Priorities and Paradigms

Since moving back to Calgary I've been without a dentist and I would really like to find one.  It is certainly not that there is any shortage , but I have had so many bad experiences with dentists in the past that I have to admit that I'm overly cautious.   This is one example why networking is so important.  I find that when people can put a face to a name, and then be reassured and in agreement with my approach towards patient care, it makes a big difference towards building a practice. 

However, one obstacle I've encountered on several occasions recently is price.  "You know I'd really like to see a naturopathic doctor but you are so expensive."  And, some ND's certainly are.  However, I believe the priorities of our society and individual paradigms may be more responsible for this perception than actual price (influenced no doubt by socialized heath care - which I'm thankful for in the case of an emergency). 

My wife came home last night after getting her hair cut and styled.  And, she was $110 more beautiful!  Also, several weeks ago I got Canadian Tire to put my winter tires on rims.  That was $167 exchange just for the labour alone.  That is more than the cost of my 1 hour new patient appointment!  I found out that Canadian Tire charges a basic shop rate of $115 per hour and raises this to $125 per hour when there is any electrical work involved.  And this work could be done by a 19 year old mechanic.

Just to clarify, I am very happy for any 19 year old who has worked hard to become a mechanic and I recognize the responsibility of ensuring an automobile is safe on the road.  However, this is not a health care provider.  So, is it unreasonable to expect to pay 25 to 50 percent more per hour for a naturopathic doctor than a mechanic?(1.)  

I believe that since people are accustomed to conventional health care being free in Canada, it requires both a paradigm shift and a change of priorities to get over the inhibition to pay for health care.  However, when conventional medicine has been unsuccessful in helping with a particular health concern we may need to ask, what do we value more: our car, haircut...etc, or health?

Footnote:
(1.) I should add that if someone came to most naturopathic doctors and really could not afford to pay, and that person was not spending $110 at the hair stylist, most would gladly work something out in that case.

Who are Environmentalists?

With the political and environmental controversy surrounding the Keystone pipelines, I realized that the role of environmentalists often seem to be separated from general society.  I heard a CBC radio host exclaim, "I don't know what the environmentalists would think of that" referring to a statement by Keystone.  As if their view would be somehow distinct from the rest of society.

What would happen if society viewed environmental scientists as health care practitioners?  There is plenty of evidence to demonstrate this to be true - our health is directly influenced by our environment.  In fact, even determining the exact role of our genome becomes very difficult because gene expression is changed depending on the environment.

I believe that when society begins to realize that environmental scientists are indeed health care practitioners, and very important ones, there will be major leaps forward in preventive medicine.  

So many choices

On the one hand, waiting for my Alberta license number to arrive could be stressful if I let it bother me.  But, there are just too many exciting opportunities for naturopathic doctors now.  As such, having the time to work through some very important decisions, without seeing patients yet, has been a blessing in disguise.

I believe that we are at the beginning of really being able to help the Canadian public due to an increased demand for integrative medicine.  On that note, I was also very happy to see that CCNM has added another primary care procedures course to the curriculum to further prepare ND's to be excellent primary care providers.  I'm so proud!

Over the past 2 months I have continued to delve deeper into the business side of running a practice and recognize that no matter how many practice management classes we took, nothing can replace a good business mentor as well as doing a lot of researching and using common sense!  All the best to everyone out there starting out - we need to stick together!!

The ND Generalist

One thing I have noticed when talking to potential patients lately is that our society tends to overvalue specialists.  A common question I get is, "what do you specialize in?" and people's reaction to my desire to work in Primary Care is bewilderment.  Yes, I have my interests: sports medicine, gastrointestinal health, etc., but I just enjoy helping people with a diverse set of presenting symptoms.  I find it is exciting and gratifying. 

In actuality, Primary Care is a specialty too.  In fact, an expert generalist can save a person a lot of pain, time and unnecessary referrals.  Of course there is a very important place for specialists, but we need to put a greater value back on general practitioners.

This is one thing I love about naturopathic doctors.  We can use a number of tools in Primary Care that work well and are often safer than a conventional approach. We can utilize botanicals, nutrition and supplements, adjustments of the spine, acupuncture, and counseling all with one patient - if it is necessary.  Possibly the greatest thing about naturopathic doctors is we do not utilize these modalities in isolation but we understand how each fits together to help the patient.

