Episode Transcript
Speaker 0
So as you all know, Mikelle and I were at the National Menopause Show back in October, and it was amazing as always.
Speaker 1
So so good. So many great speakers, such incredible evidence based information. And this year at one of the booths, we met two brilliant naturopathic doctors, doctors Nick and Nat,
Speaker 0
who just so happen to be identical twins. And what caught our eye at the booth was that they iron IV bag on display. It was like this dark brownish liquid. It was pretty hard to miss because it was pretty ugly. I'm not gonna lie.
Speaker 1
It turns out iron deficiency is a huge problem for perimenopausal women, and it often flies under the radar because a lot of the symptoms of iron deficiency in anemia mimic those of perimenopause, things like brain fog, fatigue, irritability, and jumpy legs.
Speaker 0
And what doctor Nick and Nat shared with us was that one in four women in Canada between the ages of fourteen and fifty have low iron. One in four, seriously.
Speaker 1
It's a big number. So we knew we had to sit down with doctor Nick and doctor Nat from the Durham Natural Health Center
Speaker 0
to get the full scoop. And, boy, did they deliver. Because in this episode, they're breaking everything down that you need to know about iron deficiency and anemia and perimenopause, from all those sneaky symptoms to watch out for to some really effective treatments.
Speaker 1
Might be as simple as iron supplements, or some people might need iron infusions, which is a big topic in today's conversation.
Speaker 0
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Speaker 2
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Speaker 0
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Speaker 1
So excited to have you, finally. It's been a while.
Speaker 3
It's been a while. We're excited to be here.
Speaker 1
So for our audience, doctors Nick and Nat are obviously identical twins. They are also naturopaths, menopause certified practitioners, and you are owners of the Durham Natural Health Clinic in Ajax. Did I get that right? Yes.
Speaker 0
Yes. Excellent.
Speaker 1
And we're gonna get to all of that shortly, and, a little bit more about why you do what you do and why you both do the same thing, and do it together. But we wanted to start today talking about iron because when we met you at the National Menopause Show, you had an iron IV bag, I guess, is the best way to describe it, sitting on your booth. Tell us
Speaker 0
why. Yeah. Yeah. Why?
Speaker 3
It it's quite eye catching. Right? Like, it looks like pola in a bag or molasses in a bag. Right?
Speaker 0
That's the thing. It's not pretty. Like, it's not like the clear white. No. It was like, oh, what's what's that? Yeah.
Speaker 3
Yeah. And partly for that. So everybody would stop by and be like, what exactly is that? And why would I want that?
Speaker 0
Yeah.
Speaker 3
But partly cause it's all, it's a therapy that we brought it about a year ago and we have been seeing such impact and change with women who have been receiving this therapy, that we wanted more women who are navigating perimenopause to know about it and to know about their options.
Speaker 0
And so what is the therapy?
Speaker 3
Yeah. So it's IV iron. So we are going to infuse iron into the bloodstream. So it's a quick and effective way to replete iron stores.
Speaker 1
And when's that called for?
Speaker 3
Yeah. So, I mean, we can do it when there is iron deficiency or iron deficiency anemia. So maybe we'll start talking about that and we'll talk about sort of when we would employ those two, when we would employ that therapy. So, iron deficiency is when our iron stores are just lower than they should be. So there's criteria and we fall below that. We can have that without anemia. Or we can progress where now we have low iron stores and we've progressed to low iron with anemia. We're now our body is struggling to make red blood cells. So it's a more sort of advanced state In hospital settings or in settings where there is iron deficiency anemia, and it's quite critical, an iron infusion would be indicated. So that's where we're going to use that, but somebody has to be pretty critical to be able to access that.
Speaker 1
In a hospital setting.
Speaker 3
In a hospital setting. In clinical practice, we'll use this when somebody's iron stores are just not optimal, and we'll talk to patients about their different options.
Speaker 0
And I think for a lot of people in perimenopause, they've one of my, symptoms no. That's not the right word. One of the things that I went through was heavy bleeding. You yeah. You you're, like, depleted. You feel exhausted. Like, I I didn't know about this at the time. But So what are maybe what are
Speaker 1
the symptoms that that you're saying, oh, I think this might be a good treatment option for you. What are the symptoms that our women are presenting with?
