Archive for tag: nd

Time for Graduation

In just a few days, after more than four years, I will walk across the stage, accept the Doctor of Naturopathic Medicine degree and begin the next stage of my journey. This week I thought I might write a long retrospective on my time here, or perhaps list a lot of names of friends, colleagues and mentors. Instead, in the spirit of what this blog for the naturopathic program is supposed to convey, I will write a bit more about the program as I sign off and hand the torch to the next blogger.

Being a Naturopathic Student at NUHS

As with any institution, relationship, job or task, the naturopathic program here at NUHS has attributes where it excels as well as challenges. In many cases, those challenges help the program to rise in other areas. One prime example is that we attend a traditional chiropractic university. This means we may not immediately be perceived as a bastion of naturopathic medicine and we get a lot of physical medicine in our classes. I used to complain about this as much as any other naturopathic student. We are becoming primary care and internal medicine docs, so why would we need all this adjusting, physical therapy, soft tissue work, etc.

After more than a year in the clinic, I am happy that we were trained so heavily in physical medicine. Many of my patients benefited from some type of soft tissue work, physical therapy or modality. I attribute the combined use of all tools in my naturopathic toolbox to helping many of my patients achieve positive outcomes.

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Whether physical medicine will remain a part of National University's naturopathic program remains to be seen. As our scope is defined and made into law in Illinois in the coming years, combined with the maturation, refinement and focus of our particular school's curriculum, we may emerge as a naturopathic program focused on the original vision and philosophy of naturopathic medicine as the old naturopathic doctors saw it. I am certain our program will combine that wealth of traditional medicine with the advantage of evidence-based medicine to support the clinical observations of nearly 150 years of North American naturopathic practice.

Many who email me ask what to expect here at NUHS. I say expect what you see in any organization. Those who are highly motivated to learn everything they can, those who are trying very hard and struggling, those who will skate by until they enter clinic and slam head first into a brick wall, flounder, then either learn to perform or wash out. Students who enter here will be amazed, inspired, challenged, dejected, angered, overjoyed and feel an incredible sense of accomplishment. You will be challenged by those in the allopathic community on how your medicine can work alongside their medicine (or even work). You will be ignored by family and friends who see you as their child, sibling, friend, and anything but an aspiring doctor. You will feel overwhelmed at times knowing that you are in a program every bit as (and more) challenging than allopathic medical school with as much or more cost involved, and all the while able to practice currently with a recognized scope in less than half of the United States of America.

At the same time, you are learning a type of medicine that truly follows the naturopathic principle of Primum Non Nocere or "First, do no harm." We learn to take the totality of the patient - mind, body and soul - into account. We get to the root cause of the illness and work with our patients (and other providers) to help them return to their basis for health. We learn that healthy means different things to different people and that the basis for health is a moving target as human beings encounter different circumstances, health challenges and ages throughout a lifetime. Whether this is primary lesson learned by others while here, this view that none of us "fit into a defined parameter" is the view I will carry forward in my future practice. Each patient is unique, with a unique set of symptoms, life experiences and exposures that define that unique individual and their resulting unique path back to health.

I purposely have not been using much medical terminology as I have written this blog as, quite frankly, I feel that gets boring for those who want to know what this medicine and school are all about. When you attend NUHS, you will get your fill of CBCs, CMPs, URTIs, ARDS, ECGs, TVUS, MTHFRs and HSCRPs. These terms have their place in the classroom, not in a blog discussing life in a medical school unless as a passing reference. My hope has been that I have given a glimpse into the life of a naturopathic medical student transitioning from basic didactics to clinical sciences and finally through internship and graduation.

Thank You...

Finally, since I have shared my life for the past two years, I'll be a bit selfish and will thank some folks who have made strong, positive influences on my life.

My parents Rosco and Bobbie Joe Ammons - two people who have 8th grade educations and taught me to read before kindergarten and instilled the strong value of always educating oneself regardless of career choice. More so, for teaching me honesty, giving others credit for success and accepting failure as a motivator to persevere. I love you both!

My sisters Kristie, Karen and Kathy - for being the glue holding the family together back home as I continue my wandering through life and the eastern half of the North American continent.

My great friend Richard - who has shared his loyalty through both good and terrible times. You are a symbol of the power of true friendship!

My former wife Sara - Thank you for a shared journey of learning, growing and opening my eyes to living a healthier life, in many ways. You are the catalyst for this endeavor.

Ignacio and Christina - Thank you for being incredible mentors, both philosophical as well as practical. Your patience is extraordinary and your ability to put things into perspective on both a micro and macro level is a gift I cherish!

NUHS' Chief Naturopathic Clinician, Dr. Julia Liebich - Thank you for leading by example, keeping the clinic a positive, cheerful learning environment during a time of transition in our lives. You always ensure that we have our patients' best interests and health as the focus of our care and procedures!

Finally, my very significant other, Lauren. Thank you for teaching me that who we want in our life is not necessarily the person we expect and that each day in a relationship can be more joyful, playful and rewarding than before! You make me smile and I'm grateful for the time we have together!

With that, I begin my particular path forward. I plan to continue a blog as I set up and build momentum in my practice after school. I'm sure you will be able to "google" me if you are interested in continuing to read my ramblings. I wish you the best on your own journey, whether it includes NUHS or not. You know the correct path for yourself! May your journey be safe, fulfilled and successful in whatever you choose and may it bring goodness and healing to the world in its own way!

