Why I Switched To Concierge Medicine

September 2021 will be ten years since changing to concierge medicine. A lot has changed in the last ten years! But the one thing that has remained constant is my belief of how healthcare should be delivered and received.

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, work were. 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. But 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 placed 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 an 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.

To 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 I now have gives me the chance to earn your trust and I hope it allows you to feel heard.

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.”

Why Self Care Should Be At The Heart Of Healthy Habits

self care“You can’t pour from an empty cup.” “You can only love others as much as you love yourself.” “You are no good to others if you are not good to yourself.”

Golden words that have never been truer. Isn’t that how it was always supposed to be? So how did we get this so wrong?

Ok. Let me stop for a moment. I am not judging anybody. But, let me be clear! By taking care of you, it doesn’t make you selfish. It doesn’t make you greedy. It doesn’t make you arrogant. It doesn’t mean you don’t care.

It just means that you respect yourself enough to do the work to become the best version of YOU. So therefor, collectively as a society, we can all become better!

It took me years to understand this, let alone accept it. I am still not sure I totally get it. But what I do know is that when self-care is first on the to-do list, the list doesn’t seem so daunting.

One of my greatest pet peeves is hearing “I don’t have time.” What do you mean you don’t have time? We all have the same 24 hours. It is how we use that precious commodity that matters. When we get stuck in the notion that time is finite, we lose ourselves in the maze of excuses. Once excuses become part of our everyday vocabulary, health, peace, joy and happiness becomes a distant dream. Then the tsunami of failing health, mental fatigue, hopelessness and desperation hits.

We all HAVE it! We breathe it 24 hours a day. It is in our faces every minute. To say we “DON’T HAVE TIME” seems like a little bit of an oxymoron.

I know! I know! I am usually not this gloom and doom, but when it comes to prioritizing self-care, I have a pretty low tolerance of hearing excuses.  Every single one of you is deserving of your “ME TIME,”  but it is up to you to seize it. The spectrum of longevity and quality of living is determined by the time and effort you put into you.

It is not a luxury! It is a necessity! Self-care is an act of lovingly giving to yourself what you deserve without judgement or guilt. The path is different for each of us. In whatever way you replenish yourself, remember why you are doing it.

While in that “ME TIME,” remember to allow the flurries of joy to arise within you.  Don’t silence it just because the task is finished or the clock tells you your time is up. Stay there. Enjoy that strange feeling, that familiar feeling from childhood when joy was all we knew and has now become a faint distant memory of adulthood. That’s where we are going. Back to that place where self-care wasn’t an option. It wasn’t something we had to choose to do. We just lived it.  And we were so much healthier because of it.

Everyone has different ways of getting back there. Take your time finding yours.

The road for me continues to be under construction. Different phases of my life have offered different opportunities and experiences to become healthier. I am learning new ways of healing while unlearning old patterned ways of destruction.

I like to keep it simple.

As many of you may know I am a Friends freak.  I watch very little, if any, TV. However,  when I see that my fuel tank is getting close to ‘E’, I will watch a couple episodes of my most favorite show! During those 60 minutes or so, I don’t worry about what has been left undone or how much time I am “wasting” in mindless glare of the screen.

For me, those few precious minutes remind me of the 20-something year old girl that is still within me and the carefree spirit she once danced through life with. That memory reminds me that no one has taken anything from me. I had just forgotten that part of me that was buried deep into the caves of other people’s expectations of me.

When I give myself permission to climb out of that burial site and allow myself to experience that joy, an internal glow of warmth takes over and it reminds me that I am enough just as I am –  and that all is ok and all will be ok.

And all of this because I gave myself 60 minutes to live, laugh and love. That feeling is what healthy living looks like.

Some of the other ways I utilize self-care in my healing are:

  1. Strength train 5-6x/wk. If one long block of time is not possible, break it up into 3x-10 minute sessions throughout the day.
  2. Meditation daily. This is a work in progress. Currently only doing it for 5-7minutes/day.
  3. Read one page out of any book.
  4. Look at my reflection in the mirror and tell myself one positive affirmation a day-OUT LOUD. This one is weird in the beginning and will take some getting used to. It is one thing to say it in your head, but it is another thing to say “You are total awesomeness” out loud. But trust me, it will change your day.
  5. Stretch for 180 seconds before bed. Notice how I didn’t say three minutes? Why? Because our thoughts will immediately tell us we don’t have time. But when we hear ‘seconds’, it is like, ‘oh, I can totally afford to take out a few seconds.’ Outsmarting the mind is the only way to recondition our engraved societal thought patterns of ‘I can’t’; ‘I don’t have time’; or the ‘go big or go home-all or none’ mentality.
  6. Every month, do ONE thing that scares you. Now why would we do something that is going to skyrocket your cortisol levels? Because when we do what we think we can’t, we realize just how capable we are and this will cause the endorphins to multiply exponentially.

