I took care of a patient a while ago. Younger than me and admitted for a bleed caused by ruptured esophageal varices. Esophageal varices are caused by severe liver disease - significant amount of cases are related to alcohol abuse. Blood cannot pass through the liver due to blockage or presence of scar tissue and so it backs up causing bulging blood vessels in the esophagus which can rupture at any point causing life-threatening bleeds.
I will never forget the face of this patient - full of fear and terror yet appearing withdrawn at the same time. I've seen this look before and I've seen it in patients who sensed that they're at the end of their journey. The sheer terror in one's eyes is not something you easily forget.

The bleed was so severe that the blood pressure was dropping fast from volume loss and heart rate skyrocketed since it now has to work harder to distribute the remaining blood to all of the tissues. I noticed several emesis bags in the sink full of bright red blood and knew immediately this is going to be a tough case. We rushed to prepare the room and intubation equipment and got extra nurses and tech support just in case. Once the scope went in I was shocked to realize how hard this case was going to be - the bleed was so severe you could not see anything on the camera. I'll spare you the details because describing what I saw and sounds I heard - is horrifying to those who do not work in healthcare. It took over an hour to band those vessels to stop the bleed - during that time we had to transfuse a lot of blood but the patient made it through the procedure. We arranged for the immediate transfer to intensive care so the vital signs can be stabilized from a massive blood loss. Success I thought, this person was granted another chance in life. However, when I went back to work a few days later I received the tragic news that this patient could not be stabilized and ended up passing.
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Why is this case significant? Because as a society we often look at people who struggle with addiction and conclude that they had made their conscious choices. But is this the entire truth? Were the choices really conscious? I remember one of the anesthesia providers telling me about the time he worked in the rural hospital in a community that was severely socioeconomically disadvantaged. He described children being born to mothers under the influence of street drugs, mothers who overdosed on drugs and even completely passed out from alcohol use. What future does a child have when born into a home like that? Do we think this child will grow up in a home full of love and support? Will they be carefully nurtured, hugged, tucked in at bedtime and told that they are loved? Will they be told about the importance of self-love and respect for their own bodies so that they don't reach out for substances that can severely impact their health for life? Will they be taught right from wrong or will the "wrong" we perceive as society become their every day life since that's what they grew up seeing on a daily basis?

How easily we pass judgement onto others without walking a day in their shoes. Does the infant licking clay off of the floor from hunger or spending days in the same soiled diaper will have a fair chance at life? Is the same chance in life be guaranteed to those children who are physically, verbally or sexually abused on a daily basis? Will the society understand the effects of the psychological trauma, lack of proper nutrition or substance abuse early in life on their brain development? I can tell you that growing up in constant fear and terror will have severe negative psychological effects which will later emerge as depression, anxiety, aggressive behaviors or addictions.

Understanding my own trauma allowed me to view people in a completely different light. People often ask how can we provide compassionate care to violent prisoners, drug addicts or alcoholics who end up in Hospital due to their "own" choices. Well, I guess now you know how.
When I first saw that patient and the look of the pure terror in their eyes - I did not see an alcoholic whose "conscious actions" led to their death. Instead I saw a suffering human being who most likely lived through devastating events or situations which ultimately led their life in this direction. And then, I felt sadness in my heart for the tragic loss of life, life lost too soon, life lost unnecessarily.
I felt it was necessary for me to share this with you because our society is breaking apart and maybe what we really need is less judgement toward one another and more love and compassion for each other. I might be naive here but I feel like love, mutual understanding and respect for one another - are probably the only way out of this mess.

Have you heard of Frankincense Oil?
Frankincense oil is incredibly popular and most widely used due to its relaxing and calming scent. Those who have been raised in Christian faith probably have heard of Frankincense in the Bible. Frankincense was one of the three gifts being brought to infant Jesus by the three wise men. There are many people who ascribe tremendous medicinal properties to Frankincense Oil. From killing microbes, alleviating asthma symptoms, aiding digestion to reducing heavy menstrual flow.

Before I dive into actual research I wanted to mention the history of its use.
Frankincense is derived from Boswellia trees (carterii, serrata or sacra) found in China, India, Somalia and Ethiopia as well as other regions of Arabia and Africa. The first ancient historical source that mentions use of Frankincense was in an Egyptian medical papyrus called 'The Ebers Papyrus" dated 1500 BC. In the paper it was mentioned that frankincense has been used as treatment for asthma, colds and other pulmonary and throat infections. People throughout the history have used it during religious ceremonies, burials as well as during childbirth. Frankincense resin was one of the most sought after incents and was used by Egyptians, Greeks and Romans. However, many people use it today and claim it posseses incredible healing properties.

