Ebola - Is there a Silver Lining?

            The tragedy which is striking the West African countries of Sierra Leone, Liberia, and Guinea is likely to spawn sporadic cases of Ebola in the United States for years to come.  Amidst the hysteria which the handful of cases in the United States has wrought, I can see some potential good.  Over the past few weeks, I have seen health care workers and the public health system mobilized unlike any other time in my career.  Sometimes it takes fear, real or imagined, to get things done. 

            The likelihood of you or one of your loved ones contracting Ebola is remote.   Despite appearances to the contrary, we know how to handle this.  Just look at Nigeria, a country that few would mistake for having a world class health system, which was able to stem the Ebola tide and is now Ebola free.  The reason Ebola has run rampant in Sierra Leone and Liberia is that these two countries entered this crisis with fractured public health and medical systems due to years of civil war.  These factors, combined with local customs and the slow initial recognition of Ebola, have led to the current epidemic.   It is truly unfortunate that the United States and Europe showed little interest in this epidemic until it was on our doorsteps.  Ebola will plague West Africa for the foreseeable future, but it is highly unlikely, neigh impossible, that Ebola will cause a similar outbreak here in the United States.  Hysteria should not rule the day.  We need to harness the energy and awareness wrought by this terrible disease and enact change for the better.  I know we can do this.

            As an infectious disease physician and head of my hospital’s infection control at the Charles George Veterans Medical Center, I have spent countless hours in meetings, developing protocols, giving lectures, and taking part in simulated drills in response to the Ebola outbreak.  I have become intimately familiar with some of the more mundane aspects of healthcare.  I have sought answers to the following questions - What does one wear while caring for a patient infected with Ebola?  How does one clean up blood or vomit for an Ebola patient? Will the waste management company we contract with handle the waste?  Can we even flush the toilet?  I get over a hundred emails a day regarding Ebola.  Guidance seems to change by the minute depending on whether it is the CDC, the North Carolina public health department, or our hospital system giving it.  Everyone is scared.  What if a person with Ebola walks into our emergency room?

            I have tried to convey a simple message:  the likelihood of our hospital caring for a patient infected with Ebola is small, but if it happens, we are ready.  My hope is, despite the fact that we may never care for an Ebola patient, we will have benefited from our preparation.  According to the CDC, there are over 75,000 deaths in the United States each year due to hospital acquired infections.   I have little doubt this number dwarfs the Ebola-related deaths we will ever see in the United States.  As a result of the Ebola scare, my own hospital, and all the hospitals I have contacted, is spending thousands of dollars purchasing the necessary supplies to be Ebola ready.  In addition, we are spending hundreds of hours retraining our staff in the proper use of personal protective equipment.  Hopefully, the time spent focusing on properly putting on and taking off protective gear, hand hygiene, and improving communication between staff will reap benefits that extend well beyond Ebola preparedness.  

            We should all look to the current Ebola crisis as a wake-up call.  America needs to step up to the plate and provide the leadership and resources to resolve the crisis in West Africa.  Never again should we wait for Americans to be affected before we act - the world is too small.  On a local level, we have an obligation to make sure we provide the best care possible.   I see the current crisis as an opportunity to strengthen our health system and reduce preventable complications.  Ebola is the current crisis, but it won’t be the last.

 

Next week...Ayurvedic Medicine- Following the Doctor's Orders

Ayurvedic Medicine- A visit to the Doctor

          A week has passed since I completed the UltraSimple diet detoxification.  I have gained back five of the twelve pounds I lost, and as a result, my clothes are no longer hanging off me.  Now, it is time to give Ayurvedic medicine a try.  I may be jumping from the frying pan into the fire.  Nevertheless, I manage to carve out a couple of hours from my busy work schedule to see the Ayurvedic doctor for an initial consultation.  Ayurveda sounds like pure Asheville.  If you know Asheville, you know that it is a town of cool retro-spots, good restaurants, and home of all things alternative.  I expect the Ayurveda center will be located downtown in a trendy area, but no, it is located in a modern office space on Hendersonville Road.  Imagine big box stores, Bennigans, excessive signage, and traffic congestion and you have Hendersonville Road - the least appealing area of Asheville.  Surprisingly the Ayurvedic center is not the only alternative option in this area.  The very same office building also houses an integrative medicine clinic - just one more sign that alternative medicine has gone mainstream.

