Sunday, August 28, 2016

Inspire / Expire

This is the second time within a few months I have visited this place to pay respects to people (younger than me),,,both dedicated their lives to helping others.  Through the sorrow of the homily, I remember the words "its not how long you live but more importantly how you live life".

Last week I was throwing a diva tantrum in my brain thinking I have no time.  I was working 12 hour days, missed hugging my son good night, listened to alot of unhappiness during doctor hospital contract meetings, hardly spoke with my best friend/partner for life, painfully documenting hours of patient encounters in a computer system that was updating its servers, unable to work out or hike...thank god I had Davidji and his newest guided meditations to help ground me.  In fact, when I start to catch myself stepping onto the pedestal of ego to accept my diva award.....I just think back to the casket at the front of the funeral home carrying the lifeless remains of someone that was near and dear to humanity. A lifeless body with makeup, a favorite garment, a watch that stopped ticking....surrounded by pictures that celebrate joy, love, excitement beauty....the reason we get up everyday to a new sunrise ready to live life.  I stimulate my frontal lobe to conjure up, what would it be like if I was there, would my pictures say I was happy, did I contribute to the universe, would my kids be able to fight back the tears with memories of spectacular experiences with me?  Did I do my part to make the world a better place?

Passages in some of the oldest books of wisdom paint the picture that we are crude vessels that temporarily carry and express the energy/spirit/breath of the universe.  Eventually we surrender the vessel back but the spirit rejoins the universe to continue existence as nature or a sunrise or an inspiration (inspire and spirit both come from the same root word of breath).  Right about now some of my atheist readers will be rationalizing that nothing spiritual can be proven ...... but I am pretty sure even the most concrete thinking non believer will get to a point in their journey when they yearn for a higher power to help take the last walk.  As a doctor I have been witness to it many times, the sense of calm that comes over the sufferer.  Whether it is preceded by the most searing chest pain imaginable OR persistent difficulty in catching a breath to to point of passing out OR being wheeled away by the anesthesia guy into the operating room and saying the last goodbyes to family and friends OR  being taken off life support just in time for family and friends to wish a bon voyage OR getting the last morphine dose...there is usually a point when the anguish and facial grimace are replaced by peace and a face that just resembles sleep.  I believe that is the point when the universe fills our lungs with calm...we get to see the big picture that our lives are temporary expressions of the same energy on borrowed time.  The crude material that makes up flesh and bone isn't important, what matters is the way the universe pumps life into the vessel to play the music that would only exist on paper.

When we go through life day by day, just to get a paycheck, or live for Friday when we can go out and get wasted, or refuse random acts of kindness assuming someone else will do it...we don't allow the expression of the music inside us.  Its not that we are obliged to contribute to the universe and support life, it is in our DNA to express life and support the symphony with our individual musical notes.  In ayurveda its called dharma, purpose in life.  We cant find it in a formula or in a book, you just get this overwhelming feeling of peace when your doing what the universe created you for. I think its the same peace we can experience right before our last breath when you accept the universe back in and surrender the vessel back, well I feel in my heart that when you find your expression of energy/spirit/breath, a sense of calm and joy rewards your actions by unraveling DNA to give you such a natural high.

I think its easy for us to put the blinders on and just physically go through the motions of an 8 hour work day, get home, have a drink, watch mindless TV and go to sleep.  The point to ponder is are you feeling fulfilled?  Are you happy? Have you found your purpose in life?  What will your homily be like...did you contribute?  did you suffer? OR did you live your life hair on fire, driven to express yourself just living with an endless source of energy that seems to be a beacon for others to also search out for their individual expression. Aim to breath your last breath full of energy, creativity and peace....INSPIRE.

