Patients

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.

Deep in the woods, a chiropractor encounters a bear! You won't believe what happens next!

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Courtesy PLF73/flickr. Creative CommonsSummer has started, and in my neck of the woods, that means Facebook feeds, email lists, blogs and news programs will be filled with warnings and means to ward yourself from the dangers of the outdoors. In Connecticut, the snow had not even properly melted off my front lawn before we were subjected to dire warnings about a new superdisease being carried by the region's ticks. Nevermind that this disease has been around for a hundred years, and that there have been only 10 cases of it in the past 50 years. No, this is the bug that will sneak into your bloodstream and kill you if you have the temerity to, you know, walk on the grass or something.

Recently, my Facebook feed was briefly overcome by a surge of posts reminding us of the horrible dangers of Lyme-bearing ticks and how to protect yourself from them (naturally, of course). Thank goodness the extra-virgin olive oil "trick" hasn't resurfaced yet. I'm pretty sure that was both messy and expensive for anyone who tried it.

The other day, I inadvertently horrified a couple of patients of mine when I was telling them about my exciting weekend with a like-minded group of treehuggers, camping in the field, chucking spears, and generally having an all-around good time.

My patients asked me what I used to keep the ticks off me. I said, "Nothing, really. Just did a tick check when I got home."

They looked at me like I had told them I was planning to step outside the airlock with a monkey wrench and no space suit to repair the solar panels. They were incredulous. "You didn't use anything?" they asked. Clearly, their estimation of my intelligence had just plummeted, and my abilities as a man of healing were questionable.

But it's not just the creepy-crawlies that get no love. Any intrusion of nature into our carefully-ordered world seems to be cause for anxiety.

When I put up a bird feeder on the lawn of the Center recently, and posted a picture of it online, virtually every response I received was a warning about how the bears would shred it in short order, and that I should take it down now -- NOW!! -- before the Attack of the Claws began.

In the interests of journalistic honesty, I'm going to confess right now that I'm a big bear fan. I've had many an encounter with these creatures, in the wild and in my backyard, and never seen much reason to worry, so long as nobody forgot their manners.

My Affair with the Bear began in the Dark Ages (musically speaking, at least) of the 1980s, when I was backpacking through a particularly isolated stretch of trail in Maine. I had already gone several days without seeing another human, and expected to go a few more in similarly inhuman bliss.

That morning was a pleasant lowland walk among 100-year-old pines, whose needles littered the ground and made the trail feel like a composite running track. I had stopped to take off my pack, swill down some water, and just absorb the beauty for a minute.

Standing there, I heard crunching in the bushes, and spotted an enormous black bear meandering through the undergrowth. I stood there, unmoving, as he wandered innocently closer. I was downwind, absolutely still, and he wasn't expecting any company.

As his path prepared to cross mine, I realized this was the photo op of a lifetime. Ever so slowly, I reached down to my pack and unslung my weighty 35mm SLR camera. He still didn't see me, bears being somewhat nearsighted.

But when I unsnapped the cover, the bear heard it, spotting me in a second.

And then the impossible happened.

From a distance of no more than 20 feet, I stared into the bears' eyes, and he into mine. And I was lost in his presence. I felt that bear, and in him there was nothing resembling humanity. His entire being was wild, feral and fierce and something indescribable in human terms. There was no emotion. Everything was now. Everything was present. Everything was.

And though it felt like an hour, it could only have been a few seconds before I clicked back into a sense of myself, and was once again a man staring at a bear in a forest hundreds of years old and empty of other humans.

I began to rationally consider my options. In my previous encounters with bears, I had simply made some loud noises -- yelled at them, or banged some camp pots -- to scare them off. But he was far too close for that, and he may take that as aggression. I knew I didn't want to piss this bear off.

Running away would be absurd. He would take that as fear, and with a short sprint would be on top of me to take a closer look at this puny, hairless, scared animal.

So, I arrived at the only option possible.

I opened my mouth.

And I said, "Well, good morning, Mr. Bear!"

He didn't give me a chance to invite him to breakfast. In the blink of an eye, he was gone, racing through the ancient woods in a sprint that took him out of my range in seconds.

Since that time, I've never been very disconcerted by bears. A couple of years ago, I came home from work at lunchtime, and found a bear sitting at the bottom of my shared driveway, with the neighbor's trash can in his lap, scooping out melted ice cream.

I looked at him, he at me, I reminded him to clean up after himself, and went inside for lunch.

So when the dire warnings about the imminent demise of my birdfeeder at the hands of nasty bears came pouring in, I was somewhat nonplussed.

I mean, really, who *wouldn't* want a bear in their backyard? Though I would wish that if they did decimate the feeder, they leave a few coins for a replacement.

The warnings, as I suspected, were overwrought. The bird feeder still stands, unmolested, and has brought a number of interesting and beautiful birds to my office.

I have no doubt that shortly we'll be hearing dire predictions of some new near-malaria being carried by mosquitos and the public health risk of bird poop on your car. Not to mention the sure death that will result from sun exposure without being slathered with sunblock.

As a doctor who is concerned with public health, I ought to be bringing these warnings to my patients. But I'm not and I won't, because these are, in fact, anti-health messages.

I want my patients to go outside, get plenty of sun exposure without toxins seeping into their skins. I want them to get dirty, and come eye-to-eye with a nature that we have been taught to fear. This is what will make them healthier, physically and mentally.

You see, when it comes to health, there is no "I." There is only "We." As individuals, we exist in a virtual bath of microbes. There are more bacteria in our guts than cells in our bodies; with each breath we inhale a cloud of organisms. Each time our feet touch the earth, we literally touch millions of other lives.

The same is true on a larger scale. Without the bees, our food supplies would rapidly collapse. Species of plants and insects manage one another, the knowledge which our agrarian ancestors used to their advantage, but we have poorly replaced with simple poisons. Psychologically, we cannot exist without one another, which is why solitary confinement is one of the most effective tortures we inflict on one another.

Thus, the more divorced our food supply becomes from the environment in which it should exist (I shudder at the thought of cloned meat, grown in a lab), the less effective it is, not only in providing nutrients, but in protecting us from disease.

And the more we seek to isolate ourselves from our environment, from the nightmare bears of our imagination, the sicker we make ourselves. Without a healthy intestinal microbiome, we fall ill. Without regular exposure to soil, our immune systems become dysfunctional. Without regular exposure to the sun, the wind, and the rain -- the very environment that millions of years of evolution has primed us to inhabit -- we fall victim to the diseases that we run from.

So take this doctor's advice. Ignore all of the "public health" warnings that will come your way this season, seeking you to herd you away from the alleged dangers of nature. Do your health a favor. Turn a blind ear to the fearmongers. Walk through fields without fear of imminent illness and invite all of nature into your backyard. You will be healthier for it.

How I protect your confidential health information.

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Our security policies protect your health information. In light of the recent disclosures of the U.S. government engaging in massive data collection of private information about its citizens, I am sure that many people are concerned about the security of their medical information, and whether it can be accessed by the NSA or other government surveillance organizations.

The short answer, here at the Center for Alternative Medicine, is no. The health and medical information that we have is protected from government and other unauthorized access in multiple ways, which I will describe below.

Because of the location of my practice and my somewhat unique skillset,  I have  long taken a security-conscious approach to my patient's records, an approach which informed the choices I made when we began digitizing patient data. In light of the news over the past couple of days, I have already made some modifications to the Center's security policies which will further protect my patients' health records.

Operating System Security

As a first step, as we began to put patient charts into digital form, I migrated all of the office's computers to the Linux operating system. Linux is a far more secure operating system than either Windows or MacOS. In fact, because of its secure nature, Linux is the operating system that is used by the vast majority of internet data servers, many of which are under daily multiple attack.

Linux security goes far beyond firewalls and passwords. Linux is designed from the ground up to be largely immune to viruses and "trojan horse" programs. Security is built-in to the system's design, preventing the rather massive security holes which Windows has always exhibited. Furthermore, since all of the software on my Linux systems is open, no secret back doors into the system can exist. They would be immediately spotted by the community which develops and maintains these systems.

 Backup and Online Security

The Center's secured and encrypted local network is also protected by software which immediately informs me if unidentified devices are attempting to access it, even as that access is being denied. Furthermore, none of the computers which store patient data are accessible to any device outside of our local network.

Off-site backup is handled via encrypted VPN and the data is stored on servers outside of the U.S., in a country where data privacy laws are considerably more stringent than in the U.S. The companies operating these servers cannot be coerced by the government into releasing any information.

