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  Fundamental MedicineTeresa Gryder, ND

COVID-19 Links and Thoughts 9/14/2020

9/14/2020

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WE NEED TO KNOW WHAT HAPPENED WITH THE ADVERSE EFFECT
https://blogs.sciencemag.org/pipeline/archives/2020/09/14/vaccine-transparency

It is not OK for vaccine manufacturers to hide the specifics of adverse effects, any more than it is OK for governments to hide the specifics of nuclear incidents.  If the people is to trust the makers of vaccines or the governments of countries, we need to hear prompt, factual information from them.

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COVID-19 Links 1

3/18/2020

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 This list was updated daily, 3/18, 3/19, 3/20.

In Colorado A Whole Town Will Get Tested

https://coloradosun.com/2020/03/20/telluride-san-miguel-county-coronavirus-covid19-testing/

​
Worse Than the Flu: More Contagious and More Lethal
https://nymag.com/intelligencer/2020/03/the-story-of-a-coronavirus-infection.html
​

Overview of Situation and Actions to Take
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

Johns Hopkins COVID-19 Dashboard (for tracking the numbers)
https://coronavirus.jhu.edu/map.html

Details on Lab Testing
https://www.wired.com/story/everything-you-need-to-know-about-coronavirus-testing/
​

CDC on What To Do if you are Sick
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

Dr Teresa Gryder on Self Care and Self Treatment Options
rb.gy/9gocvh

What Will Happen to Hospitals (Models by Propublica)
https://projects.propublica.org/graphics/covid-hospitals

Simulitis: Washington Post Graphic on How Social Distancing Works
https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

Dr Heather Zwickey (audio) on Immune Support and Why C19 is so Bad
https://www.naturalmedicinejournal.com/sites/default/files/media/nmj_covid_update_zwickey.mp3

Seattle Intensivist's One Page Notes 3/15/2020
https://www.kevinmd.com/blog/wp-content/uploads/ICU_one_pager_COVID_v2.3.png

Mental Health Maintenance Tips
https://www.internationalsos.com/client-magazines/looking-after-yourself-during-the-coronavirus-outbreak

Don't take Ibuprofen, Aspirin or Naproxin (Tylenol OK)
https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms

CDC Clinical guidance for Clinicians treating Confirmed cases
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
​

Diarrhea = Presenting Symptom in <50%, Presents Later, Worse Prognosis
​(Chinese study, n=204)
https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf

Social Distancing May Last a Long Time
https://www.npr.org/sections/health-shots/2020/03/17/817214311/new-analysis-suggests-months-of-social-distancing-may-be-needed-to-stop-virus

No Free Pass for Young People
https://thehill.com/policy/healthcare/488325-cdc-data-show-coronavirus-poses-serious-risk-for-younger-people
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Half of the patients in France's hospitals are under 65
https://theweek.com/speedreads/902571/about-half-frances-coronavirus-patients-intensive-care-are-under-65-health-official-says

Most Cases are Still Hidden 3/16/2020
https://www.nytimes.com/2020/03/16/health/coronavirus-statistics-undetected.html

American ICU's Will Be Over Max
http://www.centerforhealthsecurity.org/cbn/2020/cbnreport-03132020.html
​

Effect of Mitigation: No Way to Win 3/9/2020
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30567-5/fulltext

Genetics of COVID-19 Show It is NOT Manmade
https://www.modernhealthcare.com/safety-quality/covid-19-not-man-made-comparative-genomic-study-finds
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Capitalism is the Vector 3/18/2020
https://theecologist.org/2020/mar/18/virus-haunting-europe-vector-capitalism

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Single Payer Healthcare Systems Performing Better Than For Profit Systems
https://www.commondreams.org/news/2020/03/16/public-health-experts-single-payer-systems-coping-coronavirus-more-effectively
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Rich and Famous Get Tested, Regular People Wait
https://apnews.com/b8dcd1b369001d5a70eccdb1f75ea4bd
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Kushner aims to get rich on this too
1) https://www.msn.com/en-us/news/politics/guess-who-previously-owned-health-insurance-co-operating-coronavirus-testing-website/ar-BB11kwPT​
2) ​
https://www.washingtonpost.com/politics/kushner-coronavirus-team-sparks-confusion-plaudits-inside-white-house-response-efforts/2020/03/18/02038a16-6874-11ea-9923-57073adce27c_story.html

