COVID NOTES: This is a test.

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I said at the beginning of all this that the Covid-19 pandemic would take us to places we’ve never been before.

And here we are.

We are in a very strange place where the simple act of wearing a face mask declares one’s political affiliation. Where armed terrorists storm a state legislative building, intimidate lawmakers, and are treated with kid gloves. Where ignoring and undermining the only tools we have to fight a fatal disease is applauded as some malignant assertion of liberty. Where those least among us – the “heroes” of retail and restaurant – are expected to sacrifice their lives for others’ convenience and wealth.

Any crisis is a test, and as we hit 100,000 deaths, Covid has proven to be a trial of of us individually and collectively, and on many levels.

It is a test of our empathy and understanding that others are as important as ourselves. All you have to do is look around you at a store, and observe who is wearing a face mask and who is not. Those without clearly do not regard others’ lives as important as their own, and by their actions are quite willing to sacrifice their neighbors, families and friends for the sake their own convenience. Or worse, as a protest statement somehow tied to their liberty. Get over yourself, son. It’s a damn piece of cloth over your piehole, not some insidious assault on your right to free speech, buy a gun, or whatever inane offense you’ve hyped it into.

It is a test of our scientific literacy. Youtube videos presenting false narratives and fabricated science have sprouted like weeds in an abandoned mall parking lot. So many of us lack the basic science knowledge, and more importantly, critical thinking skills, needed to see past the shallow facade of these puppet shows.

It is a test of our economic system, but not in the way the right wing is touting. The pandemic has pulled aside the curtain of trickle down economics to reveal where the real power in the economy lies. Interesting, isn’t it, that when the average Joe & Nancy stop buying, the engine of capitalism stalls out. Remember this lesson the next time someone tries to tell you that it is the CEOs and investors that run the economy. It isn’t. It’s you.

It is a test of our beliefs in equality. It has been argued that some lives, because they are not widgets of production in the maw of capitalism, should be sacrificed. Or that other lives, because they are easily replaceable cogs in the money machine, can be sacrificed so that we can have our haircuts and our oh-so-critical dining experiences.

As I stand here and look at the cracked landscape of our society, I am appalled by the selfishness, greed, and inconsiderateness of my fellow Americans.

Yet at the same time, I am hopeful. I am given hope by the mother who writes daily about the tribulations and frustrations of raising her children in quarantine, yet who always sees the love and the beauty in her family’s situation. I am given hope by the people delivering groceries to their neighbors who cannot leave their houses even for essentials. I am given hope by the leaders who are demonstrating what true leadership means, by managing an impossible situation with determination, fairness and truth.

Fortunately for us, Covid-19 is not a pass/fail test. Like any good test, it will leave us – as it eventually will – with a clearer understanding of what we don’t know as well as a surer confidence in what we do understand.

And as with any good test, we will learn from it. We will glean new knowledge from the effort of having taken it. So take a moment and sharpen your pencils. The test isn’t over yet. We still have time to improve our score. And if you’re stuck on a problem, it is ok to ask your neighbor for help.

Stay healthy, and look to the light.

COVID NOTES: I'll Take One Peace of Mind, Please

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My apologies for skipping the mid-week edition of COVID NOTES. I was caught between an onslaught of patients and the urge to combat an onslaught of covid conspiracy videos, trying to inject a few grains of science and a dash of common sense. I was a bit cross-eyed by the time Wednesday hit.

Increasingly though, I’ve been seeing posts and questions on social media about the best apps to use to meditate with or good meditation music to listen to. It’s not a bad idea. From the looks of things, people are getting stir-crazy. A little meditation might help.

I’ve been meditating, on and off, since my early 20s. I’m trained in zen meditation, taoist meditation, ki meditation as taught in some Japanese martial arts, Western esoteric meditation, and plain-old secular mindfulness meditation. For the past couple of years, I’ve been teaching meditation to many of my chronic pain patients, with good results. All of these methods are good, and they all have their own special techniques, but they all begin with one simple thing: The breath.

Meditation is easy to explain, and hard to do until it gets easier to do. A lot of people never get through the “hard to do” section.

The results, though, if you stick with your training, are worth it. But let me clear up a few things. The point of meditation is not to attain some mystical state of bliss, though it can at times, help you feel blissful. The point of meditation is not to reveal to you the hidden secrets of the universe (unless that’s specifically your goal). The point of meditation, at its most basic and common level, is to teach you how to control your awareness. To be able to consciously control the focus of your attention, so you can pay attention to what is important in the moment and ignore what is not.

That may not sound like much, but it is your mind’s most useful tool. Your mind becomes like a variable camera lens, allowing you to catch the overall picture or the details as you choose. Without obstruction from the constant (and mostly useless) chatter of your mind, you can direct your thoughts on what you choose.

So how do you do it? Simple. Sit upright in a chair or cross-legged on a pillow on the floor, facing a plain wall. Your vision should be free of distraction. Having done that, start following your inhalations and exhalations with your mind.

A word about breathing, here: Abdominal breathing is best. You can tell you’re abdominal breathing because your stomach expands with each breath and your shoulders don’t rise. That draws your breath down into your physical center, allowing you to fill and empty your lungs completely with each breath.

Take a deep breath, filling your lungs, and then exhale completely, and think to yourself, “1.” Do it again, and think “2.” Continue the count until you reach 10, then start again at 1.

But I can guarantee you won’t reach 10 the first time without other thoughts intruding and you losing count. You’ll begin to wonder about what to cook for dinner. Or that argument you had with your spouse. Or worries about money or health will intrude. That’s ok. That’s more than ok, that’s what’s supposed to happen.

And when it does, return your mind to your breath, begin with the last number you remember, and go from there.

Intrusive thoughts will happen again and again and again and that is just fine. You’re succeeding. And over time, you will notice they become less noisy, less strong. You’ll never get rid of them entirely, though. You can no more stop your mind from thinking than you can keep your heart from beating. Thinking thoughts is what your mind is supposed to do. What you’re learning is how to not pay attention to all of those random thoughts.

You see, meditating is like weight training. You’re building your mind muscle. Nobody picks up a dumbell, does one curl, and puts it back down thinking they’ve built up any muscle. They do it 10 times, 20 times, and maybe 3 or 4 sets. Every time your mind drifts and you bring it back to your count, that’s a rep. Every time you’ve completed a count to 10, that’s a set. And your ability to focus your mind grows each time.

How long? Start with 5 minutes, but do it every day. Then go to 10 minutes. Then 15 or 20 minutes. Do it for as long as you feel you can and want to, but do it every day – that’s the secret.

As for the apps, the guided meditations, the mood music: Put that all away for now. That’s just another way to distract your mind from focusing while pretending that you’re actually doing something. Just set the timer on your phone instead. Once you have mastered the basics, which can take a few months, then you can start adding overlays to the basic pattern of mindfulness to achieve specific goals.

You will begin to see benefits after only a week or two though. I can’t tell you what those benefits will be, because they are unique to the individual. But you will notice them. Because now you’re learning how to pay attention to things. And how not to. You’ll be surprised what a difference that makes in your life.

If you need some help, I’ll be glad to give you additional tips. Just send me an email at avery@averyjenkins.com or text me on Telegram, @avery_jenkins, or call my office. I’ll be glad to help.

In the meantime, just breathe. This is all going to work out, one way or another. And as much as you may feel like it right now, you aren’t alone. We’re all right here, breathing alongside you.



COVID NOTES: This Is Bigger Than You Think

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I’ve had an odd couple of weeks. Well, as have we all, but I was experiencing a rather select strangeness. All last week, by the end of each day of seeing patients, I was feeling incredibly fatigued, and going home with a severe headache and nausea. No fever, none of the symptoms of COVID-19 (although at this point, the shorter list is what is not a symptom of the virus). But by the morning, I would be feeling fine again, and I’d make my merry way off to work.

It took me a little thought and a little research to figure out what’s going on. For the past month, I’ve been literally living in alcohol, at first isopropyl and now good ole’ Everclear-style. As the only disinfectant I can lay my hands on, grain alcohol is what I use to decontaminate the rooms between patients, spraying it about the table and furnishings like holy water. And about 30 times a day, I’d be dousing my hands in alcohol for a quick rinse between chores. As my exposure through skin and air built up over time, I was developing an alcohol toxicity.

Time for a change. I got online and ordered several bars of Goatboy Soaps, made in New Milford, and stopped using the alcohol on my hands. Washing hands with soap takes longer, but is likely more effective and certainly less toxic. Also, Goatboy’s soaps smell good, unlike the lingering smell of frat house carpeting that ethanol leaves on my hands.

The response was dramatic. I may not be able to go home and beat a chess master in a match after work, but then again, I never could. Yet, even with this relief, I am left with a certain malaise. Like everyone else, I’m wondering when this whole damn thing will end?

And the real answer is that it will end when nature is good and ready for it to end.

Modern humans are used to pretending that we can bend nature to our will. Only during short extremes – torndoes, hurricanes, earthquakes, floods – does nature reveal its inevitability. But for all our attempts to hide it, that inevitability is inescapable. We are far from the masters of this earth, we are its children. Badly behaved ones, at that. And when push comes to shove, it is our will that will bend to nature’s. Or, in the words of Dr. Fauci, “We don’t determine the timeline. The virus does.”

So we huddle under cover, either alone or with our atomized families. We curse, we fret, we crumble, we foolishly challenge nature’s might, and get slapped upside the head for doing so. This is what humans have done since the first thunderstorm sent us running into the first cave.

Where we paint the walls, we continue to create, whether it be in pictures, song, words, or even relationships, as strange as that may seem right now. I am seeing as new virtual communities grow online, just waiting to burst into a more material life.

There’s no way to sugarcoat this, though, it sucks right now for a lot of people. Forget making rent, let’s talk about having enough food to make dinner. Let’s talk about being stuck with a violent partner or parent. For many, this isn’t about an opportunity to create, it’s about a struggle for survival against seemingly overwhelming odds.

From that perspective, the race to re-open our world is entirely understandable. Though, to be honest, the protesters I’ve seen have been mostly concerned with their loss of haircuts and aisle-browsing at TJ Maxx, rather than the need to escape growing danger.