House Calls

Remember back in the good old days when doctors did house calls?  Well, as the provincial elections approach, several politicians are talking about mandating Medical Doctors to do a percentage of house calls.  I have no idea how they will fit house calls into their overpacked schedule but the politicians have recognized that the demand is there. The timing is appropriate in my case as I have been shocked at the leasing prices in Calgary.  There are certainly some beautiful locations to set-up a naturopathic practice, but at $30.00 a square foot per year, the price seems prohibitive right now.  Certainly there are opportunities for new ND's to rent office space in existing practices but it also might be a perfect time to provide patients with a house call service.

NPLEX Results

Congratulations to everyone who wrote NPLEX (and Boards) and passed.  It was great to get the results sooner than expected and see the right number of capital "P's" on my results page.  Thank-God!!  I would age another 10 years if I had do all that again...it makes me shiver just to think about it!  However, the exams are extremely difficult and failing the first time is not necessarily a reflection of intelligence or your ability to pass.  So, if that happened to be you, do not give up.

Well, now there is a mountain of paperwork to complete and decisions to make to begin the process of opening up a practice.  I'll keep you updated.

Post Surgery

Well, I don't intend this blog to be overly personal but I thought that I should update my mothers situation to say that she is recovering well.  She believes that her orthopedic surgeon was a perfectionist (which is a good thing!) and that he gave her good instructions before she left the hospital.  The silver lining on a horribly painful and frustrating week.

The Canadian Health Care Crisis Just Became Personal

This week has brought my family up close and personal with Canada�s overburdened and sometimes depersonalized health care system.  Last Wednesday my mother broke her leg.  My dad took her to the nearest emergency (at the Durham hospital) where she was evaluated and sent home with a partial cast to wait for surgery.  The attending MD also prescribed Ibuprofen as my mom mentioned she doesn�t tolerate some Tylenol (most likely due to the codeine).  The pharmacist rightfully caught the fact that my mother was scheduled for surgery and Ibuprofen can thin the blood leading to potential bleeding problems in the operating room.  After some phone calls, this was worked out and she was re-prescribed Tylenol without codeine. 

My mom was then referred to the Grey Bruce Regional Health Centre in Owen Sound (Ontario) for surgery to pin the broken tibia in her right leg.  She was told she would be able to get in within the next couple of days.

My family called the hospital on Thursday several times and were told that things were too busy to take my mother in yet but said if she got a letter from the attending MD she could go to London Ontario and wait for her surgery there.  However, she chose to wait for an opening in Owen Sound (which is only 30 minutes away) instead of driving 3 hours to London with a partially casted, extremely painful broken leg.

On Friday my family called the Owen Sound hospital and were told that there was no record of my mother requiring surgery and they would need get her information again.  By that afternoon, the hospital found her information and mom was booked in for surgery at 10 am Saturday morning.  She was instructed not to have any food or water. 

On Saturday morning she arrived at the hospital expecting surgery by 10 am.  However, after a 9 hour wait, without food, water, or painkillers, she was told that there was a mix-up with her 10 o�clock surgery time and she would be rescheduled.  At this point, the swelling around her broken tibia had gone down which allowed the bone to separate and move freely with the slightest movement.  This caused her excruciating pain.  So, on Saturday night she was put up in the hospital and rescheduled for surgery again the next morning. 

Finally, at noon Sunday morning (5 full days after breaking her leg) my mother underwent surgery to get two pins and a plate placed into her leg as well as an unexpected bone graft and muscle repair.  What an ordeal. 

It is hard to believe that this happens in Canada.  I have always stated that conventional medicine is ultimately best suited for acute situations but I�m beginning to have my doubts that this generalization can be applied to all hospitals in Canada.  Shame on the Grey Bruce Regional Health Centre.

Transition time

The last few weeks have seen a tremendous amount of change for my family and I.  After writing Board exams, we packed up our apartment in Toronto and took a cross Canada road trip to relocate to Calgary Alberta.  This has also been a time of transition from medical student life to business owner. 

Over last 4 years, as the title of this blog indicates, I have provided prospective students and advocates a unique inside perspective of life as a student of naturopathic medicine.  Although I will never stop learning and always be a student of medicine, I'm not certain this blog title is still appropriate.  Anyhow, as the next few months unfold, I will give some updates on the transition from student to practitioner.

