Differentiating Some Causes of Chronic Pain in Women

My grandmother and I were chatting about different chronic pain disorders that exist in women. Here is a very brief overview of three common conditions, highlighting their differences and unique symptoms. All present with muscle pain and more often in women. 

Fibromyalgia 

- often presents in younger women (less than 40)

- point tenderness over affected muscles 

- tender points in various locations on the body (11-18 tender points total)

- anxiety and stress exacerbate the pain 

- often associated with depression and chronic fatigue syndrome

- often normal laboratory values

- may be due to mitochondrial dysfunction, though many hypotheses exist

Polymyositis
- often presents in women aged 40-60 

- weakness, stiffness, and inflammation of proximal muscles 

- severe pain and stiffness felt in pectoral and pelvic girdles 

- may have difficulty swallowing, lung disease, and thickening of skin

- elevated ESR and CPK laboratory test values 

- anti-jo antibodies found

Polymyalgia Rheumatica

 - often presents in women older than age 50 

- severe pain and stiffness felt in hip, neck, pelvis, shoulder

- inflammation seen in many muscles

- temporal arteritis can also present

- "gelling phenomenon" experienced (stiffness after inactivity) 

- elevated ESR and CRP laboratory test values

10 (Everyday) SuperFoods

These days, "superfoods" are all the rage. In every health food store, you'll see all kinds of fancy (and often very expensive) superfoods that are supposed to restore health, vitality, and have you living to 105 years old (they don't actually make those specific claims, but claims pretty close to these). Some recent and popular superfoods to hit the market include chia seeds, irish moss, goji berries, acai berries/powder, spirulina, maca... plus many, many more.

But what about everyday "superfoods"? Can I eat like a superhuman without breaking the bank? Why, yes, yes you can! Here are some of my top "everyday" superfoods (in no particular order):

Superfood loving: let's see, we have some sweet potatoes, onions, and broccoli! Three everyday all-stars. 

1. Oats - known for their soluble fiber, which keeps you full, your blood sugar regulated, and lower cholesterol by binding to excess cholesterol. I also love their versatility in cooking and baking. Gluten-free too, if you buy certified g-free oats. 
2. Spinach (and other greens) - greens are important for fiber (roughage), tons of vitamins, and loads of minerals. The healthiest vegetables are the greens. 
3. Grapefruits - we all love citrus for the vitamin C, but grapefruit is said to boost metabolism. 
4. Blueberries (and other berries) - high in antioxidants like vitamin C, fiber, and generally a "dark" fruit. Similar to the greens, the darker the fruit or vegetable, the more concentrated the nutrition. 
5. Almonds (and other nuts) - healthy fats and protein. An easy snack to have on hand. Almonds in particular are a source of calcium. 
6. Salmon - good old healthy fatty acids are found in salmon. These essential fats are good for our brain, skin, and mood. 
7. Seeds - flax, sesame, pumpkin, and sunflower are all awesome. Phytoestrogens are found in seeds, which help regulate our hormones and help our body deal with the synthetic hormones lingering due to all the plastics that are abundant in our modern world. 
8. Onions - anti-microbial (awesome to eat when sick), lower blood pressure, and have anti-cancer proprieties. 
9. Sweet Potatoes - lots of vitamin A. You can even eat the (cleaned) skin for extra fiber. A good source of complex carbohydrates. 
10. Broccoli (and other cruciferous vegetables) - high in calcium, vitamin C, and anti-cancer. Aside from greens, I'd say the cruciferous veggies are the best for your overall well-being. 

Breast Cancer Causes (?)

