Community As Medicine, Cracking The Competition Code

There is a buzz among medical professionals that I’m so very excited about. It’s a sense of community and collaboration that has been missing from our profession for some time now. I had the honor of hosting the first Austin Functional Forum livestream viewing meetup last week and ever since then, I’ve been contacted by really great healthcare pros who are excited to connect, learn more, evolve their practice and find their tribe. This is something that I’ve been trying to cultivate for sometime now, but since I’ve been bi-Texas coastal for most of this year, it was a bit challenging. So I’m really grateful for James Maskell, his vision and the satellite meetup that allowed me the opportunity to plan and execute a great event where like-minded professionals came together locally. Thank you to those of you who took time out of your busy schedule to come, you made my year.

Community as medicine is one of my six pillars. This in addition to food, stress-relief, movement, sleep and play is essential for whole optimal health. Have you heard of the Roseto Effect or the Rat Park experiment? Have you heard about the latest discovery of the likely cause of addiction? If not, here you go:

http://dynamicdiscovery.ca/how-to-live-longer-roseto-effect/

http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html

My vision and dream is to cultivate a community of healthcare professionals that interact, refer, consult and grow with their colleagues for the betterment of patient care. This is the only way the paradigm is going to shift. In the past, I’ve been so ego-headed that it was a challenge to think a health coach or naturopathic could offer my patients something I couldn’t (even though I saw them for my own health issues). Now I see that Thomas Edison was not only prophetic, but totally spot on:

“The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.”

Some of us are trained in allopathic medicine where we target organ systems and symptoms, which work well in acute settings. Others are trained in diet and nutrition. There are chiropractors and osteopaths who are experts on the human frame and lifestyle, functional, integrative providers who are root-cause and prevention experts. We also have mental health professionals and people who work with spiritual and emotional causes for disease that we need to be willing to tap into as well. The only way we can truly target the whole person is through looking and referring outside our Western medicine, allopathic model box.

We have been conditioned to approach the practice of medicine with the business of healthcare in the forefront of our minds. This is not entirely our fault as the ones giving us a paycheck, whether it is insurance companies or a healthcare organization, pay on production and quantity. It’s time to release that mentality. If we go into seeing patients with service, commitment to targeting root-causes, an open-mind and open-ear, a sense of guidance, a hand of engagement and some vulnerability, outcomes are better. We also need to recognize that we don’t always have all the answers and perhaps motivational interviewing is best left to those who have the training and the time. We need to encourage a healthcare team, from nutritionists to chiropractors and health coaches and acupuncturists, because the allopathic model is not always going to be for everyone. We’re trying to build a team to help patients heal, not a team to compete against each other.

Our competition, as James and his team say on this podcast: http://functionalforum.com/competition-vs-collaboration-medicine/ (please listen, its amazing and inspiring) is not those practicing in the real medicine, root-cause way, but rather the allopathic model that is closed off to change and fine with holding up the status-quo. The other competition they mention, that I talk about in my last post, is our egos. This one is a bit more difficult to change, but if you truly want to help your patients, you’ll do some deep digging and serious inner-work to get to a place where you feel confident and comfortable in referring to and consulting with those with a different skill-set.

I believe the best way to accomplish this is to ignore the label and alphabet soup behind your name and connect to folks on a different level. There is always opportunity to learn from each other. A yoga therapist can teach us how to activate our parasympathetic nervous system through breathing techniques for our anxious patients. An acupuncturist can show us acupressure points for nausea so perhaps we can bypass the Zofran or Phenergan and all the adverse effects they can cause. Chiropractors can help us understand how structure leads to function and how it affects our microbiome.

Community as medicine is key and I’m so excited about creating this in whatever area I’m in.  That is why I’m so excited about hosting the Functional Forum viewing party and really creating a community in Austin. To me there is nothing more exciting than getting together with my healthcare buddies to geek out and discuss genomics or nF-kB or DMT-1 or the microbiome (If you’re looking those up right now and want to learn more, come to the next event!) And patients are getting into this too. It’s really fun to bring together science and experience to tailor the best plan for an individual or a patient population and it is even more incredible when you get to do it with your tribe.

So wherever you may be, I encourage you to create a safe space, whether in your office, your home, a co-working space, a farmstand and invite your friends and colleagues who have a demonstrated interest and commitment to healing the healthcare system and participating in the paradigm shift that is happening right now. That is why I started the Whole Health Co. (-llective, -mmunity, -op), so those passionate and motivated can share their vision, mission and gather a tribe of people who are ready to participate in healing healthcare.

You can start with the Functional Forum satellite meet-up or a journal club or a food as medicine talk at your local farmers market, just start. The Functional Forum folks make it super easy. You just rally a few people who want to learn and connect about whole health, an internet connection, a big screen and projector, some food and they do the rest!

It’s a brave new healthcare world out there, lets connect and build the new system together.

Here is the link to start the satellite meetup: http://functionalforum.com/meetup/

 

Image courtesy of pixtawan at FreeDigitalPhotos.net

Why Go To PA or NP School?

A few years ago, I interviewed the President and CEO of our local hospital system about the future of medicine. It was the first interview for my Heroes in Healthcare blog. I had a scheduled 30 minutes of his time and recorded the entire conversation on the phone via my voice recording device. Unfortunately, just like my first podcast, the audio disappeared and the few notes I had taken were lost in a move later that month.

