Monday, August 29, 2011

Reflections: Naturopathic Medicine, Convention and Volunteerism

By Sara Thyr, ND

The Arizona Biltmore. Photo by AANP President Carl Hangee-Bauer, ND, LAc.
Upon returning this week from the AANP convention at the Biltmore in Arizona, I have been very busy. Which is fantastic. I’m very grateful. But it has not allowed much time for reflection on all that has happened, one of the gifts that being away from our usual circumstances often affords us. But being at the convention barely allows time for a few deep breaths, much less assimilating what we are learning and assessing our place in our national association. So I will take a few moments here to offer some of my musings regarding our time together, a family of healing professionals, basking in the sun and the desert heat.

First of all, while naturopathic medicine is still not more than a blip on the national landscape of health care, I was reminded yet again at what an amazing roll we might have in really, truly repairing not only the health-care system in America, but the health of all Americans. As we move into a new era of leadership in our community, I hope that this opportunity is realized.

Which brings me to thoughts about the resignation of our executive director for the past nine years, Karen Howard. I have a love-hate relationship with Karen and possibly always have. Let’s not call it love-hate. Let’s call it love-irritated relationship. We have very different styles of communication. I’m soft, squishy, and easy to tearsand dream of acquiring tactful disagreement skills. Karen is strong and outspoken and has no problem sharing her opinion, even if that may mean (what feels like) steamrolling over quieter voices. That said, I believe with all my heart that she has been the right person for our association for most of the last decade.

Karen has brought incredible awareness of our profession to our nation's capitala stark change from the beginning of this decade. She has created networks within our own profession to assist more states in licensing naturopathic physicians, to help states with standing licenses to work together in improving scope of practice and marketability of NDs within those states, and she has taught so many of us how to come to our legislators with our information and expertise and ask for what we want. The DC FLI was an incredible undertaking and has blossomed with incredible success over the years. Most legislative health aids and legislators today know what a naturopathic physician is. This was not the case before Karen Howard took over the roll as full-time steward of our profession ten years ago.

Within the framework of the State Association Leadership Team (SALT), Karen taught us about strong associations and strategic planning. Many of us in our states' leadership roles brought this knowledge back to our states to assist local leadership in becoming more organized and strongernot to mention becoming more proactive than reactive, learning to quit operating via putting out fires and start planning for the future.

When Karen took over as executive director, our association was fractured and deeply in debt. She thrives on picking up pieces in great disarray and building something that is stronger than it was before. And that she did. While I felt her resignation like a blow to the gut, once I recovered and began to breath again, I realized that she has equipped us with the ability to move forward and continue to achieve our goals as an association. And as one physician who has worked with her for many years, I feel that I will continue to be able to achieve my own goals with much of the knowledge and experience that she has helped me acquire. I am deeply grateful for her touch in my life.

While I was working as president of the New Hampshire Association of Naturopathic Doctors, I was inspired at a SALT conference to bring in a consultant to work with our association on strategic planning. It was a challenging process, but one where we moved forward as a group and all learned a lot. One thing that I have always held from those days of meetings was about volunteerism: our consultant impressed upon me that we should never separate our volunteers from their passion.

It takes a great deal of time and commitment to volunteer for any workand perhaps most especially for this professionbecause there is so much to be done and so few people to share in the tasks, which at times seem larger than life. I have worked on putting together speakers for the AANP Convention for the past four yearstask which I think Karen inherently knew was my passion, and could rely upon me to spend many hours trying to perfect the process. It is bittersweet to let go of chairing that committeemade easier only by leaving it in such capable hands as those of Dr. Jacob Schor.

Karen Howard had an innate ability to recognize people’s passions – and help them find a way to fit service to our organization into their busy lives. I am not certain if it is testament to my lack of backbone or her great persuasive skills that I could not say no to her. Maybe I’ll try to hide for a while from our new ED! :’)

Hiring Rebecca Takemoto and her staff at Sync-Opate to handle our convention and other meetings such as the SALT and FLI was another insightful move on Karen’s part. Rebecca makes the convention run incredibly smoothly, and is perfectly cut out for a job where she is juggling 40 things at once and smiling calmly as she deals with the latest crisis. And let’s not forget the food. She makes sure that the chef’s anywhere we go provide fresh, green, allergy-sensitive foodsand as seen at the Biltmorethat taste wonderful.

When I look at our profession as a whole, from topics as diverse as the national legislative process to the process of trying to figure out what topics at a conference will be most interesting, I find myself perplexed. We are both so alike and yet so incredibly different. As Dr. Matthew Baral so eloquently said in his closing keynote address, there is no me, only us. There is no mine, only ours.

