Fearing our foods

I have witnessed a growing number of patients who are taking on diet modification to treat their chronic health conditions. Faced with the myriad of fad diets out in the media, each blaming a different food group, for all our health woes, people are not sure what to eliminate or how to go about eliminating it. They know that they currently do not feel well, often experiencing chronic pain, allergies, or digestive distress, and they know that their relationship with food has not always been a healthy one. So, like a bad relationship, they reach a point when they want to cut off ties with that troubled boyfriend named dairy, wheat, meat, or beverage.

The first two on that list, dairy and wheat, are the most commonly chosen food groups to eliminate in the hopes of improving one’s health. Many American practitioners of Chinese Medicine cite dairy as a fundamental source of evil in the body, often making claims that it produces large amounts of mucus which gum up the works of our natural physiology, and then connect this to nearly every health complaint imaginable. Wheat is perhaps the second most commonly blamed food group among American practitioners of Chinese Medicine. Wheat is claimed to cause widespread inflammation in the body, chronic fatigue, gas and bloating. These claims identify with a huge swath of the American public. 10% of Americans suffer from symptoms of IBS alone and some claim that up to 30% of the public is now seeking to reduce or eliminate wheat from their diets.

There is no belief among the Chinese practitioners, both in the U.S. and in China, that I have spoken to that support these claims (I have not spoke to everyone). Professional Chinese Medicine has its foundation in the Doctrine of the Mean which is the idea of balance in all things. The body should be able to tolerate all foods but never in amounts that are too rich or excessive, causing disease, or too little, causing nutritional shortfalls. Used moderately, milk products are believed to be supplementing and nourishing to the body. They are never referred to as “phlegm or mucus forming” substances in the professional literature. Wheat, likewise, is a warming and digestive strengthening substance and has been used in its fermented form for as a digestive regulating herb for centuries. I been told on several occasions by patient’s that their practitioners of Naturopathy, Chiropractic, or Acupuncture explained to them that ethnic Chinese do not have Gluten intolerance because they eat only rice in China while Europeans have predominantly eaten wheat. A truly generalized stereotyping of Chinese people since Northern China is the largest producer of wheat in the world and rice has only been a staple of the warmer climates in the south.

These claims, though valid for many patients and many health conditions, are troubling in the way they are being presented to the general public. A very tiny percentage of people have the medical condition called Celiac Disease, a serious health concern, while the majority are suffering from food sensitivity. The question is, is it the individual proteins, of which Gluten is one of many, or is it what we are doing to wheat which is making us sick? Is it the cheese or coffee which are to blame for all our illness? Or is it what we are doing to our cheese and coffee that is leading to disease. Wheat is split apart and broken down into its parts before its remaining white flour is used to produce fluffy, soft, and long shelf life breads. This end product is so nutritionally deficient that they have to add low quality Vitamin B back into it so that the public does not have potential nutritional deficiencies if all they can afford is to eat is bread.Dairy is heated to high temperatures to kill all the bacteria which make it both healthy and at times potentially harmful. Non-fat dairy products further reduce the quality down to broken proteins and water which hardly resembles the thick nutritional substance which came out of the cow. Coffee is served in America now in all forms except “black” it seems. People say they are drinking too much coffee but it only takes a little questioning to discover they mean frappucinos, sugary lattes, or the decadent caramel macchiato. Thousands of calories and hundreds of additive ingredients are going into these traditional food sources and fueling the illness and disease which people are now associating them with. One look at the “Gluten Free” aisle at Whole Foods shows the predatory way that food manufacturers are jumping on people’s search for healthier foods. Gluten free seems to equal cookies, cakes, chips, pizza and even beer. Hardly the food groups that those with dietary and health concerns need to be tempted with.

