Thursday, October 14, 2010

Sit down and shut up!

Yesterday, a very important concept blossomed from the discussion that the yoga class is not only a place to teach but also a place to provide a safe environment. Yoga traditionally has been used to prepare the practitioner to enter into stillness. Stillness of the mind doesn't mean "not moving". Yoga is meant to harmonize the connection between mind body and spirit. When I make recommendations to patients for considering Yoga, the answer is usually "I'm not flexible", then I mention it will help get you to a state where you can meditate; "I can't sit still". I even remember discussing yoga with a collegue in the ER, she said the poses used to get her so sweaty, she would slip off the mat and get frustrated! (I love her but... perhaps we need private lessons first?) Even in current times, we are not given tools to relax. Most of our coping skills as adults come from learned experience from childhood.

The earliest childhood experiences- I remember occasionally getting placed "in the corner" which is probably a way to reflect and meditate. Or perhaps going to church during school with classmates and being told to be quiet, fold your hands and pray. I recall praying before state finals for track and field and having one way conversations with an image of the Virgin Mary or Jesus. Or perhaps it was the few seconds before taking off from a long jump I would repeat the visualization of me taking flight, and taking flight again and again. During this time, nothing else would enter the mind. Kind of like stillness. Or perhaps playing wide receiver in 8th grade (for a whole 2 weeks) there would be the excitement of the huddle, the confrontation at the line with the opposition, then the silence before the quarterback gave the "hike!" During that time, between tripod stance and "hike", time stood still. Kinda what Deepak talks about as getting into the gap, the gap between thoughts. This is where you find consciousness. No thoughts interrupt, the mind is not diverted with the 2000 thoughts per hour an average human goes through. This is when the cells of the body find peace, no influx of fight or flight hormone, no spring board from one thought, sound, sensation to another. In writing this blog, I see how athletes can get to a state of stillness, especially martial arts (before board breaking!) Short of the sports involvement though, there are very little efforts being made to attune our children (thus our future adults) on how to settle an anxious and fluttering mind.

Wait.....a thought just emerged into my mind, in a nightclub as two bone heads get to chest thumping, before the first fist flies, all the friends will pull the roosters apart and say "calm down, relax". Then one or both will start taking deep breaths like getting ready to hoist a barbell, then back to drinking.

In summary, the usual thing being taught to boys was being placed into a corner (solitary confinement), going to your room (more confinement), or being told to "hit him back" or just "shut up, be quiet!" (think fraternity) So how are societies adults supposed to react to stressors? Probably the same way as in childhood and adolescence which is why we have heart disease, high blood pressure, insomnia and sleep/sex disorders. The American Medical Association says that stress is a factor in 75% of all illnesses. I believe it is a higher percentage. With what I have learned from Mind Body Medicine/Ayurveda-the science of life, it is the spirit that is the one existing that happens to have a human experience in the form of a cell/organ/body/being not the human that has to learn to drop into stillness and find it's "spirit". This is probably why when a neophyte drops into a class or is "dragged" to practice with a friend who avidly swears by her yoga instructor, they usually get bitten and come back for more. I would say it is due to the suggested setting of intention in the beginning, the proper use of svasana poses interjected strategically during the flow of the class and the meditative breath control during and after practice especially at final relaxation pose. Whether beginner or experienced, this 60-75 minutes will work to make a change in the way the mind performs, the way the muscles feel and the way the breath(spirit) flows. How can one avoid the temporary bliss? I would like to think the feeling is from the gentle and caring voice, the compassionate heart of the instructor but I see this happening in Bikram studios and Iyengar studios (for the non-yogis, these two forms of practice are powerful but also very physical and exact so less time is spent on the relaxation and breath work) where the newbie just rants about how good it was and gets right back for enrollment. So in effect, the poses, the sequencing and flow can be powerful tools in themselves for settling the mind.

I believe in the power of yoga to heal. It is not just asana, truely the Eight Limbs of Patangali rejoice in the science of yoga as a means for finding bliss and being one with everything. The instructors of today will be wielding a very formidable tool to make people/patients feel and exist better than they can with modern medicine. The teacher that takes her position at the front of the class with little regard will potentially turn away that curious cancer patient that would have healed or the high risk lady that would have avoided another surgery on her back. We must consider our classroom has a safe/healing place and every person that walks into it as someone who desperately needs healing. Even further, all those we teach to breath and enter into stillness that begin to walk and talk yoga will attract more of the worlds "walking wounded" to also come experience true healing (and this includes the younger generation) so the epidemic of stress related disease can be vanquished. In medicine we are taught that every patient is an individual, every individual-a human being. No matter how many sick line our waiting rooms and hallways, each one has to be given 110% of a healers focused attention. I believe no matter how big our classes get, no matter how complex the personalities are, no matter how challenged the bodies appear; every student taking yoga has a story and must be given 110% of the teachers efforts to teach the lesson of the day and drop that person into stillness. When the injured, sick or dying get a respit from disease, cells feel it, the mind knows it and the spirit lives it. As teachers of yoga we have the power and responsibility to heal.

