Evidence-Based Crunchy

“There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.”

― Hippocrates

This post has taken me a while to write, mostly because it’s incredibly near and dear to my heart, but also because I think it’s a subject that people potentially have strong ideas and opinions about, because I know I do. If you’re just reading for the first time, or haven’t read the ‘about me’ session, I’ll let you know I’m a physician. A western medicine physician. I went to a Canadian medical school and trained in both Obstetrics and Gynecology and Family Medicine in Canadian residency training programs. What does that mean? It means I spent ten years learning the ins and outs of the human body; about anatomy and physiology,; pathophysiology and pharmacology; about health, wellness and disease; about epidemiology and evidence based medicine.  I learned this in both the classroom and at the bedside and I firmly believe that practicing evidence based medicine provides our patients with the best possible care.   At the same time I consider myself crunchy; I am both politically and socially liberal, health conscious, spiritual and environmentally aware and I don’t believe these things have to be mutually exclusive

As a physician of western medicine who firmly believes in evidence-based practice but also dabbles in essential oils, eats a predominantly whole foods, plant based diet and loves a good tincture and potion, I often find myself frustrated. Frustrated at the division between what people perceive as western medicine and all other forms of complementary medicine out there. Because I don’t believe there has to be a division. I believe many forms of alternative medicine and allied health professions, whether that be Chinese medicine, naturopathic medicine, registered massage therapy, physiotherapy etc., are just that COMPLEMENTARY and can be integrated into the overall management and support of an individuals health and wellness.

And so, I consider myself evidence based crunchy (a term I wish I could say I coined, but I heard it from a fellow colleague and thought, hey that’s how I practice medicine!). So what does this mean? It means that if the evidence shows that there is a non-pharmacological treatment or remedy for something a patient is presenting with, I’m game to try it, and to be honest, often times recommend them. Kiddo has a cough? Try some honey. [Just not under the age of 1 for the theoretical risk of botulism in unpasteurized honey].  Struggling with mild to moderate depression? The first thing I suggest are lifestyle changes including exercise, meditation, mindfulness practice and yoga.  But want to try some herbal supplements or natural health products? Go for it. There is some evidence for St. John’s Wort, Omega 3’s and SAM-e’s.  Want to try to bring your cholesterol down with diet changes? Damn straight! But you got a kid with fever? I will advise against using your essential oils to bring the fever down and suggest you go with something we know works like good old fashioned acetaminophen  A pregnant woman with a UTI? You need more than cranberry juice, my friend.  If some evidence in a peer-reviewed scientific journal comes out saying differently I’ll pay attention and adjust my practice, but until then I use what I know is safe and effective and is based on the evidence.

So why am I sharing this with you? I guess it’s because I want people to realize that a lot of us in medicine see the grey between the black and white; we see the desire that many patients have to pursue what they believe to be more natural remedies; we understand your desire to take control in your health and actually DO want to support you in that. But we want to do it in a safe, evidence based manner. I think what is often misunderstood is that natural doesn’t necessarily mean safe. Plants are powerful. Many of our most potent drugs in medicine come from plants. Digoxin, a cardiac medication that needs to be monitored very closely for it’s narrow therapeutic window, comes from Foxglove.

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Many chemotherapeutic agents used to treat cancer come from plants. Tamoxifen, a drug that dramatically improved the treatment of breast cancer,  is derived from the bark of the pacific Yew tree.

I can’t speak for other physicians, though I suspect that many feel the same way that I do; we DO want you to be engaged, to take control of your health, to get engaged, to educate yourself, to make diet and lifestyle changes, but we want you to do it safely. By all means, go see a naturopath, use essential oils but please talk to us about it. We’re here to listen and support you on this journey because some of are quite crunchy ourselves.

xo

 

Finding Patients

pa·tience ˈpāSHəns/ noun
– the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.

If you read my ‘About Me’ you’ll know that this blog is about many things: being a mother/parent, a physician, and an *aspiring* endurance athlete (I say aspiring as I have only ran any signifiant ultra distances once…but I’ll get into that another time) but that they all share one thing in common and that is patience.

I can honestly say, I never knew how patient I was, or would learn to be, until I became a mother. Those of you who know me well know that I’m a doer. Before having kids I was constantly on the go. Being home doing nothing wasn’t something I did. People would watch movies or binge on Netflix during the day? That was crazy talk to me (though now sounds like a dream day….). I was out studying, running, hiking, working, involved with committees, socializing – you name it. Now with three young children my days are the opposite, mostly spent at home keeping the peace and trying to run our home. Getting out with just the baby, or alone, for that matter, is a feat for me these days.

