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

I'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

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

I 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.

The 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.

Looking 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.

7 Ways to Make This Year Better

Over the past couple of weeks, I've been talking to patients and friends about how the past year went for them. Almost without exception, I have heard how tough a year it has been, and not surprisingly; the economy is anemic, the natural world is in increasing disarray, the presidential race has illuminated a vast and perhaps unbridgeable cultural rift in our country, and the media has managed to scare the bejeezus out of everybody with terrorist ghost stories. For a lot of people, it's not a pretty world out there, and the future isn't terribly bright. But here's the secret. You can change things. Not just internally, though that is part of the process. But your will is part of what makes the world. Collectively, mankind creates the reality we live in, not only through shared values and beliefs, but also through our intent. We can create a bountiful, beautiful world, or we can create one marred by anger, fear and want. Each individual contributes to the collective reality, some to a greater degree than others, simply because they understand how to exert their will in a way that creates a large impact. Most of us, frankly, do not have that strength of intent. But we all have the ability to alter the environment immediately around us, using the raw material of the collective gestalt.

There are seven concrete acts that you can do that will change the world around you. Do these consistently, and watch the results.

Meditate

Meditation is a sure-fire way of harnessing the wild and often wasted power that exists within all of us. In the past two years, there has been a tremendous amount of research on meditation and the changes it creates, and it is the most powerful behaviour modification tool that exists. Even within a few weeks of beginning a daily meditation practice, beneficial neurological changes begin to appear. After a year or more, these changes become quite profound.

Even better, there are endless ways to meditate. Every religion in existence has some form of meditation, and engaging your spiritual side can amplify the results of your meditative practice. If you are atheist or do not adhere to any specific metaphysical tradition, mindfulness meditation has positive, powerful results.

The down side, if there is one, is that it needs to be practiced virtually every day. Once you've instilled it as a habit, this won't seem so daunting.

Exercise

Exercise is the pill for almost every ill. There are few conditions that exercise doesn't improve, and there is nobody that can achieve true health without it. And there are no excuses for not exercising. Over the years, I've gotten patients with every chronic disease under the sun to exercise, and all of them have improved from it.

You don't need a gym membership, either. A terrific cardio workout is no further away than the street out your front door. Want to lift weights? Do a bodyweight routine that uses leverage against gravity to build muscle. No time? No way. Get off Facebook.

Exercise also creates neurological as well as physiological changes that are beneficial for meeting the challenges that life throws at us. I, for one, appreciate the feeling of power and strength in my body when I am about to undertake something arduous, whether it is a long, busy day at work or a difficult meeting. My outer strength feeds my inner strength, and if you want to be powerful in this world, the power starts in your arms, legs, heart and hands.

Goalsetting: Do it right

Most people don't reach their goals, not because their goals are too difficult, but because they set the wrong kind of goals. Goals should be process-oriented, not object-oriented. For example, instead of setting a goal of, say, getting a new job this year, your goal should be talking to 10 people every week who can help you find the job you want. Instead of setting a goal of buying a new car, set a goal of putting aside $XX every week.

Process goals have the advantage of giving you frequent, positive feedback. You get that warm fuzzy feeling of looking at your growing bank account at the end of each week and realizing that you've met your goal, rather than slogging along at a goal that looks far, far away. We're designed to respond to instant, positive feedback. It's hardwired into us. Make use of that.

Additionally, process goals are more flexible than object goals. If, somewhere along the way, you decide you would much rather get that awesome commuting bike rather than a new car (a very wise decision, I might add), you don't have to change your goals at all.

Process goals will get you where you want to go, even if the end result is hidden in the far-off mists.

Time management

Look, I'm not going to mince words here. You're going to die, sooner rather than later, and you really don't have a day to waste, except for those days you choose to waste. But make time wasting a conscious choice, not a default behaviour,

Some spiritual traditions (I'm looking at you, Zen) encourage you to ignore the past and the future, and concentrate only on the present as the only time that exists. That is all well and good for focusing your attention on important matters, but it really puts the damper on long-term planning, which is not a good thing. The argument goes that if you take care of today, tomorrow will take care of itself, but that's not always true. Our environment changes constantly, and those who are not looking at the changes coming their way are the ones who will be injured by the surprise of their arrival.

Here's the thing: Buy a 50-cent notebook, steal one of the free pens from my office, and write down everything that you need or want to do. Don't worry about time, date, or priority. Just write it down, and make sure to cross them off when you've finished a task (that warm fuzzy feeling again).  You'll be surprised at how much that you thought you couldn't get done that you are suddenly accomplishing.

Also, keep the notebooks. They, as much as a daily journal, will give you a point of reflection of your life over the course of the years.

Keep it clean

Energy (and that, after all, is what we're talking about, the accumulation, control, and direction of energy) is attenuated by chaos and strengthened by order. If you're one of those people who says "Oh, my (desk, room, office) is messy, but I still know where everything is," give it up. Give it up right now. I used to be one of you, and what I sadly discovered that all the tightly focused concentration and intent and willpower would get dissipated into a steamy mess when it hit the clutter of my desk.

You want your willpower to do something for you? Don't make it march through a swamp to get to where it can do you some good.

In fact, write "clean it up" as the first entry in your new 50 cent time manager. And when you finish the first page, write it on the top of the next. And the next...

Seek the wisdom of others

Face it, you don't know everything, even if you, like I, think you do. Find mentors to help you walk your chosen paths. Find friends who will feed you when your pack is getting empty. Find assistants who are really, really good at the things you do poorly, and treat them like the gods and goddesses they are.

I often say that I am grateful to my patients, because they have taught me most of what I know as a doctor. And I know, it sounds like some cheesy marketing pablum, but it's true, dammit. I cannot tell you the number of times I have walked in the exam room to greet a new patient, and to their surprise, rather easily fixed their problem. But that's only because I had a patient last week that had the same problem, wasn't responding to the normal approach, and kept me up nights thinking about what I wasn't doing to get them better.

So, invite others into the reality you are creating and, to the extent that they are willing and able, allow them to help you create your world with you.

Wash, rinse, repeat

The common thread with everything I've said is that you can't do it once. You've got to do it frequently, often daily. Which initially sounds like a huge grind.

But the fact of the matter is, it only takes six weeks to create any new habit, good or bad. How long have you been practicing the habit of eating Doritos and watching sitcoms? Years, right? So take these six activities, do them for six weeks, and then email me and let me know what happened.

I'd say good luck, but you won't need it. Follow these guidelines, and you'll be making your own luck.

A Day To Vote

As the president of my own small company in my own small state, I'm issuing a challenge to every other employer in the USA. Today, I told my staff that the Tuesday after the first Monday in November is a paid company holiday, beginning Nov. 8, 2016. My employees have no requirement to vote on that day, and certainly no incentive to vote as I would. But I believe it is my responsibility as an employer to give the staff of the Center for Alternative Medicine the ability to recognize this most important civic day in the life of an American.

So, what do you say, fellow business owners? Are you and your executives patriotic enough to allow your employees time to vote without penalty?

Will you join me and my employees in A Day To Vote?

Meet Oliver.

Everything under the heavens has a name. Even inanimate objects, in the shapes they hold and the uses to which we have put them, are given to certain qualities that distinguish them from one another. The stones of the earth themselves have names, if you can see them clearly enough. And knowing something's name is key to knowing its soul. This was one of the beauties of man-made objects before industrialization took over. The craftsman invested  himself in his products to the degree that it had qualities and characteristics and a history making it as unique as any other individual. Who doesn't immediately recognize Excalibur, the storied sword of Arthur?

Vehicles, such as boats, automobiles, and yes, bicycles, are frequently named, more so than other things because they are closer to animate than inanimate, and their qualities are readily apparent to anyone who makes use of them. A sailor spending time at the helm of a boat will soon recognize how she carries herself through seas rough and slow differently from any other. And a cyclist can easily feel the wheels underneath him, and how they handle themselves carving a corner or sluicing down a hill in their own unique way.

We encapsulate those qualities that we see in our steeds, whether sail, pedal, or combustion powered, in the names we give them. As a result, every bicycle in my stable is named in its first few rides, as I get to know its personality.