Many of you know this doctor if you have lived or worked in Central Texas. Some have had the honor of being his patient or working along side him in the ER or clinic. He’s is incredibly skilled in the art of medicine, treats patients like his loved ones and has some of the most calming energy even in the face of emergencies. I remember one of my first days in clinic, I called him about a patient who came in with symptomatic atrial fibrillation. The paramedics were there, but they needed an order from me to treat her a. fib. I was in complete panic mode and couldn’t even begin to think of the Advanced Cardiac Life Support algorithm. After encouraging me to take a deep breath, he calmly walked me through the steps, we stabilized the patient and she went on her way with EMS. I will forever be grateful for his patience and calm through this situation and for not making me feel like a total dummy.

During our interview, we talked about how he missed his clinical practice, but felt the need to address the healthcare crisis from a different position. I also asked him where he thought medicine was headed. He told me that the frontline of medicine, the primary care providers of the future were not going to be doctors or even Physician Assistants or Nurse Practitioners, but specially trained medical assistants, community health workers, promotoras who learned about specific chronic conditions and delivered education, tools, resources and lifestyle changes outside of the clinic environment. Then if the patient needed drugs or labs or treatment, then the MD/PA/NP would take over.

I completely agree with him. I think in five to ten years, PAs and NPs will be the primary care providers and the MDs/DOs will be the specialists. This isn’t news, this has been the prevailing thought on advanced practice providers for a couple of decades now. Then in twenty to thirty years, the medical assistants, promotoras and community health workers will take over.

So why even spend your money to go to PA school or NP school? Because we’re living in today and the certification and the alphabet soup behind our name gives us credibility and legitimacy. Because in order for state medical boards and rule makers, doctors, associations to trust that we’re capable of being sources for change and responsible colleagues, we need to learn along side them in school and graduate with rigorous training. Plus it’s pretty awesome to go to PA school, especially if you’ve loved science and learning as much I have. You get to learn from leading minds in pathology, A&P, pharmacology, endocrinology, neurology and every other ology. Then you go on rotations under doctors who teach you various tricks of the trade and about the craft and art of medicine. And most importantly, you find your tribe in school. The like-minded community, your family and partners in crime, your two a.m. study buddies and competition in cartwheel contests when you need an energy boost. They make it all worth it.

Oh and your patients, they’re the main reason you should go to PA or NP school. They deserve to be treated by someone who goes into medicine for the service and not the money or prestige. We’re are the ones who are slowly shifting the paradigm away from factory medicine into a whole health model.

There are doctors who do this too, but they’re often forced into the conveyor belt of primary care and have less opportunity and time with patients. There are some trailblazing doctors who have carved a new system with direct primary care and membership-based practices. This is not to say that there aren’t amazing doctors out there, there are so many, I work with many of them. But they’re part of this broken system and often feel stuck and hopeless, I know because I talk to them often about this and that is what they tell me. To them, I applaud your commitment and persistence to the craft. I wish you for you to be empowered to take the control back from insurance companies and administrators and realize that you’re a scarce resource and actually have the biggest influence in helping change the system.v

So that’s my two-cents. I’m excited about the future for PA’s and NP’s. I love my profession and even though I am practicing clinical medicine less and less these days, I will always encourage folks to go the PA route. But I’m even more excited about having a community health worker or promotora at the end of each city block to attend to the needs of our increasingly chronically ill population. What do you think?

Photo from Ambro at http://www.freedigitalphotos.net/images/agree-terms.php?id=100103840

Your Patients Need You, But Not The Way You Think

After almost eight years of practice in primary care, urgent care and a hybrid practice of both, I have learned that 90% of my patients need me for knowledge, encouragement, a sounding board, empowerment, and some guidance more than they need me for drugs. I’ve worked in rural areas of Texas, inner cities and underserved communities my entire life and patients no longer need an ‘expert’ who orders labs and unnecessary imaging, who tells them what to take, how often to take it and return in three months to make sure the numbers we are chasing fall in range. Most chronic disease is pretty darn easy to treat.

Yes, I said it. Most chronic disease can be looked at in an algorithm and for me  it’s easy to simplify, synthesize and share with my patients. Chronic disease includes diabetes, high blood pressure, high cholesterol, obesity, hypothyroidism. If your patient is diagnosed with one or more of these diseases, the internet is replete with accurate information about the disease process, symptoms, signs, organs involved and how they’re damaged throughout the disease, the pharmacokinetics and side effects of each drug, what lifestyle change could help treat, manage and reverse the disease (s). They don’t really need us except to write for the proper drug or refer to a specialist for their eyes or feet. Or if they are emergent and way down the line and show up with a full blown heart attack or stroke or HHS, then we are definitely necessary.

Again, acute, life or limb-threatening, emergent cases, this is not easy. Treatment and management of most acute cases requires years of education and experience and to you experts, specialists,  life-savers  I bow to you, I applaud you, I thank you for all your hard work. Though I had a friend who had a few weeks of wilderness first response training and knew how to stabilize a pneumothorax better than I did and I just read about a doctor in Alaska who called a pediatric cardiologist to get advice on treating a patient who couldn’t be shipped out immediately, so there is that. But I digress, this is meant for the primary care setting.

