Hasta Luego, Nicaragua

I'm home. I know it, physically. I see my house, my car, and the backpack already waiting to go back to class. But, my mind is still in Nicaragua. This morning I subconsciously shook out my shoes before putting them on. You know, to check for scorpions, since we have so many here in Illinois. I tried to put my used toilet paper into a basket in the bathroom at Target yesterday, and stopped myself just in time. Go ahead and throw it right into the toilet, Juli. Welcome home.


The week I spent volunteering at the integrative medicine clinic in Nicaragua with Natural Doctors International (NDI) is sticking with me for much longer. Even though it was my third time going, pulling up to the rancho, strolling into the clinic, and meeting my "mami" for the week was just as exciting as ever. The village of Los Angeles on the island of Ometepe is a dry, dusty place at the end of April, as the hungry families yearn for the rains to start and signal the planting season.


The roughly 30,000 people strung around the base of the two volcanos that form the island aren't starving, though. There aren't clusters of orphaned children with protruding bellies scavenging garbage piles with flies landing in their eyes. Even though Nicaragua is the second poorest country in the Western Hemisphere -- after Haiti -- life on the island is not what you might expect. The children are mostly dressed, everyone has at least rice to make in the outdoor kitchens, and villagers are seemingly low-key for the most part, smiling, saying "Buenos Dias" as you walk down the dirt roads punctuated only by horse poop and the never-ending small fires.


Again, I'm awed by the graciousness of the people, who walk, ride, hitch, or bike to NDI's free natural medicine clinic, and then wait patiently and happily in the colorful plastic chairs out back for hours. We learned that many of them give us a run-down of five or ten general health complaints simply hoping to get a refill on multivitamins, omegas, or probiotics, which they treat like gold when we dump them into a plastic baggie for them. We delighted some children with a new toothbrush to hold while Daddy hopped up onto the table for some pain-relieving acupuncture.


We volunteers smiled as baby horses and cows causally strolled around the village. After a few days we stopped asking, "Whose horse is that?" when we realized that the animals knew where they lived and ended up back at more or less the right house at the end of the day. We struggled -- some of us more than others - to communicate with our host families in Spanish about everything from food preferences to how to refill the bucket for a shower. We even celebrated a fellow volunteer's birthday with a birthday cake and a huge bottle of Coke; the power only went out on us once.


Times were good. Patients were appreciative. Volunteers were learning. We reminded ourselves how unique NDI's clinic really is -- not just for Nicaragua -- but for anywhere in the world. Mainstream western medicine is starting to shift, yes, but it's not yet common in the U.S. to walk into a free clinic, have a consult with a naturopathic doctor and receive supplements and a take-home parasite-in-my-poo test kit, have a consult with an acupuncturist and get needled under the mango trees, and enjoy a lavender oil massage after a grievous counseling session with the in-house psychologist. I've said it before and I'll say it again: Sign. Me. Up. For. That. I even found the beach in our village this year, after three years!


By day we performed the abovementioned magic out of the 3-room open-air clinic. By night we grappled with the tough questions during our evening classes on global health history and policy. Why aren't we helping out in our own country? Why couldn't we carry in all of the donations that we raised? Why are naturopathic doctors not recognized in most states in the U.S.? Did they break ground for the new canal? Why is smoke coming out of the volcano that our village is ON!


Nothing is answered definitively; earthquakes rolled on days after I left the island. I returned home to the pile of donations that we couldn't get into Nicaragua. I still can't get my insurance to cover a naturopathic doctor visit in Chicago. We didn't cure every patient; the rancho still needs to be re-thatched before the rains come; and the clinic ran out of children's multivitamins before we even got on the ferry to head home. And it's OK. We are fulfilled. Our work was done and cannot be undone. And guess what? Hasta Luego doesn't mean "good-bye." It means "until next time." Yep, I'll be back.

Peanut Butter and Me

2015-04-16_1Yep, it's called "peanut butter and me," not "peanut butter and I," because it's about to be used as the object of the sentence -- not the subject of the sentence. Grammar geeks unite! The premise here today is that a line has to be drawn in the sand between peanut butter and me. If we keep our breakfast meeting love affair going much longer, an accumulation of pathogenic phlegm is bound to ruin my life.

