All in a Day's Work

By Marcia Prenguber ND, FABNO

Sunrise Today
Photo by fmc.nikon.d40 via Flickr, under the Creative Commons license.

All in a day’s work – a day of repeated inspiration. The challenge is how to record the events of the day, to savor the beauty, to reflect on the challenges, and process the losses. Starting the day with an early morning meeting referred to as Breast Clinic, the team of providers (pathologists, radiologists, mind-body counselors, naturopathic residents, medical, surgical, radiation, and naturopathic oncologists) sit in a darkened room to view scans and path slides. The details of the diagnoses of patients with newly diagnosed or recurrent cancers of the breast are presented, reviewing the pathologic nature of cells projected more than 200-fold on the screen in some ways give us a more real view of the enormity that these cancer cells play on an individual’s life. The stains that color these larger than life cells cast them in a friendly hue, but the meaning that those stains convey is not so good natured. I’ll admit, at first glance, this environment may not appear very inspirational. However…

The intensity of thought and depth of care that is evident during the discussion of the PET/CT scans, the path slides, and the Breast Surgeon’s review of each patient’s story as told to her by the patient is inspirational. The focus on the significance of each assessment, the conflicting information, the challenge to weigh the details appropriately make it very interesting, but inspirational? The details of each patient’s efforts to cope with the circumstances of the changes in their lives since the diagnoses, their lifestyle habits and all the rest of the information gathered by each of us in the time spent with the patients contribute to our understanding of the patients and fuels the fires of inspiration. Knowing these details about their lives gives us pause to reflect on what we do with our own moments in time. These patients inspire us to pay attention, to focus on the details, to bring to them the best that we can be, in whatever discipline we represent.

As a naturopathic physician, all of those details that patients bring to the cancer center matter to me. I look at this as winning the big prize – I get to use all that information in developing my treatment plan. And then to put icing on the cake, I get to spend time exploring these pieces of information with the patient – and just getting to know the patient. The most significant source of inspiration comes from learning who each patient is and how each one of them is dealing with this new challenge. What strategies do they each use? When and why do they choose not to know more? How do they deal with pressure from family and friends to try everything under the sun to try to treat the cancer? That these patients share this is such a privilege. Their courage, their strength, and their vulnerability inspire me. And makes me look a little deeper.

So, as the sun starts to come up in a spectacular sunrise and the morning meeting comes to a close, I am reminded that it is the start of another gorgeous day that I have the good fortune to go spend time with those patients. And to do so as a naturopathic oncologist – what a fabulous profession.

Pre-Conception Testing: A Naturopathic Perspective

By Sara Thyr, ND

Photo by lunar caustic via Flickr, used under the Creative Commons License.
When couples decide to get pregnant, most think that they just need to take good care of the baby in utero. Some only worry about nutrition and toxins after the child is born. New research about epigenetics tells us that what you bring into the pregnancy can be even more important for the long-term health of your baby. Diseases like diabetes and heart disease have been linked to toxins to which babies are exposed in the womb. Asthma and allergies are inflammatory disorders with which many children suffer, and the health of the mom during pregnancy can have a great bearing on them.

What does my obstetrician test for?

Standard medical testing might include some look at hormones for ovarian function, particularly for women trying to have babies later in their childbearing years. Most will check to see if the woman has antibodies to Rubella and vaccinate her before pregnancy if these levels are low. They might also look at thyroid function, as malfunction of this endocrine gland makes it more difficult to get pregnant and maintain a healthy pregnancy. They may even look at a woman’s vitamin D levels, and perhaps if they are very progressive check her folic acid, B12 and complete blood count. Most do not look any deeper, unless a woman is having some difficulty getting pregnant. Even then, they are not looking at all of the factors that go into having babies who are not only healthy at birth, but healthy throughout their lives.

What will a naturopathic doctor look at?

