One of the many skills that we develop while here at NUHS, and
perhaps one of the more important, is taking an assessment of a
patient's typical diet. Once we have a good diet recall or diary
from a patient, we can determine the benefits and drawbacks of the
patient's diet, the impact (for better or worse) upon the patient's
health, and then we can make modifications as necessary to help the
patient return to a basis for health.
Intern Heather Bautista taking a dietary assessment from
Intern Jerrica Sweetnich.
We start by getting a log of a patient's typical weekday and
weekend diets as many people eat differently on the weekends than
they do during the workweek. After a review of the diet with the
patient, we consult with our clinicians regarding the patient's
chief complaint, review of systems, health stressors, and treatment
plan. Part of the treatment plan involves modifications in a
patient's diet and may include the following:
...just to name a few.
Dietary modifications are a key tool to help our patients return
to a basis for health. Our health begins with the nutrients we
provide our bodies for building strong muscle, bone, nervous
tissue, and preventing or fighting infection.
With that said, I'll grab a healthy bite to eat and make my way
to clinic for the afternoon shift. This evening its time to carve
pumpkins by the fire pit and make ready for Halloween!
This past week was spent finishing and polishing my presentation
for Grand Rounds titled "Safely managing prehypertension and stage
1 hypertension with botanicals." This is a subject that is close to
my heart if you will since hypertension and strokes are a common
occurrence on my father's side of the family.
Hypertension has been called the "silent killer" as a patient
may not notice any symptoms until a significant medical event such
as a stroke or heart attack occurs. A skilled, thorough doctor
performing a routine general physical exam can sometimes uncover
masked symptoms, which a patient may not even be cognizant about. A
well-performed physical exam can help prevent illness or even
prevent an early death.
At NUHS, we are trained on basic physical exam skills beginning
in our second of 10 trimesters. We are taught to fully examine the
patient through observation, listening, touch, and measurement. As
we progress through the curriculum, we build upon our basic
skillset and learn to interpret what we discover. This
interpretation is honed under the guidance of our clinicians in the
Whole Health Center and satellite offices.
A quick rundown of some of our exam procedures includes:
This seems like a lot to do in one visit, especially if the
patient is in a hurry. We have the physical exam presented so
often, that by the time we are in clinic, we can perform this exam
in 30 minutes or less! This gives plenty of time for the remainder
of the patient visit and conversation. The general physical exam is
intended as a screening tool to determine if more focused
examinations are required for the patient. The physical exam
skillset we learn at NUHS helps us to target key systems with
quick, accurate examinations. When in practice as primary care
doctors, we will rely on this skillset each day with our future
patients. These skills will help us save lives.
Time to settle into the weekly routine again, albeit things are
a bit different this trimester. With class and clinic rotations 5
days each week, along with work on the side during some mornings
and each weekend, time is a precious commodity.
This is what a typical clinic schedule looks like for a 9th/10th
trimester ND Intern.
During clinic, we sit down for "preview" each day to discuss
upcoming patient cases and strategies for best helping our patients
in a roundtable discussion. This is a "safe zone" to bounce ideas,
debate the best strategy amongst peers and under the guidance of
our clinicians. The idea is to share knowledge through discussion
in a practical manner without judgment. This approach allows us to
discuss all treatment modalities, their benefits, drawbacks and
limitations, then move forward with the best overall treatment for
After preview, we see our patients, chart, research, develop and
bring our suggested treatment plans to our clinicians, who vet the
plans and approve or amend as required for the benefit of our
patients. We must complete all of these tasks during our shifts as
HIPPA regulations dictate that no patient records leave the
premises. We learn quickly to be accurate, concise and have all
work completed by the end of the day out of necessity.
Even though this seems like a lot of work, clinic is a fun,
nurturing environment that I look forward to every day. The smiles
on patients' faces when they begin to feel better, heal and share
is priceless! The patience, knowledge, skill and care that our
clinicians share with each intern on a daily basis set an excellent
example for all of us as future doctors.
Me with Carrie (left) and Juanita (right), both 6th trimester
The photo I'm sharing this week is of two friends and me. I was
printing something at the library the other day and ran into them
after having not seen either for about two months! This made me
realize that I was separated from the rest of campus now that I'm
in clinic and needed to visit my old friends still in their
clinical courses. Challenge accepted...
