What a weekend!

I have always maintained that more education is better, which is why I am one of only a handful of doctors statewide who is board-certified in both clinical nutrition and acupuncture. My recent appointment to the Board of Directors for the national nutrition specialty board is also a natural outgrowth of this emphasis on ongoing professional enhancement. This weekend, I received another certification which, while not a physician-level postgraduate degree, is a certification of which I am equally proud.

Today, I can happily state that I am a League Certified Cycling Instructor. I have been certified by the League of American Bicyclists   to teach courses in all phases of bicycle riding, road and traffic skills, and bicycle maintenance, to both adults and children.

Getting this diploma is a nontrivial task, beginning this summer, when I took the prerequisite class for my certification course. I then had to apply to take the certification course itself by completing a cycling resume which established my bona fides for having the necessary experience to even take the course, absorbing a stack of reading material, and then proving that I had done so by taking a test which took me -- no kidding -- 3 hours to complete.

All that was just to get in the door.

The class itself started at 5:30 Friday night, going until 10:00 that evening; resuming at 8 a.m. on Saturday, and wrapping up around 9:30 at night; and a final, "short" day on Sunday, again starting at 8 a.m. and wrapping up at 6 p.m., after which I got to go home and reintroduce myself to my kids. The dog, fortunately, remembered me.

It wasn't all sitting around, thankfully. During this time, I gave two short classes on various cycling education topics (Night Riding and Cadence, Gear Shifting and Power Output) went on one educational road ride, led and taught a portion of a second road ride, and extemporaneously taught and demonstrated a number of bicycle handling drills, all while receiving feedback from my instructors and fellow students. When I wasn't learning by doing, I was learning by watching my classmates and providing critiques of their performance.

It was, by anyone's standard, an exhausting weekend.

At the same time, it was one of the most rewarding experiences I have had. I learned a tremendous amount, not so much about cycling -- the admission process assured that my cycling knowledge was a given -- but about teaching, learning and community building. I gained far more than I expected to this weekend, and the spillover into other professional areas is obvious to me.

One question I have been asked, is why did I spend so much time and effort to achieve such a high level of competence in a field which is really outside of my professional realm?

It's a good question, but a question that is flawed by its premise. My overarching concern is with my patients' health, and I constantly preach the virtues of an active lifestyle.

But, honestly, most people are loathe to begin an "exercise program" or to continue one that they have started, unless they are faced with extraordinary circumstances (impending diabetes or heart disease, for example) . To my mind, it is more effective to find ways that allow people to incorporate exercise into their daily activities than it is  to set up a structured exercise program that will be abandoned in a month or two. (That said, I refuse to classify vacuuming a house as "exercise," as did one recent -- and exceedingly flawed --  study.)

Cycling fills that niche perfectly. It is an age-free activity (using the new, sporty trikes (check some out here), even older people or those with balance problems can safely hit the roads under their own power). It is a physical activity that most people have at least some passing pleasant experience with. Finally, cycling provides a tremendous return on investment in heart, lung and muscle performance -- which in turn, translates into decreased illness and disease, longer lifespan, decreased dependence on drugs...need I go on?

So by becoming certified to teach cycling to others, I am also improving my ability to help my patients in what I see as a very fundamental way.

The second reason I chose to take this course is that I am hoping, by providing cycling classes to adults and children in the area, to give back a little to the Litchfield community of which I am so fond and which, for the past decade or so, has given my children wonderful schools, mentors, and coaches under whose tutelage they have thrived.

I hope that, by teaching families successful cycling strategies, that I can help them enjoy this area's quiet and extraordinary beauty in an entirely new way -- while at the same time, giving them alternative activities that are healthier and more rewarding than time in front of the television or under the spell of a video game.

And, I have found increasingly over the past several years that a quote from India's famous sage and politician Mahatma Gandhi has become a governing principle in my life.

"We must be the change we wish to see in the world," Gandhi said. More and more, I am trying to live by that standard.

The (Swine) Flu Season Is Upon Us!! (yawn)

Unless you are living in a cave in the furthest reaches of the Andes, you are probably aware that FLU SEASON IS COMING! The media has certainly gone into chicken little overdrive to keep you utterly misinformed about the flu and the allegedly proper precautions to take to avoid it.

This is what is known as FUD (Fear, Uncertainty and Doubt) marketing. It was employed by IBM during the 60s and early 70s to maintain it's near-monopoly (at the time) over computer systems, which back then were the size of small garages and were fairly pricey. The technique is to scare you into buying the product by capitalizing on the customer's fears.

In IBM's case it was the fear executives had of switching to upstarts like Digital Equipment Corp., even though DEC's computers were faster, smaller, cheaper and better. In the case of mainstream medicine, the fear they inculcate is that you will die unless you buy their products. Now that's what I call purchase motivation!

