The last 5yrs has led to society embracing short cutting.
The “hack” has been synonymous with lifestyle change.
Everyone wants the 7 figures, millions of followers and immediate reversal of suffering but no one wants the arduous task of investing in learning.
In my time it was Cliff Notes night before a big final exam.
Now it’s stacked steroids, tummy tucks, testosterone, credit cards, catered food and a prescription dependant population.
Being active was exercise and organized sports during school years followed by work force labor for the rest of life. Now exercise has been substituted with computer time and hard labor is considered hallmark of lower class and minimum wage.
Exercise has been relinquished as a luxury and true dedication to sweat is just given during the month of January for a few weeks of attempting to get back to “high school weight” till an injury kicks you back to the reality of being overweight and out of shape.
Exercise SHOULD begin with an experienced coach, guru, mentor to evaluate goals, experience, short comings and resources. The usual excuse that is coughed up immediately is I don’t need a coach-I know what to do / I just have to do it!
WRONG!
If one truly knew what their circumstances needed to course correct from the abyss of hospitalization and medical procedures...it would have been engaged and continued in sustainable ritual. What most people think is that running like a Kenyan or lifting like an NFL Lineman is the outcome of exercise.
That is the sexy part of achievement but what most New Years resolution promises do NOT afford is to witness the 10-20 years of slinging mud, crying with frustration, packing in the gym clothes for rehab visits, watching friends eat without remorse .... and being very very hungry!!!
No one will engage the unsexy part AND most will attempt to “Cliff Note” their way to hollywood lifestyles.
When I analyze the excuses, I tell people it’s human to give up on an outcome...(I’m 58 yrs old and always wanted to be an Olympian) but we should never give up on hope (I may never get to the Olympics but I can talk to my God, figure out what my motivation is in real-time and put all hands on deck for a course correction). We always have a choice, agency, karma...the person who takes-on suffering...will hopefully see that there is EM-POWER-MENTin trying. (It’s ok to never being Olympic material OR being a physician that will never fit into the status quo of a prescription pusher OR being a yoga studio owner who is being kicked off the cliff of being a business owner by the universe)
I do not feel it’s in my best interest or the health of my patients to follow the vehemently enforced medical standard but I maintain HOPE and reconfigure my direction with faith that my destination will show up if I maintain dedication to healing all that I meet.
There are a lot of dead ends in the rat maze and depending on where you are it may seem like you should give up but just know there is an exit somewhere. Whether its injury or failure to maintain a business...(plan on not having six pack abs or 7 figure salaries but still show up to the gym floor, work or the unemployment line) keep moving, it’s ok to accept the reality of the situation we are in,trust the universe has something it needs you for, and ask what can I do with this- DON’T GIVE UP, THE WORLD NEEDS YOU!
October 24th Evening under the stars roll call / October 25th Full Hike around Devils Lake
Rally Point prior to hike will be The Concession Stand on the North Shore of the Lake 7:00AM Oct 25th (if no rain)
Accommodations Suggestions:
1-Tent/ RV campgrounds http://www.devilslakewisconsin.com/camping/ NO LONGER AVAILABLE
2-Best Western Baraboo Inn https://www.bestwestern.com/en_US/book/hotel-rooms.50092.html (but be prepared to cancel week of hike IF rain is forecasted as rock face very slippery with moisture)
3-Wisconsin Dells
4-Drive morning of event (note rally time at northern lake short meeting cabin is 7am!!!
Map and Link to AllTrails https://www.alltrails.com/trail/us/wisconsin/devils-lake-via-west-bluff-trail
Hiking Schedule:
Every Sunday 2-3 hours, 5 mile hike with back packs
September 27th Mallard Lake to Hawk Hollow 7.4 miles DONE!
