Shifting Gears

As of August/September 2014, I have been a witness to the inadequacies in insurance based medicine.  The old adage of when you have a hammer everything looks like a nail is still true.  The talents in some of the doctors graduating from medical school is fantastic.  Unfortunately, there are also some very average healers out there.  The problem is if you have someone fighting for your life, it would improve the odds of survival if that person was as committed to maximizing health as you.  On a good day, in the morning, after a good meal and sleep....most doctors will probably be "on their game" in problems solving your predicament.  But as you know, most people "on call" for the ER probably slept poorly.  Most people trying to get through Monday morning traffic to arrive on time for office hours probably have been through 2-3 episodes of being cut off before arriving at destination.   Most people running late in the office are contemplating how to apply the "care algorithm" for your 2 biggest problems and delay addressing the others down the list until next visit.  Most people by the end of the office day have not eaten properly and are saving the most urgent calls for immediate call back and postponing other messages so they can "get the hell home" and let the office staff deal with the left overs.  Note that the higher you go with medical training (the sub-subspecialists) the less likelihood a response will be.

Speak of the devil, I just got a text from my wife.  She is in Florida caring for a relative who is being released from a chronic care facility as the insurance just ran out on the 20th day.  The nurse was teaching how to give an insulin shot to a newly diagnosed diabetic.  She was also teaching last minute (right before discharge) education on high glucose foods choices.  Some of the info was wrong....see this picture for the "average diabetic hospital meal"

....if this meals looks like it is sustainable to you then you are probably very thin, meditate and exercise daily.  This will be an eventual failed nutrition change that a patient will use to fall off the wagon and go back to eating starchy salty foods ....or go back to smoking, drinking and watching TV/with no exercise.   

Thinking outside the box is very important for designing lifestyle changes.  As well it is helpful for maximizing survival if in a hospital.  I watched as my father suffered a catastrophic medical event, and then was witness to sustaining his life for his last 2 weeks while in CCU, step down unit, surgery, ICU then hospice.   The hospitalist was outstanding and listened to my concerns.  The initial neurosurgeon was hard to speak to, and gave black and white answers quoting statistics (so giving the average answer.....treating my Dad as a nail).  The neurologist and 2nd neurosurgeon were excellent.  The pulmonary doctor who we didn't need (of all people!) was the most compassionate and helped with the ultimate decision of withdrawing all lifesaving measures.   Biggest problem I have is with the initial doctor who evaluated him while the event was happening.  12 hours prior to event, Dad was a 78 year old independent "grandfather" who was complaining of double vision.  If the doc may have investigated further, the brain bleed may have been halted sooner.   (...but what do I know, I'm just a primary care doctor who thinks anyone with double vision, headache and on coumadin should be considered for a CT scan stat).  This is the ultimate slap in the face that if someone is not invested in the care of every patient that s/he greets "hello"....then you are ultimately being treated as a nail by a healer with only a hammer.   

Having been educated by Andrew Weil, Deepak Chopra, Joseph Helms I have imbibed the idea that the current paradigm of insurance based medical care is not the only way to heal.  There are "energy based" whole systems of medicine that have been in place for 2000-3000 years.  Some people don't identify with the artsy-fartsy softer science of healing but one doesn't have to be trained in it....just have to acknowledge it exists- so if all else fails, entertaining another path may get the suffering expedited.   (suffering of the patient in pain/suffering of the family in sorrow/suffering of the community in loss of productivity/suffering of the nation in the burden of medical bills for procedures).  I love what my gurus have taught me about being more than just a hammer.  I believe it has helped my family stay safe.  Followers of my suggestions/videos can attest to a happier level of functioning.  They can also witness the disease that presents in others who don't follow my suggestions (got some 30-40 year olds that are the living embodiment of what happens when you don't exercise, don't eat mostly a plant based diet and don't learn to meditate/be in nature/practice yoga-pray for them!please!)  

Sometimes the only way to help people realize the changes they have to incorporate in their lives is the threaten.  Like any fight or flight response, threatening a heart attack or cancer will be effective only for a short time - until the f or fl response is extinguished.  It is then up to the patient to grasp the great feeling living with a springier step, faster injury resolve, better digestion, better sleep in order to keep lifestyle changes going.  More recently, one of the bigger ways for lifestyle change maintenance has been to have a little taste of the catastrophic event.  Perhaps this is where modern medicine is good.  With all the surgical techniques and expensive medicines available, we have been able to reverse some events temporarily.  So some people get to feel what a heart attack is like, what a round of chemo therapy does, what getting around with a handicap placard is like.  For them, maintaining lifestyle is inevitable or they go back to the same negative experience.  But what of the 500,000 people that will have their first heart attack the the last thing they feel?  This is where family can come in handy.  What ever the way, your average American will have a catastrophic event occur before 50year of age.  Shifting gears before the event happens is so crucial to improve survivability.  If the patient doesn't care-the family might; if the family doesn't care the community might; if the community doesn't care the nation should.  The burden of the sick is on the backs of the surviving.  

