Archive for tag: faculty

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.

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.

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.

Leaves, Berries, Flowers and Bark

One morning when I was 18, I went out for a run in the Adirondack woods and after I rounded a corner, I stopped dead on the narrow trail and looked up to see a buck standing in my way. I stood stock still for half a minute as we made eye contact. I think I took one or two steps back, which made him hesitate and glance over his shoulder, then stamp once. He was brownish grey with dark brown eyes and a small-ish rack of antlers that made me think he was fairly young. Another shift in my posture was all it took for him to turn abruptly and bound off into the woods to my right. (This was before smart phones, and there was no power plug within 2 miles of me to power it anyways, so I didn't catch a picture, but the image stays remarkably clear in my mind.)

This experience was one of several encounters with wild things I had over the summers I spent at Tanager Lodge, a summer camp in the Northern Adirondack Park in upstate New York (the same place I traveled to for that wedding mentioned in last week's post.) That wedding trip has inspired this meditation on what Tanager fostered in me that made me gravitate towards naturopathy more than any other school of the healing arts.

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Old Map of Tanager Lodge

Tanager is a self-proclaimed wilderness camp that engages "campers and staff in a small, non-competitive community dedicated to wilderness appreciation, life skills, and individual growth." This is its 90th summer in operation.

A day in the life of a camper or staff member (I was both) starts with waking to the sound of a flute (a real one, played from atop a cliff...I'm not kidding), followed by a dip in the lake, then breakfast on open porches, cleaning and prepping camp for the day by bailing boats, peeling carrots, sweeping docks, cleaning our tents, etc., and then choosing an activity for the morning.

My favorite activity was making herbal teas. We would hike out a mile or so into the woods on a rainy day and carefully harvest all kinds of edible leaves, berries, flowers and bark. Once back in main camp, we steeped them in varying combinations. After a while, we tasted all the different teas we'd made and they helped to warm us after a morning of tromping around in the rain. The steeping of teas is pretty darn naturopathic; there's even an elective class here at National called Special Topics in Botanical Medicine in which we learn to make medicinal herbal teas (and many other things like salves, tinctures, and elderflower fritters!)

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Looking south from Indian Point (a photo I took at Tanager years ago)

If you are just beginning to explore naturopathic medicine, please do not feel that you need to come with a past full of jaunts in the woods and time spent identifying plants. I have many exceptional peers here at NUHS who came right out of the heart of cities like New York and Detroit. Not every naturopathic student loves to get their hands dirty in the garden or yearns for a hike in the woods like I do, but I am pretty sure we all have a deep respect for the natural world.

The Tanager Lodge community I grew up with strives to live by 12 Woodcraft Laws that will likely resonate with naturopathic students in some way. These laws generally parallel the community, spiritual and ethical aspects of our Determinants of Health (listen to Dr. Louise Edwards speak on the topic). I'll leave you with the list and hope that you have learned a little more about what draws me to study Naturopathic Medicine.

  1. Be clean; both yourself and the place you live in.
  2. Be strong. Understand and respect your body.
  3. Protect all harmless wild life. Conserve the woods and flowers.
  4. Hold your word of honor sacred.
  5. Play fair for fair play is truth and foul play is treachery.
  6. Be reverent. Worship the Great Spirit and respect all worship of it by others. For none have all the truth and all who worship reverently have claims on our respect.
  7. Be brave. Courage is the noblest of all gifts.
  8. Be silent while your elders are speaking and otherwise show them deference.
  9. Obey. Obedience is the first duty of the Woodcrafter.
  10. Be Kind. Do at least one act of unbargained service each day.
  11. Be helpful. Do your share of the work.
  12. Be joyful. Seek the joy of being alive, for every reasonable gladness that you can give or get is a treasure that cannot be destroyed.

 

Maybe This Will Touch Your Heart Today

OK readers, I did it! I decided. My parents were a reliable sounding board in a conversation last week and while I trust my own intuition and will follow it even in the face of resistance, being reassured with parental support really sealed the deal. I plan to start the massage program in September!

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Source: www.ieet.org

Trusting intuition is something we address in class from the very first trimester. Mostly, we have these discussions in our naturopathic theory classes, although this week in Homeopathy 1 we started a topic on How To Take the Case, which is inseparable from learning about becoming a true healer. "Taking the case" means listening to our patients without any preconceptions; it means forgetting ourselves, and dissolving the boundary between the self and the world so as to note every important detail.

In discussing both homeopathic and naturopathic theory, our professors have talked about mirror neurons, a term that defines how empathy is evidenced in brain scans; the listener's brain lights up in exactly the same places as the storyteller's brain does. Our goal as doctors is to use our mirror neurons.

One of my peers asked about how, on the one hand, we dissolve the boundary between ourselves and our patients' stories of suffering, and on the other, maintain our own sanity and refrain from shouldering the burdens of every sick patient that walks through our doors.

It is a good question. How many mirror neurons can we afford to use? Turns out, the answer is different for every doc. Of course we knew that, everyone (every case, every patient) is different, after all.

One professor told us that he sits behind a desk, with the patient opposite him; this provides a physical boundary to remind him. Another professor spoke on how her spirituality and the healing cannot be separated. Her spiritual practice involves dissolving boundaries and finding compassion for every single living thing.

During several of these class discussions our professors have sited an author named Dr. Rachel Naomi Remen, a doctor known for her work teaching other physicians how to heal from the heart. On her blog, Remembering Your Power to Heal, Remen writes of physicians: "Our habitual way of seeing things and even our expertise can blind us to the meaning of even the simplest of our daily interactions and relationships." This tendency towards blindness is an obstacle to cultivating the healer in us, and comes at least in part, from our training. One of Dr. Remen's tools for learning to see through "new" eyes is to keep a "heart journal" in which you answer three questions each day.

The Heart Journal

The first question is: "What surprised me today?"

The size of the nose ring on the girl sitting next to us at the beach; it was huge but I figured she probably loves it that way!

The second question is: "What moved me or touched my heart today?"

On our way to the beach, Hanzi was looking out the window and said, "That was cute!" I asked what, and he told me that a little girl was leading her grandmother in an investigation of something smooshed on the sidewalk.

And the third question is "What inspired me today?"

The camaraderie of the group of "Bears" gathered at the beach, all bobbing together with their big bellies in the chilly Lake Michigan water.

If this exercise is something Remen thinks we should do as professional physicians, why not start practicing it now? In addition to practicing things like taking blood pressure, evaluating cervical range of motion, or taking a history from a SIM-patient, we should probably be cultivating the healer through exercises like this.

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Hard to believe, but I did study at the beach. Here's the evidence!
Want to find a Chicago beach to visit? It's easy: CPDBeaches.com.

The skill set of a healer includes knowing how to find the beauty in the midst of the suffering we are exposed to daily for the duration of our professional lives. So, to my fellow students, don't write in a journal every day if the time commitment freaks you out, but at the very least, have these conversations with each other. Try to talk about the heart-full things, rather than the test you're dreading or the professor you can't stand. Look for the things that inspire you, the things that touch your heart, and the things that surprise you. Forgetting to cultivate our eye for these things will, I suspect, prove a grave mistake whose consequences we will learn when we go out into the real world and try to heal people.

So, I encourage you to notice the things that make you smile more than the things that make you groan. You may even find less to groan about....