low dose naltrexoneIn 1984 Naltrexone was approved by the FDA in the US for the treatment of opioid addiction, when used at doses of 50mg to 100mg per day. Acting as a pure opioid antagonist, naltrexone in higher doses blocks the effects of endogenous endorphins, that are seen in our own natural endorphins as well as those in drug abuse. Used in opioid overdose and opioid addiction, naltrexone suppresses the “high” experienced with drug use as well as helping minimize withdrawl symptoms in patients going through opioid recovery.

During the peak of the AIDS epidemic, researchers noted that when naltrexone was given in small doses to HIV/AIDS patients, T-cell levels improved! The increase in circulating T-cells helped regulate the immune system and thereby slowing down the disease progression.

It was this discovery that led to further research on understanding exactly how LDN, also known as low dose naltrexone, could be used in clinical practice as one of the greatest treatments for immune support and restoration.

Since LDN works on the deep cellular receptors, it proved difficult to find consistent ways to measure data and therefore not a lot is known on the EXACT mechanism by which LDN works. Due to the limited clinical trials, LDN could only be studied anecdotally by following the patient’s clinical response to treatment. Because of this, LDN never made it to main-stream medicine, until now.

Recent clinical research has shown that LDN, in doses of 0.5mg-4.5mg, although a pure opioid antagonist, does not appear to suppress the endorphins as seen in the higher dose, but in fact, has shown to stimulate the T-cells within our immune system.

According to LDNResearchTrust.org, LDN

  • Causes increased endorphin release
  • Increased endorphins that modulate the immune response
  • Reduced the speed of unwanted cells growing. Dextro-Naltrexone is an antagonist for at least one, if not more immune cells
  • Antagonizes “TLR,” suppressing cytokine modulated immune system
  • Antagonizes TLR-mediated production of NF-kB – reducing inflammation, potentially downregulating oncogenes

Taking Naltrexone in larger doses of 50-300mg seems to negate the immunomodulatory effect by overwhelming the receptors, so for the effect to work, the dose must be in the range of 0.5-10mg, usually maxing at 4.5mg in clinical experience.

Since LDN will only block opioid receptors for three to five hours, the body experiences a rebound effect which greatly increases the production and utilization of endorphins. Once the LDN has fallen off the receptors and excreted, the increased number of endorphins bind to the now more-sensitive and more-plentiful receptors. As a result, these new and improved receptors assist in regulating cell growth, promoting healing, reducing inflammation, and increasing immunity and autophagy.

So what does this mean for you or me?

A few years ago, I began noticing that many of my patients were being treated with LDN for SIBO/Leaky Gut Syndrome by the Gastroenterologist. In the following months, Rheumatologists began prescribing it to help treat Auto-immune conditions.  What I observed was that when LDN was added to their other medications, overall severity of symptoms and relapse rates in health drastically reduced.  I was truly dumbfounded and confused as to how a medication in lower doses that was used to treat opioid addictions was life changing in autoimmune conditions.

I began my research into this potential “miracle” treatment. Given that LDN is not used in mainstream medical practice, it made me a bit leery to begin prescribing it, but it did not stop me from learning everything I could about it.

In March 2020, when the pandemic first began, I was so troubled to see young healthy individuals affected by the virus to a degree that you would not normally expect.  Why would they have this much of a hyper response of their immune system?

The great Dr. Fauci explained it so eloquently. When the virus enters the host (us), it triggers varying responses in our immune system to be able to fight off the virus. This is normal. This is what the body is supposed to do. Some systems may have a small inflammatory response, while others have a massive explosion of their cells.

Think of this analogy: a small fire (the virus) occurs while you are cooking.  Putting the fire out with a glass of water (normal immune response) would take care of it without causing any serious issues (mild symptoms). However,  if the pipes burst and flood the whole kitchen (severe Covid symptoms) in response to such a small fire, then we have bigger problems (ventilator, death, Covid long-hauler syndrome.)

In essence, the immune system is our built-in sprinkler system. It helps put out any fire that occurs in our bodies.

Exercising, adequate sleep, limiting processed foods, minimizing stress, avoiding excess alcohol etc. keep the fire from being created.

However, due to aging, genetics, poor health choices, medical conditions etc, the immune system finds it difficult to handle even small imbalances and begins to over-compensate the response by releasing excessive cytokines and other chemicals that cause a degree of inflammation that is out of proportion to the minor problem that occurred.

The over production of inflammatory components disrupts the natural defense mechanisms and begins signaling to attack our own cells. The body gets confused as to who is the good guy and who is the bad guy, so it attacks anything that comes in its way.  Hence the term AUTO immune.

The vicious cycle of inflammation-attack-inflammation-attack causes cells to mutate and develop into what we know as the disease state. This mutation further weakens our immune system which makes each cycle of inflammation worse than the one before.

So how do we stop this hamster wheel of destruction? That is the million-dollar question. No one has the definitive answer, but LDN has some promising scope.

Months into the pandemic, the science community began to develop some understanding of the nature of Covid’s behavior. However, my attention and worry turned to the potential long-term effects of the attack on our immune system, irrespective of the severity of the symptoms one experienced.

Have you ever wondered why everyone you know suddenly is affected by some form of autoimmune?

Much research is focusing on “Post Infectious Inflammation” as a potential cause of the rise in autoimmune conditions in the last decade.

Remember when you were a kid and were diagnosed with mono or were around your friends who had it?