LUCY (spoiler alert)

Just finished this movie written and directed by Luc Besson.  I went for the action and CGI but was amazed to experience the emotion he was trying to convey.   The previews were "tasty" to movie goers looking for car chasing, guns, drugs and human blood.  Weaved into the scenes was this recurring theme of enlightenment. Watching this made me feel validated on my search for deeper healing/medicine with some of our modern day sages (Andrew Weil, Deepak Chopra, Herb Benson).  I had been on a journey to quench a thirst that the standard 200 year old texts we use for learning health are not the answer to understanding the healing power of  inherent human energy.  This energy is replicated and passed on via DNA in efforts to improve the vessel that is doing the passing.  If the vessel evolves, the universe benefits from the improvement in energy shared.   When the universe benefits, the vessel is supported to "do more".  A win win scenario to this existence.

First scene was bloody involving Asians underworld and drugs.  Innocent American  thrown into a frenzy of killing and contra ban-typical opening action movie.   The twist is when a man made substance used to bring a depressed society (with rotten teeth and poor health) into a few seconds of high/happiness- actually unlocks the path to the ultimate existing in infinite bliss. The rest of the movie was a roller coaster  used to carry viewers to the directors message of universality.  The reason most dont experience it- we have not learned to apply the true power of the mind.  Humans have just created a scaffolding of science and math to help teach knowledge and intelligence.  The problem is when the vessel passing on the information cant continue to grow/evolve due to the limits of the language the vessel created.

Knowledge is empowering, teaching is fulfilling.  I think we get too bogged down by the concept that we are all individuals and "I have a better concept" instead of "how can I can help".  We are hardwired to be heard, to be acknowledged, to feel good about being part of something (contribute).  This built-in message in our individual DNA proves we are all connected.  Ultimately we are all vessels built by a universe to contribute to its constantly flowing energy.  I believe society has destroyed this message of wanting to be acknowledged (to be liked on facebook).  The social media has taken us away from the beauty in finding our strengths and purpose in life and instead has cultivated the urgency of going for the fast reward of posting or creating what ever gets people to say WHOA!!!   Creating what is in your heart takes effort and energy.  Shooting a gun, crashing a car, stealing is has high shock value but doesn't chisel out the reward that is hidden in the bolder of a sculpture, in the paint brush of an artist or the soil of a gardener.  Our modern use of the internet has united a world separated by continents but has also stagnated growing artists healers and nurturers.

The proof to my contemplating: in listening to the moviegoers discuss what they just watched, I heard one gentleman saying to his younger texting companion:  "if you get uncomfortable with the emotion the director is trying to convey and go straight the your smart phone to feel comfortable again.....you will just have to start all over again in building up an emotional level the actor/story teller is trying to bring you to."   I liken it to computer games and ADD- if young people are constantly bombarded by speed, sound, visual experiences that demand focused attention, it will be hard to "unplug" and experience the true rewarding power of nature/the universe/existence.  That part of the brain that is getting the the stimulation programed into a computer code is small compared to the part of the brain responsible for creation, happiness, love.   Thing is, the computer programmer has found a way to deliver the "caffeine rush" to the fight or flight brain-parts that bypasses traditional "unlocking" of the reward system built in our DNA.  If given a choice to effortlessly get a caffeine rush vs read, learn, interpret, create....most people will choose the proverbial apple in the garden.

The point I was able to arrive at with Lucy: when we only go for the apple in the garden, we don't learn to utilize the massive gift created by the universe.  The vessel we exist in may have evolved from homosapien to modern day Prada wearing creatures of plastic surgery and hormones but our minds are still functioning at a little higher than cave man status.   Bottom line with Luc Besson's creation; it delivers the visual reward for Hollywood but also has the hidden lesson that we are all interconnected not only to each other but to nature/the universe.  "I am everywhere" (I give it 2 thumbs up)

