Evidence Based?

     NCNM is a pretty amazing place, full of amazing people and amazing things. One such amazing thing is the Helfgott Research Institute. The Helfgott Research Institute is a professionally independent, non-profit research institute whose mission is to conduct rigorous, high quality, research on the art and science of healing, specifically working to understand natural forms of medicine. Together, scientists from the fields of naturopathic medicine, Chinese medicine, acupuncture, immunology, and nutrition apply their expertise to the study of natural medicine. It is an absolutely fascinating place to hang out.

     I've been lucky enough to spend some time in Helfgott and work on a collaborative research project studying the cost effectiveness of birth setting, specifically in hospital versus out of hospital birth. Most of you probably know that pregnancy and birth is a subject that is quite near and dear to me and I am really excited for the opportunity to work on this project.

      In doing my research and collecting data for this project I'm come across some disheartening statements. Both the American Medical Association and the American College of Obstetricians and Gynecologists discourage options like home birth and contend that hospitals are the safest place to have a baby. This is troubling to me because ALL of the research I have found suggests that at best, this statement is only partially true and at worst, it is false and misleading. For normal, low-risk pregnancies, studies have shown home birth to be a very safe option. In fact, the United States is the only country in which obstetricians are the primary care provider for pregnant women. That means in every other country midwives are considered the normal care provider.

      Although I love "natural" birthing methods and ideology, I am hesitant to categorize myself as a "natural birth advocate." What I do advocate is the opportunity for women to have the birth experience they want; an experience in which they feel comfortable and safe. If that means being in a hospital bed with all the latest technology and interventions just a nurse call-button away, then by all means that is what should happen. But if it means sitting in a blow up pool in your living room watching Oprah between contractions then that should be an option too. Women should be educated on their options... all their options, and not be made to feel guilty or inadequate for their choice.

      In the United States, more than half the women who give birth are given drugs to induce or speed up labor; for nearly a third of mothers, childbirth is a major surgery, the cesarean section, and the current media buzz is over a woman’s “right to choose” a scheduled cesarean. At the same time, however, there are limits on a woman’s right to choose a normal birth. Due dates are increasingly tantamount to deadlines. Women who have had a previous cesarean are in many cases being denied vaginal birth all together. The old debate over “natural childbirth” seems quaint at this point.

     Today, what is normal is being redefined: from vaginal birth to surgical birth, from “my water broke” to “let’s break your water,” from “it’s time” to “it’s time for the induction.” Women are even beginning to deny normal birth to themselves. If “normal” means being induced, immobilized by wires and tubes, sped up with drugs all the while knowing that there’s a good chance of surgery, well, might as well just cut to the chase, so to speak. “Just give me the cesarean,” some are saying.

      However, there are still those mothers-to-be who long for the simpler times before micromanaged childbirth was the norm and epidurals and episiotomies were considered standard care. For these women it has become increasingly harder to find physicians who will support the type of childbirth experience they want, one in which physiology is promoted while unnecessary technology is impeded.

     Adults seeking medical care have both the right to receive medical treatment and the right to refuse treatment. They have the right to know the risks and benefits of each treatment option, including the option of no treatment at all. The legal term is informed consent which the American College of Obstetricians and Gynecologists calls a “fundamental ethical obligation of health care professionals.” The concept is predicated on autonomy, a patient’s right to make decisions about her healthcare. Patient’s rights are grounded in the Constitution, in the right to bodily integrity, to self-determination, to liberty, and to privacy. There are exceptions allowed: it is unnecessary to obtain informed consent from the unconscious, the incompetent, and the child. But unlawfully, pregnant women have been treated as an exception as well. Autonomy is an unlimited and unimpeded right. A pregnant woman, any woman, has the right to refuse anything. However, rarely are women informed as to their rights enough to exercise them in the delivery room.

      In the decades prior to Roe v. Wade, physicians decided whether women deserved “therapeutic” abortions. Feminists argued that the decision to have or not to have an abortion was one that the woman had the right to make because women are the ones who had to live with the consequences. Women’s bodies, women’s choice. Yet the argument for the right to abortion wasn’t necessarily grounded in bodily integrity, but in equality. Women could never achieve full social, economic, and political participation without control over their reproductive lives. Abortion was a proxy for equal rights.

