by Lori Gleichman, for The Bulletin Special Projects
Reprinted from The Bulletin’s U Magazine – June 2009

Bioidentical hormone replacement therapy has allowed some women to take back their lives. Two women who don’t know each other still have a lot of life experience in common, like finding themselves again after years of feeling “not quite right.” Both use words and phrases like lethargic, fuzzy thinking, “tired all the time,” extremely irritable, trouble sleeping, and night sweats to describe their symptoms. In essence, they were miserable and didn’t know why.
In both cases, they consulted their regular physicians who diagnosed depression or early menopause and prescribed pills. In both cases, they felt they needed something different and eventually had their hormone levels tested. The tests registered in the zero to “barely there” range. And both finally found a solution to their problems: bioidentical hormone replacement therapy (BHRT).
To some, BHRT is mysterious and controversial, but to Aileen Walker, 43, and Tonya McKiernan, 44, it is a treatment that has provided tremendous relief. “For me, the change was almost immediate,” said McKiernan.”

Their Stories
McKiernan experienced surgically-induced menopause when her ovaries were removed due to cancer. After suffering a variety of symptoms for years, she finally questioned the depression diagnosis and had her hormone levels checked. “Essentially, I had no hormones at all,” she said.
Walker had a similar experience, even though it has taken about a year to get her hormone levels to the point where “I feel myself again,” she said. Walker started feeling badly in her early 30s, but the symptoms escalated— irritability, fuzzy thinking, and drastic changes in her body —after the birth of her second child, Zach, at 38.
“In retrospect, I was probably having hormone imbalances for years, but after Zach, everything amplified,” she said. Doctors prescribed birth control pills after testing her hormone levels, which registered at the “barely there” mark. This didn’t sit well with Walker.
“I knew there had to be other options,” she
said. She consulted with Dr. Evelyn Brust, ND, LAC at Preventative Medicine Clinic in Bend and was amazed at the detail that resulted from the testing process and the discussion. “We went through every single line on the blood labs and discussed what it meant and why it was important,” Walker said. Walker left with a prescription for bioidentical hormone replacement therapy that has evolved over the last year to match every symptom with the right level of hormone. “Now I feel much better overall on every level,” said Walker. “I never knew hormones could make you feel so bad—or so good.”

The Power of Hormones
In fact, hormones make up one of the most important systems in our bodies. They act as chemical messengers that carry information between groups of cells, regulating growth, tissue development, sexual function, and how our bodies use food and react to events.
For women, important groups that influence how we feel are estrogen, progesterone and testosterone. In balance, they work together for health and wellness of both body and mind; out of balance, women can suffer from symptoms that seriously impact the quality of life like hot flashes; sleeplessness, irregular, heavy and painful periods, migraines and mood swings. These symptoms can start as soon as a girl starts puberty and be a problem throughout the years not just as symptoms of peri-menopause or menopause.
Ron Rosen, MD, PC with Open Paths Integrative Medicine in Bend, has seen an increase of women seeking advice about these symptoms for themselves and for their daughters, who seek alternatives to suffering or synthetic hormones. “Women are educating themselves more about health issues and have more awareness of their own bodies,” he said. “They are more willing to deal proactively with things and questioning traditional approaches to hormone replacement therapy.”
Rosen encourages people to do their research, talk to physicians in detail about symptoms and concerns. If not satisfied, look for other options. “Different practitioners offer different information and alternatives,” he said. Brust agreed. “Many of us know intuitively when something is wrong, even if it can only be talked about in terms of how we feel,” she said. “I think the integrative medicine community pays more attention to listening to patients, as well as doing the ‘science’ of medicine.”

Is BHRT the Answer?
To determine exactly what is wrong, Brust spends times with a patient discussing symptoms. She then runs a series of lab tests to determine baseline levels of hormones and other body chemistries. She also does a series of screenings for the heart, bone density, mammograms and PAP smears to determine any other risk factors that need to be considered in BHRT. Finally, she has a conversation about short- and long-term risks and benefits.
“I encourage women to look at life right now—what is critical to be addressed to make them feel better—but also to look at the future,” she said. “BHRT is preventative for many diseases like heart disease and memory loss, but people have concerns about risks as well even though there have been no studies to date that show a link between BHRT and cancers or heart attacks.”

