Why I marched?

I do not like to get political on here, because I want to be inclusive and accessible to all people. That being said, I was a part of the women’s march yesterday with my mother and I wanted to share my experience via a photo collection. I marched for myself, my mother, my family and friends, my future patients and clients, the athletes I coach, women who could not march themselves, and all men who have women in their lives in some way (which is all men). Portland had a crowd of approximately 100,000 people and it was so motivating to see so many different backgrounds, personal stories and reasons behind their choice to march. I hope through my photos you too can join a group or get involved in some cause/political action/etc., because the only way to ensure change in a way that you would like to see is to get involved yourself.

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Getting ready to march with momma

We made all our signs!

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And then got our picture taken multiple times

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The march was bigger than any of us imagined! Photo credit: Edwin Vega

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Photo credit: Carla Janelle

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At the end of the day we went home and found out we were on the news.

However you march or get involved, DO IT NOW! There is no time to wait. If I can take time away from medical school, you can too! 

Naturopathic Medicine Week -Treat the Whole person

In honor of Naturopathic Medicine Week, I am trying to post a little bit every day about Naturopathic Medicine… what we do, how we do it, and who we are!

Today during shift, I was reminded how important it is for us as doctors to look at the whole patient and treat the whole person not just their symptom or their disease. I mean hello people, a person is not just a cough or fatigue, there is more to that story. In fact, treating the whole person is one of six Naturopathic Medicine Principles.

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6 Principles of Naturopathic Medicine

How does this look one might ask?

Let’s say a person has stomach pain. There are billion things that stomach pain could be ranging from really acute, scary things to other things that are much more benign. All medical doctors (in theory) should be able to ascertain the type of pain and obtain a history about the symptom, do a physical exam, and ideally diagnose the patient with the disease or condition. But sometimes, often times more than we would like to admit, the pain is just pain and we do not have a great medical explanation behind it.

Now many doctors (including Naturopathic doctors) would just treat the symptom so the person has relief and hope that it resolves on its own. BUT!!! and this is a big but here folks… that does not treat the underlying problem. A Naturopathic doctor is charged with the goal to not only fix symptoms and figure out the condition, but to try to help correct the underlying reason that the person had the symptom or condition in the first place. This often means stepping away from the focus on a symptom and looking at the whole person…

  • What do they eat?
  • How do they sleep?
  • What are their stressors? How do they deal with them?
  • Do they have other symptoms?
  • What is their lifestyle and environment like?

The Naturopathic Physician is allowed the time to look at these underlying lifestyle issues that often cannot be addressed during a quick visit. This allows us to help the person heal themselves and hopefully avoid having to continue treating the symptom over time.

Homework Assignment!!

I am ‘assigning’ homework for anyone who is interested in supporting Naturopathic medicine, learning more about it, or wanting to do something Preventive for your health…

Take a picture of yourself with something that you would consider preventive health. This could be eating an apple, going on a walk, taking a nap, laughing with friends, getting a check up at the doctors, drinking tea, or more… take that picture and post it to your blog or social media with the caption “Naturopathic Medicine Week” or hashtag “#naturopathicmedicineweek”. If you do not participate in social media, but want to participate comment in the comments below your Preventive Health picture. 🙂

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#nmwNUNM2016 #naturopathicmedicineweek Drinking water after a long day

Naturopathic Medicine Week – Establish the Foundation of Health

Hey everyone, it is Naturopathic Medicine week from October 10-16th!

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One of the amazing things about being a Naturopathic Physician is the wide array of modalities (treatment options) that we have to choose from to help our patients become the healthiest versions of themselves. Today I have been spending most of my day on one of our most basic, but arguably the MOST important treatment modalities, NUTRITION!!!

Nutrition would fall under the therapeutic treatment order category of ‘establish the foundation of health’, which essentially means to help the patient build his/her health foundation without any additional supplements, herbs, medications, etc. This category also includes items like sleep hygiene, basic hygiene, exercise, stress reduction techniques, and more.

To learn more about the Therapeutic Order and Naturopathic medicine, check out the AANMC (Association of Accredited Naturopathic Medical Colleges) website.

