We Laugh Every Day to Stay Human

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. 

2015-10-21_vision _board
Vision Board

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?

What IS Naturopathic Medicine?

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 patients.

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.

  • Level 1 is Reestablish the Basis for Health.
    This means we look at the basics (in some ways comparable to Maslov's hierarchy, if you are familiar with that): food, water, air, shelter, sleep, exercise, spirituality, access to healthcare, toxic exposures, love, and community. Every single naturopathic treatment plan addresses some aspect of Level 1.
  • Level 2 is Stimulate the Vis.
    The Vis Medicatrix Naturae is the healing power of nature. When a surgeon stitches up a wound, dresses it, and sends a patient home to heal, he or she is relying on the healing power of nature, or the body's ability to knit that tissue back together. A naturopathic doctor might use homeopathy or acupuncture to support the Vis. In truth, every therapy we offer, including nutrition and a good night's sleep attend to the Vis because each therapy supports the body's ability to heal itself.
  • Level 3 is Tonify Affected/Engaged Organs and Systems.
    Here is where we apply therapies in a general sense. We prescribe liver-supportive foods to help a woman with PMS and menstrual cramps because the liver clears hormones that contribute to these ailments. In almost every patient we address the GI system because "we are what we digest." That is taken from that phrase, "You are what you eat," but we know that if you cannot digest the food you eat, then how can you assimilate those nutrients into your body and use them as building blocks?
  • Level 4 is Correct Structural Integrity.
    At NUHS, we go to school with chiropractic students and in that process we take adjusting classes with them. We learn to align the spine and extremities, and we learn some soft-tissue therapies like massage. We pay attention to all aspects of the physical body, including the structure, in order to optimize healing and maintain wellbeing.
  • Level 5 is Prescribe Specific Natural Substances.
    This is where many integrative doctors work, and where many of our patients assume we operate. This could be considered the level of "green allopathy," or replacing a drug with a natural substance. A naturopathic doctor uses therapies at this level when necessary, especially to help with palliation when a patient feels really sick, but we recognize that none of these "green" therapies will offer full recovery or true healing if we neglect the first 4 levels that come before it. This is where we categorize the use of botanicals and other natural substances that address specific pathologies. For example, giving a pain-relieving tincture of Viburnum to our patient with menstrual cramps. When these natural therapies "don't work" we must remember that a patient needs to attend to all the aspects of their being for nature's healing to work best. If someone eats Big Macs for every meal, they cannot expect plants alone to heal their pain.
  • Level 6 is Prescribe Specific Pharmacological or Synthetic Substances.
    Here is where most conventional medical doctors operate and where naturopathic doctors are trained to operate as well, when necessary. Sometimes we need to use pharmaceuticals in more dire situations in order to pull a patient out of a dangerous place. It is never our goal to keep a treatment plan at this level. This is a high level of intervention reserved for when it is necessary, but avoided if possible.
  • Level 7 is Use Higher Force Interventions.
    This means things like surgery and other invasive procedures. There are times when a patient needs this kind of care, for example, if they have been in a car accident and have broken bones. We will send this patient off for surgery, but will also offer supportive care at all the levels leading up to this one. We will offer everything from foods that support healthy inflammation, to homeopathics that assist bones in healing, to massage that keeps the muscles from going into spasm, to botanicals to dampen the pain and support healthy tissue regeneration in healing.

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?

Savoring Studenthood and Conference Revelations

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 meals!

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 thin. 

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 spoils

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 Thursday morning

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.

Med School Firsts and More Traveling

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 presentation.

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 tight....

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 NH.

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 medical school. 

Hanzi checks out the White Mountains scenery from a covered bridge.

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 mckenziemescon@student.nuhs.edu.

Clinic Collaboration, Gorgeous Weather, and Work To Do!

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 GI tract.

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 causes pain.

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 state.

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....