Perhaps we need to return to a system of food production that does not strip apart the essential structure of our foods. Eating as low on the food chain as possible. Think about it, whole stone ground wheat with all parts of its original self kept intact during the creation of our bread (modern whole wheat products, a nebulous term, are often split apart for processing and then mixed back together in the end product). Sea salt that contains all of its minerals and does not need to have iodine added to make it beneficial. Coffee that is black and oily, true to its roots as a medicinal product in Africa and Arabia, and unadulterated by creams and sugars. Dairy products that are safely regulated and ethically produced so that they can be served unpasteurized to the public. Above all, moderation in what we choose to eat! The Chinese Medicine principle of the Doctrine of the Mean. Let cheese be a special treat not a every meal additive. Let our meats be a dinning out, or a few nights a week centerpiece rather than a breakfast, lunch and dinner focus. Use sea salt as a delicate ingredient and not a cover up for bland food. If you have to add sugar, caramel and syrup to your coffee, making it as unhealthy for you as McDonalds, then maybe you do not actually like coffee to begin with and it’s time to switch to tea. Eating in moderation, as low on the food chain as possible, allows food to become life’s greatest pleasure and not the cause of our disease.

Seeing a Fertility Specialist

Advances in medicine have allowed practitioners to specialize in very focused areas of care. Devoting themselves to the mastery of a particular set of symptoms and disorders so that they can provide patients with the highest level of confidence in the treatments they are receiving. While most ailments start with a visit to a highly skilled general practitioner, be it a Medical Doctor or Nurse Practitioner, patients are often referred on, when appropriate, to a specialist within a focused field of medicine.

Traditional Chinese Medicine has operated in a similar manor in the People’s Republic of China. Practitioners start with a general education in both western and eastern philosophies of medicine which last for four years following their undergraduate studies. Many will then specialize in a particular field of medicine, often going on to receive a PhD and producing meaningful research for growth and development of Chinese Medicine in the hospital setting.

In California, all practitioners go through the first two of these steps, receiving a very good general education in the basics of western and eastern medical philosophies. Regulation varies state to state and competency expectations can be very different depending on the part of the country one in residing in.

Some practitioners chose to go above and beyond the expectations and basic minimums of continuing education that one must complete to maintain a license. Choosing to complete a Doctorate program, where they hopefully produce some new research, or to specialize in a particular field which they feel passionate about. I have chosen to commit myself to the study and practice of Women’s Health. In addition to focusing many hours of continued studies on the topics of Gynecology and Reproductive Medicine, I have become board certified with the American Board of Oriental Reproductive Medicine (ABORM). A medical board focused on maintaining the highest levels of competency in the integrated work of Acupuncturist, Reproductive Endocrinologist and Gynecologist. In order to maintain professional standing with ABORM, each practitioner must complete twenty additional hours of education in reproductive medicine per renewal period and be an active member in group discussions concerning research and joint practice between Acupuncturist and Reproductive Endocrinologist.

This is the level of commitment to a specialty that is needed in order to provided competency in a particular field. Patients should seek out someone who is focused on constantly continuing the education process so that they communicate with both the patient’s Medical Doctors and help explain the difficult process of Assisted Reproductive Therapies (ART).

Please visit the Marinwood Community Acupuncture website as well as the American Board of Oriental Reproductive Medicine website for further information about this specialty.

Should I be using ice after workouts?

A recent article in Outside Magazine, Stress Tested, challenged the widely held concept that we must do everything possible to eliminate inflammation in our bodies.  This theory has been put forth by trainers and alternative healers as the antidote to both local and systemic inflammation which is often cited as the primary cause of disease and degeneration in the body. This message is problematic because inflammation is the main mechanism for self healing and strength gains in our bodies. When we train a muscle group or joint complex we are essentially causing small amounts of damage to the muscle fibers which stimulates an inflammatory response in the surrounding tissues. Both white and red blood cells flood into the area along with lymph fluids which carry these helpful cells in and cellular debris out. In the short term this process is essential if we wish to heal an injury and/or increase the strength and function of a muscle.

This article also suggests that while strength and speed training release oxidizing agents/ (called free radicals) into the body, we might not want to be in such a rush to suppress them with anti-oxidants in the form of large vitamin supplements. Like inflammation, oxidative stress is labeled as a primary disease agent leading to chronic illness, but like inflammation, it is also part of the healing and strengthening process of the body. Stopping either of these natural functions from occurring may not only limit recovery and gains but may also habituate our bodies to these therapies. This may have the unintended result of lowering their therapeutic effect in the event that we do need to ice and injury or take NSAIDs to control pain.

The management of inflammation and oxidation in the body plays an important role in our long terms health. However, the natural function of inflammation is crucial for our body’s recovery and growth in our physical activities. Perhaps we should let these needs, managing oxidation and inflammation, be filled with our well chosen foods rather than accumulating more products under the onslaught of dietary and nutritional advice pushed on us in the name of strength and longevity. Train, eat, sleep, and rest to recover.

