Examining Place - The Midwest

Ah, sigh. This weekend I finally got away into the outside world where the air is significantly different from here in Chicagoland. I took in gulps of fresh air and smiled. I experienced my first corn maze in the flat, flat Midwest and sat under a tree whose red leaves came drifting down into my lap as I chewed my apple brat. I ate a candy apple, but we didn't get to pick our own apples because we were a little too late in the season for that.

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These past two weeks, for some reason, I've found myself answering questions about my life before medical school. People have been asking about the places I've lived and the cultures there. I'm quick to tell a story about places outside of the Midwest, so this weekend's little adventures served as a good tether to pull me back, and to examine my current place.

When I was studying non-fiction writing in undergrad, we often examined the concept of Place and wrote on the topic: what does it mean to be in a place, what makes a place yours, not yours, different, the same, why sit and become enveloped in this place now? It's a damn hard task, to sit patiently in place and observe it for what it is. This is especially difficult when your world moves so quickly and you are expected to work hard at attaining, achieving, getting there, making progress towards becoming a doctor.

Despite the rapid clip at which I am working to become a doctor, I try, try, try to slow down and observe this place, to take it in and notice the unique things. This weekend helped me to settle and gaze, to take in the flat farmland, to hug my boyfriend, to laugh with new friends, and to read through old physiology notes in order to refresh my memory and help me be more present in my current classes.

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When you talk about the Midwest with anyone, they inevitably say something about how nice people are here. My initial experience with this Midwestern friendliness involved some confusion, seeing as I come from Boston, a place where nobody acknowledges anybody unless they definitely want to talk. When I arrived in Chicago, a stranger would smile and ask me, "How are you?" I inaccurately perceived this as an open invitation for a full conversation. Over the past two years of living here, I've learned that friendliness does not necessarily equate to a desire to have a conversation, they're just being kind, I guess. I'm still a little weirded out by this; if you ask me how I'm doing, I still look at you sideways to figure out if you actually want me to answer that question, or not. On the other hand, my rather immediate assumption to jump into conversation has served me well, and I've made friends with shop clerks at nearly every place I buy goods and services.

Right now, the Midwest is my home, though perhaps not my truest Place. Here in Chicago, I've had to stumble along trying to navigate the culture, and I finally feel that maybe I'm able to catch these Midwesterners in stride and keep up. I have learned so much about life in the heart of classic America by living here. My greatest adventures so far have been getting to know a place by living in it, participating in the community, and feeling out the social habits of the people there. From this perspective, it's no wonder I feel so slammed with new information; it's not just the study of medicine I've been trying to assimilate, but the Midwestern way of life as well.

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So being in medical school is more than just your peers, your books, your lectures, and the other trappings of studying medicine. Many of us move to a new place to start this journey into medicine, and the culture of that new place also provides us with struggles and triumphs. If we can find the time to sit with our new place, in addition to our books, we'll learn more about the world, which will certainly make us better doctors, right?

What is Hydrotherapy? Part One

When someone asks me about naturopathic medicine, I invariably list off several of our modalities in an effort to explain my training, and hydrotherapy usually comes up. Their next question is usually, "And what is hydrotherapy?"

I'll admit, until this trimester I wasn't very good at explaining hydrotherapy. I would more or less answer with, "Well, I'm not really sure because I haven't had that class yet." This is the first post I will write as part of an attempt to accurately answer the question, "What is Hydrotherapy?" In the process, I'll examine why I am so drawn to this particular tool in the ND's toolbox.

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Here I am administering a constitutional hydrotherapy treatment
for
fellow ND student Lisa in our Friday afternoon Hydro Lab.

In naturopathic medicine, we recognize the body's ability and tendency toward self-healing. We call this the vis medicatrix naturae. The vis is the built-in guide we all have that allows our bodies to move "toward the healthiest expression of function," aka a healthy state of being (Pizzorno and Murray). Assuming that we provide our bodies the proper environment, we should be able to achieve a healthy state because theviscan work free of encumbrances (like fast food, unhappiness, too much beer, not enough sleep, or not enough love, to name a few.)  Hydrotherapy, specifically constitutional hydrotherapy, works by stimulating this self-healing mechanism, the vis.

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This photo and the rest below are from a display in the library about
the history of medicine. I love these old images depicting hydrotherapy treatments!

So what is constitutional hydrotherapy? The quick definition, as supplied by Pizzorno and Murray in the Textbook of Natural Medicine, states that it is a simple procedure "involving the placement of hot and then cold towels on the trunk and back in specific sequence (depending on the patient), usually accompanied by a sine wave stimulation of the digestive tract." The treatment "recovers digestive function, stimulates toxin elimination, 'cleans the blood', and enhances immune function." All of these actions serve to move "the system along to a healthier state."

