Study Break

I am about one month away from graduation and excited to know where I will be heading next! I was selected to be a resident at the  Integrative Family Wellness Center in Brookfield, Wisconsin. I am beyond excited to have the opportunity to continue my learning process as a resident for one year. And who knows-- it may turn into something more!

For now until August 4th I will be recalling all of the useful clinical skills I have learned and getting ready for my board exams. SO, if you have any study tips-- send them my way! Here's how I am keeping energized and healthy for boards:

• Eating small, frequent, high protein meals. High protein sustains the feeling of satiety longer and the amino acids will be used to build brain neurotransmitters.
• Taking a multi, fish oil, b-complex, vitamin D, and adrenal support. The adrenals help with the response to stress and heavily utilize the B vitamins as well as Vitamin C.
• Exercising daily-- Jillian Michaels is kicking my butt right now.
• Frequenting coffee shops-- I don't know if I consider this a "healthy" study habit, but it keeps the scenery interesting.
• Listening to theta brainwave music. Theta brainwaves are known to help memory, learning and mental clarity.
• Making time to relax and read something mindless. 
• Studying with friends. Helps my motivation and I always seem to learn something from them.

Here is a link to learn more about my program.

Herbal Energy

Spring has become my favorite season here in the desert. In lieu of my routine P90X DVD’s, I ventured out of my living room to get some fresh air. I took a hike up Piestewa Peak in Phoenix and noticed another one of my desert favorites, the Ocotillo, in bloom. Aside from its fun shape and beautiful flowers when blooming, it has some interesting medicinal properties. 

The long branches of this plant have sharp spines camouflaged by small green leaves. Historic Indian uses include placing the flowers and roots of ocotillo over wounds to stop bleeding. (Convenient that my steep hike was lined with this lovely plant!)  In botanical formulations in the clinic, the fresh bark tincture is used mainly as a lymphagogue. Lymphagogue botanicals promote the movement of the lymphatic fluid that helps with immune function and waste elimination. This class of botanicals can be further categorized by area of the body that it is known to have greatest effects. Ocotillo has an affinity for the pelvis and is therefore useful in conditions of stagnation such as constipation, hemorrhoids, fibroids or endometriosis. For example, I chose to include this botanical as a part of a formulation for a patient who had varicosities in her legs.

It is amazing to me that medicine is really all around us. I can imagine that I passed many plants on my hike that day that can be used medicinally. Often botanicals can have stereotypical uses like, “St. Johns Wort for depression,” but in reality the energetic and practical application of the plant is what gives it its unique characteristics and not always completely understood effects. Plant medicines are unique in that they often work slowly and gently to heal chronic conditions, but can be used in high does for short periods of time for acute conditions. Energetics are not easily explained properties of plant medicines, but rather to be experienced.   I am excited to have another botanical medicine rotation coming up on my next (AND FINAL!!!)  quarter of school where I will be able to learn and experience the energy of herbs!

Lost My Mojo...

Another food favorite bit the dust this week. I decided to look into the ingredients in Mojo Frozen Yogurt. I made frequent trips there last summer and planned to return shortly as I endearingly referred the impending summer in Arizona as “Mojo Season.” Looks like I won’t be going after all. All flavors of their yogurt have high fructose corn syrup (HFCS). I wonder why I didn’t bother to look into this sooner; maybe I didn’t want to know.  I don’t have many strict food rules for myself, but this is one of them—no HFCS.

Here is some information about a few better alternative sweeteners:

• Agave Nectar: boiled from the sap of the blue agave plant. Intensely sweet, low glycemic index (15) but is 90% fructose and 8% glucose. One chef doesn’t think this makes it much different than HFCS: http://www.thehealthycookingcoach.com/2010/01/another-look-at-agave-nectar.html. Can be used for a wide range of recipes including drinks, bread, and cookies.
• Brown Rice Syrup: dense liquid made by brown rice fermentation. Thick and creamy with mild sweetness. Low GI (25) and half as sweet as sugar. Best in soft textured dishes, like pies or sauces, and crunchy baked goods like biscotti. 
• Date Sugar: dehydrated, ground dates. Grainy, earthy and minimally refined and processed. Best in recipes with a dense texture and dark color like nut bread.

What about no calorie sweeteners? The problem with them is that they actually trick the body into thinking it is consuming calories. The body tastes sweet and prepares for a supply of sugar to enter the blood. When this sugar never shows up, insulin rises and which can actually lead to more cravings and increased calorie consumption.  There have also been some adverse effects in studies relating to artificial sugars including cancers and neurotoxicity. Additionally, most studies regarding its safety were short and some incomplete.  Aspartame accounts for 75% of adverse reactions to a food additive reported to the FDA.

Stevia is now a mainstream zero-calorie sweetener. Just a few years ago it was regulated by the FDA as a food supplement and only available in the supplement department of the grocery store. I guess someone caught on to this gold mine! Stevia is derived from the stevia plant sound in South America and Asia, where is has been used as a sweetener for centuries. It has no effect on insulin and one study suggests that it may actually help control insulin levels. It is also 150-300 times sweeter than sugar.

