Doc Mary News You Can Use

Naturopathic Doctors in Alaska already have by far, the most limited scope of practice of any licensed state.  If the Alaska State Medical Association (ASMA) has their way, it will be even more limited.  We need your help!

In the past year compounding pharmacists have been warned not to sell things as simple as B12 in injectable form and other natural medicines that require a prescription to us.  If they do,they risk losing their pharmacy licenses.  Our regulations for the past 18 years have been very clear.  We cannot use prescription drugs but medicines that are specifically herbal or nutritional are within our scope of practice.  We have been working hard for the past two months to preserve our right to treat patients with the same medicines we have used in Alaska for 18 years and in every other licensed state.

Our bill, HB 266 is currently stuck in Labor and Commerce.  We have made concessions requested by the Alaska State Medical Association (ASMA) and yet they will not get out of the way.  The House L&C has been closed to public testimony since February 29, yet there has been no action on our bill.  We need all House Representatives to be urged to support HB 266 but especially those who live in the districts of these folks:

Chair Kurt Olson (Kenai/Soldotna) Rep_Kurt_Olson@legis.state.ak.us

Vice Chair Craig Johnson (Southwest Anchorage) Rep_Craig_Johnson@legis.state.ak.us

Members:  Mike Chenault (Kasilof/ Nikiski)  Rep_Mike_Chenault@legis.state.ak.us

Lindsey Holmes (Turnagain area of Anchorage) Rep_Lindsey_Holmes@legis.state.ak.us

Dan Saddler (Fort Richarson and Elmendorf area of Anchorage)  Rep_Dan_Saddler@legis.state.ak.us

If you don’t live in one of these districts, you can send an email to: House_Labor_And_Commerce@legis.state.ak.us

with a cc to:  Christopher_Clark@legis.state.ak.us

If you would share your thoughts with me at:  docmary@alaskanapothecary.com  That would be great.  Thanks.

 

In an unprecedented overreach by Alaska’s Division of Professional Licensing (DPL), medical suppliers in Alaska and the lower 48 have been told not to sell  anything that is restricted by the prescription  (Rx) legend to Naturopathic Doctors in Alaska.  This includes such things as injectable vitamins and many restricted herbs that are the mainstay of Naturopathic Medicine.  This would make Alaska by far the most limited state of any of the licensed states in the US.

Here is the background story.

Naturopathic Doctors were first licensed in Alaska in 1986.  At that time there were four doctors in the state that had licenses in other states since Alaska was an unlicensed state.  Legal action against one of our providers led to an overwhelming response from consumers like yourself and our law, while not perfect, has allowed our profession to establish itself in several communities in Alaska.

By statute, we cannot “give, prescribe, or recommend in the practice:

1. a prescription drug or

2. a controlled substance.”   Controlled substances are prescription drugs such as opiates that are likely to be abused.

The DPL, who oversees our profession in Alaska, adopted regulations in 1994 that “prescription drugs” does not include a “device or herbal or homeopathic remedy or dietetic substances in a form that is not a controlled substance” with further clarification that “herbal remedies” include the extract of a plant, tree, root, moss, fungus or other natural substance.

The statute and DPL adopted regulations are clear.  Why the DPL is now ignoring their own regulations is not.

House Bill 266  and Senate Bill 175 (HB266  & SB175) would fix this problem so that as Naturopathic Doctors we can continue to serve our communities as we have for the past 18 years.  It is not an expansion of our scope of practice.  It merely enshrines the status quo.  This bill takes one sentence from our regulations (medicines derived from or a concentrate or extract of  a plant, tree, root, moss, fungus or other natural substance) and places it into our licensing law so that thousands of Naturopathic families can continue to receive the same level of care they have come to expect from our providers.