Tuesday, October 5, 2010

The Wounded Healer

I first heard this term during a conference with Caroline Myss. She was specifically referring to energy healers. I am borrowing it to speak of the "burned out physician". Before the millenium, physician burn out would be attributed to mostly ER doctors. The acuity of the patient presenting for evaluation would be one of the highest experienced by any doctor just short of the trauma surgeon, who would be called by the ER doctor upon initial evaluation and stabilization, (remember ER with George Clooney intubating a semi-dead guy before sending them "upstairs" to surgery). So this was the standard, if after finishing medical school one was to decide which specialty to apply to for resident training, when discussing ER medicine, the usual exclamation was, "high burnout". Other doc burnouts would also be the older physician just a decade shy of retirement age but getting less and less reimbursement from medical insurance companies and higher spending for malpractice, office staff, equipment.....I saw many a caring and compassionate doc, take an early retirement because of what seemed utter frustration with high bills, low payment, high malpractice and angry patients. This is not what we dreamed of in medical school thinking about a "surgical save", finding and being first to treat and solve a complicated medical illness, being the "town doctor", bringing a life into the world.

I remember when I started residency in Oak Park 1991, HMO's were becoming popular with insurance companies. There were seminars on how to fill out forms and pressing hard into the carbon copy with the number code that correlated to a diagnosis. Because of my specialty training in musculoskeletal medicine, I would have an exact diagnosis on a patients symptoms and signs but if I couldn't find it in the ICD-9 code book, I would have to label the patient's visit with some general medical illness and hope the insurance wouldn't question why the visit was so long for a "cold" when I was treating something like fibromyalgia (a "rare" diagnosis in the early 90's that I felt many women fit into I believe most other docs had the nerve to call it a "waste basket diagnosis") By the time I was in practice, these older docs were getting so upset with how slow reimbursement would take, the fact that they had to hire an additional person to deal with the paperwork, and the fact that it took so long to get things approved for treatment and most patients would blame the doc office for not approving it since the "doc was trying to keep more money in his pocket". The newer generation doctors were walking into fully functioning practices that incorporated extra manpower, software systems, electronic records and more partners so collectively, more docs could share expense, see more patients, bill more and make more. Very creative! but one problem, reimbursements continue to shrink, malpractice continues to climb, salaries remain the same but the patient load increases.

Now the mood I see is, no longer is it the hatred and resentment for insurance companies or government policy makers by the doctors, I see doctors so fed up and so young that they now are fed up with the patients. So many times I hear a complicated patient roll into the ER and the greeter, triage nurse, medical assistant and even unit secretary will start with the whispers "that guy is drug seeking, that lady is rude and an ass, that patient shouldn't be here!" and this is before I walk into the patients room as I am holding 3-4 other charts of the folks to see before the sick one. (I feel others would complain to project the feeling they received from the hostile patient that is sick and not feeling well onto me to insight contempt to the angry ill one). So the Wounded Healer/doctor of today is wounded at an earlier time in medical profession and can't retire for lack of savings. What happens if a wounded animal has no choice and is backed into a corner? Fight like savages! But in this scenario, pass the anger to someone else-the patient. I played this game and I didn't like it. I would get to the point of treating patients as a diagnosis requiring a pill. Here's your perscription and follow up with your doctor tomorrow, here's your lab results and since they are normal, take 2 days off from work, here's a psychiatrist's number, call in the morning. Treat the biggest problem, ignore the small one's and send them on in order to keep flow efficient and keep my "numbers high". In my heart I felt bad, especially if I had a patient who was alone, emotional, alot of questions or just needed a little more time to explain, a drawing board to illustrate or a shoulder to cry on but with the 5-10 charts in my hand/arms of patients waiting to be seen, I had to concentrate on time not healing.