Board, Board, Board!

It has nearly been a week already since taking the Ontario Board certification exams.  I should be used to people being intensely analytical and critical about my performance after years of practical sessions and exams, but somehow the Board examiners seemed to have a skill for making my mind go blank.  The experience was very, very humbling; in fact, it was somewhat traumatic!  The good news is that I'm told many of us will feel this way but ultimately do very well.  It is part of the affliction of being a perfectionist!

In Ontario, graduates' skills in physical and clinical diagnosis, instrumentation, Chinese Medicine and acupuncture, and spinal manipulations are all tested in practical exam sessions.  There is certainly a lot on the line as a failing grade requires a retake exam next February and an inability to start a practice in the mean time.  It is a lot of pressure to say the least.  And what is worse is that we do not know our results until October!

In the meantime, I wish everyone of my colleagues all the best with their exam results and with beginning their next chapter in the naturopathic journey, wherever it takes them.

Post NPLEX II

If I were to make a list of all the things I would loved to have known well while writing the 400 questions on the NPLEX exams, it would be a pretty long list!  I feel like each exam question was written by a specialist from a particular field of study and we were required to take our best stab at it with a generalist's training.  Well, I guess who better to write the perfect question anyways than a specialist!

Probably one of the unforeseen challenges for me was on the second day after writing the elective TCM and acupuncture exam.  During the first 20 or so questions of the afternoon core clinical exam, what happened was when I would see a case where a patient comes in with poor memory, palpitations...etc., etc., I would think, "that's got to be a heart blood deficiency," or whatever TCM diagnosis corresponded to the symptoms.  Then, I'd remember that this part of the exam needed a Western diagnosis. 

Well, it sure was a mental marathon and, I'd have to say that it was harder than I thought it would be.  But, that is the past and it's on to Board exams this weekend.  After this weekend, then we can finally celebrate!

Think three weeks of summer left

That's right, when this is all over, there are still 3 weeks of summer left to enjoy.

All the best to everyone who is writing their NPLEX and Board certification exams next week.  We've made it this far so we can do it!

NPLEX & USMLE

I guess I'm competitive by nature!  I think it takes a significant amount of competitiveness just to complete 8 years of school and then continue another 3 months of intensive studying/reviewing to prepare for NPLEX and Boards.  So, I recently could not help noticing while I was studying in a Toronto Public Library that a young woman sat down at the same table to study with her laptop and a book, "Step-Up to USMLE Step 2."  Now, I just bought this book a week ago. 

For those not sure why I would buy this book, naturopathic doctors follow a somewhat similar licensing and board certification track to medical doctors with some variation in the order.  The United States Medical Licensing Examination (USMLE) Step 2 is similar to our NPLEX 2 exams and many naturopathic graduates use the USMLE books as a part of their review material.

So, what fascinated me was the simplicity of this particular young woman's study tactics as she read her Step-Up to USMLE Step 2 book and wrote supplemental information from some online medical sources onto the pages (I realize that she will undoubtedly have many medical reference texts at her disposal).  Now on the cover of this book it says, "Comprehensive yet concise coverage...Perfect prep tool for Step 2 CK and a head start for the Step 2 CS" (note: CK = Clinical Knowledge and CS = Clinical Skills).  Yes, I really like the book because it is very concise; but comprehensive?

Wow, if that is the definition of comprehensive, what do you call the plethora of review notes, manuals and textbooks most ND graduates use to prepare for our exams?!  No disrespect intended, I just found it comical in light of some comments by outspoken critics of naturopathic doctors.  I realize conventional medicine is no walk in the park either but, if you want a real challenge: try naturopathic medicine!!

Happy Canada Day!

I've just returned from 5 days in Calgary where I attended the CAND's Health Fusion conference.  This year's topic was Environmental Medicine and the speakers were absolutely amazing.  The conference was focused on tactics to avoid chemical and heavy metal toxins, how to recognize symptoms of toxic induced loss of tolerance and how to get the body to excrete these toxins when they are absorbed.

I even had the privilege to meet one of the greatest water rights advocates, Maude Barlow (Council of Canadians), who spoke on the last day of the conference.  Interestingly, the day after the conference was over, I traveled just east of Calgary to visit family where I found out that they are unable to drink the ground water due to contamination by agriculture.

