Living Well Integrative Health Center Spring 2017 Living welllivingwellihc.ca/files/documents/spring2017news.pdf · 2017-05-29 · Living Well Integrative Health 4 2 Here’s a third

Living Well Integrative Health Center Spring 2017

Living well “Spring is the time of plans and

projects” -Tolstoy

SPRING EVENTS:

What can bud and bloom?

We strive to support individuals and their families in their efforts to live wel l by providing diversified coordinated care, guidance and education that encompasses body, mind and spirit. We promote compassion, collaboration and communication because care is "better together."

MAY 16

JUNE 23

MAY30 Make your VOTE count. Health care is a political issue. Have your say.

LW OPEN HOUSE & MENTAL HEALTH CARE FUNDRAISING ART AUCTION

Dr. Patriquin, Monica Rodriguez and the NSHA Community Health Teams partner to bring patients GROUP MEDICAL VISITS for those at risk for metabolic syndrome

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We all have a role and responsibility in engaging the system and contributing to a community and a society that begins to acknowledge shortcomings not as failures but as realities that through open communication, active listening and valuing what is heard we can truly collaborate and generate healthy sustainable solutions. Holding space for this new way we can begin to see possibilities, think creatively and find solutions to our growing crisis. Being open, honest, respectful, kind and communicative are shared values that do not undermine a system and deter people from using; rather they build trust and encourage people to use it with a knowledge that their experience will be compassionate and humanizing. This is at the heart of what can transform our medical system. Dr. Maria Patriquin MD, founder

Living Well Integrative Health

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Trauma Practice Research Project

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I am excited to be a clinician in the Trauma Practice Research Project (lead investigators Dr. Anna Baranowsy, Traumatology Institute, and Dr. Robert Muller, York University). The Trauma Practice Model is primarily a Cognitive Behavioral Therapy approach to trauma recovery that was developed by Drs. Anna Baranowsky, and Eric Gentry. It follows Herman’s triphasic model of trauma recovery (establishing safety & stabilization, remembrance & mourning, and reconnecting), and offers many different techniques that can be individualized for each client. For the purposes of this research project I am accepting clients/referrals for clients who have experienced a type I trauma (single, unexpected event, i.e., motor vehicle accident, sexual assault), and who have not received previous treatment for this. For more information about eligibility criteria and to learn what the requirements of participation are, please contact me at: [email protected]

Erin Montgomery, Registered Counseling Therapist, Accredited Music Therapist, Med, MTA, FAMI, CCC, RCT-C

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I have almost completed my training through the Toronto Traumatology Institute to become a Clinical Traumatologist and am accepting referrals for individuals who have had difficult life experiences resulting in posttraumatic stress and complex trauma. In addition to this training and approach, I have completed training through the Justice Resource Trauma Centre, at the Cape Cod Institute, and have advanced training in using music & imagery for trauma recovery.

Resource: Dr. Anna Barabowsky has a great YouTube channel with many educational videos about trauma recovery available here: http://bit.ly/2pPiUzf


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Today, I have two confessions to make:

1. Prior to becoming a physiotherapist, I didn’t really understand the full scope of physiotherapy in Canada, and

2. I have no idea what putting a “#” in front of an english sentence sans spaces means.

However, after six years as a practicing physiotherapist, and yet another year wiser, what I do know is that #physiocanhelp .

Let me give you a relevant example: here in North America, the opioid crisis is consistently in the news. We’ve all heard the alarming stats: in 2016, there were 61 deaths per month in BC, and 1 in 8 deaths for Ontarians aged 25-34 are related to opioids. Indeed, stories of loved ones who die due to opioid addiction is all too real for too many of us.

The extent to which the problem is caused by medical prescription of opioids specifically for musculoskeletal pain must be noted. Our healthcare system emphasizes pharmaceuticals as the first response to pain management, even though their original use was for palliative care in oncology. Many patients living with chronic pain would prefer pharmacological treatment, hoping it will numb the pain.

We healthcare workers know that we can’t blame our patients for wanting the drugs. Our public system endorses the prescription of opioids for both acute pain and chronic pain simply by paying for such treatment. Conversely, non-pharmacologic interventions are only available to patients who have insurance or are able to pay out of pocket. This leaves the average Canadian with the impression that opioids are effective and interventions such as physiotherapy are not.

#physiocanhelp Robin Stamm is a registered physiotherapist. It is her 3-year anniversary with Living Well.

