How do I become spiritual?

My best response can be found in the Deepak and Oprah 21 Day Meditation Challenge November 2014 - day 14:

Oprah:

Hello everyone, here we are.  The end of week 2, already and may I say again, how honored Deepak and I are to have you all share in this meditation experience with us.  And I hope you feel it too, as we gather this tribe of seekers and meditators from around the world.  We continue our journey with day 14- Spiritual Manifestation.  .

So how do you know when you’re in the flow of spiritual manifestation?  Your desires arise from your core self, from a place of pure awakened consciousness, that’s how.  When you’re manifesting from your true self you’re deeply connected to what your soul came here to do.  Rather than your desires creating an outcome of constantly doing and getting more and more and more; your desires are in search of being and becoming  more.  And there’s a sense of contentment, of joy, of harmony and love that abides in everything that you do.   These outcomes are exactly what the universe is waiting to have us all manifest.  What an extraordinary gift you give yourself and to the world when you allow your deepest, truest most cherished desires to come alive and flow from you and to you and be realized.  This is what spiritual manifestation is all about. 
So today we are going to open our heart to everything that’s possible.  Wow, that’s a big opening.  As Deepak guides us into our meditation.

Deepak:

Congratulations on completing week 2 of our meditation experience.  This marks an important milestone.  Everyone wants to attract better things into their lives but now you’ve gone deeply into the art of desire and you know what the mechanics of manifestation truly are.  This knowledge can benefit you for the rest of your life.  The culmination of week 2 is to manifest your spiritual desires.  These include the desire for inner peace.  Direct experience of the soul and connecting with God or however you conceive of the divine.  There’s a false belief that the soul is separate from the body and that desire is there for low while spirit is high.  This separation is manmade.  As far as your true self is concerned, fulfilling your most cherished desires is totally spiritual.  In fact, this is what the spiritual path is all about.  As you reflect on what you want to manifest in your life, think of what you hope to feel when you achieve it.  If you know you’ll feel loving, kind contented peaceful nourished and safe.  Your desire has its roots in spirit because these are qualities of your true self silently awaiting to manifest.  As your consciousness awakens, the qualities of your true self awaken too.  Waking up simply means becoming more self-aware.  It is finding out who you really are.  The process is natural rather than mystical.  Open to everyone, not just saints and sages.  When you awaken by practicing meditation you’re on the path for fulfilling spiritual longing, love bliss and freedom.  Learning to live from this level of pure awareness, is known is Sanskrit as Sithi.  The word may be ancient but the goal is timeless.  It exists for you, here and now.  Encountering your soul happens without effort because your soul is just as eager to connect with you.  As we prepare to meditate together let’s take a moment to consider our centering thought:  

Fulfilling My Dreams/Fulfills My Spirit

Now let’s prepare for our meditation.    Make yourself comfortable and close your eyes.   Begin to be aware of your breath and just breathe slowly and deeply.  With each breath, allow yourself to become more deeply relaxed.  Now gently introduce the mantra;

Shreem Namah

This mantra helps to manifest abundance, that brings us closer to spiritual fulfilment.  As you repeat the mantra, feel the integration of material and spiritual abundance in your consciousness.  Repeat it silently to yourself, Shreem Namah.  With each repetition feel your body mind and spirit open and receive just a little more.  Whenever you find yourself distracted by thoughts noises of physical sensations, simply return your attention to silently repeating the mantra; Shreem Namah, Shreem Namah.  Please continue with your meditation, I’ll mind the time and when it’s time to end you’ll hear me ring a soft bell.  Shreem Namah, Shreem Namah, Shreem Namah.  Just mentally….Shreem Namah, Shreem Namah, Shreem Namah.

“All life is a manifestation of the spirit, the manifestation of love.” ― Morihei Ueshiba

How I found Integrative Medicine.

