Saturday, February 10, 2018

Puppy Love

So my goal with medical practice is to help patients define a goal.  In creating my annual DrRic's Hiking Excursions....it started as a goal for me to keep activity as top priority.  Modern lifestyle keeps activity and exercise on the bottom of the "totem pole" regarding multitasking.  When we keep shoveling other tasks atop the required daily move count, before you know it January first rolls around and your 5-10lb heavier, still tired, and planning a check up with doc to most likely get started another medicine since nothing changed from the previous visit.  That is why I find it easier to daisy change small tasks and have mini successes so life isn't overwhelmed with ONE BIG GOAL OF LOSING 50 POUNDS BY SPRING.  (...individual goals may vary but you get the picture about procrastinating on health) 

During the dreaded annual wellness exam (15-20 minutes max as allowed by medical insurance reimbursement)...when I hear "I know what to do I just have to do it"....I immediately retort "please don't rely on failed routines as if your technique failed to give long term success then if will fail you again" and we don' want to have the same conversation next year. 

A common benchmark for success or failure is levels of glucose, cholesterol, and vitamins.  If your deductible is too high to invest in getting blood tests or fancy imaging studies ...then we go old school. 
-new school = test blood levels and get xrays or ct scans and determine if change has occurred.
-old school  = measure waist line, weight, level of fitness, blood pressure, diet or number of meds (the more medicine prescriptions you have accumulated / the more health has "left the building")
So the inherent problem with doctors of functional medicine is they follow numbers not the person.
If you feel good now after fixing the lab values....okay but you have just accumulated more vitamins and herbs instead of medicine prescriptions!!!  If there was a way to add old school guidance to new school measuring....that would be perfect.  Using old school ways will change the basic ways of eating sleeping activity and stress tolerance....it should be recognized as a 360 degree change but that takes motivation (in your face accountability every day during the weakest times of the day.)   A coach for keeping eyes on your activity and making you aware of goals short and long term, a nutrition expert to remind you BEFORE the crave kicks in on what is expected by end of day and a mindful coach to design and redesign do-able routines to keep a stress neutralizing routine on your daily accomplishments.  If I act as head-coach one to twice a year during your visits....I need these coaches in your back pocket with day to day/week to week motivation. 

Either way, if you are headed to and early coffin or worse, a label of "disabled" due to stent, numerous medications, physical pain or emotional imbalance has been adopted...someone has to design a template for lifestyle change.  In taking care of lowering blood sugar, I usually like to add psyllium (fiber), timing of meals, volume of meals, ingredients of meals and level of satiety (satisfying feeling of fullness).  In Toms story of lowering sugar, the odd thing is he gained weight since his last visit which doesn't make sense as his sugar level dropped down?!...  In the Q&A that ensued, I found out his sleep was being interrupted!!!  AH HA!!! but poor sleep would cause sugar to go up?  Then he revealed the answer.  Tom got a puppy and he has been the one caring for the new family member.  The little guy wakes Tom at 3 am to pee but even with this seemingly frustrating info...Tom was smiling while talking about his new best friend.  To me this is the typical result found when people participate in laughter yoga.  Small studies have been used to check pain tolerance during duchenne type laughter and it was speculated that there may be an endorphine mediated response that changed the way damage to the body was handled.  Being in love can cause the heart and mind to be bulletproof to damage / the opposite is true too.  Maximum stress can cause a normal heart to undergo anatomic changes resulting in the heart attack.

This is where my hypothesis on love and inflammation.  Tom gains weight=sugar goes higher.  Tom loses weight=sugar goes lower.  Tom finds happiness=metabolism changes.  Tom finds puppy=sugar lowers JUST LIKE HE LOST WEIGHT!!! and the test for my theory is his weight gain should have increased sugar but actually reversed it.  Now there is alot more to test, control for variables, check the lab reliability, scale accuracy...but who cares.  Tom found a friend, puppy found a home, doctor got a reason to blog, one less medicine the insurance has to pay for. 

LOL -click here to check you how laughing changes the world

Sunday, February 4, 2018

Back to Business



The proverbial "waiting room"

When I was growing up in the 70's : (
... the waiting room was where dad's would wait while babies were being born. 
The stereotypical scene was several dad's pacing back and forth anticipating the
good news.  Now the dreaded waiting room associated with western medicine
is where you wait for hours, read outdated magazines (that sick people have leafed
through) with a sign that says no phone use.  In this culture of immediate reward,
it rubs everyone the wrong way to have to deal with waiting. 

So even before I see anyone in the exam room, an unsatisfactory review is brewing.
One wonder why a doctor would care about reading reviews when they all should be
focused on patient care ....but.... salaries are dependent on satisfaction.  The current
design structure for getting paid by a hospital has efficiency and patient satisfaction
built into the formula (RVU's).   It was started in the early millennium when large hospital
organizations had to be accountable to medical insurance payers to be efficient (and
not order too many expensive tests) but insurance companies also wanted their
clients to get the "best" health care.  One parameter of measurement was patient
satisfaction surveys.  Reviewing wasn't as hot a tool in 2000 as it is now.  Additionally around
1999...there were a still primary care doctors that owned their own medical practice paying
attention to utilities, salaries, billing, malpractice insurance...even answering their own
phones and pagers at night.  (I remember someone paging me at 2am just to say they
couldn't sleep!!!)  With medicare reimbursement decreasing back then about 3% every
year.....it was only a matter of time before being a small business owner of a medical practice
would cave in to being a salaried employee.

