Transcription of Summer Wellness, #97
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Lisa: This is Dr. Lisa Belisle and you’re listening to the Dr. Lisa Radio Hour and Podcast show number 97, Summer Wellness, airing for the first time on Sunday July 21st, 2013. Today’s guests include Dr. Chris Pezzullo and Dr. Sheila Pinette of the Maine Centers for Disease Control and Prevention, Deb Girard Executive Director of the Melanoma Foundation of New England, and Dr. Elizabeth Strawbridge of the Integrative Inpatient Medicine program at the Maine Medical Center.
Wellness is something that is spoken of often and it’s something that can take many forms. On the Dr. Lisa Radio Hour and Podcast, we talk about wellness from a mind, body and spirit standpoint. Today we’re getting a little bit more physical in talking about things such as Lyme disease and skin cancer prevention, but then we’ll talk about things like acupuncture and integrative medicine. There are lots of different ways to be well. We hope that through listening to our show, you’ll incorporate some of these into your own life. Thank you for listening.
Lisa: I understand the importance of public health when it comes to Maine health and the health of our families, children, and really the environment as well. I’m thrilled today to have with me Dr. Chris Pezzullo who is the Medical Director for the Division of Population Health at the Maine CDC or Center for Disease Control and Dr. Sheila Pinette who is the Director of the Maine Center for Disease Control. Thanks for coming in today.
Chris: Thanks for having us.
Sheila: Thank you for having us.
Lisa: It’s also always very fun for me to have people that I have known in my past life. I was at Maine Medical Center at the same time that both of you are at Maine Medical Center. I was doing training. Chris, you were one of the senior residents in pediatrics when I was in the Family Medicine Department and I remember you with great fondness. You kept us all sane, you were great with the kids. It’s a crazy time when you’re a resident. When you get a good senior resident it means so much. Thank you for being part of my education.
Chris: You got it thank you. Thank you for saying that.
Lisa: It’s good to reconnect with you Dr. Pinette, actually you and I interacted because again as a family medicine resident, we worked with some of the high-risk OB team and you’re part of the high-risk OB team back then.
Sheila: That’s right.
Lisa: It seems like a lifetime ago.
Sheila: It does.
Chris: Still the same lifetime though.
Sheila: It’s all about the journey and we’re moving forward.
Lisa: Tell me how it is that you went from doing largely hospital-based work. I know in your case Chris you were resident so of course it is hospital-based and then you do outpatient pediatrics, most people choose that as a career, but both of you started out in the hospital in a more acute setting especially maternal-fetal medicine very high risk OB. You’ve gone from that to outpatient, now doing public health. Each of you has a slightly different version of this journey, talk to me about that.
Sheila: Actually, I was part of the maternal-fetal medicine program. My husband Dr. Michael Pinette and I were recruited back to Maine in 1989 to help further develop perinatal outreach program as well as to develop maternal-fetal medicine program. In 1996, I went back to school at University of New England and made a decision to do an internal medicine residency which I did at Maine Medical Center and then I started my own private practice in Cape Elizabeth where I could have easy access to my children.
By then I had five kids and so I wanted to be able to try to keep everything in balance and so that’s why I stepped to outpatient medicine. I really had a big passion about helping people to live a healthy life and to combat chronic diseases by helping with helping nutrition counseling and exercise.
Chris: I had been in private practice as a pediatrician after I left residency. I’d stayed in Portland the whole time. I had worked for Mercy Primary Care and then I worked for University Health Care. What I noticed though was that as much as I love dealing one-on-one with my patients, I also have this love of trying to help a larger group of people. One of the things I noticed about pediatrics and I think probably the same for family practice and internal medicine is that you are … even though you have a single patient you’re often working with the team and the team is the family especially in pediatrics.
I noticed that you’re always trying to guide the patient to be as healthy as they can but in the case of a child you’re also trying to guide the family to help make the patient as healthy and make family union as healthy as they can be. I felt like I was always doing a little bit of public health all the time that I was doing pediatrics so when this job became available last winter I jumped to this chance to try something a little different. I had done primary care peds for almost 18 years that means I’m pretty old. I thought I really like to see if I could help the state of Maine not just my patients.
Sheila: I think that was the same for me. I was given the opportunity to work with Commissioner Mayhew with Department of Health and Human Services and Governor Paul LePage with the change of administration. It was truly a great honor and privilege to be asked to be a part of the administration. I thought this is a great opportunity for me to move forward and continue to express my passion to health care for all the people in Maine to preserve, promote and protect the health and safety of people in Maine.
Lisa: Both of you have a connection with the University of New England which is Maine’s only medical school. We have contracts with different other allopathic medical schools out of state, but this is Maine’s only medical school. That must make you feel pretty proud?