It was a bit different for Oliver, the semi-retro baguette-and-wine bike whose build I have recounted in the previous few posts. Once the wheels were on and the saddle installed, and it began to look like a bicycle rather than a pile of shiny parts, I unconsciously began trying out names. From the frame geometry I chose and the parts I picked, I knew (or rather, hoped), that the bike would have certain features. I was seeking rather sedate handling, something that could gracefully move into a curve, but not necessarily bite it, and a measured response to my steering input, rather than the twitchiness of a sportier bike. I wanted a frame that had a little flex to it, a little liveliness without absorbing the energy of my pedal strokes.

Which brings me to an aspect of building this bike that I hadn't really thought of prior to getting there. As I installed the handlebars, and the saddle and the derailleurs, I began to wonder if I had made the right choices. Did I leave enough room in the cockpit? Plan on the correct handlebar height? Will the gear ratios work for my style of riding in these foothills of the Berkshires? When you purchase a bicycle from a shop, all of these decisions have been made for you, by people whose profession it is to make a well-riding bike. While I have a lot of miles under me, I'm no pro. And amateurs make mistakes. And maybe I had made a few.

In the process of creating anything, whether it be a table, knife or bicycle, there comes a time when you commit yourself irrevocably to the design decisions you have made. It may be when you anneal the steel in forge and oil, or put saw blade to that irreplaceable piece of your father's cherry lumber. In the case of this bicycle, it was when I cut the steerer tube on the fork. The length of the steerer tube determines the height of the handlebars, and ultimately your comfort and the bike's handling, and cannot be changed without replacing the fork or implementing various undesirable kludges.

Thus I committed myself to the wisdom of the choices I had made, and hoped that my vision had not exceeded my skills. It has happened before.

I completed the final construction of the bike in that pleasant state of anticipation mixed with some anxiety that I had somehow, in some casual moment, ignored a crucial aspect of building and design that would send me, like Icarus, crashing into the deadly waters below. I combatted that fear by putting not one, but three coats of shellac on the grips.

Then it was all done and the bike sat on the stand for a few more days of anticipation while I waited for the seatpost collar to arrive by mail, something the post office seemed to have a bit of trouble doing. Postie brought it yesterday, so last night I fitted the collar on, and went off in the sub-freezing night on a shakedown cruise.

And the assemblage of steel, sheet metal, nuts and bolts became a bike named Oliver. It is a fitting name; Oliver stems from Old German, and means "Elf Army." This is highly appropriate because my name -- Avery -- means "King of the Elves." Oliver is a comfortable, strong English name, fitting for a bike painted British Racing Green and kitted out with Brooks leather. Oliver was a retainer of King Charlemagne in the Song of Roland. Oliver's loyalty and bravery cannot be denied.

Thus it is with the bike Oliver. The handling is sure, he is responsive to the pedals, and over rough terrain (yes, that was me riding across the lawn of the First Congregational church at 10 p.m. last night), is smooth and controlled.  It is indeed the bike that I had envisioned.

And, as my daughter's boyfriend said, "It looks like it belongs in GQ!"

I'm looking forward to many enjoyable miles on this bicycle.

The wheel on the bike turns 'round and 'round...

The wheel is an omnipresent, and oft ignored, symbol of both mankind's technological prowess and our spiritual paths. It was the wheel that unburdened our backs and first brought forth roads from footpaths. It was a broken wheel to which the Buddha compared the experience of life in his First Noble Truth. It is on the Wheel of Life that Pagans experience the unbroken cycle of seasons and of life. Wheel symbolism is present in virtually every religion.

So it should come as no surprise, then, that for both practical and inessential reasons, the ability to build a bicycle wheel is considered the pinnacle of the bicycle mechanic's skills. Indeed, at its heart, a bicycle is very little but wheels, and if you get that wrong, nothing else will go right, functionally or aesthetically. So it was with a bit of some pride that I built my first pair of wheels almost a decade ago, and tested their mettle successfully against the worst that the Scottish highlands could dish out. And building the wheels for my Soma Saga was something that I eagerly looked forward to.

The shimmering, silvery rims arrived not long after the Velo Orange hubs I had ordered. By using manufacturer's measurements and online spoke length calculators, I was able to determine the exact spoke lengths I needed, and within a few hours, 80 Sapim double-butted spokes were on their way to me.

I tackled the rear wheel first. Because of the cogs on the rear wheel, the wheel itself has to be built with the hub cocked off to one side, so that the chain lines up correctly and the propulsive force is transferred without lateral stress. I couldn't have asked for a better build, to be honest, and within a couple of hours, I had the spokes laced and the wheel trued to within a few thousandths of an inch.

A few days later, I began building the front, which should have been the easier task, as both sides are equal. But as I tried to connect the last few spokes to their respective nipples, I discovered that I had made a tactical error. You see, the calculated front spoke length I needed was 260.3 mm. The spokes were available only in even lengths, so I had my choice of 260 mm or 262 mm. I picked the nearer, albeit smaller, length. And wouldn't you know that the tiny 0.3 mm difference, as it added up among the 36 spokes, turned into such a great difference that the spokes proved insufficient.

I was set back on my heels a bit by this discovery, and proceeded to put the now-useless 260 mm spokes in the spare parts bin, in the forlorn hope that I might someday build a wheel requiring them. A week later, my new order of 262 mm spokes arrived, and I rebuilt the wheel.

This time, after getting the wheel entirely laced, I could not get the spokes to tighten evenly. Some got very tight, while others remained loose. I took the wheel apart, again, and rebuilt it. Same problem. I began to think that I had mixed up my spoke lengths.

Finally, after a restless Friday night, while an unstable, wobbly wheel churned its way through my dreams, I got up determined to uncover and fix the problem. At 7 in the morning, in my bathrobe, cup of coffee in hand, I stood in the basement shop and worked my way through the puzzle. And, like so many difficulties, the problem began at the beginning. I had begun lacing it wrong in the first set of spokes, and it was such a devilishly subtle error that I could not see it in the maze of a fully laced wheel.

I rebuilt the wheel for a third time, and felt the spokes tension sweetly under my hands. Because, at a certain point, building a wheel transcends a simple matter of tightening things, and becomes an issue of gestalt. How the spoke tension feels as I squeeze them, the "pling" that the spoke makes when it is plucked. There are machines that make wheels, and the vast majority of wheels on bicycles today were laced and tightened entirely by machine, but there is a discernible, qualitative difference between a handmade wheel and one trued by blind automation. As I notched a quarter-turn here, and a 1/8th turn there, I watched the wobble slow and disappear, the rim movement sharpen up, and the wheel, made out of parts that by themselves could be crushed by the pressure of a single hand, become a unified whole capable of maintaining its integrity against hundreds of pounds of force.

Coffee cup empty, unshod feet turning cold against cement floor, I took the finished wheel off the truing stand and placed it on the new bike. And for the first time, I could see in my mind's eye, this bicycle rolling down the road, absorbing the bumps of Buddhist dharma, taking me from Beltane to Samhain and rolling me from the darkness of Yom Kippur to the lights of Hanukkah.

You see, bicycles are magic. As anyone who loves them can tell you, they not only take you from home to work or along fun loops of road. The bicycle is the ultimate freedom and the ultimate independence. I need no gas, no oil. I can pack everything I need on it, stow a few hand tools in my pocket, and I can go across the country or the world. The bicycle is the modern manifestation of the magic carpet of yore, taking you on adventures that you could have never imagined, while your spirit grows and soars.  And to take these journeys on a steed that you have conjured of your own magic? There can be no more fulfilling experience.

And it all begins with a perfectly round wheel, spinning in silence, along roads unimagined.

Deep in the woods, a chiropractor encounters a bear! You won't believe what happens next!

Summer has started, and in my neck of the woods, that means Facebook feeds, email lists, blogs and news programs will be filled with warnings and means to ward yourself from the dangers of the outdoors. In Connecticut, the snow had not even properly melted off my front lawn before we were subjected to dire warnings about a new superdisease being carried by the region's ticks. Nevermind that this disease has been around for a hundred years, and that there have been only 10 cases of it in the past 50 years. No, this is the bug that will sneak into your bloodstream and kill you if you have the temerity to, you know, walk on the grass or something.

Recently, my Facebook feed was briefly overcome by a surge of posts reminding us of the horrible dangers of Lyme-bearing ticks and how to protect yourself from them (naturally, of course). Thank goodness the extra-virgin olive oil "trick" hasn't resurfaced yet. I'm pretty sure that was both messy and expensive for anyone who tried it.

The other day, I inadvertently horrified a couple of patients of mine when I was telling them about my exciting weekend with a like-minded group of treehuggers, camping in the field, chucking spears, and generally having an all-around good time.