October 4th Morton Arboretum to Big Rock 5.9 miles https://www.alltrails.com/trail/us/illinois/morton-arboretum-and-big-rock-trail
October 11th Sag Valley Yellow Tan trail loop +/- Swallow Cliff Stairs https://www.alltrails.com/trail/us/illinois/sag-valley-yellow-and-tan-loop
October 18th St James Farm +/- Mt Hoy at Blackwell Forest Preserve https://www.alltrails.com/explore/trail/us/illinois/saint-james-farm?mobileMap=false&ref=sidebar-static-map&ref=sidebar-view-full-map
Rain Alternative to be declared week of October 20th (Starved Rock State Park alternative)
Training Schedule:
During the week before each meet up, leg work with trainers, core work with trainers, flexibility with yoga teachers nutrition work with DrRic
In youth I used to dream of being an athlete. Growing up I was fast, I would carry the 8th grade guys on my back when we played “kill the man with the ball”. (Think of me walking one step at a time with a dog pile of guys trying to weigh me down to drop the ball) I was amused that my legs could carry a lot of weight but just went with it hoping no one would figure out to grab my legs. In youth I used to dream of a lot of things so why is it we stop dreaming? You only hear of the rare human like Steve Jobs or Elon Musk or even earlier scientists like Einstein or inventors like Edison coming up with a concept that “sticks” for the rest of time. I submit to you its all based in day dreaming.
Currently best visions come at 430-500am when ideas overflow (if I allow them). I wake do my 478 breath exercise, go downstairs sit overlooking my backyard while waiting for kettle to boil then sit more while brewing my gyokuro tea anticipating the first taste all the while imbibing nature therapy. Ideas flow like a fire hose opened full force.
This wasn’t so about 18 months ago; I would wake anticipating the tasks of the day and open my computer, log into the electronic medical records and start preloading patient data while downing a pot of coffee. I remember my wife coming down one morning asking me something and I remember snapping at her as she was interrupting my flow and I only had 40 more minutes to do these charts as the ones from the day before were not complete and as soon as I entered the gauntlet of the office every second would be accounted for.
This sounds blown out of proportion BUT its true. One would think its should be easy to type, in prose style as the patient is speaking; come up with a diagnosis and a treatment plan all on the fly BUT it is not! What overshadows the time spent with patient is the arduous “CI’s” (clinical integration?) that is required for all doctor offices employed by hospital to fulfill in order to assure you get all the requirements for clinic site to get bonus. The “CI’s” go into asking about recent vaccines, Pap smears, colonoscopy, prescription meds, blood pressure... ALL not what the patient is presenting for the day of BUT are necessary as a “by the way” while you are here can we get our bonus. AND those questions and key strokes take seconds to minutes in an office visit to accomplish. (If your doctor is running 15 minutes behind and In addition now has to go through those CI questions; then enter data by checking boxes-this will take an extra 5 minutes (IT JUST FURTHER DELAYS AN ALREADY DELAYED DAY!!!) And that is just second patient of a 25+ patient day. 15 minutes behind x 25 patients = extra 375 minutes end of day (6 hours delayed to go home and eat dinner). 20 minutes behind x 25 patients = extra 500 minutes (8.3 hours delayed to go home). Now for the rare doctor running on time, adding an extra 5 minutes per patient for average 25 patients = extra 125 minutes (2 hours delayed to go home). THIS IS ONLY PATIENT CHARTING AND DOES NOT INCLUDE THE PATIENT THAT IS CALLING IN WITH A NEW PROBLEM, OR TO FIND OUT ABOUT RESULTS OR CALLING FOR REFILL OF MEDS OR CALLING FOR A 4 PAGE DISABILITY FORM TO BE FILLED OUT (all these things mentioned are hourly occurrences!!!)
So if I would be a slave to the task-master of the day (the electronic medical record) then even adding a few extra key strokes adds up. GOD FORBID IF A PATIENT HAD AN AFTER THOUGHT QUESTION AND I HAD TO LEAVE THE NEXT PATIENT ROOM TO REENTER THE ONE I ALREADY LEFT. No wonder I hear some docs are answering questions while walking out the door or literally doctor “spent 5 minutes in the room” is a common occurrence. My wife would wonder why I wouldn’t check my text messages and its because I just wanted to run out the back door after I finished the most crucial work (leaving some unfinished questions to be answered on next days schedule) and get to the sanctuary of my home. This gauntlet would occur 5 days a week and infect my “time to day dream”. In fact it induced a stress response that would wake me up at 420 for fear that I didn’t preload the charts in time to be out the door in the am to drive my son to school. No wonder heart attacks occur across the world mostly on Monday!