Sheila: We are very proud. UNE has been recognized as one of the leading medical schools both allopathic and osteopathic in taking care of rural health and primary care patients, geriatric patients as well as being one of the leading primary care medical schools for training. Sir Edward Coop often told people, he was the surgeon general of the United States, that UNE was one of the top medical schools and was great role model for other medical schools.
Chris: Actually his daughter will end up going to school there. I’ve been involved with UNE ever since I graduated in ’93. This is actually my 20th anniversary year, which we’re getting ready for the big party on October, but I’ve been amazed at how UNE has grown over the years. You know the story about the blue chairs but when we were there it had been stored … still in its infancy and it was in the small building called Stella Maris and there were these hard, plastic blue chairs that you sat on eight or nine hours a day and it was crazy. Now, they have this Alfond Center which is this gorgeous state-of-the-art building that the students just take classes in.
Sheila: Just so you know my class is the first class in 1996 to sit in those beautiful chairs.
Chris: Lucky.
Sheila: We feel and my husband who was a Dartmouth Medical School grad often times says your education is second to none and you have state-of-the-art educational facility.
Lisa: That’s true UNE really does have a beautiful campus. They also have I think a very forward thinking approach to health and public health. I always was impressed with I guess the more holistic take on health and wellness that osteopathic medicine was really beginning to have before even the allopathic physicians were thinking about it. Now of course largely allopathic and osteopathic have the same training except there’s still this holistic and osteopathic manipulative medicine approach that we don’t have.
Sheila: Truly it’s not holistic in terms of feeding you vitamins but it’s about teaching personal responsibility and helping people to learn that you can treat your mind, your body, and your soul together as a component. Your primary care provider can help you work through those and we can treat you with manipulation and help relieve pain without having to treat with medication which is more cost-effective and more beneficial for people’s bodies.
Chris: Anyone of the thoughts around osteopathic medicine is that the body really has lots of ways to heal itself so there’s … it’s like how do you get back in touch with your own healing mechanisms. When you learn to take a history which is like a big component of all medical schools at osteopathic medical schools the history really is about body, mind, and spirit history not just what’s the history of your symptom so it opens up … it’s such a much richer relationship with the patient I think is what develops with osteopathic medicine.
I think as Dr. Pinette mentioned that having manual medicine as a tool, you didn’t have to go and get some special training and that was a part of your training is not only where you’re doing all the things that you do in every medical school but you’re also learning manual medicine and how you could help their bodies feel themselves.
Lisa: We’ve gone from helping individuals and helping their bodies feel themselves to helping families and now you’re talking about helping communities. Helping the communities basically help themselves. You’re talking about public health and even though it’s called the Maine Centers for Disease Control really it’s not disease control so much as disease prevention and really trying to keep things healthy here in the state. Describe to me what are the standards for Disease Control in Maine and what are your roles within it?
Sheila: Actually as a Director of Maine Center for Disease Control and Prevention, the prevention part is also part of our title. We take care of a population of 1.3 million plus all those people who come to Maine in the summer time. Our population actually tripled, it’s to preserve, promote and protect the health and safety of all residents of Maine. We help to protect the air you breathe, the water you drink, protect you from disease outbreaks, educate all about hyper awareness and prevention and primary prevention and population health is where you get your biggest bang for your buck to have a healthier society.
Chris: I think especially in my division which is the Division of Population Health so that includes issues and illnesses like cancers, cardiovascular disease, asthma but it also contains the maternal child health program so children with special health needs. It’s really more about prevention very often in my division so it’s really CDCP, Centers for Disease Control and Prevention. I think it’s about how do you help patients and also their providers help those patients who default to living in a way that makes them as healthy as possible for the longest period possible.
How do you guide them what to eat? How do you guide them how to be physically active and how do you guide them to make sure that they’re using their medications appropriately or have access to the correct trainings for how to use those medications. It’s really a much broader approach than the way a primary care physician would just deal with their one patient.
Sheila: I think too we have to remember our social disparities I mean by bringing our population up and through collaboration and partnership with both the private sector as well as federal government, we’re able to not only deal with our racial and ethnic minorities but women and children who one of our most vulnerable populations.
Lisa: From having had Deb Deatrick from MaineHealth on the show before and other people in the public health field, I know that we have quite a large population of people who are served by the Maine Care System. We also know that we have quite a lot of people who are unemployed, who live in the rural state or rural parts of the state so reaching these different groups must be somewhat challenging given just the broad array of needs?
Sheila: I’m so pleased that you brought up Deb Deatrick. She truly is a pioneer in public health in the state and really is a guru. She is a huge supporter of the Maine CDC and Maine Health in all the work that they do. The way we have designed the Maine CDC is that we are infrastructure that is centralized but has decentralized office so we have eight public health offices where at each public health office we have regional epidemiologist, a public health nurse, we have a district liaison, we have a health inspector, so that these people help to serve those particular districts based on their geographic needs because truly geographic barriers exist in all different parts of our state.
