Latest / Wellness by Designs - Practitioner Podcast / From Burnout to Balance: Women’s Health in Rural Australia with Jayne Sharpham

Transcript

From Burnout to Balance: Women’s Health in Rural Australia with Jayne Sharpham · Wellness by Designs - Practitioner Podcast

• 0:12
  SPEAKER_03: This is Wellness by Designs and I'm your host Amy Skilton and joining us today is naturopath Jane Sharpham who runs a rural clinic in Tamworth.
• 0:24
  SPEAKER_03: And I'm really excited to be speaking with you, Jane, about women's health in rural Australia.
• 0:30
  SPEAKER_03: So welcome to the podcast.
• 0:32
  SPEAKER_01: Thank you for having me.
• 0:34
  SPEAKER_03: Such a pleasure.
• 0:35
  SPEAKER_03: We we are going to be speaking specifically about women's health today and the unique challenges that providing healthcare in a rural setting provides.
• 0:43
  SPEAKER_03: But I think we also have such a unique opportunity here to learn from you as to what it's like being a practitioner in, you know, regional, remote areas of Australia, particularly for you where you are in Tamworth.
• 0:57
  SPEAKER_03: But I'm sure many of the challenges and constraints and unique sort of set of circumstances that you see can be applied across other regional areas.
• 1:08
  SPEAKER_03: So why don't we start with your journey to setting up a clinic in Tamworth, your what you love about regional life, and then we can go from there.
• 1:20
  SPEAKER_01: Sure.
• 1:20
  SPEAKER_01: So I completed my study in Brisbane back in 2006.
• 1:25
  SPEAKER_01: I had done most of my high school or my high school in Tamworth.
• 1:30
  SPEAKER_01: My parents relocated to Tamworth when I was 10 years old.
• 1:34
  SPEAKER_01: But I moved to Brisbane to do my study.
• 1:36
  SPEAKER_01: And when I finished that with my husband, we really wanted to come back to the country.
• 1:40
  SPEAKER_01: We realized we missed the country.
• 1:43
  SPEAKER_01: So we came back and I worked in pharmacy for a few years that had my first baby.
• 1:48
  SPEAKER_01: And then I started building my practice within a chiropractic clinic.
• 1:52
  SPEAKER_01: And then that's grown to being a standalone clinic with other practitioners.
• 1:58
  SPEAKER_01: And I just love rural Australia in that we've got uh wide open spaces, we've got a really good sense of community.
• 2:05
  SPEAKER_01: Um, and I love the mountains in particular.
• 2:07
  SPEAKER_01: We we overlook the beautiful Mimbi Range where we live.
• 2:11
  SPEAKER_01: Um, yeah, and I just love the opportunities that living regionally brings.
• 2:16
  SPEAKER_03: Yes, it sounds like a beautiful lifestyle with a lot of upsides, but I'm sure as you found through Clinic, that there are also some challenges with being based in a more remote location.
• 2:31
  SPEAKER_03: When it comes specifically to naturopathic care in rural Australia, can you share with us like some of the barriers that and constraints that you uncovered when you first got set up?
• 2:44
  SPEAKER_03: Has it changed much since then?
• 2:47
  SPEAKER_01: Um, I think things have changed in terms of how people can be connected, in terms of they can do telehealth appointments and things like that more readily.
• 2:54
  SPEAKER_01: Like we're talking about when I started my practice 17 years ago, there just wasn't Zoom and things like that available.
• 3:01
  SPEAKER_01: Um, so that's helped to a certain point, but I think people still want that face-to-face connection, particularly um in communities like mine when um they just feel a little bit more supported that way.
• 3:15
  SPEAKER_01: Um yeah, I think the challenges that I see um quite commonly are that people can be quite isolated when they're living on very large properties.
• 3:25
  SPEAKER_01: Um, they're having to travel large distances to come and see our clinic.
• 3:30
  SPEAKER_01: And um, that's something that I've seen right through even when telehealth's available people still want to come and they they want to actually see someone face to face.
• 3:38
  SPEAKER_01: Um, so that's certainly a challenge for people.
• 3:42
  SPEAKER_01: Um and for myself personally, as a as a practitioner, for me, I've always had to travel for conferences and seminars, and that's required overnight stays and things like that, which at its expense.
• 3:54
  SPEAKER_01: Um, so that's just some of the challenges that I I've seen.
• 3:58
  SPEAKER_03: That's a fair bit to address as a practitioner, isn't it?
• 4:03
  SPEAKER_03: When in addition to just the standard, you know, care for clients.
• 4:07
  SPEAKER_03: And I think, you know, I'm not surprised to hear that your clients want to come and see you in person because I can only imagine how being so isolated can make you feel quite disconnected from people.
• 4:20
  SPEAKER_03: Um, but I'm sure, yeah, travel times is a lot of other elements that go into that.
• 4:25
  SPEAKER_03: And I think, you know, we are both sitting in the bracket of perimenopause.
• 4:31
  SPEAKER_03: And when we look at women's health, I love that, you know, there's a renaissance around women's health at the moment, and so many conversations, although some of them are a little um off base around perimenopause, I do love that all of a sudden this conversation, this chapter of life is very much entered the public arena, social media.
• 4:52
  SPEAKER_03: It's not something that is kept quiet behind closed doors anymore, you know, for like it was for earlier generations.
• 4:59
  SPEAKER_03: But I think when we look at both the impact of perimenopause, you know, the HPA, HPO access, stress and burnout, there's a whole lot of factors there that are going to be present for almost every woman.
