Peace on Earth, Goodwill towards All

From Michael Cronin, ND
AANP President

Kyle and I had our neighborhood Christmas party this weekend—it was a potluck of course. We have lived in our town, Cave Creek, for 12 years, and in that time we have met many folks and now consider several of them friends. They are of different ages, members of the cross country team, horse lovers, and neighbors. We track each other’s career changes and catch up with the kids and their paths. The best part about this party is our hug and wishes to each other for a Merry Christmas and happy, successful New Year.

I can’t give you a physical hug in my blog, but I am sending you, our community of NDs, a digital hug and the best wishes in 2013. May your:

• Practice prosper,
• Phones ring with new patients,
• Prescribed nutrients hit the desired targets,
• Advice be taken and recognized for its wisdom,
• Journey bring you new professional relationships that advance your practice,
• Daily readings be captivating and advance your work,
• Practice change or add a modality that keeps work interesting,
• Engagement with your state and national ND organizations effect change,
• Drive to work each day leave you feeling good and looking forward,
• Trips home from work be filled with a sense of accomplishment,
• Personal health, energy, sleep, and attitude improve,
• Road lead to finding and appreciating friendships, and
• Life be filled with love.

Happy holidays! May 2013 be your best year yet!

You Never Know Where You Will Learn Something That Changes Your Practice: Lysine for CNS Disorders and Cognitive Function

Written by Shiva Barton, ND, LAc
2011 Physician of the Year

OK, even though I am no longer Physician of the Year – that was soooo 2011 – I was asked to contribute to the AANP blog. Just when you thought it was safe...

A few weeks ago I gave a talk at the local Senior Center. I had given a talk there a few years ago and evidently I didn't kill anybody so they invited me back. The topic was, “When Would or Should a Person Consider Using CAM.” The talk was part of a community event where vendors were invited to have tables promoting their senior relevant businesses. (Did you know that there is an association of Senior Relocation Services – think selling or cleaning out houses, estate sales, etc. – and that there is an accreditation process for these services?) As I looked out over the audience there must have been 100 or more people there. The difference between this time and last time I spoke was that now I QUALIFY TO BE A SENIOR! (Big 6-0!)

I was the first speaker, which I enjoy, because people don't generally nod off right away. Anyway, I love to give these kinds of talks because it is easy to make them relevant. I generally ask who in the audience has seen the different types of complementary practitioners. Examples include, ND (not too many – i.e. none), DC, acupuncturist, massage therapist and reiki practitioner. I ask people to share the reason that they went – not so much the medical condition but why they didn't pursue conventional care. Then, I expound on each of those possibilities: conventional care didn't work, the treatment suggested had side effects, or the patient was not interested in the recommended conventional treatment. This approach to a talk can be a little dicey because you never know if someone is going to try to give you their life story. As the speaker, you must be willing to artfully interrupt someone, hopefully, without them being offended. There were plenty of good stories to build on from in this audience.

As you can imagine, it is always helpful to give a handout at this type of event. Something that is relevant to the attendee, speaks directly to them, and of course has your contact info on it. I don't find practice brochures to be that helpful in this instance. The handout that I like to give is a list of recent patients and conditions we have seen at our practice. As an example:

• 6-year-old boy with recurrent ear infections,
• 45-year-old man with metastatic colon cancer, and
• 65-year-old woman with insomnia.

Listing the ages and conditions really gets people to thinking that this might benefit themselves or a family member.

The whole talk went pretty smoothly. The feedback was good and I even got a few patients out of it. One thoughtful question stood out. Among the patients I had listed on my handout were two patients in their 80s with dementia: one with presumed Alzheimer's (beginning stages) and one with presumed Lewy Body dementia (advanced stage). One of the attendees asked me if we actually cured all these cases, rather than had only seen them—very appropriate, pointed question. Which comes to the crux of our practice—what do we consider a successful outcome?

I spoke about some of the patients who were not cured, but had improvement or successful outcomes. I particularly focused on two patients with metastatic cancer who were able to extend their lives and maintain a good quality of life before dying. I also spoke about two patients with dementia, who have improved memory and their cognitive decline has slowed but not stopped. To me, these are somewhat successful outcomes. I, of course, want everyone to be totally cured, but this isn't a reality, unfortunately.

At the end of talk lots of people came over afterward to ask me questions. The man who asked the question about cure came up to me as well. He asked me if I ever used lysine to treat dementia (I had never heard of this). He said a friend of his cured his mother of Alzheimer's disease using lysine. Of course, I was extremely skeptical, since I know that there is no cure for Alzheimer's. His friend wrote a book about it. The man said he would bring me a copy. That afternoon the book showed up at my office. The author is Brad Pitman and the title of his book is, Ma Is Back. The book is an easy read; I couldn't put it down. I recommend that you get it.

Pitman chronicles the decline of his mother's functioning to the point where she didn't recognize people, was having fecal incontinence multiple times at night, and more. Then he started giving her lysine. (I'll have you read the book to see how he figured it out.) She started to immediately and slowly improve. Eventually she was back to normal again (I think it took 6 months–can't remember exactly). Quite phenomenal and unbelievable if you ask me–except it is true! Very interesting stuff. I could go into the science behind it, but I will save that for another time.

I have a patient that I mentioned above with advanced Lewy Body dementia. She, like Mr. Pitman's mom, did not recognize her daughter, had fecal incontinence, and was not speaking an unable to feed herself. Within one week of taking Lysine, 1000 mg, three times per day, she was periodically able to: hold her food, feed herself, recognize her daughter, make conversations, be oriented times three. Now, she is not cured, and may never be, but this is certainly an improvement, with continued upswings. The treatment is inexpensive and seemingly helpful so it is worth trying it with your patients with CNS issues, especially memory disorders. I spoke about this at the New Hampshire Association of Naturopathic Doctors’ conference last weekend. A couple of ND's mentioned that they had seen benefit with neurological pain as well.

So there you are, my gift to you for this Holiday Season.

The Game is On

Michael Cronin, ND
AANP President

We are in for big changes in the US healthcare system with the re-election of President Obama and the successful review by the supreme court of the Patient Protection and Affordable Care Act (ACA).

From the original ED to the excited new CEO
in AANP's new office - Let's go! 

