Or maybe I'm just paranoid. Any time there's a change in laws governing medicare, medicaid, or health insurance, I get suspicious. Who is benefitting here? The patients? Maybe a little. The doctors? Only the ones who really milk the system for all it is worth. The insurance companies? Certainly, until and unless we finally send them packing and opt for single payer. I've been heartened to hear Trump celebrating the single payer systems that exist in other nations. Yes, it is cheaper than the shitshow we have going.
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I find it disheartening that so many people who consider themselves skeptical are really not open-minded critical thinkers, they are kneejerk naysayers. In their view anything that doesn't already fit into their particular understanding of reality is obviously nonsense. In other words, they are unwilling or unable to learn. And when these skeptical individuals band together under the banner of reason or science, without having an ounce of either to back themselves up, the result is saddening and maddening.
Discourse with all concerned parties will result in the best outcome. When the subject is medicine, we are all concerned. It matters. I understand thinking that all ND's must be homeopaths or whatever, but it isn't true. There are rational and intelligent people practicing under this umbrella, and there are crystal-believing mumbo-jumbo talking MD's out there too. I know. I know these nonsense-accepting MD's exist because they talk to me. They assume that because I'm a naturopath I will agree. My point is that the letters after the name give no assurance that you will be treated rationally. The amount of pill-shoving that goes on within conventional practice will be proven murderous someday. Chemotherapy will be thought barbaric. More on this later. If you are already interested in expressing your support for wholistic and preventative medicine under the naturopathic umbrella, you can do so here: http://www.naturopathic.org/lac#/57. THE CFI LETTER (CORRECTED AFTER ACCIDENTALLY ADDRESSING IT TO GOVERNOR SMITH): Tell Governor Brown: Don’t Endanger Oregon’s Health – VETO SB 856The Oregon Legislature has just made the terrible mistake of granting naturopathssweeping new powers to make life and death decisions for Oregonians. Unless vetoed by Gov. Kate Brown, Senate Bill 856 will give naturopaths the same authority as medical doctors (MDs) and osteopathic doctors (DOs) to make important medical and legal judgments for people’s lives, despite lacking the basic qualifications to do so. Naturopathic “medical schools” are not part of the mainstream health care education system and students are taught pseudoscience like homeopathy and “detoxification.” Unlike MDs and DOs, naturopaths do not do residencies upon graduation, but go straight into practice. Most naturopathic grads have never practiced in a hospital or specialty clinic. Yet SB 856 would give NDs the authority to make critical decisions on serious health matters, such as the authority to:
Oregon already gives NDs the most liberal scope of practice among the few states that license NDs. It allows them to practice as primary care physicians, even though their education and training is inferior to an MD and DO. It would be a mistake to put the public at further risk by giving NDs authority to make medical judgments they are not properly educated and trained to make. With SB 856, the state would be effectively forcing substandard care upon vulnerable populations who don’t have the capacity to refuse. This bill must not be signed into law. Tell Gov. Kate Brown to veto Senate Bill 856.  What do you practice in your life? I believe it was the Mahatma Gandhi who said that bit about how your thoughts become your actions and on down the line…. It was about how you create yourself by what you choose to think and believe. A practice is anything that you do regularly, even ritually. A morning cup of coffee is a common practice. If it is true that what you do becomes who you are, it is worth putting some thought and intention into your own personal practice. There are a lot of yoga practitioners out there. I count myself as one. I practice at least a little yoga every day. For me it is the avenue by which I came to recognize and respect my own body, which was necessary before I could begin to care for it. I was in denial of my body for many years. In my 20’s, though I looked fit, I could not touch my toes without bending my legs. One cannot gain flexibility without a regular practice, because it is a gradual process. And one cannot be truly strong without flexibility; if you can’t use the full range of your body’s movements, your strength is hobbled. I believe this applies to flexibility of the mind, too. If once lacks mental flexibility, one cannot learn. Many say we should all develop a spiritual practice. This is about choosing at least some