Managing Holiday Fatigue -   An Integrative Medicine Approach                               Enrique Saguil, MD     We didn...
The First Health Approach We didn’t invent the practice of medicine….                 we’re just changing the way it’s pro...
•   Legal release: I am in not receiving any financial reimbursement from Whole    Foods Market. The names in this lecture...
Your Team     Ric Saguil, MD   Jason Gruss, MD    Tom Jordan, RDKatrina Christie, LCPCMike Blumburg, LCPC Jennifer Green, ...
Ric Saguil, MDWe didn’t invent the practice of medicine….                we’re just changing the way it’s provided.
Defensive driving helps!!Be mindful on the road all the timeDon’t spend a lot of money on coursesMaintain your car
Defensive medicine hurts!! Pay attention to the patient story Don’t order with sole intention to defend Help initiate chan...
Patient “Amy”•   Low energy/fatigue•   Depressive symptoms•   Poor concentration•   Weight gain•   Constipation•   Brittle...
Ruling out Death for Amy• Bowel obstruction (tumor)• Liver disease (hepatitis)• Uterine disease (thickened endometrium) wi...
Patient “Bob”•   Midday fatigue•   Weight gain•   Hungry all the time•   Irritability with stress•   Reflux•   Depression•...
Rule out Death for Bob• Sleep study for apnea• Scope for reflux and Baretts esophagus• Psychiatric eval for major depressi...
Patient “Chrissy”•   Low energy/poor exercise tolerance (new)•   Fast heart rate/palpitations•   Diarrhea•   Reflux•   Irr...
Rule out Death for Chris•   Stress test for heart disease•   Echocardiogram for cardiomyopathy•   MRI for brain tumor•   E...
Patient Dave•   Generalized fatigue•   Weakness•   Poor sleep•   Muscle/joint pain•   Depression•   Poor memory•   Reflux•...
Rule out Death for Dave•   Rheumatoid work up for autoimmune•   Psychiatrist for depression•   MRI for brain tumor•   Uppe...
Patient Eric• CEO• “I’m fine, no stress – just fix my sleep doc”•   60 hours a week•   Strained love life•   Poor sleep an...
Rule Out Death for Eric• Watch for heart disease• Treatment plans• Counseling• Relaxation suggestions/activity• Sleep/Circ...
“Within every ailment is         the answer to it’s cure……..
Fatigue could be everywhere and part       of every disease…..?!?!
Dr Saguil Approach:• Establish the basics of•   Proper nutrition (American diets suck)•   Proper exercise (only stressed i...
Ric Saguil, MDWe didn’t invent the practice of medicine….                we’re just changing the way it’s provided.
1       Why Nutritional assessment•   Deficiency due to Standard American Diet•   Deficiency due to alcohol•   Deficiency ...
Top Dietician Tips –Tom Jordan, RD FHA1)   Balance Blood Sugars2)   Stay Hydrated3)   Nutrient Timing4)   Prevent Vit/Mine...
Macronutrients have power• Proteins in am• Carbs in pm• Water in between  Thanks and Good Night!
Absorption of the carbohydrate
SpaghettiWhite Bread
WFM - follow ANDI and MANDI….           Aggregate Nutrient Density Index…Dr Joe Furhman
Tom Jordan’s                 30 Second Meal PlanBreakfast: Protein (1 egg, 2 egg whites, cheese… toast?)AM Snack: Greek Yo...
Andy says:  the key to life is theanti-inflammatory diet!!!
???
Empower yourself - Get Help
2                 Movement•   Massage•   Exercise•   Chiropractic therapy•   Physical therapy•   Trigger point injections ...
Benefits to exercise•   Muscle pliability•   Release of endorphine•   Sense of wellbeing/acomplishment•   Social interacti...
Problems with exercise
Exercise Guidelines•    Best form is the one they’ll do•    Establish a routine•    Don’t overdo it! Avoid Push-Crash cycl...
Starting off•   Warm water exercises•   Tai-Chi•   Pilates•   Yoga•   Bicycle•   Walking•   Body weight and Functional exe...
Activity for Severe Chronic Fatigue                                -FHA EP’s Aimee and Courtney• Focus on Activities of Da...
Pranayama•   Nodi Shodana•   Ujjayi breath•   Bhastrika (bellows) breath•   4-7-8 breathing                    -5-10 minut...
3    Mental preparedness-grounding•   Meditation•   Breathwork•   Yoga•   Tai chi•   Spiritual grounding (energy healing)
Herb says….• 10 minutes twice a day = 20 minutes total of  an average 12 hour (720 minutes) day to  improve the way the br...