The problem is, of course, is that the fear that they are selling is not backed by the facts, and we expect a little better ethics out of the health care system than we do out of a bunch of computer salesmen from New York.

Nonetheless, pharmaceutical companies have FUD marketing down to an art form that IBM marketeers back in the day could only have dreamed of. Today's vaccine makers have public health officials from the federal level to village health departments hustling their goods for them. (I wish chiropractic had an army of salesmen like that, it would reduce national healthcare costs dramatically.)

The fact of the matter is, epidemiological studies have repeatedly shown that flu vaccines historically have a very low success rate, and in fact, make little difference in the course of the disease. In short, they are failures.

Although it's a bit of a comparison between rotten apples and tasty, fresh oranges, I would like to mention that a follow-up study done of the people who attended my flu clinic a couple of years ago found that 97% of them remained flu-free for the season.

The marketing hand of the flu FUD machine was also visible in the renaming of the virus. Anybody else notice how the “swine flu” was suddenly renamed the “H1N1 virus”? The main objective here was to remove any similarities in the popular mind between the similarly hapless swine flu “epidemic” of the 70s and it's attendant lethal vaccine, and the current public health travesty.

Here's why I think the H1N1 virus epidemic is similarly overrated: A virus, to be successful, can do one of two things. It can be fairly lethal, or it can be relatively benign and spread easily. A lethal virus is unlikely to spread easily because it kills its hosts before they can infect a large number of people. A benign virus can spread easily, because it doesn't make you sick enough to put you down for the count, so you walk around infecting everybody around you.

The only virus in recent history to escape the Viral Dichotomy is HIV. It managed, through its transmission method and long latency, to be both lethal and readily transmissable.

And to those who are arguing that the swine flu is the overdue pandemic, I would point them back to HIV/AIDS. That virus did create a pandemic, though it still has problems being recognized as such because prejudice rendered its initial victims invisible and, in many countries, too many people found open and honest discussion of its transmission methods to be distasteful.

The swine flu virus hasn't managed to achieve anything near the success of HIV in either lethality or transmissibility. The swine flu virus has taken the latter course, of being easily spread, over the former course. So, even if you do get it, the consequences are unlikely to be more than a couple of days of inconvenience – and, remember, the vaccine is unlikely to prevent that from occurring.

So, here's my take-home on the H1N1 (the virus formerly known as Swine) epidemic: Meh.

My recommendations for this flu season are no different than any other:

1. Wash your hands frequently. This, according to the Centers for Disease Control is the number one way of reducing your risk of catching the flu.

2. Exercise. Regular exercise has been shown to enhance immune system function.

3. Eat well. The proper diet has been shown to enhance immune system function. (If anybody wants a list of immune-enhancing foods, just send me an email.)

4. Have two chinese herbal remedies on hand: Bi Yan Pian and Yin Chiao. The first is used in traditional chinese medicine for colds, and the latter is is used for the flu.

And the fifth piece of advice I have goes beyond flu prevention: Ignore the FUD. If you do not buy the fear, uncertainty and doubt that they are selling you, you won't need the attendant, frequently dangerous, medicines.

Ghosts In The Research

As a doctor, I rely on research to inform my decisions and help formulate treatment plans for my patients. Research tells me what works and what doesnt' work. In addition, when doing acupuncture, I stand on the shoulders of many generations of doctors who have come before me, and I can rely on their experimentation and observations to guide me.

And when it comes to research on Western nutrients and chiropractic advances, I am assured that the research is free from the influence of big money. Because, let's face it, nobody is becoming a millionaire by selling Vitamin B.

Pity the poor MD, then. There has been mounting evidence for years that the research that MDs use to decide which drugs to prescribe has been tainted. And, finally, the crows are coming home to roost.

The Journal of the American Medical Association has revealed that up to 10 percent of the articles in the most prestigious medical journals were written by unacknowledged, industry-funded ghostwriters. Some 7.8 percent of named authors of 630 articles admitted contributions from ghostwriters who weren't named, with the highest percentage found in the New England Journal of Medicine (10.9 percent) and the lowest in Nature Medicine (2 percent).

In another story just reported by the AP, GlaxoSmithKline commissioned sales reps to recruit doctor-authors for ghostwritten articles supporting Paxil use. And this story followed another revelation, that Wyeth used ghostwritten reviews to push its hormone replacement therapy.

You remember hormone replacement therapy, right? The anti-cancer, anti-heart disease miracle cure for women that turned out to cause breast cancer and stroke?

And just to top it all off, it appears that the pharma companies are turning to ghostwriters once again, in this case to have the FDA change its rules to allow pharma to use journal articles (you know, the ones they wrote) to push their drugs for off-label uses.

