Monday, December 24, 2012

I wanna be the tortoise.

In the fable the tortoise and the hare, the tortoise is depicted as a wrinkled old man short of breath, blunted face, 1000 yard stare, carrying his home on his back, not allowing the events around him to change his demeanor.  The hare is the anxious, sarcastic, egocentric, gaunt individual who thinks he can improve the world around him with his version of living.  In the clinic:

-Mr tortoise always talks about metaphysical interpretations of his universe.  Seems to only engage when asked about philosophy.  Prefers organic when he can get it, otherwise nutrient dense foods and supplements.  Very slow pulse rate and seems to close his eyes when not involved in conversation....but he isnt dozing off.  Family history reveals his parents are still alive and only positive is a cousin with anger issues that snaps.  Minimal disease present in close relatives.  Cholesterol excellent.  He works as a teacher with no financial investments, simple shell for a home, with minimal possessions.  Enjoys breathing exercises, long walks, and stretches alot.  Maintains visits when he can get in every 5-10years and has no complaints.  Doesnt offer much information, somewhat withdrawn and occasionally doesnt come out of his shell, but overall healthy. 
-Mr Hare has clear genergalized anxiety.  Boarding to the point of paranoia about always thinking about abduction from UFO's.  Comes in for physicals annually and averages a visit a month for symptom control from multiple medical problems.  Eats alot of green but prefers processed foods for "energy".  Sleeps poorly probably from urinating so often as he constantly drinks from his bottle.  Has a dermatitis issue that flares up with season change or stress- always scratching.  Possible over the counter nasal spray abuse as every time he comes in, his nose is constantly twitching.  Complains of restless leg and has to constantly thump is lower extremity to feel better.  Seeks out companionship and tends to involve himself in relationships that only cater to massaging him.  Practices polygamy and is not sure of how many children he has.  Fast heart rate and high blood pressure but excellent vision and hearing for his age.  Possible irritable bowel disease in an issue with defecating anywhere.  Family history reveals a very short life span for close relatives.  Very wealthy with multiple investments always thinking about saving for next season with a few savings accounts he doesnt remember and cant find.  Likes gardening and veggies.  There is a question of abuse in a witness seeing him pick up is child by the neck.   Earlier life was behind bars but cleared his record and now well loved by his young social network and often visits gradeschools.

I essentially advised the tortoise to avoid hiking near roadways,  try to increase fluids and avoid the sun.  I would like him to join social groups but he doesnt seem interested (truthfully I have trouble deciding his gender since its not obvious on physical exam).  Told him ok to continue seafood diet but avoid foods containing too many parasites and worms. His diet his high in calcium so we postponed a bone scan for now.  I suggested he come in for physicals whenever his deductible has been met but he says only has catastrophic coverage so probably wont see me for a few years.  He does visit a chiropractor regularly for neck issues.

I had to get Mr Hare into therapy immediately so referred him over our behavioral health department.  Kept on talking about the Mayan calendar, the end of the world and how he had multiple underground sites that he was prepping.  Told him to change his diet as the processed pellets he eats were too high in binders that was causing him the stool problems.  Had to schedule him for a consult with the STD clinic at county hospital since he didnt have insurance due to preexisting medical disease and jumped around from job to job.  Will address drinking problem next week and after he sees therapist to start mind body programs and lower his heart rate.  Have to postpone the relflux and sleep study for next month after his shots.  Ran out of time this visit but as he will be seeing multiple providers, I will try to coordinate care.  Until then ok for continued exercise as he seems to love long races and competition. 

Interesting how these two characters are companions but at polar ends regarding healthcare.  Guess with out one the other cant exist.

Friday, December 21, 2012

The Screen

I received notification from my high school that a childhood friend passed away. Tony happened to be my college roommate as well. In the season of giving, it is sad to hear about loss though from every fire emerges life. As a physician, the event of passing-on always becon’s the question, could this have been prevented. The neighborhood doctors was the guy who knew the family, was available if you walked over to his house and would take care of everything from diaper rash to dementia. In the millenia, primary care doctors are thought to be where patients enter the insurance based medical maze to look for disease and stop it. (My perspective of the current system is me entering a hamster wheel of healing, trying to give undivided attention to detail, package a plan for life change, then jump back on and see the next soul that I stumble upon) It is not uncommon that as I formulate a diagnosis, tests and give reassurance, patients comment "this is the most time a doctor has spent listening to me". It is nice to get validation I am doing the right thing to heal people but I'm not here for validation! I became a doctor because of an innate urge to serve humanity. The knowledge base imbibed over the 25 years of training has taught me the essential message within the symptoms of suffering is the answer to its resolution. Problem: how to extract the right information in your annual 15minute visit and reverse life threatening disease?

You can’t.

Medical insurance penalizes doctors for spending "excessive" time in a patient visit. Most patients only have catastrophic medical insurance coverage that covers annual physical exams and nothing more. (What policy holders don’t know is that your doctor is not allowed to address chronic issues during the yearly meet and greet) This glorified visit has been truncated to be a history review; a physical exam, cursory blood tests and the statement- "don’t smoke, get some sleep, eat right, lose weight and start exercising for the next 12 months". Being on the receiving end of getting a mountain of information and only having 15 minutes to climb it, I have experienced some visits that are difficult and some that are effortless. Here is my formula to take advantage of a "wellness screen" (aka annual physical) where both patient and doctor walk away fully accomplished.

1- Expedite the transfer of information with a summary of symptoms (if you are suffering from something that is concerning to you). Write the diary in chronological form and keep it 1-2 pages large font. You will have to be poetic in descriptions but editorial in cutting out crap. Have pertinent test results available in chronological order (accordion folders are good) but don’t just hand this folder over (very overwhelming to the person that accepts the gift); when doc reviews your narrative, s/he will ask for certain tests if needed-highlight dates of testing so you can reference, pull out and show. Films are good to have but too bulky to manipulate during a physical exam and take too much off the clock to hold up and review. (Too many ingredients in the soup will obscure the essence and make it unpalatable.)

2- Stay focused on short answers to questions of inquiry. There is a tendency in chronic suffering to answer a question with "…this was preceded by…" or "…and then I developed…" leading to another problem. Western medicine docs think in single systems so jumping from digestive to respiratory to hormonal would lead to half-ass fact finding (ultimately leading to half-ass solutions)

3- Spouses (guys) usually need the partner present to make sure primary concerns are addressed in the end. This is especially true if the patient was prodded to get a checkup all the while thinking life was good. (Some don't realize how the depth of their problem effects the family.)

4- Have a list of prescription medicines, doses and times per day; supplements with ingredients and times per day and your average dietary intake per day all listed. If I can scan your "pills", I can tell you what interacts and where you don't have to spend alot of money. (As I tell my patients, if I can save you 50 bucks a month, use it to get a massage or go buy a healthy dinner!)

5- Keep up to date with medical problems suffered by relatives. This is a neon sign that helps docs figure what is in the family genetics or childhood surroundings that may lead to development of disease. (ie, if heart disease is in the family-doesnt matter if you are an athlete, we should work up your heart.....statisticians will say likelihood of heart attack is low but if you are the lucky guy/gal who is hiding a widowmaker, I have to console your family while 911 is rushing you to the hospital.

6- Research from reliable sources (Medscape, DrOz, DrWeil, WebMD) on hot topic items. Usually the buzz in social media will surround release of new information or new controlled trials. May involve a medicine you are taking or a symptom you are dealing with. It never hurt to ask for a specific test to find disease early but you and your provider have to be prepared on what to do with the results. Caution: just because your doctor writes an order doesn’t mean it will be paid for by insurance. The insurance pencil pusher will always tell my patients "as long as the doctor writes a diagnosis of maintenance/routine, it will be covered. Yeah right, I write it, then the lab says they can't run it with a "routine diagnosis code"; you get a $200.00 per test bill and there goes your life savings.

7- Ask to change into a gown before the doc enters the room so you can save time and encourage direct visualization/examination versus having to excuse yourself, change, reenter, get on the table ……When a physician is running 30minutes behind, 3 minutes of idol waiting in the hallway is stressful while other patients are peeking out of the room wondering "when am I going to be seen?". During a physical exam, if you arent ready to show, I am skipping over it and just handling big ticket items-this may miss a skin lesion or tell tale signs of thyroid deficiency......

8- Expect to come into the office for follow up discussion of results and further planning. The old thinking of no news is good news just actually means doc never got your results and didn’t call. Also know who the contact person is in the office to communicate with the doc. Modern medicine doesn’t allow time for docs to call back and answer questions personally, there is usually one person s/he trusts to relay messages and plan. (Don’t take it personally, providers are usually in and out of the hospital, office or surgery and if you insist on a personal call back, in most cases it will induce resistance or you will be placed in a long cue that gets buried in a pile of unanswered messages.)

