Looking within to a larger world

photo courtesy pixabay

photo courtesy pixabay

What better day but to spend by the heat of the forge with the sound of hammers ringing on anvils? Like my father before me, wood and words have always been my raw materials of choice. But each time my hands get hold of cold steel, magic begins to happen.

Actually, the magic begins in the forge, where fire does what Fire does -- that is, provide the energy of transformation in its raw state. Then man does what Man does -- impose his will on the mutable metal, changing it from blobs and blocks to tools and weapons and items for clothing.

And with each blow of the hammer on glowing hot steel, I see it molded with my very eyes into what existed until that moment only in my mind. Given my untutored, inexperienced state, the unerring shifting of molecules into something practically and aesthetically. pleasing I can only attribute to the blessing of Brigid, the guiding hands of Gofannon, or the blood of a smithy ancestor come alive once again in my veins.

I've honestly never experienced anything like it. I believe I'm falling in love with this most powerful and ancient of crafts, and that having tasted its fruit just a couple of times, I will remain unsated until I call the skills of a blacksmith my own.

Tomorrow I go back to the forge to finish and temper the hammer that appeared like magic out of a block of steel today. And with this hammer, and a fire, and the gift of Mother Nature's ores -- well, I can build anything, from the rockers on a cradle to the nails that hold a building together, to a temple from which we can contemplate the unknowable in all the very many forms we perceive her.

My 5 Core Principles

photo courtesy of tiameyers.com

photo courtesy of tiameyers.com

A number of years ago, I wrote down the core principles by which my practice operates. Such documents need to be reviewed from time to time, and it seems that now, during this time of rapid societal change, would be a good time. And inasmuch as my practice is an outer reflection of my inner self, the core values of my practice and myself are one and the same.

1. My patients’ health is paramount

In one sense, this is obvious. Healing is why people come to me. But a practice is a business, after all, and business concerns need to be addressed -- margins, overhead, profit and loss. Over the years, I have seen many medical and chiropractic practices, and more than a few have put the concerns of the business over the concerns of the patient. Scheduling and billing practices that suit the needs of the providers, not the patients, and treating patients as if they were simply grist for the giant medical mill are two signs that the patients’ best interests are not being looked after.

I’m proud to say that after nearly 25 years in practice, I have yet to turn a patient away because they couldn’t afford me. I have kept my fee schedule reasonable -- it has hardly changed over that time -- and I have always been willing to work out a payment plan. If that is still not feasible, I’ll take a patient pro bono, and accept their goodwill as payment.

After the thousands of people I have treated, I still feel honored each time I walk into Exam Room A and meet a new patient. It is an honor being chosen by someone to help them find health or become free of pain. And I try to make sure that, throughout their visits and their interactions with me and my staff, they feel honored.

This kind of outlook is also a basic principle of my particular brand of health care. We are, all of us, dependent on one another and our environment for our health. From the bacterial surrounding us and within us, to the friends and family beside us, our health is determined by the company we keep. So in keeping you healthy, I keep myself and my practice healthy.

2. All patients -- all people -- are equal.

It almost feels ridiculous to even mention it, but in these times, such words need to be said, out loud and up front. I do not tolerate intolerance in myself or in the people who walk through my door. Years ago, I redesigned many of my practice processes -- and even recoded some of my software -- to make my practice more open to transgender people, because so many doctors’ offices at the time were hostile to transgender men and women. Some still are. It goes back to Principle #1: All of those people around me are honored.

I will treat anyone regardless of race, gender identity, sexual orientation, religion, citizenship status or political beliefs. And at the same time, while you are in my office, as patient or guest, you will abide by this rule of respect as well. I hope for the day when I can drop this value from my list as no longer a concern, but in the past few months, I have had to remind some people that, whatever beliefs they may hold personally, bigoted speech and action will absolutely not be tolerated in my office.

3. I exist to offer an alternative.

More often than I would like, I have described myself as “The last doctor on your list that you should have come to first.” And that is in part of my own making. What I offer is unique, unlike most other doctors, even many chiropractic doctors. I am informed by science but not bound by it, guided by intuition but not blinded by it, and aware of my limitations but not afraid to push beyond them.

Unique isn’t what everybody wants in their healthcare, and I can understand that. But I stand at the border of where the tried and true has failed. Yes, I’m as capable as the next chiropractor at eliminating neck pain or taking care of a blown spinal disc. I can also guide my patients along paths to health which have been ignored or forgotten, to achieve results where other therapies have not.

It has been frequent enough that patients have come to me after years of illness and pain, and have left my care immeasurably better, that I know that this is not a fluke. And a great deal of my success comes from my adherence to Principle #4:

4. One size does not fit all.

From the day I opened my practice, I have been dedicated to the principle that customized treatment regimens work best. Unfortunately, this principle flies directly in the face of health care’s current guiding light: Evidence-based medicine.

Evidence-based medicine is built upon the idea that all patients with a certain diagnosis respond equally well to certain interventions. So, if a patient comes to my office with, say, low back pain, I’m supposed to recommend certain conservative procedures for a certain period of time, gradually replacing “passive” methods -- heat, electrical stimulation, spinal adjustments -- with “active” methods -- exercise.

Let’s just say I’m not very good at that. If a patient comes to my office with low back pain, I may end up talking to them about their marriage or job, or examining their feet or their diet. Why? Because I know from decades of clinical experience that these factors play a huge role in this kind of pain. The resulting care I provide will likely look nothing like what evidence-based-medicine declares to be the “right” treatment.

But it is exactly the right treatment for that patient.

5. Find it, fix it, and get out of the way.

My overarching job as your doctor is to make myself relatively useless in your life, as soon as possible. I aim to get my patients to the point where they are either free of the condition that brought them to my office or able to manage it largely on their own.

While I am working with them, I give my patients many tools and resources they can use to improve their condition when they aren’t visiting me, and I am not of the belief that all of my patients require ongoing care. Certainly the majority of people I see will need some measure of long-term oversight, but that is a decision that we make together. And there are some patients who leave care with a cheerful “See ya, Doc!” and won’t need to be back in my office for years.

Looking at the long term.

That said, I’ve now been in practice long enough to have as my patients the grandchildren of people who became my patients years ago. I treated their children as youths and young adults, and knowing how my care benefited them, are now bringing their own children in to see me. I have patients that I began treating as toddlers no taller than my knee, and who now tower over me, and come in for a visit when they are home on break for college.

I think these principles have served me well through the years, but more importantly, they have served my patients well. I am grateful for each and every person who has walked through my door, and remain honored and humbled by your trust in me. And that’s Principle #6: It really is all about you.

 

Are You Your Illness?

One of the things I have noticed in my decades of working with chronically ill people is that they learn to identify quite closely with their illness. They have to; it’s a survival strategy. The easiest way to adapt to pain or illness is to learn its patterns -- when it strikes, when it sleeps, what will provoke it, what will mollify it.

Psychologically, living with chronic illness or pain is like living with someone who is abusive, and from whom you have no power to escape. Eventually, you come to identify with your abuser, and make their patterns your own. This disempowerment of the self, the loss of the ability to see yourself outside of your disease, makes it far easier to live with it, yet at the same time makes it more difficult to improve.

The person who identifies with their disease is perhaps the most dangerous and difficult to help manifestion of chronic illness that I have seen, and it can take many forms. I’ve had beautiful women in tears in my office over the belief that no other would accept them as a partner because of their chronic joint pain, and I frequently see posts on social media from people whose entire public presence is built around coping with their disability. Once you have identified yourself as “I have X” (X being a diagnosis, like MS, fibromyalgia, sciatica, irritable bowel disease), separating self from disease becomes a monumental task.

Part of the problem is as a result of how we look at disease in this society. We turn health issues which are basically dysfunctional processes (an overgrowth of cells, excess deposition of fatty tissue, production of inflammatory cytokines), into a static thing: “I have IBS,” we say, or “I have arthritis.”

Once you have converted something from a process into a thing, you have made it much more difficult to change. A process is the B train on the Green Line; it can go fast or slow, make stops, let riders off and on. A thing is a rock; it does not move. It can be changed by the erosion of water and ice, but it takes eons and lifetimes will end before any discernable difference is made. Processes are malleable to time and space and changes of input. On the other hand, things don’t change, without application of saw and hammer and destructive acid.

