#353 6 Questions To Ask Your Pediatrician Before Antibiotics with Elisa Song, MD

For children in particular, especially because all of their systems are developing their immune systems, their brains, their hormones, their metabolic systems, reproductive systems. Every round of antibiotic then with that hits in the microbiome interferes with how your microbiome is communicating with their immune system and their brain and their hormones and metabolic system. To really shape their health future from an epigenetic standpoint.

I gotta get myself a little more faith, a little more love. I'm your host Krista Bigler and I'm going to guess we have at least one thing in common that we're both in pursuit of a less stressed life. On this show I'll be interviewing experts and sharing clinical pearls from my years of practice to support high performing health savvy women in pursuit of abundance of a less stressed life. One of my beliefs is that we always have options for getting the results we want. So let's see what's out there together. On the less stressed life we have back. Dr. Elisa Song. She was last here maybe 100 episodes ago. I don't know what episode we're on but it was episode 277 is what I found. The topic was anxiety, antibiotic use and self regulation for kids. It was lovely. It was beautiful. I remember our conversation at that time we were talking about nervous system devices and things you'd used on kids and I could really tell at that time there was such an alignment around. Wow, we really have to like love on our stress and nervous system piece whether you're an adult, whether you're a child. But anyway, back to her bio. She is a Stanford and many other educational places or many other university trained integrated pediatrician, pediatric functional medicine expert and mom to two thriving children. She is recently I think it's the first book we were just talking about, I'm quite sure, but it's. She's the author of Healthy Kids Happy Kids which came out May 14, so I'm checking the date on this. I don't know what day it is, but right around this time in her integrative pediatric practice, Whole Family Wellness, she's helped thousands of kids get to the root causes of their health concern and empowered parents to help their children thrive, mind, body and spirit. By integrating conventional pediatrics with functional medicine, homeopathy, acupuncture, herbal medicine and essential oils. She created her online website Healthy Kids Happy Kids quite some time ago as an online holistic pediatric resource to help practitioners and parents bridge the gap between conventional integrated pediatrics with an evidence based pediatrician backed mom approved approach. Whew. Mouthful. Thank you so much for coming on today. Welcome back.

Oh, thanks, Krista. We've been having, I've been having an amazing time just chatting with you offline so I can chat with you anytime.

Yeah, perfect. And now we're on video where this will be on YouTube also so people can really appreciate how I accidentally wore your brand colors today. And is that picture in the background? Sorry for if you're just listening to this via audio, but is that picture, Is that a painting? Did someone give that to you? Because I see that is your like logo, isn't it?

It's part, you know, that heart. It's by an artist. Her name is Debbie Arambula and she's a dear friend now, but she's called the heart artist. And that is a ginormous painting that, that she created into a little, I think they call it jicle. It's beautiful. She actually will create heart paintings of families with your colors and. Yeah, beautiful. I have her hearts all over my office.

Oh, great. I'll get that. I'll get her contact information after the fact. And why that's relevant is I feel like you're a very heart centered practitioner which you can just see in someone and especially if you're aligned in that way. So why did you write this book? Maybe let's actually start there. Like why after the website did it just feel like the natural progression of things, like I must write a book now? Or were you thinking this is my legacy that I want to lead with as I'm asking you about being a hard seller practitioner?

Yeah.

Yes.

So one thing that you know, as people get to know me that, that they will realize pretty early on is that I am definitely not a planner. We were just talking about how we need to follow our joy. And that's what I do. I just let joy lead the way. And I love to teach, I love to write, I love everything, Kids, health. And so it naturally came together at the right time. It actually was during the pandemic as we were just partially had the time right. Because the office was so slow to think about what I wanted to do. Yeah, a great. It was a great pause. And so what was I doing here? My practice was great and I was building this online space. But what kind of a legacy would I leave? Not just my legacy, but what would I leave for my kids and my grandkids? And what do I really want parents to understand, to move beyond all the fear that was going on? Right. What do I want practitioners to know so that we can break the cycle of chronic disease that we're seeing in kids. And so that's why I wrote the book. The book is really. It's everything that's culminated over the past 20 plus years. Now, as a practicing integrated pediatrician, I can say for practitioners, I wrote it to make your life easier.

Right.

So that you don't necessarily have to explain your foundational. Here's why we think about vegetables, here's why sleep is so important for kids that foundational, so that parents can. And kids can understand. And for parents, I wrote it to make your life easier because I've had kids read the book, get a advanced copy of the book, and my own kids. And it's so much easier, even with my kids, if someone else says, oh, here's the why, and oh, here's how you might consider doing it.

I was actually having an email conversation with a mom. This happens when you get the college aged, the ones that are fresh into college. So the mom's. I think this will work better coming from you.

Yeah.

So to that point, how old are your children now?

My kids, so Bode is 12 and a half and Kenzie is 14. So I have a teen in between.

Perfect. Okay. And I was gonna ask you some questions I have for you about the change of landscape in healthcare and in integrative pediatrics since you started. And I don't know if you got right into integrative pediatrics, but you just mentioned you've been in this space for about 20. Will you talk a little bit about how things have changed since you started? I don't know if your practice is. It's Whole Family Wellness, I think.

