Hypertensive Retinopathy: The Naturopathic Juxtaposition of Practice Building
Arcoma L. González Lambert, ND
Naturopathic medicine is becoming a subspecialty of a subspecialty. We have the opportunity to pay attention to details that go unnoticed or are unimportant to other physicians. My objective herein is to encourage you to be a physician who asks questions no one else asks—giving weight to the consequences of diseases that most physicians dismiss as a foregone conclusion of aging—and an ND who sweeps the path of prevention with each and every visit.
Gaze Into Their Eyes
Hypertensive retinopathy is a disease process in which NDs can choose to make an amazing contribution, as we can truly prevent it. What we can do better than any other physician subspecialty is to treat hypertensive retinopathy at grade 1. Do we in practice actually look into our patients’ eyes? Would we ever look into our patients’ eyes if it were not for Current Procedural Terminology code 99205, a high-complexity visit? Probably not. So, what if I told you that you will be the only physician who will make a real difference in a patient’s vision for a lifetime? Would you then look into his or her eyes?
The practice of NDs varies somewhat in each clinic, but what we all do the same juxtaposes this disease process and naturopathic medicine. We each have a unique view of the disease process and the path to cure. We see “dis-ease” earlier, we treat with permanent solutions (nutrition, lifestyle, exercise, etc), and we know the natural route of returning patients to balance (Hering law of cure). We are uniquely qualified to prevent, detect in early stages, and reverse hypertensive retinopathy, while other physicians are busy minimizing, dismissing, and suppressing.
The most potent argument to encourage you to look into a patient’s eyes is that you will see the exact process happening to the small vessels all over his or her body. What you see inside the eye is occurring everywhere else but cannot be grossly felt because of the compensatory nature of the vital force. Grade 1 hypertensive retinopathy is characterized by generalized arteriolar constriction, seen as “silver wiring” and vascular tortuosities. These changes occur before the development of arteriovenous nicking, cotton-wool spots, flame hemorrhages, or swelling of the optic disks, and NDs can prevent all these advancements in the disease process. We have a unique opportunity to alert the patient to changes inside the eyes, show him or her how seriously we take these changes, and treat them aggressively with all the tools in our arsenal.
Study the Map to Vascular Disease
When I assess hypertension in a patient for the first time, I especially take note of the eyes. I know that this visit may permanently change the course of the patient’s health. I often use hypertension as a prompt to screen for vascular disease, and I tell the patient the story I see reflected in the retina. I discuss whether the patient is ready to see pictures of retinopathy from my laptop monitor via Wikipedia and other sites. I make heart disease and vascular disease real to them for perhaps the first time. I can show them what hypertension does to the vessels all over the body through this amazing window of the eyes. This is often a turning point, as the patient sees the consequences of diet, lifestyle, stress, and choices. It is the most awesome practice builder that I know of because a patient will not miss an appointment with the only physician who explains the body, shows the real changes, and listens.
I see a juxtaposition in naturopathic medicine, with NDs becoming the longer-visit, more natural version of the DOs. I am here to champion a release from this trend. We can reclaim our naturopathic roots. How we approach hypertensive retinopathy could be the flame of prevention that will change the course of a patient’s entire future. No longer will staging of retinopathy be just the 5-digit diagnosis code that we record in the medical record for insurance reimbursement. It will be the “kick-me” sign that patients have been waiting their entire adult lives for. It will be our chance to create a perfect partnership with patients based on prevention. Promise yourself that when shining the light inside your patients’ eyes, you will be the physician they hoped you would be.
Arcoma L. González Lambert, ND is an alumna of the National College of Natural Medicine, Portland, Oregon. She is an internationally recognized authority on avoidable causes of cardiopulmonary diseases, particularly unknowing exposures to industrial pollutants in air, water, the workplace (heavy metal exposures), and consumer products. After finding the true cause of illness, she is particularly adept at dietary, nutritional, exercise, and rehabilitation cures using the strengths of naturopathic medicine. She has been a consultant to the natural supplement industry for more than 10 years. She is medical director of a multidisciplinary clinic, is the chief financial officer of 2 businesses, and is working toward her US Parachute Association “A” certification in skydiving.