Speaker 3
Yeah. So it's it's really interesting. When we talk to women, we see mostly women in in perimenopause. And so we're dealing with women in their forties. And listen to this lineup of symptoms when it comes to iron deficiency. It is mood changes. It's fatigue. It's brain fog. It's typically concentrating, right? It could be restless legs, sleep issues. We might get shortness of breath when we're exercising, but you can see how that list
Speaker 0
is very similar.
Speaker 3
Yeah. Right.
Speaker 0
There's a lot of crossover. Yeah.
Speaker 3
So much crossover with hormone changes. And so it's really important for us to not just always point the finger at hormones, but also understand is your, you know, is your iron contributing here? And sometimes it's not a, this it's like a, this and, like it could be perimenopause and iron deficiency. It's not an or conversation, but part of us as clinicians doing a thorough diagnostic workup is to like run your iron, look at that, make sure that things are optimal so we can at least like check that box.
Speaker 0
Right. And is
Speaker 1
it, is heavy bleeding the cause or could it be something else causing the the iron deficiency in perimenopause?
Speaker 3
That's a major cause for women in perimenopause. As you know, in perimenopause, there is often heavy bleeding. There is frequent periods. We just have this, like, excessive blood loss. So that can be one reason. It could be a fibroid. It could be adenomyosis. It could be other reasons. And that's why it's important to do like, a, okay, we're having heavy bleeding then b, why are we having heavy bleeding before we just say, oh, this is hormones to blame. So that sometimes they will refer for imaging or different things. And then we're gonna look at, like, employing the right treatment.
Speaker 1
So it might be, okay, we need to stop the heavy bleeding, and then there are different hormonal options presumably for that or more significant interventions if it's really bad. But the iron IV is is that that's not an ongoing treatment, I would assume, then, based on that.
Speaker 3
No. So the way that I always prescribe it to patients, I'm like, okay. So we need to, like, fill the bucket. Right? Your iron is low. We need to fill the bucket. And so the iron IV is a fast way to fill the bucket. But we also need to have a strategy to plug the hole in the bottom of the bucket. Right? So like if it is the heavy bleeding or, you know, we do need to talk about like kind of a double ended approach so that we're not relying on IV iron all the time. Although we do have a couple of handful of patients in the clinic right now who are waiting for hysterectomies, who are coming a little more regularly. We're just buying them time. Right.
Speaker 1
Because they have to wait for the surgery.
Speaker 0
They have
Speaker 3
to wait for the surgery. The bleeding's not stopping. It's heavy. We know why.
Speaker 1
And The other interventions haven't helped and this is
Speaker 3
They haven't they're not here yet. Okay.
Speaker 1
Fascinating. Fascinating. Maybe this is too much detail, but are you able to give some parameters? You know, like, I know a lot of people, at least where I am in Alberta, when I get my blood work done, I get the results now. I can pull them up online. And not that we want anybody self diagnosing or anything like that, but I think it's really helpful to have an understanding of some of these things, especially when you don't have the benefit of the types of appointments patients get when they come to see you. Right? A lot of us are limited to ten minute Ten minutes. Short increments. So the more we can know, the more we can get out of those appointments. What does iron deficiency look like from a Yeah. Blood work perspective? Is that an easy thing to share? Yeah.
Speaker 3
It's super easy. It actually says it on your lab requisition. So if you go so what were Lab results. Oh, sorry. Your lab results. What you will see is you will see your ferritin level. So if we're looking at, let's break this up. If we are looking at for an anemia, we will see that on a complete blood count. So we will see that on a CBC. We will see hemoglobins that are lower than the reference range.
Speaker 1
Right. And it'll say on your, on your results. It'll say it'll
Speaker 0
be flagged. Yeah.
Speaker 3
Only one twenty is the reference range and you'll be below one twenty. We will see that flagged very quickly, easily on a complete blood count. When we're looking at iron deficiency without anemia, so you're able to maintain your red blood cell production, you're able to maintain that aspect, we're gonna look at ferritin. So we're gonna look for ferritin levels. If you are below thirty, we're really confident that there's an iron deficiency happening. And it says this right on that lab report. Between thirty and fifty, there's a probable iron deficiency. Between fifty and a hundred, there's a possible iron deficiency. And ideally we want to be above a hundred.
