APRIL 15, 2011 BEING READY....FOR SLEEP

"The best way to prepare for any moment in the future is to be fully conscious in the present."

I do not know if anyone could be prepared for any moment in the future. I was not prepared when my mother died in 1982. I had no inkling that she was ill. I was prepared for my father's death as I was fully conscious in the present at that time. I was returning from graduating the Integrative Medicine Fellowship in Arizona. I left knowing he was very ill, but he did say, "I will be there when you return." He was, yet for only 1 more day. To be fully conscious in the present is knowing who you are, and what your goals and aspirations are. I am reminded of this today, as a close friend/patient/'family member' passed on who always reminded me of my dad. I will miss you, Daniel.

At this time in my life I am prepared for the future. I live each day to the fullest as if it were my last day on Earth. I say good morning to G.O.D. and thank G.O.D. for another day as it ends. (I also say good morning to Gracie, my Amazon Green Parrot every morning.) I reflect on the whole day as it ends. I ask myself if I harmed anyone unknowingly and do I owe anybody an amend or apology. I am prepared for the future. As much as this might sound morbid, I am prepared now if my life were to end. I have lived. I had aspired to be the man I always wanted to be. I have met most, not all of my dreams. I am ready.

Who doesn't want to be ready for a good nights sleep. Adequate quality sleep is just as important and vital to good health, emotional balance and long long longevity. Some people can fall asleep anywhere. I am NOT one of those individuals. I never sleep on a plane even if it is the Red Eye from the west coast to east coast. Some people have trouble falling asleep. Some people have trouble staying asleep. Sleep disorder is classified either as dyssomnias as insomnia, excessive sleeping and narcolepsy.

I want to focus on the most common which is INSOMNIA. There is acute and chronic. The acute form is from one night to a few weeks usually resulting from a stressful situation. I have had those. Have you had any episodes of acute insomnia? The chronic condition can be a result of emotional or medical issues such as chronic pain, anxiety or depression. My chronic insomnia can be traced to my medical residency days when we were required to stay up for 36-72 hours without ANY sleep. A wink here or there. Some chronic insomnia can be due to excessive alcohol, cocaine, caffeine, and other stimulants. If you ever had an addiction this can result in chronic insomnia. I can relate to that also in a distant past. Can you relate to that type of chronic insomnia?

I have read about Yin and Yang insomnia. I didn't know such types existed. This is why I read, research, study and relate. In the Yin type, the patient is exhausted and often pale. It is usually those individuals with no energy. These are the patients with chronic fatigue syndrome due to Epstein Barr Virus (the cause of mononucleosis). I have used the nervines and adaptogenic herbs for this type of insomnia.

For the Yang insomnia, this is an excessive person. This is the type A personality. I also call this individual the Type G or giver. This is the irritable, restless, or agitated person. I am the Type A or Type G with years of therapy, twelve step meetings and sponsorship NOT resulting in agitation and irritability. I still use nervines but personally I do so well with the herb, Passion Flower. I have seen others use Hops, California Poppy and Valerian. I personally have some problems with valerian. Valerian makes me a bit agitated. I have seen that in other patients as well. For those who do not want to take conventional sleep agents like ambien, halcion, or klonepin I recommend herbal treatment.

I also have had great success with a Homeopathic remedy that I use almost every night. It is by HEEL called Neurexan. It is available at http://www.longevitynutritionals.com/ It is a homeopathic using Avena sativa, Passiflora incarnata, and Zincum valerianicum.

I started with 2 sublingual tabs but it is so much better with 4 sub-lingual tabs every night.

Until tomorrow...

APRIL 14, 2011 STEPPING STONES OF FIBROMYALGIA TREATMENT

"Our lives are made of stepping stones, one experience after another in perfect and divine order"

Since I believe in taking life One Day at A Time, then it makes sense to think of one stepping stone after another. I wouldn't say that I always see the 'perfect order', but it seems there is a divinity to the stepping stones. I know that when I am ready to move to the next level in life, whether spiritually or emotionally--I am ready for the change. Life is full of different levels. As we get older we begin to move to other levels of growth without ever knowing that we are changing. Most of the time I do not see the change in myself. I only see those changes when others make notice of a change or I have recently qualified at a 12 step meeting. At those 'qualifications' I discuss my past and relive some stories. This is when I step back and say, "Wow-- I have changed." It is those stepping stones building a bridge. I am blessed for those stepping stones.