thoughts and actions that are oriented toward our highest values and goals. A cup of coffee might not satisfy this. Having some small fraction of each day that is dedicated to the big picture, to the people and things that we most love, is a simple way to remind us that we are part of that Wholeness that is the World. Regardless of your belief system—and even if you are firmly atheist or mildly agnostic—you will benefit from such a practice. The research tells us that you will live longer, be less depressed, and be more likely to request life-extending medicine when your time is short. You will love life more. I personally have been mulling on these ideas of a practice because I now have a medical practice as well. What is the core of my practice? It is evolving. Perhaps the most important thing I can do for my patients is to help them to notice the great blessings that abound as long as we live. The irritants of daily life are passing things, often irrelevant in the longterm. I practice meditation, gratitude, kindness, the four agreements, and also being in nature. My church the is river, sky, mountain, snows of winter and buds of spring. Science shows that being in natural environments lowers blood pressure and stress hormones, but I believe it does more than that. I also practice Feng Shui. Not in any traditional way, but in the deeper concept. Feng Shui taught me that the physical things that surround me either facilitate or impede my practice. I strive to make every item in my space a reminder of all I have to be grateful of, and what I am striving for. If physical things get in my way, I move them. If they are not moveable, I move other things to improve the flow. So now you know my practice. What is yours? I look forward to hearing about it. 
 YOU MAY THINK YOU KNOW ALL ABOUT IT. People who grow up around poisonous plants learn the hard way, like I did. I spent my childhood covered in itchy rashes, and with great fluid filled blisters between my fingers and toes. Soap was anathema to me; I was a wild child. Because of this early education I know what poison ivy looks like, even when it’s called poison oak, even when the leaves are off in winter. It’s the same stuff. This article is for those of you who’ve never had it, or had it once or twice, and for the people who ended up at the doctor’s office because of it. I want to motivate you to learn to recognize the plant, because the best treatment for its nasty rash is PREVENTION. Avoid contact with the plant, and avoid contact with things that have touched the plant, and you limit your risk. Nobody wants the rash. Itching is at least as maddening as pain. If you are not quite sure what it looks like, you won’t learn it from pictures or articles. You have to learn it in the field. Ask about it when you’re out in the wilds with people who know the plant. We can point it out to you in all its forms. You can limit exposure by wearing clothing that covers your skin. And you can coat your skin with tecnu or bentoquatam to prevent the urushiol from sticking to you. Tecnu is a product that solvates the oil but it contains propylene glycol (radiator coolant) which I’d rather not introduce to the environment. Bentoquatam is a product made from bentonite clay that forms a coat on your skin to block the oil from getting on you. It is probably more environmentally friendly. The leaves of both poison oak and ivy are shiny when they are new and become duller over time. Both have “leaves of three”, meaning there are three leaflets on each stem that together comprise the leaf. Both have some variability in the leaf shape, with edges that range from toothed to smooth to almost lobed, but the “leaves of three” always fit together in a similar way. The leaves of both turn red in the fall and both can have white fruit that remains on the plant after the leaves have fallen. Both like to grow along rivers and streams and forested trails, in exactly the terrain frequented by boaters. The saying “leaves of three, let it be; berries white, take flight” applies to both. There’s a debate about which plant is more contagious or causes a more severe rash. I have found nothing to shed scientific light on this question, though most people online say oak is worse. They seem equivalent in potency to me personally, and are both to be avoided. The toxin in both poison oak and ivy is a sticky oil called urushiol. It causes a type of contact dermatitis that an immunologist would call a type 4 delayed hypersensitivity reaction. The rash appears 1-3 days after exposure to the urushiol. The first symptom is an itch, then red bumps form which later become amber fluid-filled pustules. If you scratch open the pustules then you have open wounds which can get infected, complicating the problem. The final stage is the healing of the pustules and wounds, which can take a week or more. There are a lot of myths about poison ivy/oak, and