      This may explain why mainstream American feminist groups have been slow to recognize the right to reproduce along with the right to be free from reproducing. A focus of the women’s movement was shaking off motherhood as what solely defined womanhood. So perhaps there has been a reluctance to watch over the process that makes women mothers. This is the last leap for the feminist movement. This is the last issue for women in terms of actual ownership of their bodies.

      Our country has created a mythology of women who are irresponsible and don’t care. We talk about welfare queens, crack moms, and murderous women who have abortions. A culture that allows such language to permeate our subconscious inevitably dehumanizes all women, including mothers. This thinking perpetuates a phrase often invoked in exam rooms and delivery rooms: the goal is to have a healthy baby. This phrase is used over and over to shut down women’s requests. The context needs to be that the goal is to have a healthy mom. Because mothers never make decisions without thinking about that healthy baby and to suggest otherwise is insulting, degrading, and disrespectful.

      What’s best for women is best for babies. And what’s best for women and babies is minimally invasive births that are physically, emotionally, and socially supported. This is not the experience that most women have. In today’s age of evidence based medicine, women need to know that standard American maternity care is not primarily driven by their health and well being or by the health and well being of their babies. Care is restricted and determined by liability and financial concerns, by a physician’s malpractice insurer. The evidence often has nothing to do with it.

      Today women have unprecedented access to the information they need to make the best decisions for themselves, and therefore the best decisions for their babies. They are in fact in a far better position to make evidence based decisions than their doctors. They have the right to make those decisions, and they should make those decisions.

     The goal is to have a healthy family.

Portland Pictorial

        When last we left our heroine she was just getting into the swing of things as a naturopathic medical student and trying valiantly to figure out the hippie ways of Portland. Seeing as how it's been over a month since she's touched base, it is not unreasonable to to have concerns of scholastic defeat or worries that she has defected to a hippie commune where she now wears only tye-dye and spends her days braiding daisies to put in her hair. Neither scenario is too far removed from the realm of possibility...
 
        Not gonna lie... October was tough. In the last month I've taken more tests on more information than any reasonable person ever should. I don't think it would be unfair to characterize the month as a type of "baptism by fire" for my journey through medical school. That being said... I made it through... perhaps only slightly scathed.

        As a change of pace (for both me and you) I thought I might take you on a pictorial tour of Portland... where the mantra is "Keep Portland Weird"... and they mean it.  

Chanting Club... Yes it is EXACTLY what it sounds like. Yes it requires a skill level.

If you drink from a non-reusable container you will be shunned. Water bottles are fine... Jars are preferred. If you happen to be drinking tea from said jar then you are golden.

Told you.

 We have an entire room in the academic building dedicated to meditation, centering, focusing your qi, or any other style of keeping yourself grounded. You must take your shoes off before entering.

The local DHS office... where you can go to pick up your food stamps... conveniently located next door to a hemp store. Food stamps and pot... one stop shopping.

Don't even think about craving Cheetos and a Milky Way washed down by a Pepsi. However, if you have a hankering for gluten free-pumpkin seed oat cookies, apple slices or any type of tea imaginable... you're in luck.

Post-its and a lot of free time.

We are REALLY serious about decreasing our carbon footprint.

You have a PhD in biochemistry... You get to wear whatever the heck you want to class... I get it.

What is Naturopathic Medicine Anyway?

So you’ve probably been following my blog like the faithful friends I know you are and you’ve also probably found yourself thinking, “Man, all of this naturopathic medicine stuff sure does sound awesome!” Now that thought is probably immediately followed by, “Actually, I really don’t have any idea what naturopathic medicine is.” That’s okay. You’re not alone. In fact, until 6 months ago, I had never heard of it either and only 10% of people in the United States are familiar with naturopathic medicine. I would guess that it is for this very reason we are required to do a certain number of hours educating the community on natural medicine before graduation. (You better believe I am going to count the time I spend blogging for community education hours.)

