In today’s post, we share the first talk as part of the Charlottesville Center for Functional Medicine (CVCFM) Wellness Workshop Series hosted at Studio IX in Charlottesville, Virginia.
In this talk you will hear co founders Ryan Hall, Rob Abbott and Kerri Cooper introduce CVCFM and attempt to answer that all elusive question “What is Health?”
Together we explore the key components of health, seeing it as something much more than just the absence of disease or sickness.
We share our 7 Relationships for finding and sustaining well being: sleep, stress management, movement, nutrition, community, wisdom and play and begin to explore the real meaning behind each of this crucial relationships.
We offer our working definition of functional and ancestral medicine and provide some concrete examples to explain what a personalized root-caused resolution approach to cultivating wellness looks like.
We even have a short Q/A period at the end of the talk where we seek to compare and contrast diets and nutrition templates and explore some of the biochemistry behind and rationale for pursuing a ketogenic diet.
We were incredibly grateful for the opportunity to speak at Studio IX and will be back in two weeks to dig a little deeper into nutrition and the reasons for following an ancestral nutrition template.
I am so excited to finally share the launch of Pentad Integrative Health’s first full module: Gastrointestinal Imbalances.
Pentad Integrative Health is the vision of my dear friend Melanie Dorion NP and is a health education and clinician training platform that will revolutionize the way we learn and practice integrative medicine.
I have spent more hours than I can even count, staying up late after 14 hour shifts at the hospital to research and refine the content in our first two modules: the freely accessible Diet and Lifestyle Module and the previously mentioned GI Imbalances Module.
Free Diet and Lifestyle Module:
GI Imbalance Module:
The GI Imbalances Module addresses the importance of a healthy digestive system and highlights many of the common GI concerns in primary care. The discussed conditions include: intestinal permeability, dysbiosis, SIBO, constipation, indigestion and CIRS. Management recommendations are condition specific and utilize the plethora of resources from both the conventional and integrative fields. Thorough evidence-based solutions are discussed, so patients can find relief, and practitioners can find joy in bringing their patient to a greatest state of health and flourishing.
The content presented in the videos and accompanying handouts is designed as foundational learning in integrative and functional medicine, combining basic pathophysiology with practical clinical medicine. The content is accessible to both practitioner and layperson and will provide you, as a clinician, with the core skills to empower your patient, and will provide you, as a layperson, with a solid understanding of what it may take to treat and heal many of the most common underlying GI conditions.
In the second of four interactive lectures, the team at the Charlottesville Center for Functional Medicine (Rob Abbott, Ryan Hall and Kerri Cooper) describe the basic physiology and neurohormonal regulation of sleep as well as provide a look at the unfortunate consequences of poor sleep and sleep deprivation. Ryan and Kerri provided some insights on how to best track and quantify the duration, quality and timing of one's sleep. We then offer some practical and simple tips to improve one’s sleep hygiene and thus one's overall sleep.
We then seek to provide our best all-encompassing definition of stress
“Stress is any factor, both perceived and unperceived, that exerts tension on an individual or system and requires an intentional physiologic or psychological response to maintain a state of functional homeostasis.”
From this working definition we organize and discuss the differences between perceived vs. unperceived stress as well as physiological vs. psychological stress. We describe many of the common sources of underlying chronic inflammation or unperceived physiologic stress that can be uncovered with a thorough clinical history and targeted functional medicine diagnostics. We end the discussion outlining our clinical approach to building resilience and reducing stress by instituting practical and meaningful therapies addressed both perceived psychological and unperceived physiologic stress.
You can watch the lecture in its entirety or on our Youtube page.
We would love to hear your thoughts, questions and feedback!
Okay, if you’ve read the title to the post, you are probably wondering where in the world is this going.
In truth, I don’t really know, but stick with me for 1000 or so words and I think we will both find a degree of enlightenment.
Band-aids, first of all aren’t really things. It’s a brand. #registeredtrademark.
Really what we should be talking about are bandages. Adhesive bandages.
Johnson and Johnson have done the pinnacle in business marketing, essentially making their brand the item in question, or at least making them nearly indistinguishable.
Because we are on this tangent: other common examples of this brand = item thing include “Kleenex” for tissues and i-Pod for multimedia technological device? (used to just be an mp3 player, goodness where are we now).
For the remainder of this post I will use Band-aids, not because I support Johnson and Johnson, but because it will likely make things WAY easier to explain for you and me.
So why really do we wear Band-aids?