I originally flipped a coin in 1994 (graduation from Family Practice residency) to decide what my next move was to be.  The buzz then was to apply for a Sports Medicine Fellowship or Maternal Fetal Medicine Fellowship.   I had a personal "calling" to fly to Arizona and train with this white bearded guy who was teaching about nutrition and supplements.  The only catch to Andrew Weil's fellowship was you had to live in a house for 1-2 years while training with the man.   I just had a daughter and the easier path was to apply to Sports Medicine in Chicago (4 fellowships available at the time).  I was honored to be picked out of a group of docs and off I went.  So cool to learn, be the team doc for DePaul, be on the field for the World Cup, be ringside for USA Boxing, USA Wrestling, Illinois Gymnastics and be one of the docs for the Chicago Marathon.   Will always hold that year special in my life and valuable...I found out that my FP residency training was above average but yet paled in its content and training for musculoskeletal medicine and it's importance in medical disease management.
I became the Sports Medicine consultant in a large group and it was cool seeing my own FP patients and getting referrals for injury and pain.  Eventually the consults were so easy, I needed a little more challenge so decided to fix the weak link between diagnosing and treatment: the dreaded 3 page carbon copy insurance request form.  Usually it took an average of 7 days to get approval followed by an appointment with PT or ortho.  I decided to investigate Medical Acupuncture as a facilitator for pain relief while waiting for approval.  Research brought me to Joseph Helms at UCLA.  After 1 year I graduated and applied needles to my first acupuncture patient, Sheryl who suffered from chronic headaches for 10-15 years with no relief from meds and consults.  After 20-30 minutes she had NO pain!!!  For the first time in so long she had disappearance of headaches!!!  I continued with using needles scattered throughout my day for tough pain patients and boy did I have great results...I ended up doing most of my acupuncture on Saturday (my time) since the use of moxa would smell up the clinic.  Moxa is mugwort that supposedly had some "healing" properties to it.  Needles for pain; burnt herbs for healing?  Something in me was shifting.
I continued to complement my practice with this alternative medicine and at the same time this store called "Whole Foods Market" opened in Danada Square in Wheaton.  I would go there for lunch and hang out in the herb isle and watch people choosing expensive freshly made food and pouring roots and leaves out of glass containers into specially marked bags.  What kinda hippy franchise was this?!?!  Then I spotted newsletters written by Andrew Weil.  Here is this beard guy appearing back in my life.  I took some online courses for nutrition/menopause and funny, as I finished each online course, a patient would show up at my clinic with the same ailments I just read about.   I was being called to follow my dharma.  I thought I had more pressing issues with the change of administration at the hospital I was practicing in for the last 10 years.  Through a series of head butting episodes (see  my chapter "The Kick in the Ass" from Running Behind -due out fall 2015), I resigned from my position and moved to Orlando Florida.  I thought my medical career was over, eventually bills piled up and I had to look for a job.  After 18 months my restrictive covenant in IL ran out and I decided to return.   I worked a series of Immediate Care jobs (no overnight call, no hospital rounds, at the end of shift you turn your phone/pager off) but all during this time, Integrative Medicine kept pulling me back.  I had to deal with the trauma of "not being the Specially Trained Doctor with good bedside skills" and found yoga.  I ended up taking a 200 hour teacher training course with Deepak Chopra and another 200 hours with Total Body Yoga in Mundelein IL.  (couldn't get enough of this healing practice!!!)   At the right time, I received a message from a representative from The Arizona Center for Integrative Medicine asking me if I would be interested to join the fellowship.   That was how my Dharma found me again.
Since then I have been able to ease the pain of pancreatic cancer for my Mama.  Help my own healing and recovery from her loss.; find my way back to medical practice (I joined an "Integrative Group" practice in Arlington Heights 2012 -see my chapter "Quantum Moments" from Running Behind due out in 2015); and ultimately care for my Dad in his final years.  Now my calling is to set my footprint of practice in Illinois and share this with individuals, families, communities and the health profession.  I believe having a lot of hats to wear doesn't make me a weak jack of all trades who acts as a gate keeper to the world of medical drugs and procedures.  The Universe has pulled me in the direction of western medical proficient, traditional chinese medicine experience, ayurvedic healing with yoga and using food as medicine/medicine as food.   Administration has asked me, "how many hours of Sports Medicine do you want to practice?"   My answer is I cannot separate sports medicine, acupuncture, yoga, nutrition or mind body medicine into different clinics.....it is all part and parcel of creating lifestyle changes for people wanting to be healthy and minimize suffering.  

Nature Therapy

• Dr Ric....how about grounding the body by walking barefooted on the ground, on the beach, or on the lawn?

  
  
• 

  DrRic Saguil Hey Manny, American Indian folklore attributes improving the body's healing when surrounded by nature. On the flip side, when an individual has no practice of "grounding" then proceeds to submerge themselves in the frenzy of "tech", it acts as a gateway drug/lifestyle that throws every cell in the body into poor eating/poor sleep/ poor activity. (obesity/heart attack/stroke) This is how I force grounding into my schedule: stop by a forest preserve, place my toes in the sand, stare over a body of water or watch a sunset. I can feel the serotonin being produced/recharged by every cell. This is why I created DrRics Hiking Excursions- "force" patients and friends to disconnect with tech and reconnect with nature. (barefoot or hiking boots!)

  
  

  Please review the lecture I gave at REI:

  http://www.slideshare.net/DrSaguil/drric-hiking-for-health-slide-share-edition

  
  

  and the Morton Arboretum:

  http://www.slideshare.net/DrSaguil/nature-therapy

  
  

  for ideas on how to "force" nature back into your life.  

Concierge vs Integrative Medicine

A Medical Insurance CFO said she understood where I was coming from when I discussed my practice and the fact that I don't enroll in and insurance plans.  Being out of network/opting out of medicare has the benefits of not being required to purchase expensive electronic medical recording systems (and the tech necessary to maintain-I spent 2-3 hours negotiating a 30 minute compliance training slide show on Sherman Hospitals website just to maintain hospital admitting privileges...that was a chunk of an office day where I could have been paying bills!!!)
She then went on to stab me in the heart by saying, she goes to a doctor like me, her concierge doctor. Then I thought....if she negotiates price points between large corporations and medical practices, sets policy for the doctors on what they get reimbursed, "wheels and deals" strategic plans to be the middle man but show a profit to her board of directors......then she herself goes outside the usual medical insurance limitations to maintain her health-what kind of message is that for the masses of people trying to decide which plan is good for their family during open enrollment while at the same time not taking too much out of the bimonthly paycheck.   (see my blog on the Duality of Healing and Healthcare)