Hello to everyone! I hope you enjoyed your summer and are ready
for what appears to be a great fall season!
I was able to relax a bit, recharge, hike some trails back home,
and be the first person at the top of Mt. Mitchell (highest point
east of the Mississippi at 6,683 feet) for sunrise one morning
during a hike. The view was incredibly beautiful and being able to
sit, think about the past few years of school, the challenges,
rewards and decisions to come while watching the sun rise over the
southern Appalachians was one of the more peaceful moments of the
past few years of my life.
At the same time during the break, I caught up on some personal
reading that I had put off for over two years as well as some
reorganizing, consolidating and reducing for the inevitable move in
about 8 months.
Now, for the homestretch in clinic!
Here is how the Naturopathic Clinic is currently structured:
Previously, 8th Trimester interns could only see other students,
not the general public. This left many students with seeing a new
intern every four months as ONLY 8th trimester students could see
other students. So, when an Intern moved to 9th trimester, they
would transition the student patient to a rising 8th trimester
Now, students and the general public have the opportunity to see
interns beginning in 8th trimester, and, if the condition warrants,
remain with that intern for up to a full year. This helps to build
rapport and trust with the patient as well as helps the Intern with
seeing a resolution to more ailments than was previously
Finally, the most appealing aspect to this new structure, in my
opinion, is that now our naturopathic medicine students are
spending half of their education in a clinical setting! Again, in
my opinion, nothing trumps experience and "hands on" training when
learning a new skill!
Time to get back to the books! Talk to you next week!
This morning, I sit at my spot by Lake Janse and watch my
classmates walk into their last few exams as I do a small
walkthrough of my last final for the trimester, Minor Surgery.
I think of all the preparation, stress, notes, charts, diagrams,
decision trees, memorizing, practicals, dissecting, adjusting
lab...ahhh! Adjusting?!?! I'm going to be a ND, why in the
world do I need to know how to adjust somebody?!?! This was
something I heard, and even said, early in my education here at
NUHS, a historically chiropractic school.
Well, as things turned out, adjusting was highly important for
me to remember in my first trimester as an intern. Three of my
patients required manual adjustments along with physiotherapeutic
treatments (ultrasound, etc.) and soft tissue (i.e. muscle, tendon,
etc.) manipulation. As a result, I was forced both to remember and
to go back to dig through old notes on modalities I thought I would
rarely, if ever, use in my practice.
The extensive therapy that these patients each needed to return
them to a basis for health included physical medicine, part of the
naturopathic therapeutic order, as well as some supplements and
analgesics specific to their needs.
My patients, through their needs, visits and therapies, helped
me to complete my physical medicine and manipulation requirements
for graduation in my first trimester in clinic! These are
modalities that are typically completed much later in the
naturopathic internship. My physical medicine patients this
trimester have taught me a number of invaluable lessons.
My experience with the physical medicine aspect of our training
here has given me a bit to think about over this coming break and
in the coming months. I am now considering, considering mind you,
pursuing a chiropractic degree upon completing my naturopathic
training here at NUHS. I feel that having both degrees will give me
a more complete tool kit to offer patients as a Natural Medicine
Primary Care Provider. Of course, time and financial resources are
considerations in that "consideration."
Finally, I feel it's important to mention that this past week
was President Joseph Stiefel's first graduation ceremony at NUHS. I
enjoy sharing a "Good Morning" and short conversation with Dr.
Stiefel as we pass on his walk from his home to his office each
morning. In the photo, each of us is getting a "dry run" on the
graduation portrait--his for about 200 graduate photos at the
ceremony and mine for roughly 8 months from now. I enjoyed seeing
him speak to our graduates and their families and am proud to have
Dr. Stiefel as our new President. (Small trivia fact: Dr. Stiefel's
wife, Dr. Holly Furlong, was the very first blogger for NUHS.)
So, with only two trimesters to go (or possibly more if I return
for the chiropractic doctorate), I am looking back at what I have
learned, what I need to brush up on and explore new skills for my
future practice. This is what I will think about when traipsing
over the mountain trails back home over the next two weeks. Until
then, may the rest of your summer be relaxing, fulfilling, and help
you make the decisions you need to guide your future in the proper
direction for you.
• Combined Classes
• Observing in Clinic
• Botanical Medicine
• Minor Surgery
• Intern Skills
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