I have always been a patriotic Canadian but there is now a sense of urgency to protect Canada, our water, agriculture and wildlife for the next generation.  We can't take these things for granted!

Well, I must get back to work as I'm also feeling a great sense of urgency to continue studying with only 5 weeks remaining before NPLEX and Board exams. 

It's about the Zebras

As I'm hidden away studying in the air conditioned basement of a Toronto Public Library, I realize that 2 weeks of NPLEX review have already gone by.  This means that the Licensing and Board exams are looming that much closer.  Will I ever be able to remember all these details?  In my office, I could just look it up!

But, after this many years of studying and 12 months of internship, it's now really about the zebras.  There is a famous old saying in medicine, "when you hear hoof beats, think horses not zebras."  This translates to: when you have a list of signs and symptoms, think of the most likely diagnosis these point to first.  Well, this is true in practice but from the advice of practicing ND's I've listened too, not so on these upcoming exams.  I do realize that naturopathic medicine is still in the process of demonstrating to the majority of the public (and most conventional physicians) that naturopathic doctors are proficient primary care providers.  As such, our licensing boards are going to ensure that we have what it takes to catch those mysterious presentations of diseases.  Furthermore, many patients unfortunately only resort to an ND after they have been through an unhelpful ordeal in conventional medicine.

So, I do understand the necessity and therefore should not complain about being sentenced to studying inside during such beautiful weather.  However, I can say that I will be very happy on August 7th when this is all over...

The NPLEX II Saga Begins

Well it is finally here: the final mental marathon required to become a licensed ND.  My head already feels like I'm in need of a break after a 6 day NPLEX (Naturopathic Physicians Licensing Examinations) review course.  And I haven't even officially started studying yet!

Like any large and difficult task, I think half the battle is overcoming the intimidation and making a plan to break it down into smaller "digestible" components.  NPLEX II tests a naturopathic doctor's correct and safe utilization of the following components to prevent and treat disease in every organ system in the body: clinical nutrition, botanical medicine, physical medicine, physical and clinical diagnosis, lab diagnosis and imaging, pharmacology, psychology, emergency medicine, homeopathy, traditional Chinese medicine and acupuncture.  It is a tremendous scope of information!  So, for the next 10 weeks, new naturopathic graduates in Canada and the US will be reviewing and studying full time in order to be successful on NPLEX II this August.  Starting May 30th, I will be following a weekly objective schedule that breaks topics up by organ system and modality.  Of course, 8 hours of sleep, daily exercise, phosphatidylcholine and fish oil are just a few extra requirements necessary to survive the NPLEX II saga!

Well, with yet another blog post about survival, I realize that sometimes I take the risk over-informing prospective students.  Accordingly, I have periodically considered not disclosing information because some degree of naivety can be beneficial in undertaking a difficult task.  As such, in being candid with the extensive, somewhat unrelenting effort it takes to become a naturopathic doctor, my hope is not to discourage anyone from being an ND but to provide an opportunity for proactive students to become informed.  However, if for example only one or two of the naturopathic modalities are of interest to you, then maybe making all the extra effort to become a naturopathic doctor is not for you.  Keep in mind that there are practitioners who specialize in each of of the modalities that ND's are licensed to practice and maybe you would be better suited as an herbalist or registered dietitian or chiropractor or homeopath or psychologist or an acupuncturist.  At least now you can make a better informed choice.

Naturopathic Medicine Week 2011

May 9th - 15th is Naturopathic Medicine week in Canada.  If you are interested in learning the benefits of naturopathic medicine, take a look at these locations across Canada where Naturopathic Doctors will be giving free information seminars. 

This is a great opportunity for both prospective students and people who are suffering with health problems to go and get some questions answered.  Have a great week!

It's Graduation Time!

The graduating class of 2011 is done!!  It seems absolutely unbelievable...I'm sure the reality of being finished internship will quickly set in as I begin to prepare for NPLEX and board exams, but right now I'm basking in the accomplishment.  And what a journey this has been...filled with a lot of ups and downs, the appearance of gray hairs and the skills to help improve health care in Canada.

One thing I was not prepared for this last month was saying goodbye and transferring the care of many patients I have got to know very well over the past year.  Although I'm sure their new intern will work as hard as I did, there was a sadness in not continuing along their health journey with them.  Well, I do not want to end on a note of sadness as this is a time for celebration.  So, congratulations to all the naturopathic medical students in North America who will be graduating this spring.  I wish everyone the greatest success.