Educating the community on naturopathy is actually a double-edged sword; I love that I get to introduce this medicinal philosophy to those near and dear to me, while at the same time, it is a tremendous task to try to express the profound and powerful nature of naturopathy adequately. I never feel like I’ve quite done it justice. (Which is part of the reason it's taken me so long to write this post.)With this in mind, I’ve put together an elevator speech on naturopathic medicine and philosophy that will only begin to hint at the vitality of the field.

So here it is:

Naturopathic medicine is a holistic approach to medicine and treats the entire person rather than symptoms or disease singularly. It focuses on the body’s inherent ability to heal itself and facilitating that process.

 Naturopathic medicine is not simply defined by methods or modalities, rather six clinical principals:

1) The Healing Power of Nature

I believe that people are inherently good; I also believe that people are inherently meant to be well. Our bodies are amazing masterpieces of perfectly orchestrated biochemical pathways and organs and genetics and hormones and many other factors all working in concert, in perfect harmony to create the thing we call human. It is nothing short of miraculous that with everything that needs to go right, and so many opportunities for anything to go wrong, that we all turn out as well functioning as we do. Our bodies are made to quickly adapt and compensate for many different scenarios, including disease. In fact, many “disease” states, fever for example, are actually the body’s attempts to heal itself. As naturopathic physicians it is our responsibility not to overcome these self-healing mechanisms, rather to stimulate them and remove any obstacles that may be impeding the body’s natural ability. The idea is “power with the body” versus “power over the body.”

The other important aspect of the healing power of nature is, of course, nature. (duh.) Nature is a powerful force and should be treated with respect. How often do we attribute our mood to the weather or talk about the invigorating quality of fresh air? From the Industrial Revolution to the cyber revolution and everything in between, our society has moved farther and farther away from nature and has forgotten how therapeutic and healing a power it is. 

2) First Do No Harm

I think we have all probably heard this phrase before; it is one that is also espoused by our allopathic counterparts. However, I think we may have a slightly different perspective on what the essence of this phrase is. Call it “spirit of the law” as opposed to “letter of the law.” In order to avoid harming our patients, naturopathic physician utilize methods and medical substances which minimize the risk of harmful side effects, using the least force necessary to diagnose and treat while avoiding the harmful suppression of symptoms. In other words, what is the least amount of force that will do the greatest amount of good? We call this the Hierarchy of Therapeutics. This is a very rational decision making process for the physician based on knowledge, experience, and good intuitive sense into a patient’s vital force and the seriousness of the illness. It is important in patient care because using the least forceful intervention to bring about success allows for minimal side effects and patient trauma. The Hierarchy can best be depicted on a spectrum.

Low Force Interventions                                                                              High Force Interventions

Energetic Medicine	Lifestyle and Dietary Intervention	Nutritional Supplements	Pharmaceutical Drugs	Surgery
Homeopathy Acupuncture Hydrotherapy Reiki Prayer	Exercise Smoking Cessation Healthy Diet Weight Loss Allergy Elimination	Botanicals Vitamins Minerals Herbs	Antibiotics Anti-hypertensives Anti-psychotics Cholesterol lowering medications	Cardiac Bypass Angioplasty Resection Etc.

3) Doctor As Teacher

As a physician you have the most privileged vantage point to listen to others a human can find. A doctor gets to hear the innermost issues of patients, and has the opportunity to synthesize those hints and facts into a diagnosis and treatment with the hopes of improving the lives of those who seek your help. Naturopathic physicians educate their patients and encourage self-responsibility for health. Our philosophy is to empower our patients by teaching them tools to change their lives and improve their health. Because we heal by working synergistically with the body’s inherent ability to heal itself, the patient ultimately maintains power over their health rather than relying on and submitting to the mercy of medical interventions and pharmaceuticals. The principal also includes understanding where a patient is coming from and meeting them on their level; just as a teacher wouldn’t try to teach variable calculus to someone struggling to learn their multiplication facts.

