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Acne: How medication fails, and why naturopathic strategies are often best suited to solve it.

4 Feb

by Cora Rivard, N.D.

I have been helping my patients to resolve acne for the past 15 years, without the need for medication. Many have come to see me because conventional medicine failed to resolve it, or made it worse, or caused unacceptable side effects. And I see others who are seeking my help for gastrointestinal concerns, including inflammatory bowel diseases, who often have had a history of acne treatment. Both isotretinoin/Accutane use, and systemic antibiotic use in acne treatment are correlated with increased risk of development of inflammatory bowel disease (IBD) later in life.

Other common side effects of isotretinoin include: fetal damage in pregnancy, inflammation, dryness and cracking of the skin, lips and nostrils; changes in blood sugar levels; inflammation of the eyelids; conjunctivitis; and blood in the urine. More rarely, it can cause hepatitis, pancreatitis, and kidney disease. Concerns with prolonged antibiotic use include intestinal problems, obesity, increased risk of breast cancer, development of allergies, and antibiotic resistance. Prolonged use of antibiotics affects the microbiome (the trillions of bacteria, viruses and fungi that inhabit our bodies) in areas other than just the gut and skin, resulting in disease. A new report notes that people who use topical and oral antibiotics were three times as likely to show an increase of bacteria in the back of their throat and tonsils compared with non-users. Long-term use of antibiotics in acne treatment also is associated with an increase in upper respiratory infections and skin bacteria, and was shown to affect a user’s blood-sugar level.

Hormonal strategies can be helpful for some women with acne, especially when contraception is desirable anyway. But the benefits of hormonal therapies must always be weighed against the potential for increased risk of blood clots, stroke, and a slightly increased potential for anxiety, depression and other mood disorders.

My preference is therefore to help patients resolve their acne troubles before they begin interventions that are potentially harmful to their bodies. This goes back to, “First, Do Not Harm.” Even better, the strategies I use often have side benefits, instead of side effects! The combination of weeding out aggravating factors, offering individually-developed nutritional strategies, topical care, and naturopathic strategies that help to “balance” hormone function also often address side concerns a patient might have- such as focus, fatigue, PMS, mood, and/or period concerns. When considering the best approach, whether for yourself, or a child who is having concerns with acne- please begin by setting up an office visit with me.

Questions? Complimentary 10 minute “Meet and Greets” by phone are always welcome for prospective patients, and they can be scheduled online here.

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Cora Rivard, N.D., is a licensed naturopathic doctor with a private practice in Derry, NH. Seasons Natural Healthcare, LLC. She specializes in non-medication-based approaches for solving health and wellness concerns, which includes nutrition, stress management, lifestyle and natural medicine.

Flee the Flu Naturally

16 Jan

by Cora Rivard, N.D.

According to CDC regional surveillance and NH DHHS for this past week, flu has been widespread in NH- particularly in Rockingham county where it is considered “very high.” The vaccine match is excellent for the predominant A subtype H1N1 strain affecting adults 65 and over, but unfortunately only about a 58% match for the strain most likely to hit children and adults up to age 25. But even in years with a not-so-stellar match, it still can be helpful in reducing the severity and duration of illness, if not fully protective. While it is not too late to get a flu shot- it still takes a couple of weeks after getting a shot with a successful vaccine match and a receiver’s successful post-vaccination immune response to allow for some immunity to kick in.

So what can you do to help fend off the flu naturally, as well as to help support your body’s successful response to vaccination if you’ve just received the shot? Fortunately,  natural medicine techniques can do both. And, they can help keep your defenses high against all kinds of respiratory infections, not just the flu! I’ll share my favorites here that I recommend to my patients, as well as a few things to avoid. Please be advised that nothing written in a blog post should ever be taken as medical advice. You should always seek  the advice of your doctor.

First, let’s start with prevention, and then we’ll discuss what to do if you are already sick.

Prevention: 

One of my personal favorites for both first line prevention and treatment of flu is elderberry syrup. It helps to limit infection from many strains of flu and other types of viruses primarily by blocking its ability of the virus to infect one cell from another. It basically contains the virus and blocks internal spread of infection. According to this recent meta-analysis, it also appears to significantly reduce upper respiratory symptoms from colds as well as flu.  One that I recommend frequently to my own patients is Natures Way Sambucus Immune syrup. It also includes zinc, vitamin C, echinacea, and does not contain alcohol. Again, check with your doctor for advice before taking any natural remedies, especially for children. Elderberry and zinc can sometimes cause stomach upset, so taking it with food, and not overdoing it is key.

Sleep. This can’t be overstated. When flu is going around, do your best to make sure EVERYONE in your family is getting enough sleep. This is a big factor in being more susceptible to all kinds of acute and chronic illnesses. Even if you have just been vaccinated with a well-matched vaccine, just a night or so of poor sleep can knock out your ability to clear the flu virus.

Hydration. Dry air thins the mucus in your nasal passages and causes irritation, which makes it easier for flu to penetrate this protective layer. It also impairs mucus clearance and your innate immune respnse, and inhibits mucus membrane surface repair. In addition, influenza viruses can survive much longer in a dry environment than when the ambient humidity is high- humidity actually helps to inactivate the flu virus! According to prior research in a home model of flu exposure, “when humidity levels were set to 43 percent, only 14 percent of the virus particles that were released were able to transmit the influenza virus, compared with a transmission rate of 70 percent to 77 percent in a relatively low-humidity environment (23 percent). What’s more, the protective impact of higher humidity levels appeared to be rapid, with the majority of viral inactivation taking place within 15 minutes of when viral particles were first “coughed” into a high-humidity environment.”