Wholeness, yeah, the practice is Whole Family Wellness. I'm in Belmont, California. That's northern San Francisco Bay Area. And the landscape on the one hand has changed quite a bit. When I started out, I did start out of residency. My goal was to be an integrative pediatrician. And back then, it wasn't really called integrative. It was alternative medicine, holistic medicine. And so I started my practice in 2004. So that is 20 years ago. And it was a little lonely back then because there weren't a lot of pediatricians pursuing this route. There were some, there were some, but not a lot. And. And even when I did my first training at the Institute for Functional Medicine, and there wasn't even a certification back then, it was just one course applying functional medicine and clinical practice, and nothing relevant for children. So I had to extrapolate all of that and shape.

And before you had children, which is a Huge education piece, right?

Absolutely.

So often my colleagues don't take children. And one of the reasons I take children is I have children, so I'm just comfortable.

That's right, yeah. Or another reason is that maybe, unfortunately, knock on wood, their child has had a health concern and they've had to pursue this, and then they realize there's a different way, there's a better way, and the landscape has changed because now there are more and more pediatric integrative, functional medicine practitioners out there, more and more of an interest in starting to seek. It's still not enough, not nearly enough, but it's a growing community, which is awesome. What hasn't really changed is it's really not much different how our medical students and residents are getting taught. And so it's still a bigger lift to, as you leave residency, to be able to have your mind open to other ways of thinking about healthcare and what true prevention really means. So why were you.

Why were you inspired to go straight into what was then alternative and now integrative?

Yeah, it's interesting. Yeah. As I said, I did not go into this because a family member or myself had any sort of a chronic health concern, thankfully, knock on wood. But it really, as you were saying, the theme runs through. Right. If you follow your joy, the joy will lead you in the way that you need to go. And so I always knew, I want to work with children, but my mom was an obgyn, and back then she had a solo practice and she was never home. Right. So busy delivering all of our own babies. And I just thought, I don't want to do that. Right. I don't want to be a doctor. But that's all I knew about being a doctor.

So then you went to med school.

But then I knew I wanted to work with kids. Yeah. So at Stanford, I actually, my vision at first was, I'm going to be a teacher. And I thought, that's going to be. It's such a challenge. It's one of the most challenging jobs. Right. And then I thought, how can I do even greater good for kids? So I said, you know what? I'm going to be a lawyer. I actually took the LSATs, got my law school applications. I was going to be a children's rights advocate doing civil rights law. And one of my teachers, one of my professors, James Steyer, he founded Common Sense Media, which I love. Right. I had such great role models, but it was just that one is. Something was missing. Right. I knew if I did that, I wouldn't work with kids. And then they say, when.

Full circle.

Yeah. When you're looking for a teacher, the right teacher comes. And so I just stumbled upon this conference at the, you know, in Santa Clara. It was the American Holistic Medical Association. And I heard this is in the late 80s, right. I heard from people who are just starting to get known, like Deepak Chopra and Andrew Weil, Joan Borisenko, and that was it. I was like, oh, maybe this is what I want to do.

Yeah, for sure. So that's a perception of how it's changed for clinicians and the landscape of availability. I'm curious how things have changed for the kids that you've served. If there's been dramatic shifts that you've observed over time over these 20 years, you can divide that however you want. And while you're answering that, I'd like to know, and maybe you want to start here. I'd like to know also if you see shifts in the last four years and how you're serving kids now versus four years ago. Not necessarily that we're doing more telemed or whatnot, but is there big changes? Are there big swings? As we know, adults? There were big swings post Covid.

Yes.

Right.

Yeah.

So what are you seeing since 2004 to 2024 in the children you serve? And even just from 2020 to 2024 and the children you've served?

One of the things that has, I think, most significantly changed, and I don't know if it really is a reflect overall landscape, but when I started my practice, I remember when I was at UCSF doing my developmental pediatrics rotation, I saw one child with autism. And I remember my developmental pediatrician attending saying that if I saw a handful of kids with autism in my career, it would be a lot. And that. And that wasn't. I finished my residency in 2000, and so fast forward, I'm starting my practice, and I. No advertising, no nothing, opened my doors as a functional medicine pediatrician, and all of a sudden my practice was flooded. I didn't have a problem of trying to build a patient base, but it was flooded with parents of kids with autism. Right. And that's where I think in the earlier days, the functional medicine approach, this biomedical approach, was really applied to supporting the underlying clinical imbalances, the symptomatic needs for kids on the autism spectrum. Right. And so I think that awareness then eventually now, over the past 20 years, has had a ripple effect, or this. This, I guess a ripple effect on the awareness for parents with other health concerns to recognize that. Huh? Maybe this Biomedical approach could help my kid with eczema or asthma or autoimmunity or anxiety. And so I see more and more parents now seeking care for their kids who have a multitude of other health concerns. So that now my practice is not just a practice for kids with neurodevelopmental concerns, but really kids with any particular set of health concerns, which is great.

Nothing like throwing you into the deep end right when you get started on, like a neurodevelopmental. That's pretty intense, really. I know this is not a quick thing, but quickly, how. What are some of the possible pieces, not necessarily all inclusive pieces you might add to a workup of a child with autism. Foreign. Hey, I just wanted to take a quick pause to let you know that I've released a brand new training called the Four Step Blueprint to clear skin and food sensitivities. Because last year I kept seeing the same problems in my industry. More restriction, more supplements, more testing, but not more healing. So I burned down how I was practicing again and rebuilt my entire process around what was actually working for clients. Just trimming out the excess and doing what works. What emerged were four simple, really powerful steps that consistently help people reduce symptoms by about 50% or more in just a few months without adding more stress or cutting more foods. I put this training out into the world a couple weeks ago and the feedback has been honestly incredible. People message me inside the training with their questions and I respond to every single one. And the notes I've gotten are lovely and beautiful. So this feels like my part in changing healthcare and giving you the tools to heal yourself and know exactly how to do it again. If you ever need to, if you want to watch it, just go to kristabigler.com forward/blueprint. Again, that's christabigler.com forward slash blueprint. All right, back to the episode.

