Download naturopathic medicine - DMA Rehability Events

NATUROPATHIC MEDICINE
Promoting Recovery
&
Resilience
Dr. Richard Vuksinic, ND
www.enrichedroots.com
TODAY’S PRESENTATION:
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What is Naturopathic Medicine?
The Principles of Naturopathic Medicine.
ND Training and Regulation
The Naturopathic Toolkit (scope of practice).
CASE examples (time permitting)
Naturopathic Medicine
• …Is a distinct primary health care system that blends modern
scientific knowledge with traditional and natural forms of medicine.
• …Addresses general health concerns/health maintenance, acute
conditions & chronic disease states.
• …Emphasizes disease as a process not as an entity.
• …is a regulated health profession
Naturopathic Medicine
• Regulated under the RHPA
– Better regulation for public safety
• Well defined scope of practice
• (training and standard of care)
EDUCATION
• Minimum 7 yrs Post Secondary Education
• 3-4 years Undergraduate Degree
• 4 year Naturopathic Medical Degree at an
accredited college (CCNM, BINM)
– Naturopathic Doctor is a designated title
» Not a weekend online course
CCNM
(Canadian College of Naturopathic Medicine)
• YEAR 1:
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BIOMEDICAL SCIENCES
Anatomy
Physiology
Immunology
Public Health
Biochemistry
Histology
Embryology
Principles in Research
Nutritional Biochemistry
CCNM
(Canadian College of Naturopathic Medicine)
• YEAR 2:
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PATHOLOGY
Microbiology
Pathology
Pharmacology
Differential Diagnosis
Laboratory Diagnosis
Physical and Clinical Diagnosis Lab
Radiology
CCNM
(Canadian College of Naturopathic Medicine)
• YEAR 3:
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CLINICAL APPROACHES
Obstetrics
Pediatrics
Emergency Care
Orthopedics
Men’s/Women’s Health
Gynecology Lab
Venipuncture and Parenteral Therapy
Diagnostic Imaging
Minor Surgery
OSCEs –entering clinic with competency
RSNC
(Robert Schad Naturopathic Clinic)
• YEAR 4 - CLINIC INTERNSHIP
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4 SHIFTS/ WEEK FOR 12 MONTHS
PATIENT VISITS
VENIPUNCTURE
TREATMENT
SATELLITE CLINICS
– Sherbourne, Brampton
• EXTERNSHIPS
– Nicaragua
CCNM
(Canadian College of Naturopathic Medicine)
• ALL of THESE courses, plus training in the
modalitites
BEYOND 4th Yr
• BOARD EXAMS
• NPLEX
North American Licensing Exams
• CE
Continuing Education
Principles of Naturopathy
• First, do no harm.
• To treat the whole person through
individualized treatment.
• To treat the root cause of disease.
• To co-operate with the healing powers of
nature.
• To teach the principles of healthy living
and preventative medicine.
NATUROPATHIC MEDICINE
• CLINICAL CONSULTATIONS:
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INITIAL (60-90min); P/E, DDX, Labs, Rx
Follow-ups (30 min)
Acupuncture (30min)
IV (varies)
NATUROPATHIC MEDICINE
NDs treat individuals with a wide variety of
concerns and/or health goals:
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ALLERGIES -----------> CANCER
INSOMNIA --------------> SCHIZOPHRENIA
COUCH POTATOS --------> ATHLETES
DIET ------------------------> MEDITATION
NATUROPATHIC TOOLBOX:
Modalities/Scope of practice
• Acupuncture / Asian medicine
• Clinical Nutrition
– Orthomolecular
– Diet
• Physical Medicine
• manipulation
• Lifestyle counseling
• health psychology
• Homeopathic Medicine
• Botanical/Herbal Medicine
NATUROPATHIC TOOLBOX:
Scope of practice
• Venipuncture
• Gynecological exams/DREs
• Intramuscular injections
• Intravenous therapy
– (additional training)
• Lab req’s
NATUROPATHIC TOOLBOX:
Today’s Focus
• Acupuncture / Asian medicine
• Clinical Nutrition
– Orthomolecular
– Diet
• Lifestyle counseling
• health psychology
• Botanical/Herbal Medicine
– If we had more time today….
