PoY Boy, Two Thousand Eleven

By Shiva Barton, ND, LAc
2011 AANP Physician of the Year

As you probably know, I had the distinct honor of being awarded the AANP Physician of the Year Award for 2011. I cannot begin to tell you how deeply honored and grateful I am to have received this award. It continues to be very moving to me to be nominated by my peers and to be deemed worthy of this award.

I don't really remember much of my acceptance “speech”—I hope it was inspirational, or at the least, coherent. In any event, I am sincerely grateful and moved, and appreciate the vote of confidence. Naturopathic medicine is such a wonderful healing art. I think we take for granted that everyday, besides helping the garden variety illnesses, we are helping people that do not have any other options to get well. At least, that is much of what I see in my practice. We help people who, for whatever reason, are medical outcasts. And we can help many of them recover their health and lead happier, healthier and more productive lives.

It is an honor to be able to share naturopathic medicine with my patients, to teach about it at the conferences, and to inspire preceptees who come to visit my practice. So I am very grateful for being recognized as contributing to the improvement of this wonderful and challenging profession and will truly cherish this award for the rest of my life.

OK, enough with the sappy stuff...

I'm reminded of the famous quote: “There is no such thing as a free lunch.” Well, a few days after I returned home from the conference I get an email from the great Matthew Santoro of the AANP. (I say “great” when referring to Matthew because he is doing such a great job sending us the AANP Clips. Always informative, and frequently clinically relevant. Please send Matthew a big email thank you!) So Matthew emails me. Here is the subject line of that email: 

Congratulations on the PoY Award and a Request!

Well, it took me a few seconds to realize that PoY was not the Hawaiian delicacy, but AANP shorthand for Physician of the Year. As for the request, I figured that he wanted an autographed picture of me to hang in his office. Well, that would be a problem... The only picture that I have of myself in a suit - not including the snapshots of me in a tuxedo—but that's another story...—was taken about six years ago.

When I came home from this conference and told Elena, our office manager, that I had won this tremendous honor she told me in no uncertain terms that I had to publicize it. Now, if you know me—and I do remember saying this in my acceptance speech—I am the kind of person that likes to sit in the back of the room, be quiet and not draw any attention to myself… OK, well maybe crack a few jokes while I'm back there. Hence, I never make the effort to do the publicity stuff that I should be doing, such as keeping a current picture to provide to autograph hounds and to send out with press releases. This is one of the ways the PoY has already changed my life. I have to take this publicity thing seriously. (Note: neither publicity nor serious is part of my primary genetic code.)

So in order to fulfill my office manager's order and my supposition of what Matthew wanted, I had to get a professional picture taken. I arranged to have a photo session at the local portrait photographer's studio for last Tuesday. I think the idea of me potentially damaging my DNA by getting an up-to-date professional portrait was too upsetting for the forces of nature. How do I know this? Well, Hurricane Irene blew through our area and knocked out the power to the photographer's studio—one of the few structures in our community that was affected by the power outage. As of this writing, she still has no power, so the laws of nature so far are preserved. (Preserving the laws of nature, of course, is very important to us as naturopathic physicians.) Such are the obstacles encountered on the path to naturopathic greatness, or maybe even a spot on Oprah. Needing a picture, I had to take one of myself. I think I'll keep my day job...

Well, it turns out that Matthew wasn't asking me for an autographed picture after all (I still think he's great in spite of this). This is what he wanted:

We request each year that the PoY become a regular writer for our blog, Physicians Who Listen, and I’d love to have you on board! Your first due date would be the Friday, September 2, by 5 PM EDT. You can write on a topic of your choice or, at your request, we can suggest a topic for you...

This is where the “No such thing as a free lunch” comes in... Win an award, write a column. I think Matthew didn't realize that my favorite author is Dave Barry. Not sure how inspiring that will be. I remember one time riding shotgun while my brother-in-law was driving down the highway, reading a Dave Barry column about dressing up as Batman for his young daughter's birthday party. I remember we were laughing so hard and I couldn't see because the tears were running down my eyes. I remember hoping my brother-in-law could see and thinking that I was glad I wasn't driving or I would be dead. Had I died, I never would have lived long enough to get this award and write for this blog. For that I am eternally grateful, or will be grateful for as long as I live, which will not be for eternity, guaranteed... But the point of naturopathic medicine is not to help people live forever. It is to help them to be as healthy and happy as they can be, and when it is time to go, to pass peacefully, and maybe tell a few jokes on the way out.

So, Matthew, here is my first column. As you can see, I picked a topic of my choice. How do you like the picture I took?

You Never Know Where You Will Learn Something That Changes Your Practice: Lysine for CNS Disorders and Cognitive Function

Written by Shiva Barton, ND, LAc
2011 Physician of the Year

OK, even though I am no longer Physician of the Year – that was soooo 2011 – I was asked to contribute to the AANP blog. Just when you thought it was safe...

