There is a pain in my bladder.

Interstitial Cystitis (IC) is an umbrella terminology for a group of symptoms within the pelvic region and for the most part a complicated condition. IC can be chronic or intermittent, it affects both males and females although females are affected more than males. While the bulk of attention tends to be on the bladder, there are other structures/organs in the pelvic region that are also affected such as bowels, uterus, muscles of the pelvic bowl etc.  Perhaps a more appropriate terminology for IC is Painful Bladder syndrome (PBS) or Chronic Pelvic Pain Syndrome (CPPS) since chronic bladder/pelvic pain is one of the hallmarks of IC.

Signs and Symptoms of PBS/IC/CPPS

  • Urinary frequency and urgency
  • Suprapubic pain
  • Feeling of pressure/discomfort
  • Pelvic pain
  • Pain during intercourse
  • Vulva pain
  • Pain during urination
  • Perineal pain
  • Reduced urinary stream in men
  • Pain/discomfort in the tip of the penis
  • Painful ejaculation
  • Pain/ache/sensitivity in the testicles
  • Groin pain
  • Incomplete urination
  • Recurrent prostatitis that does not respond to treatment

Possible causes of PBS/IC/CPPS

  • Bladder infection
  • Trauma (surgical, physical, emotional or sexual)
  • Viral illness
  • Spasm in the pelvic region – chronic tension
  • Neurologic inflammation/Neurological windup
  • Hereditary

It is not uncommon for people with PBS/IC/CPPS at one point or another to experience recurrent bladder infections, endometriosis, irritable bowel syndrome, migraine headaches, fibromyalgia, chronic fatigue syndrome, constipation,  vulvodynia, depression and anxiety. It is mostly likely that PBS/IC is an inflammatory condition that is worsened with stress/anxiety. In addition there is a high amount of tension/tightness in the muscles of the pelvic floor which further contributes to the pain/discomfort. In a small percentage of people, there are small pin point ulcerations (Hunner’s ulcers) in the bladder wall. Some individuals have noticed that certain foods can trigger a flare up that takes days to weeks to subdue.

Conventional medicine alone has very little to offer patients that are suffering from this condition because it can involve so many organs/structures. However a combination of modalities in addition to conventional medicine can enable people to lead a more normal life.

What challenges have you encountered with this condition?

Dealing with Recurrent Bladder infections naturally

Recurrent urinary tract infections (UTI) is a type of bacterial infection that can affect one or more organs of the urinary system (bladder, ureters, kidney). The most common bacterium in UTI’s is E. Coli however this is not the only one. For some women, once they start the UTI cycle it becomes very difficult to break. I have seen women get infections on a monthly basis and this is not healthy.

The standard of care is treatment with antibiotics and this makes matters worse. Repeated antibiotic treatments causes antibiotic resistance and recurrent yeast infections. However, there is hope and I have clinically witness women go from monthly infections to one or two a year.

Signs and symptoms of a bladder infection:

1. Strong urge to urinate frequently and often

2. Painful, burning urination

3. Cloudy, bloody urine with a strong smell

4. Discomfort, pressure or bloating in lower abdomen

5. Pain in pelvic area or back

It is worth noting that some women may have these symptoms and think they have a bladder infection but in reality what they have is Interstitial cystitis (IC)/Chronic Pelvic Pain Syndrome (CPPS). This topic will be covered in a later blog. As a physician, I always do a dip stick test in addition to a looking under the microscope and doing a culture and sensitivity. This is the best way to distinguish between true recurrent UTI’s and IC/CPPS.

Natural Remedies for recurrent UTI’s

Probiotics: It is important to choose a good quality probiotic. There are many products on the market with little to no live bacteria. While eating yogurt is helpful, it is not enough as a preventative measure.

Cranberry capsules: Cranberry helps to prevent the bacteria from sticking to the inside of the bladder wall. If you have IC, cranberry may make your symptoms worse  so proceed with caution.

Vitamin C: helps to keep the urine more acidic thereby preventing bacterial overgrowth. Some IC patients may find that Vitamin C makes their symptoms worse.

D – Mannose : this is a naturally occurring simple sugar that prevents E. Coli from sticking to the bladder wall. A high dose of D-Mannose can be tried over a 24 hour period prior to using antibiotics.

Hydration: it is important to drink lots of clean filtered water to help flush the bacteria out of the bladder.

Herbal remedies: Oil of oregano, Uva Ursi, Yarrow, Echinacea, Garlic, Goldenthread, Oregon Grape, Barberry and Goldenseal can all be useful for the treatment and prevention of a bladder infection.