Why Paid Sick Leave Should be Mandatory
​
https://www.modernhealthcare.com/safety-quality/sick-staff-fueled-outbreak-seattle-area-care-centers

On the Idea that we should let everybody get it and save the economy
https://theweek.com/articles/902582/conservatives-who-sacrifice-elderly-save-economy
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On Spiritual Practice and Loving Life

3/26/2017

 
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What do you practice in your life?  I believe it was the Mahatma Gandhi who said that bit about how your thoughts become your actions and on down the line…. It was about how you create yourself by what you choose to think and believe.  A practice is anything that you do regularly, even ritually.  A morning cup of coffee is a common practice.

​If it is true that what you do becomes who you are, it is worth putting some thought and intention into your own personal practice.


There are a lot of yoga practitioners out there.  I count myself as one.  I practice at least a little yoga every day.  For me it is the avenue by which I came to recognize and respect my own body, which was necessary before I could begin to care for it.  I was in denial of my body for many years.  In my 20’s, though I looked fit, I could not touch my toes without bending my legs.  One cannot gain flexibility without a regular practice, because it is a gradual process.  And one cannot be truly strong without flexibility; if you can’t use the full range of your body’s movements, your strength is hobbled.  I believe this applies to flexibility of the mind, too.  If once lacks mental flexibility, one cannot learn.

Many say we should all develop a spiritual practice.  This is about choosing at least some thoughts and actions that are oriented toward our highest values and goals.  A cup of coffee might not satisfy this.  Having some small fraction of each day that is dedicated to the big picture, to the people and things that we most love, is a simple way to remind us that we are part of that Wholeness that is the World.  Regardless of your belief system—and even if you are firmly atheist or mildly agnostic—you will benefit from such a practice.  The research tells us that you will live longer, be less depressed, and be more likely to request life-extending medicine when your time is short.  You will love life more.

I personally have been mulling on these ideas of a practice because I now have a medical practice as well.  What is the core of my practice?  It is evolving.  Perhaps the most important thing I can do for my patients is to help them to notice the great blessings that abound as long as we live.   The irritants of daily life are passing things, often irrelevant in the longterm.  I practice meditation, gratitude, kindness, the four agreements, and also being in nature.  My church the is river, sky, mountain, snows of winter and buds of spring.  Science shows that being in natural environments lowers blood pressure and stress hormones, but I believe it does more than that.

I also practice Feng Shui.  Not in any traditional way, but in the deeper concept.  Feng Shui taught me that the physical things that surround me either facilitate or impede my practice.  I strive to make every item in my space a reminder of all I have to be grateful of, and what I am striving for.  If physical things get in my way, I move them.  If they are not moveable, I move other things to improve the flow.

So now you know my practice.  What is yours?  I look forward to hearing about it.
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SNAKE OIL.

2/4/2015

 
The irony is rich. The term "snake oil" has come to mean everything that is fraudulent. The reference is to the infamous "snake oil salesman" who pitched and sold his wares out of the back of a wagon to the unsuspecting villagers of the American west.

Snake oil has real medicinal value. It was used as medicine before the North American continent was on the map. Centuries ago the Chinese used an oil made from a cold water snake called Enhydris chinensis to treat joint pain and bursitis. It was introduced to the US by Chinese laborers who worked on the Transcontinental Railroad in the mid 1800's. There's evidence that the ancient Egyptians used it too. In the early 1700's the English had a patent medicine made from snake oil. Snake oil was sold here as a panacea in the early 1900's, but the products sold were probably more filler and adulterant than they were actual snake oil.
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So what's in it that's good for you? Snake oil, depending on the snakes used to derive it, can be a rich source of an fatty acid known as EPA, eicosapentanoic acid. EPA is used by the body to synthesize series 3 prostaglandins, which are anti-inflammatory and pain relieving. You can know EPA is important because it's in human breast milk.  EPA is effective for treating depression, improving cognitive function, autoimmune diseases including rheumatism, high cholesterol, hypertension, and more. 