My patients asked me what I used to keep the ticks off me. I said, "Nothing, really. Just did a tick check when I got home."

They looked at me like I had told them I was planning to step outside the airlock with a monkey wrench and no space suit to repair the solar panels. They were incredulous. "You didn't use anything?" they asked. Clearly, their estimation of my intelligence had just plummeted, and my abilities as a man of healing were questionable.

But it's not just the creepy-crawlies that get no love. Any intrusion of nature into our carefully-ordered world seems to be cause for anxiety.

When I put up a bird feeder on the lawn of the Center recently, and posted a picture of it online, virtually every response I received was a warning about how the bears would shred it in short order, and that I should take it down now -- NOW!! -- before the Attack of the Claws began.

In the interests of journalistic honesty, I'm going to confess right now that I'm a big bear fan. I've had many an encounter with these creatures, in the wild and in my backyard, and never seen much reason to worry, so long as nobody forgot their manners.

My Affair with the Bear began in the Dark Ages (musically speaking, at least) of the 1980s, when I was backpacking through a particularly isolated stretch of trail in Maine. I had already gone several days without seeing another human, and expected to go a few more in similarly inhuman bliss.

That morning was a pleasant lowland walk among 100-year-old pines, whose needles littered the ground and made the trail feel like a composite running track. I had stopped to take off my pack, swill down some water, and just absorb the beauty for a minute.

Standing there, I heard crunching in the bushes, and spotted an enormous black bear meandering through the undergrowth. I stood there, unmoving, as he wandered innocently closer. I was downwind, absolutely still, and he wasn't expecting any company.

As his path prepared to cross mine, I realized this was the photo op of a lifetime. Ever so slowly, I reached down to my pack and unslung my weighty 35mm SLR camera. He still didn't see me, bears being somewhat nearsighted.

But when I unsnapped the cover, the bear heard it, spotting me in a second.

And then the impossible happened.

From a distance of no more than 20 feet, I stared into the bears' eyes, and he into mine. And I was lost in his presence. I felt that bear, and in him there was nothing resembling humanity. His entire being was wild, feral and fierce and something indescribable in human terms. There was no emotion. Everything was now. Everything was present. Everything was.

And though it felt like an hour, it could only have been a few seconds before I clicked back into a sense of myself, and was once again a man staring at a bear in a forest hundreds of years old and empty of other humans.

I began to rationally consider my options. In my previous encounters with bears, I had simply made some loud noises -- yelled at them, or banged some camp pots -- to scare them off. But he was far too close for that, and he may take that as aggression. I knew I didn't want to piss this bear off.

Running away would be absurd. He would take that as fear, and with a short sprint would be on top of me to take a closer look at this puny, hairless, scared animal.

So, I arrived at the only option possible.

I opened my mouth.

And I said, "Well, good morning, Mr. Bear!"

He didn't give me a chance to invite him to breakfast. In the blink of an eye, he was gone, racing through the ancient woods in a sprint that took him out of my range in seconds.

Since that time, I've never been very disconcerted by bears. A couple of years ago, I came home from work at lunchtime, and found a bear sitting at the bottom of my shared driveway, with the neighbor's trash can in his lap, scooping out melted ice cream.

I looked at him, he at me, I reminded him to clean up after himself, and went inside for lunch.

So when the dire warnings about the imminent demise of my birdfeeder at the hands of nasty bears came pouring in, I was somewhat nonplussed.

I mean, really, who *wouldn't* want a bear in their backyard? Though I would wish that if they did decimate the feeder, they leave a few coins for a replacement.

The warnings, as I suspected, were overwrought. The bird feeder still stands, unmolested, and has brought a number of interesting and beautiful birds to my office.

I have no doubt that shortly we'll be hearing dire predictions of some new near-malaria being carried by mosquitos and the public health risk of bird poop on your car. Not to mention the sure death that will result from sun exposure without being slathered with sunblock.

As a doctor who is concerned with public health, I ought to be bringing these warnings to my patients. But I'm not and I won't, because these are, in fact, anti-health messages.

I want my patients to go outside, get plenty of sun exposure without toxins seeping into their skins. I want them to get dirty, and come eye-to-eye with a nature that we have been taught to fear. This is what will make them healthier, physically and mentally.

You see, when it comes to health, there is no "I." There is only "We." As individuals, we exist in a virtual bath of microbes. There are more bacteria in our guts than cells in our bodies; with each breath we inhale a cloud of organisms. Each time our feet touch the earth, we literally touch millions of other lives.

The same is true on a larger scale. Without the bees, our food supplies would rapidly collapse. Species of plants and insects manage one another, the knowledge which our agrarian ancestors used to their advantage, but we have poorly replaced with simple poisons. Psychologically, we cannot exist without one another, which is why solitary confinement is one of the most effective tortures we inflict on one another.

Thus, the more divorced our food supply becomes from the environment in which it should exist (I shudder at the thought of cloned meat, grown in a lab), the less effective it is, not only in providing nutrients, but in protecting us from disease.

And the more we seek to isolate ourselves from our environment, from the nightmare bears of our imagination, the sicker we make ourselves. Without a healthy intestinal microbiome, we fall ill. Without regular exposure to soil, our immune systems become dysfunctional. Without regular exposure to the sun, the wind, and the rain -- the very environment that millions of years of evolution has primed us to inhabit -- we fall victim to the diseases that we run from.

So take this doctor's advice. Ignore all of the "public health" warnings that will come your way this season, seeking you to herd you away from the alleged dangers of nature. Do your health a favor. Turn a blind ear to the fearmongers. Walk through fields without fear of imminent illness and invite all of nature into your backyard. You will be healthier for it.

Depression is a Communicable Disease

I'm very pleased to announce my first lecture of the fall/winter season, and one that couldn't be more timely. With all of the concern circulating about new infectious diseases, there is one communicable disease that is rarely seen for what it is: Depression.

Please join me on Wednesday, Nov. 5, as I present new information which shows that depression is much more than a simple neurotransmitter imbalance in the brain.

Research is now showing how depression can be transmitted among members of a community, or even between people separated by great geographical distance.

The problem is not all in your head. Depression can result from engaging in certain activities, eating certain foods, and even by the microbes in your gut.

Find out how you can avoid depression infection, and what to do if you've already caught it, at my  free lecture. Bring a friend.

Depression is a Communicable Disease

FREE

Litchfield Community Center

7 p.m., Wednesday Nov. 5

 Seating is limited, so please call 860-567-5727 to reserve your place today!

The Book of Invasions reaches the New World

Wisp of a Thing: A Novel of the Tufa by Alex Bledsoe My rating: 5 of 5 stars

This is a novel which, like its characters, possesses depths that it does not reveal readily to the casual reader. On the surface, this is a straightforward fantasy/adventure novel that is utterly enjoyable in and of itself. The characters are interesting, the pacing is good, there are plenty of surprises, and like its predecessor, The Hum and the Shiver, it draws to an exciting and satisfying climax. I read The Hum and the Shiver in a single day, and, as I promised myself, I extended my time with Wisp of a Thing to three days, not because it did not entice, but because I knew I would have to wait many months for the trilogy's final book to appear, and I wanted to postpone that bleak horizon. On this basis alone, I award the book 5 stars.

At the next level, however, this is a book about the power of words and of song. The protagonist, Rob Quillen, is driven to find the words and the song that will set his troubled soul at rest, and his search unearths a power that threatens the very fabric of Tufa society. I found the first book of the Tufa series through the songs of the band Tuatha Dea, and now I find that through the second book, I find more music from other artists. The loop from music to book and back to music has already introduced me to artists I would have otherwise never heard. I honestly cannot think of another book that has expanded my horizons in such an unusual way. From Rebecca Hubbard's steampunk aesthetic and unearthly vocals, to the haunting, candlelit performances of Jennifer Goree, my playlist has exploded with a new kind of music that I didn't know I was looking for, but now find I can't do without. Sort of like a visit to Needsville, I suppose.

At yet another level, Bledsoe's tale reaches deeper into our pre-historical consciousness. Bledsoe has taken on the task of retelling the ageless battles and unending intermingling between the Tuatha De Danann and the Formorians, within the uneasy truce that the Tuatha made with the Milesians, when they conceded the material Earth to mortal hands. Bledsoe does not hew as closely to the received wisdom as did David Drake in his retelling of the poetic Edda in his Northworld trilogy, but that should be expected, as the Celtic stories themselves are jumbled, overlapping and contradicting, unlike the Edda.