Hygiene: since most women tend to have infections after intercourse, it is always a good idea to urinate right after having sex. Avoidance of tight-fitting pants will also help in the prevention of recurrent UTI’s. Choose cotton underwear instead of synthetics. Avoid scented products in your vaginal area. There is no need to make your private smell like a rose-bush. Avoid bath additives  (ie bubble bath, scented oils etc). These products can be highly irritating to the vaginal area thus setting you up for recurrent infections.

The content in this blog is for educational purposes only.  Please consult a naturopathic physician for a treatment plan if you think you have a UTI or if you are getting recurrent UTI’s.

Adjusting to Motherhood Part 2

Adjusting to parenthood is difficult for any woman. Medically, there are three areas that can make the adjustment particularly challenging. This is by no means an exhaustive list. However, I have noticed these conditions are more prevalent than any others in my medical practice.

1. Fatigue: it appears that being fatigued is a rite of passage that most mothers must pass through. It is not uncommon for a new mom to experience fatigue for the first six weeks or so after delivery. With the recovery from delivery, getting use to a new sleep schedule and nursing a baby, a mama is bound to get fatigued. You should see a health care professional if the fatigue lasts longer than six weeks; is disabling; worries family members or prevents you from performing normal activities.   When any of these criteria is met, it is worth consulting  a health care provider to rule out anemia or hypothyroidism. Both conditions can be tested for by a simple blood test.

Postpartum anemia is a very common cause of fatigue among new mothers. A woman who was anemic in her last trimester will most likely suffer from postpartum anemia. A diet rich in green leafy vegetables, lentils, beans  and organic meat will help alleviate anemia. I never recommend organ meats as a way to replenish iron stores. The liver is an organ of detoxification. Meaning that all the toxins the animal has ever been exposed to is broken down by the liver. I do however recommend supplemental iron in addition to dietary modification in most cases. Not all iron supplements are created equal. Most supplements contain ferrous gluconate or sulfate. These forms of iron are not well absorbed by the body and are more likely to cause constipation and abdominal discomfort. I prefer a chelated form of iron. This is much better absorbed by the body without any side effects. Ideally, iron should be taken with Vitamin C and  on an empty stomach to increase its absorption.

Other ideas to alleviate fatigue include co sleeping in the same room as the baby and sleeping during the daytime when the baby naps.

2. Post partum depression: affects as many as 10 – 20 percent of mothers . It is a more serious form of postpartum blues. About fifty percent of women experience postpartum blues with irritability, crying easily, feeling overwhelmed, confused and anxious. Symptoms usually begin a few days after birth and can last up to six weeks. This is believed to be due to hormonal changes, fatigue and interrupted sleep.

Women with postpartum depression usually have difficult time bonding with their child and may experience sadness, fatigue, irritability and disinterest in life.

If you think you may have post partum depression consult with a licensed health care provider for proper diagnosing. Having a strong social network is important for alleviating post partum depression. This includes joining a moms group or just creating time to connect with other moms, friends and family. Moderate exercise such as walking is great or joining a stroller exercise group. It is okay to ask for and receive help. Get as much rest as possible and find some time for yourself to recharge.

It is important to have a diet that is high in fruits, vegetables and good sources of protein and essential fatty acid. Choose an essential fatty acid supplement that is free of heavy metals and high in DHA. Good dietary sources of essential fatty acids include fish oil, chia seeds and hemp hearts. A gluten and dairy free diet has been shown to help alleviate depression. There are several herbs such as: panax ginseng, rhodiola, shisandra and ashwagandha that are effective and safe for nursing mothers. Talk to a licensed health care provider for a treatment option that is best for you.

3. Low milk supply: most women are able to make more than enough milk for their child. However there are  several reasons for low milk supply such as anemia and hypothyroidism in mother, supplementation with formula, scheduled feedings, pacifiers, nipple shields and medication.

Eating a well-balanced diet full of good protein sources, fruits and vegetables and oatmeal daily  helps with low milk supply. Also, a good latch is paramount to having adequate milk supply. Herbs such as fenugreek, blessed thistle, vitex, milk thistle, hops, shatavari, alfalfa, goat’s rue, raspberry leaf have all been shown to be helpful with milk supply.

It is always beneficial to solicit the services of a good lactation consultant to help with latch assessment and offer additional suggestions.

Are there other challenges you have encountered?