This sounds like you have to do a lot of work to get a routine annual physical…..and you do! Unless you are not the average American with prehypertension, prediabetes, slightly overweight with elevated cholesterol, working 40-50hours weekly, and not meditating on a regular basis, you have to be your own advocate for staying healthy and living until 90-disease free and happy. If you have an Integrative Medicine physician, or an old school doc who knows how to listen-grab hold and do what you can to see them annually (no matter what the statistics say about maintenance physicals) Some docs that offer membership for a retainer fee (like a lawyer) essentially take care of steps 1-8 so you don’t have to worry about it-this is good if you can afford it. Bottom line is that if your gut tells you it's time to make a change, you are probably carrying a few medical risks already. Even with something like my Mom's  pancreatic cancer (that has a poor prognosi)s, or in Tony's case I am sure a few extra years would have been appreciated by his kids. I believe any properly trained doctor can help you template a change or find disease early, but it starts with the precious face to face time of a wellness screen.
(Anthony J D'Angelo, DMD)

Tuesday, December 18, 2012


How many traffic lights had to coordinate, how many sales people had to schedule to be switched, how many buyers had to estimate the needs for a local Tucson store, how many store clerks that have hiked the grand canyon had to be working......all this on the day I was just going to the store after a day of lectures at the Arizona Center for Integrative Medicine. 

My story starts with the 2 year fellowship I finished on the week of 12/12/12.  This was with the AZCIM (famed postgraduate school started by international author Andrew Weil)  I was accepted to the 2011 class.  Before starting, mom was diagnosed with pancreatic cancer.  I tried to continue studies but had to withdraw.  I was convinced to just postpone starting and join the following years' class.  (miracle 1)  I just happen to fit in nicely with the group of healers, residents, nurses and physicians from the 2012 class.  I also gave my mother one of the last moments of a parent being proud of a child's accomplishments....I feel this helped her pass into heaven.  Jump forward 2 years, I finished my didactic studies and flew to Tucson for graduation week.  I had planned to graduate on Friday and drive straight to the Grand Canyon to see the Colorado River.  Before flying out, weather was clear and not to cold so I packed hiking/camping equipment for hot days (water storage and shade) and cold nights (thermals and sleeping bag/tent).  Only took one rain gear as an outer shell and left everything else at home in Chicago The City of Cold Windy Snowy Hikes.  As I camped out at Catalina State Park, I was using a Jetboil outdoor canister gas heater and was running low on fuel.  Decided to take a trip to REI but just as I turned the corner to the building, remembered my credit voucher wasn't good till next day so aborted and made a U turn (miracle 2).  Cutting through a parking lot to head home, I saw this small strip mall and a tiny store that caught my eye (miracle 3).  Went in for peek and started talking to one of the sales I was leaving, he mentioned to another associate I was hiking the Canyon.  Guy said, "theres a snow storm coming" (miracle 4).  I mentioned when I last checked the Weather Channel, there were clear sky and no moisture.  He brought it up on store internet and to my bewilderment, 3-5 inches of snow to arrive the night I arrive and the day I hike down.  Not only did I pack inappropriate gear, I had no snow shoes, no crampons (snow spikes) and non waterproof boots.   After confirming the arrival of the first snow for the Canyon this month/season, I called around for crampons as I figured these were most important and useful tool if I ran into danger on he incline going back up.  Out of all the stores in Tucson, one store had one pair left in my size (miracle 5). 

Graduated from AZCIM, headed out to the Bright Angel Lodge.  Yes... ran into the snow storm but was able to unload and bed down before the chill and ice set in.   The next morning, 4 inches of snow and low cumulus clouds obscured any chance of me seeing trail or vista.  Was able to wrap my boots in Target Store plastic bags to prevent soaking my socks and used my walking sticks and headlamp to find my way down for the first 2 hours.  It was painfully slow but as the day progressed, snow stopped and softened.  Had a great time in the base of the canyon.  Hiking back up toward evening started to freeze all the wet snow.  The slippery footing and 10 hours of aching calves made for a very slow climb and with 2 hours of hiking left, I was wondering how am I going to get back up with no rangers around to help, phone drained, and temperature dropping fast with what felt like a Lake Michigan fridgid wind blast.  BLAM!!!! I broke out the crampons and like getting a new lease on life, every step was now locked in, and legs didn't have to "work" to maintain balance since spikes pierced the top layer of snow, the middle ice sheet and the bottom mud pie.  It was like I had magnetic shoes and was walking up a steel wall.  If not for the last set of crampons, from the last store in Tucson, warned by a passing salesman, at a small store I had no intention of buying from, and a hiker that just happened to be listening to the local weather forecast, and my last minute memory about store credit that didnt kick in until the next day....I would have had a dangerous hike out of an icy Canyon that has taken lives.

My trip was already planned to happen the way it happened long before I bought my plane ticket. 

Monday, November 26, 2012

Female Athlete Triad Syndrome

In medicine doctors like to use acronyms to shorten "big words".  It's ironic that the Female Athlete Triad that is intimately involved in eating/nutrition, is shortened to FAT. (IMHO, I would call it ROAR - Runner's Osteoporosis and AmenorRhea, fitting since eastern symbolism equates the warrior archetype with athleticism.)  The three major components to the medical problem are
1. an eating disorder
2. loss of normal mense
3. early onset osteoporosis
Any woman who has been in competitive athletics will usually attest to having her period/mense trickle off to a few days of spotting or turn off altogether.  Most of my runners love this as to avoid running with a napkin or changing a soaked tampon during an event.  Problem is when the brain turns off the monthly hormone cycle, it also maintains daily bodily function with minimal feedback loops (like a skeleton crew during holidays).  One of the important functions effected is calcium deposition in bone.  When the brain is more concerned about surviving a life threatening situation (predators, infection, starvation...) it diverts all energy to muscle and adrenals.  Digestion, love, strong bones, sex, creative introspection are not important and suffer for the short bursts of fight or flight.  Here is the rub....with sport events and most athletic practice, there is a call on the fight or flight response.  What if we call on the response only for the last 5-10 minutes of an uphill run?  The last repetition of a superset?  The last burst to steal base in the 9th inning?  Yes, even if society doesn't perceive exercise as a stressor, most people invoke the stress response during the endeavor.  (except tai chi and most traditional yoga where the relaxation response is intentionally practiced during the pinnacle of exercise) 
Getting back to bone basics, during fight or flight, you want abundant calcium in the blood stream for muscle to take advantage of in running fast or defense.  If too much calcium is leached from bone over the course of a few months to a few years, osteopenia is noted on xrays and bone scans.  Thin bones are expected in menopause/manopause as hormones cycles peeter off with normal aging.  If a woman enters her 40's with already thin bone, osteoporosis is diagnosed much earlier.  So whats the big deal with osteopenia or porosis in your 30's to 40's?  Talk to anyone that's suffered a stress fracture.  Pain, disability, loss of mobility, sleepless no further exercise! (usually temporary but occasionally permanent).   Telling an athlete not to exercise is like telling a smoker to stop smoking.  Anxiety, stress, a wonder of how will life go on is entertained/added onto the bone issue and the need for prescription medicines.  And here we mention the behavioral part of FAT (ROAR).  Most people who exercise are very in tune with watching/counting calories, portions, macro nutrients.  Some athletes can be obsessed with eating and according to the DSM "bible" of psychiatric pathology, there is a fine line between observing nutrition and having an eating disorder.  To keep it simple, women athletes can fall into bulemia, male athletes can fall into body dysmorphism.  (typical examples are gymnasts and body builders.....easy parents!..... this doesn't mean all gymnasts and body builders have disorders!)  If there is truly an altered sense of self and the disorder is causing disease to interrupt daily living-time for behavioral help.  (pastoral care, social worker, counselor, psychologist or psychiatrist)  If there is no harmful behavior found by a professional, we can pragmatically concentrate on nutrition and exercise.  Only in western medicine do we separate mind from body.  I remember a colleague saying with sarcasm, just increase protein and the menses will come back!  Duh!....the athlete would have done that already but then the weight comes on and performance dwindles. 
This is where the great nutritionists and registered dietitians become rock stars.  Even if a patient knows what s/he has to do, having to answer to someone with a personal created nutrition plan increases chances for sustainability.  Just telling an athlete to increase protein is not sustainable.  Just telling someone overweight to cut calories is not sustainable, just telling a smoker to stop smoking is not sustainable.  This is why it is so important to have a team involved in reversing disease.  It increases the chances of successful life change.   With Runners Osteoporosis and AmenorRhea, having an exercise coach help mix up activities that incorporate stress response and relaxation response to balance the hormonal waves of exercise; enlisting the knowledge base of a registered dietitian to weave in a calorie dense, low GI, personal preference food shift; a behavior therapist to be the pillar of support during the athletic metamorphosis, and an integrative physician to coordinate/recalibrate life planning when "snags" occur (they always occur so be prepared)
There is always the easy way out:
1. stop exercising
2. take prozac
3. take fosamax
4. prepare for prediabetes and prehypertension as the BMI increases with age

It's Your Choice.