We are grateful to our sponsors, Cathy Munoz in the House and Lesil McGuire in the Senate.  We expect push back from a small but well organized group of conventional providers  who have done this in the past as a kind of deep tendon reflex (aka knee-jerk reaction).  We need legislators to hear from you that naturopathic medicine is your choice of health care.  In these precarious times, tying the hands of your primary care providers creates an unnecessary barrier to appropriate care.

We have 90 days to accomplish our goal here.  Please contact your legislators (all politics is local) as well as our sponsors and any other legislators needed to get HB266  and SB175 passed.  If you would be good enough to share your correspondence with me at docmary@alaskanapothecary.com ,  along with any response you get, I would be grateful.

HOW TO CONTACT LEGISLATORS

POMs (public opinion messages): If you go to www.alaska.gov, you will see an icon on the right hand corner that says “the Alaska Legislature” which goes to their home page.  On the bottom of that page under “Quick Links” is a link to “public opinion messages” that will allow you to send a 50 word message to all or some of the legislators.

Direct emails:  You will find the link to particular legislators by opening up the tab marked “senate” or “house” along the top of this page.  That will bring you to the links for all the individual legislators.  If you link to “Senator Joe Blow”, it will go to the website that has the email address for that person.

Snail mail:  When people take the time to write a letter, address the envelope, affix the postage and send it to them it gets the legislators attention.  I would be happy to supply “talking points” to anyone who contacts me.

Direct testimony: Our bill has been assigned to only one committee in the House and Senate-Labor and Commerce.   Individuals can weigh in during these committee meetings by going to their local Legislative Information Office (LIO) to testify.  Unfortunately, we can’t guarantee that a bill will be heard when it scheduled since there are a number of bills that make their way through the process.  They decide the order in which they will consider the bills before them and sometimes, we just run out of time.

House Labor and Commerce:

Kurt Olson-Chair (Soldotna)

Craig Johnson-Vice Chair (Anchorage)

Steve Thompson (Fairbanks and co-sponsor of HB266)

Paul Seaton (Homer)

Dan Saddler (Eagle River)

Lindsey Holmes (Anchorage)

Bob Miller (Fairbanks)

Senate Labor and Commerce

Dennis Egan-Chair (Juneau)

Joe Paskvan-Vice Chair (Fairbanks)

Bettye Davis (Anchorage)

Cathy Giessel (Anchorage)

Linda Menard (Wasilla)

Tracking Bills:

You can track bills by signing up for email alerts (home page of the legislature, under media center).  This way you can follow the bill as it goes through the process.

On the legislative home page, you can put HB266  or SB175 in the search engine and that will bring to status of the bill up for you.

You can live stream committee proceedings by going to AlaskaLegislature.tv.  They make this available to anyone who does not live near a LIO or has problems getting to an LIO, but I have been able to watch from my lap top in my office in Fairbanks by asking the tech guy nicely.

Thank-you in advance for your continuing support of naturopathic medicine.

I have never been exposed to pepper spray.  I have a can “bear spray” that I take with me when I am out in the wilderness hiking, berry picking, etc.   I have seen someone who accidentally sprayed herself with pepper spray and I know it is exquisitely painful.  When I saw the clip of Megynn Kelly, a “news” correspondent, discussing with Bill O’Reilly the incident where UC Davis campus police were dousing protesters with pepper spray and referring to it as “a food product-essentially”, (http://www.huffingtonpost.com/2011/11/22/fox-news-pepper-spray-oreilly-megyn-kelly_n_1107332.html ) I thought, this must be the same kind of mental gymnastics Holocaust deniers go through.

Whether you are planning to “Occupy” or you’re just Christmas shopping at WalMart, chemical personal protection sprays are widely available.  People are exposed for all kinds of reasons, including pure accident.  In my naturopathic chat group, the topic of what to do for someone who has been or is at risk for exposure to chemical weapons has provided me with some valuable tips that I hope I never get to use.  My hope is you never have to use this information either but just in case…

WHAT TO BRING TO A PROTEST:

1.  Focus on spreading calm.

2.  Before the protest, shower and don’t put on any creams or oils as they will hold the chemicals next to the skin.

3.  Be well nourished, well hydrated, and dressed appropriately for the weather.  Rain gear is best with sealed ankles and wrists.  Bring a clean change of clothing in a sealable bag.

