Another good week come and gone and we're already a month into
the Fall Tri! This past week was marked in particular by more
travel and some med school firsts: suturing and a Grand Rounds
Wendy, Mallory and Lisa prepare to learn suturing
For years I've watched my dermatologist mother suture her
patients after removal of suspicious moles or biopsy of suspicious
skin conditions. She works so methodically, looping the long end
around the forceps and securing a tight knot in one smooth motion.
After my first attempt at suturing I can tell ya, it's harder than
it looks! However, after another hour of practice following that
first attempt, I'm already feeling better about it, though I still
need more practice. The tricky part is focusing on all the
components; holding the tools properly, spacing your stitches just
right, and pulling them just tight enough, but not too
Lisa performs her first sutures on a plastic arm!
I also gave my first Grand Rounds presentation to a room full of
interns, clinicians and students from lower tris. In 9th Tri
we present for about 30 minutes on a clinical question, whereas in
10th Tri we spend an hour discussing a case and research. As I
mentioned last week, I presented on The Case of the Missing Organ.
My talk focused on the concept of considering a new basis for
health in patients who present for care after having an organ
removed, and on the importance of identifying the cause of dis-ease
if removal of the organ has not solved the problem. This
presentation was inspired by two of my patients, one who has had
the colon removed, and another who has had the gallbladder removed.
I was nervous, but it seems to have been well received and now I
can check that off my to-do-list for the tri!
After an interesting week I took to the skies again for a trip
to Vermont to celebrate the marriage of one of my very oldest
friends. In addition to getting all dolled up with a delightful
group of young women (I also wrote about them in a post from March:
Crunch-Pop and Lovely Intelligent Women), I got to go for a
beautiful, brisk morning stroll with my mom and discuss patient
cases, and danced with my dad to music played by a live band.
Everything about the weekend was beautiful!
A view from the top of The Flume, a little hike in northern
Hanzi and I made a point to stop for a walk in the woods of the
White Mountains on our drive back to Boston, where we caught an
early flight back to Chicago the next day. We also got to watch the
lunar eclipse/blood moon with my parents on their back porch. I
hope you all got to see that celestial masterpiece; what a perfect
symbol of the impressiveness of this world that has conspired to
bring about all the things from the marriage of two wonderful
people this past weekend, to my reaching this stage of naturopathic
Hanzi checks out the White Mountains scenery from a covered
Speaking of a world conspiring to bring about things for us,
please do not hesitate to email me with any of your questions,
thoughts, concerns, or celebrations from your process of applying
to, or considering this Naturopathic journey. I am never too busy
to reply; I love your emails! You can reach me at email@example.com.
In preparation for some days I'll be missing for wedding
travels, I did a double shift in the clinic last Friday. After
working 7 to noon for my regular ND shift, I tagged along on the DC
side from 1-6. It was definitely a long but rewarding day.
Gone apple picking on a beautiful Sunday!
While on the DC shift, I consulted with a DC intern friend of
mine on his patient who recently experienced symptoms of a GI
bleed. I helped put together the puzzle pieces to recognize that
the likely culprit of this patient's gastrointestinal misery was
the prescription NSAID he has been taking for his knee pain, and
not the GI support supplement recommended by another ND intern. It
is well known that GI bleeding is a side effect seen with use of
NSAIDs due to their capacity to degrade the mucosal barrier of the
I was also able to help my friend understand the source of his
patient's pain based on the fact that cortisone shots work to
control the pain. Cortisone blocks phospholipaseA2, an enzyme that
mobilizes arachiadonic acid. This step is at the very tippy top of
the biochemical inflammatory cascade. Picture a large family tree
where arachiadonic acid is the great grandparent. There are good
cousins and bad cousins, and by blocking the cascade of the family
tree way up at the top we block both the good cousins and the bad
cousins from ever being conceived. Eradication of the bad cousins
makes pain decrease significantly, but blockage of the good
cousins, or the healthy inflammation, ultimately causes degradation
of tissue from loss of a healthy inflammatory response.
If corticosteroids work to decrease pain, we can extrapolate
that the patient's pain is caused by inflammatory cytokines (bad
cousins). While prescription drugs work to block this inflammation,
many botanicals and nutrients (as well as proper nutrition and
exercise) can also work to modulate the inflammatory response that
My DC intern friend and I had a great conversation about the
difference in response he sees with different rehabilitation
patients. The patients that respond best to his exercise
prescriptions are most often physically fit, they consume a
relatively healthy diet, or their injury is relatively new or
benign. The majority of patients who do not recover well are either
non-compliant, or often have poor eating habits or poor body
composition; they live their daily lives in an inflammatory
Our conversation was a testament to why we naturopathic
doctors/interns always address the basic determinants with our
patients. No matter how much physical medicine we try, it will
undoubtedly work better if we attend to the first 3 levels of the
therapeutic order as well. We must establish reasonable nutrition,
support the vis, and attend to engaged or compromised organs and
systems. More on our Therapeutic Order at another juncture!
