Travel Nurse Turns to Career in Functional Medicine

[Ashley Hay, BSN, RN, BSN, RN]

Her compassion for oncology patients was clear, however, exposure to a nurse practitioner program with a focus in integrative medicine began to change her course. After dedicating the first twelve years of her nursing career to oncology care, Bryant found herself increasingly interested in a field foreign to many healthcare professionals...functional medicine.

How did you first learn about functional medicine?

"I seem to naturally gravitate towards alternative medicine. I have always hated the statement 'there's nothing else we can do', I believe that there is always something to be done if you just shift your focus a little. I learned about functional medicine in my first nurse practitioner clinical rotation with Dr. Cheng Ruan. He put a name to my developing medical philosophy. This rotation was the turning point in my career from traditional to functional and it seemed to be right in line with the way I wanted to practice medicine." Bryant adds, "Functional medicine focuses on the root cause of disease rather than symptoms. It is like lifting the curtain on chronic disease, once you do you can never go back to just treating symptoms. The body is an amazing thing, when you give it the fuel it needs you can do so much more than just put a band aid on health problems. I work with an amazing group of people collaborating in the care of many complex and seemingly 'hopeless' cases. Most patients I see have been to several different doctors from specialists to naturopaths searching for an answer."

Tell us a bit more about the types of patients you currently treat.

"One example would be someone who has complained of debilitating fatigue for most of their life, however, lab work and traditional diagnostic tests can find nothing wrong with them," Bryant states this theme is common amongst many of her intakes. "Fatigue is a vague symptom with a lengthy list of possibilities. The functional medicine approach focuses on repairing foundational defects that may have led to the development of the disease.

"A diagnostic workup for this type of patient might begin with laboratory (serum) testing of:

• Thyroid function
• Hormone levels
• Glucose regulation
• Cholesterol
• CBC
• Liver function
• Fatty acid levels
• Autoimmune panels
• Food/environmental allergies
• Micronutrients (this test examines how the body uses each vitamin, mineral, and amino acid)

Bryant continues to explain, saying, "Testing gets more individualized from there, mostly in the direction of investigating possible environmental toxins that can many times be at the crux of chronic disease. Another avenue that we often explore is to look at an individual's genetic SNPs (also known as single nucleotide polymorphisms). These are variations in genes that affect the way the body processes internal and external toxins, (like heavy metals or BPA). Treatment plans can be personalized from these tests once you have identified where the holes are."

Can you explain the focus on the gut? Many avenues of medicine seem to lean in that direction recently.

"Functional medicine can be as complex or as simple as you make it. The truth is, most issues can be improved by healing the gut. Digestion and elimination are the mainstays of treatment initially. Without repairing the integrity of the gut and absorption of nutrients it is extremely difficult to correct larger issues. This is why traditional management of chronic disease only works for a limited amount of time. If you don't address the soil, the tree can't grow strong," says Bryant.

Let's talk about your current NP role. What are your daily responsibilities?

"I am a primary care provider at the Texas Center for Lifestyle Medicine with a special focus on issues with detoxification. Impaired elimination of everyday internal and external toxins is at the heart of every chronic disease that we know of. My job is to identify where the impairment is and optimize the patient's diet and lifestyle with personalized protocols to help the body function like it is supposed to. Although detox usually ends up being my main focus, I also provide traditional primary care services such as preventative screening referrals, physicals, and sick visits."

Bryant also had many years of infusion nurse experience, having worked in many outpatient chemotherapy infusion centers. She was expected to use her expertise to develop the infusion center, a complementary offering to the existing functional medicine clinic.

When asked about taking on that role she states, "I had to quickly shift from my nurse brain to my undeveloped business brain."When discussing struggles with adapting to her new role in a new specialty area, Bryant states, "Transitioning from nurse to nurse practitioner has been a challenging new frontier. The safety net has gotten further away, and the responsibility has gotten closer. Practicing primary care with a functional medicine twist adds another layer of complexity. This field is fairly new and guidelines are a bit more gray than traditional medicine. There is no mundane, you always have to be creative and work with the patient to develop a treatment plan that works for them. I compare this process to staring at a magic eye picture book. You have to stare at each case and slightly 'unfocus' your eyes in order to see the pattern and identify the hidden picture. This is an art form, and I feel very fortunate that I have the opportunity to develop my craft among like-minded practitioners who I can learn from."

Were you given any helpful guidance throughout your nursing journey?

"Mentorship is an important and necessary component to any new role. I am eternally grateful for the teachers I have met along my career path. My mentors have come in surprising packages; patients, coworkers, nurse managers, family, doctors."She adds that one preceptor, Dr. Ruan, helped foster professional confidence while opening her eyes to the world of functional medicine. "He was an internal medicine physician tired of practicing within the constraints of mainstream medicine. I was hooked immediately, watching how he practiced medicine using a lifestyle approach. It was amazing to see a doctor focus on more than just diagnosing and prescribing. He was just starting out in functional medicine and in the process of opening his own clinic. Fortunately for me, the timing was right to jump on the bandwagon. I quit my job after that rotation to help him open his clinic."

What is one important takeaway for others who are looking to dive into a new area of nursing?

"This experience has highlighted the importance of having a mentor that sees a potential in you that you don't always see in yourself right away. I would not be where I am at right now without standing on the shoulders of people greater than me who have taken the time to support my growth. I only hope I can do the same for someone else in the future."

[NAtoRN]

I am very interested in functional medicine. I will be starting nursing school in August 2018. I currently work as a nurses aide on a med/surg floor. Working at the hospital makes me even more interested in functional medicine. Prevention is a much better way to tackle heath problems. Do you have any suggestions? I'm thinking that I should become an RN first, get experience, and then try to get a position in functional medicine.

[Ashley Hay, BSN, RN, BSN, RN]

Thanks for reading! I'm glad to read of your interest in functional medicine too. As a HCP I find it a fascinating field of study. If you want to learn more, I'd recommend checking out the Institute for Functional Medicine Website (The Institute for Functional Medicine | Information and educational seminars and conferences on functional medicine.), they have a conference coming up in June related to autoimmunity. I'd say that seeking out any knowledge of specialties in addition to one's nursing expertise makes you a powerhouse of information. Having a nursing degree as your baseline is a great idea. Nursing is so versatile, you can branch out in to many different sectors of healthcare from there. Good luck!

[Gods_nurse]

Thank you for this article. Wonderful read!! I'm new to the idea of functional medicine. What is the take on insurances for that?