Email and Patient Communications

Similarly, the email server I use is located overseas in a country secure from U.S. governmental interference or access. Connection to that email server uses end-to-end data encryption, eliminating the possibility of passive data acquisition of both content and metadata.

Though I have not made a habit of it thus far, I have for years been equipped with the ability to send and receive email using PGP encryption. One of the changes I have made in the Center's policy this week is to begin providing my public secure key to patients who wish to use PGP to protect our doctor-patient communications. This provides a second level of security.

And while I have on occasion answered patient questions via Facebook messaging, it is something I have never been entirely comfortable with, and have never initiated. One of the policy changes this week is that neither I nor my staff will communicate health information or discuss health issues with patients via Facebook messaging.

How You Can Protect Your Health Information

There are several steps which you can take to protect your health information, and they are relatively simple.

The first is to drop Gmail like a rock. It is clearly insecure, and Google has been part of the PRISM data collection system for years. There are several other systems which offer free email accounts and which are secure and will not disclose your data to the government. The one I recommend is Zoho, though there are several others.

Second, use a VPN for all of your internet activities. The end-to-end encryption of a VPN prohibits anyone from from watching your passage through the internet (and, yes, disable cookies on your browser!)

Third, use an alternative search engine. The amount of data Google collects on you -- and provides to the government -- is enormous. Your interests are determined by your search habits, and this information is a gold mine for those interested in your health data. There are, however, other search engines that do not collect or store your search data. At the Center, we use DuckDuckGo, a flexible and powerful search engine which also enables you to perform anonymous Google searches. Another popular privacy-oriented search engine is ixquick.

How Secure Are These Measures?

With regard to your health data, I have taken steps to protect your data far and above most other health care providers. Nobody is immune to hacker attack, and I make no claims to that, but I have done my best to ensure that your data remains secure from more than the passive data acquisition that the government appears to be engaging in, as well as typical commercial skullduggery.

Over the summer, I will continue to test and refine our security measures. But rest assured that even at this moment, your confidential health information at the Center is as protected, if not better protected than at any much larger organization.

 

Thank you, and happy anniversary.

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Six years ago today, the Center opened its doors. Six years ago, I took a pretty big gamble. At what turned out to be near the peak of the real estate market, I bought a building that had, since the 1960s, been a veterinary office. I spent an ungodly amount of money to convert it from an animal doctor's office to a people doctor's office, and closed my otherwise thriving practice in Kent to focus all of my efforts on an entirely new beginning in Litchfield.

While I enjoyed my practice in Kent, I came to feel that it was too limited. I opened that practice directly from my internship and graduation, and took my first few years in practice to start adding onto my  base knowledge. My first milestone was achieving board certification in clinical nutrition, followed a few years later by passing another specialty board, and becoming a Fellow of the International Academy of Medical Acupuncture.

My goal had always been to become a holistic GP, the physician that people could turn to for drug-free treatment for all types of disorders, not simply back pain, neck pain, or headaches. And in Kent, I was able to acquire and build on those skills. But I realized that to become the type of physician that I wanted to become, I needed a location that needed me.

So when the vet's office in Litchfield went on the market, I jumped at the opportunity. And though it was a massive financial gamble, by that point in time, I had become mildly inured to that sort of thing. After all, I had left a journalistic career that had put me among the top 5% of freelance writers in the country to go back to chiropractic college and start from scratch.

Still, to be honest, I was a little nervy. This time was a bit different. Now I had a family, two kids, and a house with a mortgage; and here I was adding a second mortgage to the list, while rebooting my practice. You would have to be made of stone not to get a little jittery.

To keep disruption to a minimum, I planned to move my office over the course of a weekend, and start seeing patients just a day or two thereafter; and this was all to occur almost minutes after my general contractor pulled his last employee from the building.

The trouble was, I lacked a Certificate of Occupancy.

I scheduled the inspection for two days prior to re-opening. The inspector, a very nice man, was also thorough -- and found one electrical problem which prohibited him from issuing the certificate.

In a panic, I called up my contractor. His receptionist, no doubt used to such calls, assured me that all would be fixed in record time. And to his credit, it was. The electrician was out the next morning, and corrected the out-of-code electrical wiring. I invited the building inspector back for the following morning.

He came. He approved. He issued my Certificate of Occupancy.

And 45 minutes later, on April 6, 2007, my first Litchfield patient walked through the door.

Within months, I realized that I had made the right decision. Growing mostly by word of mouth, patients started coming to see me, not only for what chiropractic adjusting could do for them, but also for nutritional and acupuncture treatments for a variety of disorders. Within the first year, many  of my Kent patients who had stayed behind returned to the Litchfield practice (rightfully grumbling about the longer commute, it might be said).

Six years later, I have co-created, with the help of my patients, the practice of my dreams. I have patients coming to see me, not just from Litchfield county, but from Massachusetts and Long Island. Each new patient is a welcome guest and a new puzzle for us to solve together. Each day, my skills are challenged, my knowledge stretched, my spirit expanded.

And I would be utterly remiss if I didn't say thanks to Teresa Tuz, my oft-suffering office manager. Teresa had run the Kent office, and (probably against her better judgement), decided to continue the fun with me in Litchfield. She has managed the office through blizzards, floods, blackouts, faced head-on the interminable idiocy of health insurance billing, and along the way has become part of the spirit of the office. I mean, let's face it: When was the last time you heard patient and staff erupt in shared laughter at a doctor's office? But that happens many times a day at Teresa's desk.

The office has also been enriched by my tenants: Dave Pavlick, an extraordinary social worker and expert in the field of neurofeedback, and Christine DC Decarolis, one of the most dedicated massage therapists I have known. She is not only dedicated to her craft, but also to her community, to which she contributes in numerous ways.

Last night, after finishing my chart notes for the day, I locked the door, walked away from the office, and turned to look back. Six years ago, there had been nothing but an empty building, a vision, and a willingness to risk almost everything on that vision. Today, that building has become a place of hope and healing for many. My deepest thanks to everyone who has helped make it so.

 

Whereabouts Unknown

Even before the tragedy at Sandy Hook had occurred, I was aware this year that my holiday spirit had largely gone wandering for parts unknown. And as I watched the appalling news unfold, scooting into my office to tap the news feed in between seeing patients, what little joy I had in this year's season was entirely squelched by by the horror visited on Newtown.

As one patient had put it just a few days earlier, "Dr. Jenkins, this is the first place I've been to in weeks that isn't all decked out in Christmas." I think he was grateful for the respite, and so, frankly, was I. So the lack of holiday lighting, the absence of festive glitter, the avoidance of celebratory music on the office sound system, were all a part to provide a reprieve for those of us who, for whatever reason, felt overburdened by the season.

My reasons for feeling a little Grinch-like this year have been many. Aside from the obvious sadness of recent events, this year has been one of great struggle.

Having been in practice for nearly two decades now, I'm used to the unavoidable disappointments that come with my profession, one in which great distance between patient and doctor is impossible if one is to get the job done properly. But I was particularly saddened when a couple of my patients were struck by sudden, severe downturns in their health, ones which exceeded my skills or that of any other physician. These are people for whom I'd doctored for many years, and it is hard not to become attached to such people in your life, particularly when they are individuals of great worth.

Normally I am a rather ecumenical friend of religion, regarding religion -- any religion -- as my partner in helping to secure greater health for my patients, and often enlisting it to our mutual advantage. But the events of this year, both in this country and abroad, have highlighted for me the capacity for danger that religion innately possesses. Religion is the nuclear energy of the human spirit. When harnessed appropriately, it can create light and warmth that spreads beyond the individual, enabling him to shelter others in the illumination of his humanity.

At the same time, religion, like nuclear fission, creates waste which can be severely toxic and will last for generations, as it has in Palestine and Israel, Iraq and Afghanistan. And at its worst, religion, like an uncontrolled nuclear reaction, can lay devastation and waste over great swaths of our collective spiritual and political landscape. It is hard not to look at the damage caused to thousands upon thousands of lives by religious leaders, either by taking utterly immoral advantage of their charges or by re-asserting slavery for half of humanity, and not only be appalled at the carnage, but also moved at the enormous loss of potential, the wasted spiritual capital left to spiral down the drain of iniquity.

