Of Course, a Thanksgiving Post

Have you ever spent a holiday away from your family? My first Christmas without family involved working from 7-4 and coming home to a house full of stinky boys, recently back from skiing, cooking a bacon-wrapped turkey and imbibing generously of Pabst and homebrew. I cringed and thought, "This is NOT what Christmas is supposed to be like..." and then I grabbed a cheap beer and made the best of it.

In reflecting on holidays past without my close family around, I've got to say that this Thanksgiving was one of the best of all of those over the years. I may not have been home, I may have been without my cousins and aunties and uncles, not cooking alongside my parents and setting the table with my brother this year, but I most definitely was with family of a different kind.

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Only missing a few, my ND family on Thanksgiving (Photo by JheriAnne)

If you read my blog with any regularity you know about the remarkable group of fellow ND student friends that I hold so dear. These friends are my family here in Illinois, heck, they'll be my family even when I'm long gone from here! JheriAnne and her husband Shane hosted one of the most relaxing, calm, warm and wonderful Thanksgiving dinners I think I've ever enjoyed. Twelve of us gathered with our dinner contributions and dug into JheriAnne's first turkey (oh yum!). Afterwards, we lounged around watching football, trading stories, laughing, playing cards, and pouring each other another glass of wine.

I've been through a lot with these friends over the past two years of medical school in a way that's brought me closer to them than almost any other friends I've ever made. For one, we're all a little counter-culture; people who study naturopathic medicine generally march to a different drum, and we tend to live and/or think outside the box. It's remarkable how people with such different personalities and backgrounds can have a common pulse that beats naturopathy through our veins,*and as a result, allows us to find comfort in each other despite any number of differences.

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Future NDs and great friends Anayibe & Mia on Thanksgiving (Photo by JheriAnne)

In addition, we've all grown close in friendship at the same time as our brains have matured and we've grappled with new ideas, our minds stretching to accommodate buckets of new information. As I see it, we were poised for great assimilation of material and so stored the information about each of these friends at the same rate and intensity as we memorized every detail of glycolysis and human anatomy. Let me be entirely cliché, and also so extremely full of heart, when I say that I am so, so, so thankful for the friends I've made in the naturopathic program here at NUHS. I hope you all had a very happy Thanksgiving, too, and a wonderful holiday ahead.

* It sort of pains me to write that something pulses through our veins and neglect to mention our arteries, but for the sake of literary flair I have pushed aside my anatomy and physiology and left it be.

Milestones

The first A, the first D, the first B when you thought it was going to be an F. There are many milestones that all of us at NUHS experience. They are the turning points that stick in our minds and mostly serve to boost us when we occasion to remember them.

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In the beginning -- my tri 1 lab group

There's the bittersweet end of pathology with Dr. Khan, and the viscera final aka your last anatomy practical ever! The first practical in the TAC shaking in your dress shoes and sweating through both your nice shirt AND your doctor coat. Grading yourself on that first practice spine and extremities practical and realizing you failed only to pass it when it comes to the real deal a week later. The first time you watch Dr. Lou take her shoes and socks off and not miss a beat in delivering her lecture.

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My group & me after our last ever anatomy practical (photo from Teegan)

The first time you've ever thought of J.Lo and a plumber in the same context, and the first time your head jerks up because Dr. McRae just SHOUTED in lecture. The moment when you realize that the 3-compartment model actually kind of makes sense (maybe). There's the first splash or smear of cadaver fat on your lab coat, and the first time you realize you're actually super hungry in the middle of dissection lab. Experiencing your first adjustment and then the first time you get a cavitation when giving someone else an adjustment, yes! The first exam during which you notice your palms are not sweaty and you're actually breathing just fine. The first time you forget to return the markers to the library desk and you have to pay a silly amount in fines (and decide to buy your own markers.)

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My nametag milestone

There's the last time you have Dr. Ed for class, and the last time you sit through one of Dr. Humphreys' neuro-heavy lectures. The moment you realize that Dr. Richardson's stories just keep getting better, so you vow to pay attention and you learn tons of pharmacology in the process. And then you realize that Dr. Ed had Dr. Christiansen as a professor, too. The day you receive your official intern nametag to be worn at all times in the clinic. The first time you tie a tourniquet and choose a vein in phlebotomy lab, and the first time you see the red flash. The first draw you mess up that either makes blood squirt, your patient cry out, or leaves behind a little hematoma (whoops!)

