Transcription of Carrie Levine for the show Body Balance #278
Lisa Belisle: In the studio with me today I have Carrie Levine who is the founder of Whole Woman Health, a holistic health care practice in New Castle that serves women in the midcoast. Carrie is also a certified nurse midwife, and you and I have known each other for quite a while so thanks for coming in today.
Carrie Levine: I think back to the days on Maine Med.
Lisa Belisle: Yes.
Carrie Levine: Walking around.
Lisa Belisle: Yes, waiting for those babies to be born.
Carrie Levine: Waiting for the babies to be born.
Lisa Belisle: Yeah, it’s strange to think because I believe it was probably 20 years ago, plus, at this point.
Carrie Levine: Yeah, for sure, because I’ve been practicing for 17. That actually sounds about right if I was in school for three years, and I was doing some nursing at Maine Med. That was my crash course in high risk obstetrics. Here’s everything you need to know about high risk obstetrics. Bam.
Lisa Belisle: Maine Med was really good for that.
Carrie Levine: It was awesome for that, and the nurses were fantastic.
Lisa Belisle: I absolutely agree. I think they still are. I haven’t had any babies in quite a while myself, but from what I understand from other people, I think that they do a great job over there.
Carrie Levine: Yeah. I haven’t been up there in a long time. It amazes me to hear Hector’s name, that he’s still up there and around.
Lisa Belisle: Yes. Dr. Hector Tarazza, we actually had him as a Maine Live speaker, I think, this past September.
Carrie Levine: That’s awesome.
Lisa Belisle: He’s still out in the world, still doing good stuff.
Carrie Levine: That’s what I hear. I’ll never forget walking into his office and making my plea, “You have to have the residence labor sit an entire labor. They don’t understand what’s going on when they walk in for just five minutes. You have to have them sit through at least one entire labor so they get the whole picture.” He listened well.
Lisa Belisle: Did that change?
Carrie Levine: I don’t know. I don’t know if it did. I didn’t stay too long after that once I started school. I don’t know where that is.
Lisa Belisle: Why did you first become interested in midwifery?
Carrie Levine: I knew I wanted to work in women’s health. I knew that for a super long time. When I started as an undergrad at Orono, I was a peer counselor at the women’s center there. The woman who ran that program at the time in ’88 is Ruth Lockhart. Do you know Ruth?
Lisa Belisle: Yes I do.
Carrie Levine: Yeah. She started Mabel Wadsworth Women’s Health Center. I loved doing the peer counselor work. I loved the learning, that was all super fantastic. I ended up transferring schools a couple of times, but when I finished my undergrad, I went back to Ruth, and I said, “You know, I’m thinking about health care. I’m not sure if I want to be a yoga teacher or a naturopath or a physician,” or what I want to do, and she very practically in her Ruth way said, “Well, how long do you want to go to school for and how much debt do you want to have?” We talked that through, and I always felt like I wanted to be a part of the health care system as opposed to existing outside of it as a yoga teacher or a naturopath. I felt like the most change could happen from within the system. We sort of landed on women’s health nurse practitioner, and when I went back to school after I did my undergrad and had to take science classes that I had avoided through my entire undergraduate and then was applying to programs, I ended up at Case Western Reserve with a group of women who were all going to be midwives.
I had done a lot of work in outdoor education, actually, with Outward Bound and leading women’s outdoor experiences, rock-climbing and mountaineering and stuff, and got talked into doing a doula training course, so to be a trained labor assistant and went into the birthing room, and it was a total transference of skills for me. It was just women doing physically challenging things, and I was like, “Oh, well, I know how to do this. I can do this. This is easy, and this is really fun.” I decided to be a midwife.
I think the other piece of it that was super appealing was that it’s multidisciplinary in its roots. It draws from midwifery, it draws from nursing, it draws from medicine, public health, social work, and all of those disciplines, and that sort of knowledge base is so rich and I feel like creates such rich practitioners who can relate to a variety of people in a variety of different scenarios.