A few weeks ago I gave a talk at the local Senior Center. I had given a talk there a few years ago and evidently I didn't kill anybody so they invited me back. The topic was, “When Would or Should a Person Consider Using CAM.” The talk was part of a community event where vendors were invited to have tables promoting their senior relevant businesses. (Did you know that there is an association of Senior Relocation Services – think selling or cleaning out houses, estate sales, etc. – and that there is an accreditation process for these services?) As I looked out over the audience there must have been 100 or more people there. The difference between this time and last time I spoke was that now I QUALIFY TO BE A SENIOR! (Big 6-0!)

I was the first speaker, which I enjoy, because people don't generally nod off right away. Anyway, I love to give these kinds of talks because it is easy to make them relevant. I generally ask who in the audience has seen the different types of complementary practitioners. Examples include, ND (not too many – i.e. none), DC, acupuncturist, massage therapist and reiki practitioner. I ask people to share the reason that they went – not so much the medical condition but why they didn't pursue conventional care. Then, I expound on each of those possibilities: conventional care didn't work, the treatment suggested had side effects, or the patient was not interested in the recommended conventional treatment. This approach to a talk can be a little dicey because you never know if someone is going to try to give you their life story. As the speaker, you must be willing to artfully interrupt someone, hopefully, without them being offended. There were plenty of good stories to build on from in this audience.

As you can imagine, it is always helpful to give a handout at this type of event. Something that is relevant to the attendee, speaks directly to them, and of course has your contact info on it. I don't find practice brochures to be that helpful in this instance. The handout that I like to give is a list of recent patients and conditions we have seen at our practice. As an example:

• 6-year-old boy with recurrent ear infections,
• 45-year-old man with metastatic colon cancer, and
• 65-year-old woman with insomnia.

Listing the ages and conditions really gets people to thinking that this might benefit themselves or a family member.

The whole talk went pretty smoothly. The feedback was good and I even got a few patients out of it. One thoughtful question stood out. Among the patients I had listed on my handout were two patients in their 80s with dementia: one with presumed Alzheimer's (beginning stages) and one with presumed Lewy Body dementia (advanced stage). One of the attendees asked me if we actually cured all these cases, rather than had only seen them—very appropriate, pointed question. Which comes to the crux of our practice—what do we consider a successful outcome?

I spoke about some of the patients who were not cured, but had improvement or successful outcomes. I particularly focused on two patients with metastatic cancer who were able to extend their lives and maintain a good quality of life before dying. I also spoke about two patients with dementia, who have improved memory and their cognitive decline has slowed but not stopped. To me, these are somewhat successful outcomes. I, of course, want everyone to be totally cured, but this isn't a reality, unfortunately.

At the end of talk lots of people came over afterward to ask me questions. The man who asked the question about cure came up to me as well. He asked me if I ever used lysine to treat dementia (I had never heard of this). He said a friend of his cured his mother of Alzheimer's disease using lysine. Of course, I was extremely skeptical, since I know that there is no cure for Alzheimer's. His friend wrote a book about it. The man said he would bring me a copy. That afternoon the book showed up at my office. The author is Brad Pitman and the title of his book is, Ma Is Back. The book is an easy read; I couldn't put it down. I recommend that you get it.

Pitman chronicles the decline of his mother's functioning to the point where she didn't recognize people, was having fecal incontinence multiple times at night, and more. Then he started giving her lysine. (I'll have you read the book to see how he figured it out.) She started to immediately and slowly improve. Eventually she was back to normal again (I think it took 6 months–can't remember exactly). Quite phenomenal and unbelievable if you ask me–except it is true! Very interesting stuff. I could go into the science behind it, but I will save that for another time.

I have a patient that I mentioned above with advanced Lewy Body dementia. She, like Mr. Pitman's mom, did not recognize her daughter, had fecal incontinence, and was not speaking an unable to feed herself. Within one week of taking Lysine, 1000 mg, three times per day, she was periodically able to: hold her food, feed herself, recognize her daughter, make conversations, be oriented times three. Now, she is not cured, and may never be, but this is certainly an improvement, with continued upswings. The treatment is inexpensive and seemingly helpful so it is worth trying it with your patients with CNS issues, especially memory disorders. I spoke about this at the New Hampshire Association of Naturopathic Doctors’ conference last weekend. A couple of ND's mentioned that they had seen benefit with neurological pain as well.

So there you are, my gift to you for this Holiday Season.

Data Points

By Shiva Barton, ND, LAc
2011 AANP Physician

A few things happened to me recently that made me very happy to be a naturopathic doctor, and made me wonder about what's up with the rest of medicine. I will present my conclusion first in case you want to cut to the chase:

CONCLUSION
It is really so evident that by easily employing even the simplest tools of nature and naturopathic medicine you can have a tremendous positive impact on a person's health, either in conjunction with or instead of conventional medicine, depending on the situation. The influences of pharmaceutical marketing and the social glorification of technology have sent our culture looking for health-care saviors in the completely opposite direction to that which will "cure the cure."

The rest of the story, with a common theme....