Finally, I am a man who derives much of his strength from the natural environment around him. Little to me is more uplifting than a sojourn, short or long, in the woods, on the water, along a mountainous path, or even (or perhaps especially) taking in the sights, smells and sounds of the landscape about me as I pedal my way through this world, feeling absolutely sanctified to be able to experience it in that unique way that only another pedestrian or cyclist can understand.

And to this man of science and nature, it is absolutely clear that the environment is in great upheaval, one which has been caused by, and which does not bode well for, our species. Mother Nature is indeed angry, and all too few of us are cognizant of the enormous price our children are about to pay for our willful ignorance.

All of these thoughts weigh heavy on my mind and my spirit this morning, a time in which many throughout the western world celebrate family and friends, revel in the delighted squeals of children opening presents. And the thought of such pleasures does make me smile. Whether you are celebrating the birth of your savior Jesus Christ, or Dies Natalis Solis Invicti, the return of the unconquerable sun, Yule's return of the horned hunter, or the endless light of Hanukkah, this is the time to see the light in the darkness and to bask in the warmth of those around us.

Yet, to borrow from the metaphor of Christianity, within each of us is that part which has not yet arrived at the warmth of the creche. As the wise men struggled through the darkness, seeking purity while bearing the meagre gifts of their imperfection, so does each of us seek the perfect within us with often the dullest of tools and the dimmest of torches.

But if we take care of ourselves and one another, that path may not be as rocky, or as steep, as it might appear. The sun will rise again, and each day -- not just this one -- gives us another opportunity to rise above ourselves and be, not only who we are, but who we could be.

I'm on that road, too, and I'll be looking for you.

In which I unwittingly join a movement and realize the parallels between wireless routers and alternative medicine.

Join the Open Open Wireless Movement A few weeks ago, I upgraded the digital infrastructure at my office, the Center for Alternative Medicine. The new router I installed included the capacity for multiple wireless networks, so I added second wireless network without a password.

The goal was to provide a means for kids, parents, spouses, and other members of our patients' entourage to easily access the internet while waiting in the reception area. I generally don't (or at least try very hard not to) keep patients waiting, but there is usually a coterie of people in the reception room cooling their heels, either waiting for Christine DeCarolis to finish massaging a friend or David Pavlick to help someone understand the inner workings of their psyche, or for me to take the acupuncture needles out of someone. And, inasmuch as the cellphone service at the Center can only be generously described as "spotty," I thought this would be a convenient benefit for the nice people who come to visit us.

As I booted up the new router, little did I know I was joining a movement. The Open Wireless Movement:

"The Open Wireless Movement is a coalition of Internet freedom advocates, companies, organizations, and technologists working to develop new wireless technologies and to inspire a movement of Internet openness. We are aiming to build technologies that would make it easy for Internet subscribers to portion off their wireless networks for guests and the public while maintaining security, protecting privacy, and preserving quality of access."

It's an interesting idea. The internet has become a pervasive enabler of modern life, the digital road outside everyone's front door. And since I have large amounts of unused bandwidth, why not donate it to the greater good? In terms of security, the open, guest network is entirely isolated from the Center's internal network, so our data remains secure.

As I read more about the Open Wireless Movement, I realized that in many ways it parallels steps I have already taken with the Center's technology. For the past 6 years, all of our software has been based on Open Source software. Instead of Windows or OSX operating systems, all of my computers run Ubuntu. Instead of Microsoft Word, we use LibreOffice. Instead of a $30,000 proprietary Electronic Medical Records system, we use OpenEMR (a choice which allowed me to deploy electronic medical systems comprehensively long before most other doctors, and at very little cost).

All of this software is free. All of the code is open. The only payment I make is by reporting, and assisting in the resolution, of software bugs. Open Software is a community effort, that allows both users and developers to dedicate their time to create highly functional, stable applications.

Without stretching the point, this is also how I view health. We are not isolated entities, encountering and fighting off maurauding species intent on our demise. We are ecosystems. We are walking, talking, thinking conglomerates of living entities, from the bacteria that live in our gut and help us digest our food, to the beneficial prions that protect our nerves. Like whales, we proceed through life surrounded by pilot fish who both live off us and help us to live. Every single one of us is not a single organism but a cooperative collection of organisms. We cannot live without one another.

It's an amazing thought, isn't it? That we, in ourselves, are not one, but many? The recognition of that concept is why alternative medicine succeeds in the locations where traditional medicine fails. In many conditions, it is the balance between ourselves and our environment, or our micro-ecology, that is the culprit.

Mainstream medicine's tools, are blunt and traumatic in this arena. When the problem is not the presence of bad bacteria in the gut, but a lack of commensural bacteria, the big hammer of an antibiotic is a poor choice of tools. Changes in behavior, and even in thought, are more effective here than any antibiotic. There are many similar examples, but you get the idea.

And in the exact same way, alternative medicine and mainstream medicine are complementary. Where the MDs tools are weakest, mine are the strongest; conversely, where I may lack the skills to help someone, my peers in mainstream medicine are often helpful.

Or, as I put it to one of my patients, "I'm not the doctor you want to see when you're having your heart attack; I'm the doctor you should have seen 10 years ago."

So, yeah. Next time you're in our office, enjoy the open wifi. At some very basic level, we're all on the same open network already.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

A Meditation on Spirituality and Health

Self-appointed "skeptics" frequently point to practices such as mine, claiming that I'm engaging in nothing but voodoo witchcraft, preying on those so ill and so without hope that they will grasp at any straw proffered them, ante up any outrageous fee desired, and dearly pay for the false hope which I and my colleagues allegedly peddle.

My patients, of course, know the reality is far different. They know me as a hard-headed pragmatist, whose foremost rule is "Find it, fix it, and get out of the way." They know me as a doctor who will rather unflinchingly -- though I hope not unkindly -- point out how they have contributed to their own ill health, while also finding ways they can repair the damage. And they know that my fees are modest; I am unlikely to bathe in gold coin anytime soon from the revenues of my practice.

What they don't know, unless they ask, is that each discipline that I practice, whether it is chiropractic, acupuncture, or herbal/nutritional therapy, is supported by a wealth of scientific research that supports every modality that I use.

When I have used acupuncture to treat children with Tourette's syndrome -- usually successfully, I might add -- I can point to not just one, but several studies that support and guide my intervention.

When I blend a custom herbal formula for a patient suffering from a cold or urinary tract infection, I am relying on studies which show me that the herbs in question are more effective than anything in the MD's formidable arsenal. Though of course, the FDA would have the fantods were I to be so foolish as to make the claim that herbs can actually kill the bacteria causing the infection, even though studies exist demonstrating that very fact. So I won't make the claim that herbs can help cure the common cold, even though substantial research exists supporting that statement.

And when I explain to an acupuncture patient that Qi is a life-force running through their body, and that the flow of this Qi can be altered by placing needles at certain points along that flow, I know that I am using a time-tested analogy for a phenomena that we are only beginning to touch upon in Western science. It is likely that this Qi is actually a form of intercellular communication, and that acupuncture alters the nature of that communication. When you begin to change the body's command and control systems, your results are going to be powerful and intersystemic, which is why both acupuncture and chiropractic have such profound effects on people. Chiropractic adjusting, through its influence on neural communication, and acupuncture, through its alteration of intercellular ionic flow, are both acting on a meta level, thus their widespread effects.

With all of that said; with all of my adherence to the logical discrimination of disease and therapeutics, and my hard-headed emphasis on results, I cannot ignore the power of my patient's spirits, nor their immeasurable will to survive, improve, and in some cases achieve a level of health they never thought possible. Where does this will come from, and how does it manifest its results? Most importantly from my perspective, how can I help my patient harness that power?

Multiple studies have shown that intercessory prayer have little effect on disease outcome. Nonetheless, it is often through their religion or spiritual beliefs that people harness that powerful exercise of volition which dramatically alters the course of their disease.

Despite increasingly frequent forays into this domain, the realm of the spirit remains largely opaque to the otherwise piercing lenses of science. There is some evidence that  our brains are hardwired, as it were, to engage in spiritual practice; to "believe" in unquantifiable, unmeasurable forces which help to direct our lives. And those familiar with the work of Carl Jung and subsequently Joseph Campbell will recognize the hero myth as the unifying essence of almost all religions. Neurological research has shown how the regular practice of meditation, independent of the specific religious tradition of the meditator, can create long-term alterations in our brains. Nonetheless, these scattered breadcrumbs only beg the question of how these beliefs unlock such potent personal power that the course of a disease can be radically altered.

