When to schedule with the doctor:

a patient’s guide to scheduling

I get many phone calls each week from patients and parents asking,

Should I schedule an appointment?

The truth is, if you are worried enough to call and ask, then you or your child most likely needs to be seen by a physician.

Most complaints and concerns can be triaged by your doctor, at their office. You can consider your doctor’s office an urgent care clinic, during their open office hours. We are lucky enough at NFM to have both a Naturopathic Physician resident and a Nurse Practitioner on hand who will almost always be able to see you within a few hours of you calling the office.

If you feel like you need to be seen sooner than what NFM has available, then this is the appropriate time to go to the Urgent Care. If you think you are having a heart attack or a stroke, having an anaphylactic reaction, cannot breath, or are having some other life-threatening emergency such as a seizure, you need to dial 9-1-1 or go immediately to the nearest emergency room.

Otherwise, reserve Urgent Care for when your doctor’s office is closed, and save the ER for a true emergency (anaphylaxis, respiratory distress, suspected heart attack or stroke etc.)

The following list is the TOP 20 MOST COMMON PEDIATRIC COMPLAINTS derived from San Diego Children’s Hospital, with general averages a child is expected to be ill with the listed complaint per year. You can click the link of each complain to be redirected to San Diego Children’s Hospital “Your Child’s Health guideline page to read more about each condition in detail and to receive more guidance about scheduling an appointment with your child’s physician.

1.  Colds:  5-10 times per year

2.  Coughs:  4-5 times per year

3.  Croup:  1-2 times per year

4.  Sore Throat:  4-5 times per year. Mostly  with colds, occasionally with Strep

5.  Eyes with Pus or Drainage:  1-2 times per year

6.  Earache:  1-2 times per year

7.  Diarrhea:  3-4 times per year

8.  Vomiting:  1-2 times per year

9.  Wheezing:  50% of infants experience wheezing during a viral respiratory infection (called bronchiolitis).

10.  Fever:  5-10 times per year with the above symptoms/infections. 1-2 times per year without any other symptoms

11.  Skin Injuries:  Including bruises, cuts or scrapes, skin injury, and burns

12.  Head Injuries

13.  Arm or Leg Injuries

14Stomachache

15.  Headache

16.  Constipation

17.  Crying, Unexplained

18.  Immunization Reactions

19.  Hives

20.  Rashes, Unexplained

Below is a long, yet incomplete list, of more conditions and concerns that warrant an appointment with your doctor:

  • Allergic reaction concerns
  • Animal bites
  • Blood in urine or stool/ or on toilet paper
  • Broken bone suspected
  • Child refusing to eat or drink and appears ill
  • Color changes: skin, nail or lip color appears white, yellow, or blue
  • Crying baby < 3 months
  • Diarrhea that is persistent
  • Diaper rash and your child appears very sick, or it is not getting better after 3 days of treatment
  • Eyes with discharge or redness
  • Fever over 100.4
  • Fever that is not responsive to Tylenol
  • Head bonks
  • Headaches- new onset, “Worst headache of your life,” or persistent headaches
  • Joint swelling and/or joint pain
  • Loss of Consciousness
  • Muscle weakness or paralysis
  • New symptoms
  • Pallor: child appears pale
  • Penile discharge
  • Seizures
  • Sickness after recent travel
  • Supplement and home treatment advice
  • Swollen scrotum
  • Umbilical cord concerns
  • Urinary pain or frequency
  • Vaginal or uterine bleeding in menopausal women
  • Vaginal discharge
  • Worsening symptoms

And as Dr. Amy Hawkins pointed out: “When a doctor’s eyes see you, and a doctor’s hands touch you, you receive phenomenally better care than what you would otherwise receive by a doctor just listening to you over the phone.”

Are you sleeping through the night?               

Let us help you get a good night’s rest!

The New York Times published an interesting article yesterday (11/6/2011) titled “Mother’s Little Helper” about the extensive use of anti-anxiety medications and sleep aids in mothers. Read the article on the NY Times website here.

Sleep medications, such as Lunesta (a hypnotic), benzodiazepines, and even anti-depressants are all commonly prescribed, and come armed with a host of potential side effects including drowsiness, dizziness, cognitive impairment, daytime sleepiness, not to mention there is also a high risk of dependency. These side effects are significant, and certainly not tolerable by busy Moms (www.uptodate.com.)