Speaker 0
So we're pulling up my lab results. Hold on. Keep going.
Speaker 3
So many patients that we will see just hanging out with a ferritin of forty, told it's normal.
Speaker 0
Right. Well, again, because our in Canada, our ranges I think, because of our health care system are are, like, he or here versus if something in the states, like, they're often they're much narrower. So and I think it's just maybe public health. I don't I don't know the reason
Speaker 3
for that. We just changed the reference ranges for iron fairly recently here in Ontario. I'm not sure if it
Speaker 0
was,
Speaker 3
the same in Alberta or not, but these reference ranges are not talking about like this has come a long way from the, oh, if you're under thirty, you're deficient and if you're above thirty, you're normal. We're actually now catching up and saying, no, actually, if you're, you know, if you're under fifty, it's still very probable. And if you're under a hundred, it's still not optimal.
Speaker 1
Right. Do I have to come in for
Speaker 0
an IV bag or is there something else I can do if I've got Yeah. Is that where you start or No. No. What, so what is the protocol?
Speaker 3
So the often we so I always tell patients, it depends on the severity of what we're dealing with. So in the clinic in Ontario, IVI art is actually outside of our scope of practice. So we have two nurse practitioners in the clinic who do this therapy for us. And the way that we really set this up with patients is depending on the severity of where it is. So if it's really severe, and I know that we have a big mountain to climb, then we may jump right to this just so that they can feel better, faster. And that would be the only reason. And some patients will say it's really reasonable to try like oral supplementation first. And we will do that. But what I, what I've seen happen so often is women will get their iron levels checked. They're told it's low, they're told to supplement and no one follows up on whether or not the treatment actually works. Right. How many times have you heard that? And so, what we do is we put a timeline on that. If we're going to take oral iron, we're going to want to retest it in about three months. And we're going to want to make sure that we have had enough traction. Right. And that we're actually moving the needle because it sometimes, like Michelle said, like the blood loss can be so severe or pronounced that despite our oral supplementation, we're not getting any traction. And like, this was me, ferritin hanging out between thirty and fifty forever. Despite oral supplementation. Yeah. We go to their hand up, right? Like despite oral supplementation, I was like, how long am I going to give this? Like enough is enough. So like I just went and got a couple iron infusions before the holidays. And I was like, Hey, now I can probably maintain this with oral. Cause I was like keeping myself on the same spot, but I wasn't getting ahead. Right.
Speaker 1
So it can also give you that little boost to get some traction to move the needle, it sounds like. Interesting. So very nuanced. Right? This is, like, you need practitioners. We say this again and again
Speaker 0
who know Who know what they're doing.
Speaker 1
And understand all of this. I was in the same boat. I was the one raising my won't surprise any of our listeners that I was raising my hand. I feel like I raise my hand every time some some one is talking about some issue in perimenopause or potential issues in perimenopause. And it was real it was really frustrating. And, you know, the practitioner that I practitioners that I was working with at the time were like, well, just keep trying. And, yeah, it went on. I was iron deficient for years. Question. So if I
Speaker 0
go to if I don't have a naturopath and I'm going to my doctor for this and we do the blood work and it's low, is this this iron IV bag, is this something that my doctor would prescribe or is it more in your
Speaker 3
They a lot of them are not set up to do it in their clinics. Okay. And so what's been interesting for us in the clinic, like I said, it's our two nurse practitioners who do this. They're starting to get referrals from some GPs because they know that their values aren't critical enough for them to qualify, to have this done in the hospital setting.
Speaker 0
But But they know that they would benefit from it.
Speaker 3
Yeah. And they might be in this situation where, you know, oral supplementation isn't doing it for the patient and we just want to provide a different option. And sometimes with oral supplements, there's like also people will have like GI distress.
Speaker 0
Yeah. Well, I was gonna that was one of my questions. Yeah. Is this is that still a thing? Because I feel like when I was younger and taking iron, it definitely I had some distress. But also, does this IV bag have similar side effects?
Speaker 3
We're going to bypass the GI. So we bypass them, we go right into the bloodstream so we can bypass some of that, that GI distress phase. For most patients, like we said, like if your levels are, you know, low normal, they're like in the low range, like we will start with oral supplements and we'll see, we'll see how they do and we'll, we'll retest it in three months and we'll get a gauge of like, did you absorb it? How's your GI tract? Are we getting constipation? Are we getting, you know, all those negative side effects or can you handle it and your levels are moving and we go, great. Perfect.