This is a question worthy of consideration, particularly today, when much of Christianity celebrates the birth of its central figure. And as I drove home from a family gathering last night, I could not ignore the beauty and tranquility exuded by the churches I passed, all decked out for their celebrations and lit with candles for their midnight services. There is a compelling power there, not just in Christianity, but in any religion as it expresses the majesty of its office in our affairs. From the miraculous birth of Jesus to the transcendental satori of Gautama Shakyamuni to the revelations of the cave-dwelling Muhammad, there is a common thread from which has emerged some of the most beautiful expressions of art, literature and music of which humans are capable.

To that I would add religion's ability to give us the power to manifest our ideal selves in the physical realm as well as the sphere of ideas. While I cannot explain it, I would be a fool to ignore it, though it is clearly not in my scope to harness it. That is more truly the realm of the priest, the roshi, the imam. As a doctor, I must remain ecumenical to best serve my patients.

To me, this day marks both a beginning and an end. It is the end of the work year for me, and over the next week of "vacation," I lay the foundations for beginning the new year. I am looking forward to the changes I hope to bring about, both personally and in my practice. And I know that this question, the role of spirituality in health, will be one which will invite me back to ponder its challenges throughout this year. I am looking forward to the conversation about to ensue.

And I am also, as always, incredibly thankful to my patients who continue to be my most influential teachers. Thank all of you for your trust in me, and thank you for permitting me to join you down the short segment of your path that we are traveling together. I hope my guidance has not led you astray, but assisted you to become more of who you want to be.

And to all of the readers of my blog, thank you for your attention and your feedback. You encourage me to continue these public musings and consider new topics and new approaches.

Happy Holidays to all! I look forward to seeing you in 2012.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

It's All About The Lifestyle

Just recently, I had one of the proudest moments I have had as a doctor. No, it wasn't a visit from one of my patients who have undergone successful acupuncture fertility treatment. Nor was it one of those patients who end up on my doorstep after seeing three specialists at the Mayo clinic and the hot-shot New York doctor from Yale, and all of a sudden start to get better after a couple of weeks under my care.

(As I told a new patient the other day -- a patient who had come to me after exhausting all other options, "I don't mind being the House of Last Resort. If I do what I do and it works, you're going to think that I'm Thor, God of Thunder. If I do what I do and it doesn't work, I'm no worse than the rest of those chumps that you've already seen. I'll take those odds.")

On the surface, what happened the other week was nothing spectacular at all. It was just a patient who parked her bike out front and came into my office. And as soon as I found out that she had ridden to the Center for her appointment, I broke into a smile that lasted the rest of the day.

Any of my patients who are reading this blog know why this would be so. It is only the new patient who will come in and say, "I didn't know that anyone was here! I didn't see a car parked out front." A patient who has been here more than twice is more likely to say, "Oh, you rode the Redbike today." (Of course, when it is the dead of winter, 10 degrees F outside, and 4 feet of snow on the ground, the comment is generally more along the lines of "You rode your bike today?! What, are you nuts?"

I'm what is known as a "transportational cyclist." I ride my bicycle for almost any trip under 10 miles, including grocery store runs, trips to the hardware store, and I've even been known to fill up my bicycle trailer with Jerry cans of kerosene for the space heater. I would, under most circumstances, rather ride my bicycle than drive a car, and will hop on a bike with limited provocation.

And I am an absolutely shameless shill for cycling when it comes to my patients. Many of my patients are suffering from chronic diseases from heart disease to diabetes to fibromyalgia. And every single one of those diseases is responsive to lifestyle modification, particularly exercise. So my most frequent recommendation to my patients is to begin exercising, and I mean more than the rather ineffectual 20-minute meanders approved as "exercise" by most mainstream doctors. I suppose that is a fine starting point; but most of my patients will have to exert far more than that to knock those diseases back on their heels.

As I like to say, "If you aren't panting, it doesn't count."

The call to exercise is not a suggestion which meets with frequent approval, particularly because the lack of exercise is one of the causes of many chronic diseases. So I'm already addressing someone for whom physical activity may be not only a distant memory, and at this point difficult to perform, but disdained as well. It's an uphill battle.

Over the years, I have noted that the responses fall into one of four categories, much like the four children of Passover. The first, and my favorite, is the general agreement, as in, "You know, Doc, I've kinda been thinking the same thing." This is wonderful, because already the patient and I are on the same page. All I have to do is find the wedge to get them moving.

More often, the response is a variation of "I know I should exercise, but I just don't have the time." This may be true -- most mothers of young children really don't have much time to exercise -- but more commonly, it is an excuse. We tend to be able to find the time to do things that we feel are important. Sometimes it is my job to make sure you know how important exercise, and your health, really is.

A third type of response comes from a failure of confidence. "Oh no, I can't do that," this patient will say. These patients have often led entirely sedentary lives, and at this point are utterly disassociated from their bodies. They really have no idea whatsoever what their body can do, and may be terribly afraid of finding out the answer.

And the fourth, and most disappointing response is "I don't want to do that." These patients are not only unwilling, but will actively oppose any recommendations on my part that require physical activity. These patients are the ones whom I know stand little chance of succeeding in becoming healthy, because they are unable to accept the responsibility for their own health. They are the patients for whom "a pill for every ill" is a legitimate approach to wellbeing.

The best way to exercise, I have found, is to incorporate exercise into your lifestyle. And cycling is the easiest and most efficient way to accomplish this. I usually recommend cycling, instead of driving, for any trip under 3 miles. In our terrain, you'll sweat, you'll pant, and you will get a nice feeling of fatigue, especially if you are not used to physical activity. And if you have to get off the bike and walk up some of those hills, at least initially, that is just fine as well. Before you know it, you'll be riding them.

And at the same time, you are getting the grocery shopping done, gone to the post office, and picked up the dog food.

Oh, yeah, one other thing -- one stop you haven't made is at the gas station. These days, a couple of missed stops puts some jingle in your pocket. In fact, I calculated that last year, I saved about $6,000 by replacing the truck with the bicycle whenever possible. I tend to slide that little factoid into my sales pitch as well.

Upon arising this morning, I thought to myself that I really should get out for a ride today. But on the other hand, I really wanted to leisurely sip a cup of coffee and read the news. It's a dilemma faced frequently by anyone who works out on a regular basis, the competition between sloth and fitness.

Then I remembered that we were out of milk and almost out of eggs. Perfect. That means a trip to the farm was in order, a 7-mile round trip that I could easily bounce up to 10 miles by taking a couple of lefts instead of a right, and I could do the milk run at lunchtime.

Problem solved. Instead of having to dredge up the wherewithal to saddle up for an "exercise ride," all I need to do is a little grocery shopping. And the exercise disappears, replaced by just another chore, but this time enlivened by a swift ride on two wheels, while I save a couple of pennies as well. (Anyone with a child in college is no doubt familiar with my obviously single-minded focus on shaving costs wherever possible).

And when you consider that during the recently overhyped "Carmageddon" in LA, a group of California cyclists managed to beat a jet plane commuting between Burbank and Long Beach, the added time commitment to cycle from A to B is generally miniscule.

Monthly, we are faced by additional research, confirming the already large corpus which demonstrates that regular exercise is the key component in avoiding, managing and curing many chronic diseases. (Yes, FDA, I said cure. Got a problem with that?)

Cycling is one of the best ways to incorporate regular exercise into your daily routines. It is age-appropriate regardless of your age, it is inexpensive, it is effective. It saves you money while reducing your dependence on prescription drugs and even more appropriate therapies such as mine.

I think that I will put a bicycle rack out in front of the Center. Please feel free to use it.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

The Disorder Nobody Wants To Talk About

Imagine, for a moment, a disease that affects 1 in 10,000 people. That is a fairly common disorder; about the same number of people that are affected by glaucoma or deafness, and three times more frequent than brain cancer. Add to that image a mortality rate of 41%. That's a pretty serious disease, isn't it?

Let's add a bit to that picture. The treatment for this health problem is not terribly expensive, nor difficult. It requires some common, inexpensive drugs. It also requires some surgery, in the price range of $12,000. None of this treatment is particularly unmanageable or experimental, though as with any medical procedure, research would no doubt find room for improvement, and it does take a certain level of specialization.

What would you say if you found out that there is no insurance coverage for the treatment of this common, deadly disorder? And despite the fact that you may pay thousands of dollars per year for your insurance coverage, if you or a loved one had it, not a single dime will go toward the payment of life saving treatment.