Adjusting to Motherhood Part 1

A few weeks ago, I gave a talk at the Childbearing society about adjusting to parenthood. Just as each person’s journey to parenthood is different so are our experiences. The business of mothering is challenging and complex and varies from one woman to the next.

With the pregnancy of my first child, I thought I knew exactly how things were going to work as a parent.  My child was going to be well-behaved, no rolling in aisle 6 of the local organic grocery store as if on fire, no yelling or having to be carried out of such said store in a football hold as I huffed and puffed to the car.

I was pretty certain that I will just pop out the kid and life will continue as usual with my child strapped to my back or front or side for that matter. Travelling with my husband will commence as usual but with an additional person. We will continue to watch Dexter with junior sleeping sweetly in a bassinet. It never occurred to me that junior will have his own sleep patterns that are not conducive to my schedule.

In preparation for my talk, I decided to do a little bit more research about top complaints/concerns about parenthood. Of course a variety of topics came up with most of them focusing on the psychoemotional aspects of parenthood. I came across a list on the TLC network that pretty much summed up my experience and opinions about parenting thus far.

5. Everyone has an opinion.

Isnt’ this the truth. I got all sorts of advise solicited and unsolicited from people. Everything from how to not let my child ruin my life to the EASY technique. Of course the Eat, Activity, Sleep, Yoo technique was the only thing I took away from the Baby whisperer book. Basically, the baby eats, does an activity after eating (diaper change, read a book, sing a song), sleeps and then you have some time for yourself. A good way to get baby and you on a routine that is baby directed. Take whatever advise works for you and your baby and ignore the rest.

4. Parenthood takes a physical toll.

From sore shoulders to dark circles under your eyes. Being a parent is hard physical work. It can be difficult to find time to take care of yourself with a little one. It is important to continue to exercise even if that means pushing baby around the neighbourhood. Lots of community centers and gyms now offer programs such as baby and me yoga and stroller exercise. For mothers who have had a C section, please consult with your doctor. Treatments such as massage therapy, acupuncture, chiropractic, craniosacral therapy, yoga, mindfulness based meditation can all help to alleviate the physical toll of parenting.

3. There are days you are going to feel like a failure – but you are not.

As parents we all have our goods days and bad days. Parenting is not always glamorous or what we envision it to be. What really matters is that we try our very best with the purest of intention for our children’s well-being.

2. The relationships in your life will change

Parenting can be very stressful on a marriage and other relationships on your life. It is important to continue to nourish and make time for the relationships that feed us as human beings not just mothers.

1. Parenthood is the hardest thing you will ever do but it is worth it.

Being a parent is not for everyone and that’s ok. No matter the route you took to be a parent, there is nothing as satisfying as watching your child grow in front of you and become an independent human being. It is truly an amazing transformation to witness.

What challenges have you experienced as a mother?

Top 5 supplements for a healthy pregnancy and baby

As a mother of two boys, maternal and child health are very dear to my heart. Pregnant women in my practice often ask me which supplements they should be taking during their pregnancy. These five supplements are what I recommend to every woman of child-bearing age who might one day get pregnant.  Why you ask? Because these are the supplements that keep on giving. Even after a mother has had her baby, these supplements continue to benefit both the mother and baby.

1. Iron:  is an important vitamin for both maternal and fetal health. It is involved in the transport and storage of oxygen. It is required for energy and it supports the growth and development of the fetus and placenta. It is also involved in brain development and cognition.  Anemia in pregnancy may result in a baby with a low birth weight.

Interestingly enough, iron in breast milk is small but much more absorbable and the amount of iron is more dependent on maternal stored iron. A recent research study found that mother’s that were supplemented with iron during pregnancy had higher iron levels in their breast milk.  Meaning that it is important for pregnant and soon to be pregnant women to have a healthy iron level before they give birth. An anemic mother will lead to an anemic baby once born. Most women at some point or another in their pregnancy become anemic. It is always a good idea to start out with a reservoir of iron instead of a deficiency.

It is important to get a good digestible source of iron that will not cause constipation. My preference is chelated iron bisglycinate. It is relatively inexpensive and it works well. According to the University of Maryland Medical Centre, pregnant women need 27mg of iron daily. Even if a woman is mildly anemic, I still treat them with supplemental iron due to an increase risk of post partum bleeding.  As always please consult a licensed care provider before taking any supplement.

