Hello everyone, this is Dr. Hogue.
Last weekend I attended a course to learn Fascial Counterstrain (FCS). FCS is a manual therapy method that can be used to relax tissues of the muscles, bones, joints, ligaments, nerves, organs, lymph, veins, and even arteries. I attended the introductory course to see if the method was valid and have been using it since returning. So far I have seen some pretty impressive results.
FCS is a paradigm shift for me, allowing me to treat things with manual therapy which I never thought were possible. If you’re interested in learning more, come on in for a visit. You can also look forward to an upcoming post which explains the ideas and principles of the treatment in more detail.

While I have done my fair share of testing in the past, I have done very few in the past couple years despite it being a common request from new patients.

Any of you who have seen us here know that we are big fans of zinc for mental health, but it is extremely important for gut health as well. Not only does it heal the intestinal epithelium, but it also improves the microbial biome and digestive enzymes.

Metallothionein is a protein that lives in a bunch of places in our body, but the highest concentration is in the gastrointestinal tract. It is extremely important in the prevention or treatment of food sensitivities (not full-on anaphylaxis type allergies, that's a different issue). It helps to break down gluten, gliadin, casein, casomorphins, and other proline containing proteins. Which in layfolx terms is wheat and dairy. If you've noticed that you feel better when you avoid breads and cheeses, you may have a zinc deficiency.

It's also common to experience more sensitivities to food dyes and shellfish if your copper levels are too high. This is important because copper and zinc are paired minerals, and when the copper is very elevated, zinc is often very low. 

Metallothionein also helps to kill candida and keep other yeasts at bay, so if you've noticed a sensitivity to sugar and sweet foods, feeling more bloated, foggy headed, or experiencing diarrhea or constipation, then you could have a candida overgrowth that would improve with adequate zinc supplementation and possibly some additional antifungal compounds. And I never put anyone on the candida diet because it fixes nothing and just makes life really unpleasant.

So if you think you are sensitive to wheat and dairy in particular, you may want us to evaluate and treat your zinc levels. 

As a side note, I've never treated SIBO per se. I don't run the tests and I don't use the treatments, but I have extremely infrequently felt the need to send someone elsewhere to another doc who does this testing and treatment.  I did find a study that stated zinc levels were the sole independent predictor of SIBO in a specific population that was tested. Correlation does not imply causation, however this is an interesting area to consider for future studies. 

​Dr. Jen

It's been awhile since I wrote a post here, but I'm going to keep it brief! There are lots of behind the scenes changes with how we order B12 and other injectables for you. These changes involve the compounding pharmacies, the FDA, and our own personal decisions on how to move forward. 

Rather than bore you with all the details, the simplest way to describe this is that we will not have injectables available on-site anymore. We can work out an arrangement for you to commit to a series of injections, either learning how to inject yourself, or us injecting you in office. But these are individual prescriptions that we will have to order in advance from a pharmacy. 

We'll discuss individual options with you in office, during a regular appointment. We will also discuss the necessity or non-necessity of these shots for your individual case. In short, just take your sublingual B12 unless you have a wicked case of macrocytic or anemia. 

Out with the old and in with the new!
2017 was a fantastically tumultuous year for us here at Avalon. Buying the business, but losing Dr. Haff, and adding to my therapeutic repertoire are just a few of the biggies that happened. This year will be more changes in store, I'm sure, but we'll keep you posted as they happen. 

I'm still looking for some new doctors to add to the staff, and have recently had some great applicants. Interviewing, vetting, negotiating, etc all need to happen before I commit to bringing someone into our happy home, but it's all in the works. 

If you've been in the office in the past few months, you know that Sandra from Mercy Diagnostics is here with us on Fridays. So if you need a blood draw from a fantastic, patient, and fun phlebotomist, schedule any blood draws with us for Friday. She's still at another location M-Th if you need a different day (ask for details). 

We also rented one of the offices to a wonderfully kind therapist by the name of John Powell. He's technically a separate business, so you need to contact him directly to schedule an appointment. And yes, he is taking new clients. 