The Duality of Healing and Healthcare

I just got tagged for 4000.00 malpractice insurance payment and a 700.00 license renewal.   I spent 2-3 hours on a "mandatory" online education that was supposed to take a few minutes.   Multiple meetings to make sure all doctors are "on the same page"- making diagnosis and treatment plans universal.   Yet my malpractice climbs every year (even though in 20 years I have never been sued); reimbursement falls every year; my paycheck is the same as a 27 yearold just getting out of residency training (since the Kelly Blue Book says all family practice doctors should be practicing and making about the same all over the US).
Most of the doctors I know went straight from college to medical school to residency (a few of us to fellowship and a handful to a second fellowship).  Suffice it to say, most of my colleagues have not been trained in business so running an office is a tough learning curve we don't have time to do the correct way - going back to school.  This is why many choose to be an "employee" of a large corporation so you can practice with "autonomy" and leave the business to the hospital administrators.  But your med school guru didn't teach you that if your practice is run by a non medical human, compassion and time are not in the formula for turning a profit.  If a director has to answer to a board, he won't be saying "our doctors are very loved by the community, one of our physicians gave a great lecture at a local high school, we had a doc interviewed on television".   The director report is real time paper/graph generated results with prospective graphs for the future and comparison statistics to local competition.   I will never forget working for a Hospital in the Center of Dupage, the immediate care centers in the 90's closed doors at 9-10oclock to save on electricity and payroll.  All the centers except one; this Convenient Care just happened to be in the neighborhood of several board members in Wheaton!!!  (the rumor was it was closer to the Wheaton-ites than going to the hospital so they were advised to stay open later)    Alot of hospital high ranking administrators will want their employees to streamline, follow protocol, not give away anything but yet whenever I hear a COO/CFO is bringing his kid in or a board member wants to be in and out quick....it sounds like the people that make the rules of how doctors are supposed to heal, follow a different set of rules.
If you look at how much sacrifice was spent in school, how little reimbursement is given for invested problem solving, how much time is lost away from children and spouses/ waking up answering phone calls in the middle of the night and seeing sick people in the hospital.....and compare to a business major finishing college, starting a company, hiring employees (doctors) and starting another business-it doesn't compare.  It used to be an honorable and guaranteed business in the 70's and 80's ....but not now, in fact the stressors of being brought up to "do great things" but then being told that you are "standard and should be practicing in the mean average of doctors" is so heart breaking.
This is where the schizophrenia of medicine exists.  We are groomed to heal others, give back to the community, continue learning since it will help humanity.....but at the same time, don't used intuition, don't listen to your heart, follow protocol make sure you don't deviate from policy.  Isn't healing a dynamic thing that varies from person to person, from country to country, from harvest to harvest?

The Saguil Approach is to take a regular paying job (so the kids can get a great education and walk home safe).  At the same time-Sow my Healer oats-take a chance with practicing medicine from the heart, outside the wallstreet paradigm without worrying about following hospital protocol, government restrictions and getting reimbursed for healing lives and not just making pharmaceutical industry wealthier.  I joined several groups to increase chances for 40 hours a week of steady income, I also have a twice a week consulting service where I practice "no holds barred" medicine (weaving between western and alternative medicine, educating and empowering, making suggestions for relaxation practice, hand picking herbal supplements and embracing physical changes to help immunity/recovery.)
This is my duality = DrRicOnDemand-using modern technology to administer old fashioned healing.   