            I expect this visit might be expensive.  I harken back to my visit to the Naturopath:  the initial consultation cost over $100 yet paled in comparison to the cost of the recommended herbs and homeopathic remedies. Blue Cross and Shield is not taken here.  I know that herbal remedies are a big part of Ayurveda.  I can only imagine the price tag.  Herbs purchased in a grocery store are expensive enough, but import them from India and prescribe them as a remedy, and I am sure the cost skyrockets.  We will see.

            I enter the Ayurveda center, and no one is there to greet me.  I can tell by the Indian pictures on the wall, the dim lights, and the wicker furniture that I am in the right place.  A sign on a table says someone will be out shortly.  I take a seat and try to channel my inner Buddha.  That is me - Mister Low Key, not in a hurry.  In truth, I am analyzing everything.  I can only aspire to be Type B.  Fifteen minutes after my consultation is scheduled to begin, a customer emerges from the back room followed by Jesus. Not actually Jesus, but certainly a reasonable modern-day imitation. The doctor has long hair pulled back into a pony tail, a loose fitting shirt, jeans, and no shoes.  He is clearly in his element.  He is Asheville while I am just an imposter. He invites me to the back room.  We sit across from one another in two upright chairs.  His office combines modernity with Ancient India. There is a table top with a computer, books, and his scribblings juxtaposed with pictures of India, a waist-high, golden, elephant Buddha, and shelves stocked with large jars of crushed herbs.  This is a far cry from the sterile dispensary with which I am familiar.

            After casually introducing himself, the doctor launches into the usual questions that begin any visit:  “What brings you here?”  “What do you hope to gain?”  He then begins a fairly detailed inquisition into my dietary habits, lifestyle, and my general constitution.  I am expecting this line of questioning.  Of course, what he really wants to discover is my dosha.  Should I save him the effort and just blurt out that “I am a Pitta.”  I suppress the urge and answer his questions faithfully.  “Yes, I sweat a lot. No, I am not prone to constipation. In fact, I have frequent loose stools.  Yes, I would describe myself as high stress.  I suffer from insomnia, heartburn, and headaches.”  These last two admissions pique his interest.  He does not seem surprised that I get heartburn.  He asks further questions to better define my headaches - “How frequent are they? What triggers them?  How do you relieve them?”

            Next, he takes a very detailed history of my dietary habits.  I tell him about the cleanse that I just recently completed, and he nods approvingly.  In fact, I think the cleanse has stolen much of his thunder.  He recommends avoiding empty sweets - done, caffeine -done, processed foods -done.  I am becoming worried.  It appears that if I follow his dietary recommendations, the cleanse, which I am so relieved is over, will live on minus the dreaded UltraBroth.  Fortunately, he doesn’t mention cutting out alcohol.  I am not sure if this is an oversight, but I don’t ask.  I can drink my evening glass of wine or beer.  Hallelujah!

            Now that history taking is completed, we come to the physical examination.  Where will he probe? What bodily samples will I have to produce?  He pulls up his chair until we are directly across from one another, and our knees are nearly touching.  He places a square pillow as a bridge across our laps.  First he stares deeply into my eyes.  Then, he has me stick out my tongue while he studies its furrows and ridges.  I wonder if the cleft I have from biting through my tongue as an infant gives him any insight.  Then, he has me place my arms on the pillows, and he uses three fingers to check the pulses on both my wrists.  Apparently, he is much more adept at reading one’s pulse than me.  I remember reading about Ayurvedic doctors being able to appreciate three components of one’s pulse and thereby being able to derive inferences regarding overall well-being.  After a few more seconds of pulse reading, he is done.  The exam is done. No urine or blood sample required.

            He declares my constitution is Pitta.  I am amazed.  He also says my “imbalanced state” is also Pitta, but with a bit of Vata.  Now that my dosha is revealed, he can tailor a specific therapeutic plan for me.