4.  DO NOT WEAR CONTACT LENSES.  They are difficult to remove if the eyes are irritated.  If you have been sprayed and you can’t get your lenses out, this is a medical emergency-call 911 or go to the emergency room.  Better idea-wear glasses and goggles.

5.  Bring a bandana and some water or soak in vinegar and bring in a sealable bag.  If chemicals are used, cover as much of your face as possible.

6.  Bring a sports bottle filled with water to flush your eyes, skin and mouth.

7.  Put contaminated clothing in a sealable bag and bathe as soon as possible.

HOW TO HELP SOMEONE WHO HAS BEEN EXPOSED TO TEAR GAS/PEPPER SPRAY:

1.  Focus on spreading calm.

2.  Scout for a safe place to take this person to.  Lead him/her away while holding on to your arms-s/he walks forward and you walk backward.

3.  Flushing the eyes-tilt the head back and to the side.  Gently pry the eyelids open with a gloved hand and squirt from the inside corner to the outside corner of the eye in short bursts with:

a.  Water-works well but also burns, or

b.  Saline-bring lots and plenty of squirt bottles, or

c.  1/2 water 1/2  Maalox-the antacid calms irritated tissues.

4.  If the person has asthma or other serious respiratory problems, take to the emergency room.

5.  Bathing-if tear gas has been used, don’t have the person stand under the shower so the chemicals will drop down onto the skin.  Wash the hair first with the head tilted back so the chemicals go directly down the drain.  Milk is good to rinse areas that have been exposed because the calcium binds with capsaicin (the active chemical in pepper spray) and neutralizes it.

6.  Clothing-wash contaminated clothing separately, several times with detergent.  If the clothes continue to out gas, consider that outfit a casualty to the cause.

7.  Focus on spreading calm.

Even if you are not the protester type.  You might want to add a squirt bottle, goggles and protective clothing to your emergency medicine kit.

Happy Holidays and let’s continue to work for a saner world.

I took the summer off from posting on this blog and now I am back.  Did you miss me?

Last night I went to a lovely “Ladies Night Out” that was put on by the Soroptimist of Fairbanks (of which I am a member).  We had wine tasting and chocolates being served by firefighters (candy and eye-candy, my favorite).  Call it a coincidence but when I checked my email this morning there was an article on the benefits of chocolate for heart and brain health.

In a meta-analysis of seven studies that was posted on line on August 29, 2011, from the British Medical Journal,  people who ate the most chocolate had 37% less cardiovascular disease and 29% less incidence of stroke compared to the people who ate the least amount of chocolate.  Interestingly, there was also a decrease in diabetes in men but no association between chocolate consumption and diabetes risk in women.

http://www.bmj.com/content/343/bmj.d4488.abstract?sid=28788988-3f45-4f6a-8c48-c890592b6be2

Adriana Buitrago-Lopez, the chief investigator of this study, has suggested that the polyphenols in chocolate (also found in red wine) will make naturally occurring nitric oxide more available.  Nitric oxide helps open up blood vessels and thus improves oxygen uptake by tissues that use a lot of oxygen, like the heart and brain.

Whatever the explanation, I am glad to know the red wine and chocolates I enjoyed last night were good for me-in moderation of course.

The World Health Organization (WHO) has reported that cell phones may cause cancer.  A working group of 31 scientists has been meeting regularly and reviewing studies on radiofrequency electromagnetic radiation and the increased risks of cancers-especially tumors in the brain called gliomas.

