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.”

                                                                                                   

 

Pre Diagnosis Lifestyle

Met a young couple (due date before winter) coming in for wife urinary tract infection (she also had a pager strapped to her right pocket-turned out to be an insulin pump).  I inquired about how much nutrition she uses to control her disease presentation.  She didn't seem confident with her answer then she seemed down right blunt-"the registered dietitian at the hospital was an idiot with no great advise.  (I tried to make excuses for why the RD may have been in a hurry to teach lifesaving nutrition education and why the info was probably very basic.....but this has been the contention of all diabetic patients when they get their annual visit for diabetic education at the hospital) see my tutorial They were receptive to "alternative health" so I guided them into healthy ways to integrate complementary and alternative health into their lives.  Hubby seemed to really soak in my advise and ask more about his risk for prostate cancer (due to Dad's diagnosis) and when should he begin to get check ups. 

Good question.....but just like my young obese kids that come in with a diabetic parent supposedly getting "tested" regularly to watch for blood test signs of diabetes: WHY JUST WATCH AND WAIT?!?!  It is good to hear that my colleagues are helping parents find the disease and then send to a specialist for treatment.  (BTW-diabetic specialists will not see patients for "pre" guidance-they only have opportunity for prescription medicine treatment after blood tests show pancreas has started to fail) 

Scenario: if a doc will be sending to a diabetic specialist for diabetes education, nutrition counsel, exercise endeavors, cooking classes, supplements.....all after the blood tests "turn positive"....why not do it Pre Diagnosis!  Doesn't matter if "my child has always been big boned", s/he is walking into a lifetime of carrying the label of diabetic.  The diabetics of today are different from the diabetics of 20 years ago.  The biggest things that have occurred are bad foods are more readily available for any age (vending machines, microwaves, cheap fast food courts, delivery in 30 minutes) parents have OVER SCHEDULED their lives, Internet apps have slowed down activity and walking.  The biggest offense is insulin pumps being freely prescribed to anyone who "isn't controlling their sugar with regular means".   Most people can control sugar with nutrition manipulation, activity coaching and stress control.  Back to our original problem-if docs and RD's don't get reimbursed by insurance to teach, we go straight to band aids without fixing the cause.  Pumps are a god send for brittle diabetics but for this last ditch measure to be given left and right because it is now covered by insurance and pocketsize-if feel its too easy to just dial up the pump and turn up the juice to match the bad food and eating habits.

Unfortunately, patients/parents are on their own.  See the doc and always question the medicines you are being prescribed but self empower with reliable knowledge about the natural ways to lead a "Pre Diagnosis Lifestyle".

Kick Cancer's Ass!

 

 

Cancer has no rules.  Everyone can get it.  Staying healthy is key, before it; during it and after it.  Sue came to First Health Associates for a lifestyle change.  She went through one of our marquee programs with excellent results and the tools to sustain her healthy change.  Unfortunately, it struck.  In an average person, the question of "Why me?"  can be embraced and never let go of.  Sue is just finished with surgery/chemo and already planning to get back to training with Aimee our exercise physiologist!  This is not an average person, this is a fighter who is not accepting defeat.  In the face of an insurmountable object, her resolve is inspirational.  The testimonial of living that we try to inspire in patients is likewise inspiring to us.!   

 



I had the opportunity to work side by side with another doc (gently "older" than me) the other day.  I was doing a physical on an Air Marshall and he wanted to sit in.  (These physicals are like "executive physicals" from the 80's that encompassed everything short of a colonoscopy- we have to make sure these government employees are ready for anything and fit to perform.  As I was reviewing the Marshal's chart, I didn't see much of a problem short of the usual extra 30 lbs, scant scalp hair and few screening test abnormalities but I started asking my salvo of questions to make sure past and family history were devoid of risks for a premature departure from the job of crime fighter.  I  brought up the few abnormalities and along the way threw in a few fun fact suggestions for nose congestion, reflux, hearing problems.....  He seemed to resonate with a few and started asking questions seemed to be interested in my few comments so I would give him more info then move onto the next body part......then more info.....so I could see he was hungry for info/guidance.  In fact, what started as a simple review of tests and updating chart notes soon became counseling on using omega 3 oil and turmeric for the early arthritis in his ears (yes the 3 bones in there get arthritic from shooting a firearm for years) and cutting back on alcohol and considering stopping since he had some signs in his life of dependence.  Then he opened up to both of us about chest pain for the last few months!!  I appreciated his candor and took it that he was subconsciously concerned but at the same time he was always aware we were the doctors licensed by the government to flag Marshals unfit for duty.  I am used to this as when I interview someone past 10-15 minutes, they usually open up and I find the juicy information that would have been missed on standard medical history taking.  This is the info that helps shape the personal lifestyle change I create.  I figure if we take extra time to figure how they got to this mess/at this decade of life, we can plan around addressing the cause of disease and not just treat it. 

