Welcome to Dr Amy Gajjar

We are excited to announce that Dr Amy Gajjar has joined us at the Wholistic Medical Centre. 

 

Dr Amy is an Integrative Medical Doctor (GP) who combines her skills and experience in Functional Medicine with Coaching, Yoga and Ayurveda.

Dr Amy Gajjar has extensive training not only as a GP but she and is a Fellow of the Australasian College of Nutritional and Environmental Medicine and the Australasian Society of Lifestyle Medicine.

Ameeta (Amy) Gajjar – Integrative GP, Coaching, Yoga and Ayurveda

Thyroid problems – living beyond “normal”

Thyroid problems – living beyond “normal”

The thyroid gland is an extremely important gland which regulates a number of complex hormonal reactions. Because of the complexity of its inter-reactions it is readily poorly diagnosed.

As an Integrative GP, I see patients on a regular basis who have been misdiagnosed or inadequately treated for thyroid problems. Thyroid function, its’ diagnosis and treatment are areas in which I have a particular interest.

The standard medical test for assessing thyroid function is to test the levels of the Thyroid Stimulating Hormone (TSH) in the blood – however this test alone is not sufficient. Patients who have apparently ‘normal’ levels of TSH can in fact have significant thyroid problems and are therefore commonly misdiagnosed.

Misdiagnosis can lead to the distressing situation where a patient is told that their thyroid function is normal when in fact it is the cause of many of their symptoms. In these cases, a patient can find themselves on the merry-go-round of being referred off to all sorts of specialists and being put on any number of drugs for symptomatic relief (eg. anti-depressants for mood disorders, statins for high cholesterol, contraceptive pill for period problems) when the real cause is right there waiting to be discovered – if only the correct tests are performed – and interpreted correctly.

Once the correct hormonal tests are performed and the genuine underlying causes determined, an effective treatment regimen can be put in place. This can give a long-lasting benefit and a whole new lease on life to people who have needlessly suffered for, sometimes, many years.

This article explains the complexities of the thyroid and its hormonal relationships in a way that is designed to be straight forward enough for a non-medical person to understand and to enable anyone to take a more proactive role in their health management.

Introduction to the Thyroid

The thyroid gland is a butterfly-shaped gland in the neck, weighing less than an ounce. Its name coming from “thyros” – meaning “shield like”.

The thyroid gland is an extremely important endocrine gland in the body. It can be viewed like a ‘spark plug’ that initiates a number of vital functions, and also like a thermostat that then regulates those functions. If the ‘spark plug’ function isn’t working properly then some vital functions won’t be turned on sufficiently. If the ‘thermostat’ function is not working, then some vital functions will be either over-stimulated or under-stimulated. For effective treatment to be applied it is essential that we understand exactly how the thyroid is malfunctioning.

The vital functions that the thyroid has control over include cellular metabolism, temperature regulation, growth and development (especially foetal, and early childhood), fat breakdown, neurotransmitters in the brain and gut function.

Why talk about the thyroid gland?

Thyroid conditions are extremely common. They occur in women 10 times more often than in men and can be undiagnosed or misdiagnosed leading to years of ineffective treatment and loss of quality of life.

Of those that are diagnosed, some are not effectively managed. This can occur because the underlying causes of thyroid dysfunction are not sufficiently looked at, the interpretation of results is not sufficiently accurate or because the treatment options given may not be the best for that individual.

Symptoms

The most common symptoms of an under-functioning thyroid are fatigue, dry skin, low mood and constipation. However, because the thyroid gland controls so many functions, there can be a wide variety of symptoms. This somewhat explains how some of the misdiagnoses happen.

Other symptoms include, but are not limited to – cold hands and feet, irregular heart rate, swollen legs/ankles, puffy face, low body temperature, morning headaches, needing more sleep than usual, low heart rate, long recovery period after exercise or illness, poor immunity and recurrent infections, low libido, feeling of fullness in throat, sore throat, transient neck pain, menstrual problems, infertility, recurrent miscarriage, gut symptoms including ‘irritable bowel syndrome’ (IBS), constipation and bloating, brain fog, memory problems, goitre- neck lump, soft, weak pulse, puffiness around the eyes or face, enlarged tongue (macroglossia), voice hoarseness, slowed speech and slowed movements.

And, of course in an over-functioning thyroid, the symptoms may be the opposite. The gland may even go from under- to over-functioning.

How the thyroid gland works

It all starts in the brain and then cascades throughout the entire body! The hypothalamus gland in the brain secretes Thyrotropin-Releasing Hormone (TRH) which stimulates the pituitary gland (also in the brain) to secrete Thyroid Stimulating Hormone (TSH). TSH then stimulates the production of Thyroid Hormone T4 from the thyroid gland.