You know, I really wish I was making this stuff up. But I'm not. And the biggest problem is that nothing will ever come of these revelations. Like the big banks, Big Pharma is too big and too wealthy to fail.

All I can do is try to remind people that the companies that make drugs are far more interested in your wallet than your health.

But I'm a tiny voice in a very large, and largely craven, industry.

More Talk

Another episode of Alternative Healthpod is up. This week I discuss the biggest danger to health in this country. Click here to subscribe, or subscribe via iTunes. As always, if you download via iTunes, don't be shy about rating the podcast. (In case you've forgotten, 5 stars means really good. That's the one most people use, I would go with the flow if I were you.)

The Power of the Spoken Word

Interested in how (poorly) a doctor can manage his own health problems? Check out the new Alternative Healthpod podcast, "Physician, Heal Thyself!" You can do it one of two ways: 1. Go to the podcasts section at iTunes and search for "healthpod," or 2. download it directly from the feed.

If  you do go to iTunes, please rate the podcast. 5 stars would be great, but I'll take what I can get.

What’s Wrong With This Picture?

The picture on the right is of the woman nominated by President Barack Obama to be our next Surgeon General, Regina Benjamin, MD. The U.S. Surgeon General is the leading spokesperson for public health matters in the United States.

The Surgeon General shapes the direction of public health policy, and can have a tremendous effect on the health habits of Americans, as demonstrated by the dramatic drop in cigarette smoking in the years since the Surgeon General's office condemned it.

Today, the focus is turning toward preventable lifestyle diseases, such as heart disease, obesity and diabetes.  It is a sure bet that the up-and-coming Surgeon General will be out in front in confronting the lifestyle choices that cause these diseases.

And let's not mince words here. Genetics and environment play only very small roles in obesity, heart disease and diabetes. The major causes of these diseases are the Standard American Diet (SAD) and sloth.

For the most part, Dr. Benjamin is an excellent choice for Surgeon General. She is a MacArthur Foundation genius grant recipient, founder and CEO of a rural health clinic, a medical college dean, and recipient of too many awards and certificates to count.

So what's wrong with this picture? The problem is that while Dr. Benjamin may very well promote the tenets of healthy living, one has to wonder, does she actually live by those principles?

If she does not, she can use all of the oxygen in the world to recommend healthy eating and active living, but the message will not be heard.

I know through my own experience that a doctor has to walk the talk of healthful living. I can gladly cajole my patients to exercise routinely, because I train 5-6 days a week. I can lead patients into healthier diets because I eat healthy myself.

I also fall out of training and have been known to suck down a bag of Doritos like a Hoover, so I can help my patients with those pitfalls as well.

Most chiropractic physicians know that we have to walk the talk, because our relationships with our patients tend to be more of a partnership and less of a dictatorship than the MD-patient relationship.

On the face of it, what I'm about to suggest sounds like a far-fetched idea.

But if you look at the nuts and bolts of what today's Surgeon General has to do, might it not make sense to choose a doctor who lives by the dictates which he/she recommends to the populace? Who leads by example rather than dictum? Who knows how to inspire people to better health?

Why shouldn't our next Surgeon General be a Doctor of Chiropractic?

Friday Fun Facts

Fact #1 Remember, it's not all about calcium. A new study suggests that neutralizing an acid-producing diet may be an important key to reducing bone breakdown while aging. Fruits and vegetables are metabolized to bicarbonate and thus are alkali-producing. But the typical American diet is rich in protein and cereal grains that are metabolized to acid, and thus are acid-producing. With aging, such diets lead to a mild but slowly increasing metabolic acidosis which can then lead to bone loss.

Increasing fruit and vegetable intake can help reduce metabolic acidosis and thus decrease the rate of related bone breakdown.

Fact #2

“Honey, let me call you back on a land line. That annoying oxidative stress in my brain is acting up again.” Ginkgo Biloba has been shown to prevent oxidative stress in brain tissue caused by mobile phone use. Also, Ginkgo biloba prevented mobile phone induced cellular injury in brain tissue histopathologically.

Fact #3

If I was stuck on a deserted island and had to take only one vitamin with me, this would be the one. Women who have insufficient levels of vitamin D during their pregnancy may negatively impact a genetic variant in their offspring that increases the risk of multiple sclerosis.

Researchers found that proteins in the body activated by vitamin D bind to a DNA sequence next to the DRB1*1501 variant on chromosome 6. DRB1*1501 is a variant which increases the risk of MS to 1 in 300 in those who carry a single copy and 1 in 100 in those carrying 2 copies, in contrast to a risk of 1 in 1000 in the rest of the population. The team believes that a mother's vitamin D deficiency could alter the expression of DRB1*1501 in their children.

Fact #4

A guy walks past a mental hospital and hears a moaning voice " ... 13 ... 13 ... 13 ... ".

