Archive for tag: naturopathic

Naturopathic Medical Philosophy

2013-11-20_edwardsHi, everyone!

This week I'll start a series on naturopathic medical philosophy.

Here at NUHS we are fortunate to have Dr. Louise Edwards as the cornerstone instructor for the philosophical portion of our medical education. Dr. Edwards has developed a strong curriculum that incorporates all of the ideas I will be discussing over the next few weeks. With her permission, her words will appear verbatim in this blog where the circumstances are most prudent to do so. This week, I'll begin with the basics, the Naturopathic Model and our primary goal as naturopathic doctors.

The Basics 

Naturopathy is treating suffering (pathos) according to the laws of nature, using natural means.

We, as students and interns, are trained to use the most natural, least invasive methods that are within our scope of practice to help our patients return to a state of health. If higher force interventions are necessary to help our patients heal, then we will refer to a specialist for co-management, just as any other primary care provider would do.

The Naturopathic Model

  1. Health is a constant and natural state of being.
  2. Ill health is an adaptive response to disturbances in the organism.
  3. The universe is ordered and intelligent. Healing is a process that is ordered and predictable.
  4. Removal of disturbing factors (correcting the disturbances in the Determinants of Health) will create the basis for a return to normal health.
  5. Intervention should involve the least force necessary to stimulate the self-healing mechanisms.

Through recognizing and working within the Naturopathic Model, we are able to determine the root cause or "center of gravity" of a patient's divergence from a state of health. With an understanding of the root cause, we can then implement the naturopathic therapeutic order, which I will discuss in coming weeks.

Re-Establish the Basis for Health

Finally, our primary goal as naturopathic doctors is to "re-establish the basis for health." 

We accomplish this through correcting the disturbing factors impacting a patient's healthy state of being.  The patient's disturbing factors can also be described as their "Determinants of Health." Next week, I'll discuss these determinants and how they impact a patient's health, over the short and long term.

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 - 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.

Two Fellow Interns

This week I'm profiling two naturopathic interns, Heather Bautista and Echaukyei (Chucky) Ndumbi. Today, as the two of them were sitting discussing their future practices and the lives they would improve and save, I decided to set up an impromptu interview.

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Echaukyei (Chucky) Ndumbi and Heather Bautista

Heather Bautista is a native of the Chicago area. After working in the pharmaceutical industry for a number of years, Heather saw how disease was being "treated" and not healed, across the spectrum. She decided to pursue a career that helped others heal through learning proper lifestyle choices and habits. She chose a profession that gets to the root cause of a problem and finds a way, where possible, to remedy that problem to return the person to a basis for health.

When Heather was considering medical school, her experience with the pharmaceutical industry was a strong consideration in her decision to pursue naturopathic medicine as opposed to allopathic. She has a strong desire to help people heal rather than take a course of medications for an indefinite period, many times simply masking a deficiency or illness. When asked what gives her motivation for becoming a naturopathic doctor, Heather mentioned the complete sense of accomplishment and fulfillment that comes with helping another human being truly heal.

Chucky is a native of Cameroon. After his family immigrated to the United States in his early teens, he decided to continue the tradition of becoming a healer, as his family has been in Cameroon for generations. Chucky remembered how healthy his friends and family were as they consumed vegetables, fruits and meats from their farms and lived a healthy, active lifestyle. Chucky came to his decision to pursue naturopathic medicine as it espoused a lifestyle that is crucial to the basis for health as well as being eclectic in preventing, as well as treating, and curing disease, when prevention is not enough.

Chucky chose NUHS based upon the location of our campus to his home in Maryland. Chucky knew he wanted to pursue naturopathic medicine and he said he truthfully could not have prepared himself for the rigors of the basic sciences portion of the curriculum here at NUHS. Essentially, when he visited campus, he fell in love with NUHS. Chucky feels that NUHS is preparing him to become an eclectic naturopathic doctor who will use the proper modality to help his patients heal to the greatest extent possible.