Treatment Options

If BHRT is right for you, you will likely be referred with a prescription to a compounding pharmacy, which specializes in combining components for individual needs versus a dispensing pharmacy which doles out medications manufactured in an industrial setting.
You will also discuss a delivery method as BHRT is generally applied topically in a cream, in a troche that dissolves under the tongue, or a suppository.The compounding pharmacists also often plays a consulting role with patients, monitoring their symptoms and working with the physician to “tweak” the prescription to just the right levels, explained Barbara Dembsky, owner/pharmacists with CustomCare Rx in Bend. Dembsky said that people considering bioidentical hormones need to understand two things. First, the chemical structures of bioidentical hormones are identical to those produced by the human body, not simulated like synthetic hormones such as Premarin or Prempro. Secondly, each prescription is compounded specifically for each individual receiving the therapy—BHRT does not offer a “one-size-fits-many” approach.
According to the International Academy of Compounding Pharmacists, the final bioidentical hormone product is not regulated by a state or federal agency, but bioidentical hormones—like all compounded medications— are made from FDA- and USP- registered materials. “Compounding pharmacists are highly trained and subject to state board of specification standards,” Dembsky said. Both McKiernan and Walker agree that they “just feel better,” and encourage women to talk to one another about their experiences with hormone imbalances. There is no reason to suffer from the symptoms, they say.
Relief can take time, added Dr. Brust, “but if BHRT is the right path for you, most will notice a difference in the symptoms that bothered you quickly, and you will start to feel better.”
For McKiernan, that meant a better and more fulfilling life. “I have energy. I think clearly. I have emotions now,” she said. “My mom says the old Tonya is back.”

With summer here, weight issues surface anew. As we welcome summer, here’s to bathing suits and shorts, and body baring fashions.And as many of us become more body conscious, questions reappear with regards to diet once again.

There is not a day that goes by in my office that a patient doesn’t ask about weight gain/loss and diets. There are those who come in and swear by the Atkins diet, the Sommers diet or some other diet. Well folks here it is:

The bottom line is that weight-gain occurs when the amount of food intake (energy, otherwise known as calories) exceeds the amount of energy the body spends. There are illnesses, and metabolic disorders that may be the cause of this imbalance. And yes, the research
shows there is a genetic component. However, for the majority of Americans, it is really either over eating, and/or under exercising.

Let us start with the question how much energy (measured in calories) does it take for my body to function? This is known as the RMR, or resting metabolic rate. This is an individual’s energy requirement needed for the body to do the basic functions, such as breathing, and maintaining brain and vital organ functions.

This measurement can be done by an instrument that is known as a calorimeter. This is a simple test that requires breathing into an apparatus for a period of time, in the morning, prior to eating and exercising and the number is displayed on the digital screen.

Now, the reason this number is significant, I believe, is that most people think they need and burn more calories than they actually do. After some testing, it was rather surprising at truly how low this number is in patients who are considered physically active and fit. Of course this number is only the beginning of determining how many calories your body truly needs, and what would be my recommendation as the FIRST step in any weight loss/gain program.

Additional caloric needs are then taken into account, and are also a consideration in an individualized program. Quality of food does matter.

While calories are calories, there are some difference in the quality of a calorie. You may ask what does that mean? So, why isn’t a donut with its fat and carbohydrate calories, otherwise known as “empty calories?”When the body digests, and breaks down food, it needs enzymes, vitamins, and other physiologically active substances. These substances are affected by the food. Take the donut. Due to its usually high simple sugar content, a physiological affect may be the spike in some persons insulin (a hormone). Also, the donut probably wouldn’t be considered as a rich source of vitamins, and/or phytonutrients. And, in fact it probably contains trans fatty acids.

Another analogy would be this. Let say you own and drive a Ferrari. Would you really get the cheapest gas available? You might get where you want to be with a lesser quality gas in your Ferrari, but at what cost to the rest of the car, and its parts? Even my 4-wheel drive pings on low quality gas.

So, back to our body’s. The quality of food matters, if you want performance. Yes, most food will in fact give you the calories one way. However, if the food is chosen by its calories and NUTRITIONAL value, just think how well you really could feel!

Here’s to fruits and vegetables, nuts, seeds, whole grains, oils, and high quality hormone free poultry, eggs, fish and meat.And high performance high octane fuel for all you Ferrari car drivers! Let us say we are eating well.Like the gas filled Ferrari, just gassing it doesn’t keep it functioning well. It loves to be driven. (OK, it loves to be driven fast) And, so too our body’s likes to move.

So, yes exercise is important. (And, that’s a subject for another day).Our evaluation of the total energy need of our body and total caloric intake is the RMR plus the daily energy requirement of our body with exercise, a very active lifestyle and/or job.

Call 541-383-3424 to get your RMR tested.

Cross-training proves beneficial

There are many things in life that are fascinating. The capacity of the body to heal after enormous trauma and the ability of some people to accomplish great physical feats are right at the top of my list.