So, in addition to drinking plenty of fluids, avoiding diuretics like caffeine and alcohol as much as possible, and having stews, soups, and fruit to hydrate from the inside, you might also consider adding a humidifier to your home and office. Avoid any with the replaceable filters. These are usually treated with triclosan (now banned by the FDA) and other antimicrobials which can irritate lungs and worsen asthma, and have other adverse chronic health effects. You can pick up reservoir systems at most any pharmacy that can be easily emptied and cleaned weekly. Humidifiers help limit spread of flu as well as ease respiratory symptoms. Just don’t forget to clean them regularly.

Vitamin D: make sure you are getting your dose! Read my previous blog on this subject here.

Probiotics: they can help prevent colds and flu AND improve the efficacy of many vaccines, particularly the flu vaccine. I prefer food-sourced products first, such as unsweetened yogurts with live cultures, kefir, kimchi and sauerkraut. Plus, they help keep you regular! What’s not to love.

Don’t‘s:

do detoxes, use colloidal silver, and exercise caution about any over the counter combination manufactured homeopathic products.

Skip the fish oil. If you are taking fish oil, this is a good time to take a hiatus. (Again, talk to your doctor prior to stopping any prescribed supplement or medication.) Its inflammation-modulating effects can actually weaken your acute immune defenses and make you more susceptible to infection.

This is just an interesting aside, but did you know that simply observing the act or sound of someone coughing or sneezing actually boosts your white blood cell count? Your body has an amazing ability to anticipate the need for defense.

Easing Flu Symptoms:

If you’ve already got it, don’t despair. Even if you’re an iron man, or a fitness/wellness guru, eventually your number is up. This is your excuse to stay home, snooze, sip tea and brothy soups, and binge watch episodes of Golden Girls…unless you’re a parent of young children. In that case, it’s just business as usual! Regardless, you want to get through this quickly and here are some tips to get you back in your groove:

Warming/Wet Sock Therapy: This classic naturopathic hydrotherapy technique is great for draining pressure out of clogged sinuses and nasal passageways for easier breathing at night, and a way to skip the OTC decongestants (it often works better, anyway.) It might seem strange, but most kids love it! (Adults, too!) Click on the hyperlink above for my prior blog on this subject for information and directions in how to use this. Some have discovered a short cut of putting menthol on the soles of the feet, but I don’t think it works as well. Plus, mentholated topical products can be toxic for young children, so I don’t recommend their use.

Most people are not very hungry during the flu, but it is essential to keep your hydration and electrolytes supported. Here is a link to some great recipes by local clinical herbalist, Maria Noel Groves: http://wintergreenbotanicals.com/herbal-recipes/. In particular, scroll down the page to find some very tasty broth and chicken soup recipes.

Tea: most any herbal, non-caffeinated tea can be great when you’re not feeling well, with a big ol’ spoonful of honey. (No raw honey for kids under 2). One of my personal favorites is Throat Coat tea, or Yogi’s “Throat Comfort” tea. Both contain licorice, an antiviral herb great at soothing sore throats, but it can also interact with a lot of medications. It can also worsen blood pressure in some, so care needs to be taken here. Herbs like mint, chamomile, marshmallow root can be soothing and safe alternatives for most people.

A note about caring for children. For safety reasons, kids almost never require medication to treat coughs, pain or fever. Read this message from the FDA for more details about this. While uncomfortable, these are normal body responses experienced when the immune system is just doing its job. Research shows that giving medication for fevers can actually prolong the duration of illness. But if your child develops a fever of 102 or higher, you should contact his/her doctor for immediate guidance. If a child or adult you know has a nigh fever, becomes very lethargic, has difficulty breathing, or otherwise is showing signs of rapidly increasing illness, you should get him/her to the ER or an urgent care facility immediately.

Hope this helps to get you and yours comfortably through this flu season. As always, feel free to leave comments below.

***

Cora Rivard, N.D. is a licensed naturopathic doctor and owner of Seasons Natural Healthcare, LLC in southern N.H. since 2006. She works with families from all over New Hampshire and Massachusetts who seek holistically effective, non-medication-focused solutions to healthcare needs and wellness goals. http://www.seasonsnatural.com

Ice, Ice, baby: Get geared, don’t slip!

6 Jan

It’s dangerous for everyone, but for the elderly, pregnant women, parents carrying small children or workers carrying equipment, or for those who otherwise have balance or mobility issues, the likelihood of slipping on ice increases. For people with osteoporosis and other health conditions, the risk of significant injury also increases.

According to data from the National Safety Council in 2014, 25,000 slip, trip and fall accidents occur daily in the US. Snow, ice and freezing temps in the winter multiply the number of wet and slippery surfaces at work and the potential for accidents. The majority happen in parking lots, roadways, driveways and walkways where individuals travel on foot between their worksites and vehicles.

Practically all injuries from slips and falls on snow and ice fall under the classification of “traumatic injuries.” These injuries range from minor bruises, cuts and abrasions to serious bone fractures, spinal cord damage and concussions.

And sometimes, you don’t even know when it’s there. Black ice is one of the most feared hazards of winter. It is virtually impossible to see to those walking or driving on it.

So what can you do to help prevent falls for you and your loved ones when conditions are icy?