The second part of the problem becomes how we describe ourselves. Instead of a person with high inflammatory potential and impeded antioxidant processsing, we say “I have arthritis.” Rather than being a person who reacts strongly to certain foods which influence neurotransmitter production, we admit that “I have depression.”

So there we have it. We have a thing which we cannot change, which is only sufferable by controlling our behavior in the most intrusive ways possible. You might as well proclaim “I AM HEART DISEASE.” Because that, in your heart of hearts, is what you’ve been taught to believe.

This self-identity can become so strong that I have, many times, had patients abruptly abandon successful care because it was taking away a part of their selves that they had come to accept as necessary and needed. I would call them on the phone, ask them, “What is wrong?” They would reply, “It was working so well, and then I felt so bad!”

This was my failure, because I failed to prepare my patients for what they could become in the absence of disease. They could become more, not less.

Over time, I have developed a method of helping patients to realize that which they can be, without illness, without pain, and without all of the benefits they may see themselves as getting as a result of their illness.

I call it Contemplation of You As You May Be.

Step 1: Sit somewhere quiet, where you won’t be disturbed for 10 to 15 minutes. Close your eyes, and form a mental image of yourself. See yourself, as your disease affects you, in stillness and movement, in shape and color, in smell and sound. Take a minute or two, and completely build this picture of yourself in your mind. Feel and explore the effects of your disease or your pain on your body.

Step 2: Take a piece of paper, and write down all of the attributes of your illness on your body. There will be different groups of sensations: There will be the appearance -- red, pale, swollen, scaly. There will be the sensations -- burning, achy, itchy. There will be the mental -- fatigue, forgetful, hyperactive. Then there will be the emotional -- sad, mirthful, confused, scared.

There will be more than you can think of, and the first time you do this exercise, it is best not to overwhelm yourself with too many attributes. Start with the obvious ones, that’s good enough for this time.

Step 3: Having written down all of those attributes, close your eyes again, and re-imagine the mental image of yourself that you developed in step one. Then, one by one, start removing the attributes of your illness. Start with the physical ones. See yourself without the swelling, without the redness. Take your time.

Once you have a strong image of yourself in your mind without the physical attributes, begin to remove the sensations -- the pain, the burning, the ache. What do you look like without those things? How does that image of yourself feel without them? Again, take your time. This may be as far as you get the first time you do it.

But if you can go further, keep removing more and more aspects of your illness, of your pain. Take away the sadness, take away the fatigue. In your mind’s eye, what do you look like? How do you feel? How does your voice sound? What is it like to move?

Once you have removed all of the attributes of your illness, what will remain in your minds eye is you. Your without the disease. You without the pain. You without that which has forced you to be something that you are not for so long. Be prepared; your mind will keep wanting to return you to the first image. Keep yourself fixed on the self without disease.

Know that this person, this aspect of you is alive and well, and strong. Every day, do this exercise, until finding the healthy you is a trivial matter. And as that you becomes stronger and more real, the you defined by your disease becomes weaker and weaker. Eventually, you will have divorced yourself so thoroughly from the process of your illness that your therapy -- whether it is chiropractic, or acupuncture, or exercise or diet, or all of the above -- begins to take hold. You are replacing sick belief with healthy belief.

And at some point, when you look at your reflection, you’ll realize that the you in the mirror has become the you in your mind.

Coming home to a place I've always been before.

avery-aikido-2-copyI've been a fortunate man. Four times in my life, when I have needed it most, I have walked through a door to find a place to call home. A place that, at least for a time, I could unpack my suitcase of Avery trinkets, put a picture or two on the dresser, and leave leftovers in the fridge without worrying about them getting stolen. The first was when I arrived, via a rather circuitous route involving mountains, chain saws and motorcycles, at the university that was eventually to grant me a Bachelor of Philosophy degree in Interdisciplinary Studies. I remember my first night there, sitting alone in the pub in the basement of the dorm (yes, those were a thing back in the day), sipping on a beer and suddenly knowing -- without a shadow of a doubt -- that I was where I would find happiness for the next few years.

The second was when I walked into the house in which I now live. I knew -- I just knew -- that this was where my wife and I would raise our children and set down roots.

The third happened just a few years ago, as I climbed a staircase and met a room full of Druids, and in one flash, realized that this, too, was to become a home. Or, as I thought at the time, "these are my people!"

The last was just two weeks ago, as I once again stepped onto the mat of an Aikido dojo, after years of absence. I bowed, sat in the formal kneeling posture known as seiza, and began picking up the dropped pieces of my skills, beginning to re-assemble them into something similar to, but different than, what was. As I bowed before the shrine of the founder, I was filled with a flowing stillness, an unshakeable recognition that I and the universe were once again in harmony.

***

My relationship with Aikido, like any lifelong affair, has been smooth and stormy, healing and damaging, and in the end, very nearly discarded as lost. I first met Aikido through my now-deceased brother, on that twisting journey to my undergraduate school. By fortuitous accident (I was avalanche-blocked in the middle of a mountain climb in northern California), I ended up in Grant's Pass, Oregon, sleeping on a the floor at my brother's apartment. He had been dipping his toes into Aikido, and took me with him to a couple of classes. I was fascinated; the fluid force of the art was something I knew I wanted to learn. Instead, I moved back East, and returned to college, but the white practice uniforms and dark pleated skirts known as hakama were not forgotten.

Several years later, I found myself single and steadily employed in Boston. Looking for a way to meet new people (i.e., pretty single women), I discovered that there was an Aikido dojo not too far from where I lived. I signed up, and started going to classes. I loved it. At first the rolls made me dizzy, and I couldn't tell my right foot from my left, but I had no doubt that I would figure it out. Sadly, though, life started throwing some curve balls, and I had to throw my training clothes,  keiko-gi, in the back of the closet and take care of business.

So, despite our first meeting in 1978, it wasn't until 1990 -- married, re-settled in Connecticut, and returning to school to become a doctor -- that Aikido and I began our longer dance. It was, by all accounts, a slow dance. I passed my test for the lowest level certificate -- 5th kyu -- in 1991, but it wasn't until 2005 that I was ranked at 1st kyu, which is only the level before your first black belt.

I had to balance my training against going to school, starting a practice, starting a family, and being a father during those years, so I wasn't always the most diligent of students. And, let's face it, I wasn't the most talented aikidoka to ever grace a dojo's mats. But I wouldn't quit, I couldn't quit. Something kept drawing me back. Aikido's various governing bodies are generally not anxious to hand out ranks, and the rank of shodan -- or first degree black belt -- typically takes 7 years, even though that rank is still considered only the beginning of your journey. It took me until 2007 to be granted my shodan. That was 16 years after I received my initial certificate.

The achievement initially invigorated me, but by then, I was feeling pretty battered. The Art of Peace can be practiced hard or soft, and though my teacher (sensei) encouraged me to practice the latter, I chose the former. By the time I had gotten my black belt, I had shattered my nose, separated my shoulder, suffered two concussions, been choked senseless, and busted my left big toe. None of this, mind you, was the fault of my sensei or the other students I trained with. In true karmic fashion, what I brought to the dojo reflected back on me fourfold. I staggered on, but my attendance drifted off, and then stopped entirely. I think I kept paying for my dojo membership for another year or so, because I wanted to keep hope alive in my mind that I would return. I didn't. Between 2009 and a few weeks ago, I tried one comeback, which failed entirely. I didn't last a month. I hurt, and worse, I felt incompetent.

***

Though I had physically clearly left the dojo, my mind never did. Sometimes, even years after training, I would have a dream in which I was doing throws and pins. Walking down the street, I would imagine how I would respond if jumped from behind, remembering in my mind the drop and turn that effectively turned your attacker's energy into your own. Clearly, some sort of martial flame still burned inside me. The warrior sought his escape, but my body refused to cooperate.