            First, he returns his focus to my diet.  We spend extensive time going over foods I should avoid and foods I should load up on.  He encourages me to double my water intake to two liters a day.  (It seems that every discipline, including western medicine, is convinced that we are continually at risk for dehydration).  I am to avoid drinking milk in close proximity to when I drink orange juice.  Most of his dietary recommendations are fairly standard - avoid processed foods and increase my intake of natural fruits and veggies.

            He says that Pittas have a lot of heat; therefore, I need to avoid heat producing foods which will only feed my fire.  He is pleased by my frequent bowel movements, but remains concerned about my headaches and heartburn.  He says heartburn is a symptom rather than a disease itself.  When I express an openness to try herbal remedies, he smiles.  He leaps up, stares at his shelves, and contemplates out loud which jars hold the right herbs for me.  He grabs a zip lock baggie and starts adding a scoop or two of various herbal powders.  After a few moments of indecision, followed by a few clarifying questions regarding my sleep habits and bowel movements, he completes the herbal concoction and hands me the bag. He tells me to take two teaspoons twice daily mixed with hot water. 

            The visit is coming to an end.  He suggests I contact him via email in a week or two to report on my progress and possibly to schedule a visit to the Ayruvedic day spa for an Abhynanga (warm oil message) or perhaps a Shirodhara (Ayurvedic Bliss Therapy).  He says these treatments are part of the process to restore balance and promote relaxation.  The next question - cash or credit card?  Alas, my bliss is coming to an end.  The total bill is $150 for the consultation and a mere $20 for the herbs.  Compared to my naturopathic visit, I feel like I am making out like a bandit.

Ayurvedic Medicine - Hello Ancient India

            For my next foray into alternative medicine, I will travel back in time and give Ayurvedic medicine a try.  Ayurveda is one of the world’s oldest forms of holistic healing.  Ayurveda traces its origins back thousands of years to ancient India.  The first obstacle I come across in my plans to sample this discipline is how do I pronounce Ayurvedic?  Is it Aaroovadick?  Ayorveedak?  Fortunately, I don’t have to look far to find clarification from a native of India.  Do all Indians aspire to be doctors?  I share my office with a Dr. Gupta, not the world famous Sanjay Gupta, but Vinnie Gupta.  Dr. Gupta informs me the correct pronunciation is “Eye yur vaydick.”  Now that I can pronounce Ayurvedic, I am ready to find a local practitioner.  Fortunately, I now live in Asheville, North Carolina, home of all things alternative.  San Francisco has nothing on my little mountain town when it comes to non-traditional forms of medicine. Had I searched for an Ayurvedic doctor in Cleveland, Ohio, two years ago when I started this quest, I would have been out of luck.  Asheville not only has Ayurveda, but it boasts one of the few Ayurvedic centers in the United States.  Don’t lose heart Clevelanders - a University Hospitals affiliate just added Ayurveda as a wellness option - further proof that alternative medicine is not really so “alternative” any longer.

            What is Ayurveda?  Does a form of wellness therapy invented thousands of years ago still have relevance in modern times?  To answer these questions, I turn to my usual sources: my bible, Alternative Medicine - The Definitive Guide, and WebMd.  These two sources provide opposite sides of the spectrum - alternative medicine devotees versus western-trained doctors like me.  According to Dr. Deepak Chopra, Ayurvedic physicians ask “Who is my patient?” rather than “What disease does my patient have?”  The focus of Ayurveda is to promote good health rather than to treat disease.  Ayurveda believes in the connectedness of everything in the universe (Connectedness is a key buzzword for many “alternative” beliefs.  I often think my traditionally trained colleagues worry too much about the “connectedness” of their coding for procedures and billing).  Ayurveda says everything is composed of the five basic elements - space, air, water, fire, and earth (a bit simpler than the 118 elements that make up the Periodic Table).  These basic elements combine to form a person’s metabolic type or dosha.  If your dosha gets out of balance, you are prone to illness.

            I check out the three doshas - Vata, Pitta, and Kapha.  Which one am I?  Persons typically are of one predominant dosha, but may express the other doshas to a lesser degree. There are certain characteristics associated with each dosha.  My bible, Alternative Medicine, lists traits associated with each dosha.  As I read the list of general traits, I am reminded of a bad horoscope which gives general predictions that could apply to everyone.  Despite my initial cynicism, I am clearly a Pitta:  medium build; fair-thin hair (thinner than I would like); warm-perspiring skin; doesn’t miss a meal; lives by the clock; intelligent and articulate (of course); orderly-efficient; warm and loving (maybe); short-tempered (nope); heartburn (yep); hemorrhoids (yes, how embarrassing); and, acne (my friends definitely remember my pizza-faced youth).  Wow!  I am a Pitta through and through.