Real Health Care in Canada

With only 2 weeks remaining in my clinical internship, and the timing of this federal election, I was paying greater attention to the politics of the profession and the vital role naturopathic doctors have in changing the course of "health care" in Canada.  I put, "health care" in quotations because what our politicians have not yet been made aware of is that healthy people are not the ones being taken care of in Canada.  Rather, our conventional medical system is in fact a disease care system of medicine.

I realize this is my bias, but I would like to see naturopathic doctors (ND's) be the primary care gate-keepers of the health care system since we have the widest scope of practice of any health care provider (and subsequently the greatest number of therapeutic tools).  When necessary, ND's would also know when and which specialist would be best for the patient to be referred to within the conventional and complementary health care systems.  I believe this would revolutionize Canada's health care system which is in a state of patient care deterioration and financial crisis.

Most people feel like they are too busy to write or ask their local member of parliament about what health care truly means to them or to let them know about the benefits of naturopathic medicine.  But, we can all quite easily talk to our friends, mention our vision for a true health care system on Facebook or Twitter.  Many small actions will build into a large movement!

Individual Medicine

One of the challenges in naturopathic medicine is treating every person individually.  This entails pulling together treatment ideas and prescribed changes from a host of resources and, in some respects, I often feel like I am reinventing the wheel with each patient.  For the clinician, this is a recipe for a lot of work and at the end of the day, it can be difficult to separate the "office" from home life as the realization of this responsibility sets in.

This is a sharp contrast to conventional medicine which has an established algorithm or standard of care for most medical diagnoses.  I can't say for sure, but, when an MD leaves the office, it might possibly be easier for them to believe that they have done all they were trained to do for their patients and no one could expect more of them.

And, the conventional treatment protocols do seem to work for a percentage of the population.  However, the majority of patients that come to naturopathic medicine have not been successfully treated with conventional approaches and they are in need of something to address the root of their problems.  At times I wish there were more standards of care algorithms for ND's but, then I also hope that as our medicine continues to be supported by science that practitioners never utilize a canned approach.

OSCE time of year again

I would not ever want to be in the third year's shoes during the OSCE's (Objective Structured Clinical Examination).  I can clearly remember my experience last year and seeing the faces of some of the people after their exams, I feel their pain!  (My post last year stated that it was almost fun, but even after a year of seeing patients, it would take a lot of adrenalin for it to feel fun). 

One of my colleagues in 4th year took it upon herself to organize several mock OSCE's, which we nicknamed the "Moski's", in order to better prepare students for this important test.  Now, even the 2nd years do an OSCE that tests their physical and clinical diagnosis skills before they enter 3rd year.  I was happy to teach at each event and was impressed with the level of confidence some people have developed.

The OSCE's ensure a standard of safety in Primary Care and as stressful as it is having your every word and move scrutinized, they are a necessity in order to make ND's the best primary care doctors they can be.

CCNM Growing Pains

The fact that school at the Canadian College of Naturopathic Medicine (CCNM) is very difficult is something I've written about several times before.  It has been argued by some students at CCNM (who have other medical degrees) that the diversity of material in the naturopathic program adds an additional challenge on top of the tremendous course load making it one of the most difficult medical programs.  Additionally, although CCNM is over 30 years old, it still growing to an ever expanding profession.  Furthermore, to accommodate a January enrollment, CCNM has long days of class packed into one of the shortest school years of all the accredited colleges.  So, as I've written before, this can be a recipe for exhaustion and burn-out. 

At first, the thought of burn-out at a 'holistic' school may seem ironic but it certainly happens.  Then, I thought this would change after getting into clinic.  But after treating patients for almost a year, I realized that it can still be very easy to take home an exceptional amount of stress.  Stress and burn-out is common place in well established schools too.  I subscribe to Medscape (which sends me a weekly email about the latest topics in conventional medicine along with blog posts from students and professors) and see there too that conventional medical students also frequently complain about the unrelenting difficulty of their programs.  One thing I notice though, is that they do not blame their school.