• 5:17
  SPEAKER_03: But in the case of rural lifestyle factors, yeah, what else is there that needs to be considered when we're looking at the influence on these areas?
• 5:28
  SPEAKER_01: Um, I think well, isolation comes into it.
• 5:31
  SPEAKER_01: Um, so a lot of these time women um are often sometimes they're the only female living on um uh isolated property, or they might have um teenagers away at boarding school.
• 5:43
  SPEAKER_01: That's quite common as well.
• 5:44
  SPEAKER_01: Um, not so much people living within Tamworth itself, but the surrounding areas.
• 5:48
  SPEAKER_01: Um, I see a lot of that, and that that can be really hard.
• 5:52
  SPEAKER_01: Um and they're having to be the person that does all the bits and pieces of the farm running, like the bookkeeping, and then making sure that you know the guys are being fed, we're on harvest and all of that kind of thing.
• 6:04
  SPEAKER_01: And it takes a toll on those women that they're having to hold their households together.
• 6:09
  SPEAKER_01: Um, and then I think also we're seeing women that are probably a little bit more um exposed to to chemicals, so farm sprays, um, homes that may have mould in them, like old farmhouses, I do see that a little bit as well.
• 6:22
  SPEAKER_01: Um, people that have yeah, more exposure to chemicals in their environment in just their day-to-day living.
• 6:28
  SPEAKER_01: We certainly see that come through as well.
• 6:30
  SPEAKER_01: And that can impact on obviously stress and um well-being and all of that kind of stuff.
• 6:37
  SPEAKER_03: Yes.
• 6:37
  SPEAKER_03: And when you say chemicals, are you referring to pesticide drift, agricultural chemicals, um, or are there other chemicals as well that we have to be mindful of?
• 6:49
  SPEAKER_01: Um, probably more though, those um agricultural chemicals that they're being exposed to with spraying and things like that that are going on in your cropping communities.
• 6:59
  SPEAKER_02: Yes.
• 6:59
  SPEAKER_01: Um, and also sometimes water sources as well, like if they're just having bor water that's or they're having rainwater and it's coming off a really old uh roof that's rusty.
• 7:09
  SPEAKER_01: Like I've I see that often with some heavy metal toxicity coming through for patients, and that really impacts on their health.
• 7:16
  SPEAKER_03: Oh wow.
• 7:16
  SPEAKER_03: Okay.
• 7:17
  SPEAKER_03: Yeah, there's definitely a lot to be mindful of, which is why we might just take a pause from our chat about perimenopause and burnout and actually talk about your rural clinic initiative.
• 7:28
  SPEAKER_03: Sure.
• 7:28
  SPEAKER_03: Now, Jane, you have over 20 years of experience.
• 7:31
  SPEAKER_03: I mean, students, new grads, and even established practitioners would learn so much from you.
• 7:37
  SPEAKER_03: But in terms of your experience delivering patient care in regional communities, my understanding is this initiative is a program to really bridge the gap between you know education and clinical practice that maybe isn't being delivered, understandably, because in college there's so much to learn already.
• 7:57
  SPEAKER_03: And within this, like I'd love for you to share a bit about what it is, what your intention for it is, what it's going to look like.
• 8:05
  SPEAKER_03: And for anyone who's interested in learning from Jane, this is actually being launched in the first week of September, but she will be taking expressions of interest from June.
• 8:17
  SPEAKER_03: So if this is something that you're interested in, you can absolutely share your contact details.
• 8:21
  SPEAKER_03: And I'm sure Jane wouldn't mind if you reach out to her directly before that time.
• 8:27
  SPEAKER_03: But will you take us through what this looks like, why you're creating it, and what you see the outcome of a practitioner going through it being?
• 8:37
  SPEAKER_01: Yeah, sure.
• 8:38
  SPEAKER_01: So what I'm launching is the Rural Clinic Initiative, which will um happen on the 7th of September.
• 8:45
  SPEAKER_01: Excuse me, my throat just caught.
• 8:47
  SPEAKER_01: Um, yeah, so what I'm looking at doing is a five-day intensive.
• 8:51
  SPEAKER_01: So we're bringing either fourth year graduate graduating naturopaths and nutritionists, or first and second year new naturopaths or nutritionists into the clinic space so they can actually see how we run appointments and how a successful clinic um is able to sustain the number of patients that we see.
• 9:11
  SPEAKER_01: Um, and then I'm also wanting to do a lot of education in that space as well.
• 9:16
  SPEAKER_01: So teaching these people how to do compounding, how to look at the right sort of testing that they should be ordering for patients, and then also helping them understand products.
• 9:27
  SPEAKER_01: So filling that gap in between being at college and actually being in clinical practice and having a thriving clinical practice alongside some mindset things, so um things to consider with business mindset and that that type of thing.
• 9:40
  SPEAKER_01: Um, so just really wanting to use um the success that we've had in order to feed into the next generation of practitioners.
• 9:50
  SPEAKER_01: Um, because having had um graduates myself, I've seen there's vast differences in practitioners that have done training with us and training within colleges, so only in colleges.
• 10:02
  SPEAKER_01: So I'm just trying to fill that gap.
• 10:05
  SPEAKER_03: Yes, yes.
• 10:06
  SPEAKER_03: I really see across the board there is, there really should be some kind of internship mentorship program to sort of bridge that gap between college and practice.
• 10:19
  SPEAKER_03: And a lot of new grads, I think, can really struggle to start.