What’s the correct answer? What can I do, from my safe home, to help others who are not so safe? Well, for starters, reach out. Talk to people. In my practice, I’ve made it a point to identify patients who may be at risk and reach out to them regularly by text or phone, quietly gauging their status. But you don’t have to be a doctor to do this. Pick up your phone. Send a text. Even just hearing another’s concern and interest in your welfare can be a relief to those in need. Offer to drop off some food on the porch, or toilet paper, or whatever. We are all in need of something right now.

The second part of the answer is harder. We all need to give some hard, critical thought to how we have lived up to now. How could it be that we would leave so many people in desperate need, in a land still rich in resources? How could it be that we have come to dismiss the value of life, threatening minimum-wage jobholders with economic retribution if they don’t do their employer’s bidding?

Over the past quarter century, we have unwittingly normalized behavior that is antisocial to its very core. Is it surprising that nature has followed suit?

Be well. Wear masks. Wash your hands. This will end.

May our spring, when it finally comes, be beautiful.

COVID NOTES: Whatever You Have Read, It’s Probably Not True

Like lice or bedbugs, coronavirus misinformation has become an infestation on most social media platforms. From less-than reputable politicos arguing for re-opening their state while Covid-19 rates continue to soar, to Youtube videos featuring some left-field scientist or doctor, stone crazy solutions are being spewed like chamber pots onto a street in Victorian London. (It’s worth noting that many of those Youtube authorities got their street cred on the science-free fringe of antivax and climate change denial movements.)

Don’t get me wrong; for over a quarter century, I’ve been practicing alternative medicine, and I can be very comfortable in the land of woo. But also during that time, I’ve become hypersensitive to misrepresentation, miscategorization, cherrypicking and downright fraud on both sides of the medical fence. And I can smell someone trying to make a name or a buck on the latest cure-all from a mile away.

These things tend to go in fads. When I first began practicing, Vitamin C was the cure-all for everything from colds to cancer. Then it was Vitamin E. Then Vitaman D. Then antioxidants. Then probiotics.

Look, all of these nutritional supplements are good for some things. I use them in my practice all the time. And one of the big advantages of doing work nutritionally is that, in most cases, if you’ve done something wrong, you haven’t worsened the patient. They have a huge safety factor. But when you’ve got patients coming in wondering why their CVS-brand probiotics haven’t improved their hot flashes, things have gone a little bit overboard. These supplements become “discovered,” their actual uses broaden, then an entire industry is built around hawking them for damn near everything.

The same thing happens with drugs. Off-label use of dubious provenance is incredibly common, and when some drug gets a push, everyone starts getting diagnosed with fibromyalgia or osteopenia, and it’s off to the pharmacy we go. Nevermind that diagnoses are sometimes actually created to fit the drug.

The pandemic has put a rocket booster on this process. There’s an awful lot we don’t know about this virus, but what I know is that hucksters hate a vacuum, and they will come swimming in like sharks smelling blood.

People are, understandably, grasping desperately for answers. It doesn’t help that our president presumptuously touts miracle cures or mindlessly speculates on inane possibilities from behind a podium in front of the world. That just encourages folks to go running after any “researcher” with a couple of abbreviations after their name.

I’m sorry to tell you, but pretty much all of what you’re hearing and reading about Covid-19 is barnyard fertilizer. Even looking at the legitimate end of things, very few, if any, of the studies you’re reading about have been through the peer review process. I’ve been through that process myself, and it’s a grinder designed to find the tiniest loose end and pull on it until your entire article has come unraveled. When done right, peer review really does leave the fertilizer in the field.

What does that leave us with? Not much. A bunch of blind men poking different parts of an elephant and coming up with different descriptions. Clinicians nearly brain-dead from overwork grasping at any straw that might save their dying patient, and in the maelstrom, willing to try damn near anything that they imagine might work.

Here’s what we do know: Most of us will get infected and not die. But too many of us will die, in some of the most horrible ways. This will come to an end. New cases will peak, then level off, and then fall. Social distancing works, and is the best, if not only, tool we have to fight this on the large scale.

But honestly, that’s about all we’ve got and it ain’t much. Eventually – in six months, in a year – we’ll know more. But by then we might be going through round two of COVID-19, while we’re still punch-drunk from fear and grief and an administration which is the antithesis of functional leadership.

I’m sorry. It’s kind of a bleak picture, solution-wise. But that’s the unvarnished truth.

Until then, put your doubting Thomas glasses on every time you see a post, every time you see a news article that touts a great leap forward. Things don’t really work like that. We’re at the mercy of nature’s cycle of change, and it can be (for human eyes) exceedingly, painfully, slow.

Hold onto those close to you, and huddle under the roof as humanity has for millenia, until the storm has passed. Eat good food if you can find it, and make sure you get a little exercise. But for sure don’t buy what the itinerant snake oil salesman is selling you. You’re better than that.

COVID NOTES: The Faces of Hate

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Reading the news over the past couple of days, I cannot help but to note the images of the people protesting quarantines. Hatred and anger distorts the face in ways that we respond to viscerally. For me, as for many, my instinct is to react with anger as well. Once I get past the visceral response, I still have a strong emotional response: What are these people thinking? Don’t they understand that their actions put others at risk for a disease which in a few months has killed as many people as the entire Vietnam war? Are they really just contemptible fools?

Anyone who lived through the 70s and 80s can attest that epidemics can trigger radical massive shifts in behavior. HIV/AIDS caused a huge culture shift as sexual behavior rapidly morphed from the carefree 70s to the fearful 80s. Condoms became a thing, and for a while, even kissing another person was thought to be a source of exposure. Importantly, though, HIV/AIDS made its appearance just as LGBT rights were experiencing major expansions, from legal protection to increased societal acceptance.

The disease changed things. I remember very well when HIV/AIDS was only predominant in the gay community. The Reagan administration refused to recognize it, or even say the name. Conservatives across the land pilloried gay men as rightfully receiving their comeuppance for being abominations in the eyes of their god. Anti-LGBT groups grew increasingly loud and powerful, with hate messages being spewed from church pulpits and politicians’ podiums.

I also remember encountering a gay friend of mine from college. His eyes were hollow, his face haggard. No, he wasn’t infected, he explained; he had just spent every weekend for the past six months attending the funerals of friends, friends of friends, and eventually, his boyfriend. His agony was palpable, and my heart hurt for him.

Of course, during that time, HIV/AIDS was still being called “gay cancer.”

I don’t want to be too cavalier about drawing parallels between then and now. Epidemiologically, HIV and SARS-Cov-2 are radically different diseases. SARS-Cov-2, the virus causing COVID-19, spilled out of its initial infectious reservoir much more rapidly than HIV made the transition to heterosexual transmission.

But humans will scapegoat, and find an outlet to translate their fears into hostility, and 2020 appears to be set on a similar course. First was the administration’s initial refusal to use the medical term for the disease, instead calling it the “China Virus” or the “Wuhan Virus,” and Trump’s initial – and utterly ineffectual – closing of our borders to Chinese nationals. Now, of course, we see an attempt to shut the borders down entirely to immigrants, as if it that step would have any effect whatsoever on the spread of a disease already firmly implanted in this country.

Not being able to fit solely on racist platforms, it has been difficult for those inclined toward hatred to restrain themselves to a distinctive target. At least until it eventually involuted onto those who are most involved with fighting the disease. Conspiracy theories abound on the real “purpose” of the virus, and how the measures to stem its growth are somehow predetermined, coordinated steps to steal citizens of their rights.

Certainly, chaos is a prime time for bad actors to wield greater influence, but to any sane person, these protests, with the desire to increase the risk of infection, to increase the number of deaths, to propel our health care system further into disarray – well, it just looks crazy.

It is crazy. But we’ve seen this before. And we’ve also seen the outcome.

From the deaths and the tragedies of the 1980s came a resurgence of advances in civil rights. From anti-discrimination laws to acceptance into the military, LGBT people made great strides forward.

Certainly, the years preceding this pandemic has seen a rise in bigoted sentiment along all fronts, but those gains were not entirely rolled back. Those that have been were accomplished in relatively temporary ways which can be restored with concerted effort.

So what is the answer to the hatred fanned to further flame by COVID-19? How on earth can we stop this horde of angry faces from becoming the face of America? How do we cope with the idea that there are those among us who would destroy those very people who are trying to protect us?

First, remember this: News and media outlets, by their very nature, tend to magnify. Yes, there are thousands of people demonstrating. But there are far, far more of us who are following reason over emotion, and that alone is encouraging. The news media doesn’t wander by the front porches of the people ringing their bells every evening and it doesn’t run feature stories on commonplace behavior.

Even if hate does have the upper hand, it cannot last for long. Hate eats its young and sooner or later, collapses into its own hollowed-out soul.

The answer to the pandemic is to keep everything at a standstill. If you keep the wood from the flame, it eventually burns itself out, as will COVID-19. And where government fails to help your neighbor or your friend, step in. When you see a friend suffering, comfort them. And when the time is right – when the time comes to establish a new normal -- remember the lesson of this disease.

This lesson: By putting on masks, by staying at home, we are not protecting ourselves so much as we are protecting each other. The quarantine isn’t for you, it’s for the man with heart disease, the woman with diabetes, the essential worker facing a constant flood of viral load.

And when this ends – as it will – you will be able to hug closely and smile maskless at all the other people that you, through your selfless actions, are protecting.

Take care of each other. It’s the best we can ever do in our lifetimes.

COVID NOTES: Take Out the Damn Trash

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Over the past few weeks, I’ve begun settling into a routine at the office. Arriving sometime before my first appointment, I spend a half-hour or so decontaminating the building with bleach and alcohol and a hospital-grade disinfectant that I still have a few precious ounces of. I ran out of rubbing alcohol and am now using grain alcohol (CDC approved), so by the time I’m done, the place smells like a frat party that was held at a YMCA swimming pool.

I was vaguely amused when I arrived in the morning at the Litchfield Wine Cellar and asked the fellow behind their sporty outdoor counter for the biggest bottle of the highest proof grain alcohol that he had. He smiled, raised one eyebrow and said, “It’s come to that, eh?” and then I realized what this purchase must look like. There was no backing away from this one, so I fell back on my spiritual training to address it. “We all have to do what we are called to do by our inner nature,” I said, as sagely as I could.

