I'm bent over my desk at home flipping through the pages of
lecture notes from Nutritional Biochemistry, all the way back in
4th Tri, and light bulbs are glowing on the left and right
inside my little overwhelmed brain! I know we all learned this
stuff 2 years ago and we got decent grades in the class so we
should know these things, right? Well, I think we do, we know the
stuff, it's just buried under several layers of information we've
added to the pile since then.
We Laugh Every Day to Stay Human
There is just so much information about the body to try to keep
in the easily accessible shelves of my brain! In addition to
keeping that Nutritional Biochemistry within arms reach I've been
trying to keep my vision of the future close in my mind's eye. A
bunch of us 9th tri interns (plus Jack, a 10th tri) met
up at Wendy's place on Thursday last week and brought with us
stacks of magazines and pieces of cardboard (box discards from a
recent shipment of Cleveland Lab supplies). We snacked and sipped
water or bubblegum pink cocktails (what exactly was in those
again?) and paged through magazines, cutting out phrases, words,
and pictures that represent our individual visions or desires for
the future. I wish I'd taken a picture of all of us in a circle
with magazine scraps scattered everywhere! I'll have to settle for
sharing a picture of my vision board created that night.
This is the challenge, I guess, when we get to this point in our
education; remembering all the doctory and sciencey stuff we've
learned over the past 3-4 years while also holding a vision of our
desires for the future close in our minds. There is so much to
think about! And all the while, we are working with sick or
uncomfortable people for 5-6 hours every day in the clinic. This
fact helps illustrate the simple truth that each day we are exposed
to things that have the capacity to bring us down, fill us with
negativity, and suck the positive energy right out of us. And so we
have a need to keep laughing and smiling in the midst of exposing
ourselves to dis-ease all day, every day.
As interns we laugh together over the difficult cases not
because the patient's case is funny, but because we are just
constantly stunned at how much we know, how much we thought we
knew, and also how little we realize we know now that we're putting
all the pieces together. We laugh at the frown ironed into the brow
of our intern friend who is writing as fast as she can to finish
that chart before 6:30pm. We laugh at the blank looks we give our
clinicians when we realize we have forgotten to ask that obvious
question of our patient that will help us differentiate between A
and B. We laugh when we recount our attempts to explain a
biochemical process or a bodily function that is relevant to our
patients' condition. We smile when we try to recount the details of
a visit to our clinician and realize our patient is wordier than we
are, and has given us 9 stories all rolled up into one confusing
gob of elaborate health history.
And with every smile and laugh and helpless giggle and humorous
sigh, we bring some sensitivity back into ourselves. We realize the
humanness of our patients and of ourselves and of the makers of
drugs and supplements and healthcare laws and blood test kits. We
are all just here in this healing journey, mostly all trying to
help and get by and ignore the folks who are just in it to make a
buck. Because -- edicine is one of those professions where the job
is never done. Life is a challenge to our health and we aim to get
our patients to it fully. Thus, our very mission works against
itself! How will I ever see my vision come to fruition if I don't
smile and laugh and come back into my own person every day?
Happy Belated Naturopathic Medicine Week! Last week was our
nationally recognized time to celebrate and promote our medicine
and in the spirit of that I will try to answer that question we are
all constantly asked, "What IS Naturopathic Medicine?"
Here's my little elevator speech: I am a student of naturopathic
medicine. As naturopathic doctors, we are trained in primary care
and specialize in natural and least-invasive therapies. We are
trained to diagnose and treat disease and we work to address the
cause of disease, rather than just treat the symptoms. We aim to
engage our patients in their own healthcare.
If I have a captive or particularly interested audience, I'll go
on to explain that we train in an outpatient clinic, rather than in
a hospital, but because we train specifically as primary care
doctors this environment is most appropriate. We do not rotate
through specialties as conventional MDs do; rather, we take those
specialties as classroom courses while we are in our internship,
seeing patients in our outpatient clinic. Our year-long training in
an out-patient setting prepares us well for practice because we are
providing direct primary care (with the supervision of our licensed
clinicians) on a regular basis to an established group of
When we graduate, residencies are optional and competitive. Part
of the reason our residencies are optional is that our profession
has to privately fund these opportunities. Did you know that
conventional MD residencies are funded by Medicare? At this time,
naturopathic doctors are not recognized by Medicare, and thus our
residencies must be privately funded. So, there are the basics.
