Dr. Brooke’s Nook
Reflections on Hormones, The State of Family Practice, and Concierge Wellness
By Dr. Brooke Azie-Rentz, ND
I am sitting here on the 2nd night of a 3 day conference on bioidentical hormones and functional endocrinology, after having been lectured at for 9 hours straight on things I learned 14 years ago that Naturopaths have been doing for decades, realizing that I am not crazy! How I look at the art of medicine is now becoming the mainstream model. At the time I was graduating undergrad, it was being said that there would be a shortage of primary care physicians by 2015. When I decided to move across the country to attend Bastyr I told my parents that Naturopathic medicine was the wave of the future and that when that wave was sweeping across the nation, I would be in the perfect position to be surfing that wave and making a large impact on not only my local patient population and community, but the entire profession. I feel that that time is NOW.
At this conference, I am sitting among mostly MDs, ARNPs, PAs, and pharmacists that are learning about optimal levels of hormones and how current standards of normal on laboratory tests are not, in fact, optimal. In fact, one lecturer, who graduated from medical school 40 years ago, said that she learned that TSH was best under 2.5 and to always check free T3 and give desiccated thyroid (Armour) to patients as well as treat their adrenals. She remembers when Synthroid came on the market and she never understood why doctors stopped giving T3! We are discussing how when men and women hit menopause/andropause not only do their sex hormones go down, but this stresses out their adrenal glands, which leads to insulin resistance and diabetes, thyroid dysfunction, immune dysfunction, GI malabsorption syndrome/leaky gut… they have said you have to treat the underlying cause while also treating the whole person at least 50 times. My patented diamond pattern, chair- analogy (if you haven’t heard it, just askJ) has been explained at least 4 different ways… and us Naturopaths thought we were the only ones out here on this island of functional medicine and physiologic dosages. Basically, these lecturers are saying that when a patient walks in they are not just a thyroid patient, or a menopausal woman, or an IBS patient, they are a person who is a result of their lifestyle, diet and environment. You have to know how they eat, where they work, how they play, what’s their stresses… you have to know the person. You have to treat the whole person. And only by treating the whole person can we truly achieve wellness and optimum health.
And this brings me to our current health care model and our decision to switch to a concierge model at AIM. At this conference, these lecturers are talking about hour long initial visits with 30 min follow ups monthly for 1-3 years and then every 3-6 months for the duration of their doctor-patient relationship. They understand that because of the interwoven nature of the human body, changing one hormone has an effect on all the others. Therefore, rather than making sweeping changes all at once, they recommended changing 1 thing and following up a month later to see if thing got better/worse/same and then making the appropriate adjustment. They realize that change takes time. Menopause is a change that takes place over the course of 5-10 years, the chance of getting the dose right the first time is like trying to hit a moving target. With the effect of diet, lifestyle, age, supplement/medication status, diurnal hormonal patterns, cell phone radiation, xenoestrogens, etc. on all of our hormones and pathways, constant dialogue and check-ins are necessary to keep patients in optimal health. In addition, the lecturers at this conference utilized alternative lab testing such as saliva and stool and expanded testing panels to get a better overall picture of hormone/nutritional/GI status.
Wow…déjà vu… does this sound familiar to anyone else?
This is what I teach to my preceptors, residents, colleagues and patients.
I asked, how do you charge insurance for all of this? I was greeted with a laugh. She hadn’t taken insurance in 12 years was her reply! Her patients were willing to pay cash for her and all of her non-covered lab testing because she was getting results when no one else was. She was the last resort for many patients who had already been worked up by every specialist that could get their hands on them.
I believe the downfall of specialized allopathic medicine is that they don’t see the connections. The psychiatrist doesn’t take into consideration that if someone has a gluten intolerance it can cause depression. The only way you can fully see the whole person is to take the time to do it.
The allopathic model of 8 minute visits is not conducive to understanding the whole picture and taking the time to look deeper into diet and lifestyle as part of someone’s overall health picture. The main lecturer of this conference no longer does primary care; she is a specialist in metabolic and functional medicine. I don’t think that this medicine has to be a “last resort” type of medicine, or something that is only available to those with disposable income. Many people have found myself and AIM by word of mouth, maybe in a “last resort” way at first, but hopefully realize that health and wellness is a lifelong pursuit. The concierge services we are offering provide ways for our providers to have frequent contact that enable us to “keep our finger on the pulse” in a way. Adjustments or recommendations can be made more frequently when we can communicate more often, and I understand that deductibles and co pays can make frequent visits and lab testing cost prohibitive. I really do have a passion for making people better, but sometimes insurance companies can tie my hands behind my back.
My hope with our concierge packages is to make the idea of prevention medicine and optimization of health and wellness a reality. Through doctor-patient collaboration we can achieve wellness; we can prevent “dis-ease”. I don’t want to be a specialist. I like family practice. I like seeing a little bit of everything in my day to day patient load. I like the challenge of tailoring treatment plans to meet a person’s dietary restrictions/preferences/allergies, ability to take/absorb certain preparations of supplements/medications and individual body compositions. I like people. The human body is an amazing, beautiful, complex puzzle, and I am thankful to all who let me assist them in putting theirs’ back together.