All in a Day's Work

By Marcia Prenguber ND, FABNO


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.

Happy New Year: Welcome to the year 5770

By Jacob Schor, ND, FABNO


Photo by RonAlmog via Flickr, under the Creative Commons license.

We celebrated the Jewish New Year last month and we have arrived into the year 5770. It is a little more than five and a half millennia since Genesis.

Denver’s annual Gem and Mineral show was held here in Denver several weeks ago. I had hoped to go Sunday but got caught up staining our deck and ran out of time. I was hoping to find a fossil for the office. It gives me pleasure to touch something that was alive hundreds of millions of years ago. Is the world 5770 years old or, as the geologists tell us, 4.54 billion years (109) years old? Or does it matter?

Much of the time it gives me pleasure to let these two different worldviews coexist in my mind. To paraphrase Whitman, “Do I contradict myself ?... I contain multitudes….”

We live in a world of plurality, where we coexist with people and cultures that see the world differently than we do and we learn to some extent or see the world from multiple viewpoints. Our modern view is informed by scientific principles, of hypotheses tried, proven or rejected. Yet retaining some part of other perhaps unscientific worldviews has its place. Doing so gives the world more dimension and makes it a more interesting place. I have no problem with the world being both 5770 years old and at the same time being unfathomably old.

Disregarding the newer scientific worldview in favor of other views may not be the best idea. We can certainly find examples of what happens when individuals cling too fixedly to a view that is wrong.

The first example that comes to mind is how South Africa’s former President Thabo Mbeki based healthcare policy on his opinion that HIV infection does not cause Aids. Current research suggests his denial and the policies it engendered are responsible for 365,000 premature deaths.

Or consider the slaughter of pigs in Cairo. Late last Spring Egyptian authorities slaughtered all the city’s pigs out of fear of the ‘Swine Flu.’ Never mind that the flu was spreading person to person already. The people raising the pigs were Cairo’s garbage collectors and without pigs to feed they now see no profit in collecting garbage. A little bit late, authorities in Cairo are wondering what to do with the garbage that has piled up on the streets since May.

An example closer to home; I wrote about the book Catching Fire several weeks ago. This is the book written by Harvard anthropologist Richard Wrangham who argues his theory that cooked food was the driving force in evolution of habilenes to homo erectus some 1.6 million years ago. One of my former newsletter readers did not like that I wrote about human evolution. She emailed asking to be removed from my mailing list writing, “I did not evolve from slime or from monkeys; I was created by God. I do not want to receive a newsletter from someone who believes otherwise.”

There is clear advantage to seeing the world in black and white, of having set and narrow views as to how things are. Unfortunately, these sorts of views limit scientists from exploring new ideas and more importantly for me, make the practice of medicine difficult. Although it is perhaps more comfortable and easy to stick with one’s view of the world undisturbed, it does not serve the care of one’s patients to hold so fast that we miss new developments.

These ramblings bring us to a study published in the August 19 issue of JAMA that suggests that estrogen may be a useful treatment in some types of breast cancer(1). Most breast cancer cells have estrogen receptors on their surface and when estrogen binds to these receptors it stimulates the cancer cells causing them to multiply. Tamoxifen has been used for 30 years to block these estrogen receptors. This is so basic an understanding after all these years that it is hard to imagine that estrogen might be useful in treating breast cancer. Yet it seems that at least in some breast tumors estrogen will also trigger apoptosis. Apparently in the years before Tamoxifen dominated treatment, estrogen like compounds, for example DES, were used to treat breast cancer. Somehow we forgot about this.

As many of us have sadly witnessed, estrogen blocking therapies used to treat women with breast cancer stop working after awhile. The tumors become insensitive to the hormone and grow without it. In this study, Matthew Ellis and colleagues report on their treatment of 66 breast cancer patients experiencing cancer relapse and showing no benefit from estrogen deprivation treatments. Half the women were given high dose estrogen, 30 mg/day and half low dose, 6 mg/day. After 24 weeks of treatment the tumors had stopped growing or shrunk in about one-third of the women in both groups.

The researchers say they found a way to predict which women were likely to respond. Using combined PET-CT scans with a tracer attached to glucose produced a specific reaction on the scan that predicted the responders with about 80% accuracy.

How many of us will be able to let go of the world view that estrogen is bad for breast cancer and how many will be able to see that, ‘estrogens effects on a tumor are not one-dimensional,’ but rather multi-dimensional? Can we let go of our long held view and adjust to this new information?

This is part of the reason why I keep the age of the earth variable in my mind. We need to stay flexible if we hope to keep up with the science.

1. Ellis MJ, Gao F, Dehdashti F, Jeffe DB, Marcom PK, Carey LA, et al. Lower-dose vs high-dose oral estradiol therapy of hormone receptor-positive, aromatase inhibitor-resistant advanced breast cancer: a phase 2 randomized study. JAMA. 2009 Aug 19;302(7):774-80.

