TREATING CHRONIC PAIN: FOCUS ON THE DISABILITY by Cecilia L. Stevens, PhD

Cecilia L Stevens, PhD , came to naturopathic medicine after a career in research chemistry; she is now a 4th-year student at Boucher Institute of Naturopathic Medicine (BINM) in British Columbia. After her own struggles with chronic pain and Ehlers-Danlos Syndrome, Cecilia is interested in helping patients with chronic pain and illness by harmonizing naturopathic treatments with conventional medical regimens.

Cecilia L Stevens, PhD, came to naturopathic medicine after a career in research chemistry; she is now a 4th-year student at Boucher Institute of Naturopathic Medicine (BINM) in British Columbia. After her own struggles with chronic pain and Ehlers-Danlos Syndrome, Cecilia is interested in helping patients with chronic pain and illness by harmonizing naturopathic treatments with conventional medical regimens.

Congratulations to Cecilia for being awarded the NDNR STUDENT SCHOLARSHIP – 1ST PLACE RESEARCH REVIEW for 2019. With the supervision of Dr. Shabita Teja, BPharm, ND the article focuses on treating chronic pain.

Here is an excerpt:

“Formally, the definition of chronic pain is pain where therapy may provide some relief but the underlying cause of the pain cannot be resolved. This certainly applies to the lingering neuralgia that was included in the informal definition, but it also extends to medical conditions that cause ongoing tissue damage, such as osteoarthritis or autoimmune disorders, as well as to the pain of cancer or other terminal illnesses. Chronic pain can theoretically be diagnosed after only a few days of suffering. The commonality between these definitions is that chronic pain is incurable. This difficult reality adds an enormous mental and emotional weight to the pain along with its physical consequences. In order to holistically treat chronic pain, it is imperative that all aspects of this complex condition be considered.

Pain of any kind has strong mental and emotional components. This is evident clinically when observing patients’ different reactions to the same procedures; a blood draw, for example, can cause one patient severe discomfort yet leave the next patient unaffected. Although the physical stimulus is the same, it represents only 1 component of pain. Cognition, expectation, memory, and emotion also play a part in the actual experience of pain. This suggests that the experience of pain can be diminished through learned attitudes and behaviors. “

Read the full article at NDNR.com

https://ndnr.com/pain-medicine/treating-chronic-pain-focus-on-the-disability/?fbclid=IwAR3N-LetGQ7j1bksn1pvaor-qSXp59OJDwCE1rBRDrQhQLe4KDKfNC_FWHU

Tri-Colour Quinoa Porridge by Samantha Petrin

photo by Sam Petrin

photo by Sam Petrin

This breakfast is packing 15.7g of protein (34% RDA), 740mg of calcium (74% RDA), 209mg of magnesium (68% RDA), and 17.6g of fiber (70% RDA)

Recipe:
1/2 cup tri-color quinoa 
1 cup water
1 cup unsweetened almond milk
1 oz cacao nibs
1 oz chopped apple
1 tsp cinnamon
1 oz raw walnuts
1 tbsp coconut flakes
1 tbsp black strap molasses


Combine quinoa, water, almond milk, cacao nibs, apple, and cinnamon. Bring to a boil, then reduce to a rolling boil. Cover for 8-10 minutes. Remove from heat and keep lid on for 2-3 mins to let it continue steaming.

Top with raw walnuts, coconut flakes, and black strap molasses.

The quinoa and walnuts are big protein sources here, each contributing 4.1g and 4.7g of protein respectively.

The almond milk and black strap molasses are calcium contributors, with 472.8mg and 200mg respectively.
The black strap molasses is a power house when it comes to magnesium, providing us with 100mg!

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Sam is in 4th year at Boucher Institute of Naturopathic Medicine, and one of our primary clinic interns. She completed a Bachelor of Science degree in the faculty of Health Sciences at Simon Fraser University where she was co-president of the Health Ethics club and a member of the coed premedical fraternity Phi Delta Epsilon. She worked for 3 years in cardiovascular disease research before starting the naturopathic doctor program here at Boucher. Sam is passionate about following a plant-based lifestyle and learning about plant-based medicine. 

