Patients and Patience

You're not behind the desk, you're sitting in the chair next to it. Waiting. Waiting, for what seems like FOREVER for them to come look at you, examine you, swab, cut, bleed, sample, whatever you. They're taking forever. You feel wretched. Everything aches, stings, hurts. You're tired from staying up all night worrying, hurting, stressing. You only want to know what's going on and you feel like you're simply the only person on the face of the planet, and no one is able or willing to help you.

I'm trying to explain what it feels like to be sick -- to be frustrated with the status of the medical profession and confused and angry and scared. I'm trying to explain what it feels like, no matter how melodramatic it may be, to feel like someone else has control over your health, what's wrong, and if and when you'll get better. There's a feeling of being completely helpless that comes with being sick -- when there's pain, when there's no observable pattern or relatively easy diagnosis, or when it just seems to drag on forever. It's a feeling that no one seems to understand -- like being held hostage by something or someone and being powerless to do anything about it. And it doesn't go away -- that feeling -- until there's some grasp over the problem, like some answer, lab result, diagnosis, something, ANYTHING that seems to give some control over the situation.

If you, as a person, have never felt this way, count yourself lucky. But many others can't say that. Our patients likely can't say that. They come to us hoping for understanding and compassion, and the willingness and ability to find out what's wrong. I only hope that they find it.

It's hard to be the patient when you're used to being the physician. It's also hard to be a physician when you've never been a patient. William Hurt, in a 1991 movie called "The Doctor" illustrated just this. Having been an important, influential physician, he finds himself with cancer -- and realizes just how horrible of a physician (no matter how skilled) he (and some of his colleagues) could be.

People come to us in their worst conditions. They're not always in a good mood. They're not always understanding of our limitations as physicians (or students). They come to us seeking help and advice -- and of course, our expertise. Finding answers is what we're supposed to do. It's what our training is based in and what we've been working towards for our academic/professional careers.

But all of that training only provides a fraction of what our patients need from us. They need our compassion and understanding. This isn't taught in school. It comes from within, and unfortunately, it comes from experience.

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(Image source: hopeinhealingblog.wordpress.com)

For some of us, it's been sickness that has made us this way -- or abuse, or poverty, or just LIFE. For others, it's those things that are in the process of making them that way.

Be kind to each other this week, Everybody. Have a great one.

Food for Thought

Surely you've heard the phrase: "Eat to live, not live to eat." It seems that our relationship with food is extremely complicated. It turns out, it's not just our mindset right now, but also every attitude that we've had about food from our childhood that affects how, what and why we eat. Did you ever make cookies with your grandmother, or have a special birthday dinner? Was there some treat that you only had on special occasions? Did you go trick-or-treating for Halloween? Unless we've somehow managed to avoid all of those things, food has become a reward and measure of comfort in our lives.

Of course, there's nothing wrong with this. But we have to be aware of it. As we go through our lives running crazy, working ourselves ridiculous hours, studying, going from obligation to obligation, taking on way too much, it's really easy to seek consolation in our food.

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Of course, there's more to it than that. Eating these things ignites reward chemistry in our brains. Dopamine is produced leading to the sensation of pleasure. Serotonin, which most people recognize as the hormone affecting depression, is dramatically affected. In fact about 95% of the serotonin is produced in the gut. This not only regulates how much food we eat, but how we feel about how much food we eat. It has direct impact on our mood about food.

There are other, seemingly less interesting, hormones involved with food intake. Leptin, produced in adipose tissue, regulates food intake and fat storage. Deficits or defects in it lead to overeating. Another hormone, CCK, which is released from the small intestine while you eat, provides negative feedback about the quantity of food. Deficits in it (or damage to the small intestine) lead to overeating. Ghrelin, insulin, cortisol, and glucagon are also involved. *Whew!*

You see, we treat food as medicine, not just because of the hormones it induces, but because of the nutrients it provides. We can use food to medicate or nourish our bodies.

We need those nutrients to live. They provide the building blocks of everything that we are, the chemicals that sustain us, and the energy that keeps us going.

I've been doing some reading (in all my spare time) about the psychology of eating. It turns out there's a whole Institute for the Psychology of Eating. I've been exploring the ideas of why people eat; how much food we really need to live; and how we can nourish ourselves body/mind/spirit without overindulging. The topic itself is absolutely fascinating, and challenging in ways beyond all of the science.

It's food for thought.

Everybody have an amazing week!

For more information on the psychology of eating and hormonal control of eating, check out:

Summertime and the Living Is Easy

Well, that's what Billie Holiday thought. Here in good 'ol' Florida, it's HOT (and also very busy). This is the boys' last week of school; clinic is in full-swing; classes are well underway; and the schedule is getting crazy. I'm 3 weeks away from finals for the Master's program. Schedule changes are tough. I'm still getting used to being in clinic and splitting my time between classes and working.

How was your Memorial Day weekend? Mine was SUPER low key. After Acupuncture on Saturday, I spent time with friends in Tampa, and Sunday and Monday were focused on reading, research, and recovery (the new 3 R's). The Master's has me working on all kinds of stuff. I'm most fascinated, right now, with articles on lifestyle factors and inflammation. Dr. Seaman's classes really focused on some basics of inflammatory cytokines and the biochemistry of the food we eat and what it does to our body. Now I'm at a whole different level of learning with this, and it's REALLY cool. I'm discovering how the same set of cytokines, combined with other hormones use the foods we eat to make things even more complicated. How we think and feel about what's going on in our lives can lead to chronic inflammation, autoimmune disorders, and chronic disease. I'm so glad that I've chosen to study this for the rest of my life.