Today, the most prevalent types of cancer in Canada are lung, breast in females, prostate in males, and colorectal/colon cancer (Source). So, let's chat about breast cancer for a second or two. While no one can pinpoint exactly what causes this type of cancer, there are several hypotheses behind the increased incidence of of breast cancer as of late: 

- Plastics: plastics contain synthetic estrogens (xenoestrogns) which are endocrine distruptors, causing all kinds of endocrine disruption in the body (affecting not just the breast, but also the thyroid, adrenals, prostate, and more).
- Not breast feeding: not using the breast the way it was physiologically intended). Source.
- Genetics: the BRCA1 and 2 genes. Source.
- Shift work: Due to low melatonin levels due to odd nighttime light exposure (i.e. working at night) has recently be linked to breast cancer. Shift working nurses, in particular, are at risk of developing breast cancer. Source.
- Anti-perspirants: by applying these to the armpit, where is very close to the breast tissue. These products contain aluminum (a heavy metals), synthetic chemicals, and toxins. They stop sweating, but sweating is one of the body's mechanisms of detoxification. As we are not able to sweat wearing these products, the toxins that would normally leave the body through sweat, need to go somewhere... and since the breast is near by and fatty tissue to deposit in, toxins accumulate in the breast. We talked about this in one of my classes (Men's and Women's Health), but here is another source. By the way, "deodorants" don't really exist anymore. Almost all "deodorants" on the market are actually anti-perspirants; blocking perspiration.
- Bras: we didn't always wear bras, that's a new societal development, especially those with metal underwire. While there isn't any research to support this claim, there is a lingering hypothesis that bras compress the breast and that their underwire doesn't allow the lymphatics of the breast to properly drain. Whether or not this is true and is linked to breast cancer, tight clothes is not normally good for your body. For all my female readers: tonight, when you undress, take off your bra in front of a mirror. If there are bra indents/red marks on your skin after the bra is off, then it is too tight! When choosing bras, try to get ones without metal underwire if you can and make sure your bra is properly fitted (i.e. not too tight but still supporting you well to prevent sore necks/traps/back).
- Lastly, all those other cancer risk factors, like smoking, lack of exercise, obesity, stress, etc, etc, etc... 

Now that we've got the risks out of the way, here are some ways to improve your breast health!

- Massages: massage the breast, moving upwards, towards the clavicle to drain the breast lymphatics
- Consuming phytoestrogens, like soy and flaxseeds, on a regular basis
- Avoiding plastics as much as possible
- Wear a properly fitting bra and try for bra-free days if possible (weekends?)
- And all those other health promoting practices, like not smoking, exercising, getting enough sleep, maintaining a health weight, managing stress, eating well ...yadda, yadda, yadda!
- Talk to your doctor to learn more ways to keep your breasts healthy. This blog post was not meant to scare anyone into thinking that they are going to get (or got) breast cancer due to behavior X, Y, or Z, instead it was meant  to getting my readers thinking more about their overall breast health!

Semi-Salty

Those who are mindful of their sodium intake also have to watch out for "hidden" sources. Ketchup and bread are both high in sodium and are often forgotten about. This cute "dip or squeeze" ketchup packet was seen in a restaurant; the package is cute, but the product still sucks.  :P

In my last Integrative Therapeutics lecture on Monday, we wrapped up our discussion of treatment options for cardiovascular disease, congestive heart failure, and hyperlipidemia. We also chatted about hypertension (though we had already completed a model on treating hypertension, aka high blood pressure, earlier in the semester).

We broached the topic of salt when we were covering the dietary modifications portion of the lecture. Those with hypertension should be extremely mindful of their salt (aka sodium chloride) intake as too much salt can raise blood pressure. My professor mentioned the product "No Salt" (the product Nu-Salt also exists, as do many other salt imitation products). Instead of being a jar of sodium chloride (NaCl), this product is made of potassium chloride (KCl). Therefore, it is sodium-free ...yet apparently still tastes "salty". I haven't tried this product and thus can't vouch for it's salty taste, but I am intrigued by the idea of a salt-less salt. According to Amazon, the reviews are mixed.

