The Calming Power of a Shoe

As I train for this year's pilgrimage to Zion National Park, there are only a few places that present with elevation changes in Illinois.  Training weekly around local forest preserves gives the feel of nature and allows my mind to quieting down.  When one becomes used to the speed of the Internet, the speed of rush hour tailgaters, the speed of getting taxes done right before deadline-you learn to always do things with speed.  It may be good for applying CPR but you can't apply speed to waking up, eating, spending time with loved ones....these activities are meant to be slow so the brain can secrete serotonin.  This hormone then bathes the trillions of cells to reset DNA, mitochondria, allow other hormones to cycle on, allow brain tissue to perform abstract thinking, problem solve.....or just fall in love.
Fight or flight hormones are useful for escaping danger.  The human hormone feedback loop is well established to start even as an embryo.  I remember watching the ultrasound of my son in utero when we had to get a sample of amniotic fluid for testing.  We localized where he was floating in mom's bag of water; as the doctor inserted the needle through moms abdomen we could see the needle tip pierce the wall of the uterus and immediately my son moved out of the field of vision on the machine!  When Antelope are born on the plains of Africa, within minutes, they can run with the herd if danger is sensed.  When a science frog has been pithed (inserting a needle into the brain to destroy higher function) it will still lift a foot up and away when held over a fire.  (sounds barbaric but this used to be how physiology class was run in college premed).   All this thanks to the reaction of every cell to adrenaline!!!
But this was not meant to see secreted every day of the week.  When rats get electrical shocks every day in a cage they tend to ignore the pain and withdraw into a depression like state.  When children are abused every day with no hope of a respite in sight; they too withdraw, become zombie like with no emotion and a very altered interaction with the world.  A study in the 90's on adult immune diseases went back and found the patients that experience Adverse Childhood Events where at higher risk for triggering disease later.  The big buzz word now is inflammation as the trigger for 80% of all the diseases treated in a doctors office.
A little inflammation and stress response is good (think of Robot from Lost in Space- "Warning, Warning!!!" alarming the crew of impending danger), too much inflammation and stress is not conducive to a peaceful life. (think of Dr Smith from the same black and white TV series throwing the crew into turmoil after every challenge).
One really has to practice the relaxation response since it is not part of American culture. Reflection/introspection in it's most popular form used to be practiced when you sat in the corner in silence as an act of penance.  Or if you fish, hike, pray......it used to include martial arts and yoga but I see alot of hybrid yoga and mixed martial arts places that just stress the movement and not the philosophy nowadays.   Even running is broken down into managing split times, hydrating, powergels, shuffling the ipod....and not just running  to lose yourself in the cadence of your foot strikes.  I just came back from a 30 minute resistance training routine where the only thing I was thinking was "almost done"....as I worked out like a madman banging my head to Metallica's Fuel.  So my argument is even in the activities we do to keep ourselves healthy, we still turn on the stress response.
I was blessed to have experienced the classes of Herb Benson/Harvard, David Simon/The Chopra Center, Andy Weil/AZCIM and of course Deepak.  These modern day sages translated true traditional healing into modern day medical terminology.  Through hours of learning, I developed my own form of eliciting the relaxation response in myself to help during times dealing with death, sarcastic orthopedic surgeons, the difficulty of starting a private practice......and aging.  I am still finding my technique but I feel more in control of my journey now than ever before.

