Inspiring Change With Patients/Patience

Seeds of knowledge and understanding for patients sometimes get integrated easily, and sometimes it seems impossible. I am reminded to never give up on a patient just starting out, some people take longer to make changes.
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Intense seasonal allergies bring Larry, a 45-year-old construction worker, to my office. A straight-talking, upbeat guy, he's not convinced naturopathic medicine can help him, but he'll give it a try. Over-the-counter meds are not effective for Larry's sneezing, itching eyes, sinus congestion or the headaches he endures every fall and spring. Stronger pharmaceuticals give him side effects he cannot tolerate, including sleepiness and clouded thinking.

Seasonal and other sorts of allergies bring thousands of people to naturopathic doctors' offices all over the country. A treatment protocol is individualized to each patient, and there is a fair amount the patient is asked to do besides taking pills.

It's this part of medicine, where a patient needs to make significant changes in lifestyle and diet and needs to sustain those changes, that is the most challenging part of medicine. I may come up with a beautiful and what I know to be effective plan, but if the patient cannot or does not want to follow through, it's not much use. Over the past 26 years of practice, I see more and more that my primary role with patients is to plant seeds of knowledge and understanding about health, and to inspire patients to make changes they need to make. I never know where some of the seeds planted will take root!

This makes me think of a little playhouse in my backyard. This summer, I decided to replant the small flower box nestled under the front window. When I opened the bag of potting soil to put dirt in the box, I was delighted by six, 4"-high birdhouse gourd plants, the distal leaves rounded and robust, leaning lazily against each other in the fertile black soil. I bought the seeds the previous fall on a whim, enchanted by the seed packet art of the Rubenesquely shaped fruit. The idea of sturdy homes made out of gourds with round holes for the front doors struck my fancy; surely I could grow these!

Toward the end of winter, I soaked the seeds to soften their protective cases, and gingerly planted the seeds into the depressions of a soil-filled egg carton. I perched the container on a narrow table in front of my sunny kitchen window. Nearby, tomatoes, cucumbers and sunflowers integrated nutrients, water and light and grew single-mindedly into the plants they were meant to be. But the gourds never produced. I gave those seeds 10 weeks and nothing came of them, no green shoots reaching for the light, no poking little heads with seed coat hats coming up through the soil. Disappointed, I figured the seeds were duds and tossed the rich dark clods back into the sack of potting soil. I rolled the bag up and promptly forgot about the birdhouse gourds.

But they were determined to grow, albeit in their own time and with the right environs! Transplanted into their own row in the garden now, I can report, the gourds seem ecstatic to be seeing the light of day.

With my patient Larry, I was similarly pleased with how over time, he took my advice and recommendations and integrated them into his life. We talked about balancing immune function, about the essential role of the gut in immune response and how he would need to shift his diet. By limiting dairy, increasing fermented foods, limiting refined sugars and adding animal broths, he could help decrease allergic responses. I recommended showering at night and showed him how to do a nasal rinse, both approaches help remove pollen and other allergens. We talked about the use of an air purifier in his bedroom. We touched on the idea of allergic load and how allergy testing could elucidate what else he might be sensitive to, especially foods. If he cut or reduced those, he could decrease the stress on his immune system. I recommended a number of supplements such as Vitamin C and bioflavonoids to stabilize mast cell membranes in the blood; mast cells release histamine, one of the compounds in blood that causes allergy symptoms.[1] I prescribed both fish oil and probioitics, two things I know help with his allergies.[2],[3] I also gave him a constitutional homeopathic remedy for the way he experienced his allergies -- he was predictably worse while eating, was much more irritable during allergy months and also became extremely constipated during that time.[4] The remedy, Nux vomica would help the allergies, and predictably also his mood and digestive issues.

Larry embraced the plan, motivated by the severity of his symptoms, and over time made gradual improvement. Of course with allergies like that, the season ends -- the real test is the following season, where indeed, he was much less symptomatic. Then the seeds of his learning took off. He decided to try and build healthier, more balanced immune systems for everyone and got the whole family into eating more cultured foods like miso, yogurt, kefir and pickled veggies. They removed refined sugars from the house and he eventually got food allergy tested. He removed those foods he was sensitive to and has been able to stay the course. And not only that, Larry sends me patients, those with allergies as well as other complaints. He has taken the seeds of his learning and experience and expanded their reach.

I think about planting information and advice, about how you never know where seeds will fall and how or when they will take root and grow. Seeds of knowledge and understanding for patients sometimes get integrated easily, and sometimes it seems impossible. I am reminded to never give up on a patient just starting out, some people take longer to make changes. I celebrate incremental shifts patients make. I reflect back to patients the progress I see and offer more support to those who are having trouble. I am encouraged to keep planting seeds to help patients achieve more vibrant and enduring health.

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1. Kawai M. et al. "Flavonoids and related compounds as anti-allergic substances." Allergol Int. 2007 Jun; 56(2): 113-23.

2. Hoff S, et al. "Allergic sensitisation and allergic rhinitis are associated with n-3 polyunsaturated fatty acids in the diet and in red blood cell membranes." Eur J Clin Nutr. 2005 Sep; 59 (9): 1071-80.

3. Marko Kalliomaki et al. "Guidance for Substantiating the Evidence for Beneficial Effects of Probiotics: Prevention and Management of Allergic Diseases by Probiotics." J Nutr. 2010 Mar; 140(3): 713S-21S. 4.

4. Taylor MA, et al. "Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series." BMJ, 2000 Aug 19-26:321(7259): 471-6.

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