70 - 80% of those who suffer from Fibromyalgia are women. Typically the age is 30- 60 years old. There have been studies to document that women with Type A personality traits suffer the most. The symptoms vary from individual to individual. They include muscle stiffness, brain fog, sensitivity to cold, depression as well as anxiety, dry mouth and digestive disturbances. There are many theories about the cause. I have never found one that fits all the patients I see with Fibromyalgia. It varies from reduced serotonin, to food allergies to physical and emotional trauma. The conventional treatment is usually medications like Lyrica or the newest, Salvetta.

I do know that every Fibromyalgia patient needs to to use food as medicine and build up their stamina. There are many individuals who need a major detoxification program. The vitamin/supplement list for these patients is long and extensive. I utilize all the B vitamins, coenzyme Q10, fish oils, digestive enzymes and recently have been using royal jelly and bee pollen (related to my affinity for people having beehives and saving the bee population). Of course stress management is key. This could be done by guided visualization, breathing exercises, and managing negative emotions. If we all balanced our negative emotions we wouldn't be in the mess some of us are in.

Stretching is important as exercise can sometimes make Fibromyalgia even worse. The amount of herbs that can be used for Fibromyalgia is overwhelming. I never knew that so many herbs can be used for one disease. But this is why I love plants and herbs! There are some patients who have used topical applications of kelp/capsicum plasters, and liniments of infused oil of comfrey with lobelia and Viburnum opulus. The coolest (not in the sense of temperature ) is mixing together 150 ml of sunflower oil and 65 grams of beeswax (back to the bees again!). Add 100g of lanolin and cool. Then add camphor powder dissolved in oil. finally, add capsicum tincture, methylsalicylate and borax powder. One of my patients swears by this for her joints. I know it sounds complicated.

I would rather use the following herbs for joint pain.
1. Salix alba 10 ml
2. Verbena officinalis 10 ml
3. Viburnum opulus 10 ml
4. Ginkgo biloba 20 ml
5. Betula alba 15 ml
6. Fucus versiculosis 15 ml
7. Dioscorea villosa 20 ml

Total: 100ml

Apply to joints in compress or add to a cup of chamomile tea. It can also help the memory ...if you remember the ginkgo.

Until tomorrow...

Top photograph: Viburnum opulus

APRIL 13, 2011 LYME HERBAL TREATMENT

"The doctor of the future will give no medicine but will interest the patient in the care of the human frame, in diet, and in the cause and prevention of disease.”

-Thomas Edison

Thomas Edison, a non physician, said it better than anyone. This is what I want for the future of medicine. I was recently asked in an interview what 3 people in history I would want to have dinner with. My first guest would be Sir William Osler, a physician beyond all physicians. He was a true clinician with excellent patient skills. The second was Oscar Wilde, for his wit, humor, and vulnerability. The third was Franklin Delano Roosevelt. After reading the quote above, I want FDR to give up his place setting to Thomas Alva Edison. I realize I have no women at my dinner table. I wish I could have one more guest. I would love to have a sip of sparkling water with Miss Bette Davis.

One of the most interesting aspects of treating patients both conventionally and integratively is that I see a number of different treatments being used by the patient. Most of these treatments patients are using have been given to them from other Lyme Disease patients or have been read on the Internet. I find the Internet both beneficial and harmful. I have some patients who constantly surf the internet for the "cure" of many diseases especially Lyme Disease. In my opinion, those who are highly addicted to the computer for medical/health advice should be termed 'Internet Health Terrorists.' If you read about a treatment on the Internet for any specific disease, I recommend you discuss it with your Health Care Provider/Practitioner.

Is there a cure for Lyme Disease? I honestly do not know if there is a cure. I do know that if treated early (within 72 hours) there is good chance of NO transmission of Lyme Disease to the patient. The cure for Chronic Lyme needs to be researched and studied more extensively. In the same manner that the NIH (National Institute of Health) is conducting trials of medicinal mushrooms, there should be trials for various herbal treatments for Spirochetes (the cause of Lyme and other diseases).

At the Southwest Conference on Botanical Medicine earlier this month, I attended a lecture on Tick Borne Illnesses by David Winston RH. David Winston, RH (AHG) is an herbalist and Ethnobotanist with almost 40 years of training in Cherokee, Chinese and Western herbal traditions. He has had a clinical practice for over 30 years and is an herbal consultant to physicians throughout the USA and Canada. President of Herbalist & Alchemist, Inc. an herbal manufacturing company, he is also founder/director of David Winston's Center for Herbal Studies, which features his highly respected Two-Year Clinical Herbalist Training Program. He is an internationally known lecturer and teaches frequently at medical schools, symposia and herb conferences (AHG)

I have seen David lecture over the years and have always been impressed by his knowledge, passion and love of herbs. The genus, species and families of plants flow effortlessly from his mouth. I am proud to be an RH among individuals like him and many others.