Some obvious and practical answers may be: to protect a wound, to stop bleeding or to promote healing.
But as you likely I have guessed already, I am not going to waste your time writing a blog post about these reasons, I’m instead going to waste your time writing about something a little more abstract and controversial.
Terrible jokes aside, I think there’s something we need to throw out there to break the ice about this whole Band-aid discussion.
Why are Band-aids the same color as most white people’s skin?
There I said. Band-aids could be any color, and yes there are seemingly hundreds of varieties with all sorts of colors and cartoon characters out there, mainly marketed to children, but let’s just be honest with ourselves, Band-aids are tannish white. Period.
I’m not going to spend any time in this post addressing why this choice of Band-aid color may be odd, because yes, the next question could very easily be, “Where are the brown or black Band-aids?”
I’m not going there, but let’s just say it’s a conversation starter.
Back to the original intent in making the point about white Band-aids, perhaps Band-aids are tannish-white because people don’t want others to see their wounds? or Don’t want others to see they are hurt, injured, in pain or suffering?
Now we can all agree, these Band-aids, even being somewhat close in color to white skin, are still fairly obvious and it doesn’t take much to notice one on another human being.
So that begs the question:
Do we wear Band-aids so people DON’T see that we are physically hurt, needing protection and trying to heal?
Do we wear Band-aids so people DO see that we are hurt, needing protection and trying to heal?
Either way Band-aids can speak without us ever saying a word. Only problem: we aren’t able to control what it is people think we are actually trying to say.
I obviously don’t have answers to these questions, but we need to start asking them and recognize the implications of this discussion.
On one hand, If we DON’T want people to see that we are physically hurt, a tannish colored Band-aid for a white person would be a reasonable place to start.
On the other, if We DO want people to see that we are hurting, than a neon pink or “Paw-Patrol” Band-aid would probably be the best bet, but even a regular old Band-aid as we described above would likely still do the trick.
Either way, what I am describing here is either showcasing or hiding PHYSICAL wounds, injuries to the skin, soft tissue, etc.
This leads me to the climatic question for this post: If we have Band-aids for these physical wounds, carrying the capacity to either tell people we are hurt or hide it from their knowledge
What kind of Band-aids do we have for Spiritual wounds? Emotional? Mental? Financial?
How can we show people that we are hurting spirituality, emotionally, mentally and have them take notice?
I’ll take one tiny step out on a limb and say in general as relational human beings, we don’t want to remain hidden, we WANT people to see our JOY and our PAIN and either celebrate with us in joy or help us back from that place of hurt in order to rediscover that place of pure happiness.
We want other people to see we are hurting without having to tell them because we want to know they genuinely care and that we are not overlooked.
I can personally say during even the darkest days of my depression, isolating myself to only my work and the things I could control, I wanted people to see I wasn’t well and simply ask:
“Are you Ok?”
Society with a capital S (a big generalization) has created a lot of stigma around what are acceptable “Band-aids” to wear when we are emotionally or mentally hurt.
That’s not OK
Suicide letters, suicide attempts and violent cries for help seem a lot more rational and reasonable when you realize there are no great “silent” or accepted Band-Aids to say “I’m hurting and need some help,” AND that in general we aren’t great at genuinely seeing the Band-aids people choose to wear to show they are suffering.
What if as a Society, we made an effort to first become more aware of the people around us, being willing to see the Band-aids people are wearing or “not wearing” to say I’m in need of healing.
And what if, as a Society, we made a dedicated effort to be more open, more trusting, more accepting so that we could actually use Band-aids for their intended purpose.
Not to hide or cover up the hurt we don’t want people to see.
Not to confuse people as to what is really going underneath the adhesive strip
Not to inhibit the process of healing and growth that can only occur when we peel back the glue and let the light stream in.
But, to let ourselves and other people know we are not invincible, and we will need much more than a little Band-aid to ever come close to knowing what is means to be healing, healthy and whole.
Life moves faster. I try to move faster.
Last week, we featured a wonderful blog article from my close friend Ryan Hall.
Ryan, also happens to be one of the founding members of the Charlottesville Center for Functional Medicine- CVCFM (along with myself and the amazing Kerri Cooper)
I cannot share in words how I excited I am for this new wellness initiative, the true beginnings of my future for wellness in Charlottesville Va. (FYI: I will still be a resident doctor at Front Royal in Winchester, VA for the next 2+ years, but hey, you gotta start somewhere and sometime!)