I wish many blessings for Karen as she finds a new place to share her incredible strengths.

Monday, August 15, 2011

A Little Zest with That Naturopathy?

By Lise Alschuler, ND, FABNO
AANP Past-President (2008-2009)

Photo by Larry Neuberger via Flickr, used under the Creative Commons License.
My sister, partner and I were in a local florist shop this past weekend to shop for some flower arrangements. It was the end of the day and we entered this tiny, one-room floral shop that had pieces of plants strewn on the floor, pictures of arrangements on the walls, and a few flowers poking out of a vase here and there. The owner explained that she had just finished several bouquets for a wedding. She excitedly brought out her iPhone, “Here, you have to see this. I am so excited about this arrangement. It was all plants!” She brought up a picture of a truly beautiful arrangement of succulents and grasses. We oo'd and ah'd and then, getting right down to business, began to issue forth our desires.

All I can say is that the next 30 minutes were pure delight. I never knew that buying flowers could be so exciting. She listened to every word, asking multiple-choice clarifying questions in a way that suddenly made us feel like flower experts. She exclaimed with outright glee at each mention of a particular: type of flower (“Oh, I LOVE thistle!”), shape (“Mixing textures is gorgeous!”), color (“Deep reds are so earthy, so royal. I love it.”). She was masterful. Somehow she helped us to create a gorgeous bouquet that we thought of all by ourselves but, truth be told, could never have come up with on our own.

We left all commenting on how wonderful she was, how passionate she was, and how much she loved her work. It showed, too. She had a book of her work and her arrangements were stunningly beautiful. We were all a little giddy, actually, and I realized that by her unadulterated and unbridled enthusiasm, she had transformed us into delighted beings, entranced with the simple and wondrous beauty of plants.

While one might argue that she has a fabulous medium to work with, there is no denying the fact that she is definitely in her groove. And the results are incredible both in her arrangements and in her impact on her customers. I can’t help but imagine the impact that being that wildly and ardently in love with one’s craft (in my case, naturopathic medicine) would have on my patients. I love naturopathic medicine and I embrace it to its core, but I have to admit that it is the rare moment when that zest for naturopathy flows out of me, unfiltered, to my patients. There are a million good reasons why this is just not proper, useful, conducive or even appropriate… and yet I do think that I, along with several of many patients, could, every now and then, use a good dose of juicy, succulent and untempered gusto for naturopathic medicine.

Perhaps letting the medicine out of its constraints every once and while could transform naturopathic medicine into a naturopathic superhero – capable of transforming dis-ease into exuberant health in an instant.

Thursday, August 11, 2011

Domestic Violence and Patient Safety: A Personal Story

By Christine Girard, ND
2010 AANP Physician of the Year

Those of you who know me, know I am a fairly private individual. Through this blog, I have tried to expand my comfort zone by sharing with you what I hope to be funny moments in my personal life. This blog post may be my most personal–ever.

On the morning of July 2nd, William and I were in Phoenix International Airport preparing to fly to Eugene, Oregon. My god-daughter, Mikaela, is a very musically talented 16-year-old, who for the last two years has been accepted in the Oregon Bach Festival’s Stangeland Family Youth Choral Academy where she has the privilege to study with and be conducted by the top Bach scholars in the country.

While in line for airport security, I realized I had a voicemail from my Mom–unusual for an early Saturday morning. Standing in line I listened to her voice mail. She was crying, “I don’t want to do this on voice mail, but I have to. Jill is dead. They think Kenny shot her. Dale is a wreck. Jack and Judy are driving me to Dale’s. I can’t drive. I don’t know what we’re doing. We need to fly to Jacksonville. Call me when you get this.” William looked at me quizzically as I was listening to the voicemail. I motioned him to lean in and I whispered Mom’s message to him. Needless to say, he raised his eyebrows.

Once through security, I paced at an empty gate while talking with Mom. She was in the car with neighbors Jack and Judy, who were driving her to Dale’s house. Mom recounted the shocked phone call from Dale. Very little was known about Jill’s death.

Dale and Jill’s Dad, Warren, married my Mom, Carol, when Dale and I were seven and Jill was three and a half. Mom and Warren had Mark, our half-brother, five years later. We grew up in the '70s version of the blended family. Jill met Kenny in Connecticut and when the Navy transferred him to Georgia she was heartbroken. She decided to follow him to Georgia and married him soon after. She was 23 years old.