Yeah. And I want to back up a little bit, tread a little kind of lightly and respectfully here, because there's been a lot of concern about labeling autism as a disease. Right. What I really want parents to understand is when kids have autism, just like when kids have ADHD or kids have anxiety or kids have whatever it is, neurodivergence, we wanna celebrate that beautiful brain and some of the gifts that come along with it. However, there are also, for many kids, underlying significant issues with eczema or asthma or autoimmune phenomena. Gi for sure, kids on the autism spectrum are more likely to have inflammatory bowel disease. So we need to uncover some of those underlying imbalances and for kids on the autism spectrum, some of those kids are just so either sensory seeking or sensory reversed that they're not thriving in their own bodies. Right. They're not comfortable. And so helping us support that. And some have such crippling social anxieties or simply can't express what we know is inside, so need support in either getting the fine motor control to use a letterboard or actually be able to speak and communicate with words. But one of the things we look at is methylation is a big factor. In fact, in surveys of parents who have children who have benefited from a biomedical approach, methylation B12 shots is one of the number one. Also going on a gluten free, dairy free diet. Gluten and casein can cause these drug like compounds for certain susceptible kids and adults that can just have you in a total brain fog. And then environmental toxicity is another big concern. So trying to uncover what might kids be exposed to. Now from a mom standpoint, we know that for kids there has been a correlation with differences in infants gut microbiomes early on that might increase the risk later on for developing autism or adhd and especially loss of a whole genus called bifidobacteria. So for listeners for infants, bifidobacteria should be the primary probiotic genus inside your infant's gut. And we're losing that. So there's so many things that we can look at to help support kids to really thrive. And I care less about really from a functional medicine standpoint, the emphasis should be less on a diagnosis. And I tell parents all the time, I don't really, it's not that I don't care what your diagnosis is. I do because it can sometimes really help me dive into the literature and understand what pathophysiologic imbalances I might really need to look into. But at the same time it's just a label that might change or might not. And unfortunately for conventional pediatrics, if treatment is going to be recommended, there has to be some sort of a label. But it doesn't always fit, it doesn't always fit the classic picture. But really with truly personalized medicine, we can identify what is unique about the whatever imbalance is going on for your child. And how do we correct that?

I think since we're talking about kids, there's never been a better time to talk about the human experience. And I like to make light of this quite often in practice when talking to clients that oh, that's not actually a nutrition problem, but it's a human experience. Problem, and we all have to struggle with those things. So to your point, I agree wholeheartedly that the diagnosis is important, but not important. Right. What it does is in the human experience, makes us feel really good that we have an answer. And so therefore, when people don't get a diagnosis, they're like, I don't know what's wrong. Right. Because they don't feel validated by that. So I mentioned that, because that same feeling will cross over to testing. And so something I'm really careful about and I think I take decent care of on this podcast is I'm careful about how I talk about things because I Every day people come in and say, I learned that I should do stool testing. So I did this, like, consumer stool test. I'm like, that's cool. I don't find it very clinically useful. And they will say, yeah, I didn't really tell me anything, unfortunately, because the. What I want to say here is that we want to be validated. The human experiences, we want to be validated. It's so reasonable. We're all human. And so we may look for that in a diagnosis and feel better initially and then not. And then we may feel good or not good if we have a test valid, validate something or not. And a lot of things you talked about with a workup, there's a lot of evidence and proof we can create through labs. And then there's some patterns and things, especially with toxic burden. There is some testing, but I just get more out of the symptoms and the patterns and helping people with the patterns. And I think once you've been in practice for a while, too, you could make some solid guesses in general.

Yeah, I love that. I love that you say that. Because really, part of what I do in the book is give clinical clues as to whether what are some of the signs that your child might need more magnesium or more zinc or more iron, whatever it is. But there are often, if we listen to your child's body or for an adult, if you listen, truly listen to your body and your brain, it's often telling you, hey, this is off. Or I think I might need more of this, or, oh, I think I may be being exposed to that, whatever it is. But one of the. Now I've been at this for so long, I'm like, huh, one of the og, right? But really, what I caution when I teach pediatric practitioners who are just starting out, we all do this when we start. And it's part of learning about the testing and learning what clinical patterns but we want to make sure that we're not chasing the lab values, right? Because what happens then is we train our patients to do that. Because I'll have sometimes parents come in and their kids are doing awesome, right? They're thriving, like they've recovered from whatever we were trying to heal from. And then they come in and their lab, maybe their ferritin is a little low or something, is a little off on a urine organic acid test and they want to do something about it instead of just saying look, now let's set the foundations for resilience, for a nourishing diet and lifestyle so that all of these things can balance out on their own. And I think we've lost sight of that. And I really want to caution new practitioners and, and new parents who are new to the functional medicine space. We really want to create a different paradigm, right? We don't want to create the same conventional medicine paradigm where it's just looking at the tests and then fixing the tests. Right? We're looking at the child in front of us, right.