NATUROPATHIC TOOLBOX:
Today’s Focus
• CLINICAL NUTRITION IS FOUNDATIONAL IN A
NATUROPATHIC APPROACH TO HEALTHCARE
– Orthomolecular Nutrition: (Supplements)
• i.e. Anti-inflammatory action of Omega 3 fatty acids
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Adv Clin Exp Med. 2015 Nov-Dec;24(6):931-41. doi: 10.17219/acem/31243.PUFAs:
Structures, Metabolism and Functions.Wiktorowska-Owczarek A1, Berezińska M1, Nowak
JZ1.
– Diet: i,.e. Anti-Inflammatory Diet
• Decreases Neuro-Inflammation after Spinal Cord Injury
Targeting inflammation to influence mood following spinal cord injury: a
randomized clinical trialDavid J. AllisonEmail author and
David S. DitorJournal of Neuroinflammation201512:204
NATUROPATHIC TOOLBOX:
• Lifestyle counseling
• health psychology: STRESS MANAGEMENT
– Essential to promoting resilience (physiological and cognitive)
– stress and its role in chronic disease
Approaches to managing stress:
– Acupuncture
– Adaptogenic herbs (i,e, ginseng, rhodiola)
– Mindfulness Meditation
NATUROPATHIC TOOLBOX:
STRESS MANAGEMENT: TRAUMA
Somatic Experiencing
The SE approach offers a framework to assess where
a person is “stuck” in the fight, flight or freeze
responses and provides clinical tools to resolve these
fixated physiological states.
www.Traumahealing.org
Dr. Peter Levine
ACUPUNCTURE
Indications/
Promoting Resilience
SOME EXAMPLES:
• Post Stroke
• Parkinson’s
• Osteoarthritis
• Chronic Shoulder Pain
• Myofascial Pain Syndrome
ACUPUNCTURE
Indications/
Promoting Resilience
POST STROKE:
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Bringing Holistic Treatments to the Attention of Medicine
Acupuncture as an Effective Post stroke Rehabilitation ToolCecilia Farmer, BSN,
RN1⇑1University of California, Irvine, CA, USA
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3 STUDY REVIEW
Sham controlled RCTs
all 3 studies suggest that acupuncture increases quality of life and improves mobility and
activities of daily living.
Effective randomization and stratification of subjects
Small sample sizes, patient self report
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ACUPUNCTURE
Indications/
Promoting Resilience
POST STROKE:
Zhongguo Zhen Jiu. 2015 Dec;35(12):1225-30.[Analysis of optimal plan
of multiple acupuncture manipulations for shoulder pain after stroke
at different stages].[Article in Chinese
Chen D, Gao J, Chen L, Hao Z, Fan G.
• observed the effects between acupuncture combined with rehabilitation
and rehabilitation mono-therapy for shoulder pain after stroke
• Acupuncture combined with rehabilitation at the early and the later
stage acquired better improvement than rehabilitation on its own.
ACUPUNCTURE
Indications/
Promoting Resilience
PARKINSON’S:
acupuncture tx integrated with conventional tx
improved quality of life, mood (depression
scores), activities of daily living, decreased s/e of
conventional tx.
Fang-Pey Chen et al, Am. J. Chin. Med. 43, 407 (2015). DOI:
10.1142/S0192415X15500263A Clinical Study of Integrating
Acupuncture and Western Medicine in Treating Patients with
Parkinson's Disease
ACUPUNCTURE
Indications/
Promoting Resilience
• Osteoarthritis
– Decreased pain and increased mobility in osteoarthritis
patients
• Acute Lumbar Sprain
– Movement a/p improves recovery time
• Chronic Shoulder Pain
– Improved motion, decreased pain
• Myofascial Pain Syndrome
– increases mobility but did not have effect on pain in
myofascial pain syndrome - meta analysis
ACUPUNCTURE
EVIDENCE
• Osteoarthritis
– Pain management with acupuncture in osteoarthritis: a systematic review
and meta-analysis.
Taru ManyangaMaria Froese, Ryan Zarychanski, Ahmed Abou-Setta,
Carol Friesen, Michael Tennenhouse and Barbara L ShayBMC
Complementary and Alternative MedicineBMC series ¿ open, inclusive
and trusted201414:312
• Acute Lumbar Sprain
– J Tradit Chin Med. 2016 Feb;36(1):19-25.Acupuncture-movement
therapy for acute lumbar sprain: a randomized controlled clinical
trial.Lin R, Zhu N, Liu J, Li X, Wang Y, Zhang J, Xi C.