So here I am hiking in Starved Rock, getting ready to ice climb and be one with nature.  Just listening to my crampons (steel foot spikes) crunch the ice with every step I take approaching the frozen waterfall puts me into "the zone".  I wield my ice axe like a warrior and dig it into the solid mass like a harpoon and develop a swing/strike/pull timing.  Axe/axe/crampon/crampon....up we go.  Serotonin is flowing, DNA is healing, oxytocin (the love hormone) is bathing my heart and brain!  I looked at some pics a stranger had taken and I got pretty high! (I didn't even care)  Then it all came to a screeching halt.  One of the last crampon kicks I gave with my left foot - kicked off my spikes!!!  So here I was "in the zone", high up on a frozen waterfall with only one operating foot.  I would normally just say "who cares" and forget the feet using full upper body strength like Tarzan hitting each Axe like a pendulum and work my way down.  But my "fight or flight","warning, warning" hormones started to rush out of my adrenal glands and took over every bodily function.  Brain started thinking "I am going to fall and impale myself on an axe";  heart started to beat distractingly fast; hands became sweaty in my gloves and gave me a sense of slipping off my axe grips, my remaining crampon/foot could not for the life of me get a good hold in the ice; the viking like swing of the axes became wiffle ball foul tips bouncing off the mammoth ice cube.  Well, I paused for a second, laughed at myself and thought "my shoe will do fine"....and with a renewed focus on smooth striking like the beak of a humming bird hit each mark-I stuck my axes and remaining crampon till I returned to ground.
The power of the mind to effectively change the outcome of an event!!!  With just me getting down from a frozen waterfall being a chore, think about someone trying to battle cancer, feeling great about the fight and then being told by a trusted specialist-we can't help you, good luck (fight or flight).  Versus being bathed by the love and support of a community and beating disease with lifestyle changes (relaxation response)
....if only we could teach meditative breath work in grade school!!  Or get medical insurance to cover a week at the Chopra Center!

Genie in a Bottle

Eyes open 430am, my brain thinks I better get more sleep.  Mind says get up, make some tea, go push some weights and get my yoga on.  500am I am ready to start the day and no sun out, no activity on the road, Facebook says a few people liked my Detox blog but no activity.  As I make my way to the local Planet Fitness, traffic lights are all in my favor....this is like a dream.  I get there thinking it would be just me and the desk attendant and there are a whole bunch of people, even this guy on a treadmill that is just jacked up.  Probably running 7 minute miles, great form, blank stare recalling floating past the 13 mile aid station at the Chi-town marathon.
So how do I get this energetic attitude, so ready to take on the challenges of the day?  How to others seem so alive at this hour?  How can I insure my adrenal gland gets stimulated like this every morning, and how to turn on the part of the brain responsible for elation?  If I could just bottle the hormone proportions floating in my blood stream at this present time; take it out and inject it when I need it!!!!   How to then inject it into others I work with, patients I see with major illness, strangers that are suffering?  If only we could pull some blood out when happy, transfuse it back in when we are challenged with daily commuting, office deadlines, hunger from not eating properly, angry insomnia from lamenting on the "asshole encounters" from the day.
Western medicine and the pharmaceutical industry thought they could about 20 yrs ago when they found receptors in the brain for serotonin where empty in people with depression.  The answer: make a medicine that allows more serotonin to be present in the blood stream and the deficiency with be cured!!!  It worked but people were a little blunt faced, emotionless, zombie like, sleepy....and heavier.  (I guess they just assumed giving medicine would cure the disease without behavioral therapy to fix the abnormal introspection...just like cholesterol medicine without changing the diet doesn't stop the heart attack, just slows it down)
So I tried to go through an inventory of my schedule/diet/activity for the last few days and found one thing. Repetition; I was waking up for a few days straight, really pushing the plant strong foods, trying to keep up with meditation in the morning (as my Chopra Center Guru Davidji says-Rise-Pee-Meditate every am and it will make you bullet proof for the challenges of the day!)  In my Detox blog from DrRic Frequently Asked Questions, I mention that if you are trying to break bad habits and begin a new lifestyle, it is easier to set the body on a ritual/rhythm with Thinking Eating and Activity.  As your hormones are thrown into the blender of an emotional tornado, forcing the digestive system/musculoskeletal system/endocrine system into a regimented 12 hour sleep wake cycle will guide the haphazard glands into a uniform secretion.
Providing a good parachute of proper nutrients, moving muscle, engaging conversation, restful sleep and a little supplementation is important.  Everyone is a little different as to what deficiencies need repleting but most Americans need the aforementioned activities. The one drawback of ritual is some people may not see that the ritual they adopt for short term change, will also act as an anchor and hold back the journey.  A goal is always important to set but at every detox (even if it's as short as a day or two) when your mind is clear-contemplate a new pilgrimage
In the end, it isn't the need for an injection during times of challenge, it is the need to inject "healthy choices" into everyday of your life before the challenges happen.  The miracle of your body/mind/soul can let loose a tsunami of serotonin but it wont just let you pull out "calm" from your adrenal gland when you don't practice a daily lifestyle of longevity.  For most Americans (myself included) challenges begin to avalanche at about 30-40 years of age.  If you wait until that time to practice a healthy lifestyle, you will always be playing catch up and eventually western medicine and surgery will step in to place a halt on damage until you decide to start reversing disease......if you still can.  

