How People Cure People

People cure people all the time.  Maybe it’s your Wednesday night yoga class,  your Tuesday night bike group, or maybe its just having your friend over your home for a cup of tea to talk and catch up about life.  Unfortunately the medicines that are so simple and essential for our health, such as human interaction our becoming lost as we become smarter and smarter.

800px-Asanathon bike ride

PEOPLE AS MEDICINE

People curing people happens all the time, and even in the most extraordinary circumstances.  This becomes very interesting when you start looking at Neonatal Care.  So where else are humans helping to heal other humans.  How about IMPROV CLASSES!  Chicago seems to be breaking new ground by combining Improv with Cognitive Behavioural Therapy (CBT), which (CBT)  is a proven method to help decrease anxiety.  I am hoping that Seattle, my home city, will step up and become the second city to develop an Improv for Anxiety class.  We currently have several Improv groups in the area which are loaded with talented people.  My favorite classes are in the University District at Jet City Improv.  

Doctors and Improv

I firmly believe that Improv should be taught in medical school.  Meeting with patients for a first time visit is very much like improv.  The ability to handle different “scenes” or situations is really what medicine is all about is essential.  It also might make Docs more humorous which would probably be a really good thing.  The Bastyr Center for Natural Health’s Biofeedback shift can also be a fantastic place to learn skills to help shift your orientation to this wonderful world.

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Anxiety, IBS, and Hypertension. The 21st century triad

 

BF trinity

Anxiety, IBS, hypertension.  Sound familiar?  In truth a huge percentage of the US population has at least 1 of the above.  But how do these connect with one another?  Anxiety, IBS, and hypertension are known as the biofeedback triad.  These three health issues have a common treatment option that yields phenomenal results.  What is this treatment?  It is biofeedback which is a modality and a skill that utilizes either computer instrumentation or ones supercomputer (your brain) to visualize or feel different physiologic sensations that are occurring every moment such as your heart rate, breath rate, blood pressure, and even your brain waves (eg EEG).  All of these processes are categorized under “involuntary” (air quotes!) meaning we can’t control them…but that’s just a half truth.  We can control our breath rate, heart rate and blood pressure to some degree.

heart focused breathing

The First Step, The Constant Step, The Foundation

The first goal of biofeedback is to develop awareness.  Are you holding your breath as you read this post?  Quick!  Check in to your supercomputer (your brain) and notice if you have been breathing for the past minute or have you been holding your breath?  If you have been holding your breath, then you are in majority.  We hold our breath ALL THE TIME in society; when we’re anxious, stressed, afraid.  Sometimes holding our breath is a good thing, like when you’ve just been in a car accident and need to check your bumper for scratches, holding your breath to avoid breathing in exhaust is a GREAT IDEA (speaking from experience here).  But holding our breath has consequences to our physiology, specifically our CO2, hydrogen ion, and oxygen concentrations.  AWARENESS is key here.  Without the ability to develop awareness we can not change anything in  our current state of our life.  If you’re unaware that you hold excess tension in your forehead and shoulders then developing this awareness is the first step.  To develop awareness we need to provide instantaneous feedback about these processes and sensations.  So right now, check in.  Are your shoulders, jaw, and/or forehead holding excessive tension?  If so what can you do right now to lower that tension by 1 point?

Biofeedback can be utilized in a variety of ways, tools, and settings.  Step 1 is to develop awareness.  Check back for step 2, Control.

Action Steps. To Increase your awareness consider the following:

1. Locate a MBSR class in your area.  For Seattle click here 

2. Utilize Audio-books- I love this one by JKZ

3. Seek out a Biofeedback coach/Doctor/Therapist/Myself

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Squat Warm-up

This is the warm-up that I use to prepare my body for squatting with weight. Not captured on this is 1 warm-up set with weight usually 135 for 5 to prep my body for “load”. After this warm-up Anisa and I did a 1 RM Squat test. Video to Follow!!!

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My 2014 Goals

My Goals for 2014

Hello and good morning to all!  I hope you are all having a wonderful Monday as we start off the 6th day of January, 2014.  Reflecting back on 2013, many great things happened, as well as a few minor set-backs.  After such an amazing 2012 that included getting married to my wife as the best moment, I had a gut feeling that some challenges might present themselves in 2013.

On the positive end I saw my hip continue to heal, regain strength and mobility post-FAI surgery.  I am now squatting 225lbs for reps and maxed out at 265lbs on Thursday.  Unfortunately a nagging grade 1 hamstring tear refuses to heal despite not deadlifting or kettlebell swinging to any appreciable degree.