ACUPUNCTURE
EVIDENCE
• Chronic Shoulder Pain
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Acupunct Med. 2016 Jan 21. pii: acupmed-2015-010947. doi:
10.1136/acupmed-2015-010947. Randomised controlled trial of
contralateral manual acupuncture for the relief of chronic shoulder
painZhang H1, Sun J2, Wang C2, Yu C2, Wang W2, Zhang M3, Lao L4,
Yi M3, Wan Y3.
• Myofascial Pain Syndrome
– J Tradit Chin Med. 2016 Feb;36(1):1-13.Effectiveness of dry needling on
reducing pain intensity in patients with myofascial pain syndrome: a Metaanalysis.Rodríguez-Mansilla J, González-Sánchez B, De Toro García Á,
Valera-Donoso E, Garrido-Ardila EM, Jiménez-Palomares M, González
López-Arza MV.
CASE #1: M.S.- 43 yoa F
• INITIAL CONSULTATION: 2/26/13
[S]
– CC#: Chronic Migraines
– Started 9 yrs ago, worse past 2 yrs, progressive last 15mo.
– MVA preceded migraines by 4 yrs (neck and shoulder)
» Degenerative disc at C5-C6
» Chronic muscle tension
– I: 2-10/10
– CT Sept/12- WNL
– L: occiput refers to temples and behind eyes (estrogen?)
– Worse stress, noise, light
» Stress- work, caregiver for mother and brother
CASE #1: M.S.- 43 yoa F
Menstrual Hx:
- G2P1 m/c at 11 weeks with 1st pregnancy
- hx of fibroid (“grapefruit size”)
- fibrocystic breasts
- DnC and IUD
- very heavy cycles at 32 yoa
- pt denied hysterectomy
Energy:
Mental and physical exhaustion at the end of each day
Compensate by eating CHOs, sugar
CASE #1: M.S.- 43 yoa F
DIET
- 2 coffee per day
- craves, salt, carbs
- diet coke 3 x per week
DIGESTION
- BM q 2nd day
- bloating
- stool WNL
CASE #1: M.S.- 43 yoa F
MENTAL EMOTIONAL HX
- “no issues”, except:
- ROH father; had to protect her self from him
- abusive mother
- parents divorced at 13 yoa
- no counselling hx
CASE #1: M.S.- 43 yoa F
– RX MEDICATIONS:
» Topomax 100mg p.o. (Topiramate)
» Max dose for 8 weeks without effect
» s/e: low K+, parasthesia (hands and feet),
memory loss, metallic taste
» Maxalt 10 mg prn
» Advil prn
» Mirena IUD Dec/12
» Botox injections to cervical spine q 3wks
» This was the F/P once weaned off Topomax
CASE #1: M.S.- 43 yoa F
H/A SX SCORES: - a sample
DEC/12:
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4
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Maxalt
2
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Advil
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4
– There were only two, 3 day episodes without h/a
» Otherwise daily maxalt and advil use
– Similar scores for Jan and Feb/13
CASE #1: M.S.- 43 yoa F
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BP 128/02 RAS
RR: 12 breaths/min
PR: 80 bpm
TEMP: 36.4
Hypertonic trapezius mm
Otherwise P/E unremarkable
CASE #1: M.S.- 43 yoa F
• [A]:
– Chronic Migraines
• Secondary to ddx:
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Estrogen dominance
MM tension/ MVA hx
Food intolerances
Methylation pathway Anomalies (diet coke)
CASE #1: M.S.- 43 yoa F
• [P]:
– Magneleuvres (B6, Mg+, Taurine)
– Petadolex
• Butterbur
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The most prominent studies were in fact 12 weeks long, and they were double-blind and placebocontrolled involving 128 subjects. The studies demonstrated butterbur’s effectiveness for migraine
prophylaxis, with patients experiencing as much as a 60% drop in frequency of migraine attacks
compared to the placebo group. Other improvements in the petasites group included a reduction in the
duration and intensity of such attacks, as well as a decrease in migraine-associated symptoms.