A Warrior's Battle

What happens when you are given the news you have 3 months to live?  Like the climax of a movie when the group draws straws and the last person picks the short straw.  You never think it's going to be you.  So we shrug it off thinking "wont happen to me".  Then the universe reminds us our time is finite by giving a short straw to a close patient, relative, friend.  It is humbling to see the stages of suffering, it's heartbreaking to experience the visceral feeling of death as it approaches another person.  As a doctor I thought it was "proper" to be stoic to death so as to convey to the grieving family a confidence that the doc can still be a clear headed decision maker in the tornado of emotion that occurs during the last breath.  I have matured to learn that putting a shield up to the emotional suffering of others also blocks you from expressing your own suffering.  If you don't know what its like to hurt, how can you relate to the one that is hurting?   I am not saying we have to have cancer to treat it.....but we should learn compassion.  Not all people are born with this but luckily I think it can be nurtured out of someone.  I believe our cells are hardwired to come to the aid of others.  We feel good when witnessing an act of kindness.  It has been studied that when an act of kindness is performed, the giver develops high levels of the hormone serotonin just like the receiver.  It has also been measured that the observer to this act of kindness has a serotonin release just by watching.  So why is it that some people act so cold in the face of suffering.  And how ironic that some doctors that are sworn to "do no further harm" do just the opposite and harm with poor advise.

Standard Oncologist:     "you don't have to worry about eating....it doesn't matter in the long run"
Integrative Oncologist:   "lets teach you to avoid sugars, eat small meals more frequently...can you juice? .. fish is ok if you like it"
Standard Oncologist:   "the statistics on this kind of cancer are poor and you have 3 months to live"
Integrative Oncologist: "I have a patient who came in worse than you and she is alive and well in remission".
Standard Oncologist:   "the experimental protocol medicine says your outcome is not what we want, so sorry but good luck"
Integrative Oncologist:  "I don't want to worry about the cancer right now, lets work on the medical problems that will kill you first, then we can attack the cancer later with a healthier body"

I heard from a doctor that took care of my mother, he didn't want to give her false hope by trying something that didn't have statistics behind it.  Then again, our drug industry calculates in a 30% placebo response when formulating a new drug.  If the observation of and act of kindness gives hope and empowerment then why do we deny it to the most deserving people when they need it most?

Just with the open ears, the acknowledging voice and the comforting words of Dr Keith Block ( The Block Center ), I saw a change in color, posture and facial grimace over the course of 90 minutes with both Kathy and her husband as I came to support them during what was unfortunately her last consult.  Turns out the most powerful treatment over the last 6 months came in the gentle words and hands of a compassionate healer.

We'll miss you Kathy and I will keep my promise.

"Meat Soup"