And then there are the things I haven't experienced yet but that I anticipate -- the first patient in clinic, the last patient in clinic. The first colonics patient, the first real live constitutional hydrotherapy you administer in clinic. And before you get to the clinic, there's the first real live gyn exam and digital rectal exam on a sym patient. Then, there's the first actual real patient presenting for a gyn exam, or the patient who refuses to receive a treatment you really think would help. The first time a patient cries in the exam room. There will be the patient who must be told the less-than-favorable results of a blood test; the patient that keeps you up at night wondering if you said the wrong thing, or the right thing. There will be the patient who isn't responding to treatment, and the patient who comes in singing your praises.

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Officially registered for boards

And then there is this week's milestone; registering for the NPLEX Part 1 Biomedical Science Examination. I've long been thinking about February's exam, but registering today made it REAL. Honestly, it's almost too bad I couldn't have registered several months ago, as it would've brought that realness to life at the time when I should have started taking my preparation more seriously. Oh, and there's another recent milestone; watching that first video in the board review series and having your eyebrows permanently raised in anguish as you painstakingly extract basic biochemistry from the recesses of your brain. You must take several deep breaths to calm those nerves you thought you were done with after that exam when you noticed your palms weren't sweaty and your breathing was even.

I have A LOT of information to retrieve from the depths and bring back to the forefront of my memory by the first week in February. I'm totally anxious about it, and every time I sit down to study, I have to fight the urge to ditch it and do something else that doesn't make me feel quite so bad about myself. Lately, I've been reflecting on how far I've come in order to remember that all the basic science information is there; I DO own it. Writing this post has helped me continue that affirmation process, and I hope it's maybe done the same for you in some way... or maybe it made you smile or laugh, or perhaps it made you curious about what lies in store.

A Student's Role in ND Licensure

I was a little too busy writing about hydrotherapy last week to comment on the election we just had. I hope that those of you who can vote, did so! I heard that only 1/3 of eligible Americans voted. I understand that political showmanship isn't cool and that the attack ads we hear and see are sickening, but I'm still not quite convinced that the proper response to this political climate is to abstain from voting.

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I am not politically inclined, I haven't studied the subject, and I don't know enough about the people I vote for. I do listen to public radio news a lot, and I read news headlines, but I do not own a TV, so my information-gathering tactics may differ from most. I find it strange that 2/3 of the people from a country that fights fiercely to initiate democracy in other places around the world, would not show up to the polls. I am especially puzzled because these mid-term elections for local government seem to be the truer way to impact our greater (seemingly untouchable) national government. OK, that's all I'll get into on this last election, but I mention it because it's relevant to our naturopathic profession to be somewhat politically active and versed in how local government works.

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Map from http://www.naturopathic.org (click to see larger version)

It's no secret that naturopathic medicine is not licensed in Illinois, or in the majority of the United States. Currently, 17 states, Washington D.C., Puerto Rico and the U.S. Virgin Islands license or regulate naturopathic medicine. Our under-the-radar practice of healing impacts our education because we have to tread lightly when advertising our work at the NUHS clinic. Yes, we are trained to diagnose and treat disease, but we are not allowed to officially exercise this training as naturopaths here in Illinois. Our training encompasses many things that we are not yet licensed to do in many states, but we learn these things so that we are prepared to safely and effectively treat patients when the time comes that our scope of practice does include these skills. I have confidence (as do many others) that this time will come; our national state of health is ripe for our medicine.

As far as I understand, clinicians who oversee our ND clinic here at NUHS are also licensed chiropractors, and we practice under their license while we work to gain licensure here in Illinois. For those of you looking to attend NUHS to study naturopathic medicine, please do not let licensure get in the way of your decision-making. I personally chose NUHS because of the realistic environment it would provide for practicing my medicine. I do not know where I will land and I want to feel prepared to offer my services to my community, no matter the political state of naturopathic medicine in that place.

If you're curious about the process and progress toward licensure in Illinois, I encourage you to explore the Illinois Association of Naturopathic Physicians website. Also, contact your local legislator and share with them your passion that naturopathic medicine be a licensed profession. Legislators care about what their constituents care about. They want to hear from the people they represent. Your senator wants to represent your opinion and address your concerns more so than they want to hear from a group of naturopathic doctors about how much our medicine is needed by you, the people they represent.

If you are a student at NUHS, you should be a student member of ILANP. The cost is minimal and makes a big impact. When the ILANP lobbies for licensure, greater numbers help their cause, and their work in lobbying for licensure directly affects us as students. If you plan to return to another state after graduation, I highly suggest you join that state's naturopathic association, too. And, of course we should all join and support our American Association of Naturopathic Physicians. Again, greater numbers show involvement and promise when these associations work for our future practices and safe access to our medicine for our future patients. Plus, there are perks with every membership! (I get a free access to diverse naturopathic resources through my AANP membership, and I received a welcome discount to the ILANP conference this year!

