Lee Lipsenthal MD

A truly great man left our world recently. Lee Lipsenthal was a medical pioneer and one of the warmest, loving people I have had the pleasure of knowing. I met him through my affiliation with the Dean Ornish Program for Reversing Heart Disease. He was their medical director. He also was the President of the American Board of Holistic Medicine (ABHM) of which I am a member. He taught doctors how to find balance and happiness in their lives and careers (a noble and very challenging task). He exuded a warmth, love and kindness that is extremely rare in the medical world. He genuinely wanted to make medicine better and I strongly believe he did. He pioneered movements in patient care in the Ornish program (empowering patients through improving their daily lifestyles and addressing their emotional and spiritual lives) and promoted physician well-being during a time that this was just not valued by the modern medical world. These extremely challenging ventures were bold and strong but always done with a loving, kind heart which just was Lee.

In his dying days during his time with cancer, he wrote a great book which I highly recommend to everyone. Enjoy Every Sandwich is a great read about living, dying in peace, and is delivered in a style that is who Lee was: loving, caring, gentle and compassionate. The title is interesting given his years in the Ornish program which espouses a vegetarian diet. He obviously valued the other components of the program (exercise, yoga and meditation, and group support and connection) more than the rigid, dietary advice. He lived his life and preaches in his memoir the search for peace, contentment, love and connection. He clearly values these more than any kind of rigidity or rule for living. I could not agree more and appreciate his boldness and honesty in leaving this world with his true, heartfelt beliefs clearly delineated. We need this kind of authenticity and honesty. He was and is a hero in my mind and heart. I feel for his wife and kids and all that will miss him terribly but I also believe with all my heart that what he gave our world during his time on this planet was so rich and so real that I hope his memory will sustain them all while they are missing him so deeply. Thank you Lee for sharing your giant heart with me and our world.

Cracking the Chronic Disease Dilemna

I read recently in a business magazine about the goal/concept of "cracking the chronic disease dilemma". The article spoke from a business/IT perspective and the focus was coming up with a technological or system solution to this major challenge (it is estimated that this single issue is largely responsible (maybe 75%) for the out of control efforts to finance our healthcare system). I believe that there is a fundamental error in this approach (technological or shifting the delivery model (i.e. to lower level providers such as nurse practitioners or physician assistants or nurses). Not that these are "bad" options; new technology is great and the above mentioned providers are great. The problem is that these efforts would still be in the same model; attempting to care for "complicated, multifactorial" (chronic) problems with an acute care mentality and perspective.

The problem is NOT the providers or the technological support. Fixing these issues could help in a small way by giving overloaded docs support and much needed help but it will not fix the underlying problem. It also is not going to go away with phone triage interventions -- they have tried and failed. Chronic disease is "messy"; it mixes physical problems with emotional and spiritual and social challenges and therefore is not a "quick fix". These additional factors (emotional, spiritual and social) are loaded with complexity and are very often NOT clear and therefore are resistant to rapid (pharmacologic, technological) interventions. This does not mean they are not fixable, workable or within our power to address. It just means that a different approach and perspective is needed.

Chronic disease requires time, listening with open ears without fixed agendas, and dealing with the psychosocial issues that accompany the physical symptoms. This quite often requires a multifactorial approach with a wide array of solutions which often need to work in combination with the other aspects of the healing plan. This can rarely be done in a 10 minute office visit (or 30 for that matter). This also does not usually respond to the standard medical "fixes". However, it can be worked with and made better and the beauty is that when truly and thoroughly addressed, the person becomes stronger in the long run and more resilient in the future. This kind of healing has a power and strength that does not evolve out of acute care interventions (as beautiful as these can be). It has the capacity to make the individual better than they were before (not just back to baseline) but at a higher baseline that can be long-lasting and maybe even permanent!

Roseto Effect

I was just reading about a phenomenon called the Roseto effect. Apparently, the Pennsylvania town of Roseto (named after the Italian town) had a remarkably low rate of death from heart disease in the mid part of the 20th century. It turned out they ate worse, smoked more than other communities but lived long and healthy lives. The causative factor was discovered by the researchers (led by an MD named Stewart Wolf) to be a function of the social nature of the town 's people -- they were remarkably interactive and connected.

This effect went away as the immigrant town "Americanized" and became regular in its values and behaviors.

This was described in the 1960's. Why can't this be created again? Community is "buildable" even without it being the natural state of being. That is my opinion. It just has to be valued by the community and it happens. Build it and they will come.

Community Based Medicine in America

In the part of Fiji I visited (rural and removed from the main islands), there were 2 options for medical care: (1) Getting a boat ride to a hospital on the main island (3 hour boat ride -- expensive and rarely done) or (2) Handling things on your own with the aid of your friends and relatives.