So last year, I began training in Tai Chi, a Chinese "internal" martial art, which is barely even martial. It is more employed for its health benefits than its fighting skills these days, though it remains a formidable skill. But it is the most gentle of arts, taught initially as a slow dance, during which one comes more to focus on the flow of energy -- Chi, or Ki (the same ki as in Aikido), than on any possible opponents. Even in paired form, the art of push hands is gentle and mannered. No-one goes tumbling to the floor, much less flying across the floor to land in a breakfall. This should have been the ideal practice for an aging martial artist with a deviated septum and a bum shoulder. And it was very enjoyable, at least initially. I learned the flow of energy, sensing it and feeling it in a way that has also informed my acupuncture practice, making me that much more accurate in my needle placement. Throughout the winter I trained. The studio I trained at had no formal wear, so I found myself going to class in what I called the  "clothes of a broken man," a pair of sweat pants, a t-shirt, and a hoodie. The sartorial commentary alone tells you how I felt about things. I was indeed broken, my body no longer capable of what I had long trained it to.

Over time, a few things began to bother me. This training studio (I never heard it referred to as a dojo or dojang) was very westernized. A cursory bow on the mat was the only etiquette observed; people talked in class, and the entire session was treated somewhat casually. The instructor was referred to by his first name, and he talked. A lot.

I had spent most of my life training under far more austere conditions. I was trained to bow when I walked in the dojo, with a seated bow as I stepped onto the mat. Class was started with all of the aikidoka sitting seiza in a line, waiting for sensei to arrive, at which time we all bowed together, and to our sensei, shouting "Onegai shimasu!" (Please let me train with you!). The formality of the dojo is, in a way, a buffer for the sometimes dangerous activities that go on within, and a way of preparing the mind for the class. After class in the dojo, we bowed to the Founder again, bowed to sensei, and after she left the mat, we bowed to each other individually.

At the Tai Chi studio, we walked around and high-fived each other, then after another cursory bow, we walked off the mat. For someone who had emotionally and spiritually grown up in an environment of martial ritual -- and who knew what that ritual was for and the power it possessed -- this was, in the long run, very uninspiring.

I took a break last spring to focus on my cycling, as I had a couple of long tours lined up. In August, I began considering my return to Tai Chi, and found it unpalatable. It didn't scratch the martial itch inside me, the need to swing a bokken or a training partner overhead. It's taken me 58 years, but I have learned to listen to my heart. And it was telling me to go back to my long-lost love. Against the wishes of my wife (who, let's face it, has put up with a great deal of martial nonsense over the course of our marriage), I sent an email to the sensei who had guided me from my 2nd kyu to my shodan.

"Would you take me back on the mat?" I asked.

"Avery," she wrote, "you are more than welcome back!"

So I went.

My first class was fun. That was the class that I turned the key in the ignition to see if the engine still ran. I didn't care if it was two cylinders or four, I needed to know if their was gas in the

If the hakama fits...wear it.

tank and spark in the plug. There was. I even found that I remembered much of what I had left behind. Aikido had been so burned into my muscle fibers and synapses, it required very little encouragement to come out.

The second class was also fun, but in a different way. That was when I found out that I was still misfiring. As we were shown a throw, and then squared off with partners to practice it, I found that I would randomly -- in the middle of a throw -- switch from the one demonstrated to another one that my mind remembered at random. Fortunately, my training partner was flexible and put up with my chaos willingly.

A few more classes, and that had settled down. I found that I still remembered much, and was not nearly as hobbled as I feared. I also realized that my somewhat maligned training in Tai Chi had, in fact, given me what I most needed. I was softer now, I could be slower, less harsh and demanding of both me and my training partner. It was a gift a never knew I had been given. I noticed that I was smiling, and even laughing sometimes, as I worked the attacks and throws with different partners.

When I had returned to the dojo, in deference to my lack of training (and in deference to a somewhat expanded waistline), I didn't wear my hakama. It didn't seem right, somehow, when I didn't even know if I could roll or throw. Last week, sensei told me give it a try. So I put it on; it was a little snug, but it felt right, like I belonged in it. I wore the hakama for the first time Monday night, and as I rolled, fell and threw, I could feel it swirling around me, reminding me and encouraging me to stay on this path that I had almost abandoned.

At the end of class, I sat on my heels and bowed deeply, grateful for this last opportunity. I sat up and looked around, seeing the mats in front of me. I heard the quiet talking and laughter in the changing room behind me. I smelled the old familiar smells of hard work and sweat.

I was home again.

 

The Panniers That Won't Quit

anhaica-panniers.jpg

anhaica rear viewI don't trust reviews from people who have just bought the product. Still high on their purchase, they rave about a tool that they have barely used, and a review based on such limited knowledge has little value, in my mind. Which is why I've waited several months and 550 miles before writing this review of my Anhaica Bag Works panniers. Since buying my panniers, I've taken them on two tours and used them for around-town errands like going to the library and the CSA.  I'm pretty sure I know them by now. I also want to state for the record that I have no ties with Anhaica Bag Works or its proprietor. She hasn't offered me any discounts, deals or other renumeration for writing this review. This is important to know, because I'm about to come off as the world's biggest fanboy. Because these are simply the best bags I've ever used and the last panniers I'll have to buy.

I've been cycling for transportation and recreation for 40 years now, and have owned panniers from Lone Peak, Nashbar, and others. My panniers have carried books, groceries, bricks, motorcycle parts, and all the goods one needs for a 1-2 week tour. All of them have fallen short in one way or another -- too small, not durable or leaky are the usual culprits.

So when I began preparing for my Great Allegheny Passage/C&O Canal tour, I had a fairly specific set of criteria in mind. I needed size, because I was doing a self-supported camping tour; I needed reliability and durability. I needed an easy functionality; this is a tool I want to use without thinking about. Last, but not least, I wanted good looks.  I looked at all of larger pannier manufacturers, such as Arkel, Ortlieb and others, but I settled on Anhaica instead. I had some prior history with their products, a rack trunk and handlebar bag, which had both worked suitably, and I was familiar with Anhaica's standard of craftmanship -- which is very high indeed. Anhaica is a small shop in Florida, where they make all of their bags by hand. They are designed and used by the shop's owner, who, in addition to being a talented seamstress, is a cyclist herself. Everything they sell, she's road-tested. She tested the Raid panniers, for example, by taking them on a 5-week European tour.

anhaica saddle upThe Raid panniers are made out of waxed canvas, using locally-sourced beeswax, and they are lined with nylon. These bags are undeniably and reliably waterproof. The heavy canvas and attached straps and buckles are durable enough for overstuffed bags to be tossed from bike to train, bike to rocks, rubbed against trees and boulders, carried about on foot and generally mistreated, with nary a complaint. I am, by nature, hard on things, and I expect breakage. These panniers spent a lot of time stuffed to the gills, and not only failed to fail on me after 500 miles of hard usage, but seemed to thrive on the abuse. And, just in case you're wondering if something as antiquated as waxed canvas can be as waterproof as a more modern, synthetic fabric, let me put your mind at ease. These panniers endured a 12-hour soaking, with nary a damp spot inside. So their functionality on that account is assured, even after being repeatedly tossed off the bike onto the ground, or rubbed up against brick in the depths of a dark tunnel. So, durable? Check.

These panniers are simple, which is the way I like my travel gear. I don't see the need for having multiple pockets, quite frankly, because I forget where I've stashed things, and then I forget to zip the pockets closed, and then things start bouncing off. Also, I believe that you do better on expeditions by keeping your gear simple and removing as many points of failure as you can. A simple roll-and-flap set of panniers like these eliminates a lot of weak spots. Open bags also mean weird sized items will fit. The panniers are roomy, measuring 16 liters with the top fully rolled down, which gave me plenty of storage space. Other tourists end up with tents and sleeping bags strapped on their racks...not this guy. Everything fit in the bag. These bags don't zipper shut; you roll down the top like you do with Ortliebs, and then a flap covers the top. This also means you always have a tight load, with nothing bouncing around, and the pannier expands or contracts as needed Just for good measure, I added the Anhaica saddle bag, which carried my extensive repair kit. Size: Check.

One of the nice features -- actually, it turned into an essential feature -- is that one of the bags quickly turns into a rucksack with padded shoulder straps. It's not anything that you would take on a 20-mile hike in the woods, mind you, but if you suddenly find yourself on a ride-share bike with no rack, as I did in Washington DC, this feature is a lifesaver. It's also handy for taking in the grocery store  with you for shopping, then hooking it on the rack for the ride home. The hooks on the bags are very strong, and securely lock to the rack. There's no bottom bungee that you have to hook up, the top hooks do it all. In practice, there's no sway to the bags when cornering. Functionality: Check.