Our socioeconomic base is very different up north as opposed to down south and so these people help to address those needs in a way that they need to do it for the people there.
Chris: Right now for example on taking part in some stakeholder meetings, there are meetings that are occurring right now around whether we look at or how can we improve health in the, I call it, short long term like over the next five years, how are we going to help the health of Maine and change toward the trajectory? These meetings are occurring with stakeholders around particular issues. I happen to be attending the meetings related to obesity in the state of Maine and so one of the things that I can speak to is that it’s great to have [top 00:15:45] leaders from all different regions of the state because I live in southern Maine and it’s very easy and I would say before I worked at the CDC in Augusta it was very easy to be very southern Maine Centric.
You start to assume that the access to things is similar around the state, but my eyes have been opened in the past year that there are a lot of people who don’t have access. It’s not just about financial access, it maybe transportation access, it maybe that in their country there are zero to one types of providers for that particular care and they have to travel three to four hours to go for care. I mean coming from southern Maine that seems like wow but it’s the same state. We all live in the state and the state has a lot of disparity when it comes to the size and really the rurality of the state, very, very different from even the other New England state.
Lisa: We’ll return to our program in a moment. On the Dr. Lisa Radio Hour and Podcast, we’ve long understood the important length between health and wealth. Here to speak more on the subject is Tom Shepard of Shepard Financial.
Tom: A friend of mine was at a summer cocktail party with another advisor, gathered around the fire conversation was buzzing. Given the opportunity, the advisor asked if the partiers knew their number, the one that supposed to tell you how much money you need to be happy. Needless to say, kill the conversation. You’re not a number, you’re a person. You want t to use your money to make things work to save what needs saving even if it means spending investments. You want to leverage your resources to do great things with your gifts. You’re complex and the number you’re supposed to know, it isn’t important or real. You’re what’s important.
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Lisa: It’s summer time and with the summer comes certain public health considerations we of course have the great outdoors. We have what comes with the great outdoors things like ticks and other things that we call vector-borne illnesses. Talk to me a little bit about that and what are some of the things that people need to be thinking about during the summer when it comes to their health and health of their communities.
Sheila: Dr. Lisa thanks so much for bringing that up because our role at the CDC is to certainly educate and develop hyper awareness about the risk on tick-borne illnesses such as Lyme disease, anaplasmosis and babesia. Babesia is a parasite. We had 12 reported cases last year, 52 cases of anaplasmosis. Those two often times go unrecognized but they’re carried by the same tick, Ixodes scapularis or otherwise known as the deer tick. The deer tick is found on the eastern coastal and the northern area of central United States Michigan, Wisconsin.
Maine was noted as being endemic last year where we identified the tick in every single county, 16 counties as well as identified the disease. We had 1,111 cases reported that means there’s also a lot that go unrecognized. We urge people to make sure that you do daily tick checks, make sure children especially moms are checking their heads behind their ears, around their beltline and their groin. Make sure you’re wearing long sleeves like [colored 00:20:10] clothing, long pants, tuck your pants into your socks. You can use [inaudible 00:20:15] if you’re over age of three. Make sure you read your directions.
If you’re a little more holistic, you can use oil, lemon, eucalyptus, and [peacock pair cardigan 00:20:26] is also an option and make sure that you vaccinate your pets because they can get Lyme disease. We do not have a vaccine for adults and if you’re standing up, step outside make sure your furniture is closer to the home and that you might put wood chips [gowns 00:20:38] that you can have a barrier between the woods and your lawn.
Lisa: What about things like West Nile virus is this something that we need to be thinking about?
Sheila: Absolutely. West Nile virus and eastern equine encephalitis are mosquito-borne viruses from dead birds. Last year, we had seven reported pools in Cumberland County, your county. We actually identified in October our first case of West Nile virus that caused a neuroinvasive disease. Twenty percent of people or one in five will develop symptoms so often times benign presentation with West Nile virus but it’s usually feel with a fever low grade, malaise, arthralgias, more like a flu-like symptoms but they don’t go away.
Then we know that about 10% will go on to develop neuroinvasive disease that one percent mortality. Eastern equine encephalitis we have identified in deer two years ago and last year in September, we identified in a flock of pheasants, so we know that it’s here in the state and we really want to caution people not to be out during early mornings, dawn and evening at dusk. Make sure in August and September that you’re wearing long sleeves like clothing and especially our athletes who are out in pre-season making sure you’re wearing bug sprays to help prevent against that.