Don't go throwing out your peanut butter just yet. It might be fine for you to gobble down a Tablespoon of that rich creamy goodness every hour on the hour. Not for me, though. It's not good for me. One of my favorite parts of Traditional Chinese Medicine is the individualization for each person. It makes me feel special. Even though I'm really put off by the idea that I should not be eating my life-long companion, peanut butter, I still appreciate that the recommendation is personalized for my exact condition of body-mind-spirit.

2015-04-16_2I thought I was good to go. A couple of years ago I honed in on what I thought were the most important concerns encircling peanut butter and me. I knew I wanted to avoid pesticides, so I found an organic peanut butter. In my continued pursuit to ditch all things plastic and sub in glass containers, I found an organic peanut butter in a glass jar. Just peanuts and sea salt. Mmmmm, salt. Bonus points for how reasonably priced it was and how the USDA organic seal means the peanuts were not of the genetically modified variety. Grand.

Then I went on with my life, pleased with my research and findings. I smeared my glorious peanut butter on my hearty slice of organic sprouted grains bread every morning. Starting my day off right, oh yah! Sometimes I'd add a few slices of bananas and really pat myself on the back -- three food groups represented, once you count the liberal pour of cream into my coffee. I should have been feeling awesome...but I wasn't.


What was happening? I was getting damper and phlegmier by the day. It couldn't be my precious breakfast turning on me... could it? I whip out my trusty TCM-friendly food resource, Healing Whole Foods: Asian Traditions and Modern Nutrition, which I highly recommend, and I flip to the peanut butter section. It wasn't fantastic. Tears may have been shed. Here's a summary:

2015-04-16_4Peanuts are warming and sweet, affecting the Lung and Spleen systems in TCM; peanuts lubricate the intestines and harmonize the Stomach. OK, fine so far. Peanuts can increase the milk supply of nursing mothers, clear blood from the urine, treat deafness, and lower blood pressure. Great, but not applicable; moving on. Then the book takes a turn for the worst. Peanuts "greatly slow the metabolism of the Liver. Therefore they should be avoided by overweight, damp, sluggish, yeast-infected, or cancerous persons."

SCREEEEEEEECH, went my brain. I definitely have the damp, sometimes feel sluggish, and of course lose sleep at night wondering if I have every cancer under the sun. Maybe I shouldn't eat the peanut butter? What about moderation? I'm usually on board with everything in moderation. Even the book says peanuts can be helpful sometimes, for some people. "Peanuts can benefit the person with fast metabolism such as the thin, nervous person who digests large amounts of food rapidly." Well, crap. That's not the loophole I was hoping to see.

I scan the book quickly, going through the introduction in the chapter, "Nuts and Seeds," hoping to see any type of justification for me continuing to scarf peanut butter every morning. What's the general guideline they give before branching out to discuss each specific nut? "Nuts all follow a pattern of being rich in fat and protein and therefore should be used ... to tonify thedeficientperson; avoid them in cases ofexcess and dampness." Game over. I, like most overfed, over-stressed, and under-exercised Americans, am a ball of excess patterns. Stasis, stagnation, damp-heat, phlegm. Check, check, check, check!


The only passage I liked in the entire section on peanuts was the justification for eating organic peanut butter. The author notes "Peanuts are often heavily sprayed with chemicals and grown on land saturated with synthetic fertilizers. In addition, they are subject to the carcinogenic fungus aflatoxin. Organic peanuts should therefore be used -- they contain fewer chemical residues, and are less subject to aflatoxin."

Suggestions abound in this section. Nuts are serious. It states to only buy nuts in the shell, because nuts lose their nutrients after being hulled or shelled. Yikes, who's doing that? "Store hulled seeds in dark bottles in cold places... Do not store in plastic. Oil-rich food combines with plastic to form plasticides." Eww. "Toxins tend to accumulate in all seeds, so it is important to buy organic non-sprayed ones." Got it.