In America, we have quite different and many more options. We are fortunate but the amazing thing is that they live nearly as long as we do and arguably with as good or better quality of life despite diffuse poverty and minimal resources. What can we learn from these joyous, loving people? How can we be the students as opposed to us being the givers? To me, it is all in their priorities and values. They focus on completely different goals than we do. For them, life is only about connection, community, God, family and giving. For us, it is about money, fame, power, productivity, and competition. The way they care for their people is a reflection of these values and principles. We all want to be happy and healthy; we just have different ways of going about it.

By letting in their world view and mixing it with ours, we could quite possibly end the crisis of trying to manage chronic disease the way that we are currently and approach it with new eyes and beliefs and values. Then, we might just stand a chance of saving our world and even making it better. Less medical; more social and genuinely supportive. It is all within our grasp; it can be done. Chronic disease needs a new model; a community based, psychosocial, spiritual approach mixed with medical back-up. If we make the bold step away from trying to fit chronic care into the acute care model, we can improve our world and save our money. Win-win.

Medicare

I would like to proudly announce that I now accept Medicare in my medical practice. I look forward to being able to serve my senior clients with this payment mechanism. I very much like helping this population and feel strongly that I have good things to offer that are not offered in the standard system (time, open discussions about options in managing the challenges of aging and illness and chronic conditions, alternative and complementary approaches, working with emotions and spirituality in relationship to health concerns, and frank conversations about planning a good end of life.

Please call my scheduler Tarin @ (858)259-8333 to make an appointment or for any questions. She is available Monday through Friday between 8 and 5. She works for a medical device company so sometimes you get their voicemail.

Taking Integrative Medicine On The Road (To the World)

One of the true highlights of my Fiji trip was sharing my friends Michael Rubano (massage therapist and Feldenkrais practitioner and general body-mind master) and Matt Szymczak (acupuncturist and Tai Chi/Xi Gong master) with the Fijian people. I had noted on my previous trip that the most common complaint was body pain (most notably low back pain) among these hard-working people. I wanted to give them more than just Advil and Tylenol (which they do appreciate) so I invited my good friends who have devoted their lives to studying the body and bringing people relief with "non-medical, non-surgical" means.

Matt and Michael were huge successes. They worked incredibly hard and shared their gifts with many, many Fijians as well as members of our team. They worked on some people together double teaming them and the majority individually with needles, touch, body re-integration and their incredible wisdom in concert with their energetic and invigorating personas. They often worked on the ground as there were no tables. They helped young guys with rugby injuries and old people with crippled up bodies. The Fijians took them in like they were family. They loved their approaches and their styles. Michael and Matt showed them how to care for themselves and care for each other. They were humble, fun and devoted. I loved sending the Fijians to them because I knew they were going to give them something that was miraculous and totally out of their realm of previous experience.

For me (and I believe the other docs also), it heightened our capacities as doctors to have these 2 humble masters working side by side with us. It was great to know they were there and ready to give their best to anyone who crossed their paths. I have always been a believer in integrative medicine and these two healers in particular but working side by side with them was radical for me. The power to heal and to help was magnified infinitely with these 2 great men on our team.

Further Comments On Tai Chi

I truly appreciated Jenna's thoughts and words on Tai Chi. We practice Tai Chi at the start of all my senior groups and I truly believe the participants benefit in the ways described in her article. It is fun, different and challenging in a different sort of way. The NEW ENGLAND JOURNAL of Medicine even has an article on it this week for improving postural stability in Parkinson's patients: http://www.nejm.org/doi/full/10.1056/NEJMoa1107911 and an article last year showing benefit for people with fibromyalgia: http://www.nejm.org/doi/pdf/10.1056/NEJMoa0912611. It is an incredibly empowering activity that can be done by anyone anywhere.

A Guest Post from Jenna Walters

Tai Chi for Health

Tai Chi is a secret weapon in the battle against the physical and mental demands of life. It has been able to help improve health in individuals with illnesses ranging from peritoneal mesothelioma to migraines. Its quiet and slow movements bring a calm balance to the mind. It also brings strength and balance to the body. Tai Chi demands very little from its participants. The focus is on body awareness and deep breathing. Its stretching is soft and fluid and its movements are low-impact. Young, old, athletic, or the rehabilitating can all gain better health with Tai Chi.

Studies have shown that Tai Chi improves physical health. Although the movements are slow and require no added weight, those that practice Tai Chi become stronger in both upper and lower body. There is also proof that flexibility and balance are improved. The fact that the gentleness of this exercise has such positive results makes it perfect for the unfit, the elderly and for those recovering from an injury or physical ailment.

There are many other physical benefits to Tai Chi. It has been shown to help sufferers of arthritis by reducing pain and improving their general physicality and mental state. It also has been proven that it helps maintain bone density, lowers blood pressure and cholesterol, and improves sleep.

