Crunch-Pop and Lovely, Intelligent Women

Here I sit, on a plane bound for Chicago after a weekend on the East Coast, listening to the air from the blower overhead and the rushing outside the window as we taxi. The deicers blast the window inches from my face with a heavy spattering sound. The engines roar a little louder and I think of the rattle my cousin's smiling, blonde 1-year-old used to fill my ears this morning.

At this past week's Nu Delta Sigma meeting, Nadene introduced us to sound healing as presented in the book, "Tuning the Human Biofield," by Eileen McKusick. I was the lucky recipient of a sound experiment from my friend John, a brilliant healer and doctor-in-the-making. You might call us crazy, but when was the last time you checked in with the sounds in your life? It had been a while for me.

The sim patient I saw this week in my Advanced Clinical Problem Solving class complained of tinnitus, a rushing sound in his ears, and was nearly deaf. This was the only abnormal finding on physical exam as we searched for clues to the cause of his dizzy, vomiting spells. When I made kale for dinner on Wednesday night, the leaves squeaked when I stripped them off their stalks. The sound reminded me of lemons and a crisp, cold, clear evening with a sky full of stars, when the frozen snow sings underfoot.

Selfie photo on the mountain
So excited to be out skiing in celebration of one of my very oldest friends!
(She taught me to suck my thumb when I was 2.)

When I rode the chairlift at Cranmore Mountain in New Hampshire with my childhood friends over the weekend, the chairs clunked as only chairlift chairs do each time you reach a tower. I reveled in the swish of skis and the crunch-pop of poles into snow, the whoosh and shudder of skiers of various skill levels as they rocket downhill beside you. There were also those split seconds of silence when I caught a little air and my skis left the snow, allowing me to hear only the wind in my ears.

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Beautiful bluebird day in the White Mountains! There are my friends, waving at me from the lift.

On Sunday morning, I listened to the coffee maker grumble and splurt that divine bitter stuff into the pot. The bottle of champagne made an adorable pop! And we toasted our friend, a bride-to-be. We thanked her for bringing together such an intelligent, fun, active and clever group of young women. Our glasses clinked! I am back at school now, refreshed and grateful.

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All the lovely, intelligent women in our PJs, toasting our bride-to-be!

So now I sit here typing, my fingers trickling across the keys making that distinct blipping sound with each letter. I spend so much time using my eyes and my hands to observe and palpate in medicine, but I haven't engaged nearly enough with my ears. The more blood pressures I take and the more lungs I auscultate, the more familiar those healthy sounds become. I listen to the normal sounds in hopes that I'll recognize when they are different, when the lungs pop or crackle or gurgle and tell me something about the environment inside my patient.

Happy New Year of the Sheep, Goat, Ram!

So, I guess the exact name for this new lunar year in the Chinese calendar is up for debate. What's not debatable is the fact that I went to a (belated) Chinese New Year party on Saturday and ate a delicious hotpot with ingredients sourced from Chicago's China Town. Yummy! I also tried my hand (mouth?) at a Chinese blowgun and wore house slippers.

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Hotpot! (The little mushrooms were the most delicious part!)

According to both the New York Times and NPR, the English translation of this year's Chinese animal is fuzzy. "Yang" may mean a sheep, a goat, or a ram. The sheep/goat/ram debate seems to be a uniquely American and European problem. Throughout Asia, most people are settled on what exactly the word "yang" represents for them, often depending on which one of these animals lives in that particular region and whether they do good or bad things for the ecosystem.

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Party host Reed taking aim with the blowgun

For example, I learned that in Mongolia, this year is likely be regarded as the year of the sheep, as opposed to the goat, which is known for eating not only the grass but also the roots, leaving no grass for the following year. Thus, the sheep is more auspicious and one's ancestors would surely name a year for the animal that leaves opportunity for growth.

As part of our naturopathic training, we take an Intro to Chinese Medicine class in our third trimester. The course provides an excellent segue for those ND students who are considering a dual degree in Acupuncture or Oriental Medicine at NUHS. The information we learn in this class barely grazes the surface of Chinese medicine, but it does give us the capacity to converse with its practitioners based on our rudimentary understanding of the substances, organs, elements, and patterns used in Chinese medicine. We are taught to analyze a case to determine imbalances in yin/yang, internal/external, cold/hot, and deficiency/excess.

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Pulled out my old notes on Chinese Medicine for a refresher

After much debate in my third tri here at NUHS, I realized that studying in the OM program was not for me. Many of my ND peers are working toward dual degrees and take night classes in the Acupuncture/Oriental Medicine program. I hear fabulous things about the professors and the program as a whole! If you're curious about the master of science programs in acupuncture and oriental medicine here at National, don't hesitate to jump over to Juli's blog and read about it!