I’ve reduced the number of patients I’m seeing as I’ve sent Giselle to work at home for the duration, and it takes a good 15 minutes to properly disinfect each treatment room after I’m done with it. Only one patient is allowed in the building at a time to minimize cross contamination. With Dave Pavlick, the clinical social worker in one of the offices only popping his head in a couple days a week, and Kate Sobotka closed down for the duration, that leaves me a fair amount of spare time to ramble around the empty building by myself and contemplate things.

Also having laid off the woman who cleans the office for the duration, it is now up to me to handle the things she normally did – vacuum the carpets, empty the trash, clean the bathroom – and to be honest, I find this task, in combination with my pursuit of disinfecting perfection, to be refreshing. My approach to my practice is generally highly cerebral and emotional. I obsess over patient care, wondering if and how I should alter their treatment plans to maximize effectiveness. I review literature, reading up on the research that are foremost in my mind or practice. I analyze my interactions with patients, to make sure they are getting the education and information they need.

The constant cleaning brings me back down to earth. I don’t just own the practice, I also own this toilet bowl, and I need to clean that sucker out. And mop the floor. And wipe down the doors and window sills. And with each task, I’m finding that I get a closer connection to what this practice really is, as opposed to what I imagine it to be or what I want it to be.

And trust me, I take the toilet bowl stuff pretty seriously. Once, when I was working for the AMC Trail Crew in the White Mountains, I was sent to a campsite deep in the woods with winch and cable. My task was to winch up a 50-gallon drum that served as the receptacle for a one-hole privy, cap it, and with the help of any unlucky nearby hikers, ferry it up to a nearby treeless peak and call for a helicopter to hook it up and fly it out to...somewhere. I didn’t know and didn’t care.

Of course, half-way up the hole, the damn drum got caught and I had to climb down to it and unsnag things. That resulted in the predictable spillage, and made the subsequent conscription of hiker help more difficult.

Eventually the task was done, I arrived back at home base and hosed myself down before approaching anyone I knew.

The point being, though, that we all have to take out the shit from time to time, internally as well as externally. And I am using this chance to get a new perspective on my practice. Sooner or later, we will collectively take our fingers off the pause button, and I want the new normal to be different from the old normal. Even though it may have been working pretty good, as was my practice, there is still enormous improvement to be made in our society, in our government, and perhaps most importantly, in how we relate to one another.

The time will come. Use this time now, no matter how difficult, to learn and to grow (and keep in mind the most important lessons are also the most painful ones), so that when the future is upon you, it is a healthy future that you envisioned with your current mindfulness.

That sounds a little too otherworldly precious, so let me put it another way: Life may really, really suck right now, but do what you can to stagger through it and learn your lesson so you don’t screw things up again. Got it?

Have a great day.

COVID NOTES: Empty Chairs At The Table

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Here in Connecticut, we’re just beginning to approach the high tide of illness and grief that will reach us over the coming days. The epidemiologists are predicting a peak of deaths from The Virus in two weeks. To be sure, the overwhelming majority of us will survive, and most with little more than a hiccup. But the sheer scale of infection will leave none of us untouched.

As I write this, I am sadly watching my wife prepare for tonight’s Passover seder. Passover, the Jewish holiday of grief, redemption and joy, has always been her holiday, and she would begin weeks in advance to prepare the meal. On this evening the table, surrounded by as many as 20 family members, would hold the feast and the love with which Jews have always recalled their slavery and celebrated their freedom.

Tonight it will be just her and I and two dogs, sitting down to a meal that will be no less grand, but lacking for the warmth and the love of our family, today separated less by miles and more by the micrometer’s length of a strand of RNA. My thoughts turn to my youngest daughter, for the first time cooking her own seder in her own kitchen, and my eldest, who survived the infection but remains in quarantine in London. I am at a loss for their absence. It lies heavy on my heart.

And I am sure it will be much the same for my Christian friends this weekend, as they weep for the death and rejoice in the return of their savior, and who will similarly be missing the kinship of worship with others and feasting with family. Religious or secular, this time of separation is painful for all of us. Humans are not designed to be atoms of existence separated by empty, unbearable, space.

And it’s far from over. We haven’t even gotten to the bad part yet, where some will be lost to our celebratory tables forever, and some of us will lose even a table to sit at and food to put on it.

Among the wash of emotions that I’m seeing in my patients and on social media is a rising tide of anger. Anger that we’ve been ill served by those elected to act on our behalf and who instead did nothing. And when they did decide to do something, it was only to turn our tragedy into their profit.

Anger and sadness and fear is a potent mix, and the resulting explosion is rarely good. It is how jihads are created. Then again, we are Americans, born of revolution and survivors of civil war, and our inclination to reach for the best of what the founders imagined is strong. Though as any Native American, or immigrant of color or non-Christian can tell you, we repeatedly, and often dismally, fail in that regard. Nonetheless, we strive to make the ideal real.

The internet is awash with people and virtual communities providing ways to help us cope. From virtual yoga classes to internet religious observances, from instructions on how to meditate to how to exercise, many are lending their expertise and their time to help us all find ways through this time.

I find to my dismay that I feel I have little to offer in that regard. I have spent most of my life helping others, but at this time of great need, I feel a bit hopeless. I am just a chiropractor, just a man who has thought about things, perhaps at times a little too much. The only thing I can offer you is just what I am. My ears to listen, my heart to respond, nothing more, and I urge each of you to do the same. What we cannot do singly, we can do jointly.

To each of you, I can only say this:

You are my brother. You are my sister. Welcome to my table, stranger.

COVID NOTES: The Face Behind The Mask

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As I’ve been going about my days – first at the clinic and now in public – behind a mask, I’ve been noticing changes in my behavior. With patients, I find myself exaggerating the expressiveness of my eyes and amplifying the inflection of my voice, to compensate for what my face mask hides. In public, it’s almost the opposite; I feel silenced by wearing a mask, as if it were a gag preventing me from speaking out.

But what is it I want to say that I cannot? “Be careful,” I suppose, or “Take care,” and once or twice, even a snappish “Six feet, if you don’t mind.” Which, I’ll admit, at other times I might have voiced. Yet instead, because of the mask, I remain silent.

Interesting that the simple addition of some fabric and elastic should have such an effect on me, as I imagine it has on most of us. And it is worth noting that, even before The Virus direly announced its presence, we were all wearing masks anyway.

A common question to ask a Zen student during their training is “what was your face before you were born?” It has no logical answer, of course, but the intent of the question is to force the student to delve inside, past all of the masks we learn to wear, to find the Buddhist emptiness of self. I wear my doctor mask at the clinic. My husband mask at home. At the dojo, I wear the mask of the peaceful warrior, and with friends I will wear masks varied to suit the times.

What is behind all those masks? What is the “me” that I am so diligently protecting with my elaborate masquerade? What is behind yours?

Taoist philosophy holds that we are three people: The person we present to others, the person we believe ourselves to be, and the person who we really are. And the greater the disparity among these, the more difficult our lives become. One of the elements of Taoist training is not so much to discard these masks, but recognize them for what they are, and bring them all into accord with one another.

Today we wear masks of fear, or at least of grave caution (and I might add that fear is the most prominent symptom of COVID-19, and we have all been infected). But it has not always been so.

Some wear masks of anger. Others of joy. Our surgical masks today cover other masks that are already so firmly in place that we don’t always recognize them as such.

So our current predicament gives us a unique opportunity for self growth. As you put on your safety mask before braving the grocery store, take a moment and ask yourself: What mask is this mask covering? And is it the same mask that I was wearing yesterday?

I would bet good money that your answer to the latter question is a resounding “no.” Because the person you are today is not the person you were yesterday or the day before. And once you recognize that, you can move on to the more important question: What do all the masks that you wear have in common?

Finding that thread and following it through to its end can be a journey of several years, so tangled are the skeins of our existence. But if you do, you will discover a treasure that makes it all worth it. You see, you don’t really need those masks. Any of them.

Discarding them is not without risk, just as discarding your virus-prevention mask would be today. People without their masks are often seen as madmen, devils, fools, or very, very rarely, sages. Is that worth the price? Only you can decide.

Go ahead, pick up your mask. Put it on. And when you are done, throw it away.

COVID NOTES: A Compression of Grief

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People rightly point out that The Virus is turning out to be not quite the killer that we feared, though it is still proving to be 10 times more deadly than the annual flu. The problem is twofold: The first is that it is wildly infectious, and the second is that unlike the flu, which takes a whole winter to kill people, this virus is killing all the people it is going to kill all at once.

And in turn, it is causing – and in our country’s case, will cause – a compression of grief, which will surely overwhelm some of us. We will suddenly be grieving for lost family and lost friends, losses which would otherwise have been spread out over a year or two, but which will be happening within weeks or days. New York City is already storing the dead in refrigerated trucks.

And the grief isn’t just coming from death. It’s arising from the loss of our normalcy, our current way of living, and the loss of trust that some still invested in our national leadership, which has crumbled under the pressure of events that simply don’t allow themselves to be spun away. Nobody can turn this calamity into a nothingburger. Sure, most of us will live, even most of us who catch the virus. But like 9/11, which only killed in one day no more people than die in traffic accidents in 10 days, the sheer volume catches and controls our psyches.

So what do you do? What do you do when it seems that every place you turn, you are faced with more images of death, more stories of doctors and nurses stretched beyond the breaking point, more bad news to digest in a day than you normally digest in a month?

First, you do what any wise person does when the sink overflows. You turn off the faucet. You get off social media, quit watching the news, quit trawling the web.

Then say to yourself “This will end.” I guarantee you, it will. Repeat that to yourself as often as you need to hear it.

What you do next will vary from person to person, but they all have one common theme: You engage yourself in your own processes, ones in which you have mastery, rather than watching and grieving over the losses over which you have no control. For helper-type people, this may mean collecting groceries for elderly neighbors, or making face protection for health care workers. For worker bees, it may mean diving deep into your work – not just job work, but work to do for yourself. Clean the house, the windows, repair that leaky faucet, detail the car. Immerse yourself in the task at hand (this is what the Eastern philosophies call “moving meditation.”) Socializers can Facetime or Zoom their hearts out. If you’re raising little ones, take this opportunity to be with them wholeheartedly. Engage with them on their level in the mystery that this world is to them. Contemplatives – well, you can go outside and just watch a tree for a while.