I have used many of the herbs David discussed, but not in the same combination nor for extended periods of time. I returned from SW Conference with renewed vigor, excitement and passion for new herbs. I do know that some previous herbal treatments (most found on the Internet) have not been successful for my patients. Neither the Zhang (Garlic) protocol nor the Cowden (Cat's Claw - aka Samento) protocol have been effective for my patients. At first I thought there was improvement, but there was NOT. I also object to the cost of some of these protocols. Furthermore, since there is NO scientific evidence published on the Samento protocol, I must question its use. Is it scientific or a marketing ploy? I do not know, so I would rather not use it. Patients have their own voice, right and opinion. When asked, I will say I have used such protocols with minimal benefits.

The treatment of Lyme Disease is not one single treatment. I do know it is multifactorial. David Winston's herbal treatment validates my use of herbs. The two herbs I have used that are on David Winston' list are Sarsaparilla(Smilax) and Andrographis (Andrographis paniculata).

There are more than 60 - 80 herbs that can be used for specific symptoms. For example Ashwaganda (Withania somnifera) can be used for neck and muscle pain. Teasel root (Dipsacus spp) can be used for the inflammatory arthritis in Lyme patients, and the common Blueberry (Vaccinium spp) is a potent antioxidant. Today I can admit I do not know everything. Remember there is no perfection. Why do I attend conferences? I attend them to learn more. I am a sponge for learning. After listening to most any lecture I attend, I am in awe of the lecturer and the new material.

Being a newly conferred AHG Registered Herbalist, I need to learn about Traditional Chinese Medicine (TCM) and their specific herbs within a formula. A new goal for me is to be more fluent in TCM.

My success with Lyme Disease is solely based on the multitude of treatments used. In addition to herbs I utilize many supplements, some which I give intravenously. There should be a dietary and exercise lifestyle change. There should be behavioral therapy as well as some self esteem boosting hobby the patient engages in.

Until tomorrow...

APRIL 12, 2011 LYME TREATMENT PART I

"Acceptance turns us into the person we are and want to be. Acceptance empowers the events and circumstances to turn around for the better. "

In order to move forward in anyone's life there has to be acceptance. It is a key point in a 12 step program. In reality, acceptance is the key for life. There are the 3 A's. Awareness, Acknowledge and Acceptance. An example is an 82 year old female I know who has a blood cancer called Multiple Myeloma. She is a sweet , intelligent, kind woman. She is aware she has Myeloma. She acknowledges it by telling her friends and undergoing chemotherapy. She has not accepted it until recently. During the tough winter in NY, she could not go out as much as she had liked. She had time to sit with her feelings. She admits to being depressed and crying for no reasons. She finally accepted that she has the 'c' word. She allowed herself to accept this diagnosis. It finally hit her, that her life span might be shortened. Although this a harsh example for anyone, she feels better that she owned her disease. She can move forward

Antibioitcs have their role in medicine. Even though you use Integrative Medicine and other disciplines do NOT be swayed NOT to TAKE an antibiotic for Lyme. It can save your life. It is effective to get treatment within 72 hours of a possible bit. This is effective for preventing transmission of Lyme. This was my main reason as volunteer director to stock the Cherry Grove Fire Island medical clinic with antibiotics. Lyme Disease is epidemic on the island. The problem is that many of the individuals probably already have persistent Lyme Disease and do not know it.

The most common antibiotics used are tetracycline, doxycycline, amoxocillin and cefuroxime. I rotate these antibiotics for three months. I even use Zithromycin (commonly called the Z pack) but in higher doses as one of the rotating antibiotics. This is the treatment for the patient who does not recall if he/she was bitten and when, but has classic Lyme Disease symptoms.

I have seen many patients who have received intravenous antibiotics from other physicians. Some of these patients have been on antibiotics for more than 6 months. You WILL NOT find any study to support this long term antibiotic use. One of the major Lyme doctors, Dr. Burrascano was ridiculed by medical authorities for his treatment. He had patients to support his cause and was not reprimanded by medical officials.

What really disturbs me is that since there is no written protocol for Chronic Lyme why would a physician who is caring and compassionate about his patients be told he cannot treat patients in a manner that clearly does work. Today, medicine is now bound by insurance/government and pharmaceutical companies.

We do know that any immunosuppressive agents and steroids must be avoided as these will contribute to the progression of the disease. I do recommend allergy testing and heavy metal testing in patents with Lyme Disease. In my clinical experience I have found that those patients with heavy metals present either by blood or provocative urine, need to be treated first with a detoxification. This needs to be done, as the treatment for Lyme Disease will be more effective.