Finally, we get to perhaps the least important aspect of the panniers, the looks. My bike was built with a specific, semi-retro look in mind. British racing green and chrome, upright handlebars with cork grips and bar-end shifters -- you get the picture. I wanted a set of panniers that matched aesthetically with my bike, and these fit the bill perfectly. After use, the canvas has developed a lovely patina.  Believe it or not, on my GAP trip, I had no fewer than three people come up to me and tell me how awesome my panniers looked. Really? When was the last time anyone received compliments about their pannier styling? Aesthetics: Check.

Some features of note: There are some nice touches that Anhaica adds to their bags which I've not seen elsewhere. Like D rings on the tag end of the straps which loop around the working end, so you don't have loose ends flapping in the breeze or, worse, coming undone. The top flaps are also equipped with D rings so you can tie on additional items, like laundry that needs to dry, or a sleeping pad that won't otherwise fit. (That said, I found that all of my camping gear -- tent, sleeping bag, sleeping pad, stove and pots all fit easily into a single pannier.) There's a reflective stripe on the back for those really, really long touring days. Each bag has a single outside zipper pocket, but that's it. These panniers aren't filled with needless features, they are filled with simple strength and durabilty.

Downside: There isn't any. I'm pretty sure that my Anhaica panniers will outlast me and continue on into the next generation of cyclists in the family. And they'll keep looking good. Really, what more could you ask for.

So, even after all of the miles, and plenty of opportunity for me to become disenchanted with these panniers, I've found that I've only grown more fond of them, and, in fact, can't wait to use them again. Hmmm....Quebec has some mighty nice bike trails I hear...

 

 

Why this doctor is speaking up about politics. And will continue to do so.

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voting_machineLooking back on my social media activity over the past few months, it is clear that something has shifted. It's gotten away from the interesting advances in alternative medicine and groovy bicycle stuff that I usually discuss, and has plunged heavily into politics. A savvy marketing consultant would probably slap me upside the head while telling me how off-message I've gotten. And they probably would be right. What's a doctor doing talking about politics? It's really not in my wheelhouse, and the topic stands a better than average chance of driving away patients.

On the other hand, maybe politics is a doctor's business. But before we get into that, a personal mea culpa: Like so many other people in this country, I'm feeling a certain amount of concern over our collective potential futures. I'm not really fearful -- a man who has twice gambled everything he has on slim chances of success is unlikely to respond to fear -- but I am worried. It seems that we're at a pivoting point, and the pivot extends through about seven dimensions. None of us can see clearly what's ahead. As a result of my own concerns, I've been more than usually willing to participate in discussions I would normally steer clear of. What may have gotten masked in the verbiage is that I'm personally pretty accepting of a wide range of opinions. Sure, the world would be darn near perfect if everyone believed like me. It would also be incredibly boring.

Transgender people have bad backs, too.

But, professionally speaking, should I even be mentioning politics? It's something I rarely discuss with patients in person. For the most part, within the confines of the treatment room, politics wouldn't seem to affect outcomes. But the fact of the matter is, politics often plays a huge role in affecting  patient care, and can have a dramatic influence on outcomes. Let me give you an example or two.

For several years, I made it a point to reach out to the community of transgender people. Not that I have any specific skills for helping transgender people transition or become comfortable with being beyond binary gender classification, though I have sought to educate myself above the general level of knowledge. Nevertheless, those tasks are best suited to endocrinologists, surgeons and therapists. But, you know, transgender people have bad backs, too. And headaches, and allergies, and tummy problems -- all the things I treat on a daily basis. I  wanted my clinic to be a place where transgender people could just come and get their health issues dealt with in an environment where their gender identity doesn't really matter. In doctors' offices that's all too rare.

During that time, I got a glimpse of just how powerfully our political system affects individual health. A large part of what causes some of the dysfunction associated with transgender people's functioning has nothing to do with the individual, but is more due to society's rather dismal response to those who don't fit into our narrow categories of normal. While the gay and lesbian rights movement made tremendous strides during this time, transgender people were largely left behind. The mantle of shame and fear impressed upon them by our society hobbled many of our efforts to improve health. I treated transgender women who refused to exercise, fearing they would bulk up, lose their femininity and no longer "pass" as a woman. I had transgender men as patients whose use of the local gyms was hobbled by their inability to use the appropriate locker rooms.

Perhaps the greatest inhibitor, however, was poverty. Because of their status as outcasts, transgender people often find it difficult to get or hold a job. State insurance in Connecticut doesn't cover chiropractic care for anyone over the age of 18 (I have yet to make any sense out of that particular regulation), and when it does offer coverage, it provides benefits only for a chiropractic adjustment, but none of the other services I provide and that are within my scope of practice.

It is not an exaggeration to say that almost all of my services to transgender patients were, as a result of politics, public policy, and the vast bigotry inspired by social conservatives, provided free of charge. I didn't mind; part of my individual social contract is to care for the sick regardless of the ability to pay.

So the detrimental influence of politics here is two-fold: First, and most important, is how social policy and attitudes impedes the ability of transgender people to navigate a healthy path in society. Second is the social net so full of holes that I couldn't receive payment whatsoever for treatment of a transgender person's headache, if that particular treatment required nutritional or acupuncture intervention rather than a chiropractic adjustment.

An absurdly loose definition of "safe."

Politics is my business in other ways as well. Take, for example, the push to hide GMO produce from the consumer. A lot of my practice is based around nutritional intervention, and very often I am providing care for people who are very sick, and have been so for years. In these cases, the quality of the food in their diet is absolutely critical, and for at least some period of time, must be tightly managed in order to acheive the results we want. How on earth can I do that when I don't know what is even *in* their food?

I know the argument is that GMO plants have been tested as foods and found "safe."

It's an absurdly loose definition of safe. Food safety testing for genetically modified plants has consisted of exactly this: The GMO food is inserted into a livestock's feed for a period of time, not exceeding 6 weeks, while it's effect on output (eg, milk for dairy cows) and "health" (in this case, soley measured by weight loss (bad) or weight gain (good)) is measured. If the cow keeps making milk and the pig keeps making bacon, the GMO is determined safe.

There has been no legitimate long-term testing of GMOs and their role in chronic diseases such as arthritis, cancer or heart disease, not to mention how genetic modification affects the levels of macro and micro nutrients. How can I tell a patient to increase their levels of certain foods in their diet, foods that were once known to have certain levels of a nutrient, if genetic modification has changed it in unknown ways? Worse yet, what if my advice floods them with previously unconcerning levels of chemicals that worsen their condition?

That is tantamount to an MD telling a patient to take the pills in that brown bottle without a label on it. They don't know what's in it, and neither do you. Food is my patients' medicine, and through the political expediency of not requiring appropriate labeling, my ability to prescribe the kind of medicine my patients need is being stolen.

A catalyst for change.

Finally, I must address one other reason why I have felt so strongly to speak out in this political season. It is because, over the past two decades, I have come to realize that my role in patients lives is not just the dispenser of adjustments, advice, exercise and supplements; I am, sometimes by choice, and sometimes by default, a change agent. By the time people get to me, their lives are often so contorted, so distressed by malaise and malfunction, that nothing short of a grand step into the unknown will help them. I'm the guy who holds their hand and helps them make the jump.

A case in point: Many years ago, a patient came to me for nutritional advice. They wanted me to help them fix their diet. And, after consultation and examination, I found that a single change would eradicate a large piece of their health problem.

I told this patient that they needed to stop drinking. That the alcohol was taking their health and would eventually kill them.

That wasn't the first time I discussed alcoholism with a patient, nor would it be the last. It's never an easy discussion, and it is rarely something that the patient wants to hear. I try to be honest, caring and non-judgemental; alcoholism isn't a failure of morals after all. But it is a diagnosis that is loaded with massive societal overlays of blame and self-loathing.

In this particular case, the patient stormed out of my office in a rage. I felt bad, like I had failed them. My failure stuck with me for years.