“Meditators R Built for stress!”• Yet another task, in the list of tasks, to create  more “space” for tasking………
Detaching from structure•   Social media•   Web advertisements•   TV advertisements•   Concept of time constraints•   Care...
3aMood Disorder will always “piggy back”• The “D” word (Depression accelerates!)• Denial still exists with anything “behav...
In your mind, make Sunday-Friday!• The Sunday night blues have probably existed in some  form since the start of the five-...
COUCH TIME
How Can Counseling Help? –Katrina LCPC                                               FHA• Provide a safe outlet for expres...
4                     Sleep• 50-70 million americans = 20%• 15-25% of children difficulty initiating and  mantaining
Sleep “architecture”
Stages of sleep•   Stage 1•   Stage 2•   Stage 3•   Stage 4•   REM (rapid eye movement)
Dr Ric’s Standard Sleep Protocol•   Reset circadian rhythm –night•   Valerian•   Melatonin long and short•   Lavender or s...
Dr Ric’s Standard Wake Protocol• Reset circadian rhythm –day• Regimented wake time• Netty pot nasal irrigation• Hot water/...
1+4      Naturopathic Solutions – Dr Green FHA    Stress and Adrenal Support:•   Licorice     – Pseudohyperaldosterone and...
TCM• Whole System Approaches to healing•   Acupuncture•   Chinese herbs•   Tui Na•   Tai Chi
To summarize  •   Rule out disease  •   Replete the depleted  •   Behavioral grounding  •   Nutritional analysis  •   Move...
One size never fits all…  Make changes that not only work  your heart but come from the  heart….  Starved Rock…..Thanks fo...
Happy Holidays !!!             Next Lecture:  Whole Foods Market Schaumburg2012 Steps to Sustainable Weight Loss          ...
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DrRic Fatigue (slide share edition)

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Dr Ric Saguil presents a lecture on
FATIGUE
at Whole Foods Market Schaumburg
Thursday, December 8th, 2011
530-630pm

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  • Design notes: list of providersWe want this to look much more inviting—these chairs are way too cold.Had thoughts about putting the actual providers in the chairs. Could be an actual live picture with a sample patient in the red chair or could be a group of providers sitting around the table.
  • Based on a survey of our patients, we found a consistent theme of what frustrates them about conventional medicine practices and why they felt First Health was different. Since identifying these 4 key areas, we have made a consistent effort to offer our absolute best to:Listen attentively to Patients concernsMake the patient the driving force as the center of careMinimize wait timesExplain all the options for treatment, and give the patient choices (medications, alternative medicine, nutritional medicine/supplementation, psychological medicine)
  • Based on a survey of our patients, we found a consistent theme of what frustrates them about conventional medicine practices and why they felt First Health was different. Since identifying these 4 key areas, we have made a consistent effort to offer our absolute best to:Listen attentively to Patients concernsMake the patient the driving force as the center of careMinimize wait timesExplain all the options for treatment, and give the patient choices (medications, alternative medicine, nutritional medicine/supplementation, psychological medicine)
  • DrRic Fatigue (slide share edition)

    1. 1. Managing Holiday Fatigue - An Integrative Medicine Approach Enrique Saguil, MD We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    2. 2. The First Health Approach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    3. 3. • Legal release: I am in not receiving any financial reimbursement from Whole Foods Market. The names in this lecture have been substituted to protect the innocent. The recommendations in this lecture are not a substitute for health and wellness, please see your personal physician. • To get copies of this lecture, please contact me at: www.firsthealthassociates.com