She has helped many people suffering with chronic pain to learn their bodies and to

cultivate non-pharmacologic ways to manage their pain.


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Here’s a third big confession, and one I believe everyone has a right to know: on a 10-point visual analogue scale (VAS) to measure pain, the mean change in pain that one might expect with an opioid prescription is 0.9 . I would hazard to guess that every first year physio student could tell you that clinically significant change in pain is 2.0 points on the VAS. Indeed, opioids are outright ineffective for chronic pain and they are proven to be high-risk for treating acute pain: half of the individuals prescribed an opioid in

North America will become addicted. In fact, t he long-term solution to the opioid crisis will come when every Canadian has access to the best healthcare to deal with pain.

Physiotherapists, and likely all kinds of manual and movement therapists, know that there is a better way. Just like food can be medicine, the right movement is medicine for the body. We must be willing to move into the areas of pain, work through the areas of pain, and then the body can release the pain. In school we were told that if you could put the benefits of proper nutrition and exercise into pill form, you would put the pharmaceutical companies out of business.

In celebration of a healthier way to manage pain and reduce the use of prescription pain medication, let me sing my profession’s praises ~ May is National Physiotherapy Month here in Canada. “ The American Physical Therapy Association (APTA) and Canadian Physiotherapy Association (CPA) have announced a shared commitment to build on current public and private sector initiatives to address the epidemic of opioid abuse, and the tragic impact it has on society, families, and individuals.”

Please go to physiocanhelp.ca or speak with Robin for more information.

Resources:

Opioid Conference, November 2016

http://healthycanadians.gc.ca/healthy-living-vie-saine/substance-abuse-toxicomanie/opioids-opiodes/index-eng.php

Physiotherapy Practice, March/April 2017, Vol.7, No. 2

Joint CPA-APTA Statement: North American Collaboration to Address Opioid Epidemic, January 2017 http://www.apta.org/uploadedFiles/APTAorg/Media/Releases/Consumer/2017/APTA_CPAStatement_CollaborationO nOpiodEpidemic.pdf

Continued


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Fiber can help lower cholesterol, regulate blood sugars, improve digestion and help with weight loss. While many of us know that fiber is important, most Canadians don’t get enough. The daily target for women is 20-25 grams and for men 30-38 grams. There are lots of great food sources, all of which are plant-based foods: fruits, vegetables, whole grains, dried beans, legumes, nuts and seeds. Adding foods that are fortified with fiber – such as some yogurts -- can also help.

Try boosting your meals and snacks with fiber-rich foods. Here are some foods that top the fiber list: Asian pears, blueberries, bananas, and apples; green peas, spinach corn, broccoli, and potatoes; whole grain breads and cereals, brown rice, oatmeal, and buckwheat/soba noodles; all dried beans, nuts and seeds. A little here and there – it all adds up to incredible health benefits. Be sure to increase your fiber gradually and drink plenty of water!

Looking for ways to increase your fiber intake? Try these delicious wholesome muffins – each is packed with 6 grams of fiber! These grab and go snacks are easy to make, super moist and sure to please anyone. Enjoy!

Awesome Blueberry Muffins Makes 18 muffins: 143 calories + 6.2 grams of fiber/muffin

3 cups natural bran

2 cups whole-wheat flour

½ cup sugar

1 Tbsp. baking powder

1 tsp. baking soda

2 eggs

1 cup milk + 1 cup plain yogurt mixed together (or 2 cups buttermilk)

¾ cup unsweetened applesauce

½ cup molasses

1 cup frozen blueberries

Mix dry ingredients in large bowl. In smaller bowl, mix wet ingredients. Pour wet ingredients into dry bowl and mix well. Line muffin tins & bake at 375F around 20 minutes or browned.

Healthy Bites: Focus on Fiber by Monica Rodriguez, MSc, RD Registered Dietician

This updated classic is one of my favorites from Cathy Fournier RMT

Chocolate Chip Cookies (Dairy Free/Gluten Free)

2 1⁄2 cups blanched almond flour * 1⁄2 teaspoon sea salt1⁄2 teaspoon baking soda 1⁄2 cup grapeseed oil

1-tablespoon vanilla extract 1⁄2 cup agave nectar 1 cup chocolate chunks

1. Combine dry ingredients in a large bowl

2. Stir together wet ingredients in a smaller bowl

3. Mix wet ingredients into dry

4. Form 1⁄2 1-inch balls and press onto a parchment paper lined baking sheet

5. Bake at 350° for 7-10 minutes cool, serve. copyright © 2013 elana's pantry. all rights reserved.


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Living Well Welcomes Katrina Crowson, TCTSY-F in offering Trauma-Sensitive Yoga Lessons TCTSY is Hatha Yoga with an emphasis on a body-based experience. It is an empirically validated, adjunctive treatment to therapy, for complex trauma, chronic treatment-resistant PTSD, and/or grief-induced trauma. TCTSY has foundations in trauma theory, attachment theory, and neuroscience.