What we know about Jill’s death is that she was shot to death in her home in the very early morning hours of July 2, ten days before her 42nd birthday. Her husband, Kenny, is currently held without bond on charges of First Degree Murder.

In the 18 years Jill and Kenny were married, friends and family have no evidence of Domestic Violence (DV). I say that with some confidence. As Dale has said, “Even though I’m her big brother, it seems like she took care of me more than I took care of her.” Jill did just that: she took care of friends and family who were ill or needed a temporary assist. Both Warren and Dale have lived with Jill and Kenny.

Kenny’s brother and Mom have also lived with them. Family would mention arguments (as Dale says, “like any couple”), but no one could speak to any abuse–emotional, economic, psychological, sexual or physical–in their marriage. As far as the detective, assistant state’s attorney and victim advocate can see, Jill’s death doesn’t fit the normal pattern of DV.

As a family, we struggle with the many unanswered questions. As a physician, I am reminded of how important it is to assess a patient’s safety in his or her own home. DV affects approximately 28% of marriages and results in over 16,000 deaths annually. It sickens me that Jill’s is counted among them.

I encourage you to add safety questions not only to your new patient intake, but also to your routine history-taking. Click here to learn about DV screening tools for your practice. A recent article revealed that women want their physicians to ask. Please, don’t be afraid to ask your patients about DV.

If there is one thing I can say about Jill, it’s that she loved and cared for many people in her life, none more so than Kenny. He was a central part of her life for 18 years. She would want us, in the midst of our shock and anger, to remember that. She would insist that life goes on and that in life joy must be found.

When you see me at the Convention, please say hello, give me a hug, and/or tell me your newest joke. No sad puppy eyes, please. And give Drs. Olehausen and Clark an extra hug. They, along with Carolyn, my amazing assistant, ran the show (brilliantly, I might add) while I have been out on an extended bereavement leave. My thanks also to my SCNM family: Dr. Mittman, the SCNM Executive Team,  and Faculty and Staff for their thoughts, prayers and support. They gave me the freedom of time and space to begin, with my family, the lengthy journey of processing, grieving, administering, and seeking closure of Jill’s death. May her memory be eternal.

Resources for more information:

Monday, August 8, 2011

Reversing Type 2 Diabetes Using Natural Therapies

By Susan DeLaney, ND, RN

Natural remedies can help reduce or even eliminate the need for insulin in Type 2 diabetes patients.
Photo by .:[ Melissa ]:. via Flickr, used under the Creative Commons License.
Conventional medicine recommends exercise, a healthy diet and losing weight to prevent the development of Type 2 diabetes. But these same measures, along with a few supportive supplements, can also reverse the disease process. After many years of eating highly refined foods and excess sugars, one's nutrients stores are depleted. My real focus in reversing Type 2 diabetes becomes one of restoring health through nutrient rich foods. It is unfortunate that the conventional practice of medicine operates from the perspective of disease management and not the restoration of one’s health. With treatments that only manage the disease symptoms, the progression of the disease continues even with excellent control of blood sugars. Blindness, peripheral neuropathy, and heart and kidney disease are the long term consequences of a disease only held in check by medications.

In one patient's case, just eliminating all processed foods for one week, such as cereal, bread, pasta, crackers, pizza, cake, cookies--anything that made from a refined grain or sugar--reduced the need for insulin shots by 50%! He was able to maintain the reduction in his insulin doses by restricting these foods and eating high-nutrient foods such as eggs, meats and healthy fats such as butter, cheese, nuts and avocado. Beans became a daily staple of his diet, along with greens and any fruit and vegetable he desired. Daily exercise of his choice for 30 minutes each day was also initiated to improve his glucose levels.

Typically diabetics have low vitamin D levels, which is really just “the canary in the mine” indicating that they are low in all of the fat soluble vitamins such as A, D, E and K. The fat soluble vitamins (not really vitamins but pro-hormones) act together to help regulate many aspects of the immune and endocrine system. Using cod liver oil (high in vitamins A and D) along with High Vitamin Butter Oil (high in vitamin K2), these food-based supplements begin to restore these deficiencies. The diets of traditional people eating their native diets contain 10 times more fat soluble vitamins than the western diets of today. Restoring healthy fats to our diets, as well as eliminating trans fats and all refined oils that help deplete our fat vitamin stores, will help nourish the body and reduce the need for diabetic medication.