Speaker 0
Then keep with it.
Speaker 3
But for some people they're like, I can't tolerate it. Or, you know, sometimes we're putting you on like a lot of iron and it's like, I can't remember. I got a busy life. Like clients sometimes can be an issue with supplementation for some people. So it's just a different tool that we can utilize, which has been so valuable and the beauty of it and why, I mean, we've only had it in the clinic for about a year, but what has been so nice is the feedback from patients and just coming back and be like, oh, like I can, it's noticeable. Where I always stay with oral, it's this slow climb and hopefully we'll get there. And a lot of times we do, or this one just like a lot quicker. Well, we had a patient when we were at the menopause show, remember? She came up to the booth and she had just had two infusions, I think. And she came up to the booth and she was like, oh my gosh, this is the first week that I haven't napped. I was napping every single day. That's amazing.
Speaker 0
Wow. And she
Speaker 3
was like, I have energy. Like I haven't had in years.
Speaker 0
Oh, I want some of this. I don't.
Speaker 3
Don't I do think they're gonna make that impact if your levels are low. Right.
Speaker 0
I was gonna say this is like the the party bag when you go to Vegas and you're
Speaker 3
Yeah. It's not that.
Speaker 1
No. Not that. So
Speaker 0
I think this is still the case.
Speaker 1
So if you roll up to a pharmacy to buy supplements, and maybe I don't know if you have any recommendations if someone has been told they need to supplement their iron, if if there's, you know I remember a product that take a liquid iron as an example. But I also remember that iron supplements are all behind the pharmacist. Like, you have to you can't just pick them up off the shelf. So are there risks? Are there concerns? Are there you know, what are what are the what are the potential downsides of supplementing iron both orally and with an IV?
Speaker 3
It's not something that you would ever wanna do without having data to tell us that we need warrant it. Because you can actually get iron overload.
Speaker 1
Right. And what and that's bad because Look. Yeah.
Speaker 3
It can cause problems with your liver and it can have health consequences. And so we wanna steer clear of that. And so the only reason you would ever supplement with iron would be if you have data to tell us that we need to do that. And again, in a perfect world, there would be some sort of like ongoing or a timeline in terms of how we're doing this. So like when we do the, when the nurse practitioners do the IV iron in the clinic, like they're doing usually three of them and then they're retesting.
Speaker 0
And if I'm going to a naturopath and just because not everyone has the budget for it, but if I'm going to a naturopath, the retesting, is that covered by OHIP or Good question. Or is it all out of pocket?
Speaker 3
Great question. As NDs, we are outside of the OHIP model. So if we requisition the blood work, it is not covered. If you see one of our nurse practitioners in private practice, there's a fee to see them, like fee for service, but their blood work is covered. Okay. So in our clinic, because we work collaboratively with them and they're the ones monitoring and doing the IV iron component, they are the ones offering the requisitions.
Speaker 0
Oh, that's awesome.
Speaker 3
And that, that piece gets, gets covered. Covered.
Speaker 0
Cool.
Speaker 3
Yes. Very cool.
Speaker 0
I just wanna talk about what a treatment looks like. I've got the symptoms. I've we've decided this is the the protocol we're using. What what is that? What does it look like? Love what you're hearing? Don't miss our weekly newsletter. It's got expert advice, evidence based resources, practical tips, and, of course, a little humor.
Speaker 1
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Speaker 3
Patients typically come into the clinic. They will have had a consult with one of our nurse practitioners, either virtually over the phone or through video or in person where they will walk them through, risk benefits and where their values are and what the protocol would look like and then review their lab work. And then they would have them come in for their first IV. And their first IV typically runs over about an hour to an hour and a half.
Speaker 0
Okay.
Speaker 3
It's that, you know, Coca Cola,
Speaker 0
the slow
Speaker 3
drip, slow drip. Yeah. Most patients tolerate it quite well and it's dripped over that, you know, up to ninety minute timeframe. And then, and then they would leave and then they typically would come back about a week later for their next IV. Most patients are getting two to three, typically is the protocol that our nurse practitioners use before they're retesting.
Speaker 0
Okay.