The holidays are always festive with opportunity to join family members and share food and laughs.  Some will go from house to house to greet elders and cousins.  In the Filipino tradition, there is usually someone who meets you at the front door with hugs and plates.  "Hello, how are you, go eat".....all before you take jackets off!  Great tradition in my opinion but it also means as a semi-vegetarian, I will be grazing some tables that have a bounty of only beef and pork.  I have to honor the host by not turning down the food offer, but have to honor my stomach to not throw it into spasm the next morning.  The political thing to do is walk around in camouflage-(holding a plate with some essential macro nutrients and "nursing the plate" for the night).  Luckily in the last decade a select few relatives have also decided to join me on the "dark side" and shop at Whole Foods, hike, meditate, and lose weight.  I find it either takes the threat of impending doom (like a surgical procedure's) or the loss of a family member to shock a person into making the switch.  Hearing "you have to lose weight, stop smoking and exercise" from a doctor check up doesn't make lasting enthusiasm to manifest change.  This is why statistics report doing routine things like breast exams or prostate checks doesn't make a difference in mortality for the American population.  believe it or not, the USPSTF suggests against teaching self breast  and prostate exams.  This could make sense to save money for the insurance agencies/government and for the multitude of SBE teaching I gave and the prostate cancer screens I ordered but for the handful of patients I saved with early diagnosis, I feel it was worth it for them there children and children's-children.  The statistics that we apply to the general population have nothing to do with the individual.  (see Ecologic Fallacy).
Another example, dentists at UIC are taught rough spots found on physical exam to the surface of a tooth are labeled as carries (cavities), the insurance industry says there is no reimbursable disease until the rough spot has punctured through the enamel (surface) and deep into the dentin/enamel junction.  Only at this point will the insurance reimburse dentists for the corrective procedure.  The problem is when the cavity has eroded deep into this DEJ, it is days away from a root canal (resulting in killing the tooth and filling it with composite)
A final example is modern day medical insurance does not reimburse the doctor for counseling patients on healthy eating, exercise or ways to lose weight,  You technically don't have disease until your BMI gets to a high number, your sugar and cholesterol reach a high number, or your xray shows a mass in your chest.  When health crests over the test threshold, then you can get treatment and doc can get payment for time spend finding and counseling about the disease.  (Like the root canal case, once the disease is "declared" you will probably be knee deep in an unhealthy lifestyle, making it close to a miracle to reverse without medicine that only treats the effect and not the cause)
Getting back to my holiday story, as I meet with my fellow herbivores at these family functions, there will always be nod and silent understanding that you have to indulge in the feast but not go overboard.  My hard core relatives will be stoic at any event and stay the course of healthy eating - refusing all "door plates".   10 years ago this would have been babysitter suicide in that if you refused cruising the dinner table for seconds and thirds, the elder that prepared the massive layout of culinary meat eater delight would be offended and return the face slap when you asked to watch the kids this week.  I listened to Rick Bayless and Andy Weil speak downtown and remember Andy speaking of the randomized controlled trials and research about food, glycemic load, plant based diets and inflammation (making great sense) and Rick chimed in (no medical degree or university teaching status) and said in human culture you cannot take away "the feast".  It is in our oldest books of man as part of survival/history.  As we develop this disdain for food like it was evil and caused your high cholesterol, high BMI, elevated blood pressure....as hate relationship starts and we minimize nutrition to scientific elements.  IT ISN'T.  It is a life form placed on earth for humans to prosper.  Eating something prepared really fast from a drive thru window; swallowing it without chewing (like a lion that eats to over gorge in anticipation that the next meal may be a few days away) and trust the food company to use healthy ingredients while trying to make a profit....you are bound for early death and disability.  But have no fear, US health care is built to administer "rescue medicine".  In other words, we wait until a disease has manifested and changed DNA, then we intervene with very expensive procedures and medicines.  Note that this style of medicine does nothing for the health of the country and is expensive.
So your choice is make a decision to keep the "meat soup" indulgence to 2-3 times a year   OR   let go of your common sense, eat crap, don't exercise, don't control your reaction to daily stress and live like you only have a year left!

Diet and exercise wont work.

Had a patient go for PAP smear from her "primary care Gyne" in Barrington IL.  Incidental high blood pressure and cholesterol noted at visit.   I suggested first trying diet and lifestyle change with introducing exercise.  Upon recheck 2 weeks later doc says with a smirk- "...well how long do you plan on doing this?"  [before starting medicine]  "Your BMI is normal and since your not overweight, diet and exercise wont work"
 
BMI Calculator

WHAT THE F@#$!!!!  How dare this "primary care Ob/Gyn" make the suggestion that lifestyle change doesn't work.  Guess she didn't read the Lyon Heart Study, The Lifestyle Heart Trial, Framingham Heart Study.....   If it wasn't for my patient seeking me out, starting an exercise program (hasn't exercised since high school 35 yrs ago), learning about affordable nutrition (works 2 jobs as health care provider and mom), learning the value of slowing down to notice joy/feel grounded (high speed Internet life).....she would have taken the advise of this well established physician in the Barrington Community and started medications without changing harmful practice. 