I’ve listed my top seven here. Myth 1: The fluid inside the pustules is contagious. This is FALSE. What is contagious is the sticky urushiol oil. The fluid from the pustules is just serous fluid from your body and it is harmless. The oil, on the other hand, can stick to your skin, your dog, your walking stick or your shoes. It “sticks around” until it is washed off with lots of soap. If it is on your skin in one place and you scratch there, then touch somewhere else, you have just introduced the toxin to a new location and unless you wash it off you can look forward to a nice itch starting in about a day. Myth 2: You have to go get steroids to treat poison ivy. Not so, in fact corticosteroid drugs like prednisone have some nasty side effects and should only be used under doctor’s orders. Most of the time the rash is not so severe and will go away on its own given removal of the toxin and time. After you wash off the urushiol you just need to keep your sanity while the rash runs its itchy course, which takes about a week. You can reduce the immune response that causes the dermatitis by taking lots of vitamin C. If the itch keeps you from sleeping you can take an anti-histamine, but don’t take these every night longterm because they also contribute to dementia. If it makes you feel any better, you can temporarily kill the itch with cold water. After you’ve scrubbed it with hot soapy water, chill the rash with the coldest water you can get from the tap. After you cool the affected skin, don’t touch it, and it won’t itch for a while. Myth 3: You can wash the urushiol off with river water. This is debatable because there does seem to be some reduction in future symptoms from vigorous washing in river water after an exposure. Still from what we know about the chemistry of urushiol (a very long and sticky oil molecule), it can stick on the skin until you attack it with either a detergent or a solvent. Fancy soap with moisturizers is less effective for removing the oil than just plain soapy soap. Rubbing alcohol can work for removing the oil but it stings like the devil if you’ve scratched yourself too hard, and you might not want to bathe in it. Brief soaping up like we normally do will not get urushiol off. You have to really scrub it. Use a lot of soap and a wash rag, and scrub every surface especially in nooks like between your fingers. Wash well within 24 hours of an exposure, and follow that up with repeated soapy bathing any time you feel an itch. Wash your clothes and shoes in hot soapy water too. If you get all the urushiol off, you will at least avoid starting new patches.  Myth 4: You can’t get poison ivy/oak in the winter time. Unfortunately, false. You can get it any time of year. Sure, the sappier the plant is, the more urushiol it will deliver on contact. Late winter and early spring buds are particularly dangerous because they are bursting with sap and don’t have leaves yet. After the leaves have fallen in the autumn it can definitely still cause the rash. We recently confirmed this when at least two of us got the rash after returning home from an October Rogue trip. Even in the wintertime it’s best to give the plant a wide berth, because what looks like a dry twig could cause days of misery if it were to happen to get in your pants. Twigs of poison ivy have been seen sticking up out of the snow on backcountry ski trips. Myth 5: Scratching does no harm. Actually, the bad news is that scratching makes it worse. First of all, you can spread the toxic oil around your body by scratching. Second, scratching makes it itch more, because it releases more histamine. Third, scratching will open pustules and cause wounds which can get infected with bacteria. It’s best to leave the pustules alone as long as you can, draining them with a pin if they get in the way. Cover them with a bandage to keep the thin skin from coming off until the wound has started healing from underneath. If you’d rather put calamine on it that doesn’t hurt, and it does mark the area not to scratch. Myth 6: You can get immune to it. Actually it works the opposite way. The more you are exposed to the toxin, the more sensitive you get. You will get the rash faster if you’ve had it before. There are those who say if you eat the first bud of new poison ivy leaf that you see in the spring, that you will be immune. I doubt it, but people say it. As far as I know the only way to remain insensitive to the toxin is to avoid contact with it. Myth 7: Jewel weed will treat your poison ivy rash. This is definitely false. Someone actually did a study on this. Jewel weed is a pretty orange-flowering plant that grows near water where you also will probably find poison ivy/oak, but it makes no difference in the course of the dermatitis caused by urushiol. We love our folk remedies but this one is unfortunately just a nice story. This may not seem like an urgent concern, but you don’t have to look