EPA can be derived in the body from other fatty acids, but it's much easier to eat in your food. The richest sources are fish: herring, mackerel, salmon, trout, pilchards, menhaden and sardines. Fish do not make their own EPA. They get it from eating algae like spirulina, which we also can eat. Plant foods don't contain any EPA at all.

Part of the reason it's easier to eat EPA than to make it in your body has to do with human genetics. Some people have the gene to make the enzyme which lets them convert ALA (alpha linolenic acid) into EPA. Other people have mutations in their genes that limit their ability to do the conversion. Diabetes and some allergies also limit a person's ability to convert ALA to EPA. ALA is an essential fatty acid, meaning that no humans can make it; we have to get it from the diet.

If we don't make it very well, and we don't eat much fish, we need to get our EPA some other way to keep our cell membranes happy.  Many healthcare professionals recommend that we take fish oil.  Fish oil contains 12-18% EPA.  Salmon oil tops the list at ~18%.  Chinese water snake oil contains ~ 20% EPA, whereas rattlesnake oil is said to contain 8.5%. Cod liver oil has more DHA than EPA and is best reserved for specific uses, like building baby brains or healing brain injuries.

The reason why some snakes have more EPA than others has to do with the temperatures that they live in. Snakes and fish are both cold blooded, so they have to function with their bodies at the same temperature as their environments. Omega 3 fats like EPA don't harden in cold temperatures like omega 6s do. They help keep cell membranes flexible. Flexible membranes don't get injured as easily, and are able to function better. Cold water fish, or cold water snakes, will have more EPA than those that live in warm sunshine, like rattlesnakes.

The next time someone tells you that a treatment is "snake oil", remember this. Public attitudes and language reflect our history, not our future. Science continues to give us reason to revise belief systems, erase myths, and sometimes to welcome old treatments back into the fold.

What Counts as EVIDENCE

12/9/2014

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I like to say that I practice evidence-based medicine, because I am of a scientific mind and bias.  Unfortunately the scientific literature these days is increasingly biased by the funding sources.  In medicine the funding is predominantly Big Pharm, because they have the most to gain from offering medicines that are widely used.  It is becoming more and more apparent that the scientific studies that come to light are just a small sampling of the studies that are actually done, creating a bias by omission.  Big Pharm has reason to hide studies that show that their products are ineffective or worse than placebo because of side effects.

Here's an excellent Ted Talk by Ben Goldacre as to why you (and I) should be skeptical of the science that is generated by our current system.


When I was in medical school one of my teachers was Dr Thom.  He often invited us to participate in his "Parachute Study".  We weren't eager to participate, because the study consisted in going up in an airplane, and having half the group jump using a parachute and half the group jump without a parachute.  The point is that in many cases, Common Sense is adequate to determine the relative risk or benefit of a treatment.  We don't have to have a Parachute Study to know that it is better to wear a parachute if you are going to jump, than not to.  A parachute isn't a 100% guarantee that you will land on earth uninjured or even alive, but it for sure will give you at least some chance.  To jump without a parachute is to have no chance.

There is a limit to what we can know from conventional science.  And even if we do not know, we must make choices.  My choices are informed by everything that I know from science, personal experience, and assorted education.  I recognize that I as a person have personal biases.  It is impossible not to.  The first step in keeping an open mind is to recognize and admit your own biases.
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Healthcare in America is Mostly Sickcare

9/10/2013

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What I hear is that most everybody in America is frustrated about healthcare.  Maybe you have good insurance, but then the doctor doesn't listen, or the treatment doesn't work.  Maybe you're on pills and don't know what they're for.  Maybe you don't have insurance and flat out can't afford to get help.  Maybe you think something's wrong but don't want to confirm it because then you'd have to deal with it.  We all worry, and it's not easy to sort out what to do.  Doctor Google can be misleading, and sometimes terrifying.  The assortment of supplements at the store is overwhelming.  Everybody thinks they know what will help you, but they don't know your whole story.  They don't know the half of it.  It's not an easy situation.

I offer a win-win deal: I will take a thorough history and get to know you enough to have an idea how the parts of your life are affecting you.  Then I educate you about your options, including alternative and conventional therapies.  In the end, using real information you choose what you want to do.  Conventional medicine is the best answer for some situations and conditions.  Naturopathic medicine helps as long as you are willing to do more than pop pills and sit on the couch.  If I can't help you, I will help you find someone who can.  I consider it my job to provide you with current, personalized, unbiased information, not to keep you a slave to some treatment that only I can offer.