Follow Sam for more recipes, as well as her journey to becoming a plant-based naturopathic doctor!
Instagram: https://www.instagram.com/plantbased.naturopathicdoctor/

A President's Reflection by Garrett Alexander

My goal as a BNSA co-president is to bring our students together to create a community at Boucher. Our members worked hard this year to host successful events and get our students involved in the #boucherlife experience. Everyone has done an amazing job and I’d like to take the chance to thank them all for their hard work. Our next goal was to increase the efficiency and effectiveness of our communication with student services and administration. So far this year that has been a success! Boucher’s administration and the BNSA have come together and will continue to move our school forward in a positive direction. We have a few more exciting initiatives coming down the line… so stay tuned and follow @boucherlife on Instagram!

I’m very happy with how the year has gone so far and I am excited to pass along the reigns to another pair of enthusiastic students to carry us forward into next year!

Garrett Alexander, 2nd Year Boucher Student, BNSA Co-President

Garrett Alexander, 2nd Year Boucher Student, BNSA Co-President

History & Philosophy by 𝒜𝓃𝑔𝑒𝓁𝒾 𝒮𝒶𝓃𝓉𝑜𝓈

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Today’s class gave us a quick glimpse into the beginnings of Hydrotherapy and one of the Founders of the German Nature Cure
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Vincent Priessnitz (1799 – 1851) was a peasant farmer in Græfenberg and is generally considered to be the founder of modern Hydrotherapy (formerly known as water cure, involves the use of water for pain relief and treatment). He stressed remedies such as suitable food, air, exercise, rest, and water over conventional medicine
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He was the genius of cold water “Priessnitz compress”, which is a wet, drawing application meant to be applied to affected area with the aim to induce local hyperemia (increased supply of blood). The effect of compress runs in three phrases:
1. Hypothermic phase (in 2-3 mins) – local temperature goes down with constriction of skin vessels, resulting in limited supply of blood
2. Isothermic phase (in 30-40 mins) – the temperature becomes stable, constriction of vessels changes dilation
3. Hyperthermic phase ( in 60-80 mins) – local temperature increases, vessel dilation goes on, resulting in excessive supply of blood
The compress should be applied for 2-3 hours, then it must be put off. It can be repeated for 3-4 hours
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Rules of Hydrotherapy:
1. Warm up the patient first, never do it on chilly patient or after meal; very weak person
2. If the nervous system is excited by fright , terror or annoyance
3. Short duration no more than 2 min, speed.
Best time: morning on rising
Exercise after, crucial to keep body warm, or return to bed
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Examples of Hydrotherapy as used by Priessnitz:
•Cold bath
•Half bath
•Sweating bath
•Falling or Douche bath
•Sitting or Sitz bath
•Foot bath

Follow @ndstudentsantos on Instagram for more about
⚕️Becoming a Doctor: https://www.instagram.com/ndstudentsantos/

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My path to Boucher began as a challenge to myself. I always wanted to be a doctor but always thought that I was not enough. After years of self-discovery, I decided that I was fed up with holding myself back and I took on the challenge to step out of my comfort zone. With my ultimate goal of “paying it forward” in mind, I look forward to the many years of absorbing information in order to challenge and aid my future patients to live healthy and happier lives

- Angeli Santos, 1st Year Student

Flour-less Chocolate Cake by Barefoot Brit

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Serves: 9 slices

Ingredients

  • ½ C dark chocolate

  • ½ ghee (sub: coconut oil, butter or vegan butter)

  • ½ C cacao powder

  • ½ C brown sugar

  • 3 eggs

  • 1 tsp vanilla

  • ½ tsp salt

Instructions

  1. Pre-heat the oven to 300°F

  2. In a double boiler, place chocolate and ghee together -- let melt

  3. Remove from heat and add cacao, brown sugar, vanilla, and salt -- whisk well

  4. In a small bowl whisk eggs together and then temper the chocolate dough into the eggs slowly and then incorporate the eggs into the dough