Don't whitewash functional medicine with our conventional model. Right? And we do see that happening. And so that would be a change I have seen in the last four years maybe. And it's not, it doesn't probably have anything to do with the pandemic or not. It's just awareness. To your point, you started, you were originally an alternative medicine provider and now you're an integrative medicine provider. But what the change that I'm seeing is that sometimes people come to me after seeing, I'm sure as you do, many integrative professionals. And so I have to dig through and figure out was this whitewashed functional medicine. And I'm not saying I have ever been perfect in life or practice. I've made all kinds of mistakes myself. Cuz that is, we are practicing. And that's what you learn, right? That's the sweet spot. I love the statement. I think sometimes we find these terms that really work. Freaking love clinical clues over the word symptoms. Thank you. What a beautiful. It's. There is so much little tiny language that really makes that hits people differently. And I like clinical clues better than that. I think that we can learn much more from clinical clues and if we understand how to piece those together. I agree with you. And don't chase lab values. That's why when people ask me am I going to retest this, I just educate by saying you can, but it's never gonna be perfect, cuz there is no perfection. And so you're just Looking for this dramatic improvement by doing all these foundational pieces. If you're doing foundational and to your point, with clinical clues, like people may identify that they have magnesium deficiency and that may be related to many things. And so that's the cool part is what's fun as you get going is like, you may do one intervention and it creates three positive results. Cool. That's awesome.

Absolutely. I love that. Yep.

So we're looking at the positive here for you. Is there anything significant that you've noticed from four years ago to today as your clients walk into your practice?

Yeah, you know, what I would say is I noticed this more in my adolescence. We know that children and teens mental health was in crisis long before the pandemic. But through the pandemic, the reports of the increasing rates of ER visits for suicidality, even in 8 year olds younger and younger, and the number of teenage girls who have seriously thought of suicide or even have a plan nowadays, it's alarming and we need to have our eyes open to it. One shift that I could, it was starting even before the pandemic, but I can see a little more clearly now is this expectation for many teenagers, especially teenage girls, that of course they're gonna have anxiety, right? Yeah, of course they're gonna eventually be on medications because my friend is on Lexapro and another friend's on Wellbutrin, and so it's just a matter of time. So, like this expectation that this is the path they're heading towards and that having anxious feelings and being anxious is going to lead to an anxiety disorder. Right. And trying to unravel that for teenagers can be challenging because then like a parent, right. Once you have an adult, once you have your mind set that you're. That of course you're going to need medications for your high cholesterol or your high blood pressure or your whatever it is, then it makes the other stuff a little less important in your mind because then there's this belief that the medication is going to take care of it. Right. And helping kids understand. Look, maybe medications are going to be needed at some point, but they don't work 50% of the time. And even then, if they do work, they often stop working. And there's so many things that we can do to, you know, help you feel better and, and stay feeling better.

Yeah. I wonder how many kids are on a medication.

That would be an interesting question. Um, because, you know, my population, of course, is, is skewed even like a lot of my kids who have ADHD or Anxiety or depression, they're not on meds or they're just on a very low amount. And, and our goal isn't necessarily to keep them on meds. Right, right. And what I see for a lot of kids is, and I'm sure this is the same for adults, you start a med, no medication is without side effects. So then eventually, eventually maybe they're on another medication to counter the side effects. Right. And then eventually they're on three, four different medications and you're like, I don't know what's doing what now. Right, yeah. So it's the same thing with, what I really try to educate kids about now is with choosing, with thinking about medications. You should have the same due diligence when you're going in to ask for medications as you would when you're buying your first car. You would never just go into a dealership and trust that the dealer is going to give you the best car for you and make sure that you're, you don't have a lemon and that you're not going to have any problems with it. Right. You need to ask questions about your be empowered to ask questions about, to your physician about, hey, how do you know that this medicine is going to be the appropriate one? Are there other options? Are there other non medication options? What are the side effects? How can I mitigate those? All of those? And I, fortunately I'm now, because I've been in practice now for 20 little over 20 years now. It's so great. Last year, through the pandemic, I had this cohort of kids who are graduating onto college. And last year I just had a bunch of kids who flew the nest and are off in college. And for the most part it just, it makes me feel like I've done my job, that they can call me or send me a message and ask me about how they're feeling, their symptoms, like, hey, is there something I can do about this? Is there? And if I recommend something, oh, can, is there anything I should be concerned about if I start this? I love it. Like I, I want them, I want all kids to have that very important life skill, to really be their best advocates. Whether they're talking to a doctor or their boss or, you know, whatever it.

Is, that is a skill. So you went over those questions and you brought this. I have this as a question for you about the questions parents should ask their doctor before starting antibiotics for a kid. And I think they're probably the same one. So it's any medication, Are they the same questions just Double checking.

Yeah, they're a little different. Okay, so the first and foremost, similar. They're very similar. Right. But the first most important question that anyone should ask, whether you're a parent for your child or whether it's you yourself. Right. Because adults get plenty of antibiotics too. Right. So the first most important question to.

