This week I'll start a series on naturopathic medical
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
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
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.
This past week was a long and trying one for my entire family.
We thought that we had lost my mom. Without the quick, assertive
intervention of the paramedics, emergency room and intensive care
unit staff back home in western North Carolina, my mother would
have certainly died. With her permission, I am sharing this story,
how high force intervention saved her life, and where naturopathic
doctors fit into the care model, as I see it. The thoughts and
opinions expressed here are mine and are the result of my thought
process. This week's entry is a bit long and covers almost two
weeks worth of events.
In my blog this week, I'll do my best to explain how high force
intervention can be both a benefit and detriment under the proper
conditions, as can any type of medicine. Mom has a history of
asthma and heart disease and as a result was on a cocktail of 12
medications, without co-management between her various care
providers. Before I move on, I want to make the point that each of
these caregivers was honestly doing their best to care for her, yet
no communication was occurring between the caregivers on Mom's many
The story begins with my mother complaining of shortness of
breath while one of my sisters was visiting. After prodding from my
sister, my mom agreed to allow her to call 911. We are from a rural
area, so we have volunteer responders who can arrive either in
their personal vehicle or an ambulance. The first person to arrive
saw my mom fighting for breath. By the time he had gathered his
equipment, my mom was blue (cyanotic) and frothing at the mouth. He
immediately began CPR on my mother as she was now in cardiac
arrest. The ambulance arrived at this time, and within 90 seconds
the paramedics were helping my mom breathe with a ventilator.
She was immediately transported to Mission St Joseph's hospital
in Asheville, North Carolina, where the emergency room staff
quickly and accurately stabilized her. She was moved to the
intensive care unit shortly after being stabilized until her
caregivers could be notified and they could figure out what was
causing this episode. The quick, high force interventions of the
first responders and ER staff saved my mother's life.
To keep a long story short, an interaction occurred between her
many pharmaceuticals that caused a spasm in her diaphragm, the
primary muscle that helps us breathe through expanding and
contracting our lungs. Mom gradually lost her ability to get air,
and thus oxygen to the point that she lost consciousness. As a
result of taking many different medications without cross
consultation among her specialist caregivers, Mom had a reaction
that could have cost her life. At the same time, without high force
intervention, such as her intubation and respirator at the
emergency room, Mom could have lost her life. Again, I believe that
each of these caregivers was doing their best with the toolkit
available to them to help my mother be as healthy as she could be.
This is what medical caregivers are trained to do, regardless of
their specialty, field or modality.
Right now, Mom's medications have been reduced drastically, as
after review and consultation together, her specialists determined
that she didn't need as many medications as she was taking before
the incident. She is feeling much better and is excited to have one
caregiver managing all of her medications regardless of who
prescribes them. She has a great rapport with her cardiologist who
has been caring for her for over 15 years. Rest assured, I will be
watching her meds more closely now as well.
My sister Kristie, Ladybug and Mom earlier this
So, how does this relate to naturopathic medicine? This is where
my opinion comes into play, so from this point in this week's post,
I am sharing my viewpoint. I view my future role as a naturopathic
doctor as a gatekeeper. By gatekeeper, I mean the role of the
primary care doctor or central hub of care. If you imagine an ND as
the hub of a wheel, with spokes moving from the hub out to various
specialists such as endocrinologists, gynecologists, chiropractors,
physical therapists, etc., the ND can take information from each of
these specialists and incorporate that information into the 'whole
picture' of the patient, their care and their health. Whether in a
licensed or unlicensed state, the ND as the health gatekeeper, is
trained to know and understand pharmaceuticals and how they
interact not only with other pharmaceutical meds, but also with
botanicals, supplements and anything administered to the patient.
We are uniquely trained and qualified to act as our patients'
gatekeeper for their health and lives.
In closing this week, we as NDs are not the ideal choice for
high force intervention in most cases. With the exception of the
states where NDs have prescribing authority in that state's scope
of practice, we will not be involved in high force intervention
(i.e. prescribing or removing pharmaceuticals in patient care or
minor surgery/trauma etc.). We are trained more specifically for
chronic lingering illnesses and our moderate methods typically
don't have the overnight impact of a pharmaceutical. At the same
time, our interventions are much gentler and have a much lower risk
of a severe, life-threatening episode. I have a healthy respect for
those who are trained and adept at taking a person on death's door
and bringing them back time after time, day after day with the calm
precision of highly trained professionals. At the same time, after
my training here at NUHS, I'm convinced that not every situation
requires pharmaceuticals upon an initial visit. Perhaps, as we grow
as a profession and our allopathic colleagues become more aware of
our training and effectiveness, we will see a greater amount of
collaboration, communication and whole person care with NDs as the
hub and gatekeeper of a patient's medical care.
I'm elated that my mother's caregivers have agreed to her wish
of having a single doctor in charge of her medication list. This
cooperation amongst caregivers is unique and I think indicative of
the excellent care in western North Carolina as a whole. I'm happy
Mom is still with our family and hope to have her with us for many
years to come!
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.
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!
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
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
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
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!
• Combined Classes
• Observing in Clinic
• Botanical Medicine
• Minor Surgery
• Intern Skills
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