One theory is that the Epstein-Barr virus, the virus that causes mono, triggered an initial immune response to the virus. Rather than clearing the body of the virus, the EBV remained dormant in the immune system. When there was an external (environmental or lifestyle choices) or internal trigger, it activated the immune system years after the initial infection. Once again, it was our immune mediated hyper-response that led to a decline in our T-cell function.  Similar findings were also discovered in post Ebola and SARS infections. This is the same pattern being seen in Covid long-hauler phenomena.

The decline in T-cell functioning is thought to be the epicenter of where disruption and breakdown of the body system begins affecting every organ and every disease process.

I am extremely terrified of what this virus could be doing to our immune systems 5-10-15 and even 20 years down the road.  The idea is not to live with the worry of ‘what ifs.’ But if we can understand other viruses’ response to our bodies, maybe we can do the same with Covid.

The symptoms we experience on a day to day basis – headache, weight gain, vision changes, joint pain, problems sleeping, GI issues, hormonal imbalances, and the list goes on and on, is thought to be a step from the exaggerated immune response.

Even as we identify the “cause” of those symptoms, why did the “cause” even happen? Let’s say you have been having weight gain and after blood work we identify the weight gain is coming from low thyroid. So we have an answer to the weight gain, but do we have an answer to why is the thyroid not optimally functioning?

That is how deep into the cells we need to go. LDN is helping us find and fix the cause for the causes at the root – where the real healing occurs –  in the immune system. That is where we need to go. We are not just going to the root. We are going to where the seed was first planted.

On January 28, 2021, a double-blinded placebo-controlled study testing LDN 4.5mg in Covid long haul patients began. The study is scheduled to finish August 2021 with preliminary results 12 weeks from the start of the study. Early indications look promising with patients reporting mild improvement in fatigue and muscle aches. That is a start!!

After seeing the results my patients were having with the LDN and after hours, months and even years of LDN research, I felt confidant to begin prescribing it to patients I felt could greatly benefit from the additional immune support.

Since LDN is not commercially available in the lower doses, it must be compounded at an accredited compounding pharmacy.

Doses can start as low as 0.25mg/day, as tolerated and titrated weekly as tolerated until reaching optimal dose of 4.5mg/day.

For some, the optimal dose may not be as high as 4.5mg/day. The body may respond at 1.5mg or 3.35mg. There is no perfect dose. As long as there is clinical improvement, the dose will remain effective for safe long-term use.

LDN is also used for many autoimmune conditions, MS, various cancers and a wide spectrum of other disease processes.

While LDN certainly does not replace the current standards of diagnosing and treating, nor do I believe this is the “one” pill to fix everything, I remain cautiously and excitedly optimistic.

While nothing can ever take the place of our bodies’ own power to heal, it is nice to know that there is something out there that can potentially help take healing beyond the root of the problem and into where the first break occurred.

There is hope!

Stay well. Stay healthy. Stay present. And remember, just breath.

It is all ok! We got this!

 

 

Natural Ways To Raise And Maintain Your Immune SystemEight months into 2020, Covid has become a household name. However we cannot forget the other virus that visits us every winter, Influenza A & B.

Public health officials have been warning us since March that this winter will be the year of the double virus whammy, but what does this mean for us and how can we keep ourselves safe and healthy?

Strong theories suggest because of increased compliance with mask wearing, social distancing and aggressive hand washing, this flu season could be one of the lowest infectious years. It makes sense, but we shouldn’t take anything for granted.

As most of you who know me know, I believe in minimizing supplements and medications and would rather allow the body’s natural defenses to protect us.

So, let’s talk about some natural ways we can raise and maintain our immune system this winter season.

  1. Eliminate processed foods. Excessive intake of sugar and other processed foods triggers inflammatory chemicals, such as cytokines and IL-1, Tumor Necrosis Factor. Overtime, this signals a sense of false-alarm in the body and lowers the body’s response to be able to launch a defense against infections. Processed foods also cause a decrease in the white blood cells needed for optimal immune system. Studies have also shown that a diet high in sugar and salt can cause vaccines to be less effective. This is why maintaining a fresh, clean and whole diet is imperative.
  2. Hydration. Our immune system is highly dependent on nutrients in our blood stream and water is the most important nutrient. Staying well hydrated is also very important for detoxification pathways, increasing lymphatic drainage and clearing out any foreign invaders. Dehydration can contribute to muscle tension, headaches, low serotonin production and digestive issues. I recommend drinking ½-1 oz/ pound body weight. Increased and more strenuous activities will require a higher intake. For example, someone weighing 150lb requires a minimum of 75 oz/day. If plain water is not your jive, try sprucing it up with fresh fruits, lemon, ginger, mint or your choice of flavorings. If the day gets away from you and you find it difficult to get in your quota, try setting an alarm every 20-30minutes as a reminder.  It will make a big difference for your immune system.
  3. Sleep. Our immune system releases proteins called cytokines. These cytokines are needed to help keep us healthy. Sleep deprivation causes a decrease in the release of cytokines as well as a decrease in infection fighting antibodies.  I cannot emphasize how crucial sleep is for our overall well-being. Sleep requires discipline.  Make an effort to shut down all electronic devices one hour before bedtime. Wind down with soothing instrumental music and maybe a warm cup of decaf tea or your favorite non-alcoholic beverage. Take five minutes to write in your gratitude journal or just close your eyes and enjoy the flow of your breath. As simple as all of these may seem, they are the most powerful tools we have. And we each have it in abundance.
  4. Don’t worry. Be happy. Life is a canvas of stress. That won’t change. But how we react to can. Acute or chronic stress raises cortisol levels which decreases our abilities to fight off foreign antigens. Stress also inhibits the body to mount an immune response by decreasing the production of lymphocytes. Of course there are things in life that require our constant attention and can lead us into a path of uncertainty and fear.  Remaining on this path will only takes us into a pit of disease and poor quality of life. Best way to neutralize the effects of stress is to identify which coping mechanisms help you BEFORE stressors arise.  Do you feel happy after a five mile run? Do you forget your troubles after laughing to your favorite sitcom or movie? Does reaching out to your BFF put a smile on your face at the end of the conversation? Or can sitting in silence bring you the peace and calm that is needed? Go on the offense before needing to get defensive.
  5. Essential oils. Health care providers are beginning to incorporate more holistic options into the treatment plan. While much research is still needed and ongoing, the NIH in December 2019 stated, “Certain plants possess immunomodulatory properties exerting effects on various parts of the immune system on both cellular and molecular levels: T cells and other immune effector cells, cytokine, and antibody production.” There are of course many variables that need to be factored in when choosing the correct oils. We must understand the quality control and extraction process of the company.  The plant from which the oils are extracted must be from a reliable healthy source. Understanding the compression process of the oils must retain its natural concentration and properties.  Preliminary studies show certain plants target certain parts of the immune system. Although essential oils shouldn’t be a replacement for medical care, it can be a topic of conversation with your physician.  Many of you may know, I am recovering from Covid.  Not knowing what to expect, I spent two weeks in isolation waiting to see what the day would bring. In May of this year, my daughter got me to try Essential Oils for various conditions, just to see what the hype was all about. During my two weeks with Covid, I thought this would be a good time to test out how effective these oils can really be. I used them in various ways (diffused, topically applied, drops in my water, etc.) and much to my surprise, it offered symptomatic relief for each of my symptoms. I only needed to take Tylenol one time in the entire 14 days. Essential oils may not be for everyone and they are not to be used as a substitution for your prescription medications unless discussed at length with your physician, but I do believe this is another resource to natural holistic support.