I may not fancy supporting the current caustic political environment, but as an ND student, I understand that local politics are wholly relevant to my future. If I don't keep informed, I run the risk of envisioning for myself an unrealistic future. "OK, OK, now," some of you are saying, "but what IS reality, really? Isn't it what WE make it to be?" I'm not getting philosophical here. I'm being present and encouraging my peers to do the same. Let's show our support for our profession and those who are working (some unpaid!) to elevate our medicine and make it known, safely accessible, and properly understood.

What Is Hydrotherapy Part 2: How and Why

A few weeks ago I introduced the topic of hydrotherapy in this post. To learn about the basics and some of the history on modern naturopathic constitutional hydrotherapy, please refer to my last post. Once you're caught up, let's continue! How and why do naturopathic doctors use water as a therapy?

Water is known as the universal solvent, and it stores and transmits heat better than any other substance, by weight. The physiological effects of water on the body fall into three categories: thermal, mechanical and chemical. Thermal application involves changing the temperature of the body based on using water that is either hotter or colder than our normal body temperature. The mechanical effect of water on the body involves physical impact on the body in the form of frictions, immersions, whirlpools, showers, sprays, etc. Water's chemical effect on the body involves ingesting water and receiving water internally by irrigation (such as colonics.) The category we use most frequently in naturopathic practice to elicit physiological change is the thermal application of water.

The temperature ranges used in hydrotherapy are in relation to the body temperature of the patient (healthy body temp is around 98.6º F). When we use cold applications (32-65º F depending on intensity of treatment and/or patient tolerance), we are depressing function via vasoconstriction (narrowing of blood vessels), which slows blood flow. Decreased blood flow means that fewer immune cells are activated in local tissues and metabolic activity decreases, leading to a decrease in sensation (cold nerves do not transmit signals as readily) and a slower motor response of muscles due to slight contraction (tightening.) In this way, we can control inflammation, a technique that is used to treat pain as well as ligament sprains and muscle strains. These are injuries that cause the body to react with excess inflammation.

It is important to note that our body creates inflammation for a reason; increasing blood to an injured area brings more immune cells and repair ingredients to the area. We always want some degree of inflammation present if we want the body to heal, but our body can respond in excess and we may want to control it for our comfort and to elicit the smoothest healing process.

If we apply cold therapies in a general fashion (such as a cold sheet wrap or soak), we cause blood to move to the core as the whole body cools. We rarely use such applications, but might apply this in treating an exceedingly high fever to bring down the body temperature.

If we apply cold for a short amount of time, we can elicit a "reaction" effect, which causes a reflexive increase in blood flow and heat production in the area when the cold is removed. This makes the patient to feel greater "vigor and well-being." We use this application of cold more often in practice.

Alternately, hot water applications elicit responses from the body as it tries to clear the heat. This includes vasodilation (opening up of blood vessels), increased blood pressure and respiratory rate, and increased local metabolic activity. It also causes immune cells to become more active, muscles to relax, and sweating to occur. The reflexive response of removing a short use hot application causes the body to relax. 

Hot application used alone can also be cleansing and detoxifying, but care is always taken to monitor the patient and make sure they do not over-heat. An example of this is the peat bath I experienced in hydrotherapy lab last week, pictured below! I sat in this bath of about 106º F for 20 minutes and gotreallyhot. Afterwards, I was given water and wrapped in a dry sheet to continue to sweat as I slowly cooled after the treatment. The experience was extremely detoxifying, intense, and relaxing. While I had a headache later that night following treatment, I felt fabulous the next day!

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Sweating and smiling in a peat bath

When used in therapeutic application (not for too long or for too short and in appropriate alternations - this is why we require a course in this therapy!), cold is stimulating, invigorating and tonifying, while hot is relaxing and sedative. Naturopathic hydrotherapy often uses hot therapy in combination with cold therapy. We can use alternating hot and cold treatments (contrast) to increase or decrease blood flow to an area to promote healing. I practiced administering a contrast bath recently in class for my classmate Brad, whose feet had been hurting from long-distance running. Affecting blood flow is one of the major goals of hydrotherapy. The purpose of directing or moving blood flow is to increase oxygenation, deliver nutrients and immune factors, and clear toxins from tissues. This process is best elicited when combined with proper nutrition and detoxification, two important components of naturopathic practice.

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Brad receiving a hot and cold contrast bath treatment

A naturopath always monitors the temperature, pulse and respiration rates of the patient before, during and after treatment to ensure that we are eliciting the proper effects, and that the patient is safe. Additionally, we always consider the age, severity of illness/vitality, emotional state, and circulatory condition of the patient. A patient with heart failure is not a good candidate for a therapy that heavily influences blood flow. Young patients or very old patients require special consideration, for example, decreasing the variation range between cold and hot applications so as to make for gentler treatments. 