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Hydrotherapy in general is defined as "the use of water, in any of its forms, for the maintenance of health or the treatment of disease." This can include application of water to the body via "sprays, douches, frictions, immersions, whirlpools, steams," etc. Modern research on hydrotherapy techniques for the treatment of disease is lacking because, I suspect, water exists already and no one can make a buck on redesigning it; it's pretty good as it is. Maybe someday when we truly encounter its scarcity, someone will study it. Or, maybe when Big Pharma dies. Or, when pigs fly. 

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Anyways, before I get too much further into the what, let's examine where our modern naturopathic hydrotherapy came from. Much of the information we use for the basis of today's naturopathic application of hydrotherapy comes from centuries of clinical evidence, recorded and compiled by various healers over hundreds of years. Dr. O.G. Carroll, an ND who practiced in Spokane, Washington, may be considered the grandfather of modern naturopathic Constitutional Hydrotherapy in the United States, having been the one to add the sine wave stimulation. He studied with several storied and experienced hydrotherapy practitioners including Dr. Henry Lindlahr. Dr. Lindlahr practiced hydrotherapy at his Nature Cure (a name for the medicine that preceded the word naturopathy) sanitarium in Elmhurst, Illinois from 1914-1928. I should note, of course, that Lindlahr's School of Natural Therapeutics (again, a forerunner to naturopathy) was absorbed by the National College of Chiropractic (present day NUHS!) in 1926. 

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There is so much more I could share about the rich history of hydrotherapy, but I would be hard pressed to do it justice. One book I have explored is Nature Doctors by Kirchfeld and Boyle. Though the book is rather dense and doesn't really read like a story, it definitely is a good source for learning about the history of our profession. I have also sought out books written by Henry Lindlahr and those by his son, Victor Lindlahr, on Nature Cure and Natural Therapeutics. The Textbook of Natural Medicine by Pizzorno and Murray that I referenced several times in this post has a whole chapter on hydrotherapy that I have yet to finish reading. I know there are so many more books out there, too, just waiting patiently for me to finish school and find the time to devour them...feel free to point me in the right direction if you have any suggestions!

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I guarantee I've missed a lot of detail here, and I encourage you to fill in the gaps as you explore and study our medicine. Next time I'll focus more on what hydrotherapy actually does to the body, and why this makes it a useful therapy. Until then, have a lovely Week 8!  I hope everyone's midterms are going smoothly!

Learning from Naturopathy's Superheroes

If you're an ND student and haven't attended a naturopathic conference yet, please do! If you're a prospective student, you might consider attending one as well.

Last week was our nationally recognized Naturopathic Medicine Week, which culminated here on campus with the annual conference put on by the Illinois Association of Naturopathic Physicians (ILANP). This year's topic was "Integrative and Nutritional Approaches to Gastrointestinal Disorders." This was the highlight of my Naturopathic Medicine Week celebrations, which also included a lunchtime yoga class and some time spent at our campus botanical garden.

Image of schedule

This year, ILANP hosted a few of Naturopathic Medicine's Greats: Dr. Mona Morstein, Dr. Eric Yarnell, and our very own Dr. Louise Edwards (Dr. Lou). I am so lucky to have had the opportunity to learn from these remarkable docs, and intend to seek out their lectures in the future.

Dr. Yarnell arrived early for the conference and gave a special lecture for the Tri 6/7 Bot Med 2 class on Friday. I am not actually taking this class until next trimester, but the professor, Dr. Sorensen, knows I (and other ND students) have an affinity for herbal medicine and she invited us to attend.

Dr. Yarnell spent the first hour teaching us about formulation: the roles and the selection of different herbs as Leader, Helper, Deputy, Synergizer, and Driver/Harmonizer. I learned that making a list of desired actions for treatment (based on physiology and biochemistry) allows you to select the most appropriate herb as a leader, and to fill in the unmatched actions with other botanicals.

Dr. Yarnell also taught us the concept of Opposing Assistance, or using two herbs with opposite actions in the same formula. For example, if his patient needs some stimulation but not too much, instead of using a mild adaptogen, he will incorporate a strong herb and an herb with a milder opposite action to achieve a balance. He finds this yields the best clinical results. It is also a good lesson for life: moderate and find an answer by applying opposing wisdom. In the second hour, Dr. Yarnell presented a few cases so we could see how he applies these concepts of formulation in practice.