Get some Yak Trax, Nano spikes or Micro spikes. They fit over your boots, and each of these are good quality and hold up over time, and worth the expense. I have previously bought some cheaper ones available in the checkout lines of stores that rip or fall apart almost immediately with wear. Here are some quick tips about when each might be the best option:

  1. Yak Trax: Best for elderly and children. They are the easiest option to get on over shoes, they are not sharp, and they are good for use on sidewalks and parking lots. . They are safe for the carpet, and gentle on hardwood floors if you walk carefully. However, I have found that they can slip like crazy on a hard, wet indoor surface like tile.
  2. Nano spikes: Great slip control on icy surfaces with little traction “stubs”, and still suitable for sidewalks as well as other surfaces. More expensive and a little more challenging to put on. Will scratch indoor hard floor surfaces. They feel even more stable than Yak Trax.
  3.  Micro spikes: These are little crampons, and they are wonderful for off-pavement, off road hikes. They can take you up and down icy hills. They will definitely shred your carpet and floors, so don’t put on indoors, and they are not very comfortable for wear on pavement.

Off the ice, practice your balance exercises. Yoga “tree” and “airplane” poses are great for improving your balance. Simply raising one leg at a time for a few moments while balancing on the other, is another good way to practice. I also often recommend that patients practice by standing with feet hip width apart, and simply swaying from side to side slowly, then back and forth, and even diagonally, to get used the feeling of shifting your weight comfortably. This helps to train your sense of proprioception, or perception or awareness of the position and movement of the body. Always have a stable piece of furniture to grab onto, or practice near a wall for support.

Stay safe this season!

Image result for ice skating

Cora Rivard, N.D. is a licensed naturopathic family doctor and owner of Seasons Natural Healthcare, LLC, in Derry, NH, an hour north of Boston. Website: www.seasonsnatural.com.

 

 

Generic Ranitidine/Zantac Recalled Due to Carcinogenic Contamination

19 Sep

Zantac shelves

According to a spokesperson from Novartis, the distribution of Zantac by Novartis and ranitidine (the over-the-counter generic drug of this brand) has been halted by worldwide markets after a Connecticut-based pharmacy reported to the FDA that they found extremely high levels of N-Nitrosodimethylamine (NDMA), a probable cancer-causing ingredient, in all tested batches of generic ranitidine drugs. (See source articles from Medscape, Associated Press, and ClaimsJournal.com.)

This is one of the same chemical contaminants which plagued certain blood pressure medications manufactured in China over a year ago.

The FDA is working with global regulators to better understand the source of contamination. In the meantime, the FDA recommends that people do not stop their medications, but that they may choose to switch to another type of over the counter heartburn medication that does not include ranitidine, or to talk to their doctors about stopping the medication.

By Cora Rivard, N.D.

Dr. Rivard works with patients from NH and MA with gastro-intestinal concerns, with a focus on GERD and silent reflux. In the majority of cases, in her experience, reflux can be resolved without medications by using a holistic approach which addresses the causal factor(s), which may include: lifestyle, nutritional , and stress management modifications, physical medicine and other natural medicine tools.

Contact Dr. Rivard at info@seasonsnatural.com for more information.

The “What, How, Why” of Tick Bites: Everything You Need to Know NOW

7 May

Ticks

It is shaping up to be a fantas-TICK season! Please get a jump on protecting yourself, your family, and your pets by reading my previously posted article, “Updated Guide for Tick Removal, Testing and Prevention in New England,” which has been published and recommended by several local publications. This is also the perfect time to review my other article, “Plants Vs Ticks,” which outlines simple landscaping methods to eliminate and repel ticks from your property without the need for chemical warfare.

Despite what other sources might say, ticks can be active any time of year where ground is even partially visible. They can transmit diseases within a short number of hours, there is no definitive timeline for how long they must first be attached. Lastly, ticks carry a number of transmittable diseases here, so it is important to always stay vigilant to prevention efforts and any new symptoms you or your child might be experiencing- including flu symptoms, unexplained aches and pains and fatigue, rashes, and even stomach aches (especially for kids.)

And don’t forget to stock your “Ticked Off” removal device now!

Cora Rivard, N.D.

Natural Medicine for Flu: Prevention and Healing

2 Feb

by Cora Rivard, N.D.

Local clinics and hospitals here in NH and MA have been operating at a frenzied pace since influenza became widespread. Many want to know, “Can I still avoid it?” And, “Are there natural ways to treat it?”

Flu has been ferociously widespread and flu related hospitalizations and deaths have so far exceeded all other years since the CDC has been monitoring activity.  While this year’s vaccine efficacy is particularly low due to a poor match with circulating strains, it might still be helpful in reducing the severity and duration. However, even if you are running out for one today, it still takes a couple of weeks for some immunity to kick in.

So what can you do? Fortunately, there are some natural medicine techniques which can be helpful, and I thought I’d share my favorites here, as well as a few things to avoid doing. Please be advised that nothing written in a blog post should ever be taken as medical advice. You should always seek  the advice of your own doctor.

First, let’s start with prevention. For the rest of you, I’ll give some tips and recipes to help ease your groggy, feverish, aching self.