Ask if you're urinating a lot when you're drinking water, maybe you're not actually hydrating that much, or in other words, getting the fluid and nutrients into the cell. Electrolytes are minerals that help fluid and nutrients get into the cell. I recommend all of my clients start by drinking electrolytes when we begin our work together to improve energy. And then we get even more strategic with our electrolyte recommendations as test results come in. Now, generally, electrolytes are potassium, sodium, and chloride. One of my favorite electrolyte, pickleball cocktail from Jigsaw Health because it's one of the only products you can get with an adequate dose of potassium to meet my recommendations, which is critical for blood sugar, which everyone should care about. Hormone health and digestion, huge thing for relapsing digestive issues. Jigsaw Health is also maker of the famous adrenal cocktail made popular by the Pro Metabolic corner of the Internet and root cause protocol, as well as a multimineral electrolyte for recovery called Electrolyte Supreme. You can get a discount on all of Jigsaw's amazing products, including Pickleball Electrolyte supreme and Adrenal cocktail@jigsaw health.com with the code less stressed 10, that's three S's. Less stressed 10 is.

Hey, Doc, is this antibiotic really necessary? It sounds like such a weird question to ask. It's. One study found that doctors were up to twice over two times as likely to prescribe an antibiotic, even if they believe that it wasn't really necessary.

Human behavior, it's like you're trying to fill. You're trying to give someone an answer because that's what you've been called. That's right.

That's right.

You know, it's just human.

It's just human nature, and there's a lot of wiggle room. But if they believe that you want the antibiotic, they're more likely to give it to you. All right, so then it just by asking, hey, is this really necessary? Not in an adversarial way, but just in an inquisitive. I just, I really want to do the best thing for my child. Is this really necessary? Then the doctor immediately knows, oh, you're not one of the parents who came in just to get the prescription and go out the door. Because there are some parents who really just want the prescription. Right. But now they know that's not you. And so it opens the door for that conversation. Right.

I like that little nuance. It's here's the reason for the question.

Yeah, yeah. So that's the most important one. And then the other questions are similar. Right. Are you sure it's bacterial? Are you sure prescribing it just in case, or is there any testing to confirm? That's why with throat infections, a hundred percent every single time, if you're concerned that it could be a bacterial infection like strep throat, you need to have a culture for confirmation, because Epstein Barr the monovirus can look exactly the same as a strep throat or sometimes even worse. Some of the most horrible sore throats I've seen are viral. So we don't want to take unnecessary antibiotics. And. And that goes to really help.

Did they have both? Could they have both?

They actually could. They could have both. Yeah.

Yeah.

Just like with ear infections, right? A lot of ear infections are a mixed picture of virus and bacteria. But that for parents and kids to really understand, why don't we want to use unnecessary antibiotics? Because some people would think, what's the harm? It's just a random antibiotics. That's how I grew up and my mom was a doctor. Right. Every little, like sore throat or whatever. Oh, here's some antibiotics. I had lots of antibiotics as a kid. And so now what's the harm? We know they can instantly disrupt your gut microbiome. And in fact, some antibiotics may preferentially kill your beneficial microbes and preserve your pathogenic ones, which is why we'll see C. Diff infections after antibiotics. Right.

And now you have eczema.

Yeah, exactly. And for children in particular, especially because all of their systems are developing their immune systems, their brains, their hormones, their metabolic systems, reproductive systems. Every round of antibiotic then with that hits in the microbiome, interferes with how your microbiome is communicating with their immune system and their brain and their hormones and metabolic system to really shape their health future from an epigenetic standpoint. So it's really that important. One study found that antibiotic, just antibiotics or antacid medications, which also disrupt the microbiome given in the first six months of life, could almost double the risk of virtually every single allergic disease. By the time kids are four, we have an explosion of allergic diseases. I don't haven't When I was starting out in my career, anaphylactic food allergies were exceedingly rare. And now I'm filling out medical forms for school, for EpiPens, and every school season, there's several kids now. So when parents and kids understand that, and even if it's not just from a personal standpoint, from a public health standpoint, I really, I want all people to really understand we need to be really good antibiotic stewards because the crisis of antibiotic resistance is really, is worldwide.

I think years ago, the FDA put out like a call, please don't give antibiotics unless needed.

That's right.

I don't know that we really change our behavior very easily sometimes as humans again.

Yeah, yeah.

And that's. It is what it is. Cuz, you know, some people just want that. And so it's hard to. My friend who went through, she's still going through her cancer journey. She has some really beautiful thoughts on how to survive cancer. And it's befriend your oncologist to the point it's be a human and open. To the point that you said open the door for conversation.

Right.

Once you open that door for conversation, it's, oh, cool. You're one of the few and cool ones that I came to be a doctor for, so be that person. You have a big toolbox. So I'll use this example of some of the worst sore throats are viral. And so when we're talking about other options besides antibiotics when kids are sick, how do you coach people through that?

Yeah, my toolbox is just the one that I've learned over the years.

Right.