Several years later, I was interviewing a new patient. I asked them how they had heard about me, and they told me that this former, one-time patient of mine, the one who had stormed out of my office in anger, had referred the new patient to me from a sober facility. That was nice to hear, but it was the way they worded the referral that clutched my heart.

"Go see Dr. Jenkins," this patient had said. "I'm alive today because of him."

It was then that I realized that, at the core of what I do, I am a catalyst for my patients, enabling them to do things they couldn't do before. That is my most fundamental, and most important, role.

So it is in this election. I can't see much in the murk, but what I do see in this time in our country is the potential for change. The change can be good or bad, but in my very small, very limited way, I will fight for the change that I think will make this country healthier. We are sick right now, sick with anger, sick with bigotry and sick with unnecessary poverty. If I am to be true to my role as a healer, and true to myself, I feel that I need to fight for the changes that will make us all a little bit healthier.

You may not agree with my opinions, my message, or my candidates. That's fine, civil disagreement is what makes the world turn 'round, and I've emerged from political tussles with more knowledge and sometimes a fresh perspective that changes my opinion.

But just know this: I am working as hard as I can for what I believe is the healthiest outcome for us all. And I also choose to believe that you are too.

Time to turn off the air conditioning.

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mindful manFor most of the past week (and part of this week), the Center has had no climate control. The AC compressor, already among the ancients, seized completely last week. After consultations with the experts from Elite Energy in Goshen, I decided that the best thing to do was to replace both furnace and air conditioning. Frankly, I've been keeping the furnace running with magic beads and baseless threats for the past two years, so I consider this to be a good opportunity. Elite Energy came back to me with an excellent bid on the job, so I gave them the go-ahead. The catch: It won't happen until Wednesday or Thursday.

That's actually no problem, as the weather is mild, and this building is well-insulated, which means cool nights will last until noon. Then we have to open the windows.

But this experience has made me think how, in many ways, this change is beneficial for my patients. One of the essential health problems of our time is the disconnect between us and our environment. And the more we struggle to control and isolate ourselves from our environment, the sicker we become. For example, we now know without a doubt that early exposure to bacteria in the soil improves immune system functioning throughout our lives. We know that peanut allergies are likely caused by not being exposed to them as infants. We know that walks in the woods reduce the symptoms of depression and improve cognitive functioning. We know that the chemicals we use to isolate our foods from their environment results in illnesses in ourselves.

How much of a difference would it make in our health if we stopped cocooning ourselves in climate control? It's a question worth asking.

I might have a different perspective on this than many, because I have never lived in a house or apartment with air conditioning, and for the past 18 years, have relied for heat primarily on a single wood stove in the center of my New England colonial-style house with single-pane windows that rattle in the breeze. I ride my bicycle or walk to most places, including work, 10-11 months out of the year. So I've lived my life closer to the patterns and cycles of our weather than many Americans, to the point where I am surprised when I walk into a climate-controlled house in the summer. (Interestingly, though, in the 1960s, only 12 percent of Americans had air conditioning in their homes. People seemed to survive ok.)

Certainly, aesthetically, buildings open to the natural world about them are more pleasant. In the spring, I am greeted by the smell of budding flowers and freshly-mown grass wafting in the kitchen window as I have my morning coffee. Thunderstorms in the evening bring a sudden, refreshing coolness, and you can smell the ozone in the air.

Being exposed to the environmental changes brings on eating changes as well, keeping my diet in sync with my physiological response to nature.

Conversly, we know that air conditioning can cause bad health. Asthma and allergies can be worsened by air conditioning, sometimes as what is known as sick building syndrome. This is usually attributed to poorly-maintained systems. In a well-maintained system, allergies are more often relieved by air conditioning.

Outside of that instance, I would argue that air conditioning is bad for your health in other, more obscure ways, and it goes back to the principle of being dissassociated from our environment. The less contact you have with your environment, the worse you are. Not surprisingly, this notion has received little attention among medical researchers. Of the few studies published, however, the results are suggestive that more frequent exposure to the natural environment leads to better health.

Fortunately, however, I'm not tied to the research. I rely as much on the wisdom of my professional forbears as I do on modern research, and in that, the conclusions are unequivocal. Changes in environments have been prescribed since the days of Avicenna and the Yellow Emperor, and through the ages, "environmental therapy" has been an essential feature of the treatment of many serious disorders.

So, even after we get our climate control systems back online here, I think I will make more of an attempt this summer to keep my patients exposed to the healthy environment around them. In my office, patients find themselves regaining health in the most surprising ways. I should not ignore such a powerful intervention that has been used successfully for millenia.

Lies, Edzard Ernst, and Research: Don't Believe Everything You Read

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bad pharmaThere have been several articles published in medical research journals which are pointing out just how flawed, biased, and just plain wrong biomedical research has become. Such studies can cause serious harm. Paxil was used as a teen anti-depressant  for years, largely based on a study which massaged the data to come to absolutely false conclusions about its safety and efficacy. Vioxx, the miracle painkiller that killed, was allowed on the market due to research designed to hide its deadly side effects.  As far back as 2003, bias was noted in the biomedical reesarch literature, but little has been done to change things. At most, some journals ask investigators to self-report any conflicts of interest they may have. Of course, few do.

The fact of the matter is, that pharmaceutical companies control the vast majority of grant money going to research institutions, and as an investigator, your livelihood can be put on the line if your grant money dries up.

Not surprisingly, bias and hidden agendas come up in the research on alternative medicine and chiropractic in particular. Mostly this occurs in the form of journal articles using research that has been hand-crafted to make chiropractic spinal manipulation appear dangerous -- when, in fact, you have a higher risk of serious injury while driving to your chiropractor's office than you do of any treatment you receive while you're there.

A case in point is the article, "Adverse effects of spinal manipulation: a systematic review," authored by Edzard Ernst, and published in the Journal of the Royal Society of Medicine in 2007. Ernst concludes that, based on his review, "in the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation."

This conclusion throws up several red flags, beginning with the fact that it flies in the face of most of the already-published, extensive research which shows that chiropractic care is one of the safest interventions, and in fact, is  safer than medical alternatives.

For example, an examination of injuries resulting from neck adjustments over a 10-year period found that they rarely, if ever, cause strokes, and lumbar adjustments by chiropractors have been deemed by one of the largest studies ever performed to be safer and more effective than medical treatment.

So the sudden appearance of this study claiming that chiropractic care should be stopped altogether seems a bit odd.

As it turns out, the data is odd as well.

In 2012, a researcher at Macquarie University in Australia, set out to replicate Ernst's study. What he found was shocking.

This subsequent study stated that "a review of the original case reports and case series papers described by Ernst found numerous errors or inconsistencies," including changing the sex and age of patients, misrepresenting patients' response to adverse events, and claiming that interventions were performed by chiropractors, when no chiropractor was even involved in the case.

"In 11 cases of the 21...that Ernst reported as [spinal manipulative therapy] administered by chiropractors, it is unlikely that the person was a qualified chiropractor," the review found.

What is interesting here is that Edzard Ernst is no rookie in academic publishing. In fact, he is a retired professor and founder of two medical journals. What are the odds that a man with this level of experience could overlook so many errors in his own data?

The likelihood of Ernst accidentally allowing so many errors into his article is extremely small. It is far more likely that Ernst selected, prepared, and presented the data to make it fit a predetermined conclusion.

So, Ernst's article is either extremely poor science, or witheringly inept fraud. I'll let the reader draw their own conclusion.

Interestingly enough, being called out on his antics has not stopped Ernst from disseminating equally ridiculous research in an unprofessional manner. Just a few days ago, Ernst frantically called attention to another alleged chiropractic mishap, this one resulting in a massive brain injury.

Not only has he not learned his lesson yet, Ernst tried the same old sleight of hand again. The brain injury, as it turns out, didn't happen until a week after the "chiropractic" adjustment, making it highly unlikely, if not impossible, for the adjustment to have caused the injury in the first place. Secondly, the adjustment wasn't even performed by a chiropractor. As the original paper points out, "cervical manipulation is still widely practiced in massage parlors and barbers in the Middle East."  The original article makes no claim that the neck adjustment (which couldn't have caused the problem in the first place) was actually performed by a chiropractor.