I'm loving the results I get from the Walsh Research Institute protocols I've been using. The information I learned has revolutionized my practice and my success. I've also started to immerse myself in Body-positivity and the Health At Every Size Movement, which I feel is very in-line with all of the Naturopathic Principles. 

See below for some highlighted changes! 
​
Telemedicine is here!

Technically, it has been authorized for us to do telemedicine since October 1st, but since I was in the midst of purchasing the business, I kind of dropped the ball. And as I'm writing this, schools are closed due to frigid cold temperatures. Wouldn't it be great if you could meet with me via a virtual face-to-face HIPAA-compliant website? 

​You'll need internet access, and a device with a camera, but that's it. And, I'm only booking 15 or 30 minute slots, so if you feel like you need more time, then I'll need you to physically come to the office. I'm sure there will be a few bugs to work out along the way, so please be patient. 

Supplement Sale

We have a bunch of really great, high quality supplements that I do not tend to prescribe and, I'd like to make room for some new options. So, I'm giving you 50% off the supplements on the shelf closest to the hallway. Additional discounts do not apply, but if you see something you want, come get it. These are supplements I won't be replacing on our shelves in the future. 

 Click to see sale items

Expanding Availability

I will be expanding the available hours in which you can schedule with me at the end of February. Our overall schedule of 9-5 isn't changing, just how many patient-hours I have in a day. 

WHAT IS “OKAY” AND HOW IS IT USED?
 
First and foremost, “okay” is a noun, adjective, adverb, and interjection (e.g. “Okay! I get it!”). It is also an “Americanism”, a folk word adopted into our language that has basis in English but no real history. Therefore, it is a rather arbitrary word that can be used in many, many contexts to mean many, many different things.
 
Humans learn from language in what’s called “derived relations”. In simple terms, when we’re young, someone will hold up a toy dog and say “dog.” They will point to a picture of a dog and say “dog.” While going for a walk and spotting the neighbor’s poodle in the yard they’ll say, “There’s the doggie!” These derivations happen because “dog” as a word is arbitrary. Three letters. The first example is a toy, the second a photo, and the third an actual dog. However, as children we begin to derive connections among them and discover how all of these represent the canine species.
 
Also, all three could be different breeds. “Dog”, therefore, relies on relations developed over time. The more arbitrary a word, the more relations must develop to make up the difference. For example, “vegetable” requires more derivations than “broccoli”.
 
“Dog” doesn’t mean one thing only. Relations tend to group from the more personal to the more foreign. For instance, I grew up with a drooling, loud, smelly, vicious, loyal dog who, for much of our time together, was bigger than me. If I were to hear arbitrarily something like, “They have a dog,” my mind would be more inclined to draw from my hard-adopted relations, and I would be caught off guard when I meet their dog and it’s a tiny, yippy thing that’s quite kind.
 
We overlook this use of language severely when raising children, and even though contemporary research tells us plenty about how language can be used to help children grow in healthy ways, our own methods (brought to us by relations from our parents, etc.) are mildly inflexible. What we say matters more than we think because thoughts can draw from more context than words can. A thought can be filtered from a history of experiences and derived relations and end up with a simple stretch of words such as, “There’s a dog.”
 
What does this have to do with “okay”?
 
Well, what, exactly, makes something “okay” or “not okay”?
 
Think about that for a moment.
 
Did your mind tell you something like, “It depends on the situation”?
 
That’s right. It sure does.
 
For an example, someone responding to the question “How are you?” might answer, “I’m okay.” It’s now up to us to evaluate their inflection, tone, posture, and our previous experiences with this person to derive what okay means in this context. It could mean things are on the upswing, or they’re hiding how miserable they are, or they’re busy and don’t want to be bothered with silly questions.
 
If you ask me how the two-week old soup looks, I might answer, “It’s okay.” I might mean that it’s good enough to still eat. But your standards are likely different than mine. What’s okay for me might not be okay for you.
 
Let’s transfer this to the adult/child relationship. Is it “okay” for you to eat a chocolate bar before dinner? Again, this question becomes arbitrary because you might be on a diet, so no, it’s “not okay.” And I might think it is okay because as an adult we really can choose what we want to eat and when. We, personally, derive what “okay” means to us when it comes to chocolate bars and dinner, and even though we might disagree on whether or not the candy ought to be eaten, what’s okay or not okay can really only be from the perspective of “I” and “you”.
 