The AANP and Jud Richland, our CEO, are ready to engage. The AANP office has moved into a more effective workspace three blocks from the White House. Our State and Federal Affairs, Public Education and Media Outreach, and Scientific Affairs Committees have been very productive in giving advice to the 2013 workplan to optimize our efforts in achieving our common goals. The Board of Directors has now approved the AANP 2013 strategic plan.

The 2013 strategic plan has three main focuses:

1. Public Education and Media Outreach
2. State Licensure
3. ND inclusion in the healthcare system using the language of the ACA

Public Education and Media Outreach
Physicians who listen will continue to find their voices in the New Year. AANP is focused on using media to drive new patients to our members. AANP plans to bring on a media specialist who will work with naturopathic experts to increase the amount of positive media attention naturopathic physicians receive. The raised awareness of naturopathic medicine will ultimately drive traffic to our Find an ND. We will continue to improve our online patient educational tools, for example the downloadable article through Natural Health Insights. Have you visited www.naturopathic.org from your mobile phone recently? The mobile landing page directs patients straight to the find-a-doctor search tool.

State Licensure
AANP will bring a renewed focus, increased energy, and more resources to this arena in 2013. The leadership of the State and Federal Affairs Committee is dedicated to better coordination and support for states. The State Alliance is where this work occurs. I encourage you to watch the video on our release of the state legislative toolbox, and invite you to participate in the monthly webinars. The toolbox provides a variety of resources to support the states. One example tool is safety and effectiveness data on the naturopathic profession in licensed states. The webinars will help attendees how to best utilize this data in state licensure efforts. Other examples include AANP and the colleges teaming up to provide expert testimony to legislators and ideas on how to engage the voice of your patients and the support of our conventional colleagues to gain licensure in more states.

Affordable Care Act
This law affects every facet of healthcare and the 6 sections that include “licensed CAM providers” open many possibilities for inclusion of ND’s in a wide variety of programs. These opportunities will require us to fight for inclusion in every state and require us to establish a precedent early in the game. The inclusion of NDs is vital to continuing our momentum. AANP is honored to have engaged the services of Deborah Senn as our federal lobbyist. She is engaged on this issue nationwide and has the commitment, connections, and experience to optimize our efforts. We are focused on enabling NDs to participate in the best of the Employee Retirement Income Security Act health plans, provide the preventive medicine services outlined by the ACA with no out-of-pocket cost for the patient, and have access to new employment opportunities.

I would like to ask all AANP members to join and get active in your state associations. If your AANP or state association membership has expired, please renew it and get involved so that we all have the resources we need to be successful.

Staying in the Country

By Jaclyn Chasse, ND
2013 AANP Board Member

We’ve just come off of a busy time. I live in NH, a swing state, so we had been inundated with political ads, mostly negative ads slinging mud at the other side.  I was looking forward to the negativity ending, but it seems that since President Obama’s re-election, there is still a palpable tension among Americans. There is frustration, disappointment, and anger among Romney supporters. Meanwhile, there is a large proportion of Democrats who are filled with relief, gratitude, and excitement at what’s in store in America’s near future. I don’t want to get too much into politics, but I bring this up because I also hear one question which I greatly appreciate—the quiet voice asking, “We are where we are. Now, how are we going to move forward?”

I think this question represents our times, and it is one of the great challenges of being alive, being in relationship. In the naturopathic community, we actively embrace the commonalities between us—our love of patient relationship, our respect for the whole person, for individualized medicine, and our undying curiosity in figuring out the human body. However, we also are challenged by our different perspectives. Should we try to integrate more into the current medical model or should pharmaceuticals or hydrotherapy dominate a patient’s treatment plan?

I am so excited to join the AANP Board of Directors, and come to it with that quiet voice asking, “How are we going to move forward?” I was so pleased to attend my first AANP board meeting and see that question resonate with the members of the board. I can share with you that although there are differing opinions among board members, communication happens in a respectful, thoughtful, and productive way. The way I wish it could happen on a larger, national level within our legislative houses. Dissenting opinions, delivered respectfully.  I feel so grateful to be a part of such a thoughtful group. I also feel grateful that the future of the AANP is in their hands. I am confident that the diversity of members’ ideas and ideals will be represented there, and that the Board will continue to move the association in a direction that meets the needs of the members it serves.

Since the election, I’ve seen Facebook posts of acquaintances’ saying, “Forget it, I’m leaving the country.” That’s not what we need. If you have not been wholly satisfied with the work of the AANP, you shouldn’t “leave the country” either. We need your voice and for you to provide feedback through the member survey, and to connect with a board member to share your ideas, share your solutions, and share your time to make the organization and our profession better. In joining the Board, I am choosing to have an open-door policy. Please share your thoughts and most importantly, your ideas, to make this the best organization it can be.

Progress in Puerto Rico

By Efraín Rodríguez Malavé, ND
2012 AANP Physician of the Year
San Juan, Puerto Rico

This year, the AANP honored me with the 2012 Physician of the Year Award in recognition of all the work that I have done in raising awareness about naturopathic medicine and establishing the profession as legitimate and regulated. Though my journey has been long, it has been very productive.

I fell in love with the profession of naturopathic medicine in 1982. I decided to leave my home of Puerto Rico, in the East Caribbean, and attend school in Portland, Oregon, in the western part of the US, to get my ND degree. In 1984, I was sitting in a meeting at NCNM where Dr. Jim Sensenig was discussing the need to organize an association to promote and develop our profession. At the conclusion of the meeting, he asked me, “After you finish your degree are you going back to Puerto Rico to help us expand our profession?” I answered, “Yes, I will. That is my country. It is where I was born, where my family and friends live. And I’ll go back and help them with their health.” I graduated and returned home to Puerto Rico in 1986.

As soon as I arrived home, I started taking steps to regulate the profession. Eleven years after my return, our dream was realized and our law that regulates naturopathic doctors was passed. Since then, NDs on the island have been able to practice without fear of being prosecuted by MDs. Our scope of practice is broad but not full. Next year, we will be working and lobbying to clarify the language of our regulation, so it will allow us to practice to the full extent of our naturopathic medical training.

We have also recently been working on health insurance coverage. And lastly, but certainly not the least, we are working on getting the naturopathic program at Universidad del Turabo accredited by the CNME. The program met the CNME eligibility requirements in April and is moving through the self-study program and will hopefully be up for candidacy in 2013.