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Fellow students monitoring blood pressure during treatment

One important aspect to practicing hydrotherapy is to never cool a chilled patient. In any situation, a patient should never get chilled, and following treatment the patient should not get too hot, too cold, or exercise vigorously, as the treatment may not have its full effect.

Not only is hydrotherapy effective and relatively cheap to administer, but also water is non-toxic, so we can use this therapy on very sensitive patients. There are many other ways to use water therapeutically and I cannot do every method justice here! One major application I left out is the use of neutral temperatures such as dry sheets wraps and neutral baths. Know that there is a lot more to explore and to study when you take the class offered here at NUHS! I hope this post helps to clarify hydrotherapy, and gives my fellow students some words to use in explaining this modality to their curious friends and family.

Sources: Pizzorno and Murray. Textbook of Natural Medicine. 4th edition. and Conner K. Hydrotherapy Lecture Notes. 2014. 

Finding Time for Art

Happy belated Halloween! I think once Halloween has come and gone, fall has really shown itself and we're officially getting closer to winter. Winter's impending presence is evident around here; it has been in the 30s at night. Brrrr! We even had our first snow last week!

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First snow! Early morning on campus before classes began on Halloween day.

To celebrate Halloween this year, Hanzi and I went out to support the arts in Chicago. We saw a creepy opera put on by the Third Eye Theatre Ensemble called "The Medium." The show is about a woman named Madame Flora who scams customers by putting on fake séances with the help of her daughter and a "deaf and dumb" boy she has taken under her wing. When Madame Flora feels icy cold hands grab her around the neck at one of her séances, she gets terribly scared, admits her dishonesty and tries to give the people their money back. But the couple and the mother who have been coming to her séances to speak with their deceased children are convinced that Madame Flora has truly helped them to connect with their lost loved ones, and they fight her on her claims. Her customers say they know the voice and the laugh of their dead children and she must continue to help them connect with their dead!

The story is lots of fun and this particular show was put on in a black box theater, with two rows of seats along two of the walls. It was incredibly cool to feel that we were participants in the events taking place in Madame Flora's parlor.

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I left this little rhyme outside our door incase we had any trick-or-treaters come by while we were out.

It is really very easy to forget our creative side when we are so busy with school, but taking the time to either make art or appreciate it brings me so much more alive! This is something I speak with my other student friends about often; when we're really dragging we encourage each other to go create something or find something artistic to enjoy. The experience of using the other half of our brains seems to really help put everything back in balance!

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On the set of "The Medium"
(Photo credit: hanzi d. - www.hanzid.com)

After the Halloween show, as Hanzi and I hustled through the freezing rain back to our car, we had to make a stop at a bookstore called Myopic Books. It was 10:15 p.m. and the glowing red 'OPEN' sign in the window was intriguing. The place was packed with books from floor to ceiling, some narrow shelves constructed from raw 2x4s made for several narrow halls and fantastic browsing. The whole place was 3 stories, and packed with used books! I bee-lined to the third floor and parked myself in front of the alternative health section. Our spur-of-the-moment stop at this shop was totally worth it; I found a copy of "Women's Encyclopedia of Natural Health" by Tori Hudson, ND, know as THE women's health doc in naturopathic circles. And it cost me less than 10 bucks! There were signs inside the store asking us to not take photographs, so I had Hanzi snap this shot of me outside on our way out. The blustery, seriously chilly night combined with the red light in the window made for an appropriately spooky setting!

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My fab bookstore find! On Halloween night at Myopic Books in Wicker Park.
(Photo credit: hanzi d. - www.hanzid.com)

After our artsy and interesting Halloween night, I am inspired to seek out artistic endeavors in the midst of my studying. Maybe I'll doodle when I'm losing focus in class, or maybe I'll take more creative pictures on my short walks between buildings on campus. I do really love to patronize the arts; this is perhaps the best use of my time (and money), as I don't really trust myself to find time to follow through on my own creative projects in the midst of med school. Now that I think about it, I have been getting more exposure to the arts... Just last week Hanzi and I went to a show at Cole's Bar in Logan Square where several hard-rocking local Chicago punk bands covered other awesome bands like Led Zeppelin (my absolute favorite!), Bikini Kill, and LCD Soundsystem. It was such a treat to lose myself in the music, all the while surrounded by people who sought out this show to do the same exact thing.

If I can't enjoy and create art on a regular basis right now because I am too busy studying medicine, I can at the very least let the little exposure that I do get to the arts fuel my studying. I'm writing this on Sunday, and am feeling totally ready to sit down and dig in to my Phys Dx lectures in preparation for this week's exam. I realize that I've had a good fill of art lately, and it would serve me well to remember, over the next year or so of school, how it truly helps to balance my brain.