Tuesday, October 23, 2012

Hanging out with Hatred

     Spining Chaos always has a Calm Center

 To make ends meet, outside the office I work at an Immediate Care Center.  (Insurance reimbursement makes it impractical to spend more than 15 minutes of face to face time figuring out a personal strategy for lifestyle change - thus the reason everyone gets a scripted "one size fits all, this is what you have to do before next years annual visit").  No wonder the research this year says wellness check ups dont make a difference in life span!  So here I am working at a cough, cold, sprain clinic with a very expensive EMR (computer based medical recording system) that decided to crash.  So the staff at the front desk worked diligently to contact the IT guys on a sunday-yeah right!  In the mean time, I was so elated inside waiting to turn on the speed.  Why?  Any patient who has been to a clinic with paperless EMR knows the feeling of the doc facing the computer screen and spending little time looking at the patient unless you have good typing skills or know where to intuitively click boxes and scroll.   Any doc using EMR knows how frustrating it is to have to click off boxes in order to fulfill the criteria to get reimbursed for the evaluation and treatment planning and having the whole ritual take time away from patient care.  So here I am, a great excuse has been laid in front of me to ditch the computer and just write down the history, physical and treatment plan on paper.  I could usually finish with pen and prescription pad faster than it takes to click print and walk the patient to the printer.   I pulled some blank paper out of the copy machine, got my script pad and started charging down the hall chewing up one visit after the next.  It was so liberating to get people cared for, explain why they were sick and come up with a treatment plan on how to get better and not have to wait for the plan to print up at the nurses station.  Usually on a sunday, there is an after lunch crowd of sick people (referred to as the "after church group" since as church lets out, every family that has a sick kid stops off at the immediate care for an evaluation hoping to get better by monday morning school bell)  We actually didnt have much of a back up as I was really able to fly through the paperwork.  Alas.....good things come to an end.  The tech guy called and said things are fixed....and the system was up but some of the rooms where slow as molasses so.....back to pen/paper(yay!).  I ended up reverting back to full EMR (boo!) toward early evening and the whole immediate care slowed down again.   (one lady in the waiting room commented that is shouldnt be called immediate care since it was anything but immediate-I agreed but if we were 2 hours behind, the ER was 4 hours behind so I was still the lesser of two evils)

     So why do I call this hatred when it seems that I was on cloud 9?  Well, as the crowd in the waiting room started to gather with the reintroduction of the EMR system, the natives became restless.  It was such a contrast to greet families with joy (paper) vs greeting people that start the conversation with "I thought you forgot about me" (EMR).  As I opened more doors with a wave of heat, crying kids and adults falling asleep waiting, I had to do more explaining of why we were backed up, calming down, and patients at that point felt very entitled and were demanding things like personally calling the script in (calling in a script takes about 5-10minutes of waiting time on the phone to the pharmacy.....doesnt seem like much right?  If I crank out 20-30patients a day, spend an additional 5-10minutes each with a phone call, for the unlucky patient at the end of the day-thats a potential 3 hours of waiting.)  So if I am not "grounded from stress" before starting  my shift, I could easily develop a pissed off attitude like "why the F are you coming here when you should have been to your doc last week" or "get over the pain and get back to work you wimp" (at Danada Family Medicine in the 90's, I remember working with a hug ice pack on my shoulder every hour from a full thickness rotator cuff tear for weeks dealing with the pain just to get through work)   But I didnt let the hatred rule my day, I worked and did it fast.  The EMR was inching its way back into my life over the course of several hours.  Most patients I got cooled down and gave a plan for feeling better.  I am pretty sure I still have some data entry I have to catch up on but the hell with the computer.  The entire day was a testimonial that EMR may help insurance companies keep an eye on what is being charged but it only slows down the practice of medicine. Helps a little for the doc regarding making notes legible, does nothing for the patient except making the wait longer as the clicking and printing takes forever.  It still comes down to whats between my ears that figures the right questions to ask, figures the right tests to help with the diagnosis, and the right solutions to the problem.   If the patient is irritated, I become defensive, the relationship is strained before we start and that effects what is between my ears and how I use it to help suffering. 

I always tell teens that emotion is contagious.   If you hang out with a drunken mob, you will assimilate the irrational behavior of the mob.  If you hang with an abusive significant other, you will imbibe the abusive tendancies of the other.  If you watch the reporting of "yellow journalism" you will be swayed in your thinking to become entangled in the conspiracy theories of the reporter.  If you are with a room full of meditators, regardless of your expertise, you will feel the wave of relaxation experienced by the group.  If you are with a group of people looking to change the world, you will think outside the box and come up with answers.  It takes alot of practice to not let emotions around you dictate your actions.  One of the things Deepak Chopra teaches is you cannot control your environment, the only control you have is your reactions to it.    Herb Benson taught me, Deepak taught me, Andy is teaching me....meditation and the relaxation response set the ground work for longevity, health and disease free living.  Learning to be "bullet proof" to external stressors is difficult, usually need someone to teach.  If you initially invest in a good teacher it will set up for effortless development of personal practice on your own at your pace.  (one of my classmates from the Chopra Center)

Thursday, October 18, 2012

Listen to your "Inner Doctor"

- Tea and pumpkin bread while waiting for my car to be finished.
     Driving my car on the highway, I feel a cresendo/decresendo vibration with the left front tire.  I brought it into my local Sears Service Center (cheap) to save money worn tires while checking out suspension they said everything is ok but you need new tires.  Went on with my new tires and got back up to 55mph and here comes the shake again.  Need a "higher" level of experience so brought it to my Volvo dealer (expensive).  No problems seen, suspension checks out even with a local test drive.  Ok.....all in my head.  Get back on the road, shake is worse.  I jack it up and get under the car.....check out bushing, shocks, brakes, every thing looks good.  Pull on the tie rod (little metal connector that connects wheel to steering) and the thing is about to fall off.  Bring it back to Volvo and rejoice in my discovery, mechanic gets it in the air, I get called back and he says-"theres nothing wrong, what exactly are you worried about?"  Proud as a peacock, I estutely go straight for the tie rod and say, "is this normal?"  Oh sh_t, says my mechanic and they begin work.  I was thankful they at least allowed me to walk into the garage, under the car and check things out. 

     Today a study from Denmark (Cochrane Review) was released saying wellness check ups didn change the overall odds of death.  As docs, we hope to impact the health of people we see.  One of the most sacred times to establish and develop rapport and trust is the coveted annual check up.  Patients who see me know my preference is to rely on history taking to figure out a plan to optimal health.  As I have pointed out in previous blogs, my job is to get you from point A (now) to point B (optimal health, with minimal suffering).  In my heart, I feel the road blocks to point B will not be obvious.  Certainly if cholesterol or blood pressure is high -easy..... work to bring things to normal human levels.   But if all "looks ok", still have to extract that crucial bit of information from the patient/the driver about how things feel in day to day activity/driving?  What is the reaction to stress/driving fast?  What exactly are the average activities/driving habits that may speed up death/mechanical failure?  This takes a keen ear to comprehend how the patient/driver is relaying the story, a creative architect to construct a plan to change, a politician to softly suggest change without insulting the masses, and a coach to know what will probably work in fighting disease with the strengths and weakness of the individual.  Economics will always have to play a part and in todays insurance based health care model, reimbursement for being a good detective is not rewarded.  In fact, production line medicine is probably the only way to keep an office afloat considering malpractice insurance, price to maintain EMR (electronic medical records), salaries for staff needed return phone calls, discuss results, attain authorization for MRI's/PT/Prescriptions. 

     People coming to see me, want to make a change but also want to stay within the constraints of "what insurance pays for".   I have to always bring the bad news; "your insurance will not pay for being healthy, but it will pay for your medicine and surgery once you get really ill!"  I used to be able to send patients with high blood pressure, high cholesterol or obesity to my registered dietician when I worked for Central DuPage Hospital and I would work with her and make some "baby-step" changes to point B.  Now I have to encourage folks to pay out of pocket to see RD's that used to be the first line in treating the above diseases (times are tough so its a hard sell).  Way too much bad information on the internet to do it properly on your own.  [Had a guy come in with cholesterol issues and said adding fiber may help/he said he did that last year with no change in blood tests.  When asked how he did it, said he started eating 1 bowl of oatmeal daily and that was the extent of it- I said that was a good start- now just eat about 16 bowls of the oatmeal and you would have reached true suggestions for proper intake-people need customized programs from knowledgable professionals!]