It is truly a shame that fiction published by people like Ernst has had the effect of preventing many people from getting the care they need. I can only hope that someday the biomedical research community can shed its childish biases so that we all might be better served by their findings.

 

 

 

 

Diet scams: 5 ways to keep money in your pocket and get blubber off your booty.

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No. Just no. Just as night follows day, the season of dietary repentance follows the season of holiday feasting. Spiritually, all that supports the world right now are leftover well-wishes and good intentions generated by a week or two of waking up in the morning feeling like a mushroom past its prime.

And this, all good health industry marketers know, is the best time to pounce on you, prying loose those few remaining dollars in your pocket, using the time-tested tools of empty promises and before-and-after photoshoots.

So here I am, the postprandial anti-Santa, to tell you the five best ways to lose all that holiday fat (and, let's face it, you also need to lose the fat leftover from last summer and fall), and keep a few dollars in your thinning fist so you can pay the credit card bill.

1. If it's a multi-level marketing plan, don't do it. Just don't.

You've seen them. Being a doctor specializing in nutrition, I get hit up a couple of times a month. A friend starts telling you about this terrific shake/powder/meal replacement that they've started doing, and they're losing a ton of weight (and it's true, too. They're living not quite so large these days) and THEY'RE MAKING MONEY AT THE SAME TIME! IT'S TOO GOOD TO BE TRUE!!

Yes. Yes it is. Do you remember when merchandisers would sell items at low prices, saying "we've cut out the middleman, and passed the savings on to you!"

Well, multi-level marketing (MLM) is the exact opposite. By the time the consumer gets their hands on an MLM product, it's passed through so many middlemen that you could fill a small school bus with them. And every single one of them takes a cut.

Of course, it is explained to you how you can get your product virtually free if you "join the team" of the "most successful product launch in history" and begin selling product yourself.

Unfortunately, that requires a large circle of rather gullible friends, most of whom will probably come to hate you when they realize the only reason you reach out to them is because you want to sell some product -- and make them a team member too.

"Oh, your father died suddenly? I'm so sorry! But I have just the thing, my company's Anti-Blues Chocolate bar! It's filled with antioxidants that combat depression and you'll lose weight every time you eat one!"

You don't want to be one of Those People.

Also, the products are just plain not that good. One of the most popular MLM parades in my area for the past couple of years has been Isagenix. They push their weight-loss plans hard. Of course, it comes with about $600 worth of supplements, bars, meal replacements, and other items you don't really need.

I looked at the label of one of their weight loss products the other day, and -- I kid you not -- the third ingredient on the label was sugar. Of course, they hid the sugar in a fancy molecule and dressed it up in a beach-body bikini so you wouldn't notice, but it was sugar nonetheless.

You don't have to be board-certified in nutritional medicine to know that lots of sugar in a weight-loss product is probably Not A Good Thing.

There are a lot of problems with MLMs in general and Isagenix in particular, but the key ones to remember are the three Os: Overpriced, Overhyped, and Overpromised.

2. Look at the photos.

Every weight loss plan worth its hype will have tons of before/after photos to support their claims, in which frumpy housewives and flabby dadbods turn into seaside eye candy. I hate to tell you, but most of those pictures are a crock. Here's how they do it.

Photoshop. There is almost nothing that a good Photoshop hand can't do. They can remove pounds, smooth cellulite and lift boobs and cheekbones with a quick wave of the mouse. It's hard to tell with the naked eye, but there are a few sites which will tell you how massively 'shopped a picture is.

Ok. There are some pictures that Photoshop can't fix.

There are some easier ways to tell as well. Look at the lighting and the makeup. The "before" picture is almost sure to be potato-quality, with the poor schlub standing in front of a dingy mirror reflecting a sink top full of forlorn, unused, cosmetics. The "after" picture, on the other hand, will have full lighting, a pose straight from Bodybuilder 101 class, and the unused makeup from the previous shot is getting full-on pro application. Yeah, she looks great. Unfortunately, you probably won't, unless you keep your money in a belt, which will be considerably looser after you are done paying for The Product.

Also, look at the camera angle. Every Millenial-aged single male is familiar with what's known as "the Myspace angle," which is used on every dating-social media app in the universe. The camera is placed high up and close in, which makes the subject look much thinner than they are. This photography technique has led to more disappointing first dates than pretenses of a fondness for James Joyce and Emily Bronte.

The most famous -- and easiest -- before/after sleight of hand is to just simply switch the photos around in time. A supplement company popular with the body building set once pulled this stunt. Unfortunately, the company used well-known bodybuilders as their frontmen, and some fans with dated pictures of their idols, caught them in the act.

There were apologies all around, and continued claims of massive gains with dramatic weight loss. Plus, new "real" pictures.

3. The gym has pizza night.

Yes, there are gyms that offer tremendously low cost memberships; but they are also the gyms which market directly toward people who won't use their services. Thus, they can oversell memberships without worrying about taxing their rooms and equipment beyond tolerable limits.

You can tell these gyms by the fact that they use non-fitness oriented marketing techniques, such as pizza nights.

A telltale sign that this is not the gym you want to join.

They also promote "judgement free" workouts and have restrictive dress policies that prohibit members from demonstrating that their fitness regimen is actually working.

Yeah, I'm looking at you, Planet Fitness.

The biggest advantage of joining a gym, in addition to the equipment, is the ability to work out with, and be inspired by your peers. When you hang out with active people training to acheive their best in weight and fitness, it rubs off on you. Your energy is shared, and the camaraderie of a gym is a great support when you are working toward your goals.

The trouble is, Planet Fitness and its imitators, are not looking for those people. They don't want people who will actually come and use the facilities. They make more money by selling a service that people want but don't use.

As a result, the people at such gyms are generally not the ones who will inspire, teach and lead you. Those folks are all at the other gym where it's ok to grunt when you deadlift and wear shirts that show your biceps.

4. The weight loss plan and products use [insert aboriginal tribe] secrets.

Weight loss products that are attributed to herbs, foods, or techniques developed by ancient societies or indigenous cultures are invariably utter and complete rubbish. You know why? Because the problem of obesity is a byproduct of industrial culture. Historically, insufficient calories were more of a problem than excess calories and dysfunctional nutrition. Excess weight was therefore seen to be a sign of wealth and something to be aspired to, just as Victorians aped the pale complexions of the rich of their time, and modern Westerners imitate the tanned (and toned) bodies of what in the Sixties were called the "jet-setters."

Which brings me to another point. The incredibly toned bodies that some people aspire to are controlled works of mutable art requiring multiple hours of daily upkeep. Which is fine; dedicating yourself to that level of fitness is commendable. But the vast majority of people have not the time, money, or desire to achieve that. Also, for a large number of fitness models and bodybuilders, pharmaceuticals, legal or not, are part of what makes it work, and the fitness is for show only.

5. So what can you do to lose weight?

Losing weight can be amazingly simple. If you are starting with an overweight but generally healthy body, simply eat less and exercise more. You don't need any special supplements, aside from a multivitamin/multimineral supplement, and your nutritional knowledge is more important than your nutritional supplements. Although, honestly, if you just calculate your base metabolic rate, and keep your intake lower than your caloric usage, you will shed pounds.

It gets more complex if you have certain health issues, such as hormone imbalances or gastrointestinal dysfunction such as leaky gut or bacterial overgrowth, depression, insomnia or other conditions. Fixing those in a healthy manner is where I come in. But still the essence remains the same: Eat less and do more.

I have not put anyone except for morbidly obese patients on a weight loss diet for the better part of a decade. I use specialized diets and supplementation to help heal sick people, and weight loss is often a side effect of the nutritional therapy. As you heal, your body will find a healthy weight range on its own. After regaining your health, if you want to further decrease your weight, the answer is simple: Eat less and do more.

Rather than having to pay for it, losing weight is essentially free. Eating less de facto costs less, although the savings will be eaten up (heh) by the increased cost of better food. And anyone can exercise without a gym membership or special equipment. There are hundreds of bodyweight exercise routines on the web; you can also just step out the front door and go for a run.