As you can see, I try to keep things simple. It only takes spending a few minutes with yourself every day. Here are some other fun easy ideas:

  • Massages
  • Sports games with friends
  • At home mani-pedi
  • At home spa day
  • Diffusing essential oils
  • Sleepovers with your BFF’s-Pillow fights and all-nighter movie marathon allowed
  • Bubble baths
  • Head oil massages
  • Sidewalk chalk art

The possibility to be creative is endless. Doesn’t matter what you do. Just do it.

I used to write out complicated timelines and elaborate visions of how I was going to take the ‘best’ care of myself. They often required more time or more planning and if just one thing didn’t go according to plan that day, my whole intention was derailed. I would find myself in a fast tailspin towards mental and physical collision.

I have learned that when healing is kept simple, more space is available for us to learn, play and enjoy the experiences.

If we are patient enough, we will learn that the open grounds of life’s experiences will lead us to health and healing. When we truly begin loving ourselves and all of our perfect imperfections, we begin to love everyone around us just the same.

And that my friends, is what we call SELF-CARE.

Self-care is a mosaic of your best work: a one-of-a-kind masterpiece of infinite potential buried under the misconceptions of other people’s perceptions.

YOU DO YOU! Because there is no one else like you!

Be safe. Stay healthy.

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.

Have You Seen My Metabolism Anywhere?

metabolismWe all know it is coming. We fight it tooth and nail. We don’t give into the relentless annoyance of it. But yet, somehow it always seems to have the upper hand. And by “it”,  I mean your metabolism or lack thereof.

How is it that three little numbers makes us lose so much sleep?

Before starting yet another dieting spree, let’s take a step back and understand what metabolism is and how it changes through the aging process. If we don’t understand it, we can’t change it.

Metabolism is a “series of chemical reactions that sustain the living state of organisms and cells.” Metabolism can slow one to two percent each year after the age of 30.

Nutrition is the KEY to metabolism! Carbohydrates, protein, fats, minerals and vitamins comprise the majority of fuel needed to keep metabolism operational.

Let’s take a brief look at how each one plays a role.

  1. Carbohydrates: This includes starch, sugar and fiber. When eaten in moderation, carbohydrates are broken down to fuel metabolism.
  2. Protein: Proteins are the main tissue builders in the body. They are part of every cell in the body. Proteins help in cell structure and function. They are also vital in supplying nitrogen for DNA and RNA genetic material and energy production.
  3. Fats: Fats produce twice as much energy as either carbohydrates or protein. They help form the cellular structure, help absorb fat soluble vitamins and provide a reserve storage for energy.
  4. Minerals and vitamins: Minerals do not play a direct role in energy needs but play an important role in metabolism. Vitamins are essential compounds that the body doesn’t produce and therefore relies up nutritional intake.

What are some other potential causes of a slowed metabolism?

  • Hypothyroidism and other endocrine issues
  • Inadequate sleep
  • Chronic stress
  • Exogenous hormone intake
  • Hormonal imbalance (low estrogen and testosterone)
  • Medication side effects
  • Excess supplement intake
  • Excess fat intake
  • Calorie deprivation
  • Low muscle mass

The good news is that there are ways to naturally increase our metabolism. But first understand something. Chasing after a “goal” weight or “ideal” size is unrealistic and can lead to frustration and disappointment. The scale doesn’t take in to account skeletal density, muscle mass or fat reserves. It only tells you an absolute number, a number which is false and misleading.

Don’t panic yet. We are not doomed forever. Here are some simple ways (many of which we have seen before) to raise your metabolism.