What's the conclusion today? Is it a.) Never eat seeds, nuts, or nut butters ever again? No, thankfully, I'm not saying that -- to you or to myself. The better answer is b.) Take your condition into account and eat smaller, less frequent amounts of organic, non-GMO options. Balance it out with other foods that drain damp and transform phlegm. Hint: it's not a banana, unfortunately. Wamp, wamp.

What Would You Bring to Nicaragua

A brave group of volunteers and I will depart for the Natural Doctors International clinic in Nicaragua on April 25th. What will we bring? Sometimes there's no running water, sometimes there's no electricity, and often there's no break from the heat. There's no garbage pick-up, there's a shortage of biohazard and sharps containers, and disposable gloves just seem wasteful.


What we choose to bring onto the island of Ometepe in the middle of Lake Nicaragua should be intentional. New volunteers are asking how many alcohol wipes to bring, how many needles to pack, and what size gloves will work best. My brain is processing it as: "Where will we pile up those dirty wipes? How many plastic guide tubes will we accumulate after a week of acupuncture treatments? And how we can't burn the gloves." Also I'm thinking how hot it is to wear exam gloves in oppressive heat. Eww.


I'm not trying to sound like an activist or a tree-hugger, or whatever do-gooders are called these days. I'm just being a realist, and isn't that technically the opposite of idealism anyway? So lay off me. I'm simply trying to figure out what we should carry on our backs into Nicaragua, what we should drag onto the ferryboat, and what we should unload into the 3-room clinic.


There was a guy in college who always said, "Let's be serious." Well, let's be. How do I incite passion in new volunteers, make conscious choices about tipping the precarious balance in the island community, and make sure everyone comes out happy and fulfilled at the end of the 10-day program? My first year, I carefully read the volunteer packet and I remember the line about not giving your host family too large a gift. While it might seem genuine and generous to slip $200 under the pillow on the last day, it's also not well thought out. Will other host families find out? Will they feel jealous, sad, or not as good as your host family? What if it causes not only animosity between the families, but also a robbery?


While I might have felt somewhat cheap leaving a card, a $20 bill, and two bars of laundry soap for my host family last year, it was probably the right thing to do. The card said thank you for watching out for us, for cooking delicious meals for our VERY PICKY group, and for staying up well past the normal island bedtime of 8pm to wait for us to walk back from the evening meetings at the clinic. The laundry soap was to replace the ridiculous amount that I sailed through while fumbling with my sweat-soaked scrubs on your concrete washboards out back every afternoon. Let's be serious. I totally sucked at washing my clothes. I probably used as much soap on my scrubs, underwear and socks from that day as the family would for a week's worth of dirties. Plus I always left them out hanging too late at night and the red ants were all over them. The $20 was for how bad I felt when I realized that we had been walking across town every day at lunchtime to buy a Coke in a glass bottle from a competitor's store before I was finally clued in that you had your own store on the other side of the house. Way to be observant, Juli.


Even in a small, raw environment like the community of Los Angeles on Ometepe Island, things are not always easy to see. It took us two days to find out that the house mom wasn't there to welcome us when we arrived, because her own young teenage son had been in a motorcycle accident the day before. She was staying with him at the children's hospital on the mainland, and yet had arranged for her family to be present and hospitable for us when we showed up on her doorstep. All smiles. No hint of worry that would make us uncomfortable or homesick. When grandma laid that fried chicken on the table, everything was perfect.


So, we're heading back in two weeks. We're carrying down all of the medical donations we've gathered all year. We're flooding that humble, perfect, integrative clinic with acupuncture needles, essential oils, multivitamins, and anything else the naturopathic doctors, herbalists, psychologists, acupuncturists, chiropractors, massage therapists, and everyone else who passes through its open-air doors can use. I'll probably bring organic dark chocolate bars for the previous doctor who craves it. I'll pack crunchy organic peanut butter for the current doctor and his family. I'll try to bring as much coconut oil as I can, because as I last heard, "The coconut oil guy went to jail."


