This song came on today while I was driving home from a Plano hospital after making rounds. May it add peace to your life today as it has mine.


Instrument of Peace – Olivia Newton John – Lyrics

Where there is hatred, let me bring love.
Where there is doubt, let me bring faith.
Where there is falsehood, let me bring truth.
Where there is pain, I’ll comfort you.

Where there is silence, let me sing praise.
Where there’s despair, let me bring hope.
Where there is blindness, let me bring sight.
Where there is darkness, let me bring light.

And with these words I speak
Grant that I may not so seek,
To be heard but to hear
To be consoled but to console,
Not to be seen, but to see
To be loved but to love.

For when we give love we will receive.
When we forgive love, we’ll find reprieve.
It is in dying we’ll be released.
Make me an instrument of peace.

We live in an environment surrounded by pollen, pet dander, viruses and bacteria that have the potential to make us sick or sneezy. Our immune system chugs along, day in and day out, sorting through these exposures and fighting back when a potential threat to our health occurs. But is it me, or do we only notice our immune system when it lapses? We get a head cold or cough and then start in on the healthy routine to come back into balance.

Let’s do this: let’s acknowledge the importance of our immune system in a series of lifestyle strategies that are especially important now that the winter colds and flu season has arrived.

Six steps to getting stronger

Here’s a checklist to help keep your immune system strong every season of the year:

1. Nutrition is key. Avoid white sugar and sweets. Grab a piece of fruit or a handful of raisins instead of cookies, cake or pie. Watch out for oil that has gone rancid (use your nose) and check expiration dates carefully on packaged and canned goods. If your body is exposed to a lot of inflammatory foods like these, your immune system is “distracted” in its efforts to protect you.

2. Get moving. Walk 30 to 45 minutes at least three times a week. If walking hurts, try a recumbent bike or water-based therapy. Your body systems all work better when you are active – this includes your immune system!

3. Examine your exposures. Look carefully at your exposures to heavy metals like mercury (silver dental fillings or farm-raised salmon) or pesticides or other potential environmental toxins. See the Environmental Working Group’s “Dirty Dozen and Clean 15” (ewg.org/foodnews/) to get an idea which foods from commercial growers can be safely consumed, and which fruits and vegetables should only be bought from organic growers.

Ask your dentist if any of your mercury amalgam fillings are old and cracked and make sure the dentist knows how to replace them safely so you aren’t exposed to mercury when they are replaced. Chemicals like these interfere with your liver’s ability to detoxify – which hampers your immune system’s ability to do its job.

4. Get your balance. Check with your integrative medicine practitioner and make sure you are on a good balance of antioxidants, essential fatty acids, electrolytes and magnesium. Be aware that everyone’s nutritional needs are unique. If you aren’t getting adequate micronutrients like these from your diet, adding nutritional supplements can be helpful. Ask your practitioner to assess and monitor how much you need.

5. Control your stress. We know that our immune system is closely tied to our hypothalamic-pituitary-adrenal axis, which allows us to respond to both short- and long-term stress. We also know that the strategies here can’t take all of our stress away, but we can certainly learn to cope so that we can become more resilient and less reactive to life’s stressors.

6. Sleep well. Turn off the computer monitor or the TV and start a relaxation practice. It could be breath work or prayer or meditation… figure out how to “unwind” so that your sleep is deep and restful. If there is a question of sleep apnea, consider getting a sleep study and assessing the quality and quantity of sleep.

We know that a lot of our body’s restorative and detoxifying systems kick into gear while we are asleep. Rather than medicating with a prescription drug, explore emotional, mental, physical and spiritual aspects of your health to see if you and your practitioner can understand why you’re not sleeping well.

The winter cold and flu season isn’t a problem for people who follow the guidelines here. Remember our immune system and allow it to function optimally. That is nothing to sneeze at!