Pebbles on the Path

Pushing buttons

Had a long Sunday at Immediate Care.  Seems that the people coming in were not interested in getting healthy, they were more interested in getting back to the way they were before getting sick.  (What they don't get - they are sick because of the unhealthy lifestyle....may not seem obvious now but I can wait, when ready, I can help)  So I buzzed through the walk-in patients....kept the wait to 15-30 minutes and handed out a lot of prescriptions.  Kinda easy to agree with a diagnosis of infection and just write a prescription.  Another symptom, another prescription; another trauma, another xray.  This is "cook book medicine", if your symptoms fit the ICD9 code, you will get the predetermined treatment algorithm for that code.  I detached myself from the need to educate and empower and just picked up charts and discharged patients.  After work, I was looking forward to spending the remainder of Sunday with my family so we took a walk at a local forest preserve then looked for a place to eat.  Son wanted Japanese food so we drove to a local place..  After reading through the menu, I asked to waiter about the portion size for some soup.  He said "it was big".   I wanted to make sure it wouldn't be too much to eat.  He said "I don't know how much you eat".  Finally I asked how many scallops come in an order/dish and he said it was "alot of scallops".....(perhaps his full time job was at a Japanese comedy club so I went on to decide my order by just reading ingredients and guestimating portion size by price point.  We all ordered and received our food....except for my scallop order which seemed to take a long time to come out.  I ended up having some of my wife's sushi order and asked for the check and some boxes.  He came with the check and the missing order.  He said scallops take a long time to cook and he mentioned it to me (of course it was probably between the fantastic descriptions he arduously built up of the menu choices when taking our order)  I took the price of the scallops out of his tip and left saying the food was good but service not appetizing.  Then it started raining on the drive home.  I usually drive the right lane and during downpour make sure I watch my periphery and rear since people underestimate wet stopping distance.  (dry = 1 car length for each 10 mph  or follow using the 4 second rule)  Regardless, if someone is tailgating me in the right lane, they have the option to use the left lane for passing.  If they don't take the option I slow down both of our cars and increase the distance to the guy in front of me so in the event of a sudden stop, I have ample braking distance and the tail gaiter will hopefully do the same.  So on this day with windshield wipers going full speed, the only thing I saw in the rear view mirror was a very 3D looking set of headlights.   I let up on the throttle to "gently" indicate that he should distance himself or pass (not sure if male or female -too much rain).  Headlights got even closer.  I continued to focus on the scene in front of the car while my son was making fun of me pretending he was the waiter from the comedy club/sushi place we just left.  (I didn't want to invite wife and sun into this movie that was taking place behind us -reminded me of a 70's film by Spielberg called Duel where Dennis Weaver was being stalked by a relentless big red 18 wheeler villain)  The narrow right hand turn into our neighborhood was fast approaching and he was intentionally getting closer so I had to slow to a crawl to navigate the intersection/the rain/his front bumper.....and while my son was laughing from the reenactment, the car behind me started wailing on his horn.  I did the civilized thing and made the turn waving my finger to him saying you are driving to close.  I couldn't make out if male or female as my eyes were on the road hazards during the peel off.  I always like to memorize the driver and license of reckless drivers thinking that one day I will be able to discover an amber alert fleeing vehicle.  My son immediately says this is the worst day ever, then my wife say poor Daddy "so stressed".   I then calmly say...I'm not stressed....that guy is.
This is one of the reasons why it is important to practice relaxation exercises daily.   To remain calm in a fight or flight situation will help with problem solving/be a beacon for others in the frenzy to emulate me /and I believe if you react to anger or a stressful event with more stress, the options for moving forward will be limited. Think of the typical ER star- cool calm and collected physician that runs the recusitation, leaning back against the wall, calling out orders, controlling the chaos erupting over the dying patient and having everyone work in unison to bring the patient back from death.  The human body can only exist in fight/flight or unity/procreation.  If the only way you know to live is fight or flight, adrenaline/epinephrine/cortisol will be the dominant hormones and inflammation will be the dominant reaction in every cell.  (FYI....inflammation = heart disease, autoimmune disease, Alzheimer's, diabetes and cancer.)     If you develop/practice a relaxtion response regime, you can choose to be proactive/calm before an event.....(the opposite would be reactionary to all events).   Having a healthy life practice doesn't guarantee immortality but at least you did what you could to shape the future.  

Multi Level Happiness Marketing

There is something about helping (contributing) that gives satisfaction.  Humans are hardwired to be a part of "the whole".  In it's most basic sense, we can generate a good feeling (high secretion of serotonin/oxytocin hormones) when we are part of something bigger.  Think of the rush you get to see how many Likes a post on Facebook gets.  Studies measuring hormone levels in people having an act of kindness done to them show highest hormone levels as expected.  Same study didn't expect high levels in the person giving the act of kindness.  Further studies went on to find out how far this extended and documented the same hormone levels in people witnessing the act of kindness being done!

Humans have a built-in brain pathway (like a service road) that certain electrical impulses get prioritized to go from the 5 senses witnessing the event straight to the pleasure center.  The end result is a reward system that makes you feel good if you are doing good.  It gives you such a great "high" that you want to seek out doing it again-even if you witness an act of kindness.  Just see what being in nature does to you.  No matter how stressed out a parent is while traveling with the family, when you get to the destination beach; stress just melts away.  Nature has it's own beauty that acts like a beacon to draw you to it and involve yourself with it.  You get to a pristine national park and notice trash-you pick it up to keep the memory pristine.  Louis Schwartzburg filming nature. The sum of energy in the universe is meant to be everlasting and all the lives that exist within the universe live in happiness when in harmony.  The opposite can be felt as well, when you live to destroy and not contribute- life is lonely, painful and unrewarding.   Witnessing bad energy also leads to an uneasy feeling.  When you watch the morning news and see deaths that occurred overnight, every new story ends with a feeling of fear or hatred (toward the bad guys).  Watching an uplifting movie, an act of kindness or the beauty of nature will bring a sense of calm and awe.  Nature in particular expresses itself to make lives want to "join in" and be part of "the whole".

