Archive for the 'General Health and Well-being' Category

An Interview with Peter Koshland, PharmD, and Sonia Rafeh, Outreach Director at Koshland Pharm

Pharmacist Peter

Check out Dr. Richard Shames’ recent interview with pharmacist Peter Koshland and Outreach Director Sonia Rafeh of Koshland Pharm about how compounded medications can make a difference in your health and healing. They also cover current topics such as the “me too” movement and how it’s relevant to women’s health.


A three-dimensional approach to healing

Dr. Cantwell

Michael Cantwell, MD, MPH

One great aspect of working in a compounding pharmacy is getting to meet doctors from multiple disciplines with unique approaches to health and healing. We recently had the chance to interview Michael Cantwell, MD, of Rising Phoenix Integrative Medicine Center in San Francisco. He talked with us about how he takes the mind, body and spirit into account when working with his patients; his experience prescribing compounded medications; and current inspirations in his work.

~Krista Shaffer, Outreach Director at Koshland Pharm, and Peter Koshland, PharmD

Interview with Dr. Michael Cantwell

Practice Approach
I believe a doctor needs to be a three dimensional diagnostician – looking at the body, mind, and spirit. It’s important to be fluent in those three areas. A doctor might treat some of those areas himself or refer out for others.

When it comes to the body, I look at issues such as the liver’s detoxification system. Some of what alternative medicine does is to see beyond the normal ways of looking at the body. Detoxification is something that is studied in conventional medicine but is often forgotten. The body’s detoxification system determines whether a person gets toxin-mediated inflammation, which probably contributes to many cases of affective disorders like anxiety, depression, and bipolar disease, and even possibly to diseases such as autism, Parkinson’s and Alzheimer’s. So detoxification can be very helpful to look at.

When it comes to the mind, there are different psychological systems of how we progress and develop our personalities, and there are subconscious factors as well. I do a lot of subconscious work in my practice, such as hypnotherapy and guided imagery, because it’s often an area that is neglected. I also send people out for regular therapy.

Then there’s the spiritual part. I’ve written a book, Map of the Spirit, that discusses how transitions in spirituality affect health. It gives people a clear way of making that calculation. It includes all religions, including existentialism, and puts them on a level playing field. There’s a lot of spiritual disease in our society, and to not be able to treat that would mean I couldn’t really live with myself.

Compounding Success Story
I prescribe glutathione for many of my patients in various forms – oral forms that are mass-manufactured, and creams, suppositories, injections, and IV drips that are compounded. As more toxins are put in the environment (such as organophosphates and parabens), more optimal function of the body’s detoxification system is required. This increase in environmental toxins can unmask places genetically where we might have weaknesses.

Through both blood tests and genetic tests, you can get a really good idea if there are deficits in the liver’s detoxification system. In the first stage of detoxification, the liver is trying to put hydroxyl groups on everything it needs to get rid of. It then needs to substitute another group for the hydroxyl group in order to put it through the bile. The two main groups that can be substituted for the hydroxyl group are a methyl group and a glutathione group. The liver’s ability to make methyl and glutathione groups are the main variables in whether a person gets toxin-mediated inflammation.

I’ve had many successes prescribing glutathione when patients have defects of glutathione synthesis. I had one patient with poor immune function who had symptoms including rashes, nerve pain, herpes, and low energy level–symptoms which would come and go. With glutathione 500mg suppositories from Koshland Pharm, my patient’s symptoms went away and his quality of life greatly improved.

Current Inspirations
I found that working within the insurance system as a holistic doctor is very difficult. Insurance really wants to reimburse doctors to treat bodies. In the insurance system, if you’re not treating a body, it’s not reimbursable. If you’re a psychiatrist, you can bill as a psychiatrist, but you’re still treating the body as a biochemical mechanism and giving medication.

Also, there is no Medicare billing for more than forty minutes. That’s the most you’re ever supposed to spend with people. I was finding forty minutes to be way too cramped. I was losing the part that really mattered to me, which was the spiritual connection.

At Rising Phoenix Integrative Medicine Center, we set up a place that was off insurance. I keep my overhead down and pass that saving on to patients, so I can charge a reasonable hourly rate. They can then submit the bills directly to their insurance and get half of it back.

I enjoy my work at Rising Phoenix because patients really come first. It’s an old school place where pretty much if it needs to get done for a patient, we’ll find a way to do it. In a corporate environment, many times it’s easier to say “no,”
but here there’s no one to say that.

Now I think I’m ready for my next book. It’s about the four things you need to have a joyful life. The first is to know the limits of your control – know what’s under your control, what’s out of your control, and what’s mixed. The second is to have a theory of why that control exists, which relates to my book, Map of the Spirit. The third is to have a purpose, and the fourth is to carry out that purpose. Nobody ever tells you it’s that simple, but that’s it. That’s really all you need to know.