  5. Whisk until smooth (dough will be fairly thick)

  6. Put into a lightly oiled 8x8 dish

  7. Bake for 25-30 mins

  8. Top with powdered sugar, strawberries, and mint

  9. ENJOY!

Find more great recipes at BarefootBrit.com:
https://barefootbrit.com/

“Something that is a huge focus in my life is my diet! When I was diagnosed with Hashimoto’s thyroiditis, I had to change my diet significantly in order to live a more optimal life. Eliminating large food groups like gluten and dairy from my diet was a very difficult challenge (because who really wants to give up bread and ice cream!), but it allowed me to see significant changes in my health, which now makes me very proud to be someone that does not eat gluten and dairy. I have learned that having dietary restrictions is nothing to be embarrassed about, but something to embrace; it is what makes me unique. I hope that my page can help to inspire others to follow their health goals allowing them to live the life they always deserved!”  - Brittany Watters, 3rd Year Boucher Student

“Something that is a huge focus in my life is my diet! When I was diagnosed with Hashimoto’s thyroiditis, I had to change my diet significantly in order to live a more optimal life. Eliminating large food groups like gluten and dairy from my diet was a very difficult challenge (because who really wants to give up bread and ice cream!), but it allowed me to see significant changes in my health, which now makes me very proud to be someone that does not eat gluten and dairy. I have learned that having dietary restrictions is nothing to be embarrassed about, but something to embrace; it is what makes me unique. I hope that my page can help to inspire others to follow their health goals allowing them to live the life they always deserved!”

- Brittany Watters, 3rd Year Boucher Student

7 Take Aways from "Why We Sleep" by Larissa Van As

“If you know me well, you know I love to sleep. Yet, I've also grown up in the #grinding era where sleep deprivation is glorified. I've sacrificed sleep for studying (what student hasn't?) and competitively trained as an athlete after being chronically sleep deprived.

Last year, I stumbled upon Matthew Walker's book Why We Sleep and my poor classmates (who probably own earplugs now) have heard me rant on and on about how amazing this book is.  So I decided it was time to put together a list of the the juiciest parts.

The Sleep Debt 

If you haven't heard of Adenosine here is the down low. It's a neurotransmitter found normally in our brain. Adenosine rises as we wake up in the morning & causes us to be sleepy by bedtime. In contrast, levels of adenosine fall as we sleep. However, If (when?) you constantly are lacking sleep, adenosine is carried over to the next day, and the next, and the next. Creating something comparable to a debt. The idea is that sleep deprivation is additive, it collects interest. You can't pull an all nighter as a student and think you can "catch it up" with a sleep filled weekend.

What's MORE interesting is that the research on sleep deprived individuals shows that we don't even realize how fatigued we are. We think we are fine. The low level of fatigue, reduced alertness, and poor performance becomes our new normal. Sound familiar?

Why Do We Sleep?

Earlier in the night, we get more NREM sleep which consolidates information into our long term memory and finesses motor skills (athletes & gym rats take note). It also filters out the unimportant connections, and strengthens memory of important information. 

REM sleep i.e. dream sleep which occurs early in the morning hours has two functions.

One it allows us to recognize and understand emotional intelligence and social factors such as facial expressions, gestures and behaviours. It gives us the ability to control our own emotions and realize how others are feeling.

Secondly, REM sleep allows us to integrate experiences and knowledge throughout our lives to gain greater insight & associate seemingly unlike events.”

Read the full article here at www.NaturallyLarissa.com:
https://www.naturallylarissa.com/single-post/2019/01/14/7-Take-Aways-from-Why-We-Sleep

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References:

Lemoine, P., Nir, T., Laudon, M., & Zisapel, N. (2007). Prolonged‐release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. Journal of sleep research, 16(4), 372-380.

Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. Journal of Pediatric Orthopaedics, 34(2), 129-133.

Walker, M. (2017). Summary of Why we sleep: Unlocking the power of sleep and dreams by: Matthew Walker. New York, NY: Scribner.

Note: This blog post is for educational purposes. this is not medical advice. If you wish to seek out medical sleep advice please consult a qualified healthcare provider or ND.