For children when you have them out make sure there’s netting. Make sure you’re taking care of those tire swings and those pots that have water because that’s where mosquitoes breathe. We do not have a vaccine. Vaccines are found for horses and animals but the dose is six times so please don’t use animal vaccine for yourself. We hope that in the next six years, we will have a vaccine so right now it’s just about education awareness.
Lisa: Dr. Pezzullo in your practice I know you see a lot of children and you see children who are either in the midst of a sport season, getting ready for a sport season. In the summer, a lot of kids are doing summer sports and they’re thinking about the fall sports season so something that kids need to be thinking about and their parents when it comes to exercising in the heat, just a few tips for people who are out trying to enjoy the summer and exercise in the summer.
Chris: How about hydrate. Let’s make sure that they are doing double the amount of fluids that they would have in the winter and how about sunscreen. Although I’m very concerned that people have very low vitamin D often in Maine in the winter, we don’t really have to worry about that in the summer so what we have to worry about more is skin protection and prevention of future skin cancers. It’s very hard for young people to understand that what they knew now may affect what’s going to happen to them 30 years from now. I really encourage them to apply sunscreen just prior to being outside for long periods of time and to re-apply every two hours.
Sheila: Dr. Lisa, I guess you can see that Dr. Chris and I will be able to fill in anytime you need help. You want to go on vacation?
Lisa: Clearly Dr. Chris too. You guys are just ready to take over my role. It’s great, this makes me feel great because what it tells me is that you’re so passionate enthusiastic about public health and you want to get the message out there and you want really you’re very effective helping people to understand what it is that they need to do to keep themselves and their community healthy so you represent the state very well.
Chris: Thank you.
Sheila: Thank you.
Lisa: I do appreciate your coming in and talking with us today. We’ve been speaking with Dr. Chris Pezzullo who is the Medical Director for the Division of Population Health at the Maine Centers for Disease Control and Prevention and Dr. Sheila Pinette who is the Director of the Maine Center for Disease Control and Prevention. Thanks so much for all the work that you do and for being part of our show today.
Sheila: Thank you for giving us the time.
Chris: Thanks for having us Lisa.
Lisa: We on the Dr. Lisa Radio Hour and Podcast hope that our listeners enjoy their own work lives to the same extent we do and fully embrace every day. As a physician and small business owner, I rely on Marci Booth from Booth Maine to help me with my own business and to help me with my own life fully. Here are a few thoughts from Marci.
Marci: I’d like to think that I live a healthy lifestyle. I keep active, workout with my husband, make certain my kids eat well and exercise. I want everyone to be healthy and do all that I can to make sure that they stay that way. It makes me think about what I can do to make sure that my clients business to stay healthy too. Periodically, throughout the year, a financial checkup is in order to do an assessment and make certain there are no hidden symptoms that would cause a decline in business or financial health. No matter what business you’re in, make sure that you have your financial health checked regularly. Be proactive. So many people in your life depend on you to keep financially fit. I’m Marci Booth let’s talk about the changes you need, boothmaine.com.
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Lisa: It’s very important that we all be comfortable with the skin we’re in and it’s equally important that we are having nice healthy glowing skin which is something that Deb Girard wants us all to have. Deb Girard is the Executive Director of the Melanoma Foundation of New England and she’s been working pretty hard to help us all to have healthy skin lives.
Deb: Mostly Lisa we would like people to love the skin that they have and that is a very big issue not only in Maine but around the country right now as we are talking about the dangers of tanning and that’s tanning both outdoors and more importantly right now in tanning beds because as you all know in Maine, the issue of banning tanning beds for kids under the age of 18 has been a very charged issue. Clearly now, we have a mandate to increase the education that we do to build awareness about the dangers of tanning.
Lisa I want to talk about tanning. I also want to start with talking about melanoma because I know there’s different types of skin cancer and for people who are listening, I think it might be helpful for you to give us a little bit of background.
Deb: This year in this country about three and a half million people will have skin cancer. Some of those are not malignant skin cancers, basal cell cancers and squamous cell cancers account for the largest number of non-malignant skin cancers. While they can be extremely disfiguring and some percent of squamous cell cancers can get worse, the majority of the ones that were most worried about are about the 76,000 new cases of melanoma we will have diagnosed this year.
About one person every 50 minutes dies of malignant melanoma and so we’re spending a lot of time at the foundation trying to build awareness about the dangers that ultraviolet radiation play in the development of melanoma but also really to get people to have their skin checked because the thing about melanoma that’s different than other cancers is that when caught early, melanoma can be almost completely cured.
Lisa: In this information that you brought, you gave me a card and on the card it says, “Know your moles.” Talk to me about that.
Deb: One of the things that we know is that everybody needs to check their skin. You do other checks of your body whether you do breast self detection or other self detections so we would say, check your skin. Your skin is your largest organ and it’s very important to know about things that are new and changing on your body. One of the things that we do is to ask you to look at the things that might be new or evolving.