There are many other alternatives that can be used in lieu of pharmaceutical medications. Of course, you have all heard of melatonin and 5-HTP; and you are probably also familiar with the common herbs used for sleep including chamomile, valerian and the sort.

Unfortunately, natural treatment is not always as simple as taking melatonin instead of Lunesta before bedtime. In fact, it’s almost never this simple. There are just too many factors involved in getting a good night’s sleep—from personal health problems, to family and baby issues, environmental factors, your husband’s snoring…. The list can go on and on.

Here is what I suggest: schedule an appointment with one of the doctors at Naturopathic Family Medicine. We can assess you holistically and in a comprehensive manner to explore all the potential different causes of your insomnia. We offer simple, non-invasive testing of neurotransmitter and hormonal pathways that can shed light on your insomnia issues, highlighting a potential deficiency in an enzyme, hormone, nutritional co-factor, etc. This information will lead to both personalized and effective treatment of your insomnia; and it is certainly a much better method of treating than say, attempting self-treatment with various medications or herbs and hoping for the best.

Schedule an appointment today—and within a short time after testing and custom-made treatment, you will on your way to a better night’s sleep.

Sweet Dreams!

Face the (Flu) Facts:

November 1, 2011

Can a spoonful of elderberry a day keep the doctor away?

Or, in other words, who should get the flu shot this year?

Influenza Virus Vaccine Information for 2012

With the flu season in full swing already, our appointment books are filling up with requests for this year’s flu shot. And who can blame them? Last year’s seasonal flu, and not to mention 2009’s H1N1 (swine flu) outbreak was both miserable for the patient (causing some a weeks’ worth of headaches, body aches, fevers, and cough) as well terrifying for others, who feared scary complications of the flu such as pneumonia and seizures.

Thus, it makes complete sense that people are requesting a flu shot as soon as possible and not hesitating to take the plunge with this vaccine as a preventative measure to falling ill this winter.

This brings up a good point: Is the flu vaccine the best way to prevent the flu? And is there another option to flu prevention beside the flu shot?

I want to highlight a few points about the 2012 Influenza Vaccine to help you make the best decision for yourself and family.

 

Flu Fact #1: the 2012 Influenza Vaccine contains 3 influenza viruses: the H1N1 (swine flu) strain, and two other viral strains that caused the seasonal flu last year. In other words, this year’s flu shot is the same as the flu shot from last year. Two types of flu vaccines exist: one is a shot and the other is a intranasal spray.1

Do I need the flu shot every year? Usually, yes; and the CDC recommends that you do indeed need a flu shot every year. 1 If you had the flu shot last year, or better yet, actually caught the flu last year, you already have immunity to the flu strains in this year’s vaccine. That is a good thing, and you could get away with not getting the flu shot this year. That being said, your immunity does taper over time, and there is no harm in getting another flu shot this year; it would simply act as a booster for your immune system. 2

 

Flu Fact #2: The flu does not affect everyone the same.

Certain groups of people are at a higher risk of getting the flu, and are also at a higher risk for serious complications from the flu.

These groups of people include, but are not limited to:

  • Adults over the age of 65 years
  • Children under 5 years, and especially children under 2 years
  • People with Asthma
  • People with Diabetes
  • People with cancer, or who have had cancer in the past
  • Pregnant woman
  • People with altered immune systems
  • People who have HIV/ AIDS2

If you, or anyone you live with, falls into one of these high risk categories mentioned above, then making an informed and wise decision about getting the flu shot this year is essential for the health of your loved one; and a flu shot may be a good consideration.

 

Flu Fact #3: Not everyone should get the flu shot.

The groups of people who should not get a flu shot include, but are not limited to:

  • People with IgE anaphylactic egg allergies
  • Those with a history of Guillan-Barre Syndrome
  • People with a current, acute febrile illness

An even more extensive list exists for the nose spray form of the flu vaccine. The list includes all of the above contraindications, plus:

  • Children younger than 2 years of age
  • Adults older than 50 years of age
  • Pregnant women
  • People who are immunocompromised, or people who are in close contact with others who are immunocompromised
  • People with a history of asthma or wheezing in the last 12 months
  • Children taking aspirin or other salicylates2

Although it is not a contraindication, it is interesting to note that a recent study found that the flu vaccination is not as effective in those who are overweight and obese (Sheridan, 2011.)3

If you or someone you know falls into one of the above categories, scroll down to learn about other strategies to prevent the flu this season.

