Roller Boogie

Had a 60 year old come in via stretcher holding her left wrist. Had a bag of ice over it but as I got the history, patient was skating at a roller rink and slipped and fell onto her butt, and outstretched left hand. Judging from the way the wrist now looked like a hockey stick, she was fractured, just had to see how bad on xrays. Went ahead and called the orthopedic surgeon on call and it happened to be the husband of an old residency partner from West Sub Hospital. He came in to try and reduce it with a local injection. (Sometimes we can inject the area of the break with the same numbing medicine used as the dentist-with these fractures, if we can pull the broken bones apart and cast the area-may be able to hold the two broken pieces in a straight line to heal faster)

The same hour, a 72 year old lady also came in holding her right wrist and stated she just came from a roller rink party and fell on her butt and outstretched left hand. Taking off the ice pack, wrist looked ok, mild redness to where the ice was but no swelling. Her xray showed a thin line of a fracture along the same bone as the first lady. I placed her into a splint and sling and told her to see the ortho in the am. Very little pain and very healthy lady.

Obviously, there are some variables that would change the fall in both ladies; angle of the fall, speed, exact position of the extremity in addition to the health of the patient. The only tangible thing I could deduce was health. The 60 year old didn't take supplements, drank coffee, and had cholesterol "issues" was still working fulltime and was not an "exerciser". The 72 year old exercised regularly, even pointed out with her daily walking, she would take a small handheld weight and rotate it one direction then the other for the entire 20-30 minute walk. She claimed her girlfreind she walks with keeps her laughing and claims she has no stress. She gets physicals regularly and had a recent bone scan that was normal.

It was amazing the 72 year old didn't break her hip and she only suffered a small stress fracture. Being a man that sees life with the "cup half full", I would believe her exercise and stress reduction played an important part in keeping her bones thick and strong. This just backs up the Saguil Approach in utilizing preventive medicine not only before the disease is found but even after the disease has been controlled with medicines or surgeries. I have always taken pride in the patients that would take my advise to control weight, exercise and change the way stress is dealt with. Many get a false sense of security when the "lab test result" is brought back to normal with a pill. Now a days, diabetics come to the er with 2-3 pills (on average) state the last blood tests looked great at the last quarterly visit, but yet they are overweight and don't follow their carbs or calories. I even remember a diabetic I was counseling about smoking, I told him the tobacco will kill him, he answered "I know I will die, my wife will die at some point and even you (pointing to me) will die sometime. At that point I knew he wasn't listening but if I only had enough time or another visit with him, I would find another way to approach this denial. Bottom line is I always believe, no matter how many pills, medical issues or lack of money, there is a particular way to get healthier for everyone before during and after a medical issue is discovered.

From the Heart

The heart is considered a muscle in "concrete" terms. The muscle beats for about 80 years; 70 beats a minute that will sometimes speed up with stress and exercise and slow down with relaxation and sleep. The more in tune the heart is, the slower the resting heart rate. (It is rumored that Michael Jordan had a resting heart rate of 40!) During high stress it can go up to 180.....just like the Steeler's James Harrison last week during that 100 yard return! Getting the heart fit will usually reap rewards in time. I always thought running was good enough but now with the way my mixed martial arts practitioners are pushing the envelop with full body involvement like the concept of "peripheral heart action", work outs like "the 300". These practitioners are showing the medical community that a different form of exercise is being utilized to keep the heart in excellent condition. And it's not just the 20 year olds.....more boomers are adapting this form of exercise. At Contender Boxing in Aurora where I trained last year, Mike Bardash was developing routines for conditioning the legs as well as the torso. (never thought 5 minutes of throwing hands would be so exhausting).

My point is that if I medically clear a patient for heart disease, sky's the limit! Pushing the envelop will yield a healthier heart and a more grounded spirit from the triumph of making through the routine. With a healthier outlook, stress is seen in a calmer vision and easier to neutralize. I speak of the healthy heart this month since it is "heart month". The concept of getting on a treadmill, bike or in a gym is the western way to figuring out what a goal should be and if we are hitting the goal 20-40 minutes, 5 days a week. The oldest exercises, Tai Chi, QiGong and Yoga have rewarded practioners with longevity without targeting the heart muscle as goal. As I have referenced in previous blogs, I started incorporating meditation into whole body healing when a patient of mine who had high blood pressure started with yoga. In three months, he actually gained weight, got off his medicine and lowered his blood pressure. I could see the transformation over 3 months and soon after I enrolled in Medical Acupuncture with UCLA. I have seen this repetition with several other patients.