Those might be moles and lesions that you ask a health care professional to take a look at and that’s the warning sign. New, evolving itchy, bleeding dark and for people who have lots of moles, we use the ugly duckling rule and that just means that if you have a mole and your massive moles that looks different that’s changing that you really do need to have health professional take a look at that.
Lisa: You also provide the pneumonic that’s not exactly a pneumonic but it’s A, B, C, D and E.
Deb: Really when we use that with folks, we’re asking you to look at a mole in different ways. The A is for asymmetry. If you were able to fold the mole in half, would the sides meet, border irregularity. If you have a very jagged-edged mole that would be something more concerning than one that isn’t. Color variation is the C and really melanomas come in all different colors. We tend to think that they’re dark that there might be multiple shade variations through a mole but there are melanomas that have no pigmentation or very light. Really what we’re looking at are color variations within a mole and diameter.
If you have a mole or a lesion that’s the size of the tip of a pencil, pencil eraser, then that’s something that you should have somebody take a look at. E which is a new addition to A, B, C, D is evolution. Anything that continues to grow or change, you would have checked. Using those A, B, C, D, E rules can really help you bought something that can be checked and taken care of by your health care professional.
Lisa: Deb is there anything specific that the melanoma foundation is doing to educate teenagers and college students about tanning beds and staying safe?
Deb: That’s a great question and one that I love to answer. We have a really great program called Your Skin Is In. We’ve been doing this program for several years and many schools in Maine have taken part of it. Our goal is to educate high school kids about the dangers of tanning and particularly around prom time. Prom tanning has become as important as buying a dress and getting their shoes so we’d love to try to provide education at that time so that kids can understand that the skin they have is the most important thing that they have for the prom.
We also do this program for college students around the dangers of tanning before spring break so we provide an educational program for both teens and young adults and a really great pledge program that allows them to pledge not to tan and also to take part in a program that will let them win money for their school proms and for their spring breaks. We are really encouraging teachers and school nurses and principals to get their schools involved in this program.
Lisa: You have an interesting program called The Skinny on Skin.
Deb: We do.
Lisa: It’s a very creative way of trying to get people to pay attention to skin.
Deb: It is and I think that one of the things that we believe, I told you a little bit earlier that they’re going to be three-and-a-half million skin cancers diagnosed this year. Who’s going to diagnose all of those things? Who’s going to look all of those moles? It’s a lot to think that primary care physicians, dermatologists are going to do all of that. We need to have a paradigm shift here in that people who are looking at your skin regularly in places that you can’t see really need to be trained to do two things. One is to have the conversation about the A, B, C, D, E’s so that not only are they looking at their own skin, they’re looking at yours and that they learn to talk to their client about what they’re seeing.
Over the past year, we have been working on this pilot study to go out and train about 40 salons in the Boston area. We’ve been doing pre and post testing to see if it changes in fact that the way a stylist relates to their client. Are they talking to them more? Are they actually looking at their scalps on a regular basis? This project actually came out of the study that was published in New England journal about a year ago done by Ellen Gower through the Harvard School of Public Health and a young medical resident Betsy Bailey.
Betsy’s mother had a melanoma diagnosed in her scalp by her hairstylist in Houston. Betsy then began to really take a look at training stylist in that area. They came to us and said, “Could you help us design a program?” Over the last year, that’s what we’ve been working on developing some training for hairstylists and our goal will be to using an e-learning program where stylists would find a training program that may come through a hair product company, it may come through their salon multiple ways.
Our goal for the spring is to have three launch events. We have had our first launch event in Lewiston and we had 70 stylists for that program. They were so incredibly interesting because I would say that about third of those people clearly had already seen suspicious moles and lesions on their client’s heads, some of them reported that they were able to talk with them. Several of them reported that their client had a melanoma. We see success for this program as really being the consistency of which stylists are looking. The best time to look out yourself is when it’s wet. We can’t see our own scalp. We can’t see the back of our heads. We can’t see our necks but your stylists can.
What we’ve also seen is that stylists are very excited about the possibility of really being regarded as people who could impact prevention in this way. We are working at our next launch event which will be in Boston at the end of May and then we’ll also be in Manchester, New Hampshire in July to continue to spread the word and to build a group of constituents.
Lisa: There’s been a little bit of controversy about vitamin D and especially in the northern latitudes. I’m sure that this is something that you’ve talked about with people before. What is your take on the vitamin D, need for vitamin D and the fact that we get it mostly from the sun?