Food allergies
Food allergies are a very misunderstood topic, in my opinion. If I ruled the medical world, this test would be as common as a complete blood count (CBC) or thyroid testing. When people have delayed hypersensitivity reactions, they may have some random symptoms, but don’t usually know that there is an association between them and the foods they are commonly eating. Undiscovered food allergies are the most common cause of unexplained infertility. And if a woman does end up getting pregnant, she will pass all of these antibodies on to her child. The mother’s antibodies are passed on to her children, so if she does not eliminate them as much as possible during pregnancy and breast-feeding, she passes her sensitivities on to her children.

An elimination diet can be done in lieu of testing if it is not possible to work with a reputable lab. The most common foods to which people are reactive are wheat (all glutens as well), dairy products and eggs. Some also have issues with soy foods and citrus fruits.

Testing should look at the antibody IgG, as this one is most responsible for delayed hypersensitivity reactions (which is what food allergies exist unless a person has an anaphylactic reaction to a food – in which case they usually know as their tongue and throat swell, they have difficulty breathing, and are rushed to the ER.)

Testing should look at the antibody IgG, as this one is most responsible for delayed hypersensitivity reactions (i.e. food allergy reactions that do not include acute anaphylaxis).

Micronutrients
Do you eat a healthy diet? Do you take a multivitamin to ensure adequate levels of the nutrients your body needs? Do these steps ensure that you have in your system everything that is required? Unfortunately, no. I am a big fan of getting our nutrients from healthy, organic foods. Most of us have good digestive systems that will break down and absorb the nutrients that our bodies need. And in the U.S., most diseases of malnutrition have been eradicated. But inadequate levels of many nutrients can have impact on not only the health of the mother, but certainly the developing fetus. Micronutrient testing looks at the long-term levels (not what you got that morning) of all of the B vitamins, A, D, E, minerals that are critical for healthy bone formation, amino acids that help make up the muscles and nervous system, as well as antioxidants that help protect us from many inflammatory diseases. (This is also a great test for the aging population as deficiencies are linked to many disorders.) Shortages of certain amino acids can make it much more difficult for your body to detoxify. B vitamins are critical for many functions, including hormones and nervous system function.

Environmental Toxins
We are all exposed to many environmental toxins every day. Toxins—from pollution while driving or walking down the street, to pesticides and chemicals on our foods, to the plastic liner of the coffee we buy on the way to work, to the perfumes and parabens that are in our body and hair products—are all around us. Some people believe that if they are not working in an oil refinery or carpet factory that they are not exposed to toxins that can be harmful to developing fetuses. Toxic exposure is one area where epigenetics have given us a great deal of information about how we can improve the health of our newborns as well as our entire population. Bisphenol A (BPA) exposure in utero has been linked to men having prostate disease later in life. Phthalates can cause decreased testicular size. Octyphenol is linked to decreased FSH in women and decreased testicular size and function in men. PAH from cigarette smoke exposure while in utero is linked to decreased behavioral scores, ADD and asthma in children.

Some may be unavoidable—if you ride your bike to work you may inhale some vehicle exhaust. But many can be avoided, such as skin care products or cleaning supplies. And even better, you can take some nutrients that will assist your body clearing the toxins from your system more readily. This is particularly important if you are thinking about having a baby.

Hormonal Balance and Adrenal Function
Most hormonal issues can be elucidated in a thorough history with a patient. If a woman has regular cycles and is ovulating—has little to no PMS, heavy bleeding, excess facial hair, fibroids, etc.—then we likely won’t need to pursue in-depth hormonal testing. If someone has a history of early miscarriages, then looking at hormonal balance is more important, especially if she is having difficulty getting pregnant. If the latter is true, then I also always look at adrenal function testing. The adrenal glands are often overlooked unless there is severe malfunction. But more subtle changes can affect her ability to get pregnant, carry a child to term, and feel energized and strong. The adrenal glands are part of the endocrine system (the system that encompasses our hormones, including thyroid) and if there is excessive stress, insomnia, abuse history, etc., then checking the adrenals can be very helpful. Some women with increased fatigue will benefit greatly from adrenal support.

Consulting with a naturopathic doctor before, during and after pregnancy provides a great gift of increased health to your unborn child. Click here to find one in your area.