Adrenal Insufficiency vs. Adrenal Fatigue

Occasionally, new patients will come into the clinic which a chief complaint of “adrenal fatigue”. When I ask them to explain why they think that they have such a condition and what signs and symptoms led them to that conclusion the justification is often that they were simply told so by another alternative healthcare practitioner. Trying to get to the bottom of what concerns them, I ask that they elaborate on the difficulties they have been having which brought them into the clinic for treatment. Suffering from fatigue, nervous energy, sleep disruption, and anxiety are all common answers given by patients who have been told that they have adrenal fatigue. These are real, valid, and true symptoms that these patients are suffering from. The problem seems to be that they have been assigned a nebulous alternative health diagnosis that is not bio-medically or physiology based in its origin. Further, it attaches a disease name to the patient and asks them to carry it with them as they would a scarlet letter on their chest. It does nothing to help them with their complaints, other than lead them to a vast and costly prescription of supposed adrenal supplements. It really is just translating their worries into a made up disease name so that they have something to call it. While fatigue, poor sleep and anxiety from overwork or stress are very real causes of concern, the syndrome of “Adrenal Fatigue” is not a actual medically recognized condition in the body and thus we should avoid using it as one.

Adrenal Insufficiency(AI) is a genuine medical disease which may have given birth to the alternative medicine concept of adrenal fatigue. According to the National Endocrine and Metabolic Disease Information Service, part of the National Institutes of Health, “Adrenal insufficiency is an endocrine-or hormonal-disorder that occurs when the adrenal glands do not produce enough of certain hormones. The adrenal glands are located just above the kidneys. Adrenal insufficiency can be primary or secondary”. Primary AI is something people can be born with and is called Addison’s Disease. Secondary AI is a conditioner where the Pituitary gland stops producing a hormone, Adrenocorticotropin (ACTH), which causes a diminishing amount of adrenal hormones to be produced and a gradual shrinking of the adrenal glands. This is rather serious because adrenal hormones do a great many things in our bodies including regulating blood pressure, metabolising nutrients, controlling blood sugars, and the managing the immune response.

AI requires medical intervention as imbalances in these body systems can lead to kidney disease and potentially death if left untreated. The severity of the condition is why we should not confuse it with a term like adrenal fatigue which may lead patients to seek primary care from a alternative health practitioner instead of a medical doctor. I do believe Chinese Medicine most definitely would play a valuable role in both the symptoms of fatigue and anxiety associated with the term adrenal fatigue as well as the medically serious condition that is Adrenal Insufficiency. I believe we should continue to respect and work with proven diseases and practice proper referral methods when needed to ensure the health of the patient.

Oral Contraceptive Pills

The long term effects of the Oral Contraceptive Pill (OCP) are wide ranging and extremely variable from woman to woman. While there are many different reasons for starting on OCPs from contraception to the medical treatment of polycystic ovaries, endometriosis, or severe emotional dysphoria, the decision needs to be taken seriously and the risks weighed out against the therapeutic benefits.  OCPs are about 99.5% effective against pregnancy and this is the most common reason a woman might want to chose this form of contraception. It is relatively convenient and cost effective with many insurances covering it as part of an individual health plan. OCPs can  greatly improve the symptoms of a woman who suffers from severe PMS, a condition called Pre-Menstrual Dysphoric Disorder or PMDD, and can also greatly reduce the pain and discomfort associated with ovarian cysts or endometrial growths. These advantages to OCPs should in no way be discounted in the patient who is greatly suffering. Because of the convenience many women quickly make the decision to use this type of birth control without fully weighing the potential risks and complications. It is also important to note that OCPs are most often not just one ingredient but actually combinations of different hormones whose ratios determine how they will work in the body and for which patients they will be best suited.

Some of the notable risks for women to consider when choosing OCPs are very quickly stated at the end of the commercials we see so often on television. In the fine print it states that one of the most common is an increased risk for blood clots and stroke. Taking OCPs can increase a young woman’s chance of having a stroke. In fact, women who have a history of migraine headache are actually several times more at risk for a stroke while on oral birth control pills. Women with migraine who smoke are even more of an at risk group.  The use of low dose estrogen pills has been found to reduce this risk somewhat. Additional risks are an increase rate of cardiovascular disease and a potential increase in the risk of breast cancer.