Mauskop A, Grossmann WM, Schmidramsl H. “Petasites hybridus (butterbur root) extract is effective in
the prophylaxis of migraines.” Results of a randomized, double-blind trial. J Head Face Pain 2000;40:4.
CASE #1: M.S.- 43 yoa F
• [P]:
– Acupuncture: local to traps; advised weekly
– DIET:
• Eliminate gluten, diet coke, coffee
• IgG food allergy test
CASE #1: M.S.- 43 yoa F
• SECOND VISIT
[S]:
3/26/13
- 1st week of “diet plan” was “rough” (caffeine withdrawl = trigger)
- no h/a for 2weeks
- h/a returned with mm tension
< sitting at work
- no TOPOMAX; pt reports better cognitive function (less brain fog)
- f/u IgG
CASE #1: M.S.- 43 yoa F
• SECOND VISIT
[P]:
3/26/13
DIET: 100% avoidance of food intolerances for min 6mo.
IBID with addition of Glutamine. (gut repair) (“remove, replenish, repair”)
CASE #1: M.S.- 43 yoa F
• THIRD VISIT
[S]:
4/23/13
- pt reports h/a much improved
- only 1 migraine, secondary to aggravating neck and shoulder injury
- DIGESTION: daily BM, for the first time in more than 1 year
- Increased energy = first 5km race in 2 years
CASE #1: M.S.- 43 yoa F
• FOURTH VISIT
[S]:
6/25/13
H/A SX SCORES: - a sample
MAY and JUNE/13:
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Maxalt Advil
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3
1
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2
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1
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Used maxalt 11 x (single dose) in May/June, without NSAID. All other days were h/a free
COMPARE to Jan/Feb 2013: Maxalt 20 x (double dose) accompanied by 500mg-2g NSAID
CASE #1: M.S.- 43 yoa F
• FIFTH VISIT
[S]:
9/26/13
-Migraine 1/month when mm tension is aggravated
- NSAID and massage and migraines resolve within a day
- Daily BM, well formed
- Energy increasing
- Sleep is good, waking refreshed
CASE #1: M.S.- 43 yoa F
• SIXTH VISIT
[P]:
1/14/14
-Digestive enzyme
- MAINTAIN: probiotic, Mg+, B12
F/U in 6 months
Pt called 2 weeks later. Acute Cholecystitis. Appointment pending.
CASE #2: M.S.- 55 yoa F
FIRST VISIT: 1/29/13
[S]:
-daily diarrhea for past 8 months; 3-10x/day
-worse since eliminating wheat, starting whey P- and probiotic
-BM after eating
- cramps, urgency, hemorrhoids, weight loss
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Has tried everything
Hx of rectocele
Hx severe menorrhagia (req’d transfusions)
Holds stress in Abdomen
CASE #2: M.S.- 55 yoa F
FIRST VISIT: 1/29/13
[A]:
ddx
-gastritis
-whey intolerance
-contaminated probiotic
-colitis/crohn’s
-celiac dz
-parasite
CASE #2: M.S.- 55 yoa F
FIRST VISIT: 1/29/13
[P]:
LABS: b12, CBC, Ferritin, ova/parasite, stool occult; transglutaminase;
electrolytes, ANA
- No coffee
- HMF Intensive probiotic (pt was reluctant)
- UltraInflamx (medical food; p-powder, anti-inflammatory, nutrients)
- IgG food intolerance test
CASE #2: M.S.- 55 yoa F
2nd VISIT: 3/19/13
[A]: F/U labs
-low B12 (200)
- Fe (17)
- dairy, egg, gluten intolerance, sugar cane, bakers and brewers yeast
[P]
- Ibid
- Avoid food intolreances
- Weekly B12 IM (methycobalamin) for 1 month
- Digestive enzyme
CASE #2: M.S.- 55 yoa F
B12 INJECTION VISITS
3/26: no diarrhea
4/23: 2 well formed BM’s per day
weight stable at 96lbs
energy 8/10
[P] maintain previous rx, oral B12
6/25: regular bowel function;
maintain probiotic, diet, b12, glutamine
Thank you
for this listening
be happy, be healthy, be resilient
Dr. Richard Vuksinic, ND
www.enrichedroots.com
172 Wortley Rd.
London, ON N6J3Y1
519-642-7469