Whether you follow one or all of these tips, remember WE WILL get through this. We must be diligent, alert, patient and considerate. We are not only protecting our own health, but also the health of every single person.

Please stay safe. Please stay healthy – and know all will be ok.

breast cancerIt’s likely that you or someone you know has been affected by breast cancer. Studies indicate that 1 in 8 women will be diagnosed with breast cancer in their lifetime. This staggering number makes breast cancer the second leading cause of death among women, and an important reason to pay attention to your breast health, not just in October…but every day of the year.

Women spend a great deal of time tending to the needs of others. Whether you work full time or are a stay-at-home-mom, there’s always something that needs your attention. If a child or family member gets sick, women are usually on the front lines, ready to take action and care for a loved one in need. If the PTA calls asking for an extra two-dozen cupcakes for an upcoming fundraiser, or your boss needs you to attend an after-hours event with a new client, it’s often difficult to “just say no”. Always with good intentions, women end up neglecting their own health and any warning signs that may go along with an illness because they are helping others. It’s important to know, breast cancer does have a higher success rate for a cure when caught early, so awareness is the first step to a healthy, cancer-free you.

It’s still unknown why people develop breast cancer, however experts do know that breast cancer occurs when cells start to develop abnormally. Dividing more quickly than healthy cells, a “lump” can form within the breast tissue, lymph nodes or other parts of your body. Although it’s more common for women to develop breast cancer, it can affect men as well. Obesity, age, sedentary life, and a family history of breast cancer increase the risk for developing breast cancer. More recently, it’s been discovered that certain genetic gene mutations such as BRCA1 and BRCA2 also increases likelihood. Unfortunately these same genes can also increase the risk of other cancers, such as ovarian cancer.

Genetic testing may be considered if there’s a family history of breast cancer. Simple blood or saliva tests are used to identify any inherited mutations in BRCA or other genes.

Because a new lump or mass is the most common sign of breast cancer, it’s important to be aware of changes to your body. Regular mammogram screenings have decreased the number of advanced breast cancers, making it an important appointment to make when scheduling your well visits. Fifteen percent of breast cancers cannot be detected on mammograms, making self-exams another key component of your wellness routine.

Other breast cancer symptoms to watch for include breast size changes, swelling, skin irritation, breast or nipple pain, or inverted nipples, puckering of the breast skin or discharge from the breasts that is not related to child rearing. Breast cancer treatment has come a long way as more and more research and funds are invested into identifying the cause of breast cancer. As women are becoming more in tune with their bodies, they are learning the importance of   putting themselves first.

It’s important to take your health seriously, and scheduling regular well visits offers optimum health benefits that aren’t just essential for your quality of life, but for your family as well.

Dr. Raman’s Concierge Medical Practice is focused on caring for each patient’s individual needs with comprehensive, individualized treatment options and health programs.

For more information or to schedule an appointment, please CONTACT our office today! You can also learn more by connecting with Dr. Raman on FacebookTwitterLinkedIn, and Pinterest.

healthy snacksHaving been vegetarian for most of my life, nutrition was not always an easy path because of the limited food choices available. There weren’t as many plant-based foods as there is now. Back when I was growing up, there was no such thing as a “veggie burger.”  If you wanted a veggie burger, you ordered “Big Mac minus the meat.” Talk about ‘deer in the headlight stares’ every time I placed my order.

Fast-forward to 2014 when gluten sensitivities entered into my already scant food menu. The reactions were severe enough that even one bite of gluten would leave me inflamed and sick for days.

My love-hate relationship with food ended up being the biggest blessing in disguise. To be honest, I enjoyed the study of fitness and body movements more than I did about the role of nutrition in the healing process. But now, I had no choice but to understand why certain foods affected us the way it did.