Their Generation

By Bill Benda, MD

I’ve experienced an epiphany in the past few weeks, keeping in mind of course that one man’s epiphany is another man’s delusion. As I reach the end of a decade attempting to build bridges between various integrative/holistic/CAM vocations, I’m beginning to think that a true inter-professional coalescence of energies and efforts to change the foundations of our healthcare system may happen in my lifetime, but not via my generation. There are tremendous efforts, don’t get me wrong – ACCAHC and CAHCIM and IHPC and a veritable alphabet soup of organizations and individuals meeting and conferencing and symposiuming. But it seems like such a slog at times, with no cohesive voice yet to be heard above the “we need better insurance coverage” cacophony from today’s political parties.

Then I walk into a gathering of students, whether of the Naturopathic Medical Student Association (NMSA) or the American Medical Student Association (AMSA), or the chiropractic or the nursing schools, and all of a sudden issues such as competition and licensure and who gets the biggest piece of the pie are not even whispered, much less argued. Those coming after us are apparently fairly free of the baggage we tend to drag along behind us – baggage gathered over years of battle with the status quo or as the status quo. These young (and often not so young) people see the students of another healthcare profession as actual people, not adversaries - as fellow travelers on an academic sea with whom to commiserate rather than compete. For years AMSA has housed a Humanistic Medicine section, and three years ago established a Naturopathic Medicine Interest Group with an ND student from NCNM as chair. NMSA itself sits at the table with the grownups of AANP and ACCAHC and in the Naturopathic Coordinating Council. And when these scholars speak to us it is about how we are all alike, not disparate.

And another consequential point – among these student bodies are, by default if nothing else, our next AANP officers and board members, and medical school presidents and faculty, and industry leaders and lobbyists. What an amazing one-two punch – energetic youth without prejudice against traditional healthcare enemies already making inroads that their parent organizations can only long for. A virtual dream team in the healthcare game.

So this leaves us with both and opportunity and a challenge. An opportunity to move our campaign forward by giving our moral and financial support to the student cause, as it is our cause, only in a more pure state. A challenge to step back and consider that perhaps we in our later years are as blind in some ways as we are wise in others. That perhaps we should call in a less sophisticated perspective from a less “experienced” source.

I’m talking ‘bout their generation . . .

You Like Me, You Really Like Me

By Bill Benda, MD, FACEP, FAAEM
2011 Naturopathic Champion Award Winner

Dr. Benda accepts the Naturopathic Champion Award at the 2011 AANP Convention Gala.

I received an award at August’s AANP annual convention at the Biltmore, a brand new one entitled the Champion Award, which from this time onward will be given to a non-naturopathic individual recognized for his or her contributions to the field. It was a bit of a bittersweet moment, for a number of reasons, which, in my semi-shocked and semi-intoxicated state, I revealed to the gathered audience of several hundred.

You see, since the end of my second term on the AANP Board this past January, I have been contemplating my interprofessional affair with naturopathic medicine. I’ve come to realize that this relationship has followed the course of most of the intimate personal romances I’ve wandered through during my adult life: the shy, hesitant initial contact; the heady discovery of mutual interests; flirtations via email; commitment to a two-year trial, followed by another. The inevitable red flags, mixed messages, minor jealousies, extraorganizational dalliances, threats of abandonment. And finally, that inevitable choice to be made as we separate: Can we still be friends? If only for the children?

But more on this in a minute.

Back to the award presentation. After Sally LaMont came to my table and explained that I really had to step up on the stage and say a few words, I made my way to the microphone and, given that I had no clue and therefore no opportunity to prepare, had no other option than to blurt out what I had been thinking just minutes before.

I revealed that I had spent that particular day in my hotel room on the bed watching bad television and figuring out how to extricate myself from the evening gala without too much notice. How to weather the emotions that arrive whenever a relationship changes. I actually revealed to the audience that whenever I’ve thought of naturopathic physicians over the past decade I’ve felt a combination of a “deep love and a desire to kill you.” Really, I said that. It came from years of appreciation of brilliance and commitment, as well as exasperation with avoidance of dealing with internal issues. The irony of helping a profession with such beautiful and pure principals while constantly hearing about the evils of my own chosen vocation. The puzzled looks when I brought up my frustrations to my fellow Board members, as in “What are you talking about?”

Ah, well. The good news is that we will still be friends, especially for the children, as I get to continue working with Naturopathic Medical Student Association leadership knowing that they will be college deans and presidents and AANP officers and Board members in just a few years. And that I can still maintain some sort of contribution to our health-care system outside of the daily grind.

And there is something else I said on that stage that I know to be true, and will always believe to be true. Something I’ve preached and written and lectured about and sort of made my own personal integrative crusade. And that is that, when we get down to it, there are no MDs, or NDs, or RNs, or DOs in this world. No titles, no social standing, no one-upmanship. There are simply people who have chosen a particular path in their desire to help their fellow human. It is, I believe, how some of us choose to manifest love—not something we feel, or express through song, or poetry, or touch. Love is simply what we are, and it is made manifest in all of its beauty by what we do when another needs us to act on their behalf. It is this—not the money, or prestige, or social conscience—that makes the insanity of working in such a dysfunctional system tolerable. And makes living such a complex and, at times, such a painful life end up being worthwhile.

So thank you, everybody. I like you, too.

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?

A Little Zest with That Naturopathy?