I wanted to take the time now to write this short message to share with you what you can expect over the coming weeks and months as I shift and expand my content and reach!
You can continue to expect weekly blog posts from me and other supporters of A Medicinal Mind. We will also continue to share weekly podcast conversations with some of the most innovative and creative minds this world has to offer.
And of course the poetry will keep on coming as long as my heart and fingers find the strength to keep the faith.
SO WHAT WILL BE NEW?
You can expect new, weekly blog posts from the entire team at CVCFM, focusing on topics involving ancestral and functional health. Ryan has some great posts already lined up for you and we are hoping to make it a practical playground to expand your knowledge because we know your time and energy are life’s most precious commodities.
We have just started a 4-week community workshop series and hope to start posting the recordings from these hour long talks. Week 1 was a great success, except for the technology failure that prevented the audio from recording. Oh well, learning and growth experience- check.
Over the coming weeks we hope to start a CVCFM community connection page, featuring local business and initiatives in the Charlottesville region that share our core values for cultivating whole being wellness.
RIGHT NOW you can access a wonderful new resource
OUR QUICKSTART TO WELLNESS E-BOOK
It is 16 pages packed with practical tips to get you started on the “7 Relationships” we find fundamental to discovering whole being wellness.
As a bonus, for downloading the E-Book, you will get access to our 10-Part Wellness Series, a collection of daily emails filled with practical wisdom, recipes, a sample day food template/meal plan, our Nutrient Dense Food/Shopping Guide and a sample high intensity workout series you can do at home, no weights or gym membership necessary.
Trust me, I did the workout last week, it may seem simple to the athletes of the world, but try the 8x4 circuit we recommend and you will be sweating and hurting by the end guaranteed.
And this message wouldn’t be the same without a little introduction from the founding members of the Charlottesville Center for Functional Medicine
And one more video SO YOU CAN REALLY GET TO KNOW WHAT WE ARE ALL ABOUT.
I am so excited to share my most recent collaborative endeavor, the first beginnings of the Charlottesville Center for Functional Medicine. To celebrate its “birth”, I want to share with you a thoughtful post by my closer friend and colleague Ryan Hall.
In the post, Ryan shares some insightful thoughts when it comes to understanding how our evolutionarily history and current physical adaptations should inform the major lifestyle habits and choices we make every day.
You can also access this post and learn more about Ryan on the new website "Charlottesville Center for Functional Medicine" using this link:
An ancestral and functional perspective on health, well-being, and thriving brings together the gleanings from our long evolutionary past as well as the insights and discoveries of modern science to address the root causes of dis-ease. We believe the reason we see so much dis-ease is due to the reality that we have grown to exist in a environment, and develop lifestyles, that are still foreign to our genetics and the habits that shaped them.
We find within our bodies' architecture, a story of our past. That past was wildly different than our present, but our physiology hasn't completely kept up with all our advancement. There are major landmarks to our physiology that tell a tale of a daily roaming, hunting, digging, and cooperative being. It doesn't take much to see that we have lost much of that in our modernity. Let's take a brief look at some of the most curious adaptations of the modern human form.
What makes us so Human?
● THE PELVIS:
○ One of the earliest adaptations that has seen several iterations and become more refined within our form, is our pelvis. Our pelvis has grown to face sideways, rather than forward. This is fundamental to our being able to stand easily and walk on two legs frequently; to be bipedal.
● THE SPINE:
○ Our spine differs from our primate ancestors and cousins. It has come to have an S shape and protrude vertically rather than horizontally, allowing us to face forward will being bipedal.
● THE FOOT:
○ Seen through the fossil record of the last 6 million years, there has been a slow and steady development of the foot to include toes inline with one another, rather than protruding from the side to grip trees while climbing.
○ We also can see the structure of the foot change to have a full arch that isn't found in other primates. The slow inclusion of an arch can bee seen to develop over time giving us clues as to how our lives as hominids have changed.
○ The toes of the foot have grown to become shorter and bend backwards to support a forceful propulsion forward when walking and running.
● THE LOWER LEGS:
○ Through the continued progress that was needed for us to run, our lower body has developed significantly to support an energy efficient way of bipedal locomotion. Our femurs (the thigh) have come to angle in towards the midline, and our legs have grown longer. Both adaptations are to save energy while walking and running long distances daily.
○ Additionally, we have developed to have bigger bones and larger joints to support the forceful bombardment experienced when running.
