Summer Wellness, #97

[Unidentified voice]:

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. 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 the family unit as healthy as they can be. So I felt like I was always doing a little bit of public health all the time that I was doing pediatrics. And I thought, you know what? I'd really like to see if I could help the state of Maine, not just my patients. So.

[Unidentified voice]:

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 and 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.

[Unidentified voice]:

The thing about melanoma that's different than other cancers is that when caught early, melanoma can be almost completely cured.

[Unidentified voice]:

I believe wholeheartedly in evidence based medicine, but it does have 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 kind of 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.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 97, Summer Wellness, airing for the first time on Sunday, July 21, 2013. Today's guests include Dr. Chris Pizzulo and Dr. Sheila Panetta of the Maine Centers for Disease Control and Prevention, Deb Gerard, 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 and talking about things such as Lyme disease and skin cancer prevention, but then we talk about things like acupuncture and integrative medicine. There are lots of different ways to be well. And we hope that through listening to our show, you'll incorporate some of these into your own life. Thank you for listening. 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. So I'm thrilled today to have with me Dr. Chris Bozzi, who is the medical for the Division of Population Health at the Maine CDC or Centers for Disease Control, and Dr. Sheila Panette, who is the director of the Maine center for Disease Control. Thanks for coming in today.

[Unidentified voice]:

Thank you very much.

[Unidentified voice]:

Thanks for having us.

Dr. Lisa Belisle:

Now, 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 were at Maine Medical Center. I was doing training. And 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 was really. It's a crazy time when you were a resident. So when you get a good senior resident, it means so much. So thank you for being part of my education.

[Unidentified voice]:

You got it. Thank you. Thank you for saying that.

Dr. Lisa Belisle:

And it's good to reconnect with you. And then, Dr. Panette, you actually, you and I interacted because again, as a family medicine resident, we worked with some of the high risk OB team. And you were part of the high risk OB team back then.

[Unidentified voice]:

That's right.

Dr. Lisa Belisle:

So a lot seems like a lifetime ago.

[Unidentified voice]:

It does.

[Unidentified voice]:

Still the same lifetime, though.

[Unidentified voice]:

Yeah.

[Unidentified voice]:

It's all about the journey and we're moving forward.

Dr. Lisa Belisle:

Well, tell me how it is that you went from doing largely hospital based work. And I know in your case, Chris, you were a resident, so of course there's hospital based, and then you do outpatient pediatrics. You know, most people choose that as a career, but both of you started out in the hospital and More acute in the more acute setting, especially maternal fetal medicine. Very high risk ob. You've gone from that to outpatient and now doing public health. Each of you has a slightly different, different version of this journey. Talk to me about that.

[Unidentified voice]:

Well, actually, I was part of the maternal fetal medicine program. My husband, Dr. Michael Panett, and I were recruited back to Maine in 1989 to help further develop the perinatal outreach program, as well as to develop the maternal fetal medicine program. And in 1996, I went back to school at the 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 stuck to outpatient medicine. And I really had a big passion about helping people to live a healthy life and to combat chronic diseases by helping with healthy nutrition, counseling and exercise.

[Unidentified voice]:

So 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 Healthcare. What I noticed, though, is 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. And one of the things I noticed about pediatrics, and I think probably the same for family practice and internal medicine, is that you are kind of, even though you have a single patient, you're often working with the team, and the team is the family, especially in pediatrics. And 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 the family unit as healthy as they can be. So I felt like I was always doing a little bit of public health all the time that I was doing pediatrics. So it was when this job became available last winter, I kind of jumped at the chance to try something a little different. I had done primary care peds for almost 18 years. That means I'm pretty old. And I thought, you know what? I'd really like to see if I could help the state of Maine, not just my patients.

[Unidentified voice]:

And I think it's the same for me. I was given the opportunity to work with Commissioner Mayhew of the Department of Health and Human Services and Governor Paul LePage with the change of administration. And it was truly a great honor and privilege to be asked to be a part of the administration. And I thought this was a great opportunity for me to move forward and continue to express my passion to help care for all the people in Maine, to preserve, promote and protect the health and safety of people in Maine.