Xylitol is another zero calorie sweetener that has no effect on insulin levels. It is usually derived from corn, berries and plums and is EXTREMELY toxic to dogs. It is found in many chewing gums because it helps prevent tooth decay as well. It can cause bloating or laxative effects in high quantities so may not be the best substitute for a batch of cookies. 

I will now be on the hunt for a HFCS- free yogurt joint to frequent this summer! 

Metabolic Health

This quarter I have the pleasure of working with Dr. Cristina Romero-Bosch. Her practice is focused on “metabolic health.” What does that mean exactly? The word metabolism usually makes you think of people with self-proclaimed “slow” or “fast” metabolisms, referencing the manner in which they burn their food, or calories. The lucky “fast” metabolism people seem to eat whatever they want and remain at a healthy weight. But what if metabolism wasn’t just the luck of the draw and the real players in the metabolic game were actual measurable and could be manipulated? That is in fact the case and I am beginning to see many examples of this.

To begin with, there are core factors that are the foundation for health. Things like diet, lifestyle and mental/emotional health that most definitely influence the way we feel. Maintaining balance in these areas is difficult considering our modern American lives and relies on our personal willpower to make the “right” choices, exercise, make time to relax, etc. When willpower goes by the wayside, this can create fatigue on the signaling pathways responsible for maintaining our basal metabolic rate. From there, a downward spiral can occur. We feel more lethargic, get less sleep, eat more poorly, etc. By measuring the function of the adrenal glands, thyroid gland and levels of sex hormones it IS possible to see biochemical reasons behind feelings of fatigue, weight gain, insomnia, depression, and low libido. How many Americans have these types of concerns? (!!)After any disturbances in these signaling pathways are corrected, it might be possible to truly rebuild the foundation of health—where the “will” is no longer about power, but natural ability and desire.

I subscribe to Natural Solutions magazine, which recently featured and article titled, “The Hidden Epidemic: Is Your Thyroid Making You Fat?” I excitedly thumbed to this headline article when the magazine appeared in my mailbox-- having seen this work in action with Dr. Bosch. This is a good summary of one aspect of the multi-factorial approach to metabolic health. It brings to light the fact that there are considerations outside of basic labs, like symptoms, and additional lab tests that are not always standard, that can be taken into consideration when addressing thyroid health specifically. This is a must read! Take charge of your metabolic health! :)

My Final, Final

This past term I only had one course and it was a psychology class, which I did enjoy. I especially enjoyed finals week, where I only had one final and it was my last final—EVER! From here on out, I will only be doing rotations at the clinic and at elective sites. I still do have looming board exams ahead, but I have until August to study.

In my psychology class we touched on all of the various psychological conditions and became acquainted with the DSM-IV. This class was a great compliment to the patients I was seeing on Dr. Raymers rotation, which had an emphasis on psychology. One of the most interesting patients I saw was a woman who has dysthymia. She was currently taking a prescription medication to enhance her mood, but she wanted to wean down off the drug. We helped her do just that and integrated naturopathic supportive therapies into her care. One therapy was asked her to try was hydrotherapy. We are taught constitutional hydrotherapy in our clinic. The theory behind this type of hydrotherapy treatments is that they normalize the blood and lymph by promoting circulation through the tissues. Aiding the flow of blood and lymph can help move toxins and waste through the body’s organs of elimination (skin, liver, kidneys, lung, and colon) more quickly to improve health.  Hydrotherapy was one of the main treatment methods in the 1920’s and 1930’s and continues to be useful today as in my patients case. Constitutional hydrotherapy can also be useful in digestive problems like Crohn’s, respiratory conditions like chronic asthma, and immune deficiency problems—just to name a few indications. One modern day indication of these treatments is that it forces people to slow down and take time to relax. Rest and relaxation are a vital component to healing and often a luxury in our busy lives!

Empire State of Mind…for a Week

Over my break, which was the week of October 26-30th, I traveled to New York. I had the opportunity to reconnect with long time friends, listen to some great music, and learn about naturopathic medical practice.

I was able to shadow Dr. Donielle Wilson in Manhattan and Stamford, Connecticut. I saw a variety of patients with concerns ranging from infertility to halitosis, but saw a common theme in all of their treatments: nutrition.

I am not sure if and how doctors can emphasize the importance of nutrition enough. Sometimes I feel wrapped up in planning what I am going to “give to” or “do for” a patient and overlook the simple idea that re-establishing the basis for health starts with a properly nourished body. Nutrition counseling and analysis should be a top priority in a treatment plan.