● THE UPPER BODY:
○ Our upper body has changed throughout hominid iterations to drop the shoulders, relieving the constant "shrug" seen in other primates. Our waist has narrowed.
○ We have also developed to support the forward motion seen when running, through changes that allow us to swivel the upper body independently of the pelvis and hips.
○ Also, the semi-circular canals of the ears have become enlarged, allowing us a greater spatial sensory perception.
○ Our shoulders have evolved from the life we lived as well. Our shoulders have come to have great flexion. Which in combination with the ability to generate torque through he swivel of the upper body, and our long legs have given us the ability to generate great force when throwing. Something that would have surely had enormous benefit in the procurement of meat.
● OUR NOSE:
○ As we started to make our way into the species Homo, we lost the snout of previous primates an developed a protruding nose. This allows us to humidify the air as it enters the nose, further keeping the lungs moist.
● SWEAT GLANDS:
○ Our ascent into humanness included the adaptation of millions of sweat glands covering the body. In the heat of the African plains, the ability to regulate body temperature is crucial in being able to procure meat from animals that would rather be lounging in the shade.
● FOOD PROCESSING:
○ As we have evolved so did our methods of nourishment. Early on, as we began to eat roots and tubers, we started to pound our food to release its vital nutrients and to reduce the effort with which it took to chew and digest our food.
○ Eventually, we came to harness fire. This had a massive impact on us. Cooking food allows the nutrients within the foods we eat to become much more bioavailable. Meaning that it no longer took massive effort and time to chew and digest food. At the same time, we were getting more energy and nutrition from our food than we had ever before.
○ In addition to making nutrients more bioavailable, it also made food safer to eat, as cooking kills harmful bacteria that may live on the foods we consume. This freed up even more energy.
● THE INTESTINES:
○ Once cooking our food became commonplace we no longer required the extensive gastrointestinal tract that we had evolved with. Our intestines started to shrink as they had less work to do. The energy once used by the intestines put itself to good use elsewhere.
● THE BRAIN:
○ As our intestinal tract shrank our brains took that extra energy and began to rapidly expand. Over the course of a couple millions of years our brains grew to be rather large in proportion to our bodies. The faculties that developed from our brain's growth have allowed us to create culture, community, art, symbolism, language, to have reverence, and to modify our environment in ways that only cataclysmic catastrophe has before.
○ Perhaps the most defining attributes of our humanity is our ability to create culture, to cooperate and exist within in rather large communities. As we developed we have had to rely more on each other gifts and strengths.
○ Our offspring have grown to need more care over longer periods of time than previous primates (this likely allows us the developmental space to grow such large brains). As men would have gone out on hunts together, women would band together in child rearing and foraging.
○ We would have shared food with other families in our groups when our hunts were successful, because we understood that our survival was more assured when we worked together.
● ANCESTRAL DIETS:
○ Our ancestor's diets would have also varied widely from that of other primates. Instead of hanging about in the trees gorging on ripe fruit we have evolved to ingest a wide variety of plants, tubers & roots, seeds & nuts, and meat. The proportions of our ancestor’s diets and exact composition would have varied depending on their exact locale, but we can be assured that wonder bread, french fries, animal milk, and cereal grains are a novel component of the modern day diet.
The ability to stand, sweat, and breath through a protruding nose have allowed us to move about in the heat of the day without overheating. This is fundamental to the way we likely would have acquired meat. Most animals in the heat of the day want to lay about and save their energy for the cool evening when most of their activity happens. Being able to drive these animals from their rest consistently, without periods of cooling (most animals can't sweat and so regulate body temperature through panting), drives them to overheat so that a hunter can get close enough to forcefully throw their spear in a lethal manner. Persistence hunts still exist in the hunter-gatherer groups living on the planet today.
We can see that our bodies have grown to be able to move around on two legs, cover rather large swaths of land daily (up to 9 mi.), sometimes running for long periods in the heat of the day, sweating to cool the blood and the body, harvesting wild animals, gathering wild foods, lugging around our nourishment, sharing in the fruits of the labor in the natural environment free from artificial light and industrial pollutants. It is clear that we have lost many of those habits.
To be clear, we are not making a suggestion to revert back to a hunter-gatherer way of life. Rather we are encouraging the designing of a life that can include and mimic habits like those of our ancestors.
How can we design a life that supports the healthy inclusion of movement? Do we find nourishment in a way that is inline with that of those who have given us our genes? Do you spend joyful time with those you love? How can we give something back to our community? Is there time within your day or evening to consciously "slow down?" Have you heard the bird song today? The answers to these questions can reveal places where a little can go along way.