Prevention: 

  1. One of my personal favorites for both first line prevention and treatment of flu is elderberry syrup. It helps to limit infection from many strains of flu and other types of viruses primarily by blocking its ability to infect one cell from another. So taking it before exposure or shortly after symptoms begin is key. One that I recommend frequently to my own patients is Natures Way Sambucus Immune syrup. It also includes zinc, vitamin C, echinacea, and does not contain alcohol. Again, check with your doctor for advice before taking any natural remedies, especially for children. Elderberry and zinc can sometimes cause stomach upset, so taking it with food, and not overdoing it is key.
  2. Sleep. I can’t emphasize this enough. When flu is going around, make sure EVERYONE in your family is getting enough sleep. This is a big factor in being more susceptible to all kinds of acute and chronic illnesses.
  3. Hydration. Dry air thins the mucus in your nasal passages and causes irritation, which makes it easier for flu to penetrate this protective layer. In addition, influenza viruses can survive much longer in a dry environment than when the ambient humidity is high- humidity actually helps to inactivate the flu virus! So in addition to drinking plenty of fluids, avoiding diuretics like caffeine and alcohol as much as possible, and having stews, soups, and fruit to hydrate from the inside, you might also consider adding a humidifier to your home and office. Avoid any with the replaceable filters. These are usually treated with triclosan (now banned by the FDA) and other antimicrobials which can irritate lungs and worsen asthma, and have other adverse chronic health effects. You can pick up reservoir systems at most any pharmacy that can be easily emptied and cleaned weekly. Humidifiers help limit spread of flu as well as ease respiratory symptoms. Just don’t forget to clean them regularly.
  4. Skip the fish oil. If you are taking fish oil, this is a good time to take a hiatus. Its inflammation-modulating effects can weaken your immune defenses and actually make you more susceptible to infection.
  5. Vitamin D: make sure you are getting your dose! Read my previous blog on this subject here.
  6. Probiotics: they can help prevent colds and flu, or at least help limit duration. I prefer food-sourced products first, such as unsweetened yogurts with live cultures, kefir, kimchi and sauerkraut. Plus, they help keep you regular! What’s not to love.
  7. Don’t: do detoxes, use colloidal silver, and exercise caution about any over the counter combination manufactured homeopathic products.

This is just an interesting aside, but did you know that simply observing the act or sound of someone coughing or sneezing actually boosts your white blood cell count? Your body has an amazing ability to anticipate the need for defense.

Easing Flu Symptoms:

If you’ve already got it, don’t despair. Even if you’re an iron man, or a fitness/wellness guru, eventually your number is up. This is your excuse to stay home, snooze, sip tea and brothy soups, and binge watch episodes of Golden Girls…unless you’re a parent of young children. In that case, it’s just business as usual! Regardless, you want to get through this quickly and here are some tips to get you back in your groove:

  1. Warming/Wet Sock Therapy: This classic naturopathic hydrotherapy technique is great for draining pressure out of clogged sinuses and nasal passageways for easier breathing at night, and a way to skip the OTC decongestants (it often works better, anyway.) It might seem strange, but most kids love it! (Adults, too!) Click on the hyperlink above for my prior blog on this subject for information and directions in how to use this. Some have discovered a short cut of putting menthol on the soles of the feet, but I don’t think it works as well. Plus, mentholated topical products can be toxic for young children, so I don’t recommend their use.
  2. Most people are not very hungry during the flu, but it is essential to keep your hydration and electrolytes supported. Here is a link to some great recipes by local clinical herbalist, Maria Noel Groves: http://wintergreenbotanicals.com/herbal-recipes/. In particular, scroll down the page to find some very tasty broth and chicken soup recipes.
  3. Tea: most any herbal, non-caffeinated tea can be great when you’re not feeling well, with a big ol’ spoonful of honey. (No raw honey for kids under 2). One of my personal favorites is Throat Coat tea, or Yogi’s “Throat Comfort” tea. Both contain licorice, an antiviral herb great at soothing sore throats, but it can also interact with a lot of medications. It can also worsen blood pressure in some, so care needs to be taken here. Herbs like mint, chamomile, marshmallow root can be soothing and safe alternatives for most people.

A note about caring for children. For safety reasons, kids almost never require medication to treat coughs, pain or fever. Read this message from the FDA for more details about this. While uncomfortable, these are normal body responses experienced when the immune system is just doing its job. Research shows that giving medication for fevers can actually prolong the duration of illness. But if your child develops a fever of 102 or higher, you should contact his/her doctor for immediate guidance. If a child or adult you know has a nigh fever, becomes very lethargic, has difficulty breathing, or otherwise is showing signs of rapidly increasing illness, you should get him/her to the ER or an urgent care facility immediately.

Hope this helps to get you and yours comfortably through this flu season. As always, feel free to leave comments below.

***

Cora Rivard, N.D. is a licensed naturopathic doctor and owner of Seasons Natural Healthcare, LLC in southern N.H. since 2006. She works with families from all over New Hampshire and Massachusetts who seek holistically effective solutions to healthcare needs and wellness goals. http://www.seasonsnatural.com

She gets coughed and sneezed at more than she’d prefer, so she likes to share her techniques for keeping herself, and her patients, flu and generally virus-free as much as possible.

Vitamin D Misconceptions: What You Need to Know

9 Jan

vitamin d

by Cora Rivard, Naturopathic Doctor (N.D.)- Seasons Natural Healthcare, LLC

The main points:

  1. Vitamin D deficiency is especially rampant in the northern half of the U.S.,  causing a myriad of symptoms and raising risk for serious chronic disease.
  2. Vitamin D levels are not assessed often enough as a diagnostic tool, and many doctors do not do enough to raise awareness of it to help their patients.
  3. As a result, many people are not aware that a wide array of health problems can be caused or aggravated by deficiency.
  4. Most people do not know how to correctly supplement it, resulting in either suboptimal levels, or adverse effects from toxicity.