I teach my UIC medical school students that 80% of a diagnosis can and should be made with history taking.  That means prying open a patients life with properly asked questions to find out what has brought her to this point after 50 years of living.  Blanket statements of "eat healthier" and "eat more veggies" doesn't work for the average American.  In fact the government has increased suggested serving amounts since the old suggestions didn't change overall death rates.  The minimum level of blood glucose had to be lowered to call more people "prediabetic" since old threshold levels didn't decrease the diabetes epidemic.  The food pyramid had to be changed to the food plate since people found the old idea too hard to follow.  The majority of patients placed on hypertensive medicines have not been educated on the basics of the DASH diet which is the first intervention step in treating diagnosed hypertension before medicines are prescribed.

Link to National Institute of Health Info

There is a place for high blood pressure medicines, there is benefit for cholesterol lowering drugs, there is a need for quadruple bypass surgeries.  Isn't it cheaper to practice healthy Thinking/Eating/Activity prior to the 10 dollar blood pressure medicine, the 30 dollar statin and the $60,000 bypass?  

Food for thought while you take your medicine this morning.   Here is my medicine:

 

    

 

 

 Flew back from Wyoming hike sitting next to a COO from some large hospital group from the South East.  She had some nice ideas about the health and wellness of the nurses but I think her bottom line was dollars and profit.   You can get to feel good intentions and bad intentions after conversing with enough people that are emotionally on the edge (most of my patients).   I don't mean that in a bad way, I just believe disease is different now than 20 years ago.  I saw a lot of people in their 40s with the beginning presentation of a single disease process.  Now with modern technology, we are screening people earlier to find these "pre" disease states and placing people on "pre" treatment.  That is with family history of anything, if you are a little overweight, a little hypertensive and a little high on cholesterol....time for pharmaceutical intervention!  Docs don't have time to counsel on nutrition (and in my opinion my colleagues don't have enough knowledge to make good suggestions), registered dietitians don't get reimbursed for "pre" counseling so no appointments can be taken.  No one is willing to go see a psychologist or counselor for stress management or guided imagery teaching ("...I'm not crazy doc!")   So my average 40 year old is now coming in with 10 years of 2-3 medicines when back in the 90's I used to be the one who would start them on a pill.  And yes everyone is still heavy, under rested, over intoxicated, over stimulated and under exercised. 

     So this 30 something Chief Operating Officer was trying to tell me how they just built a wellness center for the "nurses" and they offered acupuncture and massage.  I didn't want to tell her I opened up the Central DuPage Hospital Wellness Center and helped design the physician community interactions along with my sports medicine clinic to get the community to become aware of the endeavor.  These things are just a write off where people can join a large club for a nominal fee and have subliminal advertisements galore of the hospital every time you use a machine.  Not to mention the rehab patients can also take advantage of a discounted membership.  All this at the expense of millions of bucks for another hook the hospital can use to pull you to them vs the other guys.  I went along with her philanthropic tone and said I work for the Immediate Care Centers in my area as my full time career.  I also exercise my calling by working an Integrative Consulting Service where I see 1 patient for 60 minutes initially and 30-45minutes for follow up just so I can extract the vital info needed to create a person program of wellness....or plan an anti-inflammatory lifestyle. 