Lisa Belisle: As I was listening to you talk, I was thinking about your decision tree as far as yoga, naturopathic medicine, midwifery. Back 17 years ago, that kind of tree didn’t exist. When I was in training, because this is when you and I knew each other, I was a family practice resident, there weren’t, like, all the people doing yoga teacher training.
Carrie Levine: No. It was totally new.
Lisa Belisle: Naturopathic medicine is only in our state a couple decades, maybe fifteen years old. How was it that you were able to kind of sit outside of the mainstream and yet know that you wanted to be in the mainstream?
Carrie Levine: Yeah, that’s such a funny question. You’re very good at the questions you ask. I sort of like to tell the story that I’ve been weird since a really, really, really young age. I can remember being 11 years old and having horrible insomnia and reading The Relaxation Response by Herbert Benson. I took a class in high school at Brookline High outside of Boston for gym credit because I hated gym called Body Mind Science, and the teacher, Marilyn Howell, introduced us to all of these alternative modalities. She brought in Feldenkrais healers and she brought in crystal healers and she brought in actors and actresses and dancers and yoga and all of this stuff, and she had these mandatory Sunday evening sessions at her house where she would teach yoga and meditation, and I loved it. I totally, totally loved it and just sort of grabbed on to particularly yoga from when I was a teenager. I had that exposure, and I guess I just knew enough that… It just always felt to me like it would be super easy to exist outside the system and do my thing, but that that wouldn’t change mainstream thoughts about health and healing, and that was what I felt like really and continue to feel like really needs to happen.
Lisa Belisle: From a timing standpoint, you’re a little off shift, because although we’ve had good women’s health practitioners for a long, long time, I think about kind of this peak in the 70’s with our bodies and our selves, and now it’s kind of coming back again. Now women’s health has really had this resurgence, but you were kind of in between those two generations. You still felt strongly enough that you kind of just moved forward on this path.
Carrie Levine: I guess I did. I think when I was at U Maine Orono I was an undergrad working with Ruth Lockhart. They used to put on conferences called Health In Our Hands, and they were women’s health conferences really mostly about empowering women, hence the title. The keynote speakers that year were Deb Soule, founder of Avena Botanicals, and Dr. Chris Northrup. They spoke together on the stage, and I can get teary just remembering that moment. That was like my a-ha moment. I was like, “It’s not an either or scenario.” It’s not one’s good and one’s bad. I never ever felt that way. I always felt like it was a continuum, and it really depended on the woman, her situation, and her intuition as to what the right answers are.
That’s how I practice today because I think the proclivity for people to sort of shun medicine, particularly in the “alternative community,” is rampant and I don’t agree with that either. I see plenty of women now who come into the office and they say, “I’m depressed. I don’t want antidepressants,” and other women will walk in and say, “I’m depressed. I want antidepressants.” To me, and this feels so much like the midwife in me, when I used to talk about pain management, but there’s this huge continuum from doing nothing to an epidural. There’s all this other stuff in between that’s available to us. I feel the same way when someone comes in now with depression. There’s an entire continuum of options available to you. How do you want to do it? What works for you? What’s realistic for you, for your time, your money, your energy, your life, because it’s different for each of us. Some of us don’t have the resources to go to acupuncture and meditate and yada yada yada, and some people feel super desperate and want a quick fix, and other people want to really work on their lifestyle stuff, and there is no judgment in where anybody is at, it’s only in trying to help support them with whatever is going on.
Lisa Belisle: It is true that integrative medicine, when it was called… I think it was initially called complementary medicine.
Carrie Levine: Yeah. It’s still called that. I just saw something come through on that.
Lisa Belisle: Or alternative medicine, actually that was, I think it was alternative and then complementary and then now we’re finally to integrative. That’s weird. It’s like there has to be an either/or. You have to choose this or the other. I feel so much more comfortable with the both/and approach. It’s because we have so many different types of people in the world and their learning styles and their health styles and how much they want to work at stuff.