By Lise Alschuler, ND, FABNO
AANP Past-President (2008-2009)

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

My sister, partner and I were in a local florist shop this past weekend to shop for some flower arrangements. It was the end of the day and we entered this tiny, one-room floral shop that had pieces of plants strewn on the floor, pictures of arrangements on the walls, and a few flowers poking out of a vase here and there. The owner explained that she had just finished several bouquets for a wedding. She excitedly brought out her iPhone, “Here, you have to see this. I am so excited about this arrangement. It was all plants!” She brought up a picture of a truly beautiful arrangement of succulents and grasses. We oo'd and ah'd and then, getting right down to business, began to issue forth our desires.

All I can say is that the next 30 minutes were pure delight. I never knew that buying flowers could be so exciting. She listened to every word, asking multiple-choice clarifying questions in a way that suddenly made us feel like flower experts. She exclaimed with outright glee at each mention of a particular: type of flower (“Oh, I LOVE thistle!”), shape (“Mixing textures is gorgeous!”), color (“Deep reds are so earthy, so royal. I love it.”). She was masterful. Somehow she helped us to create a gorgeous bouquet that we thought of all by ourselves but, truth be told, could never have come up with on our own.

We left all commenting on how wonderful she was, how passionate she was, and how much she loved her work. It showed, too. She had a book of her work and her arrangements were stunningly beautiful. We were all a little giddy, actually, and I realized that by her unadulterated and unbridled enthusiasm, she had transformed us into delighted beings, entranced with the simple and wondrous beauty of plants.

While one might argue that she has a fabulous medium to work with, there is no denying the fact that she is definitely in her groove. And the results are incredible both in her arrangements and in her impact on her customers. I can’t help but imagine the impact that being that wildly and ardently in love with one’s craft (in my case, naturopathic medicine) would have on my patients. I love naturopathic medicine and I embrace it to its core, but I have to admit that it is the rare moment when that zest for naturopathy flows out of me, unfiltered, to my patients. There are a million good reasons why this is just not proper, useful, conducive or even appropriate… and yet I do think that I, along with several of many patients, could, every now and then, use a good dose of juicy, succulent and untempered gusto for naturopathic medicine.

Perhaps letting the medicine out of its constraints every once and while could transform naturopathic medicine into a naturopathic superhero – capable of transforming dis-ease into exuberant health in an instant.

Letting Nature Heal

By Jacob Schor, ND, FABNO

Reading Lise’s blog just now generated a response that isn’t suitable for print that questioned what I could write that might be appropriate to follow her treatise on universal love and chronic disease.

I’ve been thinking about much more mundane matters; how cold and rainy it’s been in Denver in contrast to Portland which apparently has had a bit of a warm spell. Those sorts of things. OK, let’s try writing this AANP thing:

I was up later than I wanted to be last night following an interesting trail through PubMed. There is growing awareness that serotonin may affect bones for the worse, increasing bone loss and increasing risk of osteoporosis and fractures. The first hints appeared a decade back and have gradually accumulated over the years. At this point it’s pretty much a sure thing. Taking SSRIs in order to increase serotonin levels increases bone loss.

This new knowledge shows up as our suppliers are once again selling l-tryptophan and promoting its use to increase serotonin levels.

OK, so we should be a bit more cautious with blindly raising serotonin levels in our patients. But the bigger issue is what were we thinking in doing this in the first place? After all, we are we not supposed to be naturopaths and is not our goal supposed to be to stimulate the vital force or the vis medicatrix naturae or something along that line. What does feeding our patients with isolated chemicals, in this case l-tryptophan or 5HTP, have to do with stimulating the vis?

What we were thinking of course is that Prozac works by raising serotonin levels and sometimes makes people happier. If Prozac and l-tryptophan do kind of the same thing, well the later is more natural and seems like an ‘alternative medicine.’ The thing is that we are not ‘alternative medicine doctors.’ We did not go to ‘alternative medicine school.’ Perhaps we need to remind ourselves this once in awhile.

The more we understand about the human body, the less sure I am that I really understand anything. Serotonin is made in both the brain and the gut. L-tryptophan is converted into niacin or serotonin and can then be made into melatonin. The gut makes far more melatonin than the brain does. Serotonin and melatonin play at least several roles in the intestine, helping regulate intestinal motility, healing injury and moderating inflammation.

So though exceptionally easy to reach for a bottle of l-tryptophan or of melatonin I still wonder, is it the right thing to do? Might we get a deeper and more profound effect by taking a more ‘naturopathic’ approach? I often find myself imagining how particular patients might respond to a month of old time nature cure. If they were to spend day after day on forced hikes through the Austrian Alps, early to bed and early to rise, bathing in cold water, the whole deal, how many of their complaints might resolve without further intervention? Would this push start a more robust circadian cycle and by strengthening melatonin fluctuations not have some positive influence on serotonin production as well?

Neither we, nor our patients, often have the luxury of really testing out these imagined months away from job and family so we are left with the simple question. How best to restore normal function with the least intervention? In the end, patients don’t come to us for philosophy, they come to us for help. If a bit of an amino acid nudges a patient’s chemistry so that she sleeps better, it’s not the end of the world. Yet, few of us are satisfied that this is a cure, but it is an improvement.