If you are anything like me a few years ago, you’re thinking “this lady is crazy, medicine is hard and I worked my butt off to get where I am today and patients could never know more about their disease when they come into see me”. I would roll my eyes when my patients would try to give me information about a new drug or changing their diet and pretend to listen while thinking to myself that I had all the answers.

Sweet little Erica, no way. Yes, I was one of those ego-heads.

Not only is this way of thinking arrogant, but it is also wrong. We are ‘experts’ in populations of people with certain diseases, we’re not ‘experts’ of individual patients. We’ve studied evidence-based medicine, research and memorized the complex HPA-axis and the Na+/K+/Cl- action that happens in the loop of Henle and regurgitated them for tests, so of course we know everything. Wrong. We don’t.  This is where you have to release some of that ego in order to provide the best service and care for your patient.

Our patients need guidance and time, a open ear and a compassionate heart. They need someone to listen to their worries about working three jobs to feed their kids or panic about leaving an abusive relationship or their fear of losing their depressed and suicidal 13 year old. They need us to help them find the easiest and most affordable way to get more veggies into their diet and stop depending on convenient fast foods. Or a hero who is willing to stay after clinic and walk with patients for thirty minutes, break a sweat and build a community. They want someone who looks at them as a human being and not just a label with a disease who’s only value is in their blood and numbers on a piece of paper.

They need us to advocate for their needs and time. To empower ourselves and silence the higher-ups who demand more numbers and more revenue. Patients need a strong, confident source of unbiased medical knowledge who helps them find what is best for their unique biology, physiology, chemistry and neurology. Someone who curates a treatment plan that allows them to take baby steps towards big victories and motivates and encourages them to find their own individual way to heal. A provider who teaches self-care as healthcare and helps provide an easy first step to feeling good and optimistic about taking control of their own health.

Patients want and need a provider who assists, educates and empowers them to find the healer within. Can you do that?

photo credit by akeeris at http://www.freedigitalphotos.net/images/Healthcare_g355-Lady_Doctor_Teaching_p77330.html

Turn Your Clinic Into A Healing Haven In 10 Easy Steps

Today I had the honor of accompanying my Aunt Emma to her doctor in Southeast El Paso. This is a fairly impoverished area of my hometown and just like much of El Paso, it’s medically underserved. The clinic was nondescript, hardwood floors, a couple posters on the wall, cold coffee and cookies for the patients. Her doctor was adorable, compassionate, caring and remembered my aunt well and all the drawings she has brought her over her five years as a patient there. My momma had taken my aunt off of statins after some fight from me and her LDL (bad) cholesterol had gone up. “We thought that food had something to do with cholesterol, but we’ve learned that that is no longer true, you can eat what you want, as long as it’s not fried”. Those of you who know me as the food as medicine/root cause PA, know that it took every fiber in me to stay silent, but I did. I really liked that her doctor went over her cardiac risk stratification and tried to figure out her individual chance of heart disease, “you don’t smoke, you’ve never had a heart attack, you don’t have diabetes, therefore, you likely don’t need a statin to control your cholesterol, but we’ll reevaluate in three months”. Again, the thought “no we won’t, she will not be placed on a statin drug” came up but not out. She proceeded to examine my aunt, through her clothes and when she looked in her mouth she said “perfect”, which was not accurate again. I had seen some pieces of food and a non-brushed set of pearly whites just minutes earlier as I was shooting some pics of her in the waiting room, come on doc, be real, honest, teach!

Our job as medical providers is to teach, educate, pass on the very important information that patients need in order to make educated decisions about their health. The word doctor comes from a latin verb that means ‘to teach’. Our duties as medical professionals is to teach at every single chance we get with our captive audience, our patients. This doctor was so charismatic and had a tremendous capacity to encourage change, but didn’t take advantage of the opportunity. We’re considered experts to our patients, particularly in underserved communities and they listen to what we have to say with the most open ears and hearts. With that power comes great responsibility and by ignoring the spaces for educating and empowering, we’re not serving them in the most effective way we could. Her doctor had so many missed opportunities to talk about changing one thing in her diet, brushing her teeth, asking her about any kind of exercise or even what she does for fun. Many of you who know my aunt, know she is the happiest, cutest, most shining example of a ‘pure heart’ (as my niece Lily said), which goes a long way in physical and mental health, some of this does not apply to her. But there was so much that could have been said and asked in that ten minute visit that may have gone a long way and for sure would have made a difference after every three month visit in the past five years.

This experience, among others, inspired me to spread the word on what I have learned in the last three years about the art of medicine, integrative approaches and our responsibility as provider as partner. Because we now spend so much time in the clinic waiting rooms and exam rooms, we should be enveloped in information about how to make the lifestyle changes that prevent or reverse chronic disease. Turn off the Cops and novellas on the TV and get some entertainment that involves education. I’m not talking about health TV sponsored by drug companies to encourage our patients to ask for the newest treatments. If you’re insistent on having a TV, stream”Hungry for Change” or “Fed Up” and offer headphones or put on closed caption. Studies have shown that ads add to stress in patients and violence on TV increases physical discomfort.(1) We need to help our patients take their health into their own hands and make changes at home, work and life. The first step as a medical provider is to educate yourself, to practice self-care and use some of these evidence- based techniques that work on many levels in many aspects of health. The magnificent Florence Nightingale believed that the healthcare environment should “put the patient in the best possible condition so that nature can act and healing occur.” (3) So this is my list for 10 ways to transform your traditional clinic into an integrative space that will help you, your patients and your staff create a healing environment in a way that drugs cannot.