4) Treat The Whole Person

Physical, mental, spiritual, emotional, genetic, environmental, social, and other factors all contribute to pathology as well as well being. The most effective treatments (and physicians) are those that account for the multi-faceted way in which we live.

5) Identify and Treat the Cause

The naturopathic physician seeks to identify and remove the underlying causes of illness, rather than to merely eliminate or suppress symptoms and it is important to understand the difference.

6) Prevention

Naturopathic physicians emphasize the prevention of disease. This includes assessing risk factors, heredity and susceptibility to disease and making appropriate interventions in partnership with their patients to prevent illness. Our goal is to help our patient live their best lives. This idea is immediately hindered when our patients come to us with diabetes and high blood pressure and emphysema from 20 years of smoking six packs a day. Don’t misunderstand, we can, and will treat these things but how much better would your life be if we avoided these problems all together? This way our focus and energy is not spent trying to reverse issues that could have been prevented in the first place. Naturopathic medicine is committed to the creation of a healthy world in which humanity may thrive.

And there you have it; the six principals of naturopathic medicine. And yes, I realize that this elevator speech would only be appropriate if we were in an elevator to the moon but like I said, I can’t even begin to do the topic justice. And truth be told… I love talking naturopathy, and if you are reading this, chances are that I love talking to you too, so if you have any questions feel free to ask away! Leave a comment, send me a text, write me a letter, give me a call… or better yet, visit a naturopath and see for yourself.

1 week down... 191 to go...

I did it. I finished my first week of medical school. And yes, it is everything they say it is… Actually, I’m not really sure who “they” are or what is said about the first week of medical school but I can tell you it is a roller coaster for sure; a thrilling ride filled with ups and downs, some exciting twists and turns, all the while your brain is being rattled uncontrollably and you get off feeling dangerously close to puking…  then you high-five your friends and get in line again.

This week was information overload in every way imaginable. Between sitting in class from dawn to dusk, attempting to learn the names of all my new classmates, and still trying my darndest to figure out my way around Portland, my poor little brain is in overdrive. When I get home, exhausted, each evening it is not hard for me to understand why medical school is often described as the most stressful, grinding time of a doctor’s life… and I only just finished my first week. It is also not hard to understand, and appreciate, all the emphasis that has been put on maintaining balance in our lives and the importance of taking time to take care of ourselves. (After all, how can I expect to attend to the health and healing of others if I’m a frazzled, hot mess.)There were even several times during orientation that we paused so we could “re-center” ourselves by practicing some Qi Gong. (Google it.) As a non-native hippie, I may have giggled a little bit when I realized what was happening and I think the sight of over 100 people shaking out our stress, quite literally, and then “grounding our energy,” probably would have provoked some involuntary smiles from anyone who doesn’t wear tye-dye on a regular basis. Don’t get me wrong, I am not making fun here. You better believe I was eating it all up. You know what they say… When in Rome…

Luckily, Portland is the yoga capital of the world. (I’m not sure if this is a documented fact but I’m pretty confident in making this statement.)There are literally yoga studios on every corner, and usually one or two on the block in between. Now, I have not always been a yoga fan. In fact, for a long, long time I could not for the life of me understand why people did yoga for exercise. I was of the mindset that when I went to the gym to exercise I wanted to get pumped up, get my heart rate going, and possibly even sweat a little bit. What I did not want to do was hold stationary poses for some predetermined length of time while listening to a babbling brook soundtrack. That all changed after I started working in a public school system. After a long day working with students who hated school, hated learning, and weren’t shy about making sure I was well aware of these facts using less-than-polite vocabulary, I totally understood how laying on your back for 20 minutes in a silent, dark room meditating might be appealing. So I took up yoga.

