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.
This week I'll focus a bit on some of the techniques we are
learning in our remaining clinical science classes, which coincide
with our Internships.
One of our classes is "Minor Surgery" taught by Muhammad Ali
Khan, MD, who has extensive experience with surgical techniques
prior to his entering academia. Dr. Khan also teaches our basic
science pathology courses for all professional programs.
Within the therapeutic order of naturopathic medicine, minor
surgery is the most invasive and least used therapy in our
toolkits. Unless we are local doctors in a remote area, in a
licensed state with a scope of practice that includes minor
surgery, we typically would refer these procedures to a
The class covers minor surgery concepts and procedures from
start to finish. We begin the trimester with the types of minor
surgeries performed by primary care doctors along with proper
sterilization procedures for patient, personnel and operating
theatre. Once these concepts have been covered, we learn about each
of the instruments used in minor surgery, their proper handling,
and techniques unique to each instrument.
Dr. Khan demonstrates the proper technique for removing a
hangnail to the class.
No gloves or sterilization is needed as simulated limbs are
used. I'm behind the camera.
Now that we have the basics down, we learn basic suturing on
practice dummies in the lab. We learn how to perform interrupted,
continuous and vertical mattress sutures and the circumstances that
are appropriate for each of these types of sutures. The techniques
we learn include checks to ensure that infection is not trapped
beneath the suture and the patient is able to heal as quickly as
Once the suture is complete, we learn the typical healing times
for each type of suture and its location on the body, how to remove
the sutures and how to keep scarring to a minimum.
Suturing is a large part of the "Minor Surgery" class and we
spend about half of our time for the class in lab, practicing
sutures for various wounds. After Dr. Khan has given us a thorough
run-through himself, we each are given the opportunity to practice
our skills on dummies with multiple simulated injuries. Nothing can
replace repetitive practice and muscle memory to help develop a
strong skillset and confidence for future patients.
While not all states license naturopathic doctors for minor
surgery, this is a skill that is needed by all primary care
doctors, especially in remote locales where no emergency care
exists and the urgent care center is the local doctor's office.
Minor cuts, burns, hangnails, cysts, and countless other
superficial procedures can be handled by a properly trained primary
NUHS is taking into account the big picture of naturopathic care
by including appropriate training for naturopathic medical
providers regardless of the state in which we settle and start or
join a practice. We are fortunate as students to have a doctor on
staff with Dr. Khan's experience and expertise to give us the
basics on proper minor surgery techniques. I feel that his passion
for sharing his knowledge will help us provide better care for our
patients in the years to come!
• Combined Classes
• Observing in Clinic
• Botanical Medicine
• Minor Surgery
• Intern Skills
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