Standard Process

Whole health, nutrition, and wellness care are important facets of how we approach treating the whole patient. It would be nice if this could be accomplished utilizing only the nutrition found in whole foods, but the fact of the matter is that due to poor farming practices, our foods only contain a fraction of the nutrients they used to. This places us into the murky world of supplements.

Supplements are crucial in the treatment of a whole plethora of lifestyle related conditions. Finding a good supplement should be easy to find. All it should involve is picking out a supplement with the correct nutrients, in the correct amounts. Unfortunately, in the U.S., it's anything but that easy. Supplements aren't regulated by the FDA, so the entire industry is a verifiable minefield of shoddy manufacturing, poor quality control, and even completely fallacious claims. It can be tough to navigate. 

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Finding the right supplement takes a lot of research. There are a lot of great companies out there, who have manufacturing practices beyond reproach. I had the opportunity today, to tour one of those company's factories and it was impressive.

Standard Process is focused on putting whole foods, grown on their own on-site organic farm, into a supplement. They're good at it, too. They've been rehabbing their soil for years now and nutrient density and yield per acre are skyrocketing.

Touring a top-to bottom manufacturing and distribution site was a fantastic educational experience and provided me with a perfect idea of how I should assess other supplement companies I hope to work with. While many of the supplements carried at our NUHS clinic are Standard Process products, even if I decided not to use them, the company sets the standard by which I'll assess other manufacturers.

A Conundrum of Esoterica

I think I'm at risk of sounding like a broken record, but I don't believe I've ever had the experience of time flying so quickly. Sure, we all know time is relative thanks to Einstein's genius. But that's all jargon relating to physics and gravity. We've successfully bastardized the term by applying it to all circumstances in which time has been warped in our subjective experience. Hence the colloquialism, "Time flies when you're having fun." We all know that time doesn't actually speed up when we're experiencing fun; we're just more engaged in what we're doing. So really, it's being engaged in the present, in the task at hand, that truly speeds up our experience of time. And let me tell you, time spent at the clinic has been extremely engaging. Hence, this trimester has simply flown by so far.

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We've learned a lot leading up to this point. It's like you're walking into an appointment with a stack of books. You successfully diagnosis the patient (diagnosis is a strong point in the NUHS curriculum), now all you have to do is to figure out an appropriate treatment, so you turn to the massive pile of books and freeze. It's a daunting stack. There are so many considerations and no two patients are the same; still, you want to formulate a general approach that mostly works for most patients with the same general diagnosis. This isn't pharmaceutical-driven therapy; you're not getting off the hook that easy.

The stack of books is mean-mugging you, taunting you to divine a single treatment plan from the wealth of knowledge and variety of approaches you've learned. Needless to say, there's a learning curve. There's trial and error -- success and failure. This is what time in the clinic is supposed to be about. It's a time to figure out how you want to practice, what techniques you're comfortable with, and how you can effectively utilize them. It's engaging stuff. This is why time has been flying.

Not to mention, every waking moment is consumed with thoughts and strategies about how to approach your future, how to attain success, and how to reach the most patients. Needless to say, busy isn't always bad. In this case, busy is building your future on your terms. It's learning to treat patients effectively, efficiently, and with care. Time has flown so far and it's been a great trimester.

Trust

It never really struck me. I mean, I knew it, cerebrally... abstractly even, but it never really settled into my conscious awareness, into that familiar place of innate knowledge where one can FEEL what they know. I didn't feel it until today. Today I truly saw it, while I was looking into the clear, blue eyes of the patient lying supine on my treatment table, as I palpated his abdominal organs. I saw it again, undulating behind the blue, with his head cradled in my hands as I palpated his cervical spine and moved it through passive ranges of motion as I prepared to adjust him. I saw the desire to trust and, in the same moment, the struggle to do just that. I felt the struggle in his musculature as he relaxed and tensed and relaxed again. It was in these moments that the intimacy of this profession truly struck me. This person, whom I had only met a mere 30 minutes ago, was placing so much trust in me that he was allowing me to physically interact with a few of our most vulnerable areas (abdomen and neck). It was a humbling realization.

