It is always with you.
It is an easy tool to help harness your own physiology.
Lets take a moment to practice working with breath intentionally.
Watch Dr Brie's first Mindful Monday on Facebook and get a new technique you can use every day to bring mindfulness with you anywhere you go.
Controlled breathing has been shown to:
For more information on the breathing technique used in this video visit Dr Weil's website here.
You may remember the NABD list from the holidays. Not. A. Big. Deal. That is a big term in our house with two small kids and two busy adults. Triaging what is and is not a big deal is a daily practice.
It is important to know, however, that there are B.D.s as well. Big. Deal. This past week the Big Deal was being stranded on the side of i-70 with my two small kids and a flat tire. It put a few things in perspective.
Isn’t it funny how there are warning signs that we know in our heart of hearts? We know we need to listen, but we often don’t until the yellow warning becomes the red brick wall of life that stops you in your tracks.
What is a B.D.? Your health. You know this as soon as you don’t have it present any more. When your health gets buried under disease.
This was what I loved about hospital work. There are a lot of people when their health is done with yellow warnings they end up in the emergency room. If you have been privy to a night in the hospital, you know there is a lot of time for reflection. As a physician, if I would dare ask, I would hear that there were warning signs along the way. Patients would tell me, “I knew my blood pressure was a little too high” “I knew I needed to start working out again” or “I could tell something wasn’t right”.
My car gave me a warning sign too. I was busy shuffling kids around after work and getting them to gymnastics. I did not pay attention to the warning signs. I kept pushing. I am really good at pushing through. Sometimes, I am forced to listen.
Driving on i-70 at full speed going to gymnastics the tire went flat completely. Luckily, I was close to the side and was able to get off the freeway safely. As is typical with three years olds, my son was in the middle of having a fit about going to gymnastics (ah, children). Sitting in the car inches from the slow lane the trucks and cars seemed anything but slow. I turned around and was serious with my kids. We were in a Big Deal situation.
To make a long story short, I got the kids safely onto a frontage road. Three wonderful people came to our aid and we got the tired changed and headed home. After the experience (and then getting back on a busy freeway), I got off at the next exit and pulled into an apartment complex. I parked the car and crawled in the back with my kids. We hugged and cried and laughed and hugged and cried and laughed. We put on our favorite song and drove home.
Life is great at giving us second chances when we don’t listen. Our bodies, minds and spirits are amazingly resilient and when we forget to take care of ourselves we can often get up, brush our selves off, and try again.
I always feel like I have a lot of work to do. I love doctoring. I enjoy running my business and teaching. I love being a mom and a wife. Sometimes these jobs have demands that conflict with each other and somehow, the easiest person to get lost in the shuffle is me.
After the B.D. this past week, we came home and I played baseball with my son in the back yard. I walked “toddler pace” with my kids to school and giggled with them as we tried to outrun the falling snow under the tress. Fiona termed these “popcorn trees” as the ice and snow rained down on us and jumped back up from the sidewalk. I watched as my son just sat and stared, eye to eye with a vibrant pink blossom. I resisted the urge to tell him to “hurry up” or that we “had to go”. We were both captured in the moment.
It is spring. What garden needs tending? Your mind? Your body? Your spirit?
It is time to wake up from the winter doldrums. To shift the habits we have formed in the rut of winter’s snow and mud. Time to ask, “What needs my attention today?”
Life is not about being perfect and every day doing every thing. Its not about mediating daily and exercising 5 days a week, eating 5 fruits and 5 vegetables, spending time with family, getting work done, sleeping enough AND…..
If we can pay attention long enough to the small, inner voice we might hear a totally different story. We might hear: “Slow down, take it easy, play”. Today might be blend of doing one of the things we know we need to do for ourselves and giving ourselves permission to let go of “the list” itself.
Isn’t it time we started to pay attention to what our health— body mind and spirit— thinks is a Big Deal and what is Not A Big Deal?
Today I finished teaching for the semester at the Rocky Vista Osteopathic Medical school where I’m an Assistant Professor. I teach first-year medical students and the final exam is a pass fail test called “competency testing” where they diagnose and treat each other while the other faculty and I observe. For the students, it’s a nerve racking experience. For me, it’s an osteopathic marathon.
Many of you see students in the clinic. You may wonder who they are and how they got there. Perhaps you are not sure what really makes D.O.s different from M.D.s, especially if you have not had an osteopathic treatment. So here’s a little story on how an Osteopath is born.
First, we take a bright college student who took a lot of tests and did well enough to get into medical school. Then we teach them how to feel and think.