In my naturopathic practice, I regularly see women who are pregnant and/or breastfeeding who want to know how to best support the healthy development of their babies. There are concerns about childhood allergies. Many patients are interested in attaining peak wellness while preventing cancer and diabetes. I see a lot of patients with concerns about fatigue, weight, mood, sleep, weakness, statin-induced myopathy, chronic pain, fibromyalgia, infections and immune function- to name a few. Every patient, of course, benefits from a thorough work up to help figure out their diagnoses, specific risks and aggravating factors. One commonly overlooked factor which can sabotage anyone’s wellness, and cause or greatly aggravate all of the previously mentioned health issues, is vitamin D deficiency. It is a global epidemic.

Why is it usually overlooked? One reason is that education about nutrition and the role of nutrients is often not given enough time or consideration in conventional medical training, even though the bulk of evidence about vitamin D comes from medical research facilities. Second, even if they are aware, primary care practitioners may not have the time to discuss it in a short visit. Medical focus to this nutrient is usually limited to prevention of osteoporosis in the elderly (a recent study from China just disputed this generally accepted line of evidence), and rickets in children. While these areas are important, they don’t cover the whole story about why vitamin D is so important to functions of many of the body’s systems, throughout the life cycle.

Vitamin D’s origin story: UVB light from the sun reacts with a compound called 7-dehydrocholesterol in the epidermis of the skin to stimulate the first step in the production and metabolism of a vitamin D, which is biologically inactive until it undergoes 2 hydroxylation reactions to become active. It is hydroxylated first in the liver to form 25-hydroxyvitamin D, or (25[OH]D), and then by the kidneys to form 1,25-dihydroxyvitamin D, the biologically active form which functions as a hormone in the body, and there are receptors for the hormone in many body tissues. This is the primary route, though small, naturally occurring amounts can also be naturally consumed from foods such as cheese, egg yolks, cold water, fatty fish, and liver. It can also be produced by fungi as a response to irradiation, in the form of D2, and is often added to commercial foods such as dairy products, infant formula and multivitamins.

In New England, we are especially challenged by our high latitude to get enough sun exposure for adequate levels of this vitamin throughout the year. While vitamin D deficiency is common throughout the U.S. (and world), this is why it is especially common here.

So what are the misconceptions?

#1 Misconception: Testing: Doctors may not have the inclination to test vitamin D levels if they are not well-informed about its importance to many aspects of health and wellness. In my experience locally, some insurance carriers may not even cover testing for it unless there is a diagnosis of osteoporosis or a previous diagnosis of low vitamin D. So most people who are deficient and suffering from related symptoms out there have no idea they are deficient!

If your doctor doesn’t order it, and/or your insurance won’t cover it (and these tests can often range from between $120-$200 if insurance denies the claim), what can you do? You may choose to use a service such as LifeExtension, who partners with Labcorp for self directed tests. This one costs around $47. There are also panels that include it as part of a wellness screen. (I don’t have any relationships with, or receive any financial perks from LifeExtension, but I have found them helpful for patients wishing to pay cash for reasonably priced testing services for wellness, when insurance is not an option.)

#2 Misconception: The more the better! On the opposing side, there are practitioners that get very excited about vitamin D and recommend excessive doses; it cures everything! While not a “cure-all,”  it can offer dramatically positive results for those who have been deficient. Caution is always warranted because it is a fat soluble hormone that accumulates in fat cells. And consider this: synthetic cholecalciferol (D3) is registered and used as a rodenticide! Toxicity causes a quick rise in serum calcium levels (hypercalcemia), cardiac abnormalities, hypertension, renal failure, and calcification of the of the walls of blood vessels.

Controversy still remains about which vitamin D form is better to measure in lab tests, and what the results mean. For example, a typical “normal range” of 25-Hydroxyvitamin D (25OHD) is 20-100ng/mL by lab standards. My experience is that patients with levels under 30 are often symptomatic for deficiency,  and serum levels over 55-60 are just not necessary, and might even be harmful. A study shows that Hawaiian surfers spending at least 15 hours per week in the sun have ranges including the 50’s to around 70 at the highest ends. And this is where it gets interesting: UVB exposure stimulates vitamin D production only up to certain point, and then it begins to degrade vitamin D in the skin. So the body’s levels are balanced when vitamin D is gained from sun exposure. But oral vitamin D is different, there’s not the same natural correction from supplementing too much. Toxicity is therefore a concern with supplementation, but not with sunlight exposure. Research shows that taking vitamin D in bolus form (or intermittent, higher dosages) actually causes more falls and fractures in the elderly. From serum vitamin D levels from supplementation, the line between preventing fractures, and causing fractures, may be a slim window and located closer to the lower end of the “normal” testing ranges.

The 25(OH)D level achieved by oral dose of vitamin D supplementation varies widely by individual. It is likely affected by calcium intake, race, age, body fat, and individual genetic factors. Genetic variation from polymorphisms of certain genes in the vitamin D metabolic pathway can also cause wide individual differences.

What about tanning beds? While this does stimulate vitamin D production, I believe it is not worth the skin damage and significantly increased risk of cancer associated with tanning bed use.

When I review a patient’s nutritional supplements, I often find extra vitamin D included in many products: shakes, multivitamins, energy supplements, etc. It is important to look at all ingredient labels and to be aware of how much you are getting in total. Toxicity from vitamin D causes too much calcium to be released into the blood (hypercalcemia), which can cause bone demineralization, reduced appetite, nausea and vomiting, weakness, cardiac arrhythmias, increased urination and kidney problems.

