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Hello readers!  Well, I warned that it would be a long time before I'd be back blogging.  It's been a really interesting year!  With the birth of baby Krumbeck in March, graduation in June, boards in August, moving to Montana just following boards, starting to open a private practice - I've been busy!

I'll be back up blogging at my new site soon.  Please take a visit: www.mtwholehealth.com/blog.  All your favorite posts are up, and I'll be writing some new content soon.  There will be a significant shift - now that I'm a licensed physician I will be writing about helpful health tips, as well as my musings on life with a little one.

Hope to see you at the new site! 

All naturopaths are against vaccinations, right?

Continuing on the hot-button issues in the field of Complementary and Alternative Medicine (CAM) is that of vaccinations.  Once again I'm going out on a bit of a limb with this one, because I'm presenting my personal views and not necessarily those of the profession as a whole.  I can, however, share my experience of what I've seen most naturopaths advocate...

So all naturopaths are against vaccinations, right?  Certainly there are vehement opponents of vaccination amongst naturopathic physicians.  Conversely, our community of physicians also has a group who are vocal supporters of rigidly following the CDC schedule.  Most naturopathic physicians, especially those who specialize in naturopathic pediatrics, take a third stance, which I call the knowledge-based approach. 

The knowledge-based approach is based on educating the parents to make an informed decision on which vaccines to administer, and allows parents to choose the timeline.  Naturopathic doctors clearly list the risks of each vaccine, based on actual scientific evidence, not heresay or celebrity endorsement.  Physicians also clearly state the risks of each disease, and the potential consequences of not vaccinating.  Parents are informed of which age group benefits from each vaccine (meningitis and pertussis are typically more deadly in early infancy), so they are aware of appropriate timing.  Parents are given the CDC guidelines and explained the rationale behind the CDC schedule's timing.  Physicians will often point toward alternative vaccine schedules if the parents are so inclined (like Dr. Sears' vaccine schedule).

The drawbacks to this approach are somewhat obvious - Yes, this explanation takes time! This is another reason why office visits to a naturopathic pediatrician are double or triple the length to a conventional pediatrician.  It also requires intelligent and responsible parents to weigh many options and make difficult decisions, especially if they decide on an alternative vaccine schedule.

Sound like too much?  Personally, I don't think so.  Most parents are happy to be given hard data.  It makes the decision less vague, less based on the nebulous fears of "what if I do this," or "what if I do that?"  Parents, after all, only want what is best for their child.

So, after highly promoting the "knowledge based approach," here is my opinion with regards to vaccination:

1. Ignorance is never a valid reason to either vaccinate or not vaccinate your child.  Frankly, I've been surprised by some of the experiences I've had with parents in the clinic.  One parent brought in her 6-month girl (who was sick, of course), and when I asked her about the child's vaccinations she replied "I haven't decided whether to vaccinate yet."  Yet? Parents should know that there is a window of protection given by certain vaccines, that some cannot be given at all after a certain age, and that some are most necessary in early infancy.  Also, vaccines should be planned well in advance, because they cannot be administered when a child is ill.

On the other hand, I believe parents should be informed before they blindly follow a physicians recommendation to use a certain vaccine schedule.  Friends, Facebook, and the Internet are a wealth of misinformation that are bound to leave an uninformed parent terrified (whether they vaccinate or not).  Parents should also know what ingredients are in each vaccine, and whether the virus is "live" or not.  They should also know what to expect, what to do if their child has a bad reaction, and what not to do under normal circumstances (like give Tylenol - but that's another blog post by itself). 

2. All children should have a vaccine plan in place by the age of 2 months.  2 months is when the CDC recommends initiating the vaccine schedule (with the exception of those given at birth). If parents are going to delay vaccinations they should have a schedule completed - in writing - by the age most children begin vaccinations.  One copy of the vaccine schedule should be kept at home (for planning and appointment purposes), and another signed copy should be given to the child's pediatrician. This is for practical and legal reasons - the child's physician needs to have documentation of any delayed vaccines both to avoid potential lawsuits and to always have record of when the child is due for what vaccine.

The document is also helpful for pediatricians in managing sick kids.  Parents who plan to delay or refuse certain vaccines (like pertussis or those for meningitis) need to be aware of the warning signs of those diseases.  The child's physician should educate the parents on what to look for, and to let the parents know that kids who are unvaccinated may need to be taken to urgent care a little earlier than a vaccinated child.  This isn't to scare the parents, but rather to be practical so parents know what to expect. The child's vaccine schedule is incredibly useful for the physician when managing sick kids - it helps the doctor know what disease the child is likely to have or not have, and when the child may need to be referred to a specialist.

3. Every child should see a naturopathic physician.  Just kidding.  Picking a pediatrician should be based on many factors, and it is essential for parents to have a doctor they can trust.  If you feel that your doctor isn't giving you the time you deserve - give me a call!

Photo credit: piyaphantawong / FreeDigitalPhotos.net

“A restricted diet should be part of standard of care for all children with ADHD”

Whaaaaaat?  This was my response as I read this summary article in BlackBag, a free medical app that has dozens of medical news articles delivered daily to your smartphone or ipod.  The title of the summary article was exactly as I typed it above, and the author’s conclusions were based on a study recently published in the Lancet, an excellent randomized controlled trial now known as the INCA trial (“The Impact of Nutrition on Children with ADHD”). 

For years naturopathic physicians have been huge proponents of the allergy (or, more accurately, the “intolerance”) elimination diet.  In fact, elimination diets have become such a mainstay in naturopathic medicine that it has become a bit of a running joke in school - when in doubt, the answer to a test question is always “eliminate gluten” (worth 1/2 credit, at the very least). 

ND’s have used the elimination diet to treat everything from IBS to hypertension, often with astounding results.  In pediatric practices elimination diets are routinely prescribed for recurrent otitis media, constipation and a variety of behavioral problems, including ADHD.  I’ve heard my professors tell stories of children who had dramatic changes on restricted diets to the point where the children were nearly unrecognizable - bouncing off the walls and breaking furniture on one occasion, and playing quietly the next. 

This summary was published just as I was finishing my preceptorship with a pediatrician in Seattle, an MD with an excellent reputation and known for being alternatively minded.  I learned a great deal about the medical management of children in that preceptorship, and I am very thankful for that opportunity.  It was striking to me, however, to see the large number of children on stimulant medications for ADHD.  These medications carry significant risks, from anorexia and weight loss to addiction, abuse and diversion, not to mention the black-box warning for increased likelihood of sudden cardiac death.  I give credit to the pediatrician - he never took this lightly, and always made the prescription only after a lengthy discussion of risks and benefits with the parents. 

I sent the original article to him; I sincerely hope that medical doctors like him see the scientific validity of elimination diets and the huge benefit this intervention could have in terms of risk reduction. 

And, for my medical doctor readers out there who have no idea how to counsel their patients through an elimination diet: please feel free to contact a naturopathic physician near you.  The American Association of Naturopathic Physicians has an excellent website: www.naturopathic.org, click on the link that says “Find a Doctor,” and search for an ND in your area. 

Reference:
Pelsser LM, Frankena K, Toorman J, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet 2011; 377: 494-503