2. Probiotics: these are microorganisms that live in our entire digestive tract.  Lactobacillus and bifidobacterium are the major microorganisms and they play an important role in digestive and immune health. There is research to suggest that maternal levels of bifidobacterium affect infant levels as early as 3 days. Bifidobacterium  readily passes from the breast milk to the nursing baby. Probiotics enhance our immune system, enhance the assimilation and absorption of vital nutrients, promote healthy skin, decrease atopic disease (asthma, allergies, eczema) and act as Group B Strep prophylaxis. While you can get probiotics in supplement form, I always encourage people to get additional probiotics through foods such as sauerkraut, kim chee, yogurt, miso or anything fermented.

3. Omega 3 fatty acids: the 3 main types of essential fatty acids are EPA, DHA and ALA. They are called essential fatty acids because they must be obtained from the diet. EPA and DHA are readily found in seafood such as fish, squid and algae. ALA is mainly found in flaxseeds, soybean oil, canola oil.  I will discuss the problems with soybean and canola oil in a later blog. ALA is not readily converted to DHA by the body so I usually just supplement patients with DHA and EPA. During pregnancy and breastfeeding, the mother is the primary source of essential fatty acids. DHA in the developing infant is needed for visual and neurological development, cognition and hand/eye coordination. For pregnant and nursing mothers, essential fatty acids can help with mood stabilization and to banish baby brain.

4.  Vitamin D: with the war against sun exposure in full bloom, Vitamin D deficiency is becoming rampant. I have my issues with the whole everyone must wear sunscreen year round campaign but this is not the place for that discussion. Being a physician in the Pacific Northwest, I see and treat a lot of Vitamin D deficiency. Vitamin D deficiency is now becoming a significant public health concern especially the further  away  you are from the equator. Vitamin D deficiency has been linked to gestational diabetes, pre eclampsia, infection, Cesarian section and fetal growth restriction. Vitamin D in addition to calcium is also required for proper bone development. A recent paper published in February of this year suggested that supplementation may be a simple way to reverse adverse risk factors associated with low Vitamin D status. A licensed health care practitioner can check your Vitamin D status for you and suggest an appropriate Vitamin D dosage based on your lab results.

5. Prenatal Vitamin: research is just now starting to focus on the role of micronutrients in pregnancy outcomes. According to recent research,  reduction in  essential micronutrients may contribute to recurrent spontaneous abortions.   A good quality prenatal will provide you with all the important micronutrients such as magnesium, selenium, zinc, copper, chromium, manganese among others. In addition, these vitamins and minerals will be in a form that is easily absorbed by the body. Not all supplements are created equally. For example, most supplement companies sell magnesium in oxide form. This form is not readily absorbed by the body whereas the malate or citrate form is much better absorbed. I always advise women to start taking their prenatal vitamins well before they are thinking of getting pregnant. The worse thing that can happen is your hair grows thicker and faster. I also tell women that they need to think of their  womb as a garden. The egg and sperm represent the seed. In order to get a good yield of produce, you have to prepare your garden and fertilize it preferable with organic manure. When you have good soil and good seed, you have a good harvest. Pregnancy is no different.

Are there any supplements you find helpful for pregnancy and post partum?

Tips for a Chemical free summer (part 2)

I would hope that after reading my first blog, some of you would have rushed out to replace your Hawaiian Tropic sunscreen with something that is a little bit better for your health.

Pesticides are a significant source of toxicity. People are exposed to pesticides via food and the environment in particular lawn care. While research is usually focused on massive pesticide exposure, low dose long-term pesticide exposure is difficult to capture. Not to mention the fact that pesticide residue has been linked to everything from hypospadias to decreased intelligence, learning and memory in children. Children are particularly vulnerable because of their immature organs, rapidly dividing and migrating cells, higher metabolic rate and smaller size.

Ways to decrease pesticide exposure.

1. Eat locally and organically. Summer is the perfect season to do this. Farmer’s markets are filled with everything from organic produce to baked goods and plants. Summer is also a good time to  plant an organic garden and decrease your grocery bill while nourishing your body.

2. Avoid the herbicide atrazine. According to Health Canada, atrazine is used extensively in Canada as weed control for corn and rapeseed. It is also used on lawns, sugarcane fields and golf courses. According to healthy child healthy world, atrazine is an endocrine disruptor that has been linked to cancer, miscarriages, developmental and birth defects, miscarriages, weakened immune system, reproductive abnormalities and sexual changes. Visit the Health Canada site for ways to maintain a beautiful lawn without nasty pesticides.

3. Remove your shoes when you come in from outdoors. People who know me are aware that this is a big issue with me. There is a lot of environmental residue that gets attached to the bottom of our shoes. It is important to have a no shoes in the house policy for guests and family members.