Another type of long term consequence to taking OCPs is the increased difficulty in becoming pregnant later in life. It does not seem that teenage girls are advised that once they stop the pill it could take up to six months to resume a normal/regular menstrual cycle and for many women it takes much longer. Some types of birth control can reduce the production of cervical mucus over time to the point where a woman suffers chronic vaginal dryness which can last up to 30 cycles after the cessation of OCP use. This puts the woman at greater risk for infections, STDs, and later for infertility when the time comes that she does wish to become pregnant.

Clearly the primary importance for teenagers is the prevention of pregnancy and there can be no doubt that the roll of contraception is very important up until the point of desiring a child. OCPs are some 6% more effective than barrier methods but only equal to a highly educated and highly motivated charting of Basil Body Temperature and Cervical Mucus. For many low income areas oral birth control may be the best option for women to take to prevent pregnancy no matter what the statistical risks. It would be prudent to simply educate women when they first begin taking OCPs so that later in life they can be more prepared for the potential difficulties they may experience when and if they desire to achieve pregnancy.

Chronic Hip Pain AKA Dead Butt Syndrome

A tremendous number of patient come into the clinic with a chief complaint of pain and discomfort in the low back and hip. Often these are people who are accustomed to an active lifestyle of hiking, biking, or yoga and have now been sidelined by this painful condition. The pain most often feels one sided and is worse when they first wake up in the morning and take those initial steps out of bed. This is frustrating because after a night of rest and inactivity one would think that pain in a highly active person would diminish.  Patients commonly report that the pain is more severe not only when participate in running or hiking but also when they find themselves sitting for long periods of time in the car or office. Stretching seems to help for a short period of time but does not last and most people who visit the acupuncturist are not the type who like to chew Ibuprofin all day just to get through work. Maybe worst of all, is the feeling that one should rest and recover, when the activity that they are now avoiding was the one outlet for stress in their lives. The rest actually creates a new kind of tension that they have to deal with! So what is it? What is this nagging pain in the low back and hip that seemed to develop slowly over time without a specific explainable injury?

A recent New York Times article, “When the diagnosis is Dead Butt Syndrome”, coined a phrase for this condition which brings a little brevity to a very frustrating situation. “Dead Butt” is a set of symptoms resulting from overuse and inflammation of the tendons of the Gluteus Medius (GM) muscle, which sits at the top of our glutes/butts, and which causes burning or aching pain in the low back, hip, and upper leg.  The GM runs from the top of our pelvis and sacrum down to the outside border of the Femoral head.  It is part of a kinetic chain of muscles that we use when moving our legs in sports, starting with the low back and running all the way down to the lower leg and foot. A dysfunction in the GM, the crucial bridge muscle between spine and leg, can create pain which spreads along this entire chain, inevitably leading to further muscle dysfunction down the limb. The first job of the GM is to extend, move backwards at the hip, our upper leg when kicking back in a running stride or lifting ourselves up on our bike pedals while struggling up hill. Its second job is to maintain the balance of our pelvis as we do these one legged strength movements so that we do not tip over each time we balance on one leg in a yoga class or climb up a rocky trail. Basically, the muscle gets used a whole lot of the time, and worse, it gets used in a way it was not designed for which is balancing on our butts. When we sit in our cars many of us lean against the door or on the center arm rest, likewise at the office desk, and this causes the GM to contract for long periods of time to keep our pelvis balanced as we lean our weight to one side.  For active individuals this may mean that they put the muscle to good use while sitting at work and then follow it up with activity in their sport afterwards.  A long day of work for one small muscle, maybe that is why it has such a high pain potential with which to catch our attention when we have pushed it too far.

What helps with GM tendonitis? Keeping moving at work, not sitting for too long at a time, and taking standing breaks can help. Self or professional massage which works out the spasms in the Gluteal muscles can bring great benefit towards recover and regular icing around the attachment points, the outer hip and sacrum, can bring down the pain when it is severe.  Ibuprofin does work when taken diligently, throughout the day, for a short period of time as the bottle suggest. All these home therapies will be coupled with your regular acupuncture which needs to be at least twice a week for the first three weeks.  Do the work and you will learn a whole lot more about your body mechanics, how ways you were sitting or moving were causing you harm, and you will survive the dreaded Dead Butt Syndrome.