Autumn at AANP

By Michael Cronin, ND
AANP President

It is fall and we are right on schedule with our calendar and planning process. The annual planning for the 2013 work plan and budget has us at the stage of surveying our members in preparation for updating and editing the work plan at our next Board meeting. The Board planning process also includes reviewing and refining the AANP strategic objectives and Ends statements. Through this discussion our CEO, Jud Richland, will identify AANP’s priorities and put together a draft work plan and budget. The Board will work through the details of his draft and approve the final work plan and budget in December 2012.

The naturopathic profession continues to grow macroscopically with an increase in the number practicing NDs, rising student enrollment, and more patients visiting naturopathic physicians. This past weekend the ND program at National University of Health Sciences in Illinois became the 8^th fully accredited program in North America. Congratulations NUHS! Bastyr California began its San Diego program in September. An ND program in Puerto Rico is seeking candidacy for accreditation to become the 9^th accredited program.  We also see progress in California with an expansion of the naturopathic physician’s scope of practice which now includes IV therapy.

Gaining licensure in more states is our most urgent need. The largest impediment to our growth is that only 4 states (Minnesota, Idaho, Kansas and North Dakota) have been licensed since California in 2003.  Our opposition is more organized. The closer a bill gets to passage the more back room lobbying occurs to hold bills. Our state legislative efforts must be better prepared, have excellent lobbyists, have stronger media coverage and have more positive testimony and lobbying from patients wanting naturopathic care.

We recognize the important contribution that testimony from conventional physicians familiar and supportive of naturopathic medicine and doctors has to counter the claims of our opposition.  Our legislative efforts need relevant evidence and scientific data demonstrating our history of safety and effectiveness.

Our 2013 plan will improve AANP’s support in all these areas so that the tools needed to grow our profession are available for our membership to leverage.

Bastyr University California Opens

By Michael Cronin, ND
AANP President

I had the pleasure of representing the AANP at the Bastyr University California celebration and grand opening on Friday, September 14.  It was a sunny day with over 400 guests, 51 very enthusiastic students and an equally inspired team of faculty, staff and administration.  The campus is located in the Scripps Ranch area of San Diego. The opening of this campus is the 8th in North America with 6 in the US and 2 in Canada.  The California campus occupies a two story building designed and built out for the needs of the college. Click here for a photo album.

The onset and timing of the Bastyr move to California was instigated by a recruitment effort by the California Naturopathic Doctors Association (CNDA) officers. The CNDA wanted an in-state college to support the continued growth and evolution of naturopathic medicine in California.

The 3 living founders of Bastyr, Shelia Quinn and Drs. Joe Pizzorno and Les Griffin, cut the ribbon to open the campus. Daniel K. Church, PhD, President of Bastyr, greeted the crowd with great enthusiasm. He acknowledged that the move was undertaken with an awareness of the risks and excitement about the opportunities that growth brings. Dr. Church described the appointment of an advisory board from area NDs, integrative MDs and interested public members. He described this campus as having the opportunity to partner with local institutions including Scripps Center for Integrative Medicine and the University of California at San Diego. Dr. Church was pleased to announce that the Washington campus has an incoming class of 105 students. 

Moira Fitzpatrick, PhD, ND, FICPP, CHT, was appointed vice president of the San Diego campus not long ago. Dr. Fitzpatrick was on the Bastyr Board of Trustees and was asked by Dr. Church, to lead the program. She described one focus of this new campus was to become active in evolving Naturopathic medicine in global health. Tabatha Parker, ND, of Naturopathic Doctors International, has been hired as faculty and to support the growth of naturopathic medicine in global health.

From a personal perspective, the opening evoked a strong sense of pride in our community and in our colleges. Bright, wholesome and inspired people are brought together by these institutions to affect real and lasting change in how we care for our fellow humans. It is an affirmation that this is a good thing we do.

P.S. During the celebration, news that SB 1446 passed was released. SB 1446 clarifies that nutritional IM and IV therapy is within the scope of practice for NDs. Congratulations to CNDA!

Honey Update 2012

Jacob Schor ND, FABNO
2013 Conference Speaker Selection Chair
denvernaturopathic.com

It has become something of a tradition at this time of year that, as we approach the Jewish New Year, I take a few moments to use PubMed, the search engine for the medical journals stored at the National Library of Medicine, to review new publications on honey.  It’s a bit of a distortion of the more traditional Jewish custom that we have of dipping apple slices in honey and wishing each other a “Happy New Year.”

This process has become more difficult each year as there has been a rapid increase in the research publications on the medicinal effects of honey. A quick search tells me that in the last 12 months, 592 medical journal articles have been published that contain the word honey. How can I expect to keep up?

Well it’s actually simple enough, PubMed allows me to place limitations on the search.  Thus if I limit my search to list only randomized, placebo controlled clinical trials using humans as subject, the number of citations drops to a manageable six papers. I delete several of the papers, one authored by a researcher by the name of “Honey” or that mention honey only in passing.  We are down to only three. Papers worthy of mention.

I can work with that:

Last November the journal Wound Repair and Regeneration published the results of a clinical trial by Betina Lund-Nielsen and colleagues from Copenhagen.  They compared two types of bandages for the treatment of malignant wounds in cancer patients, standard silver-coated bandages and honey-coated bandages.  Patients were randomly selected to either be treated with the honey coated or the silver-coated bandages.  Sixty-nine patients took part in the study.

On average the wounds of those using the honey bandages decreased in size by 15 cm² and the wounds of those using silver bandages decreased by 8 cm².

Patients in either group whose wounds reduced in size lived considerably longer, a median survival time of 387 days compared with 134 days in patients with no wound reduction. [1]

In February 2012 German researchers Biglari et al reported in the journal Spinal Cord on the effect of honey on chronic pressure ulcers.  This was a prospective observational study.  Twenty patients who had chronic spinal cord injuries and who had developed pressure ulcers were treated with Medi-Honey.  After 1 week of treatment all ulcers were void of bacterial growth. Overall 18 patients (90%) showed complete wound healing after a period of 4 weeks, and the resulting scars were soft and elastic. No negative effects were noted from the treatment using Medihoney. [2]

In April 2012 the journal Phytotherapy Research published a report by the opthamologist M Cernak and colleagues from the Slovak Medical University in Antolska, Slovakia.