The new wounded healer is no longer offended that he can't do his job, he is just callous. I don't mean callous like Donald Trump "your cancered!", I mean callous in the form of very little to no compassion. Doc's cannot be mean spirited or rude, (yet) since much of the compensation model includes "patient satisfaction questionaires". (This is the insurance companies way of forcing the unhappy doctor to treat with a smile.) If a factory worker isn't happy about going to work, the production line yields poor workmanship. If the farmer doesn't care about quality, animal abuse. Problem in the healthcare field, no lets call it the healing field; how can a person heal another human being if before he meets the sick, the doctor already hates walking in the room. In Ayurveda, the healer blesses the sick ("namaste" -the light in me honors the light in you). In Christianity, we bless or anoint the sick, praying for a "speedy recovery". In 1994, Stephan Schmidt Ph.D. wrote "Mindfulness and Healing Intentions: Concepts, Practice and Research Evaluation". Things like an Optimal Healing Environment (OHE), teaching mindfulness to healthcare providers, nonspecific healing factors like providing a safe environment for the patient to begin healing as they enter the room. I don't think people feel a surgical looking room with stainless steel, oxygen masks, a big red biohazard trash bin is relaxing. Had a patient contact me urgently about a persistent bloody nose that was continuing to bleed even after cautery and the doc's next suggestion was surgery! I immediately thought, general anesthesia, intravenous drugs, cold steel and cameras? for a bloody nose? Now I am sure the doc thought minor surgery with a little penlight and suture but if I thought about the scenario I just mentioned, my poor patient, she probably conjured up scenes from Schindler's List. (and I am sure that got her adrenaline and epinephrine and blood pressure higher so the bleeder in her nose bled more!)

The Saguil Approach: we can't be healing illness when illness is not allowing us to heal. If you have a "bad feeling" about your doctor, if you think the diagnosis isn't right or the medicines have too many side effects, seek out second opinion, seek out trained Integrative Medicine Physicians or ask around for alternative medicine healers (for example, your local yoga studio, reiki center, acupuncturist or chiropractor). There are many compassionate and caring doctors practicing medicine out there. Bless them for being steadfast in their healing style. Unfortunately there are also many others, ask your friends and relatives, do your research and follow your heart. It is more than just an organ that pumps blood, in sanskrit it is a Chakra or energy center with relational and contextual knowledge that can sense the energy and intention of other people, situations and things. Then when you find a healing place, yoga center or genuine healer, send the "wounded healer" to her, they need to heal as well!

Please check out:

1.Mindfulness and Healing Intention: Concepts, Practice, and
Research Evaluation
Volume 10, Supplement 1, 2004, pp. S-7ÐS-14


Thursday, September 16, 2010

Genetically Modified Salmon?!!

What can I say, inspiration has hit again for the second time in the same year.

Coming in from morning run, and as I turned on my James Taylor music and turned off the TV, the announcement was that the FDA is contemplating approval of genetically modified salmon. According to the developer of the GMO salmon, the fish that have been grown thus far are not any different from wild caught salmon. The salmon's DNA has been spliced with the Growth Hormone gene from the Chinook salmon and the 'antifreeze" gene from the Ocean Pout to allow rapid growth. The Ocean Pout gene allows it to grow in cold temperatures, where Atlantic Salmon usually stop growing when season changes. The genetically modified fish will grow to full size in 18 months instead of 3 years due to the all year round eating behavior of the Ocean Pout when the Altlanic Salmon usually feeds aggressively in spring and summer. (Sounds like some major league baseball players) Supposedly the fish behaves and tastes like wild Atlantic Salmon, and scientists for the company state the only difference is the extra gene. They claim due to the dwindling salmon population and the increasing human population numbers, lab created fish will provide economic windfall to the fish industry in addition to providing more omega 3 fish oil sources and thus cut back on heart disease. (A biotech company that is actually thinking about world health sounds like an oxymoron to me). It brings up the problem with Monsanto the pesticide company patenting genetically modified corn and soybean seed. This biotech company created a seed that would live through application of pesticide. Only problem like the Gentically Modified salmon, to get the gene from one species into another, you have to fool the living beings immune system. Plants, fish and humans share the same built in mechanism for the living being to protect itself from bad gene replication. The human DNA replication system will seek out unusual genes and destroy them, those mutant gene lines that evade destruction usually mutate to form tumors or cancer. So when foreign dna is introduced by simple cutans splice and the cell doesn't recognize, immune killer cells seek and destroy the mutated cell. The way Monsanto scientists were able to get the pesticide resistant gene portion into normal seed was by piggy backing the short gene on a virus. Virus' are great at infiltrating the cell and taking over the replication in the DNA center-the nucleus of the cell. The job of a virus is to infiltrate a host cell, take over DNA control and produce mass amounts of more virus to be shed in the host until usually the host dies-(ie, swine flu, influenza). Once the virus/piggyback gene gets transcribed within the normal DNA sequence, it becomes invisible to the killer cells and the mutation begins. Good for the seed and fish industry but the concept the environmentalists are worried about, what happens to the virus that helped the "gene" get past the "bouncers"? Well, the virus also gets passed along in the Geneticall Modified Organism. The virus gets passed to all the offspring of the seed/fish as well as all those other wild seed or fish that cross breed with the mutant seed/fish. More importantly all those that eat the GMO or its offspring/crossbreeds will also be digesting and absorbing the virus. No one has been able to prove that piggybacking a virus, then absorbing/implanting any altered DNA will have implications to the human. But do your own research and listen to "your gut" regarding the idea of eating anything made from a biotechnology company. If there was no concern of money and you had two fish to choose from for the family dinner, would you pick organic or genetically modified and why?