Here’s what we taught the students at Rocky Vista in their first year in the department of Osteopathic Principles and Practice:
Today, after ten short months in the classroom, the students amazed me. Competency testing can be challenging for the students who internalize the idea that they must be perfect at everything (like I did in med school) or for the ones that blow off true osteopathy. But under the layers of nerves were students who were really feeling and changing the physiology of their classmates. Bones moved, ligaments relaxed, muscles that were too tight let go. Next year the students will learn advanced techniques and start treating more and more clinically. This year we helped them to build a foundation.
It’s true, only about 20% of the students will graduate as Osteopaths and go on to use the manual skills they have learned. But in their 4th year I can tell they still have their placatory skills. I know they will be better surgeons because they can feel still feel fascia and understand functional anatomy. They ask deep questions when taking a medical history because they understand that looking at the whole person is part of what our founder, A.T. Still D.O., called “a rational approach to treatment”.
I wish more of our Doctors of Osteopathy (D.O.s) could keep these skills honed through training and clinical practice. It is a clinical skill like any other that some are innately good at and others have to practice a lot to do well. I wish our medical system fostered the students to keep looking at the body this way. That is why you see students in our office on rotation. We want to teach them to look at people always as a good doctor will and see not just body - but mind and spirit. Dr Lisa is my “adopted D.O.” colleague—and friend—because she sees the whole person in context of their life. She considers stress, nutrition and exercise in her approach. A Doctor certainly doesn’t need to be a D.O. to think holistically.
Thanks for being a part of teaching every day you let a medical student tag along with your visit. You can always say “no, not today”. When it is ok to say yes, know that you are part of shaping a future Osteopath who might one day write a blog that incorporates all of our tenets without even realizing it until the end. It was the tenets of Osteopathic Medicine that attracted me to the profession when I was 19. Nearly 20 years later I believe in Osteopathy even more than ever. Congratulations future Osteopaths of 2021. Welcome to second year.
The Tenets of Osteopathic Medicine
The Tenets of Osteopathic Medicine express the underlying philosophy of osteopathic medicine and were approved by the AOA House of Delegates as policy.
In the summer of 2009 Dr Lisa Nguyen and I headed up to the mountains on our residency retreat weekend. We had car pooled together and we were listening to 1980s music on the radio. I was singing along. She was not. We had just met, fresh out of medical school headed to Swedish Hospital together to start a career in family medicine. On our drive up we shared our journey. It was then that I learned that, as many doctors do, Dr Lisa had gone straight through from undergraduate school to medical school and how now landed in the middle of residency in her mid 20s. I, on the other hand, had a more wandering course taking a year and a half off between college and med school to travel, study botanical medicine and live on the beach.
After two years in residency, Dr Lisa and I were both voted into the leadership position by our peers and faculty at Swedish called Chief Resident. In the life cycle of a medical path there are many stages: college, MCAT (big test), med school with two years of course work and two years of clinical work. (this is the stage that the students you encounter at our office are in).
Then there is this computerized match program that decides your "entire life", or where you will spend your residency years, the most intensive part of your training. That is where Dr Lisa and I fatefully met. For family medicine doctors this part is three years and the first year is called your internship (queue memories of Grey's Anatomy season one).
The next transition seems like the "end" but it is really the beginning. Going into practice is perhaps the biggest leap you take as a medical professional. No longer within the safety of your training cocoon, now you are a big doctor on your own and your wings are not yet developed. Dr Lisa and I decided to take that last leap together when we opened Whole Family Health at Belmar for HealthONE right after we graduated.
When HealthONE decided to close our practice, Dr Lisa was left with a decision: keep going on the medical treadmill to the next job or take the break she hadn't had since....summer vacation in college? She was just getting married, without any kids or pets, and she decided it was time. Dr Lisa started by studying medical acupuncture the summer before her big trip. Then, in January of 2017 she went to China for three months learning more about acupuncture by practicing it. This started the sabbatical year that brought Dr Lisa and her husband around the globe. They included a bike ride from Lisbon to Budapest, with a culinary exploration in each town. By the end, they had made a small footprint on nearly every continent.
After she spent a few months working in Oregon last fall, Dr Lisa and I got together and started talking about working together again. I am elated to say that once she got back, we made it happen.
This week, Dr Lisa Nguyen will start seeing patients at Direct Osteopathic Primary Care. She will expand our clinic availability by adding appointment time on Tuesdays, Wednesdays and Fridays. Dr Lisa will add to our services with acupuncture treatments for $55 for members and $70 for non members. In fact, for your first three treatments as a member you get $10 off per treatment so try it! If you stay tuned, you'll notice other exciting membership perks we have in the works. Read a special message from Dr. Lisa here.