Progress in Puerto Rico

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

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

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

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

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

Monthly Payments Coming in 2010

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

I don't know about you, but I've always found it a bit of a financial stress for my business in January when my AANP membership renewal is due. With the last few weeks of December's cash flow slow due to the holidays and quarterly tax payments due in January on top of all my other bills, it can be tough to find the funds to renew my AANP membership for the entire year. That's why I'm happy to see the AANP move to a new dues structure where one can make monthly membership payments over the course of the year. Starting December 1, 2009, the monthly payment option will be made available to all AANP members. One can still pay upfront and receive a 16% discount, or stretch out their payments over the year to keep their cash flow running smoothly. I already do this with my state naturopathic and acupuncture associations and have found it to be an easy way to keep up my membership and support the important work of my professional associations.

There are more benefits to AANP membership than ever before. The popularity of www.naturopathic.org, the AANP web site, has soared 400%, with traffic to "Find an ND" increasing 30% in the past year. If you haven't checked out the members page on Practice Development, please do so; there are many articles geared to helping you grow and maintain successful practices. Politically, The AANP has joined the debate on health care to make sure that the message is heard that true health care reform is not just about changes in the insurance system. With AANP input, the definition of naturopathic medicine has been dramatically revised by the US Department of Labor to more accurately reflect our profession. We are involved in coalitions with other health professional associations with common goals as well as the Coalition for Patients Rights to combat the AMA's efforts to limit our licensing and scope of practice. In the past year, the AANP has worked with American Health Journal to develop a 7-part PBS series on naturopathic medicine, launched a national public relations campaign, and the new Natural Medicine Journal. I could go on but I think you get my point: The AANP is working hard for you to be the successful naturopathic physicians you are trained to be and we need your active participation so we can meet our mutual goals.

In 2010, we will celebrate the 25th anniversary of the AANP. I attended the first convention in Scottsdale back in 1986, became one of the first members of the AANP, and have maintained my membership ever since. I strongly believe that my participation along with hundreds of others have helped this organization and profession grow in ways we could not have imagined back then. Membership renewal notices will be sent out soon. I encourage you to join the AANP, get involved, and help guide the naturopathic profession for the next 25 years.

Renewal in Nature

By Lise Alschuler, ND, FABNO
Vice President, Quality and Education, Emerson Ecologics

Upstream
Photo by walknboston via flickr, under the
Creative Commons license.

As I sit looking out of my new window, or rather, the window of my new home in New Hampshire, at the early splashes of fall colors, I am elegantly reminded of the beauty and grace in this wonderful world. Nature, in particular, is such a resplendent display of richness, vibrancy, and creativity. I think, deep down, it is this intense celebration of nature that inspired each of us to become naturopathic physicians, natural product manufacturers, or holistic practitioners. I am convinced, in fact, that our individual and collective respect for nature is the main twine connecting us to one another. When I think about Nature, I think about the dandelions forcing their way up through cracks in the sidewalk. I think about the collective sigh from a grove of fir trees bending in the wind. I think about the sweet stillness of the sun setting over gently rolling hills. These recollections bring me into immediate presence – the beautiful here and now of this world. What a joy.

I know, without a doubt, that my inspiration from, and confidence in, nature and the beauty of this world is due, in large part, to being a naturopathic doctor. The philosophy and community of naturopathic medicine built and then buttressed my connection to nature. Without this medicine, I can’t really imagine how I would maintain my sanity in this chaotic world. Where would I be without my weeds, trees and sunset as equalizers? This gift – rich and poignant as it is- is a gift that is meant to be shared. How does one share a confidence and inspiration in nature? Quite simply by remaining an active part of the naturopathic community, the very community that builds this inspiration. I swear to you, that there is a direct and pulsating link between active membership in the AANP and being an inspired naturalist. Admittedly, I am biased by my own experience. I have been an active member of the AANP and volunteer in the naturopathic profession since my second year of naturopathic medical school. When I reflect back upon my volunteerism, every action – as challenging as they may have been at the time – solidified my belief in, and passion for, naturopathic medicine. Out of this passion, my love affair with Nature intensified and my sanity remained (more or less) intact. That is, perhaps, the most compelling and selfish reason for being an active part of the naturopathic profession. I not only admit it, I encourage you to take your share. Join, volunteer, gain inspiration, feel the tremendous vitality of this profession and of the stunning natural world around us.