For those of you stuck in a rut, trying to change with a push or detox......try to surround yourself with positive energy.  I remember buying paint at a local store (now out of business) and the guy mixing looked and sounded like a KKK member.  Every other work in his vocabulary was F@#$.  As I was waiting for my can to be mixed, I noticed when there was a new customer, the customer would acknowledge the conversation and answer in step to the KKK guy with F#%$.  (Kind of like joining in on the mob mentality topic which was all small talk about current hot button topics).  I paid my bill and didn't join in as he seemed to bait me when it was my turn to the counter.  The opposite also happens under rain sheds when in a national park, I was in the Grand Canyon solo hiking and needed a break from the elements.  The 7 mile mark of a 14 mile hike had a shelter and others were there.  I stopped, changed my gear, re hydrated and the conversation with 3 other parties was so cool.  The topics seem to be superficial but the people that day were sharing without fear of judgement.  Soon without an uncomfortable feeling of the conversation dwindling, we all wished safe journey and carried on.  One positive experience (received, given or witnessed) generates another positive experience and so on.  Like multilevel marketing, if your down line is strong and happy, you to will exponentially manifest strength and happiness.   Seek it out!!!

Happy (Unhealthy) Doctors Week!!!

Got a nice gift for Doctors Week this am with a bag of "goodies" from one of the hospitals I belong to.   It was a container filled with colorful decorations and snacks.  I opened the bag and started pulling out the snacks and wondered.....wheres is the gift? (Mama taught me to say it's the thought that counts).   Then I got to the bottom of the red paper filler and found some golf tee's.

So I just finished my morning loose leaf green tea (Genmaicha from Adagio Teas), toast and fruit (banana) and thought good thing I'm not hungry.  If I didn't have my morning ritual, I may have been tempted to pop open the Special K breakfast bar.  The design of the "100 calorie" bags is deceiving; packaging says 100 but it's flat, small and carries about 20-30 pieces of mini size edibles. (I would not be satisfied with 1 package unless I intentionally ate one at a time and allowed the wafer to melt on the roof of my mouth then worked it with my tongue-sounds sensual but this is mindful eating - (see Jon Kabat Zinn Mindfulness for Beginners-The Raisin Story) and allows for satiety with changing blood levels of ghrelin/leptin/cortisol/serotonin/oxytocin/IGF1.   Mindless eating comes when stressed, hungry, tired, thirsty, overwhelmed, sick....and I just described every American I see in clinic.  Obesity is an epidemic and it will carry heart disease, high blood pressure and diabetes along with it for 1in3 people -excluding Colorado.  (Cool to watch on my lecture link by advancing from slide 12-slide 39 and you will see the evolution of obesity in the US.)   I calculated the total calories from all these snacks

to be 1010 calories.  (This would be in addition to 2-3 regular meals in a day!)  The downside is the glycemic index for the snacks is very high and in 30-120 minutes I would crave more fast food due to the hypoglycemia response after fast food I refer to as the "insulin dump".



In comparison, the bulk of my packed food for the day is about 1300calories- good enough for me!  I am working a 14 hour shift today so in anticipation of hunger this evening, I will plan on a pre-emptive strike to cravings with an order from local veggie restaurant if necessary.  My food looks bland compared to what I ate 20 years ago but across the hallway is a physical therapy place.  My excitement/satisfaction will come in the endorphin rush from getting on the treadmill during down time and cranking out a mile or two.  (unless the physical therapy police tell me the equipment is only for patients).  Speaking of police, if an officer of the law is found doing anything illegal the news will chastise him/her and suspend without pay until decided by a judge. No one is above the law but I am sure some law enforcement officers break rules every once and a while.

So what should we do with health care workers that are unhealthy.  Or healers that don't know the law of letting "food be thy medicine".   After prescribing medicines, most doctors would apply some anecdotal stories of what they have tried personally which is honorable but not usually deep enough to build individual templates for the wide variety of people/diseases/ethnicity/tastes/ages.  In the 90's, insurance used to cover visits to a Registered Dietitian but not now.  With some insurance companies- after you have been diagnosed with Diabetes, you will get 2 visits to an RD in the first year and then 1 visit annually (lifechanging right?).  Most diabetics I speak with roll their eyes when I ask "how informative was your visit and why are you not taking advantage of what your insurance covers?"  Looks like patients are on their own when it comes to nutrition....unless you find someone locally on EatRight.Org.  A friend told me it would be better to see someone for counseling that you know versus a stranger, at least make sure they have been through credible training.  Be your own policeman!  (Or attend local lectures like mine at Advocate Sherman Hospital April 26th!)