I am honored and blessed that my best friend, and my favorite medical professional, is joining us. I know you will find the compassion, easy going demeanor, and intelligence of Dr Lisa to be a perfect fit for DOPC. Now is the time to send a friend or a family member to join us! In fact, at our last practice that is exactly what I did when I sent my parents to Dr Lisa! We can now double our capacity and continue to make Direct Osteopathic the place where doctors get to be doctors (instead of corporate automatons) and patients get good care (the old fashioned way, by partnering with a provider they trust).
Refer a friend and get $20 off your next invoice with us.
Cheers to growth and expansion this Spring,
Some how it is December 2017. In a typical weekday evening at home, I am reminded why this time of year has the uncanny ability to fill your heart with cheer….and boil it over with overwhelm and stress.
I was home later than I wanted to be. Unable to wrap up completely at work, doing the best I can to meet the needs of here and now and today. As always. I walk in. My kids are cute, hungry, 3 and 5 years old. They go from adorable to hangry monsters within the first 20 minutes of my arrival. I had wanted to make the gingerbread man due at school with my daughter. She is in Kindergarten and helping her with her projects is a precious experience, one I consciously try to fit in my schedule as busy as it can be. She starts gluing and using glitter (of course) on the kitchen table and for a moment I am startled by the rapid sequence of mess making that ensues. I go to say something and then catch myself. I remember, this is on the N.A.B.D. list. Not A Big Deal.
We started the NABD list when my son turned 3. Three is precious, and terribly challenging. My son can be the worlds cutest human and then a beast within seconds. When the threenager collided with the emotional mood swings of a kindergartener we coined the term. I have said countless times in the last six months…
“Honey, there are BDs (Big Deals) and NABDs which one is this?” That is right, NABD. Not A Big Deal. Almost always.
As I sit to join the gingerbread project it becomes apparent that food must appear immediately in front of the 3 year old. But the window was missed and now he is in his room having a fit. I am whisked to cooking. To be fair, I am lucky and this is not my typical role. My husband is a phenomenal cook. I will forever be the mom that just “made food.” Healthy, yes. Tasty, not always. But my husband is working late tonight. I cook fast and furiously and have tacos on the table in no time. Phew. We can all eat and relax. We talk about the good things and the challenges of our day.
The glitter is moved to the appropriate art table and we dive in. There is glitter everywhere now, a little on each surface and the floor. Gingerbread man turns out beautiful. Turns out this is a BD (Big Deal), doing art with your child. I am amazed at the calm it brings me to come into the moment and glue the fine details when she needs my help. Then the 3 year old gets wind of the glitter project and more glitter goes everywhere. Of course. Not A Big Deal.
I am reminded of the book, “Don’t Sweat the Small Stuff” by Richard Carlson. I never read it but always wished I had. I felt I learned it all in the title. I probably missed some key elements since I just figured out the N.A.B.D. list and the book was published in 1997. Yes, that was 20 years ago.
My husband comes home. The dog, who is a hundred pound eight year old fur baby wags his tail vigorously in a very cute fashion. He also happens to whack the closest child cup that spills milk across the entire room. Couch, floor, art table. Luckily not the precious gingerbread man was safe, having moved to a higher surface for stabilization and drying. For a moment I look at the mess and think, “Are you kidding me?” Then I remind myself. Spilled milk. And you know what they say about spilled milk? Not worth crying over. Not A Big Deal.
It is the holidays, officially. What can you let go of? What can get crossed off the infinite “List” of “to do” so that you can have some more moments “to be”? In giving ourselves permission to add to our N.A.B.D. list we make room for the things that are a B.D.
Let the Big Deals sink in. If it is Not A Big Deal, let it go.
When I considered getting out of corporate medicine, seeing one patient every 15 minutes day in and day out, I was excited by the possibilities I saw in Direct Primary Care. But I’m not the type to recommend a big change that I haven’t tried myself, so I changed my employer based insurance for myself and my family from a low deductible plan to a high deductible plan combined with a Direct Primary Care Membership. I was amazed that by switching, not only did we have a better health care experience, we saved $183 a pay period, or $366 a month by making the simple move from a low deductible to a high deductible plan.
This year, I decided to price out on the health exchange how the math might work out for a family in 2018 converting from a low deductible plan to a high deductible with Direct Primary Care.