The Cream Rises to the Top

By Carl Hangee-Bauer, ND, LAc
AANP President

Photo courtesy of psdGraphics.
In my daily practice life as well as my "political" life as AANP President, I am always on the lookout for trends and conditions in my communities, both local and national, that have effects on my practice and my profession. I came across some news recently that caught my eye and has had me thinking about its ramifications.

Along with being licensed as a naturopathic doctor here in California, I have also carried an acupuncture license since 1989 and have been a long time member of the American Association of Acupuncture and Oriental Medicine (AAAOM) as well as my state acupuncture association. Recently, the AAAOM published a study of the acupuncture profession that found, among other things, that despite the prevalent use of acupuncture in the United States, the demonstrated cost-savings and effectiveness of acupuncture treatment, and the wide reimbursement by third party payers, many licensed acupuncturists are finding it hard to make ends meet.

In John Week's Integrator Blog, he quotes Lisa Rohleder, LAc and co-founder of the Community Acupuncture Network, who concludes that "Acupuncture education, and the conventional acupuncture business model, ought to come with a warning label, the way cigarettes do: NOT SUSTAINABLE. May take years of your life and leave you with nothing, except huge student loans."

In short, licensed acupuncturists graduate and get licensed, but then struggle for years to pay off student loans and get paid appropriately for their education and skills.  Many encounter barriers in third party reimbursement.  Many fail.

Sound familiar?

As naturopathic physicians, many of us feel that one of the reasons it is hard to make a decent living is that many people out there just don't know what an ND is. But is that truly the case? It seems to me that most if not all people know something about acupuncture -- what it looks like, what it's good for (at least pain, anyway). And yet acupuncturists are dealing with some of the same frustrations and challenges that affect the naturopathic profession.

As I said before, this has given me much to think about, and I've come to some conclusions.

First, the good news: we are not alone. If LAcs are struggling with these issues, you can bet that it's affecting other "CAM" providers. We tend to think we are unique, but maybe not so much.

Next, knowing that these challenges exist, we can and must do better on all levels. Our colleges have to do a better job at preparing our graduates to enter the healthcare marketplace. The AANP has to be more active at developing programs and resources for our member physicians in order to help them excel in the business of naturopathic medicine. Our state organizations must help build awareness of our profession and, together with the AANP, "brand" naturopathic medicine as a desired choice for patients. The AANP and the states must work together better to strengthen laws and policies that allow access to naturopathic care via state and federal programs and remove the unfair barriers to naturopathic physicians in federal and state health programs. For example, did you know that while the Department of Education recognizes ND educational programs as on par with MD and DO training, we are still effectively shut out of loan repayment programs for our ND graduates? If this is not unfair, I don't know what is.

Our graduates (you) have to take the individual initiative to learn the elements of successful practice and focus on the business of our medicine as well as its practice. There are pages devoted to practice growth and success on the AANP website.  Log-in and then visit select "Practice Resource Library" after clicking on "Practice Tools."  There are several courses taught by successful NDs that will help new graduates learn the tools to be successful.  The resources are out there and we must take the responsibility to use them.

When I graduated from Bastyr in 1984, there were few choices for people entering the profession. One could go into a solo practice, perhaps join a small group practice, teach at one of the schools, or maybe work for a supplement company. Now I'm amazed at the choices graduates have, and I am particularly excited to see the increasing opportunities in integrative medical settings for us to take our place alongside our "mainstream" colleagues. I, for one, think our profession could do much more to prepare our graduates to enter these new medical settings.

I can tell you that, both individually and collectively, we are up for these challenges. "The cream rises to the top," it's said, and naturopathic medicine is the gold standard for people seeking new choices and new directions for their healthcare.