I am not a concierge doctor.  I do not charge a retainer fee to "cherry pick" my most loyal patient and create and exclusive membership club.   I destroyed my 401 K to study advanced techniques of mind body medicine, nutrition, acupuncture, yoga instruction so I could heal myself and my patients.   I gave up a 10 year practice to break away from a Hospital in the Center of Dupage so I wouldn't be giving up more unpaid weekend time to go back and finish charts/answer phone calls and help my patients heal their suffering.   (I was told at one point that since my acupuncture wasn't reimbursed by insurance....I had to do it on my own time.....you cant charge patients over and above the negotiated prices for evaluation and treatment if an insurance contract was signed by the hospital between provider and patient.....which makes me think a concierge retainer fee is illegal)  I was working 50 hours a week, plus giving away community lecture time, I missed my daughter growing up....in fact I don't remember much from those 10 years except eating bad food in the morning, drinking alot of coffee in the afternoon, downing beer to force sleep to come....then getting shocked in the ICU to bring down my heart rate from all the crap I was doing.

No question, the guys who do concierge medicine must have a knack for making patients want to come back and pay an annual fee over and above the co pays of insurance.  But I have yet to see any of these docs do any further training in medicine above the usual requirements for maintaining board certification every 7-10 years.  In fact most of them still refer out to the specialists, still follow standard prescription protocols, may or may not hand out nutrition information, don't use alternative medicine.   To get off my soap box, there is a benefit of going concierge.  You have one doc that knows your name, goes to the hospital to admit you, in the past they were supposed to offer going to the specialist consult alongside you (I believe that practice stopped), their back log of a waiting list to get in is supposedly short so you can get in same day.   So $1000.00 a year to insure a spot on his/her list may be worth it.  That is about the equivalent of a 12 week healthy lifestyle program with 3-4 coaches at your side.  (I medically cleared a lady for a
 Largest Loser  program who was able to get off medicine for high cholesterol, depression, high blood pressure and is now down to a body weight she hasn't experienced since college....now that would be a good way to spend "a doctor retainer fee")

You just have to ask yourself, do you want to be in an exclusive club and see your doctor or do you want to change your life, get healthy and not have to see your doctor?

Make a grown man cry

We often neglect our feet.  Women purchase shoes that perk up their butts, men buy shoes that "insulate" from the elements (but weight 10 pounds), we buy cheapies with no arch support boldly stating "I don't need no stinking fashion".  Then the foot pain starts, the ankle roll occurs, the knee swelling begins or the visit to immediate care for a back pain flare up.  To show how important feet are in daily living, a guy came to see me for 10/10 pain, in ability to walk, back pain and loss of work.  I investigated all his complaints then checked his feet.  There was a tiny bump that looked sparkly.  I proceeded to inquire where all his problems began....it started with a BBQ party.  I took the smallest forceps I had to explore this shiny object.  Bingo!!! this little sliver of glass came out!   I had him walk and the foot pain left, had him stand upright and the back pain was gone, within 5 minutes, his face changed.  Done!
Many of the podiatrists I know create orthotics to change the arch of the foot.  They are made to place in all your shoes and unfortunately some feet will wonder why did these comfy shoes change?   What people don't realize is if the foundation is moved, the structure will also shift.  There is a Q-angle that serves as an imaginary line from the front of the ankle to the point on the knee up to the front of the hip.  If this angle is straight, the mechanical movement of the lower body is fluid and fast.  When the angle is off (flat feet, bow legged, knock kneed, birthing hips) some friction points can develop.  The areas of irritation are angles we have carried since childhood but the weight......oh yes, the weight we carry is not from childhood.  It's from the pregnancies, the injury, the new job driving an 18 wheeler, the lack of sex, the alcohol, the persistent athletic appetite in the face of being a couch potato.   This is when childhood angles get stressed, under stretched, over used and pushed to 10 hours of day.  Time for disability, psychiatric evaluation, chronic pain clinic, diabetes/sugar monitoring, cholesterol medicine, blood pressure low salt and a scheduled orthopedic surgery.   All this because we never bothered to care for our feet.  Even in western medicine, orthopedic foot surgeons don't have time to make orthotics, they are too busy cutting, breaking and resetting.

 The ancient practice of reflexology isn't well accepted in doctor offices due to this split of not being endorsed/supported/studied by big pharma.   If there are not studies, it can't be valid.....what most of my colleagues say.  If only they would experience the rush of serotonin after I place acupuncture in the ear or sing my crystal bowl or nebulize sandalwood/lavender essential oil.
All this stuff does make a difference.  Vanity plays in as well.  Ignorance by physician community adds to it (docs are just too busy and untrained to help with weight loss/nutrition change/lifestyle modification).  The feet are a foundation to locomotion, travel and socializing, hunter gathering....when we don't honor any part of our body, that body part will deteriorate and become a burden.  Cutting it off, taking medicine, getting a handicap placard are not going to reverse the issue.  Looking for the source of dysfunction is the key.  Finding someone who will listen/brainstorm is crucial.