I won't spoil anybody's fun by revealing the subtle meanings that Bledsoe has stowed away in this book, but I would suggest that anyone reading Wisp of a Thing do their homework if they want to enjoy some of the book's hidden richness. Like the characters in the novel, pay attention to the turning of a leaf or the feel of the wind, and greater understanding will be awarded to you.

The trouble with "middle" books in a series is that they often bog down as the author maneuvers his pieces on the board for the denoument in the final books. Bledsoe deftly avoids this problem; while I have little doubt that all the players are in the right place for the last book of the trilogy, there was no sacrifice to the current story. It kept me on the edge of my seat.

With this book behind me, it will be an empty several months until "Long Black Curl" debuts. I guess the only thing I can do is pull out my banjo and pluck out the songs I hear on the wind.

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Coming Home to the Tuatha De Danann

The Hum and the Shiver by Alex Bledsoe My rating: 5 of 5 stars

It's not often -- in fact, it's been years -- since I've read a book in one sitting. Or, rather, several sittings in a single day. But The Hum and the Shiver so enthralled me that I couldn't put it down until I was done.

I sort of backed into this book. A few days ago, I stumbled across this band, Tuatha Dea, who describe their music as celtic tribal gypsy rock. The band's latest album "Tufa Tales: Appalachian Fae" took as its inspiration the series of books of which "The Hum and the Shiver" is the first. I loved the music. I figured how bad could the books be?

This book lives up to the promise of the music, or perhaps for others, it's the other way around. At any rate, this telling of the prodigal daughter's return to her home and her people, and her struggle to reclaim herself, her heritage and reshape her future, is at turns delightful and intriguing. And though it is often difficult for an author to describe the fantastic in a realistic way, Bledsoe handles this task very well.

Bledsoe's evocation of a people hidden away in the Appalachian mountains, maintaining the Old Ways, also rings true to me. I grew up on the edge of Appalachian culture, and I remember as a 16-year-old driving down rutted gravel roads to a barn or a roadhouse with a 6-pack to sit on a picnic bench and listen to awesome banjo picking and guitar playing. This is the world Bledsoe takes as his foundation, and it is not difficult at all for me to see an Americanized Tuatha in such a place.

I enjoyed reading this book immensely, more than any other fiction I've read in years. But I fully intend to take two days, or even three, to read the next book in the series.

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The Last Great Walk, by Wayne Curtis -- a review

The Last Great Walk: The True Story of a 1909 Walk from New York to San Francisco, and Why it Matters Today by Wayne Curtis
My rating: 5 of 5 stars

Taking as his point of departure a transcontinental walk by a 70-year-old man over 100 years ago, author Wayne Curtis takes us on a spritely, interdisciplinary walk on the subject of walking itself.

"The Last Great Walk" is only roughly built around the 4,000-mile perambulation of Edward Payson Weston, a competitive walker during a time when such athletes possessed the attention given to NBA stars today. Instead of trying to recreate Weston's walk, Curtis wisely dovetails his chronicle of America's last great walk with essays on the biology, sociology, anthropology, neurology and the psychology of walking.

And a fascinating journey it is. Curtis escorts us from the La-Z-Boy museum in Monroe, Michigan to the great walking cities of the world, and from the present into shadowy prehistory where a group of primates discovered the advantages of bipedalism on the savannahs -- and spread across the world on their own two feet.

Along the way, we meet the archenemy of pedestrianism, the automobile, and survey the century-old struggle between these dichotomous forms of transportation.

Even for those of us who have stepped outside the car door and thrown away the keys, the effects -- primarily deleterious -- of the automobile on our society are surprising. For the most part, Curtis takes great pains to prevent his book from becoming just another pedestrian's screed by maintaining an even tone and allowing the facts, and the scientists and researchers who have uncovered those facts, speak for themselves. But there are times when he cannot hold himself back.

"Automobiles are the Plato's caves of the modern world," he writes. "From them we see only shadows, the rough outlines of our existence. The map of this world is drawn with fat, cartoonish markers rather than finely sharpened pencils. The detailed lines of the etchings around us are lost, replaced with hulking shapes whizzing by at sixty miles per hour, vague and often amorphous forms, save for the haunting and startingly blue Best Buy sign and the inquisitive yellow eyebrows of the McDonald's arches jutting over distant rooftops."

Walking, on the other hand, is not only transportation, but "can also be like the best sort of daydreaming, a way to explore without direction. The art of the long, aimless walk was accorded uncommon respect and attention across the Atlantic in the nineteenth century. The flaneurs -- from the French word for "one who strolls" -- filled a strange ecological and cultural niche."

As we journey on these paths, we discover how walking is fundamental to our health by giving us a sense of place and by challenging not just our muscles but also our minds.

"Being lost is an essential human condition....Abandoning the experience of being lost is like losing our facility for empathy; it's a central part of what made us human, the bedrock upon which both mobility and mind were built," Curtis writes.

I came upon this book only a few months after I rediscovered the joys of bipedalism myself, and it provided me with the rational underpinnings to my subjective experiences. I now understand why time seems to dilate for a walker, and why certain paths, though indirect to my destination, are far more appealing to me.

I also understand why life feels so much richer now that I am a walker, rather than a driver. As anyone who has abandoned their car can tell you, life gradually moves from flat 2D to a fuller three dimensions with the more footsteps you put between you and your car. Curtis explains the neurology and psychology behind this experience, and what we have lost, as individuals and societies, as we have abandoned walking.

Yet Curtis always returns to Weston's great walk across a country burgeoning with prosperity and on the cusp of transitioning to a car culture. In doing so, Curtis makes a solid case for a return to our pedestrian roots, and why it makes sense personally, socially and economically to do so. Which is why Weston's walk still matters today.


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When the clown stops laughing.

The death of Robin Williams has created a worldwide outpouring of sadness and grief that I have not often witnessed. Though we all know how closely linked depression and comedic skill can be, it is still difficult for many of us to fathom how a man that could have given us such great joy could have been so bereft as to kill himself. In Williams' case, it is made even more difficult because his humor was delivered impromptu, directly from his heart and soul. How does the playful, energetic, insightful man that we saw onstage become locked in such despair? To understand, we need to look beyond the trope of the clown with tear-stained makeup and into the blackness that, to a certain degree, we all carry within. Just as there is no yin without yang, there is no joy without despair. But what is often overlooked is that the manifestation of depression is highly variable, and no two depressions are alike. Thus, we cannot approach their management in all the same way.

Some depressions are what I call "contextual depression." That is, they stem primarily from the your attempts to cope with a difficult, albeit temporary, environment. The loss of a loved one through death or divorce, an abusive work environment, severe financial stress -- all of these are situations in which depression begins as an appropriate adaptive strategy, but due to duration, or repetition, it becomes self-destructive and the behavior can continue long after the trigger that caused it has gone.

On the other hand, some depressions may have no obvious precipitating factor at all. This form of insidious depression works its way through you in the form of negative self-talk or the erosion of an impossible perfectionism slowly stripping you of, first, self-esteem, and eventually, hope. Not only is this depression subtle in its appearance to others, you may very well hide it from yourself until it has reached what may appear to be unmanageable proportions.

A third form of depression is a "physiological depression." This is a longstanding, moderate depression which does not have its origins in behavioral or neurological influences at all, but is instead caused by a chronic, debilitating and undiagnosed disease or infection, which in turn creates behavioral changes. Researchers who have watched the behavior of sick animals have noted that the symptoms of chronic, low-level illness are virtually identical to depression: Energy depletion, appetite changes, sleeping changes and behavioral changes which favor energy conservation and protection of vulnerabilities.

While the link between depression and health problems such as MS and back pain are well-known, often overlooked are diseases such as chronic gastrointestinal disease or gland hypofunction whose only visible symptoms are those of depression. Astute investigation on the part of the clinician is necessary to uncover these hidden causes of depression.

All of these forms of depression may be accompanied by substance abuse, creating a feedback loop that increases the severity and complicates the management of depression.

Too often, though, these various causes of depression are overlooked in favor of the cookie-cutter solution of pharmaceuticals. It is true that antidepressants can lift the veil of despair for some people, so the pharmaceutical solution cannot be discounted. But, as several meta-analyses of SSRI drugs have found, the effect of SSRI drugs is much smaller than we are led to believe. This is not news. The first such study was published over a decade ago. "Listening to Prozac but hearing placebo," examined 19 clinical trials incorporating over 2,300 patients, and concluded that SSRIs are primarily placebos.

