- Never mix alcohol and tylenol. Tylenol’s other names are acetaminophen and paracetamol. It’s a common ingredient in over-the-counter cold medications (Nyquil), allergy meds, and RX pain meds like Vicodin and Percocet. People can accidentally take too much because it’s in so many different products. Tylenol is the world’s leading cause of fulminant liver failure, meaning severe, acute, and potentially fatal liver failure. Mixing alcohol with tylenol is the kiss of an ugly death. When you have a hangover and are searching the cabinet for something to treat your headache, use aspirin or ibuprofen or naproxen. They're not quite so dangerous.
- Hydrate. Most hangover symptoms are caused by dehydration. Alcohol is a potent diuretic. You might know this from the way that one beer makes you pee like you drank two. Instead of taking pills for a hangover, guzzle water. And if you know you’re going to imbibe, drink water before you even start.
- Take lots of vitamin C. Especially after a binge, vitamin C helps neutralize the toxic breakdown products of alcohol metabolism, and it helps reverse fatty liver disease. How much is lots? Four to twelve grams a day, split up into lots of doses. At the high end of this dose range it will cause diarrhea, but if you really binged, you will already have diarrhea.
- Be nice to your Gut. Drinking alcohol causes Leaky Gut. This is when food particles leak through your gut lining instead of getting processed through the cells like they should. Leaky gut compromises your immune system and is a common factor in autoimmune diseases. So eat a healthy diet with fruit and vegetables, and eat fermented foods like live yogurt, kefir, kraut or kimchi. And get help if your gut isn’t working right.
- Know when to call 911. If a heavy drinker suddenly spits up blood, it’s time to call. Alcoholics can die when blood vessels in their esophagus burst, but they can live to see another day if you call early enough. If the kids have had red bull drinks (alcohol and caffeine together) and start acting delirious, it’s time to call. Caffeine prevents people from passing out so they’re more likely to reach a blood alcohol level that is really poisonous. Oh yeah, and definitely get help if someone turns yellow. Their eyes turn first.
- Eat FISH. It’s good for your brain. Heavy alcohol consumption can cause dementia, and consuming lots of good omega 3 fats helps prevent the brain from degenerating. So learn to love those fatty fishes—or start taking fish oil.
- Drink coffee. You think I’m joking. Coffee helps reduce liver damage caused by alcohol and by hepatitis. It’s a powerful effect. Coffee also helps prevent dementia for other reasons. So enjoy your cuppa joe! It will help you sustain your Great Satan lifestyle longer.
- Sunbathe. Large expanses of skin in bright sunshine makes hundreds of thousands of IU’s of vitamin D in just 15 minutes, so get a natural dose any time you can. If you can never expose your white expanses, or if you live where the sun don’t shine, take a vitamin D supplement. It helps prevent cirrhosis.
- Take a B Complex. Thiamine is vitamin B-1, and a deficiency of this vitamin causes the severe memory loss that affects alcoholics. You need all the other B’s too, so don’t take just one kind of B. Take a quality B-complex in doses as big and regular as your drinking, and you’ve headed off this deficiency at the pass.
- Don’t be stupid. I know it’s hard not to be stupid when you’re drunk but plan ahead when you’re not drunk so that you have a ride, a coat, and a place to crash. Your body wastes heat after heavy drinking, so you can feel warm while you are descending into hypothermia. Take a little extra care if you’re feeling reckless or have a tendency to behave impulsively. Get help if you’re really headed down the drain: we need you.