I know I will treat many salt-addicts as a doctor, so I am definitely interested in salty alternatives beyond products like Mrs. Dash and Herbamare (though I LOVE Herbamare and highly recommend it; it is made of salt plus herbs and seasonings) ...and of course I will recommend that patients use herbs and spices to season food instead of salt when possible.

Vitamin B12 Injections and More

On Monday, I performed my first vitamin B12 injection. 

Vitamin B12 (also known as cobalamin), is a B-vitamin in the body. It is water-soluble, so when the body has enough of this vitamin, it will simply pee out any excess. Overdose or toxicity from vitamin B12 is extremely rare due to its water-solubility. Vitamin B12 can not be synthesized by the human body so it must be consumed. It is found in animal products, so vegetarians (who don't eat a lot of eggs or dairy) and vegans need to supplement B12. Nonetheless, even meat-eaters can be deficient in this vitamin and benefit from supplementation!

Importance: Vitamin B12 is super important for cell metabolism, DNA synthesis, neuron function, and more. If you are deficient in vitamin B12 you may feel fatigued, weak, experience brain fog or poor memory, suffer from constipation, asthma attacks (in asthmatics), have a sore tongue or canker sores, and/or decreased (numbness) or increased body sensations (tremors or tingling).

Supplementation Means: If you are supplementing, aim for sub-lingual tablets (i.e. pills that you place under the tongue until dissolved) or vitamin B12 injections. These two supplementation forms ensure that vitamin B12 is well-absorbed by the body because they enter the blood stream more efficiently than swallowing a tablet that needs to go through the entire digestive tract before it is absorbed.

Injections: Naturopathic doctors can provide vitamin B12 injections. They are very expensive and minimally painful. You simply get an injection into the deltoid muscle on the shoulder (that big muscle on the side of the shoulder). Some people get injections weekly, biweekly, monthly, or on a as-needed basis depending on their needs. Most people feel a sudden surge of energy after receiving an injection! Vitamin B12 is the energy vitamin, so this makes sense.

Who should supplement with B12? People with pernicious anemia (an autoimmune disorder) need regular vitamin B12 supplementation as they are lacking intrinsic factor, a molecule that helps with B12 absorption. Vegans and vegetarians need to supplement. People with asthma may benefit greatly. And of course those who through a medical intake, present with the symptoms of B12 deficiency. Simple blood work can also detect low levels. The elderly may also benefit.

Parting Words: Talk to your healthcare provider if you are concerned about your vitamin B12 levels. Also of note, vitamin B12 is a beautiful, bright red color, so the fluid injected into the muscle and the tablets you take sub-lingual, should be both red. Don't worry, there aren't any dyes or artificial colors; that gorgeous color is all natural!

Women's Health Week: Concluding Thoughts

Women’s Health Week 2013 took place from March 11^th to 15^th at CCNM (my school). During that period, women’s health took the focus, through a variety of events. The loose theme this year was to address the more controversial aspects of women’s health, such as natural birth, body image, alternative menstruation management, abandoning fad-diets, and the glamourization of our health concerns.

On Monday, the Canadian documentary Pink Ribbons, Inc, was shown. This film critiqued pink ribbons movement, discussed pink washing, and featured women with breast cancer who don’t appreciate their disease being turned into something that is ‘pretty, pink, and perky’.

On Wednesday, at the Moms’ Panel, six CCNM students shared their birth experiences and gave advice to the future moms and health care practionners (who will be caring for new moms) in the audience. DivaCups were also handed out. Thank you to DivaCup for donating! 

Finally, on Thursday, Meghan Telpner, Nutritionista, gave us ten simple steps to share with patients to improve overall health. Immediately after her talk, members of the CCNM family shared their body monologues at the first ever BMcompanion event. It was full of both tear-jerking and laugh-out-loud moments. If you missed it, you can hear more body monologues at the downtown Toronto, April 11^th show. Learn more about this show here. 

A big shout-out to the volunteers that helped with WHW and to all who attended the events. Thanks!