That disorder exists. It's called Gender Identity Disorder, and though we don't know the cause of it, we do know how to help people with it. Through the use of hormones such as estrogen and testosterone, and surgery to help people's bodies reflect their self-identity, we can not only vastly improve someone's health and quality of life, we can also save their lives. Untreated gender identity disorder is associated with high suicide rates, and very high levels of substance abuse, as people try to self-medicate their pain.

All too often, GID (also known as gender dysphoria) is tossed off as a problem of morals, as if it were rectifiable by the application of religion, or as a manipulative version of homophobia. Even in the psychological community, there have been attempts made to reclassify gender dysphoria as an oddball variant of homosexuality.

In particular, there is the claim that male-to-female transsexuals are simply gay men who cannot admit their attraction for other men; or, alternatively, that this same group is  sexually aroused by the image of themselves as females, and thus turn to drugs and surgery to fulfill their autoeroticism. Not only do these half-baked theories fail to explain those seeking to transition from female to male, it also fails to take into account the full range of sexual expression, as transgender people may be gay, straight, bi or uninterested, just like everybody else.

The more likely explanation -- and the one that has objective research supporting it -- is that the vast majority of people who would prefer living as the opposite gender are simply responding to the way their brain is wired.

That's right. The preponderance of the evidence these days points to the idea that for some people, during fetal development, their brain growth follows one gender track while their bodies follow another. The mismatch may be noted as early as mid-childhood, though for others the problem does not become evident until puberty, as the genders further differentiate, and as one transsexual person said, "it was all wrong!"

Even so, many people will continue to live with this precarious disconnect between their bodies and their brains because they feel they have no alternative. Afraid of the discrimination and out-and-out violence that is directed toward transgender people, even within the medical community, they suffer quietly. And their suffering takes its toll, in very high rates of depression and its end result, suicide; in drug abuse and alcoholism, as they try to manage their anguish by becoming oblivious; in unemployment and poverty, as their depression and anxiety makes it difficult to hold a job, or even worse, being fired after their condition becomes known to their employer.

The argument that transgenderism is "just" a boy who likes girls' clothing or a tomboy gone too far is like calling a melanoma "just" a skin blemish. Gender identity disorder is serious, often deadly, and levies an awful toll on both the individual and society.

Which makes the denial of coverage for this disorder little short of heinous, particularly because the solutions we have at hand are relatively successful and not particularly experimental. Unfortunately, even for those people with health insurance, denial of coverage for surgical transition is the norm, via a “Transsexual Exclusion Clause” which excludes all medical procedures related to a person’s transgender status.

With the combination of hormones and surgery, medical doctors can create an internal and external state where one's body more closely parallels one's gender self-identity. No, it's not a perfect answer; few medical responses to chronic conditions are perfect. Nor is surgery the right answer for all transgender people. But for many, the surgical answer is literally life-saving. Enter the Jim Collins Foundation:

The mission of the Jim Collins Foundation is to provide financial assistance to transgender people for gender-confirming surgeries. The Jim Collins Foundation recognizes that not every transgender person needs or wants surgery to achieve a healthy transition. But for those who do, gender-confirming surgeries are an important step in their transition to being their true selves.

Last week, the Foundation awarded its first grant to Drew Lodi. “The Jim Collins Foundation for me is a miracle," Drew said. "They helped me to stay motivated to live each day purposefully…I improved my life, mind, body, relationships, and faith. To know that people are out there who do NOT have to be helping–but are–makes me motivated to do everything I can…”

The Foundation awards grants based on a combination of financial need and preparedness. And it aims to be more than just deep pockets for people in need. The Foundation strives to empower people to find creative means of financing surgery for themselves, at least partially. Drew, for example, began funding his surgery by collecting bottles and cans for their deposits.

Having firsthand seen the results of the life-saving surgeries which the Jim Collins Foundation funds, I cannot think of a more worthy, or necessary organization deserving of your support and donations.

I know that money is tight for everyone, as this country slowly claws its way out of the Great Recession. But to the extent that you can consider a charity at all, I hope you will consider making a donation to the Jim Collins Foundation.

Gender dysphoria is the disorder that nobody wants to talk about, but that affects millions of Americans just the same.  The cost of treating every person who needs the life-transforming surgery amounts to 5 cents per American citizen. Do you think you could spare a dime to save a life?

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

What's In a Word?

Recent public events have tragically brought to the fore the way in which we use words, and how language affects us. There can be little doubt that our choice of language deeply influences our thoughts and emotions -- but as longstanding research in psychology and more recent research in neurology shows us, language can control our perceptions as well, and our use of language alters the neurophysiology of the brain.

I recently had a patient who had suffered a Mild Traumatic Brain Injury (MTBI). The long-term effects of mild brain trauma are only now becoming recognized, and few treatment options exist. In addition to other symptoms, this patient was having word-finding difficulties. In possession of a broad vocabulary otherwise, he would find himself stopping in the middle of sentences attempting to retrieve the appropriate word.

As many of my patients already know (having been subjected to my various diatribes on the subject), Esperanto has long been a topic of interest to me. Esperanto is an artifical language, created by Russian-Jewish opthamologist L.L Zamenhoff  in the 1880s, to be used as a universal second language. The most successful of the artifical languages, Esperanto is today spoken by one to two million people, and has an extensive literature of books that are not only translations from other languages, but written originally in Esperanto.

Esperanto, being designed as a universal second language, has a streamlined grammar and spelling system which is nevertheless as robust as any natural language.

And that was the important point for my patient, as I set before him the task of learning Esperanto. My hypothesis was that learning the language would stimulate the language centers of the brain to create new neuronal pathways as the additional vocabulary was acquired, and that this stimulation would secondarily aid the recovery of my patient's native language vocabulary. An associated benefit was that Esperanto's ease of mastery would give my patient a sense of accomplishment in an area where a great deal of self-confidence had been lost.

The treatment was successful, for over the period of six months as the patient learned the new language,  his English vocabulary improved concomitantly. He also took enjoyment in corresponding with other Esperantists around the world, reducing the feelings of isolation caused by the brain injury.

Zamenhoff developed Esperanto in order to increase harmony among the diverse peoples of the world, by giving us a common medium in which we could share ideas, emotions, and thoughts. He knew that all languages carried cultural baggage and biases with it, and that a language that was as neutral as possible would put all people on an equal footing.

What he didn't know, but which has only recently been discovered, is that our language determines what we are able to see. In an article published in 2009, a couple of Greek researchers found that the language you use determines how you see colors.

One of the researchers, Dr. Panos Athanasopoulos said that “Our language forces us to cut up the world in different ways. Greek speakers systematically use two different terms to refer to blue: the sky is ghalazio (light blue), never ble (dark blue), and a blue pen is ble but can never be ghalazio. English speakers would have no problem calling both the sky and a pen blue in an instant.”

To see whether language shapes our biological and physiological processes of colour perception, the researchers used a technique called event related brain potentials (ERPs). This technique tracks activity in the brain millisecond by millisecond.

The researchers found differences in visual processing of light and dark blues between Greek and English speakers as early as 100 milliseconds, suggesting that indeed, speakers of different languages literally have differently structured minds.

More recent research with deaf people has also demonstrated that language does not only control how we perceive things, but language is necessary and integral to sentience. That is, to be self-aware and self-conscious, the twin attributes most intimately tied to being human, requires that we have a language. Without language, there can be no self-awareness.

If language is one of the underpinnings of our humanity, it is not hard to understand the power of language to alter our behavior and sway our opinions. Edward Bulwer-Lytton's great adage, "the pen is mightier than the sword," is a concept that we should take to heart in these troubled days. Those who have a voice heard by millions must take great care in their use of language. Words alone can save lives -- or destroy them.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Have a Happy -- But Not Safe -- Holiday

Christmas finds me once again sitting before a warm hearth in the early morning, the silence disturbed only by the occasional crackle of a burning log. This is one of those days I relish most -- not for presents or festivities, that's not part of this family's traditions -- but for the peace and serenity brought by the rare near-standstill of our society, and a chance to reflect in the all-to-brief silence.

Instead of vehicles rushing about, each 112 square foot, 2,000 pound behemoth belting noise and exhaust on the busy road adjoining my house, there is nothing. No cars, no trucks, no roar of passage. It is a roar I've become more acutely aware of, as over the past several years, I've begun commuting to the Center either by bicycle or foot.