One way to go about ensuring proper nutrition is to perform a food allergy test. This was one test I saw utilized with almost all patients I saw during my New York visit. This is different from testing that looks for hypersensitivity allergic reactions (like a peanut allergy that causes breathing problems, for example). Food allergy tests look for delayed sensitivity reactions. By taking a blood sample, the blood is analyzed for immune reaction to a variety of foods and a list of reactive and non reactive foods is generated. Another way to determine possible allergens is to do an elimination diet. This involves eliminating the most common sources of allergy, like wheat (and other gluten containing grains), dairy, eggs, soy, and citrus. Then after eliminating these foods, they are  reintroduced one by one. Symptoms can be evaluated as possibly related to potential foods as they are introduced in an otherwise allergy free diet. On the other hand, a food allergy test will show exactly what foods are reactive and there will be no guessing as to which foods may or many not be causing problems.

Some common symptoms of food allergy or intolerance might have an obvious association, like irritable bowel for instance. Other symptoms might range from headaches, to weight gain, to fatigue. By determining if food is the underlying cause of troubling conditions such as these, the offender can easily be removed from the diet and the body can begin to heal.

All this talk about nutrition and health makes me think of the age old adage—you are what you eat. And your body will tell you if it likes what you eat in subtle or obvious ways.

A (Homebirth) Baby Story

After I took obstetrics class the second quarter of my third year, I was eligible to sign up for a birth rotation. I put my name in the hat and got a call in May that I was assigned to a 26 year old pediatric nurse expecting her first child. Her due date was October 7th which seemed to be forever in the future. Leading up to her labor, I would attend all of her appointments at the naturopathic obstetrician’s office and be ready to drop my life when the time came to help deliver the baby. That time came at 3:30 in the morning on Friday October 9th.

24 hours after the initial call, still no baby and little progression. We took mom to OB triage at the local hospital thinking an augmentation with Pitocin would be best to help make progress. The ER doc believed that she was simply having a prolonged latent phase of labor and thought that starting Pitocin would actually be more like an induction rather than augmentation. They decided to give an injection of morphine to ease her pain and send her home to hopefully get some rest. Saturday morning her contractions became more intense and lasted longer. This meant that she was actually in active labor. By the time we arrived at her home, she was 7 cm dilated. After that, the labor was textbook. Around three o’clock, she was exhausted and stated that “she couldn’t do it any longer.” Those words usually mean it’s time to push. We had her sit on the birth stool which helps open the pelvis and puts the mother in an ideal vertical position to deliver. She pushed for a total of 11 minutes and a beautiful baby girl (Surprise! Nobody knew the sex!) was brought into the world. Immediately we put the baby into mom’s arms, she let out a healthy cry and the room full of family and friends burst into tears as well. 44 hours of total labor time had culminated in the gift of life.

I learned from this experience that freedom of choice and safety are top priorities when deciding where to deliver a baby. According to a 2000 Cochrane Library study, “There is no strong evidence to favor either home or hospital birth for selected, low risk pregnant women. In countries and areas where it is possible to establish a home birth backed up by modern hospital system, all low risk pregnant women should be offered the possibility of considering a planned home birth and should be informed about the quality of the available evidence to guide their choice.” Mom was able to lay, walk, eat, and sleep in her home. She was comfortable and had the freedom to labor however she felt.

The lithotomy position has been shown to be an ineffective position to labor and push, actually works against gravity and can lead to complications like episiotomy and perceived dystocia. My Family Practice Obstetrics text states that, “Four of seven randomized controlled trials and several case study series have shown shorter labor duration and greater uterine contraction intensity in vertical positions.” Horizontal supine positions are really most convenient for doctors and procedures and do not provide much benefit to the mother.

After the birth, mom was immediately able to hold the baby; an important event that often is interrupted by hospital procedures. She also declined erythromycin eye ointment, a legal requirement in most hospitals, because she did not have gonorrhea or chlamydia, the reason ointment is applied in the first place. Recently there has been a shortage of erythromycin ophthalmic. The CDC’s website provides a substantial list of alternative ointments and culminates the discussion by adding, “STD guidelines outline recommended prophylactic treatment for infants whose mothers have gonococcal infection and for management of infants born to mothers who have untreated chlamydia. Empiric treatment is recommended for infants exposed to gonorrhea, while monitoring for development of symptoms prior to initiating treatment is recommended for infants exposed to chlamydia. Screening mothers will allow providers to identify infants with known exposure.” In essence, if you don’t have gonorrhea or chlamydia, it may be an unnecessary procedure.

Baby received oral vitamin K drops, Apgar scores of 9 and 10, and was surrounded by the love of her mother, father, family and friends. The baby must have felt incredible energy and love when she entered the world. This was a safe decision because the mother was a low risk patient, had proper prenatal care, and had an uncomplicated pregnancy. I believe that birth does not have to be an overly medical event. In this case, we were lucky to have a hospital nearby to take over for a perceived complication and valuable second opinion. I would urge any expecting mothers to consider birth at home, in a birthing center, or by a midwife as a top choice depending on risk factors. My experience exemplified an ideal birthing situation and even more fun story to tell.