Endophthalmitis is a rare but serious complication of eye surgery. Typically topical fluoroquinolones are used before and after surgery to prevent these infections. The problem is that many bacteria are becoming resistant to antibiotics, even to these heavy duty ones.  This study compared a solution that was one-quarter honey and three quarters water against a standard antibiotic.  In this study 101 patients were randomized to use either honey (n = 49) or ofloxacin (n = 52) treatment. In both groups, eye drops were administered five times a day for a week before and 5 days after eye surgery. After surgery and treatment, no significant difference in antibacterial effect was found between groups. In other words, the honey worked as well as the antibiotics.  [3] 

Best wishes for a sweet New Year to all of you.

Some of our past yearly ‘Honey Updates’ are worth reading as they contain recipes that you might find interesting.

The first one, well that is still preserved on our website, from 2005 has a nice recipe for baklava made with honey and nuts: http://denvernaturopathic.com/news/honeybaklava.html

Other past honey newsletters:

2006: http://denvernaturopathic.com/news/honeyupdate06.html

2007: This newsletter contains Rena’s Honey Cake recipe: http://denvernaturopathic.com/2007HoneyUpdate.htm

2008:  lost track of that one

2009: http://denvernaturopathic.com/HoneyUpdate2009.html

2010:  so much for consistency

2011: http://denvernaturopathic.com/HoneyReview2011.htm

References:

[1] The effect of honey-coated bandages compared with silver-coated bandages on treatment of malignant wounds-a randomized study.

Lund-Nielsen B, Adamsen L, Kolmos HJ, Rørth M, Tolver A, Gottrup F.

Wound Repair Regen. 2011 Nov;19(6):664-70. doi: 10.1111/j.1524-475X.2011.00735.x. PMID: 22092836

[2] Use of Medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury.

Biglari B, vd Linden PH, Simon A, Aytac S, Gerner HJ, Moghaddam A.

Spinal Cord. 2012 Feb;50(2):165-9. doi: 10.1038/sc.2011.87. PMID: 21931331

[3] Honey prophylaxis reduces the risk of endophthalmitis during perioperative period of eye surgery.

Cernak M, Majtanova N, Cernak A, Majtan J.

Phytother Res. 2012 Apr;26(4):613-6. doi: 10.1002/ptr.3606.

PMID: 22508360 

Why I Hate AANP Conferences

By Jacob Schor, ND, FABNO
2013 AANP Conference Speaker Selection Committee Chair

It’s such a relief that the AANP conference is over. I can finally stop pretending that I was looking forward to it. Or enjoying it!

Nothing personal. I enjoyed seeing many of you there in person, but honestly who among us would choose to spend a week hermetically sealed in an air conditioned hotel sitting in windowless lecture rooms? Are our schools graduating a new kind of naturopathic physician? Ones that like fancy hotels and that don’t need nature? If you take nature out of naturopathy, you don’t have much left.

I return home from AANP conferences dreading the arrival of our credit card bill; we spend more on a conference than we would ever consider for a vacation.

Why do we do these conferences? Because the MDs do, isn’t a good enough excuse. Because the AANP makes money off them? Well I’m not yet sure that the AANP breaks even. Because we need continuing education? That’s a joke these days as we can find all the CE we need online.

Most of the year my weekdays are spent sitting indoors at a desk with a changing array of patients sitting with me. The last thing I want to do when I take off time from work is sit somewhere else.

Why am I again chairing the conference speaker committee? It’s because like everyone in our profession I believe that the future can be better than the present—especially when it comes to our conferences. I think we can recreate our conferences and turn them into a different experience, an experience that is more congruent with whom we are both as people and a profession.

Next year is OUR chance to do it differently. As many of you already know, the conference is going to be held in Keystone Colorado in July, a week after the Fourth of July. This is a beautiful time of year to be in the Colorado Mountains. The wildflowers should be in bloom, most of the snow melted, and the mountain meadows moist and lush.

This is a location that you should be happy to visit, glad to come early to and stay on after the conference is over. In fact we are hoping to create excuses so that you do exactly that. We want you to bring your families. We want to meet those children of yours in person, not just look at their photos on your computer in the back of lecture rooms. In fact, I plan to bring my dog. We want to merge recreation with education and have you leave the conference rejuvenated. We have ambitious plans but can’t make them happen without all of you. We need your help.

This year’s Call for Abstracts is out. We need your creative ideas of things you can do, things you can teach, things that will further your colleagues’ knowledge and their ability to help patients. Submit these ideas as abstracts. Our good AANP president, Michael Cronin, has told me it is time we left behind the long marathon lectures of the past. He is eager to hear submissions that are shorter, particularly 30-minute lectures. Think short, sweet and if possible outdoors. Also think about long and slow lectures, the kind that you can stretch over an hour or two-hour hike. Maybe what you want to teach will only work with a small group of people. We will consider it! Perhaps you may get to repeat it a few times. Leave behind the old formats. We don’t have to repeat what was done in the past.

I may not be a big fan of our current conferences but I think we can make them a whole lot better. Let’s make this happen.

Wednesdays Off

By Jacob Schor ND, FABNO
Convention Speaker Selection Committee Chair

I’ve taken Wednesdays off since our first year in practice. It was easy at first. We didn’t have many patients and it made more sense to squeeze them together on the schedule. Wednesdays became my ski day and over the last twenty-one years it’s been a rare Winter Wednesday that I haven’t been on skis.

Summer Wednesdays are different - they are my dog days.  The dog and I head for the mountains and go for a walk, though in Colorado there isn’t really such a thing as a walk; we hike. These days off are essential for my mental well-being and probably for my health as well.  I’m not one for gyms or exercise machines but am content to spend a day on the trail. It gives me time to think, time to let those inner dialogues roll.

We hiked up Herman Gulch last Wednesday and I found myself thinking about which presentations are going to be on my ‘gotta see’ list at the AANP conference.  I realized that I’ve been looking forward to hearing what Britta Zimmer is going to have to say ever since reading her abstract last winter. Dr. Zimmer is the medical director of Pacific Quest, an adolescent and young adult wilderness and residential living program located on the Big Island of Hawaii.

I believe deeply that there is something innately healing about being outside in nature and I assume that many of you do as well.  There is something about the experience of fresh air, wind, rain, snow (though probably not so much snow in Hawaii), fresh running water and the sound of the ocean (not so much in Colorado), that enhances our well being. To turn this belief into a practice, now, that is a challenge. Thus I want to hear what Dr. Zimmer has to say. Is what they are doing really working?  Has she and this group at Pacific Quest figured out the appropriate dose of ‘outside’ required to help a troubled teen? I’ve got a thousand questions and I’m hoping she will be able to answer them.