I'm not cycling or walking because I lack a car, though I have little doubt that most passersby assume that. My human-powered commute takes me past a lovely marsh and across a small river, and at the slower speeds at which I travel, it is an entirely pleasant journey except for the bellowing of each car passing by. I'm sure most drivers are utterly unaware of how obnoxiously loud their vehicle is -- I certainly am, when I am driving -- but the noise can easily turn an otherwise pleasant jaunt into a sonic endurance marathon.

"My goodness," people say when I mention that I usually cycle or walk to work. "Isn't it dangerous on that road?" Or, sometimes, I'll stop on my way to talk to someone, and they will nod at the bike and say, "I would do that, except it's much too dangerous. I'm scared of being hit by a car."

It is certainly easy to see how one would reach that conclusion. Mixing it up on the road with drivers of 2-ton vehicles, many of whom might be charitably described as inattentive, would seem, on the surface of it, to be a radically unsafe thing to do.

The fact is, however, that cycling and walking is not only safe, it is life-extending. Population studies have shown that the lifespan of  cyclist is several years longer than the non-cyclist, and that city-dwellers have lower rates of obesity because they tend to walk further and more often than their suburban counterparts.

This topsy-turvy notion of what is safe and healthy is not limited to the popular view of cycling. It has grown, like a cancer, to invade the common wisdom of our culture. And I would argue that the insidious inversion of what is safe and what is not safe is, in fact, one of the causes of cancer as well as the other leading causes of death in the U.S. I'm sure everyone has heard the tagline, "Please consult your doctor before engaging in any strenuous activity." The implication is clear: If you so much as increase your pulse to the level where you actually feel it, or begin to break a sweat, you are putting your life at risk (unless you have first had an EKG and echocardiogram, of course).

But once again, the exact converse is true. The surest most direct route to an abnormal EKG is by not stressing your heart, by not breathing hard and sweating.

No. Please don't consult your doctor, even if your doctor is me. You don't need an EKG and flight clearance to exercise. What you do need is a pair of athletic shoes, an hour, and the desire to be healthy.

Similarly, please stop wiping down every hard surface with germ-killing, antiseptic wipes. Studies are now uncovering that the increasing sterility of our environment, especially that of our children, is partially causing the dramatic increase of auto-immune diseases. All you have to do to achieve maximum infection protection you learned in grammar school. Wash your hands after going potty and before eating. Don't sneeze and cough on other people. It's that simple. Not only is anything more than that overkill, it's actually detrimental.

I'm reminded of a study we once conducted in microbiology class in chiropractic school. We swabbed our skin for a sample, and then grew and identified the bacteria that were found on that sample. Our collected samples included virulent Strep bacteria, multiple bacteria which cause gastrointestinal disease, and agents of pneumonia. Yup, those were samples from normally healthy people. The point being, of course, that we exist in a world brimming with life, some of it hostile, and we are highly efficient at preventing exposure from becoming infection. We don't need to live in a sterile world. In fact, we cannot. As counterintuitive as it may seem, we would die without our bacterial adversaries.

Finally, while other doctors will advise you to avoid cold exposure, please allow me to recommend it as an excellent source of good health. You won't hear this in any public service messages, but regular exposure to cold is beneficial. Studies have found that cold exposure reduces inflammation and increases levels of pain-suppressing neurotransmitters. So if you suffer from chronic pain, one of the best things you can do is go for an icy plunge throughout the winter months.

Being out in the cold weather will also stimulate the production of metabolically-active brown fat. This is the type of fat that babies use to regulate their body temperature, but which we lose with age. Brown fat is good, as it takes the calories stored in regular fat and uses it. So being out in the cold can actually stimulate weight loss, something which many in this country dearly need -- particularly after the holidays.

If you are interested in the health of your children, one of the best things you can do is to keep the car in the garage, instead of driving them down to the end of the driveway and keeping them sitting in a warm car while they wait for the morning school bus. Both the walk and the cold weather will stimulate important health properties in your children. Better yet, let your kids walk or cycle to school, if you live within a mile or two. Such practices will dramatically increase your child's odds of living a longer, healthier life

As I finish writing this, I can see the first faint glimmer of sunrise. Soon, children will be opening presents, parents will be basking in the glow of a job well done, and everybody will be gathering about the table for a festive meal. We will have the chance to count our blessings, whether they be friends, family, shelter or health, to reflect on the year passing and the year to come. To taste that moment of silence.

Me? I'm going to savor this quiet moment by pumping up my tires and rolling the bike out of the basement and onto the road. It won't be a long trip, nor a fast one, but I will be doing the best thing I can do to ensure that I get to enjoy next  year's holiday season. And the greatest Christmas gift I could receive would be seeing others do the same.

So, to everyone who reads this blog -- all 6 of you -- have a very merry, and very unsafe Christmas!

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

A Girl, A Trike and A Disease

Denise Lanier and her trikeEvery patient who walks into my exam room receives -- at no extra charge! -- a critical evaluation of their exercise regimen, or lack thereof. At this point, regular exercise has been proven so critical in the prevention and treatment of so many disorders, from depression to cancer to heart disease to the cold and flu, that in my not-very-humble opinion, any primary care doctor who does not investigate, evaluate and manipulate their patient's exercise program is committing malpractice. Yes, it's that important. It's like not taking a patient's blood pressure or pulse. A person's participation in exercise is one of the vital signs of wellness. Frequently, my job is to find exercises that will work within the boundaries set by a patient's existing disorder while at the same time optimizing it to reduce or eliminate the effects of that same disorder.

Among the chronic diseases, one of the most problematic in the exercise prescription department is Multiple Sclerosis (MS). Because of this cruel disease's frequently erratic behavior, coupled with its prediliction for shaving away a small slice of one's competence with each renewed assault, it is hard to find and develop good exercises for my patients suffering from this disease. What was possible last week becomes impossible the next. Problems in balance or sudden weakness can make many standard exercises impossible or dangerous. And the fear of such occurrences can negate even the most committed patient's determination and my craftiest motivation strategies.

Being a recidivist transportation cyclist,  an environmentalist, and a man with a grip on the purse that would make a Scotsman proud, it has rarely come as a surprise to my patients when I suggest cycling as a good all-round exercise. Bicycles are cheap, and every time you ride it to the grocery store, you save money, while at the same time becoming healthier and increasing your longevity. As the great Oregon Congressman Earl Blumenauer once said:

"Let's have a moment of silence for all those Americans who are stuck in traffic on their way to the gym to ride the stationary bicycle."

Cycling would be an excellent activity for my MS patients as well, were it not for the unpredictable and troubling manifestations that could make it downright dangerous.

Which is why I suggest a fun, albeit unusual, alternative: Trikes.

No, these aren't your average 4-year-old's Big Wheel. I'm talking about performance trikes, trikes that have been ridden to the furthest reaches of the Himalayas, in the fastest bicycle races in the world, and on the road. They are trikes that can be ridden every day, as fast or as slow as you want, without concern for the types of crashes that can befall you on a two-wheeler.

For that reason, I think trikes are an excellent source of rich cardiovascular exercise for my patients with MS. And here's how many have taken me up on my suggestion: 0. None. Nada.

Well, all of my patients with MS, and all of you reading this blog who have MS or have friends or relatives who are suffering from the effects of  MS, I want you to take note of this name: Denise Lanier. Denise is a writing professor at Broward College. Her poetry has appeared in Bloomsbury Review, Cake, Luna, Best American Poetry blog, and various anthologies. And she has MS.

In her blog, Wonky Woman on a Bent Trike, Denise writes about her two most powerful tools for fighting this disorder (in addition to her undeniable intelligence and phenomenal willpower): A mobility dog and her trike.

This weekend, after much training, Denise will be riding her trike in the New York City Marathon, as a disabled entrant in this world-famous race, and the first entrant to do it on a tricycle.

But is she doing it for herself? For an MS charity? Certainly not - that would be too self-serving for a woman as generous in spirit as her. Denise has chosen the Leary Firefighters Association as the beneficiary of the dollars she has raised. Go here to read what Denise has to say about the foundation. Then go here and donate.

But more important than any of that, read the words this woman has written, about herself, her MS, and her fight toward health. For anyone with a chronic disorder, she is an inspiration.

