, and the recommended dose for a child is 1000-2000 units per day. (And plenty of kids are lactose-intolerant, which complicates things further.)  And other than fortified breakfast cereals and eggs, most of the Vitamin-D rich foods aren’t necessarily kid-friendly: cod, sardines, shrimp, salmon (even my adult staff are wrinkling their noses).

Luckily, supplements are so much easier and kid-friendly than they used to be; droppers of tasteless liquid Vitamin D can be mixed into food, and 1000 unit caplets are an easy solution for kids old enough to swallow pills. There are even topical creams on the market that are safe for children to use.

The sun is peeking out this afternoon, but when I came to work this morning it looked like another drizzly, overcast, damp day. We’ve had a string of them – most of the last 6-7 weeks have been damp. And that makes me think of the impact damp weather, and dampness in general, has on our health.

“Dampness” doesn’t have a place in conventional medicine; we don’t diagnose it, and don’t acknowledge its effects on the body. However, we all know people who get joint pains when it’s damp out (and we probably remember a grandfather or other elder who could predict a storm coming because their joints ached). Sinuses are highly susceptible to damp weather – I’ve been busy treating sinus problems for the past 6 wks. Allergies can definitely get worse, either from damp mold being kicked up into the atmosphere, or from swelling of the mucous membranes.

Particularly mold allergies go off the charts in weather like this. I think allergy and sensitivity to molds (including candida, which is a yeast) are very widespread to begin with. A prolonged period of dampness like the one we’ve had causes mold to grow in the garden, the carpeting, and the old wood of a home or garage – and doctors like me end up with a waiting room full of allergy sufferers.

In fact, damp weather makes most inflammations worse. Inflammation anywhere in the body involves swelling, as fluid comes into an inflamed area and brings the body’s immune cells with it. So sinusitis, arthritis, skin infections like eczema, and even urinary infections can kick up when it’s damp out. We treat all of these conditions with anti-inflammatory medicines, including steroids. All of these medications work by stopping the flow of fluid and immune cells into inflamed areas.

Chinese Medicine recognizes dampness as a condition. In that ancient system of medicine, “dampness” is the name given to inflammations, swelling, allergic reactions, and bloated bowels. An acupuncturist recognizes that humid days naturally worsen these disorders, and will prescribe certain dietary treatments: http://acupuncture.rhizome.net.nz/Deficiency/Dampness.aspx

Other natural remedies include Vitamin C and quercitin, a bioflavonoid that lessens allergic reactions. Also bromelain and other proteolytic enzymes are helpful in lessening the swelling of tissues; these should be taken between meals, since they’re not digestive enzymes.

And when all else fails … I hear that real estate is cheap in Phoenix.

This fall’s predicted resurgence of the Swine Flu seems to be all over the media right now. My office is already getting many calls from patients asking when our Swine Flu remedy will be available. Usually our homeopathic treatment is ready when the FDA-approved flu shot is ready, since it is manufactured from the same virus. We typically have it in the office by early October; but if the flu shot is delayed, our homeopathic remedy will be delayed as well.

Why offer a homeopathic remedy at all, when getting the flu shot seems simple and effective? First, there are certain people who absolutely should get the shot. The elderly, for example, or people with compromised immune systems, need that concentrated dose of the virus to boost their immunity quickly. But I have successfully treated the vast majority of my patients for decades with a homeopathic remedy, because it is just as effective and does not carry the risks and potential side-effects of the flu shot.

Basically, the flu shot gives a concentrated dose of the live flu virus to boost your immunity. But it carries risks of infection or adverse reaction – some people break out in hives, or actually get an abbreviated case of the flu. And for people with certain alergies, the flu shot carries an increased risk of side-effects. People allergic to eggs, for example, can’t get the shot at all.

The homeopathic remedy, in the form of pellets you place under your tongue, delivers a dilluted dose of the flu virus that gradually builds in the system and prevents infection. It carries no risk of actually getting the flu, and can be taken by anyone with allergies or other pre-existing conditions with virtually no chance of a bad reaction.

I’ll post again when I have a better idea of when this year’s remedy will be available; we will have it in our office and on the Apothecary website for people who want to order it online.

A patient came into my office today afraid to take an upcoming vacation to China. He’s got poor circulation, and just read about the recent study showing even more evidence that long-distance travel can double your risk of developing a fatal blood clot. Obviously, this is a hot topic, with travel at it’s peak; even in a struggling economy, those foregoing expensive plane flights are piling into the SUV and driving long distances to eke out a summer vacation.

The fact is that any long trip, whether it be on a plane or in a car, can dramatically increase your risk of developing deep-vein thrombosis, or DVT. DVT refers to blood pooling in the veins after prolonged periods of inactivity; it becomes deadly when a clot dislodges and travels to the lungs, restricting the flow of oxygenated blood-flow to the heart (known as a pulmonary embolism). There was that sad case some years ago of the war reporter, David Bloom, who died of a pulmonary embolism after spending months of flying with the US troops in cramped quarters. Preexisting conditions like a prior case of phlabitis, or taking certain medications like birth control pills, can increase that risk even more.

Luckily there are several preventive measures you can take to travel safely. First – no medication or supplement takes the place of standing up and stretching your legs every two hours. If you’re packed in the minivan headed to Yellowstone, be the hero, give into the kids’ pleas for a pit-stop, and do a few turns around the ice cream stand. When the in-flight movie is over and you’re reaching for your laptop, put it down and walk the plane aisle for a few minutes instead.

And there are several natural remedies that work to prevent clotting. I have my patients pre-medicate before long trips with 2 each of garlic and Vitamin E, and a fish oil tablet. If they have poor circulation, I will add 2 tablets of Ginkgo. All of these work beautifully as anti-clotting agents.

I recently had a patient come in who had six children, and several more pregnancies on top of that.  She’d nursed each child for many months. No surprise, perhaps, that she was seeing me for fatigue. Of course, lack of sleep and multiple demands on time and energy can contribute; but it cannot be overstated what a nutritional burden it is to be pregnant or nursing. For those nine months of pregnancy and however many months of nursing, a woman’s body is concentrating all nutrients into the placenta and, later, the breast milk. And it doesn’t have to take six pregnancies to cause nutrient depletion.

 Herbal supplements are an integral part of my practice, and are certainly relevant treatment here; but determining safe doses is critical for any woman potentially carrying and nursing a child. I treat women at all stages: they’re planning on conceiving someday, actively trying to conceive, pregnant, nursing a baby. For women hoping to get pregnant but not yet trying, I recommend increasing vitamin and mineral intake so that they are getting at least 100 mg of the B vitamins and maximum doses of vitamin D, magnesium, and other minerals. Those trying to get pregnant obviously need to avoid abnormally high doses of nutrients to protect the fetus; sometimes I will have a patient keep on the higher doses only when she is bleeding, under the assumption she hasn’t conceived. I’ll also have patients come in for IV vitamin infusions during such times.

Supplementing during pregnancy and even nursing months needs professional vigilance. I generally use a good-quality prenatal vitamin; some essential fatty acids; extra vitamin D, magnesium, and calcium; as well as some herbs known to help during pregnancy. Once a patient has stopped nursing, I usually do some nutritional testing to see what is out of balance, and try to correct that as soon as possible. I know from watching my patients (and my wife, years ago!) how important every bit of energy is when raising young children.