(try this exercise link)

Saturday, August 20, 2016

Detox you Brain

It’s so cool to witness when people / patients find a way out of suffering. Even if not labeled with an injury, infection or inflammation...when getting into a “good stride” - the eyes get brighter, shoulders go back, chest comes forward, belly gets flatter- even the voice gets full with power and creativity. All those Chakra / Energy points of the body LIGHT UP and I can see a change in the way a person is interfacing with the world. Most of us have witnessed when someone walks into a room and makes heads turn, (not even wearing expensive things, or being handsome, pretty, tall, loud...). It’s usually that person who is magically silent but charismatic and carrying an aura of confidence . You just want to take a few steps closer and listen in or investigate “who what and where” this person is about. Like wandering closer to a crackling campfire in the midst of a cold night.
It’s kinda what happens when you find a good diet, a rewarding exercise routine, a sleep-full night, or even a certain way to correct posture just enough so that annoying muscle ache can stop for a few seconds. What I find is universal with this “good stride” is that it is usually preceded by a stuck time in life followed by a “detox”. Detoxing the gut, detoxing the liver, detoxing the blood, the detox diet, rinsing the nose, clearing the breath, scrubbing the skin...we’ve all done our versions of this and felt a little better afterward. Sometimes to the point of feeling refreshed, sometimes to the magnitude of being “on fire” with energy. Alot of people forget to do the one part of our bodies that really need it the most...Detoxing the Brain.
The brain weighs about 3 pounds, is composed of tissue that does not break down (compared to skin cells, blood cells, sperm, eggs......) and is the only organ that can continue to grow and evolve even into old age. Physically we cant’t really detox the the 100,000,000,000 neurons that make up the brain. BUT if you look at what those neurons do...they use chemical messengers to set up an electric charge and through that action, a thought is created and stored in the frontal lobe. This is what sets the human species as being on top of the evolutionary ladder compared to lower lifeforms. Unfortunately, this is also a disadvantage compared to other lifeforms in that some humans with ruminating thoughts, traumatic experiences, self defeating ideas can go through life suffering ,sorrowful, socially isolated. You have probably witnessed when someone with those qualities walks into a room. People will want to move away, look away, stop listening to or stop engaging that “bad karma” person.
This is the exact quality and thought pattern that you would want to Detox out of your Frontal Lobe. When we go on a great vacation, we push the reset button on our brains. When people go with me on hikes and we hit our summit, the eyes get brighter, shoulders go back, chest comes forward, belly gets flatter- even the voice gets full. We have effectively Detoxed our Brains. Richie Davidson out of University of Madison Wisconsin has found that certain types of mental training will improve the resilience of the brain when confronted with negative life events. Without a regular practice of mindfulness, the brain can be stuck in a rut (like that circle that appears on your screen when your computer is downloading a video stream so painfully slow). This practice can be achieved several ways, you can be like the monks Davidson studied (the Dalai Lama being the most well known), or getting out to nature (like Dr Eva Selhub wrote about in her book Your Brain on Nature), or going through a 5 days immersion at the Chopra Center (I took Seduction of Spirit and met Deepak Chopra when I started my “detox practice”), or something as easy as listening to Davidji with Guided Meditations for Awakening Your Spirit (one of the best voices for meditation I have ever heard). What ever technique you stumble across and adapt to is just that...a practice that should be done on a regular basis. The human brain has about 50,000 - 70.000 thoughts per day. Some of these thoughts can add to being stuck, some of these thoughts can propel us to being that person who walks into the room and turns heads.
The bottom line is that if you do not have a regular practice of Detoxing the Brain, at least twice a day for 5-30 minutes at a time, you are missing out on the one cheapest, simplest ways to reverse suffering for yourself and others around you. If you don’t get it on your own, try hiring coaches (psychologist, counselor, yoga teacher, energy healer...) to design a practice that’s sustainable. Be patient with the journey as it does get frustrating to turn off the thoughts that want to take you on a roller coaster ride of more thoughts and ideas and to-do lists. As my friend Davidji says while doing your mindful practice, when you notice you’re drifting away to thoughts sounds or physical sensations, ever so gently, drift back to the practice. Finding a way to “ignite” your detox practice will get you to be the biggest campfire you can be.