Night out with my ND faves
Besides all this excitement of collaboration in clinic, we had
an absolutely beautiful weekend! I got to spend a night out
enjoying live music and food with my ND student friends, and Hanzi
and I went apple picking! Now, I have to buckle down and prepare my
presentation for Grand Rounds. It's called "The Case of the Missing
Organ." Stay tuned....
And, we're back!
I'm sitting at my kitchen table with a glass of wine while a pot
of risotto stews on the stove, salmon is marinating and waiting for
the oven, and the first week of the tri is complete! It is
important to remember to do as much regular living as possible
before we hit Week 4 and midterms are upon us. There's something
sweet and fresh about the first 3 weeks of the tri that really
should be savored.
My first week back was short; we had the holiday on Monday and
thank goodness for it! I flew back from Washington, D.C. early
Monday morning after an intense and amazing 4 days of an IV Nutrition Therapy
Seminar, taught by some outstanding NDs. I am now certified in
IV therapy is a topic we cover in our Minor Surgery class in Tri
9, but due to the nature of practicing/interning in a pre-licensed
state without an MD here on staff at the NUHS clinic, we cannot
actually perform IV therapy treatments in our clinic. The course
taught me so much useful information applicable to my practice of
the future, and I got to apply the skills that I don't get to use
actively in our clinic here. I am now confident that I could, at
the very least, rehydrate a patient, and at the very most offer
basic nutritive support to any variety of sick patients. The group
also offers further education in IV therapy on specific topics such
as cancer support and detox. Judging by my great experience with
the basics course, I'm likely to take more in-depth courses in the
future. I highly suggest the course if you can find the time and
funds to make it happen.
My friend Guy, a 10thtri intern, also attended the course with
me. He leaves at the end of Week 2 for an externship in Montana
(licensed state)! He expects to use his newfound skills in IV
therapy at the clinic in Billings, where he will work for the next
few months before graduation. I'll keep my fingers crossed that I
can follow in his footsteps next tri... imagine the stories I will
be able to share from the West! (Wishing Guy safe travels on his
Back to my reality, or at least sort of. I spent the first
weekend back at school attending the wedding of two dear friends.
Hanzi and I traveled to a club in Pennsylvania and besides watching
Hanzi rock it as a handsome groomsman, I got to go for a paddle in
a solo canoe, catch up with college friends I haven't seen in 6
years, dance 'til I could dance no more, and shoot trap with some
excellent help from the resident shooting instructor. I have
returned from the weekend fully revitalized!
My old college friend Harrison put it pretty well at the end of
the weekend, "I hate hangovers, and I especially hate goodbyes." It
was hard to leave such a beautiful place and such beautiful
friends, but I have returned to campus ready to rock! And speaking
of friends, a handful of my closest ND student buddies who started
in January 2013 with me are now 8th tri interns in the clinic, and
I am so, so excited to have them there with me! Congratulations to
ALL the new interns entering this next stage -- DC, ND and AOM
And now the risotto is demanding my attention and the salmon
must go in the oven... Hanzi returns from work at the library
momentarily and we'll sit down to enjoy dinner together during one
of these rare early-in-the-tri nights with no assignments hanging
over my head quite yet. Welcome back all; let us have a fabulous
Over the weekend, I got to speak with one of my dearest friends
for the first time in two years. She has been living in South Korea
with her husband where they both work as teachers. Sara and I met
when we studied abroad in Australia 8 years ago. In the years since
then, I've been the lucky recipient of many visits from Sara and
her husband wherever I've lived, all over the country. I have
totally reaped the benefits of their summer vacations as teachers.
This time, they are in the U.S. for a few weeks seeing family and I
am so excited to pay them a visit in Michigan next weekend! It's my
turn to make the trip to visit them.
When Sara came to visit in me in Truckee/Tahoe.
One of the most important reasons I moved out west from New
England after college (where I subsequently decided on naturopathic
medicine as a career), was based on my experience of studying
abroad in Australia with Sara. While studying on the other side of
the globe, I met so many Americans who hailed from all the very
different parts of the United States. I realized that I, an East
Coast girl, was so different from those girls from the Midwest, or
those girls from Southern California. We all came from very
different American backgrounds, and yet these Australians, as well
as all the other foreigners we met while out exploring, grouped me
in with all the others. I was just another American girl to
Adventuring in Australia -- getting inspired to explore my own
On account of this, I decided I had better go figure out what
the rest of my country was like before I went travelling abroad
again. While we all had some American patriotism and our language
in common, I felt so different from so many of my countrywomen. I
wanted to know what assumptions people might be making about me
based on some other Americans they'd met who, as far as I could
tell, were nearly as different from me as the Australian girls
were, or the Germans.