As I began to understand the process of how crops were grown to how they made their way onto the shelves, I knew it was time for another change in this journey. It was then that I decided to make a conscious choice to eliminate dairy from my diet.

With no meat, no gluten, and no dairy available on my list, I developed a frustration with nutrition. Initially it was a daily struggle to find something that quenched my hunger and satisfied my cravings.

I knew there were endless combinations that would have allowed me to be creative in whipping up some unique delicacies. There were also certainly no limits on the number of online resources had I just googled “gluten-free vegan food.” But the truth was, I didn’t have enough patience to be creative. This led me back to resorting to all of the processed foods I worked so hard to walk away from.

Don’t get me wrong, I do love to cook and am pretty good at it when I take the time and stay present with the process of creating.

A few weeks of eating from a box left me feeling swollen, tired, anxious and imbalanced.

That was when I accepted that nutrition was more than just eating. Nutrition was life.

I had to be realistic and straight and transparent with myself on how much time I wanted to spend in the kitchen. So, I quickly learned to put together recipes that were easy, nutritionally dense and could be made in batches and stored.

No doubt a huge learning curve for someone who would rather be doing anything else other than spending time in the kitchen. But it was where I needed to be!

I am still learning.  The kitchen may look like a tornado struck the same spot twice, but in the whirlwind of the chaos emerges the essence of healing-nutrition!

Listen, the pandemic has knocked us off of everything we knew to be safe. So if you , like many others, put on a few pounds during this time, don’t sweat it. If your anxiety levels are escalating thinking of the winter days ahead, don’t sweat it.

The body is magnificent and can reset with a little discipline and effort.

Just to have some fun this month and to get you motivated in the process, I want to share with you three of my favorite original recipes. These are by no means an elaborate creation. But for me, they satisfy my sweet cravings and bring comfort to my soul. I hope they do the same for you.

 

  1. Banana Energy Bites:

1 banana

¼ cup chopped nuts of your choice

¼ cup sweetened Baker’s coconut

½ cup peanut butter

½ – ¾ cup mini chocolate chips

1 scoop protein powder (optional)

2 tablespoons maple syrup or honey

Mix all ingredients in large bowl. Spread into greased 9 x 13 pan or make into equal size balls. Place in fridge for 3 hours. Can place in freezer if prefer more crunchier texture. Cut into squares.

Enjoy for breakfast or mid-day snack.

 

  1. Indian lentil soup

1 cup lentils (any variety)

Choice of any vegetables-fresh, chopped

1 onion

2 bay leaves

4 cloves

4 cloves garlic

1 inch piece of ginger grated

½ stick cinnamon

1 tsp fennel seeds

2 tablespoons oil

Curry masala powder (available at any ethnic grocery store)

Red chili powder (optional for spicier variety)

Salt to taste

½ can coconut milk (optional)

Chopped coriander to garnish

Soak lentils for 3-4 hours.

In large pain, heat oil. Once heated, add fennel seeds. Allow it to turn slightly brown. Then add onions, bay leaves, cloves, garlic, ginger, cinnamon. Saute until brown. Add vegetables and saute. Add 2 tsp masala powder and salt. Mix so vegetables are fully coated.

Drain lentils and add to mixture. Mix thoroughly. Add 2 tsp more masala powder (adjust to taste) and red chili powder (if desired) and salt.

Add enough water to cover to top of lentil mixture. Cover with lid on medium heat. Stirring occasionally. Continue to add more water until lentils have cooked.

Add ½ can of coconut milk and allow to boil for 5 minutes.

Turn off stove and garnish with coriander leaves.

Enjoy as a soup, with naan or on top of warm fluffy rice.

 

  1. Cream Cheese Sandwich (Can substitute dairy free spread cheese and gluten free bread)

1 tub cream cheese

1 shredded cucumber

1 finely chopped red bell pepper

¼ cup shredded carrots

Red chili powder

Paparika

Indian Chaat masala (optional. Available at Asian grocery stores)

Salt to taste

Mix cream cheese, cucumber, bell pepper, carrots. Whip until frothy. Add desired taste of chili powder, paparika, chaat masala and salt. Store in refrigerator in air tight container.

Enjoy on bread, dollar rolls, crackers. Or use as your favorite vegetable dip.

 

These are just a few fun creations I enjoy having around and hope it will spark the same for you.

Planning ahead and understanding how important nutrition is in our healing allows for us to live a life that can be enjoyed without having to compromise on some our favorites.

I am by no means a recipe developer. I am just a girl with a sweet tooth who values the meaning of living your best life, but knows it is perfectly ok to have your cake and eat it too!

Dr. Raman’s Concierge Medical Practice is focused on caring for each person as a whole, not just a list of symptoms. Our office is committed to helping our patients stay well and maintain good health rather than treating patients only after they become ill.

For more information or to schedule an appointment with Dr. Raman, please contact us today.

There are so many articles out there about an improperly functioning thyroid, it is hard to know where to begin! Let’s start at the top. How many of these symptoms describe you?Improperly Functioning Thyroid

  • Extreme fatigue
  • Weight gain
  • Irritability
  • Muscle aches
  • Depression
  • Rapid hair graying
  • Decreased libido
  • And too many other “little issues attributed to aging”

These little issues could be caused by a small gland with some big responsibilities. That gland is your thyroid.

The thyroid gland produces and stores hormones through an integral and complex pathway that is directly linked to your hormones and adrenals. The thyroid plays a part in EVERYTHING AND EVERY CELL IN YOUR BODY. It is butterfly-shaped and is found in the lower part of the neck, wrapped around the trachea.