     Dont be confused with the information being released now.  The person trained to sniff out medical disease is good at what s/he was trained for.  The caveat is even when the tests seem normal, if there is something you feel is off with your average daily activities, express yourself as best as you can to a person that knows you and has the patience to listen.

Saturday, October 13, 2012

How to change a culture?

Another Filipino couple came in for guidance on health.  She had no insurance but wanted to continue taking the medicines her doc in North Carolina started 2 months ago for blood pressure, cholesterol and sugar.  She was on 3 expensive new meds for BP, one standard statin for cholesterol and cheap med most likely for type 2 (late onset diabetes).  No old blood tests to show me, unsure about her numbers, just about finished with meds and unsure which med was for which problem but she seemed to have an allegiance to the doc she met.  So I had to work backwards and elicit has much history as possible (with my primitive knowledge of Tagalog-the major dialect in the PI)   She didnt have any immediate risks for heart attack or early death at the age of 72.  Parents were in their 90s at time of death and most of the 10 siblings alive.  She was thin, ate typical Filipino dishes and was caring for her grandkids.  I asked if the doc tried any other drugs first and she said these were the first she ever "ate".   So I am assuming the doc went straight to the top of the heap regarding expense.  Also sounds like she was never given guidance on healthy food choices or changes.  (usually the first thing to do in first diagnosing diabetes-unless sugar was dangerously high).   And now I have to repeat expensive blood tests that will probably hit the 300$ range just to see if I can get her numbers lower with diet manipulation.  (there are even supplements like krill oil, Coq10, red yeast rice, plant sterols, fiber that have a great track record in lowering cholesterol test results and will come out alot cheaper than the prescription meds dont believe me?-Dean Ornish's work on reversing heart disease with group therapy, mostly plant based diet, yoga and exercise has been approved since 2010 for bypass candidates on medicare.....thats without taking medicine)  As I posted in a blog about loving pork, speaking with a popular TV cooking host, it seems as if viewers are more interested in "home cooking" and not concerned about substituting quinoa for rice, wheat berries for bread, fish for beef.  This is the standard thinking for many patients that are first to immigrate to the US.  Their kids, the first generations here are easier to convince of changing eating patterns.  So how do I get the oldies to keep traditional food but buy into manipulating macronutrients?   Here it goes-Seven Strategies to be applied over seven days:

1-Meatless Mondays.....traditional US approach to cutting back total volume of weekly red meat.  Have to be creative 4 days a month, not much to ask-discuss fav "alternative" dishes on sunday before going grocery shopping. 

2-Fish Fridays...............same US approach to decreasing red meat, try to stick with roasted or baked.  With no other options ok to add fried but ask to use good quality oils with high smoke points (consider grape seed and organic non gmo canola since olive oil doesnt tolerate high temps)  The best fish for high omega 3 content will be Sockeye Salmon, Sardines, Herring, Anchovies, Mackerel, Alaskan Halibut, Alaskan Salmon.  Watch the farmed fish as they usually have pesticides and antibiotics. 

3-Cut the Kanin (rice)...rice is essential to every meal in the traditional Filipino kitchen.  Certain rice is known to have a very high glycemic index.  (the speed at which the food group is digested and absorbed to raise blood sugar)  There are some rice species that have a low jasmine or better yet, basmati.  Decreasing the GI or speed which food gets us our sugar highs will allow the pancreas to survive decades without turning into a diabetic gland.  In easier terms, lower GI means longer full feeling.   Decreasing volume will decrease total calories consumed at the end of the week.  An option Ron Bilaro personally uses is to substitute wheat berry for rice.   Yes texture is different as well as taste but the choice still gives the meal substance and the whole wheat is a great fiber that pulls cholesterol out of the circulation.  (....and Ron tells me at 40+, this is the healthiest he has ever felt)  Real world application of this is to cut down on breads and potatoes-when was the last time you went to a restaurant starving and gobbled 2 orders of bread before the meal even came out, then ate the whole meal since you "paid for it".   1/2 cup of cooked rice per meal only!!!!

4-Fill up with Prutas (fruits) a tropical country, Pinoys are very familiar with seeing a variety of fruits in the market all year long.  The problem is if you are in a northern US state, fruit will have to be transported a distance (2000 miles sometimes) so you may have to shop at specialty stores in winter (Whole Foods Market, Marianos, Mexican or Asian grocery chains).   Pick 2-3 servings of Prutas per day to eat for breakfast and lunch.

5-Garnish with Gulay (vegetables).........this is where we can excel due to the wide variety of veggie dishes sauted and accented with spices.   Many times a meal in their own right.  Turkey/chicken can always be substituted for beef or port in the meat accented dishes.  As stated above, the older Filipinos will probably not go for this knowing the texture is "different".    But then again, dont tell them and let's see if they notice.  Trickery can be easy with dishes like Bolabola (meatball and vermicelli in clear broth) or even Lumpia Shanghi (Filipino eggroll).  A special mention goes out to the use of Tokwa (tofu).  Asian culture is big in using tofu (bean curd) in many dishes and health benefits have been repeatedly studied with positive results.  Just try to avoid the processed tofu and stick more with whole soy foods and natural soy products (non genetically modified)   Pick 3-4 Gulay servings per day.

6-Salad or Sopas (soup) summer cool with salad, in winter warm with soup.  Both smaller side dishes or as main entre will help with satiety.  Keeping the stomach happy releases hormones of love and satisfaction.  (oxytocin and serotonin....sound familiar?  This is the same action you get with zoloft and prozac without the side effects!   Good to balance the decrease in rice. Hint: it allows you to feel satiated/full so you don't attack the rest of your meals and eat like a hungry animal.

7-Fat-busting Fiber...............yes, fat does give a sense of fullness and it is important in inflammation.  Goals in the last decade have been to increase awarenss of the imbalance of too much omega6 and too little of omega3.  Our grain raised cattle and pork have a terrible abundance of omega6 in their are what you eat so unhealthy slow moving pig/cow will pass onto you the same crap it eats.  Recent article has revealed the plight of the American farmer for the price of grain feed.   This article (click here) speaks of one American farmer feeding bulk "2nd hand" candy to fatten up cattle before slaughter.  Owner Joe Watson says his cattle are healthy with the new feed.....notice Mr Watson's weight in the interview.   So if you happen to eat Mr Watsons cattle, do you really think that yummy tasting prime rib is giving you anything that will help fight cancer and heart disease?  Read on adding fiber/grain sources to the tune of 25grams for women or 35 grams for men daily.   If tastebuds are not happy.....well at least take an omega 3 oil supplement (fish, krill or flax) as a daily regime until your next cholesterol and sugar blood test.  Click here to calculate daily fiber suggestions for your age.

Make the portion smaller, make the plate seem like it's holding alot of food (smaller size/contrasting color to food/dividers on the plate-forgive me Emily Post) and have something to refer to in measuring volume that can easily be referenced in future meals.  (For example, a small tea cup on the table will remind one of how much cooked rice is allowed in a meal....then theres the idea of having tea to slow the whole feast down so as not to devour everything then feel unsatiated.)   Timing is always important, even if there is no hunger for breakfast or lunch, it is important to stimulate the digestive tract to produce juices and enzymes, there is a physiologic cascade that begins and prepares the body for the next meal and activities of the day.   I have alot of truck drivers that come in thin as a rail, coffee and tobacco users that say they only need to eat dinner.  I tell them it is certainly a cool skill to be able to push away hunger but this is not a regular human schedule, they should do what they have to do to work however.........the body is going ask you to pay the price of poor nutrition sooner or later.    If its later, it will be so incidious that you wont notice how much damage has accumulated until an event has already occurred (diabetes, stroke, heart attack or early cancer)   The longer you wait, the bigger the mountain to climb.

The above measures are just a frame work for an average Filipino diet but if you break it down, the concept can be applied to any culture (short of the occasional vegan or wheat allergic patient.)   Read through, see how you can substitute dishes from your heritage, combine with nutrition in your locale and reliable dietary facts available from your doctor or registerd dietician.  (just need to ask for help and commit to change.....stick with it until the next season and enjoy the differences!)

Happy eating! Healthy living! Mabuhay! (Long life!)

