Time is Flying By

I can't believe it's already been a week since I last wrote. Time at the VA is FLYING by. I'll only be there a couple more weeks and then I'm back at the student clinic. Six weeks after that is graduation. I'm having this great realization that graduation is coming up on me like a freight train. Sometimes I feel like I'm stuck down on the tracks, and sometimes I'm the one driving.

I'm working feverishly on finishing the master's work. That's over in about a month. Just in case anyone was thinking about doing this at the same time as getting your DC, be forewarned: it's a TON of work -- especially the last quarter. This is not for the faint-hearted. I honestly can't believe that I've done it. There are times when I definitely feel like a masochist. It took me 6 quarters (a year and a half), but I'm almost done. Now to get all of the papers and projects done; that will be a feat.

While I'm working at the VA, I'm finishing up all the paperwork, volunteering, and other things needed. Last weekend I made a trip to Sarasota to the American Youth Cup Series I. Apparently the park where it was hosted, Nathan Benderson Park, is home to a world class rowing event. In fact, the 2017 rowing championships are being hosted there. It's a unique facility with a round lake. There are a number of events coming up there -- including several additional rowing events, a pentathlon, and a 5k. I'm hoping to attend a few more of them.


It was a quiet day (no injuries); the weather was chilly and windy (for Florida). Dr. Guadagno, Dr. Jake LaVere (a distinguished recent National alumnus), Nick Herrild, and myself braved the chills to be on hand in case anything should happen. When we weren't watching the crew members running around or rowing, we were sharing stories and business information. We had a pretty good time talking about future business endeavors, practice models, conferences, and plans.

Here's a wind-blown picture of the 4 of us.

As I continue my time at the VA, I'm seeing what it's like to be in a completely different model of care. There are things that I've learned that I know I will carry with me into my future practice, and others that I know I won't. One thing I really appreciate, and I touched on this last week, is the willingness to try something new (or discharge from care) if things are or are not working. People come in and they get better -- they stop coming in. People come in and they don't get better -- they stop coming in. It's very simple. It's ethical practice.

Well, I best stop writing here and get to some of my papers!

I hope that everyone here -- regardless of where you are in the world, are staying safe and warm.

I'll see you all next week! Have a great one!!!

New Perspectives on Healthcare

How is everybody this week? Staying warm? The weather here has been up and down -- cooler than normal for a Florida winter. In fact it's been cooler this winter than it has been any winter that I've been here. That having been said, we don't have any snow -- not even a flurry. So I suppose, if you're into the warmth, this might be the place to be.

This week is FLYING by. I've been at the VA hospital all week and I absolutely LOVE it! The docs there have been amazing! I've seen at least 2 new techniques and hope for more. I'm learning a new system of care, which is great -- and seeing how a LARGE system coordinates care for a large amount of people. One of the most fascinating things is observing complicated patients with complicated problems and how they navigate the medical system.

I've been able to hear new doctors' perspectives on healthcare, specifically about medical ethics. Being in academia so long, we're sheltered by ideal situations and our own personal beliefs about the infrastructure in medicine. The truth is, that out "in the real world" things are VERY different. Some doctors keep patients coming in for visits for "wellness care," for prescriptions, for therapies, for whatever reason, when they don't need them. They suggest these things sometimes because they feel that the patient needs or wants them, and sometimes for financial reasons. It's the frank truth, and there's a lot of controversy around this.


One of the docs I'm working with and I have been talking about discharging patients. His philosophy, and I completely agree with him, is that if we can't make someone better, help them function better, feel better, improve their daily function, then we're the wrong person for them to see. Maybe it is that our care isn't what they need -- maybe they need a surgeon, or a pharmaceutical, or something that is out of our scope, or just not our specialty. Regardless, we have to know when it's time to stop.

We have to decide what type of physicians we're going to be. We have to decide (with our patients) how best to help them -- even if it doesn't involve us.

I want to wish everyone an AMAZING week! This weekend I'm working with a team for the American Cup rowing series. I can't wait!

Week 4?

Week 4. What? How did that happen? Time is absolutely flying.

I feel like one of those time warp photos - you know the ones where someone stands still and everything passes them by 800 miles an hour. Just like this.

I feel like I just can't get everything done fast enough -- that the "to do" list keeps growing and growing, and as soon as I get things checked off, a million are piled up in its place. And yet, things keep getting checked off. We are now officially done filling out college applications for Grey. I've ordered my application for Oregon licensure. I'm nearly halfway done with this last quarter of the master's program, and I start at the VA next week.