Carrie Levine: Totally, and what’s actually going to work for someone. What works for one isn’t necessarily going to work for all. I see a fair number of those people who have tried the whatever, and it didn’t work. It’s not working. I saw a woman this week on three blood pressure medications, and I took her blood pressure and it was still evaluated. I’m like, “Okay. Why take the medication if it’s not working?” We need to find a different way. We can’t just keep giving you a snowball of medications and hope that it’s ultimately going to work. Like, in the meantime, what are you eating, what are you drinking, how are you managing your stress, how are you sleeping, all of those things because maybe if those pieces are in order, the medication isn’t needed or one will actually kick in and take effect. Yeah, no, not an either/or scenario.
Lisa Belisle: I love that you brought up the idea of blood pressure because what often happens with women’s health is that we are thought of as ovaries and the parts below the ovaries.
Carrie Levine: Yeah.
Lisa Belisle: Which I don’t mind saying the word vagina, it doesn’t bother me at all, so people, if you’re sensitive, I’m sorry, that’s just what it’s called. I don’t think that most women want to be thought of as breasts, ovaries and vaginas and uteri. None of us, we don’t, any of us, want to be reduced to that, and you’re bringing up this solid point. Like, okay, here’s a woman on three different blood pressure medications. She’s got a heart issue. I think it’s great now that we’re actually treating women like full people and men like full people.
Carrie Levine: Yeah. What a concept.
Lisa Belisle: Yeah.
Carrie Levine: That’s where functional medicine really changed my practice for sure because I wasn’t well versed in a fair amount of that. I mean, midwives, nurse midwives in the state of Maine can be primary care practitioners from an insurance and reimbursement perspective, but… man, when I think about this stuff that nobody ever taught me when I was in school that our primary care-ish… Yyu know, thyroid is the classic example. I mean, the number of women who come in Hashimoto’s thyroiditis or a thyroid issue or they think it’s a thyroid issue, they want it to be a thyroid issue. I never got trained in that, and that was really what drove me to work toward functional medicine certification was I was like, “I need a little bit more information.”
Dan Spratt, who’s the chief of reproductive endocrinology at Maine Med is a gracious consultant and teacher, but I was still uncomfortable. When people come in and they say, “Well, can you be my primary care?” The answer is no, I cannot, because essentially, other than Maine Care, I am an OB/GYN, a specialist, but my scope of practice is so broad because I’m not just looking at breasts and pelvic. I can’t, I can’t, you can’t tease that stuff out. You can’t tease out a hormone issue as being solely hormonally driven from thyroid or adrenal in the same way you can’t tease it out from stress management and nutrition. It’s all connected. That’s the beauty of what I do, but it really makes my scope of practice quite broad.
Lisa Belisle: For people who don’t have a familiarity with functional medicine, give us a little background.
Carrie Levine: I always think of my husband who’s like, “Nobody knows what you mean when you say that.” Functional medicine is a systems biology approach. What that means is that instead of looking at each system in isolation, you look at the interconnectedness of the systems. You basically look at what seem to be maybe an unrelated constellation of systems, and you’re sort of drilling down through the biochemistry to try and understand where the root of it is stemming from. That is profound.
What I’ve actually heard is that medical schools are beginning to change in that regard. I’ve heard, and I don’t know this for sure, but I’ve heard that Harvard is moving towards a system biology approach. It just makes sense. I feel like when I explain it to women, you know that, so okay, your ovaries are your primary sex hormone production site, but you also get some secondary production from your adrenals, so if you have a lot of stress where there’s a lot of cortisol upset, that’s the primary job of the adrenals, then it stands to reason that your sex hormone production’s going to be compromised, and the thyroid, ovaries, and adrenals are all on the same hormone loop. You can’t separate that stuff out. If you intervene at any level of the system you’ll see symptoms related to the other systems alleviated. In that way, you can really shift a lot. There’s that.
The other thing about functional medicine is that the primary intervention is lifestyle for sure. That’s the other piece that I love. I spend a lot of time talking to people about food and healthy living, and that’s the best. It’s time intensive care, which midwives, that’s the hallmark of what we do is spend time with people, and it’s really trying to help them fine tune their lifestyle so that they have the health and the longevity that they want. I think about a woman I saw recently with a blood pressure issue who was drinking… I don’t remember, on a daily basis. We had a conversation about that, and of course her doctor wants her to take medication, and she wasn’t exercising, so I said, “All right, let’s try this, if you’re up for it,” because some women are like, “I’m not doing that. That’s my line. I’m not cutting out the whatever, the coffee, the alcohol, the sweet every day, whatever it is, and that’s fine.” I’m like, we all live a very short life, and there has to be pleasure. If that’s your line, that’s your line. You get to decide where your line is. It’s not about being perfect.