 YOU MAY THINK YOU KNOW ALL ABOUT IT. People who grow up around poisonous plants learn the hard way, like I did. I spent my childhood covered in itchy rashes, and with great fluid filled blisters between my fingers and toes. Soap was anathema to me; I was a wild child. Because of this early education I know what poison ivy looks like, even when it’s called poison oak, even when the leaves are off in winter. It’s the same stuff. This article is for those of you who’ve never had it, or had it once or twice, and for the people who ended up at the doctor’s office because of it. I want to motivate you to learn to recognize the plant, because the best treatment for its nasty rash is PREVENTION. Avoid contact with the plant, and avoid contact with things that have touched the plant, and you limit your risk. Nobody wants the rash. Itching is at least as maddening as pain. If you are not quite sure what it looks like, you won’t learn it from pictures or articles. You have to learn it in the field. Ask about it when you’re out in the wilds with people who know the plant. We can point it out to you in all its forms. You can limit exposure by wearing clothing that covers your skin. And you can coat your skin with tecnu or bentoquatam to prevent the urushiol from sticking to you. Tecnu is a product that solvates the oil but it contains propylene glycol (radiator coolant) which I’d rather not introduce to the environment. Bentoquatam is a product made from bentonite clay that forms a coat on your skin to block the oil from getting on you. It is probably more environmentally friendly. The leaves of both poison oak and ivy are shiny when they are new and become duller over time. Both have “leaves of three”, meaning there are three leaflets on each stem that together comprise the leaf. Both have some variability in the leaf shape, with edges that range from toothed to smooth to almost lobed, but the “leaves of three” always fit together in a similar way. The leaves of both turn red in the fall and both can have white fruit that remains on the plant after the leaves have fallen. Both like to grow along rivers and streams and forested trails, in exactly the terrain frequented by boaters. The saying “leaves of three, let it be; berries white, take flight” applies to both. There’s a debate about which plant is more contagious or causes a more severe rash. I have found nothing to shed scientific light on this question, though most people online say oak is worse. They seem equivalent in potency to me personally, and are both to be avoided. The toxin in both poison oak and ivy is a sticky oil called urushiol. It causes a type of contact dermatitis that an immunologist would call a type 4 delayed hypersensitivity reaction. The rash appears 1-3 days after exposure to the urushiol. The first symptom is an itch, then red bumps form which later become amber fluid-filled pustules. If you scratch open the pustules then you have open wounds which can get infected, complicating the problem. The final stage is the healing of the pustules and wounds, which can take a week or more. There are a lot of myths about poison ivy/oak, and I’ve listed my top seven here. Myth 1: The fluid inside the pustules is contagious. This is FALSE. What is contagious is the sticky urushiol oil. The fluid from the pustules is just serous fluid from your body and it is harmless. The oil, on the other hand, can stick to your skin, your dog, your walking stick or your shoes. It “sticks around” until it is washed off with lots of soap. If it is on your skin in one place and you scratch there, then touch somewhere else, you have just introduced the toxin to a new location and unless you wash it off you can look forward to a nice itch starting in about a day. Myth 2: You have to go get steroids to treat poison ivy. Not so, in fact corticosteroid drugs like prednisone have some nasty side effects and should only be used under doctor’s orders. Most of the time the rash is not so severe and will go away on its own given removal of the toxin and time. After you wash off the urushiol you just need to keep your sanity while the rash runs its itchy course, which takes about a week. You can reduce the immune response that causes the dermatitis by taking lots of vitamin C. If the itch keeps you from sleeping you can take an anti-histamine, but don’t take these every night longterm because they also contribute to dementia. If it makes you feel any better, you can temporarily kill the itch with cold water. After you’ve scrubbed it with hot soapy water, chill the rash with the coldest water you can get from the tap. After you cool the affected skin, don’t touch it, and it won’t itch for a while. Myth 3: You can wash the urushiol off with river water. This is debatable because there does seem to be some reduction in future symptoms from vigorous washing in river water after an exposure. Still from what we know about the chemistry of urushiol (a very long and sticky oil molecule), it can stick on the skin until you attack it with either a detergent or a solvent. Fancy soap with moisturizers is less effective for removing the oil than just plain soapy soap. Rubbing alcohol can work for removing the oil but it stings like the devil if you’ve scratched yourself too hard, and you might not want to bathe in it. Brief soaping up like we normally do will not get urushiol off. You have to really scrub it. Use a lot of soap and a wash rag, and scrub every surface especially in nooks like between your fingers. Wash well within 24 hours of an exposure, and follow that up with repeated soapy bathing any time you feel an itch. Wash your clothes and shoes in hot soapy water too. If you get all the urushiol off, you will at least avoid starting new patches.  