Katy Driscoll, who manages our Rothfeld Apothecary, has dragged me into the 21st Century and designed a wonderful facebook page for us. She’s posted all kinds of helpful material and links up there, and is running a promotion for the month of July. Anyone who likes our facebook page by July 30 will get 10% off any Apothecary supplement. Check it out!

Like my colleagues all over the world, I was trained to never stop advocating for my patients, and to exhaust every option when it came to their health and survival. Yet as these options proliferate, are we physicians and caregivers taking our efforts too far, and unintentionally harming our terminally-ill patients in the process? That’s what recent research seems to suggest, as published in a powerful piece by AP medical writer Marilynn Marchione.

For the patient running out of options, our do-or-die culture seems to offer an endless supply of yet another experimental treatment, or one more drug trial. Yet its flip-side is the reality of precious hours spent in treatments that may never work, away from family members; or the endurance of horrific side-effects piled on top of an already devastating illness. Where is the tipping point, and do we physicians have an obligation to help our patients weigh these agonizing choices?

I look for cues in my patients to tell me when they are ready to shift the focus away from continuing the fight, and towards the creation of a safe space where they can prepare for the end of their life. That decision is exclusively and entirely theirs, of course, and I consider myself deeply privileged to be a part of it. I’ve treated people who’ve chosen to spend their final days half-way around the world, literally dragging themselves to one more treatment. And I’ve watched a Native American family chant around their grandfather’s hospital bed, drowning out the sound of heart monitors and breathing machines.

I’ve practiced medicine for over 35 years now, and will never cease to be humbled by the courage and dignity of my patients facing the unfathomable decision of when to say enough is enough.

As the population lives longer, bone fractures become more important. Even microfractures in the spine from collapsed vertebrae can cause pain and disability, while hip fractures can be life-threatening to an older person. On the positive side, people have become more tuned into their calcium intake as a result; but the focus on bone fracture is also why there’s a billions-per-year industry selling bisphosphonates to women who don’t yet have osteoporosis. And it’s why so many of my patients are particularly tuned in to how much calcium they need, sometimes more than any other nutrient.

Here is yet another example of how the conventional model of one organ/one measurement/one drug treatment completely misses the interconnectedness of the body system – what I call the metabolic matrix. Bones are made of more than calcium. The calcium in bones is laid in a matrix, a lattice-work of proteins, lipids, and other minerals. Now comes research suggesting that bone strength is not the same as bone mineral density, though they are related. To put it another way, not everyone with low bone density is susceptible to fractures and vice versa. The integrity of the bony matrix is just as important. This is why we always try to give calcium in a matrix form called micronized crystalline hydroxyl cal apatite or MCHC. And it’s why we look at hormones, inflammation, heavy metals and other toxins, and a wide array of non-calcium nutrients when faced with possible osteopenia or osteoporosis.

Bones can actually be thought of as an endocrine (hormone) organ, constantly in communication with other endocrine organs. Estrogen, testosterone, growth hormone, T3 thyroid, and the brain hormone seratonin are all factors influencing bone health. There’s a lot of overlap between the development of osteoporosis and that of auto-immune disease, chronic infections, cardiovascular illness, diabetes, and even gum disease.

So by all means have bone densities monitored and take a good source of calcium – but also pay attention to the lifestyle interventions that will restore balance among all of your organ systems.

I’m very pleased to share some wonderful news with you. Beth Galan, who has been the nurse in our practice for several years, is now our Nurse Practitioner. Beth has been in the field of Integrative Medicine for over 35 years, and has worked with some of its leading physicians. She is available to treat a range of conditions including allergy, autoimmune disease, environmental and chemical sensitivity; and will also be free to see my patients for acute visits and follow-ups.

Please join me in welcoming Beth in her new role as Nurse Practitioner.

At least half of my patients deal with chronic illness on a daily basis, and it can be profoundly discouraging and debilitating. There are some simple steps I share with them that can greatly help the body’s ability to fight chronic disease and grow stronger, not weaker, in the process:

Massage:  Body massage not only feels good, but it can boost immunity, improve sleep, lessen pain, and elevate mood. And remember, it takes energy to keep a muscle in spasm; massage releases that energy to where it’s helpful.

Homeopathy: Used by billions of people around the world, homeopathy relies on the body’s innate ability to heal when given the right energy “message.” It is gentle to the point of being virtually risk-free, and scientific studies demonstrate its effectiveness in a variety of conditions.