• 10:22
  SPEAKER_03: Maybe some of them don't, simply because there really needs to be more of a runway and almost like a fast track to actually have things put into place and implemented so you can they can learn from our mistakes rather than making so many.
• 10:38
  SPEAKER_03: Yeah, oh we haven't, we all, and it's such a shame that there isn't like a a really like well-structured, easy pathway.
• 10:46
  SPEAKER_03: It really does require graduates seeking out mentors and and often it's quite fragmented in terms of business or marketing or like clinical practice.
• 10:56
  SPEAKER_03: This sounds very much like a you know, not business in a box, but very much a comprehensive type of program, but with a particular flavor towards practicing in a rural setting, which I think you know is lovely to be able to be the lighthouse for all regionally based practitioners or practitioners who are wanting to step into that kind of living space and lifestyle and and really have a good understanding of what they're going to get.
• 11:27
  SPEAKER_03: So that sounds amazing.
• 11:29
  SPEAKER_03: Um, I'm that's going to be such a gift to anyone who goes through that with you.
• 11:33
  SPEAKER_03: And as I said, you know, for anyone who's listening to this who thinks, oh yes, I need this, feel free to reach out to Jane.
• 11:39
  SPEAKER_03: We'll put her um social media page and and website in the show notes for you as well.
• 11:45
  SPEAKER_03: But knowing, Jane, that one of your areas of focus is on supporting women who are navigating perimenopause alongside stress and burnout, particularly in a rural setting.
• 11:55
  SPEAKER_03: I mean, I just thought then when you were just sort of describing all the things that women have to, well, are doing in that setting.
• 12:03
  SPEAKER_03: I think, wow, that meant that's just another layer of mental load.
• 12:08
  SPEAKER_03: So I would love to explore that further and ask you, first of all, what are you seeing clinically in women that are presenting with perimenopause in the in the rural area that you're in?
• 12:20
  SPEAKER_01: Um, well, I frequently hear that they're not, they don't feel supported.
• 12:23
  SPEAKER_01: Um, so that happens a lot.
• 12:25
  SPEAKER_01: Um, they don't generally have access to integrative doctors who can prescribe things like bioidentical hormones.
• 12:32
  SPEAKER_01: Um so that they they just feel like they're being dismissed and people aren't listening to them.
• 12:39
  SPEAKER_01: I hear that nearly every day.
• 12:42
  SPEAKER_01: Um they're struggling with their mental health, so anxiety and depression, and they feel like they can't talk about that, or they feel like they're weak because they have that with their changing hormones.
• 12:55
  SPEAKER_01: Um they don't understand what's happening with their changing hormones.
• 12:59
  SPEAKER_01: I hear that a lot, and so part of my role is to help them understand what's actually going on and what this will look like.
• 13:05
  SPEAKER_01: Um, they're scared, some of them as well.
• 13:09
  SPEAKER_01: Um and then then you also have we typical symptoms like hot flushing and a lot of really poor sleep.
• 13:15
  SPEAKER_01: Um, women that have really flooding periods.
• 13:18
  SPEAKER_01: Um, one of the issues that we have where where I live is we don't actually have wonderful access to gynecologists.
• 13:25
  SPEAKER_01: So um there's often long wait times.
• 13:27
  SPEAKER_01: So women that need things like ultrasounds for fibroids and things like that that can pop up with perimenopause.
• 13:34
  SPEAKER_01: So um a lot of the time I'm having to advocate, sometimes I'm having to write letters to GPs in when in order to ask for certain testing to be done or a marina to be looked at, like to be removed, or or whatever the issue is for that particular lady, I'm having to advocate for that woman.
• 13:50
  SPEAKER_01: So she's getting that better care.
• 13:52
  SPEAKER_01: Um, and then also filling in the gaps with some of the testing as well, with some of the testing that we offer.
• 13:58
  SPEAKER_03: Yes, that is really, I feel distressed just thinking about that, because if there are fibroids that are contributing to that heavy bleeding, that kind of delay could mean someone is putting up with those symptoms for another, who knows, three, six, nine months before they're able to be seen, unless they have the means to go to some metropolitan area for care.
• 14:22
  SPEAKER_03: And as you said, that's you know, interrupting sleep, their quality of life in a setting where things sound like they're often a lot more physically demanding by the by virtue of the nature of rural living, that you know, there's going to be some kind of you know, farming activity going on.
• 14:39
  SPEAKER_03: And that's, I suppose, you know, an increased stress level, increased sleep disruption alongside those typical things we might look at, like nutrient depletion, HPA axis dysregulation, and of course, just the nature of the changing landscape of hormones as you know the ovaries are starting to wind down.
• 15:01
  SPEAKER_03: I would know when you're assessing a woman, like, and this is I'm gonna give you a couple of questions that you could kind of run with as you will, but obviously we've established getting conventional care is a real struggle.
• 15:17
  SPEAKER_03: Getting integrative allopathic care is even more challenging because I know I do know integrative doctors often have a six-month waiting list.
• 15:25
  SPEAKER_03: So it's not as easy as saying, oh, just get a telehealth session from someone in Sydney or Brisbane or whatever.
• 15:32
  SPEAKER_03: So there's a lot of elements there which would also add to stress and burnout.
• 15:36
  SPEAKER_03: So when you're assessing a woman who's coming in with you know symptoms, distressing symptoms and health challenges, how do you like to clinically differentiate between perimenopause or is it burnout or is it thyroid dysfunction?