Myth 4: You can’t get poison ivy/oak in the winter time. Unfortunately, false. You can get it any time of year. Sure, the sappier the plant is, the more urushiol it will deliver on contact. Late winter and early spring buds are particularly dangerous because they are bursting with sap and don’t have leaves yet. After the leaves have fallen in the autumn it can definitely still cause the rash. We recently confirmed this when at least two of us got the rash after returning home from an October Rogue trip. Even in the wintertime it’s best to give the plant a wide berth, because what looks like a dry twig could cause days of misery if it were to happen to get in your pants. Twigs of poison ivy have been seen sticking up out of the snow on backcountry ski trips. Myth 5: Scratching does no harm. Actually, the bad news is that scratching makes it worse. First of all, you can spread the toxic oil around your body by scratching. Second, scratching makes it itch more, because it releases more histamine. Third, scratching will open pustules and cause wounds which can get infected with bacteria. It’s best to leave the pustules alone as long as you can, draining them with a pin if they get in the way. Cover them with a bandage to keep the thin skin from coming off until the wound has started healing from underneath. If you’d rather put calamine on it that doesn’t hurt, and it does mark the area not to scratch. Myth 6: You can get immune to it. Actually it works the opposite way. The more you are exposed to the toxin, the more sensitive you get. You will get the rash faster if you’ve had it before. There are those who say if you eat the first bud of new poison ivy leaf that you see in the spring, that you will be immune. I doubt it, but people say it. As far as I know the only way to remain insensitive to the toxin is to avoid contact with it. Myth 7: Jewel weed will treat your poison ivy rash. This is definitely false. Someone actually did a study on this. Jewel weed is a pretty orange-flowering plant that grows near water where you also will probably find poison ivy/oak, but it makes no difference in the course of the dermatitis caused by urushiol. We love our folk remedies but this one is unfortunately just a nice story. This may not seem like an urgent concern, but you don’t have to look far to read stories of people who’ve gotten the poison rash on their face or genitals, which could obviously be very bad. There are also stories of people getting it in their lungs from breathing smoke from fires where it is burning. Severe exposures or reactions do need medical attention. Proper dosing and tapering is essential to manage the negative effects of corticosteroids, so please do not take them at home without seeking a doctor’s opinion. Definitely tell the doctor if you’ve been out in the woods when you get a rash. I have seen three cases so far of city doctors misdiagnosing a poison oak rash as shingles. They are not the same, and you can help the doc get the treatment right by giving them a full and proper history of your rash.  If you ask a conventional doctor, they'll tell you that double blind placebo controlled studies with large numbers of patients are how they decide on treatments. They'll tell you that these kinds of studies get peer reviewed and written up in reputable and recognized journals. Anything that doesn't have big enough patient numbers, or isn't in a journal that they already trust, is pretty much ignored. The problems with this are many. First of all, those "peers" who review the articles have been shown to be painfully accepting of total nonsense when it is written in a style that suggests medical knowledge. And second, who pays for double blind placebo controlled clinical trials? Pharmaceutical corporations, who are looking to cook up the next blockbuster drug. They aren't studying these drugs out of the goodness of their hearts. The bottom line is mega profits. If they do the right study, and get the right results, they can get FDA approval and patents and voila! They're in the money. Just the other day I was studying up on diverticulosis and diverticulitis, and listened to a top physician giving a clinical update about treatment for these conditions. Basically he was reporting on two studies that showed that antibiotic treatments for diverticulitis were no more effective than IV water. He also mentioned a great many other possible treatments, including fiber for which he said the evidence was very "weak", and probiotics, which he encouraged us to use but didn't review any studies about it, again saying the evidence was weak. Is it really weak? The studies I've seen show it as an excellent treatment option and especially good for preventing recurrences. What's "weak" about these studies is they weren't printed in the journals he reads. They were smaller sample sizes because they actually looked at people in the hospital with active diverticulitis. Anyway, the point is that the evidence surrounding "alternative" approaches like fiber and probiotics was considered less conclusive. Finding studies about natural treatments for anything is hard. This is because nobody is going to make any money studying how much water it takes to ease constipation. They won't sell drugs that way. They won't even get patient visits. People would just learn to drink the right amount of water and not get so constipated. In my practice I use the best evidence I can find, and if I can't find anything that is directly about what I'm curious about, I look at similar or related evidence. I look at how a system in the body is optimally supposed to function, and what we know about its needs and outputs when it is functioning right. I study up on all the reasons it goes wrong, and everything that is "correlated" with something about it, even if there is no evidence of causality. I try to actually understand. I know I overstretch. It is only because I have such a light patient load that I can engage in deep study about each case. A busy practice would prevent this, and this is really what I live for. I WANT to understand. There is a lot of noise about Evidence Based Medicine (EBM), and people who claim that only conventional physicians use it. This is hooey. The evidence is available to all of us, we just have to get educated enough to understand it and put it together. This is what science education is all about. If you don't study science, you can't understand the evidence, and you will have no idea how to apply it except by following someone else's practice guidelines. Which is what most doctors do. Me, I am writing practice guidelines. For the future. Because medicine is not static. What we used yesterday will be tossed out tomorrow and replaced with something else. If we can give people the tools to be healthy and not go to the doctor ever, that is the ultimate success.  Up to now I have called myself a naturopathic physician, and tried to distinguish myself from the bulk of naturopaths in that I believe that science is the light that will show us the way to the future of medicine. I do not practice homeopathy or muscle testing or any of the so-called modalities for which I have been unable to find reasonable objective substantiation.