 

Flu Fact #4: There are serious risks associated with the flu.

These include, but are not limited to, developing pneumonia, neurological complications such as seizures, pulmonary complications, sinusitis, worsening of underlying chronic disease, and other various complications such as carditis (inflammation of cardiac, heart, tissue.) The people most at risk for these complications are children under 6 months, adults older than 65 years, and those with pulmonary conditions such as asthma, COPD, emphysema, smokers, and the like. 1

If you, or people in your household, fall into any of these high-risk categories, a flu shot may be a good consideration.

 

Flu Fact #5: There are risks associated with the flu shot.

Getting the flu shot is not a guarantee that you will not get sick. Some of the common side effects associated with this year’s flu shot include: flu-like symptoms (headache, fatigue, body aches, cough), soreness at the site of injection, mild fever, and just feeling crummy. Other less common side effects include febrile seizures, acute respiratory illnesses, vomiting and diarrhea, and other sickness. More serious side effects of the flu shot include anaphylactic allergic reactions, Guillan-Barre syndrome, and Reye syndrome.2

 

Flu Fact #6: There are some strategies, other than vaccinating, to help prevent the flu.

Good ol’ fashioned hand washing is one way to prevent the spread of germs. Washing your hands after every cough, sneeze, and trip outside may be difficult… but hand sanitizer gels kept in convenient places are a good alternative to washing when a sink is not handy. Your naturopath can offer you some more ways to help reduce your chances of getting the flu this year.

 

Flu Fact #7: There are no herbal alternatives to the flu shot.

But there are herbs that help reduce flu symptoms, and can be used to help prevent contracting the flu. The most notable herb for influenza treatment and prevention is Sambucus nigra, Elderberry. This is a delicious berry that tastes great as a wine, syrup, cordial, jam, etc, and can be used medicinally this flu season. A placebo-controlled, double-blinded study from 2004 published in the Journal of International Medical Research concluded that elderberry inhibited replication of human influenza viruses A and B through a process called hemagglutination, which essentially means that elderberry blocks the viruses ability to bind to the host (you.) This makes elderberry a great addition to a daily flu prevention plan that includes other vitamins, minerals, and strategies for preventing the spread of flu (Bove, 2010.)4

  

Flu Questions & Answers:

Can you get the flu if you have had a flu shot? Yes, for a variety of reasons. One, it takes about two weeks for your body to develop full immunity to the viruses it was exposed to in the vaccine. If you are exposed to these same flu strains in that two week time period, you may become ill. Also, viruses mutate and change. It is possible that you can become sick with the flu from a strain that you were not immunized against. Last, other non-flu viruses, such rhinovirus, can cause flu-like sickness and symptoms. Unfortunately, the flu shot is no guarantee that you will not end up laid up on the couch sick this year.1

 

Can you get the flu shot too early or too late? No, whether you get the shot in September, or as late as after Thanksgiving, the effectiveness of the shot is the same. However, the longer you wait to vaccinate, the higher the likelihood that you will be exposed to the flu and get sick.1

 

Where can you get elderberry? The best place to ensure you are receiving quality products is from your Naturopath’s office. Please ask your naturopathic physician for a recommendation of a product.

 

How much elderberry should I take? The amount you need varies for each person. Talk to your naturopath about taking elderberry on a daily basis in a dose that is both safe and effective for you.

 

Does taking elderberry replace the flu shot? No. Nothing can provide immunity to a virus or disease except for: 1) becoming ill with that virus, disease, etc, or 2) vaccinating for that disease or virus. While elderberry cannot replace immunity formed from the flu shot, it may be used as an alternative vaccine measure for contracting the flu.4

 

References:

1. King County Public Health Website. Seasonal influenza (“flu”) vaccine recommendatiosn for the 2011-2012 flu season. Information updated Oct 24th, 2011. Website accessed Oct 31st, 2011. http://www.kingcounty.gov/healthservices/health/communicable/immunization/fluseason.aspx

2.  Center for Disease Control and Prevention Website. Seasonal Influenza (Flu) and The Influenza (Flu) Viruses. Author Unknown. Information updated Jun 30th, 2011. Website accessed 10/31/2011. http://www.cdc.gov/flu/

3. Sheridan PA. Int J Obes. Influenza vaccine less effective in overweight, obese people.

2011;doi:10.1038/ijo.2011.208. Article accessed online Oct 31st, 2011. Online publication: http://www.endocrinetoday.com

4. Bove, M. Influenza and elderberry: A safe, effective flu option. Jan 1, 2010. Article accessed online Oct 31st, 2011. Online publication: http://www.gaiaherbs.com/articles/detail/9/Influenza-and-Elderberry-A-Safe-Effective-Flu-Option

“ChARM-ed, I’m Sure!”