I'll maximize the space in my backpack, because we can't really ship anything to Nicaragua from the U.S. and expect it to arrive this year or intact. I'll try to remember what it was like to be there, treating patients in the backyard under the green mangos, with the end of the dry season winds providing more perfect relief than any air conditioner ever has. I didn't want more latex gloves and disposable wipes. I wanted a dry piece of cloth to wipe my forehead. I wanted a larger water bottle in case we couldn't refill anywhere until the town's water pipe was cut back on for the afternoon. I wanted more stickers and little toothbrushes to hand out to the smiling kids who've been happily waiting out back in line for hours.


We're going back to Nicaragua, and not a moment too soon. I can't wait to see how the kids we treated last year are doing now. Did we catch their parasites in time, or did they lose too much weight? Did the berberine work better than the lady's metformin? I'm definitely going to stick a giant needle into some farm worker's ST38 and see if it takes his shoulder pain away on the spot. I can't wait to find out for real how the canal project is impacting the island. I want to see if any airplanes have actually landed on the new airstrip between the volcanos. I won't climb Concepcion or Maderas (for the third year in a row), but I'll listen with excitement as my husband tells me how many times he twisted his ankle on slippery tree roots and how beautiful the view is from the top. I'll take your word for it, again.


For all the giving reasons, I'm going back to Nicaragua. But don't think it's selfless. I'm going for me. I'm going back to volunteer for a few days, sure, and I love every minute of that clinic work. But I'm also going back because Nicaragua can press my reset button like no other place I've found on earth. My family is free there. We aren't tied to time, we barely know what day it is, electronics are at a total minimum, and we're together. We're full of sunshine, water, fresh fruits and vegetables, and our lungs are full of air, because we walk everywhere. We're healthy there, even if I sometimes come home with Dengue Fever... Worth it!

Giving a Brazilian at Stroger

"Give her a Brazilian in Room 1!" This is the new catchphrase around Stroger. That's right, we're giving Brazilians at the pain clinic in Cook County Hospital. I occasionally worry that a passing doctor thinks I'm waxing ladies in the treatment room, but the concern quickly fades as I get down to business. This Brazilian is all in the ears, and the only intimate part is the bleeding. I always think bleeding is sort of a personal interaction.


According to a successful acupuncturist in Brazil, the best treatment for relieving joint pain with heat signs is to tonify the energy of the major internal organs, direct it towards the affected joints, and then bleed it out of the body. How do we do this exactly? Here's a sample case: inflammatory knee pain, let's say on the left knee. It's painful, the area is red, swollen, and warm to the touch. The patient often reports feeling warm, the pulse is slightly rapid, and the tongue is often red.


The Brazilian technique is essentially a three-step process. First, we needle the following points on the ear of the non-affected side: Shen Men, Sympathetic, Liver, Kidney, Heart, and Lung. Six needles so far, if you're counting. Then, we needle the corresponding painful body parts on the ear of the affected side of the body: Knee. OK, we're up to 7 needles so far. Totally doable. Now we let those needles rest for a while while we enter the SOAP note in the lovely electronic medical records system at Stroger.


After about 10 or 15 minutes, we take those needles all out. Next step, we get intimate. It's time to bleed the Ear Apex on the affected side. I like to give it a few hard squeezes to ensure I'm stealing as much hot blood out of this person's body as possible. Don't worry -- it's usually just a drop or two.


What happens next? Well, it varies. Often times, though, it goes like this. The patient stands up, wiggles around to "test" for any perceptible changes in pain level and range of motion, and starts to smile. "I feel better!" Pain levels are dropping from 10/10's to 4/10's in that 15-minute treatment time. Is it unorthodox? Somewhat. Is it effective? Seems to be. Will we keep giving Brazilians at Stroger? You bet.

Why You Should Never, Ever Shame a Kid for Peeing the Bed

This is going to be one of those "stories with a lesson" posts. The story is about people freezing to death in Antarctica, and the lesson is about the power of the Kidney in Traditional Chinese Medicine. Here goes.


Last night as I put my four-year-old son to bed, he pointed up to one the maps hanging in his room (we're big map people at my house) and said, "What's that big one at the bottom called again?" "Antarctica," I answered. "It's really cold there, and people really don't go to that continent." His eyes grew wide and as he tried to gauge my seriousness. "Ever?" he asked? "Well," I said, trying to tuck him in and get on with the bedtime process, "a group of men did go there to explore, but they all died."