Turning on the stress response can be useful for getting out of life threatening situations. It’s not like you have to manifest full fight or flight and carry a machete In the clinic but the rapidity of the tasks demands you think fast and use algorithms to survive the day. Here is the rub, average patient doesn’t give a shit what the doctor has to go through, the patient is suffering and just wants it to stop. Patient demands attention from the provider and demands focused problem solving to come up with answers and a plan of action. The average corporate paid doctor WILL provide that BUT it will be in algorithm form. To survive the day, every patient’s verbalized symptoms will be keyword focused. Front desk and clinic area will be focused on listening for keywords of symptoms IN ORDER to lump patient into a treatment algorithm and produce a rapid solution. The more rapid the solution, the more on time clinic runs, the MORE CI gets accounted for and the faster staff leaves to get home and spend time with family.
Unfortunately, every person notes a common symptom but the rest of what they are feeling may not be understood by a layman thus its not divulged to staff when making the appointment or at check-in on the visit day. Typically the doctor is supposed to question further (“outside the box questioning”) to make sure the symptoms are not from a deeper root cause. BUT WHO HAS TIME!!?
Patient: “...but doc its my 4th bladder infection this year”. Doctor: “...its ok as women are allowed to have UTI’s frequently...any other final questions?”
When doc is thinking in stress response 5 days a week, it doesn’t allow for “dream time”. This time is when you think “outside the box” to become inventive. More importantly become inquisitive. When patient is coming in over and over again with bladder infection symptoms ...is there something else lurking in the body that is starting to express itself? Naaa... if it was important it’ll declare itself and we can get the specialist to cut it out, burning it out or melt it out! Or more appropriately if it keeps coming back, it probably needs a prescription thrown to keep it from recurring again.
Doesn’t seem like a fulfilling career, or a great work schedule BUT nice paycheck!!! (Average primary care salary in Illinois is $181,000 annually.) BUT that’s the guaranteed base salary as you are “starting out” working as an employee. As you get established in 3 years your paycheck gets smaller and smaller as a “reverse incentive” to make you work faster and get back to the huge paycheck like the “protected” first year of working. The only way to stream line everything mentioned above in the daily schedule is to treat the whole week as an algorithm. Assume most patients will be sick from infection or sick from over eating or stressed out from life. Preload all the days of the week with the typical algorithm answer of antibiotic, diabetes pill, or mood altering drug. In fact, may as well just preload the entire month and year for figuring most patients you see will fit into the usual categories so anyone that calls with the smallest of symptoms or the beginning of a disease on recent blood test results should be placed on the most rapid medicine for the general population.
When docs don’t have time to think in abstract and go into personalized-time-consuming-problem-solving, all patients are treated like cattle and branded to end up same way. THIS IS CALLED THE ECOLOGICAL FALLACY. It is assumed the data from the individual is treated as the research outcome data coming from a larger group. Does this sound familiar? Patient Lives Matter!!! Medical community should not assume all patients coming in with symptoms will be successfully treated based on the data of the general population. If I was to give metformin to anyone overweight with an elevated glucose and assume they are not going to lose weight or change lifestyle, you pigeon hole those patients that would otherwise have committed to change and reversed their disease. BUT WHO HAS TIME TO DIVE INTO PERSONAL INVESTIGATION TO FIGURE OUT WHO THE OWNER OF THE SYMPTOMS IS AND WHAT IS THE ROOT CAUSE OF ALL THIS!?!