So anyone trying to sell you a product-loaded weight loss plan or pills or drugs is selling you something that you already have and don't need. To lose weight, all you need are three things: A goal, some discipline, and a willingness to embrace change.

Each of those are free. Keep your money in your pocket, follow my advice, and prepare to buy new clothes.

Dr. Avery Jenkins is a chiropractic physician and board certified in Clinical Nutrition and Medical Acupuncture. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

 

(Special thanks to Chris Herrington, DC for his inspiration for this post.)

7 Ways to Make This Year Better

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sunrise on rockOver the past couple of weeks, I've been talking to patients and friends about how the past year went for them. Almost without exception, I have heard how tough a year it has been, and not surprisingly; the economy is anemic, the natural world is in increasing disarray, the presidential race has illuminated a vast and perhaps unbridgeable cultural rift in our country, and the media has managed to scare the bejeezus out of everybody with terrorist ghost stories. For a lot of people, it's not a pretty world out there, and the future isn't terribly bright. But here's the secret. You can change things. Not just internally, though that is part of the process. But your will is part of what makes the world. Collectively, mankind creates the reality we live in, not only through shared values and beliefs, but also through our intent. We can create a bountiful, beautiful world, or we can create one marred by anger, fear and want. Each individual contributes to the collective reality, some to a greater degree than others, simply because they understand how to exert their will in a way that creates a large impact. Most of us, frankly, do not have that strength of intent. But we all have the ability to alter the environment immediately around us, using the raw material of the collective gestalt.

There are seven concrete acts that you can do that will change the world around you. Do these consistently, and watch the results.

Meditate

Meditation is a sure-fire way of harnessing the wild and often wasted power that exists within all of us. In the past two years, there has been a tremendous amount of research on meditation and the changes it creates, and it is the most powerful behaviour modification tool that exists. Even within a few weeks of beginning a daily meditation practice, beneficial neurological changes begin to appear. After a year or more, these changes become quite profound.

Even better, there are endless ways to meditate. Every religion in existence has some form of meditation, and engaging your spiritual side can amplify the results of your meditative practice. If you are atheist or do not adhere to any specific metaphysical tradition, mindfulness meditation has positive, powerful results.

The down side, if there is one, is that it needs to be practiced virtually every day. Once you've instilled it as a habit, this won't seem so daunting.

Exercise

Exercise is the pill for almost every ill. There are few conditions that exercise doesn't improve, and there is nobody that can achieve true health without it. And there are no excuses for not exercising. Over the years, I've gotten patients with every chronic disease under the sun to exercise, and all of them have improved from it.

You don't need a gym membership, either. A terrific cardio workout is no further away than the street out your front door. Want to lift weights? Do a bodyweight routine that uses leverage against gravity to build muscle. No time? No way. Get off Facebook.

Exercise also creates neurological as well as physiological changes that are beneficial for meeting the challenges that life throws at us. I, for one, appreciate the feeling of power and strength in my body when I am about to undertake something arduous, whether it is a long, busy day at work or a difficult meeting. My outer strength feeds my inner strength, and if you want to be powerful in this world, the power starts in your arms, legs, heart and hands.

Goalsetting: Do it right

Most people don't reach their goals, not because their goals are too difficult, but because they set the wrong kind of goals. Goals should be process-oriented, not object-oriented. For example, instead of setting a goal of, say, getting a new job this year, your goal should be talking to 10 people every week who can help you find the job you want. Instead of setting a goal of buying a new car, set a goal of putting aside $XX every week.

Process goals have the advantage of giving you frequent, positive feedback. You get that warm fuzzy feeling of looking at your growing bank account at the end of each week and realizing that you've met your goal, rather than slogging along at a goal that looks far, far away. We're designed to respond to instant, positive feedback. It's hardwired into us. Make use of that.

Additionally, process goals are more flexible than object goals. If, somewhere along the way, you decide you would much rather get that awesome commuting bike rather than a new car (a very wise decision, I might add), you don't have to change your goals at all.

Process goals will get you where you want to go, even if the end result is hidden in the far-off mists.

Time management

Look, I'm not going to mince words here. You're going to die, sooner rather than later, and you really don't have a day to waste, except for those days you choose to waste. But make time wasting a conscious choice, not a default behaviour,

Some spiritual traditions (I'm looking at you, Zen) encourage you to ignore the past and the future, and concentrate only on the present as the only time that exists. That is all well and good for focusing your attention on important matters, but it really puts the damper on long-term planning, which is not a good thing. The argument goes that if you take care of today, tomorrow will take care of itself, but that's not always true. Our environment changes constantly, and those who are not looking at the changes coming their way are the ones who will be injured by the surprise of their arrival.

Here's the thing: Buy a 50-cent notebook, steal one of the free pens from my office, and write down everything that you need or want to do. Don't worry about time, date, or priority. Just write it down, and make sure to cross them off when you've finished a task (that warm fuzzy feeling again).  You'll be surprised at how much that you thought you couldn't get done that you are suddenly accomplishing.

Also, keep the notebooks. They, as much as a daily journal, will give you a point of reflection of your life over the course of the years.

Keep it clean

Energy (and that, after all, is what we're talking about, the accumulation, control, and direction of energy) is attenuated by chaos and strengthened by order. If you're one of those people who says "Oh, my (desk, room, office) is messy, but I still know where everything is," give it up. Give it up right now. I used to be one of you, and what I sadly discovered that all the tightly focused concentration and intent and willpower would get dissipated into a steamy mess when it hit the clutter of my desk.

You want your willpower to do something for you? Don't make it march through a swamp to get to where it can do you some good.

In fact, write "clean it up" as the first entry in your new 50 cent time manager. And when you finish the first page, write it on the top of the next. And the next...

Seek the wisdom of others

Face it, you don't know everything, even if you, like I, think you do. Find mentors to help you walk your chosen paths. Find friends who will feed you when your pack is getting empty. Find assistants who are really, really good at the things you do poorly, and treat them like the gods and goddesses they are.

I often say that I am grateful to my patients, because they have taught me most of what I know as a doctor. And I know, it sounds like some cheesy marketing pablum, but it's true, dammit. I cannot tell you the number of times I have walked in the exam room to greet a new patient, and to their surprise, rather easily fixed their problem. But that's only because I had a patient last week that had the same problem, wasn't responding to the normal approach, and kept me up nights thinking about what I wasn't doing to get them better.

So, invite others into the reality you are creating and, to the extent that they are willing and able, allow them to help you create your world with you.

Wash, rinse, repeat

The common thread with everything I've said is that you can't do it once. You've got to do it frequently, often daily. Which initially sounds like a huge grind.

But the fact of the matter is, it only takes six weeks to create any new habit, good or bad. How long have you been practicing the habit of eating Doritos and watching sitcoms? Years, right? So take these six activities, do them for six weeks, and then email me and let me know what happened.

I'd say good luck, but you won't need it. Follow these guidelines, and you'll be making your own luck.

 

A Day To Vote

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a day to voteAs the president of my own small company in my own small state, I'm issuing a challenge to every other employer in the USA. Today, I told my staff that the Tuesday after the first Monday in November is a paid company holiday, beginning Nov. 8, 2016. My employees have no requirement to vote on that day, and certainly no incentive to vote as I would. But I believe it is my responsibility as an employer to give the staff of the Center for Alternative Medicine the ability to recognize this most important civic day in the life of an American.

So, what do you say, fellow business owners? Are you and your executives patriotic enough to allow your employees time to vote without penalty?

Will you join me and my employees in A Day To Vote?

Meet Oliver.

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OLYMPUS DIGITAL CAMERAEverything under the heavens has a name. Even inanimate objects, in the shapes they hold and the uses to which we have put them, are given to certain qualities that distinguish them from one another. The stones of the earth themselves have names, if you can see them clearly enough. And knowing something's name is key to knowing its soul. This was one of the beauties of man-made objects before industrialization took over. The craftsman invested  himself in his products to the degree that it had qualities and characteristics and a history making it as unique as any other individual. Who doesn't immediately recognize Excalibur, the storied sword of Arthur?