One nutritional assessment I like to have people do, is a self reflection on their feelings surrounding health, nutrition, and food. Often times we have underlying feelings about food/nutrition/health/body image that prevent us from obtaining our ultimate food/fitness/health/weight goals. Some example questions I have people fill out are listed below.

  • What is your food philosophy?
  • What routines do you have for food and eating?
  • What dietary goals or changes do you wish to make in your life?

After that, I then recommend people complete a diet diary (track everything they consume for 3 days to 1 week). I then use this date to do a comprehensive dietary analysis on the person and help them see where they are meeting their dietary goals and where they are missing the bar. Having this data is helpful before going into a large dietary change and people are able to track their own dietary changes overtime, seeing their nutritional improvement with their own eyes.

If you are interested in working on your diet or other foundations of your health, then find a local Naturopathic Physician in your area and schedule an appointment! You can also track your own diet at home using one of my free online diet tracking tools such as: Cronometer, My Fitness Pal, or any others you may find.

My name is Emma Petshow and I am a 4th year naturopathic medical student at the National University of Natural Medicine in Portland, OR. For more about myself, check out my bio or my LinkedIn. This blog is intended for information about preventive health and lifestyle improvement. The information contained on this blog is not to be used as medical advice. For specific medical advice you should consult your physician.

Naturopathic Medicine Week

Celebrate Naturopathic Medicine Week by sharing your knowledge or experience with Naturopathic Medicine. If you do not know what Naturopathic Medicine is then ask! Ask a local licensed Naturopathic Doctor (they will have the letters ND or NMD behind their name), check out the American Association of Naturopathic Physicians website, or ask me! 


More to come this week about the profession, who we are, what we do, and how you can access healthcare services! 

Back Pain – Fact or Fiction Video

This is an interesting video regarding facts and fiction of back pain and how it affects patient care and outcomes…

It is about 15 minutes long, but worth the watch. Chronic pain is an issue for many Americans, especially back pain. This video gets at the Naturopathic doctors’ goal to identify and treat the root cause and do no harm. The professor looks at pain from a different lens.

My name is Emma Petshow and I am a 4th year naturopathic medical student at the National University of Natural Medicine in Portland, OR. For more about myself, check out my bio. This blog is intended for information about preventive health and lifestyle improvement. The information contained on this blog is not to be used as medical advice. For specific medical advice you should consult your physician.

Nicaragua Medical Mission – Healthcare Part 4a

This is part 4 in my 5 part series on healthcare in Nicaragua. I did not realize how much I had to say about the different types of conditions in Nica. Since my post started looking more like an essay than a blog post, I have broken it up into a few pieces. Sorry it is such a lengthy one, but I wanted to be sure and discuss all the main healthcare issues seen in the country.

Conditions and Types of Treatment

Now to the fun part…. what kind of conditions did I see and treat.

<Please note that I am going to be vague regarding the patient description to protect the medical information of those individuals.>

1. Infection, infection, infection

The most common illnesses that were seen in the clinic were infections of all sorts. In Nicaragua, especially rural Nicaragua, most infections are bacterial in nature vs. in the USA they tend to be viral. Patients would come in complaining of difficulty breathing, cough, runny nose, or chest heaviness and upon listening to the lungs you would hear consolidation or according to the Nica doctors a “whoosh whoosh” sound. This to them meant infection, most likely pneumonia although they never did the follow-up labs/imaging to check for sure, and the proper treatment was antibiotics, NSAIDs for pain/fever, and vitamins once the infection was over. Most of these were seen in children, but some in adults as well.

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Getting ready to see patients in the clinic.

Along the theme of infection includes ones of the stomach or GI tract. Many patients come in with stomach pain, nausea/vomiting, or diarrhea (lots of diarrhea). After providing a stool sample and receiving a blood draw they would return with the results to be interpreted. More often than not patients would either have a high Eosinophil count (leaning towards allergies or parasites) and/or some type of bacterial culture in their stool (often E. Coli). While in the USA bacterial infections of the GI tract are not common, patients in Nica have the deck stacked against them.

The water supply is not purified, so many patients drink un-purified water. Also, the hygiene practices of washing hands and proper bathroom hygiene is not emphasized or even known leading to an increased chance of exposure. Lastly, the food in Nica is grown with un-purified water and washed in it as well contributing to potential exposures. Typically the treatment is an antibiotic, anti-acid (which does not necessarily protect from future infection, but it is a commonly practiced prescription to give for this diagnosis in Nicaragua), possibly a fever reducer or pain relief (Tylenol or Ibuprofen), and vitamins.