When I do lifestyle coaching online, I can sometimes spend 1.5-2 hours trying to figure who this person is...the proverbial meet the client where they stand. However ask the hospital you work for if you can spend 1.5-2.0 hours and just see a fraction of patients daily as compared to the ‘average” and you will be laughed away pointing out you are “not keeping up”. There is a saying in social work to meet the client where they are / instead of being prescriptive, try to improvise to co create a plan of action PERSONALIZED to the individual. Going right back to where I started this blog, improvising is a learned talent... or should I say its a natural talent from youth displayed in day dreaming. It’s a natural talent that in adulthood that is “unlearned” to allow algorithm medicine and the ecological fallacy to anchor.
I had an grounding conversation with Dr Pat Massey. For those of you who know me, I followed Pat from the 90's forward when I came across Alexian Brothers article about a doc that taught Tai Chi to patients with "Failed Back Syndrome" and got them off their medicines feeling no pain. This syndrome is when a patient goes through major surgery to correct an acquired defect and either; has persistent symptoms or suffers more than before surgery. I had just finished my Sports Medicine Fellowship in 1995 and felt very empowered as a primary care physician with "extra training" to have a more tools in my toolbox for problem solving disease manifestation in patients (see Annual Sickness Visit post).
Nutrition wasn't sexy in the 90's and physical medicine was booming. Rehab, trigger point understanding, exercise (marathon training and working out at Bally's) was the rage as some folks were able to take a non doctor modality (fitness) and apply it to alleviate some key deficiencies in American lifestyle. Just by adapting this available form of exercise, a small percentage of people were bitten by the running bug and reversed the onset of hypertension, high cholesterol and heavier weight. I don't mention Bally's memberships as only a sliver of gymrats have grandfathered into the newer expressions of working out at all in one 24 hour gyms. In fact the average person that jogs will run year round, the average person that exercises in a gym will weight training for a few weeks after Holiday eating. So by default, weight training on your own will be a temporary modality pulled out when inspired to attack new years resolutions.
My theory is that the runners high (endorphine and enkephalin secretion) makes people feel euphoric, is addicting and DOES NOT require vast knowledge on what to do. No matter what speed you run (even hike) the feeling from the event;
-keeps you in the moment (erasing the need to ruminate on the laundry list of things to do that day),
-gives you a bump of invincible-hormone (as our genetic code rewards the endeavor with the neurotransmitters to solidify that this habit will preserve the species so do said act again),
-moves stretches and perfuses muscle with oxygen to take away muscle stiffness, lower blood glucose and increase sex hormone,
-reinforces circadian rhythm to induce a deeper refreshing sleep (resulting in repairing trained muscle and reinforcing neural tracts to adapt new coping skills learned during the day)
The post work-out high:
-gives you a bump of invincible-hormone
-sometimes reinforces circadian rhythm (but highly depends on what stimulant you use to get through the work out -ie caffeine, red bull sugar, metallica ...)
...thus the high quit rate with working out UNLESS YOU GET SOMEONE TO DESIGN/REDESIGN and keep you on task!!!
Now that nutrition has: multiple authors, weight loss centers, patented box diets and supplement companies that have the newest Dr Oz vitamin for slimming waist line, the American public has kinda made nutrition education a needed modality to build up. Since the hospital systems do not acknowledge personal nutrition design as a domain they control...the Nutraceutical/fitness industry has taken it over. Note I said “kinda” as most Americans will not read a text cover to cover and just adapt the cliff notes on a nutrition practice from watching a YouTube video. (Super biased and sometimes poorly interpreted by vloggers that may or may not have a nutrition background).
So now the average citizen has 3 modalities that can be used to reverse/prevent disease manifestation. One roadblock is that for the power of nutrition change to take effect, its not as easy to find your groove as putting on a pair of running shoes and going outside.
-Nutrition has to be personally designed
-Weight training has to be personally designed
-Running can be initiated and fine tuned even by a high school runner
Insurance based medicine doesn't cover nutrition counseling unless you have crossed over and been rewarded with the label of diabetic or heart stent candidate or cancer patient!!!
Insurance based medicine doesn't cover exercise unless you have acquired an acl tear, back spasm, shoulder impingement or an overuse injury from work.