Deb: I think that there are couple issues about vitamin D. One of the fallacies is that the longer time you spend in the sun, the more vitamin D you get. When in fact your body can only manage about 15 minutes of vitamin D at a time so that when you are going to grocery store, when you’re walking to the mailbox, in the course of a day if you’re getting 15 minutes that’s really what you’re body is going to absorb so we would say going to a tanning bed is not a way to get vitamin D.
Tanning bed operators would like us to believe that. It’s just not true so if you are vitamin D deficient and we live in New England many, many, many people are vitamin D deficient, eat a fortified diet. Talk to your doctor and make sure you have vitamin … next time you go have your vitamin checked if you’re worried about it. It’s much safer to take a vitamin D supplement than it is to extend the amount of time that you have in the sun.
Lisa: How can people find out about the Melanoma Foundation of New England?
Deb: We’d love you to go to our website. It’s mfne.org and you’ll find a lot of information there both about our programs for teens and young adults, for our programs for hairstylist. You’ll be able to meet many young melanoma survivors on our webpage as they share their stories and what their journeys have been with their own battle with melanoma.
Lisa: We’re very privilege that you have taken the time to drive up from Boston. This is truly a very important topic for you Deb and also for the Melanoma Foundation of New England. We really appreciate your being in touch and agreeing to come up and talk with the people of Maine about melanoma and skin cancer in general. We do hope that people will go to your website to find out more. We’ve been speaking with Deb Girard who is the Executive Director of the Melanoma Foundation of New England. Thank you for all the work you’re doing.
Deb: You’re welcome.
Lisa: The goal of the Dr. Lisa Radio Hour is to help make connections between the health of the individual and the health of the community. The goal of Ted Carter Inspired Landscapes is to deepen our appreciation for the natural world. Here to speak with us today is Ted Carter.
Ted: When I enter a home or a business, I try to instantly understand that long term commitment to the property. If the move is going to be in the next two or three years, I would approach a landscape design situation completely differently than if they were to make a long term commitment for many, many, many years ahead. I delve deeply into the understanding of how people actually live in their house or which rooms they use, what do you see from the interior perspective or look out onto.
I also would try to understand what kind of play activities would be here, are there children in the picture, are there aging parents in the picture, what are the colors and textures and fragrances that most call to you? What are some of the plant materials that you recall from your earliest memories as a child? These are all things that personalize the space and make a space uniquely your own. I’m Ted Carter and if you’d like to contact me I can be reached at tedcarterdesign.com.
Speaker 1: We’ll return to our program after acknowledging the following generous sponsors. Dr. John Herzog of Orthopedic Specialists in Falmouth, Maine. At Orthopedic Specialists ultrasound technology is taken to the highest degree with state-of-the-art ultrasound equipment. Small areas of tendonitis, muscle and ligament tears, instability and arthritic conditions can be easily found during examination. For more information visit orthocareme.com or call (207) 781-9077.
Lisa: At the Dr. Lisa Radio Hour and Podcast, we believe we are helping to build a better world with the help of many. We’d like to bring to you people who are examples of those building a better world in the areas of wellness, health and fitness. To talk to you today about one of this fitness is Jim Greatorex, the President of Premiere Sports Health a Division of Black Bear Medical. Here is Jim.
Jim: Black Bear Medical is Maine’s premiere medical equipment provider for over 25 years. We have a great selection of seat lift chairs, power and manual mobility devices, walking aids, home accessibility solution such as stair glides and ramps and products to make your bathroom safer. If you or a loved one have needs to remain independent at home, come in and meet with our experienced staff at Black Bear Medical down on 275 Marginal Way in Portland and see why we are Maine’s number one choice for home medical equipment. I’m Jim Greatorex, President of Black Bear Medical. Come on in and see our trained staff down at 275 Marginal Way and at www.blackbearmedical.com.
Lisa: As listeners of our show know, I am a big fan of integrative medicine and in fact I’ve practiced integrative medicine myself and on acupuncture and traditional Chinese medicine on nutrition counseling, lifestyle work with my patients for many years so it is a great privilege to be able to spend time with another physician who actually trained in the same program that I did at Maine Medical Center and the Maine Medical Center Family Medicine Department who is out doing integrative medicine but in slightly different way.
Today I have with me Dr. Liz Strawbridge who offers integrative medicine and acupuncture consults right here at Maine Medical Center in Portland. Thank you for being with me today.
Liz: Thank you so much for having me in the show.
Lisa: Liz, you went further beyond the family medicine training and you actually done an integrative medicine fellowship also here at Maine Medical Center. Tell me what that was like.
Liz: It was actually a huge breath of fresh air. It felt like coming home. Throughout my entire medical training, I always felt like it was a little bit too cold and impersonal. As the mystery of health and healing was removed, I mean that’s the goal of our medical training is pure objectivity so anything that was left to the unknown was not very important. To me I found that to be the most entrusting and exciting and creative part of health and life is that necessary and so going back in studying integrative medicine which really just means incorporating all sorts of different healing modalities and cultural ways of healing into our perspective has really I think fulfilled what I was looking for when I went into medicine in the first place.