Friday, October 5, 2012

  (click here if you love pork)

Had a discussion with Filipino TV chef Ron Bilaro (Adobo Nation on TFC).   I told him the recent uptick in young couples from the Philippines (30-40's) coming to see me.  As with most folks in that age group, I usually find high BMI (measurement of body fat), elevated blood pressure, elevated cholesterol.  Of course most are "shocked" to find they now have risk factors for heart attack and stroke!  Yet everyone proclaims they feel great!  And I applaud the fact but also say that my training is to forecast how to get from point A to point B.  The former is how lifestyle is now, the latter is how a well balanced lifestyle should be.  Standard medical practice is to say we should lose weight, exercise daily and lower cholesterol.  DUH.....if it were easy then everyone would have done it by the time they walk into my exam room. 
The realistic approach, (which is what I love about Integrative Medicine) is to plot out a path to point B, embrace the strenghts of the patient, his knowledge base, home life, likes and dislikes; then design sustainable steps to get the lifestyle change to occur.  If it were as easy as giving a prescription for a pill and rechecking blood tests in 3 months then saying "you are good, see you next year" then by golly, heart disease would have been wiped out 18 years ago when the first statin was released.   Dont get me wrong, these meds work for people with advanced heart disease.....but to slam everyone that is found with cholesterol issues with meds and not first work on diet/nutrition/food putting a bandaid on a gunshot wound. 
Anyway......I was asking him if he build me a data base of mostly vegetable dishes from around the Philippines that my average middle age couple might be able to substitute 5 nights a week instead of a braised meat dish and not feel like they are being robbed of their heritage just to live life in the place with streets paved with gold.  Anyone that has been to a Filipino party will attest to the sight of a dining room table decked out with mostly brown colored dishes.  Lechon (roasted pig), Lumpia (eggrolls), Pancit (noodles) and steamed rice with lecheflan (sugary desert) for desert.  One of the problems with most households I visit is these feast foods will be served 5 days a week.  (not specifically the above but usually a saucy, salty braised meat dish with large volumes of rice).  Combine that with the fast foods available within 1/2 mile of most suburban/urban neighborhoods and you have the makings of -33% of all adults being obese. 
This isnt the norm for all Filipinos, neither is it the norm for 1/3 of the American families but it is thought to be a reason for the growing epidemic of obesity in the US. 
Ayurveda (Indian healing) has a dictum that for every area on earth, there are common diseases that occur.  Within that same area there will also be a harvest that treats the disease.   Perhaps Ayurveda didnt expect food to be so processed that it causes an addictive "high" when ingested or that food could be transported 2000 miles away so you can "indulge" any time of the year.  My mom used to send me 3 16inch long "Big Johns Cheese Steaks" double stacked with strip steak and dripping with American cheese, mayonaise on an Italian roll when I was in college and everyone in the dorm used to gather round and feast on my care package every month of the year. 
The bottom line with my project is to fine tune allowing patients to feel empowered yet satisfied to maintain a lifestyle that will get them to point B.  If I just say stop eating meat and increase your ingestion of rabbit food (as my brother in law refers to my lunch) most will feel robbed, and give in to the taste and smell of steak/hamburger/lechon before the 3 month time when I recheck blood levels of cholesterol.  Social media, TV adds, billboards.....for Gods sake, even the atmosphere around tailgate parties from a mile away will be drenched with the smell of hamburgers, hotdogs and barbque.  (like having alcholic hang out in a liquor store)
To me for a change to be sustainable, it has to feel good, taste good and you have to be able to show it off with pride, and this isnt one size fits all. 

(click to see the addendum post from 10 12 12)

Friday, June 22, 2012

The Fatal Fifteen

I saw a young looking kid in the office the other day. She had what looked like inflammatory acne to her face a forehead, oily skin, hair tied down for ease, thick glasses, zipped up dark colored jacket with poor eye contact. My office manager said she had booked an appointment for a skin rash. I greeted her as usual, with and open heart and mind, but something was wrong. I figured she was a teen to college student, so the possiblity of some social apprehension was normal. I slowed down my health interview so as not to frighten her and tried to give some non threatening, open ended questions to engage eye contact. (My mind took me back to highschool- freshman year I was very shy; when everyone witnessed the speed and agility I had in gym class, I got recognized; then I got identified as the kid who knew Karate; then it backfired as John Travolta came out with Saturday Night Fever and mimicked my hair style resulting in a branding as "disco-boy"....back to square one) So I compassionately engaged her interests and interjected questions of why she was there today.

Her reason for visit was right, she was unhappy with her previous doctors just seeing her face and prescribing steroid ointment. She brought forth knowledge of "injections" for psoriasis as a next step and said she was here to come up with "other alternatives" and felt that from our website, we had a nice mix of western and alternative medicine. I was able to finesse a good basis to her chief complaint without presenting myself as an average doctor she had been to in the past. So crucial is the way doctors ask questions and not the questions we ask.

I felt my history taking and physical was successful enough to have a working diagnosis. In the fast paced life of getting patients in and out, once a diagnosis is attained with confidence....of course a treatment plan is already known since the existence of the AMA, western medicine has proven that if there are "these symptoms" then most likely they can be controlled with "this treatment".....and the current fast paced treatment will be.......prescription medicines!!! Hurray for drug companies allocating billions of dollars just for the sake of improving the way humanity is suffering from disease-then educating the doctors on how to treat disease. Any way......I was set and ready to start writing her prescriptions and start thinkng wow, this was an easy diagnosis and I was able to break through the typical shy demeanor of a teen/young adult....all in 15 minutes! But something was still uncomfortable with me. My teachers from medical school called it a "Gestalt Awareness" that something inside you is sensing a message that isnt being addressed in the obvious. Deepak calls this the Law of Pure Potentiality where everything in the universe exists as one so inner intelligence if given the opportunity for expression will yield all the answers to life.

I decided to query a little more. Turns out she is actually 30 years old, has "angry thoughts" that continue since teen years. "When i stress, the rash gets worse"-easy and obvious. SO I PROBED FURTHER. What is this anger and where did it come from. Seems she has no family support and they actually avoid her when the rash is so prominent. (Typical dynamic with a dysfunctional family); maybe this is a conversion reaction she is manifesting from some poor coping skills in communication. I was able to find out there was an associated joint pain issue with the first few episodes of rash. AAHA! sounds like psoriatic arthritis.....I'll confirm this with blood tests! But wait, no joint deformity now.....fever? infection? traumatic event? It was now passed the usual 15 minute time for a visit designated as Rash, infact it was now touching on the next patients time....but still something wrong. I opened up the proverbial can of worms to define what her interpretation of family dysfunction was......suddenly her head drifts to the floor, she covers her eyes, the tissue she had hidden in her fist goes to catch the tears.

Turns out the joint swelling/rash began after she suffered a rape/physical abuse by another family member. The abuse continued nightly for a year. She wanted to get help but comes from a family where they "dont believe" in seeing doctors or letting strangers know about relationships. She is still living with the family member. Doctors she has seen for the last few years of worsening rash have quickly treated her for the same diagnosis the previous doctor gave but just with a stronger steroid since treatments are becoming less effective, thus prompting the last doctor to suggest injections of a Rheumatologic agent known to halt white blood cell activity. A saviour for people truely suffering from debilitating disease but with terrible side effects including turning off your defenses to any and all infections.

Ultimately, I immediately got her an appointment to our behavioral department for a full psychological assessment and gentle establishment of safety/sanctuary; I introduced her to my Naturopathic doctor to look for solutions in controlling these flare ups and help with allergies to environment and food and try homeopathic whole system approaches to "cooling down" this emotional fire she is dealing with. I started the thought process of using acupuncture to control future flare ups that may occur in the next few weeks with the holidays coming around and the obvious conflict ofintentional family gatherings with the person that may still be threatening her. Most importantly I gave her time to express herself in her own way with her own time. The medical business model tells me I cant spend gobs of time with everyone that walks in for heart has a healer says the answer to the patients suffering is already the patients expression, it is my job to help find his/her answers amidst the confusion and pain.....even if it means going over the average 15 minute office visit.


The Value of Value

The new driver in my family approaches me with tears in her eyes saying she “broke my car”. Her follow up statement is, how much is that? (referring to the damage). My mind streams to days 16 years ago when I would spend the whole day Sunday, waxing the outside so that soft cloth would just slip off the hood, or working in the engine bay replacing her turbo, or taking her racing with local race clubs, or popping the hood open with some younger car guys and having jaws drop like they just saw the arc of the covenant. So how much? …….it’s not in the price of repair, it is the deep cut placed into my years of caring for a one of a kind, limited edition racecar. Price was never the point, it is the responsibility being displayed.

