You may remember the NABD list from the holidays. Not. A. Big. Deal. That is a big term in our house with two small kids and two busy adults. Triaging what is and is not a big deal is a daily practice. 

It is important to know, however, that there are B.D.s as well. Big. Deal. This past week the Big Deal was being stranded on the side of i-70 with my two small kids and a flat tire. It put a few things in perspective. 

Isn’t it funny how there are warning signs that we know in our heart of hearts? We know we need to listen, but we often don’t until the yellow warning becomes the red brick wall of life that stops you in your tracks. 

What is a B.D.? Your health. You know this as soon as you don’t have it present any more. When your health gets buried under disease.

This was what I loved about hospital work. There are a lot of people when their health is done with yellow warnings they end up in the emergency room. If you have been privy to a night in the hospital, you know there is a lot of time for reflection. As a physician, if I would dare ask, I would hear that there were warning signs along the way. Patients would tell me, “I knew my blood pressure was a little too high” “I knew I needed to start working out again” or “I could tell something wasn’t right”. 

My car gave me a warning sign too. I was busy shuffling kids around after work and getting them to gymnastics. I did not pay attention to the warning signs. I kept pushing. I am really good at pushing through. Sometimes, I am forced to listen. 

Driving on i-70 at full speed going to gymnastics the tire went flat completely. Luckily, I was close to the side and was able to get off the freeway safely. As is typical with three years olds, my son was in the middle of having a fit about going to gymnastics (ah, children). Sitting in the car inches from the slow lane the trucks and cars seemed anything but slow. I turned around and was serious with my kids. We were in a Big Deal situation. 

To make a long story short, I got the kids safely onto a frontage road. Three wonderful people came to our aid and we got the tired changed and headed home. After the experience (and then getting back on a busy freeway), I got off at the next exit and pulled into an apartment complex. I parked the car and crawled in the back with my kids. We hugged and cried and laughed and hugged and cried and laughed. We put on our favorite song and drove home. 

Life is great at giving us second chances when we don’t listen. Our bodies, minds and spirits are amazingly resilient and when we forget to take care of ourselves we can often get up, brush our selves off, and try again. 

I always feel like I have a lot of work to do. I love doctoring. I enjoy running my business and teaching. I love being a mom and a wife. Sometimes these jobs have demands that conflict with each other and somehow, the easiest person to get lost in the shuffle is me. 

After the B.D. this past week, we came home and I played baseball with my son in the back yard. I walked “toddler pace” with my kids to school and giggled with them as we tried to outrun the falling snow under the tress. Fiona termed these “popcorn trees” as the ice and snow rained down on us and jumped back up from the sidewalk. I watched as my son just sat and stared, eye to eye with a vibrant pink blossom. I resisted the urge to tell him to “hurry up” or that we “had to go”. We were both captured in the moment. 

It is spring. What garden needs tending? Your mind? Your body? Your spirit?

It is time to wake up from the winter doldrums. To shift the habits we have formed in the rut of winter’s snow and mud. Time to ask, “What needs my attention today?” 

Life is not about being perfect and every day doing every thing. Its not about mediating daily and exercising 5 days a week, eating 5 fruits and 5 vegetables, spending time with family, getting work done, sleeping enough AND…..

If we can pay attention long enough to the small, inner voice we might hear a totally different story. We might hear: “Slow down, take it easy, play”. Today might be blend of doing one of the things we know we need to do for ourselves and giving ourselves permission to let go of “the list” itself. 

Isn’t it time we started to pay attention to what our health— body mind and spirit— thinks is a Big Deal and what is Not A Big Deal? 

Cheers,

Dr Brie

Today I finished teaching for the semester at the Rocky Vista Osteopathic Medical school where I’m an Assistant Professor. I teach first-year medical students and the final exam is a pass fail test called “competency testing” where they diagnose and treat each other while the other faculty and I observe. For the students, it’s a nerve racking experience. For me, it’s an osteopathic marathon. 

