Tuesday, November 27, 2007

I can't breath!

Tonight, took care of a 15 y/o who was running in the school hallway and fell backward. I thought he was screwing around but turns out another team had the gym so the indoor track team had to run in the hallways! I used to do this in the 70's during winter track and this was before technology was developed for sneaker soles. I remember seeing the "waffle" sole for the first time and wondering how in the world can anyone get good traction with these soft rubber nipples sticking out from under the shoes. Well, now in this high tech time of protein supplements, 200-300 dollar running shoes, internet running clubs, high tech water......there are still schools that have their runners train in the hallway! I shared this memory with the student and his parents and of course gave some free advise about running and performance enhancement with his running and football training.

What is more online for tonight's problem is about an asthmatic that came in after being seen 2-3 days ago for asthma. Given an albuterol inhaler to help breath temporarily (4hours) and a steroid called prednisone to speed up the lungs fixing the inflammation that was causing the wheezing. She worked for a nursing home as an assistant and made a little money. Unfortunately, this was enough of a paycheck to not qualify for a medical card. She was now responsible for paying for an emergency room visit last time that came out to 400-500 dollars. And now again since she was slowing getting better but still having problems breathing, has to come in again to get reevaluated to make sure nothing was wrong. I was wondering why the previous doctor didn't maximize on her medicines and give her everything possible to "cool" down the asthma so she would turn around fast. Well, I did what the other doc did and after evaluation, gave her a nebulizer treatment with medicine steamed through a small hand held machine with a liquid medicine going straight to the deepest portions of her lung tissues. This makes a faster difference than the 10 dollar inhaler she is using every 4 hours. Inhaled steroids would be good...yeah so I wrote a script for something but called the pharmacy and found out one little inhaler costs 200 bucks! Asked about a few different older ones and all were 100-200 each! Tried to get her a long acting albuterol inhaler so she wouldnt have to hit the rescue inhaler so often but that also was 100-200 dollars! I couldn't find anyone even walmart or kmart discount drugs to cover anything. I felt so bad for this lady but exhausted all I knew to help her get better medicines. I even tried to give her a nebulizer which I did find medicines for that walmart had for 4$ only but the nebulizer machine itself was 100-200$.

How do people trying to make a living support not only their health but the lives of their kids? In Illinois we have an All Kids Program. Even before that, how can a medicine that lasts a month and saves lives cost 100-200dollars? Really I know the answer but it sounds powerful to throw a rhetorical question out in anger. In business weekly I read of how hospitals are joining with finance companies to collect from people who visit and get care without health insurance. Not that hospitals shouldn't charge for services rendered but when will the escalating prices ever plateau? Drug companies arent helping either. Listening to Suze Orman in the background she is touting not to discount yourself to others. When you undervalue yourself to the world, the world with undervalue you! So I also should not give out care at a discount and learn to charge top dollar since not too many doctors do what I do.

Bull! I always tell my daughter hatred is infectious, mob mentality is infectious, the less you know, the more you can be influenced. This countrywide problem of healthcare is too big to stop. But you know what, I will not play the same game, that lady will be spending alot to turn off her asthma in the next 1-2 weeks but I will get her to make some changes with diet and exercise so next winter she hopefully wont get sick and if she does, she will have the knowledge to calm down the lungs before they flare up to the point of having to come to the ER which is probably the most expensive way to see a doctor quickly. I also tell my daughter smiling is infectious so is a good deed. I see she always goes out of her way to protect her friends and as long has she doesn't make naive choices, I will continue to support her for being giving. Hopefully my teaching has already paid off and she can make a bigger difference in society than me.

The Saguil Approach to asthma-

avoid smoke
improve on omega 3 fishoil intake
decrease alleric response with stinging nettles
improve bowel function the entrance point to many of the triggers for asthma (probiotics)
the antiinflammatory diet....whole grain, decrease animal protein, decrease dairy
increaseing lung volume, deep breathing exercises breath holding (swimming, yoga, meditation)
biofeedback, emotional freedom technique for psychotherapy
change the environment; pets, flowers, molds, cold, dirt, dust, food.