One study that was reported in JAMA last February found that after about 50 minutes of cell phone use, there was a significant increase in glucose metabolism in the area of the brain closest to the antenna.  (Effects of cell phone radiofrequency signal exposure on brain glucose metabolism, Volkow et al, February, 2011)  It may be too big of a leap for some but cancer cells love glucose-that is how a PET scan works.  The patient is given an IV with glucose that has a radioactive molecule on it and they look for “hot” spots-areas that have taken up a lot of the radioactive glucose because that’s where the tumors are.

It may be sometime before we will see a statistically significant increase in gliomas or other brain tumors because these tumors are usually slow growing and by the time they cause problems, they have been there for a long time.  Even though approximately 5 billion people use cell phones today, they haven’t been in common use long enough to make the case that heavy use of cell phones today leads to more brain tumors twenty years from now.

Honorable people will disagree about how significant a risk cell phones present but the precautionary principal (when in doubt, assume the risk is real), would suggest limiting your exposure is a good idea.  The Environmental Working Group has rated cell phones by how much radiation they emit (www.ewg.org/cellphone-radiation).   Besides using a “safer” phone, other ways to reduce exposure include using head sets or speaker phones.  Also, setting limits on usage by young people is probably wise.

 

The results of the Infant Feeding Practices II study was reported this week in the journal Pediatrics.  They followed 2600 healthy moms and newborns with questionnaires asking if they had given their babies herb teas or botanical supplements in the past two weeks.  About 9% reported giving their child a tea or supplement on one or more questionnaires.  The most common reason for using these products was for fussiness, digestion and colic.   The most commonly used herbal formulas were gripe water, chamomile tea, and teething tablets.

The researchers noted that the sample was not representative in that older moms with higher education and more affluent women were over-represented.   They found that sources of information came from family, friends, health care professionals and the media.

Hispanic women were the most likely to use herbal products,  which the researchers believe to be due to cultural acceptance of herbal teas.

In my practice I like to think of  nursing moms and babies as one digestive system and will often recommend the mother take remedies for the baby that will then get into the breast milk.  Of course, this can work against the baby as well.  There have been numerous reports of things like heavy metals found in Chinese and Ayurvedic botanical formulas that are of some concern.  When in doubt, talk to your naturopathic doctor before either of you take any medicine whether “natural” or “pharmaceutical”.   The fact that conventional providers are paying attention to what young patients may be ingesting besides breast milk and formula is a step in the right direction.

April is National Poetry Month.  Also, I have new “pets” at home.  I have started composting with worms.  As I have always never said, vermiculture is better than no culture at all.  I have named them Pat.  The following is for Pat.

Song of the Worms

We have been underground too long,

we have done our work,

we are many and one,

we remember when we were human.

We have lived among roots and stones,

we have sung but no one has listened,

we come into the open air at night only to love

which disgusts the soles of boots,

their leather strict religion.

We know what a boot looks like when seen from underneath,

we know the philosophy of boots,

their metaphysics of kicks and ladders.

We are afraid of boots but contemptuous of the foot that needs them.

Soon we will invade like weeds,

everywhere but slowly;

the captive plants will rebel with us,

fences will topple,

brick walls ripple and fall,

there will be no more boots.

Meanwhile we eat dirt and sleep;

we are waiting under your feet.

When we say “Attack”!

You will hear nothing at first.

Margaret Atwood, You are Happy, 1974

Earlier this month I gave a talk at “A Women’s Affair”, a three day community event in Fairbanks that has lots of booths and many people doing presentations on a wide variety of topics of interest to women.  My topic this year was “Is your home making you sick?”  I talked about chemicals commonly found in the home that can be toxic and how to make your home more eco-friendly.

While I was getting my presentation together at home,  my neighbor was working on his car.  He was gunning the engine and black clouds of smoke came pouring out.  The smell of gasoline came wafting through my house and the wail of the carbon monoxide tester convinced me it was time to relocate.   I packed up my laptop, chewed out the neighbor and went  to a local coffee shop, leaving the back door open and the fans on so that my home could air out while I  resumed work on the presentation.  The neighbor was appropriately sheepish and I am hardly missing those brain cells at all.