The man looks over to the hospital and sees a hole in the wall. He looks through the hole and gets poked in the eye. The moaning voice then groaned " ... 14 ... 14 ... 14 ... ". Researchers have discovered that a form of vitamin B1 could become a new and effective treatment for one of the world's leading causes of blindness.

Scientists believe that uveitis, an inflammation of the tissue located just below the outer surface of the eyeball, produces 10 to 15 percent of all cases of blindness in the United States, and causes even higher rates of blindness globally. The inflammation is normally treated with antibiotics or steroid eye drops.

"Benfotiamene strongly suppresses this eye-damaging condition and the biochemical markers we associate with it," said UTMB associate professor Kota V. Ramana, senior author of the study. "We're optimistic that this simple supplementation with vitamin B1 has great potential as a new therapy for this widespread eye disease."

Fact #5

What do you do when a pig has a heart attack? You call a hambulance!

People who have had heart attacks are likely to have been in traffic right before their symptoms started, according to new research.

“Driving or riding in heavy traffic poses an additional risk of eliciting a heart attack in persons already at elevated risk,” said Annette Peters, Ph.D., lead author of the study and head of the research unit at the Institute of Epidemiology, Helmholtz Zentrum Muchen, Germany. “In this study, underlying vulnerable coronary artery disease increased the risk of having a heart attack after driving in traffic.”

If you ask me, that's just another reason to cycle instead of drive.

Truth in the Funnies

Dilbert is often funny in it's truthfulness:

But it's true. All too often, people seek the natural remedies far too late. While there is wisdom in the adage "better late than never,"  there is a point at which a pathology overcomes the body's self-correcting mechanisms. And then, indeed, it is too late for broccoli.

Hydroxycut & the FDA

After 23 people reported side-effects, the FDA has forced a recall, and is recommending that people stop taking, some Hydroxycut products because of reported liver damage. Far be it from me to question the wisdom of the FDA (ahem)...but has anyone considered the fact that most people who use Hydroxycut are body builders, and that a great number of bodybuilders also take illegal steroids, and steroids also cause liver damage?

I think it is far more likely that Hydroxycut is being blamed for liver damage being caused by simultaneous illicit steroid use that nobody wants to fess up to.

Intelligent analysis suggests that we regard this as just more nutritional fear-mongering being served up by a government agency far more invested in the health of the pharmaceutical companies than it is in yours or mine.

A Father’s Pride

While the following information doesn't fall into the overall theme of this blog, I hope that my faithful readers (all four of you) will forgive me for the following post:  

LITCHFIELD, CT – Youth archer Shayna Jenkins opened up the indoor archery season with a decisive win in her division at the Connecticut Fall Classic archery tournament, held at the UConn campus in Stoors, CT this weekend.

Jenkins scored 507 points out of a possible 600 in the 60-arrow tournament, besting her closest rival by 17 points.

Her score was also the highest for any female competitor using standard Olympic bows, regardless of age or division. In addition to individual entrants from throughout the region, the tournament included teams from UConn, Wellesley, and Brandeis universities.

This win brings Jenkins' winning streak into the indoor season. This summer, Jenkins scored a hat trick, capturing the state championships in Connecticut, Massachusetts and New Jersey.

Osteoporosis Drug Increases Heart Attacks

MONDAY, Oct. 27 (HealthDay News) -- The popular bone-building medications known as bisphosphonates may have a rare, but serious, cardiac side effect. A review of available research concludes that these medications may increase the risk of atrial fibrillation -- an erratic heart rhythm that can lead to blood clots that may cause heart attacks or strokes.

"In addition to possible gastrointestinal side effects, bisphosphonates can have possible cardiac side effects. For serious cases of atrial fibrillation, there was a significant increase in risk -- about 68 percent," said review lead author Dr. Jennifer Miranda, an internal medicine resident at Jackson Memorial Hospital in Miami.

----------------------------------- I've been saying this for several years now, but Fosamax and its ilk are not the answer to osteoporosis. This is just one of several health problems caused by bisphosphates (not the least of which is that this drug causes bone erosion while it supposedly helps your body "create healthy bone."

If you have been diagnosed with osteoporosis or osteopenia, do yourself a favor and call me to find out how you can preserve bone health without giving yourself a heart attack.

And don't forget to stop by for my lecture on Wednesday night. No free food, but I promise to have loads of great information and some new jokes. Honest. I've been practicing in front of the mirror, I'm really funny.