Actually, I recommend tree-watching for any of us. Recent science has detailed for us how forests are sentient, but sentient in a way far different from our own. Unlike us mammals, trees can’t move, can’t run away, can’t run toward anything. They just have to sit and take it, whether it is an ice storm breaking their branches or a drought starving them. A fifty-year-old tree knows that, whatever the current crisis is, it will end, and it will likely remain standing. Sit and watch a tree and its birds and squirrels, and know the trees’ wisdom: This will end.

Your grief will leak back in, but more slowly now, at a pace in which it can be processed. And should disaster fall close to you, know that processing the grief will take a long time, perhaps years.

And yes, that grief will end, too. Of course, you won’t be the same person, but then again, most of us won’t be. The transitions we experience through this time will be idiosyncratic and unpredictable, but that’s not the important part. Even in good times, you aren’t the person today that you were yesterday, and gains and loss will figure into the equation of who you are when the future arrives. You’ll see who you are when you get there.

This will end. Hold that close to your hearts, my friends.

COVID NOTES: And Then, the Fear

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“I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain.”

– Litany Against Fear from Frank Herbert’s Dune.

Behind the hoarding, behind the funny memes, behind even the stories of unexpected neighborliness, lies a single underlying emotion: Fear. We are afraid of whether we will have jobs to go back to, how great an educational loss our children will suffer, whether our parents and grandparents will survive the pandemic, whether we’ll have a roof over our heads, how we will feed our families. And the biggest fear of all: What lies on the other side of this pandemic, given that most of us will survive it?

The only thing we really know for sure is that what will be isn’t going to be what was. And that insecurity is incredibly frightening for most people.

So what do we do? Honestly, most of us translate that fear into inappropriate behavior. We deny the reality and powerlessness of our situation, substituting instead a Saturday morning cartoon version of the world. We get angry, and lash out at those who are closest to us. We hide ourselves, sliding slowly into the deep dark of apathy and depression. We engage in our addictions, whether they are alcohol, marijuana, opiates or love. We throw away our self-determination and abdicate our accountability, praying that some power greater than our own will step down from Heaven, Mt. Olympus, or Washington DC, and save us.

What we are loathe to do, however, is exactly what we should do: Let it happen. Admit to ourselves that no one is in control of this situation, much less those who actually claim to be. Especially them; surrounded by the filters of opportunists and sycophants, hidden within the twin towers of money and power, they have less of a grasp on reality than the six-year-olds among us.

You don’t have control of this situation! None of us does. Nobody, through their words or deeds, has the power to stop what is happening. So just...let it happen. Begin, as Herbert’s fictional ritual suggests, by submitting yourself to your fear. Look at it. Accept it. Acknowledge to yourself that you are afraid, perhaps more afraid than you’ve ever been. And then look at why you are afraid. Is it loss of livelihood? Family? Future?

Well, the cold hard fact is that you’ve never had control over any of that. Ever. You may have fooled yourself into thinking you have, when events and desires have coincided, but if you look closely, that belief is a myth. Sometimes, you and the universe have just been headed in the same direction.

Once you understand that, you are ready to understand that “let it happen” does not equate to “do nothing.” In fact, accepting and acknowledging the fact that you are scared actually gives you more options than you had before. You are no longer bound by the restrictions of your programmed, reflex reactions.

“Let it happen” actually means “do what’s right.” Knowing that the future is uncontrolled and uncontrollable, you are now free to do the right thing, whatever it is, at that moment. It may mean keeping another at arm’s distance; it may mean reaching out and holding them tightly. It may mean giving food to a neighbor; it may mean accepting a mattress on the floor. It may mean keeping to yourself; it may mean working together to forge a new community for a new time.

It also means a certain uncomfortable recognition, at least to the audience for whom I am writing. When you recognize and accept your uncertainty and your fear, it will also free you to see that there are people who have lived as you are afraid to live, every day of their lives. And within the bounds of their poverty of certainty, they continue to live lives of meaning and purpose.

I came to understand this through the eyes of my eldest daughter, who has spent several years wandering about this planet, frequently in places riven by war and poverty. And she has experienced, time and again, that the people who live in the most precarious situations, one step away from famine, one kilometer away from war, one drink away from drought – these are the people who were the kindest and gentlest of all. They knew privation, in their hearts and in their souls, and yet would reach out to strangers coming to them in times of need.

Now, I don’t want to ennoble deprivation, or glorify destitution, as there are bad actors among us everywhere. But it is an approach, an attitude, an assumption of life as it is, that people in these situations have adopted to make their lives bearable. And perhaps more than bearable, in a way that us children of privilege cannot understand. Yet it is time that we should.

You don’t have to go to Myanmar or Uganda to find this poverty. It exists right here, right now. In Waterbury, in Bridgeport, and even closer. Maybe even next door. We are neighbors.

Blessed are the meek, indeed, for they already know what most of us do not. And in your time of fear, look to them for instruction. We will not conquer this, for there is nothing to conquer. There is only the unfolding of events and our willingness to experience the process, whether it holds unwanted grief or unexpected joy. And in that acceptance, you will find freedom from your fear.



COVID NOTES: Slowing It All Down

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I spent part of yesterday reviewing my notes and culling out the patients that needed my care despite the risk of going out and about from those whose treatment plans could be safely put on hold for a couple of weeks. It’s a delicate balance, judging pain and its siblings – depression and addiction – versus risk, given all of the unknowables about this disease, but as always, it’s best to fall on the side of safety. There lies compassion.

I plan on doing some follow-ups by phone. Everyone who’s been a patient here knows that the chiropractic adjustment or the needles are only a part of my treatment. Education, training, coaching and engaging that deeper connection to help my patients pull out the best of themselves is really the bulk of what I do, perhaps the most important part. Even a video call is pretty watered down, but its better than nothing.

Last night, I put my office manager on notice that she would be working from home again, like she was during her leave in late 2019, but she insisted on coming in this morning. She had some stuff to pick up. And of course, with her usual efficiency, Giselle got my skewed schedule back on track, walked a few patients off the cliff, and hammered the financial end of things into hardened-steel shape.

Of course Giselle and I also had some good laughs as we always do, and then she left to get back to her younglings. I watched her go, briefly wondering when I would see her again, and then turned back to the tasks of the day with that too-familiar feeling of working without my right arm.

I’m seeing patients one at a time now, with plenty of spare to sanitize the treatment rooms between patients. The front door has a sign taped to it, instructing all my patients to stay outside and either knock or text me to let me know that they are there. Then I escort them directly back to their treatment room and get to work.

With Ripe Tomato Deli shut down, it was up to Ollie’s to fill the lunchtime bill, and I had the delivery guy drop it outside. I tipped him well because he, too, is putting it on the line.

It’s slow now, because this is how it has to be. This is how it should be. And maybe it should be closer to this when this crisis has blown itself out. There’s a lot to be said for contemplation and reflection, rather than having to work my magic on the fly all the time.

Perhaps it will be. When this is over, normal isn’t going to be the same normal that we’ve been used to. It will be something different, and nobody, absolutely nobody, knows what the new normal will look like. That’s one of the reasons that everybody is scared. Just one of many.

But fear is a topic for a different day. Today is a day of satisfaction, as I sailed through its waters without trepidation of the dark deep below, and allowed some of that sense of confidence to rub off onto the patients that needed it. I know this will all get worse before it gets better, but for today my family is safe and healthy and my patients are better off for having come to the clinic.

I’m going to call that a win.

COVID NOTES: Looking Into The Dark And Seeing Light

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In Wuhan, they're hearing birds chirp for the first time in years. The canals of Venice are running clear and filled with fish. The air in Italy's beloved Alps has become clearer.

And it's all because of COVID-19. As human activity has plummeted in the regions most affected by the virus, we have seen a bloom in their environment. Where yang no longer dominates, yin grows. Where commerce screeches to a halt, life shouts in joy.

There's a lesson for us here, should we choose to learn it. For the first time in most of our lives, we have a chance to see first-hand the results of a massive shift in human behavior. We can understand empirically the benefits if we should take some of these behaviors to heart and bring them forward into the future.

While we are self-quarantined, why not use this unusual silence to listen to ourselves? Just a few brief moments in our lives to listen to what is deep in our hearts, what we truly need for our happiness.

Do we really need 63 different shampoos, or do we need the quiet buzzing of bees as they keep our plants alive? How much of those empty grocery shelves that we stare at are normally filled with redundancy and excess? Must we run here, there and everywhere in automobiles, searching and never finding what is already in our own house, or would we rather feel the sun in our faces and breathe fresh, clean air?

If you are self-quarantined, you have already made the hardest of jumps to a new way of living. When health has returned to the world, are you ready to take some of those changes with you?

This puzzle reminds me of a quandary many of my chronic illness patients face. They have identified with their disorder for so long that they cannot imagine another way of being or of behaving.

Sometimes the pull of the familiar is too strong, and they drop out of care prematurely. In getting better, they are losing a part of their self-identity and they become frightened. Scared of what may be, even though that future is healthier and has less pain.

Sometimes the crisis comes later on. They have adopted the new ways that make them stronger but cannot maintain the necessary changes in the face of old habits.

This is us. This is humanity right now. We can see plain as daylight the benefits of remodeling our behavior on the world on which we depend. But how many of us are willing to turn that newly-informed gaze inward and commit to the changes that will make us, as individuals and as a species, healthier?

Of course, I’m not talking about the social distancing. But I am talking about the behaviors that make that possible, and how they can be recombined in new ways to form communities with new boundaries, new customs, new values.

One of the tenets of Traditional Chinese Medicine is that the human body is a hologram of the universe. That what changes our environment changes us, and what changes us changes our environment. When we engage with any illness, COVID-19 included, on that basis, it can lead us to fundamental, positive changes in how we live life and how everything around us lives.