Although my concerns over serotonin and bone mass are new, the questions it raises in my mind are old. Not just for our profession, but through the history of medicine. How much does the physician intervene? How much do we step back and let nature heal? Do we know enough to help nature heal? Are our theories correct or will our misinformed attempts backfire and interfere with nature’s own efforts? Or to ask the sacrilegious question, ‘Does nature really know what to do in the first place?’

As a profession we can be almost cultish in our belief in nature as an all-knowing omnipotent healer. Let me quote a respected medical writer on nature’s healing properties:

“If the organism alone is left to the task, by its own forces and without external aid, …. we then witness nothing but painful, often dangerous efforts of nature to save the individual at whatever cost, which often terminate in extinction of the earthly existence, in death….What the vital force does in these so-called crises and how it does it remains a mystery to us like all the internal operations of the organic vital economy. One thing, however, is certain: that in all these efforts more or less of the affected parts are sacrificed and destroyed in order to save the rest.... In short, the entire operation of the self-aiding power of the organism when attacked by disease displays to the observer nothing but suffering, nothing that he could or ought to imitate if he wishes to cure disease in a truly artistic manner…..

“……the unreasoning life-preserving power when left to itself in disease, which, entirely dependent as it is upon the organic laws of the body, is only capable of acting in conformity with these laws, and is not guided by reason and reflection—the crude nature, which cannot, like an intelligent surgeon, bring together the gaping lips of a wound and by their union effect a cure; which knows not how to straighten and adjust the broken ends of a bone lying far apart, ……which cannot put a ligature on a wounded artery, but in its energy causes the patient to bleed to death; which does not understand how to replace a dislocated shoulder……which in order to remove a foreign body from the cornea, destroys the entire eye by suppuration; which with all its efforts, can only liberate a strangulated hernia by gangrene of the bowel and death; and which by the metaschematisms it produces in dynamic diseases, often renders them worse than they were originally.”

-Samuel Hahnemann

Our image of this Vis that we so eagerly wish to embrace and employ to heal all patients of all things is perhaps oversimplified. Great doctors for centuries have professed and debated the nature of this ‘power’ and how best to aid and abet it.

Our image of the Vis is a conglomeration of the ideas put forth by these great practitioners, often very conflicting ideas, that in our innocence we think are all one and the same. The proponents of the Vis Medicatrix Naturae would view our interpretation of their ideas as a hodgepodge of opposing thoughts and our attempts to utilize the healing power of nature as to be inconsistent. We are justified to criticize some of these practitioners for using violent treatments on their patients justifying their actions because they were mimicking the healing power of the body when it triggers vomiting, diarrhea, ulceration and hemorrhage.

So who am I to question whether l-tryptophan is good or bad. The only thing I can say today is that current information suggests the need to balance Tryptophan use against risk of osteoporosis.

Finding Opportunities in Discrete Challenges

By Lise Alschuler, ND, FABNO

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

For every action there is an equal and opposite reaction. So while yesterday my partner and I spent a marvelous day on a coastal Maine beach and then enjoyed fish tacos, it makes sense that today I am holed up in my office whittling away at my to-do list. That does not mean that I am happy about it. In fact, I am rather grumpy about being in the office. I have tried to remind myself that, in reality, I should simply be grateful that I had the opportunity to spend time at a beach yesterday – so many cannot. I should also be happy that I have a to-do list and an office within which I can work on that list. Easier said than done. I am reminded of something that I read a while back. When one has a headache, instead of dwelling in the pain and discomfort, see it as an opportunity to be grateful for having a head in which to experience an ache, and to enlarge one’s focus to the entire head holding the ache.

Maybe then I too have an opportunity to focus on the day holding this grumpiness, not on the grumpiness itself. It does help actually. Suddenly my irritability becomes a small part of my big day, a day which is still mostly unwritten. As my grumpiness shrinks, I am reminded that the attitude with which I am approaching my tasks is simply that – an attitude. While it is true that by feeling grumpy, I can better understand and appreciate its opposite – happiness and gratitude – it is also true that I can change my attitude whenever I choose. While wallowing in negative emotions has a certain stickiness factor, it is not an insurmountable task to let these negative emotions go. Sometimes, to do this, I focus on the emotion (anger, irritability, etc.) and then take a deep breath, purse my lips and blow this anger/irritability/etc. out. Let it go, literally and figuratively. By now, after writing all of this, my grumpiness is truly a withered feeling in the past part of this day.

Funny how, now that I am feeling more contented, my day seems filled with many more possibilities. Maybe I can finish early and take a walk in the woods, spend some time on the back porch… Who knows? So in the end my grumpiness is held within my much bigger day, just as a headache happens in a much bigger head, and we are each so much bigger than our discrete challenges.

Double Vision

By Bill Benda, MD, FACEP, FAAEM

Photo by Lomo-Cam via Flickr, used under the Creative Commons License.