Initially published in TriVita Newsletter

Textbook of Functional Medicine 2010, Institute for Functional Medicine, Ed. David S. Jones

“Patience is necessary, and one cannot reap immediately where one has sown.” – Soren Kierkegaard

I am delighted to announce that my contract to practice at the Baylor Integrative Medicine Center is now official and signed. I am so grateful to all my wonderful friends at Living Well Dallas who allowed me to continue to work intermittently while we were “crossing t’s and dotting i’s”.

I will be scheduled one day a week at the Virginia Cvetko Education Center at the Baylor University Medical Center. The center is located on the third floor of the Sammons Cancer Center, 3410 Worth Street, Dallas, TX 75246. To schedule an appointment, please call Polly at 214-820-3595.

Be Well,

Claudia Harsh, MD

I have made a move this month out of my full-time integrative practice back into a more traditional medicine job. I am excited to be working with the gynecology oncologists at Texas Oncology at Baylor University Medical Center Baylorin a supportive role. I will be seeing their clients who are being monitored for pre-invasive diseases of the uterus, cervix, vagina and vulva and working with them in the clinic setting. In addition, they have asked me to help set up a “survivorship” program to help cancer patients who have completed their therapies to regain their emotional, mental, physical and spiritual health. The best part of this is that we have NO IDEA what this will look like. One on one patient visits? Group visits? Web-based materials? Develop hand-outs? Just thinking about the possibilities makes me smile.

I also plan to work in the Cvetko integrative medicine center at Baylor one day a week so I can keep my acupuncture skills and continue to care for my integrative medicine clients. This part of the job is still in process. Once it is confirmed, I’ll post a note. In the meantime, the lovely team at Living Well Dallas has agreed to let me schedule over the next few months while all the arrangements are being finalized.

Blessings to you and yours during this season of growth and change!

Claudia Harsh, MD

The Abstract from Michelle D. Holmes and Wendy Y Chen’s recent review article just published in Breast Cancer Research is eye-catching….here it is verbatim:

Many medications have been developed for one purpose but then are found to have other clinical activities. There is tremendous interest in whether non-cancer medications may potentially have effects on breast cancer survival. In this review article, we have presented and evaluated the evidence for several commonly used over-the-counter and prescription medications – including aspirin (and other non-steroidal anti-inflammatory drugs), beta-blockers, angiotensin-converting enzyme inhibitors, statins, digoxin, and metformin – that have been evaluated among breast cancer survivors in prospective studies. Substantial scientific evidence supports the hypothesis that some of these common and relatively safe drugs may reduce breast cancer mortality among those with the disease by an amount that rivals the mortality reduction gained by currently used therapies. In particular, the evidence is strongest for aspirin (approximately 50% reduction), statins (approximately 25% reduction), and metformin (approximately 50% reduction). As these drugs are generic and inexpensive, there is little incentive for the pharmaceutical industry to fund the randomized trials that would show their effectiveness definitively. We advocate that confirmation of these findings in randomized trials be considered a high research priority, as the potential impact on human lives saved could be immense.

Breast Cancer Research 2012, 14:216 doi:10.1186/bcr3336

You know what I’m going to say here…the answer to reducing breast cancer may NOT be adding a pharmaceutical drug. Where is the control group that removed xenoestrogens and pesticides from their environment? Where is the control group that increased their consumption of cruciferous vegetables or supplemented their nutrition to modify their estrogen metabolism? I could go on…