Why I Love Homeopathy

By Louise N. Edwards, ND, LAc
AANP 2011 Vis Award Winner

Having been invited to write a post for the AANP blog (Thank you Mandisa), I logged in to see what other topics had been covered.

The most recent post by my dear friend Dr. Shiva Barton was titled, “Why is homeopathy dead?” I found this question startling and disturbing.

Once I read the post about how fewer naturopathic graduates are using homeopathy and the reasons why, it became clear to me what I wanted to write about, which is why I love homeopathy and the “slightly twisted” trail that brought me to this point. I am hoping that this will inspire some of you younger docs to lose the fear and embrace the therapy that I love the most!

To give some context, let me share a bit about my practice. I graduated from NCNM in 1988 and the Oregon College of Oriental Medicine (OCOM) in 1989. I’ve had a general family practice in Colorado where I occasionally see patients and now primarily teach naturopathic medicine at Bastyr and NUHS.
My practice is based on traditional naturopathic philosophy, always focusing on re-establishing the basis for health by correcting the underlying imbalances such as diet, hydration, sleep, exercise and mental state and then supplementing with other therapies. The therapies that I use include herbal medicine from both the western and Chinese traditions, nutrient supplements, hydrotherapy, acupuncture, manipulation, counseling, cell salts and homeopathy.

During my time at NCNM, we were only required to take 2 courses in homeopathy, both on acute prescribing. Unfortunately my instructor did not impress me with the value of the remedies, so I didn’t take any of the elective classes in homeopathy.

When I began my practice in Colorado, I occasionally prescribed homeopathy based on the acute prescribing I’d been taught in school. No prolonged histories or deep analysis just simple acute prescribing, such as Arnica for trauma, and I witnessed remarkable results! I saw profound, fast and clear responses to the remedies.

This happened so consistently I couldn’t ignore it. I began to regret that I hadn’t taken those electives because I was ill prepared to use this powerful medicine. I needed more training.

So I started studying, books and notes by George Vithoulkas and Dr. Eizyaga. I attended intensives with docs such as Drs. Paul Herscu, Robin Murphy and Rajan Sankaran. I went to conferences sponsored by the Homeopathic Academy of Naturopathic Physicians and National Center for Homeopathy.
During these years, I was exposed to many different types of prescribing: high potency, low potency, single doses, repeated doses, single remedies, combinations, families, constitutional, miasmas and more acute prescribing. I also encountered many strong opinions about which were the right ways to prescribe. Intriguingly, I found that most of these folks, prescribing in a diversity of ways, were having consistently good results. So, I experimented with all the methods, learning and refining my techniques of choosing remedies and dosing. I became ever more impressed with the phenomenal healing capacities of homeopathy. I witnessed significant pathology resolve and even more impressive to me, I observed significant and often deep seated psychological disorders resolved.

Practicing holistically, I’ve always focused on the patient’s state of mind as a central feature of their overall health. As I mentioned above, I do quite a bit of counseling. It is not uncommon for patients to tell me that they have had counseling, that they know what the problem is, the causes of their disturbance, that they have tried many times to change and that it “feels cellular” and they can’t seem shake it. This is where the correctly chosen remedy can work miracles. Literally, hundreds of times I have seen people’s state of mind transformed by the right remedy, freeing them from years of suffering. I keep hoping that the field of psychiatry will finally accept homeopathy because it will transform the practice.

For many years, there has rarely been a patient that gets out of my office without a remedy. Like Dr. Barton, I use it in combination with all the other therapies in my toolbox, including necessary pharmaceuticals (although these can often disrupt the remedy, so I have to use repeated doses). I do recommend to my students that when they are learning any therapy, that they use them singularly, so that they understand the effects of that herb, nutrient or remedy. However, once they have experience with each of them, then I encourage them to combine them, when appropriate, to optimize the treatment of each individual.

In all my years of practice, I’ve missed the remedy a few times.  I’ve seen a few provings when I gave the wrong remedy for too long (which is easily corrected), but I have never witnessed harm and am so sad to hear that students are told this is a risk. If someone were to tell me that I could only use one therapy in my practice (in addition to basic nature cure) I would choose homeopathy, because in my experience, there is no other therapy that has such profound and broad effects. That’s why I love homeopathy.

Towards a Greater AANP

As you have been hearing, there has been a flurry of new energy and activity going on at the AANP in the last few months. The recently formed Public Education and Media Outreach (PEMO) Committee is made of board members and general members who all have the goal of improving internal relationships within our profession, reinvigorating and increasing the AANP membership, and propelling the naturopathic profession into the public eye.

The PEMO Committee has been meeting regularly with great intention and strong goals to strengthen and unite our naturopathic community, reaching out to state leaders to foster communication and gain important feedback about how the AANP can better serve you. Our goal is that these efforts will create a ripple effect of outreach. We are encouraging everyone to start discussions among ND colleagues in your state, old classmates from naturopathic school, and general supporters of the profession. We are grateful for your membership in our national association and welcome all input as we work towards a better AANP.

We know that there is still much more to do! The PEMO Committee is paying attention to the branding conversations happening on Nat Chat and in other forums and conversations. We agree that increased awareness of naturopathic doctors across the country is the ultimate goal that will allow our doctors to see more patients and our profession to grow in number. We were equally inspired by the presentation given at last year’s AANP Convention by Dr. Rick Kirschner and encourage all members to watch, or re-watch, his lecture. Please do not wait to give yourself a brand such as “natural medicine expert” (coined by Dr. Oz when he referred to Pina LoGuidice, ND), or “America’s natural medicine doctors” per naturopathic doctor Dennis Godby’s advice. Add it to your business card, website, elevator speech, and state association website. Let us know what messaging is working and we look forward to coming together with renewed conversation and relationships to move our individual and collective agendas forward for our beloved profession.

We look forward to seeing you at the 2012 AANP Convention in Bellevue where we will be thrilled to introduce our new CEO, Jud Richland. As always, the convention will be a fantastic learning experience, community building event, and a hotbed of new ideas and energy about our future; you don’t want to miss it!

With gratitude and appreciation,

Drs. Carrie Runde and Holly Lucille
Co-Chairs Public Education and Media Outreach

Yin, Yang and the AANP

By Carl Hangee-Bauer, ND, LAc
AANP Past President

It is the nature of the universe to see periods of expansion and contraction. There is a time for expending energy and growth and a time for rest, reflection and recharge. We see this in the cycles all around us. An athlete must rest before and after a strenuous event. When replanted, a plant with vigorous growth will pause as it sets its new roots, preparing for the next growth spurt. In eastern philosophies this is conceptualized under the theory of Yin and Yang, and the energy from this interaction of complementary opposites drives the dynamics of our world and lives.