    She immediately said a few doctors in her area do "Concierge Medicine" as well.  I asked her what she thought that meant.  "When you take cash as a retainer for physician services and make house calls".  I said I take cash since the reimbursement from insurance for 30-60minutes of counseling wouldn't even pay for my malpractice insurance.  (1/3 monthly goes to rent; 1/3 to taxes; 1/3 to malpractice leaving me with no profit...thus the need to work a "real job"-but I love designing a way out of conventional medicine!)  It is so dynamic to hear what people think of their diseases, find out the priority at this time, emphasize strengths, let go of weaknesses and think of another way around what is to some people an insurmountable obstacle.  This is Integrative Medicine popularized by my mentor Andrew Weil, and supported not by my colleagues but more from the community.  People are tired of taking more and more medicines with very limited happiness in outcome (not everyone but a majority).   Concierge Medicine, Boutique Medicine is totally opposite.  This is where a doc that has a large following, splits off from group practice, picks 500 of 2000-3000 patients and charges them an annual retainer so they can stay in his small panel of patients.  S/he usually still will charge insurance for office visits (double dipping insurance?) but give out his personal phone number for faster access and I guess makes house calls!?!? 

      I don't need no stinking house calls.  Who the hell has time for that.  I am not here to pamper anyone or deliver medicine with a bow tie and silver platter.  If you come to me for what I spend my own money learning in 4 additional years of training....there aint gonna be pussy footing around.  I will listen, construct and help apply a life plan that very few doctors will be able to do.  I don't want to waste your time or my time if we are just here for fluff and to see who knows more about the most recent episode of Dr Oz.  Mercola charges an arm and a leg but I hear he knows a lot.  Andy Weil and Deepak Chopra don't see patients anymore as they are winding down their face to face time.  What me and my fellow graduates from post grad training do is provide a service that is hardly filled but desperately needed.  It is just to hard to break away from the paycheck and lifestyle afforded by being employed by a hospital.  You can make a good living with medical insurance but the bottom line is numbers.  Numbers for my COO like being in the black, and numbers for my docs as in you have to see 1 person every 7-10 minutes.   (No this mandatory electronic medical records thing didn't make things more efficient, it just slowed down face to face time between doc and patient to make sure notes were legible enough to get the most reimbursement)   Even if my handwriting was illegible, I could get a diagnosis, treatment and follow up planned in 1/2 the time it takes for me to listen, type, print, get a signature and discharge.  And now with the Affordable Care Act, a whole bunch of folks that were previously uninsured and unhealthy will be coming in for "free" wellness screenings and supposedly getting healthier since it is covered.  A healthier US means less obesity, less cancer and less heart disease.  Oh....wait....there aren't enough primary care docs to take care of all these people!!!  So they can just go to the ER for the 1st decade of this Obama Care, hopefully there will be more doctors coming out of school to fill the primary care gap.  Oh....wait...no docs want to do primary care cause it pays so low compared to surgery and you are a slave to a hospital system that say see patients every 7-10minutes!!! 

    This COO wont get the idea of living the anti-inflammatory lifestyle cause she is trained in dollars and cents and IMHO that doesn't translate to compassion and healing.   The two will never meet.  I am just thankful I have the opportunity to have one foot in both worlds. 

    

OVERSCHEDULED

 

 

We often base fulfillment on attaining things that we have done to impress others.  In the busy life of Internet based meetings, constant social contact, 24 hour TV, 3 shifts of work; individuals often forget they are…..individual.  It is very tempting to bury your head and just “work your hours” and go home.  There is so much going on, slowing down the bill paying machine to find your “old heart song” is too overwhelming.  It gets buried under our multi-task “to do lists” and family raising duties that living for “what I want from life” isn’t worth the effort of extracting it from deep within.   Then before you know it, your health has taken a hit, mid-life strikes and you are in too deep with the aftermath of attaining all those material things that gave temporary satisfaction. 

End game is no progress to goal/no happiness.  But now we have physical ailments and suffering, minimal at first but always ramping up quickly as the medical problems accumulate…..there goes all the savings!  A doctor I just shared my journey with told me he gave up his practice after his divorce; suffered a heart attack after selling his practice; is now alone and drives to another state to be with his kids 2 weekends a month.   Told me he has tried to meditate to find his path in life but it seems too big of a task to begin.  I told him, yes it is but the beauty is you are in control of the choice to change and a small beginning ……..is still growth and progress to your forgotten goal. 

From the Dalai Lama XIV

“Man surprised me most about humanity. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”