But you know I am going to watch this data carefully …

I am writing a couple of articles for a nutraceutical company and it’s giving me a chance to pause and reflect on my top recommendations for optimal health and well being. With more than twenty years of medical practice experience, I’ve come to honor the ability of our bodies to come into balance and heal. On the other hand, I see that there are several individual choices we can make to encourage this healing and balance. Here are the top ten recommendations – in reverse order of course!
10) Pay attention to the cycles of nature around you. When the earth is resting in the wintertime, slow down! Dormancy and rest are important times in our lives. These can be distilled down to a monthly conscious awareness of the moon cycle. During the new moon each month, pause and reflect on what you want to grow in your life as the moon waxes to full. During the full moon, consciously pause to acknowledge your accomplishments – we are quick to remember “negatives” in our lives and oh so slow to connect with the positives. For guidance in this process, I recommend studying with Lisa Michaels and the Natural Rhythms Institute. I joined nine Natural Rhythms experts to collaborate on our book “Nature’s Success System” which was published through Hay House last year.
9) Assess the relationships in your life. Do they continue to serve you? Do the friends and family you interact with offer unconditional love and support? Do you offer unconditional love and support to your friends and family? We all know people that “drain” us – recognize who and what circumstances make this worse. Find a mental health professional and explore the reasons why you stay in relationships that are unhealthy.
8 ) Become conscious of your physical health along with your core strength and posture. Move your body every day: walk, run, bike, swim – whatever! Abdominal exercises and pilates can help; yoga, tai chi or chi gong can help you become more conscious of how you hold your body as you stand, sit and exercise. I have gained an appreciation for chiropractors, massage therapists and other body workers through the years. They “repair” the damage that poor posture and overuse and inflammation have caused.
7) Ask your doctor to measure your 25-OH vitamin D3 level. Supplement as needed to the 50 – 80 range. For some people the best dose is 400 IU daily, for some it is 5000 IU. Some people need 50,000 IU weekly for three months to build up their stores and then 1000 to 2000 IU daily. I disagree with “one dose fits all” and suggest that following vitamin D levels is the ideal way to know how much of this important vitamin to take.
6) Add a high quality fish oil to your diet or eat ocean-caught fatty fish (tuna/salmon/mackerel etc) three times a week. Most people benefit for 2000 mg of EPA and DHA daily. Ask for advice from your integrative physician about whether or not you need a higher dose or an adjusted ratio of the two fats if you have an autoimmune or inflammatory disease. Avoid bargain discount fish oil and look for supplements that have had heavy metals like mercury removed. If the brand you’re using gives you a fishy “burp-back”, find a supplement that has had the fish proteins removed from the fat and keep the bottle in the freezer and take the capsule frozen.
5) Learn and practice some time of relaxation breath work every day. It can be as simple as paced breathing – counting on the inhalation to three, holding for a count of three, counting on the exhalation to three and holding for a count of three. While you’re breathing, become alternately aware of the bottoms of your feet and your connection to the earth and the crown of your head and your connection to the sky or cosmos. My favorite type of paced breathing like this connects with a prayer or an affirmation. An example would be an in breath with the mental recitation of psalm 23; I might inhale with the thought “The Lord is my shepherd” and then during the pause I’d consider what it means to have a shepherd. I would then exhale and pause and with the next inhale I’d recite “I shall not want” and then during the pause I’d consider what it means to have all my needs provided. I’d continue through the psalm line by line, stopping and pausing with each breath purposefully.

4) While you’re breathing, learn and practice other types of stress management. For you it may be prayer, meditation or listening to a guided imagery cd. Seek out practitioners who can teach biofeedback techniques or Heartmath™. Consider an energy medicine appointment with practitioners that do Reiki or Healing Touch. Try a “spirit walk” in a nearby park or woods – breath in as you walk on your right foot, breath out as you walk on your left foot. Whatever you choose, make time to do it daily. It is as important as eating and sleeping!

3) Grow your connection to your creator. Honor the gift of life you have been given today. Look with gratitude at the opportunities and blessings that you’ve received. Seek out pastoral or spiritual support to help in this area if needed.
2) Pay attention to the quality and quantity of sleep you receive each night. Sleep is our opportunity to restore our neurotransmitters and remove toxins from our body. What is interfering? Is your brain still wound tightly with worry or anxiety? Is your body sore or inflamed? Is your spirit troubled? Is your nutrition sub-optimal and filled with stimulants like caffeine and sugar? Explore this with your integrative physician – the solution is NOT solely a sleeping pill!
1) Nourish your body with lots of whole grains and colorful, organic, locally-grown vegetables and fruit. Learn to can and freeze the produce when it is abundant to last you through the winter. Add lean protein in a small amounts and keep the processed food to a minimum. Your life force energy is fed by the quality of your food!