• 15:52
  SPEAKER_03: Knowing that of course it can be more than one thing, but how do you work through that to support women in the in the best possible way?
• 16:00
  SPEAKER_01: I think it comes down to good case taking.
• 16:03
  SPEAKER_01: So actually sitting and listening to what's going on for the patient and looking at what testing they've already had done, um, and sometimes filling that gap in with testing, whether or not that's pathology or hormone screening.
• 16:16
  SPEAKER_01: Um, it comes down to the case tasting and really listening to what they're saying.
• 16:21
  SPEAKER_01: And sometimes that means that you're treating them at an acute level, so you might give them something for sleep initially, and then you're doing some testing to work out underlying factors, whether or not that's changing like low progesterone, or you know, they've had chronic stress, and so then long term you're looking at adrenal health.
• 16:38
  SPEAKER_01: Um, so that that's what it comes down to, I think.
• 16:42
  SPEAKER_03: Yes, and I'm sure as you're taking someone's case, you're also looking for micronutrient status, like what's their nutrition like, what's their blood sugar stability like, what's their cortisol rhythm looking like?
• 16:56
  SPEAKER_03: And you know, bearing all of that in mind, we know that care is always personalized.
• 17:03
  SPEAKER_03: And as you just mentioned, sometimes it's, you know, acute treatment alongside dealing with the more underlying causes.
• 17:10
  SPEAKER_03: But when you're looking at this in its totality, do you have core foundation pillars for these women, or do you have key things that are implemented for every woman that comes through your doors, regardless, that you find are really important to have in place?
• 17:27
  SPEAKER_01: Um, well, I think a lot of it, well, I'll start with diet, so making sure that they're having adequate protein because a lot of this group aren't.
• 17:34
  SPEAKER_01: They're often eating on the run um because of stress.
• 17:38
  SPEAKER_01: So there's that.
• 17:39
  SPEAKER_01: Um, a lot of them I'll pop them on some magnesium, which is just so important for so many different reasons.
• 17:44
  SPEAKER_01: Um so um, so we might look at that.
• 17:48
  SPEAKER_01: Um, I'm also always making sure their iron's screened.
• 17:51
  SPEAKER_01: I won't always go in straight with an iron because it's as we know, it can, you know, be quite high for some women.
• 17:57
  SPEAKER_01: So um making sure that's screened, so that's always something I do.
• 18:01
  SPEAKER_01: Um, and then also making sure that they have good support networks around them and what does that look like for them?
• 18:07
  SPEAKER_01: And sometimes we're their support network, they're the only people that that they can come to to actually talk about what's really going on for them.
• 18:15
  SPEAKER_01: So um there'll be that.
• 18:17
  SPEAKER_01: And then sometimes I'll also add particularly compounding nutrients in, sometimes with a magnesium base for sleep or mental health support.
• 18:25
  SPEAKER_01: So they're common things that I'll do.
• 18:28
  SPEAKER_03: Yeah, so they sound like really solid, you know, first steps to really supporting someone's body to function as it's designed to.
• 18:38
  SPEAKER_03: You mentioned before testing and screening.
• 18:41
  SPEAKER_03: What is that like in your area, both from sort of the standard allopathic tests, but also some of those more specialist ones?
• 18:50
  SPEAKER_01: Um, so sometimes this is where it gets a bit tricky.
• 18:52
  SPEAKER_01: So um it comes down to the cost for the patient.
• 18:56
  SPEAKER_01: So um a lot of the time I'll just order pathology directly for them, but they're out of pocket for that.
• 19:02
  SPEAKER_01: So um it comes down to what they can afford to do.
• 19:05
  SPEAKER_01: So sometimes I will write letters to GPs who most of the time they'll do what we're asking, but I know it is tricky for them.
• 19:13
  SPEAKER_01: Um so and we've developed with time a better relationship with some of the GPs in town, which is really good, I think.
• 19:20
  SPEAKER_01: Um so, or we'll um the other thing we do is a lot of the the companies that have testing, like obviously Designs for Health, have some testing options, and then um other companies that are based in metropolitan areas that do um kits that they can send out to patients, we'll often use those for people as well.
• 19:38
  SPEAKER_01: Um, but yeah, it does come at a cost sometimes for people.
• 19:41
  SPEAKER_01: Um, and where we can, we'll try and do referrals to GPs.
• 19:46
  unknown: Yeah.
• 19:46
  SPEAKER_03: That's I mean, you mentioned before support networks in terms of you know what kind of social structures your patients have, where they could maybe strengthen those or establish more.
• 19:59
  SPEAKER_03: But as you said, in some cases it's you as a naturopath.
• 20:02
  SPEAKER_03: But it also sounds, you know, from a health professional level, this is also something you have to be really intentional with in terms of creating relationships with local doctors and other health professionals to better support your community, given there's a lot less of you.
• 20:18
  SPEAKER_03: How I'd curious to hear how that has unfolded for you in your time in Tamworth.
• 20:25
  SPEAKER_01: I think just time.
• 20:26
  SPEAKER_01: I just think time and um being polite, not demanding at them.
• 20:32
  SPEAKER_01: Um, our nutritionist that I work alongside, she actually set up meetings with um GEP practices and would take um morning tea to them and talk about what she offers.
• 20:41
  SPEAKER_01: So there's that as well, and just networking at various business um chamber events.
• 20:46
  SPEAKER_01: I've got to know some of the GPs, that we're not all too out there or too crazy that we're actually here to advocate for our patients and we want to work with you.
