The Unlikely Partner

By Christine Girard, ND
2010 AANP Physician of the Year

Photo by patti haskins via Flickr, used under the Creative Commons License.

I went to the pet store to buy cat food for Sage, my perfect, 17-year-old, part-Maine coon cat. As I walked into the store, I saw a few cats in crates that were on display from the local shelter. I see this each time I enter this store. But that day…heavy sigh... that day, a small black and white cat made eye contact and turned over exposing her belly. I was strong. I walked by. I went to the back of the store to the cat food aisle to choose Sage’s food. I would not be suckered by a pink and white belly. I walked to the register – well, I almost made it to the register. I detoured to the cat crates. Three cats in separate crates. Two slept. One chirped and pawed at me through the plexiglass window. I texted William, my Sweetheart, with her picture. His response was something in the realm of “Are you out of your mind?”

Once home, I teased about adopting another cat. William and Sage both tolerated my teasing. This went on for a week. At that time, I bought more food for Sage at the same store and saw the same black and white face peering through the plexiglass. I texted more pictures. The manager of the store said that usually the cats are adopted within two weeks. “They have a really good turnaround time,” she said. I didn’t know cats had a turnaround time. Who knew? Reasonably assured, I went home.

I conveyed this information to William, who continued to tolerate my random musings about having another member of the family. Sage offered the occasional rolling of the eyes (didn’t know cats could do that, did you?). William by this time had asked that I cease and desist. The following week, I found myself dreaming about this cat. I couldn’t ignore her. I explained this to William. What I love about William (well, one of the things) is that he listens. I mean he really pays attention and listens. That week William went to the store to buy Sage’s food. He texted me that the black and white cat was still there. What should we do? She had been there for longer than the two weeks. I had been dreaming about her (and having private conversations with Sage about having a little sister). We couldn’t ignore her.

So, by phone, I walked William through what needed to be bought and I prepared our guest bedroom for the new cat. Sage slept. He woke later that afternoon and his world had changed. He sniffed at the guest bedroom door and hissed. Not an auspicious beginning.

Over the following few weeks, we introduced them to each other. It has gone remarkably well. Sage has been generally tolerant, and our kitten has been the annoying little sister he never wanted.

We named her Lotus because she has the pinkest nose and the pinkest belly under white fur. It reminded me of the blush of pink on a white lotus flower.

What has been unexpected is her effect on my morning yoga/meditation. She comes in the meditation room and watches intently as I light the candle and incense. As I arrange myself in lotus position, she waits patiently. Once I begin to focus, she steps into my lap, arranges herself and purrs. She just sits there quietly. Lotus in the lotus position. What I have found is that I am more motivated to meditate because I have this unlikely partner who shares this very special quiet space with me. It really is quite precious.

President's Message: Progress in State Licensure

By Carl Hangee-Bauer, ND, LAc
AANP President

Legislation to license NDs had passed the North Dakota Legislative Assembly
as work continues in other nearby states!

By now you’ve likely heard the good news that North Dakota will become the 16th state to license naturopathic doctors!

This is a great step forward for the profession and is largely the work of one person, Beth Allen, ND, who has the vision and foresight to take her inspiration and turn it into perspiration to accomplish this momentous task. It shows how the power of one dedicated person can change the world.

Hearing this news makes me think back to our licensing campaign in California nearly a decade ago, and ponder what’s in store in North Dakota. For the many of you reading this who have been involved in licensing campaigns, both successful and unsuccessful, I’m sure you share my observation of the depth of work and dedication it takes to pass a licensing bill. Creating educational pieces for legislators, dealing with misinformation campaigns around naturopathic education and safety, navigating the political landscape, and “touching” each legislator are all vital pieces to creating a successful outcome. It takes a tremendous amount of work and sacrifice to achieve this goal.