At this point, I should explain that I am one of those people that has to get in bed a good 45 minutes before I want to be asleep to allow myself time to relax and stop mentally making lists of all the things I need to do. (Coincidentally, I am also one of those people who need to set their alarm 30 minutes earlier than necessary to allow for the inevitable multiple snoozes.) I am not amazing at the meditation aspect of yoga or centering, or grounding, or turning my energy inward, or whatever the heck you’re supposed to do, but I have learned that yoga is a fantastic way to “shut down” my hyperactive brain after a long day and have made a habit out of doing a quick yoga practice before bed. Don’t worry though, for those of you who are wondering how the fluid, hippie nature of yoga and my self-proclaimed, task oriented, type-A personality can coexist it is really quite simple. Practicing yoga before bed enables me to re-center (in my own way as I’m still not quite sure what this means) and take time for myself, relaxes me in order to fall asleep faster, and sneaks in some low impact exercise after a long day of listening to lectures on the innervations of muscles. Check, check, check… to do list complete in one activity. Oh how I love efficiency.

My classes this week were somewhat daunting; as well they should be, after all, I’m going to be in the business of healing and saving lives… I should probably know what I’m talking about. As each professor came in an introduced his or her class the enormity of the amount of information I will be required to know washed over me. My anatomy professor commented that we will most likely learn between 20,000 and 40,000 new terms in medical school. That is the equivalent of becoming fluent in a foreign language. He then began his lecture which consisted of him rattling off anatomical term after anatomical term without any cohesive thread tying anything together, or at least none that I could ascertain… maybe to drive home the foreign language comment? Mission accomplished. After my last class of the day on Monday, I heard some classmates around me talking about getting together to study later that evening. All I could think was how nuts these people must be. It’s Day 1 for crying out loud! We’ll have plenty of time when studying is essential, might as well take advantage of the first few days and take some down time before everything gets into full swing. By Thursday afternoon (Day 4), I found myself in a library carrel, a little bit intimidated by all the information for which I was already responsible. With my first test scheduled for next Tuesday I think it’s safe to say the “full swing” of things is upon me. 

It is increasingly clear to me that over the next four years, I will learn (and forget) more information than most people learn in their entire lives. Goethe once said, “Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it.” I am beginning an incredible adventure and although I am under no illusion that I will ever be able to describe any part of the next four years as “easy,” I am so much more than excited to rise to the occasion and commit to the end goal. We were counseled this week to write down our purpose, why we started on this journey, and to post it in a prominent place in our homes. That way when the going gets tough and we question what on earth ever made us think this was a good idea (or when we get a statement in the mail telling us how much we now owe in student loans) we can remind ourselves why we love what we’re doing and how passionate we truly are about the path we’ve chosen. That is one thing I’ve loved about all of my classmates, when we are all together the passion in the room is palpable and synergistic, you can’t help but be stoked about naturopathic medicine… and spending long hours trying to commit to memory the biochemical ins and outs of the bicarbonate/CO2 buffering system in the blood.

Bring it on week 2.

Living the life I've imagined...

My name is Desta and I am from Virginia. Ever since I can remember, I’ve wanted to be a doctor. Except, of course, for a brief period during my formative years when I wanted to be the next Katie Couric, with the romantic, if not naive, idea that I’d only report on positive news pieces. However, as the younger version of myself thought about sitting behind a desk reporting on the evening news more and more, I realized that a lot of the success of Katie Couric (whom I may or may not still have an autographed photo of safely tucked away in my closet) type figures comes from a lot of hard work, some talent, and a couple of those lucky “big breaks.” You know… the ones that come when you’re in the right place at the right time and seen by the right person. Now for my type-A, control freak personality, the idea of luck playing any part in how successful I am did not sit well with me. (I know, I know, how sad is it that I was already well aware how I needed complete control over my situation and potential at the ripe old age of 12?) So I crossed “World Famous Journalist” off my list of things to be when I grow up. The fact that I even had that list and was systematically working my way through it to find my best option speaks even more to my logical and practical nature…