Medical insurance was supposed to be used "just in case" a catastrophic event occurs, that way you are ‘insured‘ to not go bankrupt or get turned away by a hospital. Now a days patients rely on medical insurance to cover an annual wellness visit (see Annual Sickness Visit) at which point the laundry list of issues are brought to the doctor to address and inevitably either doc says "don't worry about that one-trust me" or s/he proceeds to give a pill/referal to address the remainder of the complaints. My theory is medical school and residency is jam packed with curriculum now with the advent of electronic medical records and there is no time to teach lifesaving nutrition, exercise prescription (even some orthopedic specialists) or cultivation of mindful practice. These 3 key components are how blue zone citizens reach the age of 100+ while maintaining independence, bladder function and memory.
Luckily these modalities can be undertaken without a doctor BUT the more efficient way to engage change is to have investment in a coach to teach, apply, adapt and refine to the individual. If you have a favorite author then you may be able to try on the practice IF you read cover to cover and have a good fund of knowledge. As I alluded to earlier America has become fixated on social media and watching a book is easier than reading one. Condensing long concepts are like cherry picking your data to invent a new law of thermodynamics.
This brings me right back to my original sentence, my conversation with Dr Massey. He preceded me to develop a footprint in the area for "a different type of medical practice". He also confided in me that he took a lot of bumps in attempting to intertwine successful life changing protocols to the confines of a hospital system (JUST LIKE MY LIFESTYLE CLINIC BLUE PRINTS WHICH I WAS TOLD WOULDN’T WORK THEN SUDDENLY THERES A WEIGHT LOSS CLINIC?!!) I am now convinced if you try to sell a screw driver user a new tool called a hammer, they will look at you like you're speaking a foreign language. I have finished the gauntlet of learning to use the screwdriver, the hammer, the flash light the prybar and the glue stick (and will continue to adapt newer tools as the horizon demands) and I feel penalized when I wield these tools like a martial artist of lifestyle design. I guess it was inevitable to butt heads with "standard practice" when I embraced "alternative and complimentary approaches. I was hoping to just maintain a regular paycheck and do what I feel was right (on the down low) as my contemporaries still look at me like I'm speaking a foreign language when I speak of energy medicine, yoga breath, supplement effects, gut microbiota, medical cannabis application and "hand holding".
Looking back to last week, if felt so wrong in taking care of my patients and:
-NOT going over the allotted time for a visit
-NOT suggesting weaning down on pain meds/weaning up on medical cannabis
-NOT providing lifestyle coaching outside of insurance reimbursement
-NOT suggesting looking at my youtube tutorials to educate
The root word of doctor is “docere” which means To Teach.
The root word of patient is “patiens” which means To Suffer or Bear
The root word of heal means To Make Whole...I do not agree with a drug or a surgery to make you Whole (drugs/procedures maybe necessary to stop severity of suffering but the next step should always be taught!)...there are a few primary care docs who practice from the heart but its only a matter of time before comparison is made to the performance of all other US docs with speed medicine (lazy medicine)...at which point you “eat what you kill”...(if you dont want to see high volume-then you will need to moonlight to pay the bills)
The true healers I am collaborating with are good at what they do since they can’t rely on screwdrivers. I am sharing my tools with my new team to develop a parallel option to the embedded disease care system (see Annual Sickness Visit). Looking forward to the future, I feel so RIGHT to dive 110% into all things NOT suggested within the walls of a hospital system. I am now unemployed (which is not the first time -thanks to medical insurance reimbursement!!!) but I am unafraid as the warriors that have reversed there suffering under my care are sending out threads of compassion to sew my proverbial parachute.
I go to the township board meeting letting them know with my “special care plan”, my neighbors lawns are healthy my neighbors houses are strong and my neighborhood is safe.
I want to offer a wider template for the whole town to reap the same rewards. I offer my services at a discount as it pleases me to see neighborhoods thrive but the board says they have seen these programs in the past and don't want to invest as past experience says its not worth it.
I accept that perhaps My “special care plan’ may not be for everyone and maybe its by-chance a few properties are finding great benefit.