Here’s an exercise for you: If you are not currently in quarantine, imagine that you are. If you are already quarantined, well, you’ve got a head start. Now take a minute or two or five and imagine the world that you would like to see when you finally walk out your front door again. Is it one full of stress and more isolation and a life measured by the number of different shampoos you can buy? Or is it one which you can see more clearly now, quieter, more measured, your family close around you, your struggles for one moment in abeyance? Which burdens are you ready to pick up when the bell rings and your “normal” world starts again? Which burdens would you like to put down now?

COVID-19 has forced humanity to press the pause button. It is now that we have the chance to redirect ourselves to a healthier self and a healthier planet. It’s our choice.

Choose wisely.

Understand Your Chronic Pain

(This is the first in a series on chronic pain, its causes and treatment.)

It sounds ridiculous, but this is something that both patients and doctors forget: Chronic pain never starts as chronic pain. You don’t get up from bed one morning, rub your right shoulder and suddenly realize it has been hurting for three months.

Chronic pain always starts as acute pain. But many things change while on the road to becoming chronic pain. Nonetheless, doctors and patients alike tend to treat chronic pain as if it is just acute pain that’s hung around too long.

It isn’t. Chronic pain is an entirely different beast. And if we are to manage it successfully we have to recognize that we’re no longer treating the same pain.

What happens is this: As pain (inflammation) continues over weeks, months, or years, it causes mechanical changes, physiological changes and neurological changes; changes that did not exist when it first started.

Without tackling all three, we will not succeed in treating chronic pain.

Let’s take a simple neck sprain, for example. Somebody pulls their neck out throwing a baseball, getting into a minor fender bender, or even catching themselves when they trip. After a few days, the pain starts to ease up; they never get treatment, because eventually it turns into an ignorable dull ache, or goes away entirely.

Then a few weeks or months later, there’s a flare-up; they either repeat the motion that caused the injury, or in some other way aggravate those muscles. This time it doesn’t go away, instead causing high levels of pain day after day after day. Then they call the doctor.

The answer, unfortunately, is all too often round after round of increasingly powerful painkillers while getting physical therapy for a neck sprain. And nothing really gets better.

That’s because the problem is no longer the sprained muscles. They’ve healed. But over time, there have been changes.

Because the person has been trying to ease up on their neck, their range of motion decreases and the muscles actually shorten. They don’t have to extend as far anymore, even though they should. Same with the vertebral joints. They start to lock up, because they really don’t have to move so much these days.

The inflammation, a physiological process, has turned into a positive feedback loop, with inflammatory chemicals and other changes causing the production of even more inflammatory chemicals.

The nerves themselves become overly-excitable, as they try to protect the neck from further damage, sending pain signals back to the brain at ever-decreasing levels of stimulation.

Eventually it reaches the point where almost any movement, or even rest, causes one of more of these systems to flare up, and the pain becomes constant.

Other symptoms may appear as well, such as headache, or even fatigue, as so much of your energy is spent trying to avoid/stop inflammation and pain.

As you can see, we’ve gone far beyond a simple sprained neck. And with the chronic pain, a number of other dysfunctions begin to appear:

  • Depression. Depression is the number-one coexisting disorder with chronic pain. We cannot ignore this issue, because it limits what we can do with all of the others.

  • Stomach/Intestinal problems. Chronic pain can change the environment of your gut, forcing out good bacteria, and creating the conditions for impaired digestion, creating nausea, bloating, constipation and other problems, as well as the malnutrition that always accompanies impaired digestion.

  • Pain in other places. As your body tries to compensate and placate the original painful area, it puts increased stress on the joints, muscle and ligaments elsewhere. They’re trying to pick up the slack, and getting overtaxed and overused.

Unless we address all those factors, we will fail in eliminating and controlling chronic pain.

In the next installment of this series, I will discuss in more detail how I help my patients with chronic pain in an all-encompassing treatment plan.

Or, if you are unwilling to wait, click here to make an appointment online. Or call me at 860-567-5727 to discuss your problem with me.

I look forward to speaking with you.

Looking within to a larger world

photo courtesy pixabay

photo courtesy pixabay

What better day but to spend by the heat of the forge with the sound of hammers ringing on anvils? Like my father before me, wood and words have always been my raw materials of choice. But each time my hands get hold of cold steel, magic begins to happen.

Actually, the magic begins in the forge, where fire does what Fire does -- that is, provide the energy of transformation in its raw state. Then man does what Man does -- impose his will on the mutable metal, changing it from blobs and blocks to tools and weapons and items for clothing.

And with each blow of the hammer on glowing hot steel, I see it molded with my very eyes into what existed until that moment only in my mind. Given my untutored, inexperienced state, the unerring shifting of molecules into something practically and aesthetically. pleasing I can only attribute to the blessing of Brigid, the guiding hands of Gofannon, or the blood of a smithy ancestor come alive once again in my veins.

I've honestly never experienced anything like it. I believe I'm falling in love with this most powerful and ancient of crafts, and that having tasted its fruit just a couple of times, I will remain unsated until I call the skills of a blacksmith my own.

Tomorrow I go back to the forge to finish and temper the hammer that appeared like magic out of a block of steel today. And with this hammer, and a fire, and the gift of Mother Nature's ores -- well, I can build anything, from the rockers on a cradle to the nails that hold a building together, to a temple from which we can contemplate the unknowable in all the very many forms we perceive her.

My 5 Core Principles

photo courtesy of tiameyers.com

photo courtesy of tiameyers.com

A number of years ago, I wrote down the core principles by which my practice operates. Such documents need to be reviewed from time to time, and it seems that now, during this time of rapid societal change, would be a good time. And inasmuch as my practice is an outer reflection of my inner self, the core values of my practice and myself are one and the same.

1. My patients’ health is paramount

In one sense, this is obvious. Healing is why people come to me. But a practice is a business, after all, and business concerns need to be addressed -- margins, overhead, profit and loss. Over the years, I have seen many medical and chiropractic practices, and more than a few have put the concerns of the business over the concerns of the patient. Scheduling and billing practices that suit the needs of the providers, not the patients, and treating patients as if they were simply grist for the giant medical mill are two signs that the patients’ best interests are not being looked after.

I’m proud to say that after nearly 25 years in practice, I have yet to turn a patient away because they couldn’t afford me. I have kept my fee schedule reasonable -- it has hardly changed over that time -- and I have always been willing to work out a payment plan. If that is still not feasible, I’ll take a patient pro bono, and accept their goodwill as payment.

After the thousands of people I have treated, I still feel honored each time I walk into Exam Room A and meet a new patient. It is an honor being chosen by someone to help them find health or become free of pain. And I try to make sure that, throughout their visits and their interactions with me and my staff, they feel honored.

This kind of outlook is also a basic principle of my particular brand of health care. We are, all of us, dependent on one another and our environment for our health. From the bacterial surrounding us and within us, to the friends and family beside us, our health is determined by the company we keep. So in keeping you healthy, I keep myself and my practice healthy.

2. All patients -- all people -- are equal.

It almost feels ridiculous to even mention it, but in these times, such words need to be said, out loud and up front. I do not tolerate intolerance in myself or in the people who walk through my door. Years ago, I redesigned many of my practice processes -- and even recoded some of my software -- to make my practice more open to transgender people, because so many doctors’ offices at the time were hostile to transgender men and women. Some still are. It goes back to Principle #1: All of those people around me are honored.

I will treat anyone regardless of race, gender identity, sexual orientation, religion, citizenship status or political beliefs. And at the same time, while you are in my office, as patient or guest, you will abide by this rule of respect as well. I hope for the day when I can drop this value from my list as no longer a concern, but in the past few months, I have had to remind some people that, whatever beliefs they may hold personally, bigoted speech and action will absolutely not be tolerated in my office.

3. I exist to offer an alternative.

More often than I would like, I have described myself as “The last doctor on your list that you should have come to first.” And that is in part of my own making. What I offer is unique, unlike most other doctors, even many chiropractic doctors. I am informed by science but not bound by it, guided by intuition but not blinded by it, and aware of my limitations but not afraid to push beyond them.

Unique isn’t what everybody wants in their healthcare, and I can understand that. But I stand at the border of where the tried and true has failed. Yes, I’m as capable as the next chiropractor at eliminating neck pain or taking care of a blown spinal disc. I can also guide my patients along paths to health which have been ignored or forgotten, to achieve results where other therapies have not.

It has been frequent enough that patients have come to me after years of illness and pain, and have left my care immeasurably better, that I know that this is not a fluke. And a great deal of my success comes from my adherence to Principle #4:

4. One size does not fit all.

From the day I opened my practice, I have been dedicated to the principle that customized treatment regimens work best. Unfortunately, this principle flies directly in the face of health care’s current guiding light: Evidence-based medicine.

Evidence-based medicine is built upon the idea that all patients with a certain diagnosis respond equally well to certain interventions. So, if a patient comes to my office with, say, low back pain, I’m supposed to recommend certain conservative procedures for a certain period of time, gradually replacing “passive” methods -- heat, electrical stimulation, spinal adjustments -- with “active” methods -- exercise.

Let’s just say I’m not very good at that. If a patient comes to my office with low back pain, I may end up talking to them about their marriage or job, or examining their feet or their diet. Why? Because I know from decades of clinical experience that these factors play a huge role in this kind of pain. The resulting care I provide will likely look nothing like what evidence-based-medicine declares to be the “right” treatment.

But it is exactly the right treatment for that patient.

5. Find it, fix it, and get out of the way.

My overarching job as your doctor is to make myself relatively useless in your life, as soon as possible. I aim to get my patients to the point where they are either free of the condition that brought them to my office or able to manage it largely on their own.

While I am working with them, I give my patients many tools and resources they can use to improve their condition when they aren’t visiting me, and I am not of the belief that all of my patients require ongoing care. Certainly the majority of people I see will need some measure of long-term oversight, but that is a decision that we make together. And there are some patients who leave care with a cheerful “See ya, Doc!” and won’t need to be back in my office for years.

Looking at the long term.

That said, I’ve now been in practice long enough to have as my patients the grandchildren of people who became my patients years ago. I treated their children as youths and young adults, and knowing how my care benefited them, are now bringing their own children in to see me. I have patients that I began treating as toddlers no taller than my knee, and who now tower over me, and come in for a visit when they are home on break for college.

I think these principles have served me well through the years, but more importantly, they have served my patients well. I am grateful for each and every person who has walked through my door, and remain honored and humbled by your trust in me. And that’s Principle #6: It really is all about you.

