Havad Yad.... (Harvard Yard in non Bostonian)

Herbert Benson, MD. Prior to March 15, 2009, I have only heard of this man via the teachings of my idol, Andrew Weil. I decided to take the chance on learning a little on Mind-Body Medicine since it would be a few months until the completion of my wife’s clinic (and when open, I probably won’t have much time short of driving the kids to school). It was a last minute registration but after pleading with the person that takes care of registration, I was told it would be ok. I anticipated that I would be taking more pictures of scenic Boston than listening in on the course. Boy, was I surprised. First there was the awe-struck state of being in an institution where the leaders of medicine have graduated from. Then there was the fact that the man running the course has developed his own passion for a division of medicine that prior to the millennium was considered only catering to hippi boomers that lived in compounds or only ate vegan style. My feeling is that because patients had demanded approval from their doctors of alternative remedies and “eastern” techniques (not to mention that the Rheumatologic community had placed women with depression, muscle pain and sleep disorder into what doctors term a “waste basket diagnosis”) that doctors had to do some superficial investigation of these successful word-of-mouth treatments that they could find no journal studies on so they were placed into the same category as “chiropractic medicine”. This was an all inclusive “non MD” club that was successfully taking care of a lot of symptoms but still considered back crackers and only successful because they saw the patient frequently and placed warm hands on spasmed areas that gave a false sense of security to someone in pain that would have just improved in the same amount of time anyway. (Forgive my one sided theoretical opinion my chiropractic brothers). This was the reasoning that many a medical resident had upon graduation to the real world of getting a paycheck that dwarfed anything ever conceived as a medical student or first year resident. It was still the pervasive thought of many an attending I would run into while in the halls of my previous hospital in the “center” of “Dupage” county. This is not to detract on the talents of my fellow family practice doctors or medical specialists; this is just to reiterate the common feeling doctors had when patients would bring up the fact that a friend or neighbor suggested a local “DC” as a possible suggestion for second opinion when the back pain didn’t get better with physical therapy or injection of steroids. Patients were even apprehensive when interviewed and asked “have you ever tried “alternative” medicine techniques thinking the doctor would lambaste them if the truth was divulged that the previous back problems were gone after one or two visits to the local “manipulator”. I even see patients in the ER at Rush-Copley with a history of chronic back pain prefacing their most recent visits for therapy with; “I know you guys don’t like chiro’s but I went to see one”. … (and usually with good success!) Doctors have adopted an unchallenged bias against a concept of health care that we don’t understand and choose to ignore. Same goes for when I came back from UCLA with Medical Acupuncture certification and the first patient I treated was my nurse who was suffering from carpal tunnel of her wrist and I did the “suggested” needle placement and after 10-15 minutes, the needles had fallen out but the pain for several weeks was no more. Again after seeing a referral from a partner for “Shirley” a lady with chronic headaches that the neurologists and headache specialists in downtown chicago couldn’t help but with a few needles, the pain of several years was gone (albeit for 1 hour but still gone). I stumbled onto a facet of medicine outside the normal realm of allopathic teaching but it gave more immediate relief than any other treatment I have ever tried.