In contrast, at CCNM, the school administration and curriculum seems to take the brunt of the blame from students; and it may be warranted in some cases.  Yes, there are a lot of tedious requirements and it is difficult for the curriculum to address every naturopathic perspective in depth.  However, I can't help but wonder if some of the the students have taken the school's willingness to change as a sign of weakness instead of a sign of consideration for the students?  And, have some students perceived the never-ending onslaught of rules and requirements as an attempt to needlessly evaluate them instead of an effort to maintain credibility in a growing field?  Maybe this will be much in the same way as some people who did not appreciate their parents until leaving the nest.  While growing up they had perceptions of endless tasks and rules to adhere too, parents not allowing enough of this activity or that, and not until looking back did they realize their parents actually knew what was really best for them.

I think the naturopathic program should be longer and not streamlined into focused training on one modality.  From my experience, being able to use whatever is best and most indicated for patients, not being religiously stuck on one modality, is the ultimate difference a naturopathic doctor can offer.  I believe this is an advantage ND's have over any other primary care doctor.  The naturopathic profession is growing at a tremendous rate and CCNM grows correspondingly.  Ultimately, graduating from CCNM is no easy feat and will be something I remember for the rest of my life...seven weeks to go!

From Green to Transparency

One of the most powerful agents for change happens each time we buy a product - we vote with our dollars by supporting companies.  Over the past year I have noticed an explosion in the number of companies vying for customers by jumping on the "green" bandwagon.  The increased awareness and urgency of environmental issues has created public pressure on companies to make more environmentally conscious products. But are they?

Products in the grocery store, clothing manufacturers, many vehicles claiming to have best fuel economy in their class, even Coca cola is coming out with a 30% plant based plastic bottle.  My first inspiration for writing this post actually came from watching the Canadian Association of Petroleum Producers TV advertisement that made it sound like they leave no environmental impact at the oil sands in northern Alberta, and yet it doesn't take much searching to find out that the water available to surrounding native populations is not drinkable due to heavy metals and toxic hydrochemicals.

Many companies may claim to be green, but if they were truly transparent we would see that unfortunately money is their prime motivation, not real environmental protection.  So, be skeptical!  If a product claim doesn't make sense, it is probably not as green as it sounds.  Even if what the label or TV commercial says is true, what is the company not telling you?  As consumers continue to choose true green products, and these companies become successful, this will raise the bar for those companies who still believe that they can't make a profit without cutting corners.

Quote of the Month

"Human nature is about the only nature some people experience."

Abigail Charlson

Book Review 11

Hippocrates' Shadow. Secretes from the house of Medicine by David H. Newman, M.D.

Anyone who is currently, or plans to practice, as a health care provider should read this book.  With that said, I would not recommend this book to everyone (even though my caution may inadvertently assist in perpetuating some of the medical secrets and pseudo axioms the author illuminates) as the author boldly presents some issues of huge magnitude with the potential to shake an ardent believers trust in western medicine.

However, for those in the healthcare field, this book exposes the history behind "schools of thought" in medicine and the steps that lead to many common assumptions about the practice of medicine.  The author, who practiced as an emergency medicine doctor, runs a clinical research program and teaches at Columbia University, boldly asks if certain segments of medical education is spent teaching material that is incorrect.

The book has a great layout as most chapters begins with an ER room scenario that leads to a discussion.  A thought provoking read that is a must for health care providers.

Lasting Impressions

Over the last few months I have had several patients preemptively express a similar sentiment about the use of supplements.  In these particular cases, after the patients� have told me their concerns and reasons for coming to the clinic, they finish with a caveat that goes something like, �Now I don�t want to be sent home with 10 different supplements to take.�

I can certainly understand the intrigue many practitioners have with supplementation and the excitement that goes along with knowing which vitamin, mineral or co-factor is required for a person�s biochemistry to function optimally - nutrition in the form of supplementation is a very powerful thing.  However, this alone is not a legitimate reason to send a patient home with 10 different supplements.  As a patient, if taking that many supplements was your desire, it is not necessarily wrong (and I have several patients who have self prescribed more than 10 supplements) but it is not indicated or reasonable for most people.

I wonder if this impression also comes from an early model of naturopathic medicine where naturopaths were associated with a health food store and correspondingly sold supplements. Being confronted with this made me realize that there is a lot of power in a mental association.  For example, when you think of agriculture, do you still think of the little red barn?  This positive association connects what we eat to a small, caring farm where healthy animals run on open fields and come into a warm little red barn at night.  Although this is unfortunately seldom true anymore, the association benefits particular brands that continue to advertise something of the sort. 