I am personally of the mind that state licensing is driven by those in the states seeking licensure. They know the local terrain and issues, have the personal connections with the legislature, and have the will and passion to see that they are able to practice openly and bring the choice of seeing a naturopathic doctor to all citizens of their state. The role of the AANP is to be actively supportive. By providing training, support for educating legislators and the public, knowledge of trends in other licensed states, support at legislative hearings, and a sounding board as issues arise, the AANP is there to help those NDs in states with legislative campaigns be as successful as possible. I can tell you that even though California NDs led the campaign for licensing, we would not have been able to accomplish that if it were not for the AANP being there with us every step of the way. Every state has different conditions and influences that affect what may fly in the legislature and what may not. They say “politics is the art of compromise,” and we certainly see that in the different bills that are submitted and pass or fail. Knowing what to compromise on and what not to is one of the arts of successful passage.

Now the real work begins in North Dakota. Rules and regulations need to be written, a board formed, and a million other details that take a passed bill into law on to regulatory oversight. The North Dakota Association of Naturopathic Doctors, I’m sure, will rise to meet these challenges with the leadership that Dr. Allen has already clearly demonstrated.

Meanwhile, there are active licensing campaigns ongoing in a number of other states and I believe that the passage of the law in North Dakota will inspire and encourage those hardworking people that this can be accomplished and we will see more states licensed in the near future.

Please join me in thanking Dr. Allen and all of those who worked to achieve this significant victory. This is a significant step forward in the history of the naturopathic profession and opens the door for many more people to benefit from naturopathic medicine.

Brand New Wine in the Same Old Bottle

By Bill Benda, MD, FACEP, FAAEM

Andy Rooney, famous curmudgeon.
Photo by Stephenson Brown via Flickr, used under the Creative Commons License.

One of the worst things about aging is that we tend to become intolerant. One of the best things about aging is that we can get away with it. In fact, curmudgeonly editorializing is one of my favorite current pastimes.

So this blog submission will deal with one of my personal pet peeves: conference brochures. You may have noticed these glossy advertisements in your mailbox and on your computer screen heralding the Spring peak of the semiannual convention season, exemplified by the recently adjourned Integrative Healthcare Symposium in NYC and this past weekend’s iMosaic assembly in Minneapolis, along with a cornucopia of nutrition and functional medicine and guild gatherings taking place across the country. I don’t wish to grouse about the conferences themselves (at least not at the moment), but I do have issue with the advertising touting the wonders that await.

(Cue Andy Rooney.)

So here we are – pioneers of cleaner and less toxic therapies, protagonists in the battle to provide truth and clarity to our patients, ‘advertising’ a new way of doing old business – and yet we put out glossy brochures worthy of People and Vogue. Have you ever really looked at these things? Dig one out of your trash or junk folder, and here is what you will find:

Cover page – quite possibly a panorama of a city skyline or palm fronds swaying in the balmy breeze of a beach resort town. But more likely than not you will be greeted by a group of extraordinarily attractive and happy “health-care practitioners” a la Law and Order promos – arms crossed, heads tilted slightly upwards or downwards towards the apparently seven- or three-foot tall photographer, teeth brilliant and eyes knowing. At the front is a young woman, usually blonde Caucasian but sometimes African-American, always with a white coat and stethoscope draped around her neck – clearly a physician of some order or degree. “Hi! We’re young and hip and we like this conference!” Immediately behind her is the graying yet vim white gentleman (never a woman), also with white coat and tight yet perceptive smile. “We traditionalist docs approve of this conference, too!”

From these two handsome people on to the back row we have a variety of ethnicities, always including one Asian practitioner, a second requisite female, and in the very back a white or black young man (again, never a woman) in scrubs but sans white coat. “Medical technicians can attend this conference, too, as equals!”

Turning the front page, we then delve into the remainder of the brochure and find: The row of profile photos of well-known presenters we recognize from last year’s conclave, and the year before. The ubiquitous mortar and pestle next to some unidentified herb. The close-up of an acupuncture needle inserted just so into perfectly clear and tan skin. The slender woman with leotard in a yoga or meditation pose overlooking aforementioned balmy beach, hair pulled back in a ponytail. And of course, the sponsor hotel’s tasty spread of sustenance laid out on white-clothed tables for our culinary pleasure, complete with smiling person in a chef’s hat.