Lisa: Listeners of our show have heard our interviews with Dr. Craig Schneider who’s the director of the Integrative Medicine Program and also Dr. Steven Donnelley and how they’ve created their own integrative medicine approaches. Yours is slightly different in that yours is inpatient versus outpatient and inpatient means in the hospital. What types of things can you offer people in the hospital that you might not be able to do in the outpatient setting?
Liz: There are a few things. In the inpatient setting people are usually in the higher stage of acuity so their illnesses are … they’re suffering a little bit more strongly with their illnesses or came in for something like a heart attack for the first time so people I think are both more vulnerable and possibly open to alternative ways of healing and also I think they’re more motivated to change because they have likely undergone some strong attack to their health. They are in a place where they’re ready for new ideas, ready for dietary and lifestyle changes where they might not be ready to take that step just in the outpatient setting.
I found that working on the inpatient wards has been really rewarding especially doing some of the alternative techniques like acupuncture, hypnotherapy, guided imagery, breathing techniques. People really respond well and sometimes more powerfully than I’d felt like they responded when I was doing outpatient medicine.
The other thing that has been really wonderful being in the hospital is broadening the perspective of other practitioners whether it’s physicians, nurses. The whole culture of the hospital has been very open and welcoming but also really had been curious because a lot of them have not been exposed to integrative medicine and so I think in some respect, it’s been very educational for our health care community in general. In the outpatient setting, most people who seek out integrative medicine are already on the path to wellness in some respect so when people are surprise to see me walking around in the inpatient setting, I feel like I’m spreading the word.
Lisa: When I was resident at Maine Medical Center, they were offering osteopathic consultations with Dr. Bryan Beck and I understand there’s been another osteopathic physician who’s joined him and they were also starting to offer Reiki which is not exactly healing touch, but there is an energetic component to it. There was a little bit of an entrée for you. Was there any problem at all getting the people in the administration or within the family medicine department who embrace the type of work that you wanted to offer in the hospital?
Liz: I was really lucky because I’ve been practicing in the outpatient setting amongst other family doctors. I was able to gain their trust earlier on and I think having been a resident in the family medicine program and know a lot of the doctors at Maine Med especially Ann Skelton who was very helpful in getting me credentialed to work in the hospital. I was lucky from that perspective and I don’t know if I had been in another community or tried to do this in another community where I didn’t know a lot of the local physicians if this would have been a possibility.
I’m very lucky for that and certainly Dr. Beck has paved the way. He has been doing this for several years and started off with very few patients and now he has a list that he can barely get done by 6pm at night, so he’s really paved the way and has gotten the attention of a lot of doctors that there are other ways of treating pain and many common problems that we often reach our pharmaceuticals.
Lisa: Looking at the curriculum of the integrative medicine program at the University of Arizona which is the program that Maine Medical Center is affiliated with, it is very evidence-based. Some people have had concerns about things that are “unproven” but the reality is more and more of this is proven. We’re taking what has been known in some way anecdotally for a long time and now getting the research to back it up.
Liz: Yeah exactly and some things that aren’t proven, there’s a very low risk profile so Dr. Wyle in the University of Arizona, they’re prospecting and I agree with it is if there’s the potential for great benefit and there’s a very low or minimal or zero risk but there isn’t a randomized control study about it, then because of the low risk then I would say it’s worth a trial for the patient and that there’s a possibility that it might be helpful, but certainly I try to fit into the mold of evidence-based integrative medicine.
When I see patients in the inpatient setting, in my notes I usually document references of studies that have been done or just stay there, aren’t any studies on this but there are very little chances harm being done so that patients and other physicians who read my notes are aware of the data that’s out there.
I think I believe wholeheartedly in evidence-based medicine but it does has some shortcomings because nobody is out there really funding the studies that need to be done so it’s hard to try to bridge the two worlds, but I do see that a little bit as my role given the western medicine training. I think we have to keep within the realm of comfort of western medicine trained physicians in order to have them gain our trust that perhaps there are other modalities out there that could be helpful.
Lisa: What types of problems do you find that you’re most effective with in the inpatient setting?
Liz: It’s interesting I have the… things seem to come in waves. I remember this happened even as a medical student or resident that all of a sudden we get a ton of patients with pneumonia or stroke and you just see things in clusters. Currently, I’ve been doing a lot of work with pediatric oncology patients. There’s so much that can be done in the alternative world for them including a lot of mind-body therapies. I do accupressure with tuning forks so for kids who are needle-averse or anybody who doesn’t want needles or acupuncture, I use acupressure points and use sound healing with tuning forks on the points and that’s actually very relaxing.