The Saguil Approach would be, ask a doctor first. Once cleared, find an activity that is interesting and easy to perform (without going broke), find a group of others with the same mind set, stay away from those with bad karma, and eat things you dont feel guilty of. Don't fall into the mind set that age limits activity, embracing challenge is one of the ways people endure. The best anti-aging drug I can prescribe is "exercise".

Bun in the oven

14 year old kid came in with mom for a little problem with upper respiratory symptoms and had to leave basket ball practice early. Got a little dizzy. No other sick people at home but I knew there was something going around the community. Physical evaluation showed a stuffy nose, alot of post nasal dripping, clear chest and retracted ear drums from the nose being so stuffy. I told her and mom about what I thought and that due to the circumstances around the community and her presenting issues, she probably has what all others have and I should give antibiotics and nasal sprays if she cant wait and do the conservative way. Of course I asked, "and when was your last period?" She mentioned it was off this month (january)...a little late and short. Then obviously I asked in a politically correct way with mom in the room..."do you have a boyfriend". She said kind of and didnt make eye contact. Then I let mom ask...."are you having sex?" The kid said I had it along time ago. At first I thought....oh she probably experimented once along time ago and she is not active. Then I asked in detail....."when was the last time?"....she said "last year". Immediately I gave a sigh of relief but then I asked exactly when so I could document it....and she said "december". (I thought to myself....does she mean december 13 months ago or last month) then it hit that this is a 14 year old and the perception of time is as off as the conception of consequence. So end of story, I ordered a urine test and had to give child and mom (or should I say Mom and Mom) the news. What was shocking was the way mom asked "are you having sex"....it was as if it was a channel two new reporter asking the question, not a concerned parent who would be saying it like, please dont tell me you are having sex with someone. I felt as if the mom wasnt involve with the raising of the child....and maybe she wasnt but.....the highest likelyhood is that the mom (now grandmother) will probably raise the august baby!

Walk the walk

Deepak Chopra was commenting on his resolutions for 2009 and he mentioned that "happy people find opportunities where other people find problems". The current economy and "political climate" that has been in the spotlight for the last few months (before the election and the "bailouts"), point to recession. When I picture the black and white pictures of long lines for soup and bread in the depression era, it is hard to imagine we are in the same hardships. Working in the ER, I see people who can't afford medical insurance but are clutching a bag of Mcdonalds and talking on cell phone while watching the kids in the room play Nintendo DS. The government does cover our kids for everything from medicines to surgeries to multiple ER visits. (some will even complain about the "long wait" at the downtown VNA free clinic in Aurora as a reason to wait in the longer line at the ER). So I see that as this is a bad time for everybody, people are surviving and utilizing what is available to continue life. In many cases, people are also continuing their bad habits. Smoking, poor eating, alcohol, sedentary life and complaining about the "system". I just got off the phone with a radio talk show host and his significant other is continuing to cough through 2 rounds of antibiotics and has an appointment to see a special doctor that charges a retainer fee of $1500.00/year that will allow you to become one of his patients (and after that you still have to pay for each visit!). Uninformed people are surviving but getting worse. Informed people are trying to change but paying more now than ever for guidance and instruction. The people that are supposed to be the healers, are feeling that they have to charge over- the-top fees to survive the insults sent by the insurance companies one a month



What the hell? I thought the concept of being a doctor meant you were devoted to your patient 24/7 and were the person to call in case of emergency. It has gone from neighborhood docs with house calls to boutique medicine where doc charges per minute like a lawyer. I complain but I realize I am working as part of the problem in an emergency room ushering people in and out and placing temporary fixes here and there hoping someone else will take good care of the individual who is looking for help. Now comes my reveal:



As I mentioned earlier, Chopra was mentioning we have to live the same life that we are trying to share with others. I eventually will get to the point of practicing medicine my way, not taking insurance but yet not charging thousands of dollars. I believe I am blessed with a wife that is an excellent dentist, opening up here own clinic and truthfully, I don't have to work another day with the following she seems to have. (Patients know when you are practicing from the "heart"). I have promised god to share with others the type of health and wellness that I am experiencing now. At 46, I am healthier than I have ever felt, I choose to surround myself with positive people (from bankers to union workers to local law enforcement....I even have an old patient that is still active with Chicago FBI) and most of all, my family has chosen not to let evil or hatred in our house. I always tell patients that are suffering to seek out others that are uplifting and inspirational. Hanging with people who hate will make you hate. The analogy that anger spreads fast in a crowded elevator will usually get the one that hurts to seek out a different surrounding and a different social group. On the flip side laughter also is contagious. I think smiles are healing, handshakes can be uplifting, gifts are encouraging. I tell my patients that "turning the other cheek" is an outdated phrase; accepting an injury but and starting the healing process before it occurs is the basis for good spiritual grounding. -(see sportsinjury411 for yoga info)- Hatred, wrong doing and "bad karma" still has to be responded to, but that is why we have friends, law enforcement (thanks to Naperville, Lisle and Aurora PD) and trial lawyers. Let the "good guys" do what they have to do, trust in what your doctor has to say (but get an alternative opinion) and surround yourself with positive people.