As for the rest of the naturopathic medical schools, I believe that the Canadian colleges include more training in Chinese medicine in their curriculum than do the American schools because parts of Canada include acupuncture in their ND licensure. Another note to make about this overlap between naturopathic medicine and Chinese medicine is that as NDs we have the opportunity to sit for an acupuncture-specific board exam when we take NPLEX Part 2. If you want to practice in certain Canadian provinces, Arizona or Kansas, I believe you must sit for this board exam. In order to sit for this add-on exam, you must have upwards of 200 credits in acupuncture/oriental medicine. At NUHS, this means you must enroll in 7 specific courses in the AOM program. I looked into all of this because I intended to take every add-on board available to me when it comes time to do so, but in the end I decided I was unlikely to end up in Arizona or Kansas or most of Canada, and if I do end up in one of these places I'll tackle that obstacle when I come to it.

In the meantime, I'll be making an effort to embody these qualities of our new Year of the Sheep (/goat/ram): avoid pessimism and hesitation, be kind-hearted, clever, tender, and compassionate. Happy New Year to you all!

I Give You Permission to Research Colorful Sex

Where do we start when we talk about love in medicine? In naturopathic philosophy, love is one of our basic determinants of health; we require it to be truly well, just like we do air, water, and nutritious foods. But there are endless ways to love, and a doctor can never understand them all. What a doctor can do is appreciate love's presence with an open mind, without judgment, and with the awareness that love comes in all forms.

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(Image via www.dawn-productions.com)

Dr. Stephanie Draus' lecture in Clinical Problem Solving class this week was inspired by love. We discussed how to talk about sex with our patients. One excellent phrase I collected from her lecture was this: "Do you have sex with men, women, or both?" I never realized that question could be phrased with such simplicity. We talked about the out-dated stigmas attached to sexually transmitted diseases and why a lack of sex education causes these to run rampant, especially in the geriatric population.

We touched on the fact that sexual preference, desire, and practice are similarly stigmatized; we assume everyone having sex likes it "vanilla," that is to say, plain and simple, no bells and whistles, no games, nothing interesting. Just sex. As doctors, we cannot assume this about our patients, nor do we always need to know all the juicy details. What we do need to try to gather is whether our patients' health is at risk based on their sexual preferences, whether in regards to use of protection, or the myriad of alternative ways to experience pleasure.

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Mary Calderone was a physician and public health advocate for sexual education
(Image via izquotes.com)

So, what do we do as doctors-to-be if we find ourselves judging based on our own histories, the things we've been taught, or the lack thereof? I suppose the best place to start is by talking about it with our professors, and with each other. If you are someone who finds his or herself cringing inside at the notions of same-sex love or multiple lovers, I personally think you need to start learning by reading, listening, and well, Googling stuff. Perhaps your professors and friends can't or won't expound on the vastness of possibility and risk involved in more colorful sex, but we need to remain open to the frank notion that lots of people in our world experience pleasure in unorthodox ways. As doctors, we must be prepared to listen without judgment. We must also be willing to do our research so that we can advise our patients appropriately.

So, yes, in the name of becoming a better doctor, I am encouraging you to read up on any alternative sexual practices you can imagine. I've just given you the go-ahead to research gay culture, to wonder at how polyamory is comfortable for so many, to investigate the intricacies of anatomy and physiology in trans people, and to look up that thing you've always been curious about. I encourage you to explore resources for learning about and finding compassion for the zillion ways that one can love and be loved in this world.

My experience in finding acceptance for ways of loving that differ from my own can be understood like this: my partner doesn't like feta cheese. I like feta cheese! When I cook dinner with feta cheese (because I think its delicious!) he just decides to eat the food because he knows I'll be hurt if he doesn't eat what I've cooked, and you know what? After a few feta meals he decides he doesn't really hate feta cheese. After a few more feta meals, he decides he might actually kind of like feta cheese. What he does know is that he appreciates my satisfaction at the taste of this food, and he loves me, so he eats feta cheese for dinner with me. And of course, I do make sure to cook feta-less meals, too.

How an ND differs from a DO and Other Integrative Thoughts

Whew. I'm finished with the boards! At least for now. I didn't realize how much time and energy I was giving to studying and preparing for that big exam until the day after. Even the evening after the exam I was still energized and excited. The day after however, I was totally burned out and my brain felt like mush. The emotion of the experience was wholly exhausting.

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Cheers to getting through part 1 NPLEX!

On an easier note, how did I celebrate? First, my girlfriends and I toasted each other's success of making it through while we complained about the hard questions. The rest of the week was a difficult mix of catching up on work while also trying to catch up on sleep. And when the weekend came, I paid attention to my heart-mind by attending the Integrate Chicago conference and going out to enjoy Chicago's restaurant week.

