Tuesday, October 30, 2012

Should I see a specialist? pt 2

So lesson from last time -"trust your gut feeling when someone hands you a bogus answer".   I expect my consultants to give an expert opinion on a diagnosis, then I expect them to get back to me.  Used to be in the 90's a phone call would be made after an evaluation and plan created.   I understand with low insurance reimbursement that docs have to move patients like cattle to pay the bills, call me old fashioned, I still expect when the door is closed, full attention to whom ever I send for second opinion . 

Here is the flipside:  my patients know I spent extra time after family practice residency in a sports medicine fellowship.  There are a handful of teaching centers in Illinois that many graduates apply for but only few get in.  Most of us in primary care sports medicine are dedicated athletes or just love the musculoskeletal part of healing/health.  I think it's fantastic to know how to prevent asthma attacks with changing shoulder and upper back strength or improve post partum sex with pelvic therapy.  (It aint just knowing how to test for an ACL tear or pop a shoulder back in)   Anyway.....I remember taking a state written exam one year with a bunch of docs, saw an old friend who graduated a year ahead of me.   I was psyched about my sportsmed fellowship and mentioned....."you should consider it as well for more clinical experience"  (your average family medicine residency entails 3 years of training and most programs offer 1 month of orthopedic assisting in surgery or a sports medicine rotation").   His reaction was "a sprain is a sprain".   I honored his opinion but thought to myself, no way am I going near his clinic with any body ache, sprain, tear or dismemberment.  It's good to know first aid, RICE and how to write a note for work/school ...but......spending 4 weeks with splints/narcotics and a pending second opinion vs just 1 week with a handicap when the injury should have been rehab-ed from the start is a gia-normous waste of time!!!!!  On top of that, after 2 weeks of time off the body has now deconditioned, gained a few pounds, developed constipation and drowsiness from the meds plus a little reactive depression from not being able to exercise.  My job as a doc is to help compress the time frame of healing.  Every case is a little different, every personality with its individual desires, every brain has its own tolerance to pain so not all treatment plans fit each person.   (I scoff at hand-outs that say do this 20 repetitions 3 times a day as the sole basis of "rehab")  It does make a difference to see a well trained doc for the symptoms suffered.  

Obviously I cant speak enough for the specialty of primary care sports medicine.  Even if you aren't an athlete, kinesiology/musculoskeletal medicine/disease pathology all play into designing the best way to get someone to optimal health.  (ie....if I have an out of control diabetic who is obese, I wont just say "lose weight by starting a walking program" ... I'd get physical therapy involved, make sure his/her nutrition knowledge is maximized for her activity, then steer her toward and exercise physiologist for brainstorming a sustainable fun calorie burning activity.)   True sports medicine looks deeper than just exercise injuries.   So how to choose a doctor:

1-Primary care sports medicine fellowship trained (just ask the office if the doc completed a fellowship)
2-Orthopedic surgery is different in that all specialist can "cut".  I like sending my patients to an orthopod that has trained specifically for the region of the body involved.  (ie.....one of my favorite shoulder guys is Tony Romeo from Rush/White Sox,  most young grads have gone through enough knee scopes that they all know about ACL/meniscus repairs-so for the knee guy I go for the best bedside manner, hand injuries still go preferentially to hand surgeons.)   A must for any of my "Pods" is good bedside manner.  There used to be a magnificent hand surgeon that worked down the street when I was with CDH.  His talent in the OR was famous.....so was his anger.   Dude used to throw sterile instruments to the ground and have a tantrum if everything wasnt perfect.  I guess thats ok if he is looking out for you but I dont use healers that hurt inside or outside the office.
3-Chiropractic physicians have excellent training around Illinois so I like the ones that listen in and get the true dynamics of the patients pain.  The chiros I use have turned pain/function around faster than patients going through conventional methods.  Dr Joe Musolino in my office does great work, graduate from National University in Lombard.  Great communicator with me and physical therapy and this is what gets people better fast-coordinated efforts between all providers.   You have to research training and experience and see how they are active in the community.   Just like medical schools, if the chiro school has been around for years and continues to expand curiculum, probably a good school.  On the flipside, I spoke with a DC that took care profighters in MMA, he just wanted to refer patients to me for writing scripts of anabolic steroids, saying alot of docs he refers to do it for him.  (obviously fell into the dark side of healing for the glory of rubbing shoulders with the rich and famous.....doesnt have to be that way-see my pics!)
4-Medical Acupuncturists are powerful in their own world of healing (and have been for the last 2500 years)  When combined with conventional healing, I consider bringing them in like calling a left handed pitcher to a tie game.  For any injury that has plateaued or if an athlete needs to get better fast for a fight, game or match in 2 weeks-call in the needle doc!   I originally studied medical acupuncture at UCLA to see if I could speed up healing while waiting for the physical therapy HMO referal to be approved.  When I used it, it worked like a charm, sometime the patients would get better and not need therapy or surgery second opinion any more.  Ahh...unfortunately, insurance caught on and discontinued covering acupuncture as a benefit so I had to retire my skill.  (Only bring them out for special cases like in getting my pro MMA fighters to relax before a fight....see my pics!)

 
So if you are injured at work, in a league event, or during training; dont be embarassed to ask your provider what kind of training s/he went through.   If it seems like the injury is taking longer than expected, seek out one of us (see above) and get better faster!!!!  A "sprain is not just a sprain".     