Hypothyroidism: A Common Condition, But Frequently Misdiagnosed

Hypothyroidism is a condition where the body, for various reasons, doesn’t produce enough thyroid hormone or is unable to utilize the thyroid at a cellular level. No matter what the cause, this diagnosis has debilitating and frustrating consequences.

Being diagnosed with hypothyroid myself in 2002, I have spent the last 13 years researching, studying,
and understanding the complexity of this “little gland.”

According to the U.S. Department of Health and Human Services, about 4.6 percent of the U.S. population (approximately 18 million people) age 12 and older has hypothyroidism. As prevalent as hypothyroidism is, most people are not correctly diagnosed when they first present symptoms to their doctors because there is not a standard interpretation criteria for screening tests—meaning that one doctor may think a slight dip below the normal range is acceptable while others would argue otherwise.

Your thyroid can be affected if your adrenals are not balanced or if your hormones are constantly fluctuating. Due to the minute-to-minute variability of ALL the hormones in your body, patients are often under-diagnosed.

A single thyroid level test is insufficient to make the determination of hypothyroidism.

Many other thyroid levels also need to be checked. These could include TSH, Free T4, Free T3, Thyroid Peroxidase Antibody, Thyroglobulin Antibody, Magnesium, Iron, Zinc, Vitamin D, Hormones and Cortisol.

A patient who self-educates and self-advocates is in the best position to work collaboratively with his or her doctor to determine the best course of treatment for the symptoms and diagnosis of hypothyroidism. Self-advocacy is much easier when you choose a doctor who has experience in recognizing the symptoms of hypothyroidism as well as other hormonal conditions such as diabetes and adrenal gland issues.

Treatment of Hypothyroidism

Once hypothyroidism is diagnosed, there are many treatment options that need to be considered. Synthetic thyroid (Synthroid or Levoxyl) medication is not the only option. There are T3-only medications such as Cytomel or combination of T4 and T3 medications such as Armour Thyroid or Nature Thyroid. Patients even have the option of having their thyroid medication compounded with an accredited compounding pharmacy.

Hypothyroidism is not a cookie-cutter diagnosis and neither should be the treatment.

It is extremely important to work closely with your physician to monitor symptoms and continue to regularly check your thyroid levels.

The discussion of thyroid disease is more extensive than I can capture in a single blog post. In my 15 years of practicing primary care, I have diagnosed and corrected misdiagnoses of many patients with hypothyroidism. I understand and have experienced every symptom you may be having. I know the frustrations, I understand the suffering and I continue to live with this diagnosis everyday.

If you are suffering from any symptoms that are interfering with your life, Please contact our office today to schedule an appointment.

Dr. Raman’s Concierge Medical Practice is focused on caring for each person as a whole, not just a list of symptoms. Our office is committed to helping our patients stay well and maintain good health rather than treating patients only after they become ill.

For more information or to schedule an appointment with Dr. Raman, please contact us today.

concierge medicineIt feels like every week the world becomes a little more upside-down and inside out. What do we believe? Who do we believe? How do we make the simple day to day decisions that once took mere seconds have now extended into days? When will the vaccine be ready? Will a vaccine be ready? Where do I go to get tested? Can I have my antibody levels checked? What do I do about sending my kids to school in the fall when I am scared to let them out of my sight? And the list goes on and on……

The truth is, I don’t know that any of us have the answers –  it is okay not to know. It is perfectly okay to be feeling everything you are feeling. Don’t dismiss it. Don’t justify it. Don’t talk yourself out of it. Accept that everything you are feeling is legit and valid.

I have spent a great deal of time during these last four months in meditation and introspection.  My intention for these monthly articles is to always in some small way inspire each of you. But what do I write about that isn’t already out there? How can we have a conversation that doesn’t include a left or right or an up or a down? How can I translate my thoughts into words and hope it will inspire a wave of health and healing?

The only way I know how to do that is to be myself. Raw and authentic.

I thought I would share the story of how I came to practice with the principles and beliefs that I hold.

There was a time in my early years of practice when my patient schedule would be bookmarked with 20+ patients, all spaced in increments of 15 minutes.  I barely had time to say ‘Hi’ to them and next thing I knew, I was walking out the door. There was no time to ask them how they were doing or how the family, kids, or work life was going. We had time to address only one problem at each visit, leaving the rest for a future appointment.

I will never forget the day that I decided I needed to make a change. It was March 2011, and as usual my schedule was double booked with no breaks in sight. As a person who is time conscious, I make it a point to stay on time, but one small set back in the day would put me behind by at least an hour. The day started like any other. I was feeling good that I was on schedule and the stars were aligning.  By late morning, a quick 5 minute break opened. I felt like I hit the jackpot.  I walked into to see my next patient before that break, only to find out her beloved husband had suddenly died.  How could I leave her in the middle of her anguished tears just because the timer on the 15 minutes was ticking down? I couldn’t! So I stayed there to be with her.

I was very well aware of the angry patients that began to line up after her. They also had places to go, things to do, people to see. However, I couldn’t bring myself to tell her that our time was finished. I wanted to give her the respect of my time as she began telling me about the special love she shared with her soulmate for over 50 years.

I also knew it was not fair to the others who were waiting after her because their time was just as important and valuable.

The internal tug-o-war was too much for me to handle. Both pulled at my heart strings and I didn’t know what the right thing to do was. Stay and comfort or politely excuse myself?

It was in that moment I knew I couldn’t do this anymore.  How was I to take care of somebody in 15 minutes when they were placing so much trust in me to help them?

I went home that night 2 hours behind schedule only to collapse into a pool of defeat.