Of course we cannot reduce our humanity to the physical attributes that have come to bring us alive as we are. We can, however, use the understanding of our evolutionary history and the physical adaptations that have developed to inform our current lifestyle choices in order to more fully thrive.
We can take the knowledge of where we've been to choose where we are going.
Don't forget to check out the new page "Charlottesville Center for Functional Medicine" using this link: https://www.cvillefxmed.com/
What you will find below is an email I sent to the incoming class of medical students at the University or Virginia School of Medicine back in August 2017. To say I remember how all the words came into being would be a frank lie. It was, indeed, a bit of a spiritual experience.
While most of you reading this introduction are not medical students or have no affiliation with medicine or medical training, my intention of sharing this message is ACTUALLY FOR YOU.
Yes FOR YOU.
Because, let’s be honest I already shared it with the medical students.
So why am I sharing this with you?
Humanity's language of caring is universal and while the words below may have been initially intended for my medical colleagues, there is a meaning and message embedded that is meant for every soul interested to explore its mystery.
So if you are willing and curious, let’s start the exploration together.
Welcome to Charlottesville and the UVa SOM!
By now you have probably received an epic number of emails and are perhaps overwhelmed with all of the information being thrown your way.
It's okay. It's completely an entirely okay.
You are also probably also wondering now who is sending us this random welcome email?
My name is Rob Abbott and am a first year family medicine resident with VCU Shenandoah Valley in Front Royal, Va having just graduated with the UVa SOM Class of 2017.
With those details out of the way I can tell you who I really am.
I am a student, a human being, a medical trainee just like you, seeking to relieve other’s suffering all the while serving something greater than myself.
It is hard to imagine that just some few years ago I was spending time in the anatomy lab (the old, not so clean and nice one) identifying brain structures with my classmates and learning all of the amazing biochemical machinery necessary to make ATP from 1 molecule of glucose.
And while time does go quickly, it also doesn't. 4 years is a long time, and for some like myself who took 5 years total, it is even longer, and for others doing PhD and research work it can take a decade or more. It's a long time.
Thinking months and years ahead is wonderful (even if it seems like graduation is so far away) and having an intention and vision for yourself is incredibly powerful, but the future is not years ahead. The future is actually just the summation of the present- what we do each and every day.
Want to be a kind and compassionate physician? Be kind and compassionate each and every day. Want to eat more vegetables and less processed food, eat a couple vegetables and put down the doritos each and every day. Yes, these may seem like obvious or silly examples, but they are remarkably relevant and true.
In a more abstract sense, I like to think that we are all people transitioning between states of “being,” “becoming” and more “being”. If we simply remain in states of transition, expansion and growth ("Becoming") or thinking about who/what we want to become (skipping the challenging becoming process and going straight to some "new" state of being), we completely miss the present moment, our current state of being, the opportunity to enjoy the present and simply be.
Medical school will be full of opportunities to become- you will be evaluated constantly as part of this challenging process of becoming. Learning something new every day is becoming, studying for a summative is becoming, gaining more clinical insight during your 3rd year clerkships (at 5 AM) is becoming. Becoming is okay, we need becoming, but we also really need being.
I spent most of my early life becoming, and only becoming, because I was good at it. If you are receiving this message now you are also very likely to be quite adept at becoming. But it wasn't until I took time away from this becoming, to rest and discover how to truly be, that I could ever make peace with the becoming process.
What does being look like? For me it's engaging in creative exploration through writing, recording podcasts for my webpage, spending time in nature, meditating, practicing yoga, reading non-medical literature, growing my Christian spiritual faith and sharing a hot beverage with a close friend. There are tons of ways to be, but often, these ways of being can fall away to make room for becoming and only becoming.
I know this may sound strange or impossible given the fact that I haven't met any of you in person, but I genuinely care about all of you. I want you to happy, healthy and free from suffering. I want you to succeed and be surrounded by joy. I know medical school is challenging, but I also know it can be incredibly rewarding.
You may get to a point during your training where you feel hurt, depressed, depleted, tired, burned out, exhausted, disillusioned, physically sick, or broken.
4.5 years ago I was depressed, hurt, sick, depleted, simply done. It took a long time for me to finally ask for help, but I did. I simply asked for help. I finally accepted it was okay to be vulnerable, to say I didn’t have the answers.
There are so many people in this community here to support you. Deeply and truly support you.