Sneak Preview

While doing some research for my upcoming seminar, "Your Prescription May Be Your Problem," I came across this interesting tidbit... "During the period from 1989 to 1997 the vaccination rate for elderly persons 65 years of age in the US increased from 30 to 67%. Despite this increase in coverage, mortality and hospitalization rates continued to increase rather than decline as would be expected if the vaccine were optimally efficacious."-- from the International Journal of Epidemiology

In other words, an analysis of nearly 10 years' of data reveals that what the public health experts have been telling us is simply not true. The fact of the matter is that the influenza virus does little to prevent the flu.

You'll get more about this -- and some other revealing research -- by attending my seminar.

Your Prescription May Be Your Problem

This is an open invitation to attend my fall seminar.

Wednesday, Oct. 29, 7-8:30 p.m. Litchfield Community Center Reservations and directions: call (860) 567-5727

Drugs for this problem, drugs for that problem...if you would believe the advertising, there really is "a pill for every ill."

Unfortunately, drug advertising, like all other advertising, is a fantasy. In fact, there is a gathering body of research evidence which shows that prescription drugs cause as many problems as they solve. Certainly, for some disorders, especially acute problems, drugs are necessary. But chronic disorders are another matter entirely. From painkillers to hormone replacements to the drugs that were supposed to "cure" osteoporosis, and which have now been shown to cause bone erosion (!), the drug-based approach to chronic health problems has been proven to be both dangerous and largely ineffective.

There is a different way. A different approach to chronic disease which replaces drug dependence with self-reliance and instead of side effects offers positive effects.

At this upcoming seminar, I will show you the research that tells us:

• What are the most dangerous common prescription drugs.
• Which class of over-the-counter drugs is the leading cause of emergency room admissions.
• How you can evaluate your drug-related risk.
• What are the most common disorders, including leading causes of mortality, that can be better managed without drugs.

 But most importantly, I will show you that there are cost-effective, safe alternatives to a drug-based approach to health. These alternatives are science-based, proven by research, and have been clinically validated.

This seminar is absolutely free! Please set aside the time to attend. Space is limited, so make sure to call (860)567-5727 and tell Teresa that you are coming.  Or send me an email and let me know how many seats you need to reserve. And don't hesitate to recommend this lecture to your friends. It will be a fun, interesting, educational time.

I am looking forward to seeing you!

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Garden of Health

This lovely garden around our sign was created by one of my patients. It  is especially beautiful at night, when illuminated by the sign's spotlights.

Now I remember why I became a doctor

As you might imagine, the transition from two weeks on two wheels on the shores and islands of Scotland back to Litchfield took a bit more than a soft landing by the KLM pilot, a healthy meal and a sound night's sleep. And like anyone else returning  to work from a holiday, I was not over-enthused about unlocking the office door on that Monday morning. Oh, the paperwork! The bills! The inventory!

So  it was with some trepidation on Monday morning that I leaned my mechanical steed into the parking lot, slowed to a stop, and looked around. The first thing that I noticed was that the lawn was neatly manicured and the walk swept clean.

I unlocked the door and walked in. The dark blue carpet of the waiting room was the first thing that jumped out at me.  Usually this carpet is a bit of a mess, receiving a daily coating of dirt, grass clippings, and whatever else patients bring in with them (note to those starting their own businesses: Never, ever, ever use a solid dark color in public areas, never mind how impressive it looks. You will spend either half of your working life or half of your payroll budget keeping the darn thing clean.)

Today, however, it was spotless. I opened the door to the hallway, and was greeted by more clean carpeting, cupboards and countertops neatly wiped down, everything sparkling.

While it was tempting to attribute this to worker fairies who stole in during the night and plied their cleanliness magic, the truth was much more prosaic and important.

During my abscence, my ever-suffering office manager Teresa had taken it upon herself to make a clean sweep of the place and return it to the pristine condition that she knows I prefer.  She even pressed her sons into maintaining the premises outside, and although I understand there was some largesse involved on my part, it still went above and beyond what I could expect from an employee.  And it is true, Teresa is far more than an employee. She is part of what makes the Center a living breathing entity. She's the first person that patients see and the last to say goodbye to them. To a large extent, my success as a doctor rides on her capable shoulders.

And I probably don't say this nearly enough. Thank you very much Teresa.

After that brighter-than-expected start, I settled in to the business of being a doctor, which, in primary care, often involves seeing patients. And one after another asked about my trip, and said how glad they were that I had returned.  Slowly, my mind and spirit was dragged back -- however unwillingly -- from magical Dunedin, and not  only to the business at hand, but a slowly dawning recognition. Or, perhaps, re-recognition.

Over the years, I had begun to forget the magic that I represent to many of my patients, most of whom had unsuccessfully sought relief for their illnesses for months or years before landing on my doorstep. Somehow, I developed the reputation of being the house of last resort, which may be seen by some as a backhanded compliment -- "Heck, nothing else works, might as well try Dr. J..." but which I've always felt to be an honor.  To some patients, I'm the guy who could fix what nobody else could.

