Clinic Internship

My clinic internship has begun! I'm officially in my 8th trimester (although it took a longer to get here because of the flex track). Eighth tri ND clinic is on Mondays, Wednesdays, and Thursdays to ease us into seeing patients full time in tris 9 and 10. Being an intern allows us to put together all of the information we've learned from the basic science and clinical science classes to help patients improve their health. There will be a lot of learning and growth for my patients and me! 

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The first week of school was orientation where we learned the clinic expectations, how the clinic operates, electronic medical records, HIPAA, and OSHA trainings. In our orientation, we also talked about all the emotions that we may be experiencing, like excitement and nervousness. We are still learning, we are human, and it is entirely normal to feel overwhelmed and make mistakes along the way. Thankfully, we have our supervising clinicians to guide us, approve our treatment plans, and oversee that we give our patients safe and quality care.

I'll be able to start seeing patients shortly, after demonstrating competency performing the 72-point physical exam on a fellow intern.

If you're in the area and need naturopathic medical care, I'd love to see you! I'm able to start patient appointments on Mondays and Wednesdays from 1:30-5:30 PM, and Thursdays from 11:30 AM-3:30 PM. The campus clinic has appointments available for both students and community members. To schedule an appointment, call 630-629-9664.

Polypharmacy

In a class I'm taking called Special Populations, a topic we covered was polypharmacy. Polypharmacy refers to the effects of taking multiple (5 or more) medications concurrently to manage several health problems. This is most common in the elderly population, and it poses several challenges like unknown interactions, lack of evidence, and cost. I found this lecture in class helpful because it can be overwhelming where to begin when working with a patient who has several conditions and is taking multiple medications.

Adverse drug reactions/events are linked to preventable problems in the elderly like depression, constipation, falls, immobility, confusion, and hip fractures. Some risk factors for developing an adverse drug event include more than six chronic disease states, and taking over nine medications or over 12 doses of medications daily.

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Sadly, it's easy to get on a downward spiral with prescriptions, when one prescription is given to treat a condition, and a second is added in to combat side effects of the first medication, and so on and so forth.

In naturopathic medicine, we must be educated and prepared to help people on multiple pharmaceuticals. This includes reviewing all symptoms and medications, investigating side effects, and knowing when it's appropriate to help patients wean off of medications (in licensed states) or refer to the prescribing doctor to do so (in pre-licensed states). With naturopathic medicine, we can help patients by using botanicals that are safer and have fewer side effects in lieu or in addition to pharmaceuticals. Additionally, we have other tools in our toolbox to work with like nutrition and hydrotherapy to enhance overall well-being.

Natural Childbirth

Our daughter, Jade, has arrived! We were able to have the natural, unmedicated, childbirth for which we had been preparing. Studying naturopathic medicine helped me in many ways, and I was able to use natural healing modalities throughout the entire labor, delivery, and recovery process. 

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The whole morning I felt like labor was coming soon because ligaments were stretching in my pelvis that I've never felt before! It was as if I'd done a strenuous 6-hour workout. Around 2:30 in the afternoon the bag of waters started to break, but it wasn't a big gush, so I called my midwifery group, and they had me come into the office.

In the office visit, I was only 1-2 centimeters dilated, so the midwife instructed me to go home for a few hours and present to the hospital at 8 pm. With rupturing membranes before contractions begin, the risk of infection increases, so the topics of induction and antibiotics were discussed, and if we got to the 18-hour mark, they were strongly recommended. I decided to use all the tools in my naturopathic toolbox to speed up the process and avoid that!

Immediately upon leaving the clinic at 5 p.m., I started alternating three homeopathic remedies every 15 minutes for about an hour and a half: cimicifuga (to increase contractions); gelsemium (to increase cervical dilation); and caulophyllum (increases both). As soon as I got home, I had a castor oil smoothie to also help with contractions. The acupuncture clinic was closed, but a friend had been in communication with one of the acupuncture and oriental medicine clinicians earlier about specific acupressure points I could use, and another friend brought me some needles if I'd want to attempt doing acupuncture on myself. However, I didn't have to use acupuncture or acupressure because within about an hour, I was in full-blown labor, contracting every 2-4 minutes. The intensity increased quickly, and at that point, I knew exactly why the majority of women get an epidural, and the thought definitely crossed my mind!