By this point, you have probably received a message from two of my close friends and current students Anja Miller and Corinne Roberts regarding the interdisciplinary group Compassionate Awareness and Living Mindfully (CALM): an inter-professional group dedicated to supporting your well being though the practices of mindfulness, self care and the cultivation of resilience.
Back in 2013, upon my return to medical school, I was fortunate to start this group with the help of a few amazing colleagues and friends.
I had never "gone to school," for mindfulness, self care or inter professional communication.
I had no formal training.
i had no idea what to really do.
But I started the group because I perceived a deep need in our community to remain healthy and build resilience through mindfulness practice and simply being.
I didn't care if only one person started meditating with me or if no-one came to any of our events. I just wanted people to know we cared about their well-being. I understand meditation or mindfulness practice would not and may not be your thing, it's okay, we are all okay.
Over the past 4.5 years I've seen tremendous strides made in the UVa School of Medicine to prioritize your well-being, to promote and provide you with opportunities to renew and simply be. I helped to grow partnerships with the School of Nursing to hold retreats, FREE retreats, and days of self care to promote your flourishing. Once again, it’s amazing to see all that can happen in 4.5 years.
When I first came to school I hadn’t even heard about yoga, meditation, reflection, or mindfulness. If you had asked my first year self if sitting still for 5 minutes to pay attention to my breathing or pausing outside of a patient's room to set an intention for the encounter would make any difference I would have likely laughed you off the face of the Earth.
And when I first started practicing at the urging of a colleague and dear friend, I didn't fully believe in it. I wasn't really convinced. But I just started practicing.
Just practice, even if you don't believe.
I cannot guarantee you will find the practices of mindfulness and meditation to be helpful. Nothing is right for everyone, and everything is certainly not right for everyone, but SOMETHING is right for everyone, and you should seek to be exposed to a buffet of SOMETHINGS as part of your medical training, all for you to consider, practice and incorporate into your life.
To say I am excited for you would be a tremendous understatement.
But THIS is only the beginning, and YOU ALL are the lights to help change the lives of your patients, and to hold spaces for each other to learn and be nourished, to become and to be.
As you will soon discover, a collective stress bucket will develop in your medical school class, a figurative and sometimes literal bucket of worry.
I urge you to the best of your ability to TRY and not add to the collective stress bucket, recognizing the sometimes, most likely completely unintentionally, that you will add to someone else’s burden and this stress bucket.
We simply must be aware and take ownership of the energy we carry, the words we use and the spaces we hold. Make a joke about how much work you have left to do, how stressed out you are, or how poorly you will do on a test because you haven’t studied enough, it’s okay, it’s probably funny, but take ownership of it, be willing to accept the consequences of sharing those kinds of words, carrying that type of energy, holding that type of space.
While I may have formally graduated and "left" the medical school, my heart and soul remain in these walls and with this community. You are all amazing people with so much passion, intelligence and drive to change the world and I want to do all that I can to promote your flourishing.
If you have made it this far in this message, I commend and appreciate you.
I am still quite local and active in the Charlottesville community, returning on weekends when I am not busy with residency obligations in Front Royal.
I am more than happy to meet, talk and simply listen to whatever it is you want to share or discover.
You can respond to this email or simply bug Jill Clarke. She knows how to find me.
But in all seriousness I am more than happy to meet and share a conversation over a cup of tea/coffee.
I’ve been there. I get it. I needed help, lots of help and I am willing and open to talk with you if at some point you need help.
No judgment. Complete acceptance.
You guys have an amazing journey ahead of you and some remarkable people with which to share it.
Don't be in a rush.
Remember that if you are alive, you are breathing and if you are breathing, you can stop to take a pause.
Congratulations and welcome again.
I am so glad you have made this choice to pursue medicine.
And I look forward to seeing you flourish in the years and experiences to come.
All the best
It takes 4 minutes and 30 seconds. Unless I trip and fumble for my badge. Then it take 4 minutes and 32 seconds.
4 minutes and 30 seconds.
People run miles faster than this.
But my intention is not to run or to even walk.
My intention is to be, breath and simply be,
It starts with a phone call.
Can you see another for me?
Room 19, 72 year old female, looks like a COPD exacerbation, maybe a new pneumonia. Call me when your done.
“Okay, sounds good, will do.”
For the next 84 seconds I prepare for the pause.
I scour the electronic medical record for vitals, white count, current meds, what did the ED doc do anyway? I even get a a glance at the CXR, seems like another overread.
And then its over.