Many of you see students in the clinic. You may wonder who they are and how they got there. Perhaps you are not sure what really makes D.O.s different from M.D.s, especially if you have not had an osteopathic treatment. So here’s a little story on how an Osteopath is born. 

First, we take a bright college student who took a lot of tests and did well enough to get into medical school. Then we teach them how to feel and think. 

Here’s what we taught the students at Rocky Vista in their first year in the department of Osteopathic Principles and Practice: 

1. How to feel
   First we teach students how to feel the layers of the body. To represent different tissues we use corn starch and plastic wrap between layers of sheets. By the end of their first lab, the students can feel the difference between the vein, artery and nerve next to each other in the crease of a partner’s elbow. 
2. Functional anatomy
   Typically in med school we learn origin and insertions of all muscles, ligaments, tendons and then name nerves, veins, arteries and bones galore. The founder of Osteopathic Medicine, A.T. Still, D.O., said the three legged stool of Osteopathy is “anatomy anatomy anatomy”. This year, before the students had their traditional anatomy dissection class, we started teaching functional movement-based anatomy. Instead of focusing on how the hip bone connects to the knee bone, we asked students to think: what muscles would need to fire (and which you’d need to relax) to complete the action of pulling your knee to touch your nose? 
3. Techniques
   We group treatments into direct and indirect techniques. For example, imagine a patient who woke up in the morning with a kink in her neck and she can’t look over your left shoulder without excruciating pain. In a direct technique you as the doctor asks the patient to turn your her right to the edge where it is sensitive but not too painful. From there you either help the patient stretch through that pain barrier little by little with the right muscles (using the “muscle energy” technique), or you have her quickly move through the barrier with a specific vector to help the misalignment re-align (we call that the “high velocity low amplitude” technique - this is the one that you may be familiar with from chiropractic). Indirect techniques go into the “direction of ease”, one of my favorite concepts in Osteopathic medicine. In the example, you would move your neck all the way to the right, the way it likes to go, and relax completely. Magically (or so it seems—it’s actually related to muscle, brain and nerve physiology) this slowly allows the tight muscles and fascial on the left to reset and the barrier transforms. Indirect techniques we taught this year are termed counter strain or myofascial release techniques.  
4. Tensegrity
   This is a concept I taught this past month. It comes from architecture and engineering and has been applied to biological systems by Donald Ingber MD, PhD and other scientists. This is a concept that illustrates the amazing connectivity of our bodies. It’s not just a saying that we are all connected—it’s actually true! By observing the cellular cytoskeleton that defines a cell’s internal structure, we see that chemical conduction and gene expression itself can be influenced by the environment that surrounds. Translate that to the continuous tension and discontinuous compression systems of the body between fascia, bones and ligaments and suddenly the impact of a sprained ankle on the downstream effect of shoulder pain makes sense. 

Today, after ten short months in the classroom, the students amazed me. Competency testing can be challenging for the students who internalize the idea that they must be perfect at everything (like I did in med school) or for the ones that blow off true osteopathy. But under the layers of nerves were students who were really feeling and changing the physiology of their classmates. Bones moved, ligaments relaxed, muscles that were too tight let go. Next year the students will learn advanced techniques and start treating more and more clinically. This year we helped them to build a foundation. 

It’s true, only about 20% of the students will graduate as Osteopaths and go on to use the manual skills they have learned. But in their 4th year I can tell they still have their placatory skills. I know they will be better surgeons because they can feel still feel fascia and understand functional anatomy. They ask deep questions when taking a medical history because they understand that looking at the whole person is part of what our founder, A.T. Still D.O., called “a rational approach to treatment”.

I wish more of our Doctors of Osteopathy (D.O.s) could keep these skills honed through training and clinical practice. It is a clinical skill like any other that some are innately good at and others have to practice a lot to do well. I wish our medical system fostered the students to keep looking at the body this way. That is why you see students in our office on rotation. We want to teach them to look at people always as a good doctor will and see not just body - but mind and spirit. Dr Lisa is my “adopted D.O.” colleague—and friend—because she sees the whole person in context of their life. She considers stress, nutrition and exercise in her approach. A Doctor certainly doesn’t need to be a D.O. to think holistically. ​

Thanks for being a part of teaching every day you let a medical student tag along with your visit. You can always say “no, not today”. When it is ok to say yes, know that you are part of shaping a future Osteopath who might one day write a blog that incorporates all of our tenets without even realizing it until the end. It was the tenets of Osteopathic Medicine that attracted me to the profession when I was 19. Nearly 20 years later I believe in Osteopathy even more than ever.  Congratulations future Osteopaths of 2021. Welcome to second year.