  1. Assessing the Resting Metabolic Rate (RMR). The Resting Metabolic Rate test (RMR) determines the amount of calories your body is using at rest. The results of a Resting Metabolic Rate test can tell if you have an increased or decreased metabolism, and if your body primarily uses fats or carbohydrates for energy. This information can be used to determine the amount of calories you need to eat each day to maintain or lose weight. The testing is done by breathing into a mask that measures your Oxygen –Carbon Dioxide exchange.
  2. Increase muscle mass. Strength training three to four times a week is mandatory when trying to increase metabolism. Developing and maintaining muscle mass allows the RPR to increase. Every pound of muscle uses approximately six calories a day to sustain itself, while each pound of fat burns only two calories daily.
  3. Eat. Calorie deprivation causes the body to go into crisis mode. As a preservation mechanism, the body slows down its metabolic response by storing fat and calories. Adding protein to every meal allows a constant release of glucose and maintains insulin regulation.
  4. Drink up. Dehydration is the killer when it comes to a slow metabolism. Calories need water to process. Even small levels of dehydration can cause  a slowing of the RPR.  Try for a goal of 90oz/day. If you struggle to get down your daily water quota, consuming fresh fruits that contain natural water is a great alternative.
  5. Sleep. Think of sleep like pulling into the gas station. We have to bring the car to a complete stop before we can fuel up. Just the same, sleep forces us to stop so that the body may refuel. If we compromise on sleep, we wake up on an empty tank of gas and expected to go the same distance as if the tank was full. Not possible. To sustain life, the body saves energy by decreasing metabolism.
  6. Question your medications and supplements. Just because it doesn’t say it on the package insert doesn’t mean it can’t happen. Assume everything going into your mouth is the cause until you proven otherwise. See what lifestyle changes you can make that could help you get off of prescription drugs.
  7. Maintain zero expectations. Our body will never be how it was in our 20’s and 30’s. So how can we expect it to respond in the same manner? Don’t be disappointed because you lost “only three pounds”. Be happy you didn’t gain three pounds. Body fat percentage, changes in clothing fit, how you feel is the REAL goal.

Don’t set yourself up for disappointment by looking for a solution under every advertisement. In the US, the weight loss market is a billion dollar industry! If these companies claim to have the answer, then how come we are still the most overweight nation? These are empty promises. The diet pills, the latest calorie restricted programs that leave you emaciated and crabby, the guaranteed “to lose 20# in 20 days” nonsense.  THEY DON’T WORK.  Don’t waste your money. Our parents and grandparents didn’t seem to struggle as we are now. So how come it is the topic of almost every conversation? What was once a simple seamless process of aging has now become a race against who can promise the fastest results.

If we stop for a second and reflect, in every moment of life our bodies are in constant conversation with us. The symptoms we experience are the body’s attempt to get our attention. A slowed metabolism isn’t something to become consumed by.  It is an opportunity to live a healthier lifestyle. Rather than trying to “fix” it, listen to what it has to say.

There is no fast way to lose weight. Let me repeat….there is no fast way to lose weight. Dropping weight faster than the body can handle is a sure fire way to crash the metabolism to an all-time low.

Be gentle and patient with yourself. No matter what the scale says, you will always be worth more than those three little numbers.

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.

Low Does Naltrexone (LDN): An Aide to Immune Repair and Restoration

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!

 

 

Why I Got Into Concierge Medicine

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 Outside This Summer

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.

Why Great Hair, Skin & Nails Comes From A Balanced Endocrine System First

hair skin & NailsThe quest for great hair, skin and nails seems a lot more difficult to achieve in the winter months. Dry itchy skin, brittle fly-away whispys, chipped nails – sound familiar? The tell tale signs of winter are in the air! Understanding why colder temps affect our skin can go a long way to help remedy the problem areas, but it is important to understand the role a balanced endocrine system plays as well.

Inflammation is the single most important contributor that affects our skin, hair and nails due to the stimulation of free radicals, which accelerates aging by attaching to and damaging cells. In addition, studies have shown that there is a connection between sugar and inflammation in the body.

The main hormones that play a direct role in contributing to the decline from inflammation include:

  1. Estrogen
  2. Progesterone
  3. Testosterone
  4. Thyroid
  5. Cortisol

I have written in the past about how these hormones become imbalanced, which leads to external changes we see. But for this month, I would like to focus specifically on how colder temperatures become a factor.

As we have understood, the fundamental rudimentary cause for the external changes we see is due to hormonal imbalances. The same carries true during winter months.

The longer, darker days lowers our Vitamin D levels. The waxing and waning of the temperatures directly impacts our thyroid levels. Estrogen, Progesterone and Testosterone levels ebb and flow to try and keep the body in balance. This endless cycle causes a rise in cortisol, therefore triggering an inflammatory response which leads to cellular inflammation, disruption and malfunction.