We got to the hospital around 8:30 p.m., and I felt the urge to start pushing shortly after. The midwife arrived at 9:30 p.m., and I was finally allowed to go into the birthing tub. Being in the water decreased the pain, although it was still incredibly painful in a way that I'd never felt before. It also was too soothing, and I was getting tired quickly. I moved to the birthing stool per the midwife's recommendation, and two contractions later, at 10:24 p.m., Jade was born!

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Some other homeopathic remedies that I used during the recovery process for the past few days include: high-potency (10M) arnica for achy, sore, bruised feeling; hypericum for nerve pain; and bryonia for feeling "worse with motion." I successfully managed the pain at a tolerable level, so I didn't have to take any medications at all. Contrast showers also helped me stimulate the vis (the body's natural healing power), and I feel more refreshed when I take them.

Jade and I are both doing well, and Luis and I are adjusting to parenthood. Tired is an understatement, so I better take a nap now!

Due Date Is Days Away

I haven't blogged much about my pregnancy, so here it goes. 

Common issues in pregnancy:  I've been very fortunate to have an easy pregnancy free from morning sickness, cravings, crazy mood swings, or extreme aches and pains. As I mentioned in my April 7 blog post, Exciting Announcement , I have been working on my health and building my body up since starting the program, and I truly feel that this contributed to an easy pregnancy. If I had developed symptoms, my first line of care would have been naturopathic therapies -- botanicals, homeopathy, and hydrotherapy.

Birthing Class:  Originally, Luis and I were planning to take the one-day birthing class offered at the hospital where I'll deliver the baby. Then, a classmate recommended the Bradley Method and after looking into it, we decided it was a better option for us. The class met 2-3 hours/week for 8 weeks. The focus was on having a natural labor and delivery, how to be an informed consumer of conventional medicine, and alternative solutions for anything that may arise during the pregnancy, labor, and delivery. I'm so glad we took the class; Luis feels a lot more comfortable and confident with everything, and I feel well-equipped with tools to have a natural delivery.

An analogy is that you wouldn't run a marathon without thoroughly training for it, and neither should you go through pregnancy, labor, and delivery without thoroughly preparing by taking a high-quality in-depth class! Prenatal appointments with a doctor or midwife are not long enough to adequately educate patients. Yes, during prenatal appointments, they ask if you have questions and they answer them; however, ignorance is bliss, and so many topics we learned in the Bradley classes I would have never have even thought of asking! It amazes me how much is out there that I still don't know, and learning is a lifelong process.

Heartburn:  In May, I went through a bout of heartburn for a week, and I quickly identified the trigger --chocolate. Chocolate came up on my food sensitivity test that I discussed in my September 29 blog, A Pumpkinless Fall , so I avoided eating it for six months as recommended. When I went to California over Spring Break to visit my sister, I had chocolate several days in a row. Chocolate is one of the substances known to loosen the lower esophageal sphincter, thereby contributing to acid reflux. Add to that the increased abdominal pressure from baby, I suffered for several days. The same thing happened a few weeks ago, I decided to have chocolate three days in a row, and the acid reflux returned.

My friend and classmate suggested using chia seeds to help manage the symptoms until it passed. I mixed one tablespoon of chia seeds in 2 ounces of water and drank it immediately, without letting the seeds expand and get gooey. That way, when they reached the stomach, they would expand and absorb the stomach acid. It worked well enough that I didn't feel like I needed medication. However, it's best to listen to the body and eliminate the root cause -- I can't eat chocolate, or I'll suffer the consequences!

Chiropractic Care:  I started getting weekly chiropractic sessions using the Webster technique at our campus clinic in March. The Webster Technique is specific for pregnancy, and it analyzes the sacroiliac joint and mobilizes the restricted side and checks for tension in the round ligaments of the uterus to release the tight side. Several people have commented that I don't "waddle" as a lot of women do in pregnancy, and I think the regular care I've gotten has contributed to easy mobility without restriction. The chiropractic care has also helped with occasional back pain.

Acupuncture: A few times I've gone to the acupuncture clinic to help with sleep. During pregnancy, many points can't be used because they may stimulate uterine contractions, so they were careful about where the needles were inserted. A few of the acupuncture and oriental medicine clinicians were trained and worked as OB/GYNs in China, so I felt very comfortable being treated under their care. If I end up passing my due date or if my bag of water breaks before contractions begin, my midwife is onboard with me getting acupuncture and moxibustion to start or intensify contractions. Moxibustion is burning dried mugwort over specific acupuncture points, and it can be used to induce labor.