T4 itself is inactive and needs to be converted to Thyroid Hormone, T3. T3 is the main active thyroid hormone.  It is T3 that does most of the work.

The conversion from T4 to T3 is done mainly outside the thyroid gland, including in the gut and the kidneys. Indeed 20% of thyroid hormones are generated via gut bacteria.

There are many factors that are needed for the conversion from T4 to T3 to happen. The main nutrients required include iodine, selenium, magnesium, zinc, iron, B vitamins (especially B2,B3,B6) and vitamin D. The main factors that can interfere with the conversion of T4 to T3 include stress, heavy metals, plastics and other endocrine disruptors, also other halogen chemicals including fluoride and chlorine.

If any part of the cascade of hormones from the brain down through the thyroid to the gut and kidneys is disrupted or incomplete, or if nutrients levels are insufficient, or if negative influences are too high – then the eventual production of T3 can be inhibited.

We can already see why simply testing for TSH can be inadequate as a diagnostic tool if the problem lies further down the chain,  if the problem lies in the gut  or if the problems lies in nutrition or in the presence of too many negative influencers such as stress or chemical exposure.

The pitfalls of thyroid management

TSH is the standard thyroid test that is measured.

Tests for levels of T3 and T4 are only carried out if TSH levels fall outside of ‘normal laboratory ranges’. The problem is further exacerbated by the fact that ‘normal laboratory ranges’ are generally too wide to be sufficiently sensitive to subtle variations in TSH. TSH can also be suppressed by cortisol (stress) and other illness, making it even more challenging to interpret thyroid function if we rely on TSH alone.

There is ample research showing that T3 levels are the most predictive marker of effective thyroid function – not TSH.

Even when T3 and T4 levels are tested, the interpretation of those results is very important. Again, the acceptable ‘laboratory range’ is wide and it may be that the T3 and T4 levels lie just within the ‘normal’ range but are a good way away from being optimal.

The optimal levels of T4 are 16-18pmol/L and T3 5-6pmol/L whereas the ‘laboratory ranges’ will accept readings that are significantly lower than these optimal values. This is very common and is often referred to as ‘subclinical’ hypothyroidism whereby the patient has clinical symptoms, but all the test values fall within the ‘normal’ range.

Hashimoto’s Disease

Hashimoto’s disease is an autoimmune condition of the thyroid and many patients with an underactive thyroid actually have Hashimoto’s. Diagnosing Hashimoto’s syndrome requires antibody testing which isn’t routinely done, so patients often remain undiagnosed. In still other cases, patients can be Hashimoto’s sero-negative.

The Often Overlooked role of the Gut

The critical link between the gut and the thyroid includes the following factors:

  • 20% of thyroid hormones are made in the gut by bacteria
  • Inflammatory gut conditions, leaky gut and autoimmune conditions of the gut are toxic to thyroid function

A good long-term solution to an underactive thyroid must therefore include a full assessment of the diet and implementation of a nutritional plan that will underpin any drug program.

But thyroxine is given for under-active thyroid shouldn’t that fix the problem?

Thyroxine is the drug that is equivalent to T4. Sometimes taking Thyroxine is sufficient and it helps to alleviate the symptoms of an underactive thyroid.

Sometimes taking Thyroxine is not sufficient.

If there are issues with the conversion of T4 to T3 due to nutrient deficiencies, stress or toxins, then giving Thyroxine isn’t necessarily the solution. The roadblock that is preventing the conversion of T4 to T3 will also prevent the conversion of Thyroxine to T3. So, in those cases, taking thyroxine will not be very helpful. In those cases we need to investigate further and apply treatments that will genuinely work.

In some cases taking Thyroxine can actually make the situation worse!! This happens because the body can interpret high levels of emotional, chemical or nutritional stress in a way that converts T4 into a hormone called reverse T3 (RT3). RT3 actively works to shut down the thyroid gland – exactly the opposite of what is required! In these cases the more Thyroxine that a patient takes, the more RT3 that is produced and the less active the thyroid may become.

So, thyroxine has its limitations. The answer once again is appropriate testing, excellent analysis and coming to a diagnosis that pinpoints at exactly which part of the hormone cascade the problem is occurring.

Management of thyroid problems

Every person with thyroid problems is different. However, there are some common principles that apply to everyone, and then specific elements that pertain to the individual and to that individual’s specific thyroid condition.