            According to WebMd, those with Pitta as their primary life force are more likely to develop anger and negative emotions (bullshit! I hate this website!), Crohn’s disease (I do have bowel issues), heart disease, heartburn, high blood pressure, and infections.  Fortunately, I am an infectious diseases doctor so I should be able to handle the last of these.  Based on my overwhelming Pitta-ness, I should have had a least one cardiac bypass surgery by now.  I don’t dare wait any longer.  I need to find guidance before I croak.  I will set up my first Ayurvedic consultation right away. 

 Next week . . . a visit to the Ayurvedic doctor.

Detoxification Completed

           It is Sunday once again.  The UltraSimple Diet is over and not a minute too soon.  I am losing weight at a frightening pace.  Skinny when I started this endeavor, I am now down right emaciated.  I lost eight pounds in the last week and about four pounds in the preceding week.  The last time I was this skinny, I had just returned from eight months in West Africa (and no, I did not contract Ebola).  Getting dressed in the morning is a challenge.  What clothes do I have that won’t swallow me up and make me look like a bag of bones?  Enough about the weight loss; the question you are asking is: “how do I feel?”

            Dr. Hyman, author of the UltraSimple Diet, claims that by “reducing toxic stress” through his diet, I will feel renewed and rejuvenated.  Is it true?  In a word . . . maybe.  The past two weeks of no processed sugar, no wheat products, no caffeine, and no alcohol has certainly changed my attitude toward food.  I realize now that most of my diet in the past has been made up of these synthesized, unnatural foods.  Despite the change in my perspective, I do plan on eating many of these foods again, but in moderation.  Additionally, I will be adding many more fruits and veggies to my diet.  If the UltraSimple Diet is meant to reboot one’s attitude towards food and inspire healthy eating, then it scored a ten.  Do I feel less toxic?  Not really.  What I have felt for the past two weeks is a deep rumbling hunger.  Let’s get this straight, being hungry is not fun.  I no longer aspire to be on a reality survival show.  I want to know where and when my next meal will be.  Despite my newfound respect for food, I have learned to tolerate pangs of hunger and will no longer require a fistful of cookies to stave it off.  Although I came to appreciate the merits of sautéed veggies on brown rice, I don’t think I need to eat this particular combination again for a few months.  I also don’t see any more UltraBroths in my future (see last week’s blog post to learn the ingredients).  This morning, I happily sat down to a breakfast of scrambled eggs, toast, and turkey bacon.  Give me some credit:   I had hot water with lemon rather than my usual cup of coffee.

            I retook the “Toxicity and Inflammation” quiz outlined in the UltaSimple Diet manual.  My pre-diet score was a 16, which rated me as having a “mild imbalance,” while my post-diet score was little changed at 13.  Where did my score change?  For the past week, I have not had any heartburn, belching, or passage of gas.  Amazing.  I can’t say I really care whether I pass gas or not, but my wife was thankful.  The one area where my score worsened was general fatigue.  For some reason, the feeling of starvation also made me feel more sluggish and adverse to exercise.  Imagine that.

            What is my assessment of the whole detoxification process?  It is a bit over the top.  I don’t plan on doing a cleanse like this one again.  If rapid weight loss is your goal, then the UltraSimple Diet is great.  My wife lost six pounds, and my colleague at work lost five pounds and a few clothing sizes.  I lost over eight pounds, and I imagine I must have passed beyond the stage of breaking down fat, to digesting my own muscles.  I will now go about trying to regain much of the weight I lost.  As for the benefit of this diet and ones like it for reducing toxicity and inflammation, I remain skeptical.  I feel as inflamed today as I felt two weeks ago, and this is despite the fact I largely abstained from vigorous exercise.  It is hard to go for a long bike ride or lift weights when you are craving food.  I am glad I have joined the multitude of cleansing veterans.  I imagine my liver is smiling.  While I may not have become a cleansing devotee, I do admit it has effectively reset my attitude toward food.