Certainly, some people choose Direct Primary Care because they want a stable provider who is going to be their doctor no matter what. Others choose it because of the customer service: they value getting an appointment when they need one and talking directly to their doctor when they are concerned about something. For many, however, the deciding factor is financial.
Let’s Do some Driect Primary Care Math
I performed a search on the Colorado exchange, Connect for Health Colorado (http://connectforhealthco.com/). Using a family of four as my example, I searched for plans in Denver for “low need” patients, without a subsidy. Here’s what I found:
So the total savings by switching to Direct Osteopathic Primary Care with High Deductible Plan is $763.36 per month! That is a 42% savings!
If that family put all of that saved premium into a savings account, they’d have an extra $9,160.32 per year to cover emergencies and costs subject to their deductibles.
Regular office visits, wellness visit, most urgent care issues and day to day care would be covered through Direct Osteopathic Primary Care. Health insurance is then left to act like car insurance, to cover you when you an emergency hits. For daily savings, at Direct Osteopathic we use our discounted lab services and our in house pharmacy which can beat the big box pharmacies on generic medications. For example, our basic wellness lab panel is $29 and we get Flonase for $8.
For families looking for even more savings, Direct Primary Care can be combined with a cost-sharing insurance plan as an alternative to traditional health insurance. One of them, Liberty Health, actually reimburses for a portion of the monthly membership fees (https://www.libertyhealthshare.org/).
Now that Open Enrollment has come around again, think about how you might save if you think outside the box about healthcare this year. Even if you are lucky enough to have insurance through your employer look closely, you too might save by switching to a high-deductible plan plus Direct Primary Care.
At Direct Osteopathic Primary Care we want to keep your out-of-pocket costs low. We are built on core values of cost effectiveness and cost transparency. It's the way Direct Primary Care was started. Personally, I can never turn back.
Its that time of year again! The viruses and bacteria just had a big party because the lovely small people are back in school creating a perfect environment for spreading germs. Even if you are shielded from the littles, you are bound to come into contact with some one with a cough, a cold or a mystery nose over the next few months.
As an Osteopath, I believe the body is always trying to heal itself. Its not a matter of running around the world in a bubble and not getting exposed. The question is, how do I give myself the building blocks so even if I encounter germs, I can fight them off? My daughter and I talk about this beauty of the immune system as “the fighters”. She once asked, “do your fighters have swords?” Here’s how to arm yours for the winter battle.
Getting a cold isn’t the worst. But getting the real respiratory flu or influenza is terribly uncomfortable (sometimes life threatening) and can keep you down for weeks. If you are older than 50, have a chronic illness or are a kid, getting a flu shot is one of the best things you can do. At Direct Osteopathic, we have a limited supply for ages 3 to 64. We are using Fluzone, quadrivalent (four strains) in preservative free, single dose vials.
Text “I want a flu shot” to the office at 303-422-2236 and we will ear mark one for you. First come first serve. We have a limited supply, $25 each. If you are over 65 or want your insurance to pay for it, get the shot at your local pharmacy.
Cheers to your health all winter long.
Last weekend I was lucky to attend a conference with pharmacists, physicians, naturopaths and holistic practitioners literally from around the world. Several speakers were from Europe and the UK. There was also a gastroenterologists, neurologist and several general practitioners practicing holistic medicine like myself. This was the first time I have been to an entire conference on one treatment, low dose naltrexone or LDN.
I started using LDN several years ago or so when I came back from an integrative conference at Scripps Institute. The chronic pain specialist spoke on alternatives to narcotics for chronic pain. He mentioned things I had heard about like Tai Chi and something new, LDN. Around that time an initial study came out using it for patients with fibromyalgia who often have chronic pain and sleep that is not restorative. The first time I used it, I had an adventurous and insightful patient that noted better sleep, improved mood and decreased pain.
The compounding pharmacist that was making the medication for this patient and I became friends over this novel therapeutic and she asked if I had ever used it for Hashimoto’s or autoimmune thyroiditis. I said I had not. The pharmacist, Wendy Medved PharmD, sent articles my way about its mechanisms and how it worked in auto-immune disease. It was from there that I learned how many applications this new option could offer my patients. It has served many of my hypothyroid patients since.
LDN is made from an old generic drug naltrexone. Naltrexone has long been used for its opioid antagonist effects. If you overdosed on opiates or heroin your life would depend on this medicine or its cousin naloxone, 100 mg would be the dose. If you suffer from alcoholism, we can use it at 50 mg to help curb the urge to drink. When we start LDN we start at 0.5 to 1.5 mg and work up slowly to 4.5 mg. That is why is it compounded. And because it is compounded it adds a bit on the monthly budget ($45-60 depending on where you get it and getting to the right dose). The other problem with compounded medications is that industry isn’t motivated to study them because they can’t be “blockbuster” drugs lining their pocket books.