Speaker 3
And then we wait a month and retest.
Speaker 0
So two to three over the course of two to three weeks. And then you wait a month and then you retest again. Yeah.
Speaker 3
Okay. And then, and then depending on what caused it, how we got here in the first place, then we talk about what do we want to do? And typically the way that our nurse practitioners will do is they'll say like, you're going to go on your way and we're probably going to retest this in about six months just to see how far things have shifted or changed for you so that we're catching you before we get back to that point where you're symptomatic. Right. And sometimes at that point, we're then putting them on an oral. Yeah. And we're just going to say, you know, take an oral capsule at a reasonable dose, not heroic, you know, oral doses that, you know, should come with less side effects, GI side effects, and hopefully we can maintain it at that point. I have one patient, I can think of who has, GI issues, like I said, I believe she's got colitis, so she can't absorb it. So we have tried and she just has to come in for ongoing infusions because there's an absorption issue. So she's probably coming every few months. Oh, yeah, yeah, yeah. Yeah. We've pushed it every like four to six months. She just, we've figured out sort of what that looks like for her. And we just keep a close eye on it. And, but that's a rare case.
Speaker 0
And sorry, I I brain fog maybe, but I can't remember. I mean, I know Mikel asked the question. Is is there a brand that you guys love for for this that maybe I don't know if they have to go to a clinic to get it or if they can go to their, you know, naturopathic store. Is there is there a good brand
Speaker 3
out there? So we will use different ones. So we will use different, like, professional brands in the practice. Mhmm. I would say it's more that we're looking for, like, a different like, a type of iron.
Speaker 0
Okay.
Speaker 3
Where an iron bisglycinate generally is, like, a good form to Okay.
Speaker 1
Thank you. How common is this in your patient population?
Speaker 3
Great question. So I tried to look up stats. I'm like, how many women are actually dealing with? Because I feel like I'm so biased to see what's working with perimenopausal women. I feel like I see this all the time.
Speaker 0
All the time.
Speaker 3
Like every second. I wouldn't even say every second patient. I would say more than that. Right. That I see clinically, but statistically speaking in Canada, one in four women are walking around with low iron for women between the ages of fourteen and fifty. So ideally these are men treating men women, right? So men treating women twenty five percent. I suspect, this is my bias, but I suspect that a good chunk of those women are the women between the ages of forty and fifty, but I have no data to back that up other than my clinical experience and what I have witnessed and seen. So it's a lot.
Speaker 0
Yeah. That is a lot.
Speaker 3
That's a lot. Right? And I, yeah, and I was gonna say, I think sometimes, you know, we don't always feel our best as our hormones are shifting or changing. And if iron is low and it's happening along side this or parallel to this experience, fixing this becomes really important for me because then I've checked the box of like, okay, it's no longer your iron. Like that is not what's causing your brain fog or your fatigue or contributing to your moods. Right. Maybe we need to be focusing more on your hormones or your sleep or like other factors, but I just like to be able to check that box for our patients so that we can get a little more clear on our treatment plan or our roadmap going forward.
Speaker 1
Well, because I would think that if you're iron deficient and you're not treating that and you're going after the other symptoms, I mean, it's kind of a fool's errand, isn't it? Because Yeah. You're you know, you could have to do all the CBTI, cognitive behavioral therapy for insomnia, or take all the DaVigo, or take all the whatever, you know, products there are, or tools there are for sleep. But if you're low Iron. Right? I have the dumbest question
Speaker 0
in town, but if if iron if low iron is gonna make me tired, then why am I not sleeping? Like, what's what like, shouldn't it just make me, like, comatose all the time?
Speaker 3
In theory. In theory. But it's linked to serotonin, production. It's some of our neurotransmitter production. So Okay. Iron is involved in, like, so many biochemical pathways. That's why there's this like general feeling of not feeling well. Right. Mitochondrial production, red blood cell production, like all these things. So it's the oxygen carrying capacity to all these systems that really sort of has like kind of a bit of a full body effect in terms of how we don't feel well. And it affects like the, the quality of the sleep. So one of the big symptoms is like restless legs. So people can have restless leg syndrome and then that could be iron deficiency. And so, it's affecting like the quality of the sleep as well.
Speaker 0
I'm gonna look at my, I'm like, wait, I got that too. I'm gonna check out the show
Speaker 3
a lot.