UNDOING OUR OWN WORK
 
We might ask our child, “Are you okay going to sit on Santa’s lap by yourself?”
 
What, in this context, does “okay” mean? Perhaps “confident”, “feeling safe”, or “capable”.
 
So, our child derives that “okay” is similar to- or synonymous with- confidence, safety, and capability.
 
The following day, on the playground, we see our child climbing up the slide from the bottom and we rush over to them, pull them off, and shout, “That’s not okay!”
 
But doesn’t “okay” have to do with confidence, safety, and capability? Now our child is confused because they were feeling quite confident in their ability, and they felt quite safe, even if we didn’t. For us, however, “okay” in this context means something different, referring to “meeting social norms about how to use the playground”, “the safest way to use the equipment”, and “worrying us that you’ll get hurt”.
 
The following day we ask, “Did you have an okay day at school?” If our child is deriving “meeting norms”, “being safe”, and “managing worry” from “okay”, then they might confirm your evaluation. If the child is deriving “capable” and “confident”, then maybe they struggled in Math and Science, so no, it was not an okay day.
 
Here, though, you really want to know how they felt, overall, about their day, as in, “How was your mood and attitude throughout the day while at school?”
 
Overtime, we come to learn all that “okay” can mean and we internalize its usefulness. But children, especially young children, are learning all day every day. When they hear “That’s not okay”, they’re forced to use their experience with the word to understand what it means to them- and then to you- in this context.
 
“Did you think running out the door by yourself was okay?” is not informative. “Okay” can be so many things that undoubtedly, in some form, yes, they thought it was okay. A different way of saying this is, “I worry about you when you run off, and leaving without me can be unsafe because you could get hit by a car.”
 
This is longwinded. It’s work. So, no wonder we like “okay”, because it can be used in place of longer explanations. Adults have derived so many associations with “okay” that they’re likely to be able to discern what you meant from this arbitrary response. Yet, because we aren’t specific about why we’re upset, a child begins to internalize the function of the word “okay”. What’s “okay” becomes less and less clear.
 
We can further this by examining the phrase “It’s not okay…” as in, “It’s not okay to hit your brother.”
 
What is the “it’s” and what is the “okay”? From a developmental perspective, hitting your brother is actually quite “okay”: it asserts dominance, sets boundaries, and is an expression of internal emotional experience. The “it’s” may be perceived as relating to the child’s predisposition to form boundaries with their siblings. If that’s the case, “It’s not okay” could be internalized as, “Your desire to take care of yourself is bad.”
 
ENDING SENTENCES WITH “OKAY?”
 
The next step is to look at how we might use it at the end of a sentence to turn it into a question, such as, “Don’t go on the playground, okay?”
 
And just what the heck is “okay” supposed to mean in this context?
 
Is the playground okay or not okay? Is not going onto the equipment “okay”? Is listening to this mandate “okay”?
 
I hear this use of the word very often when an adult talks to a child, but I rarely hear this when one adult talks to another (although it does happen). Often, the function of “okay” here is to lessen the impact of hearing a mandate, and it’s part of the current young-parent’s cultural shift away from parent-as-warden and towards parent-as-friend.
 
This shift is neither good nor bad; it’s simply a change of the times. Egalitarian parenting is possible, yet many people use subtle changes in language to achieve this, and it’s worth, now that we’re a couple of decades into this new style, to begin troubleshooting.
When you end your mandate with “okay?” you’re essentially handing over the validity of your asking to the child. It’s like, “What do you think about me asking you not to go onto the playground?”
 
The response to, “Don’t do that, okay?” for a child could be, “No, it’s not okay! I’ve been helpful at home. I’m safe. I need to run around. I’m very wound up.” Unknowingly, you’ve created more tension between you and your child than if you’d simply said, “Don’t go on the playground.”
 
TRY IT OUT
 
You may be thinking, “So what? Is this a big deal?”
 