This board featuring women's health research was displayed in the school lobby all week long. 

PMI

The PMI (also known as the Point of Maximum Impulse) is the part of the body where the heart beat is felt the most. The PMI is felt best when you lie on the left side of your body, at approximately the 5th intercostal spaces (i.e. the spaces in between our ribs). On women, the left breast may need to be displaced upwards in order to find the 5th intercostal space. Simply count the spaces down from the clavicle until you reach the fifth gap. The diameter of the PMI is measured using finger pads. How many finger pads does it take to feel the whole span of the heart beat? Each finger pad corresponds to 1 centimeter (in metric units). A healthy PMI is 2.5 cm or less. An enlarged PMI may indicate cardiomegaly (i.e. heart enlargement).

Speaking of the heart, can you guess what this image means? 

(I have this image printed on a T. shirt, by the way)

Daffodils in My Future

There are daffodils in my future... 

The daffodil is the symbol of the Canadian Cancer Society

...and my future holds a lot of time with this book: 

Naturopathic Oncology by Dr. Neil McKinney, ND

As my class' (CCNM class of 2014) fourth-year clinic schedule will be published on Monday, I think it is an appropriate time to announce that next year I will be treating cancer patients at my school's Adjunctive Cancer Care Clinic Shift located in the RSNC teaching clinic.

Way back in January, I submitted my essay and resume to the selection committee, and was shortly after short-listed for an interview. I was then interviewed by the supervisors of this shift (who are naturopathic oncologists). Then, about 2-3 weeks after that, I was notified that I was selected to partake on the Cancer Care Focus Shift. Hooray!

What an opportunity! I am so happy to be partaking in this shift next year and I can't wait to learn from these experienced NDs who've been working with cancer patients for years. I definitely plan to offer naturopathic cancer care to patients in my future clinic and with this shift under my belt, I am well on my way to learning the cancer-care ropes!  

Sensitivity vs Intolerance vs Allergy

Some foods we love, others we hate. Image source here. 

The difference between a food sensitivity, food intolerance, and a food allergy: 

Food Sensitivity

1) Timing: delayed reaction occurs most often

2) Symptoms:
- Diarrhea or constipation
- Bloating, gas, flatulence, cramps
- Acid reflux (GERD)
- Headaches
- Fatigue, sleepiness
- Mental disturbances
- Brain fog or hyperactivity
- Skin reactions
3) Types of sensitivities: you can be sensitive to anything! But the most common ones are gluten, wheat, dairy, nightshades, soy, and corn.
4) Immune response: IgA or IgG (meaning delayed immune reactions)
5) Tested: with blood work against 96 common foods or an Elimination Diet. Not identifiable using a skin prick test!
6) Other notes: some food sensitivities can resolve if avoided for a consistent period of time, can develop at any time and at any age

Food Intolerance

1) Timing: slow onset. Eat the food, feel fine, hours later feel yuck.
2) Symptoms:
- Diarrhea
- Bloating, gas, flatulence, cramping
- Nausea, vomiting
3) Types of intolerance: lactose intolerance against lactose (in dairy), food additives (food dyes, sulphites, additives, etc), food poisoning (intolerance to the bacteria or toxin), etc
4) Immune response: body lacks the enzyme to break down this food/substance.
5) Tested: breath test for lactose intolerance, trial-and-error (symptoms improve with the offending agent is removed or avoided)
6) Other notes: some people can take the enzyme that they are lacking in order to eat the offending food, e.g. Lactaid, but I don't recommend this, especially not long-term.