So it is with the AANP.

Almost a year ago our association was handed a challenge and opportunity with the resignation of our long time Executive Director, Karen Howard. Her vision, hard work and leadership moved the AANP forward through a period of vigorous growth and development. During this time we grew from a relatively small association to one with headquarters in Washington, DC, visibility on a national stage, and a solid financial base. She was the right person at the right time and we will always be thankful for the role she played in the evolution of the AANP.

As the AANP leadership and Board accepted the challenges of change, we used it as a time for deep reflection regarding the future of the AANP. We asked ourselves many questions like, "What are the challenges that lie ahead for the AANP? What political and societal forces will shape our inclusion in  health care systems and in peoples lives? How do we address internal divisions and struggles typical of any growing profession? How can we look ahead and make conscious choices to maximize our potential to change the health care system in the US? What kind of leadership do we need to face these challenges as we move forward?"

Here we are, 11 months later and getting ready for our 27th AANP Convention. We have a new CEO, Jud Richland, whose past experience and vision for our profession could not have fit our hopes and expectations any better. We have an active Board whose members are engaged in strategies for, among other things, developing our public education and media affairs messaging, working on a national level for inclusion in the Affordable Care Act  and other programs, promoting state licensing and improved relations with our state affiliate associations, and setting a vision for the growth of naturopathic medicine. We have a revitalized House of Delegates examining the issues that face us as an association and a profession. And we have naturopathic doctors across the US, working with their patients to improve their health, educating those in their local communities, and advocating for licensure or improvements in their state laws in order to better serve their patients. 

I have served on the AANP Board for 4 1/2 years, two of those as President, and have witnessed the Yin and Yang of the AANP.  I believe we are on the cusp of great and positive change, and after a time of "setting our roots" we are prepared for vigorous growth and expansion. Great things lie ahead and we are ready to embrace the future.

Be a part of that change. Join the AANP and your state association. Come to the AANP convention and meet our new CEO, Jud Richland. Let your Board members know what your dreams, goals and expectations are for the naturopathic profession. Vote and make your voice be heard. Tell us what we are doing right and where you'd like to see things improve. Ask questions. Learn a few new things you can use in your practice your first day back in the office. Reinvigorate and renew ties with your friends and colleagues. 

We are the naturopathic profession and are strongest when we come together for common purpose. Be there with us as we take our next steps forward.

Board Approves Scientific Affairs Committee

By Michelle Simon, ND, PhD
Scientific Affairs Committee Chair

In January, the AANP Board of Directors approved the creation of a Scientific Affairs Committee. This committee is advisory to the AANP Board. We have seven members, Ather Ali, ND, MPH, Carlo Calabrese, ND, MPH, Peter D’Adamo, ND, Bill Walter, ND, Heather Zwickey, PhD, Michael Cronin, ND, and me, Michelle Simon, ND, PhD as chair.

Our mission is to support the naturopathic profession by facilitating access to and education about current research on naturopathic medicine and to expand the available body of naturopathic medicine research. We have three areas of focus:

1. Science and Policy - The interface of these disciplines is necessary to support licensing, scope expansion, and insurance and government program inclusion. To support policy we need to help policy makers understand the available research, facilitate its presentation in an accessible location, and update this regularly.


2. Education and Training - We aim to increase the research literacy of our profession for both our existing graduates as well as current students. This may also include increasing the infrastructure or training for ND researchers and contributing to the educational opportunities at the AANP annual conference.


3. Research Facilitation - The science itself: its techniques and objectives. The SAC aims to provide input into determining what types of research, and on what topics, might be good priorities. For example using data mining techniques or bioinformatics, whole practice research, and cost effectiveness research. We might also provide input into what studies or surveys would assist patients or potential patients in their decision-making about naturopathic healthcare. One goal might be to utilize research in order to help differentiate our profession from other healthcare professions.

In May, we provided a one page white paper focused on the cost effectiveness research of our medicine which was presented at the DC Federal Legislative Lobby Day. Watch for more to come from our Scientific Affairs Committee.

Celebrate our New Beginning, Meet and Greet Jud

By Michael Cronin, ND
AANP President

The end of July, beginning of August, is the most exciting time of year. Our Board, volunteers and staff are hard at work making sure all of the “t’s are crossed and i’s are dotted” as we draw closer to the Annual Convention.

Every time we come together, I am reminded of the great things we can accomplish when we work together. I look forward to conquering our next goals. Let’s make Lorilee Schoenbeck’s chant, “50 in 15,” into a reality and bring all citizens’ awareness to what naturopathic medicine is! Every American should know that physicians and patients can work together to facilitate the integration of health and healing. Patients should know that they do not have to settle for only their symptoms being treated. There are doctors who will target the root causes of disease so that a full and healthy life can be lived.

One of the main goals at this year’s Conference, in addition to connecting face-to-face, is to gather your feedback on how we can strengthen the AANP to achieve our goals. Additionally, we will celebrate the beginning of a new era with Jud Richland, our new chief executive officer. We would like as many of you as possible to be able to attend. With this in mind, we are extending the early bird registration for the AANP Conference through Friday, July 20, 2012.

I can barely contain my excitement to introduce Jud Richland to you. Here is what he has said so far about our community after only a few days in office, “You have chosen to commit to a profession that is truly transformational. To honor your commitment, your professional association must also commit to being transformational. Thus, for AANP the greatest danger is not that our goals are too lofty and we miss them, but that they are too low and we reach them. The association has a thoughtful and impactful blueprint for action.”

Come and celebrate with us at the AANP conference! Learn about our “thoughtful and impactful blueprint.” Find out how you can be part of the "action." Share in the enthusiasm of the AANP team and become a volunteer for a project that fires your passion.

We have an excellent CE Program and there will be lots of social and fun things to take part in like our opening and exhibit hall receptions, the “all schools” dance, and more. While in Seattle area, I would also recommend you take some time to visit the Bastyr Center for Natural Health. A new study affirms our commitment to patient centeredness. The Puget Sound Health Alliance found the Center at the top of their lists for patient experience with communication, getting timely appointments, care and information, and helpful, courteous office staff. Congratulations to the Bastyr team!