4. Invest in a water filtration system that will get rid of organic pollutants. Atrazine has  shown up in drinking water. Water can be a significant source of environmental contamination and toxicity.

5. Keep your floors clean by vacuuming and moping regularly. This is especially important if you have small children that are crawling.

6. Petition the government in your city to make sure parks and areas that children play at is free of harmful pesticides and chemicals.

7. Make your own bug repellent by using essential oils instead of DEET and permethrin. Oil of lemon eucalyptus has been shown to be just as effective as DEET. DEET has been shown to be a neurotoxin. Just remember that you have to reapply often with essential oils. Avoid scented products and cover up when outdoors. Wellnessmama is a wonderful website with information on how to make your own natural insect repellent that works.

What are you doing to decrease your exposure to environmental toxins?

Tips for a Chemical Free Summer (part 1)

With the days getting longer and the nights shorter, summer has finally arrived here in the Pacific Northwest. We have been enjoying wonderful weather consistently for the past 3 weeks here in Vancouver and with that I am now declaring summer here.

Summer activities such as barbecues, picnics, water parks, camping or just plain lazing in the sun is just around the corner. However with all this merriment and enjoyment, our exposure to environmental contaminants is likely to increase. From sunscreens to lawn care, summertime is prime time for increase exposure to chemicals that may have an adverse effect on our health and that of our children. This blog will focus exclusively on sunscreens since there is so much information to be covered.

According to the Environmental Working Group (EWG), melanoma (the most deadliest skin cancer) rates are on the increase and sunscreen alone cannot reverse this trend. The rate of melanoma has steadily increased in the past 35 years despite approximately 60% of adults claiming to apply sunscreen while out in the sun. While most sunscreens offer protection against sunburns, they are not effective at preventing DNA damage from exposure to UV rays. 

Sunscreens are made of either physical or chemical barriers. Chemical barriers contain ingredients such as Oxybenzone and octyl methoxycinnamate, are readily absorbed by the body and have been known to cause allergic skin reactions and disrupt hormones. Not something you want for your children or yourself for that matter if you are pregnant or trying to get pregnant. Physical barriers have mineral ingredients such as zinc oxide and titanium dioxide. They tend to contain nano particles which make the product non whitish when applied to the skin.

Tips for decreasing toxic exposure while in the sun.

1.  As mentioned above, choose physical barrier sunscreen instead of a chemical barrier. Avoid spray sunscreens because they contain nano particles that are not safe when inhaled and they get applied to the skin too unevenly.

2. Don’t be fooled by a higher SPF. Anything higher than SPF 50 does not offer additional protection and may actually make you stay in the sun longer and not re apply as often.

3. According to the healthy child healthy world website, it is best to avoid the sun between the hours of 10 am and 3 pm when it is the strongest. For children, wear breathable clothing that covers their hands and legs, put on a sun hat and stay in the shade. Of course adults can follow this recommendation. There are several companies such as Hanna Andersson who sell SPF clothing and sun hats. Sunscreen is not recommended for children younger than 6 months. I am aware that there are now new recommendations that say it’s ok but I say better safe than sorry. There isn’t any research looking at the link between toxicity in infants and sunscreen use.

4. Avoid any sunscreen with Vitamin A (i.e retinyl palmitate or retinol). While Vitamin A and it’s derivatives have been used for anti aging, research has shown it to accelerate the development of skin tumors and lesions on sun exposed skin

5.  Have your Vitamin D level checked by your health care provider. Higher levels of Vitamin D has been linked to a decrease rate of melanoma.

6.  Increase consumption of foods such as tomatoes, sweet potatoes, flax seeds, green tea, spinach, pomegranate, almonds, dark chocolate, broccoli, celery, apples, cherries. You get the point; a plant rich diet is chuck full of antioxidants that help reverse and at times prevent the DNA damage that occurs with UV exposure. Diet can offer significant protection in the fight against skin cancer.

7.  The University of  Maryland Medical Centre recommends herbs such as milk thistle, ginger, turmeric, billberry, ginkgo and hawthorn for their skin protecting abilities. Please consult a trained/licensed practitioner to prevent adverse reactions if you decide to take herbs.

8. Visit the EWG website to see if your sunscreen is safe. The database has over 1000 different products that can be looked up. While you are at it, don’t stop at your sunscreen, check out other personal care products that you use on a daily basis and see if they are affecting your health negatively.

What are your favourite healthy sunscreens?