So, experiment a little. Try using “okay” with your kids for a week and pay close attention to their responses- not whether or not they do the same behavior again- we have to get over thinking that if we tell a kid not to do something that they’ll learn it without reminders.
 
However, the following week I invite you to get specific: Use “Doing your homework is part of being a responsible student,” instead of, “Slacking off is not okay,” and see what changes. My guess is you’ll get grumpiness, defensiveness, or the comment will be shut down as it typically is, but test that against the less nuanced response from “not okay.” “Not okay” typically trains a patterned response, such as, “Sorry…” or a simple nod, or perhaps a verbal battle. I bet you’ll notice getting specific elicits a broader spectrum of responses. We want to see this because it means the arbitrariness is undone.
 
When you replace “okay” with a valuable connection to self, then you increase awareness. “Okay” is a judgement, albeit an arbitrary one. Naming something as unsafe, rude, scary, etc. helps define context. For your child, they probably weren’t thinking when they ran out of the store. Saying it’s “not okay” is similar to saying “is bad”, and what’s bad about running?
 
Say what you mean, which is, “You’re short, and people in cars might not see you. I’m scared when you run away.”
 
Also notice how the examples I give refrain from any sort of accusation. Saying “I’m scared” is much different from “That’s not okay.” Children come equipped with empathy. Empathy is actually how we learn as kids, by tuning into facial expressions, emotions, and mimicking behavior. “That’s not okay” leaves much to the imagination of a young child. Then we get mad at them, shouting, “You never listen!”
 
Yes, they were listening. You just weren’t giving them much to work with.
 
Try watching your use of language, okay?
 
About the author:
John Powell is a psychotherapist and Reiki energy healer. He has a private practice in Burlington, Vermont in the same building as Avalon Natural Medicine. He uses Acceptance and Commitment Therapy and Bowenian Family Systems, and focuses on working with adolescents, young adults, couples, and families on issues such as parenting, careers, anxiety, depression, and addiction.

John Powell, a therapist renting space in our office wrote the following to introduce himself to you. 

​When I was finishing my freshman year of college I was living in Ohio, had just been dumped the same day I told my girlfriend that I was in love with her, and my friends had joined a fraternity I didn’t want to join and they no longer spent much time with me. I hated my classes, too. The deep depression I found myself in taxed my mental and physical health and, after a week of barely eating, sleeping, and not going to class, I visited the counseling center. The therapist there was unbelievably supportive and helped me make some tough decisions, like dropping out of school, moving home, and regrouping.
 
This decision brought up prolonged and challenging experiences of shame, guilt, fear, and sadness, and at the same time offered an opportunity for me to step back from human DOing, and spend some time as a human BEing.
 
That, teamed with a fascination for the human brain, eventually took me down the path of becoming a therapist, an environmentalist, writer, and educator, all focused around behaviorism and the human condition. “Don’t believe everything that you think” became my motto.
 
Years in youth work (teacher, teen center programming, working in a college counseling center, etc.) and studying child development has brought me to specializing in family and family systems. I enjoy working with youth directly as they navigate adolescence and early adulthood. I also work with parents who are trying to navigate their relationships with one another and their children. I work with individuals and couples, and do some family therapy work.
 
Parenting and adulting. Two challenges that, no matter how many millions of years it’s been happening, we still need help navigating.
 
My type of therapy isn’t traditional. The last two decades have brought on incredible research about how we behave and learn. I use this research to help people practice acceptance (not as we’ve traditionally defined it) and taking action (not as we’ve traditionally done it). Specializing in what’s called “ACT” work, I like to think I offer something to this area that many others don’t. ACT allows me to marry my interest in eastern philosophies with up-to-date evidence-based therapy.
 
In August 2017, I opened Mind Body Spirit, LLC, upstairs in the Avalon Natural Medicine offices. Entering private practice is a huge risk. It’s a lot of work without the support that naturally comes from working in an organization. But for me, helping others move in the direction of what’s important to them despite the challenges along the way meant I could do the same for myself.
 