 

Are You Your Illness?

One of the things I have noticed in my decades of working with chronically ill people is that they learn to identify quite closely with their illness. They have to; it’s a survival strategy. The easiest way to adapt to pain or illness is to learn its patterns -- when it strikes, when it sleeps, what will provoke it, what will mollify it.

Psychologically, living with chronic illness or pain is like living with someone who is abusive, and from whom you have no power to escape. Eventually, you come to identify with your abuser, and make their patterns your own. This disempowerment of the self, the loss of the ability to see yourself outside of your disease, makes it far easier to live with it, yet at the same time makes it more difficult to improve.

The person who identifies with their disease is perhaps the most dangerous and difficult to help manifestion of chronic illness that I have seen, and it can take many forms. I’ve had beautiful women in tears in my office over the belief that no other would accept them as a partner because of their chronic joint pain, and I frequently see posts on social media from people whose entire public presence is built around coping with their disability. Once you have identified yourself as “I have X” (X being a diagnosis, like MS, fibromyalgia, sciatica, irritable bowel disease), separating self from disease becomes a monumental task.

Part of the problem is as a result of how we look at disease in this society. We turn health issues which are basically dysfunctional processes (an overgrowth of cells, excess deposition of fatty tissue, production of inflammatory cytokines), into a static thing: “I have IBS,” we say, or “I have arthritis.”

Once you have converted something from a process into a thing, you have made it much more difficult to change. A process is the B train on the Green Line; it can go fast or slow, make stops, let riders off and on. A thing is a rock; it does not move. It can be changed by the erosion of water and ice, but it takes eons and lifetimes will end before any discernable difference is made. Processes are malleable to time and space and changes of input. On the other hand, things don’t change, without application of saw and hammer and destructive acid.

The second part of the problem becomes how we describe ourselves. Instead of a person with high inflammatory potential and impeded antioxidant processsing, we say “I have arthritis.” Rather than being a person who reacts strongly to certain foods which influence neurotransmitter production, we admit that “I have depression.”

So there we have it. We have a thing which we cannot change, which is only sufferable by controlling our behavior in the most intrusive ways possible. You might as well proclaim “I AM HEART DISEASE.” Because that, in your heart of hearts, is what you’ve been taught to believe.

This self-identity can become so strong that I have, many times, had patients abruptly abandon successful care because it was taking away a part of their selves that they had come to accept as necessary and needed. I would call them on the phone, ask them, “What is wrong?” They would reply, “It was working so well, and then I felt so bad!”

This was my failure, because I failed to prepare my patients for what they could become in the absence of disease. They could become more, not less.

Over time, I have developed a method of helping patients to realize that which they can be, without illness, without pain, and without all of the benefits they may see themselves as getting as a result of their illness.

I call it Contemplation of You As You May Be.

Step 1: Sit somewhere quiet, where you won’t be disturbed for 10 to 15 minutes. Close your eyes, and form a mental image of yourself. See yourself, as your disease affects you, in stillness and movement, in shape and color, in smell and sound. Take a minute or two, and completely build this picture of yourself in your mind. Feel and explore the effects of your disease or your pain on your body.

Step 2: Take a piece of paper, and write down all of the attributes of your illness on your body. There will be different groups of sensations: There will be the appearance -- red, pale, swollen, scaly. There will be the sensations -- burning, achy, itchy. There will be the mental -- fatigue, forgetful, hyperactive. Then there will be the emotional -- sad, mirthful, confused, scared.

There will be more than you can think of, and the first time you do this exercise, it is best not to overwhelm yourself with too many attributes. Start with the obvious ones, that’s good enough for this time.

Step 3: Having written down all of those attributes, close your eyes again, and re-imagine the mental image of yourself that you developed in step one. Then, one by one, start removing the attributes of your illness. Start with the physical ones. See yourself without the swelling, without the redness. Take your time.

Once you have a strong image of yourself in your mind without the physical attributes, begin to remove the sensations -- the pain, the burning, the ache. What do you look like without those things? How does that image of yourself feel without them? Again, take your time. This may be as far as you get the first time you do it.

But if you can go further, keep removing more and more aspects of your illness, of your pain. Take away the sadness, take away the fatigue. In your mind’s eye, what do you look like? How do you feel? How does your voice sound? What is it like to move?

Once you have removed all of the attributes of your illness, what will remain in your minds eye is you. Your without the disease. You without the pain. You without that which has forced you to be something that you are not for so long. Be prepared; your mind will keep wanting to return you to the first image. Keep yourself fixed on the self without disease.

Know that this person, this aspect of you is alive and well, and strong. Every day, do this exercise, until finding the healthy you is a trivial matter. And as that you becomes stronger and more real, the you defined by your disease becomes weaker and weaker. Eventually, you will have divorced yourself so thoroughly from the process of your illness that your therapy -- whether it is chiropractic, or acupuncture, or exercise or diet, or all of the above -- begins to take hold. You are replacing sick belief with healthy belief.

And at some point, when you look at your reflection, you’ll realize that the you in the mirror has become the you in your mind.

Coming home to a place I've always been before.

avery-aikido-2-copyI've been a fortunate man. Four times in my life, when I have needed it most, I have walked through a door to find a place to call home. A place that, at least for a time, I could unpack my suitcase of Avery trinkets, put a picture or two on the dresser, and leave leftovers in the fridge without worrying about them getting stolen. The first was when I arrived, via a rather circuitous route involving mountains, chain saws and motorcycles, at the university that was eventually to grant me a Bachelor of Philosophy degree in Interdisciplinary Studies. I remember my first night there, sitting alone in the pub in the basement of the dorm (yes, those were a thing back in the day), sipping on a beer and suddenly knowing -- without a shadow of a doubt -- that I was where I would find happiness for the next few years.

The second was when I walked into the house in which I now live. I knew -- I just knew -- that this was where my wife and I would raise our children and set down roots.

The third happened just a few years ago, as I climbed a staircase and met a room full of Druids, and in one flash, realized that this, too, was to become a home. Or, as I thought at the time, "these are my people!"

The last was just two weeks ago, as I once again stepped onto the mat of an Aikido dojo, after years of absence. I bowed, sat in the formal kneeling posture known as seiza, and began picking up the dropped pieces of my skills, beginning to re-assemble them into something similar to, but different than, what was. As I bowed before the shrine of the founder, I was filled with a flowing stillness, an unshakeable recognition that I and the universe were once again in harmony.

***

My relationship with Aikido, like any lifelong affair, has been smooth and stormy, healing and damaging, and in the end, very nearly discarded as lost. I first met Aikido through my now-deceased brother, on that twisting journey to my undergraduate school. By fortuitous accident (I was avalanche-blocked in the middle of a mountain climb in northern California), I ended up in Grant's Pass, Oregon, sleeping on a the floor at my brother's apartment. He had been dipping his toes into Aikido, and took me with him to a couple of classes. I was fascinated; the fluid force of the art was something I knew I wanted to learn. Instead, I moved back East, and returned to college, but the white practice uniforms and dark pleated skirts known as hakama were not forgotten.

Several years later, I found myself single and steadily employed in Boston. Looking for a way to meet new people (i.e., pretty single women), I discovered that there was an Aikido dojo not too far from where I lived. I signed up, and started going to classes. I loved it. At first the rolls made me dizzy, and I couldn't tell my right foot from my left, but I had no doubt that I would figure it out. Sadly, though, life started throwing some curve balls, and I had to throw my training clothes,  keiko-gi, in the back of the closet and take care of business.

So, despite our first meeting in 1978, it wasn't until 1990 -- married, re-settled in Connecticut, and returning to school to become a doctor -- that Aikido and I began our longer dance. It was, by all accounts, a slow dance. I passed my test for the lowest level certificate -- 5th kyu -- in 1991, but it wasn't until 2005 that I was ranked at 1st kyu, which is only the level before your first black belt.

I had to balance my training against going to school, starting a practice, starting a family, and being a father during those years, so I wasn't always the most diligent of students. And, let's face it, I wasn't the most talented aikidoka to ever grace a dojo's mats. But I wouldn't quit, I couldn't quit. Something kept drawing me back. Aikido's various governing bodies are generally not anxious to hand out ranks, and the rank of shodan -- or first degree black belt -- typically takes 7 years, even though that rank is still considered only the beginning of your journey. It took me until 2007 to be granted my shodan. That was 16 years after I received my initial certificate.

The achievement initially invigorated me, but by then, I was feeling pretty battered. The Art of Peace can be practiced hard or soft, and though my teacher (sensei) encouraged me to practice the latter, I chose the former. By the time I had gotten my black belt, I had shattered my nose, separated my shoulder, suffered two concussions, been choked senseless, and busted my left big toe. None of this, mind you, was the fault of my sensei or the other students I trained with. In true karmic fashion, what I brought to the dojo reflected back on me fourfold. I staggered on, but my attendance drifted off, and then stopped entirely. I think I kept paying for my dojo membership for another year or so, because I wanted to keep hope alive in my mind that I would return. I didn't. Between 2009 and a few weeks ago, I tried one comeback, which failed entirely. I didn't last a month. I hurt, and worse, I felt incompetent.

***

Though I had physically clearly left the dojo, my mind never did. Sometimes, even years after training, I would have a dream in which I was doing throws and pins. Walking down the street, I would imagine how I would respond if jumped from behind, remembering in my mind the drop and turn that effectively turned your attacker's energy into your own. Clearly, some sort of martial flame still burned inside me. The warrior sought his escape, but my body refused to cooperate.

So last year, I began training in Tai Chi, a Chinese "internal" martial art, which is barely even martial. It is more employed for its health benefits than its fighting skills these days, though it remains a formidable skill. But it is the most gentle of arts, taught initially as a slow dance, during which one comes more to focus on the flow of energy -- Chi, or Ki (the same ki as in Aikido), than on any possible opponents. Even in paired form, the art of push hands is gentle and mannered. No-one goes tumbling to the floor, much less flying across the floor to land in a breakfall. This should have been the ideal practice for an aging martial artist with a deviated septum and a bum shoulder. And it was very enjoyable, at least initially. I learned the flow of energy, sensing it and feeling it in a way that has also informed my acupuncture practice, making me that much more accurate in my needle placement. Throughout the winter I trained. The studio I trained at had no formal wear, so I found myself going to class in what I called the  "clothes of a broken man," a pair of sweat pants, a t-shirt, and a hoodie. The sartorial commentary alone tells you how I felt about things. I was indeed broken, my body no longer capable of what I had long trained it to.