And I hope everyone reading this blog (all 6 of you) will join me this weekend in following her progress and cheering her on. In her most recent post, she suggests some ways to do it:

Here’re some ways for you to follow my progress in the marathon on race day, this Sunday, November 7th:

Online Athlete Tracker:  free race-day service, visit ingnycmarathon.org on November 7th

Text Message Athlete Alert:  sign up at ingnycmarathon.org to receive on-demand updates, one-time setup fee of $2.99

Tune In:  NBC4 New York offers live coverage of the entire race; after the race catch the 2-hour highlight special on NBC Sports

Marathon App:  for iPhone, iPod Touch or iPad, download it today!"

Then go out and buy a trike. And ride it.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Happy Anniversary

Fifteen years ago this week, I made the very long commute from Ansonia to Kent, and as a freshly-minted doctor, opened my doors to the public. Oh, my...if I had only known what was in store for me.

I had decided to begin practicing in the northwest corner because I knew that somewhere up here was where I wanted to raise my family, and at the recommendation of a doctor who at the time was practicing in New Milford. The good Dr. Hess has since passed away, but when I called him for advice for a place to open a practice, he said, "If I could do it all over again, I would have practiced in Kent."

So there, for better or worse, was where I started. On the largely-abandoned second floor of a building in the center of Kent, above a toy shop, as the "Kent Chiropractic Health Center," a name which to this day floats around the internet, cropping up in the search results from time to time. On that first day, I received a surprise delivery -- a ficus plant from my parents, to wish me good luck. I put it in the reception area.

Kent did turn out to be a wonderful place to start, and I developed good reputation there for treating muscle and joint problems. But my vision of being a chiropractic physician had always been broader than that, and while one might say my concept of a chiropractor as an alternative care primary care physician was forward-looking at the time, it was actually backward-looking. The early history of chiropractic is filled with chiropractors in rural America treating all manner of illness, naturally, using their hands and good food and their hearts to heal patients seeking a more humane form of treatment than the "heroic" medicine in vogue during the 20th century. It was not until the 1980s when chiropractors got painted into the back/neck corner, as mainstream medicine tried to contain the chiropractic threat to its pocketbook.

Only a few years after opening my practice, I returned to school for post-graduate education, while keeping my practice running. Those were busy years, as I hired my first employee, worked all day on Saturdays, and  spent every fourth weekend at the Long Island clinic of the New York Chiropractic College, culminating in passing my board examinations and becoming one of Connecticut's few doctors who were board certified in clinical nutrition.

I also moved my office during that time, so that I was no longer above the toy store, but in what was then Kent's bustling Medical Center building. I shared the building with two MDs and the northern branch office of a radiologist based in Danbury. The ficus plant came with me. With my additional knowledge base and growing clinical experience, I began to expand out more and more from muscle and joint problems into treating people with other health problems.

Kent is one of those small towns which, lacking a diverse employer base, goes through boom-and-bust cycles. When I had opened my practice, Kent was on the cusp of a boom cycle, riding the dot-com wave with a local internet company, Cyberian Outpost.

When the dot-com crash came, Kent suffered a bit. The bustling medical center bustled not quite so much, as the radiologist closed his satellite office, one MD retired and the other moved. For quite a while, I was the sole occupant of the building, which occasionally felt like practicing in a ghost town.

Satellite Office

During that time, I noticed that I could find some office space cheap in Litchfield, and opened a satellite office there. I was in Litchfield two days a week, and Kent the rest of the time.

The Litchfield office surprised me. With little marketing, only word-of-mouth, my practice in Litchfield grew rapidly. I had two rooms -- a consultation room and an exam/treatment room in an office complex otherwise filled with mental health professionals, and it was during that time that I gained a deep understanding and respect for psychologists and clinical social workers. They, too, were drug-free professionals like me, choosing to treat people with mental illness with skill and finesse instead of the blunt tools of psychiatric medications. My association with this group led to my lecture presentation at the 40th annual meeting of the Connecticut Psychological Association.

And, of course, running two offices and lecturing weren't quite enough to keep me happily busy, so I continued with my education. This time, I added to my arsenal by pursuing postgraduate board certification in medical acupuncture, giving me what turned out to be a perfect trifecta in natural medicine -- chiropractic, herbs/nutrition, and acupuncture -- the 1-2-3 punch which has served my patients well ever since.

To reflect the growing cachement area of my practice, I again changed names, this time to "Northwest Chiropractic Health Center." After a few years in Litchfield, and after having moved my family here, I realized that in all likelihood, the future of my practice was going to be in this town. The Litchfield practice continued to grow, and I was increasingly stealing time from Kent to support my patient load in Litchfield. The Kent office's days were numbered, despite my enjoyment of that small, quiet town.

Opportunity struck when, of all things, a local veterinarian decided to move across the street. When I found that this office, on Route 202 only a mile from my house, was for sale, I knew where I wanted to be.

So I took a deep breath and jumped in. Of course, after the purchase, extensive renovations were required. I really didn't think my patients needed kennels, or a place to be hosed down after their treatment here. With much thanks to the now-retired Paul Mattson, who broke every rule in the contractor rulebook by finishing the project in budget and on time, I was ready to move my practice for the fourth -- and presumably final -- time.

That's not to say that there weren't a few hiccups along the way. I learned that any time your contractor calls and says "we need to have a meeting with the plumber," it's going to be an expensive meeting. I also learned that zoning regulations can be as obscure, dated and nonsensical as any New England blue law.

I once again changed corporate names, again for the last time. The change reflected the slow but inevitable transformation in the nature of my practice, as what had once been the Kent Chiropractic Health Center became the Center for Alternative Medicine.

Opening the new Center was an exercise in blindfolded tightrope walking, as I was simultaneously closing the Kent office. Trying to ensure a seamless transition, I closed down operations in Kent on Monday, and with the help of the entire Tuz family, moved everything to Litchfield in the space of two days. I was ready to begin seeing patients -- indeed, had already scheduled them -- except for the small but vitally missing Certificate of Occupancy.

On Wednesday, the Building Inspector came to his final inspection, during which he deemed one of the outlets in one of the treatment rooms too close to the sink. It must be converted to a special GFCI outlet before the CO would be issued.

I called Paul in a panic. His office assured me that this sort of thing happened all of the time, and I was not to worry. Again, it was a testament to Paul's prowess as a general contractor that he had the electrician out on Thursday morning to fix the outlet. The building inspector returned on Friday at 10 a.m., and certified the building. Minutes after he left the building, my first patient arrived.

I had expected to lose some of my patients as a result of the move, and for a time, I did. But over the past few years, more and more of those patients have returned to my care, and I am always glad to see one of my patients from Kent. We swap stories about the old days, and they bring me up to date on the happenings in Kent.

Another milestone was passed shortly after I opened the Center, as I suddenly realized I had begun treating the third generation of a family who had began seeing me in my early days in Kent. The adolescent children I had seen back then had grown to young adulthood and begun families of their own. Realizing that this entire family had depended on me for care through so many changes was enlightening. I was finally beginning to understand the richness and depth that being a family doctor brings. I didn't have to ask these patients about their family health history. I already knew it, and had participated in it.

The Center for Alternative Medicine also brought to fruition one of my long-held goals to bring multiple health disciplines under one roof, as Dave Pavlick, one of New England's experts in EEG neurofeedback moved his offices to the building. Once again, having a mental health professional, especially one of Dave's stature, has added an interesting dimension to my professional alliances.

The thread running through this history has been my patients. The woman with asthma, who was in the midst of an attack and had no inhaler. The man in the middle of a heart attack, who had just left his MD's office after receiving a diagnosis of a cold, and who told me "something just doesn't feel right." The patient with anorexia, whose last visit was less of a discharge than a sad goodbye, as we both knew she had utterly succumbed to this most awful disease. The patient who hugged me and said, "Thank you for giving me my life back."

It is not only those dramatic moments, but also the smaller, simpler ones -- when someone sits up on the adjusting table, rotates their head in directions impossible just minutes before, and says, "thanks a lot, Doc." Or who looks at me after I take the last acupuncture needle out and says, "that feels really good."  It is really those times that keep me coming back to the office morning after morning and staying through the evening hours.

The warp to that woof is the learning. Being a doctor, especially the kind of doctor that I am, means that my education never stops. When I first began practice, nutritional analysis was in its infancy, and we had to rely heavily on questionnaires and history to deduce our patient's problems. Now nutritional doctors have an array of laboratory tests available to reduce the guesswork. And each patient visit, regardless of the problem or whether I have seen them before,  is a 30-minute postgraduate course in health, if I only have the eyes to see and the ears to hear.