Dr. Lisa Belisle:

Both of you have a connection with the University of New England, which is Maine's only medical school. We have contracts out with different other allopathic medical schools out of state, but this is Maine's only medical school. That must make you feel pretty proud.

[Unidentified voice]:

We are very proud. UNE has been recognized as one of the leading medical schools, both allopathic and osteopathic, and 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 Koop often told people that as a surgeon general of the United States, UNE was one of the top medical schools and was a great role model for other schools, medical schools.

[Unidentified voice]:

And actually his daughter wound up going to school there. So I've been involved with UNE, you know, ever since I graduated in 93. This is actually my 20th anniversary year, which we're getting ready for the big party in October. But I've been amazed at how UNE has grown over the years. I don't know if you know the story about the blue chairs, but when we were there, it had been sort of 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. And now they have this Alfond center, which is this gorgeous state of the art building that the students take their classes.

[Unidentified voice]:

So, you know, my class was the first class in 1996 to sit in those beautiful chairs. And we feel. And my husband, who's a Dartmouth Medical school grad, oftentimes says your education is second to none and you have state of the art educational facilities.

Dr. Lisa Belisle:

Yeah, that's true. UNE really does have a beautiful campus. And 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. And 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.

[Unidentified voice]:

Right. And 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. And 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.

[Unidentified voice]:

Yeah, I mean, one of the thoughts around osteopathic medicine is that the body really has lots of ways to heal itself. So there's, you know, it's sort of like, how do you get back in touch with your own healing mechanisms? And 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. And I think, as Dr. Pinette mentioned, that having manual medicine as a tool that you didn't have to go and get some special training, and that was part of your training. Not only were you doing all the things that you do in every medical school, but you were also learning manual medicine and how you could help their bodies heal themselves.

Dr. Lisa Belisle:

Well, you've gone from helping individuals and helping their bodies heal themselves to helping families. And now you're talking about helping communities and 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. So describe to me what is the Centers for Disease Control in Maine and what are your roles within it?

[Unidentified voice]:

Well, actually, as the director of the 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 summertime, our population actually triples. 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. We're all about hyper awareness and prevention and primary prevention in population. Health is where you get your biggest bang for your buck to have a healthier society.

[Unidentified voice]:

And 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. And so it's really cdcp. Right. Centers for Disease Control and Prevention. And. And I think it's about how do you help patients? And also their providers help those patients to default to living in a way that makes them as healthy as possible for the longest period possible. So 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? So it's really a much broader approach than the way a primary care physician would just deal with their one patient.

[Unidentified voice]:

And 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, you know, the federal government, we're able to not only deal with our racial and ethnic minorities, but women and children who are one of our most vulnerable populations.

Dr. Lisa Belisle:

From having had Deb Dietrich from Maine Health 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 main care system, and we also know that we have quite a lot of people who are unemployed who live in rural parts of the state. So reaching these different groups must be somewhat challenging given just the broad array of needs.

[Unidentified voice]:

I'm so pleased that you brought up Deb Dietrich. She truly is a pioneer in public health. Public health in the state, and really is a guru, and she is a huge supporter of the Maine CDC and Maine Health and 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 a 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. And our socioeconomic base is very different up north as opposed to down south. And so these people help to address those needs in the way that they need to do it for the people there.

[Unidentified voice]:

Yeah. And, you know, right now, for example, I'm taking part in some stakeholder meetings. There are meetings that are occurring right now around what are we going to look at for how can we improve health in the. I call it the Short, long term, like over the next five years, how are we going to help the health of Maine and change sort of the trajectory? And so these meetings are occurring with stakeholders around particular issues. And 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 thought 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. And 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. And it's not just about financial access. It may be transportation access. It may be that in their county there are zero to one types of providers for that particular care and they have to travel three or 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 this state and this state has a lot of disparity when it comes to the size and really the rurality of this state. Very, very different from even the other New England states.