Other contributing factors include:

  1. Drier air from vents
  2. Poor hydration
  3. Increase in consumption of comfort foods (mainly sugar)
  4. Lack of exercise
  5. Prolonged hot showers/baths
  6. Irregular sleep patterns

Until Spring can shine upon us, here are some simple tips to help :

  1. Increase hydration. It is vital to keep the body hydrated with at least 90 oz/water/day. Without the essence of water, cellular healing cannot begin.
  2. Humidifier. Worth the investment. Having one by the bedside and in rooms that are frequently occupied helps prevent skin dry out.
  3. Limit hot showers/baths. Skin that is immersed for prolonged periods of time in hot water strips the natural oils causing hair and skin to become dry. It does feel great to stay for extended time in that warmth, but that causes more harm that good. Limit showers to 7 minutes at most.
  4. Coconut oil/butter. Nothing like solid saturated fats to hydrate the skin. Apply to hair and skin and allow it to soak for 45 minutes to an hour and shower afterwards. Or leave it on overnight for better absorption.
  5. Limit sugar intake. This is not specific to winter only! Refined sugar causes insulin levels to spike thereby leading to inflammation. Be mindful of this hidden culprit.

These are very simple, yet effective means to help control and possibly prevent winter skin ailments.

As the saying goes, we can’t stop the clock. Spring will be here before we know it as soon as we get through the craziness of St. Louis winter swings!

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 Holidays

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.

What No One Tells You About Menopause

menopauseMenopause, a women’s worst nightmare or is it? By simply understanding the basic science, we can clear the myths of this dreaded change and make it the most empowering years of a women’s life.

The two predominant hormones are Estrogen and Progesterone. Menopause is nothing more than a mirror image of menarche, or the start of menses.

In the pubertal years, the E2 (Estrogen) and P4 (Progesterone) begin to increase in quantity in preparation of future pregnancies. During this time, there is an imbalance of E2 and P4 which occurs that results in PMS, development of female habitus, acne, mood changes and so on.

During the 20’s and 30’s, E2 and P4 are in prime balance which allows the opportunity for the woman to conceive. When in equilibrium, a woman feels her best.

Around 35 years of age, the body begins to prepare to slow down. This is the time, the change STARTS.

E2 and P4 levels begin to biologically drop. Progesterone declines twice as fast as Estrogen. It is this imbalance between the lower Progesterone in relation to the higher Estrogen that causes menopausal symptoms.

Walking around with higher than needed Estrogen leads to higher risk of breast, uterine, or ovarian cancers, blood clots,  and heart disease. Progesterone is there to keep Estrogen from over stimulating the cells. Progesterone also helps with sleep, balances your mood, acts as a diuretic, and gives an overall sense of calm.

When Progesterone declines in respect to Estrogen, it creates a phenomena known as Progesterone Deficiency or Estrogen Dominance.

This is when women experience acne, mood changes, sleep issues, cravings, slowed metabolism, weight gain around mid-section and hips. In essence, menopause is a mirror reflection of menarche.

The solution? That is the million dollar question. Pre-menopause, Peri-Menopause, Menopause, Post-Menopause-whatever phrase you choose to describe this phase is irrelevant because the concept is the same.

Crossing the turbulent rivers of menopause is much easier and simpler than we think because we now understand why the body is changing the way it is.

So how do we get through these years? Here are few things to remember:

  • Breathe. This is not a permanent! The hormones are trying to find their balance and they eventually will. No one can predict how long this will take. And nothing can be done to speed up the process. The body is only trying to protect you. Allow it to do so. Don’t condemn the changes you are experiencing. The body is your armor, your voice and your friend. Understand what it is trying to tell you when it speaks to you in the form of symptoms.
  • Stop worrying about the weight. The weight is a symptom like anything else. Weight gain occurs due to Estrogen Dominance/Progesterone Deficiency. There are alpha and beta receptors throughout our muscle and adipose layers in the body. Depending on how those receptors are activated in each person, is where the weight change will occur.
  • Watch your diet and move your body. Our foods are coated with Estrogen and other chemicals which worsens Estrogen Dominance. It is imperative to cut out gluten, sugar, dairy. Eat clean and as unprocessed as possible. Additionally, without exercise don’t expect the body to change. Your body will not respond how it did was few years prior. And that’s ok. But it doesn’t mean that it won’t change. This will just become the new norm. One of the places Estrogen is converted is in adipose tissues. So the more fat you carry, the more estrogen it will convert, thereby again, worsening Estrogen Dominance. Striving towards optimal body fat will help keep Estrogen Dominance controlled. Focus on feeling balanced, not skinny.
  • Make sleep a priority. Without sleep the adrenal glands cannot function at their best. The disruption to the cortisol results in further Progesterone depletion. Turn off the devices and sink yourself into restful slumber.
  • Meditate. When the mind is silenced amongst the chaos of life, we are able to center and align to the root of our existence. Take 5-10 minutes a day, close your eyes and go to the places that feel off balance and listen for the guidance given.
  • Use hormones. I am all for using hormones, IF AND WHEN IT IS NEEDED. Treating with hormones during menopause is certainly not mandatory. The fundamental question to ask is, “are my symptoms debilitating enough that it is affecting my quality of life?” If the answer is yes, use the smallest amount needed for optimal results. Hormones are like the waves of the ocean. Anything can affect them – sleep, weight, seasonal changes, stress levels, nutritional habits, exercise commitment. You may need hormones for a while and decide later they are not needed. And depending on what’s going on in life, may need them again. There is no one answer. The correct answer always is what your body tells you it needs. Hormones are not the magic solution to these symptoms. They are only a crutch to lean on while working on lifestyle modifications.
  • Stop comparing. Don’t compare yourself to your past self. Menopause is a beautiful opportunity for growth and experience. Just keep remembering the symptoms we experience is the body protecting us. This cloud WILL pass! Learn to dance in the rain and embrace the glory of being a woman. This is a period of transformation, revitalization and rejuvenation.

Menopause is the process of shedding the layers of struggle. But just be patient my friends because the wings of healing are opening to reveal the vastness of all that is authentically you.

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.

Benefits of Fermented Foods

fermented foodsWhat are fermented foods and how can they help promote a healthy gut?

Fermentation is an anaerobic process where bacteria or yeast convert sugars in food to organic acids or alcohol. This helps preserve the food while adding a little zing to the palate.

In recent years, fermented foods are finding their way to grocery store shelves for their potential benefits on gut health.

Many fermented foods are made with the help of bacterial/yeast cultures. However, most of the finished products do not contain live or active cultures, one of the main components found in probiotics.

Fermented foods contain what is knows as “prebiotics.” However, since it is in the presence of “probiotics” we see reduction in gut inflammation, it is unclear the role fermentation has on leaky gut.

And while there are no recommended daily serving sizes, it is not clear how much we need to eat to optimize our GI system.

While we can’t always rely on a boost of “good bacteria” from them, fermented foods offer other benefits. They are rich in nutrients and vitamins while adding a punch to the taste buds.

Here is a look at different fermented options:

Kombucha

Kombucha is a fermented drink using green or black tea. Most of the studies outlining the benefits of Kombucha are limited to animals or test tubes. However, they show promising hope against liver toxicity, cancer cells and lowering blood sugars. Kombucha can be made at home, but care must be taken when attempting to handle live cultures.

Kefir

Kefir is a type of cultured dairy product made by adding kefir grains made from yeast/bacteria. In one small study, kefir was shown to improve the digestion of lactose in 15 people with lactose intolerance. Another study found that consuming 6.7 ounces of kefir daily for six weeks decreased markers of inflammation. One study looked at the effects of kefir on 40 people with osteoporosis.  After six months, the group consuming kefir was found to have improved bone mineral density, compared to a control group.

Tempeh

Tempeh is made from fermented soybeans that have been pressed into a compact cake and can be used as a meat-substitue. A test-tube study found that certain plant compounds in tempeh could act as antioxidants, helping reduce the buildup of free radicals. A word of caution when using soy: soy contains estrogenic properties and should be used in limited quantities.

Probiotic yogurts

Studies have shown fermented milk products like probiotic yogurt could help reduce blood pressure, improve bone health and contributes to helping maintain body fat. Not all yogurt varieties contain probiotics. Look for ones that contain “live cultures” with minimal sugars.

Maintaining a mostly plant based process-free diet is the perfect way to help preserve and maintain gut restoration. Fermented foods only assist in this process. If you have questions about this, or any other issues going on with your gut, contact our offices today to schedule an appointment.

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on natural ways to relieve stress, CONTACT  our office today to schedule your appointment.

You can learn more by following Dr. Raman on Facebook, Twitter, LinkedIn and Pinterest.