"Virtually all of the variation in drug effect size was due to the placebo characteristics of the studies," the researchers concluded. "The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect."

Several follow-up analyses have confirmed this initial study's findings. It is also worth noting that the monoamine theory of depression, which supposedly explains the mechanisms by which SSRI's work, has never been supported by the research.

So these drugs, while they can be invaluable for some people who suffer from depression, are more likely to be expensive placebos for the majority of people. What can you do if you are one of this majority?

The first thing is, see a mental health professional -- and by this, I don't mean a psychiatrist, whose primary skill is in pharmaceuticals, but a therapist, social worker, or psychologist, who can approach depression with a much bigger toolbox than that of the psychiatrist. They can help you develop the insight and skills to help you manage your depression.

Some of these skills include the ability to break down the monolithic wall of despair into more manageable chunks. Recognize and remind yourself that depression is a temporary condition, and you have the ability to influence how long it lasts. You can also reduce the size of your depression by converting generalizations about yourself and your life into specific, limited observations. The thought that "I'm a failure" creates an insurmountable hurdle to overcome -- after all, how could you, you're a failure! On the other hand, recognizing that generalization of failure stems from the fact that you lost your job creates a much smaller roadblock. You may have lost one job, or even several -- but that doesn't mean you cannot find another one.

One of the best ways to shorten the duration of a depressive episode is through physical activity. Though it may seem extremely hard, such simple things as going for a walk or a bicycle ride can change the course of the disease. Physical activity actually changes the neurological functioning of the brain in ways that inhibit depression.

And if you can't help yourself, what about helping others? Perhaps you can't find your way to feed yourself, but maybe you can help out at a food kitchen just a couple hours a week. Research has shown that when we nurture others, we also nurture ourselves. And if you are depressed, such sustenance is the best you can find. Helping others is true soul food.

There are many, many other ways to find your way through depression. And if you are thinking of suicide, reach out for help. It's there. Even if you can't find anything else, call 911.

Dr. Avery Jenkins is a primary care chiropractic physician specializing in helping people with chronic disease. He can be reached at alj@docaltmed.com.

The Doctor of the Future

Watching the news, it is difficult to escape the conclusion that humanity is fast approaching a turning point of great impact. I'm not speaking of ISIS or the Gaza-Israeli conflagration; conflicts such as this are older than history. Rather, I'm referring to the ever-growing polarity of our possible futures. On the one hand, you have a rapidly growing income disparity and a civilization utterly dependent on cheap energy which is about to lose its primary source of that energy; a world that is already so overflowing with people that in even rich, technologically advanced countries, such basic things as readily-available water cannot be counted upon; a food supply that is so trucked-up in technology that it now causes the diseases that proper nutrition once prevented; and a worldwide ecology already in the midst of chaotic change.

On the other hand, you have technology so advanced that robots will soon be able to replace men in dangerous, life-threatening jobs, saving countless lives; the possibility, albeit remote, of extending mankind's territory to other planets; genomic manipulation to the degree that natural selection can be replaced with social selection, and entirely  new species can be created; and artificial environments designed to replace the one that our overpopulation has begun to destroy.

The latter scenario is highly unlikely, except, perhaps, as a time-limited state in the longer progress of the former. We have already passed several points of no return in the alteration of our worldwide ecology, as CO2 levels have passed the 400 ppm mark, global temperature has reached the highest peak of this geologic period and shows no signs of stopping, and we are in the midst of a mass extinction of species. Our technology is nowhere near the point of replicating on any large scale, the vast diversity of the once-living earth, and that is critical to our survival at anywhere near our current population. Anyone who places their faith in unlimited technological progress in a reality circumscribed by limited natural resources is bound to be disappointed.

This shouldn't come as a surprise. From the beginning of history, civilizations have outgrown their habitats and outlived their creative energy, leading to periods of turmoil before another another order arises.

But the cry arises: "It will be different this time!"

Perhaps, perhaps. But not in the way the hopefuls imagine. The laws of physics and biology make it inescapable that we are headed for a post-industrial society of some sort. The only real question that remains is what that society will look like.

Certainly, the cheap transfer of goods and materials will cease. The days of raising chickens in the U.S., sending them to China for processing, and then shipping them back here to be sold will be long gone. With the disappearance of cheap energy, we will primarily be able only to move knowledge, not products, over long distances. Computational devices may remain, as they are less material- and energy-intensive, and can be supported by low-powered, decentralized power grids. Though they require exotic materials, they require them in small amounts, making their continued manufacture a possibility. Large-scale, centralized manufacturing will disappear, and if we manage our affairs right, we can arrive at a safe landing with local economies intact, using local resources for small-scale creation of goods. The post-industrial society, it turns out, will have quite a different flavor than the one first imagined by Daniel Bell, instead being closer to the future predicted by neo-Malthusians.

My interest, of course, is primarily in how this will affect health and health care delivery. A lot will change under this scenario, not all of it bad.

First of all, the changes in the transportation system will yield many positive results. With people walking and cycling more, obesity and many related sedentary lifestyle co-morbidities will greatly decrease. The incidence of diabetes, heart disease and cancers will drop significantly.

With energy-intensive factory farming techniques all but obliterated, a return to local production and harvesting of foods will further enable improved health through better nutrition. Indeed, a cultural shift in this direction has already begun, despite regulatory and economic  roadblocks that have been put into place to protect the Monsanto-dominated paradigm.

A return to a more pastoral and village-centered lifestyle will also be accompanied by a decrease in the anomie of life that is a direct outcome of our currently disconnected, disembodied and overly-embroidered lives. Less depression and anxiety almost always accompanies stronger social networks.

Of course, all of this is predicated on the maintenance of a society relatively protective of both individual liberties and cognizant of the need of our strong social obligations to one another. And it's not all sun-dappled rides on two wheelers through abundant fields of grain, either.

Drug production and distribution will be inhibited, putting those dependent on such drugs, such as insulin-dependent diabetics, at risk. Essential vaccines, such as pertussis and measles, would become scarce. And antibiotics, which are already on the wane would be hard to come by, though as I have previously mentioned, that's not necessarily much of a calamity. Certainly "advanced" medicine, with its exotic potions and technology-dependent surgical techniques, will go by the wayside.

I'll make the argument that, in fact, much of that medicine and technology is largely superfluous. The advanced medicine of the latter half of the 20th century and the first decade of this one has made no impact on human longevity, measured in productive years. Many of the surgeries and medicines that are employed today are only necessary because of the society in which we live. Change the parameters of that society, and these disorders would largely cease to flourish.

What does that leave us with, health-wise? It leaves us with a health-care delivery system which is supported by locally-available resources, and which utilizes low-technology manual interventions. It would also leave us with a health care system supported by a truly interdisciplinary population of healers, unrestricted by practice laws and insurances aimed more at preserving the power and income of a protected class of professionals.

In this health care milieu, there would be more shamans and crones and fewer psychiatric wards, more midwives and fewer cesareans. There would be doctors who know the properties of herbs, where they could be found, and how they could be prepared. Who know the use of food and nutrition to turn on the genes of health. Who know foodstuffs and how to use them to cure disease, and who know the human body and its anatomy, and who can alleviate pain with their hands. Doctors who can continue to work when the lights go out.

The fact of the matter is, the doctor of the future looks very familiar. And as I more frequently walk upon the Old Paths in search of the knowledge that can help my patients, I am increasingly cognizant that the wisdom I gather is not only for the benefit of my patients today, but also for the doctors of the future.

Diseases are just stories we tell ourselves.

  Recently, I was explaining to a patient the difference between her diagnosis from a western mainstream doctor, and the diagnosis I had just given her, which emerged from an examination based in Traditional Chinese Medicine (TCM).

"Diseases are cultural concepts," I said. In mainstream Western medicine, certain symptoms, signs, and laboratory tests are grouped together because it makes sense to congregate them given that view of the body. We clump that fact pattern together, call it a disease, and give it a name. Eastern medicine may likely have no analogue, not because the disease had not been "discovered" by TCM doctors, but because when looking at a person from an Eastern perspective, it makes no sense to clump those findings all in one pile; in TCM, some go in one pile, and some in another, and neither fully replicates the Western diagnosis.

