Archive for tag: intern skills

Intern Skills - Dietary Assessments and Modifications

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.

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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:

  • Water Intake or hydration
  • Meats (unless vegetarian/vegan)
  • Vegetarian/vegan sources of protein
  • Vegetables
  • Fruits
  • Avoidance of grains (if necessary)
  • Healthy fat (Omega 3 Fatty Acid) sources
  • Dairy sensitivities
  • Estrogenic food intake and impact upon estrogen levels
  • Sugar intake
  • Fiber intake

...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!

Intern Skills - General Physical Exam

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.

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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:

  • Observing the patient, their demeanor, alertness and responsiveness
  • Observing the patient's skin for hydration, trauma, lesions, or color
  • Measuring height, weight and visual acuity both near and far
  • Taking vital signs: temp, heart rate, breathing rate and blood pressure
  • Examining the head and neck, including lymph nodes and thyroid
  • Testing all cranial nerves
  • Checking the internal components of the eye, as well as the lens and cornea
  • Checking the ear, sinuses, nose, mouth, and throat
  • Listening to the patient's lungs and heart thoroughly
  • Testing muscle strength in the patient's arms, legs, hands, and feet
  • Testing muscle reflexes in both arms and legs on each side
  • Testing patient's sense of joint awareness and planned movements
  • Performing a full abdominal exam, listening for bowel sounds (good)
  • Measuring the size of the liver and spleen through tapping and listening for a change in sound
  • Listening for any abnormal sounds in any major arteries of the body

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.

Intern Skills - Supplementation

This past weekend, Lauren and I went on a pumpkin search at a local farm here in Illinois. After a nice (yet not so healthy) snack of freshly made apple cider donuts and local fresh apple cider, we embarked on our journey through the corn maze to the secret pumpkin patch where we continued our hunt for the perfect pumpkin! As the day progressed and the sun shined in all its glory, we realized we needed some water, so we paused the great pumpkin hunt to stock up and refill with some high quality H20! Who knew that we would need to rehydrate on a little pumpkin search!? I guess that keeping hydrated is key to finding a great pumpkin. So, after filling up on water, we continued on our quest only to find pumpkin fudge instead! I guess supplementing with water doesn't help with finding the perfect pumpkin, but pumpkin fudge (in moderation) is a nice treat!

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This leads me to supplementation, another skill that is built and added to our doctor's toolkit here at NUHS. According to the Oxford dictionary, in general terms, to supplement is to enhance or complete something where a deficiency exists. In naturopathic terms, administering supplements acts in the very same way for human beings.

Supplementation can include a simple saline solution, water or electrolytes for someone who is dehydrated (on a pumpkin hunt), vitamins, amino acids or a combination of any of the building blocks, enzymes, cofactors...well, you get the idea...for any deficiency in a human being.

Just a few of the conditions that we treat with supplementation include...

  • Dehydration
  • Vitamin deficiencies
  • Anemia
  • Endocrine (hormonal) imbalances
  • Autoimmune conditions
  • Pre- and peri-natal care
  • Weight management
  • Geriatric care

Our supplementation training begins very early in our biochemistry classes with Dr. McRae, through our clinical experience training with simulated patients and practice cases until we reach the naturopathic clinic as interns. We learn the various methods of administering a supplement to achieve the greatest efficacy from the dose, whether orally, topically, or sublingually.

Through the appropriate use of supplementation, we can help our patients correct imbalances while incorporating and restoring the basic determinants for healthy living. Ideally, once our patients are returned to a basis for health, we will no longer need to supplement as their diet, lifestyle and habits can help them maintain a healthy state of living. For those who need supplementation, a properly trained naturopathic intern and doctor can provide the proper supplementation at the proper dose to help our patients be their healthiest!

Intern Skills - Botanical Medicine

Hi, everyone!

The autumn finally settled in here in Illinois this past week with crisp mornings and warm days. The trees have shifted in color just a bit on their topmost branches and I expect that we will see the full blossoming of autumn in the next two or three weeks.