How can an individual fathom how valuable something is when they have not experienced the steps required to attain, cultivate, grow and mature this “thing”? I love the scene in Jurassic Park when Jeff Goldblum’s character is scolding the scientists on recreating dinosaurs-

“…..don’t you see the danger John/genetic power is the most awesome force this planet has ever seen but you wield it like a kid whose found his dads gun/the problem with the power your dealing with here is it didn’t require any discipline to attain it….”

Fast forward to the Aquabounty Tech, splicing genes between Atlantic Salmon and a Pacific Chinook Salmon to create a fish that doesn’t stop eating during slow season and gets bigger and fatter in a shorter time. They point out it is good for humanity since we will have more fish to feed the planet. But what about the natural ebb of allowing plankton and smaller fish to repopulate and bloom for the next season of new salmon. Do we genetically modify the feeder fish of the monster salmon so the feeder fish population don’t become extinct? Or a more basic law of evolution creating an ideal body weight for a salmon-region of the ocean but the same law being broken by human technology. Is there a price to pay for creating fat fish?

Well let’s see what has happened to humans. The world obesity rate has placed the United States as 5th highest for obesity out of 192 countries in the world health organization’s statistics. The cool thing with being obese in the US is with our healthcare technology, we can take care of high cholesterol with statins, we can replace worn out knees and hips with steel, we can control diabetes with insulin pumps so you can eat anything you want, we can short cut eating disorders with gastric bypass, we can cheat heart attacks with angioplasty.

In other words, the new generation is being brought up to cater to a voracious appetite of cheap fast food, with the technology addiction that keeps them out of the gym and in front of a computer and the only learned remorse as being, “with this year’s physical exam, your new problem is _______ for which I have a pill that wont interact with last year’s medicines. Our challenge in the healing world is how to teach someone with massive risk factors, about the impending doom approaching. How to impart to someone the feeling of communing with nature, the benefit of giving and receiving, the joy in detaching from goals and the knowledge of how it feels to feel your purpose in life. What seems intangible and unimportant usually is where we end up when the shift in life comes. For most, the shift occurs on deaths door and we wait until then. Reality is with the way economy, technology, nutrition and physical disability are infecting like a viral infection, deaths door is opening sooner. The greatest teacher is personal experience but does that mean we just wait until the knee, pancreas, brain and heart give out? How do you teach someone to invest money they don't have, in a concept they have never experienced, to hold back and event they don't believe in? It is a sin to just give short cuts to remedy problems without teaching the value of evolutions rules of existence. Or showing how each individual contributes and is essential to the growth and existence of the universe. If we don’t teach living in a mindful way to coexist and contribute, there will be no remorse for actions and life will lead up to a point where the universe kicks you out of the timeline and you cease to exist (probably in a very painful and lonely ending). Guess the only solution is to educate and live by example hoping others that are "ready" for the shift remember seeing the bliss in your way of living. If they are ready, so am I; if they aren't ready, I will wait......sooner or later they will feel the urge to change-or be forced to change.


During imagination, the human body will release the same bliss hormones, burn the same neural paths and get the heart pumping as actually performing the activity. Athletes do this all the time in picturing a golf swing, free throw shot, turning a corner in a race car. The mental activity entrains the brain to know what to do when the actual time comes to perform the real event. In the hospital, if doctors didn't go through the physical and mental scenario of advanced life support -"code blues", we would probably lose a lot patients to failed resuscitation. There is a negative side to this repetitive activity of imagination/imagery. When people get into the repetition, "I will never be the same", I will never pay off these bills", "nothing ever happens the easy way for me", it is impossible to lose weight" or "I'll never find true love", it too entrains the brain to live in a way where that belief comes alive. When life is visualized through the pages of that negative story, the alternate good options to healing become camouflaged by an ending that we unconsciously bring into our lives. By choosing to "entertain" positive ideas, we can begin to move the brain to a direction of visualizing healing paths to blissful existence. Repeating positive thoughts and activities, will entrain the mind/body to live at an energy where cells work better, the mind is not effected by stress, tissues function efficiently and outcomes seem to fall into place as we dream them. In science this level of living is called the "Unified Field" where basic matter if broken down to thought. All DNA is built from this field and when the thinking brain begins to contemplate this gains a sense of "being home", there is an effortless ease of existing. I liken it to the idea that no matter how tough your day at school was (playground, teachers, lunchroom, gym class, opposite attractions, bus ride bullies...) when you open the door of your room, there is a feeling of sanctuary when just for a split second, all the previous tough experiences of the day....don't mean anything or hold any value. There is a "pause" that occurs while lying on your floor or looking up at a blank ceiling where the brain/body/spirit just float. The odyssey is to capture that pause and expand it to our entire waking day. Modern day experts have been able to coach people into daily practice bringing them to that place. Andy Weil teaches breathing exercises
that introduce a neutral "time pause" into one's life bringing you to a place where just for 5-10 minutes twice a day, you live in the moment; not worrying about problems, bills or tomorrow. Herb Benson and Deepak Chopra have encouraged to take the "quiet time" of up to 10-20 minutes twice a day and introduce a mantra or positive thought with it.
In a previous post, I mentioned as I was working an Immediate Care Center in Aurora IL, there was a frantic dad who burst in demanding care for his son bitten by something while playing baseball. Dad has a life threatening reaction to bees and he wanted his 11-year-old son given the same series of medicines for exposure to a possible bee. The dad was frantic, the kid was sweaty in his baseball uniform with flushed skin and fast breathing. Aside from that, my evaluation revealed no life threatening problems so I calmed down the dad, showed him all the monitoring equipment I had to detect impending doom. I asked the patient if I could help him calm down and I proceeded to take him through guided imagery. During my "story telling" he work on slow breath in and slow breath out. Since he was a baseball player, I had him imagine he was pitching and in slow motion going through his signals to catcher, cocking up the throwing arm, releasing the ball, fingers flicking the stitching on the ball as it was leaving his hand.....the slowest throw he could imagine happening. During all this imagination work, by the time the batter in my story swung for the ball, 5 minutes elapsed and miraculously, the boy was not red, he was relaxed (along with his dad), with no shortness of breath and no throat tightness. We just saved him an epinephrine shot, a steroid shot and a tremor inducing breathing treatment. (May have also given him a visualization to pitch better!)
Imagination is a very powerful tool to get us back to childhood. It is also a key that takes us to a place of peace. We can choose to be responsible for our everyday actions and control out future a victim of events allowing the actions of others dominate our thought patterns. In the end, the brain with all its complexity can only be positive or negative. It is impossible to think negative thoughts and positive feelings at the same time. When the mind is allowed to step into that Grand Canyon of relaxation on a regular basis, answers will appear, opportunities will form and prosperity and abundance will follow.

Escape Fire

Just watched Escape Fire: The fight to rescue American Healthcare. I spoke with the director and praised him for a job well done in empowering the American people to understand the paradigm of health in the US and get better "around the system". When I give lectures, there will always come a time when the attendees will ask, how do I take care of flare ups? This could be with anything from pain, to stable disease states to family dynamics. I always say the power of prescription medicine is in the impact it can have on symptoms immediately. Surgery, big gun medicine, acupuncture can change things fast. The sacrifice is the side effects that piggyback. In most cases, an immediate relief does allow patient to get back into the game faster (by continuing with work, training or functioning as a parent/partner) The wise man will plan the wean off during the same day as writing the prescription or performing the procedure. With the 10 minute visit (....minute clinics in Walgreens or Wal-Mart) providers specifically only address a single problem and only give just-enough medicine for a week-hoping the patient will follow-up with primary care to address the true reason for "life-imbalance". The problem I used to "prescribe to" was in seeing a patient for follow-up. If I didn't have time to fully investigate/dive into history that led to "imbalance", I would opt to just continue the big gun/high side effect/behavioral addictive medicine and get the patient in for a longer visit a few weeks down the line outside my scheduling back log. By that time the symptoms were worse, big gun med has stopped or caused a side effect, or problem fixed itself. My training would usually call for initiating the lifestyle change I have been urging the patient to go through from before. I take advantage of nutrition, stress reduction, supplementing deficiency and mind-body techniques. All those things that patients sometimes postpone for lack of time, are now easily translated as the "cure" for the crescendo of problems they comeback with.
The rub is; with the current model of medicine, RESCUE technique only works when disease has been ignored and postponed. The "rescues" only accumulate and become complex resulting in a constellation of diagnosis and intervention....yet resulting in poorer health and high financial expense. Mega-hospitals are built to care for postponed problems. Average health expenditure per person in the US is 5000-7000 dollars per year. We are also low on the list of world nations for health so the current system of constant "rescue" is flawed. What ever you do, I encourage you to listen to what you know is out of balance and start planning the fixes. Even if the plan spans over a few months to years, enlist the help of someone with nutrition experience, behavioral health knowledge and complementary medicine. Still trust in you current doctor to look out for big problems but understand the predicament with healthcare providers and that the insurance based system is stressed.
In Ayurveda, when the person preparing the meal is stressed to listen to the hunger, pick the ingredients, cook the dish, and present it......the "bad energy" of the cook-is "eaten" by the person dinning. This leads to health problems. If the person you entrust your health to is stressed to make financial deadlines, see "X" number of patients per hour, and come up with a plan for a lifetime of health and wellness....the likelihood is the plan with have the same "bad energy" in it that the provider is feeling.
Patient heal thy self, find your own "center for healing", keep western medicine "on a leash" and if you find a doc that listens and is an example of health...never let go and share with others.