The idea of Toxins in Chinese Medicine

Chinese medicine has a deep understanding of the concepts of ‘toxins’ and ‘toxicity’ in the human body.  It has functional theories as to the origins of toxins, how they manifest in our organ systems, and how exactly to treat them once they have caused pathology to develop. However, what Chinese medicine identifies as toxins, is quite a bit different from the casual and frequently used expressions that are so common in today’s alternative health care vernacular. In Chinese medicine, as practiced in the People’s Republic of China, toxins are visible to the eye of the practitioner, manifesting through redness and swelling, rotting and pustulating of the bodily tissues. The concepts include visible diseases such as sores on the skin, cystic acne, skin boils and mastitis of the breast tissue. Toxins are diagnosable through both Chinese medical theory and western medical laboratory testing. They are not, in Chinese medicine, non-descript, unseen, or hidden pathogens which accumulate in our bodies from PCB’s, parabins, carbon monoxides, or mercury.  I am in NO WAY suggesting that Chinese medicine does not recognize environmental pollutants as being harmful to health, but, I am suggesting that we need to use concrete definitions and diagnostics if we are going to claim a person has a disease. Simply telling someone that they ‘are toxic’ is harmful to the patient, in the immediate stress and worry which it causes, and in the long term actions they may take to deal with these supposed toxins. Chinese medicine uses its elaborate theories to treat illness with medicinal herbs or acupuncture and does not advocate purging oneself through fasts, cleanses, or colonics. While I would not dispute that these methods have helped some people in the past, I would posit that they are not sourced from professional Chinese medicine. Often, but not always, these methods seem to cause frequent, loose bowel movements, cramping and bloating of the digestive tract, and prolonged weakness of the body afterwards.  All of these effects are themselves consider true pathology in professional Chinese medicine which would require treatment. The cure for these ‘toxins’ can lead to a genuine disease.

Chinese medicine aside, it seems like we are exposed to the ‘idea’ of toxins constantly these days. Whether through Dr. Oz and television infomercials, books on raw food or so called Paleolithic diets, or health magazines that constantly advise us on ways to load up our bodies with all sorts of non-local and exotic foods to cleanse ourselves of toxins. The warnings are so dire and the infection of our bodies is so pervasive that one might be led to think we are all simply rotting away inside from our water, air, food, and the building materials that we live around. I have found in the clinic that this concept breeds significant fear and worry in many people.  I have on many occasions seen these worries become severe to the point where those fears actually do become a health damaging condition which now requires medicine, whether holistic or allopathic, to correct.  I have seen patient’s bodies fall apart over fears of Fukashima’s effects, I have listened to grown adults shaming themselves over having a cup of coffee in the afternoon, some non-organic wine in the evening,  or, God forbid, a piece of the all evil dairy on the weekends. Even that delicious and local Humboldt Fog Blue Cheese is now a potentially deadly indulgence which could start a whole chain reaction of toxic damage in the body.

All this worry creates so much stress which actually does lead to illness. Maybe, the signs and symptoms that people are always ascribing to toxicity are actually the same signs and symptoms of a person who obsessively worries about food and environment? Maybe we can simply stay ‘clean’ by becoming engaged in our local Mediterranean climate and food sources; you know that same Mediterranean diet which has actual scientific research to show its long term benefits? I purpose that we need to focus on the entire natural world around us that gives us health and not overly worry about the un-natural world we have to deal with during our day to day environment. I am very much for environmental activism and ecological protection through waste reduction and small carbon footprint. I just find it hard to reconcile this with the health advice we are bombarded with advising us to fly in our Acai berries from Brazil, our Seaweed from Scotland, and our Goji berries from China just to rid our bodies of these nebulous toxins.

I would recommend that each person see a professionally licensed practitioner about whatever health care concerns they may have. Check into your state licensing boards and see what professions require schooling and continued education.  If you wish to explore the idea of these modern toxin concepts you may wish to speak with a Naturopathic practitioner or Chiropractor as I believe many of these ideas circulate and originate within that community of healthcare workers.  In California, a practitioner of Chinese medicine can mean many things and not all would agree with my opinions. However, they are the theories and mechanisms of diagnosis and pattern discrimination practiced in mainland China. Our medicine believes that our health is self-governed through balance and the avoidance of either too much, or too little, of any substance in life. If we become ill it is because we ignored this principle of balance, restore balance and you will return to health. Our medicine does believe in Toxins and treats them very effectively through the use of medicinal herbs and in the right hands you will get the care that you need and not given cause for worry about those things which we cannot completely avoid.