As soon as the words left my lips, the following stream of thoughts flew through my head: Why would I tell my four-year-old a scary story as he's drifting off to sleep? OMG, he's totally going to have nightmares about explorers dying on an icy island now. He's going to be so scared that he'll pee the bed. No, he never pees the bed. He's been potty trained for almost two full years and he's almost never had an accident since. He'll be fine. It'll be fine. OMG what if he has nightmares and pees the bed?


"How'd they die?" He interrupts my runaway train of thought with a valid question. "Um, well, they froze to death after they reached the South Pole." "THEY ALL FROZE TO DEATH?" He was clearly perturbed by this, and there again went my self-chastising mental barrage of silent promises never to start a scary historical account with a child at bedtime. "Yes, but that was a long time ago and now people know what to pack and wear when they go exploring there so that they can make it back out. We're never going to go there, and you will never be that cold, OK buddy?" He honestly didn't seem worried, so I changed the subject, chatted it up about wondering what the new child of the week was going to bring for snack at school tomorrow.

I went to bed truly thinking he wasn't too scared and would probably get through the night fine. He's not prone to nightmares, he never wakes up during the night, and everything will be fine. OK. In the middle of the night, I hear the thing every parent dreads, "Mommy... I peed the bed." Now, pay attention. Here's where the real lesson of the day starts. "It's OK, buddy, I'm coming," I said in a totally calm and nice voice. I walk into his room, and he's standing on his bed, already taking off his jammies. I did the distinguishing but true parent move next, which is where you cautiously run your hand over the sheet to see how bad the damage was. "It was just a little," he said. True story. So I sent him into the bathroom to pee out the rest of what he still had in the bladder, while I did the presto chango with his bedding.

Five minutes later, we're both back in bed, calm, and headed off to dream land. I start mentally processing what just happened. I told a story about a group of explorers freezing to death in a faraway land to a kid who never pees the bed, and that kid peed the bed. Just a few drops, mind you, but he peed the bed. What happened? I scared the pee out of him. In mainstream western society, there's one way of looking at peeing the bed. In TCM, there's a different way of looking at things.


I'm going to lay some heavy TCM theory on you, but just for a minute. The Kidney controls the Urinary Bladder, and the Kidney is most impacted by the emotions of Fear and Fright. When an adult is truly and thoroughly scared (Think: getting held up by gunpoint in an alley), it's not unheard of for said adult to pee his pants, right? Well, when a kid is afraid, he's much more likely to pee the bed at night. There's more to the theory, of course, because TCM is always simple but complex, complex but simple; however, you get the basic mechanism.

2015-03-25_coversMy son was briefly scared by a torturous historically accurate bedtime story; he peed. He's a healthy, well-adjusted kid, and I'm almost positive that he'll be fully recovered from this mini-trauma and we won't be in the same urine boat tonight. On the other hand, kids who live in fear often pee the bed on and off for years. This makes complete sense in TCM, although it leaves many westerners in the dark. In fact, many people tend to make this situation much worse by shaming the child, yelling and insulting him when it happens.

"What are you, a baby?" "What would your friends think if I told them you peed the bed?" Etc., etc., etc. This happens. My heart is pulled back to a story in the Peoria newspaper a couple of years back, covering a boy about eight years old who died of dehydration because his parents wouldn't let him drink anything for over three days, to try to prevent him from peeing the bed anymore. Any doubt in your mind that he lived in fear almost constantly, from that situation and likely many other abuses going on?

In case it's not clear yet, the lesson today is to never, ever shame a kid for peeing the bed. If that kid is afraid that you'll be disappointed, angry, irritated, or ashamed of him for peeing the bed, then he's stuck in the unfortunate cycle of fear perpetuating the problem. I know it sucks to get out of your warm bed at 3 a.m. to change sheets and pajamas and wipe down a peed-up kid, but please just do it with a smile on your face. Give the kid a cuddle, and tell them it's OK and that everyone has an accident from time to time. Trust me, you're doing you both a favor.