The research in the field of Evidence-Based Design is not vast, but what does exist is robust and relevant and is rapidly growing. Dr. Roger Ulrich is a leading researcher and expert in the field and is right in the heart of Texas at A & M. What does exist focuses on the connection between the healthcare environment and its impact on patients and their families, staff and organizations.

Here are some benefits to creating an patient- centered environment (2):

– Reduction of stress and anxiety for patients and family members

– Reduction in pain and less need for pain management

– Improved patient satisfaction

– Improved job satisfaction

– Greater staff productivity

– Overall cost savings through increased operation efficiency and improved medical outcomes

So how do you do this? Easy, take a weekend, buy some paint and some artwork and get ready for some major patient impact:

1) Paint the walls a soothing color. (http://www.managedcaremag.com/archives/0111/0111.colors.html)

2) Put a plant in each corner, a small plant in exam rooms, bright colored flowers in waiting room. (Leather, Beale, Santos, Watts, & Lee, 2003)

3) Play relaxing music or sounds. (Groff, Carlson, Tsang, & Potter, 2008)

4) Diffuse soothing and relaxing essential oils throughout waiting room and in hallways of clinic. (http://www.hindawi.com/journals/ecam/2013/927419/).

5) Place artwork of nature, landscapes, vistas, bright vegetables, fruits or other pieces of positive visual distractions. (http://healingphotoart.org/about-us/scientific-evidence/)

6) Hang pictures and infographics of relaxation techniques that are easy to do while waiting. (anecdotal evidence from patients I’ve seen who love to have interactive information on walls while waiting in exam room)

7) Pictures of food as medicine. Want to reverse your DM? Try eating more vegetables on a daily basis. An accurate food pyramid or just pictures of a plant-based diet = healthy mind and body. (No one is going to go vegetarian because of a picture, but maybe it will prompt a conversation about adding more veggies than they already eat).

8) As much natural outdoor lighting possible and less artificial lighting. (http://www.hfma.org/Leadership/Archives/2014/Spring/The_Business_Case_for_Patient-Centered_Facility_Design/)

9) Have a handout of all the ways they can exchange one unhealthy habit for a healthy one. Drink one glass of water before each meal, eat a small salad before each meal, trade one of your five sodas a day for water, buy nuts and seeds in bulk and have them readily available. (no brainer here, increase health literacy)

10) Turn your physical exam into a real teaching opportunity- teeth full of plaque, talk about the importance of brushing and decreasing sugar intake, BP elevated let them know that just moving for 5 minutes an hour is beneficial or going outside to walk for 30 minutes is healthy.

These simple transformations can also be implemented in your home to make it more relaxing, inviting and a decompression zone for the hectic life that we have to auto-pilot through on a daily basis.

 

1. Ragonesi AJ, Antick JR. Physiological responses to violence reported in the news. Perpet Mot Skills. 2008;107:383-395.

2. https://accc-cancer.org/oncology_issues/articles/mayjune08/fouts.pdf

3. http://www.minnesotamedicine.com/Past-Issues/Past-Issues-2008/March-2008/Clinical-Zborowsky-March-2008

 

Photograph from nuchylee at freedigitalphotos.net

Alzhiemer’s Disease, It Takes A Village

Forgetting familiar faces, phone numbers, your way home, how to bathe, dressing  yourself, these are all sad realities of people who have progressive dementia. When my dad’s decline started happening, I was just starting college. He drove me to Austin from El Paso, an almost 600 mile trek and got lost on his return home. This was a man who taught me how to read maps and had the best sense of direction of any man I’ve ever known. The next stage consisted of a personality change from the kindest most happy-hearted man in my life to a reactive and at times mean father. Those two extreme changes prompted me to call his doctor and beg him to put him on medicine for Alzheimer’s disease (AD), “Erica, you know that this is a diagnosis of exclusion and if I diagnose your dad with this abysmal and irreversible disease the outcome is not good”. Yes, I knew this, even with just a BA in English/pre-med, I knew that Alzheimer’s was a progressive disease and my dad would never be the same.  I held onto the hope that a drug would fix him and keep him as my daddy for just a little while longer.

Now, 15 years later, he’s in a home, at peace, happy and my momma is able to live her life again. From the extensive conversations we had before we placed him in a home came this idea, that it takes a village. I believe it takes a village to get through everything challenging in life. We’re meant to have a tribe, a community, people who will not only catch us if we fall, but will always offer a hand to pick us up again and again.