Food Allergy

1) Timing: immediate onset of symptoms. Only a tiny bit of the allergen is needed to set-off the immune system. Often a medical emergency. Sometimes carry Epi-pens.
2) Symptoms:
- Skin reactions
- Eye itchy and redness
- Chest pain and shortness of breath
- Lose consciousness, go into shock
- Swelling
3) Types of allergies: this can be anything! But common ones are peanuts, other nuts, eggs, and dairy.
4) Immune response: IgE reactions (meaning an immediate immune response to the allergen)
5) Tested: this type of allergy is often determined using the skin prick test
6) Other notes: often have food allergies for life, often diagnosed/determined in childhood

Others Food Reactions

Celiac Disease - an autoimmune disease in which the body reacts to its own enzyme that digests gluten (gliadin), causing a inflammatory, cross-reaction with the gut lining.

Diabetes - no, diabetics are not allergic to sugar! They just don't have insulin (or don't respond to insulin in type 2) to get the glucose into their cells; therefore they have to monitor their glucose/sugar levels carefully to not consume more than the level of insulin they have or can handle. 

Monday Morning Dangers

It's beginning to feel like Spring here in Toronto! Today is 12*C and partially sunny. With daylight savings occurring today, that means we'll get to enjoy this sunshine thanks to more daytime hours.

With that said, please be careful driving to work tomorrow. The morning after the Spring daylight savings time adjustment is one of the most dangerous times to drive, as I discussed last year.

Secondly, because tomorrow is Monday, be extra easy on yourself, as research shows that the incidence of heart attacks is highest on Monday mornings. This paper concludes that: "The incidence of sudden cardiac death is markedly increased on Monday". 

The day after daylight savings plus the fact that it is a Monday = one very dangerous day

So take care of yourself tomorrow morning, dear reader. Take care! 

Did you know that there are organs on your face?

In Chinese Medicine, the face can be mapped by organ systems. This is may be useful for understanding the cause of acne, moles, wrinkles, sun spots, etc. First, a naturopathic doctor or doctor of traditional Chinese medicine determine will determine where is the acne/mole/wrinkle/spot is located on the "TCM Face". Second, the doctor will ask questions to see if the corresponding TCM organ is dysfunctioning. For instance,   for chin acne, they may ask about urination frequency, urine color, urine smell, the amount of water you drink, etc. 

Obviously this is one theory behind face "imperfections". At CCNM, we actually aren't trained in face reading; the image below is just something I came across online that falls in-line with Chinese Medicine principles and I personally like the theory. So please don't go thinking that all NDs are hokey-pokey, fortune-telling, face-readers because they most definitely are not trained to act this way!

I have heard from a Western perspective, however, that jaw line acne is a result of hormonal imbalance. Evidence comes from research on polycystic ovarian syndrome (PCOS); a disease in which androgen hormones are in excess and jaw and chin acne can be symptoms (note that there are other defining PCOS symptoms; please talk to you doctor/health care provider if you are curious about the diagnosis of PCOS). 

Image source here. 

Dr. Google: Pros and Cons

Ah yes, Dr. Google. We all know him, use him, and abuse him. 

When should we rely on the Internet to "diagnosis"? How much is too much? Is Dr. Google a curse or a blessing? 

Here are some pros and cons that come to mind: 

Pros: 

- Allows us to take our own health into our own hands.
- Pictures of a symptom/disease are fairly reliable in terms of diagnosis.
- Readily available and if you have a computer and Internet, free. There are so many people in the world who can not afford to see a doctor. But if they have access to the Internet, then there is hope that it will have the answer to their health concern.
- Cultivates community. There are inspiring health stores give us hope and motivate us to tackle concern X, Y, and Z. There are also forums where strangers discuss their treatment experiences, share similar symptom stories, offer advice, or ask questions, all pertaining to a particular health complaint.
- Great for milder, benign conditions that would go away on their own anyway, such as treating bug bites, soothing sore muscles, and healing minor burns.
- Learn about condition prevention (which is often not discussed in allopathic doctor visits).
- Learn about different ways to treat a condition from different countries and cultures from around the world; learn about treatments that don't exist in your own country.
- Learn about alternative treatment options (also a con, see below).
- Get a variety of opinions, beyond the one-and-only opinion of your family doctor.