Imagine if we all really looked like these people, and lived their implied existences. (I know my social life would be a lot more exciting.) But the fact is that we are not stock photo models, or Stepford-docs. We are not fetishes to the altar of our alternative therapeutic offerings. We proclaim we will not obfuscate the patient’s symptoms with drugs, or misrepresent the cause of illness as anything other than what it really is, so why are we pretending to be pretty young models when in fact we are . . . well, go look in the mirror.

What you will likely see is an actual, authentic person, lines and pouches and blemishes and all. Why don’t we put these faces on the brochure, these bodies on the beach? Why are we reproducing the very promise of physical perfection we point out as arrogant and misleading in our allopathic brethren and sistren? Why are we doing things the same old way, while stating to be somehow different?

Yes, I know this particular topic may not quite rank up there with new ways of ameliorating the side effects of chemotherapy or the nutritional impact on autistic spectrum disorder. But these ads are nothing less than a reflection of the level of the honesty our patient will be getting when we walk into the exam room.

Kenny Loggins and Jim Messina sang a song in the '70s about our flawed American political system entitled "Same Old Wine in a Brand New Bottle." What we have here is a kind of backwards take on the same problem. If we are truly offering a new, healthier wine, we really need a more transparent bottle.

Doing the DC FLI

By Susan DeLaney, ND, RN

Susan DeLaney, ND, and Trevor Holly Cates, ND, feed body and mind at the
2010 DC FLI reception on Capitol Hill.

Washington in the spring is a lovely place to visit, especially when you get to do it with a mini-convention of naturopaths and naturopathic students from around the country. The first weekend in May each year, we gather at the Capitol to learn from each other, about the basics of politics in Washington and what we can do to move our message of naturopathic health care forward. This year's event is planned for April 30 - May 2!

Each year I go I learn something new, meet new people, and reconnect with old friends. For two days, we are listening to valuable speakers, sharing ideas, and practicing how to talk to legislators about our issues. The third day, we put into practice what we have learned. Traveling in groups, we visit our respective state Senate and House members in their offices. Locating their offices in the maze of the Capitol Buildings is a bit like a scavenger hunt. Most of the discussions are with their health-care staffers, who do listen and convey the information to the representative. Meeting face-to-face in their offices with legislators and staffers provides us an opportunity to have in-depth discussions about who we are and what we do.

At first I was not sure that what we did mattered until one staffer recalled that she remembered our visit from last year! It is truly the presence of so many doctors visiting Washington that makes such a difference. Before our first annual fly-in event, no one really knew who we were. Now they know faces and stories that connect them to naturopathic medicine.

And then there is the famous, late afternoon naturopathic reception where we have earned our reputation in D.C. as the best place to hang out with healthy food and wine. Smoked salmon, fresh fruits, nuts and a fabulous kale salad have really made us the toast of the Hill! They come early and stay late to enjoy the delicious food, and socialize with their constituent NDs and naturopathic students.

When the work is all done in the evening, we walk the city, enjoy fabulous meals with friends, stand before majestic monuments that are so beautifully illuminated every evening, and find ourselves filled with awe that we have the freedom to be there. We have the freedom to do this work, and by letting our voices be heard in the halls of Washington, we help grow naturopathic medicine.

Wishing you can all be there with me this year! Registration is FREE for all members, and closes April 15!  Click here for more information and to register today!

How Poppy Got Her Name and the Limitations of Evidence-Based Medicine

By Jacob Schor, ND, FABNO

Hamantaschen. Photo by stu_spivack via Flickr, used under the Creative Commons License.

Our dog Poppy was named on the 14^th day of the Hebrew month of Adar in the year 5765. It was Purim, the Jewish holiday that commemorates the deliverance of the Jewish people in the ancient Persian Empire from destruction by an evil advisor to the king, a story recorded in the Book of Esther. Our puppy was about 12 weeks old at the time and still unnamed. We had simply been calling her ‘puppy.’