To read more about Dr. Cantwell and
Rising Phoenix Integrative Medicine
Center, see:

To read a synopsis of
Map of the Spirit, see:

Healing Thyroid Imbalance Presentation with Dr. Shiroko Sokitch

What is thyroid disfunction? What are the symptoms? How is it tested? How can it be treated on an individual basis?

Dr. Shiroko Sokitch of Santa Rosa, CA addressed these questions, and shared her unique approach to healing using both Western and Eastern medicine, in a presentation at Koshland Pharm last fall. We are pleased to share that presentation here in its recorded form.

For more about Dr. Shiroko Sokitch, see her website at

We welcome your comments, questions and feedback. All our best,

Krista Shaffer, Outreach Director at Koshland Pharm, and Peter Koshland, PharmD

Tips on maintaining health through perimenopause and beyond

If you’d like an overview of hormonal changes that happen for women at mid-life, check out this presentation by Lisa Brent, ND. Dr. Brent is a naturopathic physician who is a specialist in women’s health. We were delighted to host Dr. Brent this summer at Koshland Pharm and to hear her presentation, “Mind Over Menopause: Maintaining Health Through Perimenopause and Beyond,” and to share it here in its recorded version.

-Krista Shaffer, Outreach Director at Koshland Pharm and Peter Koshland, PharmD



6 Questions for Evaluating Scientific-Based Articles


When researching matters related to our own health, it can be daunting at times to wade through the massive amount of data available to us now through the internet. I recently saw a short article summarizing some key questions to keep in mind any time we read a scientific study.  This article with tips for evaluating scientific-based articles was written by Jane Houston and Robyn Correll Carlyle on the site

The six helpful questions they highlight are:

1. Does the study confuse correlation with causation?

2. What is the sample size of the study?

3. Is the study controlled or uncontrolled?

4. Are the results replicable?

5. Is there any conflict of interest for the authors?

6. Is the publication the study appears in peer-reviewed?


For more explanation of these questions, see this easy-to-read article at

–Krista Shaffer, Outreach Director at Koshland Pharm


Interview with Integrative Pediatrician Dr. Julia Getzelman


Dr. Julia Getzelman, MD, FAAP

Did you hear the recent radio series on Human Media about integrative medicine, entitled “The Search for Well-Being?” We feel it’s well-worth a listen, available free on Human Media’s website.

There are many different names for an integrative approach to health – functional medicine, naturopathic medicine, slow medicine, holistic medicine. In our experience, this approach to health and healing prioritizes finding the root cause of symptoms, taking the whole person (not just a specific medical condition) into account when creating a treatment approach, and spending time educating and supporting patients in healthy living choices that can help prevent disease.

We recently had the opportunity to interview one Bay Area pediatrician, Dr. Julia Getzelman, who practices functional medicine in her pediatric practice, Getzwell Pediatrics. We find this kind of holistic care for children and families inspiring and hope you do, too!

~Krista Shaffer, Outreach Director at Koshland Pharm

Highlights of interview with Dr. Julia Getzelman, MD, FAAP

The Getzwell Approach: Functional Medicine

Functional medicine significantly informs our practice of pediatric care at GetzWell – both on a day to day preventive level and in more complex cases such as autoimmune illness, asthma and eczema. This approach distinguishes us from almost all other pediatric practices. Allopathic medicine, the model in which all MDs are trained, teaches doctors that the body is a collection of independently functioning organ systems and is premised upon symptom suppression, usually through the use of prescription medication. Some call this the “one ill one pill” paradigm.

Functional medicine, using the most current science, focuses on the interlocking physiologic systems that underlie all processes that lead to health and
illness. The idea is that the body’s organ systems are interdependent, like a wheel and its spokes. In order for the wheel to turn, the spokes must be present and in balance. If you remove or even slightly bend one of the spokes, the wheel can’t function as it’s meant to. The same is true
of the human body.

At GetzWell we don’t reject the allopathic model. We provide a more comprehensive approach to care, combining the best of allopathic, functional
and homeopathic medicine. By understanding and impacting underlying causes, instead of just suppressing symptoms, we support wellness and
the body’s innate healing abilities. Functional medicine influences my daily approach to care in a variety of ways. As an example, when a baby is
born by Cesarean section (C-section) and doesn’t have the opportunity to be coated with beneficial bacteria from the vaginal antibiotics for Group B streptococcus (strep), I typically recommend probiotics for the infant. This addresses the fact that in both of these birth scenarios the baby is deprived of important microbes which are fundamental to early gut colonization and subsequent immune functions.