My personal slant is scientific.  I realize that many people consider Naturopathy to be quite "alternative".  Considering what has happened with pharmaceutical medicine, an alternative is much needed.  Naturopathic Medicine (as I use it) is a combination of traditional healing (forgotten in the age of pharmaceuticals) and the application of new knowledge about how our choices affect body function and healing.  Conventional medicine is not keeping up with the changing times. A simple change in your diet or lifestyle could do you more good than a drug that you take for the rest of your life (and save you a gazillion dollars).   Making informed, gradual improvements to your diet and lifestyle will save you money, increase your quality of life, and help you stay away from the doctor, the pharmacy, and the hospital.

If you are one of those skeptics who has avoided alternative medicine because you don't think naturopaths have any real training, come see me for a free 15 minute introduction. I would like to tell you how a science-minded skeptic like myself can embrace Naturopathy.  I can show you some of the great research that supports nonpharmaceutical and nonsurgical approaches to health.  There's plenty of it.

There are plenty of reasons to seek alternatives when facing the gauntlet of what insurance will buy for your health.  It's not cheating to get a second, or third opinion about any persistent health problem.  Before you take the toxin, or submit to the knife, it is wise to be sure that is what you need to do.

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Be Skeptical

8/31/2013

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In this day and age, it is necessary to second guess every information source.  So much "information" goes by that it becomes difficult to sort out what is advertising and what is not.  Even reporting about scientific research can completely skew the issue.  It doesn't pay to be gullible.

The problem is that we are wired to be gullible.  We humans would much rather trust in some comfortable authority figure and believe what they say, than to do all that research and work ourselves.  Figuring out the truth takes time...and sometimes the truth is elusive.  We just don't know everything yet.  We'd rather just believe.

Modern first-world culture is divisive and argumentative.  People agree to disagree more often than agreeing in substance.  As in other parts of our public arena, in the healthcare debate the shouting overwhelms reasonable conversation. Conventional treatments espoused by governments and establishment medical business may not be supported by the research. The policy came about when someone had to make a decision by a deadline using the best information available. We all do it.  We have to go on what we know, even if it is incomplete or incorrect. More information comes along, but established policy stays the same.  This is the downside of bureaucracy. Proponents of established methods will say that this must work because it is the rule, and don't worry about finding out the truth.

Alternative treatments are espoused by a wide range of practitioners and patients.  Often alternative treatments have little or no science backing them up.  Proponents say this works because they have seen it work, and maybe it did.  Just because there is no science doesn't mean it isn't true. Proponents also commonly claim that the science backs them up when it does not.

The Skeptic doesn't believe anything just because an authority said so.  The Skeptic asks questions, and studies the important questions, so as to be able to know if someone is speaking from a position of knowledge and perspective, or blowing a lot of hot air.  The Skeptic realizes that real information or falsehoods can come from any side, and runs every morsel through an internal fact-checker.  The truth is a moving target, and the skeptic is ever on the hunt.
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Obamacare

6/3/2013

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Speaking of mixed feelings....  I learned today that the penalty for not participating will be $95.  That's only $15 more than a Portland Parking ticket.  Of course, there is the possibility that decent care might result from being covered within this system.  But not necessarily.  I have a deep distrust, and dislike, of health insurance and what it has done to healthcare in America.  Mandating health insurance is... un-American.  Letting health insurance control what care is given and to whom is no better than socialized medicine.  It simply puts the power in the hands of megacorporations that are already mixed up with our government.  And it requires that everyone's personal health information go into an electronic medical record, supposedly to improve care, but potentially useful for other projects.  If the government would decide what care to provide based on what has the best outcomes for the most people, I would be less opposed to that.  It's not a simple situation, that much is for certain.  The best answer is just as the bumpersticker says: don't get sick.
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Plant (Phyto) Medicine: Wimpy vs Dangerous

6/27/2012

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I'm studying for boards these days.  We have a long list of herbal medicines we are supposed to know (in addition to a 3x longer list of Rx meds).  I consider this to be my opportunity to sort out which plants I want to use in my practice.  I am studying up on each one, and deciding if I think the evidence is sufficient for me to recommend it.  