Dr. Lisa Belisle:

We'll return to our program in a Moment on the Dr. Lisa Radio Hour and podcast. We've long understood the important link between health and wealth. Here to speak more on the subject is Tom Shepard of Shepherd Financial.

[Unidentified voice]:

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Dr. Lisa Belisle:

it's summertime 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 the health of their communities.

[Unidentified voice]:

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 of tick borne illnesses such as Lyme disease, anaplasmosis and babies. Babesi is a parasite. We had 12 reported cases last year, 52 cases of anaplasmosis. Those two oftentimes go unrecognized, but they're carried by the same tick, Ixodia scapularis or otherwise known as the deer tick. The deer tick is found on the eastern coastal and the northern areas of central United States, Michigan and Wisconsin. Maine was noted as being endemic last year where we identified the tick in every single county, 16 counties, as well as identify the disease. We had 1,111 cases reported. That means there's also a lot that go unrecognized. So we urge people to make sure you do daily tick checks. Make sure children, especially moms, are checking their heads behind their ears, around their belt line and they're groin. Make sure you're wearing long sleeves, light colored clothing, long pants, tuck your pants into your socks and you can use deet. If you're over the age of three. Make sure you read your directions. If you're a little more holistic you can use oil of lemon, euclid, eucalyptus and pericardium 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 setting up stuff outside, make sure your furniture is closer to the home and that you might put wood chips down so that you can have a barrier between the woods and your lawn.

Dr. Lisa Belisle:

And what about things like West Nile virus? Is this something that we need to be Thinking about?

[Unidentified voice]:

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, York county and we actually identified in October our first case of West Nile virus that caused a neuroinvasive disease. 20% of people, or 1 in 5 will develop symptoms so oftentimes benign. Precisely presentation with West Nile virus. But it's usually a fever, low grade malaise, arthralgias, more like a flu like symptoms, but they don't go away. And then we know that about 10% will go on to develop neuroinvasive disease. And of that 1% 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 preseason, that you're making sure you're wearing bug sprays to help prevent against that. And for children, when you have them out, make sure there's netting. Make sure you're taking care of those tire swings in those pots that have water because that's where mistakes mosquitoes breed. 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 and awareness.

Dr. Lisa Belisle:

Dr. Bozzullo, in your practice, I know you see a lot of children and you see children who are either in the midst of a sports season, getting ready for a sports season in the summer. A lot of kids are doing summer season sports and they're thinking about the fall sports season. Is there something that kids need to be thinking about in 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.

[Unidentified voice]:

Oh sure. So how about hydrate? Let's make sure that they sort of are doing double the amount of fluids that they would have in the winter. And how about sunscreen? So 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. And it's very hard for young people to understand that what they do now may affect what's going to happen to them 30 years from now. So I really encourage them to apply sunscreen just prior to being outside for long periods of time and to reapply every two hours.

[Unidentified voice]:

So, Dr. Lisa, I guess you can see that Dr. Chris and I will be able to fill in anytime you need help.

Dr. Lisa Belisle:

You guys are just ready to take over my role, which, you know what is 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 at kind of helping people to understand what it is that they need to do to keep themselves and their communities healthy. So you represent the state very well.

[Unidentified voice]:

Thank you.

[Unidentified voice]:

Thank you.

Dr. Lisa Belisle:

I do appreciate your coming in and talking with us today. We've been speaking with Dr. Chris Pizzulo, who is the medical director for the Division of Population Health at the Maine Centers for Disease Control and Prevention, and Dr. Sheila Panette, 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.

[Unidentified voice]:

Thank you for giving us.

[Unidentified voice]:

Thanks for having us, Lisa.

Dr. Lisa Belisle:

Thank you. 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 Marcie Booth from Booth, Maine to help me with my own business and to help me live my own life fully. Here are a few thoughts from Marcy.

[Unidentified voice]:

I like to think that I live a healthy lifestyle. I keep active, work out 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 certain my clients businesses stay healthy too. So 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 Marcie Booth. Let's talk about the changes you need. Boothmain.com

Dr. Lisa Belisle:

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 Gerard wants us all to have. Deb Gerard 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.