Patients were getting results, they were telling their friends, I was believing there was something to “alternative medicine” and I didn’t require a prescription or a consult. But as the corporation changed, so did the tolerance for anything outside standard operating procedure/protocol. My clinic which had been started by a small group of senior residents from West Sub Family Practice was recorded as being in the red for the last several years (even though we were able to “drop” HMO’s in the 90’s and see less patients per day and yet get reimbursed more than we ever had since the clinic started, all in attempts to not narrow the delicate patient visit down to 10-15 minutes at a time.) Well, I digress. What ultimately drove me to Harvard to learn from the best, was the desire to feel rectified in making those suggestions of nutrition, yoga, breathing, chiro and acupuncture to folks who were coming in with 3-4 pills for one or two medical issues. (Symptoms mostly from stress or anxiety), with only more pills to come in the next 1-2 decades. I knew I was right, the patients would always breath a sigh of relief when I agreed with there need for seeking out alternative treatment plans aside from permanent surgical destruction. The only problem was my insecurity in suggesting and writing prescriptions for chiro, massage or supplements at Whole Foods. I guess I needed vindication for what I was doing now in addition to leaving what was a regular paycheck working for an institution that didn’t acknowledge the trickle down cash that was generated from my continued patient loyalty for the very same practice style that I now am being questioned for since it didn’t make same amount of money as the average family practice doctor practicing in the US. (If you don’t bill what everyone else is billing, you must be doing something slow or wrong-or perhaps “spending too much time with patients who could easily be treated for what they signed up for in less than 10-15 minutes). If you have ever tried to pacify a crying widower or a man let who was just told his prostate may be cancerous, or a lady who has an abnormal mammogram and answer all questions with reassurance everything will be ok then pacifying an angry family member who doesn’t believe this is a correct diagnosis in less than 10-15 minutes and have been successful, you are a great time management person. Don’t get me wrong, it can be done. In a previous blog, I mentioned that there are some man-doctors who take pride in the high volume they can see in one day or the billing they can charge in one day and surely, an office like that has to be running at it’s maximum efficiency. From front desk to triage phone nurses to medical records to clinical nurses to billing staff. Quite a mouthful of people to pay every week just to keep on time and send those bills out to your insurance company. A great production line type of office. Reminds me of those Visa commercials where people are going in and out of a coffee shop all flowing fast and efficiently until one guy wants to pay with cash. At that point the whole system shuts down and no one gets coffee, no one serves coffee and the only way to get the flow again is if the guy uses his visa card. Same with the contemporary medical office, everything flows well with your sick care as long as it’s the usual sickness. Oh, and those are all found to be standard as long as your symptoms fit into a category that was determined by a large research company to be symptom x equals diagnosis y. Did I mention the research companies are backed by drug companies? Finally on your way out of the office, you are given a few scripts that will take care of your sickness, with the medicine that the drug company makes!
Oh oh, sorry, I still hold myself in a defensive posture when I talk about old times. The bottom line is that Dr Benson and his team at Harvard, have been going to the point of DNA and genome expression showing changes with things like mediation. There is no way to argue against DNA as proof that something as easy as “relaxation technique” from the 70’s will work to offset massive symptom lists found in our patients diagnosed with fibromyalgia, menopause, chest pain, anxiety, depression, chronic pain…… the list is endless. On my way back from Boston, I ran into a young newly hired biomechanical sales representative. This is typical, she told me at one point in her life, she was able to get off bronchodilator inhalers, inhaled steroids and oral steroids but had a flare up that put her back on all her meds. She was focusing on the fact that she has to be on inhalers and oral steroids again and her medical problem will never go away and she’s tired of taking medicines (that can lead to early osteoporosis). I told her a simple fact that at one point in her life, she was able to get off medicines and stay off. Perhaps her doc did every test, or maybe dismissed it as “see, you stopped your meds and it flared up”, or maybe no one listened to her cause she was embarrassed to say she found a time in life that needed no meds. I told her not to “poopoo” western medicine right now but after her life is settled a little to give me a call and perhaps we can go through in detail what she did and when she did it to recreate that life success she was able to attain.
I would try omega 3 fish oil, stop exposure to dairy and flour (anything enriched or processed), probiotic to strengthen the gut, might look into adrenal fatigue and medical acupuncture and yoga. With the short time I was talking to her, the high pressure will have to be addressed especially with a new sales job. But that will be another blog………..
The other health professionals I met at the Harvard course were some of the people that will change the way medicine will be practiced in the near future. The great thing was that these folks I met were from; US, New Zealand, Colombia, London, Singapore, Italy, California, Michigan to just name a few places. It’s not just booming in the US…..we’re talking global! I know I’m doing something right!

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.