Clinic Notes Digest, Issue 4, January ’24

Happy 2024 everyone! Hope you had a restful festive break and are now raring to with all the opportunities a new year brings. What do you plan to do professionally this year with your clinic work – do tell, maybe you’ll inspire someone else?!

Dr Crista was talking about the importance of killing mould in the sinuses the other day and she has produced a great worksheet for how to do this. Check it out here. The only comment I would make – as a trained clinical aromatherapist – is that the amount of drops she suggests in her video of how to make an essential oil mould-killing nasal spray is WAY too strong! I note she has added a warning and change in the middle of the video from 75 (!!!) drops to 15, thankfully. Less is more, in fact, with essential oils, and I’m also not sure I’d be advising people to use red thyme/cumin etc. Maybe I’ll come up with a recipe myself and share it if that would be useful – let me know?

PNMI are doing a couple of webinars on menopause health. A subject annoyingly close to my heart currently! First one on 16th Jan.

New year, new healthy diet? I loved the weekly newsletter intro from WDDTY this week where they admit that they get all ‘sniffy’ and frustrated with the inevitable ‘healthy diet’ tips in the media at this time of year – tips that are all pretty obvious! I confess I feel the same. How do people not know what a healthy diet is now? As they say, though, we are in the wrong here:

But of course, for many people it’s still not obvious.  Their idea of a balanced diet—as encouraged by their family doctor—is a pizza with a few veg toppings. So, we guess it’s good that newspapers continue to break the ‘news’ to a bewildered nation. ….Yes, it’s good the obvious is rolled out every new year—but you really would have hoped that folk had got the memo by now.

We talk about healthy eating all the time, and it is easy to forget that people still don’t really understand the issues or practically what to do to change. I was reminded of this once when I taught some healthy eating courses for Blackpool council for young single Mums. I went in with my usual tips, but had to rapidly downscale and come right back to basics both in terms of cost, cooking skills and even down to what certain vegetables actually were and where they came from. It taught me more than I taught them – a valuable lesson never to assume people know and to check what level of understanding they have before I launch in with what I think is ‘obvious’.

Ooh, I love a prune! So, I was pleased to see this study suggesting they are anti-inflammatory and can help bone density in post menopausal women. I’d like to think it is true, but then I saw it was funded by the California Prune Board. Who even knew there was such a thing?! Still, I may have them anyway. Watch what they are coated in, though. Sorbic acid, veg oil etc. Sorbic acid can be derived from corn – so watch out if you are corn-sensitive. You can buy unsorbated prunes in a few places, such as Whole Foods or Healthy Supplies.

Next Dr Yanuck in his Cogence newsletter was talking about the importance of not being so straitlaced, or ‘efficient’ as he calls it, in your clinical decision-making this week; to let go a bit and see what crops up. This really resonates with me.

I have been thinking recently about going back to face to face appointments and how I used to manage cases more. I did exactly what he says – I used to let patients ramble away, telling me their story in their own words, because often you find hidden clues or they come to an important realisation about something. Ironically, although it initially takes more time, I found it the most effective way to start a case, and I miss it. Sure, I have forms now from Dr K et al and they are useful, but you don’t get the same ‘feel’ for a case or a person, do you? How do they enter the room, talk to you, write, speak; what vibes are they giving off? What are the off-the-cuff remarks that hold the real nuggets? I don’t much like all this virtual clinic approach much, I have to say and I’m craving the older-school methods!

I also agree with what he says about lab testing – casting your net wide in complex cases in the hope that you catch some unexpected fishes! I do that too. Explaining it to patients is a different thing altogether though as it sounds like you are guessing! And it costs.

An interesting perspective for you next on breast cancer diagnosis from an article in the Daily Mail health section: Why Some Mammograms Don’t Spot Breast Cancer. Moral of the story – get patients to ask for ultrasound, not just mammogram. I had a ‘scare’ like this over the last couple of years, actually, and my hospital (Cornwall) did both in case, so it looks like things are already changing.

Summary: Breast cancer survivor, TV’s Julia Bradbury discovered that breast cancer may not show up on mammograms in women with dense breast tissue.  Deborah King had invasive ductal carcinoma which accounts for up to 75% of breast cancers but it hadn’t shown up on a mammogram.  But it was clearly visible on ultrasound.  Julia revealed that her breast cancer was missed on 2 mammograms as she had dense breast tissue.  She said it took an ultrasound and an entire year to finally confirm her cancer diagnosis because she has dense breast tissue. 

Dr Lester Barr, consultant surgeon specialising in breast cancer at University Hospital South Manchester, said the reason ultrasound is helpful in women with dense breasts is that it uses soundwaves to detect lumps which may not be apparent on mammogram X-rays.   Another cancer difficult to detect on mammograms is invasive lobular carcinoma – the second most common type.  

Mounting evidence suggests routine mammogram screening may cause more harm than good for some women, regardless of breast density.  Trials are underway for ABUS – Automated Breast Ultrasound which produces computer-generated 3D digital images. 

To finish: some interesting reading for when you have a spare moment ;). The Top 10 articles from last year in the Natural Medicine Journal:

1. Methylsulfonylmethane and Hair Health
   By Rodney Benjamin, Janaina Rosa Cortinoz, Lucas Offenbecker Guerra, Neelam Muizzuddin, PhD
2. L-Arginine and Vitamin C Reduced Long-Covid Symptoms in 1 Month
   By Lise Alschuler, ND, FABNO
3. Vitamin D and Covid-19
   By Jasmine Kirby, James Adams, PhD, Sarah Trahan, NMD, Tapan Audhya, PhD, Anar Musavi, PhD, Shaun Kennedy, ND, Amanda Roberson Alexander, ND
4. Can Turmeric and Indian Frankincense Relieve Acute Musculoskeletal Pain?
   By Poorvi Shah, DO
5. Clinical Application of Indigo Naturalis
   By Mark Davis, ND, Natalie Scheeler, ND
6. NAC Improves Lupus Symptoms
   By Jacob Schor, ND, FABNO
7. Quercetin in Early Covid
   By Caitlin O’Connor, ND
8. Avocado Intake Associated With Less Hypertension in Women
   By Daemon Jones, ND
9. Prediabetes as an Independent Risk Factor for Bone Fractures in Women
   By Daemon Jones, ND
10. Do Omegas Help With Depression in Patients With High Inflammation?
    By Peter Bongiorno, ND, LAc