So I proposed to her, I said, “What if you stop drinking for 30 days, and let’s see what happens to your sleep,” which was altered, “And your blood pressure and let’s try and get you moving a little bit aerobically,” like, beyond her normal exercise, and, “Get a blood pressure cup and take your blood pressure in the mornings and bring them in and let me take a look.” I just saw her recently, and she did it. I saw her 30 days, she did it. I said, “Have you noticed anything else?” She said, “I sleep so much better, and I feel so much better.” She said, “Well, I cheated three or four times,” and I’m like, it’s not cheating. I said it’s about the exception as opposed to the norm. In a body that’s balanced, small deviations like that, you can still feel well.
In a body that’s not balanced with that amount of consumption, you might not feel well every day. Her blood pressure isn’t exactly where she wanted it to be, where we want it to be, so we layered in some supplementation so that’s sort of like the next rung on the functional medicine ladder for another 30 days, and we’ll see what happens at the end of 30 days, and if we can’t get it down, then that’s the indication for medication in my book. If it’s not coming down with lifestyle, nutrition, supplementation, then, okay, you did your part, and whatever is driving it is driving it. It’s not a horrible application for medication if you want to do it that way. She was game for another 30 days.
Lisa Belisle: I completely subscribe to your way of practicing. I think it’s great, and it also is really nice in that it doesn’t feel as judgmental. In fact, it doesn’t feel judgmental at all, which is really the way that I think we need to be approaching medicine. I think we need to be able to say to people, “Here’s a fact. Alcohol can cause insomnia, it can impact your blood pressure, it can make you feel not so good. It’s not judging you for drinking alcohol. Here’s the fact, what do you want to do with it?”
Carrie Levine: Totally. There’s no judgment. The strive for the perfection is like, that’s a whole other illness, and I know you know what I mean. It’s just those people who feel like they can’t live because they’re so trying to do it so right, and we all know you can do it right and you can still end up with the short end of the stick in terms of your own health. I think about that in terms of labor. Right? You can take the Buddha incarnate, right? The marathon runner, the yogic breather, the yada yada yada, and still, she ends up with a really, really, really rough labor. You can live really, really, really, really well, and you can still end up with a major health issue. This idea of being so constrained and confined of trying to do it right that you’re sort of afraid to live is problematic on the other end of the continuum in my opinion.
Lisa Belisle: Yeah. I completely agree, and I sometimes wonder if the stress of that actually causes problems with your health, whatever those may be.
Carrie Levine: Totally. I totally, totally… I see that all the time. I do a fair amount of food sensitivity testing, which requires food elimination, and food is a sensitive issue for women. If there’s a hot spot for women, I would say that’s it. Food and the correlate weight issue is huge. I can be working with someone around food elimination, and if she just is consumed with it, beyond being able to function, then sometimes I say, “Forget it. Forget it, this is not helpful to you.” It’s like the Internet, right? It’s just like, it’s great if you can go and get a little bit of information, it’s disabling if you’re completely sucked in by it. The same thing with the food elimination. It’s a tool that helps many, not all, and if it’s helpful, awesome, and if it becomes this source of profound stress, forget it. There has to be another way because there’s nothing that will make us sicker than stress. Nothing. Nothing at all, including trying to get well. That’s my line right there.
Lisa Belisle: There is also genetics. Even if you are keeping yourself completely well and are doing everything and you don’t feel stressed about it, but you just feel like you have a pretty good lifestyle, sometimes there’s not only genetics, there’s stuff that might be going on in the environment around you, and there are things, we are raised in this interesting time where we have been given more control and we have more information, so we think that we might have ultimate control. We don’t have control. There’s just not as much control as we think that there is. All we can really do is control what we can and then deal with whatever is left.