In most diseases, prevention and education is the key. Lyme Disease is no exception. The best personal protection when outdoors:

1. Wear light colored clothing so you can see the ticks

2. Tuck pant legs into socks (use tape to wrap around the top of socks)

3. Use tick repellent on clothing and exposed skin

4. Have someone check you after returning from any outdoor activity

5. Make sure the person also checks your scalp

Until tomorrow...

APRIL 11, 2011 NASTY TICKS

"It is very important to generate a good attitude, a good heart, as much as possible " Dali Lama

A good heart and a good attitude lead to a good life. Try to the best of your ability to do this every single day. It is not easy with the hustle and bustle of a busy life. The more you generate these good feelings, the more you will reap. It is karma. Try not to be negative on your awakening. Have a positive attitude. If need be have a mantra by your bedside to say immediately upon awakening. It starts the day off with a good balance.

It is hard to believe that Lyme Disease has been around longer than AIDS. The first case of Lyme was reported in 1976, (with the first case of HIV, then known as GRIDS, in 1980) after discovering the the children in Old Lyme, CT did not have Juvenile Rheumatoid Arthritis but instead a tick borne illness. It was caused by a spirochete, like the great masquerader, Syphillis. The spirochete, Borrelia burgdorfery was transmitted from the dear tick, Ixodes scapulatris to humans. In the last 35 years, other tick borne illnesses have been identified. These are co-infections that many Lyme patients also get. Lyme is reported in just about every state within the United States. Incidence has been rising steadily for many years. The East Coast is affected more than the West Coast.

In my 17 years of clinical practice I have seen many cases of Lyme's in all of the three stages. As the former Medical Director in Cherry Grove, Fire Island, New York, I had at least 2 -3 cases per day. Some patients had just been bitten, and still had the tick on them. Others noticed a rash, but did not remember a tick bite. One patient got bit by a tick, was treated with Ceftriaxone, and two days later had a complete blood count revealing severe thrombocytopenia and leukopenia (low platelets and low white count). His blood was sent to IgeneX, the premier lab (not licensed in NY). I find it more accurate than the Center of Disease Control ( CDC) Western blot test. He was treated with antibiotics and a retest weeks later was negative. He was one of the lucky ones.

Not every patient is so lucky. I have many patients suffering with Chronic Lyme. Today is known as Persistent Lyme Disease Syndrome (PLDS). The symptoms are chronic and debilitating and include intermittent arthralgias, sleep disturbances and neuralgia. Another patient recently came to the office with memory loss progressing over 3 years. After being sent to various specialists, especially neurology, he may have a Neurodegenerative Disease based on the brain scans. An IgeneX test was done last week. The problem with the test is the cost. The test for Lyme and co-infections can cost more than $2000. And it is not covered by most insurances. Regardless of everything you read on the Internet, the first line treatment is antibiotics. I usually treat for 3 consecutive months with three different antibiotics. It this craved in stone. NO is is not, but is based on clinical findings over seventeen years.

Most of the symptoms appear as any chronic disease like Fibromyalgia and/or Chronic Fatigue Syndrome. Everything is not Lyme, but it should be considered. I see very few cases where tick borne illnesses are eradicated completely. The disease must be treated early within the first week of a bite to have effective results. So we are left with many patients having Chronic Lyme Disease. In Fire Island you must also be attentive to your pets, because dogs can get Lyme Disease. If you are not sure if you have been bitten by a tick, I would suggest seeking medical attention to be sure.

Until tomorrow...

APRIL 10, 2011 MIGRAINES

"TREAT your friends as you do your pictures, and place them in their best light." --Jennie Jerome Churchill

How do you treat your pictures? I had to think about that for a moment. Then I understood what she meant. I display my photographs of family, friends, and my partner, Rick, in beautiful frames in the den. I do have them in the best light. I love sitting on the couch in the den at night when everyone is sleeping. I glance at those photographs, some new, and many old. I reflect-- smile, tear up and even laugh to myself at some fun old times. I put those old photographs delicately in the frames. I treated those old photos with respect, dignity and love.

This is how I treat my friends --with respect, dignity and love. As I glance at those photographs I think of all the acquaintances and closer friends who are more like family.

Photographs are memories to the heart. Never forget that!