We use yoga forms to practice making choices, to notice how we feel in our body, and to learn that we are in charge of our body. Would you like to try it?

Trauma Centre Trauma-Sensitive Yoga Facilitators are trained through the Trauma Centre at the Justice Resource Institute in Massachusetts USA, founded by Bessel van der Kolk- author of The Body Keeps the Score.

Katrina is the first graduate of the TCTSY program in Atlantic Canada. Katrina holds a 500-hour yoga certification in Hatha yoga, as well as in the tradition of Krishnamacharya. For the last decade she has also been studying the Alexander Technique iPAC. Katrina owns and operates Yoga in the Workplace.ca. She has been teaching on-site yoga classes to mixed-level groups in a variety of businesses and organizations since 2006.

Katrina currently teaches group TCTSYoga lessons at Living Well Integrative Health Center as an adjunct to treatment for those who are experiencing treatment resistant traumatic stress. Katrina's private lessons allow for the option of choosing the yoga forms you would like to experiment with, or maybe having her suggest a practice for you to follow.

Are you a veteran living with PTSD? Feel free to contact Katrina to inquire about having your TCTSYoga lessons covered by Veterans Affairs Canada.

Email: [email protected]


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So, What’s a Nurse Practitioner anyway?! Understanding how Nurse Practitioners fit into your health care. by Lesley MacGregor MN, NP on April 21st, 2017

As the newest member of the Living Well Integrative Health Center, I would like to take a moment to thank Dr. Patriquin and the Living Well team for their warm welcome. It has been almost 2 months since I have joined this dynamic team of healthcare professionals, and I could not be more grateful for the opportunity to practice in this exceptional environment.

I would also like to thank the patients whom I have been involved with to date. Although change can bring on apprehension and feelings of uncertainty - the patients whom I have had the pleasure to care for have embraced this change - and for that I am truly thankful.

As a new resident of Halifax - I must admit, I was surprised to discover that Nurse Practitioners were not as commonly found as in Ontario and Alberta - where I have practiced in previous years. With that in mind - I thought I would take the opportunity to provide some information to the patients of Living Well.

Nurse Practitioners: In a nutshell, we are Advanced Practice Nurses - which means that we are Registered Nurses who have extended our education and training that includes a post-graduate degree (Master’s Degree), clinical (hands on) training and national examinations. We are registered and monitored by our Provincial regulatory body - (College of Registered Nurses of Nova Scotia).

Nurse Practitioners are autonomous clinicians - which means that we have the ability to make clinical decisions independently without “approval” from any other health care professionals. Nurse Practitioner are able to assess, diagnose illness, order laboratory and imaging tests, write prescriptions - including controlled drug substances (narcotics) and make referrals to other members of the health care team.

Why Nurse Practitioners? - well, as we know here in Nova Scotia - finding a primary health care provider (family doctor or nurse practitioner) is an ongoing challenge. This is a growing problem that is putting enormous amounts of stress on our Family Doctors. Many, many research studies have proven that in order to provide high quality, accessible health care - we must embrace a “collaborative healthcare delivery model”. Meaning, clinicians need to work together as a team and “collaborate”. Nurse Practitioners are a key part of this collaborative care model and have been proven to provide high quality, cost effective healthcare to our patients.

What does that mean for you at Living Well? - Dr. Patriquin and I are working together to provide you with high quality and comprehensive care. By using this approach we each bring our unique perspective, background and experience... and that means - more access - same day appointments - shorter wait times - and a “team based” clinic dedicated to ensuring our patients are well cared for. If you have further questions - please don’t hesitate to ask me in clinic. Also, for your reference check out the below websites for even more information on Nurse Practitioners!