84 seconds is all its takes for me to realize the real answers I need aren’t in the chart.
They will never be in the chart.
Unless I decide to put them there.
And then it begins.
The 4 minutes and 30 seconds began to tick.
I grab my white coat, pocket my phone, double check for my keys, and scoop up my stethoscope.
I start to walk. I notice the heaviness now of my burdened white coat, stained with the tears and spit up of infants.
Badges of honor I like to think.
Telling the stories of past hugs and cuddles gone awry.
I shrug my shoulders mid stride, and complete the roll of my scapula back to where they should have been all along.
There’s no time for tight trapezii during the pause.
I start to notice the ground beneath my feet, my minimalist shoes gripping my toes like a 2 year old hugging his ice cream cone.
The ground never felt so alive.
I’m nearly 2 minutes in now, 3 staircases down and I’m on to flat ground.
I begin to smell the Subway stench, the half baked bread, and half eaten sandwiches beckoning to the adventurous souls willing to wander from the comfort of the cafeteria.
3 minutes now and I’m in the lobby.
There’s a four maybe five year old kid running towards the gift shop.
He just saw the giant panda.
And it’s about time someone fed him some bamboo.
I start to smile as I round the corner, the chapel calling to my heart, reminding me it’s time to center.
There’s only one minute left.
And I’m still half full.
One deep breath in,
And a heavy sigh out,
I feel the weight begin to lessen
As the space becomes a void
And the void becomes an awareness.
That the emptying has now begun.
My heart erupts to open
As my mind chooses to close
Thoughts start to flee for safety
In the bowels of my unconscious.
There’s no room for petty attachment
In the world of empty freedom.
I feel it churning, burning, yearning to remain unseen
Judgement and hurt never dress for the party, you see.
They found out long ago
That the best way to remain unseen
is to wear no clothes.
The only problem?
Judgement and hurt forgot one thing:
One very important thing.
Naked can see naked
There's no place to run and hide
4 minutes and 30 seconds
And I’m naked at your beside.
My body become a vessel
To receive your heart and fears
It’s what the moment calls for
A pause to find my ears.
I have confession to make as we start the New Year.
Well to be honest, I have several confessions to make, but the one I want to share with you now is that despite my breadth of current training as a family medicine physician, and desire to care for people at all stages of life, I feel God is strongly pulling me more and more towards the world of pediatrics.
Yep, kids, kids and more kids.
You’ve probably heard me say on the podcast before that while I do not have kids of my own, YET, I am drawn time and time again to the world of our youth and seek more than ever to nourish strong family dynamics and supportive relationships so that kids can flourish.
I have been fortunate to have found a couple incredible mentors when it comes exploring integrative and osteopathic principles within the scope of pediatric care: Greg Gelburd DO and Jef Groesbek DO. While by no means do I feel capable yet of fluently performing manual manipulations on my patients, the foundations of osteopathic medicine are rooted far beyond simply addressing skeletal alignment. Osteopathic medicine is foundationally whole person, whole mind, whole body care and is precisely the approach I seek when looking to identify root cause disturbances for my patient’s suffering.
In an effort to bring about more awareness to both osteopathic principles and a special population of courageous children: those with cerebral palsy, I wanted to share some insights and ideas that have been growing in me since my first experience in 2013 volunteering and participating in workshops with Ruth Goldeen, OT, an occupational therapist at the University of Virginia specializing in yoga and play for children with special needs (cognitive, emotional and physical).
Osteopathic Therapy for Cerebral Palsy
Osteopathic medicine is a field that not everyone understands but that provides an alternative or a supplement to traditional medicine. For children with cerebral palsy, there can be great benefits of working with these medical practitioners who focus on the musculoskeletal system, the part of the body that can commonly cause these children pain and mobility challenges. Ongoing research is proving that osteopathic therapy may be able to treat individuals with cerebral palsy to relieve pain, reduce spasticity in muscles, and improve mobility.
What is Osteopathy and Osteopathic Manipulation?
Osteopathy is practiced by a trained and licensed osteopathic doctor. These doctors have undergone all the same training as medical doctors (there is an incredible one in my current residency class; thanks David Clark DO!), but also have special training in approaching patients in a preventative and holistic way, using a gentle manipulation practice to the musculoskeletal system, called osteopathic manipulation therapy.
The idea behind this is that all the systems of the body and brain are connected and cannot be treated in isolation. By gently stretching, pulling, massaging and manipulating the muscles and joints, an osteopathic doctor can promote wellness and healing as well as bring relief to specific symptoms. This kind of work is most often used for musculoskeletal issues, like back pain or injuries.