Part of the celebration of Purim involves the making and sharing of pastries called hamantashen. These triangular shaped pastries traditionally contain fillings made of either poppy seed or prune. How far back the tradition of making them goes is unclear. The holiday of Purim itself has been celebrated for nearly two millennia. As both opium and prunes both originated in the general vicinity in which the Purim story occurred, one might assume the custom of eating hamantashen goes back equally far in time.

In our home, we take making hamantashen seriously. We actually own a special hand crank grinder designed just for crushing the poppy seeds to prepare the filling. And I must admit that my dear wife Rena Bloom makes the best hamantashen I’ve ever tasted.

One cannot, or at least should not, eat poppy seed hamantaschen alone. All poppy plant derivatives have, to a varying degree, the same effect on the intestines. They slow things down. Whether we are talking about opium, heroine, or just poppy seed filling, they all cause constipation.

Alternating the consumption of poppy seed hamantashen with prune filled hamantashen completely solves the problem. Prunes, as we are all well aware, have a laxative action. With ease, one can achieve a balance between the poppy and the prunes’ therapeutic actions.

Let me come back to the story of our dog’s name. Six years ago, during the feast of Purim, as we sat around the dinner table consuming the last plate of homemade hamantashen, my dear wife lifted her last fragment of poppy seed filled hamantashen into the air and declared, “I love poppy.” Our young dog, up to then who had only been referred to as ‘puppy’, assumed Rena was talking about her and came bounding over to us.

This memory came back to me as I was reading a soon-to-be-published study about prunes.

We may all know what eating too many prunes will do but, in truth, this is only anecdotal evidence and until recently an unproven fact. We live in the age of Evidence-Based Medicine (EBM) and according to the rules, we had no way to know whether the laxative effect attributed to prunes was real or merely a placebo effect. That worry is over.

A paper written by researchers from the University of Iowa College of Medicine will be published next month, April 2011, which will tell us that prunes really do help constipation.ⁱ

The researchers fed 40 constipated test subjects either prunes or psyllium powder daily for three weeks in amounts that supplied six grams per day of fiber. After three weeks, the subjects took a week off and then switched therapies. During the course of the experiment, the subjects kept careful diaries, tracking all sorts of details about bowel habits that we don’t really need to discuss here. Suffice to say that when the data were collated and analyzed, it was abundantly clear that prunes had a significant effect in doing what we all know they do.

This was not a perfect study by any means. It was only a single-blinded placebo controlled trial, not the hallmark double-blinded trial that modern medicine considers the gold standard. There were only 40 subjects, 37 of whom were female. One might easily argue that this study is insufficient evidence to base clinical decisions upon.

Still, it may be the first study that clearly demonstrates that prunes do what everyone has known they do since the Book of Esther was written in the third or fourth century BCE.

This points out the weakness of our current reliance on Evidence-Based Medicine (EBM). If we adhere faithfully to the tenets of EBM, we would be obligated to suggest sodium docusate to relieve constipation, a substance that the drug manufacturers have proven works. Or if we insist on a more natural approach, we might consider psyllium, a fiber that research suggests may work better than sodium docusate.ⁱⁱ Up until now, prunes were not evidence-based medicine; they were just food. Now we can say they work better than either of the other two therapies, at least in women.

When we are dealing with serious pharmaceutical agents, it is nice to have evidence that they are beneficial. That’s because they often come with unwanted side effects. It’s nice to know that they will do what they promise. Perhaps we don’t need to require the same degree of caution with simple food therapies such as prunes. And especially with things that have so obvious and well-acknowledged action, we may not need double-blinded, placebo-controlled randomized trials.

Some times we need to preserve a bit of common sense in the practice of medicine.

___
ⁱ Attaluri A, Donahoe R, Valestin J, Brown K, Rao SS. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011 Apr;33(7):822-8.


ⁱⁱ McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther. 1998 May;12(5):491-7.