Supplements: Supporting my body with high-quality supplements is important because Baby is stealing nutrients from my body's stores regardless of whether I replenish them or not. I found a professional product for pregnancy from Metagenics that comes in daily packets with many pills: choline, EPA/DHA, prenatal vitamin, and calcium/magnesium. This made it easy to get all that I needed, in addition to consuming a healthy diet.

Diet:  I loosely followed two diets aimed at pregnancy: the Brewer Diet and the Weston-Price Diet. They both focus on nutrient-dense foods. Some foods that I tried to consume regularly include a wide range of vegetables, calcium-dense foods, pasture-raised eggs, butter from grass-fed cows, and 80-100g of protein daily. Bone broth, which I discussed in my February 17 blog, Nourishing Bone Broth , fermented foods, and liver were foods I should have consumed every week, but I only got around to preparing them a few times. There's always room for improvement!

Stretch Marks:  I made a stretch mark salve that I adapted from a website and used it almost daily since I was about three months pregnant. The ingredients are coconut oil, shea butter, another oil (I used whatever I had on hand when I made each batch such as avocado, almond, emu, olive, apricot, etc.), beeswax, calendula, and ginger. I developed no stretch marks, which I attribute to both the salve and proper nutrition.

Homeopathy: My first choice for medicine is always homeopathy, for whatever the issue may be. I've used homeopathy several times throughout my pregnancy, but I don't even remember what things I was treating because they resolved so quickly. I have my homeopathy kits packed in my hospital bag, and I plan to use remedies in labor if needed. I will definitely take high-potency homeopathic arnica after the delivery to help with the soreness.

Essential Oils:  Even before becoming pregnant, I've used essential oils aromatically and sometimes topically for sleep, mood, focus/concentration, and memory. During the pregnancy, I continued to use them aromatically, but I stopped using them topically because anything you put on your skin gets absorbed, and I didn't find time to research which ones were safe in pregnancy. I also have my essential oils packed in my hospital bag to use during labor.

Exercise:  Three to four times weekly for the majority of my pregnancy (up until a month or two ago) I've done free weights. There are tons of videos online geared towards pregnancy, and I'd occasionally do one to get inspiration for new movements. Two that I still do regularly are squats and pelvic rocking because they help prepare the body for labor and delivery. It's not hard to get my heart rate up with being pregnant, so I haven't focused on cardio because rushing to class usually does it. Living on campus and walking between my apartment and class several times helps me get 8,000-10,000 steps daily.

Visualization/Positive Affirmations:  Exercising the mind in addition to the body is just as important! I've visualized having an easy pregnancy and labor, and a delivery free from complications. Part of my visualization exercise includes thinking about challenges that may arise during the birthing process and how to work through them. Positive affirmations go along this line as well, and they reinforce my mind-body connection.

Thanks for making it to the end of this post! Please share it with any pregnant women in your life, if you feel the information may help them. If you have any questions about any of the topics, feel free to contact me at marysimon@student.nuhs.edu . After the baby is born, I'll probably write one post about the labor and delivery, and all the tools I used.

The Secret Ingredient

Every time exams approach, I do my best to thoroughly prepare by studying all of my notes a few times. Even with putting in hours of studying, the reality is that I will never know everything! I used to struggle with this fact, but coming to accept it and developing the secret ingredient -- intuition -- has helped my studying and exam-taking habits.

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Intuition can help get you through when you feel like you have nothing left to give. Using your gut instincts, even when words and concepts seem unfamiliar, helps access deeply stored information that you don't even realize you have. In a few classes, the idea of developing intuition has been discussed, not only for student-life but also to use in practice.

Intuition comes into play both during studying and test taking. When I study, I use my intuition to guide me in what questions or concepts are the most likely to be tested. I then spend more time on that material to memorize it, or I use techniques to connect the information in logical ways to easily access the information.

Intuition during exams is the second aspect. Since the vast majority of assessments at NUHS are multiple choice to prepare us for taking board exams, using intuition to sort through the remaining answers after eliminating some choices based on knowledge is better than randomly guessing.

This week I have three quizzes/exams in Botanical Medicine IV, Internal Medicine, and Environmental Medicine. I've been studying consistently for the past 4 or 5 days, but with the volume of information presented in every class, it's not realistic to expect myself to memorize everything. I always rely on my intuition, in addition to knowledge, to get me through!

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