DrRic Fatigue (slide share edition)

Managing Holiday Fatigue -

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

An Integrative Medicine Approach

Enrique Saguil, MD

The First Health Approach

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

• Legal release: I am in not receiving any financial reimbursement from Whole Foods Market. The names in this lecture have been substituted to protect the innocent. The recommendations in this lecture are not a substitute for health and wellness, please see your personal physician.

• To get copies of this lecture, please contact me at:

www.firsthealthassociates.com

Your Team

Ric Saguil, MDJason Gruss, MDTom Jordan, RD

Katrina Christie, LCPCMike Blumburg, LCPC

Jennifer Green, NDJoe Musolino, DCAmy Iaquinta, DC

Emery Paredes, PTCourtney Day, EPAimee Weber, EPYu Zhu, MD China

You

education

planning

empower

mentWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

First Health Associates

2010 S. Arlington Heights RdLL Suites

Arlington Heights, IL

Ric Saguil, MD

Defensive driving helps!!

Be mindful on the road all the timeDon’t spend a lot of money on courses Maintain your car

Defensive medicine hurts!!

Pay attention to the patient storyDon’t order with sole intention to defend Help initiate change before disease shows

Patient “Amy”

• Low energy/fatigue• Depressive symptoms• Poor concentration• Weight gain• Constipation• Brittle nails• Scanty periods

Ruling out Death for Amy

• Bowel obstruction (tumor)• Liver disease (hepatitis)• Uterine disease (thickened endometrium) with

resultant iron deficiency

• Thyroid panel testing (with dysfunctional hypo)• Anemia work up• Behavioral tx

Patient “Bob”

• Midday fatigue• Weight gain• Hungry all the time• Irritability with stress• Reflux• Depression• Alcohol use• Erectile dysfunction

Rule out Death for Bob

• Sleep study for apnea• Scope for reflux and Baretts esophagus• Psychiatric eval for major depression and alcohol

dependance• Liver study for alcohol damage• Heart scan for heart ischemia

• Check sugar• Nutritional coaching

Patient “Chrissy”

• Low energy/poor exercise tolerance (new)• Fast heart rate/palpitations• Diarrhea• Reflux • Irregular and heavy periods• Insomnia • Poor concentration

Rule out Death for Chris

• Stress test for heart disease• Echocardiogram for cardiomyopathy• MRI for brain tumor• Endoscopy for barretts• Ultrasound for uterine disease• Hormone testing for menopause

• Nutritional coaching• Pap• Counseling

Patient Dave

• Generalized fatigue• Weakness • Poor sleep• Muscle/joint pain• Depression• Poor memory• Reflux• Poor sleep/snoring

Rule out Death for Dave

• Rheumatoid work up for autoimmune • Psychiatrist for depression• MRI for brain tumor• Upper gi or endoscopy for reflux• Sleep study for apnea

• MRI• Physical therapy• Counseling

Patient Eric

• CEO• “I’m fine, no stress – just fix my sleep doc”

• 60 hours a week• Strained love life• Poor sleep and alcohol dependance• Needs a lot of coffee• Obsessive short temper• Erectile dysfunction• Reflux

Rule Out Death for Eric

• Watch for heart disease• Treatment plans

• Counseling • Relaxation suggestions/activity• Sleep/Circadian reset

“Within every ailment is the answer to it’s cure……..

….just have to listen.”

Fatigue could be everywhere and part of every disease…..?!?!

Dr Saguil Approach:

• Establish the basics of

• Proper nutrition (American diets suck)• Proper exercise (only stressed in high school)• Proper “grounding” (not stressed at all)• Proper sleep (de-valued by coffee generation)

nutrition

movemen

tGrounding

sleep

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

First Health Associates

2010 S. Arlington Heights RdLL Suites

Arlington Heights, IL

Ric Saguil, MD

Why Nutritional assessment

• Deficiency due to Standard American Diet• Deficiency due to alcohol• Deficiency due to prescription meds• Deficiency due to soda and candy (fructose)• Deficiency due to disease• Education is lacking or “info-mercial” quality

1

Top Dietician Tips –Tom Jordan, RD FHA

1) Balance Blood Sugars2) Stay Hydrated3) Nutrient Timing4) Prevent Vit/Mineral Deficiencies5) Eat Good Fat6) Think Holistic7) Additional Testing if Needed

*Consider an individualized treatment plan—because there’s no “one size fits all” approach to optimal health!

Macronutrients have power

• Proteins in am• Carbs in pm

• Water in between

Thanks and Good Night!

Absorption of the carbohydrate

Spaghetti

White Bread

WFM - follow ANDI and MANDI….

Aggregate Nutrient Density Index…Dr Joe Furhman

Tom Jordan’s 30 Second Meal Plan

Breakfast: Protein (1 egg, 2 egg whites, cheese… toast?)

AM Snack: Greek Yogurt

WATER!

Lunch: 3oz Chicken, 1/2c Quinoa, Sliced Green Peppers

PM Snack: 100 calorie pack mixed nuts, apple

WATER!

Dinner: 3-4 oz Salmon, Sweet Potato or Rice, 1c Steamed Broccoli

Andy says:the key to life is the

anti-inflammatory diet!!!