Late last year, the conversation that struck the strongest cord was one my sister brought to our attention. The fact that neurodegenerative diseases, those that rob a person and their loved ones of the mind, but keep the body intact, lack a village, lack a community. For fifteen years, my mother took care of my dad, entirely by herself, with the occasional drop-in visits from my sister and I, some lasting months, but most lasting days. We talked about how if dad had been diagnosed with cancer, that the world he built, the tribe he had once had, would be at his aid. Those people from around the world who he went to college with, Vietnam, the Peace Corps, St. Josephs, Seton, housing authority, foster grandparents, all the lives he touched and saved, would have been calling, visiting, making food for my mom, helping take care of him while she took a breath, and showering him and her with love and support. I know this to be true because the second I I took a sabbatical to go back to El Paso to figure out his next step and I reached out to my friends via social media and the universe, we received that very support that had been lacking all of those years. The shift in asking also happened after my dad was diagnosed with leukemia last summer. Once he received a diagnosis outside of his Alzheimer’s, we started seeing more of a community form and also when we felt more inclined to ask for help from others.

When I talk about community as medicine, this is what I’m talking about. I wrote about this in 2011 and how if you know someone with Alzheimer’s to visit often and be cool. But that only happens if you ask. The power of asking for help becomes difficult when your caring for someone with Alzheimer’s, there is a pride issue there, I get it, I felt it. Once my dad had cancer, my mother wasn’t expected to do it alone. Yet, around the world, as more and more people are being diagnosed with this terrible disease, they’re lost and alone and without a village. That’s why a friend of ours wants to move her husband, who has Alzheimer’s, back to Colombia, so she could have that community to assist her. That’s why I believe caretakers, who know more about the disease than most medical providers do, need a place to breathe, exchange ideas, vent, talk about the latest research and ideas in the care.

I’ve been so fired up the past few weeks when I heard about an actual Dementia Town in Holland. This has been my inspiration for my dream to build a dementia village in or around the Austin area. I’ve been looking at land, emailing the founder in Holland, researching the specifics as much as I can figure out and putting it out there as a must do in this lifetime. Of course it will be called Benny’s House and will house a restaurant, a coffee/tea shop, grocery store, library, garden, a laundry mat, maybe some office space (for those workaholics),  and a holistic clinic. It will take a village to build, but I know it’s one that will be full of life, love and community, just like I believe my parents and anyone with AD and their caretakers have deserved for a long time.

If you haven’t heard of The Roseto Effect, read about it here. The study showed how important social networks and communities are for our health and well-being. We’re in this together folks and none of us is getting out alive, so why not reach out to a stranger, why not talk to the homeless man on the way to the next SXSW venue? Believe in community, believe in the goodness of others and practice it as much as possible.

Thank you for reading.

(Photo from the community who helped me during a 500-mile pilgrimage)

Meditation, My Drug Of Choice

Yesterday morning I woke up with swollen, itchy, red eyes again, exhausted from not breathing well and didn’t want to get out of bed and go to work. Eventually I peeled myself off of my bed, late and found my bathroom occupied by my housemate. “I should have woken up earlier!” I texted my boyfriend to let him know I was going to shower at his house and ran out the door with my clothes and my dog. She was stubborn this day and ran all the way out until the end of the driveway and sat down. I was at my car, putting all of my stuff in, holding the door for her. She stayed sitting for what seemed like forever. “ELLIE!! GET IN THE CAR”, I yelled. “GET IN THE CAR!!”, even louder. I saw my housemate through the window peeking out to see what the ruckus was all about. Ellie sheepishly got up and slowly walked towards the car. I guess she didn’t want to go to work with me and that was fine, but I was already running late and just needed to get going. As we drove to Justin’s house, she started wining and crying, which she only does when I’m on edge. This made me stress even more and I could feel my frustration rise up inside me. When we finally got to his house, I ran to his door and knocked hard and fast like it was going to get him there faster. Ridiculous, I know. He opened the door and gave me a kiss. I responded, “HI, Ellie’s being crazy today, I’m late and I need to take a shower and I didn’t even get to meditate and it’s a shit day!” Justin, being the prince that he is, offered to keep her for the day as I walked into the bathroom. I took a moment and tried to meditate in the shower and just couldn’t do it. Finally, I made the decision to give myself five minutes to breathe. I went into his bedroom, shut the door, sat and put my timer on for ten minutes. When I finished, which was only about 7 minutes in, I came out like a new person. He said I looked better, more energized, less panicked. I felt like I had just taken a sedative or just finished a massage therapy session, I felt good and grounded.

It’s amazing what a few minutes of real belly breathing can do for your sanity, that’s what meditation does for me. There has been some evidence that shows that 20 minutes of meditation can feel like 7-hours of good sleep. Whatever the reason, however lacking the science may be (which it’s not), I know it works and I’ve seen it work with patients, in house, during a busy clinic day.

So what are some of the benefits of meditation? I did a whole 77 reasons piece a few months ago. Here are some of the highlights:

– Helps decrease anxiety

– Helps with time management

– Increases memory ability

– Aids in insomnia

– Reduces neurosis

– Increases endorphins (feel good drug)

– Makes it easier to manage stress

– Makes you look younger!

If you’re anti-meditation, I’ll let you in on a trade secret. People who are not ready or willing to do the uncomfortable and challenging inner work- forgiveness, self-love, reflection, all the tortuous labor that leads to growth-are also adverse to sitting in silence. If you’ve had a difficult time attempting to meditate or think it’s for the birds, count the percentage of time throughout the day that you’re able to sit in silence. How much time do you spend with no music, no smart phone, no tv, no computer, no voices, simply doing nothing? Sleeping doesn’t count. And if you need white noise to sleep, take note! If the majority of your day is full of hullabaloo, then you need meditation the most.