When I graduated from medical school, I took the oath “First Do No Harm,”  NOT  “First Do No Harm but only for 15 minutes!”

This realization left me with no choice except to make the decision to change to Concierge Medicine.

In September 2011, I began my new practice. There was an exponential learning curve during those initial days.  I had to give myself permission to take my time. I had to get used to the fact that there was no reason for me to rush. What a feeling of freedom and joy I had!!  Nine years later, my patients have become like family. I cherish hearing their stories. I relish in their experiences, and I rejoice in their healing.

Concierge medicine has allowed me to scale down my patient volume from having a panel of 3000 patients to a panel of 300 patients.  This gave me the opportunity to take care of patients in a way I never thought possible. The concept of Concierge Medicine has only come to the forefront in recent years. As more focus is directed towards preventative medicine, concierge practices will soon become mainstream medicine. The last nine years have offered me the opportunity to engage in full dialogue with each one of you. I no longer feel a sense of urgency to stop the appointments in mid-sentence in an effort to stay on time. For me, the most profound experience has been the process of learning together with my patients. I always say I don’t have all the answers, but why not find out together? To engage in dialogue that brings about mutual growth and discovery is the best platform I know how to offer.

The time gives me the chance to earn your trust and I hope it allows you to feel heard.

We don’t always get it right – but we always have something to work towards.

Why I am writing about this now is because everything around us, outside of us and inside of us, is chaos and confusion.  When equal trust spans between physician-patient, you know you have an anchor to always hold onto.

Practicing Concierge Medicine is the reason my bond with each of you allows me the space to say “You know what? I don’t know what is going to happen.  I don’t know when things are going to be okay, but together we will figure it out.”

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on healthy eating habits and achieving and maintaining OPTIMAL health,  CONTACT our office today to schedule your appointment. You can also learn more by following Dr. Raman on FacebookTwitterLinkedIn and Pinterest.

5 reasons to spend more time outsideAs the sun glares over the horizon, the warmth of its rays welcomes us to come be present with nature in the great outdoors.

After nearly 10 weeks of doing what is best for our nation and the people of it, we began to sense the door was cracking just enough to raise our excitement.

However, this doesn’t mean it is business as usual. I caution you not to fall into the patterns of previous behaviors. We are not even close to being out of the woods.

But with what we have learnt about the Coronavirus, making smart and safe decisions can ensure we keep ourselves and others safe while being able to enjoy the summer days ahead.

We are still in the nucleus of a pandemic – and unless safe guidelines are in place, even outdoor fun can put us in a major setback.

When I intended to write on this topic a couple of weeks ago, it looked very different in my mind than it does now.

How can we ignore what is happening in our streets, in every corner of our world and within every community that surrounds our lives. All of this while a virus, known as Covid, continues to silently tear through leaving a painful path of its presence.

How are we to make sense of any of what is happening while continuing to live our day to day lives? I don’t know that we can.

But getting outdoors maybe the best possible thing we can do right now.

Here are just some ideas on how to spend more time outside this summer to get you started while still staying safe.

  1. Family picnics. Go back to the good ole days with a blanket on the ground, homemade sandwiches and the lingering scent of bug spray. After a satisfying meal, just lay back and look at the massive painting of stars, each one waiting for you to make a wish.  Such simplicity.
  2. Ice cream stroll. How fun! Load up the family, after all who can’t be bribed with ice cream, and visit your local ice cream parlor. Make it a to-go order and enjoy the savory summer treats while strolling the streets of your community.  What a wonderful way to support local business, get to know your neighbors and be out in nature. Everyone wins.
  3. Family tag. Ok. You may have a little trouble getting the older ones off their screen for this one, but it may be worth a try. Do you remember the game of freeze tag? The game goes like this, if you are tagged, you have to freeze and cannot move until someone untags you? Oh boy, do I remember.  We played this all the time and I would constantly pull pranks on my friends. Right before we would begin to play, I would tell my friends that the only coolest kid was able to drink five glasses of water in 2 minutes. And I double dared them to do it. And they did. By the time the game started, they all were running around with a full bladder.  When they were tagged, they would lose right away because they were unable to stand still because they had to pee so bad! So, I won most of the time, until they caught on to my ploy. It is a blast. You should try it with the family minus the water prank, unless you are competitive like me and really want to win. It is hilarious to watch and keeps everyone hydrated.
  4. Backyard camping. How much lower maintenance camping can you get than this? Pitch a tent or roll out the sleeping back in the privacy of your own back yard. Take in the cool night breeze and reflect on how the last 10+ weeks have brought us all back to the way life is supposed to be lived.
  5. Car roof chats. If it is just a night with the two of you or you are in need of some alone time, why not climb to the rooftop of the car and enjoy conversations with each other or yourself from a different vantage point? It is amazing how a change in location can bring clarity to thoughts and feelings. It is worth finding out, right?

My friends, this was a challenging task to write this blog.  I wanted to find a way to write on a topic that was light but in no way take away from the reality of the darkness that surrounds us.

I DO NOT want to diminish the magnitude of healing that still awaits us. Our hearts are heavy and our spirits are weary. But if we don’t find ways to take care ourselves, how can we hold up our brothers and sisters?

In the few minutes you spend reading this blog, my hope is you place down all the burdens being carried upon you and remind yourself that the world is good and it will once again become our home.

As we are caught in between the splintered worlds of the unknowns, the only thing I know how to do is extend my hand.

I hope being in the embrace of nature allows you to find the solace within the inertia of more questions and not enough answers.