Sunday, June 19, 2016

Thanks Dad

My Dad has always been a teacher.  He taught me not to take crap from bullies.  He showed me the value of embracing education.  He inspired me to change lives.   He showed me how to double clutch, heel toe the pedals, controlling the yaw of a car with tire speed.  He encouraged me to work hard but shoot for a reward.  He ultimately showed me that even when faced with death, you are still in control.

Fatherhood is more than just having kids and providing shelter and  food.  It is an honor bestowed to 1/2 of the planet to propel a species forward.  There are some who do not support the position and drop the ball....(cant focus on them as it takes the beauty away from the title).  We should honor the ones that really carve out a chunk of time in what seems a mountain of burden to act as a beacon for young people to emulate.  The guys who "get it" have it hard wired in their DNA to put their arms around the ball,  head down, and plow forward no matter what lies ahead.  When I ask people to jot down a 2 week diet diary.....I try to get a snap shot of what they eat, how they vary food intake, what they crave.  Some dads with come in the 14 days of food journalling where every day looks exactly the same.  I look at them and wonder, "....this is ok with you?"  Apparently there is satisfaction in mundane and repetition....when it supports an overarching goal.  When the realization is- you have to "provide" even when the task requires the majority of your waking hours (starting at sunrise and ending at bedtime) to be actively supporting the family.  I remember a birds nest outside my window where every spring, the mama bird would keep eggs warm and papa would spend his whole day searching for worms and bugs then bringing home the prize.  It was in his DNA to fly out and provide  no matter how cold dark or wet it was.

I appreciate dad's who take on the roll of fatherhood with pride and honor.  It is too exhausting to listen to the stories of men who trash the honor and teach bad lessons.  On the flip side, it is so empowering to see when dad's step up the the plate and hit home runs in the face of adversity.

My father is one of these men.  He came over from a foreign country, established a foot hold for our family, taught and empowered the value of education, launched me and my siblings into the world, allowed my Mama to leave with family surrounding her and still seems to teach me lessons even though he isn't around anymore.

I miss you dearly Dad, I wish you where here to guide me .....thank you for being my inspiration.

Friday, April 22, 2016

I felt the Earth move....

I woke around 4, something was calling me to go downstairs.  Even my faithful companion Perry was too sleepy to wake and follow me down.  The slot blinds facing the pond were open and the night sky was glowing.  I moved to the window and looked up to see a deep breath of the moon.  Full and bright as a setting sun.  I decided to meditate to a mantra guided by Deepak Chopra in an old 21 Day Meditation.  Om Bhavam Namah = I am absolute existence: Cultivate Stillness and Commune with Nature.  It just happened to come up in one of the guided meditations I have on my phone.  After a few minutes of repetition....I became aware that the moon was moving.  (okay....we all know it takes the same course along the night sky over and over again!!) but this was different.  From my position on the couch, the silhouette of the moon was just small enough to "fit" between the slots on the blinds.  As I continued my mantra repetition.....I could see the moon moving from one slot to the next.  I thought: "that's weird" then returned back to meditation.  But trying not to think too much into this occurrence....the moon was trying to distract me.  Or was my mediation slowing down my perception so I could be a witness to the speed of the earth rotating - like riding on a carousel and pretending the carousel is standing still and the carnival grounds are all moving around you.  I continued to just be mindful of the my current place on the couch, the position of the couch in the house, the direction of the windows to the sky, the geographic location of my house to the continent, the tilt of the earth in relation to the moon, the reflection of the sun rays on the moon /through the window onto my couch and into my eyes.....all causing a reaction to my retina stimulating a nerve impulse to by occipital brain creating an image and an emotional response of craving this moment.