Carrie Levine: Have you read the book The Gene? By Siddhartha … I can’t remember his last name. He’s the same guy who wrote The Emperor… The Emperor of Last Maladies?
Lisa Belisle: Oh, it’s Lumpare, I think.
Carrie Levine: I think that’s right, yes. Whatever his name is.
Lisa Belisle: Yes, yes.
Carrie Levine: It’s so fascinating. It’s essentially the history of the gene all the way back to Mendel, Mendelian times. The hilarity of what was considered to be scientific truth through the course of history really elucidates how much we really don’t know, that we like to think we know. History has proven what we thought we knew, we really didn’t know. There is so much in that of what we think we know to be truth now. The gene thing is fascinating. The emerging of genomics to me is completely changing my practice for sure and changing health for women. I’ve taken care of a handful of women now with lifetime histories of hormone imbalances. Maybe horrible PMS and then fibroids and then endometriosis and then maybe difficulties getting pregnant or difficulties with pregnancy or difficult postpartum and then post, like, perimenopausal bleeding, abnormalities, like this whole, this pattern that is really recognizable that people haven’t necessarily made sense of and now we can look at some of the genes that regulate the hormone detoxification process and say, “This is why. This is why despite eating mostly vegetarian and being a super active woman and taking the supplements and not eating too much refined processed food, this maybe is a part of the reason why your hormones still didn’t balance. Look, here are things that we can do to support that genetic variation so that you get optimal function through detoxification.”
It’s so vindicating for women who’ve done everything, everything. Those women that we allude to did acupuncture, did the energy healing, did the whole gamut of things, had the ablations and the surgeries all across the continuum and still ended up with a pretty significant undesirable health outcome. Did she weep when she understood that her genes played a significant part, had to have played a significant part because it wasn’t anything that she did. Maybe that’s sort of the value and the freedom for women is we’re so hard on ourselves so often and we try to do the right thing and take good care of ourselves, and when it doesn’t work out, we can be really hard on ourselves, and we forget the wild card, the genes and all of the other pieces we can’t control in the environment and whatnot. Yeah. It’s huge.
There’s a researcher actually in Tallahassee where I guess they have the highest infant mortality rate in the country. They’re super committed to keeping family practice doctors growing strong. I guess not a lot of people are choosing that specialty because it’s not financially lucrative, so family practitioners, I guess, are a dying breed. Thank you for being a family practitioner.
Lisa Belisle: I will definitely attest to the fact that although my employer is very generous, I definitely am fairly low on the totem pole as far as the salary spectrum.
Carrie Levine: Right, and when you live in a rural place like most of the country does, it’s hard to get health care to these places. This woman whose name is Ruth, I can’t remember her last name, she’s one of the founding mothers of Functional Medicine, she’s a geneticist. She worked with a woman who has a PhD in mindfulness, I think. They’re piloting a 10 month prenatal program called Grow Me with a focus being on the prenatal aspect and positively affecting the epigenetics of the baby. Beginning to look at how can we as women set up our children genetically for a healthy life. It’ll be interesting to see as that research is forthcoming how that…. Does it work?
Lisa Belisle: Carrie, you see patients in your home office which is right up the coast in…
Carrie Levine: Newcastle.
Lisa Belisle: Newcastle. You also lease space from Coastal Pharmacy & Wellness here in Portland, so you do consults down here. You also do a fair amount of public speaking and outreach. We are going to put a link to your website on our show notes page.
Carrie Levine: Great.
Lisa Belisle: I really encourage anyone who’s been… I’ve been trying to send patients your direction because I know that you have a lot to offer the people that I see. I really encourage anyone who’s listening who has had questions about her health that really haven’t been answered sufficiently to consider having a conversation with you because, I think, that you’re offering information that really integrates a lot of really important ideas that not everybody has access to.
Carrie Levine: Thank you. Yeah, hoping to increase access so that women know that there is another way.
Lisa Belisle: I appreciate the work that you’re doing. I’ve been speaking with my friend Carrie Levine who is the founder of Whole Woman Health, a holistic health care practice in Newcastle that serves women in the midcoast. Carrie is also a certified nurse midwife. Thanks for coming in today.
Carrie Levine: Thanks for having me.