[Unidentified voice]:

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. And clearly now we have a mandate to increase the education that we do to build awareness about the dangers of tanning.

Dr. Lisa Belisle:

Well, 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.

[Unidentified voice]:

So this year in this country, about three and a half million people will have skin cancer. Now, 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. And while they can be extremely disfiguring and some percent of squamous cell cancers can get worse, the majority of the ones that we're most worried about are about the 76,000 new cases of melanoma we will have diagnosed this year. So about one person every 50 minutes dies of malignant melanoma. And so we're spending a lot of time at the foundation and 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.

Dr. Lisa Belisle:

In this information that you brought, you gave me a card, and on the card it says, know your moles, know your moles. Talk to me about that.

[Unidentified voice]:

One of the things that we know is that everybody needs to check their skin. You do other checks of your body, whether it's breast, 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. And one of the things that we do is to ask you to look at the things that might be new or evolving. And those might be moles and lesions that you ask a healthcare 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 in your mass of moles that looks different, that's changing, that you really do need to have a health professional take a look at that.

Dr. Lisa Belisle:

You also provide the mnemonic that's not exactly a mnemonic, but it's A, B, C, D and E, A, B, C,

[Unidentified voice]:

D and E. And really, when we use that with folks, we're asking you to look at a mole in different ways. The A is for asymmetry. So if you were able to fold a mole in half, would the sides meet border irregularity? So if you have a very jagged edge 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 molecular. But you know, there are melanomas that have no pigmentation or are very light. So really what we're looking at are color variations within a mole and diameter. So if you have a mole or a lesion that's the size of the tip of a pencil, a pencil eraser, then that's something that you should have somebody take a look at. An E, which is a sort of new addition to ABCD is evolution. Anything that continues to grow or change, you should have checked. And using those ABCDE rules can really help you spot something that can be checked and taken care of by your healthcare professional.

Dr. Lisa Belisle:

Deb, is there anything specific that the Melanoma foundation is doing to educate teenagers and college students about tanning beds? And staying safe.

[Unidentified voice]:

That's a great question and one that I love to answer. We have a really great program called you'd 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 would. 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. And 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. So we are really encouraging teachers and. And school nurses and principals to get their schools involved in this program.

Dr. Lisa Belisle:

You have an interesting program called the Skinny on Skin.

[Unidentified voice]:

We do.

Dr. Lisa Belisle:

Well, it's a very creative way of trying to get people to pay attention to skin.

[Unidentified voice]:

It is. And I think that one of the things that we believe, you know, I told you a little bit earlier that there were 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 at all of those moles? It's a lot to think that primary care physicians, dermatologists are going to do all of that. And we need to have a paradigm shift here. And 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 ABCDEs so that not only are they looking at their own skin, they're looking at yours, and that they learn to talk to their clients about what they're seeing. And so over the past year, we have been working on a pilot study to go out and train about 40 salons in the Boston area. And we've been doing pre and post testing to look to see if it changes. In fact, 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 a study that was published in the New England Journal about a year ago done by Alan Geller through the Harvard School of Public Health. And a young medical resident, Betsy Bailey and Betsy's mother had a melanoma diagnosed in her scalp by her hairstylist in Houston. And Betsy then began to really take a look at training stylists in that area. And so they came to us and said, could you help us design a program? So over the last year that's what we've been working on, developing some training for hair stylists. And our goal will be to get 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. And so our goal for the spring is to have three launch events. And we have had our first launch event in Lewiston and we had 70 stylists for that program. And they were so incredibly interesting because I would say that about a third of those people clearly had already seen suspicious moles and lesions on their clients heads. Some of them reported that they were able to talk with them. Several of them reported that their client had a melanoma. So we see success for this kind of program is really being the consistency of which stylists are looking. The best time to look at your scalp is when it's wet and we can't see our own scalps, we can't see the back of our heads, we can't see our necks, but your stylist can. And what we've also seen is that stylists are very excited about the possibility of really being regarded as people who can impact prevention in this way. So 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.

Dr. Lisa Belisle:

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, the need for vitamin D and the fact that we get it mostly from the sun?