I'm not Spiritual

Herb Benson said:
-choose a word, phrase, thought or prayer and repeat it throughout the day
Deepak Chopra taught:
-repeat your mantra over 20-30 minutes twice a day
Andy Weil gave me:
-478 breathing

The common theme is to develop some form of repetition activity, verbal/auditory and eventually linked to breath.  As Dr Weil Guided my fellowship class, breath/respiration is the easiest body system to control.  (see video)  As you gain control over the voluntary portion (taking a deep breath) of this system, eventually control comes over the involuntary system (breath/blood pressure/heart rate).  Thus the reason why modern scientists have embellished breath work as part of high blood pressure treatment.  The problem with delivery of modern treatment plans to newly diagnosed hypertension is time.  It is faster to write a prescription than to teach relaxation response, meditation or just plain "living in the moment".   It's also easy to crank up the heat over the phone....if the home blood pressure readings don't go down, increase the dose, maximize on the medicine then add another.  If only the drugs from the pharmacy came with an instruction manual on the above techniques to be done when taking pills.

I have had to soften the idea of meditation (all 3 techniques in my opinion) to my patients for making it more appetizing a practice.  If I say meditation - some people bite.  If I say prayer - most adults mention being holiday church goers.  If I say spirituality - lost and sometimes repulsed.  Like the DrOz show, if the pathology of disease or treatment is illustrated visually in layman's terms, it makes understanding and initiation of treatment more empowering.  My passion is being physical.   I love running, cardio, yoga, hiking....nature.  What better way to adopt a meditative practice than to combine it with a very tangible movement activity.   I like to change the performance of classic weight training to a modern cross fit type of activity.  I believe at any age we can adopt and perform repetition and link it to movement.

A little plug for hiking.   A nice way to say walk.  But walk is not associated with weight loss or exercise.  Those of you who count steps and calories know 30-60minutes of exercise pales in comparison to the calories burned with total steps per day.  Anyone who has calculated the calories burned on a treadmill with know moderate to intense running will burn a small amount of calories in an exercise session.  Adding up walking before, after and during the day will lead to a bounty of weight loss after a 12 week boot camp.  If walking steps helps with getting back health, repetition of mantra/breath/word should be easy to combine.  Wouldn't it be nice to rev up a single action to make a bigger impact?

Thus was born DrRic's Meditative Hiking.  I learned a walking technique while taking a Harvard course and it was breezed through in less than 15 minutes but the concept stuck with me.  I found peace with hiking in Yosemite and but the Half Dome trail was long and tough (and my first big hike) so I added the breath finger technique and I credit that to getting me back down the 7 miles of return trail.   I also felt astoundingly high (was it the summit of Half Dome or the meditative movement .....I don't know).  Regardless of the for feeling good, why not do a little more intentional walking this summer, a little intentional breath/finger tapping (no one will ever know!) a little more "unplugging" and get out the blue sky brown trail and green foliage.  Nature has a way of taking over after about 30 minutes (Shin Rin Yoku) no matter what mood rules you upon entry.

Bottom line is no matter what your religious upbringing, spiritual diversity, time for exercise, feeling of being outdoors are; you can use standard medicine to lower your blood pressure numbers or you can incorporate and adopt lifestyle change to decrease risks for disease AND get rid of your medicine!

DrRic's Out of Network Fee Schedule

Question: Which business model offers reimbursement after 90 days of submitting a bill?
Answer:   Medical insurance.
Question: Which business model is guaranteed to reimburse you lower than what you charge?
Answer:   Medical insurance.
Question: Which service-base-industry requires you to pay back for intellectual services rendered to a patient if the non medical person says you never rendered services regardless of what the patient reveals.
Answer:   Medical insurance.
Question: Which industry does a 3rd party get between a healer and a patient then makes money from both?
Answer:   Medical insurance.

2014.  Insurance based medical care requires lengthy documentation, expensive recording software, full time staff to communicate, submit and approve medical procedures.  This is before a patient ever walks into an exam room.  The only way to break even between bills and reimbursement is to see high volume.  High volume leads to rapid diagnosis and generalized treatment plans.   This is where people become "symptoms" and prescription medicines become "cures".
2014.  My wife's office manager dies from colon cancer at 56 years of age.  She had the will to live but but was given a treatment plan that was based on generalized statistics.  She actually died from a demoralized lack of hope, dehydration, starvation, and side effects of antibiotics.....the cancer didn't kill her.  I watched Kathy go through the slow approval of medical therapy, the lack of compassion to her individual case and the poor knowledge of nutrition and alternative/complementary care that would have worked well with the non cancer complications she was going through.  She did not have to suffer.
2014.  I embark on promoting individualized health care using my board certified training in Family Medicine, my alternative training in Medical Acupuncture, Yoga/Meditation Instruction and Integrative Medicine (Board Eligible).  I utilize a 3rd party secure "Cloud" medical record system that costs an annual fee of $40.00+;  I sell no supplements in my office and defer patients to reliable supplement stores in my area (where I shop); I design treatment plans utilizing what we can from covered benefits while at the same time initiating lifestyle changes that will hopefully be sustainable with as much natural change as possible.  I have partnered with Advocate Medical Group to establish a footprint in the Bartlett area so there are many insurance companies that are contracted however designated days for Integrative Consults are once a week/standard medical visits ("speed medicine") apply for the majority of my office hours.  I have to honor the healthcare group paying my salary by being financially profitable but at the same time I must fulfill my calling to teach/empower/change people with more than just prescription medicines.  No matter how long we live or how many diseases we encounter, if we lived a healthy productive life-in the end there will be no regrets.