I’m currently accepting new clients. If you or someone you know could benefit from work that is collaborative, incorporating the mind, body, and spirit, and can help them with their relationships and self-acceptance, please be in touch. My work can help with (but isn’t limited to) the following:
 
Grief and loss
Chronic pain
Family stress
School issues
Relationship issues
Sexual issues
Parenting issues
Anxiety
Addiction and recovery
Gender struggles
Self-harm
Trauma
 
Outside of therapy, I’m an avid writer (mostly fantastical fiction), musician, poet, and environmentalist. I’m often doing presentations on the environment and mental health for all ages. I also practice meditation and yoga daily, believe in the power of fresh air, and love woodworking. I grew up in the age between Nirvana and Bieber, the age between cassettes and digital music, between the car phone and the smart phone, and a time when mental, physical, and spiritual health moved from the background to the foreground. We live in a difficult time because this is an era of transition. We, as a collective whole, are creating our next chapter.

This week is Naturopathic Medicine Week, a week in which NDs try to inform people about what it is we do and why it's different from the conventional model.
 
I personally wanted to point out that NDs in Vermont have it better than NDs anywhere else in America.  I made a couple posts about it on Twitter, Instagram and Facebook.

The best part though, is that we get to live in Vermont, with the greatest patients in the country who already understand the importance of eating local and organic, who oftentimes are herbalists or know herbalists, who want to keep our environment clean, and who appreciate naturopathic medicine more than anywhere else from my experience. 

On to more practical matters, Tori is out until next Wednesday, so if you aren't getting the same great front office experience you normally get, it's because I'm not as good at it as she is. :)

I'm also extending the supplements sale until the end of the month. Not everyone checks here and our social media accounts, so I want to make sure that as many patients as possible have an opportunity to get the extra discount. 

Week one is over and things went pretty smoothly despite some behind-the-scenes hiccups. I've still been making slight adjustments to the decor and systems, so this is a summary of recent and future happenings. 

NECLA conference: Literally in the middle of Dr. Haff and I closing on the business, I left to go speak at UVM Medical Center for the Northeast Community Laboratory Alliance about the benefits and challenges of working with local Naturopathic Physicians. Attendees included management, customer service and phlebotomists from UVM and other regional hospitals. I love public speaking, and my hosts and the attendees were great. 

Social Media: I've started some new accounts and am trying to post in those places more often, rather than sending out infrequent emails. If you are a social media user, follow us on these platforms:

• Facebook - https://www.facebook.com/avalonnaturalmedicine/ 
• Instagram - https://www.instagram.com/avalonnaturalmedicine/
• Twitter - https://twitter.com/AvalonNatMed

Mercy Diagnostics: If you've been in the office in the past 8 months, I may have already recommended you use this phlebotomy site and laboratory at another doctor's office. This past Friday, we welcomed Sandra, the phlebotomist for Mercy, into my recently former office. She'll only be there on Fridays, since she is still at the other location Monday through Thursday, but if we get busy enough, Mercy will consider expanding the available days. 

Room changes: As I said above, Mercy Diagnostics is in my most recent office (for those of you who have been around long enough to remember that I used to be upstairs). Last weekend I moved into Dr. Haff's office, including moving around the furniture quite a bit. This weekend, I painted the red door and frame inside and out to match the new colors in the hallway and to visually cool down the office itself. ​

Tori will be going on vacation from the end of this week to the middle of next week, so you may not get the same quick response as she provides when she's here. I've cut down my patient load while she's gone so that I can be available for everything else. ​

Our supplement sale continues this week. 20% off all homeopathics, herbal tinctures and anything on the shelf closest to the hallway. If you've been holding off on getting something, now's the time to get it. If you need something that isn't on our shelves, we also have an online store through Fullscript at https://us.fullscript.com/welcome/avalonnaturalmedicine

It's been a busy week! My goal is to provide you with the same great level of care to which you are accustomed, while still continuing to improve. 

I've got two pieces of big news regarding supplements:

1. We now have an online store through a service called Fullscript. I have the prices set low for the time being to get everyone used to this new system. If you want to compare prices, you should see that they are similar or less than other sources. Check out OUR STORE HERE! 
2. Select in-office supplements will be marked down to 20% (or more in some cases) off the marked price for the next two weeks.  No additional discounts apply. Physician grade supplements, herbal tinctures and homeopathics are included as long as they are available.