Being a parent, patience is probably one of the most important traits you need to have, or learn. Holding your newborn as they cry for no reason for sometimes hours on end; dealing with the constant negotiation of toddlers as you try to get through a day without tantrums, getting out the door on time, getting healthy food into their mouths, getting into the bath, getting out of the bath, negotiating bedtime etc. And I can’t even imagine what the tween and teen years will bring!  The amount of negotiating, explaining and waiting that goes on in a day as a parent is unbelievable. I think of myself as patient person, but I have to say that at times I do lose my patience and I am constantly working on this. It’s SO hard as a parent to maintain composure when you’re at the end of your rope, you’ve been negotiating all day long with your brood and you just want them to go to sleep so you can have that coveted hour of two of uninterrupted adult time before you go to sleep to recharge and do it all again the next day. I’m currently reading a book called ‘Permission to Parent’ by Robin Berman who talks a lot about this and how hard it is as a parent to remove emotion from the equation. And this is something I think I do well most of the time, but that I also need to work on daily.

I also need to be more patient with my husband, who is incredibly patient with me (most of the time :). My mind works at a mile a minute and I’m constantly doing five tasks at once. I’m very organized in my own disorganized way. In my efforts to keep our family of five organized, I have piles around our house. Piles of children’s toys I want to take back up to their room, piles of toys to donate, piles of laundry to be folded, piles of clothes to donate, piles of paperwork to be filed, piles of magazines to sort through…you get the picture. And my husband, whose German heritage tends towards tidiness and order, is not into piles. His home has basically become over run with toys, baby paraphernalia and piles and piles and piles. His closet is his only sacred space left in the house.  So when I see his socks on the counter or his bike left out in our mudroom, instead of asking (dare I say nagging) him to move it, I have to take a breath and remember this is his home too. I may be the one at home these days and organizing our lives, but I need to be patient and remember it’s a shared space and he puts up with my piles so I need to relax a bit. I’m not perfect, so why should I expect him to be?

Being a family physician also requires an immense amount of patience. Gone are the days where a physician was put on a pedestal (which isn’t a bad thing) and we now are taught to practice ‘patient centred’ care where we put the patients needs, interests and wishes at the centre of our treatment. I think this model works most of the time and is a positive change in the practice of medicine. The problem comes when you are dealing with patients who doubt that you have their best interests at heart; when they don’t want to vaccinate their children because they believe the ‘research’ they have done on the internet reading testimonials and totally false information; when you disagree that the vitamins and supplements their naturopath has prescribed are indicated; when you disagree that cannabis oil is going to cure their cancer. You need an inordinate amount of patient to listen to their side, understand where they are coming from and to try to explain that you DO in fact have their best interests at heart and your goal is to optimize their health.

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And being a mother and physician while still trying/aspiring to be an endurance athlete requires a well of patience. Patience mostly with myself. I have had three children in four years. My body has changed incredibly, and I have to be kind and patient as I slowly work to get back to the level of fitness I once had. I have zero abdominal tone. I have bad PFP (patello-femoral pain syndrome) after my hips expanded to carry and deliver these beautiful babies. I am still carrying extra weight (how could I not be?! I gave birth to my third beautiful boy only three months ago!). But I have to remind myself of this almost daily, when I can barely do five push ups in a row (on my knees!), when I am out of breath after running just a few km, when I still can’t squeeze into half of my wardrobe, that I need to be patient and kind. It took 10 months for my body to change and to gain the weight, so I need to expect it will take the same amount of time to shed the weight and get my fitness back.

So that’s why I decided to name my blog finding patients. I wanted to be a bit clever 🙂 And because on a daily basis,  I am trying to remind myself to be patient; patient with my children, patient with my patients and patient with myself.

This wasn’t my plan.

From there to here.

If you asked me 10 years ago, even 5 or 6 years ago, this wasn’t where I saw myself: living on Vancouver Island, the exact opposite end of the country from where I grew up, working as a family physician and married to another family physician, mother to three beautiful boys.

Ten years ago I was in my second year of medical school, still just figuring out what the whole medical education system was all about and sorting out where I saw myself fitting in. I knew I loved women’s health. In fact, I spent a month after my first year of medical school doing an OBGYN elective at Komfi Anoche teaching hospital in Ghana.

sarah&evans
Evans, a third year medical student at Komfe Anoche Teaching Hospital who showed me the ropes during my elective.