The connection with nature is soooo powerful and can cause a shift in the way we think and feel.  The above conditions took place over 15-17 minutes of me just waking up and following an urge to move.  There is no medication that can reproduce anything close to what I just experienced in that same speed with out side effects.  I consequently had my morning Sencha green tea and proceded to create this blog -all because I paused and took notice to something in nature that we usually are too busy to marvel.  This is what I love about feeling youthful, there seems to be a peace that young people carry as they have not been exposed to so many trials and daily life interactions.  They dont get caught up in the thoughts of "how does this effect me/whats in it for me/what can I get out of this event".  I think when you let go of an outcome, there is a freedom that allows clearer thinking, appreciation for here and now....ultimately being in the moment.

My adult parents, business owners, patients  -sometimes are so caught up in worry and over planning the future, over thinking the past that they miss what is the awe of nature happening in front of them. Earth day isn't just an appreciation for this planet, its taking time to be in the moment, let the curiosity inside you come out again and be mesmerized like your first trip to the Grand Canyon or touching a horse, or hearing thunder, seeing an eagle or floating the water, just the sun above, no worry about anything but where your are right now.  aaahhh.

Happy Earth Day

Thursday, January 28, 2016

Modern Medicine

"Imagine a cliff where people keep falling off and dying.  Instead of erecting a warning sign at the top of the cliff telling people not to approach, modern medicine just places ambulances at the bottom."
-Burkitt 1991

Saturday, October 31, 2015

I am witnessing a duality in creating my "ideal medical practice".  Corporate medicine uses structure to design a healthy community.....reimbursement, budget, staff, department. building, campus.  I am using anecdotal success to design......learned information applied in real time to my salaried position.  (sounds like a watered down version of my practice but in the eyes of professional regulation, I am a family medicine doctor just like any other).

My experience with hospitals is when large hospital joins larger hospital system.....reputation brings volume (more doctors ask for privileges to practice, local business align with hospital, patients set allegiance with hospital name) and volume brings profit.
My experience with healing is all patients possess the appropriate way to improve suffering but it must be teased out of the tangled mess acquired over decades (spiritual, physical and nutritional baggage).

So can the medical model work to end suffering.  No, it can control suffering... and in a few cases successfully reverse (like what you see with visits to Mayo Clinic....people sign up, get evaluated by intake doc, speciality doc, testing doc, summarizing a few days to be send back to place of origin with homework for the local healers.  In my opinion its nothing fancy, just the impeccable timing and focused communication among several aligned physicians with a captured audience.  A well functioning local hospital can have the same success when large departments are cohesive, testing is not redundant and patient is willing to go from department to department in a single well designed plan.

The problem I experience with hospitals in the last 20 yrs is -there's poor communication between departments, between doctors, between testing facilities.  It brings excessive testing, excessive prescription use, prolonged suffering and sick days at work....this all culminates in less energy by the patient to make the visits, and be engaged in being their own advocate for finding the endpoint.  (we have all experienced this in calling the phone company to dispute a bill, getting an automated phone menu, repeating the voice commands then being switched to punch dial for a department, finally speak with a live representative describing the problems, being placed on hold to only repeat your autobiography to a fresh person who promptly forwards you to a manager extension that goes to voice mail.....kinda get the wind taken out of your sails by then right?!?! ) So imagine someone labeled with irritable bowel syndrome, fibromyalgia, non differentiated connective tissue disorder, chronic pain, obesity, metabolic syndrome........

The fix was supposed to be the primary care doctor role.  In the 90's we were given the title of "gatekeepers" to arbitrate if and when a specialist was to be seen.  Patients were very unhappy with being told, you can't go to him (not in network) or I do not believe you need that test yet (direct to consumer advertising pushes the most expensive test or pill with little to no benefit over standard).  Insurance companies acquiesced to the masses and gave more options for patients and doctors.  I remember in residency, to take care of all the insurance forms and call backs, an entire department had to be created to handle the paper chase man-hours....and this is from a speciality that receives the smallest reimbursement of all departments.  I have worked for 6 hospital systems in 2 different states and I am always told by corporate that primary care offices "do not make money".  So if you tally the budget and payments received, most primary care offices are in the red.  But....hospitals can sustain primary care practices for the trickle down profit of blood tests, surgical procedures, imaging tests, rehab......when all these things per reimbursed properly, the hospital can justify keeping primary care doctors around.