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on healthy eating habits and achieving and maintaining OPTIMAL health,  CONTACT our office today to schedule your appointment. You can also learn more by following Dr. Raman on FacebookTwitterLinkedIn and Pinterest.

working out at homeSix weeks have passed since ringing in the New Year with all of those promising resolutions to get healthy. We set our intentions and march forward to sign up for those “unbeatable” gym specials. However, Old Man Winter can get in the way of leaving the house so we can keep up with those promising resolutions.

Whatever the reason that kept you from using that newly minted membership card, look no further. Here are my suggestions on ways to stay active without having to leave your home.

The benefits of incorporating resistance training far surpasses hours on a cardio machine.  Resistance bands have become one of my absolute favorite tools to have.  The versatility as well as the safety and ease of use are suitable to almost all fitness levels.

Bands are available online or at any retail store. Depending on the brand, prices can range from $5-$30+, a very worthwhile investment.

If you have any medical concerns that may preclude you from exercising, be sure to discuss it with your physician before beginning any exercise regimen.

My Band Resistant Workout: Recommend 3x/week

Warm-up: 7 minutes

Block 1: Repeat 2x rounds.  Tie band around a sturdy structure so that both ends are available to hold. (ie a wall pillar, couch leg, a tree etc)

  1. Band squats. Extend arms straight holding on to end of the band, squat, one sec pause at the bottom and then stand. Repeat 15x reps.
  2. Alternating lunges. Extend arms straight holding on to end of band, alternate reverse lunges

Repeat 15x reps each side.

  1. Squat jack. Extend arms straight holding on to end of the band, sit low in a squat and begin jumping jacks. Repeat 30x low squat jack.

Cardio:  2 minutes high knees

Block 2: Repeat 2x rounds. Free up band from structure.

  1. Lateral pulldown. Hold band in the center with approximately 12 inches between each hand, then raise band overhead and while pulling down to chest, pull the bands apart. Stop mid chest and slowly extend back overhead. Repeat 15x reps.
  2. Bicep curls. With hands in same position as 1st exercise, rest the hands on the thighs palms facing up. Next, create tension on the band by pulling it apart in opposite direction as you flex the elbows to the foreheard. Lower back down slowly. Repeat 15x reps.
  3. Chest pull aparts. Keeping band at chest level, begin pulling the band in opposite directions to outside of chest, 3 sec pause, slowly return to center. Repeat 15x reps.

Cardio: 2 minutes run in place

Cool down/Stretch: 7 minutes.

This format is only a starting point to get you motivated to stay focused on your health. There are any number of resources (online videos, books or magazines, personal trainers) that maybe utilized to take these few exercises and transform them into a consistent way of life, no matter what the outside circumstance maybe.

Be greater than your excuses!

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on healthy eating habits and achieving and maintaining OPTIMAL health,  CONTACT our office today to schedule your appointment. You can also learn more by following Dr. Raman on FacebookTwitterLinkedIn and Pinterest.

staying healthy through the holidaysDo the holidays have you jumping for joy or running for the nearest exit? Labeled as “The Most Wonderful Time of the Year,” the holiday season can be stressful and overwhelming for some. If you are in need of a vacation to refuel after all that joy, how about trying something different this year? Staying anchored amidst the peripheral chaos will not only keep you healthy, but also give you a chance to enjoy in the merriment.

Here are some simple things to keep this year’s festivities filled with glee.

  1. Exercise. Moving the body helps to mobilize stagnant energy. Inducing a heart rate response helps delivery of oxygen to those much deprived sedentary tissues. Plus, it keeps the waistline in check. If you are able to maintain your regular schedule of workouts, fantastic! If not, try using resistance bands at home. Ten minutes in the morning and ten minutes before bed provides enough resistance training to keep your muscles from winter atrophy.
  2. Meditation. Studies have shown just three minutes of mind-stillness is enough to lower cellular inflammation significantly. One of my go-to meditation apps is ‘Insight Timer’.  It is a free download that offers 24,000 meditation options ranging from two minutes up to three + hours.  Set your alarm clock five minutes earlier than you would normally get up and head to your favorite spot. Set a timer. Turn on your favorite music or have no music at all and just let your mind get lost. Don’t stop any thoughts, emotions or feelings that arise. Let them come to the surface and just observe. Go deeper into your diaphragmatic breath as each inhale/exhale brings you to a place of calm.  Once the timer goes off, you get to choose if you are done or if you want to continue longer. There is power in stillness.
  3. Increase protein. With so many tempting processed foods surrounding us this time of year, even the most disciplined cave to the pressures of home baked goods. We all know how we get when we eat too much sugar – crabby, anxious, irritable, depressed, fatigue, joint pain, swelling – and this is all before the weight gain even starts. Do yourself a favor. You know what the outcome of a sugar splurge is going to feel like. So don’t go ALL the way there. Yet, you don’t want to deprive yourself of the simple pleasures in life. You can have your cake and eat it too, but in smaller quantities. If you know you are headed towards the dessert table, load up on high protein meals prior to start of the party. High fiber, high protein snacks curb cravings while making you feel fuller. Stock your pantry this season with nourishing snacks like dates, nuts, fruits, cut meats, pre-made protein shakes (my favorite) or anything else you find nourishing and satisfying and eat it thirty minutes before partying it up.
  4. Water. We all know water helps with satiety, but more importantly water’s function is to keep the cells operating fully and completely.  As our body begins to acclimate to the cooler temperatures, it is vital that we become more diligent with water consumption. Regulating our internal thermostat causes dehydration even before the onset of symptoms. All it takes is just a little effort to see how easy drinking water actually is.  To make the process a little easier, use water bottles with clear markings so it takes the guess work out of the equation. For those that don’t enjoy the taste of fresh water, add fresh fruits through an infuser to sweeten the deal.  Recommended intake is ½ oz per body weight in pounds/day.  Set phone reminders. Having an alarm go off every 15 minutes is surely an annoying way to keep anyone on track. Don’t underestimate the importance of staying hydrated.
  5. Relax. I often tell my patients, “Let’s work really hard the first 11 ½ months of the year so when these last two weeks roll around, we can play.”  Come on guys.  Isn’t life stressful enough as it is? Why do we want to make the “Most Wonderful Time of the Year” like all the other stressed out days? Family can be stressful. Cooking can be tedious. Hosting can be exhausting. Sleep can be deprived. Weight can be piled on. House can be random chaos. But soon everything will go back to its organized, fast-paced, hurried, no-time for each other life. Let it go. The pie doesn’t have to be perfect. The decorations don’t have to be like HGTV paid you a visit. Just breathe and remember holidays are of course about celebrating family and the joys in our lives, but it is really about celebrating YOU. It is an opportunity to reflect on who you have become this year and who you are becoming into the next. It is about all that you have learnt and all that you have released. It is about slowing our heart rate and pausing with each breath. Take the pictures. Eat the food.  Enjoy the moment. You know why? Because January 2nd is right around the corner and we will soon be back on this hamster wheel in a game we call ‘life’.