By the time I reached my last year of medical school and began the CaRMS matching process (that’s a whole blog post on it’s own!) I was torn between OBGYN and doing a Family Medicine residency with a focus on Women’s Health and Maternity. OBGYN offers a huge variety, from managing medically complex patients during pregnancy, doing on-call obstetrics, and gynecologic surgery. Family Medicine offered it’s own variety in a different way; managing people across their lifetimes, developing unique relationships as a primary care provider, with the added bonus of being able to shift your focus as your interests change throughout your career.

In the end, I went for OBGYN and matched to UBC for my training which was my first choice. They had a great program, strong in obstetrics, and I wanted to be closer to my brother and his family while I did my residency training. I was truly passionate about women’s health (and still am!) and at the time didn’t see myself settling down and having a family. I wasn’t against the idea of children, but thought it might not happen for me. I was 30 years old graduating medical school looking ahead at a 5 year residency training program at a minimum, seven years if I wanted to do an MFM fellowship.

It was at the end of my PGY-2 year (post-graduate year) of my OGBYN residency program in Vancouver, B.C. working crazy hours on call at BCWH, VGH and St. Paul’s Hospital when everything changed for me. My plan, up until that point, was to finish my residency and take it from there. I wasn’t certain what I wanted to do when I finished, but I had often dreamed of returning to Halifax and maybe doing a fellowship in MFM (Maternal Fetal Medicine).

dr.s.lea

And then it all changed. I started dating Hagen, my now husband, who was just finishing his family medicine residency. We had started our training together; he was a first year family medicine resident in Victoria where I had been placed to do my intern year as a Royal College resident. We were friends first and didn’t actually start dating until almost two years after we first met. And as soon as we started dating, I started looking at life much differently. Suddenly regularly working 80 to 100 hour weeks wasn’t my jam. Working 24 hour in-house call every other weekend? Not so much fun. I loved (and still do love) OB but realized I wanted to spend more time outside the hospital than inside. And I also realized that that was an ok thing to want. I mean, some people LOVE surgery and being a surgeon IS an amazing career, but I didn’t love it enough to make it worth the sacrifices you (and your family) have to make as a female surgeon. So I took the leap, jumped through the hoops and made the switch from OBGYN into Family Medicine. Despite having completed a general intern year and 18 months of specific OBGYN training I was only credited 6 months for that training so had to complete an additional 18 months in the Family Medicine program to obtain my certification (it’s officially a 24 month training program). In that 18 months, Hagen and I managed to produce two little boys and I was fortunate to take two 10 month maternity leaves.

So…after graduating from medical school in 2010, doing 2.5 years in the OBGYN training program, switching into Family Medicine and taking two 10 month maternity leaves I completed my training as a Family Physician in June of 2016. I’m currently on my third (and final!) maternity leave and prior to taking this leave was working as a locum physician doing general family practice, hospitalist medicine and maternity. When I return to work from this mat leave I am fortunate to be joining a group of amazing female GP maternity physicians at GROW Health here in Victoria and will primarily work there. I’m also doing some fellowship training in addictions and specifically perinatal addictions medicine so I plan to incorporate some of that into my work here in Victoria as well.

Do I miss OBGYN? Absolutely. Do I wish I were the one holding the scalpel when I scrub in to assist in a C/S? Definitely. Do I occasionally dream about going back and completing my residency training as an OBGYN when my kiddos are a bit older? Sure I do. And I’m lucky enough to have a husband who assures me if this is something I decide I want to do he would support me.

But for now, I’m happy. I have a satisfying career working with incredible colleagues and I and still get to focus on maternity and womens health. Additionally, there is fantastic opportunity for growth in my area of interest, perinatal addictions. I have an amazing husband who is also an incredible father and my best friend who not only supports but encourages me to do make time for myself whether that be going for a trail run or getting a pedicure. We have the time to focus on wellness and nutrition; to spend our time researching nutrition and creating healthy meal plans for our family. We have the time to travel, nothing extensive or exotic at this point, but we find the time to go away as a family camping, biking and hiking in Whistler and enjoying some sun in California.  And then there is the family that we have created together.

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I mean, look at those faces – who wouldn’t feel incredibly blessed to have brought those three amazing, funny, sweet, smart and wild boys into the world?  So no, this absolutely wasn’t my plan but I can say I have never experienced love and happiness like this since my I made the leap and I wouldn’t change a thing.