The Tenets of Osteopathic Medicine express the underlying philosophy of osteopathic medicine and were approved by the AOA House of Delegates as policy.​

1. The body is a unit; the person is a unit of body, mind, and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance.
3. Structure and function are reciprocally interrelated.
4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

In the summer of 2009 Dr Lisa Nguyen and I headed up to the mountains on our residency retreat weekend.  We had car pooled together and we were listening to 1980s music on the radio. I was singing along. She was not. We had just met, fresh out of medical school headed to Swedish Hospital together to start a career in family medicine. On our drive up we shared our journey. It was then that I learned that, as many doctors do, Dr Lisa had gone straight through from undergraduate school to medical school and how now landed in the middle of residency in her mid 20s. I, on the other hand, had a more wandering course taking a year and a half off between college and med school to travel, study botanical medicine and live on the beach.  

After two years in residency, Dr Lisa and I were both voted into the leadership position by our peers and faculty at Swedish called Chief Resident. In the life cycle of a medical path there are many stages: college, MCAT (big test), med school with two years of course work and two years of clinical work. (this is the stage that the students you encounter at our office are in). 

Then there is this computerized match program that decides your "entire life", or where you will spend your residency years, the most intensive part of your training.  That is where Dr Lisa and I fatefully met.  For family medicine doctors this part is three years and the first year is called your internship (queue memories of Grey's Anatomy season one). 

The next transition seems like the "end" but it is really the beginning. Going into practice is perhaps the biggest leap you take as a medical professional.  No longer within the safety of your training cocoon, now you are a big doctor on your own and your wings are not yet developed.  Dr Lisa and I decided to take that last leap together when we opened Whole Family Health at Belmar for HealthONE right after we graduated. 

When HealthONE decided to close our practice, Dr Lisa was left with a decision: keep going on the medical treadmill to the next job or take the break she hadn't had since....summer vacation in college?  She was just getting married, without any kids or pets, and she decided it was time.  Dr Lisa started by studying medical acupuncture the summer before her big trip.  Then, in January of 2017 she went to China for three months learning more about acupuncture by practicing it. This started the sabbatical year that brought Dr Lisa and her husband around the globe.  They included a bike ride from Lisbon to Budapest, with a culinary exploration in each town.  By the end, they had made a small footprint on nearly every continent. 

After she spent a few months working in Oregon last fall, Dr Lisa and I got together and started talking about working together again.  I am elated to say that once she got back, we made it happen. 

This week, Dr Lisa Nguyen will start seeing patients at Direct Osteopathic Primary Care. She will expand our clinic availability by adding appointment time on Tuesdays, Wednesdays and Fridays.  Dr Lisa will add to our services with acupuncture treatments for $55 for members and $70 for non members.  In fact, for your first three treatments as a member you get $10 off per treatment so try it!  If you stay tuned, you'll notice other exciting membership perks we have in the works. Read a special message from Dr. Lisa here.

I am honored and blessed that my best friend, and my favorite medical professional, is joining us.  I know you will find the compassion, easy going demeanor, and intelligence of Dr Lisa to be a perfect fit for DOPC.  Now is the time to send a friend or a family member to join us!  In fact, at our last practice that is exactly what I did when I sent my parents to Dr Lisa!  We can now double our capacity and continue to make Direct Osteopathic the place where doctors get to be doctors (instead of corporate automatons) and patients get good care (the old fashioned way, by partnering with a provider they trust). 

Refer a friend and get $20 off your next invoice with us.  

Cheers to growth and expansion this Spring,

Dr Brie