In every case lifestyle factors need to be addressed.  A healthy nutritious diet, appropriate exercise – not too little and not too much, sleep (it IS medicine!), stress management strategies, relaxation and fostering positive relationships. These are the foundations of recovery.

Supporting the adrenal and nervous system is critical. Functional and Integrative GPs like myself as well as some other practitioners at the Wholistic Medical Centre are trained in prescribing supplements and herbal medicines that can be used to help support the gut, liver, thyroid and adrenals.

Conclusion

Thinking of an underactive thyroid in simple terms, and trying to apply a single approach to what is a very complex situation will mostly lead to failure.

The good news is that when time is taken to fully understand a patient’s history, when a full suite of relevant pathology tests is run, and when a skilled analysis of all of the data is carried out, it is possible to achieve life changing results for many patients.

I hope this article provides the many thyroid sufferers with information that they can take into conversations that they are having with their medical teams.

I am very happy to respond to email enquiries and of course I am available for consultations both face to face in my rooms and also on Skype/Zoom for those that don’t live in Sydney.

Dr Amy Gajjar

Wholistic Medical Centre, Surry Hills

https://wholisticmedicalcentre.com.au/practitioner/ameeta-amy-gajjar-integrative-gp-coaching-yoga-and-ayurveda/

Panic attacks and traumatic stress may be helped with mindfulness psychotherapy

Stress blog pic

 

 

 

 

 

Panic attacks and traumatic stress may be helped with mindfulness psychotherapy

Sally* is a 50 year old woman who came to see me in Surry Hills after a month of having severe panic attacks. These started first thing in the morning. She experienced shortness of breath, tightness in her chest, racing heart, trembling hands and legs, nervous sensations in the belly, irregular breathing and a sense of suffocation and impending doom. Often there would be no trigger for these panic symptoms. They would be intense for around 30 mins then would persist in varying degrees all throughout the day.

These panic feelings were impacting her ability to work effectively and maintain a social life. Sally often thought during these panic attacks that she was “going crazy” and perhaps there was “something deeply wrong with her”.

Ordinarily, Sally was a highly competent, robust individual who had never really experienced any severe anxiety or panic symptoms. However, she had just been through a major life change – she had relocated to Sydney from overseas after leaving a highly traumatic and abusive relationship. This relationship involved experiences of feeling a combination of complete overwhelm, helplessness and fear. One of the coping strategies she had adopted was to “keep going and push through” with a focus on action- oriented outcomes.

There was also a past history of accumulated grief from her recent mother’s and her late husband’s deaths, which she admitted was still unprocessed within her. She was holding traumatic stress in her body.

Sally was interested in helping herself as much as she could. Although she came to see me as a GP, she did not want to use medication unless it was absolutely necessary; she preferred to turn to mindfulness psychotherapy to help her.

Mindfulness psychotherapy may be healing

Through our weekly sessions together, she learnt how to use mindfulness to slow things down and observe her internal experiences without getting completely hijacked by them. She learnt to build and discover resources within her body and mind that helped her panic symptoms. By understanding and learning how to calm her internal world Sally felt empowered to then begin processing and integrating her previous ‘undigested’ memories and feelings.

This process allowed her to make sense of what has been senseless before and to regard the feelings in her body as useful information rather than something to be avoided.

Sally now experiences significantly less anxiety. More importantly when the waves of anxiety do arise, Sally now can work with her internal states, rather than let them escalate into full-blown panic as it had before. Mindfulness psychotherapy has allowed her to witness her thoughts and feeling and get a gauge on how they impact on her body. By working directly with and navigating the information held within her body, Sally now draws upon “safe” places, both inside and outside the body to regulate her arousal and bring her back into the present moment.

She reports feeling less reactive and acting less automatically and can now make decisions based on choice.

How does mindfulness psychotherapy help panic attacks and traumatic stress?

Sally’s panic attacks were a reflection of traumatic stress stored and held within the body. As a whole, our bodies are highly intelligent systems, equipped for stress and even trauma. When there is a perceived threat, our bodies will instinctually activate our “flight/fight/freeze” mode to take action and respond to danger. This then leads to a complex biochemical cascade within our bodies that orients us for survival.

Ordinarily, we can usually cope with great stress for a period of time as long as it is temporary and/or we can make sense of what has happened to us. However, when we are faced with trauma, this survival response becomes frozen and our bodies are unable to discharge all the pent up energy. We keep re-living what has happened, even when there is no obvious threat – it’s like a bad tape that keeps playing over and over again, without an option to pause or stop. So by using mindfulness to slow down, we begin to examine more carefully what is happening and to take in new information that would otherwise have never been noticed or would have been dismissed. We learn to develop a new language for reporting on our own internal experiences and finally begin to get to know intimately our emotions, thoughts and beliefs that held us captive for so long.