Our families continue to grow stronger in connection through our marriage as my wife and I traveled to Florida where my sister’s and aunt’s families shared the holiday season at my mother’s house.

Goals for 2014

Graduate from Bastyr with a Residency or another position ready to go.

  1. Squat 315 lbs.  After said weight, I believe I will stop adding weight to the bar and focus on reps because with my hip the risk to benefit ratio gets greater and greater.
  2. Prepare more high quality foods at home so I am not left eating crap on the run.  Failing to prepare is not an excuse.  Many times over the past 6 months I was left eating just nuts for lunch.  While the healthy fats can sustain my body quite well, I am looking to thrive with my nutritional choices, not sustain.  To me being a Doctor is all about walking the walk, being congruent, and teaching my patients about a healthy lifestyle.  From my perspective, when I make a choice that is not in line with my health, it steals energy from my dream of helping others with their health.
  3. 15 minutes of mindfulness meditation for 30 consecutive days.  Re-evaluate when achieved.
  4. Write the book that is in my head and be in the process of getting it published with-in the next 18 months.
  5. Spend at least 1 week-end every month with my Grandparents.  My Grandfather is 91 and while I know he’s still vital, I have the opportunity to be spend more time with him now than at any other time in my life.
  6. Explore Washington with my wife.  We both love Hiking and I know her desire to explore our back woods has been growing stronger and stronger during 2013.  Anyone want to share their favorite WA hike?

 

What are your goals for 2014?  Share any in the comments box.

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Rock the Boards Episode 2

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Preparing for the ND clinical board exam

In an effort to prepare for the ND clinical board exams in August, I will be uploading videos regarding cases and quick facts to share with my colleagues.  Enjoy.

 

 

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Caffeine or NSAIDs for Pain? Both?

800px-Café_parisienLet’s be honest for a second.  Drinking a morning cup of coffee (or four!) tends to bring more guilt in our society than drinking a social glass or two of wine.  When people talk about their coffee consumption it is as if they are admitting that they are weak and unable to handle the stress of their life.  Regardless of this fact, it seems that every month a study is published in favor or against coffee consumption.  I personally think drinking an 8 oz cup of coffee is great for the body and allows millions of Americans to have a bowel movement everyday, which makes me really happy.  There really is nothing worse than dealing with people who are full of sh*t.  I have never been a fan of coffee, but am a strong tea connoisseur.  In fact this post was written while enjoying some green-tea at my favorite tea shop in Kirkland, WA Savrika.  My over-arching belief on these two morning beverages is that you should be able to eliminate them from your diet in a moment’s notice and not experience any side-effects such as caffeine withdrawal.

Coffee_backpack

Walking around with a coffee backpack.  Caffeine withdrawal imminent!

A fascinating Cochrane Review was published in Issue 8 of 2012 reviewed the literature on caffeine helping to improve the efficacy of analgesics (pain relievers).  I came across this review while I was reading American Family Physician.

QUICK SIDENOTE- Just because I am studying to become a Naturopathic Doctor does not mean that I don’t read MD literature.  In fact, I often find myself reading DO, DC, RD, MS, MD literature all the time.  Knowledge is just information, but applied knowledge is power.

The paper identified 19 different studies that were randomized, double-blind trials that looked at acute pain and the use of analgesics plus caffeine or just analgesics alone.  The most common dose of caffeine used was 100 to 130 mg of caffeine (a substantial dose) and either paracetamol or ibuprofen.  The studies were looking at pain from headache, post-partum, dysmenorrhea, and post-operative dental pain.  From the review “About 5% to 10% more participants achieve a good level of pain relief (at least 50% of the maximum) with the addition of caffeine, giving a NNT of about 15.”

WHAT DOES NNT mean?

Number needed to treat.  This is the number you would need to treat for 1 person to derive benefit.

Effects of Caffeine on the body

  • Increased Heart Rate
  • Increased Blood Pressure
  • Increased Wakefulness
  • Increased Alertness
  • Psycho-active stimulant.
  • Increased Endurance

How many more people did caffeine+ NSAID help vs. NSAID alone for Headache?

caff NSAIDS

THE NNT is 14

The results for dysmenorrhea were a little less stellar but still favored caffeine plus NSAID instead of NSAID alone.  134 patients out of 310 had greater than 50% reduction in pain vs. 121 patients out of 310 in a study by Ali et. Al.  Interesting, but nothing to jump out of your seat about.

The authors also separated the dose of caffeine used, with slightly higher doses being more beneficial than doses lower than 65mg.  

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