“Visionary.” Now there is a word we’ve all heard countless times as we meander the naturopathic path. Merriam-Webster defines the term as “one having unusual foresight and imagination.” We tend to view our visionaries as those among us who can see into the future, imagine unimaginable realities, lead us to promised lands if we are intrepid and willing enough to follow. We laud our visionaries, follow their writings, award them at our banquets.

As we should, should we hold to that particular definition. But from my boundless perspective, and limited experience, a visionary is not necessarily a prophet or clairvoyant, but rather someone who can actually discern the truth of the present moment – a point of view requiring far more courage to express than any tale of potential future pleasantries. Visionaries who can discern reality are fewer in number than the prescient variety, and those with the courage to voice their views are fewer still, given the political price that must invariably be paid, because the reality of our culture -- and of our healthcare system, and of our profession -- is not always pretty, and definitely not as pretty as our conference and clinic brochures tend to proclaim.

Now do not misinterpret these words –- the underlying beauty of the naturopathic and holistic and integrative et al. philosophies and therapies is alive and well, and more than worthy of love and support. But we in our optimistic, energy-medicine, “hugs heal” mentality are often more than hesitant to take a long, hard look at our internal dysfunctions, dysfunctions that are an essential part of our very humanity rather than an unwanted and obnoxious uncle who has overstayed his welcome. We hold onto historical injuries that are no longer relevant. Our organizations avoid dealing with whispered dissent from their membership. Industry fails to note that their journal advertisements and promises of health are not that much different than those of the conventional brethren we condemn.

And why am I writing these words on this particular blog at this particular time? Because as an AANP board member and associate editor of your journals and adjunct faculty at one of your medical colleges, and especially as a non-ND, I believe your profession is at a crossroads, an adolescent-to-adulthood moment of your evolution when it is time to let go of the past and create a new future. And this shift cannot, and can never, occur without first making a difficult and objective assessment at what is real in the present.

So the next time one of your fellow professionals or employees or students or board members stands up and points out the pachyderm in the pad, see if you can refrain from withdrawing from the inevitable discomfort and instead take a long, hard look at the actual information being presented. You may well find that you have a bona fide visionary in the room.

Brand New Wine in the Same Old Bottle

By Bill Benda, MD, FACEP, FAAEM

Andy Rooney, famous curmudgeon.
Photo by Stephenson Brown via Flickr, used under the Creative Commons License.

One of the worst things about aging is that we tend to become intolerant. One of the best things about aging is that we can get away with it. In fact, curmudgeonly editorializing is one of my favorite current pastimes.

So this blog submission will deal with one of my personal pet peeves: conference brochures. You may have noticed these glossy advertisements in your mailbox and on your computer screen heralding the Spring peak of the semiannual convention season, exemplified by the recently adjourned Integrative Healthcare Symposium in NYC and this past weekend’s iMosaic assembly in Minneapolis, along with a cornucopia of nutrition and functional medicine and guild gatherings taking place across the country. I don’t wish to grouse about the conferences themselves (at least not at the moment), but I do have issue with the advertising touting the wonders that await.

(Cue Andy Rooney.)

So here we are – pioneers of cleaner and less toxic therapies, protagonists in the battle to provide truth and clarity to our patients, ‘advertising’ a new way of doing old business – and yet we put out glossy brochures worthy of People and Vogue. Have you ever really looked at these things? Dig one out of your trash or junk folder, and here is what you will find:

Cover page – quite possibly a panorama of a city skyline or palm fronds swaying in the balmy breeze of a beach resort town. But more likely than not you will be greeted by a group of extraordinarily attractive and happy “health-care practitioners” a la Law and Order promos – arms crossed, heads tilted slightly upwards or downwards towards the apparently seven- or three-foot tall photographer, teeth brilliant and eyes knowing. At the front is a young woman, usually blonde Caucasian but sometimes African-American, always with a white coat and stethoscope draped around her neck – clearly a physician of some order or degree. “Hi! We’re young and hip and we like this conference!” Immediately behind her is the graying yet vim white gentleman (never a woman), also with white coat and tight yet perceptive smile. “We traditionalist docs approve of this conference, too!”

From these two handsome people on to the back row we have a variety of ethnicities, always including one Asian practitioner, a second requisite female, and in the very back a white or black young man (again, never a woman) in scrubs but sans white coat. “Medical technicians can attend this conference, too, as equals!”

Turning the front page, we then delve into the remainder of the brochure and find: The row of profile photos of well-known presenters we recognize from last year’s conclave, and the year before. The ubiquitous mortar and pestle next to some unidentified herb. The close-up of an acupuncture needle inserted just so into perfectly clear and tan skin. The slender woman with leotard in a yoga or meditation pose overlooking aforementioned balmy beach, hair pulled back in a ponytail. And of course, the sponsor hotel’s tasty spread of sustenance laid out on white-clothed tables for our culinary pleasure, complete with smiling person in a chef’s hat.

Imagine if we all really looked like these people, and lived their implied existences. (I know my social life would be a lot more exciting.) But the fact is that we are not stock photo models, or Stepford-docs. We are not fetishes to the altar of our alternative therapeutic offerings. We proclaim we will not obfuscate the patient’s symptoms with drugs, or misrepresent the cause of illness as anything other than what it really is, so why are we pretending to be pretty young models when in fact we are . . . well, go look in the mirror.