And other people have other tools. For instance, I would love to learn more about ayurvedic medicine, but I don't know enough yet to recommend ayurvedic treatments. But I incorporate homeopathic medicines, herbal medicines, essential oils. I love acupuncture for kids. It's way more doable than it sounds. But I teach parents acupressure. And one of the reasons why I talk to parents about the importance of using your integrative tools when your kids are sick are, first of all, that in conventional pediatrics, often there's not much we can do in those early stages. Right. Let's take a cold, for instance. Sudafed, Benadryl haven't been found to work. Right. They can do some harm. And yet that's what we, a lot of docs still tell their patients. Oh, try this. Right. So it doesn't work and our kids can be really uncomfortable. Let's take fevers. Also, we know that reducing fevers artificially with things like Tylenol or Motrin might help your kid feel better temporarily, but they don't help them fight the infection any faster. And in fact, some studies have found that they can make your infection last longer and make your kids more contagious, which is the exact opposite of what we want. And we use our integrative tools so that we can help our kids feel comfortable. Yes. And can compress the time, can help their body not suppress the symptoms, but do what it's trying to do, mount a healthy inflammatory response and antimicrobial response from our immune system so they can recover faster and hopefully avoid the unnecessary use of antibiotics. So for sore throats, for instance, I do if there's been strep exposure or it just, it looks like a. The classic strep picture with the kind of really beefy red tonsils with white spots and the red spots up, up on your upper palate. I always do a culture because I do treat strep with antibiotics. This is the reason why integrative is such a better word, is because it's not an either or. We use antibiotics when they're appropriate and we know how to restore and recover the microbiome when they are needed. And I do treat strep with antibiotics because I'm seeing too many kids now with. With something called pandas. Right. The pediatric acute onset neuropsychiatric disorders associated with strep, which is an autoimmune brain inflammation that can happen after strep. And so I don't want that to happen. And yet most arthroids are still gonna be viral. And what can you do? One of my favorite, like as a parent, I, I think just having this in your cupboard all year long and we travel with this. There's a. An African bush herb called Pelargonium sidoides. Okay. But you can find it on Amazon or Whole Foods or whatever health food store. It's called Oomka. U M C K A so Oomka Cold Care Syrup. As, as a practitioner, if you sold it in your office, it would be called vclear. And so that's 100% my go to. It's tasty, really easy to give. And it's been found to have in vitro activity, so in the test tubes, in vitro activity against many different viruses, including your common cold, adenoviruses, rhinoviruses, your human coronaviruses, Epstein Barr, Coxsackie, which is a handful of mouth virus, different herpes viruses and Also some activity against strep and staph and some other bacteria. Amazing, right? It's amazing. So I always start that, um. Cause that sometimes can nip things in the bud. And then from symptomatic relief. I don't know if anyone's as an adult has ever had hand, foot and mouth, but it is truly one of the worst sore throats.

I was actually gonna ask you to expand upon it. Cause it's so gnarly. And I have a handful of people where like they were maybe had a little eczema before and post Hand, foot and mouth. It's like a nightmare, right? It's like everything sucks after that.

Yeah. And I thought my hubris, right? I'm like, I've had all the colds and whatever. Because at knock on wood, I rarely get sick through the winter. Because we as pediatricians, the first couple years out, you're sick all the time, Right. But then you build up that immunity and so that memory. Right. And. But I did get hand foot of meth and I actually got daughter. Right?

Oh, no.

And yep. And this is when she was a baby and she sailed through it, Right. It was over in two days. And it was the most insane sore throat I could imagine. And Tylenol ibuprofen. I was like, I need to try something. Right. They weren't doing a thing. Right. So here's what helped though, right? Drinking a ton of throat coat tea with your demulcent herbs, right? They coat your throat with and your stomach. So marshmallow root, licorice, slippery elm, even making like jello with that if you can't swallow. Right. Or making a smoothie and mixing in, making a popsicle with it. And homeopathic medicine called it was homeopathically diluted borax and belladonna. Those two things I couldn't believe because I had to go up to Oregon. I was giving a talk and I have a fever, but my throat was killing me and I thought I might have to cancel. I started these things within. Literally within a few hours, my throat was feeling pretty good. And then by the next day when I had to talk, totally fine. So that's where using your integrative tools, just learning how to use them. First of all, it saves you a trip to the ER or to your doctor's office where your kid might pick up another thing. Right. And can really help you recover faster. I love.

So I grew up on homeopathy. I kind of wish I was trained in herbs, so I use that more. I will occasionally bring Homeopathy in. But I always say I really want to bring in more homeopathy, but I think it's a perfect place for someone to be their own child's provider. Right. Because I feel like homeopathy is so safe. It doesn't taste bad. It's so gentle.

Yeah.

I can't really even think of a negative, honestly. And when you were choosing that for hand, foot, and mouth, was that already in your toolbox or were you making a great guess based on mechanisms? Because I don't know enough about homeopathy.

Yeah, no, it was in my toolbox. And the thing is, as a pediatrician, we're often our. Our worst patients. Right. And also as a pediatrician mom. Right. Because sometimes when the kids are sick, I'm like, you guys are fine. Just lay on the couch and sleep it off. So oftentimes, when things really start to get a lot worse, this is what I do in my mind. I step back and I think, okay, Elisa, what would you tell a patient to do? And then it's, oh, yeah, I would tell them to take the borax and drink this throat co tea. And because here I was in this kind of. With this pain and delirious state, or sometimes with the kids when they're sick, or my husband, I'm like, you guys are fine. Right? And then I'm like, no, okay, what would I tell a patient? Oh, yeah, start these things.

I've had a lot of people have lots of symptoms post hand, foot, and mouth. And since this is a virus and we think about viruses hanging out in the body and kind of continuing to shed, do you think that using this post virus could still be helpful?

Yeah, for sure. Yeah, absolutely. Yeah. And there are for. And even for. Because sometimes with post viral symptoms, yes, there may be some virus lingering, but a lot of times it's your own immune system that hasn't settled down. And using there. There are some homeopathic. There's a remedy called sulfur iodide that's really good for recovery. The kind of that convalescent stage where you're having this ongoing fatigue. I just. I'm just not back to myself. And then as. As you do, right. From that. From that functional medicine standpoint, recovering the mitochondria, recovering the microbiome, all those things are so important.