All Requirements Complete

Well everyone, I sit here writing the blog this week unofficially finished with all classes, patient visits, competency requirements, file audits and procedures, with the exception of finishing my clinic hours over the coming week.

These are the minimum requirements as they stand for me as I graduate on April 17th. In many cases, all of the interns have accomplished far more than the minimum for many of these requirements. These requirements evolve as the clinic grows and matures, so if you are starting now, you should see an expanded skillset in future trimesters!

  • Total Clinic Hours: 1230
  • Primary patient visits: 225
  • Secondary patient visits: 225
  • Total Patient visits: 450
  • First Office Intakes: 20
  • Screening (Full Body) Physical Exams: 15
  • Complaint Oriented Physical Exams: 30
  • Orthopedic Exams: 10
  • Female Sensitive Exams: 3
  • Male Sensitive Exams: 3
  • Dietary Assessments: 25
  • Dietary Modifications: 25
  • Nutritional Supplementation: 25
  • In Office Hydrotherapy: 20
  • Physical Medicine (PT): 15
  • Manipulative Therapy: 15
  • Homeopathy, Acute Remedy: 15
  • Homeopathy, Constitutional Remedy: 1
  • Botanical Medicine, Tincture: 10
  • Botanical Medicine, Product: 20
  • Venipuncture: 15
  • Lab Reporting: 15
  • Outreach Hours for Clinic: 20
  • File Audits: 15

Photo of Hydrotherapy Room with Hubbard tank
Hydrotherapy Room

Speaking of requirements, since I have finished mine I'm helping out the interns currently working on the hydrotherapy shift, assisting the 8th trimester interns with their patients, updating paperwork and mentoring those following me in clinic. I have shared a pic of one of the hydro rooms with the Hubbard tank (as a peat bath fills) and the Russian steam cabinet. In other words, plenty of work is always available in the NUHS naturopathic clinic. Patients are filling the waiting room as they discover our clinic and all it has to offer!

Well, next week will be my final blog as a naturopathic student and intern here at NUHS. I'll do my best to capture the feeling, emotions and challenges ahead with my entry next week.

Four Weeks to Go

I admit that I'm starting to reminisce already about my time here at NUHS. Here are just a few of my thoughts this week as things start to wind down and rev up for the next part of this adventure!

As each of the 10th trimester Interns complete their patient numbers and competencies, transition their patients to the Interns advancing from observation to the main clinic, and prepare for the next step beyond graduation (whether joining or opening a practice, continuing with another license or starting a family), I believe each one has taken the first step on a journey of helping others with minimally invasive therapies to become healthier.

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Spring 2014 will see 11 new doctors of naturopathic medicine graduate from NUHS. These doctors will be prepared to help those with chronic illness determine the underlying cause of their disease, and where possible with the therapies that we are taught to utilize and our rigorous training on the human body and its functions, work together as teammates to return our patients to their basis for health.

This is a bittersweet time for many of us. Those of us who have developed close friendships over the past 4-5 years and fostered a sense of teamwork, cooperation, learning, teaching and accomplishment will be stepping out on our own. We will be making our way in the world as healer, educator, family, friend and human being. While we will be making our singular way, we know that we will have the support of our colleagues, loved ones and our patients.

Ultimately, the support of our patients is the driving force that allows us (motivates us) to take the next leap as we begin our journey in a profession with a scope that currently exists in only 18 states and territories along with the District of Columbia in the United States. This is both an exciting and scary time for many, especially the younger new docs who are stepping out into the working world for the first time. I continue to encourage my colleagues with the notion that they are very well educated, well trained new naturopathic doctors who are going to make a positive, healing impact upon their patients' lives. As long as that is their motivation and they manage their practice wisely, they will be rewarded with a full practice as word of their expertise spreads.

Until next week, most likely with a bit more reminiscing, enjoy the spring season and renewal of the sun's warmth!

Busy Week

This week is quite the busy week! Between finishing the move from my old apartment to the new place on campus for my final trimester, work, and seeing patients in clinic, I have been a busy guy!

This week I'm introducing two of our new clinicians in the Naturopathic Clinic here at NUHS.

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(L-R) Dr. Melissa Dybala, Intern Tim Ammons (myself), and Dr. Kathy Kamin

Dr. Kathy Kaminis a naturopathic medicine graduate of Bastyr University. She recently sold a successful practice in Arizona that she owned for over 20 years to return to Illinois. Dr. Kamin has had much success with weight loss therapies, chronic illness, and as a general practitioner while in Arizona. Dr. Kamin brings a wealth of clinical, business and practice experience to our clinic and program. Her clinical pearls and vignettes on how to set up, start, run, and build a successful practice are invaluable. She will help many of us who will be stepping out on our own in the coming months and years.

Dr. Melissa Dybalais both a naturopathic and chiropractic medicine graduate of NUHS. Dr. Dybala has been a member of a successful practice in Chicagoland for the past several years. She brings the physical medicine aspect of naturopathic care to her guidance of our interns. Combining physical medicine with the naturopathic philosophy to return our patients to a basis for health is one of Dr. Dybala's guiding principles. Combining this treatment modality with her vast knowledge of botanical treatment protocols is an advantage that our interns enjoy here at NUHS.

We are lucky to have both of these excellent clinicians join the faculty as our mentors, guides and leaders on the naturopathic side of the NUHS Whole Health Center. Each day is a joy to learn, grow and thrive under their tutelage.

Until next week, stay warm and keep plenty of vitamin D3 on hand until winter is over!

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.