Over time, a few things began to bother me. This training studio (I never heard it referred to as a dojo or dojang) was very westernized. A cursory bow on the mat was the only etiquette observed; people talked in class, and the entire session was treated somewhat casually. The instructor was referred to by his first name, and he talked. A lot.

I had spent most of my life training under far more austere conditions. I was trained to bow when I walked in the dojo, with a seated bow as I stepped onto the mat. Class was started with all of the aikidoka sitting seiza in a line, waiting for sensei to arrive, at which time we all bowed together, and to our sensei, shouting "Onegai shimasu!" (Please let me train with you!). The formality of the dojo is, in a way, a buffer for the sometimes dangerous activities that go on within, and a way of preparing the mind for the class. After class in the dojo, we bowed to the Founder again, bowed to sensei, and after she left the mat, we bowed to each other individually.

At the Tai Chi studio, we walked around and high-fived each other, then after another cursory bow, we walked off the mat. For someone who had emotionally and spiritually grown up in an environment of martial ritual -- and who knew what that ritual was for and the power it possessed -- this was, in the long run, very uninspiring.

I took a break last spring to focus on my cycling, as I had a couple of long tours lined up. In August, I began considering my return to Tai Chi, and found it unpalatable. It didn't scratch the martial itch inside me, the need to swing a bokken or a training partner overhead. It's taken me 58 years, but I have learned to listen to my heart. And it was telling me to go back to my long-lost love. Against the wishes of my wife (who, let's face it, has put up with a great deal of martial nonsense over the course of our marriage), I sent an email to the sensei who had guided me from my 2nd kyu to my shodan.

"Would you take me back on the mat?" I asked.

"Avery," she wrote, "you are more than welcome back!"

So I went.

My first class was fun. That was the class that I turned the key in the ignition to see if the engine still ran. I didn't care if it was two cylinders or four, I needed to know if their was gas in the

If the hakama fits...wear it.

tank and spark in the plug. There was. I even found that I remembered much of what I had left behind. Aikido had been so burned into my muscle fibers and synapses, it required very little encouragement to come out.

The second class was also fun, but in a different way. That was when I found out that I was still misfiring. As we were shown a throw, and then squared off with partners to practice it, I found that I would randomly -- in the middle of a throw -- switch from the one demonstrated to another one that my mind remembered at random. Fortunately, my training partner was flexible and put up with my chaos willingly.

A few more classes, and that had settled down. I found that I still remembered much, and was not nearly as hobbled as I feared. I also realized that my somewhat maligned training in Tai Chi had, in fact, given me what I most needed. I was softer now, I could be slower, less harsh and demanding of both me and my training partner. It was a gift a never knew I had been given. I noticed that I was smiling, and even laughing sometimes, as I worked the attacks and throws with different partners.

When I had returned to the dojo, in deference to my lack of training (and in deference to a somewhat expanded waistline), I didn't wear my hakama. It didn't seem right, somehow, when I didn't even know if I could roll or throw. Last week, sensei told me give it a try. So I put it on; it was a little snug, but it felt right, like I belonged in it. I wore the hakama for the first time Monday night, and as I rolled, fell and threw, I could feel it swirling around me, reminding me and encouraging me to stay on this path that I had almost abandoned.

At the end of class, I sat on my heels and bowed deeply, grateful for this last opportunity. I sat up and looked around, seeing the mats in front of me. I heard the quiet talking and laughter in the changing room behind me. I smelled the old familiar smells of hard work and sweat.

I was home again.

 

The Panniers That Won't Quit

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anhaica rear viewI don't trust reviews from people who have just bought the product. Still high on their purchase, they rave about a tool that they have barely used, and a review based on such limited knowledge has little value, in my mind. Which is why I've waited several months and 550 miles before writing this review of my Anhaica Bag Works panniers. Since buying my panniers, I've taken them on two tours and used them for around-town errands like going to the library and the CSA.  I'm pretty sure I know them by now. I also want to state for the record that I have no ties with Anhaica Bag Works or its proprietor. She hasn't offered me any discounts, deals or other renumeration for writing this review. This is important to know, because I'm about to come off as the world's biggest fanboy. Because these are simply the best bags I've ever used and the last panniers I'll have to buy.

I've been cycling for transportation and recreation for 40 years now, and have owned panniers from Lone Peak, Nashbar, and others. My panniers have carried books, groceries, bricks, motorcycle parts, and all the goods one needs for a 1-2 week tour. All of them have fallen short in one way or another -- too small, not durable or leaky are the usual culprits.

So when I began preparing for my Great Allegheny Passage/C&O Canal tour, I had a fairly specific set of criteria in mind. I needed size, because I was doing a self-supported camping tour; I needed reliability and durability. I needed an easy functionality; this is a tool I want to use without thinking about. Last, but not least, I wanted good looks.  I looked at all of larger pannier manufacturers, such as Arkel, Ortlieb and others, but I settled on Anhaica instead. I had some prior history with their products, a rack trunk and handlebar bag, which had both worked suitably, and I was familiar with Anhaica's standard of craftmanship -- which is very high indeed. Anhaica is a small shop in Florida, where they make all of their bags by hand. They are designed and used by the shop's owner, who, in addition to being a talented seamstress, is a cyclist herself. Everything they sell, she's road-tested. She tested the Raid panniers, for example, by taking them on a 5-week European tour.

anhaica saddle upThe Raid panniers are made out of waxed canvas, using locally-sourced beeswax, and they are lined with nylon. These bags are undeniably and reliably waterproof. The heavy canvas and attached straps and buckles are durable enough for overstuffed bags to be tossed from bike to train, bike to rocks, rubbed against trees and boulders, carried about on foot and generally mistreated, with nary a complaint. I am, by nature, hard on things, and I expect breakage. These panniers spent a lot of time stuffed to the gills, and not only failed to fail on me after 500 miles of hard usage, but seemed to thrive on the abuse. And, just in case you're wondering if something as antiquated as waxed canvas can be as waterproof as a more modern, synthetic fabric, let me put your mind at ease. These panniers endured a 12-hour soaking, with nary a damp spot inside. So their functionality on that account is assured, even after being repeatedly tossed off the bike onto the ground, or rubbed up against brick in the depths of a dark tunnel. So, durable? Check.

These panniers are simple, which is the way I like my travel gear. I don't see the need for having multiple pockets, quite frankly, because I forget where I've stashed things, and then I forget to zip the pockets closed, and then things start bouncing off. Also, I believe that you do better on expeditions by keeping your gear simple and removing as many points of failure as you can. A simple roll-and-flap set of panniers like these eliminates a lot of weak spots. Open bags also mean weird sized items will fit. The panniers are roomy, measuring 16 liters with the top fully rolled down, which gave me plenty of storage space. Other tourists end up with tents and sleeping bags strapped on their racks...not this guy. Everything fit in the bag. These bags don't zipper shut; you roll down the top like you do with Ortliebs, and then a flap covers the top. This also means you always have a tight load, with nothing bouncing around, and the pannier expands or contracts as needed Just for good measure, I added the Anhaica saddle bag, which carried my extensive repair kit. Size: Check.

One of the nice features -- actually, it turned into an essential feature -- is that one of the bags quickly turns into a rucksack with padded shoulder straps. It's not anything that you would take on a 20-mile hike in the woods, mind you, but if you suddenly find yourself on a ride-share bike with no rack, as I did in Washington DC, this feature is a lifesaver. It's also handy for taking in the grocery store  with you for shopping, then hooking it on the rack for the ride home. The hooks on the bags are very strong, and securely lock to the rack. There's no bottom bungee that you have to hook up, the top hooks do it all. In practice, there's no sway to the bags when cornering. Functionality: Check.

Finally, we get to perhaps the least important aspect of the panniers, the looks. My bike was built with a specific, semi-retro look in mind. British racing green and chrome, upright handlebars with cork grips and bar-end shifters -- you get the picture. I wanted a set of panniers that matched aesthetically with my bike, and these fit the bill perfectly. After use, the canvas has developed a lovely patina.  Believe it or not, on my GAP trip, I had no fewer than three people come up to me and tell me how awesome my panniers looked. Really? When was the last time anyone received compliments about their pannier styling? Aesthetics: Check.

Some features of note: There are some nice touches that Anhaica adds to their bags which I've not seen elsewhere. Like D rings on the tag end of the straps which loop around the working end, so you don't have loose ends flapping in the breeze or, worse, coming undone. The top flaps are also equipped with D rings so you can tie on additional items, like laundry that needs to dry, or a sleeping pad that won't otherwise fit. (That said, I found that all of my camping gear -- tent, sleeping bag, sleeping pad, stove and pots all fit easily into a single pannier.) There's a reflective stripe on the back for those really, really long touring days. Each bag has a single outside zipper pocket, but that's it. These panniers aren't filled with needless features, they are filled with simple strength and durabilty.

Downside: There isn't any. I'm pretty sure that my Anhaica panniers will outlast me and continue on into the next generation of cyclists in the family. And they'll keep looking good. Really, what more could you ask for.

So, even after all of the miles, and plenty of opportunity for me to become disenchanted with these panniers, I've found that I've only grown more fond of them, and, in fact, can't wait to use them again. Hmmm....Quebec has some mighty nice bike trails I hear...

 

 

Why this doctor is speaking up about politics. And will continue to do so.

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voting_machineLooking back on my social media activity over the past few months, it is clear that something has shifted. It's gotten away from the interesting advances in alternative medicine and groovy bicycle stuff that I usually discuss, and has plunged heavily into politics. A savvy marketing consultant would probably slap me upside the head while telling me how off-message I've gotten. And they probably would be right. What's a doctor doing talking about politics? It's really not in my wheelhouse, and the topic stands a better than average chance of driving away patients.