One of the greatest assets of Tai Chi is its positive impact on the mental state of its practitioners. There is a proven link between physical and mental health. Tai Chi exemplifies this bond. The slow gentleness of the exercise quiets the mind. The deep breathing allows stress and anxiety to be exhaled from the mind. At the same time, the body is stronger and less plagued by pain and other health concerns. The healing power of sleep returns. The connection between body and spirit becomes stronger. Struggles with depression, worry and mental confusion can be wiped away with these meditative movements.

Tai Chi shows the cyclical nature of physical and mental health. There is not one without the other. It is a form of exercise that asks for quiet and focus, not hard pounding demands on the body. This quiet, gentle and peaceful practice feeds the body and mind with strength and balance in a way that no other can.

Lessons from Fiji

I am still fully "lit up" by my Fiji experience. What I am most struck by is NOT what we were able to do for the Fijians (although I am proud of our efforts and the good work we did). What is front and center in my mind is the fact that Fijians live nearly as long as we Americans do (72 as opposed to 78 years on average) while spending a fraction of their national dollars on health care that we do (2.6% of GNP as opposed to 16-17% in America). In truth, the discrepancy while enormous is actually bigger if you take into account the huge sums of money we spend on health in ways that are not even incorporated into the figures (drug development, device development, supplements, home health, etc). In point of fact, the Fijians where my team went spend almost no money on health as these people live so far away from the main center of Fiji that it is rare for them to EVER have any true healthcare. Shockingly, despite this amazing discrepancy, these people live well and live long. On my prior visit, I met a man who was 108 years old. On this trip, I had the good fortune to meet many people in their 70's and 80's who were doing fine. Yes, they had high blood pressure. Yes, many may have had diabetes. Many did have body pain (most commonly low back pain) which slowed them down. A few were dying with what seemed consistent with cancer. However, they still were happy, upbeat and grateful. There just was never a sense of "poor me" or "what are you going to do to save me" or even any intense struggle or suffering.

Fast forward now to our wonderful country. We are completely enmeshed in the healthcare world. The fortunate in our society have a team of doctors, each focused on a different body part or system and the average older American takes at least 5 medicines (and very often more than ten) and a host of supplements. Even the less fortunate are often heavily entrenched in the medical world albeit without the level of service or support that the fortunate enjoy and expect. We are a "medical" world; blessed by the miracles of modern science, technology and incredible (though not perfect) medical and scientific delivery systems. However, the bottom line is that we live a couple years longer and arguably NOT better (and maybe worse) at a cost that is insane and unsustainable.

So, what's the lesson? I don't want us to abandon our gifts of modernity or go back to primitive living. I do think and believe it is absolutely critical that we look at the facts and the truth and decide how we want to proceed with consciousness and integrity. We are a society that is blessed by science and technical advances. However, despite our brilliance, we have lost what the Fijians and other indigenous societies have and value more than what we put our attention and focus on. They still have love for their clan at the core of their being. They look after their own in a way that we just do not do. Their own is not just their immediate family as far as I can tell -- it is their clan or extended family.

These concepts extend to health. They do not have "chronic disease" as we call it in our society. Chronic disease is said to account for 75% of our healthcare spending and no one seems to know what to do about it. We know it is ridiculous. We know we spend way too much at the end of life. However, we don't know how to stop (or slow) the technological "train". We don't know how to go back to "more normal" values or to slow the technological impulses and inventions and just "be there" for our elderly or our infirm in a heartful way. The Fijians know how to do this; they still do it. They meet sickness, aging and death the SAME way that they meet life -- with love, support, gratitude and their full hearts and spirits. It is not about technology, science or medicine; it is about a deep reverence for life and from a deep connection with the miracle that life is.

I am not proposing that we "throw the baby out with the bath water". We do not have to give up our technological magnificence and scientific miracles. We just need to wake up to what is real. Technology and science make life explainable and better in a multitude of ways. However, life in its essence is NOT about comfort,ease, productivity, speed, or quantity. Life is about love and connection. We CAN have it all. In many ways, we do. However, if we want to continue to have it all and pass the "allness" on to the next generations, we absolutely must learn the lesson of those who still live simple, "primitive" lives. We must remember why we are here.

Fijian Friendliness

Perhaps the most striking thing about being in Fijian villages is not the poverty, not the simplicity, not the absence of modernity, but the absolute warmth and friendliness of each and every Fijian. Young and old, men and women, big or small, the Fijians exude warmth. The universal greeting of "Bula" is their hello but it implies much more than just a greeting; it conveys warm feelings and good wishes. That is just right off the bat before they have even met you. Walking through the villages, the Fijians peer out of their homes and always extend their greeting of Bula attached to their big, warm smiles. This is not the exception; it is the way.

How amazing it feels to be immersed in such a world of openness and warmth. It changes you (at least it changed me). I felt a melting away of my exterior, my wall. I was not alone in this feeling. Our whole team felt it and loved it! It did not at all feel artificial or forced or because we were visitors or because we might give them something. It felt only like real, genuine love and kindness. It's powerful and it is a better way to live.