I keep it to myself but share it with close neighbors, and friends of neighbors as word is getting around that I can get grass to grow, houses to withstand Mother Nature, I take their success and feel good about giving and doing my small part with a small subset making a small but important impact.
THEN I find out one of the board members retires and goes on to become the first head of a “special care plan” clinic to change the town by making lawns healthy, town homes strong and the town and country safe!? And all the other board members are congratulating him stating he will make a great impact with this needed investment?!
WTF!!!
My house is smaller than the other township board members,
My neighbors houses don’t need big hammers and nails to repair what needs fixing,
My title according to the township is “average towny” with average experience in rebuilding neighborhoods,
My neighborhood impact is farther reaching and more sustainable than multimillion dollar infrastructure planning blueprints the board suggests to revamp neighbors,
My personal design takes a house at its face value and creates peace, longevity and blending with the landscape by embracing individual strengths and acknowledging weaknesses (not all houses will adapt into a one size fits all blueprint).
I have personal investment as I have rebuilt my own “average” house from the point of demolition to the current warm, resistant, and forever lasting.
Gonna have to find a new town but this time I’m taking my tools with me and building a city.
From a March 2019 Deepak and Oprah 21 Day Meditation Challenge-
"when you feel struggle... pause... try to take a step back...give yourself a moments time to find your center...that struggle is a gift a whisper your true self tapping yourself on the shoulder ever so gently to look again cause you always get to choose. Do you react to an obstacle as a negative or do you embrace it as an opportunity with the open hearted knowledge that ... All Will Be Well"
My Dad a gynecologic surgeon used to tell me stories when operating on someone and critical life and death didn't seem like it was going the patients way... he would pause, take a step outside the operating room take a deep breath and open his heart and mind to find the answer OUTSIDE the turmoil of forces trying to make him take the easy way out and "call it".
I usually will tell new patients with insurmountable lists of ailments if we go back in time and think about what happened during the time period before shit hit the fan...we can find the answer of what to reverse. It seems too simplistic BUT I believe if we act to reverse the biggest root cause...all the other subordinate roots will fall into place like a wack a mole game allowing you to see all the moles to hit.
I have made every excuse not to take the proverbial step off the staircase and have dis-empowered myself. My ego gets in the way ruminating on every unlikely scenario that might occur if I go the route of starting my own brick and mortar clinic but honestly with all the complaints I hear from docs who have started and survived without having to be financially rescued by a major health care system...I'M NOT LIKE THEM!!!
I have always had a passion to nurture the human body, fine tune the muscular system, support the digestive system, embrace the spiritual practice of ancient cultures push human performance (both athletic and regular Joe/Jane) to it maximum. I kept on telling Mama I wanted to be an athlete but she reiterated that being a physician would guarantee financial security anywhere in the world. (don't think she would have fathomed how google reviews could make or break even a Harvard graduate). I so appreciate her pushing me into this direction but look where I am:
-sports medicine trained
-integrative medicine fellowship (nutrition)
-yoga instructor and middle aged athlete/coach
When a complicated patient comes in for help, I like listening to their story as I will always try to find the answer they are looking for in the words and language they use. I feel most of use can heal ourselves but just refuse to see the way out of the pit as it is seemingly so difficult to initiate the first step. We have become accustomed to existing in the level of daily suffering and soaking in waves of sympathy every time someone asks "are you OK?" I'm not belittling chronic disease and admit wholeheartedly that I am a fibromyalgia sufferer IN REMISSION but I am not using this as an excuse for not moving on. I've worn the concrete suit that disease gives us and recognize that it is just a chore to get through a single day let alone see a higher calling. My own stumbling feet are intentionally getting in the way of finding the next milestone of aging called wisdom.
I painfully wish my Dad was around just to bounce my ideas off of but I know he gave me the answer to my query a long time ago ... I just have to extract it from his many late night lessons sitting a the kitchen table with a few beers talking about "medicine". I'm taking a moment, finding my center knowing that throughout this struggle I have your spirit behind my shoulder pushing me forward.
I miss you so much but I know what I have to do.