Fees for face-to-face time are related to the complexity of your case:

Consults at The Center of Healing (Integrative Medicine/Medical Acupuncture)

60 minutes=$300.00
45 minutes=$250.00

30 minutes=$150.00

Acupuncture=$100.00

Phone/Internet Consults (Online Link)
60 minutes=$200.00
30-45 minutes=$100.00
21-30 minutes=$60.00
11-20 minutes=$40.00
5-10   minutes=$20.00

As an alternative to seeing me, I have fellow graduates who have been trained through the same program and take medical insurance- Integrative Medicine Physicians.  Realize there is only one fellowship in the US that prepares physicians to qualify for the Integrative Medicine Board..... my alma mater-The Arizona Center for Integrative Medicine.

House Rules

When my patients come to me for lifestyle change, they usually don't bring family members in.  I love the process of creating steps to change but only assume everyone at home will be participating/supporting the steps.  No two plans are the same, everyone has different likes, educational levels, adverse memories, food 't intolerance's, stressors or previous attempts.  The one things I can't fathom is how the spouse and kids will react to the changes that are usually restrictive.

No question that if a parent is making a change the likelihood of the child having the same medical problem is high.  Whether it is expressing itself now or later doesn't matter, disease always leads to a bad outcome. To make a major shift in bad habits, craving control or trigger avoidance will take a lot of energy and may lead to some emotional "PMS-ing" even if you are a guy!  If your family and coworkers are unaware of your journey, relationships can be destroyed.  If they understand, they too may be inspired to drop a habit.

Counseling should be a requirement for the journey since unhealthy coping skills have been adopted to get you to poor health.  Excuses are abundant as to why the weight is high, cholesterol is in bold print, and kids tease you about body parts that belong in the zoo.  As tight as we hold onto and defend our reasons for ill health, it will be the ultimate "stress response" to let them go.   Think of  an addict going through the shakes, irritability, hallucinations, vomiting and headache......and that is just from caffeine!  If you are trying to let go of your "comfort food", your nightcap, your morning wake up, or any high risk behavior.....getting everyone to lend a hand would increase success.  Family should always be for you unconditionally but just in case, the behavioral health profession is very good at listening and making suggestions that have worked for your predecessors.

Home should be sanctuary as it encompasses 1/3 of your life.  During the worst times of your life, there should be a place to retreat away from stressors (work, traffic, cable TV, food industry).  If you can't harness the support of family, they should be the ones being counseled.   A happier/healthier you will exude positive energy, problem solving, creativity and love.....the law of attraction will bring positive results to those around you.  (The House Divided Against Itself Cannot Stand )

Is there anything natural for sleep?

The body should be able to regulate it's own circadian rhythm with proper care.  That means if you are healthy, work in the fields, get up at dawn, sleep at dusk and eat right-the brain has ways of secreting hormones that signal time to wake up and time to fall into brain rest.  The problem will come when we go over and above by watching TV for 24 hours, "sleeping in" for more than to consecutive days, eating poorly or with no regularity, taking stimulants like caffeine/bad carbohydrates/adhd prescriptions.  When you participate in repetative poor scheduling, the brain will think you are in a different time zone and it will not know when dusk is so the quality of deep brain wave rest will be compromised.  You will know by the mere fact that you wake up fatigued, fall asleep at the wheel, become irritable with problem solving, or memory is hampered.  

Snoring is not good.  We often attribute the sound of a child snoring to -"a good sleep".  If the snoring is associated with pauses of apnea (not breathing) then the brain  is not getting oxygen and sends impulses to the diapragm to gasp for air.  It may sound funny on youtube (or annoying to the partner) but the heart also gets shut out from oxygen and it will suffer by sending out a stress response and turning on adrenaline and epinephrine.......two hormones that are not supposed to be floating around the blood stream during peaceful shut-eye.  The only way to find out about if a loud snorer is going through apnea is a sleep study.  Medical insurance will pay for sleep studies in the lab but you usually have to get a "Home Sleep Unit" from the lung specialist and wear it for 1-7 nights.  This will document a problem and signal to your insurance doctor that a more formal and detailed test is required.  The end result is a positive pressure mask or nasal canula to wear at night so the soft tissues of the nose/mouth/throat stay open at night to allow air flow in and out.  (thus no obstruction)  NOTE-usually if you lose weight the soft tissue that is blocking the passageway will shrink allow the breathing tube to remain open.  Imaging that, a non surgical, non chemical way to get rid of sleep apnea!!!! Oh but weight loss isn't covered by insurance.  What is covered by insurance is a nasty surgery called the UPPP (see link)   

If there is not apneic issue and you are just suffering from shift work sleep problems, sometimes you can do things naturally to help the brain drift off into a sleep rhythm again but it takes ritual pattern establishment over 21 days or longer.  See my lecture on sleep  Today we have immediate access of over 100 channels of stimulating TV programs and usually a closet full of equally stimulating processed food.  Run away! Run away like you are running from zombies!!  It is too easy to open a package and say you will just have 1-2 bites but then feel guilty you ate 20 servings before the TV program finished!!  It is hard to stay true to a diet when you are weak....that is usually about 10pm to 2am. (and in ancient healing like Ayurveda and traditional Chinese medicine-one is not supposed to be filling the stomach at these hours)

You can schedule your macro nutrients to assist in bringing the brain to bedtime, you can also keep your exercise to day time, you can practice the relaxation response to induce positive serotonin secretion to help in training the brain to establish a good circadian rhythm but if this doesn't work then there are hypnotic prescriptions that will force you to sleep but it usually results in poor dream state and an addiction to the medicine.