• 20:56
  SPEAKER_01: Um I think it just takes time.
• 20:58
  SPEAKER_03: Yes, yes, and and a well-written letter as well as it's and really just um ensuring that you remember we're all on the same team here.
• 21:08
  SPEAKER_03: We all have the same goals for our patient, and that's a better quality of life and you know the best possible care we can provide.
• 21:16
  SPEAKER_03: And and I think it's it's it's easy to get a bit cynical and jaded sometimes.
• 21:23
  SPEAKER_03: Yeah, yeah.
• 21:24
  SPEAKER_03: And frustrated at the system, I think that's actually probably more so.
• 21:28
  SPEAKER_03: I mean, I think the individuals within the system are amazing, but the constraints of the system can make it really difficult for the kind of care we would all prefer that we'd be getting for ourselves and our patients, and just being mindful of that probably goes a long way, I would say.
• 21:45
  SPEAKER_01: Absolutely.
• 21:46
  SPEAKER_03: Yeah.
• 21:46
  SPEAKER_03: Yeah, yeah.
• 21:47
  SPEAKER_03: Okay.
• 21:48
  SPEAKER_03: Well, I want to dive into some more specifics around ingredients you like to work with.
• 21:54
  SPEAKER_03: You mentioned magnesium, which I mean, every human needs more magnesium.
• 22:00
  SPEAKER_03: Especially at this point in time.
• 22:02
  SPEAKER_03: But I'd love to hear more about the other key nutrients that you see being important, you know, whether that's minerals, vitamins, central fatty acids, and also where you most find you focus on for herbs as well.
• 22:19
  SPEAKER_03: In terms of the perimenopause space?
• 22:22
  SPEAKER_03: Yeah.
• 22:22
  SPEAKER_03: Well, I mean, even just general support.
• 22:24
  SPEAKER_03: I know that, you know, such a big part of that is sleep, but are you focusing more on sleep blends, energy blends?
• 22:31
  SPEAKER_03: Like where do you go from there with perimenopause?
• 22:34
  SPEAKER_01: Um, so I think I'll start with some key nutrient issues that I see where I live.
• 22:40
  SPEAKER_01: Um, so we see a lot of omega-3 deficiency because of obviously access to fresh seafood isn't overly easy.
• 22:48
  SPEAKER_01: And what you buy from Woolies isn't the same as what you can go and buy from your local fishermen.
• 22:53
  SPEAKER_01: Um, so there's that.
• 22:54
  SPEAKER_01: And some of these people there, you know, they have no access to buying fresh seafood either.
• 22:59
  SPEAKER_01: Um so we've got that as an issue, and then I think iodine is also something that I see commonly as an as a problem.
• 23:06
  SPEAKER_01: So we will iodine screen patients because as we know it's really important for breast, tissue, ovary, tissue, thyroid function.
• 23:14
  SPEAKER_01: And I frequently see that quite low.
• 23:17
  SPEAKER_01: Um, so they're key nutrients that are probably more specific for the area that I work in.
• 23:23
  SPEAKER_01: Um and then within the compounds, we'll do a lot of sleep mixes and we'll do things like um we'll add you know, natural things to help with making melatonin within that.
• 23:35
  SPEAKER_01: Um, so sleepotonin, we might do GABA, um, L-theanine.
• 23:41
  SPEAKER_01: Sometimes we'll do calcium deglucinate for patients who have quite high levels of or having issues clearing their estrogen.
• 23:49
  SPEAKER_01: So e-mixes like that, or we might do mental health mixes, so um 5 HTP for patients that are really struggling in that way.
• 23:58
  SPEAKER_01: Um and then obviously iron as well is another one that that's key.
• 24:05
  SPEAKER_03: Yes, yes, it sounds to me like it's a very nutrition-first approach or nutrient-first approach.
• 24:12
  SPEAKER_03: And when we understand how, you know, those are required for enzymes to even perform activity, of course, that makes perfect sense.
• 24:19
  SPEAKER_03: Yeah.
• 24:20
  SPEAKER_03: If we sort of reverse back a little bit to looking at food, you mentioned, of course, due to you know, the distance from coastal areas, you don't have access to fresh seafood necessarily.
• 24:35
  SPEAKER_03: Or if you do, I'm sure the prices are incredibly high.
• 24:39
  SPEAKER_03: And, you know, we know what's available in terms of tinned fish can also be somewhat um tricky.
• 24:47
  SPEAKER_03: When you're looking at nutrition, I was reading, you know, our notes before we started, and that you've got four McDonald's, two KFCs, and zero salad bars.
• 24:59
  SPEAKER_03: Yeah.
• 25:00
  SPEAKER_03: And I'm not sure what the cafe restaurant scene is like either, but talk to me about what that's like in terms of when you're looking at a client coming in and their food diary, for example, and you're making recommendations.
• 25:14
  SPEAKER_03: Where do you go from there and where do you start?
• 25:18
  SPEAKER_01: Um, it's it's I think I always start with protein with every meal.
• 25:22
  SPEAKER_01: That's where I'll start, and looking at the type of carbohydrate they're that they're consuming.
• 25:27
  SPEAKER_01: Um, but I think in terms of patients that are, you know, they've got really busy lifestyles, they're trying to juggle children and work and all the things, which is really typical in perimenopausal patients.
• 25:37
  SPEAKER_01: Yes.