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Image Source: http://blogs.trb.com/news/opinion/chanlowe/blog/

Right now we have several classes on how we, as physicians, should interact with patients. Whether it's doctor-patient relationships, jurisprudence, or clinical natural medicine -- we're discussing everything from what we're responsible for ethically, to how patients (or potential employers) might perceive us. The latter topic has created a bit of a rift in my life. We were counseled to be careful how much of our personal life we allow the public to see -- specifically, our patients. Do we give patients our phone numbers? Do we friend them on Facebook? Do we give advice out in public? Do we share pictures of ourselves online? The idea behind it incites a lot of fear -- that we'll have stalkers, or share too much that can be used against us, or somehow lose patients because of things we do, say or show.

I don't like this at all. As alternative practitioners, I think we have a little bit more lee-way than others might. Some of us are into some unique areas of study. We are more touchy-feely, and that lends itself to a different type of interaction. They say that we're less likely to get sued because we tend to be more interactive with our patients. So, except for the stalkers, why would we want to withhold that information from those people in our lives every day? I guess it's something that we all have to think about. What do YOU think?

Have a great week everybody. As always, if you have any questions or comments, please feel free to contact me.

The Student Physician

Nearly two and a half years, countless exams, memorization of facts and figures, pathologies, prescription drugs, and maneuvers that scare you to death -- and you think you might actually know "something" (but not everything). And then the first patient walks through the door and you realize nothing you could've possibly done thus far could have prepared you for what you're about to experience. Welcome to being a student physician.

Throughout my various collegiate undertakings, I've felt ignorant. There was never much of a point to thinking I knew everything or even all that much because I was constantly reminded that whatever bits and pieces I've pulled together meant only a drop in the bucket toward what's out there. I hate feeling ignorant. Maybe that's why I'm constantly reading and researching -- because I know that I don't know anything.

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Ricky in Radiology Positioning class
(Special thanks to Dave Aiello and Ricky King for this picture.)

Dr. Harrison, our clinician, brought up an excellent point last week (he has LOTS of amazing pearls of wisdom). He said that the stuff that we learn the best is the stuff that we're faced with. If there's a condition that we, a family member or friend, or a patient has, we WANT to learn about it. And so we learn those things the best. But when something is sitting right in front of you, there's this overwhelming need to know it -- right now. Sometimes that learning curve can be pretty frustrating.

Questions get asked. Tell me about your family. How are you feeling? What's going on in your life right now? Can you describe this or that sensation? As the physician, you're supposed to know, not only what it is they're talking about, but also how to put all of it together to make sense of what is in front of you. It's a complex task. Then you have to take the person in front of you, and figure out how to make them better, take away the pain they're having, help them cope with what's going on in their life, and help them re-enter their space of wellness. And of course, you hope that they're working with you on this. This takes skills they don't teach in school. We can take all of the interviewing skills sessions, basic and clinical sciences, and psychology classes and still not be able to put all of these "issues" into the complex Being that sits in front of us. So, as I sit here wearing my white coat, I can honestly tell you that nothing I've done over the last two and a half years prepared me for my first patient. Not a thing. Not even remotely. Of all the things I've learned, even over my whole life, listening seems to be the most beneficial.

One of my biggest fears when starting clinic, besides being worried I wouldn't know what to do, is that I would be stuck with pure musculoskeletal cases. I know, this is chiropractic and musculoskeletal would theoretically be a big part of most chiro's practice, but I wanted the hard cases. And I'm getting them. From complex vascular issues to hormone imbalances, I've had to do research in the first week on topics that we didn't learn in any of our classes. Before any physical exams, before any orthopedic testing, just doing the history, I'm learning so much. I love learning this way. Get a topic, find out as much as you can, and then apply it.

Pick up a copy of Harrison's Internal Medicine, and also a copy of the Textbook of Natural Medicine, and Textbook of Functional Medicine. All three of these will serve you very well. Even though these three are great resources, there are some things that still require digging. I love a challenge. Good thing I'm in the right field.

Have a great week everybody!

Hey, Everybody! Welcome Back!

Two weeks of break isn't anywhere near long enough. It seems like just about the time that I get into a new groove of being out of school, things start up again. But, this time -- it's different. I'm an INTERN!

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My intern badge

Last week was the first week in Student Clinic. We went through procedures and charting info and a bunch of other things. I think it's going to be AMAZING! Dr. Harrison (our clinician) has taken the time to explain so many things to us already. It's a whole different world, now. I don't know what I thought it was going to be like, but it's different. And I think it's going to be great. I started out this week as a secondary, and I see my first patient on Wednesday.

Break was wonderful. I was able to take some time off, do some volunteering, and work on some projects. I feel "lighter" -- having been able to accomplish some things that I hadn't had time for thus far. That having been said, I'm still behind. That's not tremendously surprising. I'm making lists and slowly getting things done.

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Sunrise over Tampa Bay

The Master's has been ongoing. My classes right now are in Botanical Medicine and Immunology. I've learned so many fascinating things. Last week I got stuck in researching zonulin and tight junctions. I've been trying to pool together all of the locations that contain tight junctions in the body, so I might be able to link proteins and chemicals that disrupt the tight junctions with disorders that occur at those locations. I have to stop myself sometimes, from going too far down the rabbit hole with some of my research -- because I'll get so engrossed that I forget about everything else. Sometimes I have to stop myself at the point of too many questions. It turns out that some of the ones that I came up with last week (according to my professor) don't currently have answers. I guess I'm not the only one with questions.

I'm looking forward to the Tri mixer -- whenever that will be -- and Wednesday with my first patient. I'm secondary on patients before then, so that will be interesting as well. Mostly, I just want to say how excited I am to be here.

Welcome back, everyone! I'm glad you're here.