I feel fine, do I need a check up?

I was in an online meeting with Deepak Chopra and he announced current research projects regarding telomeres.  These are the end caps of our chromosomes (DNA) that protect these delicate message carriers from chemicals, radiation, bad food, viral invasion....the external world.  His research finds if you meditate regularly, your telomeres stay long.  (when they get short the end is near-damage to DNA occurs and just a matter of time before mutation occurs and something grows the wrong way)  He has even enlisted the expertise of Elizabeth Blackburn who is a Nobel Laureate who discovered telomerase, the enzyme that keeps your telomeres long.

Dean Ornish's Program for Reversing Heart Disease has found reproducible results if people change to a mostly vegan diet, walk, practice stress reduction/yoga and go through group therapy.  He took the same program and proved with Elizabeth Blackburn's help the the telomeres in early prostate cancer patients stayed long and the prostate cancer in some was reversed.  Herb Benson and Jeff Dusek found the the more you meditate, the more genes change (published in PlosOne) .....imagine, that is a positive effect and you don't even have to leave your bedroom!  So now the problem is getting people to make changes like the above before disease occurs.  VERY HARD.

Luckily the price for checking telomerase activity is available and decreasing slowly.  The only company that offers the test to the public is Spectracell Labs.  For 200.00$ you can find out if you compare to others in your age group.  (The Today Show)   If your level is better than expected for age, it would be reinforcement that your lifestyle is probably healthy.  The problem could come up if an obese smoker gets the test and it looks "ok"- this might serve as positive ammunition to continue with dangerous living.  I think you would need 2 tests in time (spaced out by 5-10 years to figure if you are improving or worsening.

I would guide my patients to challenge their lives by introducing healthy Thinking/Eating/Activity to their daily routine.  It has to be a routine and you have to like it for sustainability.  If you jump off the deep end and just commit to taking vitamins and "eating when you can".....NOT SUSTAINABLE.  I believe every person has to construct their own template for change and often it is difficult to hold the microscope to yourself.  An outside opinion would always be valuable.  It is too easy to procrastinate the "Change" - something will always come up and we will reason our way out of our plans.  I like the way the registered dietitian at First Health Associates thinks.  Tom likes to develop an "implementation intention" when designing programs for weight loss.  You set a goal (easy) and when you attain goal, you are triggered to go onto the next challenge.  "Lets get you below 400 pounds first then talk about 395.".

Ultimately if you catch yourself saying, "I gotta stop this" or "I know what I am doing is bad"....every cell in your body has already unraveled the DNA, created a protein, changed the protein into a hormone, sent the hormone to your brain and created a message that "you have to change".  If you choose to ignore the message, the only thing that gets damaged is your DNA and sooner or later it won't be able to form messages anymore.  BYE!!

Have one for me!!!

Guy:    How much alcohol intake is considered healthy?
DrRic; That's a loaded question, what other medical problems do you have?
Guy:    Are you saying alcohol is a medical problem?
DrRic:  I believe it's effects can be used to "quiet emotional reactions" and some people can start out using it recreationally but end up depending on it like medicine "to get through occasional tough times"
Guy:     I saw on Dr Oz that red wine has resveratrol, an antioxidant to help fight cancer.....and I don't have any tough times in my life.
DrRic:   Reseveratrol does help as an antioxidant to neutralize dangerous life choices but you would have to take alot of volume and the toxic effects of alcohol on judgement, fatty liver, sleep and digestion make it more of a burden to the body.
DrRic:   Also, it's not the amount of tough times it's the learned reaction to them.  Stressors are a part of all human interaction (inescapable), some react badly (generalized anxiety) and some react seemlessly (meditator).  For every rise in adrenaline and cortisol the body goes through in a day, there will be less room for serotonin and oxytocin (love hormones/procreation).  That would be akin to a proinflammatory life vs and antiinflammatory life.  Developing a dependence on alcohol to neutralize the adrenaline/cortisol times will set you up for more alcohol as the challenges of life accumulate with age.