October 28, 2011

Some of you who have been to the doctor this week may have noticed that we are now asking you for your email address when you check-in, so that we may set up an account for you in Naturopathic Family Medicine’s new electronic medical record system, ChARM.

The advantages of using an electronic health record system from the physician’s perspective may be obvious, but there are some definite benefits for you, the patient, as well. In today’s post, I want to highlight those benefits for you so that you can quickly be on your way to enjoying the good life with electronic medical records.

1) Your personal health record (PHR): Now, as a patient of Naturopathic Family Medicine, you get a free ChARM PHR (Personal Health Record) that you can set up from an email invite we will send you. You no longer have to worry about losing the copies of your recent labs; all health records are now stored in your PHR for you. From the tabs present on the left hand side of your home page, you can view and export your documents into PDF formats to save on your computer and you can even print information directly from your account.

2) Request appointments online: You will be able to request appointments with the Naturopathic Family Medicine’s front desk online. Your appointments will also be listed on your personal ChARM’s calendar, and you will receive reminder emails about future appointments.

3) Send and receive messages to/ from your doctor: ChARM’s email-esque and secure messaging system will allow you to easily ask your doctor questions that may arise. This will be a quick and easy way to communicate effectively with your doctor.

4) Treatment and handouts: All prescriptions, recommended supplements, diet suggestions, and other therapies will be listed on your PHR home page. Here you can also read physician observation notes, access handouts, and review past treatments plans.

5) Monitor your progress: Under the “Reports” tab, you will be able to look back over some of your past health history, such as vaccination history and past heath vitals (like your temperature or blood pressure.) This will help you monitor your health progress independently and track health changes over time.  You can also import your health vitals yourself if you are monitoring a health detail in particular, such as your weight, your blood pressure readings, and more.

Here is how to sign up for your CHARM PHR today!

1) Give us your email address. We will add you as a new patient in our account, and will be notified via email when this occurs.

2) Watch for the email we send you, and follow the registration prompts to sign up as a new user.

Viola! You now have an account with ChARM and the ability to freely access your PHR and communicate with your doctor. ChARM will prompt you to fill in personal and health information to help provide the most complete and accurate information about you.

We think you will be just as ChARM-ed as we were by the newfound benefits of transferring over to our  electronic health record system!

And as always, if you have any questions or concerns at all, please feel free to call the office at (206) 683-4495.

In 1980, Susan G. Komen died from breast cancer just three years after being diagnosed.  She was only 36.  Before her death, Susan’s sister Nancy promised her she would do whatever it took to help eliminate this devastating disease.  Nancy founded the Susan G. Komen Breast Cancer Foundation, now known as the Susan G. Komen for the Cure, in 1982 to promote breast cancer awareness.

According to the National Cancer Institute, an estimated 230,000 new cases of breast cancer will be diagnosed in 2011 and they predict that 39,520 women will die from the disease. The good news though is that number of deaths from breast cancer has been steadily decreasing since 1990.

Early detection can literally mean the difference between life and death. All women should perform monthly self breast exams starting in their 20s.  The website www.checkyourboobies.org not only teaches women how to perform these lifesaving exams, but can also send a monthly email reminder to do so.

So this October, wear pink, get involved, and get in the habit of performing monthly exams.  It may just save your life!

The Flu…Again!

September 30, 2011

The Flu – To vaccinate or not to vaccinate…

Originally posted December 13, 2010

This time of year, this is the number one question at our clinic.  While it is hard to give a direct and easy answer, I thought I would take a minute to describe our naturopathic philosophy about the flu vaccine.  As always, if you have individual concerns, please schedule an appointment with your doctor to discuss this issue more thoroughly.

First, let’s discuss the flu.

Influenza is a potentially dangerous disease, particularly for the very young, the very old, and the immunocompromised. With influenza, one is more likely to develop secondary bacterial infections, such as pneumonia, otitis media, and sinusitis.  In rare cases, flu can even lead to serious infections of the blood, called sepsis.  Flu is not something that should be treated lightly; it is important to seek medical care if you develop symptoms such as:

  • A persistent fever of 101 degrees or higher for greater than 3 days;
  • Severe pain;
  • Severe lethargy;
  • Rash; or
  • Behavior changes.