What you will likely see is an actual, authentic person, lines and pouches and blemishes and all. Why don’t we put these faces on the brochure, these bodies on the beach? Why are we reproducing the very promise of physical perfection we point out as arrogant and misleading in our allopathic brethren and sistren? Why are we doing things the same old way, while stating to be somehow different?

Yes, I know this particular topic may not quite rank up there with new ways of ameliorating the side effects of chemotherapy or the nutritional impact on autistic spectrum disorder. But these ads are nothing less than a reflection of the level of the honesty our patient will be getting when we walk into the exam room.

Kenny Loggins and Jim Messina sang a song in the '70s about our flawed American political system entitled "Same Old Wine in a Brand New Bottle." What we have here is a kind of backwards take on the same problem. If we are truly offering a new, healthier wine, we really need a more transparent bottle.

The Real Deal

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


Photo by norwichnut via flickr, used under the Creative Commons License.

A very fit and clear-eyed gentleman introduced himself to me at the recent Integrative Healthcare Symposium. He appeared to be in his late 60’s or early 70’s. He was of medium build and thin. He was wearing a bright yellow sweater that fit tightly over what appeared to be a toned chest. He was wearing running shoes which cushioned his energetic stride as he walked toward me.

He began the conversation with questions. He reached into his conference bag and pulled out a sample bottle. He proceeded to ask me about its particular virtues. I gave him my best explanation. He appreciatively nodded his understanding and followed this with more questions. He listened patiently and appeared to appreciate my explanations. He then commented about his long-standing way of living – relying on whole foods and daily exercise as the mainstays.

He reached back into his bag and pulled out a worn looking printed cardboard.He handed this to me and I read the cover of a book that he had authored in the 70’s about healthy living. Abram Hoffer had written the foreword and was his friend, this gentleman sadly told me as he lamented his death. He then pulled out a magazine which featured a write-up of his next book - yet to be published – on cholesterol. He explained his central thesis about the medical myths related to cholesterol with fervor.

Meanwhile, I had been doing some calculations and I finally had to ask. “How old are you, if you don’t mind my asking?” “I don’t mind. I am 85 years old.” All of sudden, I realized that I was talking to the real thing. Here was an outstanding specimen of the human life form, who was, in addition, passionate to his very core about natural health, and who had stayed the course over decades of change and transformation in the natural healthcare industry and in medicine.

I had, admittedly, found myself somewhat bemused by him at first. Now, I was seriously and, gratefully, humbled. I realized, as I listened to this humble and clearly fervent elder, that I still have so very much to learn.Furthermore, most of what I have left to learn is likely very simple – those things which form the foundations of our health – such as diet, passionate living, movement.

It is, I reflected, quite easy to become engrossed in the myriad of details attendant to the progress of medicine. While valuable, and, in fact, essential to safe and effective practice, modern understandings and therapeutic rationalizations do carry the danger of distracting us from the foundations of health. Untethered, we can become adrift amidst our bits of information. I think was somewhat adrift. It took a spry 85 year old in a neon yellow sweater to help me touch back down again. As our conversation concluded, I wished him well and thanked him for his contributions and inspirations.

Watching his lively figure stride away, I smiled and felt a little lighter on my grounded feet too.

Gratitude and Naturopathic Medicine

By Sara Thyr, ND


Photo by controltheweb via Flickr, under the Creative Commons License.

I have a bumper sticker on my car that says, “What are you grateful for?”

It is one of my favorite questions…. to others as well as myself. I use it often if I can’t sleep at night. It serves to put me in a positive state of mind, reminding me of all of the many blessings and abundance in my life.

Being a naturopathic doctor gives me more to be grateful for each day.

I get to practice cutting edge medicine in a calm and comforting environment. I have the training to diagnose and treat disease, working to uncover root causes of many illnesses like few other practitioners have the opportunity to do. I get to utilize safe and effective medicines, including herbs, nutrients and homeopathy, helping to find the perfect right thing for my patients that will not interfere with other medicines or cause unwanted side effects.

My colleagues are smart, kind and good-humored. Many of them I count among my best friends. I can always rely on them for an insightful opinion and words of wisdom. The years that I volunteered as president of the New Hampshire state association, and more recently on the board of directors of the AANP, have led me to be a part of a greater good. This has also afforded me the opportunity to interact with truly amazing, gifted people. I feel so lucky to be associated with this profession.

I am grateful that naturopathic medicine makes so much sense. That is what struck me when I first learned of it. Treat the whole person, remove obstacles to cure and find and treat the cause of disease…why don’t we do that in our lives more often.

Naturopathic medicine makes me more connected to nature. It brings my attention to making our planet a better and safer place. It creates awareness in me and then those I work with to avoid toxic chemicals in skin care products, cleaning products and in the food we put in our bodies. I am more grateful for pure water and organic food because of my acute awareness that everything we put in our bodies matters.