When you think of a naturopathic doctor, what do you think of?  It is interesting how the naturopathic profession still feels the obligation to prove its legitimacy to the conventional medical community as well as the general public despite helping hundreds of thousands of people every year.  Although most ND's do not over-prescribe supplements, sometimes naturopathic medicine is growing so fast that not all ND's have embraced the role of a primary care doctor and these particular practitioners choose to practice in a more exclusive and specialized way.  This diversity can be a strength and is not necessarily a bad thing.

To help you chose an ND, most naturopathic clinics have a website that explains the practitioner's philosophy and services (I wish MD's had a website to explain their philosophy) so you can see if you are a good fit.  Remember that NDs are trained as primary care doctors who follow a therapeutic order and utilize diet, nutrition, herbs, physical medicine, lifestyle counseling and acupuncture individualized to each patient's needs.

NYGH Health & Wellness Fair

Yesterday I volunteered for our school at the North York General Hospital (NYGH) annual Health and Wellness Fair.  With the two establishments being in such a close proximity (directly across the street from each other), it was very interesting to see the range of responses to our booth.  Those who came through the fair were mostly employees of the hospital, although an occasional patient stopped by to ask questions.

I was somewhat taken aback by some of the stern looks, harsh comments and being brushed off by a small group of first year Residents.  I could not help but wonder if they thought we were a bunch of x-hippies cleaned up to look like business people instead of effective primary care doctors!  Over the course of the day, I realized that the naturopathic profession needs to remember how strange and foreign our world of quinoa, medicinal plants, and acupuncture, etc., etc., is to the average person whose medical doctor fixes all their health problems.

It is important to remember that the sample populations we are accustomed to seeing are not necessarily representative of the general consensus of the community.  The people that come to the RSNC clinic, or from my experience preceptoring in private practices, have already overcome many obstacles and boundaries to being a patient of naturopathic medicine.  If you are reading this blog, you also have already overcome many more barriers - even in terms of awareness - to understanding naturopathic medicine than the general population.  As such, there is a great need for the naturopathic profession to be culturally relevant when explaining our perspective of health to the general population and an attempt must be made to try to put ourselves in their position (and try to see things from their perspective).

There were some encouraging moments too at the fair and it was great to initiate awareness of how naturopathic medicine can help many health concerns. I should also consider the fact that we were invited to attend the NYGH Health and Wellness Fair another indication that integrative medicine is not so far into the future.

Village on a Diet

I wonder if twenty years ago we would have predicted that in 2011 people would be so fascinated with a television show about one of life's most basic physiological processes - losing weight?!  Village on a Diet has fascinated me by its simplicity.  Yet, despite a basic premise, the solutions for the town of Taylor, British Columbia are a matter of life and death for many of its citizens.

Change is difficult, especially lifestyle changes, and we can see this resistance in many of the people on the show.  What makes matters worse is a bombardment of advertising giving people the impression that they need to "ask their doctor" for something they can take that will make their life better, instead of what they need to change. 

Although the experts sent into Taylor seem to make up an effective team (despite the "suck-it-up" military style work-outs which may be required to get their weight loss goal in one month), it is very unfortunate that a naturopathic doctor was not part of the group to ensure long term diet and lifestyle changes.  This is important because living a longer, healthier life is not quite as simple as "eat less and move more" - although this formula certainly does contribute to weight loss in the short term (and many people have a serious food excess combined with a movement deficiency).  What is most important though is addressing the multifaceted root causes of obesity (beyond calories in and calories out).

The show does have many positives, and I have to say, I do love the community approach; that's a first for a weight loss show.  Finally, I realize that having a psychologist on the team was a great addition and I hope that her added help is enough to compensate for the physical shock some of the participants undoubtedly endured.  I hope this show is an indication that the general population is becoming aware that quick fixes and fad diets are not a long term solution.

Quote of the Month

"To teach is to learn twice." 

Joseph Joubert

The naturopathic Godfather

Today I met the Godfather of postmodern naturopathic medicine.  Dr. Joseph Pizzorno is an elder in the naturopathic community who graduated in the mid 1970's when there was only one naturopathic school in North America.  According to him, CAM is popular culture now in comparison to the persecution it suffered when he first started practicing.  He is currently the president of Bastyr University and also the author of the Textbook of Natural Medicine. 