Bright and early on Saturday, the most intriguing thing I learned from Dr. Yarnell's opening talk was about the need for certain bugs in our gut (that make up our microbiome) in order to breakdown certain medicinal herbs. This means that if a particular herb is not working for your patient, the problem may lie in the population of gut flora, rather than in the herb itself. If the herb's active constituents cannot be exposed via digestion by certain bugs, it cannot possibly do its job correctly! For example, research from 2012 tells us that the catechins in green tea (Camellia sinensis) requireLactobacillus plantarum, a particular gut microbe, for metabolism. Interestingly, green tea makes me sick to my stomach. Perhaps I am deficient inLactobacillus plantarumand therefore cannot break it down properly? Amazing!

Dr. Morstein opened Sunday's lectures with a talk on SIBO (small intestinal bacterial overgrowth). If ever there was a doc who speaks with conviction and does her investigative research, it is Dr. Morstein. She taught us that using antibiotics is sometimes appropriate, and that one should never be shy; call any company whose product you question and ask them about it. Go to the source to answer your question so that you may treat your patients with confidence.

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McKenzie and Dr. Lou

I reveled in presentations by many other intelligent and inspirational NDs, and was brought back to our naturopathic roots by our own Dr. Lou, who ended the conference with a presentation that applied everything we'd heard to the core of our philosophy. My congratulations to Dr. Kristina Conner, who was honored as the recipient of the 2014 Henry Lindlahr Award, and to Dr. Lou, who accepted the 2014 ILANP President's Award! I am so proud of my professors (who double as mentors), and am so thankful to benefit from their teaching! I came away from this week of celebration of our profession with the spirit of naturopathy rooted in my heart, and my drive to study hard rekindled.

My Favorite Tri So Far

I think Week 6 is a good time to get into the meat of what I've actually been up to so far in Tri 6. The best part about this trimester is that I spend relatively little time sitting in lecture, and most of my time applying and building upon what I already know through discussions and hands-on learning.

Physical and Laboratory Diagnosis (aka Phys Dx in student speak) is a beast of a class, with 6 hours per week of lecture and three more hours per week in lab. Our first practical comes this week, and I have been practicing several exams including taking vitals, as well as the head and neck, pulmonary, cardiovascular, neurological, eye, ear/nose/throat, and abdominal exams. Besides demonstrating that we can actually execute said exams, we will be tested on our ability to translate an objective finding into a diagnosis (for example, dullness on percussion of the lungs in the right upper lobe suggests consolidation and therefore pneumonia in that area.)

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Friday Manual Therapies class celebrations! Tony's birthday called for learning, pizza, and cupcakes.

Two other classes require me to sit in lecture. The first is Imagining Diagnosis, in which we just finished learning about how to recognize arthritides, like rheumatoid arthritis, on X-ray. The other is Ethical Practice Management, a class that discusses things like how to use twitter for marketing, and why networking is vital for success.

All my other courses are significantly more hands-on and interactive, the reason that this trimester is my favorite one so far. In Homeopathy 3, we sit in class, yes, but we learn remedies and have discussions about how to take a case, analyze a case, and subsequently find the correct remedy for a patient. In Applied Clinical Theory, we discuss paper cases each week and learn about how to make a diagnosis based on a history and results of a physical exam. Next, we discuss how to treat these patients by working through our therapeutic order and addressing each determinant that is out of balance.

These classes are directly allowing us to apply what we know and understand about pathology, physiology, biochemistry, anatomy, etc. (material from our first phase classes) to a theoretical patient. It is so satisfying to prepare for a class discussion and find out the next day that your diagnosis was correct and that some of the therapies you've chosen are the same ones your professor would apply!

These classes are helping me to move beyond simply identifying what is wrong with the body, to actually creating a treatment plan to solve the problem. I have two more hands-on labs that fill my week, one is phlebotomy lab where we've been learning to draw blood and take urine samples. The other is a class called Advanced Manual Therapies, which has proven to be a great review of evaluation techniques we learned in our E&M classes, and allows us to put it all together. For example, last week we learned the "upper extremity evaluation dance," which will help us to determine where a patient's source of pain or malfunction resides if they present with a problem in their arm or shoulder. We also learn how to use alternative techniques like pelvic blocking and activator to treat stubborn or sensitive patients.

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Crazy lookin', right? Lisa and Jack practice naso-sympatico.

