Julia Getzelman, MD, FAAP, is the founder and CEO of GetzWell Pediatrics in San Francisco. GetzWell Pediatrics provides holistic primary care pediatric services as well as consults for complex pediatric illnesses.

Prescriptions

for HealthA Newsletter from

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The GetzWell Approach Functional MedicineFunctional 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

updates from

koshland pharm

Our Expanded SpaceHappy New Year from Koshland Pharm! We are excited to be in our expanded space here at 301 Folsom St. – if you didn’t have a chance to check it out at the pharmacy’s 4th birthday celebration in October, please stop by to take a peek when you are in the SOMA neighborhood.

Lindsey Bourcier Attends PCCA Training in November Our Marketing and Outreach Coordinator, Lindsey, recently attended a week-long training with the Professional Compounding Centers of America (PCCA) in Houston. A highlight for her was learning how compounding can be useful for providing customized medications for children with autism. Lindsey explains, “I learned that commercially available medications typically have dyes or gluten/lactose fillers in them, which autistic children can have adverse reactions to. Even the particular texture or color of a medication can be off-putting to an autistic child. For cases like this, compounding pharmacies can make medications without dyes and gluten/lactose ingredients that can be customized to match taste and texture preferences.”

Pediatrics Issue

featured PRACTITIONERAt Koshland Pharm, we have the unique opportunity to meet doctors in different fields who have useful approaches to health and healing. In our Prescriptions for Health newsletter, we share highlights from interviews with doctors about their practices and their experiences prescribing compounded medications. If you’d like to read more about practitioners whom we have met and seen excel in patient care, see www.koshlandpharm.com/referrals.

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 (continued next page)

dr. getzelman’s TOP THREE NUTRITION TIPS FOR PARENTS 1. Model Good Eating HabitsWhat you eat as a parent really does matter, beginning when your baby is in utero. We know that amniotic fluid and breast milk take on the flavors of whatever mother eats and these exposures influence baby’s later preferences. When baby starts eating solids, it’s important not to send a mixed message: don’t eat pizza while baby eats kale puree. My hope is that by educating parents about nutrition from the beginning, everyone in the family will benefit.

2. Introduce a Variety of FlavorsWhen you begin to feed babies solid foods (typically around five to seven months of life), you are educating them about what food is. Food is information on many levels: it impacts our taste buds; it is calories; it has cultural meaning; it holds emotional messages; it contains micronutrients, and much more. If a baby’s first three months of eating solids means being offered highly processed bland and sweet foods (typical “baby foods”), what do you imagine that infant will do when we give them a meal involving complex flavors? We have a tremendous opportunity to impact the child’s palate for a lifetime not only by eating well ourselves as parents (see above), but also by offering our babies tasty, colorful whole foods from the get-go.

3. If They Don’t Want to Eat, That’s Okay! Healthy children don’t starve themselves. As a parent, this is an important message to internalize so that you don’t turn into a short-order cook or resort to the “anything’s-better- than-nothing” belief when your child goes through their picky eating phase. Kids will eat what is presented if they are hungry. It’s important to set clear messages around food and mealtimes.

canal, or when a newborn’s mother has to take 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 MedicineAt GetzWell the foundation of the care we provide 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 StoryWe 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 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 InspirationsOne 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:

getzwell.com

featured PRACTITIONER(continued)

“We like the mantra, ‘It’s your job as a parent to decide what, when and where your child eats, and it’s your child’s job to decide how much or not at all.’” - Dr. Getzelman

pediatric and compounding NEWS

New Compounding Law: H.R. 3204As 2013 came to a close, we heard questions from some patients and doctors about the new compounding legislation that was signed into law in November. Our understanding is that this new legislation will mostly impact large compounding pharmacies that: 1). ship large quantities of medications across state lines and 2). dispense many non-patient specific medications (for office use). This type of facility is being encouraged to register with and therefore be regulated by the FDA as an “outsourcing facility.” Because our pharmacy is licensed solely in California and creates mostly patient-specific prescriptions, we will continue to be regulated by our state board of pharmacy, whose high standards for quality we strictly adhere to. For further details about the recent national legislation visit:

www.koshlandpharm.com/legislation

Pediatric-Related Book Review

ADHD Without Drugs by Sanford Newmark, MDLast August, San Francisco pediatrician Dr. Sanford Newmark presented on an integrative treatment approach to Attention Deficit Hyperactivity Disorder (ADHD) at the Bay Area based Integrative Medicine Conference for the Underserved. He has written a well-researched book on the topic entitled ADHD Without Drugs: A Guide to the Natural Care of Children with ADHD, in which he analyzes and explains multiple factors that have led to a 1,600 percent increase in psychostimulant prescriptions for children since the 1970’s. In his book, he clearly presents a step-by-step approach for parents experiencing attention and hyperactivity issues in children, including diagnostic guidelines, evidence-based nutrition and supplement recommendations, behavioral modification approaches, and considerations to keep in mind in cases where psychostimulants are recommended as a part of treatment. To read more about ADHD Without Drugs, visit:

www.koshlandpharm.com/newmark

To read more health-related book reviews, visit:

www.koshlandpharm.com/bookreviews Call us at 415.344.0600 to speak with a pharmacist about a

customized pediatric formulation.

ask the PHARMACISTS

Do you have any favorite pediatric formulas?Suspension for extremely bitter drugs

It can be difficult to get a child to take a medication that has a particularly bitter flavor. Just flavoring a medication doesn’t usually mask its bitter taste. We have a great compounded suspension which includes sweeteners, bitterness suppressors as well as multiple flavors that can make a drug palatable.

Viraclear from Integrative Therapeutics

This is not a compounded formula but an over-the-counter supplement we recommend for the winter season. We trust the manufacturer, Integrative Therapeutics, because of their FDA audited manufacturing facility and their evidence-based formulations. We find it is a helpful remedy to have in a family’s medicine cabinet during the cold and flu season.

Lauren, Hoda, Peter and Maryam.

301 Folsom St., Suite BSan Francisco, CA 94105 P: (415) 344-0600 • F: (415) 344-0607koshlandpharm.cominfo@koshlandpharm.com

vitamins & supplements WHY BRAND MATTERSIn this Prescriptions for Health newsletter, Dr. Julia Getzelman discusses why she recommends probiotics for some of her pediatric patients. Probiotics are beneficial micro-organisms that can help to maintain a healthy balance of bacteria in the intestinal tract.

You can choose from hundreds of probiotic brands, as is the case with many other supplements and vitamins your doctor might recommend. Patients may wonder why brand matters, especially because with prescription medications, the generic is often as good as the higher-priced brand alternative.

Unlike medications, when it comes to vitamins and supplements, quality varies greatly. Vitamins and supplements are not held to the same standards by the FDA as prescription medications are, and the companies that make them are not required to prove their safety and efficacy through clinical trials. Some important factors to consider when selecting which brands are of high quality include: 1). the manufacturing standards used in the company’s facilities, 2). whether or not their formulations are evidence-based, and 3). the absence of harmful additives in the products.

At Koshland Pharm, we only carry brands that our pharmacists have thoroughly researched according to the above criteria. Many of these brands are only available from a licensed practitioner such as a doctor, nurse or pharmacist.

When you take a vitamin or supplement that is of high quality, you should notice an improvement in your health. If you’re not sure if your supplement is doing anything for you, it might be time to consider an upgrade. Talk with your doctor or pharmacist about any recommendations they may have.

did you KNOW…..you can now purchase vitamins and supplements from Koshland Pharm online as well as in our store.

koshlandpharm.com/vitamins

Koshland

Pharm makes prescription

medications tailored to a

patient’s specific needs.

For example, sometimes

a pediatric patient could

benefit from ibuprofen in a

suppository form rather than

in a capsule form for ease of

administration. To address

this kind of specialized need,

Koshland Pharm makes

high-quality, customized

prescriptions and works

closely with both patients

and their physicians to ensure

optimal treatment outcomes.

This newsletter is intended as a source of general information about health and healing. Because every patient and health condition is unique, it is important to always consult your doctor for medical advice to determine if a particular treatment is right for you.