Wishing you and your families a most joyous holiday season. May 2020 be a year of healing, happiness and prosperity!

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on healthy eating habits and achieving and maintaining OPTIMAL health,  CONTACT our office today to schedule your appointment. You can also learn more by following Dr. Raman on FacebookTwitterLinkedIn and Pinterest.

breast cancerOctober has become synonymous with breast cancer awareness. Everywhere you look, pink is the color you will be sure to find.

This months’ blog is dedicated to anyone who has personally been affected or knows someone with breast cancer.

It seems every day we hear about someone else that was diagnosed. Has breast cancer really become more prevalent? Or has medical technology advanced so much that we can pick up a ‘speck’ of something with the earliest of screening? I believe the answer is a little of both.

According to The National Foundation of Cancer Research, today,  the lifetime risk of getting breast cancer is about 1 in 8 for U.S. women and 1 in 1,000 for U.S. men.

While we can never 100% prevent cancer. Let’s look at the 5 scientifically proven ways to REDUCE the chances of developing breast cancer in ones’ lifetime.

Maintain healthy body weight. Excess fat converts into estrogen. High estrogen levels in the body leads to mutation of cells which can eventually lead to cancer. The American Cancer Society recommends 150 minutes of moderate intensity exercise/week. This includes aerobic as well as strength. Just another reason to get moving.

Limit alcohol. In its Report on Carcinogens, the U.S. Department of Health and Human Services lists consumption of alcoholic beverages as a known carcinogen. “Excessive and prolonged alcohol use can weaken the immune system, which is important for preventing and controlling cancer,” says Robert L. Ferris, MD, PhD, chief of the Division of Head and Neck Oncologic Surgery at UPMC. The ethanol in alcohol breaks down to a toxic chemical that can damage DNA. Alcohol may prevent the body from absorbing nutrients that may decrease cancer risk; and it increases estrogen, which is linked to breast cancer. Cancer-causing chemicals could also enter alcoholic beverages during the fermentation process. Moderate alcohol, particularly red wine, may have anti-inflammatory properties that contribute to a larger preventative goal,” Dr. Francis says. Women who drink 3 to 6 drinks per week of any type of alcohol have a 15% increase in their risk of breast cancer. You don’t have to give up your occasional cocktail just yet. Just be mindful of the amount consumed.

Breastfeeding
. Research proves mothers who choose to nurse lower their overall risk. Breastfeeding decreases the levels of free estrogen. To those mothers who struggled with this, it is absolutely ok. There are many other things you can do to protect yourselves. If breastfeeding is an option for you, choose it. The benefits clearly outweigh the discomfort of those initial nursing days.

Limit processed foods. The many revealing documentaries have exposed many of our food industry for what it is. With our crops, livestock, and even non-living products being tainted with estrogen, it is no wonder why breast cancer is climbing the charts as the leading cancer of women. Limit your red meats. A recent study from the University of North Carolina showed that eating grilled and barbecued meat increased the risk of death among breast cancer survivors. “Dangerous chemicals called heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) can be produced when cooking muscle meat like beef, pork, poultry, and lamb at high temperatures over open flame or hot coals,” says Shayna Komar, a licensed and registered dietitian at Piedmont Healthcare in Georgia. “These chemical reactions cause compounds in the meat to change into potentially cancer-causing agents.”

Know where your foods and other household products are coming from. Go green while eating as local as possible.

Let go of the stress. Stress hasn’t been proven to link to cancer, but recent studies are beginning to point in that direction.  “Studies over the last 30 years have identified psychosocial factors including stress, chronic depression, and lack of social support as risk factors for cancer progression,” state authors of the study at UTMD Anderson Cancer Center.  Another study at Ohio State University showed that stress actually turns on cancer genes. Next time you begin to get worked up, ask yourself, “Is it worth it?”

The discussion of cancer prevention is just as exciting as it is daunting. Although there are many proven ways to decrease your risk, new findings suggest we may have barely scratched the surface.

While we can’t prevent everything, we sure can try!

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on healthy eating habits and achieving and maintaining OPTIMAL health,  CONTACT our office today to schedule your appointment. You can also learn more by following Dr. Raman on FacebookTwitterLinkedIn and Pinterest.