Speaker 0
Wait, stop. Anyway. Yes. Okay. Well, I'm gonna check that. I've got recent reports. I'll look at it. I think it was fine, but Such great information. Yeah.
Speaker 1
Let's let's maybe switch let's talk a little bit about the two of you. Why did you both decide to become naturopaths and decide to work together? That's pretty cool.
Speaker 3
That's all the time. And I feel like it's like part of being a twin as to why I discovered naturopathic medicine. I'll take credit for your career path, Rob. I'll explain the story. Part of why I got interested in naturopathic medicine is because, I started to experience acne and this started in university and I would go see, so later I had like sailed through teen years and all of a sudden in my like university years, I'm like, why am I breaking out? Like, what is happening?
Speaker 0
Yeah.
Speaker 3
I would see doctors and I was told that it's bad luck. And I'm like, I have a genetic Yeah. I have a genetic identical who's got the same DNA as I do, who isn't experiencing this and nobody's asking me what I felt like were good, like important questions. I'm like, nobody's asking me about my diet or my stress levels or my lifestyle. Like, why is none of this? Why is nobody asking me about this? It was just antibiotic and here's some antibiotics and here's some more antibiotics and here's some more antibiotics and here's some more antibiotics. I was like, this does not feel right. So in order to do my own deep dive in terms of like healing my skin and recognize that there were things in my lifestyle. I was consuming a boatload of dairy and way too much milk and all these things that were really negatively impacting me. And then at the same time I discovered naturopathic medicine and I was like, this is it. This is the system of medicine that resonates for me that I feel like is preventative in its approach. And I think we were like in our third or fourth year of undergrad. So we did our undergrad together and, I always knew that I wanted to be in health. We both had kinesiology undergrad and I was in my fourth year, really not sure what the next path would be. And so I took a year off and I worked as a personal trainer and I was working in a women's only gym. And I got to see the impact of diet and exercise and how this was changing women's lives. And at the time, really we were working with women in their forties and fifties. Cause Nat worked there as well, but, and I started to see like their confidence, their moods were changing, their blood pressure was getting better. Things were shifting in their health. And I was like, this is what I want to be doing more of. Nat sort of tapped me on the shoulder and she's like, so I think that system of medicine that you're looking for, or this like extra healthcare that you want to be pursuing, is this program that I'm starting in September. And so Did you
Speaker 0
start then together?
Speaker 3
We did. So now that I've been a year off and delayed her acceptance, and then I applied late and got in and we ended up starting that same September together.
Speaker 0
Oh my God. I love this.
Speaker 3
Yeah. And then, yeah. Then we navigated school, you know, went through four years of naturopathic schooling. And then on the heels of that, we graduated and we had always talked about like, we're going to open a clinic together one day, one day we're going to do this. We're going to open a clinic, but it's going to be five to ten years from now. We are going to learn. We are going to get some experience. We're going to get a patient base and we're going to like collaborate forces. And, Literally like months after getting our license, we started to talk about why are we, why are we waiting? And so eight months after getting our license, we opened Durham natural health center. So that was back in twenty twelve. We graduated in twenty eleven. So in twenty twelve, we opened the clinic, with like very naively, you know, like not knowing a thing about business, but just having this passion and It's the best way
Speaker 0
to do it. No, seriously. Right?
Speaker 3
Like you don't know what you don't know. Like you figured out, you know, along the way and Learned a lot as, you know, like clinicians for sure, but like business owners as well. And we would, you know, we practiced, like I would practice half the day and Nat would sit at the front desk and reception and then we would swap places. And we did that for months. And so we started to grow our team and, you know, sort of where it is today. So, yeah, now we have seven naturopathic doctors, two nurse practitioners, like office admin, admin staff, the full team. Yeah. So it's amazing.
Speaker 0
That's amazing. And, and you're both menopause certified practitioners. You also like, are you able to then do MHT or does that work again with the nurse practitioners?
Speaker 3
Yeah. So we're, we got our, menopause society certification in twenty twenty two is when we both, did that. And actually our entire team has since got their menopause society certification. So all of our nurse practitioners, all of our naturopathic doctors are all menopause society certified, which is amazing.
Speaker 0
Yes. That is fabulous.