far to read stories of people who’ve gotten the poison rash on their face or genitals, which could obviously be very bad. There are also stories of people getting it in their lungs from breathing smoke from fires where it is burning. Severe exposures or reactions do need medical attention. Proper dosing and tapering is essential to manage the negative effects of corticosteroids, so please do not take them at home without seeking a doctor’s opinion. Definitely tell the doctor if you’ve been out in the woods when you get a rash. I have seen three cases so far of city doctors misdiagnosing a poison oak rash as shingles. They are not the same, and you can help the doc get the treatment right by giving them a full and proper history of your rash.  If you ask a conventional doctor, they'll tell you that double blind placebo controlled studies with large numbers of patients are how they decide on treatments. They'll tell you that these kinds of studies get peer reviewed and written up in reputable and recognized journals. Anything that doesn't have big enough patient numbers, or isn't in a journal that they already trust, is pretty much ignored. The problems with this are many. First of all, those "peers" who review the articles have been shown to be painfully accepting of total nonsense when it is written in a style that suggests medical knowledge. And second, who pays for double blind placebo controlled clinical trials? Pharmaceutical corporations, who are looking to cook up the next blockbuster drug. They aren't studying these drugs out of the goodness of their hearts. The bottom line is mega profits. If they do the right study, and get the right results, they can get FDA approval and patents and voila! They're in the money. Just the other day I was studying up on diverticulosis and diverticulitis, and listened to a top physician giving a clinical update about treatment for these conditions. Basically he was reporting on two studies that showed that antibiotic treatments for diverticulitis were no more effective than IV water. He also mentioned a great many other possible treatments, including fiber for which he said the evidence was very "weak", and probiotics, which he encouraged us to use but didn't review any studies about it, again saying the evidence was weak. Is it really weak? The studies I've seen show it as an excellent treatment option and especially good for preventing recurrences. What's "weak" about these studies is they weren't printed in the journals he reads. They were smaller sample sizes because they actually looked at people in the hospital with active diverticulitis. Anyway, the point is that the evidence surrounding "alternative" approaches like fiber and probiotics was considered less conclusive. Finding studies about natural treatments for anything is hard. This is because nobody is going to make any money studying how much water it takes to ease constipation. They won't sell drugs that way. They won't even get patient visits. People would just learn to drink the right amount of water and not get so constipated. In my practice I use the best evidence I can find, and if I can't find anything that is directly about what I'm curious about, I look at similar or related evidence. I look at how a system in the body is optimally supposed to function, and what we know about its needs and outputs when it is functioning right. I study up on all the reasons it goes wrong, and everything that is "correlated" with something about it, even if there is no evidence of causality. I try to actually understand. I know I overstretch. It is only because I have such a light patient load that I can engage in deep study about each case. A busy practice would prevent this, and this is really what I live for. I WANT to understand. There is a lot of noise about Evidence Based Medicine (EBM), and people who claim that only conventional physicians use it. This is hooey. The evidence is available to all of us, we just have to get educated enough to understand it and put it together. This is what science education is all about. If you don't study science, you can't understand the evidence, and you will have no idea how to apply it except by following someone else's practice guidelines. Which is what most doctors do. Me, I am writing practice guidelines. For the future. Because medicine is not static. What we used yesterday will be tossed out tomorrow and replaced with something else. If we can give people the tools to be healthy and not go to the doctor ever, that is the ultimate success.  Up to now I have called myself a naturopathic physician, and tried to distinguish myself from the bulk of naturopaths in that I believe that science is the light that will show us the way to the future of medicine. I do not practice homeopathy or muscle testing or any of the so-called modalities for which I have been unable to find reasonable objective substantiation.