So today, Dr. Pizzorno gave a presentation to CCNM students and staff about intestinal permeability.  As I am not a particular fan of this textbook, I was undecided on whether to attend.  However, who can miss the chance to see someone with such a reputation!  And, I have to say that the lecture was very educational and, as to be expected from someone with his number of white hairs, some controversial statements were made that only many years of experience could allow him to say.

Maybe the gray hairs creeping up on my head will help me after all!!

Blood, urine & no tears.

Today I finished my last official shift at the Gamma Dynacare Lab inside the Robert Schad Naturopathic Clinic (CCNM's teaching clinic).  Fourth year interns are required to fulfill a mininmum amount of clinical hours in the lab and also obtain a minimum number of patient blood draws, urinalysis and other tests.  Additionally, we complete a very thorough one-on-one verbal assignment that assesses our knowledge (learned in lab diagnosis theory classes) of the correct indications for ordering labs.  This learning experience was one of my favourite so far at CCNM.  It is not often that students get the opportunity to learn in a practical one-on-one teaching environment and I did not take the privilege for granted. 

Naturopathic doctors are trained to use lab diagnosis to investigate or support a clinical suspicion.  Additionally, many patients are now requesting disease risk assessment tests that can be performed with a "simple" blood test.  What is exciting is that many tests are now becoming available at point of care.  This means that soon a finger prick (instead of a more invasive blood draw into a vein), saliva or urine will be able to test most hormones and disease risk factors right in your doctors office.

Avocado...who knew?

It seems I always learn something about food when shopping at my favourite grocery store mcewans.  Even though many of the products are beyond a student's budget, I am easily persuaded when it comes to quality foods.  We usually go on Saturdays when we are certain to find a few vendors educating the customers about their products and providing samples to excite our taste buds.

Since the store's opening near to our house, I have learned a great deal about olive oils, breads, specialty meats, fine dining food combinations and most recently, avocado oil.  When possible, I always pass along cooking information to my patients and have found out that most people realize now that cooking with Extra Virgin olive oil is very counterproductive.  Virgin olive oil has a slightly higher burning point than Extra Virgin (harvested at a different time of year and contains different acidity levels) but I hear most naturopathic doctors still recommend grape seed oil as the one of the best cooking oils; and it certainly is.  So this is where avocado comes in.

Avocado oil has a burning point of almost 500F (200F degrees higher than most olive oils), just below that of grape seed, and here is what surprised me: it tastes amazing!  Furthermore, avocado is among a list of plants that contain beta-sitosterol which naturally lowers cholesterol.  Check it out at a health food store near you and ask your naturopathic doctor about more important healthy cooking tips.

That's not a kids meal

After Christmas my wife and I had the rare opportunity to take our children out for supper with us.  On both occasions, at two different popular restaurants, it was quite disappointing at what constituted a, "kids meal."  It would seem that kids eating out only enjoy a choice of: mini pizza, breaded mini burger on white bread (no pickle, lettuce, tomato), French Fries with ketchup or a grilled cheese sandwich on white bread.  That is not a meal anyone should eat, especially not a child!

I am sure that these restaurants are meeting the demands of their customers which makes me realize the magnitude of this public health issue.  Until change happens on a broader scale, be proactive in asking for healthier choices.  Skipping the kids entree choices and combining two side dishes at one of the establishments allowed for vegetables and coleslaw which were actually quite tasty.  And, sharing a small plate with your child from what you are eating may be the best choice anyways provided your selection is a healthy meal.

Happy New Year!

I hope 2011 will be a prosperous and healthy year for you.

Thank-you to all of you who have faithfully read this blog over the last 3 years.  It is hard to believe that nearly nine years ago I began this educational journey and 3 and a half years ago I signed up to be among the CCNM graduating class of 2011.  It is an end and a beginning all at the same time!

Over this next year, I will be transitioning from student to practitioner.  Many of my goals for this blog were achieved including being an advocate for naturopathic medicine to the thousands of people who have stopped by for a read.  Ultimately though, the greatest reward was when I was told by colleagues that they were inspired to start their own blog after reading this one.

Happy New Year everyone!