Tim's ND Blog

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.

1. Pay attention in the early manual adjusting classes here at NUHS.
2. Keep your notes and procedures from the early manual adjusting classes.
3. Work with a chiropractic student when studying for adjusting practicals (and offer to study with the chiros for Botanical Medicine classes, where ND students are more engaged).
4. Mostly, in your early career here at NUHS, remind yourself to be prepared for ANY patient that walks through the door. You may not know the specifics, yet you can get a good foothold on the complaint and be prepared to take it on if you apply a "big picture" view, even when the classes are information specific.

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 specialist. 

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 possible. 

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 care doctor.  

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!