This has left me in a tough spot. I call myself a naturopath but in general alternative practitioners see me as an outsider because I trust the process of science to discover repeatable results more than I "believe" in the Vis, Qi, energy, spirit, magic or whatever you want to call it. I adopt each practice based on the best information I can find. Everything is a theory: this is the best that we know at this moment. Tomorrow there may be new information and I am willing and able to update my position. I am interested in correlations and information from all fields--biochemistry, genetics, botany, ecology, sociology, psychology, physics, biology, you name it. Opinions and testimonies do not count as information to me. I have had it with hearing people's conversion experiences to believe in unsubstantiated treatments. When someone tells me they "know" something because of personal experience, I think to myself **N = 1**, and catalog that as one tiny bit of *subjective* information in a giant and expanding data set. Are we humans capable of being objective? Conventional practitioners usually see me as an outsider because I have this degree in naturopathic medicine. It takes time for them to come to know me and recognize that I am not an uncritical "believer", that instead I am a critical thinker and a seeker for the best possible treatments. Alternative medicine is a mixed bag, as is conventional. Dogma exists on both sides. I am not dogmatic. I have a lot to offer, but there is no place in this system where I can just plug in. To date I have been unable to support myself with my practice. I do not know where this will lead but at this time the only patients I've been able to see and treat are those who are rich enough to pay me out of pocket. When I discount my services, people discount my value. When I charge full rate they complain that their insurance doesn't pay. When I start moving toward accepting insurance I realize freshly what a racket it is, and get very angry. I don't have a solution for this. At this time I am searching for alternate employment, and re-imagining what I may do with my desire to rennovate all medicine by bringing the light of science to shine on it. One decision that I have made is that I am shedding the word "naturopath" from my professional vocabulary. It is an awkward conglomeration of Greek and Latin, and the meaning doesn't even come close to what I want to do. Nature disease is a bad name. I am looking for professional organizations to join that do not have that word in the title. I am looking to network and integrate with science-minded conventional practitioners. From this time forward I am a holistic doctor or an integrative physician. I am a licensed prescriber in the state of Oregon, and I am willing and able to help people as long as they are willing to work outside of the limitations of insurance. Big business does not own me. The anti-vaxxers don't own me. And the mystical believers of the naturopathic bubble do not own me either. My family has been having a rough season. My mother spilled a cup of boiling tea down her front 6 weeks ago and is still trying to grow skin back. My sister had an antibiotic resistant infection gone bad, and kidney failure from strong antibiotics and CTs with contrast. My sister's husband had a hypertensive crisis. Every family has times like this, but for me this has been an awakening.
I live in a little bubble. My bubble doesn't include calous and perfunctory treatment of people in pain. I had watched conventional doctors and hospitals doing what they do, and decided that the world really needs naturopathic medicine. Sure, naturopathic medicine still includes some unscientific treatments which I would just as soon shed. That is the bathwater, which we can throw out. We can and will let go of ideas that are proven to be incorrect. We need to be careful not to throw out the baby with the bathwater. The baby of medicine is the evidence-based treatment of people to help them build strength and vitality. This inner strength, the LIFE that we are all born with, can see us through outrageous challenges. Or we can fritter it away by ignoring and desecrating our own bodies. The doctor as teacher really needs to return. I am working up a schedule for regular guided walks in my local park, available to anyone who shows up. The emphasis is on getting people out who would not otherwise go, and also on supporting and maintaining health for all of us. The two alternative interventions which have each been shown to be as effective as antidepressants for the blues (or more effective) are fish oil and walking. Part of the healthy effect of walking may simply be from getting out into nature. Even a rainy day is food for the soul. The first Happy Healthy Walk in Gabriel Park will be today. Also, on Sunday August 30th, Dr Mindy Curry is offering a guided walk starting from Clackamette Park that may involve swimming as well. The weather prediction for this weekend is rain. Feel free to leave a comment or write in the contact form about what kind of walks you'd like. In general I think many of us crave more quality social contact, and also more movement. I am happy to teach about the medicinal herbs in the park, and also to demonstrate and lead a little bit of yoga practice and also walking meditation, as interest arises.  |
Author: Teresa GryderIntegrative Physician and Student of Life, Medicine, and the River. Archives
August 2019
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