I do a lot of diet and nutrition counseling as well as exercise and mind-body works such as yoga. What I try to do is create a whole treatment plan for patients so that when they leave the hospital, they have a document that goes through all these different modalities and give them an outline of a diet or plan for an exercise program as well as if I recommend yoga or tai-chi, I’ll give them a contact information websites that I would recommend for them to see or if it’s self-hypnosis or guided imagery I will again connect them with resources so that they can continue the strategies that we begin in the hospital and continue them as a whole lifestyle change when they leave.
Really as I’m saying I’d see a gamut of things and for awhile I was seeing a lot of cystic fibrosis patients, irritable bowel, inflammatory bowel, migraines, insomnia, fibromyalgia, post operative pain, nausea and vomiting associated with chemo so it run pretty much any diagnoses that’s amenable to integrative techniques but those are the ones that I’ve seen the most. I think the other practitioners in the hospital really think of when they think of me it’s often in the context of how to control their patient’s pain so that’s probably being the number one reason for consultation.
Lisa: You’re about a year into this I think?
Liz: About seven months.
Lisa: Seven months into it?
Liz: Yeah.
Lisa: It’s always hard the first year, some would say even harder the first five years. What are some of the lessons that you learned from doing this very different thing that most doctors wouldn’t even think that they have the training to do?
Liz: One thing that has been so important is just facing a lot of my fears. I think it’s really hard to be the fish swimming in the wrong direction in the hospital, so I’ve spent a lot of time really trying to back up what I preach. Like I said I always reference studies and I’m really trying to fit into the world of the physicians and that’s been a little bit challenging for me and I’ve had to gather a little bit of courage when I recommend an herb and I feel like I have to explain it and also ensure that it won’t interact with any other medicines and show the data and really trying hold up my torch so that it withstand the questions and skepticism of some other physicians.
The second thing I think that’s been really important is they could tell you make it and we did … and part of the integrative medicine training we did something called laughing yoga where you just start laughing and you’re faking laughing and then before you know it you’re hysterically laughing for real. Some of the things I had studied a lot of the guided imagery and hypnosis but when you’re starting no matter what you’re starting, you want to come across as an expert. Now, I’ve been doing this for several years and I feel like I am very comfortable but in the beginning I have to pretend a little bit. I have to pretend a little bit and I think I’m now hysterically laughing for real but it was hard in the beginning to really feel like an expert.
I think every doctor goes through that in any shape anyway. You sort of have the impostor syndrome. The people expect you, they call you doctor all of a sudden you’re a medical student one day a doctor the next and what happened except when I sleep. I think that’s a common theme in medical practice in general, but certainly it felt little bit more powerful now that I’m doing something very different in a very mainstream world.
Lisa: I encourage people to go to your website healmaine.com and find out more about the integrative medicine and acupuncture consults that you’re offering at Maine Medical Center. We’ve been speaking with Dr. Elizabeth Strawbridge. Thank you for coming in and thank you for the work you’re doing.
Liz: Thank you so much.
Lisa: You’ve been listening to the Dr. Lisa Radio Hour and Podcast show number 97 Summer Wellness airing for the first time on Sunday July 21st, 2013. Our guests today have included Dr. Chris Pezzullo and Dr. Sheila Pinette, Deb Girard, and Dr. Elizabeth Strawbridge.
For more information on our guests visit doctorlisa.org. Also be aware that the interviews that you hear are shortened versions of our entire conversation. If you want to hear the entire conversations so again we encourage you to go to doctorlisa.org and listen in. The Dr. Lisa Radio Hour and Podcast is downloadable for free on iTunes. For preview of each week’s show, sign up for our e-newsletter and like our Dr. Lisa Facebook page. You can also follow me on Twitter and Pinterest doctorlisa and you may check on health and well-being on the bountiful blog, bountiful-blog.com.
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Speaker 1: The Dr. Lisa Radio Hour and Podcast is made possible with the support of the following generous sponsors. Maine magazine, Marci Booth of Booth Maine, Apothecary by Design, Premier Sports Health a Division Of Black Bear Medical, Dr. John Herzog of Orthopedics Specialists, Mike LePage and Beth Franklin of Remax Heritage, Ted Carter Inspired Landscapes and Tom Shephard of Shephard Financial.
The Dr. Lisa Radio Hour and Podcast is recorded at the studios of Maine Magazine at 75 Market Street in Portland, Maine. Our executive producers are Kevin Thomas and Dr. Lisa Belisle. Audio production and original music by John C. McCain. Our assistant producer is Leanne Ouimet. Become a subscriber of Dr. Lisa Belisle on iTunes. See the Dr. Lisa website or Facebook page for details. Summaries of all our past shows can be found at doctorlisa.org.