Pertussis

Talked to my daughters classmate mom and she claims the allergy doc did a bunch of tests and all were normal but the diagnosis was still a pertussis infection. She had been out of work (stewardess) for about 3 months. Now she is a little better but still with a hoarse voice. Also the asthma that has been "dormant" since childhood is back. Doc placed her on 2 rounds of big antibiotics and is about to do it again. I told her she needed a probiotic with all that normal flora destruction, omega 3 fish oil and probably digestive acid aid. She had very good trust in her doctor but it sounded as if the doc was just blaming it on a tough bacteria and a resurgence of asthma. Obviously the doc did the right thing for looking into was caused it but probalby should have continued on with my suggestions.

In western medicine, rheumatologist do agree with the start of some reactive arthritis issues with an infection. The issue comes up as is it the infection that begins the arthritic condition or the use of antibiotics the starts it. Probably a little of both but the "Saguil Approach" always includes a probiotic to follow the use of any antibiotic. Another doc in the ER does the same with the patients she sees and I applaud her for it. I also think that patients going to the ER for terrible symptoms also expect to get a script of two before they leave to feel they got a reward for waiting so long in the waiting room. An extra 5-10 minutes usually would educate a family on why antibiotics arent always good but I am supposed to see an average or more than average of 3.5 patients per hour to show I am pulling my share of the work load in a months time. Even out of a private practice into an ER, statistics and numbers are always the way administrators determine if we are doing are job as docs. Saving lives, getting people healthier just doesnt work in the insurance business.

I give up!

The Doobies

I had a guy argue why he takes marijuana. States he functions better at work, has less inhibitions, sleeps great and has great sex. Seems like a wonder drug right? His argument was backed by a very stern determination to trump me and my medical knowledge. He was expecting to hear the usual horror stories of how drugs are bad and conservative opinion usually comes from those that are "straight" church going parents. I side stepped that and asked him if remembers being verbally abused, physically abused or bullied in highschool. I could see he wasn't ready for that rebuttal.

I simply told him that an "average human" can function in a 9-5, interact with a spouse, and sleep without a pill or bottle or weed. When we have to supplement our lives with anything, it is usually because something basic is missing. Just like my 2 other posts this month on vitamins and Monavie, even with supplements, one still has to establish basics for the body to work right. Coming up with which basic is missing in those that require marijuana for getting through the day is very tricky. In the medical field, there are specialists like "Dr Drew" who deal with addiction medicine and very well versed with knowing what would probably work best to define issues with those "who use". It takes alot of trust to open up to a stranger, it also takes a lot of trial and error to find a therapist or doctor you feel you can open up to.

The biggest step is to realize using marijuana means there is a medical reason for the desire to keep going back to it. The next step is to see a medical provider for guidance. A primary care doctor should be the first step. Unfortunately, it will usually require a family member or loved one to bring the problem to the users attention. If nothing is done, the problem eventually will compound since stress and life trials will always get worse as we get older and our worlds become more complicated.

The last thing I mentioned to him is.......look at Bob Marley, he died using weed.

Waste basket diagnosis

When I was in my sportsmedicine fellowship, I used to see a small collection of patients come into the office as a referal complaning about shoulder and neck pain. Many times it would have been fully worked up by the primary care doc and with minimal signs (if anything) on xray and mri. The usual diagnosis would be that of an issue or problem with the joint involved most. Many times it would be shoulder bursitis or pinched nerve of the neck. We would again get them into therapy, thinking the therapist used by primary care was doing something wrong. Sometimes an attempt at different medicines, often stronger, and maybe a steroid injection would be attempted. After another exhausting work up to look for neck or shoulder pathology (without finding anything) and yet a patient that is still suffering, a diagnosis of a mental disorder or a malingering patient just trying to get money from the car accident or the government was made. The average age of onset is usually 20's but patients are into 30-40 with chronic pain.

