Archive for tag: boards

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!

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.

Under the Gun - Ebola for Dinner

And we're back! We're really back, full-on, cramming for boards, prepping for patients and all. I'll admit it, the experience of preparing for boards has taken some wind out of my sails. Last trimester I was feeling ready to be a doctor. Spending time in the clinic made me feel ready to see patients and puzzle through the hard cases. More recently, I've been laboring with my 500-page board review book and feeling inadequate.

Thankfully, I can see that the deflation of my confidence comes in direct response to my anxiety about taking board exams. And I guess I am feeling slightly more capable after finishing the Cardio section yesterday and color-coding my weekly schedule this morning. Wrapping my head around a new schedule always takes at least a week, and getting it all organized definitely helps calm my mind.

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Yeah, my color-coded schedule for Tri 7

Seeing as we celebrated Martin Luther King Day this week with Monday off (thank goodness, any extra study time is treasured!), I am inspired by this piece of wisdom he wrote:

"Darkness cannot drive out darkness, only light can do that. Hate cannot drive out hate, only love can do that."

In preparing for boards, it doesn't do much good to mix negativity with those dark, foreboding clouds floating around February 3rdon my mental calendar.... I'm trying hard to stay positive while I study and am thankful for the encouraging text messages I've been getting from my ND friends who are in the same boat.

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JohnnyD instructing me in the fine art of shooting a pistol

As it turns out, even a 4-week break can't provide enough time to study as much as planned. I do have a few good excuses though.... My boyfriend Hanzi and I spent a week around Christmas in Northern Michigan with his family; we skied, caught up with some of Hanzi's old friends, and I learned how to shoot a pistol! (Hanzi's Dad is the manager of a local shooting club.)

After returning from Michigan we had a few days before we headed out to Boston to visit with my family. Our week in Boston was our first visit to my parents' new house (I wrote about their move in this post), and included pond hockey, dinner with college friends, and some quality girl time for me with one of my oldest friends. I was also lucky to spend a day working with my Mom at her Integrative Dermatology practice where she incorporates diet and lifestyle in the treatment of her patients. I had an absolute blast interviewing patients and prepping them for their visit with the doctor, though I found the electronic medical records a huge pain to navigate... things to look forward to I suppose....

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Ebola dinner lecture, my view from my seat by the fire

In addition to working in her office, my Mom took me as her guest to an informational Ebola dinner (appetizing, huh?) hosted by the local chapter of the Massachusetts Medical Society. I ate yummy salad, roast beast, soup, and chocolate cake while learning about Ebola. The lecture compared the first known epidemic in the 1970s with the disease picture of today's outbreak. I met one semi-retired female doctor who practiced general surgery who seemed wholly uninterested in naturopathic medicine, and another practicing female GP who asked me to send her an email with information about what we naturopathic doctors do. How cool!

After spending time immersed in the conventional medical world, I am happy to be back at NUHS, working on becoming a confident doctor who can hold her own in the company of skeptical, old medical doctors. If that isn't inspiration to crush these board exams, I don't know what is! Back to the books now.... Welcome back everyone!

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.