Why you should want to be treated by a Nurse Practitioner

Nurse Practitioners (NP) are a great choice to manage and treat many medical conditions.  NP’s are being utilized more often as the primary caregiver and the practice is continuing to grow.  It is estimated in 2011 there were 140,000 NP’s nationwide (Moote, Krsek, Kleinpell, & Todd, 2011).  NPs are helping to fill the gap in the numbers of physicians which is estimated by The Association of Academic Medical Colleges to be 124,000 to 159,000 physicians by 2025 (Moote et al., 2011).  These estimates predated the new national health care reform act, which will bring an additional burden to the already strained health care system, with increase number of patients requiring care.  NP’s will also play an important role in helping to relieve the burden of overworked physicians, cost containment, the quick expansion of the healthcare industry and an aging population.  NP’s are trained differently than Medical Doctors (MD).  NPs are trained to see the whole person and not just the disease that the patient has.  A Nurse Practitioner should not be thought of as a poor substitute for the doctor, but rather be seen as high quality, effective medical caregiver.

Nurse Practitioners are a critical part of a medical team caring for patients in a variety of medical situations such as hospitals, rehabilitation centers, out patient clinics, home care and many more speciality fields.  They practice in almost every clinical setting and every medical and surgical specialty (Moote et al, 2011).   To be a NP, one must first be a Registered Nurse (RN).  According to the Gallup Poll, Nurses have been the most trusted profession for 12 out of the last 13 years (CDC, 2012).   The nursing profession as a whole “plays a critical role in improving patient outcomes, increasing access, coordinating care, and reducing healthcare costs” (CDC, 2012).  Nurse Practitioners continue to develop the skills they learned while being an RN and then train in the medical model in order to examine, interpret laboratory and diagnostic testing, diagnosis medical conditions, and treat a variety of medical conditions.   In order to practice as an Nurse Practitioner, one must have received a graduate level degree which places “practical emphasis on attention to patient education, individualization of care, active listening and more (Budzi, Lurie, Singh, & Hooker, 2010). The psycho-social aspect of a patients life is an important piece of the puzzle in treating many disease processes.  NPs try to think holistically and speak to each patient about how their disease is going to affect their life and how by making lifestyle changes the patient might be able to better control their disease.  While some physicians do try to spend time on lifestyle modifications, the NP training really brings this to the forefront of patient care.  The ability to care for the whole patient is the defining strength Nurse Practitioners.

Patient satisfaction with care has been a known factor in patient compliance, health outcomes and reuse of the provider (Budzi et al, 2010).  As a general consensus, Nurse Practitioners are seen to have more time and a better ability to listen to the whole patient, not just the problem at hand.  The study done by Budzi et al. (2010) noted that when practices increased the number of NPs, the satisfaction scores of Veterans increase by 5%, while when the number of physicians was increase the satisfaction scores only increased by 1.8%.  As stated earlier, increase satisfaction betters patient health outcomes.  Besides providing high quality clinical care, Nurse Practitioners “focus on health promotion, disease prevention, health education, attentiveness and counseling” (Budzi et. al, 2010) which are seen as important pieces of care for patients. NPs focus on these important aspects that will keep patients coming back to care, which will ultimately, provide better patient outcomes.

Although some, including both lay and medically trained persons, may think that Nurse Practitioners are less educated, and therefore will have worse patients outcomes, this is simply not true.  A systematic review, covering 18 years (1990-2008), conducted by Newhouse et al, (2011), established that NPs who collaborate with physicians had similar and better care in a variety of areas as compared to the results of MDs alone.  The review analyzed 37 studies that looked at patient outcomes when cared by NPs or MDs.   There was eleven patient outcomes that were looked it in the systematic review including patient satisfaction with provider/care, patient self-assessment of perceived health status, functional status, blood glucose, serum lipids, blood pressure, emergency department visits, hospitalization, duration of ventilation, length of stay, and mortality.  Of the eleven patient outcomes, eight outcomes reported equivalent level of care between NP and MD.  These outcomes were: patient satisfaction with provider/care, patient self-assessment of perceived health status, functional status outcomes, blood glucose control, blood pressure control, emergency room or urgent care visits, rates of hospitalizations, and mortality.  NPs had better patient outcomes in managing serum lipid levels than their MD counterparts.  This systematic review supports that NPs who collaborate with physicians are as knowledgeable, and potentially more successful, in providing care to patients than physicians alone.