Misconception #3- Take it Anytime! Since vitamin D is a fat soluble hormone, it should be taken with a food/meal that contains some fat, for best absorption. It is also stored in the fat, which might reflect why many people who are overweight can have sufficient stores of vitamin D, but low circulating levels. Alternatively, if an overweight person is on a weight loss plan, their levels may may rise significantly as vitamin D is released, especially from rapid or significant weight loss- so extra caution is needed here, especially if there are issues of cardiac arrhythmia.

So how much is enough, without going overboard? I often recommend 400-600IU’s daily for young children, 600-800IU’s daily for older children, and 1,000IU-2,000IU’s for teens and adults as a general guideline. I adjust up or down depending on specific needs or risk factors, and individual responses according to testing and symptom resolution. People with malabsorption issues, or those taking medications like certain corticosteroids, heartburn medications, or anti-epileptic drugs, often have higher needs for vitamin D. I usually recommend taking a break from vitamin D supplements from late spring through the summer months for most people.

What brands should you take? While I can’t ethically put that in a post, I often recommend products that are in an oil emulsion form for best absorption. Dropper bottle products are also very cost effective since they hold so many servings.

I love feedback! Please feel free to write in a comment, and let me know what you think of this article. And, please share with your social circles.

Cora Rivard is a licensed naturopathic doctor and owner of Seasons Natural Healthcare, LLC in southern NH. She has been a healthcare practitioner, business owner, writer and advocate for family health and wellness since 2006. In her spare time she enjoys leading a school Destination Imagination team, cooking, hiking with her family, learning to play the violin, playing doubles beach volleyball with her husband, and cross country skiing. Website: Seasons Natural Healthcare, LLC. She is currently accepting new patients.

 

What ALL Women Need to Know:

8 Sep

by Cora Rivard, N.D.

(Men, too!) Did I get your attention? Sorry for the bait and switch: I put a royalty-free pic of Tom Brady and Giselle here for my New Englander audience (does it even show up??) because if I had instead titled this post as a personal story about stroke awareness and prevention- you would have just scrolled on…. admit it! And how do I know this?

Because last spring, shortly after my dear friend from college, Lauren, suffered a massive stroke, I participated in a health fair bringing all kinds of materials about stroke awareness and prevention, offered blood pressure readings, and generally mingled with attendees. Now, when a naturopathic doctor sets up at a health fair, people love to ask questions about things like cleanses, or whether there are supplements for weight loss, or to tell me amazing healing stories, chat about recipes, and ask me “Can you treat….?” And this is usually great! I have a lot of information and opinions about these things. But, they demurely shuffle (or flat out run) away when confronted with any stroke awareness mention or materials. Even when someone admittedly has risk factors such as hypertension and/or a family history for cardiovascular disease, they are loathe to discuss the “S” word. Talking about trendy eating plans, like whether Tom Brady’s lectin-free diet is really “a thing”- these are definitely more comfortable and sexy topics, and far less confrontational.

And I get it. When you’ve had a history of high blood pressure, it makes you feel out of control, which is a really helpless and frightening feeling. People interested in natural medicine like to do their own research and want to feel empowered about caring for their own health and wellness as much as possible. And the subject of stroke? Well, that is so exceptionally frightening and seemingly random that no one wants to think about it. But we have to. Because up to 80% of the time, it’s not random, it is preventable. Over a third of people (CDC  statistics-2009) were under age 65 at the time of stroke, and it is a leading cause of death and long term disability.

Hypertension is an all-too-common condition in modern times, and while it can be successfully treated, by the time new patients come to see me about it, it is often after prior prescribed medications have failed or under-performed, or have unintended side effects, or both. The important thing, and this is coming from me, a naturopathic doctor who values natural, empowering, self-sustaining approaches to successful healthcare, is that it is important to keep working with your primary care doctor and/or cardiologist to get the right pharmacological combination whenever your risk is high; this means it’s been going on for a long time, you have second stage or above hypertension, or you have a family or personal history that puts you in a high risk category for stroke. The longer you wait, the more damage that accumulates from the constant pounding to the delicate blood walls of your blood vessels, and to your organs:

stock-vector-complication-of-hypertension-heart-attack-myocardial-infarction-cardiomyopathy-brain-stroke-367285178

In the mean time, you can still work on the lifestyle and nutritional changes that can also reduce your blood pressure and stroke risks. Medications can then be reduced, and sometimes, completely eliminated with careful teamwork with your doctors. And it helps to be aware that they DO often need to be adjusted,  especially when there is weight loss, because blood pressure can get too low on the same dose of medicine(s) when the body goes through changes. Hypertension, as outlined by the American Heart Association, begins at 140 systolic, and 90 diastolic. But the absolute best time to start working on prevention is when it just starts to get over the high 120’s systolic and mid 80’s diastolic, when it is still classified as a “pre-hypertensive” category. This is the time when you have the best chance of managing things from the start, over the long term, with lifestyle and dietary modifications alone.