Q-can the average primary care doctor be an advocate for the suffering patient with a tangled mess of acquired decades of baggage?
A-yes.  If....the doc is well versed with using different tools to untangle.  (Maslow's Hammer 1966, if all you have is a hammer, everything looks like a nail)  Imperative is the ability of the doc to negotiate the truncated patient visit with the exact set of questions.  If we all doctors had 60 minutes to do a quid pro quo,  I believe even the untrained person could design a decent direction for patients to proceed to better health.  We don't have 60 minutes, we have 10 (maybe 15 if you argue to the corporation that issues your have a dedicated panel of patients that are satisfied!!!)  What Can I do in 10-15minutes?  Listen ...but interrupt if you give too much information ...all this so I can extract just enough story-line to justify writing a prescription to turn suffering temporarily down a bit.  Disease management as my guru Andrew Weil calls it.   So requirements to successfully be an advocate for creating a local Mayo Clinic experience is 1-visit time and 2-integrative medicine training.  Neither of which we are afforded as a primary care doctor coming out of residency training.

In attempting to create an Integrative Patient Care Practice (a local Mayo Clinic type center), one would have to lay out a structure to "corporate" for allocating budget.  It would have to be strategically placed in the hospital campus to anchor the new department as a destination medical specialty.  It would have to hire talented ancillary care to help with lifestyle change.  That's a lot of planning and proposal based on  anecdotal evidence from a doc that "doesn't see as many patients as an average family medicine practitioner", "practices medicine but also does that cooky acupuncture (needles or something like that)" and "teaches yoga, eats organic veggies like a hippy".  Sarcastically this is what I experienced as I went to corporate in the past, presented my vision of a Lifestyle Center and was immediately met with questions like what is the budget, is this viable for the economy of the area, who will we have to hire (even had one head walk out of the meeting early)  Difficult questions to answer for a concept that doesn't exist.  I don't blame them, this is the language they don't speak.

So for my patients who follow my blog, have no fear, I know what has been working for 20yrs and I have refined my personal life be healthier husband/father/son and it has afforded me a better spyglass to see into patients "tangled mess".  All the cool experiences I have lived through helps me avoid Maslow's golden hammer law, just in the last 10 months of my return to working for a hospital, I have seen countless patients coming in with weight loss 20-40lbs.  This as the result of educating new patients last spring about how to lower cholesterol medicine dose, wean off 1 of many blood pressure pills, or exercise with walking.  The beauty of inspiring a "way out" is you fill the sails with wind by empowering change with knowledge.  Ultimately my heart says to do whats right for my patients but my paycheck says I have to do what's right as a salaried Family Medicine provider. (I Got This!!!)

Friday, September 18, 2015

yin and yang

Hot and Cold, Anger and Calm, Adrenaline and Serotonin......there are extreme opposites that exist to emphasize and support each other.  Can't have one exist if there weren't the other.  So if you think about the majority of reasons people show up to the ER being linked to the stress response it would be valid that teaching the relaxation response would keep our ER's empty!!!  Ah but no one learns this relaxation response until catastrophe occurs and then the mad scramble to find a healthy lifestyle.  Granted there are the few who I meet in yoga class/at a retreat/on the trail/in sanctuary/watching a sunrise a beach sunset that were blessed to have experienced the Serotonin High (click for link) at a young age and continue to chase the feeling for a lifetime.  You know when you meet the lucky ones, just seems like they are so magnetic, at peace, and just living and enjoying-(downright enviable!)  And here's the cool thing; human brains are hardwired to be attracted to people, events and circumstances that emulate this.  Genetics decided that the species will survive with love as a group so it is built into the DNA to feel very "on top of the world" when you accidentally place your "experiential toe" in the pool of happiness.