The interesting thing is that, really, I'm just doing what I'm trained to do. Observing, listening, testing, looking for patterns...I just use a different map than most doctors do, and that map gives me landmarks and lesser-known paths that are obscured by the superhighways on other doctors' maps.

Still, though, I had forgotten what an actual honor it is to be that person in someone's life. Until, that Monday, when patients started hugging me.

I had timed several therapeutic interventions to launch and proceed through the early phases, where my assistance might be required, before I left for Scotland, and to conclude upon my return so that I could again assist on re-entry, as it were.

Happily, we were successful in all quarters, and my patients' achievements were manifest. They were so happy and enthused over their success, and I reveled with them. And they thanked me, and to a man or woman, they each hugged me.

And with those hugs, I remembered that beyond the bills, the thieving insurance companies, the  mendacious pharma companies, and the tremendous forces levied against my profession -- beyond all of that is the heartfelt thanks of one person to another.

And that, I remembered, is why 20 years ago, I embarked on a radical journey to become a chiropractic physician.

So, to all of my patients, let me say: Thank you. You are doing all the hard work, I'm just here to guide you along the way a little bit.  And thank you for trusting me with your health, and the health of your loved ones.

Scotland, Part III: The Scottish Character

One of the reasons that I so enjoyed my trip to Scotland was because of the Scots themselves. I like them. They are unpretentious. What you see is what you get with a Scot. And they enjoy some of the more famous stereotypes about themselves. I was standing outside of a pay toilet when a man walked up and said in the distinctive Scottish burr, "Is that thing working?"

I said, "Yeah, but you'll have to pay 20p to get inside it."

He snorted in derision. "That'll be the day, when a Scotsman pays to go to the toilet," he said.

We both laughed, and he ambled off, presumably to find a suitable facility in a less pricey neighborhood.

I've not quite figured out the whole relationship between Scotland and England, despite having read all I can find about it. Essentially it boils down to a thousand years of the two populations intermingling, beating the snot out of each other, exchanging royalty, signing treaties, breaking treaties, beating the snot out of each other some more, and then intermingling some more. Go figure.

There was not an individual I met who was not willing to stand around and chat, and some of my favorite memories of Scotland will be of the long, wonderful conversations I had there.

I spent a couple of nights in a hostel, and I must say that I loved it. The hostel was a gathering point for travelers, a bit of a community center, overtly friendly, and overtly counter-culture, minus the drugs. It almost made me think I was back in Berkeley. Again, far different from the hostels I have stayed in America.

The people of Scotland are more reserved than Americans, even the notoriously taciturn New Englanders I live among, and despite my shy and retiring nature, I could tell at times I was accidentally being the brash, noisy 'merkin.

Such as the time I finally reached the top of a particularly nasty hill, after just hammering my way up, at which point I threw my fist into the air and let out a bit of a war-whoop. Nothing that I would bet 90 percent of the Americans reading this haven't done before.

I also stopped to catch my breath, and a few minutes later, a man came out of the nearby lodge to chat with me. For the next 10 minutes he proceeded to very humorously bust my chops for my very un-British outburst. It was one of the funniest interactions I had there. (The ride down the other side of that hill was a hoot, by the way).

Finally, one of the things that consistently impressed me, was the ingenious use of technology. As an American, I'm used to thinking of my country as being the most technologically advanced in the world.

I'm afraid I had to re-think that one. It seems that the British have far surpassed us in their civic implementation of technology.

For example: Solar-powered parking meters that you can pay either by coin or by cellphone. Or traffic signals that are intelligently controlled by radar constantly monitoring traffic patterns. Or pay phones from which text messages can be sent as easily as making a telephone call. These weren't big-city Edinburgh features, either. I found such innovation in small towns as well as large.

There are more, but you get the idea. We have some catchin' up to do.

All told, I would go back to Scotland in the blink of an eye, and, in fact, I hope to do so. After all, I've only had the chance to explore one small slice of this most beautiful country.

Yeah. I'm going back there.

Scotland Part II: Edinburgh, City of Philosophers, Poets, Royalty, and…Cyclists

My trip to Scotland began with several days in Edinburgh, home of scientists, philosophers and poets. Today it is also the location of the Scottish Parliament. The city is ancient, buried layer upon layer, and you can cycle through succeeding eras, pedaling through time as you cross the city. If I were to make a comparison to an American city, Edinburgh was like Boston times 1,000. Unlike Boston, however, Edinburgh is a city of hills, and some sights which you cannot miss if you are there.

The first is Arthur's Seat (yes, that Arthur), a volcanic hill situated virtually in the center of the city. It is the first thing that you will see when your plane descends, and it is worth getting off the bike to climb to the summit.