One would think that creating a lab food source to bypass nature would save alot of "steps". Problem comes in side stepping nature. Nature has told the Atlantic salmon to decrease its appetite during certain seasons to balance the eco system and allow ebb and flow to occur. It could be likened to restocking the feeder fish in a pond, allow those small fish to repopulate so the next season, the next new batch of big fish have food to eat. The genetically modified fish are to be kept in locked in ponds and tanks but as a Purdue computer program calculated, if 60 lab fish were allowed to mix with 60,000 wild fish, the wild fish would be extinct in 40 generations. That would mean an entire planet of genetically modified fish, remember if they eat all year round, they have to eat something. Do your own research and listen to "your gut".

Finally, talk to the families with MS, Lymphatic Cancer, Lupus, Celiac disease or any other autoimmune diseases that are "on the rise". Read on GMO's, Monsanto, what exactly it means to be certified organic, why support local farmers, what transfats are, what grass fed means, why choose free range chickens. (Watch the film Dying to have Known) The Saguil Approach; a patient has to be his or her own advocate because there will be no one else to blame for poor decisions made in haste or ignorance. When I talk to my families about buying organic, I understand the price differences and feel it personally as well. I would love to buy all organic but it's too expensive. I used to lecture at Whole Foods and loved going there in the 90's when one opened up next to my Central Dupage Office. Problem is that although the arrangement of the veggies was very market-like, and the meat/fish/poultry sections had the best looking products raised grass fed or wild caught; I couldn't afford all "fancy food". The flip side is I felt low in my energy, emotion, sleep and concentration if I binged on 6-10 cheap, take out meals a week. So I would take a deep breath, plan on getting some food groups here some food groups there, but most importantly, I would keep it as my choice. I still "own" the decision of what I pick, I can take responsibility for what I prepare for my family. I let my patient families know at this point, they too can still make a choice on what is healthy (just have to do a little reading). As I mentioned in my last posting, choosing the easy way out, the cheapest way out may be necessary for the time being but usually at the sacrifice of something else later. Do what you think will be healthy in the long run, listen to "your gut" follow "your heart".

Wednesday, September 15, 2010

Lack of disease doesn't equal good health.

Had a "gut feeling" this morning to post to you (my patients, friends, family) about a concept I learned from a teacher of mine, David Simon at the Chopra Center. I usually don't like to start my day listening to death, rape, beheaded bodies found, billion dollar other words the morning news. But as I got back home the TV was on and as I went to turn it off, the last words I heard were, "in the case of Toyota and a class action law suit, judgement is being considered to dismiss the case since investigators [regarding vehicles with run away acceleration] have failed to demonstrate a defect". As I shut off the TV, the words reverberated in my mind then my soul. I feel for those individuals that were behind the wheel when the car would accelerate uncontrolled and those that were the involved in accidents. The message being sent out to the universe is, a group of mechanics have determined the ABS system, Engine Check light, Computer diagnostics and factory craftsmanship are all normal so it is either your fault or not in the control of human engineering that the accident occurred. Lack of a defect in the mechanics of your car means it appears normal and the car is safe for future driving, no intervention necessary at this time.

With guilt I admit I have said this to patients in the past. Your cholesterol is normal, no need to start and exercise program this year. Your chest xray is normal, no need to stop smoking this year. Your sugar level is normal, no need to lose weight this year. Your blood pressure is normal, no need to work on stress reduction this year. Your mammogram is normal, no need to worry about breast cancer yet. Your knee xray and medicines are keeping your pain controlled, no need to start yoga or tai chi yet. Your back mri and neurological evaluation are normal, no need to continue physical therapy exercises or work on flexibility until the next flare up. Conventional insurance based medicine is very "newtonian". Newton was a physicist who came up with formulas to explain motion (inertia and gravity). Much of the current model of medicine is based on reasoning from scientists during Newton's time. Physicians are very "linear" in their thinking. A liver makes bile and detoxifies the blood, if the tests are normal it will function forever. If you have stage 4 cancer, you will die quickly. If you take this pill to turn off acid, you should not get ulcers. In the last 15 years, I believed I was helping people by using the basic information from training and more importantly, the continued outpouring of information from drug studies and research. I now question all this new information (that is ultimately backed by some organization with money. In my mind, the text books that we have been using for the last 5 decades have established legitimacy. In my heart, I think we are only now opening to true human healing. I feel humans are very prone to entropy (disorder), take the easy way out, path of least resistance. It is usually a faster and easier decision to complete a task with the least amount of effort. Saving time and effort is not a problem, the problem comes if the consequences to saving time result in a disasterous chain reaction that ends in compromised health that is "fixed" with surgery or pharmaceuticals.