On the internet I find two dominant claims about phytomedicine. 1) Herbs don't do anything useful, are inert or inactive, and 2) Herbs might cause you grave harm and could interact with your medications and kill you.

The conflict between these two claims is amusing to me.  If plant medicine is so worthless, then why isn't it harmless?  If herbs don't do anything, then why are we so worried about them?  And on the flipside, if a plant can cause drastic changes to your physiology and interact dangerously with your medications, how can it be inert and wimpy?

Plant medicine is more useful than conventional practitioners want to admit.  Many would like to convince their patients to avoid plant medicine entirely, because it is unpredictable and unknown to them, and so seen as dangerous instead of helpful.  It is my observation that conventional practitioners are extremely concerned about interactions between herbs and medications, while they very rarely check for interactions among the medications that they prescribe.  I have studied cases in which my patients or family were prescribed many meds that are processed by the same pathways in the liver.  Their physiology must have been significantly altered in ways that have certainly not been studied.  Show me a drug study that gives four or more medications and measures their combined effects!!  Yet it is no problem finding a baby boomer on that many meds.  When people complain that herbal medicine hasn't been studied enough, remember that pharmaceutical medicine is mainly studied by the people who wish to profit from it, and that negative results are routinely swept under the carpet.

One criticism of plant medicine rings very true, and that is the inconsistency of the contents of the supplement.  Plants grow differently in different places, are harvested with varying levels of care, different parts of the plants are used, different methods are used in processing them, and different kinds and amounts of fillers are added.  There is tremendous variability in the amount and quality of the plant matter in any given capsule.  Some contain little, if any, of what they claim to contain.  There are higher quality supplements available to licensed Naturopaths, and we trust them more, but I for one intuitively trust plants more than pills.

If you can't be sure of the contents of a capsule you bought on the internet, what can you be sure of?  I am sure that plants contain more constituents than we have researched, more than we know about.  I am sure that the whole plant often has actions that one of its components does not.  All the constituents in a given plant (or combination of plants) may have a synergistic effect that we never completely understand, because of the complexity of plant matter and life itself.

So I operate on a few assumptions, based on experience and centuries-long traditions.  In most cases fresh herbs are more potent that dried and processed ones. There are exceptions when processing removes a constituent that is harmful, or when a concentrate or extract really is better.  But not always.

I am pretty sure, from a commonsense gardener's point of view, that I trust my dirt more than dirt in China.  I happen to live where the soil is good and many plants grow.  If I lived in the desert, I'd want to know that my plant medicine came from a clean place.  If I'm going to buy herbs, I'd like to know what kind of care was put into its selection and care, where it grew, how it was harvested and processed, stored and delivered.  I want a minimum of fillers, and I want to know what fillers they are.  I want to know it all.

Most of the herbs on our study list have a very long list of traditional indications, and just a tiny little bit of actual science on a few of their constituents.  A few of them have plenty of science, usually the poisonous ones.  Dr Google sends warnings about avoiding this plant, because it can kill you.  Tell me this: what pharmaceutical medication is not dangerous if overdosed?  They all are!  Toxic herbs are the most potent medicine available to an herbalist.  The trick is in knowing how to dose them appropriately.  The use of toxic herbs is not appropriate for lay people to attempt without guidance, and so the warnings are welcome.

Plant medicine is both more powerful than we realize, and more benign than pharmaceutical medications.  Its reputation should not be marred by the offenses of a few profit-seeking supplement companies.  We are designed to eat plants, touch plants, live in harmony with plants.  When you sip your coffee, or put ketchup on your burger, you are partaking of plant medicine.  Look out!!  It might make you feel better.
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Skepticism

11/15/2011

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This conversation between Richard Dawkins and D.J. Grothe is about applying skepticism to religious claims, however I can't help but to think of the ways that some medical treatments, both conventional and alternative, fail to hold up to scientific examination.  As a skeptic myself, I see that there is value on both sides, and questionable practices too.   At any rate, for anyone who wonders, this is a useful examination of our times:   http://www.forgoodreason.org/faith_biology_and_skepticism

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    Author: Teresa Gryder

    Integrative Physician and Student of Life, Medicine, and the River.

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