I have the above conversation with patients (mostly male) on a regular basis.  I will always expect a defensive stance from the patient with what is supposed to be a rhetorical question to me- "What is your healthy alcohol intake?" (expecting I will fire back with stumbling words or some form of denial) Then I boldly say I don't drink.  The reaction is raised eye brows and "really!".   Then I mention my story about the last beer being after I finished the 10/10/10 Chicago Marathon.  I decided to detach myself from this thing that no longer served me.  Truthfully I began to feel brainwashed into thinking the only way to watch a sporting event, relax after work, or finish some sweaty endeavor like cutting the grass was to order two beers, (one for chugging now and the other if the waitress took too long to come back for my next request).
Most who went to college know alcohol is a right of passage in starting to leave the nest and search for a life partner (or maybe just the next hook up) but it revolves around the keg party.  THERE!....it IS synonymous with party!!!   Somehow it transcends into middle and old age as well.  Some people will use it as an excuse for doing lewd acts...."oh...I was drunk"  or  "you were so funny last night!"(intoxicated).  So you can see how people can easily step on the throttle and increase consumption to deal with bigger life challenges. (when the right thing would be to tactically problem-solve with a clear mind). Those of you who just said to yourselves "..but I do think better with a glass in my hand" really should investigate other ways to problem solve and compare the difference.    Be patient, alcohol is immediate (like xanax) vs techniques of controlling the stress reaction take a while to learn (I'm going on 5 years and I am still a novice).  You just might be able to stop an addiction.  I don't bother with candy coating the word dependence-I just reveal it as I see fit and I don't like the effects of drinking.
It can be considered a drug that dehydrates.  Alcohol and water don't mix.  The more you drink, the drier every cell becomes.  Athletes are told not to drink before competition as it decreases stamina, strength, and performance.  I mentioned fatty liver before and this is one of the biggest contributors to the abnormal blood tests.  When the body has to detoxify alcohol, it does so with the liver.  This organ is already busy with high sugar foods, pesticides, GMOs and then we have a few drinks.  The liver starts to suffer and back up, it's called hepatic congestion....I call it slow liver failure leading to cirrhosis.  Reverse your ways now or you will be feeling the sharp end of a surgeons knife replace your liver.
So are you if you are in training for competitive sports-don't drink alcohol.
                  if you are adopting a new lifestyle change- don't drink alcohol.
                  if you are trying to lose weight - don't drink alcohol.
                  if you have a major medical problem and taking medication-don't drink alcohol.
                  if you are being treated for any psychiatric problem-don't drink alcohol.
                  if you are trying to detox your life-don't drink alcohol.
                  if you have any history in the family of alcoholism-don't drink alcohol..
You can find other docs who say it's ok to drink with any of the above but the fact that you had to look probably means you should consider abstaining.

NSAIDS

Should I take an anti-inflammatory?  I work my regular paying job at Immediate Care/Occupational Medicine Clinic and the first thing we prescribe is an ibuprofen 200mg (3 tabs) 3xdaily for the life of the injury.  There are some orthopedic surgeons that say don't interfere/reduce the inflammatory process that follows injury because it slows down healing of the injury.  This thinking is based on the fact that a "normal healthy person", should be able to mount a response to halt inflammation and reverse the injury (assuming no further damage is added).  Problem my orthopedic surgeons forget is that the inflammatory cascade that gets triggered with the smallest microscopic fiber exposure (torn fiber from a muscle, blood vessel, skin, bone....) starts a local reaction in addition to a systemic reaction.  Those of you who are fibromyalgia sufferers, or chronic arthritis patients will know of how the rest of the body "kills" when you have only injured one joint.
The surgeons get to see the inside of joints that have been injected with steroid (cortisone) and they hate it.   You can't repair mush after 'roids have been used and expect a good outcome for the graft you are inserting for rebuilding an ACL.  So for the few joints that have multiple injections prior to surgical consult, I agree with the specialist.  For the millions of others that suffer countless nights not being able to sleep, not being able to walk, where every minute of every day is "I am in pain"; I think relief is worth it.  I would use over the counter anti-inflammatory first (just because anything over the counter is considered a "non-reportable" therapy-so employers don't have to claim it on insurance) but quickly go to prescription anti-inflammatory within 10 days if the first didn't work.
The proper use of NSAIDS is to start with minimum dose at the interval of when the med will wear off. ( For aleve/naprosyn it would be twice a day; for ibuprofen/advil/motrin it would be three times a day)  After 10 days if no response, increase to maximum dose of that same NSAID.  After 10 more days with no pain/inflammation control we switch to different NSAID - I usually go for the prescription meds....I rely on the older ones that were around from when I did a Sports Medicine fellowship in the 90's (nabumetone, etodolac, meloxicam.....or older ones like clinoril, indocin, mefanemic acid).  I have alot of options but most people would throw hands in the air if pain/inflammation isn't controlled by 2nd visit.  Usually it's 2 diff NSAIDs and if no response, time for a burst of prednisone.  OOOOHHH the "P" word!!!
Yes, in some cases prednisone is necessary for controlling inflammation before we have spasm from compensating during walking, or trigger points flare up, or distant joints flare up due to the overall inflammatory response being turned on.  Only 1 time in 20 years have I had weight gain in a patient given 5 days.  There is also no literature that says steroid use for 5 days or less needs a taper (to prevent Addisonian Crisis) so when we give the medrol dose pak-6 days of decreasing dose.....it is a waste of 3 submaximal doses.  Usually there is insomnia (thus the reason for morning dosing with my 3 tabs of prednisone for 5 days).  It can also raise blood sugar for my diabetics.
If the inflammation is not acute, I would highly suggest Turmeric in capsule form (roughly 40mg of extract 4times daily) by GAIA, Source Naturals, Organic India-since they blend it with micronized pepper for better absorption.  If you can afford it, curcumin (in nanoparticle) has great anti-inflammatory properties but if not distilled/extracted properly, you wont absorb the active ingredient without pepper derivative.   Glucosamine Sulfate is a great intra-articular anti-inflammatory and can be used for 3 months and discontinued to still have effect lasting 3 more months.....so you can save 6 months a year!! and still have reported improvement in range of motion to an arthritic joint.
Another option if you are between using herbal supplements to control inflammation and prescription use = topical pain relief.  Either herbal, over the counter or prescription/compounded medicine.  From former to latter, price increases significantly.  The benefit is less side effects if used topically.  The compounding pharmacist can actually mix NSAIDs/Muscle relaxers together so you avoid taking a pill form and it cuts back on systemic side effects beautifully.
The biggest problems with the NSAIDs I mentioned will be reflux.  There are other documented side effects like heart attack from Celebrex, liver congestion, kidney damage, bleeding.  Aspirin is an anti-inflammatory that has been used for decades to control inflammation in the arteries.  If you take an aspirin a day, wait for 2 hours before doing the NSAID or else the med you use for inflammation will turn off the aspirin heart protective effects.
Most important is to work with a therapist (massage or PT) for moving the muscle tissue, maintain an anti-inflammatory diet during the healing process, do no further harm, get a second opinion if you are not progressing within a month with all the above (or switch to Traditional Chinese Medicine).