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My view in a lecture on the philosophy of care at Integrate Chicago.

Integrate Chicago is a conference put on by students of medicine from different disciplines. The organizing board included students from UIC and Loyola med schools, as well as an ND student from NUHS, and many DO students from The Chicago College of Osteopathic Medicine (CCOM). One of the most enlightening talks I attended was about the clinical application of Osteopathic Manipulative Medicine (OMM). I learned that most doctors of osteopathy (DOs) do not actually practice their manipulative medicine, which I always thought was what set them apart from MDs. The presenters were passionate about bringing OMM back into regular practice. As part of their presentation, they demonstrated a few things that can be used on hospital inpatients, such as those who have recently undergone open-heart surgery, as well as techniques for outpatient care such as an acute sinus infection. I took notes!

Not only did I learn how a more traditional osteopath uses their medicine, but I also learned that DOs describe themselves as "exactly like MDs," except that they get more training in diagnosing and treating musculoskeletal conditions. The presenters stressed that as DOs, they always use the appropriate drugs as indicated for the sinus infection or other disease, but will combine these conventional treatments with their manual therapies to help speed healing time.

This presentation was particularly helpful for me, because as an ND student I often field the question, "So, are you like a DO?" Now I can be confident in saying that we are much different than DOs and why, at least based on what I learned from the doc and students from CCOM.

The presenters opened their talk by briefly mentioning the Tenets of Osteopathic Medicine, which include a belief that "the body is capable of self-regulation, self-healing, and health maintenance." Despite this, there was a resounding affirmation in their talk that they are no different from MDs. Their treatments consist of the appropriate medications first, with their OMM used as an adjunct to this care. There was no further mention, beyond their introduction, of the body's ability to heal itself, nor their application of such a tenet in treatment strategy.

Herein lies a major difference in our medicines. An ND forms her treatment plan around supporting the Vis and addressing the basic determinants of health, which may be truly very basic (air and epinephrine, as in anaphylaxis) yet important for all cases. Also, an ND IS different from an MD, and this distinction is both important to us and necessary for treating within our philosophy of the body-mind-spirit as a whole.

We need all of these styles of medicine, each one has its strengths and integrating them all seems like an effective way to make sure each patient gets the best, most individualized care. I came away from this conference confident in what I am studying. I could keep up with the anatomy and biomechanics talk of the DOs, I could nod in understanding at the anti-inflammatory diet, I knew the biochemical pathways implicated in replacing curcumin for NSAIDs, and I understood the uses of and references to pharmaceuticals. I also better understand what challenges I will come against, even in the integrated medical environment. Thankfully, the skepticism often comes from a limitation of knowledge, and if the audience is already prepared to throw off some of their dogma, then with time, there's nothing some extra education can't fix.

Orange Peel Appearance

What happens when you've been studying microbiology for your Part 1 boards and you see a sim patient in clinical problem solving class? You come up with a somewhat obscure viral infection as your diagnosis, when something along the lines of autoimmune disease was what your professors had in mind... Such was my first reminder this week to take a step back and remember the big picture. Who can blame me though, really? I've been busy!

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The Desert Room--where I found a good reading bench.

This week's second lesson in considering the totality of things also reminded me to make space for wonder. After picking up my new glasses on Saturday (Yay! Happy eyes!), I walked over to the Oak Park Conservatory to find a reading bench among the plants. It was late morning and there were small children exploring in each of the three greenhouse rooms. Most of them were working on a scavenger hunt prepared by the curators, but some were too small for that. I alternated between reading my NPLEX study guide and watching and listening to the small humans as they went through cycles of amazement (Mommy, Mommy look at the pink flower!) and frustration (I can't find the snake! Help me!)

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The Fern Room--where I sat to smell the flowers (no joke, so fragrant!).

Thankfully, I was granted about an hour of uninterrupted study time among the cacti during which I made some good headway through the section on the urinary system. Around the time I developed a numb butt from the wooden bench, I packed up my books and set to exploring the place with my new glasses on. I'm sure some of you reading this know that feeling of newly crisp vision; texture has returned to my world! I didn't plan it so, but the Conservatory was definitely one of the very best places I could go first with my sharp new eyes. The cacti were spiny, the tropical leaves were waxy, and the flowers were bright and complex. The climbing vines sprouted tiny brownish green curly-cues and the huge, fragrant lemons hanging on their branches were beautifully pock marked (What's that disease process I was just studying with "orange-peel appearance??")

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The Tropical Room--where I conversed with some parrots.

When I finally headed out, the volunteer docent was apologetic that I had to study over the sound of kids. I reassured her it was a welcome distraction, and a good reminder before I sit for my board exam to attend to all the possibilities. Also, that I should not forget to delight in the details.