This has left me in a tough spot. I call myself a naturopath but in general alternative practitioners see me as an outsider because I trust the process of science to discover repeatable results more than I "believe" in the Vis, Qi, energy, spirit, magic or whatever you want to call it. I adopt each practice based on the best information I can find. Everything is a theory: this is the best that we know at this moment. Tomorrow there may be new information and I am willing and able to update my position. I am interested in correlations and information from all fields--biochemistry, genetics, botany, ecology, sociology, psychology, physics, biology, you name it. Opinions and testimonies do not count as information to me. I have had it with hearing people's conversion experiences to believe in unsubstantiated treatments. When someone tells me they "know" something because of personal experience, I think to myself **N = 1**, and catalog that as one tiny bit of *subjective* information in a giant and expanding data set. Are we humans capable of being objective? Conventional practitioners usually see me as an outsider because I have this degree in naturopathic medicine. It takes time for them to come to know me and recognize that I am not an uncritical "believer", that instead I am a critical thinker and a seeker for the best possible treatments. Alternative medicine is a mixed bag, as is conventional. Dogma exists on both sides. I am not dogmatic. I have a lot to offer, but there is no place in this system where I can just plug in. To date I have been unable to support myself with my practice. I do not know where this will lead but at this time the only patients I've been able to see and treat are those who are rich enough to pay me out of pocket. When I discount my services, people discount my value. When I charge full rate they complain that their insurance doesn't pay. When I start moving toward accepting insurance I realize freshly what a racket it is, and get very angry. I don't have a solution for this. At this time I am searching for alternate employment, and re-imagining what I may do with my desire to rennovate all medicine by bringing the light of science to shine on it. One decision that I have made is that I am shedding the word "naturopath" from my professional vocabulary. It is an awkward conglomeration of Greek and Latin, and the meaning doesn't even come close to what I want to do. Nature disease is a bad name. I am looking for professional organizations to join that do not have that word in the title. I am looking to network and integrate with science-minded conventional practitioners. From this time forward I am a holistic doctor or an integrative physician. I am a licensed prescriber in the state of Oregon, and I am willing and able to help people as long as they are willing to work outside of the limitations of insurance. Big business does not own me. The anti-vaxxers don't own me. And the mystical believers of the naturopathic bubble do not own me either. My family has been having a rough season. My mother spilled a cup of boiling tea down her front 6 weeks ago and is still trying to grow skin back. My sister had an antibiotic resistant infection gone bad, and kidney failure from strong antibiotics and CTs with contrast. My sister's husband had a hypertensive crisis. Every family has times like this, but for me this has been an awakening.
I live in a little bubble. My bubble doesn't include calous and perfunctory treatment of people in pain. I had watched conventional doctors and hospitals doing what they do, and decided that the world really needs naturopathic medicine. Sure, naturopathic medicine still includes some unscientific treatments which I would just as soon shed. That is the bathwater, which we can throw out. We can and will let go of ideas that are proven to be incorrect. We need to be careful not to throw out the baby with the bathwater. The baby of medicine is the evidence-based treatment of people to help them build strength and vitality. This inner strength, the LIFE that we are all born with, can see us through outrageous challenges. Or we can fritter it away by ignoring and desecrating our own bodies. The doctor as teacher really needs to return. I am working up a schedule for regular guided walks in my local park, available to anyone who shows up. The emphasis is on getting people out who would not otherwise go, and also on supporting and maintaining health for all of us. The two alternative interventions which have each been shown to be as effective as antidepressants for the blues (or more effective) are fish oil and walking. Part of the healthy effect of walking may simply be from getting out into nature. Even a rainy day is food for the soul. The first Happy Healthy Walk in Gabriel Park will be today. Also, on Sunday August 30th, Dr Mindy Curry is offering a guided walk starting from Clackamette Park that may involve swimming as well. The weather prediction for this weekend is rain. Feel free to leave a comment or write in the contact form about what kind of walks you'd like. In general I think many of us crave more quality social contact, and also more movement. I am happy to teach about the medicinal herbs in the park, and also to demonstrate and lead a little bit of yoga practice and also walking meditation, as interest arises.  I just completed a training at NCNM and what I learned is that there ARE other people in the community who are impassioned about social justice. Sometimes, when I'm walking down the street, and the people around me are completely closed off from each other, I wonder. I feel good every time that I am the one to stop and ask if someone is OK, offer a hand with something, or otherwise step up to be part of the kinder gentler world that civilization is supposed to bring. I feel our common humanity more deeply than I fear our external differences. I do not care what color you are, or what you think is sexy, or which religion you think is the right one. What I care about is joy. So presume only that I will take you as another human, doing the best you can. I hope you will see that I am no different. 