May these suggestions guide you to a path of health and healing…Be Well!
Claudia E. Harsh, MD

I thoroughly enjoyed the opportunity to talk to the breast cancer support group at the Jewish Family Services Center here in Dallas this week. This was my second visit with them and again I was impressed by the intelligence, passion and generosity of the women who are drawn to this program. This time I was introducing the idea of an integrated approach to anxiety and depression. According to the National Institute of Mental Health, the prevalence of depression in the general population in 2008 (the latest year for which statistics are available) is 6.7% of the adult population and the prevalence in women is 8.1%. Adding the diagnosis of breast cancer understandably bumps the prevalence slightly higher.

I reviewed the current pharmaceutical and nutraceutical approaches to depression and anxiety and also led the group through some paced breathing and the quick coherence technique of HeartMath. One woman announced that the breathing exercise made her feel calmer than she’d been all day!

During the discussion, one women raised the question about Tamoxifen and anti-depressants. Her oncologist told her that only a few anti-depressants could be prescribed to women on Tamoxifen. Since this is relatively new information, I’ve been researching the claim for the group and decided to post my findings here in the blog.

The concern stems from a study done in Ontario that was published in the British Medical Journal (Kelly CM et al. BMJ 2010 Feb 8:340). This reference is available on PubMed. The researchers looked at women over 66 who were on Tamoxifen and found that the mortality rate was higher in women on Paxil (paroxetine) versus some of the other antidepressants. The reason appears to be that Tamoxifen is broken down in our livers by an enzyme called cytochrome P450 2D6 (the name of this enzyme is often shortened to cyp2D6). Some medications including Paxil are also broken down by cyp2D6. If someone has a genetic variation such that this enzyme is not as efficient, they are often called poor metabolizers. This genetic variation is called a “snip” for the abbreviation single nucleotide polymorphism. If they are poor metabolizers, they will be unable to break down the Tamoxifen effectively and its benefit will be “blocked” by medications that use this pathway. (sort of like musical chairs and everyone is competing for the same seat) Paxil is metabolized by this pathway, so is Thorazine, Prozac, miconazole (a yeast medicine), and quinidine – to name just a few. If a medication has no inhibition or a weaker inhibition of cyp2D6, the Tamoxifen will be broken down more efficiently – for that reason the authors suggest Celebrex or Lexapro because they don’t compete as strongly for cyp2D6.

I read a review article by Kathleen Pritchard which was published in Breast Cancer Research Vol 12 Supp 4 (also on PubMed) and she notes that there are studies that refute the claim – one from Denmark, for example, and states that the final answer isn’t really known as far as SSRI’s and Tamoxifen. Some people are suggesting that we should test the urine for endoxifen (a break down product of Tamoxifen) and make sure that the drug is being effectively metabolized. This isn’t the standard of care as yet, nor is checking women to see if they have genetic SNP’s in their detox genes.

I’ve done the gene testing on people if they note a lot of side effects from a long list of medicines or if we’re suspicious of a problem. The testing is fairly expensive ($500 to $1000 depending on which genes we test) and is NOT covered by insurance. Another wrinkle in the discussion, whenever genetic screening comes up, is how likely is a SNP? We know from population studies of the SNP’s for cyp2D6 that about 6% of Caucasians are “poor metabolizers” of this gene. Other ethnic groups show poor metabolizer rates of 3.3% (Black North Americans), 8.4% (French), 7.7% (Southern Germans) and practically 0% in Korean and Chinese populations.

So, the take home message is Tamoxifen and anti-depressants can mix – but choosing a medicine that is less likely to interrupt the enzyme cyp2D6 is probably a good idea. Or better yet, learn coherence training and get regular acupuncture treatments!

Until next time, be well!

Most of us know how relaxed and blissed-out we can feel after a massage.  We can feel the energetic exchange of a trained masseuse focusing on our tired neck and shoulders. We can notice our tight back muscles releasing tension with a combination of massage and stretching. As the recently published Get Well & Stay Well book by Drs. Steve and Sandi Amoils noted:

“There are literally hundreds of forms of massage and bodywork, including deep tissue massage, medical massage, myofascial release, postural integration, Rolfing, shiatsu, Swedish massage, Thai massage, Trager Approach, trigger point therapy and watsu.”