    4. 4. Your Team Ric Saguil, MD Jason Gruss, MD Tom Jordan, RDKatrina Christie, LCPCMike Blumburg, LCPC Jennifer Green, ND Joe Musolino, DC Amy Iaquinta, DC Emery Paredes, PT Courtney Day, EP Aimee Weber, EP Yu Zhu, MD China You
    5. 5. Ric Saguil, MDWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    6. 6. Defensive driving helps!!Be mindful on the road all the timeDon’t spend a lot of money on coursesMaintain your car
    7. 7. Defensive medicine hurts!! Pay attention to the patient story Don’t order with sole intention to defend Help initiate change before disease shows
    8. 8. Patient “Amy”• Low energy/fatigue• Depressive symptoms• Poor concentration• Weight gain• Constipation• Brittle nails• Scanty periods
    9. 9. Ruling out Death for Amy• Bowel obstruction (tumor)• Liver disease (hepatitis)• Uterine disease (thickened endometrium) with resultant iron deficiency• Thyroid panel testing (with dysfunctional hypo)• Anemia work up• Behavioral tx
    10. 10. Patient “Bob”• Midday fatigue• Weight gain• Hungry all the time• Irritability with stress• Reflux• Depression• Alcohol use• Erectile dysfunction
    11. 11. Rule out Death for Bob• Sleep study for apnea• Scope for reflux and Baretts esophagus• Psychiatric eval for major depression and alcohol dependance• Liver study for alcohol damage• Heart scan for heart ischemia• Check sugar• Nutritional coaching
    12. 12. Patient “Chrissy”• Low energy/poor exercise tolerance (new)• Fast heart rate/palpitations• Diarrhea• Reflux• Irregular and heavy periods• Insomnia• Poor concentration
    13. 13. Rule out Death for Chris• Stress test for heart disease• Echocardiogram for cardiomyopathy• MRI for brain tumor• Endoscopy for barretts• Ultrasound for uterine disease• Hormone testing for menopause• Nutritional coaching• Pap• Counseling
    14. 14. Patient Dave• Generalized fatigue• Weakness• Poor sleep• Muscle/joint pain• Depression• Poor memory• Reflux• Poor sleep/snoring
    15. 15. Rule out Death for Dave• Rheumatoid work up for autoimmune• Psychiatrist for depression• MRI for brain tumor• Upper gi or endoscopy for reflux• Sleep study for apnea• MRI• Physical therapy• Counseling
    16. 16. Patient Eric• CEO• “I’m fine, no stress – just fix my sleep doc”• 60 hours a week• Strained love life• Poor sleep and alcohol dependance• Needs a lot of coffee• Obsessive short temper• Erectile dysfunction• Reflux
    17. 17. Rule Out Death for Eric• Watch for heart disease• Treatment plans• Counseling• Relaxation suggestions/activity• Sleep/Circadian reset
    18. 18. “Within every ailment is the answer to it’s cure……..
    19. 19. Fatigue could be everywhere and part of every disease…..?!?!
    20. 20. Dr Saguil Approach:• Establish the basics of• Proper nutrition (American diets suck)• Proper exercise (only stressed in high school)• Proper “grounding” (not stressed at all)• Proper sleep (de-valued by coffee generation)
    21. 21. Ric Saguil, MDWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    22. 22. 1 Why Nutritional assessment• Deficiency due to Standard American Diet• Deficiency due to alcohol• Deficiency due to prescription meds• Deficiency due to soda and candy (fructose)• Deficiency due to disease• Education is lacking or “info-mercial” quality
    23. 23. Top Dietician Tips –Tom Jordan, RD FHA1) Balance Blood Sugars2) Stay Hydrated3) Nutrient Timing4) Prevent Vit/Mineral Deficiencies5) Eat Good Fat6) Think Holistic7) Additional Testing if Needed*Consider an individualized treatment plan—because there’s no “one size fits all” approach to optimal health!
    24. 24. Macronutrients have power• Proteins in am• Carbs in pm• Water in between Thanks and Good Night!
    25. 25. Absorption of the carbohydrate
    26. 26. SpaghettiWhite Bread
    27. 27. WFM - follow ANDI and MANDI…. Aggregate Nutrient Density Index…Dr Joe Furhman
    28. 28. Tom Jordan’s 30 Second Meal PlanBreakfast: Protein (1 egg, 2 egg whites, cheese… toast?)AM Snack: Greek YogurtWATER!Lunch: 3oz Chicken, 1/2c Quinoa, Sliced Green PeppersPM Snack: 100 calorie pack mixed nuts, appleWATER!Dinner: 3-4 oz Salmon, Sweet Potato or Rice, 1c Steamed Broccoli
    29. 29. Andy says: the key to life is theanti-inflammatory diet!!!
    30. 30. ???