Cons: 

- Specific details and nuances are going to be lost if you crowd-source health info.
- The most popular diagnoses will be the only diagnoses featured online. The more posts or Google hits about tuberculosis (TB) causing a cough, the more people will come across TB when the search for the cause of a cough, and thus the more people will think that they have TB!
- Patients come to doctor already "self-diagnosed". Doctor I have this condition and thus I need this treatment. Makes patients more demanding and convinced they know what they have without the doctor's input.
- Scary. As the joke above says, a mere cold can seem deadly!
- People may value the knowledge and extensive training of healthcare workers less.
- Lots of medical websites are wrong info.
- May create hyporcondriacs.
- May delay medical treatment.
- Learn about alternative treatment options (a con because lots of "alternative" treatments have zero evidence to support their use).
- Hard to tell which health websites are good/reliable/trustworthy and which are plain bad.
- Relies heavily on anecdotal evidence.

What do you think? How often do you rely upon Dr. Google? Is he/she helpful?

Prevent Varicose Veins

Varicose veins are veins that have become torturous (aka twisted and enlarged, I already discussed this term) and blue due to abnormal pooling of blood. They can sometimes be painful, but often are benign other than being visually bothersome. Spider veins are teeny, tiny varicose veins; whereas varicose veins occur in larger veins (most often in the lower leg).

Healthy, normal functioning veins have valves in them to keep blood flowing towards the heart and not flowing backwards, back into the legs. When veins are varicose, these valves do not work as well, allowing . blood to flow backwards, pooling in leg veins causing them to enlarge.

How do health care professionals tackle varicose veins? 

Allopathically, you can have surgery to remove the troublesome vein entirely or to repair the valves. There is also laser surgery that can repair the vein without cutting into the vein.  

Naturopathically, we primarily focus on prevention. Prevent varicose veins by...

1) Exercising to improve circulation (walking and running are good options)

2) Avoiding crossing legs when sitting

3) Maintain a healthy weight (excess weight means more pressure on the legs)

4) Eat a low salt diet to keep blood pressure in check and to decrease water retention

5) Wiggle and shift legs while standing for long periods of time

6) Avoid wearing high heels and poor footwear that compromises feet/lower leg circulation

In terms of some simple treatment options to use when varicose veins already exist, you can elevate your legs for 10 minutes each night (try stacking a bunch of pillows under your leg when you are watching TV or when reading in bed) or wear support stockings (which are basically very tight socks that compress the lower limbs). 

Poop Therapy

Have you heard of Fecal Bacteriotherapy? 

This new therapy, which I am now dubbing "poop therapy" in my educated and professional opinion (*wink*), is a method of treating bacterial overgrowth in the intestines and colon with poop/stool. It sounds crazy, but according to a new article published in the New England Journal of Medicine (one of the most respected medical research journals), by irrigating the bowel infected with C. difficile (a horrible, horrible bowel bacteria that can sometimes proliferate in the gut) with stool, the infection can be cured. Poop therapy proved to be more effective in clearing the infection than taking rounds of anti-biotics. 

Read More: Here is the paper abstract.  Also, the Wikipedia article on poop therapy can be found here. 

Sleeping & Radiating

This week I have my Health Psychology and Radiology final exams. Here are two tidbits taken from my studying of these courses:

________________________________________

We learned a bit about insomnia (inability to fall asleep or stay asleep) due to mental illness (anxiety, depression, bipolar disorder, etc) in Health Psychology this term. While treating the underlying mental illness is key in correcting the insomnia, as naturopathic doctors, we can also teach our patients about sleep hygiene. I've talked about sleep hygiene before on the blog, but in my Health Psyc notes, we learned some even stricter sleep hygiene principles that can be used to help get our patient sleeping at night! In addition to following those recommendations previously discussed on the blog (here and here), the patient should...