• 25:38
  SPEAKER_01: Um and then they're often struggling with with fresh meals and good quality meals because um access to services that enable them to have, say, a freshly prepared meal that they can just pick up is not, and that that's a good price, is not overly available.
• 25:55
  SPEAKER_01: So it's easy just to go through a Maccas drive-thru or a KFC drive-thru because they're there.
• 26:00
  SPEAKER_01: Um so I do see that as a bit of a challenge for people, and then people who live really remotely, like um, I remember I have a lovely client who's in her 70s and now lives in in Tamworth, which is got you know fresh supermarkets, but where she used to live, for her to get green vegetables was a like fresh green vegetables was a massive thing.
• 26:20
  SPEAKER_01: And when she moved to Tamworth, she was like, I can buy fresh green vegetables.
• 26:24
  SPEAKER_01: And I was like, That's so cool, like so bad that you didn't actually have that before, but so cool that it's such a novelty for you.
• 26:31
  SPEAKER_01: And of course, people can grow their own, but you know, we've got conditions of drought and all of that kind of thing that plays a role in that too.
• 26:37
  SPEAKER_01: Um, so I think this the convenience of having fast foods available there does affect people's good choices because there isn't that availability of a fresh produce that you can just go and pick up, like a good meal delivery service or something like that.
• 26:51
  SPEAKER_01: That's not all pre-packaged or frozen.
• 26:54
  SPEAKER_03: Yes.
• 26:54
  SPEAKER_03: Wow.
• 26:55
  SPEAKER_03: So it sounds like you have to be really forward planning, you know, menu planning, you know, and and when you actually get to a supermarket, you almost have to anticipate a week's worth.
• 27:06
  SPEAKER_03: You know, you can't take it for granted that you can just pop down to your local, you know, green grocer and grab something on a Wednesday night because you ran out of broccolini, for instance.
• 27:16
  SPEAKER_01: Yeah, certainly if you live 30 minutes out of town, yeah, that's certainly it.
• 27:19
  SPEAKER_03: It's just not viable.
• 27:20
  SPEAKER_01: Yeah, so more use of like canned foods and preserved foods and things like that, um for those people living in those particular areas.
• 27:28
  SPEAKER_01: Yes.
• 27:29
  SPEAKER_01: Which time with services.
• 27:31
  SPEAKER_03: Yeah, okay.
• 27:32
  SPEAKER_03: I mean, I think there's something to be said for that.
• 27:34
  SPEAKER_03: And I do remember, I mean, this is 15, 20 years ago, a couple of clients I had out in western Sydney, and they too, even though it was a city area, had trouble getting quality produce, which meant, you know, they they sort of got the fruit that was maybe frozen two seasons ago and then artificially ripened, and they just weren't eating fruit and vegetables actually because they tasted poor, because the quality was actually poor.
• 28:04
  SPEAKER_03: And I think they were very surprised to learn that typically frozen and canned fruit, for instance, is usually harvested at its peak season because there's such an abundance of it.
• 28:18
  SPEAKER_03: And certainly for them, it was far more nutritious than getting something fresh at the time.
• 28:24
  SPEAKER_03: And I think we have we, you know, for those of us in metropolitan areas, we are in a privileged position where we can say, you know, buy local, buy seasonal, because that's easy to get.
• 28:34
  SPEAKER_03: Um, but I think for rural communities, really shifting that focus onto what's the next best alternative and the best option for them, which in this case could be preserving their own if they're growing it or preserving things when there's an abundance, but frozen and canned also could be a good option.
• 28:52
  SPEAKER_03: Yeah.
• 28:53
  SPEAKER_03: In that case.
• 28:54
  SPEAKER_03: Yeah.
• 28:55
  SPEAKER_03: Can I just ask on that note, you know, understanding that food is such a challenge, that's probably going to increase the consumption of processed foods because they are more shelf stable.
• 29:09
  SPEAKER_03: What have you seen that differs from metropolitan areas, if if at all, as far as metabolic health goes?
• 29:19
  SPEAKER_01: Well, I do believe Tamworth's got one of the highest rates of obesity.
• 29:23
  SPEAKER_01: I'd have to double check the statistics on that, but it's very high, which is pretty um, it's pretty shocking.
• 29:30
  SPEAKER_01: Um so yeah, in terms of metabolic health, you see it a lot.
• 29:35
  SPEAKER_01: And as we know with petty menopause, it's only exasperated as oestrogen withdraws.
• 29:40
  SPEAKER_01: Yes.
• 29:40
  SPEAKER_01: Um, and so women are going into their um older years with these metabolic health risks and increases their cardiovascular risk, cardiovascular health risk.
• 29:50
  SPEAKER_01: So um you certainly do see it um that women are really struggling in that way.
• 29:55
  SPEAKER_03: Yes.
• 29:56
  SPEAKER_01: Yeah, and a general population in that way, including our children.
• 29:59
  SPEAKER_03: Yeah.
• 30:00
  SPEAKER_03: That's what they're seeing.
• 30:00
  SPEAKER_01: It's easy to get the Mac and drive through because you finished sport, because that's all that's available.
• 30:05
  SPEAKER_03: Yes, yeah, and yeah, you're really hungry and your time, you know, you've got to get home.
• 30:09
  SPEAKER_03: It's a long drive.
• 30:10
  SPEAKER_03: Yeah.
• 30:10
  SPEAKER_03: Just and you can eat it in the car.
• 30:12
  SPEAKER_01: Yeah, exactly.