In conclusion, Nurse Practitioner’s are a highly educated, caring and productive team members in all healthcare settings.  NPs focus on high quality medical care while also keeping focused on the person as a whole during the treatment of the disease process.  Nurse Practitioners also have been shown to provide treatment and care on a similar or better outcome level when compared to Medical Doctors.  NPs “provide health care that is indistinguishable in quality from care provided by physicians (Budzi et al., 2010).  This is why patients should choose to be seen by an Nurse Practitioner.

 

 

References

Budzi, D., Lurie, S., Singh, K., & Hooker, R. (2010). Veterans’ perceptions of care by nurse    practitioners, physician assistants and physicians: A comparing from satisfaction surveys.            Journal of the American Academy of Nurse Practitioners. 170-176.  DOI: 10.111/

j.1745-7599.2010.00489.x

Center for Disease Control and Prevention. (2012). Announcements: National Nurses Week —          May 6–12, 2012.  Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm6117a9.htm

Moote M., Krsek C., Kleinpell R., & Todd B. (2011). Physician assistant and nurse practitioner       utilization in academic medical centers. American Journal of Medical  Quality.            26:452-460. DOI: 10.1177/1062860611402984

Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., Wilson,             R. F. , Fountain L., Steinawachs, D. M., Heindel, L, & Weiner, J. P. (2011).  Advanced       Practice Nurse Outcomes 1990-2008: A Systematic Review. Nursing Economic$, 29(5),       230-251.

What is a Nurse Practitioner?

            I have been told on a number of occasions about patients of mine being sent to see a Nurse Practitioner, instead of a Medical Doctor, when they visit a medical office or Emergency Care setting.  This seems to surprise many people who assumed they were going to the clinic to have a MD evaluate their condition and often people seem to feel they are getting short changed this patient-practitioner pairing.  I could not possibly disagree more with this notion and I went to speak to a Nurse Practitioner about what her scope of practice consists of and to what extent is she educated in comparison to a MD or Physicians Assistant(PA).  I wanted to get this description in her own words and I offer them up to my patients as both informative and encouraging in their future interactions with Nurse Practitioners in the medical setting. NPs are going to take more and more control of our health care as the new policies go into effect and we should embrace these changes as a way to receive better care, more one on one time, and greater affordability in all our medical needs. I will be adding a second part to this post in the following week about why exactly we should want to see a NP over another provider.

 

I am an Adult Nurse Practitioner (NP) who has received an Master’s degree from UCSF School of Nursing.  My degree and my national board certification allow me to care for adult patients in a primary care setting.  I am able to take medical histories, preform physical exams, diagnose, order and interpret laboratory tests.  I am also able to order x-rays, CT scans and MRI’s.  I am able to refer patients to medical specialist for advanced care.  I work closely with physicians, nurses, dietitians, physical therapist, and occupational therapist to help manage the care for my patients.  My clinic works with adult patients of varying ages.  I treat teenagers to geriatric patients in a primary care setting.  We accept patients of varying economical situations.  We accept both private and public health insurance.  I am the point person in managing each patients care.  Patients come to see me to preform ‘check-ups’ or to manage diseases such as diabetes or high blood pressure.  I can also help patients manage depression and other mental illnesses. I am able to preform these duties because of the education and prior experience I have had as a Registered Nurse (RN).  To become an NP, I had to already have the education, certification and experience of an RN.  As an RN, I had been working with adult patients with varying medical conditions in the intensive care unit at UCSF Medical Center.  During school at UCSF, I had clinical experiences that helped prepare me for this role.  The experiences varied from caring for patients with low back pain, urgent care, primary care and women’s health.  Having a variety of experiences allowed me to learn and manage a diverse population.  Other experiences at UCSF has taught me to interpret research in order to use evidence based research to care and teach my patients.  These experiences and my past work as an RN has helped differentiate me from staff nurses, physicians and physician’s assistant (PA).  As a staff nurse, I was able to monitor and assess patients conditions but in order to be able to help patients with new medications or treatments I had to rely on the NP or doctor to make the decision.  My role and education differs from a doctor (MD) and a PA.  A MD must have completed medical school and an intensive medical residency program in order to practice.  I work closely with a doctor but manage patients on my own.  A PA must complete a masters degree while having clinical experiences during school.  Although, a PA and a NP education are similar, the focus of care differs.  As an NP I never forget that I am a nurse first.  In this aspect I care for patients on a holistic level.  I care about all aspects of a patients life including the community they live in and the cultural background they come from.  These factors play highly in how I work with patients to find treatments that best suit each person individually.