Stay healthy and live well! Lesley http://crnns.ca/nursing-in-nova-scotia/types-of-nurses/nurse-practitioner/ https://www.youtube.com/watch?v=wuBq_N-K7UE http://www.npans.ca/cmsAdmin/uploads/NP_Brief_final-1.pdf


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Dr. Maria Patriquin on Mental Health Care in the Collaborative Model: We appear to have departed from age-old wisdom and refer to the mind and body as if they were separate entities. As there is no duality, there technically should be no treatment of mental illness as different from physical care and as such mental health affects us all. All experiences of being human are accompanied by emotional and cognitive responses that comprise part of our mental health and wellness and similarly can be afflicted with dis-ease. We know the evidence for care in the setting of what is established “mental illness” albeit heavily medicalized so I want to speak to some of the broader considerations for “mental health” care. At a very basic level appropriate care for patients must always consider and encompass an element of emotional or mental health care. Even in the face of what appears to be strictly physical, there are accompanying emotional and cognitive processes that require some exploration in order to ensure patients understand and feel in a healthy position to make informed decisions. I believe that early detection and intervention is important and believe strongly in the role of prevention and healthy communication around emotional health. Talking to patients while pregnant about their emotional health and wellbeing affects them positively. Parents are in such a powerful position to influence the way children grow and conceptualize their own health physically and emotionally. Collaborating with parents and children is key to fostering healthier lives and communities. We have the most number of elderly per capita in all of Canada. Knowing how to age well is important and protective. At the other end, compassion and emotional care are so integral to aiding our patients in being able to fare well what is physical decline and frailty as they age. Being able to talk to our patients about their joys and fears as they pass is only kind and is a unique privilege we earn through enduring relationships based on kind care. This kind of care is not valued, taught, encouraged or supported and needs to be. A reductionist, mechanistic approach to research and medicine coupled with a materialistic approach to consumption and provision of medical care has contributed to a shift away from wisdom of an integrated whole and contributes to an unhealthy approach to mental health and wellbeing. Our current provision of care is predicated on an illness-based model. This approach aims to treat disease, not the person. It focuses on deficits and lack of capacity. It is no wonder that it does not serve mental health care needs and contributes further to the stigma that already surrounds “mental illness”. A wellness-based model is one that considers the whole person. It is a strengths based model that embraces the bio psychosocial approach to care and places value and credibility on prevention, some medicines, interventions as well as non-medicinal approaches to care including diet, exercise, socializing, social support, one’s environment, faith, culture, sense of purpose, meaning, value and emphasizes the positive role of counseling and psychotherapy. It seeks to educate, build skills, capacity and foster resilience, which is both protective and therapeutic. It places the patient at the center of their care emphasizing choice and aligning with being patient-centered, an important pillar of the collaborative care model.


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The reality is that our system is not well nor is it serving the needs of neither patients nor providers. This creates barriers to accessing and providing care. An overreliance on evidence based medicine has replaced common sense and has discouraged and created artificial divisions where there should be integration and interdisciplinary collaboration. It has also contributed to a culture where there is more emphasis on numbers and outcomes rather than the whole person. There is lack of consideration for the qualitative experience of what is supposed to be a healing interaction and relationship between provider and patient. There is a growing body of evidence that demonstrates empathic exchange or compassionate care has significant positive health outcomes and this is not factored into the existing model. Outside some mental health care clinics hang what is internally referred to as “the wall of shame”. Provider quotas for the day, week and quarterly are visible to those awaiting care similarly for the viewing of colleagues walking by. This fosters competition, resentment, and misunderstanding and undermines the therapeutic relationship. The visible and not so visible walls of shame are contributing to our unwell system and pose significant stress and threat to the providers within it causing alarmingly high rates of mental health issues. Coupled with limited resources and high demands, mental health care providers are incredibly stressed and burned out. This is not a healthy place from which to care and indeed takes the joy from the job, which on all accounts is palpable. It robs patients of the healthy therapeutic relationship from which they can be cared for, learn from and heal. We are a healing profession and a numerical, quota based approach undervalues the art to our healing practices and deprives us of an essential joy through connection to what is meaningful for us; the work, the patients and each other. The greatest threat is to our system is the mental health of all front line health care workers and this is more pronounced in those who provide mental health care. This further contributes to the care deficit as it is accompanied by greater rates of compassion fatigue, burn out, sleep disorders, anxiety, depression, higher rates of substance abuse and suicide. It contributes to more sick days, reduced work hours, earlier retirements, greater rates of relocation and more family conflict. We cannot provide authentic care unless we are authentically living and working our value of health. We live in a chronically stressed society where every industry monopolizes on not been well or whole in some manner. Children are exposed to and suffering high rates of early life adverse events that are known to have significant long term health consequences again emphasizing the limitations of a health care model that conceptualizes mental and physical health as being separate entities. Our society promotes fast foods, unhealthy sedentary lifestyles, detachment and isolation leaving many devoid of meaning and feeling undervalued. Avoidance, quick fixes, addictions, expectations and impatience grow in what is an ever expanding appeal of “on demand” culture. These circumstances contribute to the development of more mental illness and the crisis-to-crisis coping strategy is ironically mirrored in our resource-limited provision of care. The very narrowly defined scope of collaboration has limited us and placed us in a larger deficit position. NPs, RNs and pharmacists are extremely valuable but do not comprise what is a full constitution of mental and physical health care providers. This leaves a huge gap and negates the wisdom and expertise of a large number of practitioners that could ease the burden on the institutionalized system, family doctors, patients and their families. It would also help decrease wait times.