My very favorite course this trimester is Hydrotherapy. If you've been reading my blog the past few weeks, you'll know that I adore this class. Last week, we practiced constitutional hydrotherapy, a vis-stimulating treatment that involves alternating hot and cold towels and applying electrical stim. Two weeks ago we experimented with Neti pots, as well as steam baths and naso-sympatico treatment for sinusitis.

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Neti Pot time! Pouring water into my nose.

Lastly, I get to spend four hours a week in the clinic, which you have also read about already if you've been following my posts. Observing allows us to focus on understanding how the clinic operates and to practice writing SOAP notes without the stress of actually having to treat patients or think really hard about the cases. I am so thankful that I get to watch and think and learn from my peers; many of the interns I shadow offer useful tips, teach me the finer points of writing a SOAP note, listen to my suggestions, and answer my questions about their patients.

Oh! How could I forget to mention my massage courses! I love the physically exhausting challenge of giving massage in my Fundamentals of Massage class every Tuesday night, and my class on Ethics and Practice Management is helping me to visualize how I will apply this skill in my practice of the future. Despite how satisfied I am with this trimester, I admit that I am already looking ahead to what comes next! I can't believe I am already halfway through medical school; time if flying. On that note, I better get to work preparing for my Phys Dx practical! Wish me luck!

Feel Human Again

An ND student friend of mine joined me for lunch on a bench outside on Friday and told me about how her friend who had come to visit. They went to a bookstore, they hung out, and to quote her she, "felt human again!" I'll admit, it's kind of the last thing you want to hear as a prospective student (for those of you reading this), but it's also true.

Med school has this paradoxical way of making you feel on the one hand like the most human human around, with everything that could possibly go wrong with a body probably having gone wrong with yours, and on the other hand, it makes you feel like a strange creature when it comes to "real life." As a student of medicine you will spend a lot of time in your own head, and a lot of time in the company of other med students talking about the trials and tribulations of learning medicine. I presume there's nothing quite like it.

I went out on Friday night to meet my boyfriend Hanzi downtown after his class and we went for a drink with his classmates. I was that girl who didn't order a drink at the second bar and then cut out early on account of having exams coming up this week. That's no lie by the way, week 5 has arrived, along with the first exams of the tri! So, my friend's lunchtime comment and my own experience of having my social life ruled by my books made me think.

When we interact with people outside of medical school, we get a valuable perspective on what we've actually been up to. Whether it's your parents, your best friend, your significant other, or your neighbors, having those conversations that don't require you to probe the depths for that piece of medical knowledge are wholly healing in themselves! We take our minds elsewhere. Also, these humans from outside the medical school world will often offer words of encouragement or awe or appreciation for what we're doing, even if they don't say so outright.

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Indiana vs. Northwestern field hockey game -- set up for a penalty corner

Over the weekend, I got to revel in the world outside of medical school. I went to see one of my very best childhood friends doing one of the things she does best -- coaching the Big 10 Hoosier field hockey team in their game against Northwestern here in Chicago. The experience took me out of my current world; it took me back. For a few years in college, I played Division 3 field hockey. My last year on the team, I spent most games perched at the top of the stands filming so we could study our game play later on. I eventually quit the sport due to injuries that kept me off the field and just wouldn't heal. This past Sunday at Northwestern, I climbed to my place at the top of the stands so that I could see the whole field. I was totally engrossed in the game, and loved getting a taste of the conviviality and competition of college sports. This was an environment that, at one point, played a very important role in my life.

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Coach Kate and me -- a gorgeous day on Lake Michigan

Watching the game was a blast (it made me use my brain in a totally different way than learning medicine does), but catching up with Kate, sitting on the lakeshore while she waited for her team to shower, was the highlight. We talked about our families. We reminisced. We don't see much of each other these days, but when we do it's like no time has passed.

This experience drove home the message to remember what makes me who I am, that I should not forget to peek back at the path I took to get here. The conversations we have with our non-med student people are capable of reminding us of all the other things we do besides study medicine. And actually, it helps me to recognize how many of my life experiences have pinballed me toward medical school and my specific areas of interest.

For example, why am I so intrigued by physical medicine? This is no doubt, because of my experience essentially studying the way my own body moves and how it endures training and sport. Playing college field hockey definitely forced me to do this, and my excursion to watch Kate's game this weekend reminded me of that.

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Shadowing ND intern Alaina in clinic

And now, I get to connect my ruminations with the highlights of my week! I got to observe a physical medicine patient with back pain in the clinic, and it was TOTALLY AWESOME. To clarify, it wasn't the patient's pain I found so awesome, but the fact that I got to watch naturopathic medicine in action, working on issues with ties to my days as a college athlete, with ties to the path that brought me here.