The other doc was perplexed as to why he was giving so much information.  My colleague kept on saying that was very odd.  (I was just snickering to myself, "that is the way you do it doc!")  Truthfully I saw a man that wanted to get some help for drinking and was having problems controlling his teenage daughter-the hearing wasn't a concern, neither was the chest pain.  Well, I sent him to an Ear Nose Throat specialist and got him to the hospital for a stress test. 

I don't always have the luxury of extra time with patients but I can always continue next time.  This is the trick I learned from Medicare.  We are supposed to tell the patient after the first or second complaint that they have to follow up for guidance of the next few complaints at a later time since I only have time to address 2 major symptoms.  (...and this is your grandpa who has 10 pills twice a day from 3 different specialists and may questions about the side effects to a few of the expensive pre-approved drugs.  If I have to, I will guide my patient to concentrate on the major issues we in the medical community would be concerned with to continue functioning independently while we let go of any low grade nuisance symptoms. 

So even some of the established docs don't have the right idea about how to really empower people to change the cause and not just address the symptoms.  Shop wisely!

Fork in the Road

I am awestruck with how the Universe shows itself every time I stop resisting.  It's like hiking a path at night, I know the journey is out there but I can only see what my lamp illuminates.   The forces I fight are not "the dark side" luring me to play, they are my feable attepts to try and control for every variable for the future.  Lamenting in the past can cause depression, worrying about the future can cause anxiety.  It takes effort to maintain but I try to live in the present. 

I did this in 2005 when I was sick of a new hospital administration stringing me along and saying its going to be alright as long as you sign a very legally binding contract for 5 years and you keep up with a some MGMA statistic (info pools of large medical practices and how many patients you are supposed to see to be average)   If I worried about the future, I would not have been able to leave and start this journey to present day.  No question it was hard work to survive the finger pointing from established docs and job interviews with newbie graduates, but I let that stuff go and just grabbed onto any solid step that was placed in my path.  Herb Benson from Harvard, Deepak Chopra, Andrew Weil all were part of the universes plan for me to give back.  I can confidently say a career of being a medical doctor was just a stepping stone to my true calling of healer.  I am honored to have met these world leaders and take bits and pieces of their practice philosophy to evolve mine.  I consider myself a neophyte but wonder if I too am supposed to be influencing those that I come in contact with. 

Had some free time before another hospital orientation so I stopped by Whole Foods Market.  Saw a young premed student I spoke with briefly in the recent past.  She congradulated me on getting an appointment to teach at the University of Illinois Medical School.  (have to chuckle that after years of being ridiculed as a foreign medical school graduate from the Philippines, now I am being asked to teach by the same people who pushed my application to the bottom of the pile)  Last time I spoke with her, she was deciding on which school to pick-UofI or Uof WI Madison.  Immediately I started rattling off about Madison WI.  Richie Davidson -founder of the Center for Investigating Healthy Minds (most famous subjects include Matthiew Ricard and The Dalai Lama) is a huge proponent to mind-body medicine "the new Herb Benson" of the millenium, built his multi million dollar facility there along with Dave Rakel -previous fellow of Andy Weil, now Director of the UW Integrative Medicine Fellowship.  Something special about this place-poised for being a center of healing.  I leaned a little to UofI since I am now an appointed teacher/tutor there but considering the fact that she knows so much about nutritional supplements (employee of WFM) she already has a step above all medical school candidates-she understands how food can heal.   I was so happy to hear she made a choice to move and continue premed in Madison!  I saw the reservation in her face about the stress of moving.  I then reflected on where I am now and wondered if I had the same look back in 2005.   I've moved my family into 2 states, 3 different houses, applied to a new hospital every 3 years.  The difference is the career keeps me appealing to hospitals that want experienced docs (for standard pay) so there is always a job.  The difference is the calling brings me to a more beautiful vista with every move forward.  It seems like a logarithmic unfolding of some master plan the universe has in mind.  It's daunting to know that while I consider myself a student, I will have to start teaching my style of healing and help others get to this point.  My courage is fueled by the fact that even now, someones application is being placed at the bottom of the pile and that person may be responsible for my family, my patients, my community.