"I want to be the doctor I wish I had as an athlete" - Larissa, 3rd Year Boucher Student  My story stems from my competitive figure skating career. This was my first LOVE! Unfortunately, low back pain & chronic groin tears became too overwhelming and I was forced to retire from the sport. What I didn't know was that my life after sport would be such a struggle. At 21 years old I was unable able to walk, sleep, and do every day activities without that nagging injury getting in my way. After years of chronic pain and many specialists, a wonderful naturopathic doctor solved what many others could not and taught me that much of my pain & injuries could have been prevented. She inspired me to follow in her foot steps so I can prevent others from experiencing the hard times I went through.

"I want to be the doctor I wish I had as an athlete" - Larissa, 3rd Year Boucher Student

My story stems from my competitive figure skating career. This was my first LOVE! Unfortunately, low back pain & chronic groin tears became too overwhelming and I was forced to retire from the sport. What I didn't know was that my life after sport would be such a struggle. At 21 years old I was unable able to walk, sleep, and do every day activities without that nagging injury getting in my way. After years of chronic pain and many specialists, a wonderful naturopathic doctor solved what many others could not and taught me that much of my pain & injuries could have been prevented. She inspired me to follow in her foot steps so I can prevent others from experiencing the hard times I went through.

Forest Bathing, Why Nature is Healing

Kim Niddery - 4th Year Boucher Student

Kim Niddery - 4th Year Boucher Student

Forest Bathing, Why Nature is Healing

Deep breaths of fresh mountain air, rosy cheeks, trickling tickles of sun through the trees, silence broken only by birds singing and twigs breaking beneath your feet. The moments you have outdoors force you to be present, and the thoughts that grab you are, ‘how great this feels’, and ‘why you don't do it more’.  Nature has a calling to us, it does something to us. You feel it when you sit on the grass in your backyard, when you go for a hike, or, like my fellow tree-planters, part of why you feel that draw to go back year after year. 

But what IS that exactly? What is actually going on in our physiology? And why is it something that everyone feels?

Like a mother to her little chicks, mother nature sees us. In our daily rat-race; stressed, depressed, overwhelmed, and overworked. Often we reach for technology, junk-food, medication, or material things to cure us of what we think will ease the pain and pressures of life. Now I do recognize that there are times when medication, or some sort of intervention is needed, but before you dismiss forest walks as an alternative prescription for what might ail you, “imagine a therapy that had no known side effects, is readily available, and could improve your cognitive functioning at zero cost” (Williams 2016), it’s called time in nature, and it’s science.

In a recent article in National Geographic, Florence Williams (2016) interviews cognitive psychologist David Strayer who sates that the antidote to what modern life does to us, is Nature.  Due to large scale public health problems that stem from too much time indoors, such as obesity, depression, and increasing amounts of near-sightedness, more and more scientists are looking at how nature effects our brains and bodies (Williams 2016).  With advances in neuroscience and psychology, scientists are able to quantify things like stress hormones, heart rate, brain waves, or even protein markers that “indicate that when we spend time in green space, that something profound is going on” (Williams 2016).

Nature works mainly by lowering stress, but as I try to emphasize with my patients that I work with as a student clinician, stress is nothing to scoff at. It may seem like cop-out term, but as I will discuss in a blog to follow, stress has the most profound ripple effects in the body. From your immune system, to your brain chemistry, to direct physical effects, relieving your body from stress will change your human experience and abilities.

“Shinrinyoku” is Japanese for a forest bathing trip, which is a short leisurely visit to a forest, and is seen as similar to natural aromatherapy (Li 2010).  A study was conducted to look at the effects of forest bathing trips on human immune function.  Through a series of blood and urine samples taken before, during, and after a 3-day/2-night trip to forest areas, they found that immune markers were significantly higher during their time in the forest, and that some markers stayed high for up to 30 days after the trip (Li 2010).

Beyond the benefits for mild bouts of depressed feelings, or difficult moments, time in nature has proven to be effective even for those diagnosed as having Major Depressive Disorder. Berman et al. (2012), conducted research on if walking in nature would be beneficial for people with MDD, and found that participants showed an increase in memory span, and increases in mood not associated with the memory effects.  Not only do people report these effects subjectively, but they can be measured and seen as well.