Which is a good thing. One of the greatest failures of western medicine (aside from its obeisance at the altar of Mammon) has been its failure to recognize that a disease is not a creation of biology -- it is a creation of culture.

On the personal level, a disease is, in fact, a story we tell ourselves about ourselves. It is one of the many myths we use to make sense of our lives, to collate and correlate all of the data we collect into a coherent whole, a narrative that relates ourselves to our world sequentially in time and which gives meaning to our lives.

From this perspective, then, it is the doctor's job to provide the story in which the patient immerses themselves. Our important knowledge base is less one of laboratory values and abstruse structures on x-ray than it is the particular narrative in which which each patient can find association.

For example: If I tell a patient that they have arthritis, without any qualifiers, their reaction can vary tremendously. This is because of the associations which that word has in their mind. One patient may immediately think of rheumatoid arthritis, which erodes joints and may leave its victims disabled and wheelchair-bound, fighting constant pain. Another patient may assume I'm referring to osteoarthritis, the wear and tear of joints which eventually effects us all, and may only display as some stiffness and a mild loss of range of motion. I can watch, physically, as they respond to their interpretation, sinking into themselves in resigned defeat or shrugging their shoulders as if to unburden themselves of a fly. Each patient is telling themselves the story which they will be living, and reacting accordingly.

Most people these days are familiar with the concept of a placebo -- a physiologically inactive intervention, such as a sugar pill, that a patient takes and it miraculously begins to heal them. Placebos can be extraordinarily powerful interventions, to the extent of curing people of cancer. The key aspect of the placebo effect, though, is that the patient cannot know that they are taking a placebo.

The cause of the placebo effect is that it is an item that a person can use to change the sequence of their narrative. To understand how that can be so, we must first take a shallow dive into Jungian psychology and the realm of mythology. Joseph Campbell, in his book The Hero With A Thousand Faces, describes what he calls the "monomyth." This is the tale of the hero, who leaves his safe home, fights monsters and giants, faces death (and dies), and then returns to his world and his home as a more complete (healthier) individual. This is a story that exists or has existed in virtually every culture over mankind's history, and regardless of the time, culture or language, all of these heros' journeys have common elements.

This is the journey of individuation that we all undertake during the course of our lives, and it may be a trip that we take several times in several ways. The hero's journey is also the path that many people follow when faced with a disease. I have seen patients replicate this journey many times over the past 20 years, and the pattern I have observed hews closely to the Campbellian outline.

There are several stages in the monomyth. The first is the "call to adventure," which in a clinical setting is best seen as the time of diagnosis. The hero (patient) often resists this call (denies the diagnosis), but after rising to begin his or her journey, one of the first encounters that our hero has is with a supernatural or magical helper, who often gives the hero a talisman or artifact that will aid him in his quest. Again, in the clinical context, the supernatural helper is the doctor (or magician, shaman or priest in other cultures), and the talisman in this culture is most likely to be a pill, herb, or chiropractic adjustment.

The exact nature of the talisman is unimportant, as is the factual existence of the powers that it is claimed to possess. What is most important for the hero (patient) is that "protective power is always and ever present within or just behind the unfamiliar features of the world. One has only to know and trust, and the ageless guardians will appear," Campbell states.

This is the power of placebo, and indeed, this is part of the power of every therapeutic intervention, regardless of its physiological properties. In fact, in the case of many interventions, the physiological properties are far weaker than the magnitude of its therapeutic effects. But because these are talismans imbued with protective properties, given to the patient by a figure representing a force stronger than their own, their power is magnified.

What the drug/herb/adjustment is really doing, far more important than chemical or mechanical changes, is giving the patient the power to change the outcome of their narrative. The feared enemy is no longer stronger than the hero and their playing field is now levelled.

Thus, the outcome can be changed, literally, in the patient's mind.

This approach -- seeing the disease process as a story we create, or co-create with our environment, is hardly a novel or new one. It is, however, a largely forgotten one, in a day and age when diagnosis is based primarily on laboratory testing rather than observation and interaction with the patient.

For patients, this realization that our diseases stem, to a great degree, from how we interact with our internal and external worlds can be an initially frightening revelation. One might accuse me of cruelty to suggest that a person with cancer, or heart disease, or even MS, is in some way, responsible for their disease. My words, though, are less the whip of admonishment than they are a call to hope.

Taking responsibility for something is the first step in being able to manage and control it. If a disease is declared genetic (the scientific version of "an act of God"), it becomes something impossible for the patient to overcome, because, who, after all, can defy the almighty Gene? (This approach, by the way, is also a very good way to deify the doctor for his own benefit, but that's a tangent for another day).

If you can claim ownership and responsibility for a disease, then you are simultaneously reclaiming the capacity to change it's course. You are changing the narrative of your disease. You are changing from victim to hero.

Of course, that alone isn't enough. You have to change whatever needs to be changed, behaviorally, mentally, emotionally, in order to change the actual course of your disease, and the talisman given to you by your doctor will only help you so much. The rest you must do yourself.

Any disease, your disease, is just  a story you are telling yourself. And whether the outcome is tragic or triumphant is entirely up to you.

Hey, Dad!

Two simple words  that for nearly two decades I have been unable to speak. Two words that, for much of my life, prefaced any number of of statements and questions, from the sacred to the silly to the profane. The two words that reflected one irrevocable fact that shaped my life more than any other. I had an awesome Dad. And, as a man, in many ways I am just like him. My father was an engineer who liked to tinker with things, figure out how they worked, how they broke and how to fix them. I cannot remember ever having a repairman in the house. I, being the only child with any aptitude for such things, became his gopher (as in, "Avery, go for a phillips head screwdriver")  and learned by observation, as children do. I learned how to rewind transformers, fix a faulty TV, wire a house electrical circuit and fix a toilet. Dad hated fixing toilets. Which is probably why ours broke down so often.

I translated that talent for fixing what's broken into being a doctor. Helping to fix a person is infinitely more complex than diagnosing and repairing a major appliance, but the fundamental mental processes are the same. Questioning, observing, probing, changing something to see what happens -- this is what he taught me. This is what I know.

Dad also had a philosophical bent. When his lifelong employer, AT&T, moved Dad into an executive track, they also sent him back to school. At the time -- the late 50s -- AT&T was promoting many engineers into management, and they saw that the engineer's traditional tech-only training was insufficient to prepare these men for the more complex task of managing people rather than managing circuits. So they created a special one-year school in Philadelphia, where these electrical engineers were submerged in the works of Plato, Kant and Kazantzakis. They studied art, they read literature, they explored classical music.

Dad absorbed it like a sponge, and transmitted that love for the big picture to me. I will always remember our "Culture Hour Sundays," in which Dad would play some music and talk about the composer, or introduce a Big Question, like "Who are you?" and make us discuss it. I thought it was all pretty silly, as a child. But it clearly rubbed off onto me, as I went to a college in which I studied things like the similarities between Cubist art and Einstein's theory of relativity, and read Kant, and Hannah Arendt, and tried to answer the Big Questions, like "Who am I?" I graduated with a Bachelor of Philosophy degree. Dad was proud of me.

Dad was, by his own description, "the man in the gray flannel suit," one of the army of men who, after returning from World War II, went to work in the companies grown large by the demands of the war and changes in technology, and became cogs in the machine of extraordinary economic progress that was America after the war. He was a corporate man, learning to work his will in a bureaucracy unyielding to personal intent.

But within him seethed a man wanting to break free of that bondage, to create that what he would, to be master of his own fate rather than one hand of many on the tiller of a great ship. Somehow -- I have no idea how -- he snuck that into me. In spades.

This was my father's greatest gift to me, or perhaps it was a curse. I'll never be sure. But it became clear to me early on, that I would never become the baby boom generation's version of the corporate man. I was too infected with Dad's questioning spirit and his suppressed demand for independence. I realized in my 20s that I would never be happy working for anyone beside myself. So one day I closed the door on my own budding career in management and decided that I would make it on my own or not at all.

As a father myself, I have tried to emulate my Dad as much as possible. It's still a little too early to tell how I did on that score, but I'm sure my girls will let me know. One has already launched and is, as I write this, achieving orbital velocity. The other is moving inexorably toward the launch pad, and already my heart grows heavy with her impending departure.

When I graduated high school, my parents gave me two gifts which have lasted me a lifetime. The first was a typewriter, through which I found my voice and which was the heart of my first career. The second was a train ticket to Boston, the city in which I found my destiny and that eventually became my second home.