The misconceptions about meditation are:

– I should be able to completely clear my mind

– I will not get more anxious while I am meditating

– I should not be making to do lists while I’m meditating

– Meditation is easy

Nope, nope, nope and nope. Meditation means different things for different people, but the most impactful explanation is that it allows for transformation of the mind. We meditate every single day, it’s what we choose to meditate on that makes the difference. On a daily basis we meditate on our finances, relationships, job drama, kids, debt, car trouble, politics, sports teams, new coaches, old relationships, plumbing issues, family conflicts, and all other worries and concerns of our life. Meditating is doing this but for more productive and positive outcomes.

Russell Simmons says “if you don’t have 20 minutes to meditate, then you need 2 hours”. Start small, baby steps, wake up five minutes earlier and just lay there and count your breath. Do this for as long as possible, 20 seconds, 2 minutes, whatever works for you. As long as you’re doing it, you’re creating brain patterns and habits to keep on doing it. Then in a week, increase to five minutes. You can also focus on mindful movement with no outside stimuli beside the action you’re performing, in the shower, washing dishes, watering the lawn, just focus your activity on the breath.

It’s self-care people and so imperative to our health. Do it and do it now. Thank you for reading.

Here are findings from a functional MRI: (http://lifehacker.com/what-happens-to-the-brain-when-you-meditate-and-how-it-1202533314):

Frontal Lobe This is the most highly evolved part of the brain, responsible for reasoning, planning, emotions and self-conscious awareness. During meditation, the frontal cortex tends to go offline.

Parietal lobe This part of the brain processes sensory information about the surrounding world, orienting you in time and space. During meditation, activity in the parietal lobe slows down.

Thalamus The gatekeeper for the senses, this organ focuses your attention by funneling some sensory data deeper into the brain and stopping other signals in their tracks. Meditation reduces the flow of incoming information to a trickle.

Reticular formation As the brain’s sentry, this structure receives incoming stimuli and puts the brain on alert, ready to respond. Meditating dials back the arousal signal.

The Sick Season Solution In 5 Steps

For the past few weeks, the urgent care clinics I work in have added a third provider to their usual two provider shift. Most of the patients I or the 3rd provider would see came in for the common cold, flu or stomach virus. These are illnesses that can actually be treated at home, rather than dragging yourself to the clinic, waiting for hours and possibly being exposed to other sickness while you’re there. We’ve forgotten how to take care of ourselves and our health that we depend on a well-trained stranger to tell us to rest and drink lots of fluids. So since this whole Shiny Healthy People website and movement is to put the power and resources back in the hands of patients, I wanted to write a piece that did just that. Here is my usual solution to the sick season.

Bonus: If you do these things regularly or right when you feel the sickies creeping up, you can prevent getting sick too!

1)  Drink lots of  fluids

Many of my patients believe that certain electrolyte drinks are necessary for treating illnesses and turns out they can actually do more harm than good. Those brightly colored drinks have corn syrup or sugar added to them and sugar decreases the ability of your immune system to operate optimally. If you have a cold or the flu, drinking filtered water is best as long as you’re still eating. If you’re not eating or you have a stomach bug, then add some sea salt or fruit to make it pass through your stomach lining easier and not cause irritation. Fill up a big jug or glass bottle with filtered water room temp, add some fruit or herbs, a pinch of sea salt and keep it next to your bed, and drink plenty of it. You can also warm up some water and squeeze some lemon and honey and sip that all day. Here is a really easy recipe I give out often:

-1/4 cup freshly squeezed lemon juice
-1/2 cup freshly squeezed orange juice
-1 ½ to 2 cups of fresh water
-1/8 teaspoon of sea salt

or

-3 cups of coconut water
-1 cup of strawberries
-1 cup of fresh water
-1/8 teaspoon of sea salt

2) Rest

This is kind of a no-brainer, but I’m constantly shocked at the amount of patients who request a quick-fix and a rapid return to work. When you get sick, you’re body is talking to you, listen to it! Rest is so important when you’re worn down and your immune system is begging for it so it. Get plenty of sleep at night and when you’re sick, take naps and really just relax and be present. There have been numerous evidence-based studies on sleep and the immune system and they all have the same results: sleep rules for a robust immunity and also helps you increase your resistance to infection.

3) Boost With Supplements, Herbs and Oils

Earlier this year, I attended a conference with a big wig doctor who used to work with the Oakland Raiders. He recommends 3,000 mg of Ester-C at the first sign of infection for two days, then 2,000 mg for two more days. If you have any history of kidney stones, don’t take the high dose. Ester-C better tolerated, because it is not an acid and is more bioavailable (more gets into your system). So that’s usually the first thing I have people do as it shortens their illness or stops it dead in it’s track all together, especially if you do all these other tricks in combination.

Peppermint oil for stomach bugs, just mix with some coconut or olive oil and rub on your belly. You can also make a tea with it if you have the leaves.

Chamomile is good for all viruses, especially stomach ones. It can help with inflammation and reduce fever as well.

Garlic, 2 cloves crushed up and put in water, drink quickly.

Echinacea in form of a tea or a tablet.

Clove or clove tea as written about here.