When I decided on doctor I knew I had hit a homerun... grand slam even. The idea resonated with me. It was the perfect confluence of everything I wanted out of a career; the ability to set my own course with my success directly correlated to the effort I exerted, tempered by a component of humanity and the opportunity to interact with those around me in a meaningful way. I was sold. Every major decision thereafter was made with that end goal in mind. I did all the right things, took all the right classes, and volunteered with all the right organizations. I took the MCAT and eagerly filled out endless, ridiculously expensive applications to all the right medical schools. After a decade of planning and years of preparing… I didn’t get in. Boy, was I disappointed. (I originally typed “devastated” but that seemed a little dramatic. I once had a friend ask me if I was more devastated than I seemed after being dumped by an old boyfriend. I reasoned that the AIDS epidemic in Africa was devastating, Hurricane Katrina was devastating, it would be ungrateful of me to claim being dumped by my boyfriend as devastating… Anyway, I digress.) After the initial denial of not being accepted wore off, I did what I always do and what I’m good at, I made some lists and formed a new plan to reach my goal.

For the sake of not making this the longest blog post in the history of the universe I will spare you some of the details here. Suffice it to say I went through a stint in my life that could only be described as stressful and confusing with alternating layers of heartache and frustration… like a giant, exasperating parfait. I owe a lot, and by “a lot” I mean an astronomical amount that I could never even hope to repay, to my absolutely amazing friends during this time for keeping me grounded and always encouraging me, even when I was being a big baby. They were, and still are, a constant source of inspiration and for that I am eternally grateful.

During my “Dark Days,” (ok… so I appreciate a little drama.) I started a Master’s program in Human Nutrition. It changed my life. (More drama… so sue me.) It got me started on a path and train of thought that I think is underrated in America… The healthy lifestyle. I loved the holistic and natural approach to nutrition my program espoused and each new class I started was like a brownie sundae, the kind with sprinkles and strawberries and lots of hot fudge… and yes, I do realize the irony of that statement. However, I was still sticking to the plan and, given my ridiculously over the top fascination and love of all things pregnancy and birth, had more specifically decided on midwifery, so I was talking to schools and filling out more applications to go in that direction.

One night, as I was working on some nutrition assignments, which really means I was googling everything under the sun to avoid doing the actual assignments, I noticed that my professor’s title was Dr. So-and-so ND. Seeing as how I had no idea what “ND” meant and I was quickly running out of things to google I made that my next query. That search opened up a whole new world to me while at the same time completely validating all that time I spent in high school honing my procrastination skills despite my Mom’s obvious disapproval. Double win. Sorry Mom. It turns out “ND” is the degree earned by naturopathic doctors. What are naturopathic doctors you ask? I don’t want to encroach on a planned future blog post, but they are basically doctors who practice in a very holistic way and focus on healthy lifestyle as a means of preventative medicine while fostering the body’s inherent ability to heal itself. Now you’re probably thinking, “Wow, that sounds like it would be right up Desta’s alley, and perhaps what she’s been looking for all along and all of the road blocks and obstacles she’s encountered up to this point, no matter how frustrating and disheartening, have led her to something she can really be passionate about, something that she feels in the very core of her being.” You would be exactly right. For my Mormon friends you’ll understand the allusion when I say I had that “This is the place” feeling.

In a whirlwind of research on schools and options, applications, and interviews, I was accepted to a naturopathic medical school in Portland, Oregon called National College of Natural Medicine. I quit my job teaching special education, finished up my Master’s program, endured countless “witch doctor/ crazy hippie” jokes as I explained where I was going and for what, and then I packed up everything I hold dear… sadly not everyone… and made the trek from Virginia to Portland, from genteel, southern charm, to eco-friendly, hippie liberalism.  And yes, I very much consider traveling across the entire country, even if it is in the comfort of my new, orange Jeep Patriot equipped with air conditioning and an auxiliary output for my iPod listening pleasure, a “trek.”

And so here I am, creating a blog to document my adventures as a transplanted, mormon girl from The South, learning the ways of “hippie healing.” As I sit in my not-even-close-to-put-together-yet living room, about to start my first day of medical school classes tomorrow, I’d be lying if I said I wasn’t feeling any trepidation whatsoever, but on the whole I’m excited and ready… Ready to begin a new chapter in my life… Ready to “Go confidently in the direction of my dreams, and live the life I’ve imagined,” as Thoreau would say.