 

Performing a Favor for someone:

"You are an Expert at something you know nothing about"

 

Giving a word of Advise:

"You know nothing about what you are Expert at"


-DrRic

 

Brain washed to fail

Last post I spoke of doctors being taught to use a hammer.....and consequently everything looking like a nail.

For those patients who come in with numerous prescriptions for diagnosis after diagnosis.....then more prescriptions for side effects from the first set, perhaps its not the fault of Dr Hammer.  It may be the insurance company and the drug advertisements have convinced people they are the "nails".   Viagra improves your marriage.  Statins stop heart attacks.  Hydroxycut makes the fat melt off in 3 weeks.  Cymbalta takes the pain away.   Vaccines are harmless.  GMO doesnt have to be labeled.  Gastric bypass gets you back to high school life.  You deserve a break today.  This bud's for you.  Your approved for a home mortgage even if you don't have a job. 

There is the compassionate view of everyone working to better humanity....then there are people who take short cuts.  Its not everyone otherwise our species would have died off long time ago.  Unfortunately, there are people who like to take advantage and ride the wave, survive at the expense of others.  Doug Lisle coined the phrase the "Pleasure Trap" where humans can be swayed to take the easy way out.  Maintaining a whole food plant based diet will have its merits in giving the user an overwhelming feeling of health and wellness  (dont care what my bodybuilding friends say about needing animal protein!).  Having processed foods can "concentrate" the pleasure of eating into a compact package that gives the same feeling without the fiber, nutrition, time prep, love and community.  If not trained to note the benefit of fiber, nutrition, kitchen family prep....the brain will want you to go "straight to guns" (Tom Cruise in Top Gun) instead of setting up the shot safely.  Then the brain will always want the quick short cut leading to obesity, deconditioning, cravings, food addictions......just to please the pleasure center of the brain without considering the consequences. 

I believe this is why I usually get 30-40 year olds in my office looking for a way to get off the medicines accumulated just in the "last few years"-as if disease just sprung up as they entered into the decade without any relationship to the improper living from high school and college.  Change is soooo difficult but postponing it is like a downhill truck with no brakes....the longer you wait to run off the road, the more damage will occur.  Change takes more than one visit, it is a learning curve that has to be done gently but effectively with several teachers.  I may be able to construct a campaign for winning the war but the battles I leave to my warriors.  I think the best successes for damage accumulated in the medical insurance disease maintenance model are treatment plans outside standard paradigm.  It sounds like an up sell but medical insurance does not pay to get you healthy, it pays to stabilize and manage your disease.  (I remember a patient saying I did a "bait and switch"- saw her and took the standard insurance reimbursement then sent her over to non insurance providers in the same office.  She was right but insurance doesnt pay for nutritional guidance, personal exercise, relaxation therapy and alternative healing therapies.......It Pays For Medicine!!!!)  Western Medicine in the rare case it reverses what you have-some lymphomas, congenital heart valve problems, cataracts to name a few but the majority of medical diagnosis are maintained and accumulated over an average lifespan.  What's worse is if you get a diagnosis and your doctor looks statistics up, you will be treated like the average no matter how healthy or poor you live.  Cures are thought of as chance miracles and why waste time with giving "false hope".  Lets look at miracle cures.....when a billionaire goes outside western medicine or people refuse and step away from their insurance doctor and come back from asia with a cure. 