- Avoid all screens after 7 PM. No television, cell phones, or computers. The back-light of these electronics stimulate our sympathetic nervous system, our 'flight or fight' heightened response.
- Avoid reading anything work related in the evening. It may be triggering stress! 
- Avoid evening exercise. Complete daily exercise in the afternoon or morning. Evening exercise may 'wind you up'. 
- Aim to accomplish one or two household tasks each day. It will get the 'nesting vibes' flowing, will output some energy (increasing bedtime fatigue), and will keep the house in tidier, potentially more relaxing space. 
- Complete a trial period without any coffee or caffeine. Because we all know caffeine keeps us awake...

________________________________________

While studying Radiology this morning, I came across this nifty chart that shows some common causes of radiation. Ionizing radiation is the worst; in fact, we were given this chart to help us understand why X-rays (ionizing radiation) and other forms of imaging should only be performed when the patient's case and diagnostic guidelines warrant it.  Don't be X-raying your patients all willy nilly! There must be specific presentations and patient identifiers (gender, age, body type, etc) for these types of procedures. 

Beer Boobies and Bellies

Mmm, beer! Steam Whistle Beer is Toronto's favorite brew. 

I mentioned not too long ago that beer has an estrogenic effect and since estrogen is predominately a female sex hormone, beer may not be the best alcoholic beverage for men. How does the estrogen in beer affect males? Well, when beer is over-consumed (drunk in excess), it may cause gynecomastia. Gynecomastia is a condition in which the breast tissue in men enlarges. The estrogen content of the beer can stimulate the estrogen-sensitive breast tissue, causing it to proliferate. So a man who drinks way too much beer may develop "beer boobies".

In addition to beer boobies, drinking way too much beer can also cause a man to develop a "beer belly". The mechanism of action behind a beer belly is quite simple: beer is high in calories, when we consume calories in excess they ares converted into fat, and in men, fat prefers to deposit in the abdominal region (in women, fat likes to deposit in the hips and butt regions, but in reality everywhere on the body is fair game for fat dumping, lol).

Beyond Botanicals

My third-year Botanical Medicine prof is a genius.  No lie.  He is super knowledgeable about all things naturopathic medicine (which I guess is no surprise because he's been practicing for twenty years as an ND, I do believe), especially herbs.  Often the judicial system calls upon him as an expert witness whenever there is a legal issue involving herbs/botany.

Anywho, I mention this smart professor because his Bot Med lectures are usually filled with so much interesting material; cool stuff that goes above and beyond the course curriculum. Here are five neat things (not necessarily related to botanicals) that we discussed in his classes over the last couple of weeks:

1) Top three causes of infantile colic in breastfeeding moms: coffee, garlic, or onions in the mom's diet. 

2) Long term consequence of Epilepsy medications: osteoporosis.

3) 90% of our melatonin receptors are in our gut. Therefore supplemental melatonin (which people normally take to help them sleep better) maybe be beneficial for those suffering from gut issues (such as irritable bowel syndrome (IBS)). 

4) Beer has estrogenic effects, so perhaps it is not the best beverage for men...

5) Three side effects of potassium depletion: Alzheimer's disease, leg cramps, and heart arrhythmias.

Fatigued?

We have learned that when a patient walks into your office and says "my chief concern is fatigue", we have to ask a bunch of questions to understand what they actually mean by fatigue.

What does fatigue mean to the patient? Does it mean:

 ...tired? ...sleepy? ...physically exhausted? ...apathetic? ...depressed? ...is there lassitude?

The descriptors above would each point the doctor towards a different diagnosis so it is very important to ask the right questions to make that sure he or she is going in the right direction when a patient presents with fatigue. 

Several examples of questions that may be asked to help determine the diagnosis: 

- Are you still fatigued after a good night of sleep?

- Do you feel well rested in the morning?

- Do naps help the fatigue?

- Tell me about your sleep. Is your sleep of adequate quantity and of good quality?