  • Probiotics are not prescribed although this would be protective from future infections. The clinic does not have access to probiotics to prescribe to patients. Also, there was a lack of understanding on the physician’s part regarding healthy/normal gut flora, which could be the result of a communication barrier or lack of this information being widely accepted in Nicaragua. 
  • I was taking a probiotic while in Nicaragua, to help prevent parasite/bacterial colonization in my GI tract by lack of space. The idea behind it is that if I fill up all the space for bacteria to adhere with ‘good’ bacteria that is commonly found in the gut, then the ‘bad’ bacteria that causes infection has no place to hang on to. When I tried to explain that, their response was, why would you take bacteria to avoid infection. 
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In such a beautiful country there is unfortunately a lack of infrastructure leading to increased incidence of infection and disease.

The last and probably most common infection that was seen in the clinic includes urinary tract, kidney, and vaginal infections. I combine these together, because often women who had one had the others and most of the men that came in with urinary infections they were advancing to kidney infections. These patients most often came in with the chief complaint of “chistata”, which is a local Nicaraguan word that means urinary symptoms or pain. Again the prevalence of urinary tract infections is partially associated with poor hygiene practices (either lack of using toilet paper completely, wiping from back to front, and/or decreased bathing), lack of water intake (with the heat in Nicaragua and the humidity it is easy to become dehydrated, which increases the incidence of vaginal/urinary infections), and lack of condom use or other forms of protection as well as high risk sexual behaviors. These patients would have a UA (urinalysis) done as well as a urine culture (and vaginal discharge culture for female patients). At the visit the doctors would interpret the results of the ‘exam’ and prescribe the appropriate antibiotic based on the type of infection (Bactrim for kidney/urinary or Clindamycin for vaginal). Often for female patients they would prescribe Monostat cream for fungal infections and overgrowth. Also, patients would receive pain medication and vitamins.

Infections are a commonly diagnosed thing in clinics in Nica due to the lack of hygiene, lack of infrastructure for pure water and good food, close living quarters, and lack of sexual protection and high risk sexual behaviors. The common treatment is an antibiotic based on the type of infection (not the bacteria involved but rather the location), pain reliever/fever reducer, and vitamins for after the infection resolves. Main differences between the USA and Nica in the diagnosis and treatment of infections include: 

  • Less emphasis on diagnosing the specific bacteria if it does not change the treatment vs. needing to be as specific as possible due to providing the most effective treatment and decreasing physician liability for incorrect treatment.
  • Decreased focus of lifestyle factors that contribute and lead to these infections partially due to lack of infrastructure to solve these issues vs. discussion of lifestyle factors with  the ability to change them. 
  • Treatment that is focused on resolving the infection, but antiquated information on adjunctive treatments vs. encouraging probiotics and other treatments and therapies that help support the system while it is fighting off the infection.
  • Antibiotic heavy prescribing vs. antibiotic light prescribing.

Overall the patients in the clinic were all very sick and needed treatment for multiple medical conditions. Other medical conditions that will be discussed in the rest of this blog post include: allergy, chronic kidney disease, anemia and other illnesses. 

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Doctors, future doctors, and missionaries in front of the clinic.

My name is Emma Petshow and I am a 4th year naturopathic medical student at the National University of Natural Medicine in Portland, OR. For more about myself, check out my bio. This blog is intended for information about preventive health and lifestyle improvement. The information contained on this blog is not to be used as medical advice. For specific medical advice you should consult your physician.

Nicaragua medical mission – Dias dos

I’ll be brief because I have to run this morning and eat breakfast before leaving for the clinic that I am working at in Leon!


Yesterday I got a tour of the city of Managua and had an orientation to the organization that I am working for. It was a day filled with new food, love, information, and a whole lot of Spanish.

One thing of note regarding health, since this is a health blog… There are not a lot of fresh fruit and veggie choices here. I didn’t realize how blessed I am in the states to be able to grab an apple and eat it without worry. Food for thought! 

More later tonight after my first day in clinic!