???

Empower yourself - Get Help

Movement

• Massage • Exercise • Chiropractic therapy• Physical therapy• Trigger point injections and topical w PT• Feldenkrais/specialized pt/movement disorder

clinics

2

Benefits to exercise

• Muscle pliability• Release of endorphine• Sense of wellbeing/acomplishment• Social interaction• or Solitude (removal from technology)• Indirect breath exercise (yoga)• Feeling of wake/energy

Problems with exercise

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Exercise Guidelines• Best form is the one they’ll do• Establish a routine• Don’t overdo it! Avoid Push-Crash cycle.• Expect some set backs• Take breaks when needed but don’t give up

(1:3 work to rest)

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Starting off• Warm water exercises• Tai-Chi• Pilates• Yoga• Bicycle• Walking• Body weight and Functional exercises

• Wall push-ups• Sit to Stand

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Activity for Severe Chronic Fatigue -FHA EP’s Aimee and Courtney

• Focus on Activities of Daily Living• Hand Stretches• Picking up and grasping objects• Motions needed for getting up, personal hygiene, getting dressed…• Breath Exercises

Pranayama

• Nodi Shodana• Ujjayi breath• Bhastrika (bellows) breath• 4-7-8 breathing

-5-10 minutes am and pm

Mental preparedness-grounding

• Meditation• Breathwork• Yoga• Tai chi• Spiritual grounding (energy healing)

3

Herb says….

• 10 minutes twice a day = 20 minutes total of an average 12 hour (720 minutes) day to improve the way the brain handles the remainder of the 700 minutes.

“Meditators R Built for stress!”

• Yet another task, in the list of tasks, to create more “space” for tasking………

Detaching from structure

• Social media• Web advertisements• TV advertisements• Concept of time constraints• Care not to disregard goals

• Uof I Landscape and Human Health Lab -“take a hike!”

Mood Disorder will always “piggy back”

• The “D” word (Depression accelerates!)• Denial still exists with anything “behavioral”• Happens to average joes• Sunday Night Blues

• Q: when is the highest heart attack hour?

3a

In your mind, make Sunday-Friday!

• The Sunday night blues have probably existed in some form since the start of the five-day workweek, which became institutionalized in the U.S. in 1926, after Henry Ford began shutting down his automotive factories on Saturday and Sunday. Now, science is confirming the phenomenon. In a November, 2009 paper, German and Swedish researchers said surveys of 12,000 individuals confirmed that Sundays are the least happy day for most people, while Fridays are the happiest. But a British study reported in The Observer newspaper found that 26 percent of workers questioned felt dread and apprehension on the day they were due to return to work.

COUCH TIME

How Can Counseling Help? –Katrina LCPC FHA

• Provide a safe outlet for expression• Get to the root of what is causing the fatigue• Offer behavioral techniques to manage

symptoms• Teach tools for managing/reducing stress• Provide referrals for integrative care

Sleep

• 50-70 million americans = 20%• 15-25% of children difficulty initiating and

mantaining

4

Sleep “architecture”

Stages of sleep

• Stage 1• Stage 2• Stage 3• Stage 4• REM (rapid eye movement)

Dr Ric’s Standard Sleep Protocol

• Reset circadian rhythm –night• Valerian• Melatonin long and short• Lavender or sandalwood essential oil• Netty pot nasal irrigation• Comfy clothes• Journal 3 positive sentences• Simulated darkness and quiet• 65-67 degree temp• 4-7-8 breath exercise

Dr Ric’s Standard Wake Protocol

• Reset circadian rhythm –day• Regimented wake time• Netty pot nasal irrigation• Hot water/green tea• Rhodiola or siberian ginseng• Lemon, grapefruit, cinnamon essential oil• Dawn stimulation with light or daylight (with short 10-20

min bursts later)• Music/radio talk• Protein meal/snacks regimented• 4-7-8 breath exercise

Naturopathic Solutions – Dr Green FHA

Stress and Adrenal Support:• Licorice

– Pseudohyperaldosterone and glucocorticoid-like effects– ↑ access of cortisol to receptors

• Rhodiola– For individuals who are exhausted, anxious, depressed and burned

out– Enhance energy production– Increases physical endurance

• Siberian Ginseng– Helps body adapt to internal or external stress– ↑ endurance, concentration, and oxygen delivery to tissues

• Homeopathy

1 + 4

TCM

• Whole System Approaches to healing

• Acupuncture• Chinese herbs• Tui Na• Tai Chi

To summarize

• Rule out disease• Replete the depleted• Behavioral grounding• Nutritional analysis • Movement program• Supplemental care with ND/Homeopathy• Interrupt/rescue with TCM

Don’t settle for a One Dimensional Approach!!!!

One size never fits all…

Make changes that not only work your heart but come from the heart…. …..Thanks for Listening!!!

Starved Rock

Happy Holidays !!!

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Next Lecture:Whole Foods Market Schaumburg

2012 Steps to Sustainable Weight LossJanuary 14th

Fatigue Panel Public Forum – First Health Associates

January 21st

QUESTIONS?

COMMENTS?CONCERNS?