I went to the conference last weekend put on by a consortium of pharmacists, doctors and others that have been looking to collect research and data on the many applications of this new treatment. I went primarily to find out:
And guess what? I learned!
I am excited to share with exploration of the wonderful world of medicine with those of you that follow these blogs and articles. Like all medications, if you don’t work with me, talk to your doctor before trying something new like this. Do your research on why it might (or might not) be good for you.
Read the book: https://ldnresearchtrust.org/ldn-book
Check out the research: https://ldnresearchtrust.org/ldn-clinical-trials
Never stop learning.
Do you remember the very first time you could perceive stress? Chances are you can look back on your childhood and remember a time you were impacted by stress around you. Perhaps you can marvel at how you were not impacted the presence of stress. But do you remember when you could first feel it in your body? When you noticed its presence in your mind? Are there any illnesses now that you can attribute to stress in your life? Lets deconstruct stress together and figure out if we can find the line where stress can be good but before it weighs you down.
Originally, I intended to write about berberine and bergamot, two of my favorite new supplements for heart cholesterol lowering. Or perhaps talk about turmeric, known for its potent anti-inflammatory effects, and its ability to lower your dangerous cholesterol. These topics, interesting as they are, will be covered in depth at my upcoming talk, Taming the Fire of Cholesterol. Stay tuned for details.
This blog changed, however, when my aunt died this week. Suddenly, in her sleep. It was an unexpected death, cause to be determined. As a physician I suspect a stroke or a heart attack. Either way, cholesterol is the common denominator. Losing my aunt reminds me how powerful the heart is as an emotional center, something we physicians do not often discuss. In the wake of her death, the hearts of all of those close to her are affected. In fact, her sister and best friend had a mild heart attack later that same day.
When I do Osteopathic treatments, I often note tightness in the fascia, muscles and ribs that brace the back of the heart, the mid and upper back. So many of us hold tension here. I place a hand of the tight fascia and find the direction of ease. I take musculoskeletal connections to the heart where they want to go to rest and unwind. As I do this, a natural conversation often arises about what lends to this tightness. What are the stressors caving in on you? How are you handling it? How are you taking care of yourself? Are you living in line with your passions, your goals, your dreams? Can you hold your own heart in a loving embrace?
There are books on stress management that I love by a company I have known for years, HeartMath. HeartMath talks about “congruence” and “heart rate variability”. They have biofeedback sensors and fancy computer games where people can learn how to live in “sync” with their heart. HeartMath has become so prominent in the field that when I was in medical school, cardiologists were implementing their programs to help patients practice techniques to lower their stress levels and prevent second heart attacks. They have research to prove that you can calm down erratic heart patterns and actually physically lower heart disease risk through mindful awareness and slowing down. These books and techniques remind us of the powerful intersection between our physical and emotional selves.
Stress is pervasive in our culture and epidemic in our time. My next blog series will likely be on stress and its effects. Our hearts are emotional centers that track our stress physiologically. It is important to remember that hearts need our attention. Hearts need healthy food. Hearts need oxygen, exercise and exertion (30 minutes 5 days a week is what the American Heart Association recommends to be exact). Hearts need to be in sync with our rhythm, at peace in our chest. Hearts need “in fill” time as much as they need connection with others.
When I was in medical school, I was fascinated with everything I learned. When we studied the heart I was learning the anatomy, electricity and various sounds it makes. One night, in my dorm room, I placed my stethoscope on my chest as I lay down to sleep. Lub dub lub dub. That is the sound it makes. I listened and listened. What an honor it is that our hearts keep beating, never stopping, until the end.
Next time you want a little practice to get in touch with your heart try this. It's from adapted from the work of HeartMath:
Shift and Activate
Rest comfortably, sitting, standing or laying down.
Close your eyes.
Shift your breathing to your belly.
Activate a positive emotion. Any positive emotion will do, no matter how big or how small.
How you feel seeing a loved one.
Watching a beautiful rainbow.
Drinking your morning cup of coffee.
Feel the positive emotion through your chest, expanding.
Breathe with it as long as you can.
Open your eyes.
If you want more practices like this, the heart will be the subject of our next Mindful Mondays on Monday July 10 at 5:15 PM at the office, 16 Lakeside Lane. If you are a member, this event is free. Join us and bring a friend who will love us too for a donation. Please share this email, share our invite on social media and spread the word.