I left medicine totally disgusted in 2005 and moved from Illinois to Florida where I was
going to start over and just be a dad.  The last thing I remember was being told by
administration that the hospital paying my salary was changing and if I didn't get
on board with the new salary structure (less pay more hours because I wasn't producing
the same as other primary care docs in rest of the country) then I should leave.  But in theory I couldn't leave even if I wanted to, there was a restrictive covenant in place that would bar me
from opening my own practice within a 15 mile radius and I would have to pay for a malpractice
insurance "tail" to cover any potential law suits filed against me for the prior 10 yrs.
-most patients don't see primary care docs > 15 minutes from their homes
-tail coverage costs about $10,000-20,000 to be paid all at once
-new malpractice insurance would have cost me $50,000 before I even opened my doors
-electronic medical records were being pushed by the government as an attempt to decrease
paper waste and have efficient doctor to doctor communication (more like doctor to insurance billing efficiency)
-offering medical insurance to future employees as a small business owner was impossible to afford (and still is)



But I had work to pay mortgage, kids education, medical insurance.....(I didn't have medical insurance
for about 2 yrs as I couldn't afford it...prayed every day to stay injury free).  So I signed up to be an immediate care doc.  See patients that I didn't have attachment to, finish work right on time and hand
off the the next doc.  No phone calls middle of the night.  "Treat em and Street em" was the motto.  That was not why I stayed in school until the "21st grade"  (I am now on my 24th grade / year of study).  I was disillusioned from medicine due to the harsh words of an administrator saying that my practice style of medicine didn't make a difference in the community as compared to the national average "I was below average"....until the phone call.

I remember being okay with life in Florida, payed hourly for immediate care coughs colds sutures injuries....then I got a call from an old patient from Illinois.  They were looking for my help as all the docs they were assigned to didn't give many options. He was dying slowly of cancer.  With the acupuncture training I finished before leaving for Florida, I remember designing a few options no one else thought of.  He died eventually but I hope my suggestions gave a small sigh of relief for at least his family.  This is the part of the movie where the hero thinks back in time and pieces together the keys to conquering the the big Boss bad guy.  I re-awakened my core thinking ..."I wasn't below average and all the weird things I invested in -acupuncture, breath, yoga, nutrition, exercise...gave options no other doc was offering.  They made a difference to my old patients who looked across north America for me, they made a difference for me during the time I had no medical insurance, I had to make major lifestyle changes to stay out of the hospital!  So I came back albeit slow, I still worked my way back into private practice (kinda) still holding onto my style of medicine.

So how does this pertain to the waiting room?  I learned from Andy Weil, Herb Benson, Deepak Chopra and Joseph Helms that the answer to the disease manifestation is in the patient.  Getting the answer out will take more than a blood pressure reading, a throat swab or blood testing.  There is a gentle teasing out of information from the human sitting in the exam room with you.  An exam is not just a physical exam...it should be a bio, psycho, social, nutritional, educational, introspective  interaction between healer and patient.  Look at the word 'patient'....connoted the need to take time for healing.  Done properly, the time spent in close proximity to a good healer will reveal the most direct path to heal-ing.  When we truncate the time spent in planning out the journey on our path to being disease free, there is more chance for error.  Making a mistake means back tracking and starting again.  This time loop of only inquiring about the biggest symptom and then treating with a temporary medicine till another symptom pops up to be repeated again...doesn't get anyone (doctor or patient closer to "healthy".  In fact this stutter stepping pushes healing farther away and brings chronic suffering into younger ages.  The answer is in the patient, to know the patient inside and out will be the best way an architect can design change, empowering change will beat disease.

This take more than the standard 20 minute visit (15 minutes actually but I have 20 years of experience!!!) so when I run behind by 45+ minutes, it is usually to accommodate for the 20 minute slot given for a "wellness check up" that turned out to be a multi-system, multi-symptom chronic presentation that needs fixing now.  I'm not blaming patients, they don't know that the majority of medical insurance payers are following the state's reimbursement of 49.95 for the most complex of visits (that usually takes about 45-60 minutes of face to face time to listen to plan out and diagnose.  Tag that onto a 6-9 month turn around on payment receipt...how is a business supposed to survive? Then at the same time I have to make sure service is with a smile or I wont get my "potential" annual salary.  I am not embarrassed to say...I am getting the same salary I was paid during my first years of working for a hospital.  (in 1995)  I have the potential to make what the average primary care doc makes in the US but I would have to see more patient and practice medicine like everyone else...just contributing to the time loop, but I choose not to.

I know my body mind spirit won't tolerate practicing at this pace forever BUT for now:
-I take my salary as is (at least I have a job)
-continue to change lives (check my drricsaguil instagram posts)
-save up some money doing other things (like my youtube channel and maybe an acupuncture clinic on "days off")
-hit the lottery
-vote for change
-opt out of taking medical insurance BUT charge a reasonable fee
-continue to create a sense of calm in the "waiting room" so that patients are actually healing before I walk in to start the healing process.

My faith tells me if I provide the keys for people, the Universe will open the door for both of us.
Guess I have to take a seat in my own waiting room.

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 practice...it 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 .....in 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