My friend Lauren has always been an independent, energetic, driven, and creative woman who seemed happiest juggling multiple projects at once. And she was usually highly successful at the endeavors she threw herself at. Always an optimist, she never wanted to bring up things that were negative or frustrating. When she got engaged, she was so happy about her life and her soon-to-be husband, and she was ready for motherhood. She cautiously mentioned her concerns to me that she had had hypertension and headaches for some time, especially with stress, but that the medications she was prescribed weren’t working. She had tried several different kinds. This was over a decade ago. I was fresh out of my graduate training. She was open to trying some lifestyle and nutritional approaches, and going back to her doctor (or a different doctor) for an opinion about a another pharmaceutical approach. And she worked hard, and it seemed to be working well for her! Then, marriage, 2 children arrived, time passed, moves happened, and Lauren remained optimistic and busy as ever throughout in her many roles. In our annual group girls’ trips over the next decade, we really didn’t talk much more about it. It seemed like things were going well for her, and she felt her health was being managed well enough. And then, the unthinkable happened.

We met as freshmen in college. Lauren helped introduce me to my future husband; she and her roommate shared a calculus class with him and were study partners. We became volunteer rescue squad members for 3 years together, often running on the same shifts. She could remain cool under pressure through (many) motor vehicle accident scenes, violence, maiming, death, and even through physical threat of harm from suicidal people who did not want to be rescued! There was the time we responded to a scene involving a young dying child. After we stabilized and secured our little patient for transport, I remember I felt myself beginning to lose my composure- this had never happened to me on duty. I whispered this to her and she quickly assumed the lead with all further communications, collected and calm in her demeanor with all points of contact. She’s a hero. But even Wonder-Women sometimes need help with things.

So, if you currently have high blood pressure, but figure you will address it some other time, it is time to do the uncomfortable thing of accepting the feelings of fear and lack of control and getting help NOW to treat it with the best blend of available tools out there for you. And it may take an aggressive mix of both pharmacological and lifestyle for complicated cases. It may take time and effort, to get the right balance, but you are very much worth it. For Lauren, she never knew until after the stroke that she has a renal anatomical variation that was a complication to the efforts to treat the hypertension.

She is now on the long road of recovery, and her husband has been keeping a raw daily blog for over 4 months about the trials, difficulties, and even the rare humor in the difficult, ongoing path for Lauren and her family in his dedicated full-time daily care of her while also parenting their young children. It began as a source of release and a way of disseminating updates to anxious friends and family members, but has also developed as his mission to convince others to take necessary steps to help prevent going through this. He mentions getting feedback from many who have begun taking their medication after reading his story. You can read it and follow it here: “Stroked Out” Blog

Resources:

Stroke Myths and Facts

Make Changes that Matter

How to Recognize a Stroke “FAST”

DASH dietary plan for combating hypertension

Cora Rivard is licensed naturopathic doctor at Seasons Natural Healthcare, LLC in southern NH.

The Mother’s Day Project

8 May

 

mom daughter

In seventh grade, I created a questionnaire in a notebook. Each page hosted a single question, with plenty of open lines for responses- questions like: “What’s your favorite movie? Color? Swear word? Most embarrassing moment? What are you afraid of? etc. This was passed around among all the girls in my class (I don’t remember why boys were not included, but probably because we were 12). We all delighted in reading each other’s interesting, humorous and occasionally deeply meaningful content, and it inspired some great conversations afterwards.

Thirty-two years later, with your help, I would like to try a similar, simple experiment.  In honor of Mother’s Day, I would like to ask you to share one simple piece of wisdom you have learned from your mother. Whether about yourself, life in general, or about the world. Maybe it is a quote, a particular memory that brings joy, or a special recipe, or the knowledge how to do something. It doesn’t have to be anything well-thought out, just the first thing that comes up. Choose one, and please share it in a reply to this post. If you don’t mind sharing (and don’t feel like you have to), please also give you age and what state/country you live in. Do you know anyone else who has/had a mother? Feel free to share this post with them, too! I’ll look forward to reading all responses!

—————————————-I’ll start:————————————–

44, New Hampshire: My mother was a Master Gardener and horticulturist, and loved all types of plants. She occasionally was a judge at rose shows. I remember one she brought me to as a child: surrounded by all this fragrance and beauty, I asked her what she looked for when trying to judge so many pretty things at once. She taught me that roses, like all plants, have certain genetic and situational needs that are greatly impacted by where they grow and how they are cared for. Factors such as soil nutrition, water, sun, and exposure to stressors and weather elements affect growth and blooms. When they become stressed from not having their needs met, pests can pick up the signals and attack. She showed me that if you look closely, that there is no such thing as perfection- all plants have bumps and irregularities, often scars- this is part of plant life. However, any plant well tended for its needs with patience could become healthy and beautiful. Not only that, but their individual differences and exceptional adaptations to the elements of their environments are exactly the things that make them winners in shows! (This view impacted me profoundly in how I would later train to administer healthcare for people).

by Cora Rivard, N.D.

Updated Guide for Tick Removal, Testing, and Prevention in New England

8 Mar

 

tick on neck

by Cora Rivard, N.D., owner of Seasons Natural Healthcare, LLC, a natural medicine family practice located in southern New Hampshire.

After dealing with my own late stage Lyme infection years ago, and working with patients who have Lyme disease, I know firsthand how critical it is to prevent it. This includes knowing how to move quickly with the right tools and steps when you or a family member gets a tick bite. So, I am providing you with the info here that I wish I had known many years ago! (1. Prevention, 2. Procedures for Bites.)

