Read this  National Geographic article and then take yourself out on a hike.

Do you have difficulty getting out of bed in the morning, or making it through the late afternoon hours? Do you find yourself reaching for that second, or third, cup of coffee mid-day just to get through? Fatigue can become such a usual feeling that it’s easy to assume that it is an expected part of a fast paced, demanding lifestyle. Fatigue is not normal, and I discuss with my patients why it’s important to discover underlying causes of fatigue. Here are some things to consider having evaluated if you feel frequently tired:

• Sleep – not enough sleep, interrupted sleep, or sleep disorders such as sleep apnea are frequent causes of fatigue. For more information on sleep disorders see this article by the National Institutes of Health.

• Stress – causes multiple chain reactions that contribute to fatigue. There is no avoiding stress in life. The work comes in with developing stress management strategies and continually adapting to change, because life will never be stress-free. This article by Success Magazine outlines several stress management strategies.

• Nutrient deficiencies – Anemia is a common cause of fatigue in women, and low level of D or B vitamin may cause minor fatigue in anyone. Routine blood tests show whether you are deficient in any of these.

• Blood sugar imbalance – Mid-day fatigue is a key indicator of blood sugar imbalance that can lead to afternoon energy crashes. Mental fog and fatigue after lunch or any meal can point to blood sugar issues as a potential cause. You don’t have to be overtly diabetic to have an issue here. Naturopathic physicians, excel at addressing dietary causes of fatigue, so you are best starting evaluation by consulting a licensed ND.

• Health conditions – Low thyroid function can cause fatigue, so it’s good to have this checked out annually and especially if you have thinning hair, feel cold, and have dry skin.

• Chronic health conditions and some medications can also cause fatigue. Your doctor can help you pinpoint potential causes.

The bottom line is that you should work closely with your doctor to investigate any unexplained fatigue. NDs are licensed as primary care physicians in Oregon.

Portlanders, have you heard? There are record amounts of pollen in the air. Are you feeling it?

The Willamette Valley typically has among the highest grass pollen levels in the world, and this year is exceptional. Even those who typically do not have allergy symptoms are feeling it. Sneezing, runny nose, itchy eyes, eyes feeling sandy, stuffiness at night are all symptom of grass allergy that are high this time of year.

What can be done to reduce exposure? 

• Avoid outdoor exposure before noon when pollen levels are at their highest.
• Change clothes when arriving home, and remove shoes. Rinse hair and face (entire head if you can) after being outdoors, and especially before going to bed.
• Keep bedroom windows closed.
• Use the filter function on your car fan settings if you have them, or use the air conditioning. Keep windows closed.
• Nasal rinses and eye drops help wash away irritating pollens.
• Do not dry clothing outside

What else can be done?

• Get evaluated for allergy. Knowing what you are allergic to will allow you to take action to reduce exposure, and decide on appropriate treatment. An appointment at my clinic takes about 90 minutes and is usually covered by insurance.
• Get treated. There are many effective treatments available for allergy that include any combination of: exposure reduction, immunotherapy (allergy drops – available at my clinic – or shots), dietary change, medications, and supplements.
• Importantly, take all medications for asthma as directed by your doctor in addition to any allergy control medications or supplements.

Saline rinses are very effective at relieving allergy symptoms. A nasal rinse is like a shower for the mucous membranes of the nose. It helps to wash away dust and pollen that has accumulated throughout the day, reducing inflammation and allergy symptoms.

How to use a nasal saline rinse: 

Supplies:

1. Neti pot or other nasal rinse bottle. Even a large needle-less syringe works great if you have one. For kids I recommend using a small 4mL syringe like the type that comes with medications. Kids can control these easily themselves and the volume is better for their size.
2. 8mL warm water. Use distilled, filtered, or boiled and cooled water, re-warmed.
3. Nasal saline rinse prepared packets like these or these can be purchased at any pharmacy. You can also make your own at home using 1/8-1/4 tsp sea salt or other non-iodized salt per cup of water.  (Use of iodized salt like Morton’s will cause irritation).

How to use: 
Place neti pot or bottle nozzle at the opening of one nostril and lean forward, tipping your head just slightly to the side to direct the water flow out of the other nostril.

Pour neti or squeeze bottle very gently, just to allow the water to enter the nose and come out the other nostril.

If your nasal passage is blocked and the water does not pass through, don’t worry about it. Just allow the water to enter and exit the same nostril.

Then, change nostrils, pouring in the other side using the same technique.

Tips:

• When tipping your head to the side, always keep the ear higher than the nose. Gravity will take the water through so you only need a slight head tilt.
• Do not squeeze hard or use pressure to squeeze the water out of a Neil Med or other squeezable type of bottle. This can cause water to enter the middle ear, which can be very irritating.
• Adjust the strength of the nasal rinse by adding more or less saline solution, to your comfort level. You should never experience burning or irritation when using a nasal rinse.

Challenge and Solution:

• “I just need to remember to use it.”
  Set an alarm on your phone for about an hour before you go to bed, or an hour after you typically return home. Leave out the saline rinse setup on the bathroom counter so that you have a visual reminder.
• “I have to boil water and let it cool each time.”
  Use an electric kettle and turn on for about 20 seconds to warm the water to the right temperature. Alternately, boil a large pot of water and store it in a larger gallon water container, and heat to warm the amount needed for each use.
• “I’d rather use a nasal spray. It’s much easier.”
  Nasal rinses are more effective than nasal sprays which, even if they contain effective medications, can only spritz the interior nose, leaving much of the tissue untreated. 
• “I can’t use it twice daily. It’s too hard.”
  Well, OK then. Use it once. It’s better than not at all! 
• “I always feel like I get water in my ears.”
  See Tips #2 above.
• “It burns when using the neti pot.”
  Adjust the strength of the saline by adding more or less until you find a comfortable amount for you.
• “Someone told me that I can get a parasite in my brain when I use a neti pot.”
  Understand that this is a rare occurrence when people have submerged their head in or used a nasal rinse with infected water. However, to escape this risk completely, use filtered water, distilled water, or pre-boiled water. The CDC has full instructions here. 

This year I have been included again in the select list of Portland Monthly’s Top Docs. I publish this very humbly – if you live in Portland you know that I am one among a large, smart, and talented medical community, of which I am fortunate to be a part. During the past year, the most gratifying work I have done is using immunotherapy to treat allergic disease, and providing comprehensive general primary health care with an emphasis on getting back to the basics of health. This includes using food as medicine, addressing the microbiome, and helping patients incorporate the foundational basics into treatment: exercise, sleep, and stress management. Maintaining a busy practice while raising small children has kept me busy, which is partly why you haven’t heard much from me recently. This year, I plan to expand my immunotherapy offerings, so stay tuned for more soon! In the meantime, be well, and eat your veggies!

Have you wondered or felt concerned over cell phone radiation and whether it affects you? The Environmental Working Group has released their recommendations, based on studies suggesting the use of caution – until we know more for certain. I’ve attached them here for you to view, or you can link to the article here.