Researchers in Korea used a series of MRI images documenting the brain activity of people looking at a variety of different images (Williams 2016).  When volunteers looked at urban scenes, their brains showed more blood flow to the amygdala, which is responsible for fear and anxiety, yet when they saw natural scenes, their anterior cingulate would light up (Williams 2016). This region of the brain is responsible for empathy and altruism suggesting that maybe nature makes us nicer and more calm (Williams 2016).  Another group of researchers at Stanford also scanned the brains of 38 volunteers before and after they went for only a 90 min walk in either a large park, or downtown (Bratman et al 2015). They reported that those who walked in nature had decreased activity in the subgenual prefrontal cortex of the brain which is tied to depressive rumination (Bratman et al. 2015).

Not only can we measure the effects nature has on the brain, but our physiology as well. 

According to a study published in The International Journal of Environmental Research and Public Health, even just 2hours of forest therapy reduces blood pressure, lower cortisol, relieve tension and anxiety, and improve mood (Ochiai et al. 2015). 

In the National Geographic article, Strayer discusses how your brain is not a tireless machine, but something that does get fatigued. He states that after time in nature, it is like your mental windshield gets cleaned, and you perform better, become more creative, and feel restored (Williams 2016).

As the statistics tell us that we spend less and less time as a whole out in nature (Engelmann 2001), and as we spend more and more money as whole on public health initiatives, maybe we should consider that one of the cheapest and most beneficial actions we can take is literally out your back door. 

For some of us access to green spaces is not as easy as it is for others, but for your long-term health goals, it would be something to consider to put in your future plan. “Moving to greener urban areas was associated with sustained mental health improvements, suggesting that environmental policies to increase urban green space may have sustainable public health benefits” (Alcock et al 2014). So whether you budget for taking more trips into nature, or look to move into greener areas in the future, it might be something worth taking a serious look at.

Although science is starting to put these benefits into context and something that is measurable, there is still something mysterious about what being in nature does to us. This mystery is likely personal, and will never be fully tangible or understood, but I think I would like it to remain that way.

Even though we can now better understand what being in nature does to us, why we go out and seek time in nature is not because science tells us it is good for us, but because every single person out there knows how it makes them feel. We are a part of Mother Nature, and she is a part of us, there is no other reason we need to understand why she feels like home. 

She knows, and so do you.

Yours in health, 

Kim Niddery

 

References

Alcock, I., White, M. P., Wheeler, B. W., Fleming, L. E., & Depledge, M. H. (2014). Longitudinal effects on mental health of moving to greener and less green urban areas. Environmental Science & Technology48(2), 1247-1255. doi:10.1021/es403688w

Berman, M. G., Kross, E., Krpan, K. M., Askren, M. K., Burson, A., Deldin, P. J., & ... Jonides, J. (2012). Interacting with Nature Improves Cognition and Affect for Individuals with Depression. Journal of Affective Disorders, (3), 300.

Bratman, G. N., Daily, G. C., Levy, B. J., & Gross, J. J. (2015). The benefits of nature experience: Improved affect and cognition. Landscape And Urban Planning, 41. doi:10.1016/j.landurbplan.2015.02.005

Engelmann, W. (2001). The National Human Activity Pattern Survey (NHAPS): A resource for assessing exposure to environmental pollutants. Journal Of Exposure Analysis And Environmental Epidemiology, (3), doi:10.1038/sj.jea.7500165

Li, Q. (2010). Effect of forest bathing trips on human immune function. Environmental Health And Preventive Medicine, (1), 9.

 

Ochiai, H., Ikei, H., Song, C., Kobayashi, M., Takamatsu, A., Miura, T., & ... Miyazaki, Y. (2015). Physiological and psychological effects of forest therapy on middle-aged males with high-normal blood pressure. International Journal Of Environmental Research And Public Health12(3), 2532-2542. doi:10.3390/ijerph120302532

Selhub, E. M., & Logan, A. C. (2012). Your Brain on Nature: The Science of Nature's Influence on Your Health, Happiness and Vitality. Hoboken: Wiley.

Williams, F. (2016). This is your brain on nature: when we get closer to nature--be it untouched wilderness or a backyard tree--we do our overstressed brains a favor. National Geographic, (1). 48.