I will never forget, the day after my last class, looking out the window of that train, and seeing my father with tears running down his cheeks and a huge smile on his face as he waved goodbye to his son. Many years later it was my turn to say goodbye, as I held his hand and looked into eyes rapidly fading as a the hemorrhage caused by a massive stroke flooded his brain like a a slow tsunami. I, too, had tears in my eyes and a smile on my face for the man who had given me so much -- had given me the core  of the man I had become.

Hey, Dad, thanks for everything. As long as I live, so will you.

I Am Biped.

Inspired in equal parts by laziness, a fondness for offbeat experimentation, and personal growth, I have been walking to work for the past two months. It's not a very long commute by any standard, a pinch less than a mile, although the 8% road grade is relatively indisputable and I can't quite decide if it is in the wrong direction. As things stand now, I have a sprightly downhill jaunt in the mornings, and an uphill slog at the end of the day. And since it's so short, I've been walking home for lunch as well. Sometimes I insist that the directionality, or at least temporality, of the slope be changed, but at other times it seems perfectly fine. I suppose with regard to the kerfuffle that is local geography, the gods in fact do know their business, and I should leave well enough alone. I started foot commuting by fiat one morning, when bike #1 had a flat tire and Bike #2 was on the repair stand for cable replacement. (Of course, I also have bikes #3 and #4, but we really needn't delve too deeply into my transportational quirkiness here). I have a difficult time justifying using an automobile for such a short distance, unless I'm coupling it with other errands. To me, such sloth smacks of an immorality commensurate with unfiltered Chesterfields,  pool halls and Hudepohl beer.  It also hasn't been that long since I finished reading The Old Ways, a book about walking the ancient paths of the U.K., which seeded my mind with the desire to see what a walker sees and experience the world from a walker's perspective. So I slapped on my office clothes and perambulated my way to work.

Let me note at the outset that I am not unfamiliar with walking, having been an avid hiker and backpacker for most of my life. However, I've never really integrated walking into my daily life to any great degree. So while the physical act was familiar and comfortable, the psychology of walking to places to which I once would only have cycled  proved to be entirely novel.

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If you search the term "walking" on DuckDuckGo (that's a search engine like Google only without the massive invasion of privacy), the top ten results are dominated by walking as a health measure. Fitness walking, walking your stress away, walking your weight away, walking your heart to health...those are all well-accounted for and seem to be at the top of most pedestrian's minds. Less sought after is information on commuter walking, or utility walking. or walking #justforthehellofit. I suppose as a doctor focused on wellness and prevention, I should be happy about people's interest in being healthy. And it is true that programmed health measures are necessary to help people recover from chronic illness. However, these days, I am much more interested in the integration of exercise into our activities of daily living, as it makes the exercise more effective. I mean, when was the last time you saw someone stay on the treadmill for an extra 10 minutes just for the fun of it? But if you're walking home from work or the store, you might extend your walk that much just to enjoy a beautiful sunset.

Which brings me to perhaps the best reason for putting walking into your life: It fundamentally changes the way you see your world. Call it the time dilation effect. When you walk on a daily basis, your entire perception of time becomes altered. This is very strange, and could be very uncomfortable, for people brought up in car culture. When you go places by foot, you have to account for the time it takes to get there, something we rarely factor in when we travel by car. "Oh, it's only a 10-minute trip," we say. Two or three 10-minute trips later, and all of a sudden a half-hour is gone and you're rushing to pick the kid up from baseball practice on time and you *still* haven't finished all of your planned chores.

Walking forces you to reformat that process. You are impelled to add travel time to your calculations, as it no longer appears negligible. It isn't negligible. It's now 20 minutes to here, 35 to there. So you plan ahead, leave enough time to get there. And then the magic happens. All of a sudden, you're not in a rush. You check your watch once during the trip, yeah, you'll get there on time. The rest of the time, you are focusing on the journey itself -- the heat, the cold, the sun, the wind, the temperature. Instead of being literally bound and locked into a tiny, plastic, unchanging room with windows, you are engulfed by the endlessly changing panorama that is our world. Rather than rushing through your environment far faster than your senses can process it, you are savouring your surroundings. You are shockingly in touch with your environment in a very intimate, comfortable way, especially on routes you frequently walk. I've identified two medicinal herbs growing in the wild on my way to work that I'm going to harvest for making remedies. In a car, or on a bike, I never would have even known they are there. And the smells -- oh, my, does anybody remember what a summer night smells like? Not just when you're on vacation, but every night. And how the smells of the day and evening change throughout the year as plants bloom and die, and streams rise and fall.

The richness of sensory stimulation that occurs when you're walking makes the average automobile seem like a deprivation tank by comparison. Actually, let's be clear about it: An automobile is a roving sensory deprivation device. No wonder we are so eager to fill our cars with technological auditory and visual stimulants. Every time we get into an automobile, we are starving your senses, and we are replacing the sights, sounds and scents of our richer natural environment with the equivalent of sensory junk food.

Speaking of sound, what most pedestrians and cyclists also learn is that automobiles are extraordinarily loud. Road traffic is regularly measured at 80 dB; hearing damage commences at 90 dB. The intermittent traffic along my pedestrian commute highlights the extreme noise of the average automobile. Within seconds, birdsong and peepers are snuffed out by the roar of a passing car, or three. When you are subjected to those extremes frequently, you begin to realize also how damaging it is, not just physiologically, but psychologically, and it is reflected in our culture.

Even within an automobile, the noise level is typically around 70 dB. And what is the logical result of isolating ourselves from our  environment and then filling it to the brim with artificial sights and sounds? If you can't hear your environment speaking to you, then it becomes unimportant. We have replaced the dialogue between ourselves and the world around us with a constant monologue in the echo chamber of humanity. All other voices have been drowned out to the point where most of us do not know how to listen to them even if we could hear them.

No wonder Mother Nature is screaming. We are unable to hear anything less.

So as we hear and see better when we are walking, so are we able to express ourselves more richly. Road rage is, in part, a result of being effectively gagged when we are in our automobiles. We communicate with others only through our brake lights, turn signals, headlights and horns. These are poor tools, effective only at communicating the coarsest of concepts. We can express only our direction of travel and various levels of concern, from a warning (a short beep-beep) to full-on anger (HONK!). Hand gestures, even friendly ones, are often lost to window glare, and you can forget about eye contact. Even if you are able to achieve it, the significance is almost null. Every cyclist and pedestrian can relate more than one incident of making eye contact with a driver before crossing an intersection, then having the driver almost plow into them because they had no idea that the other person was there. Inside a car, eye contact is as meaningless as a friend's description of a blind date.

Communications on foot is a different story entirely, and this was perhaps the first thing that I noticed as I began my bipedal commute. In a hurry, I thrust my body forward and step purposefully; when at ease, when enjoying my trip, I saunter. Between those extremes are shades of mood and attitude. I swagger, I hesitate, I plod through weariness and I walk with pride and strength, each step resounding through the earth. My gate changes with my mood, and with my entire body I can communicate my emotions to the world about me. And, yes, I have even danced from time to time. I had forgotten just how expressive the simple act of walking can be, and it is a joyful relief to be able to communicate so richly and so honestly with the world. Even on a bicycle, my thoughts could not be expressed so clearly as they can when on my feet.

Sometimes I think we have a world turned upside down on its head, where safety is in a speeding machine that kills 30,000 people per year, and danger is being on your own two feet.

It is truly a shame that walking should be such a forgotten activity. To the world at large, walking any distance for purpose rather than pleasure, has been delegated to the realm of the poor and the chastised. Why would anyone walk instead of drive, unless they couldn't afford a car or had their license confiscated for driving once too often after one too many? I'm sure that has been the assumption of more than one person who has driven by me over the past couple of months. I have even been stopped by the police, on the presumption that someone on foot must be engaged in some nefarious activity -- or at least have a couple of priors.

It was late, and dark, and I was slogging my way home. I saw the squad car pass and suddenly whip around in front of me, spotlight full on and blinding me. I heard a car door open and shut. A silhouette approached me.

"Good evening," the officer said. "Where are you going?"

"Home," I said.

"Where's that?"

"The top of the hill," I said.

He blinked.

"Where are you coming from?"

"Work," I said.

"Where's that?"

"Bottom of the hill," I said.

He looked at me. I looked at him. I smiled. He didn't.

"You have some ID?" he asked. I handed him my driver's license.