* Name has been changed

This case study is for educational purposes only. Results may vary due to individual circumstances.

Dr Marie PaekGeneral Medical Practice, Mindfulness Psychotherapy

For more information see:
www.hakomiinstitute.com
www.hakomi.com.au

“What does this nausea in my stomach and tightness in my chest mean? ”

What does this nausea in my stomach and tightness in my chest mean

Chest tightness can stop a person from breathing deeply

 

Michelle* was in her late 40’s when she first came to the Wholistic Medical Centre. For the previous five years she had an upset stomach, felt nauseous every day, had some bloating after meals with bouts of diarrhoea alternating with constipation. She had been advised to reduce grains, dairy products, sugar and caffeine. She followed that advice and lost 11.5 kilos. The abdominal discomfort reduced a little but did not disappear.
In the previous few months Michelle also noticed a discomfort in her chest. It was so tight that it stopped her from breathing deeply and even prevented her singing. Given that she was a singer, this had become quite a serious limitation. Further medical investigations revealed no abnormalities in her digestive or respiratory systems.

Michelle felt that she couldn’t do anymore with her diet or medication and she suspected that there might be an underlying emotional problem that was behind all her symptoms. She chose to work with a mindfulness based psychotherapy approach.

During her first session, she was guided to study her experience of tightness in the chest/throat and tightness in her abdomen. As she did this, in mindfulness, it became apparent that she had felt exactly the same feeling many times before. It felt like a strong fear. When asked to trace her earliest memory of that, she vividly remembered that at 13 she was made to sing at family functions and experienced ridicule from her cousins. In order to cope, she remembers tightening up her diaphragm and ignoring her feelings of shame and fear.
She was directed to imagine going to help her 13 year-old self: to appear in the family room and to go to her 13 year-old self in a kind and comforting way; to let her know she doesn’t have to sing if she doesn’t want to and to tell her cousins to sing themselves or to be quiet. Staying with that imagined new scene gradually produced a relaxation of the throat and abdominal contractions.

Those muscles relaxed all by themselves, as a new possibility was introduced: ‘I don’t have to go along with my family’.
Subsequent sessions revealed that feelings of fear were constant during her early home life. Sometimes after school, she would stay in the driveway outside her house, too afraid to go inside, because she did not know what she would walk into. Her father could be drunk and yelling abuse. Her mother could be either withdrawn or panic stricken.
Since her childhood she had learnt to ignore her fear and tighten her body in order not to feel it and keep going.

Over the next 5 sessions Michelle was able to go towards her ‘exiled’ feelings – they were allowed to come into her awareness and she was able to take care of them in a soothing way.
An important realisation was that she was so used to being fearful that she had concluded an existential belief of ‘I fear therefore I am’. In fact not feeling full of fear felt strange and empty, even though feeling free of fear was what she was seeking.
Once Michelle began noticing that belief in action she slowly began ‘digesting’ a new possibility of ‘I can live without fear’. This did feel strange and took some getting used to, especially as the fear would bounce back by itself. She would have to feel it and let it pass over and over again. Over 3-4 weeks the previous habitual states of fear and physical contractions gradually lessened, the abdominal tension stopped and her singing voice gradually found an open channel.
A new way of being in the world was now becoming a real possibility!

Discussion
The notion that feelings are ‘exiled’ from day-to-day awareness is fascinating. Our nervous system learns to actually shut out the unpleasant experiences from our consciousness for the purpose of getting through it. When there are no other choices and no support this is a useful ability to have had at the time.
However the underlying feelings persist in the body and the conclusions that were made based on those past events continue to influence current life. Conclusions like: ‘life is scary’; ‘I’m not quite good enough’; ‘nobody is interested in what I feel’; ‘having emotions means I have a mental health problem’ and so on, place profound limitations on our lives.
The use of mindfulness in psychotherapy allows an exploration into the emotional memories without re-traumatizing and without intellectualizing. The original pain is accessed and new more soothing experiences can be introduced. These new experiences allow new conclusions which are far less limiting than the previous ones.
In this precise and gradual way Michelle released her pattern of holding tension in her abdomen, chest and throat. She felt more at ease and confident within herself and as a bonus she became less angry with her children and more loving to her partner.

 

*Name and details have been changed. Results obtained by one person does not mean the same  can be expected by another. Each person has different life experiences and circumstances which will influence responses.

Dr Nick BassalGeneral Medical Practice, Mindfulness-Based Psychotherapy – Wholistic Medical Centre