Symptoms were usually the same: poor sleep, fatigue, multiple trigger points to muscles (mostly back), depression and headache. There is usually a trigger event like an accident, infection or stressful time of life. I found a diagnosis of fibromyocytis, also known as fibromyalgia being kicked around that lumped all these patients together. So actually other doctors were getting the same kind of patients and wondering if there was a syndrome that was being missed. Somehow though, it was thought of as a waste basket diagnosis since it wasn't "real" and was just coined so doctors could identify that a patient was suffering from something. Western medicine couldnt do anything with it short of sending the patient to a psychiatrist for psych meds. Being in sportsmedicine, I would utilize very gifted physical therapists that would have an eye for finding movement disorders and they would usually be able to help a patient get mobility back and work on flexibility. This alone would make many people feel better than they every had thus less medicines and eventually less side effects from medicines. Usually when a patient began to believe in themselves again, outlook would be better and they would be more involved with what works and get healthier. At one point, I had alot of patients with this diagnosis coming to me. I have to admit, I did get burned out since the diagnosis comes with many complicated issues and sorting things out took alot of emotion out of me. It was always rewarding to get the patient pointed in the right direction and see them get off medicines but if this took 45-60 minutes to evaluate and a family practice doctor that works for a hospital is expected to see a patient every 10-15 minutes.....I would get very backed up for the day. "Dr Saguil is running behind" was a common statement in my office (but patients were willing to wait! and I wasnt sure why they waited so long! I guess it was because I was listening and giving them some useful guidance.)

In a few years the American College of Rhuematology backed up the fibromyalgia diagnosis by saying that if someone came in with no other medical problems (like hidden hepatitis or arthritis) if they had sleep disorder, depression and 11 of 18 painful areas of muscle to specific areas on the body, the diagnosis was true. This was a "touchdown" for people with FibroMyalgiaSyndrome since a big authority said it is true and can be treated. Guess how it was treated, medicine for sleep, medicine for depression and physical therapy! So now the rhuematologists were getting all the referals instead of the orthopedic surgeons and they were doing the same thing.

Fast forward to the millenium, big difference now is the sprouting up of pain clinics! FMS is still being diagnosed but since its a very well documented disease, any average doc is treating it with a medicine for sleep, a medicine for depression and immediate prescription writing to see a therapist.....oh and a muscle relaxer and narcotic. Note....narcotic! Patients are being treated more readily by the unexperienced doc, usually adequate at first but with the next flare up, (and it is a lifetime diagnosis so a flare up is going to happen 1-3 times a year- especially in chicago), the frustrated doc is going to give potent medicine to quiet things down, but depending on the intensity of the flare, and other issues at the time, a narcotic will be relied on probably a little to much. Then comes the fast food mentality. Patient not educated on how important it is to get the fire put out immediately before resuming work and/or child care so reliance on meds like muscle relaxers and vicodin becomes more of the daily medicine than the "only for emergency" medicine. Then when the patient calls for a refill....referal to the pain clinic for narcotic management.

Don't get me wrong, the pain clinics are good, they did have a great headstart but they are now being dumped on by every doc that doesn't have the time to care for the 20-40 year old women (and rarely- men) with FMS. There are waiting times of up to 2 months before a patient can be seen. If you have ever suffered from a trapezius that is numb, tingling and a trigger for headaches and nausea, you would understand that just taking a muscle relaxer and popping a narcotic to get to that Jimmy Hendrix level of being high doesnt cut the pain and dysfunction. I have experienced this and it came after the emotional separation of me from my practice in 2005 when my previous hospital said they wanted to cut my pay since I wasnt producing like the docs in the rest of the country.

Suffice it to say, while in florida, I was finding the same suffering from FMS and because there werent as many "creative" docs there, I had no competition for patients but there was also great acceptance by patients for alternative medicine docs. The patients were getting smart and going to other forms of healing and getting better. Acupuncture works (no matter what a standard questionnaire says), mind body strengthening helps, movement like tai chi or the more popular yoga is a must and nutrition education is mandatory. You can always go the the pain clinic, get hard medicines for a few months, maybe a steroid triggerpoint injection her and there while you are on your way to flexiblity and healthy living.....or....just start with the movement, nutrition, time off and skip the narcotics.

Lets see where patients get dumped in the next decade.....with the government approving some alternative medicine therapies, may not have to get dumped anywhere since education is being given by those who dont have as many time constraints on visit time and those same....only can rely on movement since aggressive medicines are only given by doctors. I do believe there is a place for everything but not in excess and again I maintain it always starts with a good history and physical.