While at a holiday party a cousin said he wanted to go with me hiking. Then asked why do I do it. I had to think about the answer; I know there is an attraction to the "rhythm" of nature, I know there is a bliss felt when pace is slowed down, I know I think and problem solve faster and clearer for the time period after a hike, I know my best ideas for healing/growing the nonprofit business seem to come with effortless ease. So how come I can't articulate all this into a few sentences of a "hiking" mission statement? Here is my quest, and what better way to find an answer but to get into nature and allow is to present itself. I just decided to drop off my son to school and head to the Morton Arboretum. My island of nature amidst 2 major highways and 4 Chicago suburb towns. With all the trees being leaf-less, the nearby sounds of highway penetrate through to deep in the woodland area but it's just a low hum of tires and engines. I think back to when I was deep in Yosemite hiking to Half Dome. There were no highways but with the rolling mountains and redwoods, the wind would create this crescendo sound every once in a while that sounded like a jet was starting its engines. I just took the mechanical sounds encountered in the Arboretum and pushed past to get allow the wildlife to bubble through. Then I became aware of the squirl's gnawing away at acorns, birds speaking, ducks overhead, the ground fall warming up as the sun came out. Even though everything was brown, frozen, hibernating....there was still life all around that just seemed to have slowed down for the season. I felt with every step on the trail, I became connected with the prairie that was waiting to bust out in 90 days. When I slowed down (not my steps but ny questions) this cool feeling in the chest (heart chakra for my yogi's) seemed to resound. I feel the human species is hardwired to express and bath in compassion. There is a built-in reward system created when we experience love and give love. Sounds new age but when we know Hollywood banks on the fact that if/when people see compassion played out on the screen, there is a sense of happiness experience in the viewer. The action has been studied in what is called a mirror neuron. Nerve cells designed to bring out the same emotion in the observer as the one actually doing the action. Think of a large group of rescuers all working to free up a child from some fallen structure. You watch and hope and wait until one rescuer reaches in and pulls out the dirt covered child and cradles him/her in his arms while rushing to the ambulance team. A large wave of relief is felt by all the rescuers and equally felt by the viewers. The vagus nerve is triggered in the neck and chest, a full feeling develops in the same area then tears start in the eyes. All this in the comfort of your own home! Civilization, industry, technology calls us to pay attention to distractions, media, political and religious ideas in efforts to make existing together more regimented where individuals work together for the benefit of coexisting in peace. The problem arises in the idea that we are all individual and the only connect we have to others is the reaction to our actions. We exist as individuals and who we are in society is dependant on what we have. To shine out and be the best is inherently related to being better than someone else. This is such a false pretense to think we are the center of the universe and the world revolves around "me". Getting back to walking the prairie this morning, the universe doesn't exist to serve us, we exist to serve the universe. This gigantic field of energy will continue on regardless of our participation and it seems people who learn to support "it" are so at peace and with seeming prosperity and abundance that follows them. People who detract from "it", always go down in a fireball of pain, suffering and separation.

There are a lot of manmade distractions that beckon our attention with the promise of a more fulfilling life. When one is already weak, tired and sick, it seems easy to fall prey to a short cut to bliss. The problem with short cutting nature is it will always find a way to get payback. Going with the flow of the universe has its abundant rewards but it does take awareness, acceptance and daily practice. Finding time to get back into the harmony of nature "resets" my mind to shake off the false suppositions that tempt me into thinking from the ego. When I can think from an awareness that I am here to serve in this continuum of energy, the answers to all my questions just seem to appear as if they were always there, just hidden by endless stress reactions happening all around me, inviting me to join in the stress. This is why the trails choose me.


Recently heard someone say-he (the new love) was a gift from God. Still recuperating from the last "gift", it would seem that meeting someone new would be the universe paying back the heart ache it caused last time. (If that's the case.....I got a big refund coming!) Truth is the universe doesn't do things for spite, doesn't pay back, has no intention to single-handedly cause everything to come crashing down. Events happen, life happens, no secondary gain, no vendetta. The way one interprets the event depends on if you are living in the past/afraid for the future or just basking in the present moment. A marketing guy once told me; "I know you like doing good things for everyone but I am interested in prosperity and abundance. I told him there is nothing wrong with prosperity, health, abundance.....I have tasted it and feel I attract it. The problem I see is we base these on material accumulation. Monetary value is one thing, (it pays the bills) but no way does it equate with the other. I love the way Wayne Dyer says he lives to serve the universe the best way that only he can. When this occurs, there will always be a feeling that this is right, that feeling of success is hardwired into our DNA in efforts to help sustain the species. If killing and living in isolation was the best way for man to survive, Darwin would have predicted extinction by now. Any culture no matter the language spoken, if watching a touching event, will have that tight feeling in the chest, a fullness in the throat and a tear in the eye form. Compassion is meant to be repeated over and over again. (Kind of like the way George Carlin used to say God wanted the eyes to be sensitive so he sprinkled a lot of nerves into creation, same with the mouth, ears and nose. When it came to the reproductive organs....he poured the whole bottle of nerves saying; I want them to shout my name!) I believe Hollywood is a combination of mass hysteria and industry driven secondary gain. This facade of success being the biggest bank account or top grossing record or friend status on Facebook. It will never sustain a lasting feeling of happiness, there will always be something lacking, causing the seeker to go out and accumulate more of the same empty reward. One of the biggest reasons for hoarding is we are told who we are is based on what we have. Deepak has a great saying: "We spend money we don't have on things we don't need to please people we don't like." In my lectures, I always mention the true healer writes prescriptions for nutrition, grounding and movement. I feel more than the rescue medicines I prescribe, the biggest impact on life is made when I can help a person find the substance inside them that feels true reward. Helping people realize their strengths and not just point out weaknesses and then guiding back to the path of bliss that we kind of got introduced to in highschool and college but then promptly reconstructed by society to do what is available in the job market that will make the most money in the least amount of time. When so overwhelmed with maintaining the facade of success and a place in society, we sometimes don't recognize the beauty of common everyday bliss that just past by. In the case of a person in mourning from a loss, honoring what we once had is fine, lamenting on the fact that we don't have the relationship anymore, will bring all the focus of everyday life on the past and not what is happening so beautifully right now, under our noses. -Living in the Now as written by Eckart Tolle. Sometimes placing attention on those basic concepts of what can I do best that will serve this world -will turn out to be the most fulfilling and rewarding. (...this is usually what we dream of as kids/adolescents....think back right now on what you used to love doing!!) I dont mean to forget responsibility to family, ignore bills, disobey the 10 commandments or break the law. That would go without saying, but if during those times when the brain for a split second contemplates, "what should I do?" -acting in a benevolent way is an option and will always have a positive outcome. When you are one with the universe....the cool thing is there will never be any thought of events occurring for spite, revenge, payback, or secondary gain.

