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.

2015-02-20_pig
(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.

2015-02-20_mary
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.

2015-02-11_postboardscelebration
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.

2015-02-11_integratchicago
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!

2015-02-05_desert
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!)

2015-02-05_fern
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??")

2015-02-05_tropical
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.

If You Can, Shadow a Doc!

The topic for my blog post this week knocked and then walked into the room while I was sitting in a peat bath, a regular weekly thing I've been doing per my ND intern at the clinic. Jen is a 10th tri intern in the ND clinic who was on hydro laundry duty on the day of my appointment. At the end of last tri, before the holidays, Jen and I got to talking and I learned that she has family not far from the little Northern California town I moved from when I decided to come to NUHS to study naturopathic medicine. Jen had plans to travel there to visit over the break, and I thought she should definitely take a day to shadow the naturopathic doc I interned with and subsequently worked for during my last year living in California. It was relatively quick and easy to put Jen in touch by email with Dr. Ann, who graduated from SCNM and practiced in Arizona before moving her family to Tahoe for the mountain culture, outdoor environment and beauty.

2015-01-29_lunchbreak
On a lunch break from my work at Dr. Ann's office

When I first reached out to Dr. Ann in 2010, she responded promptly to my request to shadow her. I told her I was deciding if I wanted to go to school to become a naturopathic doctor and thought I should see the thing in action first. Dr. Ann was super welcoming and told me when I finally left after a year working for her that if I ever had any peers who wanted to shadow her she would be more than willing to have them.

Even though I hadn't been in touch with Dr. Ann since I mailed her a Christmas card two years ago when I first moved to Illinois, I was pretty sure she'd be receptive to my connecting her with Jen. I also thought she would totally get it that medical school keeps you so busy you don't have time to stay in touch like you wish you could... after all, she went through the same process at SCNM!

2015-01-29_lake
A vista from the drive from Nevada to the north end of Lake Tahoe

So last week when Jen slipped into the hydro room to put away some towels, I stopped her and had her regale me with stories of her visit to Tahoe and her day spent with Dr. Ann. I learned that my mentor's practice is growing and that one of the women who worked the front desk with me is still there, translating Spanish for Dr. Ann and helping to connect her with the robust local Hispanic community.

The most heart-warming thing Jen told me is that as she watched Dr. Ann do her work, she realized that the vision she has for her own future practice after graduation is a realistic one. There was Dr. Ann, working with her patients in a small, cozy, downtown office, charting while they told their story from the easy chair on the other side of the desk. Jen told me that she hadn't actually seen a real live naturopathic doctor at work yet, and that the experience was reaffirming and totally awesome. I have to say that thanks to Dr. Ann, I, too, know that feeling.

2015-01-29_boat
Beautiful Tahoe views made studying for Organic Chem (a prereq for coming to NUHS) easier!

If you are just looking into starting naturopathic medical school, I highly suggest you seek out a practicing ND in your area and ask if you can shadow them for a day or even just for a few hours. It will give you a picture of what you can expect, and will help you to keep that vision in mind when you are wallowing in the recesses of the library, trying to memorize things that seem so far removed from actual patient care. If you are a current student and have not yet had the opportunity to shadow a real live working ND, you should find one too! As far as I can tell, in our clinic we have our clinicians who oversee our work, but it doesn't seem quite the same as watching an ND go about the day in their own private practice.

One of the best ways to find a licensed ND in your area who trained at one of the accredited schools is to visit www.naturopathic.org and click on the link at the top that reads, "Find a Doctor." Or, ask around! You never know which of your professors or peers knows someone willing and able to take you on for a day. If you are not in a position to shadow an ND, or are not reading this blog post because you want to be one, becoming a patient is probably the very best way you can learn about naturopathic medicine.

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.

Photo of schedule
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.

Photo of shooting a pistol at firing range
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....

Photo of man speaking at dinner event
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!