But is there any scientific evidence to back it up? What does the research say? Let's examine it.
When you type in "frankincense" into a search bar on PubMed (National Library of Medicine made available by National Institute of Health) you get 354 results to be exact.
*According to this 2019 study which was a randomized, placebo-controlled, clinical trial (https://pubmed.ncbi.nlm.nih.gov/30670277/), frankincense could be used as a “as complementary treatment for heavy menstrual bleeding (HMB) among women of reproductive age.”

*In 2019, the International Journal of molecular sciences posted a study article discussing the frankincense as a prevention or treatment of many chronic diseases including “arthritis, diabetes, asthma, cancer, inflammatory bowel disease, Parkinson's disease, Alzheimer's, etc.”
https://pubmed.ncbi.nlm.nih.gov/31443458/

*In 2019, a group of researchers conducted “a pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee.” In that paper they have concluded that “Patients were administered BSE (Boswellia serrata extract) or placebo for a period of 120 days. The trial results revealed that BSE (Boswellia serrata extract) treatment significantly improved the physical function of the patients by reducing pain and stiffness compared with placebo. Radiographic assessments showed improved knee joint gap and reduced osteophytes (spur) confirming the efficacy of BSE treatment.”
https://pubmed.ncbi.nlm.nih.gov/30838706/

*In 2020 a research article was published discussing potential antimicrobial properties of Boswellia sacra (frankincense). Inhibitory properties were observed “toward relevant pathogens Staphylococcus aureus and Pseudomonas aeruginosa, and samples from Grade 2 of Sahily and Houjiri were particularly active against a dermatological strain Propionibacterium acnes.” “Data obtained from in vitro studies showed that all essential oils had a significant antifungal effect against Candida albicans and Malassezia furfur.”
https://pubmed.ncbi.nlm.nih.gov/32325952/

*In another study researchers have concluded that an active substance in frankincense oil called Alpha-pinene showed anti-inflammatory properties “in human mononuclear cells and mouse macrophages.” It also “showed that isolated alpha-pinene had the ability to reduce the expression of pro-inflammatory cytokines.” Cytokines as we know may elicit inflammation as they make the cell more leaky which causes the fluid shift into the tissues and swell. The researchers also describe another study in which “it was found that exposure to alpha-pinene increased T-cell activity and decreased stress hormone levels.”
https://pubmed.ncbi.nlm.nih.gov/29450138/ (This study was sponsored by an essential oil company Doterra so they do have a conflict of interest).
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There are multiple promising studies showing an improvement in memory in a rat model. Additional 75 studies are generated when you type in “Boswellic extract” in the search. Obviously many more studies should be done before we can establish frankincense as an effective treatment. However, from the research literature we currently possess it is safe to conclude that frankincense could be used as a complementary treatment for many chronic ailments.

​Have you heard of Manuka Honey? In this post I will focus on what Manuka Honey is, where it comes from and what are some of its medicinal properties. In the article published in Oxford Academic in the Microbiology Review section, the group of authors have discussed the antibiotic resistance plaguing the healthcare system today. They write, “Antibiotic resistance accounts for hundreds of thousands of deaths annually (Review on Antimicrobial Resistance 2014), and its projected increase has made the WHO recognize it as a major global health threat (WHO 2014).” (https://pubmed.ncbi.nlm.nih.gov/29069382/)

It is evident that growing antibiotic resistance is becoming a major problem today. This is why I wanted to focus on some of the alternatives to antibiotics that are available to us today. Now, the best thing that we can do as individuals is to maintain a good health thus preventing infections. However, what do you do when the infection does happen?
In 2018, I had undergone a surgery which have left me with a chronic surgical wound that would not heal for the total of 8 months. This was an incredibly traumatizing experience to me especially that at the time I have chosen not to share this with anyone. Keeping an open wound infection free is not an easy task. When searching for ways to heal my wound I have met someone (you know who you are) who has suggested I use Manuka Honey. My initial thought was “this is nuts” but when I dived into medical literature, I realized that that there is a tremendous amount of information and studies available. When I found that Manuka is widely used in wound centers in the form of MediHoney paste - I was sold.

In the article published on woundsresearch.com (https://www.woundsresearch.com/article/7749), the Author Terry Treadwell writes, “The ancient Egyptians used honey as a wound treatment as early as 3000 BC and it has been found in Egyptian tombs…Honey was an integral part of the “Three Healing Gestures” used by the Egyptians. This included washing the wound, applying a “plaster” (made from honey, animal fat, and vegetable fiber), and bandaging the wound—not much different from the treatments used today.” It is a well established fact that honey has been used as medicine for thousands of years - so how is Manuka Honey different?

Manuka Honey is most often found in New Zealand. History of its use has been dated back to the first colonies. This particular honey has been made by the bee colonies which have pollinated the manuka flowers (Leptospermum scoparium) which are native to New Zealand. The honey has been known to have tremendous medicinal properties. But are any of those claims true? What does the medical literature say about it?