Drowning in Social Media

It seems like a good concept. Get seen faster and to a larger population of humans and you will be "guaranteed" more new patients. Instead of paying 1000.00 for an ad in the local paper, just go internet and you can reach thousands. Getting plugged into someone else's database of contacts will insure a higher percentage of "clicks" on your profile/ad which translates to higher recognition/awareness of your name. But no one spoke of the side effects. Even in the pharmacy now, there are so many listed side effects to medicines you pick up that they print it on a sheet and ask you to read, understand what you read and sign that you were informed.....all in efforts to get you in and out fast with your "brand new bottle of prescription medicine". This thirst for speed, volume, public reach the masses, be in the masses, be the best of the mass and make a lot of money. No one tells you that you have to update your profiles, regularly observe how many people clicked on you, how long they stayed on your link, if they came back, if there was a phone call generated from the click, if they scheduled for a visit, how to change the profile so it takes advantage of the trending for that week, what people are trending about for the month, who else is generating high volume following (likes). Then when you get wonder what happened the next time you do the same thing and don't have the same reaction. Did I do something wrong? Why aren't people following? Am I not valuable anymore? Who else is getting my followers? What do people think of me now that I am a failure? What crazy "hollywood" stunt should I do to get attention back-it seems to work on cable TV. Like Al Pacino in the Godfather: "Just when I thought I was out, they pull me back in". If you buy into the fervor of virtual presence, you should first be grounded in what your dharma is. (Dharma comes from Sanskrit and stands for your purpose in life) If you are unsure of your original intention before the journey, the challenges you will face on the journey will shape and manipulate the way you live your life. Could be a good thing, could also turn out terribly wrong with a resultant twisted, altered package of what formerly was a compassionate idea. Growing up in mainstream America, we are taught how to succeed, that only the best will make it to success and that anything other than blood, sweat and tears will result in a lifetime of suffering and poverty. So we become very good at getting to the top by stepping on others that don't deserve your spot. I remember in Catholic school we are all part of God's creation and should love one another like we would want to be loved. This was taught to me by a tall, shadowy lady in a nun outfit that used to carry a ruler with the threat of a swift whip from the wooden instrument end onto knuckles if you didn't recite the phrases. The only time I was taught to calm the mind was in sports. When it was my time to belt test in front of the class for martial arts, or when getting ready for the state finals in a sprint and performing the ritualistic steps to slow down time and wait for the gun to go off and unleash the fury of concentrated human speed. So when do most people learn the trade of meditation and grounding.......usually at the lowest point of life. Some people don't touch on spiritual access until the last breath, some get it and move onto a higher way of living (seemingly igniting life into everyone they meet) and some are lucky to learn from parents/friends.
This virtual chat room with the rest of human kind is a great thing but if you have no substance or only have an intention of joining in because everyone else is doing it, you are just postponing the inevitable. You will find yourself with no time to relax, no true friends to share adventures with, withdrawn from nature, caught up with always having to check for new responses and update status. Sooner or later, you will ask yourself the question of why do I do this, it there something better, who am I and what is my purpose. May as well start now before you are too deeply infected by the man-made "mind virus" of virtual living.


With primitive brain function, pain and pleasure can be burned into pathways that are easily accessed again and again. For example, if seeing fire is associated with painful heat, the animal will induce an immediate response to smoke or fire by turning on the fight or flight reaction and avoid the encounter. The more the association with pain, the more nerve paths/brain maps are created to elicit faster/powerful reaction. When the stimulus of fire is not experienced for a while, the learned paths are not erased.....they are just over taken by day-to-day experiences/paths. In 10-20 years, if the painful experience comes up again, out of the depths of the brain, the path/brain map is called on again to elicit the same learned reaction in efforts to keep the animal alive. Sports medicine docs/trainers refer to this as "engrams" that an athlete learns during practice to reproduce during competition. Mind body medicine docs like Richie Davidson out of University of Wisconsin/Madison refer to developing brain paths as "neuroplasticity". Dr Davidson has studied people like the Dali Lama and gone on to state the brain will actually make neurons/brain cells if a new activity is practiced/brain path is created.

The current argument is with contemplative science, if compassion/meditation is practiced daily for years, can the brain make nerves/paths/maps that can be re-accessed in a fraction of a second to elicit an animal response just as powerful as fight or flight. YES! His work as documented with multimillion dollar biomedical machines the same postulates that Herb Benson assumed in the 70's about relaxation bringing on some healthy response in the body. All this controversy and high-end research is being documented just to say to doctors and patients: "relaxation and meditative practice on a daily basis is associated with healthier lives and less need for pharmaceutical treatment". Duuhhhaa! It is a shame we have to prove this with expensive testing/randomized controlled trials but when a pharmaceutical company comes up with 100 pages of documentation by "their scientists" that this drug will help control symptoms of your disease, an equal and opposite force must be utilized to show doctors and patients on the fence that spending 10-30 minutes once to twice a day in mindfulness will extend your life and reverse symptoms of disease.
With direct to consumer advertising, a lot of people are placed "on the fence" with deciding what is good for health. The internet is a great vehicle to get information but it is likewise a great vehicle for spreading bad information. I empower my patients to be their own advocates for living long but always discuss the information they learn with a reliable person to sort out what should be applied and what should be avoided. Spending 1000.00$ on a slew of vitamins can be cut down so the extra money can be utilized to spend on massage, healing touch, a great anti-inflammatory meal, a vacation....all that will be just as impacting to health/feeling healthy.
Americans are not taught in school how to get in touch with nature or relax. It is usually assumed that alcohol, tobacco, marijuana or buying a big house/fast car/new purse is relaxing. These things may bring on an immediate sense of happiness but it only lasts until the next day when remorse sets in. As Herb Benson and Richie Davidson both point out, cultivating the relaxation response with regular meditative practice can help "neutralize" all the stress responses we go through in 24 hours.....emotion on the highway, emotion watching the news, emotion paying bills, emotion doing someone elses work, emotion watching Jersey Shore.


Back in the 90's, I used to acquire titles to be someone. Can't be a good sports medicine doc it you don't work with a team, can't be a good family doc if you don't see 30 patients a day, can't be a successful physician without driving a Porsche. Did it all to validate me as being a good doc amongst my colleagues. Patients were praising me but administration said I still was not competitive with how the average doctor in the US bills in a day (MGMA standards). So when I didn't agree with the direction the hospital was going (insurance business model) I left private practice and worked for emergency room/immediate care centers. I didn't have to worry about finding a true cause of suffering, I just treated acute symptoms, gave medicines and told everyone to follow-up with your doctor ("Treat and Street"). Just have to follow acute care "cook books"" and not worry about bonding with humans-(takes too much time). Ha!, but little did I know, when I started to show compassion and listen, my "numbers" went down compared to how many patients were seen per hour by other docs. Then when I followed orders and moved through charts like a Jewel Grocery cashier scanning cans, then patients complained they felt rushed. I just can't win in this insurance reimbursed model. I had to figure, how do I empower patients to help themselves while at the same time, be profitable as a small business owner. I needed to find an answer and was always taught the answer is in the wisdom of other docs who have the biggest buildings, fastest cars and biggest staff. But.....I found there was a message inside, a knowledge within each cell of me that knew the exact way to problem solve and come up with the correct choice in every decision. My epiphany came when Deepak Chopra came to Chicago and I thought maybe if I heal the inner turmoil between compassion to serve and the hollywood picture of success I can be better at applying my textbook knowledge and problem solve. I listened, learned, met other non-health professionals that were healing (also met some docs that were going through the same thing as me but they seemed very angry.....complaining about the medical system and missing the event of something beautiful morphing during the lectures that allowed for an inner message to be heard.) I began to interpret feelings my heart generated and allowed these to effect my decision-making/problem solving. I didn't recklessly abandon medical protocols but I allowed for feeling comfortable with using "feeling" to help guide patients to better health. Something called me to learn acupuncture, something called me to observe an herbalist using aroma therapy, something called me to give more "free lectures" to the community, something called me to start following Andrew Weil, something called me to start teaching yoga. I would have never done any of this in the eyes of my doctor friends because it would seem "quackery practice" and I can't get reimbursed for it. Fast forward to earlier today, I am supposed to be preparing a lecture for Cancer patients but the new Hospital Wellness Center that just hired me for yoga instruction, still had to have me go through the painful administrative paperwork of credentialing, verification of training, drug testing.....I dont have time for this! In my mind, the question of why am I even teaching yoga? as my first class was filled with 20 people who had no training, and I probably will be paid just enough to take care of gas....I should just stick at filling my office hours and promoting myself using the "usual marketing companies". Well as I was being told I needed another picture ID (I live 25 miles away!) and about to stick it to the manager of HR saying, this paper-chase is sooooo frustrating and worthless and just get some "minimum wage non-MD" to teach it! A lady walked up and excused herself but had to interrupt and say; she attended the meditative yoga class I gave yesterday and in the 10 years of suffering from Fibromyalgia, had an entire day of feeling no pain: she told me it was "transforming and has been telling everyone she can't wait for next week and wanted to see me as a patient". Like a switch, all the anger left, I suddenly was speaking to an HR manager that appeared to look different and this calm was injected into my blood stream. To imagine I was seconds away from allowing self doubt to control my heart/mind, ruin another human's day and probably get on the highway at dangerous speeds taking frustration out on innocent motorists. Although it was reassuring to be validated, I feel more empowered to follow the innate wisdom that was always there but sequestered by the ego. As Deepak's Law of Karma says; My Actions are Aligned with the Universe