Vehicles, such as boats, automobiles, and yes, bicycles, are frequently named, more so than other things because they are closer to animate than inanimate, and their qualities are readily apparent to anyone who makes use of them. A sailor spending time at the helm of a boat will soon recognize how she carries herself through seas rough and slow differently from any other. And a cyclist can easily feel the wheels underneath him, and how they handle themselves carving a corner or sluicing down a hill in their own unique way.

We encapsulate those qualities that we see in our steeds, whether sail, pedal, or combustion powered, in the names we give them. As a result, every bicycle in my stable is named in its first few rides, as I get to know its personality.

It was a bit different for Oliver, the semi-retro baguette-and-wine bike whose build I have recounted in the previous few posts. Once the wheels were on and the saddle installed, and it began to look like a bicycle rather than a pile of shiny parts, I unconsciously began trying out names. From the frame geometry I chose and the parts I picked, I knew (or rather, hoped), that the bike would have certain features. I was seeking rather sedate handling, something that could gracefully move into a curve, but not necessarily bite it, and a measured response to my steering input, rather than the twitchiness of a sportier bike. I wanted a frame that had a little flex to it, a little liveliness without absorbing the energy of my pedal strokes.

Which brings me to an aspect of building this bike that I hadn't really thought of prior to getting there. As I installed the handlebars, and the saddle and the derailleurs, I began to wonder if I had made the right choices. Did I leave enough room in the cockpit? Plan on the correct handlebar height? Will the gear ratios work for my style of riding in these foothills of the Berkshires? When you purchase a bicycle from a shop, all of these decisions have been made for you, by people whose profession it is to make a well-riding bike. While I have a lot of miles under me, I'm no pro. And amateurs make mistakes. And maybe I had made a few.

Rider's view of the cockpit.

In the process of creating anything, whether it be a table, knife or bicycle, there comes a time when you commit yourself irrevocably to the design decisions you have made. It may be when you anneal the steel in forge and oil, or put saw blade to that irreplaceable piece of your father's cherry lumber. In the case of this bicycle, it was when I cut the steerer tube on the fork. The length of the steerer tube determines the height of the handlebars, and ultimately your comfort and the bike's handling, and cannot be changed without replacing the fork or implementing various undesirable kludges.

Thus I committed myself to the wisdom of the choices I had made, and hoped that my vision had not exceeded my skills. It has happened before.

I completed the final construction of the bike in that pleasant state of anticipation mixed with some anxiety that I had somehow, in some casual moment, ignored a crucial aspect of building and design that would send me, like Icarus, crashing into the deadly waters below. I combatted that fear by putting not one, but three coats of shellac on the grips.

Then it was all done and the bike sat on the stand for a few more days of anticipation while I waited for the seatpost collar to arrive by mail, something the post office seemed to have a bit of trouble doing. Postie brought it yesterday, so last night I fitted the collar on, and went off in the sub-freezing night on a shakedown cruise.

Ready for travel

And the assemblage of steel, sheet metal, nuts and bolts became a bike named Oliver. It is a fitting name; Oliver stems from Old German, and means "Elf Army." This is highly appropriate because my name -- Avery -- means "King of the Elves." Oliver is a comfortable, strong English name, fitting for a bike painted British Racing Green and kitted out with Brooks leather. Oliver was a retainer of King Charlemagne in the Song of Roland. Oliver's loyalty and bravery cannot be denied.

Thus it is with the bike Oliver. The handling is sure, he is responsive to the pedals, and over rough terrain (yes, that was me riding across the lawn of the First Congregational church at 10 p.m. last night), is smooth and controlled.  It is indeed the bike that I had envisioned.

And, as my daughter's boyfriend said, "It looks like it belongs in GQ!"

I'm looking forward to many enjoyable miles on this bicycle.

 

The wheel on the bike turns 'round and 'round...

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Spokes-in-a-wheelThe wheel is an omnipresent, and oft ignored, symbol of both mankind's technological prowess and our spiritual paths. It was the wheel that unburdened our backs and first brought forth roads from footpaths. It was a broken wheel to which the Buddha compared the experience of life in his First Noble Truth. It is on the Wheel of Life that Pagans experience the unbroken cycle of seasons and of life. Wheel symbolism is present in virtually every religion. A hub waiting to become a wheel

So it should come as no surprise, then, that for both practical and inessential reasons, the ability to build a bicycle wheel is considered the pinnacle of the bicycle mechanic's skills. Indeed, at its heart, a bicycle is very little but wheels, and if you get that wrong, nothing else will go right, functionally or aesthetically. So it was with a bit of some pride that I built my first pair of wheels almost a decade ago, and tested their mettle successfully against the worst that the Scottish highlands could dish out. And building the wheels for my Soma Saga was something that I eagerly looked forward to.

The shimmering, silvery rims arrived not long after the Velo Orange hubs I had ordered. By using manufacturer's measurements and online spoke length calculators, I was able to determine the exact spoke lengths I needed, and within a few hours, 80 Sapim double-butted spokes were on their way to me.

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I tackled the rear wheel first. Because of the cogs on the rear wheel, the wheel itself has to be built with the hub cocked off to one side, so that the chain lines up correctly and the propulsive force is transferred without lateral stress. I couldn't have asked for a better build, to be honest, and within a couple of hours, I had the spokes laced and the wheel trued to within a few thousandths of an inch.

A few days later, I began building the front, which should have been the easier task, as both sides are equal. But as I tried to connect the last few spokes to their respective nipples, I discovered that I had made a tactical error. You see, the calculated front spoke length I needed was 260.3 mm. The spokes were available only in even lengths, so I had my choice of 260 mm or 262 mm. I picked the nearer, albeit smaller, length. And wouldn't you know that the tiny 0.3 mm difference, as it added up among the 36 spokes, turned into such a great difference that the spokes proved insufficient.

I was set back on my heels a bit by this discovery, and proceeded to put the now-useless 260 mm spokes in the spare parts bin, in the forlorn hope that I might someday build a wheel requiring them. A week later, my new order of 262 mm spokes arrived, and I rebuilt the wheel.

This time, after getting the wheel entirely laced, I could not get the spokes to tighten evenly. Some got very tight, while others remained loose. I took the wheel apart, again, and rebuilt it. Same problem. I began to think that I had mixed up my spoke lengths.

Finally, after a restless Friday night, while an unstable, wobbly wheel churned its way through my dreams, I got up determined to uncover and fix the problem. At 7 in the morning, in my bathrobe, cup of coffee in hand, I stood in the basement shop and worked my way through the puzzle. And, like so many difficulties, the problem began at the beginning. I had begun lacing it wrong in the first set of spokes, and it was such a devilishly subtle error that I could not see it in the maze of a fully laced wheel.

The front wheel on the stand.

I rebuilt the wheel for a third time, and felt the spokes tension sweetly under my hands. Because, at a certain point, building a wheel transcends a simple matter of tightening things, and becomes an issue of gestalt. How the spoke tension feels as I squeeze them, the "pling" that the spoke makes when it is plucked. There are machines that make wheels, and the vast majority of wheels on bicycles today were laced and tightened entirely by machine, but there is a discernible, qualitative difference between a handmade wheel and one trued by blind automation. As I notched a quarter-turn here, and a 1/8th turn there, I watched the wobble slow and disappear, the rim movement sharpen up, and the wheel, made out of parts that by themselves could be crushed by the pressure of a single hand, become a unified whole capable of maintaining its integrity against hundreds of pounds of force.

Coffee cup empty, unshod feet turning cold against cement floor, I took the finished wheel off the truing stand and placed it on the new bike. And for the first time, I could see in my mind's eye, this bicycle rolling down the road, absorbing the bumps of Buddhist dharma, taking me from Beltane to Samhain and rolling me from the darkness of Yom Kippur to the lights of Hanukkah.

You see, bicycles are magic. As anyone who loves them can tell you, they not only take you from home to work or along fun loops of road. The bicycle is the ultimate freedom and the ultimate independence. I need no gas, no oil. I can pack everything I need on it, stow a few hand tools in my pocket, and I can go across the country or the world. The bicycle is the modern manifestation of the magic carpet of yore, taking you on adventures that you could have never imagined, while your spirit grows and soars.  And to take these journeys on a steed that you have conjured of your own magic? There can be no more fulfilling experience.

And it all begins with a perfectly round wheel, spinning in silence, along roads unimagined.