    31. 31. Empower yourself - Get Help
    32. 32. 2 Movement• Massage• Exercise• Chiropractic therapy• Physical therapy• Trigger point injections and topical w PT• Feldenkrais/specialized pt/movement disorder clinics
    33. 33. Benefits to exercise• Muscle pliability• Release of endorphine• Sense of wellbeing/acomplishment• Social interaction• or Solitude (removal from technology)• Indirect breath exercise (yoga)• Feeling of wake/energy
    34. 34. Problems with exercise
    35. 35. Exercise Guidelines• Best form is the one they’ll do• Establish a routine• Don’t overdo it! Avoid Push-Crash cycle.• Expect some set backs• Take breaks when needed but don’t give up (1:3 work to rest) We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    36. 36. Starting off• Warm water exercises• Tai-Chi• Pilates• Yoga• Bicycle• Walking• Body weight and Functional exercises • Wall push-ups • Sit to Stand We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    37. 37. Activity for Severe Chronic Fatigue -FHA EP’s Aimee and Courtney• Focus on Activities of Daily Living• Hand Stretches• Picking up and grasping objects• Motions needed for getting up, personal hygiene, getting dressed…• Breath Exercises We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    38. 38. Pranayama• Nodi Shodana• Ujjayi breath• Bhastrika (bellows) breath• 4-7-8 breathing -5-10 minutes am and pm
    39. 39. 3 Mental preparedness-grounding• Meditation• Breathwork• Yoga• Tai chi• Spiritual grounding (energy healing)
    40. 40. Herb says….• 10 minutes twice a day = 20 minutes total of an average 12 hour (720 minutes) day to improve the way the brain handles the remainder of the 700 minutes.
    41. 41. “Meditators R Built for stress!”• Yet another task, in the list of tasks, to create more “space” for tasking………
    42. 42. Detaching from structure• Social media• Web advertisements• TV advertisements• Concept of time constraints• Care not to disregard goals• Uof I Landscape and Human Health Lab -“take a hike!”
    43. 43. 3aMood Disorder will always “piggy back”• The “D” word (Depression accelerates!)• Denial still exists with anything “behavioral”• Happens to average joes• Sunday Night Blues• Q: when is the highest heart attack hour?
    44. 44. In your mind, make Sunday-Friday!• The Sunday night blues have probably existed in some form since the start of the five-day workweek, which became institutionalized in the U.S. in 1926, after Henry Ford began shutting down his automotive factories on Saturday and Sunday. Now, science is confirming the phenomenon. In a November, 2009 paper, German and Swedish researchers said surveys of 12,000 individuals confirmed that Sundays are the least happy day for most people, while Fridays are the happiest. But a British study reported in The Observer newspaper found that 26 percent of workers questioned felt dread and apprehension on the day they were due to return to work.
    45. 45. COUCH TIME
    46. 46. How Can Counseling Help? –Katrina LCPC FHA• Provide a safe outlet for expression• Get to the root of what is causing the fatigue• Offer behavioral techniques to manage symptoms• Teach tools for managing/reducing stress• Provide referrals for integrative care
    47. 47. 4 Sleep• 50-70 million americans = 20%• 15-25% of children difficulty initiating and mantaining
    48. 48. Sleep “architecture”
    49. 49. Stages of sleep• Stage 1• Stage 2• Stage 3• Stage 4• REM (rapid eye movement)
    50. 50. Dr Ric’s Standard Sleep Protocol• Reset circadian rhythm –night• Valerian• Melatonin long and short• Lavender or sandalwood essential oil• Netty pot nasal irrigation• Comfy clothes• Journal 3 positive sentences• Simulated darkness and quiet• 65-67 degree temp• 4-7-8 breath exercise
    51. 51. Dr Ric’s Standard Wake Protocol• Reset circadian rhythm –day• Regimented wake time• Netty pot nasal irrigation• Hot water/green tea• Rhodiola or siberian ginseng• Lemon, grapefruit, cinnamon essential oil• Dawn stimulation with light or daylight (with short 10-20 min bursts later)• Music/radio talk• Protein meal/snacks regimented• 4-7-8 breath exercise
    52. 52. 1+4 Naturopathic Solutions – Dr Green FHA Stress and Adrenal Support:• Licorice – Pseudohyperaldosterone and glucocorticoid-like effects – ↑ access of cortisol to receptors• Rhodiola – For individuals who are exhausted, anxious, depressed and burned out – Enhance energy production – Increases physical endurance• Siberian Ginseng – Helps body adapt to internal or external stress – ↑ endurance, concentration, and oxygen delivery to tissues• Homeopathy
    53. 53. TCM• Whole System Approaches to healing• Acupuncture• Chinese herbs• Tui Na• Tai Chi
    54. 54. To summarize • Rule out disease • Replete the depleted • Behavioral grounding • Nutritional analysis • Movement program • Supplemental care with ND/Homeopathy • Interrupt/rescue with TCMDon’t settle for a One Dimensional Approach!!!!
    55. 55. One size never fits all… Make changes that not only work your heart but come from the heart…. Starved Rock…..Thanks for Listening!!!
    56. 56. Happy Holidays !!! Next Lecture: Whole Foods Market Schaumburg2012 Steps to Sustainable Weight Loss January 14th Fatigue Panel Public Forum – First Health Associates January 21st We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

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