It is time to renew old friendships and to help AANP get off to a fresh start.  Meet us in Bellevue and be part of the discussion on how our community can come together to achieve success. Help us expand the influence and impact of naturopathic physicians. 


See you in August!

A Gathering of Dragonflies

By Jacob Schor, ND, FABNO
DenverNaturopathic.com

A group of crows is called a ‘murder.’ A group of lions is called a ‘pride.’  Is there a word used to describe a gathering of dragonflies?

On our morning walk Poppy and I observed a cluster of several hundred dragonflies flying about in a cluster 20 to 30 feet above the ground.

I have never noticed this phenomenon before and certainly would not expect to see such an occurrence in urban Park Hill; perhaps in some swampy wetland, not on the corner of Montview and Ash Streets.  Chalk it off to one peculiar season.

This has been the most peculiar of seasons. Winter faded away halfway through February and Denver had none of our expected March snow.  The radio announced a few weeks back that our mountains had only 2% of the 30-year average snowpack.  Our Catalpa tree that typically flowers for the Summer Equinox had shed all it’s flowers by Memorial Day.  We have already baked 4 cherry pies from a tree that typically does not bare fruit until July fourth.   To say it is an unusual year is an understatement of the first degree. Already, before the summer fire season officially arrived, we’ve watched the third largest fire in Colorado history burn out of control for days west of Fort Collins.

Our seasons it seems have lost their rhythm, their inner timing.

In the current issue of Science News, Nancy Ross-Flannagan reports that the American pika, those small little fur-ballish animals that sound their high pitched whistles as you approach high alpine rock fields, are in serious trouble.  For years they have gradually moved to higher altitudes to escape the gradually increasing summer temperatures of their habitats.   They have run out of space; they cannot move any higher and as Ross-Flannagan writes: “….. in the arid, mountainous region known as the Great Basin, pikas have disappeared altogether from 40 percent of the locales where they were found in the first half of the 20th century. Apparently already at the upper limits of their ranges, they’ve run out of places to run to.”
Our climate is changing rapidly yet it seems we hardly talk about it anymore.  Is it that our lives are so far divorced from the natural world that we no longer notice when crops ripen months off the norm?  Or winter fades to spring a month early?  Or bark beetles that never could live through a Rocky Mountain winter now survive and destroy our forests? It seems that subject of global warming has been dragged from the realm of science and become political in nature, the debate becoming taboo. Last year the Federal Emergency Management Agency (FEMA) declared more disasters than in any other year in US history.  More tornadoes, more floods, more storms, just as climate change and global warming models have predicted.  One might think this would garner more attention.

In the June 15th issue of New Scientist, Hannah Krakauer reported that the North Carolina legislature has taken a most unusual approach to dealing with the problems brought about by global warming.  North Carolina’s astute leaders have simply passed a law to make it go away.  Apparently,  “When a state-appointed commission announced that North Carolinians could expect 39 inches of sea-level rise by 2100, the Senate responded with a bill that legally prevents the Division of Coastal Management from using the climate model that forecasts fast-rising sea levels….”

That is an approach I would not have thought possible in educated society.  But then again we must remember that the United States has the lowest trust in scientific knowledge than any other developed country.  Actually, my recollection is that we tie with Turkey for last place.

For a while the sudden rise in the number of national disaster FEMA responded to last year was also thought to be associated with changing weather patterns.  I have not heard mention of this in the last few months.  Perhaps Congress has outlawed talk of this.

I will stick to wondering about those dragonflies.  There really must be a word…..

Keynote Presentations at AANP Convention

By Jacob Schor, ND, FABNO

Chair, AANP Conference Speaker Committee

Something unique is about to occur at this year’s AANP convention in Bellevue, Washington.  A number of the keynote speakers have presentations that revolve around and attempt to inform a common theme, the question of how our medicine works.  To my knowledge this has never been attempted at our conferences before. 

Actually William Mitchell, ND, spoke at length about the vis medicatrix naturae but this is going to be different because we are trying to understand and explain our medicine in the context of modern science. I have been asked to write briefly about these presentations and how they will tie together, so that’s what I will attempt here.

Valter Longo, PhD, from the University of Southern California, is going to review his research on fasting and cancer chemotherapy.  Fasting triggers an adaptive response that reduces the damage chemotherapy causes in healthy cells while increasing the cytotoxic impact it has on cancer cells.  While Longo’s results are of great interest to those of us who work with cancer patients, the concept of adaptive response is of interest to all of us.  This same adaptive response triggered by fasting underlies many of the traditional nature cures our profession has long endorsed. 

Robert Rountree, MD, is going to lecture on hormesis and how this applies to the action of many of the modern phytochemicals we use in practice.  Hormesis is the idea that small amounts of seemingly toxic substances can have the opposite effect, triggering an adaptive response that benefits the organism rather than harming it. 

Dana Ullman is going to take this idea of hormesis a step further and apply it to homeopathy.  Could homeopathy be another example of hormetic action used to elicit an adaptive response, just using smaller and weaker triggers?   Dana tells me he is ready to try. 

These three presentations focus on triggering an adaptive response by either stressing the organism or pretending to stress it in order to elicit a healing response.  There is another approach we employ in our practices that is the opposite.

More and more what we try to do is to remove stress and the resulting absence of stress allows restoration of health.  We have two presentations that examine this approach.  David Katz, MD, of the Yale School of Public Health will focus on basic lifestyle modifications.  Getting a patient to stop smoking or lose weight reduces the physical stress on their body.  Our own Lise Alschuler, ND, will speak on the effects of emotional stress and its impact on health and, in particular, on cancer.

We have two additional keynote speakers scheduled.  Dave Macallan, ND, is what I would describe as a serious “talker.”  A one time BBC correspondent, Dr. Macallan will help us define naturopathy to the public. 

Our last speaker is Clemont Bezold who is a part of a unique profession. He is a Futurist and will describe the potential future of naturopathic medicine.

Waging Peace

By Michael Cronin, ND, AANP President

I love the idea that what we are doing in our professional activities is “waging peace.”  This has always been how I have approached my organizing work in the naturopathic profession.  I feel this even stronger since my visit to India. While there, I learned that Mahatma Gandhi is India’s “Father of Naturopathy” and that he imported it from us.