Along with the introduction of healthy fats, I also use a fermented powdered food from fruits and vegetables taken twice a day as a supplemental shake to increase the nutrient levels, speeding up the healing process. After six weeks, my patient was able to drop his insulin by 75% with a weight loss of 8 pounds. He continues to take metformin for his elevated blood sugar levels, but after 3 months is off all insulin. Along with the reduction in his insulin levels, his Hemoglobin A1C levels have dropped from 8.8 to 7.0.

Continuing his nourishing diet and supporting his system with food based supplements should totally eliminate his need for medication in the future. Restoring health prevents the development of chronic disease and reduces the need for expensive medication. It is possible to reverse, not just manage, Type 2 diabetes using natural therapies.

Monday, August 1, 2011

In Search of the Holy Grail

By Bill Benda, MD, FACEP, FAAEM

Photo by speckyfish2000 via Flickr, used under the Creative Commons License.
I sat on an NIH panel a couple of weeks ago in Washington, D.C. Our mandate: to determine which of a few dozen grant applications deserved, through purity of methodology and virtue of intent, to be awarded funding by a commercial enterprise whose name I cannot reveal.

In fact, I wish I could tell about you the subject of the grants, or the people who sat on the panel with me, or the amount of monies given away, or how we determined who got the cash. But the NIH is very, very adamant that nothing ever, ever leaks to the outside world on what transpired those two days. Non-disclosure forms are signed, warnings are given, and papers and discs are shredded after the proceedings are completed. I imagine there is a sophisticated surveillance system set up in Bethesda, MD, to watch our every step, and should I inadvertently write the wrong words in this blog, an alarm sounds on the east coast: NIH Central Alert! Reviewer violation! Activate liquidation team! And within the hour an ominous black Prius would pull up in front of my house and bespectacled men in trench coats would emerge.

But I digress from the topic of this article. My time on the panel did serve to reinforce one particular belief I have harbored over the past couple of decades as I have explored the world of scientific investigation – that research, for all of its academic and cultural value, is not health care’s Holy Grail. It is not representative of any irrefutable fact, it is not the courier of absolute truth, and it certainly is nothing close to purity of thought and action.

Now before those of you who spend most of your waking hours in academia start sharpening your ninja swords, let me state firmly that research itself is indeed the best tool we have at our disposal to differentiate reality from fiction in the clinical arena. But it is a fragile tool, and prone to breakage and misuse. And I do hold a touch of credibility on this particular topic - I have conducted and published two randomized control trials (one funded by NCCAM), and have been providing peer review to six medical journals over the past decade or so. So I can state with some authority one thing that I have never seen echoed in any journal, except perhaps on the editorial page or in a letter to the editor, and that is: All research is flawed, and likely quite badly flawed.

Lets take a look at the process of publishing a study, from the first inkling of an idea to the final inking on the journal page. Someone, somewhere, comes up with a hypothesis. After much thinking and mulling, the hypothesis transmogrifies into a research plan–usually in conjunction with other co-investigators–then into a methodology, complete with inclusion and exclusion criteria, plans for statistical analysis, recruitment, carrying out the study, collation of data, actual statistical analysis, final conclusions, writing of the paper, peer review by a journal, revisions as requested by said journal (and perhaps repetition of this step several times), publication of the article, reading and attempted understanding by the subscriber and, finally perhaps, incorporation into clinical use.

There are countless steps where bias and error can creep into the final findings, and this doesn’t take into account influence by industry if the piece happens to be on a pharmaceutical or other medical appliance. And speaking of pharmaceuticals (and supplements), the study usually recruits a narrow demographic of males between this age and that age with this clinical condition but not complicated by that clinical condition (exclusion criteria!) and then treats at a specified dose for a set period of time. And if the positive findings are somewhat higher than the placebo effect, that pharmaceutical (or supplement) is marketed to men and women from 18 to 88 with all sorts of confounding conditions and with each very diverse patient getting pretty much the same dosage. This is part of the reason why, say, hormone replacement therapy protected against heart disease last month, but increases heart attacks this month, while protecting against breast cancer last year, but thought to stimulate breast cancer next year, and on, and on.

OK, I’m going to back up once more and restate a very important point: Research is the best tool we have at our disposal to differentiate reality from fiction in the clinical arena! But it’s simply not as perfect as we, and our media, purport. As I tell my students, no research study, no matter how well done, is the truth; it is simply another finger pointing in the general direction of the truth.

So the next time that your organization wants to put research at the top of its priority list, consider… Wait a minute...

I need to go. A black Prius just pulled up in front of my house.