First: Prevention:

  1. Get one of these by “Ticked Off.” This is hands down the best tick remover device you can get. I have tested out many styles, but my favorite by far is the notched spoon method. It can safely remove ticks of any size, even nymphs and larval sizes, with head and mouth intact every time. I like the 3 pack because it is great to have back-ups. We keep one on a hook in our home, so anyone knows where to find it quickly when needed.
  2. Wear pants (preferably light-colored so easier to visualize ticks) tucked into socks when in the woods and when doing yardwork.
  3. You may apply tick repellent sprays, herbal or chemical, to shoes, pants and legs prior to walks in the woods. For children, I recommend parents use safer, non-DEET repellants if possible. Formulations with essential oils like lemongrass, cedar, rosemary may be OK to repel ticks (but should be re-applied often). Just be extra careful using essential oils, especially on children- some can cause burns if directly applied to skin. A little applied to sock tops, pant legs/hems may be adequate: Botani Organics Tick Guard Repellant Spray — 4 fl oz(by the way- for mosquitoes, the best natural product I have used is lemon eucalyptus: Repel 94109 Lemon Eucalyptus Natural Insect Repellent, 4-Ounce Pump Spray. But I don’t know if it would repel ticks.)
  4. As soon as you come inside from outdoor work or adventures, remove your clothes (this is also entertaining for your neighbors) and toss them (the clothes, not your neighbors) in the dryer for 5-10 minutes. It’s not necessary to put them in the washers, ticks don’t drown in the wash,  but a spin through the dry heat of the dryer will kill them.
  5. Nightly tick checks. Ticks are not polite- they will crawl up until they hit a crease, fold, or simply can’t climb up anymore. Always check the nether regions, back, neck, under breasts, armpits, legs, belly button, and go through the hair and scalp carefully. Another important spot to always check (especially in children) is within the curves and folds of the ears. Do this every single evening whenever snow is not covering the ground, even if you or your children have not been outside, ticks can still migrate indoors on pets….so:
  6. Don’t Sleep with Rover. You might think it is OK since you treat with him/her with chemical treatments or with a collar, but think again. It may actually repel some ticks to crawl over to a more welcoming host to bite- you!

If you are really committed to prevention, consider some landscaping/gardening techniques to naturally keep out ticks- I discuss them in my previous article, “Plants Vs Ticks.”

Second: Steps to take when you get a tick bite:

  1. Get your tick remover. If using the “Ticked Off” device, apply traction to either side of the tick bite, pulling skin tight, and gently scoop tick out with a smooth, non-jerking motion so that the mouth parts don’t break off in the skin. If you only have tweezers, gently grasp from tick from where it is attached to the skin, and pull gently out, also applying traction to skin.
  2. Never try to burn, squeeze, or otherwise irritate the tick by putting anything on it, like essential oils or vaseline. This can cause the tick to disgorge its stomach contents into the wound, along with infectious organisms.
  3. Wrap tick in a moistened piece of paper towel or moistened cotton ball, and deposit into a zip plastic baggie.
  4. Apply hydrogen peroxide, or other antiseptic to the site of the tick bite.
  5. Call your doctor’s office to ask about their protocol for treating tick bites, and to seek advice based upon how long the tick was attached, or how inflated it appeared. Note: ticks can start transmitting the organisms that cause Lyme well before 24 hrs of attachment.
  6. In the mean time, consider sending the bagged tick off for testing. I can highly recommend the  UMASS Laboratory of Medical Zoology ‘s TickReportAs of May 2018- UMASS’s program is now only charging $15 for tick testing, thanks to a federal grant! It tests for a variety of tickborne illnesses, and returns results in about 3-5 business days (but often even faster.) Plus, they are assimilating this data to help further research into tickborne diseases, distribution and treatment. When you set up an online order with them, their website still lists the original price as $50, but as soon as you enter your address, you will see that price adjust to $15. This is a great deal- other tick testing sites can cost upwards of $100, and this one actually provides more information, fast!

For further info

Call your doctor with concerns, they might suggest preventve treatment depending on the circumstances of the tick bite, even without symptoms. “Preventive” treatment should mean full treatment time-I often recommend to patients to complete 4 weeks of antibiotic treatment in early disease. This is longer than the guidelines set forth by the Infectious Disease Society of America (IDSA). Signs and symptoms of Lyme disease and other infections may include any of the following: spreading rash, fever, head aches, stomach aches, flu-like symptoms, swollen lymph nodes, and joint aches and pains. However, it is also possible to have no signs or symptoms for weeks or months during the initial infection. It is common for the skin surrounding tick bites to get a little red and even scabby- this is because your immune system becomes activated with the mechanical irritation of the bite, and also may react strongly to the proteins in the tick’s saliva. This is not the same as an erythema migrans- the typical Lyme rash. Show your doctor immediately if you have any kind of rash or reaction, they can help to distinguish the two.

Testing for Lyme disease in humans: generally, you must wait at least a month to get tested, as it takes a while for antibodies to mount diagnostic levels. Therefore if it is likely that you might have contracted a tick transmitted illness, either by symptoms, history of deer tick bite, or by an unusual rash (since many people who contract Lyme disease never discovered an attached tick)- your doctor may opt to go ahead and treat you.

If you do go through treatment, remember to talk to your doctor about taking probiotics (take at a separate time from antibiotics) throughout your treatment period and for at least 2-3 months beyond. Antibiotics will help to kill tick-borne diseases, but they will also wreak havoc on your intestinal ecology. Probiotics can help to protect you from getting a serious intestinal infection while your defenses are down during and post treatment. Again, talk to your doctor for guidance!

Cora Rivard, N.D. is a licensed naturopathic family doctor and owner of Seasons Natural Healthcare, LLC, in Derry NH. Please visit my website at www.seasonsnatural.com. Inquiries about appointments and services may be emailed to info@seasonsnatural.com

 

 

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