Another path to follow would be the cycle/footpath along the Water of Leith, hilariously described here by the irrepressible Jacquie Phelan. This is a hidden gem in the city.

But one of the truly interesting thing for me, cycling through Edinburgh, was how cyclists are treated, both by the infrastructure and by other motorists. Edinburgh makes even Portland look like a shallow poseur in its treatment of cyclists.

First of all, the British in general are very polite. They somehow even manage to honk at you politely, as a few did as I clumsily adapted to the different traffic directionality. I thought their treatment of me, as I would make turns into the wrong lane to bear down on them head-on, or dart in front of them in a roundabout as I looked in the wrong direction, to be very appropriate.

And as I got better with the whole left-hand driving thing, I found that the motorists would invariable pass with a wide berth, expect me at intersections, and generally recognize me as a valid part of the traffic. Even the closest brush I had during the two weeks I was in Scotland was a mere whisper of what I face daily in Connecticut.

There are bike lanes. There are spaces at the head of intersections reserved for bicyclists. There are special traffic signals for cyclists. (Sometimes, these can get a bit confusing. At one light I counted no less than eight signals, not including the directional sign for the nearest gents' toilet.)

But, most of all, there are cyclists! I counted more utility cyclists in an afternoon there than I have seen in an entire year here. Some in cyclist-specific clothing, some in their work clothing, some in whatever they felt like wearing. All of them, though, treating their cycles as their vehicle of choice. (As opposed the the utility cyclists I see here, most of whom are using the bicycle only because the court temporarily removed their access to an auto.)

Yeah. It was heaven.

I cannot help but to think that should the same environment exist here, the number of utility cyclists would skyrocket. Yes, build it and they will come.

The other thing that I must mention is helmet use. Here in America, helmet use is de rigeur for any serious cyclist, a standard to which I have adhered for many years. Yet in Edinburgh, in fact in most of Scotland, helmet users are by far in the minority. Even though these are clearly serious, daily cyclists.

So, when in Rome...

Don't tell anybody but for two weeks, I left my helmet packed in my suitcase. The entire trip was done sans head protection, and, frankly, I will have some trouble re-conforming to the American standard.

Which was a sentiment which lasted for about 45 minutes of cycling in America. After two close brushes (less than 24 inches) and one extended honk, which clearly meant "Get off *my* road," I remembered why we wear helmets here.

NEXT: The Scottish Character

Scotland, Part I

While this is not quite in the theme of this blog, many patients have been asking me about my recent trip to Scotland.  So, herewith are some of my thoughts, written from the vantage point of the avid cyclist that you know I am... Part I: Geography To Stir The Soul

First of all, Scotland is the most beautiful country in the world. I will make that statement despite the U.S., Canada, and Scotland comprising the entirety of my experience. Naysayers will have to accept simply being wrong.

For some reason which I have been unable to define, the hills of Scotland reached out and grabbed my soul like no other mountains ever have, except for the White Mountains of New Hampshire. Their barren, craggy peaks and steep green sides have an in-your-face grandeur that simply challenge you to best them. You could have thrown me off the train with my hiking boots and rucksack, and I would have been perfectly happy for months exploring those hills.

Except for the fact that I would have missed the shoreline. No namby-pamby white sandy beaches here, oh no. The rocks and the water rush to meet each other in a salty embrace both powerful as the waves hit and the spray flies, and gentle, as the water laps and gurgles around the well-worn curves of its partner.

Small villages wrap themselves along the shore, squeezing themselves in between the water and the hills, utterly unpretentious in their proud claim to this hard land. The architecture is ancient, strong and functionally beautiful. These villages have refused to debase themselves to the tourist dollar. Make no doubt, the tourist economy is important here and accommodations exist, but in only one case did I encounter anything even remotely resembling the typical American tourist town, and even that place had many saving graces.

Granted, the route I traveled was a bit off the beaten tourist path, and intentionally so. I wanted to avoid the hordes of cars and people that invade the prime tourist areas during this time of year, and was successful at it.

Oh, yeah. Scotland also has castles. Reams of them. Which makes the whole castle thing entirely ho-hum from a Scot's point of view, but for me -- even coming from New England, where structures which could at least reasonably be called old exist -- something built six centuries ago, and not only still standing but still being lived in is absolutely extraordinary. If there is any warrior blood in your soul, seeing a Scottish castle perched on a rocky outcrop with a dark, brooding sky behind it will quicken your pulse and send your hand to your side searching for the hilt of your sword.

"How does this translate into cycling?" you may ask. Cycling in Scotland is not for the flatlander, of that you may be sure.

First of all, the road conditions. To listen to a Scot describe his or her roads, you would think that the pavement was nothing but a string of potholes connected by brief bits of crumbling tarmac. Accompanied by maniac motorists threatening your very existence.