 Swallowing isn’t easy to do when you’re thinking about it. When you eat it happens automatically. When you have a fistful of medications or supplements to get down, it can be unpleasant. There are few things worse than getting a large bitter pill stuck in your craw.
A 2015 study showed that 3/10 adults averaging age 50 would rather die than take a daily pill for the rest of their lives, and another 1/5 would gladly pay $1,000 to avoid having to take a daily medication. If taking pills is this undesirable, why don’t more people make the diet and lifestyle changes that would free them from pill taking? The answer is of course complex. During our lives, almost all of us will choose to swallow pills, if not longterm, at least long enough to give us relief from a temporary ailment. At some time in your young life, someone asked you to swallow a pill. Children don’t know how, and are usually given chewable or liquid medicines until they learn. In old age it gets harder to swallow pills, so we end up looking for liquids and chewables again. In the meantime, between childhood and old age, we’re supposed to be able to swallow them. There are tricks. Here is a primer. There are two main kinds of pills that you’ll be asked to swallow; capsules and tablets. Capsules are a little cylinder usually containing a powder. Usually they float, though some of them sink. Tablets, on the other hand, are made of a substance that is caked together into a mold. They can be any shape but smart designers make them round or oblong. Capsules are easier to split, and they usually sink. It helps to know if your pills are floaters or sinkers. It’s easier to swallow the same kind together. You can test each pill in a glass or water, or in your mouth, to detect if it floats or sinks. Putting pills in a glass is a good way to see how long it takes the pill to dissolve, too. (Aside: If you put a pill in a glass of water and it doesn’t dissolve in a day’s time, you probably aren’t getting anything out of it.) Pay attention to which pills float or sink, and take the same kind together. SWALLOWING PILLS THAT SINK Sinkers are the easiest to swallow because they behave like food does, sitting on your tongue. All you have to do is tilt your head back a little bit and let them slide to the back of your tongue, and then take a sip of water and swallow it. It is also possible to simply place the pill(s) at the back of the tongue using your hand, then drink. They will go down. SWALLOWING PILLS THAT FLOAT Floaters are tricker. They are easiest to swallow with a bite of pre-chewed food. If you need to swallow them with liquids, here is a trick. With the pill(s) and a modest swallow of water in your mouth, assume your best military posture, with your neck long and chin tucked. The pills will float to the roof of your mouth (your soft palate), and the good posture with chin tuck helps them move to the back. When you feel the pills on the roof of your mouth, distract yourself and swallow, or take another sip to push them along. WHEN YOU CAN’T SEEM TO MAKE YOURSELF SWALLOW This usually happens when you are trying to swallow too many pills at once, or a pill that is so big that it scares you. It floats around and threatens to dissolve and taste horrible. It’s OK to swallow pills one at a time until you are ready to try more. WHEN A PILL DOESN’T GO DOWN Usually what happens, at least in younger folks, is that the pill gets stalled out in the throat somewhere, and the natural peristaltic movements of the esophagus bring it back into your mouth. Slippery pills (like gel caps) slide back up easily. Grainy or sticky tablets can get hung up and make you gag. When a pill feels stuck, keep swallowing. Take swallows of your drink or bites of of food, and keep doing it until it goes all the way down. Some pills (like osteoporosis drugs) can hurt your esophagus if they get stuck. Your doctor will warn you if your medications have this risk. DISTRACT YOUR MOUTH To swallow a bunch of pills at once, put them all in your mouth with a bit of water, and then using your tongue place one pill between your teeth and gums, and swallow the rest. Something about storing the one pill distracts your mouth enough to get the rest of the swallow to happen normally. TAKE PILLS WITH BITES OF FOOD Liquids are harder to swallow than food. Pills that are best taken with food are also easiest to swallow with food. Basically you take a bite of food, and chew it until it is thoroughly chewed and ready to swallow. Then pop a pill or three in there and swallow it. You can chew a little more if needed to feel ready to swallow it, but try not to break up the pills. There are more tricks, but those are the basics. If you are like me, and struggle with swallowing pills, you may need some tricks. Good luck to you. May you heal quickly and no longer need pills. May you find the medicine you need in sunshine and laughter, and the nutrition you need in food. I'm pleased to announce that my new office is nearly ready. There are still a few pieces of furniture to bring in, and some new equipment on order. This is the waiting room, and that thing on the wall (left side) is a water fountain that makes a delightfully relaxing sound. My office is the one with the light coming in on the right. More photos to come.  |
Author: Teresa GryderIntegrative Physician and Student of Life, Medicine, and the River. Archives
November 2018
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