Now, if I have an especially engaged audience I may launch into
explaining our Therapeutic Order, or how a naturopathic doctor
orders their thinking when it comes to a patient case.
Whew! Thanks for sticking with me this far! There is no way I
could explain everything about a naturopathic doctor's thought
process in one (long!) blog post. Readers should know that our
training includes pathology, and so when I write about treating the
engaged organs and systems, that is informed by our understanding
of pathology and diagnosis of disease. I could go on and on! But
for now, any questions?
I'm drinking hot coffee and eating cold apple crisp, leftover
from a mini-Thanksgiving dinner Hanzi prepared on Friday evening.
We haven't had much time to cook dinners at home because if I'm not
working in clinic until 7, Hanzi is in class or working until 9pm.
A few more months of this and then, fingers crossed, we'll be back
to a relatively normal schedule with evenings free for home-cooked
But in the meantime, I'm savoring my student life. I know I have
7 months to go before graduation but I can tell things are
changing. I'm realizing that pretty soon I won't have all my
wonderful ND student friends around every day. I've always known I
like to be around people, but it hit me especially hard the other
day when I was laughing over a frustrating case with one of my
fellow interns and realized that in a few months I might not have
this kind of camaraderie to fall back on when I'm feeling spread
I realize now the importance of networking with my fellow NDs
and NDs-to-be because I need them there to call on when I am
frustrated or stuck on a case, or when I want to share a triumph.
Everyone has always said to us, "Call or email your professors when
you leave here. When you have questions, we are here for you!" And
now I'm understanding why they make that offer; because leaving the
comfortable clinic environment here at NUHS where everyone supports
my thinking process and treatment plans is probably not going to be
easy. These revelations are particularly appropriate given my
experience this weekend attending the ILANP's (Illinois Association
of Naturopathic Physicians) 3rd annual conference on campus.
Samples, schedule and connections made--ILANP conference
This was my third time attending the conference and I am proud
to say that I actually understood all the lectures this year! For
the first time ever, I realized why conferences are so amazing for
doctors in practice. I was scribbling down ideas as presenters
spoke on issues that directly related to my patients! I now have a
good collection of thoughts to bring to my clinicians for their
input on how my new knowledge can apply to the treatments I'm
offering my patients. It was definitely a light-bulb moment. I've
watched clinicians do this kind of thinking in seminars and
conferences, lectures and classrooms for years now, but for the
first time I actually got to join that club!
My favorite lectures at the conference this weekend came from
Dr. Lise Alschuler, a remarkable ND who taught several of our NUHS
professors in their med school days, from Dr. Crystal
Foresman-Landers on supporting breastfeeding moms, and from Dr.
Cristopher Bosted, who practices in Seattle and treats chronic pain
and transgender patients. Dr. Alschuler is a brilliant presenter
because she is able to zoom in and then zoom out effortlessly,
focusing on reductionist research and then seamlessly bringing it
back to the big picture philosophy of naturopathy. I aspire to
present information so well and with such an ability to explain
every little biochemical process, maybe some day! There is a depth
to Dr. Alschuler's knowledge and an ability to articulate it that I
have rarely encountered so far in my world.
Practice Management class outside on the dock on a beautiful
Besides attending the conference on the weekend, we 9th tris had
Practice Management class outside on the dock, practiced suturing
again (it's getting easier!), and got to see lots of patients in
clinic, especially as many of our first trimester students are
coming in for their physicals. And now, it's Naturopathic Medicine
Week and I gotta tell you all, the leadership within our NMSA is
absolutely rocking things these days! We have events all week long
to celebrate our medicine! Ah! I just love what I do.
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 firstname.lastname@example.org.
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....
• Leaves, Flowers, Berries, and Bark
• Farmer's Market
• Should I Study Massage Therapy, Too?
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