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These for example include the role of certified clinical counselors, psychologists, trauma informed therapists, clinical social workers and counseling nurse practitioners, midwives, many medical subspecialties, physical therapists, massage therapists and dieticians. Food is medicine. Exercise is medicine and so on. It takes a team and we underestimate the capacity of existing resources by devaluing the role of others. Miscommunication and constraints lead to misunderstanding paired with quota-based deliverables contribute to a system that fosters competition not collaboration. Our stress fosters resentment and blame. That is not a healthy space from which to care. Showing compassion to other health care providers and our patients enables us to collaborative in a constructive therapeutic manner. Collaboration does not merely require a systems review or a detailed budget. It naturally is fostered when all those within in feel heard, valued and are shown compassion and respect. If we are open, aware, transparent and communicative we can deal with the crisis head on. What we don’t know can hurt us. Suggesting that we deny a crisis reflects the illness model by suggesting that we are deficient and lack capacity to handle the truth. This unhealthy response is a symptom of our system. Knowledge is power. The very tactics and strategies used are perpetuating and growing a catastrophe at the cost of our shared sense of humanity and at the cost of people’s lives and wellbeing. Hippocrates was known to have said, “Opposites are cures for opposites”. We all have a role and responsibility in engaging the system and contributing to a community and a society that begins to acknowledge shortcomings not as failures but as realities that through open communication, active listening and valuing what is heard we can truly collaborate and generate healthy sustainable solutions. Holding space for this new way we can begin to see possibilities, think creatively and find solutions to our growing crisis. These are the shared values that do not undermine a system and deter people from using it rather they build trust and encourage people to use it knowing there will be value in a humanizing experience. This is at the heart of what can transform our medical system. As someone who has both used mental health care services as well provides them, I have intimate knowledge of just how hard it can be. The difference between a human and a human being with mental illness is a degree of suffering. We are all suffering and it is time to humanize this experience and work together towards a shared vision with common values for health and wellbeing that should serve to attract people to work here as well to retain those of us who really believe in healthy sustainable collaborative practices. Hippocrates said, “I have clearly recorded this: for one can learn good lessons also from what has been tried but clearly has not succeeded, when it is clear why it has not succeeded.” “Wherever the art of Medicine is loved, there is also love of Humanity”, Hippocrates. Dr. Maria Patriquin, Founder of Living Well Integrative Health Center Founding & Board member of the Association for Positive Psychiatry of Canada Mental Health Committee Atlantic Canada Representative; College of Family Physicians of Canada, Assistant Professor Department of Family Medicine, Dalhousie University Recipient of the 2016 Patient Medical Home Care and Compassion Award Key Informant and consultant for the current development of a Primary Care Collaborative Toolkit , Doctors NS.

2176 Windsor Street, Halifax NS Phone: (902) 406-1500 Fax: (902) 406-1501

Visit us at: www.livingwellihc.ca

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Save the date: We look forward to seeing you at our Open House and Art Auction

Fundraiser for Mental Health Care Programming June 23rd 12-7pm

Light food and refreshments will be served. Children welcome

always.


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Living Well Integrative Health Center Spring 2017 Living welllivingwellihc.ca/files/documents/spring2017news.pdf · 2017-05-29 · Living Well Integrative Health 4 2 Here’s a third

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