I am most grateful that my patients get better. That I can give them the tools to improve their health in a dramatic way, when no one else has been able to get to the bottom of their illness. One woman doesn’t need to get a hysterectomy; a young woman has a baby where she’d not been able to have one; another has resolution to very painful digestive problems; a man who came to me can breath without allergy medications, and another is able to wean off his asthma medications as his symptoms have resolved. There are many more stories just like these. It is rewarding to see that they are so happy, healthy, and yes, grateful.

One of my favorite things to do is to speak to prospective students of naturopathic medicine. I can’t imagine a more rewarding profession.

"Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity.... It turns problems into gifts, failures into success, the unexpected into perfect timing, and mistakes into important events.

Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow. "

-Melodie Beattie

Horse Paths

By Jacob Schor ND FABNO


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

This winter my dog Poppy and I started following the horse trails that lead off from the off-leash dog area at Cherry Creek State Park. With the snow, the hard freezes, and the lack of horse traffic, these paths have opened up a new world for the both of us. This is because hardly anyone knows they are there, just a few enterprising souls, enough to pack down narrow trails in the snow. Some of the trails we follow are not actual horse trails but narrow tracks made by deer. I get to see the white flashes of their tails between the trees and luckily, Poppy rarely sees them as she has her nose to the snow, schnuffeling along in her world of smells. It’s the white of these tails and also the red flash of tail feathers as our approach moves the hawks from their tree perches that highlight my memories of these solitary walks through woods and meadow.

There is a problem with horse trails though. Horses don’t mind trampling through muck, mud, wetland and swamp. They do not complain about wet feet. The hard cold spells we have had this winter have allowed me to forget these details about the ground underfoot. That is until yesterday. We’re in the midst of a thaw, the temperature reaching 60 degrees F for the last few days. Yesterday when we started our morning jaunt, the mud of the main dog walk area was still frozen but as the sun rose, we found ourselves in situations that might be described as, ‘up a creek without a paddle’ or better, without a boat; the sun and warmeth thawed the ice bridges that had allowed us to wander freely through wetlands and swamp.

This longer than usual walk gave me room to sort out some thoughts I’ve been having. In the practice of medicine, or at least naturopathic medicine, we are not following the main roads, the ‘medical standard of care.’ For various reasons our patients have either, out of necessity or personal habit chosen a ‘road less traveled.’ Some of our patients are in the habit of always choosing roads less traveled in all areas of their lives, to the point it almost seems pathological. Others will wander off onto horse trails only occasionally when the route offers advantage.

We have to remember that these alternative, less-used paths are just that. They may not be as dependable as the main roads, they may be subject to changes, with the weather, the time, or the season. These past summers walking this same area, Poppy and I have seen water levels rise by several feet when a thunderstorm adds water upstream.

These thoughts reminded me of a recent paper on macular degeneration. For years the science has suggested we use a complex of antioxidant vitamins and plant extracts to treat this condition. Almost every supplement supplier we do business with makes an, ‘eye formula’ containing almost the same ingredients. According to a review written by Elizabeth Johnson at Tufts University and published last week, we need to change our prescriptions. Both beta-carotene and vitamin E, ingredients found in every one of these formulas, not only don’t help, but may increase risk of macular degeneration. Whoops.

Reading this information creates about the same sensation as having an ice bridge give way and finding yourself knee deep in water and mud. Cold water.

If we are going to choose the less traveled paths in medicine we need to keep alert and watch our steps more carefully than those following the well worn standards of care. We cannot just follow the crowd. No one is going to post a big sign telling when we need to change course.

These thoughts remind me of the book, Mount Analogue. I read this book at a young and impressionable age. It was written, though never finished, by Rene Daumal who died in 1944 and then published posthumously in 1952. Daumal was one of a group of European intellectuals who were mountain climbers, writers and apparently drug users. Daumal and his peers apparently had a habit of utilizing unusual substances, the most notable being carbon tetrachloride, to generate transcendent experiences. Regular exposure to this substance that will not lead to a long life. This book used mountain climbing as an analogy to describe his mystical views. Leaving the details aside, there is one particular passage that has stuck with me for four decades. In it Daumal tells climbers of the importance of marking new routes with cairns, or what we in this country call ducks. In the high mountains two or three rocks piled atop one another stand out and say, ‘I’ve gone this way.’ He then tells climbers that it is their responsibility if the, ‘route proves to go nowhere,’ to trace back their steps and remove the cairns they have left.

I think of this image sometimes when I’m reading research. There are many of us exploring new routes, new ideas and new techniques. It is our responsibility to tell others what route we have taken. It is also our responsibility to come back and tell others if a route is a dead end.

In the meantime, though closed out from parts of our walk by these unseasonable temperatures, I look forward to the summer where the gravelly stream bed provides a new path to explore. The dog and I have a summer route through the park, wading knee deep in the stream, using it as a route through the woods. The only problem is remembering to bring a waterproof container for my phone as sometimes the water gets deep, suddenly. I want to be able to call someone if I get lost.

A post script:
The most well known quotations from Daumal’s book, one that was printed on the cover of a Sierra Designs catalog in the 1960’s is:

"You cannot stay on the summit forever; you have to come down again. So why
bother in the first place? Just this: What is above knows what is below, but
what is below does not know what is above. One climbs, one sees. One descends,
one sees no longer, but one has seen. There is an art of conducting oneself in
the lower regions by the memory of what one saw higher up. When one can no
longer see, one can at least still know."