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Trying not to take this beautiful city for granted either!

We spend so much time working with classmates within the confines of adjusting classes and labs, under the watchful supervision of professors and TAs, that it's incredibly easy to forget the amount of trust that is necessary. For us it has become a routine part of everyday life that takes place between our trusted classmates and us. It's easy to forget, or take for granted, the intimate power of manual therapy. It's something I've definitely been guilty of. Being in constant awe of this sacred interaction is something I will always strive for. Because, without that realization at the forefront, our interactions with patients will lose their potency. 

Ribbon Classes

2017-06-02_hoganEveryone asks the same question of me these days. It's always, "Why are you still in classes if you're already seeing patients?" In their mind, it seems that we're treating patients sans some critical information from an essential class. I ease their mind by describing the classes this trimester as "ribbon classes" -- classes that are meant to be the finishing aesthetic touches on our formal education. They're part of our curriculum to hone our diagnostic skills, our business acumen, our empathy, and our ability to pass the scores of semantical board questions [Editorial: it's so sad that so very much of our educational system is geared towards passing standardized tests]. Oh! And we learn how to avoid getting sued. The class is called Jurisprudence and it's actually a pretty solid class as it seduces the part of me that always wanted to go into law.

Speaking of useful classes, Dr. William Hogan really comes into his own this trimester. For those of you who don't know Dr. Hogan, he's a monolithic character. The fear and anxiety he foments in the hearts of his students is unparalleled here at National. In fact, the only individuals I've met that were as well versed in psychological ownership were a few of the drill instructors I got very familiar with at boot camp. I know, right now you're probably thinking, "Oh no, what a scary man...why is he teaching??" Well, why are the drill instructors teaching? Because life and death isn't a subject to be flippant about and making negligent, stupid mistakes in both the military and in medicine, results in needless death.

Drill instructors were hard on us because they cared. Dr. Hogan demands investment in learning and by the transitive property -- in our patients. He is a verifiable wealth of knowledge. Pay attention before crying the consummate millennial war cry of prejudice and discrimination. There are no safe zones in war or medicine. Let him temper you with his fire. Participate and you'll walk away a better physician. 

Salvation Army and Internship

This trimester officially marks the beginning of my clinical internship. For the next year, until graduation, my colleagues and I will be working with and treating patients under the license and supervision of various clinicians. It's a time to hone our skills of exam, diagnosis, and management. It's an exercise in understanding, in empathy. More importantly, it's a privilege to build a relationship with patients from all backgrounds, to be allowed into their personal life and history. It's a sacred experience -- and a humbling one.

Suddenly, all the classes taken over the past few years seem overwhelmingly crucial. Worry sets in. What if I've forgotten something crucial (and believe me, it seems like you forget a lot); what if I miss something? A whole slew of questions flood in. There's good news, though! All the stuff you thought you've long forgotten is still in there, laying dormant until circumstance calls upon it.

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The first patient I was with, on my first day at the Salvation Army clinic, showed up severely out of breath. The patient immediately stated a history of COPD and complained of an intense, severe left sided headache. My colleague and I immediately took his blood pressure and recorded it to be 200/90. There was a moment of disbelief, followed by rationalizations, reasons why this man couldn't, shouldn't, have blood pressure that high. We tried a larger cuff. We let him relax for a few minutes. Finally, there was no other rationalization. We had to face the music. These combined factors constitute a massive stroke risk, so we had our clinician call an ambulance.

Sure, it's the cliché medical story, but the point of this story is to demonstrate that, even though I didn't have those factors involved in stroke risk consciously available while going into that patient appointment, when I saw the red flags, the answer came to me, seemingly out of thin air. The things we learn stick with us, and the more work we put into learning the science and the pathology, the longer they remain. Don't fall into the fallacious belief that simply because you don't plan on treating a condition, you don't need to know about it. You will be a doctor, regardless of whether or not you are in acute care, patients' lives will be in your hands.