The Cascade Cycling Classic has once again come and gone, and one of its former racers was right here in Bend in this event only a few years ago.As we once again watch Lance Armstrong defend his Tour de France title, is his journey to the top of his sport not awe inspiring?Is it not encouraging to us all to face the challenges in our lives? And one of great many challenges many of us face will be to stay physically active, and to remain healthy.The sooner we all embrace the fact that our bodies are made to MOVE to stay healthy, the sooner we can get started on our journey to better health.OK, you may ask, so what is the best kind of exercise?

It is for you? Anything that you find interesting, and you enjoy doing is within your physical capacity to do.For example, say, you used to like to run, and now, this activity just doesn’t do it for you. So, change it.The healthiest people I know are those who cross train. They prevent injuries, and they seem to stick with the program.

The program being REGULAR EXERCISE. Yes, a program can consist of hiking, swimming, and yoga for a number of months, or years and than switch to say, biking dancing and weights. The point is variety is the spice of life!We have a wonderful natural opportunity in Bend to cross train, because we have seasons. The winter offers opportunities to ski, snowshoe, play hockey, and skate. Furthermore, muscle development is very sports specific.

Have you ever gone for a run after spending most of your exercise program biking? Does the phrase “out of shape” enter your mind? This isn’t necessarily true.To be great at a sport, practice makes perfect, at that activity.

However, for the average person preventing injury and boredom should be goals of any exercise program.Other fitness goals should include the following: flexibility (stretching), endurance (lung capacity and heart health), and strength. It should become obvious that it is difficult to work on each one of these components at ever exercise session.So, break it up. At one session focus on strength. For example, say you have chosen biking (mountain or rode). Focus on strength by choosing a hilly route, and doing intervals. It is a little difficult to focus on flexibility when ON your bike, so stretch after. Another session of riding may be to go for a long ride, where endurance would be the focus.

The side effect of cross training, and focusing on the different aspects of fitness, strength, flexibility, and endurance yields another gem of longevity. Increase in lean body mass. (This is determined from measurement of your percent body fat). And an increase in our RMR, resting metabolic rate. (From last month). Many people may initially experience weight loss, and then weight maintenance as the road to health includes a lifestyle in which regular exercise becomes another priority.

Remember, if exercise is not in the top 3 of your daily “to do” list, the chances of it occurring is very low. On our journey to better health, let exercise lead the way.

Call 383-3424 to have your RMR &/or percent body fat measured.

Chances are we all have experienced the aches and pains of a preventable injury at some time on our life. But, what do we do now that we have the tendonitis, the bursitis, the muscle spasms that just seem to hang around to interfere with our tennis, golf, horseback riding? Many patients come in when the ibuprofen, the muscle relaxers, and /or the OTC (over the counter medications) seem to lose their effectiveness. What started as an acute injury may in fact now have become a chronic injury, with the chronic inflammation, pain, decreased ranges of motion, and with potential long term damaging side effects.

First, get a diagnosis. Have a health care professional examine and diagnose the injury at the onset. What may feel like a muscle spasm in the low back may in fact be a herniated disc. Or vice versa. What may feel like excruciating “nerve” pain may be due to a muscle spasm.

Secondly, check out all your treatment options. In some cases, medications such as temporary use of anti-inflammatories, and analgesics may be indicated. Other options may include acupuncture, ultrasound, physiotherapy modalities, specific exercises, and surgery. These therapies can be extremely helpful in decreasing pain, and inflammation, and restoring normal ranges of motion in the joints and muscles. Often these methods when used at the same time improve healing time.

Third, set up and follow a treatment plan. Patients often ask how long will it take to heal? How many treatments of acupuncture and/or ultrasound do I need? How long do I have to take the medicine? It depends on how long you have had the pain. What the diagnosis is? And what have you been doing/and or taking to relieve it or to aggravate it. Unfortunately most people seek medical care only after nothing THEY do helps it. The recovery of an injury most often can be determined by a few things, including the medical attention within the first 24-48 hours, and the person’s ability to heal. For example, patient after patient has come in complaining that at first the “hot tub” felt great, and the next morning they couldn’t get out of bed. This treatment is rarely successful in an acute sprain/strain type injury.

Following a treatment plan from a trusted health care professional often results in the fastest recovery with the least amount of residual pain, and other symptoms. I know from personal experience it is very difficult to hear, “no skiing, biking, golf etc. for the next x amount of weeks.” However difficult it is to avoid favorite past-times, isn’t it more difficult to be injured? Compliance of a treatment plan, especially when it involves doing, or not doing something we do not want to hear is difficult.