For sure. All right, so thinking about illness, having that toolbox, we were talking earlier about anxiety, microbiota. I wanted to ask you about if things just keep coming back, because to me, I go to terrain theory, and we may have even Talked about this a hundred episodes ago. I'm not really sure, but for a while I was just asking every smart person I could their opinions on terrain theory. And you know what happened? Lots of the same answers, which was fun. So sometimes when people say, I just can't clear this X, Y, Z thing, and then let's give the caveat of I'm doing an effective protocol thing, then I bring up the con and train it's we only care about what affects us sometimes as a human. So I'd love to hear your thoughts on terrain theory. And I also want to make sure I interject a question that's separate but related to antibiotics that I just remembered. I want to ask you about post, if you are using antibiotics, if you're educating your parents to do something post as well. Okay, Maybe we should start there.

Yeah, let's start so with the post antibiotic microbiome recovery. Absolutely right. And it works best if you start it while you're taking your antibiotic course. But even if, let's say you're thinking, oh my gosh, I wonder if my child's eczema is related to the antibiotics that they had when they were toddlers and now they're in middle school, you can still recover your microbiome, right? There's just, it just takes a little longer, likely so. And in fact, one chapter in the book is really dedicated to that recovery plan because so many of us need to recover our microbiomes. Right? And really and truly the recovery plan, the foundation of it, is the foundational getting your microbiome off to the right start anyway, right? Because probiotics, they're a part of it. They're probably the smallest part of it, to be honest. Right. I tell kids and parents, recover your microbiome is not like Jack's magic beanstalks. You can't throw a hundred trillion colony seeds in your gut and expect this beautiful biome community to establish itself. It doesn't happen that way. And more is not always better either, because sometimes doing more, that's such the American kind of Western Way. 5 billion can't be enough. We need 450 billion or 900 billion. But there is some evidence that giving too much, even if it's a good thing, can crowd out some of your own native flora. Right? And then I used to think I knew a lot about the microbiome, and now I think I know some. But there's so much more to know. The more you realize we are just at the tip of the iceberg of understanding microbiome science. And when we think about microbiomes, we have to ask. Miss a tangent, but we do have to ask, okay, when you're restoring your microbiome, like whose microbiome are we restoring? Right, because your microbiome is very different than my microbiome. What's ideal for us given our ages, our genders, our ethnic backgrounds, so many different factors. So there is not one perfect microbiome. So just in that sense there's not one perfect probiotic to restore your microbiome. Right. So yes I do there are some strains that have been found in the literature and I really look for pediatric studies because that's pediatric studies are so far behind adult studies in general. But some, some good studies in kids looking at specific strains that help to restore your microbiome after antibiotics, certain strains that can reduce the likelihood of antibiotic induced diarrhea, lactobacillus, rhamnosis, GG and Saccharomyces boulardii, which are EAs find. And most of the studies have found that taking starting a probiotic alongside your antibiotic course. So if you're starting a 10 day round of amoxicillin for strep throat, you start the probiotics during that same course, but you take it at another time of day. I've heard all sorts of myths that parents have been told. If you take probiotics now, it's going to make the antibiotic less effective, which does not happen. You do that. But your probiotics need something, they need a reason to stick around. So we need to help support this goes to that terrain theory. We need to support a thriving ecosystem for your microbiota. Your microbiome is the ecosystem and microbiota are just a part of it, the organisms. And so setting that foundation, you could take a probiotic supplement with prebiotics. But the foundations for that ecosystem are really truly come back down to the foods, how we're nourishing our microbiome with the fiber and the fermented foods and the phytonutrients, how we're keeping out the neighbors we don't want. Right? That means eating, getting rid of the ultra processed emulsifiers that disrupt microbiome and the artificial colors. And it also comes down to how we're living because how we're thinking engaging our vagus nerve, how we're sleeping, how we're hydrating, how we're moving our bodies, all of those help to support your microbiome for better or for worse, right? And so if we really wanna restore healthy Microbiome we need to think about. Hmm, how am I gonna move and drink and sleep and also have the mindset that encourages those beneficial bacteria, all of my friends to come back and live around me. Right? Not the neighbors that I don't want. Right?

Yeah, I love. So you said in different words, we're just getting started on our knowledge about microbiota. Feels like we always learn and then we realize we don't know everything. And then on the other side, we also have a lot of ancient wisdom that we can lean on, that we can choose to either lean on or not lean on. And that's a beautiful opportunity as well. We can also lean on things that are always safe. So two things now. So we'll talk about terrain theory and then also you just brought up vagus nerve. I think these are all intertwined. So I'm gonna let you intertwine em however you want. And you have an entire chapter in your book about the vagus nerve. Why changes? Have you seen when you've had kids, start to stimulate optimized vagus nerve?

So you know, they're so intimately connected, right? Your gut and your brain and your microbiome and your brain communicate via the vagus nerve nerve. And when we start working on our vagus nerve, and by working on our vagus nerve, what I really mean is like the day to day, how are we engaging in a way of living that supports nervous system regulation? That's. It's gotta be, it can't just be, oh, I'm gonna go to the gym and exercise my vagus nerve for 15 minutes, right? Or half an hour. It's gotta be the way that we are living and that is the terrain, right? If we create a system, a whole connected system between our brain, our vagus nerve, our gut, gut and all of our other systems in our body, we create, we restore balance, right? We restore that balance and we restore the way our body should be working to your point and your question about what if parents, kids, adults were doing all the quote, right things, right? The supplement plan should be spot on, right? They're on an elimination diet, they're sleeping eight hours a night, they're exercising every day, but there's still not, there's something stuck, right? Very often that thing is the vagus nerve. If you go back to Dr. Navio's work with the cell danger response and the healing cycle, it's so beautiful. But I think it explains so much of why and how we get stuck in chronic health concerns. Because the final piece, when we have whatever Hit. Whether it's an infection or a psychological trauma or environmental toxin or physical trauma, our cells go through that same healing process. Inflammation, all the clinical imbalances that go into motion as a normal part of healing. Right. The final piece to kick back into health is re engaging your vagus nerve.