Am I drinking too much water?

              I have had a number of patients over the past four years who have come in for complex conditions which include the symptoms of difficult concentration, fatigue, poor memory, chronic bloating, diarrhea and frequent urination.  While these conditions in and of themselves are not that rare for me to see, they are made more unusual by the fact that they are all occurring together in the same person, at the same time.  As I have treated these patients, often middle aged females who eat a food concious diet, I have continually seen the improvements which were gained falter after only a day or two.  There seemed to be a pattern of relapse that I could not overcome.  I would take time going over diet, sleep patterns, and exercise habits with the patient.  I made efforts to discuss any depression or anxiety that they may have been feeling and many did indeed have a history of panic attacks and anxiety to report. I was always looking at the patient for some clue as to what they might be doing to increase the severity of their symptoms.
       Just recently the light bulb popped on for me while I was doing an initial consult with a new patient. The answer was not contained within the patient’s story of their illness. The answer was held right there in the patient’s hand.  The water bottle. Not just any water bottle, but the liter bottle of water, or larger, that they carried with them everywhere they went.  It came with them into the clinic from the car. It came with them from the consult room to the treatment table. It sat next to them even though they could not reach for it, in a comforting sort of way, and it was quickly grasped as soon as the treatment was over.
        “How much water are you drinking each day?” I started asking.  The responses were shocking. 2 liters…3 liters…close to 4 liters. “Why?” I asked. “Because it’s good for you”, they would inevitably reply. “Are you drinking because you are thirsty or because you think it’s good for you?” I would follow.  Not a single person in this group has replied, “because I am thirsty”.
         The fluids in the human body work within a closed circulatory system. We can only sustain so much fluid within our vessels and tissue at any one time, based on our body size, fat distribution, and the environment we live in. If a person continues to drink past this point fluids will pool in areas of the body where they should not. We place ourselves in a diseased state of edematous swelling where we start to see puffy ankles and feet, puffy faces and hands, and a constant stream of trips to the bathroom as our body tries to eliminate the fluid. We are not a system of hoses and pipes which should be flushed all day with liters of water. Our bodies are a balanced chemical blend of cells, minerals, neurotransmitters and proteins, all of which must be in balance in order for our nerves to function.  When we continually ingest water, beyond our thirst levels or environmental needs, our hearts have to work harder to move the increased volume of blood and our kidneys have to work harder to eliminate the increased volume of fluids. We have diarrhea to void extra water or have constant copious and clear urination which slowly removes the salts and minerals from our body.  The water we pass contains many of the healthy components we need to survive and function. If water is drank in great excess our brains, digestive tracts, or filtration organs can fail.
       Some of you may have heard of people dying from over consumption of water in marathons or in training but what are the effects of a lower level of constant over hydration? In high levels on ingestion is causes the cells to swell and can leading to vomiting, seizures, and even death. In lesser levels of toxicity is can cause foggy thinking, bloating, swelling, and electrolyte imbalances. The standard advice in the United States of 8 glasses a day is not based on anything scientific. It does not take into account the weather, the activity level of the individual, their age or size (surely a 100 pound woman does not need as much water as a 200 pound man), or the diet they eat which may already be rich in water dense food. Fruits and vegetables, even coffee and tea, are also made up mostly of water. So if an individual eats a diet rich in these foods and has 8 glasses of water what astronomical amount of daily water are they up to then?
            Chinese Medicine places great emphasis of the presence or absence of thirst in the patient, maybe we need to move back towards drinking to quench thirst, and not forcing fluids in an attempt to prevent something which may not be there at all.