Lastly, being preventative does pay off. Let this be part of the plan following treatment. Preventative measures may include specific exercise, protein supplementation, glucosamine sulphate, chondroitin sulphate, calcium/magnesium, MSM, and other vitamin and mineral supplementation. Regular acupuncture, chiropractic, physiotherapy, and/or massage may also be indicated. Also, rest
from physical exertion allows the body to heal and recover.

We only have one body. Let us take care of it as we enjoy our lives and our journey.

This is one of the most frequently asked questions in my practice. It is nice to answer this question rather than “Does acupuncture work?”.

We all probably know someone who has had acupuncture treatment for one reason or another, and they testify how great it worked. The fact of the matter is that acupuncture works for some people some of the time. Now back to the initial question of how it works. Basically the technique of inserting very fine needles into specific points results in a specific physiological response.

The outcome is dependent on the combination of points chosen, the clinical ability and experience of the acupuncturist in treating specific conditions, and the individual’s response to a specific treatment. The analogy I like to use is this:

Take a computer. Often here in Bend, we experience an electrical surge, disruption in our service, or maybe even a computer virus. So, we restart, restore or reboot our computers. Injury, illness, stress or trauma to our body is similar.

There is a disruption in, for example, the hormonal or neurological function in our body. By choosing specific acupuncture points, a specific message is sent to the brain. The brain receives this message and responds via the body’s many systems to heal and restore health.

The results may be a decrease in pain and inflammation, regulation of hormones, improved sleep, energy, etc. The difficulty is assessing at the onset of an acupuncture series how many treatments it will take for a specific symptom or illness to improve.

A general rule is a series of 12 visits, usually starting at a frequency of 2-3 per week. The longer the illness, and/or severe, the longer
the duration of therapy. We do occasionally have patients who respond very quickly to few treatments we call them our acupuncture “miracles.”

We also have patients who choose to come in once a month for their “tune-up.” Most of these patients have a philosophy of preventative medicine and are committed to a preventive approach when dealing with their health.

You may be wondering what conditions is acupuncture good for. Acupuncture is indicated in all pain syndromes, acute (sudden onset) or chronic, pre op, and post op. It may also be indicated in stress, insomnia, fatigue, nausea in pregnancy or chemotherapy induced, some cases of infertility, woman’s gynecological conditions, stroke, and decreased immunity.

There has been much confusion as to the differences/similarities between various primary healthcare providers. In the United States, allopathic (MD), osteopathic (DO) and naturopathic (ND) physicians are licensed to provide primary care medical services. Each profession has a rich history, and distinguishing philosophical characteristics.

All three types of medical schools require 4 years of medical education to complete there respective degrees. Instruction includes preclinical and clinical phases. Perhaps the most historically philosophical difference was concerning the use of drugs, and therefore the number of hours of instruction in pharmacology. The number of hours of instruction currently is similar in all three types of school. Emphasis is placed on musculoskeletal manipulation in osteopathic and naturopathic medicine, and these professions pride themselves in their “holistic” approach to health care. This orientation to healthcare in these schools require hours of naturopathic philosophy, and osteopathic principles and practices including manipulative therapy, in the first two years of school respectively.

All three types of medical schools rely on mostly PH.D’s to deliver the basic science instruction. As the training progresses to more applied medical subjects the involvement of faculty with clinical degrees increases. Because of the philosophical differences of the three medical professions, there has been a tendency to rely on members of the same professions for clinically related instructions. Allopathic schools use M.D.s, osteopathic schools use D.O.s, and naturopathic schools use N.D.s for the majority of clinical instruction.

It is in the clinical instruction that naturopathic medicine education departs most significantly from the common path of medical education. Clinical instruction relies most exclusively on outpatient clinics and classroom/laboratory demonstrations under the supervision of licensed N.D.s. It typically contains little or no inpatient exposure. The most significant departure from the common path of clinical instruction is exposure to alternative and complementary medical modalities. This includes training in herbal medicine, nutritional medicine, homeopathy, hydrotherapy, massage, mind-body medicine, and natural childbirth.

The large and growing public demand for alternative and complementary medicine has prompted some allopathic medical schools to introduce such modalities into their clinical instruction. Such integrated clinical education settings are expected to strengthen the common paths of clinical instruction.

The philosophies and practices of allopathic, osteopathic and naturopathic physicians cause each to be distinguishable from the others. I believe it is the common characteristics and the differences that contribute to the high quality of medical care available in the United States. We are able to experience the best of each type of medical modality, and experience an integrative medical approach to meet our health care needs.