Right.

And so if that last piece isn't kicked in, it's. We're not gonna be able to get back into that fully healed state. Or maybe we'll move into it, but we keep sliding back, that kind of push, pull. And when we think about engaging our vagus nerve, it really has to be how do we on a moment to moment basis regulate, keep our nervous system regulated. And when we have those moments of oh my gosh, I'm running late and in that sympathetic. Or I have this deadline I'm thinking about, or oh, I just got this awful text from my friend. Right. And you're tail spinning that way. That sympathetic response is appropriate. We need that kind of fight or flight. Ooh, I'm getting ready for something. But we need to turn off too. And that's the turnoff piece is what a lot of us don't have. And so. So when we can learn to balance and use our vagus nerve at any moment that we need and throughout the day, that's when I think true wellness occurs and true healing occurs when people are sick.

Yeah. I think because we don't often turn off, we don't even know that we're turned on.

Yes.

I would say it just takes. It's so hard to make this tangible to people, but it just takes an unlayering. So here's the really good news, that there's always an opportunity for us to work on our nervous system, which is going to influence our vagus nerve, which influences kind of our stuck. If we're stuck in a thing and we've been doing something really good, then there might be time for a great pause to step back to really look at that.

And I love that you said sometimes we're so stuck we don't know that.

Topic I really interested in.

And yeah. And what's fascinating, it's actually a story of one of my favorite vacations ever to Glacier Park.

Park.

And I remember so in California, it was one vacation that we had and my then boyfriend, now husband, at the time we thought, oh, let's go to. I want to go to Glacier Park. It was always one of my dreams because I'd seen in college, one of my friends had a poster, a calendar poster of Glacier Park. And this is the most beautiful place in the world. I have to go there one day. And we drove up because his dad lived in Sun Valley and his stepmom. So we drove to Sun Valley and then we made our way to Glacier park, right? And it was just a magical time. We were. We were camping. It was light until 10 o', clock, 11 o' clock at night, and just so beautiful, so fresh. And we were moving our bodies every day, sleeping our film. And then I distinctly remember as we were driving down back home, we got closer and closer to Reno. And then we were in Tahoe. And it was fascinating because I could feel this pit in my stomach starting to grow. And I realized, oh my God, for a whole week I didn't have this pit in my stomach. And I only realize it now because I didn't have it. And so now I'm going to go back and sadly I'm like, I'm sure it's going to come back and then I will forget that it's there because it's always there, right?

That was like me coming home from Arizona a couple weeks ago. And I was out in this like very carefully curated space, waking up to birds chirping and beautiful and everyone's just in a great mood, right? Like, it is just what it is. And then I got home quite late, later than expected the night I flew home. And the next morning I Woke up at 6 or 7am to 40 mile per hour winds and doing the point, I felt so jarred. I was like, oh, I'm gonna need a second.

Yeah. Like, yeah.

Oh, this is the baseline. You don't know that. Oh, this wind is so stressed. And it's just, I can't go outside. Everything's. It's just such a dumb thing. But to your point, it's. You don't know what's there until you turn it off for a second and then get the opportunity to have that. So I always wish for people that they have the opportunity to pause.

Yeah, absolutely.

And I think maybe Iran just such a tangible takeaway. So to your point, it's like you cannot complete the healing or the kind of the starting the ignition on cell processes happening again without vagus nerve stimulation, right? There's this whole process and you can't just turn it back on without that and something. I think that's useful or something. I've been like digging through this whole unconscious stress topic for a while. Cause it's like, how do you talk about something that's not always tangible to people until you tell a story like that. Right. And something I think that's useful is have you ever tried to sit in silence and just saw what happened, noticed your discomfort or your ideas or need? I've got a really popular podcast episode from the beginning of time called For People who Can't Meditate. And I used to be that person. So anyway, these are just. These are all of the signs. And sometimes it's not obvious until it hits essence. Sometimes we can also be. Someone's gonna slap me for this one. Virtually. Sometimes it's also okay that we run into a real roadblock. Cause that's where you, like, have your next epiphany. It's like, if everything's like, easy peasy.

Yeah.

And it's. I'm fine with this, like, anger that I've stored in my liver. Until you hit a roadblock, you can only get so far in your thyroid journey or whatever. Then start unlayering the pieces, the emotions.

It's all an opportunity.

All an opportunity. Louise Hay that one of my. I used to say all failures are good experiences, but I think she said all experiences are a success, which is okay with me as well. I like that one. Oh, Dr. Song. So you've got a book. It teaches us everything we need to know if we want to have healthy, happy kids. Where can people find you online?

So the best way to find me is on my website, which is healthykidshappykids.com and also I'm most active on Instagram. That's healthykidshappykids.

Perfect. Thanks so much for coming on today.

Oh, thanks for having me.