They also note that massage can have a profound effect on health including:

“Studies done by Dr. Tiffany Field on premature babies showed that those who received massage gained weight much more quickly than those who were not massaged. Studies of massage for patients with back pain show they have less pain, depression and anxiety as well as improved serotonin and dopamine levels. Other studies have reported that massage helps normalize cortisol levels in patients with fibromyalgia, depression and post -traumatic stress disorder….The healing benefits of touch have also been shown to boost general immune function and promote sleep.

So I was not surprised to read in the recent Science News (March 10, 2012) that there appears also to be a benefit with massage which includes tissue repair and reduced inflammation. Publishing in the February 1st 2012 issue of Science Translational Medicine, the researchers recruited 11 active men to participate in a workout that taxed their quadriceps (the muscle on the front of the thigh). Shortly after the exercise, one thigh on each volunteer received a 10 minute massage and the other didn’t. The researchers took muscle biopsies from both legs right after the massage and also 2.5 hours later. The massaged legs had reduced levels of tumor necrosis factor-alpha, an inflammatory protein along with activated levels of two enzymes called kinases. Two and a half hours later, the biopsies from the massaged leg showed reduced levels of interleukin-6, an inflammatory protein and elevated concentrations of PGC1-alpha, which plays a role in muscle fiber maintenance and cell metabolism.

So now you have no reason not to schedule that massage you’ve been putting off. In addition to relaxation and pain relief, you are also reducing inflammation in your muscles….aaaaaahhhhhh…..

Conscious thoughts today. Conscious (noticing with a degree of controlled thought or observation) thoughts (an action or a process of thinking) today (this segment of time). Conscious of the mind chatter that starts up with the habit of remembering, planning and thinking almost as soon as I bring my awareness to the moment. The Zen saying “gate-less gate” is at once a “thing” to pass through in our mind and also a “no-thing” that acts as distractions to our own heightened awareness.

I am reading about meditation today because I am starting a meditation group that will meet each month in the new moon window this year. I am “re-minding” myself of the different paths through the gate-less gate. I have experienced this type of connection through prayer at church, through listening to or singing music in a large music hall or around a campfire, through backpacking on the Appalachian trail, through workshops and lectures, and through my integrative medicine fellowship.

There is no single path through the gate-less gate for anyone. I hope to explore several approaches and techniques and allow the participants to practice a few of them. The benefit of meditation for me has always been a clearer focus and a lighter mood. David Fontana PhD writes in his book, “Learn to Mediate: A Practical Guide to Self-Discovery and Fulfillment”:

There are four different levels of thinking. The first and lowest level is negative thought, which includes feelings of anger, fear, sadness, regret and unease. Negative thought makes us egotistical and lazy. The second level is wasteful thought, when we waste our time worrying about things that might not happen, or about things that are outside our control. the third level is necessary thought, such as “I must not forget to pay the electricity bill” or “I must remember to send a birthday card”. the highest level is positive thought, which encourages peace, harmony, creativity, love and happiness. In meditation we can free our minds from negative and wasteful thoughts and elevate them to the highest level.

There is science behind this thought dichotomy, too. HeartMath uses the combination of breath work, focused breathing and the addition of a positive thought or memory or feeling to achieve coherence in heart rate variability – a physiologic state which has shown to decrease anxiety, lower blood pressure and improve healing.

So I explore conscious thoughts today. Join me at Living Well Dallas on Monday, January 23rd for the first “Monthly Meditations in the New Moon Window”. Whether you are new to meditation or a seasoned meditator, please feel welcomed to our group. We will begin promptly at 7pm, so please plan to arrive 10 to 15 minutes early so you can be settled and comfortable.

Just read a great blog post about approaching our lives as women in a balanced and thoughtful way….read the post here
may grace shine on all of us.

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