After fruitlessly checking my record on the computer, he returned from the cruiser and returned my license.

"Be careful," he said.

"I'll be ok," I said. "Just going to the top of the hill."

He shook his head and left.

As encounters with police tend to go, this wasn't unpleasant. But it did shake me loose from my personal point of view and realize how odd, and perhaps how dangerous, what I have been doing on a daily basis must seem.

I truly wish it wasn't that way. Sometimes I think we have a world turned upside down on its head, where safety is in a speeding machine that kills 30,000 people per year, and danger is being on your own two feet. Where comfort is defined by your insulation from your environment rather than your enjoyment of it, where noise is silence and the faster you go the more you have to rush.

Walking has its health benefits, and perhaps as a doctor, I should have written about that. How frequent walks strengthen your heart, clear your arteries, improve your digestion. All true. But the more important benefits of walking cannot be measured by cholesterol values or blood pressure. Walking is exercise for your body, but rest for your psyche. It brings you in touch with the Earth and lets your mind soar with the birds. Being bipedal is one of the most complex tasks we undertake as human beings, and when we cease to walk, we begin to lose our humanity.

Culture, biophobia, and the post-antibiotic era, or why you're going to be just fine without antibiotics.

The FUD* machine went into overdrive a couple of weeks ago, when the World Health Organization breathlessly released a report predicting the imminent apocalypse which will  be upon us as bacteria become increasingly resistant to drug therapies. “The problem is so serious that it threatens the achievements of modern medicine,” the organization said, adding that when standard treatments fail,  infectious disease deaths will skyrocket and the risk of contamination will create epidemics.

There's only one problem with WHO's conclusions. They ignore 10,000 years of human history during which, without the aid of modern medicine, the human race not only survived, but thrived. As a species, we achieved our precarious (and overrated) dominance on this planet long before what we today call medicine arrived on the scene.

The CDC itself notes that by far the largest gains in human health and longevity came about, not as a result of any medical interventions (including smallpox and polio vaccines, by the way), but as a result of improved nutrition and sanitation. That's right; the most powerful weapon mankind has ever had in its arsenal against bugs has not been drugs, but indoor plumbing.

Another major step forward occurred when medical doctors were finally willing to listen to fellow physician Ignaz Semmelweis and started washing their hands between patients. Interestingly, "Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands...Semmelweis's practice earned widespread acceptance only years after his death."

Today, this cycle of denial and rejection repeats itself. Unstated in all the dire warnings about the coming global bacterial apocalypse is the fact that it is modern medicine and agriculture that has made these bacteria possible. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and drug-resistant Clostridium difficile exist today only because of our overuse of antibiotics and the pollution of our food chain with antibiotic-laden meats. Also as a result of antibiotic therapy, we have drug-resistant candida, gonorrhea, and pneumonia.

Had MDs not been handing out drugs like candy to any kid with an ouchy ear and any adult with a sore throat, drug-resistant bacteria would not exist.

Had agribusiness not been allowed to abuse livestock to the point of deathly illness and then stuff their food with antibiotics to keep the suffering animals alive long enough to reach the slaughterhouse, drug resistant bacteria would not exist.

Not to belabor the obvious, but I think it's fair to say that more of the same thinking that created the problem will not fix the problem. New drugs will only briefly plug the holes in the dyke created by the old drugs, while making new holes themselves.

The solutions to problems such as this require a paradigm shift. As doctors, we need to look at things, not in isolation, but as part of an integrated ecosystem. Instead of looking at the bugs and what kills them, we need to look at the cultural and environmental factors that allow them to proliferate. At the same time, we should examine, not the infectious agent, but the agent that it infects.

This is the exact opposite of the mainstream medical approach, which still chooses to derive its wisdom from research which mechanistically isolates components from their overall systems.

It is beyond the confines of this blog to describe a detailed analysis, but even a cursory examination from a more cybernetic perspective will yield some insight.

First of all, it is the overuse of antibiotics in medicine that is one of the primary causes of drug-resistant organisms, even medicine itself has acknowledged that. However, in doing so, medical apologists have consistently blamed the patient, not the doctor, for this failure. Even today, in conversation with my mainstream peers, I continue to hear the excuse that "my patient demanded an antibiotic," or "I had to give them something."

While the problem is being presented as a demanding patient, the actual problem is the doctor's failure to have the appropriate tool to address the patient's rightful request.

In my office, such a demand would not be a problem, because instead of handing out a useless antibiotic as an expensive and dangerous placebo, I instead utilize substances and procedures which oppose the offending organism by enhancing the patient's existing defense mechanisms. For example, instead of killing a fever, I encourage its appropriate control. A fever is one of your body's ways of destroying invaders, by overheating them to death. Like an overgrown forest can be thinned by a controlled fire, a bounded fever can restore a natural internal ecology.

Another way I help patients manage infection is by administration of herbs that are known to cause the proliferation or increased activity of immune cells. And I can couple that with the nutrients which support immune function, and which are in extremely high demand during infection. When these nutrients become scarce, they limit the effectiveness of the immune system; introducing greater amounts allows the immune system to attain peak activity.

These approaches do not suffer from the same problem as antibiotics, because my approach to restoring health is patient-centered, not disease-centered. This is an important distinction to make.

From the public health perspective, we need to adjust the cultural factors which allow for bacterial proliferation. That means reformation of how we produce and distribute our food, and the best way to do that is to change our consumption and purchase patterns; and that, of course, means farmers markets, CSAs and neighborhood (or individual) gardens. When you buy meat from a farmer who raises and butchers his livestock humanely, you are immediately reducing the likelihood of spreading food-borne diseases.

But there is an underlying cultural premise that inhibits these systemic changes from occurring. That premise being that bacteria are bad.

The trouble being, of course, that they aren't. We live, work, thrive, play and die in a organismic soup. The bacterial biome surrounds us, engulfs us, and, indeed, integrates us. Without bacteria, we would die. We have bacteria living in our gut, which helps us to digest our food, and bacteria living in our respiratory tract which aid our immune system. With all due apologies to Sting, every breath we take and every move we make is watched over by a billion bacteria, each with their own function. Some are detrimental, some are beneficial, but each is absolutely necessary for our life to exist.

Yet we have been taught that bacteria are bad, evil killers. To avoid confronting this misunderstanding, we even use euphemisms for the good bacteria. Instead of saying to a patient, "Here, take these bacteria for your intestinal problems," I have to say, "Here, let's use these probiotics to fix your intestines." If I actually reminded people that I was giving them bacteria to ingest, they would run screaming from my office.

(As an interesting side note, I have begun treating patients with chronic sinus infections as well as acute upper respiratory infections by giving them ENT "probiotics" in the same way I administer gastrointestinal "probiotics." It is a novel approach which has both support both experimentally and from clinical experience.)

I have even heard complaints from patients in my office that we use bar soap, rather than "antibacterial" liquid soap. The problem with that complaint being that all soap is sufficiently antibacterial for all but surgical purposes, and the so-called "antibacterial" soap is actually bad for your health.

The only thing we really need to do to avoid the predicted bacterial epidemic is to shed our irrational fear of bacteria. Like most other public relations wars  -- the War on Cancer, the War on Drugs, the War on Terrorism -- the War on Bacteria is a failure. We cannot exterminate, eliminate, or even control life forms that are so ubiquitous and so necessary to our survival.

Instead of looking at the problem like warriors, let's look at it like farmers, or like good managers of a profitable, long-term business enterprise. We need to create the conditions, in both our internal and external environments which cause the good bacteria to flourish, and the bad bacteria to shrink.

This, in turn, means we need adequate supplies of clean water and nutritious food. We need an economic system which encourages physical and mental health as core components of productivity. We need a cultural environment which admires health and intelligence over sloth and anti-intellectualism.

This will not eliminate death and disease due to bacteria, but on the other hand, nothing will. The advantages of an environmental approach like I am suggesting is that it utterly eliminates the arms race between us and bad bacteria, replacing it with a heterogeneous complex system which is adaptive to our health needs and maintains a healthy competitive advantage between us and the bad guys.

Approaching the post-antibiotic world from this perspective turns the apocalyptic predictions on their head. While not a utopia, a bacterially-healthy world based on good water, good food, and flexible stability is a far cry from the death and destruction the purveyors of drugs would have you believe.

*Fear, Uncertainty, and Doubt -- the marketing technique famously used by IBM, and more recently, mainstream medicine, to maintain a monopoly in the face of competing ideas and products.