In functional medicine the health of the intestinal tract is inextricably linked to overall health. About 70 percent of the immune system is in the gut. The ‘bugs’ in our guts and what we eat provide information to our immune cells. In a child with a developing immune system, we have the opportunity to quite literally educate those immune cells by what goes and grows in the intestines.

Relationship-Based Medicine

At GetzWell the foundation of the care we provide also rests on the relationships that we have with families. These relationships often begin shortly after the baby is born and in the baby’s home – we offer house calls. Transitioning to the role of new parent is challenging on many levels and we love supporting families during this time by providing an extra level of service and sensitivity. We also provide longer appointments and 24/7 access via email and phone. We’re like the old-fashioned doc but with all the modern accoutrements.

Compounding Success Story

We don’t practice cookie cutter medicine. What we do is much more individualized than is typical of most high volume practices. We also support
the entire family. We want our families to know that they can reach out to us about anything, even if it blurs the traditional lines between pediatrics and family medicine. We want parents, and moms in particular, to come to us if they have issues we can help with, like mastitis or breast feeding problems. If we can’t provide what’s necessary, we make thoughtful referrals.

An example of a customized, or compounded medication,  that we’ve had success with is all-purpose nipple ointment from Koshland Pharm. We use it when we think there might be a fungal or bacterial infection of the breast skin or when there are nipple complaints due to breastfeeding. It has
provided significant relief for many nursing mothers. The compounded ointment is a mixture of anti-fungals, anti-bacterials, topical steroids, and sometimes ibuprofen.

Current Inspirations

One of my convictions is that whole kid care starts before your baby is born. This is supported by the science of fetal origins of adult disease. The research in ‘fetal origins’ examines the factors (including nutrition, environmental toxins, stress, etc.) during pregnancy that can shape the physical,
mental and even emotional well-being of the developing baby for the rest of its life! I invite women into my practice early in their pregnancies, or even pre-conception along with their partners, in order to set the stage for the healthiest baby possible.

For more information about Dr. Getzelman and Getzwell Pediatrics, visit:

Map of the Spirit: Assessing and Addressing Spiritual Stress As a Component of Healing

Map-of-the-Spirit-Cover-smallDo you experience spiritual stress? Could this be a contributing factor to a health condition you are facing, and therefore an important area to address as a part of your healing process?

Dr. Michael Cantwell, an integrative physician who practices in San Francisco, sets out to answer these questions in his recently published book, Map of the Spirit. Dr. Cantwell gave a presentation this January at the Commonwealth Club, explaining this unique approach of looking at spirituality as one aspect of health and healing. He realized that the paradigm he had learned in his own medical training of looking at the role the mind and body can play in illness was  missing a crucial piece for some of his patients: taking into account one’s experiences with spirituality.

Dr. Cantwell defines spirituality very broadly – as a way people find meaning in their lives, or what they believe exists or doesn’t exist beyond human experience. This looks different for each individual – dualist theology (a belief in God such as in Christianity, Judaism, or Islam) might speak to some; non-dualism (a belief in the oneness of all, such as in Taoism or Buddhism) might speak to others; atheism (the belief that God does not exist) also represents an important belief system in this definition of a person’s spirituality.

What everyone has in common, Dr. Cantwell argues, no matter what form their spirituality takes, is that their health can potentially benefit from 1) determining their beliefs and 2) living out of those beliefs in their day-to-day lives. Dr. Cantwell proposes that people can experience spiritual stress, just as they can experience physical and mental stress. Because stress has a known negative impact on our health, and, it can even be argued, leads to the majority of diseases from which Americans actually die, it is important to take into account and attempt to remedy one’s level of spiritual stress if it proves to be high.

How does one assess spiritual stress? Dr. Cantwell provides a simple formula in his book: rank on a scale from one to ten how important spirituality is to you in your life. Next, measure on a scale of one to 10 how satisfied you feel spiritually. Then, subtract your satisfaction from your interest. If the resulting number is low, you are experiencing a low level of spiritual stress; if it is high, you might want to consider taking spirituality into account when making a plan for your path to wellness.

This is only the beginning of Dr. Cantwell’s theory he presents with both practical tools (such as a the measurement of spiritual stress) as well as real patient examples (patients form diverse spiritual backgrounds). For those interested to learn more, you will find in his book four different stages of spiritual development; examples of resistance that a person may experience moving from one stage to another; strategies for removing those blockages and increasing attention to spiritual development – all within the framework of thought that one stage is not inherently better than another. Rather, he suggests that the most important time for intervention in spiritual health is when, or if, spiritual stress is high.

What if, Dr. Cantwell asks, we put spirituality onto the map of what we look at when assessing overall health? Map of the Spirit provides a practical and thought-provoking approach for patients and doctors to consider when addressing health challenges.

For more information about Map of the Spirit, see Dr. Cantwell’s website

~Krista Shaffer, Outreach Director at Koshland Pharm

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