Data Point 1
I was invited to speak at the Future of Health Wellness Summit sponsored by the Future of Health Technology Institute www.fhti.org at the Massachusetts Institute of Technology (MIT) faculty club. My topic was “Naturopathic Solutions for Minor Childhood Illnesses.” Well I always wanted to go to MIT (not really), and the summit sounded fascinating, so I accepted the invitation. There were about 10 people at the summit and I felt relieved that there wasn't a cast of thousands. But I did feel out of place. I couldn't figure out why they wanted a naturopathic physician to address the summit about advances in health technology. There were representatives there from research and development departments of McNeil, Johnson & Johnson, Children's Hospital, as well as a few affiliated MDs, all looking for the next big App to market, a new way for patients to interact with computers to improve their health or compliance, and of course to make a killing by marketing such App. I gave my talk about how we would treat certain childhood illnesses, and that naturopathic medicine is trying to move medicine back in time, but forward in effectiveness and cost effectiveness. I also told them that the better we did our jobs, the less money they would make. That definitely got a chuckle! The participants were very nice, and even listened a little between checking texts and emails. And I was done, and went off to joust with more windmills.

Data Point 2
Here's a story about a trip to a urologist. I am of the age where I have friends—and me, come to think of it—who are starting to have common aging-related dysfunctions, such as BPH (benign prostatic hyperplasia), commonly just referred to as an enlarged prostate. One of my friends told me an interesting experience he had on his first visit to his urologist to discuss his urinary tract issues, which were low force of stream and after dribbling. My friend suspected that his issues were not related to BPH but to scarring and narrowing of the terminal urethra due to recurrent herpes infections. Both of his previous primary care docs confirmed that his prostate was normal in size and firmness, and one of them was the one to suggest the alternate explanation. So after procrastinating for about a year (he's a guy—what did you expect?), my friend decided to finally see the urologist. He gets to the office, fills out the intakes, and hands them back to the receptionist. The receptionist hands him another one-page intake that the doctor requests that he fill out. The questionnaire was provided by Flomax and asked the same or similar questions that the other intake had already asked. However, this one had Flomax written all over it. My friend gets to see the urologist in a timely manner, who is a personable man in his 40s. He looks at the intakes, asks a few questions, does the exam (euphemism), declares that my friend's prostate feels fine, and gives him an Rx for Flomax (SURPRISE!). My friend asks for an explanation since three out of three docs think his prostate is fine, giving his alternate explanation. The doc says that the nodules are probably internal around the urethra, which is why they can't be felt. End of appointment.

Data Point 3
The other thing that happened simultaneously was that my mother came to visit. That isn't really that newsworthy. However within two hours of arriving, she missed two stairs, fell, and fractured her pubic bone and acetabulum. She spent six hours in the Winchester Hospital Emergency room (total cost: $7,000), one week at Mass General Hospital (MGH) (still awaiting that bill), and one and a half weeks at New England Rehab Hospital. Her experience at the local hospital was very good: thorough, friendly, efficient. Did you know that pelvic fractures are trauma or trauma/ortho cases due to the possibility of puncturing other organs, and not straight ortho cases? News to me. WinchHosp doesn't have a trauma department so they shipped her off to MGH.

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

My mom's review of MGH was pretty good. The nurses were TERRIFIC. Mostly young nurses. Very caring and attentive. On the downside: the medical staff. MGH is a teaching hospital, so there is a cast of thousands coming around to care for each patient. There are med students, interns, residents, fellows and attendings all making rounds from each department: trauma, internal med, ortho, etc. Interestingly, not one of the MD teams ever examined my mother! (Bizarre, really...) Just asked her a bunch of questions. And they would start rounds at 5am. They would ask my mom how she was feeling and her standard reply was “I don't know. I was sleeping.” I guess the therapeutic benefits of sleep have not penetrated to the hospital staff.

No surgery was needed, so my mom went off to rehab. (My 11-year-old son was a little perplexed, since his only info about rehab was from the Amy Winehouse song.) She and her roommate immediately got a gastrointestinal bug. First stop: Rx for Flagyl, even without a culture. The doc suspected C. diff (Clostridium difficile), even though my mom had no antibiotic use and her neighbor had the same thing after the same meal. Declined Flagyl. Don't they know about probiotics? In this day and age? It should be routine for all in-patients. So I brought her some probiotics. (The culture turned out negative.) By the way, the food they served was like from the 1950s or '60s. Not a fresh fruit or veggie in sight. Soda, white bread, etc, etc. How did they expect people to heal? I thought I was in a Twilight Zone rerun. (Do you young 'uns know what that is?)

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So don't take the simple things that you learned for granted. Not all health-care practices are paying attention. The non-technological “interventions” that are the basis for good medicine, such as sleep, compassion, listening, healthy food, simple preventive supplementation—nothing fancy—can have a tremendous impact on a person's health. And they ARE NOT STANDARDS OF CARE IN MANY ARENAS. These are the simple and powerful tools that SHOULD BE our starting points and should not be ignored or minimized as to their contributions towards health. Laying a fertile field grows healthy plants!