Now that I can see the light at the end of the medical school
tunnel, I am starting to think about where to explore next. I think
I have a pretty good handle on what an "American girl" is, based on
my experiences living around the country, so perhaps it's time to
head into foreign lands!
Between binge-watching Anthony Bourdain episodes, perusing
photographs of far away places on BuzzFeed, and reminiscing about
our travels of the past, Hanzi and I have caught the travel bug. We
regularly toss around the idea of living and working in another
country, and have even set some lofty goals of learning a foreign
language before we graduate with our respective master's and
doctorate degrees (we haven't made any headway on this, yet). Even
if we don't make it out of the country, we are ready to explore
another region... perhaps Alaska, or Montana, or Maine...
Of course, I also have to think about actual employment after
graduation, and for the record, I am equally excited to work as a
doctor as I am to see new places. If you're like me and think you
might want to explore, either now or later on, keep these resources
in mind. There are several networks for naturopathic doctors around
the world. Several of my friends at NUHS have traveled to work with
Naturopaths Without Borders during their breaks between
trimesters. My peers have returned with totally awesome stories of
hands-on experience treating patients, living in rural areas,
assisting in the delivery of babies by flashlight, and connecting
with local people whose worlds are so very different from ours.
In addition to delivering care to the underserved abroad,
naturopathic medicine is going global with the recent creation of
Naturopathic Federation in 2014. This organization connects
naturopathic doctors in 40 countries around the world, and
endeavors to connect our work with that of the World Health
Organization. We might be a small population here in the United
States, but we are also out there, all over the world, sharing and
advancing our medicine!
It's pouring rain right now. Our basement is probably flooding,
slowly. But all that water coming down makes for crisp, clean air!
*Takes deep breath in...*
A few weeks ago I read the abstract to a scientific paper out of
Australia that aimed to quantify the effect of exposure to nature
on participants' health, and to identify an ideal dosage of nature.
The conclusion was alarmingly reductionist. How many trees should
we plant on the roadsides in order to make people less stressed?
How can we manipulate nature in order to best serve our health
A winding path
A practice called Forest Bathing started in Japan in the 1980s.
It was developed as a treatment to relieve stress. Newer studies
have recognized that a consciously meditative walk in the woods can
boost the immune system by increasing natural killer cells. One set
of guidelines on Forest Bathing suggests you spend 3 days and 2
nights in the woods if you really want to boost your immunity.
Otherwise, you may choose to spend just one day Forest Bathing to
Hanzi and me, out for a walk in the woods
Hanzi and I went for an extremely rejuvenating walk in the woods
the other day. Relationships always take work, and my relationship
takes extra work because I'm in medical school. We brought our
cameras and our rain jackets, but nothing else. There is a trail
that ducks off into the trees that I noticed when I first started
commuting by train. I keep meaning to go find it, and we finally
did. It was a rainy day, and cool. The forest was especially green
and fragrant. We encountered two yearling deer; they were
definitely curious and not afraid of us at all. We hung out in
their presence for a few minutes while they devoured low-growing
plants and watched us curiously through their sparkly black eyes.
Hanzi and I chose to move on first; we left them to their
And when it rained and poured we went for some pseudo-nature
at the climbing gym
I found an article written a few years ago by our newest
clinician Dr. Denis Marier titled, "Ecotherapy: Embodying the
Vis Medicatrix Naturae in Clinical Practice." In it, Dr.
Marier writes about the relevance and importance of incorporating
nature into naturopathic care. I love the idea of taking a "Natural
History" with each patient in an effort to understand the patient's
exposure to and experience with the natural world. Naturopathic
doctors believe in working with the Vis, or that
healing power of nature "which always endeavors to repair, heal,
and to restore." This is evidenced in those walk-in-the-woods
smells of new greenery, the mud and wet grass, and damp rotting
wood. The natural world turns over, heals itself. So too, do
humans, who are just as much a part of nature as new leaves,
mushrooms, and rotting stumps.
Besides going out to seek nature, I am particularly fond of Dr.
Marier's idea of "naturalizing a part of your clinic grounds." Even
a city office can be naturalized with potted plants and fresh air.
One aspect of my vision for my future practice includes an outdoor
space where I can consult with patients. In his piece, Dr. Marier
also suggests assigning a Medicine/Nature Walk, which he describes
as a 3-6 hour fast from food, people, and electronics. He
encourages patients to notice how they are observed by nature,
rather than focusing only on their subjective experience. This
makes me think of the deer on my walk the other day; they were so
curious! I was observed. And I observed, too.
• Leaves, Flowers, Berries, and Bark
• Farmer's Market
• Should I Study Massage Therapy, Too?
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