• 30:13
  SPEAKER_01: Exactly, because of the long drive.
• 30:15
  SPEAKER_03: So yeah, yeah.
• 30:16
  SPEAKER_03: If if a woman came to you with perimenopause or burnout or a combination of all of those things that we've talked about, and also really compromised metabolic health that was likely problematic even before she arrived in perimenopause.
• 30:32
  SPEAKER_03: Yeah.
• 30:33
  SPEAKER_03: What other additional tools do you lean on, you know, on on top of nutritional counselling and and pro protein forward meals?
• 30:41
  SPEAKER_03: Do you have any other tools that you like to use?
• 30:45
  SPEAKER_01: Um, well, of course, making sure we're checking blood so things like insulin.
• 30:50
  SPEAKER_01: Um, that's I think really important, and monitoring HBA1C.
• 30:54
  SPEAKER_01: Um, but then we will use tools like berberine.
• 30:58
  SPEAKER_01: Um, I will use OEA as well.
• 31:01
  SPEAKER_01: I've started using that in clinic too.
• 31:03
  SPEAKER_01: Um so it's just those tools just to help with appetite and helping with that insulin response.
• 31:10
  SPEAKER_01: I've particularly seen really good results with berberine.
• 31:13
  SPEAKER_01: Um so, and magnesium, of course, the chromium, those kind of nutrients, and then our beautiful herbs too that we can throw in there.
• 31:21
  SPEAKER_01: Um, so that'll that'll be some of the approaches that we take with young people.
• 31:25
  SPEAKER_01: Yeah.
• 31:25
  SPEAKER_03: Yes, yes.
• 31:26
  SPEAKER_03: And I think that is another thing to be mindful of when it comes to you know, rural communities, knowing that this has been a likely a lifelong challenge if they've always been based there, and that whole cardiometabolic profile has not been great to begin with.
• 31:42
  SPEAKER_03: It's like it's another layer of complexity when it comes to supporting women with hormone health energy, better sleep, you know, alongside the blood sugar regulation and and all of that.
• 31:54
  SPEAKER_03: Oh, Jane, you've honestly been such a wealth of knowledge and really enlightening conversation around naturopathic care in rural communities.
• 32:05
  SPEAKER_03: And now that we're sort of sitting in that that headspace, what do you think the future looks like for rural naturopathy?
• 32:15
  SPEAKER_01: Um, I'd like to see clinics like mine be available to people like who live in regional areas.
• 32:23
  SPEAKER_01: Um and I'd love to see more practitioners come and work with us or with other clinics because I think with their strength in numbers and strength in working together.
• 32:34
  SPEAKER_01: I think strengthening the telehealth options for patients in these areas is important and making sure that the people that they're seeing understand or have some understanding of the challenges that these people face.
• 32:47
  SPEAKER_01: And so that's what I really want to try and bring up or focus on with this rural clinic initiative is to help people, whether or not they end up working with us or they end up doing their own thing, what it is actually like for these people.
• 33:01
  SPEAKER_03: Yes, I can really see why you're so passionate about closing the gap when it comes to, you know, where what's currently available and just how far there is to go for people, not just women, but people in rural areas to be able to get at least a similar level of care to those who are based in in more urban areas.
• 33:30
  SPEAKER_03: All right.
• 33:30
  SPEAKER_03: Well, I've got a fun little game for you as we come to the end of our conversation.
• 33:36
  SPEAKER_03: Um, I've got four rapid fire questions for you.
• 33:39
  SPEAKER_03: Uh no pressure.
• 33:42
  SPEAKER_03: Um, I would love to know what's your favorite herb favorite herb for burnout?
• 33:47
  SPEAKER_03: Offer burnout, wow.
• 33:49
  SPEAKER_03: I mean, it's mean asking you to pick just one.
• 33:52
  SPEAKER_03: I'll let you say more than one.
• 33:55
  SPEAKER_01: I know.
• 33:56
  SPEAKER_01: Which I don't have, by the way.
• 33:59
  SPEAKER_01: Um, I'd have to say Romania, maybe.
• 34:04
  SPEAKER_01: Followed by with ania.
• 34:06
  SPEAKER_03: Beautiful.
• 34:06
  SPEAKER_03: Yes.
• 34:07
  SPEAKER_03: Yeah.
• 34:08
  SPEAKER_03: So lovely.
• 34:09
  SPEAKER_03: Big fans of both of those herbs.
• 34:11
  SPEAKER_03: Yeah.
• 34:12
  SPEAKER_03: Um, and what is the most common mistake you see in perimenopause care?
• 34:19
  SPEAKER_03: Oh, I could go on further about this.
• 34:21
  SPEAKER_03: I well, yes, okay, I know.
• 34:22
  SPEAKER_01: Come on, hit me.
• 34:23
  SPEAKER_01: What are what are your maybe?
• 34:24
  SPEAKER_01: Probably just patients who are just put on HRT without any testing.
• 34:28
  SPEAKER_01: Sure.
• 34:28
  SPEAKER_01: Um, particularly when they're put on an estrogen and they have there's no understanding of how they clear that estrogen out of their body.
• 34:34
  SPEAKER_01: That really, really gets me because I'm like, oh, we're setting them up for other issues.
• 34:39
  SPEAKER_01: Yes, yeah.
• 34:40
  SPEAKER_01: And against HRT, I think there's a place for that.
• 34:42
  SPEAKER_01: I absolutely do, but I don't love it when it's not tested properly.