In this paper, the authors describe the strong antimicrobial properties of Manuka Honey (https://pubmed.ncbi.nlm.nih.gov/31652284/)
“Honey has long been used as a wound salve and has been found experimentally to stimulate tissue regeneration, facilitate wound debridement, reduce inflammation, and exert antibacterial properties [1]. Its antibacterial effects arise from its low pH, ability to dehydrate bacteria, and phytochemical content [2]. Manuka honey, derived from flowers of the Manuka bush (Leptospermum scoparium), in particular has been noted for its bactericidal activity. Many types of honey contain hydrogen peroxide as the main antimicrobial mechanism, whereas the antibacterial effects of Manuka honey are considered to be primarily from its substantial content of methylglyoxal (MGO), a compound found in only certain honeys [3, 4].”
“Manuka honey may be used effectively to treat disorders like atopic dermatitis, blepharitis, rhinosinusitis, and skin ulcers [23–26]. Our data corroborate the measurable antimicrobial activity of Manuka honey against a spectrum of clinical isolates from skin and soft tissue sources, including those with multi-drug resistance such as MRSA, ESBL producers, CRE, and MDR P. aeruginosa [6, 27–30].”

In this 2020 Systematic review (https://pubmed.ncbi.nlm.nih.gov/33142845/), the authors start the paper stating that the antibiotic resistance is estimated to become a leading cause of death by 2050. I wanted to include few excerpts from this paper:
“Within a medical setting, honey is often used on chronic wounds and burns to prevent infection and aid healing due to its anti-inflammatory and antimicrobial activity [4]. It can be applied as a topical treatment or laced into a dressing [49,50]. As a topical ointment, honey provides a physical barrier between the wound and the environment whilst stimulating an inflammatory response and preventing against bacterial infection [51]. Dressings that are laced with honey can be changed less frequently than those without, resulting in less pain and discomfort for patients [52]. The use of honey in this way has been shown to reduce healing time, prevent scarring and protect from microbial infection, providing an effective treatment [2].”
“Honey demonstrates several characteristics that make it effective for wound management; it has both antimicrobial and anti-inflammatory properties, it promotes autolytic debridement, promotion of granulation [70] and reduces malodour [71]. In part, its antimicrobial activity is attributed to its physical properties, including a high osmotic pressure and low pH [72]. Additionally, honey’s antimicrobial activity is due to the presence of methylglyoxal (MGO), hydrogen peroxide, flavonoids and phenols, as well as the enzyme bee defensin-1”

In 2015, the Journal of Wound, Ostomy, and Continence Nursing has published a research on palliative management of squamous cell carcinoma of the Oral Cavity (https://journals.lww.com/.../Palliative_Management_of...).
Here is the conclusion: “Honey proved safe and effective for palliative management of external and oral wounds secondary to squamous cell carcinoma in this elderly female patient. It also provided effective odor management…The anti-inflammatory and antimicrobial benefits of honey were an added bonus resulting in improvement in inflammation, pain, and exudate management. Based on our experiences in this patient and limited supporting evidence, we recommend considering honey as a safe, ingestible option for management of challenging wounds occurring within the oral cavity.”

This 2019 Irish study reached the conclusion that “Manuka honey oligosaccharides significantly reduced the adhesion of Escherichia coli O157:H7 (by 40%), Staphylococcus aureus (by 30%), and Pseudomonas aeruginosa (by 52%) to HT-29 cells. This activity was then proven to be concentration dependent and independent of bacterial killing. This study identifies MGO™ Manuka Honey as a source of anti-infective oligosaccharides for applications in functional foods aimed at lowering the incidence of infectious diseases.” https://pubmed.ncbi.nlm.nih.gov/31581550/

There are many more studies that highlight the strong antimicrobial activity of Manuka Honey. Most of them pertain to wound healing but there are many other ways in which Manuka Honey can be used.
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Now, how do you know you are purchasing high quality Manuka honey?
First, we have to make sure that the Honey is certified as there are many impure Manuka Honeys out there. MGO, UMF and Kfactor are 3 main certifications used to assure that you are getting a quality product. Many sources state that under UMF 15+ can be ingested. Higher grades of honey are considered to be medical grade honeys mostly used topically - they tend to be darker and more bitter. I am attaching a comparison chart as MGO and UMF vastly differ in their scoring system.
To conclude this post, Manuka Honey is being studied worldwide due to its high antibacterial, antiviral and antifungal activity. Due to increasing antibiotic resistance - other methods of treatment must be urgently considered. Manuka Honey appears to be one of the most promising treatments that can allow us to treat multiple ailments without adding to antibiotic resistance.