On the other hand, maybe politics is a doctor's business. But before we get into that, a personal mea culpa: Like so many other people in this country, I'm feeling a certain amount of concern over our collective potential futures. I'm not really fearful -- a man who has twice gambled everything he has on slim chances of success is unlikely to respond to fear -- but I am worried. It seems that we're at a pivoting point, and the pivot extends through about seven dimensions. None of us can see clearly what's ahead. As a result of my own concerns, I've been more than usually willing to participate in discussions I would normally steer clear of. What may have gotten masked in the verbiage is that I'm personally pretty accepting of a wide range of opinions. Sure, the world would be darn near perfect if everyone believed like me. It would also be incredibly boring.

Transgender people have bad backs, too.

But, professionally speaking, should I even be mentioning politics? It's something I rarely discuss with patients in person. For the most part, within the confines of the treatment room, politics wouldn't seem to affect outcomes. But the fact of the matter is, politics often plays a huge role in affecting  patient care, and can have a dramatic influence on outcomes. Let me give you an example or two.

For several years, I made it a point to reach out to the community of transgender people. Not that I have any specific skills for helping transgender people transition or become comfortable with being beyond binary gender classification, though I have sought to educate myself above the general level of knowledge. Nevertheless, those tasks are best suited to endocrinologists, surgeons and therapists. But, you know, transgender people have bad backs, too. And headaches, and allergies, and tummy problems -- all the things I treat on a daily basis. I  wanted my clinic to be a place where transgender people could just come and get their health issues dealt with in an environment where their gender identity doesn't really matter. In doctors' offices that's all too rare.

During that time, I got a glimpse of just how powerfully our political system affects individual health. A large part of what causes some of the dysfunction associated with transgender people's functioning has nothing to do with the individual, but is more due to society's rather dismal response to those who don't fit into our narrow categories of normal. While the gay and lesbian rights movement made tremendous strides during this time, transgender people were largely left behind. The mantle of shame and fear impressed upon them by our society hobbled many of our efforts to improve health. I treated transgender women who refused to exercise, fearing they would bulk up, lose their femininity and no longer "pass" as a woman. I had transgender men as patients whose use of the local gyms was hobbled by their inability to use the appropriate locker rooms.

Perhaps the greatest inhibitor, however, was poverty. Because of their status as outcasts, transgender people often find it difficult to get or hold a job. State insurance in Connecticut doesn't cover chiropractic care for anyone over the age of 18 (I have yet to make any sense out of that particular regulation), and when it does offer coverage, it provides benefits only for a chiropractic adjustment, but none of the other services I provide and that are within my scope of practice.

It is not an exaggeration to say that almost all of my services to transgender patients were, as a result of politics, public policy, and the vast bigotry inspired by social conservatives, provided free of charge. I didn't mind; part of my individual social contract is to care for the sick regardless of the ability to pay.

So the detrimental influence of politics here is two-fold: First, and most important, is how social policy and attitudes impedes the ability of transgender people to navigate a healthy path in society. Second is the social net so full of holes that I couldn't receive payment whatsoever for treatment of a transgender person's headache, if that particular treatment required nutritional or acupuncture intervention rather than a chiropractic adjustment.

An absurdly loose definition of "safe."

Politics is my business in other ways as well. Take, for example, the push to hide GMO produce from the consumer. A lot of my practice is based around nutritional intervention, and very often I am providing care for people who are very sick, and have been so for years. In these cases, the quality of the food in their diet is absolutely critical, and for at least some period of time, must be tightly managed in order to acheive the results we want. How on earth can I do that when I don't know what is even *in* their food?

I know the argument is that GMO plants have been tested as foods and found "safe."

It's an absurdly loose definition of safe. Food safety testing for genetically modified plants has consisted of exactly this: The GMO food is inserted into a livestock's feed for a period of time, not exceeding 6 weeks, while it's effect on output (eg, milk for dairy cows) and "health" (in this case, soley measured by weight loss (bad) or weight gain (good)) is measured. If the cow keeps making milk and the pig keeps making bacon, the GMO is determined safe.

There has been no legitimate long-term testing of GMOs and their role in chronic diseases such as arthritis, cancer or heart disease, not to mention how genetic modification affects the levels of macro and micro nutrients. How can I tell a patient to increase their levels of certain foods in their diet, foods that were once known to have certain levels of a nutrient, if genetic modification has changed it in unknown ways? Worse yet, what if my advice floods them with previously unconcerning levels of chemicals that worsen their condition?

That is tantamount to an MD telling a patient to take the pills in that brown bottle without a label on it. They don't know what's in it, and neither do you. Food is my patients' medicine, and through the political expediency of not requiring appropriate labeling, my ability to prescribe the kind of medicine my patients need is being stolen.

A catalyst for change.

Finally, I must address one other reason why I have felt so strongly to speak out in this political season. It is because, over the past two decades, I have come to realize that my role in patients lives is not just the dispenser of adjustments, advice, exercise and supplements; I am, sometimes by choice, and sometimes by default, a change agent. By the time people get to me, their lives are often so contorted, so distressed by malaise and malfunction, that nothing short of a grand step into the unknown will help them. I'm the guy who holds their hand and helps them make the jump.

A case in point: Many years ago, a patient came to me for nutritional advice. They wanted me to help them fix their diet. And, after consultation and examination, I found that a single change would eradicate a large piece of their health problem.

I told this patient that they needed to stop drinking. That the alcohol was taking their health and would eventually kill them.

That wasn't the first time I discussed alcoholism with a patient, nor would it be the last. It's never an easy discussion, and it is rarely something that the patient wants to hear. I try to be honest, caring and non-judgemental; alcoholism isn't a failure of morals after all. But it is a diagnosis that is loaded with massive societal overlays of blame and self-loathing.

In this particular case, the patient stormed out of my office in a rage. I felt bad, like I had failed them. My failure stuck with me for years.

Several years later, I was interviewing a new patient. I asked them how they had heard about me, and they told me that this former, one-time patient of mine, the one who had stormed out of my office in anger, had referred the new patient to me from a sober facility. That was nice to hear, but it was the way they worded the referral that clutched my heart.

"Go see Dr. Jenkins," this patient had said. "I'm alive today because of him."

It was then that I realized that, at the core of what I do, I am a catalyst for my patients, enabling them to do things they couldn't do before. That is my most fundamental, and most important, role.

So it is in this election. I can't see much in the murk, but what I do see in this time in our country is the potential for change. The change can be good or bad, but in my very small, very limited way, I will fight for the change that I think will make this country healthier. We are sick right now, sick with anger, sick with bigotry and sick with unnecessary poverty. If I am to be true to my role as a healer, and true to myself, I feel that I need to fight for the changes that will make us all a little bit healthier.

You may not agree with my opinions, my message, or my candidates. That's fine, civil disagreement is what makes the world turn 'round, and I've emerged from political tussles with more knowledge and sometimes a fresh perspective that changes my opinion.

But just know this: I am working as hard as I can for what I believe is the healthiest outcome for us all. And I also choose to believe that you are too.

Time to turn off the air conditioning.

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mindful manFor most of the past week (and part of this week), the Center has had no climate control. The AC compressor, already among the ancients, seized completely last week. After consultations with the experts from Elite Energy in Goshen, I decided that the best thing to do was to replace both furnace and air conditioning. Frankly, I've been keeping the furnace running with magic beads and baseless threats for the past two years, so I consider this to be a good opportunity. Elite Energy came back to me with an excellent bid on the job, so I gave them the go-ahead. The catch: It won't happen until Wednesday or Thursday.

That's actually no problem, as the weather is mild, and this building is well-insulated, which means cool nights will last until noon. Then we have to open the windows.

But this experience has made me think how, in many ways, this change is beneficial for my patients. One of the essential health problems of our time is the disconnect between us and our environment. And the more we struggle to control and isolate ourselves from our environment, the sicker we become. For example, we now know without a doubt that early exposure to bacteria in the soil improves immune system functioning throughout our lives. We know that peanut allergies are likely caused by not being exposed to them as infants. We know that walks in the woods reduce the symptoms of depression and improve cognitive functioning. We know that the chemicals we use to isolate our foods from their environment results in illnesses in ourselves.

How much of a difference would it make in our health if we stopped cocooning ourselves in climate control? It's a question worth asking.

I might have a different perspective on this than many, because I have never lived in a house or apartment with air conditioning, and for the past 18 years, have relied for heat primarily on a single wood stove in the center of my New England colonial-style house with single-pane windows that rattle in the breeze. I ride my bicycle or walk to most places, including work, 10-11 months out of the year. So I've lived my life closer to the patterns and cycles of our weather than many Americans, to the point where I am surprised when I walk into a climate-controlled house in the summer. (Interestingly, though, in the 1960s, only 12 percent of Americans had air conditioning in their homes. People seemed to survive ok.)

Certainly, aesthetically, buildings open to the natural world about them are more pleasant. In the spring, I am greeted by the smell of budding flowers and freshly-mown grass wafting in the kitchen window as I have my morning coffee. Thunderstorms in the evening bring a sudden, refreshing coolness, and you can smell the ozone in the air.

Being exposed to the environmental changes brings on eating changes as well, keeping my diet in sync with my physiological response to nature.

Conversly, we know that air conditioning can cause bad health. Asthma and allergies can be worsened by air conditioning, sometimes as what is known as sick building syndrome. This is usually attributed to poorly-maintained systems. In a well-maintained system, allergies are more often relieved by air conditioning.

Outside of that instance, I would argue that air conditioning is bad for your health in other, more obscure ways, and it goes back to the principle of being dissassociated from our environment. The less contact you have with your environment, the worse you are. Not surprisingly, this notion has received little attention among medical researchers. Of the few studies published, however, the results are suggestive that more frequent exposure to the natural environment leads to better health.

Fortunately, however, I'm not tied to the research. I rely as much on the wisdom of my professional forbears as I do on modern research, and in that, the conclusions are unequivocal. Changes in environments have been prescribed since the days of Avicenna and the Yellow Emperor, and through the ages, "environmental therapy" has been an essential feature of the treatment of many serious disorders.

So, even after we get our climate control systems back online here, I think I will make more of an attempt this summer to keep my patients exposed to the healthy environment around them. In my office, patients find themselves regaining health in the most surprising ways. I should not ignore such a powerful intervention that has been used successfully for millenia.