I love synchronicity.   I don’t think my presentation and the neighbor’s car troubles were related by cause and effect.  They are however, linked by  their meaning in my conscious mind.

One area of interest in my talk was on the subject of POPs (persistent organic pollutants) and how they accumulate in polar regions by a process called leap-frogging (also called the grasshopper effect).  This occurs with semi-volatile compounds such as dioxins and PCBs.  In warmer climates, these toxins will  be gaseous and go up into the atmosphere where winds will move them until they reach cooler climates where they condense and fall to land or sea.  These compounds stay in the environment for many years and are stored in fat cells where they become part of the food chain.   In marine environments where there are more links along the chain from plankton, shellfish, small fish, etc. the accumulation of the toxins becomes much greater than on land.

Native tribes in Alaska are requesting that a particular POP known as PBDE (polybrominated diphenyl ether) be banned statewide.  This compound is a bromine-based flame retardant that is used in electronics and furniture.  Our native villages lack the proper waste management facilities to manage these toxic compounds and so it doesn’t take trade winds for them to end up in the sea where they become incorporated into the  fish, seals and whales that are an important part of the native subsistence diet.  Scientists have linked this chemical with cancer, neurological development complications and other health problems.

“(PBDEs) have been proven to be toxic chemicals and hazardous not only to residents in homes with PBDEs but to Fire Fighters who may be called to fight fires in structures where these chemicals are present,” Jeff Tucker, chief of the North Star Volunteer Fire Department and president of the Alaska Fire Chiefs Association, wrote in a letter to lawmakers last month.

There is a bill currently before the Alaska State Legislature  (SB 27, HB 63)  which would ban PBDEs in Alaska.  A similar law has been passed in a dozen other states.  With both native populations and fire fighters supporting the ban, this should be a no-brainer.  The talk I gave earlier, my neighbor’s car, the native subsistence diet-you just don’t argue with that kind of synchronicity-you just don’t.

Like a lot of people, I have been watching the news from Japan with great interest.  And by great interest I mean bordering on obsession.  Fortunately I put my satellite TV service on hold a while ago or I know I would be flipping through the channels watching endless video clips of the devastation.  I can still devote many hours on the web and reading my local paper for the latest news.  The tsunami that I was keeping tabs on reached the Aleutian Chain with only 1-2 foot waves and no real damage reported in Alaska. 

Now with the explosions at the Fukishima Daiichi nuclear power plant and the (so far) partial meltdown of the nuclear material there, I am resisting the urge to get the television hooked up so that I can indulge in more disaster porn.  Instead I will use this opportunity to talk about what to do if the unthinkable happens.  I am not claiming any expertise on the subject but I have been looking at some useful information that I can share with you.

After the Chernobyl disaster in 1986, the biggest long term health effects-not the people who died within weeks or months of acute exposure-was a spike in thyroid cancer, especially among people exposed as children.  This was due to the radioactive iodine that was released from the accident.  Thyroid cells are especially designed to concentrate iodine and they absorb radioactive iodine as efficiently as they do iodine from food.   In the short term this can cause inflammation (thyroiditis), nodules, goiter and hypothyroidism (low thyroid function).  In the long term this could cause thyroid cancer.  Children are particularly vulnerable to radioactive iodine as they are still growing. 

Potassium iodide (chemically referred to as KI) can help to protect the thyroid gland from absorbing the radioactive iodine.  This is the same KI that is put in iodized salt.  The American Academy of Pediatrics recommends that households within 10 miles of a nuclear power plant keep KI on hand.  The American Thyroid Association recommends broadens that to within 50 miles.  In 2001 the Nuclear Regulatory Commission (NRC) required States and Tribal Authorities within 10 miles of nuclear power plants consider adding KI as a protective measure along with evacuation and shelter as part of their contigency planning.  Why they don’t  just require it escapes me but I am no politician.  The NRC has a lot of information on KI at their website:  http://www.nrc.gov/about-nrc/emerg-preparedness/about-emerg-preparedness/potassium-iodide/ki-faq.html .  They also include information on how to give this very salty substance to chidren and infants and appropriate dosages.  The ususal dose for an adult is 130 mg KI; 1/2 that for children 3-12; 1/4 that for 1 month -3 years and 1/8 that for infants under 1 month.  Some people are sensitive to iodine, especially those with an allergy to shellfish so use with caution.