Monday, November 26, 2007

Head in the clouds

It was a chilly day in Chicago and my family was in post turkey slumbering. We had a birthday to attend and it was a pool party! (Indoor of course) I haven't swam since august and the anticipation of doing "laps" got me excited but at the same time, I didn't want to injure myself with overusing muscles I haven't used in a while. I had done the usual work out the 2-3 days prior of aggressive weight training (heart rates into the 160-170 range) for 30 min followed by 40 min of cardio (bike and run with heart rates in the 130 range). I pride myself on being able to mix up the weight training with a little crew team type station to station exercise with the "300" type work out. This is where muscle hurts with lactic acid build up but the dry bronchial tube pain reminds me of the feeling from school track practice with repetitive sprints of 100, 200 yard for what seemed to be hours. Gives you a kind of razor in the trachea type feel while breathing in cold air. I feel a 45 if I can do this without injury and still notice muscle bulk increases, a 20-30 something should be able to kick my butt. Watching my wrestlers at UCF go through a workout just puts me to shame and collegiate athletes are not only muscular but ripped to shreds. (low body fat for you non-athletes) If they can do it then there's no reason I have to see guys talking and joking around waiting between sets and staring at themselves in the mirror. One of my pet peeves is when I see guys walking from machine to machine in between sets... staring at themselves as if something is going to change! After watching the extras part from the movie "300" and seeing how the personal trainers got the actors in shape for the movie.....the principal character stated many times he would work out to the point of barfing. That's the good old days measurement of exhaustion....not pulse rate taking but vomiting. You know you had a good work out if you threw up.....and only the best athletes vomited after a lift or a sprint! As a warning, there is the theory of overuse when it comes to exercise but come on....in this day of ultramarathoners, triathletes, iron men and olympians....is there is a new standard by which we can push ourselves in a gym or at home. I just think we get too delicate once we hit 30 for fear that a heart attack may emerge from nowhere so we take it easy. I plan on encouraging my older patients that have been cleared by me to push the envelope with heart rate and exercise and set a new standard.
As I was saying, I was looking forward to doing some laps and after my boy swam a little and my wife had time to socialize, got my goggles and swim fins and hit the 25 meter pool. Did some slow laps and had my cousin join me for a few....by the time I was done, 30 minutes went by and I covered about a half to 3/4 of a mile. The adrenaline wasn't spectacular but just being able to tackle the distance after being out of water so long put me on a high.....then I went on to the dinner table and saw a few pork dishes and ended up going with a little roasted pork (no skin) with a plate full of peanuts and grapes.....no guilt! The rest of the night was all the same, I actually was amazed I didn't feel sore at all. This is the kind of feeling with yoga, not the adrenaline rush of weight training but a more euphoric feeling with a feeling of being impervious to outside insult or trauma.

I am a big proponent of tai chi and yoga with stress reduction, hypertension, arthritis and depression. It is always a difficult sale to someone from a society built around getting self reward for breaking a sweat in front of a mirror over 60-90 minutes and feeling a "pump". With most of the baby boomers hitting 50-60, they will probably have a basic knowledge of the 2 forms of exercise with a picture of an short old chinese guy or a man in a turbin exercising. Truth of the matter is is you look in any local YMCA or health club, they will usually have a female instructor in yoga and a male instructor in tai chi. (Yoga seems to be the big craze now). When done properly and continued for 30 days or more, one will usually see the benefits of the gentle movement sports over the hard hitting exercises for heart health. Just takes a little encouragement to make it to the point of gaining the benefits.