 

Colorado Springs Olympic Training Center

Illinois Gynmastics Association Bravo Meet

Chris Chelios ex-Chicago Blackhawks

David Reid Gold Medalist 1996

DonWilson martial arts 1990's

Sean Murnane Chicago Bears

Felice Herrig Bellatore Fighter (the non athlete is Julian from B96 morning radio show jumped into the pic as he was leaving my office)

 

Monday, October 8, 2012

Yoga....ain't just for Girls!

 

 
     Why is it that when I advise "you should try yoga", the immediate response is, "I'm not flexible"!   I did mention "consider yoga" to one of my patients drafted by the Chicago Bears and he comment, "I want to be able to do some of the things you do" ........................"when I get older" (eeyowch!...this turning 50 business sucks)  Truthfully, yoga as a form of movement/exercise is one of the oldest forms of healing.  The true beginning of all martial arts stems from humans trying to stretch and move "energy channels" on the body that would maximize their health.  (This was before medicine and surgery....before Einstein, Newton and Aristotle)   Tai Chi involves stretching things called meridia's.  There's 12 that go up and down the front and back of the body that correspond to the positions you see in classic pictures of Tai Chi or Qi Gong.     Although time periods apart and a continent away, yoga as well uses Indian based energy channels and moves chakras with poses you see in classic pictures ....the same ones that are now the rage with most wellness centers, healing clinics, sports teams even churches and businesses.  I see practitioners trying it once and immediately professing great feelings of health and release from stress.  After my first Meditative Yoga class at Northwest Community Hospital Wellness, I had been over to get my ID picture taken and a lady approached me and said she attended the class and she felt the most positive response in pain relief from her fibromyalgia in years. 
   So the reason I bring this up is unfortunately if you attend any yoga class, the majority of participants will be women.  Some haters would say women choose yoga because they are naturally flexible so opting for an "easy" sport they can excel in is natural.  Or it's a nice way to get an hour work out if you don't want to sweat.   Or it's a good way for someone that isnt athletic to start learning about flexibility before they begin a real sport.  ( I have actually heard these excuses from men)   I politely say "you'd be surprise at what it entails.  Yoga is a combination of balance, flexibility and strength.   My ex-olympians from Cirque Du Soleil-La Nouba knew the value of having all three; imagine a male body builder pushing an object over head equal to his own body weight.  Seems easy right?  Now how about if he uses one hand; and is upside down!  Regarding the sweat, well there are some students who sweat during practice, then there are some that don't push too hard-both can be in the same class, not to mention Bikram Yoga this multimillion dollar world wide chain of studios all designed to keep you focused on the instruction in a room heated to 105 (anyone remember wrestling practice?)  Finally, professional athletes usually go to yoga after maximizing on their individual sport in hopes of getting an edge ahead of the competition. 
     From the mountain tops I say...... at 50 I have competed in body building, run marathons, climbed mountains, finished triathalons but the most rewarding (just like that lady who approached me) has been yoga.  I learned the concepts and essentials of yoga from Total Body Yoga in Illinois and was taught the deeper concepts and health benefits from Deepak Chopra/The Chopra Center in Cali.  Yoga grounded me to understand that practicing medicine wasnt about getting rich, it was about service to others.  It helped me with all my years of practice and study get through the helplessness of not being able to do anything while my mom slowly died from a terrible cancer.   As my mentor/classmate Davidji points out to me, when you feel you dont have time for yoga, it is probably the one thing you should be doing before healing the world.   So as a species I say, those that are the most inflexible, the most "relaxation response-lacking", the most muscle bound, top heavy (chicken legged), the most testosterone based/adrenaline addicted individuals that think grounding has to do with electricity are the ones who need the practice of yoga the most.  All a neophyte has to do is find a local studio, contact the teacher, explain your curiosity and try it.   9 times out of 10, you will feel the same benefit that a fibromyalgia sufferer had after countless years of no help and taking one class; the same benefit I experienced after seeking multiple adrenaline sports to satisfy my "man-liness" (from competitive shooting to rock climbing to racecar driving.....all pale in comparison to the lasting effects I get when I finish the last pose of the class-svasana!)   The effects of yoga are truly like a drug, and when you get addicted to it, you lose addictions to food, alcohol, caffeine, TV......without taking one prescription or attending one counseling session!
    I used to warm up my powerlifting routine with a few yoga poses, now I use a few powerlifting movements to warm up for a fulfilling class of yoga.   I can still sharp shoot, drift a car, dyno a rock ledge and break boards............but then again, yoga tells me I dont have to.   It ain't just for girls.

.....how to start?   Usually once a month, studios offer "community class"- to give back to the locals and entice others to come and socialize.  Most places offer your first class for free as well.  Call and ask about which class/instructor would be good for beginners.  Ask about shower facilities if you decide to check out a lunchtime class.   Be prepared to pay for renting a mat/towel (or just buy your own at walmart or target).   IMHO the hottest of hot yoga is not for beginners (I began with Bikram and loved it but the intense heat scares off some of my patients that are on the fence) , especially if you take medicine for blood pressure.  There are so many "classic" practices and modern hybrids that it would take forever to list.   I teach a meditative yoga practice at Northwest Community Hospital Wellness Center and I often teach meditation classes/topics at Bodhi Prem Yoga.   My goal with guiding people to make lifestyle changes is always embrace sustainability.  Weekly yoga practice in a studio (open class or private) is wise until you are comfortable to practice on your own.  Once you get hooked, you can usually purchase memberships or a block of studio visits to cut back on price.  Average "drop in fee" is 14-19$, cut that down by 3$ if you buy in bulk.  Enjoy-Namaste!