We devalue -nutrition, relaxation and community (usually the basis to healing in indigenous systems like traditional chinese medicine, ayurveda, american indian healing).  We hold high -material possessions, drugs, surgical corrections.  I believe it stems from exposure to symptom-only bandaid care made popular by the people selling the bandaids.   If only we spent Superbowl money on TV ads for Deepak Chopra teaching meditation, Wayne Dyer teaching empowerment or Andy Weil Educating on nutrition!!!  Watching PBS programing isnt as channel surfing eye grabbing as 10 seconds of an Xbox, beer comercial with the prettiest girls wearing little to no clothing.  Advertisers bank on the fact that if you suffer from disease (adhd/sleep deprivation/chronic pain/economic and emotional instability) your brain is under stress and will grab at fast relief of pain.  When I get a patient that works 60+ hours per week-guaranteed s/he has multiple problems and wants a short fix stating s/he cant stop working since not having the current salary would lead to death.   Then the V8 momement comes up that "the lifestyle is the disease".    As Deepak once told me, we spend money we don't have to buy things we don't need to please people we don't like....and I think this is the root of poor health. 

Messin with God

Was at a relatives house last week for a birthday celebration and met a national treasure who was visiting from the Philippine Islands. The 90 year old in the picture above. Sweet lady, quiet but when engaged in conversation, comes alive with smiles and hugs. She was walking around as my brother in law says with zero gravity; taking a cautious step, holding onto furniture, stepping with the other foot, advancing her feel for the next piece of furniture.... I sensed she was observing and enjoying the camaraderie. I always ask an elder about lifestyle to figure out what I can take out of life to hopefully propel me to the same age without many failures. Seems she just didn't go to the doctor! (Also lived in a northern town in the PI that is known for indulging in less meat and more veggie dishes.....please see my youtube video on switching to a whole food/plant based diet)

During my short stint in Orlando FL (while I was riding out my 18 month restrictive covenant with Central Dupage Hospital after leaving the "new administration") I would run into many 80 year olds getting around on golf carts. Only difference was these guys were on a slew of medicines and a bit overweight. (please see my youtube video on BMI) So what was the key to this great grandmother surviving past alot of her younger contemporaries? Not sure. I have my guesses but not what I'm writing about today.

While here, she was brought to the doctor for something small but ended up being placed on 2 medicines. The blood pressure medicine I can understand. At her age, chances for stroke are high so keeping bp low is good (unless it makes her dizzy and fall) But here is the surprise. The doc checked her cholesterol and said she should be on a statin (a cholesterol lowering medicine). Let me break it down for you:

-lady lives through Japanese occupation of the Philippines
-lives through a dictator
-lives through a revolution
-gives birth to and raises a large family
-avoids going to the doctor save a cold or cough
-avoids immunizations
-avoids PAP smears and mammograms
-eats a mostly plant based diet
-works her share and stays active
-keeps a low body weight
-makes it to 90

-then a doc in the US says he found an elevated cholesterol while she is visiting and suggests she would live longer by lowering cholesterol with a medicine? He probably didn't ask the bullet points above....I wasn't there and cant blame hime since if all you have is a hammer, everything will look like a nail. What Andy Weil and Tierona Lowdog taught me over the last 2 years was that it takes a great detective to extract the right clues from the interaction between patient and healer. (What more if you have time constraints of 10, 15 or 20 minutes!) Ask the correct questions, have a true healing purpose inside your words and be genuinely involved in finding a path to wholeness.....the answers will reveal themselves on what is best for this person. If being pragmatic and following algorithms for designing health are so right, then why is the US in this predicament of spending so much money per person yearly (6000-8000 dollars each!) and 1 in 3 are obese. (take a count of 3 people in line at your next dinner and observe how many are overweight)

-make sure your doc is listening to your answers, make sure you are listening to the messages your body is sending you, make sure you do all the research on a medicine, its benefits and side effects before you or your loved one start, make sure you work to achieve maximum healthy living and have as many odds stacked in your favor when you make the lifestyle change. Goal is to try and get to 90, be happy and have a community behind you. 

(for the flipside to this click here)