Antioxidant nutrients:  All chronic disease – whether it is cancer, heart disease, or auto-immune conditions – involves the oxidation of tissue and its resulting damage. Our tissues protect against this damage by maintaining adequate levels of antioxidant substances like vitamins A, C, and E; the minerals selenium and zinc; and accessory nutrients n-acetyl-cysteine and alpha lipoic acid. Supplementing these nutrients helps combat the ravages of chronic illness.

Movement:  There are almost no conditions in which movement is contra-indicated. Exercise regularly if you are able; if not, then a simple daily walk helps. And if you can’t walk, then seated exercises or even movement in bed has tremendous physiological benefits. Even the simplest movement brings blood and energy to the tissues, oxygenates us, lifts our spirits.

Colorful fruits and vegetables:  Bright colors and tasty flavors result from powerful substances called flavonoids. These substances improve circulation and function of our body tissues. Some, like lycopene from tomatoes, have anti-cancer properties. Others, like hawthorne berry, have been shown to improve heart function. There are hundreds of flavonoids in foods, and these “medicines” are in your salad bowl.

Acupressure:  Acupuncture needles are very slender and rarely painful. However, some people do better with acupressure (also derived from Chinese medicine) which uses finger pressure to move Qi and promote healing. In the hands of a skilled acupressurist or Shiatzu practitioner, this is a safe, non-invasive, and powerful treatment option for problems resulting from chronic illness.

Breathing:  Yes, we all breathe without thinking. But all too often, we fail to breathe deeply and effectively, depriving our bodies of fresh oxygen. Anxiety or pain can limit our chest motion. Trying to breathe slowly, deeply, and fully can increase energy, oxygen, and vitality.

Yoga:  For centuries, yoga has been an integral part of Ayurveda, the native healing system of India. Not all yoga practice involves twisting yourself into knots, like you see in the yoga magazines. Simple yoga postures are doable by nearly everyone, and are in some ways just as effective.

Adaptogenic herbs:  Certain herbs have been studied for their ability to make the body more resilient, and able to handle stress more effectively. These herbs are called adaptogens; commonly-studied ones include eleutherococcus (Siberian ginseng), rhodiola, and astragalus. They’re known for their safety, but should always be taken under the advice of a physician.

Welcome others’ support:  Going it alone is never a good way to cope with chronic disease, and can lead to feeling depressed and isolated. In this age of social networking, there are more ways than ever to feel connected, share stories, and get answers. Having the support of others is a powerful antidote to the worst effects of illness, and is associated with increased life expectancy.

As many of you are aware, there was a catastrophic water main break on Saturday that is currently affecting dozens of communities in Eastern Massachusetts, For those of you living in a restricted water zone I want to offer my advice as to safe water-use procedures.

First, make sure to consult the MWRA website regularly, as they offer detailed instructions on boiling and treating water, safe food preparation, etc.

And because many of our patients have weakened digestive tracts and immune systems to begin with, I want to make some suggestions to strengthen the bowel lining, if it should be exposed to abnormal bacteria and parasites. These are basically the same recommendations that I make when people travel to areas with questionable water supplies.

One is a strong probiotic. We use either TruFlora (needs refrigeration) or UltraFlora DF (does not need refrigeration). One capsule twice daily during times of exposure should suffice.

Second, we use the herbal antiparasitic supplement Para-Gard. Two capsules AM and PM after meals is the proper dose.

Third, we use a pre-biotic, L-Glutamine, to strengthen the bowel wall. I recommend L-Glutamine FOS powder, 1/2 teaspoon twice a day, in water that has been at a rolling boil for two minutes, of course.

This year’s recent Functional Medicine conference was illuminating and energizing, as always. One study utterly blew me away, involving a little animal called the Agouti mouse. This particular mouse is often used in research because it is genetically overweight, making it naturally more susceptible to diabetes, cancer, and a shorter lifespan than its mouse relatives.

This particular researcher gave pregnant Agouti mice a diet high in folic acid and Vitamin B12 — two nutrients critical to healthy genetic activity. The children these mice gave birth to were thinner than their parents, and had lower incidents of cancer and diabetes. Perhaps most astonishingly, they lived longer!

The essence of integrative medicine lies in the belief that one’s health improves by improving certain influential factors – nutrition, energy systems. toxicity, activity level. But this study seems to paint an even more compelling picture – that improving our own health might have positive effects on our children genetically. This is truly astounding.

I was taught in medical school that genes were like old books of conduct – static and immutable. It looks as if the actual truth is closer to the old Iroquois law, that our actions (in this case, those affecting our health) will affect the seventh generation after us.

Wow.

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.