[Unidentified voice]:

Well, I think that there are a couple issues about vitamin D and 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're going to the 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 your body is going to absorb. So we would say going to a tanning bed is not a way to get vitamin D. Tanning bed and 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 you know, the next time you go, have your vitamin D checked if you're worried about it. And 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.

Dr. Lisa Belisle:

How can people find out about the Melanoma foundation of New England?

[Unidentified voice]:

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 hairstylists and and 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.

Dr. Lisa Belisle:

We're very privileged that you have taken the time to drive up from Boston. This is clearly 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, and we do hope that people will go to your website to find out more. We've been speaking with Deb Gerard, who's the Executive Director of the Melanoma foundation of New England. Thank you for all the work you're doing.

[Unidentified voice]:

You're welcome.

Dr. Lisa Belisle:

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.

[Unidentified voice]:

When I enter a home or a business, I try to instantly understand their 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 a space and make a space uniquely your own. I'm Ted Carter and if you'd like to contact me, I can be reached@tedcarterdesign.com

Dr. Lisa Belisle:

at the Dr. Lisa Radio Hour and Podcast, we believe we are helping to build a better world with the help of many. We 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 the these fitness is Jim Greatorex, the President of Premier Sports Health, a division of Black Bear Medical. Here's Jim.

[Unidentified voice]:

Black Bear Medical is Maine's premier 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 solutions 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 270 Marginal Way and at www.blackbearmedical.com.

Dr. Lisa Belisle:

as listeners of our show know, I am a big fan of integrative medicine. In fact have practiced integrative medicine myself and done acupuncture and traditional Chinese medicine and 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 a 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.

[Unidentified voice]:

Thank you so much for having me on the show.

Dr. Lisa Belisle:

Liz. You went further beyond the family medicine training. And you actually did an integrative medicine fellowship also here at Maine Medical Center. Tell me what that was like.

[Unidentified voice]:

You know, it was actually a huge breath of fresh air. It felt kind of like coming home. Throughout my entire medical training, I always felt like it was a little bit too cold and impersonal and that the mystery of health and healing was removed. I mean, that's kind of the goal of our medical training is pure objectivity. So anything that was left to the unknown was not very important. And to me, I found that to be the most interesting and exciting and creative part of health and life is that mystery. And so going back and 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.

Dr. Lisa Belisle:

Listeners of our show have heard our interviews with Dr. Craig Schneider, who's the director of the Integrative Medicine program, and also Dr. Stephen Donnelly, 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. So what types of things can you offer people in the hospital that you might not be able to do in the outpatient setting?

[Unidentified voice]:

There are a few things. In the inpatient setting, people are usually in higher states 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. And 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. So 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. I 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. You know, the whole culture of the hospital has been very open and welcoming, but also really have been curious because a lot of them have not been exposed to integrative medicine. And so I think in Some respects, it's been very educational for our healthcare community in general. In the outpatient setting, most people who seek out integrative medicine are already kind of on the path to wellness in some respects. So when people are kind of surprised to see me walking around in the inpatient setting, I feel like, okay, I'm spreading the word.

Dr. Lisa Belisle:

When I was a resident at Maine Medical center, they were offering osteopathic Consultations with Dr. Brian Beck. And I understand there's been another osteopathic physician who has joined him. And they were also starting to offer Reiki, which is not exactly healing touch, but there is an energetic component to it. So there was a little bit of an entree for you. Was there any problem at all getting the people in the administration or within the family medicine department to embrace the type of work that you wanted to offer in the hospital?

[Unidentified voice]:

I was really lucky because I'd been practicing in the outpatient setting amongst other family doctors, I was able to kind of 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 Medicine, 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. So I'm very lucky for that. And certainly Dr. Beck has paved the way. He's been doing this for several years and, you know, started off with very few patients, and now he has, you know, 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 for pharmaceuticals.

Dr. Lisa Belisle:

In looking at the curriculum of the Integrative Medicine program out of the University of Arizona, which is the program that Maine Medical center is affiliated with, it is very evidence based, and some people have had concerns about things that are, quote, unquote, 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 kind of getting the research to back it up.