Each of the students who roam the halls of the naturopathic clinic know that when strictly looking at the mathematics of the cost of naturopathic medical school vs. allopathic medical school, the costs are very similar. At the same time, the residencies are not as plentiful, the backing of huge pharmaceutical and medical supply companies is non-existent, and the starting salary of a newly matriculated and licensed naturopathic doctor is a fraction of a new allopathic doctor's. While these are the hard facts as the profession stands today, we are growing as a group.

The success stories are mounting as NDs set up practices throughout the country. We are licensed in 17 states and U.S. territories at the time of this entry's publication. As our numbers are currently around 6,000-7,000 NDs in the USA and Canada, the word is spreading that our medicine works to get to the root cause of illness. Somewhere I've read that about 25,000 practitioners is the critical number to truly have an educated populace who knows of our profession and how we approach medical care. If this is the case, we are doing a pretty good job until now getting out the word about Naturopathic Medicine, in 17 of the 50 states so far.

As Heather and Chucky expressed today, most naturopathic medical students are not here for a huge paycheck. While we all acknowledge that we need to make enough to repay our student loans, pay our bills, live a good life, and save for retirement, our true purpose here is to save lives.

Farewell Dr. Baltazar - Part 2

Dr. Kelly Baltazar's positive impact on the Naturopathic Clinic here at NUHS was immense. That was evident from the blog entry last week, as well as comments from all of our interns currently in clinic, including those who have graduated. 

The outpouring of support and best wishes on her new journey was so great over the past two weeks that I am sharing comments from Dr. Baltazar on her journey as part of the founding team for the Naturopathic Clinic here at NUHS and her transition to Cancer Treatment Centers of America. 

Dr. Baltazar and I were able to sit down together and talk about her experiences here at NUHS as well as her plans for the future. These are quotes from the conversation we had, in Dr. Baltazar's words.

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Dr. Coe and her ubiquitous camera with Dr. Baltazar at her going-away party

What was it like to start up the Naturopathic Clinic at NUHS?

"A lot of excitement, a challenge, a sense of a 'huge task in front of us' to not only get it started but to develop a quality clinical experience."

What were the greatest challenges?

"The basic tasks of creating forms, handouts, patient scheduling, and how to fit it within the existing NUHS clinic. How will we create the structure of the clinic? The most challenging part of the process has been managing all the behind the scenes work to ensure that both the day-to-day and the big picture remain solid." 

Can you compare the first cohort with today's processes, workflow and patient interactions and the path to accreditation in such a short timeframe?

"Throughout the years, much refining of the process, with a lot of strategic decisions needing to be made and refining the details as we went. When the news came in October (2012) that we had gained accreditation, a sense of true accomplishment." 

How did you feel at that moment with regard to your role here at the NUHS Naturopathic Clinic?

"After that moment [accreditation], I felt like my task was complete and then time to think about a new endeavor for my professional and personal growth. I have set and maintained high expectations and clinical standards and the culture is in place and that is one thing that I am very thankful for." 

What next?

"I will be pursuing other professional interests and avenues that will provide professional growth for me. Moving back to patient care in a direct role rather than a teaching/mentor role as a naturopathic oncology provider at Cancer Treatment Centers of America. Time for personal life for a little bit. I will be getting married and hope to continue to run in marathons and half-marathons, cycling with my fiancé and gardening!" 

What would you like for your legacy to be?

"Accreditation and helping with the process as well as building a clinical program to meet the standards of accreditation." 

What was rewarding to you in your role as Chief Naturopathic Clinician?

"Those 'aha' moments when you can see a student truly capture a 'concept' was rewarding! However, the most rewarding aspect of my job has been seeing graduates become successful naturopathic physicians."

Thank you for doing the "grunt" work of forming, building and improving our Naturopathic Clinic to the point of accreditation. Thank you for answering the same questions from multitudes of interns day-in and day-out. Thank you for keeping a smile on your face and calm in the flurry of Student Clinic. Thank you for being a helping hand, a guide, mentor and leader.  

We will miss you, Dr. Baltazar.