12 Weeks to Change

About this time of the year, people who have thrown in the towel with a New Years resolution are looking for another way to resolve (weight, medicines or attitude).  Spring time junk mail usually brings on a flurry of products fictitiously endorsed by Dr Oz about detoxing.  When asked, most of the diabetic, over weight, high cholesterol, hypertensive, low back pain, snoring, fatigued patients I run into say "I know what to do, I just cant do it".   I disagree.  If you knew what to do, it would have lasted a lifetime.  The fact that it wasn't sustainable means it was too low in calories, too high in cardio, too many hours a day or too expensive.  My idea of sustainability is to formulate a life change that resonates with the individual.  This is the approach for Integrative Medicine, applying studied protocols in a personal individualized way that provides highest sustainable lifestyle change. (Like having an Uncle that owns a grocery to cherry pick the best items from each isle that he knows you would use and get the most out of.)
So how to start: my suggestion is to hire someone you will be accountable to every week.  The money spent will be worth every penny once you realize what you save from an annual contract with Lifetime Fitness, the prescription co pays, the non paid sick days you accumulate or the meals ordered online from outsourcing your weekly food.  If you do all this on your own and fall into the statistics that most people fail within 12 months-you just wasted a year of money, effort, exercise and morale.  Dead set on doing it alone?  At least do things to increase success of sustainability.  Get an over sized calendar, magnetize it to the fridge, note the start and end of 12 weeks and keep track of the weeks and your wins.  Start writing jotting down notes at the end of your day on 3 daily positives.  I would plan on having others in the house and at work know you are going through 12 Weeks to Change.  (You may find a family member and/or relative who was thinking the same thing!)  Having a quit buddy/group increases problem solving solutions when you hit the wall.  Everyone hits the wall.  Being prepared with maximizing on 'neutralizing stress response'/nutritional strategizing/compressing exercise (DrRics Thinking/Eating/Activity) will get you to get back on target quick.
I think the initiation of change is a detoxing.  Giving the body the break it needs from toxins, bad food, inflammatory thinking and sedentary life is refreshing.   The first morning you feel good about not having a "comfort food" craving, or your first "great" bowel movement, or think with creativity that's been missing since younger years will be glorious!  Yes the feeling and energy of youth is what most can relate to (in memory) but we've been swallowed up by this concept that you have to work like a slave, eat like a king, and move like a wounded animal in order to be "someone".  All the while we are in denial about the impending damage to our DNA we inflict with each drink of alcohol, puff of smoke or bite of synthetic food. What's worse is the concept of epigenetics says the damage we inflict on our own DNA is also passed to our children with the messages of uncoded disease glazed onto sperm and egg.
The key is to make the detox effective; and plan ahead so it doesn't have to be so aggressive next time.  The less disease you have, the less intense the detox.  If you just have to stop buying candy at the check out - easy! If you have to lose 50 pounds for a wedding in 4 months - challenging!  If you have to fight a diagnosis of metastatic cancer - probably should have started earlier but fight for your life!!! I believe most of use should be detoxing twice a year.  Ayurveda (ancient healing from India) says before change of season, we detox the body to prepare for the new harvest.  Different temperature requires different food, different harvest requires different digestion/preparation.  Change requires a well grounded emotional state since most humans prefer stability and ritual.  Especially now that we live in such a toxic environment, over dipping into food, inactivity, inflammatory relationships is such a daily activity we don't even notice how unhealthy we become; and accumulation is felt only when we are about to drown.  Wiping the slate clean is what hunter gatherers are supposed to do with each change of season.
I feel 12 Weeks to Change is slow enough to be subtle, but short enough to  impact confidence and morale. Just in time for rejoicing changes and launching into the next pilgrimage to life goals.  If you can see a doctor-good to attain baseline tests and make sure your body doesn't need extra monitoring.  If you can hire a registered dietitian- good to initiate a nutrition plan and reformulate it as you get past milestones in your journey.  If you can hire an exercise physiologist/yoga teacher/coach to move and inspire you when at your lowest you can avoid injury.   I divide the time into 3-week-blocks concentrating on
1-introducing walking breath work and supplement choices
2-food knowledge and exercise rethinking
3-detoxing, elimination, supplementation
4-intense work on Thinking/Eating/Activity and then planning for the next goal
If you cant hire the above, it's OK, keep your goals realistic, check off the days on the calendar, write your accomplishments in a bedside journal, add some form of meditation to the daily activity, try to avoid wasted time at the gym (shorten the rest times, speed up exercises, add walking to equal 130 minutes weekly) and try to follow my videos.
Set your intention for success every day/Set you attention for living clean every day!