One of the most common complaints to an internist office are headaches. There are many possible causes and the internist must find the cause. I start to think of underlying causes as stress, hormones, food or environmental allergies, dysglycemia, exhaustion, medication side effects and even chronic constipation. I always eliminate dairy and gluten from the diet in a patient who suffers from migraines. A thorough history and physical can give some important clues to the individual's headache. The intake can typically diagnose the specific type of headache and target the most appropriate treatment. Migraines are not hard to miss due to the visual disturbance, acute onset, sometimes accompanying nausea and vomiting and location in a specific spot or side of the head. We do know that migraines are neurovascular phenomena that can occur as frequently as several times a week. I have sometimes (although rarely) seen a migraine occur just once or twice a year.

In 1982, my mother was taken to the hospital in the morning of June 5th for a migraine.It was the worst headache of her life. She was sent home with a pain medication, percocet. Hours later she screamed with head pain and passed out. We found out later that she never had a migraine but the leakage of a subarachnoid bleed which eventually ruptured her aneursym that she never knew she had. Aneursyms do run in families as do migraines.

I listen carefully when a patient describes the worst headache of their life. The main difference in a migraine is the visual disturbance. The pathophysiology of a migraine involves the vasoconstriction, vasodilation and vascular inflammation. There is no clear cut etiology for a migraine. I know many patients that have migraines which can be debilitating. There are many up to date hypothesis for migraines including mast cell release of histamine and serotonin. The conventional medications that have been used for migraines include elavil, beta blockers, methyseride, imitrex and ergot.

The one herb commonly utilized for migraine relief is Feverfew (Tanacetum parthenium). It has the ability to prevent migraines in chronic sufferers. The chemical constituent that is most active is parthenolide. It is supposedly inhibiting the release of serotonin. If taken at the onset of the migraine it can be effective. The herb Butterbur (Petasitis hybridus) has been used in Europe to relieve the occurence of migraines but I have never used it. I have used other herbs including Rumex, Mahonia and Leonurus with some good results. I often have my colleagues in Naturopathic Medicine see these patients. Many migraine sufferers use the homeopathic remedies Atropa belladonna, Spigela and Gelsemiums sempervirens.

Until tomorrow...

APRIL 9, 2011 BALANCING MIDLIFE CRISIS WITH HERBS

" Saying NO can be the ultimate self-care." Claudia Black

No is a complete sentence. Most of us, including me at times has trouble with that word. Sitting on my son's bed in college is a pillow stating, "What part of No didn't you understand?" I made that pillow for him as a reminder to him that saying NO is healthy. It is taking care of yourself. I am a giver. Are you a giver? At this time in my life I am a giver with self respect. Those of us who are Type A personalities are usually givers. Giving without expectations is healthy. Giving all the time is not healthy. I have learned to give to myself. I give to myself by eating well, exercising, meditating and doing my various hobbies. All of this can boost your self esteem. Saying NO can boost your self-esteem.

Practice saying NO. You deserve it!

Life is a series of Transitions. Graduations, marriages, the possibility of grandchildren...these are special mid life events. As you get older there is pain, suffering and loss. There will be loss of a parents, friends, relatives and even pets.

This is a time in your life when all your lifestyle changes should bring you retribution, rewards, or possibly both. Have you received any rewards at mid life? I have been chosen, blessed and grateful that I see the world differently. My midlife has brought me greater self-knowledge and a large body of accumulated knowledge that is empowering. In my case it is the knowledge of plants. Midlife may also come with the baggage of unrealized dreams. I cannot say that is true of myself. It seems that many of my dreams are coming true one day at a time. Sure there have been some failures and disappointments along the way.

Do you have failures or disappointments? We all do. You are not alone.

Usually at the midlife crisis (I am in the midst of mine) we are forced to pay attention to the physical body. The body requires more care now than previously thought. I know that better than most as I see individuals when they are young, young adults, adults at mid life, and adults at old age.

The conversations I have with my partner and friends usually involve aches and pains. When it starts to involve my bowel and sleep habits, I know I am aging and it reminds me of the conversation between Bette Midler and James Caan in For the Boys. There is also the dreaded need of being closer to a bathroom as we age, and dietary restrictions due to a chronic colitis conditions. In midlife many of us begin to rely on pharmaceuticals to manage pain and other illnesses.

It doesn't have to be this way. There are herbs. I choose them as a viable alternative to pharmaceuticals. I am grateful to my Higher Power for allowing me the chance to guide others on this path.

The herbs that are a perfect fit for midlife crisis are the Adaptogens.

Top photograph: Lemon Balm

Middle Photograph: Holy Basil

Bottom Photograph: Adaptogens: Herbs for Strength Stamina and Stress Relief by David Winston and Steven Maimes

Until tomorrow...