Probiotics, which you should be taking regularly unless contraindicated or causing you issues

4) Nix White Foods and Increase The Rainbow

This means taking out breads, pastas, grains, sugar, milk, and dairy products, because they suppress the immune system and slow healing. Your body has an amazing way of healing itself if you just give it the right tools and this sometimes includes eating less while you’re sick. The body has to utilize energy to digest foods, so it’s better if you focus on keeping hydrated and eating high nutrient, immune boosting foods in small amounts. If you have a slow-cooker, just put all the colors of the vegetable rainbow in the pot, add some water or vegetable broth, some chicken if you like, salt, pepper, ginger, garlic and onion and 5-6 hours later, you have a delicious remedy!

5) Breathe and De-Stress

If you can’t breathe, this allows for another suggestion I make often, which is a neti-pot. This is an amazing invention that helps clear out your sinuses like magic. It’s not comfortable, but it works. I recommend a net-pot if you have a cold, sinus pressure, lots of mucus, productive cough. The less mucus you allow to just sit there, the faster you’ll get better. Also, steamy showers and baths are good while you’re sick.  If breathing isn’t a problem, then I want you to try to practice some relaxing breathing exercises that allows you to de-stress and focus on the present. Many of my patients freak out when they get sick because it takes them away from work, which they say they can’t afford to do. The fact that they’re sick is usually because they’re overworked, which suppresses your immune system. Mind over medicine is a real thing and if you’re focusing on deadlines and getting back to work faster, which isn’t possible, most viruses have to run their course, then your mind can’t focus on healing. Thoughts become reality, make them healthy ones and you’ll be healthier.

Hope you’re already feeling better just by reading this. 🙂  Usually if you’re otherwise a healthy human being, you’ll start to feeling better with these suggestions in 2-4 days, but the lingering symptoms can last up to two weeks. If you feel like you’re not getting better after 2-4 days or start feeling worse or have fever after feeling better, then perhaps it’s time to visit your medical provider.

Image courtesy of MisterGC at FreeDigitalPhotos.net

77 Reasons To Meditate

A dream was realized last week. I sat and learned from Harvard Medical School professors. It wasn’t about the newest advancement in diabetes treatment or a surgical intervention that will change knee replacements forever, but about a type of medicine that has been around for centuries and practiced by people of all shapes, ages, colors and backgrounds. The Benson-Henry Institute for Mind Body Medicine put on “The New Science of Resiliency and It’s Clinical Applications” and called all medical professionals to look past what we were taught in school and try a little tenderness and self-care with mindfulness and meditation. Day 1 we learned about the benefits of yoga, attachment, the Relaxation Response, and the power of empathy. The leading minds of cutting-edge research delivered some of the most inspiring and refreshing talks I’ve heard from medical professionals in a long time. Just being in Boston makes me feel like my telomeres are growing.

So in my attempt to bridge science and spirituality, I will now give you 77 reasons that I got from lectures in hopes that it will move you to at least try a few minutes of mindfulness. Why 77? Because I attended and learned these at 77 Louis Pasteur, a conference hall of Harvard Med School and I’m kind of obsessed with Harvard right now, if you couldn’t tell.

Here you go:

77. Easier to manage stress

76. Makes you look YOUNGER!! (as superficial as this is, we all know this is in the forefront of our thinking)

75. Increase in endorphins- the naturally produced feel-good drug of the body

74. Improves brain function

73. Improves memory

72. Improves sleep

71. Allows for better management of anxiety

70. Improves cerebral performance

69. Helps from brain deterioration

68. Certain types of meditation can lead you to a state of ‘superlearning’

67. Can lead to a more receptive state of learning as well as an accelerated one

66. Assists in addiction recovery

65. Can create a sustained prevention of relapse in addicts

64. Lowers heart rate (which can be a good thing for people in constant fight or flight mode, not so much for folks on drugs for blood pressure)

63. Decreases cortisol (the stress hormone)

62. Increases DHEA, the precursor to most hormones, which protects us from disease and key player in aging

61. Can decrease risk of mortality from heart disease

60. Creates a space for you to take control of your own health and well-being

59. Reduces insulin resistance, which is important in diabetes and also how certain diabetes med work

58. Reduces neurosis

57. Helps in self-realization

56. Reduces negative personality-traits

55. Lowers oxygen consumption, which helps in deeper relaxation

54. Decreases allostatic load- the price the body pays for being forced to adapt to adverse psychosocial or physical situations

53. Can change your genetic expression patterns (GEP)- what I always tell my patients is: 1) you are not your genes 2) you can turn genes on and off

52. Can aid in insomnia

51. Decreases inflammation which is involved in almost every symptom and disease from joint pain to heart disease

50. Improves brain blood flow

49. Reverses NF-kappa B and enzyme that plays a role in the immune response as well as memory

48. Changes structure of the amygdala, an area of the brain that is involved in memory, decision-making and emotions as shown on functional MRI

47. Changes in structure of the hippocampus, an area of the brain that is involved in memory and other processes. It is usually the first affected in Alzheimer’s disease.

46. Changes the structure of the pons in the brain. The pons acts as a highway to different areas of the brain and plays a key role in sleep and dreaming, including REM sleep.