President's Message: Changes at the AANP and in the Health Industry Landscape

By Carl Hangee-Bauer, ND, LAc
AANP President

It’s a busy time at the AANP (as always) and has been particularly busy for me with the leadership changes on the horizon. Many wheels are turning and progress is being made. Let me bring you up to date on a few key events and activities.


Executive Director Transition Planning

Last month I reported on the Executive Director Transition Team and our first steps. I’m happy to report we’ve made significant progress and are moving ahead at a steady pace. Most of the past month we’ve been involved in talking with experts, reviewing and discussing the future needs and goals of the association, and visualizing what personal and professional attributes are most important in our next ED. After reviewing multiple executive search firms and holding in-depth interviews with our top three contenders, I’m pleased to report that after Board approval and legal review, we have contracted with Association Strategies, Inc. (ASI), of Alexandria, Virginia, to work with us in our search.

ASI fits the needs of the AANP quite well. They have significant experience in both the non-profit world and health industry. ASI is a woman-owned and -managed organization with 25 years of service and hundreds of associations served. Their systematic approach includes an organizational assessment, a rigorous nationwide search and screening process, transition planning, and follow-through after the hire of our next ED. They have high satisfaction rate and good credibility in their industry. If you want to know more about them, here is their website: http://www.assnstrategies.com/

The AANP has selected Association Strategies, Inc., to aid in the search for the next Executive Director.
Now this process is going to speed up! It takes at least three months and more typically close to six months for a process like this to come to fruition. The latter time is more likely, given that the search will be in process over the holidays. Karen Howard has been as busy as ever, perhaps even more so recently, as she approaches the end of her tenure at the close of November. Terri Deerr will be stepping in as Interim ED December 1st. We hope to have identified and hired our new ED by the end of March.

We’ve received feedback from many of you and welcome your input. Please watch your e-mailboxes over the coming weeks as we will be surveying the AANP community to find out your wishes, vision and feedback. We’ll be talking with national and state leaders past and present, NDs across the country, teachers, staff and others intimately connected with the naturopathic community. If you have any ideas or feedback that you think would help us be most successful, please send it to me at Carl@SFnatmed.com. We will listen to all voices. If you want to apply for the position, you can contact me directly and I will connect you with ASI once our search is actively underway.

Trends Affecting Naturopathic Medicine

It has been interesting to observe some of the societal trends that have an impact on our profession recently. First, I’m certain most of you have observed some of the negative studies released in the past few weeks on vitamins and health, including the Iowa Health Study on middle-aged women, and another about associations between Vitamin E and prostate cancer risk. Since a majority of our doctors have in-office pharmacies and almost all recommend nutritional supplements as part of their treatment protocols, the public perceptions of health risks associated with vitamin use present us with challenges and opportunities. It is incumbent upon our profession to consider these studies carefully and respond intelligently and effectively. The AANP has issued a press release to this effect and I look forward to the analyses of the strengths and weaknesses of these studies in the coming weeks.

The American Medical Association (AMA) and its affiliates continue to attack and oppose expansion of practice scope and titles for a number of health professions, naturopathic physicians included. In recent weeks we have seen the news about the American Association of Family Physicians (AAFP) opposing "any expansion of naturopaths' scope of practice that is not strictly supported by their training, such as extending them liberal prescribing authority or permitting them to perform work/school physical exams or surgery." And in no case, said the delegates, should these individuals be granted "primary care physician" status. The AMA opposes use of the term "doctor" for any doctorate-level provider who is not a medical doctor (MD). I recently submitted a letter to the New York Times editor on this topic.

The AANP is working with others within our profession to craft thoughtful responses to the AAFP and AMA. With our partners such as the Coalition for Patient Rights, we are keeping an open dialogue and working to educate and inform these groups about our training, practice and professionalism. There are many misconceptions to correct, and this kind of "turf protection" argument doesn’t serve our professions or the public in this time of need for better health care. I for one believe that all health-care professions are first about doing good and working with people to improve their health. It’s a shame we can’t work together better, with good communication and mutual respect. We as NDs need to lead from the high road as we work to change this dynamic.