- Does the onset of the fatigue happen at the end of the day?

- How is your mood?

- How is the fatigued changed by exercise? Increased or decreased?

- Tell me about your diet. Are you consuming adequate calories, nutrients, and iron?

- Do you drink caffeine? How much and when?

- Etc, etc...

Pregnancy Tests and Testicular Cancer

An amazing example of the power of online communities...

Last week, I girl posted a funny comic to the online community Reddit about her male friend who used his girlfriend's unopened pregnancy test to jokingly see if he was "pregnant". The funny part of the comic was that the pregnancy test was positive! You may be thinking: Ha, ha. Guys can't be pregnant, what a faulty test... 

Wrong attitude! There is validity behind a male testing positive on a pregnancy test. 

Pregnancy tests (the ones you urinate on and wait for the blue line to appear or not), test the level of the hormone human chorionic gonadotropin (hCG) in the urine. In pregnant females, the level of this hormone drastically increases after ovulation; hCG levels increase so much that some spill into the urine, hence why pregnancy tests are able to pick it up (within 6 and 12 days after ovulation).

However, hCG has more roles in the body than simply being used as a pregnancy marker. In fact, hCG  is a great cancer marker for some cancers (cancers of sex organs, such as those affecting the ovaries, uterus, and testicles). Therefore, if a male takes a pregnancy test and it tests positive, it may indicate that he has testicular cancer. 

...so, back to our story: after the "funny" comic was posted to Reddit, tons of comments were posted advising the original comic poster that the man who took the pregnancy test should go see a doctor to be screened for testicular cancer. The girl who posted the comic replied saying that she had no idea that this was serious; she simply thought it was funny! Nevertheless, she immediately contacted her male friend and he went to the doctor.  Low and behold: he had a small tumor present on his testicle! She posted his results to Reddit and thanked the community for their diagnostics skills. The male and the original comic poster were both from Hamilton, Ontario, by the way.

Quite the story, right? Read the whole story (which made the national news) here.

Carpal Tunnel Syndrome 101

Carpal Tunnel Syndrome is one of the most frequently self-diagnosed syndromes (thanks to Doctor Google :P). As my prof described yesterday, it seems as if anytime people experience a problem in their hand or wrist, they are having a 'carpal tunnel syndrome' flare-up.  However, yesterday, in my Physical Medicine class, we talked all about this syndrome and what is specifically is required in order for a patient to truly be diagnosed with this condition.

The white horizontal band is the ligament causing carpal tunnel syndrome. Image from Wikipedia; originally from Netter. 

Definition: carpal tunnel syndrome is a compressive neuropathy (meaning a compressed nerve), in which the median nerve is squished by a ligament in the wrist (specifically by the transverse carpal ligament, aka the flexor retinanculum, shown above). Nine tendons and one nerve (the median) pass through this ligament. It often occurs during repetitive gripping, like in those who garden extensively, operate hand tools, knit or sew for a living, hairdressers, and computer users (aka everyone)... to name a few examples only.

Symptoms: When the median nerve is squished, the palm of the hand, the fingernails, the thumb, and index, middle, and half of the ring fingers, will feel numb, weak, tingly, and possibly pain. Only these regions of the hand will be affected as these are the areas innervated by the median nerve (see the image below, they are highlighted in red).

Median nerve innervation in the hand. Image source here.

Treatment: Naturopathically, we would prescribe lots of rest (less texting!), wrist supports, hand massages, hydrotherapy (ice during an acute attack, heat other times, or whatever feels best to the individual patient), and anti-inflammatory herbs. People with chronic carpal tunnel surgery may opt for surgery; however sometimes the surgery doesn't help and some people get better without any surgery at all. The surgery involves cutting the transverse carpal ligament to allow it to expand, reducing the compression/squishing of the median nerve.

Note: please seek out professional and individual health care advice. This blog post is not meant to diagnose or treat.