On the downside, in one study done in the vicinity of the Oak Ridge National Laboratory in Tennessee, two years after KI was distributed to households in the region, only 50% of the people could remember where it was or why they were supposed to take it.  KI is only helpful for radioactive iodine exposure, not radioactive cesium, strontium or plutonium which is also present in nuclear power plants and “dirty” bombs.

Dr. Jonathan Wright has been a proponent of SSKI (saturated suspension of potassium iodide) for many years.  I wrote about him in my January 15 posting “How will the Food Safety Modernization Act effect the supplement industry?”  He was once targetted by the FDA and his clinic was raided by them in 1992.  Anyway he swears by SSKI as a treatment to put in water to avoid traveller’s diarrhea, for ovarian cysts, fibrocystic breast disease and many other uses.  He reports that long term use of SSKI, such as for fibrocystic breasts, may suppress thyroid function and so he recommends occasional thyroid screening if you will be using it more than a few days or weeks..  This is a liquid that will stain anthing it touches an orange-brown color.  Be forewarned.

Food sources of iodine (besides iodized salt) include seaweeds such as kelp, dulse, kombu, wakame, hijike and nori.  Without knowing where this vegetation was harvested, there could be other contaminants but I think it is always so much nicer to get these nutrients from food than from a pill or a concentrated liquid.  Eat more sushi!

Let us hope that the unthinkable does not happen and this is just information to put in the category of good to know.  With the unrest in the Middle East and Northern Africa and now the tragedy unfolding in Asia, I think it is a teachable moment for those who say renewable energy resources and reducing our consumption of energy is unrealistic; it is time to wake up.  For myself, I want to thank Jimmy Carter, he saw the handwriting on the wall a long time ago, we just weren’t ready to read it.

House Bill 122 is scheduled for a second hearing at House Labor and Commerce on Wednesday, March 9th at 3:15 pm.  For supporters of naturopathic medicine in Alaska, it is crucial that these legislators hear from you.

This bill is intended to modernize the law regulating the practice of naturopathic medicine in the State of Alaska.  The bill as written would establish a licensing board for naturopathic doctors, allow us to be reimbursed for treating Medicaid patients-most of whom are children, provide a scope of practice that is comparable to most other licensed ND’s in the lower 48 including writing prescriptions for non-narcotic medications and require continuing education so that these primary care providers keep current with their training.

The best way to move this bill forward is for the members of the committee to hear from you, the real stake holders in this proposal.  There are Legislative Information Offices throughout the state that you can go to in order to testify directly to the legislators.  To find the one near you, copy this link into your web browser:

http://w3.legis.state.ak.us/laa/lio/lio.php

You may want to check out the web page of the Alaska Association of Naturopathic Medicine as well.  If you click on the tab marked “legislation”, there are links there for our blog that is kept up to date by our president and my esteemed colleague, Dr. Emily Kane.  There are also helpful links to finding your own legislator and ideas about points to make either in spoken testimony or in a letter to the legislators.

http://www.akanp.org

If you can’t make it to the LIO for the hearing but would like to watch the committee in action, you can stream it live on your computer by going to:

http://www.alaskalegislature.tv

As someone who has been involved in this process since we first started in 2004, I can tell you that voices matter, whether spoken or written.  If you can send a message to Representative Munoz, our bill’s sponsor and your own representative, we can finally let people of Alaska, especially those of us in under-served communities, have access to comprehensive health care coverage by well-trained naturopathic doctors.  Thanks for speaking up