This week I'll talk a bit about botanical medicine and our skillset that is developed both in our botanical medicine courses as well as in clinical practice. Botanicals are powerful tools in the naturopathic doctor's toolbox; proper instruction, use and avoidance are necessary to effectively help others with this form of our eclectic approach to medicine.

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LaKisha Brandon (9th Tri), Darius Lembert (10th Tri), and Joclyn Davis (9th Tri)
formulating and dispensing a custom tincture from our clinic dispensary.

My definition of botanical medicine is using plants and their constituent chemicals to help others heal. To that end we have a series of four botanical medicine courses before and during our clinical rotations here at NUHS to prepare us as new practitioners out in practice.

  • Botanical Medicine I
  • Botanical Medicine II
  • Botanical Medicine III - Advanced Botanical Prescribing
  • Botanical Medicine IV - Advanced Materia Medica

Dr. Lorinda Sorensen and Dr. Fraser Smith (Dean of Naturopathic Medicine) guide our ND students skillfully through this course sequence in a way that prepares our future docs with a wealth of information. We study the habitat, harvesting methods, parts of the plants that are used, and proper preparation from harvest to medicine. We are taught interactions (both beneficial and dangerous) with pharmaceutical drugs. Finally, we learn the proper times to use and avoid any botanical medicine, as well as the proper dosage method, amount and timing.

When in clinic, we custom prepare our own tinctures based upon the needs of the patient. We utilize the variety of professionally prepared, medicinal grade botanical preparations at our disposal in the clinic dispensary. We combine our botanical medicines with other therapies that can help our patients on the path to a return to their basis of health. This could be a quick turnaround or could take some time depending upon the pathology and methodologies utilized in the treatment plan. Through learning botanical medicine at NUHS, I feel that we are well prepared to enter our practices with a solid botanical skillset.

Intern Skills - Hydrotherapy

This week, I'll take a look at another of the skills that Naturopathic Interns need to master prior to graduation: Hydrotherapy treatments that we perform with the patients in our clinic as well as training patients for hydrotherapy they can do at home.

Some of the reasons that people would visit our clinic for hydrotherapy include...

  • Sinus congestion
  • Upper respiratory tract infections
  • Stress
  • Fatigue (common amongst Naturopathic Med Students)
  • Detoxification
  • Female menstrual issues

...just to name a few.

As we sit with each patient, gather the symptom picture, understand all facets of the patient's case, and work toward the center of gravity (or root cause) of the patient's complaint, we work with our clinicians to establish the best treatment strategy for our patients. Sometimes, this treatment plan includes a form of hydrotherapy.

After determining if hydrotherapy is appropriate and beneficial for our patient, we refer the patient to our hydrotherapy shift, which consists of our 7th trimester ND students. This is one of the best aspects of our program here at NUHS. Our students are not only being exposed to the clinic environment, but they are working in clinic under the direct supervision of a clinician as an observer at the halfway point in their education here, getting practical experience outside the classroom. That aside, we refer the patient with treatment plan to the hydro shift where "in office" hydrotherapy treatments such as these are performed.

Photo of Dr. Conner
Dr. Kristina Conner - ND Faculty

  • Naso-simpatico
  • Steam Inhalation
  • Russian Steam
  • Wet Sheet Pack
  • Constitutional Hydrotherapy
  • Sitz Bath
  • Poultices
  • Peat Bath

Finally, the high quality of hydrotherapy care here at NUHS is the direct result of the skill and knowledge shared by Dr. Kristina Conner, who teaches our hydrotherapy classes in the tradition of Father Kneipp and Dr. Henry Lindlahr, both pioneers of naturopathic medicine. Dr. Conner has perhaps the most thorough labs that I have experienced here at NUHS.  We are immediately thrust into treatment in a lab setting, learning the skills that are necessary for accurate diagnosis and application of hydrotherapy treatments. As a result, when we start performing hydrotherapy treatments in the clinic, we are prepared for our patients. Hydrotherapy, a powerful treatment option, is one of the more solid skillsets I will take with me from NUHS.

I will cover more of our naturopathic intern skillsets in the coming weeks. Until then, I'll be by Janse pond.