Next week . . . Ayurvedic Medicine (Ancient Indian Remedies in Asheville)

Time to Detox: The UltraSimple Diet begins

              It is Sunday afternoon.  I survived the week of “preparation” which leads up to this week’s UltraSimple Diet.  I awoke this morning with a sense of relief that I have made it this far. Unfortunately, my relief is coupled with a sense of dread regarding the week ahead.  With some difficulty, I eliminated all caffeine and processed sugars from my diet.  Early on, in an attempt to soften my caffeine withdrawal, I substituted green tea for my morning coffee, but by mid-week, I jettisoned the green tea.  Although it has a bit of caffeine (equivalent to a half cup of java), it was not worth suffering its bland taste and the nausea it induced.  I have not been perfect.  God forbid, I had a turkey sandwich on wheat bread for lunch one day, even though this was a double violation - processed meat and a wheat product.  By and large though, I have been faithful to Dr. Hyman’s instructions.  I certainly would have enjoyed a beer or two after some particularly trying days at work, but I abstained.  Now the heavy lifting begins: the cleanse.

First, I must give thanks (or perhaps blame is more appropriate) to my wife.  She is making this cleanse possible.  Not only is she going through the process of detoxification with me, but she has done the majority of shopping and the initial food preparation for this coming week.  Looking over our bill from Whole Foods reminds me that “health food” is not cheap, at least not at this time of year.  Earlier in the summer, we likely could have purchased most of the veggies at a farmers market, but as we move into fall, the selection of inexpensive produce has diminished.  The bill for a bunch of veggies (that I typically abhor), rice protein powder, and flax seed is over one hundred dollars.  Even more appalling to my penny pinching sensibilities is that these expensive, unfamiliar vegetables (radish root, winter squash, kale, chard, seaweed) are the key ingredients of the UltraBroth which is a staple of the UltraSimple Diet.  Preparation of the UltraBroth entails cooking these veggies in a large pot of boiling water for sixty minutes and then discarding them and only keeping the broth.  My goodness!  I am not sure if I am more shocked by the waste or relieved that I don’t have to eat the veggies.  The end result is a pot of yellow-grey “broth” which resembles dishwater in both appearance and taste.  I can hardly wait for my 2-4 cups a day.

Although we have barely started the UltraSimple diet, I can already tell it will not be so simple.  Fortunately, one area I don’t have to worry about is having regular bowel movements. Dr. Hyman, author of the UltraSimple diet, devotes several pages of his book to the merits of frequent stools and the horrors of constipation.  In fact, according to the UltraSimple diet, if one has failed to have a bowel movement by ten o’clock in the morning, they are supposed to take an herbal laxative.  I chuckle when I bring this to my wife’s attention.  It is already eleven in the morning, and she has failed to go.  I see a laxative in someone’s near future. On the other hand, I have absolutely no worries about meeting the ten o’clock cut-off.  Ever since my time in Ghana, West Africa, I have multiple loose stools every morning.  I kid my boys that I am infested with intestinal worms which I picked up in Africa.  For all I know, it may be true.

Breakfast consists of some lemon juice in water followed by an UltraShake.  The shake is basically a water-based fruit smoothie.  It contains a blend of non-citrus fruit, rice protein powder, flax seed, and water.  The flax seed gives it a not so palatable odor, but it is drinkable.  I tolerate the shake, but I yearn for my normal weekend breakfast of coffee, eggs, toast, and orange juice, with bacon on the side.  Around ten in the morning, I am ready for my standard mid-morning snack.  Instead of my usual energy bar, I have a cup of UltraBroth - ouch.  After a lunch of bland sautéed veggies over brown rice and some leftover UltraShake, I am downright cranky.  This week is going to last forever.  My nightmares will be full of UltraShakes and UltraBroths.  Fortunately, there is one part of the UltraSimple Diet that is not so bad . . . the UltraBath.  A long soak in a hot bath with Epsom salt, baking soda, and lavender oil is something to look forward to.  I might just drink the bath water when I am done, or would that be UltraDisgusting?

Next week . . . Detox completed.