Cerebral Palsy and the Musculoskeletal System
With this in mind, osteopathic therapies seem like the perfect match for someone with cerebral palsy. Cerebral palsy is a condition that is caused by brain damage but manifests in both neurologic and musculoskeletal symptoms. There are different types of CP and each individual has unique symptoms of varying degrees, but most children with this condition struggle with pain, mobility, muscle strength and tone, and muscle control. Treatments usually focus on using surgery, medications, and physical therapy to manage symptoms. But are there other options?
Can Children with Cerebral Palsy Benefit from Osteopathic Medicine?
Many parents turn to osteopathic doctors for an alternative or complementary treatment to help their children. Osteopathic doctors may use manipulation therapy throughout the body, on problem joints, on specific muscles, or on the neck and head. Research into how effective these manipulations are for children with cerebral palsy is limited, but there is some emerging evidence showing that it is likely very helpful.
In one study involving 55 children, those who received osteopathic manipulation therapy had better outcomes compared to a control group. They saw improved mobility and a greater ability to control their muscles. Another study proved that osteopathic manipulation could actually help improve constipation in children with cerebral palsy, a secondary symptom many struggle with and one that is well appreciated by clinicians like myself well versed in functional medicine and improving digestive health. While there aren’t many other studies currently evaluating this therapeutic technique for treating cerebral palsy, there is plenty of anecdotal evidence from individuals who have benefitted and plans for ongoing osteopathic and cerebral palsy research.
I am and will always be a proponent of evidenced informed and individualized care using the lowest risk/highest reward therapies available. Most importantly, these therapies must be alignment with the values of the patient and family, and osteopathic care certainly seems like a reasonable low risk therapy that could benefit many children with CP. It is important to note that parents of children with cerebral palsy find and work with licensed and trained osteopathic doctors with experience working with similar patients. While I am neither a DO or have significant experience caring for patients with CP, I have strongly believed it is my duty to seek out workshops and experiences beyond the scope of my current training such as those provided to me by Ruth Goldeen and the osteopathic curriculum in my residency program, to acquire knowledge so I can better treat and ultimately inform a child’s family and supportive medical team of any practices that may be helpful to their child.
In the end, we, as medical professionals should be able to work together to give a child the best possible outcomes.
We, together, best.
As I confessed in the beginning and I confessed within the paragraphs above, kids are my passion and I don’t yet have fluency in osteopathic manipulation, but I am learning every day thanks to my mentors in medical school and current residency training.
It is as I see it, precisely what the world and God is calling me to do.
Seemingly ubiquitous at the start of every year, it can be a little frightening and overwhelming when the thought of making changes starts to flood our minds. The boundaries between what we think we need, what others want for us and what seems acceptable to society can all begin to blend together resulting in a distorted sense of “What do I actually care about again?” or even “What is actually and was originally me?”
Bringing in a helpful visual we can see a spectrum of “thought content” with one end being direct, purposeful, self-reflection constructed from our “internal” dialogue, core values and foundational beliefs, and the other end being the perceptions and thoughts of the external world, the thoughts of others seeking to enter our sphere of awareness. Blurring in the middle are the shared values, conversations and relationships that interact with our relational mosaics, the mosaics of our “assembled” selves constructed from the pieces, the stories, the hearts of all things with which we relate. Positive or negative, this “relational zone” can be the grounds for nourishing connection, as well as the battlefield for misconception and misunderstanding. Assimilating negative values, thoughts, and behaviors from others such that the negative thoughts begin to move from their place on the spectrum in the discerning “relational zone” to that of your internal dialogue, your personal values, and your unique story can lead to suffering, doubt and significant distress.
Subtle and without a clear beginning, this pattern of negative assimilation can be approached gently by cultivating an engaged awareness practice of our thoughts, their origins, and how they entered the story we are currently telling ourselves.
In no fewer words this practice, this way of being is
The Heart and Science of Yoga
So as we sit, ready and engaged to move forward with a new intention, we must first pause to reflect on the true origins of this desire to progress. Are our intentions driven from the language of an internal or external source, or are we dancing somewhere in the “relational zone?”
Now poised and aware we can now curiously ask, “What really is our greater intention?, what do we, if at all, want to change?, and how exactly did this thought even come into being?
You may be surprised by the anwer.
Wishing you all a joyful beginning to the new year!