[Unidentified voice]:

Yeah, exactly. And, you know, some things that aren't proven, there's a very low risk profile. So Dr. Weil and the University of Arizona, their perspective, and I agree with it, is if there's the potential for great benefit and there's 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 if there's a possibility that it might be helpful. But certainly I try to fit into the mold of evidence based integrative medicine. And when I see patients in the inpatient setting in my notes, I usually document references of studies that have been done or just say there aren't any studies on this, but there is very little chance of 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 have some shortcomings because nobody is out there really funding the studies that need to be done. So it's hard to kind of 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 kind of 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.

Dr. Lisa Belisle:

What types of problems do you find that you're most effective with in the inpatient setting?

[Unidentified voice]:

It's interesting. I kind of have. Things seem to come in waves, and I remember this happened even as a medical school student or resident, that all of a sudden we'd get a ton of patients with pneumonia or, you know, stroke and you just see things in clusters. And currently I've been doing a lot of work with pediatric oncology patients. There's, you know, so much that can be done in the alternative world for them, including a lot of mind body therapies. I do acupressure with tuning forks. So for kids who are needle averse or anybody who doesn't want needles. For 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 work such as yoga. And 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 gives them an outline of a diet or a plan for an exercise program, as well as if I recommend yoga or tai chi, I'll give them the 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 these strategies that we begin in the hospital and continue them as a whole lifestyle change when they leave. So really, as I was saying, I see a gamut of things and for a while 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 kind of runs pretty much any diagnosis is amenable to integrative techniques, but those are the ones that I've seen the most. And 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 been the number one reason for a consultation.

Dr. Lisa Belisle:

You're about a year into this, I

[Unidentified voice]:

think about seven months, Six or seven

Dr. Lisa Belisle:

months into it, yes. And it's always hard the first year, some would say even hard the first five years. What are some of the lessons that you've learned from doing this very different thing that most doctors wouldn't even think that they had the training to do?

[Unidentified voice]:

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 sort of swimming in the wrong direction in the hospital. So I've spent a lot of time really trying to back up what I preach. So 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 kind of 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 try and hold up my torch so that it, it withstands the questions and skepticism of some of the physicians. The second thing I think that's been really important is fake it till you make it. And you know, we did a, in part of the integrative medicine training, we did something called laughing yoga, where you just start laughing and as sort of you're faking laughing and then before you know it, you're hysterically laughing for real. And 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. And so now I've been doing this for several years and I feel like I'm very comfortable. But in the beginning I had to pretend a little bit, and I think that was that's I'm now hysterically laughing for real. But it was hard in the beginning to really feel like an expert expert. I think every doctor goes through that in any shape anyway. You sort of have the imposter syndrome. People expect you. They call you doctor all of a sudden. You were a medical student one day, a doctor the next, and what happened except one night's sleep. So I think that's a common theme in medical practice in general. But certainly it's felt a little bit more powerful now that I'm doing something very different in a very mainstream world.

Dr. Lisa Belisle:

Well, I encourage people to go to your website, healmain.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.

[Unidentified voice]:

Thank you so much.

Dr. Lisa Belisle:

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 21, 2013. Our guests today have included Dr. Chris Pizzulo and Dr. Sheila Panette, Deb Gerard and Dr. Elizabeth Strawbridge. For more information on our guests, visit doctorisa.org Also be aware that the interviews that you hear are shortened versions of our entire conversation. You'll want to hear the entire conversation, so again we encourage you to go to doctorisa.org and listen in. The Dr. Lisa Radio Hour podcast is downloadable for free on itunes. For a 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 read my take on health and well being on The Bountiful Blog bountifulpath.com We love to hear from you, so please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged that they enable us to bring the Dr. Lisa Radio Hour to you each week. This is Dr. Lisa Belisle, hoping that you have enjoyed our Summer Wellness Show. Thank you for allowing me to be a part of your day. May you have a bountiful life.

[Unidentified voice]:

Sa.