Naturopathic physicians are an essential component in creating a better future. We are forwarding practical solutions that make our communities and our world a better, healthier place. We do this by promoting health and wellness and by treating disease with natural medicine to improve a person’s well-being. We pursue and promote a healthy lifestyle, organic eating, sustainable agriculture, healthy medicines and a sustainable healthcare system accessible to all.

We each have much to offer and we are learning to coordinate our efforts for greater effectiveness. This coordination continues to increase public awareness about naturopathic medicine. A recent article by John Weeks, former AANP Executive Director,  in the Huffington Post highlights naturopathic research  and how it is proving the value of integrative medicine. There are more books being written by NDs now than ever before; some of these texts are getting astronomical circulation. NDs are presenting in several professional arenas. For example, May 16, 2012, a group of NDs presented a systematic review of naturopathic care at the International Research Congress on Integrated Medicine and Health in Portland, OR. In October, there will be two naturopathic workshops at the American Medical Student Association’s pre-medical and pre-health professions national conference: Guiding Your Passion For Medicine.

To continue our coordination of efforts and increase our effectiveness, I invite you to attend the AANP conference August 15 – 18, 2012, in Bellevue, WA. For those who wish to engage with the AANP more intimately, I invite you to attend our pre-conference leadership day on Tuesday, August 14. There you will have the chance to meet, greet and engage with our new CEO, Jud Richland. We have created this day to establish improved communication and unification with AANP members and the leadership of the AANP. I hope to see you there.

Brainstorm

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

I had a meeting on my schedule today for a brainstorming session.  As I walked to the meeting, for some reason, the word, ‘brainstorm’ hovered in my thoughts. What an odd word, really. Especially considering that the meeting was a pleasant conversation of ideas being exchanged. We certainly were not raging or sending thunderous ideas that hit one another at lightning speed. Actually, it was more like we were eddying – our ideas entering into a swirling pattern of thoughts and plans ultimately creating a current of action. Unfortunately, an eddy session just doesn’t sound right. Perhaps, brainstorm is, after all, more appropriate.

One definition of brainstorm is, “a sudden, violent disturbance of the mind”, i.e. having an idea. What if an idea is, in fact, a gargantuan coordinated feat of electrons and neurotransmitters? What if every idea generated did rage through our neuronal circuitry like a gale, whipping the final result into the tightly constrained containers we call words?  That would mean that each word we utter conceals intensely packed vitality and that ideas are indeed a storm of effort unleashed.  And with that, it would seem that ideas certainly merit our full attention.

Regardless of their content, the mere energy of ideas demands notice. In fact, this gives new meaning to the phrase, “ideas matter”. Matter is condensed energy and, going along with my flow here, ideas are condensed energy, hence ideas both do and are matter!  And lest I slip completely off the edge of reasonable dialogue, let me just suggest that this diatribe boils down to one thing. People’s ideas matter, they are worthy of our attention. When we really listen to one another, we create the potential to unleash the power of our vital mind and, with that, create what would otherwise seem unimaginable. 

Why is Homeopathy Dead?

By Shiva Barton, ND, LAc

2011 AANP Physician of the Year

Despite what they may have heard about me, I have quite a few naturopathic students and young doctors that visit my office. My most recent visitor was Dr. Laura Chan, a recent graduate of Bastyr U, a smart, dedicated and enthusiastic new practitioner. She is excited, dedicated and enthusiastic about almost all the aspects of being a practitioner as she embarks on her new career. One of the things she was most notably not enthusiastic or excited about was homeopathy. Dr. Chan was interested in homeopathy when she first arrived at Bastyr. However, her training in homeopathy led her to believe that homeopathy was too complicated to use as a treatment modality in a general naturopathic practice. Now, I would like to think that Dr. Chan's experience was an anomaly, but it is not. Almost all of the students that I have been a preceptor for,  no matter the college, have had an experience like Dr. Chan. So my question is, “What's up with the way the ND schools are teaching homeopathy?”

Classical or Bust?

Is this the idea, then, that the only way you can do homeopathy is to do classical prescribing? Homeopathy, evidently, is a very serious endeavor. It seems like the version that is taught in the ND medical colleges is something similar to the following:

1.    You have to take a 1.5  - 2 hour intake and get every minute detail to be effective.

2.     Homeopathy doesn't mix well. You can only prescribe a homeopathic remedy. You can't mix it with other treatments because:

a.    The other stuff messes up the homeo.

b.    You can't tell what is working if you give homeo with something else.

3.    You have to wait a month to see if it works (this alone is a good strategy for unemployment and/or starvation of the practitioner).

4.    You can really do incredible, irreparable harm to a person's vital force if you pick the wrong remedy. I mean, we are not just talking about vital force, for gosh sakes. We are talking about VITAL FORCE here. You don't want to screw with someone's VITAL FORCE, do you?

So, the combo platter of taking too long, waiting too long, too much danger, too little income and too many rules scares people from using homeopathy in their practice.

Homeo, Homeo, Where Art Thou Homeo?

I hate to break it to you, but homeo (okay, it has a nick name now. How serious can something be with a nick name like Homeo?) is a valuable tool for the general ND practice. I encourage all of you newbies to throw out the homeo philosophy books (really!) and stick to the basics: match the remedy to the person with the symptoms.  Corresponding to the point numbered above you will find:

1.    You can use homeo in the context of a regular 1 hour new patient office exam or shorter follow up. Just take a minute to change your thinking towards a homeopathic remedy. That's really all it takes.

2.    You can use it – no, you SHOULD use it – with any other modality.

a.    The other stuff doesn't interfere with the homeo effect (by the way, neither does coffee, nor usually does mint).

b.    Homeopathy creates an “Aha” reaction, much different from the slower slope of improvement with botanicals or nutrition.

3.    Homeo works very quickly – acutely within hours and chronically within a day or two. Nothing else generally works this fast. If you don't see a change this quick, recommend another remedy.

4.    You can have side effects from any naturopathic intervention. The side effects from homeo are generally fewer and less intense than from other treatments.

Use It or Lose It

So, you new grads/new docs: give it a shot. The current rules are dogma. Let your karma eat your dogma. You can use combination remedies. You can use one remedy at a time. You can use two at a time (I double dare you!). Your patients can use mint. They can use coffee. They can take homeo right before they eat. They can take it right after they eat. They can even take it WHILE THEY ARE EATING. Just use it. You will find your groove. Mostly, you will find a very valuable tool to help people get well, which is why we took this job, isn't it? Maybe the ND schools will catch on sooner or later.