• 34:47
  SPEAKER_03: No, there's no pre-screening, there's no personalized care, there's no looking at the nuance of someone's detoxification pathways.
• 34:55
  SPEAKER_03: Um, which by the way, there was just a webinar recently come out with Tracy Blythe, who actually covered, you know, all the different options for HRT and the distinctions and you know, um differences between them and where you might apply one versus the other.
• 35:13
  SPEAKER_03: So again, it's about critical thinking, personalized medicine, and really doing the due diligence beforehand rather than just handing out the same, you know, treatment for every woman of a certain age.
• 35:25
  SPEAKER_03: So I love that you said that.
• 35:27
  SPEAKER_03: Thank you.
• 35:28
  SPEAKER_03: That's okay.
• 35:28
  SPEAKER_03: Um, can you give us one piece of advice for new practitioners, whether they're rural or not, but perhaps especially if they are.
• 35:40
  SPEAKER_01: Um I could also talk about this one all day.
• 35:42
  SPEAKER_01: Um one thing I'm really passionate about, and this is when I've had students in with us, and I this is what I teach them, and this is what I'm hoping to teach alongside a bunch of other stuff with my rural clinic initiative, is meet the patient where they're at.
• 35:55
  SPEAKER_01: So um so if they're coming in for they're really stressed and they're not sleeping, help them with their sleep.
• 36:02
  SPEAKER_01: And if you see there's all these other things that they need help with, start with the sleep stuff first, and then you can build that rapport and that trust with them, and then you can build on the other stuff, but don't try and fix everything in their first appointment.
• 36:14
  SPEAKER_01: And I made that mistake when I first graduated, and it's really overwhelming.
• 36:18
  SPEAKER_01: Yes, even for both you and the patient.
• 36:21
  SPEAKER_03: Yeah, absolutely.
• 36:22
  SPEAKER_03: I think probably every new grad has done that because we have so many tools in our toolkit and we kind of see the whole roadmap and we can kind of see what to do for every little thing, but yeah, actually, you know, we don't function like that.
• 36:36
  SPEAKER_03: Uh, we have a finite capacity and bandwidth for change and implementation.
• 36:41
  SPEAKER_03: And, you know, I'm also sleepers king and is the foundation upon which everything else functions.
• 36:49
  SPEAKER_03: So yes, love that advice and meeting them where they're at, and also I think sometimes not always, but sometimes just being really respectful of what's a priority for them too, because sometimes we might sort of see, oh, this actually is a much bigger red flag here.
• 37:05
  SPEAKER_03: But but this is the thing that's really important to you, and if we can shift it, that relieves some stress for you, which then leaves you more open to looking at those other things once we've addressed that.
• 37:15
  SPEAKER_01: So yeah, which comes down to really listening to the person, and that's probably my second thing I'd say there's listen to what they're saying to you.
• 37:22
  SPEAKER_01: Yes, and sometimes it's just sitting and listening to them, and that's what people just want to be heard.
• 37:27
  SPEAKER_03: Yes, absolutely.
• 37:29
  SPEAKER_03: I think that's such a big thing.
• 37:30
  SPEAKER_03: That's half the healing, actually.
• 37:32
  SPEAKER_03: When again, we think we look at the way the allopathic system is set up, there's no time for that, there's no room for that.
• 37:39
  SPEAKER_03: It's very much a you know, 15 minutes max.
• 37:43
  SPEAKER_03: I mean, yeah, you're lucky if you get 10.
• 37:45
  SPEAKER_03: And even if you walk out of there with the right thing, it can be really disheartening to be like, oh, I just felt like a, you know, on the production line of, you know, dispensing, medication dispensing, and and just actually having someone hold that space for you can be just such a relief.
• 38:03
  SPEAKER_03: Um, alongside everything else.
• 38:06
  SPEAKER_03: All right.
• 38:06
  SPEAKER_03: And lastly, what keeps you feeling inspired, getting out of bed every day and doing what you do?
• 38:14
  SPEAKER_01: Um, I think that's making an impactful difference in people's lives.
• 38:19
  SPEAKER_01: So seeing them come in broken and seeing them thrive, that that keeps me going.
• 38:25
  SPEAKER_01: Yes.
• 38:26
  SPEAKER_01: And and really making positive change, particularly in my area.
• 38:30
  SPEAKER_01: Like I I love where I live and that we improve people's health.
• 38:35
  SPEAKER_03: Yes.
• 38:36
  SPEAKER_03: Uh, well, look, the people of Tamworth and surrounding areas are very lucky to have you, Jane.
• 38:43
  SPEAKER_03: And I'm really excited that you've got this incredible initiative, the Rural Clinic Initiative, coming up for later in the year for new grads or any practitioners wanting to move into that space or become more proficient in that space.
• 38:59
  SPEAKER_03: So, just a reminder to anybody listening if you're interested in learning more about that, um, you can find Jane.
• 39:05
  SPEAKER_03: Her website is tamworthnaturopathy.com.au, and certainly should be taking expressions of interest ahead of the September launch soon enough.
• 39:16
  SPEAKER_03: So, Jane, once again, thank you so much for taking us through women's health specifically, perimenopause and burnout, and with your unique lens of rural health care.
• 39:30
  SPEAKER_03: And to our audience, thank you so much for joining us today.
• 39:34
  SPEAKER_03: Remember, you can find all the show notes and other podcasts on the Australian Designs for Health website.
• 39:39
  SPEAKER_03: I'm Amy Skilton, and this is Wellness by Designs.