I spent the last week, besides doing everything else, reading journal articles. I read 14 articles on various (potentially) controversial topics in nutrition: dairy, egg, whole grain, and meat consumption. It addressed cholesterol and eggs, lactose intolerance, dairy allergy, whole grains and cancer, and several other topics. But even after all of that, it was pro-ingestion. These papers were FULL of statistics. Each one loaded with numbers trying to support its case.

And then I looked at the lists of conflicts and references.

In Journal Club, we were taught to read everything with a critical eye, to see the potential conflicts, and judge the studies accordingly. For everyone that I talked to about these articles, my only comment was -- "Statistics can manipulated to support anything."


Always read with a critical eye. You never know what information might be valuable, and what might be... 87.

Have an amazing week, Everyone. And if you come across some good studies, feel free to send them my way.

85 Days

These are the weeks of dotting i's and crossing t's. How's everybody doing? Things are moving quickly here. I can't believe how fast it's going. 85 days. There are 85 days left in my experience here at National. I honestly never thought I would make it!

Now marks the chaotic time of resumé preparing, job hunting, extra courses, licensure exams, and everything else. In addition, I'm working on a million different projects plus a comprehensive exam for the master's. *Whew* There's no rest for the weary. The deadlines keep coming. Appointments are made. Guidelines are followed. But in a lot of ways, this is uncharted territory. Sure, I've applied for jobs before -- but not like this. Corporate America has a completely different way of doing things than healthcare or small business. The learning curve here is pretty steep.

We're getting back to basics in the clinic. As the 8th Trimester students come in, we're acclimating to new people and helping them get their feet wet. They're holding their own. History taking has never been more important. Each person that handles a chart adds more information. We've all been working together pretty well -- strengths complimenting strengths. It's nice to work as a team rather than individuals all the time. Our patients can definitely be served by a group of talented practitioners.

(Image source: caglecartoons.com)

Today I was given information for a case study. The patient in my case study was taking 6 medications. Yes, you read that right--6. It has become the standard that the average number of medications an elder-person is taking is 3. Most are taking more. Many are taking medications to combat their medications.

There's definitely something wrong with this. But it reminds me. A patient was speaking with me during a treatment today. She was asking me what my philosophy of medicine was. Patients sometimes believe that we hate all conventional medicine, which may be true for some practitioners. But anyone that's ever had an infection, or required surgery, knows that without those tools, we're lacking. There are alternatives to many things, but sometimes, surgical procedures are the conservative approach. It's a lot to think about.

What is it that our patients are going through? What are they taking (consuming) already? Where can we step in with THE BEST approach to help our patients? These are really big questions.

Food for thought, perhaps? (That's a whole different topic). Have a great week, everyone!

Welcome Back Everyone

It seems like ages since we last "talked." How was your Christmas? Did you have a Happy New Year? Hope everyone has made great strides on their new year's resolutions (or didn't make any).

While everyone was away, I was hard at work here in the clinic seeing patients and thinking about what's coming up next. Which reminds me, we only have a handful or so of weeks left. I am pulling things together, working hard on my master's, seeing as many patients as I can, and focusing on getting as much exposure as possible.

In a few short weeks, I'll be starting a rotation at the VA hospital where I'll be helping to treat a number of our veterans. Here at our clinic, we typically take our time with patients. Depending on what type of visit, our appointments can be 90 minutes long. However, at the VA, appointments are much shorter, and instead of about 5 patient visits per day, each practitioner sees about 20. That's going to be a big change. I'm anxious to work with a wide variety of patients and deal with some of the unique problems they're facing. It should be great experience!

We've welcomed our new interns to the clinic. Three fresh and new interns are now working with us - one of which started Trimester 1 with me, but took a different path. Several of the interns in the other clinic started with me as well. It's good to see them make it to this point! I'm really proud of all of them and honored to call them my colleagues.

We're down to the wire on a lot of things around here. At my house, we're almost done filling out college applications for Grey - down to one that's due in about a week. We'll sit in wait on all of them to see where he ends up. I have done some research and it turns out the state licensing exam for Oregon is the day after graduation. Yikes!!!!!!!!!! (Unless I want to wait until July - which I don't). So, plans are being made to fly out of Chicago right after the graduation ceremony and take the exam the next morning. Grey and I have set a tentative date for moving: June 10. This has brought a flurry of activity into the house: getting rid of things, deadlines, prep-work, etc. There are times when I feel completely overwhelmed, but I'm also REALLY excited. That having been said, I kind of feel like this:

Have an AMAZING week Everyone. Back to work! It's going to be a life-changing Trimester.