Sunday, November 11, 2007

Fear of Flying

I was flying back from a lecture in Clermont today and sat next to a wonderful young lady. She had been trying to flag down the steward before take off and the urgency in her voice made me think she was a little worried. It was headphones she was looking for to relax. I know the feeling. Several years ago about the time of the 911 tragedy, I used to have a fear of flying. I would take a xanax (fast acting valium) to relax. I think it came from years of flying back and forth to the Philippines during winter when the storms over Japan were harsh. Imagine, 2 hours after take off from a tropical island and then snow storm in Narita Japan....then only 16 more hours to fly before getting home! Needless to say it was either alcohol or drugs and drugs were cheaper. When I learned acupuncture, my instructor said he would take needles with him to France to start treating jet lag before he would even step off the plane. (The needles are so small they don't even set off security alarms) I tried this once and placed in 3 needles to relaxation points and landing didnt even phase me. From that point I was encouraged by my daughter to not stick needles in my self on a plane cause it looked "weird". I went onto acupressure techniques and breathing with meditation. (More recently I added aromatherapy-lavender- and piece of cake.

I quickly offered my seat mate a whiff of my lavender bottle and explained how it is used. Before I knew it we were up at 30 thousand feet and talking about all kinds of things. She had so much energy and life, it was inspiring to me. Usually the sick I see are worn down with a medical issue and chronic stress. Here is the perfect picture of someone with gobs of energy and life with some medical issues from not controlling or harnessing the power she wields. Stressed, on a medicine from the OB for anxiety/depression, never suggested to see a therapist, no experience of biofeedback. I forgot to ask if she ever was tested for thyroid disease of vitamin imbalance. Got a little diet hisorty from her but not enough. She also leads the typical life of a twenty something living single in "wrigley-ville". Alot of freinds and going to bars and parties. (ahhhh the good old days) What was a red flag for me was she had indicated a doctor placed her on Wellbutrin which she states helped her tremendously without gaining weight. But the doc never sent her to behavioral health. Here she is far from her initial stressor but still on the same dose.

I stressed to her that although she is feeling great with the low dose of the medicine and she uses it every day, more stressors are coming. Theres's always going to be stressors during christmas holiday, tax day, birthday and new years. God forbid she develops a sickness from Chicago winters in addition to late night partying on weekends. If she is being maintained on a level dose and a larger stressor comes up..doc is going to increase the dose or add another med. May I add that a rather large stressor for single women in the US is coming up.....30th birthday! So I gave her my advice for breathing exercises, yoga (although she sounds like an adrenaline junkie) aromatherapy and possibly acupuncture/tui na. Luckily Dr Leon Chen of East West Healing Center in Lombard also goes to Chicago and may be able to help her. Turns out there is also couple other problems typical for a person of her level and she would benefit from kidney clensing with probiotic.

I am a walking example of what I preach, The Saguil Approach-

-plan to wean off meds 2-3 weeks, have a substitute in place to help control the original issue, add a few more interventions with alternative medicine that will help control the flare up that always happens when stopping potent perscription medicines.
( although I dont think the alcohol is one thing she will give up)

Moral of this story is not to just accept a medicine as a cure. Always work to get off what you are on...whether it is a script or an herbal medicine. Nutrition and exercise are always the basis to treatment even if the doctors dont remember. I will keep an update as to how she tolerates acupuncture, anxiety sufferers dont do well and usually go to alcohol for its depresant properties. No coffee, caffeine, guarana, tobacco. She should also try carb rich diets. I usually suggest protein for breakfast and lunch then carb for dinner. In the anxious case, carbs for dinner with an evenly distributed prot/carb breakfst and lunch is good to go. Suggested breathing technique and reading into drweil.com for some pointers.

Alway insist the doc treats the mind, body and soul. In eastern medicine its all in the same package. Only in america does the body get treated without consideration of the mind. (and visa versa) serotonin that acts on the mind also is big in the colon so docs have no choice but to make it work with a multi faceted aproach.

kava kava
lavender aromatherapy
emotional freedom technique with psychology
diet and multivit changes.