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Epsom Salt (magnesium sulfate) Bath Soaks are often used for general stress reduction and better quality of sleep. But are they effective? Is there any scientific evidence behind it? Let's examine it...

I work at the Hospital and my shifts are very lengthy. After 2 or 3 days in a row my body is beyond exhausted and often feels very sore. After couple of intense and stressful shifts it takes me about a day to fully recover - physically and mentally. I am also under a lot of stress and often cannot fall asleep for hours since my mind is constantly racing.
Couple of weeks ago I purchased a book co-authored by Immunologist from South Africa: Patrick J.D Buick, PhD titled: "The Immune System Cure". It is a relatively old book but it contains a lot of good information related to our immune system function. In the book I read about the benefits of Epsom Salt Baths. I have only heard of using Epsom Salts for soaking tired feet so I was hesitant to add Epsom Salts to my bath at first but the alternative would be a sleep medication with a lengthy list of side effects - the choice was clear. After trying out this soak couple of times I came to the conclusion that I truly do not know how I ever lived without it. I sleep like a baby now and wake up feeling rested.

Epsom Salt is just a fancy name for Magnesium Sulfate. Magnesium Sulfate is an incredibly important electrolyte found in the body and is responsible for over 300 chemical processes (that we know of). One of the most important functions of magnesium is to assist in the energy production. In nursing school we learned that magnesium sulfate is used to stop the uterine contractions causing preterm labor. It is also used to prevent seizures in those diagnosed with eclampsia. Polymorphic Ventricular Tachycardia (Torsades De Pointes) a rhythm that can lead to a sudden cardiac arrest is also often treated with magnesium sulfate.

There are thousands of studies, articles and books which highlight the role of magnesium in the body. So let's review some of those. Can we even absorb magnesium through skin?
In a small experiment, a group of researchers have concluded that magnesium can be absorbed when applied topically. Here is their conclusion.
"Upon topical application of magnesium solution, we found that magnesium penetrates through human stratum corneum and it depends on concentration and time of exposure. We also found that hair follicles make a significant contribution to magnesium penetration."


Okay, now can magnesium reduce stress levels?
In the recent paper French researchers issued this statement:
“Low magnesium status has been reported in several studies assessing nutritional aspects in subjects suffering from psychological stress or associated symptoms. This overlap in the results suggests that stress could increase magnesium loss, causing a deficiency; and in turn, magnesium deficiency could enhance the body’s susceptibility to stress, resulting in a magnesium and stress vicious circle.”


In other words, our magnesium stores are depleted during the time of stress which makes us more susceptible to …..stress. Magnesium deficiency on the other hand can make us more susceptible to stress thus creating a vicious cycle. It is a well-known fact that magnesium deficiency can also lead to oxidative stress and pro-inflammatory response. The only logical conclusion I can draw here is that chronic stress I experience at work depletes my magnesium stores and therefore supplementation is important to achieve balance. 

In the research article published in 2020 by Murdoch University in Australia, the researchers have highlighted several pieces of information:

-“Magnesium is an essential mineral used as a cofactor in more than 300 enzymatic systems.”

​-“it is involved in ATP (energy molecule) metabolism, fatty acid synthesis and breakdown, glucose metabolism, protein synthesis, and DNA and RNA metabolism.”

-“Only 1% is present in serum and >99% is present in bone or intracellularly.”

Here are some other interesting excerpts from the paper:
“Cernak et al. (33) investigated magnesium status in young volunteers exposed to chronic stress (e.g., political intolerance, awareness of potential military attacks, permanent stand-by duty, and reduced holidays >10 y) or subchronic stress consisting of everyday mortal danger in military actions lasting >3 mo. Significant decreases in plasma ionized magnesium and total magnesium concentrations were found in both groups.”

“In a study by Piruzian and colleagues (34), a 6-man crew was isolated in a chamber for 105 days…Reductions in serum magnesium (total and ionized) were observed over time, with the greatest changes occurring during the first 30 days of the experiment.”

“As a physical stressor, investigations into the effects of physical exercise on magnesium concentrations have also been conducted. Blood and urine concentrations of magnesium decreased significantly following the completion of a marathon in endurance athletes.”

“The bulk of evidence suggests that both acute and chronic exposure to psychological and environmental stress are associated with lower blood magnesium concentrations and increased urinary excretion.”

It is evident that stress can affect magnesium levels. Of course it is best to check with your provider before you introduce any supplement. However, I personally really love those Epsom Salt Baths. One of my friends actually asked my why on earth do I have so many large Epsom Salt bags in the bathroom. Well now you know. Adding a lavender oil would be a cherry on the cake. I also like adding Frankincense Oil for its calming and relaxing scent. This routine has allowed me to fall asleep much sooner and remain asleep throughout the night without having  to take any additional supplements like melatonin. Most importantly - I feel much better and I am much more productive at work.