My first step away from Newtonian medicine was in studying Medical Acupuncture at UCLA. My medical indoctrination said it wasn't well understood, research came out stating it doesnt work, text books of Neurology state there are no energy channels in the body that correspond to meridias of traditional chinese medicine. I took the course anyway. I remember how I felt having it done to me, then I remember applying it to Sheryl a lady with chronic headaches on multiple medicines with multiple consults and my single 30 minute treatment gave her a few hours of a headache free life-for the first time in decades. But due to the fact that I worked for a hospital and it wasn't in the norm of practicing family medicine using acupuncture, I couldn't bill for it without lying to insurance, or I had to bill outrageous prices to make the difference of time spent away from insurance paying patients. So I was discouraged and stopped doing it. I am now learning about nutrition with Andy Weil and spirituality with Deepak Chopra but the same issues are arising, dietary evaluation is difficult to get reimbursement for from insurance even if the patient has elevated cholesterol, diabetes or obesity. If I teach this I either have to bill "creatively" or see the patient as cash only if I can't bill above and beyond the contracted medical insurance company. I am now on the path to become a yoga instructor with The Chopra Center and Total Body Yoga and I know I will be able to provide anxiety, hypertensives, chronic pain, cancer sufferers a successful addition to medicines and surgery not to mention a total alternative. Problem: insurance doesn't have ICD-9 codes for meditation, breathing or yoga. No code equals no payment or at least the need to resubmit a bill 2nd and 3rd time back to insurance company and arbitrate payment with a person on the other line who probably doesnt practice meditation or has to follow rules in a book written by a non-healthcare technician.

This "other side" of medicine is sometimes referred to as the Einsteinean approach. Relativity, energy, cosmology....all involve a concept that life is composed of an energy not well understood but that ancient traditions/civilizations have relied on for centuries. White light, gut feelings, love, bad karma, dreams, bliss, spirituality, healing hands, aromatherapy are all modern day categories where we group things for lack of any better way of definition. Andrew Weil has popularized the term Integrative Medicine with his own credentials and a decade of tolerating criticism with research from the NIH. He has worked on true preventive medicine. Family Medicine used to be a specialty training where the primary care doctor who is essentially the gate keeper of health would help the patient with preventing disease. Go into any primary care docs office now and 80% of the visits are for acute care-(colds, coughs, scrapes or ER visit followups) and maintanance care-(testing blood to refill prescriptions). Unfortunately, it is up to the patient to be his or her own advocate for health. Lack of abnormality on testing doesn't mean you are healthy. Eating right, sleeping well, keeping healthy relationships, exercise and spirituality won't keep death and disease away but it will make for a healthier and happier environment for your cells in doing their best to function at optimum levels. I believe their is an inherent energy that comes with any life, being, cell, dna molecule or atom. "Bathing" it in a healthy environment will allow for unleashing it's maximum potential. I witness this occuring and unfortunately it is very seldom but when it occurs the label of "miracle" is given. What is worse is when an event of unleashing one's maximum potential is experienced in a disease state and the body is allowed to fix itself, the excuse that "you were misdiagnosed" is given.

Bottom line, here is the Saguil Approach: if a car accelerates when it shouldn't, if a pain is happening and someone says "we can't find anything", listen to and trust the message your "gut", your inner being, your heart is telling you and act on it. A "qualified professional" saying you're fine when you know you something is wrong is never a reason to relax. I tell patients this, "thank God I can't find anything wrong, now go and start the diet you've postponed, begin the yoga class you've missed, get the sleep you deserve, cut back on work and stop spending money you don't have to buy things you don't need to please people you don't like" (last one is from Deepak). The potential energy, from that atom that makes up that dna that makes up that cell that makes up that organ that makes up your body is probably asking for permission to show itself and an environment to do what it does best; live, create and serve others. Listen to your body/mind/spirit and trust in what you feel.