It's the ego that we entertain in youth (and sometimes into adulthood), that convinces the brain that the experiential thing that pulls us to share/smile/do things for others - isn't as important as getting something and keeping it, not giving back or contributing.  It's the ego that contemplates that you are the center and all things happy are placed on earth to serve you.  This self serving tendency makes you want to accumulate and horde, you are separate from others, "you are number one", "you deserve a break today", "this Bud's for you".....but the pseudo-rush-feeling one attains from the Adrenaline High is very fleeting and usually leaves you feeling kinda charged but at the same time- kinda needing to get recharged or more as the feeling isn't fulfilling for long.

This is the difference between material happiness and experiential happiness.  Both will work to trigger an emotional wave but usually the experiential thing (like me hitting the summit of Half Dome (click for link) will far outlast the purchase of a sports car or a big screen tv.  In fact there is something called the Hedonic Treadmill where you accumulate more "things" to keep the happy only to find the "thing" you purchased doesn't reward your DNA for long- resulting in a temporary fix making this unsatisfied spiritual nomad seek out another material thing.  Even in economics, the Easterlin Paradox says increased income does not correlate with increased happiness.

I believe that those who haven't tasted the nectar of the serotonin high will go for the next best short term easy emotion that even a child can cultivate....anger/stress.  I think deep inside most Americans will seek out terrifying news, "jump scare scenes" in horror movies, big noise, flashy lights...shock value stuff that is hard to look away from.  There is a definite rush associated with reckless behavior-but again....fleeting.   And to extend this concept to food, people who want fast emotional reward will also find it comes easily with smell and taste.  Processed food will usually give the same rush as shock tv  = rapid emotional turn on followed by a feeling of empty and the need for another "hit".

The built in "lysine contingency" (from Jurassic Park) to humans is -if the individual is exposed to an environment of continuous stress/anguish/hostility/poor calories....the species' DNA says surroundings are not supportive for prosperity so the individual will develop disease and die early.
(Please see my last post The Walking Dead -click here)

Has stated in the title, both extremes have to exist.  The Adrenalin Rush is a useful thing,  but not sustainable ......and for a good reason in that the species can use it to fight off saber tooth tigers, run from fire, seek shelter in thunder, move away from spiders.  Fast and furious response, then off.  In contrast, the Serotonin High makes people come together (literally) help others, provide service ........everyone gets a lump in the throat and a sheds a tear when watching young kids get reunited with parents that have been away a long time.   Having an act of kindness done to you generates massive amounts of serotonin and oxytocin.  Even witnessing the previous act of kindness will make you generate serotonin.  Ever wonder why a person coming home from vacation or a retreat is on cloud 9 for a long time after the experience has finished.  It is hardwired into our genetic code to to seek serotonin inducing activities and places that will allow the best odds for the species to survive.

So why don't we teach this to people as a form of "preventive medicine"?  China did this centuries ago in the form of large industry stating everyone that has a job must practice a form of serotonin inducing activity during the work day-Qi Gong/Tai Chi!!!  The end result was to have a more peaceful work environment, efficient workforce, healthy employees-less sick leave!   That was along time ago but if you even pass by an Asian household now, you may be witness to a grandparent doing some type of "swimming in the air" movement while standing in the driveway.  That is the old Asian guy getting his daily dose of serotonin!  Because he was blessed in younger years to experience the Serotonin High, he continues practice well into his 70's and 80's.  It makes him feel good most of the day, its easy to do, no side effects and requires no copay.

So is it worth carrying high adrenalin levels and suffering the side effects of the reflux medicine, the blood pressure medicine, the anxiety medicine, the palpation medicine, the IBS medicine, the headache medicine?  NO! ..NO!..NO!

More importantly, is it worth keeping daily serotonin at a therapeutic level using refreshing sleep, yoga, qi gong, meditation, hiking, exercise, laughter, healthy food?    Yes! ..Yes!.. Yes!