Cannabinoid Hyperemesis

Cannabinoid hyperemesis is a condition becoming increasingly more common due to the more acceptable widespread use of marijuana. I learned about it this weekend at the Illinois Homeopathic Medical Association meeting.

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Currently, medical marijuana is legal in 28 states plus Washington, D.C., and recreational marijuana is legal in 8 states. Marijuana can be a valuable medicinal substance for many people suffering from various conditions. With that being said, as with any medication or botanical, adverse effects are possible, such as cannabinoid hyperemesis. 

Cannabinoid hyperemesis is a cyclic vomiting syndrome and extreme abdominal pain associated with chronic cannabis use. A peculiar finding in patients with this syndrome is that the only thing that provides them with relief during vomiting is taking scalding hot showers. Discontinuing marijuana is the only way to eliminate this condition. The initial withdrawal period is particularly challenging for patients because the hyperemesis becomes worse before getting better.

As a future health care provider, regardless of whether or not I'll ever be in the position to prescribe marijuana, it's important to know about cannabinoid hyperemesis because chances are I'll have some patients who use marijuana regularly, and some may present to me with this condition or develop it over time.

Naturopathic medicine could help with this condition by supporting the patient through the detox phase of getting off marijuana, and by finding alternative options such as other botanicals, homeopathy, or hydrotherapy to help reduce the symptoms for which they started using marijuana.

Blood Chemistry

Over the weekend, I attended a seminar called "Mastering Functional Blood Chemistry." We looked at several blood tests like CBC, CMP, thyroid panel, lipid panel, and more. The curriculum at NUHS has a class called Clinical Laboratory Diagnosis that teaches students how to read and understand lab reports. It provided an excellent foundation for me to build upon at the seminar. The blood can tell you a lot of information, especially when coupled with a complete physical exam and knowing the patient's chief complaint.  

BloodDid you ever wonder how labs determine the reference ranges ("normal values")? Labs take average values from some patients, probably a few hundred, and determine where the majority fell. Based on algorithms and statistics the lab comes out with reference ranges. Therefore, every lab has slightly different reference ranges. 

One problem with this is that the people used to determine the reference ranges probably aren't all optimally healthy, meaning the reference range values aren't necessarily indicative of health. At the seminar, we were given a list of functional lab values where optimal health is reflected. Functional lab values usually have a narrower range that falls within the reference ranges. This allows us to track more closely if a patient is trending toward developing problems before a reference range would flag it as being abnormal. Proactively making lifestyle changes can improve lab values before a medical condition sets in (and even after a medical condition is diagnosed!).

Naturopaths Can Do Pap Smears?

Two evenings in the past two weeks I've learned how to do male and female genital exams. When I told my sister about it, her response was, "Naturopaths can do pap smears?"

Yes! Naturopathic physicians are primary care providers, so we learn how to do genital exams, including checking the prostate for men, and doing pelvic exams and pap smears for women. Naturopathic physicians can legally, in some licensed states, offer these services to their patients. 

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Up until this point, we have been practicing and learning all the standard physical exams on classmates. One of my concerns for several trimesters was if practicing these genital exams would be the same way. Rest assured, students are NOT on the receiving end of this procedure. What a relief! The university hires highly trained individuals who work with all the medical schools in the Chicago area. They aren't healthcare professionals, but they receive yearly education on how to instruct us in proper positioning, technique, and language to put patients (and ourselves) at ease. 

Using non-invasive terminology was heavily stressed. For example, instead of saying palpate, feel, or touch, it's important to use terms that can't be misconstrued, such as inspect, check, and examine (ICE is the acronym.) Also, when reporting the exam findings, instead of saying "everything looks great", we were instructed to say everything looks healthy and normal. 

I feel more confident and comfortable with these procedures now that I've practiced them. Since all the medical schools in the area receive training from the same group of individuals, I know we are on par with conventional medical students.

Psychopathology

Depression, mania, cyclothymia, anxiety, oh my! I'm preparing for my Psychopathology midterm, and there is so much to learn.

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Why do chiropractic and naturopathic medical students need to learn about all these conditions? More likely than not, we will be treating patients with mental health conditions whether we plan to or not. The whole body is connected, including the psyche! Even though many naturopathic doctors don't prescribe pharmaceuticals (whether it be due to lack of licensure and prescribing rights, or personal choice) having general knowledge to be able to identify these conditions and provide natural solutions and appropriate referrals for counseling and is important. Also, many chronically ill individuals are taking or have been taking medications to treat these conditions, and they will come to us to address other aspects of their health.

How does naturopathic medicine approach the management of these conditions? For every single patient, regardless of their chief complaint, we address the determinants of health. It is essential to correct imbalances in the determinants of health to attain health. Some of the determinants of health include nutrition, hydration, sunlight, epigenetics, sense of community, and spirituality.

For example, depression is a condition that conventional medicine commonly treats with selective serotonin reuptake inhibitors (SSRIs). SSRIs will increase the amount of serotonin available for the brain. In naturopathic medicine, we ask another question. Why does this patient not have enough serotonin? It turns out that the gut produces the majority of serotonin (about 90%). If a patient has a poor diet, imbalances in gut flora, digestion issues, etc., an insufficient amount of serotonin is produced, leading to the symptoms of depression. We would then treat the digestive tract with dietary changes and perhaps supplements to get the body on the right track.

Wonderful Weather

I'm calling this record-breaking "high 60s/low 70s, 3-day weekend" my unofficial Mid-Tri Spring Break! Luis and I took advantage of the unseasonably warm temperatures and went to the Morton Arboretum on Sunday and Monday, located about 15 minutes from campus.

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The Morton Arboretum is one of my favorite places to get away and immerse myself in nature. Growing up in a smaller town, I was always playing outside away from concrete and traffic, and coming to Chicagoland was an adjustment in that sense.

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The Morton Arboretum is a non-profit organization that was founded in 1922. Its mission is "to collect and study trees, shrubs and other plants from around the world, to display them across naturally beautiful landscapes for people to study and enjoy, and to learn how to grow them in ways that enhance our environment."

It has 17,000 acres of land with 16 miles of hiking trails. Having an annual membership is worth it to be able to go year-round because daily admission and parking is quite pricey.

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It was a busy day there -- everyone else had the same idea with the warm weather. We saw people of all ages and backgrounds, some in shorts and tank tops, and others still bundled up. The stark contrast between winter and spring was evident, as one of the ponds still had a layer of ice on the shady side, with geese swimming on the sunny thawed side.

As my 3-day weekend is coming to an end, I have exams to study for and projects to complete. My never-ending to-do list was neglected, but sometimes it's necessary to put those things aside for some vitamin R (rest/relaxation/rejuvenation). Now, back to the books!