— Rene Daumal

Curr Opin Clin Nutr Metab Care. 2010 Jan;13(1):28-33.
Age-related macular degeneration and antioxidant vitamins: recent findings.

Johnson EJ.

The Run Hits Capitol Hill

By Dennis Godby, ND, MA

The Run: Moving Natural Medicine Forward

The Run: Moving Natural Medicine Forward has just left Washington, D.C., seven days from the first end of The Run in New York City 11-11-11 (Veteran's Day), and just 15 days from the end in Bridgeport, CT (11/17/11)!

We left Capitol Hill at 5 pm on Wednesday after a full day of meetings and photo opportunities with ten Members of Congress (Sen. Rob Portman (R-OH), Rep. Chaka Fattah (D-PA), Rep. Gary Ackerman (D-NY), Rep. Mike Fitzpatrick (R-PA), Sen. Barbara Boxer (D-CA), Rep. Edolphus Towns (D-NY), Rep. Larry Bucshon, MD (R-IN), Rep. Lacy Clay (D-MO), Sen. Mike Lee (R-UT), Rep. Tim Johnson (R-IL), and their staffs, exhausted, but extremely grateful for a wonderful, action-packed day! The staff and Members of Congress were extremely enthusiastic about The Run and our message!

1,000 thank yous to Matthew Santoro of the AANP, who made the meetings possible by setting up the appointments and doing the follow-ups for us. Also, many thanks to AANP Executive Director Karen Howard for her support of The Run. On Thursday, we talked to an additional nine Members of Congress!

Without Matthew contacting the Members of Congress in the districts and states that we ran through, the meetings would have never taken place. Also, Matthew stayed with us both days, helping us to navigate the various Congressional buildings, dealing with necessary changes in schedules, etc.

Thank you Matthew, Karen and AANP for their fantastic support of The Run!

Where's the "health" in health care reform?

By Sara Thyr, ND


Photo by D Sharon Pruitt via Flickr under the Creative Commons License.

Back in August, I read an op-ed in The Washington Post by Kathleen Sebelias, our new Secretary of Health and Human Services. It brought this issue that has been nagging in the back of my head to the fore. She really believes that Obama’s plan will improve the health of Americans. But that is impossible. That is not at all what it is designed to do. It appears to me more likely to increase the number of people who have health insurance, which has not been correlated with Americans being free of symptoms and disease.

The problem with that is that in my experience, the insurance companies have no interest in health. Their focus is by and large money.

If you want to improve the health of Americans, you must begin to look more deeply at what is causing them to be ill. Look at what they are eating, what their stress is, what their daily habits are, and assess their exposure to toxins. If we spent even a fraction of the money that currently goes to insurance companies (who’s kneejerk habit is to reject claims, not promote health) on taking the time to actually figure out the underlying causes of symptoms, we would be at least heading in the right direction.

At some point, Americans must realize that they will pay for their own health. Whether or not they want to filter that money through the pockets of insurance executives and the yachts of the owners of big pharma is up to them. But pay they will. I figure they might as well actually get healthy in the process. Something others seem less interested in.

What makes me think Americans are ready to pay for your own healthcare? They already are.

On the board of directors for the American Association of Naturopathic Physicians, we have been having the conversation about DSHEA and the supplement industry in general. Even in the currently unregulated state, it is a multi-billion dollar/year industry. I want my patients to have high quality supplements. But I also want them to have access. The real point is that people are ready to implement changes that are not advocated by their insurer. Not only ready, but happy to pay for it themselves. This is because they want to be well. Not just insured. But actually feel good, live longer, sleep soundly.

If you want to improve the health of people in America, you must work with the people who care most about their health. The two most important groups are the people themselves and the physicians who are caring for them.

When insurers control the amount of time physicians spend, as well as the practice of medicine, the care given is not better. And with all of the overhead and CEO bonuses, it is not cheaper. Mostly, the people are not more well. Most physicians do care about their patients, but have such contraint on their time, they move towards the habitual “here’s your prescription.” The drug may have serious side effects, and rarely does it get to the root of the problem.

Without getting to the root of the problem and supporting the human body, true health is outside our grasp.

If your car’s tired are going flat, is it really ideal to just keep adding air? Sure, that might work to get you to the grocery store and back. But what you really need to do is find the hole. Don’t call your car insurance company. Take it down to the shop and get it fixed. Or buy new tires. Don’t expect someone else to pay for it. They’re your tires.

We spend more than any other nation on health care. If access and money would make us well, we would not rank 25th in the world for infant morbidity and mortality. We would not be lagging behind other nations in overall wellness. Nations who spend a mere fraction of what we do on health care.

As my friend Bill Benda, MD says, this current plan will be short lived. Until we look at increasing health, not increasing insurance coverage, we will be drinking the same old wine out of a new bottle. The public will not tolerate this for very long. The proof of the pudding is in the eating. Are you well or are you not well? Believe me, you care more than anyone about your health issues, not matter how simple or serious.

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?)

---

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!