Speaker 3
Part of why we added our nurse practitioners to our team other than their fabulous humans, and it's amazing to collaborate on the naturopathic side as well as the conventional side and know when, you know, there's limitations in our medicine and when somebody needs a prescription, they've been amazing for that, is we have limitations in our prescribing rights in Ontario. Right. So we've been prescribed estrogen, vaginal estrogen. We have some limitations. Topical estrogen, all the estrogen you need.
Speaker 0
All the estrogen. But no progesterone. Progesterone. Right.
Speaker 1
Which is so bonkers to me, but anyway, we won't digress.
Speaker 3
I mean, yeah, this conversation burned out. I hope that's changing. But our nurse practitioners have been that beautiful kind of bridge. So what it looks like when patients come in and work with one of us naturopathic doctors, we then just refer to our nurse practitioners for that prescription. They'll do their due diligence on that aspect and write that script for us and offer other treatments. So now we can do the IV iron and they will do testosterone and different things. So it's been a really beautiful collaboration for our clinic and it's been a really great, addition to our team.
Speaker 0
How long have they been on with you?
Speaker 3
Jess was our first NP and she started two years ago.
Speaker 0
Okay. That's awesome.
Speaker 3
And then we added Rachel about a year ago.
Speaker 0
Yeah.
Speaker 3
And it's great. And then if patients just want to access, I would say when you work with a naturopathic doctor, we're going to do like full menopause care is what I like to describe it. Like we're talking about your diet and your exercise and your lifestyle and your prescription element and your sleep. And we're doing like full menopause care, like the full tool toolkit. But we also have the option of patients just accessing our nurse practitioners. If like, maybe they have a naturopathic doctor that they're working with, or they nurse product doctor that they're working with or they feel like they have that lifestyle component set, then they can just access our nurse practitioners for the prescription element of things. And do you know In person or virtual.
Speaker 1
Great. In Ontario though. Everybody has a big issue.
Speaker 0
Yeah. That's cheap end.
Speaker 3
Yeah. Exactly.
Speaker 1
Yeah. That that can be your next project. Sounds like
Speaker 3
Totally.
Speaker 1
You've got not much going on. Just open another clinic. Why why not? Do you do any kind of group programs, or is it like a one on one only model?
Speaker 3
No. So we actually, in July, just started to launch what we call our empowered midlife hub, and this came to light after we saw a gap within our clinical practice. We've our one on one practice is amazing and it's great, but we're really talking like high level strategy. And the work that we do as naturopathic doctors is to try to get people to change their habits and change their lifestyle and change how they're eating. And we realized that that was, and moving and all the things. And we realized that that was so much better done in community. So we launched our empowered midlife hub, which is our community group of women, all navigating this season together. We meet on zoom, for coaching calls twice a month, so we can have that accountability, that support. We have a Facebook group. It's a really amazing container where we just get to hold each other through all the things we know we need to do. I would say like with life health and health, you know, we just need to take it back to the basics, but the basics are hard.
Speaker 0
Well, and we've got so much, so much going on as well. Like finding the time to prioritize yourself is a big part of that too.
Speaker 3
That's ninety percent of it. So it's been really magical to see these women create little accountability buddies with each other and have that support and lean on each other and then have Nick and I there to coach and guide and it's been really, really fun. So that's something we've added to the practice recently that has been really great.
Speaker 0
Love this. So good. Amazing. Ladies, I think we could probably talk forever, but what just if we could narrow it down, what is the one thing you would love every woman to know about perimenopause? I think
Speaker 3
that the symptoms and what women are experiencing, the hot flashes, the mood changes, the sleep challenges, the brain fog, all of these things, these are all very real. And these are things that women will experience as they are navigating this. But with the right support and the right tools, you really can feel amazing as you're navigating this phase. And so that's what I want women to know is that you don't have to suffer through this. If you have the right team in place, you have the right strategies, you get the right assessment. This truly can be your best decade.
Speaker 0
I love that. Yay. That was so good. Thank you. Great answer.
Speaker 1
Thanks so much for listening to the show. If you like what you hear, please subscribe and write a review.
Speaker 0
So more women can find us and get a better understanding of what to expect in perimenopause.
Speaker 1
This information is not intended as medical advice. The intent of this information is to provide the listener with knowledge to support more efficient and effective communication with their medical provider.