45. Changes in the anterior cingulate cortex structure in the brain, which works in regulating heart rate and blood pressure

44. Changes in the structure of the intraparietal sulcus which directs eye movements and reaching ability

45. Changes in metabolism – monitored by oxygen and CO2 changes

44. Reverses dendrite shrinkage, a part of the neuron, which are the cells of the brain

43. Decreases blood levels of lactate, a substance that is produced when you break down sugars and causes panic attacks

42. Improves emotional regulation

41. Increases GABA levels which are hormones produced during relaxation and immunity and where drugs like Xanax, Valium and Clonopin work on.

40. Increases resilience

39. Reduces schizophrenic symptoms

38. Improves relationships

37. Improves quality of life

36. Reduces free-radical production

35. Can decrease pain

34. Increases exercise tolerance

33. Helps with symptoms Irritable Bowel Syndrome

32. Helps improve symptoms of Inflammatory Bowel Diseases like Crohns and Ulcerative Colitis

31. Helps accelerate post-operative healing

30. Reduces activity of viruses

29. Can help in asthma attacks

28. Aids in breaking bad habits

27. Aids in anger management

26. Increases empathy

25. Helps decrease road rage

24. Increases compassion

23. Helps in forgiveness of yourself and others

22. Increases synchronicity in your life (my favorite)

21. Increases equanimity

20. Reduces likelihood of criminal behavior

19. Decreases worry tendency

18. Increases will-power

17. Increases self-confidence

16. Improved tolerance for everything in life

15. Increases creativity

14. Helps resolve phobias

13. Slows mind aging

12.  Lowers blood pressure

11. Develops intuition

10. Increases serotonin

9. Helps with rational judgement

8. Encourages higher levels of brain gyrification, the process of folding as the brain grows

7. Increases grey matter in the brain

6. Increases social connection

5. Helps with ADD and ADHD in both children and adults

4. Helps you feel less lonely, allowing you to feel a part of a greater whole

3. Improves your ability to multitask

2. Increased acceptance of ones self.

1. It makes you happy!!!

What’s the common link to all of these benefits? Decreased stress. It’s a cascade effect that occurs decreased stress–> the world is a better place. So thank you Dr. Herb Benson for being a trailblazer in the science behind mindfulness and meditation. Thank you to everyone doing time and labor intensive research into the research behind meditation as medicine.

Any critics? Send me a message or write a comment and let me know your thoughts.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

21-Day Meditation Challenge

There are numerous reasons to meditation, but the main one I tell everyone is to manage stress. Stress that is related to every type of disease from hypertension to autoimmune to cancer. Meditation has endless benefits that have been scientifically proven to make you a happier more accepting individual. Your mind gets stronger, you increase your grey matter, life gets just a bit easier. Everyone has something to gain with meditation.

This month Deepak Chopra and Oprah Winfrey have a 21-day challenge. Now this isn’t really my suggestion for starting to meditate, because if you’ve never done it, you are kind of forced to go from no minutes in silence to about 10-15 minutes. I would recommend starting off with listening to the daily message and then going for as long as your mind will allow you.

Here is the link: https://chopracentermeditation.com/

Namaste,

Erica

Walk This Way To Health!

Last year I walked 500 miles through the beautiful countryside of France and northern part of Spain on the Camino De Santiago. To say it was life-changing would be an understatement. I had never walked as exercise before, I thought it was a waste of time or something the older folks do. This experience was walking as my form of transportation, no metal encasement or wheels under a seat, just me and my legs. I did suffer from a lot of physical ailments, but all of them resolved by the end of my trek.

Most days in clinic, I recommend a minimum of 120 minutes of exercise a week. This is 20 minutes a day and my go-to form of exercise is walking. The reason I ask patients to walk outside is because I believe nature has many therapeutic elements. When I suggest this while practicing in Austin during the summer, my patients look at me like I’m a crazy person. Rightfully so. You’re usually drenched in sweat the second you step outside in the summertime in Austin. But waking up early or going after the sun goes down is very tolerable and often enjoyable, so do it! This wouldn’t be a Shiny Healthy People article without the scientific backing so here it is!

1) It helps with weight loss. I could put my reference here, but this is pretty much common sense.

2) It helps increase insulin sensitivity. A Danish study done last year showed that walking increased the amount of insulin sensitivity compared to participants who did one hour of vigorous exercise. (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0055542)

3) Walking strengthens your bones as it counts as weight-bearing activity that your doctor encourages you to do when you have osteopenia or osteoporosis. (http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2011/March/talking-of-walking-in-three-easy-pieces)

4) Helps to strengthen your heart and helps prevent heart disease and stroke. (another no-brainer)

5) Walking outside allows you to get your daily Vitamin D.

6) Helps with anxiety and depression (http://www.sciencedirect.com/science/article/pii/S027273589900032X)

7) It may help with the constant pain of fibromyalgia. I know if you have fibro, you’ll say I’m crazy to suggest exercise, but the right kind, walking, briskly, in nature, is actually really beneficial. (http://www.biomedcentral.com/content/pdf/ar3225.pdf)

8) It can reduce your risk of breast cancer. The Journal of Clinical Oncology published a study that women who walk regularly after being diagnosed with breast cancer had a 45% greater chance of survival compared to those who were inactive.

9) Walking can help decrease your risk of dementia and mental decline. http://onlinelibrary.wiley.com

So there you go! Get out and get walking! I’m on may way to the desert with my parents. See you later!