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?

  
  
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  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 )