This is not true.

The roads of Scotland are glass-smooth, and allow the tire to grip the surface like a baby holds its mother's hand, every curve is banked and motorists defer to cyclists on each occasion.

OK, that might be a bit of exaggeration.

The truth of the matter is that the roads I rode were in most cases in better shape than the roads I cycle daily in Connecticut. There are no shoulders to speak of, and I also rode on many single-track roads, but the well-mannered British driver obviated the need for any sort of additional accommodation (more on that later).

The roads were hilly, to be expected as I was traveling in the southwestern end of the Highlands. But they were not hills as I am used to them in the foothills of the Berkshires. Here, I am accustomed to finding long, slow grinds of several miles in length, as you work your way from valley to ridge. Scottish hills are nothing like that. They are short, sharp, steep, lung-gasping climbs from loch's edge to cliff's edge, with sheer drop-offs to the sides and pitches that will pummel your legs, if only for a short while. Then a quick drop, and you get to reclaim that elevation, plus a little bit more, on the next climb, until you have reached the height of land.

In fact, I found myself on one hill that was so steep that my trusty recumbent bicycle was popping wheelies with each stroke. Not that he is the most sedate steed, but I've never felt myself almost pitched from the saddle in that way before!

In short, they are perfect hills for the sprinter, which I am not. Nonetheless they reward you with some extraordinary fast and fun downhill riding, with curves that will encourage you to test your handling skills and to answer the eternal question of just how far can I lay this bike over? All while gaping in awe at the majestic scenery all about you.

Walking the Talk

As a primary care physician preaching the gospel of nutrition and exercise, I have always tried to follow my own advice. Particularly this year, with my overseas adventure rapidly approaching, I have been ramping up the fitness quota, and am now pushing six training days weekly. Nobody as yet has mistaken me for Thor, God of Thunder. There's always hope, though; after all, myopia is a common disorder. Nonetheless, despite the general public's oversight in this regard, I think I'm in pretty good shape. At least, I did until yesterday.

Marilyn Gansel, a personal trainer with studios in Stamford and Kent, CT, graciously invited me for a one-on-one with her in her Kent facility. Marilyn is multi-degreed and is currently working on her PhD in sports psychology. Marilyn and I have talked with each other on many occasions about her functional approach to training, and she offered me the chance to experience it first-hand.

A Different Path to Fitness

Before we get to the embarrassing parts, first a word about functional exercise. Traditionally, strength training has been performed by isolated muscles, using benches, barbells, dumbells or machines. The exercises will work one set of muscles at a time; for example, the classic bench press, which is used to strengthen the muscles of the chest.

Functional exercise, on the other hand, uses more complex motions with weights in a variety of forms when additional resistance is needed. For example, at one point Marilyn had me doing lunges off of a step, while at the same time raising a medicine ball above my head and in front of my chest.

For fairly obvious reasons, these exercises, and the benefits they give you, translate much more readily into our day to day activities and the sports in which we participate.

And for the majority of my patients, it is these exercises, not the leg-curl machine at the gym or the physical therapist's office, that will provide the greatest benefit.

Sure, following orthopedic surgery, the isolated, single-joint, single-muscle approach is the way to go. But most of my patients with musculoskeletal complaints suffer from more chronic soft-tissue injuries. In these cases, functional exercises are leaps and bounds ahead of traditional techniques.

And for people whose disorders affect their sense of balance or coordination, training such as this can be especially helpful.

Indeed, as I found out, functional exercise training can provide benefits for those seeking to improve their overall fitness, a goal I try to impress on all of my patients, regardless of disorder.

Finding the Weak Spots

It took Marilyn all of 15 minutes to isolate some extraordinarily weak areas of which I was utterly oblivious. Because my strength training routine has focused on the larger muscle groups, some of the smaller muscles used to control posture and stabilize movement have gone somewhat neglected. Strengthening them will only improve my performance in my two primary activities, Aikido and cycling.

But as with any weak area, the path to improvement is by incorporating those exercises into my workout routine.

To this end, Marilyn showed me proper form and timing for the exercises. Although her studio is equipped with high-end exercise equipment, many functional exercises can be performed with low-tech aids. Form, posture and timing are key, however, which makes her one-on-one instruction imperative.

And even working at the slower pace required by my introduction to these exercises, I could tell that the possibilities for cardiovascular conditioning are clearly present, making Marilyn's methodology a very balanced approach.

At the end of my hour with Marilyn, I could feel that I had gotten a good, solid workout. More than that, I had discovered new ways to boost my fitness, not necessarily in a win-the-swimsuit-contest way, but in an improve-my-overall-health way.

And that's something we could all use. Regardless of your fitness level, I highly recommend you get in touch with Marilyn. Her website is www.fitnessmatters.com.