With 15 years of experience under my belt, and my first book on its way, I feel that I am poised on the precipice of what will be a second half equally as exciting as the first. I am excited about the new patients that I will see, new associates I will greet, and new challenges that I will meet (so long as they don't involve plumbing).

But most of all, I am thankful. Thankful to have had 15 years to serve my patients to the best of my ability and knowledge, and grateful to have received the trust of so many.

Though my parents have long since passed away, the ficus tree remains with me. It, like all other living things, has gone through periods where it hasn't been so healthy, was dropping leaves and looking barren. But with care and attention, it has always returned to health and continued to thrive. These days, it spends its summer next to the bench and the front door, and winters in the reception room, a reminder to me of that day long ago when a much younger doctor unlocked the door to all that would follow.

Are You Integrated?

Those of you who have followed this blog for some time, or who receive my DocAltMed Newsletter, know that I frequently point out the failings, follies, and dangers of mainstream medicine. I don't do it out of vindictiveness or spite, or because mainstream medicine is competition for the traditional medicine that I practice. However, I do feel that there is the need for a voice -- even a small one such as my own -- to counterbalance all of the advertising, marketing, and whitewashing that passes for medical "research" and news coverage. That said, I need to periodically point out that I am not fundamentally anti-medicine (though I am fundamentally anti-stupid and anti-greed). There are medicines that work, and there are times that they are appropriately used. That they are used too often, for the wrong reasons, and with little regard for patient safety is my main beef.

This is an issue which came to the fore just the other night, as I was addressing a local MS support group.

Multiple sclerosis (MS), is a chronic, disabling disease which often proceeds in a perplexing course of exacerbation and remission. This characteristic makes it exceedingly difficult for a single doctor, or his patient, to adequately assess whether or not their chosen therapy is working.

As is the case for many chronic, degenerative diseases, mainstream medicine doesn't have very good answers for people with MS. One of the points of my lecture was that alternative medicine offers equally good efficacy, typically at a significantly lower cost and with a greatly reduced risk of painful and dangerous side effects.

At the end of the lecture, one of the attendees asked me if I would be willing to treat someone even if they were taking medications.

My instant response was, "Of course I would!" It wasn't something I have to think twice about.

I frequently manage patients who are taking drugs prescribed by other physicians. They can cause collateral damage in the form of nutritional deficiencies, gastrointestinal dysfunction or organ damage, and I consider it part of my job to respond to those issues, but never would I presume to tell a patient that I could not treat them so long as they were taking a prescription drug.

As good as I am, I don't have all the answers. I never will. The other guys have some pretty good tools, too. But on both sides of the Great Medical Divide, there are doctors who put ideology above practicality, and it is exactly that type of either/or arrogance that has put our health care system in its current sorry state, with the patient often getting the short end of the stick.

Interestingly, after the lecture and the Q&A session, as I was wandering around talking to people, someone else came up to me to tell me that on at least one occasion, she had been told by an acupuncturist that she would have to give up her medications in order to begin acupuncture.

Now that's just wrong. There is no injunction against concurrent forms of treatment with traditional Chinese medicine, and in fact, that's how it is most often practiced these days in Asia, let alone the West.

It's not good science and it's not good protocol. It is just ego. And when ego gets in the way, it is the patient that suffers.

The fact of the matter is that MS is another one of those disorders, like asthma, which is likely best co-treated by both a mainstream physician and an alternative medicine physician such as myself. In this "balance of powers" best-case scenario  -- known as "integrative medicine" -- the patient's more frequent contact would be with myself, with the neurologist called in for periodic review or to help manage severe exacerbations. There is no reason for the exclusion of either discipline, and the patient would benefit greatly.

The Spectrum of Being

It's very often the first thing we ask about someone. "A baby! How wonderful -- is it a boy or a girl?" Or when we meet someone: "She's a nice-looking girl," or "He's a handsome guy." Gender identification is a core classification that everyone makes, automatically, without consciously thinking about it. Until you are confronted with just how limited that way of thinking is. I have been  fortunate to attend the past few Transgender Lives: Intersection of Health and Law conferences in Farmington CT, and from those conferences, I brought home a single, yet far-reaching fact.

Although we think of the expression of gender as binary, either boy or girl, feminine or masculine, gender is actually a spectrum of human expression in which the elements of masculine and feminine mix and combine over the entire range.

None of us are fully masculine or fully feminine. We are all a combination of gender traits to varying degrees. This mixture of yin (feminine) and yang (masculine) are what the ancient chinese philosophers had in mind in the development of the taijitu:

taijitu

That small dot of the opposite color within each side represents the simultaneous, mutual existence of opposites within each other. While the taijitu is the reflection of larger universal truths, the characterization of yin and yang as feminine and masculine principles makes the meaning unmistakeable with regard to gender.

The individual intermixture of gender is also embodied in the work of the psychologist Carl Jung, who developed the concept of anima and animus, representing the female aspect within the male psyche and the male aspect within the female.

The idea that we, psychologically, embody both genders has long been accepted. But that the blending of gender would be reflected physiologically and neurologically is a concept that has fought an uphill battle to, first of all, be recognized, and secondly, to be regarded not as a psychological or moral pathology but as a normal variant.

Transgenderism is the umbrella term for the expression of gender identity that differs from the strict male/female dichotomy recognized as normal by society. Transgender people range from those who enjoy dressing as, and behaving as, a person of different gender than their birth gender; to transsexual people who, with the assistance of hormones and surgery, change their entire appearance to live their lives as a different gender; to people who are born with the physiology of both genders and choose not to identify as strictly male or female.

Because it is so basic to our patterns of classification, gender expression outside of the norm can be quite disturbing to many people. Transgender characteristics are usually lumped together with sexuality, although sexual orientation is entirely different and unrelated to gender expression.  Transgender people, like everyone else, may be straight, gay, both, or uninterested. Unfortunately, transgender people are considered by some to be morally corrupt, or predators disguising themselves to gain intimate access to the opposite gender (this is the laughable -- and indefensible -- argument used by some in Connecticut to restrict restroom access by transsexual people).

And, though once thought of as a psychological disorder, research is making it evident that transsexual people do not suffer from some sort of behavioral aberration. More and more it becomes obvious that transsexualism is the result of neurological and hormonal activity and development in the womb. Studies of the brains of male-to-female transsexuals show that their brains are much more similar to the gender they identify with (female) than the gender they were born as (male).

Unfortunately, that research goes unrecognized at many doctors' offices, where both doctor and staff have little understanding of this segment of their patient population, and transgender people may be subjected to anything from embarassment at the hands of thoughtless and poorly-trained staff to outright discrimination because of their gender preferences.

Like most doctors, I received absolutely no education on the requirements of treating transgender people, either from a clinical standpoint or from a practical standpoint. But once I became aware of my ignorance, I undertook to rectify it. From talking to people, to reading, to attending the Transgender Lives conferences, I learned.

Much of it boils down to simple things that I already know and try to practice. Things like respecting my patients. Accepting what they bring to me as people and understanding their needs and goals for their care. Recognizing people's boundaries, and not transgressing them without permission and without good reason.

That last sentence bears a little more explanation. For obvious reasons, both personal and social, a patient may not be comfortable revealing to me their gender history, though clues may be evident in the general health history with which they provide me. But the more important question is whether gender is pertinent to the problem at hand.

And, frequently, it is not. For example, most musculoskeletal issues are gender-neutral, and whether or not my  patient is a transgender person is simply not important. Why make someone uncomfortable by delving into aspects of their life that they would rather not reveal? Being a doctor gives me great latitude to explore another person's privacy in the search for clues to the nature of their problem, but that license must be used with discretion.

Much of being a transgender-friendly practice also boils down to attending to simple things that are easily overlooked. For example, the patient whose legal name on their insurance card is Jennifer Smith would rather be addressed as David. Or that gender isn't as simple as circling the M or the F on the intake form.

So I don't use M or F on the form anymore. Instead there is a blank line for the patient to provide the gender information which most suits them.  And in addition to the Last Name and First Name entries, I have a Preferred Name entry, so that we know that Jennifer should be addressed as David, the name he prefers.

These and other alterations are subtle changes, unlikely to even be noticed except by those to whom they are directed. But for that very reason they are important.

I hope that other doctors, particularly those who provide alternative medicine services, take it upon themselves to enhance their practices in this manner. It is not difficult and the rewards can be significant.

I will unfortunately not be able to attend the Transgender Lives conference this year. It will be the first time in several years that I will miss it. But I am grateful for what the conference, and my patients, have taught me.