Saying all this I do recommend the flu shot for specific patients, especially those that fit into the criteria of immunocompromise and those who are pregnant.  These patients may have a difficult time fighting off the flu virus as well as the more dangerous bacterial infections.

However, MOST healthy people have an immune system that can fight the flu very well, and as a result, they gain antibodies that help protect the person against flu in subsequent years.  It is okay to push the immune system a little to respond to viruses and bacteria, as long as we can intervene at the appropriate time.    The flu vaccine in the shot form is manufactured by guessing which flu strains will be coming around in that year.  As a result, the ingredients are often not the same strains and the flu vaccine does not provide the antibodies to fight the flu.  That is why many people who get the vaccine still get the flu.

There is mercury (thimerosol) used in the manufacture of the flu shot, (however, there is a small stash of mercury free vaccine for kids and pregnant women) which may potentially cause problems, esp. in children and if many vaccines are given over time.  The flu mist form of vaccine is mercury free, so that is good, but it is a live virus vaccine, which means that most people who get it will actually get a small touch of the flu and potentially spread it to others around them.

Furthermore, there is recent evidence that the flu vaccine only modestly improves patient symptoms and days of work lost. This study also showed that secondary bacterial complications from influenza were not reduced by the vaccine.

Here is the link to this study: http://www.ncbi.nlm.nih.gov/pubmed/20614424 and the main results and conclusions are shown below.

MAIN RESULTS: We included 50 reports. Forty (59 sub-studies) were clinical trials of over 70,000 people. Eight were comparative non-RCTs and assessed serious harms. Two were reports of harms which could not be introduced in the data analysis. In the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation, 4% of unvaccinated people versus 1% of vaccinated people developed influenza symptoms (risk difference (RD) 3%, 95% confidence interval (CI) 2% to 5%). The corresponding figures for poor vaccine matching were 2% and 1% (RD 1, 95% CI 0% to 3%). These differences were not likely to be due to chance. Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms and an estimated 1.6 additional cases of Guillain-Barré Syndrome per million vaccinations. The harms evidence base is limited.

AUTHORS’ CONCLUSIONS: Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.WARNING: This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.

If you don’t do the vaccine, what else can you do?

We know that there is good evidence that there are other things that can protect us from the flu equally as well as the flu vaccine.

One of these is taking probiotics as a daily supplement, at 10 billion organisms per day for adults or children.  http://pediatrics.aappublications.org/cgi/content/full/124/2/e172.

Another is taking Elderberry syrup (1 tsp. per day for kids and 2 tsp. per day for adults) http://www.reuters.com/article/2009/09/10/idUS119205+10-Sep-2009+PRN20090910  (from the July 2009 issue of the peer -reviewed scientific journal Phytochemistry , Volume 70, Issue 10).

Whether you choose to vaccinate with the flu vaccine this year, you certainly have our wish for good health this season!

Tamara Cullen, ND

Safe Backpacks

August 22, 2011

Can you believe it’s almost time to send the kids back to school? With that in mind, we thought we would provide some helpful information on choosing a supportive backpack.

When selecting a backpack, look for these features:

  • The backpack itself is lightweight.
  • Wide, padded shoulder straps and an ergonomic design.
  • Multiple compartments.

The American Chiropractic Association recommends that a loaded backpack not exceed 10% of a child’s body weight, which is 5 lbs for a fifty pound child, or 10 pounds for a hundred pound teenager. Look for red marks on your child’s skin—they indicate that your child is carrying too much weight.

Worn improperly, backpacks may also cause back, neck, or shoulder pain.  They can also throw kids off balance and lead to falls. Encourage healthy habits by making sure your child wears both straps on the backpack! Discourage the use of only one strap slung over a single shoulder—which can lead to alignment problems and pain.

To ensure a proper fit, make sure the backpack isn’t sitting more than four inches below the child’s waist and that the straps are tightened so the backpack is close to the body.

Loading a backpack correctly matters as well. Looks for a backpack with multiple compartments to distribute supplies and weight evenly. Help your child determine what items are okay to leave behind at school at night and what can stay at home so that they aren’t carrying excessive weight.

Even better? Have your kids use a rolling bag!

http://www.completebackpacks.com/kids-rolling-backpacks.html

-Amanda Giger and Dr. Carly Bridge